Do Helmet Laws Kill (Bike-Sharing Programs)?

by on August 19, 2011

Cyclists in Gas Works Park (Photo: MvB)

Sightline throws an off-speed pitch at the helmet-law home plate, with a post asking if mandatory helmet laws are why bike-share programs succeed or fail. (Seattle Bike Blog readers, you can relax, you read about this several months ago: “Mandatory bike helmet laws are a big issue facing any bike share system in King County.”)

In “Unchain Bike-Sharing,” Jake Kenyon writes:

If bike-sharing has been successful in so many places, why isn’t the Pacific Northwest already in on this? Why are there only two operational bike-sharing programs in all of Cascadia: a small one in Pullman, Washington, on the campus of Washington State University, and a tiny one in Golden, British Columbia? […] It turns out there’s something the Northwest has that other places do not, and it makes all the difference: mandatory helmet laws.

The evidence for this is slight, in one way: “The only failed program in the world is Melbourne’s. It’s also the only one put in place under a helmet law.” On the other hand, the rarity of it being the only failed program says something as well. (For a rigorously anecdotal and off-topic response to bike-share programs and their existence in general, try the comment thread at Slog.)

I think we can agree with Kenyon that bike-sharing programs to tend to attract the casual bike rider, and that adding helmets to the mix (with attendant issues of sizing, style, and hygiene) takes some of the impulsiveness out of hopping on a bike and taking off. And, all of a sudden, you have Massive Head Wound Harry lurking in the back of your mind.

But the reason this post is controversial and much-commented is not really because of bike-sharing, which actual cyclists have little reason to care about — it’s because King County’s mandatory helmet law (base fine $30, court costs $51) is yet another instance where Seattle bicyclists get to sort themselves into law-abiding and law-breaking camps. (If want to bicycle bare-headed until you get caught the first time, all you have to do to evade the fine is show proof of purchase of a helmet.)

There are seemingly contradictory arguments for helmet wearing and non-wearing, but essentially they boil down to these positions: the libertarian (“It’s my choice”), the idealist (helmets don’t “work”/Scandinavian countries don’t use them), and the public safety advocate (data shows bicyclists without helmets die, the numbers are overwhelming).

Per that last point, you can dispense with a lot of the technical jibber-jabber about how helmets are supposed to work or not, or at what speeds — they do. Harborview has a round-up of study after study showing that they do:

It should be made clear that arguments against using bicycle helmets are not evidence-based; bicycle helmets are the most effective means of preventing head and brain injury and should be a requirement for cyclists of all ages.

Yet it is also true that most serious biking accidents are car-related, and that the normal state of bicycling is not catapulting off your bike into a car. You can argue that, priority-wise, you can make bicycling safer than with helmets by simply removing cars from the equation.

That has been the direction of Scandinavian countries, and their widely used bike infrastructure. I classified this under the “idealist” position, above, when it comes to helmet use, because you derive none of the safety benefits of Dutch cycling while biking in the U.S. (Yes, even if on a Dutch Bike Co. bike.)

Kenyon concludes his Sightline post by saying the Northwest “just needs to tweak its helmet laws.” His suggestions are to make not wearing a helmet a secondary offense (i.e., not something you can be pulled over for alone, but something that can be tacked on if you blow through a red light), and to exempt bike-sharing from the helmet law.

The first tweak soothes the libertarians out there, while the second plays to the idealists (“When everyone rides, it’s safer”). It’s hard to justify the first to motorcyclists, who would no doubt like the same application of the law. As for the second, you’re creating a special class of cyclist. I wonder if the better tweak would be to require mandatory helmet usage if cars are “sharing” the road: That would create an incentive for bike boulevards and other solutions where bikes are physically separated from cars.

14 thoughts on “Do Helmet Laws Kill (Bike-Sharing Programs)?

  1. Actually, there are two failed bike share programs in the world and both are in Australia: Melbourne’s and Brisbane’s.

    In Melbourne we have added $2million of taxpayer’s money to subsidise disposable helmets and in Brisbane they are buying 400 helmets and just leaving them with the bikes (while totally ignoring the part of the law that says they must be properly fitted).

    Make no mistake, helmet laws make bike share unworkable.

    Both of Australia’s schemes are currently on the path to being scrapped and no other city in Australia is remotely interested in giving them a go.

  2. Bicycles

    * There were 51,000 bicycle injuries and 630 fatalities in 2009.

    * About 153,000 injuries and 500 of the fatalities are from head injuries.

    Passenger Vehicles

    * Motor vehicles account for 294,100 TBI’s every year.

