posted 04-01-2003 08:43 PM            

Public smoking ban slashes heart attacks
15:30 01 April 03
NewScientist.com news service

A six-month ban on smoking in all public places slashed the number of heart attacks in a US town by almost a half, a new study has revealed.

The researchers attribute the dramatic drop to the "near elimination" of harmful effects of "second-hand" smoke - passive smoking. A smoke-free environment also encourages smokers to reduce smoking or quit altogether, the team adds.

Statistician Stanton Glantz, at the University of California, San Francisco, and colleagues studied diagnoses of heart attacks in the town of Helena, Montana, where the ban was imposed.

"This striking finding suggests that protecting people from toxins in second-hand smoke not only makes life more pleasant, it immediately starts saving lives," Glantz says. The researchers claim the study is the first to show that smoke-free policies rapidly reduce heart attacks, as well as having long-term benefits.

NEW SCIENTIST

posted 04-02-2003 09:13 PM            

quote:

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This work will be presented as an abstract at the 52nd Annual Scientific Sessions of the American College of Cardiology in Chicago, IL, March 30 - April 2, 2003.

Dr. Sargent’s expenses...were supported by a generous grant from ProtectMontanaKids, a project of the American Cancer Society, American Heart Association, and American Lung Association of the Northern Rockies, with support from the Robert Wood Johnson Foundation. Dr. Glantz’s work was supported by National Cancer Institute Grant CA-61021 and the American Legacy Foundation.

The authors have no conflicts of interest to disclose.

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posted 04-03-2003 02:08 AM            

quote:

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The authors have no conflicts of interest to disclose.

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Tell me you made that up.

Thanks for the offer of the study, but there's only so much crap I can take. Go over to Bill's "Banishment" thread and glom the hate-screed I posted from the NY Post. And the headlines here today are already trumpeting the upcoming (NY) state bill to ban smoking in parks and beaches (a bill about to be seriously introduced.) Not sure any more which time-warp I'm trapped in: a Victorian nightmare or a futurist dystopia.

posted 04-04-2003 11:30 PM            

Basically they looked at admission records from Dec 97 to Feb 03, stating for the 6 months (June 5 - Dec 3, 02) the ban was in effect, there was a 55% reduction in hospital admissions for acute myocardial infarction. During the 6 months that the ordinance was in force, the number of hospital admissions for AMI in Helena was –3.8 +/- 1.3 (P=.004) below the seasonally adjusted rate. The average was 6.8 per month for the periods of June to November that the ordinance wasn't in effect.

I couldn't tell if they were trying to equate the reduction to smokers not smoking as much because of the limitation or to non-smokers not keeling over from exposure to the dreaded SHS. It seems they tried to go after both by noting suspected mechanisms.

quote:

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While this effect seems large, several mechanisms, including increased platelet activation, inhibition of vascular endothelium, impairment of coronary artery dilation capacity, decrease in antioxidant substances especially ascorbic acid, aortic stiffening, and impaired heart rate variability, all of which could increase the likelihood of an acute coronary event. There are other immediate health benefits of smokefree policies; bartenders experienced significantly improved pulmonary health 6 weeks after bars were made smokefree in California.

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Also, they reviewed, but decided not to include deaths of those not making it to the hospital.

quote:

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We did not include sudden or other deaths where the patient did not reach the hospital. We did review death records for Lewis and Clark County, but did not include them because of concern about the accuracy of the assigned causes of death.

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posted 04-06-2003 01:01 PM            

quote:

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Jacob Sullum, a "journalist" who is a long time industry apologist that specializes in attacking scientific studies on secondhand smoke has written a column attacking the Helena Heart study.

Since the arguments he makes are likely to come up from other industry apologists, it is worth presenting some answers:

1. The study is "small".

There were over 500 cases included in the analysis. While this is smaller than many epidemiological studies, the effect associated with the ordinance was strong enough to detect with a high level of confidence.

It is also important to note that there was an effect in Helena, but not for people living outside the Helena area. These two facts combine to increase the confidence we can have in the findings.

2. No one reported an effect like this in other places.

The reason we could see the effect in Helena is that it is isolated geographically and there is only one hospital involved, so the whole ordinance effect appears at one time in one place. In places like California, ordinances were introduced over many years, so the effects on heart disease will be "smeared out" over time. There are also many hospitals and people do not necessarily live and work in areas served by the same hospital.

In fact, heart disease deaths fell in California faster than the rest of the country as smokefree policies were put in to effect.

3. The effect is too large.

The individual risk of heart attack associated with passive smoking is about 30%, which is within the "margin or error" of the 60% drop we saw in Helena. In addition, when you make workplaces smokefree, many smokers quit or cut down, which reduces their risks of heart attack. (Indeed, it is this drop in cigarette consumption that motivates the industry to oppose smokefree measures.)

4. The effect is too fast.

Secondhand smoke compromises platelet activity, endothelial function, and energy processing in the heart within minutes. The effects on platelets and the endothelium are as large as seen in pack-a-day smokers.

---

posted 04-06-2003 05:05 PM            

"During the 6 months that the ordinance was in force, the number of hospital admissions for AMI in Helena was -3.8 below the seasonally adjusted rate, while there was no significant change in the number of admissions from outside Helena ... There were an average of 6.8 admissions for AMI for the months of June to November during the years when the ordinance was not in effect, so the observed drop represents a reduction of about 55% in the number of admissions."

