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Surgeon says he sees three children a month with cycling head injuries he believes would not have happened had they been wearing a helmet

Cycle helmets save lives says a consultant paediatric neurosurgeon from Bristol – just a fortnight after a brain surgeon in London said that there was no point in riders wearing “flimsy little helmets” to protect their heads.

Michael Carter of Bristol Children's Hospital says he treats an average of three children a month who have suffered a head injury while cycling that he believes would not have happened if they had been wearing a helmet, reports the Bristol Post.

His views conflict with those of Henry Marsh of St George’s Hospital in Tooting, South London, who as we reported last month said that helmets had not benefited patients in his care who had been involved in bike crashes.

Mr Marsh told the Hay Festival: “I ride a bike and I never wear a helmet. In the countries where bike helmets are compulsory there has been no reduction in bike injuries whatsoever.

“I see lots of people in bike accidents and these flimsy little helmets don’t help.”

He also cited research by Dr Ian Walker from the University of Bath who found that motorists gave less space to riders wearing helmets, because they perceived them as being safer than those without the headgear.

But Mr Carter insisted that the case against wearing helmets was “weak” and often founded on research that was small in sample size. He also said his experience at work contrasted with that of Mr Marsh.

In support of his views, he cited Cochrane Review studies which combine the results of a number of studies from around the world.

He said: "We get an enormous number of cycling accidents coming in here. The vast majority of head injuries seen are not life threatening. But often [they are] painful and disruptive and require inpatient treatment. Generally it's easy to see that they could have been reduced or prevented if they were wearing helmets."

Among criticisms levelled at Cochrane Reviews in the area of cycle helmets, however, is that they are not truly independent since some reviewers have focused on their own studies and discount others, and that they do not address rotational injuries.

Another concern expressed at some studies from jurisdictions where helmets are compulsory is that they fail to analyse any perceived drop in head injuries among cyclists in the context of reduced levels of riding bikes once people have become legally obliged to wear a helmet.

CTC and Sustrans both oppose compulsion in the UK because they believe the overall health benefits associated with cycling in relation to the population as a whole outweigh any reduction in the number of cyclists they believe would follow helmets being made mandatory.

Mr Carter cited one recent instance where a youngster was struck in the head by a wing mirror and he maintained that had they been wearing a helmet, they would have been uninjured.

The circumstances of the incident were not reported, so it is unclear whether the child rode into the car, or the vehicle struck the youngster, in which case the incident could perhaps have been avoided altogether had the driver given the cyclist more room.

Unlike Mr Marsh, who has been cycling for 40 years and sports a cowboy hat while on his bike, Mr Carter no longer rides one following three separate incidents last year in which two of his friends were seriously injured and another killed.

While some might see that decision as being one based on his individual experience, unfortunate as it is, rather than looking at the wider picture, he asserts that his home city is unsafe for bike riders.

"Bristol is advertised as a cycling friendly city,” he said. “But it's actually an old Victorian city with small narrow roadways and a large volume of traffic. The roads were never designed for motorists and cyclists to use together.

"Cycle paths are incomplete throughout the city and this poses a real risk to cycle traffic. Wearing a helmet is simple and cheap. It's a minor inconvenience that at worst might be uncomfortable on a hot day, but at best might save your life."

Born in Scotland, Simon moved to London aged seven and now lives in the Oxfordshire Cotswolds with his miniature schnauzer, Elodie. He fell in love with cycling one Saturday morning in 1994 while living in Italy when Milan-San Remo went past his front door. A daily cycle commuter in London back before riding to work started to boom, he's been news editor at road.cc since 2009. Handily for work, he speaks French and Italian. He doesn't get to ride his Colnago as often as he'd like, and freely admits he's much more adept at cooking than fettling with bikes.

122 comments

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cat1commuter [1422 posts] 3 years ago
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Quote:

Mr Carter insisted that the case against wearing helmets was “weak” and often founded on research that was small in sample size.

Which is, of course, the case for wearing helmets too.

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localsurfer [202 posts] 3 years ago
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They really do cover everything when you study to become a brain surgeon don't they? I wonder how many days they spend reading ANSI specifications on helmets, protection levels, impact speeds, etc...

