[Closed] Helmets and a climate of fear.

KCR, I salute you. That is superb work! 😀

Whats with the bunny rabbits?

By the way TJ (or others) since you are so keen on the effect of helmet wearing on a population basis. Would you like to tell me why, if cycling is so beneficial to overall population health, the Danes and the Dutch don't outlive us by many years?
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy

I'll answer it for you: Becuase the equation isn't that simple. Similarly the efrfects/non effects of helmet wearing are also crowded by other issues. The trouble with many of these arguments is that a lot of the stats are garbage. For example if you are going to judge the safety or otherwise of cycling against, say, walking you are a complete idiot if you just judge it on the raw stats.

Dutch? I suspect its bad diet and smoking. Danes - dunno.

There is plenty of evidence of cycling being a positive benefit to health if you want to see it.

oh, go on then.. 😆

Just like there is plenty of evidence that hitting your head on the ground results in less injury if you have some form of protection....

point is, some of us choose not to wear protection when there is very little chance of injury from impact in the first place.

On a day to day basis there is very little chance of me dying of congestive heart disease. Therefore I'll just sit on my fat backside & reach for crisps...

Each year
Around 100 000 die from heart disease
Around 100 on bikes
Around 10 from head injuries preventable by helmets

cycling does not need to have much effect to save more people than it kills.

Around 10 from head injuries preventable by helmets

How many serious injuries are prevented by helmets though?

BDB - don't. That question gets asked over-and-over without a sensible response!!

70 a year dies in DIY accidents as a comparison. cycling really is safe 🙂

Big dugs baws - its impossible to be sure but no more than a hundred or so would be my guess ( only 600 serious injuries total to cyclists) and probably more like a dozen or two. Too few to be seen in population studies

Lots of cuts grazes and bruises tho.

& how [i]old[/i] are the people who die from heart disease? If you are aged 30 and cycle: What are the chances that you will die/be seriously injured while riding compared to being 30/not riding and dying from heart disease? The point is making the comparison between death from old age and death from youthful trauma is completely fallacious.

Lets be clear what the argument is about here.
There is ample medical evidence to support the fact that helmet usage protects individuals against head injuries.
This has been demonstrated in properly conducted case controlled studies which is probably the greatest level of evidence you could achieve for such a subject. It is not possible to double blind helmet wearers for the purposes os a study so case controlled studies is the best we've got.
The only argument here is whether helmet legislation actually offers protection to the population as a whole.
Demonstrating this protective effect statistically is obviously confounded by many factors which are difficult to measure such as compliance, traffic behavior, infrastructure changes etc.
The landmark paper here cited here by Prof Robinson who is a statistician is purely a statistical analysis on whether hospital data was affected by helmet legislation.
Speaking from a background of a full time hospital medical practitioner who specializes in trauma rather than community medicine ( see above comments) I can confidently say that data used draws some very far stretched conclusions. For one example it uses hospital admissions as a measure of number of head injuries as this is a very readily available dataset. The obvious flaw is that the changes in medical practice means that the threshold for admitting head injuries has substantially increased and this data set is not really an appropriate measure of minor head injuries that cyclists predominantly suffer from.
The paper was in effect not much more than intellectual trolling which is what academics do to gain recognition.
The statistics have subsequently been refuted by at least 10 subsequent papers.
The one credit I give this paper is in it's opening line where she states that in proper case control studies there is a protective effect offered by helmets on cyclists head injuries.
The paper should have ended there but it would have not achieved the attention it has if it did.
As somebody who does not want look after any of you, my advice is that you wear one.
There is no argument that as an individual you are safer.
It has not been demonstrated that legislation changes offer protection to the community at large, but a properly constructed prospective study has never been performed, so I say there is an absence of evidence not evidence of absence.

hugor, most sensible answer so far. In fact having read all of this and now the papers reffed here above, I would accuse TJ of cherry picking the data to suit his agenda.

