My daughter asked me about seatbelts last week. We were talking about car seats and booster seats – whether she still needed one, what made one different from the other – and at some point she asked why some countries make people wear seatbelts and others don't. She'd noticed it when we were travelling. She knew seatbelts were for safety but what she couldn't work out was why other countries wouldn't need that same safety.
I told her different countries have different rules based on what they see as safe. A bit like how different families have different rules about what's okay and what isn't.
What I said was true, on some level. But the underlying question is who decided what counts as safe?
Whose body counted
The Hybrid III 50th percentile male crash test dummy has been the primary reference body for car safety testing since 1976. He's 5'9" and weighs 171 lbs. He sits in the driver's seat in nearly all the starred safety-rating tests you see when you're shopping for a car. He was modelled on the average North American man at the time he was developed, though he hasn't been updated since, and the average North American man today is about 30 lbs heavier than he is.
A female crash test dummy does exist. She was developed in 1988 – twelve years after her male counterpart – and added to U.S. federal safety regulations in 2000. But she isn't built from female anatomy. She's a scaled-down version of the male dummy, with the same body shape, just smaller. The project manuals describe her as "a scaled-down male wearing a rubber jacket with breasts." Even now, for the front-impact safety ratings most consumers see when comparing cars, she sits in the passenger seat. The driver's seat still belongs to him.
Another one of these
I knew the medical version of this pattern from my training. Women were formally excluded from most clinical trials in the United States until 1993. The original reasoning had to do with protecting potential pregnancies after a particular drug-trial crisis, which was a fair concern at the time. But the outcome was that for decades, the data establishing what counts as an "effective dose" of most medications came from male bodies. The dose was tested on them, and then it was applied to everyone.
Documented metabolic differences between male and female bodies exist for a long list of common drugs: sleeping pills, antihistamines, aspirin, anesthesia, opioids. A 2001 U.S. Government Accountability Office report found that eight of the ten prescription drugs withdrawn from the U.S. market between 1997 and 2000 posed greater health risks for women than for men.
When I came across the crash test dummy story, what surprised me was how unsurprising it was.
I've worked around the medication version for most of my career, because inside the system as it's currently built there isn't really an alternative. The effective dose is what it is. I can watch for side effects in smaller patients, flag responses that don't track, talk about the dose ranges that exist for some medications. But I can't redose the medical field. Most of the time the job is to pay close attention to the patient in front of you and notice where the standard dose might not fit them.
None of this is an indictment of the engineers who designed the Hybrid III in 1976 or the researchers who set early drug doses. They were working with the bodies they had data on, and inside regulations that didn't include the bodies they didn't.
My daughter is six. She doesn’t even know about crash test dummies yet. She'll grow up inside the same systems I did, and at any given moment the cost of any one of these defaults isn't huge. I'm not going to change her seatbelt.
But what she was asking, in her six-year-old way, was what "safe" actually means. The more honest answer is that it depends on whose body the definition was built around, and whether anyone has gone back to check.
A Thought To Carry Forward:
The word 'standard' often tells you nothing about whose body it was built around