Risky Business

To don, or not to don (helmets), that is the question.

For many people, the instinctive response is to don. And not just to make that personal choice, but to lecture heavily those who do not. But are helmets the ultimate safety gear, or do they offer only the perception of safety? You may be surprised at the answer.

Over the last several years (or 20 or so), helmets have been promoted and in many cases have been mandated. Promotion of helmets has been backed with statistics about the number of head injuries or how many deaths are prevented with the light piece of plastic on one's head or anecdotal evidence of so-and-so who almost died and surely would have had he not been wearing his helmet.

Unfortunately, the data are not that clear. Research has not shown definitively that helmets save lives. The evidence, researchers have found, is inconclusive and contradictory. Part of the problem is the difficulty of doing studies on cyclists. Bicycling, in general, is not a risky endeavor, and very few injuries result, particularly compared to pedestrians and motorists.

Moreover, helmet-related studies have often been "case-controlled" studies, which compare a group of cyclists who had head injuries and one or more groups without head injuries. The problem with these types of studies is that suitable control groups are not always available. Other problems include the difficulty of adjusting for other differences between the head injury group and the non-head injury group (aside from the difference the researchers are looking for: helmet use). Studies have shown that cyclists who wear helmets may be more safety-conscious and follow the rules, which would result in fewer injuries (although, other studies have shown that they also tend to crash more). Also, in one study, helmet-wearers tended to be adult and female (and more responsible) and the non-helmet wearers were children and male (and more likely to take risks).

Another common study, the time-trend analysis, studies injuries over time in places where helmet use is required. The benefit of these types of studies seems to be debatable, as scientists do not agree on the criteria that should be used.

Additionally problematic are the anecdotal evidence ("My life was saved by a bicycle helmet."). Well, it's really quite difficult to say that for sure, isn't it?

In fact, for the casual, commuting or recreational cyclist, the studies do not demonstrate that helmets prevent head injuries. Helmets will, at most, prevent head injuries for high speed crashes of the sort that occur in bike races. At lower speeds, which is the speed most people ride around town, most cyclists will fall and hit their arms or their legs. Furthermore, in an accident with a car, no bicycle helmet will help--they aren't designed to.

(Here is a piece of anecdotal evidence. In the years I raced competitively--not including triathlons--1993-1999, I went to the hospital 3 times for bike wrecks, including a high speed wreck in a race where I slid across the road and hit the opposite curb with my back. I also had many, many other additional crashes. Not once did I have a head injury. But both my hips and knees still carry remnants of asphalt)

The thing we have learned is that mandating helmet use seems to make cycling safer in one way: it discourages people from riding their bikes. If you don't ride your bike, you can't hurt your head in a bike wreck. At least one study (pdf) has found that when helmet laws were mandated in Australia, a significant number of people stopped riding.

Studies of other mandated helmet laws found similar trends--that the number of head injuries declined, but so did the number of other non-head injuries, meaning that the reduction of head injuries was probably related to a reduction in bicyclists. Teenagers, in particular, were more apt to abandon the bike. Helmets are hot and sticky, and they are difficult to secure to a bicycle when the bicycle is parked (the other, more annoying, option being hauling the helmet with you). These are disincentives to wearing a helmet, and, when helmets are mandated, a disincentive to riding a bike.

AND fewer people on the roads actually make it more dangerous for others, as there is safety in numbers.

As the helmet debate probably will not provide a conclusive answer anytime soon, advocates of safe cycling need to focus on the real dangers cyclist face: the automobile. Instead of requiring cyclists to don a helmet, cities should provide the infrastructure to protect cyclists from cars and to make cars aware of cyclists' presence. This includes providing more and better bike lanes that are segregated from traffic; painting those lanes that cross intersections bright, bold colors so drivers can see bike lanes and cyclists; and creating separate turning lanes for cyclists. Additional education for young riders on safety rules would help them protect themselves in traffic.

Bicycling is a healthy mode of transportation. Getting more people on bikes could help clear the air of pollution and minimize our ever-expanding waistlines. Preaching about helmet usage, however, has the opposite effect. It makes cycling seem dangerous when it really isn't. Helmets have not been found to provide the safety that their promoters declare, and such preachiness will only serve to reduce the numbers of people getting out on their bikes. Helmet usage should remain a personal decision (so thank you for no longer preaching to me).

Some additional reads:
Dutch Cycling Union's Position
Icelandic Cycling Union's Position
European Cycling Federation's Position
Helmet use for Pedestrians
Seat Belts vs. Helmets

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