Heart Attacks and the Massachusetts Smoking Ban

Jacob Sullum | November 17, 2008

Last week the Massachusetts Department of Public Health claimed a new study shows the state's smoking ban has resulted in 577 fewer heart attack deaths per year since it took effect in July 2004. The department, perhaps hoping its spin will be accepted before critics have a chance to examine the basis for it in detail, does not plan to release the study until next year. All we have to go on is a press release, a "fact sheet" (PDF), and a story in The Boston Globe. But several things are clear:

1) Heart attack deaths were already declining before the statewide ban; the researchers claim the trend accelerated after the law took effect.

2) Judging from the graph on the fact sheet, heart attack deaths (as a percentage of all deaths) fell sharply after the ban even in municipalities that were already subject to local smoking bans, including those that had "strong" laws. That's not what you'd expect if restrictions on smoking caused the decline.

3) The reduction in heart attack deaths reported by the Globe—30 percent over three years—is much smaller than  the effects attributed to smoking bans in other studies. The report on Helena, Montana, for example, initially claimed a 60 percent reduction in heart attacks within six months, which was later downgraded to 40 percent.

4) Although Massachusetts Public Health Commissioner John Auerbach says "we believe the single most compelling reason [for the decline in heart attacks after the ban] was reduced exposure to secondhand smoke in workplaces," it's not clear what biological mechanism would account for such a quick effect. It can't be that fewer people are developing heart disease, since that takes years. Presumably what Auerbach has in mind is that less secondhand smoke means heart attacks are less likely to be triggered in people with pre-existing heart disease. Is there any evidence that, prior to the ban, nonsmokers with heart disease were keeling over dead as a result of heart attacks triggered by exposure to secondhand smoke?

Michael Siegel, who seems to have had a look at the raw data, has more (emphasis added):

In the first year after the smoking ban was implemented, there was no significant decline in heart attack deaths in the state. Moreover, there was no decline in heart attack deaths even among just those residents living in towns that did not previously have smoking bans. Thus, this study refutes the conclusions from Helena, Pueblo, Bowling Green, etc. that smoking bans immediately reduce heart attacks by decreasing secondhand smoke exposure.

The study did find a decline in heart attack rates from the first to second year after the statewide smoke-free law was implemented, but it turns out that the magnitude of this decline was not significantly different in towns with or without smoking bans prior to the state law. Thus, the study provides no evidence that the statewide smoking ban was associated with any significant decline in heart attacks, even up to two years after its implementation.

Siegel adds that cities with smoking bans did see significant reductions in heart attack deaths compared to cities without such laws in the seven-year period from 1999 through 2006. They also had lower smoking rates, which suggests they may be seeing the results of improving health in former smokers who quit as a result of the ordinances. Case-control studies indicate that the heart disease rate among former smokers falls by about 50 percent within four years of quitting.

In short, even if secondhand smoke has no measurable impact on death rates, over the long term smoking bans can be expected to reduce the incidence of heart disease (and other smoking-related illnesses) by pressuring smokers to quit. From a "public health" perspective, in fact, that is the main benefit of smoking bans. But whether we're talking about smokers or nonsmokers, immediate, sharp reductions (within the first six months to a year) are not biologically plausible, and they're not what the Massachusetts study found.

Comments

|11.17.08 @ 1:24PM|#

What happened to point 3?

|11.17.08 @ 1:27PM|#

It was shown to cause cancer in 90% of rats.

libertarian democrat|11.17.08 @ 1:30PM|#

I am not quite sure point 4 is on target, but is interesting to think about anyway.

|11.17.08 @ 1:32PM|#

It was shown to cause cancer in 90% of rats.

Much like Lefiti.

|11.17.08 @ 1:33PM|#

Keep your fact-y witchcraft to yourself; correlation is causality.

Smoking bans reduce heart-attacks, cause Obamas to get elected, and increase deaths of Pauls Newman by 100%. This has been proven.

|11.17.08 @ 1:36PM|#

And in case none of you noticed, exiling Friday Night Lights to DirecTV 101 has been proven to cause economic meltdowns in the US and the collapse of the housing market.

|11.17.08 @ 1:36PM|#

Trolls are a known carcinogen and should come with an FDA black box warning.

|11.17.08 @ 1:40PM|#

They are also high in cholesterol, make your hair and clothes smell like ass, and are unsafe at any speed.

Paul|11.17.08 @ 1:52PM|#

What I find interesting is that often times, states or municipalities are doing other things in parallel to reduce heart attacks-- or moreover, deaths from heart attacks. These things often have nothing to do with smoking bans.

For instance, a few years ago King County ordered all police cars to carry defebrillators-- as a result the heart attack death rate for King County is one of the lowest in the country (as I understand). While this is certainly a good thing, it says nothing of rates of heart attacks themselves, nor does it speak to rates of heart disease. What they've done is improved your survivability if you have a heart attack. No one stopped the heart attack.

