Martlew Letter Jamieson

David Jamieson MP House of Commons London SW1A 0AA Dear Mr Jamieson, Compulsory Cycle Helmets for Children I understand from Jane Griffiths, my MP, that you are the Minister tasked with responding to Eric Martlew’s private Bill aiming to require the use of cycle helmets by children. I also understand that you are currently considering the evidence and forming a judgement regarding Government support for the measure. I strongly urge you to oppose this measure. It is both contentious and flawed. Most importantly, the Bill will not achieve its intended aim of reducing child injuries. We can be certain of this because several jurisdictions have introduced mandatory helmet laws, including children-only laws, and not one of them has seen any reduction in injury rates – indeed, in some the rate has risen sharply. All have, however, seen large and sustained reductions in numbers cycling. I am conscious that we who oppose compulsion have a difficult job to do. We must counter a single strident message with a much more complex set of arguments, many of which appear at first sight to be counter-intuitive. The reasons for the failure of laws to reduce injury rates are not fully known. Nor is any Government of which I am aware taking measures to find out. I believe the fundamental reason that helmet laws fail is that they do not address the causes of danger, most notably careless driving. It is undoubtedly also true that the studies on which the compulsion campaign bases its argument are based on adult behaviour and injuries, not child cycle crashes. No doubt you have heard and will hear from compulsion advocates as well. When weighing their arguments I suggest the following litmus test: any submission which advances an efficacy figure of 85% or 88% should be discounted. These figures come from a single study and were revised downwards in 1996. Continued use of the higher figure indicates either insufficient research or a deliberate attempt to mislead. Beware also any attempt to characterise opponents of the Bill as “anti-helmet.” There is, as far as I am aware, no anti-helmet movement. Opponents of compulsion are often helmet wearers themselves, as I am. The consensus among cycling groups is that this Bill, if made law, would destroy the commendable progress which has recently been made in increasing both levels and safety of cycling. I wish you luck in handling this particular poisoned chalice and I hope that you will see fit to oppose this Bill at second reading on April 23. I attach some references and further arguments for your consideration. Yours sincerely Guy Chapman

Sources of information regarding helmets and compulsion http://www.cyclehelmets.org - analysis of the various reports and research on this issue http://www.ctc.org.uk - Britain’s leading cyclists’ organisation http//www.lesberries.co.uk - site of John Franklin (author of Cyclecraft) Issues mitigating against a bill to mandate use of cycle helmets by children The proposed measure has already been tried and failed in several jurisdictions. In no case has the rate of cyclist injuries or head injuries declined. It has often increased. Although injury numbers have declined, levels of cycling have dropped by up to 60%, much more than the injury numbers. Most worryingly, Alberta passed a very similar child helmet measure in 2002 and the head injury rate has since increased substantially. Doctors in New Zealand have already started a movement to have their helmet law repealed. Not only has it failed to deliver the promised reduction in injuries, the decline in cycling is considered alarming against a background of declining physical activity and increasing obesity. Nine out of ten child cyclist injuries occur in off-road play. Unless the bill is to cover private land it will necessarily be substantially ineffective in achieving its desired goals. Use of personal protective equipment by private individuals in recreation on private land is not generally considered an appropriate area for criminal law.

No effort has been made to identify, evaluate or prioritise the causes of risk and their possible remedies. There has been no attempt to assess whether helmet wearing is the best means of increasing cyclist safety. Support for the development of roadcraft by young cyclists, for example, is woefully inadequate: at best they receive a week’s cycle training at school and are thereafter left to learn by their mistakes. Addressing the results of those mistakes before considering ways of avoiding them in the first place indicates a lack of clear thought. Engineers will readily identify the parallel between this and quality control versus quality assurance.

Those injuries which helmets prevent are not the most serious, being mainly superficial cuts and grazes. This statement was given in evidence in court by an eminent neurosurgeon: ”Most experienced trauma surgeons believe that cycle helmets give only very limited head protection. Studies in Australia have shown that they give only marginal prevention of mild head injury and no effect on severe head injury, or death.” Diffuse Axonal Injury (DAI) and Subdural Haematoma (SDH) are the leading traumatic causes of brain injury; cycle helmets cannot mitigate the forces which cause these. There is no credible evidence to suggest that helmets play more than a marginal role in the worst crashes. In a recent review of nineteen cyclist fatalities where cause of death was recorded as head injury, sixteen also had other mortal injuries. The major source of danger and death to children is road traffic crashes, few of which involve cyclists. The proposed measure does nothing to address this source of danger. No crashes will be prevented. The standard UK test for helmets equates to a linear fall from a height of around 1m: the disparity between the forces in this test and in a crash involving a motor vehicle is plain.

