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Once upon a time, there was a dread disease that afflicted children.

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And in fact, among all the diseases that existed in this land,

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it was the worst. It killed the most children.

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And along came a brilliant inventor, a scientist,

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who came up with a partial cure for that disease.

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And it wasn't perfect. Many children still died,

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but it was certainly better than what they had before.

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And one of the good things about this cure was that it was free,

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virtually free, and was very easy to use.

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But the worst thing about it was that you couldn't use it

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on the youngest children, on infants, and on one-year-olds.

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And so, as a consequence, a few years later,

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another scientist -- perhaps maybe this scientist

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not quite as brilliant as the one who had preceded him,

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but building on the invention of the first one --

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came up with a second cure.

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And the beauty of the second cure for this disease

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was that it could be used on infants and one-year-olds.

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And the problem with this cure was it was very expensive,

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and it was very complicated to use.

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And although parents tried as hard as they could to use it properly,

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almost all of them ended up using it wrong in the end.

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But what they did, of course, since it was so complicated and expensive,

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they only used it on the zero-year-olds and the one-year-olds.

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And they kept on using the existing cure that they had

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on the two-year-olds and up.

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And this went on for quite some time. People were happy.

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They had their two cures. Until a particular mother,

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whose child had just turned two, died of this disease.

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And she thought to herself, "My child just turned two,

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and until the child turned two, I had always used

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this complicated, expensive cure, you know, this treatment.

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And then the child turned two, and I started using

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the cheap and easy treatment, and I wonder" --

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and she wondered, like all parents who lose children wonder --

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"if there isn't something that I could have done,

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like keep on using that complicated, expensive cure."

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And she told all the other people, and she said,

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"How could it possibly be that something

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that's cheap and simple works as well as something

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that's complicated and expensive?"

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And the people thought, "You know, you're right.

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It probably is the wrong thing to do to switch

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and use the cheap and simple solution."

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And the government, they heard her story and the other people,

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and they said, "Yeah, you're right, we should make a law.

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We should outlaw this cheap and simple treatment

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and not let anybody use this on their children."

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And the people were happy. They were satisfied.

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For many years this went along, and everything was fine.

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But then along came a lowly economist, who had children himself,

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and he used the expensive and complicated treatment.

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But he knew about the cheap and simple one.

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And he thought about it, and the expensive one

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didn't seem that great to him. So he thought,

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"I don't know anything about science, but I do know something about data,

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so maybe I should go and look at the data

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and see whether this expensive and complicated treatment

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actually works any better than the cheap and simple one."

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And lo and behold, when he went through the data,

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he found that it didn't look like the expensive, complicated

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solution was any better than the cheap one,

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at least for the children who were two and older --

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the cheap one still didn't work on the kids who were younger.

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And so, he went forth to the people and he said,

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"I've made this wonderful finding:

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it looks as if we could just use the cheap and simple solution,

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and by doing so we could save ourselves 300 million dollars a year,

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and we could spend that on our children in other ways."

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And the parents were very unhappy, and they said,

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"This is a terrible thing, because how can the cheap and easy thing

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be as good as the hard thing?" And the government was very upset.

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And in particular, the people who made this expensive solution

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were very upset because they thought,

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"How can we hope to compete with something that's essentially free?

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We would lose all of our market."

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And people were very angry, and they called him horrible names.

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And he decided that maybe he should leave the country

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for a few days, and seek out some more intelligent,

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open-minded people in a place called Oxford,

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and come and try and tell the story at that place.

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And so, anyway, here I am. It's not a fairy tale.

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It's a true story about the United States today,

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and the disease I'm referring to is actually

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motor vehicle accidents for children.

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And the free cure is adult seatbelts, and the expensive cure --

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the 300-million-dollar-a-year cure -- is child car seats.

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And what I'd like to talk to you about today

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is some of the evidence why I believe this to be true:

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that for children two years old and up,

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there really is no real benefit -- proven benefit -- of car seats,

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in spite of the incredible energy

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that has been devoted toward expanding the laws

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and making it socially unacceptable

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to put your children into seatbelts. And then talk about why --

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what is it that makes that true?

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And then, finally talk a little bit about a third way,

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about another technology, which is probably better than anything we have,

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but which -- there hasn't been any enthusiasm for adoption

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precisely because people are so enamored

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with the current car seat solution. OK.

