In poor taste

It’s possible to use current events to your cycling advantage.

In 2004, Harvard was abuzz with the news of a midnight groper in Cambridge.  Intriguingly, the most salient characteristic of this dastardly criminal was that he approached his victims on a bike.

I’m not one to let such good fortune pass without action.  Throughout  his spree of terror, I found it extremely effective to bike through Cambridge Common while jingling my keys.  North Face-clad women would peel to the sides of the path as if Moses had commanded it.  I got to and from campus in minutes!  This was extremely effective – by the end of month, I even got lazy, yelling “bike! bike! bike!” to the same effect.  Sadly, things went back to normal after he was identified.

Imagine my glee when it came out that the Craigslist killer was a Boston University MEDICAL STUDENT who operated in Boston and Rhode Island.  Smart?  Pompous?  Clean-cut?  Creepy?


My commutes to the hospital have just gotten a bit simpler.  At least for a little while.

The cycling counterculture

Fixie kids, you’re not as bad-ass as you might think.

I grew up in a California town that might as well have been midwestern.  Sure, the urban bike snob phenomenon in Boston was a surprise, but recently, I’ve been mystified by a more sinister phenomenon:  mobs of kids on BMX or cheapo 24″ bikes cruising around the urban fringe as if they were preparing for careers as moto-Shriners.  These bike squads seem to be part of the urban environment:  oversized shirts, oversized shoes, undersized bikes, no regard for traffic laws, and never ever a helmet.  To where are they going?

I rode by two such groups yesterday and couldn’t work up the nerve to snap photos from my academically spandexed perch.  There’s nothing that kills street cred more than the Ivy League.  Unless you’re Jordana Brewster.  Or Emma “Hermione” Watson.  Or JTT.

I shouldn’t be that surprised.  The public-schooled Bostonians that I met in college (not the blue-blooders that I learned to know and love) had the uncanny ability to perform front-wheelies on command – even on a 45-lb Huffy with suspect front brakes.  Additionally, there are probably as many second-hand BMX bikes on Craigslist (that I’ve always ignored) as there are road racing rigs.  Even Specialized seems to be part of the game.

A Reaver.  No BMX in the future.

Based on a quick search, this group seem to be vilified as much as our super-elite cycling community.  In 2006, a kid at Pop Warner football practice was shot by a kid on a bike.  Unfortunately, the only real exposition on a simple search for “bike gangs” was this tongue-in-cheek Canadian piece.  It’s a two-wheeled battle between the modern-day Cylons and Reavers (photo) for street cred supremacy!

I think a well-reasoned BMX hoodlum blog is a badly needed addition to our cycing community.  Takers?

Incidentally:  awesome.

Tour to Insure

If you were a California state employee, you’d have tomorrow (Friday) off.  For everyone else, come play hooky and join us on the AMA Tour to Insure!

Part 1:  Boston to Providence, led by the boys and girls of the Tufts University School of Medicine.  They leave 9am from the State House, arrive at Brown University in time for SpringFest at 1:30.  We will rendezvous with UMass Medical School at Natick at 10:30am.  Take the commuter rail back home.

Part 2:  Providence to Mystic, CT, led by the stinky hippies from the Brown Medical School.  They leave 12:40 from the Brown BioMed center on Meeting Street, arriving in Mystic around 6.  Take Amtrak back home.

Relay continues over the following two weeks covering Long Island Sound, NYC, Albany, and Buffalo.

Here’s why we’re doing it.  Luckily for everyone, it’s NOT a fundraiser ;p

46 million Americans are uninsured.
They can’t afford health insurance.
They have pre-existing conditions.
They have limited access to health plans and benefits.
No matter what, they live sicker and die younger.
The AMA proposes to solve this crisis by lobbying:
* To provide all Americans with the means to purchase health care coverage.
* To give individuals choices to select the appropriate coverage for themselves and their families.
* To promote market reforms that enable this new approach.

Lisfranc injury – occupational hazard?

Unclear what’s going to destroy me first: cycling or studying.

Lisfranc injury occurs when a bicyclist’s foot is caught in the pedal clips …  It causes fracture or dislocation at the tarsometatarsal (Lisfranc) joint.” – High Yield Gross Anatomy

Fixie kids – how common is this?

BTW:  this is only slightly less cool than:
“Calcaneal (lover) fracture occurs when a person jumps from a great height (e.g., a second story window).  I usually involves the subtalar joint and is associated with fractures of the lumbar vertebrae and the neck of the femur.”

Mandatory bike helmet proposal

I’m going to put myself out on a limb and actually advocate for the creation of universal bike helmet mandates for all ages through the AMA.  There are definitely problems with such an idea:
1) Selective enforcement by cops can lead to justice issues.  Most likely will lead to a salutary neglect situation like driving 5mph over the limit.
2) The “daredevil” theory – helmet will make you feel invincible/do crazy stuff.
3) Will reduce biking due to inconvenience.  Can Boston a Velib system work with helmets?  Can a carried helmet become a fashion accessory?

Here’s a very rough draft of a resolution I plan to take to Chicago in June.  Please advise with comments – I can change it until the beginning of May.  Otherwise, enjoy the academic references to a common conversation question.


A Resolution Promoting the Universal Use of Bicycle Helmets



Whereas, recent energy prices and a global economic recession have combined to increase bicycle sales to near-record levels 1; and


Whereas many American cities are integrating cycling into their transportation infrastructures 2; and


Whereas bicycle helmets have been shown to reduce the chance of head injury among cyclists up to 85% 3 4 5; and


Whereas current bicycle helmet laws and education for minors increase helmet use 6; and


Whereas twenty-nine states do not have bicycle helmet laws 7, and of those, fourteen have neither state nor local bicycle helmet laws 8; and


Whereas the incidence of bicycle helmet use is especially low among college students, with estimates ranging between 5% and 27% 9 10; and


Whereas helmets are mandatory for all riders in United States Cycling Federation events 11 ; and


Whereas the American College of Emergency Physicians recommends that state and local governments enact legislation mandating universal bicycle helmet use 12; and


Whereas, our AMA currently limits its advocacy for mandatory universal bicycle helmet use to the preparation of model legislation 13 14; therefore be it


RESOLVED, That our AMA include mandatory universal bicycle helmet laws in our legislative agenda at the state and local levels; and be it further


RESOLVED, That our AMA-MSS research the incidence of helmet use and bicycle-related injury at American colleges and universities; and be it further


RESOLVED, That our AMA-MSS support local chapters in the advocacy and delivery of bicycle helmet and safety education for all ages at their universities and surrounding communities.



1 .  Agence France Presse. (2005) “Bicycle sales boom in US amid rising gas prices.” Available at

 (need a real AFP reference for this)

2.  Matlack T.  (2009)  “Is Boston ready for a revolution?”  Boston Globe Sunday Magazine.  Available at

Boston is among several US cities considering a Velib-style bike sharing program.


3.  Thompson RS, Rivara FP, Thompson DC.  (1989) A case-control study of the effectiveness of bicycle safety helmets. NEJM, 320(21): 1361-7.

Bicycle safety helmets are highly effective in preventing head injury.  Helmets are particularly important for children, since the suffer the majority of serious head injuries from bicycling accidents”


4.  Berg P, Westerling R.  (2007) A decrease in both mild and severe bicycle-related head injuries in helmet wearing ages—trend analyses in Sweden.  Health Promotion International 22(3): 191-197.

Available at

Similarly, the incidence of concussion and skull fracture decreased. For non-head injuries, there were no significant changes for children.  Helmets work.


