FAQ:Helmets

''Oh gods no! And this is the short version! The long version is even more... long.''

Cycle helmets. Probably the most divisive issue in cycling today, even more so than the luddite UCI and their ban on recumbents. Having started out very pro helmet and in favour of compulsion for children, I am amazed to find myself engaged in a vigorous campaign against helmet compulsion, and to a lesser extent promotion. How did this happen? And why won't I "live and let live" when people state dogmatic pro-helmet opinions?

This is not a page about helmets (I already have several of those), it's about why I can't leave the subject alone, however much it might frustrate me. I don't like being attacked in the Press by Angela Lee and her cronies, but I absolutely refuse to let them get away with pretending that cycling is dangerous, and helmets are some kind of magic talisman. I have been told by helmet promotion activists that, by presenting both sides of the argument, I am getting in the way of people making "an informed choice". That suggest to me that it is their logic, not mine, which is at fault.

Battle lines
According to the two opposing camps, bicycle helmets are either (a) the cycling equivalent of a portable forcefield, preventing all possible deaths and injuries, or (b) guaranteed to kill you stone dead within fifteen seconds of putting them on.

It is believed that back in 1996 someone had their mind changed about the helmet issue during a discussion on Usenet, but this is probably an urban myth. Most cyclists, of course, don't give a toss whether anyone else wears a lid or not, but that won't deter the warring factions from posting.

Only two things are certain about bicycle helmets:

First, making them compulsory deters cycling. This has been proven beyond reasonable doubt in several places, notably Australia and New Zealand. This deterrent factor has several undesirable knock-on effects, notably that a reduction in total cyclist numbers tends to increase the danger of cycling (as drivers are less likely to be on the lookout for cycling); also a reduction in the fitness levels of the population. Cycling is good exercise.

Second, anecdotal evidence is worthless. Yes, plenty of us have come off head first and our helmets may have prevented serious injury. But these are not controlled experiments, and few of us are particularly anxious to go back and repeat the exercise without a helmet for comparison. People who died despite wearing a helmet rarely post about it, and there are no objective standards for assessing whether those who have crashed without a helmet have actually had their brains addled or not.

A bit of background
To understand the helmet issue properly you need to know a bit about the history. For a century or so there was no such thing as a bicycle helmet. And cycling wasn't thought of as dangerous. Then Bell came up with plastic hats, and suddenly they had a solution to a problem nobody but they could see. Then research was conducted which apparently showed that helmets saved a huge proportion of injuries. And many of us believed them - after all, they were plausible, and it was "obvious".

Although the early studies were based on types of helmets which are practically unavailable now (modern helmets are almost all certified to the much less stringent EN standards not to Snell B95 or even B90), and TR&T in particular was deeply flawed (attributing to helmets the difference between injury rates for solo black urban street cyclists and white suburbanites riding on cycle tracks with families), it is easy to believe that helmets may well prevent a high proportion of trivial injuries such as cuts and bruises. You can refer to these as scalp lacerations and contusions to make them sound worse, of course, but they are still not in any way life-threatening.

The big logical disconnect comes when you start extrapolating these figures to suggest that, because helmets prevent trivial injuries, they will also prevent serious injuries. This is clearly nonsense. Some studies are so poor they apparently show that the protective effect of helmets is greater for more serious injuries than for lesser injuries, which is at odds with the findings for every other type of protective device I can think of. Indeed, TR&T's 1989 paper says that helmets reduce head injury by 85% and brain injury by 88%. Think long and hard about that. Do you genuinely believe that a polystyrene hat is going to protect you better against brain injury than against a cut head? Because that is what they are saying here. But it's worse than that:

Telling someone that this expensive item will prevent a cut head, will sell less product than claiming it will save your life. And claiming it will save your life is only going to generate serious revenue if you can persuade people that your life is at risk in the first place.

And there lies the problem. In order to promote their product, helmet manufacturers and campaigners have to do two things: they have to persuade you that cycling is dangerous (which statistically it is not); and they have to persuade you that helmets will prevent serious and life-threatening injuries (which the evidence suggests they do not). Manufacturers are not allowed to make false claims in advertising, but "luckily" they have the helmet lobby to do this for them. That's "luckily" in the sense that, in the US anyway, manufacturers provided much of the funding which got the helmet lobby going.

Worse, the helmet lobby is now so well funded, and so well supported by handwringing "injury prevention" activists, that it has come to dominate the cycle safety agenda. And this is the main reason I am opposed to the helmet lobby. They distract attention from the things which are proven to increase cyclist safety, most significant of which is increasing cyclist numbers. In fact, by falsely portraying cycling as unusually dangerous, they actually make it less safe by deterring people from cycling. Especially dishonest is the tendency to feature head injuries sustained in road traffic crashes. Cycle helmets are designed for simple falls, at speeds of no more than about 12mph. Road traffic crashes routinely produce accelerative forces well beyond the protective capacity of motor racing helmets.

Illogical, captain
I started as a helmet advocate. After all, it makes sense doesn't it? But as it became clear to me that there was a well-known and well-documented set of data which completely contradicted the pro-helmet case, and that that those who were asking me to trust their judgement had neglected to tell me that this even existed, let alone provide any kind of rebuttal, I began to smell a rat. I started to realise the fallacy of "helmet saved my life" anecdotes (the broken helmets which people claim have saved their lives have simply broken: polystyrene absorbs virtually no energy in brittle failure, and helmets are designed to work by plastic deformation - squashing without fracturing). I found out, in short, that I had been duped. And that makes me angry.