The number of admissions they used in their scatter chart and multiple regression analysis can be found on the chart on page 10 of the study. For the months of June through Nov when the ban was in effect, there were a total of 23 admissions-an average of 3.8 per month. For the months of June through Nov when the ban was not in effect, the average was indeed 6.8 admissions per month. I don't see how these numbers add up to a decline of 3.8 from the "seasonally adjusted average". 3.8 was the actual post ban average--not the difference. The difference would be 3---or a drop of 44%, not 55%, wouldn't it?

I question too some of the other figures that were widely reported (although this wasn't addressed in the copy of the study you found, lockjaw) : "The study found the smoking ban appeared to have its biggest effect on smokers. Their incidence of heart attacks dropped by three-quarters, compared with two-thirds for former smokers and one-half for nonsmokers. " ( http://wcco.com/health/health_story_092092831.html ) I strongly suspect somebody was looking at the data funny there too.

In terms of number crunching, this should have been a pretty straightforward statistical analysis, yet it would appear they "fancied it up" so much that somehow that the actual decline of 44% grew to a reported 60% in all the headlines.

Even if health officials strongly believed there would be an immediate measurable impact during the ban, an impact of this magnitude should have raised questions in their minds. It is completely unrealistic to think it at all possible that by restricting a smokers from smoking indoors in bars and restaurants you'd see their incidence of heart attack drop immediately by 75%. It's laughable! But the researchers didn't seem to find this preposterous--they went out of their way to explain that it makes sense when you understand the biochemistry involved. (Maybe they need to pull away from their microscopes a little more often, and perhaps they'd realize they've drifted off course into Lala Land.)

But after looking at the study, I'm also wondering if maybe they should put aside the high powered statistics programs for a minute and take a stab at these numbers with a pencil and paper.

posted 04-06-2003 05:11 PM            

Certainly there may be significant factors which were overlooked in the study design. One potentially significant confounding factor would be that the size of the overall "pool" was smaller. Even if the population in and around Helena remained fairly constant throughout the study period, if there were substantially fewer visitors to Helena during this study then you'd expect to see fewer out-of-town hospital admissions. I mention this because smoking ban opponents argue that smoking bans hurt the bar, restaurant and casino industries, especially so when there are so many smoking allowed alternatives nearby to attract them. I'd expect the casinos to typically attract large numbers of customers from outlying areas who are in the 'at risk' population for heart attack (ie older people, many of them with pre-existing health problems), and if large numbers of these customers took their business elsewhere, then you'd expect to see at least some decline in hospital admissions result. Anti-smoking advocates usually flatly deny smoking bans negatively impact businesses such as casinos and bars, so it's not surprising that this isn't even mentioned as a study limitation.

Besides these problems, the numbers really are too small to justify the hullaballo this study caused in the medical community. I'm not surprised to see the news media using any excuse to over-hype health news. But health professionals should be embarassed by the degree to which they allowed themselves to get sucked in. The more sober headed among them weren't persuaded--some even used the term "Montana Error" to describe the problem of trying to apply broad statistical analyses in sparsely populated Montana. This "Montana Error" seems evident in this study--the increase in '01 over a seasonally adjusted average over whole the 5 year period for months Jun through Nov (+2.13) was relatively close to the DECREASE (-2.36) during its correlate in '02, when the ban was in effect. A spike upward is treated as part of normal variability in the baseline, the same sized spike downward during the smoking ban is considered "real data and proof that [a smoking ban] needs to be done".

The calmer heads who cautioned against overstating these findings were drowned out by the so-called "experts" who seemed to grow more giddy as time went on. "Neither of us ever dreamed we'd come to Helena, Montana, and make a significant contribution to the medical literature,"says Dr Robert Shephard, coauthor of the study as he proposes that a Helena smoking ban would save 36 heart attacks and a million dollars a year . "We wouldn't have believed it." They've hyped this so high that one could conclude that avoiding SHS does more to reduce heart attack risk than does quitting the cigarettes altogether.

posted 04-07-2003 01:12 AM            

"Antis respond with their talking points".

quote:
--------------------------------------------------------------------------------
>>>Jacob Sullum, a "journalist" who is a long time industry apologist that specializes in attacking scientific studies on secondhand smoke has written a column attacking the Helena Heart study.
Since the arguments he makes are likely to come up from other industry apologists, it is worth presenting some answers:

1. The study is "small".

There were over 500 cases included in the analysis. While this is smaller than many epidemiological studies, the effect associated with the ordinance was strong enough to detect with a high level of confidence.

It is also important to note that there was an effect in Helena, but not for people living outside the Helena area. These two facts combine to increase the confidence we can have in the findings.>>>

{Question from a nobody in the back of the room:}

How would the "non-effect" to people living outside the Helena area INCREASE the confidence in these findings? The numbers there were even tinier yet! The average number of AMIs in that area was less than 2 a month! During the study period, you could go for as many as 3 months with NO observed AMIs. And yet there was still a definite increase in outside Helena AMI admissions during the Helena ban study period, when AMI admissions were higher than average for 5 of the 6 months.

And wouldn't it be reasonable to ask whether some of that increase couldn't be attributed to the ban? In other words, rather than looking at "outside Helena" for a comparison to "expected AMI admissions", one might ask if these weren't actually 'relocated' AMI admissions--ie at-risk individuals who were avoiding Helena due to the smoking ban?

>>>2. No one reported an effect like this in other places.

