#295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk | Mark Rosekind, Ph.D.
02:29:08 Share

Hey everyone, welcome to The Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen.

It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members. And in return, we offer exclusive member-only content and benefits above and beyond what is available for free.

If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peteratiamd.com forward slash subscribe.

My guest this week is Mark Rosekind. Mark is a safety, sleep, fatigue, and policy leader with more than 30 years of experience in acting strategic, practical, and effective database solutions that enhance safety and health in complex environments. He was the chief safety innovation officer at Zoox, an Amazon-owned autonomous mobile company from 2017 to 2022. He was also appointed the distinguished policy scholar in the Department of Health Policy and Management,

at the Johns Hopkins Bloomberg School of Public Health between 2020 and 2022.

Previously, he was appointed by President Obama as the 15th Administrator of the National Highway Traffic Safety Administration. Before becoming the NHTSA Administrator, he was appointed by President Obama and served as the 40th member of the National Transportation Safety Board, the NSTB, which you no doubt will recognize is the organization that is always investigating plane crashes, train crashes, and other disasters.

Additionally, Mark previously directed the Fatigue Countermeasures Program at NASA Ames Research Center and was the Chief of Aviation Operations Branch in the Flight Management and Human Factors Division. He earned his bachelor's degree from Stanford and his master's and doctorate from Yale University and completed postdoctoral training at Brown University Medical School.

In looking at what we internally call the death bars, which you've likely heard me talk about, which we use to identify what are the threats to our lifespan, you may recall that while the four horsemen

generally get the lion's share of our attention, there's always this pesky fifth cause of death, which is deaths due to accidents. And while we typically speak about one subset of those, which are the accidents that are due to falls because they disproportionately increase later in life, there's one cause that seems relatively consistent throughout life, and that is accidental deaths due to transport.

And so I wanted to do a deep dive into this topic because frankly, when I consider my own mortality over the next decade, this occupies a disproportionate share of what might account for my relative risk of death. And I know that for many of you listening, that is also true.

In this conversation, we obviously talk about Mark's background, which is quite unique and how it led him to be an expert in this. We look at the statistics of car crashes and how that's changed over time. We talk about the groups that are most at risk and the locations where most of these incidents take place. We then look at various things that can increase the risk, such as obviously being on your phone and being distracted, the role of alcohol and cannabis, sleep deprivation and drowsiness, speed and weather.

We talk about autonomous vehicles and new safety technology. And we talk about what pedestrians need to be aware of and what resources are available for people to learn more, especially parents. And this is something I'm thinking a lot about as my daughter is on the cusp of beginning to drive. So without further delay, please enjoy my conversation with Mark Rosekite.

Well, Mark, thank you so much for joining me here today. This is certainly a topic that I don't think gets enough attention given the consequences of it. It's also a topic that I think maybe people don't necessarily appreciate the frequency of such interactions. And I guess one of the things I'm hoping to understand today is how much of the nature of what we're going to discuss today is under our control.

I know that as I think about the things that are a threat to our lifespan, a number of these things are kind of out of our control, but many of them are actually in our control. Certain diseases, for example, like cardiovascular disease, are almost entirely within our control, and genes play a role, but your ability to sort of go above and beyond the genetic hand you're dealt is significant. But here, when it comes to accidental deaths,

And as a subset of that, the role that fatigue plays in that, I want to really explore this. But I think before we do, I think it's important that people really get a sense of you and your background. When we decided we wanted to spend time on this topic, it felt almost too good to be true that we discovered you and your work.

The way things sort of work, Mark, is basically we sit around and brainstorm ideas that we want to cover, and then we go out and look for an expert. That's 99% of our podcasts work in that way. I remember when Nick came to me and said, okay, you know, this is what we found. And I was like...

Wow, that seems amazing. We're going to really answer a lot of questions I've always had. So tell us a little bit about your background, because the first thing that stood out to me was how at a very young age you lost your father. Yeah, let's start there, right? Long time ago, but it still is challenging to talk about, actually. Let me just begin by thanking you for making this topic part of your discussion in your podcast.

You already said it. This is so prevalent in everybody's life. Just being on the road. Everyone's a pedestrian at some point. We're all in vehicles moving around. And yet we have come to accept the carnage in ways that should just be unacceptable in our society. So without bringing more focus, including what you can control, like what should I be doing to be safer versus things that I can't? Just a critical conversation. I really appreciate you taking the time to do this.

And I paused for a moment because it actually was not until my Senate confirmation hearing to be administrator of NHTSA that I really talked publicly about this very much. But my father was a San Francisco motorcycle policeman. He was chasing a traffic violator and somebody ran a red, hit him, and he was killed in the line of duty. Actually, just over my shoulder, that's the shadow box with his badge and purple heart.

He was 30 years old. My brother and I, I was three and a half. My brother was two, raised by a single parent. I'm okay talking about this to start with because it just points out this is personal for me.

And I've told people, it's like, I don't wear that as a badge on my shoulder every time we have the conversation, but it is clearly foundational to sort of what has put me on a lifelong path of pursuing safety and how to make people's lives safer. And one of the things I often talk about, I'm sure we'll get to it, is if you want to know how many lives were lost on our roads, make sure you know the exact number, because every one of those numbers is...

is a father or mother or sister or brother or some relative or one of your neighbors, etc. Those are real people and we cannot bring them back. And I think that too often when we start talking about all the statistics, we walk right by the human part of this and that gets lost. And really, that's where we should always start.

Yeah, there's a quote that I'm not remembering exactly, but it speaks to the idea that a million people is a statistic, but a small number of people is a story. And I agree with that completely. I mean, I think we can get very numb to what those numbers mean. I don't know if you've seen it, but there's a series on Netflix right now that takes a lot of old footage from World War II footage.

and basically does some remarkable technology application where it puts it back into color and makes it really remarkable. And so it's a six-part series on World War II that is, like I think anybody who's watched it has shared my reaction to it, which is it's stunning. But what's hard to fathom as you go through this is the loss of life. You hear about 60 million or 80 million, I don't even remember, people lost their lives globally.

Obviously, we're aware of 6 million people being exterminated in concentration camps. And yet I realized as I came to the end of that, I don't even know what that means because I've never seen 6 million people with my eyes. I've never seen 1 million people with my eyes. So it's very difficult to explain those things. And what I think this series does very well is what you've done, which is you get a few stories.

You get a few stories that are very representative of the horrific nature of what happened. And then at least you have some semblance of saying, wow, now imagine multiplying that by a thousand or a million. And the numbers numb you. As you just said, it's like, I don't know what that really means. So it numbs you. Very often in talks, I would actually start with what we call in the business bent metal.

And so, you know, having been at the NTSB, I'll literally take photos from investigations minus the humans. But it's like this was Dawn at 20 years old. She not only lost her life, but the people in this minivan you see, four out of the five died. And the only one who didn't was a child in a car. I mean, that makes it real for people. And what you hope is people translate that to this could be you.

or a partner, or your kids, or your neighbor, you know, people that matter. And there's this huge gap between those numbers you're talking about, which most people have no concept, and the fact that when somebody actually in your circle loses their life in some kind of crash, that makes it very personal. And again, you can't bring them back. There's no coming back from that.

Well, I definitely want to get into these statistics, both in terms of people in cars, people as pedestrian cyclists, et cetera. But before we do, I do want to come back a little bit to your story because I want people to kind of understand your training and what took you to Yale. You did your PhD there, what you studied and how that ultimately kind of led to what you're doing now. So tell us as much or as little as you think is necessary for listeners to kind of get a sense of the trajectory you've taken to where you are today.

I'll give you the arc, and it's more of a zigzag. Whatever you want to go in depth, let me know, because as always, there are interesting stories along the way. I'm trained as a scientist. I was actually a pre-med at Stanford and had the incredibly good fortune to take a course called Sleep and Dreams when I was a sophomore. And it was taught by William Dement, MD, PhD, a professor in the medical school, and

And Dr. Dement was part of the team that discovered REM sleep. And some believe he was actually the guy who coined the term REM sleep. And as you know, even though we all as a human race have been sleeping since crawling out of primordial slime, we only knew about non-REM and REM in the mid-50s. And so Dr. Dement came to Stanford and started really one of the first sleep centers and was teaching this undergraduate course.

And it was just fascinating. He was this passionate, charismatic professor who was engaging. And here's this medical school professor teaching an undergraduate course, which, by the way, at the time, the two most popular courses were Sleep and Dreams and Human Sex. Another medical school professor, you know, it's kind of like for undergraduates, what else is there? It was just fascinating. But what was really brilliant about what Bill did is he actually offered a couple of courses.

You could take a course and become a TA for sleep and dreams, or you could take another course and learn where to put electrodes and how to score sleep and actually get involved in research. So the summer of my sophomore year, rising junior, I actually got signed up to be a research assistant, staying up all night in a laboratory. Think about it, that as an undergraduate was an incredible experience. You'll decide if we talk about this later, but everything got canceled that summer except one project, which was studying the effects of the waterbed surface on sleep.

was the 70s. And I actually met my wife during that study. It's worked out quite nicely. But it was a way to get involved in research as an undergraduate that you don't usually get the opportunity. So that kind of changed everything. And frankly, when I graduated, Dr. Dement made an offer for me to stay and run research projects. And the reason I bring that up is because if you knew where the electrodes went, and this is a K-complex, a sleep spindle, here's how you score sleep, you could run projects.

And so I did that for a few years and I tell people that was like doing a postdoc before going to graduate school. My direct supervisor was Dr. Dement. Okay, so I did three years of doing it. And that's why when I was ready, I actually applied to medical school but changed because at the time there was no sleep specialty. There was no sleep medicine fellowship. There was no training in any of that. Dr. Dement was pushing to make that real.

And so I decided if I wanted to spend a career looking at sleep, it was go get a PhD. And so, as you mentioned, I ended up at Yale, great academic research program, but could also get clinical training.

So if I wanted to deal with humans and projects and stuff, I could get my training in clinical psychology but still do research. The interesting spin actually after that is, and I appreciate the chance to talk a little more about this than just dates, but when I was finishing my PhD, somebody I knew from Stanford, Mary Karskadin, who had been at Stanford, and she and Bill actually created what is now the gold standard for objectively measuring sleepiness called the Multiple Sleep Latency Test.

Nobody ever thought Mary would leave Stanford. And she was about to start a new position at the Brown Medical School as an assistant professor there. She had one technician ready to go and she called me up and said, "Mark, would you like to come and do a postdoc?" So there were three of us getting her program started at Brown. It was an incredible experience. The plan was to stay, go on the faculty, etc. And instead, I ended up going back and working for Bill.

running a human research program for a while. So, you know, I'm hardcore academic sleep. But part of my job was to get new projects going. And so I got engaged with NASA Ames Group, which is one of the NASA facilities out here in Mountain View, California. And they were doing fatigue jet lag research, but didn't have many actual sleep people helping them do that. Some chronobiology circadian people. But it was fascinating because they were doing a study that required recording EEG in a cockpit.

And they weren't really sure how to do that. So part of my job was to actually help them problem solve that so we could record pilots' brain and eye movement activity in an ongoing way during flights. Fascinating. And I mention that because that was a transition really out of the very specific academic kind of environment to NASA.

And so I ended up being recruited to work there and directed the program at the NASA Ames Fatigue Countermeasures Program for seven years. And it was fantastic. And I think it emphasizes what has become sort of for me

You know, again, not just personal, but a clear focus of my career, and that is the application of the science into real world application. And so that's really been a force for me throughout my career, hence the safety emphasis. Great sleep science, but how do you use that to help people every day? Whether that's driving a car or flying a space shuttle, what do you do to make that better?

I did that for seven years. That was commercial and military pilots, astronauts, controllers at Johnson Space Center, etc. Fantastic, incredible work. Love to talk about that too, I hope. And then I started my own company, which broadened it from aerospace to basically everybody. So when I had my own company, we worked with folks in all modes of transportation, basically all over the world in healthcare, energy, military operations, you name it, it was fantastic.

The next part that was so interesting, part of the zag, was I had the opportunity to become a board member at the National Transportation Safety Board. So there are five members that are there. These are the kind of positions where they call you. You don't actually submit a resume. I had done some work at NASA helping them identify fatigue in a DC-8 crash in Guantanamo Bay before anybody knew that there was a naval air station there, a DC-8 crash. And the NASA group, we helped them at the NTSB define the methodology to investigate fatigue.

And they ended up identifying fatigue as the probable cause in that particular crash. And that has become the methodology that they use. So 10 years later, it was amazing to basically get a phone call and say, would you like to be considered for a board member position? So I was a board member at the NTSB for five years.

launched on seven crashes and sat through about 50 investigations that we voted on. And I was ready to stay for a second five-year term when I got a call to become the head of NHTSA, which is the National Highway Traffic Safety Administration. And that's the administrator of the organization within the Department of Transportation that is responsible for all car and vehicle safety regulation and enforcement.

And I was there for just a couple of years because that one is tied to the president, basically. Unbelievable experience. Again, if you think about what we just talked about, which is how do you take the science and data and actually apply it to make things safer, better, was an incredible experience there. And when I left Washington, I actually came back and worked as the chief safety innovation officer at Autonomous Vehicle Company, which is like a way at the other end of the continuum that's been fascinating as well. Wow.

It's interesting because there's this marriage between two things that you're talking about, right? Which is one could have stayed entirely within the world of sleep.

and done obviously very interesting work. And you are fortunate to have been at Stanford, which in many ways certainly was the epicenter of sleep research, at least in the US and potentially in the world. And then you've also got this interest in safety and crashes, right? Obviously the NSTB. So we're going to talk about both of these things today. I think I'd like to just start probably on the automotive safety side of things.

And I think what will come out of that is the role that fatigue plays. And then we can certainly talk about that. I said earlier, we're going to put some statistics out there. Can you give me a sense of what is the risk for death or injury risk?

that somehow touches the road. So that means, again, you're a passenger in a vehicle, you're driving a vehicle, you're a pedestrian struck by a vehicle, you're a cyclist struck by a vehicle. However you organize that, Mark, can you give me a sense of what that looked like in 1950-ish versus 1970-ish versus 2000-ish versus today? Or give us a sense of what that looks like.

