Advocacy & Safety - Richard C. Senel, M.D. Why Motorcycle and Bicycle Helmets Should Be Mandatory

Stop a minute and look at the box that your latest computer or television came in. It's packed securely and safely in expanded foam similar to what helmets are made out of. Sony or Apple wouldn't think of shipping their product without this security, but we send our children out to play with less protection than a $100 DVD player. We must not be thinking clearly. The once nerdy white foam shell helmets now come in colorful and stylish designs that any child or adult would be proud to wear. You can protect your child for the $30 that you might spend on a pizza dinner. :thumb:

An interesting article by Richard C. Senelick, M.D.

http://www.huffingtonpost.com/richard-c-senelick-md/motorcycle-and-bicycle-he_b_786402.html

Here is the lede (or what should be):

"The period of time before and after 1977 gives a clear picture of what happens when you require people to wear a helmet. Deaths and serious brain injuries were significantly reduced by the use of helmets. A 1992 study in the Journal of Trauma compared helmeted and unhelmeted motorcycle accident victims. The chance of a severe brain injury was 66 percent in those without a helmet compared to 38 percent for those smart enough to wear a helmet. The cost of medical care for the unhelmeted was more than four times greater than those with a helmet and 44 percent of the medical care was paid out of public funds." (emphasis added)



In my libertarian days, I used to think that helmet laws were a good example of government overreach. Now that so much medical care is government-paid, it is clear that helmet laws save tax money. Call it nanny state if you want, but it's needed.

Once again Kerlenbach is spot-on. The unasked question, however, is whether pedestrians and motorists should be required to wear helmets, for the same reason. I recall a ca. 1960 design of driving helmets which looked like regular street hats and which were being proposed for John Q. Motorist. Improved restraints and airbags may have weakened the argument somewhat, but helmets still might protect car occupants in side collisions.

Dr. Senel seems to be basing his bicycle helmet recommendation on:

"We know that bicycle helmets reduce serious traumatic brain injuries by 95 percent, ..." (quoted from the referenced article)

Of course! Who wouldn't, if it were true? But those big number reduction claims have long been discredited. Where helmets have been made mandatory, reductions in head injuries have no where near kept up with the increases in helmet use. See for example...

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6V5S-43GBWNW-G&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6fb98f799a8b28c2fed09de18c5e3a3a

If bicycle helmet effectiveness is no where near the 95% claimed, what's the justification for mandatory use?

Speedo

Stop a minute and look at the box that your latest computer or television came in. It's packed securely and safely in expanded foam similar to what helmets are made out of. Sony or Apple wouldn't think of shipping their product without this security, but we send our children out to play with less protection than a $100 DVD player. We must not be thinking clearly. The once nerdy white foam shell helmets now come in colorful and stylish designs that any child or adult would be proud to wear. You can protect your child for the $30 that you might spend on a pizza dinner. :thumb:

An interesting article by Richard C. Senelick, M.D.

http://www.huffingtonpost.com/richard-c-senelick-md/motorcycle-and-bicycle-he_b_786402.html

Well, I counter this article (and analogy) with another (http://www.journeyman.cc/dogfood/story/article_20.html)


This note was written as a web page. If you're reading it on a web page, you're reading it on a computer. I'd like you to stop for a moment and think about that computer. When it arrived from its maker - possibly when you bought it - it was packed in a strong cardboard box. Inside the strong cardboard box was almost certainly some polystyrene foam packaging material. Probably at least 40mm of it, surrounding and protecting your computer from the inevitable bumps it would incur in transit - bumps like being dropped from someone's hands onto the warehouse floor, or thumped up against another, similarly packaged computer.

By and large, for these sort of bumps, the packaging works, and your computer probably arrived home safe and sound.

Now think about your bicycle helmet. Like the packaging your computer came in, it is worn to protect a very valuable object - your brain. Like the packaging your computer came in, it is made of polystyrene foam - and typically it's a good bit less than 40mm thick.

I would like you to stop again, and think about the box your computer came in. I'd like you, as a thought experiment, to imagine taking your computer, putting it back it in its original box, and placing the box in the middle of the street. Now I want you to imagine getting into a car and driving into the box at just thirty miles an hour. You've imagined that? Good. Now do you think you would be able to use the computer afterwards?

