Are Surgery and Doping the Same Thing?

by | 06.16.2014 | 10:16am

Why should some medical advancements be embraced in human athletics while others are spurned? That's the provocative question advanced by best-selling author Malcolm Gladwell in an article and podcast from The New Yorker from 2013 that I recently discovered.

Gladwell, author of research-oriented books like “The Tipping Point” and “Blink,” suggests the Tommy John surgery many pitchers in baseball undergo (developed by the late orthopedic surgeon Dr. Frank Jobe it is named after the Los Angeles Dodgers pitcher who was its first patient) is similar to a performance-enhancing drug. The reconstructive surgery involves replacement of a ligament in the elbow with a tendon from another part of the body or from a cadaver. Originally designed to repair elbows damaged by the repetitive motion of pitching, some now think the surgery improves performance beyond pre-surgical levels.

Linking advancements in surgery of this nature to performance-enhancing substances like those allegedly used by disgraced baseball superstar Alex Rodriguez, Gladwell, who referred to post-surgery Tommy John as having a “bionic arm,” thinks human athletes should be permitted to use any type of drug they wish, provided it is FDA approved and is disclosed by the athlete.

“People loved Tommy John,” he wrote. “Maybe Alex Rodriguez looks at Tommy John — and at the fact that at least a third of current major-league pitchers have had the same surgery — and is genuinely baffled about why baseball has drawn a bright moral line between the performance-enhancing products of modern endocrinology and those offered by orthopedics.”

Horse racing doesn't have a Tommy John surgery — at least not yet. Some might suggest the operations to straighten angular limb deformities of young foals qualify as performance enhancing (or performance enabling). Others believe throat surgeries could be classified as helping performance in the same way that banned race-day substances clenbuterol or albuterol help horses breathe better during competition.

Gladwell's article was actually a review of the book “The Sports Gene: Inside the Science of Extraordinary Athletic Performance,” by David Epstein. The author attempts to explain why so many distance runners hail from Kenya or sprinters from Jamaica. Is it a matter of some humans being superior at certain athletics because of, as Gladwell says, “dumb genetic luck,” or is there more to it? And why should those without the genetics not be allowed to use science (aka drugs) to narrow the gap?

The late Charles Harris, a New York-based horse owner who for years fought for clean sport, once suggested the same thing as Gladwell, that all drugs should be permitted in racing, so long as they are disclosed. At least that would level the playing field, he said.

As athletics, horse racing and veterinary and genetic science move forward, will Gladwell be proven right? Will that bright moral line separating doping from science or surgery become less defined?

  • jazz mania

    Dilemmas, Dilemmas, Dillemas… Are my glasses a performance enhancing drug, are horseshoes, wraps and blinkers performance enhancing drugs? Sheeze, I’ll have to double up on sleep aids to get over this issue ‘;-)>

    • Chris Lowe

      Don’t forget your nasal strip before bed.

  • Ian Howard

    The level of abuse with restrictions is the most negative aspect of industry for the public.
    By removing them you will significantly increase the damage done to horses who have no choice but to participate in our industry and further damage public confidence in how we treat our animals.

  • stevemak

    There is an argument to be made for allowing PEDs for human athletes (with disclosure). There is a big difference applying this to horses, however. Humans can make calculated decisions as to whether it’s worth the risk, but horses have no say in the matter.

    • Barry Irwin


      • Convene

        Especially as some of the things surgically corrected can be inherited by offspring, perpetuating the problem.

    • amgm1431

      Yes!!! Amen!!! I wish that were the last word on the subject.

    • horse shoe

      horses have no say in the matter, that so true almost like saying nine month old unborn babys have no say about getting there brains sucked out and killed. oh but that’s the mothers choice where are all the stop the abuse cheer leaders at on this

    • McGov

      Horses also have no say in the matter regarding surgeries. Wonder if we asked the horse if they’d elect to have straighter legs at the cost of several months of pain and limitation….something tells me they’d pass…probably not that vain. ;)

      • betterthannothing

        Well said! The elective painful procedures horses endure to save or make more money for owners and all is terrible and why one of the top priorities of AHC members is to keep horses classified as livestock so they can get away with it…

  • Choyawon

    Bowed tendons are career ending.

