Could Pro Sports Lead Us to Wellness?

–comment from a chat at FanGraphs, September 24, 2014

So this comment caught my eye. Ever since I began following sites like BaseballProspectus.com and FanGraphs.com, and reading things like Moneyball, I’ve found myself thinking about efficiency and unappreciated or unexplored resources in different situations.

I realize this was a throwaway line in a baseball chat. But it piqued my interest because it seems to point out something that’s maybe underappreciated and understudied about how sports teams go about their business–specifically, the kinds of things they do to keep their athletes healthy.

My question is, does this represent a potential source of “Found Research” data that could help the rest of us reach wellness?

Let’s get a caveat out of the way. Professional athletes are not like you and me. They represent the pinnacle of human physical skill and by definition are extreme outliers, often in many different ways. They’ve gone through an incredible training regimen and live with environmental influences few of us will ever experience. One might think findings about these people would be hard to translate to you and me–assuming you’re not a professional athlete. Which, based on my rather minuscule readership numbers, you very likely are not.

On the other hand, athletes are humans too. If we can understand things about human biology by studying fruit flies, nematodes and yeast (note to the US Congress: we really can.), studying humans directly in any setting could be even more enlightening. Further, the unique environment professional athletes are in means there’s probably a lot of data there. Especially in the last few decades. The field of Sports Medicine has exploded and practitioners are using all kinds of tools to measure athletes and how they perform.

And, for those of you inclined to think about incentives, I’d propose there are few other fields of human endeavor where the need to keep individuals performing at peak levels of health and physical function is greater, where the rewards are higher, where the consequences of ill health starker or more visible, than professional sports. By the way, I’m including NCAA Division I collegiate athletes in the money sports of football and basketball as de facto professional sports athletes. Amateur athletics at the NCAA Division I schools? Hahaha.

So we have the convergence of some pretty cool and powerful things. Money? Check. Technology? Check. Incentives? Check. Competition? Check. Access to medical staff and interventions most of us aren’t privy to? You bet.

Put it all together and you have an environment where many kinds of cutting edge medical interventions may be tried, where the latest innovations are discussed and often applied, and where the people in charge of teams are growing increasingly analytical and data-driven. Outcomes are being tracked, records are being kept. It could be a fascinating pool of data for biomedical researchers to analyze in the search for ideas and treatments that are more generally applicable to you and me.

What might we expect to get from this kind of information? Well, to return to the quote that started this, we might learn a lot about the effects of different drugs to prevent, cure, and reduce disease, and in potential, in novel ways. Here’s something you may not know: licensed medical practitioners have a lot of leeway in administering drugs. They can vary dosage, timing, and even diseases or conditions in prescribing approved drugs. And so team physicians could potentially be seeing if there are new uses for existing drugs.

When drugs go through the approval process at the FDA, the submitting drug company chooses a specific indication, or disease, for which they seek approval, and a specific dosing regimen and patient population. All the pre-clinical work, all the clinical trials focus on that one thing, let’s say daily dosing to treat high blood pressure in adults. However, once a drug is approved by the FDA, a licensed medical practitioner can choose to prescribe that drug for many other diseases or patient populations, even though that drug hasn’t been tested for that particular situation.

What are the constraints on this, you might ask? Interestingly, there aren’t many. Why this might be is a topic for another day, although I’ll offer some thoughts from Atul Gawande about the cowboy culture of medicine that I think suggest one reason.

Off-label prescribing continues to be debated, but one clear and desired result is that medical science often advances precisely because doctors attempt a treatment in a way not previously tested. They do this because they have a hypothesis–based on what they know about how a drug works and about the cause of a patient’s disease–that the drug might help. This actually happens a lot in fields like oncology, where tumors are notoriously individualistic and often don’t respond to standard of care, and pediatrics, because clinical trials rarely test medicines on children because of the risk to the kids.

In sports, there are records of what team doctors have done to try and keep athletes healthy, including records of what the results were of this experimentation. Throw in information about rest, nutrition, genomics (if teams aren’t getting their athletes’ genomes sequenced, they should be) and other health interventions, and you have a large, albeit messy, dataset that could be used to learn about ways that might help in keeping the rest of us well.