Let's start with the final numbers from 2021, which is the last year we actually have complete data. 42,929 people lost their lives on our roadways. And you were just saying it says drivers... Gee, gee, say that again. How big?

42,929 people in 2020. That is 118 people every single day. And good for you. It's like, give me that number again. This is what I was telling you. It's like, you should know the exact number.

Because those are people, individuals, we can't bring them back. That's 118 every day. And a lot of times people often it's like, so how come I don't hear more about this? Or why are we, you know, like pandemic meant it was all hands on deck. Let's go get this. Like, how can we put up with this? When you think about it, these happen geographically separated. So these are happening all over the country.

And very often it could be an individual in one of those vehicles. So it may affect your family or your community. But very often, most of these go unreported in the general media or visibility for our society. 118 lives every single day. Just to put it in context, along with that, we have about two and a half million injuries.

which are everything from slight to very serious life-changing injuries. And those are in the context of six plus million crashes every single year. And I won't go into this in any depth, but just to put it on a global scale, it's about 1.4 million people globally every year. And that's about 3,700 people every single day.

But we're going to focus just on the United States. And I think your question is really important because we know over the years, things have come down very significantly with all kinds of different things I'm sure that we're going to talk about. But it used to be like literally 100 years ago in 1923, it used to be about 18.5 deaths per 100 million miles. Now we're down to about 1.5.

So we often talk about vehicle miles traveled or VMT, and that's important just because of the number of miles driven and the number of people that are out there doing. There's a lot of different ways to cut this. And by the way, I'm sure we'll go into some detail, but at NHTSA.gov, NHTSA.gov, NHTSA keeps all kinds of data on this. You can look up any year you want, and it's segmented by year.

ages and geography states, you know, I mean, it's like the level of detail is unbelievable what's out there. I will just comment that for a lot of people, when they look at the data, the reason I cite 21, it's the last year that we have actual final data. So we can talk about what we know from 2023, but those are estimates just done on a quarterly basis. And I'm sure we'll talk about it, but we get those and they adjust up and down a bit, but it's the big numbers that really matter.

There are two things that just jump out at me when you rattle off those stats, Mark.

The first is I'm just doing really quick math in my head, both on the global count and on the U.S. count. And this is approximately one tenth the mortality for cancer. In the U.S., it's a little bit better than one tenth, but globally, it's actually slightly worse than one tenth. A, that's incredible. It might also say that in the U.S., we are probably safer on average than globally on an individual basis. So not sure if that's true, but that would be my first thought.

The second thing that just kind of jumps out at me when you talk about this is something I remember reading.

somebody saying once that I think is absolutely true. If you read about a death in the newspaper, it's because the manner in which it happened was so unexpected or is somehow so horrific to us. And that's why you don't read about people having heart attacks. I mean, let's not lose sight of the fact that that's the leading cause of death. And that occurs 20 times more frequently than what we're talking about. And I don't know the last time I read about somebody having a heart attack for the sake of having a heart attack and dying, if it's somebody famous or whatever, but

But common things just generally don't get reported on. And I think, sadly, that's probably why we are a little bit numb to what's going on here, even though I would argue that...

There's a difference, which is those of us who are driving by and see this carnage are kind of left a bit visibly shaken by it. And I find it difficult to get information. I'll give you one example. I live in Texas and we have big roads out here that are big and fast. And I think a lot of them are not necessarily set up as the safest roads. There's a particular road near where we live, where I believe there's probably a fatal accident on this road.

three or four times a year. And yet, even after it happens, I'll go and do a quick search to see if I can get more information, and it's not readily available. It's not entirely obvious what just happened. So if that's happening under my nose where I'm seeing the accident or, you know, seeing the aftermath of it within 25 minutes or something, I can completely appreciate why most of these deaths go

unnoticed by all those except for the people directly impacted by the relationship. That's the numbness. They're off the radar. They're not visible even locally to many people. So that's why I often cite NTSB statistics or experiences because those are usually not necessarily matched casually, but there's usually a lot of people involved. There have to be fatalities and they're very visible. As you mentioned, very often it's because they're visible to the entire country and

you know, and they get invested. It takes a year, 18 months to investigate those, etc. But as you're pointing out, if it's not in the local police blotter that it happened, there's almost never follow-up that actually says, oh, by the way, you know, what we reported on last month, here's what actually happened there. And I just mentioned that because I tell you from the NTSB, when you investigate these, it's always a chain of events. It's never just one thing. And it takes a while to figure that out. And just to be clear, a lot of that sometimes is just the local resources.

Just to be clear, you know, in the last few years, traffic enforcement resources at local police departments have gone down. So as you were just saying, they may go and run to the scene when they've got to help people in that emergency situation. But the ongoing investigation may be checking a box on a form. So it stays below the radar for most people, unless you're in the circle that that person touches your life.

Yeah. And I struggle with this a lot, Mark, because I feel like there's this enormous missed opportunity. So I look at an intersection that's no more than three miles from our house. We haven't lived here for four years. I have already seen three fatal accidents at that intersection in four years.

And I can't find any really good information about the chain of events and what happened. I have some sense a little bit, but to me, it's like, why aren't there four minute videos being made that explain every one of these as a, here's what not to do. Here are the warning signs at this time of day, when the light is this way, this is a very easy mistake to make. And the other thing we don't really have a sense of Mark is the near misses.

If three accidents have resulted in fatalities, and by the way, I'm not saying three people have died. I'm seeing three fatal accidents. It's probably six or seven people have died there in three years. But I mean, you can tell me, Mark, but what would be your guess as to how many accidents have occurred there or near misses occurred there that could have resulted in fatalities? Do you have a sense of how you could even estimate that? You could. You could.

And just two things about this. One, you're describing in what we call a human factor is that safety pyramid, crashes are at the top, near misses are right underneath that, but a bigger layer. And the layer underneath that are errors. And this is why a lot of people where you see proactive safety in aviation, they do a lot of work trying to capture those errors, knowing that they lead to near misses. And when near misses get more visible, you see the panic in aviation right now because they're seeing more critical near miss incidents.

Because those are the precursors to the crashes that occur. To your point, so you could calculate that. And I got to tell you, make a list because out of this conversation, there's some concrete things that either you or I need to pursue. The one you just mentioned is we got to make these more visible rather than just the family and community feeling it. It's your point, which is even in a four minute video, you could capture what happened and what was learned from that.

And that could be enough for people to say, okay, I got to pay attention to that because I go through that intersection every day, twice. Yeah, exactly. Four times a day, I am driving through that place that is the Bermuda Triangle of death. And once a year, there's going to be a death or a series of deaths. Probably five times a day, there's a near miss. Probably 60 times a day, there's an error that could have even been a near miss.

And yet I don't actually know the predisposing factors. I'm kind of extrapolating and making up from the data out there that I know loosely that we'll talk about today. But yes, this is very troubling. So I think we've kind of hopefully made the case for why this matters. Just a couple of other questions before we get into some of the specifics. And I won't expect you to rattle off with the same precision.

But can you give some commentary on what these numbers would have looked like 20 years ago, 40 years ago, 60 years ago? I mean, I have to think that with airbags and seatbelts and better cars, better car technology in terms of the collapsibility of cars, that things have gotten better. Like, is it easier to just start in the 1950s and presumably it was just mass carnage?

What's interesting is as cars just became more prevalent, that's when the numbers went up. And yes, in the 50s, you saw huge numbers, which were actually part of what initiated efforts to establish the National Highway Traffic Safety Administration, which was what had responsibility for creating federal motor vehicle safety standards like crash testing, all of those. So if you go again 100 years back,

We're probably over 90% reduced to where we are today. Probably in the 50s and 60s are where you saw the peak of those numbers and they've been coming down. I would just say, because we're talking about this in the statistical sense,

What's interesting is we have really population level statistics we talk about, 42,929. What's interesting is we get these estimates every quarter and then it takes a while to finalize it. Again, we don't need to get into it, but literally NHTSA collects reports from every police department in the country to come up with these numbers.

So it takes a long time to collect all that data, review it, finalize it, etc. But I say that because the estimates often prompt people to say, oh, we're down 3% this quarter from last quarter.

I think we should celebrate those lives that have been saved, that are still with us. At the same time, that 2%, 3%, 4% up or down within the context of the overall population numbers, we haven't budged much. And I'm sure we're going to talk about it, but I got to give you one example. You know, a lot of people think, you know, we've cured trunk driving. It's been around forever. We know about it. We've got all these things we can do. When you look at the 42,929, the top three causes in there are

impaired driving related to drunk driving. That has stayed about 30% for 20 years. So, 30% of the lives lost are due to that for about 20 years. So, the absolute number has come down, but the percentage has stayed about the same for 20 years. And then, again, on that list right below that is speeding. And now we've got number three, that's distraction.

And I'm sure we'll be talking about all of those. But again, I think to your point, it's both the large population numbers. 50s, we started seeing that peak. Now, again, it's down to about 1.5 per 100 million miles that we see. But I do warn people is...

Again, when you start looking at just the quarterly to quarterly estimate up or down by one or 2%, that will belie what is actually the larger population things that aren't changing dramatically enough if we're ever going to actually say get to zero deaths on our roadways. And Mark, you mentioned that alcohol contributed to about 30% of those fatalities. What is the contribution of speed and distraction approximately? So speed's over 20%.

I want to say somewhere between 20 and 25%. Distraction is very difficult, right? I just actually called a friend of mine. There's this guy, Larry Blinko, who's a great statistician at NHTSA. He's starting to think it could actually be up to 30%.

And part of it, you got to realize these are not individual numbers. So somebody drinking could be on their phone. They could be going too fast. Somebody who's on their phone could be going, right? It's like they all mix and match, but they're pretty big numbers. So it's at least a third, which again, takes you into like 33, 35% range for the alcoholics.

alcohol impaired regions, speedings in the, again, 20 to 25% probably. And the distraction used to be considered somewhere in the 12%, but I think Larry's new data is going to suggest it's probably much higher, maybe close to a third with some of them. And especially if we talk about it, distraction is more than just your phone that people do in their vehicle. So when you look at all of it, just like impairment is more than alcohol now.

Yeah, that's a great question. So to be clear, I said alcohol, but really impairment is that broader category of which alcohol is probably still the most prevalent. In fact, it's so appropriate for this conversation, but impairment was always three Ds, drunk, drugged, distracted. And when I was there, it's like, and I credit my son actually, it's like, where's the fourth D, dad? Drowsy.

Because really any one of those would be enough to impair your driving ability. So now impairment, you do have to think broadly that it could be any one of those. To your point, alcohol is still the number one. Yeah. Well, there's so much I want to talk about. I'm just trying to think about how to structure it so I don't miss anything. Let's talk a little bit about, let's go deeper into this contributing factor thing. Okay. So the most obvious thing in the distraction realm is the advent of the phone. So prior to...

I don't know, early 2000s, phones were not readily used. Can we appreciate or is there an appreciable signal in the data that suggests that the downward trajectory of mortality has been slowed or in any way altered with the introduction of mobile phones 20 to 25 years ago? I think the way we would be able to characterize it is that we stopped seeing the decrease that we had been seeing.

And I say that because as you know two things. One is it's really hard to measure the distraction numbers.

I mean, it's just so difficult. Same thing with drowsy, sleepiness and stuff. And the other part is just the evolution of the phones, where first it was just, you know, on a phone call, if you will, but now it's texting and looking up stuff. I mean, it's just so diverse, the activities that you could be engaged in. And so again, I think that maybe the way to think about it is more that we were making progress in a bunch of ways that flattened or maybe got a little bit worse. And we may not be able to put all of our, quote, variants, appropriate that to specifically just phones. But I would also say it took

to a new level, the distractions you could get in your car. Because some of them have been around for a long time, playing with the radio. We can talk about buttons versus touchscreens, etc. Kids in the back seat. Those kind of distractions have been around forever. But again, I think as those were getting more controlled, you saw the numbers come down. Phones, I think, again, we could look at it more as a flattening out, probably. Has there been any significant change in the past year

40-ish years with respect to the demographics of the drivers at fault in these crashes? In other words, are we seeing a shift to younger people, to older people, anything that you can point to that there's a causal explanation? So there are two groups that seem to be most at risk. Those are the 16 to 17-year-olds and about the 65 to 70-plus.

And the conjecture around those two, clearly we're talking about people who are just learning to drive and who are at an age that don't have that frontal cortex fully developed and

I have a friend of mine, Greg Belenky, always talked about it's like there's a hole in their head right there. So we're letting those people behind a couple tons of metal who have very little experience and just learning stuff. And at the other end, you've got people getting older who actually, some of it may be aging specific effects. The other is more just how much they're actually driving and experience and that sort of thing. But those are the two main age groups that we see that are mostly affected. More men than women die in these crashes.

So many questions with that. Some of it's segmented. Some of it, to your point, the causal or contributing parts of that would just be us with hypotheses about what's actually causing those differences and things.

What was the rationale for letting people drive at the age of 16 when if you think about other things that are mandated by age, you have an age at which you can join the military, you have an age at which you can vote, you have an age at which you can drink alcohol, purchase firearms. So there are various things that seem tethered to age, but driving is the youngest.

I've always wondered, I didn't get my driver's license until I was like almost 18 because I viewed it as a badge of honor to ride my bike and take the bus everywhere. And I didn't want to be lazy. Like I was a weird kid in that way. So I personally can't relate to what it's like to be a 15 year old who's dying to get his license. But tell me a little bit about that process and how that came to be. And for example, given the stats you've just shared, why that age hasn't been pushed up?

I don't know you. I don't blow smoke. And so I don't mind, Tanya. Nobody's asked me that question before. I'm going to go look that up now because nobody's really had a discussion around that.

The discussion is all about our education system, driver's ed. In so many other areas, we've got recurrent training. I mean, you have that in medicine, you have that for professional drivers, pilots, etc. How they actually came up with that age and came up with what are we going to do around that age to actually prepare these people for lifelong driving experience?

