BMA and helmet compulsion: time to look at the evidence?

The British Medical Association subscribes to 'evidence based medicine', a decade old philosophy. EBM seeks to "empower clinicians so that they can develop independent views regarding medical claims and controversies." So, why is the BMA's new position on cycle helmet compulsion seemingly ignorant of the many medical and non-medical studies that argue cycle helmet compulsion is not such a sensible idea? And why did the BMA rely so heavily on a lobby-group death stat that grossly overstates the actual number of child cyclist fatalities, an official statistic easy to find on the internet?
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The British Medical Association has long championed cycle helmet use (so has BikeBiz.com). But, last month, the BMA decided to argue for cycle helmet compulsion.

The BMA's Board of Science is said to have "reviewed the evidence" yet the BMA's position statement included no references to papers that argue against compulsion. Instead, the collection of papers and statistics in the BMA's statement rely heavily on the papers and statistics used by the Bicycle Helmet Initiative Trust (BHIT), a single-issue political lobby group funded to the tune of £44 694 by the Freemason's.

The most glaring error in the BMA's compulsion statement is that over 50 people aged 15 years and under are killed annually by cycling accidents, of whom 70 to 80 per cent die from traumatic brain injury. This figure is the main statistic used by BHIT but is contradicted by official statistics.

In no year in the past decade have 50 children died; in the most recent year for which there are official figures, nineteen died, of whom ten had head injuries.

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 helmets for elderly pedestrians, two safety measures that would, in fact, save many more lives.

When the BMA Board of Science committee used the '50 deaths a year' stat in early November it probably was not aware this stat - originating from BHIT - is one of four serious misrepresentation of statistics by BHIT pointed out to the Advertising Standards Authority earlier this year. On October 27th the ASA revealed a complaint about BHIT's marketing materials had been "informally resolved." Such behind-the-scenes resolutions generally entail the offender agreeing not to re-offend in the future.

BHIT will likely have had to promise not to use misleading statistics in future marketing materials. However, it is free to use the disputed statistics in press releases, and continues to do so.

Reliance on such erroneous statistics is clearly not good science. It flies in the face of Evidence Based Medicine, a clinical philosophy underpinning much of modern day medicine.

If the members of the BMA's Board of Science had been aware of the full breadth of scientific studies on helmet use, and not just shown the pro-compulsion studies, perhaps they might have been less inclined to recommend helmet compulsion?

Evidence ought to be king. In October, Professor Gordon Guyatt of the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, wrote in the British Medical Journal:

"Evidence based medicine's biggest future challenge is one of knowledge translation, ensuring that clinicians base their day to day decision making on the right principles and on current best evidence. All too often clinicians are unaware of the available evidence..."

Some of the evidence that BHIT wouldn't have shown BMA can be found here: http://www.cyclehelmets.org/mf.html#1101

In the same October 2004 issue of the BMJ, the BMA's house journal, Brendan M Reilly, Department of Medicine, Cook County Hospital, Chicago, wrote:

"Some systematic literature reviews describe evidence so compelling that the right thing to do is clear. But...some caution is warranted, given the inherent uncertainty of scientific evidence, the selective reporting of clinical trials, and the potential harms of being wrong about what is right."

2104 people have so far signed the BikeBiz.com petition calling for the BMA to revisit its helmet compulsion decision. Significantly, 171 of the petition signers are doctors.


PETITION HERE:http://www.bikebiz.co.uk/bma-petition.php


SOURCES

Evidence based medicine has come a long way

http://bmj.bmjjournals.com/.../990

British Medical Journal, 30th October, 2004

The essence of EBM

http://bmj.bmjjournals.com/.../991

British Medical Journal, 30th October, 2004

ASA vs BHIT

http://www.chapmancentral.co.uk/.../ASA_Complaint?OpenDocument

The ASA complaint was lodged by helmet-claims researcher Guy Chapman: "I reported the brochure because I am very concerned that BHIT are using wrong and distorted statistics to exaggerate both the benefits of helmets and the scale of the problem. I have personally analysed hospital admissions data for children in England over several years and can see absolutely no justification for the claim that cycling is either unusually dangerous or unusually likely to produce a head injury."

Helmet compulsion article index

http://www.bikebiz.co.uk/.../article.php?id=3975

Department for Transport statistics showing that the vast majority of cyclists who are killed, are killed in collision with motor vehicles, for which cycle helmets offer only limited protection:

http://www.dft.gov.uk/.../dft_index.hcst?n=11585&l=5

Child cyclist death stats:

From Parliamentary Questions, 10 Nov 2003

Brian Jenkins (Lab) asks for statistics on child deaths in cycle accidents and what proportion involved head injuries.

http://www.parliament.the-stationery-office.co.uk/.../31110w04.htm#31110w04.html_sbhd1

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