War on the roads
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7346.1107 (Published 11 May 2002) Cite this as: BMJ 2002;324:1107
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I have been reading all of these responses with great interest. As a
cyclist who cycles to work during rush hour every day, I effectively risk
my life each day. This is not out of choice. My deciding to use my bike is
a choice. I do not accept that, as a necessary and unavoidable consequence
of that choice, I am generally "asking" to be knocked off my bike. Every
day I encounter buses who seem to think it funny to overtake and then pull
in in front of me with no warning at all; drivers who ignore my signals
and overtake me as I'm about to turn right; pedestrians who seem not to
see me at all, despite the so-called "high visibility" jacket. In fact,
quite often when you're on a bike, you get the feeling that you must be
nothing more than a figment of your own imagination because other road
users seem to think you don't count, somehow.
Given a choice, I would rather not have to share the "CAR-riageway" with
double-decker buses. But in most cases I am not given that choice because
the available space is being taken up by double-decker buses or cars,
which are obviously far more important (because these people pay good
money etc etc ad nauseam...). Given a choice, I would like to be able to
take a route to work that was safe, well-designed and well marked. But for
most of the journey, I am not given that choice. When will drivers realise
that, for the best part of last century, they had everything their way? As
a result, we now have a rail system that is falling apart at the seams, a
massively inadequate system of paths for cyclists and pedestrians, ever-
increasing asthma rates and cities which, for hours and hours each day are
utterly gridlocked. Oh yes, and "road rage", which seems to be the most
appalling attempt to justify impatience and violent behaviour yet. If I
attack a pedestrian who has walked into the cycle path and knocked me off
my bike does calling it "cycle rage" explain me beating that pedestrian to
a pulp? Shooting him/her?
We are constantly being told by the car lobby that environmentalists are
merely people who want to spoil drivers' fun. When will drivers realise
that if what they entitle "fun" actually means reducing someone else's
standard of living, or doing them physical harm, then they should really
be looking at other ways of having fun.
Competing interests: No competing interests
Anthony J Cartmell writes (something disturbingly familiar):
> The Transport Research Laboratory report 323 "A new system for
recording contributory factors in road accidents" looked at different ways
to collect and interpret road crash data, using eight volunteer police
forces. It was not a study of the causes of crashes . Although this report
is widely quoted by members of the Association of British Drivers, it is
of no use to this debate.
Yes, only eight (major metropolitan?) police forces.
Then the Transport Research Laboratory did say that:
> Knowledge about the factors which ** contribute to the
occurrence ** of road accidents can make a vital contribution to devising
methods for improving road safety.....also held the more subjective
contributory factors which were recorded by police officers.......a number
of forces have ceased to collect these factors and the systems used by the
remainder have diverged.
> A new system has been developed at TRL......report summarises
the development of the new system, describes the trial ** and presents
analyses of the data collected to demonstrate the type of results that can
be achieved **
So "not a study of the causes of crashes" at all then.
But you could probably tell that from the title:
"A new system for recording contributory factors in road accidents"
Unlike the following, also widely circulated on reclaim the streets
type web sites:
> Those looking for evidence that speeding causes crashes might
like to read TRL report 421 "The effects of drivers' speed on the
frequency of road accidents"
But then, of course, this was done using nine, or was it ten police
forces. Though only on some (specific types) of their roads, rather than
all of them as in TRL 323, if memory serves.
Competing interests: No competing interests
The Transport Research Laboratory report 323 "A new system for
recording contributory factors in road accidents" looked at different ways
to collect and interpret road crash data, using eight volunteer police
forces. It was not a study of the causes of crashes. Although this report
is widely quoted by members of the Association of British Drivers, it is
of no use to this debate.
Those looking for evidence that speeding causes crashes might like to
read TRL report 421 "The effects of drivers' speed on the frequency of
road accidents", PR058 "Speed, speed limits and accidents", CT084.1 "Speed
and road accidents update (94-98)", and LR88 "The relation between a
driver's speed and his accident rate".
Competing interests: No competing interests
It’s galling to read so many complaints about political correctness
in a journal like the BMJ. But the complaints do at least illustrate the
extent of driver unreason.
Normally you can write off Anti-PCs as people who can’t bear the idea
that more enlightened times have put their abnoxious attititudes beyond
the pale. The Anti PCs may insult people whose skins, or accents, or
origins, or sex, are different from their own but the physical harm they
do is limited unless, as occasionally happens, they provoke others to
commit violence against them.
