Keeping safe and being seen on the road

[CharleyFarley]

I'd like to know why my comments are now being held for moderator approval. I'm not aware that I've been rude to anyone, or incited any kind of trouble.

 

[matticus]

Seems an odd assumption.

Ah - then I apologise for making it. So why else would you think they had any knowledge or expertise in the matter?

 

[SpokeyDokey]

I'd like to know why my comments are now being held for moderator approval. I'm not aware that I've been rude to anyone, or incited any kind of trouble.

Mod note:

All posts in this sub-forum are moderated.

For reasons why; please see the sticky topics at the top of the forum thread list.

Many thanks.

 

[Alex321]

The wearing of bike helmets is evidently a controversial issue.

It is.

It shouldn't be, but people tend to conflate multiple points and lump them together.

I don't think there is any real doubt that if involved in a crash, a helmet will reduce the chance of head injury, or reduce the severity of head injuries sustained.

But that then leads some people to suggest they should be mandatory, which is where the controversy comes in.

Because once you start making them mandatory, that immediately acts to discourage cycling, and statistically, overall, that results in worse health outcomes because of the rarity of cyclists actually being involved in such crashes.

There is also an argument that wearing a helmet may make you less risk averse, and so while each crash is less likely to cause head injury, you are more likely to get involved in crashes to start with.

And then there are also the "binary" arguments which IMV are a complete red herring, where people say things like "you are better off making sure you are seen" as if that is an either-or choice, when they aren't. Or "It is the car driverrs who are responsible" as if that means we aren't going to be injured if it isn't "our fault".

For the avoidance of doubt - I strongly prefer to wear a helmet, and hardly ever ride without one. But that is my personal choice, and I do NOT support making them mandatory for adults, and would be very dubious about doing so for children.

 

[mjr]

I don't think there is any real doubt that if involved in a crash, a helmet will reduce the chance of head injury, or reduce the severity of head injuries sustained.

I think even that is too general, overstated and beyond the current consensus. It would be better to say that if you hit the top of your head, a helmet will reduce the impact severity.

Helmet use probably doesn't reduce the severity of head injuries such as concussion (some US helmet makers are worried enough to include a warning in the manual that it isn't an anti-concussion device), it might not reduce the chance of head injury in a crash (because of basic geometry as outlined by @Profpointy: a bigger target gets more hits), and if you hit outside the tested zone (the "top of your head" I mentioned) then basically it's pot luck and you might get some cushioning or an edge part of the helmet may break off and stab you (which I've seen happen, but don't worry, it was only a cut, not serious).

But that then leads some people to suggest they should be mandatory, which is where the controversy comes in.

That's just an extra, bigger controversy. The controversy already enters when helmet users massively overstate the protective effect and/or underplay the drawbacks, often making claims that go far beyond ones that Advertising Standards allow helmet makers to make.

 

[icowden]

Ah - then I apologise for making it. So why else would you think they had any knowledge or expertise in the matter?

I understand that they do have extensive training vis a vis head injuries. The bit that the helmet is protecting. Thus I suspect that they may have some opinions as to the effectiveness of the thing protecting the person that they are fixing and some knowledge as to whether they see fewer head injuries to people wearing cycle helmets as opposed to not. There are even protocols around helmet removal.

 

[matticus]

I understand that they do have extensive training vis a vis head injuries. The bit that the helmet is protecting. Thus I suspect that they may have some opinions as to the effectiveness of the thing protecting the person that they are fixing and some knowledge as to whether they see fewer head injuries to people wearing cycle helmets as opposed to not. There are even protocols around helmet removal.

Like you, they will have opinions ...

 

[matticus]

Look, the reason for medics pusihing helmets is very simple:

Like most people in the UK, they believe helmets are an essential protection for the modern cyclist.

Take an average medic before they start their training, and they will believe the same.

NHS staff tend to give you advice they believe to be good for your health, so it's hardly surprising they'll tell you to wear a helmet!

 

[mjr]

some knowledge as to whether they see fewer head injuries to people wearing cycle helmets as opposed to not.

Well of course they will see fewer injured helmet users, because they're a minority. I doubt any individual practitioner know if the proportion they see is significantly different to usage in their area.

 

[icowden]

Like you, they will have opinions ...

Which is literally what I said...

Ask an A&E doctor whether cycle helmets are almost entirely ineffective. I think you may find they will disagree with you.

So, I'm struggling with your response.

Of course, for evidence we could look at the BMJ study by Dr Nick Dodds, Professor Rowena Johnson (Consultant Radiologist), Dr Benjamin Walton (Consultant Anaesthetist specialising in major trauma) and Dr Julian Thompson (Consultant Anaesthetist and Major Trauma specialist) who worked on this 2019 study published in the BMJ
https://bmjopen.bmj.com/content/9/9/e027845

I tend to go with the doctors rather than the helmet designers.

 

[matticus]

Which is literally what I said...

Ask an A&E doctor whether cycle helmets are almost entirely ineffective. I think you may find they will disagree with you.

