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White cycle helmetTop scientists on cycle helmets: "The debate will go on (and on and on...)"
Science writer Ben Goldacre and statistician David Spiegelhalter say that issues surrounding arguments for and against cycle helmets are so complex that they appear to be in conflict with the British Medical Association’s official policy, “which confidently calls for compulsory helmet legislation.”
The pair joined forces to address what is perhaps the most contentious of cycling topics – a subject they freely admit they “both dread questions about” – and, specifically, the issue of whether studies can conclusively settle the debate either way.
Their main conclusions after outlining some of the problems associated with trying to establish the benefit or otherwise of helmets through scientific means?
“The current uncertainty about any benefit from helmet wearing or promotion is unlikely to be substantially reduced by further research,” and, “we can be certain that helmets will continue to be debated, and at length.”
Goldacre, who besides being the author of Bad Science and Bad Pharma, is Wellcome research fellow in epidemiology at the London School of Hygiene and Tropical Medicine, and Spiegelhalter, Winton Professor of the Public Understanding of Risk at the University of Cambridge, were writing in the British Medical Journal (BMJ).
At the outset, they say: “We have both spent a large part of our working lives discussing statistics and risk with the general public. We both dread questions about bicycle helmets. The arguments are often heated and personal; but they also illustrate some of the most fascinating challenges for epidemiology, risk communication, and evidence based policy.”
They identify two broad areas that science seeks to address when it comes to cycle helmets: “At a societal level, ‘what is the effect of a public health policy that requires or promotes helmets?’ and at an individual level, ’what is the effect of wearing a helmet?’ Both questions are methodologically challenging and contentious,” they add.
Goldacre and Spiegelhalter single out one recent study, led by Jessica Dennis at the University of Toronto, which held that compulsory helmet laws in various Canadian provinces had achieved only a “minimal” effect on hospital admissions for head injuries related to cycling.
The pair acknowledge that other studies have reached different conclusions, but describe the one conducted by Dennis as having “somewhat superior methodology—controlling for background trends and modelling head injuries as a proportion of all cycling injuries.”
By contrast, they say, case-control studies, which often find reduced rates of head injury among cyclists wearing helmets compared to those who do not, “are vulnerable to many methodological shortcomings” – for example, “if the controls are cyclists presenting with other injuries in the emergency department, then analyses are conditional on having an accident and therefore assume that wearing a helmet does not change the overall accident risk.”
Other variables they identify and describe as “generally unmeasured and perhaps even unmeasurable” include the fact that people who choose to wear helmets may be more risk-averse than those who do not, plus whether there is an element of “risk compensation” in play among those forced to wear helmets in places where they are required by law.
They run through some of the issues that opponents of helmet compulsion make, including that making them mandatory negates the positive health benefits, but again outline that the issue is more complicated than it appears on the face of it, citing a study that identified “two broad subpopulations of cyclist,” each of which would react differently to the introduction of compulsory helmet laws.
That study, carried out by the Institute of Transport Economics in the Norwegian capital, Oslo, described the country’s cyclists as comprising “one speed-happy group that cycle fast and have lots of cycle equipment including helmets, and one traditional kind of cyclist without much equipment, cycling slowly.”
The Norwegian study added: “With all the limitations that have to be placed on a cross sectional study such as this, the results indicate that at least part of the reason why helmet laws do not appear to be beneficial is that they disproportionately discourage the safest cyclists.”
The BMJ article says that “statistical models for the overall impact of helmet habits are therefore inevitably complex and based on speculative assumptions,” and that “this complexity seems at odds with the current official BMA policy, which confidently calls for compulsory helmet legislation.”
“Standing over all this methodological complexity is a layer of politics, culture, and psychology,” they say – whether that be anecdotal evidence of acquaintances who avoided injury through wearing a helmet, or “risks and benefits may be exaggerated or discounted depending on the emotional response to the idea of a helmet.”
They also point out that the Netherlands and Denmark, for example, have high rates of cycling but low rates of helmet wearing and cyclist casualties, which they suggest results from deployment of decent infrastructure, legislation aimed at protecting riders, and cycling itself being viewed as “a popular, routine, non-sporty, non-risky behaviour.”
Goldacre and Spiegelhalter do however see something of value in the helmet debate, but it’s not related to the actual wearing or non-wearing of one, or whether they should be made mandatory.
“The enduring popularity of helmets as a proposed major intervention for increased road safety may therefore lie not with their direct benefits – which seem too modest to capture compared with other strategies – but more with the cultural, psychological, and political aspects of popular debate around risk,” they say.
