New study on helmet effectiveness

This sub-forum all discussions about this "lively" subject. All topics that are substantially about helmets will be moved here, if not placed here correctly in the first place.
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Heltor Chasca
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Re: New study on helmet effectiveness

Postby Heltor Chasca » 22 Sep 2016, 12:54pm

The helmet debate will always have flaws regardless of which side of the fence you perch. Until the infrastructure and car centric culture changes, safety won't improve.

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bovlomov
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Re: New study on helmet effectiveness

Postby bovlomov » 22 Sep 2016, 1:03pm

Heltor Chasca wrote:The helmet debate will always have flaws regardless of which side of the fence you perch. Until the infrastructure and car centric culture changes, safety won't improve.

Good summary. The lack of infrastructure and car centric culture are the very foundation of the helmet debate. Every column inch about helmets is a column inch not devoted to culture and infrastructure.

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Re: New study on helmet effectiveness

Postby reohn2 » 22 Sep 2016, 1:53pm

bovlomov wrote:Am I allowed to post a Guardian comment?

thelonggrass
22 Sep 2016 11:16
0 1


The data on helmets is led from the hospital looking out. Definitely from this point of view helmets help. In the UK we might reduce cyclist fatalities from 113 to around 60-70. However there are 25 million bike owners in the UK, and 3.6m cycling at least once a month. So at a typical cost of a helmet of £30, compulsory helmets would cost the population between £110m-£750m. So the first question is that value for money, or could we improve cyclist safety better by spending £100m on something better?

Secondly, the view from the hospital out ignores the exposure rate. So it fails to consider the risk per individual or per individual journey. The UK has about 9000 hospital admissions for cyclists per year of which 2,800 are serious injuries with 110 fatalities. This is from a population of 3.6m regular/occasional cyclists (may actually be 6.6m). So one estimate of the likelihood of being KSI because of not wearing a helmet is about 0.04% per year - ignoring cycling time and journey length. Accidents are also disproportionally likely for those under 14 and over 65 and those cycling more adventurously (mountain bikes or racing). These are not high levels of risk (there were 30 fatalities related to angling in 2011 as a comparison), and may be better dealt with in other ways - reducing the factors that cause accidents for instance.

It also ignores a problem that requiring helmets may reduce the amount of cycling (I've seen estimates of a 13% drop in journeys). Since for cycling there is a safety in numbers effect - more cyclists leads to fewer accidents - so forcing helmet use might not be a positive trade off against other benefits from cycling itself. For example there were 9,500 estimated deaths in London from air pollution. Bikes on the road would reduce the car fumes that aggravate asthma and other lung problems so the net cost of discouraging cycling could be many times higher than the reduction in fatalities.

Since adults continually have to balance and judge risks, my feeling is that the scale of the problem is small for the relative burden that would be imposed, and so it is better to let cyclists choose.

I think s/he explains it rather well.


I think s/he does better than that,and particularly with the reference to the number of deaths connected to angling,sort of puts things into perspective IMHO.
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reohn2
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Re: New study on helmet effectiveness

Postby reohn2 » 22 Sep 2016, 2:05pm

bovlomov wrote:Good summary. The lack of infrastructure and car centric culture are the very foundation of the helmet debate. Every column inch about helmets is a column inch not devoted to culture and infrastructure.


And the effectiveness of a helmet law would be to reduce cycling numbers,which in turn would suit a significant number of motorists,so we have to ask the simple question.
What the intention of a helmet law or to even be seen not to wear a helmet a form of insanity?
Who's sane ones here?
I get really concerned and worried when I read the thoughts and posts on here of some cyclists,who wear a helmet and don't care if they were to be made compulsory because such a law wouldn't apply to them
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Re: New study on helmet effectiveness

Postby mjr » 22 Sep 2016, 2:10pm

Flinders wrote:There is always the elephant in the room- people who were wearing helmets which did their job properly in an accident and whose wearers therefore didn't end up in A&E at all. I know of a few of those. That's very difficult to count, though I know they try to.

That's not a serious problem. Assuming that there wouldn't have been some huge change in road danger levels which is undetectable from looking at control groups (the majority of cyclists who don't use helmets, or other types of road users), we'd be able to spot an elephant-sized hole in the A&E stats and there isn't one, so either helmet users are crashing more and the helmet-saved are roughly compensating for that increase, or the helmet-saved wouldn't have ended up in A&E anyway and all they really suffered was spectacular helmet damage, or something like that.

As often happens with science, you don't know what you think you know. Helmets seem to be very spectacular self-promoting objects. Some liken them to homeopathy, but I think they're more like a quack cure that has some dramatic distracting effect and is possibly harmful, such as the old west tales of Snake Oil.
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Re: New study on helmet effectiveness

Postby pjclinch » 22 Sep 2016, 2:21pm

Flinders wrote:There is always the elephant in the room- people who were wearing helmets which did their job properly in an accident and whose wearers therefore didn't end up in A&E at all. I know of a few of those. That's very difficult to count, though I know they try to.


