Why are politicians and lobbyists
      misrepresenting the head injury "problem"?

      Ontario's Nanny-statists Target Cyclists Again

      The helmet law debate in the Legislature came back suddenly on November 4th, 2004 after a 13 year absence. It was sudden to us because none of the parties had mentioned it during the last election, and it had become a non-issue in Ontario's cycling community following the implementation of the child helmet law in 1995. Organized cycling wasn't aware that health and safety lobby groups had been working behind the scenes at Queens Park to bring it back.

      The front man for the latest initiative is Liberal MPP, John Milloy. He introduced the bill and kicked off the debate in the Legislature. "Debate" in this case is a misnomer. The discussions that took place blatantly lacked any scientific basis; instead, it was based on anecdotal evidence, personal conviction and grief.

      It's Not about Cyclist Safety

      Milloy is backed by a collection of overbearing life-style control organizations and individuals - ThinkFirst Canada, Safe Kids Canada, and Robert Cushman among them; the same basic line up that was behind the child bicycle helmet bill. (The irony of Safe-Kids not changing its name to Safe-Adults seems to be lost on this crowd.) They apparently haven't got over the Harris government's exemption of adults in 1995.

      The appalling thing about their latest initiative is that in the intervening years never once has Milloy or his backers contacted organized cycling in Ontario to find out how the safety of cyclists might be enhanced; not that the risks of cycling are particularly high, and certainly don't match the risk manifested by the carnage that motorists inflict on each other or on pedestrians. Milloy's proposal is absolutely not about cyclist safety or even about reducing serious head injuries in a significant way. If it were the latter, he would be calling for car users and pedestrians to wear helmets. It's these two groups who suffer by far the greatest number of serious head injuries and deaths.

      Scaremongering and Emotional Manipulation

      Among the strategies used by the proponents of a helmet law is the good old political practice of scaremongering. Emotional manipulation goes hand in hand with it. Back in 1991, helmet law supporters shepherded into a hearing's meeting room a head injured young man in a wheelchair. This time around, speakers in the legislature gushed out heart-wrenching stories about the deaths of friends and relatives, as though it were only cyclists that ever die accidentally on the roadways. Let's face it, helmet law proponents have a problem; the numbers of seriously head injured cyclists in any year is very small in the context of the overall head injury picture. So they have to give the impression the "problem" is much worse than it is. An examination of Ontario's trauma data shows cycling not to be dangerous but pretty low risk; and it looks positively safe when compared to car use from which originate the vast numbers of serious head injuries.

      Pretend There's a Crisis by Abuse of Statistics

      Abuse of statistics is key to success for helmet lobbyists. All accidents and all injuries get lumped together in order to inflate the numbers and give the impression there is an epidemic of dead and disabled cyclists. The facts tell otherwise. The actual numbers are much smaller.

      The Canadian Institute for Health Information's 2004 report, 2001/2 Ontario Trauma Registry shows there were 54 distinct head injuries severe enough to require the victims to be hospitalized at one of Ontario's 11 head trauma hospitals. Since some cyclists suffered more than one head injury we estimate that there were from 35 to 50 cyclist victims. This should be compared to about 1200 victims of motor vehicle use.

      According to the Ontario Brain Injury Association in 1999/2000, 112 cyclists were admitted to hospital for major injury, though not all of them suffered head injuries.

      In a 1996 study of data for one year from two regional hospitals in the City of Kingston by the Public Health Agency of Canada, only one out 348 cyclist patients under age 20 was hospitalized for treatment of a head injury (a concussion).

      Then Tell a Lie Enough Times ....

      The most overworked claim in the lobbyists' arsenal is that bicycle helmets reduce cyclist head injuries by 85%. This claim has been repeated around world in every jurisdiction where helmet lobbyists are active. It is on the ThinkFirst Foundation Canada's bicycle safety fact sheet (see below). The claim derives from a study of 1987 data by Thompson, R., Rivara, F., & Thompson, D., A Case-Control Study of Effectiveness of Bicycle Safety Helmets, New England Journal of Medicine - May 25, 1989. The study has been roundly criticized for the application of poor analytical techniques. (See explanation By D. Robinson in the journal Accident Analysis Prevention). Even the authors themselves stated there were potential problems and reduced their estimate to 69% in another published study after examining new data (Effectiveness of bicycle helmets in preventing head injury, Thompson, Rivara & Thompson. JAMA: 1996 Dec 25;276(24):1968-73). The Bicycle Helmet Research Foundation website has a comprehensive critique and The Vehicular Cyclist's Helmet FAQ lists a number of other shortcomings.

