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Helmet-less riding?

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gg

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Jun 12 2013 at 12:56pm #

“Has no one here actually had a friend who died while riding helmetless? Because I did. And he would still be alive today if he had been wearing his helmet.”

Sorry you lost a friend and that sucks, but please don’t claim to magically know that he would still be alive if he had a helmet. No one knows that including doctors and the cop that was there or whatever.


myddrin

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Jun 12 2013 at 2:56pm #

Conversely, can you really say “I don’t have any friends who died…?”

You don’t and can’t know how many friends that you would have had but for the fact that they died before you had the chance to meet them.

I’ve had the same argument about children’s car seats.
Statement: “I don’t know why we need car seats, none of us had them and we are fine.”

To which the response is “Yeah, because only the ones that lived are hear to talk about it.”

Personally, I’ve known two people who had severe bike accidents. One was my cousin who was killed by a drunk driver at age 7… a helmet wouldn’t have done anything. He was hit by a driver going over 75 in a 30 MPH zone.

The other I worked with when I was a home health aide for people with traumatic brain injury. In a wheel chair, issues with memory, anger, talking, smelling and as well motor & impulse control. His family was convinced a helmet would have made all that go away.

I would point out that of that about 15 people I worked with at the time, he was the only bike-related accident. One other was a pedestrian hit by a cop in a high speed chase and the others were all car-related.


ericf

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Jun 12 2013 at 5:22pm #

I started riding dirt bikes at 10 yrs old, so helmet use was drummed into my empty head throughout my formative years. As an adult I continue to wear a helmet (started using one while skiing a few years ago), the only person I know that does not wear a helmet has already posted. Some people say that if aren’t you crashing, then you aren’t trying hard enough.
That said, I don’t know if helmets save lives, but they damn sure prevent stitches. It is the difference between getting up and continuing your ride vs. a trip to the ER.


MichaelCycle

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Jun 13 2013 at 9:30am #

gg wrote:
“Has no one here actually had a friend who died while riding helmetless? Because I did. And he would still be alive today if he had been wearing his helmet.”

Sorry you lost a friend and that sucks, but please don’t claim to magically know that he would still be alive if he had a helmet. No one knows that including doctors and the cop that was there or whatever.

I am resisting the urge to swear heavily when I tell you that yes, I DO know that he would be alive today if he had been wearing a helmet.

How fascinating that you seem to know the details of my friend’s accident better than I do.


Mick

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Jun 13 2013 at 1:24pm #

@MichaelCycle I am resisting the urge to swear heavily when I tell you that yes, I DO know that he would be alive today if he had been wearing a helmet.

It’s surprising to think that knowledge of that could be so definitive.

I sure there are people who have died that would have survived with a helmet. Just not clear on how someone could be certain of that.

For it to be a certain thing?

I don’t know the details, but I just don’t see how that could be.

Could you explain more?


jonawebb

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Jun 13 2013 at 1:29pm #

Does it really matter? This is his friend, for Pete’s sake.


Drewbacca

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Jun 13 2013 at 2:07pm #

I took a rock to the face once, right above the right eye… thrown by kids. FWIW, I was wearing a helmet while riding a dirtbike and needed stitches. :(


jonawebb

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Jun 13 2013 at 3:01pm #

There’s an article discussing injury and helmets at http://well.blogs.nytimes.com/2013/06/13/bike-sharing-can-mean-safer-biking/?hpw. It mentions several of the well-known studies on helmets, and other things cities are doing to reduce accidents.
A couple of points from the article:
– Helmets would prevent about 85 percent of head injuries from cycling.
– Preventing accidents is more important than preventing injury from an accident.
I agree with both of these statements. I think a lot of the arguments against helmets come down to an overemphasis on the second statement, to the extent that the significance or even truth of the first one has to be denied.


Mick

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Jun 13 2013 at 3:54pm #

The “85% ” number came from

Dr. Frederick P. Rivara, a professor of pediatrics at the University of Washington, who conducted some of the seminal work on bike helmets in the mid-1980s.

Helmets would prevent about 85 percent of head injuries, he says.

I’ve read the much-heralded works of Thompson, Thompson, and Rivara. Those works convinced me that much of the bike helmet “research” out there is not just mistaken, but actually dishonest.

