The Great Helmet Debate

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Parties to the Debate

Are cycle helmets a good thing or a bad thing? I've been following the (often acrimonious) debate since 1993 and have drawn the conclusion that it helps to know the position that the other party is arguing from. It seems to me that the participants in the debate fall at various points along a spectrum which I've divided into the following five categories:

• The Clueless Newbie - Believes unquestioningly that helmets are A Good Thing for cyclist safety. After all, it's common sense. Tends to believe that helmets will offer a high level of protection with no downside, and may have anecdotal evidence to support this. Likely to be pro-compulsion, unless already a cyclist with some experience of the disadvantages of helmet wearing. This seems to be the position of the nursing profession in the UK.

• The Informed Ignoramus - Has been presented with the available evidence, but chooses to ignore or dismiss any research whose results disagree with the prejudices of the Clueless Newbie. Refuses to consider the possibility of any downsides to helmet wearing and tends towards a belief that cyclists can be rendered invulnerable by wearing a polystyrene hat. Almost certainly pro-compulsion, probably a non-cyclist. Typically ready to defend his beliefs by quoting discredited research and made-up statistics. This is the position of BHIT and of certain politicians. Trying to reason with the Informed Ignoramus has proven to be a waste of time and has been the cause of many a flame war, however innocent bystanders often become better informed as a result.

• The Informed Lidophile - Has reviewed the available evidence and concluded that it is always better to wear a helmet than not. Appreciates that a helmet does not make a cyclist invulnerable and is no substitute for adequate cycling skills, but tends not to see any downside to helmet wearing. Often mistaken for the Informed Ignoramus (as a result of not seeing the downsides to helmet wearing) by those at the more sceptical end of the spectrum. Typically anti-compulsion, on the basis that compulsion invariably leads to a reduction in cyclist numbers resulting in a long-term detrimental effect on national health. This was the official position of the British Medical Association, arrived at openly and with the consensus of the membership, until the end of 2004. Someone at the BMA then changed the policy without consulting the membership, apparently due to political pressure, prompting numerous calls from within the membership for an enquiry.

• The Informed Helmet Sceptic - Has reviewed the available evidence and concluded that there are both benefits and risks to wearing a helmet, with helmets being at least as likely to cause or exacerbate injuries as to prevent or mitigate them. Typically opposed to the promotion of helmets, on the basis that such promotion tends to exaggerate the benefits while ignoring the risks. Strongly anti-compulsion (often mistaken for anti-helmet by the Clueless Newbie, the Informed Ignoramus and the Informed Lidophile). This is the official position of the Cyclists' Touring Club.

• The Anti-Helmet Reactionary - A relatively new group, Reactionaries started appearing early in 2004. The official line of the UK Department for Transport (and seemingly of the UK government) is that moves towards compulsion will be made when helmet wearing levels are high enough to make compulsion enforceable. This has led some Informed Helmet Sceptics to conclude that wearing a helmet is equivalent to a vote for compulsion. Being strongly anti-compulsion and sceptical about the supposed benefits of helmet wearing, they have therefore decided it is a bad idea to wear a helmet in the current political climate.

My Position

I started off as a Clueless Newbie and have become an Informed Helmet Sceptic. I tend to wear a helmet in the sort of conditions where I am most likely to have the sort of crash where a helmet might provide some benefit, i.e. when it is icy or exceptionally windy. I certainly don't wear one in the summer, when I don't want to boil my brain. I could probably be swayed toward the Anti-Helmet Reactionary stance if I felt my freedom was seriously under threat - as yet, I don't.

My beliefs on the subject are summarised in these letters that I have written to the Department for Transport and to my MP:

• My response to the Department for Transport's review of helmet effectiveness
• My letter to my MP about Eric Martlew's compulsory helmet bill

So why do we have people campaigning for mandatory helmet laws if there is scientific evidence that they may be harmful?

