Smoking Ban Increases Heart Attacks


Anti-smoking activists claim smoking bans in Scotland and Wales led to immediate, sizable reductions in heart attacks. In both cases, Michael Siegel shows on his tobacco policy blog, these assertions are unfounded.

An article in the July 31 New England Journal of Medicine cites a 17 percent decline in hospital admissions for acute coronary syndrome during the first 10 months after the Scottish ban took effect at the end of March 2006. Siegel notes that the comparison was based on data from only nine hospitals. Based on data for all Scottish hospitals, he reports, the post-ban drop in heart attacks looks similar to declines seen in previous years. Between 2005 and 2006, heart attack admissions fell by 4.3 percent, slightly smaller than the 4.6 percent drop from 2003 to 2004. The difference between 2006 and 2007 was 8 percent, smaller than the 10.2 percent difference between 1999 and 2000. The two-year drop from 2005 to 2007 (11.9 percent) was not much bigger than the two-year drop from 1999 to 2001 (10.7 percent). Although "the analysis in this paper assumes that the entire observed change in heart attacks is attributable to the smoking ban," Siegel writes, "one cannot rule out the very plausible alternative hypothesis that the observed decline in heart attacks is explained by random variation in the data and the already existing secular trend of declining heart attacks in Scotland."

In the case of Wales, U.K. Action on Smoking and Health and the British Heart Foundation cited a 13 percent drop in heart attacks as evidence of the smoking ban's immediate positive effect. But as Siegel shows, drawing on data presented by Christopher Snowdon, this decline appears only if you compare the arbitrarily selected months of October through December 2007 to those same months in the previous year. But the Welsh smoking ban took effect in early April 2007. Data for the entire nine-month period between then and the end of the year show virtually no change in heart attack admissions compared to the same months in 2006. The overall drop between 2006 and 2007 was about 1 percent, much smaller than the drops seen from 2004 to 2005 (10.3 percent) and from 2005 to 2006 (6.3 percent). Furthermore, heart attacks rose in the first five months after the ban before falling again in the next four months. Based on the post hoc, ergo propter hoc logic of activists who assume that any decline in heart attacks following a smoking ban must be due to the ban, Snowdon writes, "we might even say that the smoking ban 'caused' a rise in heart attacks in Wales."

As I've said before, many of the jurisdictions that adopt smoking bans inevitably will see declines in heart attacks in the year or two after the bans take effect. If you focus only on those jurisdictions while ignoring random variation and pre-existing trends, it's not hard to create the illusion of an effect, especially if everyone forgets how biologically implausible it is for heart attacks to fall so quickly in response to a smoking ban (whether because of less smoking, less secondhand smoke exposure, or some combination of the two). Given the vast potential for cherry-picking data, the remarkable thing is what a bad job the ban boosters are doing.

More reason coverage of smoking bans and heart attacks here.

NEXT: About as Effective as D.A.R.E.

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  1. Um, you're getting out in front of the evidence here. The medical literature suggests that the "risk of a coronary event in ex-smokers declines rapidly after quitting and within 2-3 years is similar to the risk for non-smokers."*

    Sure, not everybody will quit after a smoking ban takes effect, but those who do will have significantly fewer heart attacks. Whether smoking bans decrease heart attacks is unclear to me, but it's not implausible that they do.

    And anyway, aren't you better off arguing that people have a right to kill themselves by smoking, rather than disputing this particular finding? Picking a fight with the American Cancer Society and the medical establishment only makes you look like a crank.

    *--AJ Dobson, "How soon after quitting smoking does risk of heart attack decline?", J Clin Epidemiol. 1991;44(11):1247-53

  2. I LOVE statistics!

  3. Actually showing their dodgy science Danny makes them(ACS et al) look like Cranks. Micheal Siegel and Chris Snowdon are quite well informed in this field.

