On his 43rd birthday, Houston Astros pitcher Roger Clemens has become his generation's Nolan Ryan, the Official Hero to American Middle-Aged Men everywhere.

No Red Sox fan can have an uncomplicated opinion of Clemens -- however, this Alan Schwarz article in ESPN.com provides a nice illustration of how medical advances made Clemens' long career possible:

[F]or most of baseball history, a "sore arm" was like a malevolent genie who visited pitchers in the night, entered their joints and corroded their futures from the inside with no explanation or recourse. Johnny Beazley, Karl Spooner, Mark Fidrych ... they all faded into anonymity before medicine could fix them, medicine we now take for granted. When you consider that almost every top modern pitcher has gone under the knife at some point -- heck, some throw harder after ligament-transplant surgery -- you realize what a lucky era we're in.

So lucky that most people forget that Roger Clemens could have been one of those pitchers we never heard from again. It was 20 years ago that he and his throbbing shoulder lay on the operating table -- before any 20-strikeout games, before any Cy Young awards and before arthroscopy was a sure thing. Before Dr. James Andrews was sure he could fix him....

In June 1985, Clemens learned that a shoulder tendon and nerve were rubbing together, causing "the nerve to rise and get as big as shoelaces," Clemens said then. He tried to pitch through it but ultimately couldn't. On Aug. 23, he was told that he had a "flap tear" in his shoulder and was reportedly "devastated" by the news. The only good news was that the arthroscope, which originally had fixed knees in the 1970s, had come far enough that it could be used, instead of the more invasive scalpel, to shave down the damaged tissue.

"We had very little knowledge [about pitchers] -- they hurt and that's about all we knew," recalls Dr. Andrews, who performed the hour-long surgery on Clemens. "We began to arthroscope shoulders and started being able to see what was inside. Roger was one of the early ones."....

Clemens has been such a machine for the past 20 years that many people can't (or don't want to) believe how close we were to losing him. I asked Andrews to consider what might have happened had Clemens been born just 10 years earlier and hurt his shoulder before the scalpel gave way to the arthroscope.

"We probably wouldn't have been able to fix it," Andrews says sadly. "He probably would have fallen by the wayside."