The Vanishing Miracle of Helena and Pueblo

A couple years ago, when anti-smoking activist Stanton Glantz started claiming that smoking bans have an immediate, dramatic impact on heart attack rates, I wondered why this effect was apparent only in Helena, Montana, and not in any of the much larger jurisdictions with smoking bans. I had a similar question a couple weeks ago, when researchers claimed that a ban in Pueblo, Colorado, had caused a 27 percent drop in heart attacks–not quite as amazing as the 60 percent drop (later reduced to 40 percent) attributed to Helena's ban, but still nothing to sneeze at. An effect this dramatic should have been noticed all over the country, wherever the government imposed broad restrictions on smoking.

A new analysis by David Kuneman and Michael McFadden of the Smoker's Club suggests why it wasn't: because it didn't happen. Looking at data for California, Florida, New York, and Oregon, Kuneman and McFadden found that hospital admissions for acute myocradial infarctions (AMIs) either went up after smoking bans took effect or declined very slightly. There is no evidence of an effect anything like that claimed by Glantz and other ban proponents (such as Rosemary Ellis, editorial director of Prevention magazine, who cited the Helena study in a 2003 New York Times op-ed piece as conclusive evidence that "secondhand smoke kills"). Kuneman and McFadden note that "the number of AMIs examined in Helena and Pueblo combine to a total of about 315," while "the number of AMIs examined in the combined states studied here total over 315,000, i.e. 1,000 times the number examined in the combined jurisdictions of Helena and Pueblo. And yet neither the medical journals nor the media have paid any notice at all to the fact that in vastly larger populations, virtually no change in acute myocardial infarction rates after smoking bans has occurred."

Michael Siegel, a rare smoking ban advocate who has compunctions about bending science to fit his cause, has extended Kuneman and McFadden's analysis by including more years and by comparing states with bans to states without bans and to the country as a whole. His conclusion:

These analyses demonstrate that on a state-wide level, there is no suggestion of any large-scale effect on heart attack admissions associated with the implementation of statewide bans on smoking in child-friendly restaurants, all restaurants, bars, or bars and restaurants.

If there were a true 27% or 40% decrease in heart attack admissions due to smoking bans that occurred almost immediately (within six months, as claimed), one would have expected to see a demonstrable decline in such admissions in states that implemented such bans.

Siegel adds:

Anti-smoking groups have been too quick to go to the media with definitive claims of a drastic and immediate effect of smoking bans on heart attacks when the scientific evidence is simply not sufficient to support such claims. What is happening, I believe, is that the anti-smoking agenda is driving the interpretation of the science. As I stated before, it is an agenda which, in this case, I wholeheartedly support (I have been lobbying for workplace smoking bans, especially those in bars and restaurants for 21 years). However, I don't think the importance of the ultimate objective justifies the use of shoddy science to support that objective.