Good afternoon! Thank you, Sue [Baker], for such a lovely introduction. Thank you to Andrea [Gielen], new Dean Ellen [MacKenzie], the Raskin Family, and everyone at the Johns Hopkins Center for Injury Research and Policy.
First, I would like to say that I know we have heavy hearts today after the shocking gun violence in Las Vegas. Those of us in the public health community are saddened because we know it was preventable. One of my cousins is in Las Vegas this week and is staying in the same hotel where the shootings occurred, so I am grateful that he and his family were not harmed, but many were not so lucky. I also am grateful to the first responders in Las Vegas, first responders much like the person we honor today, Daniel J. Raskin.
I am humbled to be here today because Danny Raskin was a community hero, so receiving the Community Hero Award and being invited to give the Raskin Symposium on the 30th Anniversary of the Injury Center is an incredible honor for me.
I also am honored because Sue Baker, founding director of the Center, has been one of my heroes long before we ever met. It was more than 20 years ago at an American Public Health Association meeting when Sue Baker kindly allowed me, as an unknown student from Texas, to follow her around the scientific poster sessions and pester her with questions.
I am privileged to be here today with several of my NTSB [National Transportation Safety Board] colleagues. Please raise your hands if you are from the NTSB. These colleagues represent the best of the NTSB and I hope you will take the opportunity to meet them. I would like to especially recognize a previous Raskin Lecturer, Dr. Bob Dodd, and two previous winners of the NTSB’s Nall-Raskin Public Service Award. Steve Blackistone, from whom you heard earlier, has served as a volunteer firefighter in Bethesda for 45 years. In addition, Kenny Bragg served for 21 years as a police officer in Prince George’s County before joining the NTSB.
It also is exciting to be here because, like Danny Raskin, I have family ties to Johns Hopkins and Baltimore. This is where my mother-in-law was born. In fact, she grew up nearby on Calvert Street. This also is where my late father, an OBYGN and pathologist, arrived from Vietnam in 1960 to study under his mentor, Johns Hopkins professor Dr. Donald Woodruff.
I admit I was very nervous about speaking before all of you today, not only because this audience is composed of people I admire, but because I wanted to do justice to Danny Raskin’s memory. So, I did what researchers and scientists do when we are nervous, I gathered data. Of course, I knew about Danny’s work at the NTSB and as a volunteer fireman, but I wanted to know more about what he was like as a person, so I spoke with many people who knew Danny at the NTSB – from former Board Members to fellow investigators to colleagues and friends who played with him on the NTSB softball team. Danny’s sister Lisa also was very generous with her time in talking with me.
I found out so many wonderful things about Danny. I was told about how he was a highly capable investigator, how he had “down to earth” charisma, how he was a straight shooter, and how he had friends from all walks of life. Yet, what I heard several times, and what helped inspire this talk, was that people remembered that Danny told wonderful stories. I was impressed that people were able to recall their memories of Danny so easily and so quickly – even people who did not work with him very often at the NTSB. Perhaps, in part, it was his entertaining stories that helped people remember him so vividly and warmly. That is a lesson we can learn from Danny – the importance of the story, the importance of showing our humanity, even as we do the most evidence-based scientific work we can to save lives and prevent injuries.
At the NTSB, at Johns Hopkins, and likely at other organizations you are a part of, we often talk about data and science and evidence. But we do not often talk about stories. We do not talk about the importance of stories in helping people understand and support science. We do not talk about the synergy of science and story. So today, I would like to discuss the importance of using stories to support science and, along the way, tell you a little more about myself and the great agency I am proud to serve, the National Transportation Safety Board.
My own story in public health starts with data, and lots of it. Not long before I met Sue Baker for the first time in the 1990s, I was immersed in the world of systematic reviews, first at the Cochrane Collaboration in the United Kingdom, and then at the CDC [Centers for Disease Control and Prevention] with the U.S. Guide to Community Preventive Services.
As many of you know, a systematic review is a form of research that involves an extremely comprehensive search of the literature and uses specified criteria to choose and analyze published and unpublished studies to answer a clearly formulated question. A meta-analysis can be part of a systematic review.