If you carefully read their stuff – and the criticism of it- you might start to understand why people that were formerly helmet supporters, such as my self, get so angry about the subject.

Basically, there is data that other people interpret as saying “People with insurance are both more likely to have their take their kids to ERs with minor injuries and are more likely to have their kids wear helmets than people without insurance.” Rivara, et al, interpret it as indicating that helmets would prevent 85% of deaths.

The same methodology would likely show that helmet use would prevent 85% of broken legs , too.

The three of them have all had multimillion dollar careers out of helmet advocacy, though.


J.Str.

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Jun 13 2013 at 4:31pm #

I wear a helmet… because I look rad in it and it makes me feel awesome.

Anonymous wrote:
So I’m working on a project for a class and would greatly appreciate your feedback.

Do you or anyone you know NOT wear a helmet while biking on public streets? Why do you or your friend choose to not wear a helmet?

I’m just wondering what attitudes and motivations are out there. Thanks :-)


StuInMcCandless

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Jun 13 2013 at 8:04pm #

I don’t think I ever rode a bike with a helmet until I was in my 40s. Now I hardly ever do not. I had a couple of days when, for whatever reason, I didn’t have a helmet. I lived through it, even with about 25 miles of riding. But not having it on caused me to use a bus when one became available.

But I do have mixed feelings on the topic, as I have a mixed experience base.
* The helmet definitely did help me in a 2010 wreck.
* The helmet definitely did not help me in a 2012 wreck.
* Both were on-road, essentially one-vehicle situations.

I almost never wear a helmet while riding the unicycle, never have. I am much, much more likely to break my tailbone or an arm or polish skin than hit my head.


gg

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Jun 13 2013 at 11:59pm #

jonawebb wrote:Does it really matter? This is his friend, for Pete’s sake.

Normally it really wouldn’t matter, but this is a thread about helmet usage. There is no way of knowing if a helmet would save someone.


Benzo

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Jun 14 2013 at 7:57am #

Geez, It’s just nice to use some discretion within the community.

Otherwise conversations like this just wind up devolving in to a flame war.


jonawebb

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Jun 14 2013 at 10:49am #

Effectiveness of helmet studies are basically case-control studies. Essentially what you do is look at head injury cases, and determine how many of those people were wearing helmets. Then you look at a comparable population (controlling for things like age, gender, years of cycling, etc.) and count how many of the people in the control group wear helmets. You can then determine the effectiveness of helmets in preventing head injuries by division: if say 25% of the control population were not wearing helmets, but 75% of the population with head injuries were not wearing helmets, then not wearing a helmet triples your chance of head injury in an accident. It’s a well-established technique; there’s nothing wrong in using it.
@Mick disputes the 85% figure, which he says comes from a study Rivara published in 1989, but there are many other studies — see http://www.thecochranelibrary.com/userfiles/ccoch/file/Safety_on_the_road/CD001855.pdf for a review. These studies were done by many different researchers on different populations and they all found similar results, varying from 65-88% protection depending on the type of injury.
Wearing a helmet or not is a personal choice, but you don’t really get to believe or not in the effectiveness of helmets in preventing head injury. You either pay attention to the facts, or you ignore them. And whether you pay attention to the facts or not shouldn’t depend on whether you think helmet manufacturers hype cycling danger to sell helmets; maybe they do — I’m not saying cycling is terribly dangerous. I’m just saying that if you’re in an accident, helmets greatly reduce the chance of head injury.
Edit: BTW, I’m also not saying there aren’t more important things than helmets in reducing injury. It’s much better not to have the accident in the first place than to try to prevent injury during an accident.


gg

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Jun 14 2013 at 11:52am #

I do feel motorists don’t bother me as much because I am wearing jeans, no helmet and a muscle or t-shirt. They think I am one of them, because I don’t have a helmet.

http://www.sciencedaily.com/releases/2006/09/060911102200.htm

Maybe I ride safer due to no protection?

http://www.researchgate.net/publication/230848775_Emotional_reactions_to_cycle_helmet_use

Helmets do very little for concussions (brain hitting inside of skull).

http://www.bicycling.com/sites/default/files/uploads/BI-June-13-Helmet.pdf


helen s

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Jun 14 2013 at 3:15pm #

I would rather come out of a crash with just a concussion rather than a concussion plus leaving some flesh and blood smeared onto the roadway.


jonawebb

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Jun 14 2013 at 3:27pm #

@gg, the case-control studies effectively take into account these effects. Suppose motorists avoid people without helmets to such a degree that wearing a helmet makes you much more likely to have an accident. Then we’d expect to see very few cyclists without helmets with injuries due to accidents compared to the control group, but in fact there were a lot more. The same argument applies to people with helmets riding more recklessly. And some of the studies looked explicitly at brain injury, and found that helmets do, indeed, reduce it significantly.
This isn’t saying that those effects don’t exist — people probably do give cyclists with helmets less space — but helmets are so effective against head injury that they swamp the other effects.


