Bike helmets and safety: a case study in difficult epidemiology

I used to be a bike messenger. One day I was hit by a car and went through the windshield and didn’t hit my head, somehow. But it was another incident that solidified my belief in helmets; on a hot sunny summer day I had my front wheel hit something slick on a crosswalk and slid out from under me. I woke up on the side of the road with very concerned onlookers around and a broken helmet. The bottom line is that you don’t know when you’re going to need the helmet so just wear it.

And yet these same people have no problems surmounting all the hurdles to becoming drivers?

But is much, much, much more likely to happen to a cyclist.

I’m certainly in the “wear a helmet” crowd. Not sure about the mandatory idea, though.
I wear mine pretty much all the time now, especially after getting car-door’d in early Nov. I didn’t have it on, and thankfully didn’t hit my head. I did, however suffer damage to my right hand, and bruised my ribs and hip where I hit the ground. There’s an open claim with her insurance co.
I am fairly new to long city/road bike rides, having been a one time, long time mountain biker (always went helmet-headed then) so even more than the protection of a helmet, I wish I had somebody or some people to ride with that have extensive experience on the road and in the city so I can learn from them. Not just to follow around and have a good time (which is nice) but to truly spend some time watching and getting tips.

Oh, no, the British are quite insistent that cycling on the ‘pavement’ is a crime against nature. Even if it sometimes saves lives from the multi-ton weapons on the roads. Even if cars on the ‘pavement’ kill more people in a year than bikes on the ‘pavement’ in a century.

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However heartfelt those folks efforts may be, it’s the insurance companies who own the big ticket lobbying and that is what gets laws like this passed. And if you think otherwise, you are at least as naive as I am cynical.

Obviously driving has its own advantages, but I don’t think we should shift the balance further in the direction of driving.

Weirdly, yes. See the above comment re: cycling being seen as juvenile & cars as Big and Grown-Up.

It could happen — and, actually, I saw a pedestrian get hit less than a block from where I got hit about six months prior — but pedestrians do not spend most of their time actually exposed to cars. Yes, I got hit crossing a cross walk (the other bicyclist did not — he was hit by a car turning a corner), but I also spent 18 minutes of my 20 minute commute in the streets with cars. If I was walking, it would have been an hour-long commute but it wouldn’t have been but a few minutes total actually in any streets. I used to run 10 miles a day, and I never had an encounter with a car near as hairy as pretty much every time I’ve ever ridden a bike. I will concede, though, that I think cross walks are mostly worthless. :wink:

The data you showed are not enough to support that conclusion in any way. The same increase could trivially be explained by an increase in ridership. Or, and this was my original point, an increase in 11 people when discussing the total of all vehicular fatalities in a year could be attributed to noise.

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What conclusion?

I said that cyclist deaths had increased. That was the conclusion of my phrase.

You’re right - 11 could be statistical noise. Equally, it could be an increase of c. 10%. It’s too noisy to know.

But the deaths increased, and motorcyclist deaths decreased.

What’s wrong with a little learnin’?

The counterpoint to your argument is that insurance companies, greedy buggers that they are, do look at outcomes over a population level. Their incentive is to reduce payouts. They have determined that they fork over more money when people don’t wear helmets, so they lobbied to require them.

The same with seatbelt laws. Vehicular deaths are shrinking all the time, and seatbelts are a big part of that. Insurance wanted them, of course, because less people are hurt and it consequently costs them less money.

Just because it is profitable to advocate for less people to be killed and maimed does not mean it is evil.

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Depends on which part of Australia you are looking at. Kids still ride to the beach for a swim here in Frankston in thongs, no brakes and no helmet. Inner urban Melbourne is full of upright riding people on “cool” Mary Poppins bikes, hipsters on fixies with ridiculously narrow handlebars, ferals on old dragsters. The lycra brigade swarm Nepean highway on weekends on light expensive carbon uber bikes. and I ride my mountain bike (with helmet) when I get the time. What we don;t have yet is well planned bike lanes. I do feel we are slowly gaining the respect of other road users though; compared to when I rode from Armadale up Princes Highway to Monash Medical Centre on my bike twenty years ago. If no one abused me, tried to run me off the road or threw a bottle at me it was a good ride back then.