  • Ben van den brink

    Horses have no say and no choice, the same with the medication overuse and other practices.

  • PTP

    “The late Charles Harris, a New York-based horse owner who for years
    fought for clean sport, once suggested the same thing as Gladwell, that
    all drugs should be permitted in racing, so long as they are disclosed.
    At least that would level the playing field, he said.”

    That’s a bit utopian, imo. Aranesp use would level a playing field I guess, but it turns blood to sludge and equine athletes will die. So, then if you ban Aranesp because it may be dangerous, then you still have the issue of others using it while true horsepeople who care about their stock don’t, and they get killed by 30% win trainers.

    It’s quite the enigma when you dangle billions in purse money in front of people. Crap happens and will happen no matter what it seems.


    • Convene

      Some people will always prefer to take the easiest way out, I guess. Heaven forbid that the late Mr. Harris address himself to helping eliminate the drugs instead! Not a quick-fix – but wouldn’t that be better in the long run? I bet the horses would think it was!

      Wouldn’t it be nice if people got into racing to watch good horses run or to really breed the best horse instead of to see how much more money they can make than the next guy! I love this sport – but I don’t have a horse running because I don’t have the money or the heart to risk good animals in the “win at any cost” environment. No amount of purse money can atone for injuring or damaging these good, honest animals that way.

  • Rachel

    I think the difference is surgery corrects a known physical problem, either from conformation deformities or injury and IMPROVES the animal’s life…whether or not it then is fast enough to become a winning race horse.

    Drugs take a toll on the animal over time, while they may indeed enhance performance, you’re predisposing them to the myriad of side effects that present legal meds are known for e.g. Ulcers, fatigue, calcium depletion…etc etc

    • David

      Surgeries have side effects. A laryngeal tie-back can cause aspiration pneumonia. A laryngeal tie-back is only needed to improve or restore performance in horses during strenuous exercise. This is a legal procedure in all racing jurisdictions in North America. The procedure does not improve quality of life in horses. There are many surgeries and drugs that improve quality of life. There are many that don’t and it frequently depends on the specific case. Unfortunately this issue is not quite so simple as surgery=good and drugs=bad.

      • Beach

        Yes, not to mention the occasional idiot who doesn’t “tie back”, he/she “removes”–and then the horse has to live with that permanently–and just how much can one pray against aspiration pneumonia??? :/

        • Matt Clarke

          Veterinary surgeons who perform surgical removal of an arytenoid based upon a qualified diagnosis are not “occasional idiots” incidences of aspiration pneumonia are infrequent and most patients whose owners follow basic common sense aftercare instructions do perfectly well.

          • Beach

            I saw one horse that did not do well with it. And the vet that cared for the horse afterwards said that it should have been tied back in the first place, not removed.

    • Ben van den brink

      The horse will do fine without all the medications and surgeries, but it is not an race competitor. And it has not been one from the time of it,s birth.

  • kyle

    No. Unless it’s something like taking out a kidney to make you lighter. One test is whether the performance enhancer is dangerous and/or a health threat. Another test is whether it alters the nature of the contest or it’s dynamics.

    • Convene

      But that’s where the Lasix debate begins! Some say it’s a health threat, some say it’s not. Some say it’s a performance enhancer (alters the nature of the contest or its dynamics), some say the opposite. There are even veterinarians on both sides of the debate! As the old saying goes: who shall decide when doctors disagree?

      Short-term treatments to cure/heal diseases or injuries in a horse would be ‘way different from using either to enable the horse to keep racing until nothing will hide the condition any more.

