Bike helmets and safety: a case study in difficult epidemiology

All referenced in TFA. It’s a case study in epidemiology, so population life expectancy is kind-of what it is all about. Not being interested in population life-expectancy would be going fairly off-topic. The entire article is about how it’s more complicated than we think, and there’s not been enough studies done to analyse the data properly.

Which is fine, except when “we just don’t know!” is used as ammunition for removing safety mechanisms from basic transportation.

“We just don’t know!” so… make things more dangerous, just because?

I mean, for a while “we just didn’t know” if there was a connection between autism and vaccinations, right, so… cancel vaccinations just in case?

We don’t know, so we keep the status quo.

Vaccines were shown to prevent diseases, so we started vaccinating.

Some doubt was thrown on vaccinations, but it wasn’t solid, so we kept the status quo - lots of vaccination.

We don’t know that compulsory cycle helmets is a good thing, so we’re keeping the status quo of not having cycle helmets, in the UK. (N.B. in the UK it is highly recommended that you wear a helmet in the Highway Code, and victims have received lower compensation on grounds of not wearing a helmet.)

Now, funding for actual studies would be a good thing. And some in education, economics, energy policy, in fact everything they want to tinker with.

I’l certainly grant that. But, if it’s all as good an good idea a you say - why does it need to be a law at all? Self-preservation would be enough motivation for people to do it.

Or, do you think people are just too stupid to make their own choices and need you to enforce whatever you think is best for them?

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Hit a wall with your head with and without a helmet.

That is it really, all the rest of the discusion is frankly pointless.

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Did you read TFA?

Why would I be interested in population life expectancy?

So that would be a “no” then?

He does have the disadvantage of living in the country with the least efficient health system in the world:
http://thesocietypages.org/graphicsociology/2011/04/26/cost-of-health-care-by-country-national-geographic/
http://www.theatlantic.com/business/archive/2012/03/10-ways-to-visualize-how-americans-spend-money-on-health-
care/254736/
http://metamodern.com/2009/11/15/a-unique-health-care-system/

(That that sort of attitude isn’t unusual for Americans might be part of why they have such an inefficient system. For the record, I know plenty of Americans who aren’t jerks too.)

I read the summary in the BB post.

After looking at the absolute number of deaths – 122 cyclists were killed last year in the UK compared to ~1,000 in the US. I am not sure the statistics even matter based on such a small sample size of deaths.

What else killed ~1,000 people in the USA in a year? Let’s see:

  • 1,740 people died from Drug Use
  • 1,606 people died from Epilepsy
  • 691 people died from Hepatatis B
  • 687 people died from Menengitis

(I am sure the UK causes are even more obscure for 122 yearly deaths.)

So mandatory helmet laws, if the statistics I quoted earlier from the CDC are to be believed, would at most potentially save the 62% of those people whose deaths were due to cycling related head injuries – 620 in the US and 75 in the UK.

Given that there are ~380,000 deaths per year from coronary heart disease, I can see why they want to focus on these hand-wavy, nebulous “not wearing a helmet might make more people ride bikes and get slightly less heart disease” ideas. Because the absolute number of yearly cycling deaths is just so impossibly tiny relative to almost every other type of death.

Wear a bicycle helmet, don’t wear a bicycle helmet – statistically speaking, it just doesn’t matter.

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So basally one minuscule risk of worth fussing over than some other a little more miniscule risk.

Also, you can substitute crossing a street with “cleaning the windows”, “taking the stairs” or “taking a shower”, which are all activities with an increased risk of head injuries due to falls.

Also, head injuries are still a major concern in car crashed, despite air bags and seat belts. Car passengers would certainly profit from wearing helmets, with could be conveniently worn and stored in cars.

