Re: Helmet efficacy test

On 4/2/2025 2:16 PM, Frank Krygowski wrote:

On 4/1/2025 4:13 PM, Zen Cycle wrote:

On 3/31/2025 8:54 PM, AMuzi wrote:

On 3/31/2025 7:43 PM, John B. wrote:

On Mon, 31 Mar 2025 18:42:12 -0400, Frank Krygowski
<frkrygow@sbcglobal.net> wrote:
>

On 3/31/2025 3:10 PM, Radey Shouman wrote:

Frank Krygowski <frkrygow@sbcglobal.net> writes:
>

On 3/31/2025 12:39 PM, Radey Shouman wrote:

   Actually I was talking to Mr. Krygowski.  It seems to me that his
standards for studies on flu shots are different to those for bike
helmets, and I was curious as to what had convinced him of the efficacy
and safety of flu shots.

>
As I said, there is nationwide, ~ whole population data indicating flu
vaccines have high effectiveness in preventing infection and/or
hospitalization. There is no such nationwide data for bike helmets,
and indeed nationwide data shows no apparent benefit. And there are
serious weaknesses in many or most helmet promoting studies.

>
Could you provide a link to that data, and its analysis?

Look up cyclist fatality counts since, oh, 1980, the time during which
helmets became normalized and popular. There is no significant reduction
in fatalities. And I've given links to several articles describing
increases in cyclist concussions.

>
The following data is freely available on the Web. It seems strange
that you are unaware of it.
>
Year   U.S. bicycle fatality/ 100,000 population
1980 -- 0.422
1990 - 0.345
2000 - 0.246
2010 - 0.202
>
>
More Data
>
Year Bicycle Deaths No helmet    %              Deaths Helmet    %
2013    464    62    127    17
2014    429    59    118    16
2015    439    53    139    17
2016    425    50    138    16
2017    420    52    126    16
2018    525    60    121    14
2019    520    61    127    15
2020    535    57    168    18
2021    599    62    143    15
2022    674    62    159    15
>
>

>
Data source on that?
>
I personally know of two helmeted riders who were killed in traffic between 2013 and 2022 so it is certainly not zero although "what counts?' and 'who's counting?' may be appropriate questions here.
>

>
You may have missed it in all the chatter but Frank has repeatedly been shown the following information as well as other _recent_ corroborating studies but has refused to acknowledge them, instead choosing to state "There is no such nationwide data for bike helmets, and indeed nationwide data shows no apparent benefit. And there are serious weaknesses in many or most helmet promoting studies."
>
The information below very _clearly_ contradicts all three of those claims. Instead of arguing the merits, data, and conclusions of these studies, he instead deflects to rail against marketing tactics, engages in whataboutism with walking, and builds strawmen to attack the person (me) presenting the information.
>
https://pmc.ncbi.nlm.nih.gov/articles/PMC6747631/
>
"There was a significantly higher crude 30-day mortality in un- helmeted cyclists 5.6% (4.8%–6.6%) versus helmeted cyclists 1.8% (1.4%–2.2%) (p<0.001)."
>
"Cycle helmet use was also associated with a reduction in severe traumatic brain injury (TBI) 19.1% (780, 18.0%–20.4%) versus 47.6% (1211, 45.6%–49.5%) (p<0.001), intensive care unit requirement 19.6% (797, 18.4%–20.8%) versus 27.1% (691, 25.4%–28.9%) (p<0.001) and neurosurgical intervention 2.5% (103, 2.1%–3.1%) versus 8.5% (217, 7.5%– 9.7%) (p<0.001)."
>
and another
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https://pubmed.ncbi.nlm.nih.gov/28945822/
"Helmet use was shown to be protective against intracranial injury in general (OR 0.2, CI 0.07-0.55, p = 0.002). A protective effect against subdural haematoma was demonstrated (OR 0.14, CI 0.03-0.72, p = 0.02). Wearing a helmet was also protective against skull fractures (OR 0.12, CI 0.04-0.39, p<0.0001) but not any other specific extracranial injuries."
>
And another
>
https://pubmed.ncbi.nlm.nih.gov/29677686/
"179 effect estimates from 55 studies from 1989-2017 are included in the meta-analysis. The use of bicycle helmets was found to reduce head injury by 48%, serious head injury by 60%, traumatic brain injury by 53%, face injury by 23%, and the total number of killed or seriously injured cyclists by 34%. "
>
The other studies previously posted here that prove the effectiveness of helmets (which Frank also chooses to dismiss with no rational explanation) are:
>
https://pmc.ncbi.nlm.nih.gov/articles/PMC7025438/
>
https://www.nature.com/articles/s41598-023-35728-x
>
https://www.cpsc.gov/Newsroom/News-Releases/2021/New-CDC-Report-Finds- More-Adults-Are-Dying-from-Bicycle-Related-Accidents-CPSC-Says-it- Highlights-the-Importance-of-Helmets
>
https://www.nsc.org/safety-first/bicycle-safety-statistics-may- surprise- you?srsltid=AfmBOoq4LC_IGLItTnDBXBm4Yu6K20nqSHjsZbqpkk- jQ2y4Y1J7hfbf

