Helmets on Heads

I found a new campaign via Twitter; Helmets on Heads. It is run by helmet and bicycle manufacturer Schwinn and an organisation called Think First (think a US Headway) which advertises itself as the US’s “National Injury Prevention Foundation.”

“The ThinkFirst National Injury Prevention Foundation’s award-winning, evidence-based programs are aimed at helping people learn to reduce their risk for injury.”

Despite this quote from the Think First website, this particular campaign aims to promote greater helmet use. From the campaign’s “The Facts” page:

  1. In 2009, there were an estimated 418,700 emergency room visits and nearly 28,000 inpatient hospital stays for bicycle-related injuries.
  2. Over the past several years, roughly 1 in 10 bicyclists killed were not wearing helmets.
  3. Nearly 70% of all fatal bicycle crashes involve head injuries.
  4. Bicycle helmets have been estimated to reduce the risk for head injuries by 85%.
  5. Despite these facts, only 20-25% of all bicyclists wear bicycle helmets.

Fact number one doesn’t really tell the reader much because it is not put into any kind of context. 418,700 sounds like a lot, but it would be nice to see how this number compares to the number of pedestrian-related injuries or trouser-related injuries.

Fact three sounds believable enough and although this statistic has little to do with cycle helmets, the context is is placed in cleverly makes it appear to support the argument for greater use of cycle helmets.

Fact four seems oddly familiar, but it is at odds with more rigorous meta analyses such as Rune Elvik’s efficacy review, which places the benefit of helmet wearing around ‘net zero,’ with earlier similar studies placing the benefit of helmet wearing around the ‘negligible’ mark. This appears to be the only fact on the list which is outright dishonest.

Facts two and five are best taken together; the 20-25% of US cyclists who wear cycle helmets appear to account for 90% of the cycling fatalities in the USA.

This list is one of the most interesting uses of facts I have seen in a long time. Other than fact four, which is outright bogus, the other facts presented seem likely to be sound. However, these facts are not used to make an argument in the conventional sense (Ie: by supporting a claim) they appear instead to be used as window-dressing; largely unrelated to the cause but when taken at face value and presented in the right way, they appear to support it. Let’s take another look at that window-dressing, but with a different slant:

  1. In 2009, there were an estimated 418,700 emergency room visits and nearly 28,000 inpatient hospital stays for bicycle-related injuries.
  2. Over the past several years, roughly 9 out of 10 bicyclists killed were wearing helmets.
  3. Nearly 70% of all fatal bicycle crashes involve head injuries.
  4. On average, bicycle helmets have been estimated to provide no overall benefit to their wearers in the event of a crash.
  5. Despite these facts, 20-25% of bicyclists still wear bicycle helmets.

Ok, so I changed fact four because of the bogus nature of the original #4. More or less the same list of facts now look like an argument against cycle helmets and I didn’t even have to lie.

The campaign also provides support materials for teachers:

Q. What is the most important thing you can do to protect yourself when riding a bike?
A. Wear a helmet! The impact of a crash is absorbed by the helmet, rather than your head and brain. Talk about the brain, how easily it can become injured, and how recovering from a brain injury can be difficult or impossible, depending on the extent of the injury. Protecting your brain is important!

I agree entirely that protecting one’s brain is indeed important. This is why, especially when forced to share space with motorised traffic, I would suggest that the most important thing to do to protect yourself when riding a bike would be to ensure your bike (especially the brakes) is in a good state of repair and that you are aware of the hazards in your surroundings so that you can take appropriate action. However, it looks like I was wrong, all that is needed is to slap on one of Schwinn’s fine cycle helmets and all will be well.

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ASA: Spreading the fear to kids

This advert was brought to my attention a while back. It is for some car (yawn) but the ad also featured cyclists as well. A complaint was made to the Advertising Standards Authority (ASA):

Ad

A TV ad, for Citroën, featured a cyclist pulling up behind a Citroën C4 at a set of traffic lights on a busy urban street. Other cyclists joined him until there was a large crowd of cyclists pursuing the C4. 

