What Should Doctors Do to Prevent Traffic Deaths?

When cars first became a common presence in American cities, doctors were shocked by the carnage. In 1925, editors of the New England Journal of Medicine called the bloodshed caused by motorists “appalling” and lamented children’s loss of life as “a massacre of the innocent.” The sense of urgency was still detectable a few decades later. In a 1957 report, Harvard researchers called the public health threat posed by automobiles a “mass disease of epidemic proportions.”

The medical profession was alarmed about the bloodshed that accompanied the introduction of cars into mainstream society in the early part of the last century. Since then, views have evolved considerably. Image: New England Journal of Medicine
The medical profession was alarmed about the bloodshed that accompanied the ascent of cars in the early part of the last century. Since then, views have changed considerably. Image: New England Journal of Medicine

But as time went on, the medical establishment became much more muted in its response. Public health research gravitated to relatively minor risks — like the connection between traffic collisions and diabetes or sleep apnea — instead of more significant dangers like drunk or distracted driving. In 1987, some doctors took to the pages of the Journal to criticize their colleagues for being “relatively silent about the relation between alcohol and motor vehicle accidents.”

These shifts are charted by David Jones, a doctor who studies the history of medicine at Harvard, in a recent review of how American physicians have addressed the public health threats posed by automobiles. Looking at the last century of articles about cars and public health published in the New England Journal of Medicine, Jones charted the fascinating historical trajectory of how physicians’ views on driving-related health risks have shifted, in an article that was itself published in the Journal earlier this month.

Despite an article in the most recent edition of the Journal finding that distracted driving is associated with significantly increased crash rates among both novice and experienced drivers, Jones says doctors still don’t seem to be comfortable taking decisive action to prevent these kinds of collisions.

I recently spoke to Jones about his research. Below is an edited transcript of our interview.

It sounds like doctors have been a little bit hesitant to intervene.

Because of their position on the front line of disease, doctors become aware very early on of what types of things in our society are causing threats to life and health. The question is: What’s the appropriate response?

When the first cars started showing up on the roads in the 1890s, within 10 years doctors at medical journals were astonished by the rising numbers of people who were killed in driving accidents.

Pretty early on, probably by the 1920s or 1930s, most doctors would say the biggest problem with driving is drunk driving. That’s totally clear now. If you look at the leading cause of car accidents, it’s alcohol. Society has responded by criminalizing drunk driving, which is probably appropriate — although there are a lot of people who would say that the sanctions aren’t nearly strong enough.

What’s the role of doctors in all of this? One question that came up in the 1920s: Should everyone who wants a driver’s license undergo a medical examination? And many states considered those laws but none of them were seriously enacted. The doctors who responded to the New England Journal didn’t want to do that. That would have been a huge burden on physicians.

One of the things that struck me was, in the second half of the 20th century, in the Journal you have lots of articles about people who have weird heart problems, and is it dangerous to drive? And people who have epilepsy: Is it dangerous for driving? And people who have diabetes: Is it dangerous for driving?

And those are all true. But all of those are dwarfed by drunk driving. You can step back and say, “Why are doctors worried about the handful of people that have a heart attack and cause an accident, or the handful of people who have a seizure and cause an accident, when there are thousands or tens of thousands of people who get drunk and cause accidents?” And I think part of it is that doctors are ambivalent: Is alcohol a medical problem or not?

It sounds like doctors have become immersed in the wider cultural attitudes that are relatively permissive about driving.

Judging from the ideas you see in the New England Journal, they were reluctant to get involved in — I don’t know, what do you call it — the nanny state? Or the police state? They were reluctant to get involved in the fight between the public health powers and the society and the individual rights of the people.

David Jones is a Harvard Professor that specializes in medical history. Image: ##http://web.mit.edu/newsoffice/2010/david-jones-award.html## MIT##
David Jones is a Harvard professor specializing in medical history. Photo: ##http://web.mit.edu/newsoffice/2010/david-jones-award.html##MIT##

Should you drive if you’re drunk? The answer is clearly no. Does government have a right to punish you for doing so? Yes. Should doctors prophylactically try to get your driver’s license removed to prevent that from happening? No one has been willing to say yes to that.

