Wear a helmet: It’s common sense

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:

BHI tweet

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:

Traffic WMP1

Traffic WMP2

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.

On edit:

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.

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20 Comments

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20 responses to “Wear a helmet: It’s common sense

  1. pm

    The term ‘common sense’ really needs to be shamed out of existence in the way Godwin’s law has tended to do for inappropriate Nazi comparisons.

    Its deployment, pretty much regardless of the topic, does indeed, almost invariably, mean “I have no evidence or supporting argument for what I’m saying, but in desperation I am just going to declare it to be true in an entirely arbitrary fashion”.

    Besides, if sense were that common, there would be far fewer journeys made by car.

    Choosing to make a non-essential car journey creates a far greater risk to health and safety than choosing to cycle without a helmet (not just through the risk of RTAs but via the near-certain, cumulative, effects of air pollution). So why do the proponents of compulsory helmets not also demand the former be made illegal?

  2. Paulc

    I am really sick and tired of the “if it saves one life” comments from the pro helmeteers in forums etcf. They have no real evidence to back their claims but resort to quoting A&E doctors who claim that helmts save lives…

    Perhaps the real problem here is that cars etc. keep on hitting cyclists? Perhaps stopping that from happening is far more important than cyclists wearing helmets?

  3. otherhannah

    Really we should be aiming for ‘reasonable interpretation of available evidence’ rather than ‘common sense’ as a standard for justification. Humans are rubbish at risk interpretation, as you rightly point out. Unfortunately, most people aren’t even aware how rubbish at risk interpretation people usually are, and trying to argue risk ratios, odds, confidence estimates, etc, doesn’t get you anywhere 😦

  4. The Maeus

    The main scenario that keeps me wearing a helmet: take a turn too fast and have your bike slide out from under you, smack the side of your head on the ground — hurts a lot less with a helmet (and, yes, I’ve experienced it both ways). I only go helmet-free if I know I’m going to stay slow, am familiar with the terrain, and won’t be riding in a pack of other cyclists.

    • The Maeus

      Also, I like having a rear-view mirror, and find the helmet-mounted ones work best for me.

    • I quite often wear a helmet for similar reasons Maeus, especially if it’s cold enough for ice to be a risk. However, in terms of campaigning for safety, I would rather people concentrated on infrastructure. I would also rather, as Hannah says, people had a greater understanding of risk and how bad humans are at judging it.

  5. Whilst I basically agree with the spirit of this article i feel the stats analysis to be confused and potentially misleading. Looking (as it seems to) to american incidents of head injuries is meaningless unless this data has been correctly adjusted to take into account overall engagement levels in each activity. Far fewer adults cycle than travel in motor cars so you would expect to see less head injuries from cycling than from car use. The only possibly meaningful stats are head injury per mile traveled or possibly head injury rate per user of each form of transport.

    With unadjusted data we can easily draw spurious conclusions such as BASE Jumping is less dangerous than using the stairs – after all far more people die each year falling down the stairs than they do BASE jumping! With such stats its hardly worth wearing a parachute 😉

    I very much respect people’s rights to cycle without a helmet and choose to do this myself. However I do so based not on any proper risk assessment, more based upon convenience and perhaps over confidence in my own abilities. I would very much like to see some properly carried out research and statistical analysis of the risks.

    • Yes, I didn’t mention it here but I’ve discussed it elsewhere, ATOM. The problem with establishing which activity is riskier – cycling or driving – is in how the relative risk is calculated. Is it per hour engaged in the activity? Per mile? There are different reasons for using either of these, and they will give different answers. And then of course most of us spend a lot of time doing things that might cause us to fall, hence the high number of head injuries associated with falls. And then there’s the difference in type and severity of injury that result from these various activities.
      That said, I stand by the argument, that if you’re trying to prevent injuries at population level, you go for the most common cause (which may well be the most common activity, rather than the riskiest activity). And I also stand by the argument that cycling itself does not have to be seen as risky. Blaming a cyclist for not wearing a helmet, in a situation in which the driver was at fault, is clearly victim blaming.

    • There is some pretty detailed analysis out there, which I’ll try to post a link to later. Part of the problem is breaking it down by environment in which the travel is undertaken since rural roads, urban roads and motorways all carry different risks. Motorways are, if I recall correctly, the place where fewest accidents take place but of course they’re also a road type where you won’t (or really shouldn’t) have cyclists. Then each of those road types involves different types of crashes for motorists. Thus in urban environments you tend to get low-speed shunts. Rural roads are higher speed and motorways collisions, though they are fewer, tend to be more catastrophic.
      If you are going to make comparisons per mile travelled for drivers and cyclists, you just need to be aware of where those miles are and the amount of time/ distance each group is likely to spend there.
      On edit (to save myself commenting 3 times in a row!) there is a discussion of relative risks here http://road.cc/content/news/71717-govt-stats-over-state-risks-cycling-says-new-research-its-pedestrians-young-male although it’s not specific to head injuries. The research they drew on is here http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0050606

  6. Wearing a helmet probably helps – but I’m not so sure it’s worth harassing teenagers or even adults over.

    First off, on current evidence it seems to be a relatively low reduction in risk for the inconvenience.

    Secondly, if we really cared about the risk to cyclists, we’d do the things that maker a bigger difference: designing the roads to be safer, making sure HGVs have mirrors. Each of which is a tiny inconvenience compared to the money already being spent. But transport planners and haulage companies can’t be bothered with that, so why should teenagers have to bother with helmets?

