The Australian Helmet Debate

Helmet

A new study published by the Medical Journal of Australia found that bicyclists not wearing helmets were over four times more likely to suffer serious head injuries than their helmeted counterparts. The study was conducted by the Department of Trauma Service at Sydney’s Royal Prince Alfred hospital and looked at patients over 16 years of age who suffered head injuries related to bicycle accidents between 1991 and 2009. According to one of the authors, “Three per cent of people who wear a helmet could end up with head injuries, whereas 13 per cent who don’t wear a helmet will end up with severe head injuries.”

This study comes on the heels of Piet De Jong’s Health Impact of Mandatory Bicycle Helmet Laws conducted for the Department of Actuarial Studies, Macquarie University. His article sought to determine whether mandatory helmet laws deliver a net societal health benefit. He weighed reduced head injuries against reduced cycling to come up with a cost. From the abstract:

Using estimates suggested in the literature of the effectiveness of helmets, the health benefits of cycling, head injury rates, and reductions in cycling, leads to the following conclusions. In jurisdictions where cycling is safe, a helmet law is likely to have a large unintended negative health consequence. In jurisdiction where cycling is relatively unsafe, helmets will do little to make it safer and a helmet law, under relatively extreme assumptions may make a small positive contribution to net societal health. As such, helmet legislation appears to be a distraction from the main bicycle related health issue: the safety of the bicycling environment. The model serves to focus the mandatory bicycle helmet law debate on overall health. The methodology developed in this article is can be used in other situations where safety initiatives are proposed for healthy activities.

Another study, The Effects of Bicycle Helmet Legislation on Cycling-related Injury, was conducted by researchers at the University of Sydney earlier this year. According to Associate Professor Chris Rissel, one of the authors of the study, “Findings suggest the greatest reductions in head injuries resulting from cycling accidents come from road improvement safety measures introduced prior to 1991, such as lower speed limits, random breath testing and intensive road safety advertising.

“The case for continued mandatory helmet wearing for adults is questionable although there is a case for it continuing for children under 15, who suffered about half the head injuries reported in this study. Helmet use is likely to prevent some injury, particularly for less experienced younger age groups. However the mandatory bicycle helmet legislation is appears not the main factor behind reduced head injuries among cyclists.”

I’m not sure any new conclusions can be drawn from these studies. The main thing I take away is that helmets continue to be a red herring, distracting us from the what I view as the more important issues of road design, bicycle infrastructure, and rider training and education.

You can view our semi-official stance on bicycle helmet use here.

As always, let’s keep the helmet discussion rational and friendly (view our discussion guidelines if you’re not clear on what I mean by “rational and friendly”). Thanks!

Trends in head injuries and helmet use in cyclists at an inner-city major trauma centre, 1991—2010
The Health Impact of Mandatory Bicycle Helmet Laws
The Effects of Bicycle Helmet Legislation on Cycling-related Injury

68 Responses to “The Australian Helmet Debate”

  • Doug says:

    “The main thing I take away is that helmets continue to be a red herring, distracting us from the what I view as the more important issues of road design, bicycle infrastructure, and rider training and education.”

    Add driver training and education as well as the enforcement of existing traffic laws to that list and I think this post nails it 100%. Wear a helmet if you want and especially in situations and locations where the infrastructure lags behind in terms of safety, but let’s focus on making the streets safer and then still see if we need to argue about helmets.

  • Pete says:

    Seems to me there are two parts to the issue, and they often get mixed up when people consider whether or not to wear a helmet. First, do helmets help in the event of a crash? You might be able to delicately say that the benefit is neutral-to-positive. They probably don’t hurt, and in most single-vehicle bike crashes, such those due to road conditions, it is probably helpful to be wearing a helmet. In accidents involving a car, it may not help much, though I would speculate that a lot of car-bike accidents are not the gruesomely fatal type, and a helmet might limit you to broken le
    Second, what are the odds of my crashing? Well, riding on typical US streets your odds may be higher. Riding well-designed separated infrastructure, like in Amsterdam (or a typical recreational bike trail here in the US), your odds are probably much lower.
    So, we all do the calculations for a given bike trip and make our own choices. But it seems clear that reducing the odds of a crash happening, through better infrastructure, will make the situation better for helmet-wearers and non-helmet-wearers alike. Sounds win-win to me.

  • Phil says:

    I think it’s a mistake to frame a discussion of helmet efficacy solely in terms of interaction with other vehicular traffic. If it’s bike vs car, the helmet is a band-aid at best.

    But cyclists crash and suffer serious injuries sometimes without an automobile or high traffic city streets being involved. The first comment to your semi-official stance that you linked to cites just such a case. And it occurred on a bicycle/pedestrian only trail.

    While I agree that road design, bicycle infrastructure improvement and training and education of both cyclists and drivers will yield greater long-term safety gains for the community as a whole, the helmet may keep an individual cyclist riding on one of his local greenways out of ER or IC after he hits a stone in the path and goes over his handlebars into a ditch. The evidence may be anecdotal to date, but there are enough anecdotes to be found on the Internet to convince me it’s foolhardy to go helmetless.

    I’ll support helmet laws in the US at least until we reach universal health care coverage. As an adult, you have a right to choices. What you don’t get to choose is to be reckless on my tax dollar.

  • Richard Masoner says:

    FWIW, my Australian readers tell me that helmet legislation is pretty much a non-issue for them. It’s been on the books since 1992 and they’re all used to it now.

    I think it’s important to highlight this statistical analysis and compare against reality. In other words, somebody needs to do a sanity check:

          “Three per cent of people who wear a helmet could end up with head injuries, whereas 13 per cent who don’t wear a helmet will end up with severe head injuries.”

    Stated another way, we should see more than 4X the number of severe head injuries among non-helmeted cyclists as we do helmeted cyclists, and the study authors state as much. I don’t dispute the counting or arithmetic — it’s all very straightforward.

    The MJA charges $30 for a single week of online access to their journal, and I won’t do that (yet) to look at the methodology, but I wonder if the researchers corrected for their populations? The classic mistake made in almost *all* helmet studies in the United States has been to compare two widely varying populations: in the US studies, helmet wearers tend to be wealthier, suburban and more careful riders to begin with, whereas helmet scoffers seem to tend to ride more dangerously.

  • Daniel M says:

    Wow, Alan. One of us must be reading the other’s mind; I just spent the better part of the morning surfing the web for some useful bike helmet data.

    First of all, I am suspicious of any study that originates in a hospital, where the sample group is those who are already hurt. We have no way of knowing whether or not the helmet-wearing crowd in the study was engaging in more risky behavior and represented a greater or lesser proportion of helmeted cyclists overall than the non-helmeted riders.

    I am much more interested in studies of the general cycling public, and more specifically those who AREN’T RIDING FOR SPEED. What I’m trying to get at is the following: How dangerous is transportational cycling, in a per mile or per hour rating, when compared to driving and walking, both activities that can lead to injury, but neither of which comes with the societal baggage that it comprises risky behavior justifying a helmet at all times.

    I see it like this: in the early days of auto racing, there were no seat belts or helmets. Early auto racing was tragically dangerous, and is much safer today partially as a result of seat belt and helmet adoption. In cars used for transportation today we are expected to use seat belts but not to wear helmets, even though we frequently drive over 70mph in them! The thing to remember is that most drivers drive for safety first and speed second.

    If you take your car to a racetrack, however, you are expected to wear a helmet, even if you are not racing, because you are there for speed first, and safety second. The same thing is true with bike racing (or fast club rides): if you are riding for speed first and foremost, you should wear a helmet because you are compromising safety.