      Ottawa Public Health

      A number of false claims are contained in a position statement by Dr. Robert Cushman, Medical Officer of Health of the City of Ottawa supporting legislated bicycle helmet use. The statement is dated November 29, 2004 and written on Ottawa Public Health notepaper. Cushman is well known in Ottawa as a fervent crusader for state-imposed health and safety practices. In the Ottawa statement he claims "research has demonstrated a positive correlation between enforced legislation and increased helmet use and it is clear this is the next step we must take to protect our population". Note that Cushman claims all of us as part of his population. While his paper is replete with irrelevant and out of context statistics that make a low risk, enjoyable activity look like a pastime for the suicidal only, much worse is that it contains a number of false and unreliable claims:

      Cushman: Transport Canada reports that cyclists comprise 11% of all fatally injured and 15% of seriously injured crash victims. He refers to the source as Transport Canada 2004. Vulnerable Road User Safety: A Global Concern. Downloaded Nov. 29, 2004 from http://www.tc.gc.ca/roadsafety/tp2436/rs200403/menu.htm. A quick examination of this shows that the percentages quoted by Cushman are of vulnerable road users not all fatally and seriously injured crash victims. Cushman has overstated the numbers by 400%.

      Cushman: Transport Canada reported that in 2001, 88% of bike related fatalities were not wearing a helmet. He lists the source as Transport Canada 2001. Bicycle Helmet Safety Institute. Statistics. Arlington, VA. Downloaded Nov. 19, 2004 from http://www.helmets.org/stats.htm. This website states that Transport Canada reported that in 2001, 88% of the 80 bike related fatalities were not wearing a helmet. Transport Canada's website shows 60 cyclist fatalities in 2001. It contains no helmet wearing data. In an August 2005 reply to our enquiry concerning these data, Transport Canada stated that its data showed 12% of fatalities wearing helmets and 5% not wearing helmets. The remaining 83% were either not known or not reported. In other words, where helmet use was reported, three times the number of fatally injured cyclists were wearing helmets compared to those that were not.

      Cushman: Helmets save lives by reducing the risk of brain injury by 88%. He lists 3 sources none of which relate to saving lives or reducing the risk of brain injury. Despite over 20 years of helmet use, no study has been able to show helmet use saves lives. The reduction in risk of brain injury originates in a 1989 study (Thompson, R., Rivara, F., & Thompson, D., A Case-Control Study of Effectiveness of Bicycle Safety Helmets, New England Journal of Medicine - May 25, 1989) which since its publication has been found to be unreliable in two papers published in a scientific journal. (Curnow WJ. The Cochrane Collaboration and bicycle helmets. Accident Analysis and Prevention 2005;37:569-573 and Hewson, P, Investigating population level trends in head injuries amongst child cyclists in the UK, Accident Analysis and Prevention, (in press, accepted 25 March 2005)).

      Cushman: Helmet legislation increases helmet use and has demonstrated a reduction in the incidence of brain injury by 45%. He references work done by Macpherson et al, yet an examination of the latter's work shows no claims for reduction in brain injuries.

      This shameful piece of work, done on the public purse, wouldn't be so problematic except that it has been widely distributed to politicians. One MPP, David Levac, even quoted one of these false claims in CBC radio debate with OCBC Chairman (and author of this article), Avery Burdett.

      Alberta Intrastructure and Transportation

      An AIT webpage headed "No helmet. No bike. It's the law" claims that bicycle helmets reduce brain injuries by 88%. As referenced under "Ottawa Public Health" above, two papers published in the journal Accident Analysis and Prevention suggest the claim to be unreliable. We expressed our concern to the Alberta government but its reply indicates no interest in data that conflicts with its official policy.

      The ThinkFirst Foundation Canada

      MPP Milloy often quotes verbatim from the ThinkFirst Foundation of Canada . ThinkFirst is a tax free organization headed by Dr Charles Tator, a neurologist. It was Tator who had published in a letter to the Toronto Star the unsubstantiated claim that helmets can prevent the majority of cyclist deaths. We challenged the scientific basis of Tator's claim. The Star printed OCBC's (heavily edited) letter (and only after The Star was pressured to do so). Tator has yet to substantiate his claim.

