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May 6, 2010

Are laws requiring cyclists to wear helmets bad for our health?

Sue Abbott is a longstanding cycling enthusiast and advocate, a solicitor, a resident of rural NSW, involved in organising medical education, and a

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Sue Abbott is a longstanding cycling enthusiast and advocate, a solicitor, a resident of rural NSW, involved in organising medical education, and a blogger.

She is concerned that laws requiring us to wear helmet laws are misplaced. She writes:

“The large increase in bicycle helmet-wearing rates since Mandatory Helmet Laws (MHLs) were enacted (circa early 1990s) has not resulted in reduced head injury rates – in fact head injury rates have increased relative to the amount of cycling.

No randomised controlled trials have been done on the subject of bicycle helmet safety. Current data comes from two main types of observational study; “time trend analyses” and “case control studies”. Most of the literature that mentions bicycle helmets and bicycle helmet promotion refers back to a small number of these studies, rather than actually providing primary evidence.

Yet peer-review of bicycle research to date has led some scientists, traffic engineers and medical practitioners to conclude that helmets are actually dangerous for your health (W Curnow, ‘Bicycle Helmets: a Scientific Evaluation’ in Anton de Smet (ed), Transportation Accident Analysis and Prevention (2008) 139), analogous to findings investigated by Catalyst” ABC TV that football helmets ‘designed to prevent head injury had allowed another kind of head impact to become part of normal play’.

What really concerns me is that when you explore this matter, it becomes quite apparent that mandating the use of bicycle helmets was a commercial reality, and one grasped at by politicians in a bid to pass the cost of cycling safety onto the consumer in terms of helmets rather than expensive cycling infrastructure and education of motorists. Plainly, bicycle helmets should never have been the first and last words on cycling safety, yet the notion became the grim reality of Australian cycling.

In 2008, Civil Liberties Australia published an assessment of MHLs in Australia, and concluded that MHLs were not justified. Colin Clarke’s detailed “Assessment of Australia’s Bicycle Helmet Laws” outlines the negative impact MHLs had not only on cycling activity but on our health and the environment, in addition to the extra burden of resources for law enforcement.

Given that there are only about 2 ‘cyclist’ deaths per year per million population compared with about 2,000 plus ‘circulatory’ deaths, the question remains to be answered whether the current helmet legislation is the best option for the health and safety of our nation. Prima facie, cycling ought not to be a criminal issue but a health issue.

Further, Malcolm Wardlaw’s journal article in the British Medical Journal, “Three lessons for a better cycling future” reflects that:

–       cyclists do better when they act and are treated as drivers of vehicles

–       deaths of cyclists have increased since the introduction of helmets

–       attendant safety campaigns destroyed cycling participation, compromised public health, increased risks on the roads, and decreased road skills for all concerned.

Wardlaw’s position is reinforced by literature from the European Cyclist Federation, “Ask me why I cycle without a helmet”, which clinically outlines the perils of portraying cycling as far more dangerous than it is, and the notion that bicycle helmets offer far more protection than they actually do, advising that governments ought ‘to refrain from promoting or enforcing helmet wearing without sound evidence that this would be beneficial and cost effective compared to other safety initiatives.’

A proposed new cycling initiative is destined to fail before it gets off the ‘drawing board’. Unquestionably, the survival of the internationally acclaimed bike share program, destined for Brisbane and Melbourne this year, is under threat because of our MHLs, (the National Interest report (Friday 16 April 2010 – http://www.abc.net.au/rn/nationalinterest/stories/2010/2875160.htm). Mandatory helmet laws will literally kill spur-of-the-moment decisions to use a bike. Yet relevant state transport ministers continue with blinkered advice that:

* regular users should bring their own helmets
* helmet buying options will be provided
* helmet hiring options will be provided – though cycling authorities remain silent on the issues of nits, contagious scalp disease et al, or previously incurred damage to helmets.

Bike share programs work in other cities for one very simple reason – they do not have to contend with MHLs (http://freedomcyclist.blogspot.com/2010/04/unfortunately-for-australia-success-of.html).

We have been sold a ‘pup’ with our MHLs; we are the fattest nation in the world, and obesity is now causing more illness and premature deaths than smoking. Given that cycling rates have diminished significantly over the past 19 years there even appears to be a correlation to the obesity epidemic if not an actual contribution to the causation.

Clearly, the hoped-for community benefits emanating from MHLs have been considerably outweighed by the actual losses incurred by the community. Notwithstanding our politicians stubbornly cling to anecdotal notions that helmets save lives and protect cyclists. In a stark parallel with our previous reticence to absorb the evidence against smoking and front & side sleeping positions for babies (see Dr Ruth Gilbert – “How wrong was baby sleeping advice“), we just don’t want to face the ‘public health music’ yet!”