  4. Also Danny since when were the ACS heart specialists?

  5. Wow, now who would have thunk it. That is amazing.


  6. And look at the comment: "...And anyway, aren't you better off arguing that people have a right to kill themselves by smoking, rather than disputing this particular finding? Picking a fight with the American Cancer Society and the medical establishment only makes you look like a crank..."

    That is the type of mentality that just amazes me to no end. How can someone be so STUPID?

    Don't they understand that the group that is standing behind those lies, the group(s) that are publishing those lies are LYING?

    The writer of that comment refuses to see or is too stupid to understand the underyling and key point of the article -- the very "professionals" or "experts" she\he is counting on to provide truth and guidance IS LYING.

    Whether or not one believes in TC or banning fat or banning smoking or banning mountain climbing or whatever the nannies decide is "bad" for us -- any "evidence," any "science" any "recommendations" any "studies" any "results" are ALL QUESTIONABLE because of the FACT that LIES and false information and cherry-picking data to "prove" a point no matter what is A FRAUD and can not be believed. If they can lie for one "cause" they can lie for any other that suits their fancy

  7. Didn't you know, correlation implies causation?

  8. Now that all the bases have been covered, anyone see that fucking hilarious Paris Hilton kicking McCain in the balls ad yet?

  9. Why can't people just admit that their ideas are wrong?? I know it's a dumb question, but not every idea(i.e. smoking/trans-fat bans, gun control, welfare, socialized medicine etc) is going to work. We don't live in an ideal world and people shouldn't expect lofty ideals to carry the day. It's just not reality.

  10. >"risk of a coronary event in ex-smokers >declines rapidly after quitting and within 2->3 years is similar to the risk for non->smokers."*

    This is true only because smokers DO NOT have 'elevated risk' of heart disease. You can look at all the data you want, you will NOT find very many even MARGINALLY statistically significant corelations of that, and you will NEVER find EVEN ONE STUDY of ANY 'health issue' that 'they say' is 'caused' by smoking - including LUNG CANCER - that comes ANYWHERE NEAR the standard that should be used to indicate POSSIBLE cause and effect relationship. You (and we all) have been fed loads and loads of BULL, most of it generated, financed, and driven by Big pHARMa (pharmaceutical company interests). Check out how the People's Republic of California's medical costs have SKYROCKETED since their 10 year statewide smoking ban, and with their having the 2nd lowest percentage of smokers in the USA. check out ACS (American Con..er..Cancer Society, ALA - American Liar..er..lung Association, AHA - American Hypocrite..er Heart Association at http://www.activistcash.com, for some eye opening stuff. Just for fun, also check out John Banzhaff there.

  11. >K.T. | August 5, 2008, 10:28pm | #
    >Didn't you know, correlation implies causation?

    Correlation does NOT EVER PROVE 'cause and effect'. Else, I proved my rooster crowing CAUSES the sun to come up. There is a 100% correlation .

    Sorry, could NOT resist. This is the logical idiocy that has been driving too many of these debates. Although it's true, IF there is a cause and effect going on one SHOULD see a VERY HIGH correlation, the fact that a correlation is high DOES NOT conversly mean there has to be any relationship - or it could even be the OPPOSITE type of relationship than what you expect. So the FACT that the VERY HIGHEST correlation of LUNG CANCER with smokING I've ever seen is only about 10% PROVES ABSOLUTELY that there is NO possible way that smokING could be a single, or even a 'primary' cause of lung cancer. The 'scientific' (more properly called JUNK science, as that's REALLY WHAT it is)correlations of smoking and HEART or ANY other disease aproach ZERO, as do EVERY study EVER done of so called health problems and so called second hand smoke. Lots more info is at http://www.forces.org

  12. I'm sorry. My brain froze up at the quixotic capitalization of "smokING".

    And then it unfroze just in time to read the stupidest sentence ever typed on teh Internetz:

    So the FACT that the VERY HIGHEST correlation of LUNG CANCER with smokING I've ever seen is only about 10% PROVES ABSOLUTELY that there is NO possible way that smokING could be a single, or even a 'primary' cause of lung cancer.

