Two studies were recently published which showed a correlation between a community adopting a smoking ban and a subsequent reduction in heart attack rates. The results are based on aggregated data from several other studies. Unfortunately, we do not have access to the original reports so we cannot question their methodology directly.
The research — which incorporated data from a total of 24 studies of smoking bans across the country — found at least a 17 percent reduction in heart attacks one year after the bans had been enacted.
The other study, published in the Sept. 21 issue of Circulation, found a 17 percent drop in heart attack rates after one year and about a 36 percent drop three years after smoking restrictions had been enacted.
It incorporated data from 13 studies in the United States, Canada and Europe. Meyers’s research effort analyzed data from 11 studies of 10 public smoking bans in the same geographic regions.
We will examine the motivation for presenting the public with false information by exposing the agenda behind it later. First, we will take a close look at how this type of fraud occurs.
The crime in this case is one of omission. Both studies show impressive results based on data from multiple sources. One of these reports used data from 24 other studies and the other used 13. How many studies have been left out which don’t support their conclusions?
It would be very inconvenient for the authors and proponents of these studies if some communities experienced an increase in heart attacks after a smoking ban was put into effect, and they conveniently left those out of their research. The most conclusive study would be one which examined the data on a national level.
In fact, such a study exists and was published a few months ago.
A new study by researchers from the RAND Corporation, Congressional Budget Office, University of Wisconsin, and Stanford University is the first to examine the relationship between smoking bans and heart attack admissions and mortality trends in the entire nation, using national data. All previous U.S. studies only examined one particular city. In contrast, this study examined data from the Nationwide Inpatient Survey (NIS), which is nationally representative and includes 20% of all non-federal hospital discharges in the United States. The study has been published as Working Paper 14789 of the National Bureau of Economic Research Working Paper Series.
The study came to a completely different conclusion than the ones recently published.
The most important finding of this study is that there are just as many smoking ban communities in which heart attack admissions and mortality have increased in comparison with control communities as there are smoking ban communities in which heart attacks have decreased relative to control communities. The mean difference was found to be zero.
Thus, the study not only fails to find a short-term effect of smoking bans on heart attacks, but it also explains the positive findings of previous studies. What appears to be going on is what is referred to as publication bias.
Another major problem with studies being touted by the media and pushed by anti-tobacco activists is the level of harm attributed to second hand smoke.
Epidemiologists use “relative risk” (RR or Risk Ratio and informally including the similar Odds Ratio computation) as a means for measuring the severity of risk. The U.S. Surgeon General stated the relative risk for secondhand smoke is between 1.20 to 1.30. This is far below the minimum level at which any meaningful risk might be indicated. Both the World Health Organization and the National Cancer Institute have clearly stated that RRs below 2.0 are too low to be relied upon. The same is true of the federal Reference Manual on Scientific Evidence and textbooks such as Breslow and Day’s Statistical Methods in Cancer Research. A report by the independent health consulting firm Littlewood & Fennell characterizes RRs below 2.0 as “dancing on the tiny pinhead of statistical insignificance.”
The Surgeon General’s report went out of its way to make a claim which ran counter to the evidence. It had to be explicitly pointed out after the report’s publication that there is no justification for banning indoor smoking.
The 1992 report Revised Comments on the 1986 Surgeon General’s Report…EPA…and NIOSH states: “Risk estimates below 2.0 or 3.0 are described as ‘weak’ and thus any conclusions drawn from them are unreliable.” The summary of this 47-page document concludes: “…these reports [Surgeon General's, EPA, and NIOSH] do not provide a defensible basis for regulation of smoking in the workplace.” Comments in the report are supported by 113 references in the scientific literature.
Even with that censure, the Surgeon General’s office continues to be promote nonsense for the anti-tobacco crusade. It is shameful for a governmental organization to promote political agendas using scare tactics which run counter to the scientific data.
The 2006 SG’s report claims 46,000 deaths annually due to heart disease from secondhand smoke. But the American Heart Association website lists the following RRs for ETS: 1.25 for Cardiovascular disease, 1.18 for ischemic heart disease, and 1.13 for arrhythmic heart failure or coronary arrest mortality. None of these suggests credible risk. Death estimates are derived from relative risk. If a RR is meaningless, so are the estimates of deaths based upon it. So the big scary estimate of 46,000 deaths has no validity. It is simply a phony number put out to scare people and panic them into political action. If such death estimates were valid, the new study would not have found that smoking bans have zero effect on heart attack mortality.
The EPA (Environmental Protection Agency) also helped to promote this madness. The Surgeon General’s report relied on data from a 1992 EPA study, which concluded that 3,000 deaths per year are attributable to secondhand smoke.
The U.S. House of Representatives then held a Congressional Investigation of EPA’s findings. It concluded: “EPA could reach that conclusion [3,000 lung cancer deaths] only by ignoring or discounting major studies, and deviating from generally accepted scientific standards.” Further, it found EPA guilty of “conscious misuse of science and the scientific process to achieve a political agenda that could not otherwise be justified.” It also stated: “The agency [EPA] has deliberately abused and manipulated scientific data in order to reach a predetermined, politically motivated result.” (emphasis added.) Over the next seven years, five similar studies (meta-analyses) of secondhand tobacco smoke were performed by other researchers who, unlike EPA, followed correct scientific standards. The RRs of these studies showed a range of 0.98 to 1.03 and an average RR of 1.01, compared to EPA’s RR of 1.19. Levois and Layard performed a meta-analysis of all the original studies utilized by EPA and came up with a RR of 1.00. Furthermore, these studies all had the standard 95% confidence level. The EPA study did not qualify for that. Instead, EPA used a degraded confidence level of only 90 percent, thus doubling the likelihood that its results were mere chance.
The motivation behind this shady business comes from several fronts. The strongest force are the absolutists, the prohibitionists, the fundamentalists who would like tobacco to be eliminated from the face of the Earth. Some of them become politicians and work towards achieving that goal incrementally. Their motivation is “the ends justify the means”. Others are the media and do-gooders who are not intelligent enough or simply too lazy and ignorant to examine the background science and automatically assume people they look up to are working in everyone’s best interests.
A steep price is paid for this stupidity. First, indoor smoking bans cause economic losses. Second, they promote the kind of “save me from myself” paternalism which is a way of expanding the power of government in the name of helping people who cannot handle the responsibility that comes with freedom. There are eerie similarities between those who wish to ban tobacco and the prohibitionist war on drugs.
In case it was not clear until this point, smoking is bad for you, and you should use whatever means necessary to quit. However, it is a legal product and adults should be allowed to enjoy it even without big government nanny approbation. The danger from tyranny is far greater than the dangers of indoor smoking.
Exit question: If the general public knew how much of the science being used to push for banning tobacco was nonsense, would such legislation continue to receive support?
UPDATE: The answers to a few critiques raised by this article can be found here: Where There’s Smoke, There’s Fire.