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Monday
16Jun2008
Dispelling the myth
Mon, June 16, 2008
I have just read a wonderful pro cycling article in the British Medical Journal. (BMJ) It came out last December so you may have already seen it. If not, there is a link at the end.
What makes this piece different is that it is not written by a cycling advocacy group, but is an article for doctors by an independent writer pointing out the health benefits of cycling, and how these benefits far outweigh the slight risk of riding on the road.
This is a view that I strongly agree with. If cycling is ever to become popular again in the western world, the myth that cycling is dangerous must be dispelled.
The BMJ article comes out against helmet use on the grounds that it gives the impression that cycling is more dangerous than it really is. I am inclined to agree to a certain degree. I wear a helmet, but it is my choice; I am opposed to helmet use being mandatory, especially if it stops people from cycling.
The article points out, when helmets were made compulsory in Australia, hospital admissions from head injury fell by 15-20%, but the level of cycling fell by 35%. Ten years later, cycling levels in Western Australia are still 5-20% below the level they were before the introduction of the law yet head injuries are only 11% lower than would be expected without helmets.
At the same time, 17 times more motorists than cyclists died of head injuries in Australia during 1988, and yet no one is advocating mandatory helmets for motor vehicle drivers.
The BMJ article refers to the inherent risks of road cycling as trivial. Of at least 3.5 million regular cyclists in Britain, only about 10 a year die in rider only accidents where there is no other vehicle involved. Compare this with about 350 people killed each year by head injuries after falling down steps or tripping. (Total cycling fatalities in the UK in 2005 were 148.)
Another study estimated that out of 150,000 people admitted to hospital annually with head injuries in the United Kingdom; road cyclists account for only 1% of this total, yet 6% of the population are regular cyclists and a further 5% are occasional cyclists; 60% of admissions were alcohol related. Maybe we need helmets for walking drunks.
Finally, the BMJ article touched on a point that is the crux of the whole road death issue. In 1983, compulsion to wear seatbelts cut deaths among drivers and front seat passengers by 25%. Up until 1983, there had been a long established trend of declining deaths in car accidents. This reversed and just six years later by 1989 death rates among car drivers were higher than they had been in 1983.
Evidently, the driving population "risk compensated" away the substantial benefits of seatbelts by taking extra risks, at the same time putting others in more danger. This period saw a jump in deaths of cyclists.
Although temporary, the jump was followed by a decline and can be explained by cyclists having adapted to a more dangerous road environment through extra caution, or simply giving up cycling.
It is no coincidence that the long decline in cycling in the UK began in 1983. Between 1974 and 1982 cycling mileage in Britain increased 70%, but there was no increase in fatalities until the seatbelt law was introduced in 1983.
The civilized world should be outraged at the appalling casualty rate on our roads. It is the drivers of automobiles who are doing all the killing. In particular, aggressive drivers are the problem, speeding, running red lights, and taking all kinds of other risks.
In many cases, an aggressive driver is an angry driver, and I have heard it said that an angry driver is as much danger as a drunk driver. However, aggressive driving does not carry the social stigma that drunk driving does. It is time that it did; a dead person is just as dead whether killed by an aggressive driver or a drunk one.
Aggressive driving is unnecessary; it is just a habit, the sad this is, it has become accepted as the norm. Driving aggressively may only take five minutes off an average thirty-mile trip. Aside from the danger, there’s the mental stress, the wear and tear on the vehicle, and the gas wasted. Is it really worth it?
In spite of this, it has been proven that experienced cyclists are still safe because they become street smart, and ride defensively. Just as good, defensive drivers stay out of trouble. Inexperienced riders need to seek advice on safe riding practices, and get out there and ride. Like all skills there is no substitute for actually doing it.
It is a myth that cycling is dangerous, and car driving is safe. That seat belts save lives, because indirectly seat belts have lead to more deaths due to unsafe driving practices. However, we cannot go back. Making seat belts optional would claim more innocent lives, and would not stop aggressive driving.
I will go out on a limb here and state that it is also a myth that helmets save cyclists lives, because it is mostly the experienced bike riders who wear the helmets. It is experience that protects a cyclist’s life; but like the seat belt situation, we cannot go back. I for one will continue to wear my helmet.
