How to protect your brain by not wearing a helmet

For all discussions about this "lively" subject. All topics that are substantially about helmet usage will be moved here.
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NATURAL ANKLING
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Re: How to protect your brain by not wearing a helmet

Postby NATURAL ANKLING » 25 Aug 2020, 10:02am

Hi,
Yes I think I know all that.
As a individual rider especially like me who always ride solo have done for the last 20 years.
Most of that is not gonna apply to me.

But I can see that it's very much other peoples actions which can form a large part of cyclists fatalities, which don't always involve head trauma.
We see a this in most important and talked about things like COVID-19 and social distancing.
Unlike what the media like to press on us like "most people on this" Substitute "this " for anything you'd like from picking up dog mess to crossing the road and looking first et cetera et cetera.
That statement of course is totally rubbish, in my opinion most people are just plain stupid, every time I go out and meet people recently I will be lucky if 30% actually knowledge social distancing exist, Let alone act on it.
We can't be in everybody's houses or on every street, so any reporting on social distancing thing is likely to be incredibly in accurate.

statistics in general can only go on what we know/reported.
Like myself for once in a lifetime falling off on black ice, and physically struggling to get home, My head injuries even though mild were not reported to anyone, Except on here.
Would most people know if they were suffering from mild concussion even........er...pass... :)
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Re: How to protect your brain by not wearing a helmet

Postby pjclinch » 25 Aug 2020, 11:23am

NATURAL ANKLING wrote:Like myself for once in a lifetime falling off on black ice, and physically struggling to get home, My head injuries even though mild were not reported to anyone, Except on here.


This is why the focus is on fatalities and serious injuries for most studies: they tend to get reported.
There isn't any decent data set I've ever seem about helmet use and minor injuries, which is ironic as that's what they're actually designed for (despite the widespread assumptions that they're to save lives).

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Re: How to protect your brain by not wearing a helmet

Postby Steady rider » 25 Aug 2020, 2:18pm

Yes more likely to fall off, when wearing a helmet.

It is understandable for cyclists to think helmet use may not affect their risk of having an accident but the science shows a different picture.

Cycling UK says
https://www.cyclinguk.org/campaigning/v ... le-helmets
Some evidence suggests they may in fact increase the risk of cyclists having falls or collisions in the first place, or suffering neck injuries.


Reported; ‘helmet use increased the accident/injury rate by 14% (Erke & Elvik 2007)
Erke A, Elvik R. Making Vision Zero real: Preventing Pedestrian Accidents And Making
Them Less Severe, Oslo June 2007. page 28. https://www.toi.no/getfile.php/Publikas ... 7-nett.pdf


A New Zealand study detailed a 20% risk increase per hours cycled in association with increased wearing rates (Clarke 2012).
Clarke CF, Evaluation of New Zealand’s bicycle helmet law , Med J NZ http://www.cycle-helmets.com/nz-clarke-2012.pdf

Robinson's 1996 report provided injury data for children from Victoria and New South Wales. In Victoria, the equivalent injury numbers for pre-law levels of cyclist numbers increased 15% from 1990 to 1992, a period during which all age mandatory bicycle helmet legislation was introduced in all Australian jurisdictions. Robinson’s data in Table 2 for children in NSW shows the equivalent number of injuries increased from 1,310 (384 head + 926 other injuries) pre law in 1991 to 2,083 (488 head + 1,595 other injuries) in 1993. The relative injury rate proportional to cycling levels increased 59% from 1,310 to 2,083. The relative increase for 'other' injuries was 72% and for ‘head’ was 27%.
Robinson DL; Head injuries and bicycle helmet laws; Accid Anal Prev, 28, 4: p 463-475, 1996 http://www.cycle-helmets.com/robinson-head-injuries.pdf

Tin Tin et al provided information on the change to ‘upper extremity’ (injuries per million hours cycled) in Figure 3. It increased from 4.4 to 13.20, indicating a 200% higher rate by 2003/07.

Tin Tin S. Injuries to pedal cyclists on New Zealand roads, 1988-2007. BMC Public Health
2010;10:655. http://www.biomedcentral.com/1471-2458/10/655

Data from Nova Scotia and Alberta shows an increased risk per hour cycled following helmet laws.

GB data shows an increased accident rate as helmet use increased. See page 1 https://www.researchgate.net/publicatio ... jury_rates

From 2003 to 2016 cycle traffic increased by 25% and the number of serious injuries rose by 48 per cent.

Zeegers 2015 states that;
“Three cases could be found in the literature with sufficient data to assess both risk ratios and odds ratios: the Netherlands, Victoria (Australia) and Seattle (U.S.A). In all three cases, the problem of overestimation of the effectiveness of the helmet by using odds ratios did occur. The effect ranges from small (+ 8 %) to extremely large (> + 400 %). Contrary to the original claim of these studies, in two out of three cases the risk of getting a head injury proved not to be lower for helmeted cyclists. Moreover, in all three cases the risk of getting a non-head injury proved to be higher for cyclists with a helmet.”

