The Brick Wall

I’ve been party to The Great Helmet Debate for well over two decades now. You can’t ride bicycles regularly without numerous people – regardless of whether or not they ride a bicycle themselves – volunteering their opinion on helmets.

And it’s fine. I like debate. I like testing hypotheses. Rigorously. It’s how we make sure we get stuff right, or at the very least it’s how we make sure we’re offering coherent arguments rather than just opinions that you’re not even entitled to.

But there are many fascinating characteristics of The Great Helmet Debate, and one of them is this.

A predictable ending

Whenever I have the discussion with someone who I’d describe as a “helmet evangelist” (a term which I don’t use pejoratively, but I need some sort of shorthand for someone who is either pro-compulsion or vigorously argues that everyone should wear one), it always – provided they have the patience to get this far – ends at one point.

Every time.

I’ll get to that point in a moment. First, I need to set the scene with the point that precedes it.

The Penultimate Point

The Penultimate Point in the debate is the helmet evangelist’s million dollar question. It rears its head once we’ve all agreed that it would be nice if we separated motorised traffic from bicycles, and made sure that particularly poor drivers aren’t on the road, and that people don’t cycle along without any functioning brakes; and even after we’ve agreed (or, more likely, agreed to disagree) on exactly how effective helmets are and over what range of potential impacts, and agreed (or again, more likely, agreed to disagree) on whether or not there are certain risks which they may actually increase.

Basically, we can reach this point no matter how much disagreement there is on the effects of helmets in individual incidents and the effects of helmet policy on population level health.

The Penultimate Point is essentially this:

Even if you do everything else – if you change your behaviour, change your environment, do everything you can – why would you still not wear a helmet to mitigate whatever risk remains?

But, the thing is, I don’t need to give a reason.

Because not only do the helmet evangelists already know what the reason is, they’re already using that very reason not to wear a helmet themselves.

Hitting the wall

The Penultimate Point’s premise is that whatever you do, however careful you are, however much you change the environment, you are still at risk of head injury.

And that’s absolutely true.

But it applies not only to cycling. Taking examples only from articles published in the last few days, it applies to crossing the road, walking down a driveway, travelling by taxi, playing football, walking down the street, being a passenger in a car, using the stairs, or… you get the idea. (That’s pretty much the first page of the Google results for “serious head injury” from the last seven days, and I’ve left a number of “pedestrian hit by car” ones out. And, yes, there was one person on a bike who was hit by a bus, too.)

So my subsequent question, which brings us to The Brick Wall, is always this: Why not wear a helmet for these activities, and campaign for compulsory helmets for these activities?

At this point I’ll invariably be accused of being idiotic, ridiculous, unrealistic, stupid, laughable or suchlike. Of course you wouldn’t wear a helmet for these things! They’re different, the risks are so low.

Well, they’re not.

Risk is everywhere

Take walking as an example. Road traffic collision fatality rates for walking are around 20% higher per mile than for cycling. Note also that as a population we walk about three times as far as we cycle, so in road collisions alone the population suffers about 3.5 times the number of lives lost walking as it does cycling.

As for driving, one major study indicated that 57% of all traumatic brain injuries in the UK were attributable to road collisions.

And alcohol is alleged to cause 40% of daytime and 70% of night-time emergency admissions regardless of injury type, and, within those injuries, also causes a significantly higher rate of head injury.

This isn’t intended to be a proof of head injury risk levels; there is no “ta-dah, QED!” here. For a start, fatality figures aren’t head injury figures; but unlike head and brain trauma injuries they’re at least easily measured and reliably recorded, and are arguably a decent indicator of severe danger, which often involves head and/or brain injury.

What it’s intended to show is that the risks of head injury in activities such as walking are not demonstrably lower than the risk in cycling, and that at a population level the scale of the problem within these activities is unquestionably very significantly higher.

The ultimate reason

Risk, taken across the population, does not stop when you get off a bicycle. The figures make that quite clear. In fact they make it clear that it may not even subside.

And this is The Brick Wall against which one has to beat one’s head when trying to discuss helmets: the fact that the evangelists believe cycling to warrant a helmet when real figures show that there’s no demonstrable risk above other activities for which even the evangelists argue that a helmet is not necessary.

(And this is true even with the risks presented by shared roads. Remove that risk and the numbers shift still further: in the Netherlands only 1 in 1000 cyclists wear a helmet, yet suffer a brain injury (including minor ones) only once every 6.5 million miles.)

If anyone still argues that cycling warrants helmets then that’s a perfectly valid argument, provided they also argue that walking and driving warrant it (suitable helmets are readily available). Otherwise, it’s just an opinion, and one based on prejudice and perception rather than information.

