MANAGED CARE August 2003. ©MediMedia USA
When we all show signs of the same syndrome, we may not easily admit that it is a problem. What about a prevalent practice that kills?
OK, I've had it. I've got to ventilate about drivers with cell phones. Safety often doesn't receive due attention as an aspect of health care. You know — like wearing a bike helmet, and not resting the TV on the edge of your hot tub. But accidents kill more young people than any disease. (They're not so good for old folks, either.) Parents know their 2-year-olds are actively attempting suicide every waking moment. This reaches a peak during the teens, after which, proportionate to testosterone levels, it normally diminishes in adulthood, for activities that don't involve beer.
The relative neglect of accident reduction. Most practices don't do enough on this topic in managed care environments is surprising, since I daresay there are cost savings to be had for any group that can cut the accident rate for a given population.
In this spirit, I want to attack a public health problem more dangerous than West Nile virus, Chronic Wasting Disease, or SARS. I'm talking about the risks created to you, me, and our families by people driving while impaired — not by drugs, but by cell phones.
Objective, subjective
I am amazed how few health organizations have reacted to the literature on the impairment suffered by drivers conversing on mobile phones. What I have seen is scary. Yakking on a cell phone has the same effect on driving performance as a blood ethanol level that would get you arrested.
Phone conversation induces an attention deficit disorder that has a neurophysiological basis. Researchers at the University of Utah found that cell phones produce a perceptual impairment called inattention blindness.
It's not a matter of just being a little distracted. It's that humans can't register and respond to real cues in their immediate environment while talking to an unseen party.
Almost everyone reading this has probably used a cell phone while operating an automobile. Think of the times when you missed a turn, narrowly avoided rear-ending somebody, or just drifted out of your lane because you were zoned out on the airwaves. If you don't remember doing this, it proves that you're even worse off than you think, because I've seen you. Look out your window. Notice how many drivers have their hands in their ears? Like how they function?
Distraction-inattention has only recently been acknowledged as a cause of adverse events in medical practice. But other industries have long recognized the risk of distraction in high demand tasks. Auto accidents numerically dwarf industrial accidents as a health hazard. Yet, our level of denial — rather, our level of acceptance of death and injury by auto accident — is so complete that we tolerate the huge losses they cause as a normal part of life.
That idiot weaving from lane to lane; the jerk who can't maintain steady speed; the psycho tailgater; the moron who cuts in without signaling — that's you, my friend. It's any of us, when we blithely pick up that nasty little device and hypnotically beam our attention out of the car.
Driving while impaired, whether by alcohol, marijuana, prescription medication, or telephonics is a properly a crime. But with current tools, our legal system can't prevent it very effectively.
I suspect that complete prohibition (as attempted in some European countries and discussed in the U.S. Congress) will not be acceptable to Americans. Too many of us are willing to die — and kill — for the freedom to be constantly plugged into the blather world.
In 2001, New York State passed a ludicrous bit of legislation making it illegal to phone while driving, unless you are using a hands-free headset. This shows a total misunderstanding of the problem. Accidents aren't caused by losing your grip on the steering wheel.
They're caused by your being literally blinded by visualizing what's on the phone. Phoning blocks your perception of the immediate surroundings. What your hands are doing is irrelevant.
Maybe a better law would be when investigating an accident, police ask witnesses if phones were involved. If so, these would be treated as cases of DWI. (Or, DWIP: Driving While Impaired by Phoning.) Or we could install electronic jammers that blocks cell transmissions whenever the vehicle is in gear. Although this idea has appeal (as well as for restaurants and movie theaters), it would also block pagers and phones in legitimate emergencies.
So we could try surveillance. You might be aware that something like 25 percent of the automobiles in the U.S. today carry a memory chip, like an airplane's "black box," continuously recording a few seconds' history of the status of many of the car's electrical systems. These are used increasingly by police to reconstruct the moments prior to an accident.
They record, for example, whether the gas pedal was pressed, the brakes were engaged, or the headlights were on.
Would it be trivial?
It would be trivial also to record whether a cell phone was in use. To take it a step further, synchronizing the time with the phone company's records could disclose the party on the other end.
Maybe the Office of Homeland Security could be persuaded to retrieve the full transcript of the conversation. (Some of you might think I'm joking here.)
Or, there could be a device that only permits a phone call to be made from a moving car if it's operator assisted. Transportation Security Administration agents could screen and record important calls. Then, if there's an accident, the jury can decide whether the urgency of the call justified whatever happened.
Surgeons who pile-up in the left lane might be judged differently if they were giving orders to their ICU, or giving orders to a stockbroker.
Without the possibility of enforcing an absolute ban, all we can do is deal retrospectively with damages from drive-by phoning. Like when you toss banana peels off your porch: If nobody gets hurt, you're merely a pig.
But if you cause an injury, your negligence is part of your liability. Unfortunately, this won't deter much of the threatening driving that I have to defend against when you are on an important call.
'Get a grip on DWIP'
Public education might actually help (at least for adults, if not for teenagers, who are immune). Frankly, I don't believe education works for most behavioral problems. But, it's a necessary preamble to other preventive strategies. So, I urge my colleagues in health care to join their patients and families in dialog about how to Get a Grip on DWIP.
I read a charmingly utilitarian interview with a business executive. He was confronted with the facts of phone impairment and asked about his policy about employees using cell phones in company cars. His response was that the net gain in productivity made any losses an acceptable cost of doing business.
Obviously, our society agrees with this trade-off. But, when I weigh the cultural, artistic and historical value of the cellular conversations I've had imposed on me in elevators, theaters, and (no kidding) pre-op holding areas, I am saddened by this desperate, stoking of mass oral fixation.
And I'm sorry that to so many people, my life and theirs can be measured against this value. Until we evolve another lobe of our brain, we're going to need legal mechanisms to protect ourselves from another technology that surpasses our ability to use it safely.