Free Fernando Vina (part two)

I'm still mystified by certain aspects of Major League Baseball's drug policy.

Consider the following:

An aging pitcher is suffering from a variety of persistent injuries. They are healing slowly. He is depressed and lethargic, and anxious about his career. He goes to see his doctor. The doctor finds that the patient's testosterone count is low. He prescribes the pitcher a small dose of testosterone, as part of  his rehab. The patient is desperate, and the doctor agrees to experiment with testosterone, and see if it speeds recovery.

Questions:

1. Has the pitcher violated MLB's drug policy? As far as I can tell, yes. Testosterone is on baseball's list of banned substances.

2. Has the patient violated the law? Of course not. Testosterone is an FDA approved medication.

3. Has the doctor done anything wrong? Not at all. The doctor could also have prescribed human growth hormone, if he wanted to.  Even though HGH is not approved for injury recovery, a physician is free to prescrbe virtually any drug he/she wants to, in an off-label manner.

4. Should the doctor and the athlete feel guilty about what they've done? I don't see why. The foundation of our medical system is that physicans have broad leeway to act in the best interests of their patients, and if the physician thinks that testosterone might help the athlete he's entirely within his rights to prescribe it. The pitcher is also entitled to take every step he can to regain his health. Surely it is wrong--if not unconstitutional-- for an employer to impede an employee from receiving the best medical attention.

5. Will Major League Baseball ever find out about the pitcher's testosterone use? Not unless the pitcher tells someone. The transaction between a patient and a doctor is, of course, covered by patient confidentiality laws.

6. Does this mean that lots of professional athletes may already be using substances like testosterone--and we have no way of finding out? Of course!

7. So why did Vina and Pettitte and Bennett get in trouble? Because, presumably, they obtained their HGH without an prescription--which is illegal.

8. So wait. The league's drug policy is an attempt to prevent the use of drugs without a prescription? No. Its supposed to prevent the use of a broad class of drugs. But since the league's policies  clearly can't govern drugs prescribed legally by a physican--particuarly if they are undetectable-- it has the effect of only preventing the use of drugs obtained illegally.

9. I'm confused. Aren't there already laws in place in America preventing the use of drugs without a prescription? Yes. (And I'm confused too.)

Will someone please tell me if I've got this right?

Comments

[Philip M. Sherman]

Dear Mr. Gladwell:

I take issue with some of the material in your recent book, Outliers. First, I disagree with the state of computers as described on pages 43 – 45. Second, I disagree with statements made regarding a vertical line on the screen, pages 239ff.

On page 43, you write, “In the early 1970s, when Joy was learning about programming, computers were the size of rooms.” Actually, by 1970, there were a number of computers that were more like refrigerators: the IBM 1401 consisted of a few consoles, and the PDP line computers that began in 1960 were even smaller.

On page 45, you quote Mike Alexander as saying, “In the late sixties, early seventies, I don’t think there was anyplace else that was exactly like Michigan…Maybe MIT.” (He is referring to time-sharing computers.) The company Scientific Data Systems began its line of time-sharing computers 1961. By 1966, it offered the SDS Sigma 7, which was quite powerful time-sharing system.

On page 239, you write, “The program asks the user to punch in a set of coordinates and then draws the line from those coordinates [through the origin of the graph] on the screen.” My added phrase is in red. A line is determined by two points, not one. I know you meant that, but this should be explicitly stated.

On page 240, you write, “She’s sitting at the keyboard … to draw a line that is absolutely vertical … superimposed over the y axis … this is, in fact, impossible.” All she needs to do is enter 0 (zero) for x and any non-zero value for y. This will yield the desired line. To focus on the slope will indeed lead to an impossibility.

I did very much enjoy your book as much as I did your previous two books.

Sincerely,

Philip M. Sherman, PhD

[Chrissy Michelle Strawn]

I have been successful on many counts. I saw your talk with Charlie Rose and was impressed with your discussion. Now I just need to find the book, Outliers.

[Tia Wallman]

Dear Malcolm,
I saw you speak with Charlie Rose the other night. It was so interesting. But, still, I wish to hear about losers sometimes. So many genuises it's exhausting!My Smith Alum magazine is cluttered with Weddings and Success and Brilliant Children. How I long to read a Rilkian failure's despair on some page some where.
Best to you,
Tia

[Mohammed Elamrani]

I am reading "outliers" with a great interest. I was however not comfortable when I read on page209 about the PDI ranking countries, especially about morocco, suggesting that it is matching up very closely with the plane crashes by country. Stating that suggests that you have datas and statistics proving your case about morocco. I beleive this is NOT TRUE! I always heard that we have one of the finest bunch of pilots and I have never heard of any moroccan international flight crush!!

Regards,
Mohammed Elamrani (a moroccan!)

[John Gatt]

Mr. Gladwell,

After reading Outliers, I was questioning the differences between cultural influences and generational influences. "Americaness" is different among different generations. My grandparents were more reluctant to question authority versus our children. Is this indicative of our culture changing or are generational differences? Generational views on values (work ethics) must also be influencing some of the cultures documented in Outliers.