Best practice around the world indicates that the best way to reduce injuries and fatalities is to tackle danger at source. In this case there could be a collateral benefit in reducing overall road fatalities, of which only around half a percent are child cyclists.

Obesity and related disorders are also a rising cause of chronic health problems in children. This and road danger between them dwarf the issue of cyclist safety, however tragic individual cases may be. A law will increases the probability of inactivity-related health problems. No attempt has been made to quantify the likely cost of this shift.

Pro-compulsion Cost Benefit Analysis figures for deaths and disabling injuries prevented are arrived at by multiplying figures for injury prevention (often the inaccurate 88% value) by the numbers killed or suffering disabling injury. As the above point makes clear, this is invalid. It is more probable that helmets prevent nearly 100% of grazes and nearly 0% of fatalities. The only estimate I have seen which takes account of this suggests that around two lives would be saved annually in the UK if helmet wearing were universal, assuming no reduction in numbers cycling. Against this we know that up to half those who do not currently wear helmets will simply stop cycling. Overall this would represent a significant net cost in life-years lost., especially given the current low wearing rates

Strong use is made by advocates of anecdotal evidence, seeking to imply that where people survive while wearing helmets, the helmet is solely to be credited; and where they die when not wearing them, a helmet would have prevented death. The fallacy of these arguments is outlined above and in any case is easily demonstrated by reference to similar anecdotes with opposite outcomes.

Compulsion advocates commonly use inaccurate statistics. Frequently quoted figures of 85% and 88% for injury reductions come from a single study, whose authors published revised, much lower figures in 1996. This is so widely known that there is simply no excuse for continuing to use the higher figure. Similarly, an Early Day Motion drafted by compulsion pressure group BHIT claimed that 28,000 child head injuries annually were due to cycling. This is actually the figure for all child head injuries from all causes: only 1,200 (4%) of those came from cycling. The same organisation claimed annual NHS savings from a child helmet law of £2bn. Comparing census data with Audit Office figures, this appears to be a third more than the total current NHS spend for this age group.

This may sound like sour grapes but actually raises two important questions. First, if publicly available figures are demonstrably misquoted, how much reliance can be put on the balance of the argument; and second, if the case is so compelling, why the need to use known inaccurate figures?

The long-term stated position on helmet laws from the DfT and its predecessors has been that it should not be considered until voluntary wearing rates are already high. That is demonstrably not the case at present even for children. No reason is advanced why we would need a law in the first place if voluntary rates were already high!

Some evidence is emerging that helmets may increase the likelihood of cyclists hitting their heads in crashes, and increase the severity of the worst kinds of brain injury. This is independent of any risk compensation effect. Clearly this needs to be understood and accounted for before any helmet measure is even considered.

The DfT’s own Road Safety Research Report 30, 2002, concludes that helmets are beneficial but has been criticised on many grounds, most of which come down to the fact that it gives serious consideration only to those studies which support helmets, and explicitly excludes the types of whole-population and time –series data which indicate against helmet compulsion. It discounts without evidence the idea of risk compensations, misrepresents the experience in Australia post-law (the Australian experience is widely acknowledged in other publications as strong evidence against compulsion) and excludes both the idea and ramifications of any reduction of cycling consequent on compulsion.

Evidence of effectiveness in the small-scale studies used by helmet advocates is not shown in large-scale time series and whole population data. For example,. Edinburgh has among the highest helmet usage rates in the UK. The injury trends for child cyclists and child pedestrians trend so closely over time that it is impossible to conclude any actual benefit from the significant increase in helmet use in recent years. The National Cycling Strategy Board should have the last word, I think: “The NCS Board wishes to ensure that the question of wearing cycle helmets is placed in its proper context. Arguments which seek to present cycling as an inevitably dangerous or hazardous activity, or which suggest that helmet wearing should be made compulsory, risk prejudicing the delivery of those very benefits to health and environment which cycling can deliver, and serve to confuse the general public about the wider social and economic advantages of cycling. It must remain a decision for the individual as to whether to wear a helmet for some or all of their various cycling activities. Parents will need to take this decision on behalf of their children, bearing in mind all the particular circumstances. The Board is clear that any mandatory requirement to wear helmets on all occasions would be prejudicial to the realisation of the benefits which safe cycling can offer our society as a whole.”