Bicycle helmets – the Dutch way

Guest contributions have been rare on my blog in the past 10 years, but there were a few. Sometimes people filmed for me and sometimes I chose to publish other people’s work. Today is the first time I publish a post someone wrote especially for my blog. Ralph Marrett is an expat living and cycling in the Netherlands. Although he came from one of the only two countries in the world where there is a mandatory helmet law for all people on bicycles, he told me he respects and adopted “the ‘Dutch way’ with helmets”. He also has – as he puts it himself – “some qualifications relevant to the calculations” in his piece, “which”, he added “are hardly complex”. As a Dutch person I am always completely surprised by people who genuinely believe that wearing bicycle helmets would do any good. I absolutely do not, on the contrary, it is my conviction that wearing helmets during everyday cycling would do more harm than good. The vast majority of cycling experts in the Netherlands agrees with me. Ralph has a possible explanation for my helmet view and that of the Dutch in general that I rather like. You can find what he writes between the two double lines below.

Generally, the Dutch, or their children, do not wear helmets for everyday cycling.

I am a New Zealander, and I have been living in the Netherlands, in Amersfoort, on and off, for about three years now. I have a bike here, of course, and I have no car. So all my transport options at least begin with my bike, even if, in the end, I catch a train, hire a car, catch a plane, or whatever. For me here, as with most everyone else in this beautiful country, life outside begins and ends on a bike. And life is good.

And then, recently, my daughter rings me from Auckland, at one of those times we are both awake, to tell me, with some excitement (shared, of course, by me!), that she and her beautiful family are coming for a visit. The occasion is the BMX world championships in Brussels, in which their eldest son, twelve years old, is competing. Omg! I can’t wait.

So I start thinking about the various transport options for their short visit to Amersfoort. I know they will love to experience the place the way everyone does, on a bike. Among many things I would love them to see: the bike-friendly infrastructure, the respect shown to riders by car drivers, and the lovely forest that begins, for me, at Nimmerdor, outside my front door, and extends NW to SE for some 30km.

Of course, since their kids are in the bike racing game, they are all diligent when it comes to wearing bike helmets. It is, in fact, the law in New Zealand, as in a number of countries now, that when you ride a bike you must wear a helmet. And the question has come up a number of times, and sometimes the conversation can get quite heated…

  1. Why don’t the Dutch wear bike helmets? And..
  2. Why don’t the Dutch, of all people, wear bike helmets? !!

And the last thing I want, when they are here, is heated conversation! Because, like all my neighbours and friends here, I don’t wear a helmet. I don’t even own a helmet! And I am clearly going to be a ‘bad example’ for their kids. I get that. But I am one of thousands. And I am here, in the Netherlands, as a guest. So I feel, at least, I should honour and understand the culture I am living in.

Of course, a lot of bike riders here do, indeed, wear helmets. Basically, if you own a fast bike and are reasonably serious, riding it at some speed, perhaps for exercise, or for the challenge of experiencing different ways, different tracks, or simply for the sheer joy of experiencing your beautiful machine as an almost seamless extension of your body, you are aware that there is an associated danger. All may not go perfectly. And so you wear a helmet.

But what about the rest of us? Are we ignoring the obvious? What about the ‘huge reduction (eg. 52%[1]) in brain injuries’ that occurs when helmets are worn? Why do we, why do the Dutch, ignore these things and continue to go about our business as if the reduction in brain injuries is not a big deal – after all we are going to be riding bikes for our whole lives…

Well, just maybe, the Dutch intuitively understand something that the rest of the world appears to be missing…

It turns out that, assuming everything else stays the same, the reduction, for example, in the likelihood of traumatic brain injury expected if a helmet is worn over a whole lifetime of riding a bike is.. ‘rather less than 2 percentage points.’ And this is ‘assuming everything else stays the same’-in particular that wearing a helmet does not make an accident more likely, for example by impairing riders’ hearing, or limiting their awareness of their surroundings, or by adversely affecting the behaviour of bike riders or the surrounding traffic, even by what might seem to be a fairly small amount.

To understand the numbers, check out a recent paper available on the internet[2]. We get the following:

  1. Total cycle related traumatic brain injuries (TBIs) in 1 year (2012), t = 6611
  2. Total population, T = 16.7 million
  3. Likelihood of a TBI in 1 year, p = t / T = 0.0396%
  4. So the likelihood of a TBI over a lifetime (ages 5-85), P = 1 – (1-p)80 = 3.1%

Therefore the ‘52 percent lower risk of severe TBI’ due to helmet use will reduce the likelihood of getting a cycle related TBI in our lifetime by just 1.6% (that is, 52% of 3.1%), to 1.5%.

So which is correct? Does wearing a helmet reduce our chances of a brain injury by 52%? Or does it reduce our chances by just 1.5%? It’s really all in the terminology, and the difference is probably easier to see and interpret if we draw a couple of graphs:

The red line is the same graph in each plot, produced by computer (despite the ‘hand-drawn’ look!). Both graphs are truthfully labelled. The first plot, with vertical scale from 1 to 4%, shows what most people think when they read that there will be a 52% reduction in traumatic brain injury. The second plot, however, with scale 0 to 50%, also implicitly includes the information that traumatic brain injury is not very common in the first place.

