Bicycle Helmets and the law: a perfect teaching case for epidemiology

http://www.badscience.net/2013/12/bicycle-helmets-and-the-law-a-perfect-teaching-case-for-epidemiology/

by biehl • 13 years ago

45 58 13 years ago

awjr• 13 years ago

I think it's really important to understand the impact cycle helmets have. They negatively impact the number of people cycling. They enforce the perception that cycling is dangerous. Finally, as the study showed, they are designed to only be involved in an accident between you and the road. Not another vehicle. They bring a false sense of security.

If cycle helmets were made compulsory in the UK, it is calculated that an extra 253 people per year would die from obesity related diseases ( http://www.cyclehelmets.org/1231.html ) . Ironically cycle helmets kill.

What is interesting about this is the identification of two groups of cyclists. The 'speed' group who currently wear helmets (and usually have lycra) and then the slow group (the rest of society) who just want to go from A to B. Helmet laws specifically have a negative impact on the slow group. This is the group of people that we need to encourage.

As mentioned in the BMJ article ( http://www.bmj.com/content/346/bmj.f3817?ijkey=I5vHBog6FhaaL... ) : "For others, this is an explicitly political matter, where an emphasis on helmets reflects a seductively individualistic approach to risk management (or even “victim blaming”) while the real gains lie elsewhere. It is certainly true that in many countries, such as Denmark and the Netherlands, cyclists have low injury rates, even though rates of cycling are high and almost no cyclists wear helmets. This seems to be achieved through interventions such as good infrastructure; stronger legislation to protect cyclists; and a culture of cycling as a popular, routine, non-sporty, non-risky behaviour."

This stuff is important. The UK justice system is permeated with the belief that if you were not wearing a helmet then you were, in some way, partially responsible. It's got so bad that insurance payouts are being affected by this.

Note I personally don't wear a cycle helmet except in winter when I want to have a bigger light to see the trail ahead of me as I commute to work. However if I go out on a club ride then I wear one. I'm pushing the speed of the bike and it could slip out from under me. I do not wear it with the belief it would save me if I had a collision with a car.

codex• 13 years ago

Personally, every single bicycle commuter I have known has been involved in an accident, often multiple. The consequences are much worse than an auto accident. If I didn't wear a helmet, I might not have the courage to ride at all--even if they help only in some scenarios. I often see the risks of bicycling and not wearing a helmet downplayed, but to me this rings of agenda and not reality on the road. For example, it seems like all arguments against helmeted cycling also apply to helmeted motorcycling. Should we encourage motorcyclists not to wear helmets?

ams6110• 13 years ago

It's interesting that in the name of "healthy living" busybody types encourage us to bicycle to work (thus exposing ourselves to significantly higher risk of accidental injury) or do things like posting nag signs to "take the stairs" next to the elevators (ever compare injury rates in riding elevators vs. falling on stairs?)

revelation• 13 years ago

I guess motorcyclists wear full face helmets because they don't like gravel flying into their eye at 50mph.

That said, they still die like flies and for reasons totally unrelated to (not) wearing a helmet.

reubenmorais3• 13 years ago

There's an important (but not always obvious) difference here: individually, you're strictly safer with a helmet, but when you start forcing people to wear helmets, the disadvantages outweigh the benefits. That's why lots of cycling organizations promote voluntary use of helmets.

michaelt2• 13 years ago

Well, this stuff is always going to depend on where you are and who you know. I commuted to work by bicycle at an english university and I knew many other people who did, many without helmets, but the accident rate was very low.

On the other hand, this might be the consequence of safety in numbers, good infrastructure/cycle paths, availability of quiet roads with wide deserted sidewalks, the fact the average cyclist lived much closer than the average car driver and hence covered fewer miles of road.

I'm sure someone commuting by bicycle in London during the rush hour, or in other countries, might have a very different experience. I'd be interested to hear where you're located, if every bicycle commuter is involved in multiple accidents?

Personally I see motorcycle helmets as quite different to bicycle helmets; motorbikes tend to go a lot faster leading to very different injury patterns in accidents, from what I've read. They're also very different as signals of social status. And many governments want to increase the number of bicycles on the road, and hence don't want to make moves that discourage bicycle riders, while most governments are indifferent to or want to reduce the number of motorbikes, so if legislation reduces the number of motorbike riders they don't particularly care.

dobbsbob• 13 years ago

Same, everybody I know who commutes on a bike has horrible accident stories and my city has designated bike lanes even. That said they also don't like the helmet laws since cops here seem to only go after the poorerst riders like the homeless with tickets because they know they can't pay so can arrest them later. Whenever a major event happens here they sweep up all the homeless for unpaid helmet fines and keep them locked up long enough for foreign media not to see them on the streets.

