04 March 2009

Bicycle Helmets - Today's Bloodletting

Another guest article, this time from Sue Knaup from OneStreet.org, out of Arizona. Sue is also an associate member of the European Cyclists Federation and is a member of their helmet committee.
by Sue Knaup

One Street

Bloodletting seems a distant absurdity to us and yet, just a few hundred years ago, we lost George Washington because he trusted its rhetoric over logic when he agreed to it as treatment for a nasty cold. With only a few quiet voices protesting the countless deaths caused by bloodletting, the practice continued well into the 20 th century. Today's bicycle helmet promotions and laws hold an alarming resemblance to the pronouncements used by the bloodletters. When an illogical practice is presented as the only means of safety and dismissal of the practice is equated to certain death, even the most brilliant leader can succumb to its absurdity.

Myths about helmets charm countries most where bicycling is not commonplace. In these countries, helmet rhetoric has escalated to the point where those not familiar with bicycling believe that if you so much as swing your leg over a bicycle without wearing a helmet you will smash your head open. In such places, those who ride a bike without a helmet are chided by onlookers at every turn for their reckless, irresponsible behavior.

Where did these chiders get their information? Most helmet propaganda is originally published by insurance companies, health practitioners and government agencies who have avoided countless law suits by blaming bicyclists in crashes for not wearing a helmet, sometimes even when their injuries or death did not involve injuries to their head.

While many studies have shown that bicycle helmets do little to prevent major head injuries beyond minor skull fractures and lacerations (Curnow 2001), a few poorly executed, misleading studies are the only ones to have reached mainstream distribution. The most common bit of jargon of them all is that "cycle helmets prevent 85% of head injuries and 88% of brain injuries" when in fact, where helmet use is high, there has been no detectable reduction in head injuries. See this link for a good overview: http://www.cyclehelmets.org/1027.html .

Helmet rhetoric that sets bicycling out as far more dangerous than it is, is the greatest hindrance to programs for increasing bicycling. A great deal of truthful yet catchy promotions will be necessary to counter this noise. Remember, bloodletting was "common sense" for 2,000 years! One of the best examples for illustrating the truth is this fun quiz on the dangers of bicycling: http://www.bicyclinglife.com/SafetySkills/SafetyQuiz.htm

Mandatory helmet laws often follow the spread of bicycle helmet rhetoric, adding the weight of the law to the idea that bicycling is more dangerous than any other form of transportation. In fact, as you will have found in the above quiz, if these laws took a realistic approach to their attempt to prevent head injuries, all pedestrians and car drivers would be required to wear helmets as well. And, it seems, a law requiring the wearing of helmets inside the house would also be a good idea.

Helmet laws also present another barrier to potential cyclists who already see many barriers to starting cycling. Mandatory helmet laws add to this list and thus prevent many new riders from starting. These laws have also been proven to decrease numbers of current cyclists thus increasing the potential for crashes by hindering safety in numbers. This theory has been proven to show that a motorist is less likely to collide with a person walking or bicycling when there are more people walking or bicycling (Jacobsen 2003).

Bicycle helmets may provide some protection against minor skull fractures and lacerations, but they do not prevent major brain trauma that happens within the skull. In fact, because bicycle helmets are soft which increases friction in certain crashes, unlike motorcycle helmets, some studies have shown that they can cause neck and brain injuries from rotational motion ( V J M St Clair, B P Chinn. 2007 ).

So, in minor crashes, bicycle helmets can assist in preventing minor injuries, though the potential of their doing harm in a major crash must be considered. Like bloodletting, which, in retrospect was found to have unintentionally benefitted a few lucky survivors because they were later discovered to have high blood pressure, helmets have surely prevented nasty gashes and painful skull fractures.

Bicycle helmets can be a good choice for someone concerned about minor head injuries as long as they understand their helmet's limitations for preventing major head injuries, not unlike choosing to wear knee pads and gloves. However, some studies have shown that helmeted bicyclists take more risks than those not wearing a helmet ( Pless IB, Magdalinos H, Hagel B. 2006). Thus, whenever a potential helmet benefit is mentioned, the potential of a helmet causing neck and brain injury, as well as this risk compensation, must always be included for bicycle helmets to be presented in a truthful light.

Another important point to understand is that helmets do not prevent crashes. Improved road and pathway conditions, driver and bicyclist education, better protections for cyclists and increased numbers of bicyclists through safety in numbers, prevent crashes. Too often government officials, health practitioners and insurance companies grasp at helmet laws as a quick and cheap solution that removes them from liability and the responsibility of providing quality provisions for bicyclists.

