CRAG has not yet received a response from this submission
SUBMISSION ON BICYCLE HELMETS
When the then Prime Minister Hawke announced the ‘black spots’ program in December 1989 to reduce the national road toll and improve safety, he offered additional road funding to induce the states and self-governing territories to legislate for ten “known and effective” measures. One such is the compulsory wearing of bicycle helmets, and even though it was untested anywhere in the world, it became law Australia-wide by 1992, as “a logical progression from motorcyclists”. The states’ and territories’ laws are supported at the federal level by the prescription of a mandatory standard for helmets under the Trade Practices Act 1974.
The policy of compulsory wearing of helmets is examined here as follows:
2. Efficacy of helmets
3. Helmet laws in practice
4. Upholding the laws
The submission draws on the detailed exposition in Chapter 6 of the book Transportation Accident Analysis and Prevention, a copy of which is enclosed. It is referred to by page number designated as  etc. Other references are listed in the endnotes.
1. Origins [156, 158]
The Royal Australasian College of Surgeons (RACS) was the first to argue for compulsory wearing of bicycle helmets. Its testimony to a federal parliamentary inquiry in 1977 emphasised death and permanent intellectual incapacity from head injury and the inquiry’s report, released in 1978, recommended that the possibility of compulsory wearing should be kept under review. Precedents for compulsion were the wearing of helmets by motorcyclists and the use of seat belts by motorists.
A further federal parliamentary inquiry was undertaken in 1984, and by that stage belief in the value of helmets for mitigating injury to the brain was widespread. The RACS was urging what it called “the third major step” and some bicycle groups had accepted the use of helmets and were promoting it as a safety measure. The Australian Medical Association’s (AMA) policy was that all cyclists should be required to wear a helmet while the National Health and Medical Research Council (NHMRC) recommended compulsory use by children. The then Federal Minister for Transport stated that he supported the wearing of helmets, opining that they can save cyclists’ lives. But all such support for helmets, from medical bodies, cyclists’ groups and Minister, predated the studies that were subsequently relied upon to show their efficacy [160-61]. It was not informed by any properly conducted studies. Nevertheless, the inquiry’s final report in 1985 recommended the compulsory wearing of helmets by cyclists. Subsequent parliamentary inquiries in Victoria in 1986 and NSW in 1988 assessed the risk to cyclists as great or worsening and made similar recommendations. Their reports appear as principal exhibits in an official statement of reasons for the Federal Government to adopt this policy.
In Victoria, the Government acted from 1980 to promote the voluntary use of bicycle helmets. In 1984, an official publicity campaign highlighted the risk of death and permanent disability from head injury, its intention being to trigger parents’ fear about their children’s safety. An increase in voluntary wearing followed and in 1984 Victoria announced its intention to make it compulsory. The intention became policy in September 1989.
Two further factors influenced the development and adoption of a federal policy on bicycle helmets. In a submission to the then Prime Minster in April 1989, the prominent surgeon Sir Dennis Paterson urged the Government to take the initiative on road safety. He emphasised the occurrence of brain injury and permanent disability to young adults and children and the savings in hospital and other costs that prevention of these could yield. For cyclists, he suggested that the wearing of helmets should be encouraged with a view to it being compulsory later, but the Government opted for compulsion forthwith. Sir Dennis also pointed to need for further research and analysis on the causes of death and injury and recommended that both the Departments of Transport and Health should contribute to supporting a road safety authority with the capacity for research. But health authorities have consistently declined to undertake research or engage in the debate on the effects of the helmets policy on public health.
The second factor was an assurance of popular support. A national survey of 2000 people just before the Prime Minister’s announcement indicated that 84 per cent of respondents supported compulsory helmets for all cyclists, rising to 93 percent for their use by children. It is highly likely that most of the respondents would have been non-cyclists and favouring restrictions on other people is an easy course. Such surveys are of course no substitute for proper research and analysis.
The compulsory helmets policy was tied to the Government’s “black spots” program with the Federal Government securing the agreement of responsible ministers of the states and self-governing territories through the Australian Transport Advisory Council (ATAC). It is stated that the official purpose of the federal policy is to minimise the medical and other public costs of accidents to cyclists. This, in effect, imposed a preventive medical treatment solely upon those who choose to cycle. Ironically, the risk of serious casualty to cyclists was falling in 1989.
