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One of the huge advantages of being an editor is being able to bypass the peer review process in some instances. Earlier this year the BMJ declined to publish a letter to the editor I wrote. It questioned the decision of the BMA Board of Education and Science not to recommend bike helmet legislation. The BMJ refused on the grounds of insufficient space. (Although I don't subscribe to every conspiracy theory floating around, it seems possible there were other reasons for saying no to this letter.) I believe the questions raised in that letter are of great importance to all involved in this debate. Accordingly, with a tincture of hesitation, I am about to make journalistic history by publishing my own letter! I look forward to your comments. This journal will ensure that there is always space for reasonably short letters, especially those that criticize the editor.
My letter follows:
Douglas Carnall's report describing the BMA Board of Education and Science's position on the merits of bike helmet legislation, is remarkable.1 It suggests that the board fails to practice what the BMJ so assiduously preaches about the need for evidence based decisions. I may be wrong, so let me ask the board some questions and trust that in their desire to enlighten us, they will reply fully.
If “international evidence” implies more than the single study cited (from Australia), what other countries have provided similar evidence?
Is the board really saying that a decline of deaths and head injuries of between 37% and 51% is less important than a postulated decline in fitness?
Did the board seek to ascertain if the decline in cycling after the law changed in Victoria was sustained, and, if so, for how long and by how many?
Did the board determine whether those who quit cycling were previously riding sufficiently fast and for long enough to enhance their fitness, or, indeed, whether the quitters chose other fitness enhancing activities?
What is the empirical evidence that the proportion of helmet wearers “would have to be increased by promotional campaigns before legislation could hope to be effective”? If there is such evidence, what is the magical number to be achieved? What were levels of seat belt use in Britain before legislation was introduced and how successful were the pre-law promotional campaigns in increasing use rates?
Did the board conclude that Britain would take the same measures to reduce car speeds and separate cyclists as did the Netherlands and Denmark? If not, why is this relevant to their conclusion?
Does not the term “prohibitive” apply more aptly to the costs of care for a moderate or severe head injury than to the £12 cost of a helmet?
What evidence enabled the board to imply that collisions with “fast moving traffic” are a more frequent cause of head injury to a cyclist than a fall? Does the board accept that helmets are designed to offer protection against falls and such, not crashes?
I assume other readers will be as interested as I to learn who sits on this board, how they are appointed, and in what manner they review the evidence on which they base this and other critically important recommendations.
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