Helmet laws and overblown promotions also set in place a ready-made blame-the-victim reaction. Each time a helmetless cyclist is in a crash, their bare head becomes the focus even if the driver deliberately hit them and their injuries were not head related. Remember that whenever one of these laws is presented, it is from a knee jerk reaction, either to a recent crash or fabricated rhetoric, usually by officials seeking to avoid liability, framing the argument as making crashing safer.

Let's replace our helmets with thinking caps. If we can agree that increasing bicycling is in the best interest of our people and our planet, it's time to shift our promotions and policy efforts away from the illusion of safer crashing and into reshaping our communities into places where everyone knows the safety of bicycling.

Sue Knaup is the executive director of One Street , an international nonprofit organization that serves leaders of organizations working to increase bicycling. Most of her work involves coaching these leaders past common pitfalls so they can focus their energy on increasing bicycling.
Find out more at http://www.onestreet.org.

For a compilation of 16 studies on helmet efficacy see: http://www.onestreet.org/pdf/Bicyclist- & -Driver-Ed-helmet-efficacy.pdf .

Find a comprehensive study on safety in numbers here: http://www.onestreet.org/pdf/Safety_in_Numbers_JacobsenPaper.pdf .

Originally published on SearchWarp.com for Sue Knaup Wednesday, January 21, 2009

Article Source: Bicycle Helmets - Today's Bloodletting


Doug said...

I used to live in Chicago and rode my bike everywhere or took public transit. I remember thinking that helmets were sort of like prenuptial agreements for a marriage. How can one get a good result when one is starting off expecting the worst? I always felt safer without a helmet than with one.

Anonymous said...

This morning I turned down an icy alley on my way to work and hit a rough patch of ice. Slam, Wham! down on the side of my helmet. I picked my bicycle back up and rode on to work.

Fargo Pentameter said...

Let me see if I follow.
Bike helmets only prevent against relatively minor injuries like concussions and lacerations.
In the event of a really catastrophic bike accident, your helmet will do no good.
Therefore, you shouldn't wear a bicycle helmet because you could be in a major accident where the helmet will do you no good.
(I think I'm going to continue to strap a helmet on my non-lacerated, unbroken head.)

Singletrack Mind said...

I'm sorry, but there is no logical argument against wearing a helmet and equating it with bloodletting is just stupid. You can make rhtorical mash and site all the statistics that you want. Head + pavement = bad. Period.

Anonymous said...

Fine, don't wear your helmet... but why must you go on mocking other people for wearing one?

Maybe you can't tell but, you're only discrediting yourself with this ignorance.

Did you know mountain bikers have the lowest rates of brain injury among all cyclists, this is mainly attributed to their judicious use of helmets. Counter-intuitive for you? Probably, but the difference between a minor and major accident is usually proper safety gear.
Sorry if i'm blowing your mind here. Be sure to fill out your organ donation card.


Anonymous said...

oh goody another helmet thread. better than fast vs. slow, lycra vs street clothes, single speed vs 3 speed in a hilly city.

I am never sure if your are anti-helmet or anti-helmet law. Can you let us know definitively.

Either way, freedom of choice is the issue, right? Choice is good.

I choose to wear a helmet because when I have crashed, it saved my head from superficial wounds every time. Granted I had to deal with wounds on other parts of my body but at least my gorgeous face and beautiful hair was spared ;-)

Anonymous said...

anon 3:28

I would figure MTB's have lower rate due to lower speeds, no vehicles and no pavement to crack their heads on. that and their smelly dreadlocks.

Just a cyclist said...

Clearly, one problem here is the intolerance that inevitably came with the spread of the helmet use and that is growing ever stronger.

At the other end, worried about the state of cycling, cycling federations opposes helmet legislations for adults in just about every country where it is considered or have been enacted.

This is the reason for why I believe that NOT wearing the plastic hat is actually the most effective way to advocate cycling these days.

I've read something like that if helmet use does not increase to 50% by 2012 in switzerland, the authorithies would enact a helmet law. Surely, the safest way for them to end up where australia did, would be to reach that 50%. Then there would be no excuses whatsoever.
Of course, one may guess that along the way there would have to be a lot of blood-dripping fearmongering.

She Rides a Bike said...

