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The Opinion-Dissent columns in this issue (p 176) are not quite as vitriolic as the risk compensation debate, but none the less represent sharp disagreement over the road traffic safety record in the United States. Much of the debate revolves around differing views about what denominators to use. This is not simply methodologic quibbling; it is a problem that has widespread implications for any type of injury. Ideally, a denominator should reflect those at risk. Using the entire population in this case, although conventional in public health circles, is likely to be misleading because not everyone drives, and some drive more than others. As to whether the trends in the United States are a success or a failure, solid points are made on both sides and in the end, the decision may lie in the eye of the beholder. But one way or another, as long as there are preventable deaths, no one should be satisfied. On this, I am certain both sides agree.
More fuel for the risk compensation debate comes from two reports. The first, by Macpherson (p 228) indicates that one of the objections to legislation—that it reduces cycling and thus fitness—may well be a red herring. In an admittedly limited study, they found no differences in cyclists after helmet laws were introduced in Ontario. The second, by Berg and Westerling (p 218) suggests that in the absence of such laws, helmet use declines as children grow older. They employed an unusual but powerful statistical tool, LisRel, to show that children's helmet use is directly related to parent helmet use and parents rules.
The flames of another controversy familiar to our readers are fanned by Evans' …