Austin to Evaluate Local Emergency Room Data to Determine Whetheror Not to Implement an All-Ages Hel

[Ozark Bicycle]

[email protected] wrote:
> Ozark Bicycle wrote:
> > Bill Sornson wrote:
> > > [email protected] wrote:
> > >
> > > > My guess is the typical ER physician literally thinks bike helmets
> > > > prevent almost all head injury - that is, 85%. He doesn't know that
> > > > there is real scientific doubt about their effectiveness.
> > >
> > > Boy, he sure sounds stupid. Wonder how he became a physician?!?
> >
> >
> > It'a all part of the the Bell Sports sponsored World Wide Conspiracy to
> > Promote Helmets. ;-)
>
> This is a little like attending a panel discussion on medical ethics,
> and having it crashed by two little boys who escaped from Problem Child
> Day Care.
>

You *really* don't like it when people expose your obsessions and your
paranoia, do you, Frankie?

 

[Ozark Bicycle]

SMS wrote:
> Bill Sornson wrote:
> > [email protected] wrote:
> >
> >> My guess is the typical ER physician literally thinks bike helmets
> >> prevent almost all head injury - that is, 85%. He doesn't know that
> >> there is real scientific doubt about their effectiveness.
> >
> > Boy, he sure sounds stupid. Wonder how he became a physician?!?
>
> I guess he's like the rest of us, we never saw any scientific evidence
> that doubted the effectiveness.

He never read "The World According to Krygowski".

 

[Bill Sornson]

[email protected] wrote:
> Ozark Bicycle wrote:
>> Bill Sornson wrote:
>>> [email protected] wrote:
>>>
>>>> My guess is the typical ER physician literally thinks bike helmets
>>>> prevent almost all head injury - that is, 85%. He doesn't know
>>>> that there is real scientific doubt about their effectiveness.
>>>
>>> Boy, he sure sounds stupid. Wonder how he became a physician?!?
>>
>>
>> It'a all part of the the Bell Sports sponsored World Wide Conspiracy
>> to Promote Helmets. ;-)
>
> This is a little like attending a panel discussion on medical ethics,
> and having it crashed by two little boys who escaped from Problem
> Child Day Care.

A) I addressed you directly, Mr. Crank; and B) once again you compare your
so-called calling (helmet denouncement) to the freaking /medical/ field.
(Last time you compared lids to CANCER SURGERY, fergawdsake!)

I'll listen to a medical doctor about medical issues long before I'll listen
to some Usenet Brainiac. You just don't hold much sway, Crank.

Off to ride (with helmet, of course)... Bill

 

[Ozark Bicycle]

[email protected] wrote:

> The only serious question I have about this is: Was the entire scheme
> concocted by Bell Sports?
>
> - Frank Krygowski
>

 

[SMS]

Bill Sornson wrote:
> [email protected] wrote:
>
>> My guess is the typical ER physician literally thinks bike helmets
>> prevent almost all head injury - that is, 85%. He doesn't know that
>> there is real scientific doubt about their effectiveness.
>
> Boy, he sure sounds stupid. Wonder how he became a physician?!?

I guess he's like the rest of us, we never saw any scientific evidence
that doubted the effectiveness.

 

[SMS]

Ozark Bicycle wrote:

> Shall we gaze upon Krygowski's cowardice (i.e., the question he won't
> answer) ?

He'll never answer. None of those references above have anything to do
with what is being studies in Austin. Those studies look at whole
populations to determine if helmet laws make any difference in overall
injury and fatality rates. What's being done in Austin is to look at the
bicycle accident head-impact injury cases that come into the ER, and
evaluate whether or not the victim would have been better off or not
with a helmet. This is an evaluation that the ER doctors are highly
qualified to make, in fact they are probably the only professionals
qualified to make such an evaluation.

I haven't seen anyone claim that helmet laws make a _significant_
difference, one way or the other, in overall injury rates. There are
small differences that have been reported, but they are not
statistically significant. This is the reason that MHLs are unnecessary.

The problem with the Austin study is that they're likely to proclaim
something like, "we had 100 bicycle accidents with head-impacts and in
75% of the cases where the rider wasn't wearing a helmet they'd have
fared better had they been wearing a helmet." Then the politicians will
trumpet the 75% number.

 

[Johnny Sunset aka Tom Sherman]

SMS wrote:
> Ozark Bicycle wrote:
>
> > Shall we gaze upon Krygowski's cowardice (i.e., the question he won't
> > answer) ?
>
> He'll never answer. None of those references above have anything to do
> with what is being studies in Austin. Those studies look at whole
> populations to determine if helmet laws make any difference in overall
> injury and fatality rates. What's being done in Austin is to look at the
> bicycle accident head-impact injury cases that come into the ER, and
> evaluate whether or not the victim would have been better off or not
> with a helmet. This is an evaluation that the ER doctors are highly
> qualified to make, in fact they are probably the only professionals
> qualified to make such an evaluation....

CITATION?

Why won't Mr. Scharf answer the question of what training that ER
doctors have received that allows them to determine if an expanded
polystyrene shell would have significantly reduced the severity of a
head injury?

--
Tom Sherman - Here, not there.

 

[SMS]

Johnny Sunset aka Tom Sherman wrote:

> CITATION?
>
> Why won't Mr. Scharf answer the question of what training that ER
> doctors have received that allows them to determine if an expanded
> polystyrene shell would have significantly reduced the severity of a
> head injury?

I'm certain that you're well aware of the qualifications. Of all medical
professionals, ER doctors see the most head trauma cases involving
bicycle accidents.

If you're trying to say that the number of such cases that these ER
doctors see is relatively low, then I have to agree with you. There is
no double-blind study. You have to go with the best data that's
available, and that's from ERs.

 

[Johnny Sunset aka Tom Sherman]

SMS wrote:
> Johnny Sunset aka Tom Sherman wrote:
>
> > CITATION?
> >
> > Why won't Mr. Scharf answer the question of what training that ER
> > doctors have received that allows them to determine if an expanded
> > polystyrene shell would have significantly reduced the severity of a
> > head injury?
>
> I'm certain that you're well aware of the qualifications. Of all medical
> professionals, ER doctors see the most head trauma cases involving
> bicycle accidents.
>
> If you're trying to say that the number of such cases that these ER
> doctors see is relatively low, then I have to agree with you. There is
> no double-blind study. You have to go with the best data that's
> available, and that's from ERs.

ER doctors are trained to DIAGNOSE and TREAT head injuries.

What training do ER doctors have in accident reconstruction that would
allow them to calculate the vector of the cyclist's head at the time of
impact? Furthermore, what training do ER doctors have that allows them
to determine the amount of force reduction to the cyclist's head
provided by the expanded polystyrene shell?

--
Tom Sherman - Here, not there.

 

[Cathy Kearns]

"SMS" <[email protected]> wrote in message
news:[email protected]...
> Johnny Sunset aka Tom Sherman wrote:
>
> > CITATION?
> >
> > Why won't Mr. Scharf answer the question of what training that ER
> > doctors have received that allows them to determine if an expanded
> > polystyrene shell would have significantly reduced the severity of a
> > head injury?
>
> I'm certain that you're well aware of the qualifications. Of all medical
> professionals, ER doctors see the most head trauma cases involving
> bicycle accidents.
>
> If you're trying to say that the number of such cases that these ER
> doctors see is relatively low, then I have to agree with you. There is
> no double-blind study. You have to go with the best data that's
> available, and that's from ERs.

I can believe ERs can make categories of bike injuries, and check a box
saying whether the victim claim they were wearing a helmet or not. I don't
believe an ER person would know for sure if the helmet was actually
correctly seated on their head when the fall happened. I'd wouldn't be
surprised to find people stretching the truth about wearing a helmet. But
without knowing exactly how the accident happened, it would be foolish to
expect the folks in the ER to be able to determine if wearing a helmet would
have helped or not.

For example, perhaps a kid's helmet gets caught in the spokes when hanging
from the handle bars of the bike. The kid falls off, breaks an arm. The
helmet looks like it is scrapped up all over. If the kid's head went
through the spokes and then bounced off the pavement like the helmet did,
well, who knows what his head would look like. But in this example his head
wasn't in the helmet, though the kids is going to say he was wearing the
helmet or his parents are going to go berserk. ER person says beat up
helmet obviously saved his life. Now did it?

Another example, a mom is wearing her helmet, on the back of her head. She
always wears a helmet when riding, just like this. She falls and smashes
her face and forhead into the pavement. Now it's going to say she was
wearing a helmet, but I doubt anyone will note she never had the helmet on
correctly. The ER report says helmet was useless in this case for saving
her head. Now, if she'd really been wearing a helmet properly wouldn't it
have worked better?