Cycle helmets aren’t designed to protect cyclists against being hit by cars. They are only designed to protect against low speed falls.
Thousands of pedestrians a year are injured in falls and trips badly enough to go to hospital: http://www.cdc.gov/motorvehiclesafety/pedestrian_safety/factsheet.html

http://www.cyclehelmets.org/papers/c2023.pdf “The tests that cycle helmets currently go through mean that they should offer similar protection to a pedestrian who trips and falls to the ground. … Cycle helmets are not suitable for use by children in play areas where they can climb: the helmet straps can get caught and strangle the child.”
(That last bit is not hypothetical - http://www.cyclehelmets.org/1227.html)

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It does seem like the death rate from ‘random accidents’ is much higher than cycling deaths:

For 2010:

  • unintentional falls: 26,009
  • unintentional poisoning: 33,041

This source has similar data for year 2000:

  • pedestrians: 5,870
  • water transport: 630
  • falls: 13,322
  • firearms discharge: 776
  • accidental drowning: 3,482
  • electricity: 296+99 = 395

etc.

Probably because the population studies don’t control for factors outside the strict domain of injuries. For example bike riders who wear helmets might ride more than they otherwise would, and experience more injuries as a result.

Not if you believe Cook and Sheikh 2003, who found that helmets had an effectiveness of 186%, with each helmet wearer saving most of the life of another non-helmeted wearer as well:
http://injuryprevention.bmj.com/content/9/3/266.abstract/URL%20direct%20link%20to%20eLetter/reply#injuryprev_el_59

You’re right, clearly. Wearing helmets in cars would save a lot of lives. Sailing too, surfing, any activity where you’re potentially going to bang your bonce.

There is though a cultural prophylactic - people don’t want to, they want to rebel against rules and common sense - ably assisted by the marketing departments of, say, GoPro - to get through.

But things are changing. Skiing - it’s now the norm to wear a helmet. Seems funny now, we used to hurtle down slopes of ice and rock at 70+ mph without helmets. But enough publicity around deaths due to head injuries has shifted the wind.

Airline seats - they should really face backwards. Ask any safety engineer. All sorts of things, all around us, are not set up to take impacts and optimise the in-situ opportunities for risk reduction.

At the end of the day, it’s good ol’ common sense - it’s just plain stupid not to wear a helmet. It’s plain stupid to drink yourself silly. It’s plain stupid to eat food from dodgy restaurants.

We’re just plain stupid human beings, and those of us that seek to live long, fulfilling, energetic lives, we take care of ourselves.

I sail, surf, motorbike, ski, cycle, practice martial arts (a bit, nowadays), ride skateboards, run with my kids, and so on. But I don’t rely on miracles to save me. I know how to fall well, thanks to Judo, and in other situations, wear gear appropriate to the circumstances. I take beacons when I ski off-piste, and carry avalanche rescue gear.

Some people look at me like I’m nuts, a baked-bean survivalist hunkered in the woods. Others just say ‘that’s smart’.

God knows what will kill / injure me - but I’m not surrounded by cotton wool, I’m not a safety freak - I’m just aware and ready as I can be.

That’s just design not optimising for the risk.

A motorbike helmet is designed for more substantial impacts, but cyclists certainly wouldn’t go for that.

Bikers who wear helmets get passed closer than bikers w/out helmets, for example. At least in some countries.

Also. ER rooms see be definition only the emergencies and will of course see far more head injuries which could have prevented by helmet - however, they will not see the vast majorities of harmless accidents nor will they see they fatal ones.

Also, lobbying for helmets is a safe bet: It makes good news for slow news days, people earn money with the sale of helmets and of cour,se you do it for the children.

That’s why once in a while you’ll finde articles where the author gravely closes his piece with “the cyclist did not wear a helmet” when it was about a person crushed by a 40-ton-truck whose driver didn’t bother to look right at all.

Thankfully, the worst crossing over here have been made safer by not giving cars and cyclicst/walker green light at the same time, with no noticeable drop in speed.

So I take it your wear one when taking a shower, walking down the stairs and washing your windows or changing lights?

No. I’m washed daily by vestal virgins, I use a Stanna Stairlift, I hire people to wash my windows, and when the lights blow I move house.

Cycling barely scratches 2% mode share anywhere in Australia. There is evidence of an increase in cycling numbers in inner Melbourne and Sydney, but claiming it is booming is nonsense.

Yes - http://www.bath.ac.uk/news/articles/research/overtaking110906.html
http://drianwalker.com/overtaking/overtakingprobrief.pdf

And hi-vis clothing doesn’t help either, unless it can be confused with police uniform: