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It’s the hippocratic oath, not the hypocritic oath

May 8, 2013
Organised bike ride in Iceland. In Australia, the nation of strict helmet laws, this would be classed as organised crime.

An organised bike ride in Iceland. In Australia, the nation of strict helmet laws, this would be classed as organised crime.

Michael Dinh, co-director of trauma services at the Royal Prince Alfred Hospital, offered his perspective on bicycle helmets.

Read here: http://theconversation.com/bike-helmets-an-emergency-doctors-perspective-13935

Naturally, he misses the big picture. A response…

Geez, another bigoted article. Some doctors are the biggest hypocrites on the planet. Where’s all your sympathy for the head trauma to motorists and pedestrians, or indeed any activity that might have had an injury reduced by wearing a helmet? It’s an absolute disgrace. Cyclists make up less than 3% of road head trauma. So while you fatuously “care” about that 3%, you don’t give a hoot about the 97%. It’s absurd.

As for the “health costs”, again, major hypocrisy. They are taken up by most by disorders caused by sedentary lifestyles, obesity, smoking, drinking and baking in the sun. Where’s your cry for action there? It’s farcical that you pick on a minority just because their voice is so small that they can’t answer back.

Let’s get things straight. We are not talking about helmet wearing; we talk about helmet LAWS. Feel free to wear a helmet if you like. You don’t need a law to hold your hand. The vast bulk of people would still wear a helmet if there were no law anyway. It’s for those that won’t ride as often or at all, do we want to live in a society that BANS these cyclists or PERSECUTES them when we won’t do it to other far more egregious sections of the community burdening our health system?

That’s the irony. A cyclist is out there cycling – getting exercise, keeping fit. He’s SAVING the health system whether wearing a helmet or not. Since he is saving the health system, he has a damn right to choose whether to wear a helmet while doing so.

Because governments are are so obsessed with helmet laws, that stops them doing real safety measures: like infrastructure. Because of this inaction, it puts cyclists onto the roads to dodge traffic and causing  all the serious cycling injuries. Helmets don’t save lives. They might save a few lives. They also don’t prevent all the really serious injuries to bodies with broken bones, backs and internal injuries. Do they? No.   Those lives could only be saved and injuries only prevented if the cyclist was never on the road in the first place.

Since the government and pious nanny-staters believe helmets are gospel in road safety, nothing is done to address the real issues to make cycling safer. Basically the attitude to cyclists is “Go play in traffic. If you die or are seriously injured, we did our bit by legislating helmets. If you don’t like wearing helmets, you should not be cycling at all”. Absurd.

The key question that is never asked is this: Would you prefer a cyclist out there exercising regardless of a helmet, or would you rather he not exercise at all? If the doctors really thought about it, they’d say the latter. Lack of exercise is this country’s biggest killer. Mandatory helmet laws, by suppressing cycling and promoting it as dangerous, oppressive and inconvenient, is an accessory.

Some quotes from the article that need challenging…

* Now this been shown in a one-year study I conducted, with two colleagues, of injured cyclists and motorcyclists presenting to seven major trauma centres in Sydney.

This is utterly preposterous to study such a small sample group, over such a short period, and without any scientific or procedural basis. You know right from the go that this article is to serve a predetermine conclusion.

* The risks of severe head injury were more than five times higher in cyclists not wearing a helmet compared to helmeted ones

Given Australia has had a helmet law for over 20 years and that the wearing rate is close to 100%, unless you re-create the exact accident, how can you extrapolate the chance of injury? Just because you see a scratch or dent on a helmet, that does not automatically translate to a severe head injury. Even a cracked helmet, many do crack at the slightest impact. More importantly than that, because of the bulk of the helmet, that’s a far greater target for a heavier impact, or even any impact, than a bare head.

Even if you take at face value the “five times higher”, it’s not about that. Otherwise we’d wear helmets all the time and in all avenues of life. It’s about the overall risk, which is incredibly low. Australian data [+1] from the 1980s (pre-helmet law) showed per 10 million km travelled, NSW had 7.4 deaths, Victoria 6 and WA the lowest at 4.2. If we presume a commuting cyclist does 100km per week (10km between home and work), he would need to cycle continually for 192 years before being at risk of killed. That excludes mitigating factors like route and behaviour. At 20 kph, a cyclist takes 5 hours to cover 100km. Therefore, he’s at risk of death at 1 in 336000 years on his standard cycling rate. Really, who are helmet laws really trying to protect?

Incidentally, for drivers, the rate is .6 deaths per 10 million km travelled. Of course, drivers travel much further than cyclists. If it’s more than 10 times, then the death rate is equal. So where’s the call for helmets there? Seatbelts are not the equivalency to a cycling helmet. Seatbelts restrain, not protect. If your head is about to smash against the interior of the car, the seatbelt is thanking you. The big mistake helmet law advocates make is equating vulnerability to risk. Of course a cyclist is vulnerable if hit by a car. The solution is to remove that vulnerability, not try and protect against it.

* It’s estimated that each new case of severe brain injury costs Australia A$4.5 million.

If money is so important, get mandatory helmets on motorists and pedestrians where there are far, far more cases of head trauma. Of all the cases of severe brain injury, why don’t they ever tell you the component that is from cyclists? Because it’s a fraction of the total and would just expose helmet law proponents as discriminatory and selective. They don’t really care that much about the injuries, it’s more about elitist moralising and telling a minority how better to live their lives. Here’s some advice: unless you’re prepared to moralise against the majority, don’t do it against the minority.

* Using a telephone survey, Professor Chris Rissel from the University of Sydney concluded that cycling rates could increase dramatically if mandatory helmet laws in Sydney were repealed. In contrast, a recent National Heart Foundation survey showed that overall road safety, road speed and the presence of dedicated bike paths were the main obstacles limiting bicycle use. Only 17% of respondents identified helmet use as a potential factor.

The truth here is both. Many would ride their bikes in parks or along dedicated cycling paths if they did not live in fear of police setting up stings to book them. Sydney University’s survey showed that 25% would ride if they could go without a helmet, 8% more than “only 17%” from the NHF. Remember, that percentage is of total population. Considering the cycling population is so low at less than 5%, if 25% of the population cycled more that’s a 500% increase. You see even the snippets of data dared to be provided here, it’s not even analysed correctly.

* Diffuse axonal injury is widespread (rather than focused) damage to the brain, and is one of the major causes of unconsciousness and persistent vegetative state following head trauma. The argument here is helmets apparently exacerbate head injury severity by causing the head to twist quickly on impact, thus creating rotational forces on the brain. There have been no controlled studies in the clinical setting into the association between helmet use and diffuse axonal injury – until now. We found no reports of diffuse axonal injury in pedal cyclists, helmeted or non-helmeted.

Where’s the report? Were all the cyclists killed from a severe case of this condition? Amazing how easily a controversial side-effect of helmets is dismissed just to serve the agenda of the writer. Remember, it’s dismissed on their personal and tiny study of just one city for just one year! It’s not just rotational forces that are a side effect, the lack of protection against concussion, or even exacerbating concussion, are cited as side effects. The article does not mention “concussion” anywhere. Suspicious.

* Definitely worth helmet hair

Really? REALLY??? The objection to wearing a helmet is all about hair? Can it get this pathetic? It’s not about hair. It’s about heat and sweating. It’s about oppression. It’s about claustrophobia. It’s about discomfort. It’s about inconvenience. It’s about many things. Most of all, it’s about freedom. Virtually the entire world can cope without cycling helmet laws. It’s only Australian and New Zealand that remain the laughing stock of global cycling community, and commensurately they are stuck with their puny rates of cycling.

* These results are within the range reported by a Cochrane Collaboration systematic review

Ah, the old Cochrane review. Like flies to a poop, so too is Cochrane for helmet law zealots.  Another report done solely by self-interest groups to achieve a predetermined conclusion. Are we getting the picture? Dig deeper into that report and see the vast bulk of “head injuries” were minor scrapes and bumps. Yes, a helmet would prevent them, so let’s bump up that percentage. Except, Cochrane’s review is fundamentally different to here, so any relation to the figures is meaningless. Cochrane’s came from examining bare-headed injuries to determine whether a helmet would help, whereas the doctor here is coming from observing helmet damage and presuming the worst outcome had that been the head. It’s total fantasy land.

* Some experts against this type of observational research cite small sample sizes, and flaws inherent in case control studies, such as not being able to take into account factors such as speed and intoxication.

These experts are right. Remember, you’re talking about an almost totally helmeted society. You don’t at all add in components like risk. You certainly don’t look at circumstances or behaviour. Mostly, you totally ignore that in this helmeted society, the deaths haven’t stopped and the head injuries haven’t stopped. They are still so bad that you don’t even dare provide the full data of your study because you’d find that helmets don’t work and that by far the biggest factor in cycling accidents is sending cyclists onto dangerous roads with the false belief a helmet will protect them.

* If mandatory helmets are good enough for motorcyclists, they’re certainly good enough for pedal cyclists.

If helmets are good for both cyclists and motorcyclists, they’re certainly good enough for all road users like motorists and pedestrians. After all, they make up the vast bulk of road head trauma cases in hospitals. Cyclists are less than 3%. Remember, it’s all about those nasty costs that need to be saved, right?

Equating bicycles to motorcyclists is a common argument.  On issues of freedom, there should not be a mandatory helmet law for motorcyclists. On issues of practicality and safety, the two modes of transport are fundamentally different. First, motorcyclists travel at much faster speeds at over 1oo kph and ride within traffic. Most Bicyclists cruise along at 20kph, maybe increasing to 40kph on a downhill, and often have dedicated paths and lanes for them. Second, if a motorcyclist hates helmets, he can drive a car. He has a choice. The infringement on civil liberties is not severe. Whereas the bicycle is the transport of the people. It’s easy, free and convenient. If a cyclist doesn’t want to wear a helmet, he has no alternative, he’s banned, so the only recourse is driving or public transport. This is the last thing you want in this nation of chronic health conditions due to poor exercise. Our trauma doctor needs to visit other areas of the hospital to get a true perspective of this nation’s key health problems.

+1 http://www.cycle-helmets.com/safety_in_numbers2.pdf

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From → Cycling Free

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