It's quite easy to count over whole population: the rates of serious injury go down with increasing helmet use as fewer serious accidents appear in A&E relative to overall cycling levels. Or rather, they would if the effect you describe were significant, but in practice they don't, anywhere you look.

People keep on bringing that up as if it were a deal-breaker, but it's really a non-issue. If people stop presenting for smallpox after a vaccination programme against smallpox, the absence of anyone showing up at their doctor with smallpox is very much a key indicator that the intervention is working. If people kept on showing up at the pre-vac levels, still with smallpox, I don't think anyone would be arguing we had the right formula but we just weren't counting all the people it had worked on.

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wahoofish
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Re: New study on helmet effectiveness

Postby wahoofish » 22 Sep 2016, 3:01pm

bovlomov wrote:
wahoofish wrote:Brilliant

Do us a favour and explain your glee.



Glee - not me my friend. Just interested to see how quickly you anti types try and dismiss this research as it doesn't fit with your perspective.

I have thought long and hard about this topic since the debate last week and have come to some personal conclusions. Maybe nonsense but they are just where I have got to.

1) People who ride more competitively or participate in timed events, mtb or road, are, I.m.o., more likely to wear helmets, whether because they are required or because they make them feel safer. These people are also more likely to crash more often as they are normally working against the clock. Therefore, would this skew the numbers when comparisons are made between accidents involving helmet wearers against non helmet wearers?

2) It would be almost impossible to measure the numbers of people who have been saved from serious injury BECAUSE they were wearing a helmet as, by the very fact they may have avoided serious injury, there is probably very little recording of these accidents. I know there are a few times when I have broken a helmet and thus saved my head, but on only two occasions have I ended up hospitalised for those incidents and one was for broken ribs. The other was for concussion and broken ribs and the doctor was fairly clear on what the outcome was likely to have been had I not had a helmet on. There does appear to be a huge amount of anecdotal feedback on when people have felt that a helmet has protected them, but how would you be able to record these?

3) As a semi regular commuter, who also has participated in timed events in a few different countries, I have met very few people who have crashed badly and who subsequently stop wearing a helmet or, in a few cases, who don't start wearing one thereafter.

Doubt this makes much sense, but just my thoughts


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bovlomov
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Re: New study on helmet effectiveness

Postby bovlomov » 22 Sep 2016, 3:09pm

wahoofish wrote:...2) It would be almost impossible to measure the numbers of people who have been saved from serious injury BECAUSE they were wearing a helmet as, by the very fact they may have avoided serious injury, there is probably very little recording of these accidents. I know there are a few times when I have broken a helmet and thus saved my head, but on only two occasions have I ended up hospitalised for those incidents and one was for broken ribs. The other was for concussion and broken ribs and the doctor was fairly clear on what the outcome was likely to have been had I not had a helmet on. There does appear to be a huge amount of anecdotal feedback on when people have felt that a helmet has protected them, but how would you be able to record these?

This point has been addressed by pjclinch, above.

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Re: New study on helmet effectiveness

Postby mjr » 22 Sep 2016, 3:32pm

wahoofish wrote:1) People who ride more competitively or participate in timed events, mtb or road, are, I.m.o., more likely to wear helmets, whether because they are required or because they make them feel safer. These people are also more likely to crash more often as they are normally working against the clock. Therefore, would this skew the numbers when comparisons are made between accidents involving helmet wearers against non helmet wearers?

Not much: the proportion of riding that is competitive is very small.

Secondly, why shouldn't they be included anyway? It's one demonstration of risk compensation, feeling safer so taking risks that they would not otherwise have done so. Why should competition get a free pass to injure people unnecessarily? And why would risk compensation be limited to competition?

2 has already been addressed as mentioned.
wahoofish wrote:3) As a semi regular commuter, who also has participated in timed events in a few different countries, I have met very few people who have crashed badly and who subsequently stop wearing a helmet or, in a few cases, who don't start wearing one thereafter.

But you have met some! There may even be some like me who have to crash a few times before they considered why they started crashing so often. Hopefully, they do not get injured too badly to cycle before realising that the hat hurts not helps.
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bovlomov
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Re: New study on helmet effectiveness

Postby bovlomov » 22 Sep 2016, 3:49pm

mjr wrote:
wahoofish wrote:3) As a semi regular commuter, who also has participated in timed events in a few different countries, I have met very few people who have crashed badly and who subsequently stop wearing a helmet or, in a few cases, who don't start wearing one thereafter.

But you have met some! There may even be some like me who have to crash a few times before they considered why they started crashing so often. Hopefully, they do not get injured too badly to cycle before realising that the hat hurts not helps.

In any case, point 3 is to do with perception rather than effectiveness. What wahoofish is saying is that these people feel the helmet is a necessity. Well we know that. They're being told so every single day, by the media, A&E staff and family members.

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Re: New study on helmet effectiveness

Postby pjclinch » 22 Sep 2016, 4:54pm

wahoofish wrote:Glee - not me my friend. Just interested to see how quickly you anti types try and dismiss this research as it doesn't fit with your perspective.


