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post #16 of 1258

Re: published helmet research - not troll

DRS wrote:
> "Steven Bornfeld" <dentaltwinnospam@earthlink.net> wrote in message
> news:40D36C75.3090402@earthlink.net
>
> [...]
>
>
>>I've heard the same arguments from people who don't wear seatbelts in
>>cars. I thought they made what could be valid points--until I spent a
>>year covering head/neck trauma during my residency.

>
>
> The difference is empirically obvious. I live in the first state in the
> world that made seatbelt use compulsory (Victoria, Australia). Not only did
> the fatality rate immediately plummet but the rate of spinal injuries
> dropped 75% in the first year. There is no such corresponding data for
> bicycle helmets.


The safety improvement from seat belt use that I have seen is nowhere
near that dramatic. Nevertheless, I can tell you from first hand
experience that no one involved in a car accident that I saw the whole
year (that I asked--most of them) had been wearing seat belts.
There are many studies out there--some designed better, some worse.
There is poor compliance with helmet regulations in the US where they
exist. But certainly Kunich can show studies which cast doubt on the
efficacy of helmets in preventing head injuries. There is also this:

http://www.cochrane.org/cochrane/revabstr/ab001855.htm

which reaches exactly the opposite conclusion.
In the end, people are going to believe what they want. Unfortunately,
my tax dollars are going to pay the medical expenses of those who ignore
common sense.

Steve

>
post #17 of 1258

Re: published helmet research - not troll

John Forrest Tomlinson wrote:
> On Fri, 18 Jun 2004 18:28:05 -0400, Steven Bornfeld
> <dentaltwinnospam@earthlink.net> wrote:
>
>
>
>>Why someone would even try to suggest that helmets don't save lives
>>because there are no controlled studies to prove they do says more about
>>these people than it does about helmets.

>
> I haven't suggest anything. I've asked questions of assumptions. It's
> fine to say "I hope my helmet will protect me from brain injuries from
> hitting branches when mountain biking?" Or "Id' speculate that
> helmets will protect me from falling rocks and bricks that hit my
> head, or accidents on a bike that approximate that."
>
> But to go from that to "Wear a helmet because it'll save you from a
> brain injury" is a big leap. If you're going to advocate that people
> do something like wear helmets, at least you could be honest about the
> degree of speculation involved. And when you consider that riding a
> bike w/o a helmet is probably better for your health than not riding
> at all,



Pure speculation, JT, pure speculation.

Steve


honesty and recognition of uncertainty is even more important.
> To do otherwise is either intellectually lazy or unethical.
>
> JT
post #18 of 1258
Thread Starter 

Re: published helmet research - not troll

Jay Beattie wrote:

>
> And the New York Times wrote on May 1, 2001 that:
>
> "A report last summer on "The Future of Children" noted that 35
> states lacked bicycle helmet laws, even though "research has
> shown that bicycle helmets are 85 percent effective at reducing
> head injuries."


They should have at least hedged by saying "up to 85%." This number
came from the Thompson & Rivara case-control study of 1989. In order to
get that high number, T&R had to count even scratches on ears as "head
injuries," and had to compare wildly different groups. Yes, if you
compare helmeted middle class white kids with excellent insurance
coverage (i.e. free ER) riding on bike paths, versus unhelmeted
low-income kids who only go to the ER if it's really serious, and who
ride on streets, you'll get good results for helmets!

That's only a slight exaggeration. If you want a more serious
discussion of the shortcomings of that study, see
http://www.cyclehelmets.org/mf.html#1001


> A study in Queensland, Australia, of bicycle
> accidents among children showed that wearing a helmet reduced the
> risk of loss of consciousness from a head injury by 86 percent.


Did they give a source for that?

Other pro-helmet studies from Australia have done things like ignore the
drop in cycling, ignore the concurrent installation of speed cameras and
stiff drunk driving enforcement, etc. to maximize the supposed helmet
benefit. Still, this is the first time I recall any study but T&R's
coming anywhere close to 85%. Despite the fudging, other pro-helmet
studies come out much lower. I'd like to check the original paper.



