BMJ  2005;330 (12 February), doi:10.1136/bmj.330.7487.0-h

Editor's choice

The case for slowing down

"Forty-eight years old, profoundly asleep at nine thirty on a Friday night—this is modern professional life." Henry Perowne, neurosurgeon and central character of Ian McEwan's new book, Saturday (p 368), "hits the [hospital] corridors with an impatient stride his retinue struggles to match," considers each glass of wine on Saturday a gamble in case he is called to an emergency, and suffers an unfortunate road rage incident. BMJ readers will have shared many of Perowne's experiences, including road rage—if you don't encounter this once a week in London you can't be driving properly. Might road rage be better considered as a collision avoided—a preventive measure? Traffic collisions already account for 1.2 million deaths and 50 million injuries each year worldwide.

Speed cameras are a controversial way of reducing these collisions. Motoring organisations and the general media portray speed cameras as a cash cow for the police, an unreasonable penalty on safety conscious motorists, and a failure in injury prevention. My own 3 point penalty for travelling at 40 mph in a 30 mph zone—caught by a hidden mobile speed camera (honest guv)—made me contemplate the worthiness of the case put by the motoring organisations and the media until I remembered I had edited a theme issue on road crashes and worked for a journal whose fast track symbol is a bicycle. Hence, it cleanses my soul to publish a study that reviews evidence on the effectiveness of speed cameras and finds that they reduce road traffic collisions and related casualties (p 331). The level of evidence is poor, and better data are needed, but this review is a start and a useful advocacy tool.

The media, too, are culpable in running elderly drivers off the road (p 368). Alan Martin and others claim that media reporting of issues related to older drivers is mostly negative and is in disagreement with evidence that suggests that people over 65 are the safest of any age group. This information will surprise some doctors—I've been wondering what to do about the old lady in a nearby village who drives hazardously down the middle of the road, head permanently cocked to one side. Should I report her to the police, the women's institute, or mind my own business? What would you do?

Equally, what would you do if you were offered the chance to publish a study that hinted at problems at a cardiac surgery unit? Would you (a) suppress these high octane findings, (b) tell the department of health and local health authority before publication, (c) publish and be damned? We chose option c, and a subsequent inquiry has revealed more of a problem with the quality of the data than with the surgeons (p 319, p 324). Perhaps these are questions for our new editor, Fiona Godlee, and chief executive, Stella Dutton, to contemplate at nine thirty on a Friday night (p 323)?