Helmets cramp my style
05-08-08, 10:11 AM
#3026
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I understand your point, but I will say that I don't think that I'm mixing up means and ends here. I happen to believe that wearing a helmet increases one's safety while riding a bike. I also think that it can protect one in case of an auto accident. (Again, this is based on empirical data.) Furthermore, I disagree that one is not putting oneself at risk by riding a bike. It seems to me that as one is then sharing the road with cars and trucks, one is at greater risk than when walking. Anyway, I don't have the studies to back this up, but it just seems logical to me. I can understand your perspective as well, and if you actually can show me that one is not at greater risk of injury when riding a bike than when walking down the street I'd be overjoyed in more ways than one.
I probably already made this clear, but my point is not so much that I've found a helmet to be useful in preventing a car from killing me. Rather, the helmet can protect one's head when a car-induced accident forces one to come into contact with the ground. This was certainly true when a car t-boned me and my helmet (not my head) hit the ground. Anyway, this last paragraph is meant to clarify my comments that you quoted.
While it doesn't pertain to my particular line of thought, the "reading... on the subject" that you mention sounds quite interesting, and I'd love to check it out if you'd point me in the right direction. What are your sources?
... it's telling that more than a few times you mention in your post about the increased possibility of, or actually being hit by cars as a reason for wearing one. You might want to read a bit more on the subject because bicycle helmets are not made to withstand impacts or prevent injuries from impacts with motor vehicles.
While it doesn't pertain to my particular line of thought, the "reading... on the subject" that you mention sounds quite interesting, and I'd love to check it out if you'd point me in the right direction. What are your sources?
Last edited by drumthebenway; 05-08-08 at 10:24 AM.
05-08-08, 11:57 AM
#3027
Senior Member
It's great that you may feel by simply strapping on a helmet, you are safer but you must realize that by simply strapping on a helmet it is in no way an effective means to prevent a collision from occurring.
It must be common sense to you that certain behaviors lead to trouble more often than other behaviors as it is that certain collisions or falls result in more serious injuries than other collisions or falls.
You can check what the situation is in your area for injuries by cause, but I've found in my area that head injuries to cyclists are no more numerous than others receiving head injuries.
As an example, New Zealand has a mandatory helmet law that is vigorously enforced. here is a chart that shows the rise in helmet usage, the head injuries cyclists have received with the rise in usage and it has a comparison of head injuries with the general population
This is one example of what happens when everybody switches to helmet use.
As for the reading on the subject, there are plenty of links in the discussion here and there was one recommended that immediately preceded your post. Take a look.
It must be common sense to you that certain behaviors lead to trouble more often than other behaviors as it is that certain collisions or falls result in more serious injuries than other collisions or falls.
You can check what the situation is in your area for injuries by cause, but I've found in my area that head injuries to cyclists are no more numerous than others receiving head injuries.
As an example, New Zealand has a mandatory helmet law that is vigorously enforced. here is a chart that shows the rise in helmet usage, the head injuries cyclists have received with the rise in usage and it has a comparison of head injuries with the general population
This is one example of what happens when everybody switches to helmet use.
As for the reading on the subject, there are plenty of links in the discussion here and there was one recommended that immediately preceded your post. Take a look.
Last edited by closetbiker; 05-08-08 at 01:30 PM.
05-08-08, 01:09 PM
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What's the source of that graph? It's provocative and I'd like to know a little bit about where it comes from and what it's actually supposed to show.
As for the link preceding my post, thanks! I've just now read through it. Still, I don't see its relevance to the scenario I've spoken to, except perhaps to shore up my argument. You've said that helmets were not designed to protect riders from collisions with automobiles. The article concurs. But the article also notes that a helmet can have protective value in falls on flat surfaces, such as pavement. So when a rider is knocked from a bike by a car (and here the collision with the car is not what immediately injures the cyclist) and then hits his head on the pavement, might not a helmet be of some value after all?
As for the link preceding my post, thanks! I've just now read through it. Still, I don't see its relevance to the scenario I've spoken to, except perhaps to shore up my argument. You've said that helmets were not designed to protect riders from collisions with automobiles. The article concurs. But the article also notes that a helmet can have protective value in falls on flat surfaces, such as pavement. So when a rider is knocked from a bike by a car (and here the collision with the car is not what immediately injures the cyclist) and then hits his head on the pavement, might not a helmet be of some value after all?
05-08-08, 02:12 PM
#3029
Senior Member
I think you need to read the paper a little more closely. It specifically addresses the point of collisions with vehicles.
For more information and sources, you might want to look at
https://www.magma.ca/~ocbc/ the faq may start you out https://www.magma.ca/~ocbc/hfaq.html
https://en.wikipedia.org/wiki/Bicycle_helmet and,
https://www.cyclehelmets.org/
For more information and sources, you might want to look at
https://www.magma.ca/~ocbc/ the faq may start you out https://www.magma.ca/~ocbc/hfaq.html
https://en.wikipedia.org/wiki/Bicycle_helmet and,
https://www.cyclehelmets.org/
Last edited by closetbiker; 05-08-08 at 02:29 PM.
05-08-08, 04:51 PM
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Six Jours:
I'm now responding to your post of a few days ago. I only infrequently check the forum here so please excuse my late reply.
First of all, I never said that everybody who cycles without a helmet is stupid. I said that it would be stupid for me to ride without one. (Sorry for the lack of clarity on this point.) I've been hit by cars twice. In each case I was unable to avoid the accident -- I don't think Lance Armstrong would have been able to avoid it either -- and in one of the instances the helmet prevented a head injury. No doubt about it.
You also wrote: "Not to mention the millions of daily riders in places like Holland and Belgium who would no more put on a helmet for a bike commute than they would a Nomex suit for a walk to market." It's actually a valid point. I live in Austria in a rural village. People have been biking here for a long time. There are some old ladies who "ride" around every day without a helmet, just as they've been doing for years. But over the course of their lives things have changed, more cars have come in, people are driving more, there are more car-related injuries and fatalities -- and maybe they should actually adjust their behavior accordingly and wear helmets. I don't know.
Also, you say that someone wearing a helmet while riding to the market is over-equipped to the point of paranoia. That's simply not true. An accident can happen any time, especially where cars are involved.
As for telling people to **** off, as you so nicely put it, I'd suggest that you calm down. This is an internet forum where people from all walks of life can contribute. Quite often something is said without being articulated clearly enough (I'm especially guilty of this) and your hasty, vitriolic outburst doesn't really add to the discussion.
I do agree with chipcom that it ultimately comes down to personal choice. The notion of regulating helmet wearing seems a bit authoritarian to me. I'd much rather live in a convivial society that didn't make it necessary for me to ride with a helmet, one in which the road weren't such a dangerous place. But for now I'll stick with the helmet. Again, this is my decision.
I'm now responding to your post of a few days ago. I only infrequently check the forum here so please excuse my late reply.
First of all, I never said that everybody who cycles without a helmet is stupid. I said that it would be stupid for me to ride without one. (Sorry for the lack of clarity on this point.) I've been hit by cars twice. In each case I was unable to avoid the accident -- I don't think Lance Armstrong would have been able to avoid it either -- and in one of the instances the helmet prevented a head injury. No doubt about it.
You also wrote: "Not to mention the millions of daily riders in places like Holland and Belgium who would no more put on a helmet for a bike commute than they would a Nomex suit for a walk to market." It's actually a valid point. I live in Austria in a rural village. People have been biking here for a long time. There are some old ladies who "ride" around every day without a helmet, just as they've been doing for years. But over the course of their lives things have changed, more cars have come in, people are driving more, there are more car-related injuries and fatalities -- and maybe they should actually adjust their behavior accordingly and wear helmets. I don't know.
Also, you say that someone wearing a helmet while riding to the market is over-equipped to the point of paranoia. That's simply not true. An accident can happen any time, especially where cars are involved.
As for telling people to **** off, as you so nicely put it, I'd suggest that you calm down. This is an internet forum where people from all walks of life can contribute. Quite often something is said without being articulated clearly enough (I'm especially guilty of this) and your hasty, vitriolic outburst doesn't really add to the discussion.
I do agree with chipcom that it ultimately comes down to personal choice. The notion of regulating helmet wearing seems a bit authoritarian to me. I'd much rather live in a convivial society that didn't make it necessary for me to ride with a helmet, one in which the road weren't such a dangerous place. But for now I'll stick with the helmet. Again, this is my decision.
