DON'T KILL THE GOOSE THAT
LAYS THE GOLDEN EGG
by Thomas J. Demarco M.D.
Is bicycling really more dangerous than driving? Should we be
forcing motorists to wear helmets instead?
This analysis of the medical and environmental ramifications of bicycling
vs driving suggests that it will take more than an inch of hard foam to
achieve road safety.
Thanks largely to physician advocacy, more and more cyclists in
Canada and around the world are wearing helmets. Australia has
gone beyond simply promoting them and has made their use
mandatory. Shall Canada follow suit? Should it? The Canadian
Medical Association thinks so. I disagree.
As an environmentally-conscious general practitioner who cycles
daily, I greet the growing debate about bicycle helmets with some
ambivalence. They say any publicity is good publicity, so it's
pleasing that so many Canadians want to discuss bicycling and
bicycle safety. Still, I find much of the content of the debate
rather disturbing, particularly the arguments being put forth by
most of my medical colleagues. I believe that the ultimate
political, social and medical ramifications of this issue are
being largely overlooked.
I have worn a helmet for probably 90% of the kilometres I've
ridden over the past ten years. I feel more self-assured wearing
one, perhaps a little too much so. The helmet allows me to wear
an attached rear-view mirror, an added safety measure. My 95,000
km riding "career" has, thankfully, been accident- free so I
cannot claim that the helmet has saved me from injury. But it
does regularly save me from having cold rain and hot sun come into
direct contact with an ever-more substantial bald-spot!
In the event of a fall, having an inch or two of hard foam
between one's skill and the asphalt is better than nothing.
However, data to this effect are surprisingly scarce and
inconsistent. I have seen statistics that bicycle helmets reduce
fatalities by anywhere from 1%  to more than 50% . The
British Medical Association puts the figure at 33% . Then how
could any physician be against bike helmets? This doc sure isn't
and is all for their promotion. However, I'm strongly opposed to
legislation that makes their use mandatory.
Doctors have often been accused, with some justification, of
concentrating on treatment of symptoms and disease rather than
promoting and maintaining health. The helmet debate reflects this
unfortunate approach. I believe that most bicycle-related head
injuries can be recognized as symptoms of a more malignant
process: automobile dependence.
Though largely ignored by medical care providers, it is
increasingly evident that the principal alterable variables in
with respect to society's health are lifestyle and environmental
factors. Examples include air pollution, toxic waste, motor
vehicle accidents, occupational disease, industrial accidents and
stress. To them, we could add the concomitants of our sedentary
existence: obesity, arterio-sclerosis, osteoporosis and maturity-
onset diabetes. All these conditions are, to some extent,
directly or indirectly attributable to our reliance on personal
motor transportation. So too are some other major public health
concerns such as the greenhouse effect, acid rain, ozone layer
depletion and the Persian Gulf war. 
With this in mind, let's return to bicycle safety debate.
Riding a bike is obviously not without risk either. This risk,
however, is almost universally overestimated by the general
population. Again, the data are inconsistent and vary from country
to country. I have not found reliable Canadian figures, so we'll
look at the situation in two countries whose cycling conditions, in
my opinion, are similar to ours. In terms of number of deaths per
distance traveled, French research by Carre  showed no
significant difference between cyclists and motorists while recent
British Dept. of Transport figures suggest that the former are at
an 11.4-fold risk . Since children are heavily
over-represented in bike accidents, their relative risk according
to the British is probably greater than 20 whilst that of adult
riders is less than 5. However, statistics such as these may lead
us to overlook two fundamental considerations. The first is that
motorcar use begets greater personal displacement. Newman and
Kenworthy of Australia estimate that every kilometer traveled on
public transport replaces ten kilometers of driving . In
Britain, regular cyclists travel only one-fifth as far as
motorists (personally, I have experienced a similar reduction in
my surface mileage since destroying my driver's permit). Per
Trip, the relative risk of cycling then falls to 2.4 in the U.K.
The second "asterisk" that must accompany the bicycle's
apparently unfavorable safety record is that worldwide, 90% of
cyclist fatalities result from collisions with cars. "As a matter
of fact," writes Ed Ayres of the WorldWatch Institute, "though
bicycles outnumber cars globally by a ratio of 2 to 1, only two
percent of the world's traffic fatalities involve cyclists. When
bikes and cars are given each their own space, the risk of death
is 500 times greater in cars." 
So, bicycling is not as dangerous as popularly perceived.
Furthermore it does not contribute to the aforementioned litany of
personal and public health problems. Expressed in potential
life-years gained versus potential life-years lost, Dr. Mayer
Hillman estimates that regular cycling's net benefit to personal
health outweighs its risk of injury by a factor of 20 to
1, even in a country as hostile to cycling as Great Britain .
Cyclists very likely live longer and healthier lives than
non-cyclists and, unlike motorists, they incur no harm to society
at large .
Whenever someone chooses to cycle rather than drive, both
personal and public health benefit. Cyclists, therefore, are
allies of the medical profession. We should be doing all we can to
encourage the activity. The British Medical Association actively
does so (the BMA also promotes helmet use, but does not condone
helmet legislation). Favourable publicity and other incentives
have persuaded 50% of Ottawa's cyclists to wear helmets regularly
. I think such promotion is desirable, especially for high-risk
groups like children and off-road riders. However, like the BMA,
we mustn't support mandatory helmets, for at least 3 reasons.
