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Should it be compulsory for adult cyclists to wear helmets?

27 Jul, 11 | by BMJ Group

Last week the bmj.com poll asked “Should it be compulsory for adult cyclists to wear helmets?” 68% of respondents voted no, out of a total 1,439 votes cast. The question triggered an interesting debate. Below are a selection of the comments posted in response to the poll.

Sven Felsby: The idea of forcing cyclists to wear helmets may appear relevant, but it is ridden with pitfalls:
1. Many cyclists wear their helmets inappropriately, often tilted backwards, exposing the forehead completely. Should these people be fined?
2. Even riding a bike without helmet probably confers a health benefit compared to driving. By over-regulating, we risk driving potential cyclists back in the cars.
3. Brute force is not an effective way of changing behaviour. Use a carrot instead of a stick: exempt helmets from VAT. Encourage dealers to sell more helmets.

p.s. I ride my bike 5 miles to work every day of the year, always with a helmet.

Karin Lane: I’ve found that motorists come nearer to me when I wear a helmet. It works out about 1 out of 6 when I don’t wear one to 3 out of 6 when I do. Of course, this wasn’t a double blind RCT!

Beverley Hoyle: Women in particular tend to cycle differently from men – women specifically look for quieter off road routes to avoid fast moving traffic on major roads – many women will be discouraged from taking up cycling if it is compulsory to wear helmets. Forced helmet wearing reinforces the image that cycling is a dangerous activity – which it is not.

Transport and health authorities are working hard to encourage cycling as an everyday activity which would have a positive impact on the current obesity epidemic and to bring about a greater degree of local social interaction. Cycling also presents an affordable transport option for people from economically deprived areas. Much of this would be lost if helmet wearing became compulsory.

There is limited and inconclusive evidence to prove that wearing helmets reduces major injuries or that it would have greater benefit than getting people cycling for overall health (obesity) and social (interaction) benefits.

Fernando Martins do Vale: The Portuguese cyclist champion Joaquim Agostinho, died some years ago from a subdural hematoma, after atemporal head trauma caused by a fall from his bicycle at Algarve. He was not wearing helmet since it was an informal cycling race.

Steven Charkin: Making helmet wearing compulsory gives out the message that cycling is a dangerous activity, which it is not. The evidence that cycling helmets work to reduce injury is not conclusive, what has however been shown is that laws that make wearing helmets compulsory decrease cycling activity. Cycling is a healthy activity and cyclists live longer on average than non cyclists. In addition there is a mass effect where the more cyclists there are on the roads the safer it becomes (presumably because car drivers become more used to looking out for bikes).

Anthony Cartmell: Yes, if you want to discourage people from cycling as a mode of transport. No, if you’d prefer the benefits gained from cycling, such as reduced risk of heart disease.

Yes, if you want to follow Australia and some parts of the USA and their transport cultures. No, if you want to follow the much safer culture present in places like Denmark and the Netherlands.

But the BMA used to know this, it’s all there in the book they published: Cycling Towards Health & Safety, ISBN 0-19-286151-4

Richard Burton: Since no country with a helmet law can show any reduction in risk to cyclists, only a reduction in cyclists, why would anyone want to bring in a law for something which is clearly not effective at reducing the risk to cyclists? The largest research project about helmets showed a small but significant increase in risk with helmet wearing. There is no reliable evidence that cycle helmets reduce the risk to cyclists, and all the research that shows massive benefits from helmets has been peer reviewed and found to be unreliable.

Regular cyclists live longer, are fitter, healthier, and have a better quality of life: one researcher has said that if the benefits of cycling could be bottled, it would be the most popular medicine in the world. The only observable effect of helmet laws and propaganda is to reduce the number of cyclists, and those people deterred from cycling lose the massive benefits, and therefore the overall result of helmet laws and propaganda is a large reduction in the public health.

