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.
Or am I missing something?
Mike,
You appear to be implying that the researchers who found reduced heart attack admissions (following a smokefree ordinance) have claimed that all smokefree ordinances will reduce heart attack admissions. But I'm not aware of that occurring.
You also appear to be implying that ALL smokefree advocacy organizations have been touting and citing those studies (which found a reduction in heart attack admissions following a smokefree ordinance) in an attempt to enact similar ordinances elsewhere. I know that has NOT occurred.
Somewhat similarly, just because some smokers who post on this blog have claimed that tobacco smoke pollution doesn't cause diseases in nonsmokers, or that increasing cigarette taxes don't reduce consumption, it wouldn't be accurate for me or anyone else to claim that all smokers believe or say those things.
Regarding the heart attack admission data from CA, OR, FL and NY, these don't appear to be comparable to Pueblo or Helena, as many large CA municipalities had already enacted smokefree bar ordinances prior to enactment of the state law, the OR and FL laws don't include bars, and as you mentioned, the NY data isn't available following implementation of the law. These are but just a few methodological weaknesses of comparing data from those states with data from Helena or Pueblo.
Bill-
You are right that not all anti-smoking groups have been citing these statistics and I did not make such a claim. I used the term "anti-smoking groups" which I think is accurate. But it just so happens that one of those anti-smoking "groups" is the Campaign for Tobacco-Free Kids which is a huge part of the anti-smoking movement and which does advocacy throughout the country for smoke-free ordinances. So I don't think this is something we can just push aside by saying "Oh well - it's just one or two groups that are doing it." In many ways, the Campaign for Tobacco-Free is the anti-smoking movement - they have certainly co-opted the movement in that way.
In the mean time, I guess we'll see if you're right about anti-smoking groups distancing themselves from these claims. Let's see if any anti-smoking group goes on record as stating that they feel the conclusions of these studies have been over-stated.
Frank-
I think the AHA statistic is referring to the percentage of persons with complete heart stoppage who die before getting to the hospital, not the percentage of all heart attack victims.
Nevertheless, you make a very good point which is that a 25-40% reduction in heart attacks would be a very substantial decline. If eliminating smoking in restaurants alone has led to a 40% reduction, then I would have expected to see drastic reductions in heart attacks over the past decade as secondhand smoke exposure in all venues has dropped tremendously. But the statistics I've analyzed don't bear that out. In addition, you make it clear exactly why one would expect to see demonstrable reductions in heart attacks in states with smoking bans.
Ah, thanks, Mike. With that clarification, I see that my interpretation would be off since there would be many more "heart attack" victims who would be able to make it to the hospital than just the AHA estimate of 5% of those with complete heart stoppage requiring CPR.
So I guess to add more fidelity to the equation, one needs to figure out what percentage of the total number of cardiac events these complete heart stoppages comprise.
I'd still like to know the difference between a complete heart stoppage and an AMI event in laymen's terms. Can a number of heart attack victims who don't make it to the hopital alive be AMI victims? And if so, then how can admissions alone definitively indicate any decline in AMI events due to smoking bans?
Frank is concerned if only 5% of patients are alive, when they reach the hospotal, are they counted? I believe, for AMI the number alive is about 60% when they reach the emergency room. Consider the Florida data, about 40,000 admissions, if that number only represented 5% of AMI cases, then about 800,000 deaths from AMI would be occurring each year just in FL, in a population of 16 million. In fact our national heart attack death numbers (for all causes of heart death) is about 800,000.
I also have a few comments for Bill, true, some local jurisdictions in CA, FL,NY, and OR had bans before the state ban took effect, but i'm sure some restaurants and bars in Helena and Pueblo also had voluntary bans before the local bans kicked in. To me, this is totally analagous to the situation of local jurisdictions in states having bans. Helena's AMI' events wouldnt distinguish between some restaurants in say, Helena voulntarilly banning smoking before helena's ban, likewise, California's AMI events wouldn't distingish between local bans and the implementation of the state ban.
