Over the last quarter century I have told many patients in the emergency department, "You get only one head. There are no replacement parts. Take care of it." Very often what I'm getting at is very simple: wear a helmet.
Helmets are becoming more and more common on ski slopes. Skateboarders often wear them now. Most bicycling children protect their heads. Most states require motorcycle riders to wear helmets.
But there is an intense and vocal segment of bikers who don't want to wear helmets. They oppose helmet laws as an infringement upon their individual liberties. I wrote my first article on the subject more than a decade ago, and the available data strongly supported the protective effects of helmet use in preventing death and serious long-term disability from head injury. In the years since then, data have continued to accumulate, providing ever more convincing proof of the benefits of helmet laws for the public health.
Still, the bikers oppose efforts to enact helmet laws in the states that don't have them yet, and they mount repeated attempts to repeal these laws in states that have them. My home state of Pennsylvania is an example of success of those repeal efforts. Data collected since the repeal tell a grim and tragic tale.
One of my favorite expressions in scientific medicine is, "The plural of 'anecdote' is not 'data.'" What this means is that reports of single incidents, observations, or experiences, accumulated or aggregated, do not tell you anything of validity comparable to that of a systematic analysis of data from a scientific study.
Nevertheless, anecdotes often sway public discourse and public policy, because average citizens and politicians find them persuasive. So now, along comes an anecdote that brings a tragic irony to the public debate. The Associated Press is reporting that two days ago in upstate New York a 55 year old motorcyclist, riding without a helmet in an organized protest by a group of bikers opposed to helmet laws, lost control of his bike, flipped over the handlebars, struck his head on the pavement, and was subsequently pronounced dead from his head injury at a local hospital. Police opined that he would likely have survived had he been wearing a helmet. The effect of this incident on New York legislators' view of helmet laws seems sure to be the opposite of what the motorcyclists had in mind.
My personal political philosophy has strong libertarian leanings. And so I understand the arguments against helmet laws as infringements upon personal freedom. The data, however, tell us that unhelmeted riders cost the rest of us a lot of money. Head injuries cause a great deal of disability, and societal costs are impressive. Some say that issue is addressed when riders have health insurance, but of course it isn't. Insurance is a mechanism for sharing risk, and so the costs incurred when an insured rider is injured are spread among a larger group. All having insurance means is that you are putting money into the risk pool. Engaging in risky behavior still costs everyone else in the pool money when your behavior has unfortunate consequences.
The conclusion brings us full circle: wear a helmet!
Please let them do as they wish, provided they sign a waiver when they get the motorcycle driver endorsement that they will not sue anyone in the event of a head injury and will donate what organs are intact to the living.
ReplyDeleteBy way of a newsy note, there was a notorious middle aged woman biker who crusaded against helmet laws which were repealed in Florida a number of years ago. She inhabited the Daytona Beach area famous for its semi annual motorcycle rallies known as "Bike Week" in March and "BiketoberFest" held every October. She lost her life via head injury while riding her motorcycle. curiously there was relatively little backlash about this unfortunate tragedy on either side of the issue.
ReplyDeleteMy personal opinions have been riding a merry-go round throughout the years. At first I believed during my liberal college years in seeming Constitutional freedoms which endorse an individual's right to ride a motorcycle helmetless as long as he(she) does not endanger the safety of others. In the early 80's while taking my first ATLS course held at Maryland Shock Trauma an overzealous trauma fellow showed us the "Vegetable Garden" composed of mostly head injured motorcycle riders, and asked us who we thought was paying for the medical bills. The answer is "all of us" and suddenly I felt a vested financial interest in compelling motorcycle riders to wear helmets especially since I am expected to foot the bill for their folly. Now having lived and practiced EM in Central Florida for the past 11 years, I have read statistics that suggest helmetless motorcycle riders are killed much more frequently than helmeted ones involved in serious accidents while riding. That brings me full circle to passively not contesting the right to let "the wind blow through one's hair" while riding a motorcycle. I have to admit that the more physician-caring side of me still rues the danger of such and the personal and family sadness surrounding death by motorcycle accident. Thanks for letting me sound off. Wayne S. Barry, MD FACEP
ReplyDeleteSimple, insurance needs to state that they do not cover injuries obtained in the practice of risky behavior; riding without a helmet being very risky. Thus when they wreck and break their brains, they can exhaust any money they have paying for their care, just like the elderly do when going into a nursing home. There is no reason private insurances or government insurance should foot the bill for this. One WV study ( may not have been official "study" as much as examination of data collected) a couple of years ago showed the biggest factors in obtaining head injury while on ATV in WV was being intoxicated without helmet on public assistance. I am happy that we are all footing the bill for these folks. Glad to see that they are using their money wisely. We foot the bill for their food an medical care and broods of kids while they spend money on ATV's and alcohol. What a deal!
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