Fwd: A Bicycling Mystery: Head Injuries Piling Up
Wade T. Smith
Jul 28, 2001 19:51 PDT
A Bicycling Mystery: Head Injuries Piling Up
By JULIAN E. BARNES
Millions of parents take it as an article of faith that putting a bicycle
helmet on their children, or themselves, will help keep them out of
But new data on bicycle accidents raises questions about that. The number
of head injuries has increased 10 percent since 1991, even as bicycle
helmet use has risen sharply, according to figures compiled by the
Consumer Product Safety Commission. But given that ridership has declined
over the same period, the rate of head injuries per active cyclist has
increased 51 percent just as bicycle helmets have become widespread.
What is going on here? No one is very sure, but safety experts stress
that while helmets do not prevent accidents from happening, they are
extremely effective at reducing the severity of head injuries when they
do occur. Almost no one suggests that riders should stop wearing helmets,
which researchers have found can reduce the severity of brain injuries by
as much as 88 percent.
Still, with fewer people riding bicycles, experts are mystified as to why
injuries are on the rise. "It's puzzling to me that we can't find the
benefit of bike helmets here," said Ronald L. Medford, the assistant
executive director of the safety commission's hazard identification
Some cycling advocates contend that rising numbers of aggressive drivers
are at fault, while others suggest that many riders wear helmets
improperly and do not know the rules of the road. Some transportation
engineers say there are not enough safe places to ride.
Many specialists in risk analysis argue that something else is in play.
They believe that the increased use of bike helmets may have had an
unintended consequence: riders may feel an inflated sense of security and
take more risks.
In August 1999, Philip Dunham, then 15, was riding his mountain bike in
the Great Smoky Mountains National Park in North Carolina and went over a
jump on a trail. As he did, his back tire kicked up, the bike flipped
over and he landed on his head. The helmet he was wearing did not protect
his neck; he was paralyzed from the neck down.
Two years later, Philip has regained enough movement and strength in his
arms to use a manual wheelchair. He has also gained some perspective.
With the helmet he felt protected enough to ride off-road on a
challenging trail, in hindsight perhaps too safe.
"It didn't cross my mind that this could happen," said Philip, now 17. "I
definitely felt safe. I wouldn't do something like that without a helmet."
In the last nine years, 19 state legislatures have passed mandatory
helmet laws. Today, such statutes cover 49 percent of American children
And even some professionals have embraced helmets. While most of the
riders in the Tour de France have worn helmets infrequently, Lance
Armstrong, the American cyclist favored to win the race today, wore a
helmet through most of the race.
Altogether, about half of all riders use bike helmets today, compared
with fewer than 18 percent a decade ago, the first year the safety
commission examined helmet use.
During the same period, overall bicycle use has declined about 21 percent
as participation in in-line skating, skateboarding and other sports has
increased, according to the National Sporting Goods Association, which
conducts an annual survey of participation in different sports. Off-road
mountain biking is often considered more risky than ordinary bicycling,
but it is unlikely to account for the recent increase in bicyclists' head
injuries. Participation in off-road mountain biking has declined 18
percent since 1998, the association said.
Even so, bicyclists suffered 73,750 head injuries last year, compared
with 66,820 in 1991, according to the safety commission's national injury
surveillance system, with the sharpest increase coming in the last three
years. Children's head injuries declined until the mid-1990's, but they
have risen sharply since then and now stand near their 1991 levels even
with fewer children riding bikes.
The safety commission is investigating why head injuries have been
increasing. Officials hope that by examining emergency room reports more
closely and interviewing crash victims, they can find out if more of the
injuries are relatively minor, and how many people suffered head injuries
while wearing helmets. Some bicycling advocates have doubted the
statistics on participation in cycling, and the commission plans to
re-examine those as well.
Dr. Richard A. Schieber, a childhood injury prevention specialist at the
Centers for Disease Control and Prevention and the leader of a national
bicycle safety initiative, said public health officials were realizing
that in addition to promoting helmet use, safety officials must teach
good riding skills, promote good driving practices and create safer
places for people to ride.