      A visit to the ThinkFirst web site shows that the organization shamelessly uses propaganda as a weapon to overstate its case. On it's Bicycle Safety Fact Sheet it claims, "In Canada, there are between 100 and 130 bicycle deaths each year". According to Transport Canada data, the last time cyclist fatalities exceeded 130 was in 1978. The latest figures available show 60 for 2001 and 65 for 2002. From 1988 to 2002, the average rate is 78 per annum. The reduction is part of a general downward trend in road traffic fatalities of all categories likely owing to enforcement of impaired driving laws. Fatalities to cyclists almost identically parallel the trend for pedestrians (who as a matter of habit, unlike cyclists, don't wear helmets).

      Also on ThinkFirst's front page is the claim "Almost 500 children between the ages of 5 and 15 are admitted to Ontario Hospitals each year, with head injuries caused by cycling". This is to be contrasted with the 112 cylists the Canadian Institute for Health Information (CIHI) reports were admitted to Ontario hospitals with major injuries of all kinds in 1999/2000. Official CIHI figures from 2004 Major Head and Spinal Injury report for 2001/2 show an estimated 35 to 50 or so cyclists of all ages with head injuries of sufficient severity to be treated at one of Ontario's 11 head trauma hospitals. Even among those, it is not known how many were wearing helmets at the time.

      It is inconceivable that an organization that relies on citing of scientific reports is not aware of the body of evidence to the contrary. Either it willfully ignores it, or is not competent to be what it claims to be. Take your pick. (Links to the sources of both of ThinkFirst's claims are inoperative.)

      Canadian Academy of Sports Medicine

      CASM is an affiliate society of the Canadian Medical Association. It has published a position statement - Mandatory Use of Bicycle Helmets (McCormack & Ames, 2000) on its website. The work consists of less than 1,000 words of text and 22 references. OCBC associate, John Kane, reviewed the CASM paper and wrote a damning critique which was forwarded to CASM with the recommendation that the paper be removed from CASM's website. In his critique, Kane lists multiple cases of errors, misinterpretations, and out-of-date or irrelevant references. He complains that contrary and more current research is ignored.

      Safe Kids Canada

      (Since this article on the abuse of statistics by lobbyists was published, SafeKids has removed its website from its host server, safekids.ca, and created a smaller scale site on the server of the Hospital for Sick Kids, sickkids.ca. All the helmet material referenced below has been withdrawn. It is not known whether our criticisms were instrumental in the action taken by Safe Kids Canada but we shall continue monitoring websites like that of Safe Kids and expose misleading information of the kind uncovered below.)

      Safe Kids Canada is another non-profit tax free organization that has declared itself to be experts in cyclist safety. To demonstrate that it doesn't need the help of organized cycling in Ontario, of over 90 community partners not one is a cycling organization.

      Safe Kids blatant ignorance is manifested by its call for "safe" environments for cyclists, and "the development of bike paths and designated lanes, along with traffic calming measures, are important means of protecting cyclists from motor vehicle traffic." Anyone familiar with the works of John Forester, leading cycle educator and developer of the Effective Cycling principles on which the Can-Bike cycle training course is based, knows that such special facilities for cyclists increase the risks to cyclists and do not provide a "safe environment" for cyclists. Forester has shown through his research, cyclists fare best when they operate and are treated like drivers of a vehicle. This means cyclists are safer when they ride on the roadway and adopt the same rules and practices that motor vehicle drivers follow.

      This is more evidence that this issue is not about cyclist safety.

      Claims Based on Questionable Research

      Safe Kids promotional techniques are similar to those of the ThinkFirst organization. Research quoted is carefully selected to correspond with its support for helmet legislation, and serious questions about the research are conveniently ignored. For example, in its position on helmet legislation it likes to point to increases in helmet use rates to indicate helmet laws are working. It generally uses rates (i.e. proportion of cyclists wearing helmets) as a measure rather than real numbers, as rates can hide drops in the absolute number of cyclists after a helmet law is implemented. It quotes Nova Scotia as an example where helmet use has increased since legislation was introduced. There is no mention however that an analysis of the study's data revealed that the total number of injuries actually increased and levels of cycling fell by 40% to 60%, while the rate of head injury per cyclist after legislation remained the same!

