Helmets - the definitive thread.. ** Mod Note - Please read Opening Post **

tomasrojo

In passing, Ben Goldacre wrote a good bit about Archie Cochrane, and why we don't higly value the opinions of senior doctors if there isn't much evidence to support them:

The real challenge is in identifying what works the best, because when people are deprived of the best, they are harmed too. But this is also a reminder of how inappropriate certainty can be a barrier to progress, especially when there are charismatic people, who claim they know what’s best, even without good evidence.

Medicine suffered hugely with this problem, and as late as the 1970s there were infamous confrontations between people who thought it was important to run fair tests, and “experts”, who were angry at the thought of their expertise being challenged, and their favourite practices being tested. Archie Cochrane was one of the pioneers of evidence based medicine, and in his autobiography, he describes many battles he had with senior doctors, in glorious detail.

https://www.badscience.net/2013/03/heres-my-paper-on-evidence-and-teaching-for-the-education-minister/

tomasrojo

I don't think many people would take issue with the idea that you'd be better off wearing some kind of head-cushioning device if you are putting yourself in scenarios with any great frequency where you're likely to whack your head off a rock. But that isn't what utility- or commuting cycling is like.

I'm not sure of any studies done on large numbers of sports cyclists and just sports cyclists, but the benefit sports cyclists might attain through using helmets probably isn't well addressed in looking at whole-population studies. At the same time, the number of sports cyclists who don't use helmets, apart from maybe endurance training, must be very low.

buffalo

Kevin Irving wrote: »

People deriding trauma doctors who regularly see cycling injuries and saying "they're not experts" is disingenuous to be fair. They might not be looking at population level statistical analysis, but I'd still trust their opinion on injuries they've seen with and without helmets.

So if a doctor says something could save your life, you'd do it?

A woman's life was likely saved by her silicone breast implants after she was shot in the chest at close range while walking down a street in Toronto, doctors have said.

https://www.rte.ie/news/world/2020/0422/1133041-breast-implant-shooting/

kirving

tomasrojo wrote: »

I don't think many people would take issue with the idea that you'd be better off wearing some kind of head-cushioning device if you are putting yourself in scenarios with any great frequency where you're likely to whack your head off a rock. But that isn't what utility- or commuting cycling is like.

That's the thing - many people do, including on this thread, in particular when anyone dares suggest that a helmet may have saved their life.

I've seen on Twitter plenty of times, things along the lines of "you have no evidence to suggest that" and "how can a lump of foam protect your skull", backed up by complete pseudoscience referencing material hardness and strength data.

In terms of recommending for commuting, I guess that depends on a lot of factors. My commute is under 10 minutes in a country town on quiet roads, plenty of others differ greatly.

tomasrojo wrote: »

I'm not sure why you're invoking anti-vax in this context. You can actually see a benefit very clearly at the population level with vaccines.

The argument isn't just that the benefit of helmets is negated at the large-scale by the reduction in cyclists. It actually appears to be too modest to capture in large-scale studies, which are exactly the type of studies you need to detect small effects.

Most of the anti-mandatory rhetoric I agree with, but the fringe arguments (on both sides I may add) really are dangerous lies. I appreciate that's not where you're coming from, but it needs to be called out nonetheless.

buffalo wrote: »

So if a doctor says something could save your life, you'd do it?

Where did I say that?

An endocrinologist may have a different opinion on mandatory helmet usage than an orthopedic surgeon, that's understandable and probably expected.

The "helmets are not effective" argument should be clearly framed at a public health level, rather than an individual level, but it all get's lumped together. I really think is an important distinction to make.

I couldn't care less about how many people on my road have diabetes when I'm lying on the ground having come off my bike, I care that I haven't cracked my skull.

tomasrojo

Kevin Irving wrote: »

That's the thing - many people do, including on this thread, in particular when anyone dares suggest that a helmet may have saved their life.

I've seen on Twitter plenty of times, things along the lines of "you have no evidence to suggest that" and "how can a lump of foam protect your skull", backed up by complete pseudoscience referencing material hardness and strength data.

In terms of recommending for commuting, I guess that depends on a lot of factors. My commute is under 10 minutes in a country town on quiet roads, plenty of others differ greatly.

