Why it makes sense to bike without a helmet
howiechong.com
howiechong.com
1. Just 2 months ago, my little sister was riding on a bike with no helmet. She was struck by a car. She flew off the bike, puncturing a lung, breaking a clavicle, several bones in her face, ribs, road rash, etc. She stopped breathing at the scene. After 1 week on the ventilator, she began breathing on her own. We knew there would likely be brain damage. She woke up confused and showing most of the signs of traumatic brain injury. Fortunately just a couple months later she's done with physical therapy. Due to nerve damage she will always have a little trouble walking, but most people won't notice it. Her face didn't need surgery since the fractures healed within millimeters of their original positions. The brain is the last thing to heal, and she is a different person than she used to be, most people who didn't know her before won't notice. She can't yet hold a job or go to college. If she had been wearing a helmet it's almost certain that she "only" would have to deal with the punctured lung and a few broken bones. Her not wearing a helment not only derailed her life, but it caused major problems in the lives of everyone around her. She has 250k in medical bills and the legal minumum on liability insurance here is 25k.
2. I snowboard regularly, I've seen people without helmets die on the groomed trails. I've hit my head a few times on logs that I really wouldn't want to be running into w/o a helmet. I've never seen someone who was wearing a helmet permanently disabled by an accident.
I used to think that if you didn't want to wear a helmet it was nobody's business but your own. But when one of those cars hits you, somebody's going to pay for those hundreds of thousands in medical bills, so if you don't wear a helmet please file a DNR ahead of time.
On a "lighter" note, I tend to agree that as a society we should focus on the most dangerous things first. Right now I have a feeling that's the intersection of driving and cell phones. We can probably save the most lives by focusing on driving safety.
Oh god. How severe was it? A traumatic brain injury is something I wouldn't wish upon my worst enemy (and I know how frustrating it is. I went through a severe TBI myself).
And keep in mind that the healing is just beginning. Hell, at two months I was barely out of the hospital and the recovery took a full two years. I would guess she's not healing and has a ways to go; those effects are likely not permanent.
> Due to nerve damage she will always have a little trouble walking, but most people won't notice it.
The physical ailments are the visible ailments, but there's many more invisible ailments (at least in my case). How you think almost defines who you are and if that gets messed up, it's almost impossible to see and much more of a loss. In my view, it seems almost pointless to mention the lasting physical ailments: they're just small things you live with. They don't change who you fundamentally are.
I think in 2 years she will be fine. She will probably be a different person unfortunately. But it could be much worse.
> the doctors don't want her to start college yet.
That's completely normal in cases like this. My doctors didn't think I'd return to college for a year (and I was hardly ready at 6 months). I'm back now and at full throttle again (and going on 2.5 years). I was linear, concrete, black and white and and bad at planning for 6-9 months, and wasn't fully healed for (at least) 2 years.
> She will probably be a different person unfortunately.
A lesson I've learned is that there's nothing wrong with an injury like this changing your personality. Whether it be with fundamental personality changes or lingering deficits, it's just something you live with. How you choose to deal with them is defines who you are, not their mere presence. To this day, I'm bad at planning. To get around this, I manage it like any sane person would and nitpick every detail and put myself in the other person's shoes.
Blame the victim? How about the driver, was it not his/her fault rather than your sisters?
When it comes to collisions between vehicles and pedestrians or bikers, the vehicle has the right of weight.
Howie's evidence (as nice a guy as he is) is based on a single study by a professor at the University of Bath. (And there's a PLOS One paper which disputes his conclusions too which is worth reading: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjourna... )
There is no compelling evidence to recommend that you shouldn't wear a bike helmet and PLENTY of very solid evidence why wearing helmets have very important and life altering effects on the outcome of serious head trauma.
If you are cycling, wear a bike helmet.
So if you want to be consistent you should update your comment to:
If you are cycling or driving wear a helmet.
Cars have other safety equipment that make them unlike bicycles. These include airbags, seatbelts, crumple zones and the like.
If you are a driving, you should employ those safety devices when you do so.
Apparently that model has scored the highest Euro NCAP crash test as of 2012 (the NCAP tests tests both damage to drive AND pedestrians).
