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

smacl

galwaycyclist wrote: »

I did a traverse of the Crib Goch last Saturday in snow.

Lucky you, looks like a blast. Did something similar many years back between Ben Nevis and Càrn Mòr Dearg, crampons, helmet and the rest. I remember crawling across the arete in a minor panic, and was daintily skipped past by a very attractive blond lady going the other direction. Perceived danger and all that. Don't know if the helmet helped much, but the ice axe under the armpit sliding downhill on the descent made for a surprisingly effective hand brake.

chakattack

galwaycyclist wrote: »

With regret you walked yourself straight into that role. The drunk man under the streetlight story is a common illustration of observational bias. You have apparently argued that our observations should be biased. Your apparent argument is that we should isolate our observations to individual collisions without considering the wider evidence such as injury trends among populations where helmets are more common.

To illustrate it another way. Your argument is equivalent to saying that doctors should continue to prescribe thalidomide to pregnant women on the basis that there is laboratory evidence showing it is good for morning sickness. Under your reasoning, we would ignore any evidence of unintended consequences - such as birth defects - because it was being seen at a population level and is difficult to characterise or fully explain.

Is that an ethical or moral approach?

That would be well and good if you had any evidence of negative consequences for an individual if they wear a helmet (that outweigh the potential benefits).

Your streetlight theory is a poor cop out from a good argument.

Helmets can be considered similar to prescribed medicines and their known side effects. Generally the benefit of approved medicines outweighs the negatives like the protection by helmets provided outweighs the risk of rotational injury or a wider effective head size. Thalimide was a gross failure of the regulatory system but where your analogy fails is that the effects were on an individual basis. The women had no morning sickness but most did have babies with birth defects.

If I leave my helmet at home it won't get some lazy f*cker off the couch and into a healthy lifestyle.

CramCycle

toomevara wrote: »

But having said that I would urge cyclists to inform themselves of the possible outcomes following accidents when not wearing helmets.

I'd like to give one of these possible outcomes having experienced it myself. I was made by a helmet after cycling for 18 years without one, couple of scratches, nothing major.

My aunt seen me turn up at a family event by bike, marched me to the shop, made me by a helmet because of a story she heard. So I started wearing it, not all the time but sometimes, got into the habit until it was almost all the time.

Some months later I had my first major accident, Because of my helmet, I now have a (minorly) increased risk of stroke, constant underlying neck pain (which gets worse under various circumstances). In fact it would not have been a major accident except for the helmet (although a solicitor and barrister said that despite the case becoming necessary because I wore a helmet, if I had not worn one, the judge would have been unlikely to find completely in my favour despite 3 independent engineers, 2 witnesses and the driver who hit me changing their story 2 months later and then not turning upto the court on the day :pac: ).

If I had not been wearing my helmet, I would have had a few scars on my arms, my head would not have got caught and jerked back and I wouldn't have to take painkillers on a regular basis.

Personally I do not care, the facts are there, its much of a muchness, some people have good stories, some people have bad. Unlike other safety laws which generally attempt to prevent the user from not hurting themselves but others through possible unintentional side effects of an accident, the helmet idea, only serves to help the user, no one else and so far there isn't anything but a bunch of anecdotes and unfounded postulations saying that the benefit is founded or unfounded (but a fair amount saying it presents no statistical benefit or risk).

The big negative for me is that if a law ade it mandatory, evidence indicates cycling rates would drop and so in turn after many years, so would the general health of the population.

Make your own choice, inform yourself with the data, take anecdotes as such, realise that statistics often mislead to tell the story the writer wants you to hear and be a grown up, make your own decision.

Despite my neck issues, I already have 2 informal laws enforcing helmet wearing about 50% of the time, mainly cycling Ireland for events and my mother in law when I cycle within a mile of her house.

Capt'n Midnight

I think we need a new name for bicycle helmets as the current name suggests they'd be of some use if you were hit by a motorist.

Call them high viz hats , and reserve the word helmet for devices like motorcycle helmets that do offer significant protection in a collision with a motorised vehicle at the speeds they normally travel at.

Existing "bicycle" helmets are simply not fit for the purpose of protecting cyclists from motorists. Let's be blunt about this you can now buy cardboard bicycle helmets that can take three times the impact.
http://www.gizmag.com/kranium-cardboard-helmet-available/25788/



Also the stats are fairly clear that motorists and pedestrians would also benefit from wearing helmets so they would need to be targeted too.

galwaycyclist

chakattack wrote: »

That would be well and good if you had any evidence of negative consequences for an individual if they wear a helmet (that outweigh the potential benefits).

Uh no the evidence from Australia suggests that injuries went up. In order to be recorded these injuries must have been suffered by individuals. Therefore wearing of helmets, or the associated propaganda, or both, had a negative consequence for some individuals.

If I leave my helmet at home it won't get some lazy f*cker off the couch and into a healthy lifestyle.

Uh no I believe you are wrong there. I believe that the more existing cyclists who set a good example by cycling without helmets then the more non-cyclists might be tempted to take it up. At the moment the idea that you have to wear unusual and unattractive clothing is a barrier to cycling participation. Particularly among key sectors such as women and teenage girls.