The reason we could see the effect in Helena is that it is isolated geographically and there is only one hospital involved, so the whole ordinance effect appears at one time in one place. <<<

{Another question from the back of the room:}

If Helena is so isolated, then why was so much effort and attention put to ascertaining whether the non-Helena AMI patients had visited Helena? Suppose that non-Helena visitor traffic dried up altogether due to the smoking ban? Was this accounted for? If not, how could you determine the role this would play in interpreting a drop in visiting non-Helena AMI patients during the smoking ban?

>>>In fact, heart disease deaths fell in California faster than the rest of the country as smokefree policies were put in to effect.<<<

{Yes, you in the back of the room waving your hand:}

I'm looking at a chart published by the CDC which ranked states in terms of heart attack death rates for 1999--which is certainly AFTER the California's sweeping workplace smoking ban and 3 years before Helena's. That chart ranks Montana as 45th in the nation with an adjusted rate of 215.2. It ranks California as 27th at 252.8. Can you explain why smoking bans in 2002 in Montana would have such an immediate effect on AMIs, while the impact from the much more expansive ban in California would leave it far back in the rear behind the still unapologetically smoky Montana?

>>>3. The effect is too large.
The individual risk of heart attack associated with passive smoking is about 30%, which is within the "margin or error" of the 60% drop we saw in Helena. <<<

Excuse me! Yes, me again! I have a question. A 30% increased risk of heart attack associated with passive smoking. I understand that. However, a 60% drop in smoke-ban Helena? That suggests there's more than a doubling of risk to areas without smoking bans! Explain how your "margin of error" accounts for this. Furthermore, you've reported a 75% reduced risk to smokers! That translates to a 400% increased risk to smokers living in Helena prior to the smoking ban! Don't you find these results, well, ....startling?

>>>4. The effect is too fast.
Secondhand smoke compromises platelet activity, endothelial function, and energy processing in the heart within minutes. The effects on platelets and the endothelium are as large as seen in pack-a-day smokers.<<<

One last question. With somewhere between a third and a quarter of all American's regular smokers, and at least double that the number of Americans exposed to passive smoking, how did medical researchers ever manage to distinguish that smoking itself was such a high risk to cardiac health? In other words, if the heart attack impacts from smoking a pack a day are indistinguishable from the health impacts of indoor exposure to smokers, wouldn't it throw into question all the earlier research that failed to consider "passive smokers" and "pack a day smokers" as equivalent?

[This message has been edited by Geodge4Uceff (edited 04-07-2003).]

posted 04-07-2003 01:29 AM            

In Googling for information and quotes regarding this Helena study, I've found at least 1 link vindicating my quick take on the numbers taken from the written report lockjaw found before it was yanked:

""The passage of a local indoor smoke-free-air ordinance was associated with a significant 45% reduction in heart attack incidence for people living in the Helena region as compared to the surrounding areas,” said Dr. Sargent. “The effect of eliminating second-hand smoke exposure on admissions for myocardial infarction was immediate and sustained.” "

( http://www.acc.org/media/session_info/late/ACC03/lbct_tuesday.htm )

So how the hell did this 45% (I said 44% but why quibble?) balloon into 60%?

Enquiring minds want to know!!

posted 04-07-2003 07:28 PM            

quote:

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Originally posted by SamTheCat:
Where'd you get that? I'd like to send the link to Sullum.

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No link, Sam. Chemical Ali sent it to me before the coalition dropped a 2000 pounder on his little haid. He was concerned that the imperialist Americans would impose a NY or California style government to take away their rights to smoke or drive with cell phones. You see, he was fond of his Cohibas.

I heard that Bloomberg and Pataki both offered Saddam & co political asylum. You can see why Saddam said, "Go to HELL"! He didn't want to live under a totalitarian dictatorship where he wasn't the one imposing the laws.

posted 04-07-2003 09:28 PM            

Other questions on my mind is that smoking has been banned incrementally. This new ban just included hospitality venues, which is a very minute portion of where the majority of us spend our day. Remember the preliminary 1999 data from the CDC's National Health and Nutrition Examination Survey (NHANES) already showed that Americans exhibited a 75% DECREASE in mean cotinine levels in 1999 from measurements taken 10 years earlier in the 1988-1991 sample period.

quote:

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From 1988 through 1991, as part of the NHANES III survey, CDC determined the median level (50th percentile) of cotinine among nonsmokers in the United States to be 0.20 ng/mL (1). Results displayed in the table show that the median cotinine level in 1999 has decreased to less than 0.050 ng/mL― more than a 75% decrease. This reduction in cotinine levels objectively documents a dramatic reduction in exposure of the general U.S. population to environmental tobacco smoke since the period 1988-1991.

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If banning smoking in hospitality venues had such a drastic effect as their "data" indicates, wouldn't it follow that incidence rates of AMI would already have been drastically impacted from a 75% reduction in mean cotinine levels in American non-smokers from previous ban actions?

Also here's a little study I just found while looking for heart attack statistics on airlines to see how they compare before and after the smoking bans. It was done in Germany and published in the American Journal of Epidimiology, Mortality from Cancer and Other Causes among Airline Cabin Attendants in
Germany, 1960–1997. It shows low mortality due to cardiovascular diseases among airline aircrew workers.

quote:

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The risk of cardiovascular disease mortality for male and female air crew was surprisingly low (reaching statistical
significance among women). This is a clear indication of a healthy worker effect, wherein selection for employment and ongoing monitoring lead to a very low prevalence of cardio-vascular disease risk factors such as obesity and hyperten-sion. Since the expected number of deaths was also small,
this finding should be confirmed in cohorts with a higher proportion of older persons. On the other hand, current evidence can serve to inform cabin attendants of their advan-tageous cardiovascular mortality profile and increase their motivation to maintain a healthy lifestyle.