Issue

A viewer, who noted that none of the cyclists featured in the ad were wearing cycling helmets, challenged whether the ad was appropriate to be broadcast at times when children were likely to be watching, because it could condone and encourage behaviour prejudicial to their health and safety.

Assessment (Upheld)

The ASA considered that adults and older children would understand that the scenario depicted in the ad was fantastical and set apart from reality, because of the sheer number of cyclists involved, the lack of cars in their immediate vicinity and the fact that they were cycling in unison and chasing the C4. We therefore concluded that the ad did not condone behaviour prejudicial to the health and safety of adults and older children and was unlikely to cause harm to them.
However, we considered that younger children might not appreciate the fantastical nature of the ad and might consider that the ad represented a real-life scenario. We were therefore concerned that the ad might encourage younger children to emulate a behaviour prejudicial to their health and safety, and therefore concluded that the ad should have been given an ‘ex kids’ scheduling restriction to ensure that it was not broadcast at times when younger children were likely to be watching.
The ad breached BCAP Code rules 5.2 (Children) and 32.3 (Scheduling).
We also investigated the ad under BCAP Code rules 4.1 and 4.4 (Harm and offence) but did not find it in breach.”

The message from the ASA here is that cycling without a helmet is a behaviour, “Prejudicial to [childrens’] health and safety.” This has already been established to be false. However, the main issue here is that the ASA have not been fair with respect to the issue of safety, and behaviour which children might emulate. The driver of the car in the ad was not wearing a motoring helmet, a behaviour which children might emulate which would actually be, “Prejudicial to their health and safety.” It could also easily be argued that advertisements showing people travelling by car, “Might encourage younger children to emulate a behaviour prejudicial to their health and safety.”

The ASA, by classifying adverts of this nature as, “Ex kids,” on these grounds have managed to help perpetuate the mistaken beliefs that cycling is a particularly high-risk activity, that helmets are effective in the event of a crash with a motor vehicle, and the sadly prevailing ideology that the responsibility for minimising the risks posed to cyclists in the event of this type of crash (with the aid of ineffectual safety equipment) lies with the cyclist victim, rather than (by the moderation of dangerous driver behaviour) with the driver whose vehicle is the actual source of the danger.

Considering the relative risk posed to children by travelling by car, and the significantly greater benefits afforded to motorists in comparison to cyclists by helmet-wearing in the event of a crash, maybe we should be complaining to the ASA whenever an advert depicting people travelling by car without a motoring helmet is shown in the advert breaks surrounding children’s programming.

Rune Elvik’s Bicycle Helmet Efficacy Review

A new review of helmet research has recently been published by Rune Elvik in Accident Analysis and Prevention. The paper can be found here, although it may be behind a paywall.

The way that more mainstream media outlets report science is often interesting. Monday’s Science article about a new drug molecule demonstrating a 15% reduction in tumour mass in a specific type of cancer in rats all too often becomes Tuesday’s Daily Mail article about a new miracle drug to cure cancer. Quite often, if a story doesn’t fit the news narrative*, it is quietly ignored altogether. In the UK, the standard line from the mainstream press is that cycling is an extreme sport, like rock-climbing or sky-diving, and anyone who doesn’t use a helmet is either partially or fully to blame if they are killed by a speeding and/or drunk driver. Unsurprisingly I have not seen this new research mentioned in the mainstream press.

Road.cc picked up on the article, and ran a surprisingly scientific piece on it, although they did fall into the usual media trap of adding “balance” to science reporting, by quoting pro-helmet Professor Alistair Woodward, head of the School of Population Health at the University of Auckland. I am glad they consulted a relevant researcher rather than a non-expert as is surprisingly common in science reporting (look out for interviews with homeopaths being added to “balance” reporting on non-placebo medicine articles**). However, Professor Alistair Woodward was quoted as saying;

“Whether they cause the neck to bend more than otherwise, I suppose it’s possible. If there is an effect [on neck injuries], it’s much smaller than the protective effect from head injuries.”