    Hey jackass, weren't you like, two seconds ago, humorlessly and needlessly harping on the very fact that correlations OF ANY SORT (shit, it's catchy) do not bear upon any causation or lack thereof?

  13. The anti-smoking crusaders cherry pick the data they present and much of the media swallows/parrots it. I'm not exactly shocked.



  15. The point is, as JM suggests, that the deceptions have become so pervasive -- we're beyond the point where any of these "public health" statements can be trusted. When credibility is gone, it's gone.

  16. We looked at states' heart attack admissions pre and post ban, and found no difference compared to states without bans. http://kuneman.smokersclub.com/hospitaladmissions.html

  17. Reposting after a cyberspace burp:
    Danny K wrote, "And anyway, aren't you better off arguing that people have a right to kill themselves by smoking, rather than disputing this particular finding? Picking a fight with the American Cancer Society and the medical establishment only makes you look like a crank."

    Danny, I believe the point Jacob Sullum is trying, diplomatically, to make is that the American Cancer Society and many other of the "responsible organs and authorities" in the field have actually themselves been taken over by cranks.

    As to the importance of "this particular study," you need to realize that this is but one of almost a dozen instances which have virtually *ALL* involved similar manipulations and misinterpretations of data and results in order to present a picture agreeable with the political push for smoking bans.

    Rather than have you run all around the web, I'll suggest you simply go to the Flagship example of these studies, The Great Helena Heart Miracle, and read through the BMJ-Editor-Approved Rapid Responses there:


    I would suggest paying particular attention to "Helena 100 Days" to see the summary of unanswered criticisms that the authors have, to this day four years later, completely refused to address or defend... seemingly with full sanction by the BMJ since it has refused to print at least one valid counterstudy and also continues to print research from at least one of these seemingly irresponsible researchers.

    These studies have had *tremendous* impact in convincing legislators of the need for smoking bans and that impact was *exactly* what was intended... scientific integrity be damned.

    Kudos to Jacob Sullum.

    Michael J. McFadden
    Author of "Dissecting Antismokers' Brains"

  18. For crying out loud, the anti-smokers' claims in this study are fraudulent for the simple reason that, although they collected data on secondhand smoke exposure, they didn't present any results on whether reduced exposure made any difference. The only results they presented showed similar declines among smokers, ex-smokers, and non-smokers alike, without reference to whether they had any less exposure. They only reported that "Persons who had never smoked reported a decrease in the weekly duration of exposure to secondhand smoke ... that was confirmed by a decrease in their geometric mean concentration of serum cotinine from 0.68 to 0.56 ng per milliliter."

    But among these people, was there any decline in the rates in comparison to those who did not experience any decline in exposure? THEY DO NOT SAY, probably because there was nothing to report - which is to be expected, considering that the decline was similar in active smokers, for whom exposure to secondhand smoke is virtually irrelevant.

    This is consistent with the decline in heart disease that has been going on "only" for the last five decades!

    The Rise and Fall of Ischemic Heart Disease, by Reuel A. Stallones. Scientific American, Nov. 1980. He notes that supposed "explanations" such as diet, exercise, and smoking do not adequately account for the changes in the death rates. It includes graphs of death rates by age beginning in the 1800s, and showing the increase that began around 1920.

