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Safety vests and helmets make cyclists look ‘less human’ to other road users
(theconversation.com)
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this post was submitted on 24 Jul 2023
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There's a long term debate about the effecacy of helmets. this article from 2014 summarizes it pretty well. All the studies, both in favor and against are relatively weak compared to what we might expect, but this is epidemiology, not biology.
The biggest indicator is simply that countries with heavy helmet use have more head injuries per 100,000 miles ridden than those with low helmet use. Even that is a correlation, but causality is unclear.
All I can say is I've hit my head hard enough to get a concussion while wearing a helmet. Pretty sure I would've died without the helmet.
So I'm glad I was wearing one, and I will continue to do so every time I ride.
I've never understood why people get so upset about being forced to wear helmets. Why take a risk when it comes to what is arguably the most important part of your body? Even if you're a perfect cyclist who will never fall over (and will never suffer any kind of mechanical failure, like the seat on my bike that broke off while I was riding down a hill) it's still a sensible precaution and worth some minor inconvenience like having to bring a helmet with you or leave it attached to the bike.
Unfortunately for the perfect cyclists out there, cars don't actually care about your bike handling skills.
As a cyclist, I rarely wear a helmet because there is enough data out there to show it may be more dangerous to do so. As a motorcyclist, I wear all the gear all the time, and won't even get on the bike without a helmet. Personally, I'm really following data and research as much as I can. Low relationship between helmet use and bike safety, high relationship between helmet use and motorcycle safety
Can confirm I fell off my bike in my own Street, going about 15kph after a night at the pub. Didn't even notice I'd smashed my helmet until the next day. Glad I had it on.
This may be the case, but may also not. Concussions are pretty tricky... If we look at common causes, many are activities done without helmets, and people do survive them, and conversely, many of them happen in spite of the presence of the helmet.
So it's harder to link concussion safety to helmet use, and as the summary mentions, head injuries are currently more common in walking and driving than in cycling, so, again, it's quite difficult to study and most conclusions have quite a bit of uncertainty.
I slammed my head into the concrete really hard. Hard enough to destroy the helmet. Hard enough I could have died even wearing a helmet.
It was a totally unexpected freak accident, did something I'd done a thousand times before, only this time I fell over. You just can't predict some accidents.
I've probably crashed a bicycle or motorbike 50 times in my life. The only people who haven't crashed are people who don't ride often.
I get what you're saying, people take more risks when they are wearing a helmet. But at the same time, not all crashes are the rider's fault. Sometimes it's another vehicle. Sometimes it's an unexpectedly slippery surface. Sometimes it's a mechanical failure (have you ever had a tyre rapidly defalte suddenly at speed and then come off the wheel rim before you could stop? I have. Twice. It's not fun). Sometimes you just get hit in the face by a rock or a large bird.
Cycling is inherently dangerous. Protection is appropriate.
... also ... if the statistics say wearing a helmet may protect you... then fuck, I'll take those odds. Imperfect protection is better than no protection at all. If you cycle regularly, you will crash. There's no uncertainty in that - everyone who has cycled regularly for any period of time has crashed more than once. And head injuries are the most common cycling injury according to Australian hospital statistics (among serious injuries anyway - hospitals obviously don't collect data on minor bruises).
I actually think you've misinterpreted what I'm saying, unfortunately. The data consistently shows that head injuries are the most common form of injury for all forms of individual transport, that present in hospital. That includes modes where helmets are common like cycling and motorcycling, and modes where they are not common such as walking and driving.
The data further show that out of all modes of individual transport, cycling results in the least hospital visits per unit distance traveled.
Further, various studies suggest but can not conclude, that various policies which increase helmet use also contribute to higher rates of hospitalization for cyclists. The data also shows an inverse correlation with unknown cause in populations with lower habitual helmet use and bicycle hospitalization.
The actual point I would like to make is that the study of bicycle injury and helmet effectiveness is young, and the data are inconclusive at best.
I certainly don't want you to not wear a helmet while cycling, but when we talk about public policy, that might be another question entirely. Unfortunately, the received wisdom based on emergency ward studies on the early 80s was itself not comprehensive, and has only become less clear over time.
If we put aside the requirement that, to be meaningfully compared, the different modes of transport would need to be normalised to the number of people participating in each mode of transport, wouldn’t this support the statement that helmets prevent hospitalisation?
Well, it shows that either all places in the data set have universal helmet use (they don't) or that helmet use is not the dominating factor. Further, informing policy, is suggests that it would be better to mandate helmet use for the more dangerous modes such as walking and driving, and focus enforcement there
How do you conclude that walking and driving are more dangerous in terms of head injuries?
The article linked at the beginning of this thread lays out a good overview of the available research. This includes causes of head injury hospital visits, over half of which were from driving.
So if activity X has a 1 in 50 chance of injury, and activity Y has a 1 in 500 chance, which would you say is more dangerous?
I think I see what you are getting at... We need to look at the rate of injury per use. In traveling, we may want to look at travel times. From the article I mentioned:
Risk of head injury per million hours travelled
Which would you say is more dangerous? Those are probably the ones that should have mandatory helmets laws, no?
Do you know what “per million hours traveled” means and how it was calculated? Is it per person, cumulative across the population, something else…?
Using my example above, let’s say cycling had a 1:50 chance of injury and driving a 1:500. You’d naturally say cycling is more dangerous. Let’s also imagine on a given day in your city there are 1000 people cycling and 20000 driving (pulling numbers out of my butt, but probably not unreasonable).
With the above, the hospital ER would see 20 bike injuries and 40 car injuries per day. I.e. twice as many injuries from cars, even though the chance of being injured is an order of magnitude smaller.
That’s mostly the point I was trying to make. And why the details matter.
Also another thought on the article: to draw a fair conclusion (apples-to-apples comparison) you actually need to know the bike numbers without helmet. It could be, take the helmets off the cyclists and their injury rate skyrockets towards the motorcyclists.
It would certainly be reasonable to expect the head injury rate to go up without helmets on cyclists heads.
Yes, it's calculated across the population, it's an epidemiological study. That is, for every million hours the population as a whole spent driving, there where 0.46 head injuries (as an average). For every million hours the population as a whole spent cycling, there were 0.41 head injuries. This was before the helmet law went in to place. This means that, on a time sent basis, you where slightly more likely to receive a head injury in an automobile than on a bike. Your math would be correct, but the probabilities you listed are not those the study found.
Meanwhile, this study found that whole helmet use in Victoria and NSW increased from roughly 30% to roughly 75%, the proportion of head injuries only dropped by 13%. On the other hand, ridership declined after the helmet laws.
Raising more questions, during the same time period, the proportion of head injuries amongst pedestrians also declined by about the same amount, indicating that helmets may have partial or no responsibility for the decline.
Again, the available data suggests that without helmets, the rate of head injury stays in line with cars and walking, and with helmets, the rate stays in line with cars and walking.
I genuinely appreciate the replies and detail.
I must confess I hadn't read the articles you cited. I know the issue is complicated, so my goal was to make a very simple and transparent model to try and understand what's reasonable. The numbers you quote imply that an assumption in that model is wrong, or something really critical is missing that flips the result. It's hard to see what or understand why. In terms of head injuries, in a given day, riding is more safe than driving maybe ...? Or more people ride than drive ...? Probably not. So I'm left more confused by these numbers.
So then I went back to your references. The source of your numbers (from what I can tell) is here, which you gave above. This is an anti-helmet website, not a study. Noting that anyone can write a blog and claim numbers, I looked for the references to support their claims. There are none. So it's hard to tell if these are real studies (probably), but from when, where, cherry-picked, and so on (these details matter). Not linking to the source is a huge red flag for me and undermines any trust in what's argued.