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Fipzee [5 posts] 3 years ago
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I have had too bad falls in the last 18 months where I have trashed the helmet yet had no head injuries. In both cases I hit the ground hard and I believe that without the helmet someone would have been calling an ambulance for me. Of course a helmet won't protect against everything but I can't understand why you would not wear something that's adds protection without interfering with the enjoyment of cycling.

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Tokopah [3 posts] 3 years ago
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I'm sure specific data is quite difficult to find but the cochrane review mentioned above is a meta analysis covering several papers with good sample sizes. In the end both articles are based on the opinions and experiences of two neurosurgeons and count for a lot less than papers with large samples. There is a good amount of evedence in favour of wearing helmets, you just need to know where to look.

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WolfieSmith [1381 posts] 3 years ago
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At last. Some common sense. That wearing a helmet made you more at risk from car drivers has never had anything to do with the impact of head on pavement versus head encased in polystyrene on pavement argument. That Marsh wears a cowboy hat doesn't surprise me. He probably wears a bike helmet on a horse and a beret in the bath.  35

Those that think helmets can't make a difference under any circumstances have either yet to hit their head on the road - of have hit the road with their head already.

I refer you to my footer...

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mrmo [2094 posts] 3 years ago
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MercuryOne wrote:

Those that think helmets can't make a difference under any circumstances have either yet to hit their head on the road - of have hit the road with their head already.

Hit the ground plenty of time, hit trees, branches, rocks etc as well.

So from my experiences. on two occasions i have had glasses take a chunk out of my cheek, i have had stitches twice on my chin, i have had my upper lip supper glued back together, i have had an iodine soaked brillo pad used to scrub my face*

So obviously my head has hit the ground a few times.

and how many helmets have i actually damaged, one, the last crash didn't leave a mark on the helmet even though i broke my Oakleys and that was on a muddy road. Was i wearing a helmet for all those other crashes? no.

Other injuries, well neck pain when i missed judged the height of a branch, the helmet got caught and i got my head yanked back. a bee sting when a bee flew in the vent and didn't go out again.

I suppose it did stop me getting a bat caught in my hair i guess when i hit one when heading home after a late shift.

Helmets make a decent place to mount head lights, obviously a small metal lump strapped to the shell makes a very effective impact magnifier.

To be clear if you want to wear a helmet do so, if you don't do so. I would rather you ride a bike than worry about helmets, hi viz, etc. Why should pedestrians and cyclists play the drivers game and let them off for their shit driving?

* very odd sensation, they used local anathesthetic so whilst it should have hurt just a bit messy as the blood got splattered around.

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vbvb [620 posts] 3 years ago
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Fipzee wrote:

I can't understand why you would not wear something that's adds protection without interfering with the enjoyment of cycling.

You wear it when in a car and urban walking too, to be consistent?

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Northernbike [229 posts] 3 years ago
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doctors only push stuff the manufacturers pay them too so wouldn't take this Carter fellow to seriously if I were you however given the abuse the NHS metes out to its patients wearing a helmet during a hospital stay might well reduce injuries. Take your camelbak in too so you don't need to drink the flower water out of the vase

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fukawitribe [1945 posts] 3 years ago
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vbvb wrote:
Fipzee wrote:

I can't understand why you would not wear something that's adds protection without interfering with the enjoyment of cycling.

You wear it when in a car and urban walking too, to be consistent?

I don't - but then when I drive, I drive a car with air-bags and whilst wearing a seat-belt... perhaps some type of neck restraint might be more appropriate should I take further measures.

As a pedestrian I try and pay particular attention when crossing roads and much of my urban walks are in 20mph zones. So for me, the risk factors are radically different and wearing a helmet for all three activities would not be 'consistent'.

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MartinH [19 posts] 3 years ago
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MercuryOne wrote:

Those that think helmets can't make a difference under any circumstances have either yet to hit their head on the road - of have hit the road with their head already.

All well and good, but who's actually trying to stop you from wearing a helmet? If we're going to have the whole helmet debate at all, can we at least stick to what that debate is really about - the proposition of a compulsory helmet law? There are really very few people who'll claim that a helmet will never offer any protection whatsoever in any circumstances. And nobody - literally nobody - is trying to stop you from wearing a cycle helmet if you choose to do so.