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So, many times when you try to do research on data,

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it records complicated stories -- it's hard to find in the data.

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It doesn't turn out to be the case when you look at seatbelts versus car seats.

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So the United States keeps a data set

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of every fatal accident that's happened since 1975.

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So in every car crash in which at least one person dies,

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they have information on all of the people.

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So if you look at that data -- it's right up on the National Highway

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Transportation Safety Administration's website --

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you can just look at the raw data,

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and begin to get a sense of the limited amount of evidence

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that's in favor of car seats for children aged two and up.

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So, here is the data. Here I have, among two- to six-year-olds --

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anyone above six, basically no one uses car seats,

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so you can't compare -- 29.3 percent of the children who are unrestrained

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in a crash in which at least one person dies, themselves die.

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If you put a child in a car seat, 18.2 percent of the children die.

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If they're wearing a lap-and-shoulder belt, in this raw data,

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19.4 percent die. And interestingly, wearing a lap-only seatbelt,

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16.7 percent die. And actually, the theory tells you

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that the lap-only seatbelt's got to be worse

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than the lap-and-shoulder belt. And that just reminds you

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that when you deal with raw data, there are hundreds

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of confounding variables that may be getting in the way.

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So what we do in the study is -- and this is just presenting

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the same information, but turned into a figure to make it easier.

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So the yellow bar represents car seats,

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the orange bar lap-and-shoulder, and the red bar lap-only seatbelts.

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And this is all relative to unrestrained --

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the bigger the bar, the better. Okay.

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So, this is the data I just showed, OK?

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So the highest bar is what you're striving to beat.

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So you can control for the basic things, like how hard the crash was,

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what seat the child was sitting in, etc., the age of the child.

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And that's that middle set of bars.

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And so, you can see that the lap-only seatbelts

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start to look worse once you do that.

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And then finally, the last set of bars,

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which are really controlling for everything

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you could possibly imagine about the crash,

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50, 75, 100 different characteristics of the crash.

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And what you find is that the car seats and the lap-and-shoulder belts,

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when it comes to saving lives, fatalities look exactly identical.

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And the standard error bands are relatively small around these estimates as well.

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And it's not just overall. It's very robust

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to anything you want to look at.

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One thing that's interesting: if you look at frontal-impact crashes --

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when the car crashes, the front hits into something --

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indeed, what you see is that the car seats look a little bit better.

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And I think this isn't just chance.

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In order to have the car seat approved,

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you need to pass certain federal standards,

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all of which involve slamming your car into a direct frontal crash.

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But when you look at other types of crashes, like rear-impact crashes,

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indeed, the car seats don't perform as well.

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And I think that's because they've been optimized to pass,

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as we always expect people to do,

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to optimize relative to bright-line rules

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about how affected the car will be.

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And the other thing you might argue is,

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"Well, car seats have got a lot better over time.

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And so if we look at recent crashes --

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the whole data set is almost 30 years' worth of data --

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you won't see it in the recent crashes. The new car seats are far, far better."

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But indeed, in recent crashes the lap-and-shoulder seatbelts,

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actually, are doing even better than the car seats.

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They say, "Well, that's impossible, that can't be."

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And the line of argument, if you ask parents, is,

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"But car seats are so expensive and complicated,

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and they have this big tangle of latches,

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how could they possibly not work better than seatbelts

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because they are so expensive and complicated?"

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It's kind of an interesting logic,

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I think, that people use. And the other logic, they say,

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"Well, the government wouldn't have told us [to] use them

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if they weren't much better."

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But what's interesting is the government telling us to use them

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is not actually based on very much.

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It really is based on some impassioned pleas of parents

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whose children died after they turned two,

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which has led to the passage of all these laws -- not very much on data.

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So you can only get so far, I think, in telling your story

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by using these abstract statistics.

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And so I had some friends over to dinner, and I was asking --

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we had a cookout -- I was asking them what advice they might have for me

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about proving my point. They said, "Why don't you run some crash tests?"

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And I said, "That's a great idea."

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So we actually tried to commission some crash tests.

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And it turns out that as we called around to the independent

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crash test companies around the country,

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none of them wanted to do our crash test

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because they said, some explicitly, some not so explicitly,

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"All of our business comes from car seat manufacturers.

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We can't risk alienating them by testing seatbelts relative to car seats."

