The BMA, the BMJ, and bicycle helmet policy

The reason I pick up the bicycle helmet theme again this week is that the BMJ is running a sidebar poll of their readers (or, more accurately, of cycling tweeters and recipients of Robert Davis’s emails ;-)), asking whether it should be compulsory for adult cyclists to wear helmets.

The BMJ is the journal of the British Medical Association, the professional association and trade union of British doctors. Part of the BMA’s remit it to lobby the government on issues that its members believe are important, and it has some clout in this area. These policies are decided by a representative democracy — a group of members elected by region and by field. In recent years, this body has decided that it is BMA policy to support legislation that would make helmets compulsory for cyclists.

Doctors might not even have noticed the adoption of this policy.  To most it is probably an irrelevance — most people will not cycle in the conditions that prevail in this country and doctors are no exception. And I imagine that very few have read the quite astonishing “promoting safe cycling” pages of the BMA website. Readers of Ben Goldacre should get their Bad Science Bingo cards out before clicking the link.

Tomorrow I’ll dissect those pages and ask how they came to be so bad. But there is a more basic issue here. Never mind whether helmets are effective or not, aren’t there more important policies that the BMA should be pursuing?

In 2002, the BMJ polled readers about issues of health and road danger — a slightly more scientific and insightful survey than the free-for-all yes/no question that they ask this week, and one much better targeted to British doctors rather than every joker on the internet.  They asked readers to judge the importance, on a scale of 1 to 6, of various interventions for promoting the health and safety of pedestrians and cyclists. Helmets came out bottom of the doctors’ priority list:

Average ranking Response
3.25 More and better cycle safety training
2.87 Compulsory cycle helmet wearing
3.42 Separate lanes for bicycles in urban areas
4.04 Traffic calming to reduce vehicle speeds in urban areas
4.04 Reduce car use by better public transport and by encouraging walking and cycling
3.85 Banning motorised vehicles from towns and cities

Interestingly, helmets for cyclists was ranked as only a slightly more sensible solution than helmets for pedestrians. Indeed, the results for pedestrians look much like the results for cyclists.

It’s the most heartening thing I’ve read in a long time. Most doctors get it. They’re not ignoring the bull. Certainly all of the public health doctors and epidemiologists (the people with the most exposure to scientific methods, incidentally) that I know get it. The problem is not that cyclists are taking insufficient measures to protect themselves from danger, it is that they are put in danger by motorists and by the government policies and societal norms that support the mixing of fast-moving motor vehicles, including those driven by people known to be dangerous and incompetent, with cyclists and pedestrians in our towns and cities.

Alongside their policy of lobbying for legislation to compel the use of helmets, the BMA has drawn up a set of recommendations for motor-vehicle reduction. But while the former policy is actively being pursued in Westminster and in the nations, the latter looks to have fallen by the wayside, and is still stuck in 1997. Why?

13 thoughts on “The BMA, the BMJ, and bicycle helmet policy”

  1. UK national data shows the risk for cycling on rural A type roads to be high, 30 to 40 times that of urban minor roads, per km cycled. Safety would be improved for cyclists or for anyone walking by providing a good cycle path designed to a suitable standard and having priority over minor side roads.

    DfT figures on fatality risk, Rate per 100 million km cycled, (140/200 cc ref)
    Rural A roads – 24
    Rural other roads – 3.2
    Urban A road 4.7
    Urban other roads – 0.5
    (car occupant rural A road – 0.5 )

    The BMA policy on cycle helmets is misguided. The Northern Ireland submission on cycle helmets provides useful information.

  2. I wrote to the BMA to point out some of the errors in their strange campaigning, and was told: “Dear Mr Lennon,
    Thank you for sending us your comments regarding safe cycling.
    The ‘Promotion of safe cycling’ paper was produced by the BMA’s Board of Science, and I will ensure your comments are forwarded to them for their information.
    Kind regards,
    Naomi Butler
    Enquiries Officer
    BMA Public Information Unit”

    So it sounds like my message will be buried. Need to find a doctor friend to poke around on this one, I think …

  3. Thanks for the mention!
    I’m afraid the medical profession is a lot less on side then you may think: there are plenty of good medical people, but they are typically in areas like public health which tend to be marginalised.
    Doctors are often drivers who don’t like restrictions on their motoring, and even if they know what needs to be done and are wiling to do the right thing, they are not generally effective in bringing pressure to bear on Government.
    What they are good at doing is pushing (irrespective of evidence) “downstream” measures such as seat belts, which is why they have voted for mandatory helmets. See the relevant chapters in my book on this: . (See also on helmets the excellent site which is about the best source of peer reviewed evidence you can get).
    Doctors, like many “road safety” professionals, may say that they don’t see cycle helmets as “the answer” – but despite years of knowing about the issues, what we end up from them is – a call for mandatory cycle helmets.
    For a good group of medical people working on transport, look up the Transport and Health Study group.

  4. Please don’t think that a cycle path is the answer (a “good cycle path designed to a suitable standard and having priority over minor side roads” is not (never?) what we see provided). Collisions between cyclists and motorists usually occur at junctions, and most implementations of cycle paths introduce more junctions as well as putting the cyclist out of site of the motorist at the approach to the junction.

  5. Data from the Netherlands can be seperated into at junction and betwen junctions. I think the accident data shows the risk at junctions to be lower than in the UK and between junctions to be a lot lower.

    Designing cycle paths to a ‘standard’, like CROW, or even higher for joining or leaving points, to minimise falls, no ridges or edges is needed. Priority over minor side roads is an additional requirement.

    The UK needs to spend about 10% of its transport budget on improving cycling and walking over a period of about 10 years. This needs to go on infrastructure rather than spread into other areas. A zero VAT on cycle paths should be applied. Road safety training should be additional and seperate issues and not confused with providing high quality infrastructure.

  6. How did it come to this? The BMA is a large organisation with a byzantine committee structure, representing heterogenous groups of doctors. On the one hand you have the public health doctors looking at overall risk using statistical methods; on the other, the more emotive perspective of the A&E docs, neurosurgeons etc, whose job it is to patch up the worst cases. Both sets of views are sincerely held. Sneak the wrong motion to a barely quorate committee when the right people aren’t looking (or when is Annual Representative Meeting is restless for its lunch), and a determined old hand can surely shimmy in an ill-considered policy now and again.

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