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Helmet manufacturer ordered to pay $3 millions as compensation for brain injury

US helmet manufacturer Riddell had to pay US$3 millions in compensation to an injured football player. Rhett Ridolfi suffered severe brain damage, as well as paralysis, despite wearing a helmet. A Colorado jury found Riddell negligent in failing to warn players about concussion.

This is one of many lawsuits about brain injury while wearing a helmet. The injured person lawyer said:

“If they had told the truth, and said, ‘You have a 50 percent change of getting a concussion with this helmet,’ what mother or father would let their kid play football in a Riddell helmet? And you can still buy this helmet today.”

Helmets provide the illusion of protecting against brain injury. Helmets cannot protect against rotational acceleration, the principal cause of brain injury. Report from the Toronto Star:

“Increasingly, what helmets have become are talismans. Riddell (and every other manufacturer) understands that no space-age resin, no lightweight polymer, no amount of high-tech bafflegab is going to fully protect you if you nail something hard and fast at just the wrong angle. They manufacture the illusion of full protection …

What they’re selling is witchcraft. The fault here does not lie with the manufacturers. It lies somewhere within the culture. …

There is very little difference between wearing a helmet and wearing a piece of the true cross. Both are faith objects. The power of any talisman is that its protective aura is self-reinforcing. As long as you aren’t hurt while you’re wearing it, one presumes the talisman takes the credit. …

the surest way to protect against brain injury is to either engage in pastimes that
A) don’t require helmets or
B) have adapted themselves to relatively safe, helmetless participation. …

With the helmet goes a misplaced sense of invincibility.”

As Jerry Seinfield noted, a key issue is the culture surrounding helmets:

Bicycle helmets have the same deficiency. Additionally, they can increase brain injury:

“Protecting the brain from injury that results in death or chronic disablement provides the main motivation for wearing helmets. Their design has been driven by the development of synthetic polystyrene foams which can reduce the linear acceleration resulting from direct impact to the head, but scientific research shows that angular acceleration from oblique impulse is a more important cause of brain injury. Helmets are not tested for capacity to reduce it and, as Australian research first showed, they may increase it.“

Helmets have been promoted by claiming they protect against brain injury. This can lead to people overestimating their benefit, taking more risks. As reported in the New York Times:

“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 helmet he was wearing did not protect his neck; he was paralyzed from the neck down. …

”It didn’t cross my mind that this could happen,” said Philip, now 17.

”I definitely felt safe. I wouldn’t do something like that without a helmet.” “

Study reveals increased accidents and injuries after helmet law

Abstract

The injury rate has tripled since the helmet law.
By increasing the risk of accidents, helmets have made cycling more dangerous.

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A recent study reveals a steady increase in cycling injuries after the helmet law. Between 1991 and 2000, arm injuries doubled (indicating a doubling in accidents), while head injuries increased by 40%.

A 1996 cycling survey in Sydney revealed that cycling counts were 48% below 1991. According to the census, cycling in Sydney slightly decreased between 1996 and 2001.

This indicates that the risk of accidents more than tripled, consistent with other studies.

The study reports a reduction in head injuries since 2006. This coincides to a resurgence in cycling, with many of the new cyclists not wearing helmets. Head injury rates decreased while fewer cyclists wore helmets. Oblivious to this, the study attributes the reduction in injuries to spending on cycling infrastructure that occurred mostly in Sydney after 2009.

Oddly, this study was used as the basis of a newspaper article defending the helmet law. The usual scaremongering tactics are there, suggesting that helmets protect against serious brain injuries, even though they are not designed to do so. The propaganda did not fool many people though, as the comments below the article highlight.

Despite the large increase in head injuries while cycling almost halved, the study claims:

“the benefit of MHL to lowering head injuries”

Oddly, the study fails to mention the reduction in cycling.

What’s going on?

It is odd for a study to ignore the increase in accidents and injuries, and the decrease in cycling after the helmet law. The rise in injuries is obvious from the main graph in the study. This blindness to negative side-effects of the helmet law is similar to another study affected by confirmation bias.