> According to a 2006 French study, pedestrians are 1.4 times more likely to receive a traumatic brain injury than unhelmeted cyclists.
To fails to take into account that almost everyone walks, but very few cycle. The fact that it's only 1.4 times greater goes to show how common cycling head injuries actually are.
This is like the statistic that says that 80% of all automobile accidents happen within 10 miles of home. It's not because the area around your home is more dangerous, it's because you drive near your home more than you drive anywhere else. It's basic statistics.
The reason car drivers don't wear helmets is because of the insane number of safety features that are built into a car, from seatbelts to airbags to varying strengths of materials, that bikes simply don't have. If another car hits your car, a number of things jump into play to save your life. If a car hits you on your bike, you're gonna have a head injury at a minimum.
Of course something like that exists. Of course there's a group of people up in arms over helmet use.
Of course. Fuck me, nothing should surprise me anymore.
Another argument by them: sure, having your skull split open when falling and hitting the head on the pavement is bad, but it's really bad when you're falling and instead of a clean hit, your neck is subjected to particularly strong rotational forces due to the helmet enlarging your head, thus moving the point of impact outwards.
They are a nasty bunch.
Both can be lethal. The former is very much so, the latter usually not.
No-helmet crowd claims the severity is the the other way around.
read the paper he quoted (emphasis mine):
"The severe TBI of 1238 patients were described. The annual incidence and mortality of severe TBI were, respectively, 13.7 per 100,000 and 5.3 per 100,000. The fatality rate increased from 20% in childhood to 71% over 75-year-old. Compared to restrained car occupants, the odds ratio for having a severe TBI was 18.1 (95% confidence interval, CI = 12.8–25.5) for un-helmeted motorcyclists, 9.2 (95% CI = 7.5–11.3) for pedestrians, 6.4 (95% CI = 4.7–8.8) for un-helmeted cyclists, 3.9 (95% CI = 3.1–4.8) for unrestrained car occupants and 2.8 (95% CI = 2.2–3.5) for helmeted motorcyclists."
http://www.sciencedirect.com/science/article/pii/S0001457505...
of course this statistic is meaningless without knowing what ratio of endorsed:un-endorsed are actually on the road.
oh, and: http://www.horace.org/blog/wp-content/uploads/2012/05/How-to...
number of pedestrians injured = 1.4 × number of cyclists injured
while it reads to me as:
chance of injury while walking = 1.4 × chance of injury while cycling
which invalidates your point.
9.2 (95% CI = 7.5–11.3) for pedestrians, 6.4 (95% CI = 4.7–8.8) for un-helmeted cyclists
chance of traumatic brain injury as a pedestrian in an accident = 1.4 x the change of traumatic brain injury as a un-helmeted cyclist in an accident.
This seems to not at all take into account the probability of getting into the accident in the first place, which really makes the argument pretty moot.
If that's what you're saying, you didn't read the actual study before posting! In the second paragraph of the abstract for the 2006 french study, they clearly state "The annual incidence and mortality of severe TBI were 6.4 PER 100,000 (95% CI = 4.7–8.8) for un-helmeted cyclists"
The important part being: PER 100,000. Making your counter-argument invalid.
Cyclist - 0.41 Pedestrian - 0.80 Motor vehicle occupant - 0.46 Motorcyclist - 7.66
This does not mean I agree with his argument at all, and in fact it is pretty flawed logic to not do something that gives you 85-88% less chance of serious brain injury just because other activities may be more dangerous.
I've hit my head a few times while getting into bike accidents.
The first time, I was wearing a helmet. Mostly landed on my face, but the helmet broke and I was fine. (An ambulance was driving by and took me to the hospital as a precautionary measure. Somewhat convenient.)
The second time, I was riding a CitiBike without a helmet. I hit a pothole and somehow ended up landing on my head. I don't really remember much, except laying in the middle of the road for a few minutes trying to figure out what happened. (I do remember being pretty sure that this was the end. But I decided I didn't want to get charged for the missing bike, so got up anyway.)
The third time I was wearing a helmet again, but I landed on my hands. It was winter so I was wearing gloves with leather palms, and just kind of slid for a while. It was great. I rode 40 more miles after that one. (And I'm definitely a fan of gloves!)