2. Efficacy of helmets [141-150]
By tradition, protection of one’s own person without harm to others is a matter of individual choice. Law to compel it therefore requires, as a minimum, sound evidence that the means are efficacious.
The laws that compel the wearing of helmets stem from the fear of death and dementia from head injury. Those who advocate the use of helmets and the content of official publicity have typically focused on these dire outcomes, but they have failed to acknowledge that they are rare. The problem for policy is therefore how best to protect the community from brain injury without unfairly discriminating against a particular group.
A rational search for a solution would start from knowledge of the types of injury and their causes. There are two main types, focal and diffuse. Until the mid-twentieth century, only focal injury comprising obvious lesions was recognised. A common cause of it is an external object or cranial bone striking the brain when the skull is penetrated or otherwise fractured. Helmets used in warfare and industry therefore have hard shells which protect the skull against fracture by bullets, falling stones and the like. The first cycle helmets were of this design, but it is doubtful whether today’s soft helmets can prevent fracture of the skull and consequent injury to the brain.
The other type is diffuse injury which occurs to the nerve cells of the brain, concussion being its mild form. Its severe form, diffuse axonal injury (DAI), occurs mainly in road traffic accidents, is often fatal and is the commonest cause of dementia from head injury. It typically occurs when the person is the moving object and is subject to an oblique impulse which imparts rapid rotation to the head. The skull need not be damaged or the head even struck, as with whiplash injuries. Focal injury can also occur if bony protuberances inside the rotating skull strike the brain. Reducing rotation is therefore critical for protecting against both focal and diffuse injury, but it is an unsolved technical problem standard helmets are not tested for capacity to do it. Further, studies in Australia (1987), the USA (2003) and the UK (2007) have yielded evidence that the addition of a helmet to the head can actually increase rotation. The conclusion is that no assurance can be given that helmets of current design can protect the brain. Worse, wearing a helmet might well increase the risk of injury to it.
When the RACS urged the compulsory wearing of bicycle helmets at the federal parliamentary inquiry in 1977, it provided no evidence of their efficacy. Indeed, Dr Trinca showed a cavalier attitude to it, stating: “We could perhaps worry a little less about and take a little less time in proving what is precisely right according to all standards … As doctors we are impatient. We cannot wait for 2 or 3 years evaluation”. This is no basis for good policy. Later, the RACS argued that helmets would be efficacious because a study by two of its members, McDermott and Klug, had found a higher rate of head injury among cyclists who did not wear them than motorcyclists who did. A later study by Dorsch et al. discredited this argument, but the RACS persuaded governments that there should be no medical exemptions (Enclosure 2). By 2002, the RACS was relying on a 1993 study by several of its members for evidence of the efficacy of helmets, but it has been refuted . Neither the AMA nor the NHMRC has provided independent evidence to support their advocacy of compulsory wearing, the former merely relying on the RACS.
2.1 Evidence for the 1989 decision [158-160]
In response to a request to state the rationale for compelling cyclists to wear a helmet traffic authorities have cited six reports. None of them provides sound evidence of efficacy against brain injury.
Extraordinarily, the report of the federal parliamentary committee which recommended compulsory wearing is not cited. The committee was prematurely disposed to believe in the efficacy of helmets and readily accepted findings of the studies it cited. The most influential, a 1984 version of a study by Dorsch et al. in South Australia, included an estimate that wearers of hard helmets were 19 times less likely to die. An officer of FORS[a] who appeared before the committee on cited this estimate and the committee accepted it, but Dr Dorsch retreated from it in her own evidence and it does not appear in the final version of the study, published in 1987. The committee also cited the discredited study by McDermott and Klug of the RACS, see above. Finally, the Victorian Government, despite its own promotion of helmets, told the committee that their efficacy had not been verified. Yet the committee’s belief in the efficacy of helmets would seem to have been unshaken.
FORS, in its submission of May 1984 to the federal parliamentary committee, affirmed “unequivocally” that the wearing of helmets by motorcycle riders and pillion passengers and by bicyclists is the principal means of reducing casualties, but upon inquiry was unable to provide supporting evidence. FORS prepared a paper, “The road safety benefits of the compulsory use of bicycle helmets”, that persuaded the ACT to pass a helmets law. It claims “overwhelming evidence” that compulsory wearing would improve safety. But its focus is on head injury, not the brain, and for evidence of the efficacy of helmets it merely cites Dorsch et al. for an estimate that helmets could reduce the risk of dying by 90 per cent, and McDermott and Klug.
