Why did the injury rate triple after the helmet law?

Abstract

The injury rate has tripled since the helmet law.
By increasing the risk of accidents, helmets have made cycling more dangerous. 

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A recent study reveals a steady increase in cycling injuries in New South Wales (NSW), Australia, after the helmet law. Between 1991 and 2000, arm injuries doubled, while head injuries increased by 40%.

cycling-injuries-nsw

A 1996 cycling survey in Sydney revealed that cycling counts were 48% below 1991. According to the census, cycling in Sydney further decreased between 1996 and 2001.

sydney_cycling_counts

After adjusting for the number of injuries per number of cyclist, the risk of injury is shown below:

cycling-injury-rate-nswAs the number of cyclists decreased, the rate of injuries increased

A decade after the helmet law, the injury rate tripled, indicating a large increase in accidents.

Why did the injury rate triple?

How can the widespread wearing of a device that protects the head result in almost a 3 time increase in the risk of head injury?

There are several reasons for this unexpected result.

Safety in numbers

Safety in numbers is a well-know phenomenon in safety, that resulted from observations that the fewer cyclists, the more dangerous cycling becomes. Research published in the Injury Prevention journal concluded:

“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.”

safety_in_numbers_5

A key factor for cycling safety is the number of cyclists.  This is called “safety in numbers”.
The fewer cyclists, the more dangerous cycling becomes.
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The “safety in numbers” effect has been measured. If cycling halves, the risk increases by 52%. The 48% decline in cycling observed corresponds to an increase in risk by 48%.

Risk Compensation

There is a well-known safety phenomenon called “risk compensation“, following observations that as people feel safer, they tend to take more risks:

“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”

risk-compensation

Risk compensation is the tendency to take more risks when wearing safety equipment.
Lured by a false sense of safety, helmeted cyclists take more risks and have more accidents.
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Wearing a helmet can induce cyclists to take more risks, sometimes with severe 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 helmeted cyclists and surrounding motorists increase the risk of accidents.

Even though the decline in cycling mostly occurred in the first few years following the helmet law, the risk of injury has kept rising afterwards. This coincided with helmet promotion campaigns launched in the mid 1990′s. Helmet promotion campaigns exaggerating the benefits of helmets have given cyclists a false sense of safety, increasing the risk of accidents.

Degrading the bicycle helmet standard

Before the helmet law, Australia’s bicycle helmet standard required helmets to have hard shells. However, government research warned of deficiencies in the standard, as it failed to protect children, and failed to test for brain injury.

Instead of improving the standard based on recommendations from its own research, the government degraded Australia’s helmet standard to accommodate ”soft-shell helmets” providing little protection while increasing the risk of brain injury. Soft-shell helmets are more comfortable and facilitate compulsory helmet wearing.

hard-shell-vs-soft-shell-helmet

By degrading the helmet standard, the government legitimized a piece of polystyrene generously called a “soft-shell helmet”. However, language cannot change the facts. Calling a piece of polystyrene a “helmet” doesn’t magically give it protective abilities. Still, it can fool people into believing that it provides far more protection than it really does.

By degrading the helmet standard, the government replaced useful helmets with dangerous devices providing minimal protection. This provided little more than the illusion of safety.

This is likely to have contributed to the increase in head injuries after the helmet law.

Discouraging the safer cyclists

Following the helmet law, many cyclists who used a bicycle for transport, for example to cycle to the local shops, gave up cycling.

It is likely that transport cyclists have fewer injuries than sport cyclists, as they travel at lower speeds, and have no incentives to take risks. The increase in injuries after the helmet law can be partly explained by reduction in transport cycling.

However, the reduction in transport cycling cannot have quadrupled the injury rate. Even if sport cyclists had a risk of injury 4 times higher than transport cyclists, this could only result in a 50% increase in injury rate.

Summary

The injury rate has tripled since the helmet law. This is most likely due to:
  1. safety in numbers: the risk of accidents increased as there were fewer cyclists.
  2. risk compensation: cyclists wearing a helmet were lured into a false sense of safety, taking more risks, and having more accidents.
  3. The helmet standard had been degraded to include polystyrene “helmets” that provide little protection while increasing the risk of brain injury.
  4. The helmet law discouraged the safer cyclists.

The increase in the injury rate corresponds to an increase in risk for cyclists for the first 3 factors. However, the fourth factor cannot explain a tripling in injury rate. The helmet law is likely to have at least doubled the risk of injury.