    Now, as I see it, bikes in the US have, up until the last few years, been marketed as offshoots of racing bikes, be they lightweight road bikes or bombproof mountain bikes. You are sold on the promise of SPEED and taught to look up to those who race. Wearing a helmet (and spandex, etc.) goes along with this principle, and it is of course in the interest of those who are in the business of SELLING bikes and equipment that they implore you that helmets are a must at all times.

    I want to see statistics on bike injuries among cyclists those whose primary purpose is getting from A to B, or even pleasure rides, provided that the elapsed time is not an issue. Without this our stats are similar to auto safety stats which include injuries at track days or club meets at racetracks.

    For the record, I grew up riding in the 80’s when nobody wore helmets, and neither did I. In the 90’s I got more “serious” about biking and started to wear a helmet every time I rode, because that was what was the norm in the bike shops and magazines, and among the “serious” riders that I saw. I wore my helmet nearly every time I rode a bike from then until the last year or so.

    On my last bike tour, a 1700 mile trek from the San Francisco Bay Area up to the Oregon-Washington border and back, I started to despise wearing my helmet when I was riding slowly, especially in the heat, and started putting it in my basket when I wasn’t charging downhill at top speed. Since I got home I have made the decision that if I’m riding to get somewhere, the helmet stays at home. The last time I put it on for a recreational ride I absolutely couldn’t stand the feel of it and I haven’t worn it since.

  • Daniel M says:

    @ Phil:

    I COMPLETELY DISAGREE with your closing statement. Driving is one of the most dangerous activities one can engage in. Should your tax dollars not go to those injured in freeway wrecks? What about people who smoke and drink excessively? Or those who never exercise? Should your tax dollars be denied to them when they wind up in the hospital with health ailments? Should there be LAWS against not exercising, or smoking, or drinking too much?

    I’m sick of the nanny state, and especially people advocating for decreased freedom based on tax dollars. It really strikes a nerve.

  • Jonathan says:

    Before the discussion gets too heated, I would like to say “Thank you Alan” for gathering and summarizing these recent studies.

  • Nicolas says:

    This still the same debate. Of course helmets are a protection, but making helmets compulsary will lower the number of cyclists. It is when the cyclists are in high number on the streets that the car drivers are used to share the way and that their are less incidents.
    The french federation of bike users (Fubicy) provides the following chart (datas from Hyden, Nilsson & Risser, 1998) : http://www.fubicy.org/IMG/jpg/casq_hnr98EU.jpg
    The whole study is available (in French) here : http://www.fubicy.org/spip.php?article136

    To my opinion, we have also to consider urbanism facts. In Europe, there is a clearer border between what is center town, town and suburbs. This means that there is difference between what is a street and what is a road, and the implicit associated rules.

  • Andy says:

    The helmet is really is secondary. If someone is injured by a driver, it’s not because they are not wearing a helmet – it’s because THEY WERE HIT. The helmet has absolutely zero to do with the collision.

    While I do wear a helmet myself about 95% of the time, I think mandatory laws on helmet use are a very bad idea. I want to see many more people cycling, and if the (IMO silly) hassle of wearing a helmet stops people from riding, than helmet laws are actually more dangerous. Just get on a bike and ride!

  • Duncan Watson says:

    Since when is 4.3 equal to 5? This kind of math is endemic in helmet studies and makes me very leery of any results without access to raw data.

  • Adrienne says:

    I want to know what the parameters were for “head injury”. Scratches on your cheek are a “head injury”. Damage to the eye would be considered a “head injury”. If you put your teeth through your lip, a common injury in children, that would be a head injury. These are also the kind of injuries that helmets do nothing to prevent.

    I think many people confuse “traumatic brain injury” for “head injury” and that confusion increases concern where it is least helpful.

  • Alan says:

    @Adrienne

    According to an article on The Australian website that covered the first study above, severe head injuries were defined as “intracranial bleeding or skull fractures”.

    Alan

  • Phil says:

    Daniel M,

    Nice collection of strawmen. There is already quite a collection of laws governing most of the activities you cite. Enforcement may be spotty in some areas and effectiveness may also be varied. However, the laws do exist. Would you make the same argument about your decreased freedom for being required to wear a seat belt in a car?

    But you missed my point entirely. Lack of universal health care has forced nearly 50,000,000 Americans to use the ER as their primary source. That is a major contributing factor to the astronomical costs of health care the burden of which we all share. Until we can rectify this situation, I’m a believer that all risky behavior should at least be discouraged. All of the behaviors to which you refer are discouraged in one way or another. Requiring helmets for cyclists and motorcyclists is no different than requiring motorists to wear seat belts or requiring hard hats in a construction zone.

    I am most certainly not advocating that once someone engages is risky or unhealthy activity and suffers health consequences he should be denied care. Quite the contrary, I am advocating for universal care that is independent of one’s economic standing and available to all. It’s not the use of my tax dollars to which I object. It’s the waste of them treating things that could be avoided by exercising a little individual responsibility to the community. I want to see that minimized though I realize that such things can never be totally eliminated. I fail to see how requiring a member of the community to follow safe cycling practices (or driving practices) impinges on one’s personal freedom in any meaningful way.

  • Alan says:

    @Duncan

    “Since when is 4.3 equal to 5? This kind of math is endemic in helmet studies and makes me very leery of any results without access to raw data.”

    Thanks for pointing that out. I corrected my article so as to not perpetuate the error.

  • Daniel M says:

    @ Phil:

    So, I take it then that you think there should be laws mandating exercise and making cigarette smoking illegal, at least until we have universal health care? And why aren’t you in support of a law mandating helmet use in cars? Surely this would save lives.

    And bike accidents, by their very nature, aren’t helped by preventative care; they end up in the ER, and society pays the bill whether the cyclist is insured or not. We all pay the bill through some combination of taxes or our insurance rates. The universal health care argument is the big straw man here.

    In the case of seat belts and motorcycle helmets, there are numerous studies that show that the laws for them have saved lives. We (reluctantly) accept the loss of freedom because the law has been PROVEN EFFECTIVE. The real world bike helmet data continues to be inconsistent. Bicycling and riding a motorcycle are different beasts entirely. Many of us suspect that the risks of riding a bike for transportation are closer to those of being a pedestrian than being a motorist.

    “They who can give up essential liberty to obtain a little temporary safety, deserve neither liberty nor safety.” – Ben Franklin, 1775

  • Alan says:

    Wow, it got a little hot in here already. Let’s see if we can cool it off – I don’t want to have to moderate too many comments or shut off the discussion prematurely.

    Thanks,
    Alan

  • Daniel M says:

    @ Alan:

    It’s a deal. Sorry if I stoked the flames.

  • Grateful says:

    In a recent study conducted by a science/religion research consortium in 12 major cities on each of the seven continents, it was concluded that bicycle helmets were, in a sense, an aphrodisiac; due to the sexy nature of them and those who wear them. So who am I to argue with scientific findings? I just religiously put on my helmet, ride my bike and hope for the best. :-) :-) :-)

  • Alan says:

    @Daniel M

    No worries. This is always a tough subject, and I expected folks to get emotional. Fact is, I had decided to pass on publishing the article, then changed my mind at the last. Even though this subject has been discussed ad nauseam, I figured the recent flurry of activity in Australia warranted a heads up.

    Regards,
    Alan

  • Phil says:

    Alan,

    Me,too.

    Let me be clear. I dislike helmets. They can be uncomfortable, hot in hot weather and cold in cold. I have a 65cm head and have a hell of time even finding one that fits. I just laid out $150 for a Lazer Helium because it actually fits and isn’t uncomfortable – much – and I’m not particularly happy about it. And everyone looks like a dork in a cycling helmet (well, maybe not Levi Leipheimer, but what does that tell you).