In the 1990s, systematic reviews were relatively new and mostly confined to the world of medicine. It was named after Archie Cochrane, who was an OBGYN just like my dear old dad. This innovative method of research to get the most complete and most objective evidence on a subject was still in its infancy. I spent hundreds of hours at libraries in London and at the Texas Medical Center Library in Houston, Texas, combing journals for studies related to alcohol and drinking and then pulling and analyzing the qualifying studies. In the end, with Dr. Carolyn DiGuiseppi and others you may know, I published one of the first systematic reviews on an injury topic in the United States (“Preventing Injuries Through Interventions for Problem Drinking: A Systematic Review of Randomized Controlled Trials” in Alcohol and Alcoholism 1999).
I loved data, so I loved the idea that systematic reviews would find “THE ANSWER” quantitatively and without biases. I could not quite understand why people did not find the results of a systematic review and meta-analysis as compelling as I did. Although I volunteered at a domestic violence shelter and at a Level 1 Trauma Center in Houston, where I witnessed many shocking examples of preventable injuries, I still did not quite understand the importance of connecting these stories with the numbers that all those data points represented.
Even after graduate school, when I had jobs that taught me the vital importance of telling the stories behind the science, I was still learning. In my work at the FIA Foundation, a philanthropy that funds projects to prevent road traffic deaths globally through the Make Roads Safe Campaign, I heard stories from around the world, and became friends with people like Casey Marenge, who became paralyzed from the neck down after a car crash in Kenya but, with the help of her family, and her own very strong will, started a foundation to assist other people in wheelchairs in Africa, a foundation called Chariots of Destiny. I heard stories about children in Vietnam saved from death and traumatic brain injury by an affordable Pro-Tec helmet built by people with disabilities. I got to know a mother named Denise Dias in Guyana who created the “Mothers in Black” organization when her daughter died after being hit by a drinking driver and who then stood vigil outside the Parliament in Guyana until drink driving laws were passed.
I met so many amazing people, but somehow, it is really only now, at the NTSB, where I see the immediate and terrible aftermath of transportation disasters, that I have finally understood the absolute necessity of telling the story in order to save lives and prevent injuries.
First, let me tell you a little about the NTSB, where my colleagues and I work, and which is the agency where Danny Raskin was a human factors investigator.
The NTSB is an independent federal agency that investigates transportation disasters and makes recommendations to improve safety. Coincidentally, this year is the NTSB’s 50th Anniversary, so we are exactly 20 years older than the Injury Center. When you think of the NTSB, you may think of our dark blue uniforms with the bright yellow letters on the back. You will see us at the scene of disasters in all modes of transportation – aviation, maritime, highway, and rail as well as incidents involving pipelines and hazardous materials. We have a Most Wanted List of transportation priorities, which are 10 issues we know have the chance of moving forward if given some good hard pushes.
We do not have any regulatory or enforcement authority, so we use our powers of persuasion – NTSB’s recommendations are just that, best practice recommendations, not requirements. Fortunately, we are considered to wear the “white hats” and we make decisions solely on their safety impact, so people often want to do what we ask. In fact, we have issued over 14,000 safety recommendations to over 2,300 recipients over the years – and in all modes of transportation. In addition, approximately 80% of our recommendations have been adopted, thanks to the hard work of people like Bob Dodd and Jeff Marcus from our Safety Recommendations Office, who are here today.
The formula for our implementation rate is:
(# of recommendations closed acceptably ÷ # of all closed recommendations) * 100 = implementation rate
# of recommendations closed acceptably = (closed-acceptable + closed acceptable alternate + closed-exceeds recommended action)
# of all closed recommendations = (closed-acceptable + closed acceptable alternate + closed-exceeds recommended action + closed unacceptable action + closed unacceptable action/no response received)
As one doctor I know says, we are like infectious disease outbreak investigation teams, except what we are investigating is an outbreak of kinetic energy instead of a disease. We get as much information as we can to make recommendations to prevent the next “outbreak.” Those on-scene investigations are an important part of our work – that is why we are on call 24 hours a day, 365 days a year. Once we have finished our on-scene work, our work continues back at our state-of-the-art labs. The final result of an investigation is a very thorough report covering every aspect of an accident, including a probable cause and safety recommendations designed to prevent that type of accident from happening again.
Before I get any disapproving looks, yes, I used the word “accident”. Although the term “accident” is now not used in highway safety, we still use it for our other investigations because, under the federal statute that created the NTSB, we are charged by Congress with investigating every civil aviation accident – as well as significant accidents in other modes. Accident is a term of art in aviation. It also underscores the fact that we investigate unintentional occurrences – we leave the criminal investigations to the FBI.