Agree with you there. Its easy to find papers to support any given opinion particularly when you only read the pubmed abstracts. Thats what the media do. To read the paper and critically look at the stats yourself takes a lot more work.
Thankfully the BMA do not agree with TJ's opinion and their current stance is to support compulsory helmet usage despite the obvious evidence to the contrary. 🙄
http://www.bma.org.uk/health_promotion_ethics/transport/promotingsafecycling.jsp?page=6

"There is no argument that as an individual you are safer."

The argument is risk compensation.

Not read all 4 pages of cranial angst but is this an official 'TJ-thread' yet?

I am afraid Hugor misses a couple of things.
The case control studies have two at least major flaws.
1) - its self selecting sample and only a part of the data set. this leads to over estimation of the protective effects of helmets. You simply do not know if the helmet wearers crash more for example
2) - They ignore other factors such as risk compensation, injuries caused or exacerbated by helmets as well as other minor factors. this again will lead to a gross overestimate of the protective effects of helmets.
There is other significant flaws in the evidence as well

If the protective effects of helmets were as good as the pro helmet protectionists claim then it would appear in the epidimological data. Robinsions results have been widely replicated in other places and other countries.

I would accuse TJ of cherry picking the data to suit his agenda.

.......does the pope shit in the woods !! 😉

(or something like that )

Crossed posts -

Hugor - do you know how much fury that caused that decision in the BMA?

Many doctors including MY GP were outraged by it. There was a very fierce debate a the conference and there was much dissent when long standing positions were reversed at the whim of the chair without a proper vote.

I stood in horror at the last BMA Annual Representatives Meeting as
it voted for
compulsory cycle helmets.

A quick seach of the BMA website shows this
http://www.bmj.com/search/cycle%2520helmets

They ignore other factors such as risk compensation, injuries caused or exacerbated by helmets as well as other minor factors. this again will lead to a gross overestimate of the protective effects of helmets.

TJ you don't honestly believe in the ramblings of that physiologist who cycled down the streets of Bath wearing a womens wig as evidence that helmet wearing increases your risk? Cmon man geez!!
There has been a lot of data extrapolated from motorcycles onto cycling.
Most of this is not comparable. The speeds involved and weights of the helmets are not comparable.
Excuse my slow response I'm on a ipad.

Crossed posts -

Hugor - do you know how much fury that caused that decision in the BMA?

OK what about the AMA which is my association?
They wrong too?
Is is a conspiracy!!!

How many serious injuries are prevented by helmets though?

BDB - don't. That question gets asked over-and-over without a sensible response!!

An answer I'd be very interested in knowing but I'm not sure how you'd get any figures.

I'm not pro-compulsory wearing or anti-helmet and here's why; if I choose to pop down the street on my bike to get a packet of fags, or visit a mate down road I'll not wear a helmet. why would I? The likelihood of [b]any[/b] kind of head injury is negligible.

However, when riding the twisty paths of St Cuthbert's way with over-hanging branches, I'll wear a helmet. Not because I'm worried about a traumatic\major head injury leading to death; but because banging my head against a branch and taking a layer of my scalp or causing a gash deep enough to warrant stitches is something I'd prefer to avoid.

Hence I'd be interested in the answer to the question above. It would also be interesting to know how many A&E visits could be avoided that weren't life threatening (like my example) but obviously tie up resources.

The trouble with cycling is that it is done on very many different levels and conditions etc, and isn't that where the problem lies, i.e. applying legislation across such broad spectrum of activity.?

Has TJ hit himself with a hammer yet?

AMA?

Hugor - are you seriously denying risk compensation? it has been demonstrated in aloads of ways and places including such things as car drivers with ABS drive faster it the rain - but no it doesn't apply to cyclists?

You are doing the usual pro helmet persons tactic of rubbishing anything that does not fit your view.

anyway - there is no point in continuing this but I ask anyone who thinks Hugor is answering for the british medical establishment to look at the inks to teh discussions on the BMJ site I give above

Glitchy posts

"Glitchy"

im struggling here on an ipad with a very dodgy wifi connection in a serviced apartment in Edinburgh!!

AMA is the Australian Medical Association. It has rejected the Australian paper you keen quoting by Robinson.