Despite the paper, a review article of the body of research on the effectiveness of helmets rather than an individual study, stating that,

“When the risk of injury to head, face or neck is viewed as a whole, bicycle helmets do provide a small protective effect. This effect is evident only in older studies. New studies, summarised by a random-effects model of analysis, indicate no net protective effect.

In doing so, the article put the opinion of one pro-helmet man at the same level as an academic research review. It is hard to base too much on a single study, as there will be limitations in the design of any single study. This is why reviews of the existing literature such as this are a useful tool, they help to even out the limitations and biases of the individual studies. Sadly, because the review doesn’t fit nicely in the news narrative of “helmets are good,” it was felt necessary to include the opinion of one pro-helmet individual in an article about a review of the existing helmet literature.

The study was also picked up on by the New Zealand Herald (who interviewed Professor Alistair Woodward), who in the opening paragraph describe this review of the existing body of literature as “Contentious,” to immediately attempt to discredit the work, presumably because it doesn’t sit well with the existing news narrative. The pro-helmet bias in the NZ Herald piece continues, throughout, and culminates in the following bullet points at the end of the article:

“HEAD PROTECTION

* New research indicates wearing a helmet reduces the risk of head injury in a crash by 43 per cent.” [Neglecting to state the paper’s finding that the increased risk of neck injury brings the benefit of helmet wearing to a net of zero]

“* Previous research found the risk reduction was at least 60 per cent.

* The new findings are disputed.” [Because the NZ Herald went out to ask a pro-helmet individual to dispute the findings, and treating his opinion on the matter as having equal merit to the research to the contrary in the paper]

Bike Biz also ran a piece on the paper, largely based on the NZ Herald piece, focussing heavily on the opinions of Professor Alistair Woodward, and describing Elvik’s review of the existing body of literature as “controversial.”

The review focuses on the effects of helmet use on cyclists in the aftermath of a crash, finding there to be no overall net benefit to helmet wearing cyclists over non-helmet wearing cyclists in the aftermath of a crash. It would be interesting to see some quality research into risk compensation; whether the crash frequency and severity of helmet wearing cyclists is different from that of non-helmet wearing cyclists. I wouldn’t be surprised if the inclusion of such research into a review such as this wouldn’t bring the benefits of helmet wearing down from net zero benefit to a negative benefit to helmet wearers. However, this is just my opinion.

As I have stated previously, I see helmet wearing as a choice and I don’t have anything against anyone who choses to, or not to wear a helmet whilst cycling, walking, cooking or driving a car. It is perfectly reasonable to expect individuals to make decisions based on their own subjective fears, whilst simultaneously I’d prefer governments to make policy decisions based on objective risk. As a politician, Norman Baker’s recent defence of his choice to ride without a helmet is setting a good example rather than a bad one, by making an objective decision to not wear a helmet based on the minimal risk involved in cycling, he is portraying cycling as the safe, normal everyday activity it should be seen as.

* For more on the interesting peculiarities of mainstream news, I recommend Charlie Brooker’s entertaining and informative TV series Newswipe

** For more on the distortion and mis-reporting of science in the mainstream press (and more science-related stuff), I recommend Ben Goldacre’s entertaining Bad Science articles, ironically published in The Guardian

Anecdotes and Evidence

The petition to block the proposed Cyclists (Protective Headgear) Bill in Northern Ireland has finally attracted some attention from the larger press outlets. With wider exposure comes the usual heated discussions over helmets in the comment threads. Many of you know my own stance on helmets, but I would not want to force anyone who wishes to cycle with a helmet to do so without one.

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A helmet slpit along the vents, a common mode of failure. Image courtesy of cyclehelmets.org

One type of comment which comes up frequently on these comment threads follows the general form of “A helmet saved my/a friend’s life.” This is not particularly surprising, during my own school days I remember being shown emotive video footage of an interview with a teenager who had survived being hit by a motorist whilst he was on his bike. He proudly showed the camera his helmet, split in two and with an unshakable conviction he stated that it had saved his life. In the years since this experience, the arse-about-face approach to road safety has continued to gain traction and find its way into online materials aimed at school-age children.

