The Bike Helmet Paradox

Plastic shells keep our heads from coming open, but they also deter us from riding bicycles. And riding bicycles is good for people and Earth. 

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(Jonathan Hayward / AP)

Admonishing a teenager for smoking is commonplace. Reprimanding people for taking antibiotics when they don't really need them is the next big thing. And giving people a hard time about biking without a helmet is still entirely in vogue. It's because we care. But as we learned from the original food pyramid, sometimes good intentions pave the road to adult-onset diabetes. 

People are still questioning whether bicycle helmets, compulsory or voluntary, reduce injuries. Do we ride more aggressively when we wear them, because we feel invincible, putting our whole bodies in more dangerous situations? Drivers are more cautious around riders without helmets. While good evidence says helmets do their job in reducing head injuries, we're best to -- as in all things -- think outside of our heads.

Helmet laws are associated with a number of less intuitive behaviors. The case against them is increasingly compelling -- surfaced again last week in a report from the National Bureau of Economic Research (NBER). Analogously, the argument tests a culture where we helmet-shame people into either wearing a helmet or not riding. It's not a libertarian crusade; it's a public health question. And it's not as straightforward as Officer Friendly taught:

To start, it's unfortunately relevant that many find helmets unbecoming. They also mess up our hair. The dead keratin strands on our heads -- they put them out of order, and that upsets us. These factors do matter, in that they affect our behavior. Sometimes they keep us from biking.

More to the point, detractors contend that helmets make biking seem like too much of an ordeal, a perilous endeavor. Intimidation, of the process, means fewer bikers.

Cities like Washington, D.C., have great bike-share systems, where bicycles are everywhere for the taking. Decisions to hop on a bike are often impromptu. Who among us is never without a helmet? Or wants to carry one all day after a one-way ride -- which is a common use of bike shares. Guilt, and safety concerns that surround helmet-less biking, make many in that situation choose to drive instead. Is that better?

In Pinka Chatterji and Sara Markowitz's report for the NBER last week, they note that no nation-wide study in the U.S. has evaluated the effects of bike helmet laws on injuries. They also say that only one study has looked at helmet laws' effect on mortality -- in it, they were "associated with a 15 percent reduction in fatalities among juveniles." Their complete report is worth reading if you care to go in depth on the statistics. In short, they found that in the U.S., kids and teenagers ride less in places with helmet laws, and suggest that less riding could be what actually accounts for reductions in bike-related injuries. They also get into how people are more aggressive on roller skates and skateboards when they're wearing helmets, which results in more overall injuries. They suggest that the same could be true for bicycles. 

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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