cyclehelmets.org |
||||
|
|
||||||||||||||||
Sheikh A, Cook A, Ashcroft R. Journal of the Royal Society of Medicine 2004;97:262-265
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 [1] [2] contain many contradictions, in some cases indicating an increase in head injury relative to pre-law trends. A more comprehensive analysis from Australia [3] 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 [4] [5]).
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 [6] and New Zealand [7], 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.
References
[1] Newstead SV, Cameron MH, Gantzer S, Finch CF. Bicyclist Head Injuries in
Victoria Three Years after the Introduction of Mandatory Helmet Use.
Monash University Accident
Research Centre Report 75, 1994.
[2]
Carr D, Dyte D, Cameron MH. Evaluation of the Bicycle Helmet Wearing Law in
Victoria during its First Four Years. Monash
University Accident Research Centre Report 76, 1995.
[3]Hendrie D, Legge M, Rosman D, Kirov C. An Economic Evaluation of the Mandatory Bicycle Helmet Legislation in Western Australia. Road Accident Prevention Research Unit, University of Western Australia. 
[4] Robinson DL. Changes in head injury with the New Zealand bicycle helmet law. Accident Analysis & Prevention, 2001 Sep;33(5):687-91.
Summary in Cycle helmet effectiveness in New Zealand.
[5] Robinson DL.Costs and benefits of the NZ
helmet law.
[6] Hendrie D, Legge M, Rosman D, Kirov C. An Economic Evaluation of the Mandatory Bicycle Helmet Legislation in Western Australia. Road Accident Prevention Research Unit, University of Western Australia.
[7]
M Taylor, P Scuffham. New Zealand bicycle helmet law-do the costs
outweigh the benefits? Injury Prevention,
2002;8:317-320.
|
|
||