Jane McCredie: Hats off to helmet laws

GPs can get pretty creative requests for medical certificates at times, whether it’s workers taking a sickie or students looking for an extension on an assignment.

But some campaigners against mandatory bicycle helmet laws seem to be particularly optimistic about the outcome of their visit to the doctor’s surgery.

How would most doctors react, I wonder, to a patient presenting with a self-diagnosed “medical condition” of stinging eyes as a result of sweating caused by wearing a helmet?

That’s one strategy recommended on a Queensland cycling site as a way of getting a medical exemption from that state’s helmet laws.

Another contributor to the site claims a friend has a letter from his GP “which allows him not to wear a helmet during the day as he’d rather avoid skin cancer and wear a wide brimmed hat instead”.

That sounds about as convincing as getting a letter from your GP saying you didn’t want to wear a helmet because you couldn’t find one that matched your earrings.

If Cadel Evans could cope with wearing a helmet during his recent triumph in the Tour de France, it’s hard to see why it would be a medical issue for the rest of us. (The International Cycling Union made helmet wearing in competition compulsory in 2003 after the death of Kazakh rider Andrei Kivilev.)

The anti-helmet brigade might argue the real problem is that adults who choose to take the risk of riding bare-headed are being forced to adopt these kinds of convoluted strategems to avoid the force of the law.

It’s the same old question that raises its head whenever we’re talking about the balancing of individual freedom against the desire to protect people from preventable harms — think tobacco control, immunisation or compulsory wearing of seatbelts.

There’s no doubt a lot of people would like to ditch their bike helmets — more than two-thirds of respondents to a BMJ online poll last week said the headgear should not be compulsory for adults.

The anti-helmet campaigners do have some arguments on their side.

Riding with the wind in your hair is definitely more fun than wearing a sweaty helmet (as long as you stay on your machine) and the wonderful free bicycle programs operating in many European cities have only been so successful because helmet wearing is not compulsory in those countries.

There may even be some validity in the argument that the health benefits of increased bicycle use would outweigh the increased injuries if the helmet laws were removed.

That would be a hard one to prove, though, whereas there is evidence for the protective role of helmets (despite some of the misinformation spread on the internet). A 2009 Cochrane review found that wearing a helmet reduced the risk of brain or head injury in cyclists involved in an accident by between 63% and 88%, and facial injury by 65%.

Some countries have taken a middle way, making helmets compulsory for children only, but the risk is that ditching your helmet might then become a marker of achieving adulthood.

Cycling is clearly something to encourage in our increasingly obese and resource-hungry world, so perhaps the most important question is, how can we find new ways of doing that without compromising safety?

Jane McCredie is a Sydney-based science and medicine writer.

Posted 21 August 2011

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