A move to compulsory headgear would reinforce the erroneous
perception that bicycling is an unnacceptably dangerous activity.
This is called " dangerization" . Secondly, the measure is
costly to cyclists, especially for children who should change
helmets annually as they grow. An approved helmet costs one-fifth
as much as the average bicycle; if seat belts carried the same
relative price tag, they would cost more than $2,000 (the CMA's
initiative in making available less expensive bike helmets is
applauded). Thirdly, regardless of the fit or the weight, helmets
(unlike seatbelts) can be quite uncomfortable, particularly in
hot, humid weather. Even a regular helmet-wearer like myself was
often inclined to remove it during a recent ride in Australia's
warm Northern Territory. Largely because of these three factors,
that country has witnessed a substantial drop in bicycle ridership
once it passed its helmet law. Lately, Australia has devoted
large sums of public money to projects and programmes designed to
lure cyclists back onto their mounts .
Rather than supporting helmet legislation, we'd be much wiser to
address the ultimate source of most road fatalities: automobiles.
As they've already done with tobacco, physicians should feel
professionally compelled to show community leadership in
discouraging car use. Calling for a ban on their publicity would
be a good start. For a quick, substantial reduction in both
cyclist and non-cyclist road fatalities, I suggest that doctors
demand strict enforcement of lower speed limits. "Traffic
calming" measures, which render speeding physically impossible,
have already had a dramatic effect on accident rates in some
European cities . It is estimated by the Bristol Cycling
Campaign that universal urban speed limits of 30 kph would save
1,500 lives annually in Britain . We may also wish to
reconsider the minimum driving age. Here in Canada it is still 16
years, but in Switzerland, it is set at 18. Perhaps 20 years
would be even wiser. Measures like these would save many more
lives than mandatory bicycle helmets ever will. So too would a
helmet law for motorists, but of course I'm being facetious. Or
am I? At the turn of the century, an Irish MP named TM Healy
argued persuasively that if cyclists must bear lights then so must
carriages and cars. Wouldn't the same logic apply to another
Henry David Thoreau wrote that if there are a hundred who would
hack at the branches of evil for each one who attacks its root.
Bicycle accidents are branches. Personal motor transport is the
root. Rather than demanding helmets for cyclists, the medical
profession's energies in the bicycle safety debate would be much
more effective if directed at promoting bicycling itself.
Increased participation in this activity would not only benefit
the national health and environment, but also would contribute
significantly to road safety. Cycling is not a problem -- it is a
solution. We should not be discouraging it by advocating laws
that will drive cyclists from our roads. Let us not risk killing
the goose that lays the golden egg.
1 Downing, C. "Pedal cycling accidents in Great Britain."
Dept. of Transport, from Ways to Safer Cycling, 1988.
2 Dussault, C. "Le casque protecteur cycliste: problematique,
efficacite et relations avec les comportements Societe de
l'assurance automobile du Quebec" and Perspectives Modiales sur le
Velo, pp 313-317. Velo Quebec, Montreal, 1992.
3 Hillman, M. Cycling Towards Health and Safety, p 82. BMA,
4 It is commonly argued during the 1991 Gulf War that were it
not for its car fleet, the USA would be self-sufficient in oil and
hence would have had far less interest in initiating hostilities.
For details of personal motor transport's contribution to the
other conditions listed, refer to DeMarco, T. "The Most Dangerous
Addiction? Why the Medical Community Must be Concerned About
Automobile Dependence." Imagine, vol 1 no. 1
5 Carre, J-R. "La situation de la bicyclette en France."
Perspectives Mondiales sur la velo, pp 49-54. Velo Quebec,
6 see 3, p 46.
7 Newman and Kenworthy, Towards a More Sustainable Canberra.
Murdoch University, Perth. 1991.
8 see 3, p 46.
9 Ayres, Ed. "Breaking Away." WorldWatch Magazine. Jan-Feb,
10 Hillman, M. Unpublished presentation at Velo
Mondiale/Pro-Bike/Velo-City Conference, Montreal, Sept. 1992.
11 see 3, p 111-121.
12 Burdett, A. Personal correspondence. Ontario Coalition for
13 Krag, T. "Reflections on Safety of Cyclists and Bicycle
Helmets." Velo Quebec, op cit. pp 334-337.
14 The Australian federal government recently announced a $30
million investment for the construction of 600 kms of bike paths
in 1993 by far its biggest annual expenditure ever for such works.
The most recent data available from Monash University, Melbourne
indicates that 2 years after the helmet law, the number of
cyclists was approaching pre-law levels in adults and children,
but was still greatly reduced in teenagers.
15 see 7.
16 New Cyclist. #30, Feb. 1993. London.
(This article appeared in the Summer 1993 edition of Imagine,
the newsletter of World Without Cars, a group based in Windsor,
Ontario. The piece originally appeared in the Journal of the
Canadian Medical Association).