Hope that clarifies the issue!
05-08-08, 08:15 PM
#3031
Senior Member
Right. Skipped over that the first time around.
It was Dr. Nigel Perry's graph of cycling head injury percentage against helmet usage and head injury percentage in the general population
I first saw it when reading this page
https://www.chapmancentral.co.uk/wiki..._helmet_debate
the graph was under - History
It was Dr. Nigel Perry's graph of cycling head injury percentage against helmet usage and head injury percentage in the general population
I first saw it when reading this page
https://www.chapmancentral.co.uk/wiki..._helmet_debate
the graph was under - History
Last edited by closetbiker; 05-08-08 at 09:34 PM.
05-09-08, 11:43 PM
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Drumthebenway,
It looks like you've been caught up in the "discussion" on this board, especially with what Closetbiker and Six Jours and others have to say against helmets.
Closetbiker,
It looks like you simply like to talk a lot. I haven't been here for months (been busy with school, work, and other things), but you still like to dominate the discussion. So it is not me, it's you (to the others, Closetbiker knows what I mean).
Helmets do distribute the forces across the head, whether Mr. Chapman on ChapmanCentral believes it or not. There are at least three actions, one the distribution of forces across a much larger area, second the other the crushing effect of the helmet's foam, and third the "slipperyness" of the helmet's shell (which prevents the jerking of the head that early helmets were accused of doing; the skin has a pretty high coefficient of friction too). The graphs are pulled out of other articles, and presented out of context. Usually on Wikipedia there is a lot of discussion about what has been written into the article. If you look at the "Discussion" part of the Wikipedia article, you'll see that this article was nominated, but did not meet, the Wikipedia criteria for a "good article." That criteria is available at:
https://en.wikipedia.org/wiki/Talk:Bicycle_helmet
For the discussion, here again is an Israeli study that talks about the effects of helmets:
For those of you who are following these "debates," I would recommend going to:
https://www.pubmed.gov/
and doing your own searches. Then read the evidence from the scientific studies themselves. If possible, buy the studies and read them, but at least read through the abstracts. This way, you'll see what is written in peer-reviewed articles from medical journals.
John
It looks like you've been caught up in the "discussion" on this board, especially with what Closetbiker and Six Jours and others have to say against helmets.
Closetbiker,
It looks like you simply like to talk a lot. I haven't been here for months (been busy with school, work, and other things), but you still like to dominate the discussion. So it is not me, it's you (to the others, Closetbiker knows what I mean).
Helmets do distribute the forces across the head, whether Mr. Chapman on ChapmanCentral believes it or not. There are at least three actions, one the distribution of forces across a much larger area, second the other the crushing effect of the helmet's foam, and third the "slipperyness" of the helmet's shell (which prevents the jerking of the head that early helmets were accused of doing; the skin has a pretty high coefficient of friction too). The graphs are pulled out of other articles, and presented out of context. Usually on Wikipedia there is a lot of discussion about what has been written into the article. If you look at the "Discussion" part of the Wikipedia article, you'll see that this article was nominated, but did not meet, the Wikipedia criteria for a "good article." That criteria is available at:
https://en.wikipedia.org/wiki/Talk:Bicycle_helmet
For the discussion, here again is an Israeli study that talks about the effects of helmets:
1: J Trauma Nurs. 2007 Apr-Jun;14(2):84-7.Click here to read Links
The effect of bicycle helmet legislation on pediatric injury.
Pardi LA, King BP, Salemi G, Salvator AE.
Akron Children's Hospital, Ohio 44308-1062, USA. lpardi@chmca.org
BACKGROUND: Research supports the use of a correctly fitted bicycle helmet to reduce the risk of bicycle-related head injury. Although parents believe bicycle helmets work, a large percentage of children do not wear helmets while riding. PURPOSE: The purpose of this study was to track pediatric bicycle-related injuries presenting to a pediatric trauma center 1 year before and 5 years after 2001 bicycle helmet legislation aimed to protect children 0 to 16 years. METHODS: Prospective data collection of pedal cycle injury e-code 826.1 from hospital discharge data set from January 1, 2000, through December 31, 2005. Bicycle-related injuries among children 0 to 16 years were grouped by injury type (head, extremity, and other), age, and gender. RESULTS: For years reviewed (2000-2005), bicycle-related injuries were highest in the period May through August. Bicycle-related injury rates per 100,000 for this population were 1,452 a year before legislation. The injury rate decreased 27% (1,054/100,000) one year later. Overall, bicycle-related injury per 100,000 continues to be down by 24%. Data show that extremity injury is greater than head and other injury categories in both male (24% greater) and female (27% greater) children 0 to 16 years one year before legislation. Data show extremity injury rates per 100,000 is greater than head and other injury categories in both male (24% greater) and female (38% greater) categories 5 years later. Bicycle-related injury rates per 100,000 in boys were greater than girls for all years reported. Male extremity injury was 45% higher for 10- to 16-year-old boys than for 5- to 9-year-old boys a year before legislation and continued to rise to 58% in 2005. Male head injury rates per 100,000 were higher in 5- to 9-year-old boys (598/100,000) than in 10- to 16- year-old boys (354/100,000) one year before legislation. In 2005, the bicycle-related head injury rates per 100,000 dropped to 485 for 5- to 9-year-old vs 223 for the 10- to 16-year-old boys. Female extremity injury rate per 100,000 for 5- to 9-year-old girls in 2000 was 367, exceeding the 10- to 16-year category rate of 213 per 100,000. In 2005, female extremity injury per 100,000 was 299 for the 5- to 9-year-old girls and rose 16% to 250 for 10- to 16-year-old girls. Head injury rates per 100,000 for 5- to 9-year-old girls in 2000 were 325, ending with a rate of 254 per 100,000 in 2005. Head injury rates per 100,000 for 10- to 16-year-old girls in 2000 were 93, ending in 2005 with a rate of 91 per 100,000. CONCLUSION: The greatest reduction in injury occurred 1 year after legislation, suggesting that promoting bicycle helmet use in the community is effective in reducing injury. The overall rate of bicycle-related injury in the population studied continues to be down 24%, suggesting bicycle helmet legislation for children is an effective adjunct in reducing injury. Extremity injury rates were greater than head injury in both male and female populations, suggesting that future bicycle safety initiatives address extremity injury. Female head injury rates in the 10- to 16-year-old population changed very little from baseline and would benefit from further investigation of female riding habits and perceived barriers to bicycle helmet use.
PMID: 17579327 [PubMed - indexed for MEDLINE]
The effect of bicycle helmet legislation on pediatric injury.
Pardi LA, King BP, Salemi G, Salvator AE.
Akron Children's Hospital, Ohio 44308-1062, USA. lpardi@chmca.org
BACKGROUND: Research supports the use of a correctly fitted bicycle helmet to reduce the risk of bicycle-related head injury. Although parents believe bicycle helmets work, a large percentage of children do not wear helmets while riding. PURPOSE: The purpose of this study was to track pediatric bicycle-related injuries presenting to a pediatric trauma center 1 year before and 5 years after 2001 bicycle helmet legislation aimed to protect children 0 to 16 years. METHODS: Prospective data collection of pedal cycle injury e-code 826.1 from hospital discharge data set from January 1, 2000, through December 31, 2005. Bicycle-related injuries among children 0 to 16 years were grouped by injury type (head, extremity, and other), age, and gender. RESULTS: For years reviewed (2000-2005), bicycle-related injuries were highest in the period May through August. Bicycle-related injury rates per 100,000 for this population were 1,452 a year before legislation. The injury rate decreased 27% (1,054/100,000) one year later. Overall, bicycle-related injury per 100,000 continues to be down by 24%. Data show that extremity injury is greater than head and other injury categories in both male (24% greater) and female (27% greater) children 0 to 16 years one year before legislation. Data show extremity injury rates per 100,000 is greater than head and other injury categories in both male (24% greater) and female (38% greater) categories 5 years later. Bicycle-related injury rates per 100,000 in boys were greater than girls for all years reported. Male extremity injury was 45% higher for 10- to 16-year-old boys than for 5- to 9-year-old boys a year before legislation and continued to rise to 58% in 2005. Male head injury rates per 100,000 were higher in 5- to 9-year-old boys (598/100,000) than in 10- to 16- year-old boys (354/100,000) one year before legislation. In 2005, the bicycle-related head injury rates per 100,000 dropped to 485 for 5- to 9-year-old vs 223 for the 10- to 16-year-old boys. Female extremity injury rate per 100,000 for 5- to 9-year-old girls in 2000 was 367, exceeding the 10- to 16-year category rate of 213 per 100,000. In 2005, female extremity injury per 100,000 was 299 for the 5- to 9-year-old girls and rose 16% to 250 for 10- to 16-year-old girls. Head injury rates per 100,000 for 5- to 9-year-old girls in 2000 were 325, ending with a rate of 254 per 100,000 in 2005. Head injury rates per 100,000 for 10- to 16-year-old girls in 2000 were 93, ending in 2005 with a rate of 91 per 100,000. CONCLUSION: The greatest reduction in injury occurred 1 year after legislation, suggesting that promoting bicycle helmet use in the community is effective in reducing injury. The overall rate of bicycle-related injury in the population studied continues to be down 24%, suggesting bicycle helmet legislation for children is an effective adjunct in reducing injury. Extremity injury rates were greater than head injury in both male and female populations, suggesting that future bicycle safety initiatives address extremity injury. Female head injury rates in the 10- to 16-year-old population changed very little from baseline and would benefit from further investigation of female riding habits and perceived barriers to bicycle helmet use.