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In case there's any concern about smoking on German airlines, interestingly enough:

quote:

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We found a rather remarkably low SMR for lung cancer among female cabin attendants and no increase for male cabin attendants, indicating that smoking and exposure to passive smoking may not play an important role in mortality in this group. Smoking during airplane flights was permitted
in Germany until the mid-1990s, and smoking is still not banned on all charter flights.

---

posted 04-07-2003 11:31 PM            

quote:

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Originally posted by lockjaw02:
whenever I see anything by Glantz, I automatically think, when you're digging for dirt, you'll see alot of dirt and never any gems. When you're prospecting for diamonds or gold, you might dig through alot of dirt, but you're more apt to find find something precious. Glantz will never find anything good about tobacco, because he's only looking for the dirt since the dirt is what pays his mortgage.

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I knew he has a strong bias and is only interested in the "science" insofar as it may be useful in advancing his anti-smoking agenda. But I admit I'm taken aback by this one. That someone who calls himself a researcher would choose this study to make so much noise just boggles my mind.

What we're being told is that this study confirms indoor smoking bans will do more to reduce heart attacks (by 60%!)than virtually any medical advance or preventive practice in the history of medicine--and IMMEDIATELY! I think it took longer to paper the city with all those requisite No Smoking signs than it took for the risk of heart attack to plunge.

I wasn't aware that this ordinance necessarily impacted only the typical smoke ban holdouts like bars, restaurants and casinos, but it was obvious that the researchers were anxious to include non-Helena resident admissions whose only contact with Helena may have been a fast lunch at Helena's Quickie Burger.

Odd, but they also worked hard to include all residents of a particular zipcode which apparently extended outside the territory of Helena's smoke ban ordinance. They surveyed 500 hospital admittees over the age of 18 who shared this zip code, patients who were admitted for any reason, be it car accident or tonsilectomy, and found that 40ish percent of the patients in that other zipcode worked, and 90 percent of those working worked IN the territory covered in the smoke ban.

Now I have to ask myself why they went to all this trouble? Surveying 500 people who weren't necessarily even heart attack patients? Just to find some evidence to support including that zipcode in the test group? 500 people!!! That's as many as were actually IN the heart attack test group, and it doesn't sound like any of THEM were surveyed! If they had been, then there would have been no need to play the guessing game with their neighbors who were there to have a baby or have their appendix taken out.

This may or may not have made any difference one way or another. But with such small numbers as these, the potential is greater that flukes and fluxuations, which perhaps you can isolate and determine should have excluded them from the study, skews the results.

But regardless of these questions, these findings shouldn't be taken seriously yet, without them first being given a good hard look both again at Helena and looking for similar impacts in other places that have smoke bans. The only sensible response to the study at this point is not to plaster the "News" on every health news website on the internet, but to fold your arms, scrunch your eyebrows, and say "Get Outta Here! 60%!!!!??? You're Nuts!"

posted 10-19-2003 04:33 AM            

From the NY Times January 19, 2003

Gains on Heart Disease Leave More Survivors, and Questions.

The numbers have been inching down for decades, but only lately have doctors begun to appreciate how profoundly things have changed for heart attacks and strokes.

The stereotypical heart attack patient is no longer a man in his 50's who suddenly falls dead. Instead, the typical patient is a man or woman of 70 or older, who survives.

The decline in smoking rates did not markedly affect heart disease and stroke death rates, said Dr. Lee Goldman, a professor of medicine at the University of California at San Francisco. Smokers were dying early of lung cancer and lung disease, taking them out of the pool of people who might die of cardiovascular diseases.

A more important factor, Dr. Goldman said, is that treatment for heart attacks has changed radically.

posted 10-19-2003 02:14 PM            

quote:

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We did not include sudden or other deaths where the patient did not reach the hospital.

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Smokers 60% better at CPR, study suggests.

posted 10-19-2003 03:18 PM            

Further if those now getting and surviving heart attacks in their 70s include, typically. 20% current smokers, and 25% ex'es (since smoking was quite acceptable in thier youths) then smoke isn't quite the determinant of heart health that it's cracked up to be.

posted 10-19-2003 08:08 PM            

Glantz should probably leave "academic" work and open a PR agency.

posted 10-21-2003 12:04 PM            

quote:

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After they hid this Helena Heart "Study", anti-smokers are still using it as evidenced by ......

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I'm really hooked on this Helena puzzle. From all appearances, the study is a hokey mess! Yet it seems to be taken very seriously at virtually every level, and despite the enormous attention it's received, nobody seems to have noticed the numbers don't even add up!

Authors reported that the seasonally adjusted average number of AMIs dropped during the smoking ban from 6.8 per month to 3.8. That is NOT a 55% drop! That's just under 45%. It's unbelievable to me that with all these "high powered" researchers working on this, nobody caught this glaring mistake in arithmetic in the study's key finding!

They also reported "no significant change in the number of admissions from outside Helena (+.88)." Though perhaps it's correct to say the change wasn't statistically significant, it appears from their own charts that the number of admissions in this group increased 64%, an average gain of +1.17, not +.88). IF there was indeed an increase in this group, it might very well suggest this result was due to the effect from at-risk "non-residents" avoiding Helena during the smoke ban, raising further questions that the drop in Helena is actually a reflection of a real drop in AMIs. In other words, perhaps the overall number of heart attacks weren't much changed, but the number of persons visiting Helena who were at risk declined.

