It's a seldom mentioned aspect of my professional history that I used to do a lot of trauma surgery in my youth. I did my residency at a program that included a county hospital with a busy trauma program where I saw quite a bit of vehicular carnage and an urban hospital (which has since closed) where I saw a fair amount of what we in the surgery biz call gun and knife club action. During my time as a PhD student, I moonlighted as a flight physician for the local helicopter rescue service, Metro Life Flight, where I took care of patients with everything from cardiac disease requiring transfer to the Cleveland Clinic to near-drownings during the summer at the Lake Erie resorts, particularly Put-in-Bay, to obstetrical transfers (which terrified me) to, of course, the unfortunately copious run-of-the-mill vehicular trauma. I saw the sort of tragedy that could result. Then, in the late 1990s, as I did research for my surgical oncology fellowship in Chicago, I also moonlighted as a trauma attending at a local suburban level II trauma center.
At that point, I realized that trauma was not my thing, as I couldn't see myself at my present advanced age doing the sort of physically and emotionally demanding work that required fast decisions. It stressed me out too much to have to make such quick decisions knowing that if I hesitate it could mean that the patient dies. That's part of the reason why I went into surgical oncology in the first place. It's a lot more cerebral, and less urgent. However, I have an appreciation for those who do do trauma. I also realize that trauma is, in a way, the "purest" form of surgery in that it involves taking a body broken by mechanical forces and trying to repair it, all the while keeping the patient alive until the repairs can heal. I will, however, miss the enjoyment I get seeing presentations on tree stand falls during hunting season. (Yes, the start of dear hunting season with guns is an unofficial holiday around this state.)
I don't mention my youthful flirtation with trauma surgery so much because I think it's something so fascinating that I must tell it. (If that were the case, I'd have been mentioning it much more frequently in my blogs and social media than I have before.) Rather, it lets you know why I was so distressed when this story was forwarded to me a week or two ago that I've been meaning to address. It's a Reuters report entitled "Injuries soar after Michigan stops requiring motorcycle helmets":
In the three years after Michigan repealed a mandatory motorcycle helmet law, deaths and head injuries among bikers rose sharply, according to a recent study.Deaths at the scene of the crash more than quadrupled, while deaths in the hospital tripled for motorcyclists. Head injuries have increased overall, and more of them are severe, the researchers report in the American Journal of Surgery.
Senior author Dr. Carlos Rodriguez decided to do the study after noticing an abrupt change in the trauma unit at Spectrum Health Hospital in Grand Rapids, where he works.
The first week after the law was repealed in April 2012, he told Reuters Health, "I just could not help but notice the number of patients that had been in motorcycle crashes with no helmet on, which was enormously different in number and volume than we had experienced the weekend before."
Yes, those of us in the trauma biz not-infrequently refer to motorcycles as "donorcycles" (as in organ donation) because of the head injuries that they cause, and nothing facilitates turning a motorcycle into a true donorcycle like not wearing a helmet. Indeed, motorcycle riding is associated with a 27-fold higher risk of death per billion miles traveled than driving an automobile.
Those of us who are skeptics might wonder whether Dr. Rodriguez was experiencing that very human cognitive shortcoming known as confirmation bias, wherein we hairless apes tend to notice and remember occurrences that fit in with our preconceived beliefs and to be less attuned to and forget occurrences that would tend to falsify those beliefs. We all do it, even skeptics. The main difference is that skeptics and scientists know that they do it and try to compensate by looking for objective evidence against which to test their hypotheses and beliefs. This is what Dr. Rodriguez did, and the result was a paper presented as an abstract over the summer at the Midwest Surgical Association meeting and then published online first last month in The American Journal of Surgery as a paper entitled "Repeal of the Michigan helmet law: the evolving clinical impact".
Not surprisingly, the finding that repealing motorcycle helmet laws results in more fatalities and brain injuries is about as "Well, duh!" a result as I can imagine in that it's incredibly predictable based on what we know. However, these studies, it seems, still need to be done because, as biologically (and physically) plausible as the hypothesis that wearing a helmet decreases the risk of serious or fatal head injuries in the event of a motorcycle crash is, data are nonetheless required.
Motorcycle helmet laws: The Michigan experience
In 2012, the Michigan legislature repealed the state's motorcycle helmet law, a law that had been on the books for 35 years. In its place, the new law allowed riders 21 years old and older who have passed a motorcycle safety course within the last two years to forego wearing a helmet. One additional requirement, which was basically an explicit acknowledgement that this law was going to lead to a lot more deaths and severe injuries, is that helmetless riders must carry an additional $20,000 in medical insurance. This was, of course, almost certainly grossly inadequate, as Michigan AAA pointed out, but was in fact a concession to reality, however weak.
The Brain Injury Association, AAA, trauma doctors, and other groups promoting highway safety appealed to Governor Rick Snyder to veto this misbegotten piece of legislation, as his predecessor Governor Jennifer Granholm had done to two prior bills before. Governor Snyder didn't listen and signed the bill anyway. After a fight that had lasted decades, advocates of "freedom" had finally won based on arguments like this:
Vince Consiglio, president of American Bikers Aiming Toward Education of Michigan, called the law a useless holdover from bygone days.
"Helmet laws have done nothing to improve safety or reduce fatalities or the cost of insurance," Consiglio said in a statement. "I want to extend our gratitude to all the legislative officials and Governor Rick Snyder, who courageously supported freedom in the face of an onslaught of baseless and emotional arguments perpetuated by our opponents."
These claims are, of course, demonstrably false. I'd go further than that. Consiglio's claim is a big stinking load of fetid dingo's kidneys. Indeed, this statement reminds me a lot of the arguments that antivaccinationists make when they claim that vaccines don't decrease mortality from infectious disease, that business interests are what keep vaccine mandates in place, and that their opponents make "emotional" arguments against loosening vaccine mandates. There's also a massive case of projection here, given that arguments from anti-helmet law groups like ABATE rely heavily on appeals to "freedom," much as antivaccinationists and quacks rely on appeals to "health freedom" and accusations of "doctored statistics," again, very much like the antivaccine movement.
So now that the helmet law has been on the books for nearly four years, there are actually data to look at. In the introduction to the study, Dr. Rodriguez's notes that one year after the repeal his group had published the early clinical impact due to this legislative change, noting that although fatality rates didn't increase in hospitalized patients, crash scene fatalities increased significantly, as did intensive care unit stay, mechanical ventilation time, and cost of stay, which was roughly 50% higher. Looking at this pilot study, what struck me was how much the fatalities at the scene increased after the change in law – a more than five-fold jump.
The most recent study by Dr. Rodriguez's group is a followup to that first pilot project. Basically it's a retrospective cohort study examining a seven month period before the repeal from April to November 2011, which was compared to the same seven month period in three years after the repeal. They also collected Michigan State Department of Transportation data to determine fatalities within the western Michigan area covered by Spectrum Health Butterworth Hospital. Looking at the two cohorts, before and after the law change, the most striking differences are two. First, the percentage of unhelmeted riders involved in crashes increased from 8% to 29%, which is in line with an observational study of Michigan riders that found only 73% of them wearing helmets after the law change. Second, the percentage of crash scene fatalities increased from 14% to 63%, though the absolute numbers in this last comparison are small.
