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More pedestrians are dying in auto accidents. Abdul reflects on the public health challenges that cars pose in general. Then he sits down with Dr. Deborah Kuhls, a trauma surgeon who studies pedestrian fatalities to understand why and how to stop it.

TRANSCRIPT

[AD BREAK] [music break]

Dr. Abdul El-Sayed, narrating: King Charles is diagnosed with cancer. New research shows that exposure to police violence has consequences on sleep, mental health and more. Scientists may have cracked the code on why women are four times as likely to suffer autoimmune disorders. This is America Dissected. I’m your host, Doctor Abdul El-Sayed. [music break] Back when we bought our house in the height of the pandemic, Sarah and I wanted to be as close to her workplace as possible. I worked from home at the time, so we chose a place about five minutes away from her office. We wanted to limit her commute and our carbon footprint more generally. But a few years later, I took a job based about 45 minutes away. Fortunately, I only work from the office about three days a week. But nonetheless, that commute still means at least five hours in a car every single week. Most of the trip is on a highway, and just a week ago, the roads were a lot slicker than I thought, and I began to spin out at about 50 miles an hour. Once I got control of my vehicle, I tried to guide myself to the shoulder, but I simply couldn’t slow myself up. I went straight through the shoulder and into the ditch just beyond it. I’m lucky that I was in a patch of road that had a ditch. I’m lucky that all that happened is that I got stuck in a ditch for an hour until I got a tow. I’m lucky that I didn’t hit any other cars, because while I was sitting in that ditch, another driver lost control just like I did and hit the car in front of them. And all of us are lucky nobody got hurt. Look, let me put my cards or my car on the table here. I live in Michigan, and we put America in cars. The automobile built Detroit, it built Michigan. It built the home I grew up in. Both my parents are automotive engineers, after all. And I really love cars. The engineering, the speed, the sound, all of it. But I’m also a doctor and an epidemiologist. And from a public health standpoint, I got to face the music here. Cars, they got issues. First, there’s the fact that the average commute is half an hour. For me, I think about the five hours I spend in my car. I could be spending it doing so much else. When I lived in New York, my commute was also 30 minutes, but that was about 15 minutes walking and another 15 minutes on the subway. That 30 minutes of walking I did every day? They were priceless. That’s 30 minutes of exercise, five days a week I just don’t do in my current car based commute. Then there’s the isolation. While I’d walk and ride the train in New York. I’d be people watching, getting a sense of the community around me. In a car it’s just me by my lonesome, and I know that every other car on the road holds another lonely commuter like me. But we can’t see each other, exchange glances, or share the joy of the busker at the station while we wait for our train. Then there’s the consequences for our climate. All that driving we do contributes to climate change. And look, I drive a plug in hybrid, but I know that while I’m on the gas side, which is most of my commute, I’m burning fossil fuels into our atmosphere and it sucks. Collectively, in 2022, our vehicles contributed about 1.4 billion metric tons of CO2 emissions. That’s about 16% of our country’s entire carbon footprint. But it’s not just the environment at the global level. Just look at the built environment, the communities we build to accommodate cars. Sprawling cul de sac neighborhoods are built to accommodate transit in one way and one way only, by car. Sure, you can walk around your neighborhood, but let’s face it, it’s boring as hell. Walking by endless rows of houses. Compare that to walking around communities built for alternative modes of transit. You’ve got shopping on the walkway and people you’re sharing space with. And those car based communities, they’re self-reinforcing. The only way to get around them is by car. So a car you must have. Rinse and repeat. Which brings me back to my story. Cars themselves, much bigger today than they ever were in the past, are just dangerous on their own terms. Automobile accidents are one of the nation’s leading causes of death. And unlike other causes like cancer or heart disease, this one is on the rise, particularly so since the pandemic. I wanted to understand why exactly. So I reached out to Dr. Deborah Kuhls, she’s a trauma surgeon who studies automotive injury, and she joined me to talk about why injuries involving cars are on the rise, what it tells us about the ways we’ve constructed our society and what we can do about it. Here’s my conversation with Dr. Deborah Kuhls. 

