Sawamura's Acupuncture and Long Thoracic Nerve Palsy in 2017 - Yomiuri's Apology Six Months Later and Its Reply to Nine Acupuncture Associations

The Answer - An Apology Six Months Later and a Reply That Only Listed Possibilities

From the February 2017 Treatment to the September Apology

Sawamura served as Yomiuri's closer throughout 2016 and led the Central League with 37 saves. On February 25, 2017, during spring camp in Okinawa, he felt discomfort (tightness) in his right shoulder, and two days later, on February 27, a club trainer gave him acupuncture on the same spot.

For a long time the symptoms did not improve as hoped. The several doctors who examined him diagnosed long thoracic nerve palsy, with the finding that it was caused by an external factor and that the acupuncture may have brought on the palsy, leading to dysfunction of the serratus anterior muscle. That year Sawamura pitched in a few games in the minor-league Eastern League, but for the first time since turning professional he made no appearances for the top team.

On September 9, president Ishii, GM Katori and the trainer apologized to Sawamura, and Sawamura accepted. The next day, speaking to reporters after a top-team workout at Tokyo Dome, Katori said, "His condition was not good, and I think the people around him found it strange," and "We want to restore his [good name], for his sake too," adding, "His condition has improved quite a bit. He himself is satisfied."

The Open Letter from Nine Acupuncture Associations

On September 21, nine acupuncture and moxibustion associations sent a document titled "Inquiry Regarding Reports of Long Thoracic Nerve Palsy Caused by Needle Treatment," addressed to Hiroshi Kubo, president and representative director of the Yomiuri Giants. The nine were the Japan Society of Acupuncture and Moxibustion, the Japan Traditional Acupuncture and Moxibustion Society, the Japan Acupuncture and Moxibustion Association, the All Japan Acupuncture, Moxibustion and Massage Association, the Japan Anma Massage Shiatsu Association, the National Hospital Physical Therapy Association, the Japan Federation of the Blind, the Oriental Therapy School Association and the Japan Federation of Riryo Teachers, the bodies to which nationally licensed acupuncturists and moxibustion practitioners belong.

The document said that on September 10 "articles about medical malpractice by a trainer belonging to your company were reported by several newspapers," and that "the entire profession has received the reports with great astonishment."

There were two sets of questions, one for the doctors who examined Sawamura and one for the trainer who treated him. The doctors were asked for the exact diagnosis and its findings; whether it was true that the acupuncture was the cause, why they concluded so and why they ruled out other causes; whether any findings before the treatment had suggested long thoracic nerve palsy; the patient's outcome; if the needles were the cause, what safety measures could have prevented it; and their own opinion. The trainer was asked for the details of the treatment, namely the chief complaint and purpose, the size of the needles, and the site, direction, depth and intensity of the insertion, and whether any findings during or after the insertion indicated nerve damage, among other things. The Japan Acupuncture and Moxibustion Association posted the document on its website on September 30.

The Club's Reply - Dated November 7, 2017

Yomiuri Giants replied in a letter dated November 7; the nine associations received it on November 8 and made its contents public on November 9. According to the reply, the club spoke again with the several doctors who had examined Sawamura, and "all of the doctors say that, based on the player's symptoms and other factors, their diagnosis of incomplete palsy of the long thoracic nerve, with accompanying loss of function in the serratus anterior, remains unchanged."

On the cause, the reply said the doctors "answered that, judging from the timing of onset and their interviews with the player, the acupuncture performed by the club's trainer may have caused the palsy of the long thoracic nerve," but added, "However, the opinion was also expressed that the palsy may have arisen from another external factor involving strong force, other than acupuncture." The club's position is that all of the doctors have outstanding careers and records and that their diagnosis deserves trust.

The reply stated that "the player's long thoracic nerve palsy has already healed," and that the trainer who performed the treatment was, at the time of the reply, still working as a club trainer. The club regards acupuncture as effective and uses it for many players and staff, and wrote, "There is no change in our policy of continuing to make use of acupuncture."

Meanwhile, the full text of the reply contains nothing on what the letter asked for: the findings behind the exact diagnosis, the reasons for ruling out other causes, the site, direction and depth of the needles, and safety measures.

Assessment - The Player's Reputation and Transparency in Examining the Cause

For more than six months, from the treatment on February 27 to the disclosure on September 10, the club gave no public explanation of the cause of Sawamura's trouble. Until the disclosure, newspapers had reported his trouble as a problem with the condition of his right shoulder. Katori's words, "I think the people around him found it strange" and "we want to restore his [good name], for his sake too," amount to the club itself acknowledging that the player's reputation had suffered in the meantime. If a player was left exposed to the doubts of those around him, with no explanation, over a condition that may have been caused by the club's own staff, that is a matter of player protection and accountability.

The apology was made in private on September 9 and came to light the next day when the GM answered reporters' questions. The club issued no statement of its own. A matter concerning the health of one of its players was handled through answers to reporters alone. Without a statement, the only way to check the date, the people present and the content of the apology afterward is the newspaper reports.

The reply to the professional associations' inquiry came seven weeks later. It acknowledged the possibility that the acupuncture was the cause while also listing the possibility of another external factor. This reply is the only written explanation from the club on record. The reply did not address the treatment details or safety measures, kept the trainer on and maintained the policy of using acupuncture. An answer that leaves the policy unchanged without showing any material for verifying the cause gives other players receiving the same treatment no way to check what happened. The question is not whether acupuncture is right or wrong, but how the club examined and explained a treatment given by its own staff.

Nothing in the course of this case shows any mechanism for disclosing records of a club trainer's treatment, publicizing an accident or having a third party verify it. The qualifications and work of trainers are covered in Behind the Scenes of Trainers, and efforts to prevent pitcher injuries in Pitcher Injury Prevention.

How to Read This Article and Its Limits

The facts in this article come from newspaper articles of September and November 2017 and from the full texts of the open letter and the reply posted by the Japan Acupuncture and Moxibustion Association. Sawamura's 2016 and 2017 records (37 saves and no top-team appearances) come from Wikipedia, which cites NPB in its footnotes. The trainer's name and the site and depth of the needles are not given. The reply does not state the site or depth either.

"Medical malpractice" is the term used in the nine associations' document, and this article uses it only within that quotation. The reply sets the possibility that acupuncture was the cause alongside the possibility of another external factor, so the cause cannot be settled either way. The reply does not say what the "other external factor" was, and this article does not speculate.

The article covers events only through 2017; it does not cover Sawamura from 2018 onward or assess acupuncture as a treatment.