295 ‒ Roadway death and injury: why everyone should care and what you can do to reduce risk

1. 0:00 – 1:07

   Intro

   1. MRMark Rosekind0:00

      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, right? I mean, it's like-

   2. PAPeter Attia0:16

      Yep

   3. MRMark Rosekind0:16

      ... in milliseconds and, and you don't go out that day thinking it's gonna happen.

   4. PAPeter Attia0:19

      Yeah.

   5. MRMark Rosekind0:19

      And as you were saying-

   6. PAPeter Attia0:20

      Yeah, you don't get to say goodbye

   7. MRMark Rosekind0:21

      ... those chronic-

   8. PAPeter Attia0:21

      You don't get to say goodbye to your grandmother who's got cancer for two years. Yep.

   9. MRMark Rosekind0:26

      Someone comes to your door. They're not coming home, you know?

   10. PAPeter Attia0:30

       Yeah.

   11. MRMark Rosekind0:30

       I mean, it's just sort of a, it's a different... It's like, just like that, right? Um, and so I think that's one thing that separates it in some ways from those chronic illnesses and, you know, 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, to make happen in the automotive realm is trying to move from a more reactive safety culture to a more proactive one.

   12. PAPeter Attia0:57

       [upbeat music] Hey, everyone. Welcome to The Drive podcast. I'm your host, Peter Attia. [upbeat music]

2. 1:07 – 12:17

   Mark’s background & education, & the profound impact of transportation accidents on human lives

   1. PAPeter Attia1:08

      Well, Mark, thank you so much for joining, uh, me here today. This is, uh, this is certainly a topic that I don't think gets enough attention given the, the consequences of it. And it's, um, it's also a topic that I think m- maybe people don't necessarily appreciate the, the frequency of, of such interactions. And, uh, and I guess one of the things I'm hoping to understand today is how much of, you know, the nature of what we're gonna discuss today is under our control. Um, I know that as I think about, you know, the things that are a threat to our lifespan, a number of these things are, are kind of, uh, out of our control. Uh, but many of them are actually in our control. Uh, certain diseases, for example, like cardiovascular disease, are almost entirely within our control and, you know, genes play a role, but, but your ability to sort of, um, go above and beyond the, the genetic hand you're dealt is, is significant. But here, when it comes to accidental deaths and, and as a, uh, you know, as a subset of that, the, the, the, the role that fatigue plays in that, I, I wanna really explore this. But, but I think before we do, I, 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, uh, it felt almost too good to be true that we discovered you and your work. Um, the way, the way things sort of work, Mark, is, you know, basically, uh, you know, we sit around and brainstorm ideas that we wanna cover and, um, and then we go out and look for an expert. That's... 99% of our podcasts work in that way. Um, so anyway, it was just great to... I remember when Nick came to me and said, "Okay, you know, this is what we found," and I was like, "Wow, that, that seems amazing. [laughs] We're gonna really answer a lot of questions I've always had." So, um, but, but 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.

   2. MRMark Rosekind3:05

      Hmm. Yeah, [laughs] let's start there, right?

   3. PAPeter Attia3:08

      [laughs]

   4. MRMark Rosekind3:09

      Um, long time ago, but it still is challenging to talk about actually.

   5. PAPeter Attia3:14

      Mm-hmm.

   6. MRMark Rosekind3:14

      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, um, versus things that I can't, uh, just a, a critical conversation. I really appreciate you taking the time to do this. Um, and I pause for a moment 'cause it actually was not until my Senate confirmation hearing to be administrator of NHTSA that I really talked publicly about this very much.

   7. PAPeter Attia3:57

      Mm-hmm.

   8. MRMark Rosekind3:58

      Um, but my father was a San Francisco motorcycle policeman. Uh, 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 a shadow box with his badge and Purple Heart. Um, he was 30 years old. My brother and I, I was three and a half, my brother was two, raised by a single parent. And I, I'm okay talking about this to start with because it just points out this is personal for me. Um, 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. Um, 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 wanna know how many lives were lost on our roads, make sure you know the exact number 'cause every one of those numbers is a father or mother or sister or brother or, you know, some relative or one of your neighbors, et cetera. Those are real people, and we cannot bring them back. And I think that, 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.

   9. PAPeter Attia5:13

      Yeah, there's a quote that I'm not remembering exactly, but it speaks to the idea that, you know, uh, a million people is a statistic, but you know, a small number of people is a story. And, and, um, I, I agree with that completely. I mean, I think we, we can get very numb to what those numbers mean. Um, I'm, I don't know if you've seen it, but there's, there's, there's a, a series on Netflix right now that takes a lot of old footage from World War II and, um, basically does some remarkable, uh, 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, um, uh, look, I think anybody who's watched it has, 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. And you, you know, you hear about, well, you know, 60 million or 80 million, I don't even remember, people lost their lives globally. Obviously, we're aware of six million people being exterminated in concentration camps. Um, and yet I realized as I came to the end of that, I don't even know what that means 'cause I've never seen six million people with my eyes. I've never seen one million people with my eyes. So it's, it's very difficult to explain those things. And what I think this, um, 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. Um, and then at least you have some semblance of saying, "Wow, now imagine multiplying that by a thousand or a million."

   10. MRMark Rosekind6:58

       And the numbers numb you.

   11. PAPeter Attia7:01

       Yeah.

   12. MRMark Rosekind7:01

       As you just said, it's like I, I don't know what that really means. So it numbs you. Very often in, in talks, I would actually start with kind of what we call in the business bent metal. And so, you know, having been at the NTSB, I'll literally take photos from investigations, you know, minus the humans. But it's like this was, you know, Dawn at 20 years old, you know, and she not only lost her life, but the people in this minivan you see, you know, 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"-

   13. PAPeter Attia7:35

       Yeah

   14. MRMark Rosekind7:36

       ... or a partner or your kids or your neighbor, you know, people that matter. Um, 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, you know, that makes it very personal. And again, you can't bring them back. There's no coming back from that.

   15. PAPeter Attia7:58

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

   16. MRMark Rosekind8:35

       I'll give you the arc, and it's more of a zigzag.

   17. PAPeter Attia8:37

       [chuckles]

   18. MRMark Rosekind8:38

       Whatever you wanna go in-depth, let me know 'cause as always, there are interesting stories along the way. Um, 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 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, you know, sleeping since crawling out of primordial slime, uh, we only knew about non-REM and REM in the mid-'50s. Um, and so Dr. Dement came to Stanford and started really one of the first sleep centers and was teaching this undergraduate course. Um, 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-

   19. PAPeter Attia9:35

       [chuckles]

   20. MRMark Rosekind9:36

       ... another medical school professor. You know, and it's kinda 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 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.

   21. PAPeter Attia10:03

       Hmm.

   22. MRMark Rosekind10:03

       Okay? So, uh, think about it. That, as an undergraduate, was an incredible experience. Um, 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. Uh, you know, it was the '70s, and I actually met my wife during that study. It's worked out quite nicely. Um, but it was a way to get involved in research as an undergraduate that you don't usually get, um, the opportunity. So that kind of changed everything. Um, 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-- 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.

   23. PAPeter Attia11:02

       Mm-hmm.

   24. MRMark Rosekind11:02

       There was no sleep medicine fellowship. There was no training in any of that. Dr. Dement was pushing to make that real. Um, and so I decided, you know, 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. Um, but when I was finishing my PhD, uh, somebody I knew from Stanford, Mary Carskadon, 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. Um, 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. Um, it was an incredible experience. The plan was to stay, go on the faculty, et cetera. And instead, I end up going back and working for Bill, running a human research program for a

3. 12:17 – 16:39

   From sleep science to safety leadership: Mark’s journey in transportation innovation

   1. MRMark Rosekind12:17

      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, uh, NASA Ames Group, which is one of the NASA facilities out here in Mountain View, California. Um, 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 'cause 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 pilot's brain and eye movement activity in ongoing way during flights. Fascinating. And I mention that 'cause that was a transition, really, out of the s- very specific academic kind of environment to NASA. And so I end 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, a force for me throughout my career, hence the safety emphasis. You know, great sleep science, circadian, 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. Actually ended up, uh... That was commercial and military pilots, astronauts, controllers at Johnson Space Center, et cetera. Fantastic, incredible work. Love to talk about that too, I hope. Um, 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, uh, basically all over the world, in healthcare, energy, uh, military operations, you name it. Was fantastic. The next part that was so interesting, part of the zag, um, 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. Uh, 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 a methodology to investigate fatigue. And they ended up identifying fatigue as the probable cause in that particular crash. Um, and that has kinda become the methodology that they use. So, you know, 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. Uh, 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. Um, 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. Um, and I was there for just a couple of years, 'cause that one is tied to the President, basically. Um, unbelievable experience. Again, if you think about what we just talked about, which is how do you take, you know, 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, uh, as the chief safety innovation officer at an autonomous vehicle company, which is like a way at the other [laughs] end of the continuum that's been fascinating as well.

   2. PAPeter Attia15:47

      Yeah, it's, it's, 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 y- you are fortunate to have been at Stanford, which in many ways certainly was the epicenter of sleep research, um, at least in the US and potentially in the world. Um, and then you've also got this, you know, interest in, in safety and crashes, right? Obviously, the NTSB. Um, so, um, I, I think, you know, we're gonna 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.

4. 16:39 – 27:36

   Stats on transportation accidents & fatalities

   1. PAPeter Attia16:39

      I said earlier we're gonna kind of put some statistics out there. Can you give me a sense of what it means to be, uh, uh... You know, w- what is the risk for death or injury that somehow touches the road? So that means, again, you're, you're, you're a passenger in a vehicle, you're driving a vehicle, you're a pedestrian struck by a vehicle, you're a cyclist strike- struck by a vehicle. However you organize that, Mark, can you give me a sense of what that looked like in 1950-ish, you know, versus 1970-ish, versus 2000-ish, versus today? Or, y- you know, g- give us a sense of what that looks like.

   2. MRMark Rosekind17:21

      Let's start with, uh, the final numbers from 2021, which is the last year we actually have complete data. Uh, 42,929 people lost their lives on our roadways. And you were just saying it says drivers-

   3. PAPeter Attia17:37

      Gee, gee, say that again. How big?

   4. MRMark Rosekind17:39

      42,929 people in 2020. That is 118 people every single day. And, and good for you. It's like, "Give me that number again." This is what I was telling you. It's like, you know, you should know the exact number Um, 'cause 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 aren't we f-..." You know, like, the pandemic meant it was all hands on deck. Let's go get this. Like, how can we put up with this? You know, when you think about it, these happen geographically separated, so these are happening all over the country, right? 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, you know, 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 t- 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 gonna focus just on the United States, and I think your, um, question is really important because we know over the years things have come down, you know, very significantly with all kinds of different things I'm sure that we're gonna 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, uh, the number of miles driven and the number of people that are out there doing... There's a lot of different ways to, to cut this. A- and by the way, I'm sure we'll go into some detail, but at NHTSA.gov, N-H-T-S-A dot gov, NHTSA keeps all kinds of data on this. You can look up any year you want, and it's segmented. It's segmented by-

   5. PAPeter Attia19:55

      Mm-hmm

   6. MRMark Rosekind19:55

      ... ages and geography, states. You know, I mean, it's like the level of detail is unbeliv- unbelievable what's out there. Um, 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.

   7. PAPeter Attia20:17

      Yeah.

   8. MRMark Rosekind20:18

      Okay? Um, and I'm sure we'll talk about it, but we get those, and they adjust-

   9. PAPeter Attia20:22

      Yeah

   10. MRMark Rosekind20:22

       ... up and down a bit, but it's the big numbers that really matter.

