10 April 2008

The Great Bike Helmet Hysteria - Part 2

The Great Bike Helmet Hysteria - Part 2
What a mammoth task. I don't think I realised what I was getting into. I have waded my way through scores of research studies and surfed around the net under I was blue in the face. All while trying to make heads or tails of this Bike Helmet Hysteria.

I don't know where to start regarding what I've found. I'd like to thank most everyone who commented on the first post. There were so many great links and sober, level-headed comments. It's a shame that the points of view of these sensible people are rarely heard in the debate.

A few things are certain, however. I no longer have to jump to conclusions after reading the facts behind the issue. Now it's small step to clear-cut conclusions.

Another certainty is that virtually every bike helmet advocacy group out there quote the same statistic like it was carved in stone. They repeat it endlessly, like a broken record. No advocates question it - it is merely The Truth.

The statistic in question is that "cycle helmets prevent 85% of head injuries and 88% of brain injuries". This 'fact' is the foundation on which all bike helmet advocacy and helmet law advocacy is based upon. The populations of entire cities and states have legislation in place based on this 'fact'. This statistic dictates the lives of millions of people. Some websites try to tone it down a bit by writing things like "up to 85%" or "around 85%", but the message is the same.

As I wrote in the first post, I was curious about where it came from. As some of the readers stated, it originates from a small study in Seattle back in 1987, romantically entitled: A case-control study of the effectiveness of bicycle safety helmets - Thompson, Rivara & Thompson. New England Journal of Medicine 1989, Vol 320 No 21 p1361-7.

I found a few invaluable websites on my travels. One of them is the Bicycle Helmet Research Foundation - the BHRF from hereon in - thanks to the readers who recommended it.

It's basically a database of all helmet research and analysis. A group of scientists who don't give a toss whether or not you wear a helmet, but who prefer to know the facts on the subject. It is the most comprehensive website on the subject I have found. Leave your emotions at the door and use your brain. It's science.

Regarding the now infamous ”85%-88%” statistic, the BHRF makes it clear:
Those who have taken the trouble to analyse the paper in detail, however, have found it to be seriously flawed and its conclusions untenable.

What? Sorry? Untenable? But is The Truth! The BHRF also informs us that all studies since this infamous one have shown less or NO benefit from helmet usage. The guys who wrote that study should be in marketing, branding toxic waste as tasty and healthy.

They've done their job well. Nevermind that it was a flawed study with little merit on a scientific level! It's an impressive statistic. Just start quoting it and hope that nobody checks up on it. And nobody has, by the looks of it.

Read what the BHRF says about this statistic here:
- Why it is wrong to claim that cycle helmets prevent 85% of head injuries and 88% of brain injuries
- Misleading Claims about Helmets

This is just the tip of the iceberg regarding the science of bike helmet research. It's a big tip, but there is so much more.
- Are you more likely to be injured BECAUSE you're wearing a bike helmet? Strange but quite possibly true
- Are bike helmets designed to withstand impact and how are they tested? If you love Made in China trinkets, you'll love the story about helmet standards.
- And so much more.

Two good resources for learning more about the truth regarding bike helmets:
The Bicycle Helmet Research Foundation - The Font of All Scientific Knowledge regarding bike helmets.
The Case Against Bicycle Helmets and Legislation - from the leading cyclists' group CTC [Cyclists' Touring Group] in Yorkshire.

So, as I said, it is now far easier to come to sound conclusions on this issue. So here's a couple:
Bike helmets of Mass Distraction
But who, pray tell, is doing the distracting? And why? I'll get to that in an upcoming post.
It's a voluntary issue
It's shocking to me that people are advocating something AND legislating, based on half-truths and non-truths. A stunningly undemocratic undertaking.
The Greatest Threat
There's a world of studies and stats about how safe helmets are or aren't. But the statistics that show how bike helmet legislation kills off bike culture are just as shocking. More on that in a later post.

Fakta om cykelhjelm
Fakta om sykkelhjelm
Fakta om cykelhjälm


Samuel said...