We have a situation, where researchers claimed helena AMIs dropped 40% despite some helena establishments already banning smoking before the ban took effect. This necessirally implies the 40% reduction was due to the dissappearance of smoke in those establishments which still had smoking up til the day the ban took effect. If , say 50% of helena's establishments had banned smoking before the law, then the total impact over say, ten years should have been close to a 80% reduction in AMI's. And don't forget, I'm sure many private employers in Helena banned smoking in thier non-public workplaces long before the city ban, that should have reduced AMIs too, if half the public establishments and 75% of private employers had banned smoking before the law, Then, the impact of all this should have been in excess of 100% reducton in AMIs. - Dave
Mike,
Just because CTFK has been very successful at convincing RWJF and others to give CTFK money doesn't mean that they are the leading tobacco control organization in America.
Rather, they are just one of hundreds of tobacco control organizations.
And CTFK is probably one of the least cost effective of all tobacco control organizations, as they've accomplished very little (in terms of getting tobacco control policies enacted) after spending millions of dollars.
And CTFK's two largest lobbying campaigns were to enact federal policies that protect cigarette companies (i.e. their unsuccessful campaign to enact the 1997 cigarette industry lawsuit protection deal that was agreed to by State AGs, and their current campaign to enact FDA legislation that would protect future market shares, revenues and profits of Philip Morris).
In contrast, hundreds of other tobacco control organizatons (primarily at the local and state level) have spent relatively little money and achieved huge successes in getting hundreds of reasonable and effective tobacco control ordinances and state statutes enacted.
That said, I still think CTFK does some very important work and provides many helpful resources (albeit often indirectly) to the state, local and grass roots activists who have accomplished the vast majority of tobacco control's successes.
As the old saying goes, think globally but act locally.
CTFK could become a true national leader in tobacco control (and far more cost effective), however, if they collaborated more directly with local, state and grassroots activists, and if they made certain that all of their claims were accurate (or at least if they corrected any inaccurate or misleading claims after being informed).
Bill, I believe that CTCK, ANR, ALF,the tobacco control aspects of the ALA, ACS, and AHA, ASH, and GASP probably represent a good 80 to 90% of the multi-million dollar funding that goes into buying smoking bans around the country.
I use the term "buying smoking bans" deliberately: when you spend millions on television ad campaigns showing sweet little 6 year olds pleading for clean air as part of an effort to ban smoking in bars, when you spend millions on newspaper ads and billboards designed to make innocent people think their lives are in imminent danger simply because someone in a room with them is smoking... that's "buying a smoking ban."
You speak of hundreds of local and state groups spending "relatively little money" in pushing smoking bans. As Executive Director of SmokeFree Pennsylvania you have indicated that far from taking money for your work and expenses you actually contribute your own money voluntarily in addition to your time. But I am sure that SmokeFree PA has at least some budget that has been used over the past year to push for bans in Philadelphia and Harrisburg.
As Executive Director you surely have access to your budget details. Would you share with us perhaps the details of the "relatively little money" that SmokeFree Pennsylvania has spent this year, how it has been spent, and where it came from? My perception is that quite a sizeable amount of money has been spent here to "educate" the public about the "deadly threat" of secondary smoke as illustrated by such studies as Helena. Am I wrong in that perception? Are the details of SFPA's budget publicly available online? And, to get back to the opening point you were making, have you yourself or SFPA ever used Helena et al as an argument to promote smoking bans?
Michael J. McFadden
Author of "Dissecting Antismokers' Brains"
http://pasan.TheTruthIsALie.com
Dr. Siegel, let me start out by saying your extensions of our research are wonderfully done and most welcome!
I would like to make several points in response to you and then perhaps take another post to respond to any questions raised about our study by others.
