Why don't helmets work down under for injuries severe enough to get reported, though they may save minor scratches

[Nearholmer]

Given your mammoth list of Q&A you should be pleasantly surprised that anyone bothered to plough through all of that one.]

I am pleasantly surprised, very surprised in fact, because thread-after-thread gets devoted to arguing about helmets, and every single thread consists of a tangle of multiple, overlapping questions, and until those questions are pulled-out, and dealt with one at a time, as I’ve tried to do, the whole subject remains one of intense heat, with only occasional glimmers of illumination.

To me, recommendation is an important topic, if only because that’s the place we are at in the UK now, and surely we ought to be seeking understanding of the effect of being at that position.

What this thread is testing, blowed if I can tell. It started with a strange assertion as a title, and now has another strange assertion as a title, tomorrow, who knows? It might have yet another strange assertion as a title.

[pjclinch]

I am pleasantly surprised, very surprised in fact, because thread-after-thread gets devoted to arguing about helmets, and every single thread consists of a tangle of multiple, overlapping questions, and until those questions are pulled-out, and dealt with one at a time, as I’ve tried to do, the whole subject remains one of intense heat, with only occasional glimmers of illumination.

On the one hand you're quite right about lots of things being convolved into one another, but on the other part of the issue is that we also have a very imperfect handle on (a) what a lot of the answers to the sub-questions are and (b) how they combine and inter-relate.

To me, recommendation is an important topic, if only because that’s the place we are at in the UK now, and surely we ought to be seeking understanding of the effect of being at that position.

Typically the case with a public health intervention is it should be monitored for effectiveness, side effects etc. and then either continued or discontinued accordingly. For example, advice given out on first aid courses tends to change a little every time one goes for a refresher, but nobody has been properly monitoring the effects of helmet requirement of recommendation so what we have is a recommendation based on culture and inertia and fear of change.

UK doom/distance figures have been similar between cyclists and pedestrians for decades, going back long before helmets. If recommending helmets for the last 30 years had made a difference things should have got relatively better for cyclists. They don't appear to have done. There is work on this (e.g., Hewson's papers) but I lack the detailed statistical knowledge to be able to say whether it's fair.

Pete.

[pjclinch]

Exec summary: if one is making a public health intervention it ought to be up to the authority making that intervention (be it a recommendation or requirement) to demonstrate it is doing some good, rather than up to anyone else to demonstrate that it isn't. Working out how to monitor effectiveness should be part of the intervention.
This hasn't been, and isn't being, done with cycle helmet recommendations. Certainly not in the UK, I rather doubt nationally anywhere else.

So why do we stick with the recommendation? I suggest because it's an article of faith and has too much inertia to be changed. We've got to do something, this is something, so this is what we'll do.

Pete.

[mattheus]

To me, recommendation is an important topic, if only because that’s the place we are at in the UK now, and surely we ought to be seeking understanding of the effect of being at that position.

Well sort of ...
... actually I could happily argue that we also have public scolding, and Mandatory Helmets within certain scopes e.g. clubs, large public events, and quite a few workplaces/schools. Society is a real thing!

But otherwise, I agree with pclinch posts ^

[cycle tramp]

To me, recommendation is an important topic, if only because that’s the place we are at in the UK now, and surely we ought to be seeking understanding of the effect of being at that position.

Well sort of ...
... actually I could happily argue that we also have public scolding, and Mandatory Helmets within certain scopes e.g. clubs, large public events, and quite a few workplaces/schools. Society is a real thing!

But otherwise, I agree with pclinch posts ^

If you substitute 'people' for 'monkeys' and 'beatings on the ladder' for 'warnings about not wearing helmets' then we're pretty close
https://whatsthepont.blog/2015/03/14/5- ... nisations/

[Cugel]

So why do we stick with the recommendation? I suggest because it's an article of faith and has too much inertia to be changed. We've got to do something, this is something, so this is what we'll do.

Pete.

Our complicated modern lives are stuffed to the brim with attitudes, beliefs and habits that are based on a vast range of "articles of faith". It's very difficult to find the time, information and inclination to closely examine and test for ourselves every assertion made about the huge range of matters that can come up in daily life.

In practice we rely on the reputation of experts, authorities and others of that kind to give us what we hope are well-considered answers that they have found the time, information and inclination to derive ..... in a rational, reasonable or logical manner.