"We have moved the conversation from bicycle helmet use to bicycle
safety," Dr. Schieber said. "Thank God that the public health world is
understanding there is more to bicycle safety than helmets."
Promoting bicycle helmets without teaching riders about traffic laws or
safe riding practices can encourage a false sense of security, according
to several risk experts. Helmets may create a sort of daredevil effect,
making cyclists feel so safe that they ride faster and take more chances,
said Mayer Hillman, a senior fellow emeritus at the Policy Studies
Institute in London.
"You would be well advised to wear a helmet provided you could persuade
yourself it is of little use," Dr. Hillman said.
One parallel, risk experts said, is anti-lock brakes. When they were
introduced in the 1980's, they were supposed to reduce accidents, but
government and industry studies in the mid-1990's showed that as drivers
realized their brakes were more effective they started driving faster,
and some accident rates rose.
Insurance companies have long been familiar with the phenomenon, which
they call moral hazard. Once someone is covered by an insurance policy
there is a natural tendency for that person to take more risks. Companies
with workers' compensation insurance, for instance, have little incentive
to make their workplaces safer. To counter such moral hazard, insurers
may give discounts to companies that reduce hazardous conditions in their
factories, said Robert Hartwig, chief economist for the Insurance
"People tend to engage in risky behavior when they are protected," he
said. "It's a ubiquitous human trait."
Even cyclists who discount the daredevil effect admit that they may ride
faster on more dangerous streets when they are wearing their helmets.
On May 5, Noah Budnick, a 24- year-old New York resident, was wearing a
helmet and cycling on Avenue B in Manhattan when he had to pull out from
the side of the street to avoid a double-parked car and a taxicab idling
behind it. As he moved to the left, the cab pulled out, striking Mr.
Budnick. He broke his fall with his hands and did not hit his head on the
ground, but the accident left him with a deep cut on his leg and a badly
Although the cab was at fault for the accident, Mr. Budnick said, if he
had been riding more slowly he might not have had the accident.
"I probably would have ridden more cautiously and less aggressively
without the helmet," he said. "I don't know if I would ride in Manhattan
at the speed I was going."
Still, many cycling advocates contend that it is not bicyclists but
drivers who are more reckless. Distractions like cell phones have made
drivers less attentive, they say, and congestion is making roads more
dangerous for cyclists. They also believe that some drivers of sport
utility vehicles and other trucks simply drive too close to cyclists.
Brendan Batson, a 16-year-old high school sophomore in central Maine, had
been knocked off the road twice by drivers, so as he entered the home
stretch of a 60-mile ride on May 26, he was wearing his helmet. But as he
passed through Norridgewock, Me., riding along the shoulder of a rural
highway, a pickup truck struck him from behind. It hit Brendan with
enough force to rip the helmet from his head, the straps gouging his face
before tearing off. Brendan was dragged along the road, past a friend he
was cycling with, then thrown to the side. He was killed instantly.
It is difficult to show statistically that drivers have become more
reckless in the last decade. The percentage of fatal bicycle accidents
that involved cars has declined, falling from 87 percent in 1991 to 83
percent in 1998, according to the C.D.C.
Thom Parks, a vice president in charge of safety for the helmet maker
Bell Sports, said safety standards could be upgraded and helmets could be
designed to meet them. But that would make helmets heavier, bulkier and
less comfortable. "There are limits to what a consumer would accept," Mr.
Parks said, adding that if helmets became bigger, fewer people might wear
Dr. James P. Kelly, a neurologist and a concussion expert at Northwestern
University Medical School, said that even as helmets were currently
designed, patients who were wearing them when they were injured were much
better off than those who were not.
"Bicycle helmet technology is the best we have for protecting the brain,"
Dr. Kelly said. "The helmets serve the function of an air bag."
But the most effective way to reduce severe head injuries may be to
decrease the number of accidents in the first place.
"Over the past several decades, society has come to equate safety with
helmets," said Charles Komanoff, the co-founder of Right of Way, an
organization that promotes the rights of cyclists and pedestrians. "But
wearing a helmet does not prevent crashes."
Copyright 2001 The New York Times Company