First Nationwide Study Finds No Link Between Smoking Bans and Reductions in Heart Attacks

Last year, criticizing a CDC-commissioned report from the Institute of Medicine that endorsed highly implausible claims of immediate, substantial reductions in heart attacks resulting from smoking bans, I noted that the authors had ignored the most comprehensive study of the subject, which found no such effect. Now that study, which at the time of the IOM report was available as a working paper from the National Bureau of Economic Research, has been published by the Journal of Policy Analysis and Management. Instead of looking at small cities with volatile hospital admission numbers—the M.O. of studies that linked smoking bans to dramatic reductions in heart attacks—the authors of the new study, led by Kanaka Shetty of the RAND Corporation, used nationwide data to see if smoking bans were associated with changes in hospital admissions or mortality. "In contrast with smaller regional studies," they write, "we find that smoking bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases." In fact, "An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a smoking ban are as common as the large decreases reported in the published literature."

Since 2003, when activists began claiming that workplace smoking bans immediately cut heart attacks by 40 percent or more, I've been saying that some jurisdictions will see such drops purely by chance, while others will see no change or increases of similar magnitude. Before you can say that smoking bans are associated with short-term declines in heart attacks (leaving aside the biological plausibility of such a link), you have to show that the first phenomenon is more common than the other two. Anti-smoking activists such as Stanton Glantz, preferring to cherry-pick examples that fit their theory, have never done that, and now we can plainly see why: It isn't true. Although heart attacks do decline in some places with smoking bans, there are just as many places where they rise. On average, the difference between jurisdictions with smoking bans and jurisdictions without smoking bans is essentially zero.

So how was the IOM committee able to claim "consistent" results in favor of the claim that smoking bans immediately reduce heart attacks? Two words: publication bias. Shetty et al. write:

We show that there is wide year-to-year variation in myocardial infarction death and admission rates even in large regions such as counties and hospital catchment areas. Comparisons of small samples (which represent subsamples of our data and are similar to the samples used in the previous published literature) might have led to atypical findings. It is also possible that comparisons showing increases in cardiovascular events after a smoking ban were not submitted for publication because the results were considered implausible. Hence, the true distribution from single regions would include both increases and decreases in events and a mean close to zero, while the published record would show only decreases in events. Publication bias could plausibly explain the fact that dramatic short-term public health improvements were seen in prior studies of smoking bans....

We show that positive and negative changes in AMI incidence are equally likely after a smoking ban, which suggests that publication bias, not outcome heterogeneity, explains the skewed results seen in prior reviews. The IOM and other policymakers have relied on the weight of the published literature when making decisions. However, it appears that publication bias did not receive sufficient attention. Our results suggest that only positive studies have been published thus far, and the true short-run effects of governmental workplace smoking bans would be more modest in the U.S. Inclusion of such unpublished negative studies might change the conclusions of the IOM and other decision makers on this issue.

Don't hold your breath. Hyperbolic claims about drops in heart attacks following smoking bans, like hyperbolic claims about the mortal danger posed by the merest whiff of tobacco smoke, fit the agenda of the anti-smoking movement too well to ever be re-evaluated simply because they happen to be a load of crap. If the activists and officials who have endorsed these claims were concerned about telling the truth, they would not have been so reckless to begin with.

Michael Siegel, who for years has been doggedly criticizing the myocardial infractions of his fellow anti-smoking activists, wonders, "Will anti-smoking groups share and/or publicize the results of this new study or will they simply ignore evidence that does not fit their pre-determined conclusions?" Siegel's tobacco policy blog, where he regularly points out the unacknowledged whoppers told in the name of a smoke-free society, supplies the answer.

[Thanks to Bill Hannegan for the tip.]

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  • Almanian||

    God damn it! I finally quit smoking, and you guys keep coming out with these "oh, it doesn't matter, smoke yerssel tae death, or not, Almanian" articles! Stop it!

  • Almanian||

    ...although Mayor Bloomberg and the other statists nannies overlords No Labele-ers thank you!

    Er, wait or...no, they don't, either. Never mind...

  • ||

    The literature on smoking itself is pretty clear - it does put one at significantly greater risk.

    The risk of second-hand smoke is far more questionable and the bans on smoking in public places are little more than the non-smokers and nannies imposing their taste on others. While I don't like the smell of tobacco smoke, I can choose not to enter a restaurant or bar which allows smoking and I damn well have no business telling you you can't smoke in your own car.

