Arguments over helmet wearing keep coming up and are fairly well rehearsed. There’s the “common sense” pro-helmet argument which runs roughly: wear a helmet as it will help if you hit your head. This is questioned in various ways: am I more likely to hit my head cycling than walking or driving? By wearing a helmet am I making cycling seem more dangerous than it is? Will wearing a helmet change my behaviour such that I take more risks? Will it change driver behaviour so that they take more risks around me? And is it really going to do anything if a tipper truck driver fails to notice me and drives over the top of me.
These are sometimes countered with testimony from surgeons saying that helmet use saved various patients’ lives. With some frequency those who are insistent on helmet use will just return to the original “it’s common sense” followed by “are you afraid you’ll mess your hair up?” Then the argument can deteriorate somewhat. I should add at this stage that the argument is rarely pro-helmet vs anti-helmet. It’s usually pro-helmet vs pro the choice not to wear one if I’m nipping to the shops via the back roads.
In following these discussions it seems to me that the phrase “common sense” is often used when someone hasn’t sought out any facts to back their argument up. They don’t feel a need to go looking for facts because to them the case they’re stating seems obvious, it’s commonly known, it’s “common sense”. However, when you examine these common sense arguments they often seem to be a gut, unexamined reaction that isn’t actually backed up by all the data available. In response to a challenge someone may go and find some evidence to back up a common sense argument but often that data suffers from confirmation bias. It’s data chosen with a particular end in mind, it’s partial and there may well be other data that presents a very different picture.
A few weeks ago I got into a brief discussion with someone on Twitter from the Bicycle Helmet Initiative Trust, a charity which states that it “is committed to saving young people’s lives by promoting safer cycling and, in particular, the use of cycle helmets”. Someone from the trust tweeted that:
To which I pointed out that teaching the children about the difference between objective and subjective risk might have been more useful. The BHI Trust replied that they were happy to debate the issue but admonished “Let’s be sensible”. So I started to wonder about what we mean by being sensible and the ways in which we use claims of sensibleness as a rhetorical device in an attempt to shut down argument. And if you don’t teach children properly but just repeat something that’s “common sense”, what you get is tweets like these from full grown adults:
It’s news to me that personal protective clothing (PPE) is essential when cycling. Oh I might want to wear it if I’m going fast down hills, but arguing that it’s essential means that cycling is inherently dangerous and puts the onus on the cyclist to make it less so, rather than examining the wider reasons why cycling might seem or actually be dangerous.
It is commonly recognised amongst those who investigate health and safety that PPE should be a last resort, not a first one, hence this advice from NHS Scotland. PPE only protects the person wearing it whereas the hazard can be removed from everyone if it’s tackled at source. Thus the organisation argues, “PPE must always be regarded as a ‘last resort’ to protect against risks to safety and health. Engineering controls and safe systems of work must always be considered first”. In countries where cycling is viewed as normal and cyclists have clearly separate space very few of them wear helmets, because the hazardous element to cycling has been greatly reduced.
However, since the UK does have hopelessly inadequate cycling facilities, should I wear a helmet? Will it help? Well as counter-intuitive as it might sound, the jury is out on that one. And yes, I know A&E doctors will often say that someone’s life was saved by a helmet. But do they actually know that? Much as I respect the ability of those who work in such departments, there is a difference between treating an injury, and carrying out scientific tests on the best way to prevent that injury. There is evidence that in some falls helmets actually increase the chance of rotational injury. (You can read more about rotational head injuries here and here although I warn you, it isn’t fun. Or search on “Diffuse Axonal Injury”. Such injuries are apparently very common in motor vehicle accidents). In a very detailed paper here Bruce Barcott argues that whilst helmets do a great job in a major crash, they don’t really help prevent concussion. (Unfortunately due to the ingrained belief that bike helmets work, there has been little done to improve them. In contrast, helmets for horse riders are continually researched and developed).
In the interests of covering all possibilities, let’s assume for a minute that actually, PPE is the first port of call and that helmets work. This being the case, are there other times when I should wear one? Is there anything else I do that is as likely as cycling is to cause me a head injury? The Center for Disease control gives the US stats. Cycling doesn’t appear. Falls dominate but “motor vehicle crashes were the third overall leading cause of TBI [traumatic brain injury] (14%). When looking at just TBI-related deaths, motor vehicle crashes were the second leading cause of TBI-related deaths (26%) for 2006–2010”. This would suggest to me that, if helmets do work, I really ought to be wearing one in a car. In fact, it would help whilst I’m out and about as another 10% are due to assaults. In the US, cycling doesn’t seem to register as a single cause.