But wait, the study authors claim the helmet law was a success!

Despite the large increase in head injuries, the study  claims:

“the benefit of MHL to lowering head injuries”

How can the study authors make such a ridiculous claim?

  1. They ignored the decreased in cycling after the helmet law. Instead of using surveys that had counted the actual number of cyclists, they ASSUMED that cycling increased with population growth.
  2. The strong rise in injuries from the study’s main graph was ignored. How can the study authors have failed to notice this? This blindness to negative side-effects of the helmet law is reminiscent of a study affected by confirmation bias.
  3. The introduction of the helmet law occurred at the same time as other road safety measures, notably a crackdown on drink driving and lower speed limits. These measures lowered the speed of cycling accidents, thus reducing head injuries. However, the study authors attribute ALL the apparent relative reduction in head injuries relative to arm injuries to the helmet law, without taking into consideration other factors. This is a common mistake of failing to assess confounding factors.
  4. The study reports a reduction in head injuries since 2006. This coincides to a resurgence in cycling, with many of the new cyclists not wearing helmets. Head injury rates decreased while fewer cyclists wore helmets. Oblivious to this, the study attributes the reduction in injuries to spending on cycling infrastructure that occurred mostly in Sydney after 2009.

This “study” is like doing a cost benefit analysis while ignoring the costs and exaggerating the benefits.

This study was funded by a government who, struggling to justify its counterproductive policy, commissions “studies” to defend it. The bureaucrats quote this “study” as following:

“A recent study from the University of New South Wales showed that the initial benefits of the mandatory helmet laws have been maintained over time.”

Do they think we are complete fools?

This study did not fool a UK reporter:

As the fallout from Australia’s failed bike sharing schemes continues, it seems we haven’t seen the last of government-funded research showing that helmet laws are great actually, thanks very much.

The authors, Olivier, Walter and Grzebieta, previously published a paper in 2011 claiming to “end the debate about the effectiveness of cycle helmet legislation”, but which was severely criticised by fellow boffins

the government of NSW has commissioned research which (surprise!) finds the effect of their helmet law is massive and sustained, ignoring the uncomfortable fact that helmet wearing rates have actually fallen back significantly without any accompanying jump in head injuries.

The authors …  include all types of minor flesh wounds, bruising etc. which you would certainly hope would be prevented by helmet use, rather than looking at a reduction of critical injury / death which is what public health policy should be worrying about, when the alternative is serious sedentary disease.

It’s generated some nice headlines and superficial reinforcement for the helmet law (which is probably what the government were really trying to commission).

Such a “study” helps bureaucrats refuse to admit they made a mistake.

How does that serve the public?

US government drops claim that helmets reduce 85% of head injuries

The US government has dropped its claim that bicycle helmets reduce 85% of head injuries. The claim came from “research” conducted by avid helmet advocates in 1989. Many researchers have tried to replicate its results, but have been unable to do so. Amid severe criticism over the implausible claim, the authors had to re-work their data, and arrived at a lower effectiveness rate.

Despite the claim being disowned by its authors, it has been eagerly quoted by helmet advocates, keen to push helmets. The US government has kept quoting the claim on its web site.

In 2013,  the US Department of Transportation agreed to delete the claim following a petition lodged by the Washington Area Bicyclists Association under the Federal Data Quality Act. The Data Quality Act requires information on federal web sites to be accurate and supported by appropriate research.

This was first reported by the Washington Area Bicyclsists Association. This followed its successful campaign against a bicycle helmet law in Maryland in early 2013, including this testimony.

Cyclists escape helmet fines

Nerendra Jeet Singh, a Sikh cyclist, went to court in New South Wales (NSW), Australia over a fine for a bicycle helmet. He escaped the fine, after arguing that his identity and his religion are of prime importance. He mentioned that Sikhs have exemptions from wearing bicycle helmets in Canada. In South Australia, Western Australia and Victoria, Sikhs can have an exemption from wearing helmets.

A government official tried to justify the legislation by regurgitating the usual nonsense:

“Wearing a secure helmet reduces the risk of brain or head injury by up to 60 per cent”

This is based on an old discredited “study” funded by the government. The number of people who believe such nonsense is dwindling. The government fails to mention that helmets increase the risk of accident and injury.

