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Cycle helmets - major study

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UK and Europe
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17 April 2003
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Paul Smith
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  1. In message <[email hidden]>, Tony Raven <[email hidden]> writes

    Quoted message said:

    As they point out, both sides dismiss the "evidence" and "research" of the other side. I found it a
    balanced presentation of both sides. YMMV

    Well, doesn't it depend whether the dismissal of the "evidence" and "research" was preceded by
    consideration? I entered the helmet debate as definitely "pro". Actually, none of the evidence and
    research in favour of helmets I have seen since seems at all convincing and I have therefore shifted
    my opinion towards the sceptics. I suppose the authors of the report would argue that I have
    dismissed the "evidence" and "research" of the other side. So be it, but I have considered it.

    John Franklin writes in "Cyclecraft", "The life-saving value of helmets is sometimes overstated,
    whilst the real-life experience of countries where the wearing of helmets has become more common
    suggests that, overall, head injury reduction is minimal."

    I believe that Mr Franklin is something of an authority in matters of cyclist safety and his words
    appear to me to sum up the helmet arguments succinctly. The question that needs to be put now is, if
    helmets have only a limited effect why is there such a strong campaign going on to persuade people
    to wear them. In whose interest is this, apart from the helmet manufacturers' and distributors'?
    --
    Michael MacClancy

  2. "[Not Responding]" <[email hidden]> wrote in message
    news:<[email hidden]>...

    Quoted message said:

    All the evidence seems to be that the agenda is to increase voluntary helmet use to a point where
    compulsion can be brought in with relative ease.

    In this environment every time you wear a helmet you are making a vote, however unwillingly, for
    compulsory helmet laws.

    Although I classify myself as pro-choice, and would never tell somebody they shouldn't wear a helmet
    if they want to, in my heart of hearts I kinda feel this way, too.

    I'd be genuinely bummed out by compulsion. It's a real quality-of-life issue for me. And I'm
    speaking as somebody who's hit his head loads of times (most recently when walking into a lampost);
    just never while cycling.

  3. Richard Burton said:


    How can it be balanced when it ignores the largest piece of evidence, which coincidentally,
    doesn't support its preconceived ideas?

    Can you give me a reference to that piece of work?

    Tony

    --
    raven-family.comraven-family.com

    "The reasonable man adapts himself to the world; the unreasonable man persists in trying to
    adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George
    Bernard Shaw

  4. Sorry Tony, but no I can't. There have been several reports about the fact that head injuries and
    related deaths have not decreased pro rata, but only in line with the decrease in cycling that
    helmet laws have brought about. Most were from Australia/NZ, but the last one was from the USA,
    where heavy helmet promotion increased helmet-wearing, but had the perverse effect of increasing
    deaths/injuries pro rata.

    Do a search for cycle helmets and you'll find lots of stuff.

    Rich

    "Tony Raven" <[email hidden]> wrote in message
    "]news:[email hidden]...

    Quoted message said:
    Richard Burton said:


    How can it be balanced when it ignores the largest piece of evidence, which coincidentally,
    doesn't support its preconceived ideas?

    Can you give me a reference to that piece of work?

    Tony

    --
    raven-family.comraven-family.com

    "The reasonable man adapts himself to the world; the unreasonable man persists in trying to
    adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George
    Bernard Shaw

  5. Richard Burton said:

    "Tony Raven" <[email hidden]> wrote in message
    "]news:[email hidden]...

    Quoted message said:
    Richard Burton said:


    How can it be balanced when it ignores the largest piece of evidence, which coincidentally,
    doesn't support its preconceived ideas?

    Can you give me a reference to that piece of work?


    Sorry Tony, but no I can't. There have been several reports about the fact that head injuries and
    related deaths have not decreased pro rata, but only in line with the decrease in cycling that
    helmet laws have brought about. Most were from Australia/NZ, but the last one was from the USA,
    where heavy helmet promotion increased helmet-wearing, but had the perverse effect of increasing
    deaths/injuries pro rata.

    Do a search for cycle helmets and you'll find lots of stuff.

    On the whole it seems reasonably balanced, until you get to the conclusions.

    (1) There must be a high level of scientific evidence that bicycle helmets are effective in reducing
    the rate of head injury to bicyclists.

    and then

    "The first of these criteria has been met."

    This is probably the single most contentious point. The pro-choice lobby would argue that not only
    do helmets have no measurable effect on the rate of head injuries but they actually increase the
    risk of other injuries.

    Regards,

    Tim.