Mikhail

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Jun 14 2013 at 3:42pm #

gg wrote:Helmets do very little for concussions (brain hitting inside of skull).

And you were talking about death which is different than injures. And this fact is well known.


Steven

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Jun 14 2013 at 4:38pm #

The same argument applies to people with helmets riding more recklessly.

Jonawebb, I’m having trouble seeing this. Let’s imagine that helmets don’t help at all, but riding safely does.

Suppose we study 100 riders. To make things simple, they’re all of the same age, gender, etc. 75 ride safely. They also all wear helmets. 25 ride unsafely, and none wear helmets. The safe 75 get 20 head injuries. The unsafe 25 also get 20 head injuries. (The difference, we’re supposing, is entirely due to riding styles, not helmets.)

Of the 40 injuries, 50% were wearing helmets. Is the control group the remaining 60 uninjured, or all 100? In the first case, we’re got 55 safe helmeted uninjured riders plus 5 unsafe unhelmeted uninjured riders, so 8% of the control group weren’t wearing helmets. In the second case, we’ve got 25% not wearing helmets. But in either case, there’s a huge difference between 50% and the others, “proving” that helmets work, even though in this example they don’t. It’s merely that our safe riders also choose to wear helmets.

It seems like, unless you’re controlling for whatever besides helmets could really be causing a difference in head injury rates, a retrospective study like this can only measure “helmet use or something else correlated to helmet use”, and can’t distinguish between the two.

Or have I misunderstood how you’d interpret the above data? Please explain how to interpret it so it shows that, in this pretend example, helmets aren’t helping.


gg

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Jun 14 2013 at 11:50pm #

For the record, I am not condoning not wearing a helmet at all. I am merely saying that people should do as they please regarding it. I wear one if I am on a ride that requires it, but that is about it these days. I mean, I am riding a fixed gear going under 20mph, it isn’t like I am riding a Ninja doing a wheelie on Rt 28 in traffic. Do what you feel comfortable with. I did find those studies kind of cool though. I never see helmets in much of Northern Europe. Of course drivers are much better than here in every regard.


jonawebb

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Jun 15 2013 at 9:36am #

@Steven, you start with two groups, the control group and the case group. The control group is just there to measure helmet usage in general. So suppose 75% of riders wear helmets as in your example. You have 40 riders in your case group, half wearing helmets. So in your example we see helmet usage leading to more head injuries (I’m assuming all accidents involve head injury in your example.)
But that is not, in fact, what the case-control studies show. Helmet usage leads to less head injury. So, as a result, we can conclude that recklessness associated with helmet use, if it exists, is not so common as to overwhelm the protective effect of helmets.


gg

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Jun 15 2013 at 10:01am #

One thing I read about helmets, is they suppress cycling because they create a climate of fear, instead of a climate of joy and happiness. Lets face it, when you see people riding in places like Sweden and Finland, they are gleeful and very few wearing helmets. When you see people ride around here, they have a more cautious look and are usually wearing a helmet. I never was big on the fear thing. The chances are very slim a helmet will make any difference for myself. Sure I could be flattened and there is some outside chance a helmet might have made some difference, but I just don’t have fear for that tiny chance. I like to think of cycling as a joyful time and I ride route to get away from cars even if it takes longer. I deal with cars, but you would be amazed at how few bad areas you deal with once you know the entire area like the back of your hand. For example, if you are coming out of Pittsburgh and want to take Penn, I ride this cool alley route that even has a tiny sidewalk involved. No cars. It is great fun, but of course riding on Penn would be faster. I think this kind of cycling is way more important than riding in areas like 5th Ave past Ellis School into Oakland with a helmet and feeling safe because you have that plastic thing on your head.

