So, lets see.... the usual claim is SHS causes 35,000 heart attack deaths per year, among 300M USA resident population. Pueblo comprises about 1/3000th of this population. SO 35,000 X 1/3000= 10 CVD deaths per year in Pueblo. This assumes Pueblo has the same population age profile as the USA.
It looks like about 60% of all AMI victims are admitted to the ER and about 40% die before even getting to the ER and are never admitted.
So, it looks to me like if SHS causes 10 deaths/year in Pueblo, then about 15 SHS induced AMIs survive long enough to be admitted in Pueblo's ERs. and most of those are survived.
The Amer Heart assoc says about 5% of all amis are SHS-induced.
So acording to the study, if 399 amis/year and a half were admitted pre ban, then 266/ year were admitted. 5% of 266 is 13 SHS induced amis/year. My previous model said 15 SHS amis were admitted in Pueblo, so this approximately checks out.
So i have examined two claims both of which project Pueblo should ahve had about 13 to 15 SHS induced amis/ year pre ban.
If all these SHS induced amis had occurred because of public place exposure, then Pueblo would ahve had about 13 to 15 fewer SHS induced amis per year post ban, or about 23 amis fewer in the year and a half post-ban.
So, since the paper says Pueblo had 399 amis pre ban in a year and a half, then we should expect the paper to find about 399-23= 376 amis, post ban, but the paper actually found 291.
So, the authors found very many fewer amis post ban in 1.5 years, than the generally assumed claim would project. ( 376 vs 291)
So, what went wrong here? ( Doc...how am I doing?? do I get a free public health PhD from BU now???)
it could be the authors have discovered public SHS caused 399-291= 108 amis in 100,000 residents, then SHS must be really causing 3,000 X 108= about 300,000 amis in the USA which make it to the ER, and about 200,000 ami deaths per year which die before Er admission. This is about seven times more than the 35,000 generally claimed.
The trouble with this model is, that the USA only has about 500,000 total amis admitted through the ER / year, and according to the findings of these authors 300,000 of these admissions are public SHS induced.
So, if these Pueblo authors are correct, in their findings, then almost all USA ami admissions through the ER are public SHS induced. Throw in residential SHS induced amis, and you are actually saying people would not have amis if it were not for SHS. In fact, if all SHS in homes and public places were eliminated, we would ahve a high negative number of amis/ year across the whole USA.
Now, if the Surgeon general is correct, that 70% of SHS was eliminated since 1988, then in 1988, SHS was causing 70/30 X 300,000= 700,000 admissions through the Er in 1988. Trouble with this is we know from HCUP that in 1993 ( first year avaialble), there were only 404,000 ami admissions.
So the Pueblo authors are definitely wrong to blame the ban for a 108 ami decline in a year and a half.
Of course this line of reasoning also disproves Helena.
Dave K
Of course this line of reasoning also disproves Helena.
The difference lies in the fact that no reasoning occurs amongst these people. At least no intelligent reasoning.
Pueblo
American Heart Association president stated: "The ordinance will likely continue to decrease the number of heart attacks and save lives every year."
Just out of interest has the number of heart attacks continued to decline?
Study:
Pre-ban Jan 2002 to June 2003
Post-Ban July 2003 to Dec 2004
When is the follow up study?
Does anyone know the admission data for 2005 and Ytd 2006? (2000/2001 would be useful too)
west
----
Hey, gabanz,
After my last post, i rememberred that Circulation is the AHA's journal. and the AHA has now officially sanctioned Pueblo.
Certainly the Circulation editors and referees know the previous claim that SHS causes 35,000 amis a year, and certainly they must be familiar with the AHA's claim SHS causes 5% of all amis.
It would seem to me that forthright Circulation editors and referees would have thought " Wait a minute how can the ban cause a 27% decline when we already know SHS is responsible for about 5% of all amis?"
"and even more to the point, since most exposure happens in the home, and the ban did not reduce home exposure, it would be reaonable to expect this paper to find somewhere around a 1to 5% drop, not a 27% drop."