PMID: 17579327 [PubMed - indexed for MEDLINE]
https://www.pubmed.gov/
and doing your own searches. Then read the evidence from the scientific studies themselves. If possible, buy the studies and read them, but at least read through the abstracts. This way, you'll see what is written in peer-reviewed articles from medical journals.
John
Last edited by John C. Ratliff; 05-09-08 at 11:51 PM. Reason: Complete sentence
05-10-08, 12:22 AM
#3033
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For those of you who feel that countries where there are lots of bikes and helmets are not emphasized don't have problems, take a look at this abstract:
Note the presence of head injuries in the fatalities, where only 14% of the hospitalizations involving bike accidents had head injuries, but 90% of those which were fatal had head injuries. Does that tell us something?
John
1: Accid Anal Prev. 2008 Jan;40(1):192-9. Epub 2007 Jun 21.Click here to read Links
Epidemiology of bicycle injuries in 13 health divisions, Islamic Republic of Iran 2003.
Karkhaneh M, Naghavi M, Rowe BH, Hagel BE, Jafari N, Saunders LD.
Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. mohammad.karkhaneh@ualberta.ca
Bicyclists are vulnerable road users for severe injury all over the world. The nature and extent of such injuries are less well known in Iran. Using data from a comprehensive survey conducted by the Ministry of Health and Medical Education in 13 health divisions of Iran, in 2003, we examined circumstances around bicyclist injury and death. Trained health workers completed the survey instruments by interviewing patients who stayed more than 24h in hospitals and/or relatives, hospital personnel and by reviewing patient charts. Data were cross-matched with medico-legal documents to prevent missing deaths. The information that was collected from 64 cities/towns' emergency departments (EDs), over the study period, showed that 440 injured cyclists were hospitalized and/or died due to traffic collisions. Most injuries occurred in males (94.8%) and in the young (median age: 14 years with 75% </=18 years). Head injury occurred in 14% of all hospitalized and in 90% of fatally injured bicyclists. Striking a moving vehicle increased the odds of death (OR: 32.3; 95% CI 3.5-291.0) as well as the odds of severe injury (OR: 1.9; 95% CI 1.2-3.2) compared with other mechanisms of injury. As a conclusion, bicyclists in Iran, particularly males and young children, are vulnerable to severe injury and death when struck by moving vehicles on highways.
PMID: 18215548 [PubMed - in process]
Epidemiology of bicycle injuries in 13 health divisions, Islamic Republic of Iran 2003.
Karkhaneh M, Naghavi M, Rowe BH, Hagel BE, Jafari N, Saunders LD.
Department of Public Health Sciences, School of Public Health, University of Alberta, Edmonton, Alberta, Canada. mohammad.karkhaneh@ualberta.ca
Bicyclists are vulnerable road users for severe injury all over the world. The nature and extent of such injuries are less well known in Iran. Using data from a comprehensive survey conducted by the Ministry of Health and Medical Education in 13 health divisions of Iran, in 2003, we examined circumstances around bicyclist injury and death. Trained health workers completed the survey instruments by interviewing patients who stayed more than 24h in hospitals and/or relatives, hospital personnel and by reviewing patient charts. Data were cross-matched with medico-legal documents to prevent missing deaths. The information that was collected from 64 cities/towns' emergency departments (EDs), over the study period, showed that 440 injured cyclists were hospitalized and/or died due to traffic collisions. Most injuries occurred in males (94.8%) and in the young (median age: 14 years with 75% </=18 years). Head injury occurred in 14% of all hospitalized and in 90% of fatally injured bicyclists. Striking a moving vehicle increased the odds of death (OR: 32.3; 95% CI 3.5-291.0) as well as the odds of severe injury (OR: 1.9; 95% CI 1.2-3.2) compared with other mechanisms of injury. As a conclusion, bicyclists in Iran, particularly males and young children, are vulnerable to severe injury and death when struck by moving vehicles on highways.
PMID: 18215548 [PubMed - in process]
John
05-10-08, 02:02 AM
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I'm having a few major problems here, mainly that:
1) Physics need not apply. Explained multiple times.
2) "Head injury" has no clear definition. A scratch? A concussion? Even with a helmet you can, and probably will get a minor head injury, you're still dealing with a good deal of force. There is no attempt from anti-helmet "researchers" to determine that they have no injury reducing effects, they purely stick to simplistic values. Seems to be number skewing to me being as data is way too simplified.
Not that I'm going to make fun of people or really care if others wear helmets, I'm not your mother I don't need to make sure everyone is protected. Personally whatever helps cycling, yes?
...But I do care if people are going to throw around stupid biased arguments and try to act like it's a science, that does make you look stupid.
1) Physics need not apply. Explained multiple times.
2) "Head injury" has no clear definition. A scratch? A concussion? Even with a helmet you can, and probably will get a minor head injury, you're still dealing with a good deal of force. There is no attempt from anti-helmet "researchers" to determine that they have no injury reducing effects, they purely stick to simplistic values. Seems to be number skewing to me being as data is way too simplified.
Not that I'm going to make fun of people or really care if others wear helmets, I'm not your mother I don't need to make sure everyone is protected. Personally whatever helps cycling, yes?
...But I do care if people are going to throw around stupid biased arguments and try to act like it's a science, that does make you look stupid.
05-10-08, 11:11 AM
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Coupla points, John:
1) Don't include me in your "anti-helmet" group. I'm not anti-helmet. I'm anti-"helmets save your life every time you fall off a bike and you're an idiot if you don't wear one!!!".
2) Nobody is arguing that helmets never prevent injury in pediatrics, so the Israeli study is a bit of a non-sequiter. The argument is that, statistically, helmets do not appear to substantially affect the rate of death among adult cyclists.
3) Nobody is arguing that head injury is not the leading cause of death among cyclists, so the Iranian study is also misplaced. The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists.
4) The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists.
5) The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists.
Hopefully the point has finally gotten across...
1) Don't include me in your "anti-helmet" group. I'm not anti-helmet. I'm anti-"helmets save your life every time you fall off a bike and you're an idiot if you don't wear one!!!".
2) Nobody is arguing that helmets never prevent injury in pediatrics, so the Israeli study is a bit of a non-sequiter. The argument is that, statistically, helmets do not appear to substantially affect the rate of death among adult cyclists.
3) Nobody is arguing that head injury is not the leading cause of death among cyclists, so the Iranian study is also misplaced. The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists.
4) The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists.
5) The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists.
Hopefully the point has finally gotten across...
Last edited by Six jours; 05-10-08 at 11:25 AM.
05-10-08, 04:05 PM
#3036
Senior Member
You might want to search "helmets save lives" with Johns name as poster and see what you get, to see who you're dealing with.
Last edited by closetbiker; 05-10-08 at 04:16 PM.
05-10-08, 04:50 PM
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Coupla points, John:
1) Don't include me in your "anti-helmet" group. I'm not anti-helmet. I'm anti-"helmets save your life every time you fall off a bike and you're an idiot if you don't wear one!!!".
2) Nobody is arguing that helmets never prevent injury in pediatrics, so the Israeli study is a bit of a non-sequiter. The argument is that, statistically, helmets do not appear to substantially affect the rate of death among adult cyclists.
