The BMJ has a very lively and thought-provoking letters section. As well as the print version, theres also a letters section on BMJ.com and before you submit a letter of your own you should make sure your points havent already been raised by earlier correspondents.
Below youll find four letters. One from the BikeBiz editor and three that have already been published on BMJ.com (of which the last one has some good website links for further research on the pros and cons of helmet wearing).
This is a debate that will roll on for a few weekly issues of the BMJ.
LETTER FROM BIKEBIZ:
Oh, dear. Cycle helmets. The BMJ just loves this subject. Which makes it odd that such a flawed article was allowed to pass as an editorial. Im no scientist but the cracks in Bicycle helmets: it's time to use them are so wide you have to wonder whether the authors have themselves suffered head trauma at some stage because they clearly have massive blindspots when it comes to presenting a fair and impartial case.
The main point seems to be that reports of head trauma have gone down at the same time as helmet use has increased. No other explanation is even considered. No evidence, except anecdotal, is offered for the supposed increase in helmet use. Why didnt the authors consider that cycle use may be down? Or that car speeds might have been restricted in some areas leading to less injuries? There are many possible reasons for the drop in reported head injuries.
Personally I wear a helmet and its reasonably obvious even to helmet haters that wearing one will prevent injury should you happen to fall from your bike. But road cyclists dont often fall from their bikes (its different for mountain bikers) and even those that do, usually report their heads remained unmolested by tarmac. Sadly, some cyclists die from head trauma and helmets could have saved them. But look at the stats, opening the mail is a risky operation too.
So is walking along the street, yet do scientists clamour for pedestrians to wear helmets? And far more deaths and head injuries would be prevented if drivers wore helmets too.
Im all for more helmet sales but whether to wear bonce protection or not should be up to the individual, not safety-nannies. As has been shown in Australia, once helmet use is mandatory, cycle use drops dramatically. And as the BMA well knows, the health benefits of cycling far outweigh the risks.
So, please, let there be less one-sided scare-mongering, all it does is deflate cycle use. If safety-nannies must argue that cyclists should be dressed head to foot in armour, then at least they could argue the same for all activities, because life, dear reader, is risky.
THREE LETTERS ALREADY POSTED TO BMJ.COM:
Alternative explanation for the trend in head injuries
28 October 2000
Dr Conor Linstead,
From the data presented by Cook and Sheik, it cannot be inferred that the reduction in head injuries over the study period relative to the total number of cyclist injuries indicates a correlation between wearing cycle helmets and a reduced incidence of head injuries. The data are insufficient to draw this conclusion.
The authors have failed to account for confounding factors that influence the types of accidents involving cyclists, such as traffic patterns and cycle facilities. The authors hypothesis may indeed be correct but the same trend could potentially result from other scenarios. For example, the period of the study coincides with an increased awareness of cycling issues amongst local authorities and an associated increase in the provision of cycle facilities such as advanced stop lines and cycle lanes and paths. It is quite feasible that these facilities lead to a reduction in the type of accidents that result in head injuries while increasing the number of more minor accidents, giving a constant rate of admission but a reduction in head injuries. In my opinion the biased interpretation of the data in this paper adds little to the debate on the effectiveness of cycle helmets.
More helmet nonsense
28 October 2000
True, helmet wearing might make a small difference to the rate of head injuries in cyclists. However a cyclist in the UK is 6 times more likely to be killed than in Denmark or Holland, where virtually nobody wears helmets. The problem is not abscence of helmets, but abscence of a culture of respect for cyclists evident amongst both motorists and planners. This sort of research is about blaming victims rather than solving problems.
Inadequate Control for Confounding Factors
29 October 2000
Researcher, cycling accidents
The authors refer to lack of controls in other studies but it appears their own study lacked a few of its own.
Most but not all serious head injuries to cyclists result from motor vehicle involvement. The authors appear not to be aware of, and the report does not acknowledge, an important change in the pattern of cycling that may mask a change in motor vehicle involvement. With the trend of a rising popularity of the mountain bike has come an increase in off-road trail cycling. Thus, while overall cyclist exposure to the risk of an accident may have remained constant, the exposure to risk of an accident involving a motor vehicle may have fallen.
Another serious omission is the absence of information on prevailing rates of head injury among other road users. Robinson in Australian Doctor, 27 February, 1998,
http://lash.une.edu.au/.../ozdoc.html showed cyclists in Western Australia over a two decade period experienced declining head injury percentages similar to other road users, substantially because of a series of driver behaviour modification measures imposed by the government.
More of Robinson's research on the effects of Australian bicycle helmet legislation can be found at: http://lash.une.edu.au/.../velo.html
Additional sources are on The Bicycle Helmet FAQ at: