Helmets maxi-FAQ

Are you sure you want to ask this question?
OK, I assume you have come here for a reason. You have read the Mini-FAQ and you want more. More what? If you're here for the five pound argument then please look here first.

This page is not intended to be polemical, but nor is it guaranteed to be wholly free of bias since I find that my reading of most helmet reports is coloured somewhat by my understanding of the previous ones. If you don't trust me (and you'd be wise not to, after all I'm just some random bloke ni the internets) and you don't trust BHIT (wiser still!) then you have only one option: to find and read as much of the source data as you can. I give you fair warning: this will take a while. My helmet resource is far from complete and it contains over 700 documents of one sort and another. I am writing this in response to comments from uk.rec.cycling but this is me speaking, and if you don't like it - well, then you'll have to write your own.

And I have to be honest here, this is not so much a helmet FAQ as a helmet scepticism FAQ. It is an explanation of why scepticism is a valid view, as much as a look at the evidence. But then, I make no pretence to being anything other than a sceptic.

OK, hit me with it
Right, so the health warning has been ignored and you're still here. I'm going to divide the document up into chunks, in line with standard elephant-eating procedure. In many cases the situation for children is somewhat different to that for adults, and many helmet laws (and most helmet campaigns) cover only children, so the case for children is considered separately in some places.

You will see a lot of statistics. "Aha!" you will think, "Statistics are like bikinis: What they reveal is interesting, but what they hide may be vital." And you will be right. So I've tried to give some of the background. So this page violates another mildly sexist axiom, that web pages, like skirts, should be long enough to cover everything important, but short enough to remain interesting. This page is long. It's long because there are no short answers. Well, I suppose there is a short answer to the question "are helmets a good thing?" and that is "yes and no".

Risks of cycling
All discussion of the benefits or otherwise of helmets hinges on the perceived risk inherent in cycling. So, with shamelessly Anglocentric emphasis, here are some of the key figures.

You may note that the real figures do not always match up to the claims made by helmet promoters. I do not know why they exaggerate the risks - I have my suspicions, but states that one should never attribute to malice that which can be adequately explained by incompetence.

Helmets Work!
Yup, they definitely work. Up to a point. The $64 question is, of course, what point. Let us review some of the claims of efficacy:

Age profile
Both helmet efficacy and accident involvement appear to be strongly age-dependent. It appears that the greatest benefit is experienced by the youngest children, but the highest number of accidents is experienced by teenaged boys. Again, it would be a mistake to suggest that the differential efficacy between younger and older children is a function of the helmets themselves - older children have more fully-formed skulls, and of course they are bigger and stronger. Teenaged boys are an injury risk just sitting still - and you know what happens when they get into a car!

There appears to be some merit in encouraging young children when learning to ride to wear something on their head - as well as knee pads and elbow pads. Once confidence and competence are gained this benefit is much harder to establish.

Helmets don't work!
For sure, helmets definitely don't work. For certain given values of "work" of course...

Two Old Women
Long and terrible arguments have raged between road and off-road cyclists, often both opposed to compulsion but with a completely different perspective on what constitutes "reasonable precautions". Like the two old women holding a slanging match between upper windows on opposite sides of a cobbled street, they are arguing from different premises. This is eloquently summed up here:

This also goes to the heart of the disparity between observational studies and population and time trend statistics. It is not alone in identifying fundamental differences between the helmeted and unhelmeted populations:

Logical Fallacies
Logical fallacies abound in the helmet debate, and can be seen from those on both sides of the argument - and even those in the middle. Logical fallacies are actually a common feature of all debate, and the more heated it becomes, the more entrenched the positions adopted, the greater the likelihood of their coming up. There are some good sites on the web regarding logical fallacies and how to recognise them. Nizkor is good, and so is Stephen Downes' guide to the logical fallacies. To a large extent they rely on a common fundamental flaw: the confusing of rationalisation with reasoning.

Logical fallacies will also creep in when the writer is looking to inject certainty. The helmet issue is fraught with contradictions and any truly authoritative statement is likely to require precision of wording, or many caveats. Usenet is a forum well suited to lengthy discourse, but (to show my prejudices) web forums tend to attract readers with less appetite for detailed argument, and a greater tendency to try for soundbytes. Soundbytes, in helmet wars, are almost invariably fallacious - in my view, anyway.