We are an independent agency and we have five independent board members, like myself, who are nominated by the President and confirmed by the Senate for a certain term of office, so our terms are not tied to Administrations or elections. We do not report to anyone – not the U.S. Department of Transportation (DOT) or any other federal agency – so we can make recommendations to anyone. We always perform our analyses alone - completely independent of any other agencies and organizations.
Ultimately, our work results in products that contain recommendations to advance safety including reports, safety studies, and special investigative reports. We deliberate, we make decisions, and by law, we vote on all items in public, during our meetings governed by the Government in the Sunshine Act. Also, we are so transparent that you will never see more than 2 Board Members together at a time discussing an investigation unless we are doing so publicly and it is webcast!
Federal agencies, states & territories, and the industry have used our recommendations to make progress in areas such as: airbags, impaired driving, seat belt laws, school bus design, safety barriers in road design, setting standards for signage, to name a few.
Because of NTSB’s detailed investigations, it may seem that our work is largely technical and mechanical, but like you, my 400 colleagues at the NTSB and I never forget that the true purpose of our work is to serve people. Their stories help us remember that. Part of our work is to assist people who have been affected by a transportation disaster - victims and families of victims. As a Board Member, I talk with family members at the scene and I consider it a responsibility and a privilege. Survivors and family members share their stories with me and I carry those stories with me whenever I speak about our safety recommendations.
One person I will never forget is a woman who was seriously injured in a train accident and wrote me a letter. Eight people died and 185 were hospitalized when an Amtrak train that was speeding derailed at a curve 2 years ago in Philadelphia. I received her letter not long after our public board meeting. I was not feeling particularly happy at the time because I had not managed to convince my fellow board members to vote with me so I had cast a lone dissenting vote. I felt that the lack of positive train control, or PTC, a system that would have slowed the train and prevented the accident, should have been listed as a primary probable cause, rather than just the engineer’s mistake in speeding. From the public health perspective, I felt PTC was like a vaccine, everyone knew they should have it and everyone knew it would have prevented the disease or accident.
So I was very frustrated – and somewhat mad at myself that I could not convince anyone else to vote with me! Then I received the letter. She identified herself as one of the passengers and proceeded to describe the horrific way she had been injured when the train derailed, saying that her life had changed forever. She ended by saying she knew that PTC would have prevented it and even took the time to thank me for my efforts and to tell me not to give up because people like her were counting on me. She said not to forget about people like her, people who were injured for the rest of their lives because PTC had not been fully implemented, as the NTSB has been recommending for decades. I was embarrassed, as someone trained in injury prevention, that it took this woman’s letter for me to remember the many, many injuries in addition to the deaths that occur in an accident. But I will not forget her story.
Sometimes the story is not about someone killed or injured at all. Sometimes it is just a personal story that reminds people of a face behind the numbers. That was the case in Utah. At the NTSB, we are sometimes criticized for our safety recommendations. We are not often criticized by the public – who seem to understand our mission, but rather, by groups that are misinformed and worry unnecessarily that they might lose profits if a safety recommendation is implemented. Nowhere has that been more evident than with our recommendations related to impaired driving.
Ten thousand people. That is how many people die every year due to alcohol-impaired driving in our nation. The NTSB has made many different recommendations in this area. We have recommended reducing the illegal per se BAC (blood alcohol concentration) limit for all drivers; conducting high-visibility enforcement of impaired driving laws; incorporating passive alcohol-sensing technology into enforcement efforts; expanding the use of in-vehicle devices to prevent operation by an impaired driver; and DUI [driving under the influence] courts and other programs to reduce recidivism by repeat DUI offenders.
We made all of these recommendations 4 years ago as part of our Reaching Zero study, but we get the most criticism for our recommendation for states to reduce their illegal per se to .05 BAC or lower. This is despite the fact that about 100 countries around the world already have a .05 or lower BAC law and there have been dozens of studies demonstrating that such a law would reduce the number of impaired driving crashes.
I always try to be optimistic, but even I was a little surprised earlier this year when, against high odds and during a short legislative session of 45 days, the State of Utah passed the first .05 BAC law in the United States. You may remember that Utah and Oregon passed the first .08 law also.