Other findings included a higher hospital mortality in unhelmeted patients compared to helmeted (10% vs 3%, p=0.04); a higher injury severity score (19 vs 15, p=0.004); a higher abbreviated injury score (AIS) for head injuries (2.2 vs. 1.3, p<0.001); a lower Glasgow coma score (GCS), which is a measure of consciousness in which a low score is worse (12.6 vs 14.0, p=0.009); percentage of patients requiring the ICU (55% vs. 31%, p=0.001); and percentage of patients requiring mechanical ventilation (24% vs. 12%, p=0.01). It was also noted that a higher proportion of unhelmeted riders were intoxicated in the univariate analysis, but that alcohol intoxication was not a significant independent predictor for any of the dependent variables.
Overall, these two studies are a good first attempt at determining the effect of the repeal of motorcycle helmet requirements in Michigan, except for individuals under 21, and its results are not in the least bit surprising, as the authors note in their conclusion when they characterize their findings as "not surprising" and as reflect "existing literature on the subject." One potential shortcoming is that it would have been useful to examine more motorcycle seasons before the change in the law. Similarly, as the authors note, their hospital's catchment area includes only western Michigan and not the entire state.
So how do we reconcile this finding with the relatively low motorcycle fatality rate observed in 2014? It's hard to tell. Fatality rates and crash rates fluctuate year to year based on a number of factors. None of this stopped ABATE from making an astoundingly numerically challenged statement:
ABATE's president, Vince Consiglio, noted that "helmets don't prevent accidents ... in Michigan, there's more people killed wearing helmets than without."
He sounds even more like an antivaccine activist, doesn't he? After all, that's basically the same argument antivaccine activists make when they point out that most victims in measles or pertussis outbreaks are vaccinated, ignoring the fact that vaccines aren't 100% effective and that if you calculate risk of disease, the unvaccinated face a 23-fold increased risk of, for example, pertussis compared to the vaccinated.
Unfortunately, getting crash statistics out of the Michigan website is maddening because there isn't an easy year-to-year comparison that I could find. Instead I had to manually extract scads of data for each year from 2005 to 2014, the first and last years for which data are published on the website, in order to put together a quick and dirty spreadsheet to look at the numbers. The first thing one has to note is that, for whatever reason, the number of motorcycle crashes in 2014 was the lowest in at least ten years (I know, I went back to 2005), and not by a little. In 2014, there were 2,860 motorcycle crashes; the year with the next lowest number was 2011, with 3,104 crashes. So of course the number of fatalities were down. Just for yucks, I looked at the percentage of fatalities over the years, comparing the period from 2005 to 2011 (before the helmet law change) to the period from 2012-2014 (after the helmet law change, except for the first three months of 2012). Guess what? The percent of fatal motorcycle accidents averaged 3.3% from 2005 to 2011; from 2012 on, it was 3.8%, a 15% increase. Is that real? Is it something that will be sustained? I don't know. In comparison, the percentage of injuries remained roughly the same, 74% from 2005 to 2011 compared to 73% from 2012 on. The disparity between deaths and injuries could be explained by a shift to higher injury severity scores, as found by Rodriguez, or by confounders that are not available in the raw data tables I looked at. Regardless, based on what we know thus far, it is incorrect to argue that motorcycle fatalities are decreasing, as ABATE does. That is not the correct metric. Sure, in raw numbers, they are down, but so is the total number of motorcycle crashes, with 2014 being a year with an unusually low number of motorcycle crashes. As a percentage, motorcycle fatalities are up 15% since enactment of the law.
Even so, the finding of this study is plausible, based on what we already know, and it suggests that the problem might be getting worse. Certainly a study from the University of Michigan also suggests that there's a problem.
Motorcycle helmets versus injury and death
I've compared anti-helmet law activists to antivaccine activists mainly because there is a depressing similarity in the quality and types of arguments they use, which largely rely on cherry picking data and innumeracy. However, there is a fairly large difference between the issue of school vaccine mandates and the issue of mandatory motorcycle helmet laws, which is that unvaccinated children endanger many others while those who don't wear motorcycle helmets endanger mainly themselves. The consequences of many unvaccinated children include disease outbreaks and increased morbidity and mortality. The consequences of having anywhere from 30-40% of motorcyclists not wearing their helmets (which is around how many opt out in states without mandatory helmet laws) include more motorcyclists who die or who survive and suffer severe traumatic brain injury. Thus, the arguments for motorcycle helmet laws are even more prone to revolve around "freedom" arguments than school vaccine mandate laws are to invocations of "parental choice" and "freedom."
In my reading, I discovered some rather interesting history behind motorcycle helmet laws. Motorcycle helmets, it turns out, were worn by racers as early as 1920, but a more interesting tidbit is that motorcycle helmets were more widely worn during World War II as a result of the work of Hugh Cairns, a consulting neurosurgeon to the British Army, who first became concerned about helmet use after he treated T. E. Lawrence – a.k.a. Lawrence of Arabia—for a fatal head injury suffered during a 1935 motorcycle accident. He later published several landmark papers using clinical case reports to show how helmets mitigated the severity of traumatic head injuries after crashes of military motorcyclists.
In the 1960s, after two postwar decades during which the motorcycle evolved into a symbol of freedom and masculinity in the US, the federal government got involved:
The 1966 National Highway Safety Act introduced drastic and unwelcome changes to US motorcycle culture. The law, which was introduced after the 1965 publication of Unsafe at Any Speed, Ralph Nader's scathing indictment of the US auto industry's vehicle safety standards, included a provision that withheld federal funding for highway safety programs to states that did not enact mandatory motorcycle helmet laws within a specified time frame. This provision was added after a study showed that helmet laws would significantly decrease the rate of fatal accidents. The National Highway Safety Act was passed without debate on the helmet law provision.11 Adoption of this measure drew upon a broader movement within public health to expand its purview beyond infectious disease to "prevention of disability and postponement of untimely death."
As a result, between 1966 and 1976, nearly every state passed helmet laws in order to avoid losing federal highway dollars. Oddly enough, the biggest holdout was the state of California, where arguably motorcycle culture was at its most intense, and as a result motorcycle clubs and organizations had developed into a powerful anti-helmet law lobby. Over time, the influence of these groups grew throughout the country. In 1975, Congress revised the National Highway Safety Act to remove the tie between federal road funding and motorcycle helmet laws. Thus began a series of unplanned natural experiments in public health epidemiology showing the effect of these laws:
During the next 4 years, 28 states repealed their mandatory helmet laws. The consequences of these repeals were most succinctly expressed in the September 7, 1978, Chicago Tribune headline "Laws Eased, Cycle Deaths Soar." Overall, deaths from motorcycle accidents increased 20%, from 3312 in 1976 to 4062 in 1977. In 1978, NHTSA administrator Joan Claybrook wrote to the governors of states that had repealed their laws and urged them to reinstate the enactments. She cited studies that showed motorcycle fatalities were 3 to 9 times as high among helmetless riders compared with helmeted riders and that head injury rates had increased steeply in states where helmet laws had been repealed. "Now that some states have repealed such legislation we have control and experimental groups which when compared show that one of the rights enhanced by repeal is the right to die in motorcycle deaths," opined an editorialist in the June 1979 issue of the North Carolina Medical Journal.
