Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Litigation delays recovery from traffic injuries.
- J. David Cassidy (12 April 2004)
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Most Preventable ?
- Richard Hockey (13 April 2004)
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Health Impact of Traffic: Greater than Injuries Experienced
- Peter L. Jacobsen (14 April 2004)
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Road accidents in the non-industrialized countries- forgotten determinants and trivial solutions
- Mohanan Nair (14 April 2004)
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Green lights
- Hugh E Matthews (15 April 2004)
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Road safety: Who is responsible?
- Milind S Deogaonkar (17 April 2004)
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Re: Road safety: Who is responsible?
- Guy A Chapman (20 April 2004)
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Proper Citation for World Report
- David A. Sleet (5 August 2005)
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J. David Cassidy, Professor of Public Health Sciences University Health Network, MP 14-327, 399 Bathurst St., Toronto, Ontario M5T 2S8
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Dr. Barry Pless suggests that litigation is one way to prevent traffic injuries. This point is often made by the legal community, but I know of no scientific evidence to support it. On the contrary, there is increasing evidence that litigation prolongs recovery of common traffic injuries (1-5) and diverts resources and attention away from important prevention countermeasures. (6) There may be some examples where litigation has prompted legislative action to correct isolated manufacturing or design problems in vehicles or roads, but tort laws can also create substantial barriers to recovery that have a huge impact on entire populations of injured victims. References 1. Cassidy JD, Carroll LJ, Cote P, Lemstra M, Beglund A, Nygren A. Effect of eliminating compensation for pain and suffering on the outcome of insurance claims for whiplash injury. N Engl J Med 2000;342:1179-86. 2. Cote P, Cassidy JD, Carroll LJ, Frank JW, Bombardier C. A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature. Spine 2001;26:E445-58. 3. Cassidy JD, Carroll LJ, Cote P, Holm L, Nygren A. Mild traumatic brain injury after traffic collisions: a population-based inception-cohort study. J Rehabil Med 2004; Suppl.43:15-21. 4. Carroll LJ, Cassidy JD, Peloso PM, Borg J, von Holst H, Holm L, Paniak C, Pepin M. Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004;Suppl.43:84-105. 5. Mayo R, Byant B. Outcome in consecutive emergency department attenders following a road traffic accident. Br J Psychiatry. 2001;179:528 -34. 6. Evans L. A new traffic safety vision for the United States. Am J Public Health 2003;93: 1384-6. Competing interests: JDC has received grants in aid of research from provincial government traffic injury insurance programs in Quebec, British Columbia and Saskatchewan. |
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Richard Hockey, Data Analyst Queensland Injury Surveillance Unit
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I would think that the largest and defintely the most preventable modern epidemic would be tobacco related disease and mortality. We all have to travel by whatever means but smoking has no redeeming features. Smoking kills 19,000, Australians a year, more than 10 times the deaths due to road crashes, and costs the country $21Billion compared to the cost of road crashes of $8Billion. Competing interests: None declared |
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Peter L. Jacobsen, Consultant USA 95822
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Over 100 years after the beginning of the traffic injury epidemic, medicine still wonders how to prevent it. But more importantly, does medicine know the magnitude of the disease burden? If people avoid walking and bicycling because they fear being injured by motorists, then the disease burden includes inactivity, and the total burden is much, much larger than the WHO measures. Competing interests: None declared |
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Mohanan Nair, Fogarty International Fellow Joint Centre for Biethics, 88 College Street, University of Toronto, Ontario, Canada M5G1L4
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Injury prevention needs to be the prime agenda in road traffic accident interventions. The picture is all too complicated in the non- industrialized world, where the causes are multifarious. Unfortunately, legislation and litigation alone looks too simple a solution1, especially when the law enforcing machinery is weak and vulnerable. Kerala in India provides an excellent example. In the recent past, there had been several protests against mandating the use of helmets for two-wheeler riders in the state! Same is the plight with seat-belts. On the surface of it, this may look funny. But there are valid allegations raised by these protesters. The condition of the roads is pitiable and the driving licenses are often available at a cost, thanks to the rampant corruption in the licensing offices. There are no facilities available to the police to assess the drunken status of drivers. The poor and deplorable state of the public transport system makes private vehicles unavoidable and the majority can afford only two-wheelers or ‘used cars’. The population of two wheelers has increased several folds in the past few decades and it is common to find twenty or thirty years old vehicles on the roads. The population of auto-rickshaws, the three wheelers plying for hire has also multiplied several folds cramming the roads and adding to air and noise pollution, the loudest horn being the proudest posession for any driver! Roads are never maintained properly and automatic traffic signal systems are unheard of except in some major towns, where they function erratically even if present. Safety in design of vehicles is sacrificed for cost and condemned models from the industrialized world are sold with high advertisement and the consumers are lured by the ‘low cost’ and dire need. Even the ‘fitness certificate on emission’ could be purchased in the open market, at a cost four or five times of that prescribed by the government, without even producing the vehicle for examination. Added to this is the lobby of legal personnel, health care providers and middle-men that have developed ‘accident claim litigations’ as a high profit industry. The protesters against the ‘helmets’ allege large corruption involving administrators and the helmet manufacturers. One will be forced to believe such allegations, if they look at the enthusiasm with which the law enforcing officials penalize the ones who do not wear helmets for a while and ignore the same after a few weeks. The poor plight of roads, unsafe designs of vehicles, lack of foot- paths and pedestrian crosses, lack of traffic signals, rampant corruption in issuing driving licenses and fitness certificates for vehicles, lack of road safety education and above all, the lack of civic awareness about the ‘right behaviour in roads’ are all contributing to this public health problem of huge dimensions. Unfortunately, legislation and litigation are also being misused in these set-ups by the unscrupulous to achieve their agenda. Reference: 1. Pless B. Road traffic injury prevention. BMJ 2004; 328:846. Competing interests: None declared |