However, there are very vocal groups actively campaigning to stop you from legally getting on a bike if you're not wearing a helmet. And that, right there, is the debate. Whether or not cycling in even it's most innocuous form is, statistically, so inherently dangerous that it should be enforced by law that protective head gear needs to be worn at all times. (It isn't). And whether cycle helmets are such an effective preventative measure against the majority of causes of serious injuries inflicted on cyclists on our roads that they justify their specification in such a law (they're not). And whether or not a compulsory helmet law would discourage significant numbers from taking up cycling in the first place, and whether or not that would have implications for public health, road congestion, pollution and the environment...

Yes wearing a helmet is not a bad idea and will offer you some protection in certain circumstances. By all means wear one if you want to (I nearly always do), and recommend them to others if you feel that way inclined (I sometimes do that too). But recommending something and making it a legal obligation are two very different things. And the second one shouldn't happen unless the statistical, scientific, societal and political considerations in it's favour are absolutely compelling. Which, as far as legal helmet obligation goes, is not even close to being the case.

Oh, and until the case for obligation is compellingly made, please stop vilifying those who choose not to wear helmets. It's their choice and they're really not doing anything wrong.

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mrmo [2094 posts] 3 years ago
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fukawitribe wrote:

As a pedestrian I try and pay particular attention when crossing roads and much of my urban walks are in 20mph zones. So for me, the risk factors are radically different and wearing a helmet for all three activities would not be 'consistent'.

some numbers
https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...

Quote:

Between 2011 and 2012 KSI casualties increased for pedestrians, pedal cyclists and
goods vehicles by 1, 5 and 5 per cent respectively.

So getting worse for non drivers?

Quote:

Compared with the 2005-09 average, there have been reductions in the number of
reported KSI casualties (of between 12 and 31 per cent) for all of the main road user
types, with the exception of pedal cyclists.

Definitely not looking good is it?

Quote:

Pedestrians made up around 41 per cent of child casualties and 68 per cent of child KSI
casualties. The number of pedestrian KSI casualties fell by 4 per cent to 1,545 in
comparison with 2011.

Pretty crap that, can't even drive and not safe on the roads...

Quote:

During 2012, 86 per cent of reported and damage only accidents occurred on built-up
roads. Non built-up roads accounted for 12 per cent of accidents, and 2 per cent of
accidents occurred on motorways.

are cars safe in an urban environment with that sort of breakdown?

Quote:

The current best estimate based on the
data available is that there are around 710,000 non-fatal road casualties in Great Britain
each year,

that is a lot of accidents!

Quote:

11.8 per cent of adults (aged 16 years or over) reported that they were involved in at
least one road accident in the past three years, with 5.7 per cent reporting being
involved in an accident in the past 12 months.
 Questions about child (under 16 years) road accident involvement have been included
in the NTS since 2010. In the last three years 5.5 per cent of children reported being
involved in at least one road accident and 2.8 per cent reported being involved in an
accident in the past 12 months. The figures for children involved in road accidents were
around half of those reported by adults.

and people keep on banging on about helmets, I would suggest there are more pressing concerns if you want to tackle road safety!

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fukawitribe [1945 posts] 3 years ago
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mrmo wrote:
fukawitribe wrote:

As a pedestrian I try and pay particular attention when crossing roads and much of my urban walks are in 20mph zones. So for me, the risk factors are radically different and wearing a helmet for all three activities would not be 'consistent'.

some numbers

....

and people keep on banging on about helmets, I would suggest there are more pressing concerns if you want to tackle road safety!

Indeed, some old favourites there and some new ones which are interesting. Not sure the relevance to my point mind, but still all good.

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J90 [408 posts] 3 years ago
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The pros wear helmets. Your argument is invalid.

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Wolfshade [200 posts] 3 years ago
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I am sure that the neurosurgen also took into account that the children would have been less likely to be involved in an accident if they weren't wearing a helmet, oh wait. Probably not.

Once again, let us ignore the facts and stick to anecdotes, after all they make much better sound bites.

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mrmo [2094 posts] 3 years ago
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fukawitribe wrote:

Indeed, some old favourites there and some new ones which are interesting. Not sure the relevance to my point mind, but still all good.

F*** helmets, they are a distraction from the real debate, why do www allow car drivers free reign, why do we accept that killing people is acceptable?

Lets have a real debate, how can we stop people dying, not this phoney debate about hi viz and helmets.

