Greater Greater Washington

Bicycling


Feds will stop hyping effectiveness of bike helmets

Two federal government agencies will withdraw their longstanding claims that bicycle helmets reduce the risk of a head injury by 85%. The decision comes in response to a petition the Washington Area Bicyclists Association (WABA) filed under the federal Data Quality Act.


Photo by dno1967b on Flickr.

In 1989, a study in Seattle estimated that helmets prevent 85% of head injuries. Later efforts to replicate those results found a weaker connection between helmets and head injuries, but public health advocates, government web sites, and the news media often present it as fact.

Bad information can cause problems, even when it is promoted with the best intentions. If people think that helmets stop almost all head injuries, consumers will not demand better helmets, and legislators may feel it makes sense to require everyone to wear one. WABA asked two federal agencies to correct the misinformation, and after a lengthy process, they've agreed to do so.

How effective are bicycle helmets?

In theory, helmets should absorb the shock from a crash. If your head strikes the ground or a vehicle, your brain could be seriously shaken by the sudden deceleration. With a helmet, the foam around your head forms a cushion.

They can also prevent head fractures by spreading the force of the impact. It's like the difference between being hit on the head by a rock or a beach ball with the same weight.

It's hard to tell how often helmets actually prevent head injuries, however. Experiments on people are unethical, so instead researchers collect hospital data on people involved in bicycle crashes.

In 1989, a team of researchers led by Dr. Robert S. Thompson, a preventative care specialist at the Group Health Cooperative of Puget Sound, collected data about cyclists in Seattle who went to area hospitals after a crash. Only 7% of the cyclists with head injuries wore helmets, but 24% of those without head injuries did wear helmets. Their statistical analysis, which was published in the New England Journal of Medicine, estimated that helmets had reduced the risk of a head injury by 85%.

Dr. Thompson's study was a "case-control study" like those that first found a link between smoking and cancer. There is no true "control" group, but epidemiologists say these studies are good for showing whether something has a good or bad effect on health, though not for quantifying it.

Dozens of researchers sought to replicate the Thompson findings in their own communities. They also found that helmets reduce the risk of head injuries, but less frequently than Thompson's team found. Some studies even found that helmets increase the risk of neck injuries. If you consider the entire body of research rather than just one study, and look at both head and neck injuries, helmets only reduce the risk of injury by about 15% to 45% .

Nonetheless, public health advocates seized on the 85% estimate as a good way to communicate risk: failing to wear a helmet makes you more than 6 times as likely to experience a head injury. Government websites and newspapers have repeated it to the point where it has become ubiquitous in discussions about bicycle helmets.

Misinformation encourages helmet laws, discourages better helmets

Bicycle safety is one of WABA's central missions. It requires helmets on all rides that it organizes, and it sponsors the Bicycle Helmet Safety Institute, an independently-funded organization that reviews bicycle helmets and encourages improvements in their design. In the 1990's, WABA supported proposals to require children under the age of 16 to wear bicycle helmets, which eventually became law.

But WABA draws the line at laws requiring adults to wear helmets. Such laws do little to promote safety, but they discourage bike sharing and other uses of bicycles for short trips.

This year, WABA fought hard against a bill in the Maryland General Assembly that would have required all adults to wear bicycle helmets on any trip, no matter how short. The Maryland Department of Transportation supported the mandatory helmet bill, citing the 85% estimate, while an article about it in the Washington Post cited a figure from the Centers for Disease Control (CDC) that helmets prevent 80% of head injuries. Fortunately, objections from cyclists persuaded the bill's sponsor not to move forward with it.

Recently, most helmet research has focused on making helmets cool, rather than more protective. Better ventilation and more fashionable designs might encourage more people to buy and wear helmets, but it does not make them safer. Could that be because everyone is assuming that helmets are already 85% effective? Would that change if people thought helmets were less than 50% effective?

WABA pushed agencies to correct the misinformation

Last February, I sent emails to both CDC and NHTSA, pointing out that the 85% estimate is incorrect and providing citations to newer research. Laurie Beck, an epidemiologist from CDC promised to remove the error.

Meanwhile, NHTSA staff told me that they were too busy to discuss the matter, so we made a formal "request for correction" under the Data Quality Act, which requires information on federal web sites to be accurate and supported by appropriate research.

Two months later, NHTSA agreed to remove the 85% estimate from its website. We expect other agencies to follow the lead of NHTSA and CDC, though some may need some encouragement.

This probably won't be the last we hear this factoid. Some nongovernmental public health advocates have ignored the results of the last 20 years of research and won't correct their stump speeches simply because the federal government removes an outdated estimate from its websites.

Will NHTSA step forward? The agency funds a lot of data collection efforts, and it clearly seems to think that the public needs to know how effective helmets are. Now that it concedes that it has been propagating the wrong answer for all these years, will it fund the research needed to provide the correct answer?

A version of this post is cross-posted at WABA Quick Release.

Jim Titus lived aboard a 75-foot coast guard cutter at Buzzards Point boatyard in southwest Washington until he was 2. Since then he has lived in Prince George's County, going to school in Ft. Washington, Accokeek, and College Park before moving to Glenn Dale. He represents Prince George's on the state of Maryland's Bicycle and Pedestrian Advisory Committee, and is on the board of directors of the Washington Area Bicyclist Association. Professionally, he works for a federal agency, which asks not to be identified. 

Comments

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People were probably making similar arguments in regard to safety belts in cars half a century ago.

by Ron on Jun 4, 2013 10:51 am • linkreport

"People were probably making similar arguments in regard to safety belts in cars half a century ago. "

what, that they discouraged driving and so led to more obesity, cause driving is good exercise?

by AWalkerInTheCity on Jun 4, 2013 10:53 am • linkreport

pardon - "That laws mandating them discouraged driving ...."

by AWalkerInTheCity on Jun 4, 2013 10:54 am • linkreport

Your triump is that the study you cite suggests helmets are40 percent effective. And that the earlier results of 65% were just misleading everybody? Wow. By the way, i'm a WABA member and i support helmet laws - because i've also worked in an emergency room....

by Tom M on Jun 4, 2013 10:58 am • linkreport

Hear hear. Rather than focusing on helmets, people should focus on traffic safety in general. You want to prevent people from needing a helmet.

by Jasper on Jun 4, 2013 11:01 am • linkreport

I don't understand what the length of the trip has to do with the prudence of wearing a helmet.

by jmc on Jun 4, 2013 11:02 am • linkreport

@Tom M
First, it's 85% (NHTSA claim) vs ????%. The studies cited by WABA show: "Helmets reduce head injuries by 25–55%, but because of the increased risk in neck injuries, the combined reduction in head and neck injuries is only 2–26%."

By the way, i'm a WABA member and i support helmet laws - because i've also worked in an emergency room....
If you are a cyclist then you should know about how mandatory helmet laws reduce bicycling and may actually make cyclists less safe overall. As a health professional surely you are aware of how focusing narrowly on one single health outcome can mean ignoring the secondary detrimental effects that could have on other health outcomes.

by MLD on Jun 4, 2013 11:07 am • linkreport

@TomM: The statistics are provided in greater detail in WABA's request for correction and the longer article on the WABA blog from which this post was drawn.

Basically, helmets appear to reduce head injuries by 35-65%, and the net reduction in injuries is on the order of 15 to 40%.

These are huge diferences: If helmets are 85% effective, then biking without a helmet increased the risk of injury by 566%. If helmets are 25% effective, then biking without a helmet increases the risk of injury by only 33%. Can you see how a rational person might make different decisions with those alternative pieces of information?

by JimT on Jun 4, 2013 11:13 am • linkreport

PS: I see MLD addresed the numbers. Differences in what he and I say are a function of whether you relay on the most comprehensive meta assessment (numbers MLD cites) or do a rough ad hoc combinatio of the two meta assessments (which I did). But the points are the same.

by JimT on Jun 4, 2013 11:15 am • linkreport

Do you guys bike without a helmet? I don't because I've a) seen the impacts of head injuries due to not wearing helmets and b) i've been saved from head injuries due to wearing a helmet. I do not, as a health professional, suggest that more inexperienced bike riders NOT use helmets. I do not believe that more people riding without helmets would "increase safety" as you suggest. So i believe a rational person would ride with a helmet.

by Tom M on Jun 4, 2013 11:18 am • linkreport

Congratulations!

by Miriam on Jun 4, 2013 11:19 am • linkreport

I am going to be foolish and ignore the #1 rule of internet cycling discussion: do not get into an argument about helmets.

I had to dig in to your studies to find this, but:
"This formal summarisation of studies of individual cyclists in various settings has confirmed the clear benefits of helmets in terms of injury risk. The upper bounds of the 95% confidence intervals provide conservative risk reduction estimates of at least 45% for head injury, 33% for brain injury, 27% for facial injury and 29% for fatal injury."

How hard was that? You have the data and the studies. You do too good of a job of tearing down the 85% without replacing it. It leaves the impression that helmets are not effective for physical protection when that is clearly not the case. Helmets protect the rider in a crash, period. And for that reason, I will wear one whenever possible (though I'll ride CaBi without one and not go crazy about it either).

The largest issue is that the safety issue starts conflating all sorts of issues. Physical safety in a crash, avoiding crashes (i.e. behavioral issues by cyclists and drivers), and health issues (e.g. obesity). Yes, they are related, but they can be addressed separately as well. Those are secondary issues about crash avoidance and overall health.

Don't get me wrong, for those secondary reasons I do oppose mandatory helmet laws. But I'm sure as heck going to wear one whenever possible for my own personal protection.

by Brian S on Jun 4, 2013 11:22 am • linkreport

@Tom M
Do you guys bike without a helmet? I don't because I've a) seen the impacts of head injuries due to not wearing helmets and b) i've been saved from head injuries due to wearing a helmet. I do not, as a health professional, suggest that more inexperienced bike riders NOT use helmets. I do not believe that more people riding without helmets would "increase safety" as you suggest. So i believe a rational person would ride with a helmet.

That's fine and is a separate argument from arguing for a helmet law. People should wear helmets, and the data shows that most people do. I usually wear a helmet and most of the other bicyclists I see on my way to work are wearing them. But we shouldn't mandate them because that leads to less bicycling and actually probably makes bicycling less safe.

The problem is that bogus stats like "85% effective" lead misinformed politicians and the public to advocate for helmet laws when helmet laws are not a good idea. Nobody is advocating that more people should ride without helmets.

by MLD on Jun 4, 2013 11:24 am • linkreport

Also I'm not sure why this was edited from the WashCycle/WABA version I read to exclude the actual data about helmet effectiveness. As we can see already from a few posts people are just assuming Jim is complaining without providing contrary data.

by MLD on Jun 4, 2013 11:26 am • linkreport

" I do not believe that more people riding without helmets would "increase safety" as you suggest. So i believe a rational person would ride with a helmet. "

for an individual to ride with a helmet is clearly safer than to ride without one.

That is true because A. not riding at all is not presented as an option, ergo the health benefits of riding vs not riding do not effect the choice B. We are talking of one individual, therefore the critical mass effects do not effect the choice.

In the real world laws to mandate bike helmets, and even the alleged tendency to overestimate how dangerous biking is, DO discourage biking, resulting in A. less exercise, more obesity and worse health outcomes ( both via obesity and other pathways) B. MORE accidents, due to critical mass effects.

by AWalkerInTheCity on Jun 4, 2013 11:31 am • linkreport

Again, even if US cities were like Copenhagen or Amsterdam and cyclists here had protected, dedicated bike lanes, there are still many reasons why a cyclist can crash-- and why a cyclist should wear a helmet. Equipment failure, wet pavement, distractions, rider inexperience are all potential causes of crashes.

Even if bike helmets are not completely effective, when you're going 12-20 mph from four or five feet above the asphalt, I would rather make sure my brain has an extra bit of protection.

by 202_cyclist on Jun 4, 2013 11:31 am • linkreport

You might want to note that the Bicycle Helmet Safety Institute still says that helmets "can prevent up to 88 per cent of cyclists' brain injuries."

by Gavin on Jun 4, 2013 11:32 am • linkreport

Now if we could mandate wearing a helmet while sitting on your sofa, watching TV, and eating junk food, THAT would almost certainly result in better health outcomes.

by AWalkerInTheCity on Jun 4, 2013 11:32 am • linkreport

"Even if bike helmets are not completely effective, when you're going 12-20 mph from four or five feet above the asphalt, I would rather make sure my brain has an extra bit of protection"

Who here is suggesting you avoid wearing a helmet?

by AWalkerInTheCity on Jun 4, 2013 11:33 am • linkreport

@Brian S: Please see today's Washington Post or the longer WABA article which provide esimates of helmet effectiveness.

I agree that something needs to replace it, and if you look at WABA's request for correction, that is what we asked NHTSA to do. So far, however, they are declining to do so. I have no idea why.

by JimT on Jun 4, 2013 11:34 am • linkreport

@MLD...now that I look at other sources, you are right. The Washington Post has a very balanced article on the issue that takes into account Jim's broader position. This GGWash article is lessened by omitting some of that information.

by Brian S on Jun 4, 2013 11:35 am • linkreport

@TomM: The other day, I drove my car and parked about 1.5 miles from my office, where I can park for free, loaded up my backpack and road to my office. Then after going about half way, I realized I had left the helmet in the car.

I continued to work without the helmet, and road back to my car later.

Had there been a law requiring a helmet, I would have walked my bike back to my car and arrived at work about 20 minutes later.

by JimT on Jun 4, 2013 11:37 am • linkreport

@AWalkerIntheCity:

Responses such as this make it appear that wearing a bike helmet while cycling where there are many potential hazards is silly and ridiculous.

"Now if we could mandate wearing a helmet while sitting on your sofa, watching TV, and eating junk food, THAT would almost certainly result in better health outcomes."

Again, if you fall off of a bike going 15 mph and hit hard concrete or asphalt, would you rather have more protection for your brain (a normal, functioning brain is essential for almost every life function) or less protection?

by 202_cyclist on Jun 4, 2013 11:40 am • linkreport

@JimT:

I don't think anybody here is advocating mandatory helmet usage but the comments dismissing helmets as providing no additional protection are foolish and irresponsible.

by 202_cyclist on Jun 4, 2013 11:42 am • linkreport

I want more protection, ceteris paribas.

But ceteris is NOT always paribas. Sometimes the choice is biking without a helmet, or not biking at all.

How do you feel about laws mandating sun block use while biking? Do you think we need a safety campaign to discourage people from biking without sunblock?

The point of my response is that you cannot look at the impact of either helmet laws, or even of helmet "hype" WITHOUT looking at the impact of discouraging the activity. CVD is a much bigger health problem in the US than head injuries to cyclists. I say that as a regular helmet user.

by AWalkerInTheCity on Jun 4, 2013 11:44 am • linkreport

"I don't think anybody here is advocating mandatory helmet usage but the comments dismissing helmets as providing no additional protection are foolish and irresponsible"

who here as dismissed helmets as providing no additional protection? certainly not me - I bike regularly, and I cannot remember the last time I rode without a helmet.

The context here is A. Serious legislative proposals for mandatory helmet laws B. resistance to bike share, because of the frequency with which bike share users do not wear helmets C. Large numbers of people who do not bike, or who limit their biking, because of their perceptions about bike safety.

Those are important issues.

by AWalkerInTheCity on Jun 4, 2013 11:47 am • linkreport

TomM,

i support helmet laws - because i've also worked in an emergency room..

Have you ever had a pedestrian or motorist admitted with a head injury? Do you support mandatory use of walking or motoring helmets?

by David C on Jun 4, 2013 11:48 am • linkreport

It's a tradeoff between two different kinds of safety. Biking without a helmet is less safe than biking with one for reasons I think most cyclists understand. But prevention/reduction of injuries in a collision is just one part of the safety factor, which also involves preventing and reducing the severity of the collisions themselves.

This is where the safety-in-numbers effect comes into play. Speaking cynically, a biking route is still safer for me as a helmet user if there are other, helmetless riders. Doesn't make an accident any better for them but both of us being on the road makes that accident less likely in the first place. (SEE- BIKESHARE, CAPITAL)

The one thing that really encourages helmet use is bicycle use. If people are using their bikes more they will take greater steps not to be left without a helmet, especially after they discover which trips are most common for them, and ESPECIALLY after they start hearing of other accidents cyclists have suffered.

Encouraging new bikers is overall a much more effective safety project than a mandatory helmet law for current cyclists.

by Pennsy on Jun 4, 2013 12:13 pm • linkreport

The discussion about whether bike helmets should be improved is the more interesting part of the original posting (and the one being ignored in the comments). Helmets prevent some head injuries, better helmets could prevent more.

I ride a motorcycle, and ride only with a full helmet (i.e. full-face, not one of those silly beanies) because motorcycle crash research (see the aptly-named "Hurt Report") seems unambiguous about how something like 60 percent or more of all impacts to the head are to the face--especially the lower face area, i.e. people have their teeth/jaws smashed in or even ripped off. It's also rather unambiguous that motorcycle helmets do save many lives and help prevent brain damage.

Assuming the mechanics of bike crashes are similar to motorbike crashes save for lower average speeds (force of gravity and the fall to the ground is the same on a bike or motorbike), I marvel at how ridiculous and inadequate typical bike helmets seem, sitting like a giant mushroom on top of someone's head, held on by those thin straps.

Maybe more would wear bike helmets if they looked something like a well-ventilated version of this ski helmet!?: http://www.ruroc.com/rg-1-helmets/14-rg-1-core.html

by boris on Jun 4, 2013 12:26 pm • linkreport

As a health professional surely you are aware of how focusing narrowly on one single health outcome can mean ignoring the secondary detrimental effects that could have on other health outcomes.

Probably not, given that most ER staff are not epidemiologists and generally react to traumatic injuries in the same way that laymen do--non-analytically. If I saw car crash victims at work every evening, I'd probably be a staunch advocate for mandatory helmets for car passengers.

by oboe on Jun 4, 2013 12:32 pm • linkreport

boris

A cyclist goes under their own power, unlike a motorcyclist, and needs to go uphill frequently, unlike a skier (I am waiting for the cyclist J-bar so i can only bike downhill). So weight has to be a consideration in bike helmet design.

by AWalkerInTheCity on Jun 4, 2013 12:32 pm • linkreport

but the comments dismissing helmets as providing no additional protection are foolish and irresponsible

I haven't seen those comments in here.

The problem with advertising the 85% stat is that it's encouraging us to sell helmets as a panacea, rather than researching/developing more effective approaches toward bicycle safety. (The neck injury stat is especially alarming, and we should probably be rethinking helmet design as a result)

Nobody is saying that helmet usage is bad or ineffective. However, failing to wear a helmet is also not necessarily the borderline-suicidal risk that many have made it out to be, especially in a low-speed urban setting.

You should wear a helmet if you have access to one. Politicians and policymakers should also work with accurate data.

by andrew on Jun 4, 2013 12:43 pm • linkreport

Walker,

I get that, I just wanted to throw that out there for the sake of discussion about how good bicycle helmets really are.

Actually, when peddling around the city I never really wear a helmet, partly because I am vain and they look so pathetic, and yes, I'm aware of how inconsistent/irrational that is.

by boris on Jun 4, 2013 12:44 pm • linkreport

From what I have seen in the studies, there are numerous methodological problems that make conclusions difficult to draw. Small numbers, self reporting bias, different populations. There is also a pervasive paradigm about helmets that people want to fit the data into, ignoring other facts.

The June Bicycling mag article is very good shows that most helmets are not very effective at most injuries. If that is true, then it tends to contradict the dominant paradigm of helmets being very effective. It also raises an important questions: because we have assumed helmets are effective, the research and marketing have not improved helmets, thus undermining safety.

by SJE on Jun 4, 2013 2:31 pm • linkreport

Dr. Thompson's study was a "case-control study" like those that found the link between smoking and cancer. There is no true "control" group, but epidemiologists say they're a good way to show whether something has a good or bad effect on health without quantifying it.

Card-carrying epidemiologist (and cyclist) here. The way you've described the research methods here makes case-control studies sound pretty weak. First, case-control studies do have control groups (hence the name case-control). In this study, the cases were cyclists who came into an ER with a head injury. There were two control groups, one of which included cyclists who came into the same ER with non-head injuries. Helmet use during the crash was then compared in each group. Second, case-control studies *do* quantify the effect on the health outcome (that's what the 85% is). We typically use something called an odds ratio to do it -- in this case, the 85% is comparing the odds of helmet use among those with head injuries to the odds of helmet use among those with other injuries. Given certain assumptions, this ratio of odds can be interpreted as the relative difference in risk between helmet wearers and non-wearers.

Overall, it was a well-designed study. I think its biggest limitation (now) is that the data are over 20 years old. Who was wearing helmets 20 years ago? If the most cautious cyclists were the predominant helmet-wearers (I could be wrong), then anyone you compare to them is going to look relatively risky.

by Sara on Jun 4, 2013 2:34 pm • linkreport

I'm glad that this is really about getting good numbers, which may in turn result in better analysis of the relation ship of those numbers. I'm neither an ER doc nor epidemiologist, but I bike in the city a fair bit (usually, but not always helmeted). The gear I think could get more praise would be gloves, since the couple times I've fallen, I instinctively knew that if my hands hit the street first, I'd be ok. I know that not a whole lot of physics calculations occur while on trajectory, but bring on the larger, more recent and more sophisicated studies.

by Lisa Swanson on Jun 4, 2013 2:59 pm • linkreport

On the issue of the safety impact of bicycle helmets, a recent article in Bicycling magazine looked at efforts to develop bicycle helmets that do a better job of preventing concussions, and the obstacles such efforts face:

http://www.bicycling.com/senseless/.

One of the obstacles is the result of the Consumer Product Safety Commission's adoption of a standard for bike helmet quality back in 1999. The problem is that it is difficult for the CPSC to amend that standard to reflect marginal design improvements, because government regulations must generally be supported by a cost-benefit analysis, and it is difficult to quantify the benefits of reducing the incidence of concussions. And liability concerns make it tricky for manufacturers to tout new helmet designs as improving safety. So why would people buy a better-designed but more expensive helmet if the cheaper helmets also meet the (old, unchanged to reflect recent research) safety standard?

by Black Jack on Jun 4, 2013 3:02 pm • linkreport

If you think helmets increase neck injuries, come out and say so. If you think helmets decrease riding, why not give away helmets?

by Johan on Jun 4, 2013 3:19 pm • linkreport

My sister, a neurologist convinced me to wear a helmet when she said that she's the one who gets called to declare people brain dead. You do what you want.

In my view, though, the debate should not focus on serious fatal incidents, but on minor injuries. I have bonked and scuffed some helmets in my 20 years riding, but my bald head is as pretty as ever. If you're vain about your hairstyle getting mussed by a helmet, you aren't going to be styling with a bald patch and some scars.

by mtp on Jun 4, 2013 3:20 pm • linkreport

@Sara:
As other commenters have pointed out, there were a few editing snags--the check the longer version on the WABA site which should clear up the second-half of what you say.

I'd love to have your perspectives on what we said in the actual request for correction, if you have time to read it and either post comments here or email them to me.

The reason to say that case-control studies are not so good at quantifying effects is discussed in some detail in that petition, but I'll summarize here.

Most important, there is not really a randomly selected control against which the case population is compared. The mere fact that a group of people that did not get a head injury is called a "control" does not make it a true control. There is no reason to believe that the case and control populations would have been the same but for their different helmet-wearing and head-injury experience.

The validity of the quantification from a case-control study depends on the helmet-wearing proportion of the non-injured "control" being the same as that of the underlying population. This should be true with a rare ailment like head injuries--but amng those who went to the hospital it was not a rare ailment at all. The assmption that the "control" is like the true unerlying population tends to be assumed rather than tested--often there is no good data to allow one to estimate the proportion of people who wear a helmet.

If the actual propensity to wear a helmet was greater among the people who went to the hospital without a head injury, than within the total population,then the results overstate the case. I think that is somewhat similar to the point you are making.

The problem here was not with the Thompson study but with those who used it for more than it was meant to me. No doubt the Thompson study was the best to the bunch--did we mention that it was published in the New England Journal of Medicine? But a single study is just a single study, and to hype a single study of one city as if it provided the universal answer--when there was an entire suite of studies giving a lower estimate--demonstrated governmental bias at its worst.

by JimT on Jun 4, 2013 3:24 pm • linkreport

How do you feel about laws mandating sun block use while biking? Do you think we need a safety campaign to discourage people from biking without sunblock?