3) Nobody is arguing that head injury is not the leading cause of death among cyclists, so the Iranian study is also misplaced. The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists...
Hopefully the point has finally gotten across...
1) Don't include me in your "anti-helmet" group. I'm not anti-helmet. I'm anti-"helmets save your life every time you fall off a bike and you're an idiot if you don't wear one!!!".
2) Nobody is arguing that helmets never prevent injury in pediatrics, so the Israeli study is a bit of a non-sequiter. The argument is that, statistically, helmets do not appear to substantially affect the rate of death among adult cyclists.
3) Nobody is arguing that head injury is not the leading cause of death among cyclists, so the Iranian study is also misplaced. The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists...
Hopefully the point has finally gotten across...
1: Singapore Med J. 2006 May;47(5):367-72.Click here to read Links
Comment in:
Singapore Med J. 2006 May;47(5):357-8.
Helmet use and bicycle-related trauma in patients presenting to an acute hospital in Singapore.
Heng KW, Lee AH, Zhu S, Tham KY, Seow E.
Emergency Department, Tan Tock Seng Hospital, Singapore. kenneth_heng@ttsh.com.sg
INTRODUCTION: To describe the relationship between bicycle helmet use and injury pattern sustained by patients presenting to an emergency department (ED) in Singapore for bicycle-related trauma. METHODS: Data was collected from all individuals treated for bicycle-related trauma between September 1, 2004 and May 31, 2005 using a closed-ended questionnaire. RESULTS: 160 bicyclists with mean age of 34.4 years (range 10 to 89 years) were surveyed. Among them, 80 percent were male and 30.6 percent were non-residents. Helmets were worn by 10.6 percent of the patients. Alcohol was clinically detected in 11.3 percent of bicyclists. There was no difference in bicycle helmet use between Singaporeans and non-residents (p-value is 0.275). However, compared to younger bicyclists, bicyclists aged 30 years or older (p-value is less than 0.05), and compared to recreational or sport bicyclists, those who commute by bicycle, tended not to wear helmets (p-value is less than 0.01). Compared to Singaporeans (p-value is less than 0.05), non-residents and bicyclists aged 30 years or older (p-value is 0.011) believed that helmets did not protect against head injury. Comparing the helmeted group with the non-helmeted group, injury patterns by body region were: head injury 5.9 percent versus 40.0 percent (p-value is less than 0.01); facial injury 5.9 percent versus 37.1 percent (p-value is less than 0.05). Not wearing a helmet, being hit by a motor vehicle and age were significantly associated with higher injury severity scores, after adjusting for several potential confounding factors. CONCLUSION: Bicycle helmet use was low in our sample of injured patients. When worn, protection against injury was demonstrated. A campaign to promote use of bicycle helmets should be targeted at non-residents and older bicyclists. Authorities should consider compulsory helmet laws for bicyclists and expanding anti-drunk driving campaigns to target alcohol-intoxicated bicyclists.
PMID: 16645684 [PubMed - indexed for MEDLINE]
Comment in:
Singapore Med J. 2006 May;47(5):357-8.
Helmet use and bicycle-related trauma in patients presenting to an acute hospital in Singapore.
Heng KW, Lee AH, Zhu S, Tham KY, Seow E.
Emergency Department, Tan Tock Seng Hospital, Singapore. kenneth_heng@ttsh.com.sg
INTRODUCTION: To describe the relationship between bicycle helmet use and injury pattern sustained by patients presenting to an emergency department (ED) in Singapore for bicycle-related trauma. METHODS: Data was collected from all individuals treated for bicycle-related trauma between September 1, 2004 and May 31, 2005 using a closed-ended questionnaire. RESULTS: 160 bicyclists with mean age of 34.4 years (range 10 to 89 years) were surveyed. Among them, 80 percent were male and 30.6 percent were non-residents. Helmets were worn by 10.6 percent of the patients. Alcohol was clinically detected in 11.3 percent of bicyclists. There was no difference in bicycle helmet use between Singaporeans and non-residents (p-value is 0.275). However, compared to younger bicyclists, bicyclists aged 30 years or older (p-value is less than 0.05), and compared to recreational or sport bicyclists, those who commute by bicycle, tended not to wear helmets (p-value is less than 0.01). Compared to Singaporeans (p-value is less than 0.05), non-residents and bicyclists aged 30 years or older (p-value is 0.011) believed that helmets did not protect against head injury. Comparing the helmeted group with the non-helmeted group, injury patterns by body region were: head injury 5.9 percent versus 40.0 percent (p-value is less than 0.01); facial injury 5.9 percent versus 37.1 percent (p-value is less than 0.05). Not wearing a helmet, being hit by a motor vehicle and age were significantly associated with higher injury severity scores, after adjusting for several potential confounding factors. CONCLUSION: Bicycle helmet use was low in our sample of injured patients. When worn, protection against injury was demonstrated. A campaign to promote use of bicycle helmets should be targeted at non-residents and older bicyclists. Authorities should consider compulsory helmet laws for bicyclists and expanding anti-drunk driving campaigns to target alcohol-intoxicated bicyclists.
PMID: 16645684 [PubMed - indexed for MEDLINE]
1: J Trauma. 2007 May;62(5):1118-22.Click here to read Links
The current injury situation of bicyclists--a medical and technical crash analysis.
Richter M, Otte D, Haasper C, Knobloch K, Probst C, Westhoff J, Sommer K, Krettek C.
Department for Trauma, Orthopaedic and Foot Surgery, Coburg Clinical Center, and Hannover Medical School, Germany. info@Qfoot-trauma.com
BACKGROUND: The purpose of the study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. METHODS: Technical and medical data were prospectively collected shortly after the crash at the crash scenes. RESULTS: Included were 4,264 injured bicyclists from 1985 to 2003. Fifty-five percent of the bicyclists were male and 45% were women. The mean age of bicyclists was 52.0 years. The crashes took place in urban areas in 95.2% of the cases, and in rural areas in 4.8% of the cases. Collision opponents were cars in 65.8%, trucks in 7.2%, bicyclists in 7.4%, standing objects in 8.8%, multiple opponents or objects in 4.3%, and others in 6.5%. The mean collision speed was 21.3 km/h. The helmet use rate was 1.7%. Fifty-five percent of bicyclists used bicycle traffic lanes before the crash. The mean Maximum Abbreviated Injury Scale/Injury Severity Score (ISS) was 1.45 of 3.9. The incidence of multiple injuries (ISS>16)/death was 2.0%/1.5%. The ISS/Maximum Abbreviated Injury Scale score was higher in bicyclists without a helmet than in bicyclists with a helmet, and in bicyclists who had not used bicycle traffic lanes than in bicyclists who had used bicycle traffic lanes (t test, p<0.05). CONCLUSION: In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two-thirds of the head injuries could have been prevented by helmets. More consequent helmet use and an extension of bicycle traffic lanes for a better separation of bicyclists and motorized vehicles would be simple but very effective preventive measures.
PMID: 17495710 [PubMed - indexed for MEDLINE]
The current injury situation of bicyclists--a medical and technical crash analysis.
Richter M, Otte D, Haasper C, Knobloch K, Probst C, Westhoff J, Sommer K, Krettek C.
Department for Trauma, Orthopaedic and Foot Surgery, Coburg Clinical Center, and Hannover Medical School, Germany. info@Qfoot-trauma.com
BACKGROUND: The purpose of the study was to analyze the actual injury situation of bicyclists in Germany to create a basis for effective preventive measures. METHODS: Technical and medical data were prospectively collected shortly after the crash at the crash scenes. RESULTS: Included were 4,264 injured bicyclists from 1985 to 2003. Fifty-five percent of the bicyclists were male and 45% were women. The mean age of bicyclists was 52.0 years. The crashes took place in urban areas in 95.2% of the cases, and in rural areas in 4.8% of the cases. Collision opponents were cars in 65.8%, trucks in 7.2%, bicyclists in 7.4%, standing objects in 8.8%, multiple opponents or objects in 4.3%, and others in 6.5%. The mean collision speed was 21.3 km/h. The helmet use rate was 1.7%. Fifty-five percent of bicyclists used bicycle traffic lanes before the crash. The mean Maximum Abbreviated Injury Scale/Injury Severity Score (ISS) was 1.45 of 3.9. The incidence of multiple injuries (ISS>16)/death was 2.0%/1.5%. The ISS/Maximum Abbreviated Injury Scale score was higher in bicyclists without a helmet than in bicyclists with a helmet, and in bicyclists who had not used bicycle traffic lanes than in bicyclists who had used bicycle traffic lanes (t test, p<0.05). CONCLUSION: In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two-thirds of the head injuries could have been prevented by helmets. More consequent helmet use and an extension of bicycle traffic lanes for a better separation of bicyclists and motorized vehicles would be simple but very effective preventive measures.
