Bicycle Helmets - Today's Bloodletting
Posted: Wednesday, January 21, 2009
by Sue Knaup
One Street
Bloodletting seems a distant absurdity to us and yet, just a few hundred years ago, we lost George Washington because he trusted its rhetoric over logic when he agreed to it as treatment for a nasty cold. With only a few quiet voices protesting the countless deaths caused by bloodletting, the practice continued well into the 20 th century. Today's bicycle helmet promotions and laws hold an alarming resemblance to the pronouncements used by the bloodletters. When an illogical practice is presented as the only means of safety and dismissal of the practice is equated to certain death, even the most brilliant leader can succumb to its absurdity.
Where did these chiders get their information? Most helmet propaganda is originally published by insurance companies, health practitioners and government agencies who have avoided countless law suits by blaming bicyclists in crashes for not wearing a helmet, sometimes even when their injuries or death did not involve injuries to their head.
While many studies have shown that bicycle helmets do little to prevent major head injuries beyond minor skull fractures and lacerations (Curnow 2001), a few poorly executed, misleading studies are the only ones to have reached mainstream distribution. The most common bit of jargon of them all is that "cycle helmets prevent 85% of head injuries and 88% of brain injuries" when in fact, where helmet use is high, there has been no detectable reduction in head injuries. See this link for a good overview: http://www.cyclehelmets.org/1027.html .
Helmet rhetoric that sets bicycling out as far more dangerous than it is, is the greatest hindrance to programs for increasing bicycling. A great deal of truthful yet catchy promotions will be necessary to counter this noise. Remember, bloodletting was "common sense" for 2,000 years! One of the best examples for illustrating the truth is this fun quiz on the dangers of bicycling: http://www.bicyclinglife.com/SafetySkills/SafetyQuiz.htm
Mandatory helmet laws often follow the spread of bicycle helmet rhetoric, adding the weight of the law to the idea that bicycling is more dangerous than any other form of transportation. In fact, as you will have found in the above quiz, if these laws took a realistic approach to their attempt to prevent head injuries, all pedestrians and car drivers would be required to wear helmets as well. And, it seems, a law requiring the wearing of helmets inside the house would also be a good idea.
Helmet laws also present another barrier to potential cyclists who already see many barriers to starting cycling. Mandatory helmet laws add to this list and thus prevent many new riders from starting. These laws have also been proven to decrease numbers of current cyclists thus increasing the potential for crashes by hindering safety in numbers. This theory has been proven to show that a motorist is less likely to collide with a person walking or bicycling when there are more people walking or bicycling (Jacobsen 2003).
Bicycle helmets may provide some protection against minor skull fractures and lacerations, but they do not prevent major brain trauma that happens within the skull. In fact, because bicycle helmets are soft which increases friction in certain crashes, unlike motorcycle helmets, some studies have shown that they can cause neck and brain injuries from rotational motion ( V J M St Clair, B P Chinn. 2007 ).
So, in minor crashes, bicycle helmets can assist in preventing minor injuries, though the potential of their doing harm in a major crash must be considered. Like bloodletting, which, in retrospect was found to have unintentionally benefitted a few lucky survivors because they were later discovered to have high blood pressure, helmets have surely prevented nasty gashes and painful skull fractures.
Bicycle helmets can be a good choice for someone concerned about minor head injuries as long as they understand their helmet's limitations for preventing major head injuries, not unlike choosing to wear knee pads and gloves. However, some studies have shown that helmeted bicyclists take more risks than those not wearing a helmet ( Pless IB, Magdalinos H, Hagel B. 2006). Thus, whenever a potential helmet benefit is mentioned, the potential of a helmet causing neck and brain injury, as well as this risk compensation, must always be included for bicycle helmets to be presented in a truthful light.
Another important point to understand is that helmets do not prevent crashes. Improved road and pathway conditions, driver and bicyclist education, better protections for cyclists and increased numbers of bicyclists through safety in numbers, prevent crashes. Too often government officials, health practitioners and insurance companies grasp at helmet laws as a quick and cheap solution that removes them from liability and the responsibility of providing quality provisions for bicyclists.
