Myocardial Infractions

A government-commissioned report promotes smoking bans by tweaking the evidence.

Six years ago, when I asked an epidemiologist about a report that a smoking ban in Helena, Montana, had cut heart attacks by 40 percent within six months, he thought the idea was so ridiculous that no one would take it seriously. He was wrong.

Since then 10 other studies have attributed substantial short-term reductions in heart attacks to smoking bans, and last week an Institute of Medicine (IOM) committee endorsed their findings. But a closer look at the IOM report, which was commissioned by the U.S. Centers for Disease Control and Prevention, suggests its conclusions are based on a desire to promote smoking bans rather than a dispassionate examination of the evidence.

Thousands of jurisdictions around the world restrict smoking. Some of them are bound to see significant drops in heart attacks purely by chance, while others will see no real change or significant increases. Focusing on the first group proves nothing unless it is noticeably bigger than the other two groups.

The largest study of this issue, which used nationwide data instead of looking at cherry-picked communities, concluded that smoking bans in the U.S. "are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction." It also found that "large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature."

That study, published by the National Bureau of Economic Research (NBER) in March, suggests that publication bias—the tendency to report positive findings and ignore negative ones—explains the "consistent" results highlighted by the IOM committee. But even though the panelists say they tried to compensate for publication bias by looking for relevant data that did not appear in medical journals, they ignored the NBER paper, along with analyses that found no declines in heart attacks following smoking bans in California, Florida, New York, Oregon, England, WalesScotland, and Denmark.

If smoking bans reduce heart attacks, the effect could be due to declines in smoking, declines in secondhand smoke exposure, or both. The IOM report settles on that last explanation, quite a leap given that "only two of the studies distinguished between reductions in heart attacks suffered by smokers versus nonsmokers."

In any case, when people stop smoking, their heart attack risk declines gradually over several years, and it’s hard to see why the risk would fall any faster for people exposed to secondhand smoke. Furthermore, estimates from the CDC and the American Heart Association indicate that smoking and secondhand smoke together account for about 25 percent of heart disease deaths. So how could a smoking ban, even one that eliminated all smoking, cut heart attacks by 40 percent (or 47 percent, as another study claimed)?

The IOM panelists dodge these issues by declining to estimate the size or the timing of the impact from smoking bans, citing the limitations of the studies and the wide variations between them. But "if you can’t even estimate the magnitude of an effect," notes Michael Siegel, a Boston University public health professor who was one of the report’s reviewers, "you are hardly in a position to conclude that [it] exceeds random variation combined with the known secular decline in heart attack rates."

Even while taking refuge in imprecision, the IOM committee tries to make transparently absurd claims seem plausible by intimating that spending a half-hour in a smoky bar just might kill you, even if you were completely healthy when you went in. If so, where are the bodies? The report concedes "there is no direct evidence that a relatively brief exposure to secondhand smoke can precipitate an acute coronary event."

Siegel, who faults the IOM committee’s "sensationalistic" approach, is a longtime supporter of smoking bans who nevertheless tries to separate his political advocacy from his scientific analysis. It’s too bad the authors of the IOM report, who immediately used it as an excuse to demand strict smoking regulations throughout the country, did not follow his example.

Jacob Sullum is a senior editor at Reason and a nationally syndicated columnist.

© Copyright 2009 by Creators Syndicate Inc.

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  • ||

    Awesome article Mr. Sullum!

    The best way to fight disgusting propaganda aimed at destroying freedom is through facts and an examination of reality, both of which you do in grand fashion here.

    Good stuff.

  • ||

    Which the average citizen will promptly ignore.

    "See! The scientists said so! And it's for a good cause!"

  • Christian Louboutin||

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  • Christian Louboutin||

  • Xeones||

    Not sure about my heart itself, but retard spambots are way worse for my blood pressure than secondhand smoke.

    Will no one rid Reason of this troublesome bot?

  • Domtar the Space Alien||

    Will no one rid Reason of this troublesome bot?

    Look not to me, Earthling.

  • Xeones||

    Look not to me, Earthling.

    Wouldn't dream of it.

  • Art-P.O.G.||

    Maybe we can get anonymity-bot to destroy it. I read somewhere that reckless androids have a low tolerance for other reckless androids.

  • Spartacus||

    You shouldn't talk about Lawrence Summers like that.

  • ||

    I'm a nonsmoker, who hates being around smoke. In light of that, I do the obvious thing: I don't visit establishments that have heavy smoking. I really don't know why anyone needs to do more than that.

  • @||

    Because they're not as smart as you, R. That's why we need the iron fist--I mean the benevolent hand--of government to protect The Children­® and other living things.

  • John Tagliaferro||

    If only the people infesting my neighborhood were like you.

  • ||

    Please stay where you are. A member from the he local Smoking Sequestration and Elimination Committee will be by soon to make a minor adjustment in your thinking on this subject.

    When instructed, just lie back in the chair. You'll feel a little pinch.