I find your comments dismissing sunblock as providing no additional protection to be foolish and irresponsible.

by oboe on Jun 4, 2013 3:25 pm • linkreport

Why not instead help to design better helmets which address the shortcomings, and make them free for qualified low income riders? In Sweden, they have created a totally new inflatable helmet (Hövding) that only appears around the neck until deployed. Here we rationalize not using them.

by Johan on Jun 4, 2013 3:31 pm • linkreport

Big difference between correcting government information and killing helmet laws...

by Johan on Jun 4, 2013 3:32 pm • linkreport

There's a couple of things that I think could use more study-- the correlation between cyclist speed and head injuries (with and without a helmet), and the trade off between improved health through riding that may compensate for any new risk associated with riding (with or without helmets).

by Mark on Jun 4, 2013 3:40 pm • linkreport

Since some are linking to the June Bicycling article, it's worth linking to the BHSI response noting all the misinformation in that article: http://www.bhsi.org/bicyclingmag1305.htm

On the larger issue, I like the perspective of the WABA release that overhyping helmet quality reduces interest in R&D to improve helmet safety. Also, much of the discussion against mandatory helmet laws points to the lack of helmet usage on bikeshare systems and the safety benefits of having more riders. It seems like a new type of helmet that could be sanitarily distributed and returned to bike rental stations would keep ridership high and increase helmet usage.

by Dan H on Jun 4, 2013 4:06 pm • linkreport

If you think helmets decrease riding, why not give away helmets?

Part of the reason that helmets decrease riding is thought to be that they make cycling look dangerous. So giving helmets away doesn't solve that. But you can get free or cheap helmets from many many locations. DDOT and MPD used to give them away for example.

by David C on Jun 4, 2013 4:06 pm • linkreport

mtp, do you wear a helmet in a car or when walking? Does your sister ever declare motorists or pedestrians brain dead?

by David C on Jun 4, 2013 4:08 pm • linkreport

"My sister, a neurologist convinced me to wear a helmet when she said that she's the one who gets called to declare people brain dead. You do what you want. "

we dont do what we want. I want to bike in a fairfax county that has so many cyclists that drivers are used to seeing them, and where the county can clearly see the benefit to more biking infrastructure, and where there are laws to keep biking safer. We do not have any of those three, in large part because we do not have enough cyclists. While there are many reasons for that, to the extent an exaggerated perception of the dangers of cycling plays into that, that perception is itself a danger.

by AWalkerInTheCity on Jun 4, 2013 4:17 pm • linkreport

"Here we rationalize not using them."

No. We. Don't.

We merely want the facts correctly known so that A. We don't have laws that MANDATE helmet use, with resultant negative consequences FOR SAFETY AND HEALTH B. People do not misperceive the safety of cycling

by AWalkerInTheCity on Jun 4, 2013 4:19 pm • linkreport

@David C "Part of the reason that helmets decrease riding is thought to be that they make cycling look dangerous."

I've heard this several places, but is there ANY evidence supporting the idea that more bikers wearing helmets leads to fewer total bikers because it makes cycling look dangerous? That's like saying the more people wearing seat belts leads to less driving because it makes driving look dangerous or more people wearing life preservers leads to less boating because it makes boating look dangerous.

There is evidence that REQUIRING everyone to wear helmets leads to fewer bikers, but that seems more related to convenience and fashion rather than the perceived danger of biking.

by Dan H on Jun 4, 2013 4:27 pm • linkreport

There is evidence that REQUIRING everyone to wear helmets leads to fewer bikers, but that seems more related to convenience and fashion rather than the perceived danger of biking.

I think that's what David C is getting at, which is that requiring helmets means people perceive cycling as extra dangerous because, "gee, the government MAKES you wear a helmet!"

I do think emphasizing helmets too much makes bicycling look dangerous to people who do not bike. And even people who do bike mis-perceive the dangers of cycling, especially what types of crashes are common and how to prevent them.

by MLD on Jun 4, 2013 4:34 pm • linkreport

what MLD said

I dont think its a problem that riders like me WEAR helmets. Its the constant focus on helmets. Whenever theres a bike accident the press always focused on if they rider had a helmet - not if they were riding correctly, not if they had appropriate lights, etc, etc.

I am reminded of the old joke - some guys are shooting up drugs, and someone asks them if they worried about AIDS? "Oh, we're safe, we're wearing condoms"

by AWalkerInTheCity on Jun 4, 2013 4:39 pm • linkreport

@MLD, David C was responding to the proposal of giving away helmets. That is, simply increasing helmet usage without a mandate will scare people away from biking by making it seem more dangerous. That you then say "emphasizing helmets too much makes bicycling look dangerous," is the exact same statement that is also unsupported by any data I've seen.

The focus after bike accidents that try to figure out what the biker did wrong, is a problem that goes well beyond helmet usage.

It's also worth noting that road biking in much of the D.C. area IS dangerous. People legitimately say they don't want to bike if it means sharing a lane with cars on a 35mph road. When I see a biker doing this, I don't look at their head & say "ooh, they have a helmet, therefore it must be dangerous." Having fewer people wear helmets won't make it suddenly seem safer. Awareness of danger does discourage biking, but the solution is more bike safety education, more bike friendly roads designs, and better ways for bikers to protect themselves if they do get in an accident.

by Dan H on Jun 4, 2013 5:00 pm • linkreport

i will let Dave C speak for himself. I am all for bike helmet giveaways, (i really didnt read him as opposing them) - I think they will be limited because of $$. But they dont address the misleading perceptions that come from bad data, and from "hype"

How dangerous driving on a 35 MPH road is is debatable. Is it more dangerous than lots of things people do without helmets? is it more dangerous than riding on any speed road without sunblock? Is it more dangerous than a sedentary lifestyle?

And to get more bike wonky, is the increased danger on a faster road the kind of danger that is addressed by helmets?

by AWalkerInTheCity on Jun 4, 2013 5:06 pm • linkreport

"The focus after bike accidents that try to figure out what the biker did wrong, is a problem that goes well beyond helmet usage."

yes, but the reflexive focus on helmet usage is part of the problem.

by AWalkerInTheCity on Jun 4, 2013 5:07 pm • linkreport

let me ask everyone this

do you think the benefits of wearing helmets are such that its a GOOD thing to have false data out there? Would it be better to tell everyone that helmets prevent 95% of head injuries, because wearing a helmet is a good thing?

by AWalkerInTheCity on Jun 4, 2013 5:08 pm • linkreport

I crashed on my bike near Mt vernon, head went thud... the helmet took all the impact and I was fine.

So I'm not sure what the point is of challenging the study with comments like "It's hard to tell how often helmets actually prevent head injuries, however."

by polo on Jun 4, 2013 5:12 pm • linkreport

There is evidence that REQUIRING everyone to wear helmets leads to fewer bikers, but that seems more related to convenience and fashion rather than the perceived danger of biking.

In a jurisdiction where it's illegal to ride a bike without a helmet, someone who finds themselves out and about without a helmet will likely be dissuaded from riding a bike. This is particularly relevant in the case of bikeshare. And it goes beyond "convenience" or fashion.

by oboe on Jun 4, 2013 5:13 pm • linkreport

It's also worth noting that road biking in much of the D.C. area IS dangerous. People legitimately say they don't want to bike if it means sharing a lane with cars on a 35mph road.

Sorry, but this ain't particularly dangerous. It may *feel* dangerous, but hundreds of area residents doing just this perfectly safely shows it's not dangerous.

by oboe on Jun 4, 2013 5:15 pm • linkreport

@polo,

I crashed on my bike near Mt vernon, head went thud... the helmet took all the impact and I was fine.
So I'm not sure what the point is of challenging the study with comments like "It's hard to tell how often helmets actually prevent head injuries, however."

I crashed my bike a month or so ago. Wasn't wearing a helmet, and was perfectly fine. (Had my only bad wreck in 15 years a couple of weeks ago, and was wearing a helmet. Was also perfectly fine.)

I'm not sure what your point is.

by oboe on Jun 4, 2013 5:18 pm • linkreport

"So I'm not sure what the point is of challenging the study with comments like "It's hard to tell how often helmets actually prevent head injuries, however.""

that was a way to introduce the study, to show that you can't use physics to determine the actual benefits of helmet use, and you can't use an actual experiment, so we are left with some very iffy epidemeological approaches. Which conflict, and the more recent studies indicate something less than 85%, but the 85% is still widely cited.

And the amount MATTERs because we have policy decisions to make. No one is saying you shouldnt choose to wear a helmet (I wear one) but that policies that either mandate wearing them, or that limit bike share, are net BAD for safety.

by AWalkerInTheCity on Jun 4, 2013 5:19 pm • linkreport

Yes, if I biker can't travel at a speed that is reasonably close the cars in the same lane, I think it is more dangerous than riding without sunblock and more dangerous than getting one's exercise separately from one's commute.

That many people do it doesn't make it safe. oboe's comment that hundreds are doing it therefore it it's not dangerous denies the data. First, the people biking on many roads have enough experience and strength to maintain a safer speed and know which situations to avoid. A novice or beginner biker (which is what the fear of danger discussion is focused on) does not have that experience and speed.

This also depends on the road. On my commute, there is a 1.5 mile stretch where even people who seem very experienced chose the sidewalk over the road.

In general, I'm all for more accurate presenting of data and actual risks. The helmet arithmatic is very simple. Safety-focused bikers rarely get in accidents, but they do get in accidents a non-trivial number of times. A fraction of those who get in accidents hit their heads. Those who hit their heads are much less likely to have serious injuries if they were wearing a helmet. It's not a panicked story, but it shows the real benefits of helmet wearing.

What perplexes me is that some of the same people complaining about overhyping the helmet safety data are clinging to unsupported statements about helmet usage increasing fear.

by Dan H on Jun 4, 2013 5:25 pm • linkreport

This may be getting into the weeds, but in the petition itself we lay out a chronology that seems to give rise to the inference that NHTSA (or someone providing NHTSA technical advice) came to treat the helmet information as more of a propaganda tool than pure public information: Rather than lower the estimate, they started saying "up to 85%" following the lead of a pediatrics report. What is "up to 85%" if not propaganda.

They are similarly resistant to withdrawing the claim that helmets are the most effective way to avoid a head injury while conceding they have no study to back it up.

Thanks to several of you who pick up on the idea that this little project has been about the government providing the accurate story. Thanks also to commenters here and on Washcycle who helped get me up to speed last winter.

by JimT on Jun 4, 2013 5:40 pm • linkreport

@DanH: This may not be fully satisfying, but in the petition we distinguish government agencies from advocates. If public health advocates want to hype high estimates like 85% that's one thing. Often they feel that a sBut government agencies and the new media need to provide the straight scoop

by JimT on Jun 4, 2013 5:48 pm • linkreport

Sorry I wanted to say that public health advocates may feel that caveats present a mixed message that makes it harder to convey their key message. But government agencies have the duty to be accurate and unbiased even if the truth is itself a mixed message. One hopes that the media will follow the government

by JimT on Jun 4, 2013 5:50 pm • linkreport

...and report what we actually know rather than exaggerated claims, but may be difficult until the government really puts out the best estimate it can. Early indications are that it won't, and we will be left with 85% out there, but with a caveat. As distasteful as it may be to push an alternative factoid that better represents the studies but is also flawed, doing so may get people closer to the state of knowledge than leaving 85% out there alone.

by JimT on Jun 4, 2013 6:00 pm • linkreport

I've heard this several places, but is there ANY evidence supporting the idea that more bikers wearing helmets leads to fewer total bikers because it makes cycling look dangerous?

Well, that wasn't was I was talking about. I was talking about helmet laws or aggressive helmet promotion. There may be some relationship between people wearing helmets and others finding the activity dangerous, but I don't know of any data to support or deny it.

There is evidence that REQUIRING everyone to wear helmets leads to fewer bikers, but that seems more related to convenience and fashion rather than the perceived danger of biking.

Perhaps, but it's reasonable to hypothesize that perceived danger is also a factor.

Those who hit their heads are much less likely to have serious injuries if they were wearing a helmet.

Well, I think that is the fact that we're still trying to establish. I don't think we can say that 100% confidence right now.

by David C on Jun 4, 2013 9:28 pm • linkreport

Remember all those people who quit driving because of seat belt laws and everyone went to mass transit which brought car sales to almost zero? Neither do I.

by Someone on Jun 4, 2013 9:35 pm • linkreport

Someone, that's totally different. Cars come with seatbelts, so there's no inconvenience issue. Nor does it make driving less pleasant. Nor do most people have an alternative to driving.

On the other hand we have many studies that show that bicycle use drops after mandatory helmet laws. So you're point is completely irrelevant and not nearly as clever as you think it is.

by David C on Jun 4, 2013 9:50 pm • linkreport

@Someone: I think that you are trying to find something that drivers might do that would be analogous to requiring a cyclist to wear a helmet. That's hard to do.

Seatbelts are in the car and part of new equipment, but wearing seatbelts was never mandatory back when manufacturers did not have to provide them. But no one has discovered a way to safely design a helmet that is always with the bike.

Here are a few things that might be more analogous: Requiring passengers of all boats to wear life jackets, require pedestrians to wear bright reflective clothing at night, prohibit large loose items in passenger compartments of automobiles, require all school buses to be equipped with seatbelts and booster seats.

by Jim Titus on Jun 4, 2013 9:57 pm • linkreport

Jim, this is brilliant. I particularly like the way you framed the argument that overhyping the effectiveness of helmets takes away the pressure to improve designs.

This is real advocacy.

by contrarian on Jun 4, 2013 11:09 pm • linkreport

I love how people who can jump in a car without thinking about it every morning (the single most dangerous thing they will do in the course of a day) go into fits over the idea that someone might bike without a helmet. Doesn't matter where they're biking, how they're biking, or for how long they're biking, the mere idea that someone might do something so "stupid" and "dangerous" is beyond the pale. From the guy in the car, complacent because it's an accustomed and ignored risk. This is what needs to change in the helmet "debate".

by Mike on Jun 5, 2013 7:45 am • linkreport

Each year in the United States more than 900 bicyclists are killed, 20,000 are admitted to hospitals, and 580,000 receive emergency room treatment. For the population as a whole, there are approximately:
◦ 1.8 billion bicycle trips
◦ 300 injuries per million trips
◦ 1 death in every 2 million trips.

by Tom M on Jun 5, 2013 9:15 am • linkreport

"Yes, if I biker can't travel at a speed that is reasonably close the cars in the same lane, I think it is more dangerous than riding without sunblock"

I think thats dubious. First off most cycling accidents are at intersections, and do not involve following traffic in the same lane. Second, I dont think you are aware of how dangerous and common skin cancer is. Third, the cycling that will be discouraged is ALL cycling in roads, not just the handful of most dangerous ones.

" and more dangerous than getting one's exercise separately from one's commute. "

If you assume that they will get the same amount of cycling elsewhere. But IIUC studies have shown that making cycling (and walking) for transportation more viable, increases the total amount of exercise. It does not come at the expense of gym visits.

by AWalkerInTheCity on Jun 5, 2013 9:34 am • linkreport

I particularly like the way you framed the argument that overhyping the effectiveness of helmets takes away the pressure to improve designs

+1. Excellent work -- thanks for your advocacy.

by Bitter Brew on Jun 5, 2013 9:48 am • linkreport

TomM,

Actually, there haven't been 900 cycling deaths in a year since 1988. Last year there were 677. And according to NHTSA there are only about 50,000 injuries every year. So your numbers are way off. Where did you get them?

Also, I don't know what your point is.

by David C on Jun 5, 2013 10:04 am • linkreport

"580,000 receive emergency room treatment. "

I know one person personally who landed in an ER due to a bike accident, and several who have ended in an ER due to kitchen accidents.

The govt should mandate wearing gloves while using sharp kitchen knives.

especially while slicing bagels. Perhaps bagel slicers should me mandated in every household that buys lox.

by AWalkerInTheCity on Jun 5, 2013 10:10 am • linkreport

I think a lot of people are talking past each other here. I commute by bike. I get that overhyping risk is bad both because it can scare people and decrease the incentives for innovation and policy changes. I'm pushing back on the opposite extreme of people denying there are legitimate risks. This is also a bad way to promote increased biking.

When I say it's dangerous to ride slowly on a 35mph and have cars break and swerve around you, the statistics on injuries miss an obvious possibility. Most people who don't think they can safely ride in this situation don't. Therefore, they don't get hit by cars on those roads.

On one rode I usually take, I'd say over half the bikers I see are on the sidewalk rather than the road. This includes fit looking people who look like experienced bikers. Even with the risks of right turn swipes, we're all not delusional to look at this specific situation & say the sidewalk is still safer. Saying it's safe and not a reason to worry parallels the "helmets work and we don't need better helmets" argument quite well. If we want more people biking on busy arterial roads, we need to be comfortable saying it isn't safe for many and to advocate for more bike lanes or parallel trails.

The other denial of evidence that is running through many comments is the safety benefits of helmets. For example, I said what should be an obvious statement, that, when you have a bike accident and hit your head, helmets reduce injury. Despite many studies and personal examples, this shouldn't be debated, but David C directly denies this and many others downplay the fact (going to the ER after a bike accident is equivalent to cutting a finger in a kitchen & needing a few stiches!?). The uncertainty in studies is about precisely how often bikers have a head hit that is bad enough for the helmet to help, but not so bad that the helmet wasn't enough to save someone. There is added uncertainty about whether certain types of helmets increase neck injury risk, might be worse from helmet wearing, but only a 3 studies examined neck injury with widely varying results (see the article linked from the WABA site: http://www.cycle-helmets.com/Elvik2011_helmet_reanalysis.pdf). Denying these data doesn't help.

by Dan H on Jun 5, 2013 10:34 am • linkreport

I bike to work 3-4 days per week and bike recreationally on the weekends. I estimate that about 90% of the people I see biking are wearing helmets. Are all of these people ill-informed, misguided, sheeple? Not likely. It is more likely that they understand the dangers to their brain from hitting asphalt going 15 mph.

Again, nobody is talking about mandating helmet usuage but given how important a healthy brain is to the most basic life functions, why would you not want to take the minor and easy step of wearing a helmet?

by 202_cyclist on Jun 5, 2013 10:36 am • linkreport

I have seen several accidents (and know of one fatalty on the W&OD trail, a path that is exclusively for pedestrians and cyclists (with no vehicles except for the intoxicated driver this past weekend). Even if we had sharrows, dedicated lanes, and all of the other neat bike infrastructure that people on this blog make a big deal about advocating, there are still many other factors that can cause an unexpected crash and that justify wearing a helmet. For example, I ride several thousand miles each year and I am completely confident riding in traffic. My rear wheel punctured last week while biking to work and my rear tube flatted immediately. Had it been my front tire while going downhill, I would have likely crashed.

David C-- is this situation I just mentioned not dangerous? IF you hit your head on the pavement as a result of this crash, would you not want extra protection for your head?

by 202_cyclist on Jun 5, 2013 10:41 am • linkreport

"I'm pushing back on the opposite extreme of people denying there are legitimate risks."

I dont see people saying that. There ARE risks. Thats why I (and most of us here, and I guess Dave C too) push for better infrastructure, better laws, more courses on safe riding, and, why yes, all of us (afaict) wear helmets.

But net net, most of the people afraid to bike would look a lot better actuarially if they were not so afraid.

"When I say it's dangerous to ride slowly on a 35mph and have cars break and swerve around you, the statistics on injuries miss an obvious possibility. Most people who don't think they can safely ride in this situation don't. Therefore, they don't get hit by cars on those roads."

I personally want more alternatives to sharing a lane at 35MPH - I want more parallel alternatives, and more segregated infrastructure (and in some places, lower speed limits). But this isnt a thread about vehicular cycling (weve had those, BTW) its about the accuracy of data wrt bike helmets.

"

T"he other denial of evidence that is running through many comments is the safety benefits of helmets. For example, I said what should be an obvious statement, that, when you have a bike accident and hit your head, helmets reduce injury. Despite many studies and personal examples, this shouldn't be debated, but David C directly denies this and many others downplay the fact (going to the ER after a bike accident is equivalent to cutting a finger in a kitchen & needing a few stiches!?)"

actually you can kill yourself with a kitchen knife, and you can also get an infection that kills.

I have a friend who biked to work every day. His wife died in a household (not kitchen) accident. I also have a friend whose husband died of skin cancer. Dont tell me that comparing the real, but often exagerated risks of biking, with other risks is trivializing anything. Please.

Dave C has I think a philosophy background and likes to make strong statements. I will leave it to him to correct your view of his views, if he feels it necessary.

But right now, in NoVa where I live what I see is not people who are part of this conversation refraining from wearing helmets (the ones who fail to wear helmets are almost entirely working class hispanics who I think are part of different discourses- they also love to ride in sidewalks, BTW). What I see instead is pushback against cycling in roads in general "cause its suicidal" skepticism about bike share "What about helmets? and in md, a proposal for mandatory helmets. And lots of people who dont ride, even when its an obvious solution to a transportation and/or exercise problem.

by AWalkerInTheCity on Jun 5, 2013 10:57 am • linkreport

"Are all of these people ill-informed, misguided, sheeple? "

No one here said they were.

"Again, nobody is talking about mandating helmet usuage"

you are incorrect. a legislator in MD proposed exactly that. And in Va, biking friendly laws were defeated, in a context where many people see biking as "suicidal" And in each city with a bikeshare rollout, there are opponents complaining that it invites riding without helmets.

And guess what, it does. because people dont always have a helmet with them. But it also encourages more riding and a healthier lifestyle

"but given how important a healthy brain is to the most basic life functions, why would you not want to take the minor and easy step of wearing a helmet?"

because in SOME instances, its not minor, but effectively means that one will not ride. And a healthy heart and cardio vascular system is just as basic to life functions. So we make an intelligent tradeoff, just as we do wrt sun block, to wearing a helmet in a range of lifeactivities, and to many other decisions that impact our health and safety.

by AWalkerInTheCity on Jun 5, 2013 11:01 am • linkreport

@AWalkerInTheCity

Where in this discussion have any of us suggesting mandating helmet use?

by 202_cyclist on Jun 5, 2013 11:06 am • linkreport

"@AWalkerInTheCity
Where in this discussion have any of us suggesting mandating helmet use?"

No one here has suggested mandates (just as no one has discouraged wearing a helmet, and indeed everyone thinks its a good idea) but it has been suggested in the public discourse to which this post contributes - and not just by fringe elements, but by elected officials with the power to change law.

Again, the point of the post is that the govt should give the correct data on the benefits of helmet use. Do you disagree with that? I do not. I also think that SOME hype around helmets (most of the nonriding public, the news media, etc, seem to think helmets are more important to riders than lights, than biking in the correct direction, not to mention than being fit, or wearing sunblock) is damaging.

Do you ride in southern Fairfax county? Maybe the problems due to lack of critical mass dont resonate as much with you as they do with me.

by AWalkerInTheCity on Jun 5, 2013 11:16 am • linkreport

Where in this discussion have any of us suggesting mandating helmet use?

Nobody HERE has, the point is that the people in power have. And that's exactly what he said. You are misreading if you think anyone here is saying that people here are calling for mandatory helmets.

I am unsure as to why a discussion about how bad stats are bad and we should combat the use of bad stats to justify bad laws has turned into people getting personally offended about helmet use.

by MLD on Jun 5, 2013 11:17 am • linkreport

@MLD

"I am unsure as to why a discussion about how bad stats are bad and we should combat the use of bad stats to justify bad laws has turned into people getting personally offended about helmet use."

The reason why some people get offended by this is because it is irresponsible to suggest that there is no safety improvement from wearing a helmet when biking or that not wearing a helmet is as dangerous as not wearing sunblock or cutting a vegetable. These are exaggerations. There are very real risks that I and others have noted, of biking without a helmet-- even if you have all of sharrows and dedicated bike lanes you could hope for.

by 202_cyclist on Jun 5, 2013 11:25 am • linkreport

"The reason why some people get offended by this is because it is irresponsible to suggest that there is no safety improvement from wearing a helmet when biking or that not wearing a helmet is as dangerous as not wearing sunblock"

No one here has said there is no safety improvement from wearing a helmet.

as far as the relative dangers of riding without a helmet, or without sunblock, do you have numbers? most rides, I dont hit my head. Most rides I take, I AM exposed to the sun.

according to the CDC there were 9000 deaths from melanoma in 2009.

by AWalkerInTheCity on Jun 5, 2013 11:30 am • linkreport

" There are very real risks that I and others have noted, of biking without a helmet-- "

Do you think those risks justify inaccurate statistics? Do you think they justify the belief that a helmet is more important than having lights on your bike at night (BTW thats not an idle question - again, the helmet issue is often raised against bike share, but bike share bikes have lights, working brakes, etc - many of the bikes I see riddent at night do not have lights, and I suspect some do not have good brakes)

by AWalkerInTheCity on Jun 5, 2013 11:34 am • linkreport

The reason why some people get offended by this is because it is irresponsible to suggest that there is no safety improvement from wearing a helmet when biking or that not wearing a helmet is as dangerous as not wearing sunblock or cutting a vegetable.

