Tuesday, November 11, 2014

Bicycle Helmets - Helmet laws - A Neutral perspective.

The Bicycle Helmet Law debate

[Article still being written, but please read, and comment]

 

A recent online discussion drew my attention to a strong ongoing conversation regarding bicycle helmet laws.

Specifically: Should bike riders be legally obliged to wear helmets?

I always wear a helmet when on a bike, and I have yet to meet anyone who would deny me that choice.
But its not a choice, its the law. like seat belts.

But many bicycle riders feel it should be a choice .

Why?

Lets set the Stage.

Cycling is good - very good
  • Cycling is very healthy.
    Not just cardiovascular fitness but flexibility, stamina and mental health also.
    British Medical Journal : The health risks and benefits of cycling in urban environments.
    Environmental Health Perspectives  Do the Health Benefits of Cycling Outweigh the Risks?,
    The Health benefits of cycling are massive, even in the face of significant risk from personal injury, and exposure to pollution, The benefits out weigh the risks by 9 to 1.
    In fact; if you are over 65 years old and regularly ride a bicycle, it will add 10.8 years to your life expectancy.Thats the fountain of youth!... Why isnt everyone cycling.
  • Cycling is Cheap,
  • Cycling is Great for the Environment,  
  • Cycling is Great for the economy,
  • Cycling is a Great way to solve traffic congestion
  • Cycling is a Great social activity

Cyclists as a group are treated badly by the community.
Despite all that, Cycling in general is given bad rap by pretty much everyone who can get a clean swing.
If cyclists were an ethnic minority, the prejudice they encounter would breach many human rights laws, for example;

      Cyclists as a group are the subject to 
  • Regular dangerous harassment of cyclists by many vehicle drivers, which to my (non-juridical) mind is indistinguishable from Aggravated Assault.
  • Blatant town planning indifference 
  • Legislative neglect
  • Animosity against cyclists in the mainstream media borders on outright prejudice;
         The Australian - The menace of Urban cyclists
         CourierMail - 15 reasons we hate cylcists

Conspiracy theories aside, some in the cycling community consider this a rallying point
The right to not wear a helmet has become a rallying point for some in the Cycling community, against these issues.
It seems a line in the sand is being drawn, and the cycling community is saying "this is the point where we wont be pushed around anymore".









So why is this issue the wrong place to "Make a Stand"?

  • Bicycle helmets only affect Bicyclists.
    People who dislike cyclists, dont care whether or not they wear helmets. There is no one who comes of worse from making helmets optional other than cyclists.
    In fact people with an irrational hatred of cyclists would probably prefer cyclists don't wear helmets. What is really weird is that many people who are cyclists become cyclist haters once they get into their car.
  • There are far more important issues for the Cycling community to address: 
    • Bike paths,
    • Road Usage enforcement,
    • Bicycle parking,
    • Bicycle access on public transport.
    These are all battles that need to be continually fought, and wasting time complaining about having to wear helmets is a stupid distraction from them.
    I have found 6 web sites (Sites not pages) specifically addressing the helmet issue, but very few addressing the more important issues listed above.
  • If Helmets are made optional, people will not wear them because they are lazy.
    Not because the have considered how dangerous it is with/without them, or because they know they possess a superior situation awareness. But because they cant be bothered going upstairs to get their helmet. Yes people are that stupid, and they will have accidents, and will injure themselves.

  • Without helmets, there are people who WILL DIE, who would not have otherwise.
    There are many others who will suffer horrific injuries that would otherwise have been avoided.
    Although we cannot name the people or their injuries, they will happen nevertheless. It is Predictable, It is inevitable, and most importantly it is Tragic.

Helmets are good and they work
I consider myself a cyclist at heart, but I hate pain, and I like my head.
If someone warned you that you were about to be flung headfirst into a metal pole/brick wall/gutter at 40 km/h, but I had the option of putting on a helmet first, You would I would put a helmet on, and so would any sensible person.

If you ride a bike, its only a matter of time (NOT SKILL) before you will encounter that situation.
When you do encounter that situation, if you are wearing a helmet, it WILL protect you.

If it does not outright save your life, it is more than likely going to significantly limit any head injury.
There is no evidence (despite much disinformation to the contrary) that a helmet will in any way increase your injury, or cause other ones.
I have heard talk of more neck injuries, there is absolutely no evidence of that.
These are not opinions. These are backed up by rigorous, Peer reviewed, Published Scientific papers (see references at the end of this article).

There are many independent web sites that are anti helmet and mainly against helmet laws.
Some are openly biased,  which is really just a function of their enthusiasm but often this means the methods of data selection, or interpretation of it is skewed or invalid, which means they can't be taken seriously

In one example, the site referenced hearsay or anecdotal evidence, except for one article which later on had published an erratum withdrawing some of its interpretations.