So, to return to the Dutch. Unlike most of the rest of the world, essentially all Dutch people ride bikes, and of course all their friends and relations do too. So they actually understand the ‘big picture’ of bicycle riding in the Netherlands. The picture on the right more closely represents what they know and understand than the picture on the left.

And more than that, they do understand when wearing helmets really is worthwhile and not counter-productive, and then they wear them! So I think, for the Dutch, the current law is completely appropriate.

And I do hope my daughter’s family will understand and appreciate their collective wisdom!

[1] Helmets prevent severe head injuries in bike accidents, Linda Thrasybule, Health News, 19 Aug 2016
[2]Traumatic Brain Injury in the Netherlands: Incidence, Costs and Disability-Adjusted Life Years

Some people who race in the Netherlands do choose to wear a helmet. To the Dutch these people are then no longer cyclists, they have become bicycle racers instead.


54 thoughts on “Bicycle helmets – the Dutch way

  1. John…

    If you wanna be pro Choice… be!

    Be accountable of your choice the day you have had an accident.

    You are comparing the seatbelt price to a helmet price?? Really?
    That would be enough imho opinion to think about your inputs. I personally would be ashamed to go on the financial argumentation.

    Then you claim that helmet do not protect? I hope you can proof you claim… if not, that is insane and mean.

    You compare cycling with walking? Unless you have side wheels it is NOT.
    The speed is way different.
    You don’t walk on the road.
    Try to stop at cruising speed when a car (or cyclist, or even pedestrian)) cuts your way.

    Why do you claim cars have different “energies” but not for pedestrians.

    No one tells that we shouldn’t make road safer for any participant. But you can fall down even without a third party involved (only you are just a perfect human being with no failure with your bike). And unless you are trained to fall down and land on your feet, then a helmet will most likely prevent you from serious injuries if not from death.

    No, there is never a 100% guarantee… it’s all about increasing the probability in your favour.

    1. You suggested people were too lazy to use a rabbits foot.
      I pointed out that in addition to other disadvantages (comfort, ease of use) they are also cost comparable with the vehicle itself, and need replacing many many times over the life of that vehicle. A seatbelt is a one time purchase for the life of the vehicle that is a tiny fraction of the vehicle cost.

      Claims that helmets prevent 70% of injuries are easily disproved by looking at two pieces of data:
      – The ratio between head and limb injuries
      – The per mile injury rate when helmet wearing rates change suddenly.

      For the first there is no difference in the ratio between people who do and don’t wear magic hats, for the second we have a couple of places which have instigated helmet wearing regulations and therefore saw a step change in wearing, and no step change in injury rates.

      I compare cycling with walking because both are things that we do under our own steam, so the energies are ‘human scale’ (jogging at 10mph is ~half the energy of cycling at 15, driving at 25 is >30 times higher) The injuries/deaths per mile travelled by bike and foot in the UK are effectively identical. That’s despite the fact the you don’t walk on the road (which isn’t actually dangerous)
      I have come off various bikes – I’ve never hit my head. When I used to wear a helmet I bashed it on a regular basis.

      To suggest that “a helmet will most likely prevent you from serious injuries” you are seriously arguing that if you come of a bike in any state you will most likely suffer from serious injuries. That is clearly rubbish.
      Additionally most serious injuries aren’t anything to do with the top of the head (I had a friend who’s face was smashed in because a helmet meant that he didn’t slide off a rail that he face planted, but slid and twisted all along it because the hat caught on the top).
      So aside from the rarity of any injury, let alone serious injuries, and the paucity of head injuries even within that tiny subset… you then have to make a significant difference… And the population studies simply don’t show any effect (and even if they were 25% effective you would expect to see the effect clearly).

      There isn’t a guarantee… You could easily get your neck broken because your helmet, which hasn’t been tested for rotational inputs or ability to slide, snags on a cats eye, or a drain cover…

      The energies which a helmet is certified for are sufficiently small that I can guarantee you won’t go from “donor” to “fine”, you might go from “sore head” to “less sore head”, but I’d suggest that gloves are more important protective device.

      No helmet is advertised on the basis of increased safety, because they aren’t safety devices, they are fashion accessories.

      1. John, YOU WON! Congrats!
        I am out of the discussion.

        For the others, who like me based on John’s argument have a melon head, check that:

        Gloves: must be as well… it’s not either helmet or gloves or bicycle lanes, or defensive cycling, or…

        And yes: helmet should be worn as well for skiing, hockey, ice skating, or any other activity which could result in brain damage…. but some brains doesn’t need to be protected….

        Helmets are even lowering impact on neck in case of accidents, while helmets with visor can increase visibility by reducing blending. They reduce only visibility while being extra low on the bike (aero position). And can reduce sun burns, or sunstroke.

        I think the fashion people won’t use helmet because their nice haircut will be destroyed. OMG

        1. “And yes: helmet should be worn as well for skiing, hockey, ice skating, or any other activity which could result in brain damage…. but some brains doesn’t need to be protected….”

          So you always wear your helmet in the shower, and in the kitchen, and walking – all of which are as likely to result in a TBI.

          What is it about cycling that you think is dangerous?

          If you really want protection why aren’t you advocating motorcycle standard helmets.. they are actually tested for crashes which have lateral momentum.

          At the “right” speed in the “right” crash a helmet will lessen the impact… but those are incredibly rare events, as evidenced by the very small number of people worldwide who end up in a persistent vegetative state from cycling accidents.

          There is no way a cycle helmet will “save your life” in the way most people understand the term (die or be fine), at most it will slightly reduce the TBI you suffer.
          Given that the skull and CFS are designed to withstand collisions… until you are actually penetrating the skull the brain is well protected.
          Motorsport collisions have in ear accelerometers to asses the severity of impacts, and these have to able to register accelerations as high as 400g! And in almost every case the driver walks away. Note that that 400G is *after* their high tech helmets have done their thing.

          The skull is pretty tough, and being suspended in fluid is pretty good protection mechanism for something like a brain. It fares less well when spun, which is why motorcycle helmets have to pass a ‘slide’ test, to ensure that they don’t catch and twist the head. Cycle helmets… don’t have a slide test at all.

        2. Georges, do you realise you are writing on a blog published from a country where 17 million people disagree with you. No matter how many stupid videos you show. As this blog post explains: we know too much about how little risk there really is. The Dutch are not easily fooled by helmet manufacturers. Cycling is not more dangerous than walking, we will keep on doing both without unnecessary “safety measures”.

          1. I lived in that 17 Mio people country and cycled in/around it. So you can guess I have had some xp with Dutch and their knowledge and capacity to cycle too.

            And I have been nearly shot down too.

            Actually, the funny part: your Dutch folks are not wearing a bicycle helmet… but will wear a ski helmets. A case of schizophrenia? 😉

            You wanna see those videos as “stupid” when the last one Bell shows their lab measurements ? Do!

            And you and the Dutch will have right.. the helmet companies are wasting money for developing more and more efficient and buying expensive lab measurements devices.

            I have seen what amount of money other industries were pumping into the Dutch advertisers… and they bought it.

            I am happy that my friends (and myself) were saved by wearing a helmet. My melon head wasn’t cracked.

            And I wish you and the no-helmeter to never have to regret not to have worn one.

            Be well!

            1. Georges, you will never convert a non-believer. I see you have been brainwashed well. You make so many false comparissons. I have cycled for over 50 years, and I have been in a car crash. No, I will not wear one, end of story.

            2. Brainwashed? I got the arguments from flat earther…

              Good you were lucky to never have the need of a helmet.

              So you had no accident and no need of a helmet. While I can name at least three people who can testify that they were saved by a helmet. My quintessence: you were lucky. Good for you.

              In the end: the discussion should be how to make streets and road safer. And wear protection.

              While many people prefer to be binary and “think” either or.

            3. Stop trying. You believe in helmets, the majority here doesn’t. Nothing you say is going to change that. Hard to accept but that’s how it is. Since you are only repeating yourself I will now stop publishing your posts. End of story.

            4. If your head is melon then that explains a lot.

              Mine has bone.

              “I am happy that my friends (and myself) were saved by wearing a helmet. My melon head wasn’t cracked.”

              The only way you can demonstrate that those specific incidents would have been fatal without a helmet is to reconstruct them.
              There is *no* way a helmet would have taken a fatal head collision and left you basically unscathed.
              The basic physics and biomechanics don’t allow it.

              Would you have each hurt your head a bit? Yes, quite possibly.
              Would you have had a TBI, or been killed? Almost certainly not.

              The fact that hundreds of times more people are “saved by their helmet” than ever died from cycling injuries shows how ridiculous the claims are.

            5. Apologies for the rapid double post…

              “While I can name at least three people who can testify that they were saved by a helmet.”

              I can show you three liars then.

              None of those people will have the required expertise to make that statement in court – they would be torn apart by anyone with even a modicum of relevant materials and mechanics background.

  2. Thanks for your post.

    I will never understand what’s the problem with wearing a helmet. Are we too lazy?

    Sure, the Netherlands are having a lower incident rate. They have another cycling infrastructure AND another cultural bicycle affinity.
    Neither the less, there are still some intersections, crossing, where car/trucks might crash you down, turns that are not as safe to take, and other rough or more egocentric cyclists that may push you around (yes, I speak by own experience)

    It’s not because we should wear helmet that we shouldn’t make cycling more safer, including investing in road infrastructure for bicycles.

    And there are still Dutch people wearing helmets…

    1. I’ve never understood why car drivers aren’t required to wear full Nome suits, HANS devices and F! rated helmets, are they just lazy?

      The issue is that helmets don’t offer significant protection (if any at all) and the emphasis from most “road safety” discussions is on the lowest form of risk mitigation (PPE), and one that has officially been designated to NOT be PPE (in the UK at least).