Increasingly, people who challenge a helmet fine in court escape it. In NSW, the defence of necessity allows people to break a law to avoid even more dire consequences. Bicycle helmets increase the risk of accident and can cause brain injury. To avoid these dire consequences, cyclists can ignore the helmet law.

This might explain why the police now rarely book cyclists for not wearing a helmet in NSW (except occasionally on the Pyrmont bridge in Sydney). It is pointless harassment: most people give up cycling, those who prefer to keep riding can challenge the fine in court.

In Victoria, Alan Todd successfully challenged a helmet fine in court, avoiding the fine.

In Queensland, Jasdeep Atwal successfully challenged a helmet fine in court, asserting the rights of the Sikhs to ride bicycles. The efforts of the Sikh community have led the government to reform the law to add religious exemptions from the helmet law in Queensland.

Trying to deny that helmets can aggravate brain injury

Abstract

Several studies have reported that bicycle helmets tend to increase rotational acceleration in an accident, increasing the risk of brain injury.

A study funded by Australian government set up unrealistic conditions where rotational acceleration is low. The study results are arbitrarily generalized to all helmets in all conditions. This is deceitful, as the study unrealistic conditions are not representative of real life accidents.

An interview with an author of this study revealed that the study was not set up to address rotational acceleration, that soft-shell helmets are for cosmetic purposes, not really for protection, and that current helmets do not appear to protect for brain injury.

 

What causes debilitative brain injury?

Scientific research on brain injury reports that most brain injury is caused by rotational acceleration:

“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.

Rotational acceleration means the head turning quickly.  This quick rotation can create shearing inside the brain, tearing apart brain tissue and severing critical neural connections.  This severe brain injury is called diffuse axonal injury.  It can lead to permanent disability, when people have trouble operating normally, like in a vegetative state.  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,” “

Rotational acceleration is different from linear acceleration, which occurs when a moving object hits an obstacle, like a head hitting a wall.  Helmets are designed to protect against low levels of linear acceleration, for impacts below 20 km/h.  However, they are not designed to protect against rotational acceleration.

Helmets cannot protect against rotational injury but they can increase it, according to research done in Sweden:

“The non-shell helmet did in all trials grab the asphalt surface, which rotated the head together with
the helmet. The consequences were in addition to the rotating of the head, a heavily bent and compressed neck, transmitted on through the whole test dummy body after the impact.  …

This gives an average angular acceleration of 20800 rad/s² for rotating the head from 0 to 0.26 rad during the 5 ms. Löwenhielm proposes 4500 rad/s² to be the maximum angular acceleration that can be tolerated for a limited time period, which also is suggested by Gilchrist and Mills.”

Soft-shell helmets are helmets without a hard shell.  They are the most common type of bicycle helmet.  Most have a thin layer of plastic on top, less than 1 mm.  Some have a cloth on top of the polystyrene.

Soft-shell helmets grabbed the road surface, and then amplified rotational acceleration to four times higher than the tolerable maximum.

On impact, the larger head volume amplifies rotational acceleration.  A study done in the UK reports that a difference of just 3cm in helmet circumference increases rotational acceleration by 150%:

“the 3000rad/s² to 8500rad/s² measured during abrasive and projection oblique tests with size 54cm (E) helmeted headforms. However, for the most severe cases using a size 57cm (J) headform, rotational acceleration was typically greater than 10,000rad/s² and increased to levels of 20,000rad/s², a level at which a 35% – 50% risk of serious AIS3+ injuries is anticipated.”

The difference between a helmeted and non-helmeted head is about 20cm.

This risk has been reported by other studies, including a study done by the Australian government before the helmet law.  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. 

This risk is not easy to isolate in real life, as there are often other contributing factors.  However, a doctor from New Zealand reports that helmets convert what would have been focal head injuries into much more debilitating brain injuries:

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

This is consistent with Canadian data that shows the length of stay in hospital increased following helmet laws, from 4.3 days to 6.9 days, suggesting more severe head injuries.  In addition, the number of serious head injury admissions increased by 46% from 2000-2001 to 2003-2004.

A very strange “study”

Bicycle helmets are often presented as preventing brain injury, even though they are more likely to aggravate it. Making mandatory a device that can aggravate brain injury can have serious implications.

The Australian government introduced a policy of mandatory helmets despite being warned of this risk by its own researchers. Since then, it has not only failed to warn the public of this risk, but also attempted to deny it.