Anyway, if everyone was riding with no helmet, I suspect there would be more people willing to give cycling a try because it doesn’t look so scary. I think a lot of people would cycle if it didn’t appear to be like a death wish.


buffalo buffalo

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Jun 15 2013 at 11:47am #

Knew I’d seen this somewhere. Via Wash Cycle: 85% claim discredited, withdrawn by feds. http://www.waba.org/blog/2013/06/feds-withdraw-claim-that-bike-helmets-are-85-percent-effective/


helen s

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Jun 15 2013 at 11:55am #

People having to wear mandatory seatbelts, strap their kids in, and the proliferation of air bags to reduce injuries or death (which happen frequently) does not seem to scare people away from traveling by automobile.


jonawebb

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Jun 15 2013 at 12:08pm #

@bb, another reference to the 1989 Rivara study. Many studies by other researchers since — see the review article…
Edit: BTW I totally agree with people deciding to wear helmets or not. People can decide. Just don’t claim that they don’t protect against head injury in an accident.


cburch

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Jun 15 2013 at 9:22pm #

helmets don’t create fear, awful infrastructure and even more awful drivers do.

a helmet wont save me if i get run over by some idiot doing 50 while texting on a 25 mph city street, but it will help a lot if i slide out on some ice and fall over in junction hollow going 5-10mph.


Steven

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Jun 16 2013 at 2:10am #

So in your example we see helmet usage leading to more head injuries

The point is that in my made-up example, there’s zero actual connection between helmet usage and head injuries. So the fact that this type of analysis says otherwise demonstrates a flaw in the analysis.

This is why case-control studies don’t provide great evidence. As Wikipedia puts it, “Case-control studies are observational in nature and thus do not provide the same level of evidence as randomized controlled trials. The results may be confounded by other factors, to the extent of giving the opposite answer to better studies. A meta-analysis of what were considered 30 high-quality studies concluded that use of a product halved a risk, when in fact the risk was, if anything, increased.”

The links in the article show how this type of study can produce results that are completely wrong, not because the researchers made errors, but because this type of study is very limited in what it can show.

So it’s important not to put too much emphasis on studies of this type, or to imagine that having a large number of similar studies of this type provides additional “proof”. Like I said, this type of study cannot distinguish between helmet use and any other factor that varies in the same way, unless the researcher specifically finds a way to account for that other factor, whatever it might be (riding style being just one example).

Of course, a lack of solid research doesn’t prove helmet are useless either. It could well be that the studies are, in whole or in part, measuring the effect of helmet use, not some other factor. But we just don’t know for sure (or not from case-control studies, anyway — perhaps there are better studies out there somewhere).


gg

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Jun 16 2013 at 7:35am #

Interesting about case control studies. I certainly am not buying into those wild numbers, stating a helmet helps 85% or whatever. Too funny. I also wonder who is coming up with this nonsense? The helmet industry/lobby? Anytime there is huge money to be made trust of an industry pretty much gets tossed. It is all about the almighty dollar. Oh yeah, remember to replace your helmet every other year or so. That is what the industry says. They go bad! If your helmet is older than that, might as well not wear it! Goodness!


jonawebb

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Jun 16 2013 at 2:03pm #

Steven wrote:Like I said, this type of study cannot distinguish between helmet use and any other factor that varies in the same way,

So what you’re saying is, helmets themselves might not protect against head injury, but riders wearing them somehow acquire the ability to protect their head somehow. Oh…kay. Well, if that was true, until we figure out how that remarkable protective ability is acquired, wouldn’t wearing helmets be a way to access it?
It’s beginning to feel like I’m arguing with someone who just won’t believe in global climate change or evolution or something like that. No matter what evidence I provide, there’s always an out — not contrary evidence, but some thing the study didn’t take into account.
But maybe you don’t know that in science, disproving a commonly held theory, while it’s not easy, is a way to get famous. If helmets really weren’t protecting from head injury someone would do a study that shows that. And it’s just not happening. There’s no helmet manufacturers association secretly guiding the work of researchers all over the world.
If you want to show helmets don’t work, you have to find some evidence that they actually don’t work — not that they don’t work as well as they might, or that some particular study had a flaw, etc. — but that people wearing helmets had head injury at the same or greater rate that people not wearing them.