But what about children? In the majority of cycling—driving accidents it is the driver at fault but the stats are different for the under 12s. So is cycling high on the list of things that cause head injuries in children? Wolters Kluwer, a company which provides information internationally to health organisations, gives stats that show that falls are the most common cause of head injury followed by motor vehicle crashes, pedestrian and cycle accidents, sports and, rather sadly, abuse. It advocates helmet use for cycling and some sports, but despite stating that high speed motor vehicle accidents are more likely to cause severe brain injuries, does not argue that children should wear helmets in cars.
If I drill down into the stats, I reach the conclusion that I at least ought to wear a reinforced hat after a glass of wine and once I’m over 65 I’m going to glue a motorcycle helmet to my head. So how have we arrived at this situation in which helmet use for cycling is “common sense” but it isn’t advocated in situations in which head injuries are most common? Well I would suggest it’s to do with who we think is actually responsible for causing accidents.
Reports of motoring accidents almost universally blame the car, making it the subject of the verb rather than the object. When I put “car accident news” into a search engine one of the first hits I get is “Dad’s fears after a car crashes into his garden”. To read the article I would have had to click on several adverts, so I didn’t. From the headline I get the impression of a wildly roaming car bounding around the countryside and terrorising suburbia by wilfully rampaging around gardens. I suspect the truth is that someone drove the car into the garden, since cars are not in fact wild animals. Changing tack and searching instead on “car crash” I get this from the BBC in which a car “left the road”. This article worries about older drivers but nonetheless says a “car slammed into” a person not that it was “driven into” a person. This article despite discussing speeding and driver behaviour, still quotes someone saying “cars go to [sic] fast on the road” rather than arguing that “cars are driven too fast on the road”. Back when we had carriages pulled by horses, this grammar might have been correct. Now that cars are purely mechanical and not drawn by animals with a mind of their own, it’s about time we took responsibility for the way in which we drive them.
In these situations, in which the car is an active agent and the subject of the verb, anyone injured becomes the hapless victim of chance. In this news story the driver injured her head, but there’s no mention of a helmet. This driver suffered a serious head injury, no mention of a helmet. I don’t doubt that sometimes the drivers are innocent victims, either of other drivers, or of some unforeseeable mechanical failure. However, news stories repeatedly make the car the active agent, as if the driver were some innocent bystander, whether or not the driver was at fault (and make no bones about it, if you were driving too fast for the conditions, you were at fault).
Contrast those accounts with this account of a cyclist suffering serious head injuries and the way in which the reporter felt the need to comment that he was wearing a helmet. By making PPE the focus of stories about cyclists, the cycling itself becomes a dangerous activity in which the cyclist is at least in part to blame, simply by engaging in that activity. And the neat trick here is that if cycling is dangerous and the cyclist is at fault, by extension the driver in any car/ bike collision isn’t. Thus Women Writers can quote someone saying “I find that mundane tasks, like driving, allow me to pour new ideas into my head”, and driving becomes something everyday, safe and innocuous that can be undertaken whilst thinking about other things.
So it isn’t necessarily common sense to wear a helmet whilst cycling. Or at least, if you apply the same standards of risk assessment, it is common sense to wear a helmet whilst engaged in many other activities. Look beyond the obvious and it makes even more sense to engineer environments such that you’re less likely to have the accident in the first place. For cyclists, this means separation from motorised traffic. For drivers it means better training, retesting and a realisation that controlling a ton of metal at three times the speed at which humans have evolved to travel is anything but mundane.
As AT OM pointed out in the comments below, to assess whether cycling is more or less dangerous than other activities, one needs to make comparisons based on how often these activities are carried out. This is something I have discussed before, in a previous post about helmet wearing and you can read a report by staff at University College London here.
If you want to see just how truly bizarre arguments over helmet use can become, see this article in the Dorset Echo (HT to @gazza_d) in which a mother argues that cycle helmets should be compulsory after her son hit a pedestrian, knocking the pedestrian unconscious and causing her a head injury. Yes, let’s go over that one more time. Cyclist hits pedestrian. Cyclist has cuts and bruises, pedestrian has head injury and the logical response is for the cyclist to wear a helmet, apparently. Well actually, no. The logical response would be to examine how the accident came about and then try to prevent something similar happening in future. Is the infrastructure such that at that point cyclists and pedestrians are brought into conflict? Is the child aware that pedestrians often step out without looking and so you need to leave them plenty of room? Is the child aware of appropriate speeds on a bike? Is he aware that you need to be able to stop in the distance that you can see and that you save valuable seconds by covering your brakes? And yes, Dorset Echo, he is a child, not “Cyclist Jordan Moore”. He’s fifteen, he’s not about to do the TdF. And since he is 15, if his mum wants him to wear a helmet she should make him wear one. For crying out loud.