NeedMoreGears

smacl wrote: »

..... Say we see 20 such posts per annum, out of a population of say 1000 contributing boardsie cyclists. (Picking numbers out of the air, for sure, but roughly the right order of magnitude). That gives us a 2% probability of such an event happening to any given cyclist, in any given year. ......

This makes me think I need to put back on the stabilisers I tend to fall off about once a year and generally manage to bang my head when I do so. I think it must be old age - when I was in college about thirty years ago, I cycled more or less the same amount, considerably more recklessly, with poorer quality brakes and tyres and never fell off at all.

In response to an earlier post asking about experience in other sports, I kayaked for many years and always wore a helmet. But then again you'd find yourself upside down in a kayak a lot more often than you'd fall off a bike. I rarely wore one sea-kayaking but always when surfing where again the risk was being washed along upside down with the potential for smacking your head on the sea bed or a rock. On the other hand I never wore a helment during my pathetically short hurling career.

smacl

galwaycyclist wrote: »

I believe that the more existing cyclists who set a good example by cycling without helmets then the more non-cyclists might be tempted to take it up. At the moment the idea that you have to wear unusual and unattractive clothing is a barrier to cycling participation.

So are you advocating that those who currently wear helmets, high-viz, and/or gaudy lycra, should stop doing so in the interests of the greater good?

Particularly among key sectors such as women and teenage girls.

The fairer sex seem well able to make up their own minds on what constitutes suitable cycling attire. While my wife wouldn't want me leaving the house to go cycling without helmet and bright clothing, she wouldn't dream of wearing anything that ridiculous herself. Perhaps the basket on her bike acts as a crumple zone, who knows. As for teenage girls, mine at least, you have to sometime distinguish excuses for being lazy with the literal text given. Helmets and hi-viz are a hideous abomination, but if that's the only way of getting to Dundrum to shmooze about with her mates, all bets are off.

Once again speculation, but I'd say the primary reason kids and young teens don't embrace cycling is that they've collectively managed to convince their parents to drive them everywhere. Note once college age is reached, where cycling is realised to be a cheap and effective form of transport, the mum and dad taxi company has gone belly up, and all available funds must be directed towards booze and partying, the humble bicycle is embraced once more. Try finding anywhere to park your bike any evening in UCD if you're in any doubt.

chakattack

Now you're really stretching it...individuals as part of the population ...back to australia again too...fumbling in the dark?

Helmets are one thing but I'm not giving up my lycra!

I have even been thinking about commuting in a skinsuit for more strava glory

Is there a voodoo ritual I can practice as I cast away my helmet in favour of the greater good?

galwaycyclist

Regarding seatbelts Monkeybutter writes:

monkeybutter wrote: »

Even moving it to 1979 , and basing it on the citizen info website being incorrect, there is still a marked decrease from 628 deaths in 1978 to 410 in 1985. What are we attributing that to? Infact moving it to 1979 makes an even stronger argument for it.

Obviously not all are passengers or drivers in cars, but a marked decrease all the same, unless there was a reduction of 200 in pedestrian cyclist etc deaths, certainly no argument against the use of seat belts.

Just to deal with this.

Studies of crashes, experiments with crash death dummies and human cadavers predict that wearing seatbelts should prevent death in crashes that would otherwise be fatal.

This source suggest a 72% reduction in mortality among wearers of lap and shoulder belts.

http://aje.oxfordjournals.org/content/153/3/219.full

For the sake of keeping our numbers clean I am going to assume 60%. So starting at 0 if we get 25% of car occupants to wear seatbelts deaths among that group should go down by 15%, if the wearing rate is 50% we should get a 30% reduction and so on.

Irish road deaths in 1979

The numbers that follow come from Irish offical publications. In 1979 mandatory seat belt wearing was introduced in Ireland; in addition, there were serious fuel shortages and the interurban speed limit was reduced from 60 mph to 55 mph. In the second half of 1978 the blood alcohol limits had been reduced and there was an associated drink drive campaign (Mulkeen 1982). Any or all of these measures might be expected to bring about a reduction in road deaths. Clearly it could be expected that 1979 would become a land mark year in the history of Irish Road safety;

So what were the actual results? There are two standard reports available on this issue, RS 255 "The initial impact of seat belt legislation in Ireland" (Hearne 1981) and RS 408 "Seat belt wearing rates in Ireland" (Golden 1991). Writing in 1981, Hearne found that seat belt wearing rates in Ireland had gone from one in four, to one in two in the space of eleven months. So according to our model, deaths among the target group should have gone down by anything up to 15%.

However, Hearne reports that "the legislation has had no significant effect in the period considered on the severity of driver injury."

If we look at the actual crash figures then a slightly different picture emerges. There were increases in fatalities to both pedestrians and car users in 1979. Car user fatalities went up by 4% from 248 to 258 while pedestrian fatalities went up by one from 226 to 227 (Road Accident Facts 1982).

According to the tables given by Golden, there were 570 fewer injury/fatality crashes involving motor vehicles recorded in 1979 compared with 1978, so the fatality rate for car users per recorded injury accident actually went up. Hearne himself notes that "the number of drivers killed in single car crashes was higher than had been expected". Single car crashes are almost universally associated with inappropriate speed; that they should have increased in severity in a country that had just reduced the general speed limit is somewhat perplexing.

