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Highlights of Discussion on Mandatory Bicycle Helmet Laws

This document contains highlights of discussion regarding Mandatory Helmet Legislation for Bicyclists on Usenet newsgroups back in 1994.

From: Noel Weyrich
Newsgroups: dc.biking
Date: 28 Apr 94 21:59 PDT
Subject: Re: Helmet Laws

scotty@verdix.com writes:
S> When you look at a car driver, required to be strapped in and having a
S> fairly good chance of being protected by an air-bag in most otherwise
S> head-damaging collisions, you don't get the impression that a helmet
S> requirement is going to be worth the legislation for the minor
S> improvement it would make
Minor improvement? 40,000 Americans die in auto accidents ever year, most are head injuries. A head is completely unprotected in side crashes, in crashes that crumple the front end, etc. Please, read the paper. Why do race drivers wear helmets? They're strapped in!

On the other hand, of the 900 cyclists who died last year in America, many were wearing helmets. Three of the six cyclists who have died in the Philadelphia area in the last two years were wearing helmets. One was hit by a car with a vinyl roof. The TV news showed the helmet imprint, GIRO, spelled backwards, pressed permanently into the damaged vinyl roof.

I'm merely saying that the rational defense of bicycle helmets does not make sense because if we really want to stop deaths, we should start with the major causes of death. Here are the figures from the National Trauma Society.

Brain injury is the leading killer of young adults. 75,000 Americans die of traumatic brain injuries each year. Between 70,000 and 90.000 will endure lifelong debilitating loss of function, each year. Young males, 15-24 highest risk group. Causes:

What is rational public policy here? Where do we start. Helmets for motorists (or just their child passengers) seems to be the most promising!

From: JACOBSENP@delphi.com
Newsgroups: rec.bicycles.soc
Subject: Re: Mandatory Helmet Legislation
Date: Tue, 23 Nov 93 23:02:25 EST
Good, unbiased information is hard to find. I suggest Cycling Towards Health and Safety by the British Medical Association (Oxford University Press, 1992, ISBN 0-19-286151-4). Although not available in the States, you might have better luck in Canada. The Orange County (Calif.) Bicyclist Coalition distributes it here. They sum it up nicely: "The question of helmet goes to the heart of policy-making for cyclists. Sooner rather than later it should be realized that the route to encouraging cycling and making it safer lies in the provision of safer cycling networks, enforced lower speed-limits, and in changing the attitudes and behavior of drivers rather than cyclists." (p.88)

Be prepared for a tough battle. It is hard to oppose "safety." The proponents will trot out statistic like helmets prevent 80 percent of head injuries, but neglect to say that only 2 percent of all head injuries are major (that is, a concussion lasting more than 15 minutes, and remember symptoms of a minor concussion are nausea and wooziness). They ignore that in 3/4 of all serious injuries and fatalities a car is involved (BMA, p 47), "in collisions with motor vehicles other injuries can assume greater significance and may indeed cause death" (BMA, p 128), and that a pedestrian or cyclist struck at speeds greater than 30 mph is likely to suffer severe or fatal injuries but at speeds less than 20 mph the casualties are likely to be slight (BMP, p 122).

From: JACOBSENP@delphi.com
Newsgroups: rec.bicycles.misc
Subject: Re: bicycle helmets compulsory
Date: Sun, 16 Jan 94 18:22:04 EST
This thread has been going strong for a long time; this response is to several postings and is 300 lines.

pgn@waikato.ac.nz writes:
PGN> I have seen two cases, where cyclists have fallen off their
PGN> bikes from no fault of there own and hit their head. If they
PGN> weren't wearing their helmets they would either be talking
PGN> gibberish, and dribbling heaps, or dead by now!!!.
The mythology surrounding helmets and the degree of protection they offer is astounding. Science is not about repeating anecdotes--in reality, more than 95 percent of the cyclists fatalities in the us and uk, (and I suspect, new zealand) involve motor vehicles. Your friends might have been shaken up pretty badly without a helmet, but a car has to be involved for them to have been killed.

