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For Immediate Release: November 29, 2005
Do Smoking Bans cause a 27 to 40% drop in admissions for myocardial infraction in hospitals?
November 29, 2005
The Smoker’s Club, Inc. is proud to present a study by two of its researchers, David W. Kuneman, a retired Missouri research chemist, and Michael J. McFadden, author of "Dissecting Antismokers’ Brains." Kuneman and McFadden, using easily obtained and verifiable government statistics on acute myocardial infarction (heart attacks) determined that the overall rate of AMIs in states where widespread smoking bans have been introduced have clearly NOT shown the 30 to 40% drops that have been so loudly predicted by researchers presenting smaller studies based on data from isolated towns. Instead they have discovered that there is virtually no effect at all on AMI rates from smoking bans while basing that conclusion on a database roughly 1,000 times as large and stable as the data used to make the opposite case.
In April of 2003 Drs. Richard Sargent and Robert Shepard, backed by Stanton Glantz of Americans for Nonsmokers Rights, announced that a smoking ban in the small town of Helena, Montana had resulted in an amazing decrease in AMIs among both smokers and nonsmokers. The initial press release claimed a 2/3 drop for smokers and a 50% drop for nonsmokers. The timing of this announcement was most fortuitous, giving support to the newly enacted and hotly resisted smoking ban in New York, and adding important support to the movement toward the first nationwide smoking ban in the world: Ireland.
A year later the actual peer-reviewed study made it to the British Medical Journal and the claims were scaled back to an overall reduction of about 1/3 in heart attacks and a quiet admission near the end of the body text that the reduction in nonsmokers was so small or nonexistent that it couldn’t be analyzed with any meaning. But by then the damage had been done: the resistance in New York had been quashed and the Irish government and a fair number of the populace had been hoodwinked into believing there was incontrovertible evidence that secondary smoke was doubling the heart attack rates among nonsmokers.
Earlier this month, just before the Antismoking Lobby’s all-important vote for a smoking ban in Chicago, another fortuitously timed press release made the news: a study almost identical to that of Helena, this one conducted in Pueblo, Colorado, had found similar results. (Just within the last week (November 23rd) another announcement came out of the small town of Greeley, Colorado with a similar claim: this one based on 16 heart attacks and again surrounded by official sounding quotes about the deadly threat of secondary smoke… just days before Chicago’s all-important vote.)
The two main studies examined roughly 315 heart attacks in a population base of 200,000 people, a very small and unstable statistical sampling by the standards of modern epidemiology. Still, the results were widely presented and reported to the media as having great significance in what they indicated about protecting workers and the public from the "threat of secondhand smoke." This presentation and reportage took place despite the fact that neither study separated and analyzed nonsmokers as a separate group, so neither study could actually, in a true sense, say anything at all about the effects of secondhand smoke on nonsmokers.
The present Kuneman/McFadden study examines a population base of roughly 70,000,000 people (the combined populations of California, New York, Florida, and Oregon… all states with widespread smoking bans for which data are available) … 350 times as large as that of Helena and Pueblo. It also examines 315,000 AMI admissions: a number literally 1,000 times as large as that used in Helena/Pueblo. It did not find a 50% reduction in AMIs nor a 35% reduction, nor a 27% reduction. If found NO reduction. In at least two of the states there were actually small, although completely non-significant increases in AMIs rather than the predicted massive decreases.
If researchers deliberately sift through enough small local jurisdictions with smoking bans, it will of course be possible to find a few unusual circumstances where a sharp decline in ER admissions for AMI has occurred at the same time a smoking ban took effect. Superficially at least this appears to have been what was deliberately done. Statistically, it is much less likely large populations will experience unusual circumstances where ER admissions for AMI decline suddenly for any random reason.
As the study authors conclude, "this story has been told by no one, broadcast nowhere, and heard by not a soul."
2) Mike Siegel's blog analysis and followup comments:
3) BMJ Response: http://bmj.bmjjournals.com/cgi/eletters/328/7446/977#123038
4) Jacob Sullum's REASON column: Hit and Run
Press Release Approved by Samantha Phillipe
The Smoker’s Club, Inc.
PO Box 814
Center Conway, NH 03813
Do Smoking Bans Lead to Fewer Heart Attacks?
January 15, 2006
Victoria Advocate - Victoria, Texas
Advocates on both sides of the smoking ban debate are calling into question a recent study linking secondhand smoke to heart attacks, but a local physician is standing behind the research and is calling for all public buildings in Victoria to be made smoke-free.
On Nov. 15, the Advocate ran an Associated Press story that said, "Heart attack rates in Pueblo, Colo., dropped by 27 percent in the 18 months after a smoking ban was imposed."
While testifying before the city council on Dec. 6, local physician Dr. Taylor Starkey cited the AP story as evidence of the health benefits that would result from a ban on smoking in Victoria restaurants.
"Do something great," he told the council. "You can prevent heart attacks like they did in Pueblo."
But Dr. Michael Siegel, a professor at Boston University School of Public Health and an advocate of smoke-free policies, said the Pueblo study conclusions "fly in the face of common sense, an important criteria in judging scientific data."
He said that if all smokers quit, it would take five to 10 years to cut the frequency of heart attacks by one-third to one-half. Given that fact, he said, it is hard to imagine that banning smoking in restaurants and bars could bring about an immediate 27 percent decline in heart attack admissions.
"There is no question that there's a strong connection between secondhand smoke and heart disease," Siegel said. "Nevertheless, I happen to think that when you look at the evidence out there that has linked the smoking bans with these immediate declines in heart attack admissions to hospitals, the evidence is just not strong enough at this point to draw conclusions."
