Bicycle Helmets: Time for a sense of perspective
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To focus on injury mitigation in cyclists to the exclusion
of addressing the causes of crashes, as is the trend in
public debate at present, risks fundamental errors - not
least the apparent post hoc fallacy of assuming that cycling
head injuries are the result of failure to wear helmets,
rather than of the types of crashes cyclists experience.
I recently analysed Department of Health data on child
hospital admissions for England for the period 1995/96 to
2002/03. From this analysis it was apparent that:
- the proportion of head injuries in child cyclists on the
road is hardly different from that of child pedestrians;
- the risk of head injury in offroad cycling is an order of
magnitude lower than in road cycling;
- cycling is far from being the leading cause of head injury
admission, being behind trips and falls and even assault.
It is interesting to me, as both a cyclist and a parent, to
explore the reasons that cycling is seen as a uniquely
dangerous activity, when a dispassionate look at these and
many other statistics indicates very clearly that it is not.
Some of us will recently have witnessed "lightbulb moments"
in friends and colleagues who we have accompanied as "bike
buddies" in Bike Week. The comment "well, that was less
scary than I thought" will have been uttered many times this
past week!
I have a view that there are a number of factors at
work here:
- head injuries raise a spectre of intellectual disablement
which cannot be "fixed" by modern medicine, even though
this is very rare - the fact that such injuries are now
thought to be mainly the result of rotational forces which
helmets do not mitigate (and may even aggravate) adds a
touch of irony;
- even trivial head injuries can bleed spectacularly, which
combines with the fear factor above to ensure the maximum
likelihood of attendance at A&E or a minor injuries unit
"just in case" - even though in most cases treatment is
limited to dressing or, at worst, stitches - so that
nurses, for example, "see a lot of cycling head injuries";
- there exists a substantial industry whose expensive
product will not sell unless a culture of fear is
maintained, and the protective effect
modern helmet if they were told bluntly that they are tested
only for the equivalent of a fall from a stationary riding
position, yet this is the literal truth (and explains the
wide disparity between claims made by manufacturers, whose
claims are controlled by advertising regulations, and by
helmet advocacy groups, who still quote the discredited 1989
Thompson, Rivara and Thompson study);
- the culture of fear extends in particular to the danger of
motor traffic, with some justification as the estimated
10% of child cycling which is on-road results in half of
all cyclist admissions;
- there is a widespread and undoubtedly false belief that,
firstly, there is nothing that can be done about the
source of this danger
(i.e. drivers cannot be made to drive more carefully), and
secondly, that no amount of riding skill can reduce
the danger;
- fundamentally, most of those campaigning for helmets are
not cyclists and have little understanding of the vast
range of different activities and scales of risk which
that term encompasses - it is as if all outdoor activity
from afternoon walks in the park to free-climbing were
considered under a single umbrella.
One thing struck me very forcefully when analysing the
admissions data. Motor vehicles account for around 10% of
child hospital admissions but half of all injury fatalities
(Office of National Statistics). This greatly increased
danger is shared by cyclists, (far more numerous)
pedestrians and motor vehicle occupants. The danger is
inherent in the source, not the victims' activities.
A proper study of head injury in cyclists cannot evade these
facts. It is well known that cyclists in particular are
generally not to blame in crashes involving motor traffic;
what is less well known is that riding techniques already
exist which dramatically reduce the chances of some of the
more common sorts of crash. It is to be hoped that public
debate on cyclist safety will soon lose its cyclopean focus
on injury mitigation devices which, it has to be said, are
not associated anywhere in the world with improvements in
safety, and shift onto prevention, both by improved driver
behaviour and better riding skills.
Guy
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May contain traces of irony. Contents liable to settle after posting.
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88% of helmet statistics are made up, 65% of them at Washington University