For those concerned about public health, the unfolding events were viewed with alarm. In the June 1980 issue of the American Journal of Public Health, Susan Baker, an epidemiologist and director of the Johns Hopkins Injury Prevention Center, compared the situation to one where "scientists, having found a successful treatment for a disease, were impelled to further prove its efficacy by stopping the treatment and allowing the disease to recur."
In contrast:
In Europe, meanwhile, where helmet laws were being enacted for the first time, studies were showing an opposite effect. In Italy, where a compulsory motorcycle helmet law went into effect in 1986, a group of researchers compared the accidents in 1 district (Cagliari) during the 5 months before and the 5 months after the law's enactment. They found a 30% reduction in motorcycle accidents and an overall reduction in head injuries and deaths.
Nothing has changed in 30 years, it would appear. If there's one finding that has been consistent about these laws, it's that, whenever a state mandatory helmet law is repealed, inevitably studies come out a few years later showing an increase in head injuries, death, and medical costs in that state. There is also a strong correlation between repeal of universal helmet laws and a subsequent increase in motorcycle-related death, traumatic brain injury, and disability. Indeed, a 2009 study of more than 70,000 patients from the National Trauma Databank revealed that mortality among helmeted motorcyclists was 3.8% compared to 6.7% among unhelmeted motorcyclists. Those states with partial and no helmet laws had significantly higher mortality than those with universal helmet laws. Its authors concluded, "Unhelmeted motorcycle crash patients suffer more severe brain injuries, consume more resources, and have the worst payor mix. Society bears a large financial burden for these uninsured unhelmeted patients. There is a survival advantage for helmeted patients." In addition, a cross-sectional study looking at national discharge data found that patients hospitalized after a motorcycle crash in states without universal helmet laws are "more likely to die during the hospitalization, sustain severe traumatic brain injury, be discharged to long-term care facilities". There are plenty of other studies showing exactly the same thing across a number of states and countries, so much so that there is a very strong consensus that motorcycle helmet laws save lives.
Moreover, there is growing body of evidence that it is universal helmet laws that save lives. What we in Michigan now have is what is known as a "partial coverage statute," because it still mandates helmets for riders under 21. Such laws are not enough and, in fact, tend to produce results indistinguishable from what is observed in states with no mandatory helmet law at all. For example, a 2007 analysis found that universal helmet laws are associated with a 31% decreased fatality rate among motorcyclists 15-20 years of age. The reasons why this might be true are not fully known, but some have suggested that in states with partial coverage statutes, enforcement is virtually impossible:
While an unhelmeted rider is very conspicuous in a state with universal coverage, enforcement is far more problematic under partial coverage, leading researchers to assume that a partial coverage statute is virtually unenforceable (Branas and Knudson, 2001, National Highway Traffic Safety Administration [NHTSA], 1980, National Highway Traffic Safety Administration [NHTSA], 2002 and Sass and Zimmerman, 2000). Empirical justification for treating a partial coverage law as indistinct from no law is supported by the simple correlational study by Sosin et al. (1990) and a small difference in observed helmet use between partial and no law states (NHTSA, 2004).
Whatever the reason, at the very least, partial coverage laws are not as effective as universal coverage and may not be effective at all. That's where we are in Michigan now.
Personal freedom versus evidence
In a free society, we are faced with questions that balance individual freedom and risk. Which direction we choose to go in depends not just on evidence, but on our values. Public health imperatives can make powerful arguments for limiting certain types of freedom, such as the "freedom" to send one's unvaccinated children to school to endanger other children by facilitating outbreaks of vaccine-preventable diseases. When the person who suffers as a result of invoking his freedom is no one other than himself or herself, it's a little harder to use a public health imperative as a rationale for limiting the freedom not to wear a motorcycle helmet, but not impossible. After all, if not wearing a helmet results in a much higher risk of traumatic brain injury and death, with attendant much higher medical costs, then an argument can be made for requiring helmet use. At the very least, society can invoke the very arguments used by anti-helmet activists to invoke personal responsibility. It can require unhelmeted cyclists to pay more for vehicle and health insurance and impose penalties on those who lie about their helmet use in order to avoid paying extra. Michigan's law does some of that, but not nearly enough. Even its requirement that unhelmeted riders carry an additional $20,000 in insurance, as paltry as it is, has been criticized as a "windfall" for the insurance industry—which, by the way, was very much opposed to Michigan's repeal of its mandatory helmet law, because it knew what the toll would be.
Here's the problem. If the debate over universal mandatory motorcycle helmet laws were an honest one, it would boil down to this. We know that repealing mandatory helmet laws will lead to an increase in unhelmeted riders from around 5-10% to around 30-40%. (One study estimates only 58% now wear helmets in states without mandatory helmet laws.) We know that not wearing a helmet greatly increases a rider's chances of dying or suffering severe traumatic brain injury in a crash, which means an additional 20-35% of riders will subject themselves to that increased risk. We can therefore estimate fairly reliably how many more riders will die, how many more will suffer severe traumatic brain injury, and how much more money they will cost. Let those advocates of "freedom" simply make the argument on those terms and say, "We believe our freedom not to wear a helmet is worth this cost in human lives, disability, and money." Then let the chips fall where they may. One can almost admire Robert Ford, chairman of Massachusetts Freedom First, an auto group that had earlier led a successful campaign to repeal the state's seat belt law, for the purity of the argument he made in the late 1980s against helmet laws, as horrible as that argument was from a public health perspective:
We do not want to be told how to behave in matters of personal safety. We do not want to be forced to wear seat belts or helmets because others think that it is good for us. We do not want to be forced to eat certain diets because some think that it too may be good for us, reduce deaths and medical costs, and make us more productive citizens. We do not want to be forced to give up certain pastimes simply because some may feel they entail any amount of unnecessary risk.
This is the argument. It's not one that we frequently hear in so unvarnished a form. Instead, we have groups like ABATE denying the mountains of evidence that helmet laws save lives using the very same techniques beloved of denialists of all stripes, be they anthropogenic climate change, evolution, or vaccine efficacy denialists, referring to helmets as "self-protection equipment with questionable benefits" and scientific evidence supporting helmet use as "DOCTORED statistics, the misrepresentation of facts, and outright lies used by the safety-crats to support their position." These arguments are used to convince legislators that there will be no cost involved in repealing motorcycle helmet laws. If those favoring repeal of mandatory motorcycle helmet laws were really in favor of personal responsibility and freedom, they'd happily admit the danger of what they're doing in the public debate over these laws and insist on provisions forcing motorcyclists who choose to go helmetless to pay the true cost of their decision.
I won't hold my breath waiting for that.
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You're a brave man, posting that here.
My thoughts are the same as at that other blog: riding without a helmet is a lot of fun but dangerous, and you have to ride at the time of year when there are no flying bugs.
Your last sentence, in its tacit acceptance of helmet freedom laws under the condition that the helmetless "pay the true cost of their decision", obliquely admits that there is a difference between helmet-freedom activists and anti-vaxxers: the former are not actively endangering the lives of others in their assertion that they have the right to endanger themselves.
I don't see much of a difference between this and drug legalization advocacy: the belief that people should have the freedom to decide what to put in their body, what to do to their body, etc. etc.
So I offer the following thought experiment. If you actually believe that every single person should be responsible for themselves to the fullest extent:
* If you ride a motorcycle without a helmet, you have to either have insurance sufficient to cover your entire medical costs, or can pay for it out-of-pocket, or you will not get treatment.
