Category Archives: Helmet Law

The cobra effect

The cobra effect is where an attempted solution to a problem actually makes it worse.

Its origins are briefly described here.  In India, the government was concerned about the large number of venomous cobra snakes in the city.  It set a bounty for dead cobra snakes.  Some people responded by breeding cobra snakes as a way to earn income.  Once the government realised that, it cancelled the program.  Cobra breeders then set the worthless cobra free.  The wild cobras multiplied, making the problem worse than before.  The apparent “solution” had made the problem worse.

This effect has also been labelled the law of unintended consequences, described here.  One of its most common causes is the failure to take into account people’s reactions.  Some bureaucrats assume that people are like passive pieces on a chess board, that they can manipulate through legislation.  This ignores that people react to policies.  Many government policies are well meaning, but the way they are implemented lacks imagination and foresight.  People react in unanticipated ways that can make the policy perverse.

History is full of perverse government intervention.  The alcohol prohibition in the 1920’s in the US is one.  In the US, the “war on drugs” has the perverse result of having a record number of people in jail, yet drug use increased.  Perverse policies can go on for years before they are reversed.

In the case of the bicycle helmet law, the main reaction to the legislation has been to give up cycling.  An independent assessment estimates that cycling levels were 50% below previous trend by 1996.  This has the unintended consequence of loss of health benefits from regular exercise.  It also has another unintended consequences: according to the well understood “safety in numbers” phenomenon, a 50% decrease in cycling results in a 51% increase in the risk of accidents.  This corresponds to the 50% increase in the risk of death & serious injury observed after the helmet law.

This reaction seems to have taken the bureaucrats by surprise.  That is odd, as there were warnings this would be the case.  In 1985, cycling declined sharply in schools that mandated bicycle helmets.  It seems that the core issue is not an inability to foresee the negative side-effects of a legislation.  It is more likely a dogmatic approach.  This is confirmed by the attitude of many bureaucrats who exaggerate the benefits of polystyrene-based helmets, while ignoring the decline in cycling and the increase in the risk of accidents.

Why the emergence of such a dogmatic approach?  It was the result of the way the law was introduced.  The Royal Australasian College of Surgeons lobbied for more than 10 years for a helmet law.  By then, they and the bureaucrats & academics they had influenced had built up a huge emotional stake in this policy.  Part of the lobbying involved sponsoring “studies” exaggerating the effectiveness of helmets while ignoring the increase in accidents.  This reinforced the belief that helmets can only improve safety, and were seen as the magic solution to cycling safety. The resulting group-think meant that the belief in helmets remained unchallenged, despite being groundless.  This obviously seemed a “good” policy, that did not require much due diligence.

By the time and evidence emerged that the helmet law had failed to reduce injuries, this emotionally committed group did what most people would have done in such circumstances: try to justify themselves.  If it meant commissioning “research” obfuscating the failure of the helmet law, so be it.

The damaging unintended consequences should have been enough to end this disastrous experiment.  However, bureaucrats and politicians who have managed to convinced most people that “helmet save lives” through misleading advertising have no incentive to admit they made a mistake.

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Trying to deny that the helmet law reduces cycling

Abstract

Cycling was rising in Australia by 10% per year until the helmet law. Afterwards, it dropped by 30%.
A government commissioned “study” has misrepresented a bicycle rally as a revival in cycling.

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Bicycle travel in Australia was increasing by 10% a year from 1986 to 1989, before the helmet law. After the helmet law, surveys showed cycling declined by 30 to 40%. An independent assessment estimates that cycling was 50% below previous trend by 1996.

The Victorian government commissions studies defending its policies through organisations like the Monash University Accident Research Centre (MUARC). MUARC has published studies claiming the helmet law had reduced head injuries. Such “studies” use biased statistics, resulting in misleading claims defending the legislation.

MUARC conducted this study, claiming that adult cycling recovered two years after the helmet law.

According to the study, child cycling dropped 30% but did not recover.

MUARC_count_child_cyclists

Yet adult cycling appeared to recover.

MUARC_count_adult_cyclists

Why would adult cycling recover but not child cycling?

A bicycle rally passed through one of the counting site in 1992. At that site, there were 451 cyclists in 1992, versus 72 in 1991.