I'm going to go look that one up. I don't know. That's the first time somebody's actually asked me that, but it's fascinating because I would also say part of your point is we've actually not gone back to question whether we need to change that or not, which as you know, comes up all the time. I can give you an example. I could pontificate and say, look, I mean, kids were working jobs. They needed to be able to get there and dah, dah, dah. And it's like, okay, maybe all of those things are true. Is that true today? I don't

I don't know. The other thing that has always struck me, one thing you should know about me, Mark, I do love driving and I love driving race cars. So I love all things motorsport related and I love, I love drifting, like doing all of these things.

And one of the things I've been trying to encourage my wife and daughter, my daughter's 15, we're coming into this discussion and I've been trying to organize a course for my daughter and some of her friends where we get a group of really good driving instructors on a 20 acre skid pad to really teach them high end driving skills. The stuff I certainly didn't learn when I was young.

But the things that I've learned driving a race car, which is everything not to do, like your natural inclination when this happens is going to be to do this and you will spin the car. And if you're lucky, nothing else will happen. If you're unlucky, you'll hit something else. And if you do this, you'll actually flip the car.

And I don't believe that you can just academically outlearn that you have to just do the reps. You have to be on the track in the car doing it over and over again.

So again, I'm guessing that there has been some calculation that has said we can't justify putting those resources into mandatory driver education, right? It's just people have decided that we just can't request that kids learn that. I don't think so. I think it's the first part of your question, which is I don't think people have questioned from the beginning. Why did we even start there?

Are we preparing these kids well enough for this life experience of driving? And how do we revisit that in our knowledgeable, technology-driven society? How do we actually go and upgrade that to something that could actually save their lives and the people around them better? I don't think those questions have been asked. And I'm with you. I think the intellectual academic part of lessons, great. But unless you do the muscle memory part of the behavioral piece of actually experiencing it,

I don't think there's any question. I don't mind telling you, since you're familiar with F1, you know, Jean Todd, and I've gotten to know him over the years. He's got this high level panel. And what's been fascinating, he is now the UN sort of ambassador for global road safety. Oh, I didn't know that. And he has taken that on from not only his F1 days, but his Ferrari days, etc. But he's taken this on with a passion. How do we take what we've learned there and applied it? And why am I mentioning that? Because you already have the one idea about the videos.

This is another one you should write down because this is one of those investments, right? If we get these kids early, it's a lifelong investment of the ones who actually learn how to do this and be better at driving than the ones who sit in the course or do it online and never get behind the wheel to know where the signal is. That's not really much education. And again, I think it's more not that the analysis is done and we should write it off. I think it's people haven't asked those questions or taken the time. And I mentioned John just because you know what?

Let's send them a letter. Let's come up with what you're doing. Formulate that and send a letter and say, so somebody at the very least ought to do this and let's study it and see if you can't come up with a course that would make sense. Because what we just talked about is that investment now could be huge in saving lives and costs. Yeah.

Let's talk a little bit about the locations. I always tell my patients that there are three areas where you need to really have a heightened sense of awareness to protect yourself. And feel free to just correct anything I'm saying that is not 100% correct because, again, my data is a little bit old. But the three things I say is, one, you have to be hypervigilant in intersections. And that's both the standard four-way intersection, but also a T-intersection, like when you're coming out of a mall or something and you're coming out of a gas station or something like that.

The second place is the two-way traffic without a median. Devastating, especially as I said, we have these roads here that are 60 mile an hour roads with no median. So personally, those roads scare me, but they're unavoidable where I live.

And then I think the third place you have to be aware is on freeways and in particular around exits and on ramps where people are acting sometimes irrationally, merging, trying to get off at the last second, trying to get on, doing silly things like that. And I basically say, look, if you can harness the power of your attention only selectively while driving, make it those three spots.

So what would you say to that, Mark? What would you add to that? And can you comment on what fraction of fatalities are a result of crashes under those three scenarios?

Yeah, I think you've actually nailed it. I'm not sure I can give you the exact percentages for each one of those. It's actually in the order of you've got. And all I would do is say, you've got the intersection part, which is any intersection, as you pointed out. The second is beyond just the median in the road, it's any road separation. So that's true, not only of vehicles, but also pedestrians and bicyclists. You would think about the median in the middle, but it's also on the sides where...

Unfortunately, the last 10 years, we've seen literally a 50% increase in pedestrian deaths. Again, I'm sure we'll talk more about that. But again, that has to do with what you're describing, not just the median in the road, but let's expand that to separation deaths.

of the vehicles from, again, the sides where pedestrians and cyclists might be as well. So I think those garner it and you're on and off ramp of any kind of system. Again, with the issue there is the speed differential. The challenge you have there is trying to figure out not just that I have to merge, but the speed you need to merge with traffic going at whatever their flow is in that particular situation. I think the other part

It's great for us to talk about the statistics. You know, we love to hit the bell curves and like these are the highest. But I always point out, we also got to do those edge cases because lives still get lost in those.

One of my mantras is never again. You know, when those kinds of special education has happened, you need to share that data. Hence that four minute video. So interesting, whether it's common or edge case. So it doesn't happen again. You shouldn't need every intersection in the world or everywhere, you know, to go through that kind of loss of life to decide we should change something. We should do something different here in some way. And unless you make it visible, understanding the causal and contributory factors, you can't make those changes.

And just so I understand, Mark, I've seen accidents where a driver makes a slight mistake, but it becomes catastrophic. And I'm always taken back to 1994 when my hero, Ayrton Senna, died May 1st at Imola.

And Max Mosley, who was the head of the FIA at the time. I knew Max. Oh, you did? Wow. Yeah. Max said something very, very insightful at the press conference in the days following Senna's crash, because the press, understandably, were completely fixated on why he crashed. How did Senna crash? And Mosley said, you're asking the wrong question.

He crashed because he is the best driver in the world driving a car at the physical mechanical limit of what it is capable of doing. Crashes are going to occur. The question isn't why did he crash? The question is why did he die?

And he really made sure that the sport took a turn at that moment in, we will not tolerate drivers dying. We might not be able to stop the crashes, but there will be no more deaths. And knock on wood, there has only been one death in F1 in the 30 years since. And what I find fascinating

troubling is I'm gathering from you that that analysis isn't being done for the 42 plus thousand people who died in 2021, where someone is saying what contributed to the death and what can be learned about making that the ultimate thing that we put a buffer between. For example, when a person makes a mistake,

you always want to have more of a buffer for that mistake to not result in the nature of force that could kill them. So for example, in a racetrack, that's the difference between having a bigger runoff than a smaller runoff. That's the difference between having more impact absorbing things in areas where we expect people to potentially go off. And yet my guess is that analysis on the individual basis isn't necessarily being done. That is correct.

And I think what you do see are the level of analysis that we can cite, the segmentation, etc., that again are at sort of more population level than into the specifics of a particular crash at that particular site with those particular individuals. Again, I'll cite the NTSB. This is why it takes a year plus to do an investigation because you're going to look at all of the factors that are involved there, identify both the probable cause as well as contributing factors,

and then make recommendations so it doesn't happen again, which again, I hope we talk about this some more, but those investigations are reactive, but they're intended to take information so you can prevent them from reoccurring again in the future. And I think that, again, is what separates NTSB investigations that are so thorough from, again, what we've been talking about at the local police department level. They just don't have the resources or time and other kinds of things to go and do those kinds of analyses. Does NTSB only investigate

trains and airplanes and sort of huge things. Like what's the mandate of the NTSB? Because it says transportation, which you would think includes all forms of transportation, but obviously it can't do this type of analysis for cars. Exactly right. The NTSB is required to investigate every aviation crash.

So that's the big commercial stuff, but that's also the local general aviation stuff that happens in every community all over the place. But then it investigates specific crashes that occur that have national importance. And so in every mode of transportation, mostly, for example, on the roadway, you see mostly buses and trucks because those are big. When there are fatalities, there's more involved usually.

But they can do single individual crashes as well. So when I was there at the NTSB, we did several related to distraction with folks on their phones, for example. Now, when you go into it, you don't know exactly what you're going to find, but you get enough information to say, we should go after and see this because it would allow us to make recommendations that would have national importance to do that. How did those come to you? Given the sheer volume of these crashes, how would the NTSB make a decision or determination that this

car accident is potentially one we're going to put resources towards. I mean, do you have some inkling of what the cause is before and you think this is basically the illustration case? Let's pull the cover back on the NTSB a little bit to see how this process goes. And it's very much what you're talking about.

So we got to do all aviation. What are the high opportunity investigations we could look for in marine, in roadway, in other areas? In fact, people don't realize it, but pipeline and hazardous material also fits under there. So pipeline is a mode of transportation that gets investigated as well.

But to your point, what happens is it's like, so what are the hot issues that we think are going on in this industry? And then you wait for calls. And where do those call comes? They come from everywhere. A local PD might call about one that's going on. You could get it from official. The FAA lets you know about a crash of something that's going on somewhere. There's an op center, 24-7 op center at the NTSB. It gets all of those phone calls. And again, to your point, you won't know ahead of time, but if somebody says, well,

We think this was involved, we think that was involved. You have to make a decision. Do we go after that and look and then maybe find out it wasn't the case,

But if it is, that's the one that you want to be able to go in depth on so you can make recommendations to the entire industry or individuals or whatever you need to do to try and get changes. Now, when we think of the NTSB or when I think of the NTSB, I think of aviation and everybody thinks of the black box. You guys have this amazing data recorder that almost without exception is recoverable and it contains not only what the pilots said up until the moment of impact, but

but also the telemetry. You actually see this was the position of this aileron. This was the thrust on this engine. This was the yaw in the state. I mean, you know every detail of it. What do cars have in them that allow the NTSB to do that kind of thorough investigation? I mean, I'm a little embarrassed. I don't know the answer to this, but I assume the car still contains some sort of a black box for telemetry. I mean, I know my racing cars do, but I assume streetcars have some of that.

Yes, and just to start, those black boxes are actually orange.

Yeah. And that's partly so you can find them, right? Yeah, yeah. That besides all the other beeping that's going on, it's like sometimes you can just spot it that way. Vehicles do have an EDR, electronic data recorder. And there's actually no reason you would even know that because you don't really have access to it. And what's interesting is most states, another conversation if you choose, but there are some of these things that are controlled at the federal level through NHTSA, Federal Motor Vehicle Standards, and other kinds of regulatory standards.

authorities that are there. And many of these things, though, they're actually controlled at the state level. Okay, so that's kind of important about which things are. So EDRs are where there's a basic federal requirement. But to your point, in aviation, there are hundreds, sometimes now the newer ones, thousands of variables that you can get from those recorders. And the EDR in most vehicles, it's the basics. And there's always this

tension between the industry about how much data they want to leave out versus those on the investigation side that know more is better. So some of these very recently only recorded like 30 seconds or a minute worth of data, maybe three minutes back. And then, and this is a debate even in the aviation ones, in the old days, they used to record over

For those of us who want to say, how long have they been braking hard like that? Or how long have they been at that speed for whatever else? In a vehicle on the road, EDR, you may not have a long period of data to track that kind of thing. So it's both the variables that are recorded and the amount of time that it records and that is available to you post-crash to be able to look at all that and reconstruct what actually happened there. And is that...

One of the more important data sources you would rely on when the NTSB did indeed come in for auto accidents? Absolutely. That and of course, you talk to everybody. So witnesses not only in the scene, but you talk to family and other people, you know, work, all that kind of thing. And within the fatigue realm, when you look at that, it's literally if this is a trucker who was on the road.

You're looking at literally where's their hotel motel key and can you actually see that they got in the room and then we have to look to see if they were on their cell phone or not where they're actually sleeping when they need you know it's like you go with the electronic pieces you can and then there's all the other human elements of that that you use to try and piece at a minimum.

the three days before the crash. And again, you extend that based on what you're finding to go back, which is why I'll just make one thing. I have a few soap boxes I'm sure we'll touch on. One of the hardest things is people speculating in the first 24, 48 hours of what happened.

Having launched on seven different investigations, the first one was a Reno air show crash, was air races in here. Huge. But what happens is everybody, the media in particular, it's in the first 24, 48 hours. So like, here's what caused that. And then before you know it, it's like already established. And I used to go back to the D.C. and say, OK, so how often do we actually see, you know, that first 24, 48 hours speculation end up in the final report?

People couldn't really think of many. Maybe a little element of it shows up. The thorough investigation uncovers things you would have never known if you stopped at that first 48 hours. So my biggest thing from a safety standpoint is if you're not careful, you take action based on the speculation. Now you've spent a year doing a bunch of changes and things that may actually not have had any role in the crash that you were investigating. So the speculation can really bite you if you're not careful. Hence, the data sources like EDRs are critical.

What can you glean about phone use in the car? It's so common now. I sort of have this innate anger when I pass somebody and they're on their phone. And I don't mean like they're talking and the phone is wherever it is. I mean, they're holding their phone and you can see it as you drive past them. I sort of feel like, is this that much different than if you were drinking a beer and I could see the bottle?

What is your view on that? And how difficult is it for, let's assume that a crash does not rise to the level of being one of the very, very few that the NTSB looks at, but yet it still becomes a manner of like a criminal prosecution or something like that. I mean, how much data are they able to infer if a person wasn't actually speaking on the phone, which I assume is the easiest thing to figure out from the cell signal. So let's actually start with, if you're going 55 miles per hour,

and you take five seconds to look at your phone, your eyes off the road, you can travel the distance of a football field. You know, then that's playing with the radio on your phone, whatever it is. Five seconds at 55 is enough to take you a football field. And I'm sure we'll talk about this if we do more impairment stuff, but it's a very straightforward, you know, when you're driving, three things you need to be taking care of. Your hands on the wheel, your eyes on the road, and your head in the game.

So when you talk about distraction, anything that pulls you away from one of those is going to be a problem. And we now know that talking on the phone can degrade your performance equivalent to 0.08 alcohol kind of performance decrements. Again, we don't have to get into all the data, but there's really good data that even hands-free can do that.

Because as you know, there's no such thing as multitasking, right? It's switching, et cetera. And so people are like, it's legal. You're like, hands-free, it's okay. It's like, no, it's not. Because if you're engaged in that conversation, then your head's not in this game anymore.