Zeegers T, Overestimation of the effectiveness of the bicycle helmet by the use of odds ratios’ http://www.fietsberaad.nl/?lang=nl&repo ... dds+ratios

Porter 2016 report in the US detailed that cyclists wearing helmets had more than twice the odds of suffering an injury than cyclists not wearing helmets.

NZ data shows the overall accident rate is about double that of pre helmet law days, mainly due to falls.

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Re: How to protect your brain by not wearing a helmet

Postby Jdsk » 25 Aug 2020, 3:02pm

You've just switched from falls to head injuries. Which do you want to discuss?

It's also pointless to mix lay summaries in magazines with campaigning essays with reviews of primary publications with the primary studies themselves.

There are two good ways into this: published primary studies and systematic reviews.

Jonathan

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Re: How to protect your brain by not wearing a helmet

Postby pjclinch » 25 Aug 2020, 3:22pm

Steady rider wrote:Yes more likely to fall off, when wearing a helmet.


That's not the same thing as "if I wear a helmet, I'm more likely to fall" though. It means that helmet wearers fall off more then unhelmeted people, but since helmeted people are more prevalent in the population doing riskier, fall inducing things that means you can't simply correlate helmets with falls in a random individual.

Steady rider wrote:It is understandable for cyclists to think helmet use may not affect their risk of having an accident but the science shows a different picture.


Up to a point, but only up to a point. Science can't reliably say to A Random Rider as they set off on a A Random Journey that their chances of a fall if they wear their helmet are greater than if they don't.

Steady rider wrote:Cycling UK says
https://www.cyclinguk.org/campaigning/v ... le-helmets
Some evidence suggests they may in fact increase the risk of cyclists having falls or collisions in the first place, or suffering neck injuries.


Some evidence does say that, but there again some evidence says helmets reduce serious head injury by 85%. The neck injuries thing suffers from the same problems as any other case/control studies, and if you want to throw out your C/C that say they make things better because of methodological issues then I'm afraid you have to throw out the stuff that says they make things worse too.

Steady rider wrote:Reported; ‘helmet use increased the accident/injury rate by 14% (Erke & Elvik 2007)


This is a bad title. "Helmet use is associated with" would be better. Much like the prevalence of car crashes is almost certainly far higher where full roll cages are fitted and the drivers wear helmets and flameproof suits, it isn't the safety gear that's increasing the crash rate, it's the driving as fast as possible (and, indeed, just a bit faster...) that causes the crash. There is feedback in to how fast one is willing to go from the safety gear, but it's still not the same as it being the primary cause.

Steady rider wrote:Robinson's 1996 report provided injury data for children from Victoria and New South Wales. In Victoria, the equivalent injury numbers for pre-law levels of cyclist numbers increased 15% from 1990 to 1992, a period during which all age mandatory bicycle helmet legislation was introduced in all Australian jurisdictions.


But since the general reckoning is that the law discouraged cycling to the tune of 1/3 or so, and it's likely that that concentrated the cycling demographic in to those doing relatively risky things, again that's not a smoking gun that helmets cause falls. This applies to the other cites too.

Work like Robinson's is a good indication that helmet laws are not a great way to improve public health, but it doesn't tell you, as an individual about to start a ride, whether you are more likely to crash if you wear your helmet than if you don't. The data isn't good enough to tell you that sort of thing, which is why Goldacre & Spiegelhalter describe the questions as "methodologically challenging and contentious"

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Re: How to protect your brain by not wearing a helmet

Postby pjclinch » 25 Aug 2020, 3:43pm

Jdsk wrote:There are two good ways into this: published primary studies and systematic reviews.


They might be better than alternatives, but they're still not much good in this particular case. The primary studies are all over the place so the systematic reviews don't have a signal to extract from the noise (unless the selection criteria are gamed). The population level stuff is fairly consistent in showing that laws are not a Big Win, but they can't realistically tell you about individual safety.

This is why a noted and outspoken campaigner for publishing evidence and using systematic reviews to support medical/health interventions and an internationally famous researcher and communicator on risk conclude "In any case, the current uncertainty about any benefit from helmet wearing or promotion is unlikely to be substantially reduced by further research".

I quote that editorial a lot because when it was published I'd spent over a decade looking hard for smoking guns and never finding any. Lots of heat, very little light. I originally started looking to reinforce my choice of always wearing a helmet (starting back in '89 and lasting until 2003) but I just ended up finding it boils down to "not proven". I'm quite convinced that laws to require them are a Very Bad Idea, but at an individual level there really isn't anything convincing. We have not, as yet, developed the tools for this one, and saying systematic reviews are the Gold Standard is, I'm afraid, a bit like saying a chisel is the best tool for soldering in a joinery set.

