Picture of Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

The photograph in the Globe and Mail was impressive. Thousands on the Ride to Conquer Cancer bike ride in Toronto reflects both the current popularity of cycling and people’s willingness to support cancer charities. According to the photo caption, it had raised over $119 million; 20 million dollars this year alone. An immense achievement. Cycling has of course, been long linked with cancer fundraising through Lance Armstrong, long time champion for cancer sufferers who gave so many people hope and inspiration and raised millions for his cancer charity. Sadly, his doping admission destroyed his personal reputation and popularity, did untold damage to his cancer work, and disappointed millions of cancer patients.

Doping seems inextricably linked with cycling and will be once again in Canadian consciousness with the release on Friday June 13th of “La Petite Reine”, a biographical film about Genèvieve Jeanson. Its timely release will reprise the pressure on athletes to perform, the role of parents and coaches, and our own expectations of top athletes. The doping story in cycling doesn’t seem to have dimmed public interest however and, as the Tour de France begins in a few weeks, cycling fans will look forward once again to watching the pain, suffering, and glory of the heroes and villains of the cycling world and still hoping to believe.

Cycling is more popular than ever, in spite of the seemingly relentless adverse publicity—even if we allow ourselves a quiet smile at the modern cycling phenomenon, the MAMILs (middle-aged men in lycra). Doctors are not immune and, if coffee room chat is an accurate measure, may be particularly vulnerable to the MAMIL phenomenon. It is easy to forget the risks, however, when thinking of the considerable health benefits. To give this a medical context, do read this Australian newspaper article based on the crash injuring Sydney Medical School Professor Paul Haber when a 4×4 vehicle ploughed into their group of seven cyclists.

What can we do? We need to keep in perspective the public health benefits of physical activity and the wider benefits of this cycling movement. Serious road crashes are relatively rare, but they are preventable. There is no medical solution, its about the environment, the law, and society. Doctors may not have a direct part to play in changing government transport policy, the legal system, nor road design but they can give leadership, highlight the risk of injury and advocate for change.