Many people wrote to the government about bicycle helmets, mentioning the risk of brain injury from rotational acceleration. Suddenly, the government had an answer to this concern, claiming:

“A 2009 study by the University of NSW confirmed the effectiveness of a bicycle helmet in reducing angular acceleration and subsequent brain injury in crashes”.

This study was not published in any scientific journal and could not be found anywhere. After much insistence, a copy was obtained from the Roads & Traffic Authority, a government agency. This study was commissioned and primarily funded by the Australian government. The abstract states that the study’s aim is to

investigate the ability of a bicycle helmet to reduce angular head acceleration“.

It seems to be a “study” with a pre-determined conclusion, like this one.

The study was set with unrealistic conditions, by

  1. Using a type of hard-shell helmet not representative of the most common type of helmet used
  2. Testing at unrealistically low speeds of 5 to 11 km/h
  3. Testing on a non-abrasive surface not representing standard road conditions
  4. Failing to test for oblique impacts

Other studies have reported high rotational acceleration with soft-shell helmets, at speeds above 30 km/h, on a standard road surface, a more realistic setup. Oblique impacts tend to be the impacts generating high rotational acceleration. This study set up minimized the likelihood of encountering rotational acceleration, which is supposed to be the object of the study.

The study used a helmet with a ABS shell, like the one shown on the right, then arbitrarily generalised its results to all bicycle helmets, including the soft-shell helmet, the most common helmet today.

The study conclusion makes no mention of the unrealistically low speeds (5 km/h to 11 km/h) chosen. How can any serious accident protection research only do tests a low speed? It is well known that speed is a major factor affecting the severity of an impact. Testing only a low, unrealistic speeds is almost useless.

The study tested a low speeds like 5 km/h, even though the risks they are “studying” have been reported at higher speeds like 30 km/h.  The study then claimed that the risk doesn’t exist.

The conclusion fails to qualify the results by mentioning it was not using a realistic road surface. The flat surface used reduces the risk of the helmet sticking to the surface on impact. On a road, the polystyrene helmet would have most likely stuck to the road and generated high rotational acceleration, as reported by other studies.

Despite the unrealistic conditions, the study results are generalized without qualifications or justification. The study claims that

“At worst bicycle helmets do not appear to exacerbate head injury risks arising from angular acceleration.”

This is deceitful, as this “conclusion” is the result of the peculiar set up of the study, that cannot be generalised beyond the laboratory rather unusual conditions.

Interview with an author of the study

To better understand the circumstances behind this study, CRAG has interviewed one of the study authors. Here is an extract from this interview:

Why use hard-shell helmets?

“The helmets were supplied to us”

Why not use a soft-shell helmet, the most common type used today?

“ the soft-shell helmet doesn’t do much – basically for cosmetic purposes – falls to pieces very easily - When touched can dent easily - Main function of soft shell helmets to ‘retain foam in semi-rigid format,’ not really for protection

Carbon fibre helmet (often used in motorcycle helmets) offers more protection but weighs more and deemed too heavy for bicycle riders – therefore not used in bicycle helmets”

The tests were done at speed from 5 km/h to 11 km/h.  Why not higher speeds like 20 km/h?

“We had borrowed the RTA’s crash dummy and didn’t want to damage it”

Why use a flat surface and not a road surface?

“Time constraints at the time but did recognise need  to replicate road conditions”

Do you believe that the conditions used in the study are realistic of real-world conditions?

“No “

The study concludes that helmets do not increase rotational acceleration, yet it doesn’t mention the context of study.  Are you sure that this study is comprehensive enough to assert that, any helmet, in any situation, does not increase rotational acceleration?

the study does not address any oblique impact issues so therefore does not address potential increase in rotational acceleration of the brain

… current helmets on the market are limited in preventing rotational acceleration

… there is no rotational testing element in the helmet standard. the current test method in the AUS/NZ standard is only related to linear injuries and only needs to pass a linear test. The current AUS/NZ standard does not include a rotational acceleration test”

Why isn’t the conclusion of the study qualified within the bounds of the experiment?

“within the limitations of the study, the conclusion raised that there is a risk of another possible head injury

… current helmets are only tested for linear injuries

In your opinion as an expert, do helmets do their job?

“As long as there is no oblique impact, yes

… But in an accident with any oblique impact, probably not

.. Current helmets do not appear to protect for brain injury such as concussion or haematoma

Hmmm…

There is a strange discrepancy between the study bold claim that helmets do not increase head injury through rotational acceleration, and the admission that the study did not include any oblique impacts, therefore could not assess rotational acceleration.