  • Ratko||

    Why? We can only guess. How, now that's easy, with endless PSAs, cartoons, school programs, drives, et cetera, et cetera, all manipulating vunerable empty little minds to ignore freedom, reality and fact in exchange the wonderful world of PC activism it's not surprising weak minded gulible people who feel powerless, unaccepted and insignificant would be eager to make an easy fix and trade those feelings the illusion of power, control, and rightousness offered in the Crusader Complex (if there is no such thing as Crusader Complex, there should be). If some, even many become upset their rights are being trampled and freedom taken, the crusaders need not be forced to revert back to those unpleasant impotent feelings that would come from an honest examination of their own actions since they've already almost certainly concluded that a consensus exists that what they are destroying is "bad" making what they doing "good" thus validating their actions "correct."

    History over the last century or so reveals this technique skillfully employed by even a small number of devoted political activists can achieve incredible results: hundreds of millions murdered, countless many millions more tortured, brutalised, deprived of liberty, enslaved.

    Many would say I'm comparing apples and oranges. I respect their right to their opinion. Asked how he found solutions to so incredibly complex problems,

    Einstein answered something to the effect that he looked for the least complex solution because it's the nature of the universe that the most simple one is correct.

    Clever man that Einstein and from what I've seen there are few answers in the complex gray areas either you respect liberty or you do not.

    No less human than anyone else, I'm disgusted by various activities, pursuits, habits, and who am to judge? Never once in my life pushed to outlaw anything, but have opposed many laws that never should have been to begin with. When people feel entitled to tweek and lie and manipulate the law to deprive others of their freedoms they're socialists regardless of what they call themselves, they just haven't used their little "methods" to shovel people in ovens ...yet.

    So I hear you, R, and your approach is in my opinion the obvious and logically correct one. And you can rest assured that whatever liberty it is you happen to have use for I'll never be out in the shadows working to take it from you, even if it disgusts me.

  • Nanny State||

    I don't visit establishments that have heavy smoking. I really don't know why anyone needs to do more than that.

    Gaia have mercy on your heathen soul.

  • Anonymous||

    Looks like someone on the reason staff is a /b/taHNNNNNNGGGGG!

  • kc||

    I didn't know Stephen Covey had a heart attack....

  • ||

    It doesn't matter what the truth is. People want someone to verify what the feel is the truth even if it's entirely wrong. Those who care about the truth already know.

  • daksya||

    smoking and secondhand smoke together account for about 25 percent of heart disease deaths. So how could a smoking ban, even one that eliminated all smoking, cut heart attacks by 40 percent

    Heart disease is not the same as heart attacks. Clarify, please.

  • Christian Louboutin||

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  • The 3 Monkeys Guide to Health||

    This mirrors an article we wrote a month ago exposing the same type of nonsense in a couple of other studies which relied on the same cherrypicked data method of research.

    Full article here: http://3healthymonkeys.wordpre.....-omission/

    Some points were raised by critics, which we then addressed in a subsequent article: http://3healthymonkeys.wordpre.....eres-fire/

  • ||

    I like the fact that we are funding programs with ever increasing tobacco taxes while counterproductively trying to end said activity. (at least we are doing that here in the great nanny state of Minnesota.)

  • Joe C||

    What would it take to start a petition to ban banning things? If it was successful, it could be taken a step further to ban all previous bans. This may be the best idea I've had in months.

  • ||

    Its funny to hear the views of Michael Siegal in this context, to demonstrate the frauds he personally initiated with the 220 bartenders study he used to sell smoking bans in the first place. Is he just a little bit pregnant?

    Wouldn't it be easy, if we were all packaged clones and our lives were all identical? We could sew this up and package population studies as real science tomorrow. As it stands the credible power of postulation can never go beyond the wisdom found, sitting around a bong.

    The most extreme exposures imaginable applied to the longest exposures possible [the precautionary principle] found 220 bartenders would die, by one of the long list of so called "smoking related diseases" so we are all at risk?.

    After his minuscule risk was developed, his comrades applied the statistical scrap to entire populations. Regardless of cultures age and a number of other factors, which would make significant exposures of the type described virtually impossible from the outset. Can an 80 year old be expossed to cigarette smoke for 40 more years? How realistic is it to contend they all will? Can you say baby boomers?

    The creation of 450,000 in the States, with a ten percent population and corresponding 45,000 in Canada smoking a much different product with no additives sells gospel in place of science.

    If we look to the long term exposures that are apparent; a dose response relationship can be postulated by many of the hyperbole research results, which demonstrate higher risk among heavy smokers than lighter smokers. Plot the data points on an x/y chart and extend that line through the average bartender who is expossed to less than one cigarette a day. Look beyond that point and you find zero risk by casual exposures which exists beyond the point that all dose response risk goes below the baseline.

    If the prophets of gloom and doom wish to make their case show them the data points and ask them to explain the 450,000 numbers.

