Did New York's Smoking Ban Cut Heart Attacks?

In his latest attempt to make the claim that smoking bans cause an immediate 40 percent drop in heart attacks seem less preposterous, Stanton Glantz is citing data from New York City, where a ban on smoking in bars and restaurants took effect in 2003. Glantz claims there was "a 13% drop in heart attacks in New York City" between 2003 and 2004, which "provides more evidence for a large immediate effect of eliminating exposure to SHS [secondhand smoke]." Michael Siegel, who supports smoking bans but has been challenging his fellow anti-smoking activists to stop abusing science in service of their cause, notes several problems with this argument:

1. A 13 percent drop does not make an effect three times as large seem plausible.

2. The New York City drop was in heart attack deaths, as opposed to heart attacks generally, which was the measure used in the Helena, Montana, study co-authored by Glantz that reported the 40 percent drop. Deaths are affected by changes in treatment as well as changes in risk factors, so you could have a drop in heart attack deaths without a drop in heart attacks.

3. The drop in heart attack deaths continued an accelerating downward trend that began years before the smoking ban took effect. Taking that into account, Siegel calculates that, at most, a 4.6 percent decrease in heart attack deaths could be attributed to the smoking ban.

4. The fact that heart attack deaths dropped after the ban took effect does not mean the ban caused the drop. By the same logic, Siegel writes, you could say the ban "caused a 9.3% reduction in drug and alcohol-related deaths in New York, since the number of deaths from drugs and alcohol dropped by this amount from 2003 to 2004." Maybe people are drinking less because the smoking ban has discouraged them from lingering in bars; maybe the ban has caused people to cut back on smoking and therefore on other forms of drug use associated with it. Or "one could conclude that the smoking ban caused almost a 10% increase in deaths from hypertensive heart disease, since deaths from this cause increased from 1,337 to 1,459 from 2003 to 2004. Perhaps what happened was that smokers, unable to smoke in bars and restaurants, became more anxious and their hypertension worsened." Siegel notes that Glantz has been quick to criticize such post hoc, ergo propter hoc reasoning when it's used to claim that smoking bans hurt business revenue.

Notice, too, that Glantz refers to a "large immediate effect of eliminating exposure to SHS." In a BMJ letter defending the Helena study, by contrast, he and his co-authors say it "is important to emphasize that the observed drop in AMI [acute myocardial infarction]...represents a combination of lower exposure to secondhand smoke as well as the fact that smokefree policies lead some smokers to cut down or quit." Glantz plays up the latter point when he's trying to make his claim seem plausible but ignores it when he's trying to show how dangerous secondhand smoke is. The publicity and press coverage surrounding the Helena study decidedly did not emphasize that the drop in heart attacks might have nothing to do with secondhand smoke, that it could instead be caused by a decrease in smoking.

As I've argued, even the latter explanation is inadequate to explain a drop of 40 percent. Siegel agrees.

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  • ||

    Um, I don't think you have to be a tobacco industry lobbyist to know that the deletirious effects of smoking (or breathing second hand smoke*) are cumulative and take a lot more than one year to occur. Likewise the benefits of quiting or being able to avoid second hand smoke.

    Who the fuck could possibly take a "study" like this seriously?

    *assuming there are any deletirious effects of second hand smoke.

  • ||

    Who the fuck could possibly take a "study" like this seriously?

    People already drinking the kool-aid, that's who. Most normal people's bullshit detectors go off like geiger counters with crap like this.

    I hate SHS myself, and I must say I'm enjoying my favorite watering holes more now that I don't come home reeking like last-week's ashtray, but come on.

  • ||

    "Most normal people's bullshit detectors go off like geiger counters with crap like this."

    By normal I am assuming you mean about 1% of the population. Normal people (normal in the sense of average) are very receptive to Bullshit. Look at the popularity of John Stossel.

  • ||

    Heard on the news this morning that a Chicago suburbs (Elk Grove, I think?) has proposed making it illegal to SELL cigarettes. Prohibition, here we come!

  • ||

    As it happens, I agree with you. In the old days, smoking regulations made a lot of sense. Smoke-free restaurants and cafe's are pleasant for both casual smokers and non-smokers alike. It's only a nicotine fiend that needs to smoke during a meal.

    The real issue is: an awful lot of people think it's impolite to smoke during mealtime. And the old days (1985), non-smoking areas were genuinely inadequate. Yes, non-smokers have a "right" not to go to a restaurant that allows smoking just as smoker has the "right" to do the opposite. Strangely, the market wasn't providing a very good solution for non-smokers; they went, and had a less-than-perfectly-enjoyable meal. It unfortunately took government prodding to level things up. I'm the first to admit it: smoking regulations are for reasons of etiquette, with health as a good excuse to do so.

    Now, things have gone to far the other way. I agree on one issue: second-hand smoke for waitrons has got to make working in a bar a lot less fun. Of course, such jobs are self-selecting: most waiters and waitresses in smoky bars seem to smokers themselves...

