John C. Ratliff

Charles, you have put together an incredible website. Thanks for the opportunity to see it. I enjoyed both of the My Tube videos too. It looked to me like a vision of "what could have been," and "what could be in the future," if we can get more cyclists on the roads and less in their cars. I was struck by the lack of vehicular traffic that the cyclists encountered in the videos.

There was one statement in the lower video of the touring group that really struck me, and I'd like to throw it out to this group. The narrator was talking about the English in history, and probably by analogy the touring group too. He said "...That's no-nonsense--we get rid of our enemies by making them our friends..." I think that we need a bit more of that here.

John

trombone

I laughed when I read the last sentence of the report you quoted. This is a study which indicated that 100% of the accidents where riders wore helmets were fatal. How on earth can you jump from that to the conclusion of the last sentence? This type of faulty logic is typical of these types of studies. Usually they arrive at this conclusion by looking at the accidents suffered by non-helmeted cyclists, and making assumptions about how many of them would have had a better outcome had the cyclist been wearing a helmet. This is a highly speculative exercise at best, and is further compounded by the fact that in many cases (and I don't know if it's the case in this specific example) the estimates of whether a helmet would have helped in those cases is based on the wildly optimistic percentages in papers such as the discredited one already discussed.

I'd be very interested, John, if you have any studies in your file which:
- properly control for variables including socio-economic, age and gender in the control cell
- properly control for the risk exposure (ie where necessary include data on the numbers of cyclists / amount of cycling undertaken on the roads pre and post helmet legislation or promotion, where appropriate, or between data cells)
- do not rely on speculation of how many non-helmeted cyclists involved in accidents might have been better off wearing a helmet

There are other variables which should also really be controlled for, but those three will do for a start. It's a genuine question which I hope you can help with. To date, I've yet to see a study which actually manages just these three.

John C. Ratliff

You raise good points about the control of these studies. But in this case, please recognize that they did discuss age differences in this study. I don't think that they were controlling for socio-economic differences, but this was in Belgium too, which may not be so stratified as are we (don't know, just that it's a different culture). Concerning the three fatalities documented with helmets out of the 86 total (in twenty-some injuries, they could not tell whether there was a helmet or not), on one of them they had an eyewitness who stated that the helmet was dislodged slightly before the fatal collision. The writers did feel that helmet wearing would have helped some, and that is from the physicians and surgeons that did the work on these people. When I get home, I'll try posting all of their remarks on helmets. Again, it helps to read the studies fairly thoroughly.

Concerning the other studies, I'm not sure that any of the ones I've printed out meet your criterion. It is possible that some that I have not yet read, for which I've posted abstracts, may though. If I get some time, I'll check.

John

trombone

Thanks; I appreciate your time going through the studies.

There is some precedent for studies which fail to adequately control variables becoming the basis of public policy, only later to be shown to be erroneous. One such case is HRT in women. For many years, it was accepted that taking HRT lowered the risk of coronary disease; indeed that few still abounds in some places, for example here. Doctors were told to recommend HRT to patients on the basis of this protection alone. However, it was later shown that this was in fact not the case, and that HRT offers no protection against heart disease. How did this happen? None of the original studies properly controlled for socio-economic variables. It turned out that women in higher income groups tended to be at less risk of heart disease (perhaps as a result of healthier lifestyle choices), and they were also the group that tended to (and could afford) HRT. In many studies undertaken, the control cell of 'women not taking HRT' was affected by this bias (reflecting also the difficulty in selecting suitable control cells), leading to a correlation being mistaken for causality. When these effects were properly controlled for, the effect was no longer apparent.

John C. Ratliff

trombone,

In the case that you discuss, the link states information from Goodman & Gilman, 11th Edition, about HRT. My wife is a hospital pharmacist and pharmacotherapist, and she says that by the time these texts get printed, they may have entries that are out-of-date. We subscribe to the New England Journal of Medicine for that purpose--keeping up-to-date.

The same goes for these studies that keep getting quoted here--they become out-of-date when new studies are published. Yet we keep re-visiting them, and arguing the same issues over and over. That is why I go to the PubMed.gov site to see new studies. It is really revealing, as the body of knowledge keeps growing.

On the study of 86 cases quoted above (Depreitere, et al, 2004), they had recommendations for fuller coverage of the head by bicycle helmets, especially the frontal and temporal regions of the head.