Dr. Abdul El-Sayed: Okay. Can you introduce yourself for the tape?

Dr. Deborah Kuhls: Sure, I’m Deborah Kuhls, and I am a trauma critical care surgeon at the Kirk Kerkorian School of Medicine at UNLV. And I’m also the chief of trauma at University Medical Center of Southern Nevada. 

Dr. Abdul El-Sayed: We really appreciate you joining us today. And I kind of want to go way back. What got you interested in understanding the consequences of automobile injury? When did that become a focus for you and your work? 

Dr. Deborah Kuhls: So I developed an interest in it during my training. In trauma surgery, we see kind of repetitive behaviors that result in injury and the injuries can be so devastating that the idea of preventing them was certainly mentioned, like during my training. But it’s something that really resonated with me. And the more I did trauma surgery, the more it resonated with me. And then I learned also at the very end of my training, and as I started as an attending surgeon, that it is required for all verified trauma centers to actually do injury prevention. And so it it seemed like it was definitely the right career for me because I enjoyed caring for injured patients, working with their families, because both the patient usually and their family, they got up thinking it was going to be a normal good day and it’s anything but that after injury. And injury usually happens so quickly that I think people just don’t anticipate that their life is potentially changing right in front of their eyes. 

Dr. Abdul El-Sayed: Yeah, I I wanted to ask because um as listeners know, I’m from, Michigan and we’re like in the heart of Auto Country. And we literally put the country on wheels, which may or may not be a good thing. And often when we’re talking about injury, it’s not a good thing. Can you tell us a little bit about some of the clinical hallmarks of injury by automobile, like, what are the kinds of injuries that you usually see when somebody is either struck by an automobile or involved in an automobile accident? 

Dr. Deborah Kuhls: So I see a whole variety of things. So let’s just take people who are struck by an automobile. I live in Las Vegas, and that’s one of our real challenges, is how to decrease the number of people who are hit by automobiles and actually killed by automobiles. And the types of injuries that they sustain because they’re completely vulnerable, road users, is what we call them. And, you know, as people are driving quickly and sometimes in large cars, we can just imagine the force that hits a person. So it’s their injuries are across their entire body. So many will have a brain injury. Um. They can have um a spine injury, sometimes that leaves them paralyzed. The bones in their chest are broken uh there which is largely ribs and in their abdomen um we typically abdomen and pelvis. We see a lot of pelvic injuries because the bones take a lot of the force, and then they break. But also we see internal injuries that can be really highly varied from the what we call the solid organs, liver and spleen. And if they’re severely injured, those patients immediately start bleeding and with pelvic fractures as well. There are a huge number of blood vessels that run through that area. And they can they can very easily bleed and potentially bleed to death. The extremities again, depending upon the size of the car, how high it is off the road and the size of the person. Uh. The extremities can be. You know, broken into many pieces. Um. Sometimes they get actually dragged by the car, so then they get the equivalent of, like, a burn on that part of their body. So I would say people who get struck by vehicles are among the most injured because all of our safety devices that we’ve now, some are incorporated by laws and some by the desire for people to be safe in their automobiles. None of those safety measures really, you know, affect the pedestrian. We call them pedestrians or people who are walking. Um. Similarly, people who are on bikes, um they’re unprotected. Um. And so all of the safety initiatives, um in terms of automobile manufacturing, so forth are they don’t protect the pedestrian at all, at all. And so they remain some of our most serious um injuries. But clearly, one can get very injured in other ways by automobiles. 