Peter Epstein writes:  
PE> So, why don't you try to get the cycle manufacturers and other 
PE> bike groups to get the message out that helmets do indeed 
PE> work?  Maybe collect some statistics to show their effectiveness.
One reason we have these "helmet wars" on the net is that these statistics show wildly different results. One paper shows a table of estimates of lives helmets would save from a half-dozen or so papers. They range all the way from zero to 85 percent. Some even show that helmeted cyclists are involved in *more* accidents.

This latter concept is called risk compensation or homeostasis. Other examples are personal injury rates going up in airbag-equipped cars and anti-lock brake-equipped cars getting in more accidents. Proponents of this concept believe that helmets alter the behavior of the bicycle and motor vehicle operators, either consciously or unconsciously. You can test this theory; go for a mountain bike ride on the gnarliest trail without a helmet and see if you ride slower.

A bicycle helmet is intended to reduce the impact forces. However, it can't protect against impacts that a motor vehicle can impart. To protect against a 20 mph impact, you need 6.5 inches of foam; 30 mph, 15 inches; 40 mph, 29 inches. At a half-inch of foam, a bicycle helmet adds little protection to that that nature provides.

A Bell Sport 2000 motorcycle helmet weighs 1700 grams, a Giro Ventoux bicycle helmet weighs 200 grams. Yet the motorcycle helmet only protects against a 12 mph impact. You are kidding yourself if you believe a bicycle helmet will save you in the event of a motor vehicle collision.

Mark Hoppe writes:
MH> Regarding helmet laws: they protect the PUBLIC. There is no
MH> question of a helmet's safety value. BECAUSE the law
MH> ALLOWS it, you are granted the PRIVILEGE of riding on
MH> PUBLIC roads. To do so, you must follow the laws: stop at stop
MH> signs, use signals, have reflectors, and yes, require YOU to
MH> wear a helmet.  Surprisingly, the law has not yet required
MH> licensing for bicycles. They are not infringing on your rights,
MH> they're granting a privilege, which carries certain
MH> requirements. Wearing a helmet can be one of them.

Highways are public highways, built and maintained for the use of all the people. The legal handbook "American Jurisprudence" states "all persons have an equal RIGHT to use [the highways] for purposes of travel."

Operating a motor vehicle on highways is a PRIVILEGE because you endanger others.

MH> What I WOULD like to see is mandatory helmet laws for
MH> children below a certain age. They are not old enough to
MH> understand all the issues and make a mature decision, and in
MH> some cases, neither are the parents.
From the LA Times, December 12, 1993: "Numerous studies have confirmed that young children under 8 are not physically, behaviorally or cognitively able to be safe pedestrians or cyclists.

"Children ... view traffic situations differently than adults. Young children do not perceive danger. They can't properly judge the speed or distance of a moving car and have no idea that a car needs room to stop. Their field of visions is one-third narrower than that of adults. Children think because they can see a car, the driver can see them. They can't readily determine the direction a sound is coming from. Children react spontaneously and unexpectedly. They are in perpetual motion and easily distracted."

They go on to explain that pedestrian accidents are the leading cause of severe injury in young children. (N.B. the phrase "pedestrian accidents." Pedestrians injuries are not caused by tripping on shoe laces--they are being struck by cars.)

Child cyclists are just a sub-set of child pedestrians. Developing a solution for these injuries/fatalities will require a more comprehensive solution than just requiring child cyclists to wear helmets.

Should we require helmets for pedestrian children? Keep in mind that severe injuries typically include more than just those injuries a helmet could prevent. A pedestrian/cyclist hit at more than 20 mph will likely die of injuries that a helmet cannot prevent.

??> PS. At least I haven't yet read that classic from the
??> motorcycle helmet arguments--they mess up your hair. :-)
I wonder if that could have anything to do with the fact that there are now 90% fewer Sydney secondary schoolgirls cycling to school than before helmets were made mandatory? I mean, 9 out of 10 of them wouldn't give up cycling to school because helmets mess up your hair, would they?