Here, as elsewhere, they blame the victim. But this time the victim
is not merely reviled. The victim is injured or dead. And they shouldn’t
be.
It is not good enough to argue, as Bernard C Abrams does, that TB or
coronary heart disease kills more people. Far more children are killed by
cars than by predatory paedophiles but we don’t accept the latter risk as
‘tolerable’ on that account.
If you analyse the assumptions drivers have to make before they
assert that road safety campaigners are being unreasonable, you have to
conclude that drivers believe not just that their business is inherently
more important than that of anyone on foot, but that their business is
inherently more important even than the lives of anyone on foot. There is
no other explanation for their attitudes. Scratch a driver and you find
someone who really believes he or she has the right to kill people who
happen to be in the wrong place at the wrong time.
How else do you explain the way a man told me over lunch about a
neighbour’s recent experience? He had turned too fast round a corner and
run into two young girls on a crossing. One was killed, the other badly
injured. “Poor chap,” said the man, “He didn’t stand a chance!”
I’ll bet his neighbour received a fine. I’ll bet the girls' parents
wished they could have got away so lightly.
This is a British problem. Walk around Vancouver, or Detroit, or
even parts of southern Portugal, and most drivers will stop to let you
cross the road they are turning into. This provision remains in our
highway code but has been steadily watered down by officials anxious to
please drivers. Drivers in these other places see absolutely no reason to
treat people on foot as any different from themselves.
It’s a British problem because, as a legacy of the days when the
gentry drove round in carriages, generations of school children have been
indoctrinated to defer to drivers. If they so much as hear a car, they
are taught to wait until it goes by.
The lesson is that the police and others who indoctrinate children
this way are not teaching pedestrians, they are teaching tomorrow’s
drivers. When these children pass their tests they expect a level of
abjection that no civilised society would tolerate.
This is a BMJ matter, because people who don’t accept a duty of care
to other road users, who drive without regard for the safety of others are
unwell, whatever the medical term. If they exhibited the same behaviour
in any other context than a conflict between driver and pedestrian or
cyclist they would be sectioned as sociopaths. It is a BMJ matter
because, once the illness is recognised, which may be beginning to happen,
one wonders how the NHS will cope with their treatment.
Yours sincerely,
John Dwyer
Competing interests: No competing interests
In Holland, more people cycle more safely than in the UK. We could
easily import one reason for this; after any road trauma in Holland, the
better-protected party is held legally responsible. This extra, legal risk
to drivers is likely to make them much more careful of less-dangerous road
users. Gerald Wilde (BMJ 2002;324:1149-1152 (11 May);
http://bmj.com/cgi/content/full/324/7346/1149
admirably demonstrates the reality of risk compensation. Risk compensation
can work for us.
Here is that unusual thing; a simple, if partial, solution to a
complex and intractable problem. Let's go Dutch. Let the law protect the
weaker party. Let's make our roads safer to use.
Competing interests: No competing interests
Wearing cycle helmets has its own problems and not necessarily of
help with high risk takers. Traffic calming is good. Use of bicycle lanes
can put cyclists at increased risk as there is a danger when going past
residential entrances or crossing junctions when using the
pavement....people do not expect you to be there.
Highly reflective clothing helps.
Competing interests: No competing interests
Editor- There are alternatives and hope to control the high burden of
traffic injuries in developing countries. It is much possible to increase
the number of vehicles and simultaneously decrease the number of injuries
with enforcement of traffic safety regulations.
We have interesting numbers in Rio Grande do Sul state, Brazil
(Table), after the implement of the new National Traffic Code. It
establishes heavy fines for exceeding the speed limit and accounts
cumulative points obtained for each transgression, which can lead to
temporary suspension of the Drivers License. Furthermore, there were
installed speed cameras on roads and important avenues, even though with
warning signs where cameras are positioned. These actions, allied to a
more severe control for seat belt use, lead to a significant decrease in
injuries and deaths in this state comparing 1997 to 2000 rates (RRR = 0.31
95%CI (0.21,0.41) for deaths/vehicles and RRR = 0.31 95%CI (0.23 to
0.38) for injuries/vehicles).