The paper should ahve been rejected as implausible simply because the numbers don't add up anywhere near what the prevailing literature projects to be expected. and the clams of the authors are simply impossible.
However, if the authors would rewrite their paper to specifically state the decline is large with respect to what is generally believed re amis and SHS, then it would be accepted with this caveat. The referees should ahve asked the authors to identify more control jursidictions, and explain in much more detail why such a huge decline is plausible.
To accept and even prepublish this paper without this obviously needed scrutiny, is another violation of scientific and journalistic ethics. Dave K
Peer review is the justification for sound science. Once a study is accepted and published it becomes a reliable, sound and accepted reference. (Like case law).
If the review process works then the Pueblo study would become one such reference. It woud be hard to disagree with its conclusions without a rigourous alternative study.
Yet the study is, in many people's opinion, somewhat unscientific in its methodology and conclusions.
Could it be that the Peer review process is flawed?
This question seems to go to the heart of scientific inquiry and ethics far nore than how a study is funded.
Yet Pueblo is, maybe, an example of where peer review is broken. This would beg the question, what can be done when the peer review process itself breaks down?
west
----
For "Peer Review" think "Old Pals' Review".
That's how it is in envrionmental science so presumably the same here.
I wonder how many studies S Glantz has 'peer-reviewed'.
.
Perhaps we could ask why out of the entire population of the U S of A the only two "significant" studies come out of these two little whistlestops. Where are the comparable studies from New York, LA, Boston, Dallas, Miami, Chicago, Seattle, Philadelphia etc... The number of lives saved there must be truly stunning.
Yep, the peer review process is broken. and so is editorial integrity.
As Dr. Siegel has said many times, antismoking is going to be the death of the reputation of public health. Dave K
Sorry i'm trying hard to remember when public health actually had a reputation,which was not associated with scaremongering,nannyism or sheer hypocracy.
chunk makes a good point about the small size of these towns/cities and this so-called phenomena.
How about entire STATES? California, Delaware, New York, New Jersey, Massachusetts, Florida, Maine and the rest of them.........
Chunk/ Gabz
Michael and Dave K have done an exhaustive study that was praised, and then supplemented by Dr Siegel on exactly that topic. IIRC, the heart attacks rose in the states that had bans compared to banless states and the country as a whole where the heart attacks declined.
Somebody hereabouts could likely provide a link.
Brian-- thanks for the compliment on another thread that I just now read. Since you're an actual pro, I'll paste that in my scrapbook as high praise indeed.
Sorry to go off-topic but... more "fraud" and "conspiracy" uncovered at Big Pharm.
http://www.nytimes.com/2006/09/
3...artner=homepage
Dave K.
Thanks for the great analysis.
Walt.
Although the pharmaceutical industry has seized an opportunity presented them by the War on Smoking, they did so way after it had begun. While they may fund a lot, they are only a sideline player.
Public Health specialists like those who ran the Tuskeegee experiment (1942-72), the massive sterilization campaign (1909-69), and who experimented on foster children in the 90's with AIDS drugs, are most responsible for the War's scientific misconduct and political abuse.
Link to kuneman McFadden states' heart attack study http://kuneman.smokersclub.com/
h...admissions.html
and just search this blog "state and heart attack" or search HCUP to find Dr. siegels more elaborate analysis. dave k
I makie mistakie.... I said
Now, if the Surgeon general is correct, that 70% of SHS was eliminated since 1988, then in 1988, SHS was causing 70/30 X 300,000= 700,000 admissions through the Er in 1988. Trouble with this is we know from HCUP that in 1993 ( first year avaialble), there were only 404,000 ami admissions
This is a math mistake. actually, if the SG is correct that 70% of smoke eliminated since 1988, then the 300,000 ami admissions projected by Pueblo authors becomes 1,000,000 in 1988. or more than twice the number records say were actually admitted. dave K
Of course the anti claims are predicated on the farce that secondhand is hazardous.....a claim that is not validated by the American Cancer Society air quality testing or OSHA:
http://cleanairquality.blogspot....st-
results.html
There are actually 4 posts that address the issue of trends in acute heart attack admissions on a state and/or national level, and the implications for interpreting the Helena and Pueblo studies:
http://tobaccoanalysis.blogspot....claim-
that.html
http://tobaccoanalysis.blogspot....art-
attack.html
http://tobaccoanalysis.blogspot....at-
smoking.html
http://
tobaccoanalysis.blogspot....admissions.html
Any chance of you covering this story for us Doc?
