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

Felloffmebike

I'm sure this has been discussed before but I'm interested in a lot of recent comments about wearing or not wearing a helmet. It never occurred to me not to wear one but recently I'm picking up a lot of people who seem to have a different view. Why is that? Does wearing a helmet not make it safer if you fall, even a little bit? And those who advocate not wearing one, is it a safety thing or a style thing or a macho man thing or what? Or is there some evidence that a helmet doesnt actually give you any protection or even that wearing one could be dangerous in itself.

I'm not looking to start an argument, just interested in the different views.

Mod note

Title changed - this can hopefully be considered the definitive helmet thread that can be pointed to whenever anyone wants to start another discussion on the subject - I'll put a link from the FAQs to it also

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Chuchote

Lumen wrote: »

Your implied suggestion is to always wear a helmet when cycling drunk.

My brain is itching for an alternative solution but I just can't quite put my finger on it.

Heh… a few more glasses of Black Bush or Jemmy's may make you think straighter…

buffalo

Chuchote wrote: »

Dermot Illogical wrote: »

Dublin Bikes, 16m journeys in the busiest traffic in this country over 7 years. 1 head injury fatality, a student who fell off after a few late-night beers.

Mind you, that one fatality might have been avoided if he'd had a helmet on.

It's true, we'd avoid a lot of fatalities and traumatic head injuries if helmet use was promoted and encouraged more among people consuming alcohol.

I support you entirely in this Churchote. Drinking helmets for everyone!

edit: DYNF Lumen!

tomasrojo

Chuchote wrote: »

even in those places brain surgeons often call for use of helmets, since they're the ones who see the effect of head injuries when they do happen.

You do get prominent surgeons who completely disagree though, such as Henry Marsh. He says they're just too flimsy to make a difference. (I should really say "I have heard of one prominent surgeon who disagrees; there may be others")

Mayer Hillman, who wrote some thoughtful commentary on the issue, said that in any case it doesn't do to put too much emphasis on catastrophic outcomes when they're pretty unlikely. He compared putting the opinions of surgeons over other experts to seeking advice on whether to buy lottery tickets and only asking lottery winners.

Chuchote wrote: »

My own feeling is that it's like seat belt use - when both cycling and helmet wearing become the norm, this will be less important to people, it'll just be part of cycling.

To some extent, helmets have been normalised. People don't laugh at people wearing them anymore; not the way they used to. However, they're substantially different from seat belts, in that they look at least somewhat "goofy", to use bikesnobnyc's word, they don't conveniently and automatically store themselves inside the bike when you're finished cycling, and their efficacy against serious head injury in a collision can reasonably be argued to be zero, with error bars. At least that's essentially what David Spiegelhalter and Ben Goldacre argued in the BMJ, and they're both distinguished, in the field of statistics and epidemiology, respectively.

There is of course the possibility that a much better helmet could be developed, but if you have people iike Rivara saying that the current design prevents 85% of head injuries, that takes the pressure off coming up with a design that really does work well.

Chuchote

Seriously, though, I was in Holland a few years ago and was chatting to friends, and (secondhand…) one had a friend who was a young brain surgeon and who was pressing him to wear a helmet because of the head injuries he'd seen; he said that the feeling among brain specialists over there is that helmet use would be a good thing.
It would probably be a more useful TED talk to get some of them talking about the injuries they'd seen and whether helmets would have prevented them rather than the one I quoted above.
So… back to trying to fix the dishwasher…

PokeHerKing

Chuchote wrote:

Mind you, that one fatality might have been avoided if he'd had a helmet on.

Chuchote wrote:

Because the figures suggest that they're not needed. As Dermot Illogical writes above:

Do we have figures of how many brain injuries were avoided in that same period due to helmet use?

CramCycle

I have found since I stopped wearing my helmet that my hair is more volumised and softer in work. It also hides my increasingly large bald spot from anyone under the height of 5'10.

This reduces my stress levels, makes me feel more confident, leading to greater productivity at work.

All in all, the benefits of not wearing a helmet are stacking up. I imagine the net gain to the irish economy is more than the VAT on a typical helmet (which if they were really safety equipment should be zero rated regardless).

Chuchote

PokeHerKing wrote: »

Do we have figures of how many brain injuries were avoided in that same period due to helmet use?

I think it would be hard to make up such figures; after all, if you're knocked to the ground and your helmet saves your head, you're not so likely to be in the hospital.

I don't really have a dog in this fight; I've taken to wearing a (MIPS) helmet; if others don't want to, I'm fine with that.

It seems to me that we're not getting good figures from people with no initial prejudice but with sound knowledge. If we could get figures from brain surgeons and rehab, and A&E (or whatever they've changed the name to now in the craze for renaming rather than improving), and racing cyclists, who have the most crashes and the most dangerous crashes - then we might be better able to judge.

tomasrojo

PokeHerKing wrote: »

Do we have figures of how many brain injuries were avoided in that same period due to helmet use?