We now have a number of whole populations where helmet compulsion has been applied. And once you take into account the drop in cycling which the helmet law caused, not one of these shows any significant reduction in cyclist head injury rates. Minister for Transport David Jamieson acknowledged that the Government knows of no case where cyclist safety has improved with increasing helmet use.

How can this be? The short answer is that we don't know. Helmet campaigners are now starting to say it's because people are wearing them wrong, as well over nine out of ten helmets are incorrectly worn. This is hardly surprising: most helmets (a) don't fit very well, and (b) when worn correctly (i.e. minimal movement) are distinctly uncomfortable, especially in hot weather (I didn't really believe this until I started riding more without a helmet).

But this doesn't really wash. There are a lot of time series covering a lot of countries, and in every case injury rates have remained static or (quite often) risen as helmet use has risen; when there are large step changes in helmet use there are no corresponding changes in head injury rates, particularly when compared to pedestrians (a handy control which removes the effects of, for example, better traffic enforcement).

To add further confusion, there are all the possible confounding variables. For example: it seems logical to suppose that those most likely to be deterred by scaremongering and inconvenience are those who are least committed to, and least experienced in, cycling; by implication, those most likely to crash. So one would expect the injury figures to fall by much more than the drop in cycling. This has not happened. And there are some logical pitfalls to avoid, too. In the USA, the injury rate has increased by 40% while helmet use has risen to nearly 50%, suggesting that helmets are actually causing increased casualties - but the causal relationship could just as easily be reversed, with increased helmet use being a response to increased risk.

The 85%/88% figures from the Thompson, Rivara and Thompson study, far and away the most optimistic ever published, with even the authors scaling down their estimates in later work based on the same figures, are now, according to at least one helmet advocate, so firmly embedded in the "injury prevention community" that a change "would not be helpful". Yup, it's wrong, they know it's wrong, but having invested so much time and money getting it out there, they are not about to start using a more accurate figure just in case the whole house of cards comes tumbling down. And we fell for it. More fool us.

All this is counter-intuitive, of course. But so is the incontrovertible proof that seat belt laws were a waste of time (Adams, 1995). The BBC in particular has been appallingly biased in putting the pro-helmet case, portraying opposition as being a libertarian backlash against a technically sound but authoritarian policy. Experience from around the world shows the opposite: compulsion often increases risk and never reduces it.

Why not let it lie?
There are two reasons why I can't let the argument lie. First, aggressive helmet promotion (including compulsion) deters cycling. There is no factor which is more closely linked to increased cyclist safety than the numbers who cycle. The reasons are obvious: more cyclists means that the primary causes of danger, motorists, are more used to cyclists and more likely to be cyclists themselves. But there is almost certainly more to it than this. Some evidence shows that helmeted cyclists are more likely to hit their heads, other evidence suggests that helmets are largely ineffective against the rotational forces implicated in the worst brain injuries; and of course risk compensation theory says that people will increase their risk taking to compensate for the perceived reduction in danger due to helmet wearing. This last would be particularly dangerous if the benefits of helmet wearing are exaggerated.

And second, the helmet zealots have essentially deprived us of the right to live and let live. Government policy is against compulsion not because it has failed everywhere it's been tried, not because it's illiberal, not because it ignores the vast range of cyclists, types and styles of cycling, but because current usage rates are too low. In other words, as far as the Government is concerned every cyclist who wears a helmet is voting for compulsion. Fighting helmet zealots with reason is not only challenging, arguably it's no longer an option.

My position
All in all I would say that the evidence in favour of helmets is equivocal. There are many other things which seem to me to be much more likely to result in genuine improvements in cyclist safety, but all these are lost behind the fog of statistics and fearmongering thrown up by the helmet promoters. It is surely significant that the leading helmet promoter in the UK is obese and admits to not being a regular cyclist; not one single cycling body in the UK was prepared to back a recent Bill compelling helmet use by children, and that includes the trade body whose members profit from selling them. For myself, sometimes I wear a helmet, sometimes I don't. When my children and other scouts are forced to wear them I tell them what sort of injuries the helmet might prevent. Most important, I tell them that the helmet is not a magic talisman: if you want to live it's your own skill and vigilance which will save your life, not a piece of polystyrene. Think of them as being made of meringue covered in eggshell and ride accordingly.

So, why am I campaigner against helmet compulsion? Because I firmly believe that far from being the first, best thing a cyclist can do to increase safety, helmets are essentially irrelevant in preventing serious and fatal injuries. Efforts to promote and compel helmet use have failed to deliver measurable benefit wherever they have been tried, and they are a dangerous distraction from the real business of cyclist safety. By scaring people off their bikes they make my daily travel more dangerous.

The CTC, with a 125 year history of working for cyclists, is more likely to be right on this issue than a single-issue pressure group who exist solely to promote helmets (saving the manufacturers millions in advertising), and the CTC's considered position is that we should be left to make individual informed choices. Informed in the sense of knowing all sides of the argument, that is.