Friday, March 4, 2016

Bicycle Helmets – Today’s Bloodletting

(I wrote this article seven years ago. So sad it remains relevant today.)

Bloodletting seems a distant absurdity to us and yet, just a few hundred years ago, we lost George Washington because he trusted its rhetoric over logic when he agreed to it as treatment for a nasty cold. With only a few quiet voices protesting the countless deaths caused by bloodletting, the practice continued well into the 20th century. Today’s bicycle helmet promotions and laws hold an alarming resemblance to the pronouncements used by the bloodletters. When an illogical practice is presented as the only means of safety and dismissal of the practice is equated to certain death, even the most brilliant leader can succumb to its absurdity.

Myths about helmets charm countries most where bicycling is not commonplace. In these countries, helmet rhetoric has escalated to the point where those not familiar with bicycling believe that if you so much as swing your leg over a bicycle without wearing a helmet you will smash your head open. In such places, those who ride a bike without a helmet are chided by onlookers at every turn for their reckless, irresponsible behavior.

Where did these chiders get their information? Most helmet propaganda is originally published by insurance companies, health practitioners and government agencies who have avoided countless law suits by blaming bicyclists in crashes for not wearing a helmet, sometimes even when their injuries or death did not involve injuries to their head.

While many studies have shown that bicycle helmets do little to prevent major head injuries beyond minor skull fractures and lacerations (Curnow 2001), a few poorly executed, misleading studies are the only ones to have reached mainstream distribution. The most common bit of jargon of them all is that “cycle helmets prevent 85% of head injuries and 88% of brain injuries” when in fact, where helmet use is high, there has been no detectable reduction in head injuries. See this link for a good overview: .

Helmet rhetoric that sets bicycling out as far more dangerous than it is, is the greatest hindrance to programs for increasing bicycling. A great deal of truthful yet catchy promotions will be necessary to counter this noise. Remember, bloodletting was “common sense” for 2,000 years! One of the best examples for illustrating the truth is this fun quiz on the dangers of bicycling:

Mandatory helmet laws often follow the spread of bicycle helmet rhetoric, adding the weight of the law to the idea that bicycling is more dangerous than any other form of transportation. In fact, as you will have found in the above quiz, if these laws took a realistic approach to their attempt to prevent head injuries, all pedestrians and car drivers would be required to wear helmets as well. And, it seems, a law requiring the wearing of helmets inside the house would also be a good idea.

Helmet laws also present another barrier to potential cyclists who already see many barriers to starting cycling. Mandatory helmet laws add to this list and thus prevent many new riders from starting. These laws have also been proven to decrease numbers of current cyclists thus increasing the potential for crashes by hindering safety in numbers. This theory has been proven to show that a motorist is less likely to collide with a person walking or bicycling when there are more people walking or bicycling (Jacobsen 2003).

Bicycle helmets may provide some protection against minor skull fractures and lacerations, but they do not prevent major brain trauma that happens within the skull. In fact, because bicycle helmets are soft which increases friction in certain crashes, unlike motorcycle helmets, some studies have shown that they can cause neck and brain injuries from rotational motion (V J M St Clair, B P Chinn. 2007).

So, in minor crashes, bicycle helmets can assist in preventing minor injuries, though the potential of their doing harm in a major crash must be considered. Like bloodletting, which, in retrospect was found to have unintentionally benefitted a few lucky survivors because they were later discovered to have high blood pressure, helmets have surely prevented nasty gashes and painful skull fractures.

Bicycle helmets can be a good choice for someone concerned about minor head injuries as long as they understand their helmet’s limitations for preventing major head injuries, not unlike choosing to wear knee pads and gloves. However, some studies have shown that helmeted bicyclists take more risks than those not wearing a helmet (Pless IB, Magdalinos H, Hagel B. 2006). Thus, whenever a potential helmet benefit is mentioned, the potential of a helmet causing neck and brain injury, as well as this risk compensation, must always be included for bicycle helmets to be presented in a truthful light.

Another important point to understand is that helmets do not prevent crashes. Improved road and pathway conditions, driver and bicyclist education, better protections for cyclists and increased numbers of bicyclists through safety in numbers, prevent crashes. Too often government officials, health practitioners and insurance companies grasp at helmet laws as a quick and cheap solution that removes them from liability and the responsibility of providing quality provisions for bicyclists.

Helmet laws and overblown promotions also set in place a ready-made blame-the-victim reaction. Each time a helmetless cyclist is in a crash, their bare head becomes the focus even if the driver deliberately hit them and their injuries were not head related. Remember that whenever one of these laws is presented, it is from a knee jerk reaction, either to a recent crash or fabricated rhetoric, usually by officials seeking to avoid liability, framing the argument as making crashing safer.

Let’s replace our helmets with thinking caps. If we can agree that increasing bicycling is in the best interest of our people and our planet, it’s time to shift our promotions and policy efforts away from the illusion of safer crashing and into reshaping our communities into places where everyone knows the safety of bicycling.