That's a very hard trend to disentangle. If you look at hospital data (case-control studies) comparing helmeted cyclists with unhelmeted cyclists who've have been hospitalised, you can see a lower incidence in serious head injury among the helmeted. However, you can also see a lower incidence in lower body injury as well. Essentially, higher-income people tend to have fewer collisions with motorised vehicles (they live in safer neighbourhoods for a start) and also are more likely to wear helmets, so the helmet is probably not the main thing making the difference in those studies, but the income level of the patients. This is "confounding", and income confounding is really common in case-control studies. You could, to be trivial, find an association between lower head injuries and eating five a day as well.

If you look at trends for serious head injury per million cyclists, on the other hand, as helmet-wearing rates rise, you usually see serious head injury rates go up (though not stratospherically).

So there's no clear way to calculate how many lives have been saved, if any. As Spiegelhalter and Goldacre put it, the direct benefit is too modest to capture.

Chuchote

tomasrojo wrote: »

So there's no clear way to calculate how many lives have been saved, if any. As Spiegelhalter and Goldacre put it, the direct benefit is too modest to capture.

Or we're not calculating the right way, maybe.

I mean, while racing cyclists are obviously the group that have the most crashes and the most dangerous ones, they're also the fittest, and the most likely to know how to recover from a small crash. They universally (I think?) wear helmets, but they are presumably at greater risk of crashing and of head injuries than people cycling in urban traffic. Or are they?

tomasrojo

Incidentally, it's been linked before, but Ben Goldacre discusses this statistical tangle in this podcast at 1:12:45
http://feeds.soundcloud.com/stream/188278861-britishcomedyguide-richard-herring-lst-podcast-61-ben-goldacre.mp3

He says it's a very good example of the pitfalls of epidemiology in general.

(The podcast, as with all Richard Herring's podcasts, has sections that are junvenile, and NSFW, even if you have a workplace that lets you play podcasts out loud.)

irishrover99

tomasrojo wrote: »

If Essentially, higher-income people tend to have fewer collisions with motorised vehicles (they live in safer neighbourhoods for a start) .

I don't buy that that at all. Would a wealthy person who could afford really top end bike just cycle around Foxrock or Castleknock. I also find that a lot of the wealthy areas are close to major road networks, N11, coast road ext ext.

I'm not sure where that statistic comes from. Maybe some of the more wealthy boards cyclists can share their experiences.

tomasrojo

Chuchote wrote: »

Or we're not calculating the right way, maybe.

I mean, while racing cyclists are obviously the group that have the most crashes and the most dangerous ones, they're also the fittest, and the most likely to know how to recover from a small crash. They universally (I think?) wear helmets, but they are presumably at greater risk of crashing and of head injuries than people cycling in urban traffic. Or are they?

Oh, yeah, they're definitely at greater risk of crashing.

Hard to tell though. Since helmets became compulsory, the number of cyclists dying in races has gone up. But lots of other things have changed as well. There are scores of people here better qualified to tell you how things have change than me though.

tomasrojo

irishrover99 wrote: »

I don't buy that that at all. Would a wealthy person who could afford really top end bike just cycle around Foxrock or Castleknock. I also find that a lot of the wealthy areas are close to major road networks, N11, coast road ext ext.

I'm not sure where that statistic comes from. Maybe some of the more wealthy boards cyclists can share their experiences.

Well, for example, in the Thompson, Rivara and Thompson study (source of the 85% claim), no-one in the group of helmet-wearing cyclists had actually been hit by a motorised vehicle. They were all simple falls. A lot of the higher-income cyclists were recreational cyclists and accompanied children.

tomasrojo

irishrover99 wrote: »

I don't buy that that at all. Would a wealthy person who could afford really top end bike just cycle around Foxrock or Castleknock. I also find that a lot of the wealthy areas are close to major road networks, N11, coast road ext ext.

I'd also rather cycle on the N11 than, say, the Old Finglas Road. Similarly, cycling around South Dublin is definitely less stressful than cycling through Inchicore and Drimnagh.

(Not a statistical argument, obviously.)

irishrover99

tomasrojo wrote: »

Well, for example, in the Thompson, Rivara and Thompson study (source of the 85% claim), no-one in the group of helmet-wearing cyclists had actually been hit by a motorised vehicle. They were all simple falls. A lot of the higher-income cyclists were recreational cyclists and accompanied children.

I reckon that study will need to be updated soon enough. A lot of the people i see around laragh on the weekends and especially last time i done the W200 wheir yummy mummy types and golf daddies after ditching the clubs for a new recreation sport.

tomasrojo

There's some claims about low-income children (and ethnic minorities) in that:
http://www.theaa.com/public_affairs/reports/facts_about_road_accidents_and_children.pdf

Child from low-income family five times more likely to be killed on the road

I don't know how credible a source that is (or rather, how credible its sources are), but I don't think the claim that members of low-income families are more likely to die on the road is all that controversial.

