As one of the increasingly demoralized fans of the Los Angeles Angels, I took the latest news about Shohei Ohtani almost in stride. The Angels, you may have heard, announced Thursday that their star pitching prospect from Japan had suffered a major injury in his pitching elbow and would have to undergo Tommy John surgery if he was to pitch again. That meant he probably would be out of the rotation for most of the next season.
Of more relevance to the baseball world — indeed, to athletes at all levels, whether pro, semi-pro, school or youth sports — the announcement was an acknowledgment that Ohtani’s stem cell therapy was a failure.
If you’re umpiring, that makes the count three strikes and out for stem cell treatment on the Angels pitching roster. Strike one was Andrew Heaney, who tried stem cell injections in 2016 to try healing his aching ulnar collateral ligament, then opted for Tommy John surgery before July 1 that year. Strike two was Garrett Richards, who undertook the therapy around the same time, stayed with it into this year, but mostly stank when he returned to the rotation, and finally opted for surgery in July.
Ohtani chose stem-cell treatment in June after suffering a ligament injury after nine starts, with four wins. He didn’t pitch again until Sunday, when he lasted only 2 1/3 innings. The UCL, which is the key ligament for pitchers, tethers the upper arm to the forearm on the inside of the elbow.
We observed in July that if there was a silver lining in Richards’ announcement, it was that the news might help dispel the hype about stem cell treatment for muscular injuries, many of which are sports-related. Stories of high-profile sports figures experiencing “miracle” cures of muscle and ligament damage were all too common, prompting athletes and laypersons alike to pay thousands of dollars for the unproven treatments.
Ohtani’s experience only reinforces the need for caution. Yet among the dispiriting aspects of his injury is that Angels General Manager Billy Eppler, speaking at a hastily-called news conference Wednesday, was still describing Ohtani’s stem cell treatment as a “conservative” option. The treatment involves extracting stem cells from a patient’s bone marrow or fat deposits and injecting them directly into the injured tissue, with the expectation that the cells speed the healing process along, ostensibly by transforming into muscle or ligament cells themselves.
Here’s a pro tip for Eppler: A treatment that is scientifically unproven, unapproved by the Food and Drug Administration, regarded by medical experts as experimental, and for which your own team refuses to cover the cost, isn’t “conservative.” It’s radical and potentially dangerous. Advocates of these treatments tend to cite anecdotal evidence that they work, but it’s wise to remember that the plural of “anecdote” is not “data.” We’ll repeat what Paul Knoepfler, a stem cell expert at UC Davis, told us soon after Richards’ announcement: “The state of the medical science of stem cells for musculoskeletal conditions is still relatively primitive. It just isn’t ready for prime time.”
Even Steve Yoon, the Angels team physician who performed the stem cell therapies on Richards and Ohtani, acknowledged to me in July that “there are no high-level studies that have shown that using stem cells can help ulnar collateral ligaments heal any better than just rest and therapy and time.” He said pitchers could be especially difficult candidates for the treatment, because their motion places a unique strain on the UCL. That means the ligaments need not merely to heal, but heal in a way that leaves them strong enough to withstand the strain.
As we write, Ohtani hasn’t confirmed that he’ll undergo Tommy John surgery. It’s not hard to understand why pitchers and their teams would wish to avoid the procedure if at all possible. Named after the Dodgers pitcher who pioneered the procedure in 1974 and went on to a successful post-surgery career, it involves transplanting a tendon from elsewhere in the body to replace the damaged UCL. According to statistics compiled by Jon Roegele of the Hardball Times, pitchers can need more than a year to recover to the point where they can face hitters off the mound, and a year and a half before they can pitch in a game at their pre-surgery level. If Ohtani goes through with the surgery now, he won’t be expected to throw another pitch until 2020.
It’s also true that Tommy John surgery has been somewhat oversold as a panacea for injured pitchers. Roegele’s assiduous number-crunching reveals that the median pitcher who underwent the surgery in 2000-2009 “appeared in about 60 games or logging about 100 innings pitched over the rest of his major league career.”
That’s what a healthy relief pitcher would notch in a single season and a starter would have in a half-season, Roegele observes: “That’s not the sort of post-surgery career one might envision.”
The sterling reputation of Tommy John surgery may owe much to a sort of cognitive bias: We judge it by the subset of pitchers who have had successful post-surgery careers, including John himself. But Roegele cautions that more than 80% of the major league pitchers who have had the surgery never throw another pitch at that level.
That leaves the question of what the Angels should do about Ohtani. Eppler maintained on Wednesday that the team still sees him as a two-way player—pitching in the rotation and batting at all other times. But that’s treating him as a circus act, not a long-term mainstay of the team. There’s a reason why great-hitting pitchers have been erased from baseball over the decades—if a player can hit, you want him in the lineup every day, not once or twice a week.
Ohtani reminded us what he’s capable of during Wednesday’s game, after the news about his possible surgery came out: He went 4-for-4 at the plate with two home runs. That suggests that the proper course is to make Ohtani a full-time batter. Pitchers, except for truly outstanding pitchers, are always more common than good hitters — the Angels, like most American League major league teams, currently maintains a roster of six outfielders to fill three spots, six infielders to fill four spots, three catchers for one spot, and 18 pitchers.