    I recognize that the jury is out on the effectiveness of helmets. But until a refereed study concludes that the helmet is of absolutely no use at all – zero, nada – I’m going to wear mine and advocate that all cyclists regardless of age do also.

  • Brent says:

    I found this quote useful in the continuing helmet debate. It’s from an early 1990s study on travel risk:

    “The safety of walking and bicycles depends almost entirely on the other transportation with which they must mix.”

    http://www.piercelaw.edu/risk/vol4/winter/halperin.htm

  • Alan says:

    @Brent

    So true. Thanks for sharing the quote.

    Alan

  • Billi says:

    I divide the issue into helmets for children, and adult helmet use. I grew up with two kids that suffered traumatic head injuries that altered the course of their lives. One is still affected by it, cannot drive due to seizures and works menial jobs despite being fairly intelligent. Children by nature are much more susceptible to traumatic head injuries. There are many things adult do that we don’t allow children to do, because we wish to protect them since they are more fragile. Bike helmets alone are not really the answer, good bicycle education is another part of it, along with a safer environment for them (and us) to ride. That may be trails, lanes, traffic calming, wide shoulders, whatever. interestingly enough, In the US kids are more likely to die riding in a car, than while riding a bike.
    Adult helmet use: I believe bike helmets reduce traumatic head injuries, I know people who have crashed and broken helmets instead of skulls. Obviously in a high speed collision it wont help, or matter much, but most bike accidents do not even involve cars. I am pro helmet, but not pro helmet laws. I wear a helmet for another reason, I want children to see adults wearing helmets. For the minor discomfort and inconvenience i feel a helmet offers a fair bit of protection.

  • Alan says:

    @Billi

    Well said, Billi.

    Regards,
    Alan

  • Richard Masoner says:

    I come at it from the opposite direction from @Billi — I do *not* wear a helmet as an example to children, to demonstrate that cycling is a safe activity that doesn’t require special gear. This is a little bit problematic in California, because helmet use is compulsory for bike riding children.

    BTW, I’m hearing there might be serious proposals for universal helmet laws in California for the 2011 legislative season.

  • Billi says:

    “The safety of walking and bicycles depends almost entirely on the other transportation with which they must mix.”
    I do agree that other vehicles are a large part of the equation, albeit, one I cannot control. Likewise in the same way it can (and already has been right here) that the problem is in inadequate roadway design. ie: the Amsterdam Argument. I believe bike/ped safety needs to start with accepting that in the US, we currently live in an auto-centric environment. To me that means accepting responsibility for doing all I can for my own safety. Everyday I see that how I ride, affects how the traffic around me responds. I can make choices to be ride safer, to use lights at night, make good lane position choices, and ride predictably. I do see drivers do all sorts of crazy stuff,( and cyclist and pedestrians.) And many places in my city are darn near inaccessible by bike, and that needs fixing. And Yes I am an LCI, though I feel the league has lost it’s way in many areas. For myself in the world I ride in I cannot afford to “depends almost entirely on the other transportation with which they must mix” I have to be willing to protect myself.

  • Saddle Up says:

    Everytime I read this debate on this website I’m left with the impression that transportation cyclists do not understand that they are by a very large margin the smallest portion of the cyling community. Mountain bikers and road riders far out number transportational cyclists. Crash a mountain bike out on the trail in the mountains even at slow speeds and there is a higher risk of head injury, the same goes for a road rider travelling at speeds much greater than what a transportational cyclist would be travelling at.

  • somervillebikes says:

    i was on a group ride this past weekend. one of the cyclists had just started to cross a major urban intersection after waiting for the cross signal. he was standing on his pedals to accelerate off the sidewalk (we had just exited a bike path). within a few feet into the intersection, his pedal snapped, causing him to go down fast and hard. here are some descriptive facts from this event:

    1) cyclist was riding at no more than 5 mph
    2) cyclist was following all applicable rules of the road
    3) no motorist was involved
    4) no other cyclist was involved
    5) cyclist slammed head against pavement, cracking his helmet at the point of impact
    6) cyclists came away with scrapes, bruises, and a bad headache

    from these facts, we can rule out any aggressive, fast, negligent or off-road cycling. we can also rule out motorist negligence. it was simply an accident, due to mechanical failure.

    had the cyclist not been wearing his helmet, we don’t know what would have happened, and we can’t *conclude* that he would have ended up with more serious head injury, but considering that the force and location of the impact, common sense predicts that injuries could have been much worse.

    this is not a statistic, but merely an anecdote.

    another example: i was struck by a motorist while cycling (as a transportation cyclist), causing me and my four year daughter, who was riding in a child seat, to fall to the pavement. her head collided with the pavement, causing her helmet to crack much like in the example i provided above. although she sustained no serious injury, an ER visit concluded that she did get a concussion. would she have sustained worse injury if she hadn’t been wearing a helmet? no one knows for sure. but again, common sense dictates that she probably would have.

    this also is not a statistic, but an anecdotal example.

    but these anecdotal examples are enough for me to choose to wear a helmet. it’s my choice. however, i don’t believe use should be mandatory. i would put myself in the same camp as billi: i believe that helmets certainly can reduce the severity and/or prevent some serious head injuires, but helmet use should not be mandated.

    it would be really nice to see discussions that completely separate the issues of helmet effectiveness and helmet laws, which are two completely different debates.

  • Alan says:

    @Saddle Up

    That raises an interesting question. From the feedback I receive from our regular readers, I get the impression that most are not strictly transportational/utiltiy bicyclists, but that many are also sport riders. I’d be curious to know how it splits out. Perhaps I’ll put together a poll.

    Regards,
    Alan

  • Hippiebrian says:

    In no way is transportational cycling so dangerous as to REQUIRE putting on a styrofoam hat. If that makes you feel better, go for it, however the risk is so low and, for me, the plastic hat so uncomfortable that I prefer not to wear one. I base that on studies which state that it is far more dangerous to walk or ride a car than it is to ride a bike as far as head injuries go. There is some good info here: Ken Kifer’s Bike Pages. I believe there is a link on this site.
    I cannot help but agree with the British Medical Assosciation’s opinion that any mandatory helmet law reduces cycling so much as to affect the health of the general population, and on that basis came out against mandatory helmet laws. If you look at the general health here in the United States, how can you want to get anything passed that would in effect reduce the amount of regular excercise our “super-sized” citizenry is already getting?
    I just want to add one more thought here. 90% of bicycle hospitalizations are caused by automobile-bicycle collisions. Really, should our first line of defense be putting relatively useless styrofoam hats, not even tested to real world conditions, on every cyclist’s head or should it be to educate automobile drivers and to hold them strictly accountable when they break traffic laws? It isn’t bicycles that are dangerous, it’s cars. Let’s never forget that!

  • 300 Pound Gorilla says:

    The 3% and 13% numbers sound off to me. Maybe it’s a particularly dangerous area?

    On bicycle safety in general: Cycling is safer than average life even without safety equipment. Riding in a car is more dangerous than average life no matter how much safety equipment you use. I wonder: if everyone stopped riding in cars, would cycling still be safer than average life? Let’s find out.

    My kids volunteer to wear helmets because they know we can’t afford a ticket. Personally, I wear one only after dark…because the only headlight that I have is on a helmet mount. Someday, I’ll move it to my fork.

  • Erik Sandblom says:

    @ Phil
    “until a refereed study concludes that the helmet is of absolutely no use at all – zero, nada – I’m going to wear mine and advocate that all cyclists regardless of age do also.”

