When you’ve just ‘celebrated’ your 87th birthday there’s not much joy to be had from looking forward to whatever academic activities may lie ahead. But, there are some lessons – and perhaps a few pleasures – when you take the time to look back at life as a would-be scholar and activist.
Over my 50 years of academic life, much of my time and energy involved what might now be called ‘advocacy’. In the old days it was less politely referred to by terms that might be paraphrased as being one who ‘agitated feces’. As such I fought many health care battles and lost most of them. Those that I might have put in the “win” column were undoubtedly due also to the passage of time and other forces.
Some examples might help illustrate some of the many failures and my reactions to them. In the early part of my career I tried to convince the healthcare community that children with chronic illnesses were at considerably increased risk for psychosocial problems. I did so calling on my research, giving many lectures, and by trying to lobby, advocate, and play politics. Nothing seemed to work. Later, a consortium of talented, well-respected colleagues and I tried to put forward the view that those with chronic disorders should be considered as a group, i.e., what came to be known as a non-categorical approach. We asserted, supported by our studies, that it was the chronicity that mattered most, not the specific underlying disease. But paediatrics mainly continues to operate in disease-defined silos. After 25 years of effort, our push had little success.
During the latter part of my academic life I entered the field of injury prevention. I did so when I discovered that injuries were the leading cause of death among children and young adults. What followed was a variety of studies on topics ranging from child car-seats to house fires. Later, I had the unparalleled benefit of being able to preach from an editor’s pulpit. I enjoyed this opportunity to share my views with a captive audience. But there was no way to determine what effect, if any, my editorials may have had. And, I realized that these editorials were mostly preaching to the choir.
A possible exception to the succession of disappointments occurred in 2001 when the late Ron Davis, a fellow editor and I, persuaded our publishers (the BMJ publishing group) to ban the use of the word “accident.” We took this initiative because we were convinced that most injuries were preventable and we reasoned that as long as many physicians and most of the public continued to view injuries as ‘accidents i.e., simply the result of bad luck – not much effort would be invested in their prevention. The ban was short-lived, eventually reversed after succumbing to an avalanche of letters to the editor opposing the decision. The counterproductive A word is back in fashion and it seems many readers and policy-makers continue to view injury prevention as futile. After all, why struggle against random events?
Another such battle that has not yet ended, is one favoured by many prevention naysayers who assert that most safety measures (e.g. seatbelts) are fruitless because their benefits will always be offset by increased risk-taking (e.g., speeding). Their theory is that we have a set point of risk tolerance such that any preventive measure is counteracted by less concern with risk. This so-called ‘risk compensation’ idea remains widespread, especially among those who oppose certain safety measures such as bicycle helmet laws. Clearly, belief in this discredited notion makes prevention far more challenging. This is especially so when policy makers need to be persuaded to spend time, money, or effort and can use the theory to avoid any of these elements. I fought to refute the notion, in print and in debates. Clearly, whatever success I may have had was at best partial because the view is still held by many.
A related and equally contentious idea is that among children, risk-taking is necessary for normal development. Once again, I opposed the idea. Apart from the absence of empirical studies to support it, I never received an explicit response to my frequent dissents. Essentially, I kept asking how the risk-taking proponents could accurately predict when a risk will be safe and when it might prove fatal. Some while ago a well-funded Canadian group were proposing a similar approach to prevention. This organization, SMARTRISK, also urged that risks could be taken provided one did so safely! At one time, the Royal Canadian Air Force military aerobatics demonstration team, the Snowbirds, (the only such team to operate without a support aircraft) were heralded as ‘representatives’ of SMARTRISK. I was reminded of the Snowbirds involvement when one of these pilots crashed. Several journalists noted that over a period of 35 years 6 Snowbird pilots had died while performing.
My repeated challenges to SMARTRISK prompted it to threaten me with legal action. Eventually, the organization was dissolved. It re-emerged as Parachute Canada. In contrast to its predecessor, Parachute’s messaging is entirely in line with the prevention mainstream. Maybe the dissolution of the original group can be seen as a small victory but, in general, over the years of so many such battles I have come to feel a bit like a Don Quixote.
Although looking forward may not be appealing to any elderly former academic, I conclude that looking back is not necessarily much better. Especially not if much of one’s career has involved ‘swimming upstream.’ This was the title I chose for a speech I gave after receiving an award from the Canadian Pediatric Society. I guess the key question is, did I enjoy the swim? Would I want to do it all again?
The answer is a clear ‘yes’, although if I did, I hope I would have much better results.
The Aged One