      Mary L. Chipman, researcher for the Department of Public Health Services, University of Toronto agreed. Commenting on the author's work in a letter to the Canadian Medical Association. she said, ".... despite this effort to observe more cyclists, he (one of the authors) actually observed fewer after legislation, so I am quite convinced that the number of cyclists has been dropping."

      Cycling Reduced by Enforced Helmet Laws

      Safe Kids then disputes Dorothy Robinson's well documented evidence of decreases in cycling in Australia (Head injuries and bicycle helmet laws published in Accident Analysis Prevention 1996 Jul;28(4):463-75) by claiming that Ontario suffered no such declines. Safe Kids references work carried out by Alison Macpherson et al, published November 2002 in Injury Prevention (abstract).

      Unfortunately, the Ontario study applied poor scientific procedures to base its opinion on. It compared year on year data that were from observations that were not at the same places at the same times, or in similar weather conditions which in Ontario is extremely variable. Neither can the data be considered a reliable indicator of what happened in the remainder of Ontario. Observations were carried out in the Toronto Borough of East York which had been a mini-laboratory for promotion of helmets over an extended period prior to the law. Nowhere else in the province was a similar program carried out. In addition, there were problems with the published data; counts for 1999 were understated. Such errors do not create much confidence in the report cited by helmet proponents.

      Cycling Drops in NS and BC

      Data in studies from Nova Scotia and British Columbia indicate that cycling declined after helmet laws were implemented.

      For Nova Scotia, as mentioned above under the heading "Claims Based on Questionable Research", year on year observation data in LeBlanc et al's study showed that the principal effect of Nova Scotia's law was that it reduced head injuries by reducing cycling.

      Evidence of declines in British Columbia's cycling show up in Traffic Collision Statistics British Columbia 1995-97 published by the Insurance Corporation of BC. Total cyclist injuries declined by 35% in 1997 compared to levels in 1995, the last full year before legislation in September 1996. As a comparison, pedestrian injuries declined by only 7%. This suggests cycling dropped by around 28%. (Levels were still 31% lower in 1999, three years after legislation.)

      A study for the UK's Department for Transportation also found evidence of declines in cycling in the report, Foss R & Beirness D., Bicycle helmet use in British Columbia: effects of the helmet use law, University of North Carolina Highway Safety Research Center and the Traffic Injury Research Foundation. Ottawa: 2000. The authors detected that cyclists in the age range 16 to 30, the group most likely to be effected by a helmet law, dropped from 50% to 35% as a proportion of all cyclists observed.

      A BC decline in cycling would not be surprising, given that the law was enforced by BC police forces.

      Overlooked by many commenting on this issue is law enforcement. Unlike Australia and BC, Ontario's child helmet law has never been enforced so it would be no surprise if Ontario's law has had little effect on levels of cycling. Macpherson later conducted a seminar at the University of Pittsburgh showing that by 1999 helmet use had returned to pre-law levels. So there was no net effect of Ontario's child helmet law on either cycling levels or helmet use.

      Less Spin, More Science, Required

      A study MPP Milloy likes to quote claims a 26% drop in child head injuries in provinces implementing helmet legislation. It appears he wasn't advised that not all scientists accept those findings. An article appeared in the Canadian Medical Association Journal citing the study containing the 26% claim. In the same edition, there are three letters that question the conclusions reached by the authors.

      Another criticism of the same study appeared in Pediatrics, the journal where the claim first appeared. The author was Australian, Dorre Robinson, a professional statistician who has been carrying out helmet research for over 12 years. Her letter pointed out that head injury reductions were not associated with helmet wearing as the latter wasn't even considered. Rather there was an attempt to associate reductions with helmet legislation. On looking closely at data in legislating provinces she revealed that reductions did not coincide with the introduction of legislation but occurred prior to legislation in one province and more than one year after in another.

      (Since our report was originally placed on The Vehicular Cyclist website, another case of poor Canadian research has been exposed. More ...)

      It's essential that propaganda and junk science is challenged wherever it appears. Our rights are too important to be legislated away on the flimsy and contradictory evidence proponents are putting forth. John Milloy and groups like ThinkFirst and Safe Kids are applying the old political art of spin.

      When a limitation is to be imposed on the rights of citizens, the onus is on the legislating body to present a bullet-proof scientific case in support of whatever measure it plans to take. In this case, that criterion has not been satisfied. An adult helmet law is not supported by currently available science.

      "The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-meaning but without understanding."

      US Supreme Court Justice Louis D. Brandeis

December 2008
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