      Cycling is not an inherently dangerous activity, unlike driving. Driving is inherently dangerous due to the energies involved in moving a large mass of vehicle at high speed. The energies involved when cycling are far lower.

    2. John,
      Last time I have checked,

      -for most countries wearing a safety belt during car driving is mandatory

      – the car energies involved is higher but there is a protective “cage” around as well. A car can be better seen. Driving alone with no human factors (fatigue, drugs, etc) is not dangerous too. Even with higher energy. The energy only comes into account when there is an abrupt stop.

      And claiming that “ helmets don’t offer significant protection (if any at all)” tells a lot to be polite. If one wants to focus “on road safety” alone: it’s about the step behind road safety, when an accident is happening. Car safety belts don’t make the “road” more safer. But reduce the potential consequences.

      – there are more then enough cases where a helmet saved from heaviest head/brain injuries. Just lately I read from a guy who’s from wheel broke. No helmet would have made him to an organ donor. I experienced it for myself too. A friend had an accident lately because his trailer broke: “only” a multiple forearm break.

      It doesn’t mean that someone being “pro helmet” is against “safe bicycle road infrastructure”. And that’s all the point.

      I never understood: What is the disadvantage of wearing a helmet? (Unless one is a narcissistic or egocentric bloke who have anyway other issues)

      Arguing against wearing helmets is IMHO the level of arguing against a car safety belt. Period.
      From there I am happy to agree to disagree, hoping that the “helmet-denials” will be consequent enough to not wear their safety belt in cars.

      1. And seatbelt laws haven’t reduced road casualty rates – they’ve moved the casualties outside the cars, but they haven’t actually improved safety.

        The “cost” of a seatbelt is genuinely negligible – it’s a tiny fraction of the cost of the car, always available, self adjusting and is very rarely uncomfortable.

        The “cost” of a helmet can exceed the cost of a bike, they are a separate device, with a very short lifespan, usually poorly adjusted and very rarely comfortable when cycling. They are also actively dangerous *off* the bike.

        There will be no case where a cycle helmet has made a difference between “donor” and “fine”. They protect against minor lacerations and abrasions, they might slightly reduce the energy in an impact (certainly not enough to go from donor to nothing) but they are also likely to increase the much more damaging rotational energy of an impact.

        Pro Helmet is falling to the fallacy that “something must be done, this is something so we’ll do it”.
        I am pro choice (since on a personal level the evidence is that they make no difference), but actively anti promotion, since the benefits of cycling vastly outweigh the risks, even without adding some additional requirement.
        Cycling is almost exactly as safe as walking (it’s just a tiny bit safer actually), and I don’t see you promoting walking helmets, you’d rightly be laughed at.

  3. I am a Dutchman and I wear a helmet…but only only on my recumbent trike. To be more visible, because of the low silouette of the trike rider. So my head and helmet is most likely to be seen. My helmet is orange, with orange reflective dots and white and red lights. I also carry flags on my trike. A trike has a very low change of tipping over. I happened once. I landed on my side, my head never touched the pavement. so I do not need a helmet for safety. Just to be visible. That is all.
    On my Dutch city bike, I never wear a helmet.

    1. I’ve flipped my bent trike sideways (due to an Audi driver driving straight at me), and had it flipped end over end (rear ended on a roundabout). On neither occasion did my head make contact with the ground (or anything else) – I can’t tell whether that would still be true had I been wearing a plastic hat.

  4. I wonder if frame geometry has something to do with all this. In Europe the standard bike that’s sold is a stable general purpose bike. In North America the standard bike that is sold is a specialized sport bike (mountain biking or racing) which are not so stable.
    The trend in unstable bikes goes back to the early 1970s when racing bikes became fashionable. Then in the 1980s mountain bikes were fashionable. Entire generations have grown up thinking that cycling was an unstable activity not knowing any different.
    I believe that there should not be a helmet law anywhere but if that is politically impossible then the helmet law could be changed to only apply to racing bikes and mountain bikes. Bikes that had frame geometry where it was not possible to flip forward would be exempt.

    But of course it would be better to just deconstruct the entire idea that head injury can happen. All the studies need to be picked apart and their methodology examined and any that didn’t follow proper scientific methods (either by accident or were intentionally fraudulent) would be discounted. Then compare to other activities where the state may or may not insist on safety clothing.

  5. It is tough for all the helmet pushers here to recognise because they are likely suffering from cognitive dissonance.

    The Netherlands is the safest country in the world for cycling and it has the lowest helmet wearing rates.

    Countries with high helmet wearing rates such as Australia, New Zealand and parts of the USA are all dangerous place to cycle.

    The facts are quite simple. Of course the relationships between the causes and effects are quite a bit more complicated to sort out, but that’s life. Nonetheless, the upshot is that if you want safe and abundant cycling (as well as vital and attractive cities) then you should copy the example of the Netherlands and have a very strong justification if you differ in some respect.

    Another difficult fact for the helmet pushers is that one of the biggest cause of head injuries is car crashes. You can find stories in the press every day of people receiving serious head injuries while riding in cars.

