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Ms. Brody's research tends to be superficial, which seems related to the "health column" format she works in.

I find it discouraging that general writers on this topic love the lousy epidemiology, but ignore the burgeoning literature on the biomechanics and pathology of traumatic brain injury. As most here are aware, helmets mitigate point loading of the skull, preventing fractures. Skull fractures can lead to rapid death from tearing of arteries and "epidural" blood accumulation with pressure on the brain. However, it is also the informed consensus that helmets are of minimal value in mitigating concussion, a much more common result of bicycle accidents. This fact will never be reflected in the death statistics.

I have crashed a few times and wear a helmet because of the purely subjective sense of security it gives me and my family. It did once come in quite handy years ago, when I was forced off the road and set upon by a frisky gang of young men and I will certainly wear it to my next fistfight.

I also wish to wear a helmet to all of my upcoming fistfights!

A nearly universal fallacy is that helmets prevent concussions. While they almost certainly ameliorate other head injuries, they do virtually nothing to prevent concussions.

Also, similar story on facial injury while wearing a helmet.

BHSI was launched by WABA, but they state they're funded by consumers. Nitpicky, I know, but funding for any of this is scarce so it's important to keep the accounting straight.

I hear people all the time say that they had an accident and got a concussion*, but thank god they were wearing their helmet or it would have been worse so that's why they always wear one. Well, maybe. You did get a concussion, after all, so how effective was it really? But maybe you avoided a cranial fracture, which of course is a very good to avoid. I'm glad folks wear them, but I think it gives a false sense of security and safety, and calling those who sometimes chose not to wear one stupid is, well, stupid.

*Including my GF. Her immediate post-accident confusion and short-term memory loss was the only time I've ever been smarter than her (although I did let her talk me out of calling 911, so I still wasn't that smart).

What always grinds my gears is people who slap on a helmet and then bike recklessly - riding against traffic, running red lights/stop signs when there is active traffic, etc. The helmet doesn't protect against stupidity.

Sometimes I see people riding with a helmet on without using the chin strap or people who ride with a helmet dangling from their handlebars or backpack.

My theory is that drivers think bikers are stupid for not wearing a helmet, so they drive more carefully around unhelmeted ones.

I rather avoid a collision than mitigate one.

"people who ride with a helmet dangling from their handlebars or backpack"

Hi there, that was me: hot afternoons when the morning was chilly. And yes, I have received comments. Questionable perhaps, but choice is a beautiful thing.

I do miss riding helmetless. Every now and then I forget mine and wonder why I feel so good. On the other hand, I have the medical letters after my name and am supposed to know something academic about TBI. The irony would be simply too rich if I got severely tumbled while practicing unprotected bicyclism.

The worst part about it is that people think these represent a safe design. They represent a certain approach toward helmet design that stopped evolving 20 years ago. Better designs that provide real protection are possible, and nothing's being done out of the false sense that the existing helmet designs are good enough.

To follow onto Crickey's comments, helmets provide limited protection because they were designed to provide limited protection. Go look up the standards for bike helmets, they are minimal. They basically provide protection from low-speed falls. They're good for kids and others learning to bike, because falls are common when starting out. They shouldn't be expected to provide any protection in a collision with an automobile, because they're not designed to.

A bike helmet that was designed to protect your head at adult cycling speeds, and in collisions with cars, would look and feel like a motorcycle helmet.

I was really disappointed with this article and I'm glad WashCycle has taken it on. The NYTimes is normally an excellent paper, this article is not up to their usual standards. What I particularly like about the Times is that even the parts of the paper that other papers consider throw-away -- like travel, style and health -- are well-written and well-researched. That's why this piece was doubly disappointing.

"Sometimes I see people riding with a helmet on without using the chin strap"

I have a theory that the helmets MPD buys for its bike cops do not have functioning chin straps which is why none of them buckle them.

"or people who ride with a helmet dangling from their handlebars or backpack."

