Editorial comment on motorcycling

Fair days in the Pittsburgh area witness a dramatic increase in motorcycle traffic. Alco noticeable are many motorcyclists without helmets, following repeal of the helmet law by Gov. Rendell in 2003. Few issues promote more passionate opinion and argument among motorcycle riders than that of helmets, and it has become as much a political argument as a practical one. As a critical care physician caring for motorcycle injuries and a rider with over 40 years experience I’d like to have the opportunity to comment on helmets and motorcycles.

Opponents of helmet use safety suggest that safety should be a choice rather than a requirement. Safety is a good choice but individual riders should have the right to make bad choices that end in disaster if they so choose. The public’s right to make bad choices is a lesser evil than government bureaucrats mandating standards not pre-approved by the public. In so doing, libertarian organizations equate safe practices with individual preferences. As a physician that deals with head injuries every day, I would like the opportunity to counter that argument because this is a safety issue and has nothing to do with freedom of choice.

The medical literature regarding motorcyclist’s head injuries is very clear. Head trauma is a devastating injury for riders and their families and rehabilitation for survivors is prolonged and expensive. Injury expenses for unhelmeted motorcyclists far exceed that of helmeted riders (1). More importantly, the burden of caring for a head injured patient is frequently borne by the taxpayers, regardless of the insurance status of the injured rider. One study showed that the costs for 105 patients, followed up for a mean of 20 months, were more than $2.7 million dollars, with an average of $25,764 per patient. The majority (63.4%) of care was paid for by public funds, with Medicaid accounting for more than half of all charges (2).

It’s the State’s responsibility to point out public safety issues. The same States have no problem mandating seat belts for automobiles and child seats because the evidence conclusively supports their use. By ignoring common sense and a mountain of convincing data, Pennsylvania and other States repealing helmet laws send a signal that they don’t care about the safety of motorcyclists. If the State says it isn’t a big issue, then why should riders worry about it? If they’re too dumb to make the right choices, let them. As a direct result, some riders that would have walked away from accidents will instead end up in chronic care facilities at great expense their families and the taxpayers.

The evidence is clear that the use of helmets dramatically increase the real chances of surviving an accident with an intact brain. The evidence is convincing enough to create a threshold where it becomes the State’s responsibility to point those chances out to riders in a very legally binding way. Indemnity for motorists of all varieties should be apportioned fairly according to risk. Those who exercise their right to ride without adequate protection should be rated by insurance companies like any other outstanding risk factor such as speeding citations. This would add much needed perspective to the current “freedom to choose devastating head injuries” mindset of some riders. The benefit of choice simply doesn’t outweigh the cost, human and monetary.

1) Hospital cost is reduced by motorcycle helmet use. Brandt MM, et al. .J Trauma. 2002 Sep;53(3):469-71.
2) The public cost of motorcycle trauma. Rivara FP, Dicker BG, Bergman AB, Dacey R, Herman C.JAMA. 1988 Jul 8;260(2):221-3.