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Posts Tagged ‘Quit Smoking’

The article we published recently, Smoking Bans Reduce Heart Attacks: Lying By Omission, was posted for discussion on LinkedIn. Since the discussion and comments are only viewable to members of the Cornell network, we cannot address any issues which are being raised directly on LinkedIn.

A member of the network forwarded some of the comments to us and we will address them here. Please take a moment to register and comment on our site if you would like to join in the discussion. We are willing to answer your questions but we have to know the questions exist in the first place.

Since a few commenters made multiple points and because there is overlap on some of the issues raised, we will first post the comments in full and then address the individual points.

Vernon C.:

Do you deny that smoking causes heart and lung disease? Do you deny that we, as a society, pay higher health insurance premiums when there is a higher incidence of disease? Then why is it questionable for society to limit smoking by any method it chooses in order to reduce our costs?

Bonnie F.:

The article is focusing on the smoking issue and the specific way in which scientific data about secondhand smoke has been manipulated to promote indoor smoking bans. The larger point seems to be that letting public officials with pretty fundamentalist agendas get away with lying to the public about the science in order to get laws passed is setting a bad precedent.

Steve K.:

And this makes the public officials different from the ‘I had no idea nicotine was addictive’ Tobacco CEOs in WHAT way? Secondhand smoke is DISGUSTING. I do not CARE what the science says, it is DISGUSTING, and I have absolutely no problem with smoking being banned EVERYWHERE.It is also a public health risk, and if the health issues are not enough for you, look at the fire statistics. The only likely supporters of smoking are people in the tobacco business and firefighters – depending on whose numbers you want to use, tobacco is responsible for 40% to 80% of house fires.. which keeps them employed.

Mark C.:

A implies B, and I believe B, so A must be true. This fallacy is the foundation of public support for bogus science. People like the conclusions so they accept any rationale that comes their way. They really don’t care if the science is bogus, so long as the conclusion is what they want to hear.

But, just because A is bogus, doesn’t mean B is false. Matter of fact it is easier to get bogus A’s accepted when B is true.

Eric S.:

Hi there. Tobacco is a known carcinogen. I would anticipate that, since the smoking bans have only recently gone into effect, it’s a bit soon to be able to trace benefits to reduction in disease from second hand smoke. Are you aware of any studies that measure the reduction in carcinogenic material that occurs by retention/conversion in the smoker’s lungs and blood stream?

Please be careful about charging fraud in the discussion of the health effects of tobacco ingestion (smoke, chew, etc.) when the obscene fraud practiced by the tobacco companies and their allied state representatives has been well documented.

Marc M.:

>>The larger point seems to be that letting public officials with pretty fundamentalist agendas get away with lying to the public about the science in order to get laws passed is setting a bad precedent.<<

I don’t even know where to start with this comment, but let me start by saying I live in Texas, a state well known for folks with fundamentalist agenda’s lying to the public about science to get laws passed, albeit in quite a different manner than you might be thinking. That said, Mark makes an excellent point that notwithstanding the possible misinterpretation of allegedly bogus science (where the general scientific consensus is fairly consistent in favor of anti-smoking activists, however), there is still an extremely strong case in favor of indoor smoking bans on just the yuck factor, amongst other reasons.

And it is interesting that the 3 Monkeys also repeat the mantra about the alleged economic catastrophe that would occur with indoor smoking bans, which has repeatedly been show to be bogus (including in several places here in Texas!).

And Steve, firefighters are never in favor of things that actually start fires. I wold rather take my training and sit on my rear in the fire station than make a fire – fires are tragedies in terms of both potential for lives lost AND for the loss of personal history and memories when it is damaged by smoke, water and fire.

Steve K.:

Re: Fire prevention – what I was trying to convey is that I have never heard of a fire department advocating a ban on indoor or unenclosed flame sources. (maybe someone has done so, but I have not heard of it) There must be commerical fire suppression systems that could be installed over gas stoves. Beyond that, ban all unenclosed flame sources, and if a fire is found to have been started by an unenclosed flame source, send the person responsible a bill for the full cost of fighting the fire.
Fires started by cigarettes are NOT accidents, they are acts of stupidity. Why should firefighters have to risk their lives to put out such fires? How many fewer firefighters would a community need if cigarettes were simply banned?