I have a whole page on logical fallacies - see how many you can spot. Bonus points for catching me out.

Compulsion
Consider the following example from Target Risk:


 * All human beings are mortal.
 * Socrates is a human being.
 * Therefore, Socrates is mortal.


 * A river empties into the sea through a delta.
 * The delta has three channels, all of equal size.
 * Therefore, damming two of the channels will reduce the flow of water to the sea by two-thirds.

One of these is self-evidently true, the other patently absurd. So here is another statement:


 * Cyclists can suffer head injury in a crash
 * Helmets reduce head injury in the event of a crash
 * Therefore cyclists should wear helmets

This is clearly analogous to one of the two statements above. But which one? Wilde's comment on the second statement is this: "One cannot stem the flow as long as there remain alternative routes to the destination. One cannot reduce mortality due to accidents and lifestyle-dependent disease unless all opportunity for premature death were eliminated by law or made impossible through technological intervention. And that, of course, can never be fully achieved. In the case above, the river would simply develop a fourth channel."

This is, of course, not a precise analogy. But it is a fair point. And especially when you consider that risk is not a measurable absolute, but a cultural construct, and one which varies from person to person. One person will be happy to go bungee jumping and skydiving, another will ferry Tarquin and Jocasta to school in the Range-Rover to avoid the danger posed by - well, by people ferrying Tarquin and Jocasta to school in the Range-Rover. Risk aversion varies with social class, gender and age. Middle-aged, middle-class women are very risk averse, teenaged boys from poorer social backgrounds are the least risk-averse. This is hardly a big secret. And the reason that helmet laws fail to live up to expectations may well be that they are trying to coerce people into someone else's pattern of risk-taking.

And there is no possible doubt that laws have failed to deliver anything close to the claimed levels of injury reduction. Far from preventing 85% / 75% / 69% / 65% / insert random percentage here of injuries, actually they don't even prevent enough injuries to pay for all the helmets in reduced healthcare costs. And even that is not actually a surprise - cycle injuries are rare, and you have to buy an enormous number of helmets to prevent any significant number of injuries.

Have a look at percentage head injury versus helmet wearing rates for Western Australia and New Zealand, probably the two most closely studied helmet law jurisdictions:



The NZ chart does not show the figures for the whole population - these follow pretty much the adult trend. Reductions in head injuries seem to follow enforcement of traffic laws, and modal shifts away from road cycling. This is obvious, since cars are the major source of serious head injury.

So: helmet laws fail for a number of reasons, including:


 * they are sold on traffic danger, but helmets are not designed for traffic crashes
 * they are sold with grossly exaggerated efficacy figures
 * cycle injuries are rare so enormous numbers of helmets are required to yield measurable reductions in
 * aggressively enforced laws deter cycling and reduce "safety in numbers" benefits
 * risk-averse cyclists are already wearing helmets, and the rest may risk compensate away any benefit.

Abuse@
Now we come to the vexed issue of helmet wars. Helmet threads are inevitable, the consequence of a clash of deeply held beliefs. They are also - contrary to what many might think - productive, at least on uk.rec.cycling. It has been suggested that nobody changes their mind as a result of a helmet war, but actually that is not true, a lot of us started as strongly pro-helmet and have had our eyes opened by the presentation of evidence which - let's be honest - helmet proponents don't so much as address, as sweep under the carpet. It often comes as a shock to people, even experienced cyclists, to find that there is any evidence at all to contradict the 85% figure they've been presented with for over a decade.

They are productive up to a point, the point where a helmet thread becomes a helmet war. At this point positions have been taken, trenches dug, and anybody going "over the top" is likely to come under heavy fire from the opposite side. The debate tends to become robust (read: seriously bad tempered). It is only a matter of time before someone posts one of the classic Liddite throwaways:

For some reason those who post these arguments seem to get upset when the response is widespread withering scorn. Who could have predicted that? That is such an atypical reaction to the assertion that one person has the monopoly on truth!

Here is a point to ponder: the people putting the sceptical viewpoint have often read dozens, sometimes hundreds, of helmet papers. Those arguing the points above usually turn out not to have read any, beyond the carefully-edited abstracts recycled by pro-helmet campaigners. Hmmmm.

