Abstract

In the mid 1990’s, evidence emerged that the bicycle helmet law had failed to reduce the risk of cycling injuries. Governments responded by commissioning “studies” exaggerating the benefits of helmets while ignoring their tendency to increase accidents. Such policy-driven studies are quoted in official government communications to justify its controversial policy.  

These deceitful practices waste precious resources while real cycling safety is neglected. This might explain why Australia has one of the worst cycling safety record among developed countries, with a fatality rate 5 times greater and a serious injury rate 22 TIMES higher than best practice.

The hidden side of scientific research

Generally, research is conducted with scientific discipline, with a purpose to further scientific knowledge. However, sometimes the entity funding the research has a vested interest in a certain outcome, compromising the independence of the research.

This has been the case for some research funded by drug companies for example, where the research results are used to sell or promote drugs. Powerful government and corporate interests are increasingly influencing scientific research through controlling its funding, as reported by Brian Martin from the University of Wollongong:

“In the routine practice of scientific research, there are many types of misrepresentation and bias which could be considered dubious. However, only a few narrowly defined behaviours are singled out and castigated as scientific fraud. A narrow definition of scientific fraud is convenient to the groups in society — scientific elites, and powerful government and corporate interests — that have the dominant influence on priorities in science. Several prominent Australian cases illustrate how the denunciation of fraud helps to paint the rest of scientific behaviour as blameless”

Government is a large source of research funding. 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.”

Governments responded by commissioning “studies” defending its policy, then quoting such policy-driven studies to justify its policy.

The Henderson report: a policy-driven study

In 1995, the Motor Accidents Authority of New South Wales (Australia) commissioned a policy-driven study that became known as the Henderson Report.  Written in an authoritative style, it pretends to be scientific. That illusion breaks down when one notices two unusual features for a scientific report:

1. It contains many strongly worded, unqualified assertions.  Researchers with scientific integrity tend to be very careful with their assertions, making sure they are backed up by sufficient evidence and qualified by their context.  You rarely see unsupported or unqualified assertions in a scientific report.
2. Assertions are not annotated, making it impossible to verify the data source.

Official evaluations of the helmet laws commonly employ biased selection of research and statistics, resulting in benefits being unduly attributed to them and adverse effects (like an increase in the risk of accidents) ignored. Despite data showing that cycling safety has lagged pedestrian safety since the helmet law,  policy-driven studies found a way to claim that the helmet law was a success. For example, a 1997 report from a government agency made two misleading claims:

1. “Cycling casualties decreased after the helmet law”.  This ignored the decrease in the cycling.  Per cyclists, cycling casualties increased.
2. “A ‘strong correlation’ between higher helmet wearing rates and lower casualties”.  The underlying data indicates the opposite.

Abstract

Some studies attempt to “prove” that helmets reduce injuries rather than genuinely attempt to understand their actual protective effects. Bold claims are made. Yet the data does not support them. While such studies are well meaning, their misleading claims can push people towards counterproductive solutions. 

One example is this study, that states it is designed to

“demonstrate the safety benefits of helmet use“.

It seems that the researchers assume that helmets are effective and attempt to prove it. This lacks scientific discipline. It seems like an attempt to prove a preconception. With such an approach, there is a strong tendency for confirmation bias. People seek to confirm their existing beliefs.

The bias is revealed in this newspaper article:

“But the percentage of injured cyclists who needed treatment for serious head injuries dropped from 10.3 per cent in 2005 to 2.5 per cent last year.”That could be put that down to helmet use,”  “

What is odd about this conclusion is that helmet usage in the area was lower in 2009 than in 2005. Lower helmet usage was correlated with lower head injuries. How can lower head injuries can be credited to helmets when fewer people were wearing helmets?

The study report indicates unhelmeted cyclists had an Injury Severity Score (ISS) of 7, much higher than helmeted cyclists with an ISS of 4. ISS reflect all injuries, not just head injuries (25% of injuries). A higher ISS indicates more severe accidents. Differences in head injuries cannot be fully attributed to helmets. Accident severity affected the outcome. This is a common error is statistics, not checking for confounding variables. This renders the study conclusion invalid:

“The study confirmed the utility of helmet use in preventing serious head injury after cycling accidents.  This was the only factor in this study to influence the severity of injury.”