If these studies do not canvass for all the measures being taken to reduce heart attack deaths, then they're useless.

TallDave|11.17.08 @ 2:17PM|#

Wow, just think how many lives can be saved if they pass a ban on dying!

|11.17.08 @ 2:25PM|#

It actually did reduce heart attacks, but only because it reduced the sheer number of flip out moments where an anti-smoking zealot's head with a would explode with righteous indignation at the merest whiff of tobacco smoke.

OK, so it did decrease the number of deaths by exploding heads, which the study conveniently overlooked.

|11.17.08 @ 3:18PM|#

Thus, the study provides no evidence that the statewide smoking ban was associated with any significant decline in heart attacks, even up to two years after its implementation.

Logic is a bitch, ain't it?

For instance, a few years ago King County ordered all police cars to carry defebrillators-- as a result the heart attack death rate for King County is one of the lowest in the country (as I understand).

Careful with the "as a result" there, Paul.

Although it might be that just the thought of some half-trained jackboot shooting electricity through your heart is enough of a shock to get you going again.

|11.17.08 @ 3:27PM|#

It was shown to cause cancer in 90% of rats.

Which is a good thing, unless you like rats for some perverse reason.

|11.17.08 @ 3:28PM|#

even if it saves a few lives, the lives the people chose to live were their own free will. it IS NOT THE GOVERMENTS JOB TO NANNY YOU! they are supposed to provide defense against invasion and promote trade. It is up to YOU YOURSELF AND YOU! to make your own descions, if you want to smoke like a train and mainline trans fats, good for you, i will not but it is your choice, and neither I nor big brother have any say in that matter in a fre world. now in a 1984 world all menus and food shall be regulated, people engaging in unhealthful lifestyles as deemed by the goverment shall be reeducated. etc etc. see how stupid bans on smoking and trans fat etc are. they allow goverment at the dinner table and in your home, a place they SHOULD NEVER BE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

|11.17.08 @ 4:34PM|#

Tulpa, I'll have you know that liking rats is not perverse, and that they make very good pets.

Paul|11.17.08 @ 4:59PM|#

Careful with the "as a result" there, Paul.

But that's just it. There are 'competing' claims as to what's causing the reduction in heart attack deaths. It's possible that smoking bans cause a drop in heart attack deaths, but logic suggest that it can't account for anywhere near 100% of the drop since the ban. It just can't. If that were the case, we could probably drop all the other heart attack prevention methods, and just go with smoking bans. We'd probably save a lot of money on defibrillators. I hear-tell those things aren't cheap.

Robert Enders|11.17.08 @ 5:16PM|#

I am a security guard and an EMT-B. Here are some points:
1. It is easier to use a semi-automatic defibrillator than it is to program a VCR. You hook up 2 pads and press two or three buttons, depending on the model. The device that these police would using will not shock a person if it detects a normal heart beat.
2. The thought of having a half trained jackboot shocking you will not revive you if you are in cardiac arrest, because you won't be experiencing any conscious thought at all.
3. Defibrillators are getting cheaper and are appearing in shopping malls and restaurants. You can even get one for your home and have Medicare pay for it. As availability becomes more widespread, fewer people will die from heart attacks.

Paul|11.17.08 @ 7:46PM|#

Defibrillators are getting cheaper and are appearing in shopping malls and restaurants. You can even get one for your home and have Medicare pay for it. As availability becomes more widespread, fewer people will die from heart attacks.


FWIW, I totally agree.

|11.17.08 @ 10:02PM|#

This is a great site if you like bullshit. Sure, smoking is harmless.

Baja|11.18.08 @ 3:04PM|#

The researchers forgot that dioxin, in the smoke of typical chlorine-contaminated (paper and pesticide residues) cigarettes is already known to cause heart attacks...and a lot more.
No dioxin is possible from plain tobacco, the big scapegoat here.

If fewer people in that time period were exposed to dioxin (from typical Dioxin Dowels or elsewhere), that could account for fewer heart attacks. It could be because fewer people are driving polluting SUVs, or driving at all.

|11.18.08 @ 6:24PM|#

The Massachusetts study is just another confirmation of what is already known, that smoke free laws reduce heart attacks -- as evidenced by a long line of studies, including Helena, Pueblo, New York, Monroe County, Indiana, Italy, Ireland, and Scotland. Still, propagandists like Sullum try and pick apart each and every one that comes out, even as the science becomes more and more clear.

Sullum, who has taken money from the tobacco industry to write articles favorable to them, is not fooling anyone who doesn't want to be fooled.

|11.20.08 @ 4:11PM|#

Hmmm, jquizzix..... have you actually READ any of the studies you mention - Helena, Pueblo, Italy, Ireland etc. ?

If you have, there's the proof that the propagandist and liar is you, and not Mr. Sullum. But maybe you're just naive or lazy....