Head even with my bum? My back hurts just thinking about doing that on a bike.

You do realize that’s a motorbike helmet?

Yes. We know that countries like the USA with a higher helmet wearing rate have higher cyclist injury rates than countries with lower helmet wearing rates like the Netherlands, but that doesn’t tell us that helmets cause the high injury rates, just that if we want to reduce injuries, there are much more significant factors than helmets.

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If Lance Armstrong is anything to go by, maybe American cyclists are just drugged up to the eyeballs. Mind you, now that I’m stereotyping, the Netherlands doesn’t seem to be an appropriate oppositional comparison.

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Well, except that motorists are fully encased in steel crash cages, and wear federally mandated seatbelts when driving. Other than that… totally identical to bicycles.

Because head injuries are some of the worst, most dangerous injuries the body can sustain. Sure, being a fatass might kill you 5 or 10 years early, but slamming your unprotected head into the pavement at 20 miles per hour will kill you in a day, if not instantly.

Besides the massive difference in risk, It’s also a lot easier and cheaper to say “place this $20 helmet on your head, please” than “change your whole lifestyle”.

Still, only 1,000 US cycling deaths per year isn’t many. Maybe it just doesn’t matter?

Each year, nearly 1,000 persons die from injuries caused by bicycle crashes, and 550,000 persons are treated in emergency departments for injuries related to bicycle riding. Approximately 6% of the bicycle riders treated in emergency departments require hospitalization. Head injuries account for 62% of bicycle-related deaths, for 33% of bicycle-related emergency department visits, and for 67% of bicycle-related hospital admissions.

For comparison, Wikipedia says in the USA there are ~4,500 motorcycle deaths per year, and ~35,000 automobile deaths. So 1,000 bicycle deaths, ~620 of which are head injury related… I’d still say wear a cheap bicycle helmet, unless you for some reason enjoy taking unnecessary, pointless risks.

Did you read TFA? Individually, you seem to be correct - an individual putting a helmet on seems to make them safer, but there’s noise in the data. Population-wise, it’s even noisier, and the trick seems to be that if you mandate that the population will wear helmets when cycling, then a statistically significant number will quit. Then there’s number-crunching to be done over whether this actually raises or lowers population life expectancy. (Cyclists live longer than non-cyclists. Cyclists that don’t suffer head trauma live longer than those that do.)

However, it might be incorrect at the individual level. Some suggestions are that drivers take more risks around cyclists that are wearing a helmet. (Of course, some will be dicks and just be more aggressive to someone who looks weaker, like a cyclist with, or without, a helmet, or someone driving a tiny car.) So there’s some studies that show accidents go up when cyclists wear helmets.

Me? I ride cautiously, like I drive. I assume everyone else is actively trying to kill me. I’ve had a few near misses, but largely I slowed into them because I was looking ahead. I wear a helmet most of the time, but I think my risk of damage from heat-stroke in summer is greater than the chance of it preventing greater damage.

Why would I be interested in population life expectancy?

It’s a specious comparison. Where does it say that the purpose of cycling is to increase population life expectancy versus … provide them basic transportation?

I have a basic expectation that cars won’t needlessly kill the people inside them when they make common mistakes. I expect the same from bicycles. If you (or someone around you) make a mistake, a $20 bike helmet is going to make it far more likely that you don’t die, just like seatbelts and steel safety cages in automobiles do. The devices we use for transportation should have functional basic safety mechanisms. That is their purpose. (that said I will readily concede 1,000 bicycle deaths per year is not very many and maybe it just doesn’t matter at all in the big scheme of things.)

Do people drive more dangerously in large SUVs where they perceive themselves to be “safer”? Do other motorists drive more aggressively around large automobiles because they look “safer”? This strikes me as extraordinarily difficult stuff to measure through science, and more of an anecdotal excuse to have a particular opinion.