15 Jan, 15 | by Barry Pless
In some circles I am regarded as an injury prevention fascist, safety hysteric, protect the children fanatic, a wuss, or worse. This has come about because I consistently push for more prevention and less risk taking. I am not at all convinced that risk-taking is good for child development, as some would have us believe. Nor am I convinced that having a serious injury with possible life-long (if not life-threatening) consequences builds character, or whatever. But I was not the least bit surprised when I recently came across two newspaper accounts one of which challenged these views. I responded to it but not yet to the other.
The first was in Canada’s National Post (NP). It was written by its editorial board who were prompted by a municipality’s ban on tobogganing on certain hills. That action was based in part on the work of Dr. Charles Tator, a renown pediatric neurosurgeon and founder of ThinkFirst Canada. Tator’s study revealed huge risks of a ‘catastrophic injury’ from tobogganing. (http://www.tandfonline.com/doi/abs/10.1080/17430437.2011.614787?journalCode=fcss20#.VLapHsZpwyE) To be specific, his research found that over 4 years tobogganing had the fourth highest chance of grave risk, exceeded only by diving, snowmobiling, and parachuting. In that time frame about half of the serious injuries involved the head and one quarter the spine. This placed tobogganing among the most dangerous of all recreational activities. Tator made it clear that he was not suggesting that tobogganing be banned or regulated, but he did urge greater caution.But the lawyers for the municipality fearful of liability suits had other ideas.
In contrast to the ill-informed NP editorial board, a wiser and more responsible health reporter, Andre Picard, argued that tobogganers should not have to “pay for ‘liability chill.” He acknowledged that tobogganing is a “high-risk” activity but that the risks can easily be reduced. He added, “What is more difficult to contain is the voracious appetite of personal injury lawyers and the financial fearfulness of cash-strapped municipalities.” He went on to write, “In fact, while helicopter parents and overly cautious public health officials often get blamed when ridiculous bans on tobogganing, road hockey, skateboarding and the like are instituted, the real culprit is a torts system that has lost touch with reality.” As Picard summarized, “risks can be reduced by improving control and better head protection”. Importantly, he also quoted Drs. Tator and Francescutti (former Canadian Medical Association president) who asserted that “municipalities should provide information on how to ride safely rather than block off popular hills”.
In contrast, in its infinite wisdom, the National Post editorial that bordered on ridiculing Tator and which encouraged many commentators to contribute their mostly foolish and irresponsible views. (The link to the editorial is http://news.nationalpost.com/2015/01/05/national-post-editorial-board-the-freedom-to-toboggan/) Only a few commentators, (including, ironically, the editors themselves), acknowledged that the community had an obligation to remove dangerous obstacles, etc. I was disgusted with the tone and content of the piece and posted this comment. Undoubtedly, as is true for most letters I write to editors, it will do little except make me feel a bit better.
“It is hard to imagine why a supposedly responsible editorial board of a respected paper should ridicule the important message Dr. Tator issued. For the editors to make the comparison with car crashes is entirely inappropriate and ironic because I assume they have no problem with laws that regulate how cars are used! Similarly the comparison with personal responsibility with feeding grizzlies is simply embarrassing. Surely even Post editors would agree that at the very least the community shares the responsibility to prevent injuries of all kinds; that it is not simply up to the individual. That is why grizzlies don’t wander freely and communities notify snowmobilers that lakes are half frozen. This is a disgusting editorial that comes close to ridiculing one of Canada’s leading neurosurgeons and one of the few who makes a huge effort to keep people out of his operating room. Praise, not mockery, is the morally correct response and the editors owe Dr. Tator and their readers a huge apology.”
To which “John Smith” (??) wrote: “@barrypless – your angst is what is ridiculous. Are you Dr. Tator’s houseboy? Be thankful for writers and editors that don’t kneel down and kiss the ring of someone with a bit of fame and are willing to question their statements. And yes, it is up to the individual. Grow something in that mansack.”
Then, just as I was getting ready to post this blog, I came across a report from the Irish Times based on an editorial in the BMJ that criticized rugby’s “tribal, gladiatorial culture”. (Note: European rugby is not the same as American football). The editorial describes the rugby culture as one that “sees parents, coaches and schools encouraging excessive aggression and playing on when injured.” As the author, a paediatric neurosurgeon, Michael Carter wrote, “Anyone who has spent an hour picking skull fragments out of the contused frontal lobes of a teenage rugby player is entitled to an opinion on the safety of youth rugby.”
One possible solution offered by Carter is that the age of contact rugby be increased to 12 years. He noted, however, that a 14-year-old sustained three head injuries in one game and speculated that the increased interest in rugby is related to it becoming a professional sport. That has lead to a preference for hulk-like players. These problems seem similar to those now experienced by the National Football League in the US. Carter called attention to New Zealand’s approach to the issue which entails “teaching people how to play the game safely and correctly. “
The BMJ editor, Fiona Godlee, added: “Let’s call the current state of monitoring and prevention of rugby injury in schools what it is: a scandal. It needs urgent remedy before more children and their families suffer the consequences of collective neglect.”
My reaction is, “Right on, Fiona!” (although I doubt if more monitoring will help much). To my surprise and pleasure, so far most of the Responses in the BMJ have been supportive and constructive. Eventually, however, I expect we will hear some vociferous ‘risk-is-good’ voices but somehow I doubt that their owners would accept a spinal cord injury if risk-taking continues to be encouraged.