In reply

Abstract

The ongoing discussion on whether motorcycle helmets should be used always sparks debates that are both lively and passionate. The response from Dr. Heller on my commentary 1Thoma T.G. Commentary: advocating for safety-the motorcycle helmet debate.Ann Emerg Med. 2009; 53: 501-504Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar advocating motorcycle helmet use is no exception. It is obvious that the writer is very passionate about the issue of personal choice. As an advocate in traffic safety and injury prevention, I'm equally passionate about saving lives. Unfortunately, these arguments won't be solved here. Heller concedes that injury and death are reduced with the use of motorcycle helmets, and uses economic arguments to defend personal choice. As stated in his response, the cost of increased death and disability from not using motorcycle helmets is hard to calculate. There have been scores of studies that looked at types of economic losses from not using motorcycle helmets. The numbers vary substantially and if motivated, people from both sides of the argument can find data to support their opinion. The author cited a work from Hundly et al2Hundly J.C. Kilgo P.D. Miller P.R. et al.Non-helmeted motorcyclists: a burden to society? A study using the National Trauma Database.J Trauma. 2004; 57: 944-949Crossref PubMed Scopus (66) Google Scholar from the Journal of Trauma in 2004. This study put the uninsured costs of caring for excess injuries incurred by not wearing helmets at about $30 million annually. This does not include the insured costs which also negatively impact insurance premiums. On the other extreme of this argument, Nebraska calculated cost estimates for motorcycle crashes in 2007. They looked at wage and productivity losses, medical expenses, administrative expenses, motor vehicle damage, and employer costs. Their total projected cost for motorcycle crashes in 2007 was $30,671,000 in Nebraska alone. 3National Safety CouncilInjury Facts 2006 Edition. Nebraska Office of Highway Safety, Lincoln, N E2006Google Scholar Although the actual number of economic impact to the citizens is obscure, we can agree that there is some negative impact. As an advocate in traffic safety, my goal is to help reduce injury and death. If while doing so there is a positive economic outcome, it strengthens my stance. As a society we've chosen to produce rules that prioritize the value of human life. To suggest that society might economically benefit by people not reaching retirement age is reminiscent of Jonathan Swift's “A Modest Proposal” without the satire. If we were to follow that line of thinking, we could make mandatory seatbelt laws optional after the age of 50. This would certainly reduce a demographic that will have a negative economic impact on society in the near future. Thankfully, that is not the way we function as a society. As stated in my original commentary, freedom of choice is an argument that's honest and hard not to respect. Although I understand different people have differing opinions, I have never regretted my efforts at traffic safety. There are various groups who advocate behaviors that require people to use safety features that they might otherwise choose not to. If these efforts have saved lives by making people buckle their seat belts, place their children in child safety seats, not drive under the influence of alcohol, or put on a motorcycle helmet, then we have achieved our objective. Unhelmeted Motorcyclists: Do They Really Cost Us a Dime?Annals of Emergency MedicineVol. 54Issue 6PreviewDr. Thoma's cogent commentary on the issue of helmet use by motorcycle riders effectively refutes the 3 main medical arguments against helmet use.1 Any fair perusal of the overwhelming data summarized in his references would conclude that there simply is no medical controversy about whether injury and death are greatly reduced by wearing a helmet.1 But it seems equally clear that these facts provide little justification for our various state and national professional organizations–including the American College of Emergency Physicians–to adopt an advocacy position on an issue where the overall impact on the public health is small but the impingement on personal choice for a minority is significant. Full-Text PDF