Medicine's Rising Costs Put Hippocratic Oath At Risk

*** TRANSCRIPTION COMPANY BOUNDARY ***
..DATE:
20110316
..PGRM:
Fresh Air
..TIME:
12:00-13:00 PM
..NIEL:
N/A
..NTWK:
NPR
..SGMT:
Medicine's Rising Costs Put 'Hippocratic' Oath At Risk

DAVE DAVIES, host:

This is FRESH AIR. I'm Dave Davies, filling in for Terry Gross.

When health care policy is debated, some warn that a greater role for
government means bureaucrats will be rationing care. Others counter that
insurance companies are already doing that.

Our guest, Gregg Bloche, is a health policy analyst who says doctors themselves
increasingly have to decide which patients will get expensive tests and
treatments and which ones won't. In his new book, Bloche argues that modern
medicine forces doctors to disregard the Hippocratic Oath, which obliges them
to put their patients' interests above all else.

He says society needs to rethink the relationship between physician and patient
and be more honest about the choices that are made in providing health care.
Gregg Bloche is a graduate of both Yale Law School and the Yale Medical School,
and he completed a residency in psychiatry at the Columbia Presbyterian Medical
Center.

He was a health policy advisor to Barack Obama's presidential campaign, and
he's now a professor of law at Georgetown University. His new book is "The
Hippocratic Myth: Why Doctors Are Under Pressure to Ration Care, Practice
Politics, and Compromise their Promise to Heal"

Well, Gregg Bloche, welcome to FRESH AIR. Now, you write in the book that under
the health care system we have now, doctors are often put in the position of
rationing care and, you know, withholding or denying some treatments or tests,
sometimes without even really being aware of it. Give us an example of how this
works.

Dr. GREGG BLOCHE (Author, "The Hippocratic Myth: Why Doctors Are Under Pressure
to Ration Care, Practice Politics, and Compromise their Promise to Heal"):
Yeah, let me tell you about Sara(ph).

Sara was an 82-year-old grandma who was visiting her daughter, and she suffers
a massive heart attack. Paramedics rush her to the hospital, she's quickly
taken to the intensive care unit and put on all manner of monitors with fancy
chemicals dripping into her body through all sorts of tubes, and this is
costing tens of thousands of dollars just to keep her alive for a few days.

The doctors come to a conclusion that her prognosis is dismal. They think she
almost certainly is not going to make it, and in their minds, understandably,
almost certainly becomes certainly.

And they tell Sara and her daughter that things look really dismal and that
they'd better start making plans, end-of-life plans, and that it didn't make
sense to continue aggressive treatment.

And only later does a doctor come in, say something really tactless about how
much it costs to provide all this treatment. The reference to cost causes the
daughter to flip out, become enraged and to demand all aggressive treatment.
And the doctors, afraid of the daughter, go ahead and treat Sara really
aggressively. And within a couple of weeks, Sara walks out of the hospital on
her own power, and she lives for another year or so.

And for the doctors, this was a shock because the tiny, tiny chance that Sara
could make it became in their minds a zero chance. The fact that she made it
shows that there was a chance. But the reality was that these doctors were
under tremendous pressure to set limits on behalf of their health plan;
tremendous pressure not to spend tens of thousands of dollars on Sara when they
were pretty sure that she wasn't going to make it.

And I talked to one of the doctors later on, one of the doctors involved in
these decisions. And you know what he told me? He told me: Yeah, we ration
care. We ration care every day.

And so sometimes are aware of it, and sometimes they're not because it's so at
odds with the Hippocratic ideal that they kind of push it to the back of their
mind and then out of their mind.

DAVIES: And what was that tactless thing that the doctor said to Sara's
daughter?

Dr. BLOCHE: Well, one of the doctors comes into the intensive care unit while
Sara's daughter is sitting by the bedside and says: Well, have you ever stayed
in a really expensive hotel? And Sara says: Yeah, I guess so. And the doctor
says: Well, you know, how much do you think an expensive hotel costs? Sara says
maybe: $600, $800. And the doctor says: Well, this room costs $10,000.

And of course, the message there is you are wasting the public's money by being
here. You are wasting the public's money by continuing to breathe, and it was
that moment that led Sara's daughter to flip out, to become furious; that
moment of loss of trust.

And what are the lessons that the doctors, the other doctors took from that?
Well, not that covert rationing is a bad thing but rather we've got to do
better at keeping the relationship intact because we can't afford to provide
Sara that room in that really expensive hotel.

DAVIES: Now, help us understand what it is doctors are thinking about when
they, you know, deny a treatment that might be beneficial but is expensive. Is
it because they have rules from a medical director above them? Do they get a
cash incentive for saving money? How does it actually work?