The study authors knew about the bicycle rally. Yet they included it in the study, claiming:

“Another explanation for some of the increase in bicyclist numbers in 1992 is related to the fact that there appears to have been a bicycle rally passing through one of the sites …

From a statistical point of view, however, an occurrence such as this is a true observation, well within the bounds of “normal” behaviour for that time period, and cannot be excluded from the analysis”

The whole point about those comparisons is to keep everything else the same. Same sites, same observation periods, same time of year, so that noise does not distort observations.

The site with the bicycle rally showed a 6 TIMES increase. This is not “normal behavior”. It distorts the results. Yet the study authors chose to include it. This misrepresents a bicycle rally as a revival in cycling.

 

A recent “study” commissioned by the Queensland government claims:

 “In Melbourne adult cyclist numbers doubled after the helmet legislation”.

, quoting the study mentioned above. How they arrived at this conclusion is a mystery. This “study” was edited several times by the Queensland department of transport.

The fundamental role of science is to serve the truth.
It is NOT to serve the interests of the state.

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Research on helmet law in the UK

In the UK, the helmet law has been debated for a long time, with the usual set of emotional arguments from helmet believers.  So far, rationality has prevailed, thanks to the efforts of the Cyclists Touring Club and independent researchers.  Here is some of the research that has help sanity prevail.

 

The Hillman report, one of the most comprehensive early research done in 1992.  It was ahead of its time.  Much of what was described in the conclusion subsequently happened in Australia and New Zealand.

The insightful conclusions for the report include:

By wearing helmets, cyclists are at best only marginally reducing their chances of being fatally or seriously injured in a collision with a motor vehicle which is the predominant cause of these injuries. Even the most expensive ones provide little protection in these circumstances. Moreover, the argument in favour of helmets would have validity if there were proof that behaviour does not change in response to perceived risk. But there is no such proof. Safety devices encourage higher levels of risk-taking. As a result, cyclists are likely to ride less cautiously when wearing a helmet owing to their feeling of increased security. After all, the message of the advocates of helmet wearing is that such a practice will protect the cyclist’s head adequately in the event of any accident, not just a minor one when cyclists are hit by very slow-moving vehicles or fall off and hit their heads on the ground. Cyclists may be less likely to have an accident if they are not wearing a helmet, and are therefore riding with greater care owing to an enhanced sense of their vulnerability. 

Furthermore, people are discouraged from cycling if their perception is heightened that it is a ‘dangerous’ form of travel and that it is only safe to do so if a helmet is worn. The result of this is that the considerable latent demand for cycling – an ideal mode for the majority of the population for most of their journeys – continues to be suppressed. As cycling is also a convenient and routine way of maintaining fitness, a significant route to public health is prejudiced. 

There remain then three questions to be answered. First, should helmet wearing be made mandatory? The report on which this paper is based has revealed no case for such a law. In addition to the absence of proof that helmet wearing reduces the risk of head injury, such a law would represent an infringement of civil rights. Moreover, where it has been introduced, it has led to a significant reduction in cycling

The second question to address is whether, whilst not making it mandatory, cyclists should nevertheless be encouraged to wear helmets -in effect, obliged to do so by ‘moral’ persuasion rather than by law. However, other than concern on the civil rights issue, the approach to helmet wearing by this means rather than by coercion through legislation would appear to be equally invalid. 

This then leads to the third question concerned with alternative and effective ways of reducing the risk of accidents, and therefore of head injury, among cyclists. The primary means of reducing serious head injury among cyclists is to create an environment in which accidents are less likely to occur. Such a strategy based on tackling the source of accidents in which cyclists are involved has far greater scope for reducing head injuries than the questionable benefits of promoting helmet wearing among cyclists.

 

The 2005 report form the National Children Bureau focused on cycling safety, not just cycling helmets.  The section on bicycle helmets, written by an experienced cyclist who regularly wears a helmet, concludes:

“The conclusion from the arguments outlined above is that the case for cycle helmets is far from, sound. The strong claims of injury reduction made by helmet proponents have not been borne out for fatalities (which this paper argues is the most methodologically sound test of effectiveness) in real-life settings with large populations. …

the benefits of helmets need further investigation before even a policy supporting promotion can be unequivocally supported. ….