Shoot the Messenger
One reason why I am suspicious of pro-helmet arguments (and I know others share this) is that the most vociferous proponents of helmets tend not to be too scrupulous. In the UK, the leading pro-helmet group is BHIT. They have been responsible for a number of dodgy claims, which I detail in this table. In a bizarre twist on the BHIT ASA complaint ruling, BHIT complained to ASA about a briefing document for MPs which contained a section much like the above headed "myths" and "facts". ASA decided that the Parliamentary briefing was a marketing communication (selling what?) and ruled that although the myths were indeed false claims made by the helmet lobby, and the facts were indeed accurate, because there was dispute about the extent to which the (acknowledged true) facts rebutted the (acknowledged false) claims, this was misleading. Er, right.

BHIT has derived much income from grants from the Department of Health and Department for Transport - that's you and me. Thus far what they have delivered in return for around £100,000 of public money is a couple of reports claiming that helmet promotion can increase helmet use (really? who would have thought it?) but containing too little data to evaluate the other claims contained, a conspicuously inaccurate Early Day Motion, and campaigning for a helmet law. These political campaigning activities must be done out of their unrestricted funds, but much of their income (e.g. Government grants) is restricted.

BHIT have also engaged in some seriously distasteful emotive campaigning. When Troy Parker was killed riding off the pavement into the path of a car on a bike with defective brakes, they brought his grieving mother to Westminster to press the case for a helmet law. Leaving aside for a moment the fact that there is no proof a helmet would have saved his life, as the Coroner said, it was riding on the footway and having defective brakes which caused the crash. And they have a video about a boy who is reduced to a vegetable after crashing his birthday present bike (unhelmeted). Curnow shows that this kind of brain injury is most likely to be caused by a type of force against which helmets provide no protection, and could even exacerbate. But BHIT make no claims to be a cycle safety charity - their sole interest is in promoting helmets.

In short: the Government is paying them a lot of our money to provide expert information on cycle helmets. They do not do this. They are propagandists. In addition to the dodgy claims above, they also continue quote, uncritically and often without even the "up to" qualifier, the 85% figure - even after accepting to the ASA that they should not make such claims.

In the USA helmets are strongly promoted by the National SafeKids Campaign. Would you be surprised to learn that they are sponsored by Bell? Probably not. Especially when you hear about recent moves in the USA towards helmets for soccer... Guess what figure they quote in their helmet promotion campaign? Yup, 85%.

Which invites the question: if helmets are such a good idea, why is it necessary to lie in order to promote them? I'll leave you to ponder that one at your leisure.

Can we stop now?
Right, so now you can quote at least three studies to support your pre-existing point of view, whatever that might have been. So how has that helped, exactly?

It has helped in this way:


 * you are better informed
 * you understand that there is no simple answer to the question of whether helmet use is good or not
 * you realise that simplistic arguments - on either side - are almost invariably incomplete, usually to the point of uselessness.

And now you are ready, Grasshopper, for the Great Truth: When cycle safety interventions are ranked by likely effectiveness, helmets are always placed last. The reason is simple and obvious. It is risk management 101: first reduce risk at source, then reduce exposure to risk, and only when this fails apply personal protective equipment.

CS Downing's "Pedal Cycle Accidents in Great Britain" (TRRL, 1985) rated the efficacy of interventions in reducing cyclist casualties thus:

Note that this was before helmets really started to take off, and risk-averse cyclists had just started to wear hard shell helmets.

The fundamental flaw with helmet promotion is that it ignores this principle, and elevates cycle helmets - a palliative measure, and one designed only for a small subset of the accidents which cause serious injury - to first place. In fact, only place. Helmet lockers are marketed as a "cycle safety programme"; helmets "help children cycle safely" But this is arrant nonsense! Cycle safety is not about planning for when you hit the ground, still less about making it less unpleasant to do so - it's about not hitting the ground in the first place!

So you can join the urc regulars in singing our variation on the Blue Öyster Cult classic:
 * You see me now, a veteran
 * Of a thousand helmet wars
 * I've been living on the edge so long
 * Where the winds of limbo roar
 * And I'm young enough to look at
 * And far too old to see
 * All the scars are on the inside
 * I'm not sure that there's anything left of me

About the author: Unlike some people Guy Chapman does not consider himself one of Earth's foremost authorities on helmets, although he knows some people who are. He has, however, read an awful lot of helmet papers.