Whatever. And so again, I think that's one of the challenges you have when you're looking at all this is how diverse they are. So to your point, the NTSB will go and get all the kinds of data. Locally, they're probably never going to get that. So what would you look for? And I often think about this when I do drive by those people, usually because I'm going the speed limit here and they're going less than that in a faster lane because they're sitting there staring at something, right?

is I'm always sitting there thinking I know enough to basically ask the police department get those phone records. I want to know if a signal was bouncing off a tower somewhere locally was that going on? And of course, nowadays we have more cameras everywhere.

And so can I show that they actually were on that phone at a certain place, whether it's their video or video from a vehicle you might be in, etc. There are more sources for that kind of information. But to your point, if you didn't know about an EDR or, you know, video or that again, you know, an investigation of the NTSB, you get a subpoena if the phone company won't give it to you and literally get the records to know if they were on the phone during a certain time.

That stuff's available. And most crashes, insurance companies even, aren't going to necessarily pursue all of that. But those things would be available depending on what happened for you to, again, like any other investigation at NTSB level, you could go after that stuff to determine what was really there. Just a couple of weeks ago, we're on El Camino here in California.

So it's three lanes, 35 miles per hour speed limit. And we're stopped. We had seen a motorcycle officer who had stopped somebody a while back. All of a sudden now he's coming up on the left. We're like in the middle. So there's another vehicle on the left. But the guy's coming up, splitting the lane because we're stopped. And he's literally looking in the cars because I can see his helmet turning and looking in the cars. And the guy next to us was on his phone. I mean, I was sitting there just watching him, you know. And the cop came up and looked in there and like starts shaking his head.

And the guy put it down. And I'm thinking like, that's the difference when you actually have someone looking at you, whether it's video or something else that says you shouldn't be doing that. And you and I know that as soon as the cop went by, he's back on the phone again, right? So, Mark, have there been any technological solutions proposed?

to dramatically lessen the burden of phone use while driving. And again, to be clear, I say this as someone who would be inconvenienced by it myself. I'm constantly using long drives when I take them as a chance to get caught up on phone calls and listen to podcasts and audiobooks. And even though my hands are on the wheel and my eyes are on the road, I'm

there's no doubt, especially in a phone call, it takes my head out of the game a little bit. So again, phone companies and consumers alike would be, I'm sure, opposed to this. But is there no technology solution proposed to make it much more difficult to be distracted while driving?

There are. It's interesting because companies did oppose it quite a bit, but there are now, and you should look on your own phone, but there is usually now a button that says, don't call. And it has a message. It'll send a text or a voicemail basically and says, I'm driving now, call you later or leave a message or whatever. So there are technological things. Yes, but it still requires the user to take the action. And again, the question is like,

How can you make this so that you don't have to opt into it? Right. And those could exist as well. They already do. Phones can now tell when your vehicle is moving. So accelerometers and other sorts of things do that. And I think what you're getting to, which is interesting, is that's a whole nother choice issue about you're moving above a certain speed. So you're out of a parking lot or whatever else. We jam it or we just don't let it happen.

That would be an interesting battle, I bet, for some. And that's why it's so interesting about your hypothesis there, because right now you could just make the decision. I'm going to shut it off or I'm going to put on airplane mode and I'm not going to get anything while I'm here. So when I was at the NTSB, Debbie Hersman was the chairman.

And we were investigating a couple, as I mentioned, crashes where clearly cell phones were an issue. And we made a recommendation that cell phones should not be used in cars except for emergency situations. And I remember exactly around that time because I used to call Debbie and we would be talking about stuff and she had a long commute and she used to use that to catch up with all kinds of stuff. And then all of a sudden we were doing these investigations and I would keep getting her voicemail. And

And then as we got closer to our recommendation, et cetera, I said, I know what's going on now. She goes, yeah, I wanted to know what it would be like to shut the phone off or put it in a bag in the back. And you know what? It's really inconvenient. But I'm a better driver when I'm doing this than when I'm doing it the convenient way. So to your point, there's the technological. That's sort of a societal back to our question. Like, do we make that vote and say, no, we're not going to let you do that if you're moving?

But you always have the personal choice about if it's important enough to you, you can decide. And the personal choice in some cases could also mean you can differentiate. It's like I'm on a strange road. I'm a little faster. I got more people in the car. I'm not going to do that as opposed to open roads, speed limit. There's nobody around. Music's not even an issue. Again, you could make more choices when you did that.

Yeah. Or do I have the ability to override it? And I mean, this is how I perhaps erroneously justified in my own mind, which is I'm now steeped in the practice of identifying hotspots and whatever it is I'm doing, if I'm listening to something or if I'm on the phone.

I at least convince myself, again, this might not be true, but I convince myself, okay, you're just going to pay more attention right now because this is the intersection and you're looking both ways, even when you have the right of way or that kind of thing. But yeah, the other example of this would be, again, it would be,

hideous to look at, but you could easily install a breathalyzer in every vehicle that allows it to not start without a blood alcohol below. You might even make it a more egregious setting than 0.08 and make it 0.05 or something like that.

And nobody would want those in their cars because they're so unsightly. I think they do actually have devices like that for people who have been convicted drinking and driving. But when you just look at the numbers of deaths due to intoxication and distraction, it begs the question, right? Like how much would we be willing to be inconvenienced to save, call it 50 lives a day? Because that's about what you would do. You'd save about 50 lives a day, right?

If you took those two things off the table, if people didn't have phones in their cars and they couldn't have alcohol in their system when they drove, that's a pretty good estimate, right? About 50 people per day would be alive. A third of 118, so maybe 40. So let's go back a moment. Realize you're different now.

When you were talking about being on the phone in certain places where you're going to pay more attention, you're different in a good way because you're actually cognizant. You're thinking about those things and what risk they would create for you. And again, in your framework, it's like, what can I control? What's out of my control? Well, that's something you have control. You're different than most people because you're even thinking those things. So that actually does make you safer in those situations than someone who isn't even thinking there's an issue with me thinking

talking on the phone and playing with my radio. And by the way, I'll do that. It's like that puts you in a different place than those folks. But going to your other, it's not hypothetical anymore. Congress just passed a law that new cars will have to have a technology that can detect whether you're at the 0.08 level or higher. And what's interesting is that technology has actually been in the works. So take it as a model for what you're talking about with phones. But that technology is

has been in the works for a long time. It's called Dads. It's one of them. And it has a free breath sort of analyzer and also stuff that's in the steering wheel that literally is looking at molecules in the air. And it's what you said, is it won't start if it hits...

It's for everybody. Now, how will it differentiate between someone in the car who's incredibly inebriated and presumably putting particulate matter of ethanol or whatever metabolite is being searched, but the driver, let's assume, is not?

the designated driver. I mean, that's why you do that. Right now, it's specific enough with the, and that's why I think the latest has both sensors, the one that's in the wheel, as well as the other more general one. And they've done enough research to be able to differentiate those. The last thing I'll just say is, what's interesting, that's one form of it. The legislation that just passed is that basically car companies are going to have to provide a technology without, again, it's more of a performance target.

than it is the mechanism. And so other people could come up with different ways to be able to do that. But I mentioned this because I think you're onto something here, which is it took maybe decades to get this legislation from Congress to say we should have this in every car because of the lives it could save. And part of that was the ongoing debate

Sometimes about technical things, more often about what we've started this conversation with, the societal value. If we think it's more important to inconvenience you if you're drunk than it is to allow you to kill someone else on the roadway. When did drunk driving...

fall out of favor. Like I get the sense that there was a day in which driving drunk was a normal thing to do. Like nobody cared that you had a drink and got in your car. Clearly that's not the case today, despite the fact that the numbers are still as high as they are. Was there a particular moment in time in which an accident changed all of that? Or was it just a general sense of awareness? I will apologize to them, but it really was about MAD, Mothers Against Drunk Drivers.

And the woman who started it lost a child in a drunk driving crash. And this is what, in the 80s? And that's why I'm trying, I'm kind of applying, because I think it was late 70s, early 80s. But they really are the first ones to have a, quote, victim group that said this should not be allowable anymore. And so I would say it wasn't so much an individual crash. But they put faces to a set of crashes and a cause. And took it to the state house.

to Congress. It's like, "We cannot let this happen anymore."

And people don't know this, but Matt actually provides counseling services and all kinds of other things that they do. But they really are the model, again, a victim group that said, we need this issue in front of our society. It's not OK. And so they're the ones to get 0.08 and all. Again, see, that's one of the things every state has to vote for what the blood alcohol level has to be. And so everyone's different. But they're the ones who pushed. It used to be higher and then finally got to 0.08.

They're the ones who basically are the ones who push especially hard. Others did as well, but they were right out there in the front for this new legislation regarding the technology. And they're the ones who will make sure that the pressure stays on to see the technology actually integrated within vehicles coming. So I think that's an example of what you're talking about. It could be a crash.

high visibility, maybe a celebrity. What do we do about this? Or it can be this new model that was created with MAD, which we see in other arenas as well. Yeah. I always find that the individual cases do more. You're probably familiar with the case of Libby Zion, just for folks listening. So Libby Zion was a woman admitted to a hospital in New York. I can't even remember if it was Presbyterian. I think it was Mount Zion. Was it Mount Zion? Yeah, you're right. It was Mount Zion. She was admitted to the ER. I

A resident who technically probably wasn't even qualified to make a decision that was being made about her care made a decision to give her, I don't even remember the details, gave her a medication while she was already on an MAOI and it resulted in her death.

And even though I don't really think this was just about fatigue, I think it was more about resident supervision. It became the linchpin case that her father basically took against the medical community about resident work hours and might have taken 15 years from her death until the changes that were imposed on resident work hours, which was kind of at the end of my training period. But again, it all came back to this woman's death.

wasn't about the million other insane stories that resulted from medical residents being exhausted. So I guess I bring all of this up to say, Mark, have we had that moment yet with distracted driving? Do we have the equivalent of mothers against drunk driving? Or do we have the equivalent of Libby Zion's death? Because I have my story. So my story is I used to work with a guy named Nick Venuto.

Nick and I sat opposite each other in our offices and Nick was a really, really amazing guy. We always say this, but truly an amazing guy.

a remarkable cyclist, but he was so committed to his family that he used his commute, his long commute on his bike to do the bulk of his training so that he didn't have to do any cycling during the week and he could just do his main training on the weekends. He had just won one of the most remarkable time trials in Austin, which was the Mount Palomar climb, which is an epic climb, one of the hardest climbs in the United States.

Anyway, it was a Tuesday afternoon in May of, I want to say 2010, 2011. We were both just leaving the office together and I was going to drive home to get on my bike to then ride to where I did my intervals that day. And he was riding home.

And I remember thinking there were two places I could go and ride that day. One was up Torrey Pines and the other was on the bike path of 56, which was a bike path that ran along a freeway. That was the road that he always took home. And I was like, maybe I go ride that way and I'll ride out one way with him. I ultimately ended up deciding to go up Torrey Pines that day.

That day when he was driving home, a woman in an SUV in the right-hand lane, which is the lane adjacent to the bike path where there's a hill that you have to go up. It's about a 12-foot hill at about 40 degrees with a fence, was on her phone. And I think what happened is the car in front of her stopped and she drove up the hill through the fence, hit and killed Nick on a path that I rode on most days.

And I mean, I spent the next two years so goddamn angry that I wanted to start carrying a gun when I rode my bike to shoot any motorist that got anywhere near me. I mean, that's how pissed I was. And I thought to myself, how many times does this happen?

Like this is one guy that I just happened to know who died, but this is happening constantly. And why are people not more irate? Why is something not being done about this? Forgive my long story, but is there a movement around these? It's not just the cyclists and pedestrians, it's other drivers who are victims of the distracted driver. And by the way, I want to say one more thing. I am a distracted driver sometimes.

I could easily have been that woman. There are times when cars in front of me are stopping and I haven't caught it until the last second. And just because it hasn't resulted in an accident, I don't know that it makes me morally any better than that woman. Well, it's personal for you too then, just as we started. Very much so. Again, I paused at the beginning because I don't often talk about my father, but it's personal for a lot of people. But I think what's interesting is the stories actually aren't told enough.

That's what we're talking about, MAD. They told the stories, this should stop. We have not reached the societal unacceptability, the societal outrage that you just portrayed at the level of, we just got to stop it. And that's why I say MAD helped bring the visibility, but the legislation for technology in the vehicle just got passed. It's not even in the cars yet, right? I mean, it's still got to figure out how to do that part. So you asked it earlier, we could do the same thing with distraction.

And I think good and bad. The good part is people are asking questions like what you just did. How do we take this to the next step? We have models, alcohol impaired driving. We have ways to go after this and even do better with technology and things, et cetera. How do we do that in the realm of distraction?

And you've also identified why it's so hard. The bad part is even us people who are trying to be really good, trying to save lives and do the right thing, it's hard. There's still some things where we make choices, even knowing choices like that's not really the best thing to do here.

And that's a challenge, which is even really good folks who know what's going on. I have friends of mine in the police department. It's kind of like, I want to make sure I see every one of those police cars stop at the stop sign. No rolling because you're the model for others. It's OK. Watching that motorcycle game, not his head of the guy who was on his phone, etc. It's like.

We need all the available mechanism strategies we have to change many of these things. And what you're getting to is there are so many of them. We can look at the top three, but that doesn't necessarily get rid of all of them.

But I think to your point, and a lot of what you focus on in these conversations is, so what are the things that are under your control, though? So for you, if that means watching a little bit more about when you're on those calls and how you're paying attention to them, hands-on or hands-off, et cetera, and that's why I'm part, you're already different because you're already thinking about where those danger zones are. Someone who doesn't even think about that is at a higher risk.

Okay? And as we talked about it, this is risk management. What's under your control, what's not, it's risk management. And what you choose to actually try and control and take care of, others that will still put you at risk in certain situations.

Yeah, one of the things I've often wondered, Mark, is there any research into the lives of those who kill other people on the road and how their lives are forever impacted? Because I have to be honest with you, I think until right now, as I'm telling this story, I've never once given a thought to that woman who killed Nick. Truthfully, I've hated her guts, but I don't know that that's fair. And I don't know anything about her life today. I don't know how often she thinks about Nick. I don't know what she lives with.

