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This is a letter that I wrote to my MP regarding a private member's bill proposing legislation to make cycle helmets compulsory for children. You can see the text of the bill here:
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27 January 2004
I understand that Eric Martlew MP has introduced a Private Member’s Bill calling for the introduction of compulsory helmets for child cyclists. I hope that I can persuade you to vote against the bill, if you have not already decided to do so. The benefits of cycle helmets are unproven and controversial. There are of course times when a helmet may prove beneficial, but the choice of whether to wear a helmet or not should always be left to the individual cyclist or, in the case of children, to their parents. There is no case for compulsion; indeed the British Medical Association is opposed to compulsion [2]. In countries where mandatory helmet legislation has been introduced, absolute numbers of cyclist head injuries have sometimes been reduced (in Alberta they increased). Unfortunately, any reduction is more than accounted for by the corresponding reduction in numbers of cyclists [3], [4]. It seems likely that the reduction in cyclist numbers would be even more pronounced among children than among adults. Children’s helmets come with warnings that they should not be used for other forms of play, due to risk of strangulation. If children have to keep putting a helmet off and putting it back on again during the course of normal play, it seems likely that they will simply cease the activity that requires a helmet. When inactivity has become a major health issue and obesity in children is a real problem, it would be foolish to introduce legislation whose benefits are dubious and whose most significant immediate effect would be to reduce the numbers of children engaging in an activity that offers significant health benefits. It is for this reason that the BMA is opposed to mandatory helmet legislation. So why are helmets controversial? It seems obvious that protective headgear must be a good thing, but this is not necessarily the case. Helmets are designed to protect against skull damage and resultant brain injury in low speed falls of the type that are likely to occur off road, where the legislation will not usually apply. They are not designed to protect against collision with cars, where in any case life-threatening injuries are likely to occur to organs other than the brain. Helmets are not designed to protect against the more serious rotational brain injuries, and indeed may increase the risk and severity of such injuries [1],[8], [10],[13],[15],[16],[18],[19],[21]. A cycle helmet significantly increases the effective diameter of the head, increasing the risk of the head contacting the ground in the event of a fall. If the head is rotating on impact then it is likely to stop, while brain rotation continues. The likelihood of head rotation stopping on impact is increased by the pointed backs on most modern cycle helmets. For the same reasons, helmets may also increase the risk of neck injury [14],[24]. In some circumstances helmets may increase the risk of an accident occurring in the first place. The most commonly mentioned mechanism for this is risk compensation, but it is also significant that a helmet can be uncomfortable to wear in warm weather. Discomfort reduces the ability to concentrate as does overheating caused by the insulating properties of a helmet. Helmets can also result in sweat dripping into a cyclist’s eyes, reducing the cyclist’s ability to see where he is going. Bearing in mind Alan Meale’s Early Day Motion 1783, certain inaccurate figures provided by the Bicycle Helmet Initiative Trust are likely to be raised in any debate on the bill. I feel therefore that I should highlight these figures: “Approximately 28,000 children annually receive a serious head injury as a result of a cycling accident”. In fact, government statistics show that 4,809 child cyclist injuries (all types, all severities) were recorded in 2002 [9]. “85% of head injuries could be avoided by wearing a helmet”. This figure came from a 1989 study [20] and was later accepted by the study’s authors to be wrong [21]. Peer review also found the figure to be excessive [7]. “Cycle helmets could save the NHS £2 billion annually in the cost of treating child accident injuries.“ This seems unlikely when extrapolation from government statistics [6], [17] suggests that the NHS spends approximately £1.5 billion annually on treating children aged 5-15 for all illnesses and injuries. BHIT also does not consider the cost to the NHS of treating diseases of inactivity. I attach a few references, though I fully appreciate that you will not have time to follow them all up. For further reading, I strongly recommend the reports on John Franklin’s website. John Franklin is widely recognised as the UK’s foremost expert on cycle safety: Yours sincerely Danny Colyer BSc(Hons) References [1] Brain Association of British Columbia - “Concussion in Sports Handbook” [2] British Medical Association - “Cycle Helmets” 1999 [3] Cyclists Rights Action Group - “Case Against Compulsory Helmet Wearing in the ACT” [4] Cyclists Rights Action Group – “Change in Casualties to Cyclists Following The Helmets Law” [5] Carnall, D - “Cycle helmets should not be compulsory” British Medical Journal 1999;318:1505 [6] Census 2001 – “Children” [7] Cochrane Injuries Group – “Helmets for Preventing Head and Facial Injuries in Bicyclists” Cochrane Comments and Criticism 2001 [8] Corner, J P et. al. - “Motorcycle and bicycle protective helmets: requirements resulting from a post crash study and experimental research” Federal Office or Road Safety report No CR 55, Canberra, p5 (1987) [9] Department for Transport – “Road Accident Casualties by Road User Type and Severity” [10] Ellerton, A L - “The (ASTM/SEI) Helmet: Setting a Legal Standard” Equine Law [11] Franklin, J - “Bicycle Helmet Effectiveness – a broader perspective: A Critique of Department for Transport Road Safety Research Report No 30, 2002” 2003 [12] Franklin, J - “Cyclecraft” Stationery Office 1997 ISBN 0-11-702051-6 [13] Holbourn, A H S - “Mechanics of head injuries” The Lancet, 2, 338-441 (1943) [14] McDermott et. al. - “The Effectiveness of Bicyclist Helmets: A study of 1720 Casualties” J Trauma 34,834-44 (1993) [15] Mendoza, I D - “U S Patent Application 20020023291” (2002) [16] National Health and Medical Research Council - “Football injuries of the head and neck” AGPS, Canberra (1994) [17] National Statistics – “Hospital and community health service expenditure: by age of recipient, 1999-00” Social Trends 32 [18] Ommaya, A K & Gennarelli, T A - “Cerebral concussion and traumatic unconsciousness: correlations of experimental and clinical observations on blunt head injuries” Brain, 97, 633-654 (1974) [19] Standards Association of Australia - “Australian Standard 2063.2” (1990) [20] Thompson, R, Rivara, F P, Thompson, D C - “A case-control study of the effectiveness of bicycle helmets” New England Journal of Medicine 1989; 320:1361-7 [21] Thompson, R, Rivara, F P, Thompson, D C – “Effectiveness of bicycle helmets in preventing head injury” Journal of the American Medical Association 1996 Dec 25; 276(24):1968-73 [22] United States Department of Transportation - “Trauma Systems and Mechanism of Injury” [23] Wardlaw, M J - “Three lessons for a better cycling future” British Medical Journal 2000;321:1582-1585 [24] Wasserman, R & Buccini, R - “Helmet Protection from Head Injuries among Recreational Bicyclists” Am J Sports Med, 18 (1), 96-97 (1990) |
I received the following reply from my MP on 10/02/04:
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Thank you for your letter of 27 January concerning Eric Martlew's Private Member's Bill. Although I have been sympathetic to this proposal, I will consider very carefully what you say. However, the Second Reading of the Bill is down for 23 April and I have constituency engagements that day which means that I will be unable to attend. Thank you for taking the time and trouble to write to me. Please do not hesitate to do so again at any time. With all good wishes Yours sincerely |
So my letter may have had no effect on the bill's success (although the cynic in me conjures up images of an MP reading my letter and thinking: "I really don't want to be seen voting one way or the other on this, lets book some alternative engagements"), but at least we have one MP who is now better informed. It is worth noting that Roger Berry signed Early Day Motion 1783, proposed in October 2003 by Alan Meale and citing BHIT misinformation as fact, so he clearly wasn't properly informed before!
Danny
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