published helmet research - not troll

Steven Bornfeld wrote:
snippage
This is something that the anti-helmet partisans continue to repeat...

Doesn't this seem a wee bit pejorative to you?


To expect risk compensation to show up on occasion in cyclists when
you have advertising campaigns like Bell's "Courage for your head"
doesn't seem farfetched to me.

"Risk compensation" is a pretty well recognized phenomenon.
It's rational conduct, provided you have an accurate way to gauge
the reduction in risk. If you place excessive value on a safety
device, your decisions will be sub-optimal.

If you put an airbag in the steering wheel, drivers will slightly
raise their borderline when deciding if a risky move is worth
taking. If you replace the airbag with a large steel spike and
remove the seat belts, they will either refuse to drive the car or
will drive it with extreme caution. They would be compensating
for the greatly increased consequences of a crash by attempting to
greatly reduce the probability of a crash.

Let's say you read in the newspaper that helmeted riding is 1/14th
as dangerous as unhelmeted riding, and have no reason to disbelieve
it. Wouldn't you be more willing to ride a bicycle with the helmet
than without it? You might think it too dangerous to ride to the
grocery store without the helmet, but if you could reduce the risk
by 93% by wearing a helmet, you just might use the bike to fetch
that gallon of milk. That's risk compensation.

Mitch.

Mitch Haley wrote:
Steven Bornfeld wrote:

snippage
This is something that the anti-helmet partisans continue to repeat...


Doesn't this seem a wee bit pejorative to you?


To expect risk compensation to show up on occasion in cyclists when
you have advertising campaigns like Bell's "Courage for your head"
doesn't seem farfetched to me.

"Risk compensation" is a pretty well recognized phenomenon.
It's rational conduct, provided you have an accurate way to gauge
the reduction in risk. If you place excessive value on a safety
device, your decisions will be sub-optimal.

If you put an airbag in the steering wheel, drivers will slightly
raise their borderline when deciding if a risky move is worth
taking. If you replace the airbag with a large steel spike and
remove the seat belts, they will either refuse to drive the car or
will drive it with extreme caution. They would be compensating
for the greatly increased consequences of a crash by attempting to
greatly reduce the probability of a crash.

Let's say you read in the newspaper that helmeted riding is 1/14th
as dangerous as unhelmeted riding, and have no reason to disbelieve
it. Wouldn't you be more willing to ride a bicycle with the helmet
than without it? You might think it too dangerous to ride to the
grocery store without the helmet, but if you could reduce the risk
by 93% by wearing a helmet, you just might use the bike to fetch
that gallon of milk. That's risk compensation.

Mitch.

I can't speak for you. No, I think that I am significantly risk averse
that if I can keep my risk to a minimum I will. Of course if one is
already engaging in an activity which is obviously risky (say downhill
racing) it is possible that someone who otherwise might not engage in
the activity could feel sufficiently protected to consider it where
otherwise he/she would not. But I doubt that anyone afraid to bicycle
to the corner grocery for milk will be emboldened by a helmet.
But if you are going to posit this as an actual phenomenon, you should
be able to demonstrate it. That wouldn't be very easy to do.

Steve

On Sun, 20 Jun 2004 17:31:22 -0400, Steven Bornfeld
wrote:



Protection coming out of the factory is not the responsibility of the
CPSC. Do they do an adequate job? Is the only criterion the amount of
damage the vehicle could do for others?
I don't have the answers--just thinking.

Think about this -- if for some reason you think it's important to
somehow protect cyclists with mandatory inspections and rules, why
don't you also consider the dozens or hundres of other activities that
are at least as dangerous and suggest intervention in them too. Of the
top of my head I suggest looking into wearing helmets on buses and
trains, more inspection of food in restaurants for sharp objects, more
acitive inspection of sidewalks, inspections of high-heel shoes (or
perhaps licensing) to deal with hurt ankles. These are other things
that will certainly help a few people who might be injured, right?

JT.

John Forrest Tomlinson wrote:
On Sun, 20 Jun 2004 17:31:22 -0400, Steven Bornfeld
wrote:



Protection coming out of the factory is not the responsibility of the
CPSC. Do they do an adequate job? Is the only criterion the amount of
damage the vehicle could do for others?
I don't have the answers--just thinking.


Think about this -- if for some reason you think it's important to
somehow protect cyclists with mandatory inspections and rules, why
don't you also consider the dozens or hundres of other activities that
are at least as dangerous and suggest intervention in them too. Of the
top of my head I suggest looking into wearing helmets on buses and
trains, more inspection of food in restaurants for sharp objects, more
acitive inspection of sidewalks, inspections of high-heel shoes (or
perhaps licensing) to deal with hurt ankles. These are other things
that will certainly help a few people who might be injured, right?