Chuchote

tomasrojo wrote: »

There's some claims about low-income children (and ethnic minorities) in that:
http://www.theaa.com/public_affairs/reports/facts_about_road_accidents_and_children.pdf

Child from low-income family five times more likely to be killed on the road

I don't know how credible a source that is (or rather, how credible its sources are), but I don't think the claim that members of low-income families are more likely to die on the road is all that controversial.

Would it be that poor kids are more likely to be playing unsupervised on the roads? I know I've seen obviously poor kids aged around 10-12 in Rathmines racing across and through traffic and the wrong way down traffic on BMX bikes, and have sent up a quick desperate prayer to their guardian angels and ministers of grace to defend them.

tomasrojo

Chuchote wrote: »

Would it be that poor kids are more likely to be playing unsupervised on the roads? I know I've seen obviously poor kids aged around 10-12 in Rathmines racing across and through traffic and the wrong way down traffic on BMX bikes, and have sent up a quick desperate prayer to their guardian angels and ministers of grace to defend them.

Yes, I assume so. There's quite a difference between how kids play in Dundrum and how they play (or used to play) in O'Devaney Gardens.

Traffic light discipline is better in higher-income areas, I think, too. I don't have a statistical source for that.

Lower-income areas also seem to have less ability to stop their neighbourhoods becoming rat runs.

tomasrojo

irishrover99 wrote: »

I reckon that study will need to be updated soon enough.

It's from 1989! There can't be many studies that old that get cited as often.

irishrover99

Chuchote wrote: »

Would it be that poor kids are more likely to be playing unsupervised on the roads? .

I can believe that as i was one of them myself but most of the road deaths we hear about these days are people out proper cycling or commuting. Maybe kids been killed is not reported as much but i haven't heard of one lately

tomasrojo

It doesn't have to be a road death to appear in a case-control study. It just has to be an injury that is treated in a hospital. (The death of a schoolboy was very prominent in the news a few months back, but I'd rather not go into that.)

Lumen

tomasrojo wrote: »

I'd also rather cycle on the N11 than, say, the Old Finglas Road. Similarly, cycling around South Dublin is definitely less stressful than cycling through Inchicore and Drimnagh.

(Not a statistical argument, obviously.)

South Dublin is the worst place in Dublin to cycle, IMO. Entitled impatient b'stards the lot of them.

Conversely, my former hood in D15 was a pleasure to cycle around. I rather racistly put this down to the positive driving influence of first generation ex-EU immigrants. I never saw a car driven aggressively by a brown person, but possibly because they'd only recently passed their tests. I've read elsewhere about aggressive driving being a white male thing, culturally, maybe that's true also.

tomasrojo

YMMV, I guess!

(I still liked cycling around Drimnagh and Inchicore, but there was more aggressive driving, and I think it was from people passing through on the way to the Chapelizod bypass.)

Chips Lovell

In South Dublin you're also more likely to have people driving vehicles that are unsuited to the environment they're being used in, e.g. large, high-powered sedans and off-road vehicles. They then get frustrated that they can't past cyclists in them and resort to dangerous overtakes.

Chuchote

irishrover99 wrote: »

I can believe that as i was one of them myself but most of the road deaths we hear about these days are people out proper cycling or commuting. Maybe kids been killed is not reported as much but i haven't heard of one lately

As far as I know, all the recent cycling deaths were from being hit by cars or trucks; one was a little lad crossing a junction on his cycle to school; a couple were women who were hit by turning trucks.

doozerie

Lumen wrote: »

South Dublin is the worst place in Dublin to cycle, IMO. Entitled impatient b'stards the lot of them.

Get off my Internet you ruffian, you are rather impeding one's ability to post promptly.

PokeHerKing

Yeah my take on it would be it can't hurt to wear one! While still obviously understanding that similar to a seatbelt there will be certain accidents were it won't make a blind bit of difference if you're wearing a helmet or not!

doozerie

irishrover99 wrote: »

Would a wealthy person who could afford really top end bike just cycle around Foxrock or Castleknock.

I can't see why not. It wouldn't be my choice, but it is a valid one.

Dermot Illogical

PokeHerKing wrote: »

I was more interested to know why people who would be avid cyclists would be arguing against wearing one?

Just to be clear, I would never argue against wearing one. I'm arguing against anyone who tries to force me to wear one.

I learned to cycle before helmets existed. We survived.

One thing you'll never see me without is gloves though. They are much more awesome. Keep your hands warm, give you somewhere to wipe your snot, and will potentially save you from the pain of trying to comfortably use bathrooms while suffering from road rash. Proper useful.

doozerie

PokeHerKing wrote: »

Yeah my take on it would be it can't hurt to wear one!

It actually can, as addressed at various points during the thread.

Personally I wouldn't use that as a basis for arguing that no-one should wear one, but when making a decision as to whether you want to wear one or not it's good to weigh up all the facts on both sides of the argument. It's very easy to dismiss genuine facts and concerns if we perceive them as being counter to (our own version of) common sense, we all do it but it's a lazy trap that we'd all benefit from working harder to avoid.