I really enjoyed all three books and especially enjoyed the last chapter describing your family and Daisy.

[Elizabeth Sanders, DO]

As a family physician, I have prescribed testosterone replacement. I think there is a distinction between a testosterone deficiency and doping. If this player sought medical care because of injuries, slow recovery and general fatigue and his physician set about testing and seeking an explanation for the patient's complaints and what was discovered was a deficiency of testosterone....then it is not only reasonable but therapeutic to REPLACE the lack of hormone. This maintains a man's bone density, too. It might be a fair, clinical assessment that this athlete would be at risk for osteoporosis LATER in life. A doctor's job is to assess risk and benefits for care in terms of short and long term outcomes. Had the REAL intention of this athlete....and physician....was to take testosterone for therapeutic replacement, then his measured levels of testosterone should be easily documented to be in NORMAL PHYSIOLOGIC range and not excessively high. And the player/patient might have discretely and openly gone to his team and disclosed that he is being treated for a MEDICAL condition....and treated appropriately. There are treatment guidelines most physicians follow with regards to male hormone deficiency or hypogonadism. The issue is if the player/patient is seeking advantage and LYING that it is for therapeutic reasons.

[Roderick Holliday]

Malcolm,Malcolm,Malcolm, I have justfinished reading The Outliers .I must tell you that I was very moved by the Book.Rosato comes to mind, it so true this is how God wanted man to live a quiet slow life. When you talked about the mother who questioned her child about School, the trip to the Doctor you must have been peeping in my window because you described my wife and son , when i read it I laughed out loud, my wife wanted to know why, I handed her the book.

Malcolm my Father i believe is an Outlier, He dropped out of grade school, fought in World War II under Patton became a Bricklayer, he started to Preach at about 30 years of age. He has Built 3 Churches converted over 3,000 people to Christ. The first Church has a world wide outreach Ministry, they send a group to South Africa each December.

Your are a God send, your book is going to help me help a lot of People . I love KIPP , I have a Friend who get Sworn in Monday as a member of the Dougherty Co. GA. School Board. I told her about Kipp. Thanks

Rod Holliday

[Glen]

I have a question, how does one develop the skills for success if they have not been blessed with a great family, correct situation, and great genes? RE: Outliers.

[Mike Brooks]

I am a psychologist and the director of a center for psychological services in Austin, Texas (www.ApaCenter.com). I enjoyed "Outliers" and the myths of success that you went about debunking. With the 10,000-Hour Rule (which I had come across before) along with other information that you provided (such as your description of KIPP, at which I had worked), you made a strong case for the importance of effort over innate intelligence or ability.

With this being the case, I was surprised that you made no mention of the work of psychologist Carol S. Dweck. In her large body of research, she has shown that praising children for their intelligence rather than their effort results in kids who are less inclined to tackle challenging tasks and undermines achievement. Her recommendation to parents is that they praise effort (something that kids can control) instead of intelligence (something that is often considered more of a trait and not under direct control) to help foster a "growth mindset" in children. Children who have a growth mindset, she contends, are much more likely to achieve success in school and in life than children who view intelligence as fixed.

Dweck's research findings, I believe, would have fit perfectly into Outliers and further supported your case. Moreover, parents would benefit from this knowledge because so many still have the misunderstanding that "little Johnny" should be constantly reminded how smart he is so that he will have high self-esteem. Ironic as it seems, this approach is actually counterproductive.

Still, "Outliers" is a a wonderful read, and I'm recommending it to many friends, clients, and colleagues. I'm looking forward to your next one and congratulations on your success.

[Rach]

Hi -- I'm wondering if you think "climate change" and more recently "recession" fit your Tipping Point paradigm? Thanks

[Bill Campa]

I LOVE your audiobook versions of OUTLIERS and now listening to BLINK.
That said, some suggestions to help me and other audiobook lovers enjoy the future books even more:
When you are listing the contents of each disk, please stick to a consistent pattern: 1-1, 2-1, 3-1, etc. In the BLINK audiobook, it is listed almost every which way, and when it is uploaded to an mp3 player, it is often all over the place! I literally have to load each disk separately, then delete it to add the next disk to listen to. There should be a simpler way to enjoy your audiobook, aside from listening to it at home or car on a CD player.
The audiobook, when it is uploaded onto a windows media player device, pulls up a BLINK 182 album, along with its listings and artwork! Please help make sure that your audiobook is easily found in Windows Media Player internet databases. You are a Times Warner audiobook, after all.
I can say that even though it is pain to load each disk individually to my mp3 player (Sansa View) the book is well worth the trouble. I hope others will find it worth the trouble as well.
Most Sincerely,
Bill Campa
byl@aol.com

[T.M. (Terry) Bradley]

I am a teacher in the allegheny highlands of virginia...the homestead is our claim to fame...simply stated, your book, outliers, is one of the top five though-provoking events in my life (I am 49)...I have done nothing but talk about it to my friends...I saw you on C-Span and purchased the book the next day, then the audiobook...thank you for all of your research and refresehing insights...the Kipp group is especially relevant for this high school teacher...I date an 8th grade algebra teacher, and she refuses to concede until she figures out a problem...I cannot tell you how many times I spoke back to my dashboard, or laughed...we consistently confuse activity with achievment...thanks again

[Rod Wilson]

I was pleased to discoverthat someone else was learing to trust their brain to think without verbalizing the process. I have found that I just as I use news and other information on tv, radio as background noise I feel that my mind assimilates much of it without conciously paying attention.I have made some decisions that are quite contrary to accepted wisdom. It is only when I needed to explain it to a 3rd party that I have had to delve into the recesses of my store of knowledge.