Patrick Carr: The health benefits of cycling far outweigh the risks. Such measures portray cycling as inherently dangerous when in reality it is not. It may dissuade people from cycling, especially for practical, everyday journeys, and damage public health.

Sally Guyer: I will stop cycling or move to another country if wearing a helmet ever became compulsory.

Invest in a proper infrastructure for cyclists, stop scaremongering, and normalise the image of cycling.

Helen Booth: Cycle helmets do not protect cyclists from impacts with motor vehicles. They are designed to be useful at 12 mph or less and only protect the side of the head. If you want to campaign to force cyclists to wear helmets then you should also campaign to force motorists and pedestrians, as they would be just as “useful” to them. Why not run a campaign to get motorists to respect vulnerable road users instead of victim-blaming? It is actually really dangerous to have people putting their faith in the delusional idea that a helmet will somehow save their life – when there is a whole host of evidence to suggest otherwise. Also, studies have found that motorists give helmet wearing cyclists less room as they wrongly assume the cyclist will be protected if they hit them. Furthermore, in countries where helmets have been made mandatory, levels of cycling have gone down as this puts off many potential cyclists as it makes cycling appear far more dangerous than it actually is (it isn’t!). As there is “safety in numbers” the research shows that the proportion of head injuries does not drop – but the number of cyclists does. And in the Netherlands, where there are more cyclists per head of population than anywhere else in the world, nobody wears helmets and there are very few injuries. This shows cycling is not dangerous – what can make cycling dangerous is having to share the road with heavy fast moving motor vehicle traffic, and no helmet is going to protect you from that. How about starting a campaign for segregated cycling facilities instead? That would be far more useful. Read the research at: www.cyclehelmets.org you might learn something.

Geoff Cleaver: What about the increase in the severity of brain injuries and increased neck injuries in helmet users? Wearing a helmet is dangerous.

Jim Parkin: As a cyclist who always wears a helmet, I am against this law as the biggest factor increasing my safety is having more cyclists on the roads; compulsory helmet laws tend to reduce cycling levels. I would also wonder whether this reduction in cycling levels has a greater adverse effect on public health than any potential reduction in head injury rates amongst the remaining cohort of cyclists – many of whom would already have worn helmets.

Deptfordmarmoset: Cycling in itself isn’t dangerous. Motorised vehicles are a danger to cyclists. There’s nothing about a helmet that makes motorised vehicles drive less dangerously around cyclists, in fact there may be evidence to the contrary.

Richard Moss: I am pursuaded that the overall health benefits of a relaxed attitude to helmets far outweighs any benefits of compulsion.

Go to Amsterdam, where almost nobody except foreign toursists wears a helmet, but levels of cycle safety are high. Compare with London, where people get dressed up for cycling as if going into battle. It doesn’t need to be a battle, and making it frightening puts people off, reducing their likelihood of taking exercise.

More deaths are caused by lack of exercise than the handful caused by lack of helmet.

Dave Holladay: I would suggest that you need to put up references to your own papers and publications that show the health benefits of cycling outweigh any possible gains from wearing cycle helmets. For starters there is the seminal work by Meyer Hillman for BMA, “Cycling Towards Health & Safety,” British Medical Association, OUP, ISBN 0-19-286151-4. This is supplemented by articles in BMJ by Malcolm Wardlaw, and helmet specific debate, is best informed by a wide range of impartially listed references on the website http://www.cyclehelmets.org/ which should be listed as very relevant reference reading.

Further I would suggest that your efforts be far better directed to deal with the epidemic which is killing and permanently injuring thousands of people every year and yet the BMA takes no action to mitigate or reduce the toll, when a very basic and simple measure has been proven to deliver significant results http://www.bbc.co.uk/news/health-12481423

Specifically on helmets and the enhanced risks these introduce

The very serious detail of rotational injuries from severe acceleration of the head enhanced and even induced by the presence of the helmet, frontal flesh, and jawbone/cheekbone damage enhanced by the wearing of a helmet, and the significant danger of death or paralysis from severe flexing and damage in C1-C5 upper spine region also enhanced by helmet being present should be considered in any reporting of cyclist injuries.