    --
    God said, "div D = rho, div B = 0, curl E = - @B/@t, curl H = J + @D/@t," and there was light.

    tjw.hn.orgtjw.hn.org locofungus.btinternet.co.uklocofungus.btinternet.co.uk

  6. Tim Woodall said:


    The pro-choice lobby would argue that not only do helmets have no measurable effect on the rate of
    head injuries but they actually increase the risk of other injuries.

    I think you mean the anti-helmet lobby. The pro-choice lobby, of which I consider myself one, would
    argue that it is up to each individual to weight the arguments and exercise their own personal
    choice in whether or not to wear a helmet.

    Tony

    --
    raven-family.comraven-family.com

    "The reasonable man adapts himself to the world; the unreasonable man persists in trying to
    adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George
    Bernard Shaw

  7. Richard Burton said:

    I'm afraid I don't concur that it is balanced, and it appears to be yet another "scientific"
    analysis which ignores the fact that no whole population experience which shows that helmets are in
    any way effective.

    I tend to agree - the people who wrote it fail to mention, as far as I've read so far, the
    acknowledged fact that although most fatalities result from impact from a car, this kind of crash
    falls outside the design parameters of bike helmets. The "research evidence" for protective effectis
    mainly in single-vehicle accidents at speeds below 12mph, as far as my understanding goes.

    Guy
    ===
    ** WARNING ** This posting may contain traces of irony. chapmancentral.comchapmancentral.com (BT ADSL and
    dynamic DNS permitting)
    NOTE: BT Openworld have now blocked port 25 (without notice), so old mail addresses may no longer
    work. Apologies.

  8. On Mon, 21 Apr 2003 19:23:29 +0100, "Just zis Guy, you know?" <[email hidden]> blathered:

    Quoted message said:
    Quoted message said:

    I'm afraid I don't concur that it is balanced, and it appears to be yet another "scientific"
    analysis which ignores the fact that no whole population experience which shows that helmets are
    in any way effective.

    I tend to agree - the people who wrote it fail to mention, as far as I've read so far, the
    acknowledged fact that although most fatalities result from impact from a car, this kind of crash
    falls outside the design parameters of bike helmets. The "research evidence" for protective
    effectis mainly in single-vehicle accidents at speeds below 12mph, as far as my understanding goes.

    Let's throw some more from the Favourites folder into the discussion - cycle-helmets.comcycle-helmets.com
    magma.ca~ocbc bmj.com1035 (interesting pros & cons if you
    plough through that last collection; sample quote: "cyclists in countries such as The Netherlands
    and Denmark, where helmets are rare, are safer than those in New Zealand and Australia, where
    helmets have been mandated for years"😉

    Pete
    ----
    btinternet.com~peteajones

  9. Tim Woodall <[email hidden]> wrote: ...
    | On the whole it seems reasonably balanced, until you get to the conclusions.
    |
    | (1) There must be a high level of scientific evidence that bicycle helmets are effective in
    | reducing the rate of head injury to bicyclists.
    |
    | and then
    |
    | "The first of these criteria has been met."
    |
    | This is probably the single most contentious point.

    I agree. The author appears to mean by (1) that helmets are provably effective in particular
    individual cases, which is true as many here testify. Once you're flying through the air en route
    for some hard stuff it's a good idea to put your helmet on. But there is another meaning to (1) i.e.
    that the effect is generalisable over all the other factors causing accidents, which is precisely
    the question at issue. It was bad authorship IMHO not to have made that clear.

    yours, pro-choicably & anti-helmetarianly,

    --
    Patrick Herring, Sheffield, UK anweald.co.ukanweald.co.uk

  10. Tony Raven said:
    Tim Woodall said:


    The pro-choice lobby would argue that not only do helmets have no measurable effect on the rate
    of head injuries but they actually increase the risk of other injuries.

    I think you mean the anti-helmet lobby. The pro-choice lobby, of which I consider myself one,
    would argue that it is up to each individual to weight the arguments and exercise their own
    personal choice in whether or not to wear a helmet.


    Indeed. However, it is disingenious of a report that claims to have a balanced look at the pros and
    cons of helmet wearing to take the generally accepted view that, once a collision or accident has
    occurred, a helmet will usually reduce the risk of head injury and then to ignore the other
    evidence that suggests that _compulsory_[1] helmet wearing dramatically increases the risk of the
    collision occuring.

    From the figures for NSW and Victoria, my belief is that it is the compulsory wearing reducing total
    cycling numbers, reducing the "visibility" of cyclists and in turn increasing the number of
    cycle/motorvehicle collisions which are the accidents that tend to lead to head injuries (and lower
    body injuries) that is what is swamping any possible benefit of helmets.