http://cleanairquality.blogspot....son-
behind.html
EPIDEIMOLOGY def,
From the book of Stanton Glantz's definition of artful and designer research methods.
epideimology.. means finding in favor of the funding party
Hi,
Very informative blog. Hope you don't mind but i have bookmarked it.
Financial Blog Home Business Blog Affiliate Blog
It's incredible to see that this shoddy research is presented as real while serious research like Enstrom & Kabat's is treated like garbage.
Dr. Enstrom this week started his own site where he describes what happened to him after the publication of the famous study in BMJ. Particularly interesting to read is his defense page.
Imo, with this site Dr. Enstrom starts the second serous website on the internet (after this one) that counters the lies and deception of the main stream tobacco control movement. I hope that in the next years, many other serious scientists will follow their example.
Thun of the ACS: "This is the second attempt (the Enstrom/Kabat study) by TOBACCO INDUSTRY CONSULTANTS to publish flawed analyses of environmental tobacco smoke using cohort studies from the American Cancer Society. Sadly, the forum in which such studies are influential is NOT THE SCIENTIFIC WORLD -— SCIENTISTS RECOGNIZE THESE STUDIES FOR WHAT THEY ARE -— but in communities that are considering clean air laws." (My emphasis.)
My apologies if this lying, meant-to-deceive crap has been pointed out before.
Dr. Siegel, we know that you are not a believer in censorship. You know better than anyone how it feels to have opposing views swept under the carpet.
You and benpal, JTF, are great. You know the science. (And you all agree that SHS is not equivalent to Sarin gas) But the tobacco control issue as it relates to smoking bans in bars or restaurants is not very complicated.
I only have one thing to say to Bill Godshall and every other anti out there. Then I am done here. And I will copy and paste this letter ad infinitum:
__________________________________
MEMO
TO: Bill Godshall "Send you a plague of dead frogs"
FROM: Every bar and restaurant owner in Pennsylvania
DATE: September 31, 2006
RE: My livelihood and food on the table for my children
Dear Selfish, Nosey, Busybody:
Thank you for your bizarre, misguided, and misplaced interest in _____(name of establishment). As you know ______(name of establishment) strives to provide our guests with a relaxed atmosphere and great hospitality in which to enjoy our great food, wine, beer and spirits among their friends and family.
Your comments are always welcome.
However, after reviewing your demand to ban adults from engaging in legal activities like cigarette smoking on my property, a few alarming facts have come to my attention.
Upon consultation with my attorney and after reviewing the public records stored in City Hall, it appears that your name is not on the deed to this property.
In addition, my CPA and I have checked the invoices and have not found one bill that you have ever paid here.
Therefore, on advice of counsel, I must conclude:
This is my property! I pay the bills here! And if you don't like it there's the door. Don't let it hit ya where the Good Lord split ya!
Butt out, (pun intended)
The Management
Dave K. -- thanks for the link to your pages with the study you and michael did, I had lost it.
Wiel -- your link to Dr. Enstrom's site is AWESOME. He does an excellent job of proving many of the things most of us have been saying about anti-smokers, particularly Glantz, for years. Thanks!
Eric Blair - you're sooooooooo bad 
Gabz, you saw the original Word Template Letter to the Editor.
Godshall should be happy Dr. Siegel bans profanity and personal attacks on his blog. (I don't need that to make my point, Doc).
Every time Godshall or any other smoke Nazi posts (on this or any other forum), please feel free to copy and paste that letter in response.
