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Doctors Oppose Bike Helmet Law: British Medical Journal Survey

By Ryan McGreal
Published August 05, 2011

The Telegraph reports on a recent survey from the British Medical Journal which found that two-thirds of its reader community of British doctors oppose mandatory bike helmet laws.

The BMJ has published a selection of respondent comments on its blog. A number of comments point out that the health benefits of cycling far outweigh the risks, and that mandatory helmet laws serve only to reduce the number of cyclists without reducing the rate of risk, hence producing a net reduction in health.

Since no country with a helmet law can show any reduction in risk to cyclists, only a reduction in cyclists, why would anyone want to bring in a law for something which is clearly not effective at reducing the risk to cyclists? The largest research project about helmets showed a small but significant increase in risk with helmet wearing. There is no reliable evidence that cycle helmets reduce the risk to cyclists, and all the research that shows massive benefits from helmets has been peer reviewed and found to be unreliable.

Regular cyclists live longer, are fitter, healthier, and have a better quality of life: one researcher has said that if the benefits of cycling could be bottled, it would be the most popular medicine in the world. The only observable effect of helmet laws and propaganda is to reduce the number of cyclists, and those people deterred from cycling lose the massive benefits, and therefore the overall result of helmet laws and propaganda is a large reduction in the public health.

Other comments point out that helmets are not actually designed to protect cyclists from collisions with motor vehicles:

Cycle helmets do not protect cyclists from impacts with motor vehicles. They are designed to be useful at 12 mph [19.3 km/h] or less and only protect the side of the head. If you want to campaign to force cyclists to wear helmets then you should also campaign to force motorists and pedestrians, as they would be just as "useful" to them. Why not run a campaign to get motorists to respect vulnerable road users instead of victim-blaming?

The peer-reviewed BMJ is a wholly owned subsidiary of the British Medical Association, which is the professional organization of medical doctors in Britain. A February 2011 statement that precedes the survey notes that the issue is controversial but that the BMA "supports compulsory wearing of cycle helmets when cycling for children and adults."

A number of respondents to the BMJ survey referred to research published by the British Medical Association itself, including Cycling Towards health & Safety by Meyer Hillman, which runs counter to the BMA's support for a helmet law.

Ryan McGreal, the editor of Raise the Hammer, lives in Hamilton with his family and works as a programmer, writer and consultant. Ryan volunteers with Hamilton Light Rail, a citizen group dedicated to bringing light rail transit to Hamilton. Several of his articles have been published in the Hamilton Spectator. He also maintains a personal website and has been known to post passing thoughts on Twitter @RyanMcGreal.

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By chimochimo (registered) | Posted August 05, 2011 at 17:27:45

At this point the law here is mandatory for those under 18. So it's really a non point, regardless of the disputed math in the studies cited. But regardless, helmet, no helmet. I really don't care. I tend to walk far more than ride. I do have a bike. I do not have a helmet. If I chose to ride on a regular basis, I would wear a helmet. I do hope that yourself(Ryan) and any avid or casual bikers can answer a burning question I have. If 1, 2 or even 6 cars are stopped at the lights at Kenilworth and Main in the curb lane and a cyclist comes along behind those 1, 2 or even 6 vehicles. Where does the cyclist stop? Where does the law require he or she to stop?

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By two wheels good (anonymous) | Posted August 06, 2011 at 23:10:13 in reply to Comment 67518

Lane splitting / filtering is legal in some jurisdictions, but not in Ontario, so you come to a stop a safe distance behind the vehicle in front of you.

To be more safe you should be in a blocking position in the lane, that is more or less in line with the left hand tire track of the vehicle in front of you

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By HamiltonBrian (registered) | Posted August 06, 2011 at 13:26:34 in reply to Comment 67518

I'd stop behind the last vehicle. In cases of a long pile-up, such as Dundurn heading south, I'll try to ease on up forward as safely as I can.

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By Undustrial (registered) - website | Posted August 06, 2011 at 00:47:20 in reply to Comment 67518

That's an interesting question...not quite sure that I've ever heard of a specific law. Personally, I generally tend to stop behind the last car. I take a lane when I ride, so it's only sensible to act like a car at lights.

On the other hand, in jammed up traffic, it's far safer to ride up between or beside cars which are stopped. In a traffic jam, why add to the congestion? Not something I do often, though.

