The Editorial Board will be pleased to receive and consider for publication correspondence contalning Information
of interest to physicians or commenting on issues of the day. Letters ordinarily should not exceed 600 words, and
must be typewritten, double-spaced and submitted In duplicate (the original typescript and one copy). Authors will
be given an opportunity to review any substantial editing or abridgement before pubilcation.
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