  • vinceNYC

    The late Charles Harris, a New York-based horse owner who for years fought for clean sport, once suggested the same thing as Gladwell, that all drugs should be permitted in racing, so long as they are disclosed. At least that would level the playing field, he said………………BINGO….let the free market work

    • Barry Irwin

      Wrong attitude. Do you work on Wall St. and have a Super Trainer?

      • Beach

        The above will set up too much of a culture of “use and abuse”, possibly by a lot of people who don’t know what they’re doing with the drugs–or, who don’t have enough ethics to care, except for $$$$.

    • circusticket

      Race to the bottom. The public would abandon horse racing faster than you can blink. Isn’t the free market wonderful!

    • forestwildcat

      That’s one of the stupidest things iv’e ever heard

    • Ben van den brink

      You probably do not mind, if four or five horses during racedays breaks down before the crowd, as long as your horse win,s. If you,re owns horses, i,ll wish you an lot of fate.
      You have not seen an horse, damaging his/ her,s leg before the crowd.

  • Jay Stone

    Allowing open use of drugs to level the playing field is a stupid suggestion as it would cause long term harm to most horses. Most surgeries done on race horses are done to repair a natural flaw in their bodies which shouldn’t be considered performance enhancing since they originally had that ability. Using human analogies is pointless since humans have choices that equine athletes don’t have.

    • Lexington 4

      No, Jay, a particular horse having a surgery to reverse a “natural flaw” did not “originally [have] that ability”. That is the very reason they needed the surgery.

      Breed that horse on and see what happens.

      I really have never understood how all of the people crying about Lasix and how breeding horses who ran on Lasix weakens the thoroughbred gene pool and yet can’t put two and two together on the subject of corrective surgeries.

      It is almost comical.

      And remember Jay, not ALL drugs are bad. Chances are you take a few prescriptions yourself if you are like most people. The fact that horses cannot make choices is why it is important that their human caregivers MAKE THE EFFORT of separating the helpful drugs from the harmful ones on their horses’ behalf and allowing them to benefit from the miracles of modern science. Throwing out ALL drugs is intellectually lazy.

      But then again, there are a lot of lazy people out there. Many of them who haven’t exercised in 20 years and take prescription drugs while sitting up in the stands (or more likely air conditioned buffet) while patting themselves on the back for declaring that their horses should work through a professional athletic career solely on “hay, oats and water.”

      • guest

        I think Jay was referring to quotes in the article from men who said all drugs should be allowed as long as they are disclosed, which sounds absurd to me.
        Nobody here is talking about banning ALL drugs, just the ones that enable people to cheat & harm the horse’s health.

      • Jay Stone

        I’m just against random use of all drugs in race horses because while some serve a useful and safe purpose many others do much long term damage. As far as surgeries are concerned I was mainly thinking of throat work which in most cases is done to restore a horse to their originally breathing capacity.

        • Sue M. Chapman

          Tie back surgery caused by a paralyzed flap is a band aid which might help some horses. Why can’t horses breathe? The size of their esophagus is simply too small. It is congenital.

          • DeniseSteffanus

            You mean trachea. When a horse develops a paralyzed flapper, half the trachea is obstructed. Tie back surgery restores original function.

          • Sue M. Chapman

            Thanks for correcting me. The size remains the same, which I believe is an inherited defect in some crosses.

        • Ben van den brink

          It might be good on short term buisiness, but it is terrible harmful in the long term

      • Sue M. Chapman

        Bone shaving, etc. on foals and young horses to correct congenital flaws, as opposed to defects, has been done by consignors for years to market sales horses to create cosmetic perfection.

  • betterthannothing

    “Why should some medical advancements be embraced in human athletics while others are spurned?”

    Good: medical advancements to cure ailments.

    Bad: medical “advancements” to enable or enhance performance or alter physical appearance to deceive horse buyers. Those could turn into an abusive, inhumane, dishonest slippery slope like drugs have.

  • amgm1431

    Another researcher once wrote that if there were a drug that would win a person a gold medal but kill the person the next day– people would take it.

