Tuesday, November 13, 2012
Beating the importance of bike helmets into everyone
Here's a great article questioning some wisdom that has become quite conventional.
[As you may know, I rather like that kind of thing.]
Like a lot of preventive health ideas, we have beaten the importance of bike helmets into (onto?) everyone's head. Overall, this is probably a good thing.
I was lucky in my previous job to be able to walk or ride my bike to work. On the few occasions I failed to wear a helmet, I was castigated by my children, my wife, and even passers-by on the street. When you're a doctor, there's higher pressure to practice what you preach. [Hey, nobody ever said role modeling is easy.]
Like seat belts before them, helmets have become so routine that riding a bike without one makes me feel naked.
But what is the cost?
We can calculate real and theoretical costs of head injuries due to bike accidents. There are sobering stats: 91% of those killed while biking in 2009 were not wearing helmets. So the danger is real. But what about people choosing not to ride a bike because of mandatory helmet laws?
The article compares cities that have bike sharing programs, where people pay very little (or nothing) to borrow city-maintained bicycles and use them as a healthy, non-polluting transportation source.
Author Elizabeth Rosenthal, anticipating New York City's inauguration of a bike sharing program, compared cities that required helmets with those that didn't. Perhaps unsurprisingly, cities requiring helmets had much less uptake of bikes than cities that don't. Examples:
--Melbourne: Climate:Temperate/ Helmets:Required/ Uptake: 150 rides/day
--Dublin: Climate:Rainy/ Helmets:Not required/ Uptake: 5000 rides/day
--[editor's conclusion]: Happiness: Dublin
An expert that Rosenthal interviewed summed up the thinking this way (with some U.S. counterpoint):
"Pushing helmets really kills cycling and bike-sharing in particular because it promotes a sense of danger that just isn't justified--in fact, cycling has many health benefits," says Piet de Jong, a professor in the department of applied finance and actuarial studies at Macquarie University in Sydney. He studied the issue with mathematical modeling, and concludes that the benefits may outweigh the risks by 20 to 1.
He adds: "Statistically, if we wear helmets for cycling, maybe we should wear helmets when we climb ladders or get into a bath, because there are lots more injuries during those activities." The European Cyclists' Federation says that bicyclists in its domain have the same risk of serious injury as pedestrians per mile traveled.
Yet the United States National Highway Traffic Safety Administration recommends that "all cyclists wear helmets, no matter where they ride," said ... an agency official.
There's an ironic (but happy-ending) twist to this story: Three days after the article ran, former Boston Red Sox manager Bobby Valentine was riding his bike in New York's Central Park. He made the unwise choice of reading a text while biking, then flipped over his handlebars, injuring his knees and hips.
Said Valentine (per the Los Angeles Times story): "I shouldn't have been reading a text while I was riding. That's the wrong thing to do. But at least I was wearing my helmet."
[Two days after that, Red Sox management fired Valentine for leading the team to their worst record in 47 years. Unclear if helmets were involved.]
This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.
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