Without knowing exactly what happened outside the ER, the ER guys would come
to the wrong conclusion.

 

[SMS]

Cathy Kearns wrote:

> I can believe ERs can make categories of bike injuries, and check a box
> saying whether the victim claim they were wearing a helmet or not. I don't
> believe an ER person would know for sure if the helmet was actually
> correctly seated on their head when the fall happened.

This is true, but it's fair for that to be included in the data. Every
incorrectly worn helmet skews the results against the positive effects
of helmets.

> I'd wouldn't be
> surprised to find people stretching the truth about wearing a helmet.

The ER doctors can usually tell, due to abrasions. For accidents serious
enough to require an ambulance, the police report will state whether or
not a helmet is used. But again, if people lie about wearing a helmet,
that skews the results against the positive effects of helmets.

And of course the biggest factor working against the results is that
many accidents that would result in an ER visit if the cyclist wasn't
wearing a helmet, are not going to be included as a positive effect for
helmets because the helmet prevented an ER visit in the first place.

> For example, perhaps a kid's helmet gets caught in the spokes when hanging
> from the handle bars of the bike. The kid falls off, breaks an arm. The
> helmet looks like it is scrapped up all over. If the kid's head went
> through the spokes and then bounced off the pavement like the helmet did,
> well, who knows what his head would look like. But in this example his head
> wasn't in the helmet, though the kids is going to say he was wearing the
> helmet or his parents are going to go berserk. ER person says beat up
> helmet obviously saved his life. Now did it?

Very weak.

> Another example, a mom is wearing her helmet, on the back of her head. She
> always wears a helmet when riding, just like this. She falls and smashes
> her face and forhead into the pavement. Now it's going to say she was
> wearing a helmet, but I doubt anyone will note she never had the helmet on
> correctly. The ER report says helmet was useless in this case for saving
> her head. Now, if she'd really been wearing a helmet properly wouldn't it
> have worked better?

Yes, this is true. But remember, the AHZs railing against the Austin
study are more concerned about the opposite, that the ER results will
show a positive effect for helmets. Every incorrectly worn helmet works
against the results they fear.

> Without knowing exactly what happened outside the ER, the ER guys would come
> to the wrong conclusion.

You're trying to claim that every accident has amazing and unrealistic
circumstances. Maybe there's a chance that one accident will be
something like your example of the helmet hanging on the bars, but you
have no reason to believe that most accidents have such improbable causes.

The bottom line is that, like other ER studies, the AHZs are terrified
of the results. They know that ER physicians are the most highly
qualified medical professionals to evaluate helmet effectiveness. They
know the results of all the other ER studies. Rather than fight the ER
studies, they should concentrate on the battles they can win.

 

[Helmut Springer]

SMS <[email protected]> wrote:
> What's being done in Austin is to look at the bicycle accident
> head-impact injury cases that come into the ER, and evaluate
> whether or not the victim would have been better off or not with a
> helmet. This is an evaluation that the ER doctors are highly
> qualified to make, in fact they are probably the only
> professionals qualified to make such an evaluation.

You have so far missed to provide any reason why an ER doc should be
qualified to to judge about the potential differences a helmet would
have made, a call that requires detailed knowledge about the actual
maechanics of the respective accident and quite some physics and
engineering know how. Care to elaborate?

--
MfG/Best regards
helmut springer

 

[Lo]

> > Why won't Mr. Scharf answer the question of what training that ER
> > doctors have received that allows them to determine if an expanded
> > polystyrene shell would have significantly reduced the severity of a
> > head injury?
> I'm certain that you're well aware of the qualifications. Of all medical
> professionals, ER doctors see the most head trauma cases involving
> bicycle accidents.

I would have thought neurosurgeons see more. Here are some comments
from someone with experience treating cycling head injuries:

"The earliest murmurings that I heard against helmets were from a
neurosurgeon who I worked for in 1994. He claimed that cycle helmets
were turning what would have been focal head injuries, perhaps with an
associated skull fracture, into much more debilitating global head
injuries. We had a couple of examples on the ward at the time, and it
was a bit worrying. However, I wasn't too convinced as I figured that
the injuries that would previously have been focal head injuries may
well have been resulting in death, so the neurosurgeon was never
actually seeing them. Instead, they were making their way straight to
the pathologist."
(from: Cycling: your health, the public's health and the planet's
health. Dr Ashley Bloomfield, Public Health Physician
Presentation for Making Cycling Viable New Zealand Cycling Symposium,
Palmerston North 14-15 July 2000)

So, in the neurosurgeon's experience, helmets were turning what would
have been focal head injuries, perhaps with an associated skull
fracture, into much more debilitating global head injuries. Dr
Bloomfield thought that perhaps these people would have died without
the helmets .... but there's little or no evidence of this in the
fatality statistics. One paper from Australia reported that, after
helmet laws, 80% of cyclists wore helmets, as did 80% fatally injured
cyclists.

