Urban Cycling, Part 2: Hit and Run Drivers and Bike Helmets

A doctor colleague of the skeptical cardiologist was riding his bike on a quiet road here in St. Louis recently when he suddenly awoke in a hospital bed. His friend who was riding in front of him heard a crash, turned and saw a black car making a U-turn and speeding off. Fortunately, the good doctor, suffered only the concussion and multiple bruised ribs and will live to ride again
He is in his seventies and I asked him if he would, indeed, climb onto the saddle of a two-wheeled vehicle in the future and he indicated yes, but never again on roads shared with cars.
I also inquired as to the state of his bike helmet post-trauma: it was shattered into multiple pieces.
In a previous post I pondered the question: Does cycling to work make you more or less likely to die?

cycling to work for many individuals would provide the daily physical activity that is recommended for cardiovascular benefits. However, cycling in general, and urban cycling in particular, carries a significant risk of trauma and death from accidents and possibly greater exposure to urban pollutants.

In the Netherlands cycling to work likely makes you less likely to die.

One study quantified the impact on all-cause mortality if 500,000  people made a  transition from car to bicycle for short trips on a daily basis in the Netherlands and concluded

For individuals who shift from car to bicycle, we estimated that beneficial effects of increased physical activity are substantially larger (3–14 months gained) than the potential mortality effect of increased inhaled air pollution doses (0.8–40 days lost) and the increase in traffic accidents (5–9 days lost). Societal benefits are even larger because of a modest reduction in air pollution and greenhouse gas emissions and traffic accidents.

In St. Louis, however, I suspect my longevity would be substantially reduced by cycling the 15 miles of heavily trafficked roads from University City to St. Lukes Hospital in Chesterfield. I would be cheek to jowl with SUVs, pick-up trucks, and mini-vans full of distracted, texting and chatting commuters.

Should  Bike Helmets Be Mandated?

Like most people I know, my colleague wears a bike helmet religiously when cycling. He, like many who have shared their bike accident stories with me, believes the bike helmet saved his life. I certainly can’t refute that possibility but it is impossible to know with certainty.
I’ve posted my analysis of the wisdom of mandating bike helmets here and even after hearing the good doctor’s story,  I still refuse to wear one.

A commonly cited statistic is that bike helmets reduce serious head injuries by 85% and brain injuries by 88%.  This comes from an observational  study  published in 1989 which has serious limitations and has never been reproduced. For an exhaustive critique of these data see here.
I think a fair summary is in this British Medical Journal editorial which is behind a paywall but can be reviewed as a PDF here (bmj-june-2013.pdfbicycle helmets and the law).
 
Larry Husten, a journalist, who writes an excellent cardiology blog at cardiobrief.org apparently agrees with me and has recently written about “The Unintended Consequences of Bike Helmets.”
I encourage everyone to read his post which can be found here.
Here is his main point:

I am opposed to public health campaigns that focus on helmets, thereby implanting in people’s minds the dangers of cycling. Instead, in my view, the public health agenda regarding cycling should be to promote the far greater health benefits of cycling. The overarching goal of any public health campaign should be to dramatically increase cycling in the US, thereby encouraging physical activity and helping to reduce obesity and diabetes.  In tiny Denmark, by way of example, one expert, Lars Bo Andersen, PhD, of Western Copenhagen University of Applied Sciences, reports that “26 persons were killed in the whole country in cycle accidents last year, but more than 6000 deaths were avoided due to the huge amount of physical activity this behavior is a result of.”

Circuitously Yours,
-ACP
Speaking of Holland, the skeptical cardiologist will be visiting this hotbed of cycling, tulips and dikes in July.
I’ll be staying in Haarlem but wandering around the country researching cycling, assisted suicide and the Dutch dairy industry which may be responsible for the Dutch having gone from being among the shortest people in Europe to being the tallest in the world.