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Nice write-up. One way for helmet-wearers to reduce neck injuries is to select helmets that are round, i.e., shaped like your head. The aerodynamic racing helmets with their elongated, spherical shapes increase the risk of your neck bending in unnatural ways upon impact.

Of course, the proposed helmet laws never get into what kind of helmet is safe. You could wear an orange cone on top of your head and be in compliance.

Bike helmet laws are just bad policy. We should favor policies that encourage bicycling and bikesharing, and it's well known that helmet laws will have the opposite effect.

Very nice write up. I would add the following to the section on case control studies: If careful riders choose to wear helmets and careless riders do not, these studies will show an effect where none exists.

This was a point made in Pucher and Buehler's City Cycling. I think it needs to be in the writeup because it is a bias that, AFAIK, cannot be "controlled."

Also, I sense that you are trying to appear "reasonable" rather than "dismissive." This is probably a good idea, but also can introduce a bias.

Thank you , Jim.

This points out that perhaps the helmet manufacturers ought to spend some R&D trying to reduce the rotational injury issue. Just because the helmets may have a net safety benefit does not mean that we can't make them better. ANSI and Snell look at impact levels, and are silent on rotational injuries.

Crikey7: IMO they've spent too much effort trying to convince people that helmets are essential to look too hard at the data or talk openly about the drawbacks.

Cyclists who are killed or seriously injured on our roadways are usually cyclists that were struck by an automobile, often from behind. In these cases, a helmet is virtually ineffective. Bicycle helmets simply don't have the energy absorbing ability to prevent serious injury at automobile speeds and energy levels. Therefore, bicycle helmets don't do much to prevent serious injury and deaths to cyclists. I suspect that the 10-20% reduction in injuries mostly comes from relatively minor injuries, scrapes, bruises, mild concussions.

The real danger here is that helmets are becoming a panacea, catch-all in terms of cycling safety. They are at the top of many lists of cycling safety equipment, when they should be more towards the bottom. I contend that high visibility reflective clothing and equipment, safe cycling tactics and education for both cyclists and drivers, traffic calming measures, and improved cycling infrastructure in communities (complete streets and physically separated cycling lanes) will do far more for protecting the craniums of cyclists than a helmet ever will. Cyclists in European cities are far safer than cyclists here in the USA, despite the fact that almost none of them wear helmets. This is due to better infrastructure and better road-sharing culture, with less selfishness all-around than we see on American roads.

The helmet issue has become complex, but I think it can be summed up as "Wear one if you wish, but don't expect it to do anything."

Frankly, I think more lives would be saved by daytime flashers on bikes. But helmets are good, too.

And flashing amber lights on bikes are illegal!

I wonder if there are any studies showing the effectiveness of wearing a helmet while driving a car. Race car drivers wear helmets to protect their head in a crash. Are cycle helmets any more (or less?!?) effective at preventing injury than auto helmets? If not, a cycle helmet law is only fair if there is an accompanying auto helmet law.

First, from my experience, bikers with helmets ride faster than those without, so the potential impact a helmet must deal with is greater. Second these studies rely heavily hospital data. What about those who never go to a hospital. A friend's helmet once split in half from an impact and and he walked away and never went to a hospital. Third, its incredibly short sighted to sacrifice safety merely to increase ridership.

ArtR - I wouldn't suggest sacrificing safety (and I do wear a helmet). However I think increasing ridership, both adds to safety (via the safety in numbers effects) and via improvements to health.

We had a good discussion here back in 2009, rather than reposting I thought I'd provide a link:
http://www.thewashcycle.com/2009/10/the-helmet-thing.html

I humbly recommend two of my postings, the one referencing Malcolm Gladwell and the one citing the NY Times article.

I also recommend this discussion:
http://www.thewashcycle.com/2010/08/do-adults-need-to-wear-helmets.html

I will repost something Wash wrote, because I think it gets to the crux of the matter:
I have a working list of most important safety gear. It looks like this (in order):

1. Sober, skilled cyclists
2. Bike in working order
3. Lights/reflectors (at night only)
4. Sunscreen (day only)
5. Goggles/glasses/sunglasses
6. Helmet
7. Gloves
8. Drinking Water
9. Bell/horn

I once read a piece that made a pretty good argument that mandatory sunscreen for cyclists would save more lives than mandatory helmets, but sadly I can't find it.

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