Thursday, September 22, 2016

Helmets--Oh Yeah, We're Going There!

Yeah, I know.  On the list of fun topics to discuss, helmets rank right in between politics and anal warts.  But don't blame me, because the media started it:


(Which is why pro cyclist injuries and deaths declined so steeply after the UCI instituted a helmet rule in 2003.  Oh, wait...)

A major study of bike helmet use around the world from more than 64,000 cyclists has found helmets reduce the risks of a serious head injury by nearly 70%.

The study also found neck injuries are not associated with helmet use and cyclists who wear helmets reduce their chance of a fatal head injury by 65%.

Wow.  Sounds conclusive, right?  Well, not so fast:

The compulsory wearing of bike helmets in Australia has long been a source of frustration for some cyclists, who argue it reduces participation rates. Previous studies have indicated helmet use encourages risk-taking behaviour or does not reduce serious injury to the brain.

But a comprehensive review by Australian statisticians Jake Olivier and Prudence Creighton from the University of New South Wales that drew together data from more than 40 separate studies found helmet use was associated with dramatically reduced odds of head injuries.

What?

New South Wales, Australia!?!

CUE RECORD-SCRATCH SOUND!

In case you forgot, New South Wales is the possibly the most bike-hostile place in the world:


Gay, a member of the junior party in the Liberal-National coalition, is minister for roads for New South Wales, and has described himself as “the biggest bike-lane sceptic in the government”. The NSW government is about to get rid of a much-loved and much-used AU$5m (£2.4m) protected cycleway in Sydney’s city centre – a move Clover Moore, lord mayor of Sydney since 2004, describes as “a shocking breach of trust”.

And recently raised all of its bicycling-related fines into the stratosphere:


And that's not including the fine for not carrying ID while cycling, presumably so they can make sure all those other charges stick and you don't give them a fake name like "Mike Hunt" or "Flavius Scranus" in order to dodge the fine.

So yeah, I'm going to look askance at any research paper that comes from a place where the fine for not wearing a plastic hat is over $300--and doubly so when it's presented at a Finnish safety meeting:

The findings were presented in Finland this week at Safety 2016, the world conference on injury prevention and safety promotion.

Which sounds a lot like a euphemism to me:


Plus, what kind of safety conference has a ferris wheel?


Those things are dangerous!


Okay, well actually the ferris wheel Freds say they're not dangerous.  They probably just seem like they're more dangerous than they are to people who don't know anything about them--you know, like bicycles.  That's why I always wear a helmet when I go to the amusement park.

And while I'm striving for accuracy, I suppose it's not entirely scientific to deride a study just because it comes from a certain antipodean state with an anti-bike bias, or because I find the alliterative juxtaposition of Finnish safety meetings and ferris wheels to be conveniently amusing.  We need to look at the actual study, right?  Well sadly I can't, because it's behind a paywall and I'm not made of money over here (I'm made of high-modulus carbon fiber), so for the purposes of this blog we'll have to settle for the abstract:

Methods: Four electronic databases (MEDLINE, EMBASE, COMPENDEX and SCOPUS) were searched for relevant, peer-reviewed articles in English. Included studies reported medically diagnosed head, face and neck injuries where helmet use was known. Non-approved helmets were excluded where possible. Summary odds ratios (OR) were obtained using multivariate meta-regression models stratified by injury type and severity. Time trends and publication bias were assessed.

Okay, so they looked at a bunch of injured cyclists in various places--or, more accurately, articles and data about injured cyclists that other people have already collected and interpreted.  Now, how is it even possible to draw new conclusions about any of this data if you don't even know the total number of helmeted versus unhelmeted cyclists riding around out there in the general population?  And what were the circumstances that led to these injuries in the first place?  Isn't it possible the head injury odds they're presenting really just amount to statistical noise?

