The Vanishing Miracle of Helena and Pueblo

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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.

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14 responses to “The Vanishing Miracle of Helena and Pueblo

  1. Groups with political agendas misrepresenting science to further their agenda? Shocking. I don’t believe it.

  2. “The fact remains, however, that publication of “negative” studies without adequate attention to having a large enough sample size to draw definitive conclusions remains a problem…”

    –Stanton Glantz, Primer on Biostatistics, 5th Ed. pg 197

    I’ve read most of this book at one time or another, and go back to it often. I can’t recall him ever addressing the opposite problem: a false positive due to a small sample size that will go away if you increase the sample size (something that happens in my lab all the time, hence the need for replication).

    Apparently, only positive results count as “definitive conclusions”.

    Dr. Glantz goes on:

    “Thus, in this area, like the rest of statistical applications in the medical literature, it is up to responsible readers to interpret what they read rather than take it all at face value.”

    Indeed.

  3. Am I missing something, or shouldn’t year-to-year population changes have been accounted for somewhere in this analysis?

  4. Mr. Wilson, Siegel addresses the issue of population changes in a post today: http://tobaccoanalysis.blogspot.com/2005/11/when-you-dont-like-what-you-hear.html. An effect of this magnitude should be apparent regardless of year-to-year population changes. In any case, Siegel’s comparisons with other states would make an AMI boost from general population growth irrelevant. It’s possible that population grew more in the states with bans (perhaps due to the attraction exerted by all those newly smoke-free bars and restaurants) but quite implausible that there was enough differential population growth to disguise a 40 percent (or 27 percent) drop in heart attack rates.

  5. It seems to me that myriad other factors could/are be(ing) ignored regarding the stats on heart attacks in the studied areas. For example, are the overall health statistics regarding the populations in the compared area otherwise the same? weight, age, gender, ethnicity?
    Does the time frame really allow for the the proported beneficial effects of the absence of smoke? Over the long term could the absence of smoke in some bars and restaraunts lead to greater patronage which could adversely effect other metrics for personal well being, like excess alcohol consumption or over eating of less healthy food…

  6. Does the time frame really allow for the the proported beneficial effects of the absence of smoke?

    Of course not. Its facially absurd to believe that the smoking bans would lead to instant, gigantic reductions in heart attacks.

    Only someone who is either (a) profoundly stupid or (b) deeply dishonest would say otherwise.

  7. As go Helena and Pueblo, so go the world!

    Eh…NOT!!

  8. Who would have thought the ID guys and the anti-smokers are similar?

    Lets pair them up, put ’em in bags and toss them in the ocean! Just like my aunt millie’s unwanted kittens!

  9. Does anyone know where to find the source data for the original Helena study, or if it’s available to the public?

  10. Who would have thought the ID guys and the anti-smokers are similar?

    Tell me about it. Just look at how many people seem to accept the claim that incidental exposure to second hand smoke is hazardous to health without anything approaching authoritative facts.

  11. http://www.webmd.com/content/Article/115/111726.htm

    Oh, but they were probably pressured into doing that by liberal Coloradoians. (Colorad’ohians?)

  12. Sulla wrote: “Does anyone know where to find the source data for the original Helena study, or if it’s available to the public?”

    I have publicly asked for the data for Helena and its clones to be made available over on Mike Siegel’s blog. I doubt it will be forthcoming.

    Maybe they’ve given it all to Philip Morris to lock up in the vaults that used to be filled with “secret tobacco industry documents” ?

    Michael J. McFadden
    Author of “Dissecting Antismokers’ Brains”
    http://TheTruthIsALie.com

  13. As long as we’re channeling David Byrne on today’s H&R:

    “Facts just twist the truth around”

  14. The unfolding of the Helena Haunting continues…

    http://bmj.bmjjournals.com/cgi/eletters/328/7446/977#123038

    Michael J. McFadden
    Author of “Dissecting Antismokers’ Brains”
    http://www.Antibrains.com

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