So in Ireland in 1979, deaths among cars users should have dropped by upto 15% but went up by 4%.

Something happened among car drivers that overwhelmed and overtook the protective effect of reduced speed limits, drink drive legislation and seatbelt wearing.


What might that have been?

One of the common sense arguments is that if you make people feel safer doing something that is risky they respond by taking more risks.

Sources

• Golden J.M., RS 408 "Seat belt wearing rates in Ireland" Environmental Research Unit, Dublin, 1991
• Hearne R., RS 255 "The initial impact of seat belt legislation in Ireland" An Foras Forbatha, Dublin, 1981
• Mulkeen E. Technical Digests Series, 12-Road Transportation and Safety, An Foras Forbatha, Dublin, 1981
• Road Accident Facts 1982

monkeybutter

galwaycyclist wrote: »

Regarding seatbelts Monkeybutter writes:




Just to deal with this.

Studies of crashes, experiments with crash death dummies and human cadavers predict that wearing seatbelts should prevent death in crashes that would otherwise be fatal.

This source suggest a 72% reduction in mortality among wearers of lap and shoulder belts.

http://aje.oxfordjournals.org/content/153/3/219.full

For the sake of keeping our numbers clean I am going to assume 60%. So starting at 0 if we get 25% of car occupants to wear seatbelts deaths among that group should go down by 15%, if the wearing rate is 50% we should get a 30% reduction and so on.

Irish road deaths in 1979

The numbers that follow come from Irish offical publications. In 1979 mandatory seat belt wearing was introduced in Ireland; in addition, there were serious fuel shortages and the interurban speed limit was reduced from 60 mph to 55 mph. In the second half of 1978 the blood alcohol limits had been reduced and there was an associated drink drive campaign (Mulkeen 1982). Any or all of these measures might be expected to bring about a reduction in road deaths. Clearly it could be expected that 1979 would become a land mark year in the history of Irish Road safety;

So what were the actual results? There are two standard reports available on this issue, RS 255 "The initial impact of seat belt legislation in Ireland" (Hearne 1981) and RS 408 "Seat belt wearing rates in Ireland" (Golden 1991). Writing in 1981, Hearne found that seat belt wearing rates in Ireland had gone from one in four, to one in two in the space of eleven months. So according to our model, deaths among the target group should have gone down by anything up to 15%.

However, Hearne reports that "the legislation has had no significant effect in the period considered on the severity of driver injury."

If we look at the actual crash figures then a slightly different picture emerges. There were increases in fatalities to both pedestrians and car users in 1979. Car user fatalities went up by 4% from 248 to 258 while pedestrian fatalities went up by one from 226 to 227 (Road Accident Facts 1982).

According to the tables given by Golden, there were 570 fewer injury/fatality crashes involving motor vehicles recorded in 1979 compared with 1978, so the fatality rate for car users per recorded injury accident actually went up. Hearne himself notes that "the number of drivers killed in single car crashes was higher than had been expected". Single car crashes are almost universally associated with inappropriate speed; that they should have increased in severity in a country that had just reduced the general speed limit is somewhat perplexing.

So in Ireland in 1979, deaths among cars users should have dropped by upto 15% but went up by 4%.

Something happened among car drivers that overwhelmed and overtook the protective effect of reduced speed limits, drink drive legislation and seatbelt wearing.


What might that have been?

One of the common sense arguments is that if you make people feel safer doing something that is risky they respond by taking more risks.

Sources

• Golden J.M., RS 408 "Seat belt wearing rates in Ireland" Environmental Research Unit, Dublin, 1991
• Hearne R., RS 255 "The initial impact of seat belt legislation in Ireland" An Foras Forbatha, Dublin, 1981
• Mulkeen E. Technical Digests Series, 12-Road Transportation and Safety, An Foras Forbatha, Dublin, 1981
• Road Accident Facts 1982

Right you seem to be missing the picture here, you are taking 1979 to 1980 as one year in isolation. This is a bad error on your part. It's a classic case of someone trying to look for bad analysis in data to try and prove a point by ignoring the obvious bigger picture.

Take the period 1978 to 1985, you have a 200 person per year decrease in the number of road deaths. This is off the RSA website, which doesn't break down betwen the types of deaths, but theres no reason to assume the percentages are massively different between 1978 and 1985. Not all of these are attributable to seat belts, but the timing is hardly a coincidence.



Lets look at the article you have quoted, there were 570 fewer crashed involving injury from 1978 to 1979, versus what overall numbers?

Thats a very large decrease, what caused this decrease, were their just less crashes, randomly? or were their less injuries due to the wearing of seat belts. I doubt there was any marked difference to 1978 as the death figures decrease at a steady pace. Yet the quoted article still makes a claim that it had no effect on the severity of injury, what about the 570 less total then?


Yer argument is that advances in safety cause people to take more risks, but the facts and figures clearly point that any risk is clearly outweighed by the introduction of these safety features, with a reduction to 250 from 640 in the last 30 years.