Dr. BLOCHE: Increasingly, we're seeing financial incentives to be frugal. In
fact, actually, in the health reform bill, one provision that's troubling in a
law that, for the most part, I think is a wonderful moral advance for our
country, one provision that's troubling is the creation of so-called
accountable care organizations that might well have Medicare in the business of
giving doctors incentives covertly to skimp on care.

I think we'll be seeing more of this. We also certainly have rules being set by
medical directors in large medical group practices, rules that lay out policies
for limit setting.

What we don't have, Dave, what we don't have, and this is really a troubling
thing, what we don't have is candor in health insurance contracts and in the
laws and regulations that govern Medicare and other public programs, candor
about the balances to be struck between costs and benefits.

DAVIES: Now, you write that insurers typically promise to pay for any treatment
that is, quote, "medically necessary," unquote, right?

Dr. BLOCHE: Exactly.

DAVIES: Now what - that sounds pretty clear: You've got to do what you need to
do. Why does it leave wiggle room?

Dr. BLOCHE: Well, the average person thinks that medically necessary care means
all care that might potentially be beneficial. But the reality is it's a wide-
open term. It typically gets construed by courts and administrative agencies to
mean the care that most doctors provide. And so doctors get to set the
standards.

But patients and the public expect that it means all necessary care. And so
when we find examples of covert rationing, when we find examples of potentially
beneficial care being denied, we tend to get really angry.

DAVIES: And I'm sure a number of cases have gone to court on this. What do the
courts say about the legality of rationing care based on cost, on saving money?

Dr. BLOCHE: Well, the courts have been all over the map on this issue. The U.S.
Supreme Court, 11 years ago in a unanimous decision, in a case known as Pegram
versus Herdrich, said explicitly that HMOs ration care, they offer doctors
incentives to ration care, that that is legal, that the Congress of the United
States approved of this when it enacted the HMO Act back in the early 1970s and
that there ought be no liability for it, at least under federal law.

But other courts, state courts, in hearing cases when insurance companies have
refused to cover care, have oftentimes insisted on the provision of all
potentially beneficial care. And to a large extent, the courts defer to doctors
to set standards of care.

DAVIES: Well, you've told us how doctors are often withholding care in some
cases, rationing it; sometimes consciously, sometimes unconsciously. But you
also believe that, in a way, this is inevitable, right?

Dr. BLOCHE: Yes. Yeah, absolutely.

DAVIES: Why?

Dr. BLOCHE: Well, first of all, we're going to have to find some way to set
limits. We cannot afford anything like what we're spending on health care
today, and we're certainly not going to be able to afford what we're projected
to spend in the future.

We spend almost a fifth of our national income today on medical care. And
within 25 years, unless we change dramatically, we're going to be spending
about a third of our national income on medical care. And we're doing that by
borrowing from our kids.

This is a huge part of why we're running a one-and-a-half-trillion-dollar
federal budget deficit and why those deficits are projected to continue at
nightmarish levels.

The debates in Congress today over discretionary spending - chump change
compared to what we're spending on the Medicare program and the Medicaid
program. So we have to find some ways to set limits.

DAVIES: Our guest is Gregg Bloche. He is an attorney, health policy analyst and
a psychiatrist. His new book is "The Hippocratic Myth." We'll talk more after a
short break. This is FRESH AIR.

(Soundbite of music)

DAVIES: If you're just joining us, our guest is Gregg Bloche. He is a
physician, a psychiatrist, an attorney and health policy analyst. He's written
a new book called "The Hippocratic Myth: Why Doctors Are Under Pressure to
Ration Care, Practice Politics, and Compromise their Promise to Heal."

Now, you've written that a lot of people say that 30 percent of health spending
is wasted on care that is not effective. If we know that a lot of the tests and
treatments that we're providing don't really help, how do we get a handle on
that? I mean, can you wean out those which aren't effective and thereby reduce
costs?

Dr. BLOCHE: To some extent yes, but that's not going to be the whole of the
solution to our problem of health care costs.

There's two things going on here. Number one, we're just not putting the
resources in to doing research on which treatments do and don't work that we
ought to be putting in.

Now, the health reform law takes a big step forward with a - an unprecedented
committed to what's called - what we policy wonks call comparative
effectiveness research. And that's just a fancy way of referring to research
that tries to figure out which of the treatments we use now actually work.

What's amazing is that probably only about 10 to 20 percent of the treatments
that doctors use today have been tested based on the so-called gold standard of
clinical science, the randomized clinical trial.

And then even when a treatment tests in, a treatment is shown to work really
well for the sample that's studied in the clinical trial, in the real world
patients are all different. And so we're never going to be able to have solid
science that can tell us in advance, for sure, whether the treatment is going
to work or not.

So let's do the research, but let's be realistic. Let's pragmatic about the
limits of that research.

