Tuesday, January 22, 2019

Journalism, Journalists and Twitter

The video of the teen wearing the red Make America Great Again hat in a face to face confrontation with a drum-pounding Native American went viral on social media.

Having spent more than four decade in the media, I am not surprised that newspaper journalists and television news reporters quickly cobbled together a narrative for publication and for broadcast.

For years I have contended that journalists should cooperate rather than compete. To a certain extent this position has been validated by the ICIJ stories, the International Consortium of Investigative Journalists. If the hundreds of journalists working on this story had worked together, a far more accurate story could have been written and in much less time.

For instance: it would have been clear that the Native American gentleman approached the teens and not the other way around as originally reported by many media outlets. Also, someone would have done the simple math and questioned the claim that the drummer was a Vietnam vet. It took days before this fact made it into the Washington Post.

I've also believed that stories should not be rushed into print. Stories should be done with accuracy in mind, not speed. All too often journalists make assumptions. Assumptions are quick. But, assumptions are also often wrong.

Personally, I think there is a good story here. But, sorting it out will take a bit of time. Social media will attack this story immediately. This cannot be prevented. But, in my humble opinion, journalists must not add to the confusion. I want to look to journalists for truth and not for conjecture.

The chap featured below, was the inspiration for this post. I do hope everyone understands I am treating him as the voice of journalism. After all, he was the chair of one of the most respected  journalism departments in the province. His position, his actions, are the one's respected in the industry today.

The other day I saw the above tweet in my Twitter feed. It was posted by Paul Knox, a retired journalism professor from Ryerson in Toronto. Knox had tweeted that his bs detector was left quivering by the response of the teenage boy featured in the viral video of the standoff between the boy and a Native American gentleman.

I tweeted a reply. I didn't mean to upset Knox. I simply wanted to tell him that, after looking at the time stamp on his post, I was surprised a journalism professor was still pumping out the all-too-quickly reported original take on the incident. Many news outlets were retracting their original stories at the time. The story as it was unfolding was becoming more and more complex.

Knox got his knickers in a knot. He took great offence at being accused of "pumping out" a premature take on the incident. He responded by pumping out a number of rapid-fire, defensive tweets.

Knox put me in my place, telling me I was wrong to think he had any preconceived opinions. He didn't. But, "as for more questions, yes, I have them," he tweeted. He continued, "If I were a reporter chasing the story I’d ask them. I’m not. I’m retired and on Twitter." Retired and putting his much bragged about BS-Detector to good use, I might add.

I told Knox, "I feel very strongly about journalism. It's an incredibly important job. But, since retiring, I've learned Edward R. Murrow was right: journalists have thin skins. Journalists are quick with fast quibs but slow with meaningful responses & Twitter is not the best venue." I wasn't just thinking of Knox here but all the journalists reporting this story. I wondered if the chap with drum was really a Vietnam vet but I didn't contact any reporters with my question. I've tried that in the past and it leads nowhere good.

Knox didn't appreciate my reference to Edward R. Murrow and a famous remark of his. He took my remark very personally. In retrospect, I'm not surprised. At one point, Knox told me, "Please don’t lecture me about journalism. I spent years and years dealing with these issues. The best journalists are skeptics as hell. But counter-narratives emerge all the time, on many different kinds of stories. People finally speak up. Another video surfaces ..."

Knox sure knows how to bring out the snorting, charging bull in me. Counter-narratives are one of my personal red flags. Get the story right the first time. And be damn careful with the counter-narratives.

A journalist must do the job properly the first time, make the background calls and check all the facts. And tread lightly when it comes to counter-narratives. These put my own BS-detector a quivering.

Think of the famous 60 Minutes Benghazi Report. The show, based on a counter-narrative, had one flaw: the counter-narrative was wrong.

According to the Poynter Institute:

. . . “60 Minutes” aired a report that called into question the official version of what happened when the U.S. diplomatic compound was attacked in Benghazi, Libya. At the core of the story was a source, Dylan Davies, who worked as a security contractor for the State Department. Davies had a book coming out that purported to share new facts about what happened that night, and what he did.