Polystyrene foam is just polystyrene foam. Polystyrene foam is a light, weak, compressible solid which rapidly becomes brittle with age and is easily damaged by solvents. It doesn't become magically stronger just because it's formed into a cycle helmet. The same foam that didn't protect the computer in the thought experiment is equally not going to protect your head in similar circumstances.

Dr. Senel seems to be basing his bicycle helmet recommendation on:

"We know that bicycle helmets reduce serious traumatic brain injuries by 95 percent, ..."

Which we all know is absolute bunk, yet there are those who swear on stacks of bibles that it's true, despite evidence to the contrary.

Another Kool-Aid drinker who pulls out the same discredited numbers and revisionist history.

From the motorcycle side, I'll bet they try hard to ignore the study that said full-face helmets (like the pic in the article) can act as a 'guillotine' of sorts, transferring facial impact directly to the spine and severing the spinal cord at the base of the skull, causing immediate death. Read that one in '93. And when he stated that it's a 'fact' that most motorcycle injuries are at the public's expense, I knew we were dealing with a mouthpiece for the pro-helmeters out there.

Anybody else ready for the lies to stop?

In my libertarian days, I used to think that helmet laws were a good example of government overreach. Now that so much medical care is government-paid, it is clear that helmet laws save tax money. Call it nanny state if you want, but it's needed.

Helmet laws like those in effect in Australia levy a substantial cost on healthcare systems because savings from fewer head injuries pale in comparison to the costs incurred by decreases in cycling, a mathematical model concludes. (http://www.newscientist.com/article/dn17032-bicycle-helmet-laws-could-do-more-harm-than-good.html)

So we want to save health care cost.

What are the health cost for a motorcyclist that dies on the road from not wearing a helmet - $0.
What are the health cost for a motorcyclist that lives with life long disabilities by wearing a helmet - often over $1,000,000.

For the sake of saving health care cost, we should encourage motorcyclist to ride without helmets.

In my libertarian days, I used to think that helmet laws were a good example of government overreach. Now that so much medical care is government-paid, it is clear that helmet laws save tax money.....

No it is not clear at all. Evidence suggests that bicycle helmet laws cost society more money than they save. Cycling is *healthy* and good for society whether helmets are used or not.

Even if bicycle helmets did save tax money (evidence suggests they don't) a mandatory helmet law could never save more than a tiny fraction as much as would a law against being overweight or eating junk, for instance. If saving tax money really is your goal, then you should focus on policy that could actually have a measurable impact on public health costs.

So, you're all for government determining what we can and can't eat, right? Why or why not.

The best reason for a helmet I have ever found ... :twitchy:

http://miami.whosarrested.com/assets/mugshots/000/169/050/images/large.jpg

http://miami.whosarrested.com/assets/mugshots/000/169/051/images/large.jpg

Hold on I'm going to post a picture of an obscenely obese person on a government sponsored scooter about to have a government sponsored stroke.

oh here ya go

http://www.industrializedcyclist.com/wedysdrivethru.jpg

Yes, it's clearly beneficial for cyclists and motorcyclists to wear helmets; but the ultimate question is why not motorists too? I'll tell you why - because if motorists had to wear helmets, it would piss-off a lot of women and a lot of politicians and therein lies a prime example of the shear bigotry of so many aspects of our society. Oh, we simply can't have a rule that would piss-off all those women. The laws should have been bundled together:- do we want helmets for everyone or no-one? Not some minority that can be easily oppressed. A similarly stupid law would be to legislate for black people to wear helmets; or mexicans, or people in wheelchairs!

Research by Dr. Mayer Hilman (UK) into cyclist head injury fatalities (can't find the source, unfortuantely) showed that about 92% of those who died from brain injury would have died anyway from other, less immediately threatening injuries. He estimated that only about 6 UK riders would have their lives saved p.a.