However, I have found some sites, which although openly advocating a side, seem well thought out, and the links reference seem at least semi legit.

http://helmetfreedom.org/helmet-research/

I refer only to "peer reviewed" articles, as this is the best guarantee of neutrality and accuracy. If you are not aware of the peer review process, it is the backbone of the scientific community, and is essential for medical research, and other areas where accuracy, diligence and and integrity are essential. A quick Summary of Peer Review.

The Key Questions

How much safer are you on a bicycle if you are wearing a helmet?
      If you are in an accident, you are at least 48% less likely to get a head injury according to
 
      [Article:   Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia—An evaluation - Monash University ]


Does wearing a helmet make you more susceptible to any other injuries or problems?
    According to the Cochrane meta analysis there is no evidence (report was for under 19 only).


How affective are legislative measures vs non legislative (ie training initiatives, free helmets etc).
    According to the Canadian  report legislative measures are far more effective and save lives.

Are mandatory helmet laws a significant obstacle to people riding bikes?
Short answer "yes".

Long Answer "no" : This effect is cancelled out when other pro bicycle measures such as bike paths are added (Bike usage increased 44% in Victoria over 2 years after the mandatory helmet laws attributed to other measures).


In fact that is the end game solution. When multi part solutions are put in place to encourage cycling


Summary:
Helmets work. Stop being precious about it and wear your damn helmet - it may save your life.

Even if you are such a skilled exponent of the bicycle that you consider any accident unlikely then consider the uncoordinated, lazy, stupid people who will get hurt and killed if helmets are made optional. If you don't have the conscience to think of them, then you probably don't have the right to be forcing this decision on their behalf.






                                                                                                                                                              Article 1
Title : Mandatory bicycle helmet use following a decade of helmet promotion in Victoria, Australia—An evaluation
Authors : Maxwell H. Cameron, A.Peter Vulcan, Caroline F. Finch, Stuart V. Newstead
Publisher: Monash University Accident Research Centre
Date : 15 June 1993
Scope: Population of Victoria, Australia (approx 4.5 million) over 2 years
Link : http://www.sciencedirect.com/science/article/pii/000145759490006X

Quick Summarised answer :
The mandatory law reduced the number of bicycle related head injury deaths by 48% and 70% in the first and second years respectively. During these years, bicycle use had increased (44%)
                                                                                                                                                             

Article 2
Title : Bicycle-Associated Head Injuries and Deaths in the United States From 1984 Through 1988 - How Many Are Preventable?
Authors : Jeffrey J. Sacks, MD, MPH; Patricia Holmgreen, MS; Suzanne M. Smith, MD; Daniel M. Sosin, MD
Publisher:
Date : Dec 4 1991
Scope: Population of USA (250 million) from 1984 thru 1988
Link : http://jama.jamanetwork.com/article.aspx?articleid=393673

Quick Summary:
"..the helmet law has been an effective road safety intervention that has lead to a 19% (90% CI: 14, 23%) reduction in head injury to cyclists over its first 3 years"
                                                                                                                                                              

Article 3
Title : Head injuries to bicyclists and the New Zealand bicycle helmet law
Authors : Paul Scuffhama, Jonathan Alsopa, Colin Cryerc, John D. Langleya
Publishers : a Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand
                    b Centre for Health Economics Research and Evaluation, Sydney University, Sydney, NSW, Australia
                    c South East Institute of Public Health, Tunbridge Wells, Kent, UK

Date : Feb 1 1999
Scope: Population of New Zealand (4 million) from 1988 and 1996
Link : http://jama.jamanetwork.com/article.aspx?articleid=393673

Quick Summary:
"..the helmet law has been an effective road safety intervention that has lead to a 19% (90% CI: 14, 23%) reduction in head injury to cyclists over its first 3 years"
                                                                                                                                                              

Article 4
Title : The promotion of bicycle helmet use in children and youth: an overview of reviews
Authors : Kelly Russell, Michelle Foisy, Patricia Parkin andAlison Macpherson,*
Publishers : Alberta Research Centre for Child Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada/Cochrane Child Health Field, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada/Division of Pediatric Medicine and the Pediatric Outcomes Research Team (PORT), Hospital for Sick Children, Toronto, Ontario, Canada
Date : 15 NOV 2011
Scope:  Meta analysis from Cochrane review. 21 observational studies and 14 experimental studies.
Report refers only to results for children.

Link : http://onlinelibrary.wiley.com/doi/10.1002/ebch.901/abstract


Quick Summary:
Odds of head injury hospitalizations reduced by 27% to 45% depending on jurisdiction

No adverse events were associated with helmet use among cyclists.
                                                                                                                                                             

Article 5
Title : Helmets for preventing head and facial injuries in bicyclists
Authors : Diane C Thompson2, Fred Rivara1,*, Robert Thompson3
Publisher:Cochrane Injuries Group
Date : 25 OCT 1999
Scope: Population of USA (250 million) from 1984 thru 1988
Link : http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001855/abstract