Marc M.:

Steve, you were on the hill about the same time (OK, a few years earlier, but not much) as I was – don’t you remember the ban of candles in campus residence halls? And that was back in the 80’s.

Gas stoves are relatively contained flames and there are codes which govern the installation of such objects – only in commercial occupancies are there rules requiring fire suppression systems. These codes are promulgated for fire prevention reasons and supported by the fire service through the NFPA and other organizations.

Re: fires started by cigarettes – the problem with a fire is that you don’t always know what caused the fire before you put it out – often you don’t know what started it. They get put out, then we determine cause. But there would probably be little decrease in the number of firefighters required because staffing and deployment patterns are governed by time and distance more than by actual numbers of events. Plus, most fire departments now are actually EMS delivery system that provide fire suppression as an ancillary service, so decreases in numbers would impact those services more than the fire suppression services.

And no doubt fires caused by cigarettes are acts of stupidity (or drunkenness, actually, but that may be the same thing).

Here is a distillation of the points raised above, and the answers:

  • Tobacco smoking is a major cause of house fires and indoor smoking even at home should be banned.

Factually incorrect. According to the CDC and the NFPA, cooking fires are the number one cause (40%) of house fires. However, it is worth noting that although under 12% of fires (4% of fires originate in the living room, family room, or den; 8% in the bedroom) can be attributed to smoking, it is responsible for more (25%) of the fatalities.

It seems likely that many of the people who were involved in fatal fires with smoking as a cause were impaired by alcohol at the time. By logical extension, we should advocate a ban on drinking alcohol at home. We are sure an intrepid researcher can unearth a strong connection between drinking at home and all sorts of preventable physical and property damage.

We pay for the fire department through taxes and we are required by law to have fire insurance. On on unrelated note, health insurance should be like fire insurance – covering catastrophes, not routine medical expenses.

  • Big Tobacco lied about the extent of the dangers associated with their products, therefore claiming that there is fraud involved in research supporting indoor smoking bans is probably a lie supported by Big Tobacco.

Even if Big Tobacco were directly funding research showing how data is being manipulated to support indoor smoking bans, it in no way changes the fact that data is being manipulated. Aside from the lack of direct funding from Big Tobacco, those sources arguing for an examination of the underlying research have been proven right by the original research.

The primary justification for curtailing the freedom of businesses to choose to allow their customers to smoke indoors and for customers to choose to support such businesses is based on the health risks posed to the employees by the secondhand smoke. According to the Surgeon General’s report the actual correlation between secondhand smoke (aka ETS, Environmental Tobacco Smoke) and things like cardiovascular disease, ischemic heart disease, and arrhythmic heart failure or coronary arrest mortality is low enough to be attributable to statistical noise.

Here’s a bit of perspective: the highest risk ratio is for cardiovascular disease, at 1.25. The risk ratio of dying from a traffic accident (for women) on Friday the 13th is 1.38 according to research published in the American Journal of Psychiatry. Therefore it is safe to bet that traffic will be light on November 13th, 2009 because all our female readers will have opted to take the bus or train to work instead.

  • Many people simply find tobacco “yucky” and therefore it should be banned anywhere it may come into contact with others. Also, smoking is really bad for you.

Smoking tobacco is bad for you and there is no great controversy in saying so. However, it is not the issue we are dealing with here. To reiterate: the issue is that the science shows no ill effects from secondhand smoke, therefore the justification for banning smoking indoors in the name of protecting employees is nonexistent.

The “yucky” argument is flat out childish and sophomoric. Try to defend against it when used as an argument against something you like, which other people abhor.

  • People making out on TV is “yucky” and against my religious values, therefore it should be banned from being broadcast.

There is no law forcing anyone to own a television, watch particular shows, or derive spiritual sustenance from it. Turn it off, change the channel, or don’t buy a TV in the first place since broadcasters are providing their audience with what they want. You can affect change by not being part of the audience.

  • Small dog breeds are ankle biting terrorists and should be banned. They are a menace to everyone with ankles, and creating something called a “dog” which can get its butt whooped by a 10 lb. house cat is an affront to the basic dignity afforded to every living creature.

No law forces anyone to buy a small dog or hang out at the dog park. In the rare instance you are bitten by one, call the police and file a report.