This scenario may somewhat explain the unbelievable claims made regarding the ban's impact on smokers' heart attack. Though not mentioned in the abstract, media reports told us that smokers' heart attacks there declined 75%--and if so, it's implausible that the decline was due to the smoke ban. More plausible would be the idea that non-resident smokers avoided coming to Helena. I believe approximately half those in the hospital's regional area lived outside Helena (and outside the smoke ban), yet these would have been counted among the Helena group if they'd worked or even just briefly visited in Helena.

Because of these discrepancies between the numbers in the authors' charts and the numbers in their discussions, and because this study continues to get so much attention though it's still unpublished, I was curious to take another look at what little information had actually been made available last spring, when the study was first presented. And what I found were even more bizarre questions...

Compare the 2 charts (one for Helena, one for outside Helena)in the following powerpoint presentation to the supposedly "same" 2 charts in lockjaw's copy of the study's abstract, which used to be available on tobaccofreekids. Both the abstract and the presentation appear to have been delivered at that annual meeting of American College of Cardiology last spring. One chart represents the number of AMI Helena patients in each month over a total of 63 months. The other chart similarly represents the number of AMI non-Helena patients. The plotted numbers printed on the charts in Powerpoint differed from the corresponding numbers printed in the abstract in nearly half the Helena/non-Helena data points--62 out of the 126 total.
http://www.no-smoke.org/HelenaPowerPoint.pdf

Does anybody know a reasonable explanation why this would be?

edit: ubb repair

posted 10-21-2003 03:02 PM            

quote:

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Originally posted by lockjaw02:
Milloy smokes em hard in a blazingly good editorial on the Fox News Channel.

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Milloy rightfully points out that a drop in AMI's also took place in 1998. That drop was even slightly larger than the drop witnessed during the smoke ban.

In fact, fluxuations of this magnitude, both upwards and downwards, can be found occuring 6 times in the 5 years covered in this study. A "significant change" that you actually find occurring 10% of the time in a 5 year period? How can any reputable scientist brashly credit the smoking ban to just one of those episodes?

The study's a joke.

posted 10-22-2003 12:21 AM            

quote:

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Originally posted by Geodge4Uceff:
The study's a joke.

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Geodge, I wish I were better with the numbers, but I wholeheartedly agree with your last line.

I figured you only commented jokingly, but your off-the-cuff remark you e-mailed to me that this whole "fluctuation" may have been simply a artificial condition that the smoking ban may have created by detering older retired out of towners from venturing into the Helena area casinos and thus causing a reduction in the tranient population at higher risk for having AMI's (those damn excitable smoking gamblers) really got me thinking about the genius in that remark. One has to wonder about the economic effect of the Helena area casinos during that 6 month ban. Would you like to bet the "researchers" didn't account for such a confounding factor?

Hmmm, maybe time to do a little poking around into the "casino effect"?

posted 10-22-2003 12:32 AM            

Helena gaming revenue drops in first quarter of smoking ban

Quarterly gambling revenue collected within the Helena city limits dropped 10 percent compared with a year ago, even though gambling collections were up elsewhere in the county, new state revenue figures show.

But experts say it is too early to say whether Helena's ban on smoking in all public places, including bars and casinos, is responsible for the decline.

"This doesn't prove anything, but it's not inconsistent with people going outside of Helena and gambling," said Paul Polzin, director of the Bureau of Business and Economic Research at the University of Montana. "You'd have to wait until the next quarter to see if there's any trends here. Because with more information, you get more confidence."

Mont. Bill Exempts Casinos from Local Smoking Bans

Sen. Joe Tropila (D-Great Falls) said that since Helena's smoking ban went into effect, businesses in the city have been losing money and jobs are being impacted.

"The people of Helena have every right to do what they want to with the health and welfare of their community, but they don't have the right to tell other people what their property rights are," said Sen. Tom Zook (R-Miles City).

posted 10-22-2003 01:15 AM            

I continue to think the most damning evidence against this bilge is: Milloy's discovery that similar random dips had occurred before; that there's no evidence of this phenomenon elsewhere where bans have been imposed; that there was no evidence (because it wasn't asked) that any of these folx before, during or after the ban, had frequented smoky places, no evidence of whether they lived with smokers; and no way to separate the effects, if any, from a smoker's own smoke and that of others around him. To attribute a smoker's heart attack to ETS in a restaurant is beyond the insanity that marks this movement.

posted 10-22-2003 01:26 AM            

quote:

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The data are from billing records for people who reached the hospital. There is one other hospital in the area, the Ft. Harrison Veterans A dministration M edical Center, which is located adjacent to the city limits, but which does not ad mit patients after 5 p.m.; am bulances are directed to St. Peter’s emergency room after hours or if the patient is unstable. The VAMC hospital only admits about 10 acute AMI patients from all over western Montana per year. If the patient is unstable they are transferred to St. Peter’s, then back to the VAMC after they have been stabilized. We did not include sudden or other deaths where the patient did not reach the hospital. We did review death records for Lewis and Clark County, but did not include them because of concern about the accuracy of the assigned causes of death.