One of the Pueblo researchers, Dr. Carl Bartecchi, said on Saturday that the team planned to submit the study to a medical journal within the next three days, and that he could not comment on the research because journals disapprove of giving out information on a study before publication.
Michael J. McFadden, Mid-Atlantic regional director of The Smokers Club, raised additional concerns about the Pueblo study, one being that the researchers did not differentiate smokers from nonsmokers in the study.
He said that smoking ban advocates have twisted the results of the Pueblo study to say that the number of heart attacks dropped because of decreased exposure to secondhand smoke.
"We have no idea at all if heart attacks went down at all in nonsmokers," said McFadden, who is the author of a book on the politics and science of the antismoking lobby titled "Dissecting Antismokers' Brains."
"They did not analyze the numbers of nonsmokers. The results are meaningless. Why didn't they measure it? The main reason they didn't measure it is they wouldn't get their figure."
McFadden called the Pueblo study and a similar study done in Helena, Mont., "political propaganda." He pointed instead to a study he and David W. Kuneman, a retired pharmaceutical chemist, conducted.
The McFadden/Kuneman study examined the total number of heart attack admissions in four states that had enacted some sort of smoking ban in restaurants and/or bars. They compared the total number of heart attack admissions in the year before the smoking ban to the year after enactment of the smoking ban.
The data was retrieved from the Healthcare Cost and Utilization Project, http://www.ahcpr.gov/data/hcup.
McFadden said that one reason his study has more validity than the Pueblo study is that his is based on public information, which anyone can access.
"Go to Helena or Pueblo, you can't check the data," he said.
Also, McFadden and Kuneman state in the report, "Statistically this larger population base makes for a far more stable statistical environment and the data from this population would provide a far sounder scientific basis for decisions about smoking bans that will affect the lives and livelihoods of millions of people."
The states examined in this report include California, New York, Florida and Oregon. California banned smoking in bars in January 1998, New York banned smoking in bars and restaurants in July 2003, Florida banned smoking in restaurants in July 2003, and Oregon banned smoking in restaurants that allow children in July 2001.
In California, heart attack admissions increased 6 percent. In New York, heart attack admissions increased 0.4 percent. In Florida, heart attack admissions decreased 0.7 percent. In Oregon, heart attack admissions decreased 0.1 percent.
McFadden said that his study shows that smoking bans do not lead to an immediate drop in heart attacks.
"An effect of such smoking bans can certainly not be ruled out, especially because the 2004 data for New York and Florida are not yet available (so only the first six months post-ban could be examined)," Siegel said in his blog. "However, it does seem quite clear that if there is an effect, it is not nearly as immediate or dramatic as suggested in press releases."
Siegel said in a phone interview that there is no question that heart attacks went down by 27 percent in Pueblo. "The flaw is in assuming what happened in Pueblo was due to the smoking ban," he said.
Siegel gives an alternative hypothesis for the sharp drop in heart attacks in Pueblo: random variation. The incidence of heart attacks typically rises and falls over time, especially in a city the size of Pueblo, which has about 100,000 people.
Proponents of the Pueblo study say that researchers also looked at a nearby county that had no such smoking ban. In that county, heart attack admissions stayed about the same.
"If the city next to them didn't see any fall in heart attack rates and Pueblo did, then you have your control population right next door," Starkey said.
But Siegel said that this observation is not incompatible with his alternative hypothesis of random variation.
According to his blog, assuming the drop in heart attack admissions in Pueblo was random, rather than due to the smoking ban, then there wouldn't be a similar drop in heart attack admissions in a nearby city.
Siegel is concerned that the Pueblo study could undermine legitimate efforts to provide smoke-free workplaces.
"When advocates cite this kind of data, that is so clearly inadequate, it's only a matter of time before the public takes a look at it, and can see there's absolutely no substance to these claims.
"I'm afraid that it's going to undermine our credibility once people see we're stretching the science."
Siegel said that a smoking ban in Victoria could potentially lead to a drop in heart attacks, but not for five to 10 years or more, and the results would not be as drastic as those reported in Pueblo.
McFadden, who co-authored the four-state study, said he is not convinced that "normal" exposure to secondhand smoke in bars and restaurants has any bearing at all on heart attacks.
But Starkey remains convinced the Pueblo study is accurate.
Victoria will not see a Pueblo-esque drop in heart attacks, Starkey said, "because we only banned it in restaurants."
He added that he believes there would be a big change "if we banned smoking in all public places."
The Pueblo smoking ban study has not yet been published in a peer-reviewed medical journal, but instead was made known during a presentation in November 2005 at an American Heart Association meeting.
Siegel said that's probably just a matter of timing. "It was presented at a scientific conference, and I'm sure that the authors are pursuing publication in a medical journal. But the lag-time between submission and publication is long (six months at the very least), so it may be a while before the article appears in print.
"So although I tend to disagree with the study conclusions, I don't have any reason to believe that there's anything political going on with it."
And while Siegel thinks more studies are needed to measure accurately the health effects of tobacco smoke, Starkey doesn't.
"I think research dollars should be spent on finding cures for cancer and not trying to find more evidence that smoking is bad for you, that smoking is unhealthy," he said. "I think that there's plenty of evidence in the medical community, plenty of evidence in the scientific community that smoking is incredibly harmful.
"The money is best spent on curing cancer and heart diseases and not repeating the same studies over and over again," Starkey said.
Patrick Brendel is a reporter for the Advocate. Contact him at 361-580-6535 or firstname.lastname@example.org, or comment on this story at www.VictoriaAdvocate.com.
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