  • ||

    Secondhand cigarette smoke makes me nauseous, gives me a pounding headache, makes my clothes and my hair stink. It's not just a matter of "taste". It makes me sick. Literally. People with compromised respiratory systems are affected even more. I think this is an issue where the whole "free to do what you want as long as it does not harm others" comes into play. Smoke all you want as long as you don't make other people sick. The only way I see to do this is to not smoke in most public areas.

  • Karl ||

    Unfortunately, people too often define "public areas" as "where ever I want to go" without regard to the desires of the actual owner of said "public area".
    -K

  • Max||

    Well, there you go. Smoking is in fact probably good for you. Thank God for libertarian skeptics who shine the light in dark corners of nanny-state supersticions. There is no fucking mercury in fish either, and lots of alcohol makes the liver stronger. Here's to looking at ALL the evidence.

  • Old Mexican||

    Re: Max,

    Max, H&R's pet yorkie.

    Here, Max! Here, boy, go fetch! That's a good boy! Yeah!

    No, no, noooo! Don't do your banalities on the carpet! Bad boy, Max! Bad, bad boy!

  • Old Mexican||

    It is also possible that comparisons showing increases in cardiovascular events after a smoking ban were not submitted for publication because the results were considered implausible.

    Now we know where the East Anglia dwellers learned their scientific methodology from: The anti-smoking zealots.

  • ||

    Seriously? That's the best they can do? Studies supporting the Received Wisdom weren't submitted?

    If that's all they got, then I hereby declare the Science to be Settled.

  • LarryA||

    The anti-smoking zealots learned it from the gun control folks, who learned it from the sex police, who learned it from the alcohol prohibition folks, who learned it from...

  • ||

    "Will anti-smoking groups share and/or publicize the results of this new study or will they simply ignore evidence that does not fit their pre-determined conclusions?"

    A query on the order of "Will the sun rise in the west tomorrow or will it continue to rise in the east?"
  • ||

    ^ blockquote fail ^

  • Old Mexican||

    I still don't like to smoke, thanks. But I certainly do not subscribe to downright LYING about smoking and its effects to call for a ban on people's choices.

  • ||

    Here's a newsflash - the truth of things counts for very little in the scheme of things.

  • ||

    If that is the case, try jumping out of a plane at 15,000 feet without a chute.

    Gravity is only a theory, after all.

  • ||

    A theory is defined as ~"damn near a scientific law". "Only a postulate" would be a better saying.

  • The Other Kevin||

    If there were a substance that, when spread by a person, immediately caused others in the vacinity to contract cancer, I'd say most sane people would push to ban that substance outright. However, that's not the case with smoking.

    I understand that the law of diminishing returns is at work here. Most people are well aware that smoking is bad for you and can cause some serious, even deadly, health problems. But in order to turn opinion even more strongly against smoking, cigarettes have to be portrayed as being more and more deadly.

    At some point, though, exaggeration will take away from the original message. When you go from "Smoking can cause a lot of health problems" to "OMG! ONE WHIFF OF SECONDHAND SMOKE CAUSES CANCER IMMEDIATELY", the whole message becomes a joke. I think this is a lot like sex offender lists. They expanded from listing actual rapists, to anyone who drew a dirty picture or any teenage who sexted their girlfriend. As a result the whole concept has become nothing but a joke.

  • Paul||

    Highly recommended book from the late nineties about the lies behind the anti-tobacco movement.

    The only thing about the book I disagree with is the subtitle: "And why it will fail" when referring to the anti-smoking scam movement.

    It has succeeded spectacularly.

  • Helen Lovejoy||

    Won't somebody please think of the children?

  • Statist||

    This just proves we need more smoking bans & funding.

  • Statists||

    Granted!

  • ||

    People with compromised respiratory systems are affected even more. I think this is an issue where the whole "free to do what you want as long as it does not harm others" comes into play. Smoke all you want as long as you don't make other people sick.

    This is where the whole personal responsibility thing comes into play. People who are unusually sensitive to tobacco smoke (or anything else) have a personal responsibility to look after themselves.

    Don't smoke. Don't go into smoking establishments. Ask people smoking near you to stop. That kind of thing.

    Not "Smoking makes me feel blecchy. Therefore, I am entitled to call upon the state to punish those who make me feel blecchy."

  • Statist Barbie||

    Personal responsibility is hard!

  • Allergic to Peanuts||

    This is where the whole personal responsibility thing comes into play. People who are unusually sensitive to tobacco smoke (or anything else) have a personal responsibility to look after themselves.

    Negative. The entire world must adjust its peanut consumption to my patterns of travel.