So now we've shown and all agreed that these are just opinions, and it's not surprising that A&E doctors on average* have the same view as Joe Public. Why do you think a random opion poll is of interest, or indeed any use in this discussion? Does that answer why:

So, I'm struggling with your response.

*do note that plenty of A&E staff are also sceptics. When I had my forehead stitched-up post RTA, hardly anyone mentioned helmets, across the many staff I dealt with. Most of them don't care how you got hurt - their job is to patch us up. Hurrah!

 

[Alex321]

So now we've shown and all agreed that these are just opinions, and it's not surprising that A&E doctors on average* have the same view as Joe Public. Why do you think a random opion poll is of interest, or indeed any use in this discussion? Does that answer why:

It is not remotely a "random poll". These people have regularly seen cyclists coming in with a variety of injuries. They aren't just opinions based on guesswork, or what has happened to one individual.

And of course, you completely ignored the BMJ research linked in the post you responded to (and in another post by myself). That is not opinions, it is statistical evidence, with a significant sample size.

 

[matticus]

Alex, if these people were wisely dispensing advice on the basis of the injuries they see, they would be campaigning strongly for car passenger helmets.
They are not.

I also doubt they are conducting any statistically sound studies; we have seen from innumerable PROPER studies how hard it is to find strong effects from helmet-wearing, so the idea that busy A&E staff can do better is laughable.

It is not their job to assess cause and effect, and they are not trained to do so (it would be pretty hard given they never see the cause of injuries!). It's like asking a car bodyshop technician about safe driving techniques.

 

[mjr]

Which is literally what I said...

So, I'm struggling with your response.

Of course, for evidence we could look at the BMJ study by Dr Nick Dodds, Professor Rowena Johnson (Consultant Radiologist), Dr Benjamin Walton (Consultant Anaesthetist specialising in major trauma) and Dr Julian Thompson (Consultant Anaesthetist and Major Trauma specialist) who worked on this 2019 study published in the BMJ
https://bmjopen.bmj.com/content/9/9/e027845

I tend to go with the doctors rather than the helmet designers.

Firstly, the study has the usual problem that it only considers those who have crashed and been injured badly. It may be that helmet use increases crash risk or severity.

Secondly, there's several odd things in that data set: the helmet use to non-use is almost exactly the opposite of the last official statistics; the injured riders are disproportionately male, 85+% when I think it's 65-70% in the whole cycling population; and the non-users are massively more drunk, 15+% of them compared to 2% of users. This is waved away with the single sentence "It is also assumed that populations of helmeted and unhelmeted cyclists are similar, when other studies have demonstrated (although for a paediatric population) that this is not the case" rather than explored further.

Then there's the big question of how many incidents were even within the design parameters of cycle helmets, rather than being things like collisions. I don't think that's even in the data.

This study is too limited, with too many red flags, to be useful evidence about helmet use in general. It in no way "provides a strong association between the wearing of a cycle helmet and a significant reduction in brain injury," contrary to the authors' claim. It might say something, but the differences between the user and non-user populations seen would have to be taken into account.

It's reminiscent of comparing helmet using well off park hobby cyclists with poorer inner city utility riders.

 

[Alex321]

Firstly, the study has the usual problem that it only considers those who have crashed and been injured badly. It may be that helmet use increases crash risk or severity.

Secondly, there's several odd things in that data set: the helmet use to non-use is almost exactly the opposite of the last official statistics; the injured riders are disproportionately male, 85+% when I think it's 65-70% in the whole cycling population; and the non-users are massively more drunk, 15+% of them compared to 2% of users. This is waved away with the single sentence "It is also assumed that populations of helmeted and unhelmeted cyclists are similar, when other studies have demonstrated (although for a paediatric population) that this is not the case" rather than explored further.

Then there's the big question of how many incidents were even within the design parameters of cycle helmets, rather than being things like collisions. I don't think that's even in the data.

This study is too limited, with too many red flags, to be useful evidence about helmet use in general. It in no way "provides a strong association between the wearing of a cycle helmet and a significant reduction in brain injury," contrary to the authors' claim. It might say something, but the differences between the user and non-user populations seen would have to be taken into account.

It's reminiscent of comparing helmet using well off park hobby cyclists with poorer inner city utility riders.

That study shows that IF you are involved in a smash with injuries bad enough to require hospital treatment, THEN the likelihood of head injury or even death is significantly reduced if you were wearing a helmet. That is all it shows. It says nothing about likelihood of getting into a crash in the first place, or about overall severity of injuries.

It is absolutely a possibility that wearing a helmet increases crash likelihood. I personally believe it has no effect on the amount of risk I am prepared to accept - but that is totally subjective, and it is possible I am wrong - it is even more possible that while many will not take more risk, enough will to be statistically significant.

Not too sure how it would increase severity, while those numbers are showing the opposite.

I'm not surprised at all by what you are describing as "anomalies" in their data.

Males (and particularly young males) are generally accepted to be more risk-prone (which is why their car insurance premiums are higher - nor were until outlawed), so I would expect more injured male riders than the proportion of males in the overall riding population.

I would also expect far more drunk riders to forget to put on their helmet, if they normally wear one, which would probably be enough to explain that figure.