1. Nobody has suggested that there is no safety improvement from wearing a helmet. Nobody here at least.

2. The fact that riding with a helmet is safer than riding without tells us NOTHING about the relative risks of biking vs other activities.

3. There is actually very little data about the relative risk of bicycling vs other activities and I haven't really seen anything that suggests it is "irresponsible" to ride a bike with or without a helmet. I do think people should wear a helmet but I think there's little that shows that riding without is more dangerous than a whole host of other activities people engage in on a regular basis, ESPECIALLY if this means that harping on it means that people ride less.

by MLD on Jun 5, 2013 12:00 pm • linkreport

@contrarian: Thanks. You are one of the commenters (Falls Church is another) who helped orient me last winter.

@Dan H: I have found myself thinking many of the same things you wrote, both about everybody's need to be careful about exaggerating, and the cyclist-specific comparative risk assessments we all must make. I wish drivers who think I am foolishly in the lane had a better understanding of the continual need to pick between possibly risky options that we face, which drivers usually do not need to deal with. Even when I make the wrong decision about whether to use the full lane, I think that it would help if drivers understood the factors leading up to me (retrospectively wrong) decision.

@202_cyclist. To the extent that the original wording of this post set a tone skeptical of helmets, I wanted to let you know that some of the editing snags were corrected, which may have helped to resolve some of the issues that earlier commenters noticed.

@MLD and AWITC: You make such well-reasoned comments that I usually wish I had run my drafts by you before publication. Alas, my posts are usually PG- or Maryland-centric, but if you ever decide you want to save me from hanging myself on the next post with a more general theme, drop me a line.

by JimT on Jun 5, 2013 12:03 pm • linkreport

you can't use physics to determine the actual benefits of helmet use, and you can't use an actual experiment, so we are left with some very iffy epidemeological approaches

Hah. This is just wrong; there are many ways to physically test the effectiveness of helmets. We could use cadavers or gell-man mock ups, subjected to impacts that approximate a head hitting the pavement. Also there are human body finite element calculation of impacts, that I believe are used in automobile crash studies.

In any case, comparing the effects impacts on the cranium, I would lay strong odds that the results will show less injuries for helmets; but it would be nice to see the data.

by goldfish on Jun 5, 2013 12:26 pm • linkreport

For example, I said what should be an obvious statement, that, when you have a bike accident and hit your head, helmets reduce injury. Despite many studies and personal examples, this shouldn't be debated, but David C directly denies this

No, I didn't. I disagreed with the statement (emphasis mine) "Those who hit their heads are much less likely to have serious injuries if they were wearing a helmet." That is a long way from helmets reduce injury by some value greater than zero. I don't think you can find evidence to support the claim I quoted - perhaps I'm wrong. For example, in many cases the injuries that were avoided in studies that show an advantage to helmets were lacerations and scratches.

Further more, the idea that any of this is so well established that we are beyond debate is significantly premature. There is a pretty heated debate out there about this and the ranges of values are pretty wide. Maybe we'll get to a point where the evidence is incontrovertible, but we aren't there yet.

by David C on Jun 5, 2013 1:47 pm • linkreport

It seems I can't bold. Emphasis is on "much less" and "serious".

by David C on Jun 5, 2013 1:48 pm • linkreport

"Hah. This is just wrong; there are many ways to physically test the effectiveness of helmets. We could use cadavers or gell-man mock ups, subjected to impacts that approximate a head hitting the pavement"

Those experiments would give you some idea of how forces aligned on particular axes are dissipated by the helmet. It would tell you nothing about how effective the helmet is in preventing serious injury because we don't really understand the relationship between force of impact, direction of impact, and degree of (cumulative) brain injury. The best way to understand that would be to experimentally beat people in the head in a controlled fashion, but that approach has ethical issues. If this was an easy problem, DoD wouldn't be spending a ton of money trying to understand traumatic brain injuries. (Though it may be that research helps inform bicycle helmet design as a side effect.) Until we better understand the science of brain injury, yes, weak epidemiological studies are the best we can do.

The automobile analogy is flawed, because modern car interior safety is predicated on never letting a head hit anything but an airbag; it doesn't really depend on permitting a minimal safe degree of impact the way a bike helmet is.

At any rate, this continued harping on whether helmets are safer than nothing is pointless. The questions that the hysterical helmet boosters are ducking are: how much benefit is the helmet?; should public resources should be put into helmets or some other safety measure?; and, how much additional risk is someone accepting if they don't wear a helmet for a given trip (based on speed, route, etc.)? Just saying "it's safer" is irrelevant: whenever someone points out that NASCAR helmets and 5 point harnesses are safer in cars than simple seatbelts alone, the response is something like "you're just being absurd". But why? Why is the bike helmet something people must accept because "it's safer" when society sanctions accepting other risks (such as not wearing a car helmet)?

by Mike on Jun 5, 2013 1:55 pm • linkreport

If this was an easy problem, DoD wouldn't be spending a ton of money trying to understand traumatic brain injuries. (Though it may be that research helps inform bicycle helmet design as a side effect.) Until we better understand the science of brain injury, yes, weak epidemiological studies are the best we can do.

The DoD research is on high speed impacts, from shrapnel and explosions, 3-6 orders of magnitude higher strain rates. The high strain and failure behavior of viscoelastic materials at such speeds is mostly unknown and difficult to measure. Moreover the interaction of the pressure wave on the solid structures -- bony casing with soft plastic brain tissue, covered with a helmet, both with large openings -- is an unconquered challenge.

However, the head impacts are much slower, and the impact loads are simple and much better understood. I submit the injuries can indeed be quantified by correlation to animal models.

I agree that the problems are similar, and probably research into bicycle head injuries could leverage the DoD helmet work.

by goldfish on Jun 5, 2013 2:36 pm • linkreport

Just saying "it's safer" is irrelevant: whenever someone points out that NASCAR helmets and 5 point harnesses are safer in cars than simple seatbelts alone, the response is something like "you're just being absurd". But why?

Because driving is normative, and its practiced by "normal" people. Cycling on the other hand is fringe behavior--it's a wonder we allow it at all, at the very least we should regulate it as heavily as possible.

by oboe on Jun 5, 2013 4:38 pm • linkreport

Oh c'mon -- conceptually, helmet laws aren't that different from seatbelt laws. This isn't some unique form of oppression visited upon cyclists because they're outside the mainstream.

(And, frankly, while bike commuters may be a relatively rare breed (outside of college towns), cycling per se is hardly "fringe behavior." It's something we let kids do it without any form of licensing, for example. That suggests a fairly high level of social acceptance of the activity.)

by BTDT on Jun 5, 2013 7:45 pm • linkreport

@BTDT: Of course bike helmets are the same as seatbelts, except for being completely different. A correct analogy would be car helmets. Did you wear a car helmet the last time you were on a car or bus? If not, why?

by Mike on Jun 5, 2013 8:27 pm • linkreport

And to add to Mike's point. There is an argument that seatbelts make other users safer by keeping passengers from becoming projectiles and keeping drivers in front of the steering wheel where they can regain control. There is no such advantage to helmets.

by David C on Jun 5, 2013 8:55 pm • linkreport

One of the sticking points in this discussion is that WABA seems to be (to borrow a colleague's phrase) barking up the wrong evidence tree. Even with its limitations, the epidemiologic data support the use of helmets to prevent head injuries in cyclists. These studies were not designed to answer the seemingly similar, but fundamentally different, question: should bike helmets be mandated? As has been pointed out, this other question takes into account the potential benefits of not mandating helmets. Clearly, based on the ~100 comments here, it's not working to shoehorn one type of data into answering a separate policy question.

So, if they haven't already, I would encourage WABA to engage researchers to actually answer this separate question. For example, GW has an exercise science department with faculty expertise in fitness and injury epidemiology. (Full disclosure, I work as an epidemiologist at GW but on a very different topic.)

The caveat is that by taking an evidence-based approach, WABA needs to be open to the idea that a helmet law may have an overall net benefit and consequnetly be willing to reverse the direction of their advocacy.

by Sara on Jun 6, 2013 9:04 am • linkreport

What do you mean that WABA is barking up the wrong tree? If you're going to criticize it helps to be specific enough for people to understand the criticism.

by Mike on Jun 6, 2013 9:43 am • linkreport

Sara,

Even with its limitations, the epidemiologic data support the use of helmets to prevent head injuries in cyclists

Which Jim concedes above. He just disagrees with the amount that it does so. As a scientist surely you'll agree that this is relevant - as relevant as the binary question of do they help or not? You sound shockingly dismissive of the importance to get the facts right.

Personally I'd be open to the idea that a helmet law may have an overall net benefit (from a health standpoint) but would still oppose such laws because adults should be free to make dumb decisions that harm only themselves - or else they're not really free at all. But at least such laws would less offensive to me.

by David C on Jun 6, 2013 10:00 am • linkreport

AFAICT we have a reasonable and growing body of research on the safety benefits of helmets, which Jim points out. We also have a reasonable and growing body of research on the health (and other) benefits of biking.

What we mostly lack, is a deep understanding of the impact of mandatory helmet laws on the amount of biking. IIUC the data from Australia suggest a significant impact. We have no such data from the US, because no major jurisdiction (any jurisdiction?) currenly mandates bike helmets for adults. So its difficult to empirically test the effects of such policies.

We can begin to look at the effects of bike share - a form of biking often associated with less helmet use (and I believe, more often with helmetless riding by otherwise safe riders than is the case with personally owned bikes - though better understanding the relationship of the helmetless riding with other safety factors would be illuminating). We have seen significant increases in bike riding associated with stable numbers of bike accidents and fatalities. Im not sure if there is enough data there for a statistically valid study, but it seems to lend empirical support to the notion that critical mass is important, and may well more than offset the impact of helmetless riding (note there are confounding factors with bike share - slower speeds on the one hand, more inexperienced riders on the other)

by AWalkerInTheCity on Jun 6, 2013 10:10 am • linkreport

David C, yes yes, I absolutely agree that the it's important to get the best evidence we can about the protectiveness of helmets. I didn't mean to dismiss that idea at all. My point was that one could do research to quantify the net benefits (or not) of helmet laws -- which seems to be what folks have been asking for above. The philosophical argument about whether helmet use should be mandated is separate and far above my pay grade. (Frankly, I think we're on the same side here...I would just like more data.)

by Sara on Jun 6, 2013 10:10 am • linkreport

"My point was that one could do research to quantify the net benefits (or not) of helmet laws -- "

do you agree that such research would need to incorporate study of the impact of such laws on the quantity of riding, something well beyond exercise physiology or fitness studies?

by AWalkerInTheCity on Jun 6, 2013 10:13 am • linkreport

(note Im not necessarily on the same side as David C this as a liberty issue - but we are far, far from even having to confront this issue - at this point, based on the data and research we DO have, I am convinced that mandatory helmet laws would be an overwhelming public health negative)

by AWalkerInTheCity on Jun 6, 2013 10:16 am • linkreport

David C:
"Personally I'd be open to the idea that a helmet law may have an overall net benefit (from a health standpoint) but would still oppose such laws because adults should be free to make dumb decisions that harm only themselves - or else they're not really free at all. But at least such laws would less offensive to me."

Do you oppose mandatory seat-belt requirements and helmete laws for motorcycle riders as well?

by 202_cyclist on Jun 6, 2013 10:23 am • linkreport

@Sara
There are some papers that attempt to combine the helmet effectiveness data with studies from Australia on the impact of mandatory helmet laws on cycling rates.

Here is one such example:
http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1368064

Seattle is the only major US city with a mandatory helmet law I believe.

by MLD on Jun 6, 2013 10:34 am • linkreport

@sara: if you would like to set up a meeting to explore the opportunities you see to move forward, please do so and I would be happy to attend. A serious grant proposal to do the analysis should gain some traction. It is unfortunate that all we really have in the USA is a suite of studies done more than 15 years ago, regarding the question explored here.

Far from barking up a tree, we have actually been removing the invasive vine that will otherwise kill the tree. As long as a group of public health advocates and their allies in academia are content to simply repeat a finding from 25 years ago, because it helps promote a policy goal, they will continue to be frustrated by the seeming paradox of being thwarted by the very people they thought they were trying to help.

Information should influence policy, not the other way around. Rather than worry about the particular positions people take on policy proposals, I suggest looking more closely at how people in this particular sub specialty have allowed accuracy to be hijacked.

Compare nhtsa's biased presentation fir decades and minimalist effort to undo the damage with how the environmental agencies handle climate change or exposure to pollutants. They bend over backward to avoid cherry picking and cite the range of studies. If called on a number being wrong they replace it with the updated range. They don't simply say that since the accurate estimate does not support their policy, they'll stop giving out the information.

by JimT on Jun 6, 2013 10:36 am • linkreport

Do you oppose mandatory seat-belt requirements and helmete laws for motorcycle riders as well?

Already addressed by David C 8 comments above yours:

There is an argument that seatbelts make other users safer by keeping passengers from becoming projectiles and keeping drivers in front of the steering wheel where they can regain control. There is no such advantage to helmets.

As for motorcycle helmets I don't think we should have laws mandating them but then again the health benefits of motorcycle riding are less clear than for bicycling. Seatbelts have clear advantages for other people and that is why we should mandate wearing them.

by MLD on Jun 6, 2013 10:38 am • linkreport

This debate is missing one of the more important points in Jim T's post. Many of those who push for helmets think that the issue stops once you have achieved the goal of getting a helmet on a cyclist's head. That mindset had stalled any push to find out if we can design helmets that provide better protection without the adverse side effects, namely neck injuries. We might even accept slightly worse head protection if the neck injuries dropped significantly.

We needed to toss out old data that gave a misleading picture, in part so we can gear up to collect new, better and more useful data.

by Crickey7 on Jun 6, 2013 10:39 am • linkreport

nonlibertarian comparison of bike helmets and motorcycle helmets

bike helmets - safety benefits - but possible reductionin riding due to helmet laws will lead to lower safety, and loss of health benefits. Net net unclear, but one study from australia suggests helmet laws a net negative.

Motorcycle helmets - Safety benefits (larger than for bike helmets due to larger size, possible on a powered vehicle, higher speeds, etc?) Reduction in riding possibly associated with lower safety (but less documentation for critical mass effects than with bikes) Almost certainly minimal or zero health loss due to less riding (any CVD benefits from motorcycle riding?) Net net of motorcycle helmet laws, from public health POV, almost certainly positive.

by AWalkerInTheCity on Jun 6, 2013 10:58 am • linkreport

@AWalkerInTheCity:
Motorcycles pollute less than vehicles, so discouraging motorcycle riding through mandatory helmet laws leads to reduced health for everyone else.

This is about as strained and spurious of a connection as those who say that noting the safety improvements (not mandating but merely noting) of bike helmets leads to reduced bicycling.

Again, will you and David C admit that if you fall off of your bike going 15-20 miles per hour from four or five feet above the ground and your head hits the hard asphalt, it is a good idea to have more protection for your head instead of less. This shouldn't be a debatable point. Admittedly, helmets might not be 100% effective but they provide your head and brain more protection than you would have if your head struck the ground without anything interupting the force of the collision.

by 202_cyclist on Jun 6, 2013 11:06 am • linkreport

"Motorcycles pollute less than vehicles, so discouraging motorcycle riding through mandatory helmet laws leads to reduced health for everyone else. "

thats true, that should be added to the motorcycle equation

but then it should also be made more explicit for biking. Plus biking for transportation is more likely to be associated with greater density and urbanist design, and so with more more walking and transit use as well.

"This is about as strained and spurious of a connection as those who say that noting the safety improvements (not mandating but merely noting) of bike helmets leads to reduced bicycling."

I have not said that NOTING the benefits of helmets (the real benefits, not the 85% effectiveness claim) will lead to reduced cycling. I said that A. helmet laws will B. having less bike share will C. I share the concern that excess focus in PR campaigns on the dangers of biking will reduce cycling, but I know of know empirical studies on that. D. I am also concerned that the focus on helmets, will lead cyclists to underestimate the importance of other health and safety measures - riding with appropriate lighting, riding with the flow of traffic, riding with a safe bike, and, yes, wearing sun block

I am tired of having to respond to a strawman.

"Again, will you and David C admit that if you fall off of your bike going 15-20 miles per hour from four or five feet above the ground and your head hits the hard asphalt, it is a good idea to have more protection for your head instead of less."

As I said above, I ride with a helmet. I can't recall the last time I rode without one. I don't see why I need to repeat this.

I am tired of having to respond to a strawman.

by AWalkerInTheCity on Jun 6, 2013 11:16 am • linkreport

"This is about as strained and spurious of a connection as those who say that noting the safety improvements (not mandating but merely noting) of bike helmets leads to reduced bicycling."

You're just making this up; nobody has said that. The criticism was of the characterization of helmets as "the single most important thing" without any factual basis. Now that this has been cleared up for you, I hope we don't have to keep beating this dead straw horse.

"Again, will you and David C admit that if you fall off of your bike going 15-20 miles per hour from four or five feet above the ground and your head hits the hard asphalt, it is a good idea to have more protection for your head instead of less"

Will you admit that if you are in a high speed automobile, bus, or rail collision that your head is safer inside a helmet with your body secured by a 5 point harness? It is a good idea to have more protection rather than less, why do you focus on the comparatively small cyclist population (most of whom already wear helmets) and ignore the much larger auto/bus/train passenger population who are dangerously riding without helmets and 5 point harnesses?

by Mike on Jun 6, 2013 11:27 am • linkreport

Do you oppose mandatory seat-belt requirements and helmete laws for motorcycle riders as well?

I support seat belt laws because they protect others, but I oppose motor cycle helmet laws (even though I think riders should wear one).

by David C on Jun 6, 2013 11:31 am • linkreport

"This is about as strained and spurious of a connection as those who say that noting the safety improvements (not mandating but merely noting) of bike helmets leads to reduced bicycling."

but we HAVE mandatory helmet laws for motorcyclists, and I was specifically addressing why it may make sense for motorcylicsts but not for bicyclists.

So Im confused with why you are taking issue with my distinction. You have said repeatedly that no one here is advocating mandatory helmet laws for cyclists, but your logic (that the cost benefit for bicycle helmet laws is similar to that for motorcycle helmet laws) suggests to me you DO support mandatory bike helmet laws.

If not, why not? Are you also against motorcycle helmet laws? Or do you share my belief that the cost benefit is different?

by AWalkerInTheCity on Jun 6, 2013 11:36 am • linkreport

Again, will you and David C admit...

Yes. You're likely better off with more protection. And helmets likely give you more protection. But I disagree that it's a debatable point - I think very reasonable people hold the opposite opinion.

will you admit that if you fell down while walking at 2-3 miles per hour from four or five feet above the ground and your head hits the hard asphalt, it is a good idea to have more protection for your head instead of less. And if so, why shouldn't we be talking about walking helmets too?

by David C on Jun 6, 2013 11:39 am • linkreport

David C:

"will you admit that if you fell down while walking at 2-3 miles per hour from four or five feet above the ground and your head hits the hard asphalt, it is a good idea to have more protection for your head instead of less. And if so, why shouldn't we be talking about walking helmets too."

The risk of falling and hitting your head is, to the best of my knowledge, negligible. The risk of crashing or falling off of a bike even with all of the sharrows, dedicated lanes, and everything else that people on this blog advocate for, is not negligible. Rider error, equipment failure, rough and uneven (such as potholes) pavement, weather (slick roads), and animals (many times I've has squirrels run immediately in front of my bike) are all potential causes of crashes. Your comparison is ridiculous.

by 202_cyclist on Jun 6, 2013 11:48 am • linkreport

People fall on sidewalks all the time. Especially where there are icy conditions, sidewalks in poor condition, etc. I guess there are few head injuries because most people can break the fall with their hands. Without actual data I would be reluctant to say that head injuries from falls while walking on sidewalks are negligible.

However I would guess the largest number of head injuries to pedestrians occur due to auto accidents while crossing the street. If you already have your helmet with you for crossing, you might as well wear it while walking on the sidewalk though.

I also suspect that head injuries are more common, relative to exposure, for hikers. I've never heard of a hiking (as opposed to mountain climbing) helmet though.

by AWalkerInTheCity on Jun 6, 2013 12:01 pm • linkreport

The risk of falling and hitting your head is, to the best of my knowledge, negligible....Your comparison is ridiculous.

Are you kidding me? Tell that to Robert Atkins or Natasha Richardson.

According to the Centers for Disease Control and Prevention (CDC), over one million Americans suffer a slip, trip, and fall injury and over 17, 000 people die in the U.S. annually because of these injuries.

Slip and fall accidents and trip and fall accidents are the leading cause of brain injury in individuals over the age of 65.

There are many more head and brain injuries from slip and falls then from bicycle crashes and more fatal ones as well. And that doesn't even count all the pedestrians who are hit by cars and bicycles and falling objects.

More here:

http://www.braininjuryinstitute.org/Brain-Injury-Causes/Slip-And-Fall.html

by David C on Jun 6, 2013 12:02 pm • linkreport

BTW, 202, if you are riding your bike (and thus have a helmet with you) and you lock your bike up, and then need to walk across an arterial to get where you are going, to keep your helmet on while you cross? If not, why not?

by AWalkerInTheCity on Jun 6, 2013 12:04 pm • linkreport

David C:

Natasha Richardson died from a ski accident, not a walking accident (http://abcnews.go.com/Entertainment/Movies/story?id=7119825&page=1). The speed of biking is about 5-6 times (at least) that of walking and it is easier to react for various reasons if you slip while walking than if you fall off a bike.

Your comparison is ridiculous.

by 202_cyclist on Jun 6, 2013 12:07 pm • linkreport

Wiki says richardson died in a skiing accident.

Atkins is the more notable case - as there was a rumor he died due to a heart attack (somewhat controversial, since he advocated low carb diets). In fact he died due to brain injuries due to a fall during a snowstorm.

I have found no info on whether or not he was wearing a helmet.

by AWalkerInTheCity on Jun 6, 2013 12:07 pm • linkreport

"The speed of biking is about 5-6 times (at least) that of walking and it is easier to react for various reasons if you slip while walking than if you fall off a bike."

So if you are weighing costs vs benefits, then it makes more sense to wear a helmet while riding than while walking. Gotcha.

But if you are merely asking if its safer to wear a helmet than not to wear one, its safer to wear one, while walking.

By the way, speed of motorcycling is typically about 4 to 5 times the speed of biking right?

by AWalkerInTheCity on Jun 6, 2013 12:10 pm • linkreport

@202_cyclist - if your real concern is a public health perspective on reducing injuries from falls then you should be arguing for mandatory installation of grab bars in all tubs and showers and making scatter/throw rugs illegal.

For biking, after a sound bike and rider, the single most important safety device is lights. Reflectors are mandated and no one here disputes the reasoning behind that mandate. Lights a required equipment and no one here disputes the reasoning. All those obstacles you mentioned can be seen at night with a light.

No has argued that a helmet offers zero protection or advocated non-helmeted biking is superior (just as safe) to helmeted biking. the problem is with the data over estimate of the injury risk reduction, the emphases on that bad data leading to mandatory helmet laws and the negative consequences to public health of those laws.

by Tina on Jun 6, 2013 12:11 pm • linkreport

202

this is from the brain institute

"Slip and fall injuries for most of us are nothing more than a simple embarrassment, however a simple slip and fall could lead to a serious brain injury. The greatest risk of falling, in fact, is that you will hit your head on the way down. Slip and fall accidents are a leading cause in brain injury. Statistics report that approximately 35% of brain injuries are caused by falls. People slip on icy sidewalks and water spilled on the ground. They fall over a curb in a parking lot or their kids’ toys in the driveway. And household falls are extremely common, especially with the elderly—bathtubs, loose rugs, and stairs are accidents waiting to happen."

This seems to imply that falls while walking are a significant cause of brain injuries. If thats false, I suggest you go complain to the brain institute about their misleading website.

by AWalkerInTheCity on Jun 6, 2013 12:13 pm • linkreport

@David C:

1)There are vastly more walking trips than biking trips.
2)Pedestrians are going much slower than cyclists.
3)There isn't typically the equipment failures while walking that you have while cycling.
4)Pedestrians have better infrastructure than cyclists.
5)Pedestrians can stop quicker than cyclists.
6)You have a lower center of gravity as a pedestrian than a cyclist.