• Some more bio about Sue Abbott:

– commenced my cycling existence on the back of my parents’ bikes in Holland, before being moved onto my own bicycle by the time we reached England and Cyprus

– have cycled for well over 40 years throughout Europe, the US, the Mediterranean, and Australia

– have lived in Scone for the past 26 years with my rural proceduralist husband

– coordinate “unsponsored” continuing medical education (CME) for doctors, primarily rural proceduralist and emergency physicians

– we have 4 adult children none of whom own a car

– I completed a law degree at Newcastle Uni at the end of 2009 and was admitted as a solicitor in February 2010

– have never worn a helmet as have always felt they were a commercial reality that did not afford the protection claimed by the hype

– member of the cyclists’ rights action group based in Canberra

– booked by the police in Scone in March 2009 for not wearing a bicycle helmet while riding a bicycle

– took the matter to court at both the local and district court level

– raised the narrow defence of necessity; that it was necessary to cycle without a helmet on therapeutic grounds and grounds of civil liberties

– court of first instance received a criminal conviction, which was subsequently quashed after I appealed the matter in the district court

– actively involved in campaigning to repeal the laws

– dismayed by evident lack of academic process in determining the rationale for mandatory helmet laws – anecdotal evidence has dictated our current cycling reality, not science

– also dismayed at the lack of consistency applied to this matter because if government rationale was to always protect us from the perils of our life-style choices, why has smoking, over-eating and overdrinking not been outlawed?  The data on these habits is catastrophic yet government has not reacted to save us.

32 comments

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32 thoughts on “Are laws requiring cyclists to wear helmets bad for our health?

  1. Cycling outlaw style –only in Australia or New Zealand

    […] Are laws requiring cyclists to wear helmets bad for our health? – the article I wrote for “Croakey” (Crikey’s Health Blog), concerning this vexed […]

  2. Cycling helmet laws: what does the evidence really say? – Croakey

    […] Abbott, a longstanding cycling enthusiast, argued that the laws are misplaced, and a leading public health advocate Clinical Associate Professor Chris […]

  3. Bicycle helmet laws are “failed public policy” - BackwardsRider Social Network

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  4. Pete

    Sue appears to be one of these so called civil libertarians who really have little interest in public health ( the health and safety of the masses)
    Sure I agree – for many people who hop onto a bike and meander at 5kmh for a few km are unlikley to benefit from a helmet – unless they are run into by a car or a lycra cyclist going at 30kmh
    Also for many of these gentle bicycle riders the cardiovascular benefits are negligible. If you wish to get a cardio benefit you need to ride at more than a sedate pace over a few kms.
    I’ll keep using my helmet . I personally know of many peopole who still have an intact head thanks to the protection of their cycle helmet

  5. Ride2Wk

    G’day all,

    great to see the debate on this issue is still strong – keep it up and lobby the pollies to repeal the silly “nanny” law.

    2 things that I think have been missed in the debate so far are;

    1/ Now I’m an engineer and cycleway designer, not a lawyer, but if a non-helmet wearing cyclist (not at fault) gets hit by a motorist (at fault) and suffers a permanent head injury that they may have suffered with / without a helmet anyway, doesn’t the insurance company claim “contributory negligence” and NOT pay any compensation to the victim? Instead the victim ends up suffering both the head injury and being poor due to loss of income. They end up on social welfare at tax payer expense, instead of the cost being borne as it should by the hazard causing motorists through the insurance system.

    2/ Helmet laws turn average bike riders who prefer not to wear a helmet into “law breaking cyclists” in both the public eye and the police eye. How much whinging is there from motorists about bikes breaking the road rules including not wearing helmets. Now I don’t advocate breaking the law but the helmet laws fuel that dangerous fire even further. (Yet those same hipocritical drivers speed, don’t indicate, use the mobile while driving, use fog lights in good weather, park on foot paths, run red lights, drive in bike lanes etc etc.)

    To medical people like Jenny Haines, I appreciate the work that you do. (I’ve badly broken my back snowboarding and needed to be screwed back together.) But the medical profession is too narrowly specialised and doesn’t consider non-medical factors or even other medical issues that they are not familure with. They need to recognise other human behaviour factors such as risk compensation and other health issues such as obesity & heart issues that cycling offset as mentioned by others.

    Safety on our roads is far bigger than most people’s narrow vision can see. It even needs to extend beyond road injury /safety to global warming, peak oil, social connectivity and all those “greenie” or “social” issues.

    Open your eyes and try to consider the bigger picture. Mandatory helmet laws are short sighted little picture.

  6. Andrew

    andy

    You seem to be rather biased against the work of Curnow. I doubt that you made the effort to look at it objectively.