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sean1 [177 posts] 3 years ago
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From NHS statistics the vast majority of head injuries occur as a result of either falling over, assault, or being in a motor vehicle crash.

Also most child head injuries occur in the home, or in playgrounds.

About two thirds of adult head injuries involve alcohol.

The reality is that head injuries from cycling are a tiny fraction of what the NHS deals with.

However the medical profession continually bleats on about cycling helmets but never ever mentions head protection for going to the pub, walking down stairs, travelling in a motor vehicle, playing in a playground, etc.

I never quite understand the obsession with cycling helmets, if the medical profession wanted to reduce the incidence of head injuries in the general population then there are far better ways of achieving this.

When talking about helmets for cyclists, then you should also include helmets for pedestrians as well. No difference.

http://www.theguardian.com/uk-news/2014/apr/23/duchess-cornwall-brother-...

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fukawitribe [1945 posts] 3 years ago
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mrmo wrote:
fukawitribe wrote:

Indeed, some old favourites there and some new ones which are interesting. Not sure the relevance to my point mind, but still all good.

F*** helmets, they are a distraction from the real debate, why do www allow car drivers free reign, why do we accept that killing people is acceptable?

Lets have a real debate, how can we stop people dying, not this phoney debate about hi viz and helmets.

Fine - quite agree with your feelings. I was merely responding to a comment which I felt was mis-applying statistics to make a point. Not sure why I happen to be the lucky one you chose to jump down their throat.

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FluffyKittenofT... [1788 posts] 3 years ago
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MercuryOne wrote:

At last. Some common sense. That wearing a helmet made you more at risk from car drivers has never had anything to do with the impact of head on pavement versus head encased in polystyrene on pavement argument. That Marsh wears a cowboy hat doesn't surprise me. He probably wears a bike helmet on a horse and a beret in the bath.  35

Those that think helmets can't make a difference under any circumstances have either yet to hit their head on the road - of have hit the road with their head already.

I refer you to my footer...

First off, I usually take references to 'common sense' as meaning 'what I am about to say will consist entirely of unsubstantiated assertions and will be a waste of your time'. That term really needs to die a death.

And who thinks 'helmets can't make a difference under any circumstances'? That's a classic straw-man, no?

All sorts of things might make a difference under all sorts of circumstances, that's completely besides the point, or you'd wear a helmet for getting out of the bath and stab-proof vest when going for a walk round London.

Anyway, neither this guy nor the previous anti-helmet one are authorities on the topic of road safety and public health in general, regardless of how many bad brains they've looked at. Its odd the way professionals get treated as experts on things that are only tangentially related to their day job.

(Not to say they shouldn't express a view or construct an argument, just that the media and people in general seem to attach peculiar levels of significance to them just 'cos they have something to do with brains)

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oldstrath [848 posts] 3 years ago
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J90 wrote:

The pros wear helmets. Your argument is invalid.

As do professional racing drivers, so do you wear a helmet in your car?

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tomturcan [66 posts] 3 years ago
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There's something askew in the arguments for and against helmets. For several years I rode motorcycles and no-one would argue against wearing helmets (although once upon a time some did). Bikers were very careful with their helmets, choosing bright colours (almost never black), testing standards in excess of the minimum and (increasingly) full-face. They never put stickers on them, as the glue risks weakening the structure. In cycling, the argument against seems to be they are flimsy and give a false impression of providing better protection than they do. If so, the response to this shouldn't be not to wear helmets, but to improve the ones that are worn. With so much investment going into advances in cycle technology it's a scandal that the industry continue to market helmets against a EU testing standard that is not fit for purpose (i.e. protects against impacts from a stationary fall rather than impacts at average cycling speeds). Volvo were a company that made their reputation from taking a different view of safety that the rest of the car industry. I wish one of the helmet manufacturers would do the same for cycling helmets, and I'm sure they would find that actually a lot of people care more about their chances of reducing injury than the merits of a argument against wearing protective headgear based on an inadequate safety standard used as a means to market high-margin low-efficacy wearable products.

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OldRidgeback [2798 posts] 3 years ago
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J90 wrote:

The pros wear helmets. Your argument is invalid.

The pros are going really fast and pushing the boundaries because they're racing. I wear a helmet when I'm racing or training, because it's a risky activity. I've crashed when racing, or training for racing, many times.