In view of this detail it is clear that the testing of helmets is flawed, and a practical test of a helmet on a full body-form impacting a “road” surface obliquely at a cycling speed – has taken place but is not well known. This is more realistic than square-on drop test at a lower speed, with only a head form (no body mass to place twist/bending force on a “neck” element). Helmet suppliers actually steer well clear of claiming any of the benefits in reducing injuries that as asserted to arise from wearing a helmet

I also understand the a couple of million years of evolution has actually provided us with a good inbuilt protection for the brain in the form of the cranium which in a healthy adult is only at 30% of its impact capacity when hitting a flat surface at 20mph, and it is covered with a sacrificial, and self repairing skin & hair padding which shears rather than grips any coarse surface. By comparison a cycle helmet is at approx 250% of its impact capacity in a 20mph impact and is of little use in any impact with a moving motor vehicle.

Perhaps the best headgear for a cyclist is that which was developed for racing cyclists as the bunch of bananas, or a simpler cap of cotton or wool. this is soft, and fits the head closely (in a universal 1-size for all way) and all perform a similar function. They also fold down and slip into a bag or a pocket, so that they don’t get damaged or crushed and compromised with the benefit that they do the job and don’t become an encumberance. A soft “head-cosy” performs same function as layer of skin & hair, and does not add significant size & weight to head.

Mike Clark: The statistics on the benefits to the general commuter cyclist of wearing helmets are far from convincing. Countries with the lowest rates of helmet wearing and the highest rates of cycling, such as Denmark and The Netherlands also have the highest safety records. Countries such as Australia with compulsory helmet wearing have seen a drop in cycling rates and also a very poor take up of city cycle hire schemes, in contrast to hire schemes in London and in Paris. The example of Denmark and The Netherlands suggests that we would be much better off putting resources into improvements in our cycle network and promoting cycling as a healthy and logical means of transport, rather than depicting it as a dangerous activity.

Mouth: Be silly not to. As a road user we try to not make mistakes ourselves but unfortunately a lot of the time have to compensate for others. Whilst I agree that the standard of protection offered needs to improve before compulsion is in place, surely something is better than nothing?

Helmets are compulsory for horse riders under 14 and I reckon on a percentage front I’m sure you’d be more likely to fall off a bike than a horse. Doesn’t make sense to me.

Some say that it’d put them off riding off they HAD to wear a helmet. As for kids they just have to do as they’re told and if we can form their habits now surely that’ll stick with them and naturally as they age they’ll choose to wear a helmet anyway. I already told my lad (10) that he’s to wear a helmet and if I ever catch him without he gets his bike taken off him.

Paul M: Helmets have clear benefits for certain types of cyclist, notably mountain bikers and road racers. For leisure or utility cyclists however, they offer no greater benefit than would also be derived by pedestrians, motorists, and many other groups who are not currently obliged to wear helmets. The great majority of utility road cyclists’ injuries would not be mitigated by wearing a helmet, either because the impacts are at far higher speeds than helmets are designed for, or because they are not head injuries in the first place – a helmet wouldn’t have helped the ten or so cyclists killed by being run over by HGVs in London so far this year.

Riding a bike should be, as they used to say “as easy as riding a bike” – as soon as you demand that people get themselves up in lurid costumes and wear helmets, high-vis jackets etc you are making a statement that cycling is not a normal, everyday activity like walking or driving a car. That way you discourage people from taking up cycling which has far greater deleterious effects on society than the small number of head injuries that arise to individuals not wearing a helmet.

Simon: Why blame the cyclists? It is the fast and badly (or illegally) driven road vehicles that cause the cyclist deaths and serious injuries.