I wonder whether this researcher is aware that the study he participated in is being used to promote soft-shell helmets, that he admits are for “cosmetic purposes, not really for protection”.

Ethical issues

Is this research or is this disinformation? This study still hasn’t been published in a scientific journal, escaping scrutiny from independent researchers. Its only purpose seems to be to defend government policy, like other policy-driven studies funded by the government. This is a deceitful attempt to cover up the risk that helmets can aggravate serious brain injury.

The government is expected to fund research that can lead to better helmets, like it did in 1987 (before the helmet law). Commissioning research to cover up the deficiencies of a government policy is deceitful. If a private company was caught commissioning fake research to cover up deficiencies in its product, there would be an outrage, with the government punishing the company heavily.

The primary task of public servants is to give honest and impartial advice, NOT to cover up their previous mistakes in a self-interested manner. When they engage in misleading and deceptive conduct, who is there to keep them honest?

How can using public funds to deceive the public be justified?

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July 2013 update 

The same team of researchers published a related study in 2013, entitled: “Bicycle helmets: head impact dynamics in helmeted and unhelmeted oblique impact tests“. It is is based on the flawed study described above.

Like the “study” described above, this later study sets up unrealistic conditions. Nothing can be concluded about real life accidents from such unrealistic conditions.

This study has already been peddled by helmet zealots and bureaucrats as “proof” that bicycle helmets reduce rotational acceleration. Public money well spent?

Junk science

Abstract

The failure of the bike share scheme in Brisbane led to calls to exempt bike share from the helmet law. The government response was to commission a study to defend its controversial  legislation. Bureaucrats even edited the “study” in favor of the legislation. Such “research” should not be misrepresented as science.

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A strange “study”

The failure of the bike share scheme in Brisbane led to calls to to exempt bike share from the helmet law.

A document obtained under the Right to Information legislation (RTI) revealed that the government response was to commission as “study” to defend its controversial helmet law. CARRS-Q was only given 13 days, and paid a generous $35,000 to produce a “study”.

13 days is too short to conduct high-quality research. Thus the “study” is mostly a re-hash of previous studies vindicating helmets.

Email correspondance obtained under RTI revealed more shocking findings:

the report was reviewed no fewer than three times by the State Government’s Transport and Main Roads Department before its public release, with some significant changes made to ‘strengthen’ the supposedly academic findings.

Since when does academic research gets edited by the party commissioning it, in favor of its own agenda?

The study press release is full of bold claims, lacking supporting evidence. It dismissed calls to exempt bike share from the helmet law, backing the government agenda.

The government (surprise!) quoted this commissioned “study” to dismiss calls to review the helmet law.

Such use of dubious studies is not new. Governments have commissioned many policy-driven studies since the failure of the helmet law became apparent. Using junk science is not new among helmet zealots, as shown in Canada, where zealots use various tricks and optimistic assumptions to push for a helmet law. 

Where is the evidence?

A close look at the study reveals wide discrepancies between its bold claims and the evidence.  As would be expected from a report produced in a short time, and edited by the bureaucrats commissioning it, it is full of errors, invalid claims and unexplained discrepancies.

The study makes some strange assertions, for example:

the reason they don’t cycle is because it doesn’t fit in with their lifestyle

There is no evidence backing up this statement. This indicates the amount of “research” conducted. Somehow the study ignores that cycling numbers could conservatively double if the helmet law was repealed.

The study attempts to deny that cycling declined after the helmet law. It makes this strange claim:

”In Melbourne adult cyclist numbers doubled after the helmet legislation was introduced”

How this conclusion was reached is a mystery. The quoted source is another policy-driven study. It is difficult to see how such conclusion can be reached, even from the dubious data quoted. Perhaps it is one of the edits from the bureaucrats.

Figure 2 on page 26 of the study reveals that cycling injuries increased after the helmet law, despite a lower number of cyclists. This is consistent with what has been observed in other states. In NSW, the injury rate tripled after the helmet law, due to a strong increase in accidents. 

cycling-injury-rate-nswThe injury rate tripled after the helmet law

This is hardly an indication of the success of the legislation. Yet that didn’t stop the study authors from claiming that the helmet law had been a success.