Read the BMJ article here
What makes this piece different is that it is not written by a cycling advocacy group, but is an article for doctors by an independent writer pointing out the health benefits of cycling, and how these benefits far outweigh the slight risk of riding on the road.
This is a view that I strongly agree with. If cycling is ever to become popular again in the western world, the myth that cycling is dangerous must be dispelled.
The BMJ article comes out against helmet use on the grounds that it gives the impression that cycling is more dangerous than it really is. I am inclined to agree to a certain degree. I wear a helmet, but it is my choice; I am opposed to helmet use being mandatory, especially if it stops people from cycling.
The article points out, when helmets were made compulsory in Australia, hospital admissions from head injury fell by 15-20%, but the level of cycling fell by 35%. Ten years later, cycling levels in Western Australia are still 5-20% below the level they were before the introduction of the law yet head injuries are only 11% lower than would be expected without helmets.
At the same time, 17 times more motorists than cyclists died of head injuries in Australia during 1988, and yet no one is advocating mandatory helmets for motor vehicle drivers.
The BMJ article refers to the inherent risks of road cycling as trivial. Of at least 3.5 million regular cyclists in Britain, only about 10 a year die in rider only accidents where there is no other vehicle involved. Compare this with about 350 people killed each year by head injuries after falling down steps or tripping. (Total cycling fatalities in the UK in 2005 were 148.)
Another study estimated that out of 150,000 people admitted to hospital annually with head injuries in the United Kingdom; road cyclists account for only 1% of this total, yet 6% of the population are regular cyclists and a further 5% are occasional cyclists; 60% of admissions were alcohol related. Maybe we need helmets for walking drunks.
Finally, the BMJ article touched on a point that is the crux of the whole road death issue. In 1983, compulsion to wear seatbelts cut deaths among drivers and front seat passengers by 25%. Up until 1983, there had been a long established trend of declining deaths in car accidents. This reversed and just six years later by 1989 death rates among car drivers were higher than they had been in 1983.
Evidently, the driving population "risk compensated" away the substantial benefits of seatbelts by taking extra risks, at the same time putting others in more danger. This period saw a jump in deaths of cyclists.
Although temporary, the jump was followed by a decline and can be explained by cyclists having adapted to a more dangerous road environment through extra caution, or simply giving up cycling.
It is no coincidence that the long decline in cycling in the UK began in 1983. Between 1974 and 1982 cycling mileage in Britain increased 70%, but there was no increase in fatalities until the seatbelt law was introduced in 1983.
The civilized world should be outraged at the appalling casualty rate on our roads. It is the drivers of automobiles who are doing all the killing. In particular, aggressive drivers are the problem, speeding, running red lights, and taking all kinds of other risks.
In many cases, an aggressive driver is an angry driver, and I have heard it said that an angry driver is as much danger as a drunk driver. However, aggressive driving does not carry the social stigma that drunk driving does. It is time that it did; a dead person is just as dead whether killed by an aggressive driver or a drunk one.
Aggressive driving is unnecessary; it is just a habit, the sad this is, it has become accepted as the norm. Driving aggressively may only take five minutes off an average thirty-mile trip. Aside from the danger, there’s the mental stress, the wear and tear on the vehicle, and the gas wasted. Is it really worth it?
In spite of this, it has been proven that experienced cyclists are still safe because they become street smart, and ride defensively. Just as good, defensive drivers stay out of trouble. Inexperienced riders need to seek advice on safe riding practices, and get out there and ride. Like all skills there is no substitute for actually doing it.
It is a myth that cycling is dangerous, and car driving is safe. That seat belts save lives, because indirectly seat belts have lead to more deaths due to unsafe driving practices. However, we cannot go back. Making seat belts optional would claim more innocent lives, and would not stop aggressive driving.
I will go out on a limb here and state that it is also a myth that helmets save cyclists lives, because it is mostly the experienced bike riders who wear the helmets. It is experience that protects a cyclist’s life; but like the seat belt situation, we cannot go back. I for one will continue to wear my helmet.
Read the BMJ article here
Reader Comments (40)
Yet, people still crash and are still hit by cars or take a fall from going into a pothole or from trying to avoid a suicidal jaywalker. And, unlike in a car without seatbelts, there aren't 2 more wheels to keep you upright or a ton of metal to absorb the crash first.