Add your own personal touches of course. It gets to the heart of the issue, much to Bill's chagrin.
It's really funny, Eric........it seems that the only ones that abide by Doc Siegel's rule against personal attacks are the anti-smokers, but that isn't surprising to me. Personal attacks are their stock in trade, whether it be on this blog, other websites or in public.
I particularly enjoy the public ones, especially when they occur during radio or TV interviews/debates, or during public hearings before legislative bodies........those are absolutely priceless, as they can not be denied, deleted, or said to be taken out of context after the fact
Oh, and by the way,
Now I have noticed Pueblo's ami rate both pre and post ban are much higher than the national rate.
In the USA , 300M persons had 500,000 ami admissions through the ER. If Pueblo is representative, pueblo city residents should be having about 167 amis annualy. or about 250 in each year-and-a-half.
The paper says Pueblo city residents had 399 pre ban , and 291 post ban in each year-and-a-half.
It also says, Pueblo county residents not covered by the ban and of about 25,000 persons ( Pueblo has about 100,000 population) had 89 amis pre ban, and 76 amis post ban. Note the county without a ban did move in the same direction. Pueblo county residents appear to ahve ami rates more in line with the national figures. Pueblo county rssidnets should be expected to have about 63 amis in each year-and-a-half.
ElPaso County has about 350,000 residents so we should expect about 875 amis each year-and-a-half based on the national data. ElPaso county had 984 pre ban and 955 post ban. This is a little high, but much closer to the national rate.
all-in-all,
It looks to me like Pueblo was just returning to a more normal ami rate in the post ban era.
Pueblo probably happened to ahve an exceptionally high ami rate pre ban during that year-and-a-half studied. Dave K
"It's incredible to see that this shoddy research is presented as real while serious research like Enstrom & Kabat's is treated like garbage.
Dr. Enstrom this week started his own site where he describes what happened to him after the publication of the famous study in BMJ. Particularly interesting to read is his defense page."
Submitted and rejected at the BMJ the following.
For the life of me I can't understand why. Do you supose they are running short on hard drive space???
I sent it to James Enstrom and Sheldon Ungar regardless, in suport of credibility.
I am amazed how may opinions fall prey to the belief; If Tobacco dollars funded research, that research is no longer valid.
This opinion from the outset is a personal attack not only on the researcher’s character but also an attack on others who peer reviewed the study and found no evidence of impropriety or bias in the model.
The largest flaw in such a statement is the observer has expressed a personal belief of little or no confidence in the methodology employed and that of its core credibility.
A belief the method fails to form reliable proof of the existence or non existence of risk, or by extension causation or association.
If the system works it must be able to provide direction demonstrating either position otherwise the process becomes mute in its ability to produce anything of value. In a marginal study the odds say as many negative finding as positive findings may be found dependent on human intervention and confounding application With a 95% confidence interval, 5% of the time results would be due to random chance.
If the criticism is solely in response to a negative finding which was not expected, the fundamentals in exhibiting facts via a system which only produces favorable results can be seen as suspect as well. Common sense would tell us if the results can be directed or predicted science and it’s practitioners are harboring a fraud.
If the possibility exists a study could be produced, pass peer review and scrutiny of the most educated of experts in the field and exhibit no fatal flaw in examining the model, does this not state the process can not be evaluated to represent more than an opinion, which could be fashioned to merely reflect the position of its funding source?
So too could the proof be easily dismissed forming the now “simple opinions” which the critic does agree with.
Is it so easy to believe; Tobacco has a vested interest in results yet so hard to believe there are investing interests supporting the opposite results?
If funding source indicates a flaw, the entire system of evaluation is also flawed. Studies which currently are believed to be credible proof; tobacco industries sell products which harm consumers can therefore no longer be considered valid.
It is almost impossible to find a substantial following in those who agree, or at minimum who understand; there are other industries at the table as well, many of whom could similarly gain from a positive proof of ETS causing harm. Not the least of which would be those interested in the sale of smoking cessation devices but including other polluting industries who seek to avoid or minimize connection with so called smoking related diseases. Major charities who seek self promotion and funding which could be seen as a bias as well.
