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.