How did it happen? In part, because people in Utah requested safety information and the NTSB was able to provide it. When Utah legislators reached out to me early on, we provided unbiased information and I testified twice in their state legislature. We told them that in countries with a .05 BAC law, people consume more alcohol per capita and yet were less likely to die from impaired driving. We told them that a .05 BAC law is a broad deterrent that decreases the number of impaired drivers on the road at all BAC levels – high and low – so amazingly, it also reduces the number of high BAC drivers, who are involved in the most crashes, from getting behind the wheel. We showed them studies demonstrating that even at a .05 BAC, people have problems with coordination, vision, and steering. When people called me a prohibitionist, we told them that a .05 BAC law was not about drinking at all – it simply helps people to separate their drinking from their driving. We told them that a law could save 1,790 lives nationwide every year.
Opponents of the .05 law used scare tactics and spread misinformation through expensive full-page ads in many newspapers. These ads contradicted information from NTSB, NHTSA (National Highway Traffic Safety Administration), the CDC, and many other sources. But these ads told a story, a false story, but a story nonetheless. Opponents tried to mislead Utah residents with a story about innocent people getting put in jail after having one drink with dinner. I have to admit, they were clever and had catchy slogans like “Arrive on vacation, leave on probation.”
We provided stacks of information and studies and statistics, all of which legislators and the governor appreciated. I thought surely the statistic of saving 1,790 lives a year would be all they would need. But no, in the end, although our statistics helped, it was the power of the story that prevailed. My first op ed was full of numbers but my second op ed, which was even more well received, talked about my brother, a doctor, who often visited Utah with his family to snowboard and did not want to get hit by drunk drivers. I wrote that by passing a .05 BAC law, they would be taking the first step to saving 1,790 lives nationwide, and I thanked them for protecting their families - and mine. I cannot tell you how many comments I got about “the story about my brother”! More importantly, supporters of .05 BAC also showed up at hearings to tell their story, often citing the NTSB.
The NTSB is not here to engage misguided opponents of safety in a public fight (as much as I love a good fight for a good cause). We are here – as an objective source - to provide solid, accurate, independent safety information for people to make informed decisions. These personal stories help people understand that information and remember it.
The first part of the title of my talk is “Inspiring Data” and I know it sounds somewhat ambiguous. Do I mean that data is inspiring? Well, yes, it is, to me, data is always exciting and always should be the basis of what we do. Or do I mean that we need to inspire people to believe in data, to inspire people to support data? Perhaps that is the more important interpretation. Science alone and story alone cannot do it, but together, they are a more powerful force than the sum of their parts. That is the synergy of science and story.
As scientists and as those who believe in science and data, it is our job to tell the story of data, to make the data sing, to make people feel something about the data. That also is a lesson from Danny Raskin.
Maya Angelou said:
“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
– Maya Angelou
Danny Raskin made people feel good and they remembered him for it. We can make people feel something about data and science using stories and perhaps they will be inspired to support worthy, evidence-based efforts. Perhaps it will help inspire the political and public will in support of the good work that you do every day.
My son is in the fourth grade and, coincidentally, his class is studying heroes. They are studying the classics we know such as Ulysses and Jason, but also living heroes such as Malala, the young Nobel Peace Prize Winner, and yes, Harry Potter and Percy Jackson. As my 9-year-old told me, to be a hero, you need to have a quest, you have challenges, and often, you have tools to help you. All of you, as supporters and creators of science and data, are today’s heroes. We have a quest to advance evidence-based information, and our tool is not a sword or a wand, it is the story. Stories are what will inspire the public to remember the science.
Maya Angelou also said:
“I think a hero is any person really intent on making this a better place for all people.”
– Maya Angelou
In these times, when sometimes it seems that a misleading story can overcome science, it is up to us, as people who believe in data, to remember the power of the true story to support good science. The story helps us make sense of the data. The story helps us feel something about the data. The story helps us remember the data. The story helps us bring humanity to the data. In addition, we should remember, there is ALWAYS a story. That is the synergy of science and story. Let us all tell our stories and, to paraphrase Maya Angelou as well as echo the mission of the Injury Center, let us make this a better, safer place for all people.
Thank you again for the tremendous honors of inviting me to give the Raskin Symposium and for presenting me with the Community Hero Award. Happy 30th birthday to the Johns Hopkins Center for Injury Research and Policy!