* The same applies to lung cancer treatments for anybody who started smoking after, say, 1986 (we'll make an allowance for people who started before it was firmly established in the public eye that it was as unhealthy as it is - I know, I know, 1986 is extremely generously late in that respect)
* The same applies to anyone who does drugs of any kind
* The same applies to people who don't wear a seat belt
* Etc. etc.
* Needless to say, none of the people in the above list can have their injuries or illnesses covered by any government-run or government-subisidied health insurance program
That would be an interesting society to live in...
In rereading my previous comment, I realize that it came out far more in favor of the thought experiment than I intended. So let me hasten to add right now that I *don't* think it's a good idea.
@ Yerushalmi
Unhelmeted riders may cover medical costs by selling their organs.
Helmets are just half of the story. I see a lot of bikers in The States who do not wear protective clothing as well. If you turnover your bike while wearing jeans and a shirt you are going to have your skin and musculature replaced with asphalt!
I have an uncle who did so while wearing a padded leather suit to protect him, yet he still got torn up by sliding across the road. I wouldn't dare to imagine what would've happened had he not been wearing it...
ABATE "...noted that “helmets don’t prevent accidents...". The European study "...found a 30% reduction in motorcycle accidents...". I find the later surprising, I would have expected a slightly lower accident rate where riders do not wear helmets as they will feel more vulnerable and so ride slower. I think on this one measure ABATE are probably technically correct. Of course the accident rate is totally different to the fatal accident rate, or the rate of disabling injuries. Not wearing a helmet is Darwin Award candidate behaviour.
I do think the ethics are interesting where the only party directly impacted is the rider, to what extent should the effects on health costs and the families of crash victims be considered? Should riders who choose not to wear a helmet have to get signed permission from their next of kin?
Searching "Arizona motorcycle helmet laws" shows where I reside has a similar age-based motorcycle helmet laws. Similar, but worse in that a motorcycle helmet is legally required for under 18 years of age. This is depressingly similar to Arizona's bicycle helmet law (bicycle helmets required for under 18 years age only). Whenever I have a family with kids riding bicycles (which is most families), I review (at well visits) the Arizona bicycle helmet law and remind parents that seat belts are important (and required) in the car and that helmets are like a seat belt for their child's head on a bicycle. I've only had two patients (teens) tell me they were ticketed for not wearing a bicycle helmet while on their bicycles, and given how many children I don't see wearing bicycle helmets, this tells me the law is not often enforced (but how to you ask a 10 year-old for ID, anyhow?).
The arguments made by those opposed to motorcycle helmets are depressingly similar to those opposing vaccines. At least I don't see "anti-helmetationists" claiming vast global conspiracies to spread cancer, sterility and death by mandating helmets. And I think it's fair to say no one is worrying about "herd immunity" levels for motorcycle helmet wearing. Not a whole lot to cheer about, but better than vaccine deniers.
This all reminds me of a bumper sticker now rarely seen but still very applicable: "You can't fix stupid". Sometimes you can't, but we humans can learn, so try we must.
#6 - Perhaps it is down to the kind of bikers; those who are willing to have helmets "forced" upon them are perhaps more likely to be cautious drivers by nature whereas those who are willing to forgo helmets are more reckless and accident-prone?
#8
Possibly. My brother refuses to wear seatbelts while driving, regardless of any laws to the contrary. I'm quite convinced that the reason he won't is because there is a law. Despite the fact that he's closing in on 70, he is still a bratty little boy in some ways. If you tell him he's not allowed to do something, that is the thing he will do.
He also curses loudly at bicyclists who don't stop at stop signs or who violate other traffic laws. I know he doesn't really grasp the irony.
@Amethyst and ProhJohn, I can think of another good reason why not wearing a helmet could cause fewer accidents. Wearing a helmet, particularly a full-face one, can restrict your vision, thus making accidents slightly more likely.
I'm not a motorcyclist, but if I was, I'd still take my chances will a full-face helmet.
WITH full face helmet.
**sigh**
@Julian: I don't know about South Africa, but in the US motorcycles generally have rear view mirrors, for the same reason cars are so equipped. (There may be some antique motorcycles that don't, as there are antique cars that don't.) That should compensate for any loss of peripheral vision that a full-face helmet might cause.
There is also a matter of training. Commercial truck drivers are used to the notion that they have blind spots, and make sure to check these blind spots before changing lanes. The same should be true for motorcyclists wearing helmets: they learn to adjust their driving habits to make sure there is no vehicle in the neighboring lane before changing lanes. At least the ones who persist in driving motorcycles do; the ones who don't tend to give it up soon after being in an accident.
@ #4
Selling organs? Tasteless, even for you.
The link between intoxication and no helmet use may reflect an inability to assess hazards.
Wearing a helmet, even a full face one, has a marginal affect on necessary perception. A good helmet doesn't cut down peripheral vision that much. Plus, with wind doesn't cut across your eyes and make them water when you turn your head. Also, at 60 mph, a bug splat to the face is very distracting.
#14 - Not to mention painful/potentially dangerous. I wonder if the Mythbusters have tested the impact of a decent-sized bug hitting your face when going highway speed... I remember them testing a slushee against the windshield of a car and the results were terrifying.
Eric Lund, I was talking about peripheral vision. A full face helmet cuts your field of vision by over 60 degrees.
@ ProhJohn
I'm not so sure. We have seen or are seeing similar arguments against seat belt, condom or anti-HPV vaccines: the idea that, because people are feeling protected, they are going to engage in more risky behavior.
I always thought this argument was only looking at one side of the issue.
For one thing, humans tend to stick to a pattern of behavior. Most will put their helmet on and simply keep driving the way they were driving before. Feeling their head is protected doesn't mean they suddenly relish the idea of scraping the hull of their vehicle or of breaking a leg.
Also, putting on protections is a ritual, a break between that you were doing and that you are about to do. As such, it may enhance the awareness of the risks the driver is about to take. I don't think that a soldier doning his armor is really thinking himself invincible. He won't last long, this way. His thoughts are more likely focused on him about to get out and being shoot at.
tl;dr: for every one who takes more risks out of a feeling of being protected, I am pretty sure there is at least another one who will take less risks because of being reminded of being vulnerable.
And most will simply keep doing that they were doing.
If the protective item is any good at it, the latter two groups will benefit the most from it.
@ Julian Frost
That is indeed something to look for when choosing one's protective equipment: to acquire something which will actually help you, not hinder you.
In my country, mountain guides were complaining a few years back about tourists going hiking in the glaciers with plenty of equipment, but without really knowing how to use it. In their cases, the argument of people taking risks because of feeling protected was accurate. It's not just the equipment, it's also how you use it.
Mind you, the same guides would not have thought any higher of these tourists if they had come without equipment.
I've been a rider since 1969... Pretty much every kind of bike there is - dirt, supersport, cruisers, sport-tourers, whatever. IMHO, anyone who rides without a helmet is working on a Darwin Award. I wear a top of the line, full face, helmet, and leathers whenever riding. Having seen some of the late grease spots on the road, I wish every had the sense to do the same.