Closely linked to this is procrastination. So often not reacting quickly gives time for our brain to more appropriately assess alternatives.(not conciously) When after what appears to be a long time (days or weeks) an appropriate solution presents itself from seemingly nowhere it is that thinking without thinking that has been going on.....that is all for now

[Brandon]

Yes. You did.

But that was MLB's perspective on it all through the 90s and where did it get them.

[Desmond M. Penigar]

Desmond Penigar is playing basketball in Austria. Mr. Gladwell, I play professional basketball in Austria, before that I played in Germany and South Korea, and I had a little stint in the N.B.A. I received my degree in Sociolgy from Utah State University. Two years ago I declined an offer to play for more than 25,000 dollars a month and took a job as a youth counselor making a little more then ten dollars an hour, and right before I decided it was time for me to play Basketball agian I taught high school P.E and Coached basketball. I would like to talk to you about something. My email address is desmond_penigar@yahoo.com

[Roslyn Ellison]

Greetings Malcom,
Established & run Community LIbrary and Reading Educational Centre on First Street in Trench Town Kingston 12. Secular & Apolitical. Outside the box in every way. Dec 1993..to now 2009...
we have.. and this is from many sources... the best secular collection of books in any public library in Jamaica.
Every book hand picked. No dewy decimal. Afro Centric focus throughout as well as classics.Early, Juvenile & Adult. Big kids korner. Literacy area & a powerfull Cultural spoken word group of youngsters. Emphasis is access to current information, writing research skills & critical.
thinking. If you have a moment please check http://www.trenchtownreadingcentre
Home: rationale & history & photos to 2000
Updates pg- rebuilding 2005-08.
would love to have signed books of yours.
Anthony Winkler read @ centre in Dec...

Knowledge is power
Roslyn Ellison facejamaica@hotmail.com

[Roslyn Ellison]

damn..should a takin typing like my mother told me!
http://www.trenchtownreadingcentre.com

have DVD slideshow of Cente in action

your books are wht we need. We encoucage and press for original thought & critical thinking not skills taught or appreciated in schools our client frequent

again thank you

[Gil]

test

[dd]

good

[Nancy Kim]

There is a mistaken concept in Outliers, Page 18: Joseph is not 'man on the strength of his own brilliance and insight' (Gladwell 18), as Mr. Gladwell puts it. "'I cannot do it, Joseph replied to Pharaoh 'gut God will give Pharaoh the answer he desires'" (Genesis 41:16 NIV). I know how irritating it is when others are nit picky about our own writings, but a wrong concept must be righted, because one's book does not only affect one's own life, but also the many lives of others. Thank you.

[Ian Bentley]

Malcolm

I have tried on several occasions to reach you via a couple of e-mail address I was given, but alas you are a difficult man to run to ground!

A group of us is in the process of launching a concept on the Xing network called ‘MavenCrowdsourcing’. I unashamedly admit that my concept is based on the theories that populate your brilliant book, 'The Tipping Point'. What I have done is to simply take the different threads of your book and weave them into a cohesive business model. This I have melded with the crowdsourcing concept into a very powerful internet business tool.

It is open to all the Mavens, Connectors and Salesmen of the world.

Here's hoping that you as their Spiritual leader will join us on https://www.xing.com/net/crowdsourcing/

Anyone interested can join me on Xing.com through this link:
http://www.xing.com/go/invite/8780172.fe7156

Anybody interested in discussing any aspects of the concept with me are welcome to e-mail on mwibent@mweb.co.za

Best regards

Ian Bentley
(along with fellow pioneers, Matthias Eichhoff and Thomas Andersen - the MavenCrowdsorcerers!)

[gil]

מלקולם יקר:
ספרך BLINK מדהים

[anika sharma]

i have only one q, malcolm..actually 2..

1. how come you are not on fb?

2. how come there are no women examples in outliers...considering what you wrote is so so true...

[Peggy Jay]

There is no author whom I enjoy more. Thank you, thank you. TIP...GRAMMAR!: you and your editors must learn about the uses of the words "less" and " few, fewer". All of your books contain many errors with these comparisons. Learn and fix them. Then you may be cloe to perfect I make mistakes too. Peggy

[ellen turk]

dear mr. gladwell,
my name is ellen turk and i own a copy of your book "outliers". i liked it so much, i got a copy for Christmas adn i lent it to my mom to read as well. But now, arguments have started to crop up at the dinner table about how to pronounce the word "Outliers". Mom thinks it makes an ee sound when you say it (as in EAgle) but i think it makes an i sound (as in EYE). Please write back and inform me so we can settle our dispute.
thanks, ellen turk