But my impression is that there are two deaths at every death and that a part of the person who killed this person is at risk. And this is a very different type of homicide. This is not first degree murder. This is involuntary vehicular manslaughter. Nobody wakes up thinking they want to kill someone today in their car.

I know your training is in psychology, so I just wonder if there's any aspect of your training that gives you a sense into what those people go through. And by the way, is that something we should be tapping into to help create more of a zeitgeist around this? It's not just the lives of those who die, it's those who live. 25 to 33% of people in a crash are going to have PTSD within 30 days or longer. There is a literature on that. And I would just say, going from the statistics to the individual, Matt is quite good at

and actually not only having victims' families talk about what's going on, but they have drivers who have killed someone that are also part of who speaks to folks about what this does to change their life. And sometimes that's jail time. Sometimes even if they don't go to jail, it changes their life forever because they are waking up every morning. Survivor's guilt,

Anybody who really cares about humanity is going to carry that with them for the rest of their lives. And so, yeah, we see numbers. Actually, again, close to a third, basically, people are going to have PTSD, some aspect of that. And then telling those stories can be very powerful.

Before we go into some other things I want to chat about, I want to round out some of the other contributing factors. Where does weather rank on this list? Whether it be rain, snow, ice, sudden darkness or cloud, how much does that contribute? So I'm going to just drop a small bomb here for a minute about something and then to answer the question, then we'll come back to it whenever you're ready. But NHTSA did a study, came out in 2015, that showed in the chain of events, the

The last event before a crash, that 94% of the time it's a human choice or error. Okay, and that's my language, human choice or error. So then the question is, what are the other 6%? Well, 2% are vehicle defects, 2% are the environment, 2% other.

And so to your question, the environment is both the physical environment, potholes, road conditions, et cetera, and then things like weather. It's virtually nothing. Not a lot. That's right. So that does happen, but it's going to be small compared to the other. And again, we can talk a little more about the 94% because there's been some controversy about that number, but that's a soapbox for me. You've got to be ready to get into that one.

Let's say more about that then. So where's the controversy around that? Are there people who are arguing that that number is too high, that that's overstating it? What's interesting is nobody's actually addressed the number. And so you'll tell me where you want me to, okay, that's enough of that, Mark. Let's go on to something else. But let me just start. This is why a crash is not an accident. A crash is preventable. An accident implies it's inevitable.

And most people don't know this, but the word accident started getting used mostly in occupational environments like the work setting in the 20s and 30s when companies didn't want any responsibility of on-the-job injuries and deaths. Oh, that was an accident. I would say it's like it was an act of God. It was unintentional. Nobody could do whatever.

And part of the reason I bring that up is because if you believe in safety, that by investigating, you can determine the causal and contributory factors and then intervene in some way by changing. So you prevent it from reoccurring, you prevent whatever, then that's what safety is about. It's a crash.

And if you didn't believe in that and you really think it's an accident that's inevitable, why are you trying to make changes, investigating, et cetera? No. And that's the mission of the NTSB, investigate those crashes to make recommendations so they don't reoccur. Okay.

So what's interesting is there's two elements to this. One is, as a NASA scientist, pretty much you could start any paper with 70 because it was so well established. 70 to 80% of incidents, you know, that pyramid we were talking about, 70 to 80% were human factors related. It was just a given after all this research and things were going on. You know, the Institute of Medicine report, right, to errors human, 100,000 medical errors every year due to human, etc.,

And so it always surprised me. It's like 94% shouldn't actually surprise anybody. But there is something which I call safety misdirection. And that's where two things are going on. One, denial. Let's not deny what the causal or contributory factor was. And the other is blame. And so the old version of safety misdirection is, oh, the car companies are just blaming the drivers for stuff.

Okay, and they want to sort of avoid it's kind of like the corporate accident language. Let's get away from that. And so I always point out that what I learned at the NTSB is you can have safety or you can have blame. If you want to blame people or that's not going to get you to the safety. The safety part is identifying the causal and contributory factors.

And then intervening so those things don't happen again. Which, by the way, even if it's the human, that very often, as we've already discussed, there's a different intervention like technology, which our society happens to turn to a lot. When it's something about our human behavior that's hard to change, well, what's the technology we might be able to use that either supports, helps, or just eliminates the ability to do that?

So that's one of the things, the controversial part that's been interesting is people saying, well, if you talk about 94%, you're just trying to blame the drivers, etc. Now, there are some car companies and some people in the autonomous vehicle space that love to do that. So it's, again, how they use the data. But scientifically...

A huge part of this is human choice or error. Then we still have the challenge of then how do we address those to make sure those things don't reoccur again in another place? So again, it's a little bit of a soapbox for me when I hear about people like, oh, that 94% has been, it's like, no, it's not. Nobody's actually arguing about the number. I think it's more the blame and shame part, which again, doesn't get you safety no matter what.

So you can't deny what the sources are and blaming people. In fact, nowadays it's like, oh, you're just blaming the driver. Then they point and they start blaming the car. They blame the software. That's still not going to get things fixed for you. So you're going to save lives. So there you go. I'm with the 94% and think that that other 6% shows that last event in the chain is very small percent is going to be weather or potentially defects.

I don't know if you will have this statistic, but while we're on the topic of cause and fault, we talk about nearly 50,000 people a year died last year. Do we know how many of those people were the people who were the cause of the mistake that led to the crash versus people who were presumably not doing anything that would have led to a mistake?

We don't have that level of

detail of those specific crashes that occurred to be able to tell that. The reason I'm asking, by the way, is to sort of make the point that there are two elements to this. There is what can I do as a driver to make sure I'm not the one who makes the mistake? And then what can I do as a driver to make sure that when the other driver makes the mistake, I'm in a position to react better or see their mistake before it's happening?

And I think about this a lot as a dad who is starting to talk a lot about this to his daughter. If I'm driving her to school, just ask her. It's a nonstop lecture. It's, hey, Olivia, did you see how I did that? Did you notice why I did that? Why did I look there? Did you see what that driver just did?

What I'm assuming is that we have to be vigilant on both fronts. It's not enough to just say, I'm going to drive at a responsible speed and I'm not going to hold my phone and I'm not going to drink. That's a great first step. I don't think it's the complete step. You have to assume this is the mantra I use, Mark. And my wife thinks this is

A little grotesque, but I don't care. I say it to her all the time. I say, I want you to imagine that somebody woke up today with the stated purpose of killing you. So they've been handed an envelope. The envelope contains your name and they're told to kill you today. But here's the catch. They're not allowed to use a gun. They're not allowed to poison you. They have to do it with their car.

So I said, armed with that knowledge, how would you drive different today? It's only one car. You're going to see thousands of cars today. It's only one. But there is someone out here who's trying to kill you. They're being paid to kill you. What will that knowledge do to your attention? And how will you treat each intersection, each on-ramp, each off-ramp, each T-joint,

All of those things that we talk about. I don't know that that's a great way to go living your life. It's a bit morose, but it's the only heuristic I've come up with to help with the other half of the equation. That's why I asked the question, right? I don't know how to quantify the effect size of each of these things. Is it worth the baggage and the overhead, the emotional overhead of playing that game? Could be your life.

So yeah, it's worth it. And I said this at the beginning, which is thank you for bringing this topic up. Because at the core, like you say, your mantra of what's under your control, what's out of your control, that's what we're talking about here. But even the things that are out of your control, you can be more vigilant to some of the risk factors or other things that you could do. At the higher conceptual level, I would say, and maybe just a slight sort of reworking exactly what you said, but part of this is situational awareness.

essay. I mean, you know this in racing. It's a big thing in aviation. And I think it's what you just literally articulated with your daughter. Did you see how I looked at that? Did you see that car over there doing whatever? So I think that is huge. And the second part is what we would typically frame as defensive driving. It's a little different than what you portrayed, but it is the same thing, actually, which is there are people that are out here that are not making the good choices you are

but who are on their phone or drunk or haven't had enough sleep, you don't have any control over that. But with your situational awareness and driving defensively, there are things you can do. So besides scanning here, looking there, you can come back again. You can look at those intersections where you know things are higher. So that if that raises your vigilance, that could be enough for you just to pause at that stop sign longer.

And it becomes not even an error, let alone a near miss or worse. And so I think that's what you're portraying. The situational awareness includes following the rules, doing the good. And then the other is the defensive driving part is don't think everyone else is doing the same thing. They're not. And I would just say, whether they're intending to get you or not, those bad choices are going on. Those errors are going on.

And so, yeah, I think that's actually a great way to approach it. And I think, unfortunately, it's so easy to drive nowadays. A lot of folks, especially with even newer technologies, some people have their heads so far out of the game, they've lost the situational awareness, right? It's all about the music, the conversation, et cetera. So all of that is lost. So no, I think that's actually...

When you're doing your other training with the muscle memory stuff, that needs to be in there too, because part of this is the mental game of making the right choices and knowing that other people won't. Then what can you do? Yeah. Let's now talk about some of these more contributing factors in a little bit more detail. And I want to start with substance abuse or substance use or whatever you want to call it. We've talked about alcohol, of course. Give people a sense of what does it take to reach 0.08? Because I suspect it's a lot easier to get to 0.08 than people realize.

Yeah. In fact, most people in the safety arena with alcohol like to say that impairment starts with the first drink. And I think that's a great, like, as soon as you pull up alcohol, that's going to start changing your reaction time, thinking everything's going to start changing. I've got a great model to demonstrate this. So I drive a racing simulator and I've done this game where I will have a glass of wine

and get in the simulator. And to be completely clear, with a glass of wine, I do not perceive anything in my own level of awareness. I don't feel a buzz. There's nothing like that. However, in the simulator, there's a noticeable difference. Even at a glass of wine where I'm sure I am below 0.08 because I weigh a lot and I don't feel buzzed in any way, shape or form,

I don't drive as well. I miss the apex more. I'm more likely to spin. It's a subtle difference, but it's absolutely noticeable in that environment, which is much, much more demanding than just driving home from the restaurant. But as a general rule for someone my size, I've never taken a breathalyzer test, so I don't actually even know what 0.08 is.

So for you, that's going to be two to three beers and one good shot of hard liquor. Over what period of time? Within one to two hours. Okay. But you're bringing up a great point, which is why I always hesitate to give too much information about that. Because you can go online with some pretty good BAC estimators. Because your age, your weight. Your health.

Exactly. All of those things, whether, again, it's less alcohol content in beers and wine, you know, versus, again, hard liquor stuff. Over the time course, you were just about, did you eat and what did you have in your stomach when you read? It's like there's so much there. I think actually even more important is what you were telling in your story, which is there's very often a disconnect between this subjective experience and the objective one.

which is that very often people think they're doing a lot better. We see this parallel in alcohol and sleep loss. I'm doing great. I'm really fine. When if you look at the objective performance measures, they're just doing horribly.

Or they're off but don't realize how off they are. So that disconnect's really important. That's why you say, I'm good to go, whether it's not having enough sleep or, you know, I had a couple glasses of wine, but I'm okay. Had enough to eat and da-da-da-da, I'm good to go. That disconnect, I think, is actually bigger risk than sometimes the exact amount of alcohol you have in your system. Yeah, and I would argue that the sleep one is just the same.

If I don't have a great night's sleep, it shows. And again, that's, I think that's, what's kind of cool about a simulator is you're simulating driving around at 200 miles an hour. And at that speed, things are happening three times faster than when you're in a car on the road, even on a freeway. And of course you're turning constantly, right? So the stakes are so much higher and the forces and inputs are so much more subtle. Any wrong input will lead to a significant change in output.

And it is remarkable how you can feel fine for the mundane task, but not for the drive.

Add that to your course you're creating, right? So besides the muscle memory, whatever, it's like you'd love to challenge, especially those adolescents with even whatever's appropriate there. Sleep loss would be better than alcohol, obviously. But think about that as a challenge just for them to say, I feel fine. Give me the rating on the one to 10 scale and then show the objective measurements and driving, like you say, even the mundane ones. Yeah. Let's talk about other substances. And I think the most relevant is cannabis.

What did the data say about cannabis use and driving? It's not good in that what's happened is in alcohol, there's a really good established protocol with, you know, here's what impairment means at point away. And by the way, we can use a breathalyzer. We can use blood. There are drug recognition experts, DREs that can use behavioral measures on scene. And we know they hold up in court.

With cannabis, there is still ongoing debate of what defines impairment. And so if you can't even get that defined, and then you have no roadside kinds of measures...

And it's harder, as you know, whether you're using breath, hair, all these other things that people are trying to do. It ends up, well, you know, it sticks around in your system longer or can be in the follicles for this long. It's like there is no good measurement. So we don't have the impairment definition. We don't have good measures to get us there to sort of figure out how we do that. And the other thing which is really dangerous is the polyusage. It's rarely one of these on their own.

With cannabis, you see alcohol or other kinds of things that people are using at the same time. So that makes it even more difficult to figure out, especially in the roadside kind of environment of what people are actually using. And so, I mean, this is now, I was administrator six, seven years now ago, and all this research was still going on to try and define what I was just describing. That as all these states now start making it more legal,

I always tell people when you're voting for that in your state, don't think about the sport of cannabis, but instead think about what that's going to mean if somebody next to you on the roadway has been smoking and in some way is like the level of impairment of alcohol. People just don't think of that part. And unfortunately, while the alcohol is pretty well defined, the cannabis part is very poorly defined. In that time, we still don't have it figured out yet.

Is there a manner in which we can at least extrapolate from the standpoint of understanding, right? So alcohol is a CNS depressant.

I guess at the risk of just talking through something that seems self-evident, what is the mechanism by which you think ethanol is contributing to mistakes? We're talking now about the subset of mistakes that lead to bad enough crashes and potential fatalities. Like, is it that people end up driving too quickly when they're drunk? Is it that their reaction times are so slowed when they're drunk?