When listening to stories claiming a helmet saved someone’s life, it is important to remember that anecdotes aren’t the same as evidence. Consider the following:

With no control experiment, where all variables other than whether or not the rider was wearing a helmet left unchanged, it is impossible to state with any confidence whether or not the helmet had made a difference, or to appropriately quantify any difference it may have made.

The effects of risk compensation also need to be considered. For those who have been told and accepted the idea that a helmet will save their life, there will be an increase in their perceived safety which will have an effect on their behaviour. This also goes for the operators of motor vehicles, who will perceive a helmet-wearing cyclist as being less at risk from their vehicle. It is possible that the change in behaviour both on the part of the cyclist and the motorist caused by the effects of risk compensation were instrumental in leading to the collision. This effect has been studied with ABS in the Munich taxi experiment, and can also be seen in the increase in the severity and number of pedestrian and cyclist casualties following the introduction of compulsory seat-belt legislation, drivers felt safer with seat-belts and adjusted their behaviour to compensate for the reduced risk to them by driving faster and braking later. This resulted in decreased safety for those not travelling inside a car.

There are safety concerns attached to wearing a helmet, including increased risk of rotational brain injury which can be further exacerbated by the interaction between the air vents on a helmet and irregularities in the road surface leading to an increased risk of neck injuries. These effects are often dismissed due to the acceptance even amongst helmet advocates that there are limits to the protection a helmet can provide; if a helmet-wearing cyclist is injured in a collision, the injuries they sustain are uncritically regarded as being “less substantial than if they had been without a helmet,” when in fact they may have been exacerbated or even caused by the wearing of a helmet.

Plenty of cyclists survive collisions, accidents and other incidents despite not wearing a helmet. Unlike the sensational “Life-saving helmet,” stories we all see whenever there is a discussion regarding helmets, people who survive collisions, accidents and other incidents whilst not wearing a helmet rarely link their survival to the fact that they were not wearing a helmet.

It is human nature to find causal links between events which may in fact be unrelated. This is how we end up with things like lucky pants and ritualistic behaviour of athletes and sports-fans; people struggle to separate correlation from causality. For example, I have been involved in several minor incidents due to motorists over the years and survived each one of them. On every occasion I was wearing boxer shorts, but it would be foolish to state that my survival was definitely caused by the fact that I was wearing boxer shorts. At the very least I’d want to see the results from a control experiment where I was wearing budgie-smugglers in the same situations.

Northern Ireland Cycling Ban

Or as you may have heard it reported, Northern Ireland compulsory helmet law proposal. Referring to it as a cycling ban may seem a bit melodramatic, but all you need to do is look to other countries where similar laws have been enacted. All of them suffered a massive drop in the rates of cycling as people chose other modes of transport where their freedom was less impinged accompanied by no change in head injury rates.

Cycling rates in Northern Ireland will drop if the law is enacted, and those who used to cycle will move to other forms of transport, mainly the car. More cars will degrade the living standards for everyone in Northern Ireland, through pollution, congestion and increased risk of injury on the roads.

Many of you may think, “That’s Northern Ireland, it doesn’t affect me here in England/Scotland/Wales.” Sadly however, it does affect everyone in the UK. Most simply put, if you want to visit Northern Ireland or are sent there for work, you can not longer cycle there without wearing a plastic hat. All of the wider benefits to society which come from increasing cycling rates work in reverse when you actively decrease cycling rates. For example, the healthcare costs will increase in Northern Ireland, both through sedentary health conditions due to the reduction in cycling, and increases in road casualties and air pollution illnesses. Everyone in the UK pays towards that.

The cycling ban is a terrifying step backwards for the revival of the bicycle as transport in the UK, placing responsibility for road safety squarely on the shoulders of the victims whilst cheerfully ignoring the root cause. It is an assault on the freedom of the people of Northern Ireland (and Great Britain too)  and the embodiment of everything which is wrong with policymaking in the UK as a whole.