>
> Even preschoolers who do not ride in traffic and toddlers on
> tricycles need head protection "whenever and wherever they are
> cycling," insists Dr. Elizabeth C. Powell of Children's Memorial
> Hospital in Chicago. Dr. Powell, a specialist in pediatric
> emergency medicine, notes that helmets can also reduce the risk
> of facial injuries when a child falls off a tricycle or bicycle."


Why of course they can! Also while playing hopscotch, of course.


> I guess it all depends on whether you live in New Zeland or
> Australia. Or whether you are Rivera or Scuffham. For every
> scientific study you come up with, I can find one or two that go
> the other way.


I take a different view. In fact, most scientists take a different view
in such situations.

When cold fusion was trumpeted about 15 years ago, there was one team
(similar to Thompson & Rivara) that published a miracle of success.
There were others who disagreed.

The scientific community didn't say "Oh well, it can go either way."
They kept testing.

In the long run, cold fusion seems to be a dud - at least, by the method
proposed.

This seems to be what's happening with bike helmet research. T&R have
gained fame by saying "85%!!!" but results of mandatory helmet laws
(passed as a result) are pretty dismal. Some other self-selected
case-control studies still give optimistic results, but large population
data doesn't.

It may be that helmets help only if you're lucky enough to be part of a
case-control study, I don't know. But it's worth remembering that
self-selected case-control studies are never accepted for the usual
questions, like "Does this drug prevent cancer" and the like. It's far
to easy to bias the results.



> And in the final analysis, it really does not
> matter, because we all just do what we do -- and, with minor
> exception, we are all too old for the MHLs in most states. MLHs
> are mostly a kid thing, and my kid wears a helmet when he is
> riding or skiing -- but not when he is walking, showering, or
> playing with his Legos or YuGiOh cards. Yes, I know that is
> inconsistent when we look at injury patterns, but we have learned
> to live with that inconsistency. -- Jay Beattie.


Perhaps it really does not matter to you. But it really does matter to
me.

I'm bothered by the portrayal of all cycling as an extreme activity.
I'm bothered that there have already been attempts to blame cyclists for
injuries caused by negligent drivers, because the cyclist didn't wear a
helmet. I'm bothered by the drop in cycling caused by enforced MHLs,
and I'm bothered by the mixed message given to kids by America's
unenforced MHLs. And I'm bothered by pro-helmet prejudice and the
resulting lack of rigor when examining supposed pro-helmet data.

You'll decide for your kid, of course. But I kind of hope you'll
somehow stay away from statements like "Omigod, NEVER ride without a
helmet!!!" If you want to scare him, it's better to just tell him about
the boogeyman.


--
--------------------+
Frank Krygowski [To reply, remove rodent and vegetable dot com,
replace with cc.ysu dot edu]
post #19 of 1258
Thread Starter 

Re: published helmet research - not troll

Steven Bornfeld wrote:

>
>
> Well, that's the problem, isn't it? Tough to run a controlled study
> of this type in real-life conditions.


It would be tough if there weren't such things as mandatory helmet laws
(MHLs). Or even better, _enforced_ MHLs. When you've got a step
increase in the percentage of cyclists in helmets for a whole country,
it's not a bad test of "real-life conditions." All you have to do is
remember to account for the decrease in cycling those laws have caused.
(Pro-helmet papers have been known to ignore a 35% cycling drop, and
count the 30% HI drop as a good sign!)

> Why someone would even try to suggest that helmets don't save lives
> because there are no controlled studies to prove they do says more about
> these people than it does about helmets.


Your statements are too vague to be of use.

The people I know who say helmets don't save lives are the people who
have spent the largest amount of time examining the actual data. The
people who claim they must are typically people who have read a few
helmet promotion blurbs.

Is that what you meant, exactly?


> I've heard the same arguments from people who don't wear seatbelts
> in cars. I thought they made what could be valid points--until I spent
> a year covering head/neck trauma during my residency.