I'd modify Yerushalmi @1's suggestion and make the condition for riding without a helmet be that you must carry insurance that provides for lifetime care with total disability. The policy must explicitly include unhelmeted motorcycle riding as an activity that is covered.
And if you're caught riding without a helmet and without the insurance, your motorcycle is confiscated and sold at auction. No pussyfooting around.
We saw a similar phenomenon around here in the early days of hand-held GPS devices. People would bring their GPS devices with them on hikes in the White Mountains, get lost, and have to call for a rescue. They could tell the people staffing the call center exactly where they were, but they had no idea how to get to a trailhead, let alone the one where their car was parked. That problem was solved, as I understand it, by imposing a fee on being rescued (the fee was waived for cases of actual injury or medical emergency, so that people who really needed a rescue wouldn't be afraid to call for one).
More recently, there were cases of people making wintertime drives through Oregon's Coast Range following the advice of their GPS systems to use US Forestry Service roads, which usually aren't maintained for winter use.
My original point is that people who are properly trained, or have the ability to adapt their thinking, tend not to fall into these kinds of traps. If you learn to drive a motorcycle with a helmet on, you learn that there are spots that are harder for you to see, and you adjust your driving habits accordingly--just like commercial truck drivers get used to checking the blind spots. According to the OP, the Michigan law includes a requirement to have had a motorcycle safety course within the last two years, so presumably novice motorcycle drivers are still required to wear helmets, at least until they have taken the course, even if they are over 21.
I don't know about Michigan, but in New Hampshire there is a separate endorsement on the driver license for operating a motorcycle. We probably don't require helmets in this state--we don't even require adults to wear seat belts (they are required for passengers under 18), and I know that we didn't have a helmet law as of the mid-1990s. But I haven't looked up the relevant statutes, so I'm not sure.
To ride without wearing a helmet is the epitome of selfishness, not just to the family that must care for the TBI survivor (for a lifetime), but to society in general (cost).
I have a friend who's son suffered a TBI while riding his crotch rocket in LA. He was wearing a helmet, too. The before and after pictures were startling. After literally thousand of hours of physical and mental rehab, the kid was maybe 30% functional and barely able to care for himself. He ultimately succumbed to his injury- after years of what must have been agony for his family.
And the cost? Had to have been millions...I'm all in on helmet laws.
Here's my sticking point with regard to helmet laws. There is no doubt that they save lives; but if saving lives is truly our primary goal, then why are motorcycles legal in the first place?
This very article links to a study showing that motorcycles are associated with a 27-fold increase in fatalities. Whereas repealing helmet laws appears to result in something less than a twofold increase on top of that. It isn't riding a motorcycle without a helmet that is dangerous; it is riding a motorcycle, period.
What is the justification for restricting our freedom this much, but not that much, in the name of protecting us from our own bad judgment?
@Dan - the same reason why, even though cars kill lots of people every year, they are legal as well....we, as a society, have made a decision that transportation is important and why have very few restrictions on what can and cannot be used on the roads.....
It's cool you're asking these helmetless riders to pay their own way but I'm opposed to singling them out. I've been driving for 30 years and have yet to have been over the legal limit for alcohol. I can truthfully say that I am tired of paying for that societal cost as well.
I agree wholeheartedly, Julian Frost #10. Not only with peripheral vision but also reflexive, timely 'twitchy' yet accurate movements of the head, neck strain encouraging one into a downward looking posture where the wind balances, the 100 Hz droning drowning out the changes of ingress of sneaky vehicles in multi-lane traffic -- There is, invariably, a limiting of situational awareness thus limiting of perceived options to take in the event of an impending collision.
Ahh; But there is a learning curve, Eric Lund #12. Personally, I would curently choose to wear a full-face Shoei but there was initially a sense of disconnection from elements of traffic with attendant lack of self-confidence/trepidation of action. It was quite unsettling how *incompetent* as an operator of my ole', familiar KZ1300 I suddenly felt.
This is not usually a problem which arises from cyclists themselves (it is invariably the car that blindly switched into a non-cleared lane). Helmented, or not; I suspect you have never ridden.
I'd guess that there are technological solutions, these days -- Perhaps a camera-based wide-angle 'rearview' hud inside the helment, or something. That would still be an extra layer of not-quite-natural for the brain/triggered 'muscle memory' to learn to filter through for the tech to be useful.
I commiserate with those who have received an open-face bugspat and concurre that bugs, rain, sand, dumptruck soil, and haystraw can also be quite the impediment to awareness -- I once had a little honda custom 250 belt-drive which would top out at 86 mph downhill in a hurricane. My helment was of the old dirtbike open-face variety where I'd also cut out the chinguard to facilitate using wet snuff. There was no faceshield; When the preying mantis bisected on the bridge of my nose and frantically pawed at both my ears... It's a good thing that gyroscopic forces can keep the thing upright even though my hands were busy removing my helment .. coming into a curve at the top of a hill did not help much.
But there are 'situations' where I'd absolutely feel endangered by being forced to wear a helment. A lonely flat-country road with nothing but cornfields on either side, for instance; You didn't see the diesel slick through the glare on your faceplate so now your flying off through the cornfield where the helment's lower chinguard bill decided to pretend it was a plow and plopped off your head while doing so.
===============================
I would submit that there is a much deeper problem with cycling -- Relentless law enforcement conditioning.
In the south, there is a highly disproportionate number of power-trippin' Bubbas which, due to morning sexual tension with his siblings, just can't help but feel up his oats a little more by harassing bikers.
No matter the good judgement of the cyclist, cognizant that it is usually interaction with traffic which leads to a bad trip, they are whipped into line as soon as they are two miles an hour over while maneuvering away from the pack -- Cyclists are targed by cops and always have been.
Helments?? The cop makes you take that off anyways while he's doing the farcical safety lecture as the now-relatively high speed steel and glass blows on by down the road.
You know? It occurs to me that
Perhaps, it is just as prudent to charge the conventional motorist more for his insurance until he takes a motorcycle safety course to, at least, be instructed on how to see motorcycles:
http://articles.sun-sentinel.com/2013-03-09/news/fl-finding-fault-in-mo…
Dan Welch @23 -- While the relative increase in risk involved in riding a motorcycle is very large, the absolute risk is still not enormous. Practically the whole population seems to be in their cars all the time, and about 30,000 a year die in auto accidents -- a horrific toll, but out of a population of 300,000,000 the annual fatality rate is of order 1 per 1000. You can of course make that significantly lower by driving very carefully (though of course one must realize that it's only a comforting illusion to think you're entirely in control).
Some people just love motorcycles so much that it's a risk they're more than willing to take.
Incidentally, about cars, and driving, I tell my kid in the winter that 30 mph looks pretty slow until you're doing it sideways. Then all of a sudden it's terrifyingly fast.
I'd be curious to see if there is an impact on patient admissions between states with mandatory helmet laws and states without. If there is an increase in the number of severe head injuries when there is no helmet, I would imagine that would translate to fewer hospital beds available for other cases. Would patients get turned away or diverted from closer hospitals because there isn't space?
Perhaps the number of incidents is low enough that it doesn't have a significant impact on bed availability, but it would still be interesting to know the impact on other patients.
