New study on helmet effectiveness

[Nigel]

The full paper appears to be here:
http://ije.oxfordjournals.org/content/e ... 3.abstract

which is available to read if you have a UK academic login through Athens and the like.

There are five papers from Thomson and Rivera in the sample from the 1980s and 1990s, which makes me want a good statistician to go over it all to establish whether this data analysis has any merit.


- Nigel

[Mike Sales]

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.

Well, you will find quite a lot of research at [url]cyclehelmets.org[/url] but no certainty about whether the damn things do any good.
A lot of people have tried to be relevant.
I tend to think that if any country does mandate them in the future the opportunity needs to be taken to do a proper before and after study, with the resources of a government.

[Mattyfez]

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.

Well, you will find quite a lot of research at [url]cyclehelmets.org[/url] but no certainty about whether the damn things do any good.
A lot of people have tried to be relevant.
I tend to think that if any country does mandate them in the future the opportunity needs to be taken to do a proper before and after study, with the resources of a government.

Doesn't the Australian model show just that, more injury per cyclist and less cyclists? But no one shouts very loudly publicly about it as on the surface, it seems it can't be true.

[drossall]

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"!

Thanks. You've accidentally answered a question for me.

Over the holidays, I read the Bad Science book, for reasons that have nothing to do with cycling (which isn't mentioned as far as I recall), and everything to do with an interest in science (I'm a physics graduate). I did notice that Ben Goldacre speaks highly of the Cochrane Reviews, which I knew had been criticised in the case of the cycling one.

So I wondered what the Bad Science folk, being as near an independent source as one could get, made of the statistics in the helmet debate.

Now I know. To be fair, I think I had previously seen the piece to which you linked, but not recently enough to spot the connection.

[661-Pete]

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.

It might have been better if wahoof had explained his "brilliant" as referring to the above-mentioned publication which appears to uphold his point of view. Rather than a sarcastic innuendo targeting us "anti types" - as he sees fit to call us.

Let's get this straight: I'm not out here to disparage those in favour of the helmet. Merely to state my view that the case is 'not proven', and that there are many benefits - mainly to do with encouraging people to cycle - to be gained by not giving the promotion of helmets too high a profile.

And as for compulsion: doesn't the Australia example tell us something?

Anyway my aim is to avoid crashes as far as possible, rather than to regard crashes as inevitable and mitigate their effects.

OK let me put it this way: suppose that a passionate pro-helmet cyclist crashes and breaks his neck, leaving him a helpless quadraplegic the rest of his life. Will he take comfort in the knowledge that his brain was left relatively undamaged due to the lid he was wearing?

I'd prefer to die.

[pjclinch]

Over the holidays, I read the Bad Science book, for reasons that have nothing to do with cycling (which isn't mentioned as far as I recall), and everything to do with an interest in science (I'm a physics graduate). I did notice that Ben Goldacre speaks highly of the Cochrane Reviews, which I knew had been criticised in the case of the cycling one.

So I wondered what the Bad Science folk, being as near an independent source as one could get, made of the statistics in the helmet debate.

Now I know. To be fair, I think I had previously seen the piece to which you linked, but not recently enough to spot the connection.

The BMJ editorial mentioned at various points in the Helmet Ghetto is reproduced in Goldacre's book "I think you'll find it's a bit more complicated than that". Good book, well worth a read for highlighting numerous points of problem and idiocy across science publication and reporting.

Pete.

[axel_knutt]

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.

Well, you will find quite a lot of research at [url]cyclehelmets.org[/url] but no certainty about whether the damn things do any good.
A lot of people have tried to be relevant.
I tend to think that if any country does mandate them in the future the opportunity needs to be taken to do a proper before and after study, with the resources of a government.

That's a good website, but if all the countries that have helmet laws had repeated the US helmet study that I linked above we would probably have had a fairly reliable answer to the question by now. Instead of that we get endless debate, and an endless succession of irrelevant studies based on counting casualties at the door of A&E. Repeating studies that tell people what they want to hear, and ignoring the ones that don't.

In Bad Science, Ben Goldacre warns that testing proxies that are presumed to be indicators of a health benefit is not the same as demonstrating a reduction in mortality, and yet that's all we seem to do with helmets. Not so long ago antioxidants were presumed beneficial on the basis of lab tests, but when a controlled study was done it had to be terminated prematurely because the antioxidants were killing people.

