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Making helmets compulsory: ethical arguments for legislation

Sheikh A, Cook A, Ashcroft R. Journal of the Royal Society of Medicine 2004;97:262-265

Original paper


Summary of original paper

The paper examines the medical/ethical arguments around using the law to enforce behaviour that is perceived as good for the community. A cycle helmet law is the example chosen. The authors judge the issue against four criteria: a) Is the goal of the programme good? b) Does the programme achieve the goal effectively? c) Does it do so efficiently? d) Does it do so in a manner consistent with the values and liberties of the target population? The conclusion is that all criteria are met, although the argument in favour of mandation is weakly paternalistic. The authors believe there to be a strong case for making cycle helmets compulsory for cyclists of all ages.

BHRF Commentary

To show that cycle helmets are effective, the authors reference four observational studies which, they say, reveal a strong association between increasing helmet use and declining rates of injury. These studies are:

The first two papers are unreliable because they are undermined by the falls in cycle use and falling head injury trends for non-cyclists concurrent with increases in helmet use in the target populations and of which they take no account.. The Monash paper and evaluations in subsequent years by the same institution (Newstead, Cameron, Gantzer and Finch, 1994; Carr, Dyte and Cameron, 1995) contain many contradictions, in some cases indicating an increase in head injury relative to pre-law trends. A more comprehensive analysis from Australia (Hendrie, Legge, Rosman and Kirov, 1999) showed no benefit from increased helmet wearing and the concluded that the law had not been cost-effective. The two English references lack independence, being the author's own works. Their 2000 paper has no reliable helmet use data and no comparision of trends.

To demonstrate that helmet laws are effective in achieving their goals, the authors cite two references, one the same as above:

The Monash study is unreliable for the reasons given previously. Data from Scuffham et al has been reanalysed to show that over a more representative period either side of the New Zealand law, cyclists have fared no better than the population at large with regard to reductions in head injury, whilst the law led to a large decline in cycle use (See also Robinson, 2001; BHRF, 1237).

As people who have followed the debate about cycle helmets, the authors must be aware of the serious criticisms that have been made against all of these papers, much of it published in the medical press. However, they make no reference to such criticism and do not seek to address the issues that have been raised. Instead, they infer incorrectly that opposition to cycle helmet compulsion is based only on grounds relating to civil liberties, whereas in recent years it has been increasingly on matters of evidence and fact. Similarly no reference is made to more recent authoritative analyses from Australia (Hendrie, Legge, Rosman and Kirov, 1999) and New Zealand (Taylor and Scuffham, 2002), that concluded that cycle helmet laws had not proved cost-effective.

The authors also dismiss the possibility of a helmet law leading to substantial reductions in cycle use, citing unreferenced 'evidence in our possession' as their sole justification, even though this runs counter to substantial and widely accepted evidence to the contrary. Throughout, the paper makes no reference to any of the substantial body of evidence that has found no benefit from an increase in helmet wearing. The paper is therefore unable to present a balanced view of the evidence and its conclusions lack substance and credibility.


BHRF, 1237

Robinson DL, . Costs and benefits of the NZ helmet law. .

Carr, Dyte and Cameron, 1995

Carr D, Dyte D, Cameron MH, 1995. Evaluation of the bicycle helmet wearing law in Victoria during its first four years. Monash University Accident Research Centre Report 76.

Hendrie, Legge, Rosman and Kirov, 1999

Hendrie D, Legge M, Rosman D, Kirov C, 1999. An Economic Evaluation of the Mandatory Bicycle Helmet Legislation in Western Australia. Road Accident Prevention Research Unit .

Newstead, Cameron, Gantzer and Finch, 1994

Newstead SV, Cameron MH, Gantzer S, Finch CF, 1994. Bicyclist Head Injuries in Victoria Three Years after the Introduction of Mandatory Helmet Use. Monash University Accident Research Centre Report 75.

Robinson, 2001

Robinson DL, 2001. Changes in head injury with the New Zealand bicycle helmet law. Accident Analysis & Prevention 2001 Sep;33(5):687-91.

Taylor and Scuffham, 2002

Taylor M, Scuffham P, 2002. New Zealand bicycle helmet law - do the costs outweigh the benefits?. Injury Prevention 2002;8:317-320.

See also