A key claim from the study is that exempting bike share from the helmet law would result in increased head injuries. This is based on an old discredited “study” conducted by helmet activists, that claimed that bicycle helmets protect against 85% of head injuries. Since, the researchers disowned this claim. Why is it used as the foundation for this study then?

The study ignores that helmets tend to increase the risk of accidents, DESPITE the fact that its own data indicates an increase in injuries after the helmet law.

There are so many errors in this study, that it would be too long to list. Some of them are described herehere, here, and here.

Why was real-world evidence ignored?

The study makes a lot of strange  prophetic statements, without referring to real-world evidence. For example, the claim “Only requiring bicycle helmets to be worn by children or when riding on the road would result in substantial increases in the percentage of riders in crashes who sustain head injuries” contradicts the most relevant evidence available.

The best evidence we have of what might happen if the helmet law was relaxed is the experience in the Northern Territory.  NT relaxed its helmet law in 1994 and reduced its enforcement.  Since then, the helmet wearing rate is the lowest in Australia, cyclist hospitalisations per capita are the lowest, and cycling to work is 3 times higher than the national average.

The study makes prophetic claims about bike share, without referring to real world evidence. In London, after 7 million trips, there were no fatalities and only 9 injuries requiring hospitalisation. The serious injury rate is 3 times lower than for all cyclists. Bike share is safer that walking.

bike share London 3Bike share is safer than walking. The helmet requirement is irrational.

With its low speed and upright position, bike share is safer than walking.
Why require a helmet?
How can such stifling policy have greater benefits than costs?
Why not require pedestrians to wear helmets then?

Official misrepresentation of Australia’s bicycle helmet law

Abstract

The helmet law has failed to achieve its stated goal of reducing the cost of cycling injuries.
Several government agencies have 
obfuscated this disappointing result through misrepresentation.

The information below is an extract from CRAG submission to the Prime Minister in 2009.
Following this submission, the federal government abandoned its policy of supporting compulsory bicycle helmets.

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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.[17],[18]Federal authorities also criticised an exemption which the Northern Territory granted for adults on cycle paths[19],[20], 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.

Fatalities

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 [162], 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

YearTotal road usersAdult          ChildPedestriansAdult         ChildBicyclistsAdult          Child
19892505           296428             7354               44
19902093           238344             7647               33
19911915           198292             5135               23
19921783           191297             5324               17
19931775           178284             4730               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.

Injuries

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.

 

Usage

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[21], but FORS’s advice to its Minister on the compulsory helmets proposal did not mention this or the need for monitoring.[22]

Monograph 19

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 [164].

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 [166].

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.[23]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 [165].

The myth that cycling is dangerous

You’ve heard it again and again:

“Cycling is dangerous”

When we keep hearing the same statement again and again, we can end up blindly believing it. This is a well-known manipulation technique, mentioned by Daniel Kanheman in his acclaimed book “Thinking fast and slow“:

“A reliable way to make people believe in falsehoods is frequent repetition, because familiarity is not easily distinguished from truth. Authoritarian institutions and marketers have always known this fact.”

How dangerous is cycling?

Not as dangerous as it has been portrayed. According to this assessment and this summary, cycling is less dangerous that walking for the same distance traveled.

In other words, cycling to the shops is likely to be less dangerous than walking to the shops.

Statistically, one can expect a severe head injury from cycling once every 8,000 years of average cycling.
Wardlaw M. British Medical Journal 2000;321(7276):1582 (23 December), doi:10.1136/bmj.321.7276.1582

What type of cycling might be dangerous?

Sweeping statements such as “cycling is dangerous fail to distinguish between very different types of cycling.

downhill-mountain-bike-small-3cycling downhilll

Sports cycling can be dangerous

Yet cycling as a mode of transport is safe.

lady cyclingThis is less dangerous than walking

bike share London 3 This is even safer

With its low speed and upright position, bike share is safe. In London, after 7 million trips, there were no fatalities and only 9 injuries requiring hospitalisation. The serious injury rate is 3 times lower than for all cyclists.

But they keep telling me that all cycling is dangerous!

The myth that all cycling is dangerous comes from years of helmet promotion campaigns. Scaremongering tactics manipulate our fears to push helmets.

How do you promote helmets for a safe activity? Make it look more dangerous than it really is.

This is eloquently illustrated in this report:

“our politicians and transport bureaucrats feel compelled to constantly remind us of how dangerous cycling is …

“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 could have a big fall and you could suffer a major brain injury.”