> If you're trying to say that the number of such cases that these ER
> doctors see is relatively low, then I have to agree with you. There is
> no double-blind study. You have to go with the best data that's
> available, and that's from ERs.

http://www.kvue.com/news/local/stories/101106kvuebikehelmet-gv.2b9cf576.html
(A news article on the Austin Helmet Law) states:

"Al Bastidas, 43, calls his old photographs sobering reminders of a
biking accident that nearly killed him.
"My head hit the 90 degree angle roof. I flew over, a witness believed
it was about 10 feet high in the air and landed on top of her roof,
shattered the windshield," said Bastidas.
"He suffered extensive injuries to his brain, and spent eleven days in
the ICU, and even longer recovering.
"Bastidas credits a helmet with saving his life."

So, we know he had a serious head injury when wearing a helmet. Can
anyone really say how badly he would have been injured without it?

ER doctors don't seem any better qualified to decide on whether a
helmet would have helped prevent a head injury than they were to tell
me whether stress prevents ulcers. If I'd gone to the ER 15-20 years
ago with an ulcer, I'd have been told it was caused by stress.
The guy who discovered helicobacter was ridiculed by his colleagues and
told that his theory couldn't possibly be true.

And, AFAIK, ulcers are a relatively common ailment. The average ER
doctor (as opposed to the neurosurgeon mentioned by Dr Ashley
Bloomfield) might treat a cyclist with a head injury serious enough to
cause dizziness or loss of consciousness for a minute or two once every
month or two.

Or, go back a couple of hundred years, when, in the experience of
treating physicians, blood-letting was one of the most effective cures
there was. Didn't George Washington have a minor ailment, but some
people claimed he died from loss of blood after being bled numerous
times by perhaps half a dozen different doctors?

The ironic aspect of this debate is that it's all about whether helmets
work, instead of whether helmet laws work. The whole idea of studying
ER data to determine whether to implement a helmet law is crazy. If
the Council wants to know the benefits or otherwise of helmet laws ...
they should be reading the studies of helmet laws.

Anyone got an email address for the council, so we can explain that to
them, instead of debating it here?

 

[[email protected]]

SMS wrote:
>
> None of those references above have anything to do
> with what is being studies in Austin. Those studies look at whole
> populations to determine if helmet laws make any difference in overall
> injury and fatality rates.

Sorry, Steven, but you're wrong yet again. Two deal with bike
helmets in general (even their promotion) and their effectivenss, or
lack of. One has "volunatry" in the title, and it examines the effect
of tripling helmet use, to about 90%, via promotion _before_ a law.

And, as you should recall from previous discussions, it finds no
detectable benefit.

> What's being done in Austin is to look at the
> bicycle accident head-impact injury cases that come into the ER, and
> evaluate whether or not the victim would have been better off or not
> with a helmet. This is an evaluation that the ER doctors are highly
> qualified to make, in fact they are probably the only professionals
> qualified to make such an evaluation.

Absolute nonsense. ER doctors are highly qualified to treat injuries.
That's the focus of their training. They are NOT trained in evaluating
hypothetical effects of protective gear.

Unfortunately, many are also not trained in understanding their own
limitations. So they - like you - may imagine they have qualifications
that they lack!

- Frank Krygowski

 

[Ozark Bicycle]

[email protected] wrote:

<snipped>

> Unfortunately, many are also not trained in understanding their own
> limitations. So they - like you - may imagine they have qualifications
> that they lack!
>

Good gawd! My Irony Meter just *exploded*!

Try a Self-Awareness Supplement, Frankie, your levels are very low!

 

[[email protected]]

SMS wrote:
> Cathy Kearns wrote:
>
> > I can believe ERs can make categories of bike injuries, and check a box
> > saying whether the victim claim they were wearing a helmet or not. I don't
> > believe an ER person would know for sure if the helmet was actually
> > correctly seated on their head when the fall happened.
>
> This is true, but it's fair for that to be included in the data. Every
> incorrectly worn helmet skews the results against the positive effects
> of helmets.

