Heartstopping Discovery

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Anti-smoking activist Stanton Glantz is claiming that a smoking ban in Helena, Montana, cut heart attacks in half. "This striking finding suggests that protecting people from toxins in secondhand smoke not only makes life more pleasant, it immediately starts saving lives," he says.

Glantz and his co-authors have not published their research, which was reported at a recent meeting of the American College of Cardiology, so it is hard to evaluate. But descriptions of their findings, which were based on hospital records from the six months when the ban was in effect (it was suspended due to a legal challenge), prompt a few observations and questions:

1. Assuming the decrease in heart attacks was not coincidental, it could have been due to smokers who cut back or quit as a result of the ban rather than the elimination of secondhand smoke.

2. Even taken at face value, these data do not indicate that secondhand smoke causes heart disease, as Glantz and his fellow activists claim. Acute effects of the kind he is suggesting would be limited to people already suffering from heart problems. Robert West, a smoking cessation expert interviewed by the British magazine New Scientist, speculates that exposure to smoke triggers production of white blood cells, which generate clotting agents when they break down. "If someone is teetering on the brink of a heart attack," he says, "this clotting is likely to tip them over."

3. According to Glantz, the actual decrease in heart attacks was about four per month on average, from around seven to around three. Why didn't Glantz look at heart attacks in a big city with a smoking ban, such as Los Angeles or San Francisco, where the samples are much larger and a dramatic drop like the one he is claiming would have been obvious? Indeed, why haven't hospitals in such cities noticed that they are seeing about half as many heart attacks as they used to?

If you believe Glantz, the entire state of California should have seen a big drop in heart attacks when it banned smoking in all workplaces. Likewise Delaware. And now that New York state has adopted a similar ban, heart attacks should drop precipitously there as well. Or is there something special about the way hearts work in Helena?

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  1. Hey Lefty–

    Belive me, “utter nonsense” is the status quo among far too many clinical investigators. In my work I read 20-30 scientific studies a month, a significant portion of which are clinical studies (mostly about nicotine/smoking, as a matter of fact) conducted by MD’s. I’ve read some that do a wonderful job outlining the limitations of their study and are careful not to over-extend the significance of their results–but these are what I would consider “exceptional”.

    Most MDs don’t have a clue about how to conduct a controlled experiment and objectively present their results. This isn’t really their fault; MD training no longer emphasizes the scientific process. There’s just too much information for them to cram into two years of didactic instruction and two years of clinical rotations to train them as scientists as well as physicians.

    Most good physician-scientists have a PhD as well as an MD, or they had exceptionally good training in a basic science as an undergraduate.

  2. I suspect the smokers went outside to light up and froze to death before a heart attack got ’em.

  3. Brian, the reasoning applied in this study is similar to that of a politician; start with an agenda and make the facts fit. Any high school dropout can see the holes in thinking that an overnight cure exists for a long term, insidious condition such as heart disease by passing a city ordinance.

    If they say it long and loud enough, though, people will believe it.

  4. They opened a new hospital in East Helena?

    New ambulance team saving lives so they don’t die in the hospitals?

    There are so many ways to explain this that I thought it was an April Fool’s story.

  5. I wouldn’t be too quick to dismiss this story. Second hand smoke contains some nasty stuff – probably not enough to cause much chronic damage, but enough to raise heart rates, etc. Second hand smoke could well be the straw that broke the camel’s back. Is it really so insane to think that people on the verge of a heart attack might include a subset that spends a lot of time in smokey bars?

  6. The NPR story I heard actually went into some detail on this, listing possible reasons for this correlation, and didn’t seem ridiculous at all given more facts. They also specifically quoted other research which had previously shown some signs that 30 minutes of exposure to second-hand smoke similar to bar or restaurant levels did raise heart rate significantly and a few other heart-and-smoking related tidbits that combined with the statistics from Helena led them to make their conclusions.

    Still, I would suspect California would be a better model on which to base statistical analysis, and I’m willing to bet a dollar that the researcher in Montana really doesn’t like it when people smoke. 8^)

  7. Er, and Lefty: The ban was state-wide, immediate and comprehensive (smoking was banned in *all* public places), which somehow led the researchers to believe that they would get “better” results there than in other places where the ban has been either more local, more gradual, or had more exceptions.

  8. Studies have shown that merely speaking increases heart rate, respiration and blood pressure, too.

    My heart flutters a little in the titty bars…

  9. Doing a study over 6 months seems fishy to me. Humans, like every other creature on the planet, have seasonal variations in behavior and habits. A study of the 12 months before and after the ban would be more interesting.

  10. NPR reported this yesterday and I almost fell out of my chair at the obvious stupidity of linking immediate heart attack benefits to a city-wide ban on smoking.

    It would be pretty easy to find out if the 4 people were regulars at the bars and restaurants around Helena. Did they attempt to find out? Not as reported. My guess is they were in nursing homes or in their own home prior to kicking off. Or are they saying you benefit by reverse osmosis from miles away?

    Calling this “empirical evidence” and reporting it as a breakthrough is utter nonsense and they should be called on it.

  11. “The actual decrease in heart attacks was about three per month on average, from around seven to around four”

    There’s seven people in Helena?

  12. The sample group is clearly too limited to produce meaningful results.

    I don’t think many people think smoking is good for you, but I am consistently amazed at how the anti-smokers blatantly use exaggeration and misinformation in their campaigns.

  13. Tom, I don’t think it’s all attributable to advertising, but instead to a statewide smoking ban. The last time I visited California I noticed that even those who were still smoking were acting almost ashamed of it. I *was* walking around with a very young child, so that could have had something to do with it, but I suspect that ban accounts for most of the “tipping point” of anti-smoking sentiment in that state.

  14. From the LA times today:

    State health experts say that per capita tobacco consumption in California has declined by more than 60% from 2000 to 2002 and that Golden State smokers consume less than half the national average.

    Ergo, heart attacks should also have dropped 60%.

    Does anybody else smell something fishy in that 60% drop in a two year period, all attributed to advertising? Does it count smuggled cigarrettes?

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