DAVIES: Now, one of the things you write in the book is that when high-tech,
very expensive treatments and tests are developed, they tend to get employed,
and patients billed for them, whether we really know whether they work or not.
Can you give us an example of that?

Dr. BLOCHE: Exactly, exactly. Well, one recent example, really a nice piece by
the health journalist Julie Applebee, sets this example out.

Back in 2007, a so-called 64-slice CT scanner came into use, really high-
resolution. Cardiologists loved it. They started buying it for their offices,
and...

DAVIES: What does that mean, 64-slice?

Dr. BLOCHE: It means 64 different levels of images very close together. A CT
scanner works by taking a cross section of the part of the body that it's
scanning.

DAVIES: So you get a three-dimensional picture, in other words, right?

Dr. BLOCHE: Exactly. It's a three-dimensional picture that's made up from a
whole bunch of slices. Imagine looking at cross sections, at multiple levels of
something. You can do a cross section of the brain at multiple levels. And the
closer the cross sections are to each other, the finer the resolution on the CT
scan.

So 64-slice is just a fancy way of saying a really high-resolution CT scanner,
so high-end resolution that you could put people in it and look at their hearts
and figure out how much coronary artery blockage they had without putting a
catheter inside their arteries to pump dye into their arteries, which was a
rather scary way of assessing levels of coronary artery blockage.

So the cardiologists loved this. They could buy this machine and charge a huge
amount for it and show beautiful pictures, stunning pictures, colorful
pictures, of people's coronary arteries and the degree of blockage.

Only thing is that this test, it turn out, only turned useful for a very small
number of patients who had serious coronary vascular disease. Medicare agreed
to pay for it only for this small number of patients.

But the cardiologists exercised their right to petition their government. They
lobbied Congress. Seventy-nine congressman from both parties wrote a letter to
the agency that runs Medicare, saying: Cover this thing. Medicare soon
rescinded its limiting rule and agreed to cover the test much more broadly.

So politics plays a big role in the movement of expensive technologies that
yield only tiny benefits right into the marketplace. And then the developers of
these technologies know that. And so they keep spending. The investment bankers
know it. The venture capitalists know it.

And so the money train of investment keeps pouring resources into the
development of technologies that are at once astonishingly, dazzlingly
impressive in engineering terms and in computer software terms and really crude
in terms of the human biology that they rely upon.

DAVIES: So it seems that we have two things working at cross purposes here. We
have this expensive stuff being developed that may be marginally effective but
which then gets used a lot because powerful interests promote them.

But then you have health plans saying: Not so fast. We think we can give you
Tylenol and send you home.

Dr. BLOCHE: Exactly, exactly. And the two sides represent the two sides of us.
The special interests who are able to get their technologies onto the market
despite lack of proof that they work rely upon use loving the technologies,
having hope in the technologies and believing that those technologies will save
grandma.

That's why they were able to get 79 congressmen, in the case of the 64-slice CT
scanner, to write in because those congressmen know that it's really easy to
portray government as stinting on grandma's care.

DAVIES: And doctors - I mean, one of the examples that you point to is doctors
- how often should they order MRIs for women looking for breast cancer, right?

Dr. BLOCHE: Right.

DAVIES: And there's a truly legitimate question there about how often those
should be ordered, and they're expensive, right?

Dr. BLOCHE: That's right, that's right.

DAVIES: So is that one of those cases where you think in the real world, in a
rational world, doctors are going to have to make some tough decisions and use
that less frequently than you would if you wanted to be completely thorough and
catch every single case? How do we make that calculation?

Dr. BLOCHE: Yeah. There's a tiny, tiny advantage that you can gain in lots of
cases by doing an MRI to assess the risk of breast cancer, compared to doing a
mammogram. And yet doing an MRI can cost upwards of $1,000. A mammogram is, of
course, much cheaper. And so there's a balance to be struck there.

We need to talk openly about that balance. Right now, the practice rules that
tell doctors when they should and shouldn't order MRIs to screen for breast
cancer say nothing explicitly about the role of cost. We need to have an open
conversation about how to count costs, about how to count costs not just when
we're talking about MRIs to rule out breast cancer but in a bunch of other
situations involving both diagnostic screening tests and actual treatment.

If we have an open discussion of cost, if we have rules about much cost will
count in health plan contracts so that people can make choices in advance,
then, you know what, we will have a sense of tragedy. We will have a sense of
possibilities foreclosed by the realities of our budgets. But we will not have
the kind of outrage that emerges when we think our doctors are doing all, and
in fact they've covertly counted costs.

DAVIES: You say in discussing what we need to do, that we need to empower
doctors to say no to care that's technologically possible and may prolong life,
that you have to empower doctors to do so even when the consequences seem
tragic and develop rules that will, at times, result in heartrending outcomes.