---

There may have been less people in the casinos within city limits and more outside. They did NOT include death records (AMI victims had to be transported farther?) and they did not even include data on such. That can even add up to more AMI victims, with more dying. That can also add up to no change.

posted 10-22-2003 11:44 AM            

quote:

---

Originally posted by SamTheCat:
I continue to think the most damning evidence against this bilge is: Milloy's discovery that similar random dips had occurred before; that there's no evidence of this phenomenon elsewhere where bans have been imposed; that there was no evidence (because it wasn't asked) that any of these folx before, during or after the ban, had frequented smoky places, no evidence of whether they lived with smokers; and no way to separate the effects, if any, from a smoker's own smoke and that of others around him. To attribute a smoker's heart attack to ETS in a restaurant is beyond the insanity that marks this movement.

But again (genuinely asked)-- what am getting wrong?

---

Sam,

posted 10-22-2003 12:22 PM            

quote:

---

Originally posted by lockjaw02:
Hmmm.

Gosh darn, geodge! 10% redeuctions in revenues in 1st quarter under the ban? Not inconsistant with people going outside Helean and gambling? Less outsiders coming in, and more Helena residents heading outside city limits (and away from that specific hospital) to partake in fun and games. Who wudda thunk it?

---

Yeah, who wudda thunk it......certainly not radical anti-smoking activists who are compelled to argue publicly such a scenario would be unthinkable. Business is supposed to boom under smoking bans.

It's one thing for proponents and opponents to smoke bans to bicker about future impacts from smoking bans--that's not surprising, but here we see a situation where this bickering has "contaminated" the scientific research into heart attack.

You folks have no doubt seen this problem over and over again, since the board is devoted to the "junk science" issue...

But I admit I'm genuinely surprised at how much attention a "crap" study like this one has received. The findings were so implausible, but it seems that in the media and in the public health circles the sheer unbelievability that SHS could be responsible for 60% of all heart attacks rendered this study MORE credible rather than LESS!? Bizarre.

posted 10-22-2003 02:31 PM            

quote:

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Originally posted by SamTheCat:
Also, why are first-hand smokers (the folx most likely to go out of their way to smoke) relevant at all? Unless Glantz is presuming that first-hand smoking isn't all that bad for you... unless you're also exposed to secondhand smoke? Okay-- what've I gotten wrong here?

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Their goofy statistics supposedly demonstrated smokers benefited the MOST in Helena during the smoking ban! These findings are even more mysterious and inaccessable than the overall numbers, but the authors claimed heart attacks dropped 75% for smokers, 67% for former smokers, and 50% for nonsmokers.

And unbelievable as it sounds, those statistics indeed WOULD suggest that SHS is at least as bad for you as smoking.

I believe the American Heart Association claims smoking doubles a person's risk of heart attack. By claiming SHS bans result in a 60% drop in heart attack, the authors have shown SHS bans do more to force down heart attack rates than would eliminating smoking altogether.

Of course, I don't think that these "researchers" understood how to read their own statistics. If they couldn't see that their own numbers don't support their claim of a "60% drop in heart attack", then they probably misread those eye-popping statistics I just mentioned as well. As I told lockjaw, it looks to me like they interpreted their own data upside-down.

quote:

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I continue to think the most damning evidence against this bilge is: Milloy's discovery that similar random dips had occurred before; that there's no evidence of this phenomenon elsewhere where bans have been imposed; that there was no evidence (because it wasn't asked) that any of these folx before, during or after the ban, had frequented smoky places, no evidence of whether they lived with smokers; and no way to separate the effects, if any, from a smoker's own smoke and that of others around him. To attribute a smoker's heart attack to ETS in a restaurant is beyond the insanity that marks this movement.

But again (genuinely asked)-- what am getting wrong?

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Nothing! I think what you've said makes perfect sense!

posted 10-22-2003 03:42 PM            

But it occurs to me there's another explanation ~

quote:

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"[The study's co-author] Shepard acknowledges that critics will point to his and [his partner] Sargent's support for the smoking ban in refuting the study.

'They can say what they like. The bottom line is, the data speaks for itself. We don't have to apologize for our particular bias,' Shepard said."

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"The data speaks for itself"????

WHICH data? Just one day before the presentation itself, the American College of Cardiology prepared a statement quoting Dr. Sargent: "The passage of a local indoor smoke-free-air ordinance was associated with a significant 45% reduction in heart attack incidence for people living in the Helena region as compared to the surrounding areas."

The next day, Dr Sargent actually made his presentation, and there he claimed his findings show a "Significant fall of -4.0" AMIs, and illustrated his claim with data showing instead a fall of just -3.0. And at this presentation, he was now also claiming, not a 45% but a 60% reduction in heart attack incidence.

During that presentation, he presented his attendees with two similar, yet distinctly different data sets of the same study. (If this were accounting, an "oops" like this would raise worries somebody was "cooking the books".) Yet NEITHER of those data sets supported the claims he was making of a 60% drop.

How did the same man offer all these conflicting versions of his own study? And all of them at the same time? In conjunction with this one presentation on Apr 1 to the ACC?

"The data speaks for itself" and may say as much about the study's authors as it does SHS. Is Dr. Sargent a dummy? Or is he just overconfident that everyone else is?

And if what they HAVE revealed to us shows us that the researchers have misread their own data, and are in possession of at least two substantially different VERSIONS of this data, what about the parts we HAVEN'T seen? How can one have much confidence the whole thing isn't garbage from top to bottom?

posted 10-23-2003 12:28 AM            

Actually I'm willing to discount this second hospital, which only gets 10 AMIs per year, though, otoh, + 5 cases might indeed make a difference when you're working with samples whose "huge" variations are from 6.8 to 3.8 cases-- total. The sample size itself raises an eyebrow. In any case, I remain suspicious of discounting not only those who died mid-ambulance, but discounting county death certificates, presumably, at least, signed by the corpses' docs. This smacks of picking cherries, an Aunt hobby.