How can the researchers have missed accident severity as a relevant factor?

This is confirmation bias. Researchers look for data that matches their existing beliefs. They tend to miss data that does not confirm their belief.

Despite the lack of scientific discipline, the bias of the researchers, and the flaws in the study, the government claims that this “confirms” that helmets are effective.

This is typical of studies attempting to “prove” the effectiveness of helmets. While such studies are well meaning, they can mislead people towards false “solutions” to cycling safety, while more effective measures are neglected.

The Roads & Traffic Authority of NSW has commissioned an advertising campaign to promote bicycle helmets.  As many of those campaigns are, it is deceptive, while portraying cycling as more dangerous than it really is.  Here is a short extract from the ad:

“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”

The underlying message is:

1. Cycling is dangerous
2. Wearing a polystyrene hat makes cycling ‘safe’

These misconceptions have been refuted many times, for example here.

The core message people retain from such ad is “cycling is dangerous”.  Helmet promotions like this one are known to scare people off cycling.

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

HelmetFreedom has put together an analysis of this misleading ad.

HelmetFreedom has also some sample letters you can use to write to your MP.

In 2000, the Australia Safety Transport Bureau (ATSB), a government agency, released a “meta-analysis”, that claims to provide overwhelming evidence that bicycle helmets reduce the risk of brain injury.  This claim was rebutted in 2003, highlighting a lack of understanding of scientific mechanism of brain injury, failing to take into account rotational acceleration:

“This examination concentrates on injury to the brain and shows that the meta-analysis and its included studies take no account of scientific knowledge of its mechanisms.  Consequently, the choice of studies for the meta-analysis and the collection, treatment and interpretation of their data lack the guidance needed to distinguish injuries caused through fracture of the skull and by angular acceleration.  It is shown that the design of helmets reflects a discredited theory of brain injury.  The conclusions are that the meta-analysis does not provide scientific evidence that such helmets reduce serious injury to the brain, and the Australian policy of compulsory wearing lacks a basis of verified efficacy against brain injury. “

The ATSB did not reply to the rebuttal, thus giving up on its claim.  Despite being discredited, this “analysis” is still used by the RTA (a government agency) to defend the helmet law.

In 2011, a new meta-analysis re-assessed the meta-analysis done by the ATSB in 2000.  It reports:

“This paper shows that the meta-analysis of bicycle helmet efficacy reported by Attewell, Glase, and McFadden (Accident Analysis and Prevention 2001, 345–352) 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“.

The 3rd International Conference on Injury Prevention and Control

[NOTE: The official Web site for this conference, which was formerly located at www.nisu.flinders.edu.au, is no longer available. Links from this page have been removed accordingly. ]

The 3rd International Conference on Injury Prevention and Control was held in Melbourne, Australia from February 18-22 1996. For bicycle helmets, there was a poster session and an oral session.

Many of the world’s leading helmet activists were there: Michael Henderson (Australia); Diane Thompson, Robert Thompson and Frederick Rivara (HabourView/Puget Sound, Seattle); Philip Graitcer (head of the WHO Helmet Initiative); John Langley, Paul Scuffham (Otago, New Zealand); Stig Hakansson (Swedish Helmet Initiative); Peter Vulcan (Monash Accident Research Centre); and others. Representing “the other side” was Nigel Perry of New Zealand.

While a common theme which emerged was that “any helmet is better than no helmet”, this was rather contradictory to other issues raised, namely that bad fitting helmets can provide little or no protection; and that it is difficult for many people to find a helmet that fits properly. To add to that, from New Zealand we had an interesting new concept that people simply don’t know how to wear their helmets properly!

