Surgeons in Scotland debate the helmet issue - do they increase cyclists' safety or not?

nadimk wrote:

to say that helmets are a red herring is false, to say they are not a relatively cheap, unharmful way to protect the head is false and has no basis in evidence.

i'm not arguing that helmets can't protect your head: they can. i'm arguing that the evidence points to the fact that helmets don't actually decrease the overall incidence of head injuries: hence, they're a red herring. they can protect your head but it's not as simple as whether they'll take a blow if you fall off your bike. there's lots of other factors, eg the altered perceptions and attitudes of other road users, or whether your safety is adversely affected by your own risk compensation, or what road conditions make people feel that they're necessary. who knows whether these negate the benefit the helmet can give? I don't for sure, but I haven't seen any large scale data that shows a correlation between helmet use going up and head injury levels going down. where mandatory laws have required the use of helmets the incidence of head injuries among cyclists has remained on the same trajectory (slightly down) in spite of a dramatic increase in helmet use. there's all sorts of factors in the equation and some of them correlate; helmet usage and safety levels don't.

nadimk wrote:

You like others cite "evidence" from countries where they do x, y, and z to say helmets aren't needed. This is highly biased "data" and does not constitute evidence. It lacks generalizability to England and the US where we don't have anything like Copenhagen and Amsterdam.

nope, what i'm doing is saying: if you want to make cycling safer, forget about helmets and concentrate on the real issues. look at what the safe countries are doing, and do that. don't focus on stuff that will make a minimal difference, if it makes a difference at all.

nadimk wrote:

Just wear a helmet and save us the cost of taking care your head injury when you crash, particulary in England's publically funded healthcare system.

why is it my responsibility all of a sudden when i'm on a bike? what changes? why not the same argument for car occupants? or diy enthusiasts? or rugby players? or pedestrians?

bikeboy76 wrote:

Yorkshie Whippet wrote:

Does is make me ride in a safer manner? Not always. I take more risks than I would without.

That's right, I have never been white water kayaking without a helmet, it must be the helmet that makes me do it.

I hope you never raft without a helmet. It will save your life. Seriously. Just put it on and go rafting. You will be safe.

You got me there. I wish I could say New Zealand... but sadly I can't. At least it was a close vote.
As for helmets... just wear them for God sakes. It's clearly of benefit in many types of accidents and as for it making you feel more secure ao as to take more risks... don't forget you've still got the other 95% of your body which is clad in only 1-3 layers of fabric... Ooch! Has anyone forgotten that it is possible to die from other injuries other than a head injury... very possible!

Colin Peyresourde wrote:

The case of Fabio Casartelli seems a case in point. He would be alive today (most likely) if he had been wearing something on his noggin.

Then the same would be true of the American author Kurt Vonnegut, killed by the head injuries he sustained falling down the stairs in his home.

People are killed in trips and falls. Trips and falls are the biggest cause of head injury. So don't separate cycling out as especially dangerous or productive of head injuries, because it isn't!

There was not mass head-injury related carnage amongst cyclists before the introduction of styrofoam hats for cyclists, and the degree to which cyclists /are/ killed hasn't changed obviously since they were But you wouldn't know that from the general assumption of Doom for those not wearing them now.

jayme wrote:

In this debate several people have claimed that in certain situations a helmet may make the injury worse. Is there any actual evidence for this to back up the claim? What type of situation is it?

A helmet effectively makes your head bigger. That means that there's a bigger lever to twist stuff like necks and it also means you've got more chance of hitting it to start with (as does the slightly increased weight). This is elementary physics.

It's also not very relevant, because you can't choose your accident type. What you can do is look at the overall effect of helmet wearing on serious injuries and see that there's none to speak of.

How about minor injuries (according to someone up there ^^^ any head injury is serious, hell, I was lucky to get away with cutting myself shaving the other day!)? A helmet is very likely to be good against these, but how many do you get cycling? I get more round the house, but ICBA to wear a helmet there. I suspect you can't either.

Helmets are specced for low speed falls with no motor vehicles involved. if any extra protection in these instances is good then the Dutch would wear them, because their much vaunted infrastructure doesn't protect them from low speed falls with no motor vehicles involved. But their wearing rates are the lowest in the developed world, and coincidentally so are their rates of serious head injury.

nadimk wrote:

Don't people in England call physicians by their proper prefix,Dr., not Ms or Mr. Typical.

British surgeons – a designation reserved for those who have obtained membership of the Royal College of Surgeons – are addressed as Mr, Mrs or Miss rather than Dr.

In my experience they take umbrage if you get it wrong!

I used to wear a helmet all the time, then I read the research literature! The evidence for helmets usage reducing head injuries in cyclists as a population is quite strong. However, the argument is much more nuanced than just saying helmet wearing is a good thing, because other factors need to be taken into consideration.

