Why I don't wear a bike helmet.

[bluehillside Retd.]

Prof,

No all accidents that don't involve head injuries are 'less serious' than those that do.

Did you mean “no” or “not” there?

If there are more accidents it is likely that there will be more serious accidents too.

Yes. So the question then is, which leads to the lesser overall incidence of serious head injuries – helmet wearing or not helmet wearing? You can have both a larger number of potentially serious accidents and fewer overall cases of serious injury for the reason I set out. Only if the increase in accidents causes a greater number serious injuries than would be the case without helmets though does the argument work. 

…and if there are more accidents whose effects are reduced by wearing helmets  For example why would a spinal injury that results in someone being wheelchair bound somehow be 'minor'.

That’s a fair point, but a complicated one. How would you compare the impact of, say, crippling brain damage against that of a spinal injury? I don’t know, but again if you want to argue that the increase in accidents means cyclists shouldn’t wear helmets then it’s for you to explain that. For what it’s worth though, as a rule of thumb most I think would agree that brain injury is more serious than body injury. I speak as someone who rides with a friend who lost his leg (mortorbike rather than bicycle) and I know which he’d pick.     

And don't forget that many (perhaps most) cycling deaths are the result of crushing injuries caused by collision with large vehicles at low speed. In many cases the vehicle passing too close to the cyclist or turning across them is a major contributory factor. Wearing a helmet wont help at all in these cases, but risky behaviour on the part of the driver will certainly increase risk.

But again, you can’t just assume that all these accidents happen because the cyclist wore a helmet and so the lorry driver took a bigger risk. If the driver couldn’t see the bike he couldn’t see the bike, no matter what the headgear of the rider. For a fair comparison you need to quantify the increase in such accidents that happened only because the driver saw the helmet and because of that decided to take a bigger chance than he normally would – which presumably would be a much smaller number than the total number of crush deaths.

[ProfessorDavey]

One of the problems of the article is that the nature of the accidents and the nature of the head injuries is not stated. For example:

What does that mean? Who are they counting? Here is a story that illustrates a small part of the difficulties to which PD is alluding.

At the beginning of the First World War the soldiers of the British Army were equipped with a soft peaked cap to wear on their heads. As the war progressed, it became obvious that there was serious danger from objects falling from the sky. When artillery shells landed (and there were a lot of artillery shells), they would exploded, killing anybody nearby but they would also throw lots of dirt and stones and bits of dead soldier into the air which would eventually come down often on top of other soldiers.

In late 1915 and early 1916 they introduced steel helmets for all soldiers and the cases of head injuries soon started to .......

... increase. Staff at medical posts were seeing more head injuries than before. Why? Well the reason was, of course that the events that caused the injuries they were seeing would not have been survivable and the medical staff would not have seen them at all.

So, if the data for the 51% quoted above was gathered by looking at A&E records, you need to be sure that the extra injuries are not coming from people who would previously have been killed.

You have to be really careful with the data to be sure exactly what you are counting.

Note: Steve, I am not necessarily disagreeing with you. If the statistic of 0.41 head injuries (Is that all head injuries? severe head injuries? How did they estimate the million hours, especially for pedestrians)  per million hours is the case, the risk is fairly low - it's a rate of less one head injury in two hundred years for an individual cyclist.

All true I guess and points to the complexity of making judgments on the matter.

However I might come back to an early point - given that the rate of deaths and serious injuries suffered by cyclists remains really low per mile traveled (regardless of whether there are increases or decreases linked to helmet wearing) and that cycling has huge health and environmental benefits, we really should be doing all we can to get more people onto bikes. Compulsory helmet wearing is a block to that - not just for the 'I'll look stupid' reason (which I have little time for but accept it exists). Don't forget that many cities now have cycle hire schemes which are a fantastic way to get more people cycling (and perhaps the most environmentally friendly, cheap and fast way to get around many cities). Are we really going to expect people to carry their own helmet around with them all the time, in case they need to hop on a Boris bike?

[ProfessorDavey]

But again, you can’t just assume that all these accidents happen because the cyclist wore a helmet and so the lorry driver took a bigger risk. If the driver couldn’t see the bike he couldn’t see the bike, no matter what the headgear of the rider. For a fair comparison you need to quantify the increase in such accidents that happened only because the driver saw the helmet and because of that decided to take a bigger chance than he normally would – which presumably would be a much smaller number than the total number of crush deaths.

It doesn't need to be 'all' just more.

I know this is not fully joined up, but we know that helmet wearing resulting in a change in behaviour such that drivers pass closer to bikes. We also know that HGVs and lorries are disproportionately more likely to be involved in cyclist deaths than other types of vehicle and that 'passing to close to the cyclist' is a contributory factor in accidents involving HGVs and bikes.

[ProfessorDavey]

That’s a fair point, but a complicated one. How would you compare the impact of, say, crippling brain damage against that of a spinal injury? I don’t know, but again if you want to argue that the increase in accidents means cyclists shouldn’t wear helmets then it’s for you to explain that. For what it’s worth though, as a rule of thumb most I think would agree that brain injury is more serious than body injury. I speak as someone who rides with a friend who lost his leg (mortorbike rather than bicycle) and I know which he’d pick.