@Dan: First, simple physics dictates that in a collision between two vehicles of vastly different size (say, a car and a motorcycle) the smaller vehicle comes out much worse. The extreme case of this is accidents involving pedestrians: at speeds up to about 30 km/h the pedestrian is likely to survive, but at higher speeds the probability of the pedestrian dying rapidly approaches 1. This is one reason why pedestrians are not allowed on motorways (except in emergency situations), but we don't prohibit pedestrians on other roadways. Some states, including New Hampshire, require motorists to yield to pedestrians in crosswalks. Many non-US countries will automatically assign fault to the driver who hits a pedestrian.
Second, if you are in a car you have a half ton or more of metal protecting you. This won't always help if the crash is sufficiently severe (e.g., hitting a moose at motorway speeds is almost always fatal to the driver as well as the moose), but it's more protection than a motorcycle offers (i.e., none). The same issue applies to bicyclists, who in New Hampshire are not allowed to use the sidewalk (at least if they are over 12).
I don't see any justification for allowing pedestrians and bicycles on roads but not allowing motorcycles. You can make a case for banning motorcycles on motorways, since pedestrians and bicyclists are prohibited on such roads--but the usual argument is that since motorcycles can maintain minimum speeds (typically 40 or 45 MPH in US states that have minimums; 60 km/h for European motorways) they should be allowed. Bicyclists usually cannot maintain these minimum speeds.
I won't ask how you know this, and I don't have firsthand experience with it either. But there was the snowy evening, when I was a passenger in a van coming north from Logan Airport, that I saw a car spin out on I-95. Starting from the second-from-right of four lanes, he went in front of us, bounced off the barrier in the median, and then slid in front of us into a snowbank on the right side (luckily without hitting another vehicle). It was not obvious what he had done to precipitate that spinout, which must have been terrifying for anybody in that car--it was bad enough to watch.
Amethyst @15. The Mythbusters did test if an insect can kill a motorcycle rider. It was plausible, if a goliath beetle hit an unprotected throat. h__p://mythbustersresults.com/bug-special
The one time that I spun out (on Lake Shore Drive), it was more of a slow-motion perception.* Fortunately, it was late and there was very little other traffic – just enough for three guys to pass by and help push me out.
* Same thing another time when some guy tried to change two lanes to the right and emerged without warning from in front of a semi. I managed to thread the needle between him and the guard rail and only sheared off the side-view mirror.
Let those advocates of “freedom” simply make the argument on those terms and say, “We believe our freedom not to wear a helmet is worth this cost in human lives, disability, and money.”
Okay.
The government isn't your mommy, and it shouldn't have people with guns making you make "safe" personal decisions; the only person directly injured by your lack of helmet is you.
(If one wishes to make the argument that they shouldn't be allowed to because their family will suffer, well ... it's hard to see how that doesn't extend to "riding a bike at all" or anything someone else thinks is Too Risky.
No. Just, no. It's not anyone else's damned business.)
It's not vaccination, where a stupid decision hurts innocent third parties; people's lives are their own to risk with stupidity. If they don't own themselves, they own nothing at all.
(n.b. I say this as someone who knows people who've died in motorcycle wrecks, and who views riding one at all as basically insanely dangerous, and does not.)
You know? I've always respected that sticker on my wheelbarrow which proclaims "Not for hiway use!". Doing so makes me feel like a pussy.
Gilbert,
If it displays "Not for hiway use", I think the manufacturer needs a better legal department.
Eric -- I 89 mile 22 near Warner, deceptively icy, touched the brakes at 35 mph to check the surface and instantly lost control. Hit a snowbank going backward after scrubbing off most of the speed, and suffered nothing worse than a broken tailpipe. Cheap, cheap lesson.
And hey, I can maintain over 45 mph on my bike! Just give me an unending 12 percent grade and a slight tailwind. I'm thinking Lost River up in the Whites.
Sigvald @33. I have some sympathy for the Libertarian argument about helmet use, except for the fact that a person with serious traumatic brain injury -- who doesn't die outright -- is going to cost society a huge amount of money over their remaining lifetime, unless they carry insurance to cover the horrendous costs. I'm not an actuary, but my guess is that insurance sold specifically to cover lifetime disability due to helmetless riding would be very, very expensive.
I've taken to calling extreme Libertarianism "The New Irresponsibility" -- if more Libertarians accepted arguments like this one, I might be a bit more receptive. But probably only a bit.
A gentleman I work with, needing a second vehicle for his expanding family and wanting to save money, got a motorcycle. A coworker offered him a helmet to use until he could buy his own. That weekend he took it out and wound it out. While going around a long sweeping bend something happened. It might have been a blowout of the front tire. He ended up doing what he described as skydiving through a pulpwood plantation.
The end of a heavy branch hit the faceplate almost straight-on like a spear. It deeply grooved and creased the faceplate before deflecting off to the side. And then he hit a trunk tree with the crown of the helmet.
He was knocked unconscious and woke to see what he describes as 'big country guys in camouflage leaning over him'. He describes imagining the tune of Dueling Banjos playing as he remembers that he is in a deeply rural area, by himself, completely at he mercy of big southern boys.
As it was, the man and his boys had been hunting in the woods when they heard what they as a crashing noise that just kept on going. They found the mangled bike and followed the trail of broken trees to where a man, bleeding and with an obviously broken leg lay with his head still inside a helmet that was completely split in half. At first they thought he had to be dead.
When he moved the man sent one of his sons to go get their truck. They gingerly got him into the truck bed and drove him to a local rural hospital.
As it was he was diagnosed with cracked skull, compressed vertebrae, concussion, leg broken in three places, and several cracked ribs.
After their ambulance run the country boys went back and collected the pieces of the motorcycle and helmet. The cycle was mostly parts. The helmet didn't survive. It was split in half from the crown and the faceplate was deeply grooved, scratched and dented but it kept him from being impaled by a branch and having his head splattered on a tree trunk.
The next day they delivered the wreckage to my friend's house. Monday my friend's wife showed up at starting time with the destroyed helmet in hand. She wanted to meet the man who had loaned him the helmet and thank him for saving her husband's life.
It took weeks for the leg and bruises to heal but after twelve weeks he was ready for light work. He has another bike and always wears a helmet.
"Donorcycles"? HA! Back in the day, when I worked in the ED of an inner-city hospital (San Bernardino, CA), we used to call them "Murdercycles"! At the time, I lived in Fontana only about a mile from an infamous "Hells Angels" hang-out bar.
Close relative was a pilot of student and he was visiting control tower with other students. It was April. Air traffic controller said: "Liver-exchange-weeks have now begun." Student's didn't get it, so air traffic controller explained theirs inner circle wisecrack.
Here in Finland icy roads melt and dries in April and so all motorcyclists take their bikes out of carages and ride on roads. Crashes rise sharply and so also organ donations too.
Air traffic controllers have to give highest priority for those planes or helicopters that transfer organs.
I've told this true story many times for some bicyclist in live and internet forum and I can see they are thinking/abashed ;D
I think there is a continuum with taking foolish risks at one end and taking incredibly stupid moronic risks at the other, and while the libertarian argument makes some sense to me there are people who need to be protected from themselves to protect the rest of us (See the effect on highway deaths when drinking age was raised to 21.).. But if you take moronic risks, you should make provisions that protect, or at least indemnify, against the costs to everyone else. After all, don't libertarians believe in "strict liability"?
I am reminded in all this of something I heard a veteran say that is kind of applicable here: "There are old Rangers and there are bold Rangers, but there are no old bold Rangers."