And not even drunk. Let's not even use that word. When they are under the influence of alcohol, what are this suite of mistakes that they're making that are leading to these catastrophic errors? So I think the two big categories are any performance-related ones which are degraded or impaired. So that would be sustained attention, reaction time, decision-making. And the others are the ones we talked about, and that is the subjective perception part being disconnected.

where they have no sort of, you know, their decision-making, like it's really okay. So we know basically with alcohol, all those CNS things that you were talking about are going to be, again, be degraded or impaired in some way. And again, I talk about this the same way with fatigue.

And I'll just use that as the example for the moment. But there's this like continuum everyone is like you're asleep here, you're awake over here, but the alertness in between is a continuum. And so I think most people would absolutely agree being asleep at the wheel not good. But that continuum beforehand we know that with sleep loss, circadian disruption, alcohol,

that basically your performance will degrade way before you actually say fall asleep or drunk enough to go unconscious. And that's why I call that degraded as opposed to the impairment where literally you can't perform at all. But at least in the sleep realm, I mean, we can see 50% reduction in your decision-making, 30% reduction in your memory. We can see 50 to 75% increase in your reaction time. These very specific things when you're in the driving mode,

trying to deal with the situation are going to affect you and your ability. And that's why I always tell people, it's like way before you have that fall asleep, go unconscious, you've got these performance degradations that put you at risk. But in that sense, I mean, to me, sleep and cannabis seem very similar in that

They're sedating and there's clearly a spectrum from completely debilitated to loosely less functional. And there's no real way to measure it directly the way you can use a breathalyzer for alcohol. Are there differences between how we view drowsiness due to sleep deprivation or sleep interruption?

and cannabis use, which again, I'm just bringing up cannabis, not because it's the only other substance out there besides alcohol, but because as you said, it's becoming more and more ubiquitous. I think there's a belief on some level, maybe somewhat warranted that it could be less toxic than alcohol. I think a lot of people are turning to cannabis now over alcohol. And I wonder if there are unintended consequences of that with regard to this domain.

Well, and I'm in complete agreement with you there, which is that I think it remains hypothesis, but with everything we know about how physiology and the brain and things work, it's got to be. We may not be able to quantify it quite yet. Here's a comment I often make about sleep loss and circadian disruption. When you lose sleep, you disrupt the clock. All aspects of human capability are degraded or impaired in some way. So I mentioned that because

a new study comes out and says, oh, we just linked this now to cancer in a new way or immune function in a new way. And I'm kind of like, OK, so now we have more data and we can be more exact in certain areas. Good thing. But the overall comment holds, which is kind of what you're saying here, too, which is that everything we know about how cannabis works in the brain, how it's going to affect us physiologically, performance wise, we know that's not going to improve things. It's going to degrade them. And while we may get better at quantifying how bad that is,

Let's be clear, it's not a good thing for driving under the influence of that. I think that's what's going to happen here is that we will get there. There's some great people at NIH and other places that are working on how to get that impairment level defined, to think about what the test could be, etc. We'll get there. Took a decade or two, frankly, to get the alcohol ones in the way they are now. We'll get there. But for the moment, let's be clear, everything we know is

That's a negative. It's not a positive. And we may get better at it, but it's still not going to improve things in some way. I'll just make another general comment, which is, I think, the sleep part that's interesting. Everyone sleeps. They think they're an expert.

And it's kind of interesting that everyone is like, yeah, I've lost some sleep and, you know, I'm still here. I'm fine, etc. Whereas, again, people will think about alcohol and cannabis. You know, that's more of a choice. And by the way, I don't drink or I don't do this, etc. No one's ever going to say, yeah, I think that sleep thing, I just stopped it. That's a requirement.

for just our existence. And so it's slightly different that way. Are there any other prescription drugs that play a significant role in this? I mean, the obvious ones that come to my mind would be benzodiazepines, but is there any other class of drugs that frequently enough show up on the impairment side of the equation? Thank you for bringing this up because drunk drugged

People always think of cannabis, etc. But that includes prescription medication and over-the-counters. So any antihistamine that makes you drowsy, any sedating antidepressant, Trazodone gets used, any one of those that you're taking has the potential to affect your

sleepiness alertness level when you're actually driving. So I'm glad you brought that up because everyone thinks of the big ones, alcohol for sure, cannabis, we got to start talking about, but these others, you think about it, prescription, something you don't want to just read the label. You want to talk to your healthcare provider about that and see how much could that affect me and the over the counters as well.

Those are all big issues. And we, again, it's the polypharmacy. You see that a lot, that there's multiple things, but trying to pull out exactly what they were. That's often after the fact. Post hoc, you go interview people and say, oh yeah, it's allergy season. And are you taking the one that's sedating or are you taking the one that's the non-drowsy version of it? Let's talk a little bit about speed.

which still makes up a pretty sizable fraction of the contributing forces. Is that changing? Is that less today than it was 30 years ago? It strikes me that clearly cars are faster today than they used to be, but are people necessarily driving them faster today? And is that not offset at all by...

the far greater impact of technology, which we haven't come to talk about yet. So we should certainly spend some time talking about seatbelts and airbags. But yeah, what's the general throughput of speed in this equation? It's a big factor. Force equals mass times acceleration. It's all about the energy.

So when you're going faster, you're talking about when a crash happens, there's just more literally impact of what's going to come out of that particular collision. And so it's interesting. Speed has actually gone up, and that has more to do with the capability of the vehicles, roadways, and the technologies. Think about, I mean, you're a racer. There's always like, how do we get better, faster, et cetera. Although it seems that cars...

Outside of SUVs, probably cars are getting a lot lighter. So when you think about mass times deceleration, which I assume is a big part of what that force is that people are experiencing, does that not offset it on the car side of the equation? Not very much because generally cars are getting bigger. Now that we've added SUVs and others, when we look at what's going on out there, there's people describe it as a weight bloat that's occurred.

And unfortunately, they do protect you. If you're in one of those energy-related kinds of crashes, the bigger the protective cage you have around you, the better off. People have a tendency to say, I want to be in that vehicle, not in the little small version where I could get killed doing that sort of thing. I think what's interesting is we do see

This is why it's so complicated. But we do see like during the last recession, during the pandemic, the deaths go down, but sometimes other particular things like speeding goes up.

And we can have all kinds of hypotheses about, are there fewer people on the road? Is just the density different, et cetera. They're all hypotheses. We think about those. We don't really know. But I bring it up because it's interesting that even the economic environment of our society can end up having effects beyond the usual causal or contributing factors, for example, that we're mostly focused on in this conversation. So even those things can have that societal ripple. And-

I would just say for the speed side, two other things, which is I'm sure we'll talk about the safe system approach, and that has to do with safer roads. And one of the things they look at is controlling speed through road design. So that's where roundabouts or what they call speed diets, where you basically two become one lane, and then instead we're going to have a more dedicated pedestrian or cycling lane where you can use, et cetera. And then the last thing I'll just say on the technology is

There's a huge debate. It's not where the alcohol is, where the technology's passed legislation, but there's a lot of discussion about speed limiters now and whether or not, as we've been discussing, and I said this earlier, society very often, when we have human choices or things that we want to deal with, we go to technology. So all of a sudden now, speed cameras and speed limiters in vehicles are in more discussion than they have been in a decade.

Yep. Makes sense. All of these things are, you'd pull them out of our dead lifeless hands if you don't let me drive quicker and don't let me talk on the phone and whatnot. I want to go back to another kind of deconstruct the accident question. Do you have a sense or are these data knowable as to what fraction of those fatalities are?

in the vehicle are a result of the integrity of the vehicle being lost due to the collision itself versus a flip? In other words, how often is avoiding the flip of the vehicle with a lower center of gravity a relevant part of this equation? Yeah, that's actually a big deal. And when you look at the crash tests are done, it's interesting, they don't actually crash vehicle to vehicle. The crash worthiness of your vehicle is tested against a big block of cement, basically.

But now there are different versions of that. So there's a side impact. And now over the last years, there's also an angled one as well. And then rear end. And then you can add all kinds of other variations of that as well. And I would say that's the kind of thing I don't keep in my head anymore. But there are some databases that get at least into things like rollover. And that's where the side impact is critical, right? Because that's mostly going to happen with the center of gravity when you actually have...

You're up on a curb or some other thing that's going to tip you potentially, and again, the direction that you're hit, et cetera. But there is some data on that to show sort of which are the versions. And that's why they added things like the angled collision, basically, recently, just to figure out that, you know what, there's enough of that going on. We should understand the crash worthiness of eagles when they're hit at an angle like that.

Are electric vehicles indeed significantly safer than non-electric vehicles on the basis of a lower center of mass and on the basis of not having an engine typically in the front during a front collision, therefore can have much more force absorptive capacity? Or is that more of a marketing strategy?

We don't have sufficient data yet to sort of make that factual comment per se, but I think you've identified all of a range of the factors that actually differentiate electric vehicles from the standard. And as you know, right now, one of the biggest things is just getting the myths separated from the fiction that is told. There are still more fires in ICE vehicles than there are in EVs. Some of that's about batteries. Some of that's about just the population that's out there of these different vehicles. I mean, it's like you got to get into that level of data analysis.

That's why I'm talking about the segmentation and stuff. So some of these things, again, NHTSA.gov is one place, the Insurance Institute for Highway Safety, they do a lot of great crash testing. And I'm sure we'll get into some of that when we talk about some of the vehicle specific things. But you can get a little bit more of that data. My caution is always that some of that is still in development as far as understanding the kind of differences. Hypothesis, like on what you were just identifying,

But the level of segmentation to actually make factual statements, I think we're still developing a lot of that. Let's talk about where autonomous driving comes in. If you believe that north of 90% of these crashes have at their root cause errors by humans, then you would think that an autonomous vehicle

provided the entire network of vehicles is autonomous, that's always been the big if, right? It's not enough to just have some autonomous vehicles. That could actually make things worse. You have to kind of have everything being autonomous, would certainly have the potential to do better. I don't think it goes from 94 to zero, but it seems that there's a glad path. What is your view of autonomous vehicles and the hope that they bring to this problem? In many ways, I wonder, is that the solution as opposed to

built-in speed limiters, breathalyzers. I mean, I was also going to half-jokingly suggest that if we can put all of those things in cars, we can also probably put in eye flicker sensors and we can track microsleep.

Because I think back to when I was in residency how tired I would be driving home and I could barely hold my eyes open I mean clearly we could sense that so there are clear things you can build in to make humans Less likely to hurt themselves. But at some point you might just say let's just put all of our energy into autonomous vehicles So this is a fun part of a conversation which is

The general comment we've already been discussing, which is when society has issues that are around human behavior and choices and errors we make, then do we often look to technology as a way to help us do better, save lives, improve situations?

So there's another study that NHTSA did where they actually looked at 14 different technologies as straightforward as seatbelts, airbags, electronic stability control, 14. And over 50, 52 years, how many lives did those technologies saved? 613,501. And those are just the 14 they looked at, which were related to the Federal Motor Vehicle Safety Standards and other things that are in vehicles.

So you can't do this, but I point out at 40,000 lives a year, we could have gone 15 years with no lives lost on our roadways. Kind of our conversation, not necessarily injuries or crashes, but technology works. And I'll say this as the caveat to start with is the potential is unbelievable, but we still got to prove it's going to work, fully acknowledging that these new systems will also introduce new risks.

Okay, I think again when I told you people like to point their blame then it does like still got to prove it and we also got to acknowledge that now we're going to have software risks and other kinds of machine learning and technological risks that are introduced. We got to make sure we address those as well. Your point that we may get to zero in some areas should we even expect that in others. Having said that,

What you just described actually is the way I think we need to be using technology. So those are really in two big areas. The advanced driver assistance systems, ADAS, are the things that are already in cars. I'm sure you've got them in yours. Automatic emergency braking, lane keeping assist, cruise control, rear camera, all these different systems that are independent.

And so when you think about it, those are a part of, again, advanced driver assistance. How do we support the driving task by giving you these things that we know when you look this way, you can't be looking that way, but we could give you visibility to that situational awareness again that could actually help with that. The higher level is a fully autonomous vehicle.

And let's just say, you know what, we're going to take out the steering wheel, the pedals and everything else. It's going to do the entire task. And the way sometimes this is separated is at the lower levels. SAE actually has these five levels and I'm not going to get into all of that. But you can think about it basically as at the lower levels, the human is responsible for monitoring the environment and the vehicle.

There's an interim level, level three, where the vehicle will do some of those things. But if it needs you back in the loop, it's going to let you know, take the wheel. And level four and higher is vehicle's going to do it for you. It's going to monitor the environment and the vehicle and handle the driving task. Just so I understand, Mark, is Tesla the best example of, is that the furthest along technology in the driver assist commercially?

I'm not sure it's further along, but I would say it has the most integrated systems of pulling those separate systems in. But what you just said that's so important is the label that often gets used, autopilot, gives a sense that it is autonomous driving, when in fact it's what you just said. It's actually a collection of autopilot.

driver assistance systems, which actually even they publicly, because of regulatory requirements, that's level two. I was just about to say, is that level two or three? But it's level two. You got it. And probably that's one of the more integrated systems that uses all these different things. But you're seeing even the traditional automakers basically offering all these different systems that are in there. So one of the ways, take a step back, is to realize if we're going to take the

280, 300 million cars that are on the road today. It can take anywhere from 10 to 12 years to

to actually penetrate the fleet with new technology. That seems optimistic. I was going to say probably longer. I mean, it would seem to me at least 20 years to overturn that fleet. And that would also include, like, this is going to be one of those moments where I imagine a real regulatory challenge. So I love internal combustion engines. I am an internal combustion engine junkie. And not only that, I love naturally aspirated internal combustion engines.

And I'm not going to embarrass myself by saying how many of those I have, but I have a belief that those things aren't going to be made for very long. And that's why I love to have them. I like the engineering. I love the sound, et cetera, et cetera. So for example, like a 1967 Corvette, you can still drive it today, even though it doesn't meet a single safety or emissions standard that exists today, it gets grandfathered in

As you go along. But when we start to think about autonomous vehicles and you get to this point where you say, well, look for the system to really work, every vehicle must be a level four or level five. That is a totally different regulation. That's no longer just saying to the car producer, you can't make a car that doesn't meet these requirements. It's saying to the consumer, oh, by the way, you can't have that car anymore. Is that what's necessary here? My one thing for you is horses.