This is in the face of an increasing number of cars on the road.

If you mess up seatbelts, abs, air bags still clearly have a better statistical chance of catching you than if they aren't there.

Otherwise the safest bet would to ride around in an open cockpit scared of your life.

Beasty

Lies, damn lies and statistics ... (I'm a mathematician by the way;))

Anyway, it's always worth adding to the anecdotal evidence, as the statistical evidence does seem to get somewhat twisted to suit the arguments of whoever is using the data in question.

I had a fall around 4 years ago. The good news is I cannot remember anything about it, so a lot of my evidence may be considered to some extent "circumstantial". However I reckon I hit the deck head first - all my injuries were upper body, the most serious one being to my head. No vehicles involved, just a very dodgy bit of hard shoulder hit at speed which, according to eye witnesses, sent me flying over the handlebars

In terms of the injuries, well it looks like my head took the brunt. I won't show the photos again but nearly half my face was covered in pretty bad road rash and I had a nasty gash around my eye. I never bothered counting how many stitches they took out but it must have been well in excess of 50, but that was mainly as a result of the skin graft I required,

The helmet was cracked and I was concussed - spending 4 days in hospital

Did the helmet save my life? It may have - I'll never know (there again it probably didn't)
Did the helmet reduce my injuries? I would say probably, but again no-one actually knows
Will I always wear a helmet when riding a bike? - yes
Am I for mandatory helmet use? - no, I am for personal choice

However what I will say is that those who are entrenched in the "helmets do more harm than good" camp seem to me to be simply wanting to make an argument out of the whole issue. To suggest that cyclists should refrain from wearing helmets to encourage others to take cycling up is, in my view, absurd

Rob A. Bank

Bike helmets first appeared in the USA the best part of 40 years ago, where there is a strong tradition of helmets in sport. In order to pander to that peculiar American male fetish for helmeted sports (American Football, Baseball), cycle helmets were introduced in an effort to show that cycling was a ‘serious sport’, and also to increase it’s ‘macho’ ‘dangerous’ image i.e. totally unlike those other inferior unhelmeted un-American sports like soccer, which are for women, kids and whimps.

This effort was (and is) gleefully supported by the polystyrene lobby and those with an interest in selling useless gadgets to cyclists. Even though if bike shops had any sense, they would realise that international studies suggest that as helmet wearing increases the total number of cyclists (and therefore their market) declines.

The one thing people seem to agree about with on this thread is that there is a lack of good statistical data in this area.

Surely this lack of good evidence is significant.

If bike helmets were any good at preventing serious head injury or death the evidence should be overwhelming by now, after more than 37 years of monitoring.

Rob A. Bank

I notice people are quoting nurses, doctors, wives and even Mother-in laws to support the notion that helmets make cycling safer.

Few would disagree that helmets might reduce superficial injury to parts of the head, but is it really protecting the brain ?

There is a very good reason why boxers hit the chin when trying to knock someone out.. it is the farthest point from the center of the head. It is also the reason why boxers tuck their chin in and hide it behind the gloves when defending themselves. A blow there has more leverage to produce significant rotational brain injury… thus rendering the recipient unconscious.

Severe rotational brain injury is the factor which causes death or disability in most road traffic head injuries.

The cycle helmet effectively makes the head into one big chin.

Might I also throw in this opinion from a neurosurgeon quoted in the literature... He claimed that cycle helmets were turning what would have been focal head injuries, perhaps with an associated skull fracture, into much more debilitating global head injuries.

doozerie

galwaycyclist wrote: »

I believe that the more existing cyclists who set a good example by cycling without helmets then the more non-cyclists might be tempted to take it up. At the moment the idea that you have to wear unusual and unattractive clothing is a barrier to cycling participation. Particularly among key sectors such as women and teenage girls.

I tend to agree with the idea that making "odd" clothing and kit look necessary for cycling acts as a deterrent to people who don't cycle but might consider doing so. However, I think that when you talk of people setting a "good example" by cycling without helmets it suggests that you've lost the argument of trying to convince people that helmets are not necessary.

I believe the arguments in favour of not wearing a helmet are strong, they are certainly strong enough to give someone plenty of food for thought. If a person considers those arguments but decides to wear a helmet anyway, then that's fine, that's entirely their choice (that describes me, for one). When you try to bend people to your own will by asking that they not wear a helmet for fear (ironically) that it'll instil fear in others then you are going way beyond the remit of encouraging educated choice and are getting into the area of dictating to people. Effectively you are going to the extreme end of the scale and wrapping back round to join the "wear a helmet or die" brigade in their philosophy of "I can't convince you therefore I'll yell at you". That's an approach that'll likely alienate the people that you are trying to reach out to.

tomasrojo

chakattack wrote: »

You're embellishing what i said a little. I said injury reduction and not life-saving.

