Do we really know what the #1 cause of Tommy John is? I think it's easy and maybe lazy to just point to overuse. A huge part of the equation to overuse is how prepared pitchers are for the workload. Almost no pitching coach would say 50 pitches is too much for a starter, but for many, it absolutely could be (especially early in the season).
And I wouldn't expect many pitchers to ever say they don't want the ball. I didn't say I agreed with this. Just talking about his point of view. I had Tommy John. There are certain things that I'd do again even knowing they could lead to surgery.