    No joke – here are two:

    No clear evidence from countries that have enforced the wearing of helmets. British Medical Journal by Dorothy Robinson march 2006. This one you can read the whole thing for free

    Head injuries and bicycle helmet laws. Accident Analysis & Prevention by Dorothy Robinson July 1996. This one is pay per view

    Times series studies like Ms Robinson’s typically show no benefit while hospital studies show large benefits. However, most hospital studies do not correct for alcohol. The two that did found that alcohol has a stronger correlation to head injury than helmets, and that sober cyclists are more likely to wear helmets. See my comment in an earlier post.

  • Nick says:

    I’m not saying that the anti-helmet scientists don’t try and present their results in creative ways too, but with respect to this article below I have presented my take on some deceptive use of stats, and based on the data available to me what I think is really going on.

    I actually believe if this study had been conducted by anti-helmet researchers they might have used the same data to write a completely different article AGAINST the helmet laws.

    I believe this paper can demonstrate that helmets are protective of at least minor head injuries, but i don’t think there is enough data on SEVERE head injuries to make any conclusion. The authors actually combined minor and severe injuries for their main analysis yielding the 5.3 odds ratio. Given that the helmet law argument is about the cost to society of head injury, i think SEVERE injuries are what is important because these are what is associated with exorbitant cost.

    Some important points:
    1) The only statistically significant finding in the paper is that more non-helmet wearers had a higher % of ‘skull fractures or intracranial bleeds’.
    2) The reduction in head injury rates from 10.3% to 2.5% is notable – but not statistically significant – so could be due to random variation (the confidence intervals overlap), or an effect too small for the power of this study to detect.
    3) Figure 2 shows no trend in incidence of severe head injuries versus helmet use, and suggests that the authors’ choice to compare 2005 to 2010 was completely ‘cherry-picked’ because there is a big bump on the graph at 2005. This bump seems to be a part of normal fluctuation as it is similar in size to bumps throughout the 90s. if anything the rate of severe head injuries is very stable and probably more stable that helmet use.
    4) Figure 1 shows an increase from about 2007 in admissions but this is due to an increase in the head AIS score of 2 category, the AIS score 3+ category (severe) stays the same. (note the typo on the x-axis, the first 2010 should read 2005).

    With regard to point (4) above there has actually been a slight reduction in helmet use during this time, according to figure 2. The most obvious reason for the increase in minor injuries – despite what the authors say – I would guess is the increased proportion of low-speed cyclists (commuters, etc) versus high speed (road cyclists), and maybe also due to increased driver awareness of cyclists due to increased numbers.

    Now, with regard to point (1) above, if you look very carefully you might notice the following. Figure 1 uses categories of AIS score = 2 and AIS score 3+. But, in contrast the main finding of the paper (point 1) uses data which would fall into both categories. This means combining SEVERE head injury, which is the category associated with the large $4M public health cost, along with a category described as “isolated concussion and simple skull fractures”. I’ll bet that without including the minor injuries (AIS=2) that the result wouldn’t come out as statistically meaningful. Looking at figure 1, for the period 2008-2010 used for table 3, the ratio of SEVERE head injuries to simple skull fractures is somewhere between 2:1 and 3:1. So, if the last row of table 3 just looked at SEVERE head injuries the comparison would be probably 3 (1%) helmet wearing severe and 2 (4%) non-helmet wearing severe injuries. I would be absolutely stunned if this difference of 3% could be shown to be statistically meaningful (p<.05) in this dataset, with so few observations of SEVERE head injury.

    So, the true state of affairs is probably that not wearing a helmet is associated with a greater risk of “simple skull fractures”, but there is no association, or a very small association, between helmet use and incidence of SEVERE head injury.

  • Naomi says:

    There is always a lively discussion among cyclists in Australia about this topic – bordering on religious fervor on both sides (which I don’t quite understand). The issue too often gets sidetracked from the center of the debate, which is whether wearing a helmet should be Law – thus of a significant enough economic benefit to the community to warrant legislation and take away people’s right to choose, into whether a helmet can help in certain accidents and this greatly frustrates me.

    For a taste of this from a local perspective and some of the inherent methodological and statistical problems faced by researchers on the topic you may want to look at discussions over on http://www.sydneycyclist.com

  • Fergie348 says:

    More anecdotal evidence from the hinterlands. I was riding home from the ferry (Larkspur, CA) with a guy (let’s call him Brian) that I know from riding bikes to/from the ferry.

    We were riding down a moderately trafficed street after dark and he wanted to get up on the sidewalk to activate the crosswalk lights so we could get traffic to stop and we could cross the street safely. He misjudges the angle and depth of the curb junction with the street and goes over the handlebars of his bike. I hear a crunching thud and ride over to find him lying on the sidewalk bleeding from the side of his chin. He cut his chin open on the sidewalk, scraped up his hands and bruised his knees from the fall, which occurred at no more than 5 mph and involved no other vehicular traffic. He went to the hospital and got stitched up. We looked at his helmet later and it clearly saved his temple from a dent or crack – who knows how badly he would have been injured if he hadn’t been wearing one? I’m glad he didn’t have to find out..

    Both he and I took note of the insurance policy paying off – Less than $100 and a minor inconvenience invested. The payoff? Potentially lifesaving – he gets to watch his kids grow up. Pretty compelling to him and me – no way I’ll ride any significant distance in any circumstance without a helmet and gloves.

  • Phil says:

    Erik,

    “No clear evidence” does not equal “absolutely no use at all”. Let’s be careful with the language. The thing that Dr Robinson suggests that there’s no clear evidence of is whether enforced wearing of helmets is beneficial to the community.

    In fact, Dr Robinson advances the following in the first line of the abstract. Case-control studies suggest that cyclists who choose to wear helmets have fewer head injuries than non-wearers. As long as anecdotal evidence like that which somervillebikes provided along with the link in the first post in Alan’s “policy statement” continues to be posted, I’ll keep my helmet on.

    Somervillebikes is correct. We should separate a discussion on helmet effectiveness, which is a discussion of individual risk and acceptability, with helmet law effectiveness, which should be a discussion of community cost versus community benefit.

    I think it would be hard to dispute that helmets can be effective for certain types of accidents. Some cyclists will be at greater risks for these types of accidents than others based on where they ride, the condition in which they ride and their skill level. Whether the level of occurrence of these accidents is sufficient to make it cost effective for a community to enforce mandatory helmet wearing is another matter.

  • BB says:

    I think whether we personally choose to wear a helmet sometimes clouds the debate re: mandatory laws. I live in Australia, I have been cycling 40 years and I often choose to wear a helmet because of the cycling conditions. However, when I pootle 2kms along a sun-dappled bike path at a rate of knots only a little faster than walking with one small intersection and no other path users to pick up some shopping, it bugs me that I’m supposed to put the helmet on (which I don’t). Yes, my pedal could fall off or I could run into a tree, but, in that instance, as an adult, I’d assess the risk as reasonable. If I climb a ladder to get at cobwebs I don’t wear a helmet, if I cross a busy road as a pedestrian I don’t wear a helmet, if I am a passenger in a car with the top down doing 110km in the country I don’t wear a helmet. What I would like, now that I have reached adulthood, is the option to assess a given situation.

    In passing, I’d also like to mention that a couple of the middle-aged women I work with have mentioned that they enjoyed cycling as a child, but, would not get a pushbike now as they wouldn’t want to wear a helmet. Neither of them is atheletic and I’m sure their general health would improve with a few gentle kms each day. I don’t know how common a response that is and I’m not saying that it’s not a little shallow :) Has anyone found any stats that indicate the number of potential adult cyclists that are put off by the mandatory law and the health benefits this may prevent?