    If the helmet pushers were being consistent then they would advocate more strongly for the usage of car-helmets in order to prevent the numerous deaths and injuries that occur every day on our roads to car passengers and drivers.

    But bike-helmet advocacy tends not to be about facts, it’s about feelings. For example, there is a gentleman in this thread who seems to be confused about the difference between motorcycles and pedal cycles. That’s a common feeling: ‘all two wheel vehicles are alike’. Not true, but it’s what people feel.

    ‘I saw someone die’ is another feeling. That’s terrible of course. However, the same story repeats itself numerous times per day all over the world, involving car passengers and car drivers. Surely they deserve protection too?

    Often the helmet pushers ignore the simple fact that mandatory bike-helmet requirements cut cycling levels and reduce public health. Australia and New Zealand have demonstrated this convincingly, much to the detriment of people who live there.

    Car-helmets, on the other hand, would improve public health almost unequivocally. If they reduce the amount of driving – that improves public health. If they save lives – that improves public health. The only negative effect is the risk compensation effect – people may drive more dangerously while wearing helmets. Of course the same applies to cyclists.

    In any case, if helmet pushers here want to earn some respect then they will immediately pledge to push car-helmets at least as strongly as they push bike-helmets, if not more so. And then actually go forth and do so.

    However, if you advocate only bike-helmets and not car-helmets then you are being hypocritical and either you are irrational or you have an insidious, hidden agenda to cut cycling levels — much like what happened in Australia and New Zealand.

  6. I don’t care about your micro/macro bullsh*t and statistics. People can be profoundly affected by head injuries that do not fit into the Traumatic Brain Injury category…and a helmet can prevent those more “minor” injuries.
    i was at the scene of a car/cyclist collision one day. The cyclist died at the scene after crying and calling for his family as he lay on the ground. There were pieces of skull, hair and blood on the front windshield frame where his head hit it.
    DO NOT tell me that a helmet would not have decreased his chance of serious injury and death! WEAR A HELMET!!

    1. The father of a friend of mine died when he, in an office, got git by a door. A helmet might have saved his life.

      People die. It’s tragic, especially when it’s caused by an accident. That doesn’t mean that you should live your whole life in fear.

    2. Certainly, wear a helmet if you decide to. When making public policy, however, it is best to follow scientific methods and consider statistical information rather than anecdotal.

    3. > “i was at the scene of a car/cyclist collision one day. (…) WEAR A HELMET!!”

      Perhaps the cyclist should’ve worn a helmet, or perhaps the driver shouldn’t have hit the cyclist. One is operating a deadly weapon, the other isn’t.

  7. Question: Did I get it right that t = 6611 is the total number of cyclists involved and injured in 2012? If so, the calculations should be changed, because the number of cyclists (specifically) with TBI within those 6611 is only a very small portion.

    1. Not what is stated.

      Total cycle related traumatic brain injuries (TBIs) in 1 year (2012), t = 6611
      Total population, T = 16.7 million.

  8. In your article, you only take into account TBIs.
    How would the numbers change if you’d account for more shallow head injuries, which imho, is where wearing a helmet might make a more obvious change.
    I’m asking, because I want to try to undertand this, for myself, as a cyclist – i’m no pro/con helmet advocate, but having crashed with my bike i got lots of nasty knee and hand injuries and scratched my helmet really good. So, while I don’t think TBIs were on the table, I do think the helmet got me out of getting some stiches on. Thus, my initial question: how do the numbers change if you account for all cycle related had injuries?
    Thank you!

    1. I’ve been cycling in Amsterdam for more than half a century now and I’ve never fallen off, yet you keep crashing with your bike. What’s wrong with you.

      1. I love that Dutch bluntness 🙂 I’ve been riding a bike (not racing) for more than 50 years in Australia, and I’ve fallen off my bike just a few times – worst at the age of 18 when I got a little bloodied. I was going round a corner very fast on a racing bike – narrow tyres plus gravel on the road! I don’t wear a helmet and have a court case next year as a result, where I’ll attempt to enlighten the magistrate and police to the joys and benefits of cycling (I don’t like the word, but it’s easier then “riding a bike”). Now, to the point of “What’s wrong with you”. I grew up in a country town and road my bike everywhere, every year until I was 19 or so and became more of a driver. I think all those years of youthful riding probably helped me become very competent on a bike. Most Australians do not have this experience – they have been brain washed to believe cycling is a dangerous activity, and they generally do not have a lot of experience. That’s what’s wrong with them.

