The Downside of Risk Reduction

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.

The mere hint of this phenomenon (which can at times be difficult to measure) typically threatens the public health establishment because it is so thoroughly invested in the philosophy of risk reduction – a defeatist philosophy that insists that the best we can do is to minimize harm from behavior that will supposedly take place no matter what.

Deeper still, it is mostly a repackaged expression of modern cultural (rather than scientific) conviction, which denies and relativizes moral truth, and which prizes absolute sexual freedom above all else. Modern culture desperately needs a technical remedy for STD epidemics in order to validate its preferences. If the undesirable side effects of sexual license can be eliminated, then on what grounds could objections to such license be sustained? If, on the other hand, “risk reduction” actually results in more harm than good, it would be a crushing blow to prevailing aspirations for complete sexual autonomy.

This is not to say that all measures that have the ability to reduce risk are to be categorically rejected. The problem is that we make little to no effort to situate technical innovation in an ethical framework, which should always complement a person’s innate dignity and never rob a person of hope.

I was reminded of the importance of hope from an unexpected source over the Christmas break watching Dickens’ A Christmas Carol on TV. The transformational moment in Ebenezer Scrooge’s life comes after his regrets are intensified (and his joys refreshed) by the Spirits of the Past and Present. He is confronted with his own mortality. Terrified by the sight of his own grave and the waste that has defined his life, he pleads in exasperation with the Spirit of the Future: “Why show me this, if I am past all hope?. . . .Assure me that I yet may change these shadows you have shown me, by an altered life?”

Hope for an altered life is simply indispensible – and precisely what risk-reduction measures generally fail to cultivate. Is it far fetched to imagine that Mr. Scrooge would today be treated for a mood disorder, or provided with potent sleeping pills, should he be troubled by restless nights? Such measures would simply hold in abeyance the truth that stings, but ultimately sets him free.

What most STD risk-reduction measures ultimately say about the human person is false; people are capable of more; they deserve better. That is the good news. And in modern western cultures, where faith has atrophied and the moral sense has been obscured (as John Paul II noted in Veritatis Splendor), it is literally the Good News that desperately needs to be made known. It is the antidote to the radical individualism and relativism that deceive and destroy. Those bankrupt ideas constitute the feeble foundation that props up the failing cause of STD-control by risk reduction.

The Center for Disease Control in Atlanta has in successive years released depressing reports on the extent and persistence of our national STD epidemics. Those with power and influence seem disinclined to change priorities, but what is really needed is something fresh – something Tennyson clamored for in his 1883 poem, Ring Out, Wild Bells: “Ring out the false, ring in the true; ….Ring out a slowly dying cause;….Ring in the love of truth and right;….Ring in the nobler modes of life . . .”

There is an appealing alternative to confirming untold millions in various forms of misery. Why not ring it in?

Matthew Hanley’s new book, Determining Death by Neurological Criteria: Current Practice and Ethics, is a joint publication of the National Catholic Bioethics Center and Catholic University of America Press.