    * Side-impacts accounted for 27% of all fatalities in 2009, with 60% of those fatalities involving brain injury. That means of the 33,963 fatalities in passenger vehicles: approximately 9,170 died from side impacts, and 5,502 died with brain injuries!

    Conclusion

    Dead is dead. Helmets save lives! Helmets on people in cars don’t cost a dime more, and yield the same benefits. Let’s mandate helmets on drivers of ALL vehicles.

    You were serious about that “helmets save lives” thing, weren’t you?

    Addendum

    Please, don’t say “but passenger vehicles wear seat belts!” And still 5,502 died from head injuries – what’s you point? That 5,502 dead people in cars is OK simply because they wear set belts, but 500 bicycle fatalities requires mandatory helmets? Present your argument to the panel of psychiatrists at your next mental competency hearing.

    Please, don’t come back with a case based on Vehicle Miles Traveled. Are you suggesting it’s OK to allow 5,502 people to die simply because they drive cars more often, and further? See that “mental competency” thing above.

    • @Terry: What’s your crank-with-agenda point, again? You could save everyone on the internet some head-scratching if you’d forego the attempt at cleverness and just make your argument.

  3. Unfortunately the fact is that bicycle helmets at best provide very marginal protection. Much less than people have been led to believe. That’s why head injuries have gone up with helmet use. They also increase the risk of additional brain injury due to the common shape and outside texture. Typically also bicycle helmets are badly designed for impact on a human head due to the faulty way they’re tested for rating purposes. This makes them particularly dangerous when put on children.

    Looking at the research referenced by Harborview more recent analyses have found the Attewell study cited to be full of bias plus more recent research has found helmets provide no overall protective effect.

    If want to wear a helmet make sure it is as close to the shape of your head as possible, that it is a single piece that will distribute force and the outer surface is such that it will not bind on impact. In the case of children the helmet should contain an inner lining that has been tested to compress against a soft human skull.

  4. Dan, if you’re going to say things like “very marginal protection,” you’ve got to provide links. That Harborview meta-study may have looked at old data, but it did contain 12 different studies, concluding: “Overall, helmets decrease the risk of head and brain injury by 70 to 88 percent and facial injury to the upper and mid face by 65 percent.” Even with bias, that’s not marginal at all. You appear to be saying those studies were incredible bullshit, which I am fine with, if you have evidence of that and, correspondingly, can indicate why the “new” studies are free from error.

  5. It’s really only necessary to refute one study, which Dr Elvik has done. That throws Harborview’s claims into question as it means they have not evaluated the studies they cite. Add the fact that they mysteriously fail to cite any research done in the last ten years and we have a clear possibility of selection bias.

    One of the things we must see if helmets are really 60+% effective is a much higher percentage of deaths and permanent brain damage in countries where helmet use is low to non-existent.

    Furthermore anyone who has cycled for the last 20 years should be well aware that bicycle helmet design has changed. Protection as the main imperative has given way to comfort and aesthetics. It is quite amazing that anyone really believes something that consists mainly of holes, thus failing the first rule of helmet design, is going to provide serious protection.

    What do wearers think is going to happen when that cute looking piece of plastic catches against the tar as it hits the road, twisting their neck and causing the brain to rotate rapidly before smashing into the skull? Anyone who simply states having something stuck on the top of my head must be better than nothing has evidently not really considered the possible unintended consequences.

  6. wearing a helmet reduces the chances of a serious head injury and in my humble humble opinion not wearing one just makes you a C**K

  7. I believe Dr Rune Elvik covers this quite comprehensively. You’ll also want to look for a report by Bill Curnow.

    A cursory search will turn up information on bicycle helmet design and testing methods. They are not tested on anything remotely resembling a human head (shape is not enough). Nor are they tested for any scenario other than a direct linear impact, which is the least likely to cause serious injury.

    For information on standards you can look at Snell B-90, the old standard that at least provided some decent protection against direct impacts, and EN1078, the newer, weaker standard.

    It should also be quite easy for you to find the injury numbers which show that injuries have gone up in real terms in Australia since the introduction of helmet laws.

    Thankfully I think the tide is turning. Mexico and Israel are giving up on bicycle helmet laws. Britain has looked at the evidence and concluded there is not sufficient reason to mandate helmet use.

    • At first glance, the table would seem to show that as helmet use has increased, the number of head injuries has remained, as a percentage, more or less the same. I can see how you might think that argues against helmet effectiveness.

      But since the chart doesn’t break out helmet-wearers from non-helmet-wearers, or head injuries from fatalities, it doesn’t tell you much, except that if you got into an accident on your bicycle the last 10 years, you had an 11% to 12% chance of head injury requiring a visit to a hospital.