When people say, I'm never going to be able to buy my ICE vehicle again or one in the future, it's like, you know what? People still breed them, raise them, race them, own them. They're always going to be ICE vehicles. You're going to still have it around and do what you need to do. But I think it also brings up the enormity of the problem. Yeah, this is the biggest infrastructure problem I can imagine.

Yes. And that's why when I was administrator, we actually put out the first federal automated vehicles policy.

And people were screaming, well, that's a nice policy, but like, what are you going to regulate? And I used to say, what are we going to regulate? It's just a huge issue. The autonomous vehicles aren't there yet. There's some great programs going on demonstrating their potential, but they're not there yet for full deployment throughout our entire society. They're not there yet. They're great demonstration pilot programs, larger ones. And there are a lot of problems that are going on as well with some of the companies. So that is still, again, to be proven.

and understanding where the risks are with that model, we still need to get there. That's why I think one of the ways to conceptualize this is we're probably on a path. There used to be a debate, and I think we know what the answer is now. Do we just go along the levels, one, two, three, four, until we get up to four and five fully autonomous? Or do we jump right to four and five and let's go for the full thing? I think we're seeing it now just by what we're talking about. ADAS is that stepwise strategy.

Get people familiar with the technology. See where the advantages are. See where it helps you. See where it might actually save your life, etc. That'll move us toward it to where eventually it's like, I'd like to just get my hands off the wheel, period. At least for my commute or something else, let the vehicle do it. Again, if you want to race or do something else, that's a different environment, different task you want to do. But I think now that question's been answered that we're probably going to be going through these steps.

Where technology is introduced, we need to get enough data to show it's really going to make a difference. And then when we have that, I think people are like, okay, it's built in, it's working, etc. And then there'll be more comfort at some point. The two examples I'll give you

One is, when I was administrator, one of the things we did was actually challenge the auto industry to make automatic emergency braking standard on every new vehicle by 2022, or at least 95, 99%, like of all the new vehicles. We originally had 10 manufacturers, and a couple months later when we launched this program to try and get this going, we had 20 manufacturers...

basically in covering about 95 to 99% of all new vehicles. And the whole idea was they would get in the room and spend some time saying, what are the criteria that we want to see everybody? It's called democratizing safety. So it's not just if you buy a higher end car or it's an option that I can, it's like, no, democratize means every new vehicle, AEB. And the Insurance Institute Highway Safety says, if Evercard had AEB, we could probably reduce 50% of the rear end crashes with that. Wow. Yeah. Yeah.

And just to be clear, Mark, this is not the warning that comes on when you're about to hit somebody, but it actually will break if the distance and rate of speed between you and the car in front of you triggers an algorithm that says you're going to hit this thing. Peter, this is why it's so great to have some time to discuss this stuff. AEB actually has multiple elements to it. The warning is one.

Another is if you don't break, it'll break for you. Another one is if you break, but you don't break hard enough because of the distance, it will actually add breaking power to what's going on. And so that was what this working group was, is let's figure out what the performance criteria will be for this AEB group.

mandate that we want to see. Now, why I'm bringing this up is because it was not a regulation. And pretty much that's because every regulation that had come through recently, like when I was there, was 10 or 12 years in the regulatory pipeline. And so we said, you know what, let's just challenge them and see who would agree. And like I say, we end up having 20 manufacturers come together. And I mention that because somebody just put a report out that basically they met that requirement.

Now, why is that relevant besides the fact that everybody's got AEB and all those new vehicles? Again, to our point, that's not retrofitting everything else. So there's still plenty of cars that don't have this yet. It's going to take a while for all of that to change.

The other thing that most people, it's not a secret, but most people don't understand this, but to get a regulation through, you need to have an office management budget basically do a cost-benefit ratio, right? They got to do a calculation that says it's worth it. It usually takes a penetration of at least 10% of the vehicle population to get enough data to do that kind of analysis. OMB needs to do a cost- Management and budget. Yeah, OMB needs to do an analysis of

of something because it's the government that's mandating it. That's why they have to be able to say, yeah, if we mandate this, the cost to the industry to do this is X, but then how do they assign a cost to life? Oh, the numbers are there.

Always debated, but do a search on. Yes, but the number of the cost of life doesn't include loss or pain and suffering to the people who are left behind. It's economic loss of life, meaning you lost 10 years of your life working where you would have made this amount of money. So it's probably an underestimate of the true value of life by far.

Absolutely. And part of what I'm bringing up is you typically need at least 10% penetration in the vehicle population, even to collect the most basic data to send it to them. It's like if it doesn't even have the data for that cost benefit, so they can do their straightforward lives versus, we have this technology, how many lives do you think you're going to save? And what data do you have to demonstrate it and substantiate it enough for the cost to the car, the manufacturer, the society?

So, again, I think that's one of the challenges you see going on to what we were saying before is that seeing these stepwise additions to these driver assist systems are getting added. Things like AEB that are now standard allowed that. So the agency just came out recently with there's something called an advance notice for proposed rulemaking and a notice for proposed rulemaking. I don't know which one it is. I forget. But basically, they're now going to regulate AEB.

And I like to point out as part of the reason that they'll be able to do that at an even better level, like maybe extending it to trucks, heavier vehicles, etc., is because of this other work that was done that made democratized it as something that needs to be out there that everyone should be able to have in their vehicles.

So again, I think we will see this stepwise going. But I also point out that when we want to get to the full autonomous vehicle, you said this earlier, I want to bring us back to it. The mixed fleet is going to be a huge problem for everybody. And if you think about it, it's going to be at least three groups, fully autonomous vehicles, vehicles that have a lot of the ADAS support systems, and people that are just driving cars that don't have any of that stuff in it.

And they'll all be on those streets. You won't know which is which necessarily. Mercedes just came up with a different color light for when it's in autonomy for some of the things that they're doing. But earlier, our conversation about defensive driving is like, just think about how more challenging that kind of environment is going to be. Let's touch briefly on drowsiness. I realize this is

kind of your life's work. It's also the one that I think people who listen to my podcast regularly are very familiar with the implications of sleep deprivation. What are the most important things you think you want people to understand with respect to how compromised sleep impacts driving? I'm going to repeat what I said earlier, which is lose sleep, disrupt your clock, the circadian clock in our brains, lose sleep, disrupt the clock, and you will pay for it.

by having human capabilities degraded or impaired. That is across the board. So I don't care what your job is or what task you're on, but if you're not getting the right sleep at the right time, you're going to pay for it. This is one of those, you can't fool human nature, just nature period. You can't fool it. There will be a price to pay.

And is there any regulation about when a truck driver can drive? I understand there's clear regulations about how many hours he or she can drive, but are there regulations that say, we'd like you to stay within your circadian rhythm and do your driving. We'd like you to see a sunrise and sunset and drive accordingly. Even though I know that that's not necessarily convenient and it might be far more convenient to drive through the night. So what's really interesting is if you understand sleep in the clock,

Some of what we would do as a society is exactly opposite the way the world actually runs. And so there are regulations in aviation and trucking and rail and a lot of other places, as you already mentioned, the resident training hours, etc. To your point, I always point out there's the two physiological elements you got to deal with, the sleep part and the clock. Usually it's easier to deal with the sleep part. And people still don't do that well. But as you know,

Just to be clear, if you don't have 10 hours off your job, commuting, getting eight hours of actual supine sleep opportunity doesn't mean you're going to get the sleep, but at least eight hours opportunity. Maybe nine hours if what residents used to do is live in the hospital, maybe. But so, yeah, you can have a little bit better on the sleep part. But to your question, the circadian piece is a lot harder. And keeping that stability in a 24-7 society, military operations, air traffic control, moving goods,

operating airports. It's like, these are 24 seven. This speaks to, again, I think the general theme here that I'm hearing Mark is we're going to quickly approach the limits of what humans are willing to do in terms of the sacrifices they're willing to make. And therefore we have to come up with technology to work around that. We're not going to be willing to live in a society where nothing happens at night.

So we have to automate those processes so that we don't have to rely on individuals functioning at fractional reserve and fractional capacity. You got it. But we are so far away from that in our society now. Yeah, it might not be in our lifetime. You and I probably won't appreciate the full extent of pick your favorite sci-fi movie where the trucks are just autonomous vehicles that are transporting things on freeways at night. Right. I say that because

start at the beginning, which is the information, even naivete and ignorance of society around the dangers, not just the performance, but that is still an emerging, I mean, it's been going on for a while. I feel like Bill DeMint, who wasn't just a professor of mine, but became a friend and colleague and teacher and mentor, all those things. He was probably one of the leading voices who said, we got to pay attention to this because the price is too high.

And he always pointed out that if we don't start with education so that people appreciate not just what the cost is, but for me and Bill, there's a lot of like, if you appreciate what the benefits are of getting the sleep you need and keeping the schedule, et cetera, that should outweigh putting yourself through this other stuff. That's the individual piece. But then it gets to what you just described is if we really accept that as a society, then we have to move to what are the solutions going to be?

Right. And again, it's not always intervening on the individual. Give them drugs. It's like, no, it doesn't have to be that. It's going to have to be these other things like technology that helps us offset those choices we make as a society that could still put us at risk. Yeah. Let's close our discussion, Mark, with a couple of things that people can take away as far as actions that they can take to avoid hurting others and being hurt. And let's start with that of being a pedestrian.

So what can an individual do as a foot pedestrian to minimize their risk? Let me start with a basic question. How many times is a pedestrian killed when they have the right of way in a situation? So they're not jaywalking across a red that they shouldn't be. They're doing the right thing. They're either up on the sidewalk and a car comes up on them or they're crossing when they should be crossing and someone runs in. There's a give a sense of that.

I don't. It's a great question. And I'm not sure we have that data just because of the categories that these would be placed in. Because again, if they weren't doing something illegal, I'm not sure that that kind of information would necessarily be collected. So in other words, we could probably back into it if we, I assume the data are tabulated for every time the pedestrian is quote unquote at fault. And I know we're trying to get out of the at fault mentality here and just solve the problem. But you could say, look,

Of the 42,000 people who died, 6,000 were pedestrians. And we have a really clear example of 1,000 of those pedestrians were the ones at fault. And the driver tried to avoid them at the last second, but couldn't. And then we could maybe say, well, look, in 5,000 of those cases, the pedestrian was not. But do you have a sense of what a pedestrian can do specifically around their situational awareness? What do they need to be on the lookout for to reduce those odds?

You bet. And I think it is worth noting, again, in the last decade, that number has gone up 50%. This last year, the estimates are 7,500 people have died as pedestrians of those numbers. So that's significant. So to the specific actions, the choices that you have, one is if there's a sidewalk, be on it. And again, that's just separation, right, from the driving that's going on. Yes.

If there is no sidewalk, you actually want to walk against the traffic. So that's for visibility stuff of what's going on.

You already mentioned it. It ends up, I mean, we do know 64, 67% of those fatalities occur outside of intersections. So they're happening elsewhere. But it does mean that if you're crossing, you want to find an intersection that's got a crosswalk if you can and has some system of stop signs or counting for when you should go. And you want to follow those rules as best you can. Okay. The other one I think is visibility.

I can't tell you how, especially at night, which is when most of those occur, over 50% are simple, straightforward visual things, making sure people can see you. And the other one I think nowadays in particular, we mentioned it for driving, but situational awareness is critical. And so it's amazing how many people could be either drinking or on their phone with head down. So distraction, the kind of things you think about as a driver, you would apply to pedestrians and cyclists as well.

Are cyclists included in that 7,500 deaths per year? No, I think those are just pedestrians. And I don't remember the cyclist number, but it's there. Yeah. As someone who rides his bike still outside, though not nearly as much as I used to. And frankly, a lot of that is due to just...

my lack of faith in drivers, I certainly adhere to the principle of always assuming the car doesn't see me and always assuming that the driver is a moron. And those assumptions are surprisingly accurate more often than I would like to acknowledge. I mean, the amount of people that will pass you, so they've presumably seen you, only to then want to turn right directly in front of you is remarkable.

But yeah, I think all of those make sense. The walking on the other side of the road, the being completely aware. And I just think as a general rule, as a pedestrian, also assuming drivers don't see you, they're calibrated to look for bigger, faster things than you. So you just have to kind of assume they're not seeing you. You know, in California, pedestrians have the right of way wherever they are.

But I always point out having a law on your side. Having a law on your side means nothing if you're hit and dead or injured. I always find that to be the dumbest argument ever, which is assume you never have the right of way, even when you do have the right of way, when you have that big green light and the big walking sign, still assume that a driver is going to make a mistake because the consequences are much higher for you than them, even though legally the law's on your side. Anything else, Mark?

We've sort of throughout this discussion infused as much insight we have as far as behaviors that you can take into your own hands. And aside from the obvious, I think the obvious ones are so clear. But I do, again, want to reiterate this thing of looking...

Both ways through the intersection. I always tell people left, then right, then left, because it's that left one that's going to kill you when you're driving. So left, right, left scan before the intersection when you have right of way. The other thing for me, Mark, is when I'm on a four lane road, two in each way.

I'm never in the left lane unless passing just because, especially with these non-median roads out here, it's that much harder for somebody to cross and weave into my lane. So it's staying in the right-hand lane. It's really funny. We've got these 75 mile an hour roads out here that have no median. And there are typically two or three lanes only in total, two in one direction, one on the other. And sometimes they're one and one.

And those are nerve wracking, you know, a one-on-one 75 with no median. Those are roads where I will not talk on the phone. I will not listen to a podcast. All I'm doing is imagining how quickly could I veer off to the right if a truck got into my lane. If I can just a slight nuance to what you said is part of the defensive piece of that is don't expect or assume that people are going to actually follow the rules.

And so you may be at that intersection and looking, but it's like, don't think because someone's got a stop sign there, don't assume they're going to follow the rules, whatever they are. And that includes yellow lights, red lights. No, if there's someone there and their potential risk, your choice is whether you decide to proceed through, slow down, pause. Those are things that are under your control. Yeah, it's really funny. Two days ago, I was driving somewhere and I was

I was in the right-hand lane and I was going to make a right-hand turn into something. And I didn't actually realize that there was a driveway before where I make my right. I put my right blinker on, and this is a pretty quick road. It's about a 50 mile an hour road. And I'm coming up to, I'm now probably about...

