Skeleton sliders, left to right, Ander Mirambell of Spain, Patrick Shannon of Ireland and Jeff Pain of Canada show their decorative helmets during an FIBT World Cup and European Championship competition in Innsbruck-Igls, Austria. (Associated Press)

Skiers and snowboarders are continuing to put fashion before safety by forgoing helmets, according to a commentary by a Toronto neurosurgeon published Thursday in the Journal of the American Medical Association.

Dr. Michael Cusimano, a neurosurgeon at St. Michael’s Hospital, said until helmets become part of the winter sport culture, trotting out statistics and evidence supporting helmet safety will have less impact on the decision to wear them.

Cusimano wrote the commentary to take advantage of the attention being paid to Olympic athletes as they scream down mountains and icy slides at hair-raising speeds, sometimes ending in even more hair-raising crashes.

"Despite compelling evidence that shows wearing a helmet significantly reduces the chance of head and brain injury, there are still those who argue that helmets are not fashionable or part of the ski culture," wrote Cusimano.

"We have established the safety benefits but now we must find ways to integrate helmets so it becomes another piece of standard equipment for people on the slopes. It is time for everyone who has a stake in skiing and snowboarding to do their part to make the slopes safer."

Alpine Canada and their regulatory counterparts require racers to wear helmets.

But 120,000 people in North America suffer head injuries while skiing or snowboarding for recreation each year, research shows. Recent studies have shown that helmets help reduce the risk of head injuries by up to 60 per cent.

According to the commentary, a shift in attitude toward helmet use is necessary to quash cultural stigmas.

Cuismano points out there has been some positive examples of change. During the 2009 U.S. National Ski Safety Week, ski areas in California, Colorado and Washington offered discounts on helmets through the Lid for Kids safety awareness program.

And some ski resorts include a helmet with their ski and snowboard rental packages for children and youth.

"Resorts have two reasons for promoting helmets — one, it keeps their customers safer and two, they are also seeing a discount in their insurance premiums when the slopes are safer places," Cusimano wrote.

"Role modelling can also have a powerful effect on what people sense as normal. Ski patrollers and instructors understand that helmets lessen the risk of traumatic brain injury and view themselves as role models for the public; however, most do not wear helmets regularly."

Certainly, Olympic athletes are presenting some of the best opportunities to raise the issue of helmet safety.

The helmet of Olympic skeleton slider Patrick Shannon bears a leering white skull to remind him of his near-fatal crash three years ago in Germany.

Irish native Shannon slammed into the ice wall at about 136 kilometres an hour and cracked his helmet, broke his jaw and smashed his hip. There were ice burns all over his body and his face needed stitches.

"We are on the brink of changing the culture in skiing and snowboarding towards helmets," Cusimano said. "What we need is action by various stakeholders so wearing a helmet no longer becomes a fashion decision but rather common sense."