    In the main post, Sue put a reference to
    “Bicycle Helmets: a scientific evaluation”
    http://books.google.com.au/books?id=IlRychZFYwQC&lpg=PA139&ots=9q_leuiSd4&dq=curnow%202008%20scientific&pg=PA138#v=onepage&q=curnow%202008%20scientific&f=false

    This was published in 2008 in Transportation Accident Analysis and Prevention.

    You attempt to discredit it by mentioned something not related, published in 2006.

    This is not right.

    If you are going to criticise an author, at least have an open mind and make the effort to check the references put in the main post.

    If you had bothered to look at it, you would have discovered that the design of current bicycle helmets is based on a discredited theory of brain injury. Rotational acceleration is the main cause of brain injury. Yet bicycle helmets only provide very limited protection against linear acceleration only.

    Bicycle helmets are not effective in protecting against brain injury because they are not designed to mitigate its major cause.

    You claim that “There is serious research out there about the effect of helmets on head and brain injuries”.

    That research from Curnow is serious research andy.

    There is plenty of misleading research on this topic though. The most famous one was published by Thompson & Rivara in 1989. It claimed that helmets protect against 88% of brain injury. This is not possible due to design limitations, as helmets can’t protect against rotational injury.

    This research was funded by Bell, a helmet manufacturer. Is it a surprise it arrived at an impossibly optimistic conclusion about the effectiveness of helmets, using a flawed methodology? Can you spot a conflict of interest there?

    Most case-control studies suffer for the flaw that the groups are not random. There is no way to know whether they ride in different circumstances are exposed to different types of risk. How can you make credible conclusions from that?

    Most studies that claim that helmets are effective are case-control studies, and they are flawed.

    Most ‘whole-population’ studies, done before and after the introduction of the helmet law, found no evidence of a decrease of head injuries due to helmets.

    In the real world, there is no evidence that helmets provide significant protection.

    If you look at the SCIENCE behind bicycle helmets, it becomes a bit clearer.

    How about you have a look at Curnow’s article mentioned above first, with an open mind?

    You will be then in a better position to criticise.

  7. Chris Gillham

    The response from Jenny Haines as an IC nurse for 22 years is in line with the blinkered view of Australia’s medical profession, particularly the Australian Medical Association, since this public health disaster began unfolding almost 20 years ago.

    http://www.cycle-helmets.com focuses on the effect of the mandatory helmet law in Western Australia before and after its enforcement in mid 1992.

    A summary … government road surveys and a barrage of anecdotal evidence showed a reduction in public cycling participation around 30% – much worse among school children. Did the WA hospital admission rate for cyclists fall from its pre-law average around 640 per year? No. It barely moved. Odd when you think about it … how can there be at least 30% less people cycling but no reduction in cycling accidents/injuries?

    The years rolled by and cyclist numbers gradually rose during the 1990s until they had recovered to pre-law levels by 1999/2000. What happened to the annual number of cyclist admissions to WA hospitals? That figure rose substantially during the 90s to close the decade with 913 admissions in 2000.

    Cyclist road numbers recovered to the same level as before the law, but there was a 50% increase in hospital admissions? That’s almost 300 extra cyclists, young and old, injured and in hospital each year.

    So what’s happened since 2000 in Western Australia? Cyclist road numbers have continued to increase according to the survey counters, but what the media prefers to ignore is that huge numbers of people now cycle without a helmet, most aware that police enforcement of the helmet law almost vanished (but not quite) around 2000. A majority of cyclists don’t wear helmets in Perth’s poorer middle to outer suburbs and I estimate the metropolitan average at 50%. Hospital admissions have remained around 900 cyclists per year since 2000.

    So the law discourages 30% of cyclists from healthy exercise, puts about 50% more cyclists in hospital, and the injury rate stabilizes when many cyclists stop wearing helmets. The immediate safety failure is obvious but the real harm is caused among the tens of thousands of people who instead drive, reducing their fitness in the world’s most obese country, adding to greenhouse gases and increasing the car density/accident risk for all road users.

    OK, helmet law supporters consider these good results. Can they present some statistical evidence, rather than opinion, as to why they consider these good results?

    They might try to salvage their argument by pointing out that there was a small percentage reduction in cyclist head injuries vs other body regions in WA following law enforcement. Unfortunately, the overall increase in accidents and hospital admissions meant that although the percentage was less, there were actually more head injuries because of the greater overall number of accidents/injuries … i.e. 30% of 640 = 192 / 25% of 900 = 225. Of course, that’s ignoring the hundreds of additional broken legs, arms, necks, etc.

    A doctor or nurse treating a head or other bodily injury, whether or not the patient was wearing a helmet, has little idea what were the circumstances of the particular accident. The facts indicate mandatory helmets increase accident rates per cyclist for various reasons including risk compensation, increased head diameter, incorrect wearing and rotational force. These broader influences aren’t recognised by medics who assume a cracked helmet prevented or lessened rather than caused the injuries they are treating, head or body. Medical professionals are too close to the trauma to have an objective overview of the cyclist accident/injury rate. I respect their work and their opinion, but in this case they are wrong and the government data consistently proves it.