Misconception 1: Cycling is dangerous. … Melbourne newspaper The Age quoted an emergency physician who opined that riding a bicycle on Melbourne’s roads was “verging on suicide” – an almost hysterical assessment of the risk. ….

The reality is that riding a bicycle is a safe activity. The following table shows Australian government data on the relative injury risk of a number of sporting and recreational activities.  …

Unfortunately, despite the evidence, governments continue to portray cycling as unusually dangerous”

The claim made in the fear mongering propaganda quoted above is particularly misleading, considering that cycling to the shops is safer than walking to the shops. Even though cycling is less dangerous than many comparable activities, it is portrayed as being particularly dangerous.

A funny parody of this ad highlights how cycling is misrepresented as being far more dangerous than it really is.

Not every country suffers from fear mongering tactics from their government. In the UK, the transport minister admits that:

(cycling is) a “safe activity” … safer than walking

In Canada, the hysteria about cycling being “dangerous” is being challenged in the media:

“bicycling had the lowest “burden” of deaths and head injuries of the three transportation modes …

There were 14 deaths per 100 million trips for bicycling, 15 for walking and 10 for driving – remarkably similar. …

Are these risks high? One way to think about this is the number of trips for one death to happen: one car occupant dies every 10 million trips and one pedestrian or cyclist dies every seven million trips. ….

Both walking and bicycling are active modes of travel. The physical activity they entail reduces the risk of developing many chronic diseases, including heart disease, diabetes, certain cancers, and dementia. Many studies have compared these benefits to the injury risks. All have found that the benefits greatly outweigh the risks. The benefits of walking and cycling (lower risk of death from chronic diseases) are 10 to 100 times higher than the risk of death from injuries

US data reports:

“Research studies and data clearly show that, in the current environment, cycling benefits greatly outweigh its tiny risks. We know of no study that contradict this fact.

Contrary to common belief, cycling is safer than many other activities.

Cycling is over three times safer, per mile, than walking.

 

The art of politics, and its unintended consequences

Economic vs political decision making

For those frustrated after dealing with uncompromising bureaucrats and politicians who refuse to acknowledge the damage they have caused, the field of economics can explain how such disasters can happen, and the built-in incentives that prevent corrective action.

There is a strange discrepancy between economic and political decision making, that is eloquently explained in this presentation by economist Thomas Sowell.

“Economics is the study of scarce resources which have alternative uses…

Politics is the art of the plausible ….

Economics involves trade-offs. Politics involves solutions, real or imaginary …

You generate political support by creating a “crisis” … After you convince people there is a crisis, you show your solution … When it leads to a detrimental result, the only cure for this new bad situation is more of the same policy”

Economics is the study of scarce resources that have alternative uses. The rationing of scarce resources is inevitable. A famous saying in economics is “there is no such thing as a free lunch“: you can’t expect results without allocating resources. Economics involves trade-offs between alternatives at its core.

Politics is different. Politics tries to ignore the inherent constraints that economics must deal with. Instead it pretends that grand objectives can be achieved at no cost. Bold promises get votes.

Politics is the art of the plausible. What politicians advocate doesn’t have to be possible, merely believable. Much legislation is not properly thought through, resulting in unintended consequences.

Politicians love to talk about solutions, as if they had no associated costs. Yet there are no magic solutions, there are only trade-offs. You make something a little better at the expense of making something else worse. If resources are devoted to a particular issue, they can’t be spent dealing with other issues.

Politics involve solutions, real or imaginary. The perspective of trade-offs is lacking. Alternatives are not explored objectively. The touted solution is put forward, typically by exaggerating its benefits and ignoring its side-effects.

A solution needs a crisis. A crisis can be easily manufactured using creative statistics. A crisis does not mean that it is worse than many other undesirable issues facing society, or even that it is getting worse.

It’s easy to call anything a crisis, exaggerate its negative aspects, then call for a solution without considering alternatives. A policy is put in place, supposedly to respond to the crisis. Despite its well-meaning intentions, it can result in harmful unintended consequences.

Sometimes the situation becomes worse. The bureaucrats then call for more of the same policy, throwing more of other people’s money at the “crisis”. The cure for a failed policy is often more of the same.

An insidious side-effect of a failed policy is to create a new set of bureaucrats and consultants who make a nice cushy living out of it. They are happy with the status quo, it works nicely for them.