Cycling itself isn't dangerous. Hitting your head on pavement is. And when you are in traffic with cars, the likelihood of hitting your head increases.
Why go unprotected when it is so easy and convenient to put on a lightweight helmet. Yeah, you might still be brain-damaged, but maybe you'll be able to speak and walk instead of drool and have a feeding tube.
I don't know of any adult cyclist who hasn't had some incident where they were either sideswiped, nearly sideswiped, hit a big pothole or wet manhole cover, or just happened to fall over because they had a brain-freeze and didn't unclip from their pedals at a stoplight. Even more so with friends who ride off road, except for them, it's a technical downhill or a log that's too high that does them in.
Who knows, maybe it's all the news about cycling saddles being bad for your love life that is slowing down cycling use, not the requirement of helmets. But I doubt that helmet use, as opposed to increased sedentary lifestyles, is the reason that fewer people cycle.
Kids must wear helmets and they still cycle - until they can get access to a car - and then they don't.
People said the same things for years about seat belts and airbags in cars - i.e., that they don't work - it's better to be "thrown clear", etc. A bunch of nonsense. People used to say, what's the harm in driving a bit drunk, as well.
Hard-core cyclists don't shave their legs for beauty or aerodynamic reasons - they shave them to avoid some of the worst effects of road rash. If road rash is common enough to go to the extreme effort of shaving your legs, why not do the simple thing of donning a helmet. If you can get road rash, you can hit your head.
We should stop pretending that cycling in traffic doesn't have some level of danger involved. Not requiring helmets doesn't remove the danger any more than sticking your head in the sand does.
I'm not sure what the answer to this is, but cycling education for all(focussed around road positioning and hazard awareness) might be a good start.
I don't think that one can compare seat belts to cycle helmets: seat belts work (car crash mortality went down after seat belts were made compulsory, even though trip numbers stayed the same whereas this is not true of helmets).
Andrew
Of course cycling in traffic has some risk involved: no-one is pretending it doesn't. But being in a car is riskier, and being a pedestrian is (probably) riskier also, and nobody makes pedestrians or car drivers wear helmets. Or gets all high and mighty about it.
Misleading oneself into thinking that you are safer with a helmet is fine. Just don't make me wear one.
Andrew
Helmets do protect against road rash I agree, but there is no evidence that they protect against major injury and the assumption they do, is counter productive in so many ways.
Wear a helmet if you prefer (it will after all stop scratches and bruises), but don't assume it is any more use than your gloves and don't insist that other wear special cycle equipment when cycling should be as easy as jumping on a bike.
Helmets do not equal safety.
Pedestrian accident figures are similar to cyclists and we don't think wearing helmets is sensible for them.
AIUI, the reduction in cycling in Australia coincided with the mandatory helmet law.
1. Horsepower, 2. Attitudes, 3. Types of roads built, 4. Traffic levels, 5. Norms, 6. Ads, 7. Licensing standards, 8. Public funding of infrastructure, 9. Convenience foods, 10. Electronic distraction devices, 11. Alcohol, 12. Personal schedules, 13. Fair/effective law enforcement of moving violations, etc.
In each case the trend is not positive and reflects behavior patterns common to those in denial of self-destructive addictions. For cycling to become safer and more acceptable to a wider group will require numerous trends to be reversed. Cycling per se is certainly not dangerous but many variables that cyclists have little or no control of have become worse with time along with man's needs for speed and conveniences.
To remain safe, cyclists have learned to be more aware and ride accordingly. It is quite common nowadays to see many motorized vehicles driving over 50 mph in 30 zones, much more than 30 years ago.
Jack
There are far too many people on the road who do not have the moral capacity to be entrusted with the power that operating a motor vehicle provides.
Yes, I ride daily.
"I have read of too many automobile, bicycle or motorcycle operators dead do to absent or failed helmet use."
My web blog depicts the shattered BELL bicycle helmet post FORD F-150 Truck mirror 'brush' while I rode a local S.C. roadway.
Without said helmet my skull would have been 'cracked like a melon'.
Note, the fellow who impacted me is a motorcycle rider who was driving (badly) his employers work truck.
FACT: Helmet use has afforded me injury free bicycle and motorcycle riding for over forty (40) years.
