Bicycle Helmets and the law: a perfect teaching case for epidemiology

It's interesting that in the name of "healthy living" busybody types encourage us to bicycle to work (thus exposing ourselves to significantly higher risk of accidental injury) or do things like posting nag signs to "take the stairs" next to the elevators (ever compare injury rates in riding elevators vs. falling on stairs?)

I guess motorcyclists wear full face helmets because they don't like gravel flying into their eye at 50mph.

That said, they still die like flies and for reasons totally unrelated to (not) wearing a helmet.

There's an important (but not always obvious) difference here: individually, you're strictly safer with a helmet, but when you start forcing people to wear helmets, the disadvantages outweigh the benefits. That's why lots of cycling organizations promote voluntary use of helmets.

Well, this stuff is always going to depend on where you are and who you know. I commuted to work by bicycle at an english university and I knew many other people who did, many without helmets, but the accident rate was very low.

On the other hand, this might be the consequence of safety in numbers, good infrastructure/cycle paths, availability of quiet roads with wide deserted sidewalks, the fact the average cyclist lived much closer than the average car driver and hence covered fewer miles of road.

I'm sure someone commuting by bicycle in London during the rush hour, or in other countries, might have a very different experience. I'd be interested to hear where you're located, if every bicycle commuter is involved in multiple accidents?

Personally I see motorcycle helmets as quite different to bicycle helmets; motorbikes tend to go a lot faster leading to very different injury patterns in accidents, from what I've read. They're also very different as signals of social status. And many governments want to increase the number of bicycles on the road, and hence don't want to make moves that discourage bicycle riders, while most governments are indifferent to or want to reduce the number of motorbikes, so if legislation reduces the number of motorbike riders they don't particularly care.

Same, everybody I know who commutes on a bike has horrible accident stories and my city has designated bike lanes even. That said they also don't like the helmet laws since cops here seem to only go after the poorerst riders like the homeless with tickets because they know they can't pay so can arrest them later. Whenever a major event happens here they sweep up all the homeless for unpaid helmet fines and keep them locked up long enough for foreign media not to see them on the streets.

>If I didn't wear a helmet, I might not have the courage to ride at all...etc.

So wear a helmet, there is no law whatsoever prohibiting you to wear one.

Me, I am a datum point for the argument that helmets stop you from cycling. I used to ride a bike everywhere before the compulsory helmet laws were introduced. After, cycling became so much less convenient, you had to make sure that you brought your helmet, that you kept it secure, and I plain do not like the way bicycle helmets feel on your head.

I hate the compulsory helmet laws, and I want them gone.

There are many things there to unpack.

Where do you live where "every single bicycle commuter" has been in at least one accident which is "much worse than an auto accident"?

Can you be more definite about what you're comparing? It seems like you're talking average-case car-car collision with worst-case car-bike collision. The worst-case consequence of an auto accident is, what, the Ibadan tanker truck explosion in Nigeria which killed 100-200 people? And it's not hard to find reports of car crashes which kill 6 or more people.

(For that matter, every walker and runner I know has been involved in accidents, like tripping, falling down stairs, or hitting a low branch.)

There's nothing preventing you from wearing a helmet when you ride. I know people who don't feel safe unless they have lots of reflectors. I don't feel safe when I have to ride on a road with cars, except during the non-rush hours during the day.

The problem about scenarios is they exclude the cost/benefit discussion. I can easily think of a scenario where wearing motorcycle body armor would help. For that matter, I can think of a scenario where wearing a wet suit while cycling would useful - what if you fall into a cold river while crossing it? I could probably come up with a good reason for bringing an air tank - if a tanker car crashes and releases toxic fumes in the air, then you can still breath and get away.

The point of the article was that the cost/benefit calculations for a bike helmet are complicated. There's no clear signal that they are useful. There are scenarios where they are useful, yes, and scenarios where a helmet requirement is a net negative. Both are mentioned.

You say the risks are "downplayed." Did you not read the article, much less its references?

You ask "Should we encourage motorcyclists not to wear helmets?" That's a very different topic. As the article points out: "a recent study identified two broad subpopulations of cyclist: “one speed-happy group that cycle fast and have lots of cycle equipment including helmets, and one traditional kind of cyclist without much equipment, cycling slowly.” The study concluded that compulsory cycle helmet legislation may selectively reduce cycling in the second group."

I am a member of that second, slow group. I bike at about 18 kph. This is slower than the fastest marathon runners. I believe there's an evolutionary argument that running speeds and slower are generally safe for the human body. (Either that, or we need to start putting safety gear on Usain Bolt!)

