Fatalities from Motorcycle Accidents The Politics of Helmets for

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Fatalities from Motorcycle Accidents                             venous administration of fluids, external cardiac
TO THE EDITOR: In their article in August on the                 massage, flutter valve thoracostomy, pericardicen-
role of helmets in reducing head injuries from                   tesis and pharmacological cardiac support were
motorcycle accidents,' Luna, Copass and Oresko-                  all utilized when necessary.
vich conclude in part that "the death rate for                      It would be fallacious to interpret our results
those with and without helmets was not signifi-                  and conclusions as proof that helmets are of no
cantly different." However, they only studied                    value to a motorcyclist involved in an accident.
motorcycle accident victims who came to the hos-                 Instead, our results indicate that it is the overall
pital emergency room. Unless their statement,                    force impacted to the rider's body during an
"of the fatalities listed, there were no pronounce-              accident that determines mortality.
ments of death at the scene," also includes all who                             GREGORY LUNA, MD
                                                                                Department of Surgery
died at the scene, perhaps their conclusions should                             Harborview Medical Center
                                                                                University of Washington School of Medicine
be more limited. It is possible that the difference                             Seattle
between their observation and that of others lies
in the fact that most motorcycle accident victims                The Politics of Helmets for
who die of head injuries die at the accident scene.              Motorcyclists
                                 MAX BADER, MD
                                 State Health Officer            TO THE EDITOR: Dr. Luna and his co-workers
                                 Health Division                 have done a fine job in their article' in the August
                                 State of Oregon Department of
                                   Health Resources              issue of demonstrating once again that the use of
                                                                 helmets will reduce severe head injury and long-
   1. Luna GK, Copass MK, Oresrovich MR, et al: The role of      term neurological defects from motorcycle acci-
helmets in reducing head injunes from motorcycle accidents: A    dents.
political or medical issue. West J Med 135:89-92, Aug 1981
                      *      *      *
                                                                    Even in the face of such dramatic evidence,
                                                                 motorcycle owners still feel that it is their right
Dr. Luna Replies                                                 as citizens to risk serious injury if they choose.
TO THE EDITOR: This is in response to Dr. Bader's                Society on the other hand is forced to pay
inquiry regarding the validity of our conclusion                 part or all of the medical expenses incurred in
       the death rate for those with and without                 such accidents and to provide welfare assistance
helmets was not significantly different." First, as              for the victims of severe neurological injuries.
stated in our article, there were no pronounce-                  These costs are enormous and the funds could be
ments of death at the scene. All accidents within                spent on social programs that would benefit the
the city of Seattle in which emergency personnel                 entire society rather than on one unfortunate and
-that is, firemen or paramedics-were called were                 not too bright individual.
included in our series. Although city police have                   One way to solve the dilemma of the rights
the authority to pronounce patients dead at the                  of the individual versus the rights of society
scene without involvement of firemen or para-                    would be legislation requiring proof of a sub-
medics, this is not done. The organizational effici-             stantial insurance policy (1 to 2 million dollars)
ency and skills of the paramedics in the Seattle                 for those persons who wish to ride without hel-
area definitely contribute to the relatively low                 mets. Proof of ownership of such a policy would
mortality rate in our study. Resuscitation attempts              allow the rider to pursue his individual right to
including establishment of a tracheal airway, intra-             highway roulette without interference by the state.
                                                                  THE WESTERN JOURNAL OF MEDICINE                423

At the same time, society would be protected                     The Face of Medicine
from having to bear the costs of his recklessness.                     Medicine has a changing and unchanging
                                  MARCUS A. CONANT, MD                 face, and it is as necessary to learn the
                                  San Francisco                        meaning of the first as it is to recognize
                           REFERENCE                                   and cherish the second.
   1. Luna GK, Copass MK, Oreskovich MR, et al: The role of                                 Sir F. M. R. Walshel
helmets in reducing head injuries from motorcycle accidents: A
political or medical issue? West J Med 135:89-92, Aug 1981
                                                                 One wonders if the young doctor of today, as he
                         *     *     *
                                                                 emerges from the protective womb of his
TO THE EDITOR: I am writing in response to the                   residency training, gives a moment's thought
article, in the August issue of the journal, entitled            to what tremendous changes have come about in
"The Role of Helmets in Reducing Head Injuries                   the medical world he is now entering?
From Motorcycle Accidents: A Political or Medi-
cal Issue?"                                                      Does he realize that medical practice now is
   This syllogism would make Karl Marx proud:                    at once more difficult, yet simpler, thanks
   Fifty-nine percent of the unpaid medical bills                to third parties and technology; that his
   are borne by taxpayers.                                       colleague of a generation or two ago dealt
   Motorcycle helmets reduce head injuries.                      more with the art of medicine but less with

   Therefore, since society is financially respon-               the bureaucracy?
   sible for an individual's health, prerogatives
   should be replaced by a law mandating helmets.                That the good old family doctor enjoyed the
                                                                 intimacy of the house call when sometimes his
   Who says doctors are against Socialized Medi-                 best and only medicine was a cool hand on a
cine?                     ALAN H. WALTHER, MD                    fevered brow, yet that he was denied the
                                  San Diego                      comfort of the weekend and nighttime coverage
                                                                 in the ER, as we have it now?
Motorists, Seat Belts and
Individual Freedom                                               Surely this young doctor would be appalled by
                                                                 the ulcer treatment of yesteryear-those
TO THE EDITOR: Luna and co-workers contribute                    horrible Sippy powders and sickening half-and-
proof that the use of helmets by motorcyclists is                half, round the clock, on the hour. Now the
medically advantageous.' The accompanying edi-                   ulcer, by fiberoptics seen, quickly gets a
torial by Dr. Trunkey2 adds pertinent societal                   prescription for an antacid and cimetidine.
and economic arguments for requiring all motor-
cyclists to wear helmets. However, the probable                  And the GI surgeons of today may never know
benefit from universal helmet usage by motor-                    the joy (or the tedium) of the three layer
cyclists pales to virtual insignificance when com-               anastomotic closure-so meticulous, as he
pared with the savings in lives, suffering and dol-              pops in an instant row of staples-so simple,
lars that could be achieved if seat belts (with                  yet miraculous.
shoulder harnesses) were universally worn by
motorists. The loss of "individual freedom" to a
motorist who is required to wear a seat belt is,                 The dermatologist of not too long ago had only
if anything, less than a cyclist's loss from a manda-            coal tar, sulfur, aquaphor and salicylate.
tory helmet, and the advantage (collectively) to                 Now he just decides whether therapy shall be
society is greater. Thus, it seems inappropriate to              methotrexate, hydrocortisone or fluorinate.
require motorcyclists to practice self-protection
unless we are willing to require automobile drivers              The heart doctor of that bygone era used a
and passengers to do likewise.                                   stethoscope to listen and his fingers for
                                   DAVID A. HERBERT, MD          percussion; now he depends on ultrasound,
                                   Los Angeles                   telemetry, echocardiography, in making his
                           REFERENCES                            decision. For HBP and CHF old timer had
   1. Luna GK, Copass MK, Oreskovich MR, et al: The role of
helmets in reducing head injuries from motorcycle accidents: A   phenobarb, dig, salts of mercury-little more;
political or medical issue? West J Med 135:89-92, Aug 1981       today we are blessed with dozens of diuretics,
  2. Trunkey DD: Helmets for motorcyclists (Editorial). West J
Med 135:136, Aug 1981                                            methyldopa and beta blockers galore.

     424       NOVEMBER 1981         * 135 * b

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