The only evidence of efficacy of helmets which Sir Dennis Paterson offered in his submission to Mr Hawke in 1989 was Dorsch et al. (1987).
Clearly, belief that helmets protect cyclists from severe injury to the head was widely accepted by 1989 even though evidence for it was lacking. It appeared to be a matter of common sense, respected medical bodies were saying it and authorities were advocating it. Everybody “knew it”. So when ministers meeting as ATAC came to consider compulsory wearing, no-one queried whether helmets were effective. Exaggerated claims abounded: “The medical evidence is overwhelming”, “Young children in simple falls from their bicycles are finishing up with permanent brain injury and helmets contribute to their safety”. The meeting turned to practical problems of enforcement.
2.2 The mandatory standard [153-156, 161]
The mandatory standard defines the helmets to be compulsorily worn. Its officially stated purpose, as of 2007, is to set minimum requirements to prevent or reduce the risk of injury or death. It is modeled on the voluntary standard prepared by Standards Australia (SA), a private body and, clearly, it should ensure that helmets protect the brain. But commissioned research, by Corner et al. in 1987, reported that the standard tests were deficient in merely ensuring protection against a direct blow but not in reducing rotation, which a helmet could even increase. Also, unlike the control of therapeutic goods, the mandatory standard does not include monitoring for adverse effects. The SA standard before 1990 required helmets to have hard shells, but to overcome an obstacle to mandatory wearing it was amended to allow soft helmets. The amendment degraded the standard, but the Department of Transport advised its minister that it was being upgraded and would result in improved helmets.
Our submission to the Treasury’s review of the mandatory standard in 1998-99 argued the need for a test to ensure that helmets reduce rotation, but officials relied on advice from SA which takes no cognisance of rotation and our argument was disregarded. The review gave less attention to the safety of cyclists than the benefit to the helmets industry. Nevertheless, the responsible minister declared that the new standard would ensure that helmets provide the necessary protection. Late in 2002, we called on SA to include a test for rotation in its voluntary standard. The response says there is not sufficient evidence that standard helmets would perform poorly against rotation (Enclosure 3). This ducks the issue that evidence should ensure that helmets always reduce rotation.
Progress on the current review of the mandatory standard has been greatly delayed because the ACCC relies upon SA for technical advice and waited for it to revise its standard. SA published its revised standard in November 2008, but it includes no test for rotation because, it would appear, the helmets industry would not be able to satisfy it. In three submissions to the current review by the Australian Competition and Consumer Commission (ACCC), we have argued that the standard is deficient in lacking such a test, but we have received no indication in subsequent communications that the validity of our argument is recognised. And authorities have never warned the public of the deficiency.
2.3 Formal review [160-61]
In 2000, the ATSB belatedly attempted to establish the efficacy of bicycle helmets by making a formal review of 16 studies, though only three of them had been published prior to the policy of compulsory wearing. The review (Road Safety Report CR 195) was also published as a slightly altered version in 2001, in the journal Accident Analysis & Prevention. ATSB claims it to be a scientific study and to provide clear evidence that helmets reduce the risk of brain injury and death, but papers by Curnow in the same journal rebut the claim, a rebuttal that ATSB has been unable to defend. Any claim that the review might have to scientific validity is thereby relinquished and in question is whether any public purpose was served by publishing it in the journal.
3. Helmet laws in practice [161-66]
The safety of all road users was improving when the helmet laws were introduced. Though federal authorities did not make arrangements to measure accurately the effects on cycling and casualties for Australia as a whole, data from disparate sources serve to provide estimates. In short, participation in cycling declined after the laws, by an estimated 40 per cent for children and perhaps by 20 per cent for adults. Serious casualties to all road users, including fatal head injury, were decreasing, but cyclists shared less than commensurately in this trend; the risk to them therefore increased relative to others. The helmet laws might well have changed the perceptions and behaviour of motorists towards cyclists so as to increase the risk of accident to them. For example, a recent study found that the distance between a passing motor vehicle and a cyclist was less when the cyclist was wearing a helmet. Other adverse effects of the reduction in cycling include the loss of health benefits from exercise, increased pollution if car travel is substituted for cycling and fewer children gaining the benefits of experience as a cyclist before driving a car.