That depends entirely on the nature of the injuries. Not all 'serious' head injuries result in permanent brain damage. Likewise there are plenty of non-brain injuries that will result in life changing effects or death or premature death.

[bluehillside Retd.]

Hi Prof,

All true I guess and points to the complexity of making judgments on the matter.

However I might come back to an early point - given that the rate of deaths and serious injuries suffered by cyclists remains really low per mile traveled (regardless of whether there are increases or decreases linked to helmet wearing) and that cycling has huge health and environmental benefits, we really should be doing all we can to get more people onto bikes. Compulsory helmet wearing is a block to that - not just for the 'I'll look stupid' reason (which I have little time for but accept it exists). Don't forget that many cities now have cycle hire schemes which are a fantastic way to get more people cycling (and perhaps the most environmentally friendly, cheap and fast way to get around many cities). Are we really going to expect people to carry their own helmet around with them all the time, in case they need to hop on a Boris bike?

I think I’d need firmer (or any) data on the numbers of people who aren’t cycling at all because they’re put off by the idea of wearing helmets. I’m not arguing for compulsory helmet wearing for cyclists in any case – just for wearing a helmet being a better idea than not given the seriousness of the potential consequences. So far as I can tell I don’t take more risks when I wear a helmet (ie, all the time), and I have no sense of vehicles passing closer to me than they used to when I didn’t wear a helmet. The friend I mentioned by the way (the amputee) did come off couple of years ago and landed on his head. His helmet split more of less from front to back – had that been his skull I hate to think what the outcome would have been.       

It doesn't need to be 'all' just more.

Yes, but the amount of “more” would need to be greater than the amount of more arising from not wearing a helmet for the point to make sense. 

I know this is not fully joined up, but we know that helmet wearing resulting in a change in behaviour such that drivers pass closer to bikes. We also know that HGVs and lorries are disproportionately more likely to be involved in cyclist deaths than other types of vehicle and that 'passing to close to the cyclist' is a contributory factor in accidents involving HGVs and bikes.

It is, but for the most part lorry and bus crush deaths happen not because they pass too close to the cyclists but rather because they just can’t see them at all in their mirrors, so typically will take a sharp left turn and the cyclist will be run over amidships. It’s horrible, but you can’t assume that it happens because the cyclists aren’t wearing helmets.   

That depends entirely on the nature of the injuries. Not all 'serious' head injuries result in permanent brain damage. Likewise there are plenty of non-brain injuries that will result in life changing effects or death or premature death.

Yes I know, but if you’re going to make comparisons then you need some basis to do it. Do more spinal injuries (for example) actually happen because cars pass too close because the cyclists are wearing helmets and, if they do, how should we measure the effect of that against the reduction in brain injuries helmets cause when they are worn? The choice seems obvious to me (and I suspect to you) but that’s all it is – a choice. The doctor quoted in the NYT article thinks the same way too by the way.         

[jeremyp]

However I might come back to an early point - given that the rate of deaths and serious injuries suffered by cyclists remains really low per mile traveled (regardless of whether there are increases or decreases linked to helmet wearing) and that cycling has huge health and environmental benefits, we really should be doing all we can to get more people onto bikes. Compulsory helmet wearing is a block to that - not just for the 'I'll look stupid' reason (which I have little time for but accept it exists). Don't forget that many cities now have cycle hire schemes which are a fantastic way to get more people cycling (and perhaps the most environmentally friendly, cheap and fast way to get around many cities). Are we really going to expect people to carry their own helmet around with them all the time, in case they need to hop on a Boris bike?

I think that's more a contributing factor to people not riding bikes than the idea that they think they would look silly. In fact, in this country, I think it is more or less accepted that cyclists where helmets. If it wasn't, this thread wouldn't exist.

[ProfessorDavey]

I think that's more a contributing factor to people not riding bikes than the idea that they think they would look silly. In fact, in this country, I think it is more or less accepted that cyclists where helmets. If it wasn't, this thread wouldn't exist.

Sadly I think there are plenty of people who'd be put off cycling if they were forced to wear a helmet. And no I don't think it is 'more or less accepted that cyclists where helmets'. There are plenty of people who don't - I'll take a very unscientific 'straw poll' of wearers and non-wearers as I cycle across London tomorrow morning. Certainly enough cyclists for a meaningful survey. My gut feeling is that a little more than half wear helmets but probably more than a third don't.

[ProfessorDavey]

It is, but for the most part lorry and bus crush deaths happen not because they pass too close to the cyclists but rather because they just can’t see them at all in their mirrors, so typically will take a sharp left turn and the cyclist will be run over amidships. It’s horrible, but you can’t assume that it happens because the cyclists aren’t wearing helmets.

But these things are related - a lorry ignores a cyclist, passes too close rather than actively overtaking, resulting in both the cyclist being in the critical blind spot and the driver having failed to fully recognise the cyclist's presence (as would happen if they actively overtook). Lorry turns left and ... well you know what happens.