Tips For New Cyclists

I have read a number of guides containing tips for new cyclists over the years. Most of the guides are the same as this, and contain advice which centres around buying a sports bicycle and modifying it and your attire to make up for the shortcomings of using this type of bike for everyday transportation purposes.

Myth: You have three choices of bike; road, mountain or hybrid.

The bicycle retail industry in the UK is focussed mainly around the sporting end of the market. Cycling for sport is fine, but it does mean that many bike shops advise their customers to get sports bikes which are inappropriate for their needs.

The bike needs of most people boil down to a desire to get from A to B, in relative comfort on a reliable bike. This type of bike is a roadster, or “Dutch bike.” Some examples of useful, everyday transportation bicycles include:

Pashley Roadster/Princess Sovereign

 
 
 

There are many more bikes which are fit for everyday transportation. All of these bikes contain all or most of the characteristics described in a previous post, mudguards, chain-guard/case, upright riding position, low-maintenance and reliable mechanical parts (internal hub gears, drum brakes, hub dynamo), durable tyres, lights and a frame-fitting lock. With a bike like these, you can simply hop on the bike in whatever clothes you are wearing and go.

Most bicycles for sale used to fall into this category, but as they were replaced by cars in the 1950s and 60s, the bicycle industry in the UK (and most of the English-speaking world) responded by marketing cycling as sport instead, in the hope that people would spend money on cars and bikes. This approach worked to a degree, most people own a bike, they simply don’t really use it. The reason for this is the reason for the typical guide written for new cyclists focuses on how to endure using  a sports bike for everyday transportation, with bicycles marketed as sporting goods, the average person buys a sporting bicycle.

Myth: You need a toolkit/pump etc.

If you use a sporting bicycle for general transportation, the limitations of doing so will make themselves known, either through frequent punctures or components such as brakes and gears needing frequent adjustments. Roadsters also  suffer from punctures, but much less frequently. This is because they come with much more durable tyres (sports bikes come with lightweight, puncture-prone tyres). Gears and brakes on a roadster will need much less attention and maintenance because their gears and brakes are internal and more durable.

Chain cleaning and maintenance are mentioned in a lot of articles, but riding a bike with a full chain-case means that chain cleaning and lubricating needs to be done much, much less frequently.

Being prepared for these situations isn’t a bad idea, but it will not feel as important if you have the right kind of bike.

Myth: You need cycle-specific clothes, and a shower when you get to work.

A sport bicycle will come without mudguards, or a chain-guard/case. This leads to filthy water from the road being sprayed up your back during and after rainfall, and oily filth from the chain ending up on your trousers.

The sporty feel of the bike encourages you to travel at a greater speed, which will make you hot and sweaty. A marginal drop in speed reduces aerodynamic drag by a more-than-proportional amount, so that whilst travelling more slowly will get you to your destination a few minutes later, you will not be sweaty and in need of a shower and/or change of clothes.

Myth: You need a helmet,and a high-visibility tabard.

Helmets and high-visibility gear are heavily promoted by various levels of government and the cycle industry as necessities for cyclists. The dubious benefits of helmets have been discussed here previously. High visibility gear is not a legal requirement before or after dark (unlike lights), but it can have benefits for those concerned about not being seen by negligent motorists. The promotion of both of these types of gear by government makes cycling look more dangerous than it actually is, and contributes to the stagnation and decline of cycling as a mode of transport.

Both helmets and high-visibility are a reaction to the poor conditions and lack of provisions for cyclists on the roads. I would not judge an individual negatively for choosing to use either of them, but it is the job of government to tackle the root cause of the problem rather than promoting things like helmets and high-visibility, designed to treat the symptoms of a problem.