I always find it sad when people refute peer reviewed publications and in their comments do a terrible job of it. The BHRF comments about Thompson, Rivara & Thompson's paper is poorly written from a scientific perspective. I do like that they have found numerous issues with the study, but the references for what they claim are extremely inadequate and their claimed calculations are not shown. It just looks like a news article instead of a serious critical scientific review. Perhaps that is all it is.
In any case I must applaud them in interpreting scientific papers for the general public.

Anonymous said...

I'm interested in your conclusions about why you think helmet use is unnecessary or possibly dangerous. Is that coming? Do you consider anything in this post to contribute to the dialog in a substantive way? I guess your point is that there is lot to wade through on the subject.

2whls3spds said...

Thanks for the research and your conclusions. Unfortunately someone discovered not too many days after we left the caves and our subsistence way of life, that the best way to market anything is through emotional appeal. I have worn helmets and have not over the years. I consider myself to be a competent cyclist; I have had a few crashes over the years, most while racing, but that is to be expected when you ride at that level. Some while wearing the old hairnet style helmets, others with more modern plastic space helmets and yet others with no helmet at all. In none of my crashes could I say the helmet made any difference one way or the other. Until a formal, comprehensive testing protocol is developed I can't see how anyone in good faith can stand on the statement that helmets will save lives.

In the US I suspect most mandated helmet use is due to one reason and one reason only...to reduce liability in a litigious situation.

It is a sad social commentary that it comes down to lack of personal responsibility.


Zakkaliciousness said...

Thanks for the comments.
Anon: i find it important to learn that the one statistic on which all bike helmet advocacy hangs onto with their fingernails is one that is seriously flawed.

i have never set out to declare that helmet use is unecessary. i merely wish to learn, for myself, the facts surrounding the issue. because i can see that people are getting wool pulled over their eyes by bike helmet advocates and legistlators who simply haven't learned the facts for themselves.

with that said, there is interesting scientifc research out that raises the question of whether bike helmets do more harm than good in fall situations. i'll get to that at some point.

at the end of the day, i think that helmet use is a voluntary issue and it should remain so.

i've never set out to 'contribute to the dialogue in a substantive way'. this is a personal journey to learn the facts and.

Anonymous said...

I wrote the comment on the 7 year old girl with brain damage after hitting her head in a fall from a bike.
Interestingly, in MD, the law requires children 12 and under to wear a bicycling helmet. Obviously this law didn't help this girl.
The girl usually wore a helmet. On the day she was injured, she was walking home from school with a friend. The friend lent the girl her bike so the girl could ride past a boy's house to see if he was out in his yard. The girl who was injured was on an unfamiliar bike without her helmet, and she was clipped by a woman we all call "Crazy Mary" because she thinks people can listen to her through their microwave ovens, etc. The driver has some sort of mental illness, but one that with proper medication allows her to keep her drivers' license. Of course, she doesn't always take her medicine.
Unfortunately, in the US most car drivers have little experience with sharing the road with bicyclists, and many bicyclists are unpredictable. We also have very few designated bike lanes. This is the reality of bike culture in most of the US.

Ed W said...

I went looking for the source of the 'helmets prevent 85% of all head injuries' statistic a long time ago. Teh best I could find was a study that claimed they could prevent 40 to 80 percent of injuries, and in statistics, that qualifies as a Wild Assed Guess.

But it really doesn't matter. Helmets can prevent some injuries, though as I tell students, they're good to have after something bad has already happened and you're about to hit the ground. But otherwise, I'd like you to learn to avoid situations that could cause a fall and learn the skills that may help in an emergency.

Simple falls are responsible for 80% (there's that number again!) of all injuries to cyclists, so if we teach people to anticipate slippery road conditions or objects than can cause a diversion fall,we can prevent injuries and avoid discovering just how effective (or ineffective) a helmet can be.

Since I often ride at night, I applied reflective tape to my helmet in order to provide a human silhouette for overtaking drivers. Estimating the range to a human outline is much easier than estimating the distance to a small light or reflector.

Greg said...