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Now, eventually, one did. Under the conditions of anonymity,

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they said they would be happy to do this test for us --

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so anonymity, and 1,500 dollars per seat that we crashed.

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And so, we went to Buffalo, New York,

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and here is the precursor to it.

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These are the crash test dummies,

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waiting for their chance to take the center stage.

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And then, here's how the crash test works.

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Here, they don't actually crash the entire car, you know --

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it's not worth ruining a whole car to do it.

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So they just have these bench seats,

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and they strap the car seat and the seatbelt onto it.

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So I just wanted you to look at this.

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And I think this gives you a good idea of why parents think

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car seats are so great. Look at the kid in the car seat.

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Does he not look content, ready to go,

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like he could survive anything? And then, if you look at the kid in back,

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it looks like he's already choking before the crash even happens.

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It's hard to believe, when you look at this, that

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that kid in back is going to do very well when you get in a crash.

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So this is going to be a crash

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where they're going to slam this thing forward into a wall

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at 30 miles an hour, and see what happens. OK?

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So, let me show you what happens.

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These are three-year-old dummies, by the way.

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So here -- this is the car seat. Now watch two things:

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watch how the head goes forward,

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and basically hits the knees -- and this is in the car seat --

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and watch how the car seat flies around, in the rebound, up in the air.

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The car seat's moving all over the place.

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Bear in mind there are two things about this.

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This is a car seat that was installed by someone

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who has installed 1,000 car seats, who knew exactly how to do it.

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And also it turned out these bench seats

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are the very best way to install car seats.

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Having a flat back makes it much easier to install them.

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And so this is a test that's very much rigged in favor of the car seat,

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OK? So, that kid in this crash fared very well.

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The federal standards are

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that you have to score below a 1,000

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to be an approved car seat on this crash,

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in some metric of units which are not important.

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And this crash would have been about a 450.

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So this car seat was actually an above-average car seat

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from Consumer Reports, and did quite well.

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So the next one. Now, this is the kid, same crash,

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who is in the seatbelt. He hardly moves at all, actually,

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relative to the other child. The funny thing is,

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the cam work is terrible because they've only set it up

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to do the car seats, and so, they actually don't even have a way

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to move the camera so you can see the kid that's on the rebound.

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Anyway, it turns out that those two crashes, that actually

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the three-year-old did slightly worse. So, he gets about a 500

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out of -- you know, on this range -- relative to a 400 and something.

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But still, if you just took that data from that crash

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to the federal government, and said, "I have invented a new car seat.

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I would like you to approve it for selling,"

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then they would say, "This is a fantastic new car seat, it works great.

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It only got a 500, it could have gotten as high up as a 1,000."

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And this seatbelt would have passed with flying colors

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into being approved as a car seat.

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So, in some sense, what this is suggesting

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is that it's not just that people are setting up their car seats wrong,

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which is putting children at risk. It's just that, fundamentally,

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the car seats aren't doing much.

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So here's the crash. So these are timed at the same time,

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so you can see that it takes much longer with the car seat --

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at rebound, it takes a lot longer --

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but there's just a lot less movement for child who's in the seatbelt.

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So, I'll show you the six-year-old crashes as well.

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The six-year-old is in a car seat, and it turns out

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that looks terrible, but that's great. That's like a 400, OK?

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So that kid would do fine in the crash.

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Nothing about that would have been problematic to the child at all.

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And then here's the six-year-old in the seatbelt,

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and in fact, they get exactly within, you know,

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within one or two points of the same. So really, for the six-year-old,

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the car seat did absolutely nothing whatsoever.

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That's some more evidence, so in some sense --

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I was criticized by a scientist, who said, "You could never publish

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a study with an n of 4," meaning those four crashes.

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So I wrote him back and I said, "What about an n of 45,004?"

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Because I had the other 45,000 other real-world crashes.

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And I just think that it's interesting that the idea

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of using real-world crashes, which is very much something

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that economists think would be the right thing to do,

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is something that scientists don't actually, usually think --

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they would rather use a laboratory,

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a very imperfect science of looking at the dummies,

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than actually 30 years of data of what we've seen

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with children and with car seats.

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And so I think the answer to this puzzle

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is that there's a much better solution out there,

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that's gotten nobody excited because everyone

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is so delighted with the way car seats are presumably working.

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And if you think from a design perspective,

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about going back to square one, and say,

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"I just want to protect kids in the back seat."

