CRAG

Abstract

Doctors developed a belief that helmets would be essential to reduce cycling injuries. They lobbied for compulsory helmets, without requiring the necessary controlled trials to assess their effectiveness and side-effects, ignoring their own scientific discipline.

Pressured by doctors, politicians set up a committee with a predetermined objective to introduce compulsory helmets. The pre-convinced committee focused on preparing for compulsory helmet legislation rather on than assessing its potential benefits and side-effects.

Complacency led to negligence. Government research warnings that bicycle helmets were not suitable for children and that soft-shell helmets can aggravate brain injury were ignored. Government research recommended to strengthen the helmet standard to remedy those deficiencies. Instead, the government weakened it to accommodate soft-shell helmets to facilitate compulsory helmet wearing. The government ignored the most comprehensive research available at the time that concluded that “there is no evidence that hard shell helmets have reduced the head injury rate and that helmets were significantly correlated with a higher fatality rate”.

Despite being the first in the world to introduce such controversial legislation amid contradictory evidence, the government imposed a helmet law nationwide, without a trial period and without plans to assess its effectiveness.

Australia now suffers the consequence of this negligence. Its cycling serious injury rate is now 22 TIMES higher than in the Netherlands. The significant increase in the risk of accidents, death and serious injury since the helmet law has been ignored.

The hidden costs of this policy are yet to be fully quantified. Cycling has declined sharply, resulting in a loss of health benefits likely to incur significant public health costs. Bike Share, a safe mode of transport that has provided significant benefits in many cities worldwide, cannot operate successfully under the helmet law.

The costs of this policy are rising, while the government wastes more public funds trying to obfuscate its failure and mislead the public about the effectiveness of polystyrene “helmets”.

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Table of contents

Forming the belief

Promoting the belief

Preparing for legislation

Setting the law

The consequences of negligence

Denying the failure

Making it worse

The neglected human factor

Start of renewal

Summary

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Forming the belief

Following the precedent of helmets for motorcyclists, a belief developed that cyclists, especially children, needed more protection and that helmets could provide it. The Royal Australasian College of Surgeons (RACS) had been influential in bringing compulsory seat belts and motorcycle helmets and was urging for a bicycle helmet law as the “third major step“. A leap of faith arose that this would be the solution to cycling safety. Without scientific evidence, doctors lobbied for a helmet law. The RACS claimed in 1978 that cyclists should wear helmets, but provided no evidence of efficacy. Dr Trinca said:

“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 in contradiction with the strict medical discipline that requires careful trials of new drugs to prove their effectiveness and test for negative side-effects. “Remedies” can sometimes be more harmful than beneficial. The strict medical discipline prevents harmful remedies from being deployed on a large scale. Despite this, some doctors felt urged to “do something” based on little more than a belief, ignoring scientific discipline and medical ethics.

A leap of faith arose that a bicycle helmet law would be like the motorcycle helmet law

Doctors pushed for helmets with the best of intentions. However, they had jumped at conclusions too quickly. Countries that have achieved the lowest rate of cycling injuries have focused on reducing the risk of accidents. The RACS pushed for an unproven theory without the standard safeguards required in its own medical discipline.

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Promoting the belief

Pushed by the RACS, politicians were also under pressure to “do something”. In 1978, the House of Representatives Standing Committee on Road Safety recommended that:

“cyclists be advised of the safety benefits of protective helmets and the possibility of requiring cyclists to wear helmets be kept under review“.

But the evidence submitted to the committee as published in Hansard includes nothing on the efficacy of helmets as protection. Indeed, in the reports of later parliamentary committees that led to the present policy, the earliest study cited (by McDermott and Klug) is dated 1982.

They took efficacy for granted, assuming that bicycle helmets provide significant protection without bothering to assess how much protection they really provide, or whether they could be harmful. Helmets were recommended based on a mere belief that they “protected”, without considering side-effects.

The government responded with a campaign to promote helmet wearing. In Victoria, the RACS did likewise, even putting a case for compulsory wearing to the Premier in 1982. Helmet manufacturers started advertising bicycle helmets that became their most profitable product. By the end of the 1980s about 30% of cyclists wore helmets, according to government road surveys, although these were mostly commuter rather than recreational cyclists.

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Preparing for legislation

The 1978 inquiry issued a final report in 1985. It recommended that cooperation of states and territories should be sought to

“review the benefits of bicycle helmet wearing … and unless there are persuasive arguments to the contrary introduce compulsory wearing of helmets by cyclists on roads and other public places”.