  • forestwildcat

    Screws and wires in weanlings and yearlings – Big problem

  • Mimi Hunter

    If you get really strict about it, anything could be considered performance enhancing. Food, water, tack that fits, anything. Surgeries that correct damages from an injury are one thing. Surgeries to correct genetic problems are something else. And there is a huge gray area. And then there are therapies that can have amazing results. Lava Man’s stem cell treatments – would he be allowed to race? Pressure chamber treatments that enhance healing? Things that haven’t even been thought of yet? Somebody said ‘Breed the best to the best, and hope for the best.’ So how do you know you are starting with the best or a surgically enhanced ‘best’?

  • Nicole Arciello

    From Horseracing Wrongs:

    While Gladwell’s thesis has merit, to even suggest that that same thinking could be applied to racing – as Paulick does by referencing Harris – is repellent. Mr. Paulick, ultimately what separates horseracing from every true sport on the planet is informed consent: Professional human athletes are the autonomous final arbiters on what goes into their bodies; professional racehorses are – forgive the emotionally charged word, but it is what it is – common slaves, with zero control over their lives.

    Furthermore, when a juiced ballplayer breaks down, he goes on the disabled list, rehabs, and returns to his trade; when a drugged/doped racehorse breaks down, he dies. So you see, Mr. Paulick, we’re not even remotely in the same neighborhood.

  • Barb Carey

    Sorry Ray I think you’re wrong on this one #S541foodsafety

  • mary.knight12

    I have read Malcolm Gladwell and I think he is quite an original thinker. However, overriding the body’s natural, built-in governors is a recipe for disaster. When the natural limits of the body are extended artificially, the feed-back mechanisms that provide automatic safety controls are unable to do their work and the all too often result is system failure. The very catastrophes that the sensationalistic media like to showcase, such as heart attack (cardiovascular failure) and broken limbs (bone failure) are the very visible results of this. Performance- enhancers are detrimental to all athletes.
    While there is some lively debate as to whether or not SALIX is a performance-enhancer, it is unlikely the sport will survive without it. The loss of use due to EIPH would be too costly for owners to bear, especially when there is a tried and true remedy available to all.

  • Beach

    “Others believe throat surgeries could be classified as helping
    performance in the same way that banned race-day substances clenbuterol
    or albuterol help horses breathe better during competition.”

    This is picking a nit out of your overall point, but the problem with this, IMHO, is that clenbuterol or albuterol(especially used around training or racing) may bronchodilate but they also result in significant cardiac stimulation, which, at exercise, could produce fatal arrhythmias. Luckily I don’t have asthma or COPD but as a nurse I have given my fair share of these treatments. I know what the patients look like afterwards, and what they say about how they feel. I could not imagine ANY mammal, even though aspects of mammalian physiology are different, running 1 1/2 miles around a track after receiving this medication. Unless collapse is your goal. In addition, some of the throat surgeries also make aspiration of food(and thus, choking and infection) a whole lot easier–even if “breathing” is supposedly better.

    stevemak and Barry Irwin make a good point below. The creature with the alleged higher brain development has the capacity to understand ethics–in this case doing what is right, fair, or good for the creature who has no control over his/her own health or possible fate. Some might not like me getting all Scriptural here, but it is also a practical truth–“those to whom much is given, much is expected.” Thus, people, DELIVER for the horses under your care. Can’t say it any plainer.

  • Michael Castellano

    Performance enhancing drugs are a quick fix with deadly long term consequences, both for humans and horses. They have already taken over racing. Nature would have never given rise to such a compromised breed like today’s. Bad breeding choices and the use of more drugs than I can name has left us with 10 race career horses going to the breeding shed, as long as they can run a little. The drugs are covering up for a breed filled with “cripples,” as the rail birds call them. Many of the top trainers have become pharmacologists to keep their horses running.

  • Bellwether

    No Brainer….

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