I don’t often post things on our Cyclomania egroup but the helmet development below strikes me as one that deserves wider dissemination.  The email from John Franklin of the Cycle Campaign Network to which we are affiliated says it all.  If any members of the Campaign are in the medical profession this is the time to act.

Bryan

-----Original Message-----
From: John Franklin [mailto:john@...]
Sent: 07 November 2004 22:17
To: CCN Exchange
Subject: [ccnexchange] URGENT: BMA support cycle helmet law

Please read the following message. If you know doctors, please ask them to voice their concern to the BMA
about the selective evidence used by BMA to change its position and the undemocratic closed process that has
taken place.

CCN and CTC will be doing what they can to address this threat, but your help will be needed.

------------------------------------------------------------------------

As many of you will already be aware, the British Medical Association has
suddenly changed its position on cycle helmets - the BMA now supports
compulsory use of helmets by both adults and children. The paper justifying
this decision may be found at:

http://www.bma.org.uk/ap.nsf/Content/cyclehelmetslegis?OpenDocument&High

The original position of the BMA was arrived at in 1999 as a result of
extensive gathering of evidence from many points of view. The decision not
to make helmets compulsory was fully explained in a report called Cycle
Helmets. This was an open process. The result was a reasonably balanced
presentation of the evidence then available, although it was lacking in
effective treatment of the issue of risk in cycling (actually very low).

The change of stance has been, by comparison, a closed process sprung as a
fait accompli. The new policy in most respects rejects the findings of the
original study, yet in general on the basis of evidence already available in
1999! I am distributing this critique of the pro-compulsion paper to
interested parties, notably doctors who may be members of the BMA, in order
to ensure that you become aware of what is being done in your name. You may
be inclined to object to the sudden change of heart by the BMA.

There are some specific points I would like to emphasise, on the basis of my
own knowledge:

1. The paper begins by creating the impression that there is large support
for a cycle helmet law in the medical profession. In support of this, it
cites a single communication from a single doctor. However, the BMJ carried
out an opinion poll of its readership in 2002. This showed some support for
a cycle helmet law, but roughly equal support for a pedestrian helmet law
for children. The respondents showed far higher support for measures against
bad driving and reduced speed limits to reduce danger at source. The poll
results can be found at:

bmj.bmjjournals.com/cgi/content/full/324/7346/1107/DC1?ck=nck

These results do not justify the claim that doctors want a cycle helmet law.
If the BMA wishes to alter its stance on an important public health issue,
it should do a professional job of it and poll its members openly.

2. The paper rejects evidence that helmet laws suppress cycling, especially
by children. The reasoning is that experience in Australia is "out of date".
In support of this, the case of Ontario is cited, where legislation
apparently did not suppress child cyclists. There is a simple reason for
this; the Ontario law was never enforced. If a law isn't enforced, it can't
deter cycling, can it? The evidence that helmet laws deter cycling is so
overwhelming that one could write a paper on the topic alone. Cycle use in
Australia is still below, or hardly above, what it was in 1990 (before laws
were passed) when population increase is accounted for. In Western
Australia, the population has increased by 33% since 1990, but cycle counts
only rose above pre-law levels again in the last couple of years. Cycle use
was growing in WA before the law was passed - the law destroyed that growth
permanently. Those interested are recommended to see www.cyclehelmets.org
for a litany of examples. By taking Ontario as an example to "prove" helmet
legislation does not suppress cycle use, the BMA stray into the realm of
intellectual corruption. See:

Burdett A. Efficacy of cycle helmets and ethical arguments for legislation.
J R Soc Med 2004;97:503.

3. In justifying the "need" for a helmet law, the paper cites various injury
figures. These appear large, but only because so many slight injuries are
captured. In reality, there are about 3,000 serious injuries in road cycling
accidents per year, and 130 deaths. This works out at on average 1,000 years
of cycling by the cyclist population per serious injury, 3,000 years per
serious head injury, and about 20,000 years per death. In other words,
cycling is a low risk activity and puffing out the figures by including a
mass of slight injuries does not change that. The cycling environment in
Britain presents risks comparable, or less, than driving in France.

The paper claims that there are more than 50 child cyclist deaths a year in
Britain. This is not correct. There are about 20-25 deaths in road accidents
(which are accurately reported by the Police, if less so by coroners), of
which approx. 15 will have suffered fatal head injury. Contrary to the
impression given, pedestrians are just as prone to serious or fatal head
injury as cyclists, or perhaps a little more so. In addition to the 15
on-road deaths, there will be a small number of off-road deaths.

The pedestrian population faces higher risks per mile travelled than
cyclists, by a factor of 1.6, and pedestrians are far more vulnerable than
cyclists, adults pedestrians being about twice as likely to be killed in a
reported road accident than adult cyclists.

The reality is that the actual risk in cycling is low and does not warrant
draconian measures imposed at the individual level. The best way ahead is to
increase cycle use, which makes it safer anyway, and provide more effective
cycle training and sensible advice on when a helmet may provide some
benefit. A cycle helmet is not intended to provide protection in a road
accident. It is fundamentally unethical of the BMA to propose helmet
legislation as a road safety measure.

4. In support of the effectiveness of legislation, the paper cites a number
of claims about helmets preventing brain injuries and helmet laws reducing
deaths and serious injuries. Reductions in deaths and head injuries after
helmet laws have always run in line with prevailing trends for pedestrians.
The Victoria helmet law is often cited as a success, but it was introduced
along with measures against speeding and drunk driving. Pedestrian deaths
fell 45% in the first year of the cycle helmet law. Pedestrian hospital
admissions for concussion fell by 28% and 75% in the first and second year
of the cycle helmet law, respectively - pretty much the same as the result
for cyclists.

Careful follow up studies have failed to produce any convincing evidence
that helmet laws reduced serious injuries in the cyclist population. This
point is carefully dealt with in presentation material that may be found at
the web site of the Cross Party Cycling Group of the Scottish Parliament
(note that this material has just been revised and a new version will be
placed in the next few days).

www.scottish.parliament.uk/msp/crossPartyGroups/groups/cpg-cycle.htm

The large discrepancy between predictive observational studies, reporting
60-75% prevention of brain injury, and the null results of legislation is
easily explained. Observational studies are based on samples drawn from two
totally different groups: those who do self-select to take a treatment
(usually a minority) and those who do not (usually the vast majority).
Inevitably confounding social factors have such a massive influence that the
results may mean very little. The current crisis of confidence in
observational epidemiology arises from similar experience with Hormone
Replacement Therapy and vitamin supplements. The problem of unreliable
science has become acute in the cycle helmet issue because proponents of
helmets and helmet laws absolutely refuse to face up to the realities of the
situation.

PERSONAL VIEW.

I finish with this personal view. The BMA has acted with inexcusable
arrogance in this matter. The decision has been taken behind closed doors,
the membership has not been effectively informed (there is no mention of the
change of policy in the current edition of the BMJ), the evidence presented
is so selective as to amount to intellectual corruption, especially with
regard to the denial of the deterrence of cycling by legislation, on the
basis of a single province where the law was never enforced. I would hope
that those reading this will likewise feel outraged and make their feelings
known to the BMA.

Kind regards,


Malcolm Wardlaw.


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