As football season approaches, Abdul talks about his years on the field and his growing ambivalence to the sport in the face of new research about its health consequences. He interviews Prof. Kathleen Bachynski, author of “No Game for Boys to Play” about the public health impact of football.

Transcript

[Sponsor note]

Abdul El-Sayed: The FDA fully authorized the Pfizer-BioNTech COVID-19 vaccine. Full authorization for the Moderna vaccine is expected soon. Meanwhile, the Biden administration recommended eight-month COVID-19 boosters for the general public. And Moderna begins phase one trials in an mRNA-based HIV vaccine. This is America Dissected. I’m your host: Dr Abdul El-Sayed.

Autumn is my absolute favorite season. As a kid, I loved going back to school, and apple picking and sweater weather and my birthday, or as the rest of you all call it, Halloween. And in my neck of the woods, the trees treat us to a symphony of fall colors. Vivid hues of red and orange and yellow that are the color palette of the season. But most of all, I love football. I played throughout middle and high school, I still remember jogging out onto the field on the backdrop of the high school marching band. I love the camaraderie of working with my team to accomplish something we couldn’t have done alone. And as an angsty teenage boy, there was something satisfying about knowing that I could run headlong into someone else on the football field, particularly for a brown kid in post-9/11 America, who was constantly told explicitly or implicitly that I didn’t belong. And the football field, it was one of the few places where I felt I did belong. I felt free. But to what end? What did my seven plus years of football give me and what did it cost? I’m old enough now and society has progressed far enough to understand the role that toxic masculinity has in making people think that prowess on the football field says anything about someone’s strength as a human. There are serious consequences, after all, to society telling men that they’re defined by their ability to knock another human down. At the same time, sports generally, but football in particular, teaches a number of important life lessons about teamwork and leadership. You didn’t always like each of the other 10 people in the field with you, but you had to learn to rely on each other. But as I’ve gotten older and taking the lessons of football into my life, I’ve also begun to question what else from football may have followed me. I was nowhere near good enough to play beyond high school, and that’s probably a good thing because we’re learning a lot more about the consequences of a repetitive low-grade head trauma, the kind you get on the football field, play in and play out. Football helmets are really hard, so most people think their heads are fully protected, but they’re probably protecting the wrong part. Even though helmets protect your skull, they don’t necessarily protect your brain, which sloshes around in a protective fluid inside your skull. That fluid protects us from most of the potential damage we might incur in our lives. But under rotational force, our brains whip around in there and hit the inside of our skulls. That’s what causes concussions and CTE. Over time, this can cause grave consequences for cognition, mood and overall function. This, it’s come to our attention in some of the most tragic ways.

[news clip] Family and friends, a former NFL standout Junior Seau, gathered outside his Oceanside, California home in shock and grief. The former San Diego Chargers linebacker was found dead of a gunshot wound this morning.

Abdul El-Sayed: Junior Seau was one of the roughest, toughest players in the ’90s. I grew up watching him play, marveling at a speed, fearlessness, and ability to deliver a punishing tackle. But with every one of those tackles, his brain was taking a beating too. Tragically, he died by suicide at 43 as he struggled with cognitive impairment and mental illness. Seau’s family donated his brain to the National Institutes of Health, who found substantial evidence of CTE. The NFL has worked doggedly to try and silence the conversation about the negative health impact of football, after all, they sell more tickets when fans aren’t asking what the long-term consequences of that huge open field tackle might be for both players involved. For years, they tried to cover up or silence the connection between football and CTE. But after players sued the league, they agreed to a billion dollar settlement in 2013. Later, however, it came out that the league was systematically offering Black players less money in claims through a process called, quote unquote “race norming,” using bunk research claiming that Black players have lower cognitive abilities to begin with, to argue that the consequences of CTE for these players isn’t as severe. It’s all kinds of awful. The juxtaposition between race and public health are critical here. Remember this?

[news clip] That protest by Colin Kaepernick, the 49s quarterback knelt instead of standing during the national anthem at last night’s game.

[news clip] Colin Kaepernick’s protest against racial injustice seems to be gaining traction.