Let's stick to the issue. Seatbelts are a side point. They're not
really comparable - largely because seat belts are tested and certified
for serious collisions, the ones that cause most serious accidents.
Bike helmets are definitely not.

So tell us about your head trauma experience. Since we're talking about
saving lives, what percentage of the head trauma fatalities you saw were
cyclists?

You probably realize that nationally, cyclists are less than 1% of that
problem, right?

Was your experience different from the national average? I'm quite curious.

--
--------------------+
Frank Krygowski [To reply, remove rodent and vegetable dot com,
replace with cc.ysu dot edu]
post #20 of 1258

Re: published helmet research - not troll

On Fri, 18 Jun 2004 19:24:50 -0400, Steven Bornfeld
<dentaltwinnospam@earthlink.net> wrote:


> But this is like saying that a
>seat belt shouldn't be worn because it won't save you from crushing
>injury of the thorax in a head-on 60 mph crash.
>Safety measures shouldn't be discarded because they are not 100% effective.


I haven't said anyone should wear a seatbelt and I haven't said anyone
shouldn't wear a bicycle helmet. I've asked, repeatedly in this
thread, for some evidence of speculation about overstated dangers. If
helmet proponents want to push for wider helmet use, I think it's only
fair that they be honest about what is known and identify their
speculation as such. That's not a lot to ask -- for honesty.

JT
post #21 of 1258

Re: published helmet research - not troll

Shayne Wissler wrote:

> "John Forrest Tomlinson" <usenetremove@jt10000.com> wrote in message
> news:34q6d0hkroniv8qi4qv7o0bep0krigpvmv@4ax.com...
>
>> Now what evidence do you have about helmets protecting against dented
>> skulls or brain injuries?

>
> I have an idea for an experiment. Go outside and have someone hold a brick
> about 2 feet over your bare head and have him drop it. Observe the pain and
> damage (assuming you're still conscious). Then try the same experiment on
> your friend, but have him wear a cycling helmet. If he laughs at you, you
> may be able to infer from this, experimentally, that he thought it was not
> necessary to run the experiment to know that you would end up with a damaged
> head and he wouldn't.


Here's another experiment.

Get someone to swing a baseball bat so that it misses the top of your
skull by an inch.

Now wear a cycle helmet, and repeat the experiment.

Report back which hurts the most.

--
Keith Willoughby http://flat222.org/keith/
I have seen the enemy, and he is quite short.
post #22 of 1258
Thread Starter 

Re: published helmet research - not troll

Steven Bornfeld wrote:

>
> There are many studies out there--some designed better, some worse.
> There is poor compliance with helmet regulations in the US where they
> exist. But certainly Kunich can show studies which cast doubt on the
> efficacy of helmets in preventing head injuries. There is also this:
>
> http://www.cochrane.org/cochrane/revabstr/ab001855.htm
>
> which reaches exactly the opposite conclusion.


It's scary to me that a person can get serious medical training, yet
come away with your attitude. "Some go one way, some go another way.
Oh well, no point examining the methodology. We'll just go by gut
feeling."

Seriously, is that how they select chemotherapy drugs??


> In the end, people are going to believe what they want.
> Unfortunately, my tax dollars are going to pay the medical expenses of
> those who ignore common sense.


Good grief. Sounds like more gut feeling to me!

Why not compute what percentage of your tax dollars to to auto accidents
(40,000 fatalities per year), to pedestrian fatalities (6500 per year),
to drownings (over 4000 per year). Then start thinking about obesity,
smoking, and all the other causes of preventable death.

Given the numbers, the 700 or so bike fatalities per year in the US are
NOT going to keep you from buying your next Mercedes! (As if the others
did...)


--
--------------------+
Frank Krygowski [To reply, remove rodent and vegetable dot com,
replace with cc.ysu dot edu]
post #23 of 1258
Thread Starter 

Re: published helmet research - not troll

Steven Bornfeld wrote:

>
>
> John Forrest Tomlinson wrote:
>
>> And when you consider that riding a
>> bike w/o a helmet is probably better for your health than not riding
>> at all,

>
> Pure speculation, JT, pure speculation.