I occasionally ride without my helmet and it would actually be my preference but here in the States our streets are still a long way from welcoming bicyclists. While I haven't encountered much aggression from driver, it does happen. The main problem that I see where I live is that most people still drive huge vehicles, too fast, while multi-tasking, and are just not looking out for bicyclists. I'm not wild about wearing my neon-yellow reflective vest either but at least I know I will be seen. I think we just need more progress here in getting drivers used to sharing the road with bikes and more investment in bike lanes and paths before I'll be ready to give up the helmet.

Anonymous said...

I don't understand why the firm believers in bike helmets take the abnormal risk of driving cars and walking WITHOUT a helmet.

neuromancer said...

Out here in Bangalore, helmet wearing riders are relatively scarce. So, it gives u a lot of visibility, and ppl look at u as some elite guy / a racer in fact. So it serves other purposes :)

But, minor injuries are still worth wearing a helmet for, even if it means that u'll take more risks acc to that study. Its sorta like a license to take some more risks :)

Adrienne Johnson said...

It isn't about 'you suck if you wear a helmet'. The whole issue is WHY do YOU wear a helmet and why does that mean I have to do the same? Most people can not give a reasoned, educated answer to that- only an automatic statement of belief in its properties.

"She Rides A Bike" states "The main problem that I see where I live is that most people still drive huge vehicles, too fast, while multi-tasking, and are just not looking out for bicyclists." If you think a bike helmet is going to help you in that situation, go out right now a run your helmet over with even a Smart car and see what happens.

'Anonymous @3:28' states "Be sure to fill out your organ donation card." One of the worst bicycle accidents in the San Francisco Bay Area was just last year and involved 3 cyclists who were run down by a police officer who fell asleep at the wheel (2 died). One cyclist was crushed under the car and the other had her leg severed from her body. There is no helmet in the word that will help in that situation.

What is difficult in this discussion is that people put more energy into faith in helmets than in learning how to ride (or drive) safely. If wearing a helmet makes you more comfortable, go for it. But I prefer to actively protect myself through better riding skills. I can assure you, that I will be less likely to suffer brain injury than the inexperienced or arrogant and unsafe (but helmeted) rider.

Rick Hurst said...

I don't see the comparison to bloodletting here, as wearing a helmet certainly does you no harm!

I agree it should definitely be personal choice. I generally wear a helmet when riding my bike, depending on the circumstances, but rarely wear one when skateboarding at a concrete skatepark, which is much more risky, and i'll admit this is partly due to peer pressure - i'd hate to see the same in cycling, where it becomes socially unacceptable to wear a helmet

workbike said...

I guess I should begin by apologising as I used to use some of these arguments when working in a bike shop and selling helmets.

Five minutes of actually looking at the evidence showed that wasn't helping anyone, and now I won't wear a helmet to show people cycling is safe: On my worst prang so far I probably avoided rotational injutries by not wearing a helmet.

Keep up the good work: we need to keep the facts out there.

workbike said...


"i'd hate to see the same in cycling, where it becomes socially unacceptable to wear a helmet"

Agreed, but the opposite is often the case. I've been shouted at, bullied and insulted for not wearing a helmet by fellow cyclists.

townmouse said...

I think the point of the article is that helmets potentially do do harm: they discourage cycling, they make cyclists take more risks, they cause rotational injuries and (not mentioned here but also commonly cited research) they also make motorists take more risks around helmeted cyclists. Simply encouraging helmets (not just mandating them) causes these problems, hence it's not just helmet laws that are the problem. Yes there's a also downside to not wearing a helmet but wearing or not wearing is a balance of risks and benefits, not the no-brainer it first appears to both sides of the argument.

I've made my decision, I don't wear one. But I've given up arguing with people who want to make me wear one. Life's too short. I'm glad that this site is here to do the arguing for me.

Thanks for such a lucid assemblage of the known facts, few as they are

Rick Hurst said...

@workbike interesting stuff, this article is certainly an eye opener, I always presumed wearing a helmet is the "right thing to do", but if they a: might actually cause more harm, b: act as a barrier to getting people to cycle in the first place c: lead to some sort of lycra clad, helmet wearing supremacy, then i'll have to reconsider my stance. I'll continue to make my 5-year old kid wear one though - he's prone to cycling head first into immovable objects!

Robt P said...

Great article- balanced, objective, well informed, lacking hysteria and sensationalism.

Just like the comments that followed it. :roll eyes:

Thanks for the link, M.

Anonymous said...

depends how fast youre going too, if your just tooling around like most on this blog or on copenhagen cycle chic then yes maybe a helment is not needed. i have had a few times in competition where i am sure i have escaped serious injury because of my helmet.
those pesky seatbelts in cars are over rated too;)

Mary said...

Yikes. There are so many flaws in logic here that I hardly know where to begin.

It's hypocritical to criticize the methodology of studies that have shown cycle helmets prevent injuries while at the same time blindly citing studies that support your theory, without actually providing the references for others to evaluate those studies' methodology. You haven't even provided journal names for most of your references! It's always a bad sign when the study you're criticizing is published in the New England Journal of Medicine, and those supporting your claim are in completely obscure publications without rigorous peer-reviewing processes.

Where's your data that the pro-helmet movement has been started by insurance companies and misinformed health care providers?

And, by your 'safety in numbers' argument, I should always wear a helmet because I can never be sure that the area I'm cycling in has enough cyclists to raise awareness of my presence to motorists.

This is obviously an area of great debate. You need better methodological review of BOTH SIDES of the evidence before your argument will hold up to even mild scrutiny.

Just a cyclist said...

Mary, one could only wish that pro-helmet campaigners ever would scrutinize their data in that same manner that you propose...

Mary said...

Exactly! And until someone does objectively look at all the evidence, this debate will continue on as meaningless, anecdoctal babble...

Erik Sandblom said...

Mary, the anti-helmet people are not telling anyone not to wear a helmet. They are telling governments not to require or encourage helmets.

Just a cyclist said...

Mary, Just let's hope that no laws get enacted based on the anecdotal babble before all objective facts have been taken into account. Something tells me that reversing such a law will be way more difficult than enacting it, no matter what the objective evidences might say.

nathan_h said...

"This morning I turned down an icy alley on my way to work and hit a rough patch of ice. Slam, Wham! down on the side of my helmet. I picked my bicycle back up and rode on to work."

Almost precisely this happened to me back in New York's icy December, on an invisibly smooth patch of ice on a 90º turn (Sands St. before the BK Bridge). My folding bike flew out from under me and I hit the pavement on my side. My neck works pretty well for keeping a regularly sized, unpadded head away from the ground. I picked my bicycle back up and rode on to work.

Erik Sandblom said...

Icy patches should be salted or gritted, and cyclists having problems with ice should use spiked tyres, or just slow down.

Accidents are best avoided!

Motorcycle helmet lock said...

Yes i do belive we should wear our helmet last week i was riding and hit a patch of black ice and slam in to to the rail and hitting my helmet boy was i glad i had it on.

nathan_h said...

"Icy patches should be salted or gritted, and cyclists having problems with ice should use spiked tyres, or just slow down."

Believe me, we all complained loudly after that storm and the city has done much better since. I feel like you misunderstood my comment however (and are falling into the same condescension as helmet lecturers). I am a slow rider. I don't need or want special tires, headgear, or any other equipment than my bicycle. I was not complaining about ice or saying that it explains the need for anything. Quite the opposite! That has been my only bicycle fall in six months of daily riding, it was due to black ice (that no one could have seen, fellas) and it was absolutely a non issue. I also fell on sidewalk ice while walking after that storm. Big whop. My head did not contact the ground in either case. People that are always banging into things with their helmets should consider the voluminous common denominator.

Nate (Salt Lake City) said...

Articles like this are the reason why I visit this blog every day.

Two points:

Those who insists that bicycle riders wear helmets should be going absolutely crazy in favor of wearing helmets inside cars. The fatality ratio is roughly 50 to 1 - so helmeted motorists would have a huge impact on the highway death rate.

Helmet advocates who will not insist on helmets inside cars are, I believe, not really interested in Safety.

They are interested in something else: which is rarely discussed.

This is the concept of Martyrdom: that no form of physical exercise should be comfortable ... or fun.

As an example: pick up a copy of the latest BICYCLING magazine. There is Pain on every page. According to them, Suffering is really what riding is about: including a perforated salad bowl on top of your head.

The manifestations of this Pain paradigm are everywhere. It's what helps to keep America fat and afraid.

Anonymous said...

This is all very interesting. I'm not sure where I stand on the issue.

I do believe that wearing a bicycle helmet to prevent superficial injuries is a valid reason to don one. As an avid motorcyclists, as well as an avid bicyclist, almost ALL of the motorcycle apparel I wear is worn to prevent the "superficial" injuries. I am not delusional, or naive enough to believe that it will save my life, but the motorcycle accident I had 15 months ago, where a person ran through a stop sign and I vaulted over the hood of their car, provided me with evidence that I was much better off with full leathers, boots and a helmet, rather than cargo shorts, a tank top, flip-flops and a bandanna. (And don't dispute that, because I see motorcycle riders dressed in that style of gear often.)