    We can take the data points formed by levels of exposure and duration in a dose response perspective, to demonstrate the same improbable points of health risk with the 4000 or now 100,000 "deadly ingredients" versus actual exposure levels as well. The higher the number of ingredients, in contrast to the current norm, should by logical perspective, indicate each ingredient by volume measure is extremely low and lowered again by every ingredient you add.

    Looking at the data points for the smoking studies in question, which show lower numbers of heart attack reductions, with higher population smoking ban studies consistently. Any level of intelligence should realize the reductions are not in total population, but among a much smaller subset of population. A data point so seldom provided. It should also be obvious with a higher population average of those "at risk" in smaller retirement communities than in larger urban centers [What subset would fit? the elderly perhaps?].

    For self described "experts", these people involved in selling the discomfort of smokers, seem to be a load short of a brick on all fronts.

    Zealotry does that to a person; it eliminates basic logic and reason as the disease progresses. What we can't fathom so far, is how a few damaged and phobic, one trick ponies, reduced to essentially pot head intelligence, can rise to lead so many.

    Always follow the money...

  • ||

    Its funny to hear the views of Michael Siegal in this context, to demonstrate the frauds he personally initiated with the 220 bartenders study he used to sell smoking bans in the first place. Is he just a little bit pregnant?

    Wouldn't it be easy, if we were all packaged clones and our lives were all identical? We could sew this up and package population studies as real science tomorrow. As it stands the credible power of postulation can never go beyond the wisdom found, sitting around a bong.

    The most extreme exposures imaginable applied to the longest exposures possible [the precautionary principle] found 220 bartenders would die, by one of the long list of so called "smoking related diseases" so we are all at risk?.

    After his minuscule risk was developed, his comrades applied the statistical scrap to entire populations. Regardless of cultures age and a number of other factors, which would make significant exposures of the type described virtually impossible from the outset. Can an 80 year old be expossed to cigarette smoke for 40 more years? How realistic is it to contend they all will? Can you say baby boomers?

    The creation of 450,000 in the States, with a ten percent population and corresponding 45,000 in Canada smoking a much different product with no additives sells gospel in place of science.

    If we look to the long term exposures that are apparent; a dose response relationship can be postulated by many of the hyperbole research results, which demonstrate higher risk among heavy smokers than lighter smokers. Plot the data points on an x/y chart and extend that line through the average bartender who is expossed to less than one cigarette a day. Look beyond that point and you find zero risk by casual exposures which exists beyond the point that all dose response risk goes below the baseline.

    If the prophets of gloom and doom wish to make their case show them the data points and ask them to explain the 450,000 numbers.

    We can take the data points formed by levels of exposure and duration in a dose response perspective, to demonstrate the same improbable points of health risk with the 4000 or now 100,000 "deadly ingredients" versus actual exposure levels as well. The higher the number of ingredients, in contrast to the current norm, should by logical perspective, indicate each ingredient by volume measure is extremely low and lowered again by every ingredient you add.

    Looking at the data points for the smoking studies in question, which show lower numbers of heart attack reductions, with higher population smoking ban studies consistently. Any level of intelligence should realize the reductions are not in total population, but among a much smaller subset of population. A data point so seldom provided. It should also be obvious with a higher population average of those "at risk" in smaller retirement communities than in larger urban centers [What subset would fit? the elderly perhaps?].

    For self described "experts", these people involved in selling the discomfort of smokers, seem to be a load short of a brick on all fronts.

    Zealotry does that to a person; it eliminates basic logic and reason as the disease progresses. What we can't fathom so far, is how a few damaged and phobic, one trick ponies, reduced to essentially pot head intelligence, can rise to lead so many.

    Always follow the money...

  • ||

    Limp wristing may cause others to call one butterfingered, while sitzkriegs can most certainly lead to sphincteralgia.

  • ||

    Tobacco Control organizations like the American Cancer Society, ASH, Tobacco Free Kids, etc., have become nothing but Perception Management firms. They are paid to CREATE "truth". Created truth is controllable. PM uses select information involving falsehood and deception. Really smoke and mirrors to get people to believe what they want the "truth" to be. Not to be confused with public diplomacy, Perception Management as a rule uses deception to influence emotions to an end. The difference between real and perception is like a stick of dynamite and the A-bomb. Wars can be created using Perception Management! Everyone, really, has seen PM in practice, and small business owners are experiencing this with legislation against their Constitutional rights. It requires absolutely no courage to support a popular position, even if completely wrong or illegal. This is a very dangerous road the public is taking in regard to enacting smoking bans!

  • battery||

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  • abercrombie milano||

    My only point is that if you take the Bible straight, as I'm sure many of Reasons readers do, you will see a lot of the Old Testament stuff as absolutely insane. Even some cursory knowledge of Hebrew and doing some mathematics and logic will tell you that you really won't get the full deal by just doing regular skill english reading for those books. In other words, there's more to the books of the Bible than most will ever grasp.

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