5.  Thompson DC, Nunn ME, Thompson RS, Rivara FP.  (1998) Effectiveness of bicycle safety helmets in preventing serious facial injury.  JAMA 276(2).  Available at

“Bicycle helmets offer substantial protection for the upper and mid face in addition to their known protection against head injuries. Helmets do not appear to offer any protection for the lower face.”  Don’t fall on your chin.


6.  Macknin ML, Mendendrop SV.  (1994) Association Between Bicycle Helmet Legislation, Bicycle Safety Education, and Use of Bicycle Helmets in Children,” Arch Pediatr Adolesc Med 148(3): 255-259.

Helmet use increases with legislation and education; effects are most significant with both in place.


7.  Current US motorcycle and bicycle helmet laws – April 2009.  (2009) Insurance Institute for Highway Safety.  Available at


8.  Helmet laws for bicycle riders. (2009)  Bicycle Helmet Safety Institute.  Available at


9.  Kafefuda I, Henry KL, Stallones L. (2009) Associations between childhood bicycle helmet use, current use, and family and community factors among college students. Family & Community Health 32(2): 159-166.


10.  Rodgers GB. (1995) Bicycle helmet use patterns in the United States: a description and analysis of national survey data. Accident Analysis and Prevention 27: 43-56.


11.  Road, track, cyclocross rulebook.  (2009) United States Cycling Federation.  Available at .


12.  Universal Bicycle Helmet Use.  (2006)  Ann Emerg Med., 47:306.


13.  H-10.977  Helmets and Preventing Motorcycle- and Bicycle-Related Injuries


14.  H-10.985  Bicycle Helmets and Safety


Relevant AMA and MSS Policy:


H-10.977  Helmets and Preventing Motorcycle- and Bicycle-Related Injuries

It is the policy of the AMA to:  (1) encourage physicians to counsel their patients who ride motorized and non-motorized cycles to use approved helmets and appropriate protective clothing while cycling;

(2) encourage patients and families to inform and train children about safe cycle-riding procedures, especially on roads and at intersections, the need to obey traffic laws, and the need for responsible behavior;

(3) encourage community agencies, such as those involving law enforcement, schools, and parent-teacher organizations, to promote training programs for the responsible use of cycles;

(4) urge manufacturers to improve the safety and reliability of the vehicles they produce and to support measures to improve cycling safety;

(5) prepare model state legislation for cyclists’ mandatory use of helmets while cycling; and

(6) advocate further research on the effectiveness of helmets and on the health outcomes of community programs that mandate their use.  (CSA Rep. 3, I-93; Reaffirmed: CSA Rep. 6, I-98; Reaffirmed: CSAPH Rep. 2, A-08)


H-10.980  Motorcycles and Bicycle Helmets

Our AMA (1) encourages efforts to investigate the impact of helmet use by riders of motorcycles and all bicycles, in order to establish the risk of major medical trauma from not wearing helmets, the costs added to the health care system by such behavior, and the payers of these added costs (i.e., private insurance, uncompensated care, Medicare, Medicaid, etc.); and (2) will explore ways to ensure the wearing of helmets through the use of disincentives or incentives such as licensing fees, insurance premium adjustments and other payment possibilities.  (Res. 423, I-92; Modified and Reaffirmed: CSA Rep. 8, A-03)


H-10.985  Bicycle Helmets and Safety

It is the policy of the AMA (1) to actively support bicycle helmet use and encourage physicians to educate their patients about the importance of bicycle helmet use;

(2) to encourage the manufacture, distribution, and utilization of safe, effective, and reasonably priced bicycle helmets;

(3) to encourage the availability of helmets at the point of bicycle purchase; and

(4) to develop model state/local legislation requiring the use of bicycle safety helmets, and calling for all who rent bicycles to offer the rental of bicycle safety helmets for all riders and passengers.  (Res. 7, I-90; Modified by Sub. Res. 208, A-94; Reaffirmed: CSA Rep. 6, A-04)


H-10.987  Use of Helmets in Bicycle Safety

Our AMA (1) supports appropriate efforts to educate parents and children about bicycle safety, including the use of bicycle helmets, and (2) supports working with the American Academy of Pediatrics and other appropriate organizations to ensure widespread distribution of information and educational materials about bicycle safety, including the use of bicycle helmets, to both medical and non-medical audiences.  (Sub. Res. 72, I-89; Reaffirmed: Sunset Report, A-00)

Opportunity costs

I was recently informed that i should keep my cycling “habit” under wraps if I had plans of applying to competitive surgery residencies.  Apparently, the impression is that it eats too much time.

