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Abstract
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Although few drugs, surgical technique, and public health measures are put into widespread use today without rigorous testing and evaluation, such assessment of efficacy is the exceplion rather than the rule with countermeasures against accidental injury. Many countermeasures now in use have never been evaluated; others continue in use long after they have been proved to be ineffective. Driver education, for example, is being widely adopted in the face of mounting evidence that it does nothing to prevent accidents. Programs of "home safety education" continue to be formulated despite considerable evidence that they do not produce the intended results.
This unconcern for--if not downright resistance to--systematic research on effectiveness has several consequences: (1) It permits programs of questionable value to absorb funds and manpower that might better be used in developing effective programs. (2) It precludes the possibility of a cost-effectiveness approach, which promises to be at least as useful in injury control as it has been in other areas of social concern. (3) It develops and strengthens vested interests connected with established programs--and thus it increases the resistance against objective evaluation. (4) It lulls the lay public into a false sense of security, since the public is likely to assume that accident countermeasures have the same degree of validity as other public health measures.
The signal contribution of the paper that follows lies in its challenge of a "safety measure" that has long been accepted and disseminated by professionals and laymen alike. Although the population studied is both small and in some respects atypical, the findings are strong enough to warrant further study of larger and different populations.
The methodology employed is also worth emulating. Recognizing the bias inherent in medical records and the difficulty of obtaining valid and representative responses to mail questionnaires, the investigator resorted to both interviewing and observation, which, though unquestionably expensive, are probably the most effective methods of data collection available to the research worker studying accidental injury.
Language: en |