JT.

Not to be facetious--some of these are already being done, with mixed
results. Certainly you know the sorry history of the inspectors for the
NYC Depts. of Health and the buildings department.
What you are saying is that cycling is not significantly risky, and if
this is your belief you are certainly right to believe regulation is
unnecessary. But if you agree (as I do) that cycling is not taken
seriously in this city and country, is this an issue to you? And if it
is, what do you think could change this?

Steve

On Sat, 19 Jun 2004 07:29:14 GMT, (Bill Z.)
wrote:


I've no idea about Australia or NZ, but maybe
the law was actually enforced there. It
sure hasn't been where I live.


I live in New Zealand and have cycled here over the period during
which the helmet laws were introduced, so perhaps my observations on
this subject may be of interest.

The helmet laws are enforced sporadically. However the more usual
police attention is extended towards those cyclists not using lights.
There is usally a blitz at the start of winter. But generally the
police are overworked and understaffed so have better things to do
than slap tickets on miscreant cyclists. Nevertheless the helmet law
in NZ is well entrenched. We still get the school students wearing
them on their handlebars syndrome, but most people just accept helmet
wearing as part of cycling life. The adults that don't wear helmets
are usually those that don't obey the other road rules either.

SNOOPY




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On Fri, 18 Jun 2004 23:13:44 -0700, Peter
wrote:

The 30% or so drop in ridership when surveys were done in NZ and
Australia just before and after helmet laws went into effect would seem
to be one good reason. I didn't keep any statistics at the schools I
observed, but there was a similar drop.


I can't speak for Australia, but here in NZ there were other
socioeconomic reasons that don't get reflected in the bare statistics
that have lead to the decline of bicycle riding over the last twenty
or so years.

Twenty plus years ago there was a thriving local car assembly
industry, sustained by high tariffs on fully imported cars. These
tariffs have now gone and so has the car assembly industry with the
result that cars are now a lot cheaper to buy. Coupled with the
removal of tariffs was the arrival of built up second hand Japanese
import cars which meant that lower prices took almost no time to
trickle down through the entire car market. The motorcycle market
took the biggest hit with motorcycles becoming almost extinct. The
motorcycle helmet law preceded the push bike helmet law by several
years, so I don't think you could say the decline in motorcycle use
was in response to the introduction of a motorcycle helmet law.

Also car reliability and better rust protection has resulted in many
'old' cars being avialable as cheap reliable transport instead of the
'cheap unrelaible transport' they were before. In addition the
running costs of cars in NZ became much lower in real terms with the
relative declind in petrol prices vis a vis the late 1970s.

The early 1980s was was also a time of great deregulation in the
retail industry. Suddenly there was a lot more casual work available
with shops for the first time being allowed to open on Saturdays and
Sundays. This also co-incided with reduction in student allowances
for tertiary study and the introduction of student fees. In other
words there was greater incentive for the 'bike riding demographic' to
take up part time work and more work available for them to take up.
Many employers don't take kindly to employees arriving in a sweat with
chain grease on their skirt. Also there was the question of a tyranny
of distance between institutions of study and where the jobs are.
And many part time jobs finish late at night. With a general
perception that society is becoming 'less safe' some parents would
rather pay for their kid's car than get them to ride a bike. So
suddenly for many students the luxury of a car became a near
necessity. And yes the same can be said for senior high school
students now too.

What I have just stated in not definitive proof of anything. But I
do want to suggest that correlating cycle use with the introduction of
cycle helmet laws is not just the statistical exercise it might appear
to be.

SNOOPY






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On Sun, 20 Jun 2004 17:14:41 -0400, Steven Bornfeld
wrote in message
:

One of the key factors in changing my view was the fact that I had no
idea the population level studies even existed. Helmet promoters were
telling me that helmets save 85% of head injuries and 88% of brain
injuries, stated as fact, but then I found that even the original
authors had revised these estimates downwards

Well, this is a different issue. I am concerned with whether the
safety studies are flawed. Intent is not an insignificant issue, but
I'm not really concerned with that for the purposes of this discussion.
Certainly if these studies were funded by the helmet manufacturers it
casts things in a different light.

Anything with the Safe Kids logo is tainted by Bell sponsorship.

