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Today’s press release from the Cochrane Collaboration promoting Non-legislative intervention for the promotion of cycle helmet wearing by children leads with a statistic:
"In 2003, 595 children were killed or seriously injured while cycling in the UK – that’s almost two a day."
In the most recent year for which there are official figures, nineteen children died from cycle related causes, of whom ten had head injuries. Ten is a much smaller number than 595.
Those who say even one death is too many when it comes to helmets for children on bikes, don’t say the same about the wearing of helmets by children in cars or when walking, two safety measures that would, in fact, save many hundreds of lives.
Lumping in deaths with serious injuries plays two ways, said Ben Cooper of Kinetics, a helmet anti-compulsionist, owner of a Glasgow bike shop which sells helmets.
"Of the 595 children killed or seriously injured while cycling in 2003, an unknown percentage were already wearing helmets, which had little or no benefit to them," said Cooper.
"On the other hand, it is certain that none of the 2381 children killed or seriously injured while walking in 2003 were wearing a helmet. From this, it’s clear that wearing a helmet while walking is of much more benefit. In fact, pedestrian injury is the leading cause of accidental death in children in the UK."
The Cochrane Collaboration study makes no mention of helmets for other "dangerous" activities, such as walking, golf and football, just cycling.
Lead reviewer Dr Simon Royal, of the University of Nottingham Medical School, said:
“There is good evidence that community-based helmet promotion programmes that include handing out free helmets increase the number of children who use them."
Cooper disagrees:
"There is this idea among helmet campaigners that the lack of take-up of cycle helmets is due to cost. Their idea seems to be that, the cheaper helmets are, the more likely people are to wear them. This runs contrary to all studies of human psychology. The more something is valued, the more people want to wear it, and the more likely they are to make sure it fits and they’re wearing it properly."
Rod Turner, fiercely pro helmet and owner of Freewheel of Nottingham, Dr Royal’s patch, is of the same mind as Cooper.
"It’s a bad idea to give helmets away. People respect things that they pay for and don’?t usually respect those things they are given.
"However, I might view the scheme in a better light if the give-aways were decent quality and if proper advice on sizing and fitting were given. The likelihood is, though, that the helmets would be ill-fitting cheapos, thrown at a child who would wear it like a baseball cap."
The sales director of the UK distributor of Met helmets is also unconvinced of the merits of free helmets:
"It would encourage users to feel that helmets are a commodity, sold in supermarkets," said Fisher Outdoor’s Matt Ward. Supermarket staff do not generally offer cycle helmet sizing or fitting advice.
Anti-compulsion campaigner Malcolm Wardlaw has little faith in the objectivity of the Cochrane Collaboration: "This initiative does not merit credibility and it should be criticised as yet another example of ignorant meddling. Real safe cycling for children means parental supervision and safe local streets and sensible road bikes for sensible cycling."
Wardlaw said Dr Royal’s views "perfectly typifies the whole problem of the current treatment of this issue by medical academics."
He likens the debate to other medical scares: "The story of cycle helmets is just another story of bad science getting out of control, like the MMR vaccine scare. It should be seen in the same class."
For Wardlaw’s full reply, see base of article.
Ben Cooper makes the point that a bicycle helmet has no safety benefit if fitted incorrectly. "Giving away helmets without proper instruction in their fitting and use is irresponsible and a waste of money," he said.
"A bicycle helmet is a one-shot device that has to be looked after. Even dropping a helmet accidentally can reduce its effectiveness by 50 percent or more. Will children be inclined to care for something that they are given for free, and told that they have to wear? Or will they reluctantly strap it on any old way, and not look after it?"
Freewheel’s Rod Turner said cheap helmets force people off bicycles and on to sofas:
"I have been in cycle retail for many years. We have sold helmets from day one. They are much better looking nowadays, fit better, are well-ventilated and are relatively-speaking cheaper than they were. However, the cheapest helmet we sell retails for £25, which is too expensive to be mass-market.
"This Cochrane bunch are well-meaning and will be difficult to argue with but the bike trade should be pushing the argument for stylish, well-fitting, properly ventilated helmets at as good a price as possible. We should ban cheap and nasty helmets because cheap rubbish is what will put people off bikes."
