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The original title for this editorial was “saying goodbye and thanks” but it occurred to me that some might leap to the conclusion that I have decided to retire as editor. Being uncertain whether this would be greeted with glee or gloom, I decided to change the title to the above.
In the normal course of events, when an author receives a galley, the instructions are to check it carefully, make no major changes, and return within 48 hours. One of the many benefits of being an editor is that such rules can, at times, be broken. When I received the galley of the editorial I originally wrote for this issue, my heart sank. It was a set of unrelated ideas, none developed sufficiently well to merit publication. So, at the risk of upsetting our devoted technical editor, I asked that it be replaced with this one, which I hope clearly says what I want it to say.
I wrote the first draft of this editorial some time after one of my mentors, Jack Tizard, died. Jack was a world renowned psychologist with whom I worked on the Isle of Wight study, which, parenthetically, paid no attention to injuries. Nevertheless, he played a critical role in my training and was a good friend. I deeply regretted that I had not thanked him properly for all he did for me before he died. And he was only one of many mentors about whom the same misgivings applied. Hence, this editorial.
I was reminded of this unpublished draft when I delivered an acceptance speech for the Ross Award from the Canadian Pediatric Society. As is customary on such occasions, I thanked my families—my wife and children and my metaphorical parents, siblings, and children: teachers, colleagues, and trainees. In doing so I reminded the audience of the importance of thanking all these before they die, not in posthumous eulogies. The broader point I was making was that in the world of injury prevention as in most research, little of what we do is a solo effort. Whatever we may think we have achieved reflects the influence and input of our families, and above all, that of our mentors.
For example, when I went to London as a fellow in social pediatrics in the early sixties, I was an eager-to-learn, would-be researcher. My mentor, Bob Haggerty, said I should contact, among others, Ronnie Mackeith. After we met at Guy's Hospital, he took me to dinner at his club, the Athenaeum, the shrine of writers and artists. (MacKeith was an expert on Samuel Johnson and the editor of Developmental Medicine and Child Neurology.)
This was the first of his many spontaneous acts of kindness. The last was when we left London two and a half years later. He called me the night before our ship was to sail and presented us with a case of claret. Overwhelmed by the likely difficulty of getting the case on the boat train along with two children, we compromised: I accepted one symbolic bottle and left it with my in-laws for safe keeping. They drank it on their 50th wedding anniversary!
Whenever we met he offered much wisdom and more aphorisms than I could ever remember or use in a lifetime. But he, too, died (on my birthday) before I could express my gratitude for all he had done, including encouraging my interest in writing. He influenced my development as a person and as an investigator. Saying thanks for all that is fundamentally different than saying thanks for the invitation to the Athenaeum or the case of claret.
The world of academia is a strange one, and that of research stranger still. Most who choose this path do so because they believe the benefits far outweigh the sacrifices. Few have any illusions that they will make great discoveries, but all are driven by the challenges of trying to find answers to tantalising questions. As well, the life of an academic is an opportunity to influence the lives of others by teaching and mentoring.
That's where saying goodbye and thanks come in. I don't suppose it really makes much difference whether we die raging “against the dying of the light” or succumb peacefully with letters of appreciation scattered around our bedside. Perhaps the letters don't mean much at that time and only make the sender feel better. Nevertheless, I urge readers to not put this act off until it is too late. Doing so may even be good for the soul.
Banning accidents: an addendum
Vigilant readers will have noticed a BMJ editorial written by Ron Davis and me entitled “Banning accidents”.1 The editorial announced that in future all BMJ publications would avoid the use of the word “accident”. The main arguments in support of this move need not be spelled out for readers of Injury Prevention, but neither Davis nor I were prepared for the storm of criticism that followed, most of which appeared on bmj.com. (I urge readers to visit this site and follow the “Sturm und Drang”.) When the dust finally settled, the score was about 25 against and 25 in favour. In spite of the draw, we felt obliged to offer a global reply. In summary, it reaffirmed our conviction that the “A” word is undesirable for many, many reasons beginning with the fact that it has so many meanings, especially with respect to preventability. We acknowledged that some injuries are not preventable, and, in fact, when the editorial was being drafted (and Davis deserves all the credit for initiating it), I was prepared to concede that the primary event could in some cases be appropriately called an “accident”. On this point, however, Davis was more of a hardliner than I, and in the end we stuck to our guns. It was when the term was applied, as it so often is, to the subsequent injury, that we were equally and vigorously opposed.
In our reply we also disagreed that there was a critical difference between injury predictability at the individual and population level but agreed that these could be two sides of the same coin. The argument that “most people understand that `accidents' are preventable” was easily demolished; if they did, there would be no incentive to ban the term and the evidence, even from Girasek's study,2 supports this view. When accused of censorship, of being Orwellian, and totalitarian, we conceded that the use of the word “ban” may have been stronger than was intended and reminded readers that we had no intention of being draconian in its application. We also noted that language changes, and that although past attempts to change how English is spoken have failed, it does not diminish the need to challenge how it is written in a scientific context.
Will banning the “A” word reduce injuries? There is no evidence it will, nor is there evidence it will cause harm. I, for one, still maintain that part of the reason governments have been so indifferent is their failure to view injuries as they do other diseases and that this is driven, in part, by the continued use of the word “accident”.3
We strongly disagreed with one repeated criticism that in banning the use of the word “accident” we were blaming the victim. I have often stated that the victim can only be blamed when it is clear that society has done all that is possible to prevent injuries—a condition rarely fulfilled. Finally, and most surprisingly, there was concern that much editorial effort will be needed to find a suitable substitute. The best evidence to refute this lies in the pages of this journal—rarely have we been forced to use the term “accident” and we have never, ever had difficulty finding a suitable replacement —usually (surprise! surprise!)—the word “injury”.
Accompanying this issue is a supplement sponsored by the National Institute for Occupational Safety and Health. As each of the editors (Nancy Stout, Gordon Smith, and I) note, we believe many of the papers have relevance for readers with interests other than workplace injuries. I urge readers to not only skim Injury Prevention from cover to cover, but to extend this practise to this and any future supplement. I rarely read a paper that does not include at least one useful lesson. Admittedly, sometimes the lesson is what not to do, but more often it includes ideas that can, with imagination, be translated from one field to another.