  9. Reminds me of the Harley owners who refuse to wear a helmet because it impedes their hearing ! Hogwash on no helmets.

  10. Pretty much all of the objections I’ve read in the reply all suffer from the same flaw: they proceed from the incorrect perspective, utilizing the micro and not the macro to analyze the problem. That’s understandable, since really only professional statistical analysts and people such as epidemiologists will know the implication. Most of us interpret the world around us in the micro sense, since that is what matters most in our daily lives and activities. When dealing with public health however, you ask an epidemiologist, not an ER surgeon or a ‘medical professional’. Why? Because small changes in policy and behavior have broader implications than just the most immediate.
    Case in point: wearing helmets.
    Without getting into the fact that bike helmets are NOT designed to protect from collisions with motor vehicles, their primary purpose is to protect from low-speed impacts such as those experienced when a rider falls off their bike or collides with a stationary object. In this they are quite effective, however they are generally trumpeted by ‘safety experts’ as a no-brainer safety measure that protects against far more than what is actually the case.
    Why is this important to view from a macro perspective? Because humans are not logical creatures. It’s been shown that rabidly encouraging (or requiring) helmet use, indeed branding the very act of cycling (any cycling, not just race) as an ‘inherently dangerous’ activity, has the effect of diminishing its appeal as a viable means of transport, driving people to other modes but mostly encouraging them to use private autos. This has the effect of encouraging more sedentary lifestyles, which carries a whole host of long-term health risks that drastically shorten projected lifespans. An epidemiological analysis of this complex web reveals thus that the marginally increased risk of terminal injury on a POPULATION scale that comes with not wearing a helmet during normal utility cycling (that is, not sport cycling) is dramatically overcome by the positive health and vitality benefits of encouraging more active lifestyles.
    Does having good infrastructure help? Of course it does. In fact, once you get to a certain volume of cyclists without such infrastructure you would be forced to pick cyclists or motor traffic since the two don’t mix in high volumes. But people and policymakers exert far more energy bashing people for not wearing helmets or citing studies that prove their limited value than they do advocating for good infrastructure. Indeed, it’s not uncommon to find the most vocal advocates for helmet wearing to also be the most vocal advocates AGAINST bicycle infra. At this point, their advocacy in these two issues should be seen as cancelling itself out and the individuals in question ignored and relegated to the peanut gallery.

  11. I have read the full article and whilst I don’t live in the Netherlands, I live in the UK, I will always wear my helmet and suggest others to wear theirs.

    I understand that from what I’ve been told there are more specific off road cycle routes in the Netherlands, unfortunately there aren’t in the UK and I have to frequently cycle alongside the traffic.

    Also, a few years ago I came off my bike after I clipped a kerb and my helmet ended up being cracked right down the middle, my head was absolutely fine.

    Therefore the above is the reason I will always wear my helmet.

    1. As always, I respect the individual’s right to choose but what you’re demonstrating here is exactly what the article is explaining. Your perspective is the same as the ‘ER Surgeon’ that is trotted out to praise the magical safety properties of 2lb domes of styrofoam (domes which, btw, Volvo [a car company] has proven are not designed or tested to protect from car crashes). This presents a micro-scopic perspective of the problem. What the article presents is the more critical population-level MACRO-scopic perspective and the way that wording affects a person’s perspective.
      Now, I have zero clue as to the nature of your cycling (a.k.a. disclaimer). I have both a utility bike (10mph>) and a 1982 Campy Raleigh drophandle (15mph<) and the only reason I don't wear a helmet on the latter is bc I only ride it off-road on a trail with thick grass and soft soil to either side (in mixed traffic or open road, i WOULD wear one). There are some dicey spots on my route and I've found myself unwilling to test my mettle bc of not wearing a helmet. While that means my ultimate speed is lower, the chance of me calling for an ambulance is greatly lower as well. My utility bike, which I ride for all normal trips, is a heavy, tall-geared and beastly thing around 30kg or 4.5st that I COULD get up to 15mph but I'd likely suffer some sort of cardiac arrest shortly after. I never wear a helmet whilst riding it because I know from experience that drivers give me more leeway sans-helmet (and even more if I hold an umbrella a-la-Dutchie). I also know, thanks to Volvo, that bike helmets are only tested to protect against low-speed falls. I haven't fallen off a bike in 10 years and even then it was because i was speeding in the rain on smooth tires and worn concrete and slid). Everyone in my area drives larger SUVs and trucks (American ones at that) so I know that getting hit by the 1.2m-high bluff-faced bonnet of a truck (we don't have pedestrian crash safety testing) is not something a helmet will protect against. It might be a calculated gamble or even an example of me saying 'sod it' but I enjoy my errands far more not trying to ward off the stupidity of others with security theatre.
      I clip kerbs at least once or twice a week since even the bike infra here isn't designed for bikes (give that to some uni students and have them bat it around for a while). While there are times I've come close to taking a spill, my utility bike's config and low speed usually means all I have to do is drop a foot quickly to reassert my balance. It rains quite a bit here and the parish/county rarely replaces road infra until it has the potential to pull a Houdini on a Volkswagen so the kerbs up into parking lots are frequently worn and slick. My rear tire (Schwalbe Marathon Plus) almost always slips a few inches sideways since i go up at an angle (too steep to mount straight on) so I've just gotten used to this.
      As I said before, it's your choice to wear a helmet but please don't use your micro-perspective as justification for broad population-wide policy of recommendations. My father, brother, and sister all ride bikes as do my relatives in California. I don't try to use my experience to convince them to abandon their styrofoam crowns but I also am very blunt and adamant that they not try to bully me into using one either..

    2. So because you once fell off your bike and your helmet failed (brittle failure doesn’t absorb significant energy, cycle helmets absorb energy by plastic deformation – being permanently crushed) you always wear one.

      That’s pretty poor logic.

      My recommendation would be more to stay away from the kerb, so that you aren’t at risk of clipping it.

  12. I feel that there is a miss understanding of satitstics in this article. It’s interesting in the approach but as an old Prof once said the author, from my prospective, is using the satistic more like a drink uses a lamp post, more for support than for light.
    The quoted statistic identifies a population at risk. So for any given incident which would have a tbi outcome the chance of it is reduced by 52% by wearing a helmet. So for that individual it’s 50/50, vs. 100%.
    To the extent that wearing a helmet increases the risk if a tbi incident then the author should present that increased risk factor. I would argue that perhaps riders that wear helmets are more cautious.
    I worked for years in health care and generally when we would see motercycleist without helmets we would call the organ donors.
    Wear a helmet or not is a personal preference but helmets can and do save lives.

    1. Are drivers who speed above 100 km/h without helmet and fire suit organ donors?

    2. Exactly, helmets reduce risks and save lives. Since most TBIs are not-traffic related, but caused by incidents at home, i’d recommend everybody to start wearing a helmet when climbing the stairs at home, and when in the bathroom, especially when barefoot on a potentially wet floor. The chance of a serious injury when an incident occurs will be highly reduced.

  13. And even then, that study is at odds with many others. In LA:

    Click to access IJARO180008.pdf

    Overall, 292 patients had severe trauma (AIS>2). Significant head trauma (head AIS>2) was diagnosed in 142 patients (10%). The prevalence of significant head trauma was 35% in the group of patients with helmet and 34% in the group without helmets (p-value=0.84). It should also be noted that the prevalence of all significant trauma was 26% in the group of patients with helmet and 20% in the group without helmets (p-value=0.048). The overall mortality was 1%. There was no difference in mortality between helmeted and non-helmeted patients.

    Also, major trauma defined by ISS was seen at 16% in the helmeted group in comparison with 7% in the non-helmeted group (p-value<0.001).

    1. I really hope that the Dutch attitude about helmets will continue to remain as it is , where it’s completely a choice that each person can make without peer pressure and the like. But at least in Zeeland, I notice that a lot of little kids are wearing them, and even some older ones as well. So it’s hard to say whether or not this will slowly change in the coming years or decades. It starts to become more normal, especially among the enthusiasts who are also wielrenners and likely wearing helmets when doing that. The conversation about it also often comes up from the foreigners, especially Germany and Belgian, where helmet usage is much higher. The Netherlands is probably the only country remaining where helmet usage is in the low single digits, so it’s become the oddball out. While I have never tried (and don’t ever plan to) to discourage anyone else from using a helmet, I also really don’t want to see the Netherlands become like Denmark, where almost 40% of the population feels a need to wear a helmet. There, it’s no longer an “each person to his/her own” mentality. If you don’t wear one, there will likely be someone who will try to tell you why that’s not a good idea and the usual lecture about safety.

      I’m simply baffled that my Danish friends, who have cycled their entire lives and without helmets until about 10 years ago, feel less safe now than they did all those preceding years. Supposedly cycling is getting safer in Denmark, but you’d never know it really.

      1. I’ve recently started commuting to work by eBike, along a winding bike path that mainly follows a river. The path is generally empty of other human beings – they are on the congested roads having a bad time – this is Melbourne, where car is king. I can often be doing 32km/h, even on gravel, without a helmet. Most people (Australians at least) would think this is foolish. However they do not think it is foolish to travel at 110 in a car without a helmet. It is a matter of knowing your own skill level – with much practice your bike becomes like a part of your body, and your senses extend to the pedals, wheels and brakes. You are one with the road, the air and the sky. You are fully alive and aware. You know an accident is a possibility, and you adjust your speed and direction accordingly in the various situations that arise. Thank goodness for the Dutch.

    2. Perhaps we might review the ‘Head Trauma’ & linked injuries. Research in the late 1940’s noted that the cranium, a brilliant protective housing for the brain, constructed of energy absorbing fused bone plates, and covered by a self-healing sacrificial layer of flesh and hair, was at just 30% of its impact strength in a flat-plate 20mph impact (a helmet is destroyed in a 20mph impact – at roughly 260% of its impact strength)

      However a flat plate impact does not accurately reflect a ‘head-on ground’ impact in a cycle crash, which tends to be at an oblique angle, with most ‘face-plants’ probably made worse by helmet wearing, as the chin and face can be forced into the ground by the peak of the helmet and the ABS visors (not safety tested) do shatter and embed pieces in the soft facial tissue (or even eyes).

      The far more serious head trauma comes with or without a helmet in the violent acceleration of the brain within the cranial cavity especially rotational acelleration, which can be exacerbated by the snatch of a styrene helmet on the road (where the flesh will shear as the protection against snatch), and the enlarged head size created by the helmet, and the often ridiculous compromising of the design by wearing it on top of a woollen balaclava etc.