But there are some problems with translating this trove of data into the public realm for people to analyze and leverage. Let me describe three: the risk of litigation, the value of proprietary information, and privacy and consent.

First, litigation. I’ve been following the legal battle over payments to retired NFL players for injuries incurred during their playing days. This has been messy and public and has opened the NFL to a lot of criticism. Would having medical data openly available make this kind of litigation both riskier for sports leagues in the future, and more likely to occur? Years later, would expert witnesses be able to identify warning signs in the data?

My response to that is, yes, that could happen, which is why you do want the data out there as quickly as possible. When data is available for more eyes and brains, one of two things will happen: useful connections will be seen and publicized, some of which may suggest incipient harm to athletes. Or, nothing clear will be found, which supports an argument by the team and league that they were acting in good faith based on state of the art knowledge at the time the data was generated and therefore they could not reasonably have been expected to find clear warning signs of damage to athletes in the data.

What about proprietary information? It’s true that trade secrets can be a useful way to maintain market share. But in sports leagues, just like in many other business sectors, personnel churn is the norm. A USA Today article from 2012 has a nice table of the average tenure of the past five managers or head coaches for each team across the NFL, MLB, NBA and NHL. It won’t surprise anyone to note that the median is just a few years across sports. I took the data from the NFL coaches table and created a simple frequency histogram to show the distribution of coaching tenures among the 32 NFL teams over the last five positions tracked in the USA Today study:

Given that head coaches generally don’t last long, and that their staffs also are subject to turnover on a regular basis, it’s difficult to argue that there can really be anything like long term trade secrets in the major sports leagues. At best there might be a few years of advantage but once a team shows success, that leads to the spread of ideas as coordinators and assistant coaches move out to lead their own groups. Check out these coaching trees, courtesy of Wikipedia:

While companies and organizations might wish it were otherwise, one of the key things that walks out the door with any employee is her or his experiences and knowledge. The non-compete clause is often a standard feature of employment contracts, but how enforceable it is still isn’t clear. In any case, I expect teams benefit at least as much as they lose from the spread of information, so it seems that concerns over proprietary information also wouldn’t stand in the way of sharing medical and health data with the public.

Which brings me to privacy and consent. This is the biggest hurdle as far as I’m concerned. I’ve made my living at times in the field of biomedical research and two of the most important things that have to be taken into consideration when studying humans are the related concepts of privacy and consent. All humans have a right to privacy about their health information–that’s why the Health Insurance Portability and Accountability Act (HIPAA) was passed in 1996, and why every time you go to a medical practitioner you have to sign that form asserting your rights to privacy. It’s part of why the Google guys have been tentative in their forays into health informatics.

Further, when people do agree to have their biomedical and health information distributed, they have to give informed consent. Whether biological samples are being taken for genetic or other analysis, or information about test results are revealed to additional individuals or parties, the patient, must be informed and give her or his consent.

Athletes under the care of team physicians are in a physician-patient relationship, and therefore privacy of information is assured. In order for the data to be distributed more widely, athletes would need to sign a consent demonstrating that they understand that their information will be studied and used for a variety of purposes, and that anonymity isn’t assured.

Would I sign off on something like that? I honestly don’t know. From the standpoint of an athlete, the main incentive is altruism. The knowledge that, by allowing the study of data from athletes today, athletes and others in the future will benefit, perhaps in great measure. Would that be enough? You know, I think it might.

One of the amazing, fascinating, hopeful things about research with human subjects is just how willing people are to help. Whole families consent to be studied in genetic research all the time, knowing their data will be published and also knowing that anything a scientist finds will only help other people in the future, if at all. The Personal Genome Project at Harvard, the 100K Wellness project at the Institute for Systems Biology, and many other research projects show that a lot of people are very willing to let their data be free in order to help advance the causes of medicine, health and wellness. Maybe athletes would be willing to do the same. It can’t hurt to ask.

And so, it would be interesting to see if some kind of data sharing and release could be negotiated between pro sports teams and interested researchers. Maybe something already has, and if anyone knows of arrangements like this I would love to hear about them. Because as we try to get to a future of wellness, rather than curing illness, it’s impossible to predict what piece of data will make a difference. Capturing what sports teams are doing might just be a key brick in the path that leads us to health.