The study come from these records: "Between January 1990 and June 2000 86 pedal cyclists underwent a neurosurgical intervention for head injury in the University Hospital of Leuven. The medical records were reviewed and the computer tomography (CT)-scans of the head and the skull X-rays were studied. All possible traumatic skull and brain lesions were studied..." They also sent out questionnaires to those who survived, and got 59 responses. So they did a pretty complete job on this study, but realize that their cases were people who had undergone neurosurgical intervention.

Their Table 1 was illuminating, as it showed that of the 86 cases, 74 (86.0%) had a skull fracture. Of those without a vehicle involved (Number=42), 39 (92.9% involved a skull fracture. Of those with a motor vehicle involved (Number=44), 35 (79.6%) had a skull fracture. Extracerebral hoaematoma of the total group (N=86) was 34 (39.5%); acute subdural haematoma, 29 cases for 33.7%; contusion, 63 cases for 73.7%; intracerebral haematoma (arising from contusion), 15 cases for 17.4%; basal ganglia intracerebral haematoma, 1 case for 1.2%; gliding contusion, 5 cases for 5.8%; diffuse axonal injury, 11 cases for 12.8%; subarachnoid haemorrhage, 45 cases for 52.3%; intraventricular haemorrhage, 11 cases for 12.8%; and brain swelling, 66/80 for 82.5% (apparently, there were some fatalities where this would not appear). The point here is that the diffuse axonal injury, which should be what is the biggest danger according to some on this forum, only registered 11 cases of these 86 cases (12.8%), and gliding contusion 5 cases (5.8%). There is a lot more to this table, which I will not reproduce because of copyright problems, but which all of you should see. It was from these results that the authors made the recommendations on helmets. Yes, they do state "THe question arising from this is whether bicycle helmets are capable of offering any protection in such collisions," referring to bicyclist/auto collisions. But they do call for more helmet usage, based upon their findings.

Depreitere has followed this up with another study:

This study does not mean not to wear helmets, but that there are certain regions that the helmets do not completely protect because of lack of coverage. I do know, as a result of an analysis of my own injuries from my last bicycle accident, that if one tucks his/her head in these kind of accidents, then contacts the roadway, the bicycle helmet does protect the temoral region of the head. The helmet and the shoulder take the impact, which is shown on my helmet and the abrasions/contusions on the top of my shoulder (now scars).

I have switched helmets because of this study, to a hard-shell design which has better coverage.

John

charles vail

John,
I have a V2 recumbent too as well as too many "safety bicycles"! And yes.....there have been accidents and some of these millions have been severely injured and even killed. The high wheelers were more dangerous and about like falling off a horse. I do wear a helmet but I am not under any delusions that it will help much, if at all, in a severe impact. For that reason, I ride like a ninny some might say. I actually brake on hills at times and I don't take corners very fast except on my recumbent. I have fallen over three times on my recumbent but all at slow speed, trying to unclip from the pedals. I have since gone back to
BMX style pedals and don't clip in anymore. It down right hurts when your skin hits pavement! Avoiding crashing is my main objective since any big fall will cost me money, time and mobility. I just don't think the real issues are being addressed regarding bicycle safety with all the focus on helmets.
It seems to me that most statistics indicate that when automobiles hit cyclists they often die but when cyclists merely crash they have a much lesser chance of fatality. I just don't remember anyone ever severely crashing on their bicycle or even a motorcycle in my youth all the way to my twenties. From the reading on this forum it sounds like many crash and often. That leads me to believe that more riders today are reckless buffoons or riders back then were just better or more careful. The only other explanation is that people might be lulled into thinking they are protected by a helmet and simply ride in a manner that pushes the limits of sensibility and they simply take too many chances with their hide. Its puzzling to be sure.

charles vail

I think the movie was made in the country on a Sunday. Brits in the 1950's and Americans didn't drive as much and especially on a Sunday. These days we make no distinction on observing a day of rest and many drive their automobiles for trips under 2 miles. Its a sad fact and I agree that the more cyclists on the road the safer it is in general for cyclists. In my own rural community (Western Washington) there isn't much traffic on a weekend and cyclists often come out where I live to ride in order to avoid the heavier city traffic. Making friends is good.