So if you’re a neurologist and you diagnose a patient with epilepsy that’s not controlled well with medication, do you have an obligation to call the motor vehicle agency and say, “Revoke that person’s license”? There are a small number of cases where doctors are expected to do what they can to pull someone’s license. It’s not true for alcohol.

So if a doctor happens to know that their patient is an alcoholic, they typically would not make any effort to get involved with licensing. Or there isn’t even a course of action for them to do that.

I believe both of those things are true. That doctor would not think that that is the doctor’s role and if the doctor were to call the Bureau of Motor Vehicles and say, “I just want to let you know that Mr. Smith is a habitual alcoholic,” I don’t think that are any legal or policy mechanisms to do that.

But in other cases there wouldn’t be a policy mechanism. I know with vision, there are very clear controls.

If an ophthalmologist sees a patient and that patient’s vision is 20 over 400, is that doctor required to call the registry? I don’t think so.

I’ve never, never heard of anyone reporting a patient as a result of alcoholism. And if doctors started doing that, it would cause a huge problem for the profession and society more broadly. People would either stop going to the doctor or they’d never admit to a doctor that they drank. People just don’t see that yet as the role of medicine.

The research article that was recently published in the Journal was about cell phone use. This is a less well-surveilled issue by doctors. One of my colleagues, Amy Ship, who works at the Beth Israel [Deaconess Medical Center] in Boston, she said she routinely asks her patients, “Do you text and use cell phones while you drive?” If they say yes, she reads them the riot act. And it’s her opinion that all doctors should do that. What percentage of doctors ask patients about this? I bet it’s close to zero.

Do you think that’s because car collisions aren’t considered a public health issue in the same way diseases or other public health threats might be?

Since the 1950s, and maybe even back as far as the 1930s, there have been public health researchers who have made the case that car accidents are a public health problem, because they’re usually in the 10 top causes of death each year. I think most doctors would admit car accidents are a public health problem.

Doctors won’t release a newborn from the hospital unless the family demonstrates that they have a car seat. Pediatricians will routinely screen parents about use of car seats, use of seat belts. So pediatrics has embraced this wholly. Do all doctors screen patients about seat belts? Back in Massachusetts they used to but as soon as Massachusetts passed a seat belt law, doctors stopped caring. They assumed that everyone was wearing seatbelts.

Why do you think driving is treated differently than other public health threats?

Say you’re seeing someone who is a bad or dangerous driver and you tell them to quit driving. We’ve structured our society in such a way, especially outside of the cities, you’re really car dependent. And so if you’re intervening against someone’s ability to drive, it’s a massive imposition: It can interfere with someone’s work; it can interfere with their ability to get groceries; it causes all sorts of problems.

If you’re a doctor with a patient with epilepsy and you call to report that patient to the registry, that’s not something you enjoy doing because what an awful impact this is going to have on the person’s life. So intervening in that way is a very different intervention than telling someone to quit smoking. So I think that drives part of the ambivalence.

And the other part is, is it really doctors’ role to tell people not to drink and drive? Do we live in a police or nanny state, or do individuals have to do the right thing?

The New England Journal published its first article about cell phone use in 1997, and it showed quite clearly that there’s no doubt that people who use cell phones have higher accident rates. Their recommendations, both in that article and the editorial that accompanied that article, were really modest. They were not going for a ban on cell phone use. They were saying that it’s the role of individual responsibility.

I’m not saying that response is wrong, I am just saying that is one response that puts the onus on the individual. And all you have to do is look around at other cars next time you’re driving and you will realize that individuals are not acting on that responsibility. People are constantly on their cell phones while they drive. So you know, appealing to individual responsibility is well and good, but the question is: What do you do when people have dropped the ball?

  • Mcass777

    I don’t know, take the train to work?