Ben Cooper, no fan of cycle helmets, believes promotion of quality helmets is the key, not the giving away of the crappy ones:
"Make helmets fashionable. Make them cool. Run an ad campaign with good-looking people wearing sexy helmets. Don’t try to scare people into wearing them, that won’t work."
For a comprehensive review of cycle helmet literature and a statement why compulsion would be counter-productive, download this helmet policy PDF from Cycling Scotland:
http://www.cyclingscotland.org/downloads.asp?DLsection=11
FULLER TEXT FROM MALCOLM WARDLAW
This perfectly typifies the whole problem of the current treatment of this issue by medical academics.
1. There are two basic types of evidence concerning the effectiveness of helmets as an intervention. The most widely reported type is "observational case-control studies". That is, doctors in casualty departments compare cyclists who were and were not wearing helmets and note any differences in levels of head injuries. Quite a number of these studies have been published showing that those with helmets were much less likely to suffer serious head injuries. The Cochrane collaboration only considers this kind of evidence.
However, there is another kind of evidence. This is follow-up study in countries or states where helmets have become popular or where laws have been passed compelling use. One would reasonably expect that head injuries would fall as helmets became popular. But this never happens due to helmets. No follow-up study has ever shown that serious head injuries fell because of rapidly increasing helmet use. The reason why "private investigators" like me are so angered by medical academics is thay they simply ignore this evidence that mass helmet use is a futile intervention. They pretend awkward facts do not exist. Or, they miscontrue the results by claiming that an effect actually due to campaigns against speeding and drunk driving was due to helmets.
Medical academics make no attempt to investigate the scientific puzzle as to why one kind of evidence shows helmets are effective whilst another kind of evidence shows they they are not. Quite simply, they are lousy scientists, but they go on enjoying the authority of their position because so few medics have actually taken a competent study of this issue.
2. It has recently been recognised that observational case-control trials are extremely prone to giving wrong results when applied to voluntary behaviour like helmet wearing, or the MMR vaccine, or smoking cannabis, or taking Hormone Replacement Therapy. In each of these examples, it was believed that there was a cause and effect relationship, when in fact there was not. For instance, it was thought that Hormone Replacement Therapy conferred on women protection against Coronary Heart Disease. The evidence was subject to review and it was considered that "the science was settled", yet when HRT was tested properly on a population of women it turned out that either there was no protection at all, or else the HRT made things a little worse! Where have we heard this before? The problem was, women who took HRT voluntarily had higher social status and many positive lifestyle factors that gave protection from CHD. This was not properly taken into account.
It is the same with cycle helmets. Canadian results show that rich children are about three times more likely to wear helmets than poor children. But poor children are far more likely to be K/SI in a road accident, rather than just fall off their bikes, because they tend to be more exposed to dangerous traffic than rich kids. That is the real reason cycle helmet research gave the false positive. Medical academics have no idea about this, so far as I can tell because they simply are not very good scientists – they lack the suspicious streak that prevents a real scientist from making such blunders. Some of them are maybe just unable to write off the years of work they have done on the issue. I suppose I must sympathise with them, to a degree.
The story of cycle helmets is just another story of bad science getting out of control, like the MMR vaccine scare. It should be seen in the same class.
This paper – http://jech.bmjjournals.com/…/345?etocEfficacy, effectiveness, and the evaluation of public health interventions, Mauricio L Barreto J Epidemiol Community Health 2005;59 345-346 – is highly topical in relation to lousy research into cycle helmets – but it is that lousy science that is dominating policy. This paper does not mention cycle helmets, but concerns other cases where flawed observational case-control studies brought harm by misdirecting policy. There is a crisis of confidence developing in epidemiology due to slovenly research in a number of cases.
By the way, the null result for mass helmet use does not necessarily mean that helmets will not provide some useful protection in the kind of crashes for which they are designed (MTB, BMX, falling off on a wet night). I think the basic problems are that far too much has been made of their relevence to improving the welfare of utility cyclists, and expectations of their benefits have been exaggerated to a (probably dangerous) degree.