Firstly, there is some evidence that helmet usage adversely affects risk taking behaviour, i.e. riders feel safer, so take more risk and drivers perceive riders as being safer so drive more dangerously around them.(see for example, Adams and Hillman, 2001, The Risk Compensation Theory and Bicycle Helemts, Injury Prevention,7, 89-91)

Secondly, if we are interested in reducing in negative health consequences, then we need to consider all the effects of increased helmets as a whole. For example, there is evidence that, if helmet’s are made mandatory, cycle use decreases and that the negative effects of reduced physical activity outweigh any gains from reduced head injuries (de Jong, 2012, The health impact of mandatory bicycle helmet laws, Risk analysis, 75, 782-790).

The final point is a little more complicated. Whilst increased helmet usage may reduce head injuries within a population, what about for you as an individual? If the occurrence of severe head injuries occurring in common cycling crashes is reduced by helmet usage but certain uncommon ones are increased, then at a population level, there may well be a net positive effect, but if you’re one of those individuals with an increased risk, then that is little compensation. There is evidence that the probability of serious head injuries resulting from angular accelerations may be increased when a helmet is worn (see for example, Curnow, 2003, The efficacy of bicycle helmets against injury, Accident Analysis and Prevention, 35, 287-292). The theory being that firstly, making the head effectively bigger makes you more likely to hit it in a crash and secondly it increases the torque (turning force) by increasing the length of the lever for any applied force. These types of loadings are not examined in some of the research that has carried out direct measurements of head impacts with/ without helmets(and current helmet testing procedures) . The case for helmets reducing neck injuries is also much less strong. Further, there are strong suggestions that modern soft-shell helmets are more likely to suffer from these effects than older hard-shell ones (because the hard-shells are more likely to slide). So, if you are a rider in a situation where the common low-energy, ‘falling off’ type crashes are unlikely, then wearing a helmet could be more dangerous than not in the less common high-energy impacts. Potentially, leading to an increased overall risk.

My take on all this is :
Where there is a relatively high probability of low-energy impacts but less of high-energy impacts (i.e. off-road or in group riding situations or in general for less-experienced riders), wearing a helmet may make you, as an individual, safer and in these situations, I still where mine. However, as an experienced rider when the probabilities are reversed (e.g. commuting through traffic) I no longer wear my helmet.
I would therefore, also encourage others whose riding does not fit in the ‘exceptions’ case to wear a helmet, but based on the research, strongly oppose any form of compulsion.

nadimk wrote:

Don't people in England call physicians by their proper prefix,Dr., not Ms or Mr. Typical. Y.

No - because by tradition in the UK Consultants and Surgeons use the title Mr and Physicians use the title Dr. It's a mark of status. You would be insulting a Surgeon if you addressed him as Dr.

Why is that "Typical" btw?

Not only about fashion, but the associated matter, marketing and sales.
Where are all these people who fall off at "low speed"?
How did I manage to survive for years wearing only a "hairnet" type crash hat for racing, and the rest of the time nothing or a cotton cap?
How did my eyes survive without wearing protective sunglasses all the time?
Withou "health and safety" excesses, lots of us have managed quite nicely, and I have no recollection of excessive head injuries pre-helmet. Though if people want to wear them, taht's entirely their choice, as is the decision not to do so.
Organiser of sportives seem to think they can make it a condition of participation. Maybe that has some merit, as quite a lot of riders apparantly regard it as a "race". If they are happy wearing a helmet fine, my view is just rock up at the start, paid my money, no law being broken, off I go. In the hundreds participating who will notice?

It all comes down to this - if you feel safer and happier with a bit of plastic on your head that is designed to cope with 20 kph impacts, and may mitigate a glancing blow injury at higher speeds, then wear one.
With the cost of kit now, what's another £80-100 you might ask? I do ask, and have decided that perhaps it might be spent otherwise. My choice, quite simple.

Geoffroid wrote:

I think all cyclists should wear a full face motorcycle helmet. You can never be too careful.

I realise that was facetious but this was a debate we had in motor rallying years ago - full face vs. open face helmets. I would always ask - would you prefer to break your neck or your jaw?

Like the seat-belt debate this will run for years until there is enough data to make a convincing case one way or the other. But, also like the seat belt argument, I am convinced that the data will show that wearing a helmet significantly reduces the risk of serious injury. In the meantime I'll just belt-up

Carvers wrote:

@dullard - and vs the injuries caused by not wearing a helmet how do those stats stack up? That's all that i want to clarify, if it's 1/1,000 injury then is it worth raising? 1/10 is maybe worth worrying about, but I'm pretty sure the odds are stacked in your noggin's favour when you do wear a helmet

Nobody knows if there is a real risk from increased neck injury, or if the protective effect to the head outweighs that. There are too few accidents recorded, an absence of comparable helmeted and helmet-less populations, and the data captured isn't detailed enough. This is part of what makes this debate so eternal - there's no definitive evidence one way or the other, so we're reduced to make a series of assertions based on person belief of what seems reasonable.