Wear a helmet. It's pretty easy to fall off your bike, and you don't really want to injure your head.
> wearing a helmet may create a false sense of security and induce risk-taking that cyclists without head protection might not make.
> Bike helmets discourage cycling
We are not discussing if not wearing a helmet should be legal, A competent adult should be able to go base jumping, ride a motorcycle, or just bang their head against the pavement if they please, but that doesn't mean your not an idiot for doing it without any good reason.
But as he opens,
> Several of them asked me: Where is your bike helmet?
We're clearly discussing the validity of the choice as an individual to choose to not wear a helmet, and the argument that it induces risk-taking? Well consider that fact, and use your head and don't take extra-risk.
Or about discouraging cycling? Does the existence of helmets discourage cycling? Does me, or you wearing helmets discourage other people from cycling? The study at least says that mandatory helmet laws discourage cycling.
Now, if you choose to go base jumping for the adrenaline, to ride a motorcycle for the freedom, and thrill, fully aware and accepting of the risk, that's great, and better to you.
Similarly, if you want to ride without a helmet because it you think it makes you look cooler, you like the wind in your hair, prefer the convenience to the safety, or even if you are just trying to be different, a contrarian. Sure, do what you want. But stop fucking pretending it's because "It's safer".
Risk of head injury per million hours travelled
Cyclist - 0.41 Pedestrian - 0.80 Motor vehicle occupant - 0.46 Motorcyclist - 7.66
"but that doesn't mean your not an idiot for doing it without any good reason."
So by this logic someone not wearing a helmet while in a car is also an idiot ;)
That may also be true, assuming that we have similar data showing that helmets help as much in cars as they do on bikes.
Considering that car incidents are vastly different however, I suspect a helmet in a car incident doesn't have quite the same affect on head injuries.
And even if they have proven to be useful, the studies are almost certainly with helmets that much more closely resemble a motorcycle helmet. In which a case the convenience and comfort helmet have a much more significant impact, which plays directly into my comment of "without a good reason"
Additionally, I'd really like to see the paper where that statistic came from, sadly it doesn't give the numbers in the abstract. And while it's totally anecdotal I know a non-zero amount of people (directly or indirectly) who have had a head injury cycling, yet zero as a pedestrian. Despite knowing vastly more people who spend vastly more time walking. Saying that you're more likely to get a head accident walking is a pretty strong claim. Thus I'd like to see strong evidence.
Cars also travel under different conditions from bicycles as well (certainly not many highway bicyclists), and as such i would presume that motorists would be involved in many more high speed crashes (although data on that would be interesting to see).
So comparing injuries on bikes to injuries in cars definitely seems like an apples to oranges comparison at first blush.
The real reasons are often personal, simple and embarrassing things like: "I don't want to wear a helmet cause it is not cool", "I want to be contrarian", "I will create controversy and get a lot of discussion focused around me". And then it is just a matter of finding some statistics or anecdotes to support the position.
This happens in every sphere of life.
It seems this is a case of that. The danger is now not only to himself to also others if anyone starts listening and stops wearing helmets.
But I think in this case they went to far and the message contains its own destruction so to speak. They tried to hard to justify it and they appear too irrational to hopefully anyone take their advice to heart.
If you're just beginning cycling, please use roads that are bicycle friendly. Use a road with a wide shoulder or a bike lane and slow traffic. Don't use the busiest curbed downtown street.
I speak as a severe traumatic brain injury survivor. I don't take any unnecessary risk, explicitly to avoid the chance of re-injury. Growing up around helmets as the son of two ski patrollers, wearing a helmet is a part of life. It does not inhibit my riding and while drivers might be less careful around me, I won't take that risk.
> Children and toddlers on foot are far more likely to receive traumatic brain injuries than cyclists
A traumatic brain injury is, at best, a severe concussion[1] and worst case can result in death or a coma that lasts for months. I would just like to make that clear.
[1]:https://en.wikipedia.org/wiki/Traumatic_brain_injury#Severit...