From: D. Robinson
Newsgroups: rec.bicycles.soc
Subject: Re: Mandatory Helmet Legislation
Date: 1 Dec 93 06:32:20 GMT

mjvande@PacBell.COM (Mike Vandeman, commenting on another cyclist's post)
MV> ??> At the risk of re-igniting the helmet wars, I'll state that one 
MV> ??> of the reasons that I feel safer riding around Seattle than
MV> ??> in suburban or rural king county is because of the sheer number
MV> ??> of bicyclists in the City, many of whom are unhelmeted.
MV> ??> Motorists in Seattle are used to the presence of cyclists,
MV> ??> and accept them as part of the street scene. Forcing the
MV> ??> unhelmeted cyclists off the streets would only make cycling
MV> ??> more dangerous.
MV> Not very good use of logic. Where is the proof that even one 
MV> bicyclist would stop riding because of such a law?
I can't believe you wrote that! Have you not seen the counts of numbers of cyclists pre and post mandatory helmet legislation. In NSW, for example, they did counts of children's cycling 2 months before and 10 months after mandatory helmets, and found and overall reduction of 38% in numbers of cyclists counted.

But if that doesn't convince you, a group in Darwin actually stopped people in the street and asked them if they cycled, or used to cycle and the effect mandatory helmets had on their cycling behaviour. 22% claimed to have given up cycling because of the helmet legislation, and 20 or 30% said they cycled less. Do you really need any more proof?

MV> How would you answer the misery of a mother whose child was
MV> severely injured because of a lack of a helmet (say, influenced
MV> by "macho" peers like you encouraging him not to wear a
MV> helmet)?
My first answer would be to try and prevent injuries to child cyclists by promoting better cycle education programs in schools. Promoting helmets would obviously play a part - encouraging children to think wearing a helmet is trendy. But you can really do a lot more to improve the safety of child cyclists by proper training and education than by forcing them to wear a helmet or give up cycling.

My second answer is that I'm really beginning to doubt the efficacy of mandatory helmets in preventing even head injuries. As you have probably heard, in the first year of mandatory helmet legislation in victoria, child cycling went down by 36%, child head injuries went down by 32%. Where's the benefit in that? Yes there were fewer cyclists, but apparently the risk of head injury was not reduced for any individual cyclist.

From: D. Robinson
Subject: Re: Mandatory Helmet Legislation
To: danielc@panix.com (Daniel Convissor)
Date: Fri, 10 Dec 1993 19:26:04 +1100 (EST)
In-Reply-To: "Daniel Convissor" at Dec 4, 93 08:54:11 am
Other data confirm the changed road conditions. Following the introduction of speed cameras, the proportion of motorists speeding fell from 23% in December 1989 to 4% in June 1993 (Williamson, 1993). Impact speeds affect head injuries. Janssel et al., (1985) estimated that, for vehicle-cyclist accidents, for a drop in impact speed from 40 to 30 km/hr, head impact acceleration would fall by 50%
Table A1. Road Deaths in Victoria per 100,000 population 

Year                 Deaths

1989                  17.8
1990                  12.4
1991                  11.3
1992                   8.3

Cyclists, it seems, have not been so lucky. Most estimates suggest that, following mandatory helmet legislation, injuries have gone down by less than the numbers of cyclists, representing an increase in the injury rate per cyclist. This appeared to be the case for hospital admissions from bicycling accidents in Victoria, as noted above. Since children are usually considered to be particularly at risk, it is interesting to consider relevant statistics for children. Numbers of head and other bicycling injuries were available from the Victorian Injury Surveillance System (VISS), which monitors accident data for children under 15 from five Melbourne hospitals. Surveys taken in May/June 1990, 1991 and 1992, reported by Cameron et al. (1992), indicated that total children's bicycling activity had reduced by 36% in the first year of the helmet law, and by a total of 45% in the second year.