Dr. Abdul El-Sayed: Yeah. I mean, what you’re describing is a very complex set of injuries. And, you know, what you just said makes sense is that we we’ve designed the automobiles to protect the people inside, not the people outside. And, you know, in part that’s part of that is like the cars have just gotten bigger. And, you know, that is almost a protective device for the folks inside, but they also reduce visibility. It means that the the nature of the injury, just basic physics um the injury is going to be worse for somebody outside. One of the, you know, the reasons that we wanted to chat today is because pedestrian injuries have skyrocketed over the past several years. Can you just tell us first and foremost, like, is there a demographic that’s being affected most by pedestrian injury? 

Dr. Deborah Kuhls: So what we’ve found in our community. So we’ve studied this in Southern Nevada. Because I think if we know the demographic that is most injured, then we can reach out to them with specific interventions to try to keep them safer. So in in terms of like age distribution and so forth, we find that it’s bimodal, meaning that there are really two groups that appear to be most disproportionately injured. And it’s the younger group that may be distracted by texting while they’re walking across the road or something. And then an older group. And so um, it really is is bimodal in in that way. And what we also know is that these are people who probably don’t have a lot of alternatives for transportation. And they will be taking a bus and then crossing a street, and then perhaps not be looking, or somebody is trying to avoid the bus and and and hits them. Um. So that’s one demographic. And I’d like to also just comment on, on roads as well. And this may be this likely varies by geographic area, but in the area in Nevada where I live, the roads are very wide. And the blocks are extremely long. And while you can have a crosswalk, between blocks or in the middle of a block that isn’t very common. And so for pedestrians to get to a crosswalk, they often have to walk a fair distance um to find a crosswalk, to then walk. So the demographic of those who ride ride public transportation, and the crashes that happen surrounding those areas has also been an area of focus that we’ve looked at, and we’ve tried to intervene. And the engineers that design roads and bus stops and so forth. They have done a very good job in reconstructing some of those areas to make them safer. But as you can imagine, in like metropolitan areas and so forth, that’s a huge undertaking to go back and re-engineer, um roads and bus stops and so forth. 

Dr. Abdul El-Sayed: Yeah. No. One of the the pieces that that I really appreciate you highlighting is the length of a block. I didn’t think about that. Let’s say you’re trying to walk to a strip mall on the other side of a block. If that block is really long and the strip mall is right in front of you, you might be tempted to just try and cross the road. 

Dr. Deborah Kuhls: Yes. 

Dr. Abdul El-Sayed: And that just increases the probability that you’re going to be a pedestrian in a collision with a car. Um. And the the, the that note about these bimodal distributions, you can imagine two very different causal chains, right. Young people I’ve been in situations where folks are literally jaywalking across the street, looking at their phone and you just oblivious to your, your, your approaching them. And then obviously in the situation with seniors, um less able to evade a car or potentially even see a car coming in a situation where they could be crossing. Um. And it just speaks to the nature of the way we’ve designed so much of our space. Right? So much of it has been designed specifically around cars without the engagement of the idea of what happens when cars and people intermingle. And to your point, a lot of the folks, um in the way that you shared it don’t necessarily have alternatives to automobiles. So if you’re somebody who can’t afford a car in a car driven society, that means that you are by definition exposed to what happens because we’ve built everything around cars. Um. And sometimes I think we take that for granted. I, in Michigan, we are remarkably unwalkable outside of a couple of uh our cities. And, you know, you start to appreciate when you’re walking in a cul de sac neighborhood. Um. A lot of them just don’t even have sidewalks. I mean, these are literally built to to just engage in cars and says a lot about uh the way that industry is wrapped around in the way we built around particular industries. But it also forces us to think a bit about what happens in a situation like the one we face, where the cost of owning a car over the past several years has has gone up tremendously. The cost of buying a car has gone up. Literally the way we’ve built our society has priced people out of the basic mode of transit. And to add insult, well injury to insult, it it then leaves you a lot more liable to to being injured. I want to um sort of think a little bit about some of the hypotheses around what’s driving this. I’d like to break it down, maybe in, in like pedestrian features and driver features. And on the pedestrian side, you named a couple of them. Could you go a little bit deeper into some of the hypotheses that that we think may be causing this increase in pedestrian injury? 