4. Upholding the policy [160-61]
Federal authorities’ commitment to compulsory wearing of bicycle helmets has never wavered since 1984 and overstatement of its value has continued. Despite the deficiencies of helmets that Corner et al. found in 1987, federal authorities pressed hard to uphold compulsory wearing.
The main effort was directed to Western Australia in 1994, where a parliamentary committee was reviewing its helmets law. FORS made a submission which shows declining trends in casualties after the introduction of helmet laws in Australia, but its analysis neglects other explanatory factors – see Appendix 1. These factors include improved road safety generally and a decline in cycling, which FORS underestimated, and the possibility, well known at the time, that wearing a helmet can change behaviour and the risk of accident. Also, some treatment of statistics was unsuitable and, underlying all of these, was failure to understand that the real problem is how to prevent severe injury to the brain, not just trauma to the head.
According to Peter Walsh, the former Senator and Minister for Finance in the Hawke Government, the “black spots” program was not evaluated properly and was driven by opinion polls, not policy rationality. He described the processes followed as, “a classic demonstration of how not to make policy decisions”. These criticisms would certainly appear to be applicable to the bicycle helmets component.
5.1 Criteria for policy
The Productivity Commission recently adumbrated the meaning and criteria of evidence-based policy. Compulsory wearing of bicycle helmets is examined here against these.
As compulsory wearing had not been tried in any other country, introducing it was an experiment in policy terms, but it was not backed up by any defensible rationale. Contrary to the views expressed by various parliamentary committees, the risk of serious casualty had been declining. Federal authorities relied too much upon these committees’ reports and untested sources for evidence of the efficacy of helmets . Insufficient attention was given to the Victorian Government’s statement that helmet use was not high enough anywhere in the world for a scientific examination of their efficacy to be undertaken.
Authorities have relied unduly upon Standards Australia for advice on the content of the mandatory standard. Undue weight has been given to the interests of the helmets industry at the expense of the safety of cyclists, and serious deficiencies in standard helmets which Corner et al. found were glossed over. The Government has never been able to guarantee the safety of the helmets which cyclists are forced to wear.
The basic problem for policy was how to protect the brain from the rare injury that results in death and disability. It would appear that authorities did not understand that the main cause of this injury is rapid rotation of the head in collisions with motor vehicles and that standard helmets provide no sure means of protecting from it. Indeed, they are likely to aggravate it. Authorities gave too much attention to commercial helmets and, like the officially stated purpose of the mandatory standard, to head injuries generally, though nearly all of these are mild with no lasting effects. Studies relating the occurrence of head injury with the wearing of helmets were used to provide evidence of their efficacy, but the few studies which relate them to brain injury have no cognisance of its types and main cause, rotation of the head. Reducing it is an unsolved problem and helmets are not tested for capacity for it. Worse, three studies have shown that wearing a helmet is likely to increase rotation. Consequently, the policy of compulsory wearing of helmets provides no solution to the basic problem and puts undue responsibility upon cyclists.
The way in which the policy was developed was flawed. Undue reliance was placed on advice from surgeons, including Sir Dennis Paterson. As Senator Walsh noted, after 1987 “increasingly, the Government, and most importantly Hawke, became hostage to narrow and unrepresentative pressure groups” Advice tested in open consultation might have provided insights into adverse effects and unintended consequences.
Victoria’s announcement in September 1989 that it would compel the wearing of bicycle helmets from July 1990 gave the Federal Government an opportunity to observe the operation of the policy before committing itself. Victoria could have been assisted to study and measure its effects, but this opportunity was missed.
Since the policy began, official certitude about its efficacy in the absence of evidence has been apparent. Ministers declare that “helmets save lives” as if it were beyond doubt. Sir Dennis Paterson’s call for research and analysis and his recommendation that the Departments of Transport and Health should be involved in a road safety authority with substantial capacity for research have not been implemented. Health authorities have not taken any interest in the effects of the policy on public health and responsibility has been fragmented among a range of federal and state agencies.