So, yes, the comparison is ridiculous.

by 202_cyclist on Jun 6, 2013 12:15 pm • linkreport

http://www.cdc.gov/injury/wisqars/pdf/10LCID_Unintentional_Deaths_2010-a.pdf

unfortunately CDC does not break down the deaths due to falls on the sidewalk, vs deaths due to falls indoors, or how many were connected to brain injuries.

by AWalkerInTheCity on Jun 6, 2013 12:15 pm • linkreport

I seem to recall that while Richardson was on skis when she fell, she wasn't actually skiing but merely trying to walk in her skis, but the point is completely irrelevant. There are many people who fall, hit their head and die. And they would be better off if they wore helmets.

But if you are merely asking if its safer to wear a helmet than not to wear one, its safer to wear one, while walking.

Right.

202, If your point is that there is some threshold measure - head impacts per minute or per mile - above which it is reasonable to expect/require helmets, what is that threshold and what is the measurement of head impacts per unit for driving, motorcycling, walking and biking?

by David C on Jun 6, 2013 12:17 pm • linkreport

@Tina:

"No has argued that a helmet offers zero protection or advocated non-helmeted biking is superior (just as safe) to helmeted biking. the problem is with the data over estimate of the injury risk reduction, the emphases on that bad data leading to mandatory helmet laws and the negative consequences to public health of those laws."

David C and others have been dismissive of the safety benefit of helmets.

Also, I agree with you that lights are important but they do very little to improve your safety during the day.

by 202_cyclist on Jun 6, 2013 12:17 pm • linkreport

202

all those points 1- 6 address relative cost benefit of wearing a helmet. They do not address the simple question - is it safer to wear a helmet or not wear one? Which is the question you posed relative to biking. As if it ended all discussion.

by AWalkerInTheCity on Jun 6, 2013 12:17 pm • linkreport

202, if the standard is: bike helmets make you safer when biking therefore you should wear them, then the same is true for walking. If you have a more nuanced standard, then I'd like to hear it.

by David C on Jun 6, 2013 12:19 pm • linkreport

"David C and others have been dismissive of the safety benefit of helmets."

Thats a lie. Okay. We have supported JimT who provided data showing that the benefits of helmets seems to be less than advertised. And we have opposed laws mandating bike helmets, the use of the helmet argument to oppose bike sharing, and the frightening of people about biking that may lead to less riding. But no one said one should not ride with a helmet - I do so ride, and I think Dave C has said he does.

"Also, I agree with you that lights are important but they do very little to improve your safety during the day."

And by the same token helmets dont help with non-head injuries.

Why are you minimizing the importance of lights?

by AWalkerInTheCity on Jun 6, 2013 12:21 pm • linkreport

@202_cyclist

I don't get it, what the hell is your overall point? Seems like you're just arguing for nothing.

by MLD on Jun 6, 2013 12:23 pm • linkreport

@202_cyclist -@David C and others have all written above that helmets reduce risk of injury while biking. @David C has also written that helmets reduce risk of injury while walking.

The dispute is with the misleading interpretation of data as to the risk reduction helmet wearing provides; the emphases on that bad interpretation/data, and the resulting negative impact to other public health concerns relative to biking such as the safety in numbers effect and reduced physical activity. Why don't you address this point?

There is already a socially accepted norm of helmet wearing. The majority do it and recommend it to others, like condom wearing. Why do we need a law?

Again, if your concern is public health impact then go after the tub/shower grab bars and throw rugs.

by Tina on Jun 6, 2013 12:26 pm • linkreport

@MLD:

My point is that it is irresponsible to claim that riding without a helmet is fine or that they only offer a insignificant improvement in safety.

What is the point of David C and others in opposing voluntary helmet usage-- something that does improve safety?

by 202_cyclist on Jun 6, 2013 12:26 pm • linkreport

@202_cyclist - please find the quote in this thread where someone has opposed voluntary helmet wearing, b/c I have not seen it.

by Tina on Jun 6, 2013 12:30 pm • linkreport

Since a particular commenter just keeps repeating the same false claim, it's probably time for people to just ignore the troll.

by Mike on Jun 6, 2013 12:32 pm • linkreport

My point is that it is irresponsible to claim that riding without a helmet is fine or that they only offer a insignificant improvement in safety.

Irresponsible based on what? We all know and have said that riding with a helmet is safer than without. But I don't think there's nearly enough evidence that riding without a helmet if you want is any more "irresponsible" than 1000 other things people do on a regular basis. Do you have the evidence that shows otherwise? "Put up or..." is the phrasing I believe.

Like we said, 677 people in the US died from cycling last year. And 17,000 die each year from slip-and-fall accidents. So what's more "irresponsible," biking without a helmet or not wearing a helmet 100% of your life?

What is the point of David C and others in opposing voluntary helmet usage-- something that does improve safety?
Where has David C opposed voluntary helmet usage? He has said repeatedly that wearing a helmet is more safe and that people should wear helmets:
"You're likely better off with more protection. And helmets likely give you more protection."

Nobody has opposed people wearing helmets so getting your pants in a wad about that is distracting and silly.

by MLD on Jun 6, 2013 12:34 pm • linkreport

Here are just a couple:
Okay, Tina, here are just a couple:

"Now if we could mandate wearing a helmet while sitting on your sofa, watching TV, and eating junk food, THAT would almost certainly result in better health outcomes."

"Do you think we need a safety campaign to discourage people from biking without sunblock?"

There have also been comments suggesting that cutting vegetables is a greater risk than biking without a helmet.

So, yes, these quotes do appear to be trivializing the protection and safety provided by bike helmets.

by 202_cyclist on Jun 6, 2013 12:35 pm • linkreport

@202-cyclist -none of those quotes opposes voluntary helmet wearing while biking.

You seem to be trivializing the huge public health impact that throw rugs and absence of grab bars in showers and tubs imparts, as well as injury from other types of falls while walking including being struck by motor vehicles.

by Tina on Jun 6, 2013 12:43 pm • linkreport

"Now if we could mandate wearing a helmet while sitting on your sofa, watching TV, and eating junk food, THAT would almost certainly result in better health outcomes."

I was trying to address, in a humorous way, the issue of encouraging certain activities. If we placed impositions on being a couch potatoe, and that led to less of it, that would certainly mean much less cardio vascular disease, a vastly more important public health issue than brain injuries due to bicycling.

I did not by that mean to state that one should not wear a helmet when biking. I am sorry you took it that way. I do beleive that encouraging MORE biking is a net benefit to public health, and I have at least anecdotal evidence that helmet concerns discourage more biking.

"Do you think we need a safety campaign to discourage people from biking without sunblock?"

Deaths from melanoma are a serious issue (though far less so than cardio vascular disease) I do not have data on how many deaths from melanoma are specifically associated with bicycling (since sun exposure is cumulative, that would be hard to say). I think the arguments for large scale safety campaigns focused on helmets apply to sun block as well. I do not understand why you are regularly minimizing the importance of wearing sunblock. its NOT a trivial issue.

"There have also been comments suggesting that cutting vegetables is a greater risk than biking without a helmet."

I spoke of kitchen accidents in general. Which can be fatal. The point is that while biking is an activity with dangers, its far from the only one. Yet people perceive it as very dangerous - with impacts on their own health, and with impacts on all the rest of us who bike (since lack of critical mass impacts safety)

by AWalkerInTheCity on Jun 6, 2013 12:50 pm • linkreport

202

the other day I was telling a friend about bike share.

she asked "well what about helmets"

This person is overweight, and has struggled with her weight for years. She does not get a significant amount of exercise. I have little doubt that she would be better off, actuarially, riding a CaBi bike without a helmet than not riding one at all (which is the likely incremental result of her avoiding riding without a helmet).

yet she will probably avoid CaBi, because of her concern about helmets.

That is a reality, repeated, I believe,thousands or tens of thousands of times across this country.

I believe its a matter of serious concern. Im puzzled why you do not share my concern.

by AWalkerInTheCity on Jun 6, 2013 12:55 pm • linkreport

"Like we said, 677 people in the US died from cycling last year."

of which some died from things other than head injuries. And at least a few I guess died from head injuries despite wearing a helmet.

by AWalkerInTheCity on Jun 6, 2013 12:57 pm • linkreport

@AWalkerInTheCity:

This is just an excuse. If your friend was serious about starting to bicycle, they could buy a good helmet for less than $50. Helmets weight about six or eight ounces and you can strap them to almost any bag or purse. When people say that bringing a helmet with them is some great burden, I am not convinced. That person likely would not have cycled anyways.

by 202_cyclist on Jun 6, 2013 1:08 pm • linkreport

It may be an excuse, it may not be. You dont know them so Im not sure how you can say.

And its not merely a matter of owning a helmet. its having it WITH you when you take out a CaBi bike. The whole point of bike share is to be able to take out a bike spontaneously, unplanned, in a place you may have arrived at by other means. Thats why bikeshare and mandatory helmet laws do not mix well.

By the way, I do bike with a helmet, and carrying it around when I walk (from wherever I parked my bike) IS an annoyance. Sometimes I will even wear it instead while walking. I consider that especially beneficial when walking across arterial roadway, which is a dangerous activity.

Do you wear your helmet while crossing the street? Why not?

by AWalkerInTheCity on Jun 6, 2013 1:16 pm • linkreport

the best part of this is that maybe helmets will get better and safer if now people don't think they're currently safe enough

by will on Jun 6, 2013 1:17 pm • linkreport

@202_cyclist - it is apparent from your response that you have little understanding of facilitating healthful behavior change among individuals let alone on a population scale. I find your response judgmental, glib, distinctly lacking in compassion, trivializing of real issues, and totally self-centered.

by Tina on Jun 6, 2013 1:18 pm • linkreport

202

Why do yuo believe helmetless riding appears to be more common for CaBi riders than for bike riders in general?

What do you think is driving that?

by AWalkerInTheCity on Jun 6, 2013 1:19 pm • linkreport

This is just an excuse. If your friend was serious about starting to bicycle, they could buy a good helmet for less than $50. Helmets weight about six or eight ounces and you can strap them to almost any bag or purse. When people say that bringing a helmet with them is some great burden, I am not convinced. That person likely would not have cycled anyways.

Data from Australia where they have mandatory helmet laws says otherwise - that if you make everyone wear a helmet then fewer people will bike.

75% of DC cyclists wear helmets. I'm not sure why you have such a huge problem with this.

by MLD on Jun 6, 2013 1:23 pm • linkreport

Wow, wow, wow! I missed this.

"It's hard to tell how often helmets actually prevent head injuries, however. Experiments on people are unethical, so instead researchers collect hospital data on people involved in bicycle crashes."

The benefit of helmets is from injuries averted-- people who didn't go to the hospital. It is likely these studies are seriously underestimating the effectiveness of bike helmets since a helmet will prevent an injury and, thus, a trip to the hospital.

by 202_cyclist on Jun 6, 2013 3:09 pm • linkreport

Continuing on this, I have fallen a few times (one trip to a hospital while racing in college). I've only had one hospital trip out of a couple of dozen crashes. Of course, this will underestimate the effectiveness of helmets if they only count the accidents serious enough to send cyclists to the hospital.

by 202_cyclist on Jun 6, 2013 3:14 pm • linkreport

202, I'm glad that you agree that what little scientific evidence we have of the efficacy of helmets is of dubious value.

by David C on Jun 6, 2013 3:20 pm • linkreport

This is like judging the effectiveness of seatbelts by only looking at the number of people at the Emergency Room. The correct measure of effectiveness would be injuries averted in the first place as well as the reduction in the seriousness of injuries because a seatbelt was worn.

With the helmet study, looking at people at the hospital is only a small percent of the total number of people in bike crashes. Of course that will give you a smaller percentage than expected.

Hopefully WABA will appologiize and retract this but I doubt it.

by 202_cyclist on Jun 6, 2013 3:23 pm • linkreport

"It is likely these studies are seriously underestimating the effectiveness of bike helmets since a helmet will prevent an injury and, thus, a trip to the hospital."

My last crash, I actually heard my head impact the pavement. I got stitches at the hospital from my glasses digging into my face. Helmets do little for a facial impacts.

My helmet? One little scrape.

by Crickey7 on Jun 6, 2013 3:24 pm • linkreport

@David C:

The conclusion to be reached is that helmets are likely far more effective than these studies have estimated if they prevented trips to the hospital in the first place. It makes a stronger case for wearing a helmet.

by 202_cyclist on Jun 6, 2013 3:25 pm • linkreport

@Crickey:

Unless you wear a downhill mtn bike helmet, it is to be expected that it wouldn't protect your face from these unfortunate lacerations. Based from your coherent post, however, I am guessing that you had no concussion or brain trauma. Thus, the helmet did the job it was suppose to.

by 202_cyclist on Jun 6, 2013 3:27 pm • linkreport

There are 63 studies in the metastudy. My impression is that not all of them are based on looking at hospital patients. Its in fact the one that resulted in the data that JimT is questioning, that is so based.

So we have a cited 85% that no one else could replicate in similar studies. We have some reason to think that this TYPE of study might be biased low. but we also have data suggesting the actual number is significantly less.

Im not sure, on that basis, why WABA would want the 85% number reinstated.

But feel free to email CDC with your analysis.

by AWalkerInTheCity on Jun 6, 2013 3:28 pm • linkreport

@AWalkerInTheCity:

Since you feel you're so knowledgeable about this, how many bike accidents/crashes lead to trips to the hospital? I have no idea but I think it is a very small percent out of the total number of crashes. It is also highly likely that the protection provided by the helmet reduced the seriousness of the accidents, averting hospital trips.

by 202_cyclist on Jun 6, 2013 3:34 pm • linkreport

The conclusion to be reached is that helmets are likely far more effective than these studies have estimated if they prevented trips to the hospital in the first place. It makes a stronger case for wearing a helmet.

No, because you don't understand how the research has been done. They look at frequency of other injuries in both groups, and then look at head injuries in both groups. And then compare the rates. They are specifically trying to measure the number of people who never went to the hospital in the first place - that's the entire point of the study.

by MLD on Jun 6, 2013 3:36 pm • linkreport

correction - it appears all that were included in that metastudy were based on hospital patients. However its mereluy speculative that there were a significant number of people in accidents that could have caused serious brain injury without a helmet, who simply walked away with no hospitalization with a helmet.

That is justification for calling for more comprehensive study. Its not justification for citing a non-relicatable number. Two errors in (possibly) opposite directions do not result in a good number.

by AWalkerInTheCity on Jun 6, 2013 3:36 pm • linkreport

"Since you feel you're so knowledgeable about this, how many bike accidents/crashes lead to trips to the hospital? I have no idea but I think it is a very small percent out of the total number of crashes. It is also highly likely that the protection provided by the helmet reduced the seriousness of the accidents, averting hospital trips."

Whether a significant number of those instances involved what would have been serious brain injury is entirely speculative. yet you dismiss studies of the impact of helmet laws on amount of biking, and net cost benefit of helmet laws, as speculative.

by AWalkerInTheCity on Jun 6, 2013 3:38 pm • linkreport

@MLD:

It is pretty simple. 1) Wearing a helmet likely prevented an injury in the first place. 2) No injury, no trip to the hospital. 3) No trip to the hospital, no way to know how large the sample size is.

Why are you so strongly against a simply, inexpensive, device that prevents serious brain injuries?

by 202_cyclist on Jun 6, 2013 3:40 pm • linkreport

@AWalkerInTheCity

You are just making this up now. Where --point to just one place-- where I said anything about mandatory helmet laws.

by 202_cyclist on Jun 6, 2013 3:41 pm • linkreport

Since you are so knowledgeable

what proportion of bike fatalities involve head injuries?

what is the statistical relationship between not wearing a helmet and other biking attributes? (such as riding an unsafe bike, riding without lights, etc)

What is the impact of helmet laws on ridership?

What is the impact of ridership on safety?

how many cyclists have contracted melanoma from riding without sun block?

by AWalkerInTheCity on Jun 6, 2013 3:42 pm • linkreport

My point is that the helmet did nothing. Hours ago I said that too many proponents of helmets think the sole issue is a binary wear/don't wear. It's more complicated than that. It has to include the effect of suppressing rates of healthful riding, and it has to recognize that we need better data on helmet design/effectivness.

by Crickey7 on Jun 6, 2013 3:43 pm • linkreport

I'd like to ask to put an end to the "why are you against..." or "why won't you admit..." and so on. Feel free to keep arguing this back and forth for weeks if you want, but we don't want the debates to be personal, and that is too close to personal.

I am going to start editing any comment which has the word "you" or something of that nature employed in a negative, accusatory, critical, etc. way.

by David Alpert on Jun 6, 2013 3:44 pm • linkreport

@Crickey7

No brain trauma or concussions despite what sounded like a fairly serious crash. It sounds like the helmet did exactly the job it is suppose to do. You wouldn't expect a helmet to prevent a broken collarbone, bruised knee, or scratched cheek. That is not what helmets are designed to do. As a result of the accident, was there or was there not any brain trauma, skull fracture, concussion, or similar injury?

by 202_cyclist on Jun 6, 2013 3:47 pm • linkreport

202

Bike helmet laws, and other related public policies are what this is about. Its not whether WABA or Dave C or JimT or myself suggest wearing a helmet (we all DO)

So unless you are just arguing for the sake of arguing, or unless you currently or formerly worked at NHTSA and have a personal stake in JimT's criticism of the agency, Im not sure what you are getting at.

My own posts that you found so objectionable were specifically addressed to MANDATING things.

In fact we live in a world were elected officials have called for mandatory bike helmet laws in the USA. Where many more citizens have so argued. Where people oppose bike share because many bike share riders do not wear helmets. Where potential riders are deterred from riding due to perceptions about bike safety.

I also note that while you have not called for mandatory bike helmet laws in this thread, neither have you stated your opposition to them.

by AWalkerInTheCity on Jun 6, 2013 3:48 pm • linkreport

"Why are you so strongly against a simply, inexpensive, device that prevents serious brain injuries?"

One more time, no one here is opposed to helmets.

I ride with a helmet.

I merely support JimTs call for more accurate data, and I oppose policies whose NET effects on public health I believe would be negative.

by AWalkerInTheCity on Jun 6, 2013 3:50 pm • linkreport

@202_cyclist: This type of study is generally viewed as biased high, because it equates relative risk with the odds ratio.

I'm waiting for Sara to jump in with a better explanation of how these studies work, but in the meantime, here is what they do:

First, they look at people with head injuries, and get the ratio of people withe helmets. Call that:

HI_helm/HI_nohelm.

Then they look* for data on the total fraction of people wearing helmets. Call that

helm/no_helm.

Then they calculate the odds ratio:

odds = (HI_helm/HI_nohelm)/(helm/no_helm)

Then they recall that mathematicians have long known that under some circumstances,

relative_risk = 1 - odds.

They hope those circumstances apply, and declare that they have estimated relative risk.

Note that the people who are saved by helmets do have an impact on the study: Had they not been saved but worn a helmet, then the first ratio would have been higher.

*They don't usually have data allowing them to estimate (helm/no_helm). So they look for something that they hope will be close. Often what they do is go to the hospital and get that ratio for people with a bike accident but no head injury. One might doubt that this is good enough.

We stayed away from that in our challenge. The government has the discretion to decide that the state of the art is better than nothing, and NHTSA and CDC based 85% on the Thompson study. So we just pointed out that the rest of the studies got a lower answer.

by JimT on Jun 6, 2013 3:50 pm • linkreport

@AWalkerInTheCity:

Noboday has mandating anything and nobody has suggested this on here. The title of this post is, "Feds will stop hyping effectiveness of bike helmets." This makes it sound as if helmets are not effective in prevent brain injuries. This is simply not the case.

Also, as I have pointed out your post and others have compared wearing a helmet to cutting vegetables. Again, this trivializes the chances of brian injury from a bike crash. This is irresponsible to do.

by 202_cyclist on Jun 6, 2013 3:52 pm • linkreport

You totally miss what I'm saying. The helmet barely contacted the ground. It was essentially untouched.

To recap:

I wore a helmet. I crashed. I hit my head. I went to the hospital. My helmet was a non-factor.

by Crickey7 on Jun 6, 2013 3:53 pm • linkreport

@Jim T:

Again, if you only looked at people in the Emergency Room or on the operating table and used that to judge the effectiveness of seatbelts, you might very well conclude they are only effective 40% of the time. This isn't the sample size you should be looking at. To suggest that only looking at the cyclists who came to the emergency room is severely flawed.

by 202_cyclist on Jun 6, 2013 3:54 pm • linkreport

@Crickey:

I wore a helmet once when I crashed and scraped my knee. Why would you expect a helmet to protect your chin, cheek or other part of your face where you got stitches. That is not what they are designed to do.

by 202_cyclist on Jun 6, 2013 3:57 pm • linkreport

[This comment has been deleted for violating the comment policy.]

by AWalkerInTheCity on Jun 6, 2013 3:59 pm • linkreport

Again, if you only looked at people in the Emergency Room or on the operating table and used that to judge the effectiveness of seatbelts, you might very well conclude they are only effective 40% of the time. This isn't the sample size you should be looking at. To suggest that only looking at the cyclists who came to the emergency room is severely flawed.

NO.

It is not flawed in the way you describe. The study looks at people who HAD head injuries and also people who DID NOT have head injuries. The seat belt analogy doesn't compare two different populations, it's only looking at one.

by MLD on Jun 6, 2013 4:01 pm • linkreport

"Noboday has mandating anything"

http://articles.baltimoresun.com/2013-02-13/news/bs-md-bike-helmet-law-20130212_1_helmet-law-bike-lane-advocates-fight

by AWalkerInTheCity on Jun 6, 2013 4:05 pm • linkreport

@MLD:

Again, it is simple. Very simple. Wearing a bike helmet like prevents many cyclists from needing to go to the hospital. No trip to the hospital, nothing to count. Nothing to count, smaller number of total accidents reported.

by 202_cyclist on Jun 6, 2013 4:10 pm • linkreport

@MLD:

The cyclists at the hopsital are also the most serious injuries. Thus, not only are the total number of bike accidents grossly underreported but the ones that are observed at the hospital are the most serious injuries. Two flaws with this study.

by 202_cyclist on Jun 6, 2013 4:14 pm • linkreport

@MLD:

Show me where on this posting, anyone has proposed a mandatory helmet law.

by 202_cyclist on Jun 6, 2013 4:25 pm • linkreport

"Wearing a bike helmet like prevents many cyclists from needing to go to the hospital."

That's an assumption. Shouldn't we test that, rather than assume it?

by Crickey7 on Jun 6, 2013 4:28 pm • linkreport

@Crickey7:

Sure, that is what should be tested but that isn't what was used by WABA or Jim T to criticize NHTSA's promoting the use of bike helmets.

As Sara above asked, if helmets prove even more effective as the result of such as study, would WABA issue an appology? Will they advocate for helment use?

by 202_cyclist on Jun 6, 2013 4:33 pm • linkreport

@202_cyclist: Would you care to explain how you would conduct a case-control study? Or do you think that this particular method is always inadequate?

In light of what you are saying, would you agree with the 8th paragraph of this post, which seems to be making the same point as what you said?

But let's make sure we are on the same page as to what they do:

1. They are pretty good for calculating the fraction of people wearing helmets, from among those with the head injury. Would you agree?

2. They are not so good for calculating the fraction of people wearing helmets from among those who did not get a head injury. Would you agree?

3. Whether they are biased high or low in estimating the relative risk reduction, depends on whether over- or under-estimate the fraction of people wearing helmets among those who did not get a head injury. Agree?

4. Off hand, we can not say whether the people who go to the hospital after a bike crash without a head injury, are more or less likely to have worn a helmet than the rest of the population. Agree?

by JimT on Jun 6, 2013 4:34 pm • linkreport

What a load of crap. I have been using bicycle helmets since they were the ugly egg shaped white Bell helmets, including when I raced (and got teased horribly by my teammates). I have been saved from horrible head injury/death many, many times over the years and any helmet is better than no helmet.

by Una Nelson-White on Jun 6, 2013 4:35 pm • linkreport

why keep repeating the same arguments with someone who's obviously not listening?

by Mike on Jun 6, 2013 4:36 pm • linkreport

@202_cyclist - every study has flaws. that is the nature of epidemiological research. A better study design for this injury would be a longitudinal study. Case-controls are undertaken often because they are cheap and fast to do and can provide some observational information that can be used to decide if more research is warranted. If you want a flawless study it will not be found in this universe. However a better study is a longitudinal one. I encourage you to volunteer if ever approached to participate in such a study.