Dr. Deborah Kuhls: We’ve talked about some of them, as we take a deeper dive um I think there is the, I think assumption that drivers are very aware of their surroundings, right? In that that I think there’s the assumption that drivers see the pedestrians and again, in in my city and in others, they can be crossing at night, in dark clothing, and I really think they expect to be seen. But when you look at the driver’s side of it, you have people who are in a hurry. Right. Our lives have gotten more complicated. We’re in a hurry to get somewhere by a certain time. We know that there’s increased speed. And so that even if you have an alert driver who can actually see a pedestrian. So if you’re traveling faster, your ability to to respond and actually stop the vehicle is going to be longer because you’re speeding. Um. And then if there’s decreased visibility, it might not the driver might not even see the pedestrian until they’re very, very, very close. That that’s one hypothesis. And we noticed that a lot of pedestrians are in dark clothing. I assume just not in my state, but in in other states. So it decreases the visibility from their perspective. And we’re all distracted by our cell phones largely, um texting, getting phone calls. And it’s not uncommon that you have both a distracted driver and a distracted pedestrian. And so what we um try to instruct pedestrians is be sure to make eye contact with the person in the automobile. But that’s challenging, right? If you have wide streets. Um. And you could be hit on any one of, I don’t know, 6 to 8 lanes, depending upon the area. Um. You can have people who turn right on on red who again should be looking at the crosswalk that presumably would be right in front of them. So we think actually that distraction is a huge component as well for both. And I think for people who are just really struggling to to get to locations and who are the pedestrians, um I think our, our hypothesis anyway, is that they, they get desensitized to the potential danger of getting hit by an automobile. And I think, generally speaking, for people who are drivers, our automobiles have become essentially like our living rooms. Right. So they’re they’re very comfortable, which we all appreciate. Right. But there are a lot of gadgets. There’s the ability to entertain the passengers with various video devices. There are lots of options that that we have that we can we can do climate control. We can really fine tune the music that we’re watching or listening to or something like that. So there are a lot of distractions within an automobile, and they’re so comfortable that I think that the our hypothesis is that people are so comfortable in their vehicles that they don’t realize that if they don’t drive really responsibly, that they could be a vehicle of death, um not only for themselves and the passengers, but for people around them, whether they be pedestrians or, or people in um other vehicles. [music break]

[AD BREAK] 

Dr. Abdul El-Sayed: You know that point that you made about the design of cars? There are so many ways to get distracted. I remember when I did my driver’s training. This would have been in the late ’90s, and one of the things they made you do was turn on the radio. And, you know, I think about the gigantic touchscreen on my dash now and all of the different things that I can do, um and let alone the phone that is right there for the touching. If it pings me with so-and-so message and then, yeah, I commute quite a long distance to work, and I’m usually on the phone most of the time. And so, you know, I can be caught up in my conversation, uh discussing some minute detail of work. Uh. And it means that you may not be as focused on the circumstances uh around you. And you can imagine in all of that, right? With all of those distractions, it gets a lot more complicated. And then there’s also the fact that I drive. I live in Michigan, and for half the year, it’s potentially snowy. I drive a, an SUV, and I drive a hybrid SUV in case I get shamed. And don’t at me anybody on on X or Twitter, but but my SUV is very big, and that means my visibility is not as good as it might have been if I were more at the pedestrian level, right? I’m driving usually with my head a good foot or two feet higher than the average pedestrian. And so sometimes I, you know, I think a lot. I have a six year old, and I always tell her, when you’re going to cross in front of anybody’s car, you got to cross way in front of the car so that they can see you. My six year old, I could if she was right in front of the car, I couldn’t see her. And that always scares me to death. And I think about what happens when a higher degree or a higher proportion of the cars that we drive are larger. And so you have that reduced visibility above and beyond the fact that it’s just particularly comfortable and you can get lost in whatever activity it is that you are um pursuing, aside from driving the killer vehicle that you’re driving. I I wanted to ask you, as you think about automotive design, you talked about um being designed specifically to protect the folks inside the car, not outside the car. Has there been any attention paid to automotive design to protect potential pedestrians? 