  • Bomber says:

    I don’t need any of these studies or figures, just this. I began wearing helmets because I knew it was a good idea. Then once when I fell off my Mt. bike at 35 mph, I felt my head make contact with a tree stump. I could feel the helmet flex and absorb the blow. It was as though it happened in slow motion, I will never forget that feeling. I remember removing my helmet and literally giving it a kiss after the crash. I still have that helmet to this day, keep it as a back-up. I know in my heart of hearts that I would have been badly hurt without one. This crash was off-road; I can only imagine it being much worse on the concrete. I won’t get on the bike without a helmet.

  • voyage says:

    Complications…

    Here, have a layperson-accessible headache:

    “Lies, Damned Lies, and Medical Science”

    http://www.theatlantic.com/magazine/archive/2010/11/lies-damned-lies-and-medical-science/8269/1/

  • erik says:

    i don’t wear a helmet as of late, but now that the rainy season is back i may dust it off. when i’m confident of the terrain, that’s one thing, but wet adds that unpredictable dimension that takes you down fast. otherwise, i meticulously maintain my bikes and check for stress fractures regularly on such parts as cranks, i trust myself to ensure that a catastrophic failure won’t happen.

    red herring indeed. even among cyclists, as we see here. let’s all just enjoy the ride, and keep advocating for real policy improvements in our communities.

  • Urb Anwriter says:

    185 lbs, that’s me
    35 lbs, bike and gear
    30+ km/hr (yes, I know, Imperial measure up there, metric down here)

    Traffic; free-flowing but busy.

    Car: Nissan 300Z with bloody long coupe doors.
    No parking, no brake lights, no turn signals, no glance in the driver’s mirror.

    And lightly squeezed by traffic on my left.

    BANG.

    I heard the helmet smack the ground the first time. And then the very best sound I’ve ever heard, that of the second impact. They hauled me away in an ambulance. Two days in the hospital. No head injury. Oh, and no helmet left. A rigid, ‘skater-style’ bin in red. Smashed.

    But I’m still here, still riding, still writing, and with (I’d wager) as many brain cells as before.

    That should convey my position on helmets.

  • Jay says:

    Would I prefer to ride without a helmet? Yes.

    Do I mind wearing a helmet? No.

    They’re very lightweight (foam!), not particularly uncomfortable (adjustable!), easy to lock to my bike when I leave it unattended (convenient!), and it may very well lessen the chance of a serious head injury (ouch!). If a car runs directly over my head, ok, I’m probably SOL, but for providing some degree of deflection or impact absorption from other glancing blows? It probably helps.

    As my haircuts get increasingly short, there is less hair to be messed up as well, so for me, I’ll gladly wear my helmet!

    I’m also fairly risk averse as city bikers go, with daytime running lights and an ANSI tier II reflective vest on at almost all times.

    If it were a serious inconvenience, I’d still wear it, but I certainly don’t find it to be one.

  • 300 Pound Gorilla says:

    I couldn’t help cross posting this in a helmet discussion.

    http://pathlesspedaled.com/2010/11/youre-doing-it-wrong/

    I’d say doing it wrong is better than not doing it. Even regarding helmet preference.

  • Wytze says:

    Please, leave the stories of ‘a helmet saved my live’ out of the discussion!!
    Nobody, and really I do mean nobody is advocating a law to deny you your helmet use. So don’t forget: you still get to wear a helmet if you want to, even if there will never be a compulsory helmet law.

    The discussion is: Would you go as far as to impose your believe onto all other cyclist in your country. Does everybody need to be forced to wear a helmet just because you don’t have a problem with it?
    Like the women mentioned by BB at 4:11pm: Do you realise you would also prevent non athletic riders from taking a ride in the park, because they will see it as a dangerous activity, because the government said so? They desperately could benefit from a little exercise.
    So is it worth a law? Aren’t people wise enough any more to decide this on their own? And remember that enforcing such a law would also costs a lot of tax money!

  • Bob Baxter says:

    In the 1970s many states passed mandatory helmet laws for motorcyclists. Politicians then discovered that motorcylists were also registered voters and were extremely unhappy about the laws, and the helmet laws disappeared. As long as the memory of that debacle is around I doubt we will see many bicycle helmet laws passed.

  • Phillip says:

    I said it last week, I’ll say it this week. If you think strapping a scrap of beer cooler on your head is going help you, then you’re living in a fantasy world. In order to be effective a helmet would have to approach the size, weight and construction of a motorcycle helmet. The best we can do is try to use the thing under the helmet more often.The discussion is over.These aren’t the droids you’re looking for. You may go about your business now.

  • Frits B says:

    @300-Pound-Gorilla and others wondering about the 33 vs 13%:
    “The comparison rate in the study was 180ish helmeted riders vs 30ish non-helmeted riders. 3 of each group had serious head injuries.”
    There’s a somewhat similar discussion going on over at copenhagenize.com.

    As for helmet laws for children vs adults: Dutch hospital stats show that the age group most at risk here are the over-sixties. Brittle bones, balance problems, slow reactions. Children are much more flexible, have instinctive reactions and fall from lower heights as their bikes are smaller.

    Can I refer to this interesting bit of info: http://hembrow.blogspot.com/2010/08/brain-injuries-and-dutch-cyclist.html? I know, the situation is quite different in the US. My personal opinion is to leave the decision to wear a helmet to the individual: whatever feels best. Freedom of choice.

  • Garth Madison says:

    Why do some individuals get so emotionally riled up by a discussion of helmet laws? It is not a big deal, and not an unusual measure. A helmet on a cyclist is a piece of safety equipment comparable to a seat belt on a motorist, and seat belts have been mandatory for 3 decades.

    It seems incontrovertible that a helmet protects the wearer from sustaining more serious injuries in certain types of accidents. That seems much more important than minor issues of comfort or whether a helmet looks “cool,” which is an entirely subjective concern anyway. Individuals complained about seat belts in cars, too, because they weren’t cool and were uncomfortable, and yet most eventually adjusted.

    The more important context of the debate is probably the low ridership numbers. Hopefully serious accidents are not all that common in any environment, but we do not seem to have much data about the effectiveness of current helmets in transportation riding, or the frequency and type of accidents, because so few people engage in the activity, and there is correspondingly little money or motivation to study it. Maybe there are more effective safety measures possible – a redesigned helmet or other equipment entirely. I sure would appreciate such developments.

    Moreover, bike riding, and thus safety, are not the ubiquitous presence in our society that automobiles are. We do not worry about the effect of seat belt laws on “drivership” numbers. We have more detailed data showing a health benefit, and a strong public interest in promoting that health benefit. Perhaps the current time is not the best one for worrying about universal helmet laws for cyclists, because the focus should be on promoting this type of alternate, more efficient transportation. If we ever get to a point where cycling is as widespread as driving, we can worry about mandating the most appropriate safety measures. At that point, a helmet law may well be a sign of our success, as much as some of us bemoan its necessity now.

    In the meantime, I’ll wear mine religiously, if not with any emotional fervor. The rest of you are welcome to provide the comparison non-helmet-wearing injury data!