For instance, in one heart study, a meta-analysis (Law et al) Law admits to excluding the largest studies ever done (the Cancer Society's CPS-1 and CPS-2, with a total of 2.2 million subjects) "because," he said, "they were inconsistent with other studies." As, in fact, they were. Both CPS's showed no effect whatsover from secondhand smoke. Ie: 1.0 (95%, 0.97-1.04) and 1.0 (95%, 0.90-1.07). One of these two studies, btw, was the basis for the Kabat & Enstrom study showing...1.0. At any rate, the studies Law did choose were extraordinarily weak. Of the 19 he picked (a mixed methodological bag), 11 lacked statistical significance, and 7 produced results of less than 2.0. In all, he teased out a meta-analytical RR of only 1.23. And he wouldn't've gotten that much, if he hadn't picked his cherries.

Mary McCarthy supposedly said of Lillian Hellman that everything the woman writes is a lie, including "and" and "the." Too bad McCarthy (a smoker) didn't live to meet Stanton Glantz or the other Helena perps.

posted 10-23-2003 09:53 PM            

quote:

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Originally posted by SamTheCat:
Actually I'm willing to discount this second hospital, which only gets 10 AMIs per year, though, otoh, + 5 cases might indeed make a difference when you're working with samples whose "huge" variations are from 6.8 to 3.8 cases-- total. The sample size itself raises an eyebrow. In any case, I remain suspicious of discounting not only those who died mid-ambulance, but discounting county death certificates, presumably, at least, signed by the corpses' docs. This smacks of picking cherries, an Aunt hobby.

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Sam, ordinarily I'd say yes to discounting the Veteran's hospital, however, the researchers also said they checked other hospitals. They had to in order to announce that AMI rates were up slightly outside Helena. However, you're right on about the "researchers" discounting of death certificates.

The most telling thing to me is that MIlloy stated he asked Dr Sargent, to repeat this study in NY, and was told that it would be too hard:

quote:

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It’s been about six months since New York City’s smoking ban went into effect. I asked Dr. Glantz’s colleague if he would be studying whether the NYC smoking ban experience confirmed or contradicted his Helena study claims.

He mumbled something about such a study being too difficult because of all the data involved.

But I can see where anti-tobacco researchers wouldn’t want to have too much data. It just might clear up the smoke they’re blowing in our eyes.

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What kind of load of poppycock is that?!? It should be easier to see a whopping hypothesized 50% reduction in AMIs in NY City where a similar all-inclusive ban has been implemented, but most patients are mere minutes from most hospitals. No, I do believe that the reasoning is somewhere in that 10% reduction in casino profits in Helena proper during the first quarter of the ben and the increases in the more rural areas, farther away from hospitals with the unanalyzed deaths. The most plausible scenario is that AMI's simply didn't decrease, but that the ban just killed more AMI sufferers by making them party in the casinos and bars further away from more immediate medical care.

Geodge also sent me this in the cybermail (Sorry, geodge, I'd have put it in my own words, but you're so damn good at it):

quote:

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To help flesh out the picture, let me explain how it looks at the small casinos I'm familiar with--and none of this has anything to do with smoke bans, it's just the nature of these businesses in general. Keep in mind, this isn't necessarily the situation in Montana. I don't really know.

But with the casinos I'm familiar with, the patrons are much more likely to be older, and suffer various health problems. I'm surprised how many of them are younger who aren't working due to some long-term disability. Like the retired, I suppose, they have more time and with infirmities, perhaps less options available for other outside interests.

Out-of-town visitors come in by the bus load...local people go to the casinos, but out-of-towners will take those big charter buses and travel many miles away from home to go to these casinos. Even a small casino will see at least several hundreds but more likely several thousands of out-of-towners in a week. I don't know how far the average visitor travels...I do know these casinos advertise themselves on billboards and radio stations - appealing to customers hundreds
of miles away.

More than a few (as in MANY!) of these gamblers are obsessive about it. They lose all track of time. They avoid sleeping....not unusual for a gambler to go without sleep for more than 24 hours. When traveling the bus, most try to spend 100% of the time in the casino and save their sleeping for the return home on the bus. They may forget to eat. Even in casinos where there is no drinking, you'll find customers almost "intoxicated" from the gambling itself. It's stressful to win. It's even more stressful to lose. They forget to take their medications at the right time. They may forget and leave their medications at home.

There are ambulances coming and going many, many times throughout the week. Chest pains, seizures, collapses, fainting spells, fights, difficulties breathing, you name it. I even heard a story about somebody suffering a "burst bladder" because they refused to leave their slot machine to use the bathroom. I don't know if they just wet themselves, or if it was something more serious, but I do know the ambulance was called.

Now.........common sense would tell us that you're going to find more heart attacks among these folks than in the general population, no?????? So if fewer of them are coming to town, then fewer of them will be having heart attacks while they're there. But like you say, without more data it's impossible to say for sure how much impact this had on those Helena numbers.

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Are these Helena "researchers" geniuses? I doubt it. More like anti-smoking ostriches with their heads in the sand.

posted 10-24-2003 12:21 AM            

quote:

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Originally posted by lockjaw02:
...however, the researchers also said they checked other hospitals. They had to in order to announce that AMI rates were up slightly outside Helena.