    There may be some risk compensation occuring but I don't believe that that will be affecting the
    head injury rate which tends to be as the result of car/cycle collisions where the extra 1mph or so
    that someone might risk in a given situation is unlikely to make much difference to the collision
    rate. OTOH, for single bike accidents that 1mph might make the difference between making it around a
    "slippy" bend and losing it. (I don't believe that much more than 1mph can be involved because given
    the same conditions, i.e. commuter, training, racing etc, then 1mph is likely to be all that is
    physically and reasonably available - although top speed on decents might vary by a bit more. I very
    nearly overcooked it on the windcheetah last week. 1mph may well have made all the difference
    between "heart stopping exhilaration on two wheels" and sliding across the road on my side - and
    possibly hitting my head - can I claim this as a serious head injury that didn't occur because I
    wasn't wearing a helmet? ;-P )

    Even motorcycle helmets appear to have a very small effect (if any) on fatal injury rates. It, of
    course, depends on how you calculate the rate.

    From bikersrights.comgoldstein.html

    If a major concern of policy makers is the prevention of fatalities, helmet legistlation may not be
    effective in achieving that objective.

    If the overall cost to society of motorcycle accidents is the issue, then cost-benefit analyses that
    adequately consider the tradeoff between head and neck injuries must be conducted BEFORE the cost
    effectiveness of helmets can be determined.

    And a site to show that you can, relatively easily, "show" that compulsory bicycle helmets are an
    extremely dangerous initiative: (see footnote [1] again)

    agbu.une.edu.aubhacc.htm

    Finally, and unfortuately I can't find it again now, the fatality rates per 100,000 hours are
    something like 50% HIGHER for car drivers and passengers than they are for cyclists (1998 figures
    IIRC) If we could only convince people that they would be safer cycling to work instead of driving
    then the increased cyclist number would probably make it safer still. (for my commute - 8 miles - it
    takes me about 20% longer by bike than car on average although the s.d. for the bike is very small
    (one snowy day excepted) while for the car it is a significant proportion of the mean) (My best ever
    time for the car is just over 15 minutes (although that was motorway and is about 1/2 mile further
    than the route I cycle) while my best time for the bike is about 20minutes (unfortuantely I didn't
    time it but I started getting changed at work at 17:15 and I was in the house, at home, by 17:40)

    Regards,

    Tim.

    [1] I use compulsory here because, as far as I can see the "voluntary helmet wearing" education
    campaigns don't seem to have had the negative effects that the laws have. I would further
    suggest that a NO helmet law (i.e. cycling helmets must NOT be worn) would similarly affect
    cycling numbers and hence increase accident rates. However, I would suspect that had Australia
    spent the umpteen million dollars on cyclist training and driver education instead of voluntary
    helmet wearing education then they may well have seen significant health gains rather than the
    general trend continuation they did see during those years.

    --
    God said, "div D = rho, div B = 0, curl E = - @B/@t, curl H = J + @D/@t," and there was light.

    tjw.hn.orgtjw.hn.org locofungus.btinternet.co.uklocofungus.btinternet.co.uk

  11. Tim Woodall said:

    There may be some risk compensation occuring but I don't believe that that will be affecting the
    head injury rate which tends to be as the result of car/cycle collisions where the extra 1mph or so
    that someone might risk in a given situation is unlikely to make much difference to the collision
    rate. OTOH, for single bike accidents that 1mph might make the difference between making it around
    a "slippy" bend and losing it. (I don't believe that much more than 1mph can be involved because
    given the same conditions, i.e. commuter, training, racing etc, then 1mph is likely to be all that
    is physically and reasonably available - although top speed on decents might vary by a bit more. I
    very nearly overcooked it on the windcheetah last week. 1mph may well have made all the difference
    between "heart stopping exhilaration on two wheels" and sliding across the road on my side - and
    possibly hitting my head - can I claim this as a serious head injury that didn't occur because I
    wasn't wearing a helmet? ;-P )

    A rather more plausible risk compensation mechanism is that when perceived risk is lower less
    attention is paid to the task at hand.

    Since many accidents are avoided by a mechanism of early perception and planned avoidance, it
    follows that less attention can easily lead to an increase in accidents.
    --
    Paul Smith Scotland, UK safespeed.org.uksafespeed.org.uk please remove "XYZ" to reply by email speed
    cameras cost lives

  12. Tim Woodall said:

    On Mon, 21 Apr 2003 18:10:43 +0100,

    Indeed. However, it is disingenious of a report that claims to have a balanced look at the pros
    and cons of helmet wearing to take the generally accepted view that, once a collision or accident
    has occurred, a helmet will usually reduce the risk of head injury and then to ignore the other
    evidence that suggests that _compulsory_[1] helmet wearing dramatically increases the risk of the
    collision occuring.

