Category Archives: Propaganda

Trying to deny that helmets can aggravate brain injury


Several studies have reported that bicycle helmets can increase rotational acceleration. Rotational acceleration is the primary cause of brain injury.

The Australian government commissioned a study to defend its controversial helmet law. The study set up unrealistic conditions fostering low rotational acceleration. The study claims that helmets do not increase brain injury. This is deceitful. The study unrealistic conditions are not representative of real life accidents.

An interview with a study author revealed the study was not set up to address rotational acceleration. The author said:

“soft-shell helmets are for cosmetic purposes, not really for protection, …
current helmets do not appear to protect against brain injury.”


Look at a bicycle helmet. It has been designed with comfort in mind. It is made of light weight material that grip the road on impact rather than glance off it (as is the case with motorcycle helmets).

Helmets increase the volume of the head. In the event of an accident, this increases the risk of the head hitting the road.

The increase in the volume of the head, coupled with the gripping of the road surface, means that when a head comes into contact with the ground at speed, the head rotates quickly. This quick rotation is the main cause of brain injury.

What causes brain injury?

An old popular belief is that brain injury is caused by a direct hit the head, like a head hitting a wall, causing linear acceleration. This is focal brain injury. Bicycle helmets are designed to reduce focal injury. The polystyrene reduces linear acceleration by compressing on impact.

Scientific research done in the 1970′s has revealed that the main cause of severe brain injury is not focal injury but diffuse axonal injury:

“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 can create shearing inside the brain, tearing apart brain tissue. This is diffuse axonal injury. It can lead to permanent disability. 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,” “

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.”

Soft-shell helmets amplified rotational acceleration to four times higher than the tolerable maximum. Soft-shell helmets are helmets without a hard shell. They are the most common type of bicycle helmet.

On impact, the larger head volume amplifies rotational acceleration. 3cm increase 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.

In 1987, an Australian government agency released research that highlighted 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

doctor from New Zealand reports:

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

In Canada, the length of stay in hospital increased increased following helmet laws, from 4.3 days to 6.9 days. The number of serious head injury admissions increased by 46%.

A strange “study”

The Australian government introduced a policy of mandatory helmets. Many people wrote to the government about brain injury from rotational acceleration. The bureaucrats claimed:

“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 commissioned by the government. It was not published. After much insistence, a copy was obtained from a government agency. 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 (Oblique impacts generate high rotational acceleration)

Studies have reported high rotational acceleration with soft-shell helmets, at speeds above 30 km/h. This study fostered low rotational acceleration. 

The study used a helmet with a ABS shell, like the one on the right. Then it generalised its results to all bicycle helmets.

The study conclusion makes no mention of the unrealistically low speeds (5 km/h to 11 km/h). How can accident protection research only do tests a low speed? Speed is a major factor affecting impact severity. Testing only a low 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. Other studies have reported that helmets tend to stick to the road surface.

Despite the unrealistic conditions, the study claims are generalized without qualifications:

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

This is deceitful, as this claim is the result of the peculiar set up of the study. It cannot be generalised beyond the laboratory conditions.

Interview with an author of the study

CRAG has interviewed one of the study authors:

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”

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”

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

“No “

Is this study comprehensive enough to assert that helmets do 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.”

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

Ethical issues

Between 2006 & 2009, the University of NSW earned $248,000 from helmet “studies” such as this one.

This study is still not published, escaping independent scrutiny. Its purpose seems to be to defend a controversial government policy.

The government is expected to fund research to improve helmets, like it did in 1987 (before the helmet law). Commissioning research to mask deficiencies of a government policy is unethical.

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


July 2013 update

The same team of researchers published a related study in 2013. It is called: “Bicycle helmets: head impact dynamics in helmeted and unhelmeted oblique impact tests“.

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

Bureaucrats have peddled this study as “proof” that helmets reduce rotational acceleration.
Public money well spent?

