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Bike helmet laws backfiring: doctor

Here is an article from a doctor who has actually researched this topic and is able to look at the issue from a broader perspective, taking into account the damaging effects on health from discouraging cycling.

“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.” 

This is a refreshing change from the scaremongering we typically get, that usually results in more people being scared of cycling.

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Canberra Times article

WHAT TO TELL THE KING

Helmets protect soldiers and workers, so let’s make cyclists wear them too and save our children from dreaded brain injury. The idea seemed plausible. Surgeons advocated it and as early as 1978 a Federal parliamentary committee on motorcycle and bicycle safety recommended that it be kept under review. The initial response of the federal and Victorian governments was publicity campaigns to increase voluntary wearing.

By 1985, a Federal parliamentary committee inquiring further into helmet wearing declared its belief that all cyclists should wear one. A surgeon-backed group noted that the reason was “obvious to all safety-conscious people but the facts supporting this assumption are not easily obtainable in the research literature” – but then they seized on a study by Dorsch and others in South Australia, which “presents convincing evidence for what has been suspected all along,” and urged helmet wearing for all.

Dorsch provided the best evidence the committee had, but hers was a preliminary study only, she retreated from it in her own evidence and the Victorian Government’s submission indicated it used too small a sample to be scientific. Despite all this, the committee recommended compulsory helmet wearing. In 1989, the Federal Government claimed “overwhelming evidence” it would improve safety, and bribed the states and territories to legislate. There was no evidence of increasing casualties, however; deaths to cyclists had been declining for 20 years and head injuries in the ACT, for example, had fallen sharply.

So the helmet laws are based on popular belief rather than knowledge. For those who remember, it’s like the children’s story of Chicken Little, hit on the head by an acorn. “The sky is falling”, she concluded. “I must hurry to tell the King.” On the way she met Henny Penny … . So her story was relayed from one bird to another, and all believed it. Distracted in their panic, they made easy prey for Foxy Loxy, and no-one was left to tell the King..

The story our politicians swallowed has made Australia an easy captive market for the international helmets industry.

Governments failed to provide the protection due to cyclists by properly evaluating the efficacy of helmets. Though helmets protect soldiers and workers from small, fast-moving objects, their testing and design are unsuitable when it is the person that is moving. No allowance is made for heads being connected to bodies and only the cushioning effect of a direct impact to the top of the head is measured.

Most impacts to the head in accidents occur to the front and sides. Like a knockout blow to the jaw in boxing, they impart a rotational force, which theory and experiments with animals have shown is the main cause of brain injury, not direct impact.

Australian research in 1987 showed that the added mass of a helmet may actually increase rotational force, and to minimise it helmet shells should be very stiff. Instead, to make wearing more acceptable the Australian standard for helmets was degraded on political advice to allow cheaper soft shells. The helmet industry’s market expanded, but research showed soft shells grab the surface upon impact, rotating the head.

In its 1994 inquiry on head and neck injuries to footballers, the National Health and Medical Research Council examined evidence for the efficacy of bicycle helmets. It concluded that helmets may possibly reduce soft tissue injury, but “the use of helmets increases the size and mass of the head. This may result in an increase in brain injury.” As no similar inquiry has ever been made on head injury to cyclists, legislators got no proper advice before passing helmet laws, thereby risking increased danger to cyclists.

Following the helmets law, cycling declined sharply as people gave it up rather than wear a helmet. Though warned this effect was likely, governments failed to monitor it properly, measurements of numbers of cyclists being mainly incidental to surveys of helmet wearing.

An observational survey of law compliance and helmet wearing by bicyclists in New South Wales – 1993, by Smith and Milthorpe, reported on matched surveys made for the Roads and Traffic Authority. These counted 6072 child cyclists (under 16) passing survey sites in April 1991, before the helmets law commenced to apply to them on 1 July, and 3887 and 3478 passing the same sites in similar weather in April 1992 and 1993. The respective declines were 36 and 43 per cent. Consistent across-the-board declines were found at road intersections, at school gates and in recreational areas, as well as in Sydney, inner rural and outer rural areas. This implies that they are realistic estimates of the reduction in cycling. No equivalent surveys were made of numbers of older cyclists pre- and post-law.