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I don't there's anyone in this room who'd say,

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"Well, the right way to start would be,

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let's make a great seat belt for adults.

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And then, let's make this really big contraption

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that you have to rig up to it in this daisy chain."

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I mean, why not start -- who's sitting in the back seat anyway except for kids?

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But essentially, do something like this,

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which I don't know exactly how much it would cost to do,

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but there's no reason I could see

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why this should be much more expensive than a regular car seat.

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It's just actually -- you see, this is folding up -- it's behind the seat.

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You've got a regular seat for adults, and then you fold it down,

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and the kid sits on top, and it's integrated.

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It seems to me that this can't be a very expensive solution,

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and it's got to work better than what we already have.

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So the question is, is there any hope for adoption of something like this,

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which would presumably save a lot of lives?

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And I think the answer, perhaps, lies in a story.

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The answer both to why has a car seat been so successful,

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and why this may someday be adopted or not,

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lies in a story that my dad told me, relating to when he was a doctor

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in the U.S. Air Force in England. And this is a long time ago:

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you were allowed to do things then you can't do today.

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So, my father would have patients come in

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who he thought were not really sick.

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And he had a big jar full of placebo pills that he would give them,

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and he'd say, "Come back in a week, if you still feel lousy."

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OK, and most of them would not come back,

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but some of them would come back.

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And when they came back, he, still convinced they were not sick,

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had another jar of pills. In this jar were huge horse pills.

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They were almost impossible to swallow.

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And these, to me, are the analogy for the car seats.

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People would look at these and say, "Man, this thing is so big

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and so hard to swallow. If this doesn't make me feel better,

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you know, what possibly could?"

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And it turned out that most people wouldn't come back,

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because it worked. But every once in a while,

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there was still a patient convinced that he was sick,

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and he'd come back. And my dad had a third jar of pills.

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And the jar of pills he had, he said,

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were the tiniest little pills he could find,

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so small you could barely see them.

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And he would say, listen, I know I gave you that huge pill,

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that complicated, hard-to-swallow pill before,

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but now I've got one that's so potent,

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that is really tiny and small and almost invisible.

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It's almost like this thing here, which you can't even see."

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And it turned out that never,

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in all the times my dad gave out this pill, the really tiny pill,

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did anyone ever come back still complaining of sickness.

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So, my dad always took that as evidence

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that this little, teeny, powerful pill

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had the ultimate placebo effect. And in some sense, if that's the right story,

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I think integrated car seats you will see, very quickly,

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becoming something that everyone has. The other possible conclusion

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is, well, maybe after coming to my father three times,

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getting sent home with placebos, he still felt sick,

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he went and found another doctor.

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And that's completely possible. And if that's the case,

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then I think we're stuck with conventional car seats for a long time to come.

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Thank you very much.

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(Applause)

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(Audience: I just wanted to ask you, when we wear seatbelts

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we don't necessarily wear them just to prevent loss of life,

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it's also to prevent lots of serious injury.

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Your data looks at fatalities. It doesn't look at serious injury.

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Is there any data to show that child seats

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are actually less effective, or just as effective as seatbelts

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for serious injury? Because that would prove your case.)

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Steven Levitt: Yeah, that's a great question. In my data, and in another data set

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I've looked at for New Jersey crashes,

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I find very small differences in injury.

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So in this data, it's statistically insignificant differences

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in injury between car seats and lap-and-shoulder belts.

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In the New Jersey data, which is different,

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because it's not just fatal crashes,

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but all crashes in New Jersey that are reported,

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it turns out that there is a 10 percent difference in injuries,

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but generally they're the minor injuries.

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Now, what's interesting, I should say this as a disclaimer,

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there is medical literature that is very difficult to resolve with this other data,

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which suggests that car seats are dramatically better.

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And they use a completely different methodology that involves --

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after the crash occurs, they get from the insurance companies

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the names of the people who were in the crash,

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and they call them on the phone,

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and they asked them what happened.

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And I really can't resolve, yet,

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and I'd like to work with these medical researchers

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to try to understand how there can be these differences,

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which are completely at odds with one another.

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But it's obviously a critical question.

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The question is even if -- are there enough serious injuries

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to make these cost-effective? It's kind of tricky.

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Even if they're right, it's not so clear

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that they're so cost-effective.