    This moderate liberal thinks: set a level playing field with reasonable ventilation regulations to avoid the old race-to-the-bottom perverse market from the old days. And leave it at that. For what it's worth, I voted against the crazy new Washington State smoking ban.

    This moderate liberal is also fully sympathetic to conservative appeals to regulation of pornography. Not to ban it, but to keep it out of public places where you otherwise would have no choice but to have it in your face.

    For example: the bucket of X-rated videos with female genitalia on the cover at the local convenience store just doesn't belong next to the pasta section, no matter how useful it might otherwise be for product placement.

  • ||

    linguist,
    Looks like you have a potentially lucrative part-time gig there.

  • ||

    People Adapt, a small dose of "regulation" (we tell you how to live) can often be absorbed in a free society.

    In California, the first state to outlaw smoking indoor in public places, most small bar owners have started using a loophole in the law. California law banning smoking has a clause that says bars with less than 2 employees are exempt from the rule. So many bar owners have given a 0.005% ownership of their business to the busboys, servers and dishwashers, making them Part-Owners who get salaries and therefore the business has 0 employees and 25 owners.

    But even that aside in other places, going outside and hanging out with other smokers has created a great conversation starter. I've met many girls and a few good friends while outside having a smoke and gasping for the second hand smoke of a hot girl. (give me cancer baby!)

    I know being in freezing weather must make this particularly annoying of course.

    The law is stupid, next they'll outlaw knives because they are known to have cause 123444 deaths and injuries every year. And to compensate for all the "Knife Free" kitchens a new tax will be introduced to pay for the government agency who will do the "cutting" of poultry and other items for the public, since cutting your food is far too important to be left to the markets and thus must be regulated. There will also be a multi-million dollar budget for a new department in the federal government to "educate" the public, spend a few million dollars a year on advertising and then declare a War on Knifes and then erect another department with a multimillion dollar budget to combat all the knife bootleggers and illegal knives coming from Mexico and Canada. Oh and knife makers support Terrorists!!!

    (the knife bit was of course exaggerated)

  • ||

    Looks like you have a potentially lucrative part-time gig there.

    Hmmm. You're right! I've connections in southern states, too...
    I'll cut you in for giving me the idea, mk!

  • ||

    (the knife bit was of course exaggerated)

    Im not sure how bad the exaggeration was, considering that banning pointed knives has been proposed in the UK. Apparently this will end the "rash of stabbings" they've experienced.

    If that doesn't work presumably they will license the possession of grindstones.

  • ||

    HAHAH, Isaac. This relates so well to the other thread about England, and I love this story:

    I moved to London just after the ban on handguns. There was a sudden rash of robberies with samarai swords and muggings by toaster! LOL

  • ||

    Bazil writes:
    [It's perfectly nice to go outside for a smoke after the meal.]

    Well, yes. That is a traditional solution to the problem: retire to the library for cigars and port. Probably it's more fun in a mixed setting. The idea that smoking should be avoided during a meal is a tradition that should never have been lost in the first place.

  • ||

    thecoach,
    I know I'm a little late posting this....but what's wrong with John Stossel?

  • ||

    Wow! 13% of all heart attacks were caused solely by smoking in bars and restaurants alone? That's insane! Thank you NYC for prolonging the lives of those smokers by an additional 13%. So now they'll die at 60 instead of 55? Great! That's five more years of taxes they'll get to pay to fund all those great social engineering projects we need, like smoking bans.

  • ||

    Wow. So did I just imply that there's a vast conspiracy afoot to keep us all alive longer so we'll pay more taxes? *shudder*

  • ||

    The smoking ban in bars must be the cause of this. Because when I go out, I see so many middle-aged men with heart conditions in Manhattan and Brooklyn bars.

    Wait a second, that's not true at all!

    A simple demographic survey of the NYC bar crowd would point out what obvious BS this supposed correlation is. I guarantee the average age of a bar goer in NYC is well below the age in which any real risk of heart disease kicks in.

    Older people do frequent bars, but not enough of them do for it to be the reason why there has been a 13% decrease in heart attacks, or heart attack deaths.

  • ||

    Doesn't matter, you know: the anti-smoking crowd (particularly those self-righteous assholes who make those godawful TV PSAs) will ignore the cirticism and quote the Glantz figures as if it were the Sermon On The Goddamn Mount. But hey: never let the facts get in the way of "The Truth"...

  • ||

    The law is stupid, next they'll outlaw knives because they are known to have cause 123444 deaths and injuries every year.

    No, they won't, because these bans were never about "health" in the first place, or certainly not primarily about health. Mostly they are about satisfying the demands of the majority who don't want to smell it.

    The idea that smoking should be avoided during a meal is a tradition that should never have been lost in the first place.

    Smoking in a restaurant was never about smoking "during" the meal, it was about both having something to do before the food arrives, and then enjoying a smoke after finishing the meal. It just happens that these times don't coincide for the whole group of people in the restaurant.

  • charles||

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