Problem one: he lied to the show about what he did and saw, thereby making a core piece of evidence in the “60 Minutes” counter-narrative false and undercutting the entire segment.

Problem two: it only took days for other news outlets, such as The Washington Post and The New York Times, to reveal significant flaws with the story, and with Davies. . . . "

I bow to the professor. He is, of course, right when he talks about journalism. He's been a guiding force in the industry for years. I'm sure his positions, when it comes to journalism, are completely defensible. It is how things are done. But, my contention is that folk, like the good professor, should be confronted. The old rules have let us down time and time again. It is time for a new playbook.

The old BS-detector has let us down too many times. Need proof? Read:

Who's a photojournalist?

The New York Times couldn't recognize a staged photo!

Or think of the infamous UFFI story. Thousands of people's lives were severely impacted by that bit of shoddy journalism. Retirees who had put their faith in their home as their retirement nest-egg saw it shrivel because a lot of journalists wanted to be first with the story. The counter-narrative, although true, never got traction.

The counter-narrative never got traction. I still see the UFFI myth treated as truth by the media.

Or how about another famous BS-Detector failure: Liberation Therapy?

People, people full of hope, died having this procedure preformed out-of-country. My heart doctors were not fooled but journalists were. Today, even the doctor behind the theory admits it does not work.

I believe journalists need more than a BS-Detector. Journalists need time and facts and money.

Thursday, December 6, 2018

A bridge with a future

As the former owner of a heritage automobile, I was disappointed when Í first inspected the re-opened Blackfriars Bridge. When I expressed my disappointment and explained why the poor paint and lingering corrosion bothered me, my friends patiently explained it's an old bridge, not an old car. It's been rehabilitated, not restored.

I thought for a moment. I recalled how my old Morgan was built in the days before seat belts. When I sold the roadster, the first thing the new owner did was install seat belts. This was an act of rehabilitation and something I should have done years ago. I had allowed myself to be seduced by the restoration mythology. Old or new, equipment must meet today's safety requirements. Anything else is stupid. I had been stupid.

Still, I wonder about all the unpainted stuff I found all over the Blackfriars Bridge. And the corrosion would not have been acceptable on an old car, rehabilitated, restored, re-anything.

All that said, I have to admit I was wrong. My letter to the editor published in the local paper was the raving of a crotchety old man. A geezer. It's a bridge.

The truth is those running the City of London should be quite proud. The continuing presence of the Blackfriars Bridge over the North Branch of the Thames River is quite remarkable. The fact it also still carries traffic is a rare achievement.

 If you had assumed a 143-year-old structure would not have been designed to meet today's demands, you'd have been right. (Heck, my Morgan was only 45 year old and it fell short.)

It is for some very good reasons that the Blackfriars Bridge of today is not, for the most part, the original structure. Instead, it is a ghost, an elegant reminder that the past is gone, that times change and that stuff must change too or be left behind. The Blackfriars Bridge has changed. It has not been left behind.

This is not a restored structure but a rehabilitated one, and a somewhat repurposed one. It no longer carries horses pulling farm wagons but cars, albeit in only one direction, plus numerous pedestrians and cyclists.

Top detail of derelict Wrought Iron Bridge Co. bridge arch.
It was almost 70 years ago that the bridge load was restricted to five tons. A few years later it was necessary to do "significant work" to strengthen truss members and reduce vibration. By 1986 the load limit had to be reduced again. This time to only three tonnes.

Since that first "significant work" was done, the bridge has undergone a lot of significant remedial work. It could be argued the bridge standing over the river today is a new bridge which incorporates the visual elements of the original bowstring-arch truss bridge.

I'm old enough to recall when hundreds, if not thousands, of wrought-iron bridges were still in use throughout both Canada and the United States. Almost all are now gone. Worn out, demolished, replaced.