   11. PAPeter Attia20:25

       There are two things that just jump out at me when you rattle off those stats, Mark. The, the first is I'm just doing really quick math in my head, both on the global count and on the US count, and this is approximately 1/10 the mortality for cancer. Uh, in the US it's a little bit better than 1/10, but globally it's actually slightly worse than 1/10. Um, so, uh, A, that's incredible. It might also say that in the US we are probably safer on average than globally on a, on a individual basis. Um, so not, not sure if that's true, but that would be my first thought. Um, the, the second thing that just kinda jumps out at me when you talk about this is something I remember, you know, somebody saying once that I think is absolutely true. Um, if you read about a death in the newspaper, it's because the manner in which it happened was so unexpected or so- 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, um, 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. It's, if it's somebody famous or whatever, um, but you know. So common things just generally don't get reported on and, 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 we see as e- those of us who are driving by and see this carnage are kind of left a bit visibly shaken by it. Um, and I find it difficult to get information. I'll give you one example. I live in, uh, I live in Texas, and, you know, we have big roads out here that are big and fast and, and I think a lot of them are not necessarily set up as the safest roads. And there, there's a particular road near where we live where, um, I, I believe there's probably a fatal accident on this road three or four times a year. Um, 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. Um, 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, I can completely appreciate why most of these deaths go unnoticed by all tho- uh, all those except for the people directly impacted by the relationship.

   12. MRMark Rosekind23:07

       That's the numbness. You know? They're, they're off the radar. They're not visible, even locally, to many people.

   13. PAPeter Attia23:12

       Yeah.

   14. MRMark Rosekind23:13

       So that's why I often cite NTSB statistics or experiences because those are usually, you know, not necessarily a mass casualty, but there's usually a lot of people involved. There have to be fatalities, um, and they're very visible. As you mentioned, very often it's because they're visible to the entire country, you know?

   15. PAPeter Attia23:30

       Yeah.

   16. MRMark Rosekind23:30

       And they get invested. It takes a year, 18 months to investigate those, et cetera. 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-

   17. PAPeter Attia23:41

       Yep

   18. MRMark Rosekind23:41

       ... you know, what we reported on last month, here's what actually happened there." Okay? And, and I just mention that 'cause I tell you from the NTSB, when you investigate these, it's always a chain of events. You know? It's never just one thing. Um, and it takes a while to figure that out. And, and just to be clear, a lot of that sometimes is just the local resources. You know, I mean, uh, 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, that lo-

   19. PAPeter Attia24:11

       Yeah

   20. MRMark Rosekind24:11

       ... you know, they may go and run to the scene, right, when they've gotta help people in that emergency situation, but the o- ongoing investigation may be checking a box on a form, you know? And then so it stays below the radar for most people, unless you're in the circle that that person touches your life.

   21. PAPeter Attia24:29

       Yeah, and I, and I struggle with this a lot, Mark, because I feel like there's this enormous missed opportunity. So I, I look at an intersection that's no more than three miles from our house. We've only lived here for l- we, we have lived here for four years. I have already seen three fatal accidents at that intersection in four years. Now, I'm not, 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 is that, 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, right? You, you, you know, if three accidents have resulted in fatalities, and by the way, I'm not saying three people have died. I'm saying three fatal accidents. It's probably, you know, 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?

   22. MRMark Rosekind25:51

       You could. Um, and just two things about this. One, you're describing in, what we call in human factors, that sort of safety pyramid.

   23. PAPeter Attia25:58

       Yeah.

   24. MRMark Rosekind25:59

       Crashes are at the top, near misses are right underneath that but a bigger layer, and the, and the layer underneath that are errors.

   25. PAPeter Attia26:06

       Yeah.

   26. MRMark Rosekind26:06

       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, 'cause they're seeing more critical near-miss incidents, because those are the precursors to the crashes that occur, right?

   27. PAPeter Attia26:26

       Yes.

   28. MRMark Rosekind26:26

       And so I think, yeah, you know, to your point, so you could calculate that. And I gotta tell you, make a list, because out of this conversation, there's some concrete things that either you or I need to pursue. And well, the one you just mentioned is we gotta 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 gotta pay attention to that," 'cause I go through that intersection every day, twice.

   29. PAPeter Attia26:56

       Yeah, yeah, exactly. Four, four times a day, I am driving through that place that is the Bermuda Triangle of death. And it, yeah, once a year, it, there's gonna be a death or a series of deaths. Uh, probably five times a day, there's a near miss. Probably 60 times a day, there's an error that could've 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 sort of y- you know, humal- you know, sort of the data out there that I know loosely that we'll talk about today. But, um, but yes, this is, um, this is very troubling.

5. 27:36 – 34:49

   Trends in road fatalities & the key contributors—impairment & distraction

   1. PAPeter Attia27:36

      So I think, you know, um, we, we've kind of, I think, hopefully made the case for why this matters. Just a couple of other questions before we get into some of the specifics. Um, and I won't expect you to, um, rattle off with the same precision, but can you give some commentary on what these numbers would've looked like 20 years ago, 40 years ago, 60 years ago? I mean, I have to think that, you know, with, with airbags and seat belts and better cars, better ca- car technology in terms of y- you know, the collapsibility of cars, um, that things have gotten better. Like, is it easier to just start in the 1950s and presumably it was just mass carnage?

   2. MRMark Rosekind28:15

      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, um, if you go, again, 100 years back, we're probably over 90% reduced to where we are today. Um, probably in the '50s and '60s are where you saw the peak of those numbers, and they've been coming down. Uh, I would just say, 'cause we're talking about this in the statistical sense, what's interesting is we have really population level statistics we talk about, 42,929. Um, 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, et cetera. 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, right, 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 gonna talk about it, but I gotta give you one example. You know, a lot of people think, you know, we've cured drunk driving, right? 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, impaired driving related to drunk driving. That has stayed about 30% For 20 years. So at 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-

   3. PAPeter Attia30:20

      Mm-hmm

   4. MRMark Rosekind30:20

      ... all of those. But again, I think, you know, 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, you know, per hundred million miles that we see. Um, 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 gonna actually, say, get to zero deaths on our roadways.

   5. PAPeter Attia30:49

      And Mark, you mentioned that alcohol contributed to about 30% of those fatalities. What is the contribution of speed and distraction approximately?

   6. MRMark Rosekind30:58

      So speed's over 20%. Uh, I wanna say somewhere between 20 and 25%. Um, distraction is very difficult, right?

   7. PAPeter Attia31:08

      Yeah.

   8. MRMark Rosekind31:08

      I mean, it's just like, um, but I, I just actually, uh, called [laughs] a friend of mine who's... 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%, okay? And part of it you gotta realize these are not individual numbers, right?

   9. PAPeter Attia31:24

      Yep.

   10. MRMark Rosekind31:24

       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. Um, but they're pretty big numbers. Um, so it's at least a third, uh, which again takes you into like 33, 35% range for the alcohol impaired region. Speeding's in the, I, again, 20 to 25% probably, and the distraction used to be considered as somewhere in the 12%, but I think Larry's new data is gonna suggest it's probably much higher, maybe close to a third with some of them. And especially if we talk about it, you know, distraction is more than just your phone, um, that people do in their vehicle. So when you look at all of it, just like impairment is more than alcohol now.

   11. PAPeter Attia32:04

       Yeah, that's a great, great question. So to be clear, I said alcohol, but really impairment is that broader category, um, of which alcohol is probably still the most prevalent.

   12. MRMark Rosekind32:14

       In fact, at NHTSA, um, it's so appropriate for this conversation, but impairment was always three Ds: drunk, drugged, distracted.

   13. PAPeter Attia32:23

       Mm.

   14. MRMark Rosekind32:24

       And when I was there, it's like, and I credit my son actually, [laughs] 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.

   15. PAPeter Attia32:43

       Yeah. Well, there's so much I wanna talk about. I'm just trying to think about how to, how to structure this so I don't miss, uh, uh, miss anything. Um, l- let's talk a little bit about, um, more... Let's, let's go deeper into this contributing factor thing. Okay. So, um, the most obvious thing in the distraction realm is the advent of the phone, right? So prior to, I don't know, early 2000s, right, phones were, you know, not readily used. Um, 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, uh, introduction of mobile phones, you know, 20 to 25 years ago?

   16. MRMark Rosekind33:34

       I, I think the way we would be able to characterize it is that we stopped seeing the decrease that we had been seeing.

   17. PAPeter Attia33:40

       Okay.

   18. MRMark Rosekind33:41

       Okay? Um, and I say that because as you know, two things. One is it's really hard to measure the distraction numbers.

   19. PAPeter Attia33:48

       Yep.

   20. MRMark Rosekind33:49

       Right? I mean, it's just so difficult. Same thing with drowsy, you know, and sleepiness and stuff. Um, and, 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 on the... Yeah, I mean, it's just so diverse, the activities that you could be engaged in. And so, again, I think, um, 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, you know, quote, "variants"-

   21. PAPeter Attia34:16

       Mm

   22. MRMark Rosekind34:16

       ... all of our, right, appropriate, that to specifically just phones. Um, but I would also say it took to a new level the distractions you could get in your car, 'cause some of them have been around for a long time, playing with the radio. We can talk about buttons versus, you know, touch screens, et cetera. Kids in the back seat. Um, you know, 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.

6. 34:49 – 42:14

   Demographics of drivers involved in crashes, & the life-saving potential of better driver education programs

   1. PAPeter Attia34:49

      Has there been any significant change in the past 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? Any- anything that you can point to that, um, for which there's a, there's a causal explanation?

   2. MRMark Rosekind35:13

      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, you know, t- don't have that [laughs] frontal cortex fully developed. Um, 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 don't have, you know, very little experience and just learning stuff. And at the other end, you've got people getting older who actually, um, 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, um, that are mostly affected. More men than women die in these crashes. Um, and again, there's a lot-- 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, you know, what's actually causing those differences and things.

   3. PAPeter Attia36:26

      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, uh, an age at which you can join the military, you have an age at which you can vote, you have an age at which, uh, you can drink alcohol, purchase firearms. So there are various things that seem, you know, tethered to age, but driving is the youngest. And I'm, um, I, I've always wondered... You know, I didn't get my driver's license till I was, like, almost 18 because I v-viewed it as a badge of honor to ride my bike and take the bus everywhere, and I didn't wanna be lazy. Like, I was a weird kid in that way. Um, so I personally can't re- I can't relate to what it's like to be a 15-year-old who's dying to get his license. Um, but, but w- tell me a little bit about that, that process and, and how that came to be and, and for example, given the stats you've just shared, why that age hasn't been pushed up.

   4. MRMark Rosekind37:26

      I don't know you, so I'm like, I don't blow smoke, [chuckles] and so I don't mind telling you, nobody's asked me that question before. And, and I'm gonna go look that up now because nobody's really had a discussion around that. You know, the discussion is all about our education system, driver's ed. Um, in so many other areas, we've got recurrent training, right? I mean, you have that in medicine, you have that for professional drivers, pilots, et cetera. How can we take these young people... I, I, you know, how they actually came up with that age, um, and came up with what are we gonna do around that age to actually prepare these people for lifelong driving experience, I'm gonna go look that one up. I, I real- I don't know.

   5. PAPeter Attia38:07

      Interesting.

   6. MRMark Rosekind38:07

      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, right? Which as you know, comes up all the time of-

   7. PAPeter Attia38:18

      Y- y- yeah, exactly. May- may- maybe there was a reasonable... I, I, I can give you an example. I could pontificate and say, "Look, I mean, kids were working, you know, jobs. They needed to be able to get there and da, da, da." And it's like, okay, maybe all those things are true. Is that true today? I don't, I don't know. Um, the other thing that has always struck me, um, and, oh, one thing you should know about me, Mark, I, I do love driving. Um, and I love driving race cars, and I... So I love all things motorsport related, and I love doing, um, you know, I love drifting, like, doing all of these things. [lips smack] And one of the things I've been trying to encourage my wife and daughter-- my daughter's 15, so she'll be, you know, she-- we're coming into this discussion. And I've, I've been trying to organize a course for my daughter and some of her friends where, um, we, we get a group of really good driving instructors on a, you know, 20-acre skid pad to really teach them high-end driving skills. Um, n-n-the stuff I certainly didn't learn when I was young, but, um, the things that I've learned driving a race car, which is everything not to do, right? Like, your natural inclination when this happens is gonna 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. Um, 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. Um, 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.

   8. MRMark Rosekind40:11

      I don't think so. I think it's what we went-- 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 people, you know, 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, you know, to something that could actually save their lives and the people around them better? I don't think those questions have been asked, okay? 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, I don't think there's any question. I don't mind telling you, um, since you're familiar with F1, you know Jean Todt and, um-

   9. PAPeter Attia40:55

      Yeah

   10. MRMark Rosekind40:56

       ... he actually, 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's sort of ambassador for global road safety.

   11. PAPeter Attia41:06

       Oh, I didn't know that.

   12. MRMark Rosekind41:06

       And he is-

   13. PAPeter Attia41:07

       Okay

   14. MRMark Rosekind41:07

       ... he, he's just taken that on from, you know, not only his F1 days, but his Ferrari days, et cetera. But he's taken this on with a passion, you know, to like, how do we take what we've learned there and apply it to... And why am I mentioning that? 'Cause you already had 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, right? Of the ones who actually learn how to do this and be better at driving than the ones who took, sit in the course or do it online and never get behind till they're actually know where the-- you get behind the wheel to know where the signal is, you know, where your turn signal at. 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 mention Jean just because you know what? Let's send him 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.

7. 42:14 – 49:10

   Critical areas where drivers need to be hyper-aware to protect themselves

   1. PAPeter Attia42:14

      Let's talk a little bit about the, the locations. I always tell my patients that there's, there are three areas where you need to really have a heightened sense of awareness to protect yourself. Um, 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, um, the, the str- standard four-way intersection, but also a T intersection, like when you're coming out of a mall or something and that, you know, you're coming out of a gas station or something like that. Um, the second place is the, uh, two-way traffic without a median. Um, dev- devastating especially as I said, we have these roads here that are 60 mile an hour roads with no median. Um, so you know, personally, those roads scare me, but there's, they're unavoidable where I live. And then I think the third place you have to be aware is, um, on freeways, and in particular, around exits and on-ramps where people are acting sometimes irrationally, you know, merging, trying to get off at the last second, trying to get on, you know, doing silly things like that. And, and I basically say, "Look, if you can harness the power of your attention only s- you know, selectively while driving, make it those three spots." So what, what would you say to that, Mark? Would you... Where, what would you add to that, and can you comment on what fraction of fatalities are a result of crashes under those three scenarios?

   2. MRMark Rosekind43:48

      Yeah, I think you've actually nailed it. Um, I'm not sure I can give you the exact, uh, percentages for each one of those, but inter- it's, it's actually in the order you've got. And all I would do is say you've got the intersection part, which is any intersection, as you pointed out, right? Um, 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.

   3. PAPeter Attia44:11

      Mm.

   4. MRMark Rosekind44:12

      Okay? So, you know, you would think about the median in the middle, but it's also-

   5. PAPeter Attia44:14

      Yep

   6. MRMark Rosekind44:14

      ... on the sides-

   7. PAPeter Attia44:15

      Yep

   8. MRMark Rosekind44:16

      ... where, you know, 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, um, not just the median in the road, but let's expand that to separation of the vehicles from, again, the sides where pedestrians and cyclists might be as well. Um, so I think, you know, those, those garner it and, and your on and off ramp of a, you know, any kind of system. Again, with the issue there is the speed differential, right? Uh, and that, that's the, the challenge you have there is trying to figure out not just that I have to merge, but you know, the speed you need to merge with traffic going at whatever their flow is in that particular situation. Um, and I, 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 gotta do those edge cases because lives still get lost in those.

   9. PAPeter Attia45:16

      Yeah.

   10. MRMark Rosekind45:16

       You know? And, and I think one of my mantras is never again. You know, when those kinds of especially edge cases happen, you need to share that data, hence that four-minute video is so interesting, whether it's common or edge case, so it doesn't happen again. You know, you shouldn't need every intersection in the world or every what, 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.

   11. PAPeter Attia45:45

       And, and just so I understand, Mark, there, it... I, I've, I've seen accidents where a driver makes a slight mistake, um, but it becomes catastrophic. And I'm, and I'm always taken back to 1990, uh, '94 when, uh, my, my hero Ayrton Senna died, uh, May 1st at Imola. And Max Mosley, who was the head of the, uh, FIA at the time-

   12. MRMark Rosekind46:12

       I knew Max

   13. PAPeter Attia46:12

       ... did. Oh, you did? Wow.

   14. MRMark Rosekind46:14

       Yeah. [laughs]

   15. PAPeter Attia46:14

       Max-

   16. MRMark Rosekind46:15

       Yeah

   17. PAPeter Attia46:15

       ... 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. Ev- w- how did Senna crash? How... S- 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. [lip smack] Um, and what I find 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, um, you know, when a person makes a mistake, you always wanna have more of a buffer for that mistake to not result in the nature of force that could kill them. Uh, so for example, on 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, like, that analysis on the individual basis isn't necessarily being done.

   18. MRMark Rosekind48:12

       That is correct. And I think what you do see are the level of analysis, you know, that we can cite, the segmentation, et cetera, that again are at sort of more population level Then into the specifics of a particular crash at that particular site with those particular individuals. So, uh, you know, again, I'll cite the NTSB. This is why, you know, it takes a year plus to do an investigation 'cause you're gonna look at all of the factors that are involved there, um, 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, um, you know, those investigations are reactive, but they're intended to take information so you can prevent them from reoccurring again in the future. Um, 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, you know, police department, you know, level. They just don't have the resources or time and other kinds of things to go and do those kinds of analyses,

8. 49:10 – 56:31

   The role of the National Transportation Safety Board (NTSB) in accident investigations, & the importance of data sources like event data recorders (EDRs) in accident reconstruction

   1. MRMark Rosekind49:10

      you know? So there's a big gap.

   2. PAPeter Attia49:12

      Does, does NTSB only investigate, you know, trains and airplanes and sort of huge things? Like, what's the mandate of the NTSB? 'Cause it, it says transportation, which you would think includes all forms of transportation, but it obviously it can't-

   3. MRMark Rosekind49:24

      It does

   4. PAPeter Attia49:24

      ... do this type of analysis for cars.

   5. MRMark Rosekind49:26

      You're exactly right, and it ends up the NTSB's 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, um, specific crashes that occur that have national importance. And so it, in every mode of transportation, you see mostly, for example, on the roadway, you see mostly buses and trucks 'cause those are big. When there are fatalities, there's more involved usually, okay? Um, 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, okay? Now, when you go into it, you don't know exactly what you're gonna find, but you get enough information to say, "We should go after and see this," 'cause it would allow us to make recommendations that would have national import, im- importance to do that.

   6. PAPeter Attia50:19

      And how, how did those come to you? Gi- given the sheer volume of these crashes, how would the NTSB make a decision or determination that this car accident is potentially, you know, one we're gonna 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?

   7. MRMark Rosekind50:44

      So let's pull the cover back on the NTSB a little bit to see how this process goes, and it's, it's very much what you're talking about. So we gotta do all aviation. What are the high opportunity investigations we could look for in marine, in roadway, right, in, you know, 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 [chuckles] that gets investigated as well. Um, but to your point, uh, what happens is, is 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. You know, the FAA lets you know about a crash of something that's going on somewhere. It could come... 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, you know, 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, you know, the case? Um, but if it is, that's the one that you wanna be able to go in depth on so you can make recommendations to the entire industry, right, or individuals or whatever you need to do to try and get changes.

   8. PAPeter Attia51:58

      Now, w- when we think of the NTSB or when I think of the NTSB, I think of aviation, and we, uh, everybody thinks of the, you know, the black box, right? You guys have this-

   9. MRMark Rosekind52:07

      Mm-hmm

   10. PAPeter Attia52:07

       ... amazing data recorder that almost without exception is recoverable, and it contains not only what the pilots said up until the moment of impact, um, but also the telemetry. You, you actually see this was the position of this aileron. This was the, you know, thrust on this engine. This was the yaw in the st- I mean, you know every detail of it. Um, what, what do cars have in them that allow the NTSB to do that kind of thorough investigation? I mean, uh, I'm, I mean, I, I, 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. Um, I mean, I know my racing cars do, but I assume street cars have some of that?

   11. MRMark Rosekind52:49

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

   12. PAPeter Attia52:53

       Yeah. [laughs] That's, yeah.

   13. MRMark Rosekind52:54

       Um, and, and that's partly for, you know, so you can find them, right? [laughs]

   14. PAPeter Attia52:56

       Yeah, yeah.

   15. MRMark Rosekind52:56

       That besides all the other beeping that's going on, it's like sometimes you can just spot it that way. And 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, okay?

   16. PAPeter Attia53:10

       Yeah.

   17. MRMark Rosekind53:10

       Um, and, 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 authorities that are there. And many of these things, though, they're actually controlled at the state level, okay? So that, that's kind of important about which things are... So EDRs are where there's a basic federal sort of 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. In the EDR in most vehicles, it's the basics. Um, and there's always this tension between the industry about how much data they wanna leave out-

   18. PAPeter Attia53:54

       Yeah

   19. MRMark Rosekind53:54

       ... versus those on the investigation side that know more is better if we understand. So some of these very recently only recorded, like, 30 seconds or a minute worth of data, maybe three minutes back. Uh, and then, and this is a debate even in the aviation ones. In the old days, they used to record over. And so, you know, for those of us who wanna 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, the variables that are recorded and the amount of time that it records and that it's available to you post-crash to be able to look at all that and reconstruct what actually happened there.

   20. PAPeter Attia54:36

       And is that one of the more important, uh, data sources you would rely on when the NTSB did indeed come in for auto accidents?

   21. MRMark Rosekind54:44

       Absolutely. That, and of course, um, you talk to everybody. So witnesses not only in the scene, but you talk to family and other people, you know, work, all of that kind of thing. And, and you know, like 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. Were they 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-

   22. PAPeter Attia55:22

       Hmm

   23. MRMark Rosekind55:22

       ... what you're finding to go back, which is why I'll just make one thing. I have a few soapboxes I'm sure we'll touch on. One of the hardest things is people speculating in the first 24, 48 hours of what happened. Because I, having launched on seven different investigations, the first one was a Reno airshow crash, was air races in here. Huge. But you know what happens is everybody, the m- media in particular, it's in the first 24, 48 hours, and so, like, "Here's what caused that." And then before you know it, it's, like, already established. And I used to go back, you know, to the DC and, and say, "Okay, so how often do we actually see, you know, that first 24, 48 hour speculation end up in the final report?" People couldn't really think of many. You know, maybe a little element of it shows up, but, you know, the, the thorough investigation uncovers things you would've 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.