Hi Zak,

If you going to link to an anti-helmet group like BHRF (and they're hardly neutral in this debate :-) you should, in fairness, give the other side a chance. For instance, there's a reasonable set of more or less pro helmet arguments at:




(And if I rode in lovely Copenhagen I might very well not wear a helmet. But I ride in lovely (but rather dangerous) Seattle - (where that study you dislike so much was made). And here I'd wear a helmet in the car, too, if it was socially acceptable :-)

Unless you've spent time on the roads somewhere, suggesting what sort of safety equip they should use is probably a bad idea...

Zakkaliciousness said...

I don't regard the BHRF as 'anti-helmet' - they are merely scientists and statiticians who prefer to see facts presented properly, instead of being twisted and contorted.

Nobody is really 'anti-helmet', now are they? there is no financial gain from taking this stance. some people prefer freedom of choice and resent the authorities dicating their lives in the case of helmet laws and peer pressure finger wagging.

Helmets.org, on the other hand, are one of the many groups who quote distorted facts and even mock those who write articles that don't agree with them, like their ridicule of a scientific article in the New York Times.

They, like many pro-helmet advocacy groups have a lot to gain. "Consumer Funded" it says on their website. The helmet manufacturing industry actively finances and supports such groups. As ever, where there is distortion of the truth, follow the money.

I prefer sober, perhaps even dull, facts and science to profit margins and corporate lobbying.

BHRF presents the research and comments on it. all very bland and all very boring. but they have nothing to gain from bringing the science to the forefront. No corporation finances them. And what corporation would? they merely think, as do i, that cycle helmets are an individual choice.

Jen said...

I actually love my helmet. I wear it all the time. Supercute pink skateboard-y thing. Adorable.

But not saying everyone has to wear one...half my friends do, half don't.

I'd take offense though if someone were to criticize me for wearing one. I'm not an experienced cyclist, and I'm paranoid, so I feel the need to wear one.

osf said...

Thanks for the links. And the discussion. As a helmet wearer (for the last 25 years) I find this interesting. The most compelling argument has to be that helmet laws kill cycling. I guess I have no problem believing that.

The hysteria that I live with every day in the USA without a doubt is just that. I regularly am asked if I ride my bike on these roads ("Well, yes..."). People cite killer cars as well as sand and potholes that make it dangerous. Not much to say in response... And the wear your helmet or die hysteria is also there.

I still have seen no evidence that modern helmets make matters worse. Found any?

In the end, wear one or don't, but ride your bike!

Justin Knotzke said...
This comment has been removed by the author.
Justin said...

I looked into this helmet debate a few years ago and was shocked by what I read. You mean to tell me that it ISN'T common sense to wear a helmet ?!

It just seemed so obvious from the outset. But after reading much of what was out there, I came to the realization that there is no real proof, yet, that helmets help.

What I can't figure out is if this is because a proper test/protocol hasn't been found yet, or because he;mets simply aren't really that safe.

I wear one when I train and race. I don't always wear one when I commute. Depends on how I feel.

Back up 10 years and you looked a little goofy in the racer scene if you wore one. Now, not wearing one and you look a little goofy. ;-)

Anonymous said...

Here in the USA if anybody has a well considered rational view on a subject then people feel that it's only fair to balance that out and give equal time to extremists who distort the truth for their own gain.

We've really got big problems here, but then Europe was pretty messed up back in the day so maybe there's still hope for us.

David said...

I've seen a lot of comments about the rabid pro-helmet lobby, but I only seem to see rabid language coming from the anti-helmet lobby. I realise that many are suspicious of the possible financial gain of helmet manufacturers by legislation, and the anti-helmet advocates have (as far as I can see) no financial gain. But why do I see anti-helmet people using words like "stupid" and "asinine" when we're trying to have a rational discussion? That kind of supposed argument makes me stop paying attention and does nothing for their cause.

As for the claims of "not wearing a helmet makes me a more defensive cyclist," I've seen plenty of oblivious and dangerous cyclists without helmets. You may be a defensive cyclist sans helmet, but I would credit you, not the helmet.

My second point may counter my first a bit, but I'm curious. I find it curious that in the analysis of the British study that said that cars maintained a greater average distance from the cyclist when he was not wearing a helmet, no one bothers to suggest that maybe he was riding differently without the helmet.