Abdul El-Sayed: The NFL effectively blacklisted Colin Kaepernick out of the league. For years, I boycotted the NFL over its treatment of Kaepernick, but the NFL is only the tip of the iceberg. As a proud University of Michigan alumnus, it would be a lot harder to boycott college football and my Michigan Wolverines. Then there’s the fact that while the NFL and NCAA athletes are adults, the pipelines that feed these billion dollar industries are filled with children whose parents let them play, believing that football is harmless, or that it might be the only ticket to a college education. But what’s a college education if the path to getting there means potentially irreversible damage to the very organ you’re working to educate? Indeed, fewer and fewer high-income families who are more likely to be white are letting their kids play football. That means that more of the kids playing are Black and LatinX. More and more, we’re hearing calls to address the long-term consequences football may have on kids, often from unlikely places. In fact, last week this PSA came out.

[PSA little boy voice] Mom, dad, let’s talk about tackle football. I just learned about CTE. If you put me in tackle today—

[PSA older male voice] By the time I’m a senior in high school, I”ll have played 13 years of tackle football. I could already have CTE, and it will continue to destroy my brain even after I stop playing. So by the time I’m your age—

[PSA adult voice] I could be fighting depression, struggling to keep my thoughts straight, I could become violent even towards my own children. When I’m your age, what will matter to me is not my youth football career—

[PSA little boy voice] Keep me out of tackle football until I’m 14.

Abdul El-Sayed: And in case you didn’t recognize the voice, that was legendary quarterback Brett Favre, calling for an end to tackle football before 14. But Autumn and football are right around the corner. And as the NFL and NCAA seasons gear up, I wanted to revisit the conversation about football and CTE. All of this leaves me torn. Like I said, I love the game of football and I honestly can say it’s given me a lot. But at the same time, I can’t know what it may have taken, for me or millions of others who played as kids. And today, I’ve invited on a guest to help us dive into football and CTE. Professor Kathleen Bachynski has been thinking about these issues as a public health researcher and author. Her book, “No Game for Boys to Play”, explores the public health consequences of football. Her take on all this after the break.

[ad break]

Abdul El-Sayed: Well, let’s get started. Are ready to go, are you taping?

Kathleen Bachynski: Yes. Let me double check. Yep, it’s on. I’m good.

Abdul El-Sayed: Fantastic. OK, can you introduce yourself with the tape?

Kathleen Bachynski: Absolutely. My name is Kathleen Bachynski and I’m an Assistant Professor of Public Health at Muhlenberg College in Allentown, Pennsylvania.

Abdul El-Sayed, narrating: Dr. Kathleen Bachynski has been thinking about the role that sports and culture play on our health for a while. She’s the author of No Game for Boys to Play, a deep dive into the origins of youth football in the United States and the public health crisis it created. I wanted to talk to her about how we should be thinking about the growing evidence regarding football and chronic traumatic encephalopathy, or CTE.

Abdul El-Sayed: Well, we really appreciate you coming on the show in light of what I think is a really important book that you’ve written, No Game for Boys to Play. Can you tell us what is CTE?

Kathleen Bachynski: Yes, CTE is short for chronic traumatic encephalopathy, and that’s a bit of a mouthful but it’s basically a progressive degenerative brain disease. And it has some similarities in terms of symptoms with other chronic brain diseases, such as dementia or Alzheimer’s. But it’s characterized by a few unique things as well. In particular in CTE, there’s a build up of a protein called tau, which is T A U. And normally that protein is in your brain in normal amounts, but in CTE, you see a buildup of this protein where it kind of clumps together around your brain cells and those cells end up losing the ability to function properly if too much of that protein is clumping. And CTE has been associated with repeated head trauma. And it’s probably been mostly discussed in contact sports, but there’s also been cases as well in members of the military or intimate partner violence or pretty much any kind of situation where you might have repeated exposures to head trauma.

Abdul El-Sayed: And you focused your book on football in particular, particularly youth football. What led you to write about it?

Kathleen Bachynski: Well, I had a little bit of a circuitous path. I never played football myself, but I did play high school and middle school soccer. And I had sort of a big injury. It wasn’t a brain injury in my case. I ripped my ACL, which is a knee ligament. I had to have surgery in high school. And by the time I went to do my master’s in public health, I realized it wasn’t just me. I had a bunch of friends and classmates who’d had a variety of sports injuries. So I really wanted to study sport injury as a public health issue. And kind of selfishly, I first wanted to try to study knee injuries because I’d had a knee injury. I was sort of most impacted by that myself. But it turned out when I was doing my masters, I was able to find an adviser who was a neurologist who kind of pushed me more in the direction of studying brain injuries. And when I started to study brain injury in sport, I just got absolutely fascinated and compelled because the brain is so complicated and so precious. And I thought, you know, there’s so many wonderful things that sports do and I want us to try to prevent brain injuries so people can enjoy the health benefits of sports as long as they can.