Injuries to child cyclists did not decline commensurate with their numbers. Table 1 shows numbers of head and other injuries in NSW and, in brackets, my calculation of what they would have been if they had declined as much as the number of cyclists.

                                TABLE 1 

       HOSPITAL SEPARATIONS, INJURIES TO NSW BICYCLISTS UNDER 16
                   (source NSW Department of Health)

    Year ended    Head        Incr.   Other       Incr.
    30 June       Inj.        risk    inj.        risk

    1991/91       384                 926     
    --------------------------------------------------law for <16 y.o
    1991/92       272 (246)           815 (593)
    1992/93       273 (219)   +24%    893 (528)   +68%

By the second year, rates of head injury to the remaining cyclists were 24 per cent above pre-law and other injury 68 per cent, in contrast to an increase in road safety for pedestrians and road users generally, following better detection of drink-driving and speeding.

A similar decline in cycling followed the commencement of the helmets law in the ACT in July 1992. The Department of Urban Services measured average daily cycle volumes for one week during the spring of 1991 and 1992. Its July 1993 report, Bicycling in the ACT- a survey of bicycle riding and helmet wearing in 1992 stated: “Based on automatic counts of cycles for one week at 23 cycle path locations, mean weekday cycle path daily volumes were recorded in 1992 to be about one third lower than the similar period in 1991, with mean weekend daily volumes declining by about half.”

The report suggested on page 5 that twice as many days with rain recorded during the 1992 survey period than 1991 “could have accounted for the reduction in cycling between the two surveys” – but this is not plausible because page 12 recorded that “all bicycle data collection was undertaken on rainless days” and detailed records show little variation in the weather.

By 1994, in its report ACT Bicycle Volumes, trends, variations, survey results, helmet wearing and cyclists’ characteristics 1991-1993/94, the Department belatedly conceded that “the most apparent reason” for the “remarkably consistent decline in cycling between 1991 and 1992 may be the introduction of helmet legislation in 1992.” The report went on to say that an increase of 34 per cent had been recorded for 1993/94, and to suggest that cycling may have bounced back to previous levels “after the initial settling-in period when riders establish new habits.” The suggestion is not valid. The 1993/94 counts were done mainly in February, when cycling is seasonally higher than in spring and counts available for four sites in the same month, December, show no significant change from 1992 to 1993.

Though cycling declined by more than a third, admissions of bicycle casualties to public hospitals did not. According to the ACT Department of Health and Community Care there were 89 admissions for fiscal 1991/2, immediately before the law, and 87 and 88 in the following two fiscal years. This suggests the risk of serious injury to the remaining cyclists increased by more than half, much like NSW.

One likely cause of an increased rate of injury is that children feel safe with a helmet on and are less careful. In Victoria, a study following much official publicity about helmet wearing found that teenagers believed helmets would save them in a serious accident with a bus or a truck! Over-confidence would increase the risk of accident – in which a helmet is likely to reduce soft tissue injury but increase brain injury.

Governments concerned for the well being of our youth would review the helmet laws. Instead, seeming to be content with creating an impression of effective action, however false, they misuse statistics to reinforce it.

According to The Canberra Times of June 5 1998, a spokeswoman for Urban Services said assertions that helmets do not reduce the incidence of injury are not backed by the facts. She used national data for casualties, cited in a Federal Office of Road Safety leaflet. From a pre-law base period 1987-90 to post-law 1993-96, it shows a decline of 33 per cent for cyclists compared to 23 per cent for all road users. FORS credited the difference to the helmet laws.

This assessment is biased. Including 1990 in the base period inflates the difference, but is wrong because the first helmets law was introduced in Victoria in mid-1990. As the last was in mid-1992, in the ACT, it is fairer to compare 1989 with 1993. The respective declines, 29 and 24 per cent, are then less different.

More importantly, FORS ignored the decline in numbers of cyclists. Taking this into account, the result of the law has not been the increased safety that FORS claims, but continuing casualties at a higher rate and loss of exercise beneficial for health … the truth the greatest casualty.

What to tell the king? Democracy owns no king but the people. Governments owe them the truth about the helmet laws. Only an open and independent inquiry can tell it.


This article was written by Bill Curnow, and was published in The Canberra Times on 29 August 1998.

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