    Keep up the good work, Sue Abbott, and congratulations to Crikey for allowing the publication of a few facts concerning this issue. It’s a pity Australia’s mainstream media remains so disinterested in public health and safety.

  8. Freedom rider

    Eponymous wrote

    “I think the argument that wearing a helmet does not improve your safety is madness. Utter madness.”

    Typically head injuries are about 10% of hospital cases and other injuries to cyclists about 90%, arms, legs, etc.

    From 100 injuries, 10 head injuries may occur, how many to the face not protected by a helmet? Actually more than to the skull part of the head is the answer. So from 100 injuries helmets may help save say 5 head injuries, probably not severe, a 5% return in saving injuries would be one estimate.

    If the 14% increase in accident rate is included (see previous post), 100 goes to 114, say 6 saved head injuries, net result 108 injuries by wearing a helmet. Take another look at Table 2 and Table 5 in
    http://www.cycle-helmets.com/robinson-head-injuries.pdf

    Additionally the important aspect of trying to protect the head from rotational injury is an issue, see http://www.cyclehelmets.org for more information or http://www.cycle-helmets.com/helmet_statistics.html or Curnow’s work.

    By wearing a helmet you are probably doubling the risk of making contact due to the increase in size compared with a bare head and the torque for turning the head could also be about 30% higher. Anyone who does not wear a helmet will have a lower risk of accident, head impact and reduced risk of the high dangers associated with rotational acceleration of the head and brain injury. people not wearing helmets may just enjoy their cycling more and reduce the major risk of not exercising.

  9. Dr Paul Martin

    Firstly, to the ‘ICU Nurse of 22 years’: Tell me you’re joking…

    I would be extremely surprised if any cyclist who has had their head ‘run over by a truck’ would end up in ICU. In my broad experience they end up in the morgue. A bicycle helmet will do nothing for this type of impact. Are you aware of what they ACTUALLY test for in the AS/NZS2063 Standard for Bicycle Helmets? I’m sure you are not.

    They are tested for very limited impacts, at speeds no greater than 19.5km/h (the speed the helmet reaches if dropped 1.5 metres). Not all sizes are tested (notably absent in testing are small children’s helmets…). Go to your local State Library and read up on them – I did and I was shocked at how inadequate they are.

    Bicycle helmets do afford some protection but only in certain circumstances:
    – it will reduce lacerations and minor head (scalp, not facial) injuries in low speed falls (assuming you actually hit your head and not injure your arms, legs, neck – which is far more likely).

    They DO NOT reduce the risk of serious head (ie. brain) injuries in significant impacts. They should have never been marketed as being effective at preventing serious head injury. Now we have a generation of ‘believers’.

    Nobody is saying that this argument is about mandatory NON-wearing of helmets. It is suggesting that it should be OPTIONAL, no more. If you want to wear one, fine – go for it – I’m all for that – that’s your choice, if we had a choice. The problem with people that are happy with helmets is that they just don’t care about MHLs – but they should. If helmets were so important then why is there an exemption for passengers of three- or four-wheeled ‘bicycles’ BUT only if they are PAYING passengers! So it is OK to not wear a helmet if it affects a business?

    It is not mandatory to wear sunscreen at the beach yet skin cancer in Australia costs the country a fortune (and many lives) – I’m assuming you were going to use the ‘cyclist head injuries cost the tax payer millions!’ argument… that is tired one.

    With bicycle helmets, I am pro-choice (I’m pro-choice in other areas too…). I am in full support of laws for the common good – this is not one of those laws.

    Dr Paul Martin
    Consultant Anaesthetist
    MBBS, FANZCA
    Brisbane, Australia

  10. RidesToWork

    Eponymous summarised the issues:
    1. MHLs do not deliver widespread improvements in injury rates
    2. Helmets do not improve your safety.

    They are different issues, but the first is most significant for public health. A paper in the British Medical Journal in 2006 – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410838/?tool=pubmed reviewed all helmet laws that increased wearing rates by at least 40 percentage points and found no clear evidence of benefit.

    So there’s no benefit. But the health consequences of discouraging cycling (a healthy form of exercise), and also increasing the accident risk because of reduced Safety in Numbers, leads to significant public health problems.

    Many cyclists (like Liz) think helmets help because the helmet split. Perhaps Liz could tell us how much the foam compressed. If it compressed to a fraction of its former size, the helmet helped. Splitting suggests rotational forces (the main cause of brain damage) may have been involved. Helmets (apart from the Phillips helmet) provide very little protection from rotational forces and in some cases can increase them.