D_Alex2• 13 years ago

If I didn't wear a helmet, I might not have the courage to ride at all...etc.

So wear a helmet, there is no law whatsoever prohibiting you to wear one.

Me, I am a datum point for the argument that helmets stop you from cycling. I used to ride a bike everywhere before the compulsory helmet laws were introduced. After, cycling became so much less convenient, you had to make sure that you brought your helmet, that you kept it secure, and I plain do not like the way bicycle helmets feel on your head.

I hate the compulsory helmet laws, and I want them gone.

dalke2• 13 years ago

There are many things there to unpack.

Where do you live where "every single bicycle commuter" has been in at least one accident which is "much worse than an auto accident"?

Can you be more definite about what you're comparing? It seems like you're talking average-case car-car collision with worst-case car-bike collision. The worst-case consequence of an auto accident is, what, the Ibadan tanker truck explosion in Nigeria which killed 100-200 people? And it's not hard to find reports of car crashes which kill 6 or more people.

(For that matter, every walker and runner I know has been involved in accidents, like tripping, falling down stairs, or hitting a low branch.)

There's nothing preventing you from wearing a helmet when you ride. I know people who don't feel safe unless they have lots of reflectors. I don't feel safe when I have to ride on a road with cars, except during the non-rush hours during the day.

The problem about scenarios is they exclude the cost/benefit discussion. I can easily think of a scenario where wearing motorcycle body armor would help. For that matter, I can think of a scenario where wearing a wet suit while cycling would useful - what if you fall into a cold river while crossing it? I could probably come up with a good reason for bringing an air tank - if a tanker car crashes and releases toxic fumes in the air, then you can still breath and get away.

The point of the article was that the cost/benefit calculations for a bike helmet are complicated. There's no clear signal that they are useful. There are scenarios where they are useful, yes, and scenarios where a helmet requirement is a net negative. Both are mentioned.

You say the risks are "downplayed." Did you not read the article, much less its references?

You ask "Should we encourage motorcyclists not to wear helmets?" That's a very different topic. As the article points out: "a recent study identified two broad subpopulations of cyclist: “one speed-happy group that cycle fast and have lots of cycle equipment including helmets, and one traditional kind of cyclist without much equipment, cycling slowly.” The study concluded that compulsory cycle helmet legislation may selectively reduce cycling in the second group."

I am a member of that second, slow group. I bike at about 18 kph. This is slower than the fastest marathon runners. I believe there's an evolutionary argument that running speeds and slower are generally safe for the human body. (Either that, or we need to start putting safety gear on Usain Bolt!)

But motorcyclists and moped riders, downhill skiers and Tour de France riders, all go at a faster rate. The energy in a collision goes as the velocity squared, so there's 6x more energy in someone going 45 kph than at 18. This translates to a lot more possible damage, so more of a need for protective gear.

Hinrik• 13 years ago

Another potentially harmful effect is that drivers tend to be less cautious around helmeted cyclists: http://cordis.europa.eu/news/rcn/26335_en.html

analog31• 13 years ago

This is a study that I'd definitely need to see repeated. The "reproducibility crisis" looms large.

rdtsc3• 13 years ago

If cycle helmets were made compulsory in the UK, it is calculated that an extra 253 people per year would die from obesity related diseases

It seems you'd need work upstream a bit to prove your point. The conventional wisdom is that bicycle helmets are a "good thing".

Ok so 253 extra people will die from obesity. What about the ones that will not die but be disabled. What about those that don't die from falling of the bicycle but get disabled permanently or temporarily.

They enforce the perception that cycling is dangerous.

Is that so controversial though. Cycling, absent dedicated bike lines, separate bike paths, and very well organized intersections is dangerous. Heck, driving is dangerous, riding a bike among cars is even more dangerous from what I understand. Now, I don't have the data, you seem to have some, so I can't point to any studies right of the bat here.

Finally, as the study showed, they are designed to only be involved in an accident between you and the road. Not another vehicle.

Well ok, the helmet protects the head. Hitting the road because a car hit the cyclist or a deer or someone put a stick in the spokes, I can see having a helmet, even one not designed for automobile accident protection as a better idea than not having one.

One thing I can see is the false sense of security. I buy that argument. Someone before talked (sorry, can't remember who or where or if it was study or not) how when they were riding alongside cars and if they had a helmet, cars actually drove closer to them, and if they didn't, cars gave them more room. That's interesting I think.

D_Alex2• 13 years ago

What about the ones that will not die but be disabled...

You mean disabled by obesity, right? I am sure there would be LOTS.

salvadors• 13 years ago

> They enforce the perception that cycling is dangerous.
Is that so controversial though. Cycling, absent dedicated bike lines, separate bike paths, and very well organized intersections is dangerous.