A federal parliament committee was set up in 1985. Early in the course of its inquiry (before it had reviewed all the evidence), it said:

“It is, of course, this Committee”s belief that all cyclists should wear a helmet to increase cycling safety.”

The committee had made its decision prematurely. Like the 1978 committee, it took efficacy for granted. Its mandate was biased from the start, with a pre-determined objective to introduce a helmet law. Such a biased approach is not conducive to an objective assessment. The committee completed neither a cost/benefit analysis or an assessment of potential side-effects of a helmet law.

Legislation was pushed through, not because it provided compelling benefits but because a biased committee could not see compelling evidence NOT to introduce it. This approach reverses the onus of proof. Proponents of a law are not required to show it provides a net benefit. They can merely assert that they cannot see compelling evidence NOT to introduce the legislation. This is a dangerous approach lacking important sanity checks.

In 1987, the Federal Office of Road Safety (FORS), a government agency, completed research on helmets that highlighted several serious deficiencies with bicycle helmets:

“The substantial elastic deformation of the child head that can occur during impact can result in quite extensive diffuse brain damage. It is quite apparent that the liner material in children”s bicycle helmets is far too stiff …

rotational accelerations were found to be 30% higher than those found in similar tests using a full face polymer motorcycle helmet. More work needs to be done in this area as there would seem to be a deficiency in rotational acceleration attenuation that may be the result of insufficient shell stiffness ….

a high proportion of impacts were to the lover facial and side of face areas and it is imperative that the temporal area be more fully protected than it is by current bicycle helmet designs. “

The research recommended changes in the Australian helmet standard to rectify these deficiencies. None of these deficiencies have has been rectified. Twenty five years later, Australia still does not have an appropriate standard for child helmets and helmets are still not tested for rotational acceleration, the primary cause of diffuse axonal injury – a debilitative brain injury.

There are two types of brain injury: focal and diffuse. Focal injury occur when the skull is damaged from being hit. Diffuse injury occurs when the head rotates quickly. The skull may not be damaged, but there can severe internal brain injury. This article reports from a surgeon who operates on cyclists:

” “The ones with brain swelling, that”s diffuse axonal injury, and that”s bad news” …

the whole brain is shaken up, creating many little tears in its inner structure …

Such patients undergo personality change, can contract epilepsy and have difficulty controlling their anger. They might become unemployable. Depression is a common accompaniment to brain injury. Rosenfeld sees patients” families shattered, too. “They”re never the same. It often leads to marriage disharmony and family breakdown.” …

Rosenfeld”s opinion is candid. “I don”t know if [helmets] do much to protect the inner part of the brain,” “

The dangers of bicycle helmets have also been reported by a doctor from New Zealand:

“cycle helmets were turning what would have been focal head injuries, perhaps with an associated skull fracture, into much more debilitating global head injuries”

Before 1990, the bicycle helmet standard prepared by Standards Australia required helmets to have hard shells. The committee amended this standard to accommodate soft-shell helmets. Soft-shell helmets are more comfortable and make compulsory helmet wearing more acceptable. They provide questionable protection while increasing the risk of neck injury and brain injury. It is doubtful whether soft-shell helmets do much to prevent focal brain injuries, as there is no hard shell to take the blow.

A soft-shell helmet tends to disintegrate on impact, absorbing little energy. This crumbling is what many people ironically mistake the helmet for as having saved their life:

“The next time you see a broken helmet, suspend belief and do the most basic check – disregard the breakages and look to see if what’s left of the styrofoam has compressed. If it hasn’t, you can be reasonably sure that it hasn’t saved anyone’s life.“

It is doubtful whether soft-shell helmets provide a net safety benefit. Evidence provided in court is telling:

“So in at least one case now, a High Court has decided that the balance of probability was, in the matter before the Court, that a cycle helmet would not have prevented the injuries sustained when the accident involved simply falling from a cycle onto a flat surface, with barely any forward momentum. …

the QC … repeatedly tried to persuade the neurosurgeons … to state that one must be more safe wearing a helmet than would be the case if one were not. All three refused to do so, claiming that they had seen severe brain damage and fatal injury both with and without cycle helmets“

Instead of improving the helmet standard based on the safety recommendations from its own research, the government degraded Australia”s helmet standard to accommodate a type of helmet providing questionable protection while increasing the risk of debilitative brain injury. This compromised safety. Although the standard was degraded, the Department of Transport advised its minister that it was being upgraded and would result in improved helmets.

It seems ironic to compromise safety in the name of safety. It seems that pursuing its pre-determined objective (to introduce a helmet law) was more important than improving the protection provided by bicycle helmets. The committee may have lost focus on the initial goal to improve safety.