Yes, there is that one paper that concludes that helmets are safer and is also criticised for its incorrect statistical analysis. But flaws in statistical analysis only mean that the study was not properly conducted, not that helmets are ineffective.

Yes, helmet laws deter many from taking up cycling, and this is a big problem in Canada and the US.

Yes, driver and cyclist education will do far more for cyclist safety than wearing a helmet.

But, neither of those arguments really convince me not to wear a helmet.

Zakkaliciousness said...

David: nobody is trying to convince you not to wear a helmet on this blog. that's quite clear if you read the content.

the right-wing fundamentalist rhetoric of the helmet lobby is hardly more civilised than those who do not support them.

who is this anti-helmet lobby of which you speak? i've only ever seen 'pro helmet' and 'pro enlightenment'.

Zakkaliciousness said...

oh, and if you can't mock right-wing fundamentalists, then who can you mock!?

Anonymous said...

I suppose a summary is in order:

- There isn't enough evidence that bike helmets safe lives, let alone significantly. The most-quoted statistics in favour of helmets, are flawed.

- Good bicycling infrastructure, awareness, and "safety in numbers" safe much more lives. Yet helmet laws allow planners and politicians to check a box "something done to promote safer bicycling" -- and if there's any effect, it is mainly through discouraging cycling. It just lets them blame "your fault, you weren't wearing a helmet", whereas the prevention of the accident should have been the goal in the first place. (But not the way it's being done in e.g. Finland: cumbersome intersections, that force bicyclists and pedestrians to come to a halt and make a detour a few metres to the side, while cars can even turn the rounded corner very fast. That's logic as old as cars: "cars are dangerous to bicycles and pedestrians, so lets make bicycling and walking more cumbersome". Bicycles are supposed to be a convenient and quick means of transport within a city! In Finland, cars are also not supposed to let bicyclists cross intersections without traffic lights, although they're supposed to let pedestrians cross them. Neither happens very often. This is very much a car-dominated culture.)

- Bicycling itself safes lifes, being a healthy sport. Yet helmet laws discourage bicycling, by making it more inconvenient, and making it seem unsafe (which it can be in places with helmet compulsion, because those places don't take the right measures to increase safety!)

- A bicycle helmet is much more cumbersome to wear than, say, a seat belt, or even a motorcycle helmet. You can't really leave it with the bicycle (or someone will urinate in it), so you have to drag it all along. And strapping it conveniently with eyeglasses and wool caps (in the winter) is not a fast procedure. (Perhaps a winter helmet design with integrated wool cap could be made, that would be less of a discomfort.)

- Wear a helmet if you want, but don't force it on me. It's my head, not yours, not the state's. Unfortunately, the popularity of helmets may encourage the state to make them compulsory, and skip better means to make bicycling safer and more convenient.

Zakkaliciousness said...

goodness me. THAT was a brilliantly concise summary of the entire situation. thanks for that. [saves me writing it... :-)]

2whls3spds said...

After observing quite a few cyclists over the weekend...

If a helmet is not worn correctly it is not going to do you any good at all. Of the 30 some people I saw Saturday 20 were wearing helmets of those perhaps half were worn correctly. What is really sad is the bulk of the ones not being worn correctly were the children, supposedly the highest at risk group.


Tobey said...

All I know about helmets is, the past two times I've been in a bike accident, they saved my head. The first was a patch of sand that had me vaulting over the handlebars and onto the sidewalk face first. I hit on the front of the helmet edge and only scraped my chin. The second time was simply commuting to work 6 months ago on a bike trail. I was heading downhill, not too fast (I was using my brakes gently to keep form building up a lot of speed) and on the right was a big metal wall by the highway and on the left was the oncoming lane and a large ditch. The lane is narrow here, and two guys come speeding under the underpass, side by side, the second guy in my lane. He didn't slow down, he didn't move, he stayed right in my path. I had nowhere to go so I braked as hard as I could and braced myself. I woke up in the ditch beside my bike, the two guys had fled and I was left with the back of my helmet badly cracked and my collarbone in two pieces. Both times unexpected. The first was my fault for not paying attention, but the second wasn't anything I could have prevented without superpowers. So I never ride without my helmet. I don't read surveys and don't listen to the pro or con helmet-izers. I just know I'd have some serious head damage if I'd been sans helmet, after seeing it in the aftermath. Whether anyone is legislating or not, I won't ride without one. 'Cause you never know who is coming on the other side of the underpass.