Amy Aeron-Thomas: RoadPeace does not support mandatory cycle helmet legislation. Any potential benefits from helmets are outweighed by the discouragement of cycling. Cyclists should not be penalised, either by criminal or civil law, for cycling without helmet, hi-viz or reflective clothing.

We look forward to the vote on reversing the burden of proof in collisions involving cyclists and pedestrians. The duty of care needs to lie with those posing the threat to others.

Andy Banks: How about dedicated, Dutch-style bike lanes? Harsher penalties for dangerous drivers, especially those who kill cyclists? Compulsory cycle training before anyone is allowed to learn to drive? Banning HGVs from town and city centres?

Let’s face it, a helmet isn’t going to help anyone who has been crushed under the wheels of a left-turning lorry.

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  • Dudleyracher

    I have been cycling now since i was 7years old and have never worn a helmet.To date i have come off my bike approximately 9times and so far am none the worse for it, and on balance wearing a helmet would not have been a help.The more important thing is to ensure that the cycle is in perfect working order as a lot of accidents are caused by broken break cables and loose nuts etc:-.I should add that i am now 73years old and still use my bike regularly,Dudley

  • Dr Sarah

    How many cyclists lives would be saved by: stopping at red lights, not going the wrong way down one way streets, removing the headphones to be more aware of your surroundings, not weaving in and out of traffic like a maniac….I could go on…..

  • Reg

    Irresponsibility by any type of road user is dangerous, why single out cyclists?
    They cause lass fatalities than do motorists.

  • Downfader

    Cycle helmets, as I so often state, are not the issue or the solution to the issue. The issue is human behaviour that leads to collision or fall, deal with that and we deal with the problem.

    Cyclists represent 2% of all traffic according to the DfT. Head and brain injuries of cyclist related origin are around 2%. Thats an NHS stat iirc. Another NHS stat says that 65% of all head and brain injury are drink related. So on this basis you have to ask where is the actual risk? It is no good trying to “save just one life!” Its the majority you have to think about.

    Erke and Elvic have peer reviewed a lot of the research and found that under closer scrutiny that Australian cyclists were 14% more at risk after compulsion came in. They also found that head and brain injuries rose significantly. The helmets just were not preventing the injuries people like BHIT, Headway and Brake say they will help with.

    Another study I read (sadly I forget the source so you may have to google) stated that New Zealand cyclists were 20% more at risk after their barehead-ban came in. There have also been drop-offs in cyclist numbers in Aus and NZ of around 30%+ (even more with children). Reason's cited have been “..to dangerous..” – use of armour such as helmets leads to this conclusion, it seems.

    UK helmets are mostly EN1078. These are tested to a basic 12mph drop on a weighted anvil from between 1-1.5m. It simulates a stationary fall. I have tried to squeeze helmet manufacturers for more details but this is as far as they would tell me. Specialised Helmets do make a B90 SNELL tested helmet which is slightly better tested.

    Helmet compulsion will also cause many problems for the bike shops and the industry that supplies them. A “legal” helmet will have to conform to a specifc standard, and often these laws dont favour higher tested helmets. Australia saw several problems with bike shops having to ditch old style helmets that didnt conform, they lost a lot of money. They also lose money when cyclists give up, as the evidence has shown internationally.

    Why are the BMJ debating this when we have major problems with drink, drugs and obesity in this country. Cycling needs to be free and easy, encourging it will lower the obesity and diabetes numbers significantly. The BMJ in all truth should be actively making a stand on road safety issues, not helmets. They should be lobbying the Government, the Police and the CPS to deal more effectively with dangerous driving/cycling.

  • http://www.ageofchange.wordpress.com Martin

    To suggest that there is no evidence that wearing bike helmets reduce injuries seems like a pretty big generalization. Here's two studies that suggest their effectiveness in reducing head injuries.
    One from Australia
    http://www.smh.com.au/lifestyl

    And Sweden
    http://heapro.oxfordjournals.o

  • paul womack

    Who was allowed to vote in this poll?