But there's the rub - many experts, authorities and others of that ilk are no such thing but are, in one way or another, pretending to that status. Some are self-appointed as they enjoy the status - but not the hard work to legitimately hold it. Others are more expert at spinning PR in pursuit of a hidden agenda than they are at furtling for any kind of truth. Some feel that the dogmas of an ideology are the correct answers, handed down by olde wise folk of yesteryear who cannot and should not be doubted.

So for poor us, the moderns in a vast and churning sea of recommendations, it ends up with us choosing a pleasing style of rhetoric rather than a resilient and hard-won reputation. "I like the cut of their jib so will believe all they say". We end up as belief-fans, mediated through personality fannery.

Its a poor way to decide something but often the only way unless we're prepared to do a lot of investigating and examining and reasoning ourselves. But becoming one's own expert is a very difficult thing to do. SO many things need expertise. The process of becoming expert takes those 10,000 hours per subject! (And a constant reviewing process). I make do with becoming merely competent (just) at about 5 of them (out of 5000).

There are hundreds of things I just guess at.

[cycle tramp]

What is absent from the debate isn't the stories which read 'my cycle helmet saved my life' but rather 'they wore a cycle helmet and still sadly died' stoires.

[Cugel]

What is absent from the debate isn't the stories which read 'my cycle helmet saved my life' but rather 'they wore a cycle helmet and still sadly died' stoires.

Shock adverts perhaps - pictures of crushed cyclist heads after a car loon hit, inclusive of the mangled polystyrene coated with brain?

Some horrible truths are forbidden to us. The excuse for not seeing such photo evidence, including the true horrors of war, is that it will somehow make us immune to the emotional responses we'll at first have but then mute as such evidence becomes commonplace.

A difficult set of issues, this journalism as evidence-portrayal thing.

[Stevek76]

Do we know whether or not it has even a 5% “off-putting” effect though? I suspect not.

Promotions campaigns aren't that well studied, CyclingUK's PFD has a few references on the point which do lean in the 'more than you might think' direction but it's only a few. Though note that 5% is assuming cycle helmets protect all possible cycling injuries, not just the head, so is a big overestimate. Around half (46% in a 2012 study that looked at hospital records) of GB cycling fatalities are 'head only' and helmets can perhaps mitigate half of those, so 1-2% is probably more realistic, 5% is just the bounding.

In areas with higher cycling rates I really don't see even 5% being hard to achieve though. Areas with higher rates are those with greater utility cycling (e.g. parts of Bristol, Oxford, Cambridge, certain London boroughs like Hackney) and those are the sort of people and trips you're far more likely to put off by adding inconvenience. Those people don't cycle because they particularly like bikes or cycling, they're on a basic bike in mostly 'normal' clothes, they're probably running <20psi in the back tyre half the time and use the LBS (or bribe with snack/beer and/or rely on goodwill of more 'cyclist' friends) for basic maintenance tasks including punctures. These people are far more sensitive to the perceived safety and convenience factors, which is why you only see them in limited locations.

Ultimately, as I said above, I think there's a real problem with the direction of burden of proof here. It shouldn't be up to people to demonstrate all the issues with a proposed mitigation measure. It should be up to cycle helmet advocates to build the case for them.

The first step is to demonstrate there is a risk that actually requires intervention - given the relative rates of head injuries for walking and car travel, let alone other every day activities this strikes me as a hurdle that has not yet been overcome.

The second step is then to demonstrate a net health benefit, not just a 'in the event of a crash' benefit and that side effects do not outweigh the proposed intervention.

This pretty basic stuff in doing H&S risk assessments properly, but has been completely bypassed when it comes to cycle helmets.

[Jdsk]

...
I am pleasantly surprised, very surprised in fact, because thread-after-thread gets devoted to arguing about helmets, and every single thread consists of a tangle of multiple, overlapping questions, and until those questions are pulled-out, and dealt with one at a time, as I’ve tried to do, the whole subject remains one of intense heat, with only occasional glimmers of illumination.
...

Thanks for trying.

Yes, teasing out the many different questions so that we can discuss what's known and what isn't known about each is vital.

But unfortunately I no longer expect it to work in this forum. Not enough of those glimmers.

Jonathan