This post is part of a series: it starts with the intro to the helmets issue, then the summary of the best evidence on helmets, then a quick diversion into how dangerous cycling is and an attempt to define terms. And there’s more…
Brake, the “Road Safety” charity, say yes:
Helmets are effective for cyclists of all ages, in crashes which do and do not involve another vehicle.
That matters, because if cycling safety is in the news, journalists will go to Brake for an easy quote.
The British Medical Association also say yes:
Helmets provide equal level of protection from cars (69%) compared to other causes (65%)
This is important, because the BMA is a highly trusted organisation with political influence, and their current policy is to endorse the criminalisation of riding a bicycle when not wearing a helmet.
Interestingly, president of the Automobile Association Edmund King, who was giving away free advertising bicycle helmets in London this week, disagrees with the nation’s medics on both issues:
We don’t think helmets should be compulsory but we think there are benefits… Our view is that helmets do not protect against cars but they may protect against some of the 2.2m potholes which often are the cause of smashes into the ground by cyclists.
Carlton Reid adds a little detail:
Most bicycle helmets are designed for falls to the ground from one metre at speeds of 12mph. They offer almost zero protection in collisions between bicycles and fast-moving cars.
The risk reduction provided by helmets in bicycle crashes that do and do not involve motor vehicles is one of the few sub-group analyses that was performed in the case-control studies that are covered by the Cochrane Review, and it’s no surprise that this is the source for the BMA’s claim. In bicycle hospitalisations that did not involve cars it reported nearly 70% fewer head injuries in the helmet wearers. In bicycle hospitalisations that did involve motor vehicles there were nearly 70% fewer head injuries in helmet wearers. A helmet is equally effective at preventing head and brain injury in crashes with cars as in solo crashes.
What makes Edmund King and Carlton Reid think they know better than the nation’s medics and road safety campaigners? Indeed, what makes them think that they can go around claiming the opposite of the cold hard corroborated stats of the Cochrane review?
Well actually, they’re not. Not quite. King and Reid are judging helmet efficacy by a slightly different metric to the Cochrane Review. The Cochrane Review is the looking at the set of bicyclists who have had an accident of a severity that hospitalises but does not kill outright. The review says nothing about deaths, for example, and as the Cochrane Review itself notes, more than 90% of cyclist deaths are caused by “collisions” involving moving motor vehicles (the same proportion is found again by a separate route in the TRL review and again in NYC). But only 25% of hospitalisations were caused by motor vehicles. And while Cochrane suggested a whopping 85% of head injury hospitalisations (which in turn account for around half of all cyclist hospitalisations) could be avoided by wearing a helmet, the TRL review of post-mortem reports found that only 10-16% of all cyclist deaths might have been avoided. Hospitalisations, of the sort reviewed by Cochrane, are not representative of deaths. Fall off your bicycle and you might get hurt. Get hit by a car and you might die.
That’s because when you fall off your bicycle, chances are you are toppling over some way — precisely the sort of simple fall that a helmet is designed for, and the sort of fall that is least likely to cause life-threatening injury to any other part of the body. When hit by a car the body might be crushed, or thrown up and around at speeds that helmets are not designed for, and so there are many more opportunities to suffer fatal trauma to other parts of the body.
(As an aside, Brake actually get this one the wrong way ’round:
Nearly 50% of cyclist admissions to hospital are for head and facial injuries, and the majority of cyclist deaths and injuries are a result of head injury.
TRL has the answer to this one: around three quarters of cyclist fatalities did indeed involve a serious head injury. But only about a quarter involved only a serious head injury. The rest also involved one or more additional life-threatening injury. The Brake claim is at best misleading.)
This doesn’t mean that the BMA and Brake are all wrong* and King and Reid are completely correct. A car at speed may be able to cause the sort of multiple trauma that merely falling over doesn’t, but that doesn’t mean that cars aren’t also capable of causing the sort of crashes that helmets are designed for, especially in low speed city traffic.
So Edmund King is wrong**. But within the untruth he is communicating an important truth: cars are responsible for the most serious injuries and death, and helmets will rarely help in those cases.
Brake and the BMA are correct. But their strictly truthful statements hide the crucial details, without which they are liable to seriously mislead.
* Indeed, they can’t be wrong. You can provide a hypothesis for why helmets might be useless in crashes with cars, but no hypothesis can trump the real world stats that say helmets are useful in crashes with cars.
** Carlton Reid is not wrong, because he specified fast-moving cars.
At War With The Motorist 