  • http://twitter.com/steinsky Joe Dunckley

    Hear hear! We could save many many lives if we did more to ensure that motorists stop at red lights, and stop motorists driving the wrong way down one way streets (I saw one last week who stopped at the “no entry” sign, hesitated for a moment, then stepped on it and raced down the little street at about 40 — perhaps he thought the faster he went, the less time he would spend putting people at risk), stop them being distracted from their surroundings, and stop them veering around things like pedestrian refuges…

  • http://www.personal.dundee.ac.uk/~pjclinch/cyclingchild.htm Peter Clinch

    Very good to see so many BMJ readers using a broad evidential base from real-world track records of what helmets actually do and have done to form their opinions.  Hopefully the BMA's Board of Science will follow suit and review it's public health own-goal calling for compulsory cycle helmets.

    Even promotion of cycle helmets appears to put people off cycling (not really surprising, since it effectively suggests you have a dangerous activity and stigmatises people against non-wearers), so it is time to not merely abandon attempts to force people into them but to stop openly promoting them with dubious evidence too, simply leaving it to individuals to make an unpressured decision.

  • t1mmyb

    Well, at least they're cycling and not in a car, reducing the life expectancy of the surrounding population through exhaust emissions…

  • http://www.kimharding.net/blog/?cat=9 Kim

    I have an uncle who suffered a subdural hematoma, after atemporal head trauma caused by a fall after tripping on a rock while walking. Does this mean we should all be wearing helmets to walk? The level of head injury is about the same per Km travelled as walking, so why isn't the BMA calling for compulsory walking helmets? The risk of suffering head trauma while travelling in a motor vehicle is far higher per Km travelled, and yet there is no one call for motoring helmets, why? What is it that make BMA members to bicycle phobic?

  • nitramluap

    A few points:
    - Bicycle helmets offer very limited protection and need they to be a lot better
    - Helmet promotion and compulsion is detrimental for bicycling on many levels
    - Cycling is safe. Even *if* we were to accept that cycling is 'dangerous', helmets don't magically make it 'safe'
    - it's about time we followed the leaders (The Dutch) and acknowledge what is really causing the harm to cyclists (and pedestrians).

    Dr Paul Martin
    Specialist Anaesthetist
    MBBS, FANZCA

  • nitramluap

    We've posted about this story from an Australian perspective here: http://helmetfreedom.org/

  • http://twitter.com/CliveAndrews Clive Andrews

    Dr Sarah. The answer: Really not many. The overwhelming majority of deaths and serious injuries to cyclists are caused by the actions of drivers, not by their own perceived mischief. Headphones and red lights don't kill cyclists. Drivers do.

  • Steve

    This debate should not really about helmets, but about educating, regulating and punishing drivers. Never worn a helmet and never will, utterly pointless. On a side note, if our standard of driving were not so terrible around cyclists we would almost certainly see many more cycling tourists in our country from our European neighbours with a corresponding boost to local businesses.

  • CJ

    “Steven Charkin: Making
    helmet wearing compulsory gives out the message that cycling is a dangerous
    activity, which it is not.” Is he being serious??? I can see how traveling
    at 50+km/h on a road with cars passing, or just riding in traffic for that
    matter, is COMPLETELY safe!!!

    And to all the people saying that it is not going to help if you get
    “crushed under the wheels of a lorry” or something similar – THANKS
    FOR STATING THE OBVIOUS! Doesn't matter what you are wearing or not wearing, it’s
    not going to help!!!

    If people don't want to wear helmets, then they mustn’t! They must just not
    complain if they (or someone they know) gets clipped by a car and falls over,
    hitting their head on the pavement, and suffering head trauma (potentially permanent)
    that could maybe have been avoided by wearing a helmet.