Hugor - trouble is this stuff has been done befoer and positions are entrenched.

I simply see no possible case for compulsion when injury rates are so low and effectivenes of helmets is so low.

Great for the minor injuries of the sort MTBers get - which is why for real MTBing I wear one - but not great at the one in millions chance of debilitating or deadly major injury which is such an unlikely risk I am prepared to accept it.

Are yo in favour of drinking helmets? compulsory helmets in cars? both would save many many more lives.

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You are digressing my friend.
I go back to my original statement that the unsolved debates concern legislation not safety for an individual.
A politician may hold your views but as a medical officer I am disappointed in your stance.
I'm not interested in drinking helmets or driving helmets, but I am in support for drinking boots which I will wear over the next few days.

Do you advise your patients to not wear helmets for fear of risk compensation?

TJ have you hit yourself on the head with a hammer yet? Something between a tap and a whack will be fine.

"I go back to my original statement that the unsolved debates concern legislation not safety for an individual."

Not true. If you are going to crash a helmet is a good thing. If wearing a helmet increases your risk of a crash through risk compensation then wearing a helmet may be a bad thing.

So even an individual may not benefit from wearing a helmet.

Perhaps this explains why many helmet advocates justify their position by the number of times it has prevented injury in a crash. Perhaps helmet wearers crash more often?

@GW can you believe he removed his gloves to the left of him to drink that beverage?
He could have got hurt.

Perhaps helmet wearers crash more often?

Risk compensation:
Hmmm of course it exists but [b]anecdotally[/b] I'm not sure it has [i]any[/i] influence at all when road riding (except when ice/snow are added to the equation). Off road definitely, but then I am often confronted with terrain or a section where I think 'I might fall off' Wearing a helmet encourages me to attempt these things.. But while on road. I don't think I'd ever think. 'I fancy my chances with this car because I've got a helmet on'. Additionally the fear of road rash would stop me doing things long before the influence of the helmet comes into play.

Hugor _ I wouldn't dream of telling anyone to do anything like that - I think its patronising in the extreme .

Also. When it comes to risk compensation... A lot of people who justify not wearing helmets do so because they say cycling isn't dangerous. 😕 That after all is what the OP is talking about. So on one hand helmet wearers are travelling in fear of cycling, while at the same time underestimating the dangers because of the false sense of protection provided by their helmets.

Sorry. You can't have it both ways.

Personally I think risk compensation comes into play with body armor and neck braces in DH. There is no standard to be met for these items and I fear young kids are doing stuff thinking they are safe.
I live near Cwm Carn DH and have treated lots of kids wearing this stuff who thought so.
I digress.
Point is that I accept risk compensation but not in regular recreational cycling which is safe as people have stated above.

"I'm not prepared to accept some comparison to another scenario."

But sometimes you have to. If risk compensation has been proved to exist elsewhere why should cycling be exempt? Risk compensation is a reasonable explanation of why no big helmet effect is seen at population levels along with the fact they provide only limited protection.

A good study risk compensation was the Munich Taxi Driver study.

http://psyc.queensu.ca/target/chapter07.html

Regular driving which is safe but still demonstrated risk compensation.

TJ it's a joy to watch your technique here. I love the post about entrenched positions above.. I think the stw expression is oh the ironing!!

Hugor, thanks for the other medical view

If risk compensation has been proved to exist elsewhere why should cycling be exempt?

Hugor, you talk a lot of sense, and your way of communicating your point is very good.

Not sure you fit in with the general theme of STW "debate" though 😉

You either have to:

A- Argue for the sake of it, don't worry about facts or being accurate. It's only the Internet it won't matter.

Or adopt the following attitude......

B- "I think I'm cleverer than you, so either accept my entrenched view without question, or I'll insult you"

With regards to REGULAR RECREATIONAL CYCLING I believe wearing helmets:
1. definitely prevents head injures

2. doesn't subject the rider to greater risk of crashes through risk compensation.

Given that the majority of citizens abide by the law and do not risk challenge themselves in their daily commute to work I see no reason to not wear them.