1) The time expansions beyond six months are certainly important in the wider scheme of showing the effect or lack of effect of bans on AMIs, but two things need to be remembered in this regard:
1A) Our study was primarily a response to and criticism of Helena and similar work. Helena claimed a drastic drop in AMIs in six months. Our work has shown such a drop to be likely no more than a statistical blip. It has also raised the question of why Helena, Bowling Green, Falls River, Pueblo, and Greeley ALL showed such seemingly significant effects when those effects do NOT seem to be replicated in the wider state-level data. Is it possible that Antismoking advocates have deliberately sought and cherry picked such towns even while knowing that holding them up as the norm would be a blatant misrepresentation?
Anyone who has seen my original (and of course unanswered) criticism of the original Helena study in the BMJ at:
http://bmj.bmjjournals.com/cgi/e.../7446/
977#55832
has seen quite clearly how Helena was deliberately misrepresented to media around the world by supposedly responsible Antismoking researchers and organizations. I called such misrepresentation a fraud after careful thought as to the implications of that word. If Antismoking front groups for the ALF and RWJF have been deliberatey picking out exceptions and presenting them as the norm, it would only extend the charge of fraud even further.
and
1B) Even if such extension beyond six months DOES show a reduction in AMIs or general heart attacks, it should be clearly pointed out that such reductions are far more likely to largely or entirely the product of reduced smoking effects on smokers themselves rather than fantastical claims about "protecting nonsmokers from the poisons" of secondary smoke.
2) Dr. Siegel, I know you still believe secondary smoke to be a significant threat to hospitality workers. I strongly and deeply believe that scientific evidence does not support this. Just as Helena et al have been created and twisted in the promotion of the Antismoking agenda, I believe that most of the studies out there indicating such dangers have also been created and twisted. It may SEEM on a superficial level that there is a lot of supportive data for your position, but I would argue that a good bit of that data is spurious, particularly when conclusions drawn from exposure to actual smoky conditions are extended to apply to conditions in venues with modern ventilation and air-filtration systems.
3) You wrote: "I think by harping on these data, anti-smoking groups have set themselves up for failure, and therefore done a disservice to the overall effort to protect workers from secondhand smoke." and I wanted to suggest that if you haven't done so already that you invite Dr. Elizabeth Whelan of ACSH over here for a visit. She has expressed VERY similar sentiments for years!
4) If I enter the search definition:
helena "smoking ban" (AMIs OR "heart attacks")
into Google, I come up with 907 results. Adding the name kuneman to that search string reduces the result to 3. It would be nice if the Antismoking Lobby offered to repair the damage it has done to scientific credibility by lending us the power of their microphone in order to equalize those results.
5) There was no need for a comparator group. Our study was meant to be a comparison to Helena. Helena et al claimed that a smoking ban brings about an immediate drop of 30% to 50% in AMIs. Dave and I used a database 1,000 times larger than Helena/Pueblo and found NO drop, much less a 30 to 50% drop.
6) Unlike the authors of Helena, Dave and I will very happily and openly answer any and all questions about and criticisms of our study when we become aware of them.
7) I am still waiting for the 1,000 page report on Bowling Green that Stu Kerr recommended I read. He has never sent it to me or given me further response to my repeated requests to him and the Ohio Antismoking group that he suggested I contact.
I would be quite pleased to read and comment on the formal studies of Pueblo, Bowling Green, Falls River, and Greeley themselves if the authors and publicists of those studies would do more than simply produce press releases and/or give interviews about them. The data for our study is fully and openly available to the public and to researchers for examination, checking, and criticism. Is it too much to ask that the authors in the other cases make their data similarly available? Or does their data now imitate the "secret tobacco industry documents" that they used to scream about?
9) Despite the fact that heart attack rates in Massachusetts increased at a rate 2,000% higher than the national average (32% vs. 1.5%), Dave Kuneman and myself will refrain from making claims about what happens when the protective effect of secondhand smoke is removed from a population. {note to the humor impaired... look up the word sarcasm.} Can you imagine the publicity if Stanton Glantz had found the opposite case to be true for an entire state?
Michael J. McFadden
Author of "Dissecting Antismokers' Brains"
http://pasan.TheTruthIsALie
Per Michael McFadden's inquiry, the overwhelming majority of SmokeFree Pennsylvania's expendures are for rent, utilities and phone, and we haven't received any funding from RWJF, any drug company, or state tobacco settlements.
