Whaaaat??? What on earth is this blog going to be about?
Recently in baseball, there’s been a lot of talk about cheating, and specifically, pitchers using “different” materials on the ball. Sitting on every baseball mound is a rosin bag, historically filled with rosin powder, which is a sticky substance extracted from the sap of fir trees, to improve grip strength. This is legal. Mid-summer season, especially in humid climates, the pitchers get a pretty good grip on their own. But in April or September/ October, the ball can become slippery. The grip is crucial to create the spin and movement of baseball pitches. The more movement, the harder to hit. This is why the league-wide batting average is the lowest ever, at .236.
On May 26, 2021, umpire Joe West noted an ”abnormal” substance on the bill of Giovanny Gallegos’ cap, forcing him to change hats mid-game. The hat is then examined and we have a “hat-gate”. This is not the first time substances have been noted on a pitcher, but it is illegal. You cannot use “other” substances to improve your grip.
Already this season, we’ve seen additional examples. Late May, a ball went to an NL dugout and players took turns touching the “sticky material”, lifting the baseball open-palm-down, adhered to their hand (akin to a wide receiver in football). On another ball, it was so gooey that three inches of seams came off when an opponent tried to pull the glue off.
Hall of Fame pitcher, Steve Stone, has identified a way to deal with this. There can be a league-sanctioned material, readily available to all pitchers, which would be rosin-based. In our post-COVID times, the same rosin bag is then used by all pitchers. Late in spring training when arms are strong, the pitch spin of every pitch from every pitcher would then be documented. Rapsodo is a baseball pitch analysis software program that tracks pitching metrics, including spin (RPMs). As the season progresses, pitchers would be allotted about 2-3% variation in each pitcher’s expected range. Within a given season, it’s near impossible to make natural mechanic adjustments to improve RPMs much more. For example, 2300 RPMs may be the average spin for one pitcher’s pitch. But if 2300 RPMs suddenly becomes 2600 RPMs, then the pitcher is cheating. (Trevor Bauer, who admitted to using foreign materials, saw his four-seam fastball jump from 2358 RPMs in 2019, to 2779 in 2020 when he won the Cy Young). Baseball would no longer need to rely on umpires spotting materials on caps, jerseys, gloves, arms, or hair. They wouldn’t need to check rosin bags for varying concoctions. Video replay would not be needed to catch them in the act. After all, pitchers are the best magicians in the game in sleight of hand. Pitchers are very different and will always look for an advantage, but this takes away some variability. Because we know the revolution of every pitch every pitcher throws in all of baseball, it would be easy to enforce.
So what does this have to do with neurosurgery?
One of the most common questions a neurosurgeon faces is, “How many of these surgeries have you done?”. After all, one metric of surgeon proficiency or expertise is the frequency of performance. Would you pursue surgery with someone doing it for the very first time? However, a surgeon may conflate a complicated surgical procedure they rarely perform, in the category of more common procedures, to give the impression of familiarity. Surgeons may also blatantly inflate their numbers, to gain experience. If one looks at spine surgery websites around Denver, nearly every practice advertises minimally invasive procedures (MIS), yet few truly perform tubular MIS. But more so, how does a patient know what number is “a lot”? How many times does a surgeon need to perform a surgery to be “good”?
Turns out, it completely depends on the surgery. For example, conjoined twins occur in about one out of every 200,000 births. Only two percent of the 40% that survive after birth are connected by the head. That means if you need your brain separated from your Siamese twin’s, few surgeons in the world have had much practice. On the contrary, if you need a minimally invasive lumbar spine fusion, you could easily find a surgeon who does tubular MIS fusions 30-50+ times per year.
So how can patients find a surgeon who is proficient in the type of surgery they need? Neurosurgeons could have their “surgical stats” published by an independent party, just like a pitcher’s RPMs. A patient could search their local area for the surgeon with a reasonable average number of that particular surgery per year and compare. Of course, to get the most current statistic, the recent yearly average could be listed, and patients could compare with what their surgeon discloses. If a surgeon reports more than 2-3% off their known average, they may be applying a foreign substance to their neurosurgical baseball.
Of course, case numbers aren’t quintessential to neurosurgery like they are in baseball… a particular surgeon could perform many badly, or few well. But this solution could improve some transparency to the public.