The title of the session was "View From the Top." It was not lost on any of the four panelists - Ruben Amaro Jr., Peter Luukko, Howie Roseman, and Adam Aron - that their franchises have been enjoying the view from less-lofty vantage points lately.

All four missed the playoffs in their most recently completed seasons, and Amaro's Phillies are scuffling along below .500 this year.

"We have four of the most enjoyable jobs on the face of the earth," Sixers CEO Aron said, adding after a comic pause: "When our teams are winning. It does get a bit more challenging in the other circumstance."

The four were at Lincoln Financial Field for "The Impact of Sports," a symposium organized and sponsored by the Rothman Institute. The focus was on sports business as well as health issues. As it turned out, that juxtaposition went a long way toward explaining "the other circumstance" - losing - that has governed Philadelphia pro sports for the last year.

Do the body count: Andrew Bynum, Jason Richardson, Ryan Howard, Chase Utley, Roy Halladay, Jason Peters, Jason Kelce, Todd Herremans, Chris Pronger, Danny Briere.

Injuries - including several particularly vexing ones - blew holes in all four franchises' plans. They were hardly the only problems, but they were significant.

"We're in the risk business," Amaro said. "We hope to make intelligent decisions, but it's all about risk. You don't know what's going to happen. It's not an exact science."

The next panel discussion - "Managing the Physical Impact of Sports" - served to underscore just how inexact. Team doctors Peter DeLuca (Eagles and Flyers), Michael Ciccotti (Phillies), and David Rubenstein (Sixers and Soul) talked at length about the variables and challenges they face in treating elite athletes.

Bottom line: As advanced as orthopedic medicine is, it is not the assembly line we tend to believe it is. The teams make risk-reward decisions based on information from doctors, and that information is not only imperfect, it is subject to approximately one million variables.

While acknowledging the enormous benefits provided by the development of the MRI, Ciccotti said it's "a bit double-edged. . . . The MRI is so precise, it shows lots of things that don't necessarily have clinical significance. If we took 100 people here who are nice and pain-free, we'd find all these little things. Sometimes interpreting that is challenging."

Considering that 25 percent of adults have some rotator-cuff damage, according to Rubenstein, you can get an idea what Ciccotti faced in trying to diagnose Halladay's most recent physical problems. There was a bone spur. There was fraying around the cuff. But what was causing Halladay's issue and what was just normal wear and tear for a 35-year-old who has thrown thousands of major-league pitches?

Aron said the Sixers had MRIs on Bynum's knees when they traded for him last August.

"His knees looked very different in September than they did in August," Aron said, "and they got worse and worse as the season went on. . . . We had six of the greatest physicians in the country, who were right inside of the knee and were not necessarily unanimous about what was going on because the situation was so complex."

Multiply all this uncertainty by the dollars involved - tens of millions - and you see what's at stake when Bynum never plays, when Pronger can't find a solution to post-concussion problems, when Peters tears his Achilles tendon a second time after surgery, when Utley's chronic knee problems kept him off the field for chunks of 2011 and 2012.

Amaro had to order up four MRIs this week alone: on Howard's knee, on Utley's rib cage, on Carlos Ruiz's hamstring, on Mike Adams' back. It was already going to be tough to decide Utley's value when his contract expires at the end of the season. A fresh injury is not going to simplify things.

Aron said new Sixers GM Sam Hinkie will use all the latest information available to decide whether to try to re-sign Bynum. What was clear, after listening to the executives and the doctors, is that no exam and no MRI can deliver absolute certainty.

That leaves one other possibility. However . . .

"We really don't have a crystal ball," Amaro said.

All they can do is get the best medical information possible, try to make sound decisions, and hope their luck gets better.

It almost couldn't get worse.