But that's not really the issue; the issue is that those who promote
helmets, don't admit that there is acontrary view. Over here
charities are not supposed to present one side of an argument as if it
were the only side, but the helmet charity do. Bell must be laghing
up their sleeve to see chairities raising money to do their sales work
for them using claims they cannot make because of laws on claims made
in advertising!

Actually the real position is probably that helmets prevent most
trivial injuries and very few serious ones. There is a probably
narrow band of cases where helmets may turn a serious injury ionto a
minor injury, but risk compensation also means that there is another
band of cases where the crash would not have happened in the first
place had the rider not been wearing a helmet.

This is something that the anti-helmet partisans continue to repeat,

Who are the anti-helmet partisans? How many have you come across to
date? I've met maybe two people who are anti helmet. The balance are
sceptical or pro-helmet. Most pro-helmet soon become sceptical.

and I'm not sure what you mean by this. I am inclined to think you're
saying that folks feeling relatively protected will engage in riskier
behavior. I think this is speculative; the same argument the right uses
in this country to attack dispensing of condoms. I've seen plenty of
risky behavior from both helmeted and non-helmeted riders. Of course
this is anecdotal, but I doubt anyone would seriously contend that
people drive more recklessly because they are wearing seat belts.

Here you are wrong: not only do people contend this, it is actually a
mainstream view. Taxi drivers in Germany and Denmark were found to
drive more aggressively in cars fitted with ABS. Drivers who did not
habitually wear seat belts were found to drive faster when persuaded
to wear seat belts. Seat belt legislation has never resulted ina
reduciton in road deaths, but it did lead to the biggest recorded
increase in pedestrian, cyclist and rear-seat passenger deaths in the
UK. The arrival in the second-hand market of the first generation of
cars with drivers' airbags has seen a sharp rise in fatalities of
front seat passengers of young male drivers.

A good book on the subject is Risk by John Adams.

I do have a problem with helmet promotion which igniores the
distinction between different kinds of crash and different kinds of
injury. The idea that because a helmet saves a cut head it will
necessarily prevent massive brain trauma when hit by a pseeding truck
is laughable, but by using a single figure for injury reductions that
is exactly what the promoters are trying to imply.

I don't doubt that this is done; I personally don't know anyone that
cycles who buys that position though.

If you repeatedly tell a 14-year-old that helmets prevent 85% of head
injuries and 88% of brain injuries, what will be the effect on their
riding?

I think that safety measures in general should promote a healthy
respect for the dangers implicit in any given activity.

But the dangers in cycling are low.

I would view
effective cycling instruction in the same way. For that matter, one
must demonstrate competence before being licensed to drive a motor
vehicle. In spite of this training many drive with a blatant disregard
to the real dangers.

Because the danger is not to them, or at least they get all the
benefit of the aggressive driving and only part of the risk..

I feel you are almost certainly right about effective cycling
instruction being more important to safety. For that matter, at least
here in the states a very large proportion of those wearing helmets wear
them incorrectly. One wonders how different the population studies
would be were riders fit properly with helmets.

Hard to say; since up to 96% of hemets are not worn correctly that
suggests the problem may be with the helmets not the wearers. I've
twice found people wearing the blessed things back to front!

Another issue is cultural; in the UK, and in Europe and most of the
rest of the world, the bicycle is seen as a legitimate means of
transportation. In the U.S. it is overwhelmingly still seen as a toy.
As a consequence of this, very few cyclists--even those who bicycle for
legitimate transportation follow even basic transportation regulations.

A great reason to challenge that failing :-)

(As an aside, while on a bicycle tour I once rode through a red
traffic signal in London--a transgression for which I was vigorously
chastised by several pedestrians. I didn't do it again.)

Heh! Red lights are treated as "give way" by all comers, motorised
and cycling, in London :-)

I assume that
the way increased cycling will improve safety is first that there are
less motor vehicles on the road.

- drivers see more cyclists so are expecting them
- drivers are more likely to be cyclists and know how to behave around
them

Furthermore, I would assume that once
cycling reaches a certain critical mass it will have a political
constituency to effect changes in access, motor vehicle regulations etc.

No, I don't think so. There's no money in it.

I have analysed
UK child hospital admissions returns and found that there is no
significant difference in the proportion of head injuries suffered by
road cyclists and pedestrians, despite helemt wearing rates only
around 15%.

Again, I must ask if this pertains to total number of incidents,
proportion of head injuries among total injuries, head injuries per unit
time, etc. This is a complicated issue; I trust that you have looked at
the design of the studies as apparently some of the journals have not.