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The emergence of policy-driven studies


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.
This is not a scientific report.  It is unsubstantiated opinions presented as facts.  Here are a few of them (From the Executive Summary, under “The effectiveness of head protection”):
  1. “Helmet design and construction is based on known mechanism of head and brain injury”.  Not true.  This ignores rotational acceleration, the main cause of brain injury.
  2. “At the very minimum helmets halves the risk of head injury”.  Not true.  Helmets can aggravate brain injury through rotational acceleration.
  3. “Those who do not wear helmets are several times more likely to sustain injury to the brain tissue”.  Not true.  Ignores that helmet wearers are more likely to have accidents.
  4. “in Victoria, the number of bicyclists with head injuries decreased by 48 per cent”.  Misleading.  Ignores the decline in cycling and head injury reduction for pedestrians.
  5. “The vast majority of head impacts occurring … are easily survivable if a Standards-approved helmet is worn”.  Not true.  Helmets are not designed to protect in a serious accident.
  6. “No studies have come to conclusions contrary to the above”.  Not true.  The Hillman report (1992), one of the most comprehensive and famous review of helmet research at the time, is ignored.

Many assertions in this report are false or misleading.  The report ignores evidence that does not support helmets.

This “study” has received much criticism, notably in the vehicular cyclist:

“Individuals and organizations zealously pushing mandatory helmet use for cyclists are continuing to churn out reams of propaganda. One of the more voluminous efforts is Michael Henderson’s “The Effectiveness of Bicycle helmets: A Review” 1995, a politically motivated paper prepared on behalf of the Motor Accidents Authority of New South Wales, Australia apparently in a desperate effort to justify the State’s botched law outlawing cyclists who ride without a helmet.

Henderson’s report recycles much of the same old material that’s been cited by others over the years. The studies he references fail to provide a real world context, and to show any particular understanding of cycling. Although presenting bicycle head injuries as a worldwide problem, Henderson neglects to provide us with any sense of the size or scope of it.”

Contrast the bold narrow claims from this report with the more comprehensive approach from the Hillman report:

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.”

Subsequent policy-driven studies

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.

The helmet law was introduced as a part of a package of road safety measures including a crackdown on speeding and drink driving. The number of cyclists reduced significantly. Any assessment of the helmet law must take into account these confounding factors. Yet many government-funded “studies” like this one did NOT adjust for this, attributing all apparent improvements to the helmet law. Such negligence is difficult to comprehend. How could the “researchers” miss such basic adjustments? It is odd that these mistakes favor the legislation while the government funds the “research”.

Most medical case-studies, claiming that the helmet law has been effective, are also riddled with errors. They typically start from the assumption that helmets save lives and attempt to “prove” it by selectively fishing for data that supports their predetermined conclusion.

Some government studies not only contain false claims, but fail to rectify them after being corrected.

In 2000, the Australian Transport Safety Bureau (ATSB), a federal government agency, released a meta-analysis, that claimed to provide

overwhelming evidence in support of helmets for preventing head injury and fatal injury“.

This claim was rebutted in 2003, highlighting that:

“the meta-analysis … take no account of scientific knowledge of [brain injury] mechanisms”

The ATSB did not reply to the rebuttal, thus giving up on its claim. Despite being discredited, this analysis is still used by the government to defend the helmet law, claiming that helmets reduce the risk of head injury by 60%.

In 2011, a meta-analysis re-assessed this ATSB meta-analysis. It concluded:

This paper … 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 …

According to the new studies, no overall effect of bicycle helmets could be found when injuries to head, face or neck are considered as a whole.

Publication bias is the tendency of contradictory or inconclusive results not to be published, resulting in a literature formed of apparently consistent findings that exaggerate the actual effect. Time-trend bias is the tendency to pick a specific time period that exaggerates the actual effect.

Since then, various government agencies have wasted more taxpayers money by commissioning policy-driven “studies”, attempting to obfuscate the failure of the helmet law.

A prominent university seems to be moving away from policy-driven studies, as reported here:

“the faculty wished to move away from conducting sponsored policy studies for government because this did not generate valuable intellectual property

The dire consequences of this dishonest behavior

Independent researchers who have studied the result of the helmet law have come to different conclusions.