Alternatively, I hear emergency medicine docs love cycling and would welcome another of their kindred souls with open arms.  Pediatrics?

Incidentally, a bunch of med students from Tufts, UMass, Brown, and UConn are linking together a Boston-NYC cycling relay on April 17-18 in a “Tour to Insure.”  It’s going to be hard to keep that off the CV.

Modernizing the LBS

I am one of the rare cycling enthusiasts who dreads bike shops.  In fact, I view visits as I would trips to the dentist’s office – I suppose that makes mechanics into bicycle doctors in my mind.  Interestingly enough, admitting that local bike shops are hospital-like public resources might make them more sustainable in the internet sales age.

The traditional LBS has a lot going for it.  It holds a useful monopoly on bike repairs and the purchase of bikes I’d actually want to ride; it also provides a location for expertise, impulse buys, and community building.   I have watched my local shop hook my classmates on cycling, and another offer patient puncture repairs to a squadron of pre-teens rolling in on their BMX hogs.  Obviously, a shuttered LBS is a loss to the community.

What it doesn’t do well is sell cycling-related merchandise at prices competitive with those available on the Internet.  Two experiences stand out in my mind:  (1) Last year, I rolled into a shop on a bike shod with a new set of racing wheels.  After informing the proprietor of the wheels’ e-provenance, I was promptly lectured that I should have bought from them, the LBS.  Why did I buy from the internet when I could have purchased the same thing locally?  Easy – I saved $250, that’s why.  (2) Yesterday, I walked into my other LBS, the sponsor shop, to purchase some stuff.  Even after a team discount, I was amazed how much they charged for stuff offered for less everywhere else – including at LBS #1.  I knew that I was overcharged, but I did my duty and bought stuff anyway.  What a drag.

But what kind of duty is this?  It seems that cyclists are obliged to pay more than they are absolutely required in order to subsidize our bike shop’s existence.  It’s hard to imagine walking into any other kind of store and uncorking this kind of consumer behavior – unless you’re a true elitist who insists on organic shopping. (joke?)  It’s monetary charity towards a good cause – a cycling community – without the tax deduction.

Why don’t we make this charitable arrangement official?  An LBS membership of a more-than-nominal sum of say, $25-50, in return for internet-level pricing and fringe benefits such as front-of-the-queue repairs, would bring purchasing home without having to resort to uncompetitive pricing and bruised feelings for those on the periphery of the chum circle.  Of course, the guy who walks in off the street can pay sticker price.  REI does a version of this, and nobody complains – and nobody’s trying to “support” REI!  I’d love to move more volume through my LBS without having to emotionally justify my “contribution” each time – I’d probably spend about the same amount of money, but I’d feel much better about handing it over.

Also work on the snobbery, and I’ll be a LBS convert.


But as much as I dislike LBS snobbery, there is definitely a community benefit to strictly enforcing a no department store bike repair policy.  I snapped this photo in front of a library of a community in which this policy has been in place for years.  Beaters perhaps, but there was not a department store bike to be seen.

Community conditioning

Behold the future.

I’m too old for this s**t

Props to CBS’s How I Met Your Mother for bringing back this classic as the “Murtaugh Rule.”

There’s something about cycling that turns a reasonable adult into an overgrown child.  Perhaps it’s because we associate bikes with childhood and revere the age of 16 for our initiation into the adult world of automobiles.  If so, it could explain the outrageous risks taken and rules broken by some people once we saddle up.  (This could also contribute to the condescending view of motorists towards cyclists).