The effects of the policy on cycling and casualties have not been monitored Australia-wide in a uniform way to measure its effects on cycling and casualties and to enable corrections to it. It has not been properly evaluated despite evidence of unintended and detrimental effects on public health. A concern is that public agencies have responded to criticism of the policy with obfuscation. For example, the ATSB continues to tell ministers that helmets protect the brain ignoring the evidence that has been presented for a number of years in reputable scientific journals.
5.2 Evaluation of the policy
Available data indicate that the policy has not met its purpose of reducing the public costs of accidents. Rather, it would appear that the risk of serious casualty to cyclists including fatal head injury has increased relative to other road users. By discouraging cycling the policy has had many adverse effects. These include loss of the benefits for health that result from the exercise of cycling, and increased pollution, noise and traffic congestion as car trips are substituted for it. The benefits and joys of cycling have been stolen from a generation of children which has lost the opportunity to learn to use roads safely before driving a car, and to understand, first-hand, that the roads are shared by a variety of users.
A recent study by Professor Piet de Jong of Macquarie University, “Evaluating the health benefit of bicycle helmet laws” comprises a mathematical model which purports to balance the benefits of increased safety against costs due to decreased cycling. Even though the study uses the most optimistic assumptions, in particular that wearing a helmet reduces the cost of injury, it concludes that helmet laws do not deliver a net benefit and indeed impose a considerable health cost on society.
To undo these harms to society, the obvious first step would be to terminate the policy and repeal the mandatory standard, making it clear to the public that the safety of helmets cannot be guaranteed. The states and territories would then not need helmet laws for “black spot” funding and could be expected to repeal them. This would encourage cycling at no net cost to the public, rather a net gain. The helmets industry would lose a captive market – but it never earned it. Some cycling groups might protest, but they would not experience any real loss and their members would be free to continue wearing helmets if they chose to.
5.3 Wider implications
It is likely that other national road rules and practices would be found wanting if subjected to rigorous examination. The Government therefore should invest more to strengthen scientific research, including in-house capacity as suggested by Sir Dennis Paterson. The aim would be to change the culture of dealing with road trauma, from reaction reflecting popular assumptions to measures supported by evidence.
1. As use of bicycle helmets stems from fear of death and dementia from head injury, the policy of compulsory wearing requires certainty that they protect and never harm the brain. But supporting evidence is lacking and standard helmets are deficient.
2. No uniform monitoring Australia-wide was done to measure the effects of the policy, but available data indicate that cycling declined, losing its benefits for health and for children, and that the risk of serious casualty and fatal head injury increased.
3. Rather than correct the policy, authorities have obfuscated its adverse effects. It should be terminated forthwith, the mandatory standard repealed and capacity for scientific evaluation of policies for road safety strengthened so as to minimise harm.
Cyclists’ Rights Action Group 30 April 2009
APPENDIX 1: Official misrepresentation
Federal authorities’ commitment to compulsory wearing of bicycle helmets has never wavered since 1984 and excessive assurances of its value have continued. Although federal authorities knew of the deficiencies of helmets that Corner et al. had found, they pressed the states and territories to pass laws for compulsory wearing. The federal minister threatened to seek reimbursement of funds in the event of non-compliance and he dismissed his South Australian counterpart’s reservations, arguing that permanent brain injury would be prevented., Federal authorities also criticised an exemption which the Northern Territory granted for adults on cycle paths,, but their main effort to uphold compulsory wearing was directed to Western Australia.
Western Australia [162-63]
Opposition to compulsory wearing of helmets was strongest far from Canberra, Western Australia being the last state to legislate, in 1992. Its Parliament’s Select Committee on Road Safety reviewed the application of the helmets law to adults in 1994. As this threatened the integrity of the national policy, the Federal Office of Road Safety made a submission which argued for upholding the law FORS’s argument on the effects of compulsory wearing on fatalities and injuries, and the fall in rates of usage of bicycles is examined here.
FORS presented two graphs which purport to show the effect of compulsory wearing on bicycle fatalities. The first, Figure 1 (with data for 1994 and pedestrians added here), is misleading in not taking any account of the effect of the fall in usage.
Figure 1. Road user fatalities, Australia (indexed to 1986)
Separate listing of fatalities to children and adults, as in Table 1, together with data from surveys showing declines in cycling post-law , makes it possible to correct for both the effects of reduced usage and the general improvement in road safety.
