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, cycling injuries increased sharply. cycling_injuries_following_helmet_law 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 injury rate is shown below: cycling_inury_rate_following_helmet_law_2 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_6A 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.” ”

1989 study found that helmet wearers were 7 times more likely to have accidents. How can a flimsy piece of polystyrene compensate for all these additional accidents?

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 its research recommendations, the government degraded Australia’s helmet standard to accommodate ”soft-shell helmets”. Soft-shell helmets are more comfortable and facilitate compulsory helmet wearing. However they provide little protection and can cause brain injury.  hard-shell-vs-soft-shell-helmet By degrading the helmet standard, the government legitimized a piece of polystyrene generously called a “soft-shell helmet”. This provided little more than the illusion of safety. 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 more protection than it really does. 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.

But wait, the study claims 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 make such a claim?

  1. It ignored the decreased in cycling after the helmet law. Instead of using surveys that had counted the actual number of cyclists, it ASSUMED that cycling increased with population growth.
  2. It ignored the strong rise in injuries. How can the study authors have failed to notice this?
  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.

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.”

What? 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?

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.

Federal government abandons compulsory helmets policy

The Federal Government instigated in 1989 the nationwide policy of compulsion to wear a helmet, by offering ‘black spot’ funding for roads to the states and territories. All complied by 1992.

In 2009, CRAG made a comprehensive submission to the Prime Minister calling for the Government’s policy on helmets to be based on sound evidence of their efficacy. We (CRAG) said that the prime need was to protect the brain, the main site of fatal and disabling head injury, but that research had shown a potential for helmets to aggravate it.

We also pointed out that cycling declined sharply after helmets became compulsory. Benefits of the exercise for health were lost, but the risk of serious casualty, including fatal head injury, increased compared to other road users. As the policy had failed to serve its purpose, we called for corrective action.

The PM did not directly reply to our submission. Instead, the Federal Government quietly abandoned the policy later in 2009, stating in a letter to CRAG:

“Please note that helmet wearing policies are entirely determined at a state and territory government level and not linked to federally administered black spot funding”.

Despite being the instigator of this policy, the federal government has now disowned it, and refuses to take responsibility to fix it.

The federal government remains responsible for the mandatory standard for helmets. It is supposed to guarantee the efficacy and safety of helmets, but it does not. The standard does not contain a test for rotational acceleration, that would assess whether helmets can aggravate brain injury.

We in CRAG are working to press the Federal Government on the mandatory standard.

Political parties supporting cycling

In Australia, the Liberal Democratic Party supports cycling through its policy opposing victimless “crimes”. It states about the bicycle helmet law:

Mandatory bicycle helmets – not only are such laws offensive to liberty, but they do not achieve their aim.

You may not be able to vote for the Liberal Democratic Party for the parliament (local Member of Parliament), but you can vote for the Liberal Democratic Party in most states for the senate.

In Western Australia, the Democrats support the decrimilisation of cycling without a polystyrene hat. You can vote for the WA democrats in the senate.

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.

Canada: helmet laws have made little difference to head injuries

A recent Canadian study found that bicycle helmet laws had little effect on head injuries. The study analysed 14 years of data, comparing provinces with and without helmet laws. Unlike other studies in this field, it attempts to remove the effect of confounding factors by controlling for background trends and modelling head injuries as a proportion of all cycling injuries. It concludes:

the incremental contribution of provincial helmet legislation to reduce the number of hospital admissions for head injuries is uncertain to some extent, but seems to have been minimal.

This study has been reported here:

“(the study) analyzed the rate of cycling-related hospital admissions for head injuries across the country between 1994 and 2008 — an enormous research sample of more than 66,000 people…

What they found initially seemed to suggest that this legislation improved public safety…

But upon closer inspection, according to Dennis and company, this positive effect failed to stand. On the contrary, the researchers concluded that head injuries were decreasing across the country at a rate that wasn’t “appreciably altered” by the new helmet laws. Other rider health initiatives — namely, public safety campaigns and the introduction of better bike infrastructure — rendered the contribution of helmet laws “minimal” …

Mandatory helmet laws, meanwhile, may discourage riding to the point where public safety as a whole suffers from the relative decrease in physical exercise.”

The effect is consistent with an analysis of cycling fatalities in Canada, that concludes:

It is apparent that mass helmet use is not contributing to the reduction in cyclist fatalities, at least not in any measurable way. The results suggest that traffic authorities should refocus to put their efforts into other proven measures.

The study contradicts other studies that had claimed a benefit from helmet legislation in Canada. However, many of these studies have serious methodological flaws rendering their claims invalid. Often, such studies are done by helmet advocates keen to “prove” their beliefs, with a disturbing lack of scientific discipline.

This has led Ben Goldacre, an epidemiologist, to provide an insightful overview of the challenges of evaluating the effectiveness of helmet legislation:

Standing over all this methodological complexity is a layer of politics, culture, and psychology. Supporters of helmets often tell vivid stories about someone they knew, or heard of, who was apparently saved from severe head injury by a helmet. Risks and benefits may be exaggerated or discounted depending on the emotional response to the idea of a helmet. For others, this is an explicitly political matter, where an emphasis on helmets reflects a seductively individualistic approach to risk management (or even “victim blaming”) while the real gains lie elsewhere. It is certainly true that in many countries, such as Denmark and the Netherlands, cyclists have low injury rates, even though rates of cycling are high and almost no cyclists wear helmets. This seems to be achieved through interventions such as good infrastructure; stronger legislation to protect cyclists; and a culture of cycling as a popular, routine, non-sporty, non-risky behaviour.

Helmet laws are ineffective compared to other safety measures. As the safest cycling countries demonstrate, other measures are far more effective to reduce injuries. Helmet laws seem to contribute little to safety, while reducing cycling and taking the focus away from more effective measures.

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