John C. Ratliff

I remember those days well, and it was a time when every kid had a bike, and each family had one car, at least on our street. I went all over Salem, Oregon on my bike from the time I was about 8 years old, through high school and college. I simply don't remember the traffic being like it is today, especially the impatient drivers of today. And, of course, there were no cell phones or other distractions. A radio in a car was considered an accessory at that time.

I also did crash my bike back then (mid- to late-1950s), but these did not get to the hospital unless there was a broken bone. A abrasion and contusions, along with a migraine headache, did not qualify to get me a trip to the hospital. I think the kids learned more because we rode more, and that may have led to better bike handling skills than today's kids have.

John

closetbiker

In the study printed in Accident Analysis and Prevention 36 (2004), what were the g-forces upon impact to the cyclists?

Tests for approved designs of bicycle helmets require protection up to 300 (a drop from 2 meters), so if that force was exceeded, wouldn't it be resonable to assume a skull fracture to be expected? DAI wouldn't be a factor in a case where the skull was fractured to a degree that the resulting bleed would over-ride it.

It would seem to me that 300 g's were exceeded resulting in these fractures (unable to be prevented by a bicycle helmet).

I would also bet that the study does not or cannot determine the impact force that led to the fractures but the importance of understanding this point is as important as determining in a test if a helmet can withstand a drop from 6 feet or from 60 feet.

I wouldn't like to be told a helmet can withstand a fall from 60 feet when it was only tested from a fall of 6 feet.

John C. Ratliff

Closetbiker,

First, all injuries were checked for, and the results were that only 11 cases resulted in DAI.

Now, let's do some math. There were 86 cases, and three (all fatal) cases where helmets were documented. The sent out questionaires to these people, and got back 59 responses. None of those in these responses had worn helmets. That leaves 24 possible cases where it is possible (but not determined) that helmets were worn. But, for the skull fractures, we had 74 cases which included this injury. If you subtract the 24 undetermined cases, and the 3 fatals with helmets, from the 86 total cases, you have 59 cases of unhelmeted bicycle riders suffering skull fractures.

The authors specifically stated that they did not feel helmets would protect against car collisions. But, looking at the number of skull fractures, I wrote the following above: "Of those without a vehicle involved (Number=42), 39 (92.9% involved a skull fracture. Of those with a motor vehicle involved (Number=44), 35 (79.6%) had a skull fracture." Now, if we assume that all of those 24 undetermined wore helmets (unlikely), and the three fatals where helmets were used, that leaves 12 cases involving a skull fracture without a vehicle involved (probably much higher, as these were independent variables). What I'm saying is that there were a large number of skull fractures that happened when the cyclist was not wearing a helmet, and was not involved with a motor vehicle.

It would be good if you actually read the entire study. More later from another study.

John

closetbiker

So it seems there was no measurement of the g-forces in the impacts.

If the authors specifically stated that they did not feel helmets would protect against car collisions, we have a bit of a problem because as far as deaths to cyclists in my province, in the last 20 years, out of 128 deaths, there have been only 4 deaths (that I know of) that didn't involve a motor vehicle.

1 involved a collision with a train, 1 (just this past summer) involved a roller blader and a cyclist colliding on a MUP, 1 involving a high speed collision with a telephone pole and just 1 from a cyclist falling by losing balance. There could be more, but I'm not aware of any.

I've always said a helmet absorbs 300gs of force, but it's far more than likely that the vast majority of deaths to cyclists involve far more force than 300gs

Without knowing what the forces were in the collisions that led to the deaths, use of the study is not much better than the TRT study that compared children on bicycles falling to the ground at low speed and comparing them to adults riding at much higher speeds and colliding with cars. It's apples and oranges. One group were exposed to far greater forces than the other and a comparrison is not useful.

If you had 2 cyclists, one wearing a helmet and one not, and you were to drop a ping pong ball on the head of the helmeted cyclist and a bowling ball on the head of the helmetless cyclist, it wouldn't really be fair or serve much purpose to say that the helmeted cyclist received less injury than the helmetless cyclist, would it? It wouldn't be right to claim the helmeted cyclist received less injuries than the helmeted cyclist because of the helmet.

We know the cause of death but cannot know if a helmet could have prevented the fracture unless we know what the measurement of the force was that caused the fracture.

