‘Do no harm’ – An open letter to Dr Andy Eynon

An open letter to Dr Andy Eynon reported by the Daily Echo as being the Director of Major Trauma at Southampton General Hospital. A copy of this letter has been posted to Dr Eynon.

As a society we place a certain amount of trust into those who have earned the letters “Dr.” in front of their name. These letters suggest that an individual is exceptionally knowledgeable in their chosen field. However, there comes a danger with these two letters; a tendency to believe oneself an expert in other fields, fields which may be at best only tangentially related to the area of expertise lies.

When I first read the Daily Echo piece, I was interested to see if your call for compulsory cycle helmets was due to the publication of a new piece of research from a research group you head. It had been a few months since I had checked the latest research into the effectiveness of cycle helmets and the wider impact of making them mandatory, I found myself wondering if a number of new, ground-breaking articles had been published which had tipped the consensus in this area. The previous consensus I had garnered from a wide reading of the research in this area had been that, at best, under some limited circumstances, cycle helmets may provide marginal protection to the individual in the event of a road traffic collision. On a country-wide level, when cycle helmets are made mandatory, the criminalising of cycling without a helmet costs many, many more lives through inactivity than could ever be saved by cycle helmets. A quick check of your name on Pubmed didn’t show up any research into effectiveness of cycle helmets, nor the public health costs associated with helmet compulsion laws.

There are people out there who are doing this research, people with PhDs, or who are working towards them in exactly this area. I have no doubt that you are good at what you do, and should I sustain a major trauma I trust you would do an excellent job of the repair work. However, you simply do not appear to have the necessary credentials to call for a mandatory cycle helmet law. Your position allows you to project your opinion on the matter to a wide audience, but in the process you are drowning out the voices of the real experts in this field. Of course the general public will not necessarily appreciate this distinction, but I find it hard to believe someone such as yourself could not.

I appreciate that in your line of work you are uniquely privy to the damage which poorly-driven motor vehicles can do the bodies of cyclists. I also appreciate that anecdotally it may seem to you that the frequency and/or severity of injuries sustained by cyclists are related to whether or not they were wearing helmets. However, I trust that you can appreciate that “I reckon,” is not a suitable basis for policy, even if it comes from someone with those two little letters in front of their name.

I am not a physician, but I do know that “do no harm” forms the very core of medical ethics. Whenever someone in your position ignores the body of evidence in this area and calls for mandatory cycle helmets they do a great deal of harm indeed. Mandatory helmet laws are a disaster for cycling rates, whilst providing no meaningful benefit to those cyclists who remain. Many more are harmed through inactivity than could be saved by even the most generous estimates of cycle helmet efficacy, whilst those who wish merely to get around on a bike are needlessly criminalised.

If you are genuinely interested in improving cyclists’ safety, I urge you to publicly retract your call for a mandatory cycle helmet law. Instead of ineffective ‘more padding’ approaches to road safety, put your efforts and influence behind campaigns aiming to reconfigure our road network to make cycling (and walking) safer, more pleasant and more convenient. By fixing our road network we can gain both a reduction in injury rates for vulnerable road users and a reduction in all of the costly medical conditions which are exacerbated by our increasingly sedentary lifestyles, through an increase in cycling rates. If you want to make a positive difference for cyclists, reject helmet laws and support the work of organisations such as the Cycling Embassy of Great Britain.

Note to reader: I am happy for this letter to be edited and re-used by anyone, anywhere in the world where a physician starts to think their expertise extends into areas it clearly does not.


17 thoughts on “‘Do no harm’ – An open letter to Dr Andy Eynon

  1. Dr Eynon’s pronouncement in this area illustrates two key things about doctors, especially consultant surgeons in hospitals.

    One is that they are arrogant, and believe too much in their own capabilities. That does not mean they are not nice people – you can be a pleasant, charming, kind and courteous – but arrogant – individual, just as much as you can be an arrogant a*sehole. Either way, they become conviced that their views are more relevant or more importannt than those of others, and as specialists they lose sight of the bigger picture.

    The other, which I think applies to traditionally-trained doctors of all stripes, is that they are in the business of sickness, not the business of health. I have NEVER in all my more than 50 years on this earth been asked by my GP surgery to attend health advice sessions. I have never had a medical, and I have never had printed or similar information on how to maintain a healthy lifestyle.

    I do in fact have a medical examination every year – my employer requires one every three years for insurance purposes but is willing to pay for one every year – which is useful to ensure that those nasty things which can happen to middle aged men are nipped in the bud. (The rubber glove up the back passage does serve a useful purpose, after all). However, I am sure that virtually all of the advice I get about how to stay fit, within safe body mass indices, and clear of avoidable conditions comes from paramedical staff – physios, exercise consultants, nurses.

    The point is that Dr Eynon and, sadly, the BMA as a body which also has non-neurosurgeons, even diabetes and obesity consultants, are just not geared up to promote health, just to repair the wreckage afterwards, so such crass misdirections are, I fear, inevitable from them.

