Charles and Barry Pless argue that, with a quarter of crashes in the United States now attributed to mobile phone use, "we can't wait for perfect evidence before acting."
Although there is still some uncertainty about the association between mobile phone use and risk of crashes, given the proliferation of mobile phones, the prevalence of distracted driving is undoubtedly increasing, they write.
Texting is the riskiest activity because the distraction is cognitive and visual, they explain. Handheld phone use (particularly when making or receiving calls) comes next, and hands-free use is probably the least dangerous.
Convincing causal associations are notoriously difficult to determine, particularly in this area, they say. However, physicians and policy makers "must often make decisions and act before they have solid proof."
They therefore decided to proceed by taking as "given" that the risk was "causal, substantial, and likely to grow unless more successful preventive measures are introduced."
They discuss possible interventions, such as education, legislation and technology, but point out that evidence supporting the effectiveness of education and legislation is inconsistent.
They believe the most promising solution to distracted driving caused by the mobile phone may be more technology. For example, software that prevents texting while driving or a signal jamming key that prevents mobile phone reception when the ignition is engaged.
"Ultimately, a technical solution is needed that blocks texting and conversations by drivers while permitting passengers to use their phones as they wish," they write. Until nudging works fully, they suggest regulatory bodies "must be instructed to incorporate the best available technological preventive measures into all new mobile phones and cars."
They recall the long delay between the first scientific evidence and the public's recognition that drunk driving is unacceptable, and say "we cannot accept such a long process in the case of distracted driving."
Studies must continue, but ... "we cannot always wait for perfect evidence to act. Doing nothing, or avoiding the tough options, can have disastrous consequences," they conclude.
- C. Pless, B. Pless. Mobile phones and driving. BMJ, 2014; 348 (feb04 5): g1193 DOI: 10.1136/bmj.g1193
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