   24. PAPeter Attia56:27

       Yeah, I-

   25. MRMark Rosekind56:27

       Hence the data sources like EDRs are critical.

9. 56:31 – 1:05:30

   The dangers of phone use while driving

   1. PAPeter Attia56:31

      What can you glean about, uh, phone use in the car? Um, I- it's so, it's so common now. Like I, I, I sort of have this innate anger when I pass somebody and they're on their phone. A- and I don't mean, like, they're talking and the phone is wherever it is. I mean, 'cause, uh... I mean, like, they're holding their phone, and you can see it as you drive past them. I, I sort of feel like is this that much different than if you were drinking a beer and I could see the bottle? Like, uh, what i- what is your, what is your view on that? And, um, how difficult is it for an investiga- uh, 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. Um, but, but yet it still becomes a, a, a matter of, like, you know, a criminal prosecution or something like that. I mean, h- how much data are they able to infer, um, if a person wasn't actually speaking on the phone, which I assume is the easiest thing to figure out from the cell signal?

   2. MRMark Rosekind57:32

      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, okay? So just let that, [laughs] you know... And that's playing with the radio, on your phone, whatever it is. Five seconds at 55 is enough to take you a football field, right?

   3. PAPeter Attia57:58

      Yeah.

   4. MRMark Rosekind57:59

      And I'm sure we'll talk about this if we do more impairment stuff, but there kinda is 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 gonna be a problem. And we now know that talking on the phone can degrade your performance equivalent to .08 alcohol kind of performance decrements. And w- um, again, we don't have to get into all the data, but there's really good data that even hands-free can do that. 'Cause as you know, there's no such thing as multitasking, right? It's switching, et cetera. And so people are like, "It's legal. I'm, like, hands-free. It's okay." It's like, no, it's not. 'Cause if you're engaged in that conversation, then your head's not in this game. Whatever. Um, and so again, I think, you know, that's one of the challenges you have when you're looking at all this, is how diverse they are. So to your point, um, the NTSB will go and get all the kinds of data. Locally, they're probably never gonna get that. So what would you look for? Well, a- 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 'cause they're sitting there staring at something, right? Um, is I'm always sitting there thinking, I know enough to basically ask the police department, "Get those phone records." I wanna know if that was, you know, if a signal was bouncing off a, 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?

   5. PAPeter Attia59:35

      Yeah.

   6. MRMark Rosekind59:35

      Whether it's their video or video from a vehicle you might be in, et cetera, 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 a, uh, again, you know, an investigation at 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. In most crashes, insurance companies even aren't gonna necessarily pursue all of that. Um, 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. I got... I had just a couple 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, and there was, uh, 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 'cause we're stopped, and he's literally looking in the cars, 'cause I can see his helmet turning and everything, looking in the cars, and the guy next to us was on his phone. I mean, I was sitting there just watching him, [laughs] you know? And the cop came up and looked in there and, like, starts shaking his head, you know? And the guy put it down, and I'm thinking like, "That's the difference when you actually have, you know, 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? He's got-

   7. PAPeter Attia1:01:01

      So, you know, Mark, have there been any kind of 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, um, who, who would be inconvenienced by it myself, right? 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, there's no doubt, especially in a phone call, uh, it takes my head out of the game a little bit. So, so again, uh, you know, phone companies and consumers alike would be, uh, I'm sure opposed to this. But is there no technology solution proposed to make it much more difficult to be distracted while driving?

   8. MRMark Rosekind1:02:02

      There are. It's, uh, 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." You know, it's like, don't... And so you can literally... And it has a message. It'll send a text or a voicemail basically and says, uh, uh, literally, "I'm driving now, call you later," or, "Leave a message," or whatever. So there are technological things.

   9. PAPeter Attia1:02:29

      Yes, but it still requires the user to take the action. And, and again, uh, you know, the, the question is, like, how, how can you make this so that you don't have to opt into it?

   10. MRMark Rosekind1:02:42

       Right. And those could exist as well. They already do because veh- the phones can now tell when your vehicle's moving.

   11. PAPeter Attia1:02:50

       You're right.

   12. MRMark Rosekind1:02:51

       Right? So accelerometers and other sorts of things do that. Um, and I think what you're getting to, which is interesting, is that's a whole 'nother choice issue about, you know, if 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, right? Um, that would be an interesting battle, I bet, for some, and that's what's s- so interesting about your hypothesis there because right now you could just make the decision, "I'm gonna shut it off," right? Or, "I'm gonna put it on airplane mode-"

   13. PAPeter Attia1:03:22

       Right

   14. MRMark Rosekind1:03:22

       ... "and I'm not gonna get anything while I'm here." So when I was at the NTSB, um, 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. Um, and I remember exactly around that time because I used to call Debbie and we would, you know, be talking about stuff, and she had a long commute-

   15. PAPeter Attia1:03:50

       [laughs]

   16. MRMark Rosekind1:03:51

       ... 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, you know? 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, you know, a bag in the back and not... And you know what? It's really inconvenient."

   17. PAPeter Attia1:04:13

       Yeah.

   18. MRMark Rosekind1:04:13

       "And I'm a better driver when I'm doing this than when I'm doing it, you know, the convenient way," right? 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, "Nope, we're not gonna 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, you know, the personal choice in some cases could also mean you can differentiate, right? It's like I'm on a strange road-

   19. PAPeter Attia1:04:38

       Yeah

   20. MRMark Rosekind1:04:38

       ... and I'm a little faster, I got more people in the car, I'm not gonna do that, as opposed to open road, speed limit, there's nobody around, music's not even an issue. Do you take another... You know, a- again, you could make more choices when you did that.

   21. PAPeter Attia1:04:52

       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, you know, I at least convince myself, again, it, this might not be true, but I convince myself, "Okay, you're just gonna pay more attention right now because this is that inter- this is the intersection and you're looking both ways even when you have the right of way," or that kind of thing. Um, but yeah, the extr- the other example of this would be, a- again, it would be

10. 1:05:30 – 1:11:32

    How drunk driving was addressed through advocacy & legal changes

    1. PAPeter Attia1:05:30

       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 know... You know, you might even make it a more egregious setting than .08 and make it .05 or something like that. And again, 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, uh, of drinking and driving. But when you, when you just look at the numbers of, you know, people who are, you know, the, the number of, um, deaths due to intoxication, um, and distraction, um, it begs the question, right? Like, how much would we be willing to be inconvenienced to save, call it 50 lives a day? 'Cause that's about what you would do. You know, you'd save about 50 lives a day 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 pe- about 50 people per day would be alive.

    2. MRMark Rosekind1:06:34

       A third of 118, so maybe 40.

    3. PAPeter Attia1:06:37

       Yeah.

    4. MRMark Rosekind1:06:38

       Mm-hmm. So let's go back a moment. Realize you're different when you were talking about, like, being on the phone in certain places where you're gonna pay more attention. You're different in a good way 'cause you're actually cognizant. You're thinking about those things and what risk they would create for you, and again, in your, you know, 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 'cause 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 talking on the phone and ch- playing with my radio and by the way, I'll do th- 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 .08 level or higher, and what's interesting is that technology's actually been in the work-

    5. PAPeter Attia1:07:33

       Hmm

    6. MRMark Rosekind1:07:34

       ... so take it as a model for what you're talking about with phones. But that technology has been in the works for a long time. Uh, NHTSA and others call it DADSS. It's one of them, and it has a free breath sort of analyzer in the pit and also stuff that's in the steering wheel that literally is looking at, you know, molecules in the air, and it's what you said, is it won't start if it hits ... And it w- it's for everybody.

    7. PAPeter Attia1:07:57

       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?

    8. MRMark Rosekind1:08:11

       Right. I mean, the designated driver, right? I mean, that's why you do that.

    9. PAPeter Attia1:08:14

       Yeah, yeah.

    10. MRMark Rosekind1:08:15

        Ha- Well, 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, okay? Uh, what's-

    11. PAPeter Attia1:08:28

        Wow.

    12. MRMark Rosekind1:08:28

        Well, just 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 gonna 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 mention this because I, 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 s- what we've started this conversation with, the societal value if we think it's, you know, more important to inconvenience you if you're drunk, um, than it is to allow you to kill someone else on the roadway.

    13. PAPeter Attia1:09:16

        When did drunk driving fall out of, you know, favor? Like, I, I, 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, um, despite the fact that the numbers are still as high as they are. Was there a, was there a particular moment in time in which an accident changed all of that, or was it just a general sense of awareness?

    14. MRMark Rosekind1:09:44

        And I will apologize to them, but it really was about MADD, Mothers Against Drunk Drivers. Um, and, you know, the woman who started it lost a child in a drunk driving crash.

    15. PAPeter Attia1:09:58

        And this is, what, in the '80s?

    16. MRMark Rosekind1:10:00

        Yeah, and that's why I'm trying, I'm kind of apolo- 'cause I, I think it was late '70s, early '80s.

    17. PAPeter Attia1:10:05

        Okay.

    18. MRMark Rosekind1:10:06

        But they really are the first ones to have a, quote, "victim group," you know, that said this is-

    19. PAPeter Attia1:10:11

        Yeah

    20. MRMark Rosekind1:10:11

        ... should not be allowable anymore. And so I would say it wasn't so much an individual crash.

    21. PAPeter Attia1:10:17

        Mm-hmm.

    22. MRMark Rosekind1:10:17

        Um, but more-

    23. PAPeter Attia1:10:19

        But they put faces to a set of crashes and a cause.

    24. MRMark Rosekind1:10:23

        And took it, like, to the State House, to Congress. It's like, "We cannot let this happen anymore." Um, and people don't know this, but MADD actually provides counseling services and all kinds of other things that they do. Um, but they really are the model of, again, a victim group that said, "We need this issue in front of our society. It's not okay." And so they, you know, they're the ones to get, you know, .08 and all that. Again, see, that's one of the things. Every state has to vote for what the BAC, ba- you know, blood alcohol level has to be. And so every one's different. Um, but they're the ones, you know, who pushed. It used to be higher and then finally got to .08. Um, they're the ones who basically are the ones who pushed 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, you know, this new model that was created with MADD, which we see in other arenas as well.

11. 1:11:32 – 1:21:40

    The need to address distracted driving & the psychological impact of distracted driving accidents on victims & perpetrators

    1. PAPeter Attia1:11:33

       Y- yeah, I always find that, that the individual cases do more th- uh, y- you're probably familiar with the case of Libby Zion. Um, 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 or, or-

    2. MRMark Rosekind1:11:48

       I think it was Mount Zion.

    3. PAPeter Attia1:11:49

       Was it Mount Z- Yeah, you're right. It was Mount Sinai.

    4. MRMark Rosekind1:11:51

       Yeah, I think so, yeah.