  2. I agree. NHS is generally about illness and not health. This is a case in point. Helmets might seem to protect you from injury (illness), but as you eloquently point out they are actually bad for health overall because they discourage cycling and do nothing to address the cause of the injury itself. Symptom not cause.

  3. Your suggestion that somehow by expressing his professional opinion, Dr Eynon should have his integrity as a Dr and the ethics by which he operates called into question, is both laughable and deeply offensive

    Perhaps you’ve now seen the Trauma One documentary on ITV tonight where Dr Eynon and his colleagues battled sucessfully to save the life of 14 year old boy who sustained a traumatic brain injury after a cycling accident which was undoubtedly worsened by the lack of a cycle helmet

    Have you actually bothered to look up Andy Eynon’s professional credentials? As the head of one of the UK’s 12 Major Trauma Centres and an hugely experienced Dr who specialises in Emergency and ICU medicine, I’ll take his view over your anecdotal BS any day of the week

    A large study of 3900 cyclists around 20 years ago and the Cochrane review of existing evidence, both found strongly in favour of cyclists wearing helmets, with a marked reduction in traumatic head injuries amongst those cyclists who wore helmets.

    A lot has changed since then? Yup, roads have become more congested, bikes have become light and quicker which simply increases the speed and the consequential Kinematics Of Injury, and cycle helmets have got a whole lot better. No new evidence is any more rigorous than the above or substantial enough to challenge it any way

    As a 999 ambulance clinician, I’ve recently been out to two cycle vs car RTC’s where cycle helmets have, in my professional opinion, substantially reduced the head injuries to the cyclists involved. Neither were the cyclist’s fault, one involved an Olympic cyclist on a training ride, hit by a car. The latter’s remark to me afterwards was: “Thank **** I was wearing a helmet”

    I don’t know a single one of my colleagues who holds a different view or who would allow their children to ride a bike without a helmet.

    They’re lightweight, stylish, inexpensive and extremely effective. In no way can I see that they detract from the enjoyment of cycling, indeed it seems to me that many people like them as a styling detail and often an effective place to mount lights etc. Your suggestion that somehow people will be deterred from the sport if helmets were made compulsory is farcical. Anyone who isn’t farm animal stupid is already wearing one and has been for a long time

    Unless you’re prepared to actually deal with the heartbreaking, life changing and expensive consequences of your reckless suggestions, as people like myself and Dr Eynon do, day in day out, then I strongly suggest you desist from this kind of nonsense?

    • Congratulations on completely failing to grasp the message of this piece. I suggest you properly re-read the post before posting any further comments.

      Let me be absolutely clear: Being a trauma surgeon, or a paramedic in no way qualifies a person as an expert on specific items of personal protective equipment. Whilst I would certainly value Dr Enyon’s opinion on what to do about injuries arising from an electric shock, I would not value his opinion regarding the design of, or appropriate use of a residual current device when designing electrical equipment. Even though the two things are superficially related, being able to treat someone who has received an electric shock in no way qualifies a physician to comment about the effectiveness of equipment which may protect from electric shock. I am not calling the character or ethics of Dr Enyon into question, merely proposing that he has succumbed to ‘authority creep,’ whereby (deservedly) being a respected authority in a particular area leads to the assumption of authority in unrelated fields where it is not deserved. How is that not abundantly clear to you?

      I also suggest you read this piece about the problems with the Cochrane review you mentioned in your comment.

    • “Your suggestion that somehow people will be deterred from the sport if helmets were made compulsory is farcical.”

      I don’t think chestercycling said anything about any sport, did he? I don’t think he’ll mind me saying that I don’t think he takes much interest in sports.

      • “I don’t think he’ll mind me saying that I don’t think he takes much interest in sports.”

        Fair. I only found out who Bradley Wiggins was when they covered the Tour de france last year on BBC Breakfast.

  4. I don’t think this letter is very useful at all. In fact, I think it is quite dangerous. It is obvious that cycle helmets offer significant protection within an activity that is inherently dangerous, and I feel that you are detracting valuable attention from this, merely to make an almost personal attack on somebody who is acting within the public’s interest.

    I completely appreciate how passionate you are about cycling – so am I. I understand that you feel this policy may do harm to the sport, but I don’t think that your approach of trying to retract (or boycott) the introduction of such simple and effective safety measures can even begin to justify these fears.

    You put a good argument forward in terms of seeking alternate measures to improve road safety. Why on earth don’t you focus on this? Use your passion in a constructive way – Not to trivialize essential safety precautions, or to criticize an individual’s ego, but to promote policies that are in fact going to make a difference to the cycling community, and the general public.

    • It is obvious that cycle helmets offer significant protection within an activity that is inherently dangerous

      It is comments like this which make letters like this one necessary; just because something seems obvious does not mean it is true. A good example of this phenomenon can be found here.

      may do harm to the sport

      I’m not generally concerned with sports issues on this blog.

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