Dr. Deborah Kuhls: Yes, there there has been. Certainly backup cameras. Um. There have been, um devices that are placed on cars that will detect another vehicle and and including a pedestrian. So there are some innovations in that area as well. And those are, those are great innovations. Um. And I think we, you know, applaud the industry for trying to make cars safer for people outside the cars as well as people inside the car. But um and I spoke more about those safety devices in the car previously, but those external that would detect someone like a pedestrian in dark clothing and so forth. Those are really great. It will take a number of years, though, when we look at how long people drive cars before they’re not drivable anymore and so forth. It’s going to take a period of time for those really to to take effect. And I would say that I haven’t looked at all the manufacturers and so forth. They may uh be optional on some vehicles. So I think our government has played a huge role in terms of either encouraging or actually mandating certain safety devices. So I think it’s really important that we look at that aspect. There are many other factors, right? One is also the design of of roads and roadways. And that’s a really specialized area of engineering. 

Dr. Abdul El-Sayed: I want to get to the roadways question. I want to ask you one more question about cars though. 

Dr. Deborah Kuhls: Sure. 

Dr. Abdul El-Sayed: And this has been a hot debate because there have been there has been this debate about self-driving cars. And once you enable what a self-driving car basically is, it is enabled with so many of these sensors that ostensibly this thing can drive itself. And there was a recent case with a pretty prominent company called Cruise, where there had been an accident and a woman was hit by actually a human driven car was flung underneath a self-driving car that then ended up dragging her a considerable distance. And there have been a number of ethical questions about how do you program a car in these uh situations where you got to choose between hitting a baby versus hitting an a group of adults? Like, how do you assess that? But one thing that is going to become clear is that these cars are going to become more and more effective. And there’s this nexus between almost I don’t think we’re going to go entirely self-driving as much as um as as much as techno optimists think we are. I think what’s going to happen is you’re going to have more and more of these tech enabled cars that will do things like automatically stop when they sense something that you may not sense. I want to ask you, you talked about government and the role that government and policy have in mandating this. As you think about this problem, now where do you stand on it on this question of of self-driving cars? Do you think that we could get to a point where they’re more more effective and safer over time? Do you think that there’s a role for government in mandating more and more of these tech specs that sort of augment the human driver? How are you thinking about it? 

Dr. Deborah Kuhls: So I would just say that that is not one of my strengths in terms of background. Uh. I do think that with not only the type of technology that we’re talking about, those signals, if you will, have to be interpreted. And artificial intelligence is a huge topic these days, and I think that can help to integrate the data. I would say in my own city, we’re starting to see self-driving like cabs and so forth, but it’s not something that I really have the background to truly evaluate. It does seem like for the foreseeable future that you would want human beings being able to intervene, if you will. And there there are so many factors, including you mentioned dragging, right? You would, when a human is driving a car, I would presume if they hit someone and that person is being dragged, it would cause some noise to be interpreted as what’s going on here? First of all, oh what was that impact? And I presumably didn’t see that person. Right. Um. And, and a number of relevant thoughts would go through our head, but I would just say that is a great question and a great question for the future. 

Dr. Abdul El-Sayed: Yeah. 

Dr. Deborah Kuhls: And I think our governing bodies, they really need to look at all, all of the data. But their overall the goal of our elected representatives, as well as those that are appointed by our elected representatives. Their duty is to protect the public. Right. And so I think that has to be a guiding force. I’m a physician. My guiding light is to help save lives. When I work as a physician, and when I look at traffic safety, my my physician lens is very much part of of looking at injury prevention. 

