Bike helmets and safety: a case study in difficult epidemiology

Given that head injuries account for a significant number of motorist deaths, it seems awfully dumb not to wear a helmet while driving.

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No, itā€™s not just because some people like to control others. Ultimately, itā€™s always, always about money. In the US, seatbelt laws did not exist for most of the history of automobiles, nor was it mandatory to have insurance Who does that law benefit? Insurance companies, obviously. And they did in fact lobby for mandatory insurance. And when they got that much, they also wanted to reduce claims.

Then came the helmet laws for motorcycles - and the motivation was the same - an attempt to reduce claims. Among other problems, helmets are not always safe to wear. In the desert, for example, even at full speed, the heat beating down on a helmet creates a risk of heat stroke. And, helmets make it difficult to hear surrounding traffic clearly, which is essential in avoiding collisions. But, the helmet laws are enforced, because insurance is, if nothing else, a game of making bets using statistics. And that is what keeps the champagne on a actuaryā€™s table. There are fewer motorcycle riders in the desert than elsewhere, and there will be fewer bicyclists as well - so those dangers may be ignored.

A second industry profits collaterally from these laws, and that is (in the US) the Public Health Service. Because, making a issue out of helmet laws provides epidemiologists with employment - and that employment is promoted by in turn promoting the issue even further - whether or not any high-quality studies can ever be achieved. Just as statistics promising reduced FINANCIAL risk to insurance companies keeps the champagne on the actuaryā€™s table, creating and promoting a public health issue does the same for epidemiologists and the human machine that surrounds them.

And that is why thereā€™s a push for more helmet laws. It has exactly nothing to do with what is beneficial to riders, and never did.

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Like this: Youā€™re riding along, 15 mph, in the cycle lane in a major city centre. Blue BMW turns left without warning, just turns left. you brake, controlling as well as you can, but this is an instant in time. You turn in with the car to minimise impact speed, but your right handlebar grip jams on the rear passenger side door as you impact, and with nowhere to expend, your inertial energy converts from forward motion to rotational around the axis dictated by that jammed grip. You pivot whip-fast, landing on your head - right on top of it - and as time slows, you notice the click-crunch of every single vertebra along your spine compressing as the shock wave of the impact combined with the sheer mass piling in from above them passes through your vertical axis. You think ā€œthatā€™s gonna mess my back upā€, while youā€™re watching the proximity of the rear tyre still in motion near your head, and think of your kids.

The bike retains energy, and after flinging upwards, piles into you, cutting you in several places. You roll as best you can in this tangle of chain, sprockets, gears and frame, away from the vehicle. Blood pouring from cuts and impact abrasions up and down your body, you swear to get attention and groggily stand up.

Without that helmet, I would have followed the example of my brother, who enjoyed a three month hospital stay after a similar event. Luckily for me, I only suffered my first concussion, and have some difficulty remembering names, and also feel absent-minded a lot of the time. Weā€™re about six months on now. Iā€™ve never had any difficulty with my wonderful mind, so Iā€™m fairly pissed about the whole thing, and the awful driver who immediately tried to blame me is going to have a merry dance with his insurance company.

I donā€™t necessarily agree with making it law, for the reasons outlined in the article, but I do believe in educating every damn cyclist in what happens if you donā€™t have this gear. There are too many people on the road who consider themselves danger-free, too few people telling them what really happens in accidents, and the cycle sales industry and their associated representation is all too keen to push people onto the open road without alerting them to the dangers.

I would never, ever go out without my helmet before, and sure as eggs are eggs, will continue to follow that policy. Law or no law.

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wow - snap!

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Boris Johnsonā€™s advocacy of this, without proper education for cyclist, is one of the impulses behind the huge number of undercapable cyclists on the roads in London right now.

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Of course, what you describe could easily happen to a pedestrian, Happens all the time, actually,

So I take it you wear a helmet while walking? Or at least crossing the street?

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OMG. Thereā€™s always education - itā€™s a little abstract, but it seems to work.

Do you bang kidsā€™ heads with a stick to show them what itā€™s like?