Simon joined road.cc as news editor in 2009 and is now the site’s community editor, acting as a link between the team producing the content and our readers. A law and languages graduate, published translator and former retail analyst, he has reported on issues as diverse as cycling-related court cases, anti-doping investigations, the latest developments in the bike industry and the sport’s biggest races. Now back in London full-time after 15 years living in Oxford and Cambridge, he loves cycling along the Thames but misses having his former riding buddy, Elodie the miniature schnauzer, in the basket in front of him.
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71 comments
But maybe a ride on which you'd be very unlikely to fall off your bike?
Surely the likelihood of an accident ocurring has to be taken into account, otherwise we'd all wear helmets all day long.
i love it when people write 'end of debate' on helmet stories. you know, just sayin'
Proof that even the most obvious and simple answer to a problem can be clouded by utter stupidity and argued to the n'th degree if one side refuses to acknowledge the real issue:
"I think I look a prat in a helmet"
Well you dont so grow the f**k up and put a helmet on idiot.
I suffer from a painful scalp condition which is seriously aggravated by wearing a helmet. If they became compulsory, I'd pretty much have to give up cycling.
Does that make me an idiot?
Yes but that ISN'T the real issue.
I don't think it's quite as simple as that.
EDIT Oops! Meant to be quoting the comment above, sorry Mr Will!
"End of debate"? I wish...
What this does demonstrate, pretty conclusively, is that the positives/negatives of helmets are so hard to quantify that the case for compulsion can only be based on massively flawed 'evidence' which begs the question:- what is the underlying agenda behind compulsion?
Fingerless gloves, ball exposing lycra shorts and a skin tight top with a banana poking out of the back pocket set off with jauntily peaked cycling caps... Yeah, we are all really thinking "It's the helmet that's making me look silly here isn't it"?
You've taken a whole heap of nonsense and tried to pass it off as fact.
"I've had several head injuries in my life without a helmet.." And if you'd been wearing on maybe you wouldn't have had damage at all? Talk about anecdotal.
I agree with Conlinth on this.
If some people don't want to wear them that's fine by me but trying to argue that an inch of polystyrene is no better than nothing at all is just daft.
I notice that plenty of people with no helmets wear gloves. Why bother as they aren't any better than your skin when in contact with the road surely? Maybe try oven gloves and then no oven gloves and see which does more damage...
If only Rapha made helmets.................
So, to add to the fun...
After my recent experience, my helmet might have saved my forehead/brain but may have made my cheek worse. Who knows? Similarly, my glasses stopped my eyeball getting scratched but did bite my eyebrow
But I've found that parents and solicitors are happier after the accident when they find out you were wearing a helmet. It might well help stop people arguing contributary negligence, which is nice to know, and it stops parents telling you you're a twit!
(not a judgement but a fact of parents)
why do people who wear helmets always want to convert others to their way of thinking? i have never seen a comment from a non helmet wearer asking for the banning of helmets but have seen plenty from helmet wearers who seem to want helmet use to become law. give it a rest!
Just avoid landing on your head
A quick observation.
(a) By definition, most of us bike riders are laymen in terms of cycle helmet science, right?
(b) The cycle helmet scientists (i.e. experts, not laymen) cannot agree on the helmet debate, right?
If you accept the above, (and why wouldn't you?) surely, there is no point in anyone coming on here to express their *opinion* about who is right or wrong. Why not simply accept that some favour one side, some favour the other; we can all make our own choice at the moment, so why get so aggressive/defensive when trying to persuade others to accept your preference?
Me? I'll wait until the evidence is incontrovertible.
You won't get blamed for any head injuries, this is just another myth put about by the helmet zealots to justify their opinions. There has never been a case where a cyclist has been blamed or had their damages reduced in a court of law because they weren't wearing a helmet. The insurance companies have tried this tactic many times, but always withdraw it at the doors of the court, because they know it would be thrown out.
The mechanics of bicycle collisions are complex and unique, so the chances of what you suggest are, like my suggestion, nothing more than speculation. Given the number of "helmet saved my life" stories which involve the cyclist head-butting various parts of a motor vehicle, I'd say that it is quite likely that a head will hit something before the rest of the body, and therefore your forward speed is totally relevant.
Not really because they don't provide a control. You can't ethically make half the riders wear helmets and half not to measure what benefit helmets provide. Even if you could, riding in a peloton doesn't reflect the way that most cyclists use their bike so it only tests for one condition.
That's the problem with the existing case control studies too, they aren't really control studies because they don't control for all the variables. Until they do, there won't be an answer as to why the case control studies can't be reconciled against whole population time analysis. If a study claims that helmets will prevent 85% of head injuries as the Thompson Rivara Thompson study does, then that safety benefit must manifest itself in the before/after data in countries that have mandated helmets, and that's the problem because it doesn't.
Ah yes, the good old "my opinion trumps all the facts" proposition. Since nowhwere with a massive rise in helmet wearing, whether due to a law or propaganda campaign, can show any reduction in risk to cyclists, to argue that helmets are not effective is based completely on the facts.