  • Adam Herstein

    I don’t buy the argument of altering someones way of life by taking away their privilege to drive if they are caught driving drunk. Drunk driving is a conscious decision, and one should consider the consequences before getting behind the wheel drunk. Whatever inconvenience it is to you to not drive, think of how inconvenient it would be for the person that you potentially could hit and injure or kill with your car. Driving is a privilege, not a right, and if you can’t handle it then you should be off the road.

  • “It sounds like doctors have become immersed in the wider cultural attitudes that are relatively permissive about driving.”

    It sure does sound that way to me after reading this article. Its an interesting double standard. About as many people die from motor vehicle misuse as with gun misuse. While there is no widespread discussion about tightening up driver qualifications, enforcement, and punishment, either from the medical establishment or the public, there is plenty of discussion about tightening up gun purchase background checks, physician intervention in keeping guns out of the hands of the mentally suspect, and putting much heavier penalties on straw gun purchases and felons or restricted persons in possession.

    Also, both of these problems are primarily caused by willful misbehavior and cause deaths in onsies and twosies. While the high profile cases get the headlines (90 year old men in SUVs mowing down children on sidewalks, young white men with assault rifles mowing down moviegoers or schoolkids) the everyday carnage goes on unnoticed.

    Perhaps motorists get a pass because more people drive as a central part of their lives (hence the “there but for the grace of god go I” mentality) and we have become accustomed to killing each other with cars? As I said to my legislator, as a bicyclist, I spend far more of my time looking over my shoulder for wayward motorists than I spend watching for wayward gunmen.

  • I agree in principle. This breaks down with hard-core alcoholics who drive. We have a revolving door justice system for DWIs in New Mexico. Short of locking them up and throwing away the key, they keep driving illegally and keep getting arrested. Felony DWI matters little to some of these hapless folks, nor does your life or mine.

  • JamesR

    FWIW Doctors are immersed in motoring culture as much as anyone else is, perhaps even moreso due to the level of affluence their high average salaries afford them. Take a drive past your average suburban doctor’s office and check out all the high end Audis, BMW, and other expensive German cars that plenty of them drive.

  • Adam Herstein

    So install breathalyzers in their vehicles that prevent the engine from starting unless they are sober. These people are criminals and shouldn’t be given pass after pass – especially since they are putting innocent people in danger. If this is a recurring problem, then they should be getting therapy and counseling instead of being in and out of jail.

  • You will not find a disagreement with me on that. I believe breath-interlocks are often a precondition with DWI. That assumes the person obeys.

    We just had another arrest over the weekend. 4th time DWI driving without a license and her seven year old kid in the car. Not sure where she got the car. No license. Arrested for felony DWI and child endangerment. Revolving door.

    Alcohol is a serious issue in this state. Its not surprising it overlaps with driving.

  • Adam Herstein

    It’s clear that the threat of jail is not stopping a lot of people from drinking and driving. Instead, the state should be providing counseling and therapy to try and fix the root cause (whatever that may be) instead of just throwing people in jail.

  • Kevin Love

    The #1 public health threat due to car drivers is the lethal cancer-causing poisons that they produce.

    Public health professionals in other countries do not ignore this grave threat. For example, Health Canada has developed an AQBAT model for predicting deaths and injuries among the population due to being poisoned by car drivers.

    One example of its application is by Toronto’s Public Health Department, led by the Medical Officer of Health, Dr. David McKeown. He has produced a Report determining that in Toronto:

    *Car drivers poison and kill 440 people every year.
    *Car drivers poison and injure 1,700 people every year so seriously that they have to be hospitalized.
    *The cost of people being poisoned by car drivers is $2.2 billion per year just in this one city alone.

    The Report may be seen on the City’s official website at:

    http://www.toronto.ca/legdocs/mmis/2007/hl/bgrd/backgroundfile-8046.pdf

    My question is this: Where is New York’s report on this lethal threat? Why are our public health officials ignoring these deaths and injuries?

