Cracking The Helmet Debate: Part 1

This is the first of a two-part series by Kevin Ransom that explores the many issues related to the wearing and safety of bicycle helmets – including the debate over whether states or cities should pass mandatory helmet laws; how much protection they offer; the various medical studies comparing the frequency and severity of cycling head injuries, with and without helmets; the efficacy of helmet laws and how different studies often reach different conclusions.

DETROIT— There’s no disputing American cities have become more bicycle-friendly in recent years – or that this is a very good thing for everyone involved. Nor is there any argument about the many virtues of cycling – from its health benefits to the important ways that increased cycling can contribute to a city’s sustainability.

There’s also no denying that wearing a helmet while cycling greatly reduces one’s chances of suffering a serious head injury.

"Helmets have a limited ability to protect the contents within the skull. The purpose of a helmet is to prevent skull fractures, which can be fatal." ~ Amy Teddy, Injury Prevention Program manager, University of Michigan Health System

But once the conversation turns to the topic of legislating bicycle safety by passing laws that would require cyclists to wear helmets – and the effectiveness of such laws – there is still considerable debate.

According to the Insurance Institute for Highway Safety, only 21 U.S. states and the District of Columbia have mandatory bicycle helmet laws, and they usually apply only to young riders under age 16. Michigan does not have such a law. In some states, including Michigan, a few individual communities require helmets for some or all riders.

Meanwhile, helmet laws have long been in effect in various other countries, notably Australia, Canada and some European nations, and many studies have been conducted on the efficacy of those laws.

Fueling the debate on the subject is the fact that such studies – as is often the case with studies on health, medicine, safety, food, etc. – frequently reach different conclusions. There’s also some discussion about how much protection is provided by helmets, and what kinds of injuries they do and don’t protect riders against.

So, the debate generally takes this course: A study is published about how much safer you are if you wear a helmet, and that gets reported by the press, and everyone focuses on those results. Then, weeks or months later, a different study is published about the efficacy of helmet laws – which is a different subject –  and everyone focuses on that. Complicating this is that some studies focus specifically on teens and children, while others include adults, and so on.

So the debate continues, unresolved, and the public comes away feeling as conflicted as ever.

Since a few more studies were reported just last month, we thought it might be productive to discuss them in this broader context –  with the input of local cycling advocates and medical professionals – instead of just reporting on the latest study.

The strong case for wearing helmets

First, on the medical front: In 2009, the Cochrane Injuries Group reported the results of five different case-controlled studies conducted in the 2000s that concluded that wearing helmets reduced the risk of head and severe brain injury for all ages of bicyclists by anywhere from 63 percent to 88 percent.

They also concluded that helmets provided equal levels of protection for crashes involving motor vehicles (69 percent) and crashes from all other causes (68 percent). Injuries to the upper and mid facial areas were reduced by 65 percent.

Those numbers obviously make a strong case for wearing helmets.

And Amy Teddy, program manager for the Injury Prevention Program at the University of Michigan C.S. Mott Children’s Hospital, reports that, over the last five years, almost 90 percent of the patients admitted to the hospital for a bicycle-related head injury were not wearing helmets at the time of their accident.

“We can fix bones, but brains are far more difficult,” says Teddy. “Brain injuries are life-altering. I’ve never met a patient that was wearing a helmet and (later) questioned it – especially when they look at the damage, and (consider) what could have been the outcome.”

Teddy does note that “helmets have a limited ability to protect the contents within the skull. The purpose of a helmet is to prevent skull fractures, which can be fatal.

"An analogy I often use is this: Think about a glass of ice water. The glass equals the skull, the water equals the cerebrospinal fluid, and the ice equals the brain. If you move the table that the glass is sitting on, that equals the ice moving. If you hit the side of the glass, that equals the brain moving. If you put a koozie around the glass, the ice will still move,” she says.

The U-M Health System hasn’t taken a stance on the issue of mandatory helmet laws, but Teddy says, “as an injury-prevention professional, I believe that policies, programs and any other effort that help keep communities healthy and safe are worth considering.”

The results of one-year Australian study published in May by Michael Dinh, M.D., which he conducted (along with two colleagues) of injured cyclists and motorcyclists at seven major trauma centers in Sydney, shows some somber facts.

“The risks of severe head injury were more than five times higher in cyclists not wearing a helmet compared to helmeted ones,” wrote Dinh, co-director of trauma services at the Royal Prince Alfred Hospital. The risk for motorcyclists not wearing helmets was three times higher than for those wearing helmets.

“Severe head injuries were defined as any with significant brain hemorrhage, complex skull fracture or brain swelling. Some 70 percent of such patients end up on a ventilator in intensive care units; many patients with severe head injuries are left with permanent brain damage,” he wrote.

Helmet laws can discourage some from riding

In terms of mandatory helmet laws, there is this seemingly unusual phenomenon: A few studies or surveys have reported that such helmet laws can discourage some people from riding bicycles, for various reasons: Some people just don’t like to be told what to do, some think it’s inconvenient, some find helmets to be uncomfortable, etc.

Whatever the reason, discouraging bicycle riding is counter-productive in a nation – or a city – where we are trying to encourage more people to ride, especially when cycling is rightfully touted as a great way to combat other health problems – like obesity and adult-onset diabetes – that are huge public-health issues in America.

This is why many cycling advocates – including staffers at two Michigan advocacy groups we spoke to – are opposed to mandatory helmet laws. Although, it should be stressed, they absolutely encourage everyone to wear a helmet while riding.

End of Part 1. See Part 2 tomorrow.

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