Restoration: really?
I was disappointed by the new bridge because too many folk, often journalists, refer to it as a "restored" historic gem. It isn't. It's better.

The myth of restoration is a killer. Structures have been demolished when found impossible to restore. Restoration can be an impossibly high bar to clear.

The engineers who rebuilt the London bridge proclaimed quite openly they were rehabilitating the structure. Rehabilitating is not restoring.

There is very little of the original bridge in this latest incarnation. This is as it should be if the goal is to keep the bridge in use. Once we get our heads around the truth that restoration is not the only way to honour the past, opportunities open all around us. Think of Old Quebec. As I wrote in a previous post:

I am old enough to recall when many of the present "heritage" structures (in old Quebec) were not there. Many of these buildings were not restored but recreated. Much of the area's 18th century ambiance so loved by tourists is faux.

Once we accept that our new bridge is a glorious salute to the past, a glowing, functioning memory, we find it possible to openly ask, what is the best approach to preserving the illusion of age? We can bring artists and historians into the rebuilding effort and not just engineers. Artists like Ted Goodden, who featured the bridge in his art, would have brought a lot to the rehabilitation table.

Those who take the time to look will discover that the new Blackfriars Bridge is magic--a practical answer coloured by lots of romance and a little sentimentality. Gérard Morisset, the art historian behind the reclaiming of Old Quebec's heritage texture, argued it is completely acceptable to restore a structure "to a state of completeness that may never have existed."

A construction update picture posted by The City of London.
Make no mistake about it, the reopened Blackfriars is new bridge, a stronger bridge, a bridge with a future not just a past. This is not just a facade like the old roomless hotel pasted into the northeast corner the Budweiser Gardens. This is a working bowstring-arch truss bridge. Appreciate it.

Saturday, December 1, 2018

On my death, to my Indian friend, I leave my pacemaker.

So how dependable are pacemakers? Well, the University of Michigan has a program for recycling devices no longer needed by their original owners. Why are they no longer needed? Uh, the heart patient has died.

Pacemakers cannot make a heart beat that no longer has the strength to continue. There's no point in flogging a dead horse, as they say.

Tossing out perfectly good pacemakers with the cadavers is seen as a waste by the U of M folk. Working with funeral directors and crematorium staff, along with interested individuals, the U of M is recycling pacemakers that still have life in them, so to speak.

And who takes the old units. Why the third world. Many pacemakers are good for up to ten years today. Many folk die long before a decade has passed. Put these used units in the right patients and it it is a match made in heaven.

For more information, click the My Heart Your Heart link.

Thursday, November 29, 2018

Medical 'breakthroughs' hyped by media

This topic is tough to discuss. The danger is that one may come across as simply a defender of the medical device industry. I'm not.

Another danger is that one may come across as a media-hater. Again, I'm not. I worked at two newspapers and one television station and have great respect for many of the folk with whom I once worked.

Medical devices are often foreign objects surgically implanted into the human body -- a damn hostile environment for many materials. Corrosion is but one of the immediate threats.

Think about the discredited Liberation Therapy treatment proposed as a treatment for MS (multiple sclerosis). Doctors were slow to embrace the untested surgical treatment as it often involved the off-label use of a coronary artery stent being inserted in a vein in a patient's neck.

The media was quick to attack the doctors, government regulators and insurers for their reticence. The Post Media paper in London, Ontario, ran a story about a local woman unable to obtain government health care funding for the treatment.

When I looked into the wisdom of placing a stent in a patient's neck, I was told by the medical professionals questioned that they would not do it. Why? Too dangerous.

Liberation Therapy is no longer bandied about as a miraculous cure for MS. The doctors and clinics that were so quick to provide the treatment should be ashamed. Patients died having this surgery. It was a high-risk-no-reward treatment. And the press should be ashamed of the role it played in advancing this quackery.

So, is there a problem with medical devices? Yes. But it is a complex problem and the breathless reporting of patient-recipient horror stories, as I've encountered on CBC, is not the adult discussion needed.