    "Between 1900 and 1920 the death rates attributed to diseases of the heart were relatively stable. An abrupt change came in 1920, when an upward trend was established that continued for 30 years. The abruptness of the change was accentuated by a deficit of deaths in 1919, the year that followed the excessive mortality of the influenza pandemic of that time... An examination of the deaths by 10-year age groups shows, however, that the change in slope was characteristic of the mid-adult years. The death rates for diseases of the heart among people younger than 35 decreased steadily throughout the first half of the century, and the death rates increased steadily for people older than 75. If the change in slope were due to vagaries in the reporting or the classification of the deaths, then the reason for the change to be so highly selective for the age groups between 35 and 75 is obscure... Through 1950 the death rates increased steadily for the old and decreased steadily for the young. The change in the trend of the death rates that came in 1920 affected the people whose ages were in between. In contrast, the recent decline in the death rates has affected all age groups... The mortality rates for ischemic heart disease reached their peak in the mid-1960's, and by 1970 a declining trend was well established... The decline in cigarette smoking has been much more pronounced, however, in middle-aged men than in middle-aged women, a difference that is not at all in accord with the equivalence in the decline in mortality for the genders. Moreover, the lack of association for older people between ischemic heart disease and smoking as well as serum cholesterol raises the question of how a reduction in smoking could effect a decrease in risk for this age group." (The Rise and Fall of Ischemic Heart Disease. RA Stallones. Scientific American 1980 Nov;243(5):53-59.)


    The decline in death rates since 1970 has been as large among smokers as among non-smokers.

    Temporal trends in coronary heart disease mortality and sudden cardiac death from 1950 to 1999: the Framingham Heart Study. CS Fox, JC Evans, MG Larson, WB Kannel, D Levy. Circulation 2004 Aug 3;110(5):522-527. "Nonsudden CHD death decreased by 64%, and SCD rates decreased by 49%. These trends were seen in men and women, in subjects with and without a prior history of CHD, and in smokers and nonsmokers."


    In fact, the difference in heart disease rates between smokers and non-smokers is consistent with different rates of exposure to an infectious genuine cause or causes, to which the population as a whole has experienced less exposure over the last several decades.

    Furthermore, because they are incapable of identifying the major cause(s) of heart disease, they are incapable of controlling for confounding by it and therefore they are not entitled to make specious claims about lesser so-called "risk factors" (which are weasel words in the first place.)

  19. or we could just say that since half of all nonsmokers die from vascular diseases, and if the claim is true that smoking increases these risks 2.25-fold, then more than all smokers die from vascular diseases, and there are none left over to die from lung cancer.

  20. Why isn't anybody stating the most important aspect here?

    Even if a smoking ban caused a verifiable 100% decline in heart attacks, it doesn't change the fact that it is still a choice.

    One could argue that wearing a motorcycle helmet decreases motorcycle highway deaths by x%, but it won't change the fact that people have the right as to whether or not they wear that helmet.

    People will argue that ETS harms "innocent" people - something that diverges from the helmet argument - but in reality it's no different. No person is exposed to smoke who hasn't made the choice to do so. Nobody forces another to walk into a bar. Nobody forces you to sit there and deeply inhale. It is 100% within one's own control.

    These "studies" are meant to snowblind the public and force them into a submissive posture. After all, if innocent people can be saved, shouldn't we do all we can to do so? Yet, this tactic is only successful because few are successfully fielding the argument of choice.

    We can refute facts until we're blue in the face, but what has it gotten us so far? It's all about choice...

  21. Ryan, you are way wrong on this. The facts have hardly ever been argued so far before state legislatures and city councils considering smoking bans. If, as the ACS falsely says, working eight hours in a venue that allows smoking equals smoking 16 cigarettes, property rights and choice arguments won't stop or repeal bans. We have to win this fight by accurately stating the risks, if any, secondhand smoke in bars and restaurant presents. That's what we did in St. Louis and we beat the antismoking movement there as badly as it could be beaten.

  22. Scientific Evidence Shows Secondhand Smoke Is No Danger

    Written By: Jerome Arnett, Jr., M.D.
    Published In: Environment & Climate News
    Publication Date: July 1, 2008

    The Heartland Institute

    Exposure to secondhand smoke (SHS) is an unpleasant experience for many nonsmokers, and for decades was considered a nuisance. But the idea that it might actually cause disease in nonsmokers has been around only since the 1970s.
    Recent surveys show more than 80 percent of Americans now believe secondhand smoke is harmful to nonsmokers.
    Federal Government Reports
    A 1972 U.S. surgeon general's report first addressed passive smoking as a possible threat to nonsmokers and called for an anti-smoking movement. The issue was addressed again in surgeon generals' reports in 1979, 1982, and 1984.

