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Archived Comments for: Repeal of the Pennsylvania motorcycle helmet law: reflections on the ethical and political dynamics of public health reform

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  1. Missing the Mark

    Harold Weiss, University of Otago

    16 June 2010

    This analysis of the repeal of the Pennsylvania motorcycle helmet law should have gone further to be of more practical use to public health practitioners and policy makers. It misses some key aspects of the science surrounding the helmet debate, oversimplifies the coarse, chaotic and yes, often crass political nature of the policy making process and frustratingly sidesteps the main question it posed, namely: “Was the repeal of the motorcycle helmet law the best public policy decision for the people of Pennsylvania?”

    Though not all helmet debate discussion is focused on whether helmets work or not, much of it is when trying to frame the issue for anti-mandatory helmet organization members, legislators, media, health professionals and the public. On this aspect, the discourse emanating from the mandatory helmet repeal side often contains some unfortunate parallels with denialist strategies used in other public health and environmental issues where the direction of the science is very much settled. Among a list of attributes described by Diethelm and McKee (Denialism: what is it and how should scientists respond? Eur J Public Health 19: 2-4. 2009) one can find among helmet efficacy deniers the following: Use of fake experts, denigration of real experts, selectivity of weak science to denigrate consensus, misrepresentation and use of logical fallacies. The impact of these intellectually dishonest strategies on legislative and executive decision making should not be understated. It is not so much that politicians believe all the propaganda (though some do succumb and repeat the worn-out falsehoods), but it opens up for others a deliberative space to discard the science and public health as unsettled and just focus on the politics. This is also related to the role of the media which was acknowledged by the author, but not well explained. How was it repeal “reformers” had better access to media and what role did the media play (or not play) in accurately presenting the science? Or did the media, as it often does in search of situational balance for controversial issues, try to present two sides of the argument, regardless of what the weight and quality of the evidence was on each side?

    I am also concerned about the statement: “their choice to not wear a helmet does not pose a physical threat or danger to anyone else.” In the case of motorcycle helmet laws, those who support repeal of helmet laws ignore an important and robustly demonstrated physical threat to others; namely to children and young adults not covered by the repeal. When states go from all age coverage to covering only youth (most repeals do this for political palatability, as did Pennsylvania’s) the reality is that helmet use goes down among youth riders who are suppose to be covered by the remaining law (presumably due to less enforcement). The result? It has been shown that “Universal helmet laws are associated with fatality rates that are 31% lower among motorcyclists 15-20 years of age” than states that still require helmet use by riders under age 21 (Houston, D. J. (2007). "Are helmet laws protecting young motorcyclists?" Journal of Safety Research 38(3): 329-336).

    I also take issue with the importance of public perception. It plays a role, but according to a survey in 2000, 81 percent of adults reported that they favored mandatory helmet use laws for motorcyclists (National Highway Traffic Safety Administration, 2000 Motor Vehicle Occupant Safety Survey. Washington DC: US Department of Transportation). Even among motorcyclists the support was 51 percent. Yet in Pennsylvania, as elsewhere, an organization that represented about 1% of the state’s relatively small proportion of motorcyclists fought successfully for an opposing policy. The legislative process is usually much more complex, chaotic, money driven and nuanced than intellectually balancing public opinion, individual rights and public health. Sometimes when votes are close such balancing matters little and it would be naive to think otherwise in the political machinations that lead to public policy.

    This point is driven home by considering why 21 states, representing half the U.S. population, have kept their Universal helmet laws intact. While repeal “reformers” often do have intangible and very tangible forms of money, power and influence of the legislative process, similar situations probably exist in many of those states that have kept their helmet laws. So limits to influence and appeals to reasonable balancing of public good and private rights is not impossible to achieve. But the closeness of the contest is what makes the issue controversial, the outcomes uncertain and it seems, perpetually engaged in.

    Finally, the view expressed by the author that public health policy “should not unnecessarily infringe upon the rights of others to enjoy the freedoms that all of us are accustomed to” minimizes the perspective that helmet advocates are not being draconically restrictive by supporting helmet laws. With a helmet law, those that chose to ride can still chose to ride, but with a helmet on. The complete other side of the argument is actually whether an activity that results in 34 times the risk of a traumatic brain injury death /vehicle mile than autos should be allowed at all. Helmet advocates already have balanced freedom needs by advocating improved brain protection if one does ride. Most of the freedom desired remains intact, despite the highly hazardous nature of the activity.

    In the end, this article lends little fresh perspective on just how policy makers or public health professionals decide on or recommend policy and how they are suppose to “give equal weight” to such vastly different concepts as “freedom of choice” versus proven and substantial increase in risk of death and serious permanent brain injury. Often, if not usually, the policy making process is a much murkier beast.

    Competing interests

    None declared

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