PMID: 17495710 [PubMed - indexed for MEDLINE]
John
Last edited by John C. Ratliff; 05-10-08 at 04:52 PM. Reason: add to last sentence.
05-10-08, 05:26 PM
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Jesus, John.
The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists!
Why would you respond to that argument by putting up a link to a study indicating that cycling Singaporeans suffer fewer scrapes to the head when they wear helmets?
The argument is, again, that helmet use doesn't seem to have much effect on rates of death among adult cyclists!
Why would you respond to that argument by putting up a link to a study indicating that cycling Singaporeans suffer fewer scrapes to the head when they wear helmets?
05-10-08, 07:51 PM
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Well, that's your argument, Six jours. Mine is that injuries are lessened by use of bicycle helmets, specifically head injuries. And it is not just "...fewer scrapes to the head..." that we're talking about here.
There was one study that did show a slight decrease in death rates, and that was looking only at fatalities. Here is that study.
Now, a decrease of just 239 deaths by using the bicycle helmet, while important to those 239 people, may not be statistically huge at all. But it is there. Therefore, your statement that "it doesn't seem to have much effect" may be correct (although that statement does imply that there is some effect), unless you are one of the 239 people.
John
There was one study that did show a slight decrease in death rates, and that was looking only at fatalities. Here is that study.
1: Inj Prev. 2006 Jun;12(3):148-54.Click here to read Links
Changes in traffic crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet, or bicycle helmet, United States, 1982-2001.
Cummings P, Rivara FP, Olson CM, Smith KM.
Harborview Injury Prevention and Research Center and the Department of Epidemiology, University of Washington, Seattle, WA, USA.
OBJECTIVE: To estimate the contributions of five risk factors to changes in US traffic crash mortality: (1) alcohol use by drivers and pedestrians, (2) not wearing a seat belt, (3) lack of an air bag, (4) not wearing a motorcycle helmet, and (5) not wearing a bicycle helmet. DESIGN: Longitudinal study of deaths; attributable deaths were estimated using data from other studies. SETTING: US traffic crashes in 1982-2001. SUBJECTS: People who died in a crash. MAIN OUTCOME MEASURES: Counts of deaths attributed to each risk factor, change in rates of deaths, and counts of lives saved by changes in risk factor prevalence. RESULTS: There were 858 741 traffic deaths during the 20 year period. Estimated deaths attributed to each factor were: (1) alcohol use, 366 606; (2) not wearing a seat belt, 259 239; (3) lack of an air bag, 31 377; (4) no motorcycle helmet, 12 095; (5) no bicycle helmet, 10 552. Over the 20 years, mortality rates attributed to each risk factor declined: alcohol by 53%; not wearing a seat belt by 49%; lack of an air bag by 17%; no motorcycle helmet by 74%; no bicycle helmet by 39%. There were 153,168 lives saved by decreased drinking and driving, 129,297 by increased use of seat belts, 4305 by increased air bag prevalence, 6475 by increased use of motorcycle helmets, and 239 by increased use of bicycle helmets. CONCLUSIONS: Decreased alcohol use and increased use of seat belts were associated with substantial reductions in crash mortality from 1982 through 2001. Increased presence of air bags, motorcycle helmets, and bicycle helmets were associated with smaller reductions.
PMID: 16751443 [PubMed - indexed for MEDLINE
Changes in traffic crash mortality rates attributed to use of alcohol, or lack of a seat belt, air bag, motorcycle helmet, or bicycle helmet, United States, 1982-2001.
Cummings P, Rivara FP, Olson CM, Smith KM.
Harborview Injury Prevention and Research Center and the Department of Epidemiology, University of Washington, Seattle, WA, USA.
OBJECTIVE: To estimate the contributions of five risk factors to changes in US traffic crash mortality: (1) alcohol use by drivers and pedestrians, (2) not wearing a seat belt, (3) lack of an air bag, (4) not wearing a motorcycle helmet, and (5) not wearing a bicycle helmet. DESIGN: Longitudinal study of deaths; attributable deaths were estimated using data from other studies. SETTING: US traffic crashes in 1982-2001. SUBJECTS: People who died in a crash. MAIN OUTCOME MEASURES: Counts of deaths attributed to each risk factor, change in rates of deaths, and counts of lives saved by changes in risk factor prevalence. RESULTS: There were 858 741 traffic deaths during the 20 year period. Estimated deaths attributed to each factor were: (1) alcohol use, 366 606; (2) not wearing a seat belt, 259 239; (3) lack of an air bag, 31 377; (4) no motorcycle helmet, 12 095; (5) no bicycle helmet, 10 552. Over the 20 years, mortality rates attributed to each risk factor declined: alcohol by 53%; not wearing a seat belt by 49%; lack of an air bag by 17%; no motorcycle helmet by 74%; no bicycle helmet by 39%. There were 153,168 lives saved by decreased drinking and driving, 129,297 by increased use of seat belts, 4305 by increased air bag prevalence, 6475 by increased use of motorcycle helmets, and 239 by increased use of bicycle helmets. CONCLUSIONS: Decreased alcohol use and increased use of seat belts were associated with substantial reductions in crash mortality from 1982 through 2001. Increased presence of air bags, motorcycle helmets, and bicycle helmets were associated with smaller reductions.
PMID: 16751443 [PubMed - indexed for MEDLINE
John
Last edited by John C. Ratliff; 05-10-08 at 07:54 PM. Reason: add materials
05-10-08, 08:07 PM
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At least you're honest, John. None of the breathless "80 percent safer!!!" foolishness.
Of course, that doesn't make for much of a debate. I have always maintained that, all other things being equal, helmets probably make cycling a little bit safer. The difference is, however, so small that it makes no sense to mandate helmets, or to argue that anyone who chooses not to use one is an idiot, organ donor, Darwin candidate, etc.
IMHO, all the "anti-helmet" folks want is to be let alone.
Of course, that doesn't make for much of a debate. I have always maintained that, all other things being equal, helmets probably make cycling a little bit safer. The difference is, however, so small that it makes no sense to mandate helmets, or to argue that anyone who chooses not to use one is an idiot, organ donor, Darwin candidate, etc.
IMHO, all the "anti-helmet" folks want is to be let alone.
05-10-08, 09:13 PM
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At least you're honest, John. None of the breathless "80 percent safer!!!" foolishness.
Of course, that doesn't make for much of a debate. I have always maintained that, all other things being equal, helmets probably make cycling a little bit safer. The difference is, however, so small that it makes no sense to mandate helmets, or to argue that anyone who chooses not to use one is an idiot, organ donor, Darwin candidate, etc.
IMHO, all the "anti-helmet" folks want is to be let alone.
Of course, that doesn't make for much of a debate. I have always maintained that, all other things being equal, helmets probably make cycling a little bit safer. The difference is, however, so small that it makes no sense to mandate helmets, or to argue that anyone who chooses not to use one is an idiot, organ donor, Darwin candidate, etc.
IMHO, all the "anti-helmet" folks want is to be let alone.
Since I'm not a researcher, I'll let the others defend any particular numbers that they put out there. But being a safety and health professional, I will not say that helmets have no value, as I know that they do. I have had coursework in epidemiology, and do know a bit about how to interpret studies. The studies that I've cited above show that helmets have value. If a good argument can be made to have people use helmets, then there is no need for mandatory helmet laws. But that effort needs to be made.
In scuba diving, the industry came to a consensus standard on the safety equipment needed for divers to become certified to dive. These are enforced on dive charter boats.
But the bicycle industry has no consensus standard for bicycling, be it the equipment necessary to be on the road, or for the bicyclist to wear. One study I saw showed teens not eager to wear helmets, because of social factors. There is no consensus standard on training bicyclists like in diving, which may be fine for our freedoms, but leaves something to be desired for the kids in a community, especially in poorer communities without much infrastructure for this type of thing. 'Just something for you to think about.