  • cynical||

    Don't be ridiculous. If someone is unusually susceptible, they're disabled, and everyone else should do whatever it takes to accommodate them. That's why we've banned peanuts and shellfish.

  • ||

    I don't think I am unusually sensitive. A big part of the reason there is an anti-smoking campaign is because it makes so many people sick. Again, it's the personal choice of the person to smoke that is affecting other people. Shitting on the sidewalk is disgusting and unsanitary. We have toilets for that sort of thing. Similarly, smoking is a dirty habit that, when done indiscriminately, creates a hazard for everyone around. Do it someplace where the hazard to others is minimized.

  • T||

    Funny, in most places, smokers were indoors in bars and restaurants. Then smoking bans started, and smokers were moved outdoors to annoy passersby.

    It's almost like it was an unintended consequence or something.

  • Brett L||

    The smell of gas station hotdogs has the same effect on me, but I'm not in favor of banning them, nor boycotting gas stations that sell hotdogs. I hang out in smoky bars so I don't have to deal with whiny bastards like you. Not smoking made me feel homicidal for years, but nobody cared about how I felt.

  • ||

    A big part of the reason there is an anti-smoking campaign is because it makes so many people sick.


    I am 55 years old and the "makes so many people sick" complaint is a recent phenomena. That tells me that something else is going on here.

  • johnl||

    When I was a kid, my grandparents smoked and it never bothered me. Then we stopped visiting them and I went years without any regular exposure to smoke. Now I get an allergic reaction before I even smell or see smoke.

  • ||

    John. If your comment is as tongue in cheek as it sounds then disregard this. If, however you are serious then you need help. You more or less openly admit that you talk yourself into being ill. That is an illness in itself. And just to let you know, you can't be allergic to tobacco smoke because it contains no proteins. The only allergy you'll aver have from it is one you talk yourself into.

  • ||

    RE: Helen Lovejoys' comment. Children were not allowed in pubs when I was young. It was against the law. Therefore adults went to the snug, back bar or tap room so they could enjoy a drink & smoke (at the same time!) with no children. Now we force people to smoke in their own homes in front of the children! Yes the ban was thoroughly thoughtout. Blame Caroline Flint & Dr. Jill Pell for the mess we are in!

  • Helen Lovejoy||

    so people never smoked at home before it was banned?

  • ||

    Hilarious! I grew up in a house where most people smoked. They smoked at the dinner table, usually after the meal was done, thankfully. I remember as a child, finishing my dinner while 4 or 5 people sat and smoked around the table. They smoked in the living room watching TV. I remember getting in the car, having my dad roll up the windows, light up a cig, and away we went. I remember getting burned accidentally as an adult, holding a cigarette, would gesture without looking around first.

  • ||

    I don't think I am unusually sensitive. A big part of the reason there is an anti-smoking campaign is because it makes so many people sick.

    Why is it that suddenly so many people are "made sick" by tobacco smoke? How did those same people (or the people who shared that propensity at the time) survive the decades where smoking in public was ubiquitous? Seriously, getting sick from tobacco smoke has got to be psychosomatic for at least a large percentage of those affected, if not the majority.

    Again, it's the personal choice of the person to smoke that is affecting other people. Shitting on the sidewalk is disgusting and unsanitary. We have toilets for that sort of thing. Similarly, smoking is a dirty habit that, when done indiscriminately, creates a hazard for everyone around. Do it someplace where the hazard to others is minimized.

    Like maybe a bar where you know people smoke, so people who are made sick by tobacco smoke can stay away from it?

  • johnl||

    It's not psychosomatic it's something else. Remember there didn't used to be so many asthmatics or peanut allergic people either. Maybe it was the widespread lowlevel application of tobacco smoke that was keeping us healthy.

  • ||

    Yeah, like a bar, outside, where the smokers who want to engage in that activity can do so, and those that don't want to won't have to. And no, it's not "psychosomatic". It makes people sick. How hard is that for you to understand?
    I have very good friends who smoke. I love them dearly, and I don't think they are lesser people because of the habit. I wish it did not make me sick, as it would be easier to spend time with them, but that is not the case.

  • ||

    Yeah, like a bar, outside, where the smokers who want to engage in that activity can do so, and those that don't want to won't have to.

    Why can't smokers sit inside? If you know that a bar allows smoking, and smoking makes you sick, what is so difficult about just not patronizing that bar? Quite aside from concerns like where the smokers are supposed to go if it's raining, or if it's snowing (as it is at this moment in the Twin Cities).

    Look, I'm not demanding that I be allowed to smoke wherever and whenever I want. I just want to have the option of bars where I'm allowed to smoke, rather than a blanket ban.

    Incidentally, I'm a pipe smoker. I have no desire to sit outside for an hour just to smoke a pipe; that means I generally don't smoke anywhere but at home. In general, I don't even care; I rarely smoke outside the house anyways. All I'm saying is that letting individual bar owners decide whether to allow smoking — bar owners! I'm not even arguing to allow smoking anywhere other than bars! — is more fair than a blanket ban on smoking.

    And no, it's not "psychosomatic". It makes people sick. How hard is that for you to understand?

    I didn't say it was psychosomatic in your case; it might not be. Even if it were, "psychosomatic" doesn't mean "not sick"; you're going to be sick, either way. It would only mean that you were sick because you expected to be sick. I have no way of knowing whether that's true in your case, but the rise in people who get sick from tobacco smoke with no reason behind it makes me think that it's because people expect to get sick from tobacco smoke.

  • T||

    Glad to see somebody else thinks most of the "smoking makes me sick" is psychosomatic.

  • ||

    I once had someone get upset from a new empty pipe that had never been smoked.

  • ||

    Single digit salute to the NAZIS........and kiss my white harley ridin ARSE!!! Bunch of bigotted lying PIGS!!

  • ||

    Again, it's the personal choice of the person to smoke that is affecting other people.

    There are two choices at work here: The choice of the smoker to smoke, and the choice of the non-smoker to stick around inhaling smoke until they puke.

    Why should we privilege the non-smoker's choice, again?

  • Marshall Keith||

    I was surprised that this study came out of the University of Wisconsin. One department does a legitimate study and another commits science by political agenda. They just released to JSOnline that prior to the ban the air in a bar was unhealthy by EPA standards. Problem is they only took one half hour sample and the EPA calls for a Minimum of 18 hours of sampling or the test is invalid.
    http://peoplesrepubmadison.wor.....al-agenda/

  • ||

    Unfortunately, this study will never see the light of day in any of the mainstream media outlets that have their tongue so deep within tobacco control's buttcrack that its coming out the other end. The NY Times, the WaPo, etc. gleefully printed the SGs "one whiff can kill you" press release. If they report this at all, it will be because they found that one of the authors of the study lived in the same college dorm as someone who went on to work for RJ Reynolds, and is therefore a mouthpiece for big tobacco.
    That being said, secondhand smoke and indoor smoking bans are old news for public health. Outdoor smoking bans, third and fourth-hand smoke (smoke particles from the clothes of someone who has been near a smoker - no, I am not making this up!), and encouraging employers, especially in health care, to refuse to hire smokers, are what the do-gooders are pushing for now. And to think that this all started 20 years ago with them merely asking for designated indoor smoking areas.

  • ||

    Everybody, believe what you want to. We would all like to live in an IDEAL world but the FACT is we don't. Facts such as 'no one person ever recorded from dying from SHS'! 160,000 deaths from tobacco every year, 250,000 from booze & 330,000 from poor diet, these definietly not facts but stated by previous government. Why? To introduce new laws therefore more taxes / fines!So let's just stick to facts, not estimates, not guesses, not wild one off surveys that question 100 people so it can be based on a population of 60,000,000!!
    Do you remember the smoking debate? According to ASH, Flint & Pell, smoking causes everthing from in-growing toe nails to cervical cancer. Now they say smoking does not cause many of the things stated at that time but what the hell, we've got the ban in because that's what WE wanted. In other words they lied!!
    Just go with the facts, if you can find them. For example, I asked Alan Johnson six times the number of people questioned for the governments' survey prior to the smoking debate. How many were smokers? How many non-smokers? Age groups etc etc the whole facts so I could gain a clear, concise understanding. Eventually I received ASH's estimates from one of his phelps! No facts. No relevent information, nothing. And this was the HEALTH MINISTERS' response.

    No facts.

    What a sad country we live in where we introduce laws based on estimates, guesses and non-facts.

    And Helen Lovejoy, people did smoke at home prior to the ban but now they are FORCED to. No choice in the matter.

  • Soft Cuddly Balls of Death||

    For several years, my town had smoking and non-smoking bars and restaurants, and the non-smoking places all went out of business. Given the choice, people just didn't go to them. Since that wasn't "fair", we now only have the "choice" of not smoking anywhere, even in a tobacco shop. Because, uh, FREEDOM! Or something. It's 40 miles to the nearest bar where I can smoke and drink, and do them at the same time, indoors. I live in Alaska, so that's a pretty big deal.

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