It was argued that real (i.e. anecdotal) cases should be used to promote helmets as this is very persuasive. Given that virtually all of the attendees were already completely sold on helmets as “the” solution, it was not considered an issue that this approach gives a misleading picture and over-emphasises helmet benefits while distorting the real scale of bicycle injuries. Someone was heard to state that “negative cases will always occur”. This is of course true, but it is no reason to dismiss them!

Moral, social, ethical and legal issues are not the concern of injury prevention professionals, or so they say. Never mind that the research studies they conduct are geared for one ultimate purpose: to provide the needed support for helmet legislation which they have already pre-determined as being “the way to go”. One researcher was heard to argue that it was their job to provide figures to politicians to make decisions on laws, and if they want these figures in context then they should ask. When asked shouldn’t these figures be provided in context it was simply argued that this wasn’t their job.

It was argued by one attendee that scientists have a responsibility to give a balanced view and that they were not doing so. By highlighting the benefits of helmets and ignoring the negative results, not putting cycle injuries into perspective, and ignoring the social impact of children being required to wear helmets virtually everywhere, it was argued that they had lost balance in injury control and that this was wrong.

The hypocrisy of it all. Head injury rates per time-exposure for car occupants and cyclists are about the same. Helmets can potentially benefit car occupants as much as cyclists. Injury prevention professionals know this but they see promoting such helmets as futile. Interestingly, this is largely due to the “dork factor” which they have systematically attacked and eroded for cyclists, but which poses a far greater obstacle with motorists. Add to that, most of the injury prevention professionals are probably not overly keen in having to wear helmets in their cars themselves. When it is put to them that they should wear a helmet in a car if they promote cycle helmets (and the corollary of bicycle helmet laws) they are at a loss. To them a cyclist is irresponsible if they don’t wear a helmet, and therefore must be forced to do so, but they are not irresponsible when they themselves ignore the dangers for motorists. The hypocrisy of this doesn’t seem to dawn on them.

In discussions on the Australian situation it was bemoaned by many that the Australian police now had little interest in enforcing the law. Action was called for to lobby the Government to start “re-emphasising helmet wearing” (Note: it is a fact that a fresh series of “wear your helmet” radio commercials emerged on Australian radio stations not long after the 3ICIPC conference). It was also commented that once the law had been passed the Government’s general attitude was that they had done all that was necessary for cyclists, so other measures were not needed. Representatives of cycling organisations have commented to similar effect, that it is difficult to “get anything done” these days.

Stig Hakansson gave a talk about helmet initiatives in Europe, but in particular the Swedish Helmet Initiative. They’ve been promoting various helmets for a long time, but everything was going fine until 1990 when the tragedies started – children dying from suffocation when their bike helmets got stuck in play equipment, trees and other objects – they’d hung themselves! A comment was made along the lines of “We knew we’d killed, but didn’t know we had saved anybody”. However their faith in the approach overcame all obstacles and they came up with the self-release buckle system so kids couldn’t get hanged. This system makes the helmets unsuitable for use in traffic. Nevertheless, someone was heard to suggest it was badly designed play equipment and a tree in the wrong place that caused the problems! It’s not as if the kids actually climb the trees on purpose, surely!

Thompson, Rivara and Thompson presented data from the latest of their emergency room case-control studies which this time found that helmets provide a 70% decrease in risk of head injury, but were reportedly at a loss to explain the negative results from New Zealand. Nothing was said of the similar failures shown by Australian data, possibly because Australian researchers have been slightly less than honest in ignoring the reduced cyclist numbers and generally safer roads after the law while readily quoting figures which showed less head injuries and high helmet wearing rates.

Rivara gave a five point plan or set of goals for increasing helmet use in their campaign in Washington State:

    Number of Cyclists Killed in Road Traffic Accidents in NSW
            Year    Killed   Helmet  No Helmet  Unknown
            1989    19        3        13        3
            1990    20        1        18        1
            1991*   10        7         3        0
            1992     6        5         1        0
            1993     8        7         1        0
            1994    23       16         5        2
            1995     ?        ?         ?        ?

            * Helmets law introduced in NSW in 1991, on 1 January for 
              cyclists 16 and over and on 1 July for children under 16.