I'm not aware that anyone affiliated with our organization has publicized the findings of the Helena or Pueblo studies, as I think more research is needed before drawing scientific conclusions of causality.
I'm pleased to acknowledge that our organization has been advocating smokefree workplace legislation in Philadelphia, in the PA General Assembly, and in many other jurisdictions ever since 1990.
Before that, I advocated smokefree workplace legislation on behalf of several other public health organizations, and was instrumental in getting the 1987 Pittsburgh Smoking Pollution Control Ordinance
enacted.
I posted the previous comment, but for some reason my name didn't appear on the posting. Bill Godshall
Bill, thank you for your response to my query about SFPAs funding and expenditures. I had thought that I had seen a TV ad a few months ago with the SFPA logo at the bottom but it is possible I was mistaken.
I note you do not get funding from RWJF, Pharmas, or State funds, but are you saying that you actually are operating without any funding other than the rent for an office space, heat, and a phone line? I had assumed that even if your own position was volunteer that SFPA had at least some paid staff.
If indeed the above is the case I congratulate you not just for you and your staffs' dedication as volunteers but for both hard work and real talent: SFPA has managed to achieve a fairly high profile in the PA and Philadelphia smoking ban battles!
And a question: if State and national groups are not putting money into SFPA, then where in Pennsylvania is such money going? And why are they NOT supporting you?
Michael J. McFadden
Author of "Dissecting Antismokers' Brains"
http://pasan.TheTruthIsALie
SmokeFree Pennsylvania has never had any paid staff, just volunteers.
In 1999, after the Philadelphia County Court of Common Pleas rejected our Petition to Intervene in AG Mike Fisher's settlement with the cigarette companies (it was amazing to see 15 of Fisher's lawyers and 15 cigarette company lawyers in the same courtroom going up against our one lawyer who was working pro bono), we organized the statewide campaign urging the PA legislature to appropriate 30% of PA's settlement funds for smoking prevention and cessation programs.
After the legislature appropriated 12% of the settlement for these programs, SmokeFree Pennsylvania chose to not submit proposals for any of the PA DOH tobacco control program contracts because we wanted to remain independant.
Then we urged the legislature to oppose legislation supported by then Governor Schwieker to protect retailers who were caught selling tobacco to youth, which was enacted in 2002 after a very public battle
(we nearly got it defeated on the House floor, which surprised many House Republican and Democratic leaders).
Also, after suggesting many cost effective tobacco prevention and cessation programs to the PA DOH for their implementation, we've publicly criticized the PA DOH's ineffective antismoking advertisements and other tobacco control programs that waste public funds.
Since then, the PA DOH and most of its tobacco control contractors stopped collaborating with our organization.
But we continue keeping them informed of our activities and legislative opportunities and threats, and continue providing assistance to them with their programs.
Ironically, earlier this year, SmokeFree Pennsylvania was the organization that publicly opposed
Representative Veon and Governor Rendell's proposals to cut the PA DOH tobacco control budget.
But on the same day in July that the PA legislature gave itself a pay hike,
it approved cutting the tobacco prevention and cessation budget by 25%.
Bill, you wrote: " SmokeFree Pennsylvania has never had any paid staff, just volunteers." and
"After the legislature appropriated 12% of the settlement for these programs, SmokeFree Pennsylvania chose to not submit proposals for any of the PA DOH tobacco control program contracts because we wanted to remain independant."
Bill, I am honestly surprised and my respect for you has gone up. We may strongly disagree on the issue of smoking bans and the harms of secondary smoke and even on whether smoking itself is a good thing or a bad thing (I see it as being both to some extent, but believe you probably see it as being close to 100% bad) but I'll respect any idealist willing to work without pay for what they believe in. Heh... we're the most dangerous kinds of opponents to have cuz you can't make us go away just by cutting our budgets. :>
That being said... I still disagree strongly with the impression you gave in one of the posts here that you believed Helena was not heavily capitalized on by most Antismoking groups and activists in their promotion of smoking bans. Helena (and clones), Eisner (and clones), Kato (and clones), and Dr. Siegel's bar workers studies are so religiously cited that at Philly's last ban hearing I was able to pre-write my testimony in response to them, KNOWING that they would be cited by the Antismokers ahead of me.
