Epidemiology of whiplash
- LES BARNSLEY, Senior Lecturer in Rheumatology
- University of Sydney
- Department of Rheumatology
- Concord Hospital
- Concord NSW 2139
- Email: email@example.com
Space restrictions prohibit a comprehensive refutation of the uneven treatment of the whiplash literature presented by Ferrari and Russell.1 They fiercely interrogate research that does not support their view, yet uncritically embrace literature favouring their preconceptions. Central to their argument is the assertion that there are different rates of chronic whiplash in different countries, and that “chronic injury related damage cannot account for the wide differences”.
A valid comparison between the prevalence of any condition in two places would require that it is measured in the same way. Balla's study comparing Singapore and Australia was little more than anecdotal from interviews of selected Singaporean doctors compared with the data from Australia.2 Such data may be fatally corrupted by recall, case selection, sampling, and expectation bias.
Caution should be observed in comparing insurance claim rates between countries. There is no international consistency in notification of accidents or insurance or compensation procedures. Conclusions drawn from such comparisons3 are unsustainable and subject to the ecological fallacy. The frailty of using insurance claims as a surrogate for the incidence of injury does not seem to have been considered by Ferrari and Russell. A claim is a behaviour arising from a combination of motivation, enabling circumstances, perceived benefits, costs, social norms, peer and family pressure, and fear of current or future pain and disability—all factors extraneous to the injury itself. The Victorian experience in Australia is particularly pertinent. Fewer claims for whiplash were noted after the introduction of legislation creating bureaucratic barriers, disincentives, and up-front costs for potential claimants. Some then concluded that whiplash is a behaviour and not an injury.4 A more sober view is that if it is harder to make a claim, fewer people will make one. To extrapolate beyond this is unjustifiable: the apparent change in incidence …