And it strikes me that this involves really hundreds of decisions about
different kinds of tests and treatments. You decide what's a reasonable,
rationable set of recommendations, and then you expect doctors to tell their
patients: We as a society have decided we can't afford to give you this test
for this condition.

Dr. BLOCHE: What the doctor can then do is to say to her or his patient: That's
not something that I'm allowed to do, that's not something that the rules
permit me to do, just like a lawyer is not allowed to present false information
to a tribunal, even though it's a lawyer's obligation to stand by his or her
client. The key here is that society ought to be making these rules.

We make these rules in other parts of our public and private lives. The federal
government values life for the purpose of making decisions about airline
safety, making decisions about occupational safety. The Environmental
Protection Agency acts based on values of life. And the Office of Management
and Budget within the White House tries to make sure that regulations are
consistent in different agencies in how they value life.

In fact, there's people who research this, and the general consensus is that we
value life, for purposes of public policy, roughly between $5 and $10 million
per life saved.

Now, this all sounds pretty brutal. It certainly is a way in which economics
earns its moniker, the dismal science. But the reality is if we go above that,
if we, say, spend $50 million to save a life in health care, as opposed to $5
to $10 million, then that $50 million we don't have to save a bunch of other
lives, and that's $50 million that leads to the sacrifice of other people's
lives.

And so those decisions need to be made as visibly, as publicly in health care
as they are in other areas of our public affairs.

DAVIES: Well, Gregg Bloche, it's been interesting. Thanks so much.

Dr. BLOCHE: Thank you very much, Dave, for having me.

DAVIES: Gregg Bloche is a health policy analyst and law professor at Georgetown
University. His new book is called "The Hippocratic Myth."
..COST:
$00.00
..INDX:
134568775
*** TRANSCRIPTION COMPANY BOUNDARY ***
..DATE:
20110316
..PGRM:
Fresh Air
..TIME:
12:00-13:00 PM
..NIEL:
N/A
..NTWK:
NPR
..SGMT:
'60s Figure Owsley Stanley Dies In Australia

DAVE DAVIES, host:

Owsley Stanley, a sound engineer who's better known for mixing high-quality LSD
for The Grateful Dead, The Beatles, Jimi Hendrix, Ken Kesey and others, died
Sunday in Australia in an auto accident. He was 76.

The Oxford English Dictionary includes the noun Owsley to mean a potent form of
LSD. Owsley also designed the Dead's skull-and-lightning-bolt logo and the Wall
of Sound sound system, which the Grateful Dead used in their live performances.
This one was recorded in 1971. I'm Dave Davies, and this is FRESH AIR.

(Soundbite of song, "Not Fade Away")

Mr. JERRY GARCIA (Lead Guitarist, The Grateful Dead): (Singing) I wanna tell
you how it's gonna be. You're gonna give your love to me. I wanna love you
night and day. You know our love will not fade way. You know our love not fade
away.

My love is bigger than a Cadillac. I try to show you, but you drive me back.
Your love for me has got to be real. You're gonna know just how I feel. Our
love is real, not fade away....
..COST:
$00.00
..INDX:
134520198
*** TRANSCRIPTION COMPANY BOUNDARY ***
..DATE:
20110316
..PGRM:
Fresh Air
..TIME:
12:00-13:00 PM
..NIEL:
N/A
..NTWK:
NPR
..SGMT:
The 'Secret History' Of Baseball's Earliest Days

(Soundbite of music)

DAVE DAVIES, host:

This is FRESH AIR. I’m Dave Davies in for Terry Gross.

Among the ritual sounds of spring in America are the crack of bats and the snap
of leather as baseball revives for another season. But just how old is the
national pastime? The guy to ask is our guest, John Thorn, who was recently
named the official historian of Major League Baseball. He's spent a lifetime
studying and writing about baseball, and in his new book he researches what he
calls the Paleolithic era of the game. He believes some form of baseball may
date back to the American Revolution.

For much of the 20th century, Americans believed the story that baseball was
invented by Abner Doubleday in Cooperstown New York around 1840. That tale has
been discredited for years and Thorn says it's clear baseball has no single
inventor, that it evolved over time. Thorn's book is called “Baseball in the
Garden of Eden: The Secret History of the Early Game.” He notes on the first
page that you can find a reference to baseball in a 1798 Jane Austen novel. I
asked him to begin with a reading from the introduction.

Mr. JOHN THORN (Author, “Baseball in the Garden of Eden: The Secret History of
the Early Game”): (Reading) Reflecting on the appeal of history in Jane
Austen's Northanger Abbey, heroine Catherine Morland comments, I often think it
odd that it should be so dull, for a great deal of it must be invention.
Indeed. And in no field of American endeavor is invention more rampant than in
baseball, whose whole history is a lie from beginning to end, from its creation
myth to its rosy models of commerce, community, and fair play; the game's epic
feats and revered figures, its pieties about racial harmony and bleacher
democracy, its artful blurring of sport and business - all of it is bunk,
tossed up with a wink and a nudge. Yet we love both the game and the flimflam
because they are both so American. Baseball has been blessed in equal measure
by Lincoln and by Barnum.

