Doc,
The obvious way to test your alternate hypothesis explaining the observed decline is to look at jurisdictions without smoking bans, but with improved detection and treatment protocols and see if they, too, are having heart attack declines similar to jurisdictions with recent smoking bans.
And while you don't say it here, many times we have discussed non ban areas , probably with the same improvements in diagnosis and treatments having the same effect of lowered ami rates, so the likelihood you are right is enhanced by those facts.
I understand the difference between angina and myocardial infarction. And, I do appreciate that a prompt, accurate diagnosis of angina can direct a physician to medical interventions (drugs, lifestyle changes, diet) that will likely reduce the risk of heart attacks in those patients so diagnosed. But, since the study shows there was also a decline in admissions for former smokers and smokers, it seems reasonable to assume that some factor (or factors) other than the ban may have been involved.
Since I have no expertise in those areas, I’ll leave it to the professionals to sort out the medical issues.
I do have a question regarding another area of the study, however.
Prior to the ban in Scotland (and elsewhere), the public was being told that there would be no adverse economic consequences to the ban. Non-smokers, they were told, would likely replace those smokers who might choose to stay home rather than give up having a smoke with their pint.
Presumably, the non-smokers were staying away from smoky pubs to avoid exposure whether for concern about their health or simply to evade the nuisance factor. The non-smoking clientele did not materialize to the degree expected.
In those cases, there would be no decrease in exposure to secondhand smoke. Even those who did start to go out to pubs following the ban would not experience any noticeable decrease in exposure to SHS.
The ban would result in significant decreases in exposure to secondhand smoke only in those non-smokers who regularly attended at smoky pubs and/or restaurants. Only a fraction of the overall population would likely be affected.
Do you know if this factor was taken into consideration during the study? If only a fraction of the population actually experienced a decrease in exposure to secondhand smoke, how can the overall reduction in admissions be attributed directly to the ban?
Don't understand why my post from last week was largely overlooked but the NEJM article cited below explains that improvements in treatment accounted for roughly 50-55% of the decline in CHD mortality from 1980-2000 while lifestyle changes accounted for the remaining percentage. This article touches upon several important technologies as well as several lifestyles.
Ford, E.S., Ajani, U.A., Croft, J.B., Critchley, J.A., Labarthe, D.R., Kottke, T.E., Giles, W.H., Capewell, S., 2007. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. New Engl. J. Med. 356, 2388-2398.
The most important finding was that the reduction in smoking prevalence accounted for only 12% of the reduction. Considering that cigarette smoking is way more of a health risk than SHS, it is only logical to conclude that the implementation of comprehensive smoke-free policies would only lead to a marginal reduction in CHD mortality at best.
the study reported serum continine of mean 0.68 ng / mL pre ban, and 0.56 post ban. which is an 18% drop in exposure in nonsmokers. According to the study, that caused a 21% drop in amis among nonsmokers.
Me thinks this means , if true, that if shs exposure decreased 100% among nonsmokers, that would eliminate all heart attacks in nonsmokers, of course, impossible.
anon, i agree completely... if half the smokers exposure drops, and causes a 12% decline, how can a ban which still allows exposure at home cause a 17% drop?
The Canadain Heart and Stroke Foundation web site states:
http://www.heartandstroke.com/
si...ics.htm#decline
Risk factors: Eight in 10 Canadians (80%) have at least one risk factor for heart disease or stroke (smoking, alcohol, physical inactivity, obesity, high blood pressure, high blood cholesterol, diabetes).
- Since the risk of heart disease also increases with age, should that not also be included?
- How did the Scottish Smoking Ban Study compensate for better health care intervention on all the other risk factors?
- Did they do an age analysis between the two years?
according to the americal heart assoc, california , after adjustment for age, did worse in heart attack trends than the USA overall, between 1991 and 2001, ( and this is when Ca should have done better, since their ban passed in 1995, and bars added in 1998 http://www.americanheart.org/
dow...s2005Update.pdf
Please can somebody explain. On p3 of the paper it seems to be stated twice that acs is classed as ICD-10, code I21. On p9 we have "Only 52% of our patients received a clinical diagnosis of ICD-10 codeI21 (AMI)." Fiftytwo percent of what group of people? Is the classification as acs unique to this study or not? If it is, how can comparisons be made with the other studies on the incidence of AMI? Is AMI a subset of ACS or not. I'm obviously being a bit thick, and I'm getting frustrated trying to understand what's going on.