Abdul El-Sayed: Yeah. You focus in particular on football, and our knowledge of CTE and of the kinds of injuries that cause CTE has really evolved over time. You know, when I was young, it used to be thought that if you had one of those really, really big open field hits where you quote unquote “get your bell rung” that was the moment where you really were worried about concussion and therefore worried about long-term consequences. But, you know, there are a lot of plays in football where hitting your head against something that is either immovable or moving at it, is just part of the game. And what we’ve come to understand is these lower grade kinds of events can also have their own consequences. What is it about football in particular that made it the focus of your work? And what would it look like to think of a football without, you know, without the kind of potentially concussive or CTE causing damage?

Kathleen Bachynski: Boy, those are great questions. For me, the reason I sort of was drawn to focus on football in particular was firstly just that it’s so popular, there’s millions of kids, mostly boys and some girls, who play every year. And something about football that really distinguishes it is that you have these repeated full-body collisions as an inherent part of the sport. And there’s not that many other school sports that have that. There are certainly other sports that do. But as a good point of comparison, ice hockey, most kids aren’t body checking. Kids usually aren’t allowed to body check until after age 14 or 15, depending on the league. And boxing, for example, that certainly has full-body collisions, but you don’t typically have school programs for kids. So football, I thought, was uniquely popular and it has this mechanism of repeated injury kind of baked into the essence of tackling that poses a particular risk.

Abdul El-Sayed: Is there something in particular about these injuries in youth that makes them substantially more dangerous?

Kathleen Bachynski: There’s a couple of things that might make them more dangerous. One is just that the nature of of the risk for CTE or other chronic disease is that it does seem to be cumulative so the more exposure you have, the higher your risk will be. And if you start at age six or seven and play all the way through high school, that would be 10 years of exposure, and that’s pretty much double as compared to somebody that starts in high school and maybe only plays three or four years of football. So part of the worry about kids is if you start at a really young age, it’s just increasing your potential length of exposure time. Other worries—which I think we’re still learning about, I think we still have a lot we don’t understand about this—but we do know that the brain is still developing and there might be risks by having an exposure to repeated brain trauma while your brain is still in the process of developing that makes you especially vulnerable. And then the last sort of anatomical thing is that kids’ heads are just a lot bigger proportionally to the rest of their body so you tend to get a little bit more of that bobblehead effect where they have weaker necks and bigger heads. So even if the force of impact is lower when you’re small, the anatomy might make you a little bit more vulnerable for that reason.

Abdul El-Sayed: Hmm. You argue in your book that it’s a moral abdication to allow young children to play football. You know, given what we understand about the cumulative impact, what age do you think it is appropriate to allow kids to play football, if at all?

Kathleen Bachynski: That’s a tough question. I don’t think there’s a magic answer, but I sort have two answer to this. One is like my ideal world answer and one is my practical answer. My ideal world answer would be if I was starting the whole youth sports landscape from scratch, like I was implementing everything from the ground up, I probably wouldn’t have any collision sports for kids until they were 18. I would have modified versions thorugh 18 where maybe you’re playing flag football or you’re playing ice hockey without body checking, you’re playing non-collision sports. And then when you reach adulthood, then you can make the choice as an adult if you want to engage in repeated collisions. With the world we have now, maybe down the road that may be possible, but I don’t think that’s possible near term. So my more practical response is, I think starting with under 14 is the way to go. And I think I have two reasons for that. One is more of a cultural reason and what is more of a biological reason. The cultural reason is that high school football is so deeply popular, deeply culturally ingrained, it has a much longer history in our country than Pop Warner or youth level elementary middle school leagues. So I think practically for cultural reasons, it’s easier to shift towards flag football for those younger ages rather than saying we’re just going to get rid of football for everyone under age 18. And then biologically, I think there is a real argument as well for that age, because a lot of rapid brain development happens in your sort of pre-puberty age like 10, 11, 12 years. So if you could even postpone tackling those few extra years, I think you would get a meaningful benefit. So my more practical response would be to start with saying under age 14, maybe we can shift things more towards flag football or touch football instead.