That may actually be more linked to cyclists riding too defensively, in effect riding in the gutter rather than further out which requires active overtaking by a lorry or car rather than helmet wearing.

But the point remains if a driver fails to fully recognise the presence and vulnerability of a cyclist then problems are likely to be encountered.

[SteveH]

But these things are related - a lorry ignores a cyclist, passes too close rather than actively overtaking, resulting in both the cyclist being in the critical blind spot and the driver having failed to fully recognise the cyclist's presence (as would happen if they actively overtook). Lorry turns left and ... well you know what happens.

Yes - the cyclist is so badly injured that s/he dies anyway, with or without a helmet. Bad example.

[BeRational]

Eh? In bizarro world maybe.

I can assure you that when people see cyclists without helmets, first they think what a twat, secondly they hope they crash

[SteveH]

I can assure you that when people see cyclists without helmets, first they think what a twat, secondly they hope they crash

You, maybe, but you are not privy to other people's thoughts. Not very rational of you, I must say.

[Robbie]

If a cyclist chooses not to wear a helmet and is in an accident with resulting in head injury, who else is hurt as a result of him or her not wearing one? I'd say it is a calculated risk by the cyclist, entirely up to them to weigh up the pros and cons and make a decision. A believer in helmets could argue that a non-wearer sets a bad example to children but parents generally kit their children out with appropriate gear for cycling, including helmets. I don't see any kids out on bikes without helmets except very little ones who still have stabilisers (tho' some little ones like having a helmet, they feel grown up and look cute in them).

It's not worth arguing about.

(I'd be interested to know if cycling clubs insist on members wearing helmets. I know someone who belongs to such a club, along with his children, I will ask next time I see or else google cycling clubs - but later, going back to bed after a drink of milk. Night night or good morning.)

[ad_orientem]

I can assure you that when people see cyclists without helmets, first they think what a twat, secondly they hope they crash

Or is that just you?

[ProfessorDavey]

I can assure you that when people see cyclists without helmets, first they think what a twat, ...

Maybe so.

... secondly they hope they crash

But that's not what the psychology research tells us. What it tell us is that the driver is a little more cautious when passing a cyclist without a helmet.

[ProfessorDavey]

I think that's more a contributing factor to people not riding bikes than the idea that they think they would look silly.

I gather that when several areas in Australia (Melbourne, Sydney and Western Australia) brought in compulsory helmet wearing cycling reduced by 30-40%. That's a huge reduction and a lot of people who wont cycle is required to wear a helmet.

Data on helmet wearing percentage in London coming up later in the morning.

[ProfessorDavey]

Data on helmet wearing percentage in London coming up later in the morning.

OK - scores on the doors.

This morning approx. 8:45 - Clerkenwell Road (from St John St) and Old Street as far as Old St roundabout.

Cyclists wearing helmet - 56 (61%)
Cyclists not wearing helmet - 36 (39%)

I certainly missed a fair few either because too many to count in clumps or because I needed to seriously concentrate on the road!! However nothing to suggest those I missed would be predominantly in one group or the other.

Also saw a woman cyclist being treated by paramedics after an accident - no idea what had happened. She was wearing a helmet.

[jeremyp]

Sadly I think there are plenty of people who'd be put off cycling if they were forced to wear a helmet.

That's clearly true. However, I don't think "because I would look silly" is a reason that a statistically significant number of people would use. "Because I would have to buy one", "because I would have to carry it around", "because it is hot and uncomfortable", but not "because people would think I look silly". 

There are plenty of people who don't - I'll take a very unscientific 'straw poll' of wearers and non-wearers as I cycle across London tomorrow morning. Certainly enough cyclists for a meaningful survey. My gut feeling is that a little more than half wear helmets but probably more than a third don't.

But the half that do don't get targeted for ridicule.

[ProfessorDavey]

That's clearly true. However, I don't think "because I would look silly" is a reason that a statistically significant number of people would use. "Because I would have to buy one", "because I would have to carry it around", "because it is hot and uncomfortable", but not "because people would think I look silly".

True although we have no idea what proportion would stop cycling for each of those reasons. We do have evidence that were helmet wearing to be compulsory cycling rates would drop markedly, perhaps by as much as 40% is previous experience were repeated. That's a huge drop and would have a detrimental effect on health and also the environment.

But the half that do don't get targeted for ridicule.

Maybe so, but I think cyclists wearing 'cycling gear' (more than just a helmet, but lycra etc) are sometime the target for abuse. On my cycle across London I wear helmet and cycling gear (because it is sensible, hi-vis, dries quickly etc) - I've received abuse which seems based on the notion that somehow because I look that way I must be some kind of cycling activist fanatic.

[jeremyp]

Maybe so, but I think cyclists wearing 'cycling gear' (more than just a helmet, but lycra etc) are sometime the target for abuse. On my cycle across London I wear helmet and cycling gear (because it is sensible, hi-vis, dries quickly etc) - I've received abuse which seems based on the notion that somehow because I look that way I must be some kind of cycling activist fanatic.

That is true.