Preventing injury in childhood
BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.a298 (Published 19 June 2008) Cite this as: BMJ 2008;336:1388
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I have posted before (BMJ 2006;333:200 (22 July), doi:10.1136/bmj.333.7560.200, http://www.bmj.com/cgi/content/full/333/7560/200) about the way that schools can actively prevent children from adopting safety measures because of misplaced aesthetic preferences.
Since I last posted on this subject there has been no change in the attitude, and no unbending by my local schools.
Peter English.
Competing interests: Parent
Competing interests: No competing interests
I don't think the CTC is anti helmet. It seems to strive for neutrality on this subject, it's position being summed up by 'If a helmet gets you out cycling wear one, but if it puts you off don't bother'.
The helmet debate excites great controversy among cyclists so it makes sense for the CTC to sit on the fence on such a divisive issue.
The BMA on the other hand believes cycling is so dangerous lidless cycling should be banned, an astonishingly extreme view that seems arrogant and remote to many CTC members and laughable to the majority of (non helmet wearing) cyclists.
Competing interests: CTC Member
Competing interests: No competing interests
Charles Essex regards CTC's attitude to cycle helmets as "bizarre". It's only bizarre if you accept some things which I personally find to be quite unsupportable. In fact, I believe that many helmet promoters are guilty of "recycling nonsense".
You have to accept that cycling is uniquely dangerous or productive of head injuries, but according to DoH data many more children are injured as pedestrians than as cyclists, and the head injury percentage of admissions for child cyclists is lower than for child pedestrians. Actually the data shows that the number one indicator for severity of child head injuries is involvement of motor traffic; I am not aware of any cycle helmet designed or certified for such impacts.
You have to accept that helmets prevent meaningful numbers of significant head injuries, but when wearing rates rose from 45% to over 90% in New Zealand following compulsion the proportion of head injuries in cyclists trended worse than that for pedestrians, and if you plot over time the proportion of cyclist and pedestrian admissions which are head injuries, not only can you not see which year saw the doubling of wearing rates, you can't even tell which group is which. And the same applies for other jurisdictions where compulsion applies - numerical reductions in injuries are proportional only to the reduction in cycling overall.
You have to accept that prospective studies are unassailably correct, and population statistics always wrong, but prospective studies told us that combined HRT was protective against coronary heart disease - it turned out that this simply an artifact of the population which takes up HRT, and there is good evidence that the same applies with cycle helmets. I recommend everyone to read the detail of Thompson, Rivara and Thompson's influential 1989 study and to note the dissimilarity between case and control populations.
You also have to accept that wearing a helmet has no effect on the risk taking profile of the cyclist, an assumption which is directly contradicted by Pless' research on the subject (which was, incidentally, set up in order to prove the opposite). It is likely that this also explains the finding by Rodgers (1987) that helmeted cyclists were at a small but significantly higher risk of fatality.
Now you may choose, as helmet promoters do, to simply ignore or repudiate contradictory evidence, and thereby assert that all the evidence with which you agree is in support of helmets, but inflated estimates of protective effect have never been borne out in any real cyclist population, and it remains the case that cycling is safest where helmet use is least common. As a former minister of transport acknowledged, there is no known case where cyclist safety has improved as a result of increases in helmet wearing. Whatever the magic bullet is for cyclist safety, it's pretty certain that helmets are not it - actually the only thing which appears always to be correlated with safer cycling is more people doing it.
CTC's position, then, is that it is up to those promoting an intervention, to prove their case. Far from being bizarre, this is actually a core premise of both the scientific method and evidence-based practice.
Yes, this is counter-intuitive and goes against two decades of assiduous propaganda funded in part by the helmet manufacturers. Perhaps it would be wise to consider that CTC, a body committed to cycling and cyclists rather than to "policy-based evidence making", genuinely has cyclists' best interests at heart and has expended a great deal of time and effort investigating this issue.