  • Kevin Love

    In most countries, repeat drunk drivers will indeed find themselves imprisoned for a long, long time. I have no problem with this.

  • Kevin Love

    The root cause appears to be that driving is, in many cases, a faster, easier and more convenient way of getting from A to B than walking, cycling or public transit.

    That can be fixed.

  • JamesR

    You’re certainly not the first to realize any of this and NYC government is obviously aware of the problem – the Clean Air Act limits parking requirements in Manhattan for this very reason.

    I’m every bit as concerned – no, more concerned – about the homicidial maniac threatening pedestrians and cyclists’ lives, weaving in and out of lanes, while driving a low-emissions, hybrid-powered yellow cab as I am about your average combustion-powered private car, most of which you’ll see fewer and fewer of if we finally get congestion pricing.

  • traal

    In New Mexico, it takes four DWI offenses before they’ll stop giving you your license back automatically. No wonder DWI laws aren’t taken seriously there.

  • Fbfree

    I believe that the trauma and health problems that motoring inflicts outweigh the influence of driving a nice car. Societal expectations around driving are the greater problem, but doctors are in one of the best positions to both be convinced and make a strong case against driving, once they aren’t shouted down for it.

  • Kevin Love

    After reading about the deaths and injuries due to people being poisoned by car drivers, here is another publication by Toronto Public Health. This one shows the positive benefits of reducing car use and using walking, cycling and public transit for moving from A to B.

    I strongly recommend the analysis on page 14, “Population health benefits of reduced motor vehicle travel.”

    Where are the reports by New York’s public health officials? Why is this superb level of analysis not being done in New York?

    See:
    http://www.toronto.ca/health/hphe/pdf/roadtohealth.pdf

  • Consider these levels of deaths and illness are after 40 years of Clean Air Act and pollution control measures, including the phase-out of tetraethyl lead from gasoline. Organolead combustion aerosols led to widespread and very high lead levels in humans, which affects the brain and kidneys. We were literally poisoning our cities with lead-rich auto exhaust as lead was present in quantities greater than a gram per gallon. Do the math. The late Clair Patterson, a brilliant geochronologist at Caltech, did much of the seminal work sorting that out back a few decades ago, fighting against an implacable industry.

    The crashes and bloodletting are highly visible down sides of unfettered auto-dependence, but the quiet but steady pollution problems, which also include nonpoint source pollution to soil and water bodies intensified by urban hardening (streets and parking lots) in addition to pollution generated by raw material production, goes on year in and year out. One has to balance that all out against the perceived benefits, so to speak.

    http://protectingwater.com/automobile.html

    Yes, as Kevin said, crashes are the tip of the iceberg. The money and power of the transportation industry that is centralized in cars, and the public’s crystallization around a civilization paradigm that has made the car intrinsic to its existence, is hard to turn around.

  • The distances are often long down here and public transit is a far cry from an efficient, integrated system. I was on a board that oversaw our county’s interactions with the North Central Regional Transit District of New Mexico. Let’s just say that there was a lot of room for improvement in connectivity, route optimization, and scheduling.

    A good friend, a now retired physicist who is legally blind, told me that using transit connections, it took him most of a day to get from Los Alamos to the airport in Albuquerque. Via private minivan or my car, its a two hour trip. That’s the problem. We need to make transit work.

  • oooBooo

    Doctors, including psychologists play an important role as bureaucrats and informants in totalitarian systems. Under all forms of government they also serve a useful role as state intellectuals to justify the powers those in government want to have. Furthermore they can help institutionalize political opponents, cranks, malcontents, and other people who don’t share the politically correct and politically dominate views. Doctors, having a position of trust in society, thus vitally important to shaping society towards a desired utopia and why they must be on board with it.

    Meanwhile, if we really wanted to save lives, the big hitter, are treatments that end up killing patients, drug interactions, drugs by themselves, and medical errors. Deaths due to the medical industry dwarf deaths in traffic collisions and even the wishy-washy “externalities” added to it by orders of magnitude.