Wednesday, November 28, 2018

Thank you, Medtronic.

My heart doesn't beat well. At least, it doesn't beat well on its own. I have a one hundred percent heart block. This a problem with my heart's electrical system and not a problem with my arteries. I'm not concerned about having a heart attack. What threatens me is heart failure. You see, on its own my heart would beat only about 30 times a minute, maybe even less. Without my pacemaker, my ankles would swell, fluid would gather in my gut and surround my heart. My lungs would fill with fluid and I'd have a difficult time breathing. Within days I'd be dead.

My pacemaker is an implanted medical device attempting to partially correct my heart's electrical system failure. It is not a perfect solution and there are problems associated with having one implanted. How anyone could think that having a chunky metal box inserted into one's chest and attached to one's heart by 26-inches of wire could possibly be risk-free puzzles me.

CBC is reporting that tens of thousands of medical devices distributed worldwide — like pacemakers — were approved for sale with little scientific evidence . . . 

CBC claims devices such as pacemakers are suspected of having played a role in more than 14,000 reported injuries and 1,416 deaths. This number is so large because it includes problems associated with a number of devices, of which pacemakers are but one.

Digging deeper I discovered CBC posted an interactive medical device database of associated incidents. I typed pacemaker into the device category field.

I discovered 157 deaths and 1,291 patient injuries are associated with pacemakers. This is not all that surprising when the complexities of the system and the all-too-clear dangers are considered.

Simply making a pocket in a patient's chest and inserting a metal box is fraught with danger: infection, blood clots,  stroke and the list just grows. And, if a problem does arise, the solution may well demand another operation. Surgery is never risk free.

What did surprise me were some of the incidents that made the list. I admit to cherry picking but this is my point. Don't just take the numbers and other bits of information at face value.

The CBC encourages us to question the motives of the device makers. The manufacturers may be driven by a need for profit. I suggest the CBC, and all news folk, should face questions as well. Journalists may have their own demons driving them forward. Think viewers, readers, awards and even think profits. I like to think it's the demand to tell a good story that blinds them.

So what were the surprising incidents that made the pacemaker incident list? Here are a few:

  • patient piloting air ambulance involved in plane crash died. no evidence to support a device-related cause for the event.
  • generator and associated leads were removed due to infection. source of infection unknown. patient died from liver cirrhosis.
  • patient died due to acute coronary artery disease. device tested and functioned properly and within specification. patient was 85.
  • pacemaker implanted for heart block. developed non-ischemic cardiomyopathy with ejection fraction diminishing. root cause was physiological.

Now maybe a good time to read the CBC fine print:

  • CBC has not verified the accuracy of the data. 
  • Reports might have been filed to Health Canada with inaccurate or incomplete information. 
  • There is no certainty that the medical device caused the reported reaction. 
  • A given reaction may be the result of an underlying disease, process or another coincidental factor. One report may be tied to multiple parts of the same device and multiple reactions may be connected to a single patient. 

The data does not reflect any CBC assessment of association between the health product and the reaction(s).

I'm on my second pacemaker. I got seven years out of my first unit before the battery failed. I apparently suffered no infection from the replacement surgery. My luck seems to be holding. But, I cannot be completely certain I escaped the threat of infection until a full year has passed.

My original lead, the 26-inch wire connecting my pacemaker to my heart, was retained and reused. It has now been operating in a very hostile environment, the human body, for eight years. How long that lead will last is anyone's guess. The electricity-conducting wire could corrode or succumb to metal fatigue. Leads do fail and the frequency increases with time. And, of course, there is always the threat of manufacturing defects and recalls.

Just living carries risks. I simply live with a few extra risks. But risks in life are often nicely balanced by rewards. I believe the risk/reward ratio associated with my pacemakers are weighted heavily in favour of my pacemakers.

Thank you Medtronic.

Despite the scary tone of some of the CBC reporting concerning pacemakers, the ICIJ stories, the source for the ongoing CBC reports, is often not as frightening. The ICIJ is actually fairly reasonable. The following is from the ICIJ report titled: Frequently asked questions and resources for readers.

