Do we have a morbid preoccupation with cycling danger?

4517967520_9a62baff89An insightful letter published in the British Medical Journal makes the point that we have a morbid preoccupation with cycle danger and that the British Medical Association support of compulsory helmets was based on a “single isolated study in unusual circumstances.”

Transport & Health Study Group said in its letter:

“For many years the British Medical Association opposed compulsory cycle helmets on the basis that they would reduce rates of cycling. It only changed this policy as a result of the Ontario study. Apart from this single isolated study in unusual circumstances (high rates of voluntary wearing and no enforcement of the law) all studies of the effects of cycle helmet legislation show that the rates of cycling fall. The serious doubts about the study raised by this new work must surely raise questions about whether the BMA should continue with this policy.

The BMA already says that legislation should only be introduced when rates of helmet-wearing are already high, as they were in Ontario, but this nuance is not widely recognised”

The letter — which can be read in full here, under the second headline — outlines how when you compare local bicycle and car journeys it is safer to cycle in England than to drive in France.

The authors end by saying “Whilst there are risks to cyclists that can and should be reduced it is time for us to also to consider the deaths that are caused by a morbid preoccupation with cycle danger.”

The letter follows a recent article in the BMJ written jointly by Bad Science author and academic Ben Goldacre and risk statistician David Spiegelhalter. They said:

“The enduring popularity of helmets as a proposed major intervention for increased road safety may therefore lie not with their direct benefits—which seem too modest to capture compared with other strategies—but more with the cultural, psychological, and political aspects of popular debate around risk.”

Meanwhile in the US the federal government has been forced to stop using the claim that helmets prevent 85% of head injuries. Cyclehelmets.org writes:

“US federal agencies The National Highway Traffic Safety Administration (NHTSA) and the Centers for Disease Control (CDC) have decided that they can no longer justify citing the claim that bicycle helmets reduce the risk of head injury by 85%. No subsequent research has ever found a benefit anywhere near as great.

The agencies had been challenged under the Data Quality Act to show why they still continued to cite the earlier estimate, which is often seized upon to exaggerate the potential benefits of helmets and to support helmet laws.”

A road.cc article also point to a possible explanation why helmet laws have been found my many studies to be ineffective. It quoted a Norwegian study which said:

“With all the limitations that have to be placed on a cross sectional study such as this, the results indicate that at least part of the reason why helmet laws do not appear to be beneficial is that they disproportionately discourage the safest cyclists.”

The Norwegian research shows a weak case for helmets and the authors outlined how its findings are “inconsistent” a Cochrane review — such reviews are usually widely viewed as usually trusted in medical circles, but the Norwegian authors said the “study inclusion criteria applied in the Cochrane review are debatable” and point to a [undeclared] conflict of interest in the Cochrane review.

5 Comments

  1. I would leave this little poser to consider: If you are struck, if you skid and loose control or generally fall off your bike and bang your head off the road, do you think that you would be (a) more or (b) less likely to suffer injuries?

    I hit a patch of black ice on a road in Blackrock (Dublin) two years ago and thank my lucky stars that I always wear a helmet. I was shook up but generally uninjured.

    I hit a pothole on the Leopardstown Road Twenty years ago and suffered a black eye, bruising to my ear and a gash on the side of my head that required 4 stitches. I always wear a helmet.

    Compulsory helmet wearing may need more study, but for me it just makes sense. Any parent that sends their kids out on Irish road without a helmet should reconsider this decision.

  2. I would tend to agree with John – but I’m equally sure that the compulsory wearing of helmets would signal the death knell of the Dublin bikes initiative. Already, I have no doubt (without empirical evidence) that tourists who avail of the bike hire in Dublin are unlikely to be fully compliant with the normal rules of the road – or, indeed, have the same cycle skills as a regular commuter. I make this observation based on my experience of cycling in Vienna, which has a very high compliance rate. Most breaking of lights, ignoring of pedestrian crossing and other misdemeanours are by those on the Citybikes or by groups on other rental machines.

  3. “If you are struck … and bang your head [in an event not involving a bicycle], do you think that you would be (a) more or (b) less likely to suffer injuries?”

    Can you think of any circumstances of acquiring such an injury which don’t involve bicycles? In case you can’t, here are some major ones (from Wikipedia):
    32% of traumatic brain injuries (another, more specific, term for head injuries) are caused by falls,
    10% by assaults,
    16.5% by being struck or against something,
    17% by motor vehicle accidents,
    21% by other/unknown ways

    For how many of these circumstances do you advise wearing some kind of protective headgear?

    Remember that riding a bike is not unusually productive of head injuries.

  4. For anyone interested in further research in the Helmet/No Helmet debate, the following web address may prove useful: http://www.webmd.com/fitness-exercise/guide/head-injuries-causes-and-treatments particularly in relation to child safety. Parents of young children, especially boys will find it frightening.

    I work in the Safety/Construction arena where the use of Personal Protective Equipment (PPE) is the common sense, when all else fails, final line of defence against injury. In most cases it’s use is mandatory. Failure to follow the rules can lead to death and injury. Failure to comply with the law in this matter can lead to loss of employment and/or prosecution.

    It is not always practical or even advisable to wear PPE during a whole range of other activities. In some cases the wearing of PPE can inhibit safety. There is an on going debate as to the effectiveness of head gear for boxing, but the use of helmets for abseiling, rock climbing, canoeing and the like is a good idea. Anyone involved in rally driving would probably be aghast at the idea of competing without a helmet, and the rest of the protective equipment. All in all, it’s “horses for courses” and there is no one size fits all solution.

    Unfortunately 54 people lost their lives in construction in Ireland in 2011. There were over 1.3 million work days lost in 2010 due to illness and injury in Ireland. I have no doubt that the use of PPE and proper planning could have reduced this. I am equally confident the absence of PPE, such as Helmets, Hi-Vis Vests etc. would have led to a greater number of injuries and loss of life.

    I’ll continue to use a helmet for cycling and actively encourage others to do so as well. I am not sure about making it mandatory, but anyone who sends a child out onto Irish roads on a bike without a helmet should consider what they are risking. A brain injury isn’t just for Christmas……..

    Instead of looking for reasons not to wear a helmet, what is the problem with wearing one?

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