I recently got over a two-month case of cycling-induced TMJ.  After class last winter, I decided to ride my beater down the stairs to wow a (married) classmate.  Wasn’t a big deal – I’ve done much worse many times before.  (Cycling stunts, not philandering)  Unfortunately, I’d neglected to take into account that I was on my way to the hospital and was wearing not cleats, not sneakers, but a doctor costume that included slick dress shoes, a tweed coat, and a bow tie.  Two steps from the bottom, my feet slip, I’m on the bar, and I pitch forward onto – strangely – my chin and belt buckle.  The dean witnessed it all from a distance, and noticing no paralysis, walked off chuckling.  I had to hide my bleeding palms from patients for the rest of the day.  FML.

The second thing is acne.  For two months every summer, I get some nice zits across the forehead right on the helmet line.  Incidentally, they recur for two months in the winter when I share a goalie mask during hockey season.  Somebody needs to invent a rapidly sanitizable helmet retention system.  Acne?  Seriously?  I’m too old for this s**t.

Oh, Providence

If there’s a state that can fail to run with Mr. Obama’s gravy train, it’s Rhode Island.

Knowing that a great day like today might convince me to do something wild, I took a hemi-slick Sir Stumpy out onto the streets of Providence.

Sir Stumpy - hemi-slick

A few miles in, I followed a procession of cars into the beautiful Swan Point Cemetery.  As nice and as historic as the Blue Hills Cemetery is, biking is allowed there, as long as it’s done respectfully.  Biking is NOT allowed next door at the Butler (Psychiatric) Hospital.

Swan Point Cemetery, Providence

Then I decided to check out the recreational development on the south side of College Hill.  India Point Park was bustling with families and picnicking lovers (it would have been creepy to photograph them kanoodling).

Lo and behold, I saw a very welcoming entrance arch to the jewel of Rhode Island – the East Bay Bike Path.

EBBB - India Park

Normally, the I-195 Washington Bridge connects India Point Park in Providence to East Providence.  Unfortunately, construction on I-195 had diverted bicycle traffic north to the rickety Henderson Bridge.  The last time I’d checked, the reconnection was supposed to happen in February.  Was it?

EBBB - Washington Bridge


The white man’s burden

I was reading Exploded Hub’s post on bike theft when I considered how difficult it is to elevate the status of cycling in a society in which you can get by without a bicycle.

Horse theft was a capital offense in the Old West because the horse represented an individual’s lifeline in a setting in which there simply were no other transportation options.  Today, automobiles nearly fit that role.  If your bike dies, there’s a car to pick you up.

It seems that the ideological goal of cycling advocacy is to elevate cyclists to “separate but equal” status.  A problem (aside from the obvious) is that not all bicycle users wish to be “cyclists.”  Cyclists love bikes and will go to the mattress for their passion.  Or obsess over suspension pressures and custom paint jobs.  Then there are people who ride bikes because that’s what they have.  This leads to a bit of a perception problem:

If cycling advocates work their tails off to get dedicated cycling lanes and oblivious bicycle riders use them incorrectly, who ends up with pie on the face?  Clearly, infrastructure improvements are meant for the uninitiated as much as they are for enthusiasts.  But would there be justice in trying to self-police bicycling behavior?  Even the obvious differences in SES creates philosophical obstacles.  And what can we do about our gangs of BMX-equipped teens who swarm on sidewalks?  Or the hard-working bearded bike messenger who sprints through red lights?  Tough.

Tangential question – many wheels are stolen in Boston; where would one go to purchase a stolen beater wheel?    I imagine the total number of wheels to bikes that need them works out to nearly a zero-sum game.  It’s hard to imagine that there’s an inner-city cycling squad that requires replacements of beater wheels that are regularly ridden into oblivion.  And if this team exists, are they also cycling enthusiasts?  Hrmmm?

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