That's why I stated the figures as I did. Cyclists admissions 49%
head injury, pedestrians 46% head injury, 15% helmet wearing rate.
So: cyclists and pedestrians suffer roughly the same proportion of
head injuries. The ratio is pretty much unchanged with helmet use.
By comparing the ratio you normlaise out exposure. You can do similar
calculations with severity ratios and show that the proportion of
cyclist inuries which are severe are unaffected by helmet use.

By contrast, Liddites claim "head injuries fell in Australia following
the law" which is literally true, but they fell by less than the fall
in the number of cyclists.

Look at graph 2 he http://agbu.une.edu.au/~drobinso/bhacc.htm

Help me out here--this may be a UK expression--what is FUD? And why
would you not be anti-helmet if the evidence is that they aren't useful
in protecting against serious injury?

FUD is a very American expression: Fear, Uncertainty and Doubt :-)

I am not anti helmet because I think they can prevent many
uncomfortable minor injuries. I am not against mountain bikers
wearing shin pads or elbow pads, or unicyclists wearing wrist guards.
I don't think these things should be mandated or even officially
promoted. They are there, use them if you want.

That, of course, is a fundamental problem. Any agnostic who argues
with a True Believer will end up sounding like an atheist, even though
they are not.

This of course is true. But unlike religion, this one should be easy
to determine if the will is there.

So it seems to me. When I read the balance of the evidence I
certainly came to that view :-)

You're supposed to try to disprove, not prove, your
initial premise. In this case the researchers [...] decided on the
outcome before they started.

Well, sure. That's the way it is supposed to be. But drug trials are
not conducted by folks looking for the drugs not to work. Of course,
one cannot do a double-blind study on this. But this is a very serious
charge against the NEJM, and I would have expected to hear about it.

It's not a particularly serious charge against them, actually; it's a
study with an error in it. It happens all the time. It is an
indictmentof their peer review process, though. But not as bad as the
Cook & Sheikh paper in Injury Prevention.

Actuarial data relies on long-term trends and large data
sets. In this case it looks more like a kneejerk reaction to asingle
incident. As those who follow pro racing know only too well, the
mandatory use of helmets has not stopped racing cyclists from dying of
head injuries. The numbers are in any case too small for robust
statistical comparisons to be made.

It was, IIRC, not based upon any one incident. The USOC had lost all
of its liability coverage; the racing season was delayed while another
policy could be found. This one was hammered out de novo.

The fact remains that it was probably due more to the prejudices of
the underwriter than any sound actuarial judgement.

Only about 10% of cyclist injuries are to the area covered by the
helmet and many (possibly most) cyclists who die of head injury also
have other mortal injuries. Most fatal cyclist injuries are of course
sustained in crashes involving motor vehicles: it is motor traffic,
not cycling, which is dangerous.

Come on! That's a little like saying driving a car isn't
dangerous--it's those darned OTHER drivers who keep crashing into me! ;-)

Not at all. Motor traffic is responsible for 10% of child hospital
admissions in the uk but 50% of fatalities. Offroad cycling accounts
for 90% of all cycling activity but only half of hospital admissions.

Cars are dangerous to others in a way that bikes are not.

Well, as you say, there's cycling, and then there's cycling. I made a
decision after a serious crash in my first year racing that I was
finished. It's a bargain you make with yourself--I won't race again and
THEN I'll be safe. I was not spared a head injury by my helmet, but I
probably saved myself having my eyes cut up by the broken glass I fell into.

Sure. I don't do technical downhill - too risky. I fact the kind of
riding I do it's very unlikely a helmet would ever be of benefit, not
least because I ride with my arse a foot off the ground :-)

Now, this is likewise the kind of statistic that bothers me. I am
assuming that you are speaking of cardiovascular risk. OK. But the
choice should not be cycling vs. couch potato. I have never seen a
study actually pretend to predict life extension based on a particular
volume of cardiovascular exercise anyway. However, for those who cycle
for fitness instead of purely for transportation (as I do) one cannot
assume that someone who stops cycling will do no other aerobic exercise.
There are other confounding factors, such as that those who bicycle or
do other forms of aerobic exercise are less likely to smoke. I have
seen studies that attempt to correct for this, but they are mostly fantasy.

Sure - but the message is sound. Cyclists live longer than average;
this would not be possible if cycling were extraordinarily dangerous.

These are the proportions of all admissions which are due to head
injury. So, if you have a bike crash, you are not markedly more
likely to suffer head injury than if you are hit as a pedestrian.

This assumes that the total number of person-hours spent cycling is
roughly equivalent to the total number of person-hours spent as a
pedestrian.