From: D. Robinson
Newsgroups: rec.bicycles.soc
Subject: Re: Possible Helmet Law FAQ (from Cyclists' Public Affairs Group)
Date: 13 Dec 93 04:34:30 GMT
Mandatory helmet legislation in Victoria was estimated to reduce cycling activity by 36% in Melbourne. Numbers of cyclists counted on the road went down by even more - 42% Numbers of head injuries using hospital admission data for bicycle injuries went down by 37% (1000 or more data points each year). If, Thompson and Rivara's estimate of an 85% reduction in head injuries from helmet wearing were correct, this simply would not be possible.

Before mandatory helmets, 31% of cyclists observed on the streets wore helmets. Afterwards, 75% did. Working on the before and after percentages of head injuries, these figures imply that a helmet has a 27% chance of preventing a head injury for a cyclist involved in an accident. But they also suggest a 20-30% increase in the accident rate, so that head injuries in total are no different, but the chance other equally debilitating injuries such as facial or spinal would appear to have increased.

In towns where lots of people cycle to work (The Bicycle Planning Book (1978) quotes Cambridge as having 30% of people cycling to work, Peterborough, 25%), drivers become aware of cyclists and it becomes safer and a more acceptable behaviour. You are no longer a nutcase, or a freak for doing so. Town and transportation planners consult and provide for cyclists. A measure such as mandatory helmets, without which there would be two thirds more cyclists on our roads, seems to be the worst possible way to get people cycling.

If you provide statistics to show me that the head injury rate (or the total medical cost of injury) per cyclist, or per mile cycled, is lower for American helmeted cyclists, than either Dutch non helmeted cyclists, or cyclists in some of these British cities where lots of people cycle to work, then your case is proven.

If not, then maybe Governments should be doing other things. Encouraging voluntary helmet wearing, education programs in the schools, more speed cameras, more random breath testing, policing of all traffic laws, and especially driver education.

All of these things have been shown to work and significantly reduce deaths and injuries on the roads. Mandatory bicycle helmets have not, except by the amount they have caused people to give up cycling.

From: D. Robinson
Newsgroups: rec.bicycles.misc
Subject: Re: Helmet cost/benefit ratio
Date: 1 Feb 94 23:04:58 GMT

Eric Wassermann wrote:
EW> Avery Burdett wrote:
EW> AB> One other point, nobody has yet figured out what the effect of
EW> AB> the increased G force is when you add three quarters of a pound
EW> AB> to a head.  This is of particular concern with small children
EW> AB> because the increase in weight is that much greater on a small
EW> AB> head.

EW> As you may have been saying above, the additional risk
EW> imposed by the helmet mass in the case of small children is not
EW> so much to the head as to the cervical spine.  For all I know,
EW> this could be a major concern.  No one I've talked to has much
EW> to say about it, however.
I think there is some data on this. McDermott et al. (Trauma, 1993, p834-841) found a significant increase in neck injuries for helmet wearers (3.3% Of unhelmeted riders sustained neck injuries while 5.7% Of helmeted riders sustained neck injuries - a 75% increase in helmet wearers, but not a particularly large effect overall). That compared 366 helmeted riders and 1344 non helmeted riders admitted to hospital in Victoria before helmets were mandatory.

His estimate of the probability of preventing a head injury for cyclists over 18 was 25% (28.6% Of helmet wearers had head injuries while 38% of non- helmet wearers had head injuries). This is probably about right. The problem is a that a 25% reduction is peanuts, compared with increased accident rates from reduced motorist awareness from the huge reductions in cyclists on the roads, the loss of health benefits from causing people to give up cycling and the other measures such as enforcement of speed limits can have on the head injury rates for both pedestrians, cyclists and even car occupants. [I changed wording here --DC]

