Ten years after publishing an article in CMAJ1 about the negative implications of bicycle helmet legislation, I continue to be dumbfounded by the broad consensus within our profession in favour of such laws.2
A fundamental problem with emphasizing and legislating helmet use is that it reinforces the popular misconception that road bicycling is dangerous. The predictable result of such a message is decreased ridership, as Mary Chipman astutely warns.3 Thanks to superior cardiovascular fitness, the average cyclist outlives the average noncyclist, helmet or no helmet.4 Ultimately, helmet laws save a few brains but destroy many hearts.
Observations in several countries over the past 30 years have demonstrated how road cycling safety is consistently related to the numbers of riders.5 The converse is also true: individual risk rises as ridership declines, a pattern well documented in the US over the past decade. As helmet laws there have become widespread, and as road cycling has become less popular, the rate of injury per active cyclist has risen by 50%.6
Fatal cyclist head injuries represent far less than 10% of all road-related deaths. Instead of fixating on protection for a small minority of road users, why don't physicians champion prevention of crashes and support measures that make roads safer for everyone? A priority should be to lower urban speed limits, especially on residential streets where traffic-calming devices should be standard. We should also support the elimination of all free parking, both public and commercial. By reducing both the speed and convenience of driving, we'd instantly witness dramatic declines in fatalities and everyone would benefit from model shifts to healthier, safer and more environmentally friendly forms of transport, such as walking, bicycling and public transit.
Thomas J. DeMarco Physician Whistler, BC