Cycle helmets should not be made compulsory, according to medical experts. The surprise finding from a poll of readers of the British Medical Journal suggests there is no simple answer to improving cycling safety.
More than two-thirds of the journal's readers (68 per cent) voted against mandatory cycle helmets for adults out of a total of 1,427 people who cast votes.
The key reason for their disquiet was that making helmet-wearing compulsory might deter people from taking up cycling, reaping the health benefits that flow from it.
One respondent said: "It gives out the message that cycling is dangerous, which it is not. The evidence that cycling helmets work to reduce injury is not conclusive. What has, however, been shown is that laws that make wearing helmets compulsory decrease cycling activity. Cycling is a healthy activity and cyclists live longer on average than non-cyclists."
Another said: "Since nowhere with a helmet law can show any reduction in risk to cyclists, only a reduction in cyclists, why would anyone want to bring in a law for something which is clearly not effective at reducing the risk to cyclists?" Australia made wearing helmets compulsory for cyclists in 1991 but two Sydney University researchers called last year for the law to be repealed.
They argued that the fall in head injuries since the law was introduced was due to improvements in road safety, such as random breath testing. Figures from Western Australia suggested that cycling fell 30 per cent after helmets were made mandatory.
Only New Zealand has followed Australia and introduced a similar law.
Chris Rissell, one of the researchers, said: "I'd recommend a trial repeal in one city for two years to allow researchers to make observations and see if there's an increase in head injuries, and on the basis of that you could come to some informed policy decision."
As doctors are the ones who have to deal with the injuries that result from cycle accidents, eyebrows are likely to be raised at their resistance to mandatory helmets. But the respondents were looking at the wider impact of making helmet wearing compulsory and balancing the benefits (fewer head injuries) against the harm (fewer people cycling).
One said: "If the health benefits of cycling could be bottled it would be the most popular medicine in the world."
The Olympian who owes his life to a helmet
James Cracknell has the scars to prove helmets can save lives. It took 25 staples to put his head back together after the Olympic rowing champion-turned-adventurer was hit by the wing mirror of a fuel truck at 75mph while riding in Arizona last year.
He had been attempting to travel from Los Angeles to New York in 16 days by cycling, rowing, running and swimming the entire distance. His family was called to his bedside after the crash, which shattered his helmet and broke his skull in two places. He survived, despite spending several days in a coma and also suffering bleeding on his brain.
"There is only one reason I survived," he says on his website. "My cycle helmet." A year on and Cracknell has launched an awareness campaign to encourage more riders to: "Use your head, use your helmet." He says: "I want [it] to become as normal as clunk-clicking your seatbelt on."