Dr. Abdul El-Sayed: Yeah, I appreciate that. You were beginning to talk about roads. Um. Tell us a little bit about some of the innovations in terms of designing roads to be safer for pedestrians. 

Dr. Deborah Kuhls: Clearly visible um crosswalks and visibility, even in terms of if a pedestrian is in a crosswalk. I live in, in an area that I’ve mentioned before, has really long blocks and really wide roads and fairly high speed limits, actually. Um. And if there is a pedestrian crossing, particularly where there isn’t uh a traffic light, um it’s very helpful as a driver to, to know by flashing lights there is a pedestrian in a crosswalk. And I think that’s been really helpful. And um, I’ve learned a lot from actually engineers um in this regard. And probably have a lot more to learn from them. But also in the middle of a very wide road to have what’s called a pedestrian refuge, a place that is and often it’s concrete or concrete, some other material that’s separates the the two different lanes going in opposite directions that it creates, like a refuge for them. If they can’t make it all the way across multiple lanes, which sometimes people with disabilities or are slow for any other reason, that if they can only make it halfway, they at least have a fairly safe refuge in the middle. But they’re not standing literally on the median strip or something like that. So those have helped. Um. There has been a little bit of research done, even on um types of substances that are used in road construction. And, and I trust our engineers and in that regard. But I think that’s an area of continued investigation. And I’m really grateful that we have people who totally specialize in those areas. And I think when we are starting to look at behaviors, the intersection of engineering and behaviors is is interesting as as well. 

Dr. Abdul El-Sayed: Yeah. 

Dr. Deborah Kuhls: That’s one of the one of the really important aspects of traffic crashes that I think we really need to understand. And we’ve made a real distinction in language between crashes and accidents. Um. Accidents, I think if we if we look up actually the definition of accidents, it’s like they’re unavoidable, they’re random occurrences and so forth. But the majority of crashes that happen in the US, and I would suspect in in other countries as well, um are related to a behavior, um and whether it’s driving under the influence of impairing substances. And that data has been very clear for a long time. So trauma centers, hospitals that actually routinely screen find that there are they’re positive for substances that potentially could impair the impair the driver in more than 50% of the cases. And I’ve been out of fellowship now for almost 24 years. And that was a fact when I was a fellow over two decades-

Dr. Abdul El-Sayed: Wow. 

Dr. Deborah Kuhls: –ago. And it continues and probably gets even more complex today. That’s that’s just one behavior. Speeding uh is we’re finding we’ve studied our citation data, and that’s one of the most common reasons for citations to be given by law enforcement. And speeding where you can potentially lose control of your vehicle, if you’re speeding if you see a pedestrian or some other vulnerable road user. Your time to respond to avoid a crash and injuring or killing a person is decreased, right? Because you’re going very fast. And if we couple that, then with speeding even more inappropriately let’s say in bad weather, you’re from Michigan. In Nevada we get so little rain that when we get rain, we have a lot of oil on the roads and the roads are very, very slippery. And we see increased motor vehicle crashes. 

Dr. Abdul El-Sayed: Yeah. 

Dr. Deborah Kuhls: So those are just some of the behaviors. And since Covid, we started to really notice this with Covid that what are considered aggressive drivers, that number has gone way up as well. And we all understand that Covid and sheltering in place and all of the other aspects of the Covid Covid pandemic that occurred caused a lot of frustration in people and often caused hardship, right? 

Dr. Abdul El-Sayed: Yeah. 

Dr. Deborah Kuhls: Many people weren’t able to work and so forth that we started to see more aggressive drivers, and that has not really abated. And it’s just like maybe when we’re at home and something is really bothering us, we would have the privacy, let’s say I don’t know I’m just going to use a dramatic example of screaming in your house, right? Um. 

Dr. Abdul El-Sayed: Mm hmm. We’ve all been there before. 