Well, maybe yes and maybe no.  But the danger here isn't the idea that helmets may offer you some additional protection from injury, which frankly sounds pretty reasonable to me, and which is why I wear them sometimes.  The danger is that these sorts of studies lead to conclusions like this:

Conclusions: Bicycle helmet use was associated with reduced odds of head injury, serious head injury, facial injury and fatal head injury. The reduction was greater for serious or fatal head injury. Neck injury was rare and not associated with helmet use. These results support the use of strategies to increase the uptake of bicycle helmets as part of a comprehensive cycling safety plan.

Funny how the conclusion is never  "make conditions safer for cyclists," isn't it?  But wait, actually it is--in an earlier paper about bicycle-related head injury trends in New South Wales, co-written by Jake Olivier, one of the very people behind this most recent study.  Indeed, in this earlier paper (WARNING: PDF) there's a graph showing a decline in head injuries--after increased cycling infrastructure:



The conclusion?  New South Wales needs more infrastructure development:
Not only that, but the paper also warns of the dangers of "meta-analyses" (which is what the most recent study is) and says that such studies can be biased when they relate to legislation:

"Results from mata-analyses should be interpreted with caution since ultimately, they are analyses of statistical studies rather than a large statistical study in itself and sample bias will always be present regardless of who is carrying out the analysis, particularly when it is related to a political agenda or legislation."

Yet this is exactly what this most recent study is--a meta-analysis being used in support of mandatory helmet laws:

The researchers cautioned that helmets were not a “panacea for cycling injury” and did not eliminate head or face injuries or offer protection to other parts of cyclists’ bodies. But it does make the case more difficult for those who oppose mandatory helmet wearing, they said.

“The legislation of mandatory helmets for cyclists is a controversial topic and past research on its effectiveness has been somewhat mixed,” the study said. “Irrespective of past research, the results of this review do not support arguments against helmet legislation from an injury prevention perspective.”

So sorry, but based on the researcher's own caveats in an earlier paper, I ain't buying it--nor do I understand why so many people pretend there aren't cities on Earth where people cycle safely in huge numbers and that helmets have absolutely fuck-all to do with it.

Instead of passing dumb laws and clobbering people with massive fines and presenting the media with dubious studies all we need to do is copy the cities where cycling actually works and that's that.

Speaking of helmets, in yesterday's post I featured the rider who commenter "bad boy of the north" subsequently dubbed "The Narwhal:"


(Thanks again for the photos, Aaron.)

And I was delighted to see that the Narwhal himself left a comment:

Anonymous said...

Hey! That's me - the narwhal.

I have a rearview camera under my seat that Bluetooths to my tablet on the selfie stick.

It works like a rearview mirror and record my rides from behind.

Thanks for making me famous, Bikesknob!

September 21, 2016 at 2:14 PM 

Though after reading it I have to admit I was even more confused.  After all, with any number of video recorders available out there in the marketplace--not to mention good old-fashioned analog rearview mirrors--one wonders why you'd endanger yourself and others by taping a golf club onto your head. 

But hey, he's wearing a helmet, so clearly he's 70% safer than I am!*

*(No offense to the narwhal by the way, I support whatever it is you're doing, and you make the world--or at least the Williamsburg Bridge--a far more entertaining place.)

74 comments:

McFly said...

healmeants!

McFly said...

helmets

Anonymous said...

Hola from Baltimore.

janinedm said...

I can't believe you're going to contradict a meta-analysis! Next you're going to try to tell me that sugar plays a role in heart disease.

Fourhourerection said...

Balls!

weasel said...

I'm in

Lieutenant Oblivious said...

7th, why do these posts have to drop during lunch? Scranus!

Esteemed Commenter DaddoOne said...

I put my 13th month old in a purely trailer on the bike path in a helmet.
she HATED it until I took the helmet off.
she's SEATED, 6 inches above the ground and we're on the bike path.
helmet is staying off

N/A said...

NARWHAL SIGHTING ON THE BRIDGE.

The Narwhal said...

Bikesknob:

I wrote rear view, not rearward view.

A mirror ain't gonna reach there.

Anonymous said...

Careful janinedm you are on top of a fourhourerection.

art said...

How timely...
http://retractionwatch.com/2016/09/13/we-have-an-epidemic-of-deeply-flawed-meta-analyses-says-john-ioannidis/

Lieutenant Oblivious said...

Narwhal? Of course, Monodon monoceros, why didn't you say so in the first place.

According to Mark Twain, there are 3 types of liars: Liars, Damned Liars and Statisticians! Have we now achieved a fourth level "results from meta-analyses"?

So four electronic databases (MehLINE, EMBarASS, CONODOMDEX and SCranus)were searched. What I'd like to know about the study conducted by Australian statisticians Jake Olivier and Prudence Creighton from the University of New South Wales is who funded it?

Anonymous said...

Narwhal, I would have to say that having a 5 foot pole protruding from your head is probably more of an accident risk than what you may be avoiding with this skillfully curated rearview mirror. for instance, what if you look sideways and clothesline a passing rider, or worse yet a passing truck. however if the goal is not safety but drawing attention to yourself, well done.

Anonymous said...

The narwhal needs to hang a handkerchief or tattered piece of towel off of his rear-view recording "device" like painters do with their ladders on vans.

Joe said...

Won't someone please think of the children

Anonymous said...

"record my rides from behind"

That's what she said!
That's what she said!

N/A said...

however if the goal is not safety but drawing attention to yourself,

Of course it is. What other reason could there be?

janinedm said...

I didn't want to address the narwhal because he's been pretty goodnatured about the ribbing, but I'm also surprised no one has brought up Shermer's Neck.

babble on said...

Wait. That's a tablet hanging from a golf club taped to your head?? A tablet. You're distracting yourself whilst riding the streets of New York City by playing the video feed from the camera under your butt??? Unfuckingbelievable. Never dreamt I'd see this day, but here it actually is.

So very sorry about your luck, Mr Narwhal, sir, but it appears we might actually be related. You're the first person I've ever heard of who is easily as fucktarded as I am. Only even I can appreciate the beauty of an elegant simplicity. Maaaaaan oh man. Sucks to be you.

chauz said...

And while I'm striving for accuracy, I suppose it's not entirely scientific to deride a study just because it comes from a certain antipodean state with an anti-bike bias, or because I find the alliterative juxtaposition of Finnish safety meetings and ferris wheels to be conveniently amusing.

Oddly, I think I'd enjoy reading your term papers. You got skillz.

recumbent conspiracy theorist said...

Hey Narwhal if you shaved your sideburns you'd have a pretty righteous Frank Zappa thing going on.

Captain Spaulding said...

Nar Man, So if someone attaches a big long section of toilet paper to his butt, he'll know it's there. Genius! I raise a Guinness to the nar man. So this quasi hi tech git up allows him to see where he's been while he's seeing where he's going (one eye on one, one eye on the other). Hello I must be going.

Anonymous said...

if my helment saves ME from serious injury, i don't care what happens to the rest of you dick-noses.

Dr. Joyce Bothers said...

Babble, Is that your sly way of proposing a relationship with the Nar Man?

Orange is the New Green said...

No helmet means your daughter isn't protected from falling Fall leaves.

Chris said...

Helments make everything safer!

http://mandelics.com/helment_safety.jpg

wishiwasmerckx said...

CrossVegas Report:

-Wout van Aert won for the second year running. He was resplendent in his world champions skinsuit and matchy-matchy socks. He MURDERED the field. Jeremy Powers was 1:09 behind.

-You can rearrange the letters in Wout van Aert to spell "Navelwort," but only if your scrabble partner is not wearing her glasses.

-The funny name results closely traced the actual results, with Wout, Toon and Thijs all scoring top ten finishes.

-The Rapha hipster guy was resplendent with his carefully-curated fakerjack beard and pink helmet, but he soon discovered that he is not in fact all that by being run over by the belgian train. The first seven finishers were all Belgian, followed by the German national champion.

-The deciding factor was a 200 yard uphill sand bog. Those who were able to ride it generally gained almost 10 seconds on those who became bogged down and had to dismount and run. This is where I hung out.

-The rider from the Ukraine was dropped immediately, and probably did not appreciate me calling him Borat while yelling encouragement.

Flavius Scranus son of Octavious Scranus, head scribe, 7 BC said...

My name is not fallacy sir. And yes I always wear my healment whilst charioting about.

Victor Kaminski said...

vsk said ...

The risk of bleeding to death by femoral artery severing is 200x greater on a non bike path mixed use road vs. a separated bike path. Sue every .gov that removes or fails to install separated bike lanes. Much as the municipality has the power to fine you for non helemental use, there should be some over arching arch power, like Copenhagenize, that can fine every city until they comply with some mandatory percentage of separated bike lanes to mixed use roads ratio.

You want me to pay AUD$ 300 for not using a helmet? Fine, I'll dump a fucktonne load of smug litigation upon your bankrupt shithole for failing to provide me with a "safe" place to conduct my bikecycle cycling.

Dear Narwhal, I use the Third Eye mirror to great success. I won't bike around anywhere without it. Now if you could Bluetooth a Fly6 Light-Cam to Google Glass, you'd have some trick kit going !!

A tip of the hat to Ms. Babble and JanineDM.

vsk

potbellyjoe said...

How many degrees are between the narwhal and bacon?

Quality post Snob. My job is in statistical analysis. Coincidently one of my pet peeves is when stats are [mis]used as a means to support a political point. When I hear, "We need a study to show..." It drives me up the wall.

Just one more reason to hate politicians. Add it to the pile.

Sax Huret said...

Assuming there are any genuine mandatory helmet proponents (personally I think such an individual is more unicorn than narwhal) do they think of this as a mandatory seat belt thing or something?

recumbent conspiracy theorist said...
This comment has been removed by the author.
streepo said...

Look at Mr. Fancy pants SUNY Albany alum flashing his critical thinking skills!

recumbent conspiracy theorist said...

Sorry Snob I see you already had the statistical analaseez under control. I've fallen out of the habit of clicking all the links since they no longer lead to Recumbabe.

bcstractor said...

Good thing my patent on that ran out a few years ago or I'd be after him with his rear view camera.

Anonymous said...

Americans (especially children!) are literally turning into giant flabby bags of goo. F#ck helmets and get people riding bikes. In fact, make helmets mandatory for drivers, but not for cyclists. That would get a lot of bikes out of the basement.

Sure helmet research is all over the map, but there is zero controversy on the dire health effects of obesity.

So much hand wringing over helmets, while society is going to hell in a diabetes handbag.

The Narwhal said...

I like to think of the helment as not so much of a safety item but as a multipurpose BarFly for the head.

Sax Huret said...

@Anonymous Folks won't even be honest about the climate change consequences of motorists (which is a fairly straightforward case of cause and effect), good luck getting them to be real about the link to obesity or other sedentary diseases.

bad boy of the north said...

I'm tipping my hat to mister snob for making me famous for fifteen seconds.
The narwhal,thanks for taking the ribbing in good spirits as long as you don't spear anyone in the ribs in the meantime.
Hey,meta analyse this.

Fnarf said...

Hey, he called you "Bikesknob" not "Bikesnob". Knob. Heh heh.

Albért Scranús said...

Let's not forget to ask also: How do we know which of those published studies were performed using sound, reproducible methodologies, and how many were total shite? Publication doesn't guarantee scientific soundness; not even peer-review guarantees that.

Pathetic Old Cyclist said...

META ANAL

Pathetic Old Cyclist said...

Narwhale could probably use a handlebar mount for his phone / rearview mirror. I guess he would then just be some Dork like the rest of us instead of a famous Narwhale.

bad boy of the north said...

wow,there's even a narwhal song.sorry and you're welcome.now try to get THAT song out of your head.

Lock Robster said...

B-52's know what's up: "There goes a narwhal, wah-ooo-wah"

leroy said...

Back when my dog used to coach me, he set me up with headgear similar to Mr. Narwhal's.

Instead of a tablet on the end of the rod, he hung a bag of Cheetos.

I never did catch the Cheetos, but it wasn't for lack of trying.

BamaPhred said...

The Narwhal is officially my "I don't care what you think, Feels good, man" hero. You go, Narwhal.

Anonymous said...

So much jabber about narwhals and nobody's dropped bacon.

https://gaming.youtube.com/watch?v=vEZG14eGmR8&list=FL-EuSNjWiBj1UFe1Q35bc3Q

dancesonpedals said...

I preferred Lone Wolf sightings, but he's been hiding.

The King of Park Slope said...

BIKE KNOB

< snork >

Hee Haw the Barista said...

GNAR WHAL

Amirite?

mike w. said...

LIES,DAMNED LIES, and STATISTICS.

Lieutenant Oblivious said...

KNOB SNOB
KNOB SLOB
BIKE SLOB
Dirty Marin

Some guy from upstate said...

I have a vewy good fwiend in Wome named Flavius Scranus!

Grump said...

I thought the guy from Wome was Biggus Dickus.

GW Hayduke said...

¡Me!

Blaue Reiter said...

Very much loving that no single commenter has engaged the helment debate itself- nice! I suppose it's all thanks to the narwhal, who I confess I snickered at until he commented about his view of helments whereupon I had to confess it's where I mount a light in the winter, and maybe... I am a bad, judgemental person.

Paul Heckbert said...

A data point for the "do helmets prevent neck injuries?" debate: Famous long-distance cyclist Danny Chew, aka "the Million Mile Man", and co-founder of Pittsburgh's Dirty Dozen bike race, broke his neck in a crash while cycling while helmeted two weeks ago. It appears he's now paralyzed from the waist down. At http://www.bikepgh.org/message-board/topic/danny-chew/ you can read about the crash and see a video Danny created after the crash, in which he says "the helmet might have saved my life".

Deepstirfried said...

Maybe you can live with cyclists should wear helmets until much needed infrastructure is in place... or maybe where infrastructure is not in place. I can't decide if your argument is about civil liberty or safety. You may remember when you gave a talk in Melbourne with fyxo and you started by mentioning our helmet laws and the audience made a meh sound (except for two guys who thought you would buy them a beer if they agreed with you) because we basically couldn't give a rat's about a small piece of foam. Sure, I don't wear a helmet on well setup paths in Europe and I think we could look at where we enforce the rule but your attack on the data is tinged with wish-thinking. There are many instances where helmet laws have improved medical outcomes. The corollary of your argument seems to be that we should get more head injuries and lobby government to show that infrastructure would improve the situation. This is true but not useful.

Persia said...

Sigh, helment debate.

But thanks so much Snob for distinguishing between the demented anti-cycling regime in New South Wales and the rest of Oz, because it sure sucks to be a cyclist there and the population of Victoria (next state down) is rapidly growing with refugees from the not even slightly Gay experience in Sydney. Welcome, people and the coffee is way better too!

Thar She Blows said...

Narwhales have no need for a bell because they have a horn.

babble on said...

Joyce - EW! Dear girl, how very Freudian of you. I'm Jung at heart, though, and I always acknowledge a kindred spirit. True enough, I'm a dirty girl, but honey, he's like a brother to me.

Mr Deep. Yes yes yes of course. We all understand the benefits of protection. My last concussion was sustained wearing a MIPS equipped Shadow, and I wasn't moving fast, either. Helmet fucking schelmet. The greatest danger i face daily is from speeding, reckless, self-rigteous texting eating smoking PARTYING entitled fucking motorists, and there isn't a helmet out there anywhere going to change that.

The helmet debate is a foil. It's a dirty trick: black magik. There are a good many MadMen marketing lines the general public has bought and paid for many times over, to the detriment of all. Swallowed em Hook Line and Sinker. And as long as we're talking about how dangerous it is out there on the roads on a dinky little BYEcycle without yer goofy little foam hat, the whole fucking "Was She or Wasn't She Wearing a Lid?" debate, then nobody is talking about how DRIVING A MOTORVEHICLE IS A PRIVILEGE NOT A RIGHT and THAT CARRIES WITH IT A METRIC FUCKTONNE OF RESPONSIBILITIES.