The state of MD had a bill introduced this winter/spring that would mandate helmets. That is the genesis of this debate locally.

by Tina on Jun 6, 2013 4:37 pm • linkreport

The point isn't that people in the comments have (and nobody accused you of doing so), the whole point of this series has been that in Maryland this was a serious proposal and proponents of these proposals use terrible stats like the 85% paper to back their claims up. Even when the rest of the research says otherwise. And the contradictory research was not done by bike advocates, or anti-helmet forces, but by OTHER RESEARCHERS and published in peer-reviewed journals.

On the research, respectfully you are severely mistaken. The papers don't try to come up with some "injuries saved" number for the total cycling population. People who don't go to the hospital don't need to be counted, because you don't need to count them to figure out what impact helmets have on safety.

All you have to do is look at two things:
1. People who went to the hospital with a head injury from cycling
2. People who went to the hospital with an injury (but NOT a head injury) from cycling

By comparing the helmet-wearing rates of these two groups, you can figure out a number. This number tells you: "in an injury-causing crash, what effect does a helmet have in decreasing head injuries?" You don't have to measure the people who never had an injury at all; what would that tell you?

Actually, it would probably tell you that bicycling is pretty safe period and so whether you wear a helmet or not doesn't really affect your overall chance of being injured that much, since crashes are not that frequent.

I will also point out that Jim cited research numbers to contradict other research, but both were numbers. What you are arguing for is a non-numbers based approach, essentially an approach without information. So instead of proof, you just want us to trust your gut that helmets are better?

by MLD on Jun 6, 2013 4:37 pm • linkreport

no one ON THIS THREAD has proposed a mandatory helmet law (including at least one individual who has not disavowed support for such a law) JUST AS no one ON THIS THREAD has opposed helmet use (and indeed we all wear helmets).

However once again the reason this MATTERS is because of debates over mandatory helmet laws, debates about the safety and desirability of bike share systems, debates (such as in virgnia) about the desirability of laws that would encourage more biking - and because of individual pereceptions of the safety of biking.

I understood that to be the context for Jims post. If you are familiar with current issues in transportation, I might think you would understand this to be the context.

by AWalkerInTheCity on Jun 6, 2013 4:38 pm • linkreport

@JimT:

It has been several years but since I took research methods but how can you ever conclude that the people who do go to he hospital with bicycle-related injuries are representative of all cyclists who've crashed? I am not a researcher but there seems to be serious methodological issues with this. Again, I have probably crashed three dozen times. I have only gone to the hospital once.

Until you can account for all of the unreported crashes where the cyclist walks away fine because he/she was wearing a helmet, these studies will be seriously flawed.

Again, I go back to the seatbelt example. Only looking at auto-crash victims at the emergency room leads you to ignore all of the people who were fine after small fender-benders because they were wearing a seatbelt.

by 202_cyclist on Jun 6, 2013 4:46 pm • linkreport

"As Sara above asked, if helmets prove even more effective as the result of such as study, would WABA issue an appology? Will they advocate for helment use?"

WABA already advocates for helmet use.

http://www.waba.org/education/documents/FittingaBikeHelmet.pdf

"Bicycle safety is one of WABA’s central missions, and we have strongly supported bicycle helmets for the last few decades. We require helmets on all rides that we organize. One of our sponsored projects is the Bicycle Helmet Safety Institute (BHSI), which reviews bicycle helmets and encourages improvements in their design. (BHSI raises its own funds, and is not supported by WABA membership dues.)"

by AWalkerInTheCity on Jun 6, 2013 4:47 pm • linkreport

@MLD:

"On the research, respectfully you are severely mistaken. The papers don't try to come up with some "injuries saved" number for the total cycling population. People who don't go to the hospital don't need to be counted,:

Nope, it is this that is severely mistaken. It is precisely injuries averted that helps you judge the effectiveness of wearing a bike helmet. That is specifically what they are designed to do. Bike helmets are not designed to help you watch the Nationals, make a cup of coffee, or brush your teeth. They are designed to avert injuries. To suggest otherwise suggests a serious misunderstanding.

by 202_cyclist on Jun 6, 2013 4:50 pm • linkreport

"Again, I go back to the seatbelt example. Only looking at auto-crash victims at the emergency room leads you to ignore all of the people who were fine after small fender-benders because they were wearing a seatbelt."

there are large numbers of cyclists who are hospitalized for reasons unrelated to head injuries - since presumably a helmet has no impact on THOSE injuries, they can provide a control.

Suppose people hospitalized for those injuries had the same rates of helmet usage as people hospitalized for head injuries. That would seem to suggest that those hospitalized for head injuries were no more likely to be helmetless than the general biking population.

by AWalkerInTheCity on Jun 6, 2013 4:51 pm • linkreport

@MLD:

"By comparing the helmet-wearing rates of these two groups, you can figure out a number. This number tells you: "in an injury-causing crash, what effect does a helmet have in decreasing head injuries?" You don't have to measure the people who never had an injury at all; what would that tell you?"

Injury-causing crashes are only the worst crashes. Helmets are designed to prevent injuries, of course. You absolutely have to count all of the crashes where there were no injuries to evaluate the effectiveness of helmets.

by 202_cyclist on Jun 6, 2013 4:52 pm • linkreport

@202_cyclist - Until you can account for all of the unreported crashes where the cyclist walks away fine because he/she was wearing a helmet, these studies will be seriously flawed.

Again, I encourage you to participate if ever approached to volunteer for a longitudinal study on the crash-injury risk of biking.

You seem to be agreeing that the data on which NHTSA based its conclusion is flawed. We have better data for car crashes than we do for bike crashes -primarily b/c car crashes contribute to 10's of thousands of fatalities and injuries a year (see FARS) and thus warranted data collection and study.

Are you familiar with biking rates in the Netherlands and Denmark? Helmet wearing is not the socially accepted norm there that it is here,-most do not wear helmets-the opposite from the US - yet the injury rate-including head injuries- to the population of bicyclers is much lower than it is here. Do you have a hypothesis for that difference?

by Tina on Jun 6, 2013 4:54 pm • linkreport

"Nope, it is this that is severely mistaken. It is precisely injuries averted that helps you judge the effectiveness of wearing a bike helmet. That is specifically what they are designed to do. Bike helmets are not designed to help you watch the Nationals, make a cup of coffee, or brush your teeth. They are designed to avert injuries. To suggest otherwise suggests a serious misunderstanding."

but its impossible to directly tell that.

So you look at the differences in helmet use between people who sustained serious injuries, and the general population of cyclists. To get a proxy for that, you use cyclsits hospitalized for non head injuries. If helmets are very effective, there should be few helmted riders among the injured, compared to the general cyclist population. Its the hospitalizedfor other reasons who are the control - they represent both those who had no head involvemnet, and those whose head injuries were prevented by a helmet.

by AWalkerInTheCity on Jun 6, 2013 4:55 pm • linkreport

Injury-causing crashes are only the worst crashes. Helmets are designed to prevent injuries, of course. You absolutely have to count all of the crashes where there were no injuries to evaluate the effectiveness of helmets.

This sounds like a great cohort study. Why don't you do it?

by Tina on Jun 6, 2013 4:57 pm • linkreport

Tina:

In the Netherlands, cyclists are usually going
1) much slower
2) Dutch-style bicylists are heavier and more stable
3) cyclists are more experienced
4) larger bike culture likely leads bikes to be better maintained.

In the Netherlands and other European countries, a lot more people also smoke, so I don't really see your point. People in Europe can make poor decisions as well.

by 202_cyclist on Jun 6, 2013 4:58 pm • linkreport

@Tina:

If you're willing to fund it, perhaps. To rely on a couuple of flawed studies, however, to question the safety and effectiveness of helmets is irresponsible.

by 202_cyclist on Jun 6, 2013 4:59 pm • linkreport

Nope, it is this that is severely mistaken. It is precisely injuries averted that helps you judge the effectiveness of wearing a bike helmet. That is specifically what they are designed to do.

They are designed to avert head injuries. And that's what the studies do, because they look at people who had head injuries and those who did not. Those who did not have head injuries make a fine control group - it does not matter that there are zillions of people out there who crashed and had no injuries at all. You ignored my earlier comment where I pointed this out.

The difference between this and your seat belt example is that the seat belt example has no control. It doesn't compare anything. The bike research compares people who got the injury helmets are designed to prevent (HEAD injury) with those who did not get head injuries. Do helmets prevent other non-head injuries? I don't think so.

It has been several years but since I took research methods
I am not a researcher

Then I suggest that it would be wise to listen to the 3+ people who do know what they are talking about and are telling you that you are mistaken.

by MLD on Jun 6, 2013 5:00 pm • linkreport

To rely on a couuple of flawed studies, however, to question the safety and effectiveness of helmets is irresponsible.

The NHTSA relied on ONE study for it's 85% number.

The paper Jim cites in this article relies on more than 13 studies to come to its conclusions.

Who has more research behind their number?

by MLD on Jun 6, 2013 5:02 pm • linkreport

I'm not sure anyone is questioning the safety of helmets. They're saying that certain conclusions have been bandied about without question, that there are significant methodological issues with the single study on which those conclusions were drawn, and that they are so flawed as to be useless as a guide for action.

by Crickey7 on Jun 6, 2013 5:06 pm • linkreport

@202_cyclist -I have ridden in both places and I did not find the Dutch and Danes to be slower.

The reason for better safety is multifactoral -the most important factors you left out: safety in numbers and all the downstream consequences of that including investment in facilities and the culture among car drivers and laws.

Mandatory helmet laws have been shown to depress numbers of bikers. The effect of that is decreased overall safety, and increased bad outcomes associated with chronic disease caused by lifestyle.

by Tina on Jun 6, 2013 5:06 pm • linkreport

@MLD:

"The difference between this and your seat belt example is that the seat belt example has no control. It doesn't compare anything. The bike research compares people who got the injury helmets are designed to prevent (HEAD injury) with those who did not get head injuries. Do helmets prevent other non-head injuries? I don't think soL

Again, you should be comparing people who got head injuries vs those who didn't (including those at the hospital and those who were able to walk away because their head was protected). This is the relevant sample size.

by 202_cyclist on Jun 6, 2013 5:10 pm • linkreport

@Tina:

"The reason for better safety is multifactoral -the most important factors you left out: safety in numbers and all the downstream consequences of that including investment in facilities and the culture among car drivers and laws."

I have seen several crashes on the W&OD trail (I also know of one fatality several years ago). There are zero cars on the W&OD trail, plenty of bicyclists, and excellent, paved facilities. Should cyclists not wear helmets there?

by 202_cyclist on Jun 6, 2013 5:13 pm • linkreport

" This is the relevant sample size."

sample size doesn't mean what you think it does.

you are in way over your head man.

by AWalkerInTheCity on Jun 6, 2013 5:14 pm • linkreport

"I have seen several crashes on the W&OD trail (I also know of one fatality several years ago). There are zero cars on the W&OD trail, plenty of bicyclists, and excellent, paved facilities. Should cyclists not wear helmets there?"

Where has anyone here said cyclists should not wear helmets?

by AWalkerInTheCity on Jun 6, 2013 5:15 pm • linkreport

Again, Tina, nobody on this blog has discussed mandatory helmet laws. You should not object to the use of helmets, however, because of the what policies some legislature may or may not choose to enact.

by 202_cyclist on Jun 6, 2013 5:16 pm • linkreport

@AWalkerInTheCity:

Here is what another person said, just two posts ago:

"The reason for better safety is multifactoral -the most important factors you left out: safety in numbers and all the downstream consequences of that including investment in facilities and the culture among car drivers and laws."

Even when you have Copenhagen-like conditions here, there are still hazards to cyclists, hazards that should be mitigated by wearing a helmet. Tina implies that if only we had better infrastructure, we would not need bike helmets. In fact, she notes that they aren't the 'social norm' in Amsterdam.

by 202_cyclist on Jun 6, 2013 5:18 pm • linkreport

Again, you should be comparing people who got head injuries vs those who didn't (including those at the hospital and those who were able to walk away because their head was protected). This is the relevant sample size.

Whew, glad you caught this glaring problem that the peer reviewers at the NEJM and other major journals missed! Thank you, 202_cyclist!

Seriously though, you have no idea what you're talking about.

by MLD on Jun 6, 2013 5:19 pm • linkreport

"Again, Tina, nobody on this blog has discussed mandatory helmet laws. You should not object to the use of helmets, however, because of the what policies some legislature may or may not choose to enact. "

no where has tina objected to the use of helmets. What several of us have objected to is the posting of a misleading statistic, that HAS been used in support of effort to pass mandatory helmet laws.

BTW, Im curious, do you personally support mandatory helmet laws?

by AWalkerInTheCity on Jun 6, 2013 5:19 pm • linkreport

We know that good hygiene and sanitation prevent disease. We still conduct studies into how they do it, and what methods are more effective than others, becuase it's not enough just to know that something works.

by Crickey7 on Jun 6, 2013 5:22 pm • linkreport

"The reason for better safety is multifactoral -the most important factors you left out: safety in numbers and all the downstream consequences of that including investment in facilities and the culture among car drivers and laws."

Even when you have Copenhagen-like conditions here, there are still hazards to cyclists, hazards that should be mitigated by wearing a helmet. Tina implies that if only we had better infrastructure, we would not need bike helmets. In fact, she notes that they aren't the 'social norm' in Amsterdam."

what she noted is that Amsterdam has less helmet use than we do, and yet fewer accidents. She implied that its because of certain factors, most notably critical mass - critical mass is hurt by mandatory helmet laws - helped by bike share (which is resisted for reasons related to helmets) and hurt by the fear of biking being "dangerous". You suggested other reasons amsterdam may be safer, which she contested.

None of that implies its a bad idea to ride with a helmet, or to ride with a helmet on the W&OD.

by AWalkerInTheCity on Jun 6, 2013 5:22 pm • linkreport

@202_cyclist 1) its not a "sample size", its the population from which your sample is drawn. The number of people you get from that frame is the sample size. The size from any frame can be large or small.

Your hypothesis is that this single case-control study underestimated the effectiveness of helmets to prevent head injury -is that right? The thing about the scientific method is that one must develop a hypothesis and test it. One can't just throw out a hypothesis and claim its true w/o testing it because "conventional wisdom" seems to support it.

The history of epidemiology is the history of conventional wisdom being shown wrong. See Semmelweis, see Snow, see Likcint, see the Framingham study, see "Back to Sleep", see the Diabetes Prevention Program, etc.

by Tina on Jun 6, 2013 5:23 pm • linkreport

We're not objecting to the use of helmets, we're objecting to your foaming at the mouth about how it's irresponsible to pick at any data about helmets. Or claim that there are other, safer things people should concentrate on more.

Your attitude is detrimental to cycling.

by MLD on Jun 6, 2013 5:24 pm • linkreport

and BTW as an aside the W&OD is NOT copehagen like conditions, or cope isnt at all like what Ive been led to beleive - do they have runners, walkers, dogs with leashes across the trail, etc on the cycle tracks in Copenhagen?

by AWalkerInTheCity on Jun 6, 2013 5:24 pm • linkreport

@202_cyclists - You should not object to the use of helmets

I do not object to the use of helmets. i wear a helmet and I encourage others to wear a helmet. I have noted that helmet wearing is the norm in the US.

What I object to are mandatory helmet laws for reasons stated above.

What I object to is NHTSA basing policies on outdated data.

I also object to USDOT using inaccurate data about segregated bicycle tracks in setting policy, something it has done for 40 years.

by Tina on Jun 6, 2013 5:27 pm • linkreport

@MLD:

How is my attitude detrimental to cycling? If you ride enough, eventually you are going to hit the pavement. When you do so, your head should be protected. I ride 3,000 - 4,000 miles per year, by the way.

by 202_cyclist on Jun 6, 2013 5:28 pm • linkreport

" I ride 3,000 - 4,000 miles per year, by the way."

do you realize that does not lend credence to the mistaken things you have said about the data, studies, and policies in question?

by AWalkerInTheCity on Jun 6, 2013 5:30 pm • linkreport

@Tina wrote: If you're willing to fund it, perhaps. To rely on a couuple of flawed studies, however, to question the safety and effectiveness of helmets is irresponsible.

One of the things missing in this umpteenth repetition of helmet/no-helmet argument, is that there is no constituency to fund such studies. Likewise, the sort of studies I suggested above, which could lead to real improvements of helmets.

A number of people have noted how bad the bike helmets are: clunky and uncomfortable, with no face and neck protection. So of course people don't like to wear them. But who has the money to fund improvements, or comparative studies? Studies like that cost a couple of million $. For cars there are car insurance agencies and automobile makers, but for biking, nothing. The advantage of bike, its inexpensiveness, is its disadvantage here. Unlike a car, the safety equipment is separate from the bike, so frame maker have no interest in this problem.

by goldfish on Jun 6, 2013 5:32 pm • linkreport

@Tina, et al:
"What I object to is NHTSA basing policies on outdated data."

If helmets are proven safer than these studies indicate, will you actively advocate the use of bike helmets?

by 202_cyclist on Jun 6, 2013 5:33 pm • linkreport

@202_cyclist: if you are willing to assume that helmeted and unhelmeted cyclists get into the same composition of accidents, then all you need is the fraction of head-injured cyclists wearing a helmet, and the fraction of all cyclists who wore a helmet. This takes awhile to wrap your mind around but it is a consequence of Bayes theorem.

by JimT on Jun 6, 2013 5:33 pm • linkreport

cyclists should be able to question data on bike helmets, without being accused of opposing the wearing of helmets.

by AWalkerInTheCity on Jun 6, 2013 5:34 pm • linkreport

"If helmets are proven safer than these studies indicate, will you actively advocate the use of bike helmets?"

I gave money to WABA, which actively advocates the use of bike helmets. Even without any additional studies.

Now will you tell us if you support mandatory bike helmet laws?

by AWalkerInTheCity on Jun 6, 2013 5:36 pm • linkreport

@JimT
"if you are willing to assume that helmeted and unhelmeted cyclists get into the same composition of accidents, then all you need is the fraction of head-injured cyclists wearing a helmet, and the fraction of all cyclists who wore a helmet. This takes awhile to wrap your mind around but it is a consequence of Bayes theorem."

Nope, not at all. The cyclists I see not wearing helmets are not at all representative all cyclists. Most of the most confident, experienced cyclists I see while biking to work 3-4 days per week all wear helmets.

by 202_cyclist on Jun 6, 2013 5:36 pm • linkreport

I ride 3,000-4,000 miles a year, and it ticks me off that such rubbish about something so potentially important gets preserved as gospel. We deserve real facts, even if they upset prior understandings. Especially if they upset prior understandings.

by Crickey7 on Jun 6, 2013 5:37 pm • linkreport

"Nope, not at all. The cyclists I see not wearing helmets are not at all representative all cyclists. Most of the most confident, experienced cyclists I see while biking to work 3-4 days per week all wear helmets."

where I live those not wearing helmets mostly appear to be hispanic immigrants. They disprorportionately ride not only without helmets, but without lights at dusk (or even at night) often against traffic. Think about that.

by AWalkerInTheCity on Jun 6, 2013 5:39 pm • linkreport

"The cyclists I see not wearing helmets are not at all representative all cyclists. "

you missed the point - its that cyclists INJURED for things other than head injuries are representative of all cyclists. Not that non helmet wearers are.

Again, do you think that helmets prevent injuries other than head injuries?

by AWalkerInTheCity on Jun 6, 2013 5:40 pm • linkreport

@202_cyclist-I have seen several crashes on the W&OD trail
The W&OD is a multiuse trail, not a segregated bicycle track. The latter are the safest for biking. Multiuse trails are less safe than riding in the road with cars (with road defined)

by Tina on Jun 6, 2013 5:45 pm • linkreport

@202_cyclist- Even when you have Copenhagen-like conditions here, there are still hazards to cyclists, hazards that should be mitigated by wearing a helmet. Tina implies that if only we had better infrastructure, we would not need bike helmets. In fact, she notes that they aren't the 'social norm' in Amsterdam.

The w&od are a far cry from the segregated bike tracks such as is found in Denmark. Multi-use trails such as the W&OD are not the same and are more dangerous then segregated bike tracks.

by Tina on Jun 6, 2013 5:48 pm • linkreport

@AWalkerInTheCity

He's saying that unhelmeted cyclists are untrained rubes who get into more accidents than the pros with 3K-4K miles per year under their belts.

by MLD on Jun 6, 2013 5:49 pm • linkreport

@goldfish - i did NOT write this
If you're willing to fund it, perhaps. To rely on a couuple of flawed studies, however, to question the safety and effectiveness of helmets is irresponsible.

by Tina on Jun 6, 2013 5:52 pm • linkreport

@202_cyclist - If helmets are proven safer than these studies indicate, will you actively advocate the use of bike helmets?

I already do! I advocate helmet wearing!! I ADVOCATE HELMET WEARING!! I do NOT support policies based on outdated or incomplete data; I do NOT support mandatory helmet laws.

by Tina on Jun 6, 2013 5:54 pm • linkreport

But MORE than helmet wearing - as a priority above helmet wearing - I advocate using lights!!!!!

by Tina on Jun 6, 2013 6:03 pm • linkreport

@202_cyclist: I overlooked one of your previous comment to which I shall respond when I have a better keyboard.

If you think that helmeted cyclists are less likely to get into a serious accident than unhelmeted, I hope you can see how the simple odds ratio approach would thus attribute injuries to the lack of a helmet that are actually caused by other factors. Thus the Thompson study's simple odds ratio of .25 was too low. Yet when they did their logistical regressions for an adjusted odds ratio they got an even lower odds ratio of 0.15.

I should mention that there are two ways of looking at these studies. In theory the "control" is like a c

by JimT on Jun 6, 2013 6:04 pm • linkreport

Ditto on lights. Consider using them in flashing mode even in daylight.

by Crickey7 on Jun 6, 2013 6:09 pm • linkreport

...control population and is representative of every cyclist in the population as far a helmet wearing. And we do the math one way. Or we can view it as every person who is similar to the head injured except for helmets and head injuries. The statistical analyses try to split the difference between those two extremes and are a bit of both.

by JimT on Jun 6, 2013 6:10 pm • linkreport

@202_cyclist and others: Here is a decent explanation of case control studies, especially section 5.

by Jim Titus on Jun 6, 2013 7:01 pm • linkreport

Today my daughter showed her kindergarden class how she rode on a balance bike and now on an ordinary bike, without training wheels and with a helmet. Each child shows a talent and the other children ask questions or comment.

Earlier in the week another child had also brought in a bike, but without a helmet. This is a Quaker s school where c

by JimT on Jun 6, 2013 8:11 pm • linkreport

...comments are welcome but affirmations are the best. I smiled as one little girl who is always the best at affirmations said: " You ride very safely."

by JimT on Jun 6, 2013 8:14 pm • linkreport

@202
The conclusion to be reached is that helmets are likely far more effective than these studies have estimated if they prevented trips to the hospital in the first place.

How should they measure how many trips to the hospital were prevented?

Wearing a bike helmet like prevents many cyclists from needing to go to the hospital.

OK, where is the proof?

If the claim is that helmets reduce risk, and existing studies is the proof of that, you can't then turn around and say that those studies are massively flawed and that therefore helmets are even safer. If the studies are flawed, then you have no proof that helmets reduce risk and so you have no basis for the claim.

how many bike accidents/crashes lead to trips to the hospital? I have no idea but I think it is a very small percent out of the total number of crashes.

If very few people are in crashes, and very few crashes lead to trips to the hospital, why do we need to wear helmets again?

To rely on a couple of flawed studies, however, to question the safety and effectiveness of helmets is irresponsible.

No more irresponsible than relying on those same "flawed" studiies to prove the safety and effectiveness of helmets

@Una I have been saved from horrible head injury/death many, many times over the years and any helmet is better than no helmet.

Wow, maybe you need to slow down or something. I know a bike messenger who's been doing that for like 30 years, never wears a helmet and will crush almost anyone in speed chess.

by David C on Jun 6, 2013 9:58 pm • linkreport

Bizarre debate.
If some are concerned that helmets might reduce cycling, why not exempt bikes from consumer product liability laws completely so bikes will be cheaper and more widely available. Lead paint goes on smooth and shiny, and it might help attract kids to biking.

All these cyclists paranoid about government mandating something say they always do anyway. Not exactly textbook tyranny. Especially as helmets have evolved, the real shared enemy is right beneath our nose: chin straps. I hate them chin straps.

by Mtp on Jun 6, 2013 11:35 pm • linkreport

Ask football players how well helmets protect against brain injury. Bicycle helmets don't protect you from brain injury but they might protect you from a skull fracture.