The studies and reports of studies that smoking bans are mainly based on and passed with are full of inaccuracies, confounders, setup problems, and misleading statements. And these are the high profile flagship studies. If I had the time and the expertise to sit down and dissect every one of the "mountain of studies" that antismoking extremists like to wave in the air, I'll bet there wouldn't be a molehill of really decent stuff left... at least as regards the "threat" of secondary smoke.
As you can see... I may have more respect for you now... but we still disagree rather strongly.
Michael J. McFadden
Author of "Dissecting Antismokers' Brains"
http://pasan.TheTruthIsALie.com
I read these studies with great interest as I am a musician who has seen a significant drop in my work as a freelancer since our ban was implemented in February 2005 in Columbus, Ohio. I have had close to 20 years of successful steady work in this business prior to the Columbus, Ohio ban.
Our city council members who have ties with anti-tobacco organizations parrot the many things I have read in this blog about the closemindedness of many of those involved with the antismoking movement. When questioned, smug curt remarks have been their replies..... as if it was a crime to even ask the questions.
I am happy to see someone speak honestly about the tactics of many anti-tobacco organzations.
I have run into a bit of net abuse from uninformed people on the anti-smoking side.
Cowardly tactics, insults, etc... the run of the mill things that I am sure many have experienced who do question whether many of these studies are truly conclusive.
All of these personal attacks have stemmed from my being honest about my personal loss of club work in Columbus, Ohio since a smoking ban has been put into effect that includes clubs that are 21 and over.
They would prefer that I promote the lie that "no economic damage" occurs in bars when all-inclusive smoking bans are implemented by hoping I would be intimidated into silence.
I will not lie "for the greater good" or "for the children" who are not even allowed into the establishments where I play my music.
Thank you for being a voice of reason in a movement where it seems the majority of the followers of the movement use tactics that parallel mindsets I had only witnessed before when confronted with those involved in religious fanaticism.
I'd like to add to the discussion that the reason you don't see any great reductions in hospital visits after smoking bans are implemented is that the air quality facts regarding secondhand smoke have been greatly exaggerated.
Consider this government air quality testing:
http://cleanairquality.blogspot....s-
anything.html
Further to note, regarding earlier comments about activist organizations Tobacco Free Kids, American Lung, American Cancer, American Heart, it may be argued that they have been somewhat ineffective in "buying smoking bans", but not because they haven't been well funded from the Nicoderm people at RWJF.
$99 million from RWJF to ALA, ACS, AHA: http://www.rwjf.org/research/res...?id=2002&
ia=143
$70 million from RWJF to Tobacco Free Kids: http://www.rwjf.org/reports/grr/.../grr/
035929.htm
RWJF owns $5.4 billion in J & J (Nicoderm manufacturer stock) the only stock they own by the way:
http://www.rwjf.org/files/
public...ate.pdf#search=
Hi,
The value of the analysis performed on a population isolated from such factors as high migration is that the study's results appear to have no other credible explanation than that second hand smoke contributes to disease in a statistically significant manner.
After reading you rather contorted evaluation of these well designed studies, and your introduction of seemingly contradictory evidence by including States with fluid populations and out of state hospitalization destinations, I have only one question. Are you now or have you ever received any form of compensation from the Tobacco Indutry?
Richard-
I consider your comment to be a public accusation that I have taken tobacco industry money.
Please either provide documentation to support your accusation, or retract it.
Hi Michael,
I accept your statement that you have never received compensation of any kind from the Tobacco Industry, and apologize for upsetting you by asking if you had done so.
Sincerly,
Richard Campbell
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