Only wholeness leads to clarity

Authors Lee and Mann argue for law compelling use of cycle helmets by children to prevent road deaths and serious injuries.1 This observer is surprised that the peer reviewers allowed publication of material lacking evidence either that the actual risks faced by child cyclists justify compulsion, or that the real world results of helmet compulsion in other countries justify compulsion in this country. These shortcomings are typical of papers in the medical literature that attempt to address the issue of cyclist safety. I believe that these chronic shortcomings are primarily the consequence of the failure of the peer review process. In the first place, it is irrational that consideration of helmet laws for children is restricted only to cycling, or even begins with cycling. Although, tragically, around 30 child cyclists have been killed on public roads annually in recent years, typically 110 child pedestrians are killed annually.2 Estimates of death risk per kilometre travelled derived from standard data sources3 do not suggest that child cyclists face greater risks than child pedestrians in most age groups. It is in any case evident that the average child is almost four times …