An Assessment of the Mandatory Bicycle Helmet Law in Australia
by D. L. Robinson

Estimate of the maximum benefit from helmet wearing:
Using the hospital data and the estimated changes in helmet wearing in the year before and after the helmet law, it is possible to obtain an upper value for the probability that wearing a helmet will prevent head injury. As shown in calculation 1, this works out at 27%. Some of this is likely to be due to the changed road conditions noted earlier which affected admissions resulting from collisions with a motor vehicle. Overall, the estimated benefit of helmet wearing is consistent with estimates by McDermott, Lane, Brazenor et al. [1993]. In a retrospective study of 261 cyclists wearing approved helmets, 105 wearing non approved helmets and 1344 unhelmeted casualties admitted to Melbourne or Geelong public hospitals following bicycle accidents in 1987-1989, a reduction of 25% in head injuries was observed for cyclists aged 18 or over wearing approved helmets and a 31% reduction for female cyclists. Neither reduction was statistically significant. The overall reduction was estimated to be 39% (not adjusted for age or sex of rider), but head injury was significantly more frequent in helmeted riders over 18 (P < 0.001). Older riders were also more likely to be struck by a motor vehicle (32.9% vs 26.1%). McDermott's Table 1 shows male riders wearing approved helmets were significantly younger than unhelmeted riders (averaging 15.6 vs 17.8 years, P < 0.002) and some of the apparent difference in head injury rates may have been due the age differences in male riders. The estimates for riders over 18 or for female cyclists may therefore be a better estimate of the benefit of helmets.

Literature estimates of the benefit of helmets have varied widely. A Swedish report estimated they would prevent 13% of head injuries [ECF, 1991]. Mills [1989] estimated helmets could prevent 32% of head injuries in the UK, but, in the US, Thompson et al. [1989] estimated 85% would be prevented. The latter was based on observing only 23 head injured cyclists wearing helmets out of a sample of 325 (7.8%), compared with 23.8% helmet wearing in a control dataset of non head injured cyclists receiving emergency room care. Attempts were made to adjust the odds ratios for age, sex, income, education, cycling experience and the severity of the accident. Those who choose to wear helmets may differ in many respects from those who do not, including traffic conditions and type of roads used for cycling, so comparison of dissimilar samples using statistical adjustment techniques will always be difficult. Applying Thompson's estimate of an 85% reduction in head injury to the 28.6% of approved helmet wearing riders over 18 with head injuries in McDermott's study would imply a very unrealistic head injury rate of 191% in non helmeted riders, very different to the actual value of 38%. Thus we may conclude that Thompson's estimate of the reduction in head injuries is not valid for hospital admissions in Victoria, though helmet wearing has some benefit in reducing the number and severity of head injuries for cyclists involved in accidents.

Don't Kill the Goose the Lays the Golden Egg:
Why the Medical Community Should Cease Support of Mandatory Helmets for Cyclists

by Thomas J. DeMarco, M.D.

(This article is reproduced from the newsletter of World Without Cars, a group based in Windsor, Ontario. The piece originally appeared in the Journal of the Canadian Medical Association).

Expressed in potential life-years gained versus potential life-years lost, Dr. Mayer Hillman estimates that regular cycling's net benefit to personal health outweighs its risk of injury by a factor of 20 to 1, even in a country as hostile to cycling as Great Britain (Hillman, M. Unpublished presentation at Velo Mondiale/Pro-Bike/Velo-City Conference, Montreal, September 1992.).

From: Daniel Convissor
Subject: Re: Bill the Biker
To: ebikes@panix.com
Date: Fri, 1 Apr 1994
In-Reply-To: Steven Cherry [I think --DC]

SC?> A couple days ago I saw TV coverage of Bill Clinton, Hillary, and
SC?> Chelsea riding bicycles while on vacation in San Diego....

SC?> However, I was disappointed to see that none of them were wearing
SC?> helmets.