DAVIES: Well, John Thorn, it's great to have you here. You do spend a lot of
time documenting the game in the early 19th century. You said there were
different versions of the game in Massachusetts and New York. How do they
differ?

Mr. THORN: The Massachusetts games is far older and involved overhand throwing
by, what we call today, the pitcher. It had anywhere from nine to 14 in the
field, and sometimes more. You would be thrown out, a ball would kerplunk you
in the ribs between the bases and this is part of the delight, the sadistic
delight of this game, that you could create an injury to an opponent’s pride,
if not to his body, because the ball was actually rather soft.

The New York game, which is, in it’s essence, the same game; they're both
baseball games. The New York game’s distinctions involve the creation of a foul
territory, the inability of putting a batter out between the bases in this
undignified way, you have to tag him out or force him out at a base.

DAVIES: So you couldn't plunk him, in other words?

Mr. THORN: You couldn't plunk him, but the New York game had the underhand
pitching style, which made batting very much easier.

DAVIES: And something more like the New York game eventually won out, right? Do
we know why?

Mr. THORN: I believe the New York game won out through superior PR, because I
have played re-creation games, I have umpired re-creation games for the
Massachusetts game and it is a fantastically fun game, both to play and to
watch. And how it became the game that got away is beyond me, because the New
York game I think, in many measures, is inferior. It claimed for itself,
manliness and gentlemanly conduct, but manliness was really a characteristic of
the Massachusetts game. That’s where bravery was on display.

DAVIES: Because you could get hit by the baseball?

Mr. THORN: Also because you did not have to stay between the base as while you
were running, so you could lead your opponents on a merry chase into the
outfield and beyond.

DAVIES: And there was no foul territory in the Massachusetts game?

Mr. THORN: No foul territory. So one of the particular skills of the
Massachusetts game was what they called slide hitting. So you would position
your hands on the bat and raise the upper hand so that the ball would be ticked
behind you between the additional catchers or scouts that were behind the
primary catcher, and you would just run for days.

DAVIES: And there were four bases?

Mr. THORN: There were four bases plus home plate.

DAVIES: Right. So you were to touch each base in succession once the ball went
in some direction. But you might run all over the place of avoiding a hurled
ball in between.

Mr. THORN: You might. In fact, the distance between the home plate, or strikers
point, and first base was very small so almost everybody was able to get to
first. But then getting around the bases, that was the tough part.

DAVIES: You know, I have to say that people who are used to the modern game
might listen to that description of the Massachusetts game and say it's not
baseball, it's chaos. But you’ve umpired it. You like it

Mr. THORN: I like it and it is a structured chaos. It is not mere tag or a game
that we know from Spenser's "Faerie Queene" as base or prisoner’s base. It has
rules, it has regulations and it rewards skill.

DAVIES: Was the game back then an urban game or a rural game, or both?

Mr. THORN: Both. It is - I believe the game predates cities as we know them.
The game did not arise in an urban slum. This is a farm game brought to the
cities and then exported back to the farms. And one of the charms of this
Edenic pastime, particularly for bachelors in the city, is it reminded them of
the farms they had just left behind.

DAVIES: And how did you determine that - that it migrated from farm to city?

Mr. THORN: The earliest mentions that we can find of baseball by old timers
take you back to west-central Massachusetts in the 1750s, '40s and in one
citation 1735. The game has no record in the cities until, at the very
earliest, 1805. And more likely the famous find by George Thompson of two ball
clubs scheduled to play in order to promote drinks and revelry at Jones's
cottage in New York in 1823, at the corner of what is now 8th Street and
Broadway.

DAVIES: And when the game was played in the early 19th century, were their
uniforms? I take it they did not have catcher’s mitt - did not have fielding
gloves, right?

Mr. THORN: No. Fielding gloves are a much later innovation, the 1870s, and
there's no indication that the early clubs had uniforms but they may have worn
ribbons on their front shirt - on the fronts of their shirts. They may have
worn ribbons on their jerseys, because the exchange of ribbons, which is a very
medieval custom, was a part of the organized game from its earliest days - that
the winning team would entertain the losing team at a post game banquet and
they would exchange prizes.

DAVIES: And how did the ribbon figure in?

Mr. THORN: The ribbon was something that was worn on the jersey during the
game, of each club, and the losing club would forfeit its ribbons to the
winning club.