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Correction:

The study ONLY looked at the electronic billing records of the patients at this one hospital, and the paper records if the electronic records were lacking info. They sorted the patients into two categories...those that were the "Helena" group and those that were the "outside Helena" group. In the methods they used to do so, they went first by zip codes of the patients' residence. They also looked through charts to determine whether there was evidence that a patient in zip codes in the OUTSIDE group should actually be counted as IN Helena based on the fact (laughable, I know) that they ate at least one meal or spent the night at least once in Helena before their AMI.

They determined AMIs went UP outside Helena because there were more than average patients in the "outside" group (based on the their zip code) who had AMIs.

However you look at it, this is weird methodology.

posted 10-24-2003 01:27 PM            

quote:

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Originally posted by lockjaw02:
Lucky me, Sam. I downloaded the copy before they "pulled" it. Can e-mail you a copy if you really want to lose your lunch over this rotten "peach".

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posted 10-24-2003 03:05 PM            

quote:

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Originally posted by lockjaw02:
However you look at it, this is weird methodology.

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Isn’t it, though?

And because of the peculiar methodology used to assign patients to "Helena" and "Outside Helena", any change in visitor traffic could mislead and risk false conclusions in interpreting any drop or increase in the seasonally adjusted AMI rate.

This “flaw” shows up very clearly when you play with real numbers, so I thought of a simple hypothetical which would illustrate. Let's say that before the smoke ban, St Peter’s hospital saw an average of 8 AMIs a month. With this peculiar system used to "assign" these AMI patients between “Helena” and “Outside Helena”, 6 of these 8 patients were counted in the “Helena” group and 2 in the “Outside Helena” group. Looking at them more closely, however, let's say you determined that of those 6 in the "Helena" group, only 3 of them actually lived/worked in Helena. The other 3 were just visiting when they took sick or shortly before they became sick, but that was all it took for them to be included in the “Helena” group.

THEN a smoke ban was passed – just in the town of Helena. Less than half the patients served by St. Peters actually live IN Helena, so let’s assume for purposes of this illustration that the Helena smoke ban annoyed potential visitors and these visitors changed their behavior accordingly, taking their business elsewhere. Let’s assume that visitor traffic dried up. Now, if any of these no-longer-visiting-Helena patients are brought to St Peters suffering a heart attack, they will be put in a different group than they would have been before the ban. Now they are placed in the “Outside Helena” group.

So let’s assume for this illustration, only those AMI patients that actually lived/worked in Helena were counted as "Helena" AMIs. There were no visitors. (Let me emphasize again, this is just a hypothetical.) Because there are no visitors, the expected number of AMIs for the Helena group SHOULD be 3, not 6, but there is no accounting for a drop in visitors in the statistical equation. So during this hypothetical, when St Peters actually DOES admit only 3 AMIs to the “Helena” group during the smoke ban, it looks to them as if “Helena” has had a 50% drop in heart attack.

But those “Helena boycotters” who were deterred from visiting Helena do continue to have AMIs. Pretend just one of those would-otherwise-be-visiting patients lived in the St Peters territory, and was taken there after their AMI. Pretend two other patients who lived outside of Helena also suffered AMIs—though they didn’t visit Helena, these patients weren’t regular Helena visitors before the ban either. So now there are 3 AMIs a month at St Peters in the “Outside Helena” group. It looks as if “Outside Helena” heart attacks have increased 50%. And total AMIs at St Peters have dropped from 8 altogether to 6.

But assume there were another 2 persons had AMIs. These individuals didn’t live in Helena, and they were too distant to be in St. Peter’s territory either. But they were regular visitors to Helena before the ban. Annoyed by the ban, they took their business instead to Bozeman. So when they took sick, they went to the Bozeman hospital instead of the hospital in Helena. These two people have dropped off this study’s radar screen altogether.

Recapping the heads-in-the-beds in this example? There were 8 AMIs before the ban. There are still 8 AMIs after the ban. There WAS no drop in heart attacks at all! However, statistically it looks like Helena had a 50% drop in AMIs, and the "outside" Helena group had a 50% increase. The two folks in Bozeman don't get accounted for at all! Even if ALL the SAME people who destiny had originally planned to inflict with a heart attack actually DID have one as expected? It would still misleadingly appear as if heart attacks dropped 50% due to the smoke ban.

This was just a hypothetical....but the numbers are pretty close to what was observed in Helena. Total AMIs at St Peters was 8 and half a month. AMIs in the “Helena” group appear to have dropped by 3 a month. AMIs in “Outside Helena” looked like they increased by sixty-four percent. And we can guess all day long about where the other 2 and a half people went.

The radicals of course would be quick to scoff at the suggestion that visitor traffic to Helena would dry up like this. And I agree. It might go down, even go down enough to bring real suffering to the business community, but it wouldn’t be likely to dry up completely. But what boggles my mind is that radicals, health officials, and the gullible media DIDN’T find the idea equally ridiculous that a smoke ban could drop heart attack rates by 60% in the very first month it was implemented!

We know nothing about any of these patients in terms of their pre-post SHS exposure, nor how the smoking ban impacted their own smoking behaviors. It may be that the drop was real but it was completely unrelated to the ban at all! Maybe a residential senior citizen facility or convalescent hospital was shut down? The numbers are so tiny, something like this could have a measurable effect.