Ah fair enough. I should have looked back to see exactly what you said, but it was really the claim that such evidence as as good as real-world evidence got that I was interested in.

tomasrojo

smacl wrote: »

Absolutely, but what this says to me is the array of anecdotal material demands some further investigation. At a guess, we'd see a couple of such anecdotes relating to a crash with a knock to the head and a "praise be to the helmet, it saved my life" line each month. Say we ignore whether or not the helmet helped them as we simply don't know, but accept that they came off their bike and had some degree of an impact to their head. Say we see 20 such posts per annum, out of a population of say 1000 contributing boardsie cyclists. (Picking numbers out of the air, for sure, but roughly the right order of magnitude). That gives us a 2% probability of such an event happening to any given cyclist, in any given year. Small, but significant.

There are a few problems I can think of with such an approach. Are people posting on Boards typical of general population of cyclists, or are the number among them a disproportionate number of the type of cyclists who push themselves hard to improve on their previous best? Do they feature more mountain bikers than the general population? A 2% probability of incurring a head impact in any given year is higher than I'd expect for a cyclist who mostly cycles to the shops and back, but seems more credible for a competitive or off-road cyclist.

And should we not also look into neck injuries and compare how those who fall wearing a helmet compare with those who fall without wearing one? Or compare the rate of diffuse axonal injuries (generally due to rotational injury) to injuries more typical of linear impact?

I think the general strategy to take when anecdotal evidence suggests a trend is to devise an experiment to test whether the trend is real, or to look in independently gathered data (e.g. census data, traffic count data, hospital admission data) and look for the trend there. In-depth analysis of anecdotal data is not usually very rewarding.

So I think the two best approaches employed so far, and the two sources generally drawn on are the case-control studies (generally based on hospital-admission data and such like) and the trend in head-injury rates in jurisdictions with rising helmet use, comparing the cyclist trend with the trend for other road users.

The problem is that these two sources give very different pictures, which is part of the reason these helmet threads tend to go on a bit.

tomasrojo

Nothing to do with helmets as such, but one of my favourite misconceptions that is supported only by anecdotal evidence is "fan death", where the South Korean media publish stories about people dying unexpectedly and note that an electric fan was running in the room at the time of death.

Korean reporters are constantly writing inaccurate articles about death by fan, describing these deaths as being caused by the fan. That's why it seems that fan deaths only happen in Korea, when in reality these types of deaths are quite rare. They should have reported the victim's original defects such as heart or lung disease, which are the main cause of death in these cases.

http://en.wikipedia.org/wiki/Fan_death

monument

The problem here is that, if you take a broad view, wearing a helmet is an extreme act -- it's used for fringe activities in general and most cyclists around the world see no need for them. Helmeted cyclists take an extreme position. But with years of social pressure / helmet promotion / reinforcement of the idea that cycling is something to fear, helmeted cyclists have rationalised that a helmet is a must.

Another problem is treating all sorts of cycling and cyclists as the same.

Beasty wrote: »

Lies, damn lies and statistics ... (I'm a mathematician by the way;))

Anyway, it's always worth adding to the anecdotal evidence, as the statistical evidence does seem to get somewhat twisted to suit the arguments of whoever is using the data in question.

Err... and I guess this is anecdotal evidence on a population level scale....

https://www.youtube.com/watch?v=WvquSD2PcCE

Beasty wrote: »

However what I will say is that those who are entrenched in the "helmets do more harm than good" camp seem to me to be simply wanting to make an argument out of the whole issue.

Why do people simply want to make an argument out of the issue?

Beasty wrote: »

To suggest that cyclists should refrain from wearing helmets to encourage others to take cycling up is, in my view, absurd

Such a view is influenced by your thinking on helmets.

doozerie wrote: »

I tend to agree with the idea that making "odd" clothing and kit look necessary for cycling acts as a deterrent to people who don't cycle but might consider doing so. However, I think that when you talk of people setting a "good example" by cycling without helmets it suggests that you've lost the argument of trying to convince people that helmets are not necessary.

I believe the arguments in favour of not wearing a helmet are strong, they are certainly strong enough to give someone plenty of food for thought. If a person considers those arguments but decides to wear a helmet anyway, then that's fine, that's entirely their choice (that describes me, for one). When you try to bend people to your own will by asking that they not wear a helmet for fear (ironically) that it'll instil fear in others then you are going way beyond the remit of encouraging educated choice and are getting into the area of dictating to people. Effectively you are going to the extreme end of the scale and wrapping back round to join the "wear a helmet or die" brigade in their philosophy of "I can't convince you therefore I'll yell at you". That's an approach that'll likely alienate the people that you are trying to reach out to.

How on earth is what you quoted him saying even close to dictating to people?

GradMed

In a rush, so sorry if these have already been mentioned, but came across these articles in The Cochrane Library

Helmets for prevention of head and facial injuries in bicyclists
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001855/full

Helmets reduce bicycle-related head and facial injuries for bicyclists of all ages involved in all types of crashes, including those involving motor vehicles.
(The authors respond to criticism of the paper in the comments section.)

Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005401.pub3/abstract

Bicycle helmet legislation appears to be effective in increasing helmet use and decreasing head injury rates in the populations for which it is implemented. However, there are very few high quality evaluative studies that measure these outcomes, and none that reported data on possible declines in bicycle use.