Bicycle helmets helmets are designed for adult heads.  They are too stiff for children more deformable heads.  Despite this, helmets are promoted as “protecting” children, without appropriate warnings.

The Victorian Government”s submission to the committee said:

“The incidence of bicycle helmet use has not yet reached a sufficiently high level anywhere in the world for a scientific examination of helmet effectiveness in injury reduction to be undertaken.”

Despite flimsy evidence of efficacy, the committee recommended that the states and territories should introduce compulsory wearing of helmets by cyclists on roads and other public places.

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Setting the law

The RACS pressed the Victorian Government to make helmet wearing compulsory. The Victorian Parliament adopted a RACS recommendation for compulsory wearing, and legislation was announced. This increased pressure on the Federal Government to “do something”. Surgeons of the RACS were active in pressing the government. A former minister in the Hawke Government observed that after 1987:

“increasingly, the Government, and most importantly (Prime Minister) Hawke, became hostage to narrow and unrepresentative pressure groups.”

He also said the black spots program was not evaluated properly and was driven by opinion polls, a view supported by official documents.In 1988, the largest ever cycling casualty study was published, involving more than eight million cases of injury and death to cyclists over 15 years in the US. It concluded:

“There is no evidence that hard shell helmets have reduced the head injury and fatality rates. The most surprising finding is that the bicycle-related fatality rate is positively and significantly correlated with increased helmet use.”

Rodgers, G.B., Reducing bicycle accidents: a reevaluation of the impacts of the CPSC bicycle standard and helmet use, Journal of Products Liability, 11, pp. 307-317, 1988.

This study focused on hard-shell helmets that provide better protection than soft-shell helmets. Though this study was published a year before the announcement of compulsory helmet wearing as Federal policy, the Federal Office of Road Safety (FORS) gave no warning about it to the ministers who decided on the policy. The FORS did not act upon the 1985 committee”s recommendation that it should establish the costs and benefits of universal bicycle helmet usage. The FORS, the proper authority to advise government on the efficacy of helmet wearing, did no evaluation of it. Though the stated purpose of the compulsory helmet wearing was to reduce the cost of bicycling injuries to the community, the FORS did not seek advice from the National Health and Medical Research Council or other health authority. This was negligence.

The government ignored evidence showing that helmeted cyclists had a higher fatality rate

By 1989, just before the government decided to introduce compulsory wearing of bicycle helmets, an officially commissioned survey showed that public support for it was 92% for children and 83% for all riders. Politicians sometimes do what most people believe should be done, regardless of its effectiveness, as mentioned here:

“Modern politicians have become so adept at monitoring public opinion that they”ve developed a preference for wanting to be seen fixing problems rather than to actually fix them.”

In 1989, Prime Minister Hawke announced compulsory helmet wearing as Federal policy. This was a condition of providing funds to the states and territories for eliminating so-called “black spots” in roads. In response, they passed the world”s first laws to compel cyclists to wear helmets.

Responses to enquiries in 1997 showed that no government in Australia, federal or state, made the necessary verification of the efficacy of helmets before imposing legislation. A study from Western Australia indicating that helmet wearers had more severe injuries appears to have been ignored. The belief that a helmet law could only improve safety seems to have fostered a dangerous complacency that led legislators to negligently ignore key evidence.

The Prime Minister categorised compulsory wearing of bicycle helmets as a known and effective measure. This cannot be true as it had never been tried anywhere in the world before. The evidence indicated caution towards compulsory helmet wearing, particularly with soft-shell helmets that provide questionable protection while increasing the risk of brain injury. Helmet law believers could have pushed for a trial to better understand the law”s effectiveness and side effects. Instead, the government deployed across the nation an unproven policy without plans to assess its effectiveness.

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The consequences of negligence

The timing of the helmet law was odd as cycling safety was improving. Deaths of cyclists had been in long-term decline despite bicycle travel in Australia increasing by 10% a year from 1986 to 1989. Cycling is known to be a beneficial activity, no more dangerous than being a pedestrian. Why impose helmets only on cyclists? This discriminates against a healthy, economical and environmentally friendly mode of transport – particularly important in Australia which is one of the world”s most obese countries now with a carbon tax.

Why introduce this legislation? It was discriminatory, its benefits were questionable and its side-effects were not assessed, while it was not addressing any problem. Was there an independent party checking the suitability and safety/health benefits of this legislation before it was introduced? This indicates shortcomings in the legislative process.

