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Driving With Parkinson’s: A Public Safety Hazard?
The automobile is a powerful icon in Western society. It has become essential to our independent activities, both social and economic. The entire structure of a community is often built around the car. Not only is auto travel essential in many communities to such daily activities as grocery shopping and getting medical care, but through advertising it has become a symbol for youth and vigor. No wonder those of us with medically debilitating conditions want to maintain our driving privileges for as long as possible!
Problems with driving that are caused by the symptoms of PD and the effects of medications increase as the disease advances. Motor symptoms, visual and perceptual problems, and the side effects of medications (such as the “sleep attacks” attributed to some dopamine agonists) can make the driving experience dangerous. And the danger is not just for us, the people with Parkinson’s, but also for our passengers and other drivers. For some PWPs, the dangers of driving are further exacerbated by psychiatric problems, delays in making up our minds, and dementia.
While it is clear that driving sooner or later becomes a problem for most PWPs, a question remains: is driving by PWPs a public safety hazard? This was the question posed at a recent National Transportation Safety Board hearing entitled “Medical Oversight of Chronic Debilitating Conditions”.
The Washington hearing was held following an anecdotal review of a several multi-vehicle accidents that resulted in fatalities to innocent adults and children as well as to drivers. The objective was to examine public policy issues involving law enforcement, medical care, and public education for drivers with chronic medical conditions.
I attended the hearing as a “party member”, one of those representing a group of interested individuals. We were allowed to question the witnesses who presented information as part a panel presentation and discussion of the issues. Our “party” included representatives of various disease groups. Other parties included a consumer safety advocacy party and some Federal and state agencies.
PD, of course, is not the only medical condition in the spotlight, and as it turns out, not the one that raises the greatest concern for public safety. By far the biggest problem is alcoholism. One emergency-room physician told us that no day goes by without her treating victims of a crash involving a drunk driver. Other medical conditions also considered in the hearing included Alzheimer’s, epilepsy, sleep apnea, and diabetes (which causes sudden uncontrollable loss of consciousness). One questioner asked – not entirely facetiously - if an elevated testosterone level in teen-aged boys was considered to be a debilitating medical condition.
My own questions to panel members focused on what evidence there was of safety problems involving PD drivers.
I did not receive very clear answers. Because record keeping for Parkinson’s-related accidents is difficult, precise data on numbers and proportions of accidents involving PWPs is hard to come by. Wisconsin was the one state represented at the hearing for which PD-related information was available. The Wisconsin witness told us that five accidents out of 35,000 crashes (one in 7,000) each year were PD related. This ration is clearly well below the estimated prevalence of PD in the adult population.
I was pleased that the key government officials came away with the same conclusion as I did. Probably thanks to the self-awareness and self-regulation among PWPs themselves, PD is not a safety hazard per se. It would appear that the question of whether or not to continue driving is a matter appropriately left to the judgment of each of us PWPs, and the judgment of ourselves and our families.
Perry Cohen, Ph.D., is a consultant for PDF in therapeutics development and other patient-orientated issues.