SC?> In addition, California recently enacted legislation that makes it
SC?> illegal for minors under the age of 18 to ride without a helmet!
SC?> Currently only warnings are being given, not citations.  Chelsea 
SC?> and an unidentified school-friend of hers were in clear violation of
SC?> this new law.
That's great! I'm glad to see our first family believes in direct action, protesting these stupid laws. :) I put that smile regarding the direct action, which I'll bet is not the case. But, these laws are stupid, blaming the victim, see below.

SC?> In fact, the O.C. Register reported that Chelsea's friend was hurt
SC?> when her bike ran into an opening door of a pick-up truck.  Luckily
SC?> she got away with only minor bruises.

Let's see. Who's at fault here? The bicyclist for not wearing a helmet or the driver for opening a vehicle door without looking? See, the helmet laws can end up blaming the victim.

From: Daniel Convissor
Subject: Re: Bill the Biker
To: ebikes@panix.com
Date: Fri, 1 Apr 1994 23:07:24 -0500 (EST)
In-Reply-To: Steven Cherry

SC> It's possible to believe these are stupid laws, and yet think it's wise
SC> to wear a helmet.
Yup. That's me.

SC> And to believe these are stupid laws and yet think it's 
SC> wise for the Prez to set the best possible example for the world.
Riding a bike with or without a helmet is a great example. Riding a bike without a helmet is better than not riding a bike at all. Fine, it is better to ride a bike with a helmet than ride a bike without a helmet, but helmet legislation ends up deterring more cyclists than it saves.

SC> I think in your zeal to register your distaste for helmet laws you're 
SC> confusing two quite different things.

From: Daniel Convissor
Subject: Re: Bill the Biker
To: ebikes@panix.com
Date: Fri, 1 Apr 1994 23:38:58 -0500 (EST)
In-Reply-To: Vicki Richman

VR> The libertarian case: It's my bike (or vehicle), and it's my
VR> life, and the law has no business protecting me against myself by
VR> requiring helmets (or seat belts).
That's not my case.



From all the research I've seen on the topic, which is A LOT, the answer is clearly no. The few people it saves are far outweighed by fewer people cycling and thus there is more illness and energy use.

VR> My reply: 
VR> The public has a stake in your conduct on the open road.
VR> For example, suppose I am an excellent driver, but I have a
VR> single, momentary lapse of good sense, and I strike you on your
VR> bike. You are not wearing a helmet and are killed. Now I am
VR> driven into bankruptcy by your family's lawsuit, and I am doomed
VR> to bear the guilt of killing another human being. I am shattered,
VR> destroyed, a pariah and a vegetable for the rest of my days.
If you are willing to drive a car, that is a price you may have to pay. This happens over 100 times every day in the US alone. And let me point out, that most of the times it happens, a cyclist is not involved. Driving is very dangerous. If you, or others, are not willing to suffer those consequences, don't drive.

VR> Suppose, however, that you are wearing a helmet and suffer only
VR> minor scrapes and bruises. I am liable only for the cost of your
VR> bike. I gladly make restitution, resolve to be more careful in
VR> the future, and go on with my life.
Though helmets are helpful, their degree of actual protection in a major accident is not as great as you think. Most likely, if the accident would have killed me while not wearing a helmet, the accident would render serious brain damage if I was. Yes, that's better... I guess... hmm... but anyway that's another debate. The point is you would probably get sued anyway, and those hospital bills for dealing with serious brain injury ain't cheap. And please, don't "resolve to be more careful in the future," after you have an accident. At that point, it's too late. Be more careful now.

Now, the point I raised in my previous letter was where the blame is being pointed. Here, you are clearly laying the blame on the cyclist for the unhappy or happy ending of the story. In either case, the cyclist got creamed. Who's to blame for the tragedy? The motorist.

VR> Your right to personal liberty does not extend to increasing the
VR> liability of motorists to such a devastating extent. The common
VR> good of all must prevail.
But drivers' liberty to use their cars end up costing our society dearly. I agree, the good of all must prevail. It's time to reduce automobile use. That responsibility rests on each of us as individuals and on our government in creating public policy.

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