Making such a careless statement takes from the credibility of the primary methodology as a basis of substantial proof ETS or primary smoking for that matter have been proven to be harmful at all.
The long standing dispute between views at the WHO of non linear association as opposed to views of the American EPA in linear dose response relationship supported primarily in Epidemiology research further complicates the discussions. The WHO is now planning to debate the no safe level exists theory in the near future. How can any position be credible when so much controversy still exists after many decades of research in deciding how specific biological harm develops and now a new argument exists in the calculated results as described herein.
In short choose your words, they may one day come back to haunt you. Science is given integrity through respect of the discovery process balanced by the integrity of skilled practitioners. Many fell pray to scientific bias in the past leading to burning of witches, Eugenics and the atrocities during the second world war. A scientist who fails to respect discovery becomes a politician and no one wants to be honored with that distinction as of late.
The World Health Organization produced a major study which showed ETS harm and association was insignificant. The study was only criticized in the limitations of the size of the groups observed. Summed up with a statement more research is needed. The Einstrom-Kabat study failed no such flaw but rather personal integrity attacks were the only substantial criticism voiced. Among the few who did criticize methodology and named perceived flaws in the research included the incredible statements of James Repace who asserted the study groups were poorly confounded due to levels of exposure.
This of course would attack the credibility of research studies based in both CPS1 and CPS11 research groups which could be also judged similarly. SAMMEC research for one is heavily dependent on assumed exposures, along with an extended lifespan exceeding predictions at birth in it’s assessment of cost. The list of minor studies which are included in the EPA Meta analysis and the bulk of studies which formed the classification of ETS as a carcinogen could also largely be dismissed due to similar flaws.
Repace himself can be seen as self interested as described above when classifying a “tobacco industry study”, as it is no secret he has been well paid in his advocacy to promote a position of harm. How many Repace citations in other research would that position discredit? In fact in the case of the information he provided in court submissions it could be found at least one legal case was decided on questionable evidence based in his own more recent arguments.
For over a decade I have heard anti-tobacco advocate Stanton Glanz make the shocking public statement “Tobacco contains radioactive isotopes” this could seriously jeopardize his own credibility, in understanding the science he is indisputably aware of. The phosphorous content of soils and fertilizers which substantiate his claims are also evident in other organic crops. Why does he not inform the public of the situation fully if he truly believes a danger exists? It seems logical simple regulation can alleviate the situation.
Alternatively he could be seen to, not in fact believe a real harm exists, consistent with his inaction. Therefore one would have to conclude he is deliberately misleading the public to substantiate a personal agenda.
The haunting begins.
In Closing
What is truly astounding is the enormous resource base invested in the holy grail; the scientific proof ETS is harmful to non smokers. Has anyone seriously considered the purpose of such an exercise? The proof will be used primarily to legitimize societal hatred of the victims of an unsafe product, nothing more nothing less. Declaring “smokers kill their neighbors” or as recent enhancements to SAMMEC research attempted to demonstrate "smokers kill babies" In addition to lobby efforts driving them from public spaces, employment and even the basic human right to medical attention and housing. This smacks of a place in infamy which was the basis for autonomy rights and the words “never again”. The proof could not be used to vilify further an industry to any substantial degree as claimed by the extremists.
If the product is unsafe and the proof exists as seen in the WHO-EPA Spectral analysis research completed in March of 2006 complimented by many similar physical studies of late. In examining the NNN and NNK pre-existing in the tobacco used. Smoking risk in total population can be decreased significantly by the manufacturers, but only if they are directed to do so. Is it not more ethically responsible to reduce that risk through product regulation of ingredients and preparation, which will directly save lives in place of creating coercive means of controlling those lives. Controlling in kind that of community.
How many will voluntarily involve themselves in creating fear, violence and hatred against neighbors relatives and friends or complete strangers for that matter. All justified in "for their own good". What will you support in the future for the good of others?
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