Helmet laws and overblown promotions also set in place a ready-made blame-the-victim reaction. Each time a helmetless cyclist is in a crash, their bare head becomes the focus even if the driver deliberately hit them and their injuries were not head related. Remember that whenever one of these laws is presented, it is from a knee jerk reaction, either to a recent crash or fabricated rhetoric, usually by officials seeking to avoid liability, framing the argument as making crashing safer.
Let's replace our helmets with thinking caps. If we can agree that increasing bicycling is in the best interest of our people and our planet, it's time to shift our promotions and policy efforts away from the illusion of safer crashing and into reshaping our communities into places where everyone knows the safety of bicycling.
Sue Knaup is the executive director of One Street , an international nonprofit organization that serves leaders of organizations working to increase bicycling. Most of her work involves coaching these leaders past common pitfalls so they can focus their energy on increasing bicycling. Find out more at http://www.onestreet.org . For a compilation of 16 studies on helmet efficacy see: http://www.onestreet.org/pdf/Bicyclist- & -Driver-Ed-helmet-efficacy.pdf . Find a comprehensive study on safety in numbers here: http://www.onestreet.org/pdf/Safety_in_Numbers_JacobsenPaper.pdf .
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Top-level comments on this article: (6 total)Good article! I'm undecided on the cycle helmet issue, but your article has certainly increased my doubts about their effectiveness and their potential to increase some risks.Bloodletting is actually still in use in modern medicine, although only for conditions where it has demonstrable benefits (such as haemochromatosis) - it's not an absurd or illogical practice in itself, but was applied illogically by physicians and quacks in the past, for a wide range of conditions.
Thank you, Ben. Your clarification on bloodletting is spot on. Bicycle helmets themselves are also not absurd, only the deceptions that have been applied to them.Sue
Thanks for the insightful article. If I might make an observation, I would say that the issue of helmet-wearing goes far beyond cycling. Helmet wearing is promoted, and sometimes enforced, for many other activities, like roller-skating, horse-riding, ice-skating, skiing, surfing (!), and canoeing (!!). None of this is based on any serious risk assessment whatsoever. Of all the non-work activities for which helmets are recommended, only motorcycling causes any significant amount of head injuries.Taken together, ordinary falls (as on level surfaces or stairs), injuries to motor vehicle occupants, and assaults account for almost all head injuries. The medical community focuses on the activities that have insignificant risk, in both relative and absolute terms, and ignores the rest. Bloodletting indeed.
Great stuff! And right on the money. If you want cycling to be safer, simply stop pretending it's dangerous!
Hi Sue,I was wondering if you could supply the original citations for articles in your article? When I Google "Curnow 2001, helmet" all I get is your article.Also, Googling:V J M St Clair, B P Chinn. 2007 turns up mostly your article. However, further research, with the complete citation which I found elsewhere turns up: Motorcyclists' Helmets and Visors-Test Methods and New Technologies and the conclusion of the study was actually pro-helmet at least for motorcyclists, bicyclists are not part of the study:It was concluded that a consumer information scheme would provide the most rapid delivery to the market of helmets offering improved head protection and that this could be the first step towards improved regulations in the future.It took some digging but I did findPless IB, Magdalinos H, Hagel B. 2006 Risk-Compensation Behavior in Children. The conclusion: Results of this study provide no support for hypotheses about risk homeostasis theory among children using PE (Protective Equipment). The validity of the theory appears highly doubtful for children in this age range.Which is to say that according to the study wearing a helmet does not cause risky behavior.You bet. And thanks for your interest.I sent a response with the links to these citations yesterday, but it appears that I cannot include links in these comment boxes. But you can find all three of these citations on the cyclehelmets web site linked in the article. Use that site's search engine.One note - in this article I meant to cite the Pless et al 2006 article along with the commentary on the cyclehelmets site; not the Pless citation by itself.Sue
Carful with claims mixing "risk compensation" with "risk homeostasis"!"Risk compensation" is a well known human behavior which no one outside the bicycle community would put in doubt: if something appears more risky than before you use more caution than before (if you do not believe me, just quit the brakes from your bicycle and see if you really do not drive more carefully)."Risk homeostasis" is a dubious hypothesis claiming that the humans tend to keep the risk at always the same level (therefor "homeostasis"). As humans do not have a sense for risk and it can easily be shown that they tend to overestimate some and underestimate others, it is quite obvious that it should be highly unlikely to be this case.The results of Pless and Hagel have to be read in this light.
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