Dr. Deborah Kuhls: Somehow. Yes. And somehow I think when people get into their vehicles, they feel, again, it’s a private space that they can just the vehicle becomes an outlet for their frustration, and that often that turns into aggression. And that’s becoming a huge problem in traffic crashes. 

Dr. Abdul El-Sayed: So we talked about some of these driver level features, distraction being a big one. Uh. Aggression being one, speeding being another, being high or drunk, or under the influence in any way uh being another one. What are some of the things that um that you recommend to pedestrians, uh around being able to, to be safe um when, when they’re um using roadways? 

Dr. Deborah Kuhls: So for for pedestrians, I recommend they are always in a crosswalk and if possible, to make eye contact with the driver. And make sure that they feel safe that the driver actually sees them. Because in a lot of instances, that is really not the case and that they are not impaired in any way or distracted in any way. So not to have earbuds in, listening to music because they may miss someone tooting their horn at them, or other sounds that may indicate that they should be more cautious. And I would say also wearing clothing that can be easily seen. And if they’re going to be walking at dawn, dusk or dark that they should wear light colored colored clothing. And actually, given what I do, if if I needed to be a pedestrian on a regular bas– basis, I would also um have reflective some reflective gear um to make myself more, more visible. And I would be very cognizant of what the speed limit is in that particular area. Um. And just assume that people are generally going above the speed limit. So it’s one thing if you’re, let’s say, in a school zone where it’s 15 or 20 miles an hour, then it’s it should be known that cars would be traveling slower. Although that has been an issue as well, that many drivers, either they don’t see the school zone or they ignore it and they just continue going along at whatever the the speed is before and after. And just be aware of those. Um. And in terms of weather, just understand that in really bad weather that drivers may not be able to stop and to just be, I would say be overly cautious. And if I could speak to one other very related um, vulnerable users. I think that we have a lot of motorized carts, which are really great. They allow um people who are not able to to walk long distance to actually get out. Um. They get outside, they can, you know, travel um short distances and and so forth. But most of them are don’t really have reflective gear on them, for instance, so that they become more visible, and then they have to realize that they’re lower, right? So it may be more difficult to see them. So again, I would urge them to be really cautious. I would also actually advocate, um for um people who are normally pedestrians to be involved in their communities. And if they see a really unsafe environment to to engage with government and the legislature and advocate for themselves. 

Dr. Abdul El-Sayed: Yeah. 

Dr. Deborah Kuhls: Um. Because I don’t think they have uh as unified of an advocacy group as some other road users. 

Dr. Abdul El-Sayed: Yeah, that’s a really good point. I want to pick up on two points that you made. One was on these these new motorized vehicles you talked about, you talked about carts. But then there’s also these ubiquitous scooters. Um. And so they sort of occupy this, this interesting space where they do enable a certain kind of transit, which is really liberating, but at the same time can be really quite dangerous because they’re less than predictable. And um people don’t often uh use them in the most responsible way. And you’ll have one of these cutting really quickly into the road 20 miles an hour, which is a lot harder to adjust to than somebody walking at five to six. And uh that becomes really dangerous. And then too often folks aren’t wearing their helmets, even though they’re moving pretty quickly. The other point that’s important to bring up is around engineering. It’s not just how we engineer our roadways or our cars, it’s also how we engineer our whole societies. Um. The notion that we have such a paucity and limitation in mass transit, where, um so much is so driven by cars, the need to be in a car, or the exclusion from a car, um that creates a situation where you have uh this kind of interaction where pedestrians get hit. Um. We really appreciate you joining us today and and talking to us through some of the causes and consequences of pedestrian injury. Um. Our guest today was Dr. Deborah Kuhls. She’s a professor of surgery and chief of the section of critical care at the Krikorian School of Medicine at UNLV’s Division of Acute Care Surgery. And she’s also program director at the Kerkorian School of Medicine Surgical critical care fellowship program. And finally, she’s also the medical director of the University Medical Center’s trauma intensive care unit. Dr. Kuhls, we really appreciate you joining us and sharing your wisdom and all the work you do to save lives in these circumstances. 