The bicycle helmet law was an uncontrolled, large-scale experiment. Despite being unproved and risky, there was neither a trial period or a comprehensive assessment. Transport authorities neglected a unique opportunity to assess its effectiveness. This was negligence. Such a sloppy approach would not have been allowed under standard medical practice.

One side-effect of this policy was to reduce cycling. Such an effect was known to be likely (in 1985, cycling had declined after some schools mandated helmets for students) and could have been measured on a consistent national basis. Instead, measurements of cycling before and after compulsion were mainly incidental to surveys of helmet wearing. Transport authorities started to confuse cycling safety with helmet wearing. Helmet wearing compliance was measured more carefully than safety improvements. As a side effect, these surveys revealed a sharp decline in cycling of about 30% for adults and 40% for children.

This decline reversed an uptrend growing at 10% a year. An independent assessment estimates that cycling levels were 50% below previous trend by 1996. This decline also changed the nature of cycling. Cycling as a recreational transport mode declined the most. Sport cycling rose in prominence, giving cycling an image as a dangerous sport. Australia now has low female participationin cycling. At 21%, it is lower than in the US at 32%, and in Europe around 50%. As observed by Julian Ferguson, from the European Cyclists’ Federation:

“Riding in New York or Australia is like running with the bulls — it’s all young males”

The main result of the helmet has been to reduce cycling

The helmet law only persuaded 9% of child cyclists to wear a helmet, while approximately 44% gave up cycling. Injuries to the skull constitute about 10% of cycling injuries, while “helmets” are only designed to provide limited protection at low speed IF the cyclist falls on top of his/her head. At best, helmets might mitigate a few per cent of minor cycling injuries. The safety benefits of imposing a device that provides questionable protection on 9% of cyclists are likely to be marginal at best. There were no safety benefits, however, as the risk of death and serious injury increased by 50%. Helmets make little difference in a serious accident, as Dr Carwyn Hooper from St George”s University in London reports:

“Looking at evidence, it does not matter if people are wearing a helmet or not, any serious accident on a bike is likely to kill them,”

Before the law, cycling was increasing in popularity and becoming safer. After the law, cycling was falling and becoming more dangerous.

This is consistent with safety in numbers, a primary factor in cycling safety. This factor is clearly explained within a 2003 paper published in the Injury Prevention journal:

“the behavior of motorists controls the likelihood of collisions with people walking and bicycling. It appears that motorists adjust their behavior in the presence of people walking and bicycling … A motorist is less likely to collide with a person walking and bicycling if more people walk or bicycle. Policies that increase the numbers of people walking and bicycling appear to be an effective route to improving the safety of people walking and bicycling.”

This impact can easily be underestimated. Even under conservative assumptions of a 22% decline in cycling, the risk of accidents increases by 16%. This results in a net increase in cycling injuries despite an increase in helmet wearing. A 44% decline in cycling increases the risk of accidents by 41%. This cannot be compensated by a 9% in helmet wearing. The helmet law is likely to have increased the risk of death & serious injury by indirectly increasing the risk of accident.

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Denying the failure

In the mid 1990s, evidence emerged that the helmet law had failed to improve safety. Several researchers reported this. A bicycle activist who promoted helmet wearing and initially believed in the helmet law looked at the data and concluded:

“It is fair to say that, so far, there is no convincing evidence that Australian helmet legislation has reduced the risk of head injury in bicycle crashes.”

State governments ignored the warnings from independent researchers. Once people have invested time and effort in something, they are reluctant to admit they have made a mistake. Government became entrenched in its position, stuck in defensive mode. As noted by University of Armidale researcher Dr Dorothy Robinson:

“mandatory bicycle helmet laws increase rather than decrease the likelihood of injuries to cyclists …

Having more cyclists on the road is far more important than having a helmet law, for many reasons …

[the] governments [which introduced the helmet laws] do not like to admit they”ve made mistakes”.

Government started funding “studies” defending its helmet law policy. Such policy-driven studies have been used to cover up the failure of the helmet law. Official evaluations of the law commonly employ biased selection of research and statistics, resulting in benefits being unduly attributed to the helmet law and adverse effects (like a decline in cycling or an increase in the risk of accidents) ignored. Bill Curnow, once a scientist from the CSIRO, wrote as a conclusion in a scientific article:

“Compulsion to wear a bicycle helmet is detrimental to public health in Australia but, to maintain the status quo, authorities have obfuscated evidence that shows this.”