    That’s why you need statistical analysis of helmet laws – comparing head injury rates before and after the large increase in helmet wearing due to legislation. The reason why helmet laws didn’t reduce head injury rates is probably quite complex.

    1) Helmets aren’t anything like as effective as most people think (look at all the helmeted cyclists who die of head injury).

    2) Because cyclists over-estimate the protection they may be more likely to mingle with fast traffic, when any sane non-helmeted cyclist would choose another route. This is an example of risk compensation. A sane helmeted cyclist who understood the risks would do the same as a non-helmeted cyclist, but helmet laws were “sold” by grossly exaggerating the benefits of helmets.

    3) Reduced cycling reduces Safety in Numbers which increases the risk that motorists won’t see cyclists or give them their right of way at intersections. Since most serious head injuries result from car/bike collisions (and many involve forces far greater than the design limit of bicycle helmets), so it’s no wonder that helmet laws don’t work.

    So, given that helmet laws haven’t reduced injury rates, but they have discouraged cycling and are likely to make public bike schemes unviable, why have them?

    Why can’t governments admit the truth and repeal them, so that all cyclists can enjoy increased Safety in Numbers and have a lower risk of head injury, whether or not we choose to wear a helmet?

  11. mothlight

    Liz, I’m glad you came out of your fall without a serious injury. But if I was you, I would be complaining to your helmet manufacturer for making and marketing an ineffective helmet. Bike helmets absorb force through compression of the material. If they crack, then the helmet failed. They certainly don’t absorb force after it cracked and might not have absorbed much before it cracked since the absorption requires the structure of the helmet to spread the impact through a larger area and away from the impact zone. It seems to be a common believe that cracked helmets mean the helmet did its job
    http://www.cyclehelmets.org/1019.html

    I only wear a helmet because I don’t want to be fined. I have no belief that it will help me in any way if I’m hit by a car at even a moderate speed. I especially hate that motorists think that a helmet is going to save me if they run me over.

  12. Nik Dow

    Another factor missed by the Nanny State enforcers is that cycling safety increases with more people cycling. So the reduction in cycling numbers caused by MHLs makes those who continue cycling less safe.

    The safest places in the world for cycling are countries that do not have MHLs, such as Denmark and the Netherlands.

    In Denmark, growth in cycling has stalled, not because of MHLs but because of promotion of helmet wearing by the Government and a National cycling association. Just promoting helmets puts people off cycling because it adds to the perception that cycling is dangerous, which is the major factor detering more people from cycling.

    Given the lack of good provision for cyclists in Australian cities by our governments, it is hypocritical for them to require us to wear helmets. Fix the problem, don’t apply a faulty bandaid.

  13. Eponymous

    Surely there are 2 separate issues here, and I’m having trouble differentiating them from the post or the comments.
    1. MHLs do not deliver widespread improvements in injury rates
    2. Helmets do not improve your safety.

    I think the argument that wearing a helmet does not improve your safety is madness. Utter madness.

    However, this effect can be negated by roads getting owrse and busier. Telling people not to wear a helmet solves nothing. Surely the way forward is to wear one and improve cyclist conditions?

  14. Bicycle helmet laws are “failed public policy” says public health expert – Croakey

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  15. bcray

    Oops, bad typing 🙁 The previous should clearly have said:

    Motorists slaughter and *injure* far more of each other and pedestrians every year *than* bicyclists.

  16. bcray

    Bicycle helmet promoters suffer from two major problems: denial and consistency.

    Denial

    It doesn’t matter how much you wish for bicycle helmet laws to work EVERY single one has failed to produce an overall population health benefit. There are 2 sensible, and 1 stupid response to this:

    1) Believers in the helmet approach can examine why the helmets and laws are failing, determine what has gone wrong, and fix it. Sensible.

    2) Those who don’t agree with the helmet approach can declare the experiment failed, after two decades of trying, and call for the abolition of the laws and a switch to other approaches which work. Sensible.

    3) Believers can deny the facts, stick their heads in the sand, and let the health and safety disaster continue. Stupid.

    Why do law promoters prefer (3) over (1)? Don’t they care?

    Consistency

    The Australian Government will tell you, on the assumption bicycle helmet legislation works – as they claim, that if seat-belted, air-bag protected car occupants wore “bicycle” helmets that they would save a mere A$350million year in health costs (it rises to A$500 million if the vehicle fleet isn’t fully air-bag equipped).

    The New Zealand Government will tell you something similar, we’d be better off if motorists wore helmets.

    Motorists slaughter and injury far more of each other and pedestrians every year and bicyclists. According to the helmet theory many of these deaths and injuries could be avoided, saving far more hurt and dollars and the insignificant benefit gleaned from making bicyclists wear them.

    Despite this the vast majority of bicycle helmet promoters drive bareheaded, walk bareheaded, while calling bareheaded bicyclists idiots (or less polite terms).