    So I will wear my helmet when I (occasionally) cycle, but I shan’t be very worried if I forget it. Unless my wife is looking.

  7. “helmets for horse riders are continually researched and developed”

    The bicycle helmet industry would have us believe the same is true of its products. Its bollocks of course; bike helmet standards haven’t changed significantly since the 90s and they continue to have no effect on the KSI rate for cyclists, despite mandation in some jurisdictions and widespread adoption in others.

    In the interest of separating marketing from reality, how does the equestrian helmet industry’s research manifest? Have equestrian KSIs decreased in recent years?

  8. Rebecca

    A very good article. My reply lately, to people who comment on my lack of helmet, has been to say bicycling is safe. I think we have forgotten that. Far safer than traveling in a car, running, jogging, walking or stairs.
    On my bike I just roll along safely.

    Here are my anecdotal stories. Hurrying down the stairs while getting ready for our holidays, I tripped and slid down the stairs, once breaking toes, once injuring my hip. It is not uncommon for me to trip while walking, resulting in bloody knees, twisted wrists and once a broken elbow. I broke my wrist while gardening. I had a hairline fracture from walking quickly and falling down a ramp set-up while our porch stairs were being rebuilt. I flipped out of a hammock, banged my head hard and injured my coccyx.

    The four accidents I have had in fifty years of cycling were minor, due to a badly designed sidewalk cut, a large puddle where I thought the curb cut was, trolley tracks and a bike with mechanical problems. I picked myself up and went on my way with minor injuries. I have always been a slow cyclist. Of course helmets are suppose to work best in low speed falls like mine. Falls where I have just gotten up, cleaned off the blood and healed in a day.

    I have never had anyone suggest, after one of my falls while walking that I should wear a helmet.

  9. rdrf

    Good post with sensible arguments. Of course, sensible arguments won’t make the slightest bit of difference to the otherwise intelligent “common sense” brigade.

    Helmet advocacy is a serious red herring in the way of cyclist (and other road user) safety, based on the idea – as you indicate – of cycling being the problem of cyclist safety, and not the danger from motor vehicular traffic to cyclists and other road users.

    Some good points to suggest are:
    + Is cycling more hazardous than being a car passenger, particularly over long journeys – and why not then wear a helmet when sitting in a car?
    + What about adaptive behaviour (risk compensation) by both other road users and wearers?
    + The second point explains the lack of evidence when looking across populations where helmet use has been taken up with compulsion. See this http://rdrf.org.uk/2013/12/27/the-effects-of-new-zealands-cycle-helmet-law-the-evidence-and-what-it-means/

  10. If a person is going to ride a bike they should use a helmet. Period. You can do without a lot of body parts, but we all know that the most important part to keep intact is your brain. The helmet protects the brain, that’s it. Get an approved helmet, one that is brand new, (not one from a garage sale). And wear it each and every time you get on that bike. If you like life, and if you like having control over your own brain and body, a helmet is the way to go. Some of my kids never agreed to wear helmets when riding. Solution – no bike riding for them while they were children. I can not stress the importance of wearing a helmet.

    • I think you should (re?) read the post and the comment just above your own.
      How do you deal with the following problems?
      1. There are other activities which are demonstrably as dangerous as riding a bike yet we do not advocate wearing a helmet for all of them
      2. There is a big difference between riding in the TdF going downhill at over 40mph in a big group of riders and pootling along a towpath to the shops. Cycling is not one monolithic activity. See this http://www.cyclehelmets.org/1261.html on how you’re more likely to need a helmet and have a head injury if cycling competitively
      3. PPE is a last resort not a first one. Focusing on the wearing of helmets whilst cycling detracts from more effective safety measures such as better infrastructure and puts the onus to be safe on the cyclists, not on the ones causing the danger
      4. Advocating safety equipment turns cycling into a dangerous activity, rather than something ordinary and everyday. See this for examples of how safe cycling is https://aseasyasridingabike.wordpress.com/2013/12/31/not-dangerous/

      And to repeat what’s pointed out in the comments above, do you always ask someone with a head injury of they were wearing a helmet? If they slipped whilst walking, or were a passenger in a car, would you tut and say they should have worn a helmet? If not, why not?

      • Thanks for all that information . Personally, I don’t need to read other websites to confirm my opinion that wearing a helmet is a necessary precaution when riding bikes. Fact is, if you hit your head on something solid or hard , or against a hard object, i.e. concrete etc, while you are cycling and not wearing a helmet, your injury will be far greater than if you are wearing a helmet. That fact never changes.

      • Actually the evidence for the protective effects of helmets are mixed. They may worsen rotational injuries and their effects on concussion are unclear. I’d give you links to facts by people who have investigated these things but evidently you’re not keen on evidence-based research.
        Either way, you could make the same argument for hitting your head under any circumstances, in which case you might as well wear a helmet most of the time. You should particularly wear a helmet if you drink alcohol, given the increased risk of injury if you’re inebriated. The arguments you put forward for wearing a helmet whilst cycling can be put forward for many activities.
        There is also evidence that PPE changes people’s behaviour making them more likely to take risks and therefore more likely to injure themselves. Obviously though actually, you know, facts and stuff won’t persuade you because as far as you’re concerned you just know best.

    • paulc

      hmmm and I suppose these folk are mad because none of them is wearing a helmet?

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