The helmet law was introduced as a part of a package of road safety measures including a crackdown on speeding and drink driving. The number of cyclists reduced significantly. Any assessment of the helmet law must take into account these confounding factors. Yet many government-funded “studies” like this one did NOT adjust for this, attributing all apparent improvements to the helmet law. Such negligence is difficult to comprehend. How could the “researchers” miss such basic adjustments? It is odd that these mistakes favor the legislation while the government funds the “research”.

One of the “studies” done by an Australian government agency in 2000 claimed to provide

“overwhelming evidence in support of helmets for preventing head injury and fatal injury“.

This claim was rebutted in 2003, the study highlighting that:

“the meta-analysis … takes no account of scientific knowledge of [brain injury] mechanisms”

The government agency did not reply to the rebuttal, effectively giving up on its claim. Despite being discredited, this analysis is still used by government to defend its policy. This study was re-assessed in 2011 by an independent researcher who concluded:

“This paper … was influenced by publication bias and time-trend bias that was not controlled for. As a result, the analysis reported inflated estimates of the effects of bicycle helmets …

According to the new studies, no overall effect of bicycle helmets could be found when injuries to head, face or neck are considered as a whole“

Publication bias is the tendency to cherry-pick studies that suits a particular predetermined conclusion.

Despite the repeated empty claims from politicians that

“helmets save lives and lower the severity of injuries”,

independent researchers are not fooled:

“If helmet laws were effective, we should have seen a reduction in head injuries,” she said. But instead, we saw a reduction in cycling, which leads to increased sedentary lifestyle diseases – obesity, strokes, heart disease. By discouraging cycling, helmet laws actually increase health costs.”

Even helmet salespeople do not necessarily claim that helmet save lives. After being asked

“Can your helmet save your life?“,

a helmet manufacturer salesperson shrugged and laughed uncomfortably, before responding

“Can it?” “Well, not save your life, no.“

What is it that politicians know that helmet salespeople don”t?

The government funded a study trying to deny that bicycle helmets can aggravate brain injury through rotational acceleration. This risk has been reported for soft-shell helmets at high speeds on an abrasive road surface. The “study” set up unrealistic conditions where rotational acceleration was unlikely to be high. It then magically generalized the results to all helmets in all conditions. This is deceitful as the study unrealistic conditions are not representative of real life accidents.

There is a stark contrast between the claims from the policy-driven “studies” funded by the Australian government and the findings of independent researchers. In the view of independent researchers from Norway:

“no studies have found good evidence of an injury reducing effect”.

While British doctors say:

“[A helmet law] gives out the message that cycling is dangerous, which it is not. The evidence that cycling helmets work to reduce injury is not conclusive. What has, however, been shown is that laws that make wearing helmets compulsory decrease cycling activity. Cycling is a healthy activity and cyclists live longer on average than non-cyclists. …

Since nowhere with a helmet law can show any reduction in risk to cyclists, only a reduction in cyclists, why would any country want to bring in a law for something which is clearly not effective at reducing the risk to cyclists?”

In the view of an Australian surgeon who operates on cyclists:

“The best evidence is that [a helmet] doesn”t make any difference to serious head injury when riding a bicycle …

initial research used to back the mandatory laws was “deeply flawed and criticised”. Some newer findings, he said, showed that these laws could increase the chance of serious injury. “On a society-wide basis, it seems as though the compulsory wearing of helmets is diminishing the number of people riding bicycles” he said. “The number one health concern is heart attacks and obesity. “Anything that can be done to decrease that would be a good thing.” “

The policy-driven studies did not fool the rest of the world, who chose to shun this policy.

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Making it worse

In the 1990s, compliance surveys revealed that about 30% of cyclists still ignored the law. Transport authorities then staged an extensive media campaign that made people believe cycling is dangerous and that wearing a helmet makes it “safe”. Loaded slogans like “Where”s your helmet?” were used relentlessly.

In advertising, you don”t need proof. Actually, it doesn”t even have to be true. Advertising tends to associate a strong positive emotion with a message, such as associating a feeling of safety with wearing a helmet. Various emotional and exaggerated “testimonies” made you believe it wasn”t possible to ride a bicycle without hitting your head sooner or later, and that a helmet will save you. Authority figures and “experts” appeared on television asserting that you NEED to wear a helmet because cycling is too dangerous.

Transport authorities still fund misleading campaigns such as this radio advertisement broadcast in 2011 that claims:

“Don”t think that little ride to the shops warrants wearing [a helmet]? Well I”ve got news for you. Even on a short ride you can have a big fall and you can suffer a MAJOR brain injury”

A bicycle activist created an amusing parody of this deceptive ad, pointing out what is missing.