So, when helmet advocates ask the reason why, even after I’ve changed my behaviour to ride as safely as possible, I don’t wear a helmet for certain types of cycling (and, believe me, there are types of cycling for which I value my helmet very much) I can only offer one reason.

It is the very reason they (and I, and you) don’t wear a helmet when they’ve changed their behaviour so much that they’re not even cycling.

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32 thoughts on “The Brick Wall”

  1. You’re so right! Helmet promotion relies on two points: cycling is incredibly dangerous and a helmet will make you safe, neither of which is true. Someone’s making billions out of the public’s gullibility.

    1. Well said Richard.
      However there is different approach to the penultimate point. The penultimate point assumes that choosing to wear a helmet does not affect anything else. There are no side-effects.
      That is not true. Side-effects must be taken into account.
      An important side-effect is an increased risk of accidents. This has been observed for example in Australia, after a helmet law was imposed. The rate of cycling injuries tripled.
      http://crag.asn.au/3038
      Helmet evangelists can’t claim to be mitigating risk by wearing a helmet when the risk of accident increases several times. They need to demonstrate that the polystyrene compensates for the increased risk of accidents.

    1. No-one mentions the very real risk, at least for me, of cooking my brain as a result of wearing a helmet, and dying as a result. But heat-related illness doesn’t just cause death, it causes blinding headaches, temporary blindness, increasingly out-of-it behaviour, headspins, homicidal insanity and perhaps other effects. Will one of these helmet evangelists willingly use something that is going to kill them, and perhaps several members of their family as well?

      1. something that is going to kill them, and perhaps several members of their family as well

        [citation needed]

  2. Alas both sides are readily trumped by our old friend, the British Legal System. I now feel I have to wear a helmet for protection …. from lawyers.

      1. Yes, I read all that. Do you think that will stop them trying to argue it in court? Or stop insurance companies from routinely subtracting 25% for no helmet. Maybe … but I just don’t want to have to have that argument in case of an incident.

      2. “Yes, I read all that. Do you think that will stop them trying to argue it in court? Or stop insurance companies from routinely subtracting 25% for no helmet.”

        Of course it won’t stop the legal vultures arguing their case in court, but in all cases bar one unique one, they have failed.

        And no it won’t stop insurance companies cynically trying to reduce victim’s damages by 10% or 25% but they have always dropped this when challenged.

        Perhaps you’re too much of a victim, far too willing to accept that it might have been your fault, when the fault lies with others. Get yourself some good legal representation and present the facts, not the assumptions.

        “Maybe … but I just don’t want to have to have that argument in case of an incident.” Why not? It’s worked in every case so far.

  3. It seems to me that helmet evangelists broadly fall into two categories: exhortation, and compulsion by law.

    Up to a point I don’t have a problem with exhortation, ie we really do urge you to wear a helmet for your own safety, and think about your children/the NHS budget etc. At one level that is just friendly, and quite possibly sensible, advice. After all, if I were to plan a holiday in Afghanistan, I might well accept advice that I should wear a bullet proof vest and a steel helmet, because that bottom of the triangle solution in the HSE matrix, ie personal protective equipment, really is all that is available. If I were planning an afternoon ride on my mountain bike around the commons near my home – some steep tracks littered with stones, slippery mud and concealed tree roots – I would almost certainly wear a helmet.

    The problem with exhortation, especially when it is, as so often, rather forcibly expressed as “you will only have yourself to blame, don’t be selfish etc” is that what might in one sense seem like sensible personal advice can be twisted into a defence, or a justification, whereby a reckless motorist justifies his behaviour in running you down or a barrister argues for a reduction in the compensation you should receive from that motorist’s insurers for “contributory negligence”. It is no use arguing that it was the motorist alone who created the situation which injured you, and that your mere choice of clothing and equipment attaches no blame to you, because in the real world that is what happens, and the exhorters must know this, indeed by the sound of it some of them revel in it, as demonstrated by the piece of work who wanted people to retweet an incitement to insurers to refuse cover to cyclists who aren’t wearing helmets. That may fall short of compulsion but it is certainly coercion. (How would that work, by the way? Most cyclists’ insurance claims are made against another road user under civil tort law. A motorist’s insurer has no option but to cover the claims which the motorists might face – they have no discretion to decide that certain plaintiffs’ cases have no merit, that is for the courts to decide).