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By misterque (registered) - website | Posted August 06, 2011 at 02:25:13

A survey of less than 2000 doctors in a country that has more than 100000 is hardly a study, a consensus or a reason to take off one's helmet.

Every case controlled study shows that helmet use reduces mortality and morbidity in cyclists that get in accidents. This means that helmets reduce injury when accidents happen. The Cochrane Collaboration has done a reasonable, but not perfect, meta analysis showing helmets help and don't harm. The conflicting studies are soft. Dr. Piet de Jong's study about mandatory helmet laws decrease ridership misses out on competition for recreational exercise (blading, yoga, dance, hiking, swimming) that has grown over the same time period. The study of increased driver aggressiveness with helmeted cyclists is completely ridiculous

Helmets have been shown to reduce injury in hockey, lacrosse, football, construction sites (this helmet needs to be improved drastically), military conflict, motorcycling, race car driving, rock climbing, etc etc.

So why on earth are elements of the cycling community continuing to cling to such poor evidence? Especially when it can lead to increased harm.

Even if the jury were out on this one, a helmet should be worn in the interim, based on the copious case controlled studies that show the helmet's effectiveness. But the jury is not even out on helmet use.

Mandatory helmet laws along with proper education (drivers and cyclists) with excellent cycling lanes is the way to go.

Tonnes of yummy links here: http://www.bhsi.org/

Comment edited by misterque on 2011-08-06 02:27:43

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By burtthebike (anonymous) | Posted August 07, 2011 at 04:22:27 in reply to Comment 67536

Dear Misterque, you quite obviously either haven't read anything about the helmet debate or you are deliberately misleading people.

The case control studies you quote are all methodologically unsound, and have been roundly criticised in peer review: they are all short term, small scale projects. The evidence that you dismiss as being "soft" have been peer reviewed and found to be robust: they are all long term, large scale (sometimes whole population) studies. There are international scales for the reilability of evidence, and the research showing no benefit from helmets is rated much more reliable than that showing massive benefits.

You say that helmets have reduced deaths and injuries across a range of activities, but provide no evidence. In the only activity of which I have knowledge, motorcycling, this has not been shown.

You finish up by saying that helmets should be worn, as the case control studies show that they are beneficial, but case control studies have been shown to be wrong on a number of occasions, producing results exactly opposite to reality, and many scientists will not rely on those results unless supported by more reliable evidence. In this case, the reliable evidence flatly contradicts the case control studies. So you want to make people wear something which can only be shown to work on the flimsiest of evidence, which is contradicted by much more reliable evidence? You would appear to have a practically religious belief in helmets and dismiss any evidence which doesn't support what you "know" except that you don't know it, you only believe you do.

For those of you slightly more open minded, try looking at a few facts rather than quasi-religious beliefs cyclehelmets.org

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By math geek (anonymous) | Posted August 06, 2011 at 23:28:35 in reply to Comment 67536

misterque said"A survey of less than 2000 doctors in a country that has more than 100000 is hardly a study, a consensus or a reason to take off one's helmet."

Actually that's a pretty good study. The story said 2/3 (66.6%) of the 1427 surveyed doctors opposed the helmet law, so knowing that, and assuming the doctors questioned were chosen at random from the list of all doctors we can do the statistical calculations and find a confidence interval of 3.02 with a confidence level of 99%

What that means is if you were to survey all 100000 doctors in the country you could be 99% sure that between 63% and 69% of them would oppose the use of helmets.

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By SpaceMonkey (registered) | Posted August 07, 2011 at 21:02:09 in reply to Comment 67582

Even if 5000 out of 5000 surveyed Drs responded that they disagree with a helmet law, the study is still flawed for one basic reason. Dr's are the wrong people to be asking. It's good to poll Drs on things like what the best type of treatment is for an illness, not on the safety of helmets. Now, if the study polled 1000 helmet safety engineers, then we have something to talk about. Polling Drs on the safety of bike helmets is like Polling Drs on whether one way or two way streets are best for traffic flow.