The scaremongering is not true. Cycling is not particularly dangerous, no more than being a pedestrian:

“risk assessment reveals that cycling is not a more risky activity than the other modes of transport. …On the other hand, risk assessment does provide evidence of the much greater vulnerability of pedestrians.”

Helmet ads typically use scaremongering tactics to scare people towards the “protection” provided by helmets.  As a result, many people become scared off cycling.

Politicians and government officials kept repeating that “helmets save lives” even though the government has been unable to provide supporting evidence. Powerful emotional testimonies claiming “my helmet saved my life” were prominently broadcasted. Manipulative and misleading techniques suggested that cyclists would suffer serious brain injury unless they wore a helmet. This is deceitful as soft-shell helmets are known to increase the risk of serious brain injury, particularly the chronic disability they have been portrayed to protect against. Advertising can be manipulative in insidious ways. Scientific research on helmets provides a different message:

“Protecting the brain from injury that results in death or chronic disablement provides the main motivation for wearing helmets. Their design has been driven by the development of synthetic polystyrene foams which can reduce the linear acceleration resulting from direct impact to the head, but scientific research shows that angular acceleration from oblique impulse is a more important cause of brain injury. Helmets are not tested for capacity to reduce it and, as Australian research first showed, they may increase it.“

Even though helmets do not provide a solution to serious brain injury, fear of chronic disability has been used as a scare tactic to promote helmets. This leads to an exaggerated opinion of the protection provided by helmets.

This manipulative and misleading campaign was effective. Most Australians now believe that cycling is dangerous and that helmets save lives. However, it had negative side-effects. Such propaganda tends to create a culture of fear that harms cycling. Cycling kept declining further. By 1996, cycling in Sydney had declined by 48%. Many people overestimate the protection provided by a piece of polystyrene, being misled that a helmet will “save” them. A similar outcome was reported in survey a UK cyclist survey following helmet promotion campaigns:

“the majority of the people surveyed do have an exaggerated opinion of the effectiveness of cycle helmets, and an exaggerated opinion of the risks of cycling, and that the two are associated …

the exaggerations in the promotional material are likely to both prevent some people from cycling because of the fear of the risk, and to induce risk compensatory behaviour in those who chose to cycle and wear a helmet“

A false sense of safety can lead to more risk-taking, accidents and injuries, undermining the initial objective to reduce injuries. Although this seems speculative, real world data can shed some light. The state of Western Australia (WA) has collected the most accurate cyclist hospitalisation data, shown below.

After the helmet law was enforced in July 1992, the number of cyclists dropped by 37%. In 1993, cycling hospitalisations were only slightly below 1991, despite fewer cyclists on the roads. The risk of injury per cyclist increased by 38% while the risk of injury for pedestrians dropped by 8%. Cycling injuries kept rising. In 2000, the risk of injury per cyclist was twice what it was before the helmet law.

This is similar to what was observed in New South Wales (NSW), where the risk of accident more than tripled. Head injuries increased significant;y despite cycling dropping by half.

Even if helmets were 100% effective, it is not possible to compensate a tripling in the risk of accident with a 9% rise in helmet wearing.

For child cyclists in NSW, the risk of accident almost doubled, while the risk of death and serious injury increased by more than 50%.

Real-world data indicates that the helmet law has failed to achieve its stated objective of reducing the cost of cycling injuries.

A false sense of safety can induce people to take more risks, leading to more accidents and more injuries. This tendency is called risk compensation, a well-known safety factor as reported here:

“the law of unintended consequences is extraordinarily applicable when talking about safety innovations. Sometimes things intended to make us safer may not make any improvement at all to our overall safety”

Wearing a helmet can induce cyclists to take more risk, sometimes with serious consequences, as reported in the New York Times:

“the increased use of bike helmets may have had an unintended consequence: riders may feel an inflated sense of security and take more risks. …

The helmet he was wearing did not protect his neck; he was paralyzed from the neck down. …

”It didn’t cross my mind that this could happen,” said Philip, now 17. ”I definitely felt safe. I wouldn’t do something like that without a helmet.” ”

Risk compensation affects not only cyclists but also motorists who tend to be less careful around helmeted cyclists. As reported in a study published by the University of Bath in the UK:

“Bicyclists who wear protective helmets are more likely to be struck by passing vehicles”

Both the behaviour of the helmeted cyclist and surrounding motorists tends to increase the risk of accidents.