It's really a ridiculous argument to be having. For any casual cyclist (not the MAMIL/road warrior type) cycling at 5-10mph is no more dangerous than going for a run through your neighborhood and far less dangerous than driving a car. Should NASCAR drivers wear helmets? Certainly! Should a motorist going around the block to the grocery store strap it on?

Recent studies here in Australia (where helmets are mandatory for everyone) make it quite clear that helmet laws severely curtail casual/utilitarian use, don't provide an important reduction in head injuries and that the fastest way to reduce head injuries for cyclists, motorists and pedestrians alike is to crack down on aggressive/dangerous drivers.

Cycling isn't dangerous. Getting hit by a car is dangerous.

by jbris on Jun 7, 2013 3:23 am • linkreport

@Mtp, you missed my comment up thread where i pointed out that reflectors are mandatory (built into all new bikes sold for about 35 years now) and lights are legally mandated, and there is no protest to that.

The issue is incomplete data regarding the ability of helmets to reduce injury risk and the effect of mandatory helmet laws based on those data.

by Tina on Jun 7, 2013 8:01 am • linkreport

jbris:
"It's really a ridiculous argument to be having. For any casual cyclist (not the MAMIL/road warrior type) cycling at 5-10mph is no more dangerous than going for a run through your neighborhood and far less dangerous than driving a car."

Falling from several feet above ground and hitting your head on the hard asphalt going 10 mph is not inconsequential. You can cause serious injury to your head and skull from that. Additionally, I have stated several reasons above why there are a lot more risks of falling while biking than running.

David C:
"Wow, maybe you need to slow down or something. I know a bike messenger who's been doing that for like 30 years, never wears a helmet and will crush almost anyone in speed chess."

First, isn't one of the reasons to bike to get somewhere efficiently? Second, there are also people who smoke a pack of cigarettes each day and that don't have heart disease or cancer. I don't really understand your point. I also know someone who was hit by a car last year while biking. He was knocked off his bike and hit is back and head. He needed physical therapy for his back but his head was fine because he was wearing a helmet.

by 202_cyclist on Jun 7, 2013 8:16 am • linkreport

@202_cyclist -

Your acquaintance was not injured from "falling". He was injured from being struck by a car. The danger in that illustration is the car and car driver.

by Tina on Jun 7, 2013 8:40 am • linkreport

No, Tina. I don't think either of us are doctors but his injury was from striking the pavement-- again hitting hard asphalt from several feet in the air.

by 202_cyclist on Jun 7, 2013 8:42 am • linkreport

possibly if there were more cyclists around the driver would have been more alert to look for cyclists - or that might even have been better infrastructure.

lack of critical mass has consequences.

That has to be part of the discussion of mandating helmets.

Which btw, HAS now been advocated IN THIS THREAD - by mtp.

So, can we hear whether you support mandatory helmet laws.

You have been debating this for two days, and I still do not see your position on mandatory helmet laws.

by AWalkerInTheCity on Jun 7, 2013 8:53 am • linkreport

@Una: I have been saved from horrible head injury/death many, many times over the years and any helmet is better than no helmet.

I rode a bike for years and years without a helmet -- because that's how old I am -- and never crashed. This includes the 2 years I rode a bike without functional brakes. (It seemed like a good idea at the time.) Then I started wearing a helmet, and that very same year, I crashed twice: once on the road and once from being doored. Therefore, I conclude that helmet-wearing is hazardous and causes crashes.

(Note: I don't actually conclude this. And I do wear a helmet.)

by Miriam on Jun 7, 2013 9:01 am • linkreport

@202, my point is that I don't believe his life has been saved "many, many times over the years". The only way he could know that would be to recreate the experience without a helmet and see if he dies. What has happened is that he has fallen many many times and he had a helmet on and he didn't die. But we don't know that he didn't die because of the helmet.

My other point is that if you're involved in many many crashes over the year that could have had severe repercussions then maybe you aren't a very good cyclist and you should take a class or slow down or stop drinking or get some new glasses or something because that is certainly not the norm.

Finally, if

1. the average cyclist were involved in many, many crashes over the years (let's call it one every 10 years?) that would have resulted in horrible head injury/death but for a helmet.

2. And, about 50-70% of cyclists wear helmets

Then about 30-50% of all cyclists should be dying every ten years, or about 3-5% of all cyclists should die every year. But that isn't what happens, which means that his entire comment is complete and utter horsepucky.

Those are my points.

by David C on Jun 7, 2013 9:39 am • linkreport

Like I said in my previous post riding at speed or in large groups is dangerous. From the speeds that people keep posting on here yes, you should all be wearing helmets. But you also shouldn't be comparing your road-warrior/MAMIL cycling experiences on higher speed suburban and exurban roads with some 28 year old using bikeshare to ride a mile through the city to get to work.

I've been a mostly casual rider in urban environments for 30 years. I rarely ride out to the suburbs because it's dangerous and because I know a helmet is going to stop a car from running you down. As has been stated, this report doesn't mention how many people with TBIs were wearing helmets, how fast they were going and where they were when they crashed. I'm going to venture a guess that a good many of them are amongst the risk takers - the macho guys who like to take cycling to a dangerous extreme - the ones cruising the hills in the peloton on the weekends trying to muscle cars out the way.

I own a 3/4 skateboard helmet (I've watch too many of those little syrofoam mushroom lids not do what you all are saying they're supposed to do) that I wear whenever i take my road bike out or whenever i go on a group ride. When I ride the 5 blocks to the grocery store on my english racer, going 10mph on one-way streets where the speed limit is 20mph I don't wear a helmet . . . because it's no more dangerous than a hundred other things I could do that I don't wear a helmet for either.

@202

"Falling from several feet above ground and hitting your head on the hard asphalt going 10 mph is not inconsequential."

I'm not sure how you run but I do it upright on two feet. When I'm running at full stride my head comes up maybe 6-10 inches higher than if I were just standing there (so my head is 6-7ft off the ground). My normal riding position is fairly upright but I also ride a properly fitted bike so when i'm upright in the saddle I'm only about 6 inches higher than if I was just standing there. I have no idea where you're getting this "several feet" business. As someone who has wiped out on a bike more than a few times and who has also been tripped in a road race there is no important difference in that fall to the pavement.

by jbris on Jun 7, 2013 10:05 am • linkreport

@AWalkerInTheCity:
"possibly if there were more cyclists around the driver would have been more alert to look for cyclists - or that might even have been better infrastructure.

lack of critical mass has consequences."

And maybe one day I will find a pot of gold when I step outside in the morning and perhaps the Magic Hat will also flow out of my sink. Until then, however, it makes absolute sense to take the prudent measure of wearing a helmet.

Additionally, for the 58,492 time, even if we had all the sharrows, dedicated and protected lanes, and zebra stripes you could ever hope for, there are many other causes of crashes/falls. We have no way of knowing but I would think collisions with cars are just a small percent of all bike crashes. It is likely that most crashes are caused by rider error/judgement and lack of experience.

by 202_cyclist on Jun 7, 2013 10:10 am • linkreport

"And maybe one day I will find a pot of gold when I step outside in the morning and perhaps the Magic Hat will also flow out of my sink."

Huh? critical mass growing is a reality, and safety is improving in places where it is. No magic hats or pots of gold.

" Until then, however, it makes absolute sense to take the prudent measure of wearing a helmet."

for the millionth time, I wear a helmet, Tina wears one, Dave C wears one, MLD wears one, JimT wears one. No one here is opposed to wearing helmets. We all support wearing helmets. For one thing, I wouldnt want to get a brain injury that would leave my brain so dysfunctional as to keep forgetting something thats been repeated to me dozens and dozens of times.

"Additionally, for the 58,492 time, even if we had all the sharrows, dedicated and protected lanes, and zebra stripes you could ever hope for, there are many other causes of crashes/falls. We have no way of knowing but I would think collisions with cars are just a small percent of all bike crashes. It is likely that most crashes are caused by rider error/judgement and lack of experience."

theres total crashes, ones that cause serious injuries, and ones that cause fatalities. Someone may here may well have the data, especially on the latter. My impression is that by far the majority of fatalities involve bike/car collisions, and of those it splits about 50/50 into driver vs cyclist fault - but many of those could be reduced with better infrastructure.

by AWalkerInTheCity on Jun 7, 2013 10:16 am • linkreport

and again

I can gain the benefits of wearing a helmet AND those of encouraging critical mass, by WEARING a helmet, but ALSO oppossing mandatory bike helmet laws, supporting bike share expansion, and calling for balanced safety campaigns - and for improved safety data and studies.

I still do not understand why calling for improved safety analysis implies opposing wearing helmets.

by AWalkerInTheCity on Jun 7, 2013 10:23 am • linkreport

Wearing a bike helmet like prevents many cyclists from needing to go to the hospital.

As someone who actually rides--and has gone to the hospital on one or two occasions--this seems like an entirely spurious claim. A bike accident resulting in a serious head injury--but no other damage--is a pretty rare event.

@202_cyclist:
As Sara above asked, if helmets prove even more effective as the result of such as study, would WABA issue an appology? Will they advocate for helment use?

WABA does advocate for helmet use. LOL.

by oboe on Jun 7, 2013 10:23 am • linkreport

@AWalkerInTheCity:

Again, the crashes that are serious enough to send cyclists to the hospital and the crashs that result in fatalities are not representative of all cycling crashes. I've probably crashed 10-20 times (at least) since I've biking. Only one crash/fall resulted in a trip to the hospital. I am sure many other cyclists have similar experiences.

Also, read David C's posts. Read many of the other posts. Wearing a helmet is being directly questioned.

by 202_cyclist on Jun 7, 2013 10:23 am • linkreport

Again, the crashes that are seriou"s enough to send cyclists to the hospital and the crashs that result in fatalities are not representative of all cycling crashes. I've probably crashed 10-20 times (at least) since I've biking. Only one crash/fall resulted in a trip to the hospital."

That does not contradict what I said.

"Also, read David C's posts. Read many of the other posts. Wearing a helmet is being directly questioned."

he never suggested that one should not wear a helmet. He did question some arguments for wearing one. Thats not the same thing.

Jbris did say that he does not wear helmets for short, slow trips within DC. I will let him discuss his personal cost benefit.

BTW, you have responded to me yet again, and you still have not answered a very simple question. Do you personally support or oppose mandatory helmet laws?

by AWalkerInTheCity on Jun 7, 2013 10:35 am • linkreport

oboe

one of the best reasons to wear a helmet is to protect brain function. Brain injury can impair memory. that could result in someone repeating a false statement many times, despite frequently being corrected. While compassion for the brain injured is certainly worthy, its better to wear a helmet and prevent brain injuries.

by AWalkerInTheCity on Jun 7, 2013 10:37 am • linkreport

@AWalkerInTheCity:

I understand that the goal is to get more people to bike and to encourage more sustainable transportation. I support that. I have personally advocated for bike lanes and more bike infrastructure.

If someone wants to be so dumb and risk cracking their skull and risk a brain injury, that is their choice.

I suppose we can also have more people ride transit if transit agencies weren't required to maintain safe vehicles and trains and could lower their ticket prices. This would result in less driving and increase sustainable transportation. Is this a good idea, however? This is a similar argument that you and the others here are making about bike helmets.

by 202_cyclist on Jun 7, 2013 10:40 am • linkreport

"My other point is that if you're involved in many many crashes over the year that could have had severe repercussions then maybe you aren't a very good cyclist and you should take a class or slow down or stop drinking"

This is a really important point that I was alluding to -

I've been doored 3x with the most recent one happening about 5 years ago. I was only really injured in one of them (the most recent one - one I just hurt my hand and the other I wasn't really hurt at all) and I was only injured because I was riding faster than I normally do (late for work). I'm a lot more cautious now about approaching cars with tinted windows. I ate it on wet trolley tracks when i was new to Philly (learned that lesson quickly). I once lost it after hitting a pothole at speed.

A bike has been my main method of transport (with supplemental transit or carshare) for 14 years. In those 14 years I've had 5 accidents. 2 of them resulting in injury and both of those involving speed. Zero resulting in head injuries. Most of the injuries I hear about in my cycling community are (rare) leg/hip/arm injuries. Then again most of the people I know don't ride tucked into a racing position or in fast moving traffic so that might have a lot to do with it.

by jbris on Jun 7, 2013 10:40 am • linkreport

"I suppose we can also have more people ride transit if transit agencies weren't required to maintain safe vehicles and trains and could lower their ticket prices. This would result in less driving and increase sustainable transportation. Is this a good idea, however? This is a similar argument that you and the others here are making about bike helmets"

it might be a good idea, if the transit safety regulations were not cost benefit justified, and if claimed safety benefits were exaggerated based on incorrect studies. Though Im not sure that adding more riders to transit results in safety improvements in the way it does for biking. But you are speaking of regulations, so Im confused. you have said repeatedly that no one here is calling for mandatory bike helmets. How does a discussion of safety regulations become relevant. Are you saying you DO support mandatory helmet legislation? If so, then we can discuss the safety implications of said legislation. If not, I dont know why you are bringing up a regulation analogy.

by AWalkerInTheCity on Jun 7, 2013 10:46 am • linkreport

"I understand that the goal is to get more people to bike and to encourage more sustainable transportation"

to be clear, getting more peope to bike is not only about more sustainable transportation. Its about safer biking, because getting more people to bike improves safety for those already biking. I am not sure if you agree or disagree with that. If you agree, we can discuss the implications of that for things like helmet laws, bike share, and safety campaigns. if you disagree, we can discuss the evidence for and against that proposition. But if you post as if there were no critical mass benefit to safety, but refuse to say that there is none, then we cant have a productive discussion of the key issues wrt helmet policy.

by AWalkerInTheCity on Jun 7, 2013 10:49 am • linkreport

@walker - helmets don't protect your brain. They protect your skull. Soldiers and football players are two groups who are almost always helmeted yet have incredibly high rates of TBI.

Not saying that helmets can't save lives but let's not pretend they prevent TBI.

by jbris on Jun 7, 2013 10:49 am • linkreport

note, I meant specific safety regs on transit. Look at calls for FRA to relax certain requirements relative to passenger cars - look at states that have increased speed limits from 55MPH on interstate highways, etc. Not every safety regulation makes sense.

Similarly, refusing to MANDATE helmets does not mean ending all safety regs relative to bike riding. For example no one here that I know wants to end the requirements to ride with lights at night. Personally, Id like to see that enforced more in NoVa where I live. Someone who rides without lights does not only endanger themselves, but also pedestrians and other cyclists.

by AWalkerInTheCity on Jun 7, 2013 10:54 am • linkreport

@202_cyclist - I don't think either of us are doctors

You have no idea what my training is.

his injury was from striking the pavement-- again hitting hard asphalt from several feet in the air.

After being struck by a car. See "momentum" p=mv

by Tina on Jun 7, 2013 11:06 am • linkreport

@202_cyclist- it makes absolute sense to take the prudent measure of wearing a helmet.

Yes it does. i believe everyone here agrees w/ you on this point.

The dispute is with accepting w/o question incomplete data used to set policy for 30 years that has lead to consequences like legislation for mandatory helmet laws based on incomplete those data, that in turn has negative health and safety consequences for bike riders.

by Tina on Jun 7, 2013 11:15 am • linkreport

@202_cyclist - even if we had all the sharrows, dedicated and protected lanes, and zebra stripes you could ever hope for, there are many other causes of crashes/falls.

This ignores the injury-from-crash rate in places that do have much better infrastructure, like in the Netherlands and Denmark.

We have no way of knowing but I would think collisions with cars are just a small percent of all bike crashes.

Yes we do have a way of knowing what proportion of fatal/serious injury crashes affecting bikers are with automobiles. See FARS.

See this study also: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.300762

by Tina on Jun 7, 2013 11:22 am • linkreport

@Tina:

"Yes we do have a way of knowing what proportion of fatal/serious injury crashes affecting bikers are with automobiles. See FARS."

No, Tina, we have zero way of knowing right now what percent of total bike crashes/collisions involve vehicles. jbris said he's been in five accidents-- two resulting in injuries. I've probably been in 20 falls/accidents. Out of these 25 accidents/crashes, only three have likely been reported. We're just two cyclists. There are tens of millions of cycles. Again, there is no way of knowing presently what percentage of all accidents/crashes are with vehicles.

by 202_cyclist on Jun 7, 2013 11:28 am • linkreport

Yes we do have a way of knowing what proportion of fatal/serious injury crashes affecting bikers are with automobiles. See FARS.

See this study also: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.300762
"Yes we do have a way of knowing what proportion of fatal/serious injury crashes affecting bikers are with automobiles. See FARS."

"No, Tina, we have zero way of knowing right now what percent of total bike crashes/collisions involve vehicles."

Total =/= fatal/serious.

by AWalkerInTheCity on Jun 7, 2013 11:33 am • linkreport

@202_cyclist - did you already read the study i provided a link to? In fact we do have data we can use to estimate: crashes with automobiles/all crashes

by Tina on Jun 7, 2013 11:37 am • linkreport

Sorry Tina, you'll have to personally witness every bicycle crash in America in order to satisfy this guy. Don't you know that's how research works?

by MLD on Jun 7, 2013 11:41 am • linkreport

@MLD -oh right. And there's no measurable difference between falling and being hit by a car.

by Tina on Jun 7, 2013 11:44 am • linkreport

@MLD:

The question is how many injuries do helmets prevent. To know this, you need to know how many accidents/falls there are. This is your population size. Not trips to the hospital. Not the number of cyclists hit by cars. You need to know how many total bike accidents there are to estimate the number of injuries that helmets prevented.

Again, you can't estimate the effeectiveness of seatbelts just by counting the number of auto-accident victims at hospitals. You need to know the number of crashes and the number of accidents prevented. How is this any different with bike helmets?

by 202_cyclist on Jun 7, 2013 11:52 am • linkreport

I concur w/ @David C.

If someone probably crashed 10-20 times (at least) since I've biking, there's some problem. That's not normal.

by Tina on Jun 7, 2013 11:53 am • linkreport

"Again, you can't estimate the effeectiveness of seatbelts "

if seatbelts prvented a particular kind of injury, but there was another kind of injury that often resulted in motorists being hospitalized but that seat belts did not prevent, you COULD use a similar type of study to estimate the impact of seatbelts.

There are such types of injuries for cyclists (lots and lots of hospitalizations for arm/leg/torso injuries) which is why it can, in the absence of a source on all bike accidents, be used to estimate the safety benefits of helmets.

Now, 202, can you clarify your position on mandatory bike helmet laws - for or against?

by AWalkerInTheCity on Jun 7, 2013 12:01 pm • linkreport

@Tina:

"I concur w/ @David C.
If someone probably crashed 10-20 times (at least) since I've biking, there's some problem. That's not normal."

I've been biking for 20+ years. If you bike, you're going to crash. This happens. Most of the crashes/falls have been mountain biking. I've crashed twice in college while racing (I got a flat front tire once while going downhill). I've been doored once. Another time, I was riding by the Rosslyn Marriott and a car was pulling into the intersection and I knocked his license plate holder off with my shoe. Another time, I was riding on the Mount Vernon trail and a runner did a u-turn and ran into me.

My point is, accidents happen, especially if your ride a lot. You've said that you wear a helmet. Only 1-2 or my my incidents have involved cars. It makes absolute sense to protect yourself when these events do occur-- and they will eventually.

by 202_cyclist on Jun 7, 2013 12:01 pm • linkreport

@202_cyclist - seatbelts do not prevent crashes nor is that their purpose. They minimize injury during impact.

We have an estimate of how much injury/fatality is prevented from seatbelt use. See FARS.

No - you need to know how many accidents/falls there are. This is your population size.

No, This is not the denominator. The denominator is the population exposed to the risk, in this case: risk of bike crashes. Thus the population at risk is the total number of people who ride or total miles ridden or a calibrated combination.

by Tina on Jun 7, 2013 12:03 pm • linkreport

If bike ridership is suppressed, it actually may make cycling more dangerous. Studies show that the more bikes are on the streets, the more drivers compensate for their presence. More riders means lower injury rate per mile travelled, on average.

The fixation with helmets as being synonymous with safety is somewhat misplaced. There's a whole lot more going on.

by Crickey7 on Jun 7, 2013 12:08 pm • linkreport

"My point is, accidents happen, especially if your ride a lot. You've said that you wear a helmet. Only 1-2 or my my incidents have involved cars."

that makes sense for someone who spends a lot of time mountain biking.

Mountain bikers certainly need to be more concerned about helmets than about critical mass, which probably doesnt matter to them at all.

You might note that this is a blog about transportation and urban planning (mostly) not about recreation or mountain sports.

It sounds of like of all the accidents you had while engaged in transporation cycling - not mountain biking, and not racing - the majority DID involve autos. One involved one of the more notorious infrastructure problems in the region (the Rosslyn "circle of death" and another involved dooring, where critical mass would hopefully mean drivers and their passengers being more aware of cyclists, and where better bike infrastructure (cycle tracks, or at least better placed bike lanes) would help.

"It makes absolute sense to protect yourself when these events do occur-- and they will eventually"

and who here , other than jlbris, says they do not use helmets at all times.

by AWalkerInTheCity on Jun 7, 2013 12:12 pm • linkreport

point of logic

If I say "you should drink orange juice. It makes you immortal"

And person X says "drinking orange juice does not make you immortal" It does not follow that person X disagrees with "you should drink orange juice"

I hope that is understood.

by AWalkerInTheCity on Jun 7, 2013 12:14 pm • linkreport

@202_cyclist - I've been biking for 20+ years

Well I've been biking for ~35 years!

I can remember only crashing 2x!! Maybe there are more but certainly fewer than I can count on one hand.

Both times that I remember were attributed to a slippery surface. The 2nd time my ulna was cracked (this is the most common bone break in America b/c there is a reflex that causes one to stick his/her arm out when an imbalance is sensed.) My head was not involved, though I was wearing a helmet.

I have not yet had a crash involving a car. Most drivers are pretty ok. (though I have had many many scary close calls.) I conclude that I am a much better bike rider than you - indisputably I am much better at avoiding crashes.

by Tina on Jun 7, 2013 12:14 pm • linkreport

@202_cyclist - Most of the crashes/falls have been mountain biking.

I don't mountain bike. we are discussing bicycling as a transportation option, not as a high risk pasttime.

by Tina on Jun 7, 2013 12:18 pm • linkreport

Again, you can't estimate the effeectiveness of seatbelts just by counting the number of auto-accident victims at hospitals. You need to know the number of crashes and the number of accidents prevented.

You can't know the number of accidents prevented, because you can't count things that didn't happen.

You can estimate the number of accidents prevented, but that's not the same thing.

by Miriam on Jun 7, 2013 12:48 pm • linkreport

---seatbelt use doesn't prevent crashes---

we look at seatbelt use/non-use among those involved in a crash to estimate the injury reduction of seatbelt use.

(Speed/red-light cameras prevent crashes!!)

by Tina on Jun 7, 2013 12:54 pm • linkreport

@Tina:

"---seatbelt use doesn't prevent crashes---

we look at seatbelt use/non-use among those involved in a crash to estimate the injury reduction of seatbelt use."

Seatbelt use prevents injuries when crashes occur. As with bike helmets, that is what we should be trying to find out-- the number of injuries prevented through wearing a helmet.

Tina:
"I don't mountain bike. we are discussing bicycling as a transportation option, not as a high risk pasttime."

Yes, of course I understand this. I bike to work 3-4 days per week throughout the year. Fortunately, I have not had any crashes or falls but some close calls. Last week, my tire punctured while biking to work and my tube deflated immediately. Had this been my front tire, I would have likely crashed. Another time, I nearly crashed while going around a corner while clipping into my pedal. I had another close call with a wet and slippery sewer cover.

None of these involed vehicles. All of them could have resulted in serious injury had I crashed. There are many hazards that have absolutely nothing to do with cars, the amount of bike lanes, or number of other cyclists out there.

by 202_cyclist on Jun 7, 2013 1:00 pm • linkreport

I don't mountain bike. we are discussing bicycling as a transportation option, not as a high risk pasttime.

Not to divert from the main conversation, but mountain biking isn't a particularly high-risk pastime. I've been mountain biking (competitively and otherwise) for two decades, and I've only ever had two falls where a helmet was likely to provide protection.

