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British Medical Association (BMA) and helmets

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In 2004, the British Medical Association changed its stance on cycle helmets, calling for people of all ages to be banned from cycling unless wearing a helmet. The BMA had previously encouraged voluntary helmet use but had opposed compulsion. CTC immediately contested the BMA's policy change.
The BMA supports helmet laws despite their clear threat to public health
The BMA supports helmet laws despite their clear threat to public health

Background

In November 2004, The British Medical Association announced that it was changing its stance on cycle helmets.

It previously believed that helmet-wearing should be encouraged but not  enforced by law, as this could reduce cycle use, undermining its wider health and other benefits.

However, it re-considered its policy and in 2004 said that it believed that helmets should be compulsory for cyclists of all ages. This change was formally endorsed as BMA policy at the BMA's Annual Representatives Meeting (ARM) in July 2005.

The BMA’s previous policy was based on a comprehensive examination of the helmet issue, published in 1999. By contrast, its subsequent stance was based on a short paper which took a very selective view of the evidence, ignoring a great deal of evidence to the contrary.

The BMA's paper cited a number of misleading (and in some cases incorrect) references without referring to published critiques of these; it identified just one counter-argument to its conclusion (even though many are raised in the published literature), and this one argument was dismissed on entirely spurious grounds.

For the full debate, see:

British Medical Journal debates helmets

In March 2006, the BMA's British Medical Journal (BMJ) included a paper by Australian-based statistician Dorothy Robinson, arguing that there is no evidence from countries that have enforced the wearing of cycle helmets that there has been any benefit to public health.

Robinson reviewed data before and after helmet legislation in Australia, New Zealand and Canada and  concluded that helmet laws discourage cycling and produce no obvious response in the number of head injuries. She says: "This contradiction may be due to risk compensation, incorrect helmet wearing, reduced safety in numbers (injury rates per cyclist are lower when more people cycle), or bias in case control studies."

She suggested that helmet laws are counterproductive and that governments should instead focus on measures that lead to clear drops in casualties, such as campaigns to against speeding, drink-driving, and failure to obey road rules. "Helmet laws would be counter productive if they discouraged cycling and increased car use," says Robinson. "Wearing helmets may also encourage cyclists to take more risks, or motorists to take less care when they encounter cyclists."

The Journal also published a counter-opinion by four academics who have long pressed for helmet laws.

The crux of their argument is that, even if helmet laws discourage people from cycling, this does not necessarily indicate significant harm to public health as it is unclear by how much they reduce their cycle use, or for how long. Unfortunately, the authors failed to mention any of the published evidence available at the time on the health benefits of cycling, including the following:

  • That the number of people dying annually of heart disease due to physical inactivity (c42,000[1]), and from obesity (c30,000[2]) both massively outweigh those who die while cycling (c130[3]), let alone those whose deaths result from head injuries which a helmet might have prevented, even on the most optimistic assumptions about their effectiveness (n.b. motor vehicles are involved in around 90% of cyclists’ fatal and serious injuries[4], whereas helmets are only designed for impact speeds equivalent to falling from a stationary riding position[5]);
  • That those who cycle into middle adulthood can have a level of fitness equivalent to being 10 years younger[6] and a life-expectancy 2 years above the average[7];
  • That, thanks to these extra life-years, the health benefits of cycling far outweigh the risks[8] – by a factor of 20:1 according to one calculation[9];
  • A study in Copenhagen found that compared with those who cycled regularly to work, people who did not do so had a 39% higher mortality rate, regardless of any other cycling or other physical activity undertaken by those in each group[10]

There is also some very informative analysis in the 'rapid responses' to these articles on the BMJ website - responding to Dorothy Robinson's article, to the counter opinion (including a posting from CTC Campaigns Manager Roger Geffen), and to the general debate - the tone of all three threads is strongly supportive of Robinson.  There is also a BMJ editorial on the subject. (Links available on CycleHelmets.org site).

References:

[1] Britton A McPherson K. Monitoring the progress of the 2010 target for coronary heart disease mortality: estimated consequences on CHD incidence and mortality from changing prevalence of risk factors. A report for the Chief Medical Officer. National Heart Forum, 2001.

[2] National Audit Office. Tackling obesity in England Stationary Office, 2001.

[3] Department for Transport.Road Casualties Great Britain 2004, Table 5c. DfT, 2005.

[4] Department for Transport.Road Casualties Great Britain 2004, Table 23. DfT, 2005.

[5] Glanville H and Harrison N. Cycle helmets.  British Medical Association, 1999.

[6] Tuxworth W et al. Health, fitness, physical activity and morbidity of middle aged male factory workersBritish Journal of Industrial Medicine vol 43. pp 733-753, 1986.

[7] Paffenbarger R et al. Physical activity, all-cause mortality and longevity of college alumni. New England Journal of Medicine, vol. 314(10) pp 605-613, 1986.

[8] British Medical Association. Cycling: towards health and safety. Oxford University Press, 1992.

[9] Hillman M, Cycling and the promotion of health. PTRC 20th Summer Annual Meeting, Proceedings of Seminar B, pp 25-36, 1992.

[10] Andersen L et al, All-cause mortality associated with physical activity during leisure time, work, sports and cycling to work. Archives of Internal Medicine, 160: 1621-1628, 2000.
 

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