    Your reference [1] is the personal page of an beef cattle geneticist. It has not been peer reviewed
    nor been published, nor are any publications on helmets listed in her publications list. Without
    having checked every reference in the DfT report I believe it is based almost entirely on studies
    that are published in peer reviewed literature. I do not see it being disingenous at all in ignoring
    someone's personal web page in such a review.

    Tony

    --
    raven-family.comraven-family.com

    "The reasonable man adapts himself to the world; the unreasonable man persists in trying to
    adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George
    Bernard Shaw

  13. Tony Raven said:
    Tim Woodall said:

    On Mon, 21 Apr 2003 18:10:43 +0100,

    Indeed. However, it is disingenious of a report that claims to have a balanced look at the pros
    and cons of helmet wearing to take the generally accepted view that, once a collision or accident
    has occurred, a helmet will usually reduce the risk of head injury and then to ignore the other
    evidence that suggests that _compulsory_[1] helmet wearing dramatically increases the risk of the
    collision occuring.

    Your reference [1] is the personal page of an beef cattle geneticist. It has not been peer
    reviewed nor been published, nor are any publications on helmets listed in her publications list.
    Without having checked every reference in the DfT report I believe it is based almost entirely on
    studies that are published in peer reviewed literature. I do not see it being disingenous at all
    in ignoring someone's personal web page in such a review.


    ??? There wasn't a reference in [1]. I gave two URLs, one to show that even for motorcycle helmets
    their efficacy is disputed and one to show that it is relatively trivial to analyse the Aus results
    and get a negative benefit for legislation.

    But this isn't the sole preserve of "beef cattle geneticists". Finch et al. 1993 Report No 45,
    Monash University Accident Research Centre and Smith and Milthorpe 1993, Roads and Traffic
    Authority both used matched before and after samples and both conclude that the primary effect of
    helmet legislation has been a dramatic decrease in cycling while only a minimal decrease in head
    injuries (2x decrease in cycling, 13% decrease in head injuries IIRC. The latest numbers I remember
    seeing said head injuries are now higher than before legislation while cycling is still 15% down
    but I may well have seen that in a newsgroup posting rather than a formal paper - I can't remember
    where I saw it)

    Scuffham, P.A., Langley, J. D., Trend in cycling injuries in New Zealand under voluntary helmet
    use, 1997 analysed the trends in head injuries from 1980 to 1992 (I think - just before helmet
    wearing became compulsory anyway) and found that the increase in voluntary helmet wearing during
    this period has had little effect on the number of serious head injuries as a proportion of all
    serious injuries.

    Then there are papers like Robinson, B; or Robinson D.L.

    And you don't have to mention the only paper that the anti-helmet lobby quotes: Hillman. The fact
    that the paper that started this thread manages to dismiss Hillmans concerns is ridiculous (I don't
    recall them mentioning any of the other papers - maybe their methodology is sufficiently flawed that
    they can be ignored) but they do mention Hillman and so can't just assert that there is now
    overwhelming scientific evidence that cycling helmets reduce the rate of head injuries but need, at
    least, to argue why Hillman's claims are bogus.

    I would like to get hold of a copy of Ulrich? paper where the four items in the conclusion that are
    listed come from . I would be interested to see how (s)he defines "risk of head injury".

    And yes, all the statistics might be bogus: Cameron, Heiman and Neiger 1992 state it is "almost
    impossible to isolate and measure the contribution of cycle helmets", and that "there are no
    reliable figures on which to base analysis" but, to me at least, if the benefits of helmets were as
    good as many claim then I don't believe people would be able to dispute the benefits using what
    looks to me as reasonable analysis of the results in Aus, NZ and Canada.

    I supose the one (hopefully indisputable) good thing out of all of this legislation, nobody disputes
    that helmet wearing increased significantly post legislation, even in NZ where the rates were
    already very high. Cyclists are obviously a law abiding folk. :-)

    Tim.

    --
    God said, "div D = rho, div B = 0, curl E = - @B/@t, curl H = J + @D/@t," and there was light.

    tjw.hn.orgtjw.hn.org locofungus.btinternet.co.uklocofungus.btinternet.co.uk

  14. Tim Woodall said:
    Quoted message said:


    ??? There wasn't a reference in [1].

    In which case I apologise for misreading your post.

    Tony

    --
    raven-family.comraven-family.com

    "The reasonable man adapts himself to the world; the unreasonable man persists in trying to
    adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George
    Bernard Shaw

  15. Patrick Herring said:

    I agree. The author appears to mean by (1) that helmets are provably effective in particular
    individual cases, which is true as many here testify. Once you're flying through the air en route
    for some hard stuff it's a good idea to put your helmet on.