 Let's see: A "Case-control" study of cyclists presenting to ER. Oh, and another "case-control" ER study. And what's this? Yet another "case- control" ER study? And gosh, another "case-control" ER study?

Sure, why not?

 OK: Case-control studies are very easy to do, and if they confirm the accepted truth (that bike helmets are very worthwhile) they are easy to get published.

I'd be very surprised if someone came up with different findings _couldn't_ get them study published due to your perceived cultural bias

The message - either implied or specifically stated - is that "since the people in ER without helmets did worse than the people in ER with helmets, then everybody should wear a helmet each time they ride a bike."

ok, how about "since the people in ER without seatbelts did worse than the people in ER with seatbelts, then everybody should wear a seatbelt each time they drive a car."
Seatbelt data is taken from ER visits. According to you, that data is worthless.

 The first hidden assumption is that the people in ER are representative of "everyone who rides a bike." That is obviously not the case. Only a minuscule percentage of people who have ridden bikes have ever presented to ER. Almost all bike riders will never bump their head, at least never beyond the level of "ouch!" Most people will never ever need a helmet.

ok, how about "The first hidden assumption is that the people in ER are representative of "everyone who drives a car." That is obviously not the case. Only a minuscule percentage of people who have driven cars have ever presented to ER. Almost all drivers will never crash their car, at least never beyond the level of "ouch!" Most people will never ever need a seat belt."
Your claim of the assumption that most people in the ER not being representative of everyone that rides a bike is a red herring. Sure, the vast majority of people who ride bikes will never need a helmet, just like the vast majority of people who drive will never need a seat belt. The issue is - if there comes a time when you do crash, a helmet/seatbelt can be extremely beneficial.
Remember that seatbelt detractors fear mongered by claiming the seatbelts can cause internal injuries or prevent you from getting out of the car after you crash. Sure there were a few cases of that, just as there are a few cases where wearing a helmet can create an unsafe situation - But as you so often chant during RBT gun debates - you have to weigh benefits vs detriments - the ER data shows helmets as the clear winner.

 The second (hidden?) assumption is that if everybody does begin wearing a helmet each time they ride a bike, society will somehow benefit - perhaps by lower medical costs? Perhaps by lives saved? But one of my main points has been that has not happened.

You have no data to support the claim that there has been no drop in medical costs, and the ER data clearly shows lives have been saved.

When helmet use rapidly increased in the U.S., in the 80s and 90s, there was no corresponding drop in bike fatalities. You're going to love making fun of the source, but the number are the numbers:
https://www.vehicularcyclist.com/kunich.html 

That data doesn't take into account the increase in cycling popularity, a more accurate representation would be # of deaths per mile ridden. IOW - those are raw numbers, not percentages, and The ER data contradicts your assertion.