You should wear a helmet regardless. It's easy to misjudge. I remember seeing a cyclist at U.C. Berkeley laying on the ground with blood pooling around his head. No helmet. From what I can tell, he was zipping downhill and hit a water fountain. You might think that the middle of a college campus is a fairly safe place to bike given the lack of cars, but in truth, it can get dangerous pretty quickly. Lots of student walking around not paying attention and, in Berkeley's case, steep hills.
> I dutifully wear the helmet here, while my Dutch friends laugh at me.
Better to be laughed at wearing a helmet than being laughed at while being a vegetable.
> The roads are not built for bicyclists
There is another more insidious element -- in some parts of the country, there is a negative aspect of motorist culture where motorists are irritated by and hate bicyclists. Really doesn't make any sense but if you go on tours through rural parts on a road bike, be prepared to be honked at and have beer cans thrown at you. I wouldn't be too shocked to hear that on a secluded country road you might end being a target and be specifically clipped or pushed off road.
That probably sounds totally ridiculous to our but that happened to two of my coworkers.
Adults tend not to fall over, voluntarily or in-, while walking around. There are plenty of ways to fall over and hit one's head while cycling that aren't under one's own control at all.
Consider purchasing a bulletproof vest too, you never know.
>> Bike helmets discourage cycling.
Yes! We should require all CAR drivers to wear helmets. Imagine how less likely drivers are to engage in road rage when they're wearing dorky helmets, not to mention safety on the road.
I tweeted w/ Ian Walker a bit about it, and though he hasn't written up a reply he disputes their conclusions (just for full disclosure).
Here's more cheap talk: http://summaries.cochrane.org/CD001855/INJ_wearing-a-helmet-...
http://summaries.cochrane.org/CD005401/INJ_bicycle-helmet-le...
Over 20 years ago, i rarely wore a helmet commuting, mountain biking. When you're young, life seems forever. Luckily, I had some sense to listen to my colleagues one day and wear my helmet while doing my usual run across some headlands. I was volunteering at a clinic at the time and frankly I was weary of the MD and NPs digging me for NOT wearing my helmet (they have seen it all). My styrofoam plastic encased ANSI helmet literally saved my life sustaining a rt temporal crushing cavitation that left me only with the standard clavicular fracture and embedded asphalt abrasions to my nasal bridge, upper and lower limbs that still reminds me today. Moreover, the logistics of the Nat. Park Service, the nearby public hospital emergency room, the public university insurance and my saviors at that free medical clinic further eased my burdens from this unfortunate accident.
Believe me, I applaud changes in public policy encouraging mass transportation with biking right up there in the fore, however, when it comes to health behavior/policy look at more data.
and maybe consider a seat belt and stop smoking, too.
Well thanks for wrapping up the debate in the first sentence after your intro! If a helmet will save your life then why would you not wear it? It seems like your argument for wearing a helmet in the car is a lot better than your argument against wearing a bike helmet.
Would you run, as fast as you can, head-first into a concrete wall?
No, it does not make sense to bike without a helmet.
Statistically correct, I guess, but I'm a pessimist so wear a helmet anyway.
But repealing such laws seems hard, politically. Any ideas on how to support such a repeal?
So...compulsory seat belt laws reduce the overall quality of life? Say what?
"(with the main mechanism being reduction of physical activity, and resultant deterioration in health)."
Arguably, the greater good is done by not enforcing helmet laws, because vastly more people will bike, and thus get more exercise, outweighing the few major accidents per year.
Before asking that question, I wonder how many people don't bike because of the helmet versus how many say that they don't bike because of the helmet but really would take any excuse.
Intuition says that a car might be traveling (on average) double the speed of a bike--which puts us at 4x the amount of stored energy in your head which can dissipate. Unfortunately, bicycle helmets are almost definitely useless at this speed.[1]
It's also unclear if the same mechanisms for brain injury apply, though I don't have any statistics on this matter. My impression is that strict blunt force trauma is no longer the prevalent mechanism for injury in cars---you're more likely to get whiplash or some sort of quick rotation that puts you in a coma due to the brain sloshing around. Helmet or no helmet, it's difficult to protect against rotational modes.
