Friday, January 22, 2010

The downside of risk reduction

Containing the STD epidemic by harm reduction robs people of hope that they can change their lives.

Hall of Fame quarterback Troy Aikman sustained at least seven concussions over a twelve year NFL career. He brings a perspective few can to the long-term effects of head injuries on players. Aikman proposes a surprising remedy: “For years, I've said the best way to eliminate head injuries is to take away helmets. Players would be a lot less willing to jump in and stick their heads in if their noggins weren't protected. I used to say that tongue-in-cheek. But I'm starting to believe that's a pretty good idea.”

In other words, the helmet is a device that enables greater risk taking on the football field, even as it provides a measure of protection from any given highlight-reel collision between players bigger, stronger, and faster than ever before. Such hits would be exceedingly rare were it not for helmets. The net result is that there is, paradoxically, a greater level of head injuries in today’s game with helmets. Indeed, other commentators note that the rates of concussions are lower in the rough and tumble sport of rugby – whose players wear no helmet – than in American football.

If those claims are true, it lends further credence to the concept known in public health circles as “risk compensation” or “disinhibition”, which suggests that people respond to technical advances by exposing themselves to greater risk than they ordinarily would.

A similar dynamic stymies progress in containing the STD and HIV/AIDS epidemics that afflict us today. The World Bank’s AIDS experts acknowledge that greater risk taking occurs not only in response to preventive measures such as condoms, but also to advances in treatment such as antiretroviral therapy. The British Medical Journal called risk compensation the Achilles heel of HIV prevention. The pope (among others), however, is often rebuked when he expresses concern that condoms too often convey a false sense of security. Full article from

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