Marko82

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Jun 16 2013 at 7:55pm #

Correlation does not imply causation i.e., it might be that the safe people are the ones who would wear a helmet.

I always wear a helmet – but the few times I’ve crashed my bike my head has not hit the ground at all, not even a scuff mark. Did the helmet prevent me from having a head injury? No. Could it have? Maybe. I think that is the point being made in not trusting these studies.


Steven

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Jun 16 2013 at 10:46pm #

riders wearing them somehow acquire the ability to protect their head somehow.

No, I’m saying that safe riders do various things in an attempt to improve their safety, like riding in the correct direction on one-way streets, using lights at night, slowing down when approaching intersections, etc. One of those things is wearing helmets. Some combination of those things is effective. To determine which particular things are effective, a mere case-control study doesn’t help. A study would need to tease out helmet use from all the things that accompany it.

A case-control study can tell you that it’s beneficial to be the type of safe rider who wears a helmet and does a bunch of other things for safety. All together, it proves that they make you safe. It can tell that helmet use is a good marker for whether you’re such a safe rider. If you wear a helmet, you’re more likely to do all those other things.

Imagine there’s a button that says “Safe riders rock!” It’s super-popular among safe riders, but everybody else thinks it’s dumb. As a result, it serves as a good marker for safe riders. A case-control study will prove that people with these buttons get in fewer accidents. But a safety campaign centered on increasing the popularity of the buttons will not be effective. Pinning a button on as many unsafe riders as possible won’t make them safer. Could helmets be like those buttons, to some extent?

If you want to show helmets don’t work

I’m not saying that. I’m saying if the only data we have is a big pile of case-control studies, then we just don’t know. They might work great. They might not be doing much. We have no good evidence one way or the other, as far as how they work in practice (unless there are other, better studies out there).

I think they probably do work (and I always wear mine), but I’m merely guessing. Claiming there’s research and science proving they work in practice is what I’m objecting to.

I’d love to see some well-designed research that tries to disentangle helmet use from other factors, to see if we can measure their effect outside of a lab. But I don’t see how you could do that with a mere case-control study.


gg

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Jun 16 2013 at 10:59pm #

Steven wrote: I’m saying if the only data we have is a big pile of case-control studies, then we just don’t know.

I think we know more than that. We all ride bikes. Several of us have had slide outs or whatever. I think most would agree it isn’t all that easy to hit your head unless something hits your head. It isn’t going to be the ground unless you are flying over your handlebars. That kind of wreck is rare. Therefore, I think we really know the answer. Helmets do very little in reality, but they make some companies one heck of a lot of money. If you get hit by a bus, it might help, but it might not. For the most part they are sort of overkill. The skull is pretty tough.

Anyway, this is not my thing. If you are a fear type, then wear one. I just don’t see a reason to.


byogman

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Jun 16 2013 at 11:35pm #

I found this interesting:

https://en.wikipedia.org/wiki/Hierarchy_of_evidence

Case control studies rank pretty low, but better than case reports (the experience of me or my friends), which, other than intuition based arguments have comprised most of the back and forth here. So helmet wins there in my book.

You’re not going to get randomized controlled trials with people no matter what. To the extent there are really controlled conditions it’s in a lab, measuring accelerations with and without a helmet. You can argue that more or different conditions should be measured, but by the info we have, helmets do reduce accelerations. Another win in my book.

I think it’s fair to argue whether helmet wearing is worth it due to the risk being so low. I probably wouldn’t on the GAP only, or riding in Amsterdam or Copenhagen. But I think it’s pretty strange to argue that they don’t make you at least ~a little~ safer.


Drewbacca

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Jun 17 2013 at 12:21am #

I find yinz lack of faith disturbing.


jonawebb

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Jun 17 2013 at 6:11am #

@Steven et al, those things would reduce accidents, but not head injury. So the case control studies could account for that by comparing total injuries to head injuries.


Benzo

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Jun 17 2013 at 8:35am #

Grant Peterson of Rivendell cycles tends to make a lot of the same points about helmets. He also mentions that cyclists who swerve around a bit in traffic tend to be passed with a bit more space by drivers in general.

However, people have different reasons for riding.

Some people like to ride on sketchy gravel roads and dirt paths with less predictable conditions for fun, and have a high risk of sliding out. These people probably want helmets.