Meyer Hillman, a rather famous researcher for the British Medical
Association, has computed that the years of life gained due to cycling
outnumber the years of life lost by a 20 to 1 ratio.

From what I've seen, the speculation in this discussion has come from
you! "Common sense" indeed!



--
--------------------+
Frank Krygowski [To reply, remove rodent and vegetable dot com,
replace with cc.ysu dot edu]
post #24 of 1258
Thread Starter 

Re: published helmet research - not troll

Steven Bornfeld wrote:

>
> Safety measures shouldn't be discarded because they are not 100%
> effective.


Perhaps that's true.

But safety measures shouldn't be strongly promoted unless their benefits
are proven in large populations.

They shouldn't even be considered for mandating unless it's proven that
the resulting benefits outweigh the detriments - including the important
benefit of personal freedom, for one's self and one's family.

And they shouldn't receive the lion's share of promotion unless other
measures are much less effective.


Unfortunately, bike helmets seem to look relatively useless in large
population studies (as opposed to limited case-control studies with
self-selected subjects).

Mandating, and perhaps even strong promotion, of bike helmets tends to
drive people away from cycling, by making it seem extraordinarily
dangerous. And promoters have successfully convinced the public that
cycling is, indeed, dangerous - despite data to the contrary.

And it's still true that often, the ONLY thing people hear about bike
safety is "Always wear a helmet!!!!" Nothing about rules of the road,
lights at night, maintaining the machine, etc.

I've seen enough helmeted families riding facing traffic, or riding at
night without lights, to know that the emphasis needs to be changed.


Recently, a member of my extended family was in for some minor medical
care - interestingly, related to being hit by a car while walking. The
physician heard mention of bicycling, and asked "Do you always wear a
helmet?" When the answer was "No," there was some scolding.

Think about that. Nothing about "Do you follow the rules of the road?
do you ride on the right? Do you use lights at night? Is your bike
mechanically sound?" And of course, nothing about "Do you wear a helmet
when crossing the street?" _despite_ the recent car impact!

Clearly, the emphasis is mistaken.


--
--------------------+
Frank Krygowski [To reply, remove rodent and vegetable dot com,
replace with cc.ysu dot edu]
post #25 of 1258

Re: published helmet research - not troll

Frank Krygowski wrote:
> Steven Bornfeld wrote:
>
>>
>>
>> Well, that's the problem, isn't it? Tough to run a controlled
>> study of this type in real-life conditions.

>
>
> It would be tough if there weren't such things as mandatory helmet laws
> (MHLs). Or even better, _enforced_ MHLs. When you've got a step
> increase in the percentage of cyclists in helmets for a whole country,
> it's not a bad test of "real-life conditions." All you have to do is
> remember to account for the decrease in cycling those laws have caused.
> (Pro-helmet papers have been known to ignore a 35% cycling drop, and
> count the 30% HI drop as a good sign!)



I don't know how you can call this a real test with any control. In
your response to Jay, you just said:

"Other pro-helmet studies from Australia have done things like ignore
the drop in cycling, ignore the concurrent installation of speed cameras
and stiff drunk driving enforcement, etc. to maximize the supposed
helmet benefit. Still, this is the first time I recall any study but
T&R's coming anywhere close to 85%. Despite the fudging, other
pro-helmet studies come out much lower. I'd like to check the original
paper."


If there were confounding factors in the prior example, you can't come
back and now say these can be ignored.

>
>> Why someone would even try to suggest that helmets don't save
>> lives because there are no controlled studies to prove they do says
>> more about these people than it does about helmets.

>
>
> Your statements are too vague to be of use.



I'm not suggesting you use it. I am suggesting that antihelmet
partisans can be depended upon to parse the data out there selectively.

