There was one story from the sports world that took a backseat to arguably a much more important and relevant news story this week, the Inauguration and transfer of political power. Last week, during the National Football League's AFC Division Play-off football game between the Kansas City Chiefs and the Cleveland Browns, Chief's quarterback Patrick Mahomes suffered a concussion and had to sit out the rest of the game. There was a chance that he wouldn't be cleared to play for today's AFC Championship Game with the Buffalo Bills. Football concussions have received a lot of attention in both the medical literature and lay press in the past several years, particularly due to the long-term health implications of multiple and repetitive concussions and association with something known as chronic traumatic encephalopathy. NFL players have suffered from chronic and debilitating headaches, memory loss, depression, anxiety, sleep disturbances, and even early death as a result of this disorder. It's great that the NFL has finally recognized that this is a major problem. Whether or not the rules changes to decrease the risk of concussion, as well as the so-called concussion protocol that the NFL has implemented to determine when players can return to competition after suffering a concussion will be effective or sufficient is another question. Only time (and further research) will tell.
Here's where things get a little interesting. Football players wear protective gear - mouthguards, helmets, neck rolls, etc - to try to decrease the risk of concussion. The football helmets that the players wear today are high-tech and certainly worlds better than what I wore when I played little league football. There have been more than a few experts, however, that have suggested that football helmets are part of the problem. In other words, some experts have suggested that football should be played without wearing a helmet! Wow! Does that even make sense? It turns out, that is does.
These experts argue that players get a false sense of security by wearing a helmet, and as a result, players are much likelier to do things that are dangerous (tackle helmet first, throw their body around, etc). As it turns out, there is ample evidence for this phenomenon, which is known in the psychology literature as risk homeostasis or risk compensation. Strictly define, risk homeostasis suggests that individuals adjust their behaviors in response to a perceived level of risk. They become more careful when they sense greater risk and less careful if they feel more protected.
There are numerous examples of risk homeostasis or risk compensation in the literature. For example, individuals have been shown to drive more recklessly (generally, they drive faster) following the introduction of anti-lock braking systems and seatbelts. Similarly, studies have shown an increase in risky behaviors following passage of laws and/or regulations requiring bicycle helmets, motorcycle helmets, and ski helmets. The economist, Gordon Tullock went so far as to suggest that if governments were really serious about reducing the number of traffic fatalities in their country, they would mandate that automobile manufacturers install a sharp spike ("Tullock's Spike") on the steering wheel of every car that they produce. When you consider this outlandish suggestion, perhaps doing away with football helmets doesn't seem like such a strange idea.
We are starting to see evidence of "risk homeostasis" with the COVID-19 pandemic today. While there are a number of reports suggesting that the roll-out of the COVID-19 vaccine has been anything but smooth, I am worried that people will generally be more willing to take risks once that they are vaccinated. Unfortunately, this would be a disastrous result! We know that the two vaccines that are currently being used in the United States are 95% effective at reducing the chance of COVID-19 disease. In other words, if you have received both doses of the vaccine, your chances of getting sick from SARS-CoV-2 is fairly low. However, we still don't know if the vaccine will reduce the risk of infection. The important distinction here is infection versus disease - people can still be infected with the SAR-CoV-2 virus without getting the disease, COVID-19.
If we are going to come out of this pandemic, we need to wait until enough people around the world have acquired either natural immunity (from actual infection with the virus) or acquired immunity (from vaccination). Until that happens, we need to remain vigilant and continue to wash hands, wear a mask, and socially distance. Now is not the time for risky behavior. We've come so far, we cannot let our guard slip now. Let's not add another example of risk homeostasis to the medical literature!
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