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Still not a single serious injury on the Boris bikes, thoughā€¦

How about this: cycling isnā€™t dangerous.

Unless you consider riding in a car so risky youā€™d wear a helmetā€¦ stop picking on cycling.

And you know what? The lionā€™s share of the risk associated with cycling is due to cars. And still, planet-choking motorists have the temerity to hang shit on cyclists.

I drive a car sometimes, but I consider it a (historically, past and future) rare privilege I donā€™t really deserve, while I consider cycling no less a right than being allowed to walk around in public space unimpeded.

Iā€™d say the most effective form of education on the subject would be regularly cycling to school. You can learn a fair bit about staying out of the way on the footpath, before graduating to the roads.

Australia and New Zealand (two countries with compulsory helmet laws) would have to be the worst places in the world to cycle. I am Australian and have lived in both countries but am currently living in the UK where helmets are not mandatory.

Cyclists in Australia and NZ look like theyā€™re competing in a race: they wear special clothing, helmets, have different bikes and cycle in what looks like dangerous traffic to me. In York, UK, I cycle on a Dutch bicycle which allows me to sit upright rather than hunched over the handle bars, I can wear dresses and skirts and I cycle at a leisurely pace. Because there are so many cyclists on the roads here, we are very visible and always on the minds of motorists who never fail to give way at least not that Iā€™ve seen. There is also extensive off-road cycle infrastructure.

Helmets give the impression that cycling is sporty and dangerous. It can be both but it can also be neither.

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If you bike in traffic, bike as you would drive your car. Understand the risk. Donā€™t do it tired or drunk. Donā€™t pretend youā€™re at a race or that youā€™re a racer, regardless if you have all the gear or not. If you do that, a helmet is optional. My rule of thumb would be to wear a helmet on the bicycle if you would wear a helmet while driving the car.

And if you donā€™t do the above the helmet probably wonā€™t save you from hurting yourself. Donā€™t think it gives you security from bad reflexes or from the usually pretty horrid brake distance you have on your bike. Donā€™t think it makes you more visible to other people in the traffic.

Donā€™t think riding a bike with a helmet makes it safer. If you do youā€™ll end up making bad mistakes.

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Iā€™m not picking on cycling - Iā€™m a cyclist.

If the roads were devoid of powered vehicles, then only cyclists, potholes and other deviances from road perfection would be to blame.

Cycling is not inherently more dangerous than walking. Well, maybe a little. But include vehicles, and youā€™re in a mad matrix of probabilities and capabilities.

The current climate of blindly encouraging more people to cycle around has over-cooked the ignorance of safety angle. Itā€™s somewhat lambs to the slaughter, with the seeming idea being that change will occur as outrage mounts.

Boris Johnson, who I halfway admire as a politician, and halfway donā€™t, combined with cycle stores and pumped-up agencies like the London Cycling Campaign - theyā€™re all responsible for teasing people out onto the open road without making it clear what menaces people face. And theyā€™re deadly. Why do you think people continue to get crushed by lorries turning left at junctions? Itā€™s because they lack the perception and anticipation to realise theyā€™re putting themselves into danger by sliding into the gap on the left of those vehicles. They donā€™t understand the risk.

Iā€™ve been cycling in London for 25 years or so. Iā€™ve had numerous offs, always due to cars. I keep a barge pole between me and taxis, lorries, emergency vehicles, delivery vehicles and so on. Iā€™m fit, so Iā€™ve got the go to move on when I need to.

But the cyclists - this new-found enthusiasm for the roads means that outlyers are popping up more and more frequently. Cyclists who arrogantly take substantial risks, believing that that other road users must give way and permit them their path. One guy last week, at Wandsworth roundabout, came across the pedestrian crossing, paused briefly as the vehicle lights changed to green, THEN peeled out into the path of the accelerating vehicles, forcing a four-abreast line of traffic to screech to a halt, including me. He had all the gear and a fast bike, he was fit and clearly experienced - but wtf? If one vehicle had not been paying careful attention - which, in the situation, was lucky for him - he would have been history.