The more cyclists there are, the less dangerous cycling is. Things that discourage cycling thus make it more dangerous for all other cyclists (and vice versa).

nedwin• 13 years ago

Ok so 253 extra people will die from obesity. What about the ones that will not die but be disabled. What about those that don't die from falling of the bicycle but get disabled permanently or temporarily.

From the paper:

"Modelling studies have generally concluded that regular cyclists live longer because the health effects of cycling far outweigh the risk of crashes"

cageface• 13 years ago

Right after I first moved to San Francisco one of my new roommates was hit by a car while riding his bike downtown. He put a large, helmet-sized dent in the car's windshield. He spent a few weeks in the hospital anyway but he would have been dead if he hadn't been wearing his helmet.

baddox3• 13 years ago

Lots of deaths of pedestrian and even automobile drivers/passengers could probably also be prevented with bicycle helmets.

jchrisa4• 13 years ago

Our family does without a car and I take my daughter to school or pick her up in my cargo e-bike. Neither my wife or I wear helmets as speeds are slow around here and there are plenty of other family bikers. I think my daughter is safer when I'm not wearing a helmet, as I can see and hear better and most importantly it's easier to make eye contact with drivers when you don't have a helmet on.

eCa• 13 years ago

What kind of helmet impairs vision and hearing? I haven't heard this before so I'm curious.

alistairSH• 13 years ago

Downhill racing helment? Motorcycle helmet? Neither of which you'd normally wear on a road bike.

jchrisa4• 13 years ago

Would you be able to take in all the sites and sounds around you on a nature hike, say you are going birdwatching or something, just as well with a foam hat on? If you can see your helmet at all then that's part of your peripheral vision you are sacrificing. And if you can't see your helmet it's probably not gonna do much in a car crash anyway... I prefer not to get hit and one way to do it is ride in a part of the world that respects people on bikes. When I lived in Mountain View I wore a helmet... but I also didn't bike much.

jessaustin6• 13 years ago

Every helmet I've ever tried impairs hearing at speeds easily reachable on a bicycle. When I hear the rushing of air in and around a helmet, my aural sensitivity and awareness of overtaking motor vehicles is decreased. This isn't so much of an issue on high speed roads, as many vehicles on such roads can approach without making much noise. However, it's huge on city streets on which most vehicles don't exceed about 40mph. My hearing isn't even that good, but when I've been riding in traffic for several weeks, without turning my head I can easily tell UPS trucks (very dangerous) from SUVs (not paying attention but fairly predictable) from straight trucks/semis (pretty safe since they are on alert in urban environments; just don't pass them unless you know you can get clear before they turn).

jchrisa4• 13 years ago

I don't want to dwell on the negative, but a big reason I don't wear a helmet is because I think they send the message that what I'm doing is dangerous when it's exactly the opposite.

And that message is part of the whole complex of ideas keeping otherwise healthy people in their cars. It's been documented (and backed up by my and others anecdotal experience) that motorists are more respectful of riders without helmets.

There are plenty of resources here's one http://cyclehelmets.org/

rdtsc3• 13 years ago

I think they send the message that what I'm doing is dangerous when it's exactly the opposite.

I would imagine most people would qualify what you are doing as dangerous. There maybe nothing technically wrong you do while riding, but if you are sharing the road with cars it takes one tired, drunk, texting or senile or otherwise inattentive driver to squash both you and your daughter. They don't even need to go that fast.

I have seen it myself -- dad hauls his kid in one of those trail-behind carriers, it is nighttime already. Rush hour traffic. Flag barely seen, not big or high enough. People coming home tired and overworked, I've seen a close call once. Very scary stuff. Honestly I was thinking "what a dumbass" about that particular parent. And I can't see how it would be otherwise in that one case.

Most bicyclists I know have had serious falls. Some been hit by cars on rural roads. Out of my acquaintances that are motorcyclists, many are now ex-acquaintances and that is not because we fell apart but because they are dead now. It is often not their fault, it is a drunk driver, or other drivers' fault, it just they are exposed and vulnerable around large heavy SUV sized cars moving around.

that motorists are more respectful of riders without helmets.

Use of "respectful" here is a bit funny? It would seem they are not thinking exactly "respectful" thoughts, probably thinking "What is this crazy guy doing here? He is going to get himself killed!". Well ok maybe it doesn't matter as long as cars stay away, but that doesn't' help promote the idea of safety, it promotes the negative idea -- people who bike are crazy unsafe and need to be protected from themselves.

interstitial2• 13 years ago

The government knows what's best for you. Stop being so individualistic.

dreamdu5t• 13 years ago

I'll take responsibility for my life and you busybody do gooders can fuck off.