But motorcyclists and moped riders, downhill skiers and Tour de France riders, all go at a faster rate. The energy in a collision goes as the velocity squared, so there's 6x more energy in someone going 45 kph than at 18. This translates to a lot more possible damage, so more of a need for protective gear.

This is a study that I'd definitely need to see repeated. The "reproducibility crisis" looms large.

>What about the ones that will not die but be disabled...

You mean disabled by obesity, right? I am sure there would be LOTS.

>> They enforce the perception that cycling is dangerous.

> Is that so controversial though. Cycling, absent dedicated bike lines, separate bike paths, and very well organized intersections is dangerous.

The more cyclists there are, the less dangerous cycling is. Things that discourage cycling thus make it more dangerous for all other cyclists (and vice versa).

>Ok so 253 extra people will die from obesity. What about the ones that will not die but be disabled. What about those that don't die from falling of the bicycle but get disabled permanently or temporarily.

From the paper:

"Modelling studies have generally concluded that regular cyclists live longer because the health effects of cycling far outweigh the risk of crashes"

Lots of deaths of pedestrian and even automobile drivers/passengers could probably also be prevented with bicycle helmets.

Downhill racing helment? Motorcycle helmet? Neither of which you'd normally wear on a road bike.

Would you be able to take in all the sites and sounds around you on a nature hike, say you are going birdwatching or something, just as well with a foam hat on? If you can see your helmet at all then that's part of your peripheral vision you are sacrificing. And if you can't see your helmet it's probably not gonna do much in a car crash anyway... I prefer not to get hit and one way to do it is ride in a part of the world that respects people on bikes. When I lived in Mountain View I wore a helmet... but I also didn't bike much.

Every helmet I've ever tried impairs hearing at speeds easily reachable on a bicycle. When I hear the rushing of air in and around a helmet, my aural sensitivity and awareness of overtaking motor vehicles is decreased. This isn't so much of an issue on high speed roads, as many vehicles on such roads can approach without making much noise. However, it's huge on city streets on which most vehicles don't exceed about 40mph. My hearing isn't even that good, but when I've been riding in traffic for several weeks, without turning my head I can easily tell UPS trucks (very dangerous) from SUVs (not paying attention but fairly predictable) from straight trucks/semis (pretty safe since they are on alert in urban environments; just don't pass them unless you know you can get clear before they turn).

> I think they send the message that what I'm doing is dangerous when it's exactly the opposite.

I would imagine most people would qualify what you are doing as dangerous. There maybe nothing technically wrong you do while riding, but if you are sharing the road with cars it takes one tired, drunk, texting or senile or otherwise inattentive driver to squash both you and your daughter. They don't even need to go that fast.

I have seen it myself -- dad hauls his kid in one of those trail-behind carriers, it is nighttime already. Rush hour traffic. Flag barely seen, not big or high enough. People coming home tired and overworked, I've seen a close call once. Very scary stuff. Honestly I was thinking "what a dumbass" about that particular parent. And I can't see how it would be otherwise in that one case.

Most bicyclists I know have had serious falls. Some been hit by cars on rural roads. Out of my acquaintances that are motorcyclists, many are now ex-acquaintances and that is not because we fell apart but because they are dead now. It is often not their fault, it is a drunk driver, or other drivers' fault, it just they are exposed and vulnerable around large heavy SUV sized cars moving around.

> that motorists are more respectful of riders without helmets.

Use of "respectful" here is a bit funny? It would seem they are not thinking exactly "respectful" thoughts, probably thinking "What is this crazy guy doing here? He is going to get himself killed!". Well ok maybe it doesn't matter as long as cars stay away, but that doesn't' help promote the idea of safety, it promotes the negative idea -- people who bike are crazy unsafe and need to be protected from themselves.

However, it pays substantially less for such folks as it does for the folks such folks are angry about.

Bicycle related injuries are not what any insurance company is worried about, while obesity, diabetes, cardiovascular diseases and motor vehicle related injuries actually really are the issues that keep raising the cost of your insurance - you just don't see it that way, because you don't want to take responsibility for the costs your lifestyle imposes on the society.

I'm dreadfully sorry if this has come out as addressed to an individual - speaking epidemiologically, this is absolutely about all of us, collectively. I would never recommend anyone to not wear a helmet, but I would rather see their choice of transport be the bicycle as often as possible, and mandatory wearing of helmet will not help that.

Do you live in the USA? If so, have you been living under a rock? Don't you know that now your insurance pays for everybody, no matter what their "attitude"?

Besides, cyclists are pretty healthy overall, as compared to the motorized-barcalounger operators. If one gets run over, it doesn't cost "your" insurance near as much as the 1500 matching sedentary automobilists with diabetes and heart disease.