I'm an intern in Beaumont hospital, it's a personal choice at the end of the day but please wear a helmet as the benefits of wearing one appear to outweigh any risk.

p.s There's a study underway, just commenced in February, looking at cycling infrastructure and reducing injuries in cyclists

monument

GradMed wrote: »

Helmets for prevention of head and facial injuries in bicyclists
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001855/full

http://www.cyclehelmets.org/1069.html

Summary of criticisms

Principal criticisms of the review are:

The review is not independent. Four of the seven papers selected for inclusion were the work of the reviewers themselves and their data dominate the analysis, comprising 77% of the cyclists on whom the review is based. Furthermore, these four papers are based on only two data sets and have themselves been much criticised for fundamental methodological shortcomings (BHRF, 1068).

Only case-control studies were considered for inclusion, although non-randomised studies of this type are acknowledged to be prone to bias because of the difficulty in controlling for the many independent variables (BHRF, 1052).

The paradox presented by the failure of other types of studies (e.g. whole population and time-series data) to show any benefit from large increases in helmet use - let alone the substantial benefits predicted by the studies reviewed - is left unstated and unaccounted for (BHRF, 1096).

The authors are dismissive of the possibility of risk compensation. However, it has subsequently been demonstrated that child cyclists often ride more riskily and suffer more crashes when wearing a cycle helmet (Mok et al, 2004) and that adults are more likely to ride on busier roads if helmeted (Gregory, Inwood and Sexton, 2003).

Similarly no consideration is given to rotational injuries, which dominate the most serious injuries. Helmets have not been shown to mitigate rotational brain injury and there is evidence they may increase the risk and/or severity of rotational injury.(BHRF, 1039).

Claims are accepted of efficacy for which no plausible mechanism exists (e.g. the prevention of mid-face injuries), where the reviewed data set is too small to make reliable inference (e.g. the result of collisions with motor vehicles), and which would not be possible even if helmets prevented all head injuries (e.g. an increase of 35% in cyclists wearing helmets leading to 66% fewer head injuries).

There is misleading interpretation of 'odds ratio', which is used interchangeably in the review with 'percentage reduction in head injuries'. This exaggerates the predicted benefit of helmets and masks the fact that studies of this type are not truly predictive, being essentially the authors' estimate of what proportion of the observed differences between two groups can be assigned to a single factor. Furthermore, the reviewed paper showing the least benefit from helmets is omitted from computation of odds ratio, thus again exaggerating benefit.

GradMed wrote: »

Bicycle helmet legislation for the uptake of helmet use and prevention of head injuries
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005401.pub3/abstract

http://www.cyclehelmets.org/1181.html

I'll let anybody interested click on the link rather than posting the BHRF's commentary.

GradMed wrote: »

but please wear a helmet as the benefits of wearing one appear to outweigh any risk.

You have not made the case for such and none of the flawed studies you quoted even attempt to look at the full picture.

greenmat

For me you should always wear your helmet. Had a recent spill which in my mind reinforces the need to wear one for me anyway. Entered a small roundabout on my way to work, prob too fast, damp greasy road, leaned over prob too far and before i knew it my head was striking the road. Hadn't even time to react. Accident was entirely my own fault but without helmet I definatly would have ended up in Hospital with a smashed up face, needing time off work. For that reason alone it's worth it. The helmet protrudes a fair bit at the forehead which took the entire impact, dented and cracked right through. I would almost certainly have done some real damage to my face/nose/jaw but thankfully got away with it, just some swelling at forehead and a bit of a headache later. This was a low speed incident but had potential to require me to need a long spell out of work. That helmet was the best €100 I've ever spent since I started cycling.

Rob A. Bank

GradMed wrote: »

I'm an intern in Beaumont hospital, it's a personal choice at the end of the day but please wear a helmet as the benefits of wearing one appear to outweigh any risk.

Is the author of the first article you quoted the same Diane C. Thompson who was involved with that classic example of junk science from Seattle published in the New England Journal of Medcine in 1989 ?

The authors compared a helmeted group who rode supervised in parks in the leafy suburbs with an un-helmeted group who rode unsupervised on busy roads in the city centre, and then attributed all the difference in head injuries to helmets !

For a complete evisceration of that article might I suggest you read "Misguided doctors or marketing agents?" and question the authors transparency in reporting conflict of interest when they are directly or indirectly funded by helmet industry-supported organisations like the Snell Foundation.

Keep_Her_Lit

monument wrote: »

The problem here is that, if you take a broad view, wearing a helmet is an extreme act -- it's used for fringe activities in general and most cyclists around the world see no need for them. Helmeted cyclists take an extreme position. But with years of social pressure / helmet promotion / reinforcement of the idea that cycling is something to fear, helmeted cyclists have rationalised that a helmet is a must.

Can you accept that at least some cyclists who choose to wear helmets are capable of independent thought? I wear a helment on nearly all cycle journeys. I don't see cycling as something to fear. On the contrary, I love it and am equally happy on a fast Wicklow descent or mixing it up with heavy urban traffic.

But I know that it's difficult to cycle for long periods of time without ever falling off. And I also know that once I fall off, I don't get to choose how I land or exactly what happens to me before I come to rest.

Since I started cycling to work almost 29 years ago, I've had four crashes during which my helmeted head struck the road. Two of those resulted in the destruction of the helmet. In all cases, I suffered no injury whatsoever to my head, neck or face.