    This is by no means proven; it seems likely that helmets have little effect on severe impacts, and
    exacerbate torsional injuries.

    "many here testify" - in fact, the sheer number of "helmet saved me" anecdotes illustrates that that
    assessment cannot be correct in the majority of cases.
    --
    David Damerell <[email hidden]> Distortion Field!

  16. Tony Raven said:
    Tim Woodall said:
    Quoted message said:


    ??? There wasn't a reference in [1].

    In which case I apologise for misreading your post.


    That's OK. I reread my posting twice to try and see what confusion I had caused and it all seemed
    clear to me but obviously wasn't sufficiently unambigious.

    I think it was you who said the (original) paper seemed well balanced, and I would agree. Except for
    the one statement that has kicked off this sub-thread. (I haven't read the paper very carefully so
    there may be other things I disagree with but this claim was the only one that made me stop and
    reread to make sure I understood why they were claiming it)

    Regards,

    Tim.

    --
    God said, "div D = rho, div B = 0, curl E = - @B/@t, curl H = J + @D/@t," and there was light.

    tjw.hn.orgtjw.hn.org locofungus.btinternet.co.uklocofungus.btinternet.co.uk

  17. David Damerell said:
    Patrick Herring said:

    I agree. The author appears to mean by (1) that helmets are provably effective in particular
    individual cases, which is true as many here testify. Once you're flying through the air en route
    for some hard stuff it's a good idea to put your helmet on.

    This is by no means proven; it seems likely that helmets have little effect on severe impacts, and
    exacerbate torsional injuries.

    "many here testify" - in fact, the sheer number of "helmet saved me" anecdotes illustrates that
    that assessment cannot be correct in the majority of cases.

    Not necessarily. The helmet saved me cases could all be true and evidence of a dramatic risk
    compensation "attitude" amongst cyclists. (Personally I don't believe it but it could be true)

    This could also then be used to explain the Aus results. Those who wore helmets before are still
    cycling, those who didn't have stopped cycling. The helmet wearers were the ones having all the
    accidents and so there has been a negligible drop in accidents despite a halving of cycling. (Again,
    I don't believe it!)

    There are other possible explanations I can think of as well but given that this is an emotional
    subject already I think it is probably foolish to pour oil on the flames ;-)

    Regards,

    Tim.

    --
    God said, "div D = rho, div B = 0, curl E = - @B/@t, curl H = J + @D/@t," and there was light.

    tjw.hn.orgtjw.hn.org locofungus.btinternet.co.uklocofungus.btinternet.co.uk

  18. Tim Woodall said:
    David Damerell said:

    "many here testify" - in fact, the sheer number of "helmet saved me" anecdotes illustrates that
    that assessment cannot be correct in the majority of cases.


    Not necessarily. The helmet saved me cases could all be true and evidence of a dramatic risk
    compensation "attitude" amongst cyclists.

    We do this every time. Yes, it is also possible that helmets make one grossly accident-prone, but
    equally that is not an argument for wearing one. :-)
    --
    David Damerell <[email hidden]> Distortion Field!

  19. David Damerell <[email hidden]> wrote:

    | Patrick Herring <[email hidden]> wrote:
    | >I agree. The author appears to mean by (1) that helmets are provably effective in particular
    | >individual cases, which is true as many here testify. Once you're flying through the air en route
    | >for some hard stuff it's a good idea to put your helmet on.
    |
    | This is by no means proven; it seems likely that helmets have little effect on severe impacts, and
    | exacerbate torsional injuries.

    Yes, actually I agree with that but forgot when posting.

    --
    Patrick Herring, Sheffield, UK anweald.co.ukanweald.co.uk

  20. David Damerell said:


    it seems likely that helmets have little effect on severe impacts.

    Not necessarily so. Since 1993 they have had black boxes on Indy cars gathering data when accidents
    happen. Its been found that the human body can withstand decelerations up to 130G - much more than
    previously thought. A major safety increase was achieved by putting crash attenuators on the back of
    the car - basically a 6" crushable aluminium honeycomb can. The slight reduction in deceleration
    resulting from the crushing 6" of honeycomb in a 200mph rear end into wall crash was sufficient to
    improve survivability significantly. In that light an inch of foam could make a difference at speeds
    and decelerations well outside those set in the various testing standards.

    Tony

    -- raven-family.comraven-family.com

    "The reasonable man adapts himself to the world; the unreasonable man persists in trying to
    adapt the world to himself. Therefore, all progress depends on the unreasonable man." -- George
    Bernard Shaw

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