Monday, May 24, 2010

The bicycle helmet debate

Wearing a helmet when you ride a bike may seem like common sense, but it's controversial here in San Francisco. The dangers are highlighted in a recent NY Times article:

Whether you ride on hectic city streets or bucolic back roads, helmets are essential armor. Bicycle helmets have been shown to reduce the risk of head injuries by up to 88 percent and facial injuries by 65 percent, according to a Cochrane Database Systemic Review published in 2000. Bike riders who play against those odds do not fare well in accidents. More than 90 percent of the 714 bicyclists killed in 2008 were not wearing helmets, according to the Insurance Institute for Highway Safety.

(Interesting to note that SF Streetsblog somehow overlooked this story in its May 20 "Today's Headlines" feature, even though they obsessively tally every cyclist injured by a crash with a motor vehicle in the Bay Area.)

Some see the whole helmet movement as just another manifestation of greedy US capitalism:

The reason is quite simple. All the main helmet manufacturers are American. When they started suddenly promoting helmets in the late 1980’s, they targeted their local market and aimed helmets at those who cycled there; namely sports enthusiasts and hobby cyclists. The helmet was yet another piece of ‘necessary gear’ to be sold. The manufacturers capitalized on their branding of cycling as a fast-paced, sweaty sport.

And why am I not surprised that Andy Thornley of the SF Bicycle Coalition doesn't wear a helmet when he rides?

Neither does Chris Carlsson, one of the founders of Critical Mass:

It’s not a moral imperative to buy a commodity that offers meager protection in order to be critical of a ridiculously hostile road structure. You don’t deserve to die, or even suffer injury, just because you refuse the "common-sense Consumer Duty" to buy and wear a helmet. Road engineering today guarantees serious accidents between bikes and cars, and of course, cars and cars. You may survive a slightly higher percentage of these predictable and designed "accidents" wearing a helmet, but you are reproducing an insidious logic when you criticize bare-headed cyclists. It is terribly false to place the onus for traffic safety on the individual vehicle driver, whether car or bike. The system is designed in such a way that it is entirely predictable that many thousands of people will die in the "normal" course of events on America’s roadways. Cyclists who ride without helmets do not thereby deserve the fate handed out by the unforgiving streets of America.

Out of this neurotic muddle, Critical Mass was born. Carlsson is now an old guy, and in the Times article a doctor has a special warning for us old guys:

People over 30 should be particularly careful because their gray matter is not packed as tightly as it used to be. And I don’t mean that only figuratively. “As you age, your brain shrinks, but your skull does not,” Dr. Gardner said. “That extra space means that the brain can bounce around inside the skull and may be more easily damaged from a blow.”...Even a light blow to the head can be serious. “You don’t have to be going fast to hurt your brain,” said Dr. Gardner, president of the American College of Emergency Physicians. A simple concussion can be debilitating, keeping you off the job or operating at half speed for weeks. “And every concussion increases the likelihood that you will have an injury to the brain if another concussion occurs,” Dr. Gardner said.

That's why Steve Young, the great 49er quarterback of days of yore, retired from professional football: his doctors told him that any more concussions and he could end up as a complete basket case. Unlike most quarterbacks, Young had a habit of lowering his head and plowing into defenders when he ran with the ball.

You can cite accident studies that demonstrate that helmets protect your head in an accident, but The Guardian's Steve Jones is unconvinced:

Context is important here. The most recent federal statistics on bicyclist accidents shows there were 716 bicyclists killed on roadways in the U.S. in 2008, or about 2 percent of all traffic fatalities. Certainly, helmets might have prevented some of those deaths, but from public health or statistical perspectives, this is a pretty low number.

Here's the New York study that tells us that "Nearly all bicyclists who died (97%) were not wearing a helmet." That means that 694---or 97% of the 716 fatal accidents noted by Jones---might have been prevented had the cyclists been wearing helmets.

But the most dramatic testimony is from those who have had an accident that would have been a lot worse if they hadn't been wearing a helmet:

I crashed my bike and was knocked out. I was wearing a helmet, which had a big dent in the forehead area. I fully believe I would not be capable of typing this had I not been wearing a helmet. For me that is the end of that argument !

Another anecdote from the Bay Guardian's blog:

During the production of the film, one of the actors was riding down Dolores Street on a bicycle and ended up going head first into a car windshield. The actor was wearing no helmet, which by all accounts would have protected him from the injuries he received to his brain which resulted in the need of surgery. The young man basically had to learn to do everything over again, as if he was almost an infant.

And this:

I've been cycling for 2 decades, and have known more than 1 person who died (no, not hit by a car) because they fell off their bike and cracked their head open on the sidewalk, or ran into another bicyclist. Both completely survivable if a helmet had been worn.

I of course am not a cyclist, but surely the moral of the story is that you should wear a helmet when you ride a bike.

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At 4:50 PM, Anonymous Tawrence Tulkie said...

This is hilarious! The reason people wear helmets in the US is because:

1) There is poor healthcare here and you're likely to pay big for an injury.
2) General cultural paranoia about everything.
3) There is TERRIBLE bike infrastructure here (unlike Europe) so the odds of a collision with a car is much higher in the US.

I can't believe these people get so bent out of shape about it. It's the capitalists man!!!

At 9:00 PM, Blogger Rob Anderson said...

The thing is that dedicated cyclists---those that are ideologically committed to cycling---want to portray cycling as a lot safer than it really is. But they are in denial about the dangers. As bike messenger and author Robert Hurst says, "I believe it's silly to overlook the dangers of cycling in traffic, and there is a faction of cycling advocates who seem to want to do that. On the other hand, I hope I made clear in my book that the benefits of bicycling far outweigh the risks."
And this: "There are those[cyclists] who bristle at any suggestion that cycling is dangerous, because they fear it will scare noncyclists away from ever ditching their cars and trying a more healthy form of transport."

But many cyclists themselves seem to be delusional about the risks.

At 11:07 PM, Anonymous Paul said...

Helmets are a catch-22, and even more so here in the States than elsewhere in the developed world. The biggest reason for which a lot of cyclists neglect to wear helmets is that doing so leads others to believe that cycling is more dangerous than it actually is. One researcher also theorized that cyclists wearing helmets were more likely to be NY Times article from 2001, which makes some other interesting observations:

"Many specialists in risk analysis argue that something else is in play. They believe that the increased use of bike helmets may have had an unintended consequence: riders may feel an inflated sense of security and take more risks." (The same pattern was found to occur among drivers when anti-lock brakes were introduced, so this isn't unique to cyclists.)

"Dr. Richard A. Schieber, a childhood injury prevention specialist at the Centers for Disease Control and Prevention and the leader of a national bicycle safety initiative, said public health officials were realizing that in addition to promoting helmet use, safety officials must teach good riding skills, promote good driving practices and create safer places for people to ride." Hmmm... bike buts at the CDC? And do you understand now why cycling classes for children are so vital?

"But the most effective way to reduce severe head injuries may be to decrease the number of accidents in the first place."

See also: this Next American City article on the helmet controversy, and this TA piece on safety in numbers.

So, which do you think is easier: Addressing all of the psychological factors that lead cyclists and motorists to behave more dangerously when helmets are involved; or creating safer infrastructure that reduces conflicts between cyclists and motorists, and encouraging more people to ride bikes and walk? Of course it's easy for anyone who thinks that cyclists engaging in a "dangerous hobby" don't deserve infrastructure to insist that we're crazy for not wearing them. But the issue is much more complex than that, and it's not unreasonable to suggest that making our streets safer might much do a lot more to save lives than forcing people to protect themselves from accidents that could be prevented.

At 9:38 AM, Blogger Lex said...

Normally safety issues come down to statistics. Construction workers wear helmets because they save them from injury or death. They don't sit around saying "You know, if people on the street see us wearing helmets it might discourage them from wanting to be steamfitters or iron workers. I think I'll keep my helmet off."

Cycling is a Cause and Causes make people put aside logic.

"Yes, I know a helmet might save my life but it's so important that we get more people on bikes that I'm willing to put my life on the line."

And please don't tell me "bike helmets are different." Do you see anybody on the Tour de France riding without a helmet?

At 11:54 AM, Blogger Rob Anderson said...

"Of course it's easy for anyone who thinks that cyclists engaging in a 'dangerous hobby' don't deserve infrastructure to insist that we're crazy for not wearing them. But the issue is much more complex than that, and it's not unreasonable to suggest that making our streets safer might much do a lot more to save lives than forcing people to protect themselves from accidents that could be prevented."

Typically elaborate and muddled rationalization for dumb, self-destructive behavior. Infrastructure for cyclists and wearing helmets are two different issues. And of course no one is "forcing people" on bikes to do anything. The issue isn't complex at all; if you have a realistic sense of the dangers of cycling, you would wear a helmet.

As cycling experts themselves---Bert Hill, Robert Hurst, John Forester---tell us, most cycling accidents have nothing to do with other vehicles; they are "solo falls." On the other hand, almost all the cyclists who have fatal accidents weren't wearing helmets.

At 11:55 AM, Anonymous Paul said...

The point is this, Lex: Putting a helmet on every cyclist isn't going to reduce the number of accidents. And, as several of the above sources note, helmets actually may lead to more risky behavior because they provide a false sense of security for both the cyclist and drivers. Research has shown that the best ways to prevent accidents are education (for both cyclists and drivers), improvements to infrastructure, and simply having more cyclists and pedestrians out on the streets.

The safety gains from these measures benefits all road users, unless you consider automotive speed to be an overriding concern for safety. That, I think, is the discussion that we should be having here—not whether or not every individual cyclist should submit to a personal safety measure which, after decades of research, safety experts have concluded may actually increase the number of accidents and have a more harmful effect on a large scale than the safety affordances provided to individuals.

At 12:31 PM, Blogger Lex said...

"The point is this, Lex: Putting a helmet on every cyclist isn't going to reduce the number of accidents. And, as several of the above sources note, helmets actually may lead to more risky behavior because they provide a false sense of security for both the cyclist and drivers. "
I didn't say it would. But it would reduce deaths and injuries. That seems like a worthy goal.

I don't buy the "helmets actually may lead to more risky behavior because they provide a false sense of security" argument for a second. Do soldiers in helmets behave recklessly because of their helmets? Do construction workers walk under steel girders think their helmets will save them? How about motorcyclists? Do they drive at 100MPH because they think their helmets will keep them safe?

Helmets are a standard safety measure worldwide. They're not controversial in any area but cycling where ideology gets in the way.

Your comments about a safer infrastructure are legitimate but that's a separate issue. The TDF racers I mentioned in my earlier comment ride on car free roads but they still wear helmets.

At 12:34 PM, Blogger Rob Anderson said...

On the contrary, the point is that every cyclist has to take responsibility for his own safety by wearing a helmet. All the infrastructure in the world isn't going to protect you from a head injury if you accept these lame excuses for not wearing a helmet. Obviously Paul hasn't really read the links I've provided in the post he's commenting on, just like he didn't read the Grand Jury report he commented on earlier.

At 1:15 PM, Anonymous Tawrence Tulkie said...

No, the point is it's totally retarded to argue about this. If you don't wanna wear a helmet fine! Just don't preach about it one way or the other... what a silly conversation!

At 2:37 PM, Blogger Rob Anderson said...

I disagree. What rationalizing not wearing a helmet shows is how out of touch with reality some cyclists are.

At 3:36 PM, Blogger rocky's dad said...

And so when this arrogant cyclists chooses not to wear a helmet and gets into an accident and suffers a severe head injury and permanent brain damage and has no health insurance but requires life time care, guess who pays?

They go on public assistance.

At 6:37 PM, Anonymous Paul said...

You're both talking right past me. Lex, I've provided several links which cite academic research and objective analysis on the specific topics of helmet usage increasing risky behavior and discouraging adoption. Try reading some of them, and if you're still going to say that you "don't buy the argument" you should provide evidence to the contrary. Otherwise there's no discussion to have.

TDF riders wear helmets because they're racing on dangerous streets in close proximity with a bunch of other competitive cyclists. I wear a helmet when I'm on long rides, and I will do so during the AIDS LifeCycle ride from here to LA in a couple of weeks—not because the ride requires it but because it's a good idea on unfamiliar roads with speeding drivers and lots of other cyclists. Those conditions, however, are very different from those that I encounter when I'm riding my 40lb. Schwinn down the bike lane on Valencia at 10mph. People who take all of the other important safety precautions (riding predictably, paying attention, signaling, wearing lights at night) are not "irresponsible" just because they choose not to wear a helmet. They've just made a relative risk assessment that's easy to cherry-pick for anyone who thinks that cycling's relative dangers make it inherently unsafe.

"How about motorcyclists? Do they drive at 100MPH because they think their helmets will keep them safe?"

I shouldn't have to convince you that this is certainly the case for many people. They may not be driving at 100mph, but do you honestly think that motorcyclists would ride as fast as they do—and some do ride quite fast—if they didn't feel safer because they're wearing a helmet and body armor? Obviously you missed the bit from the Times article that I linked above, which shows the same tendency among drivers:

"When they were introduced in the 1980's, they [anti-lock brakes] were supposed to reduce accidents, but government and industry studies in the mid-1990's showed that as drivers realized their brakes were more effective they started driving faster, and some accident rates rose."

The other relevant quote, since you probably won't actually read the article:

"With ridership declining over the same period [1991-2001], the rate of head injuries among bicyclists has increased 51 percent even as the use of bicycle helmets has become widespread."

Weird... The number of cyclists decreased, but the actual number of head injuries increased. That correlation is also evident in the graph titled "safety in numbers" here, which shows a pretty clear relationship between the number of cyclists (% of trips), the number of fatalities per km traveled, and the percentage of cyclists who wear helmets. I'm not saying that nobody should wear helmets, or that helmets are not a reasonably effective deterrent to head injuries. But it's also wrong to suggest that helmets are anywhere near 100% effective in preventing fatal injuries, let alone head injuries. History has proven, however, that good infrastructure, education, and more cyclists and pedestrians on the streets are very effective in preventing most fatal accidents from happening in the first place.

At 10:14 PM, Anonymous Paul said...

Whoops, I just noticed that a few of my links got mangled. The sentence in my first comment should have read:

One researcher also found in his research that drivers who pass helmeted cyclists did so closer under, presumably under the assumption that helmeted cyclists will ride less erratically. (He also found that when he wore a wig motorists gave him a wider berth.) Then there's this NY Times article from 2001, which makes some other interesting observations.

Sorry these didn't make it through originally. You should really read them both.

At 9:36 AM, Blogger Rob Anderson said...

Paul is providing links to articles on studies but not the studies themselves, whereas I provide the link to the actual New York City study that examined fatalities on their streets over a ten-year period. They found that 97% of cyclists who died on their streets weren't wearing helmets, and 74% of those fatalities were specifically caused by head injuries. You don't die from broken bones or road rash.

The NY Times article Paul cites---his link still doesn't work---is cautious about interpreting the data it uses: "What is going on here? No one is very sure, but safety experts stress that while helmets do not prevent accidents, they are extremely effective at reducing the severity of head injuries when they do occur." And this: "They[experts] believe that the increased use of bike helmets may have had an unintended consequence: Riders may feel an inflated sense of security and take more risks."

The Next American City article---it's not a study---could have been written by Paul, since it's clearly biased. But even Justin Glick makes this concession to safety: "Instead of trying to ameliorate the extent of a bicycle injury, we should be putting our efforts into preventing the injury from happening in the first place." Well, of course. But obviously wearing a helmet helps you avoid a head injury when an accident does happen. Glick cites the New York study as saying that few cyclists are injured when riding in bike lanes but doesn't mention the fatality figures for those not wearing helmets.

The Transportation Alternatives article cited by Paul notes the safety-in-numbers approach: the more cyclists on the streets, the safer they are. But recent data in SF contradicts this thesis. In San Francisco the 2008 Bicycle Collision Report notes that, even though cycling in general is up in SF, injury accidents are also up:
"A major finding of the report is that the 468 bicycle injury collisions that occurred in 2008 represent a 3.8 percent increase in bicycle crashes over the previous year, and is the highest annual total in the 10-year period analyzed by the report."

And who exactly is responsible for injury accidents to cyclists? The report finds that "Of the 312 bicycle injury collisions in 2008 where fault was assigned, 49 percent of the time fault was assigned to a motorist, and 50 percent of the time fault was
assigned to the cyclist." The dangerous behavior by cyclists that leads to injury accidents: "In collisions where bicyclists were assigned fault, the top three reasons were for unsafe speed, failure to stop at a red light, and failure to stop at a stop sign."

At 10:10 AM, Anonymous Dave said...

Count me in as someone who thinks it's insane to get on a bike without a helmet. I've only had one bad accident in years of riding – but if you'd seen the huge dent in the side of that helmet, and imagined that, sans helmet, that would have been my head – I wouldn't be around to type this had I been riding helmet-free.

And for the record, my accident did not involve another vehicle, just a little bit of unexpected gravel on the road.

Darwinism will undoubtedly take care of many of the idiots who want to ride around without a helmet.

At 5:48 PM, Anonymous College Helmet Decals said...

This is exactly true, we have to pay attention first for the safety of our family. It is more safer to wear helmets even when riding bicycles and especially for kids!

At 12:59 AM, Anonymous Paul said...

Here's a thought experiment: Replace every instance of "bicycle" or "cyclist" with "car" and "driver", respectively; or even "sidewalk" and "pedestrian". Surprise: It's still true! Though bike helmets aren't even intended to withstand lethal forces, they do the job pretty well. And if you subscribe to the belief that danger lurks behind every corner, and that a preponderance of safety features makes us all safer (despite tons of research concluding the opposite), then you should probably be wearing a helmet on the sidewalk and in your car. As you say, "obviously wearing a helmet helps you avoid a head injury when an accident does happen." But when "when" is "rarely", it doesn't make a whole lot of sense. That's why I'm not wearing a helmet in bed right now, despite the possibility that an earthquake could bring my entire apartment building down on my head while I sleep.

For every touching story of a cyclist whose life was quite possibly spared because they were riding a helmet, there are many more drivers, car passengers, and pedestrians who would most certainly be with us today they'd been wearing helmets. There's a counterpoint to that fear-mongering in every story of a cyclist who's been crippled by an automobile despite wearing a helmet, or been injured or killed in an accident that resulted from overconfidence on the part of one or both parties because they were wearing a helmet. And how many of those fatalities could have been prevented if we had safer places for people to bike in America? I think that if you were to look more closely at the conditions in which those 714 cyclists died, you would find that many of them could have been avoided if those people had been provided with better, safer infrastructure.

Unlike the helmet manufacturers, though, we lack a commercial lobby that commissions studies to prove the effectiveness of bike lanes, etc. in preventing injury or death. (Not that any such studies would convince you, anyway.)

Where are the statistics that show how much more likely you are to die of a head injury while biking than in a car accident, or as a pedestrian struck by a car? Do you know what percentage of bike accidents result in head injuries, or how many of the cyclists who died of head injuries would have actually survived their injuries if they'd been wearing a helmet? Because unless you know these things, there's no point in spouting off figures that tout the supposed protective qualities of helmets. A large percentage of a very small number does not a large number make, and there are many more factors at work in a cyclist's relative safety than whether they've got a piece of foam strapped to their head. The helmet "debate" is ridiculous because it assumes that none of the other preconditions for accidents are worth solving, including the tendency of cyclists in helmet-crazed nations like the US and Australia to take more risks. And it fails to consider the power that this cultural exaggeration of danger has to dissuade perfectly reasonable, law-abiding, risk-averse people from getting on a bike in the first place. It's a vicious cycle.

Go to Amsterdam, Copenhagen or Berlin and tell me that cycling is "inherently dangerous". The difference is clearly cultural, and our refusal to consider bicycles as anything but dangerous recreational contraptions is the single greatest factor contributing to the danger that we experience daily on city streets—not our choices as individuals to don expensive gear that might protect us from a statistically unlikely head injury.

At 4:30 PM, Blogger Rob Anderson said...

You persist in elaborate and silly justifications in defiance of common sense on bicycle helmets, which aren't expensive at all, by the way. You continue to ignore the New York City study that found that 97% of cyclists who died weren't wearing helmets. I suspect that that percentage would apply in all US jurisdictions.

At 6:39 PM, Anonymous Paul said...

Unless you know that any of those cyclists' lives would have been saved if they'd been wearing a helmet, that's a completely pointless statistic. How many motorists or automobile passengers would be alive today if they'd been wearing a helmet? Or how many pedestrians struck by cars, for that matter? The proportion of cyclists who died not wearing helmets is also meaningless without data about how statistically likely a cyclist is to have an accident to begin with. The data that I've referenced seems to indicate that cyclists who wear helmets are more likely to to get into an accident, and for that reason alone I think it's perfectly reasonable not to wear one if you take all of the other, much more important precautions. And it's downright irresponsible to chide cyclists for not wearing helmets while also poo-pooing education efforts, which are a much more effective method of preventing those accidents in the first place.

The streets are relatively dangerous for everyone. Insisting that cyclists are in more danger than anyone else, though, is just fear mongering; and it's harmful because telling people that bikes are "dangerous" makes it less safe for those of us who are capable of making our own risk assessments and just riding more safely. Cyclists are safer in places where riding a bike is respected as a normal, everyday activity for anyone—not as a risky "hobby" for young, white people, as you're so keen on portraying it. These overblown fears are self-perpetuating, and they engender ill will toward cyclists which, on the whole, poses a much more serious threat to our personal safety than the very rare fatal head injury. We don't get the respect that we deserve if we're perceived to be risking our lives simply by riding in the street, and your hate speech reinforces those perceptions.

The "helmet debate" does, too, and the subject is needlessly polarizing because it distracts from the goal of making streets safer. Insisting that everyone should wear a helmet is just poor safety strategy because it addresses (poorly, still) a very rare problem while shifting focus away from the much bigger issue of creating a safer environment that would prevent most accidents from happening in the first place. Smart safety policy eliminates the preconditions for incidents rather than trying to mitigate the effects of completely avoidable ones.

You clearly don't give a rat's ass about people's safety, though, as evidenced by your knee-jerk dismissal of the notion that slowing traffic would save people's lives. Your agenda isn't to make anyone safer. In fact, you see safety as a literal roadblock to commerce and (apparently the irony is lost on you) personal mobility. It seems to me that your agenda is just to ridicule people who disagree with you. You offer no solutions to any of the city's problems—just condescending and insulting diatribes on theirs. That's juvenile, antisocial, and irresponsible behavior for somebody who supposedly wants to become a district supervisor.

At 9:42 AM, Blogger Rob Anderson said...

Here's a link to the American Association of Neurological Surgeons on head injuries in various recreational activities. Cycling is obviously the riskiest activity to your head.

At 10:42 AM, Blogger Rob Anderson said...

Here's functional link to the American Association of Neurological Surgeons site.


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