Abdul El-Sayed: Yeah, I want to I want to ask a couple of follow up questions on that. One is that I went to grad school in the U.K. where I decided I wanted to try playing rugby. I played football through my youth so, you know, started in Pop Warner and played in middle school and played in high school. And there are moments, and I’m not going to lie, where I have trouble finding a word and I’m like, I wonder if that was one too many hits to the head, both in football, but then also playing lacrosse and other sports. And so when I started to play rugby, it’s interesting, right, because you don’t wear pads, but there’s a split moment when you’re about to make contact with someone where I think both players become immediately aware of their mortality. And so that pop that you get when you’re wearing pads, when you’re taught to hit through the other player, you don’t quite get as much in rugby. I’m wondering if there’s any insights on whether or not the kind of padding that football players wear may actually, ironically, lead to worse head injuries.

Kathleen Bachynski: I think there is. And there’s certainly really good research on the history of spearing and football, which is effectively using your head as a weapon, which obviously you wouldn’t do in the same way in rugby because you don’t have that protection. And spearing obviously is associated both with brain injury, but also with the potential for paralysis or a spinal cord injury. And there’s great research that shows that you don’t really have a whole lot of spearing until plastic football helmets were introduced in the 1950s, 1960s and that led players to use their heads as a weapon in a different way that they hadn’t before and caused more injuries. And spearing was subsequently banned, happily, for very good reason, catastrophic injuries to go down. But I do think having that padding unfortunately does increase the risk for those more subtle, not always even diagnosable, sometimes called sub-concussive hits, where you can have that cumulative trauma because you are engaging in collisions in a way that you wouldn’t if you didn’t have that kind of hard shell, that hard padding. So I think rugby is a really interesting point of comparison. There’s certainly concussion risk in rugby as well, but it’s definitely the case that when you don’t have the head protection in the same way that you do in football, you are going to be a little bit more cautious in how you hit or how you collide. And so I think there really is some real potential there to think about are there ways we could adapt and maybe in some ways maybe reduce the amount of equipment in a way that might make the sport a little bit safer?

Abdul El-Sayed: Yeah, there’s one comparison, actually, for the first time in decades, Olympic boxers in 2020 didn’t wear headgear. And what they’d found was that the headgear was not associated with lower risk of concussion. And there were good arguments to suggest that boxers who wear headgear are not boxing as defensively so they may actually take more hits to the head because they feel that they’re artificially protected via the headgear. So it’s an interesting comparison there. You know, the other thing that anybody who played football will tell you that there was always, you know football starts in August and you start with two a-days and there’s a day at which you’re allowed to start wearing pads. And on those first days wearing pads, everybody’s rearing and ready to go and so there are a lot of tackling drills. And in the first week after you get your pads on, there’s always this thing that we call the hitting headache, which is you get a headache just because you were hitting for the first time. And, you know, we always sort of thought about it as like, oh, well, you know, it’s not a big deal. But, you know, in hindsight, reading your book, you know, you think about you’ve got all these kids who are hitting each other as hard as they possibly can in these like very, very intense hitting drills and everyone’s got a headache from it. That can’t possibly be a good thing. So it’s important to think about what the public health implication of that really is.

Kathleen Bachynski: Yeah. I really love that point because I think one of the most important encouraging cultural shifts of even just the last decade or maybe 15 years has been to say, no, this isn’t just a headache to ignore or it’s not just getting your bell rung, it’s not just seeing stars—like these are symptoms of a potential brain injury and you should get them checked out and if you do get diagnosed with a concussion, you should be waiting and wait till you get cleared before you return to play. And even that alone gives me hope that we’re making some progress because it’s extraordinary ot think, you know, it wasn’t that long ago when we were kids, but I can certainly say I had the same experience in soccer, too. I distinctly remember being hit and briefly losing consciousness, waking up with my concerned teammates around me, and everyone was like, oh, she can get back up, like you’re good to go, like the sense of relief, and just going back out on the field. And I feel so grateful now that kids today hopefully are much less likely to have that experience because they would have, you know, coaches and trainers who are aware that you need to check this child out, this athlete out and see if there is something more serious going on here.

Abdul El-Sayed: Yeah, and, you know, it’s interesting, the cultural component that you raise is really important. Of course, football is very much associated with a particularly masculine and oftentimes toxically masculine culture. And so much of it was about, you wanted to be able to get back up and play for your team and you really aren’t allowed to show pain or vulnerability. That’s part of the sport. How much do you feel like this conversation about CTE and tragic deaths by suicide to really prominent football players, folks like Junior Seau, who represented that culture to a whole generation of boys who grew up playing football—how much do you think that’s actually permeated into the culture of football where there is a space now and a respect for the long-term consequences of doing this over and over again?

