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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.
Latest Comments
- marmotte27 1 sec ago
Tried engaging with logic yet? If so, seems not to have worked out for you.
- Nick T 1 hour 20 min ago
As a motorbiker as well as cyclist, that side nod is how I greet other riders
- andystow 3 hours 36 min ago
I use Newton meters (sorry, US based) a lot at work, and I usually use the dot to make it clearer, N·m. I'll use N-m if I'm in a hurry. Otherwise...
- Dnnnnnn 6 hours 37 min ago
Boatsie, is that you?
- timmyotool 8 hours 27 min ago
£52 of sale price is so impressive, when you see some companies giving small %age of profits from sales to similar initiatives. Well done Galibier!
- wtjs 8 hours 35 min ago
If drivers routinely get away with this then how the hell do MPs like this expect it to work for bikes?...
- Rendel Harris 10 hours 36 min ago
When was the submission? I have been informed by the Met that although they have to send an NIP within fourteen days they then have up to six...
- Another_MAMIL 11 hours 10 min ago
While I agree, not all bike fitters are equal. I found their know-how varies enormously—some are considerably more expert than others.
- katar_6 11 hours 12 min ago
Now on my PC it says again that I don't have a subscription. I ask you to indicate what should be done to avoid this situation.
- Creakingcrank 12 hours 17 min ago
Like Hawkinspeter, I am a bit of a tool squirrel. I bought one of these. It is really neat and well made, but I've found it rather confusing to use...
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71 comments
Your suggestion that forward progress is going to be halted in the majority of cases is fairly sensible (although just a suggestion as there are no facts to back that up) but it would really only be relevant in terms of helmets if it was in fact the helmet which hits the immovable object first which seems less likely to be the majority of cases.
Obviously a crash could result in going head first into an immovable object (and I'm not sure it's that impact which the helmets are designed for) but it seems more likely another body part will hit the object and the head will hit the floor (which I think they are designed for). In the latter case, you may still end up with some broken bones but you may be saved from having a gash on your head as well.
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.
I agree that collisions are complex and that my point, like yours, is just an opinion so neither of us are going to be able to prove one way or the other. But, you can't have it both ways, you can't discount the 'stories' in one argument and then use them to validate your opinion in another, either a lot of people have hit their head and it's saved their life (and helmets help) or you don't believe this to be the case (and helmets are useless).
My assertion was that due to the head being a small part of the body, if something was going to hit something, it's less likely to be the head, especially if you take into account the instinct to put out your arms or protect your head. The countless stories could still be explained if something else hits the object and the head then hits the ground or object afterwards. I was just suggesting that in that scenario (which I suggest seems more likely), the helmet would be protecting the head from the impact it was designed for and the forward speed is not relevant.
The real problem is why the BMA changed its policy on spurious grounds and haven't revisited that decision, despite promising to do so. As one commentator so accurately pointed out, the BMA is a trade union for ex-medical students, not a medical body. Its decisions are certainly not based on evidence.
clunk click every trip
If I'm doing a stage of the tour de france and reaching speeds of 80kmh, I'll wear my helmet. If I'm cycling to the shops to buy a pint of milk, I won't. End of debate.
Wonderful logic. Regular cycle helmets are designed to ameliorate the effects of impacts of just over 12mph, ie. the speed at which you might cycle to the shops to buy a pint of milk
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.
And you don't seem to understand a single thing about cycle helmets "end of debate" or not.
They are tested to about 20kph, so might just be effective for a low speed trip to the shops to buy a pint of milk, but at 80kph the forces involved are so outside the limits of their design that they are useless. In fact, they increase the danger from rotational injury, which is far more dangerous than direct impact.
its all down to strap tightness. Dont get them started on the impact of aeroshells on helmets and the resultant speed increases caused by having all those watts to be spare
Im glad that is settled then.........................
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