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By Mr. Meister (anonymous) | Posted August 07, 2011 at 17:42:58 in reply to Comment 67582

Back in the 1950's doctors used to routinely tell women to smoke in order to lose weight. How does that look now 50 or 60 years later? In the 1970's as seatbelt laws were enacted I heard all the same silly arguments against wearing seatbelts. As time goes by all those asinine reasons for not wearing seatbelts become more and more laughable. Anybody care to wager a few pesos that 50 or 60 years from now we will see the same thing about all these "reasons" for not wearing bicycle helmets.

Common sense is a wonderful thing. Try it some time.

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By rednic (registered) | Posted August 06, 2011 at 11:29:27 in reply to Comment 67536

Mandatory helmet laws along with proper education (drivers and cyclists) with excellent cycling lanes is the way to go.

Well if cyclists should wear helmets Why not all automobile users as well ?

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By Mr. Meister (anonymous) | Posted August 07, 2011 at 08:22:20 in reply to Comment 67550

Seat belts, air bags, crumple zones.

Racing drivers do wear helmets.

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By misterque (registered) - website | Posted August 07, 2011 at 06:11:41 in reply to Comment 67550

Automobile users are required to wear a restraint called the seatbelt by law. Almost all cars now have airbags to also protect the driver. If you chose to wear a helmet in a car, I imagine it would reduce your morbidity and mortality. For example, race car drivers wear them.

A helmet is the only one of the three above options available for protecting one's head.

C:)

Comment edited by misterque on 2011-08-07 06:12:12

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By SpaceMonkey (registered) | Posted August 06, 2011 at 09:17:35

I have to admit that I don't wear a helmet when I ride my bike, but I don't think it's a wise thing to do. I keep telling myself that I'll get a helmet, but it just hasn't happened yet. I think it would be foolish for someone to say something like "See? some Drs oppose the helmet law, so it means that it's okay not to wear one". I still plan on getting a helmet one day... maybe I'll finally do it this weekend.

In a previous helmet article, I posted a link to a bike crash in the TDF where a rider was going at a good speed (maybe 50km/h) and his helmet bounced off the pavement. He's fine. Anyone that sees that video and can say that bike helmets don't really increase safety is lying to themselves.

Just something that crossed my mind now... curious to hear others' thoughts. I know that bike helmets and motorcycle helmets are much different from each other, but if a helmet is designed, mostly, to help at low speed crashes, shouldn't it be more important for a cyclist to wear a helmet than a motorcyclist?

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By HamiltonBrian (registered) | Posted August 06, 2011 at 13:25:25

I don't know; I rather like keeping my melon intact if I ever have the misfortune of crashing or being hit.

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By misterque (registered) - website | Posted August 07, 2011 at 06:08:53

These are up to date, excellent studies. C:) <- that is an emoticon with a helmet on its head.

http://goo.gl/ZCyDG

http://goo.gl/fmjbI

http://goo.gl/JsThr

Mandatory helmet laws, education for drivers and cyclists, separate cycle roads.

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By burtthebike (anonymous) | Posted August 08, 2011 at 02:37:20 in reply to Comment 67587

The first link is to a researcher talking about his own work, hardly a reliable source of criticism.

The second link is to a report about research issued very recently, and far too soon for peer review. It may be open to challenge on a number of points e.g. it uses 20 year old data, which may not be reliable.

The third link is to research which has been peer reviewed and has been challenged http://injuryprevention.bmj.com/content/16/4/219/reply

Frankly misterque, you appear to be deliberately misleading people, or your belief is so embedded that you dismiss anything which doesn't agree with it.

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By misterque (registered) - website | Posted August 08, 2011 at 15:35:49 in reply to Comment 67619

Dear anonymous person,

I am not intending to mislead anyone nor am I engaging in any nefarious behavior. Nor does the post engage in any insulting comment about intellectual intransigence. So polite yourself up some.

http://goo.gl/ZCyDG It is a discussion page, and not the direct study. Contained on it is an amazing discussion with comments from the original authors, disagreeing professors, statisticians, editors and well established researchers. There are all kinds of challenges to the paper in the discussion. The original author(s) answer them very well. The discussion is polite, focused and informative from both sides. So your first complaint is way off, this is hardly a solitary wank fest by the author(s).