    Is this inconsistency stupidity? Hypocrisy? A burning desire to get a head injury? Something else?

    Postscript

    Bicycling is not particularly dangerous, its health benefits outweigh its small risks. Ride a bike, on the road – and not in the gutter! If you choose to wear a helmet forget you’re doing so, never believe it will protect you – therein lies disaster. And if you think you need a helmet because of the traffic today think again – helmets are NOT designed for use in traffic, they are only for falling off stationary bikes unaided by anything other than gravity.

  17. Freedom rider

    Having researched the issue of cycle helmets for many years I know there are problems with helmet laws. Surveys of children cycling in New South Wales pre law 1991, counted 6072, post law 1993, count 3414, down 44%. Surveys from Melbourne found 30 more teenagers wearing helmets but 623 fewer cycling. The biggest effect of helmet laws is to discourage cycling. Survey data from Victoria documented an extra 297 were wearing helmets compared with 1110 fewer cycling, 1991 compared to 1990.

    see Robinson DL; Head injuries and bicycle helmet laws; Accid Anal Prev, 28, 4: p 463-475, 1996 http://www.cycle-helmets.com/robinson-head-injuries.pdf

    Both the safety and social effects of helmets laws have been questioned, Erke and Elvik (Norwegian researchers) 2007 stated: “There is evidence of increased accident risk per cycling-km for cyclists wearing a helmet. In Australia and New Zealand, the increase is estimated to be around 14 per cent.”

    http://www.ta.org.br/site/Banco/7manuais/colin_clarke_cycle_helmet.pdf provides details in the appendix of errors from Australia.

    Moderate cycling has many physical and mental health benefits (BMA 1992) by reducing the risk of developing heart disease, diabetes, high blood pressure, colon cancer and depression, and helping to control weight and increase fitness. Dr Hillman from the UK’s Policy Studies Institute calculated the life years gained by cycling outweigh life years lost in accidents by a factor of 20 to 1. Bupa reports, “everyday cycling, where the exercise leaves you breathing heavily but not being out of breath, is an effective and enjoyable form of aerobic exercise. This is the type of exercise that is most effective at promoting good health.”

    There is a basic health problem with helmet legislation that makes it not worthwhile. The fatality risk factor for cyclists is about 1 in 100,000 and if helmets could prevent 10% of deaths (they do not because of other serious injuries, chest for example, and they incur more impacts due to the extra size of a helmet) then 1 in 1,000,000 may be saved. In practice about 33% or more may wear helmets without a law, meaning possibly 67% would not wear them. Australia had a 36% reduction in cycling due to their helmet law (Vic 1991), meaning roughly half of the non-wearers stopped cycling. So the hopeful gain from a helmet law would be one life saved from 1 million cyclists, however from 1 million non-wearers, roughly 500,000 stop cycling and increase the risks of more heart disease, stroke, diabetes etc. The WHO formula, which can be used to calculate lives saved be cycling and shows that from 500,000 people cycling, approximately 100 lives can be saved. The end result, a helmet law, can result in 100 times more harm than the intended good. Of course with an increase in the accident rate (14%), extra harm results, plus people are fined and children stopped by the police.

    Therefore to answer the question “Are laws requiring cyclists to wear helmets bad for our health?” the answer is yes they are.

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  19. robwalls

    There’s something about the logic of mandatory helmet laws that escapes me. If cycle helmets are so necessary for cyclists, why are they not also obligatory for motorists? Head injuries sustained in motor accidents would be a significant factor in road deaths.

  20. Juffy

    Trevor – “But for an office worker or someone who just wants to go a couple of kilometres down the road they should be able to do this in a relaxed mode and not have to shower and change at both ends.”

    I agree. So what’s stopping them?

    * Lack of bicycle-friendly infrastructure
    * Dangerous conditions on the roads
    * Compulsory helmet laws, according to the article.

    I don’t believe cycling “always descends” into the lycra-clad racer collective, it’s just that we’re the only ones batty enough to ride in cities like ours. You will always have sub-group of riders who want to go fast, it’s our ‘normal’ riders that are missing. None of ‘us’ are forcing ‘them’ to go fast.

  21. Jon Hunt

    The problem of course is the lack of evidence, for or against. My understanding is that there is no evidence that bicycle helmets prevent serious head injuries. All they are is a piece of foam. Imagine a car running over your new DVD player still in its box. It’s still going to get squashed, much like your head would be. I know of a doctor who still sustained a base of skull fracture after coming off, despite the helmet. In other words, I can not see how a piece of foam will help you much if you hit a car hard enough to break the windscreen, or dent the bonnet. It might prevent you from needing stitches, and as far as I can tell this is confirmed by evidence. Personally I wouldn’t ride anywhere without a helmet, after all it is the law and can not hurt. But I don’t really expect it will save my life. If I come off and get run over by a car it’s not going to help much. Motorcycle helmets on the other hand are a different story.