Political decision making applied to the bicycle helmet law

Sounds familiar? This is the perverse process that brought the bicycle helmet law to Australia. From the history of the helmet law, the typical steps are there:

  1. Even though cycling head injuries were not greater than pedestrians or motorists, the government, lobbied by misguided doctors, singled out cycling as being a “problem” requiring government intervention.
  2. At the time the legislation was introduced, cycling was rising, providing significant health benefits to society, while cycling injuries were falling. There was no “problem” to fix.
  3. The policy failed to achieve its objective. The unintended consequence was to reduce cycling and to increase the risk of injuries. Before the policy the “problem” was getting better. After the policy, it was getting worse. The bureaucrats response has been to call for more of the same policy.
  4. The bureaucrats have funded many “studies”, using creative statistics, to defend their policy. These studies may be worthless from a scientific point of view, but they are useful political propaganda, often quoted in media responses to justify the policy. There seems to be no shortage of academics willing to take easy money for policy-driven studies.
  5. The bureaucrats keep trying to justify their policy using a naive narrow point of view exagerating its benefits while ignoring its side-effects. They still use long discredited claims like “helmet protect against 85% of brain injuries“, even though helmets are more likely to aggravate brain injury. They ignore negative side-effects: the decline in cycling, or the increase in accidents and injuries. They still defend the helmet law based on its theoretical benefits while ignoring its actual results. They seem unable to distinguish between helmets and the helmet law. Even though helmets can protect in some circumstances, that doesn’t mean that forcing them on all cyclists is a good idea, any more than it would be for pedestrians.

The  ideology can be seen in this road safety strategy. The unimaginative bureaucrats can think of nothing better than this to improve cycling safety:

“Develop educational communications to target bicycle riders to increase the use of helmets”

Proven measures to improve cycling safety have been well documented. Whoever drafted this “strategy” seem uneducated about those proven measures. Yet they suggest “educating” cyclists on the magic benefits of polystyrene helmets, while they continue to do nothing to address the core issue: the danger from motorists.

That they are so blinkered and unimaginative to believe that more helmet promotion is the solution to cycling safety illustrates the abyss of their ideology.

A broader perspective

Economists bring a perspective that can be helpful to assess policy decisions. By taking a broader perspective, considering the full consequences of a law on society, and comparing it with alternatives, people can rationally assess whether its benefits are worth its costs.

Other countries have chosen different approaches to cycling safety. The results speak for themselves. In Australia, the cyclist fatality rate is five times greater than in the Netherlands, while the serious injury rate is 22 TIMES greater.

It’s not hard to figure out which policy works best, except if you are a bureaucrat who makes a nice cushy living out of the current status quo, or a politician who gains votes by pretending to “do something for safety” while most people have been fooled into believing that the current policy “save lives”.

A funny parody of a fearmongering helmet ad

Listen to this.

Contrast it to the original ad.

A bicycle activist has created an amusing parody of a fearmongering ad commissioned by a government agency to promote bicycle helmets.

The ad makes this extraordinary claim:

“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

This is misleading nonsense for two reasons:

  1. The chance of getting a major brain injury while cycling gently to the shops is less than when crossing the street as a pedestrian. To tell cyclists they have been singled out to wear a helmet when their risk of head injury is lower than others makes no sense.
  2. It is suggested that wearing a helmet would prevent a severe brain injury. That is not true. Bicycle helmets are not capable of doing that. On the contrary, they are known to increase the risk of brain injury. It is ludicrous to use brain injury scare tactics to push people towards the “safety” of polystyrene helmets that are known to increase the risk of brain injury.

This ad misleads people by reinforcing two myths:

  1. Cycling is dangerous
  2. Wearing a polystyrene hat makes cycling “safe”

These myths have been refuted many times, like here for example:

  1. Cycling is safer than netball.
  2. Bicycle helmets increase the risk of accidents and injury.

The core message people retain from such ads is that “cycling is dangerous”.  Helmet promotions like this one are known to scare people off cycling. This turns people away from a safe, gentle and healthy mode of transport.

This “message” was commissioned by “road safety” bureaucrats who are very generous with taxpayer’s money to fund propaganda. How can it be money well spent to tell people that cycling is dangerous when other bureaucrats from the health department are spending taxpayer’s money to encourage cycling?

HelmetFreedom has put together an analysis of this misleading ad.

HelmetFreedom has also some sample letters you can use to write to your MP, so that we can put an end such waste of our money.

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