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Rapid Responses: Rapid Responses published:
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Heath responsibilities
- Colin Fred Clarke (13 December 2007)
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responsibilities to include information verification?
- Peter J Clinch (13 December 2007)
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Helmets don't work, cycling does
- Richard M Keatinge (13 December 2007)
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Recommending cyclehelmets is counterproductive
- Hansel H. de Sousa M.D. (14 December 2007)
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Colin Fred Clarke, Hon Sec CTC Yorkshire and Humber Region YO41 1BU
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The article by Harald Schmidt raises many issues of concern. The public is in danger of being mistreated by the various well-intended measures to reduce overall health costs. Patients who are sick could be subject to many questions, almost like a trail, interrogation and if found guilty, subject to various measures. Each case could be subject to legal considerations and potentially legal aid costs. The medical profession should treat sick and ill people to the best of their ability and available resources, together with advising on other aspects of heath care but without engaging in a judge and jury roll. It is important for patients to be able to trust their doctor and answer questions without fearing suitable treatment may be withheld. The focus of medicine should be on improving services and treatments, for example helping people avoid developing a drink's problem and how to treat alcoholics effectively. There are many ways the medical profession needs to improve the services it provides and without harming the trust and respect people have for it. The article mentions " People often behave in ways that jeopardise their health. As well as smoking, lack of exercise, and excessive consumption of alcohol or food, other examples include poor dental hygiene, insufficient sleep, excessive salt intake, sunburn, unprotected sex, cycling without a helmet, or not taking preventive measures when travelling to areas with high risk of infectious disease." You could include any activity involving a risk, not treating people but judging them. Consider " cycling without a helmet" is a point in question, most people around the world would fail this test, see the VeloCity report "The Case against bicycle helmets and legislation" below for why this test would not be valid. www.ctcyorkshirehumber.org.uk/campaigns/velo.htm or a pdf copy with inserts can be obtained by emailing Colin@vood.freeserve.co.uk or viewed at http://cyclingedinburgh.files.wordpress.com/2007/10/colin-clarke-velo -city.pdf I would suggest a medical levy could be introduced to help with funding, a lower drink drive limit to reduce accidents, a comprehensive road safety approach, a balance index for cycle training and pedestrians to reduce falls. Regards Colin Clarke Competing interests: None declared |
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Peter J Clinch, Clinical Scientist Ninewells Hospital, DD1 9SY
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The author suggests that "cycling without a helmet" jeopardises one's health, which raises a tangential but important point: if one looks closely across the breadth of the available literature about cycle helmet efficacy this is far from clearly the case[1]. This illustrates a wider point that people can only be expected to even consider acting responsibly for the good of their own health if they have access to information that is clear and correct in the first place. Wherever the blame actually lies, if we are to blame victims for wearing the wrong clothes we need to be certain we are giving the right advice, not expressing our personal prejudices about what sensible clothes are. One responsibility in the hands of health professionals, rather than the public, is to make sure that information available to the public to promote their health is as sound as possible. Peter Clinch. [1] with the above in mind it is perhaps worth noting that the BMA's call for compulsory helmets does *not* look closely at all of the available literature, merely a very limited and highly selective subset of it, and accordingly comes to a biased and frankly unsafe conclusion that is not clearly to the benefit of wider public health. Competing interests: None declared |
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Richard M Keatinge, Doctor Gwalchmai Surgery, Anglesey, LL61 6DQ
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Harald Schmidt suggests that cycling without a helmet jeopardises health. He may be reassured that this is incorrect. A recent and comprehensive account in the BMJ shows that the mass use of cycle helmets has no perceptible effect on the proportion of head injuries and deters people from cycling.1 Furthermore, ordinary helmetless cyclists have a much lower death rate than non-cyclists.2 Inactivity can indeed jeopardise health, and we should positively encourage cycling. If anyone mentions helmets, we can reassure them that cycling is not particularly dangerous, and that there is no obvious benefit from a helmet.3 1. D L Robinson. No clear evidence from countries that have enforced the wearing of helmets. BMJ 2006;332:722-725 (25 March). doi:10.1136/bmj.332.7543.722-a, http://www.bmj.com/cgi/content/full/332/7543/722-a 2. Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med 2000;160: 1621-8. http://archinte.ama- assn.org/cgi/content/abstract/160/11/1621 3. Malcolm J Wardlaw. Three lessons for a better cycling future. BMJ 2000;321:1582-1585 (23 December). http://www.bmj.com/cgi/content/full/321/7276/1582. Competing interests: None declared |
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Hansel H. de Sousa M.D., Anesthesiologist Northwood Surgery, Easton, PA, USA, 18045
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More than a few of my obese patients have objected to the suggestion of cycling for exercise. They perceive cycling as dangerous because of the commonly recommended use of cycle helmets. It is difficult for me to convince them otherwise, when authorities such as Dr. Schmidt equate cycling without a helmet with smoking, excessive consumption of alcohol or food, poor dental hygiene, unprotected sex, etc. Hansel de Sousa M.D. Nazareth, PA, USA Competing interests: None declared |
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