I don't think it's a stretch to guess that a collision with an automobile can far exceed that of 300gs and judging on how many times cyclists fall, and the record of motor vehicle involvement in their deaths, that it's the excess forces that collisions with motor vehicles produce that are the problem. One just has to question whether a bicycle helmet is made to handle that situation. Too many helmeted cyclists die. An examination as to why this is has to be done. Irony abounds when stories such as helmet promotion cyclists die wearing helmets

https://www.charlotte.com/112/story/330074.html

It seems to me the answer is that what kills cyclists cannot be managed by a bicycle helmet. If there was was effectiveness of reduction of deaths to cyclists who wear helmets, it would have shown up by now, but alas, the death rates remain the same.

PS - I guess I only managed 1 week in respecting my decision to "ignore" John

charles vail

Drivers are more hostile it seems and often distracted by cell phones or under the influence of narcotics and alcohol. The main problem I see however is the general lack of patience and consideration for others. Combative attitudes and "in your face" comments seem fairly normal especially amongst younger, under 40, drivers. The attitude that, "I have to get somewhere and nobody better slow me down or get in my way", seems prevalent as evidenced by the road rage stories we often hear about. Its a disheartening phenomenon that I don't think will change in this generation. It might be all the social changes in the last 50 or so years that have helped shape the generally poor attitudes amongst too many people.
Strap on your body armor and avoid automobiles whenever possible.

closetbiker

and something I noted on my recent trip to London.

There, cyclists and motorists treated each other with respect and it shows in the collisions and injury rates.

From what I noticed, few wore helmets and most rode right in the middle of the streets showing that it's not just in Northern Europe (that segragates cyclists from motorists) where unhelmeted cyclists are injured less often than in NA, it's in London too, where unhelmeted cyclists ride with motorists and have fewer head injuries than NA where far more people wear helmets.

closetbiker

a new study by Jan Garrard from Deakin University says there are less girls (women) who ride bikes than men, but when they do, it has been shown that they have less injuries and fatalities than the men do. (in Australia men averaged 0.58 and 39, fatalities and injuries per 10 million km and women averaged 0.3 and 21) Big suprise, eh?

The percentage of girls (women) riding bike dropped more than guys riding dropped when the MHL started up. (Before the helmet law women comprised 30% of the total time cycling and after the helmet law the number of females counted was 14%)

Maybe, because of the hair issue?

Contrasting Australia, in Denmark, the Netherlands and Japan, there is no gender difference

It seems the people who stand to benefit are discouraged by unfounded scare tactics from taking part in what benefits them.

trombone

Just to clarify; Closetbiker's post brings up an important point.

Most of the studies John has referenced speak to the issue of whether it is in the cyclists individual interest to wear a helmet.

There is a separate issue as to whether mandatory helmet laws are a good thing.

Concluding 'it is in the individual cyclists interest to wear a helmet' for issue 1 helps inform the answer to issue 2, but does not necessarily lead to the conclusion that mandatory helmet laws are a good thing. This issue has to be judged separately on its own distinctive merits.

I'm sure this distinction is well understood by everyone in this discussion; however when both topics are under discussion at the same time it can get confusing.

gramseca

I rock a domepiece about 90% of the time when im cycling
but mandatory helmet laws would be wack, the fun part of biking, for me at least, is that there are very few rules and regulations. if there were laws for everything someone thought was dangerous in biking it wouldn't be any fun

John C. Ratliff

Trombone,

I think you are correct, that we have two separate issues, mandatory helmet laws, and the effectiveness of the helmets in real-life accident situations. I have not been able to devote much time here recently, as I have a lot of work to do with my classes. Once they are finished, I'll resume posting some more detailed info.

John

bauptown

Thanks Guys, I now wear a Helmet, don't even feel it on my head. This thread convinced me.
B. Andrews

ekitel

helmets are stupid, styrofoam heads! you were put on this earth to improve yourself, not to become slaves to the modern american cult of 'safety first', ride prudently, but don't make an ass of yourself just trying to preserve your fragile mortality, there are many more lives than this one, your time will come when it's time, no sooner nor later, so just live right and take that piece of foam off yer head

John C. Ratliff

There are many forks in the roads. Some take us where we want to go, and some take us in a different direction. Some can take us over a cliff. We have choices to make, and those choices will determine the outcome, not some idea that "...your time will come when it's time, no sooner nor later..." That is the essence of accident prevention. If you follow the above logic, you will end up on some roads you don't really want to travel down.

John

ekitel

I'm sorry helmets are not stupid, just a personal choice, though it bothers me that so many people wear them that it makes those of us who choose not to look as if we are being foolish, which is definitely not the case.