Competing interests: BHRF (http://www.cyclehelmets.org)
Competing interests: No competing interests
The concerns about obesity in children, the increase in the price of petrol and the need for greener transport alternatives will mean that more children will use bicycles for journeys as well as recreation. The Cycle Touring Club [CTC] takes a bizarre attitude to cycle helmets. In a letter to the Daily Telegraph, the policy co-ordinator for the CTC claims that cycle helmets only protect against minor injuries and uses the argument that hardly anyone in the Netherlands wears a cycle helmet other than for sports cycling, with very few cycling casualties and head injuries [ref 1]. This is as specious as claiming that skiing has a very low injury rate because there is a very low injury rate at skiing in Switzerland.
In each case there are cultural factors that lead to a low injury rate. Even the casual visitor to the Netherlands will realise that cycling is a universal method of transport from a very young age so cyclists, motorists and pedestrians are attuned to bikes on the streets. In Switzerland, many [but not all] Swiss will have skied since an early age, so are less likely to injure themselves than annual holiday skiers.
My recent enquiry to the CTC about cycle helmets which produce less air/wind noise produced the response “…if it bothers you, just don’t wear [a helmet]” [Chris Juden, CTC Senior Technical Officer, personal communication].
If the CTC, the “National Cycling Organisation”, has an antipathy towards cycling helmets amongst its senior officers, then helmets will clearly not be promoted by the UK's most high profile cycling organisation. I believe this is to the detriment of the safety of children on cycles.
References 1. Chris Peak, policy co-ordinator, CTC. Letters to the Editor. Daily Telegraph 18 June 2008
Competing interests: CE is a member of the CTC; worked in the Netherlands for a year; is a very keen cyclist; and is a very keen skier.
Competing interests: No competing interests
In Editorials Graham Kirkwood and Allyson Pollock1 reporetd that United Kingdom Child Safety Week will be launched by the Child Accident Prevention Trust on 23 June this year. I also agree with the authors that UK may lag behind not only other European countries but also the others countries in the world.
Still now, there is no complete household survey regarding the unintentional death and injury in the world which can be easily averted by awareness of parent and relatives in the community. The United Nations pointed out that by 2020, if appropriate action is not taken, road-traffic accidents could be the third leading contributor to the global burden of disease and injury2. A comprehensive study in Bangladesh revealed that the main cause of child mortality is drowning3. In children aged 1-4 years, 26% of all deaths were due to drowning, followed by pneumonia (23%), malnutrition (16%), and diarrhoea (10%). The authors of that paper also compared other studies and concluded that there has been a gradual shift in the cause of child deaths in Bangladesh from infectious diseases to noncommunicable diseases and injury. In 1983, 9% of all deaths among children aged 1-4 years were due to drowning; by 2000, this had risen to 53%4.
In conclusion, we need campaigns for better road safety to lessen road traffic accidents, increased supervision and swimming lessons for children to prevent drowning and household safety education to prevent suffocation, falls, poisoning and animal bites.
We declare that we have no conflict of interest
*Dewan Sakhawat Billal Ph.D
Noboru Yamanaka MD, Ph.D
billalds@wakayama-med.ac.jp
Division of Infection and Immunity research Center, Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama 641-8509, Japan
References
1. Kirkwood G, Pollock A. Preventing injury in Childhood. BMJ 2008 336:1388-9. 2. The lancet. Accelerating action on road safety. Lancet 2008; 371:960.
3. Rahman A, Rahman AKMF, Shafinaz S, Linnan M. Bangladesh health and injury survey: report on children. Dhaka: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of the People's Republic of Bangladesh; Institute of Child and Mother Health; United Nations Children’s Fund; Alliance for Safe C hildren, 2005.
4. Health and Demographic Surveillance System, Matlab. Registration of health and demographic events 2000, vol 33. Dhaka: ICDDR, B, Centre for Health and Population Research, 2002.
Competing interests: None declared
Competing interests: No competing interests
no such thing as an 'accident'?
Whatever happened to the BMJ's prinicpled and much-vaunted policy of never allowing the word 'accident' in its pages? This editorial includes the word at least three times!
I was impressed when you anounced this decision, and although others have been slow to follow, I had hoped that you would remain strong: injury and trauma happens for a reason, not 'by accident'.
Helene Brandon
Competing interests: I lead on risk management issues
Competing interests: No competing interests