And can motorcycles kill others? Take a look at this link:
http://www.snopes.com/photos/accident/seemotorcycle.asp
Do they? In any case, "everyone else" is not a viable civil plaintiff as far as the term of art is concerned.
#32 - Aha, interesting. Goliath Beetles are some amazing behemoths. Thankfully the odds of hitting one seems miniscule at best!
@Daniel Corcos: I love it! :)
(Incidentally, am I the only one for whom the "Notify me of followup comments via E-Mail" checkbox appears to do nothing?)
Yerushalmi,
Nope. It does not work for me either.
@Not a Troll: Scandalous.
@ Yerushalmi
Thank you very much. Apparently it was tasteless for Janet :-(
Yet I have it on the authority of a grifter by the name of Mike Huckabee that “Harvesting human organs is beyond barbaric, it’s unimaginably grotesque and evil”.
Will no-one else speak out against the horrors of organ donation??!
@ HDB
https://www.youtube.com/watch?v=aclS1pGHp8o
That's why I always put my helmet on.
Here in Finland icy roads melt and dries in April and so all motorcyclists take their bikes out of carages and ride on roads. Crashes rise sharply and so also organ donations too.
This story totally confirms all my stereotypes about Finns, so therefore it MUST BE TRUE.
Suddenly I am craving a nip of Lakka.
I have no problem with organ donation. I have a real problem with selling organs for donation.
@janet: I have no problem with organ donation. I have a real problem with selling organs for donation.
I have no problem with people selling their own organs (i.e. a kidney). And I have no problem with Planned Parenthood being compensated for tissue storage. Since PP has been found to be innocent of any allegations brought against it, even by a hostile grand jury, I think we can all call those videos that claim PP sells organs as bunk.
I *do* have a problem with people selling their own kidneys, because money corrupts. Seriously. Already there are people in desperate need of cash who are lying about their medical history in order to sell their plasma; we don't need that happening with organ donation as well. And then there's the predatory aspect. In countries where this is legal, there are people taking organs from people who don't really understand the implications, but who understand that they will get money.
Amethyst @43. Yeah, goliath beetles are monsters, for sure. Considering they're only native to African tropical forests, I wouldn't be worried.
@Calli Arcale: put that way, I agree with you. I was, unfortunately, thinking that if I needed to, I would be willing to sell one of mine. But then, I'm a well-educated, adult woman. I didn't go beyond those implications to coercion or desperation. Boo for my being thoughtless.
Narad, go to the link below, which I think gives a good critical overview of libertarians. I don't always agree with Prof. Dutch, but even when I don't his opinions are worth reading.
SteveJ, there are Goliath beetles or something very much like) in the Negev. It is quite an experience to be in a small room and have one come in and fly around the ceiling light; fascinating and frightening at the same time.
http://www.uwgb.edu/dutchs/PSEUDOSC/NoLibert.HTM
Almost twenty years ago, at end of a trek, in Nepal I read about a proposed law change in India. The change in law that was proposed was to allow people to sell any of their organs including their heart. I don't know if this was every done but it was proposed as an economic aide to the very poor.
^ I think it was a 60 minutes spot where I saw a report on the poor (mostly women) who had sold one of their kidneys for money and how they were suffering the health complications years later from having only one kidney. IIRC, the buyers of the kidneys were mostly British.
Goliath beetles may not be much of a threat to your average rider here in the States, but -
Back when the 17 year cicadas were flying around, I was driving down the road at about 45 with the windows down, enjoying a beautiful sunny day, when one came in the window and hit me in the center of my chest, just where the shoulder belt comes across. The cicada exploded all over my chest and up under my chin (they are cream filled, I swear).
I had to turn around, go home and take a shower to feel clean again.
http://money.cnn.com/2005/01/06/news/funny/warning_labels/
Not a Troll #35, once you walk into Bed, Bath, and Beyond and see that ugly warning wrapped around the otherwise beautiful toilet brush with the pink, pearlescent handle and bright blue indicator strands interspersed amongst the soft, pastel, and genuinely pleasing to the eye brush, you realize that lawyers are all for naught as people who would scrub their butthole with this cheap, plastic crap are overwhelmingly illiterate to begin with -- After seeing this, one swiftly arrives at Nirvana and abandons all care of the inevitability that it's going to be Clintons and Bushes all the way down.
except for the fact that a person with serious traumatic brain injury — who doesn’t die outright — is going to cost society a huge amount of money over their remaining lifetime, unless they carry insurance to cover the horrendous costs
So either refuse to treat people who do knowingly stupid things, or make bikers have insurance to cover their expenses on others.
(The latter is libertarian enough, given the unlibertarian "we're going to take care of you no matter how stupid you are".
[Nozick explicitly makes an argument for liability insurance on the grounds of risk to others in ASU, and you can't get more libertarian than Nozick.]
The problem with extending that too far is eventually we end up with "we're going to enforce that you exercise and eat what we say is healthy because otherwise your poor health costs us too much", which would be a ridiculous strawman except for people saying it over and over as a facially serious suggestion whenever the downside of "take care of everyone forever" comes up.
Which is ... a totalitarian outcome, even if a completely well-intentioned one.
But that's the entire problem with trying to take care of other people - you end up being their mommy, either in the controlling way or the walked-all-over way.)
I still think, to make the best of a bad situation, states that do not require motorcycle helmets should have opt-out organ donation programs.
No one is forcing anyone to wear that helmet or to donate their organs (after their death), but maybe it would reduce some of those waiting lists.
"Back when the 17 year cicadas were flying around..."
I used to get the creeps when they would fly into my hair but your story tops that for the grossness factor.
Now that I am not outdoors so much, I do sort of miss the little buggers (and fireflies too)
Which is … a totalitarian outcome, even if a completely well-intentioned one.
It's all good until they step on your insert-risky-behavior-of-choice-here. Which is why I mentioned drinking and driving. Many otherwise respectable people do this and though the laws have been strengthened if you've ever been to an office party you can see it is still quite common.
I'm not evening talking about libertarianism; I am referring to logical consistency in condemnation of behaviors.
^ even not evening....sigh.
If you want to see libertarianism carried to an extreme you must read this:
http://volokh.com/2011/02/15/asteroid-defense-and-libertarianism/
Hmm, I always thought libertarianism gone wild was like this
http://m.imdb.com/title/tt0078446/
In those states with partial helmet laws (optional if over 21—compulsory if under 21) the problem of enforcement can be handled easily by the issuance of different color license plates for those under 21. This would make it real easy for patrolpersons to tell at a glance if a rider without a helmet was legal.
In the same manner those over 21's wishing to ride unhelmeted could purchase another color plate along with required excess insurance for projected medical costs. Those always riding helmeted would probably receive less unwanted attention from law enforcement as well as fewer risks to life and limb.
If you want freedom, you must pay the price.
Re: the cartoon above. I wonder when Governor Snyder is going to make the ingestión of lead-laced wáter optional. Is this more of Republican "small government?"
I think motorcycle statistics go up and down because the age of the population varies; there's some evidence that as people get older, their transportation preferences change.
Both of the severe motorcycle accidents my husband was involved in were the fault of drivers pulling out of a side road right in front of him, too close for him to stop safely. Both times his helmet and leathers protected him, including when the water truck started to crush the back of the bike, with his leg still stuck underneath (he's lucky that way).