I think of that City Paper cover photo. (https://www.washingtoncitypaper.com/news/article/13036951/what-do-dc-cyclists-have-against-bike-helmets).I think that guy wrote in and said he wears his helmet when he races but not when he's just riding around. Seems reasonable.

"My theory is that drivers think bikers are stupid for not wearing a helmet, so they drive more carefully around unhelmeted ones."

Well, there was that study in the UK that determined that drivers pass closer to a helmeted cyclist than unhelmeted one. But I think it was a pretty small difference, and I don't think it's been repeated enough for me to give it too much validity.

I occasionally see people riding a bike with a motorcycle-style helmet. And I think (1) that would provide some actual protection; (B) that would be really hard on the neck and shoulders on anything but a short ride; (III) you really couldn't use your peripheral vision very well, which is more important on a bike than a motorcylce because of the lack of mirrors; and (iv) what would that do to your neck, torsionally, in an accident.

Regarding iv, perhaps motorcycle helmets are designed with smoother surfaces with less angular material to catch on things in an accident. It's not something I've ever researched.

I'll add the following, unverified stat:

100 percent of motorist and pedestrian deaths and 100 percent of serious injuries occurred to people who were not wearing helmets.

The bike helmet concept is up against serious constraints on weight, size, and heat retention. Other than the logical, but pragmatically dubious, MIPS concept of allowing some rotational slip between the head and the helmet shell, and that airbag collar contraption, I'm aware of nothing out there. Any "improvement" might reduce the acceptability of helmets.

And we are stuck with speculation and anecdote. The idea of getting any sort of meaningful signal in a clinical trial is hopeless and we are already bad at doing comparative effectiveness testing, even among drugs under clinical conditions.

There are risks to cycling and no one should kid themselves about them. As everyone says, mitigation should focus on the fixable stuff like infrastructure and behavior.

I face the same thing with offshore racing: If I fall off the boat in the middle of the night, do I want to be dragged to death by my tether in seconds or say bye-bye to the boat and float for a few days before I die? The best idea, it turns out, is to learn how to stay on the boat.

Research indicates the air bag concept is the way to go here. Those moaning about bike helmets ought to be pushing to have these devices be tested and approved for sale here. These helmets are not perfect, but the designs would get better, and costs drop, if they were available in the mass market here.

https://engineering.stanford.edu/magazine/article/air-bag-bike-helmet-could-protect-against-concussion

Laws that outlaw adults from riding bicycles without helmets show little evidence of helping the overall safety situation - the usual counterargument is that cyclist safety results from having more cyclists in traffic. Unfortunately laws requiring helmets for adults reduces interest in cycling and reduces further the likelihood of getting to enough cyclists on the road to change the mindset of motorists, who are the main problem for serious accidents after all.

I have been commuting for about 20 years, 20 miles round trip most days. Early in that time I and several others came upon a woman who had been sideswiped by a car and fallen head first into the curb, splitting her helmet in half lengthwise. Amazingly she was conscious and even able to tell us that she wanted to ride home. Her pupils gave her away and someone called 911 - concussion. Even if I can't be sure that the helmet saved her life, I'm pretty sure it saved her from a lot more of an unpleasant injury than she had. So when I plan to ride in traffic much or ride at what passes for high speed for me I wear one. But I do so knowing it just helps and isn't a cure-all.

But if I'm riding a mile to the nearby grocery store entirely on a trail riding an old bike at 8 mph, why do I need a helmet?

Exaggerating about the benefits of helmets is probably a good thing as long as they don't try to pass mandatory helmet laws.

There's a counter-intuitive argument that going without a helmet might be safer because people with helmets are more afraid of crashing, so they ride more carefully. That effect only works if people think it's dangerous to ride without a helmet.

I was glad I was wearing a helmet when:
- My head hit a low hanging tree limb while I was riding on the shoulder
- I tripped in my bike shoes and fell head first into a door frame
- My handlebars didn't have room for a headlight

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