Demystifying Medicine One Month at a Time

Helmet, Helmet, Helmet…NOT!

Here’s a great article questioning some wisdom that has become quite conventional.

As the French say, “sans casque.” (photo: WBUR, Boston)

[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. Example:

  • 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 LA 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.]


  1. Robin

    Thanks for writing on this. My family is “car-lite” and we bike most places. I’ve been surprised by how many people, even complete strangers, will comment on how what we’re doing is dangerous. One woman was shocked that I’d bike while pregnant saying how likely I was to fall. I explained that since I have not had a bike accident since age 12 but I have fallen down the stairs several times in my adult life, I was at more risk walking the stairs than biking.

    We also don’t put a helmet on our little daughter in her seat because it kinks her neck forward and makes it hard for her to breathe. Imagine putting a helmet on a kid in a carseat…of course it wouldn’t work well. But we’ve gotten comments on that too.

    My favorite resource on this topic is (aka How to Not Get Hit By Cars). Our city also has an “Urban Commando Bicycle Commuting” two part class that emphasizes defensive riding.

  2. Renae Yamashiro

    The Physician-Patient Alliance for Health & Safety (PPAHS) is an advocacy group dedicated to improving patient health and safety. Doing so involves many facets. Hospitals need to leverage technology to provide necessary monitoring of patient vital signs. Management needs to enable healthcare providers to reduce safety risks by implementing procedures centered on patient safety. Physicians and patients alike need access to information on patient safety and must take an active role in preventing adverse events..

  3. Kayla

    My 13 year old daughter fell off her bike yesterday, she is saying her head hurts, unforchutly i don’t make her wear a helmet. What should I do?

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