Issue 28 / 1 August 2011

GPs can get pretty creative requests for medical certificates at times, whether it’s workers taking a sickie or students looking for an extension on an assignment.

But some campaigners against mandatory bicycle helmet laws seem to be particularly optimistic about the outcome of their visit to the doctor’s surgery.

How would most doctors react, I wonder, to a patient presenting with a self-diagnosed “medical condition” of stinging eyes as a result of sweating caused by wearing a helmet?

That’s one strategy recommended on a Queensland cycling site as a way of getting a medical exemption from that state’s helmet laws.

Another contributor to the site claims a friend has a letter from his GP “which allows him not to wear a helmet during the day as he’d rather avoid skin cancer and wear a wide brimmed hat instead”.

That sounds about as convincing as getting a letter from your GP saying you didn’t want to wear a helmet because you couldn’t find one that matched your earrings.

If Cadel Evans could cope with wearing a helmet during his recent triumph in the Tour de France, it’s hard to see why it would be a medical issue for the rest of us. (The International Cycling Union made helmet wearing in competition compulsory in 2003 after the death of Kazakh rider Andrei Kivilev.)

The anti-helmet brigade might argue the real problem is that adults who choose to take the risk of riding bare-headed are being forced to adopt these kinds of convoluted strategems to avoid the force of the law.

It’s the same old question that raises its head whenever we’re talking about the balancing of individual freedom against the desire to protect people from preventable harms — think tobacco control, immunisation or compulsory wearing of seatbelts.

There’s no doubt a lot of people would like to ditch their bike helmets — more than two-thirds of respondents to a BMJ online poll last week said the headgear should not be compulsory for adults.

The anti-helmet campaigners do have some arguments on their side.

Riding with the wind in your hair is definitely more fun than wearing a sweaty helmet (as long as you stay on your machine) and the wonderful free bicycle programs operating in many European cities have only been so successful because helmet wearing is not compulsory in those countries.

There may even be some validity in the argument that the health benefits of increased bicycle use would outweigh the increased injuries if the helmet laws were removed.

That would be a hard one to prove, though, whereas there is evidence for the protective role of helmets (despite some of the misinformation spread on the internet). A 2009 Cochrane review found that wearing a helmet reduced the risk of brain or head injury in cyclists involved in an accident by between 63% and 88%, and facial injury by 65%.

Some countries have taken a middle way, making helmets compulsory for children only, but the risk is that ditching your helmet might then become a marker of achieving adulthood.

Cycling is clearly something to encourage in our increasingly obese and resource-hungry world, so perhaps the most important question is, how can we find new ways of doing that without compromising safety?

Jane McCredie is a Sydney-based science and medicine writer.

Posted 21 August 2011

Sorry, there are no polls available at the moment.

13 thoughts on “Jane McCredie: Hats off to helmet laws

  1. Simon A. Collins says:

    Of course the ICU make helmets compulsory for RACING – those guys travel very, very fast. That does not mean that they should be compulsory in situations where it is rare for cyclists to travel over 20kph.
    I think that it makes sense for cycle helmets to be compulsory for those mixing with traffic on roads (predominantly adults) but where cycleways are designed for travelling at 15-20kph, and where bike-share programs could be encouraged for the public benefit, helmet laws probably do more harm than good.

  2. Pete Bradley says:

    This is a thorny one. As an emergency doc in the past, I am well aware of the head injury saving potential of the bike helmet, but at the same time, having ridden a cycle to school up hill and down dale my whole life until late teens, with no helmet, and never even came close to a head injury, I have mixed feelings about the mandatory wearing laws….
    It does discourage casual use of a bicycle, and I know I would have hated to have to wear one, which would have been just one more thing to worry about being stolen when leaving the bike anyway, and it will tend to kill off the use of the hire cycles provided in the city, and this scheme works well overseas mainly because they are cheap and easy to use because no special equipment is mandated.
    My feeling is for adults they should be voluntary, then those who believe they are important would be motivated to have and supply their own, but casual visitors/users could decide on a basis of low probability of accident to go without. Especially as nowadays there are so many cycle-ways separated form traffic altogether, so the risk of severe injury to the cyclist is minimal – for paedestrians a different matter…? Are we going to enforce helmets for paedaestrians as well? We have to draw the line somewhere, surely…?