    So let’s think a bit why doctors are really needed with regards to transportation politics.

  • Andy Chow

    The root cause is alcoholism. Alcoholism leads to other undesirable life-altering outcomes (such as loss of job). If that person has multiple DUIs, it is obvious that they have serious issues with alcohol other than just being careless when exiting the bar or friend’s house.

  • Jeffrey Baker

    “Doctors won’t release a newborn from the hospital unless the family demonstrates that they have a car seat. ”

    Look, it’s my hobby horse again. Pediatrics indeed will not admit the possibility of life without a car. That’s unfortunate and contributes to our suburban vehicular arms race where the car seats and the cars they can fit in, and the houses the cars can fit in, only get larger over time.

  • Joe R.

    I’ve read in a number of places that deaths from auto pollution are at least a order of magnitude greater than deaths from collisions. You’re right. Where is NYC’s report on this grave threat to public health? Moreover, it’s a quality of life issue. In the early 1980s I noticed a slight improvement in air quality after vehicles had to meet tighter emissions and mpg standards. And then by the early 1990s things got worse when the SUV craze started. Arguably, they were worse than even the 1960s because you had a lot more automobiles on the streets compared to then, even if the average auto was cleaner. Due to auto emissions, it’s rare I can go out during the warmer 6 months of the year except at night. And I don’t suffer from asthma or any other lung disease. Rather, I just find the air too thick with gasoline fumes.

    I’m really amazed more people aren’t upset by this facet of auto use. Nearly everyone knows someone who has cancer, or has died of cancer. They fail to make the connection that a lot of these cancers are caused by environmental pollution, with motor vehicles being a primary culprit in populated areas. Why haven’t we taken steps decades ago to both limit motor vehicle use, and to require zero emissions vehicles in populated areas? We need the same kind of outrage here that spawned the environmental movement 40 years ago. Yes, in the end people may have to accept that using personal motor vehicles will be less convenient and more expensive. Is that such a high price to pay for a cleaner, healthier environment, combined with a potential increase in average life expectancy of at least 25 years?

    Incidentally, doctors could be major players at getting the air cleaned up but it seems all they want to do is protect the huge income they make from treating cancer patients. I vaguely remember (and I could be wrong) hearing the AMA coming out against electric cars in the early 1990s because it felt they would radically reduce cancers (and hence the huge income hospitals get from their oncology departments).

  • Jonathan R
  • Joe R.

    Confiscate the car if someone is driving without a license. That’s the only way suspending or revoking licenses will be effective in keeping bad drivers off the roads.

  • Wewilliewinkleman

    “Vehicular arms race” Sorry but using language like this only puts you in the category of kook.

    You may want to live in a city without cars, but to me that’s the equivilant of the people who want to live out in the backwoods in a cabin and live off the land. It’s a choice your welcome to make, but don’t count me in.

    In an earlier post about truck traffic in NYC it was proposed that goods can be moved around by bike delivery and little train cars. The only thing I can think of is “do you wash your underwear in the bathroom sink?” or “do you sleep on a inflatable mattress?”

    I’d love to see little put-put delivery trains and or bike delivery vehicles deliver washing machines, mattresses, or other large objects common to everyday life. Just where are these so called “staging areas” for the alternate vehicles supposed to go? Will the city go in with the powers of eminent domain and take people property away to create these so called staging areas and are we as taxpayers supposed to pay for them?

    Do I believe there are ways to better manage vehicle traffic? Definately, but taking the position of removing vehicle traffic from a city and because is “violent” is just too much.

    Oh and today I saw a young mother pushing the double wide stroller jaywalk across the street. She was too busy looking at her phone to watch the traffic. Should she be charged with child endangerment?
    ,

  • M

    One of the arguments I often find myself up against, especially with older individuals in Los Angeles, is “it’s so much better than it was! You couldn’t see anything when I was a kid.” Which sure, we’re doing better in that you can see the mountains some of the time. But we still are suffering, we still have air pollution levels that are beyond what is set by federal standards. The work is not done.

