Prohibition, Cigarettes and Bike Helmets

Jim Titus's excellent work in correcting the official government statements on helmet efficacy has me thinking about the best way to promote helmet use - and I recognize that not everyone agrees that we should either out of concern that doing so makes cycling look dangerous or because of doubts that helmets are even worth promoting.

A recent post on Marginal Revolution got me to thinking about the various ways we can change behavior. We can try to force people to change their behavior from the top - through government enforcement, or we can push people to change their behavior from the bottom through social enforcement. Both can be effective, but when we compare their use in reducing smoking or alcohol use, the former seems to be more effective. And while using inflated claims and cherry-picking data can be a part of social enforcement, I think we can agree that that is not only unethical, but possibly counter-productive in the long run. 

In the United States, we tried to curtail alcohol use by making it illegal and for 13 years it mostly was. We shut down breweries and distilleries (though wine was still legal) and threw bootleggers into prison. Ironically, alcohol use had already begun a steep decline before prohibition due to social pressures, but after prohibition alcohol use not only returned to pre-prohibition levels, but exceeded them and continued to climb until the 1980's. 

No similar law was ever instituted for cigarettes and yet, smoking has been in a long decline. 

Sure, we've taxed cigarettes like crazy, set up programs to help smokers by getting them the help they need and limited the places you can smoke (almost nowhere)  as well as where you can advertise it (almost nowhere), but the taxes on alcohol are high and we've raised the drinking age. No doubt we might see a significant change if we stopped allowing alcohol ads on TV, but then we probably wouldn't have TV anymore. 

But a larger cause in the drop of smoking is probably the growing perception that it is unhealthy and unattractive. 

Americans would probably be better off if everyone decided to quit smoking, and they would probably be better off if everyone decided to quit drinking and they would probably be better off if everyone decided to wear helmets when biking. But mandating behavior, especially when the public isn't convinced, hasn't proven to be the best strategy. 

And if we're going to convince cyclists that they're safer with helmets, we need to start by being credible which is what Jim has been pushing for and I'm happy to see the government moving in that direction. I hope to see other opinion makers in the media and medical profession follow suit. Still, other dubious facts like this 

about 90 percent of bicyclists killed in the United States in 2009 were not wearing helmets. 

Continue to be repeated. More on that here. And from the same article, the new one making the rounds 

Bike accidents contribute to more sports-related head injuries than any other activity.

Which is likely inaccurate, and is by no means a measure of risk. It's inaccurate because while cycling does result in twice as many head injuries as football, not all cycling is sports-related. If we counted only recreational cycling, that number would go down quite a bit. I'd bet that there are more pedestrian head injuries per year, but we just don't count walking as a sport. 

And it's not a measure of risk because it doesn't consider exposure. How many hours a week does the average person even spend playing football compared to cycling? The number itself is more a proxy for how much people cycle, not how much people who bike are at risk for head injuries. 

And It would help to put energy into making better helmets if possible, as Jim notes, since more effective helmets would make for a stronger argument. It's unfortunate that it has taken NHTSA this long to pay attention to this issue and I doubt it signals a shift to greater interest in cycling safety, but moving away from the inflated 85% effective claim hopefully means the conversation won't begin and end with helmets.

Comments

[Jonathan Krall]

IMO, getting educated on safe bicycling practices is the number one thing a person can do to stay safe on a bicycle. Perhaps our social efforts should be focused on that.

[Mike]

The social efforts have already worked, and most cyclists are already wearing helmets. At this point helmets are just another anti-cyclist whipping boy.

[ACyclistInTheSuburbs]

And lights. I would mandate having lights when biking after dark.

Oh wait, never mind.

[freewheel]

I have a really hard time believing that cycling leads to more head injuries than football. More likely, there is over- or under- reporting going on.

[Michael H.]

Smoking is just plain disgusting. In my unbiased, completely neutral opinion. (OK, maybe not so neutral.) Plus it has an immediate effect on everyone else in the immediate area.

Moderate alcohol use may confer modest healthy benefits, although it's true that too many people drink far too much of it. And many people become unruly and violent after drinking too much.

I guess I should say something about bike helmets too. I think they can be useful in some situations, but not that effective when getting struck by a car traveling at high speed.

I'm not as concerned about whether CaBi users wear helmets or not. It's fairly difficult to ride fast on CaBi bikes (which is a good thing). This means that any accidents tend to be at much lower speeds than other bike accidents. Plus the heavy weight and stable design (lower center of mass) makes the bikes more difficult to tip over.

I remember reading that there were no serious head injuries among CaBi users, at least up through this past winter. Or maybe one or two such injuries. In any case, that's an amazing number, considering that there have been a few million trips on CaBi over the past 2.5 years. The slow speeds make it easier for both riders and car drivers to avoid collisions.

[Smedley Burkhart]

Helme(n)ts make sense as a small part of a global approach to safety, but their main purpose, other than to support the industry, is talismanic. We wear them to make ourselves feel safe in a world where the threats are overwhelming and nearly all out of our control.

Mandates have the same superstitious motivation, but at the level of the society.

Oh, and Heaven preserve us from "better" helmets. Can you imagine how awkward and wienie-looking real concussion-mitigating kit would be?

[black jack]

To Smedley: I remember looking at the big dent in my bike helmet after a crash a few years ago, and thinking what would have happened to my brain had I not been wearing that helmet. I don't regard wearing my helmet as talismanic, but as a prudent precaution against real but statistically-unlikely dangers - similar to wearing a seat belt, and paying for auto and homeowners insurance.

The assault rifles and the thousand rounds of ammo in my basement - now THAT's talismanic. ;-)

PS actually new concussion-mitigating helmets look not so different from current ones: check out http://mipshelmet.com/find-a-helmet

[Smedley Burkhart]

Thanks, black jack. I wear a helmet for the reason you do, but I also recognize its talismanic importance to me. If I forget it, which I sometimes do, my anxiety, when I realize it's not on my head, is far out of proportion to the increased risk.

What's different about the gear you linked? I wonder what sort of data they're basing any claims on. Preventing concussion isn't as straightforward as preventing skull fractures.

[freewheel]

All the misinformation surrounding helmets is not helping. I wear one based on my understanding that it will lessen the severity of a concussion upon impact. Not true?

No laws (not just helmet laws) should be enacted based on speculation, anecdotes, and subjective perception.

[MB]

"No laws (not just helmet laws) should be enacted based on speculation, anecdotes, and subjective perception."

Why do you hate America, freewheel?

[freewheel]

OK, MB, I'll reconsider my position. After all, if speculation (they haz WMDs?) was good enough to launch a war, then it should be good enough to enact helmet laws.