No it doesn't, because it compares like with like. You have already
been injured: is your injury more likely to be a head injury if you
are a cyclist? Answer, not really. Are you more likely to be injured
per se as a cyclist? Probably not, inless there is a motor vehicle
involved.

The risk levels comparison: 10% of cycling is on road, 90% off road.
This is a simply amazing statistic. In the U.S. even most mountain
bikes are never ridden off road.

Includes bike paths and trails. You might be surprised :-)

So what would you change? As you've pointed out, cars are heavily
regulated because of the greater danger. The industry is more powerful
economically and politically. So what would be the focus of improving
bicycle safety vis a vis automobiles?

First, enforce traffic regulations (for all road users) inna zero
tolerance stylee. Second,make sure that quality bike training is
available for all. And third, make sure that anybody who drives badly
gets a chance to find out how the other half live as they do without
their license for a while.

Thanks for your interesting and thorough discussion. This is obviously
an important issue for you. The issue of helmet mandates is frankly
unimportant to me. What is important is the truth regarding helmets and
bicycle safety, for myself and my family. As someone who has been
permanently injured in crashes I'm sure it is something on which we both
can agree

It is a matter of life and death, literally. I spend between one and
two hours every weekday riding my bike on the roads, and I have kids.
I cannot afford not to take an interest :-)

Guy
--
May contain traces of irony. Contents liable to settle after posting.
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88% of helmet statistics are made up, 65% of them at Washington University

John Forrest Tomlinson wrote:
On Sun, 20 Jun 2004 18:35:47 -0400, Steven Bornfeld
wrote:



Not to be facetious--some of these are already being done, with mixed
results. Certainly you know the sorry history of the inspectors for the
NYC Depts. of Health and the buildings department.


I have no particular knowledge or opinion on that, but if you seem to
think that public health inspections don't got well, it's strange that
you would want to bring inspections into cycling.



What you are saying is that cycling is not significantly risky, and if
this is your belief you are certainly right to believe regulation is
unnecessary. But if you agree (as I do) that cycling is not taken
seriously in this city and country, is this an issue to you?


And if it
is, what do you think could change this?


It's an issue because a focus on helmets is anti-cycling. And safety
inspections, given a lack of any significant problem in this area is
anti-cycling. They are actions that cost money with little benefit.
They make people think that bikes are dangerous. They will likely
discourage people from cycling.

That's my problem with your various suggestions. Who are you trying to
help? Why is cycling so special that it demands this sort of
(negative attention)? What makes you believe that it is so dangerous
or injuries are so widespread that action is needed? Particularly
when the big dangers to cyclists are our extremely car-oriented
society? I just don't understand what you have against cycling or
why. Is it something about your own injury?

JT

No, counselor. A simple "I don't think there's a problem here" would
have been sufficient. I never said I thought that action was needed.
I only suggested to those who opposed mandatory helmets by saying that
other measures were more important to safety that their objections had
more to do with freedom to choose than it did to the efficacy of helmets.

Steve

On Sun, 20 Jun 2004 18:35:47 -0400, Steven Bornfeld
wrote:



Not to be facetious--some of these are already being done, with mixed
results. Certainly you know the sorry history of the inspectors for the
NYC Depts. of Health and the buildings department.

I have no particular knowledge or opinion on that, but if you seem to
think that public health inspections don't got well, it's strange that
you would want to bring inspections into cycling.


What you are saying is that cycling is not significantly risky, and if
this is your belief you are certainly right to believe regulation is
unnecessary. But if you agree (as I do) that cycling is not taken
seriously in this city and country, is this an issue to you?

And if it
is, what do you think could change this?

It's an issue because a focus on helmets is anti-cycling. And safety
inspections, given a lack of any significant problem in this area is
anti-cycling. They are actions that cost money with little benefit.
They make people think that bikes are dangerous. They will likely
discourage people from cycling.

That's my problem with your various suggestions. Who are you trying to
help? Why is cycling so special that it demands this sort of
(negative attention)? What makes you believe that it is so dangerous
or injuries are so widespread that action is needed? Particularly
when the big dangers to cyclists are our extremely car-oriented
society? I just don't understand what you have against cycling or
why. Is it something about your own injury?

JT

"Frank Krygowski" wrote


IIRC, every helmet promotion I've ever encountered has talked about
saving lives. If that's not the issue, someone needs to inform the
"safety industry."

Except the info put out by the helmet companies. They know better.

Bell's standard user manual.
http://www.bellbikehelmets.com/main/...tandard_US.pdf
Read the first couple of paragraphs.

Pete