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The neglected human factor

Why these surprising results? A key factor that has been neglected is the impact that wearing a helmet has on cyclist behaviour. For some people, having to wear a helmet means no more cycling. For others it means taking more risks. Neither reaction improves cycling safety or public health. Helmets effect cyclist behavior, as reported by the Institute of Transport Economics in Norway:

“There is evidence of increased accident risk per cycling kilometre for cyclists wearing a helmet”

Another factor in risk compensation is that helmets tend to encourage people to ride faster, as reported in 2011 by the Risk Analysis international journal:

“those who use helmets routinely perceive reduced risk when wearing a helmet, and compensate by cycling faster”

Increased speed significantly increases the severity of injuries in case of an accident, as reported in 2012 by the Monash University Accident Research Centre:

“Chances of a head injury increased threefold at speeds above 20km/h and fivefold at speeds above 30km/h”

What is the point wearing a helmet if it induces people to ride faster? At most, a helmet can only reduce a 50 km/h impact to the equivalent of a 45 km/h impact.

The best way to avoid injuries may not be to wear a helmet, but to ride slower.

A slow and careful rider without a helmet is probably less at risk of injury than an overconfident helmeted rider taking risks at higher speeds. With a helmet law, the safer type of cycling is illegal while the more dangerous one is vindicated. This is the irony of a counterproductive policy, as mentioned in a 2012 study published by the Institute of Transport Economics in Norway:

“at least part of the reason why helmet laws do not appear to be beneficial is that they disproportionately discourage the safest cyclists.”

How counterproductive is a helmet law? In Australia, the cyclist fatality rate is five times greater than in the Netherlands (where very few wear helmets), while the serious injury rate is 22 TIMES greater. This huge difference indicates an accident rate several orders of magnitude higher.

John Pucher, a US professor at Rutgers University in New Jersey, researched how several countries have made cycling safe, convenient and practical. Infrastructure, legislation to protect cyclists, training and measures to discourage car use are emphasized. Helmets played no part in making cycling safer. John Pucher said:

“Compulsory wearing of helmets was “a Band-Aid strategy” adopted by governments shying away from more difficult initiatives of building separated cycle ways, calming neighbourhoods and educating drivers and riders.”

An overemphasis on helmets can result in neglecting more effective safety measures like reducing the risk of accidents.  This might explain why Australia’s serious injury rate is 22 TIMES greater than in the Netherlands

Transport authorities have ignored the link between helmets and risk-taking and seem unable to make a connection between helmets and accidents. Many people still believe that helmets are the key to cycling safety. Those who pushed for the helmet law have difficulty accepting that the actual results of their policy do not match their good intentions. They justify the helmet law by claiming

“helmets can help to reduce head injury by up to 60 per cent, and brain injuries by 58 per cent”

quoting their own discredited “study“. They ignore that helmets increase the risk and severity of accidents, which is more significant in terms of injuries. They seem unable to distinguish between helmets and the helmet law. Even though it may be beneficial for some cyclists to wear helmets, that doesn’t mean that forcing all cyclists to wear a helmet at all times is any more a good idea than forcing all pedestrians to wear helmets.

Helmet law believers seem unable to distinguish between the objective to improve safety and the naive way it is attempted. According to “safety in numbers” research, a 44% decline in cycling increases the risk of accidents by 41%. This cannot be compensated by a 9% in helmet wearing. The increase in the risk of death & serious injury after the helmet law indicates that the negative side-effects are dominant. 20 years later, helmet law believers are still touting the theoretical benefits of helmets while ignoring the failure of the helmet law to reduce the risk of serious injury. How can such a narrow-minded view still influence policy? Such disconnection from reality indicates people stuck in their ideology, unable to admit they have made a mistake. This is irrational and harmful. The helmet law should be judged on its results, not on its intent.

The odd discrepancy between the helmet law dogma and real world evidence has been noted in Health on the Move 2, a report from an independent British society of public health and transport practitioners and researchers. The section on bicycle helmets evidence reports:

“The failure of mass helmet use to affect serious head injuries, be it in falls or collisions, has been ignored by the medical world, by civil servants, by the media, and by cyclists themselves. A collective willingness to believe appears to explain why the population-level studies are so little appreciated. ….

The disconnect between received wisdom and the facts is stark.“

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Start of renewal

In 1994, the Northern Territory in Australia relaxed its helmet law and reduced its enforcement. Since then, the helmet wearing rate is the lowest in Australia, cyclist hospitalisations per capita are the lowest in Australia and cycling to work is three times the national average.

Bike share schemes have been introduced with great success all over the world, providing valuable health and environmental benefits. Even in cities without a history of cycling, the benefits can be significant. For example, in Seville, Spain:

“Traffic congestion and pollution are declining for the first time in 30 years. Businesses are thriving along bike routes and around the newly improved public spaces that are breathing fresh life into the central city. The number of car trips into the historic city center has plummeted from 25,000 a day to 10,000″

Bike share schemes have been successful all over the world, except in Melbourne and Brisbane, where they are crippled by a helmet law. This form of slow, upright cycling is safe. The helmet requirement is irrational.