Dorothy Robinson, a researcher from the University of Armidale, said:

mandatory bicycle helmet laws increase rather than decrease the likelihood of injuries to cyclists …

Having more cyclists on the road is far more important than having a helmet law, for many reasons …

[the] governments [which introduced the helmet laws] do not like to admit they’ve made mistakes”.

Bill Curnow, once a  scientist from the CSIRO, wrote as a conclusion in a scientific article:

“Compulsion to wear a bicycle helmet is detrimental to public health in Australia but, to maintain the status quo, authorities have obfuscated evidence that shows this.”

An independent group of public health and transport practitioners and researchers wrote in their report:

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 disconnect between received wisdom and the facts is stark.

These are strong words from independent researchers, revealing frustration at the government unwillingness to admit they made a mistake.

For how long can policy-driven studies sustain failed policies?

In what way can this be justified as good use of taxpayers money?

Such deceptive studies add little to scientific knowledge. They exaggerate the reduction of minor injuries while ignoring the increased risk of serious injuries. Such deceitful practices have dire consequences. They tend to mislead policy makers towards false “solutions” to cycling safety, while neglecting more effective measures, like reducing the risk of accidents.

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 greater than best practice.

The practice of commissioning dubious studies to defend its failed policy while neglecting more effective safety measures constitutes an abuse of public trust among the bureaucrats entrusted with cycling safety.

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Misguided study affected by confirmation bias


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.

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Deceptive ad portraying cycling as dangerous

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.

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Misleading “study” from a government agency

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“.

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The 3rd International Conference on Injury Prevention and Control

The 3rd International Conference on Injury Prevention and Control

[NOTE: The official Web site for this conference, which was formerly located at, 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:

  • increase parent awareness
  • remove cost barriers
  • overcome the “nerd factor”
  • target 6-12 year olds
  • focus on helmets – not riding behaviourThe last point is interesting. Don’t address the cause just the symptoms. Just give them a helmet and point them towards heavy traffic. It was argued however that trying to improve behaviour doesn’t work. You have to wonder though if maybe they dismissed education too readily. Perhaps their idea of cyclist safety education is to tell people to wear a helmet; and if they still don’t wear a helmet then conclude that education has failed.

    Paul Scuffham of New Zealand presented the paper “Trends In Cycle Injury In New Zealand Under Voluntary Helmet Use”. This study concluded that “The percentage of serious head injury among cyclists has not shown the expected decline as cycle helmet wearing has increased”. This study also found that promotion of helmets (never mind legislation) had reduced cycling, something like a 27% drop in teenage cycling in the 5 years leading up to the law. The author was apparently given a hard time in his presentation, with some members of the audience attacking the results and saying they simply must be wrong, and yet it was reported that the New Zealand Land Transport Safety Authority (LTSA) had sent the research back “two or three times” to Otago for checking and further investigation – but the results stood. I have also heard that Peter Vulcan had stated that he had checked the New Zealand figures and couldn’t explain them, but insisted that helmets do work.

    The attacks on Mr Schuffham seemed a little unfair, as it seemed that he had obviously tried very hard to find a positive result which simply wasn’t there. While it is believed that Mr Schuffham is still in favour of helmets and helmet legislation, it was reported that he felt that, perhaps, the benefits of helmets were being oversold.

    “Regaining Balance In Injury Prevention”, presented by Nigel Perry of New Zealand. “This short presentation will highlight some of the ways in which New Zealand, a country held up as an example by the WHO Helmet Initiative, has erred and the absurdity of some of its actions. We will argue, that though the motives behind most pro-helmet campaigns might be commendable, that compulsory laws are a “step to far” and indicate a loss of balance in injury prevention. In introducing such laws we are building an undesirable environment for the next generation, and those that do exist should be abolished.”

    “Cycle Helmets: Fit To Buy Or Bought To Fit?”, presented by Judith McCool of New Zealand. In the wake of the other research from New Zealand which found that the risk of head injuries had not decreased with increased helmet wearing, Judith McCool visited all 53 shops in Christchurch which sell helmets and asked for help in purchasing one. In all 53 cases she argued that she had be given bad, poor, or wrong advice. Ironically, the paper was co-authored by John Langley, who was reported to have complained at a round-table discussion at the conference that he was unable to find a helmet that would fit him!