This study was funded by a government who, struggling to justify its counterproductive policy, is funding more “studies” to defend it. This trend was reported here.

This did not fool a UK reporter:

As the fallout from Australia’s failed bike sharing schemes continues, it seems we haven’t seen the last of government-funded research showing that helmet laws are great actually, thanks very much.
…
The authors, Olivier, Walter and Grzebieta, previously published a paper in 2011 claiming to “end the debate about the effectiveness of cycle helmet legislation”, but which was severely criticised by fellow boffins
…
the government of NSW has commissioned research which (surprise!) finds the effect of their helmet law is massive and sustained, ignoring the uncomfortable fact that helmet wearing rates have actually fallen back significantly without any accompanying jump in head injuries.
The authors fail to consider long-term trends in admission protocol when comparing arm:head injury admissions over two decades. They also include all types of minor flesh wounds, bruising etc. which you would certainly hope would be prevented by helmet use, rather than looking at a reduction of critical injury / death which is what public health policy should be worrying about, when the alternative is serious sedentary disease.
It’s generated some nice headlines and superficial reinforcement for the helmet law (which is probably what the government were really trying to commission), but this is far from the conclusive study that is being spun in the media.
Opposition to helmet legislation in Australia continues to grow and academics on the other side of the fence are unlikely to struggle to dismiss the conclusions of this paper.

Barefoot running and cycling

An interesting analogy between barefoot running and cycling:

For years it has been ingrained in to folk that go hill-walking that it
is *essential* to wear “stout footwear with proper ankle support”, with
the latter taken to mean a high lacing cuff and the phrase really
meaning big, stiff hiking boots.

In more recent times folk have started to realise that this is a lot of
tosh, and in fact the literature on foot injuries tells you
counter-intuitive things about how and when feet get injured (like more
often in shoes than barefoot). Such people have started taking to the
hills in sandals and trainers, realising that the human foot isn’t an
evolutionary misfire but is perfectly capable of looking after itself as
long as the user engages in the ancient Zen mind-trick known as “looking
where they’re going”.

But you tell this to the boot die-hards, and they look at the scuffs on
their dreadnoughts and say they prefer intact toes to bloody puddings on
the end of their feet, and how their boots have saved them from terrible
injury etc. etc.

I used to preach the gospel of Big Boots too, but entering a Mountain
Marathon had a curative effect. All these people doing this regularly,
faster and over rougher terrain than I usually do, and hardly a pair of
boots in sight, perhaps they know something I’ve not been accepting?
c.f. cycling trip in Amsterdam and helmets…

This analogy is from by Peter Clinch, from Dundee, Scotland.

I love this part:

the ancient Zen mind-trick known as “looking where they’re going”

This highlights the difference in philosophy between the two groups.

One takes responsibility for being cautious enough to avoid injuries.
The other relies on technology to compensate for higher risk taking.

The belief in the “protection” using shoes is like the belief in the “protection” using helmets:

Both appear to “protect”, even though they can result in increased injuries.
Both seem so “obvious” than few people question them.
Both are harmful in ways that are counter-intuitive.
Both have their strong advocates who show a religious faith in them.
Both induce a false sense of safety, resulting in increasing risk taking.

In cycling, as the shoulders are much wider than the head, most falls do not result in the head touching the ground. Should it happen, the scalp makes the head slide, reducing friction and rotation. This reduces the risk of brain injury through rotational acceleration.

With a helmet, the larger volume of the head makes it more likely for the head to hit the ground. The polystyrene helmet tends to stick to the road and increases rotational acceleration. This increases the risk of brain injury.

Is this “protection”?

We can be fooled into accepting “protective” equipment that is not necessary, and even harmful. After the helmet law in Australia, the risk of injury tripled.

Helmet manufacturers know how to exploit our fears using scaremongering advertising. It takes effort to escape such insidious influence.