I'm guessing the Australian study you reference above is the same as the one they mention (thank you for linking directly to it). This is a nearly 30 year old paper from UNE, looking at the numbers one year after helmet laws were introduced in Vic and NSW. Without going into detail about some of the questions I'm left with (e.g. what is the variance in the year-to-year numbers they're comparing the 1-year changes against? - if that variance is larger than the 1-year change then the change is statistically meaningless - and so on), I figured, regardless, this is a poor source to draw such significant conclusions from (old, 1 year of noisy data, limited geography etc). Surely there are more recent studies that track the longer trends with more complete data?
Looking at the papers that cited that paper, I find this, which is a 2018 meta analysis of 21 studies (including the older AU one) from Norwegian researchers. This should be a better source, given it covers a much wider timespan (collectively), populations, geography, methodologies etc. They also spent a lot of time on the uncertainties, biases, etc to aid in the interpretation of their results.
There's a lot of good information in the abstract, but here's what I think is the headline result:
"The summary effect of mandatory bicycle helmet legislation for all cyclists on head injuries is a statistically significant reduction by 20% (95% confidence interval [−27; −13]). Larger effects were found for serious head injury (−55%; 95% confidence interval; [−78; −8])."
There's lots more of interest to this discussion at the link. But I haven't gone through the paper beyond the abstract. I'm happy to take the abstract as written (since I have a job and other things to do today).
So what to make of all this? My experience is that there are two types of people. A small but very passionate minority of riders that are really, really against helmets. And the rest of the population who don't really care that much. They ride and wear their helmet - sometimes forget it and hope they don't get caught - but otherwise don't think about it.
The biggest issue I feel we should be directing our energy towards is improving the cycling infrastructure by separating bikes from cars. Cars are the biggest danger to riders. Until we do a better job at that, and without the benefit of a metal cage around us like cars provide, simple steps to protect our heads - the helmet - make a lot of sense, to me at least.
EDIT: some minor wording clarity.
https://www.sciencedirect.com/science/article/abs/pii/S0925753515001812
Also relevant:
https://www.parliament.wa.gov.au/parliament/commit.nsf/(Evidence+Lookup+by+Com+ID)/0EF0B4AD3D8F53CA482583CC001FFB7E/$file/cs.ccs.190327.tbp.001.cg.002.pdf
That meta study is actually quite interesting as a source for specific data. For instance, this paper found that the swedish helmet law had low effect on head injuries because it causes low risk cyclists to stop cycling.
This paper demonstrates that a safety-in-numbers effect exists for cycling, suggesting that we have policy which encourages more cycling.
What most of the sources cited demonstrate, and which I haven't contested because its pretty self evident, is that out of people admitted to the emergency department of a hospital, those who where wearing helmets had less head injury.
That meta study, and most of the cited studies, does not account for the injury rate for time spent by cyclists, or the total number of cyclists on the road. As seen in studies linked elsewhere in this thread, helmet laws do have an impact on those metrics also, and can be detrimental to the safety in numbers effect.
Surely that's like what happened in WWI (I think) where they found making soldiers wear helmets created more head injuries than before. They almost stopped using them before realising that less soldiers were returning dead so they just increased medic capacity to handle it.
Wearing a helmet is going to result in a head injury in an accident which would otherwise have caused death.
Naw, all injuries go down. It's not survivor bias, it's a solid inverse correlation.
Places without helmets tend to have a better cycling culture and infrastructure
That's quite true. And they get it because enough people are cycling that there is demand for it. Mandatory helmets laws actually discourage cycling. The data on that is clear. The data on whether mandatory helmets laws increase safety is much less clear, however.
When it's a matter of public policy, one should consider both these factors... A clear cost for an unclear benefit, and change policy as our knowledge continues to evolve.
Now compare that to fatalities. There's the answer to your second sentence.
Yeah, fatalities also go down. All hospitalizations do. It's not survivor bias, it's a solid inverse correlation between helmet use and injury. Netherlands, Denmark, Japan all have very low helmet use and very low injuries.
