If Heart Attacks Fall in a City Without a Smoking Ban, Do They Still Make Headlines?

A study recently reported in the journal Circulation finds that the hospitalization rate for acute myocardial infarction among Medicare patients fell by about 6 percent a year between 2002 and 2007. This general trend— which the researchers attribute to factors such as improved medication, better surgical treatment, and a decline in smoking—is one reason it's not safe to assume that reductions in heart attack rates immediately following smoking bans are caused by newly smoke-free air in businesses bound by the laws. Michael Siegel notes that a 2007 study of New York patients "found an 8% decline in heart attacks in the year following the statewide smoking ban," a drop the researchers attributed to the law. Likewise, a 2009 meta-analysis "showed an 8% decline in heart attacks associated with smoking bans in 11 published studies." These results do not look very impressive in light of the pre-existing national trend. 

Last year an Institute of Medicine report endorsed the idea that smoking bans have an immediately noticeable impact on heart attack rates. Yet the report's authors declined to estimate the magnitude of the effect, citing the limitations of the existing research. "If the IOM committee was unable to quantify the magnitude of the effect of smoking bans on heart attacks," Siegel asks, "then how does the committee know that the decline was significantly greater than 6%?"

It's true that some jurisdictions have seen drops substantially bigger than that after implementing smoking bans. These tend to be small cities with small samples and volatile admission numbers, such as Helena, Montana, and Pueblo, Colorado. Since hundreds of jurisdictions have smoking bans, there are bound to be some outliers. It is reckless to read data from places like Helena and Pueblo as evidence of an effect unless there is some indication that they are representative. The only nationwide study (PDF) to consider that question—a study that the IOM panelists overlooked in their eagerness to prove the benefits of smoking bans—found that "large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature."

Comments

[?]

This is all just secondhand not-having-a-heart-attack from nearby cities with smoking bans.

[MRK]

In other news, the effect of global warming is expected to be reduced in coming years due to the increase in pirate attacks off the coast of Somalia. I got the data right here:
http://en.wikipedia.org/wiki/F.....nglish.jpg

[robc]

That graph would be funnier if it had a proper x axis and a best fit curve, instead of the cheating curve/x-axis that is used.

Do people not realize is humor is based on truth?

[capitol l]

y-axis --->

-log([pirateships]/[allships])base10

x-axis --->

temperature in kelvin

dy/dx=KsubP=aargh! constant

[Mango Punch]

Smoking is bad for you, I smoke yet I know this. Things that make smoking harder and hence reduce smoking frequency/rates are therefore good for broader public health. The argument against smoking bans is one of personal liberty not one of trying to discredit health studies.

[Zeb]

True. But the argument against many of the arguments for smoking bans may have to be about discrediting bad health studies.

[R C Dean]

The argument against smoking bans is one of personal liberty not one of trying to discredit health studies.

When the smoking bans are justified by bogus health studies, then the argument can damn well be about their shitty studies.

It helps reveal the true motivations of these neo-puritan crypto-prohibitionist nannies.

[BakedPenguin]

It's a pretty well established chain of events:

1) Junk Science sponsored by government.
2) Fear mongering stories in the MSM about junk studies.
3) Crappy legislation proposed by power-lusting political dirtbags, who also go on to ensure funding for 1)

It's a vicious cycle.

[JW]

If Heart Attacks Fall in a City Without a Smoking Ban, Do They Still Make Headlines?

No. Next question?

[James Ard]

Unless the ban has prevented a heart attack from second hand smoke, which I doubt, I could care less about studies like these.

[Anomalous]

Likewise, a 2009 meta-analysis "showed an 8% decline in heart attacks associated with smoking bans in 11 published studies."

I never meta-analysis I didn't like.

[Russell Seitz]

Since oxygen deprivation is the proximate cause of myocardial infarction, it seems germane that Helena and Pueblo counties are on average a mile or more above sea level.

Thin air may amplify the vasoconstrictive effect of smoke , but studies focusing on the high country can only cloud the epidemiological signal-- if any.

[Michael J. McFadden]

It should be noted that the NBER study referred to by Jacob Sullum is actually *not* the only national level study that's been done in the U.S. David Kuneman and I carried out a study over five years ago that showed no decline in heart attacks after bans using a population base over a thousand times as large as Helena's.

The publisher of the Helena study, the British Medical Journal, refused to publish our work however, saying, ""Our main problem with the paper was that we did not think it added enough, for general readers, to what is already known about smoking and health."

This statement was made despite the fact that a Google search on the Helena smoking study produced over 400,000 hits at that point in time and despite the fact that our results were clearly and diametrically opposed to the results of that study.

You can read more about it at:

http://www.acsh.org/factsfears/newsID.990/news_detail.asp

and you can read the original unedited submission at:

http://www.scribd.com/doc/9679507/bmjmanuscript

Finally, there are two excellent articles examining other studies in this area that have been written by Christopher Snowdon, author of "Velvet Glove, Iron Fist: A history of antismoking." They are available at:

http://www.spiked-online.com/index.php/site/article/7451/

and

http://velvetgloveironfist.blo.....alian.html

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

[Michael J. McFadden]

It should be noted that the NBER study referred to by Jacob Sullum is actually *not* the only national level study that's been done in the U.S. David Kuneman and I carried out a study over five years ago that showed no decline in heart attacks after bans using a population base over a thousand times as large as Helena's.