    A 1986 surgeon general's report concluded involuntary smoking caused lung cancer, but it offered only weak epidemiological evidence to support the claim. In 1989 the Environmental Protection Agency (EPA) was charged with further evaluating the evidence for health effects of SHS.
    In 1992 EPA published its report, "Respiratory Health Effects of Passive Smoking," claiming SHS is a serious public health problem, that it kills approximately 3,000 nonsmoking Americans each year from lung cancer, and that it is a Group A carcinogen (like benzene, asbestos, and radon).

    The report has been used by the tobacco-control movement and government agencies, including public health departments, to justify the imposition of thousands of indoor smoking bans in public places.
    Flawed Assumptions
    EPA's 1992 conclusions are not supported by reliable scientific evidence. The report has been largely discredited and, in 1998, was legally vacated by a federal judge.

    Even so, the EPA report was cited in the surgeon general's 2006 report on SHS, where then-Surgeon General Richard Carmona made the absurd claim that there is no risk-free level of exposure to SHS.
    For its 1992 report, EPA arbitrarily chose to equate SHS with mainstream (or firsthand) smoke. One of the agency's stated assumptions was that because there is an association between active smoking and lung cancer, there also must be a similar association between SHS and lung cancer.
    But the problem posed by SHS is entirely different from that found with mainstream smoke. A well-recognized toxicological principle states, "The dose makes the poison."

    Accordingly, we physicians record direct exposure to cigarette smoke by smokers in the medical record as "pack-years smoked" (packs smoked per day times the number of years smoked). A smoking history of around 10 pack-years alerts the physician to search for cigarette-caused illness. But even those nonsmokers with the greatest exposure to SHS probably inhale the equivalent of only a small fraction (around 0.03) of one cigarette per day, which is equivalent to smoking around 10 cigarettes per year.
    Low Statistical Association

    Another major problem is that the epidemiological studies on which the EPA report is based are statistical studies that can show only correlation and cannot prove causation.
    One statistical method used to compare the rates of a disease in two populations is relative risk (RR). It is the rate of disease found in the exposed population divided by the rate found in the unexposed population. An RR of 1.0 represents zero increased risk.

    Because confounding and other factors can obscure a weak association, in order even to suggest causation a very strong association must be found, on the order of at least 300 percent to 400 percent, which is an RR of 3.0 to 4.0.
    For example, the studies linking direct cigarette smoking with lung cancer found an incidence in smokers of 20 to around 40 times that in nonsmokers, an association of 2000 percent to 4000 percent, or an RR of 20.0 to 40.0.

    Scientific Principles Ignored

    An even greater problem is the agency's lowering of the confidence interval (CI) used in its report. Epidemiologists calculate confidence intervals to express the likelihood a result could happen just by chance. A CI of 95 percent allows a 5 percent possibility that the results occurred only by chance.
    Before its 1992 report, EPA had always used epidemiology's gold standard CI of 95 percent to measure statistical significance. But because the U.S. studies chosen for the report were not statistically significant within a 95 percent CI, for the first time in its history EPA changed the rules and used a 90 percent CI, which doubled the chance of being wrong.

    This allowed it to report a statistically significant 19 percent increase of lung cancer cases in the nonsmoking spouses of smokers over those cases found in nonsmoking spouses of nonsmokers. Even though the RR was only 1.19--an amount far short of what is normally required to demonstrate correlation or causality--the agency concluded this was proof SHS increased the risk of U.S. nonsmokers developing lung cancer by 19 percent.
    EPA Study Soundly Rejected

    In November 1995 after a 20-month study, the Congressional Research Service released a detailed analysis of the EPA report that was highly critical of EPA's methods and conclusions. In 1998, in a devastating 92-page opinion, Federal Judge William Osteen vacated the EPA study, declaring it null and void. He found a culture of arrogance, deception, and cover-up at the agency.
    Osteen noted, "First, there is evidence in the record supporting the accusation that EPA 'cherry picked' its data....