Common sense suggests that helmets should save lives. It is reasonable for people to have preconceptions based on common sense. Unfortunately many people, particularly those without scientific backgrounds, become quite distressed when scientific observations challenge their preconceptions. Even more so if those preconceptions are based on common sense.

A scientist, with an open mind, will become curious and start looking for mechanisms to explain the unexpected observations. A non-scientist is more likely to close his mind and assume that the observations must be wrong. People start cherry picking the observations that support their preconceptions and dismissing the observations that challenge their preconceptions. This is scientific fraud and the intellectual equivalent of sticking your fingers in your ears and saying: "La la la".

Unfortunately there are a lot of people out there who are unwilling to have their preconceptions challenged and prefer to say: "La la la".

"I've browsed your website and there are pictures of your children wearing helmets. How does that square with your anti-helmet stance?"

I do not have an anti-helmet stance. I have an anti-compulsion stance and I have an anti-ignorance stance.

Anti-compulsion partly because I am satisfied on the basis of the available evidence that, in many circumstances, helmets impose greater risks than they mitigate, but mostly because I believe that the choice to wear a helmet should be an informed choice made by the individual.

Anti-ignorance because one cannot make an informed choice if one is ill-informed.

There are risks associated with wearing a helmet. There are also risks associated with not wearing a helmet. It is down to the individual to balance those risks and decide whether or not to wear a helmet.

The levels of risk vary from individual to individual, they vary with experience, with riding conditions and with the type of riding being undertaken. They cannot be precisely measured and must be estimated. To have a fighting chance of esimating risk levels accurately, we must at least have some idea of what the risks are.

I offer my children the choice of wearing a helmet or not. As long as the helmet fits properly, I do not believe there is a strong enough case on either side for me to insist either that they do or do not wear a helmet (except when we stop at a playground, when I insist on the helmets being removed because of the strangulation hazard that they present). Of course, I take great care to make sure that their helmets are properly fitted. I would not expose my children to the dangers inherent in a poorly fitted helmet.

My two usually choose to wear their helmets. I suspect that this makes them more confident (risk homeostasis). While they're learning to ride, I regard that as a good thing.

I'm going to finish this section by moving away from risk. It has become increasingly fashionable in recent decades (perhaps largely because of the compensation culture that has unfortunately been imported from the US) to make decisions based solely on risk. But what if a risk is associated with a benefit?

What if cycling is more fun without a helmet? Is it worth making a pleasurable activity less pleasurable in order to make a small reduction in an already small risk?

What if cycling is more practical without a helmet, because you don't have to worry about what to do with the helmet when you reach your destination? Is it worth making a practical mode of transport less practical in order to make a small reduction in an already small risk?

If you tried to avoid all risk, you'd never leave the house. In fact, you'd probably never leave your bed. Chances are you'd then die early from a heart attack.

The Evidence

Actually I don't propose to present any evidence here, but rather to suggest places to look. The letters referred to above include a number of references, many of them hyperlinked. Otherwise I recommend the following sites, particularly cyclehelmets.org:

• cyclehelmets.org - The benefits and risks of cycle helmets.
• John Franklin - Author of "Cyclecraft", John Franklin is widely acknowledged as Britain's foremost expert on cycle safety.
• The Ontario Coalition for Better Cycling - Links to some useful studies and statistics.
• BMA Report Summary - A summary of the BMA's official position.
• Snell Memorial Foundation - The best helmets are Snell certified.

Further Information

• nohelmetlaw.org.uk - As I add this link (18/03/06) this domain has only just been registered, but knowing who registered it I anticipate it developing into a useful resource.
• The Helmet Timeline
• World Health Organization Helmet Initiative
• Cycling Health (New Zealand)
• Pete Clinch's helmet page
• Simon Brooke's helmet page

And finally...

A little bit of helmet humour (with a serious side):

• BMJ Report on Cycle Safety - A slightly cynical explanation of the BMA's official position.
• Bikereader's helmet questionnaire - Do you need a helmet?
• The Heretic - More from Bikereader

Danny
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