Thing is, to save myself, my kith and kin, and others injury due to my own driving, Iā€™m on the Advanced License program, or whatever it is. You learn an absolute ton about safety, anticipation, empathising with the motivations of other road-users, etc. But Iā€™m a safety outlier. London is chock full of foreign drivers, tens of thousands of uninsured drivers, drivers with ā€œlicensesā€ obtained by paying off their domestic agency, DHL vans late for deliveries and under-the-gun, and so on.

To encourage a flood of inexperienced cyclists into this mayhem is idiocy. To educate them would diminish the number of new cyclists - theyā€™d be aware of the risk, and back off.

The one thing you can note is the money. There is a lack of money invested in cycling infrastructure safety, and itā€™s only in the last few days that Boris has, at an optimum political moment, caused more to come in - but not enough.

The point is, and youā€™re right, that the roads are dangerous due to vehicles. Every time I get on my bike, Iā€™m utterly aware of that, and take whatever precautions I need to to avoid becoming a KSI.

Youā€™re right about regularly riding to school. Fantastic.

At the end of the day, and Iā€™m a self-reliance, independence geek, itā€™s down to people knowing what theyā€™re getting into that matters. Laws, rules, procedures - none of it is going to work, the overall cycling mix is just too multi-dimensional to have one ā€œsaving graceā€ way of dealing with it.

And did I mention that every cyclist should ride as if theyā€™re an ambassador for cycling? That way, you can avoid annoying people, who carry their anger to the next cyclist.

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They actually do that themselves and learn from it.

Itā€™s not a reasonable response, since medicine and common sense know full well that a padded head is protected from injury. Thatā€™s not anecdote and to imply that it is is disingenuous and merely posing.

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And that is why thereā€™s a push for more helmet laws. It has exactly nothing to do with what is beneficial to riders, and never did.

So all the people who lobby for them, many citing personal tragedy, are all lying sacks of cynical shit. Got it.

Some of your points regarding helmets and seat belt laws may well be valid. The argument is undercut, though, by your simplistic, cynical, all-inclusive statements about the motives of those who pushed for or passed them.

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Yes youā€™ve got it. & this thread seems to be chock full of people doing this same dumb kind of argument.

This. Always, I notice, well-equipped, but lacking any road-sense, or, indeed, manners. Yellowjackets, I call 'em.
(I too bike everywhere. I watch where Iā€™m fucking going, though)

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Most of 'em, anyway.

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Yeah, some probably donā€™t. In my experience those, who do not realize that hitting people really hurts people, are in for a nasty surprise when they learn that lesson in their teens.

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Other studies have shown that the reason at least some Canadian laws didnā€™t have an immediate off-putting effect was that they werenā€™t actually enforced: http://www.cyclehelmets.org/1023.html

Oh please. Why not say that for everything? You are ā€œassuming so much extra riskā€ by not exercising. Are you going to not pay for the healthcare of anyone overweight?

Heart attack? Eat less fatty food, Iā€™m not paying for your damn healthcare. AIDS? Donā€™t have sex, Iā€™m not paying for your damn healthcare. Car accident? Donā€™t drive a car, Iā€™m not paying for your damn healthcare. The flu? Get your flu shot, Iā€™m not paying for your damn healthcare. Cancer? Donā€™t live near power lines, Iā€™m not paying for your damn healthcare.

You can live in your libertarian fantasy-land where everyone pays for their own health because their sicknesses and injuries are their own fault. Me, Iā€™ll team up with these other ten-thousand people and put our money in a common pot. Weā€™ll see who goes bankrupt first.

But more importantly, you didnā€™t understand the point of the article, which is that itā€™s not clear if helmets and helmet laws will end up costing society more, which brings me to:

Did you read the article weā€™re discussing? The point of it is (a) the jury is, actually, still out, and (b) those studies you quote are completely irrelevant to the discussion, because, as the original article discusses, they deal with people who have already had the accident, so they ignore both the cyclists who are not in the emergency ward and the people who are not cyclists yet.

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