>
> The people I know who say helmets don't save lives are the people who
> have spent the largest amount of time examining the actual data. The
> people who claim they must are typically people who have read a few
> helmet promotion blurbs.
>
> Is that what you meant, exactly?
>
>
>> I've heard the same arguments from people who don't wear seatbelts
>> in cars. I thought they made what could be valid points--until I
>> spent a year covering head/neck trauma during my residency.

>
>
> Let's stick to the issue. Seatbelts are a side point. They're not
> really comparable - largely because seat belts are tested and certified
> for serious collisions, the ones that cause most serious accidents. Bike
> helmets are definitely not.
>
> So tell us about your head trauma experience. Since we're talking about
> saving lives, what percentage of the head trauma fatalities you saw were
> cyclists?


They don't usually call the dentist on the head trauma fatalities. I
was called on facial injuries. There were a substantial number of
cycling accidents. Most weren't wearing helmets, but then this was 28
years ago.

>
> You probably realize that nationally, cyclists are less than 1% of that
> problem, right?



If it's you, you're 100% dead.

Steve

>
> Was your experience different from the national average? I'm quite
> curious.
>
post #26 of 1258

Re: published helmet research - not troll

John Forrest Tomlinson wrote:
> On Fri, 18 Jun 2004 19:24:50 -0400, Steven Bornfeld
> <dentaltwinnospam@earthlink.net> wrote:
>
>
>
>>But this is like saying that a
>>seat belt shouldn't be worn because it won't save you from crushing
>>injury of the thorax in a head-on 60 mph crash.
>>Safety measures shouldn't be discarded because they are not 100% effective.

>
>
> I haven't said anyone should wear a seatbelt and I haven't said anyone
> shouldn't wear a bicycle helmet. I've asked, repeatedly in this
> thread, for some evidence of speculation about overstated dangers. If
> helmet proponents want to push for wider helmet use, I think it's only
> fair that they be honest about what is known and identify their
> speculation as such. That's not a lot to ask -- for honesty.
>
> JT


I spend far too much time over at the dental newsgroup from folks who
still think fluoride is a Communist plot, that fluoride caries data are
false. Likewise, we're assaulted daily by folks who think we're
poisoning our patients with mercury, that vaccines cause autism, etc,
etc. My experience and expertise ain't worth crap.
You want to believe this is a helmet manufacturer conspiracy, go right
ahead. I have no intention of wasting time proving that the earth isn't
flat.

Steve

Steve
post #27 of 1258

Re: published helmet research - not troll

Frank Krygowski wrote:
> Steven Bornfeld wrote:
>
>>
>> There are many studies out there--some designed better, some
>> worse. There is poor compliance with helmet regulations in the US
>> where they exist. But certainly Kunich can show studies which cast
>> doubt on the efficacy of helmets in preventing head injuries. There
>> is also this:
>>
>> http://www.cochrane.org/cochrane/revabstr/ab001855.htm
>>
>> which reaches exactly the opposite conclusion.

>
>
> It's scary to me that a person can get serious medical training, yet
> come away with your attitude. "Some go one way, some go another way. Oh
> well, no point examining the methodology. We'll just go by gut feeling."


I don't know what "attitude" you're detecting, other than that I
disagree with you. I fully expect that the studies that support your
position are all well-designed.

>
> Seriously, is that how they select chemotherapy drugs??
>
>
>> In the end, people are going to believe what they want.
>> Unfortunately, my tax dollars are going to pay the medical expenses of
>> those who ignore common sense.

>
>
> Good grief. Sounds like more gut feeling to me!
>
> Why not compute what percentage of your tax dollars to to auto accidents
> (40,000 fatalities per year), to pedestrian fatalities (6500 per year),
> to drownings (over 4000 per year). Then start thinking about obesity,
> smoking, and all the other causes of preventable death.


What is your point?

>
> Given the numbers, the 700 or so bike fatalities per year in the US are
> NOT going to keep you from buying your next Mercedes! (As if the others
> did...)


Well, that's very nice.

