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I will concede that the study of this(for no apparent or logical reason) very emotionally charged debate, is epidemiologically challenged.
I will also argue that so much of what we try and study in epidemioliogy falls foul of the same bias, flaws in data collection and study design.
In such cases we can only work with the data we are able to draw, as it still has significantly more merit than the alternative- conjecture.Given all of this, I don't feel bad about the conclusions I have drawn, on the singular outcome I was interested in.
Finally- as a related side note I tried quite hard to find any professional cyclist head injury data and the only one I could find suggests and increase in head injuries in the contemporary group(65 elite racers still active and reporting injuries from 2003 to 2009) vs the historical group (65 professional road cyclists surveyed from 1983 to 199)
Published 2015 IJSM:
https://www.semanticscholar.org/paper/Changes-in-sports-injuries-incidence-over-time-in-Barrios-Bernardo/fd999fd0654fdb84f2e4c735320f3a71df012417I would love it if anyone can find better data on this aspect- which should be interesting and statistically relevant given introduction of helmet use in 2003.
Long term cohort studies- given the CTE issues in other sports- would be fascinating as well.
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This:
I will concede that the study of this(for no apparent or logical reason) very emotionally charged debate, is epidemiologically challenged.
and this:
All I intended was to post the most recent reviews, all of which- bar the one from Taiwan- show fairly consistently that helmet wearers have better outcomes in head, neck, facial injuries, hospital stay, and long term outcome.
Part of the answer to the failure of epidemiological studies to support promoting or mandating helmets is in the size of the effects being studied. In the real world (non racing) serious head injuries are quite rare events. What looks like a large change in the likelihood of those injuries is actually a very small change compared to the millions of injury free cycling trips made each day. The scare effect of people saying everyone should always wear a helmet can be large, as evidenced by the large decline in cycling in Australia when helmets became compulsory.
A large decrease in physical activity, active travel, has significant health impacts at population level. The relevant balance of these effects is the basis of the Piet de Jong paper referenced by Goldacre and Spiegelhalter. https://nacto.org/wp-content/uploads/2015/07/2012_de-Jong_Health-Impacts-of-Mandatory-Bicycle-Helmet-Laws.pdf
Charlie_L
Every now and then it does us good to exercise our “helmets and the law” debating skills. Sadly it seems that @eyebrows has left the discussion and is “no longer active” on lfgss.
Presumably he/she has gone back to MRCP revision. Nevertheless I will try to examine some of research links posted by @eyebrows (in separate postings here) in case he/she is looking.
There is a lot to learnt from examining helmet related questions further. I agree with the view of Prof. David Spiegelhalter and Dr. Ben Goldacre that such an examination provides a perfect teaching case for epidemiology. I think their BMJ article is essential reading for anyone seriously interested in the academic research.
http://researchonline.lshtm.ac.uk/989799/1/bmj.f3817.full.pdf
Their short paper highlights what I think are a couple of fundamental truths:
and: