Thread by @galwaycyclist

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit There has now been time for initial appraisal of this paper. It may be that some claims may be presented to the public as indicating a protective effect for cycling helmets when in fact the methods used by the authors are unlikely to provide meaningful information.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms
@CyclingIreland @rtenews @HealthyIreland @RSAIreland
@RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin In order to ensure a complete debate some perspective is needed.

Medical doctors generate spectacular claims of helmet benefit using methods that are inherently biased and not scientifically valid in my view.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin I view the majority of claims of helmet benefit coming from medical doctors as being derived using methods that are;

1. Scientifically invalid,
2. Inherently biased against the poor,
3. Implicitly racist.

Doctors who push cycling helmets are a threat to public health.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin The most widely cited medical bike helmet studies do not review actual crashes - there is no examination of what happened what the helmet did or didn’t do.

No examination of how the person was struck or how they fell.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin Instead medical doctors have used observational or case control reviews of injury rates among groups of patients.

They select those groups based simply on whether they wear helmets or not.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin But helmet wearing is a marker of socio-economic status and race. If you wear a helmet you are more likely to be white from a high income family with college education.

Being white and from a high income family has an established protective effect against injury.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin The poor and members of ethnic minorities are at increased risk of injury from all causes, burns, electric shocks, traffic collisions and collisions while cycling bikes.

Among the reasons are that the poor frequently have to live and cycle in places that are not very safe.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin Prominent medical bike helmet "studies" involve comparing injuries among a group of richer, mainly white people (helmet users) with injuries among a group who are poorer and more likely to be black or members of other minorities (non users).

This is not scientifically credible.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin Foley et al cite the recent Dodds et al paper in the British Medical Journal Open Edition also based on the @TARNaudit dataset

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin If you go to the British Medical Journal Open Edition website there is a rebuttal (by me) of the same paper.

bmjopen.bmj.com/content/9/9/e0…

"nothing meaningful about the effects of cycle helmets [...] can be concluded from studies using the methodology employed"

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin There is an omission in my response: The last sentence in 3rd paragraph should read "children of parents classified as never having worked or as long-term unemployed (NS-SEC 8) had a death rate as cyclists that was 27.5 (6.4 to 118.2) times higher." ("as cyclists" added)

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin In essence much of medical assertions of helmet "benefit" amount to blaming the poor and marginalised for the established effects of being poor and marginalised.

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin Finally Foley et al cite the Olivier and Creighton and the Alena Høye meta-analyses as indicating a protective effect for helmets. These are screenshots of word searches on those papers.

Does anybody see a problem?

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin @FergalBowers

@SVUHTrauma @drconordeasy @ryanjtw @jamesfoley273 @marina_cronin @noca_irl @TARNaudit @louisebrent28 @kgildeaTCD @CiaranSimms @CyclingIreland @rtenews @HealthyIreland @RSAIreland @RCPI_TrafficMed @svuh @AssocEmergMedIE @britishtrauma @cyclistie @dublincycling @DublinCommuters @IBIKEDublin @FergalBowers @med_indonews @PriscillaLynch @IMT_latest @sthompsonIT
@IT_HealthPlus @paulcullenit @eilishor
@susmitchellSBP @muirishouston @cathshan