It's far easier and more expedient to blame the victim, and plus, that way nothing has to change.

Soflo'd said...

While noncorrelatable statistical variance is congruent with all irrespective data points, various isolinear distributions aggregate perpendicular to the mean average of probability density. Systemic bias is rarely confined to a zero sum null hypothesis... So simply put, dees izz all bullshiiite... So wear a helmint...beats drain bramage.

Deepstirfried said...

Dear babble, I agree that helmets are not the solution and I have had a broken pelvis, hip, spine and ribs without scratching my helmet so they are not always necessary even in severe road trauma situations, but they have the potential to be very useful. So constantly arguing that they don't work is spurious. My point about Melbourne is that I don't think we talk about helmets much because we have to wear them. You all seem obsessed and yet you don't uniformly have to wear them. Complain about infrastructure, bad policing, cars in general and ignore the helmet debate.

21st Century Cave Art said...

Wait... The Narwhal wasn't watching Netflix?

bad boy of the north said...

i would like to visit Australia one day.but if I do it ain't gonna be beeking.don't want no fine for going styrofoamless.i'll have to go pedestrial,instead.

BikeSnobNYC said...

bad boy of the north,

It's a long way to fly just to feel like you landed in Florida.

--Wildcat Rock Machine

Dave - Everywheere said...

Here in the land of the free, home of the brave we have a choice about do/don't wear a helmet (at least in NY if you're over 14. I'll wear mine, you don't have to if you don't want to. If you don't want to wear one, then you have to accept the a somewhat higher level of risk. If you're OK with that, then we're all good.

bieks said...

Besides, a handlebar mount wouldn't have got the narwhal fame or his new name.

The Narwhal said...

Thanks for the support, people of the commentariat. Unfortunately I won't be able to keep up my witty retorts, as I was harpooned on my way home. It's hard to be funny with my hands all slick with my own blood. And that angry old guy with the wooden leg is coming right for me. Adios compadres

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Blaue Reiter said...

Looks like I jinxed it: sorry everybody!

Colin.cycling said...

The main author of the report, Jake Olivier, has made some questionable statements about cycle helmets and legislation, recently one article stated, ‘No strong evidence bicycle helmet legislation deter cycling’. He was being very selective in pushing this view, selecting states without extensive actual road survey data and not relating to surveys that did show strong evidence e.g. Melbourne road surveys revealed 30 more teenagers wearing helmets compared with 623 fewer cycling (based on 64 survey sites and 10 hours per survey) and NSW surveys showed 569 more children were wearing helmets compared with 2658 fewer cycling (based on more than 100 survey sites). For adults counted at road sites in NSW a 26% reduction occurred from 1991 to 1993, down from 5734 to 4251.

see
https://www.mja.com.au/journal/2016/205/2/no-strong-evidence-bicycle-helmet-legislation-deters-cycling

and
http://www.cycle-helmets.com/au-assessment-2015.pdf


Supporters of the Australian legislation also claim that cycling levels soon recovered but this is mainly based on inner city cycling levels that had a high population growth. See Fig 7 page 16 of the Au evaluation.

The method used in the meta analysis compares injuries/deaths by helmet wearers v non wearers but there are differences in behaviour in the two groups, see Table 19, page 23 for examples. Page 18 mentions the proportion in fatality cases that had been drinking, 10% for helmeted and 29% for non wearers. Table 22 page 35 provides details of the shoulder-upper limb to lower limb, ratio 0.621 for not worn and 0.968 for wearers, 55% higher for wearers. Watching the cycling on TV this year a number of cases occurred with a broken collar bone resulting from falls. The data suggests that wearers have a higher proportion of falls and this will change the overall proportion of head injuries compared to other injuries. The reports used in the meta analysis do not in general specify if the cyclist fell or was involved in a motor vehicle collision. It cannot be considered a reliable guide to overall safety.

Information concerning Jake Olivier evidence to the Senate;
http://crag.asn.au/helmet-fanatics-misleading-tricks-exposed-at-senate-inquiry/