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NATURAL ANKLING
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Re: How to protect your brain by not wearing a helmet

Postby NATURAL ANKLING » 25 Aug 2020, 4:24pm

Hi,
We could always start talking about selfies on their related deaths :?

https://en.m.wikipedia.org/wiki/List_of ... and_deaths

"Indian Ministry of Tourism asked states to identify and barricade "selfie danger" areas, its first national attempt to deal with the selfie deaths. Mumbai Police identified at least 16 danger zones after a man drowned attempting to save a selfie-taker.[6] No-selfie zones were also established in certain areas of the Kumbh Mela because organizers feared that bottlenecks caused by selfie-takers could spark stampedes."
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Re: How to protect your brain by not wearing a helmet

Postby Jdsk » 25 Aug 2020, 4:30pm

pjclinch wrote:This is why a noted and outspoken campaigner for publishing evidence and using systematic reviews to support medical/health interventions and an internationally famous researcher and communicator on risk conclude "In any case, the current uncertainty about any benefit from helmet wearing or promotion is unlikely to be substantially reduced by further research".

Yes, it is worth rereading that.

And I doubt that either of them would look at the currently available evidence and say "Yes more likely to fall off, when wearing a helmet.".

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Re: How to protect your brain by not wearing a helmet

Postby landsurfer » 25 Aug 2020, 4:33pm

So let me get this right;

Because i am a non helmet wearing cyclist I am safer while cycling on the roads than a cyclist wearing a helmet .....
?
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Re: How to protect your brain by not wearing a helmet

Postby Jdsk » 25 Aug 2020, 4:33pm

pjclinch wrote:
Jdsk wrote:There are two good ways into this: published primary studies and systematic reviews.

They might be better than alternatives, but they're still not much good in this particular case. The primary studies are all over the place so the systematic reviews don't have a signal to extract from the noise (unless the selection criteria are gamed). The population level stuff is fairly consistent in showing that laws are not a Big Win, but they can't realistically tell you about individual safety.

That depends on what "good" means. Showing that we don't have any clear answers looks very good to me when there are such strongly expressed views flying around. And that's a crucial purpose of evidence-based methods... identifying stuff we just don't know.

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Re: How to protect your brain by not wearing a helmet

Postby Steady rider » 25 Aug 2020, 5:24pm

Because i am a non helmet wearing cyclist I am safer while cycling on the roads than a cyclist wearing a helmet .....


Opinions will vary but based on the risk and factors affecting falling, my view would be you are safer not wearing one.

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Re: How to protect your brain by not wearing a helmet

Postby pjclinch » 25 Aug 2020, 7:58pm

Jdsk wrote:
pjclinch wrote:
Jdsk wrote:There are two good ways into this: published primary studies and systematic reviews.

They might be better than alternatives, but they're still not much good in this particular case. The primary studies are all over the place so the systematic reviews don't have a signal to extract from the noise (unless the selection criteria are gamed). The population level stuff is fairly consistent in showing that laws are not a Big Win, but they can't realistically tell you about individual safety.

That depends on what "good" means. Showing that we don't have any clear answers looks very good to me when there are such strongly expressed views flying around. And that's a crucial purpose of evidence-based methods... identifying stuff we just don't know.


Yes, I'd say we're in accord there. Lots of folk demanding/being sure there is a Clear And Simple Answer though.

And that it's not clear is a good reason to concentrate on the stuff that is (e.g. changing the riding environment so there are fewer collisions with fast/heavy stuff)

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Re: How to protect your brain by not wearing a helmet

Postby DaveReading » 25 Aug 2020, 8:39pm

pjclinch wrote:
Steady rider wrote:Yes more likely to fall off, when wearing a helmet.

That's not the same thing as "if I wear a helmet, I'm more likely to fall" though.

Actually, it means exactly the same thing.

Both statements signify that the likelihood (i.e. probability) of falling off is higher if and when you're wearing a helmet. I'd love to see the proof of that.

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Re: How to protect your brain by not wearing a helmet

Postby pjclinch » 25 Aug 2020, 8:44pm

landsurfer wrote:So let me get this right;

Because i am a non helmet wearing cyclist I am safer while cycling on the roads than a cyclist wearing a helmet .....
?


You might be able to argue that if everyone was an "average cyclist" (particularly that the data about accidents all came from "average cyclists") on an "average trip", but it'd frankly be quite a stretch even then, and anyone suggesting without further contextual information that A Random Cyclist at the start of A Random Ride would be clearly more likely to fall if they were wearing a helmet, all else being equal, is going way beyond the sure evidence.

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Re: How to protect your brain by not wearing a helmet

Postby pjclinch » 25 Aug 2020, 9:22pm

DaveReading wrote:
pjclinch wrote:
Steady rider wrote:Yes more likely to fall off, when wearing a helmet.

That's not the same thing as "if I wear a helmet, I'm more likely to fall" though.

Actually, it means exactly the same thing.

Both statements signify that the likelihood (i.e. probability) of falling off is higher if and when you're wearing a helmet. I'd love to see the proof of that.


No, they're not the same. The first is about an "average cyclist", the second is quite specifically about me as an individual.

"Average cyclists" are affected by the way that riskier (typically sports) cycling is dominated by helmet wearers, so that boosts their apparent tendency to fall off. But if on my Saturday morning trundle to the baker's along a dead straight road with hardly any traffic where I'm not in any hurry I uncharacteristically decide I'll dig out my lid, there is no clear evidence to suggest that the risks are any greater.

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