Hopefully the work of the Cycling Embassy of Great Britain will help to reverse this sad trend

Myth: Weight is important

If you want to race your bike, or ride up mountains, weight becomes more important, but for everyday transportation it is largely irrelevant. Even an extra few kilograms is very little in comparison to the weight of a rider, and once the bike is moving even a large amount of extra weight simple melts away.

Many of the drawbacks of sport bicycles come from an obsession with weight; lightweight tyres puncture more easily, lighter derailleur gears are less durable than internal hub gears and essential items such as racks, lights and locks are omitted from sport bicycles to save weight and create an accessories market containing essential items which should really be included with, or built into a practical transportation bike.

Now, that isn’t to say that some things won’t make riding a bike more pleasant. If you want to carry things, a backpack will be less pleasant than panniers. Panniers which convert into backpacks are available (although considering how obviously good this idea is, there are very few of them around). Alternatively, permanently-attached Dutch-style panniers are also a good option, just throw your backpack or bag-for-life full of stuff in there whilst you ride the bike.

A frame-fitting lock is useful, but a D-lock is a worthwhile investment (If you want even more peace-of-mind, try this lock). I will write about good locking technique in a future post. The wind-chill effect you get whilst riding means that you may feel the need for gloves whilst cycling for more of the the year than you do when walking. For transportation purposes, cycle-specific gloves are a bit of a con, just find something comfortable which keeps the wind out too.

A bit of adjustment to basic bike fit, understanding why bikes have gears and keeping your tyres at the right pressure will also help make the experience easier and nicer in the long run.

How I wish this were a parody

I managed to stumble across this Department For Transport website, “Be Bright, Be Seen.” It is aimed at young children and after studying the site and playing the game, the main messages of the site seem to be:

  • Cycling and walking are very, very, very dangerous and abnormal activities
  • If you choose to engage in this kind of reckless behaviour, it is you, the child, the victim who is responsible for ensuring you do not become the victim of a negligent motorist
  • To do this you must dress up like an Xmas tree whenever you dare to have the audacity to want to cross a road
  • If you do somehow manage to live long enough to become an adult, it will be one of your basic human rights to drive a heavy & fast vehicle inattentively in the presence of children, without the terrible burden of any responsibility if you hit one, unless they are wearing the Xmas tree outfit that is. Then you might be partly to blame.

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Taken from the DFT’s victim-blaming website Flash game.

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Obviously the bitch had it coming. Taken from the same site.

I also found links to some “Educational material,” for children, again provided by the government. This included Amir’s story:

“After I’d opened up all they presents – they wanted to get the birthday cake ready – so I decided to go over to Jordan’s to show him the bike. I was sorted. I had my helmet, my trainers with the reflective strips and I even clipped on the lights and made sure the batteries worked before I set off. Well, it’d be dark by the time I was coming back, you see. You need to be seen by other road users. That’s really important. Be Bright, Be Seen. They’re always saying that in school. I was only going to Jordan’s so I didn’t bother with the pads or the gloves.

The road was quite quiet but there were loads and loads cars parked all the way along. Anyway, I’m going up and down gears, testing the brakes.

Then, just as I looked up, this car door suddenly opened – right in front of me. I tried to brake but it was too late. It knocked the wind right out of me. Banged my chin, broke my nose and cut all my hands up too. Good job I had my new helmet on.

This is a great way to promote healthy, ethical and socially responsible transport to the next generation. Pads and gloves as a safety measure? No mention of the fact that the motorist who doored him was responsible for checking that there was no oncoming traffic at the time. By the sound of it, the helmet didn’t do a thing to help him, as you’d expect.

“It’s not put me off my bike though. No chance. But I’ll be a lot more careful in the future. Deffo. Just as soon as I’m better… Two weeks and counting.”

I bet you will, it was your own fault that an adult opened a car door right in front of you after all. Being a kid is full of responsibility, I bet he can’t wait to grow up and get his driving license so he can do away with being responsible once and for all.

EDIT: Email the DfT about this awful site if you feel as I do. Hopefully a bigger blog which specialises in this kind of disgrace will help spread awareness of this DfT crap.