Check out cyclehelmets.org for those facts, you might be surprised.
There has never been a case of contributory negligence being found in a court of law in any public road collision. The sole case where not wearing a helmet was found to be so was of such peculiar circumstances that it does not apply to any other case. Just tell your parenta and solicitors to examine the facts, and if they still insist that not wearing a helmet might be contributory negligence, change your solicitors. Not much you can do about parents except suggest that they read cyclehelmets.org
It's practically a religious thing "I believe this, so you have to as well". It's effectively zealotry of the worst kind, and the people who do it are quite happy to ignore facts which disprove their beliefs.
Unfortunately, it's not just the helmet wearing types who insist that you wear a helmet, just look at the people who want to bring a law in: Eric Martlew, Angie Lee, Annette Brook etc, etc, none of whom ride a bike, but have the effrontery to tell cyclists how to do it.
This would be all fine and dandy, if only those who want to force others to wear helmets accepted it, but they don't. They ignore all appeals to factual evidence, relying instead on opinion, anecdote and bad science to support their pre-concevied position.
There is a very large number of people who want to make cycling without a helmet a crime, when, as you point out, there is no clear evidence either way. Do you think you could have a word with these people and get them to desist?
I can't find whom I'm replying too but I don't believe for one second that the behaviour of motorists is affected by cyclists wearing helmet. "She's wearing a helmet, I can get a bit closer!" nor do I think that helmeted cyclists take more risks.
. Presumably her head was travelling at 12kph or less when it hit the ground. We'll never know whether a helmet would have saved her but why take that risk?
I wear a helmet and no longer worry about looking like a prat.
Also, I know it's not 100% relevant but Natasha Richardson died after slipping on ice while stationary (ski-ing)
Crashed on a group ride Wednesday front wheel went from under me on a wet corner and other than road rash I survived! Head hit the ground hard and trashed my £150 helmet but it did the job and saved my skull
I had a bike accident when I was a teenager. I was riding off road down a hill. I attempted to stop before hitting a fallen tree trunk which was obscured by long grass. My front brake seized and I next found myself being thrown off, over the handlebars landing on the top of my head. This resulted in my helmet taking the impact and splitting down the centre. If I was not wearing one who knows what state my head would have been in. There is so much traffic on the roads these days with inadequate roads fit for all modes of transport to share, particularly for bikes, as we all know. I know that wearing a helmet is not popular, but perhaps more advertising to the dangers of not wearing one, could be the way forward? Then it is purely down to everyone to make their minds up.
And THIS is precisely why I wear a helmet: it MIGHT save my skull.
However when I was delivered to A&E two weeks ago having been knocked off - but without a scratch on my helmet - I still had to restrain myself from having an argument with a nurse who told me it was "just as well I was wearing a helmet..."
This whole debate reminds me so much of the argument over global warming. Some people just won't accept the experiences of other people as evidence. They are anecdotes not proof. And no number of studies are accepted because they only show a correlation at best. The fact is we will never have empirical evidence on this sort of issue because you can't ask 100 people to have the same crash with and without a helmet and see which ones suffer injury or death.
So those people who demand proof do so knowing the only proof they will ever have already exists. If they choose to disagree on the benefits of helmets that is fine, but it has been proven as best as it can be.
At the same time there should be no compulsion, just choice. But I ask you would you go white water rafting without a helmet? The risk of hitting your head on a rock is higher but cycle 100,000 miles (or pick a figure)and the risk equals out, and would you rather not have the helmet when it is your head against the tarmac?
Until I can control the actions of motorists moving at speed in giant metal boxes I will choose to wear my helmet.
the point of the BMJ paper is that this evidence will probably never come, so dont hold your breath.
Yeah but, I had head injuries whilst:
1) In a van, van overturned.
2) On a bike, landed on chin.
3) Walking downhill, slipped on wet leaves.
4) Working indoors in an office!!!
5) Poodling to shop to buy a pint of milk, nasty one - concussion, probably rotational injury, helmet could have made it worse.
6) At a party.
7) Canal path, Cheek bone hit Cast iron boat (missed the water, doh).
I would have looked pretty silly wearing a helmet in most of these situations.
Precisely. Which is why all those with *opinions* or anecdotal evidence (both for and against) should just STFU and leave it to individual choice.
And, for the love of God, why can't people stop asserting that their helmet *definitely* saved their head from injury? How can they possibly know this? I have no problem if they state that it *probably* saved their head, but I guess that would be nowhere near sensational enough for most.
until the Man deploys some decent infrastructure and the rage-o-maniacs tone it down a few tics, bubble's on me bonnet.
And I have to ride down a steep hill just to get milk and butter.
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