More on The Kuneman – McFadden Heart Attack Study
Do Smoking Bans cause a 27 to 40% drop in admissions for myocardial infarction in hospitals? A preliminary study by David W. Kuneman and Michael J. McFadden.
New Study Casts Doubt on Claim that Smoking Bans Substantially Reduce Heart Attack Admissions. By Michael Siegel. In addition to confirming Kuneman and McFadden’s findings, I extended their analysis by…
When You Don’t Like What You Hear, Attack the Messenger – But Don’t Discuss the Issues.
Press Release. From The Smoker’s Club, Inc.
Dave Hitt: The Facts
The Helena Study
The Helena Study Chart and Fraud
Do smoking bans lead to fewer heart attacks?
January 15, 2006
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, 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 pbrendel@vicad.com, or comment on this story at http://www.victoriaadvocate.com/.
To: The Smoker’s Club, Inc.
Sent: Wednesday, December 14, 2005
Subject: EPA Report rehash
Sent: Wednesday, December 14, 2005
Subject: EPA Report rehash
Today at http://www.epa.gov/smokefree/pubs/strsfs.html, I found a page where EPA rehashes its defunct report on a web page, “Last updated on Wednesday, September 28th, 2005.”
I left them a message: “HOW DARE YOU?!?!?!? Your lying and exaggerated report on second-hand smoke was thrown out by the courts, and still you publish a rehash of this horrible slander that just makes life miserable for 25% of the population. You know as well as I do that second-hand smoke does absolutely nothing!!!”
Pieces of this page have turned up in the press releases of the Colorado legislators who are again trying to push through a state-wide smoking ban everywhere there are workers. I feel absolutely flummoxed. How can they publish such lies on a government web site??? To whom do I complain???
A Newsletter Reader
I have just one question about the methodology of these growing number of “ban = immediate heart attack decrease” studies. The Associated Press put out an article yesterday about the American Heart Association (AHA) issuing a call to change CPR methods. That article attributed an estimate to the AHA that “more than 95% of cardiac arrest victims die before they get to a hospital”.
Assuming the AHA estimate is true, then the question is: How can the methodology of studies such as Helena, Bowling Green, Pueblo, etc where they only count hospital admissions be valid, if the vast majority die before ever reaching a hospital?
A 20-50% reduction in hospital admissions, assuming that Acute Myocardial Infarctions and heart attacks are the same thing since they’re often used interchangeably by anti-smokers’ claims, would seem huge if hospital admissions represent only 5% of the total cases out there.
Nederlands nieuwsbericht (Dutch news item)
Horeca: Hartaanvallen lager door rookverboden?!
Horeca: Hartaanvallen lager door rookverboden?!
UK: Smoking Ban the Lies Exposed.
Helena: 1,000 days
12/4/05 BMJ By Michael J. McFadden
This time the world should be invited to see the truth and the British Medical Journal should be in the forefront of ensuring that such an invitation is heard.
12/4/05 BMJ By Michael J. McFadden
This time the world should be invited to see the truth and the British Medical Journal should be in the forefront of ensuring that such an invitation is heard.
Trends in Heart Attacks in Lewis and Clark County Show Prematurity of Helena Study Conclusions
December 9, 2005 By Michael Siegel
Drs. Brad Rodu and Philip Cole of the University of Alabama at Birmingham presented historical data on trends in the heart attack mortality rate for Lewis and Clark County (which includes Helena) for the years 1979-2001.
These data demonstrate that there is significant random variation in heart attack mortality trends (which suggests that there is also substantial random variation in heart attack incidence trends) in Helena, since 85% of the county population lives in Helena. This random variation is so marked that the observed heart attack mortality in several years is dramatically lower than, or higher than, the trend in preceding years.
December 9, 2005 By Michael Siegel
Drs. Brad Rodu and Philip Cole of the University of Alabama at Birmingham presented historical data on trends in the heart attack mortality rate for Lewis and Clark County (which includes Helena) for the years 1979-2001.
These data demonstrate that there is significant random variation in heart attack mortality trends (which suggests that there is also substantial random variation in heart attack incidence trends) in Helena, since 85% of the county population lives in Helena. This random variation is so marked that the observed heart attack mortality in several years is dramatically lower than, or higher than, the trend in preceding years.
January 12, 2006
Letter to the British Medical Journal from Dr. Brad Rodu and Dr. Philip Cole.
The AMI mortality data from Pueblo confirms our position that neither report involves anything more than random variation.
Letter to the British Medical Journal from Dr. Brad Rodu and Dr. Philip Cole.
The AMI mortality data from Pueblo confirms our position that neither report involves anything more than random variation.
The Rest of the Story: Helena Findings Defy Common Sense; Strongest Argument Yet For Prematurity of Study Conclusions
January 9, 2006 By Michael Siegel
I have yet to present what I think is the strongest evidence to date that the conclusions being widely disseminated regarding these studies are unwarranted and far too premature.
January 9, 2006 By Michael Siegel
I have yet to present what I think is the strongest evidence to date that the conclusions being widely disseminated regarding these studies are unwarranted and far too premature.