    Garth-

  • Hippiebrian says:

    The other day (I think it was Sunday), I had a bicyclist yell at me to put on a helmet. She was riding on the sidewalk going against traffic riding her carbon fiber trek-giant-ized whatever it was. Is this where we’ve gotten with the whole helmet debate, where it’s okay for someone riding as dangerously as possible worried about how I, following traffic laws and paying attention, adorn my head? Really?
    Listen, I am by no means “anti-helmet”, and if you think it will save your head, go for it. I have Ross Perot syndrome (larger than average ears) and they just don’t make helmet straps to go around them. Period. When I do wear one, it is extremely uncomfortable and not only increases fatigue but takes my mind off traffic when that is where it should be. Which way would you consider safer for a dude like me?
    That being said, a mandatory helmet law would be absolutely rediculous. Choice is the only way to go on this, espescially until testing is done on these lids that match real world conditions. They test helmets directly on top, 11 mph on level ground, 8 mph on simulated curbs with 35 lbs. in them. Should this make me feel safe, when I’m 200 plus lbs. and most head strikes are on the side or back (not directly on top in the center?).
    In my opinion, this whole arguement places focus exactly where it should not be. Focus should be on how to control car traffic, which is the real danger. Like Holland and Denmark (where nary a helmet is to be seen), maybe a little focus on getting us out of traffic more than we are. It shouldn’t be on the bicyclist, as transportational cycling is inherently safe. Sure there are exceptions, but the only person I know personally who has had a head injury that has affected his life was a pedestrian, not a cyclist.
    I could go on, but I just want to make one more point. Per hour participated, both soccer and basketball have more head injuries than bicycling. Should we mandate helmets for soccer and basketball players? Don’t laugh, first bicyclists, then…well, you know how that goes.
    And Fergie, maybe if he hadn’t been trying to jump curbs, a helmet wouldn’t have been necessary…just sayin’…

  • 300 Pound Gorilla says:

    Thanks Frits.

    Sample size is too small for me to consider that the results mean anything at all.

    Garth, a helmet is absolutely not comparable to a seat belt. The respective amounts of risk and risk avoidance are not even in the same ballpark. I agree, though, that the emotional content of helmet discussions is excessive.

  • Wytze says:

    @ Phil 12:03pm and Garth 5:25am

    The comparison with seat belts in cars aren’t appropriate at all. By discouraging car use you do not penalize overall public health, no, in contrary the less car users the better it is for our health as shown in this graph: http://www.greencrawler.com/blog/wp-content/uploads/2009/10/fat-graph.jpg
    So instead, let’s make helmet use for motorists mandatory! It will save more lives (after all, there are more motorists suffering from head injury then cyclists) and the public health will benefit from less obese people.

  • Frits B says:

    @Garth: ” If we ever get to a point where cycling is as widespread as driving, we can worry about mandating the most appropriate safety measures. At that point, a helmet law may well be a sign of our success, as much as some of us bemoan its necessity now.”
    Holland has 16 million inhabitants who own 18 million bicycles. I don’t know the figures for Denmark but those may not be far off. Also countries in South-East Asia count millions of cyclists, none of whom wear helmets. Seems to me that when bicycles are even more common than cars, the entire helmet argument goes away. What was it with “safety in numbers”?

  • Bomber says:

    A Law, that is a very tough question because of the variety of speed of riders out there. But on public roads/highways there is a reasonable expectation of requiring helmets, like motorcyclists who are used to this in so many states. Dedicated bicycle paths where motor vehicles do not go, probably not.

    Also I take exception to the person who called them a “piece of beer cooler”, they are much more than that, look into what goes into them. Not that I’m opposed to putting some ice and cold beer, into one ;-)

    -Bomber

  • Hippiebrian says:

    Bomber, there is a big difference between requiring motorcyclists to wear helmets and requiring them for bicycles. Motorcycle helmets are tested and approved based on real life conditions, such as road speeds and human weights. Bicycle helmets are not, nor can they be, tested to real world conditions. If they were as effective as motorcycle helmets, they would be as heavy and as bulky as motorcycle helmets and be totally unuseable on human powered vehicles, where weight and ventilation are too important. There is also a big difference between going 60 mph on a motorcycle and 15 or 20 at most as a transportational cyclise (average for most is 10-12 mph). There is also the real side effect of bicycle helmet laws, as proved in Australia, of less people riding bikes, and in a country that is getting progressively fatter and the cost of the increased heart trouble, diabetes, kidney failures, and everything else that goes along with increased obesity, in no way can it be a good idea to pass legislation that will effectively decrease how much excercise Americans are getting.
    Also, as an aside, the difference between cycling and motorcycling (I do both, however am considering getting rid of the motorcycles and car all together) is that motorcycling is a dangerous activity, with expodentially more potential for massive injury and death, whereas transportational bicycling is a relatively safe activity, espescially compared to motorcycling, driving, and yes, even walking (check the stats on head injuries of pedestrians compared to cyclists).
    I do have to note here that not one poster who is against mandatory helmet laws, including myself, suggests you do not wear one, yet people want to force the rest of us to do what they feel is a good idea for them. Curious…

  • Garth Madison says:

    The point is that seat belt laws do not discourage driving. Driving is a ubiquitous part of daily life, and nobody thinks twice about having seat belts in every car. A helmet on a cyclist is absolutely comparable, as a basic safety measure designed to minimize injury. If you get in a bad enough crash, on any kind of vehicle, your odds are not great, whatever safety equipment you’re wearing.

    The opponents of helmet laws seem to be citing to comfort and fashion, and claiming they should be unfettered by anyone else’s beliefs about safety. A safety law or regulation is not about belief or about imposing what one person thinks is good on others who disagree. It is about the state mandating use of a proven safety device on the basis of its interest in preserving the lives and health of its citizens.

    Helmets may need further study to determine if they have the kind of effect that serves that state interest. Right now, I don’t think enough adults ride bicycles for the state to care one way or another. When the state does care, and the members of the general public bike enough to think of a helmet the same way they do a seat belt on a car, we presumably will have much better infrastructure, bike safety, and education in place, and yes, have succeeded.

    Some of the European countries are an interesting comparison. Some of them seem to have achieved common bike usage. What is the status of helmet laws over there? Were helmet laws defeated or simply never proposed? As to the effect on ridership levels in places like Australia, the studies appear to come to mixed conclusions – as per an earlier ecovelo post on that subject.

    Motorcycle helmets are perhaps less comparable than seat belts, as a motorcycle at speed is an inherently dangerous activity, and a helmet won’t help you. You’re really risking death on a motorcycle. A bicycle accident is much less likely to be fatal. However, that doesn’t mean there is not a risk of injury in a bike accident. It just means that a helmet might actually minimize that less serious bicycle accident injury. Of course, motorcycling is much less common, like bicycling, and so the state might not care as much about motorcycle injuries, except to the extent it adds to public healthcare costs. The minority who fight safety laws are a majority of that subculture, and so more vocal. Perhaps that simply argues in favor of waiting to develop safety laws for bicycles until it’s a more common mode of transportation.

    Cycling is also very different than walking or playing sports. You are going considerably faster on a bike, and falling from a height in an uncontrolled manner, usually onto a hard surface. Where there is an increased risk of heavy impact from the nature of a sport, like American football, you do start to see helmet regulations, though it’s arguable whether they are beneficial, too (e.g., compare head injuries in Australian rugby and American football). Nobody is advocating requiring helmets for every activity, including walking and playing sports. By the same token, you cannot escape safety regulations in those activities either – most sports have at least some minimal safety equipment requirement, even if it’s just shin guards in soccer.

    Anecdotal evidence might not be too helpful, but I don’t hear any of the opponents of helmets describing how they smacked their head on the pavement in a crash and walked away unscathed, despite the lack of a helmet. Also, you cannot assume that you will never get into an accident involving a head impact because you obey the traffic laws, don’t jump curbs, ride slowly, etc. – you cannot predict what obstacles you might encounter or how other traffic will behave. In any case, if we get solid data on helmets and bike accidents indicating that helmets minimize injury, and we ever have enough general public ridership that the state cares enough to mandate helmet use, along with providing safer bike routes and such, I would be perfectly content. If we ever get to the point where bike helmets are as ubiquitous and unnoteworthy as seat belts, I’ll be ecstatic.