Kathleen Bachynski: Oh, I think that’s such a profound question. I think part of why we have the shift in awareness now is not just the increased brain imaging and medical studies, although those are hugely important, but having role models who represent this very historically masculine culture speak out and be willing to share about their symptoms. Somebody like Junior Seau who tragically died, but also other players who are living with symptoms—you know, be it changes in behavior, mood swings, cognitive issues—speaking openly about them, speaking openly about both about their mental health and brain health, and giving younger athletes a role model of like this is what masculinity can look like and you can talk openly about this. So I think part of why we’re having this conversation is sort of historical, or challenges to that historical idea that what it means to be a man includes playing through pain and not talking about the symptoms you’re experiencing. So I think having a challenge to that is crucial for both male and female athletes to hopefully have a chance at better long-term health.

Abdul El-Sayed: I thought Simone Biles’ recognition of her own mental health and the willingness to force us all to rethink what the point and value of sports really are during the Olympics is a really important demonstration of that. And I love you know, I love that that came from an athlete who is so dominant like Simone Biles, but also from a sport that stereotypically is the polar opposite of football, but also one where the amount of toughness that gymnasts have to have to be able to practice their sport, I would argue, is the same as or greater than any football player out there. And I just thought that was such an important cultural comment. You know, the other side of it, though, is I played a lot of football in in my childhood and I loved football. And the reason I loved football is because it is a sport that is truly and deeply a team sport. Unlike a lot of other team sports where you can have one standout player who can pick up a team and put them on the shoulders and still win games, in football, right, it doesn’t really matter if you’re a star if the rest of the team doesn’t do what it needs to do, you will not succeed. And I think in that respect, there’s so much that I learned about teamwork and leadership on the football field. And I wonder what your response is around the costs and benefits of football to folks who say, well, there’s a real, there’s a real role in football in teaching teamwork and inculcating lessons of teamwork because of the implied vulnerability, right? When you when you get tackled, you actually feel some pain and it forces you to invest in your teammates in a way that’s beyond just saying, I don’t want to lose today, but that’s: I don’t want to get pinned to the floor and hit from behind. What’s your response to them when they say it teaches a unique sense of teamwork and leadership in a way that other sports just may not?

Kathleen Bachynski: I think I first of all, I totally agree that team sports are extraordinary in the benefits they confer, I certainly say this is a former soccer player, that there is something just amazing about being part of a team. And I think you do make a good point that not all team sports are alike and there’s certainly ones that have more unique roles for different position players and where you have to sort of not depend on one single star. But I don’t think football is totally unique. And even if it were, I would argue that we can teach pretty much all of those same values that we cherish so much for our kids, learning discipline and teamwork and also just having fun, all the benefits we want with sports—that can be done without the risk of repeated brain trauma. And I think we could potentially modify the sport in certain ways. Again, having, you know, flag football or touch football is an option. We can also consider other sports. I mean, I’m biased for soccer, but I’m sure there’s other ones as well. And even with soccer, too, we would be thinking about maybe kids don’t need to be doing headers at age nine. There’s ways to modify these sports where you can have those same social benefits but not have the same level of risk. And to the point about the stakes, I don’t think the way to teach kids teamwork is to have the stakes be you’re responsible for one of your teammates not getting severely injured. I think there are ways to have the stakes be meaningful to kids without having it be a stake of injury. And in fact, I think Simone Biles is an amazing inspiration in that regard, too. I mean, I think she showed even when the stakes are an Olympic medal, sometimes the best decision you can make for your health and also for your team,—because American women also did awfully well this past Olympics—is to set back when it’s warranted. So I think those are the kinds of lessons that I hope we can teach through team sports and do it in a way that is a much lower risk for kids’ brains.