DAVIES: So you tell us that, you know, baseball got going probably in the 18th
century and was actively played in the early 19th century and then really kind
of came to its own after the Civil War. How much was gambling a part of the
whole thing?

Mr. THORN: I don't think you could've had the rise of baseball without
gambling. Baseball was a boys game and not worthy of the attention of adults,
not worthy of press coverage. What made baseball seem important was when
gamblers figured out a way to spur interest in it, so that gambling would just
become, of course, the original sin for current baseball, courtesy of the 1877
Louisville fix, the Black Sox scandal, Pete Rose, you name it.

In the beginning there were people who turned their noses up at gambling but
they recognized the necessity of it. It was - you would not have had a box
score. You would not have had an assessment of individual skills. You would not
have had one player of skill moving to another club if there were not gambling
in it.

DAVIES: Mmm. So you had organized baseball clubs. Now did the gambling sort of
begin, external to that? That is to say people who ran gambling games on the
street discovered it was fun - that people would be interested in watching the
game if they would take and pay bets on it?

Mr. THORN: Yes. Absolutely. There were touts at the ballgames with baseboards
in hand and they would be taking their bets between innings. They would bet on
the outcome of an individual at bat. It was absolutely rampant. When gamblers
were banned from the sidelines - and they formerly had a section of the
bleachers devoted to them, it was the pool box. The pool box was banned so pool
rooms grew up right around the ballpark and people who are now playing
billiards - the name which subsequently became known as pool, was not
originally pool - bet these tandems much the way the country sees with betting
on the NCAA Final Four.

DAVIES: Well, money always helps to fertilize the growth of any new enterprise.
So how did the gambling money then get into the game itself? I mean were - did
they pay players?

Mr. THORN: Inevitably, when players were a - when ball-playing teams were a
combination of amateurs and pros, or whether they were going for a percentage
of the gate and some star with salaried and everybody else was on the hook, it
was easy to approach a ballplayer and say look, I'll give you as much for this
game as you would make the entire year if you'll help to throw the game. So
game fixing, which we think of as the Black Sox scandal in 1919, dates as early
as 1865. That is when we had our first scandal and three players were banned.

DAVIES: And in this post-Civil War period were the team's professional? Were
they paid to play the game?

Mr. THORN: We think of the 1869 Cincinnati Red Stockings, the unbeaten squad
that toured from one coast to another and was undefeated in 57 first-rate games
and a handful of others against scrub teams, we think of them as the first
professionals. But professionalism had entered the game, certainly by the mid-
1860s, and ballplayers we know were being paid by the beginning of the 1860s.
The first all professional team probably dates to about 1866.

DAVIES: We're speaking with John Thorn. He's a baseball historian whose new
book is “Baseball in the Garden of Eden.”

We’ll talk more after a quick break.

This is FRESH AIR.

(Soundbite of music)

DAVIES: If you’re just joining us, we're speaking with John Thorn. He is the
official historian of Major League Baseball and the author of the new book is
“Baseball in the Garden of Eden: The Secret History of the Early Game.”

You know, we said we like to think of baseball as sort of fixed and unchanging,
but it has changed. What are some of the major changes that we saw, you know,
from the game of the 1880s to the modern game?

Mr. THORN: I think enclosed ballparks is of enormous importance because now you
had a fence, no matter how distant, that you could hit the ball over and little
by little slugging came into the game. Now Ty Cobb, Sam Crawford, Frank Chance,
you name the hitting heroes of the first decade of the century, there was no
point in them hitting the ball, swinging at a pitch the way Babe Ruth did
because they weren't going to drive no mushy ball in the seventh inning over a
fence 500 feet away anyway.

The innovation of enclosed fields and ever diminishing distances to the wall so
that the ballplayers - you get larger. The fields get smaller. Power becomes
more easy to accomplish. The game changes. Pitching becomes a game of throwing
breaking balls, you can't throw a ball down the middle. You cannot take it easy
with batters seven, eight, and nine because anybody can hurt you in today's
lineup.

DAVIES: So the fact that they enclosed the fields and made them close enough
for hitters to hit a ball out of the ballpark required pitchers to pitch more
aggressively and not give hitters that chance.

Mr. THORN: Actually, I'd say they began to pitch more defensively.

DAVIES: Mm-hmm.

Mr. THORN: Today’s pitcher nibbles at the corners, throws more breaking pitches
than fastballs, with a handful of exceptions, and those exceptions tend to be
relief pitchers. So good ole country hardball, the kind of ball that Cy Young
might throw or Walter Johnson might throw, that's pretty much a thing of the
past for a starting pitcher.

DAVIES: And the ball itself, how much has it changed since, say, the Civil War?