I don't know, 300 feet before where I'm about to make my right. And a woman came to the edge of the road where, again, I didn't even realize there was a road. It's easy to miss road. And she looked, saw me, but saw that I had my right blinker on and just pulled out, assuming I was going to turn right there. Now, you could argue, well, technically, I guess she's right. I had my blinker on. But I had that blinker on long before she showed up, thinking I'm turning, you

And, again, I had to really slam on the brakes not to hit her. And she would have taken the brunt of that, not me. Regardless, again, it's not about fault. It's what is the consequence of this awful collision. And I was amazed that she pulled out. She pulled out when my rate of speed hadn't even begun to slow. And I wondered to myself...

How does she not see how fast I'm going? Like, what did she think I was going to do? Somehow, like I'm on a rail that's going to allow me to turn that quickly. But see, that's a perfect, perfect example of what we just talked about. Don't assume people are going to follow the rules or that what you're seeing is what's going to happen.

And to what you just said is she wasn't thinking, you know, she just assumed that that right signal meant you were turning right into where she is. And my point is, even though maybe I was at fault when it's all said and done, maybe it's my fault that I had the blinker on when I wasn't planning to turn right there. But I think taking fault out of this is the right way to go. And instead thinking root cause effect root.

root cause effect, because the only accident I've ever been in my life, Mark, was a very bad accident where the other person was 100% at fault. They ran a red light while I was going correct speed limit, which was 50 miles an hour through an intersection. And luckily for this woman, I hit the passenger side, not the driver's side. She was the only person in the car.

I'm in a pickup truck. She's in a sedan. I hit her so hard that both vehicles were a write-off. It's the only vehicle I've been in where the airbags deployed. And what struck me is...

how amazed I was at how quickly it happened because I was driving this way and she was stationary to make a left. So it wasn't like I was looking at her. I saw her the whole time, but never thought she would just jet out in front because it wasn't in my usual going through the intersection, somebody over there, somebody over there. It was the woman right in front who erroneously thought she had a green light to go, even though she had a red arrow pointing

And she just pulled out slowly. And I did probably get the brakes on before I hit her. But I think about that. And I think had she had a passenger in that car, could have been a very different situation. And it happens so quickly that you don't have to make the mistake to suffer the consequence. I really appreciate you telling these stories. Some people are good at it. Some people don't like to talk about them. But this touches everybody.

I mean, you've lost someone in a roadway and the emotions you were experiencing are so justified and understood and your approach to how you think about it now that are based in all of that. Same thing here. Those two drivers you just talked about with different things, it's like neither one of them thought, again, I'll go out today and see if I can get killed. It's not just the other way, right? It's that one too. It's like, let me see if I can run into somebody to do it. It's like, they're not doing that.

But it's a complex dynamic environment with humans that are imperfect and make bad choices and also errors in what they do. And how do we try and do that more safely? And I think, again, those encapsulate everything we've been talking about. Big societal changes. How do we make this better for everyone? But a lot of it comes down to your behavior, what you can control, the stuff that's out of control. You can still do something about in some situations.

I think it's also, we didn't talk about this much and you made just one quick comment in there. There's a whole culture around cars.

That's part of what's going on here, too. I mean, it's our independence. It's economics. It's family. It's just sort of the American way, right? Don't tell me how. So there's a lot going on here that also are at play, which I think when we talk about, are we ever going to have fully autonomous so we can save lives? Like, I'm not sure we know that yet. Maybe we work that way when the data can justify it. But for the moment, there's a huge car culture that's in operation here as well that clearly is affecting our choices.

and willingness to give certain things up for these other societal benefits that we know we could attain. Yeah. Are there any resources, Mark, that you would point people to who are kind of interested in the, what can I do? There are, again, lots of things that hopefully will happen technologically, and we can debate the policies all day long. But at the end of the day, everybody listening to this is going to get in their car today. And

I hope we've given people a lot of strategies. Is there anything you would point people to, especially parents maybe who have teenage kids who are starting to drive where we can, as you said, I think get them started in the best way possible because you start to create patterns of behavior early. So let's hold the kids for a moment.

And I think the place to start a few websites, NHTSA.gov is a great website that you can go on. It has a VIN, Vehicle Identification Number Lookup. So if you're wondering, do you have a defect and recall that you should take care of, you can do that.

Car seats. You can literally go on there and put your kid's birth date, height, weight, and it'll actually give you recommendations of whether it's backwards, forwards, booster seat, etc. Really good with that. And all the data we're talking about that I can't keep in my head is on that website. And so it's a great source for things. We haven't talked about it, but NHTSA runs a new car assessment program, NCAP. It's the five stars. Stars for cars. It's what's on the Monrovia label on your new car.

That's the stars evaluating its crash worthiness and some other factors. What's it called? It's NCAP new car assessment program. Okay. So again, when you're thinking about where should I start? Well, just start with the ratings. So NIST has got all this different stuff. That's a great resource there. Next would be the insurance Institute for highway safety. IIHS. They do a lot of the crash testing, but they also have a lot of research that they do.

So they're the ones who do the top safety pick and other kinds of things. So that AEB challenge I talked about, that was actually a collaboration between NHTSA and IIHS doing that challenge for the industry to democratize AEB. And besides the crash information, they also have other studies and things they do. So really good there. National Safety Council.

NSC. They have great data because they all have car stuff, they have pedestrian stuff, they have cyclist information. They're really good for general resources for safety, including roadway pieces. Sorry, that one again was? That's the National Safety Council, NSC. NSC, okay. Yep. And the fourth one I would mention is Safe Kids Worldwide.

And they actually certify car seat technicians because it ends up, and I'm going to get this number wrong, but 60, 70% of car seats are installed incorrectly. I know it's over 50%. So it's great to do all that work to get the right one, but then if it's not incorrectly, so Safe Kids Worldwide actually does that too. I think those four are great resources for different things. When you get to the teenagers,

Couple things. AAA actually has different kind of driver contracts that you can use.

So that's the insurance company also has a foundation. So they have a lot of good auto safety information there as well. But they actually have contracts that you can do with your kids. And I would just say you should also look up because depending on the state, they may have graduated licensing. And that licensing for new drivers actually includes, can you have other kids in the car? No. Can you drive after dark? No. This for six months, this for a year. It's

Et cetera. And so I was just talking to a friend. It's like, oh, we did the AAA. I'm like, you should look at the graduated licensing along with the AAA and just see what the elements are and then come up with your own.

And I hate to say this because as a scientist, you'll appreciate this too, but feel free to experiment with her. You know, put that training program you were talking about. There's some simulator work. There's also some actual driving work. There's the intellectual part that would supplement any formal stuff she gets from another source. But do that. I mean, that's the intervention. I would do your own assessment then to sort of... Could you measure some of that in the simulator, for example, to see if now you have an NM1, totally get it, but it's her life you're trying to save. So...

Whatever you could do there to try and bolster her with more education, experience, etc. That would make her, again, more situationally aware and defensive when she's driving, along with the skill set, I think would be great benefit. The other thing I'll just tell you that's interesting is we've seen in the last.

Five to 10 years, young drivers are less and less interested in getting their driver's licenses right away. So we're seeing kids in college that don't know how to drive, you know, or they're waiting till after college when they have a job or they're picking their location by public transit. And this might be a great trend, given what you said about the maturation trend.

Of kids anyway. So yeah, you know, one thing I'll just share with you with my daughter, she's not psyched about this, but she's going to be driving a manual transmission truck. That's actually going to be her car. And every time she fusses about it and

says, Oh, you know, I just say, I mean, you could take the bus. Like that's cool too. But if you want to drive, you're going to be driving stick. And there's a big part of that is the connection to the drive. And it reduces at least one of those variables in my mind, which is the distractibility. And she's nervous about rolling backwards on Hills. And I'm like, good, concentrate harder and learn the skill. Yeah. So that becomes a non-issue for you. Yeah.

Well, Mark, this has been really illuminating. It's quite disturbing, as we've talked about, and I almost wish there was a way that we could convey every one of the 42,929 stories of the people who died two years ago, the most recent data we have here. I think it, on some level, it sometimes takes those things. Unlike when you think of all the chronic diseases that I spend most of my time thinking about and talking about, they disproportionately affect older people.

Your risk of death from cardiovascular disease, stroke, cancer, and Alzheimer's disease, this is disproportionately a disease of the elderly. Whereas when I last looked at this, which was 2020, and I can't imagine the data have changed that much, the thing that stuck out to me the most was that automotive deaths are

were the most uniform cause of death by decade of anything in the top 10 causes of death. There was nothing more uniform than dying in a car.

Equal opportunity killer. Which is why let me, I know as we start wrapping, just two things that I think would be good, especially for you to be thinking about. One is that, and these are where the parallels are there. One of the differences, however, is between health and say the safety element, et cetera, is, and one of the reasons I've really looked at safety and transportation from my sleep interests is death can be instantaneous.

I mean, it's like in milliseconds and you don't go out that day thinking it's going to happen. And as you were saying, you don't get to say goodbye to your grandmother who's got cancer for two years. Yeah. Someone comes to your door. They're not coming home. It's like just like that. Right. And so I think that's one thing that separates it in some ways from those chronic illnesses and many other kinds of things.

But I would also say there's some real significant parallels when I think about this, because one of the big pushes that I've tried to make happen in the automotive realm is trying to move from a more reactive safety culture to a more proactive one. Which again, I think the parallel there of what you do for prevention and thinking about how do we eliminate or mitigate the things we know that can cause bad stuff, promote the ones we know that will make good stuff happen. How do we do that?

And I think that's been a challenge having worked at NASA as a NASA scientist on the aviation side. They're very proactive. I mean, in aviation, they went 12 years. In the U.S., no person died in a commercial aircraft crash in like 12 years. OK, and then it was one. And I always tell people, it's like it's so hard to get there. It's even harder to stay there.

saving all those lives. But that takes a proactive culture that says we're going to do what we can to eliminate or mitigate, diminish what those risks are and promote the good stuff we know that's going to make a difference. You do that all the time. This is why I said thank you at the beginning, because bringing this into that realm and not just public health, this is like societal safety and what we get here. There's a real parallel there that there's a chance to be more proactive. Now you think about it, investigation is reactive.

Bad thing happens, we investigate, but it's to make it proactive. That what we learn from there has to be translated into some action that's going to prevent it from happening again. And that's where, frankly, and always, again, I've already said thank you, I'll do it again. Just having people discuss this and think about it, tell their story to someone else, those can save lives.

I don't know your daughter at all. I've known you for this period of time, but it's like you're way better off, both the fact you've talked about it, you've thought about it, and will basically provide that context and skill set to your daughter.

You may not even be around when it saves her life or her kid's life or some other person in her sphere, because that's the societal change in a proactive way that's going to make the big difference. And yeah, I think we need to save them one at a time. Your friend, my father, the consequences are so significant, but we can't bring those back. How do we use those as opportunities, though, to make the future for you, your daughter, your

her family, my kids, et cetera. What do we do to make that in a proactive way, safer for the future? You're doing that straight on with the healthcare. The parallel is there in this realm as well because the costs are so high. If there's one thing I could do based on this discussion, Mark, because I now realize there's so many pieces that are changing with the technology that are going to move us in the right direction. But if I could make a change today,

Based on what we discussed, it would be that I wish that for every significant accident or fatality that occurred in a given city, the story was told in two fronts. The story was told in the human sense of the story so that we understood the life or lives that were lost and the consequences and how that's going to ripple through forever. How Nick's wife lost her husband and Nick's kids lost their dad.

but also in a very clinical autopsy-like manner of the accident.

I really think that every time a horrible accident or fatality occurred, if each of us could see a 60 second video that would say, this is what happened on this date and this time. And these were the contributing factors. That's it. And everybody has to invest. It's not a big price to pay for those of us who are alive that for every time somebody dies, you got to invest a minute in hearing how it happened.

No other technology at this point in time, just the explanation of what happened is going to make us better drivers. No question. This is why I was not kidding about write those down, the four minute video or like what you're talking about now. And I would just slightly extend to say, not just identifying the causal contributing factors, but if there's any action involved,

that people could actually take to do differently. And think about this with that local intersection you keep talking about. Without what you just described, it's going to keep happening. People aren't going to know what happened there or if there's anything different they could do to spare their lives. It's not going to change without what you were just describing. Yeah. Yeah. Figure out how to do that. Mark, thank you very much. Really appreciate your time and your insight today. Thank you. Enjoy the conversation.

Thank you for listening to this week's episode of The Drive. It's extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members. And in return, we offer exclusive member-only content and benefits above and beyond what is available for free. So if you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription.

Premium membership includes several benefits. First, comprehensive podcast show notes that detail every topic, paper, person, and thing that we discuss in each episode. And the word on the street is nobody's show notes rival ours.

Second, monthly Ask Me Anything or AMA episodes. These episodes are comprised of detailed responses to subscriber questions, typically focused on a single topic and are designed to offer a great deal of clarity and detail on topics of special interest to our members. You'll also get access to the show notes for these episodes, of course.

Third, delivery of our premium newsletter, which is put together by our dedicated team of research analysts. This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter. Fourth, access to our private podcast feed that provides you with access to every episode, including AMA's sans the spiel you're listening to now and in your regular podcast feed.

Fifth, the Qualies, an additional member-only podcast we put together that serves as a highlight reel featuring the best excerpts from previous episodes of The Drive. This is a great way to catch up on previous episodes without having to go back and listen to each one of them. And finally, other benefits that are added along the way. If you want to learn more and access these member-only benefits, you can head over to peteratiamd.com forward slash subscribe.

You can also find me on YouTube, Instagram, and Twitter, all with the handle PeterAttiaMD. You can also leave us a review on Apple Podcasts or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed.

The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions.

Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peteratiamd.com forward slash about where I keep an up-to-date and active list of all disclosures.