      1) Here are my problems with the data: If 50% of the biking population wears bike helmets, that means 50% aren’t. Unless we can establish the rates at which helmet-wearing vs. non-helmet-wearing cyclists visit hospitals, we’re blind to helmet effectiveness.

      2) I can’t automatically correlate “significant protection” with the generic classification of “head injury.” I’m not sure if that would include facial trauma (which most helmets don’t protect against), or head injuries that led to fatalities. Of these, I’m most interested in head injuries vs. fatalities, since a helmet that saved a life could also leave you with a head injury.

  8. The Studies quoted on the Harborview link cited in the article are all “observational” studies, which cannot be used to drawn causality conclusions. Observational studies cannot control for all possible confounding effects and often produce perversely incorrect conclusions.

    The list of studies cited omits all the studies which find helmets do not have any effect – there are plenty of these including the important, recent Elvik paper. Conclusion: the author of this list is biased.

    In the case of Hormone Replacement Therapy (HRT), observational studies showed a protective effect for some types of cancer. Finally a randomised double-blind study was undertaken which proved the opposite was the case. Observational studies are dangerous and should not be used to inform policy.

  9. Yes, the Melbourne bike share is a huge failure. Each bike ridden about 0.75x a day compared to a similar scaled scheme in Dublin where the figures are more like 6x a day. Brisbane just recently launched their scheme, so it is too early to tell, but preliminary figures are not promising.

    This is a recent study (Elvik 2011) which reexamines old helmet studies and finds they inflated the impact of helmet wearing and finds when you add in neck/face injuries caused by wearing a helmet, the net effect of wearing a helmet is basically zero.
    http://dx.doi.org/10.1016/j.aap.2011.01.007

    In case you can’t see the article behind the paywall, the conclusions are:

    1. A re-analysis has been performed of a meta-analysis of the protective effects of bicycle helmets reported in Accident Analysis and Prevention (Attewell et al., 2001). The original analysis was found to be influenced by publication bias and time-trend bias that were not controlled for.
    2. When these sources of bias are controlled for, the protective effects attributed to bicycle helmets become smaller than originally estimated.
    3. When the analysis is updated by adding four new studies, the protective effects attributed to bicycle helmets are further reduced. According to the new studies, no overall effect of bicycle helmets could be found when injuries to head, face or neck are considered as a whole.
    4. The findings of this study are inconsistent with other meta-analyses, in particular a Cochrane review published in 2009. However, the study inclusion criteria applied in the Cochrane review are debatable.

  10. I have to admit after several bicycle accidents involving cars while young that left goose egg sized lumps on my head I can’t say that current helmets would have made a difference. If you compare a motorcycle helmet with a bicycle helmet they are not even close in safety standards. It is just more nanny state ideals run amok. Of course if the safety Nazis have their way we will be wearing full coverage motorcycle helmets to ride bicycles soon. Maybe even self-inflating air bag clothes.

  11. I’ve noticed that those who are in favor of helmets post a decade old study (Thompson) which does not say what people think it means. Or those pro-helmet use “common sense”, personal anecdotes, or they insult those of us who even dare to ask why there’s a double standard on helmets. Why are the LEAST AT RISK group (cyclists) forced to wear helmets, only.

    I also noticed that people who push helmets HAVE TO INSULT those of us who don’t want to use them. Why not stop the childish insults and answer our objections. Why not helmets for motorists, pedestrians, children, showering, and walking up and down stairs. That’s because helmets are ridiculous in those realms and if you think too long about it, you’ll realize that they are absurd for all cases. But you don’t think because it’s easier to dodge the hard questions, fall back on platitudes (anything helps), and to mock us.

    Those against helmets have done studies, they have population data, and there’s a wealth of data from those countries which were dumb enough to propose an unproven, un-uniform (helmets vary in quality), and untested solution to a public safety problem.

    The maker of a new bullet proof vest shot himself to prove that his vest works. This is standard for safety equipment. The googles I wear protect my face from the acid I might spill on them. Helmets totally fail this test. Most people who are injured or died on a bicycle didn’t do so because of lack of helmet. They were hit by a high speed car.

    The entire helmet debate is a giant distraction for the real danger to cyclist and it’s awesome for those who don’t want to do anything for real bicycle safety because they are such a time suck. When we continue to push helmets, we continue to give people excuses to do nothing to make real safety changes.

    There are studies on what works and does not work for every intervention. Put up a paper which shows that helmets have saved significant lives from high speed impacts 30 MPH plus from motor vehicles. Until then helmets are a sad distraction which keep us unsafe.