If you are hit by a motor vehicle, especially coming from the opposite direction, with a collision speed in excess of 30mph, the standard helmet will protect you somewhat, from about 12/14mph of the impact. However, you may:
1. flip up over the hood, hit the windscreen with your head and break your neck (death/paralysis)
2. flip right over the car (possibly ditto) and be run over by following vehicle
3. splat into the windscreen of a 40 ton truck (a 30mph to stop or even 30 mph one way to 30 mph in the opposite direction) in which case the force of the impact may sever a major blood vessel (aorta, anyone), push your ribcage thro' your lungs/heart/blood vessels/cause massive internal haemorrhaging, etc)
4. go over the hood of the car/pickup and land rolling on the other side with only relatively minor injuries
5. the aerodynamic rear of a fancier helmet may catch the ground/vehicle and spin your head round causing spinal/brain shaking injuries
6. land on your face pushing your nose up into your frontal cortex
7. etc., etc.

I always wear a helmet to save me from minor damage but prefer to avoid putting the helmet to the test by avoiding being hit.

The carefully researched British Medical Assoication study, Cyclng & Health, showed that the benefits of cycling as little as 4 miles daily were about 20 times more likely to extend your life span by keeping you healthy than you were to die in a traffic collision.

By the way, jumping off the ridgeline of a 2 storey house is the equivalent of a 30 to zero crash. Fancy relying on a helmet to keep you alive if you go off head first?

For the sake of this discussion, I don't care about what people eat, what pedestrians, car drivers or passengers wear, what you wear when you jump off the house, or any such things. Most bike crashes are simple affairs: clip-out failure, scraping a curb and falling, hitting a pothole, or maybe a bump from a car. In each you will fall with varying degrees of force from the bike, and there is a good chance of hitting your head. I would much prefer hitting my head with a bike helmet on, than not. I would prefer not having the accident in the first place, but as Lance said, if you're afraid of falling off the bike, don't get on it. For the more serious and less likely accident - getting hit by a car at speed, etc. - a helmet won't help, nor will anything else other than avoiding the crash.

There is a good chance, when riding a few thousand miles a year on the road, that at some point I will have a significant crash that will bounce my head off the ground. Maybe the helmet will save me from a knot, maybe from a fracture, maybe from a subdural hematoma, or maybe from nothing at all. I am not convinced that drivers behave less safely around me because I have a helmet, and I do not believe that I take more risks because I have a helmet. It's also possible that a helmet could cause one kind of injury while preventing a different one (Seatbelts help preserve your face, chest and head at the expense of your neck and back - I'll take whiplash over smashing into the windshield any day.) Those things are possible, but unlikely. So as I said in a previous post, the cost of wearing it is minimal, while the benefits are significant.

no one is saying that there should be a ban on helmets and wearing one should be illegal. This article is saying that there should be a law for people to wear bicycle helmets and to not wear one should be illegal. That's quite a difference, so this proposal has to be justified.

The justification for this lies in the belief that bicycle helmets reduce all serious TBI by 95%, which know is not true. We also know that the toll of injuries of people on bikes is no greater than those same injuries to others who are not riding bikes, so there is no justification of need for a law.

Further, helmet laws have been around for quite some time and we know what happens when they get passed. The publics health suffers while head injuries to cyclists continue. The blind eye to these facts by the author is not shared by others, so more often than not, mandatory helmet laws are defeated and choice is retained.

I favor motorcycle helmet laws and children's bike helmet laws. Adult bike helmet laws probably would do more harm (discouraging adult causal riders, encouraging discriminatory enforcement) than good (reducing/eliminating an occasional head injury).

There should be a law that mandates every man should wear a cup.

I think we need better enforcement of laws that prevent deaths and serious injuries to cyclists.

Motorists get away with causing serious injury and death, and then place the blame for these deaths on cyclists because the "should have been wearing a helmet"

It seems to me that unless a law is going to be enforced there is no point writing it at all.

In the UK the police appear unable or unwilling to enforce the prohibition on using handheld mobile phones while driving. Just about every day I'm out (on foot or by bike) I see people using their phone while driving. If the police cannot enforce this what hope do they have of enforcing legislation requiring cyclists to wear helmets?

It seems to me that unless a law is going to be enforced there is no point writing it at all.

At least with what I casually observe, it seems to have an effect on tort cases.

... Most bike crashes are simple affairs: clip-out failure, scraping a curb and falling, hitting a pothole, or maybe a bump from a car. In each you will fall with varying degrees of force from the bike, and there is a good chance of hitting your head. I would much prefer hitting my head with a bike helmet on, than not. ...For these type of accidents, you would be much better off not hitting your head in the first place rather than relying on a helmet. May I suggest going back to grade school and learning to tuck your chin into your chest when you go to ground. It works extremely well.