Table: Deaths and Injuries related to Traffic Accidents in Rio Grande do Sul, Brazil, from 1997 to 2000. Year Deaths Injuries Nº vehicles Population 1997 1,144 18,884 2,619,719 9,634,688 1998 952 15,317 2,730,490 9,634,688 1999 902 15,038 2,972,383 9,634,688 2000 887 14,712 2,974,883 10,179,801 Detran-RS – Coordenadoria de Estatística (www.detran-rs.gov.br) Data from state roads, federal roads and capital of the state.
Prof. Renato Seligman
Department of Internal Medicine - Universidade Federal do Rio Grande do
Sul,
Emergency Department of Hospital de Clínicas de Porto Alegre,
Hospital Municipal de Pronto Socorro de Porto Alegre,
Collaborator of the CRASH Study
seligman@via-rs.net
There is no competing interest
Competing interests: Table: Deaths and Injuries related to Traffic Accidents in Rio Grandedo Sul, Brazil, from 1997 to 2000.Year Deaths Injuries Nº vehicles Population1997 1,144 18,884 2,619,719 9,634,6881998 952 15,317 2,730,490 9,634,6881999 902 15,038 2,972,383 9,634,6882000 887 14,712 2,974,883 10,179,801Detran-RS – Coordenadoria de Estatística (www.detran-rs.gov.br)Data from state roads, federal roads and capital of the state.
A lot of talk here about "vulnerable" victims, "reclaiming" the CAR-
riageways for "people" (those tin boxes contain several) and there being
no point in training and educating children.
These same people probably tell their kids to go out into the street
to play to show those motorists who the CAR-riageway belongs, spend a
fortune sending them to the best public schools to be trained abnd
educated, and drag them along to anti-bypass protests.
Developed countries, unlike the UK, have vastly superior motorway and
trunk road networks, make it illegal to jaywalk, and teach their kids not
to put their hands in the fire, play with sharp implements, or play on the
CAR-riageway.
And that's why they have low child casualty rates.
And it's also why they can afford the LUXURY of home zones and
letting their kids play in them.
Whilst this country insists on on forcing cars which account for over
80% of all passenger miles (including planes and ferries) and most of it's
freight through the middle of towns and villages, and it's kids to believe
that cars MUST stop for them, children will continue to be innocent and
vulnerable "victims".
But not of motorists.
But of self styled "safety" experts, politicians who can't drive,
"Doctors" who seem to have lost the capacity for research and logical
thought, and their parents.
Ask your children what the stopping distance from 30 is: not one will
know.
Do you?
Competing interests: No competing interests
Both Dr Mackenzie and Dr Cattermole argue that the BMJ has double
standards when it comes to publishing pictures of patients. They ask if we
have written consent from the dead man depicted on the cover of our "War
on the roads issue?" We do have double standards, but we believe that they
are legitimate--and our ethics committee agrees.
The written consent applies to information about patients that
emerges from the doctor-patient relationship. Patients expect that
relationship to be confidential, and information about them should be
disclosed only with their consent.
Pictures that are taken outside of that relationship are wholly
different, and the same rules do not apply. News photographers do have
codes about consent, but they are not nearly as strict as those covering
the doctor-patient relationship--and nor should they be.
Our ethics committee agrees that with such photographs it is
legitimate for the BMJ to apply the same rules as the rest of the press.
Richard Smith,
Editor, BMJ
Competing interests: No competing interests
Re: BEYOND YOUR BRIEF, BMJ!
Mr Torrance's response to the question of road deaths is painfully
stupid. The concern the BMJ has and we working in the field of health,
both mental and physical, is nothing to do with PC. Cars are in our view
the most detrimental aspect of modern consumer society, not only killing
vast numbers of people, maiming even greater numbers, but contributing to
the general psychosis of a system where roads replace community. There is
nothing "fashionable" about opposing the car as Torrance claims. Indeed
the car is the ultimate fashion icon of western capitalist civilisation.
Torrance's suggestion that those most personally affected by car-related
suffering be excluded from the debate is execrable. He claims to speak in
favour of those who 'just want to get on with their lives', yet his
selfishness blinds him to the fact that all car-victims wanted to do is
get on with their lives, a contingency which their death renders somewhat
difficult. And now Torrance would even deny them a right to protest
against this killing machine. Such fascist thinking has no place in
rational debate.
Norman Armstrong
Competing interests:
None declared
Competing interests: No competing interests