Wonder how many 'pro vs con' helmet use reports or mandates have come and gone during these intervening years?
That's precisely why I wear a helmet. Cycling is dangerous because of such drivers. Doesn't mean you don't ride, but (i) you learn to drive like you are invisible and (ii) you wear a helmet to provide yourself with a minimum of protection - really a halfway decent chance against brain damage in many situations.
On average, the healthcare costs of those who don't ride a bicycle are much higher and the longevity is lower for those who don't ride. supoporting stats from the National Safety Council
-Gary
"FACT: Helmet use has afforded me injury free bicycle and motorcycle riding for over forty (40) years."
Sorry, WRW, but your statement is opinion not fact. It may be a fact that you have 40 years of injury-free riding but I suspect it was not due JUST to wearing a helmet. Unless of course you get your head "smacked" every time you ride.
Do you pay attention while riding? Do you look ahead for possible conflicts with other traffic that allow you to avoid the conflicts? Do you ride predictably? Have you developed riding skills that allow you to avoid collisions in emergency situations? Or did this arrive "magically" because you wore a helmet?
My opinion is that collision avoidance has more to do with our riding skills than with just wearing a helmet. I know people that have 40 years of injury-free riding that have not worn a helmet. As for myself, I wear a helmet every time I ride because one never knows when one will have need of it.
However, I don't believe Dave's post is about the helmet debate (so let's not let it go there). It is about the impression that cycling is more dangerous than it actually is. Of course, cyclists are "vulnerable" so there is a certain element of risk inherent in the activity (just as in swimming?) but I believe that developing our riding skills and pratices help us to manage that risk.
Gene in Tacoma
On the subject of helmets, I'm against mandatory helmet laws for adults (though I wear one myself), but I'm for it where kids are concerned. They are at most risk for falls and accidents, and it's virtually impossible for a parent to mandate their use without some government help.
I agree with the first anonymous commenter, who pointed out that hitting your head on the pavement is the danger that helmets attempt to mitigate.
Regarding bicycle safety perceptions (held opinion).
'One has NO protection from a rearward incident astride bicycle or motorcycle.'
(Note, automobiles and trucks employ a specific rear 'crush' zone expressly for such an occurrence.)
The best insurance you can employ is to equip yourself with protective garment, choose a desired cycling route with care and LUCK!
That said, opinion does not nullify this FACT, Messrs. Duggan, Jackson and myself can empirically prove our safety policies have worked.
(ALL have 'posted' associated after incident photographic evidence or reports.)
'No brag or opinion, just fact!'
Alive to bike another day ...
"That said, opinion does not nullify this FACT, Messrs. Duggan, Jackson and myself can empirically prove our safety policies have worked. (ALL have 'posted' associated after incident photographic evidence or reports.)
'No brag or opinion, just fact!'
Alive to bike another day ..."
Based on this post and re-reading your previous post, I understand you are saying that wearing a helmet saved your life. Yes, that can be a statement of fact. And it is also a fact that you were able to keep riding for years after that incident because you were still alive. I can understand that. And I agree that wearing a "protective garment" (do you mean "helmet"?) will help to reduce one's injuries.
However, your phrasing used the word "afforded" which I interpreted to mean that wearing a helmet was what kept you injury-free, when you meant (I think) that because you were wearing a helmet you are still alive to keep riding and that during that time you were injury-free. I certainly cannot dispute that.
Would you agree though that riding safety is not just about wearing a helmet? If I am reading your post correctly, your "safety policies" also state to "choose a desired cycling route with care". I would agree to that and also add to continuously improve our bike handling and traffic communication skills.
To quote Kent Peterson in his article "Safety First: Tips and Techniques for Riding in Traffic":
"...the bicycle helmet is not some kind of magical protective device. A helmet may lessen your injuries in some types of accidents but a helmet alone does not make you 'safe'." The point to me is that focusing just on the helmet leaves out important factors that may help even more to improve riding safety.
While all cyclists are vulnerable, they can mitigate that risk through improved bike handling skills, clear communication with other traffic, and, yes, wearing a helmet. Full disclosure: I wear a helmet when I ride and so does Kent Peterson. Thanks for the civil discussion.
And, Dave, thanks for the thought-provoking post. I hope we can help other road users and non-cyclists understand that the actual risk of cycling is lower than the perceived risk.