    So, wonderful lifesaving helmets aren’t protecting people from the big bad motor vehicles because people just aren’t strapping them on their heads the right way. Brilliant! It should also be pointed out that it takes “a good 10 to 15 minutes” to adjust your helmet properly. Many case-control emergency studies (such as the recent one from Seattle) have found very high protective benefits for helmets, but it seems that those studies must have been conducted in other parts of the world where people actually know how to wear a helmet properly.

    I should point out that most of the helmet legislation in Australia actually stipulates that the helmet must be “correctly fastened to the head” (or words to similar effect) so perhaps the solution is simply to get the police to start dishing out fines to offenders. After all, if your helmet isn’t properly fastened then you are breaking the law.

    “Efficacy Of Mandatory Bicycle Helmet Legislation In NSW”, by Merdyth-Ann Williams of NSW, Australia. This poster claimed that “Since legislation [in NSW] there has been a decrease in bicyclist fatalities of 60% and serious injury of 21%.” That is an impressive reduction in fatalities, until you look at the actual data:

        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.

    This table shows number of cyclists killed in NSW. Source: Roads and Traffic Authority of NSW, Road Traffic Accidents in NSW Annual Statistical Statements. CRAG does not at present have access to the statistical statements for 1995 and later.

    The 60% reduction was apparently derived by comparing 1990 (20 deaths) with the average for 1991-93 (8 deaths per year). There is no statistical significance in these figures, with such small numbers being subject to large variation due to random chance. However, two points are immediately obvious; one being the large increase in deaths in 1994 (the author may have been less than honest in ignoring the 1994 figures which she surely had no excuse for not being aware of), the other being the high representation of helmeted cyclists. In fact, helmeted cyclists accounted for 80% of the post-law deaths (excluding those where helmet wearing status was known), which matches the observed percentages of helmet wearing (85% for adults and 76% children, or 80% overall). This was noted by Robinson (Accident Analysis and Prevention, 1996): “excluding cases where wearing status was not known, 80% of cyclists in NSW from 1992-94 were wearing helmets when killed on the roads (RTA 1992-94)”.

    The “reduction in serious injury of 21%” is apparently a measure of the reduction in head injuries compared with non-head injuries. This type of analysis is misleading. Firstly because various anti-speeding and measures and RBT had made NSW roads safer at the same time as the helmets law was introduced. Reducing motor vehicle speed and involvement in bicycle accidents has been shown to lead to significantly greater reductions in head injuries compared with reductions in other injuries. Secondly, because they assume that all other factors are equal (eg that riders forced to wear helmets aren’t taking more risks and suffering more overall injuries than before, with the protective benefit of their helmets cancelled out by increased risk taking).

    Williams states that “since legislation bicyclist head trauma has been significantly reduced”, but this should not be so quickly attributed to helmets. After the law, NSW saw a 39% decline in total head injuries to children under 16, but child cycling also declined by 39%. At the same time, head injuries to child pedestrians declined by 19%, and head injuries to children from all road accidents declined by 26%. After allowing for the decreased cyclist numbers and safer roads (shown by the decrease in pedestrian injuries), the relative risk of head injuries to cyclists actually increased!

    For adults, head injuries also declined by 32% while non-head injuries declined by only 4%, but there is no reliable data for the measure of change in the numbers of adult cyclists (although it is likely to be similar to that of children since “adult” is defined here as over 16 and the older teenagers represent a large proportion of bicycle users and are the most averse to helmet wearing).

    For a more detailed look at the NSW data, click here.

    Finally, the poster “The Effectiveness of Wearing Pedestrian Helmet While Walking From Home to School in Elementary School Children” by Tatushiro Yamanaka and Arata Ogihara was also of interest. “The principal of the school can decide whether helmet wearing should be a rule for pupils”. Yes, in Japan some kids have to wear helmets while walking! The paper concludes that it hasn’t reduced injury rates significantly (injury rates were 0.18%/0.22% and head injuries 0.012%/0.018% for helmeted/unhelmeted kids). What is frightening is that they introduced the rule in the first place, and how few people amongst all those present seemed to think that it had gone too far.

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