Two surgeons in Edinburgh, both of whom ride bikes regularly and both experienced in treating injured cyclists have crossed scalpels over the issue of whether cycle helmets improve riders’ safety.

Lynn Myles, a consultant neurosurgeon at the Western General Hospital in the Scottish capital, described as a “keen cyclist” believes they do.

Taking the opposing view is Chris Oliver, consultant trauma orthopaedic surgeon at Edinburgh Royal Infirmary, who also happens to be chair of cyclists’ organisation CTC Scotland.

The issue is debated by them on Surgeons’ News, the website of the Royal College of Surgeons of Edinburgh, which has some 20,000 fellows and members throughout the world.

Ms Myles begins by acknowledging that she is “under no illusion that it [a helmet] will save me in the event of a high speed collision with a car or lorry (nothing will)” – a common criticism aimed at those who insist all cyclists should wear one – but adds that “most cycling accidents aren’t of the high-speed variety.”

Instead, after outlining other things that can be done to improve cycle safety such as addressing traffic speed and improving road layout, she says: “Most of the head injuries I have seen in cyclists are the result of low velocity crashes or simple falls due to ice or wet roads.

“There is no doubt in my mind that a well-fitting cycle helmet will reduce the incidence of scalp laceration and open fracture and will help to reduce the energy transfer to the brain.”

Apart from in sports, where she believes the type of potential injuries justifies governing bodies making helmets mandatory, Ms Myles isn’t calling for helmets to be made compulsory; she does point out though, that “in my department all neurosurgeons, neurologists neurointensivists and neuroanaesthetists wear cycling helmets when cycling – we can’t all be mad!”

Mr Oliver, however, maintains that “there is no justification for helmet laws or promotional campaigns that portray cycling as a particularly ‘dangerous’ activity, or that make unfounded claims about the effectiveness of helmets.

“By reducing cycle use even slightly, helmet laws or promotion campaigns are likely to cause a significant net disbenefit to public health, regardless of the effectiveness or otherwise of helmets,” he adds.

Like Ms Myles, he points out that helmets “are (and can only be) designed to withstand minor knocks and falls, not serious traffic collisions,” and says there is evidence that wearing one can increase certain types of injury.

Mr Oliver acknowledges that “whilst there is a correlation between helmet guidelines and reduced cyclists’ injury numbers, the evidence suggests this is wholly or mainly due to reductions in cycle use, not improvements in safety for the cyclists who remain.”

He goes on to highlight that a fall in the number of cyclists can put remaining ones at greater risk due to the absence of a safety in numbers effect, and outlines other arguments against compulsion.

He also warns against what can be termed compulsion creep, saying that “schools, employers and the organisers of non-sporting cycling events (e.g. sponsored rides) should not seek to impose helmet rules for their pupils, staff and participants.

“These rules are not justified in terms of health and safety, they are likely to reduce the numbers and diversity of people who take part in cycling, and they may in some circumstances be illegal.”

Mr Oliver believes that “individuals should be free to make their own decisions about whether or not to wear helmets, with parents making these decisions in the case of younger children. Their decisions should be informed by clear information about the uncertainties over helmets.”

As we regularly see here on road.cc, the helmet debate is an emotive one and it’s an issue that strongly polarises opinion; the fact that two senior medical professionals working in the same city and dealing with the aftermath of incidents in which cyclists have been seriously injured have such differing opinions on the subject is a reflection of that.