  3. Tony Brown says:

    I don’t see this as thorny at all. I have a helmet with fracture in it from an encounter with a car that came straght through an intersection at low speed. I was doing <15 km/hr. My family are still amused at how “funny” I was while concussed and I have an CT scan which was fortunately normal.
    If total separation of bikes and cars were possible, PERHAPS we could relent on helmets. The reality is that despite significant growth in bike paths the vast majority of cycling journeys are on roads shared with cars and will be for the foreseable future. If we are going to encourage safe cycling for fitness and transport we need dedicated cycleways that actually go somewhere. A pretty path that meanders beside the creek is wonderful on a sunny Sunday but does not help one to get to work efficiently and is not usually long enough to be a useful training curcuit for fitness. Even if cars and bikes can be separated crashes do occur and heads are at risk.
    I appreciate that there are those who think that they should be able to accept the responsibility because it is their head being protected. When head injuries do occur they are managed in public health facilites using public funds and the public has an interest in their prevention.
    Safe cycling should be encouraged. This means structural changes to roads and paths etc. Until then helmets should remain compulsory.

  4. David Cunningham says:

    When I had patients who objected to being compelled to wearing helmets (they called them bash hats) I replied that I agreed that they should not be made to wear them but, as the average head injury resulting from not wearing a helmet cost the tax payer about $40,000.00 they should put up a bond to that amount so that they should not become a burden on the tax payer. This had the effect of terminating the conversation.

  5. Marion Bailes says:

    I am spending two months in Bonn, Germany at the moment, and am very impressed with the number of people who use bicycles to commute here: the elderly, middle aged, youth and children. Helmet wearing for adult cyclists is not compulsory and most adults I see riding don’t wear one. Nor do they have racing bikes or wear lycra. However, there are bike lanes on almost every road and if there isn’t a bike lane, one is allowed to cycle on the footpath. Bike racks abound at office blocks, shops and parks. I would favour changing the law in Australia to one stating that adult cycle helmet-wearing is only compulsory for cycling on roads with cars, and not for cycling on designated cycle paths. At the same time I would lobby for more infrastructure to make cycling safer and more convenient.

  6. Sue Ieraci says:

    The only fatal head injury I have seen was from racing (pre-helmet days) but I have seen many other injuries with car vs bike.
    We all know that public health measures work on a population basis – it’s pointless to say that you personally ride a bike and have never had a head injury – but statistically, people do.
    There are various possible approaches. Why not have the people who manage injury databases come up with the most significant risk factors for serious injury? If, for example, it is location (main road), speed (racing) or whatever is found, then we could strictly enforce helmets for that setting and ease off on other settings.
    On the other hand, if helmet-rebellion is a fringe movement, then just let it die out as the generations change. Kids these days grow up assuming that helmets, like, hats and sunscreen, are a normal part of outdoor activity. Maybe there’s no need to change anything at all.
    The computer screen is a much greater threat to physical fitness than cycle helmets will ever be!

  7. jackie23708 says:

    Re posting by: David Cunningham 01/08/2011
    “When I had patients who objected to being compelled to wearing helmets (they called them bash hats) I replied that I agreed that they should not be made to wear them but, as the average head injury resulting from not wearing a helmet cost the tax payer about $40,000.00 they should put up a bond to that amount so that they should not become a burden on the tax payer. This had the effect of terminating the conversation.”
    David, a lot more people injure their heads from car accidents than from cycling accidents. Same goes for pedestrians. Don’t you think they should all be wearing helmets too? These people are also a burden to the tax payer if they get injured. I think all these people should also put up a bond of $40,000 if they choose not to wear a helmet when doing these activities.
    The real solution is building proper cycling infrastructure, like they do in the Netherlands, Denmark and other European countries. Helmet-wearing is being used all too often as a distraction to the real issues. Speeding by cars for example is a much bigger problem.

