And Just Thinking About the Sandwich Will Give You Palpitations

Richard Sargent, the physician and anti-smoking activist who co-authored the 2003 study that claimed a smoking ban in Helena, Montana, led to an immediate 40 percent drop in heart attacks, explains how such a dramatic effect is possible:

"We used to think that heart disease came after years of exposure," said Dr. Richard Sargent, board-certified in family practice with St. Peter's Community hospital in Helena, Mont.

Then studies in the 1990s began pointing to heart attacks that were happening very rapidly from short-term exposure to second-hand smoke, Sargent said in a phone interview.

"If you go into a restaurant for a sandwich, if you go into a bar for a beer and you get exposed to a heavy amount of second-hand smoke, you're just as at risk for a heart attack as a smoker," he said. "Working eight hours a day in a smoke-filled environment is the equivalent of smoking a pack a day."

Michael Siegel, another physician and anti-smoking activist, explains why Sargent is full of crap. Siegel worries that "the anti-smoking movement is quickly becoming a complete joke."

Notice that Sargent initially seems to be claiming that dosage doesn't matter: One sandwich in a smoky restaurant gives you the same heart attack risk as decades of smoking–in which case diners exposed to secondhand smoke could start smoking without raising their heart attack risk. Does that seem like sound health advice for a family doctor to give?

But then Sargent says, in effect, "Forget what I said about eating a sandwich or drinking a beer; it's actually working all day in a bar or restaurant where smoking is allowed that's equivalent to a pack-a-day habit." Again, this implies that waiters and bartenders in such establishments might as well start smoking, at least when it comes to heart disease. So far Sargent is not claiming that exposure to secondhand smoke poses the same lung cancer and emphysema risks as smoking. But give him time.

[Thanks to Linda Stewart for the tip.]