Steve ('89 Honda)

>
>
> --
> --------------------+
> Frank Krygowski [To reply, remove rodent and vegetable dot com,
> replace with cc.ysu dot edu]
>
post #28 of 1258

Re: published helmet research - not troll

Frank Krygowski wrote:
> Steven Bornfeld wrote:
>
>>
>>
>> John Forrest Tomlinson wrote:
>>
>>> And when you consider that riding a
>>> bike w/o a helmet is probably better for your health than not riding
>>> at all,

>>
>>
>> Pure speculation, JT, pure speculation.

>
>
> Meyer Hillman, a rather famous researcher for the British Medical
> Association, has computed that the years of life gained due to cycling
> outnumber the years of life lost by a 20 to 1 ratio.
>
> From what I've seen, the speculation in this discussion has come from
> you! "Common sense" indeed!


Yeah, yeah. I'll bet he hates helmets too.

Steve

>
>
>
post #29 of 1258

Re: published helmet research - not troll

Frank Krygowski wrote:
> Steven Bornfeld wrote:
>
>>
>> Safety measures shouldn't be discarded because they are not 100%
>> effective.

>
>
> Perhaps that's true.
>
> But safety measures shouldn't be strongly promoted unless their benefits
> are proven in large populations.
>
> They shouldn't even be considered for mandating unless it's proven that
> the resulting benefits outweigh the detriments - including the important
> benefit of personal freedom, for one's self and one's family.
>
> And they shouldn't receive the lion's share of promotion unless other
> measures are much less effective.
>
>
> Unfortunately, bike helmets seem to look relatively useless in large
> population studies (as opposed to limited case-control studies with
> self-selected subjects).
>
> Mandating, and perhaps even strong promotion, of bike helmets tends to
> drive people away from cycling, by making it seem extraordinarily
> dangerous. And promoters have successfully convinced the public that
> cycling is, indeed, dangerous - despite data to the contrary.
>
> And it's still true that often, the ONLY thing people hear about bike
> safety is "Always wear a helmet!!!!" Nothing about rules of the road,
> lights at night, maintaining the machine, etc.
>
> I've seen enough helmeted families riding facing traffic, or riding at
> night without lights, to know that the emphasis needs to be changed.
>
>
> Recently, a member of my extended family was in for some minor medical
> care - interestingly, related to being hit by a car while walking. The
> physician heard mention of bicycling, and asked "Do you always wear a
> helmet?" When the answer was "No," there was some scolding.
>
> Think about that. Nothing about "Do you follow the rules of the road?
> do you ride on the right? Do you use lights at night? Is your bike
> mechanically sound?" And of course, nothing about "Do you wear a helmet
> when crossing the street?" _despite_ the recent car impact!
>
> Clearly, the emphasis is mistaken.


Feel free to start another thread. My advocacy of helmets does not in
any way make me irresponsible regarding these other issues. Do you
believe it does?

Steve

>
>
post #30 of 1258

Re: published helmet research - not troll

Erik Freitag <erik.freitag@pobox.com> writes:

> On Sat, 19 Jun 2004 00:21:50 +0000, Bill Z. wrote:
>
> > This is not true. Children do not ride less due to helmet laws,
> > particularly in California, where the helmet laws are not enforced (or
> > rarely enforced.) If you tell a young teen to start using a helmet when
> > he previously didn't want to, you can expect a negative reaction (natural
> > rebelliousness.) Kids who started using helmets when they started riding
> > bicycles don't have that reaction.

>
> I think this is another evidence-free (in the statistical sense)
> assertion. I offer a counter-anecdote - my kids, 11 & 13 won't ride to
> school because they don't want to wear their helmets because helmets make
> them look like geeks, like their dad. Dad won't let them ride without one
> because there's a law ...


See if you can prove otherwise. I've seen the police drive by an
unhelmeted kid riding a bicycle numerous times. I've never seen
an officer stop a child.

If they don't cite anyone, the law won't have any effect. In fact,
I doubt if most parents are even aware of the law.

BTW, your kids may be just using that as an excuse. If you told them
they couldn't use a helmet, they might insist on using one, just to
be rebellious. You konw, 13 years old ...


--
My real name backwards: nemuaZ lliB
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