    Those who advocate compulsion seem, to me, to be even more sinister. They are primarily motivated by some personal experience – “a helmet saved my life/my friend’s life/ the life of someone my friend knows” – which in my view makes them the very last people whose views should be considered, because their arguments are emotional, not rational. The aspect I find sinister (while having every sympathy with them for the events which have befallen them and which have motivated their actions) is that people who have undue influence through some position of responsibility, such as a political office, celebrity status or, as in the recent case, access to write a column in a national daily newspaper, exercise that influence to pursue a purely personal agenda. There is also of course the question of whether they have a financial conflict of interest – Ms Turner and her husband James Cracknell arguably do have such a conflict as he is a Brand Ambassador for a helmet manufacturer. I accept your argument that we should consider the arguments, rather than focussing ad hominem on the arguer, but I don’t think such potential conflicts of interest should be ignored.

    Somehow, the compulsion advocates, or their close relatives the coercion advocates, always bat away all the other examples where helmets might also be compelled, such as walking, travelling in a car, climbing ladders etc, but without rational explanation of why. I don’t oppose compulsion in use of personal protection equipment in principle – there are I think two arguments why compulsion may be the right thing, and are the right thing as regards, in particular, motorcycle helmets and car seat belts. Firstly, there is a well-established body of scientific, peer-reviewed, evidence that significant benefit is gained by wearing a motorcycle helmet or a car seat belt, in terms of reductions to the numbers and severities of injury. I happen to think that you could probably reach the same conclusion for car-traveller helmets, if anyone were to conduct the necessary empirical research into their efficacy. On cycle helmets however, and quite probably also helmets for skiers, dinghy sailors (getting a crack on the head from the boom swinging over) and others, either there is no evidence at all because no-one has researched the matter, or in the case of cycling there has been substantial research which has either proved inconclusive on the benefits, or has been shown to have methodological flaws or inherent bias (all the detail you could wish for at http://www.cyclehelmets.org) . As a corollary to the first argument, you should consider disadvantages in other areas which might counter the benefits in the area of study. For cycle helmets, even if they were demonstrated conclusively to benefit direct head trauma cases, you have to look at the disincentive effect on other health outcomes eg obesity, heart disease etc, quite apart from non-health outcomes, something which all those A&E neurosurgeons somehow don’t take into account because they only treat head injuries, and it is a colleague on the other side of the hospital who transplants hearts or treats Type 2 Diabetes. I don’t believe there are any such corollary factors for either motorcycle helmets or seat belts – sitting in a car does nothing for your general health.

    The second argument, which perhaps links to my corollary above, is the extent to which the individual harm becomes public harm. I think the case for seat belts is compelling on that basis – never mind the rates of injury, per mile or per hour travelled, the sheer number of cases is such that the NHS would bear far too heavy a burden, at the cost of all of us as taxpayers or as patients whose treatment is further delayed by hospital overstretch, to be permissible. (cue the Type 2 diabetes timebomb, and the cycle helmet debate)

    I don’t know about motorcycle helmets – I don’t know enough about how many cases, in absolute numbers, are involved. Similarly I don’t know how many cases relate to pedestrian head injury, gardening or DIY. I do however know that, sadly, even if the incidence among cyclists, measured per mile, or per hour, or per trip, was very high, the absolute numbers have a much less dramatic effect on the functioning of the health service simply because there are so few of us. There are even fewer skiers, or horse riders, so the same argument applies there – even if riding a nag without a hat is nuts, it should not be compulsory to wear one.

    1. Paul,

      I’m sure all your comments are informative, but could you sum up in 200 words or less please? Life’s to short.

  4. If just had a Twitter exchange with Bez on this article which was clearly getting compromised by the 140 words limitation so I’m here to expand.

    Bez’s article is a very good solid analysis of the situation on UK helmet use and I have no argument with that. Unfortunately clear analysis doesn’t sem to feature too highly in the decisions people make about such things, either by Joe/Jane Public or by those who call the shots (MMR vaccine anyone?). They often go on gut feeling, or the collective gut feeling of others. Such gut feeling is readily enhanced by appeals to emotion, and many pro-helmet campaigners use this as a tool to gain support.

    However, if that were the only factor, then campaigners like Bez might have a chance of having their evidential approach accepted. Unfortunately Rule 59 of the Highway Code recommends that cyclists use a helmet among other PPE. In order for Bez’s arguments to be accepted this needs to be removed. While there is official sanction for helmet use there is little chance of counter agruments gaining traction among the wider public. And which governemt department is going to come out and say -we were wrong -you don’t need to use a helmet. The media would have a field day the next time someone had a head injury cycling.