The publisher of the Helena study, the British Medical Journal, refused to publish our work however, saying, ""Our main problem with the paper was that we did not think it added enough, for general readers, to what is already known about smoking and health."

This statement was made despite the fact that a Google search on the Helena smoking study produced over 400,000 hits at that point in time and despite the fact that our results were clearly and diametrically opposed to the results of that study.

You can read more about it at:

http://www.acsh.org/factsfears/newsID.990/news_detail.asp

and you can read the original unedited submission at:

http://www.scribd.com/doc/9679507/bmjmanuscript

Finally, there are two excellent articles examining other studies in this area that have been written by Christopher Snowdon, author of "Velvet Glove, Iron Fist: A history of antismoking." They are available at links in a separate post since more than two links are not acceptable to the filters here.

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

[Michael J. McFadden]

It should be noted that the NBER study referred to by Jacob Sullum is actually *not* the only national level study that's been done in the U.S. David Kuneman and I carried out a study over five years ago that showed no decline in heart attacks after bans using a population base over a thousand times as large as Helena's.

The publisher of the Helena study, the British Medical Journal, refused to publish our work however, saying, ""Our main problem with the paper was that we did not think it added enough, for general readers, to what is already known about smoking and health."

This statement was made despite the fact that a Google search on the Helena smoking study produced over 400,000 hits at that point in time and despite the fact that our results were clearly and diametrically opposed to the results of that study.

You can read more about it at:

http://www.acsh.org/factsfears/newsID.990/news_detail.asp

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

[Michael J. McFadden]

btw... Author/Historian Christoper Snowdon has written two EXCELLENT articles about the smoking bans / heart attack studies:

http://www.spiked-online.com/index.php/site/article/7451/

and

http://velvetgloveironfist.blo.....alian.html

- MJM

[Michael J. McFadden]

Mr. Sullum, Dr. Siegel has answered your headline question quite well in his blog entry today at:

http://tobaccoanalysis.blogspo.....cular.html

It's sad however, that despite the fact that he and others have thoroughly discredited virtually all the headlined secondhand smoke studies where the data and or the methodology have been available enough for critical examination that he *still* persists in believing in the overall benefit of smoking bans. His belief seems to primarily rest upon two pedestals:

1) That because there may possibly exist some very small number of individuals with asthmatic tobacco smoke triggers so exquisitely sensitive that they would not be able to work in the bar of their choice even if that was the only bar that still allowed smoking in all of New York City *and* had a state of the art air ventilation/filtration system.

and

2) That the studies that are NOT checkable by ordinary mortals without proper credentials and funding, the large scale epidemiological studies that have indicted secondary smoke exposure as a cause of lung cancer, are valid despite the abysmally poor showing of the studies that ARE so checkable.

::sigh::

It's kind of like arguing with someone who strongly believes in the powers of their local psychic. James Randi is called in and shows conclusively that the table tilting, the banging noises, the lights flickers and the cold fogs are ALL gimmicks. But the "true believer" will simply smile and say, "Well, the psychic says she can hear dead people talking in her head and you HAVEN'T disproved THAT so therefore I still believe."

The charlatans have been shown to be charlatans by virtually every objective test and measure that is possible... but they still somehow seem to get otherwise good, solid, objective folks like Dr. Siegel bobbing their heads up and down in agreement when they say, "I hear dead people."

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

[Michael Siegel]

To answer the question posed in the title, not only do they not receive headlines, but anti-smoking researchers hide the data and pretend that they do not exist. See my commentary on the new study out of Canada which purports to show that cardiovascular disease admissions fell in Toronto in association with the smoking ban, while remaining steady in two comparison cities. The problem? The data (hidden in an Appendix not included as part of the published paper) clearly show that there were dramatic declines in cardiovascular disease admissions in BOTH comparison cities during the study period.

http://tobaccoanalysis.blogspo.....ular.html.

That Michael McFadden points out that it is difficult to believe that some anti-smoking studies are fallacious while some are valid is a testament to the importance of those of us in public health being beyond reproach in our scientific integrity. This is not the case with the anti-smoking movement today, and as a result, the public is (justifiably) losing confidence in the accuracy of the health claims that are being made.

Michael Siegel, MD, MPH
Professor
Boston University School of Public Health

[Michael J. McFadden]

Actually Dr. Siegel, my statement was a bit stronger than saying, "that some anti-smoking studies are fallacious while some are valid"

What I said was that you "and others have thoroughly discredited *VIRTUALLY ALL* the headlined secondhand smoke studies where the data and or the methodology have been available enough for critical examination..."

How many wires and pulleys and rheostats and fog machine operations have to be exposed before you and other honest scientists will be willing to admit that the psychics are bogus? That there simply is NO reproduceable, valid, double-blind, properly constructed research out there that shows any real long term significant health threat to normal people who would be exposed even for a lifetime to the low levels of smoke that would be expected in any decent smoking-allowed establishment today and that could be mandated as a standard for allowing such establishments?

I believe that the ONLY way to claim the contrary is to fall back on the highly misleading "no safe level" statements that would also mandate an end to such things as patio dining and indoor alcohol service.

- MJM

[[e-mail]]

A URL update/correction: http://acsh.org/2007/07/a-stud.....ack-study/

shows the full story behind the unsuccessful attempts to get the Helena Study properly corrected in a subsequent, much larger, analysis submitted to the BMJ, Circulation, and Tobacco Control.

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