An ER doc who is against bike helmet laws?

Are they doing something healthy? Or are they subversive social radicals, endangering their own lives?

I used to be RABIDLY pro-helmet-law.  I believed the common arguments (some of which I still believe) for forcing everyone to wear helmets.  The main ones are:

• Cycling is risky and we need to mitigate the risks
• We live with socialized medicine where we all pay for the foolhardy when they bash their brains in
• Helmets are extremely effective in preventing head injuries and saving lives
• There is no logical reason not to wear a helmet.
• If someone doesn’t want to wear a helmet – fine!  They can just go ahead and stop cycling.

I’ll preface the following comments by saying I ALWAYS wear my helmet personally.  But making it a law is a different kettle of fish.

Despite the religious fervour from some health professionals and policy-makers on the need for helmet laws, there are a few clear downsides to them.  It goes back to my philosophy that nothing in life is black and white, or all good with no bad.  Over the years I’ve been open to reading the evidence for and against helmet laws as they have been adopted in various places, and my opinion has changed.

Let me outline a few of the arguments against helmet laws.  Far from being radical, silly, or signs of poor judgment, they are actually quite logical, and backed up with statistics if you care to look into them.

There is some evidence that cyclists take more risks if wearing a helmet, and there is some evidence that cars are more aggressive around cyclists if they have a helmet on.  It shouldn’t be that way, but this may be an issue.

Helmet laws promote the perception that cycling is a risky activity.  It’s not.  Your odds of dying on a bicycle are somewhere in the neighbourhood of 1 in a million km travelled.  And you can greatly decrease those odds by using lights, following the rules of the road, and learning to cycle defensively (Can-Bike courses!).  Everything in life has a risk.  Cycling is a lot safer than many things we do.

Some people stop cycling if forced to use helmets.    And given that the mortality reduction from the exercise of cycling outweighs the mortality increase from cycling without a helmet by somewhere around 10:1 to 20:1, it’s a no-brainer (excuse the pun) that we don’t want to discourage cycling, even though our reasons might be noble.  Stated another way, the statistical likelihood of a helmet saving a cyclist is tiny.  So it doesn’t take many people stopping cycling and losing the exercise benefit before the public health benefit of the law is cancelled out.  And statistics from areas where helmet laws have been adopted say that the numbers of cyclists who give up are probably quite signifant.  Why?  I don’t know.  The big complaint I’ve heard is “helmet head” (messy matted hair) when you get to your destination.  I don’t care about it, but I try to put myself in the shoes of a 15 year-old girl going to meet her friends at the mall.

Cycling is good.  It provides much-needed exercise.  It acts as a roadway decongestant as more people leave their cars at home.  It keeps our city air cleaner and reduces GHG emissions.  It frees up urban space to use for HUMANS instead of cars.  There is no downside.  We should be doing everything we can to encourage it and be very careful not to DIScourage it (hear that Rob Ford?)

Furthermore, if this is really being done as a public health measure, then why do we not force people to wear helmets in cars?  Before you laugh, let me say that in 14 years of ER work, I have seen only one serious head injury in a cycling accident, where I think damage was perhaps mitigated by a helmet being worn.  On the other hand I have seen many dozens of serious head injuries from people riding in cars.  So as a public health manoeuvre we could clearly produce much more benefit by forcing drivers to helmet-up before driving to the mall, then by having bicycle helmet laws.  Why does this sound ridiculous?  Because we look at driving as safe and necessary and cycling as risky and optional.

It turns out that cycle helmets are not the panacea that they were made out to be.  Lore has it that “bicycle helmets are 85% effective in reducing head injuries”.  This was a mantra, so oft-repeated that it became true.  But as far as I can tell, those numbers came from studies done by dropping weights onto the heads of some very unlucky monkeys.  Not exactly real-world testing.  In the real world, cyclist deaths often result from catastrophic, multi-system injuries that no helmet, or whole-body armour, would prevent.

Also consider that Denmark and Holland have death-by-head-injury rates in cyclists that are small fractions of our rates.  And nobody wears a helmet on a bike unless they are involved with racing.  (A friend of mine from The Netherlands says: “we would assume you are handicapped” if you wear a helmet to commute).  So obviously helmet laws are only a VERY SMALL part of making cycling safer.  If they were a big part of it, they’d be dropping like flies in Amsterdam.

I can’t see a helmet on anyone. They must all be at very high risk.

I think that governments and public-health folks like to force helmet laws on people because it’s free, easy, doesn’t require any real thought or effort or planning, and they can pat themselves on the back publicly and talk about how they’re working to make cycling safer, without actually making cycling any safer at all.

Don’t worry buddy. Just put a helmet on and you’ll be plenty safe.

So I say to our politicians – repeal the helmet law in Nova Scotia.  Give people the choice to wear a helmet or not.  Cycling without a helmet is WAY healthier than not cycling at all.  And while all these crazy radical scofflaws are cycling around without their helmets, perhaps we could be working on ways to make them truly safer.  Like separated bike infrastructure.  Or car-free zones in our cities.  Or lower residential speed limits.  Or serious penalties for a driver who hits a cyclist.  There are lots of useful things to do.  But they are difficult and cost money.  So I suspect the status quo of “I’ll force you to be safe by wearing a helmet” will remain.

For a great TED talk on this issue by Mikael Colville-Andersen, click HERE.