    So while I don’t disagree with Bez and it’s a great article for reference, I’m not sure his arguments have much purchase outside cycle campaigns. At the end of the day most cyclists I see in the UK wear a helmet.

    My original tweet was along the lines that if you say you don’t need a helmet then you don’t need infrastructure either. My argument there would be that pedestrians and cyclists have about the same risk of KSI: but cyclists have far less infrastructure to protect them. So if you accept that pedestrians are safe enough, as seems to be the government position, why not the same for cyclists? Bez replied that a large part of the infra argument is to get more people cycling. The cynic in me says that even if Bez has a point, there would be some who would readily use the equivalent risk argument to do nothing. However, more positively, I’d counter that more people cycle where there is infra because they feel subjectively safe and that this is the same with helmets. So if recommending helmet use encourages more people to cycle because they feel subjectively safer as a result, I say fine. And to paraphrase what I wrote above, the helmet use cat is out of the bag now and enshrined in HC Rule 59, so there’s little actual use in trying to put it back in, at least at the moment.

    Helmet use should not however, be compulsory, as PaulM says above.

    I hope that’s a bit clearer.

      1. typo cobblers!

        “…many fallacies OF helmet advocacy…”
        “…tellING people to wear them…”

    1. “At the end of the day most cyclists I see in the UK wear a helmet.”
      Where?!! London commuters perhaps, but Traffic counts I’ve seen tend to show about 20-30% wearing helmets.

  5. Nice article.

    Jitensha, looking at your points:

    I slightly sit on the fence about helmets – I have always worn one, not because I have had to, but because I want to. I have removed large sticks embedded into helmet casings and have on numerous occaisions replaced helmets (remember when Giro/Spesh used to replace broken lids?! FOC) where bits have snapped on after crashes (only involving me). I have felt happy to have been wearing a helmet on those occasions as the stick probably would be in my head and bits of my face might have been torn of in those crashes. The key point is that those crashes involved only me and resulted in a fall, when often the face/head is first to hit the floor.

    What this debate is (or at least seems) to be about is cyclists taking the responsibility for their safety. It is about cyclists interacting with vehicles – and the obvious resulting injury or death. Rarely is the key resulting injury a head trauma – it is internal organ or bone damage caused by a fragile body impacting with a fast moving metal object or being crushed by it. Not only does the helmet not cover the most vulnerable part of the body in most of these accidents, they are not designed to take the weight of a vehicle or the impact of hitting one moving at speed. For the injuries in question, a helmet won’t save a person. Allover body armour will likely not save a person against an HGV. The argument is entirely separate. The only way to protect a person is to move them away from the vehicles.

    Pedestrians have (usually) the safety of a rasied curb separating them from traffic and most pedestrian accidents involve people crossing other than at crossing points. Cyclists at present do not have that protection – worse, they have designated a strip of coloured paint in the lawful path of vehicles, with no prescribed right of way.

    Cyclists should wear helmets in my opinion – they are safer wearing them. They are not however, “safe” wearing them and there should be no suggestion that they are. Making helmet wear a legal requirement is pointless and unworkable – for reasons explained above. I will continue to wear one most of the time when I am riding – but there are times when I don’t, for my own reasons – and this is the point. A cyclist’s safety from themselves is their own business and should stay that way. A cyclists safety from those around them should not be – “the victim pays” is not a sound approach either morally or legally. Cars and vehicles are proven to be a danger to cyclists (and pedestrians) beyond that which any PPE can protect against – so move the source of danger away from the vulnerable. This is the basis of any health and safety process.

  6. Chaps, I’m sure that we all appreciate all the posts, but I have limited time and won’t read anything which is too lengthy. It’s always good to be succinct.

  7. Has anyone got statistics for risk of head injury normalized by exposure time? That seems conspicuously lacking in all of these discussions. I think it’s the one where cycling may have unfavorable values. I’m personally in the “I wear one, but don’t favor compulsion” camp, but would rather have a discussion illuminated by facts that don’t shade towards my predilections.

    1. Working from either the total fatalities in the 2011 Road Casualties report and the distance travelled in the 2011 National Transport Survey, or the derived per-mile fatality rate, then you can derive an estimate for fatality rate. If you assume average cycling speed is four times that of walking (say, 12mph vs 3mph) then cycling comes out with a bit over three times the fatality rate per hour of exposure.

      Same caveats apply: fatality is not head injury, not all figures are hugely reliable, and you need to ask the question of whether the most important value in terms of prioritising head protection is risk by distance, risk by time, or total population harm. And even then it remains only one piece of a very large puzzle.

      But yes, you’re right, cycling compares less favourably in terms of general trauma risk when normalised by time.