Yes, you can overstate either way.

But at the same time, it's widely believed that "helmets save lives". This may be true in some scenarios, but, if so, it seems to be a very small number of events in the overall picture, or else there seem to be an equal number of events that balance it out by taking lives, because the net effect is a helmet benefit that seems to be too modest to capture, to use Ben Goldacre and David Spiegelhalter's wording.

Which isn't the same as saying that they have no effect. We're just having a lot of trouble agreeing what it is, though I lean strongly towards Goldacre and Spiegelhalter's take.

tomasrojo

Also, if you bring up helmets either way on Twitter, say goodbye to the rest of your day!

Chips Lovell

tomasrojo wrote: »

Also, if you Twitter, say goodbye to the rest of your day!

FYP

CramCycle

Kevin Irving wrote: »

How about they remove VAT from cycling helmets if they want to encourage usage? Maybe even give a tax credit toward them? Better that that claiming the 20% back on my health expenses for the year. I buy my helmets in the UK for this reason.

Zero rate VAT would make sense, I also can't see the VAT generated by helmet sales as being enough to generate enough income to be of concern to the countries books.

I'm very happy to agree that in large scale studies, the overall benefit of mandatory helmets is negated by the reduction in cyclists. ie: preventing safety in numbers, other health benefits, etc.

Thats actually not what they show, iirc, they show that % of cyclists with serious head injuries remains constant, alongside a reduction in numbers of cyclists. So overall, they would, in my opinion look to be a net negative if you count numbers on bikes and to also have no affect at all and just look at percentages.

Personally though, I've been knocked out cold while wearing a helmet and hitting the edge of a rock at at least 30kph. I'd have no trouble saying the helmet minimised my injuries as far as possible and the doctors agreed. Some will say I have no hard evidence to say that the helmet helped, and I might not, but they can try out the same accident helmetless and gather some evidence if they'd like to argue that assertion. I certainly won't be repeating it.

It might have, I don't know. Hitting your head of a rock seems unlikely in the majority of cycling accidents, where you MTBing? If it was commuting, would you have ridden differently if you hadn't a helmet. What caused you to fall? Was there a different issue which should be addressed first. I don't like anecdotes in these discussions, so I won't use my usual one. The only personal thing I can say is that I have only hurt my head cycling while wearing a helmet. This indicates to me that i shouldn't wear a helmet. But thats misleading, and there are several other factors which must be considered. How often do I wear/not wear one, how are others behaviour influenced, how is mine influenced, do I only wear it during higher risk cycling activities eg racing/MTBing or all the time. Life isn't as simple at anecdoetal or population level as just giving one piece of information. These bits of info need to be taken into account in smaller population sizes.

In another crash, the rear axle bolt hit my helmet in the temple area, and left me really dazed. Again, I'm very confident in saying that the helmet prevented a skull fracture. Take a look. Statistically extremely unlikely, but I cycle enough that it adds up over time, and I only need to be on the wrong side of that statistic once to ruin my life.

Can I ask how?

Should they be mandatory though? Absolutely not.

Should they be worn as must as practically possible? Yes, IMO. And by that I mean daily commuting on the road at a decent speed, MTBing, cold weather. Going to the local shops or over to the park on a summers day, no.

And thats pretty much my point, most people already do a dynamic risk assessment when they go out. There is no difference in the shop vs commute except time for most people, but intrinsically people realise in any situation, the longer it goes on, the more of a risk that accompanies it. They will also take into account personal experience, so location matters, time of day matters, time of year matters and so on. You have done so yourself by highlighting these points in examples. The issue I have is when people don't wear one, getting derided in public (or online) by people who have no idea of the situation or parameters and are effectively talking out their arse. Simply out there are too many factors to make simple statements.

People deriding trauma doctors who regularly see cycling injuries and saying "they're not experts" is disingenuous to be fair. They might not be looking at population level statistical analysis, but I'd still trust their opinion on injuries they've seen with and without helmets.

