COMMENT & ANALYSIS: Helmets are clearly an emotive subject and the debate on helmets stirs up misunderstandings on both sides — IrishCycle.com has to stress that its position is based around being against the State promoting helmets, individuals should do what they feel is best for them.
For the record: I have never intended “shaming people who want to” wear helmet. This website’s most-read article on helmets — 6 reasons bicycle helmets shouldn’t be any government’s policy — is focused on Government policy, not individuals’ action.
But if, in a wider debate about the policy of helmets, you interject with personal experience of “a helmet saved my life” or a similar line, you’re probably going to be linked to this British Medical Journal (BMJ) article. The article includes the line: “Supporters of helmets often tell vivid stories about someone they knew, or heard of, who was apparently saved from severe head injury by a helmet.”
Please don’t take this personally and please don’t see it as me telling you what to do — if you enter a policy discussion or what I perceived (rightly or wrongly) to be a policy discussion, I’m going to be talking about policy. I’m truly sorry if you think I’m talking about your personal usage of helmets, I’m not.
I’ve been told — often by total strangers — to wear a helmet and know how that feels, so, I try and avoid telling others the oppsite of what not to wear. But if you want me to avoid the discussion when the State is promoting poorly proven safety gear while lagging on proven solutions, that’s a hard ask for me.
Saying helmets protect against things of very low risk is not like saying what’s the point in measles vaccine when it’s so uncommon compared to other illnesses. This kind of line is a new recurring theme to equate people against the push for cyclists to wear helmets as being like part of the anti-vaccination moment. The issues are not comparable. Or another line of attack is simply to say anti-helmet promotion is anti-science. It’s not.
That BMJ article linked above was written by Ben Goldacre, Wellcome, research fellow in epidemiology and author of Bad Science, and David Spiegelhalter, Winton professor for the public understanding of risk. These two are about as far away from anti-science as you can get.
In any case bicycle helmets are not like vaccinations on any level — the vaccination equivalent for cycling would be better cycling infrastructure which prevents collisions.
When you point out that the most common brain injury — concussions — cannot be prevented by helmets you often get even more easily tackled arguments. For example, you get told things like the reason catastrophic head injury is less common than concussion is we have a way to prevent it in low speed collisions, ie helmets. But this holds little water.
While pro-helmet research is “vulnerable to many methodological shortcomings”, we have a huge on-going population-level case study to look at for non-helmet wearing, ie the Netherlands were helmet wearing rates are 0-1% and deaths per km traveled by bicycle are the lowest. The aim of Dutch infrastructure design is not to just avoid collision with motorists but also avoid single bicycle or bicycle-bicycle collisions etc.
But — the usual response goes — “we don’t have their infrastructure”. That’s another reason helmets are a distraction to real safety — we should be building it rather than wasting time disusing safety gear. It should be remembered: One of the most common sources I hear calling for helmets are the same type of people who argue against infrastructure or law changes which might affect motorists.
Mentioning flaws in helmet research and you get told things like that you are misrepresenting studies that disagrees with your dogma — never mind that you already linked to an epidemiologist pointing out flaws in pro-helmet research. Never mind that the systematic reviews of research often held up as a beacon of science are often based on flawed research to start with — a systematic review of a bunch of flawed or weak research will only be a strong as its overall source material.
Never mind that there’s dogma on both sides. The pro-helmet researchers are not only dogmatic about their own work, they have attacked solid work of others which indicated that motorists overtake closer to helmeted cyclists. The attack on that research was later debunked by the author of the passing distance research.
Sometimes at this point the debate forgets about science and everything discussed and circles back to something like — sure, helmets are cheap and easy to put on, just do it, we’re told. Again, this is fine at an individual level for yourself, but the people making this type of argument are usually committed cyclists — barriers to mass levels of cycling are overall not getting in their way. Bike share would be dead with this attitude and bike share never really took off in some cities with helmet laws.
If anything should be treated like a vaccination, maybe mass-cycling should be. It might not be as strong as all vaccinations, but maybe we should have an even greater focus on mass-cycling being viewed as part of the solution to inactivity, road deaths, air and noise pollution, carbon emissions, and liveable in urban and rural areas. In that context, helmet promotion as a policy looks rather unbalanced.
Then we might be then asked “what about Copenhagen” where notably more people do cycle with helmets than the Netherlands — with heavy helmet promotion a number of years ago Copenhagen reportedly suffered a dip in cycling numbers. The Netherlands also has the better safety record, a more diverse set of people cycling, more teenagers cycling, and more cycling overall (commuter cyclists going from work to home are more likely to be ok with helmets).
Frustrated, a last line of attack is often that you should repeatedly bang your head against a wall first with and then without a helmet and tell the person how you got on. This is daftness, of course. But it also usually shows that people arguing against you were not listening about concussions being the main and most likely source of a brain injury and impossible to protected against with a helmet.
Maybe helmets should be advocated for those who are engaging in risky behaviour (or maybe the risky behaviour should be limited) or for those with poor balance. But, for everybody else, the risk of head injury is similar or greater doing other activities such as walking or being in a car, even with air bags etc.
Goldacre and Spiegelhalter were indisputably right on one thing: “we can be certain that helmets will continue to be debated, and at length.”
Note: One or two people might be able to tell this article was promoted by a recent twitter discussion, but that discussion touched on recurring themes. So, it’s best explaining that better here with more space than on twitter.
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