So even if we went with this article's suggestion of wearing helmets in cars, there's a large possibility the numbers wouldn't look any better. I wear a helmet on a bike because it maximises my protection given the amount of inconvenience it gives me. Nothing about car statistics invalidates this trade.
This is terrible terrible advice for any place that doesn't fit that criteria, and might as well be bad advice in the town that DOES fit this criteria.
Slowing cars down on streets where bikers and pedestrians are present will save many lives, mostly those in cars, additionally some who are not.
"Why it makes sense to drive wearing a helmet"
Based on:
We can also approach it from the perspective of injuries per million hours from a 1996 Australian study looking at head injury risk before the beginning of any helmet laws:
Risk of head injury per million hours travelled
Cyclist - 0.41 Pedestrian - 0.80 Motor vehicle occupant - 0.46 Motorcyclist - 7.66
I'm sure if I dug hard enough I could find evidence that cocaine can help the human body in some type of way, that doesn't mean its right.
A good example of this is air travel. Most of the risk in air travel is concentrated at the end points. The high risk parts of flight are getting on or off the ground, and flying through the high traffic area around the airport. When flying at cruising altitude between the endpoints, the risk is lowest.
Overall, a very long flight is more risky than a short flight, but if you went by risk per million hours travelled the long flight might actually appear to be less risky.
This is the argument that bugs me the most. Isn't this the same as saying "If you're going hiking, taking a medical aid kit may create a false sense of security and induce risk-taking that hikers without a medic kit might not make.". No it's a dang medical kit, just take the damn thing!
I will always remind vividly is how hard the side of my head hit the pavement. No doubt it would have been really bad without the helmet. I ended up with badly scorched fingers, a big mark on the helmet where it hit the pavement, but no head injury. Please, use a helmet.
Very well written - but a particularly poor content and irresponsible use of statistics.
Sell them a hi-viz tabard or coat. These are cheap (tabard) or slightly more than an average helmet (coat). The thinking is prevention better than cure. If you can avoid the impact in the first place then that is a better place to be. Hi-viz works, there are studies from 3M and plenty of others to prove it (if you think 3M are biased). In real life I have been ticked off for not wearing a helmet by riders in black - you know the ones - male, black clothing, helmet, smart-arse attitude.
Make sure the helmet fits. There isn't a lot of point being strangled by a blob of polystyrene foam. The straps have to be done up tight for the helmet to do what it is supposed to do. Generally I point customers away from the American brands - Giro, Bell - and towards the European brands because the straps are much better on the proper European brand helmets. They lie flat with the face and don't have buckles that catch the skin. Again, the no-viz riders in black protected by their magic helmets rarely do the straps up and you can flip the helmet up off their heads with a single finger.
Sell trouser clips and sensible footwear. In the UK leisure cyclists need to be aware that a denim trouser caught in the chain (or a shoelace) will throw you straight over the bars head first onto the road. Trouser clips (and stiff-soled cycle-specific shoes) prevent that from happening.
Sell lights that work. The front light is probably more important than the back. Just a basic flasher will do. Drivers are used to seeing idiot cyclists on the road in front of them riding without lights, they are easy enough to pick up with headlights. However, overtaking drivers do not expect some cyclist coming the other way. So lights are vital particularly during the spring/autumn/winter months.
For me, with interactions with customers, the helmet is also part of a use scenario. Mountain biking? Doing back-flips on a BMX? Road-racing? Small child on trailer? We actually have specialist and different helmets for those scenarios. Same for people returning to cycling from having not been on a bike for a while, we have affordable and easy to adjust helmets for those folk too.
My message is that cycle safety isn't just about wearing a helmet. Wearing a helmet does not make you safe any more than an airbag makes a motorist safe. True safety is to be found elsewhere, by being properly visible to all other road users and in riding a bike that isn't going to self destruct due to some unanticipated interaction with clothing. It is also in having the skills to ride a bike in a way that is neither cowardly or cocky.
If you ride the same route every day and know every pot hole, recognise the plates on the cars that pass you every day and have never had the slightest chance of a mishap you do have to think 'why am I carrying this block of polystyrene with me every day? Am I doing this just to please my car-driving mother?'
Finally if made-in-China polystyrene was that great they would make the fronts of trucks from the stuff.