[horizon]

Even if this paper had published 100% effectiveness,

I do wear good footwear when cycling not only because it is 100% effective. I don't like wearing it (in the summer) but accept the discomfort as it is effective against a near 100% probability of minor and perhaps worse injury that would occur without it. No-one really has to campaign to get cyclists to wear shoes (well, OK, there are a few flip-flop wearers out there!). OTOH, as you say, even if a helmet were proven to be effective, its use is very unlikely. Helmet wearing and promotion has to be based on an erroneous concept: that an accident is normal, likely and almost inevitable. This is the mindset that new cyclists accept uncritically and it is what makes seeing a large group of helmeted cyclists so bizarre - what are they all thinking? Emperor's clothes comes to mind.

I am sure that it is at least partly this that makes anti-helmet wearers vociferous: what helmet promoters are saying about cycling not just what are they are saying about helmets.

[Vorpal]

That's a good website, but if all the countries that have helmet laws had repeated the US helmet study that I linked above we would probably have had a fairly reliable answer to the question by now. Instead of that we get endless debate, and an endless succession of irrelevant studies based on counting casualties at the door of A&E. Repeating studies that tell people what they want to hear, and ignoring the ones that don't.

I don't think we would have had a reliable answer. All the studies like that tell us is that it isn't beneficial to make helmets a legal requirement.

Helmet proponents would still argue that we should wear them because they help prevent head injury.

It is an emotive, neverending topic, and people on both sides will carry on ignoring the stuff they don't want to hear.

Helmets are and will continue to be the red herring the prevents road danger reduction in car-centric countries.

[drossall]

The BMJ editorial mentioned at various points in the Helmet Ghetto is reproduced in Goldacre's book "I think you'll find it's a bit more complicated than that". Good book, well worth a read for highlighting numerous points of problem and idiocy across science publication and reporting.

Pete.

Thanks. That's now on my Kindle - although I may have to wait until next summer holidays to have time to read it

[Cunobelin]

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.

None of which can be "proved", the claim is there, but is it accurate?

[axel_knutt]

Helmet proponents would still argue that we should wear them because they help prevent head injury.

Yes but the issue is the distinction between saving lives and protecting the head from impacts, in which case you/they are begging the question.

The objective is to reduce deaths among cyclists, and preventing head injury is merely a putative means to that end. If we can conduct an experiment that will establish whether helmet wearing does indeed reduce deaths, then the issue of whether helmets prevent head injury becomes redundant. If it were shown that compulsory helmet legislation increases fatalities then the debate is over unless and until someone comes up with a means of preventing risk compensation.

I don't dispute there will be those who continue to argue, just as the Vatican continued contradicting Galileo for centuries, but the debate will be over in the same sense as it was in respect of heliocentricity.

I think that the fact that we've systematically avoided conducting this experiment for 40 years says all you need to know about the debate.

[Phil Fouracre]

Er! Can I ask a question? How would you set about carrying out this experiment? do you get everyone wearing a helmet and smash their heads into the gorund? Speaking, of course, as someone who has never felt the need to wear a magic hat.

[axel_knutt]

Er! Can I ask a question? How would you set about carrying out this experiment? do you get everyone wearing a helmet and smash their heads into the gorund? Speaking, of course, as someone who has never felt the need to wear a magic hat.

As I said/linked above, the experiment has already been done! The question is: why in the last 40 years hasn't it been repeated enough times to establish whether the result is statistically reliable? Instead, we keep endlessly repeating studies that don't even address the issue.

They're systematically avoiding repeating the experiment that will answer the question because the first attempt gave them the answer they don't want, that's why the result was spun to look like the complete opposite of what it actually was.

[Hobbs1951]

This is, and always has been an interesting debate; I am a long time cyclist and motorcyclist. I don't wear a bicycle helmet on the road but often wear one off-road - my logic there is not to protect me in case of a fall but it offers some protection from overhanging foliage etc. I sometime ride my motorcycle, late at night in the summertime, without a helmet (I don't live in or near a city).

I don't want to hijack the thread but I rarely hear discussed the issue of eye protection, and I often see helmet wearers wearing no eye protection at at all (that seems perverse) - save spectacle wearers.

I always wear technical eye protection on two wheels - whether powered by me or the wretched internal combustion engine - think how much damage that small stone or grit does to your car windscreen, or an insect in your eye ?

Thanks for reading this.

Jon.