http://goo.gl/fmjbI Truly all papers must survive the test of time. The authors have no vested interest in preventing cycling from happening, they are not sponsored by car companies and the like (Walter, Scott, Injury Risk Management Research Centre, Faculty of Science, UNSW; Olivier, Jake , Clinical School - Prince of Wales Hospital, Faculty of Medicine, UNSW; Churches, Tim; Grzebieta, Raphael, Injury Risk Management Research Centre, Faculty of Science, UNSW). The journal in question is a PEER reviewed journal on Accident and Injury prevention, so it does not get published unless it passes muster. This peer review process would also look at the validity of the data. So although it is early in this paper s life it is NOT correct to dismiss it at your convenience.

http://goo.gl/JsThr Agreed it is being challenged, and challenged well. All studies will be challenged. The challenge will be reviewed by people that understand the statistics. If there is problem with data or interpretation then the study will be retracted by the journal or corrected by the authors. Since this paper could be viewed as a 'challenge' to those studies (especially the BMJ) I would not automatically dismiss the study challenged. Nor should you.

The topic is open for discussion. I have given access to many sources that help me formulate my decision. These links have allowed you to post specious comments and trash talk. Please take the time to link to the studies that have led you to your open minded decision that puts real heads at risk right now.

Thanks.

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By Mr. Meister (anonymous) | Posted August 07, 2011 at 08:29:39

How about a little common sense?

One of the great arguments against cycling helmets is that they are designed to protect us from a very limited type of accident. My car was designed to get me from point A to point B. If I were to collide with a cyclist my car would do great harm to the cyclist even though it was not meant to do so. Just because it was not designed to do so does not remove the ability to do so.

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By Undustrial (registered) - website | Posted August 07, 2011 at 10:37:06 in reply to Comment 67593

And just because you didn't mean hit someone, doesn't mean you weren't the one who brought five tons of steel to the encounter. When I cycle, I bring roughly twenty pounds.

If the inherent dangers of cars "prove" anything it's that automobile traffic needs more restrictions, not everybody else. As a cyclist, I don't assume that people need to don extra protective gear to protect them from me - I accept that it's my duty not to hit them.

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By Mr. Meister (anonymous) | Posted August 07, 2011 at 17:37:49 in reply to Comment 67600

I agree but my wearing a helmet in my 1 1/2 ton car does not do a damn thing to protect your head. It is up to you to wear a helmet or to bear the consequences of not wearing one.

I do not ride a bike anymore but in the past I have put many miles on my bikes. I am actually very bike friendly on an ongoing basis and when I drive. Cyclists' attitudes have changed have changed over the years and a great many of them are in for a very rude awakening. We are facing a growing attitude of entitlement not only in cyclists but in our society as a whole. Attitudes like "it is my right to bike anywhere I want." This is bringing cyclists into a collision course with cars.

There are plenty of restrictions on cars. It is bicycles that are going to see some more restrictions in the coming years. How long before bikes need insurance? How about licenses? Safety checks to make sure brakes and noise makers work? My personal pet peeve is cyclists who ride after dark without lights, we really need to stop that nonsense. If cyclists want to be taken seriously they need to behave seriously.

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By Undustrial (registered) - website | Posted August 07, 2011 at 21:05:47 in reply to Comment 67606

Riding after dark without lights is illegal. As is riding without a bell or working back brake (must be able to skid on dry pavement). Sadly, of the three, the only one you're likely to actually see a ticket for in this town is the bell.

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By Dale (anonymous) | Posted August 08, 2011 at 14:15:44

Anyone who rides long enough in city traffic and/or has ever hit the pavement/ground at high speed understands the logic and necessity of wearing a helmet. What's troubling is that many people wear their helmets in a fashion where they aren't doing any good (too loose, too far back on the head, ill fitting, etc.). As someone earlier in this thread pointed out, watch the video of various professional cycling crashes to see firsthand the efficacy of a properly worn helmet. Note that professional cyclists complained quite loudly when helmets were first mandated, but now that they've all seen or experienced a crash where the head impacts the ground yet the cyclist walks away, the whining has stopped and there is no resistance to the rule whatsoever. Also note that they are professionals, some of the best bike handlers in the world, yet opt to wear helmets.

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By bicycle helmet (anonymous) | Posted March 06, 2012 at 01:08:43

Greetings! Very helpful advice on this article! It is the little changes that make the biggest changes. Thanks a lot for sharing!

Regards:
bicycle helmet

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