In 2010, Melbourne and then Brisbane introduced bike share schemes. However, usage is Melbourne is 20 TIMES lower than in Dublin, a city of comparable size. Danish urban planner Mikael Colville-Andersen, who specialises in cycling, noted:

“Good ideas tend to travel and this idea, that you simply must wear a helmet when you cycle, has not. What does that tell you? You are the fattest country in the world, you should be encouraging cycling, not convincing people it”s dangerous.”

Bike share is safe. For example, in London after about seven million trips (average length five kilometres), there were no fatalities and only nine injuries requiring hospitalisation. The serious injury rate is 25 per 100m kilometres, compared to 69 per 100m kilometres for cyclists in London. This is not surprising considering its low speed and upright position. It seems the helmet requirement is driven more by ideology (or an attempt to defend government policy) than by an objective assessment of the relative risk of bike share. The irrational helmet requirement discriminates against a safe mode of transport, as mentioned here:

“It would be arbitrary to impose legislation on cyclists, who do not face clearly higher risks than pedestrians or drivers.”

Bike share schemes in Mexico City and Tel Aviv have boomed since the Mexican and Israeli Government repealed their mandatory all-age helmet laws. The Australian cities of Sydney, Perth, Fremantle and Adelaide have publicly declared their support for partial helmet law repeal to encourage public use of bike share projects.

Even in the US, where the belief in helmets is strong, people are questioning the suitability of helmets for bike share, as noted by Piet De Jong:

“Pushing helmets really kills cycling and bike-sharing in particular because it promotes a sense of danger that just isn’t justified — in fact, cycling has many health benefits …

Statistically, if we wear helmets for cycling, maybe we should wear helmets when we climb ladders or get into a bath, because there are lots more injuries during those activities.”

So far, State Governments have rejected calls to exempt this safer form of cycling from the helmet law. They have even rejected calls for a trial exemption. In 2011, the Queensland Government commissioned a “study” to defend its policy. Only 13 days were given to produced this study that was then significantly edited several times (to favor the legislation) by the Department of Transport and Main Roads. The government then used this fake “study” to dismiss calls to review the helmet law.

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Summary

Many people take for granted the protection provided by helmets without considering their side-effects. Evidence indicates that the protection they provide is minor, while they increase the risk and the severity of accidents. Is this really worth the “protection”?

It should not be taken for granted that the protection provided by helmets outweighs their risks.

This cannot be dismissed as speculation. After reviewing evidence in a court of law, NSW District Court Judge Roy Ellis concluded:

“”Having read all the material, I think I would fall down on your side of the ledger …I frankly don”t think there is anything advantageous and there may well be a disadvantage in situations to have a helmet and it seems to me that it”s one of those areas where it ought to be a matter of choice.”

It is odd that such a controversial device has been made compulsory in the name of safety. The law may have been introduced with good intentions. However, the process to introduce it was lacking important safeguards and sanity checks. The parliamentary committee pushing for it did not have to demonstrate that the law would provide a net benefit.

Such negligence has most likely contributed to the 55% increase in the risk of death and serious injury for child cyclists in NSW observed after the helmet law.

Instead of admitting it had make a mistake, the government engaged in deceptive and wasteful attempts to obfuscate the failure of the helmet law through the funding of misleading, policy-driven “studies”. The failure of this policy was further compounded by a wasteful media campaign misleading the public about the risks of cycling and the effectiveness of helmets.

The unfounded conviction that helmets are the key to cycling safety has diverted focus away from more effective measures that can reduce the risk of accidents. This might explain why Australia has one of the worst cycling safety record among developed countries, with a serious injury rate 22 TIMES higher than best practice. The hidden costs of this policy are yet to be fully quantified.

Negligence and complacency, combined with a series of mistakes and deficiencies in the legislative process, have compounded to produce a damaging policy that has not only failed to achieve its goal to reduce injuries, but has also significantly reduced cycling. This decline in cycling results in a loss of health benefits that increase public health costs for no benefit. Additionally, the helmet law prevents a safe mode of transport, bike share, from operating successfully and delivering the same benefits as many other cities have achieved all over the world.

Acknowledgement: Much of the historical information has been sourced from CRAG submission to the Prime Minister in 2009 that is still awaiting a response, and from this article. Both documents include references to information sources.