In fact, given the choice between never wearing a helmet on the street, versus never wearing a helmet on the trail, I'd choose trail every time.

by oboe on Jun 7, 2013 1:03 pm • linkreport

@oboe-ok. Didn't mean to disparage your hobby. Flying over precipices and jumping over logs looks kinda risky, though i am fully aware "looks like" is conclusive of nothing.

by Tina on Jun 7, 2013 1:13 pm • linkreport

202,

If there are no studies that count the things that you think need to be counted and thus all are invalid, then there are no studies that show that helmets reduce risk. So on what do you base your support for helmets?

by David C on Jun 7, 2013 1:14 pm • linkreport

@202_cyclist - that is what we should be trying to find out-- the number of injuries prevented through wearing a helmet.

Yes. Everyone agrees. The results of the thompson study from 25 years ago that have been used to set policy including backing up efforts to mandate helmets despite the detrimental effects of those laws is what is contested.

by Tina on Jun 7, 2013 1:17 pm • linkreport

@202-cyclist - Last week, my tire punctured while biking to work and my tube deflated immediately. Had this been my front tire, I would have likely crashed.

Well this very thing happened to me last week too! But it WAS the FRONT tire! I was going downhill on RI Av heading for the light at 4th St NE and it blew out loudly and dramatically while I was going really fast in a dicey situation - but i did not crash. I guess I'm just more skilled than you. :-)

by Tina on Jun 7, 2013 1:19 pm • linkreport

@oboe-ok. Didn't mean to disparage your hobby. Flying over precipices and jumping over logs looks kinda risky, though i am fully aware "looks like" is conclusive of nothing.

That's just the story we (MTBers) tell people in order to make ourselves look cooler...

:)

by oboe on Jun 7, 2013 1:19 pm • linkreport

@202_cyclist
There are many hazards that have absolutely nothing to do with cars, the amount of bike lanes, or number of other cyclists out there.

Please read this study: http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2012.300762

by Tina on Jun 7, 2013 1:21 pm • linkreport

"Yes. Everyone agrees. The results of the thompson study from 25 years ago that have been used to set policy including backing up efforts to mandate helmets despite the detrimental effects of those laws is what is contested."

Without having any idea at all the number of injuries helmet usage prevents, we have no idea if proposed helmet mandates are beneficial or not. The monetary value of life is about $6M. A fair cost/benefit analysis would look at the number of injuries and fatalities prevented compared with the number of people who would now forego biking because of this barrier to entry (however minor it is--- a $50 helmet weighing less than eight ounces) and the increased risk to all of the other cyclists becuase there are fewer of them.

It could be entirely possible that a helmet mandate leads to improved social welfare (measured by the reduced injuries and fatalities and reduced costs of those injuries). Until we know how many injuries helmet usage prevents we can only guess on one side of the debate or the other.

by 202_cyclist on Jun 7, 2013 1:24 pm • linkreport

1) Without having any idea at all the number of injuries helmet usage prevents,

we have "an idea". See all the studies, including the Thompson study.

2)we have no idea if proposed helmet mandates are beneficial or not

Yes we do. See all the studies about helmet laws repressing biking and about the safety in numbers effect, and the risk reduction for CVD from biking as compared to the risk of injury from biking. Plenty of evidence; respectable body of knowledge.

by Tina on Jun 7, 2013 1:28 pm • linkreport

The monetary value of life is about $6M. A fair cost/benefit analysis would look at the number of injuries and fatalities prevented compared with the number of people who would now forego biking because of this barrier to entry

See CVD, and studies comparing the injury risk from biking w/ & w/o a helmet and the risk reduction of CVD obtained from biking.

by Tina on Jun 7, 2013 1:30 pm • linkreport

It could be entirely possible that a helmet mandate leads to improved social welfare (measured by the reduced injuries and fatalities and reduced costs of those injuries). Until we know how many injuries helmet usage prevents we can only guess on one side of the debate or the other.

no we don't have to guess. We already know that helmet laws impair public health for two reasons: 1) they depress ridership and thus overall safety and 2) they depress ridership and thus depress overall physical activity

by Tina on Jun 7, 2013 1:32 pm • linkreport

Tina, you still don't get it! If you just ignore all the evidence and studies that already exist, clearly you can see that there is no evidence out there on the topic!

by MLD on Jun 7, 2013 1:32 pm • linkreport

@Tina:

There have been studies of the amount a helmet mandate suppresses demand. Yes, we know the cost of a mandate. Until we know the number of injuries prevented, however, we don't know the potential benefits of a helmet mandate. No, you can't just estimate this by counting the number of cyclists at a hospital. Most cycling falls and crashes do not result in trips to the hospital.

Saying a helmet mandate is/is not benefical is pure, 100%, conjecture.

by 202_cyclist on Jun 7, 2013 1:33 pm • linkreport

this CBA http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1368064

only looked at the health costs of less cycling and didn't even look at the safety costs of loss of critical mass (nor did it consider the other costs of less biking, nor did it even consider the personal inconvenience and cost of helmet wearing that presumably motivated individuals to not wear helmets) It STILL found costs of helmet laws to exceed benefits.

by AWalkerInTheCity on Jun 7, 2013 1:33 pm • linkreport

@MLD:

Would you estimate the number of mosquite bites that lead to malaria by only counting the number of malaria patients at a hospital? This is what you're asking us to do with bike helmets.

by 202_cyclist on Jun 7, 2013 1:34 pm • linkreport

202 the cost of demand suppression has likely increased with the spread of bike share. Bike share systems are mostly killed by helmet laws, and they are a powerful tool in increasing the amount of biking (especially among former non riders) So any study of demand suppression done before bike share became important is probably outdated and way underestimates the cost.

by AWalkerInTheCity on Jun 7, 2013 1:37 pm • linkreport

"Would you estimate the number of mosquite bites that lead to malaria by only counting the number of malaria patients at a hospital? This is what you're asking us to do with bike helmets."

if you wanted to look at the effect of netting on malaria, examining the netting or non netting status of people admitted for malaria, and similar people admitted for other reasons, would seem to be a reasonable approach

by AWalkerInTheCity on Jun 7, 2013 1:39 pm • linkreport

Would you estimate the number of mosquite bites that lead to malaria by only counting the number of malaria patients at a hospital? This is what you're asking us to do with bike helmets.

It has been pointed out a dozen times how the studies work and you are being willfully ignorant about why the research is relevant.

Your analogy is wrong because you haven't identified a prevention device, but I would go with it. Let's say I wanted to test how well a new drug prevented fatalities in malaria cases. I could compare the rates of drug-taking between fatal malaria cases and non fatal malaria cases and get a good idea of what effect the drug had on those people. This is how the bike studies work.

This has been explained to you multiple times by multiple people. Papers have been linked which show that this is a valid way to do this research that produces accurate results. You have ignored every one of those posts and continue to rant in an ignorant fashion. If you would like to continue to have a thoughtful discussion please read the information that people have provided for you or go away.

by MLD on Jun 7, 2013 1:40 pm • linkreport

@MLD:

Thanks for explaining-- I understand. jris said in his post that he/she has crashed five times. I've probably crashed/fallen 15-20 times. This is 25 times, resulting in two hospital trips between the two of us. So, just counting the number of people at the hospital or the helmeted vs. non-helmeted people at the hospital can totally tell you how many bike accidents there have been. Makes sense, thank you for explaining.

by 202_cyclist on Jun 7, 2013 1:51 pm • linkreport

@202_cyclist, please see Epidemiological Study Design. Here's one source:

http://books.google.com/books?hl=en&lr=&id=OqjB1WBrjjEC&oi=fnd&pg=PA1&dq=epidemiology+study+design&ots=1D5Fo01Feo&sig=yPeYNjqCWKWE1wGl0v450TmiwKo

by Tina on Jun 7, 2013 1:55 pm • linkreport

"So, just counting the number of people at the hospital or the helmeted vs. non-helmeted people at the hospital can totally tell you how many bike accidents there have been. "

what the study is trying to explain is not how many bike accidents there have been, but what percentage of brain injuries were prevented by helmets. As you have been told numerous times.

I am not sure why you do not understand this.

by AWalkerInTheCity on Jun 7, 2013 1:56 pm • linkreport

In order to measure "how effective are helmets at preventing head injuries in crashes" you do not need to know how many total accidents there were. You just need a set of accidents that were bad enough to potentially cause head injuries but did not, and a set of accidents that did cause head injuries, and compare helmet-wearing rates.

If you had actually read this paper posted by Jim T and read section 5 on page 2 you would understand this.

Again, the studies are not measuring "how many bike accidents have there been" so there's no reason for them to need to know that!

by MLD on Jun 7, 2013 1:57 pm • linkreport

@MLD/AWalkerInTheCity:

Again, what at all makes you think that injured cyclists at the hospital are even slightly representative of all cyclists who've crashed.

by 202_cyclist on Jun 7, 2013 1:59 pm • linkreport

do you believe that cyclists who've crashed and are not admitted to hospitals at all, are more likely to be wearing helmets than cyclists who have crashed, and were hospitalized for non head injuries?

Remember, the non head injured hospital admitted cyclists only need to be representative of all cyclists in their helmet wearing behavior.

by AWalkerInTheCity on Jun 7, 2013 2:04 pm • linkreport

and again, they arent supposed to be representative of all cyclists WHO HAVE CRASHED, but of cyclists in general. IE a the general population of cyclists, as a comparison to those hospitalized with brain injuries.

by AWalkerInTheCity on Jun 7, 2013 2:05 pm • linkreport

"do you believe that cyclists who've crashed and are not admitted to hospitals at all, are more likely to be wearing helmets than cyclists who have crashed, and were hospitalized for non head injuries?

Remember, the non head injured hospital admitted cyclists only need to be representative of all cyclists in their helmet wearing behavior."

I have no idea and until we know and have better data, it is just pure conjecture on either side of this debate.

by 202_cyclist on Jun 7, 2013 2:08 pm • linkreport

@202_cyclist
what makes you think that injured cyclists at the hospital are even slightly representative of all cyclists who've crashed

An understanding of epidemiological and statistical methods

by Tina on Jun 7, 2013 2:11 pm • linkreport

@Tina:

Just like injured drivers at the hospital are representative of all drivers (when in fact they are more likely to have been speeding, intoxicated, etc...)?

by 202_cyclist on Jun 7, 2013 2:13 pm • linkreport

@202_cyclist
I have no idea and until we know and have better data, it is just pure conjecture on either side of this debate.

This is the exact same argument put forth by big tobacco regarding the health effects and addictive nature of cigarettes. They put forth this argument with full knowledge of their deceit and exploited the diffence between scientific infernec and legal "shred of doubt"

by Tina on Jun 7, 2013 2:15 pm • linkreport

@Tina:

"This is the exact same argument put forth by big tobacco regarding the health effects and addictive nature of cigarettes. They put forth this argument with full knowledge of their deceit and exploited the diffence between scientific infernec and legal "shred of doubt"

Thank you for uncovering this vast and nefarious conspiracy by the evil helmet industry. We can all rest easier now.

by 202_cyclist on Jun 7, 2013 2:18 pm • linkreport

I have no idea and until we know and have better data, it is just pure conjecture on either side of this debate.

This is starting to remind me of philosophy debates at 3 am in college. How do we know that we know what we think we know when we really don't know if we know what we know?

by Miriam on Jun 7, 2013 2:21 pm • linkreport

@202_cyclist -I am pointing out that disregard of established valid scientific methods is nothing new, whether or not the science being dismissed is comprehended.

by Tina on Jun 7, 2013 2:22 pm • linkreport

202 the cost of demand suppression has likely increased with the spread of bike share. Bike share systems are mostly killed by helmet laws, and they are a powerful tool in increasing the amount of biking (especially among former non riders) So any study of demand suppression done before bike share became important is probably outdated and way underestimates the cost.

This bears repeating.

DC will become a "safe" cycling city when people ride bikes here the same way that they do in, say, Key West or Cape May. It has to become normative, universal, and unfettered by regulations that no other mode of transportation are subject to. Denying folks the use of bikeshare unless they have a helmet at hand is counterproductive to that goal.

by oboe on Jun 7, 2013 2:23 pm • linkreport

"Thank you for uncovering this vast and nefarious conspiracy by the evil helmet industry"

She wasnt addressing a statement made by the helmet industry, she was addressing statements made by you.

I am all for more data collection on bicycle injuries. In the meantime we must work with the data we have to answer the questions we have. The best and most methodologically sound work, as shown by JimT, suggests an effectiveness rate of well lower than 85%. In fact less than 45%. Based on that and what we know (based on a 2006 australian study) of bike suppression, and based on the conservative (IMO) bike benefits of the de Jong study, the CBA for adult helmet laws is clearly negative. The CBA for bike share, I beleive, is clearly positive.

As for unbalanced bike safety campaigns, I am dubious that there is a positive CBA to emphasizing one safety measure relative to other safety measures whose importance is less disputed.

by AWalkerInTheCity on Jun 7, 2013 2:25 pm • linkreport

@202_cyclist: At the risk of repeating a link, the discussion by the Thompson team
on misconceptions about case-control studies
would answer a number of your questions.

by Jim Titus on Jun 7, 2013 2:34 pm • linkreport

Not that evidence matters to any of the true-believer anti-helmet crowd here, but...

"Results
The observed bike helmet use rate rose from 0% to around 45% during the first 4 years of the coalition. The rate plateaued at that level for 3 years then rose again to 67% in the years immediately after enactment of the bike helmet law. The number of admissions for bike-related head injuries was 71 for the year before the start of the coalition. It fell to around 50 per year for the first 3 years then again to around 30 over the next 3 years. The total number of admissions fell to 24 with the rise in helmet use after the legislation went into effect in 1995."

Trends in bicycling-related head injuries in children after implementation of a community-based bike helmet campaign

David Wesson, Laura Spence, Xiaohan Hu, Patricia ParkinDepartment of Surgery, Baylor College of Medicine, Houston, TX and the Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada

Still think bike helmets are not effective?

by 202_cyclist on Jun 7, 2013 2:54 pm • linkreport

I suppose the Journal of American Medicine is hack science also.

"From 1984 through 1988, bicycling accounted for 2985 head injury deaths (62% of all bicycling deaths) and 905,752 head injuries (32% of persons with bicycling injuries treated at an emergency department). Forty-one percent of head injury deaths and 76% of head injuries occurred among children less than 15 years of age. Universal use of helmets by all bicyclists could have prevented as many as 2500 deaths and 757,000 head injuries, ie, one death every day and one head injury every 4 minutes."

Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. How many are preventable?

Sacks JJ, Holmgreen P, Smith SM, Sosin DM.
http://www.ncbi.nlm.nih.gov/pubmed/1820476

by 202_cyclist on Jun 7, 2013 3:04 pm • linkreport

Still think bike helmets are not effective?

Holy moly. No one has said that helmets are not effective!!!!!!!! I just don't know what to say when you ask that question. What the hell are you talking about?

And as for your study, it's about what a multifaceted, multidisciplined, community-based campaign to promote bike helmet use by children did in 1989. There are so many reasons that this is inapplicable to this argument that I don't even know where to start.

I'm done.

by David C on Jun 7, 2013 3:05 pm • linkreport

@202_cyclist
.. anti-helmet crowd here..
.doh.

by Tina on Jun 7, 2013 3:05 pm • linkreport

"Not that evidence matters to any of the true-believer anti-helmet crowd here"

There is no anti-helmet crowd here. If I email you, will you send me a new helmet Bell helmet (blue preferably) ? I only have one, and I'd like a second helmet.

by EnoughStrawManStuff on Jun 7, 2013 3:05 pm • linkreport

I want to go back to a world where this 330-comment thread never existed.

by MLD on Jun 7, 2013 3:10 pm • linkreport

@David C:
"The number of admissions for bike-related head injuries..."

Head injuries-- exactly the injuries that helmets are designed to protect against and prevent.

by 202_cyclist on Jun 7, 2013 3:11 pm • linkreport

Trends in bicycling-related head injuries in children after implementation of a community-based bike helmet campaign

yeah. WABA helped get legislation passed that mandated helmets for people under 16 in DC. I believe MD has the same law. Whats your point?

by Tina on Jun 7, 2013 3:11 pm • linkreport

@AwalkierInTheCity

Bikeshare is heavily used at rush hours, such that some people can't get one. So if helmets were required, some riders might switch to their own bikes, freeing up bikeshare to the helmeted faithful. Helmet laws could lead to a net INCREASE in total cyclists.

by mtp on Jun 7, 2013 3:12 pm • linkreport

202

do you read what you link to?

"DESIGN: Review of death certificates and emergency department injury data for 1984 through 1988. Categorization of deaths and injuries as related to bicycling and head injury. Using relative risks of 3.85 and 6.67 derived from a case-control study and varying helmet usage from 10% to 100%, population attributable risk was calculated to estimate preventable deaths and injuries."

IE they used case control data - the very data you disparage. They took the 85% that JimT has already shown to be incorrect, surpassed by new studies ALSO using case control, and applied it to the data on the number of brain injuries.

by AWalkerInTheCity on Jun 7, 2013 3:14 pm • linkreport

"Bikeshare is heavily used at rush hours, such that some people can't get one. So if helmets were required, some riders might switch to their own bikes, freeing up bikeshare to the helmeted faithful. Helmet laws could lead to a net INCREASE in total cyclists."

I know of no evidence for that effect, and considerable evidence against.

http://en.wikipedia.org/wiki/Bicycle_helmets_in_Australia#Helmets_and_bike-share_schemes

by AWalkerInTheCity on Jun 7, 2013 3:18 pm • linkreport

@mpt - we have evidence to reject your hypothesis. Results indicate a decrease in bicycling as a result of helmet laws.

by Tina on Jun 7, 2013 3:22 pm • linkreport

@MLD -I'm amused by its likeness to 'Waiting for Godot'

by Tina on Jun 7, 2013 3:24 pm • linkreport

I think mpt is saying if ONLY bikeshare required helmets. But even that doesn't make sense. And it would be completely unenforceable.

by MLD on Jun 7, 2013 3:25 pm • linkreport

"More than 90 percent of the 714 bicyclists killed in 2008 were not wearing helmets, according to the Insurance Institute for Highway Safety."

But go ahead, question the safety of wearing helmets. Again, not wearing a helmet when biking is as dangerous as cutting vegetables in your kitchen. As dangerous as sitting in your backyard without sunblock.

http://www.nytimes.com/2010/05/22/health/22patient.html?_r=0

by 202_cyclist on Jun 7, 2013 3:26 pm • linkreport

@202_cyclist
"More than 90 percent of the 714 bicyclists killed in 2008 were not wearing helmets, according to the Insurance Institute for Highway Safety."

were the fatal injuries head injuries or some other type of injury? this is an important question.

by Tina on Jun 7, 2013 3:29 pm • linkreport

"More than 90 percent of the 714 bicyclists killed in 2008 were not wearing helmets, according to the Insurance Institute for Highway Safety."

This claim comes from looking at FARS data and also seems damning. Especially when combined with this statement based on a gallop poll.

Half (50%) of bicyclists wear a helmet for at least some trips, with 35 percent using them for all or most trips.

But this data is based on Police Accident Reports and many of these do not include a separate entry for bike helmet use. So the FARS data is based on the crash narrative. If no information is given, it should be listed as unknown.

Unfortunately, it appears that nearly all of these cases that should have been coded as "unknown" (including a considerable number where the bicyclist actually was using a helmet, but such usage was either never noted or overlooked in the narrative) were instead coded as "not used"

One strong indicator that the FARS bicycle helmet use data should not be fully trusted is the fact that the "unknowns" are so few in number. It is simply not credible that a low priority data element such as bicycle helmet use would have a precision associated with it that is a factor of 20 better than that seen for much higher priority data elements such as seat belt or motorcycle helmet use (0.5% "unknowns" vs. 11% or 10%)

In 2008, there were 0 unknowns listed.

And the data reported by states does not match the state's data in the FARS.

California data from the StateWide Integrated Traffic Records System (SWITRS) indicates that at least 13.2% of fatally injured bicyclists were using a helmet during the period 1994-98 (since SWITRS combines "unknowns" and "not used" into a single category, the helmet use rate is actually a minimum estimate and could be much higher, depending upon the relative number of true "unknowns" and how biased the distribution might be), but only 3.4% supposedly were doing so according to FARS.

And some cyclists are listed as wearing seatbelts or using child protective seats.

Even a cursory examination of the data indicates FARS was underestimating actual helmet use among fatally injured bicyclists by up to an order of magnitude or more during the period 1994- 98. Although the situation has improved considerably since then, FARS continues to underestimate overall bicycle helmet use in the US by a factor of two or more as of 2004 (the most recent data available)

And, of course, you have the self-selection bias as well. [Plus, observation of cyclists has never shown anything near the 50% helmet use that people reported to Gallop].

by David C on Jun 7, 2013 3:32 pm • linkreport

@Tina:

Presumably most of the fatal injuries were not sprained ankles or bruised knees.

by 202_cyclist on Jun 7, 2013 3:33 pm • linkreport

"Again, not wearing a helmet when biking is as dangerous as cutting vegetables in your kitchen. As dangerous as sitting in your backyard without sunblock."

You are quoting me out of context which his dishonest, and you are failing to understand things explained to you many times, which are stupid.

BTW

http://www.cancer.org/cancer/cancercauses/sunanduvexposure/skin-cancer-facts

"Melanoma, the most serious type of skin cancer, will account for more than 76,600 cases of invasive skin cancer in 2013. It accounts for more than 9,000 of the 12,000-plus skin cancer deaths each year. "

12,OOO skin cancer deaths every year. EVERY FRIGGING YEAR! Why are you minimizing that. Why are you pro-cancer? Why do you discourage people from wearing sunblock?

Do you bike without sunblock?

by AWalkerInTheCity on Jun 7, 2013 3:34 pm • linkreport

@David:
"[Plus, observation of cyclists has never shown anything near the 50% helmet use that people reported to Gallop]."

But earlier you said:
"And, about 50-70% of cyclists wear helmets"

So, which is it? Perhaps you are just making this up as you go along.

by 202_cyclist on Jun 7, 2013 3:36 pm • linkreport

"Presumably most of the fatal injuries were not sprained ankles or bruised knees."

Do you think there are no fatal biking injuries other than head injuries?

by AWalkerInTheCity on Jun 7, 2013 3:36 pm • linkreport

@AWalkerInTheCity:

Here is what you said. Your words, not mine:
"The govt should mandate wearing gloves while using sharp kitchen knives."

This implies you think riding without a helmet is about the same risk as cutting vegetables in the kitchen.

by 202_cyclist on Jun 7, 2013 3:38 pm • linkreport

@AWalkerInTheCity:

"How do you feel about laws mandating sun block use while biking? Do you think we need a safety campaign to discourage people from biking without sunblock?"

Again, your words, not mine. Again, this can easily be interpretted as trivializing the safety benefit of wearing a helmet.

by 202_cyclist on Jun 7, 2013 3:39 pm • linkreport

"Again, this can easily be interpretted as trivializing the safety benefit of wearing a helmet."

How? Skin cancer is NOT trivial, nor is the importance of wearing sunblock trivial.

I was showing that there can be something that clearly saves lives, yet we do not mandate it. For very good reasons.

by AWalkerInTheCity on Jun 7, 2013 3:42 pm • linkreport

Again, not wearing a helmet is about as dangerous as cutting vegegtables:

"We retrospectively reviewed the British Columbia
Trauma Registry (BCTR) for all patients with serious injuries and mortality from cycling, skateboarding, and inline skating from 1993 to 2003. The BCTR inclusion criteria are length of stay greater than 3 days and death.

However, for cyclists, there was a
documented increase use during the study period from
16.8% in 1993 to 56.1% in 2003. There was a modest
decrease in severe head injuries from 23.2% in 1993 to
17.1% in 2003. Of the people who did not wear a helmet,
41.9% had head injuries, compared with 23.1% who wore a
helmet (P .001). The non-helmet users also had a higher
mortality rate (4.2% vs. 2.7%), but this was not significant
(P .197)."

David E. Konkin, M.D.a, Naisan Garraway, M.D.a, S. Morad Hameed, M.D., F.R.C.S.C.a,
D. Ross Brown, M.D., F.R.C.S.C., F.A.C.S.a, Robert Granger, M.D., F.R.C.S.C.b,
Stephen Wheeler, M.D., F.R.C.P.C.c, Richard K. Simons, M.B., F.R.C.S.C., F.A.C.S

Presented at the 92nd Annual Meeting of the North Pacific Surgical Association, Vancouver, British Columbia, November 11–12, 2005

by 202_cyclist on Jun 7, 2013 3:43 pm • linkreport

"This implies you think riding without a helmet is about the same risk as cutting vegetables in the kitchen."

no it does not. It shows that there are dangers in areas of life we do not think of as dangerous, and yet we do not feel the govt should mandate protections.