John C. Ratliff

Ekitel,

If it bothers you, you are not secure in your choice.

John

closetbiker

Depends on how you look at it. In all but a few areas where a helmet law is strictly enforced, the majority do not wear helmets. In fact helmet wearing overall is very unusual. Maybe what your feeling is pressure from a small, misinformed group that is intolerant of anothers views.

trombone put it well when he posted,

*risk is never wholly eliminated, and realistically never can be. We just work to an arbitrary level that represents acceptable risk... occupational health and safety programmes try and manage risk to an acceptable level. If workers are in no more danger then when, say, walking down the street, then we would probably say that no further measures were necessary, even if more is technically possible.*

Maybe the greatest blow to cycling advocacy done by helmet promoters is the implied impression that cycling is more dangerous than it is. A study in the UK found that the proportion of cyclist injuries which are head injuries is essentially the same as the proportion for pedestrians at 30.0% vs. 30.1%. so I would never ridicule a cyclist for wearing a helmet if he doesn't wear a helmet when walking down the steet, but I sure would wonder why it was that the cyclist would feel it was nessasary for riding and not walking, when they run the same risks for head injury. I think that behavior risks making them look not really foolish, maybe just un- or mis-informed.

Further, little attention is paid to the benefits of cycling relative to it's risks. Hundreds of people choke to death each year while eating. Now, no one would ever give up eating (or develop some device that would filter food making it unchokable) because it's clear that it's benefits far outweigh it's rare risks. Same with riding a bicycle without a helmet. Helmetless cyclsts have less brain injury than non-cyclists (everyone forgets the health benefits of cycling as a preventative measure for the massive problem of strokes and instead, concentrate on the rare risks of trauma). Heck, it would make more sense to stap helmets onto the ends of ball point pens because in Canada, more people die from choking on ball point pens each year than die on bicycles.

For as much as people fear traumatic accidents, they make up a tiny portion of deaths each year. Far more prevelant are deaths that are reduced or prevented by regular cycling. Cycling results in a net reduction in people needing medical attention. There's less risk in cycling than not cycling. It's benefits outweigh it's risks, despite what some would have others believe.

John C. Ratliff

A couple of quick points (I'm taking a break from a final exam). First, the proportion of injuries to the head verses other body parts has nothing whatsoever to do with the rate of injury. Please note that for some "pedestrian" style activities, we do use helmets, and these include rock climbing, sports such as football (American style), and wrestling (different headgear, but protective even on padded mats). Closetbiker, would you then recommend that we play tackle football without helmets?

I agree about the "fear" aspect, in that we should not fear a head injury because of the activity of bicycling. But part of that has to do with ensuring that if a fall does occur, there is protection available. When on two wheels, falls can easily happen. They did for my boys when I was teaching them to bicycle. They have for me as an adult. It has been said about bicycling that it is not whether someone will fall, but when.

Now, about those ball-point pens, do you have a reference for that one? I have never heard of this, and I've been in the safety field for 30 years. So please provide a link or something...I may need to get an advisory out to my workers.

John

dcrocker

I wear a helmet whenever I ride with a group of cyclists. That's where I see the most crashes these days. I usually wear a helmet when I ride to train, even if it is by myself. But when I'm tooling around, especially on a bike path, I like to take the helmet off. I just like the feeling of freedom, although I know that if I were to fall I would wish I had the helmet on. And knee pads and elbow pads, but it's all relative.

I've raced for 25 years. And for the first 8 of those years, if you saw a guy with a helmet on, he was a Fred. Except for races, then it was mandatory, but my first race helmet was a 'hairnet.' Helmets these days are really superbly made, so it's hard to argue against wearing one in a training environment. It's amazing how culture has changed. Now when I see a guy on a training ride without a helmet, I think he's a Fred.

There are two things that I feel strongly about. The first is that wearing a helmet is no substitute for technique. I see guys bombing along the bike path, refusing to slow down for pedestrians and small kids, and yelling "bicycle!" They often are pretty dorky looking. The better racers don't try to ride fast on bike paths. It's just not good cricket. The second is that people have no business telling me that I am stupid on the occasion that I am tooling along the bike path, minding my own business, without a helmet. For some reason, this paternalism occurs more here in Washington, DC. Heh heh. Many of the best bike handlers I see in the city are couriers, and many of them don't wear helmets.