  • Joe R.

    Most urbanists realize for now delivery trucks are necessary. Those aren’t the motor vehicles we seek to get rid of in cities. Rather, it’s the vehicles which aren’t strictly necessary for a city to function, such as private automobiles. If we could whittle urban traffic down to delivery/sanitation/construction/emergency vehicles and buses, I would be a happy camper. That would probably result in a 90% reduction in traffic.

    The best way to manage vehicle traffic is to provide other means for the majority in autos to get around. In the long run perhaps delivery trams or cargo bikes will be feasible in cities, but for now we still need delivery trucks. It’s better for everyone if we get rid of unnecessary traffic so these delivery trucks can make their rounds faster.

  • Joe R.

    I find it amazing how many people only think of pollution they can actually see. In many ways, we might have been better off if carbon monoxide, carbon dioxide, and other auto pollutants were highly visible. We would have had more public support to reduce them to zero.

    Electric vehicles are the obvious solution. Despite what naysayers tell us, they were viable even 50 years ago. Instead of batteries, the electric vehicles could have gotten their power on the fly, via inductive pickup. Now that we finally have decent batteries, there’s no excuse for electric vehicles to not become the norm.

  • Heather Gramp

    The #1 health issue caused in large part by cars. Obesity, and more specifically chronic disease and death caused by lack of physical activity — which acounts for an estimated 10.8% of all cause mortality in the U.S. (about 9% globally)! We’ve lost energy expenditure over the past 50 years in the areas of occupation, home life, and transportation — even while “leisure time” physical activity has increased. Active transportation is a key solution to this tremendous global health problem!

  • Tonyguy

    Doctors became drivers…. end of story.

  • Wewilliewinkleman

    Who are “urbanists”? If we live in a city aren’t we all “urbanists”? Or is “urbanist” just term for people who have an overly idealistic view of a city is? Kind of reminds me of people who throw around the word “sustainability” which for the most part is an opinion and not necessarily a fact. And any reading I’ve done regarding sustainability clearly lays out how economics plays a roll in “sustainability” and how you can’t have “sustainability without a strong economic plan to make “sustainability” work.

    There’s a lot of so called “urbanists” that throw out plans for remaking a city, but have no economic basis to support the drastic changes they want to impose.

    Oh, we can have a city where we can reduce 90% of traffic by getting rid of cars. Sure we can, but who’d want to live there? Imagine people who have a who have a job, a child in day care, one in grade school, groceries to shop for, doctors to visit, dry cleaning to pick-up, etc. Yes, people manage when they don’t have a car, but the expectation that you are going to take away people’s cars and expect ALL of them to do what they need to get done on a bus or a bike is crazy.

    You are going to drive the middle class (which is the backbone of every urban environment) out of the city. And once the middle class is gone, who will be left to support the little businesses that dot the streets, collect the sales taxes which support mass transit and make the city interesting? What you’re going to get is disinvestment like you haven’t seen since the 1960s. And what you will have left is the very rich and the very poor and a bunch of bike riders. Sounds like a scenario from a Twilight Zone.

  • Joe R.

    People use cars in cities because they have incentives to do so. If people were charged the actual price of on-street car storage, emergency services for collisions, external costs of air pollution, etc. a lot fewer people in urban areas would use cars. Not helping the matter is that we’ve continually reduced funding for public transit. I like to tell people that 75 years ago NYC had only 1 million fewer people but less than 10% of the motor vehicles it does today. Despite this, the city functioned quite well, arguably better than it does now. You don’t need large numbers of private cars in urban areas. Yes, people need to get around, but a lot of the things you mentioned are within walking distance of where many people live. So are elementary and middle schools. It’s not much of a stretch to imagine a combination of improved public transit, infill development, and disincentives for car use resulting in a 90% reduction in traffic. Everyone would benefit. Deliveries would be made faster, people would save the money they currently spend on cars, cities would save greatly on medical bills for car-related injuries and cancers caused by air pollution. More people would want to use bicycles. We ended up where were are not because cars are such a great solution for urban areas, but because of government and private industry incentives to switch people to cars.