      A further injury which might escape the head trauma filter is catastrophic damage to C1-C5 vertebra & the cerebral cortex, where the head (nominally 10% of body weight) is leveraged through the neck (C1-C5) by the other 90% of body weight.

      That noted the classic novice cyclist injury is the broken collar bone. This bone is essentially the ‘fuse’ that will break instead the bones in the arms when landing on your hands. Regular cyclists will probably have had a few falls, and like parachute jumps, you can even practice ‘dismounting’ from a moving bike without hurting yourself. I’ve left a bike at c.30mph when the front wheel jammed, and watched it fall, as I somersaulted through the air, at least twice, before rolling out, & getting up swearing at the now unrideable bike.

      Clearly some better analysis is needed.

  14. Regarding the Fietser/Wielrenner (“cyclist”/”bicycle-racer”) thing, is it not fair to say that a Wielrenner is still a type Fietser as well? Is one not a subset of the other? I imagine that the words are used in different contexts. One is purely descriptive and the other is a hobby, or a sport. They seem to me to compare to “pedestrian” and “runner” in English. Someone out for a run is still technically a pedestrian too, but just not the first thing that comes to mind when we hear the word “pedestrian” (probably because that vast majority of people travelling on foot are walking in everyday clothes rather than running).

    Is that a fair analogy, or is a Wielrenner never a Fietser in any respect – the two are mutually exclusive?

  15. Have you seen the mess a car crash can do to drivers and passengers? If the helmet wearing countries carried their logic forward then safety would be increased if everyone in a car was obliged to wear full racing fireproof suit and crash helmet with neck-brace combined with full racing harness attached to a proper roll-cage. Only makes sense.

    It has been suggested that a better method for car safety would be a simple spike in the centre of the steering wheel to return drivers from their sense of comfortable vulnerability, then they might consider the vulnerability of other road users too.

  16. Thanks for this take on things! It helps that the infrastructure here in Holland is amazing, so the number of accidents is really low.
    Whenever I do get in the discussion I try to explain the reasoning by extending the reduced probability in brain damage. I mean, it also reduced the probability of brain damage when you fall down the stairs with 52%, so it actually is really irresponsible not to put on your helmet before you walk up or down the stairs.
    And as a road cyclist/bicycle racer/wielrenner I do wear the helmet when I’m on my road bike. It’s actually frowned upon not to wear a helmet in that situation. Because speeds are a lot higher increasing both the probability of an accident and the gravity of injuries in case of an accident.

  17. Hope you’re a organ donor. BTW the rest of us pay the bill for non helmet wearers. One study found that 75% of non helmet wearers receive public assistance after non fatal TBI injury. They don’t happen often but when they do they are catastrophic injuries that cost millions and transform lives.

    1. Sorry Bill, but do you really think anyone would take your comment seriously in the Dutch context? Virtually nobody wears a helmet here. As the article explains, we all know too much about the risk involved and the difference wearing a lid could have. It is negligible. This makes your comment ludicrous.

    2. Most forms of TBI are not catastrophic, nor do they cost millions. Most of them are light concussions, some are heavy concussions, and very few have long-term effects. It’s very hard to get accurate numbers on these since there are so few of them, but the figures from the dutch ‘hersenstichting’ assume that 30% of TBI doesn’t need a doctor, 30% only visits GP, 40% go to hospital. Of the last 40%, 56% gets stays at least for a day in the hospital.

      That makes from all TBIs only 22% gets admitted to hospital. And many of those will be dicharged the next day.

      1. I should have read the linked article, it provides very accurate numbers. They use slightly different definitions, but the pattern seems to be the same as numbers from Hersenstichting

    3. First of all, I can’t think of any injury that’d cost millions in the Dutch healthcare system. Secondly, helmets reduce the probability of fatal TBI by 52%, do the expected, overall difference between wearing and not wearing a helmet is not the difference between millions and nothing, but between millions and half of millions. Way to miss the point of the post and stick with your agenda!

    4. I’m sure we pay more for the smokers, drinkers and druggies among us. We’re just a bit more relaxed, both as motorists and cyclists, so in general there’s more safety for all of us.

  18. Another way to look at this is comparing rates of TBI between helmet wearing and non-helmet wearing countries. I don’t have my stats available but going from memory it’s something like this:

    NZ: 31% of cyclist fatalities caused by TBI.
    NL: 31%
    US: 33%
    Canada 34%
    MN (US) 37%

    If wearing helmets was effective then certainly NZ should indicate a significantly reduced rate of TBI as a percent of all causes. Many people in the U.S., perhaps 50%, wear helmets so why does the U.S. not have a lower rate. Some provinces in Canada require helmets and they are frequently worn in others yet they are not seeing a reduction in TBI. These differences BTW are all considered statistically insignificant.

    MN has one of the highest per capita rates of bicycling in the U.S. and from appearances perhaps 70% of cyclists wearing helmets but no reduction and actually a statistically significant increase.

    At one point a group at Uni Sydney was working on a project to see if mandatory helmets resulted in a reduction in TBI (Informal analyses indicate no change in TBI from pre helmet (1996?) to post helmet IIRC).

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