Semantics aside,
'Lack of safety, not risk, while riding a bicycle or motorcycle is (sadly) engineering FACT!'
('you will fall down' helped or not :-)
An interesting related example:
Novel automotive 'hybrid' or pure electric technology is taking an ominous new turn for cyclists and pedestrians GLOBALLY.
How so, LOW AUDIBLE (warning) SOUNDS!
Caveat, during electric motive power operation (engine off) combined with an aerodynamic chassis and tires exhibits NEAR SILENT operation. (0-30 MPH speeds, approaching or departing)
Twice during these past weeks I have successfully evaded a TOYOTA 'Prius' incident while on bicycle (local road) and in car (windows down, A/C off, radio off) at a U.S.P.S. parking lot.
The concern lay in advanced engineering that permits improved efficiency, unfortunately, highlights unforeseen safety limitations for BOTH cyclists and public.
I understand a vision impaired individual has recently alerted industry and suggested some form of audible alert expressly for such wares.
As more electric vehicles soon occupy these GLOBAL roadways cycling and pedestrians must beware things you may not hear 'coming or going'.
Thanks to Dave for permitting conversation regarding cycling perceptions or safety (cyclist, public) ...
Few motorists want to collide with cyclists. The main reason they do is that they "didn't see them".
tOM
I don't think anybody, anywhere, would disagree with your statement that "collision avoidance has more to do with our riding skills than with just wearing a helmet."
That's obviously the case, just as collision avoidance in motoring has more to do with driving skills than wearing a seatbelt.
The helmet debate is about when you fall (and, if you ride a bike regularly, you will fall, or be hit, at some point in your bike riding career), what should you do to protect your most important asset - i.e., your un-healable brain.
You seem to answer the question by stating "As for myself, I wear a helmet every time I ride because one never knows when one will have need of it."
No credible study has shown that wearing a helmet increases head and brain injury. Helmets definitely prevent fractures and penetration by curbs and rocks that could damage open-skull brain tissue. They also provide some absorption of impact, like (but much more than) an egg carton. Seems silly not to use one regularly and doesn't seem to be an unreasonable burden - after all bells and lights are mandated in some states - and brakes are mandated in most - even for single-speeds.
I simply don't believe that mandatory helmet use, common in many states, is the reason for lesser bike activity or the perception that cycling is "dangerous". Cycling is more dangerous than swimming - there aren't lifeguards in cycling and, other than sharks, there aren't predators (e.g., cars).
Does mandatory helmet use - or massive promotion of helmet use (which is typically the case) - keep people off of dedicated bike paths or inhibit their use in communities that are more "bike friendly"? The answer is that where there are dedicated bike paths or where motorists are better conditioned to cyclists - there is more cycling.
The BMJ article is not about "mandatory" helmet use - it simply comes out against helmet use at all - and bases it on the presumption that fewer people cycle because the promotion of helmet use makes them fearful to cycle. That is hogwash - and pretty stupid for a medical journal (albeit, really a trade journal for doctors) to promote.
This would be like a dental journal not promoting tooth brushing because it might make people fearful of eating and getting a cavity.
Tooth brushing works to prevent cavities, but is not totally effective. Helmet use works to prevent brain injury, but is not totally effective.
I brush my teeth and wear a helmet.
Harry from NYC.
"Raisin was involved in a crash during the Circuit de la Sarthe that resulted in a hematoma on the right side of his brain. He was rushed to the hospital and remained in a coma for over one week and paralyzed on the left side of his body. "I had a hematoma the size of a lemon in my brain because my head hit the ground so hard that it split my helmet and lacerated the top of my head," Raisin said. "I have seven staples in the top of my head; if it wasn't for wearing my helmet the doctors said that my brain would have been lying on the concrete.""
Is Saul Raisin "overestimat[ing] the amount of protection that a foam helmet can give you"?
Anon 8:24
Yes, yes, yes, and yes. I agree with your post. I was not debating helmet use.
Regarding my discussion with WRW, I was trying to clarify his statement that "...helmet use has afforded me injury free bicycle and motorcycle riding for over forty (40) years." I explained in my post how I interpreted his use of the word "afforded". Hence, my statement about cycling skills.
BTW, Thank you for clarifying that the BMJ article was against all helmet use.