    As for driving the middle class out of cities, the reason the middle class left the cities in the 1960s was because of a combination of welfare expansion resulting in an influx of poor people from states without much welfare, deferred maintenance of public transit, and finally expansion of urban highways which ruined a lot of viable neighborhoods. Arguably the last thing had the greatest effect driving the middle class out. Discouraging car use won’t cause significant numbers of people to leave the city. For one thing, upwards of half the people in NYC don’t even own a car. For them a city with fewer cars is a plus. For another, for every auto-dependent person you drive out there will be two who will gladly take their place. A lot of people nowadays expressly want to live in places where going without a car is possible.

    As for the term urbanist, I didn’t invent it. I’m using to loosely refer to people who want cities to be like cities, not like suburbs.

  • andrelot

    I disagree. There is nothing about using cars that prevent people from still getting physical activities elsewhere. Absolutely nothing precludes people from going to a gym, for instance. Using cars (or trains, or subways etc) is a massive improvement to the age when people would sweat before arriving for an office job.

    The real issue is that people eat too much too often, while our life has been modernized in ways that reduced the energy expenditure required for daily things in life.

  • andrelot

    Even the metro areas with the best transit networks still won’t allow people to commute easily on a reasonable radius from anywhere in the metro area (say, 40 miles). So a reasonable level of car traffic will be always needed unless we want people to be completely stuck on linear transportation networks, which would greatly reduce the array of choices they have for shopping, socializing, working etc.

  • Joe R.

    Sorry, but commuting 40 miles each way is ridiculous, especially in an age when many jobs can and should be be done from home. A better solution is more affordable housing closer to the central city, or perhaps faster transit. If people really want to live 75 miles from where they work, that could be a 30 minute commute on high-speed rail. Driving 40 miles to work is just nuts. On a good day that’s 2 hours each way.

    The problem with cars in cities is that whatever new choices they may make available to suburban residents, they cause many problems for city residents. That includes pollution, congestion, carnage, and use of space for roads instead of other things. Why is it OK to crap on city residents for the sake of the suburbs but if the reverse happened suburban residents would go ballistic? Maybe NYC residents should rent a bunch of SUVs and speed around cul-de-sacs in NJ or LI. That’s exactly what these people are doing to us.

  • Kevin Love

    No, it does not count. Why? Because there is no analysis or quantification of the harm to public health by car driving or benefits to health of active transportation.

    How many people in New York are being killed and injured by being poisoned by car drivers? How many people in New York are being killed and injured due to being crushed by car drivers? That six-pager has zero data.

  • Kevin Love

    There are plenty of major car-free urban zones in cities in Europe and Japan. The people who live there enjoy a greatly enhanced quality of life.

    Or, instead of going that far, a train leaves from New York every morning for Toronto. Which has North America’s largest car-free urban zone with hundreds of residents, parks, schools, church, a zoo and an airport. All in the car-free zone. See:

    http://www.theurbancountry.com/2011/06/no-cars-no-traffic-signals-no-deaths.html

  • I see. So in the age of the internet, each particular government has to perform its own data collection to prove the same thing.

  • Merlin

    Why haven’t doctors taken the lead in promoting healthier forms of transportation, and demanding safer streets?

  • Nina C

    Why are we only talking about doctors and not other medical professionals like nurse practitioners who also see patients? Shouldn’t there be a protocol for cautioning patients with drinking problems NOT to drive after drinking? Shouldn’t it be discussed as part of the checkup? Granted alcoholism carries a lot of denial, still it’s appropriate to talk about it.

  • ladyfleur

    Maybe the question is why people drive after they drink. The answer is simple: in most places, there’s no other convenient way to get home. We wouldn’t have such a big problem if we built cities that didn’t require driving, either by making them walkable, having 24/7 transit, or having reasonably inexpensive taxis.

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