It seems to me that unless a law is going to be enforced there is no point writing it at all.

In the UK the police appear unable or unwilling to enforce the prohibition on using handheld mobile phones while driving. Just about every day I'm out (on foot or by bike) I see people using their phone while driving. If the police cannot enforce this what hope do they have of enforcing legislation requiring cyclists to wear helmets?Easy, London has had several crackdowns of scofflaw cyclist. Cyclist are easy political targets.

Easy, London has had several crackdowns of scofflaw cyclist. Cyclist are easy political targets.

I've never observed such a crackdown. I've had to take evasive action to avoid the usual antisocial cyclists who plough through red lights at pedestrian crossings even when pedestrians are crossing, seen a number of cyclists travelling at speed on pavements (sidewalks) etc.

The problem with crackdowns on cyclists is that the cyclist who is generally responsible but once in a while takes a shortcut (e.g. using the pavement for a short distance when no pedestrians are using it) is more likely to cooperate with the police, while the antisocial cyclist who doesn't care about rules at all and considers the world to be their personal racetrack will simply ignore the police and cycle away. In the absence of any form of registration of bicycles there is little the police can do, unless they are a position to give chase.

At least with what I casually observe, it seems to have an effect on tort cases.

Perhaps, but when laws are implemented with at least the stated aim of improving safety I'd rather see the improvement in safety than an increase in prosecutions. It's all very well having something extra to hit an errant driver with after they cause an accident, but the fact the accident happened in the first place shows the law failed in its stated aim.

http://www.lcc.org.uk/index.asp?PageID=1057

Ah, a one-day crackdown in one small part of London. Perhaps this was a successful venture, certainly I never noticed anything like that during my years of regularly passing through that area.

Even so it would still seem that a cyclist who does not wish to cooperate with the police can escape fairly easily, unless an individual police officer cared to give chase through the crowded streets. Just as a cyclist violating any law requiring a helmet to be worn could escape... or of course they could claim it was stolen while they were out and they were riding home.

...So as I said in a previous post, the cost of wearing it is minimal, while the benefits are significant.

Nice backpedal there. What you said in your previous post was something very different -- that laws compelling people to wear helmets would "save tax money."

No it is not clear at all. Evidence suggests that bicycle helmet laws cost society more money than they save. Cycling is *healthy* and good for society whether helmets are used or not.
This kind of "evidence" is as bad as the pro-helmet "evidence". It's easy to spin these kinds of numbers to support your favorite conclusion.

Helmet laws like those in effect in Australia levy a substantial cost on healthcare systems because savings from fewer head injuries pale in comparison to the costs incurred by decreases in cycling, a mathematical model concludes. (http://www.newscientist.com/article/dn17032-bicycle-helmet-laws-could-do-more-harm-than-good.html)

Nudge a few parameters in the "model" and you'd be able to reach the opposite conclusion.

While there's some value in these kinds of studies, people should not read too much "certainty" in them.

Here we have the standard caveat that indicates that the study might not represent the real world. (I don;t think that you can't really get good enough numbers, which means that treating things which try as a bit suspicious is reasonable.)


Precise numbers on the costs and benefits of cycling and the use of helmets are hard to come by and often contentious.

The following is the typical fault of these kinds of "models".


Pless, though, contends that de Jong's model overvalues the health benefits of recreational cycling.

Then, the author rather dismisses the whole thing at the end!


However de Jong, a native of bike-loving Holland, makes clear that he would not discourage people from wearing helmets. "I go to Holland and places like that, and I don't wear a helmet," he says. "I used to live in London, and I wore a helmet all the time."

For these type of accidents, you would be much better off not hitting your head in the first place rather than relying on a helmet. May I suggest going back to grade school and learning to tuck your chin into your chest when you go to ground. It works extremely well.

It has nothing whatsoever to do with "relying" on a helmet. Crashes happen fast. Sometimes there is time and the presence of mind to tuck and roll, sometimes not. Regardless of whether I have on a helmet, I will try to hit the ground properly. Doesn't it make more sense to do both, than to "rely" on your ability to protect your head in a crash?