The three you just mentioned also have a heavy cyclist culture, and infrastructure in place that facilitates separate biking though
That's quite true. And they got that via sustained policy to encourage cycling. It's been quite demonstrated that mandatory helmets actively discourage cycling, leading to both a disinvestment in infrastructure and drivers being less comfortable around cyclists (thus more dangerous)
I am not making a point about individual choices. Anyone should feel free to wear a helmet. But public policy is a different beast, and the data on mandatory helmets laws are inconclusive as to benefit and clear as to cost.
Good lord, no.
If having to wear basic safety equipment that literally dons and removes in a split second 'discourages' you from cycling, you are either incredibly vain or outright lying to yourself about the true causes of not riding.
Most people are vain, yes.
I think the debate around helmets is beside the point. Why? Because it's not really up for debate that helmets prevent brain injuries.
If danger from road users increase because of wearing a helmet, that's an issue with the drivers and the non-separated infrastructure.
As a daily commuter riding a bike, I say we keep the helmets. It's like wearing a seat belt and should be mandatory as long as we have a semblance of socialised healthcare.
Except that mandatory helmets discourages bicycling which causes disinvestment in safe infrastructure, and keeps drivers unfamiliar with cyclists. This makes cycling much more dangerous. Note again that the mass cycling cultures do not have mandatory helmets laws and are also much safer than Australia.
Also, it's weird that cycling is singles out for mandatory helmets. Fully half of all head injuries from individual transport happen on automobiles, yet nobody is suggesting mandatory helmets for car occupants. Even walking creates a larger number of head injury hospital visits. The arguments for mandatory bicycle helmets apply there too.
Ultimately, at a time that we need greater investment in mass cycling than ever, for individual safety and for the environment, mandatory helmets laws are counterproductive
The meaningful number when comparing eg driving/walking to biking head injuries is not the absolute number but the fraction. If you’re 100 times more likely to get hurt when doing X compared with Y, it means X is inherently more dangerous/risky and warrants extra protection. Even if far fewer people overall do X.
I’m assuming here that far fewer people ride than walk/drive on your average day.
And the people who seem most discouraged by helmets are those who always want to tell you how discouraged everyone is by helmets. My experience is that most people who ride don’t really give a shit / are happy to have something to protect their noggin.
1000% agree we need better infrastructure. Separating bikes from cars should be priority number one and will have the biggest safety impact by far.
It's true, to get the best data, we need a common denominator, which is just not available. The initial post of this thread was pointing out that the studies all around are weak, including the study that lead to mandatory helmets use policy. What information we do have is suggesting that more ridership results in better infrastructure which results in less injuries over all
I think we all agree that the most important factor here to getting people on bikes is providing the feeling of safety (+ actual safety) and convenience, which I would argue needs to be better infrastructure first, helmet law relaxations second.
Can you imagine if they do helmet law relaxations first? The media would have a field day.
If someone is more discouraged to ride because helmets are a hassle or might ruin their hair, instead of death by car due to poor infrastructure and car-centrism, then I'd look at such a person sideways.
It's not really an either/or. In order to get investment in infrastructure, there needs to be interest in cycling. This means removing barriers where present. A great example of this is in bike shares. New York City introduced a bike share in the early 2000s, and that helped to increase ridership. Increased ridership lead to the construction of miles of inner city separated bike lane.
The Melbourne bike share had consistently low ridership, and was abandoned entirely in 2019. They explicitly cited the helmet law as the reason.. In Brisbane, 85% of people said the helmet law was why they didn't use the bike share.
If we want to increase actual cyclist safety, we desperately need the infrastructure, but for the infrastructure we need cyclists. One of the best methods for getting more cyclists doesn't work in Australia. Maybe that should change.
Not if you don't read the research, as you apparently haven't. As the poster above pointed out there really is a lot of debate and the research supporting helmets is of very poor quality.