Here are some interesting You Tube videos about bicycle helmets and accidents. I would not want to be in the accidents shown on the track without a helmet.
https://www.youtube.com/watch?v=n1Q_Il3enZ0
https://www.youtube.com/watch?v=S0tMhlhnga0
https://www.youtube.com/watch?v=I9YI1pSeVTQ&NR=1
https://www.youtube.com/watch?v=tYVQp...eature=related
John
Last edited by John C. Ratliff; 05-10-08 at 09:24 PM.
05-10-08, 09:50 PM
#3042
Senior Member
Actually, I sense a different "agenda" by the anti-helmet people. I sense that whenever someone tries to say that helmets have worked, at least for them, that these people want to degrade their reasoning. At one point, I thought that Closetbiker was simply responding to me, and vise versa, in a kind of vicious cycle. So I simply quit writing for a while. I see that Closetbiker has found someone else to respond to. So this is not the "anti-helmet" folks wanting to be left alone, but a conscious effort to degrade the efforts of others who feel that helmets have value.
John
John
Pretty funny when John and I have discussed how we agree on almost all points on helmets apart from "helmets save lives" and that I have been wearing a helmet while commuting for longer than John has and he knows I've spoken on the positives aspects of wearing one.
Pretty much falls in line with a post I made some time back where I asked John to clear up some unfounded accusations he's made and didn't.
I'll try again. Please clear up the new accusation and clear up the old ones too.
John has posted,
I would rather not have people read about helmet testing,
I ridicule people for wearing helmets,
I disagree that there are studies which show advantages of helmets,
I am saying helmets don't work,
I don't read the studies and,
I've advised him to not wear a helmet.
I think John see what he wants to see even when it's not there, but correct me if I'm wrong.
Last edited by closetbiker; 05-11-08 at 12:32 PM.
05-10-08, 10:47 PM
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So Closetbiker, what have you been saying in the last few months to these fellows who write here about the benefits of helmets?
And this isn’t mocking?
or this:
Or this
Now, in light of these quotes, how can you say this?
John
Originally Posted by Closetbiker
... or it is a testament to the gullibility of the "believers" of a helmets role in cyclist safety.
Originally Posted by Closetbiker
looks like a typical hockey player to me
Originally Posted by Closetbiker
I think you're still completely out of it.
Originally Posted by Closetbiker
maybe he should have worn his helmet this way ...
... or maybe work on not being so stupid
... or maybe work on not being so stupid
Originally Posted by Closetbiker
so am I right to think John is labeling me anti-helmet crusader trying to degrade others who feel have value?
05-11-08, 04:31 AM
#3044
Senior Member
Thanks for making my point John.
There's just such a uniquely particular quality to your views.
* and btw, association is not the same thing as causation. One could make the argument that Denmark has one of the lowest rates of deaths to cyclists because no helmets are being worn, but that would just be association and not causation. Just as we know it's not the presence of helmets that causes a lower rate of deaths to cyclists, we all know the real reason is there is a tremendously low rate of deaths to cyclists is the lack of collisions between cyclists and motorists, not because helmets are being worn.
There's just such a uniquely particular quality to your views.
* and btw, association is not the same thing as causation. One could make the argument that Denmark has one of the lowest rates of deaths to cyclists because no helmets are being worn, but that would just be association and not causation. Just as we know it's not the presence of helmets that causes a lower rate of deaths to cyclists, we all know the real reason is there is a tremendously low rate of deaths to cyclists is the lack of collisions between cyclists and motorists, not because helmets are being worn.
Last edited by closetbiker; 05-11-08 at 01:24 PM.
05-11-08, 05:28 AM
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Regarding the 239 people. You would be right, if having a helmet would have prevented their death, this is a positive thing. But, rarely is anything without an unintended consequence.
I personally am scared to death to dive. Yep. I would love to, but I suspect years and years of TV showing me people with the bends and munched by sharks have warped my mind. I think it is correct that people dive together with whatever safety gear people require.
My concern with those of the pro-helmet faction being so strident is that they are convincing parents that riding a bike is the same way, so we have a very few kids growing up in the USA riding a bike.
So, offset that 239 with thousands dying early from obesity due to not riding as a kid. If you constantly beat the drum that you are an organ donor without a helmet, don't be surprised when parents decide the safest thing is to not let their kids ride at all. Which would be the case. Except that lack of exercise is more deadly by far.
I rather doubt you can convince people that it is important to wear a helmet without causing many people not to wear a helmet - or ride the bike - out of fear.
I personally am scared to death to dive. Yep. I would love to, but I suspect years and years of TV showing me people with the bends and munched by sharks have warped my mind. I think it is correct that people dive together with whatever safety gear people require.
My concern with those of the pro-helmet faction being so strident is that they are convincing parents that riding a bike is the same way, so we have a very few kids growing up in the USA riding a bike.
So, offset that 239 with thousands dying early from obesity due to not riding as a kid. If you constantly beat the drum that you are an organ donor without a helmet, don't be surprised when parents decide the safest thing is to not let their kids ride at all. Which would be the case. Except that lack of exercise is more deadly by far.
I rather doubt you can convince people that it is important to wear a helmet without causing many people not to wear a helmet - or ride the bike - out of fear.
05-11-08, 05:34 AM
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Much of my concern is how much "safety equipment" is imposed on us, implying that our entire life is surrounded by danger. No wonder everyone is fat, they are afraid to get off the coach!
I am nearly 50 years old, in excellent health, much of the due to things people consider risky. Cycling, hiking alone, swimming in a natural river.
Could I die someday? Sure, and a meteor could hit me too. I am going to be dead someday anyway, and I have already had kids.
The issue on helmets is very interesting to me because it really shows well how our society in the USA has attempted to convince people that there is no risk in life. It just isn't true.
I am nearly 50 years old, in excellent health, much of the due to things people consider risky. Cycling, hiking alone, swimming in a natural river.
Could I die someday? Sure, and a meteor could hit me too. I am going to be dead someday anyway, and I have already had kids.
The issue on helmets is very interesting to me because it really shows well how our society in the USA has attempted to convince people that there is no risk in life. It just isn't true.
05-11-08, 11:38 AM
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Since I'm not a researcher, I'll let the others defend any particular numbers that they put out there. But being a safety and health professional, I will not say that helmets have no value, as I know that they do. I have had coursework in epidemiology, and do know a bit about how to interpret studies. The studies that I've cited above show that helmets have value. If a good argument can be made to have people use helmets, then there is no need for mandatory helmet laws. But that effort needs to be made.
But the bicycle industry has no consensus standard for bicycling, be it the equipment necessary to be on the road, or for the bicyclist to wear. One study I saw showed teens not eager to wear helmets, because of social factors. There is no consensus standard on training bicyclists like in diving, which may be fine for our freedoms, but leaves something to be desired for the kids in a community, especially in poorer communities without much infrastructure for this type of thing. 'Just something for you to think about.
Then you should probably wear a helmet the next time you're in a track race. Being a grown man, I trust you to make those kinds of decisions for yourself.
05-11-08, 05:26 PM
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I haven’t been able to find the time to contribute much to this thread recently, but I did want to make some comments about some of the studies being bandied around by Winston and John.
You’ll notice that virtually all of the studies quoted follow the same pattern. They take some hospital admissions data. They correlate head injury rates with helmet wearing, often including an extrapolation of how many of the non-helmeted riders’ injuries could have been avoided if they had been wearing helmets. They then jump from that correlation to a conclusion that wearing helmets is beneficial – and often throw in another line about it being particularly the case for children.
In so doing, these studies are riddled with statistical and methodological errors which generally fall into two types:
- equating correlation with causation
- lack of rigour in isolating variables under investigation
I haven’t read all the studies quoted recently, but here are a few warning signs from the ones quoted recently in this thread:
For example in the Abu-Zidan, F.M. et al. (2007) study:
" A generalized linear model was used to test the effect of age, sex, helmet use, cause of injury, year of injury, place of injury and whether the injury occurred on public or school holidays on the Injury Severity Score (ISS) in those patients who had head injury and those without.”
Note that no consideration was taken of exposure (eg amount of time spend cycling). A pretty glaring error. Further consideration of the socio-economic factors would be nice to, especially as they have been shown to produce errors in this type of stuffy in the past.
The Berg, P. and R. Westerling (2007) study suffers from the same error (although has a larger data set):
"Outcome evaluation was based on data from the Swedish National Hospital Discharge Register concerning all bicycle-related injuries from 1987 to 1996”. Again no control for variables such as exposure, socio-economic factors and location.