  8. Canada Rides says:

    Helmet laws are not necessary. They create the idea that riding a bicycle is a dangerous thing to do. It is not. To have a “Certified” helmet, it must pass a test falling from 4 feet, landing on the crown of the helmet. — That’s it — The helmet will not protect you if you are hit by a car … You were hit by a car … a car! If a helmet was designed to protect a rider from impact of a car, it would be a full face motorcycle helmet. It is statistically more dangerous to walk across the street than ride a bike. Pedestrians are not forced to wear helmets. It is 10,000 time more likely that you will have a head injury in a vehicle, with seat belts and airbags than while riding a bicycle, but divers and passengers are not forced to wear helmets “For their protection”. People must wake up and understand that an 18 ounce piece of styrofoam is just silly. What will keep people safe riding are clearly marked cycle lanes, separated cycle paths and a decrease in urban road speeds.

  9. Sue Ieraci says:

    Canada Rides – being hit by a car while cycling does not imply that the car hits you in the head – the car throws you off the bike, onto the ground.
    Perhaps we need the current generation of kids to grow up helmet-savvy before the culture changes.
    As far as relative risks go, the statistical significance of pedestrian injuries is that almost everybody walks – many fewer people cycle. The correct data would be the number of injuries for each pedestrian metre travelled.

  10. Arno S says:

    People keep quoting the Cochrane Review as the “gold standard” on helmet research. My understanding is that the 88% figure comes from flawed research. Why is this figure still quoted, even though it is invalid? Why isn’t the Cochrane Review updated to indicate that this number is incorrect?

  11. Canada Rides says:

    To Sue Ieraci – “Perhaps” we need the current generation of drivers to grow up pedestrian and cyclist aware before the the culture changes. Oh, and I’ve got the numbers … over 1.2 million km are ridden EACH DAY in Copenhagen by cyclists … there have been ONLY 78 injuries last year to cyclists … that’s 25 000 to 35 000 cyclists traveling each day – and that’s on a 37% mode share … Children begin riding bicycles at the age of 4 and continue for the rest of their lives. Drivers are taught to open the left hand door by using their right hand, thereby forcing the body around to the left and shoulder checking before opening the door. Yes, a culture change is required … quickly … price per litre of gasoline is 1.25 and climbing … I would much rather be spending my money on good food and fun, not on sitting in traffic for an hour.
    Back to helmet thing – culture change, safe roads, separated paths and slower urban speeds saves live … not a silly piece of styrofoam.

  12. matt says:

    if MHL’s are so good then why does no other country adopt it? they’ve been laughing at our fail for 20 years now. also, there is no cycling culture here,(or any other culture for that matter) except for the lycra brigade.

  13. Andrew Watkins says:

    I commute 2-300k/week on bike in Melbourne. Not wearing a helmet is clear proof that there is nothing up there worth protecting. Even on a bike path one’s head is 1.5m above the ground and travelling at up to 20-30 k, on the road if commuting it is travelling 1.5m above a very hard surface at 20-50k. I don’t want my kidneys walking around Melbourne inside anybody else any sooner than absolutely necessary.

    The environment in Germany, Netherlands etc is vastly different, although I agree fully with the comments about decent infrastructure and the need to encourage bicycling by making it easy. Bicycle paths ( at least of the standard provided here ) do not, however, cut it for those who have to do long bicycle commutes to work, a practice which is worth encouragement and support.

    Firstly, they are competent drivers in Europe. We are not. It is hard to get a licence in these countries and one is well taught. The level of aggression and sheer stupidity on the roads is vastly lower, as are speeds – even in places like Germany in which it is normal and safe to do well over 200k on a motorway town traffic limits are 30-50 kph and are respected. Similarly for small country roads.

    Secondly, in most of these countries there are varying grades of strict liability for drivers – if one hits a cyclist or pedestrian in a car, the default assumption is that you ( as the driver of the most lethal vehicle ) are at fault. Cyclists and pedestrians are therefore a protected species and simply not worth the trouble of hassling – they are respected and given a wide berth, generally repaying this respect with consideration for the car driver. Have just returned from Germany and it is bike heaven.

    Contrast this with the “I once saw a cyclist run a red light so I can flatten you if you make a mistake” attitude which is so common among some subgroups of Oz drivers.

    Most of the attempts on my life have been by error, inattention or stupidity (and sometimes my own too), but every month or so there will be one which is clearly deliberate. When I make this point to European friends ( cyclists or motorists ) I get slack jawed incomprehension, but one only has to talk to a few Oz cyclists to know that it is a routine part of life in Oz city roads.

    Mandating cycle helmets does have its down side, but we have to fix a lot before it would be in any way safe to consider a relaxation of the law.

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