The cycle helmet debate shows the dramatic power of real life events in shaping our understanding of causality. Tragedies happen; child cyclists are killed or left disabled for life; and we cannot let go of the belief that something
could and should have been done to stop that particular event from happening – especially when that something is so simple as wearing a helmet. We find it hard to accept that the helmet may have made no difference. We find it harder to accept that encouraging or forcing children to wear helmets might also encourage them to ride in a more dangerous way and paradoxically to increase the risk that they will suffer an accident. And we find it much harder to accept that compulsory helmet use might put children off cycling altogether, leaving them less physically active, and – many years later – more likely to die of heart disease. Think of all the uncertainty behind that line of argument, compared with the seeming rock-solid conviction that a helmet could have saved that particular child’s life, at that particular time. And of course the fact that we are talking about children, who have a claim on our protection and who are still getting to grips with the world, makes it so much more difficult to accept the limitations on our ability to prevent them coming to harm. We cannot ignore the human suffering, pain and loss that lie behind the research and statistics. But our response to it demands reflection and perspective as well as sympathy and conviction.

 

In 2011, the Transport and Health Study group, an independent British society of public health and transport practitioners and researchers, released Health on the Move 2, a book aimed to be “a clear and comprehensive account of what would constitute a healthy transport system.”  The section on bicycle helmets evidence, approaches the topic of the helmet law from a health perspective.  It includes a summary of the research on the helmet law.

The report is written in a neutral tone, yet you can sense the frustration of the researchers here: 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 report conclusions include:

The disconnect between received wisdom and the facts is stark.

The facts are:

2. There is however a disturbing discrepancy between engineering or clinical evidence of the effectiveness of helmet wearing (which suggest them to be effective) and population studies (which suggest that they are not).
3. Plausible explanations of this discrepancy include cyclists taking greater risks because they think their helmet makes them safe or drivers taking less care of helmeted cyclists because they see them as less vulnerable. A single study has examined this but its findings supports the latter of these.

5. It is now well established that legislation mandating cycle helmet use causes a reduction in the levels of cycling and thereby does more harm than good.
6 It is unclear whether this is because many people find cycle helmets troublesome, because many people find them unfashionable and odd or because people consider the mandation of helmet use as evidence that cycling is dangerous.”

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Helmet believers doubtful after increase in injuries

A helmet advocate researched Canadian provinces with a bicycle helmet law. What he found shocked him. Provinces with a helmet law experienced relatively more injuries.

“A study that compared six-year periods on either side of the helmet laws in the four provinces that have them calculated a reduction in fatalities of 37 per cent and a reduction in cycling of 20.5 per cent, for a net reduction in fatalities of 20.4 per cent. In provinces without helmet laws, there was a reduction of 29.5 per cent.

Other Canadian studies reports a decline in cycling and an increase in the rate of injury for children.

“Compared to adults who were not required to wear helmets, children’s cycling (<13 years) fell by 59%, with a 41% reduction for teenagers aged 13-17 …

The observed post-law number of injuries – 1676 per year – is 2.37 times higher than would have been expected for the amount of cycling.  In contrast, the safety of adult cyclists (who were not affected by the law) improved.

Thus, far from improving safety for children and teenagers, the risk of injury seems to have increased after Alberta introduced its helmet law.  Similar calculations (Tables 2 & 3), show increases in the risk of head and non-head injuries requiring ER treatment for both children and teenagers, as well as increased risk of head injuries for children, and non-head injuries for children and teenagers admitted to hospital.  In contrast, risks for adults generally decreased.”

Similar result in the US, as reported by the New York Times:

the rate of head injuries per active cyclist has increased 51 percent just as bicycle helmets have become widespread. …

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.” “

A recent study in New Zealand reports a similar result:

“The New Zealand Medical Journal research found a 51 per cent drop in the average hours cycled per person from the 1989-90 period when compared to 2006-09. …

Comparing the ratio of cyclist to pedestrian injuries from 1988-91 to 2003-07 showed cyclists’  injuries more than doubled compared with pedestrians “

Similar result in Australia. Cycling decreased by 40%, the risk of injury tripled.

The most surprising outcome of bicycle helmet laws is an increase in the rate of head injuries.

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Bicycle helmets and public health in Australia

This is a summary of an article by William J. Curnow published in Health Promotion Journal of Australia 2008 : 19 (1) 10-15

The Federal Government adopted the policy of compulsory bicycle helmets in 1989 to minimise the public cost of accidents and it induced the states and territories to pass the world’s first laws for it. This article evaluates effects on public health in Australia.