Abdul El-Sayed: Yeah, I really appreciate that answer. And I agree. I, you know, in my conversations with a lot of folks who have sort of turned themselves into football defenders, as both a doctor and a scientist and then and also someone who grew up playing football and really loved football and still enjoy watching football, even if with some guilt associated with it, I do think that there is a moment right now where we have to be thinking about what evolving into a more healthy and honest set of values looks like, and what that means for our sport and that, of course, carries a lot of tradition and culture with it, but that can also change, and that, I think in so many ways and in so many instances demonstrated it needs to change. But then that brings us to the, you know, the broader point, which is that football is big business in America. And it’s not just the NFL and it’s not even just college, it’s high school and even into middle school where it has such a cultural role. How do we start to take on some of the broader consequences that so many are dealing with because of football and start to reform some of these institutions? What’s it going to look like and what’s it going to take to get that reform done and start to actually inculcate these values into the sport.

Kathleen Bachynski: That’s a big question. It’s definitely not going to happen overnight. And I think a lot of it is going to happen from the ground up. I think it’s those individual parents and school boards and local community leaders who might gradually say maybe we’re going to start our league at tackle at age 10 instead of age 8, and sort of gradually, those individual decisions. But I also take some inspiration from—I guess every public health has to say this at some point—some inspiration from the history of tobacco, where you look at cigarettes and what an extremely powerful industry that was. And again, something that didn’t happen overnight, but a combination of education, a combination of policies. In the case of tobacco, certainly there’s individual education on the risks. There was also policies that might say we’re going to limit where people can smoke. We might increase the age at which you can buy a cigarette—all kinds of policies that gradually, over time gradually shifted the culture. And I think similarly, what we might see with youth sports generally and maybe in some cases football specifically, is sort of gradual change. I think we are doing a pretty good job on the education piece. Of awareness this isn’t just seeing stars, awareness of what brain injury symptoms look like, and then start to combine that with some policies. Some of it could be on the local level, of the local YMCA or the local youth leagues are saying we’re going to increase the age at which you tackle. You also have state-level policies about return to play after experiencing a concussion. I think gradually if you combine these things, that hopefully will start getting us towards a healthier landscape. But it’s also very much the case that the NFL, college football, high school football are a really deep part of American life so I don’t think this is something that’s going to just be a light switch that’ll turn overnight. I think it’s going to be the gradual work of public health advocates and parents and school boards to make this happen over time.

Abdul El-Sayed: And this is a conversation we have all the time, but is your perspective on it more about harm reduction or is it more about abolition?

Kathleen Bachynski: I’m probably at this point closer to the abolition side of things. I think harm reduction is possible, but I think especially for the younger kids, I think it makes sense to not have tackle football be an option for the six-, seven-, eight-year olds, to at least start there. And the way I sort of think about it is I do think the responsibility there lies on the sports leagues and sports administrators. The analogy I think of is sort of like over-the-counter medication, like if it’s available in the pharmacy, you assume this is fine, doesn’t have major side effects. I think if you’re offering tackle football for six- or seven-year olds, a lot of parents will just understandably sort of trust that this must therefore be an appropriate sport for my six- or seven-year old to play because it’s on offer and the people in charge have made that decision. So I do you think there is a burden of responsibility for leagues to say we got to start somewhere, and probably the best place to start is to say we’re not going to be offering tackle for six- and seven-year olds. We are just not going to put that as an option and instead we’re going to offer lower risk alternatives. And I think that ultimately is what I would like to see happen.

Abdul El-Sayed: Mmm. There is of course an equity challenge here, which is to say that in a lot of high-income school districts are already struggling to, to field football teams because a lot of the higher-income families aren’t letting their their boys play, and that means that a lot of the consequences that we’re seeing, lower-income folks, where football still remains a really dominant culture. How do you think about some of these equity challenges, and what will it take to make sure that the impact, right, the CTE impact of football isn’t as dramatically inequitable as it starting to appear?

Kathleen Bachynski: That is a really important question. I think some of it—I guess this is like the really bird’s eye view—but I think some of it won’t change until we have fundamental social reforms such that a college football scholarship is no longer what looks like the best possible option for kids who are trying to get an education and trying to move forward in life. And unfortunately, I think a lot of the inequity we see is where we have communities where that might seem like the only possible option. And so building communities where it’s not necessary to get a college football scholarship to be able to go to college where, you know, if you so choose to do that, I think is crucial. And I think ultimately some of that change will need to come from colleges in terms of what they’re putting on offer, what kinds of scholarships they’re offering. And then some of that will have to come from broader community changes that happily, a lot of progressives, I think, are already talking about in terms of what do we need to do to broaden the options. Because if you see—I mean, a lot of them, the lack of equity, I think, is coming from the people who have other options are not choosing football for their kids. And I think that speaks volumes, and that’s not an acceptable or equitable situation to be in.