I know you've used that as an excuse for helmets not working; but in my
view, if a commercial product can't be correctly used by its typical
user, that in itself comes under the heading of "not working."

And that reminds me: I recently rode with our area's former chief
helmet promoter, the one who had tried to get our club to lobby for a
MHL in our state. Even she had her helmet tilted back so far that the
top-front of her head was totally exposed. This despite her time spent
showing videos in schools, passing out leaflets, etc. about the
wondrous properties (and proper use) of helmets.

My point is this: if someone as motivated as she can't wear hers
properly, it's time to blame the product and its designers, not to use
the duped consumers as an excuse.

> > I'd wouldn't be
> > surprised to find people stretching the truth about wearing a helmet.
>
> The ER doctors can usually tell, due to abrasions. For accidents serious
> enough to require an ambulance, the police report will state whether or
> not a helmet is used. But again, if people lie about wearing a helmet,
> that skews the results against the positive effects of helmets.

"The police report will state" incorrect information much of the time.
This has been discussed in detail at
http://www.zzapp.org/rileygea/itsa/helmet2.htm

> And of course the biggest factor working against the results is that
> many accidents that would result in an ER visit if the cyclist wasn't
> wearing a helmet, are not going to be included as a positive effect for
> helmets because the helmet prevented an ER visit in the first place.

If that were true, then sudden large increases in helmet use would
cause simultaneous sudden large drops in ER visits. But, as noted in
the papers I cited in yesterday's post, that is apparently never true.

> The bottom line is that, like other ER studies, the AHZs are terrified
> of the results.

(I wish you'd can the disparaging acronym. It's childish and
inaccurate.)

Personally, I'm not "terrified" of anything. But I'm somewhat
disgusted at this new, typically biased, transparent attempt to use
pseudo-science to mandate purchase of a commercial product, and to
paint cycling as being terribly hazardous.

I also find it disgusting that you continue to use such sloppy thinking
to defend an attempted law that you claim to disagree with. From here,
it looks hypocritical at best.

> Rather than fight the ER studies, they should concentrate on the battles they can win.

I have contributed to successful fights against MHLs on three separate
occasions. I'm not sure about your record in this regard, but I
believe it's a complete zero.

Of course, lack of knowledge or experience has never prevented _you_
from claiming to be an "expert," has it, Steven? ;-)

- Frank Krygowski

 

[Ozark Bicycle]

[email protected] wrote:
> SMS wrote:
> > Cathy Kearns wrote:
> >
> > > I can believe ERs can make categories of bike injuries, and check a box
> > > saying whether the victim claim they were wearing a helmet or not. I don't
> > > believe an ER person would know for sure if the helmet was actually
> > > correctly seated on their head when the fall happened.
> >
> > This is true, but it's fair for that to be included in the data. Every
> > incorrectly worn helmet skews the results against the positive effects
> > of helmets.
>
> I know you've used that as an excuse for helmets not working; but in my
> view, if a commercial product can't be correctly used by its typical
> user, that in itself comes under the heading of "not working."
>
> And that reminds me: I recently rode with our area's former chief
> helmet promoter, the one who had tried to get our club to lobby for a
> MHL in our state. Even she had her helmet tilted back so far that the
> top-front of her head was totally exposed. This despite her time spent
> showing videos in schools, passing out leaflets, etc. about the
> wondrous properties (and proper use) of helmets.
>
> My point is this: if someone as motivated as she can't wear hers
> properly, it's time to blame the product and its designers, not to use
> the duped consumers as an excuse.
>

If you don't handle and cook chicken (for example) properly, you run
the risk of food poisoning. Shall we blame the purveyors of the
chicken, or the consumer for the resultant trip to the hospital? After
all, properly handled and cooked, chicken is not a hazard. Yet,
salmonellosis is far from rare. Isn't it incumbent upon the
consumer/user to use the product safely?

 

[SMS]

Lo wrote:

> "The earliest murmurings that I heard against helmets were from a
> neurosurgeon who I worked for in 1994. He claimed that cycle helmets
> were turning what would have been focal head injuries, perhaps with an
> associated skull fracture, into much more debilitating global head
> injuries. We had a couple of examples on the ward at the time, and it
> was a bit worrying. However, I wasn't too convinced as I figured that
> the injuries that would previously have been focal head injuries may
> well have been resulting in death, so the neurosurgeon was never
> actually seeing them. Instead, they were making their way straight to
> the pathologist."