Mr. THORN: The ball between the Civil War and say 1900, there's a lot of
variation. The home club supplied the ball and those home clubs that had good
hitting clubs might supply a livelier ball. The league made specifications as
to how the ball should be made beginning in the 1870s, but these were sometimes
ignored. Taking a ball that had been bashed around for four or five innings and
replacing it with a clean ball, this didn't start until the 1920s. It was after
a Cleveland shortstop named Ray Chapman was hit in the head on a cloudy day by
an under armed submarine delivery pitched by Carl Mays and he died a day later,
that the white baseball became paramount. Formerly, it was mushy, it was dirty
and the pitchers had an edge.

DAVIES: And when did the rule that allowed you to get someone out in the field
by throwing the ball at him, plunking him, when did that disappear?

Mr. THORN: This is a – this idea that, archaic versions of baseball disappear
is mistaken. They survive. When I was a boy I played ballgames in which you
could be struck by the ball between the bases and retired. So the archaic
versions go back to the farm or go back to the playground. But in the
"Knickerbocker Base Ball Club rules of 1845" and the rules as formalized at the
convention in 1857 and expanded upon by the Major Leagues in the years, in the
1870s and beyond, soaking was never on the highest level of play, but it
continued to lurk at the town level or county level.

DAVIES: Soaking, that’s whacking somebody?

Mr. THORN: Soaking, plugging, yup.

(Soundbite of laughter)

DAVIES: Okay. Did you play baseball as a youngster?

Mr. THORN: I played baseball poorly. I had a pretty good glove. I could run.
But I never mastered hitting. You know, I was always behind the decent
fastball. I couldn't pull.

DAVIES: And have you always been passionate about the game?

Mr. THORN: Baseball was more than a passion for me. It was my ticket to
becoming an American. I was born in a displaced person’s camp to Holocaust
survivors and when I came over at two and a half I had already begun to speak
German but I was stateless. I learned English by being thrust into a nursery
school environment and learning to read off the backs of cereal boxes and
baseball cards. So I fell in love with the cards before I'd even seen a game.

DAVIES: You’re now Major League Baseball’s official historian. What does that
mean? What do you do?

Mr. THORN: I serve. That is my mission. My mission is I take it philosophically
to mean that baseball has looked at what I've done over the years and thought
that I might be helpful in attaching younger fans to the joys of the history of
the game - that baseball is a tremendously exciting game. There's no question
that the game as played on the field today is far better than it was 20 years
ago, 40 years ago, 60 years ago and so on. However, some things have been lost
in terms of our attachment to story and I'm hoping that I can make the game’s
history come to life.

DAVIES: Do you have a favorite place to watch a game?

Mr. THORN: At my age, which is 63, I will say that the trip to the ballpark,
which involves a two and a half hour auto trip each way, becomes a little
rigorous. So the shorter distance to the refrigerator from my couch is very
appealing.

(Soundbite of laughter)

DAVIES: What about Minor League ballparks? They’re everywhere. Great fun,
aren't they?

Mr. THORN: Minor League ball is great. If any of our listeners are Major League
fans who have not seen Minor League ball, I cannot urge them strongly enough to
try it. If you want to see where the old ballgame lives, this is where it
lives.

DAVIES: Well, John Thorn, it’s been fun. Thanks so much.

Mr. THORN: Thank you, Dave.

DAVIES: John Thorn is the official historian of Major League Baseball. His new
book is “Baseball in the Garden of Eden: The Secret History of the Early Game.”
You can read an excerpt on our website, freshair.npr.org.

Coming up, Ed Ward on country soul singer Percy Sledge.

This is FRESH AIR.

(Soundbite of music)
..COST:
$00.00
..INDX:
134570236
*** TRANSCRIPTION COMPANY BOUNDARY ***
..DATE:
20110316
..PGRM:
Fresh Air
..TIME:
12:00-13:00 PM
..NIEL:
N/A
..NTWK:
NPR
..SGMT:
When A Rock Historian Loves Soul Singer Percy Sledge

DAVE DAVIES, host:

The great singers from the golden era of soul tend to fall into one of two
categories, there's gospel soul, whose vocal technique comes from the church,
with singers like Aretha Franklin or Wilson Pickett, who actually started
singing in church. And then there’s country soul, which tends to be quieter and
sung by people with rural backgrounds, like Arthur Alexander, Swamp Dog, and
the master of country soul, Percy Sledge.

Rhino Records has recently released Sledge’s complete Atlantic recordings.
Here’s rock historian Ed Ward.

(Soundbite of song, “When A Man Loves A Woman”)

Mr. PERCY SLEDGE (Country soul singer): (Singing) When a man loves a woman,
can’t keep his mind on nothing else. He’d trade the world for a good thing he’s
found. If she is bad, he can’t see it. She can do no wrong. Turn his back on
his best friend if he puts her down

When a man loves a woman...