    In order to confirm its hypothesis, EPA maintained its standard significance level but lowered the confidence interval to 90 percent. This allowed EPA to confirm its hypothesis by finding a relative risk of 1.19, albeit a very weak association.... EPA cannot show a statistically significant association between [SHS] and lung cancer."
    The judge added, "EPA publicly committed to a conclusion before the research had begun; adjusted established procedure and scientific norms to validate its conclusion; and aggressively utilized its authority to disseminate findings to establish a de facto regulatory scheme to influence public opinion."

    In 2003 a definitive paper on SHS and lung cancer mortality was published in the British Medical Journal. It is the largest and most detailed study ever reported. The authors studied more than 35,000 California never-smokers over a 39-year period and found no statistically significant association between exposure to SHS and lung cancer mortality.

    Propaganda Trumps Science

    The 1992 EPA report is an example of the use of epidemiology to promote belief in an epidemic instead of to investigate one. It has damaged the credibility of EPA and has tainted the fields of epidemiology and public health.
    In addition, influential anti-tobacco activists, including prominent academics, have unethically attacked the research of eminent scientists in order to further their ideological and political agendas.
    The abuse of scientific integrity and the generation of faulty "scientific" outcomes (through the use of pseudoscience) have led to the deception of the American public on a grand scale and to draconian government overregulation and the squandering of public money.

    Millions of dollars have been spent promoting belief in SHS as a killer, and more millions of dollars have been spent by businesses in order to comply with thousands of highly restrictive bans, while personal choice and freedom have been denied to millions of smokers. Finally, and perhaps most tragically, all this has diverted resources away from discovering the true cause(s) of lung cancer in nonsmokers.


    Air quality test results by Johns Hopkins University, the American Cancer Society, a Minnesota Environmental Health Department, and various researchers whose testing and report was peer reviewed and published in the esteemed British Medical Journal......prove that secondhand smoke is 2.6 - 25,000 times SAFER than occupational (OSHA) workplace regulations:


    All nullify the argument that secondhand smoke is a workplace health hazard.
    Especially since federal OSHA regulations trump, or pre-empt, state smoking ban laws which are not based on scientific air quality test results.
    Mark Wernimont
    Watertown, MN.
    US Supreme court decision 1992 NEVER OVERTURNED...

    A U.S. Supreme court decision during the early 1970's ((Lloyd Corp v. Tanner, 407 U.S. 551 (1992)) said a place of business does not become public property because the public is invited in.

    So, by that same reasoning. A restaurant or bar is not public property. We need to support small business and stop regulating them out of business.

    Richard Doll was the British doctor who discovered the link between smoking and lung cancer. Here's what he said about the risks of shs.

    "His findings have sometimes sparked controversy. So too has the man.

    In 2001, he riled the anti-smoking lobby after appearing to downplay the risks from second-hand smoke.

    In an interview on BBC Radio 4's Desert Island Discs, he said: "The effects of other people smoking in my presence is so small it doesn't worry me."


    In Ohio, a year after the comprehensive smoking ban, 8 Senators have introduced a bill: SB346 to provide exemptions to the ban for family-owned businesses and private clubs. I have attached a letter the Senator wrote to the SmokeFree organization a short while ago.

    Smoking bans are raging through the country and the world, and much of what we read is based upon poor science and exaggerated claims. Read the results of the largest study ever conducted on shs. http://www.heartland.org/Article.cfm...

    Smoking bans are not about health. They are about money and control and the movement toward prohibition. Read how and when this movement started. "In 1975, British delegate to the World Health Organization, Sir George Goober informed that august body of the means by which smokers could be encouraged to quit:"foster an atmosphere where it was perceived that active smokers would injure those around them, especially their family and any infants or young children who would be exposed involuntarily" to secondhand smoke." http://fightantismokertyranny.blogspot.com/20...

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