    Garth-

  • Richard says:

    Just two points I want to make here: first, there’s been lots of discussion about the Australian studies that indicate that helmet laws decreased ridership. These studies are anything but definitive, as they measured only about a year’s worth of activity, immediately after the introduction of the law. Who knows what’s happened to ridership since then? No one. And it’s interesting that Wytze says that there’s no place for anecdotes such as “a helmet saved my life” in this debate, but goes on to cite a similar anecdote about decreased ridership! Let’s be consistent, shall we?

    A second point is that several commenters have said that “no one is saying that you can’t wear your helmet.” But of course those who argue that wearing helmets makes cycling seem dangerous are indeed saying just that.

    As for me, I’ll wear a helmet. Mine’s pretty comfortable and quite cool in summer. And even if it only protects me from a glancing blow in a slow speed fall, that’s okay by me. After all, a nasty bonk on the head may not be life-threatening, but it’s still a drag.

  • Andy says:

    Garth,

    You made clear and valid points, however there is the issue of extent. It is likely always safer to drive wearing a seat belt, but I can assume that it is only safer if I were using a 5-point safety harness, a full faced helmet, and wore a flame retardant suit. Surely studies could indicate that those safety precautions are superior, however we don’t have laws catering to that. We have to draw the line somewhere with safety gear.

    The argument is not so much about whether wearing a helmet while biking is safer or not. The argument is about whether less people are riding when helmet laws are in effect and presuming that those people are then fatter, live shorter lives, put more burden on insurance payments, call in sick more often, etc.

    If the same logic was applied to cars, and we were required to have “too much” (defined by whomever) safety gear, than people may not drive as much and instead walk and bike more. So by urging for more safety precautions in cars, and less for bikes, than we’d all be more active and have fewer overall health consequences.

  • Brent says:

    @Garth:

    Wikipedia says that the Czech Republic, Finland, Iceland, Slovakia, Sweden, and Spain have compulsory helmet legislation in some form, whether for all ages, for minors, or for “interurban” riding. The notable exceptions are the Netherlands, Denmark, and Germany, which all have high cycling mode shares (relative to the U.S.) and low injury rates. In general, the safety of cycling in these countries is attributed to superior cycling infrastructure.

    A recent Dutch study found that cycling’s benefits outweigh its risks by some twelve times:

    http://www.usatoday.com/news/health/2010-07-09-bike-cycling-city_N.htm

    If compulsory helmet laws decrease cycling, a net loss of societal benefits would likely result.

    I believe that mandatory helmet laws in California would reduce cycling on campuses like Stanford, Davis, and USC, where toting a helmet would mean just another hassle for students. Too, it would probably reduce the numbers of individuals renting bicycles to ride on beach paths and the like.

    If helmets were mandatory for bicycles, I wonder whether other similar (and perhaps equally “dangerous”) human-powered conveyances — tricycles, inline skates, skateboards, Elipti-Gos, etc. — would be included. This exists:

    http://www.flickr.com/photos/paysbascyclechic/5171359180/

  • Wytze says:

    @ Garth 9:09am

    Such a long story and still so many mistakes. Risking a long story as well, I’ll brake it down for you:

    “The opponents of helmet laws seem to be citing to comfort and fashion, and claiming they should be unfettered by anyone else’s beliefs about safety.”
    No, we say that a helmet law affects cycling in general, as shown in Australia. After the helmet law passed the numbers of cyclists went down, but still the numbers for casualties went up! in other words cycling became far more dangerous, so negative in two ways: more casualties from cyclists that kept cycling, more obesity due to the cyclists that stopped cycling. Where is the general benefit in that? here are the numbers: http://www.cycle-helmets.com/imgs/injuries_number.gif and http://www.cycle-helmets.com/bicycle_numbers.html

    “Some of the European countries are an interesting comparison.”
    Yes you are right, but not in your advantage. Look at the following graph http://www.cyclehelmets.org/jpg/1079_3.jpg Do you notice helmet use in USA 38% and the absurd high casualty rate? Now look at the Netherlands! 0.1% helmet use, and only 1 casualty every 50 million km. You’d almost think there is a correlation ;) but sadly there is not, unfortunately it is not as simple as not wearing a helmet. It is all due to bicycle paths. Governments just see helmets as a cheap way out, to get cyclist fatalities down. But in the long run cycling lanes are the cheapest way to get health costs down. Because cyclist rates will go up, obesity and it’s related diseases go down and also important, the overall traffic casualties go down (it is very difficult to die when there are only cyclists around, you know)

    “Cycling is also very different than walking or playing sports. You are going considerably faster on a bike, and falling from a height in an uncontrolled manner, usually onto a hard surface.”
    Look at the Dutch statistics here: http://img.medscape.com/fullsize/migrated/461/679/amjhp461679.fig3.gif and you will see that there isn’t much difference between walking or cycling in casualties and that with only a 0.1% helmet use! For the Americans you might see that walking is even 2 times more dangerous then cycling per km, haha, you’d be better off cycling to your work than walking. So, your assumptions were incorrect again.

    “Anecdotal evidence might not be too helpful, but I don’t hear any of the opponents of helmets describing how they smacked their head on the pavement in a crash and walked away unscathed, despite the lack of a helmet.”
    There are no “opponents of helmets”, there are only opponents of helmet laws!! Why don’t you understand the difference? Nobody here is trying to get people to stop using helmets, they are just against a law that would make the use of it mandatory!!
    But for your information: the strange statistics show that people using a helmet are more likely to crash or fall than people without a helmet. On average I cycle 3000km a year for 25 years without a helmet and never bumped my head. On the other hand, I sometimes wear a helmet during mountainbiking and there I crashed a dozen of times and broke multiple bones. The funny thing is I never crashed without a helmet. There’s your anecdotal evidence. A bit like people with SUV’s crashing more than people riding sedans, I guess.

    Statistics play a nasty game, things that seem so obvious are not that simple at all, especially not when time enters the equation. But luckily for many situations there are useful examples, like Australia. Unfortunately people making the rules and laws are to busy to research all precedents, so, like you, they go by there gut feeling, and that’s not always the right one.

    Again, I am not against helmets, I am only against the law making them mandatory.

  • Wytze says:

    @richard 10:32 am
    Here are the numbers for a longer period, scroll to half way down the page. http://www.cycle-helmets.com/bicycle_numbers.html
    In the Netherlands cycling numbers keep rising and also notable is that in the Netherlands 55% of the cyclists are female, same in Germany and Denmark! In ‘helmet’ countries the percentage of female cyclists is always extremely low.
    I think mainly the numbers for the type of cycling in Australia would be very interesting. My gut feeling (a very dangerous thing as I told you in a previous post) says the utilitarian trips to the shop and taking the kids to school, etc will have dropped hard. I do not think that the race cyclists and mountainbiking scene will have suffered from the law; they will probably have maintained a steady growth.

    Anyone any numbers on that?

  • 300 Pound Gorilla says:

    Garth – ha ha Here’s a couple anecdotes for you. I was going down hill as fast as I could go. My front wheel snagged on a piece of broken pavement. I went over the handlebars and landed on my head. It hurt. A lot. But not for more than a few minutes. I took two stitches and was on my way with no appreciable damage.

    Here’s another one. My brother’s head has hit the pavement several times. Once, his head actually cracked the pavement. If I recall correctly, none of those accidents required stitches or hospital visits. He’s fine.

    Also, I agree that no one is arguing against helmets. We’re just arguing against helmet laws. That’s a huge distinction.