      But it’s worth pointing out the important point that when I travel from home to the shops or to the station, and I choose between walking and cycling, I don’t get any say in the distance I travel: my house, the shops and the station are all pretty fixed, even in the current weather. The shops are a mile away, not five minutes away. So when I choose my mode, it’s the distance that counts.

  8. You may be interested in scientific paper that came out two days ago: shivaji et al: The epidemiology of hospital treated traumatic brain injury in Scotland, BMC Neurology, 2014, 14:2 , http://www.biomedcentral.com/1471-2377/14/2/abstract.

    Haven’t had time to read it yet, but figure 1 shows the numbers for causes of TBIs for different age groups. In all age groups, falls are the biggest proportion (overall 47% of TBIs), except for age 15-34 where assaults cause twice as many TBIs as falls.

    Cycling isn’t used as separate category, and I’d have to read the details to see if cyclists would be in the “motor vehicle related”, “falls”, “struck by” or “other” group (or different groups depending on the type of incident).

  9. Meanwhile Down Under, cycling with the wind in my hair has cost me thousands of dollars and hours of time in court appearances, landed me with a criminal conviction, barred me from travelling to or through the States, but most importantly given me oodle and oodles of fun & a sense of freedom too precious to trade for daft regulations!

  10. I expect pedestrians would benefit from helmets and the private and social benefits in avoided head injuries would exceed the costs, But that’s true for lots of activities we don’t regulate and instead simply cop the social cost. It might be it would be too hard to enforce, too intrusive, etc etc.
    Here in Australia, advocates of mandatory bicycle helmets simply got lucky in the early 90s. At the time the largest cycling constituency by far was children i.e. parents. From an adults point of view, it was a no-brainer; lots of kids didn’t like it but they didn’t carry any weight.
    The “evangalists” in Australia are those opposed to the law. As far as the vast majority are concerned, the law’s been around for more than 20 years and is part of the furniture, like being compelled to wear a seat belt.

      1. Evangelists are invariably the ones who want change. In the UK, the evangelists are preaching mandatory helmet laws. In Australia, the evangelists are preaching repeal of the mandatory helmet laws. Provided majority opinion is with them (as I suspect it is in both places), those who support the status quo don’t need to evangelise.
        I took the term from the article but I don’t like it (that’s why I put it in quotes). It’s meant to be pejorative in the article despite the disclaimer and betrays the author’s view on the issue. But as the Australian example highlights, being an evangelist is more a function of whether you’re seeking to change the status quo.

    1. That’s a strange description of evangelism, Alan.
      Evangelism to me is a strident and insistent portrayal of personal beliefs, done with the intent of changing the viewpoint of others using primarily emotive arguments.
      I think the helmet zealots are much more likely to fall into this category – think of all the ‘helmet saved my life’ stories that are light on facts and heavy on emotional rhetoric.
      Those advocating helmet choice are much more likely to be seeking rational debate, as this article demonstrates.
      For sure, there may be some evangelism on the ‘choice’ side, and there are certainly some rational supporters of compulsion, but the trend is as I have described.

  11. A fundamental part of the hierarchy of H&S interventions is that PPE sits at the bottom as the last resort measure, on a list which begins with “Remove the Hazard” and progresses through various degrees of managing the risk, through physical means (safety guards closed before machines start working) down the a reliance on on the human factor of compliance with signs and signals (and we know how *effective* traffic signals are for this )

    A big problem on the roads is that we do not have the methodical and unbiased investigation of any incident to unravel the elements of hazard and risk and the way they combine to a mix of many causal factors which like a string of lottery numbers all line-up to deliver a tragic result.

    Sort that culture out and we’ll be much closer to safer road use

  12. Glad i saw your tweet about this today as this seems the best possible place for me to vent about the full-pro-kit-wanker ‘evangelist’ who decided to advise me that “you should wear a helmet mate” when he passed me on CS8 as I turned off towards work this morning. Funnily enough I’d noticed him riding through Vauxhall Cross and then on Vauxhall bridge, and when he pulled in front of me waiting at the lights onto Millbank I was thinking how unnecessary all his garb looked in all his lycra kit, clip in pedals, bleeping Garmin, expensive looking ‘messenger bag’, shiny helmet and speedy looking bike – for the commute into work (i assume). But I kept my opinions to myself instead of shouting them out as our paths diverged.
    You can be sure I’ll let him know all my opinions in regard to the ‘correct’ bicycling attire if I do see him again. And point him in the direction of this blog to express my feelings on why I may not choose to wear a helmet every time I ride a bike.

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