And it's not just severe TBI; mild TBI can result in a long period of expenses and care as well. Personally, I think helmets are a public good, just like vaccines. I had to get used to using a seatbelt in the rear seats of a car, but you really only need one experience where you almost fly through the windshield from the back seat to remember to put it on.
@ JeffM #22
"To ride without wearing a helmet is the epitome of selfishness, not just to the family that must care for the TBI survivor (for a lifetime), but to society in general (cost)."
Unhelmeted riders pay their fair share to society with free organs.
Sigivald@61
The first one is wholly unethical not to mention impractical. Where is the line that something is stupid enough not to treat?
The second makes sense but would be impossible to enforce. Making sure all bikers wear helmets is infinitely more practical than making sure all unhelmeted bikers has proper insurance.
I think this is where the major difference between this and say diet and exercise. Things like weight or certain conditions can tip insurance companies off it someone is lying about activity and diet. Some employers are now monitoring steps (on a voluntary basis) and offering reduced premiums for employees who hit a certain number. Smoking or drinking can likewise be monitored (I know life insurance companies will sometimes do nicotine, alcohol and/or drug testing of applicants).
However, for riding without helmets the insured could lie about it and the insurance company would likely only find out in the case of an accident, which is likely too late. Point being, this is not a case where the free market would be an effective regulator. Rather, it is more likely that insurers hike everyone's rates in order to compensate for the huge but mostly undetectable risk that helmetless riders pose to them.
But beyond that, it is not simply a financial drain on society (though that is the largest problem):
In this way it is truly a public health issue as your right to make poor decisions appears to be associated with in other demographics as well. It's possible that something Jockaira's suggestion in #68 could help with this issue but it's also possible that theory of what causes this decrease is wrong and such an intervention would have no effect.
Either way, I believe that the financial argument is good enough on its own.
Not a Troll@64
Not sure where the inconsistency is. Legal penalties, public awareness campaigns and at least in my experience societal condemnation are all much strong for drunk driving. Which makes sense as it is a much greater risk to society in general.
But no helmet laws means that if people lie to insurance companies society foots most of the bill, whether through increased premiums or state funded care. At least drunk drivers can be pulled over before causing an accident which together with a history of alcohol related problems or even mandated testing by the insurers at least gives them a shot at preempting the problem.
tl;dr
Without mandatory helmet laws and the resulting tickets providing a paper trail, it would be next to impossible for insurance companies to catch people who lie about this ahead of time. Since the market cannot put financial pressure on people who engage this potentially very expensive behavior, society is left with the resulting financial burden.
Daniel Corcos@71
Also tasteless.
@ Capnkrunch
I don't know if it is possible to lie to insurance companies in case of head trauma. Concerning my post #71, you may find it tasteless, but it was more serious than my post #4. The overall cost for society is not as obvious as you say it is.
capnkrunch@72
Not sure where the inconsistency is.
It is not an inconsistency in legislation. It is in attitude. It is much like your point about it being unethical not to treat someone. A someone whose risky behavior caused or allowed the damage to themselves to occur.
I just have a hard time when people starting pointing fingers on what society is going to pay for as far as health care and behaviors when with few exceptions we all engage in some type of risky behavior. Ones we may not even know about at the present time.
In case it's not obvious, my mention of bravery in #1 was in reference to comment counts.
The number here ended up respectable, so I hope you continue to broaden your horizon.
The phrase "evolution in action" comes to mind.
Solution: externality taxes and externality fees.
Taxes and fees on externalized costs that would otherwise be imposed on society at-large, to nullify the cost. For example divide the total cost of smoking-related illnesses by the total quantity of tobacco sold, use the revenue to treat smoking-related illnesses, thereby zeroing-out the net cost to society at-large.
As applied to motorcycles & helmets:
Two colors of MC license plates: one for "required to wear helmet," the other for "not required to wear helmet." (Credit to Jockaira @ 68 for this!)
Requirement that license plates be highly visible on MCs, unlike current practice where some models of bikes seem almost deliberately designed to allow effective concealment of license plates.
Substantial difference in registration cost between the two types of plates (helmet and non-helmet). The cost of each type of plate pays for its related MC injuries. The difference in cost between them, pays for the cost of added injuries to non-helmet-wearing riders.
Riding non-helmet on a helmet-only plate incurs a traffic ticket with cost 2x to 4x the yearly cost of a non-helmet plate.
Some portion of the ticket revenue is distributed directly to jurisdictions in accord with the jurisdictions of the officers who ticket the riders. This provides a high incentive for enforcement (and we could correspondingly make parking tickets less vicious but that's another issue for another day).
Net result: All medical costs of MC crashes are "internalized" to riders rather than externalized to society. MC registration cost reflects cost of actual risk. Ticket enforcement incentivizes appropriate registrations.
Per my "smoking-related costs" example, this template can also be applied to tobacco, alcohol, high-risk foods, high-risk sports (e.g. mountain climbing gear), and so on.
And, it sets the paradigm for a tax on the most dangerous externality of all, carbon emissions.
=====
Not A Troll @ 25:
Alcohol is a factor in roughly half of murders, suicides, and auto fatalities, and roughly 1/3 of rapes (rapist is drunk and/or gets victim drunk), and probably half of MC fatalities. Not to mention pandemic spousal and child PTSD from violent alcoholic rampages. So, darn tootin' those costs would all be compiled into the alcohol externality tax.
The fact that "moderate" drinking _may_ have health benefits is irrelevant; an "occasional" cigar won't give you cancer either, but the total taxes paid by the "moderate" drinker or "occasional" cigar smoker will be proportionally lower, and neither has any rational basis to complain.
capnkrunch @ 72:
All that "monitoring" of exercising, smoking, drinking, eating, pooping, and scratching your derriere, is the hallmark of a totalitarian society. My externality tax proposal achieves the same result of nullifying the costs to others (including to insurers), without the relentless spying and stalking, and the coercion that goes along with. As for "whether you walk enough," that's straight out of the movie _Brazil_ with its combination of tyranny and absurdism.
You really do not want to live in a world where the number of steps you take each day is counted and tallied and subject to reward & punishment. In any case, it'll be tied up in lawsuits from advertisers who want to mandate your daily required number of ad exposures. Or they'll mandate that you wear earphones while walking, to be able to deliver the ads. But hey, the New Orthodoxy is that free will does not exist, except for Alpha Oligarchs who get to impose their will on everyone else, so just shut up and do as you're told. "Everything that is not forbidden is required."
And no, government has no more right to tax or penalize "sin" than it does to protect "sanctimony," see also the old arguements against gay marriage based on "protecting the sanctimony of marriage." Yes, they really said that. My externality taxes would replace "sin" taxes entirely, and replace the entire complex of social opprobriums, stigmas, and similar emotional nonsense, with a simple rational cost equation for each activity. This will also have the effect of thwarting the opposite pole of recalcitrant defiant attitudes, replacing them with rational calculations as well.
When a cost difference adds up to something tangible such as the equivalent of a nice vacation, people will tend to give up their bad habits of their own rational free will. And that's what we want: a society of intelligent people acting wisely of their own free will, rather than a society of stupefied drones who are relentlessly monitored and herded about, like so much livestock.