You could say the selection bias is I see those who report negative changes. Over several hundreds of cases, I see factors contributing to poorer outcome, resulting in me making a choice for myself and those I love--not for you. You do you--and I truly hope it all turns out well for all concerned.

True in that I don't see those who are 100% fine nor those who died. It's a clinical practice not a research study--typical of the clinical head injury pop (i.e. those identified as having injury and the opportunity to get further support via location and/or funds (though I do some probono).)

I dont tell anyone they "should" have done anything, as it is: 1) Too late since the injury has already happened; 2) and irrelevant for my goal of providing mental health and cognitive support post-injury. People get hurt. I don't care what action did or did not cause it.

Exactly this.

Vast majority of mass shooters would not be classified as mentally ill on assessments. Also, the vast majority of people with mental illness are not picking up guns and killing indiscriminately. Other countries have similar rates of mental illness, but not similar rates death by gun. It's the guns.

As no one with severe brain or spinal injury should be left without healthcare, lifetime assistance, and dignity of life. THAT is what needs to be mandatory!

I did not opine in any of my responses that it should be mandatory--only the observed effects of head meets concrete/steel/tree, etc. I want helmets to be worn by those I love, but ultimately it is their choice. As for mandatory--I wish that good universal health care was mandatory in this world.

People make regretful choices; some people push the limits and sometimes fail. Some people take utmost care and still get hurt. A helmet is not a cure-all, but my experience tells me I will wear one. Your brain--Your choice. I 100% hope it turns out well for you. No one should suffer a severe TBI.

I think helmets are a good idea, and want those I care about to wear them. If someone wants to risk it all--I truly hope all goes well and they continue with their lives. I get no pleasure from bad outcomes. Nor do I ever feel it is "deserved" even if reckless.

Lots of reasons. People aren't exactly clamoring to protect themselves. That being said, some VERY vulnerable people do wear helmets at home. No where did I opine that helmets should be mandatory or not--simply gave my observations of outcomes in bike versus car or some other bike event.

At no point--in any post--did I opine about mandatory helmet laws. I shared my clinical experience after seeing too many have their lives completely altered due to serious head injury. I see unhelmeted riders and simply hope that they remain safe. Your head...your choice. May you not have a bad day.

This is not to say that severe injuries can't happen with auto--as they most definitely do--but that seat belts and airbags do help, for sure. So why not strive for at least one layer of protection? In car vs bike, bike never wins.

Seriously, though--clinically my practice has seen mild injuries more with injuries in autos, while opposite with bicycles. When I see an unhelmeted rider in an urban setting (one with poor cycling infrastructure), I truly hope they don't become a statistic.

After treating hundreds of patients, not one ever said, "I would have been better off without a helmet." In contrast I have heard many say they may have died or been more impaired without one. Thus I definitely choose to protect my noggin. For those that don't, I truly wish them health + good luck.

The question to me is risk versus benefit. I have seen a number of mild head injuries with car accidents, which would have been much worse if no seat belts or airbags. On the other hand, in bicyclists vs autos, my experience has been that the head injuries tend to be more severe or catastrophic.

"The examined literature confirms that wearing a helmet while cycling is beneficial, regardless of age, crash severity, or crash type. The relative benefit is found to be higher in high-risk situations and when cycling on shared roads and particularly preventing severe head injuries."

I find this instructive--consistent with my decades of clinical experience in communities lacking the cyclist-friendly infrastructure of the Netherlands. pmc.ncbi.nlm.nih.gov/articles/PMC...

Can we not do both? Helmets and improved infrastructure? As a neuropsychologist I have seen way too many poor outcomes from auto vs bicycle. Helmets really can help when fitted properly--but we do need improvements so that rate of accidents decline to begin with.