By your standards, the fact that I was wearing a helmet on those occasions makes me an "extremist". If all the arguments against helmet wearing are valid, it should follow that my decision to wear a helmet was the wrong one and that I would have fared better (or at least no worse) had I followed your advice and adopted a less extreme position over those years. This doesn't seem credible to me.

Of course, I can't re-enact those accidents helmetless to remove any doubt. Which leaves you free to claim that my helmet probably made no beneficial difference and that my skull and brain would have been just fine and dandy bouncing off the tarmac without any protection.

I oppose compulsion when it comes to helmet wearing, in both directions. That is, either by using the law to compel cyclists to wear helmets against their will or through moral blackmail, by accusing those who have chosen to wear helmets of making the roads less safe for cyclists in general. Cyclists should be free to make their own decisions on this important matter, without any pressure from either the pro- or anti- sides.

And since I'm only deciding for myself, the only statistics that really matter are drawn from a population of 1. The four helmet strikes I've previously described here and here can be dismissed as anecdotes. But for me, they represent a complete data set and give me all the information I need to make an informed decision before setting off for work in the morning.

True, I don't wear a helmet while strolling to the shop, running for a bus or ascending the stairs in my home. But then, I've never hit my head doing any of those things. It's all about weighing up the risks and striking the right balance. I'm happy that I've got it right, for me at least.

monument

greenmat wrote: »

For me you should always wear your helmet. Had a recent spill which in my mind reinforces the need to wear one for me anyway. Entered a small roundabout on my way to work, prob too fast, damp greasy road, leaned over prob too far and before i knew it my head was striking the road. Hadn't even time to react. Accident was entirely my own fault but without helmet I definatly would have ended up in Hospital with a smashed up face, needing time off work. For that reason alone it's worth it. The helmet protrudes a fair bit at the forehead which took the entire impact, dented and cracked right through. I would almost certainly have done some real damage to my face/nose/jaw but thankfully got away with it, just some swelling at forehead and a bit of a headache later. This was a low speed incident but had potential to require me to need a long spell out of work. That helmet was the best €100 I've ever spent since I started cycling.

If you hit your head and a helmet cracked it means the force was greater than what the helmet is able to take -- so there's a risk of brain damage and you should have went to a doctor or straight to A&E regardless of how it looked.

Thankfully cyclists are the least likely road users to obtain serious brain injury and the least likely to sustain permanent brain damage.

In any case... Sounds like better and cheaper interventions would be to (a) slow down where needed, or generally if needed, and (b) not to lean over too far.

Is it possable you would have been going slower and taking less risks if you were not wearing a helmet?

Beasty

monument wrote: »

If you hit your head and a helmet cracked it means the force was greater than what the helmet is able to take

It means the helmet did its job - it cracked under the force and spread the impact across your skull, reducing the risk of that cracking as well

doozerie

monument wrote:

How on earth is what you quoted him saying even close to dictating to people?

Providing people with information on both sides of the helmet argument and leaving them to make up their own mind on whether to wear a helmet or not is encouraging reasoning and the making of educated choices.

Trying to convince people via the argument "you don't need a helmet because look at all those other cyclists over there who don't wear a helmet" is trying to bend people to your point of view via peer pressure. That, to me, is dictating to people, though I could think of worse things to call it, what would you call it?

And trying to guilt people into not wearing a helmet because you believe not wearing one sets "a good example" is, amongst other things, extremely patronising.

monument wrote:

Such a view is influenced by your thinking on helmets.

That cuts both ways.

dreamerb

Adding to the "my helmet anecdote" - I cycled just for commuting / destinational reasons (i.e. never racing / group cycling / long distance). I've gone off the bike four times in 25 years:

once, lorry passed too close and I came off in the backdraft - didn't hit my head, and I don't think I had a helmet at the time. Mild road rash on knees and torn up jeans;

another, car cut left in front of me in traffic on a very wet day - hit the rear left light array on the car, and apologised to the driver because I was too shocked to realise it was her fault for leaving no braking room. Wearing helmet, no head hit. Minor bruising only;

third - just fell off, having miscalculated a turn stupidly. Wearing helmet, no head hit. Damage: pride;

final one - smidsy white van driver, fractured bones in arm and wrist, broken nose, road rash to chin and wrist. It's the only one where the helmet may have made a difference - I think my forehead would have hit harder and as a minimum my nose would have been smashed further backwards. Or maybe I'd have had a serious head injury - who knows? In the immediate aftermath I thought "helmet saved my life" - at this remove I'm far more detached.

I would never proselytise against helmets, but not in their favour either. It may mitigate the effects of an accident but I also agree that excessive safety gear is inclined to reduce cycling numbers, so on a population (as distinct from the individual) level, I thing "dangerising" is an inherently bad thing. Amsterdam, the Hague, Brussels, Paris, Berlin - most cyclists don't wear helmets - they don't have incredibly high fatality rates.