Governments ill-informed

Contrary to official views, risk to cyclists was falling in the late 1980s: Figure 1.

Figure 1.  Serious casualties compared with the strong growth in cycling, Australia

Governments in Australia ignored Australian research in 1987 which showed that helmets have potential to aggravate fatal and disabling brain injury. Instead, reliance was placed on a decline in head injuries to cyclists in Victoria while the wearing of helmets was increasing. But Figure 2 shows a similar trend for pedestrians; the decline was not due to helmets.

Figure 2. Most severe injury, per cent to head, Victoria

The Australian Transport Safety Bureau (ATSB) and the Cochrane Collaboration claim that helmets reduce the risk of brain injury, but articles by Curnow in Accident Analysis & Prevention rebutted this. In an ensuing debate in AA&P in 2007/8, Curnow had the last word; ATSB declined even to participate.

 

Compulsory wearing in practice

Official surveys before and after the helmet laws found declines in cycling: Table 1.

Table 1. Participation in cycling, Australia

State/territory    % Class of cyclist Decline pre-to post-law
NSW                33 Children <16 36%  in 1st yr of law, 43% by 2nd yr
Victoria             24 ChildrenTeenagers 36%  in 1styr of law in Melbourne46%  by 2nd yr, in Melbourne
Queensland       19 Schoolchildren > 22%, in 1st yr of law
W. Australia      11 SchoolchildrenAll crossing 2 bridges 20%,  1991-93; > 50%, 1991-9638%  on Sundays, in 1st yr of law
S. Australia         8 Schoolchildren 38%,  1988-94
Tasmania             2 No data No data
Aust. Capital Terr. All on bicycle paths 33%,  1st yr week days, 50% weekend
Northern Territory Children, teenage 45%  in 1st yr

 

Australia-wide, the decline in cycling by children is estimated as 40%. The data are insufficient for a similar estimate for adult cyclists, but 29% fewer were observed in Melbourne after the first year of the law and declines in all-age cycling occurred in Western Australia and the ACT. Also, censuses show a 47% decline from 1986 to 1991 in cycling to work in the five States with helmet laws – a reversal of the rising trend of Figure 1.

Less cycling results in loss of the benefits of the exercise for health, which the British Medical Association estimated would outweigh the loss of life due to accidents. Also, studies indicate that motorists seeing fewer cyclists make less allowance for them, thus increasing their risk of casualty.

Table 2 shows serious casualties (fatal and hospitalised) to adults (16+) and children from 1989, before any helmet laws, to 1993, when all were in force.

Table 2. Serious casualties to road users, Australia 1989 – 1993

Year Total road users Adult            Child Pedestrians      Adult             Child Bicyclists            Adult            Child
1989 27323            3938 2882               1083 898                 760
1990 23921            3371 2664               1050 950                 707
1991 21824            2817 2325                 866 768                 502
1992 20734            2752 2316                 862 775                 464
1993 21325            2634 2262                 752 805                 442
Change, 1989-93 -24%            -33% -22%               -31% -10%              -42%

Clearly, adult cyclists did not share commensurately in the general improvement in safety. Nor did child cyclists; the fall in casualties only matched their lower numbers.

In Victoria, cyclists’ claims for head injuries decreased more than non-head. Authorities ascribed this to helmets, but pedestrians showed a similar trend – see Figure 3. This suggests other causes; it is not evidence of efficacy of helmets.

Figure 3: Per cent head injury, of accepted TAC no-fault claims, Victoria

Efficacy of helmets would be shown if casualties had lower wearing rates than the whole population of cyclists, but Table 3 shows this not to be so.

Table 3. Helmet wearing of casualties and whole population

State         Year Casualties, helmet worn Casualties, not worn Casualties,     % worn Population,    % worn, year
Victoria   1999 198 51 80 75
NSW,      1993 192 56 77 74, 83* (1993)
Q’land,    1994 441 136 76 67-89**(1993)
Sth Aust. 1994 67 4 94 86, 91*  (1993)

* child, adult   ** range of primary and secondary school students and adults

Deaths in Australia by head injury decreased from 1988 to 1994 by 42% for all road users and by 38% for pedestrians. But for cyclists, the decrease was only 30%. Considering the decline in their numbers, this suggests greatly increased risk to them.

 

Main conclusion

Compulsion to wear a bicycle helmet is detrimental to public health in Australia, but authorities have obfuscated evidence that shows this.

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