Their view is biased, as anyones who only sees the worst would be. There are even anecdotes here of A&E doctors saying lucky you were wearing a helmet as they sat there with a hurt ankle. Biases are hard to account for in real life and scientific literature. As someone who has taught many doctors in my younger years and again more recently, bias they cant seem to get over and statistics they struggle to understand.

rubadub

Kevin Irving wrote: »

The other argument of "your skull is harder than foam" argument is anti-vaxxer levels of misinformation and should be called out as such.

would you say the same about the "sure I have a seatbelt, airbags, bumper, no need to be wearing the cycling helmet I already own in my car" argument?

I find it bizarre that there are seemingly so many people out there saying you would be a complete idiot not to wear one on a bike, yet they do wear them in the car!? some making out you should do everything you reasonably can to stay safe. The cycling style helmet itself is said to be a good design for in car use.

Go into any A&E and find a doctor dealing with head injuries from a car crash, ask them if a helmet would have helped?

tomasrojo

CramCycle wrote: »

Their view is biased, as anyones who only sees the worst would be. There are even anecdotes here of A&E doctors saying lucky you were wearing a helmet as they sat there with a hurt ankle. Biases are hard to account for in real life and scientific literature. As someone who has taught many doctors in my younger years and again more recently, bias they cant seem to get over and statistics they struggle to understand.

Yeah, that happened to a colleague of mine. She was wheeling her bike through a gap in stalled traffic, and a driver rolled his car forward without thinking or looking up from his newspaper (think that was why he wasn't looking in front of him) when the car in front started to move, causing her to fall and hurt her wrist. She showed me her helmet the next day I saw her to make sure it didn't need replacement, because the ambulance people had told her she was very lucky she'd been wearing a helmet. The helmet was as good as new; not even a little scratch. She had fallen over and stopped her fall with her arms, and only her wrist was injured.

And, yeah, there are a lot of stories from statisticians about doctors not being very competent with (or, to be fair, very interested in) stats. There are obviously exceptions to this.

E.g.
https://www.bbc.com/news/magazine-28166019
https://www.washingtonpost.com/news/posteverything/wp/2018/10/05/feature/doctors-are-surprisingly-bad-at-reading-lab-results-its-putting-us-all-at-risk/

AndrewJRenko

Hurrache wrote: »

On this topic, someone called Sam Waide was appointed the new CEO of the RSA this week.

Not this Sam Waide anyway;

https://twitter.com/colmanos/status/1273185439663493120

tomasrojo

I've been trying to follow this. Looks intriguing ...

Stark

Hah, this is good

https://twitter.com/OConnorOisin/status/1273763488582811648

Hurrache

He can't even use the correct word in the first word of his tweet, unless he's talking about an orderly one to come see him in his office with a sock full of cue balls (see what I did there?)

magicbastarder

i ended up getting a bell helmet in cycle superstore today. third time in a row with bell, they must just understand my head. none of the giros i tried, or any others, were as good a fit.

What model was it MB so I can keep it in mind for when I'm next looking for a helmet??

magicbastarder

this one. €150 in cycle superstore.

https://road.cc/content/review/241111-bell-stratus-mips-helmet

(worth mentioning; my wife also bought a helmet today, but for horseriding. she got a kask, and has similar problems to me re getting one that fits; the kask was the only one she found which was a good fit. hers cost €500)

magicbastarder

actually, the one i got is the 'ghost' version; i think the main difference is the back and sides of the helmet are reflective, so it's two tone.

CramCycle

Took a header through the back of a Hyundai today. 100% my fault. Details swapped, I've agreed payment. It's all on camera (mine). He laughed as he hasn't realised I went through his window till he heard me say sorry. Anyway, in relation to helmets. I wasn't wearing one. I hit the bumper, went over the handlebars. Raised my elbow reflexively around my head. This shattered the window instantly. We were doing less than 20km/hr. Elbow is cut up and a scratch on my head on the left side. The scratch is from a bit of glass hanging down. My head was so close to the cross beam that I would have had a nasty bump if I was wearing a helmet. Since I wasn't I was able to defend my head and face naturally. Would I use this anecdote to say helmets are a bad idea. Of course not, anecdotes are not anything anyone should base policy on. There are scenarios they are hugely beneficial, some they are not. Evidence indicates that in the majority of cases, most people make a dynamic risk assessment and this is sufficient, as making them.mandatory doesn't improve things.

tomasrojo

Cram, regardless of the debate, I'm really sorry to hear about your injuries, and also really happy to hear you're ok.

magicbastarder

madra de dios. glad you're OK.

https://getyarn.io/yarn-clip/6ee020bf-6182-456a-a43a-98c2e7c6d891

magicbastarder

how are you today? any stiffness/soreness?