  22. Trevor

    Juffy. Lighten up. You have missed the point. For those of you who want to be heroes, do the 26Km commute and try and beat your PB every second day on your $12K feather light bike. By all means go for it, & wear a helmet for goodness sake. But for an office worker or someone who just wants to go a couple of kilometres down the road they should be able to do this in a relaxed mode and not have to shower and change at both ends. That is the point I was making.

    By the way I think the Europeans still have our measure on the competitive side of cycling though, even if it is drug enhanced professionals.

  23. GonzoBonzo

    My cycling friends made me do it. “Wear a helmet!” they insisted. So rather than argue my way through all the peer pressure I grabbed a daggy old old yellow stackhat from one of my kids and joined them for a cruise along the Brisbane River’s bikeway. That was on a Sunday. I reckon some idiot arborist had decided to start his weekend early instead of properly trimming a giant fig branch overhanging the path because the next thing I knew I was laid out on the concrete with an almighty pain in the neck after a big, fresh and pointy twig had tried to check on the existence of my brain. Which remained intact.

    This is not the kind of hazard mentioned in all the textbooks, showing that merely being hit by a car, thrown over the bonnet and landing on the top of your head is not the only way to die on a bike. My daughter did this a month ago and, after being laid out on the road for an hour, eventually regained consciousness. We truly, dearly, passionately love our helmets.

    I look at people dangling their helmets from their handlebars and resign myself to try and believe it’s further proof of Darwinian selection.

  24. Reds in the bed

    “No randomised controlled trials have been done on the subject of bicycle helmet safety. Current data comes from two main types of observational study; “time trend analyses” and “case control studies”. “???

    RCTs are suitable for therapeutic interventions, as in testing which of two drugs or a drug versus a placebo leads to a better outcome for the patient. For an RCT to be effective it is best for it to be a “double blind” trial, where neither the patient nor researcher is aware of what therapy is being administered.

    To claim in this case that evidence is lacking due to there having been no RCTs conducted is either intellectual dishonesty or a genuine lack of knowledge of evidence based medicine, either of which is surprising for a health blog!

  25. Liz

    Wearing a helmet makes intuitive sense. It made sense the day I fell off my bike doing my daily 13km commute and whacked my helmeted head on the footpath. The helmet split and I ended up in emergency under a spinal injury protocol. Luckily, no permanent damage and no visits to Jenny in ICU. Without the helmet I would’ve been much worse off. Now that’s just me and I really can’t comment on the evidence.

    Regarding evidence, where’s the solid data that helmet requirements discourage cycling? Lack of infrastructure and fear are the bigger issues.

    I fell off the bike rushing to avoid oncoming traffic thanks to some woeful cycling infrastructure. So the argument about helmet mandates being a way of exonerating govt is compelling. But it is not an argument against wearing helmets themselves.

    As a 15 year old with her first road bike I recall protesting about the need to wear a helmet. My parents emphasised that not only would it protect me, but would send a message to drivers that I take my safety seriously. That has always given me a sense of cautious confidence which is one of the essential ingredients of good cycling. So perceptions become important here.

    Regardless, it seems the real issue here is about personal choice versus regulation. So we will interpret the evidence to suit our argument and continue to talk at cross purposes.

  26. andy

    is also an avid cyclist, but is dismayed at the tosh being peddled here.
    There is serious research out there about the effect of helmets on head and brain injuries, but author and those she quotes selctively don’t believe it. Instead they reanalyse other people’s data for their own ends. As referenced above, Curnow is a prime offender here.
    It is unlikely that an ethics committee would permit a randomized controlled trial of the effect of helmet wearing in humans, because of the risk that those randomized to not wearing helmets will come to harm. Given this, what remains is serious analysis of the existing data, rather than the selective view presented here. I recommend a rebuttal of Curnow’s self-referential work presented in Accident Analysis & Prevention, Volume 38, Issue 2, March 2006, Pages 277-278 or the publically available Cochrane collaboration analyses on the issues for interested readers.

    I share Abbott’s frustration that our national rates of exercise are so poor, but unlike her, am not happy to sheet this nor the difficulties of poorly-conceived bike hire schemes that are aimed at tourists home to MHLs . Our inability to exercise as a nation has many factors. Helmets are cheap, easily available and easy to wear.

    Abbott’s comments about death rates from cycling are misguided. Proportionally the big harm in head and brain injuries, as Jenny Haines has pointed out above.

    As Abbott tells us, the “public health music” is playing, but Abbott, Curnow and supporters a have a tin ear.

  27. SBH

    coupla things

    1 do helmets work? Ask Fabio Casatelli. Oh wait he’s dead after a fracturing his skull in a chute.