Another from the Richter, M. et al. (2007) study:
"In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two-thirds of the head injuries could have been prevented by helmets”
This is just plain wrong. Cyclists are not at ‘high risk’ of head injury compared to the general population (so what are they comparing to?), and the ‘two-thirs’ figure is also plain wrong, taken as it is from the discredited Thompson, Rivara & Thompson paper from 1989. The tone of the piece (‘unsatisfactorily low’) really gives the game away on this one. This is junk research.
The Depreitere, B. et al. (2007) study made me laugh, actually.
"The common designs of commercially available bicycle helmets do not prevent direct contact loading on the temporal and zygomatic arch region and this contact loading is potentially harmful. The present preliminary study strongly questions the effectiveness of these helmets in providing accurate protection of the temporal and zygomatic area”
So here is a study pointing out the limited effectiveness of cycling helmets, and recommending we all wear even more protective gear. As far as I can tell, there is no discussion of the actual risk level being mitigated against, so this recommendation exists in a vacuum –another common error. (Cyclists also suffer neck injuries, so should also be wearing neck braces. Heck, they suffer injuries. So no-one should ride. )
The 2007 Pardi LA, King BP, Salemi G, Salvator AE. Israli study linked by John also contains a number of classic methodological errors:
“the greatest reduction in injury occurred 1 year after legislation, suggesting that promoting bicycle helmet use in the community is effective in reducing injury.”
Amazingly, there is no discussion of the effect, seen, studied and referenced over and over again, that the introduction of helmet legislation causes rapid and significant drops in the number of cyclists on the roads. Yes, of course injury rates will drop if there are less cyclists. It’s another manifestation of the error of not controlling for one of the most significant variables – exposure.
There are dozens and dozens of these studies, and amazingly they all contain the same basic errors, namely:
- lack of control for exposure. It has been shown that the promotion of helmets, and the introduction of helmet legislation, causes a drop in the number of cyclists. This most basic fact is never discussed, let alone a more comprehensive control for this key variable.
- lack of control for riding style. Hospital admission data contains very little about who these riders are, and how they were riding. Are the risk factors different for someone riding to the shops on an errand vs training for a triathlon? I’d suggest they could be, but it’s never tested or controlled for.
- lack of control for socio-economic factors. This is particularly the case for children; kids from less advantaged homes are more likely to be riding unsupervised on busier streets (compared to more advantaged kids riding supervised in parks or in quiet neighbourhoods). Advantaged kids are also more likely to be wearing helmets. This leads to a correlation of helmet wearing with safer riding, but it is not causation – the riding conditions are much more significant.
- continual referencing of previous flawed research. The number of times that dratted Thompson, Rivara & Thompson study crops up – even in recent papers – is tedious.
- highly speculative inferences. This is particularly the case where ‘estimates’ are made on the number of helmeted cyclists who ‘would have been killed’ (or conversely non-helmeted cyclists who would have been ‘saved’) are made based on nothing more than hospital admission data.
- reliance on a single data source. This is particularly the case when hospital data is used. There are a number of problems, never discussed, with this type of data. Firstly, the data was not designed for being used in this way, so may lack crucial information (including some of the factors outlined above). Secondly it runs the risk of being self-referential. You could hypothesise that more risk-averse, safety conscious people are more likely to report to their ER with a minor injury, rather than just going home and hoping it heals up OK. You could also hypothesise that more risk-averse, safety conscious people are more likely to wear a helmet. If this is the case, you would see a higher rate of non-critical hospital admissions for those types of people. This would tend to skew the statistics drawn from admission data towards a conclusions that helmeted riders suffer less severe injuries. Cross referencing multiple data source helps to eliminate this type of error. But it’s rarely done.
- lack of discussion of / control for risk compensation. This very real phenomena (where people wearing safety gear take more risks) is never even mentioned in passing, let alone tested for.
- lack of discussion about whether helmets cause other road users to view cyclists differently (despite research that indicates motorised vehicle drivers behave differently towards cyclists in helmets)
- No consideration of the number of other cyclists on the roads (despite research that shows that a general increase in the number of cyclists is correlated with a drop in cyclists injury rates)
- No balancing of the overall health benefits of cycling vs the documented effects of promoting helmet usage leading to a drop in cycling participation rates
So why is it that so many of these studies are so poorly executed? Several reasons; hospital admission data is cheap and easy to get hold of, whilst controlling for other variables is much harder and takes much longer. The current academic environment tends to favour research volume over quality, so the endless replication of poorly executed studies is useful for institutions to bolster their published output (and secure research grants). Another problem is that so many of the studies are written by medical researchers. Many of the factors which needs to be controlled for are outside the expertise and experience of standard medical researchers; medical research can be quite insular, hence why I expect the researchers are not turning up in their lit searches relevant information from non-medical journals (such as safety, traffic, psychology and materials science).
For all the small-scale studies done on hospital data, there are some huge data sets out there relating to the introduction of helmet legislation. Sadly the data is far from perfect, as governments introducing such legislation rarely if ever conduct meaningful ‘before and after’ studies. Nevertheless, analysis of these data sets time and time again reveals that there is no significant effect on injury rates related to the introducing of such legislation (and the associated rise in helmet wearing). Closetbiker’s graph is an example of this.
For this reason, I am against mandatory helmet legislation. It does not seem to lead to a good outcome (generally cycling rates drop dramatically, fewer cyclists = less safe environment for cyclists = relatively more injuries; note that there is an absolute drop in number of injuries related to their being fewer cycles on the road). It also makes the introduction of bike hire schemes and more casual bike usage more difficult.
I’m less sure about whether wearing a helmet as an individual is worthwhile. It’s better to ride without a helmet than not ride at all, IMO. But they will help protect your head in certain, rather limited, conditions. Then again, wearing one might cause you to have more accidents owing to risk compensation and the more aggressive behaviour of other motorists towards you. So I’d say it has to be down to individual choice. I’d never judge someone on their decision as to wether to wear a helmet or not.
You’ll notice that virtually all of the studies quoted follow the same pattern. They take some hospital admissions data. They correlate head injury rates with helmet wearing, often including an extrapolation of how many of the non-helmeted riders’ injuries could have been avoided if they had been wearing helmets. They then jump from that correlation to a conclusion that wearing helmets is beneficial – and often throw in another line about it being particularly the case for children.
In so doing, these studies are riddled with statistical and methodological errors which generally fall into two types:
- equating correlation with causation
- lack of rigour in isolating variables under investigation
I haven’t read all the studies quoted recently, but here are a few warning signs from the ones quoted recently in this thread:
For example in the Abu-Zidan, F.M. et al. (2007) study:
" A generalized linear model was used to test the effect of age, sex, helmet use, cause of injury, year of injury, place of injury and whether the injury occurred on public or school holidays on the Injury Severity Score (ISS) in those patients who had head injury and those without.”
Note that no consideration was taken of exposure (eg amount of time spend cycling). A pretty glaring error. Further consideration of the socio-economic factors would be nice to, especially as they have been shown to produce errors in this type of stuffy in the past.
The Berg, P. and R. Westerling (2007) study suffers from the same error (although has a larger data set):
"Outcome evaluation was based on data from the Swedish National Hospital Discharge Register concerning all bicycle-related injuries from 1987 to 1996”. Again no control for variables such as exposure, socio-economic factors and location.
Another from the Richter, M. et al. (2007) study:
"In bicyclists, head and extremities are at high risk for injuries. The helmet use rate is unsatisfactorily low. Remarkably, two-thirds of the head injuries could have been prevented by helmets”
This is just plain wrong. Cyclists are not at ‘high risk’ of head injury compared to the general population (so what are they comparing to?), and the ‘two-thirs’ figure is also plain wrong, taken as it is from the discredited Thompson, Rivara & Thompson paper from 1989. The tone of the piece (‘unsatisfactorily low’) really gives the game away on this one. This is junk research.
The Depreitere, B. et al. (2007) study made me laugh, actually.
"The common designs of commercially available bicycle helmets do not prevent direct contact loading on the temporal and zygomatic arch region and this contact loading is potentially harmful. The present preliminary study strongly questions the effectiveness of these helmets in providing accurate protection of the temporal and zygomatic area”
So here is a study pointing out the limited effectiveness of cycling helmets, and recommending we all wear even more protective gear. As far as I can tell, there is no discussion of the actual risk level being mitigated against, so this recommendation exists in a vacuum –another common error. (Cyclists also suffer neck injuries, so should also be wearing neck braces. Heck, they suffer injuries. So no-one should ride. )
The 2007 Pardi LA, King BP, Salemi G, Salvator AE. Israli study linked by John also contains a number of classic methodological errors:
“the greatest reduction in injury occurred 1 year after legislation, suggesting that promoting bicycle helmet use in the community is effective in reducing injury.”