It has nothing whatsoever to do with "relying" on a helmet. Crashes happen fast. Sometimes there is time and the presence of mind to tuck and roll, sometimes not. Regardless of whether I have on a helmet, I will try to hit the ground properly. Doesn't it make more sense to do both, than to "rely" on your ability to protect your head in a crash?Do you wear a helmet when you drive a car?

Nice backpedal there. What you said in your previous post was something very different -- that laws compelling people to wear helmets would "save tax money."

The tax saving are more applicable to motorcycle helmet laws, because those accidents are more likely to cause expensive (in terms of medical costs) head injuries (read the OP's linked article). No backpedling here. Whether adult bicycle helmet laws would save tax money is probably incapable of being determined, but I think pretty clearly would discourage casual cyclists.

There should be a law that mandates every man should wear a cup.
Especially when going to the airport for a TSA pat down.

Ah, a one-day crackdown in one small part of London. Perhaps this was a successful venture, certainly I never noticed anything like that during my years of regularly passing through that area.

Even so it would still seem that a cyclist who does not wish to cooperate with the police can escape fairly easily, unless an individual police officer cared to give chase through the crowded streets. Just as a cyclist violating any law requiring a helmet to be worn could escape... or of course they could claim it was stolen while they were out and they were riding home.http://www.bikeradar.com/road/news/article/400-cyclists-fined-in-london-crackdown-27937/

Do you wear a helmet when you drive a car?

You seem to have an unusually absolutist view of things. No, I do not wear a helmet in the car, but I do wear a seatbelt. The goal is to reduce risk; it cannot be eliminated. Bike helmets reduce risk for a very small cost. The only way to eliminate the risk of cycling is not to do it - the same is true with driving. Wearing a helmet while driving would make only a small marginal increase in safety at a rather high cost in comfort. But there is a reason race car drivers wear helmets. The difference between high speed driving and normal highway driving makes the risk reduction caused by wearing a helmet a sensible choice.

http://www.bikeradar.com/road/news/article/400-cyclists-fined-in-london-crackdown-27937/

All well and good... all I can say is that I've lived in London for the last 15 years and have never seen any signs of any police crackdown on cyclists.

They may be out and I hear anecdotal evidence of the odd cyclist being caught and fined, usually for a minor infraction that made no difference (e.g. a friend was fined £30 for "cycling on the pavement" when what he did was used a short section of empty pavement to avoid heavy traffic), but if there is, or has been, such a crackdown it's certainly news to me.

... Whether adult bicycle helmet laws would save tax money is probably incapable of being determined, but I think pretty clearly would discourage casual cyclists.

Since cycling benefits health rather than risks health, any discouragement of it costs society money.

... The goal is to reduce risk; it cannot be eliminated...

... and wearing helmets is one of the more ineffective ways to reduce risks to cyclists, yet to many it seems it is very effective. That is because they have a poor grasp of the issue. It's not because there isn't merit in wearing a helmet, it's just that the benefits are far less than many believe.

* and to be fair, it really isn't that many that believe helmets are effective protection. World-wide helmets are a rarity. Use is concentrated in counties in which helmet companies are located and bicycle use is low. It really hasn't spread too much in Asian and European countries and even in the States and Canada, fewer than half of all cyclists wear them *

It has nothing whatsoever to do with "relying" on a helmet. Crashes happen fast. Sometimes there is time and the presence of mind to tuck and roll, sometimes not. Regardless of whether I have on a helmet, I will try to hit the ground properly. Doesn't it make more sense to do both, than to "rely" on your ability to protect your head in a crash?


Two points. 1) it has nothing to do with presence of mind because there is no time to think. Either your body knows how to fall, or it doesn't. You can try to teach your body to do it by studying judo or aikido or something like that, but some people are just too unathletic and too uncoordinated to avoid injury. Apparently I'm good at it because I've managed to fall thousands of times while skateboarding in pools and ramps and downhill without hitting my head, and have even flown over the bars helmetless on motorcycles without hitting my head at all, but 2) with a big helmet on my head it is basically impossible to avoid hitting it: it just takes up way too much space to tuck it out of the way.