Table 1. Fatalities to road users, Australia 1989 – 1993
|Year||Total road usersAdult Child||PedestriansAdult Child||BicyclistsAdult Child|
|1989||2505 296||428 73||54 44|
|1990||2093 238||344 76||47 33|
|1991||1915 198||292 51||35 23|
|1992||1783 191||297 53||24 17|
|1993||1775 178||284 47||30 15|
|Change, 1989-93||-29% -40%||-34% -36%||-44% -66%|
Source of data: FORS, 1997. Road Fatalities Australia: 1996 statistical summary.
The fall in fatalities to all cyclists from 1989 to 1993 can be explained as being the product of improved road safety and declines in cycling of 40 per cent by children and perhaps 20 per cent by adults; it is not evidence that the helmet laws reduced the risk of death. FORS also claimed that the reductions in head injuries and fatalities are far greater than the decline in cycling, but this made no allowance for the general improvement in road safety; the claim is irrelevant.
FORS stated that helmets have little or no effect on injuries other than to the head, but this discounted the possibility, well known at the time, that wearing one could change behaviour and the risk of accident. Decreases in head injury in some states were cited, but with no allowance for improved road safety or the declines in cycling. According to FORS, reduction in head injury is the best measure of compulsory wearing, but this highlighted its failure to understand the real problem, namely, how to protect from brain damage and consequent death or chronic disability, not from minor trauma.
For Victoria, FORS noted that in the first year after helmets became compulsory, cyclists’ claims on the Transport Accident Commission (TAC) for head injuries decreased by 51 per cent compared to a fall of 24 per cent in non-head injuries. In the second year, the respective decreases were 70 per cent and 28 per cent. FORS said that Lane and McDermott (1993) ascribed the difference to increased helmet wearing. As the difference would seem to be unaffected by the general improvement in road safety or declines in cycling, it might appear to be persuasive evidence of the efficacy of helmets – until inquiries to the TAC revealed a similar trend for pedestrians. This is shown in Figure 2, the vertical line showing the start of the helmets law. Again, it would appear that the cause of the decline in the risk of head injury was changes in other conditions, not helmets.
Figure 2. Per cent head injury, of accepted TAC no-fault claims, Victoria
Source of data: Transport Accident Commission, pers. comm. 1.12.95.
FORS discussed the fall in bicycle usage as shown by survey data from Victoria, NSW and Western Australia. For all three states, the declines in cycling that followed the helmet laws were underestimated and similar declines pre-law to post-law which had been measured in Queensland, the ACT and the Northern Territory were disregarded. FORS argued that reductions shown in surveys are not a proven result of helmet laws, which could only be found from much bigger surveys or over a longer time. “Unfortunately, long term data is not available”, it said, but it is government, not fortune, that was to blame for that. It was known in 1985 that cycling had declined when private schools compelled students to wear helmets, but FORS’s advice to its Minister on the compulsory helmets proposal did not mention this or the need for monitoring.
FORS’s Monograph 19 (1997) makes three arguments. The first is that compulsory helmets resulted in serious casualties to cyclists declining by more (33 cent) than all road users (23 per cent), from the 4 years “prior to compulsory wearing” (1987-1990) to the 4 years after (1993-1996), but if 1989, the last year before any helmet laws, is compared with 1993, the first year when all were in force, the respective declines are 31 per cent and 25 per cent, much less different. FORS says use of a 4 year period allows evening out of random variations from year to year, but the argument is specious because the numbers in each year exceed 1000. (By contrast, FORS’s submission to the review of the law in Western Australia, discussed above, claimed a reduction in fatalities by using numbers of less than 200.) Also, it is wrong to include 1990 in the base period because the helmets law came into effect in Victoria mid-year. As casualties to all road users in 1990 were 13 per cent below 1989, those to cyclists being unchanged, this results in further over-statement of the difference in the declines in the two groups from pre- to post-law. Also, FORS disregards the decline in numbers of cyclists. Taking this into account, it is clear that cyclists became worse off compared to other road users .
Second, FORS states that helmet wearing rates, as measured from casualty crashes, are negatively correlated with deaths and casualties to cyclists, but it provides no details of statistics or sources. The meaning of the claim is not clear and it is at odds with data on wearing rates of casualties .