Yes, that's the logical conclusion from the FARS data as well. If you
take the injury data out of context, and ignore the fatality data, you'd
say that helmets have no effect. When you include the fatality data, you
see just how well helmets work.

 

[SMS]

Lo wrote:

> The ironic aspect of this debate is that it's all about whether helmets
> work, instead of whether helmet laws work. The whole idea of studying
> ER data to determine whether to implement a helmet law is crazy. If
> the Council wants to know the benefits or otherwise of helmet laws ...
> they should be reading the studies of helmet laws.

That is the bottom line. Almost no one disputes that helmets work, just
as almost no one disputes that helmet laws don't work.

 

[gds]

[email protected] wrote:
> gds wrote:
> >
> >
> > 1)Frank, you are confusing the "discovery" process with the validation
> > process. Most drugs are first discovered and only after that discovery
> > are they put through clinical trials. It is only very recently that
> > biomedical scince has reached the point where drugs are designed to do
> > specific things. Until now various compunds were simply discovered to
> > have an effect. And they were sold and marketed without understanding
> > how the effect was accomplished.
> > Do you think that the natives understood how quinine worked? Nope they
> > just knew it worked.
>
> I don't see how you can characterize this attempt at a study as being a
> "discovery" process. First, helmets have obviously been discovered by
> now. But more importantly, the physicians quoted make it clear that
> they think it's a validation process. They are claiming it will
> demonstrate the value of helmets. "... there's really no doubt what
> the outcome is going to be," said Dr. Steve Berkowitz, CEO of St.
> David's Healthcare."
>
> (I note Berkowitz seems blissfully unaware of the evidence of his

I'm referring to process issues not the specifics of helmets.


>
>
> > 2)You are also confusing real world ER visit behaviour with whatever
> > you think it might be. Most studies I've seen report just the opposite
> > of what you are suggesting. That is the poor and uninsured use ER's and
> > the wealthier and insured use other modes of getting care.
> > Of course, if the injury is really severe that doesn't apply and the
> > ambulance goes to the ER.But since you posit that there are virtually
> > no serious injuries from cycling that shouldn't mean much.
>
> I'd like a citation on the "most studies" parrt of that.


Google Emergency room visits and insurance status and you will find
tons of them!
Most of the studies find that uninsured have higher ER utilization
rates than insured. In the studies that did not find this relationship
they found that the high utilizers were the "publicly insured" that is
medicaid and medicare. If you want to argue that the medicaid and
medicare populations using ER's for health care have the same socio
economic status as privately insured go right ahead, but I don't
believe that to be the case.

>
>> > 3) You are absolutely wrong in stating that an ER doc needs to know and
> > understand all the issues that you list to make a judgement concerning
> > the level of injury and the use of a helmet. He may need to know all
> > that if he wants to say "how" the helmet prevented a more serious
> > injury. But to say "from what I've observe injuries in those cyclist
> > reporting the use of a helmet are less (or more or the same) requires
> > none of that. It is an observation of end point and not an explantion
> > of how one got there.
>
> If he is to judge whether a helmet would have made a difference, ISTM
> he needs to know quite a lot about helmets, and about the specific
> crash. Would an auto body mechanic be able to say whether anti-lock
> brakes would have prevented a particular accident? Very, very
> unlikely!
>
> And, BTW, the ER doc would certainly have to recognize the possibility
> of sampling bias due to self selection! Again, the method they're
> using would give credit to the red cotton cycling caps!
>
> I see no evidence these docs are even dimly aware of such matters.
> >From what I know from my ER doc friend, they are trained in body
> repair. But unless they are into real research (and have specialized
> help) they don't know much about the fine points of experimental
> design.
>
> - Frank Krygowski

Again you are not reading what I write. An ER doc does NOT need to
understand how a helmet works in order to make the statement " patients
who reported wearing a helmet had less severe injuries than those
reporting not waring a helmet." Such a statement does not explain
anything causal but mearely suggest a relationship (correlation).

Don't you think it would be interesting and important to see what a
whole bunch of folks that actually see and treat such injuries observe?
I do! Let's not get caught up in the specifics of this study and any
bias it may have. If it is biased it is no good--no argument. But the
idea of knowing the observations of lots of folks who treat trauma on a
regular basis is clearly an important bit of knowledge.