Motorcycles and bicycles are likely not comparable. But, the non-highway speeds "in-town" are comparable. More so than bloodletting, in my opinion, however.

With that, I will say that I have a number of "types" of bicycles, and when I ride my roadie with lycra (blaspheme that I am) and a helmet, the "majority" of the 4 wheeled crowd will buzz within inches of me, and often cutting me off to turn to the right direction. However, when I ride my townie/urban vintage schwinn with no helmet, I will invariably get lots and lots of room and far more courtesy.

Finally, I must say that in over 40 years of being an avid bicyclist, both slow and fast, I have heard a million or more excuses to not ride a bike. I have NEVER heard a single person say that they don't/won't/can't ride a bike because they have to wear a helmet.

I see both sides...but, not sure about the arguments.

Mikael said...

Great comment, Nate. Thanks.

Mary: www.cyclehelmets.org.

Mikael said...

So let's say you wear a helmet and 'believe' it will help...

- do you wear a lifevest when swimming or just hanging out on a beach?

the lifevest is a fantastic piece of safety equipment and actually designed to save lives. it would be, to me, logical that your sentiments about bike helmets would extend to other activities. You have a higher risk of drowning that getting a serious injury on a bicycle.

- And what about driving in a car? Do you wear a motorcycle helmet? If not, are you irresponsible? Reckless? Your risk of head injury is far higher in a car than on a bike. An Australian study showed that if motorists would wear mc helmets, 25% of the lives lost each year could be saved.

- And the simple act of walking down a city street... higher risk of head injury than cycling. Do you helmetize when pedestrianizing?

- And don't forget your steel-toed shoes. You never know when something heavy might drop on them.

Anonymous said...


(please note background statistics and references at bottom)


Mikael said...

and if you visit http://cyclehelmets.org - The Bicycle Helmet Research Foundation - you'll find the studies mentioned in the links above picked apart and thrown out to the junk science trash can.

Anonymous said...

A crash meets the definition of Nassim Taleb’s black swan event for an individual. A crash is an event that cannot be foreseen, and may have great consequences. You can run all the statistics you want, but there is no way to predict whether you are going to crash today. Obviously, some cycling activities are riskier than others, such as racing, mountain biking etc. However, this is system wide, or averaged risk. For the individual, whether you are going to crash or not, is completely unpredictable.

If a decrease in the number of cyclist raises the average risk of a crash, and helmet laws and even advocacy do reduce the number of cyclists, then helmet laws and advocacy build increased risk into the system. As an individual, you may believe that a helmet is appropriate preparation for a black swan event. It is certainly your prerogative to protect yourself, but if you advocate for helmet laws, you and your neighbor are facing an increase probability of encountering such an event.

The above argument only refers to risks associated with crashes. Weighing in all the attributes of cycling that reduce risk to a population, such as less pollution, healthier citizens, and safer streets, then the balance of system risk reduction is far in favor of not advocating or requiring helmet use.

An individual, organization, or government that is responsible for total system risk of the activity can legitimately require practices that reduce the average risk of a system. However, if the overall risk of an activity is increased by requiring individual personal protection, it is unconscionable to require that practice.


Mikael said...

good to hear from you, rex. a pillar of calm and logic in a world of chaos... :-)

katrygg said...

"An Australian study showed that if motorists would wear mc helmets, 25% of the lives lost each year could be saved."
Are you refering to Ryan GA. World J Surg. 1992 May-Jun;16(3):398-402? or do you have a different reference?

Ryan (green.ryder) said...

I'm fortunate to live in one of few provinces in Canada that does not have a helmet law for people 17 and older.
The Conservative Party of Ontario's leader wanted to implement a helmet law for EVERYONE. Thankfully he stepped down last week!

I've fallen off many times, but I always brace for it and have never even come close to landing on my head.
I have however slipped twice this past winter while walking. Came much closer to hitting my head both those times.

Watch this:

I tried this myself, and can say it's true. Cars pass closer when you wear a helmet.

Anonymous said...

this post is nothing more than data mining to support the no helmet lobby. please take such misinformation out ....


Anonymous said...

The no helmet lobby? One may only wish there were anything such... to balance out the misinformation screamed out by the helmet lobby. But then, the latter have got other types of support as well, one may imagine... $$