Amazingly, there is no discussion of the effect, seen, studied and referenced over and over again, that the introduction of helmet legislation causes rapid and significant drops in the number of cyclists on the roads. Yes, of course injury rates will drop if there are less cyclists. It’s another manifestation of the error of not controlling for one of the most significant variables – exposure.
There are dozens and dozens of these studies, and amazingly they all contain the same basic errors, namely:
- lack of control for exposure. It has been shown that the promotion of helmets, and the introduction of helmet legislation, causes a drop in the number of cyclists. This most basic fact is never discussed, let alone a more comprehensive control for this key variable.
- lack of control for riding style. Hospital admission data contains very little about who these riders are, and how they were riding. Are the risk factors different for someone riding to the shops on an errand vs training for a triathlon? I’d suggest they could be, but it’s never tested or controlled for.
- lack of control for socio-economic factors. This is particularly the case for children; kids from less advantaged homes are more likely to be riding unsupervised on busier streets (compared to more advantaged kids riding supervised in parks or in quiet neighbourhoods). Advantaged kids are also more likely to be wearing helmets. This leads to a correlation of helmet wearing with safer riding, but it is not causation – the riding conditions are much more significant.
- continual referencing of previous flawed research. The number of times that dratted Thompson, Rivara & Thompson study crops up – even in recent papers – is tedious.
- highly speculative inferences. This is particularly the case where ‘estimates’ are made on the number of helmeted cyclists who ‘would have been killed’ (or conversely non-helmeted cyclists who would have been ‘saved’) are made based on nothing more than hospital admission data.
- reliance on a single data source. This is particularly the case when hospital data is used. There are a number of problems, never discussed, with this type of data. Firstly, the data was not designed for being used in this way, so may lack crucial information (including some of the factors outlined above). Secondly it runs the risk of being self-referential. You could hypothesise that more risk-averse, safety conscious people are more likely to report to their ER with a minor injury, rather than just going home and hoping it heals up OK. You could also hypothesise that more risk-averse, safety conscious people are more likely to wear a helmet. If this is the case, you would see a higher rate of non-critical hospital admissions for those types of people. This would tend to skew the statistics drawn from admission data towards a conclusions that helmeted riders suffer less severe injuries. Cross referencing multiple data source helps to eliminate this type of error. But it’s rarely done.
- lack of discussion of / control for risk compensation. This very real phenomena (where people wearing safety gear take more risks) is never even mentioned in passing, let alone tested for.
- lack of discussion about whether helmets cause other road users to view cyclists differently (despite research that indicates motorised vehicle drivers behave differently towards cyclists in helmets)
- No consideration of the number of other cyclists on the roads (despite research that shows that a general increase in the number of cyclists is correlated with a drop in cyclists injury rates)
- No balancing of the overall health benefits of cycling vs the documented effects of promoting helmet usage leading to a drop in cycling participation rates
So why is it that so many of these studies are so poorly executed? Several reasons; hospital admission data is cheap and easy to get hold of, whilst controlling for other variables is much harder and takes much longer. The current academic environment tends to favour research volume over quality, so the endless replication of poorly executed studies is useful for institutions to bolster their published output (and secure research grants). Another problem is that so many of the studies are written by medical researchers. Many of the factors which needs to be controlled for are outside the expertise and experience of standard medical researchers; medical research can be quite insular, hence why I expect the researchers are not turning up in their lit searches relevant information from non-medical journals (such as safety, traffic, psychology and materials science).
For all the small-scale studies done on hospital data, there are some huge data sets out there relating to the introduction of helmet legislation. Sadly the data is far from perfect, as governments introducing such legislation rarely if ever conduct meaningful ‘before and after’ studies. Nevertheless, analysis of these data sets time and time again reveals that there is no significant effect on injury rates related to the introducing of such legislation (and the associated rise in helmet wearing). Closetbiker’s graph is an example of this.
For this reason, I am against mandatory helmet legislation. It does not seem to lead to a good outcome (generally cycling rates drop dramatically, fewer cyclists = less safe environment for cyclists = relatively more injuries; note that there is an absolute drop in number of injuries related to their being fewer cycles on the road). It also makes the introduction of bike hire schemes and more casual bike usage more difficult.
I’m less sure about whether wearing a helmet as an individual is worthwhile. It’s better to ride without a helmet than not ride at all, IMO. But they will help protect your head in certain, rather limited, conditions. Then again, wearing one might cause you to have more accidents owing to risk compensation and the more aggressive behaviour of other motorists towards you. So I’d say it has to be down to individual choice. I’d never judge someone on their decision as to wether to wear a helmet or not.
05-11-08, 10:20 PM
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Trombone,
Your detailed post requires a bit more study for any reply by me. I do appreciate the thought that you have put into it. My one question is whether, in your opinion, any study on bicycle helmets or bicycle injuries has met the criterion that you have laid out above? I'll look at this post in more detail this week, and reply accordingly.
I do have one comment on this paragraph:
Please note that we are talking about an injury rate, and not the numbers of injuries. The rate, if it is a rate per number of bicyclists, should not be affected by a drop in the total number of those bicyclists. The number of injuries may drop, but the rate could go up because of the loss in the total number of cyclists, if the rate per number of bicyclists is what is being analyzed. We commonly see this in small companies who have a single injury, and their rate goes way up as it is compared on the basis of the number of injuries per 100 employees (200,000 hours worked).
More later...
John
Your detailed post requires a bit more study for any reply by me. I do appreciate the thought that you have put into it. My one question is whether, in your opinion, any study on bicycle helmets or bicycle injuries has met the criterion that you have laid out above? I'll look at this post in more detail this week, and reply accordingly.
I do have one comment on this paragraph:
Originally Posted by Trombone
Amazingly, there is no discussion of the effect, seen, studied and referenced over and over again, that the introduction of helmet legislation causes rapid and significant drops in the number of cyclists on the roads. Yes, of course injury rates will drop if there are less cyclists. It’s another manifestation of the error of not controlling for one of the most significant variables – exposure.
More later...
John
Last edited by John C. Ratliff; 05-11-08 at 10:27 PM. Reason: add paragraph
05-12-08, 12:01 AM
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Thanks for the response, John. Much appreciated.
I've yet to read one in a journal that covers all the above areas; that's not to say there are none. Some are of course better than others, but it's fair to say I have a general distrust of research based solely on hopital admission data (which is the vast majority), as I don't see that these data are especially useful for answering the research question as posed.
Of course; what you have correctly identified is that thare are problems when data are not baselined for exposure, and with small sample sizes. Many research papers fall into these traps. For example, the Israeli study you cite earlier states:
"The overall rate of bicycle-related injury in the population studied continues to be down 24%, suggesting bicycle helmet legislation for children is an effective adjunct in reducing injury."
As you note, talking about 'overall rate per population' (essentially simply the absolute injury rate, assuming Israel has a relatively stable population) is not helpful. We need to know the 'overall rate per cycling population' , ideally also baselined against the amount of time spent on a bike - so 'overall rate per hour cycled' or 'overall rate per km cycled' for example. I've yet to see a research paper based on hospital admission data discussing either of these types of measures (or other similar ones baselined to exposure that one might devise).
Please note that we are talking about an injury rate, and not the numbers of injuries. The rate, if it is a rate per number of bicyclists, should not be affected by a drop in the total number of those bicyclists. The number of injuries may drop, but the rate could go up because of the loss in the total number of cyclists, if the rate per number of bicyclists is what is being analyzed.
"The overall rate of bicycle-related injury in the population studied continues to be down 24%, suggesting bicycle helmet legislation for children is an effective adjunct in reducing injury."
As you note, talking about 'overall rate per population' (essentially simply the absolute injury rate, assuming Israel has a relatively stable population) is not helpful. We need to know the 'overall rate per cycling population' , ideally also baselined against the amount of time spent on a bike - so 'overall rate per hour cycled' or 'overall rate per km cycled' for example. I've yet to see a research paper based on hospital admission data discussing either of these types of measures (or other similar ones baselined to exposure that one might devise).