It doesn't change my sceptical perspective because it's a meta-analysis, in other words a study of other studies, rather than new research in its own right. And those other studies didn't convince me, so why should what boils down to a re-working of existing stuff that didn't convince me?

wahoofish wrote:1) People who ride more competitively or participate in timed events, mtb or road, are, I.m.o., more likely to wear helmets, whether because they are required or because they make them feel safer. These people are also more likely to crash more often as they are normally working against the clock. Therefore, would this skew the numbers when comparisons are made between accidents involving helmet wearers against non helmet wearers?


It's certainly one of the problems in coming to hard conclusions, but the fact that it's difficult to come to reliable conclusions is very much part of why it's a bit daft to spend so much energy promoting them. It's popular to give them the benefit of the doubt, but since the doubt can go both ways that's not a safe position to take. You need a firm conclusion about positive benefit before you go about promoting them as a safety intervention, and despite the headlines this recent publication doesn't actually firm up anything.

wahoofish wrote:3) As a semi regular commuter, who also has participated in timed events in a few different countries, I have met very few people who have crashed badly and who subsequently stop wearing a helmet or, in a few cases, who don't start wearing one thereafter.


I've stopped wearing them since a bad crash (caught by a car spinning out of another collision as I was sat stationary) where I was wearing a helmet which was split in the collision, but that anecdote aside this is an area that is heavily weighted by public attitudes. If you want to meet people who've crashed and not started wearing helmets, go to NL and follow up people who've crashed. If you want to meet people who've suffered a nasty head injury and not started wearing helmets, follow up folk from A&E who've fallen downstairs or off ladders. In neither case will there be much pressure from society that you'd be mad not to wear a helmet, so people carry on as before but perhaps take a bit more care, but if you bang your head coming off a bike in the UK the public perception will greatly reinforce the reaction. The fact that you'll get a totally different take by travelling to the other side of the North Sea, where the ground is just as hard and the force of gravity much the same, shows it's about culture rather than absolute protective effect.

A slightly different perspective, of those people with science training who've gone and read over the research on cycle helmets in any degree of detail I know several (me included) who've stopped bothering with helmets having been keen wearers and even advocates of them, but I don't know any who've gone from being sceptical to convinced of the need for them.

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Re: New study on helmet effectiveness

Postby axel_knutt » 22 Sep 2016, 5:49pm

It isn't new at all though, is it.

Yet again we have another study looking at survivability given that an accident has already taken place, but that doesn't address the question of whether non-helmet wearers cycle more carefully, and whether careful cycling offsets the disbenefit of wearing no helmet by avoiding accidents. It merely begs the question, and biases the study in favour of helmet wearing if non-helmet wearers have fewer accidents.

Since this issue has been a bone of contention for at least thirty years now without any apparent willingness to do any relevant research, you can't help but wonder at the scientific community being so systematically obtuse and incurious.
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Re: New study on helmet effectiveness

Postby Mike Sales » 22 Sep 2016, 5:55pm

axel_knutt wrote:Since this issue has been a bone of contention for at least thirty years now without any apparent willingness to do any relevant research, you can't help but wonder at the scientific community being so systematically obtuse and incurious.


Goldacre and Spiegelhalter had sometning to say about this.

In any case, the current uncertainty about any benefits from helmet promotion or wearing is unlikely to be reduced by further research. Equally, we can be certain that helmets will continue to be debated, and at length. The enduring popularity of helmets as a proposed major intervention for increased road safety may lie in not their direct benefits- which seem too modest to capture compared with other strategies- but more with the cultural, psychological and political aspects of popular debate around risk.


http://www.badscience.net/2013/12/bicycle-helmets-and-the-law-a-perfect-teaching-case-for-epidemiology/

"To modest to capture" versus "65% benefit"!

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Re: New study on helmet effectiveness

Postby axel_knutt » 22 Sep 2016, 6:07pm

Flinders wrote:There is always the elephant in the room- people who were wearing helmets which did their job properly in an accident and whose wearers therefore didn't end up in A&E at all. I know of a few of those. That's very difficult to count, though I know they try to.


wahoofish wrote:It would be almost impossible to measure the numbers of people who have been saved from serious injury BECAUSE they were wearing a helmet as, by the very fact they may have avoided serious injury, there is probably very little recording of these accidents. I know there are a few times when I have broken a helmet and thus saved my head, but on only two occasions have I ended up hospitalised for those incidents and one was for broken ribs. The other was for concussion and broken ribs and the doctor was fairly clear on what the outcome was likely to have been had I not had a helmet on. There does appear to be a huge amount of anecdotal feedback on when people have felt that a helmet has protected them, but how would you be able to record these?


Here's how it's done: divide the country into two halves matched for confounding variables, make helmets compulsory in one half and optional in the other, then count the fatal head injuries in each group. It was done in the US in the 1970s, but you've never heard about it because it didn't give them the answer they wanted to hear. AFAIK it's never been repeated either, for the same reason.
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Re: New study on helmet effectiveness

Postby axel_knutt » 22 Sep 2016, 6:15pm

the current uncertainty about any benefits from helmet promotion or wearing is unlikely to be reduced by further research.

I'm not sure I agree. We need to do some relevant research first, and then see whether it's telling us anything.
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