    5. PAPeter Attia1:11:51

       And, um, she was, um, admitted to the ER. Um, a resident who technically probably wasn't even qualified to make a decision that was being made about her care made a, made a decision to give her a medic- I don't even remember the details. Gave her a medication while she was already on an MAOI, and it resulted in her death. [lip smack] And even though I don't really think this was just about fatigue, I think it was more about resident supervision, it became the, the, the linchpin case that her father basically took against the medical community about resident work hours. And I don't know, it might've been, it might've 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, um- But again, it all came back to this woman's death, right? It wasn't about the million other insane stories, um, that resulted from, you know, r-residents be-- medical residents being exhausted. Um, so I guess I bring all this up to say, Mark, you know, have we had that moment yet with distracted driving, right? Do we have the equivalent of Mothers Against Drunk Driving, or do we have the equivalent of Libby Zion's death where, um... 'Cause I have my story, right? So my story is I used to work with a guy named Nick Venuto. Um, and, um, Nick and I sat opposite each other in, in our offices. Um, and Nick was, um, a really, really amazing guy. We always say this, right? But, but truly an amazing guy. Um, a, a, a remarkable cyclist and, uh... 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. Um, he had just won one of the most remarkable time trials in Austin, which was the Mount Palomar climb, which is a epic climb, one of the hardest climbs in the United States. Anyway, it was a Tuesday afternoon in, um, in, in May of, God, I wanna say 2010, 2011. We were both just leaving the office together, and I was gonna drive home to get on my bike to then ride to where I did my intervals that day, and he was riding home. Um, 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. Um, and that's, that was the road that he always took home. And I was like, "Do I wanna... 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, um, 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, again, 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? And, and, and so I guess my-- the, you know, forgive my long story, but, like, is there, is there a movement around these victims of... And I-- it's not just the cyclists and pedestrians. It's other drivers who are victims of the distracted driver. And by the way, I wanna say one more thing. I am a distracted driver sometimes. I could easily have been that woman. Th-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.

    6. MRMark Rosekind1:16:32

       Well, it's personal for you, too, then, just as we started.

    7. PAPeter Attia1:16:37

       Very much so.

    8. MRMark Rosekind1:16:37

       Yeah. And, uh, 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 MADD. 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 gotta stop it." Okay? And that's why I say MADD 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 gotta figure out how to do that part. So you asked it earlier. We could do the same thing with distraction, okay? And, and I think good and bad. The good part is people are asking questions like what you just did. You know, how do we, how do we take this to the next step? We have models. You know, 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 really-- people who are trying to be really good at what, you know, 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, right? Um, and, and that's a challenge, which is even, you know, really good folks who know what's going on. [chuckles] I have friends of mine in the police department, you know, and it's kinda like, "I wanna make sure I see every one of those police cars stop at the stop sign. No rolling, no..." [chuckles] You know, it's like we gotta-- 'cause you're the model for others, it's okay. Watching that motorcycle go, you know, nod his head at the guy who was on his phone, et cetera. It's like we need all the available, 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, right? But that doesn't necessarily get rid of all of them, okay? But I think to your point, and a lot of what you focus on, you know, in these conversations is so what are the things that are under your control, though? So for you, you know, 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 in part you're already different because you're already thinking about where those danger zones are. Okay? Someone who doesn't even think about that is at a higher risk, okay? And as we talked about it, this is risk management. That's the part, you know, 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.

    9. PAPeter Attia1:19:20

       Yeah, one of the things I've, 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, you know, 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. Um, 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 if-- I don't know what she lives with. Um, but my impression is that there are t-two deaths at every death, um, and that a part of the person who, who killed this person is at risk. And this is a very different type of homicide, right? This is not like, you know... y- this is not first-degree murder, right? This is involuntary vehicular manslaughter, and nobody wakes up thinking they wanna kill someone today in their car.

    10. MRMark Rosekind1:20:25

        Yeah.

    11. PAPeter Attia1:20:25

        Um, d- are you-- I know your training is in psychology, so I just wonder if there's any aspect of your, um, training that, that, that gives you a sense into what those people go through and, and is that-- By the way, is that something we should be tapping into to help create a, a more of a zeitgeist around this? It's not, it's, it's not just the lives of the, of those who die, it's those who live.

    12. MRMark Rosekind1:20:46

        25 to 33% of people in a crash are gonna have PTSD within 30 days or longer. So, I mean, that, there is a literature on that, and I would just say going from the statistics to the individual, MADD is quite good at actually not only having victim's families talk about what's going on, but they have drivers, you know-

    13. PAPeter Attia1:21:07

        Mm

    14. MRMark Rosekind1:21:07

        ... 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 just, it changes their life forever 'cause they are waking up every morning. Survivor's guilt, you know, anybody who really cares about humanity is gonna carry that with them for the rest of their lives. And so, yeah, we see numbers, actually again, of close to a third, basically, of people are gonna have PTSD, some aspect of that, and then telling those stories can be very powerful.

12. 1:21:40 – 1:33:14

    Navigating the roads & lowering your risk of accidents: weather, human error, & defensive driving

    1. PAPeter Attia1:21:40

       Before we go into some other things I wanna chat about, I wanna round out some of the other contributing factors. Um, where does weather rank on this list? Um, is it, you know, whether it be rain, snow, ice, dark- you know, sudden darkness or cloud, like w- how much does that contribute?

    2. MRMark Rosekind1:21:57

       So I'm gonna 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, a study, came out in 2015, um, that showed in the chain of events, 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, uh, the physical environment, potholes, road conditions, et cetera, and then things like weather. And so again, it's a chain of events.

    3. PAPeter Attia1:22:44

       So it's virtually nothing. It's virtually nothing-

    4. MRMark Rosekind1:22:47

       Not a lot

    5. PAPeter Attia1:22:47

       ... is what you're saying.

    6. MRMark Rosekind1:22:48

       That's right.

    7. PAPeter Attia1:22:48

       Yeah.

    8. MRMark Rosekind1:22:48

       So it does happen, but it's gonna be-

    9. PAPeter Attia1:22:50

       Yeah

    10. MRMark Rosekind1:22:50

        ... you know, small compared to the other. Um, and again, we can talk a little more about the 94% 'cause there's been some controversy about that number, but that's a soapbox for me. You gotta be ready to [laughs] get into that one.

    11. PAPeter Attia1:23:01

        Well s- let's, let's say more about that then. So where's the controversy around that? Are there people who are arguing that it's much-- that that number's too high, that's, uh, that that's overstating it?

    12. MRMark Rosekind1:23:10

        What's interesting is nobody's actually addressed the number. And so, um, and again, I-- you'll tell me where you want me to, "Okay, that's enough of that, Mark. Let's go on to something [laughs] else." But let me just start. This is why a crash is not an accident, okay? A crash is preventable.

    13. PAPeter Attia1:23:30

        Mm-hmm.

    14. MRMark Rosekind1:23:30

        An accident implies it's inevitable. And most people don't know this, but the word accident started getting usely- 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 always say it's like it was an act of God, it was inev- you know, unintentional, nobody could do whatever.

    15. PAPeter Attia1:23:52

        [laughs]

    16. MRMark Rosekind1:23:53

        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 contributive- contributory factors, and then intervene in some way by changing, right? So you prevent it from reoccurring, you prevent whatever, then that's what safety's about. It's a crash, right? And if you didn't believe in that, and you really think it's an accident that's inevitable, why are you, [laughs] you know, 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, um, you know, as a NASA scientist, pretty much you could start any paper with 70, 'cause 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 that were going on. You know the Institute of Medicine report, right? To err is human. 100,000 medical errors every year due to human, et cetera. Um, and so what always surprised me is, 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. Like, 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, mm-kay? And they wanna sort of, you know, avoid... It's kinda like the corporate accident language, right? It's like, 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. You know? If you wanna blame people or da, da, da, da, that's not gonna 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, then very often, as we've already discussed, there's a different intervention like technology, which our society happens to turn to a lot, right? 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? Mm-kay. 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," et cetera. 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, right, 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, you know, hear about people like, "Oh, that 94% has been..." It's like, no, it's not. Nobody's actually argued [laughs] about the number. Um, I think it's more the blame and shame part, uh, which again, doesn't get you safety no matter what, right? 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, you know, they start blaming the car, they blame the software, they blame the, you know. That's still not gonna get things fixed for you so you're gonna save lives. So there you go. I'm with the 94% and think that, you know, that other 6% shows that last chain of, that last event in the chain is a very small percent. It's gonna be weather or potentially defects.

    17. PAPeter Attia1:27:21

        Okay. I don't know if you will have this statistic, but while we're on the topic of, 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, um, people who were presumably not doing anything that would've led to a mistake?

    18. MRMark Rosekind1:27:53

        We don't have that level of detail of those specific crashes that occurred to be able to tell that.

    19. PAPeter Attia1:28:00

        A- and the reason I'm asking, by the way, is to, 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, I think about this a lot as a dad who is starting to talk a lot about this to his daughter, right? If I'm driving her to school, you know, just ask her. It's a nonstop lecture.

    20. MRMark Rosekind1:28:39

        [laughs]

    21. PAPeter Attia1:28:40

        It's, "Hey, Olivia, did you see how I did that? Did you notice why I did that? Where did, why did I look there? Did you see what that driver just did?" And I'm, I... And, and, and, and, and so I guess what I'm, what I'm assuming is that we have to be vigilant on both fronts. It's not enough to just say, "I'm gonna drive at a responsible speed, and I'm not going to hold my phone, and I'm not gonna drink." I think that that's a great first step. I don't think it's the complete step. You have to assume... This, this is the, this is the mantra I, I, I use, Mark. Um, 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, 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 one of, it's only one car. You're gonna 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?" You know, all of those things that we talk about. And, um, a- and honestly, I, I just, 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 way, it's the only heuristic I've come up with to help with the other half of the equation. Um, that, that's why I ask the question, right? I don't, 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?

    22. MRMark Rosekind1:30:43

        Could be your life. So yeah, it's worth it. And, 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, SA.

    23. PAPeter Attia1:31:18

        Yeah.

    24. MRMark Rosekind1:31:18

        Which we kn- I mean, you know this in racing. It's a big thing in aviation. Um, and I think it's what you just literally articulated with your daughter, right? "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. And so it's, 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, 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 situation awareness and driving defensively, there are things you can do, right? 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, right? And so I think, you know, what, that's what you're portraying. You know, the, the situation awareness is, 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.

    25. PAPeter Attia1:32:27

        Right.

    26. MRMark Rosekind1:32:28

        They are not. Right? 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, uh, that's actually a great way to approach it. [laughs] Um, and I think, you know, unfortunately, it's so easy to drive nowadays. A lot of folks, especially with even newer technologies, um, some people have their game, 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 on how to... That needs to be in there, too, 'cause part of this is the mental game of making the right choices and knowing that other people won't, then what can you do?

13. 1:33:14 – 1:47:12

    The impact of impaired driving: alcohol, cannabis, prescription drugs

    1. PAPeter Attia1:33:14

       Let's now talk about some of these more, these, these contributing factors in a little bit more detail, and I want to start with, with substance abuse, uh, or substance use or whatever you want to call it. Um, we've talked about alcohol, of course. Uh, gi- give people a sense of what f- what, what does it take to reach .08? 'Cause I suspect it's a lot easier to get to .08 than people realize.

    2. MRMark Rosekind1:33:37

       Yeah. In fact, uh, most people in the safety arena with alcohol like to say that impairment starts with the first drink.

    3. PAPeter Attia1:33:44

       Mm-hmm.

    4. MRMark Rosekind1:33:45

       And I think that's a great, like as soon as you pull up alcohol, that's gonna start changing your reaction time, thinking, everything's gonna start changing.

    5. PAPeter Attia1:33:52

       By the way, I've got, I've got great, I've got a great model to demonstrate this. So I d- I drive a racing simulator, um, and, uh, I can... And I've done this game, right, 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-

    6. MRMark Rosekind1:34:23

       Mm-hmm

    7. PAPeter Attia1:34:23

       ... where I'm sure I am below .08, 'cause I weigh a lot, um, 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. Um, it's, 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. So, um, but, but as a general rule, for someone, you know, my size, w- I, I've never taken a breathalyzer test, so I don't actually even know what .08 is.

    8. MRMark Rosekind1:34:59

       So for you, that's gonna be, um, two to three beers and one good shot of hard liquor.

    9. PAPeter Attia1:35:06

       Over what period of time?

    10. MRMark Rosekind1:35:07

        Uh, within one to two hours.

    11. PAPeter Attia1:35:10

        Okay.

    12. MRMark Rosekind1:35:10

        Okay? But you're bringing up a great point, which is why I always hesitate to give too much information about that, 'cause you can go online, you can go online with some pretty good BAC estimators-

    13. PAPeter Attia1:35:21

        Mm-hmm

    14. MRMark Rosekind1:35:21

        ... um, because your age, your weight, you know, your-

    15. PAPeter Attia1:35:25

        Your health-

    16. MRMark Rosekind1:35:25

        ... your physical-

    17. PAPeter Attia1:35:25

        ... presumably, yeah

    18. MRMark Rosekind1:35:26

        ... all, exactly. All of those things, whether, again, it's, um, less alcohol content in beers and other 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 re- 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 the 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, right? 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, uh, you know, "I had a couple glasses of wine, but I'm okay. Had enough to eat, 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.

    19. PAPeter Attia1:36:25

        Y- yeah, and I, and I, and I would argue that the, the sleep one is just the same. If I'm... If I don't have a great night's sleep, it, it shows. And again, that's, I think that's what's kind of cool about a simulator is you're, 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. Um, and the forces and inputs are so much more subtle, right? Any wrong input will lead to a significant change in output. And it's, it is remarkable how you can feel fine for the mundane task, but not, not for the drive.

    20. MRMark Rosekind1:37:07

        Add that to your, add that to your course you're creating, right?

    21. PAPeter Attia1:37:10

        [laughs]

    22. MRMark Rosekind1:37:10

        Besides the muscle memory, whatever, it's like you'd love to challenge, especially those adolescents, with even, you know- Whatever's appropriate there. Sleep loss would be better than alcohol, obviously.

    23. PAPeter Attia1:37:21

        Yeah.

    24. MRMark Rosekind1:37:21

        But, you know, think about that as a challenge, just for them to say, "I feel fine, give me the rating on the 1 to 10 scale," and then show the objective measurements in driving, like you say, even the mundane ones.

    25. PAPeter Attia1:37:32

        Yeah. Let's talk about other substances, and I think the most relevant is cannabis, right? So, um, what, what are the, what, what do the data say about cannabis use and driving?

    26. MRMark Rosekind1:37:46

        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.

    27. PAPeter Attia1:37:57

        Mm.

    28. MRMark Rosekind1:37:57

        At .08. 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. We have a lot of the... And we know they hold up in court. You know, I mean, it's just a really good... With cannabis, there is still ongoing debate of what defines impairment. And so if you can't even get that defined-

    29. PAPeter Attia1:38:20

        Mm

    30. MRMark Rosekind1:38:20

        ... um, and then you have no roadside kinds of measures, and it's harder, as you know, whether you're using, you know, breath, hair, all these other things that people are trying to do, and it ends up, well, you know, it sticks around in your system longer, or it 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 [chuckles] to sort of figure out how we do that. And the other thing, which is really dangerous, is, you know, the poly usage. You know, it's rarely one of these on their own, you know? So we can, like in 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 know, I, I mean, this is now, uh, I was administrator eight years a- Come on, I can do the math. Six, seven years now, um, ago. And y- we, the, all this research was still going on to try and define what I was just describing, you know. That as all these states now start making it more legal, it's gonna put it out there on the... I always tell people, "When you're voting for that in your state, don't think about your, you know, the sport of drinking, you know, of cannabis, you know. But instead, think about what that's gonna mean if somebody next to you on the roadway, uh, you know, has been smoking, and in some way, you know, is like the level of impairment of alcohol." You know, and people just don't think of that part. And unfortunately, while the alcohol is pretty well defined, the cannabis part is very poorly defined. And in, in that time, we still don't have it figured out yet.
14. 1:47:12 – 1:54:15

    Mitigating the effects of vehicle speed

    1. PAPeter Attia1:47:12

       Let's talk a little bit about speed, which is, um, still makes up a pretty sizable, uh, fraction of the contributing forces. Is that changing? Is that less today than it was 30 years ago? Um, it strikes me that maybe, you know, clearly cars are faster today than they used to be, but are people necessarily driving them faster today? Um, 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 seat belts and airbags. But, but just, yeah, what's the general throughput of speed in this equation?

    2. MRMark Rosekind1:47:51

       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, you know, there's just more literally impact of what's gonna come out of that particular collision. Um, and so it's interesting. Speed has actually gone up, and that has more to do with the capability of the vehicles, roadways, uh, and the technologists. Think about, I mean, you're a racer. You know how much... There's always like, how do we get better, faster, et cetera?

    3. PAPeter Attia1:48:17

       Although it seems that, 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, um, does that not offset it on the car side of the equation?

    4. MRMark Rosekind1:48:35

       Not very much, because generally cars are s- getting bigger. And, you know, now that we've added SUVs and others-

    5. PAPeter Attia1:48:42

       Mm-hmm

    6. MRMark Rosekind1:48:43

       ... um, you know, when we look at what's going on out there, there's kind of, uh, people describe it as a weight bloat that's occurred.

    7. PAPeter Attia1:48:49

       Yep.

    8. MRMark Rosekind1:48:49

       Um, you know, and unfortunately, they do protect you, right? I mean, if, 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 wanna be in that vehicle, not in the little s- small, you know, version where I could get killed doing that sort of thing." Um, I think what's interesting is we do see, uh, this is why it's so complicated, but we do see, like, during, you know, uh, the last recession, um, during the pandemic, um, we actually see sort of the, the, um, the deaths go down, but sometimes other particular things like speeding goes up. Okay. And we can have all kinds of hypotheses about are there fewer people on the road, is just the density different, et cetera.

    9. PAPeter Attia1:49:35

       Mm-hmm.

    10. MRMark Rosekind1:49:36

        They're all hypotheses. We think about those. We don't really know. But I bring it up 'cause 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, you know, in this conversation.

    11. PAPeter Attia1:49:52

        Yeah.

    12. MRMark Rosekind1:49:52

        So even those things can have that, you know, societal ripple. Um, 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 gonna have a more dedicated pedestrian or cycling r- you know, 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, uh, and I said this earlier, society very often when we have human choices, you know, or things that we wanna 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.

    13. PAPeter Attia1:50:51

        Yeah. No, it makes sense. Uh, again, I, all of these things are, you know, you'd, you'd, you'd pull them out of our dead lifeless hands if you don't let me drive quicker and don't let me, um, talk on the phone and w- and whatnot. Um, I wanna go back to another kind of deconstruct the accident question. Do you have a sense, uh, or, or, or are these data knowable as to what fraction of those fatalities in the vehicle are a result of the, the vehicle just being, you know, the integrity of the vehicle being lost due to the collision itself versus a flip? Uh, in other words, you know, how often is avoiding the flip of the vehicle, you know, with a lower center of gravity, uh, a relevant part of this equation?

    14. MRMark Rosekind1:51:39

        Yeah, that's actually a big deal. And when you look at the crash tests are done, there are, uh, the... It's interesting, they don't actually crash vehicle to vehicle. You crash, the crash worthiness of your vehicle is tested against a big block of cement, basically.

    15. PAPeter Attia1:51:53

        Yes.

    16. MRMark Rosekind1:51:54

        But now there are different versions of that. So there's a side impact, and now over the last years, there's also a, a angled one as well, and then rear end, and then you can add all kinds of other variations of that as well. Um, and I would say that's the kind of thing I don't keep in my head anymore. Um, but there are some databases that gets at least into things like rollover.

    17. PAPeter Attia1:52:16

        Mm-hmm.

    18. MRMark Rosekind1:52:16

        Um, and that's where the side impact is critical, right? 'Cause that's mostly gonna happen with the center of gravity and when you actually have, you're up on a curb or some other thing that's gonna tip you potentially, and again, the direction that you're hit, et cetera. But there is some data on that, um, to show sort of which are the versions. And that's why they added things like the angled collision basically, um, recently just to figure out that, you know what? There's enough of that going on. We should understand the crash worthiness of vehicles when they're hit at an angle like that.

    19. PAPeter Attia1:52:43

        Is this an area where electric vehicles are... Well, let me just ask the question more broadly. Are electric vehicles indeed significantly safer than non-electric vehicles on the basis of a lower center of mass and the, on the basis of not having an engine, uh, typically in the front during a front collision, um, that therefore can have much more force absorptive capacity? Or is that more of a, a marketing, uh, strategy?

    20. MRMark Rosekind1:53:09

        Yeah. I, I think, um, we don't have sufficient data yet to sort of make that, um, factual comment per se, but I think you've identified all of the fact- of range of the factors that actually differentiate electric vehicles from the standard, right? Um, and as you know, right now one of the biggest things is just getting the myth separated from the fiction or the, the other fiction that is told, right? Um, you know, there are still more fires in ICE vehicles than there are in EVs. Some of that's about battery, some of that's about just the population that's out there of these different ve- I mean, it's like you gotta 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. Um, the Insurance Institute for Highway Safety, they do a lot of great crash testing. Uh, and I'm sure we'll get into some of that when we talk about some of the vehicle-specific things. But, um, 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.

15. 1:54:15 – 2:04:08

    The promise & challenges of autonomous vehicles for road safety

    1. PAPeter Attia1:54:15

       So let, let's talk about where, um, autonomous driving comes in. Um, it, you know, look, if, if, if you, 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. Uh, would certainly have the potential to do better. Um, I don't think it goes from 94 to zero, but, but, you know, it, it seems that there's a glide path. What, 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 gonna half-jokingly suggest that if we can put all of those things in cars, we can also probably put in light f- like eye flicker sensors, and we can track micro-sleep 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, 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."

    2. MRMark Rosekind1:55:46

       So this is a fun part of a conversation, which is the general comment we've already been discussing, which is, you know, when so- when society has issues that are around human behavior and choices and errors we make, then, you know, 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 seat belts, airbags, electronic stability control, 14. In over 50, 52 years, how many lives did those technologies save? 613,501. Okay. 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, you know, 40,000 lives a year, we could have gone 15 years with no lives lost on our roadways, right? Kind of our conversation.

    3. PAPeter Attia1:56:49

       Yeah.

    4. MRMark Rosekind1:56:49

       Not necessarily injuries or crashes, but you know, if we could have lumped all those together. Technology works, right? And, and I'll say this as the caveat to start with is the potential is unbelievable, but we still gotta prove it's gonna 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, and then it does, like, still gotta prove it, and we also gotta acknowledge that now we're gonna have software risks and other kinds of, you know, machine learning and technological risks that are introduced. We gotta 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 assistant systems, ADAS, are the things that are already in cars. I'm sure you've got 'em in yours. Automatic emergency braking, you know, lane keeping assist, um, you know, cruise control, rear camera. We've just got all these different systems that are independent that you were talking, right? Um, and so when you think about it, those are a part of, again, advanced driver assistant systems. 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. Okay? The higher level is a fully autonomous vehicle. Okay? And let's just say, you know what? We're gonna take out the steering wheel, the pedals [laughs] and everything else. It's gonna do the entire task. Okay? And the way sometimes this is separated is at the lower levels, SAE actually has these five levels, and I'm not gonna 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 gonna let you know, "Take the wheel." And level four and higher is vehicle's gonna do it for you. It's gonna monitor the environment and the vehicle and handle the driving task.

    5. PAPeter Attia1:59:05

       So just so I understand, Mark, if you look at the, like, I, is, is, is, um, is Tesla the best example of... Is that the furthest along technology in the driver assist commercially?

    6. MRMark Rosekind1:59:18

       Thank you. Um, and that's exactly... 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 driver assistance systems which actually even they publicly, because of regulatory requirements, that's level two.

    7. PAPeter Attia1:59:47

       I was just about to say-

    8. MRMark Rosekind1:59:47

       Just to be clear

    9. PAPeter Attia1:59:47

       ... is that level two or three?

    10. MRMark Rosekind1:59:48

        Exactly.

    11. PAPeter Attia1:59:48

        But it's level two.

    12. MRMark Rosekind1:59:49

        Yeah.

    13. PAPeter Attia1:59:49

        Okay.

    14. MRMark Rosekind1:59:50

        You got it.

    15. PAPeter Attia1:59:50

        Yeah.

    16. MRMark Rosekind1:59:50

        You got it. And probably that's one of the more integrated systems that uses all these different things, but you're seeing, you know, 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 gonna take the 280, 300 million cars that are on the road today, it can take anywhere from 10 to 12 years to actually penetrate the fleet with new technology.

    17. PAPeter Attia2:00:21

        Yeah, I, that, that seems optimistic. I, I was gonna say probably longer. I mean, it would seem to me at least 20 years to overturn that fleet. Um, and that would also include, like, this is gonna be one of those moments where I imagine a real regulatory challenge, right? So if you... So, so I love internal combustion engines. I am an internal combustion engine junkie, and not only that, I love naturally aspirated internal combustion engines.

    18. MRMark Rosekind2:00:47

        [laughs]

    19. PAPeter Attia2:00:48

        And I'm not gonna embarrass myself by saying how many of those I have, but I have a belief that, you know, those things aren't gonna 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. It's unlikely that, you know, a car... 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-

    20. MRMark Rosekind2:01:14

        Mm-hmm

    21. PAPeter Attia2:01:14

        ... 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?

    22. MRMark Rosekind2:01:44

        So I, uh, my one thing for you is horses. When people say, "I'm never gonna be able to buy my ICE vehicle again"

    23. PAPeter Attia2:01:52

        [laughs]

    24. MRMark Rosekind2:01:52

        ... or one in the future, it's like, you know what? People still breed them, raise them, race them-

    25. PAPeter Attia2:01:59

        Mm-hmm

    26. MRMark Rosekind2:01:59

        ... own them. Uh, you know, there are always gonna be ICE vehicles, that internal combustion, you know, you know, that fully-

    27. PAPeter Attia2:02:05

        Yeah

    28. MRMark Rosekind2:02:05

        ... you're gonna still have it around and do what you need to do. Um, but I think it also brings up the enormity of the problem.

    29. PAPeter Attia2:02:13

        Yeah, this is the biggest infrastructure problem I can imagine.

    30. MRMark Rosekind2:02:17

        Yes. Yep. And that's why, uh, 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 gonna regulate?" And I used to say, "What are we gonna regulate?" It's just a huge issue. Uh, 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, you know, throughout our entire society. That they're just, they're not there yet. They're great demonstration pilot programs, you know, larger ones, et cetera, but they're not... And there are a lot of problems that are going on as well, okay, with some of the companies. So that is still, again, to be proven, and understanding where the risks are with that model, we're 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, you know, till 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, right?
16. 2:04:08 – 2:09:54

    Automatic emergency braking (AEB): the effectiveness & challenges of implementing AEB as a standard feature in new vehicles

    1. MRMark Rosekind2:04:08

       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, um, basically 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 wanna see everybody?" It's called democratizing safety.

    2. PAPeter Attia2:04:46

       Hmm.

    3. MRMark Rosekind2:04:46

       So it's not just if you buy a higher end car or, you know, it's an option that I can... It's like, no. Democratize means every new vehicle, AEB, okay? And the Insurance Institute of Highway Safety says if every car had AEB, we could probably reduce 50% of the rear end crashes with that. Okay?

    4. PAPeter Attia2:05:03

       Wow.

    5. MRMark Rosekind2:05:03

       So big... Yeah.

    6. PAPeter Attia2:05:05

       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 brake if the distance and rate of speed between you and the car in front of you triggers an algorithm that says, "You're gonna hit this thing."

    7. MRMark Rosekind2:05:20

       So Peter, this is why it's so great to have some time to discuss this stuff. AEB actually has multiple elements to it.

    8. PAPeter Attia2:05:27

       Hmm.

    9. MRMark Rosekind2:05:27

       The warning is one. Another is if you don't brake, it'll brake for you. Another one is if you brake but you don't brake hard enough 'cause of the distance, it will actually, um, add braking 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, um, you know, mandate that we wanna 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 in all those new vehicles? Again, to our point, that's not retrofitting everything else, right? So there's still plenty of cars that don't have this yet. It's gonna 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, you know, to get a regulation through, you need to have an office of, you know, management budget basically do a cost-benefit ratio, right? They gotta do a calculation that says it's worth it. It usually takes a penetration of at least 10, 10% of the vehicle population to get enough data to do that kind of analysis.

    10. PAPeter Attia2:06:53

        [laughs] I'm sorry.

    11. MRMark Rosekind2:06:54

        And so with new technology-

    12. PAPeter Attia2:06:55

        Uh, uh, OMB needs to do a co-

    13. MRMark Rosekind2:06:58

        Office of Management and Budget.

    14. PAPeter Attia2:06:58

        Yeah. OMB needs to do an analysis of something because it's the government that's mandating it. That's why. So they, they have to be able to say-

    15. MRMark Rosekind2:07:09

        Cost benefit

    16. PAPeter Attia2:07:09

        ... yeah, the, that if we mandate this, the cost to the industry to do this is X, but then how do they assign a cost to life?

    17. MRMark Rosekind2:07:17

        Oh, the numbers are there. Always debated, but they've a-

    18. PAPeter Attia2:07:21

        But, but the nu-

    19. MRMark Rosekind2:07:22

        Do a search on-

    20. PAPeter Attia2:07:22

        Yes, but the number of the cost of life is, is, is, is, um, doesn't include loss or pain and suffering. It inc- like, to the people who are left behind. It's simply loss. It's economic loss of life, meaning you, you, you know, you were, you lost 10 years of your life working where you would've made this amount of money. So it's, uh, my, my point is it's, it's probably an underestimate of the true value of life, by far.

    21. MRMark Rosekind2:07:46

        Absolutely. Absolutely. And, and part of what I'm bringing up is- You typically need at least 10% penetration in, in the vehicle population-

    22. PAPeter Attia2:07:55

        Yeah, which is huge

    23. MRMark Rosekind2:07:55

        ... even to collect the-

    24. PAPeter Attia2:07:56

        Yeah

    25. MRMark Rosekind2:07:56

        ... the most basic data to send it to them.

    26. PAPeter Attia2:07:59

        Yeah.

    27. MRMark Rosekind2:07:59

        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 you think you're gonna save? And what data do you have to demonstrate it and substantiate it enough for the cost to the car, the manufacturer, the society, right?

    28. PAPeter Attia2:08:15

        Mm.

    29. MRMark Rosekind2:08:15

        Um, so again, I think that's one of the, the, 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, um, uh, there's something called an advanced 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 gonna 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 and other ar- you know, like heavier vehicles, et cetera, is because of this other work that was done, you know, that may democratize 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 wanna bring us back to it, the mixed fleet is gonna be a huge problem for everybody. And if you think about it, it's gonna 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, right? They're just sort of like... And they'll all be on those streets. You won't know-

    30. PAPeter Attia2:09:34

        Yeah
17. 2:09:54 – 2:14:43

    Sleep deprivation: the impact of poor sleep, drowsiness, & disrupted circadian rhythm on driving

    1. PAPeter Attia2:09:54

       Let's touch briefly on, on drowsiness. I, I, I realize this is kind of your life's work. Uh, it's also the one that I think people who listen to my podcast regularly are very familiar with the implications of, of sleep deprivation. What, what are the most important things you think you want people to understand with respect to how, um, compromised sleep impacts driving?

    2. MRMark Rosekind2:10:17

       I'm gonna repeat what I said earlier, which is lose sleep, disrupt your clock, the circadian clock in our brains. Um, lose sleep, disrupt the clock, and you will pay for it by having human capabilities degraded or impaired. That is across the board.

    3. PAPeter Attia2:10:34

       Yep.

    4. MRMark Rosekind2:10:34

       So I, I don't care what your job is or what task you're on, um, but if you're not getting, you know, the right sleep at the right time, you're gonna pay for it. This is one of those you can't fool hu- you know, human nature, just nature period, you can't fool it. There will be a price to pay.

    5. PAPeter Attia2:10:51

       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?

    6. MRMark Rosekind2:11:13

       So what's really interesting is if you understand sleep and 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 for, uh, in aviation and trucking and rail, um, and a lot of other places, as you already mentioned, the resident training hours, et cetera. But to your point, they're usually mostly focused... I, I always point out there's the two physiological elements you gotta 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, you know, if, if you don't have 10 hours off your job, commuting, getting eight hours of actual supine sleep opportunity, doesn't mean you're gonna get the sleep, but at least eight hours-

    7. PAPeter Attia2:12:04

       Right

    8. MRMark Rosekind2:12:04

       ... opportunity. Uh, you know, maybe nine hours if what residents used to do is live in the hospital, right? I mean, 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, [inhales] military operations, air traffic control, moving goods, you know, it's just like, uh, operating airports, it's like these are 24/7, um, keeping energy go- I mean, just on and on, 24/7 operations.

    9. PAPeter Attia2:12:33

       And, and this, this, this speaks to, again, I think the general theme here that I'm hearing, Mark, is we're, we're gonna quickly a- 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, right? Like, it's, uh, you know, we're not gonna be willing to live in a society where nothing happens at night. So we're g- we have to automate those processes so that we don't have to rely on individuals functioning at fractional reserve and fractional capacity.

    10. MRMark Rosekind2:13:09

        You got it. [laughs] I mean, that, that's... But we are so far away from that in our society now.

    11. PAPeter Attia2:13:14

        Yeah, it might not be in our lifetime. It might not be... Y- you and I probably won't appreciate the full extent of, you know, uh, you know, pick your favorite sci-fi movie where the, the trucks are just, you know, autonomous vehicles that are transporting things on freeways-

    12. MRMark Rosekind2:13:28

        Right

    13. PAPeter Attia2:13:28

        ... at night, but...

    14. MRMark Rosekind2:13:29

        Right. But I, I say that because, start at the beginning, which is the information, even naivete and ignorance of society around the dangers, not just the perform- but that is still an emerging... I mean, it's been going on for a while. This, I feel like, you know, Bill Dement, 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 gotta pay attention to this 'cause the price is too high." And he always pointed out that if we don't get, if we don't start with education so that people appreciate, you know, not just what the cost is, but for me and, 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, you know, putting yourself through this other stuff.

    15. PAPeter Attia2:14:19

        Yeah.

    16. MRMark Rosekind2:14:19

        That's the individual piece.

    17. PAPeter Attia2:14:21

        Yeah.

    18. MRMark Rosekind2:14:21

        But then it gets to what you just described as if we really accept that as a society, then we have to move to what are the solutions gonna be, right? And again, it's not always intervening on the individual, give them drugs, do this. Like, no, it doesn't have to be that. It's gonna have to be these other things like technology that's helps us offset, right, those choices we make as a society that could still put us at risk.