Next time somebody peddles “safety” equipment, ask

Does the risks warrant the equipment?
Could the “safety” equipment do more harm than good?

Calls to repeal the helmet law in New Zealand

Cycling Health New Zealand

This site is interesting as it presents a broad range of common-sense arguments, taking the perspective of public health. This is broader than the narrow perspective that helmet zealots insists on, claiming that their exaggerated estimates of helmets effectiveness is all that matters, while ignoring the increase in accidents and injuries, and the decrease in public health from discouraging cycling.

Some New Zealand politicians have privately admitted that the helmet law is a failure, and that they wouldn’t mind if it fell quietly into oblivion.

This article highlights how the debate has reached the mainstream media in New Zealand, following research published by Colin Clarke in the New Zealand Medical Journal in 2012.

It is an interesting approach to increase awareness of the harm done by the helmet law. The loss of health benefits from the reduction in cycling contributed to 53 premature deaths per year. This undermines the helmet believers classical emotional argument: “if it only saves one life”. Despite being unproven, it still fools people.

One cyclist association, the Cycling Advocates’ Network has denounced the helmet law as a failed experiment doing more harm than good, calling for an independent review.

The New Zealand government seems a little bit open minded. They are honest about the limited capabilities of “helmets”, but still don’t acknowledge the harm that the helmet law has done to cycling levels and cycling injuries.

Many comments below the article highlights that many people are aware of that the law has been counterproductive. Some comments suggest that the helmet law is not strictly enforced.

This research is also reported in this article, that mentions an earlier research done last year by the Transport and Health Study group, an independent British society of public health and transport practitioners and researchers. It is called Health on the Move 2, a book aimed to be “a clear and comprehensive account of what would constitute a healthy transport system.”

This is not primarily about cycling. This group of researchers cannot be labeled “anti-helmet”, as some people like to denigrate those who dare to question their beliefs.

The section on cycling can be found here. It is a summary of the recent research on helmets and the helmet law. The report is written in a neutral tone, yet you can sense the frustration of the researchers here:

“The failure of mass helmet use to affect serious head injuries, be it in falls or collisions, has been ignored by the medical world, by civil servants, by the media, and by cyclists themselves. A collective willingness to believe appears to explain why the population-level studies are so little appreciated. ….

The disconnect between received wisdom and the facts is stark.“

These are strong words for a group of researchers for whom cycling is not the core focus. It is no surprise to those who have been trying to get helmet zealots to pull their heads out of the sand. It can be frustrating to get people to admit that their cherished beliefs could be wrong, and that they made a mistake, especially when they have no incentive to do so.

It is positive to see such articles in the mainstream media. It shows that the media is starting to pay attention to what is really going on, rather than to pander to common prejudices. New Zealand may not be far from repealing this counterproductive law.

The surprising impact of helmets on safety

Abstract

Contrary to popular belief, helmets main impact on safety has not been the protection they provide, but the increased in the risk of accident associated with them. Helmets protect, but not enough to compensate for the increased risk of accident.

Although the motivation for wearing a bicycle helmet is to reduce the risk of death & serious brain injury, the net result of imposing a helmet law has been to increase the risk of death & serious injury.

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Two types of injuries

Broadly speaking, there are two types of injuries relevant to bicycle helmets:

Minor injuries like bruises and lacerations to the skull.
Severe injuries like brain injury, skull fractured, or neck injury that can lead to disability.

Bicycle helmets provide cushion against minor head injuries. On hitting a flat surface, the polystyrene compresses to attenuate the impact. However, in a serious impact, helmets tend to “fail”, or break into pieces, providing little protection. A polystyrene based helmet is not designed to protect in a serious accident:

“In cases of high impact, such as most crashes that involve a motor vehicle, the initial forces absorbed by a cycle helmet before breaking are only a small part of the total force and the protection provided by a helmet is likely to be minimal in this context. In cases where serious injury is likely, the impact energy potentials are commonly of a level that would overwhelm even Grand Prix motor racing helmets. Cycle helmets provide best protection in situations involving simple, low-speed falls with no other party involved. They are unlikely to offer adequate protection in life-threatening situations.“

A soft-shell helmet is a piece of polystyrene covered by a layer of plastic less than 1mm thick. It can protect in a minor accident. However, it is not designed to protect in a serious accident.