I have not been able to find data on the number of fatalities from kitchen injuries, but fatalities from household injuries in general far outnumber bike fatalities.

by AWalkerInTheCity on Jun 7, 2013 3:43 pm • linkreport

In the study above, the likelihood of a head injury is twice as high for people who did not wear a bike helmet. This sounds like a good reason to wear one. I am sure others will tell us, however, we can't trust the Canadians.

by 202_cyclist on Jun 7, 2013 3:45 pm • linkreport


"We retrospectively reviewed the British Columbia
Trauma Registry (BCTR) for all patients with serious injuries and mortality from cycling, skateboarding, and inline skating from 1993 to 2003."

Of the people who did not wear a helmet,
41.9% had head injuries, compared with 23.1% who wore a
helmet (P .001).

IE out of a population that had serious injuries or mortality, more of the non-helmeted had head injuries, and more of the helmeted had non head injuries.

by AWalkerInTheCity on Jun 7, 2013 3:50 pm • linkreport

@David C -good catch re: FARS data than you.
@202_cyclist - Presumably most of the fatal injuries were not sprained ankles or bruised knees.
This is glib and indicates a lack of understanding of the importance of the question. One can bleed out on the road before EMT arrive with or without a helmet.

by Tina on Jun 7, 2013 3:51 pm • linkreport

"In the study above, the likelihood of a head injury is twice as high for people who did not wear a bike helmet. "

But I thought you said that helmets prevent 85% of head injuries, and the believing the prevent only half of them, makes one part of the antihelmet crowd?

"This sounds like a good reason to wear one. "

Yes, its why I wear one.

Its not a good idea to mandate them though.

Do you wear sunblock when riding on sunny days?

by AWalkerInTheCity on Jun 7, 2013 3:52 pm • linkreport

I don't even understand what you're on about now. First you spend a day blasting research methods and then you start posting research paper after research paper that uses those same research methods you didn't like? What is your problem?

by MLD on Jun 7, 2013 3:53 pm • linkreport

^ *thank you*

by Tina on Jun 7, 2013 3:53 pm • linkreport

""How do you feel about laws mandating sun block use while biking? Do you think we need a safety campaign to discourage people from biking without sunblock?"

Again, your words, not mine. Again, this can easily be interpretted as trivializing the safety benefit of wearing a helmet."

You never actually answered the question though.

by AWalkerInTheCity on Jun 7, 2013 3:53 pm • linkreport

"What is your problem? "

202 is a mountain biker and racer, has had several serious accidents, and has probably avoided severe brain injury on several occasions thanks to his helmet. I am guessing this is VERY emotional for him, and he reads ANY doubt about helmets as possibly leading to deaths by people in his exact same situation - perhaps he sees us as willing his own death.

I do not know if he knows anyone who has died from a household accident or from skin cancer. I do not know if he watched a close relation succomb to cardio-vascular disease, as I have. We all have reasons for our emotional reactions.

by AWalkerInTheCity on Jun 7, 2013 3:58 pm • linkreport

and critical mass wouldnt have helped him as a mountain biker, nor would it help him much scooting fast down the W&OD - where indeed, there may be too many cyclists for optimal safety.

by AWalkerInTheCity on Jun 7, 2013 4:00 pm • linkreport

@Jim T:

Much of the research about the effectiveness of helmets looks like it is two decades old and much of the research also focuses on recreational and competitive cycling. With that said, it seems pretty clear that the research also shows wearing helmets to be an effective way to reduce head injuries and brain trauma.

Perhaps a better headline for your post would have been, "Helmets effective at reducing injuries but more research is needed," rather than that NHTSA is hyping bike helmets, implying some conspiracy.

by 202_cyclist on Jun 7, 2013 4:01 pm • linkreport

@AWalkerInTheCity:

"But I thought you said that helmets prevent 85% of head injuries, and the believing the prevent only half of them, makes one part of the antihelmet crowd?"

Where did I say this? Again, stick with the facts and do not make things up.

by 202_cyclist on Jun 7, 2013 4:04 pm • linkreport

@AWalkerInTheCity:

Do you have reading comprehension issues? I am not asking this to be glib. I am asking this as a serious question.

I have said repeatedly that I bike to work 3-4 days per week. I bike to local meetings. I bike to visit friends. I bike to the supermarket. Yes, I bike both recreationally and I bike as a mode of transportation. Yes, I understand safety in numbers and critical mass.

by 202_cyclist on Jun 7, 2013 4:07 pm • linkreport

Except NHTSA actually changed their number based on a filing saying it was incorrect. Thats more than "more research is needed"

Perhaps if you think NHTSA acted improperly in changing the number, you should file to get them to change it back.

by AWalkerInTheCity on Jun 7, 2013 4:08 pm • linkreport

@AWalkerInTheCity:

For what it is worth, I haven't raced in years. Also, half of my annual miles are commuting trips and other bike trips where biking is a form of transportation.

by 202_cyclist on Jun 7, 2013 4:08 pm • linkreport

@AWalkerInTheCity/MLD:

Study, after study, after study has proven helmet use while biking to be effective to reduce injuries. I have also observed this. The reason why I think this is a serious issue, is because being indifferent or even critical of the safety of wearing a helmet will put people at additional risk that could have been avoided.

by 202_cyclist on Jun 7, 2013 4:13 pm • linkreport

@AWalkerInTheCity:

I also haven't been mountain biking in three years unfortunately. I bike to work several times per week.

by 202_cyclist on Jun 7, 2013 4:17 pm • linkreport

One of the major risk factors for being injured while riding a bike is being male. Therefore, no men, of any age, should be allowed to bicycle, ever. Then we will reduce injuries a lot.

by Tina on Jun 7, 2013 4:17 pm • linkreport

"Where did I say this? Again, stick with the facts and do not make things up."

Thats rich coming from someone who has called us "antibike helmet" and can't find quotes from us (certainly none from me) discouraging helmet usage. None.

You have repeatedly taken issue with the post and those of us defending it. yet all it does is say that helmets are about 50% effective (or slightly less) not 85% which is what NHTSA said before. So if you agree witht the post, I dont know what this is all about.

You may know critical mass intellectually, but I dont think its as emotional, as personal an issue to you as it may be to some of us. And its not as personal an issue to you as helmets are.

by AWalkerInTheCity on Jun 7, 2013 4:18 pm • linkreport

"Study, after study, after study has proven helmet use while biking to be effective to reduce injuries. I have also observed this. The reason why I think this is a serious issue, is because being indifferent or even critical of the safety of wearing a helmet will put people at additional risk that could have been avoided."

Even if the criticism is based on truth? IE that helmets add less to safety than some have said?

The safety issues related to low ridership are also documented. I experience them in southern fairfax county where A. drivers often do not look out for cyclists, of whom there are not many B. most drivers are not cyclists and so are less understanding of cyclists but most importantly C. bike infrastructure options are genuinely lousy and dangerous - I feel I do take my life in my hands when I ride around there - YES i wear a helmet, but if someone right hooks me and crushes my side and my internal organs, I will still be dead or seriously injured. Not to mention I can still can get a severe head injury or concussion even with my helmet. And we dont have good infrastructure there, in large part because the county does not prioritize it, cause there arent many bikers.

So any minimizing of the importance of critical mass puts cyclists at risk. Including me. and unlike you and helmet wearing, I can't even do anything about it, other than move.

by AWalkerInTheCity on Jun 7, 2013 4:25 pm • linkreport

202

when was the last time you biked on little river turnpike in Annandale? On columbia Pike from annandale to Baileys (where we had a fatality a while back)

Please bike on those routes before posting any more please.

by AWalkerInTheCity on Jun 7, 2013 4:27 pm • linkreport

@AWalkerInTheCity:

I attended an ANC meeitng last month to advocate for bike lanes. I emailed my ANC commissioners and DDOT staff this week to advocate for additional bike lanes. I understand critical mass. I understand that drivers will hopefully give cyclists more respect if there are more bicyclists on the road.

I also understand that a reduction of at least 50% in the number of reported head injuries is very substaintial. That is why I find it curious that of all the issues for WABA to be concerned about, they are on a crusade about whether the reduction in head injuries is 50% or 85%. And, yes, despite what you might protest otherwise, your comments and those of others here can be interpreted as critical of the benefits of helmet usage by any fair-minded, reasonable person.

by 202_cyclist on Jun 7, 2013 4:27 pm • linkreport

@AWalkerInTheCity:

I bike on Constitution Avenue and Wisconsin Avenue every time I bike to work.

by 202_cyclist on Jun 7, 2013 4:28 pm • linkreport

202

If i ride in annandale, with my helmet, and I am killed because of the lousy infrastructure and lack of critical mass, by a vehicle crushing my internal organs, do you promise to take care of my loved ones?

by AWalkerInTheCity on Jun 7, 2013 4:28 pm • linkreport

There is a tendency of those who are involved in an accident where they hit their head and were wearing a helmet to attribute their lack of injury to the helmet.

Without good data showing the real effectiveness of helmets, that is like my attributing my current crashless streak to my medallions personally blessed by Mother Theresa. G_d rest her soul.

As I posted yesterday, I had an accident a little while back where I hit my head pretty good, the helmet did literally nothing to protect me . . . and I suffered no head injury other than stitches. Had the helmet come into play, I might very well attribute my lack of injury to my helmet. And I would have been totally wrong.

We need better data. Period.

by Crickey7 on Jun 7, 2013 4:30 pm • linkreport

"@AWalkerInTheCity:
I bike on Constitution Avenue and Wisconsin Avenue every time I bike to work."

So? At rush hour? How fast does traffic go on Wisc ave at rush hour? Little river is posted at 45, and most of the time (and esp on weekends when i more often ride) its going at 55. Plus there are a whole bunch of alternatives around DC. There arent any for me. Its not that these are the most direct routes, for some directions they are the ONLY routes.

You are lobbying for bike lanes? In a city with a pro Biking DOT, a city that had Gabe Klein as its transport director where biking is a huge thing to a big part of the population?

In fairfax there are people who want to ban biking on arterials. There are legislators who opposed the bike safety laws VBF supported. There are legislators opposed to using transporation funds for bike improvements.

by AWalkerInTheCity on Jun 7, 2013 4:34 pm • linkreport

202
If i ride in annandale, with my helmet, and I am killed because of the lousy infrastructure and lack of critical mass, by a vehicle crushing my internal organs, do you promise to take care of my loved ones?

by AWalkerInTheCity on Jun 7, 2013 4:35 pm • linkreport

@AWalkerInTheCity:

I used to bike up Massachusetts Avenue, where there are plenty of cars and people drive 40 mph. So, yes, I know about riding with vehicles.

by 202_cyclist on Jun 7, 2013 4:36 pm • linkreport

I bike on Wisconsin every day. It's actually a pretty mellow route for cyclists, probably the best N/S route in all of NW DC.

by Crickey7 on Jun 7, 2013 4:36 pm • linkreport

I also understand that a reduction of at least 50% in the number of reported head injuries is very substaintial. That is why I find it curious that of all the issues for WABA to be concerned about, they are on a crusade about whether the reduction in head injuries is 50% or 85%.

I wouldn't call it a "WABA crusade." A lot more effort is put into their other programs, including helmet and general safety awareness. This was just writing some letters to government agencies.

As for why it was done, it's because of the recent push in Maryland for a mandatory helmet law, which WABA and many cyclists are against. Proponents of that law use the NHTSA-cited 85% statistic to make claims about helmet laws that are not true. And many cyclists would prefer it if government agencies reported statistics that are supported by lots of research and not just cherry-picked from a single study.

And pretty much everything that Crickey7 said.

by MLD on Jun 7, 2013 4:37 pm • linkreport

they are on a crusade about whether the reduction in head injuries is 50% or 85%

Its because policies that are bad for the overall safety of biking and bad for the overall public health impact of active transportation have been based on this one study whose results are an outlier; whose results have not been able to be reproduced.

Wear a helmet and encourage others to do so. But don't accept policies that lead to an overall decrease in the safety of biking-for-transportation and a decrease in population level physical activity.

by Tina on Jun 7, 2013 4:40 pm • linkreport

The other point is that letting NHTSA and other government agencies use old and potentially incorrect and outdated stats as gospel means that they are encouraged to use outdated stats for all aspects of cycling, which could result in reforms that make cyclists safer that should happen NOT happening.

by MLD on Jun 7, 2013 4:40 pm • linkreport

@Crickey7:
"As I posted yesterday, I had an accident a little while back where I hit my head pretty good, the helmet did literally nothing to protect me . . . and I suffered no head injury other than stitches. Had the helmet come into play, I might very well attribute my lack of injury to my helmet."

Let me get this straight--- you got stiches. You said yesterday that you fell hard enough that you heard yourself hit the pavement. You had no concussion? No skull fracture? No large bumps on your head? But your helmet did not do anything? What is a helmet suppose to do, if not prevent these things?

by 202_cyclist on Jun 7, 2013 4:41 pm • linkreport

" used to bike up Massachusetts Avenue, where there are plenty of cars and people drive 40 mph. So, yes, I know about riding with vehicles."

40?

Im talking a road thats posted at 45. People routinely go 50 to 55. Then there are the crazies who go over 55, but the police probably get some of them. In a suburban area, where they dont expect you to be, and dont want you to be.

But if you dont mind riding like that, well more power to you. I wont. It freaks the hell out of me. I use buses and their bike racks to get by bike to more bike friendly places. When I dont have time for that, I dont ride. And no, I dont like gyms. If I ride less, I exercise less.

But its good to know you will take care of my loved ones whether I get hit by a truck or die of a heart attack.

by AWalkerInTheCity on Jun 7, 2013 4:45 pm • linkreport

"Let me get this straight--- you got stiches. You said yesterday that you fell hard enough that you heard yourself hit the pavement. You had no concussion? "

you dont follow the nationals, do you?

by AWalkerInTheCity on Jun 7, 2013 4:47 pm • linkreport

Helmets do not cover the front of the skull very well. I put a tiny scratch on the helmet. The noggin got checked out at the hospital and is as I said, no fracture, concussion, or "large bumps".

Maybe if we stopped thinking that the safety question begins and ends with slapping a lid built to current standards on your head, we could get better answers.

by Crickey7 on Jun 7, 2013 4:47 pm • linkreport

@Crickey:
"Maybe if we stopped thinking that the safety question begins and ends with slapping a lid built to current standards on your head, we could get better answers."

Again, nobody has said this. I stop or yield at all intersections. I use headlights and taillights when riding at night. I ride in the direction of traffic.

by 202_cyclist on Jun 7, 2013 4:50 pm • linkreport

@AWalkerInTheCity:
"But its good to know you will take care of my loved ones whether I get hit by a truck or die of a heart attack."

Perhaps if you are a little more dramatic, yes.

by 202_cyclist on Jun 7, 2013 4:51 pm • linkreport

Then it seems strange that you have been so wrapped up in and focused on this one tiny aspect (percentage change in effectiveness) of one part of bicycle safety.

by MLD on Jun 7, 2013 4:52 pm • linkreport

All I can say is, I beleive that you will save more lives advocating use of lights than helmets. It sure would be nice to have actual, methodologically sound studies that showed which of us is right, so that we could deploy the scarce resources have most effectively.

by Crickey7 on Jun 7, 2013 5:07 pm • linkreport

...and we will save more lives with more segregated bike tracks than we will with more helmets....

by Tina on Jun 7, 2013 5:10 pm • linkreport

And disc brakes. I'm sure they've saved my life. I know this because it rained this morning, I used my disc brakes, and I did not die. Therefore they saved my life.

by Crickey7 on Jun 7, 2013 5:17 pm • linkreport

@Crickey7, heehee

by Tina on Jun 7, 2013 5:25 pm • linkreport

Maybe if we stopped thinking that the safety question begins and ends with slapping a lid built to current standards on your head, we could get better answers.

As someone who has experienced a high-speed crash twice due to not wearing gloves, I propose we pass a mandatory glove law for all cyclists regardless of age. After all, an ounce of prevention is worth a pound of cure.

by oboe on Jun 7, 2013 10:12 pm • linkreport

Did anyone else catch the recent article in Bicycling Magazine? Apparently, helmet effectiveness has stagnated because the CPSC has not updated the standard since 1999.

We've learned a lot about head injury since then.

So, helmets have gotten lighter, better fitting and better ventilated since then, but not really any safer.

by Z. Fechten on Jun 10, 2013 3:11 pm • linkreport

One of the big distinctions that needs to be made here is between wearing helmets and encouraging others to use them. Even if they aren't mandatory, look at the dialogue around them, even on this page; it's all "OMG I've fallen on my head a lot of times biking and I'd be dead if I hadn't worn a helmet and you're zooming along a few feet from the pavement and you're going to spill your brains on the ground unless you wear a helmet which is effective a lot of the time!!!!!!".

Someone said that a rational person wouldn't bike without a helmet after reading about bike safety. No. A rational person would never get on a bike at all after reading comments like that. A rational person does not want to fall on their head, helmet or no helmet, especially if there is some chance that it won't protect them anyway.

As a result, there are few cyclists on the road and more motorists, low demand for quality bike infrastructure, and more crashes. And thus, more injuries, including injuries that occur to other parts of the body and injuries that occur at speeds or conditions for which helmets provide no protection.

Whatever your personal actions are regarding helmet usage, if you can't find a way to encourage someone else to wear a helmet that doesn't play up the "dangers" of riding a bicycle, then I ask you to say nothing at all.

by stepthrough on Jun 10, 2013 3:30 pm • linkreport

@stepthrough -I mostly agree. What would you say about riding in the dark with and w/o lights?

by Tina on Jun 10, 2013 4:11 pm • linkreport

@Tina, et al:

I went to the Nationals game this weekend and was thinking about this afterwards. It is rare that someone has died after getting hit in the head with a baseball. Batting helmets are also not 100% effective. Additionally, batting helmets would have done little or nothing to prevent most of the baseball-rlated injuries at hospitals.

I am sure the requirements that little leagues and other organized baseball leagues have to wear helmets while batting discourages some people from playing baseball (leading to greater obesity, heart disease and other health problems). Hyping the danger of batting also discourages some from playing, as does the cost of a batting helmet and the burden of having to carry it with you. Do you oppose helmet usage for sports such as this? If so, should there be a WABA-led crusade against helmet usage for baseball or hockey such as there is against bike helmets?

by 202_cyclist on Jun 10, 2013 5:11 pm • linkreport

@stepthrough:

Bicycling is pretty safe but perhaps we shouldn't pretend it is a zero-risk activity.

by 202_cyclist on Jun 10, 2013 5:14 pm • linkreport

Look at what you three did. I hope you're happy with yourselves.

by MLD on Jun 10, 2013 5:21 pm • linkreport

202

do you think batting helmets should be mandated by the govt for adults? (its not even mandated for kids, BTW - I assume there are still some kids who play baseball outside of organized little leagues)

Also since WABA is a cycling org, why would they care about baseball or hockey?

and is there a govt website with incorrect data about the safety of batting helmets?

by AWalkerInTheCity on Jun 10, 2013 5:30 pm • linkreport

should there be a WABA-led crusade against helmet usage for baseball or hockey such as there is against bike helmets?

There is no WABA-led crusade against helmet usage.

by David C on Jun 11, 2013 9:27 am • linkreport

So, which is it? Perhaps you are just making this up as you go along.

Helmet use statistics are very unreliable and it matters what year you're talking about. Helmet use is up over the last two decades, so for older studies you need to use a smaller number. Helmet use is somewhere between 30% and 70%, but it depends on where, when and who.

by David C on Jun 11, 2013 9:42 am • linkreport

@Tina - Riding without lights I consider extremely dangerous! That is my other issue with the helmet hubbub... All the effort given to promoting helmets (with the sub-message that riding a bicycle is dangerous) is taking away from other safety programs - distributing free bike lights, educating people about *not* riding on the sidewalk or in the door zone, educating motorists, offering bike fit and maintenance services, and of course advocating for better infrastructure. Better to prevent a crash in the first place, I say, with safe riding habits and environments.

@202
Nothing is a zero-risk activity. Driving, walking, taking a shower. There is a body of research about the number of people who are injured by tripping over their pets each year. Non-activity is not without risk either, of course, then you are just being sedentary and increasing your risk for the biggest killers, heart disease, cancer, and stroke.

by stepthrough on Jun 11, 2013 10:01 am • linkreport

Since the question of other safety equipment has come up in the recent comments, I'll add that it also came up in our petition. The longer article on the WABA site mentions in the footnotes that we had a second complaint: NHTSA's repeated claim that "helmets are the most effective way (or device) to prevent head injuries and fatalities".

We said:

NHTSA has repeatedly stated that helmets are the most effective way (or device) to prevent head injuries and fatalities, but my requests to obtain documentation for the claim have been unsuccessful.57 NHTSA did provide one document that seems to suggest that efforts by safety advocates to get people to wear helmets may are more effective than other efforts that safety advocates might take,58 although the document largely leaped to that conclusion rather than carefully estimating the costs and results from alternative advocacy efforts. But regardless of the validity of that conclusion, the website states that wearing a helmet is the most effective thing a cyclist can do, which is very different from being the most effective thing for NHTSA to advocate.

Many cyclists in the Washington area doubt NHTSA’s claim.59 They believe that the most effective way to avoid a head injury or a fatality is to ride safely and not have a crash. Avoiding the use of a cell phone and/or headphones may be more important than wearing a helmet. Among the types of safety equipment, helmets are not at the top of the list. Working brakes and running lights may be more important. Even wearing sunscreen may do more to prevent premature death than helmets.

Thus NHTSA violates the Data Quality Act by making a claim that it is unable to substantiate, in the face of reasonable alternative theories.

NHTSA rejected this second request, for reasons that I believe to be erroneous. I have appealed that decision and will probably write about it here on GGW when I hear back, presumably in about two months.

by JimT on Jun 11, 2013 10:40 am • linkreport

@stepthrough -I concur!

by Tina on Jun 11, 2013 12:22 pm • linkreport

FYI: Nine days after this blog post, the New York Times cites the same study and quotes the author without questioning the data:
http://mobile.nytimes.com/blogs/well/2013/06/13/bike-sharing-can-mean-safer-biking/

by Graham S on Jun 13, 2013 11:45 pm • linkreport

Thanks for the heads up. I guess we can't expect writers for the New York Times to read the Washington Post, can we? But I am pretty sure that Ashley Halsey does!

I did get a nice note from the New York Streetsblog people so it will be interesting to see whether any New Yorkers write the Times asking for a correction.

But hey: Look at the bright side, at least the Times didn't cite NHTSA or CDC for the claim.

by Jim Titus on Jun 14, 2013 7:03 am • linkreport

Interesting the narrow focus on "head-injuries" as if that is the only injury you sustain on a bicycle. A more important question is whether helmets reduce your risk of a fatality!

Regardless of the answer to this question, the decision to wear a helmet is the sole responsibility of the rider and NOT the government. Afterall, you could make the same argument that we should wear helmets in cars. Hell, why not just wear full body armor since it will definitely make you safer!

by Bill Smith on Jul 24, 2013 7:41 am • linkreport

Someone in this long,long string said the US has over 900 cycling fatalities per year. That is certainly way too high; it is less than 700. In addition, cycling accounts for 3% of serious and fatal head injuries while automobiles account for 61%. So, not many people actually die riding their bikes. Just for a little odd (and sad) comparison, over 9,000 Americans die every year from gun homicides. My point is that cycling is actually pretty safe and numbers suitable for objective comparison may not exist. Other types of accidents account for far more fatalities:
Medical errors kill 200,000 people every year (Scientific American on-line, Aug 10, 2009).In addition, there are:

29,843 accidental poisonings (CDC 2007)
42,000 traffic related deaths (CDC 2007)
23,443 killed in falls (CDC 2007)
9,146 gun homicides (FBI 2009)
1,826 knife homicides (FBI 2009)
and 3,443 drownings, not related to boating(CDC 2007)

Of the 630 killed in bicycle crashes in 2009, nearly 15% occurred in only 5 states, FL, CA, TX, NY, and AZ (http://www.bikingbis.com/blog/_archives/2011/2/14/4749974.html).

Automobile accidents account for 61% of all traumatic brain injuries, while cycling accounts for only 3% (braininjury.com).

by rkim on Aug 8, 2013 11:04 pm • linkreport

Helmet cracked - my head didn't! No argument - wear a helmet!!

by twiga on Aug 9, 2013 1:50 am • linkreport

You could also wear a full football uniform and reduce your risk even further or not ride and bike at all. Holy crap.... wear one if you want to or don't wear one. Just mind your own business and live a little while your still on God's green earth.

by Travis on Apr 5, 2014 12:38 pm • linkreport

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