18. 2:14:43 – 2:27:47

    Protecting pedestrians: strategies for reducing the risk of fatal accidents with pedestrians

    1. PAPeter Attia2:14:43

       Let's close our discussion, Mark, with a couple of, um, 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, um, that of being a pedestrian. So what, what can an individual do as a foot pedestrian, um, to minimize their risk? Uh, 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, they're, they're doing the right thing. They're either up on the sidewalk and a car comes up on them, or they're, they're crossing when they should be crossing and someone runs the... Do you, do you have a sense of that?

    2. MRMark Rosekind2:15:30

       I don't. It's a great question, and I'm not sure we have that data.

    3. PAPeter Attia2:15:35

       Okay.

    4. MRMark Rosekind2:15:35

       'Cause it, just because of the categories that these would be placed in, um, 'cause again, if they weren't doing something illegal, I'm not sure that that kind of information would necessarily be collected.

    5. PAPeter Attia2:15:45

       So in other words, it's easy... I mean, 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, but it, you could say, look, you know, of the 42,000 people who died, you know, 6,000 were pedestrians, and we have a really clear example of 1,000 of those pedestrians were, were the ones at fault. Um, 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, but do you have a sense of what, what a pedestrian can do specifically around their situational awareness? What do they need to be on the lookout for to reduce those odds?

    6. MRMark Rosekind2:16:33

       You bet. And, and I think it is worth noting, again, in the last decade, that number's gone up 50%, and la- this last year, the estimates are, like, 7,500 people have died as pedestrians-

    7. PAPeter Attia2:16:45

       Phew

    8. MRMark Rosekind2:16:45

       ... you know, of those numbers. So, uh, that's significant. So to the specific actions, the choices that you have, one is, you know, if there's a sidewalk, be on it. Okay? And again, that's just separation, right, from the driving that's going on.

    9. PAPeter Attia2:17:02

       Yep.

    10. MRMark Rosekind2:17:03

        Um, if there is no sidewalk, you actually wanna walk against the traffic.

    11. PAPeter Attia2:17:07

        Yep.

    12. MRMark Rosekind2:17:07

        Okay? So that's for visibility stuff of what's going on. You already mentioned it. It ends up, um, I mean, we do know 64, 67% of those fatalities occur outside of intersections, so they're happening elsewhere. Okay? Um, but it does mean that if you're crossing, you wanna find an intersection that's got a crosswalk if you can and has some system of stop signs or, you know, counting for when you should go, and you wanna follow those rules as best you can, okay? The other one I think is, you know, visibility. I can't tell you how... You know, again, especially at night, which is when the most of those occur.

    13. PAPeter Attia2:17:45

        Mm.

    14. MRMark Rosekind2:17:45

        Over 50% are at ni- uh, just, you know, simple, straightforward visual things, uh, making sure people can see you. And the other one I think, and nowadays in particular, we mention it for driving, but situational awareness is critical. And so it's amazing how many people, you know, could be either drinking or on their phone with head down. Um, so distraction, the kind of things you think about as a driver, you would apply to pedestrians and cyclists as well.

    15. PAPeter Attia2:18:10

        Do, are cyclists included in that 7,500 deaths per year?

    16. MRMark Rosekind2:18:13

        No, I think those are just pedestrians.

    17. PAPeter Attia2:18:15

        And let's say approx-

    18. MRMark Rosekind2:18:16

        And I don't remember the cyclist number-

    19. PAPeter Attia2:18:17

        Okay

    20. MRMark Rosekind2:18:17

        ... but it's, it's there.

    21. PAPeter Attia2:18:20

        Y- 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, um, I, I certainly adhere to the principle of always assuming the car doesn't see me and always assuming that the driver is a moron. Um, 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 wanna turn right directly in front of you, is remarkable. Um, but yeah, uh, you know, I think, I think, I think all of those make sense. The, the, the walking on the other side of the road, the, the being completely aware. And I just think as a general rule as a pedestrian, also assuming drivers don't see you. They're, they're-

    22. MRMark Rosekind2:19:15

        Right

    23. PAPeter Attia2:19:15

        ... they're calibrated to look for bigger, faster things than you. Um, so you just have to kind of assume they're not seeing you.

    24. MRMark Rosekind2:19:24

        You know, in California, pedestrians have the right of way wherever they are. But I always point out, you know, having a law on your side-

    25. PAPeter Attia2:19:30

        Yeah, who cares? Yeah, having a law on your side means nothing if you're hit and dead or injured. It, it, yeah, I always find that to be the dumbest argument ever-

    26. MRMark Rosekind2:19:37

        Right

    27. PAPeter Attia2:19:37

        ... which is assume you never have the right of way.

    28. MRMark Rosekind2:19:40

        Right.

    29. PAPeter Attia2:19:40

        Even when you do have the right of way, when you have that big green light and the big, you know, walking sign, still assume that a driver's gonna make a mistake because the consequences are much higher for you than them-

    30. MRMark Rosekind2:19:53

        Yep
19. 2:27:47 – 2:33:46

    Empowering safe driving: essential resources & tips for parents & teenage drivers

    1. PAPeter Attia2:27:47

       Are there any resources, Mark, that you would point people to who are kind of interested in the, the what can I do, right? So we, there, again, lots of things that hopefully will happen technologically and, you know, we can debate the policies all day long, but at the end of the day, everybody listening to this is gonna get in their car today. And-

    2. MRMark Rosekind2:28:06

       Right

    3. PAPeter Attia2:28:06

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

    4. MRMark Rosekind2:28:29

       So let's hold the kids for a moment. And I think the place to start, a few websites, NHTSA.gov, N-H-T-S-A dot gov, is a great website that you can go on. It has a, uh, VIN, vehicle identification number, lookup. So if you're wondering, do you have a defect and recall that you should take care, 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-

    5. PAPeter Attia2:28:57

       Mm

    6. MRMark Rosekind2:28:57

       ... booster seat, et cetera. Really good with that. And all the data we're talking about that I can't keep in my head is on that website.

    7. PAPeter Attia2:29:05

       Okay.

    8. MRMark Rosekind2:29:05

       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 Monroney label on your new car that's the stars evaluating its crash worthiness and some other factors as well.

    9. PAPeter Attia2:29:22

       And what's, what's, what's it called?

    10. MRMark Rosekind2:29:24

        It's NCAP, New Car Assessment Program.

    11. PAPeter Attia2:29:28

        Okay.

    12. MRMark Rosekind2:29:29

        So again, when you're thinking about where should I start, well, just start with the ratings.

    13. PAPeter Attia2:29:33

        Yep.

    14. MRMark Rosekind2:29:33

        So NHTSA's got all this different stuff that's a great-

    15. PAPeter Attia2:29:36

        Okay

    16. MRMark Rosekind2:29:36

        ... resource there. Next would be, um, 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.

    17. PAPeter Attia2:29:46

        Mm.

    18. MRMark Rosekind2:29:47

        So they will d- 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. Um, and besides the crash information, they also have other studies and things they do. So really good there. Um, National Safety Council, NSC, they have great data because they'll have car stuff, they have pedestrian stuff, they have cyclist information. They're really good for general resources for safety, including roadway pieces. And then the fourth-

    19. PAPeter Attia2:30:23

        And that, again, sorry, that one again was N-

    20. MRMark Rosekind2:30:24

        That's the National Safety Council, NSC.

    21. PAPeter Attia2:30:27

        NSC, okay.

    22. MRMark Rosekind2:30:28

        Yep. And the fourth one I would mention is, is, um, Safe Kids Worldwide, and they actually certify car seat technicians 'cause it ends up, and we're gonna get this number wrong, but 60, 70% of car seats are installed incorrectly.

    23. PAPeter Attia2:30:45

        Yeah.

    24. MRMark Rosekind2:30:46

        I mean, I know it's over 50%, so you know, it's great to do all that work to get the right one, but then if it's done [laughs] incorrectly. So Safer, 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 kinda driver contracts that you can use. Um, so that's, the insurance company also has a-

    25. PAPeter Attia2:31:10

        Mm-hmm

    26. MRMark Rosekind2:31:10

        ... 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, 'cause depending on the state, they may have graduated licensing, and that licensing for new drivers, um, actually includes, like, can you have other kids in the car? No.

    27. PAPeter Attia2:31:30

        Yeah.

    28. MRMark Rosekind2:31:30

        Um, can you drive after dark? No. You know, and, like, this for six months, this for a year-

    29. PAPeter Attia2:31:35

        Yeah

    30. MRMark Rosekind2:31:35

        ... et cetera. And so I was just talking to a friend and 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 'cause as a scientist you'll appreciate this, too, but you know, feel free to experiment with her, [laughs] you know?
20. 2:33:46 – 2:38:36

    Promoting a culture of proactive safety

    1. PAPeter Attia2:33:46

       um, this has been really illuminating. Um, it's, it's, it's quite disturbing, um, as, as, as we've talked about. And, um, I almost wish there was a way that we could convey, you know, every one of the forty-two thousand nine hundred and twenty-nine stories of the people who died two years ago, the most recent data we have here, um, because I, I think it, you know, on some level, it sometimes takes those things. You know, 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, right? Your risk of death from cardiovascular disease, stroke, cancer, and Alzheimer's disease, this is disproportionately a disease of the elderly. Um, whereas when I last looked at this, which was twenty twenty, and I can't imagine the data have changed that much, the thing that stuck to me the most, that stuck out to me the most was that automotive deaths, uh, were the most uniform cause of death by decade of anything in the top ten causes of death. There was nothing more uniform than dying in a car.

    2. MRMark Rosekind2:35:01

       Yes.

    3. PAPeter Attia2:35:02

       Equal opportunity killer.

    4. MRMark Rosekind2:35:05

       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. Um, one is that, and these are where the parallels are there, um, 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, right? I mean, it's like, uh-

    5. PAPeter Attia2:35:36

       Yep

    6. MRMark Rosekind2:35:36

       ... in milliseconds and, and you don't go out that day thinking it's gonna happen.

    7. PAPeter Attia2:35:39

       Yeah.

    8. MRMark Rosekind2:35:39

       And as you were saying-

    9. PAPeter Attia2:35:40

       Yeah, you don't get to say goodbye

    10. MRMark Rosekind2:35:41

        ... those chronic-

    11. PAPeter Attia2:35:41

        You don't get to say goodbye to your grandmother who's got cancer for two years. Yep.

    12. MRMark Rosekind2:35:46

        Someone comes to your door, they're not coming home, you know?

    13. PAPeter Attia2:35:50

        Yeah.

    14. MRMark Rosekind2:35:50

        I mean, it's just sort of, it, it's a different, it's like [snap] just like that, right? Um, and so I think that's one thing that separates it in some ways from those chronic illnesses and, you know, 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, 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 twelve years with no-- in the US, no person died in a commercial aircraft crash in like twelve years, okay? And then it was one, right? And, and I always tell people, it's like it's so hard to get there.

    15. PAPeter Attia2:36:53

        Yeah.

    16. MRMark Rosekind2:36:53

        It's even harder to stay there, you know, saving all those lives. But that takes a proactive culture that says we're gonna do what we can to eliminate or mitigate, right, diminish what those risks are and promote the good stuff we know that's gonna 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 gonna 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, you know? I-- It's like 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 those kinds of, 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, right, person in her sphere, 'cause that's the societal change in a proactive way that's gonna 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, her family, right, 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, 'cause the costs are so high.

Episode duration: 2:40:54