    2 The reference to football injuries is about how when severe injuries are prevented game tactics develop to result in many minor injuries as players willingly subject themselves to multiple impacts. To be analogous to cycling you would have to be suggesting that because they wear helmets cyclists willingly hit their heads more often which is either nonsense or dishonest.

    3 the article quoted “Transportation Accident Analysis and Prevention (2008) 139)” is a) incomplete and b) I couldn’t find any reference to helmets increasing injury rates just that they don’t protect you from angular acceleration.

    I agree that most chutes don’t end with a head injury but the ones that do however are far more likely to be catastrophic without a helmet. the real danger to cyclists is cars but why then don’t you write an article that focusses on that instead of this disingenuous and frankly pissant moan about you rights.

  28. Juffy

    Trevor – that’s because the majority of people who ride at the moment are the lycra-clad heroes (of which I am one) who want to go fast. We’re the lucky ones who have showers, and secure places to put our machines, at work. We also have the motivation and fitness to ride the ridiculous distances to get around our sprawled cities.

    I live 26k from the CBD. The only other cyclists I see on my route to work are the fit buggers like myself, until you get within 5-7k of the CBD where the ‘normal’ people join in. Look at the distances the Europeans you’re talking about are riding – I’ll bet they’re not doing 26k in evening wear.

    Jenny – no one’s saying don’t wear a helmet under any circumstances, except for the pollies who think that if it’s not compulsory then we’ll all start sailing down the freeway with no protective gear at all. As David said in the first comment – “If you are riding in dangerous conditions on busy roads then you may think it a good idea” and bloody oath it IS a good idea: otherwise we’d end up as one of your patients. But currently you can be fined for not wearing a helmet while doing 5kph on a path through a park, which is patently ridiculous.

  29. joel.cass

    To Quote:

    “football helmets ‘designed to prevent head injury had allowed another kind of head impact to become part of normal play’.”

    Ok – the research is regarding damage from regular impact. Do you know any cyclists that bash their helmeted heads against objects all day, or even once a week? Month? Year? It’s a flawed argument.

    Furthermore, most helmets have a clear warning: If an impact is sustained, replace the helmet.

    This is just another flawed argument from someone who comes from a place where the infrastructure is better, the traffic is slower, and the commute is safer. by all means, go back to Holland on your next holiday and enjoy the helmet free ride.

    Helmets on bicycles, in my opinion are like parachutes for skydivers. You’d be stupid to cycle without one. Accidents can happen anywhere at any speed, the force of falling 2m onto a hard surface is enough to cause a serious injury. Remember that when you fall on your legs there is a lot of shock absorbtion. When you fall on your head there is hardly any, except from that absorbed by the spine and neck. And no one wants to be a paraplegic.

    Seriously, anyone who doesn’t wear a helmet, wake up to yourselves. Today’s helmets are so light and allow so much air through that you can forget you have them on.

  30. Jenny Haines

    Oh please!! As an intensive care nurse of 22 years experience in critical care, 33 years in nursing in total, I am happy to conduct tours of neurosurgical intensive cares and wards to show cyclist what happens to a persons head when they come of a bike and hit it on the ground or end up lodged under a car or a bike. Or I could take you to ED and you could see the cyclists brought in by ambulance after a truck or a car has run over someone’s head. Not a pretty sight I assure you. Helmets may not be as evidence based as they should be but at least, worn correctly they offer some protection to the eggshell that your skull can be in the event of an accident.

  31. Trevor

    Also completely agree. I also read with dismay about the problems the bike hire schemes in Brisbane were facing with regard to the MHL. Clearly enforcing this law will be the death knell of these schemes or in the very least they will only be a small fraction of what they could be. When you think about what the health benefits would be if these schemes did become popular they would far out weight the small benefit we get from the MHL. I also have seen these schemes operating in Europe and thought it was tremendous to see the number of these hire bikes lined up at the train stations in Munich.

    Another point I have observed concerning our bike culture and that of the European. They seem so much more relaxed about it. It is nothing to see women in evening gown or men in suits cycling leisurely through the city. For some reason here, it seems to always descend into racing to get from point A to B in as fast as time as possible. Generally clad in lycra or other sporty attire. While I concede our weather is warmer I am sure we could still take a leisurely cycle from one end of the CBD to the other without ending up a sweaty mass. It seems just much more refined to not be so competitive.

  32. David Sanderson

    I completely agree. Riders should be able to make their own judgements. If you are riding in dangerous conditions on busy roads then you may think it a good idea. However, if you are riding at moderate speeds on bike paths on largely flat terrain then it is unnecessary to have your enjoyment compromised by wearing one of these things.

    I dislike the nanny state catchcry but this is definitely an example of excessive regulation.

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