Do all medical devices have problems?

No. For example, pacemakers and implantable cardioverter defibrillators (ICDs) have revitalized and saved millions of lives.

I'm not keen on having man-made stuff implanted into my body. I've had car problems, microwave breakdowns and expensive camera battery failures. Stuff fails. It is a fact of life. Sadly, sometimes stuff fails because of poor design or shoddy workmanship. This is not acceptable in any situation but it is a worst case scenario when it involves the failure of a medical device. The ICIJ is doing us all a service.

The ICIJ asks who is watching the medical device makers? I wonder who is watching the journalists?

Sunday, November 4, 2018

Who's really endangered? Answer: Newspaper editors.

This opinion piece contains many questionable numbers. In the old days it would've been spiked.

"Who's really endangered?" My answer may surprise you: Newspaper copy editors.

A quick reading of the opinion piece written by Elizabeth Nickson left me asking, "Where is a copy editors when you need one?" Copy editors are an important and respected part of every newsroom — or, at least, were in the not-so-distant past. These talented, well educated, team players fixed grammar, corrected spelling and checked both usage and style for agreement with the newspaper's in-house style guide. (This post would look quite different if I had a copy editor.)

Copy editors acted as proofreaders, fact checkers and polishers of dull prose. Exceedingly knowledgeable, copy editors had solid backgrounds in journalism. Some of the best were first-rate reporters before moving to the desk.

Sadly, copy editors are a dying breed. Many have been given early retirement, their jobs declared redundant by the giant media conglomerate owners.

The opinion piece written by Elizabeth Nickson, a fellow at the right-wing Frontier Centre for Public Policy, often called a right-wing think tank, is a good example of writing in need of a skilled copy editor.

 Nickson immediately stakes out the territory she is attempting to control: The sixth great extinction. "Unlike climate change, the notion of the sixth great extinction is not contested vigorously . . .," she claims, moving quickly to a full frontal attack on Paul Ehrlich, whom she derisively calls "the godfather of extinction science."

Unfortunately, it seems Nickson got her godfathers mixed and predictions as well. She tells us that Ehrlich predicted 27,000 extinction a day by 2000. He didn't. It was Edward Wilson, the father of sociobiology and a champion of biodiversity, who made that prediction, sort of. He predicted 27,000 extinction a year.

That's more than 70 a day, an amazingly high number until you understand the professor is talking about the destruction of the world's rainforests, the most biologically diverse places on Earth. He is not talking about black-tailed prairie dogs in the west or caribou in Canada's distant north. He does not restrict his prediction to large mammals and birds and this should come as no surprise; Wilson is the world’s leading authority on ants.

Ehrlich's and Wilson's ideas have attracted a lot of opposition over the years. It's a rich, complex world and, just as one would expect, not every biologist studying endangered species agrees with either man. Nickson would be in good company if her facts were correct but they aren't.

Nickson does no better reporting on the black-footed prairie dog situation in Colorado. Numbers are again the Frontier Centre writer's downfall. I won't go so far as to say Nickson is wrong but there is no doubt that her writing lacks clarity. People familiar with the situation in Colorado were puzzled by the Nickson numbers.

Nickson claims 12 million acres was demanded to protect to the black-tailed prairie dog. "In court, the state's scientific rigour won, hands down," she says.

Tina Jackson, Species Conservation Coordinator with the Colorado Department of Natural Resources , wrote me, "I am not sure where they got that information about black-tailed prairie dogs in Colorado." Neither Jackson nor James Baker, also with the DNR, was aware of this ever being taken to court.

Elizabeth Nickson was good enough to share some of her research links with me for this article. Reading through the links, and links to links, she sent me I found the following:

The earliest published estimate of prairie dog occupied acreage in the state (Colorado) is from C.P. Gillette in 1919 . . . (Gillette believed) prairie dogs inhabit about 12 million acres in the State . . . [Is this the source of the 12 million number?]