Anonymous said...

> and two guys come speeding under the underpass, side by side, the second guy in my lane. He didn't slow down, he didn't move, he stayed right in my path.

And were those guys wearing helmets?

I was actually referring to a similar situation, when I earlier said that helmet-wearers engaged in an arms race can be a danger to the rest of us. They think they're supermen, and nothing will happen to them, so they can speed and crash -- just like nothing much will happen to the motorist running over a bicyclists (in fact he gets a free new windshield and a bonnet under Finnish legislation).

Anyway, I was crossing from university courtyard over a multi-use path and a road. Having just stopped on the edge of the multi-use path to wait for some cagers, suddenly there's a crash and the back of my bike is thrown from under me. Some helmeted fuckwit was speeding down the hill, and he must have been so far when I started crossing the multi-use path, that I didn't see him, and at a reasonable speed he should've been able to steer or slow down for the crossing point (you can't get out of the way, because you have to stop on the edge to wait for the cagers, who won't stop for you -- it's a clusterfuck location). He took quite a flight (sideways, not over the handlebars), but I'm not sure the helmet was of much help. Maybe it skidded the ground a bit, but it certainly wasn't broken, and he seemed to keep the head up, just like I've also experienced to do. (I just got messed up gears and one broken spoke. I didn't fall over, although I don't think I had yet put a foot on the ground.)

Zakkaliciousness said...

The whole "My Helmet saved my life" angle is also covered from a scientific angle on the Bicycle Helmet Research Foundation's website.

In short, it is said that: ”As there is no evidence that helmets save lives or serious injury at all across cyclists as a whole, most of these perceptions of helmet benefit must be mistaken.”

The odds are that the helmet DIDN'T save you from injury or death. That's the science. This BELIEF that a helmet did is not the same as fact. Here's a good link.

Anonymous said...

Your mention of the BHRF had me initially very interested. From time to time I look for a clear scientific analysis of the effectiveness of helmets. Instead I was disappointed by the information on the BHRF website you linked to. As part of my work, I study scientific research. The BHRF site in my opinion is weakly presented and has an unbalanced view. I know that helmet issues seem to raise a lot of emotional arguments, but if I was presented with a piece of research like the small amount of the BHRF website I read, I would reject it outright. Even in the few screen fulls I read, they managed to dismiss a pro helmet argument using a piece of research, then contravene that same research to present their own argument.

Let people make up their own mind about wearing a helmet, but lets try to give them some good solid information to consider.

One of the big problems no one has mentioned is the change in helmets over the years. Back in the late 80's helmets had a thick plastic outer shell, and came well down the head. Compare these to today's helmets, which have a much less coverage, and only a thin outer shell. Let's not forget inbetween there were the 'shell-less helmets' with just some lycra holding them together. All these changes will make it very hard to relate data over the years.

Another thing which will impact the statistics is the change in driver behaviour. On my commute, 20 years ago I would often have cars come extremely close to me (my knuckles slid along more than one vehicles side). 10 years ago the most common problem was cars pulling out of a side street in front of me. These days the most common problem is cars cutting me off. I am sure other long term commuters will have noticed differences in driver behaviour in their own towns. Again something which will make comparison over the years difficult.

I guess my search for solid scientific information continues.

Zakkaliciousness said...

the BHRF, at least, lists the names of the original studies that have been done on the subject.

if you don't fancy the BHRFs comments or ananlysis, you can just get a hold of the original studies and read them.

Morten said...

I was just alerted to a fun site about helmet compulsion :

They even link to a Danish site, that of the DCF (dcf.dk) , that they claim to cooperate with...

Zakkaliciousness said...

hey morten. fun site.
can you please email me? i have a couple of questions for you.
thanks. copenhagencyclechic [at] gmail.