Pedestrian fatalities - far larger in number than cyclist fatalities - dropped faster, despite the shocking lack of pedestrian helmets.

Also note that there are two different Y scales used, skewing the trendlines. There's a reason statisticians use percentages - Toms chart is an illustration of that. Let's se how an actuary would look at it

 Data analysis from more mainstream sources confirms that point.
https://www.bmj.com/content/346/bmj.f3817.full? ijkey=I5vHBog6FhaaLzX&keytype=ref  says, among much else, "The linked paper by Dennis and colleagues (doi:10.1136/bmj.f2674) investigates the policy question and concludes that the effect of Canadian helmet legislation on hospital admission for cycling head injuries “seems to have been minimal.”1 Other ecological studies have come to different conclusions,2 but the current study has somewhat superior methodology— controlling for background trends and modelling head injuries as a proportion of all cycling injuries.

I'm not sure what the motivation was of the people who wrote that paper, but the study they linked (https://www.bmj.com/content/346/bmj.f2674) directly contradicts their claim.
"Between 1994 and 2008, 66 716 hospital admissions were for cycling related injuries in Canada. Between 1994 and 2003, the rate of head injuries among young people decreased by 54.0% (95% confidence interval 48.2% to 59.8%) in provinces with helmet legislation compared with 33.1% (23.3% to 42.9%) in provinces and territories without legislation. Among adults, the rate of head injuries decreased by 26.0% (16.0% to 36.3%) in provinces with legislation but remained constant in provinces and territories without legislation. "
Sure it goes no to say "injury rates were already decreasing before the implementation of legislation and the rate of decline was not appreciably altered on introduction of legislation.", but they offer no other data such as the previously mentioned incidents per miles ridden.

This finding of “no benefit” is superficially hard to reconcile with case-control studies, many of which have shown that people wearing helmets are less likely to have a head injury.3 Such findings suggest that, for individuals, helmets confer a benefit. These studies, however, are vulnerable to many methodological shortcomings. If the controls are cyclists presenting with other injuries in the emergency department, then analyses are conditional on having an accident and therefore assume that wearing a helmet does not change the overall accident risk...."

I see, so there's some ludicrous assumption that helmets are supposed to prevent you from crashing? "wearing a helmet does not change the overall accident risk."....welllllll duuuuhhhhhh.
Where on earth did you ever get the idea that helmets are supposed to prevent you from crashing?

 Again, people showing up at ER are _not_ typical.

Again, that's a red herring.

 And while I've given up maintaining my files of helmet studies, there certainly are case-control studies showing that helmets are not wonderfully effective. I've previously linked the Crocker paper from Austin, that found that when controlling for the confounding factor of blood alcohol, helmets on adults did not display statistically significant benefit.

Which is another tangent, but it also doesn't state whether the deaths were from head injuries. Fail.

 Here's another case-control paper that claims large benefit, but the comments (by a correspondent of mine) show less enthusiasm when he drilled down a bit: https://www.sciencedirect.com/org/science/article/ pii/S1538958824000766
 So odds ratio of 0.52 on "head injury." Wow. But my correspondent's comments:
 .......
"I note some specifics where helmeted cyclists are the losers …
 Concussion : non helmeted 26.9%, helmeted 31.0% [Read that again, Zen!]

As discussed before - the percentage of concussions is likely to increase with a helmet wince the helmet can reduce a fatal head impact.  From your link:
"established evidence has reported a reduction in fatal head injury of 65–71% in patients using a helmet (Høye 2018; Olivier and Creighton 2017)."

 Facial fracture : non helmeted 5.1%, helmeted 8.0%
 Facial lesion : non helmeted 20.0%, helmeted 26.5%
 Intracranial hemorrhage : non helmeted 1.7%, helmeted 1.8%
 Intracranial hemorrhage, not specified : non helmeted 0.6%, helmeted 0.9%
 Subdural hemorrhage : non helmeted 1.1%, helmeted 2.7%
 I also note there was suspected alcohol involvement among 20% of non helmeted and 3% of helmeted."
.....
 I can dig up more of that sort of thing, and we can devote the rest of our lives to this discussion. But the benefits are modest at best,

That's your spin, not bourne out by the data,

and they are comparing only ER patients, who (again) are _not_ perfectly representative of the general population.

More herring, sir?

There is data indicating the helmeted percentage of people who show up at ER exceeds the helemeted percentage in the general population. That showed up strongly in the earliest pro-helmet papers, and in some others afterwards. Here are a couple articles pointing that out for other activities:
https://pubmed.ncbi.nlm.nih.gov/31335753/
 https://onlinelibrary.wiley.com/doi/pdf/10.1111/joim.12363    that says, among much else, "Surprisingly, wearing a helmet was associated with
significantly greater injury severity including the likelihood of a concussion."  (I've seen similar data regarding bicycling, but I'll have to dig deeper to find it.)
 So again: People presenting to ER are not typical of the total population. That alone casts doubt on case-control studies.

You've made your point repeatedly, using data and assumptions I find specious, lacking, and outdated.
IOW - you haven't convinced me.

 But let's take a wider view here. What are people trying to do when they promote bike helmets as being necessary? Or highly valuable? Or even mandatory?

Give you a chance to survive a potentially fatal or permanently debilitating head injury. I know, you're not buying it. That's fine.

 I'm not going to assume, as Mr. Tricycle Rider does, that those people are doing it so they can have power over others. (Um, even though he's apparently wanting that power over parents of kids!) I'm going to assume they are hoping for some societal good - maybe to reduce the nation's medical costs? Maybe to reduce general misery? Maybe they get an unspecific frisson of pleasure out of having "done some good"? Feel free to comment on why _you_ always counsel people to wear a helmet every time they ride on a normal road!
 In my view, none of those work. The only dollar-vs.-dollar study I've seen on helmets came out of Australia many years ago, after its nationwide MHLs came into effect. The helmets were a clear loser. Costs spent on helmets _greatly_ exceeded any identifiable medical savings.

I put value into the money I've spent on helmets. They've protected me from more severe head injuries more that I like to remember.

 And IIRC, that didn't even take into account the beneficial effects of riding a bike. As I've mentioned several times, I know of at least five studies that determined the benefits of bicycling greatly outweigh its risks or detriments. Some of those studies specifically evaluated medical costs - health care dollars saved vs. spent due to bicycling. The _worst_ result was a 7 to 1 benefit in favor of bicycling. IOW, if you dissuade people from riding, national medical costs will rise, not fall.
 It doesn't take much to dissuade people from bicycling. America has been doing it for decades, claiming riding is so dangerous that you really should not do it unless you wear a really, really weird hat - or unless you ride only on some very special strip of asphalt, which is also fear mongering.
 If the special, funny looking hat really did confer huge benefit, it should confer it on non-cyclists who suffer far more brain injuries. Again, pedestrian and motorist TBIs and fatalities dwarf those of bicyclists. Even you, a big mileage rider, are statistically more likely to get serious TBI while in your car. But I doubt very much that you put on the helmet (that you already own!) when you're driving. And remember, the most easily identifiable TBI victims are the ones who are dead. But bicyclists comprise only about 0.6% of America's TBI fatalities.

Then why ban AR-15s?

 TLDR? Case-control claims about wonderful bike helmet benefit have not panned out in the general population. ER visitors are not the same as the general population. But if helmets are such a miracle, why not not spend the same energy promoting them for pedestrians (including - gasp! - runners, who move fast!), for motorists (yes, it's been seriously proposed), for people using ladders, people using stairways, elderly people just walking around their homes, people playing pickleball (I don't, but I've heard our bike club members' experiences) etc. etc.

Alarmism duly noted and dismissed as alarmist.

 Why "dangerize" bicycling? Bicycling is _not_ very dangerous. I does us no good to pretend it is.

So don't' wear a helmet. I have seen much information to support that suggesting helmet use dissuades people from cycling.
I'll continue to wear mine and feel good about it.
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