And I also think that from a driver awareness perspective, Dublin's improved hugely in the last five years. That's numbers of us, not helmets. Still, I wear a helmet...

monument

Beasty wrote: »

It means the helmet did its job - it cracked under the force and spread the impact across your scull, reducing the risk of that cracking as well

From Cyclecraft:

A helmet works through absorbing some of the force of an impact by itself deforming. The liner of shock-absorbing material acts as a buffer which reduces the acceleration forces that reach the skull. In this way helmets can prevent minor wounds to the head. Once the liner is fully compacted (which happens at quite low forces), it provides no further protection and all the residual energy passes directly to the skull. Thus the ability of helmets to afford useful protection in more serious crashes, such as those that involve motor vehicles, is much less certain.

When you get to the point that he helmet cracks or crushes then the skull absorbs energy -- it may or may not be enough to do damage. It's worth getting your self checked out.

doozerie wrote: »

Providing people with information on both sides of the helmet argument and leaving them to make up their own mind on whether to wear a helmet or not is encouraging reasoning and the making of educated choices.

It seems you don't like information about the Netherlands -- with more cyclists, tiny percentages of helmet use and the lowest serious injury and death rates....

doozerie wrote: »

Trying to convince people via the argument "you don't need a helmet because look at all those other cyclists over there who don't wear a helmet" is trying to bend people to your point of view via peer pressure. That, to me, is dictating to people, though I could think of worse things to call it, what would you call it?

Presenting anecdotal evidence on an individual level is ok?

But presenting anecdotal evidence on a population level is "peer pressure"?

That's a good one.

doozerie wrote: »

And trying to guilt people into not wearing a helmet because you believe not wearing one sets "a good example" is, amongst other things, extremely patronising.

Those are not words or phrases I would come close to using.

To be clear: I think helmet use for average commuting cycling is a part of "dangerising" cycling, but I would try to avoid asking others to set an example or to guilt people.

doozerie wrote: »

That cuts both ways.

Sure it does... you can remind me of that when I go around calling other's views absurd... something I have so-far yet to do.

Keep_Her_Lit wrote: »

Can you accept that at least some cyclists who choose to wear helmets are capable of independent thought?

Never said otherwise, so I'm not going to correct myself for something I have not said. But at the same time few people if anybody can fully remove themselves from the effects of social pressure / promotion / reinforcement regarding this or any issue -- I can't say I can.

Keep_Her_Lit wrote: »

...had I followed your advice...

I don't recall giving you advice on such. Or have I?

Keep_Her_Lit wrote: »

By your standards, the fact that I was wearing a helmet on those occasions makes me an "extremist".

I have not used the word extremist. Somebody can take am extremist action without generally becoming an extremist. One does not always have to follow the other.

Keep_Her_Lit wrote: »

And since I'm only deciding for myself, the only statistics that really matter are drawn from a population of 1. The four helmet strikes I've previously described here and here can be dismissed as anecdotes. But for me, they represent a complete data set and give me all the information I need to make an informed decision before setting off for work in the morning.

I'm nearly sure I'm on record more than a few times in previous threads that helmets may be useful for those who engage in risky behaver (compared to your adverse cyclist around the world), or those prone to accidents for what ever reason or those who are just not great with balance.

Beasty

monument wrote: »

From Cyclecraft:

A helmet works through absorbing some of the force of an impact by itself deforming. The liner of shock-absorbing material acts as a buffer which reduces the acceleration forces that reach the skull. In this way helmets can prevent minor wounds to the head. Once the liner is fully compacted (which happens at quite low forces), it provides no further protection and all the residual energy passes directly to the skull. Thus the ability of helmets to afford useful protection in more serious crashes, such as those that involve motor vehicles, is much less certain.

When you get to the point that he helmet cracks or crushes then the skull absorbs energy -- it may or may not be enough to do damage. It's worth getting your self checked out.

It has absorbed energy in getting to that point - ie it's done it's job

But actually the quote refers only to "compacting", and I would suggest there may remain some capacity to "compact" further even when cracked

I am not suggesting a helmet will always be of benefit, but even that quote states the ability to afford protection in more serious crashes ... is much less certain

ie there remains some scope for it to afford some protection in such circumstances

greenmat

monument wrote: »

If you hit your head and a helmet cracked it means the force was greater than what the helmet is able to take -- so there's a risk of brain damage and you should have went to a doctor or straight to A&E regardless of how it looked.

Thankfully cyclists are the least likely road users to obtain serious brain injury and the least likely to sustain permanent brain damage.

In any case... Sounds like better and cheaper interventions would be to (a) slow down where needed, or generally if needed, and (b) not to lean over too far.

Is it possable you would have been going slower and taking less risks if you were not wearing a helmet?

My accident was totally my own fault, have been off the bike for 6 weeks injured (Knee injury not from a crash) and if honest was just enjoying being back on the bike, made a stupid simple mistake when cornering. I hit the ground hard with front of helmet, brushed myself down and cycled on to work. I work as a paramedic so the last place in the world i wanted to go to that morning was A&E. Between myself and a colleague I got checked over, I'd live to see another day. Would I take less risk without a helmet, I don't know, as I always wear one. The risks we take when decending, don't think a helmet would do much to protect you if it all went horribly wrong yet we all still love the trill of a fast decent.