SPDUB

Ray D'arcy talking about Eamon Ryan not wearing a bike helmet at the start of his show monday 22nd June

Hurrache

Did Ray happen to mention that he runs in the same breath? He runs don't you know, probably wearing a helmet.

If there was ever an example used to show how someone goes from being lighthearted and fun on radio and TV to becoming Victor Meldew as soon as he stepped into middle age, it's Ray Darcy.

tomasrojo

He's strangely dreary alright.

CramCycle

tomasrojo wrote: »

Cram, regardless of the debate, I'm really sorry to hear about your injuries, and also really happy to hear you're ok.

Cheers, my ego is damaged but I am mentally dressing it up as being better than I am by completely accepting responsibility and playing the moral high ground that way which has eased the brusing somewhat.

magicbastarder wrote: »

how are you today? any stiffness/soreness?

Shoulder is sore. I presume I tensed up a bit so despite my elbow hitting the window, my shoulder took the shock if that makes sense. No mobility issues compared to the other side, just soreness like a muscle ache or bruise.

SPDUB wrote: »

Ray D'arcy talking about Eamon Ryan not wearing a bike helmet at the start of his show monday 22nd June

Was Ray the one who had people wearing helmets on his advert for Today FM on Dublin Bikes

EDIT: Yes he was

https://www.youtube.com/watch?v=lVRA4qfwl5E

Seth Brundle

CramCycle wrote: »

Was Ray the one who had people wearing helmets on his advert for Today FM on Dublin Bikes

EDIT: Yes he was

The same Ray Darcy who should not still be in Ireland given his promise to leave if Enda Kenny was re-elected in 2010!
But unfortunately Ray seems not to be a man of his word

Euppy

CramCycle wrote: »

Took a header through the back of a Hyundai today. 100% my fault. Details swapped, I've agreed payment. It's all on camera (mine). He laughed as he hasn't realised I went through his window till he heard me say sorry. Anyway, in relation to helmets. I wasn't wearing one. I hit the bumper, went over the handlebars. Raised my elbow reflexively around my head. This shattered the window instantly. We were doing less than 20km/hr. Elbow is cut up and a scratch on my head on the left side. The scratch is from a bit of glass hanging down. My head was so close to the cross beam that I would have had a nasty bump if I was wearing a helmet. Since I wasn't I was able to defend my head and face naturally. Would I use this anecdote to say helmets are a bad idea. Of course not, anecdotes are not anything anyone should base policy on. There are scenarios they are hugely beneficial, some they are not. Evidence indicates that in the majority of cases, most people make a dynamic risk assessment and this is sufficient, as making them.mandatory doesn't improve things.

Firstly, hope you heal quickly and aren't feeling too rough.


The main point you get across is something that has annoyed me with most debates about helmets. They are based on anecdotes, personal experiences and perceptions of safety. I have read so many comments from people that say if they weren't wearing their helmet when they crashed they would have died. Nobody knows the true counter-factual and this statement cannot be verified.


What we need is a database of major cycling accidents and fatalities. It should document cause of death e.g. head injury or internal bleeding, crushed organs etc. Unfortunately that may be distressing for friends, families to have available.



My guess is that most cycling fatalities are not to do with head injuries and whether these people were wearing a helmet or not, would not have changed the outcome. And if this is the case, we could stop the arguments being about the irresponsibility of the helmet-less cyclists and focus on driver behaviour and suitable cycling infrastructure.


This cant happen until we have actual hard data though.

eeeee

Hope you feel better Cram, and you're icing that elbow and shoulder (and soothing the poor ego).

MojoMaker

Swift recovery Cram.

No damage to the bike at all?