Intended for healthcare professionals


Child safety in cars

BMJ 2006; 333 doi: (Published 07 December 2006) Cite this as: BMJ 2006;333:1183

A partial assessment?

There may be nothing factually incorrect in this Editorial, but it
comes over as an incomplete and one-sided account of the subject.

First, by giving the total number of child casualties in cars, it
creates an impression that this is the scale of the potential benefits
from compulsory child seats. But some of these casualties will be among
children not even following the existing requirement to wear adult seat
belts, and it is simplistic to assume that parents who ignore the existing
law will follow the new law. And correct child seats merely reduce
injuries compared to adult seat belts, not eliminate them. So the benefit
from this law is likely to be rather less than implied.

Second, there is no consideration of cost-benefit. Whether in the
work of NICE or in the growing use of Regulatory Impact Assessment in
Government, we are increasingly seeing cost-benefit, not as some negative
financial hurdle to be overcome, but as a positive tool to help us make
the most effective use of societal resources. That sense is missing from
this Editorial and from the wider debate of child seats.

Thirdly, there is no consideration at all of risk compensation,
hinted at by Ward in his Rapid Response. It is delusional to assess one
part of the consequence of a measure (the changed incidence of injury when
an accident occurs) if there are other consequences we are ignoring (the
changed probability of an accident occuring).

There are, no doubt, people who oppose this law on libertarian
grounds. I am not one of them; I would happily see much stronger legal
constraints applied to driving. I, like I assume Hayes and most BMJ
readers, want to see fewer injuries on our roads. The challenge is to use
the evidence base to find the most effective way of achieving that.
Putting high-profile effort into token laws that do not address the causes
of accidents and may make very limited difference in practice to the
consequences is not the best way forward.

Competing interests:
None declared

Competing interests: No competing interests

01 January 2007
John Swanson
Written in private capacity
9 Randalls Road, Leatherhead, Surrey, KT22 7TQ