Abdul El-Sayed: Yeah, no that’s a really brilliant point, which is to say, you know, thinking about the norm of success and what is modeled as a successful outcome is constrained by all of the other potential successful outcomes that are systematically denied to a lot of people. And that is a frame of our inequity more broadly beyond sports and sports on offer. Dr. Kathleen Bachynski, thank you so much for joining us today. Your book is “No Game for Boys to Play.” I hope that folks will pick it up and think a lot about the way we think about sports and entertainment and the potential public health impacts that they have. And you know, football is one of those places where the impact of children playing and the long-term consequences suggest that we really ought to be thinking about the role that this particular sport has in our society and who should be able to play, right, and what the impacts could then be. Really appreciate you taking the time and appreciate you joining the show.

Kathleen Bachynski: Oh, it’s my absolute pleasure. Thank you so much.

Abdul El-Sayed: As usual, here’s what I’m watching right now. The Delta variant accounts for nearly all of the 143,000 COVID cases diagnosed yesterday. Cases have climbed by 44% over the past two weeks, and deaths have more than doubled. The vaccination rate continues to creep upward, though, but not nearly as fast as we need it to—in no small part, due to GOP politicians spending more time battling vaccines and masks then COVID-19 itself. One of the biggest battle lines has been over employer vaccine mandates. But that fight has changed, as the FDA fully authorized the Pfizer vaccine, replacing its emergency use authorization. Full approval for the other COVID-19 vaccines is expected soon, though the practical distinction between full and emergency use authorization are minimal, particularly considering that billions of people have had these vaccines. But the lack of full authorization may address any lingering legal questions over whether or not employers can impose vaccine verification, which could open the door to a lot more employers requiring their employees to be vaccinated. Meanwhile, last week the administration recommended a COVID-19 booster shot for the general public eight months after the date of the second dose. You’ve been hearing about this from me for quite a while, and my opinion hasn’t really changed. See, the CDC published three papers last week the administration argues justify their position. Two are from New York, showing that while the vaccines remain protective against hospitalization with COVID-19 over time, protection against infection with Delta over time, may wane. A third showed that protection against infection among seniors in nursing homes waned by a larger degree. Some new data from Israel shows that among people over 60 who received a third dose, the risk of breakthrough infection dropped to a sixth. But here’s the thing, in a world with unlimited COVID vaccines, a third dose would be just fine. But we don’t live in that world. Instead, we live in a world where we’re debating giving third doses to people in high-income countries, while billions in low-income countries still haven’t gotten their first. And in that world, a new variant can zip between countries within weeks. So I’d rather we vaccinated the most vulnerable abroad to protect them and ourselves, than giving ourselves a third dose. After all, I thought we’d gotten past that “America first” thing already. Let’s not ignore the fact that Pfizer and Moderna stand to make billions by selling hundreds of millions of doses in a lucrative market and have been pushing the evidence of waning immunity for some time. While a booster is bad policy, making the personal decision to forgo it doesn’t mean that your dose is going to go into an arm abroad. So given its added protection against infection, it’s worth taking. I’ll be getting mine. For more on this, check out my newsletter, The Incision at Incision.substack.com. Finally, Moderna has begun Phase 1 trials for a new HIV vaccine based on the same mRNA technology they used in their COVID vaccines. It reminds us about the odd world in which we live. We rely on pharmaceutical companies to produce necessary medications. Yet as corporations, they’ll always think about their revenue and stock prices first. And that’d be fine if our politics could make sure their profit motive didn’t seep into public policy. But our politics, as it stands, don’t. I look forward to seeing the results of these new mRNA vaccines, and if it means that we finally have a vaccine against HIV, wouldn’t that be an amazing thing? Now I just hope that they set it a fair price and make sure that everyone who needs one gets one. That’s it for today. On our way out, do me a favor and go to your podcast app and rate and review our show. It goes a long way to getting it to other folks. And if you really like us, go on over to Crooked Media’s store and pick up some merch. We’ve got our new logo tees and mugs, our Safe and Effective shirts, and our Science Always Wins shirts and dad caps, in a new color.

Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith and Ari Schwartz. The theme song is by Taka Yasuzawa and Alex Sugiura. Are executive producers are Sarah Geismer, Sandy Girard, and me: Dr. Abdul El-Sayed, your host. Thanks for listening.