It has nothing whatsoever to do with "relying" on a helmet. Crashes happen fast. Sometimes there is time and the presence of mind to tuck and roll, sometimes not. Regardless of whether I have on a helmet, I will try to hit the ground properly. Doesn't it make more sense to do both, than to "rely" on your ability to protect your head in a crash?


You seem to have an unusually absolutist view of things. No, I do not wear a helmet in the car, but I do wear a seatbelt. The goal is to reduce risk; it cannot be eliminated. Bike helmets reduce risk for a very small cost. The only way to eliminate the risk of cycling is not to do it - the same is true with driving. Wearing a helmet while driving would make only a small marginal increase in safety at a rather high cost in comfort. ...According to you "Doesn't it make more sense to do both".

On helmets, you sound very hypocritical to me.

Which is more uncomfortable, a head injury or wearing a helmet. Therefore, by your own measure, you are a hypocrite if you do not wear a helmet when driving a car.

On helmets, you sound very hypocritical to me.

If you will agree call a professional driver who wears a helmet while racing, but not while driving on the highway, a hypocrit, I will agree to plead guilty to exactly the same hypocrisy.

If you will agree call a professional driver who wears a helmet while racing, but not while driving on the highway, a hypocrit, I will agree to plead guilty to exactly the same hypocrisy.So your position now is that only professional cyclist need wear helmets while they are racing and you are OK with them not wearing helmets in none race rides? As well as non-professional riders never wearing helmets.

That is a significant reversal in position.

There is a good chance, when riding a few thousand miles a year on the road, that at some point I will have a significant crash that will bounce my head off the ground.

^^ This is the key piece of unfactual information that the entire mandatory helmet argument is built upon.
If you ride in a manner that guarantees " a good chance" that you'll have a significant crash causing a head injury in a few thousand miles, you definitely need a helmet.
Sorry to break it to you, but everyone does not share your handicap though.

Edit: of course having spent quite a bit of time riding down there when visiting my ex, kids and grand kids, I can see why you have this perception of greater danger.

Do you wear a helmet when you drive a car?

Yes I do ... especially at the track!

http://data.cyclegiant.com/pgroups/29883_image1.jpg

This kind of "evidence" is as bad as the pro-helmet "evidence". It's easy to spin these kinds of numbers to support your favorite conclusion.

There is a lot of really soft data on all sides, no doubt. However, I would argue that the preponderance of evidence, that I have unfortunately spent a lot of time perusing, points to bicycle helmets being ... non-beneficial to society. Not only is there inconclusive evidence, the issue is complex, especially considering the different yet interlocking consequences of helmet use for children versus adults.

There is a lot of really soft data on all sides, no doubt. However, I would argue that the preponderance of evidence, that I have unfortunately spent a lot of time perusing, points to bicycle helmets being ... non-beneficial to society. Not only is there inconclusive evidence, the issue is complex, especially considering the different yet interlocking consequences of helmet use for children versus adults.

But if it wasn't for the need for some to ensure everyone makes the same choices that they do, bicycle helmets would be much more neutral to society. I really, really, really, think it highlights a flaw in humanity in general that this is even a debate, rather than a simple "wear one if you want to, don't if you don't" nobrainer.

There is a lot of really soft data on all sides, no doubt. However, I would argue that the preponderance of evidence, that I have unfortunately spent a lot of time perusing, points to bicycle helmets being ... non-beneficial to society.

I would disagree as you've phrased it -- bicycle helmets do offer modest benefits.

Bicycle helmet laws, on the other hand, are clearly detrimental to public health.

Conflating helmets and helmet laws is a classic tactic of the pro-helmet-law activists, as if the only way to promote anything beneficial is to mandate it. Even if bicycle helmets could prevent 100% of all cycling-related injuries, that's not sufficient by itself to support mandating helmet use.

Well, it's clear that enforced helmet laws are detrimental to the overall public health. But it is also questionable that helmets themselves are detrimental (the rotation argument, the bigger target argument, risk compensation argument, changes in driver behavior, etc.)

I would disagree as you've phrased it -- bicycle helmets do offer modest benefits.

Bicycle helmet laws, on the other hand, are clearly detrimental to public health.....

It could also be the case that the very existence of the bicycle helmet, law or no law, detracts from overall public health, even as it provides benefits to individuals who use one.