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Hugh E Matthews, GP Herne Bay CT6 5RE
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The example given in the editorial of a pedestrian and a car both assuming they had right of way at a green light points out an obvious way to reduce injuries, at least in the city in Canada where the author works. Simply, don't give a car and a pedestrian a green light for the same piece of road at the same time. This seems so simple and obvious that I am surprised a major Western city still has a system of signalling so likely to cause accidents. There is no need to rely on drivers knowing that pedestrians may also have a green light and right of way if it cannot happen. There is always the possibility of someone going through on red and this is harder to prevent, but why increase the risk unnecessarily? If there was a train crash and it was revealed that both trains had been given a green signal, assuming the drivers would know which had priority, or two aircraft collided having both been given a signal to land, how much public outcry would result? A green light consciously and subconsciously means 'go' in almost every country. The fact that nothing is done to remove this fatally flawed system just shows how little impact road fatalities have compared to other much safer forms of transport. Competing interests: None declared |
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Milind S Deogaonkar, Post-doctoral Fellow, Neural Transplantation and Gene Therapy program, Department of Neurosciences, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Road safety is a major public health issue in developing and over- populated countries like India. Unsafe roads, unsafe vehicles and little concern about traffic rules to drivers and pedestrians alike make it a major killer. The three major ingredients of road safety (1) -improved vehicles, improved roadways and driver safety- are as a rule, disregarded in most of the developing countries. This is why 85% of the annual 1.2 million deaths on road, occur in developing countries (2). In a country like India, this ‘hidden epidemic’ augments the disease burden and adds more stress on already under-funded public health system. Improving the conditions of rural and urban link roads is important. Indian businesses will be benefited by the ongoing ‘Golden Quadrilateral’ project, which involves building of high-speed freeways. Conversely though, as an effect of these high-speed motorways vehicular accidents may increase. Safety of vehicles running on these roads is questionable. Omnipresent and rampant corruption in the motor vehicle division (Called RTO in India) means, roadworthiness of vehicles is not properly tested. The un-roadworthy vehicles can become killer weapons in the hands of half-trained or un-trained drivers. It is common knowledge that obtaining a driving license in India does not necessarily involve passing a driving test. Improving awareness of general population as to why it is important to follow traffic rules can bring about a change in this situation. It needs to be supported by a strategic long-term effort to improve the roads, make vehicles safe and make traffic education compulsory. This effort has to be sustained, backed by strong political will and accompanied by population education. Even simple measures like bicycle helmets (3), prevention of drunk driving (4), use of seat belts (5) and improved lighting on roads (6) will count towards major reduction in deaths on road(7). 1. Vernick JS, Teret SP. Making vehicles safer. Am J Public Health 2004:94: 170. 2. Jacobs G, Aeron-Thomas A, Astrop A. Estimating global road fatalities. TRL report 445. Crowthorne: TRL Limited, 2000. 3. Robinson DL. Head injuries and bicycle helmet laws. Accid Anal Prev 1996; 28: 463-475. 4. Adams J. Risk. London: UCL Press, 1995. 5. Centers for Disease Control and Prevention. Achievements in public health, 1900-1999. Motor-vehicle safety: a 20th century public health achievement. Morb Mortal Wkly Rep MMWR 1999;48: 369-74 6. Renton F, Pond P. The effect of street lighting on the incidence of injury and death caused by road traffic crashes. Cochrane Library 2004 (in press) 7.Pless B. Road traffic injury prevention BMJ 2004; 328: 846 Competing interests: None declared |
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Guy A Chapman, n/a Abindon OX14 4RN
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I was astonished to see Milind S Deogaonkar's Rapid Response in which he cites Dorothy Robinson and John Adams while concluding the exact opposite of what Robinson and Adams have shown. Has his chain of logic been edited out? Or has someone missed the point? Seat belt laws have not saved lives. Cycle helmet laws have not saved lives. And yet pressure groups and governments seem intent on repeating these failed experiments time and time again, presumably in the pious hope that this time it will be different. Of course, it never is. Competing interests: None declared |
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David A. Sleet, Assoc Dir Science CDC - 4770 Buford Highway, NE, K-63, Atlanta, GA 30341
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The citation to the World Report in the Pless article cites WHO and the World Bank as the authors, which is incorrect. The report should be cited as: Peden M, Scurfield R, Sleet DA, Mohan D, Hyder AA, Jarawan E, Mathers C.(Eds) World report on Road Traffic Injury Prevention. Geneva, Switzerland: World Health Organization. The text also received the 2004 HRH Prince Michael (of Kent) Premier International Road Safety Award Competing interests: None declared |
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