Let's make helmets mandatory after we outlaw being a fat fuck and eating like shit.

JoeAltmaier4• 13 years ago

Unfortunately my insurance pays for folks with your attitude. So yes its my business. Unless you want to sign a waiver for bicycle-related injuries? No?

jype3• 13 years ago

However, it pays substantially less for such folks as it does for the folks such folks are angry about.

Bicycle related injuries are not what any insurance company is worried about, while obesity, diabetes, cardiovascular diseases and motor vehicle related injuries actually really are the issues that keep raising the cost of your insurance - you just don't see it that way, because you don't want to take responsibility for the costs your lifestyle imposes on the society.

I'm dreadfully sorry if this has come out as addressed to an individual - speaking epidemiologically, this is absolutely about all of us, collectively. I would never recommend anyone to not wear a helmet, but I would rather see their choice of transport be the bicycle as often as possible, and mandatory wearing of helmet will not help that.

jessaustin6• 13 years ago

Do you live in the USA? If so, have you been living under a rock? Don't you know that now your insurance pays for everybody, no matter what their "attitude"?

Besides, cyclists are pretty healthy overall, as compared to the motorized-barcalounger operators. If one gets run over, it doesn't cost "your" insurance near as much as the 1500 matching sedentary automobilists with diabetes and heart disease.

dingaling• 13 years ago

I'll take responsibility for my life and you busybody do gooders can fuck off.

Those 'do gooders' are also the ones that advocate changes to traffic laws to accommodate cyclists, and sponsor cycling lanes, to make the environment safer for your pursuit.

Do you want them to cease that, too?

finnw• 13 years ago

http://en.wikipedia.org/wiki/Association_fallacy

shirro• 13 years ago

Bike helmets are mandatory Australia wide and it is enforced. I have no idea if the net effects are positive or negative but the behaviour is so normalised now people rarely question it.

I don't think it represents a disincentive to people exercising or kids riding to school. It might have when introduced but I suspect other lifestyle changes have more impact. When I was a kid I had to ride a couple of km just to see a computer. I had two television stations and my only electronic game was pong so riding my bike was the only way to stay sane.

Where it is a problem is you don't carry a helmet around with you so you can't just hop on a mates bike or hire a bike without putting someone else's helmet on which isn't attractive. I have considered hiring a bike when interstate but the helmet thing has always put me off.

jype3• 13 years ago

I've been commuting by bike ( http://www.youtube.com/watch?v=TgvjnOJwWTU ) for about 20 years now and I feel that every motor vehicle occupant should be wearing a helmet.

The case is quite clear: Most people who die in cars have not had their heads protected by a helmet at the time of the fatal collision. While they might very well be dead regardless, so might the occasional cyclist that got run over by a lorry while not wearing her helmet, so this doesn't really enter the argument.

When helmets are mandatory for car occupants, I shall laugh at their faces and ask them if they feel any safer crossing the railroad tracks. I'm also certain my ill manners will improve road safety by a measurable margin.

And, of course, I wear a helmet most of the time.

angersock• 13 years ago

I am truly baffled at the number of people here against bicycle helmets--have you never had to interact with someone who has suffered brain damage?

I'd wear two damned helmets if it ever saved me being in that position.

jype3• 13 years ago

I find it hard to believe anyone here is against bicycle helmets.

I can only see people who think helmets should not be mandatory, because the data shows this will reduce the number of people using their bicycles for casual transport, which in turn increases their risk for a wide range of health problems and simultaneously makes cycling more dangerous for everyone else, because fewer cyclists on the road means fewer drivers will take enough care to notice them and give them their space.

glomph• 13 years ago

More people get brain damage falling down the stairs or off ladders in their own homes though. Should we mandate helmets in the home?

brg• 13 years ago

Cost-benefit analysis and the role of government in personal safety laws is very interesting. One of the best TED talks is Steven Levitt on children's car seats. They do not seem to more beneficial than seat belts passed infancy. These are very much related, as BC has increased the age at which children need to be confined to a car seat to 9.

Steven Levitt: Surprising stats about child carseats http://www.ted.com/talks/steven_levitt_on_child_carseats.htm...

pconf• 13 years ago

IMO the most important aspect of this whole debate is money. Lots of money is made from manufacturing and selling bicycle helmets. That's why the bicycle-naive general population only knows about helmets when asked about bicycle safety.

Given that skills training, traffic engineering and other key components of real (i.e., statistically defensible) bicycle safety are not profitable how would you go about fixing this dysfunctional aspect of our automobile-centric cultures?

Bicycle Helmets and the law: a perfect teaching case for epidemiology

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