  • http://www.facebook.com/john.cossham John 'Compost' Cossham

    I always wear a helmet, being an every day city cyclist.  I once had an accident, where my pedal broke off and I came right off the bike and the back of my head hit the road hard… except it wasn't my head, it was the sacraficial helmet, which was severely damaged.  I know I would have been badly injured or worse had I not been wearing a helmet.

    However, if someone chooses not to wear one, that's fine by me, although I feel that wearing one is more sensible than not, for the reason above, that wearing one saved me an injury or disability.  I would rather people wore them and cycled, or didn't wear them and cycled, than didn't cycle.  Anything which makes cycling less popular is bad, hence compulsory helmet wearing isn't a good thing, if the statistics are correct that it discourages cycling.

    John Cossham, York, UK

  • http://twitter.com/Fattastic Amanda Chang

    I guess when it comes down to it, it should be a choice.  I ride to work everyday and choose to wear a helmet.  I have been knocked off my bike and my helmet saved me from a serious concussion.  I understand the argument that a helmet will not save your from a lorry or a car careering into you, however it can make a serious head injury, not so serious.

    In the end, my opinion is that it shouldn't be compulsory, but it is something that a high frequency cyclist should think about.

  • http://twitter.com/SportsDoc_Chris Chris Hughes

    We at the Clinical Journal of Sport Medicine are holding a similar poll on the issue of mandatory wearing of cycle helmets, and a blog post on the topic. Come and tell us what you think here http://cjsmblog.com/2011/08/06… and vote on the issue on our poll here http://journals.lww.com/cjspor… . Clearly a hotly debated topic, my take is that cyclists should definitely be wearing helmets on the roads and I'm leaning towards legislation for this

  • tomjuddis

    We know that government always announcing new law. I also read in news that it be compulsory for adult cyclists to wear helmets. I think it is not necessary thing.

  • advinjhonsean

    Important thing is to ensure that the cycle is in perfect condition, as many accidents are caused by broken wires, nuts and break lose. I think this is still use the wheel on a regular basis.

  • Dlesser

    I cycle and I don't wear a helmet.
    During my many years of cycling I have had 4 KOSI accidents.
    1 of those resulted in a serious head injury.
    It was the result of a collision with a deer on a quiet country lane.
    I mention this because so many responses seem to focus on safety being achieved by riding away from cars and away from busy main roads. In my experience cycling accidents can happen anywhere at any time.
    I don't wear a helmet now because cycle helmets are only designed to protect a cyclist from an extremely limited range of injuries at low speeds.
    A helmet that would offer any useful level of protection would be too heavy and hot to be usable by a cyclist.
    I probably wouldn't cycle if the law said I had to wear a largely useless piece of future landfill.

  • Jason Hurdlow

    1. If you ride a bike and don't wear a helmet you're just stupid. Sorry, can't say it any other way.
    2. I've never meet anyone who said they wouldn't ride a bike because they thought helmets were or looked stupid. Usually the deterrent is one of cost, weather, distance, seat comfort, or laziness.
    3. Every cyclist in my part of the world will refuse to ride with you if you don't wear a helmet.
    4. A helmet has probably saved my life at least twice… neither involved a vehicle.
    5. Cycling IS dangerous. No need to apologize for that. It is an enjoyable activity with known health benefits. Whether the risk level is acceptable to you is a personal choice.
    6. I feel no pity for grown adults who choose to ride without a helmet and suffer traumatic brain injury or death as a result of that decision. (Darwin award maybe?)
    7. Statistics do show that death rates from cycling accidents go down drastically when riders wear a helmet. I believe Bicycling magazine even had an article about it lately.

  • Bobert

    cool story

  • http://www.safetyhelmetsforkids.com/ safety helmets for kids

    People don’t seem to realize the importance of wearing a helmet & how it can prevent brain injury. Children sould be taught to wear safety helmets right from the start & it would carry over into adulthood.

  • Roflynn

    I dont want to wear a helmet to mitigate risks of injury to myself, and place little value on the opinion of those who would seek to resolve their own insecurities by imposing their will on me.

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