Some people are just trying to ride a couple miles to work on 25-35mph speed limit streets with lots of stop signs and red lights. These people may or may not want to wear helmets.

Some people ride all winter and have to control their bike in snow, rain, ice, and slush. These people probably want helmets.

Other people are just trying to ride a few trails for exercise or for fun. These people may or may not want to wear helmets.

Some people ride road bikes and want to ride fast and train hard to…. umm.. ride faster and longer, these people probably want helmets.

Some people are just trying to load up their pannier bags with groceries. They may or may not want to wear helmets.

Some people go flying down hills on narrow trails in the woods, just inches from trees, these people probably want helmets.

Other people want to ride to a cafe, bar, or restaurant to meet up with friends a few miles from home without driving. These people may or may not want helmets.

Some people ride bikes with massive suspension systems and go flying off jumps while flying down trails, these people probably want helmets.

Other folks play weird games like bike polo and go over the bars, flip backwards, topple sideways, and get smacked with mallets, these people probably want helmets (some want face cages too).

I think it really depends on what kind of riding you are doing, hat your risk tolerance is. If you’re especially concerned about concussions, you can try sourcing MIPS, Conehead, or import an ABUS Kranium helmet to go beyond CPSC levels of protection.

However, if you want to do certain things like race, go on most cycling club rides, go on a flock ride, then you are required to have a helmet (possibly due to insurance requirements or group ethos).


edmonds59

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Jun 17 2013 at 9:02am #

^That – is it, right there, everything. Excellent. Nice work.

It’s entirely possible that the OP’s “project” had nothing to do with helmet use, per se, at all. Rather, it may just to have been to find out how long some X group of people on the internet could keep this festival balloon of an issue aloft.


gg

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Jun 17 2013 at 10:18am #

byogman wrote: But I think it’s pretty strange to argue that they don’t make you at least ~a little~ safer.
______

They no doubt make you a little safer. I don’t think you can argue that. Even if it was .05%, that is a little safer. I think it would be more like 3-7% safer, but that is just a guess. I ride a fixed almost all the time, so my top speed isn’t exactly blistering down a hill.

The last crash I had was going over railroad tracks at an angle that wasn’t quite enough with a semi-flat rear tire, that I was unaware of. The tracks caught my rim and threw me sort of face first over the right side of my handlebars. I extended my right arm to soften the landing. No major problems with that crash.

The most dangerous part of my rides are probably going over the Highland Park Bridge at night. If I bite it on that sidewalk, that could be a problem for my head. Therefore, I don’t fly across it. I am more cautious. I ain’t getting any younger!


Steven

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Jun 17 2013 at 1:07pm #

To the extent there are really controlled conditions it’s in a lab, measuring accelerations with and without a helmet.

But behaviors change when helmets get involved. Motorists may drive farther away, or more slowly, when they see helmetless riders. Risk-taking cyclists with no helmets might also be more likely to ride close to cars. Or just the opposite: cyclists with no helmets might decide to stick to trails. Does all that outweigh the clear pure-physics benefit of helmets?

So the case control studies could account for that by comparing total injuries to head injuries.

That’s a very good point. I’ve now read the 2009 Cochrane review you posted, and I see it included only studies which did that. They wouldn’t have been fooled by my examples. So I guess my main argument is with the way you originally described the studies, not the actual studies. Thanks for posting the link.

Still, it would be nice if those studies could directly address the question of whether helmets reduce the number of head injuries. They instead address the related question of whether helmets reduce the number of head injuries among cyclists who crash.


reddan

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Jun 17 2013 at 2:56pm #

IIRC, one of the criticisms commonly levied at the Thompson case-control studies is that the source data, if not restricted solely to facial and cranial injuries, also indicates that helmet use is correlated with lower incidence of broken legs.

This does not mean that there is anything wrong with the source data, or with the means of analysis…it simply points up a problem with drawing conclusions regarding causal factors.

Personally, I’d be shocked if helmets did not decrease injury to some extent. How much is hard to tell, as, to my knowledge, no mass-market vendor of cycling helmets specifically states what types of collisions their helmet is rated to withstand. The only available clues are the published testing protocols…reading said protocols is one of the reasons why I have no confidence in any of my helmets to protect me beyond a nigh-stationary fall.

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