A good editor will tell a newspaper writer to deliver the goods before the turn. Break a newspaper story into two parts and a large number of readers won't make the turn. Editors keep stories short, interesting and accurate.

Today, a great number of people are failing to even pick up the paper, let alone make it past the turn. If newspapers want to bring back the readers, bring back the copy editors.

Black day for the blue pencil

Monday, October 15, 2018

CBC earns an incomplete for seat belt story

The CBC is making a big deal of its investigation into the need for seat belts in school buses. I can see the argument. I often accompany my oldest granddaughter on school outings. I sit in the school bus with the children and I feel weird not wearing a seat belt. It has never felt right and so I did some research.

Finding the definitive answer is not a quick search. It turns out this is a complex problem and a lot of folk have given it a lot of thought. Heck, even the researcher quoted this morning in the CBC report was once featured in a New York Times piece carrying the headline "Study Rejects Requiring School Bus Seat Belts."

Kathleen Weber, the researcher quoted by the CBC, told the Times that all the members of the committee examining the question of seat belts use in school buses were in agreement: the benefits of requiring seat belts were sufficiently small, and the problem itself sufficiently small, that the committee could not justify the cost.

I don't like that answer. If seat belts work, put them in the school buses. Period. End of discussion. Surely, cost does not enter into the equation. We are talking seat belts. How much can seat belts cost? The present system of making school buses safe, compartmentalization, cannot be cheap.

No, the question is: do seal belts work? Or more accurately, do standard seat belts work with little children? Think carefully before answering. If you do, you'll realize little children do not ride in the backseat of the family car restrained only by the three-point seat belts provided. By law a booster seat is required. Why? For safety.

In Canada, over a two-year period, 28 children were reported to have sustained injuries consistent with seat belt syndrome; seven of these children remained paraplegic. Among the 16 injured children eight years of age and older, four were properly restrained with three-point seat belts.

Booster seats are an attempt at preventing maladjusted seat belts from causing serious injuries and even death to improperly restrained children. Ill-fitting seat belts are a big safety concern. Studies show children are especially vulnerable to suffering a seat belt caused injury. Transport Canada has some well founded concerns.

As I mentioned, I have grandchildren. I own two types of booster seats: one a booster cushion and the other a high-backed booster seat that installs using the Universal Anchorage System (UAS/Latch). Both are legal in Canada but not everyone in the world agrees. The use of booster cushions is restricted to older children in Great Britain and Europe. In those places, my grandchildren would be breaking the law by using booster cushions.

Whenever possible, I use the high-back booster seats which attach firmly to the car's UAS system. I leave the booster cushions at home in the garage. My gut feeling is that the high-backed, anchored boosters deliver improved protection. I think the Europeans are making the right decision. I'd like to see this style of booster seat, paired with properly designed seat belts, used in school buses.

The Fifth Estate did one thing right. They found IMMI in Indiana. This is a company developing innovative seat belts for school buses. One product features a five-point system that appears to deal with the biggest dangers posed by traditional three-point seat belts. Kudos to the Fifth Estate for finding the IMMI company and bringing it to our attention.

An independent study of the IMMI product or products may be necessary but surely it could be done quickly. Let's make school buses, already remarkably safe, safer still.

Lastly, one-sided attacks, like the one launched by the CBC, make for attention-holding television but such attacks don't encourage folk to come to the table for an adult discussion. I'm not surprised the minister refused to meet with the CBC Fifth Estate reporter. It appears on the face of it that the CBC folk had an agenda and it wasn't getting at the whole truth and nothing but the truth. It was attacking a government bureaucracy. It was in telling a good story.

When writing a post for my blog, an immense amount of information must be found and read. I admit it may overwhelm me. A better system would be for journalists to work together and to work longer, ignoring self-imposed, artificial deadlines, to deliver accurate information. Below, is just a very small sample of the info found and examined.

