A government-commissioned report promotes smoking bans by tweaking the evidence.
Eric Gisin
Myocardial Infractions
Jacob Sullum | October 21, 2009
Six years ago, when I asked an epidemiologist about a report that a smoking ban in Helena, Montana,
had cut heart attacks by 40 percent within six months, he thought the idea was so ridiculous that
no one would take it seriously. He was wrong.
Since then 10 other studies have attributed substantial short-term reductions in heart attacks to
smoking bans, and last week an Institute of Medicine (IOM) committee endorsed their findings. But a
closer look at the IOM report, which was commissioned by the U.S. Centers for Disease Control and
Prevention, suggests its conclusions are based on a desire to promote smoking bans rather than a
dispassionate examination of the evidence.
Thousands of jurisdictions around the world restrict smoking. Some of them are bound to see
significant drops in heart attacks purely by chance, while others will see no real change or
significant increases. Focusing on the first group proves nothing unless it is noticeably bigger
than the other two groups.
The largest study of this issue, which used nationwide data instead of looking at cherry-picked
communities, concluded that smoking bans in the U.S. "are not associated with statistically
significant short-term declines in mortality or hospital admissions for myocardial infarction." It
also 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."
That study, published by the National Bureau of Economic Research (NBER) in March, suggests that
publication bias-the tendency to report positive findings and ignore negative ones-explains the
"consistent" results highlighted by the IOM committee. But even though the panelists say they tried
to compensate for publication bias by looking for relevant data that did not appear in medical
journals, they ignored the NBER paper, along with analyses that found no declines in heart attacks
following smoking bans in California, Florida, New York, Oregon, England, Wales, Scotland, and
Denmark.
If smoking bans reduce heart attacks, the effect could be due to declines in smoking, declines in
secondhand smoke exposure, or both. The IOM report settles on that last explanation, quite a leap
given that "only two of the studies distinguished between reductions in heart attacks suffered by
smokers versus nonsmokers."
In any case, when people stop smoking, their heart attack risk declines gradually over several
years, and it's hard to see why the risk would fall any faster for people exposed to secondhand
smoke. Furthermore, estimates from the CDC and the American Heart Association indicate that smoking
and secondhand smoke together account for about 25 percent of heart disease deaths. So how could a
smoking ban, even one that eliminated all smoking, cut heart attacks by 40 percent (or 47 percent,
as another study claimed)?
The IOM panelists dodge these issues by declining to estimate the size or the timing of the impact
from smoking bans, citing the limitations of the studies and the wide variations between them. But
"if you can't even estimate the magnitude of an effect," notes Michael Siegel, a Boston University
public health professor who was one of the report's reviewers, "you are hardly in a position to
conclude that [it] exceeds random variation combined with the known secular decline in heart attack
rates."
Even while taking refuge in imprecision, the IOM committee tries to make transparently absurd
claims seem plausible by intimating that spending a half-hour in a smoky bar just might kill you,
even if you were completely healthy when you went in. If so, where are the bodies? The report
concedes "there is no direct evidence that a relatively brief exposure to secondhand smoke can
precipitate an acute coronary event."
Siegel, who faults the IOM committee's "sensationalistic" approach, is a longtime supporter of
smoking bans who nevertheless tries to separate his political advocacy from his scientific
analysis. It's too bad the authors of the IOM report, who immediately used it as an excuse to
demand strict smoking regulations throughout the country, did not follow his example.
Jacob Sullum is a senior editor at Reason and a nationally syndicated columnist.
Strabo
> In article <hc2i41$6o2$1...@news.eternal-september.org>,
> "Eric Gisin" <gi...@uniserve.com> wrote:
>
>> http://reason.com/archives/2009/10/21/myocardial-infractions
>
> Nice cut and paste job of an article by a long time tobacco company
> apologist who has been on their payroll for years according to
> http://www.sourcewatch.org/index.php?title=Jacob_Sullum
>
Smoke break!
Light 'em up if you got 'em.
Robert Broughton
You need not have gone to the trouble, Shawn. Sullum wrote a book about
smoking called _For Your Own Good_. This title is a clear indication that
he's full of shit.
--
Bob Broughton
http://broughton.ca/
Vancouver, BC, Canada
"Even on [finance] terms, we have never been a company that tolerates
facts." - Robert Murdoch, Feb. 5, 2009
Eric Gisin
"Shawn Hirn" <sr...@comcast.net> wrote in message
news:srhi-708B14.2...@atoulouse-552-1-42-74.w92-136.abo.wanadoo.fr...