ED WARD: Percy Sledge was unhappy. His high-school sweetheart had dumped him
and gone to LA to be a model, taking one of his best friends with her. It was
Christmas Eve 1965, and he was performing with the Esquires Combo at a health
club in Sheffield, Alabama. In the middle of the set, he just lost it.

Just hit me a chord on the keyboard, he told the organist, "Pop" Wright, and he
began improvising a song, "Why Did You Leave Me, Baby?" Quin Ivy, who'd been
producing some records locally, was there and invited him to record it.

It was the moment Percy had been waiting for ever since he'd left Leighton,
Alabama, for Muscle Shoals - a larger town where Arthur Alexander and Percy’s
cousin, Jimmy Hughes, had already recorded hits. He’s been bugging Jimmy to
tell Rick Hall, the owner of Fame Studios, where Jimmy had recorded, about him.

There were a bunch of young white guys hanging around the studio writing songs
and playing in the house band, including Dan Penn, Spooner Oldham and Jimmy
Johnson, and when Percy approached them with "Why Did You Leave Me, Baby," they
thought the melody was great but the lyrics needed work.

Sledge went to his mother's house and worked steadily for three weeks, and
finally came back to Quin Ivy with the new version. Explaining his absence, he
told Ivy, When a man loves a woman, he can't keep his mind on nothing else.
Ivy's ears perked up, and he and Percy and a few of the other guys got to work,
and before long, they set Percy up in the vocal booth and started recording.

Meanwhile, in New York, Jerry Wexler of Atlantic Records was in search of a new
studio in the South to record soul artists in, and when he got a call from Rick
Hall about "When a Man Loves a Woman," he asked to hear it. He signed Percy
Sledge right away and took the record and added some extra horn parts in a
Memphis studio, then rush-released it.

Doesn't it sound better now? He asked Hall during a phone call. Hall had to
tell him that, in the rush, Wexler had released the original version. It sold
like crazy, hitting the top of the soul and pop charts in early 1966.

Three months later, Sledge had another hit, "Warm and Tender Love," but it was
with Dan Penn and Spooner Oldham that he was to do his most spectacular work;
they seemed to be able to write songs that fit his sense of drama perfectly.

(Soundbite of song, “"It Tears Me Up"”)

Mr. SLEDGE: (Singing) I see you walk with him. I see you talk to him. It tears
me up. It tears me up. And start my eyes to crying. Oh, oh, I can't stop
crying. I see him kiss your lips, and squeeze your fingertips. It tears me up.

WARD: Both "Warm and Tender Love" and "It Tears Me Up" were hits in 1966 - Top
10 soul, Top 20 pop - against heavy competition. But the greatest Penn/Oldham
masterpiece in his career, didn't do very well at all. Maybe there was just too
much else happening in 1967, or maybe the song was too subtle for the radio.

(Soundbite of song, “Out of Left Field”)

Mr. SLEDGE: (Singing) When least expecting it, based seeing it. Bring light to
the darkness, oh what a thing. I needed someone to call my own. Suddenly out of
left field. Out of left field, out of left field. Out left field, love came
along. I was walking down a railroad that went nowhere. Building dreams that
were all left by the wayside. Then out of the blue. Honey, I found you. Oh
yeah.

Sugar and peaches is a paradise thing...

WARD: He kept recording, though, with a remarkably eclectic range of material:
country songs, Ray Charles songs, Bee Gees songs - and made them all his own.
There are probably no two soul singers as dissimilar as Percy Sledge and Wilson
Pickett, but listen to what he does with Pickett's first hit.

(Soundbite of song, "I Found A Love")

Mr. SLEDGE: (Singing) I found a love. I found a love. I found a love that I
need, whoa yeah.

WARD: “I Found A Love," though, was only released in Germany, which was
symptomatic of where soul music was in 1974, in decline in the United States.
Percy was still big in Europe, and he was huge in South Africa, where his 1970
tour in the middle of a cultural boycott didn't help his image back home.

But as times changed, Percy Sledge didn't. He was nominated for a Grammy in
1995, and in 2005, he was inducted into the Rock and Roll Hall of Fame. He's
still at it, not touring as much as he once did, but still playing, mostly in
the South. Go see him if you get a chance.

DAVIES: Ed Ward lives in the south of France and blog at
wardinfrance.blogspot.com. He reviewed “Percy Sledge: The Atlantic Recordings.”

You can listen to three tracks on our website, freshair.npr.org where you can
also download Podcasts. You can also join us on Facebook and follow us on
Twitter at nprfreshair.

For Terry Gross, I'm Dave Davies.

(Soundbite of music)

Mr. SLEDGE: (Singing) Come, come, spread your presence of love all over me. Oh,
can't you see...

(Soundbite of music)
..COST:
$00.00
..INDX:
134172710

Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.