Now we would like you to imagine that an individual with such a view was in a position of power – say as mayor of Big Major City – and used some shady statistics to justify banning certain breeds of small dogs. Due to the importance of Big Major City, many other cities followed suit and banned those breeds as well. Then a report is issued citing selected cities in which banning those small dogs improved quality of life. In fact, the report is so positive that the mayor of Big Major City and others begin pushing to expand on the success of the original ban by extending it to include all dogs.

All that, because some nutter thinks dogs are “yucky”.

  • The reports indicating an economic decline after smoking bans were put into effect are false and misleading.

We came across research which clearly showed an economic decline as a result of indoor smoking bans. To argue otherwise you must show a flaw in the research or provide some other source of data to back up that claim.

Absent a smoking ban, how can someone who finds secondhand smoke “yucky” go about creating change? By choosing with whom you do business. Whether it is a restaurant, bar, or bowling alley, by choosing to direct your business to places with a smoke free environment your actions are causing them to be more successful and thereby encouraging more of that type of business.

The fact that many nightlife places were environments which encouraged smoking shows that the majority of people voted with their hard earned money to keep those places thriving. It means that many of the people who participated in nightlife either liked having a cigarette with their drink or did not mind that others did. To argue that bars and clubs did not suffer economically after smoking bans were put into effect is to ignore the huge support they were receiving from locals and to ignore that people respond to incentives. Furthermore, if only a small percentage of nightlife participants are non-smokers and/or cannot tolerate secondhand smoke, where are all the extra people coming from to replace the smokers who choose to stay at home?

Freedom is what is at stake here. Smoking is dangerous and bad for you, but so are many other things. The indoor smoking bans in effect are the result of the minority imposing their views and beliefs on the majority by lying. The economics show that the majority of the public impacted by ban were against it.

Exit question: If the indoor smoking ban cannot be justified based on science, are supporters of the ban essentially guilty of “we’re just trying to do what’s best for you” paternalism? If that is true, what can citizens do to prevent something like this from happening in the future?

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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.

Report #1:

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.

Report #2:

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.

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Smoking still kills more men than women, because men started smoking substantial numbers of cigarettes long before women did. But, because so many men have now quit, male death rates from smoking are decreasing in many European countries where female death rates from smoking are still increasing. Taking men and women together, smoking causes about 0.7 million deaths per year in the 27 countries of the present European Union, including 0.3 million deaths per year before age 70 (more than one of five of all deaths before age 70). Those killed by tobacco before age 70 lose, on average, about 23 years of life (and those killed by tobacco at older ages lose, on average, about 8 years).

We are all for equality between the sexes, but this is not quite what we had in mind.

Sir Richard Peto, professor of medical statistics at the University of Oxford, UK, said “In Western Europe tobacco causes more premature deaths than anything else does, and among both men and women about a quarter of those who smoke throughout adult life will be killed by tobacco before they are old, unless they can manage to stop smoking.”

There are solutions which make quitting tobacco far easier than it once was. Eating a healthy diet can make cigarettes seem less appealing. If the nicotine cravings are too difficult to beat then invest in an e-cigarette so you can get your fix without the cancer.

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Smokers around the world today found themselves in complete shock to learn that eating a healthy diet may help them quit smoking. Seriously.

The connection between the two is not what one would expect. Certain items enhance the taste of cigarettes – such as alcohol, caffeinated beverages, and meat. Dairy products, vegetables, and fruit may worsen the taste for many people.

Now, don’t try cheating by eating healthy and not giving up on the cigarettes.

Smokers of menthol cigarettes were less likely to report that any foods or beverages altered the taste of cigarettes, a finding that suggests menthol covers up bad tastes stemming from items consumed with cigarettes, the researchers said.

Remember, at the end of the day, it is entirely up to the individual to make the decision to quit. If that doesn’t happen, nothing will work.

“Every deterrent treatment requires willpower,” Rose said. “This approach alone will not work. It may make cigarettes less pleasurable, but ultimately, if a person is craving a cigarette, he will start smoking again.”

Rose recommends that diet modifications be used in combination with standard nicotine replacement therapy, such as the nicotine patch and nicotine gum, to help with withdrawal.

Sources:

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