Riding on the road is a different matter. I wear a helmet sometimes, sometimes not.

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Flying Scot [970 posts] 3 years ago
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Pro's wear helmets for the same reason I do. That they are mandatory for competition therefore you have to wear them, this extends to training, as you need to be conditioned to using it.

My kids wear them because I believe they do work at the low speeds and with less distance to fall.

The medical advice, like all medical advice, changes constantly.

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don simon [1309 posts] 3 years ago
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I walked into a kitchen cupboard door a couple of weeks ago. I think that wearing a helmet would have saved my life.
Wearing helmets in the kitchen should be compulsory.

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700c [1150 posts] 3 years ago
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This guy isn't talking about compulsion, he's talking about his experience and belief based on his expertise of head injury.

You'll never get the statistics to give a definitive answer on this, simply because you can't compare what would have happened to an injured child if the same accident occurred with/ without a helmet.

The experience and professional opinion of this guy is useful, and can't be rubbished by quoting from google, as people are trying to do here.

As for arguments trying to rubbish 'common sense', well you would think people would understand that helmets offer some physical protection, however small, regardless of views on all the external factors, but certain people on here will argue white is black, so may as well save your breath.

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racyrich [299 posts] 3 years ago
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All arguments about helmets should include the simple question : what do the Dutch do?

They manage to do 10 times the cycling mileage we do without wearing helmets and without suffering carnage.
It's pretty simple. People don't just fall off their bikes and die. It's incredibly rare for someone to suffer a fatal injury from a cycling (but not a motoring) related injury. It takes a serious impact. One incurred by a motor vehicle.

Ignore pro cyclists. Again, they weren't dying in their droves when they didn't wear helmets. Paris-Roubaix helmet-less was not some sort of Russian roulette. It's a massive, helmet manufacturer-led con.

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ChairRDRF [361 posts] 3 years ago
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Pro cyclists are far, far more likely to be injured per hour riding than typical commuter cyclists. I used to think that this was DESPITE them wearing the latest helmets, having the best maintained bikes, information through race radio of hazards ahead, a vested interest in not crashing, high quality bike handling skills and superb back up medical care immediately available. I now think that one of the reasons for their very high rate is BECAUSE of wearing the latest helmets, having the best maintained bikes etc. Has helmet wearing resulted in reduced chances of serious injury (or even death) amongst racing cyclists?

So don't forget risk compensation/ behavioural adaptation - I talk about as a reason for the negative effects of increased levels of helmet wearing following compulsory helmet wearing here: http://rdrf.org.uk/2013/12/27/the-effects-of-new-zealands-cycle-helmet-l...

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gazza_d [471 posts] 3 years ago
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I wonder how many children he sees a month with head injuries from falling over whilst playing or whilst in cars?

Also basing your sample on the injured people who come though the door of your ED means it's already flawed.
How many children ride bikes in his area?
How many suffer other injuries?
Do we know how the incidents occurred and who was at fault?

Safer streets would be a better call than helmets

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Some Fella [890 posts] 3 years ago
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I keep seeing the phrase 'i believe......' both from this Michael Carter fella and from the "Ive got this mate who fell off ....."crowd
Its fair enough the helmet nazis justifying their delusional reliance on a bit of plastic and preface their anecdotes using the the phrase but when a man of science uses it they immediately undermine their own argument.
I believe in unicorns but it doesnt make them real.
When someone starts their sentence with "I *know* for sure after extensive and definitive research that helmets are effective...." then i may start to listen.

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WolfieSmith [1381 posts] 3 years ago
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No problem with not wearing a helmet. I'm all for choice. What I don't accept is the twaddle that they never make any difference when in certain circumstances they do.

As for wearing them in a car or on foot? Red herring time wasting nonsense. Grow up.

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LinusLarrabee [119 posts] 3 years ago
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Do helmets cause more injuries than they prevent? That's the only question worth asking. From that, a rational decision can be made wether or not an individual wishes to wear a helmet.

All that other crap being argued above is the dumb part of the brain trying to justify crappy decision making. It's the same kind of stupidity in action when you see people using their mobiles whilst driving or not wearing their seat-belts. Which is fine, but FFS, just admit your dumb brains aren't working and stop trying to pretend there's some kind of rational thought behind it.

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