Wear a Helmet!

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!