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Helmets make little difference in a serious accident, as Dr Hooper reports:

“Looking at evidence, it does not matter if people are wearing a helmet or not, any serious accident on a bike is likely to kill them,”

Wearing a helmet can induce cyclists to take more risks, sometimes with serious consequences:

“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 helmet he was wearing did not protect his neck; he was paralyzed from the neck down. …

”It didn’t cross my mind that this could happen,” said Philip, now 17. ”I definitely felt safe. I wouldn’t do something like that without a helmet.” ”

While helmets can reduce minor head injuries, they can also increase the risk of neck injury. Contrary to popular belief, helmets are not designed to protect against severe brain injury, and may aggravate it some circumstances.

Yet most helmet studies fail to distinguish between minor and sever injuries. Minor and severe head injuries are lumped together into a category called “head injuries”. The much larger number of minor injuries masks the trend in severe injuries. An apparent reduction in minor head injuries can mask an increase in severe injuries.

What does the data tell us?

Relevant data that can shed some light on this issue comes from New South Wales (NSW), Australia. It includes minor injuries, separated as head injuries and non head-injuries, for child cyclists before and after the helmet law. It also includes data for death & serious injuries for child cyclists and pedestrians.

Before the helmet law, about 20% of cyclists wore helmets. After the helmet law, about 80% of cyclists wore helmets. To make sense of the data, it is worth keeping in mind two key factors affecting injuries:

There were 40% fewer cyclists after the helmet law. The risk must be adjusted per cyclist.
The helmet law was introduced at the same time as other road safety measures, like a crackdown on speeding and drink driving. Injuries declined significantly for pedestrians, who face a similar risk as cyclists, being hit by motorists. By adjusting for safety improvements observed with pedestrians, we can isolate the effect of external factors, so that we can better understand what can be genuinely attributed to helmets.

A detailed analysis of the data can be found here. Additional injury data for pedestrians can be found here. Here is a short summary of the analysis of the data:

Compared to what would have been expected without the helmet law, the risk of non-head injury for cyclist almost doubled. This indicates that the risk of accident almost doubled. Explanations for the increase in accidents include risk compensation and safety in numbers.
Compared to what would have been expected without the helmet law, the risk of death & serious injury increased by 57%. This indicates that helmets did protect against some serious injuries, but not enough to compensate for the rise in accidents.
Compared to what would have been expected without the helmet law, the risk of head injuries for cyclists increased by 40%. This indicates the helmets were more effective at preventing minor injuries.

Compared to what would have been expected without the helmet law, the risk of accidents almost doubled, the risk of death & serious injury increased by 57%, and the risk of head injury increased by 40%.

The data indicates that bicycle helmets do protect, but not enough to compensate for the rise in accidents.

Accident avoidance vs protection

Although helmets do protect, they have not protected enough to compensate for the rise in accidents. The net safety effect of imposing helmet has been to increase the risk of injuries, both head-injuries and non-head injuries, and both minor and serious injuries.

However, the sharp increase in the risk of accident is the most significant impact of helmets on safety. Why wear a “safety device” that increases the risk of accident while failing to protect sufficiently to compensate for this increased risk of accident?

There is an odd discrepancy between the motivation for wearing bicycle helmets (to reduce the risk of death & chronic disability), and the actual result of the helmet law: a much higher risk of death & serious injury.

Share your story

Did you stop cycling after the helmet law? Did that mean you did less physical exercise, and might be suffering health problems as a result?

Did you believe the hype that “helmet save lives”, then started to take more risks when riding, until you had a crash? Would you have had such a crash without the false sense of safety provided by your helmet?

Has the helmet law has been beneficial or harmful to you?

Share your story here.