Dr. Deborah Kuhls: It’s been a pleasure, and I really hope that the people who are listening take, take this information to heart to be safer. 

Dr. Abdul El-Sayed: Well. Thank you. We appreciate you sharing it. 

Dr. Abdul El-Sayed, narrating: As usual, here’s what I’m watching right now. 

[clip of unspecified British news reporter] We’ve received breaking news from Buckingham Palace, which has announced that the King has been diagnosed with cancer. 

Dr. Abdul El-Sayed: The Royal Palace announced that King Charles, 75, was diagnosed with an unspecified cancer last week. He’d been pursuing treatment for an enlarged prostate when the cancer, which is not prostate, was identified. He’ll pause his public events as he pursues treatment. This show is called America Dissected. So why am I talking about a British monarch? Well, because the show is about health and society, and I want to give credit where credit’s due. One of the biggest challenges we talk about regularly on the show, either indirectly or directly, is stigma. And too often, stigma keeps folks from getting the care that they need. Prostate care? Yeah, that’s not high on the list for almost anyone. If you don’t know why, just Google prostate exam. Okay, maybe don’t do that. Suffice it to say that King Charles being public about his health experience creates a permission structure. It normalizes getting the care you need when you need it and that matters. A new study in the journal Jama Internal Medicine is highlighting the broad impact of police murders of unarmed Black people. There’s no doubt that the consequences of these murders hit victims’ families hardest, but the impact it goes deep and broad. The study assessed the sleep quality of Black folks compared to others in communities affected by police murders of unarmed Black folks. And they found a significant reduction in sleep quality among Black folks, but not others. The probability of short sleep was about 50% higher in the 90 days following an event. I share this because it’s way too easy to assume that the impact of police violence are limited to people it directly effects. The study shows that that’s just not true. It affects whole communities. If it doesn’t rob folks of their lives, it robs them of so much else, including their sleep. Ask yourself what else it might do. After all, quality of sleep itself is associated with everything from heart disease to automobile accidents. But even beyond the downstream impacts of sleep. Ask yourself about the even broader impact of the stress and anxiety that may be robbing folks of it in the first place. It’s a reminder that health really is collective. Finally, scientists may have cracked the code over why women are up to four times as likely to suffer autoimmune disorders as men. In a paper published in the journal Cell last week, scientists identified a particular molecule that may be to blame. Biological females have two X, females have two X chromosomes, compared to biological males who have an X and a Y chromosome. You could imagine that with two X chromosomes, you might have two times as much of the protein material that’s encoded on the X chromosome, which you would, except for a molecule called Xist, which serves to inactivate one of the X chromosomes. The challenge, though, is that it may also be generating complex molecules that may trigger an immune response. It’s not a perfect correlation. Biological males still do, after all, have autoimmune disorders like type one diabetes, which is an autoimmune reaction against the cells that make insulin in the pancreas. And it’s more common in men. But this discovery may help unlock more information about how autoimmune disorders develop and how to prevent them or treat them. That’s it for today. On your way out, don’t forget to rate and review. It really does go a long way. Also, if you love the show and want to rep us, do drop by the Crooked store for some America Dissected merch. And don’t forget to follow us at @CrookedMedia and me @AbdulElSayed no dash on IG, TikTok, and Twitter. [music break] America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producers are Tara Terpstra and Emma Illick-Frank. Charlotte Landes mixes and masters the show. Production support from Ari Schwartz. Our theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Leo Duran and me. Doctor Abdul El-Sayed, your host. Thanks for listening. [music break] This show is for general information and entertainment purposes only. It’s not intended provide specific health care or medical advice, and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the views and opinions of Wayne County, Michigan, or its Department of Health, Human, and Veteran Services.