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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
Or maybe non-helmet wearers are less inclined to read, and therefore comment on stories about helmets cos they're nothing to do with them, or maybe they're just better at crashing without hitting their heads, or maybe they're just better at not crashing in the first place
>“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.”
People who are riding slowly to the corner store often don't wear a helmet. (I've done it).
If more people weren't wearing helmets they'd ride slower?
I give these people an F (fail) for there report. At least the could have said "For the same ride at the same speed a helmet is safer", as well as "people who ride slowly are more like to be not wearing a helmet" and "not wearing a helmet may is likely to make people ride more cautiously".
Has anyone else noticed from the comments how many helmet wearers seem to hit their heads, some multiple times, while nobody without a helmet has posted about hitting their head?
You clearly missed my earlier post.
I suppose one could say there are more people still around to talk after they've hit their heads, perhaps those that weren't wearing one tend not to be able to write posts on websites anymore. Or there may be more helmet wearers that read this website or they're more inclined to post about accidents as they feel something has saved them and they want to spread the word.
I like to think it's a mix of all three.
Yes, the pro-helmet lobby do have this fantasy that hospitals and nursing homes are crammed full of brain injured cyclists who didn't wear helmets.
Not advocating cycle helmets, but this is amusing:
https://www.youtube.com/watch?v=HNoo9ZekHbs
And for balance,
Bike helmets don't keep you safe
And that expensive helmet, no safer than the cheap one.
https://www.youtube.com/watch?v=zyIucLcCKKc
But what about the legal situation ? - a recent Legal case in Edinburgh convicting a driver who killed a cyclist ( not the first one either) had an incredibly lenient sentence on the grounds that the cyclist might have survived if she was wearing a cycle helmet. She wasn't. Eh....no ......it wasn't helmet or no helmet that killed her was it? It was the motor vehicle hitting her from behind that killed her. But the legal establishment thinking appears to assume that the cyclist is in some way negligent if they aren't wearing a helmet. So - even if you're not badly hurt in an incident - it would appear that you are at a legal disadvantage if you've chosen not to wear a helmet.
The point is that so long as a 'Helmet Debate' takes place, attention is diverted from actually DOING something to lessen the killing, injury and intimidation of cyclists by motor vehicles.
There are very real solutions to the dangers to cyclists but these would all involve some degree of inconvenience to the motorists complete control of the road. Governments have been in thrall to the Car/Road lobby for over half a century now and are unlikely to change. So - they find it much more convenient to redirect attention from the cause to a "Debate" about just how much the victim is to blame for being killed, injured or intimidated by their lobbyists.
The same thing is used in most of politics. Man-Made Climate Change is a clear parallel.
For decades, scientists insist it's a catastrophic event. Oil companies keep it being referred to as "A Theory" for decades and a subject for some abstract debate. In the meantime, absolutely nothing is done to alter the situation. Cosmetic fudges are made which change nothing.
Same with Economists warning of the Banking Crisis.
If ever those in charge wish to derails something they don't like they "Call for a debate" and carry on as normal.
There was - you'll notice - no similar 'Debate' about the existence of America, of Nuclear Fission or the efficacy of the Motor car.
There was money or power in them.
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.
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.
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.
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
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..."
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)
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.
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?
the point of the BMJ paper is that this evidence will probably never come, so dont hold your breath.
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.
Just avoid landing on your head
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!
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.
It's funny, the website you mention in your above post about cycle helmets seems to try and convince people that helmets are actually a bad thing, which is the same thing you are criticising only it's pro your argument so I guess that's ok? I've read a few of their critiques of reports and they don't seem very impartial on the ones pro helmets but seem quite vague on the anti helmet ones. Interesting reading though.
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)
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
If only Rapha made helmets.................
"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?
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?
I don't think it's quite as simple as that.
EDIT Oops! Meant to be quoting the comment above, sorry Mr Will!
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