Third, FORS finds from pooled data for 1988, 1990, 1992 and 1994 from its Fatality File that known wearers of helmets suffered fewer severe head injuries on average than non-wearers. It concludes that the absence of a helmet significantly increased the number of severe injuries by up to 21 cent. It is not clear that the finding has any clinical importance, it not being shown that the number of head injuries was related to fatality, nor even stated that head injury was the cause of death, and the data are confused by a change in coding practice by which multiple injury to a single region of the body was coded as multiple in 1990 but under that region in 1992. Also, the data span a great increase in the wearing of helmets after compulsion, and a change in the standard. In 1988, hard shells were required, but from 1990 cyclists were able to wear soft helmets. A more apt description of FORS’s pooling of data is jumbling together and obscuring the important trends that are shown in Table 3 .
1. Fears of death and chronic disability from head injury led to compulsory wearing and the mandatory standard for bicycle helmets, but without their efficacy against the injury to the brain that has those dire results first being verified.
2. The public relies on government to verify efficacy, but the standard was modified in such a way as to compromise safety and the public was never warned.
3. Compulsory wearing was a response to the precedents of motorcycle helmets and seat belts rather than experience with cycling, which was showing decreasing risk.
4. Though new to the world, compulsory wearing was not introduced and monitored so as to measure its efficacy in practice, but it is evident that cycling has been discouraged to the detriment of health and the risk of casualty has increased.
5. A thoroughgoing review is needed of the policy of compulsory wearing of bicycle helmets, the mandatory standard for them, and associated processes of government. It should be open and independent of regulatory authorities.
[a] Federal Office of Road Safety, subsumed into Australian Transport Safety Bureau (ATSB) in 1999.
 Attewell R, Glase K, McFadden M. Bicycle helmet efficacy: a meta-analysis. Accident Analysis and Prevention 2001; 33: 345-352.
 House of Representatives Standing Committee on Road Safety. Report on motorcycle and bicycle safety. AGPS, Canberra, 1978.
 House of Representatives Standing Committee on Transport Safety. McDermott evidence, 1984, p. 1081
House of Representatives Standing Committee on Transport Safety. Report 1985, para. 34.
 Minister for Transport Australia. Media release 115/84. 9.8.84.
 Department of Transport and Communications, pers. comm. 24.6.92
 Brown, Bob, Minister for Land Transport. Pers. comm. 21.2.92
 Mill, JS. On liberty and other essays. World’s Classics, New York, Oxford University Press, 1991.
 Evidence to the House of Representatives Standing Committee on Road Safety 28.6.77, p. 833.
Submission to the motorcycle and bicycle helmet safety inquiry by the House of Representatives Standing Committee on Transport Safety, 23 May 1984.
 Federal Office of Road Safety, pers. comm. 25 September, 1997
 FORS, letter of 24 June 1992.
 Cyclists’ Rights Action Group submissions dated 21.7.05, 17.5.07 & 24.4.08.
 Reported in the Australian Left Review, April 1992.
 Walsh, Peter. Confessions of a failed finance minister, Random House Australia, Sydney, 1995, pp. 170, 227.
 The Hon. Joe Hockey MP, Minister for Financial Services & Regulation. Pers. comm. 12.5.2000.
List of enclosures
- Bicycle helmets: a scientific evaluation. In “Transportation Accident Analysis and Prevention”. Nova Science Publishers Inc. New York. 2008.
- Letter from national Road Trauma Advisory Council to ACT Minister for Urban Services, 15.1.92.
- E-mail message from Neill Patterson of Standards Australia, 30.4.03.
 Point 19 of ACT Cabinet Submission No. 3007, 23.3.92, released under the 10-year rule.
 Verbatim report of ATAC 80th meeting DA 90/23, at page 10.
 Manzie, D. Minister for Transport, Northern Territory. Media release 31.3.94.
 Hon. Neil O’Keefe, Parliamentary Secretary for Transport, letter to P. Mead, 10.8.94.
 Evidence to the House of Representatives Standing Committee on Transport Safety inquiry on motorcycle and bicycle helmet safety, 1985.
 Minister’s brief, ATAC 79th meeting (obtained under FOI).
 McFadden, M. Pers. comm. 28.10.98, FORS reference K98/167.
Finch, C.F., Newstead, S.V., Cameron, M.H. and Vulcan, A.P., Head injury reductions in Victoria two years after introduction of mandatory bicycle helmet use, Monash University Accident Research Centre report No. 51, July 1993.