Even if I am rarely successful, at least I am persistent. After my recent radical decision to publish my own letter to the editor of the BMJ on the subject of helmet laws, I have been embroiled in a similar controversy in Quebec. Our transport minister is considering such legislation, but the antihelmet lobby is trotting out all the usual chestnuts. This lobby usually consists of pro-bicycling groups. Perhaps as a consequence of having not worn helmets for too long, they are convinced that a helmet law is anticycling. I regard it as quite the opposite. In any event, after an essay by the president of Le Monde a Bicyclette appeared in the Montreal Gazette, I wrote a rebuttal using the same arguments as I gave in my letter to the BMJ. The Gazette was hesitant to publish my contribution because the editor thought it sounded too much as if only doctors knew what was best when it came to head injuries. I pleaded guilty.

I also recently wrote an editorial for the Canadian Medical Association Journal, commenting on a paper examining trends in spinal cord injuries in amateur hockey in Canada. Helmet use (and misuse) is also an issue in this sport, and the juxtaposition of bicycling with hockey reminded me of an article in my favorite journal—the Medical Post. It was about a legendary ophthalmologist, Dr Tom Pashby, shown in these marvelous photos. The article described this 84 year old surgeon's long campaign to require hockey players to wear helmets.

Forty years ago, his 14 year old son was concussed when his head hit the ice during a hockey game. At the time, the neurosurgeon bluntly told Pashby he was “stupid” to let his son play hockey without a helmet. Pashby then began to lobby for a “no helmet—no hockey” rule. He also insisted that all minor league hockey players be required to wear helmets with visors or face guards for eye protection.

The payoff for amateurs is impressive. Over the last 23 hockey seasons there were 1860 eye injuries and 298 blinded eyes. In 291 of the latter, the players were not wearing a visor. In comparison, last year there were only five serious eye injuries in amateur hockey in Canada.

For better or worse, professional athletes are often seen as role models, by adults as well as children. What these millionaires wear, and how they behave, has a profound influence on much of the public, as do the regulations under which their sport operates. Although professional hockey players are now obliged to wear helmets, it appears that the regulation neglects the obvious requirement that the chinstrap be properly fastened.

Professional players who choose not to wear a visor face a different picture than amateurs who do. In mid-February, for the second time in one week, two players on the Montreal Canadiens hockey team were hit in the face by a puck. One, who had a previous eye injury, still declines to wear a visor. “No, I've been playing this way too long to change now”, was his thoughtful answer. The other had his larynx crushed by a puck. Ironically he had become a visor wearer after a serious eye injury. Recently a third player lost an eye when struck by a puck. He will never play again. Another escaped blindness by millimeters but will miss several games because of blood in the eye. Dr John Little, the Canadiens ophthalmologist, has been advising players to wear visors for over 20 years.

Undoubtedly, some players believe there is a stigma attached to visors. They are often abused and taunted by fellow players for choosing to do so. One TV commentator argues that “feisty” players hide behind their visors; that it is a sign of weakness; that it gives them a false sense of security, and leads to more high sticks. The latter is unproven, but even if it were true, the league need only enforce existing regulations to remedy this. It is agreed that visor use will only happen when the league insists, just as it has compelled players to wear helmets. The fact that the league does not require visors is irresponsible and sets a bad example for younger players. As does the fact that well known players have been pictured wearing helmets with the straps dangling loose.

These examples makes one wonder how much those responsible for this, or other professional sports, care about the safety of their players, let alone the example such behavior sets for others, especially the young. As Dr Pashby realized, sports injuries at all levels are frequent and often very serious. Many are preventable by the proper use of proper gear but many others can only be prevented by strong regulations governing players' behaviour. It goes without saying that such regulations are useless if they are not consistently enforced.