  • Hippiebrian says:

    I do have a little anecdotal evidence, however it’s not in the head injury category.
    I know I’ve already mentioned my “Dumbo” problem, but let me get a little deeper here. I bought a helmet a couple years ago after listening to everyone chide me for not wearing one figuring, like has been mentioned here, what harm can it do? I plunked down $150.00 on the helmet that felt the most comfortable in the store, and the one that had the most room between the straps, for obvious reasons.
    My first ride, I was fine for the first 5 or 10 minutes. Then the strap rubbing on the bottom of my ear really began to bug me, so I stopped and adjusted the straps some more until they no longer rubbed the bottom of my ears. Problem is, that caused them to rub on the back of my ears, which was just as irritating. Imagine trying to ride your bike, pay attention to traffic, and react to situations with someone rubbing a nylon strap back and forth against the back of your ear (right where the ear attached to the head). Do you see my problem?
    That being stated, while I am sure helmets might improve the safety somewhat on those with normal features, on a guy like me wearing one makes it more dangerous to ride due to the inability to the obvious distraction. It will, if mandated, also make it less likely for me to be eager, like I am now, to get on the bike and go. I am sure there are many more like me, which would nullify any supposed positive effects of a mandatory law.
    If helmets work for you, by all means use them, but please understand they are not beneficial to everyone.

  • 300 Pound Gorilla says:

    Hey, I just thought of something. This study was at a hospital trauma center. That means that the data is based entirely on people who needed to go to the hospital trauma center. Sydney is among the most livable cities in the world. It is up and coming as one of the world’s leading cycling cities. It has a population of 4.5 million people. Sounds to me like one hell of a lot of cycling going on. During a 20 year span of all that cycling, only 210 people needed to go to the hospital trauma center. That’s not even once a month in a city of 4.5 million. A grand total of 6 had serious head injuries. That’s one every 3.333 years for a city of 4.5 million.

    I just don’t see the risk. And, I don’t understand the push for a helmet law in the face of that kind of data. It’s like saying that everyone should buy lottery tickets because sooner or later someone is going to hit the jackpot. I’ll keep my money. Thanks anyway.

  • Garth Madison says:

    I never suggested anyone was arguing to ban helmets. However, a number of you are arguing that helmets are not necessary, and oppose using helmets for yourselves.

    I was not even advocating in favor of an immediate helmet law, just pointing out the bases on which one might be justified by public policy. Like I said, the studies on whether helmet laws negatively impact ridership levels are contradictory and uncertain, but this probably isn’t the time. We need better infrastructure, more riders, and more data first.

    Also, I had in mind a $20 helmet. I cannot imagine spending $150 on a helmet – that would be prohibitively expensive for a lot of riders, and we’re trying to make riding more accessible. Besides, you have to replace it once you’ve sustained a blow. And Gorilla, I’m glad you’ve been lucky so far, though if you’d had a helmet on you probably wouldn’t have needed stitches ;)

    Garth-

  • Tim in SB says:

    I am not in favor of helmet laws. When I was in college, I never paid to have my crappy bike properly tuned and I didn’t ride very often, so purchasing a helmet was way low on my list. I’m not sure if a helmet law would have made me buy a helmet or just discouraged me from riding at all. That probably depends on how the law was enforced.

    I’m in my 30s now and didn’t start wearing a helmet regularly until a few years ago. As an adult I have never had a bike accident on pavement (knock on wood). Since I’m fair-skinned in So Cal, I used to wear a wide brimmed hat for sunblock instead of a helmet, but I gradually came to wear a helmet more often. These days we are “car light” and I ride every day with a helmet.

    California has a helmet law for minors and it has been frustrating trying to get my 3 year old son to wear one. He started riding a push bike on his second birthday and has always fought wearing a helmet. When he is adamant about not wearing one and we tell him he must or he can’t ride, he has often decided not to ride and instead go back inside (he is a strong-willed little man). This makes it a difficult “law” for my wife and I to actually enforce. So, there have been times when we let the helmet rule slide because we would rather him be active and happy outside those afternoons instead of in the house pouting.

    I think he is safe riding at slow speeds on the sidewalk, with us hovering closely with him, watching for cars pulling out of driveways, and teaching him about safety. He runs as fast as he rides and he has fallen and knocked his head on the pavement or other hard objects many times while running or jumping off of things or other stunts he attempts. What I don’t think is safe, is for him to ride on the street in our residential neighborhood with most vehicles speeding through at over 35mph. Cars speeding around on our street have always been one of our biggest safety concerns for our kids.

    By the way, many of the little and big kids I see riding around town are not wearing helmets, and I would guess that many of them don’t own them due to the cost.

  • Andrew Robinson says:

    The debate continues! May I throw in a short article I wrote a few years back: “Cyclists: be safe — be seen as a bad target” — my suggestion is that the look of the helmet can add to its efficacy.
    http://www.bbc.co.uk/dna/h2g2/A1986951

  • brane says:

    I comment on de Jong’s paper only. One should read his analysis’ qualifications, as they delimit the working extent of the model (and especially one should read them before citing his paper as a ‘proof’ for or against helmet law).

    Summarizing:
    one: “…even if the analysis suggests there is no net societal benefit to a mandatory bicycle helmet law, this does not argue that an individual is not benefited by wearing a helmet.”
    two: “…the model…assumes a helmet law makes bicycling less attractive and hence reduces cycling.”
    three: “…a reduction in cycling does not necessarily imply an equal reduction in exercise, since cycling may be “substituted”.”
    four: “…the discussion…is in terms of statistical averages and sets off gains and losses across different individuals.”
    five: “…the analysis…is based on a “representative” bicyclist and does not distinguish between different groups of bicycle riders. Different groups may have different accident rates, for example children and racing bicyclists appear to have higher accident rates. Thus a targeted helmet law may be warranted.”

    De Jong’s model is based on this inequality with 4 variables:

    e * q > (beta) * (mu) (de Jong (1))

    As with any mathematical model, you’d first examine its base assumptions. For this model some of the assumptions seem reasonable, while I’d challenge others. E.g., I would question the soundness of the ‘beta for bicycling’ value. Beta values (basically a measure of how safe cycling is in an environment) seem fraught with subjective interpretation and I am not convinced that it is even a measurable quantity. Other values used are “pulled” from published literature. But I accept that for a qualitative assessment, the model does integrate many variables (variables that pro- or anit-helmet groups isolate to further their prejudice position) and subject them to a simple predictive formula. Still, its two main assumptions are (1) cycling head injuries are rare, and (2) helmet law decreases ridership. While (1) is (thankfully) true and is the main factor that generates de Jong’s conclusion (i.e., low head injury rate makes helmet’s (positive) health cost overwhelmed by the (negative) cost of even slight decrease in cycling adoption). It seems to me that (2) can be mitigated so that a population can accept helmet law with no drop in cycling adoption. Given that any individual can benefit with a cycling helmet there is no reason that people can’t accept this simple gear with no qualm (if required helmet use does not decrease ridership (as may be the case in the US), de Jong’s equation breaks down and its conclusion invalid). This seems to me what we as cyclists should be striving for: not a narrow framework of helmet use or non use but a broader framework where we are open and receptive of all forms of cycling enhancement.

  • brane says:

    One thing that is obvious from reading some of the comments: there is a confusion about how people understand this kinds of studies. The de Jong model is an actuary predictive formula as applied to society as a whole. As I recount above, it weighs the costs of brain injury with or without helmet vs the cost of lost health benefit assuming that helmet law deters cycling uptake. It is a population study and should not influence you as individual: so that IF YOU ALREADY CYCLE, it behooves you to use a helmet because the health of your brain is not equatable to the health of a bunch of people not wanting to cycle because of helmet law.

 
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