Sixteen passengers died and 13 were injured in the Humboldt Broncos bus crash. The charter bus company involved in the crash had already installed seat belts without a federal rule, but none of the players were wearing one.

Research link: http://www.who.int/roadsafety/projects/manuals/seatbelt/seat_belt_manual_module_1.pdf

The three-point lap and diagonal seat-belt used by adults is not designed for children’s varying sizes, weights, and the different relative proportions of children’s bodies. For example, a smaller portion of a child’s abdomen is covered by the pelvis and rib cage, while a child’s ribs are more likely than an adult’s to bend rather than break, resulting in energy from a collision being transferred to the heart and lungs.

Consequently three-point lap and diagonal seat-belts may lead to abdominal injuries among children, and will not be optimally effective at preventing ejection and injury among them. Appropriate child restraint systems are specifically designed to protect infants and young children from injury during a collision or a sudden stop by restraining their movement away from the vehicle structure and distributing the forces of a crash over the strongest parts of the body, with minimum damage to the soft tissues.

Child restraints are also effective in reducing injuries that can occur during non-crash events, such as a sudden stop, a swerving evasive manoeuvre or a door opening during vehicle movement.

Seatbelt Syndrome in Children: This is an interesting paper. Seat belts are good but, when it comes to their use with children, proper booster seats are an excellent addition to increase safety. It should be noted that there are a number of opinions on what exactly constitutes a proper booster seat. For instance, look up what is demanded in Great Britain.

http://www.roadsafetyobservatory.com/HowEffective/vehicles/child-restraints (The researchers found that abdominal injuries mainly occurred in children using only a seat belt, emphasising the need for belt-positioning boosters. (Jakobssen, 2005))

(The main system for safely restraining occupants in vehicles is, of course, seat belts. However, seat belts do not fit children properly, and do not fit babies at all. This means they are less effective in protecting children, and in some circumstances, could even cause injury.

Children are not simply smaller adults; they are proportioned differently, their bones are not fully formed and their skeletal structure does not cover and protect their internal organs in the way it does in adults. All of these things change as children grow older, meaning that the type of restraint system they use also needs to change, until they reach the point where the seat belts can provide the same protection as for adults. (Burdi and Huelke, 1969, WHO, 2009))

Child Car Restraints Compared with Seatbelts
A USA study of 2 to 3 year old rear seat child passengers in crashes that resulted in at least one vehicle being towed away between 1998 and 2004 concluded that the odds of injury were 81.8% lower for toddlers in child seats than for toddlers wearing seat belts. (Zaloshnja, 2007)
Another American study comparing the use of child restraints with seat belts by 2 to 6 year old children involved in vehicle crashes between 1998 and 2003 found that compared with seat belts, child restraints (when not seriously misused) were associated with a 28% greater reduction in the risk for death in children of that age group. When including cases of serious misuse, the effectiveness was slightly lower, at 21%. (Elliot, 2006)

A study of crashes in 15 states in America between December 1998 and May 2002 involving 1,207 children aged 12 and 47 months, seated in the rear of vehicles, found that the risk of serious injury was 78% lower, and the risk of hospitalisation was 79% lower, for children in forward facing child restraints than for those in seat belts. (Arbogast, 2004)

A study of 17,980 children under 16 years old involved in crashes in 15 states between December 1998 and November 2002 found that the risk for inappropriately restrained (defined as using a seat belt rather than a child safety seat or booster seat) children was almost double that of appropriately restrained children. (Durbin, 2005)

An analysis of fatal car accidents in the USA between 1982 and 1987 estimated that children in child safety seats were 50% less likely than unrestrained children to be killed, but those using the car’s adult seat belts were only 36% less likely to be killed. (NHTSA, 1998)

When these estimates were updated in 1996, the estimates for the effectiveness of seat belts on their own had increased to 47% in cars and 48% in light trucks or vans. The effectiveness of child restraints had also increased from 69% to 71% for under one year olds and from 50% to 54% for one to four year olds. (NHTSA, 1996)