"The most important finding was that the reduction in smoking prevalence accounted for only 12% of the reduction. Considering that cigarette smoking is way more of a health risk than SHS, it is only logical to conclude that the implementation of comprehensive smoke-free policies would only lead to a marginal reduction in CHD mortality at best."
Anon (can't you use a more original name?) the only possible defence for this 'study' against your findings would be that Pell counts 'acute events', whereas your linked study refers to 'CHD deaths'.
I know you would expect the trend in the number of deaths from AMI to correlate well with the number of AMI events, but a blanket 'CHD' label would include many deaths from chronic heart conditions, not just heart attacks. It is arguable that smoking bans would not change the mortality rates for chronic conditions, as such people are already too far gone, and would probably avoid 'smokey' places already. I say this is 'arguable', not that I accept the premise that smokey pubs and bars would cause 'acute' events either.
Pell, in her report, actually acknowledged that the drop in deaths from heart attacks in Scotland, in the same 10 month period, was only 6%, but chose to use this statistic as somehow favourable to her agenda. She didn't seem to see the irony in the fact that it clearly aligned with all of the other published Scottish health statistics that showed a decline in AMI of (at most) 8% in the whole year after the ban compared with the year before.
Personally, I just don't accept that there really was a decline of 17%. I'm not suggesting that Pell was lying, more that the whole process of data collection and categorisation was probably flawed. I have worked in UK NHS hospitals while long-term studies such as this one are being conducted, and I know very well what goes on in the background - especially if a study is placing additional demands on already overworked administrative and clerical staff. To suggest a 17% drop that - conveniently - was only visible to her research team, but was not apparent across the whole of Scotland's health service just defies all logic and credulity.
So I think what we have here is another example of GIGO
.
Sorry, the last 'Anonymous' was me - just when I chided 'anon' for his/her name! 
Talk about being hoist on one's own petard!
My final word on this truly miserable and unbelievable study comes by way of a quotation. I invite Dr Siegel to print this in big bold letters and stick it onto his PC monitor, less he should ever forget:
"Of experiments intended to illustrate a preconceived truth and convince people of its validity: a most venomous thing in the making of sciences; for whoever has fixed on his cause, before he has Experimented, can hardly avoid fitting his Experiment to his cause, rather than the cause to the truth of the Experiment itself."
Thomas Spratt, 'History of the Royal Society', 1667
1667! - just shows that the human race never really learns!
What affect poverty on heart attacks?
http://news.bbc.co.uk/1/hi/world...cas/
7536486.stm
"Governor Arnold Schwarzenegger of California has signed an executive order to sack 22,000 state workers and put 200,000 on the minimum wage."
It's a pity Stan Glantz doesn't work for the state.
Brian,
Good points. I was not so much arguing about the semantics from each respective study as much as trying to show that if a reduction smoking prevalence leads to only a marginal decrease (12%) in CHD mortality (whatever events that may include), then smoke-free ordinances would at best only be able to provide a fraction of that decrease in CHD mortality.
Anon
Your argument was well made and I agree with it.
I was just paying Devil's Advocate and demonstrating how the other side would use weasel words to avoid debating the substantive point.
You could go even further and observe that a decline in smoking prevalence contributes 12% of an overall decline in CHD deaths of about 50% over 20 years (as reported in your linked study - or about 2.5% per year on average). Consequently the reduction in smoking prevalence (which fell from the low 40s% to the mid 20s% in that period as I understand it) actually accounts for only 12% of 2.5%, ie a 0.3% per year decline in CHD deaths!
It's a bit of a stretch to go from 0.3% to 17%, isn't it?
.
Another LIE perpetrated by TC.They know full well that by including Greece their statement will be erroneous http://www.tobaccojournal.com/
Ne...pe.49137.0.html
Dr Siegel,
As a British resident I have been able to obtain acute myocardial infarction data for Wales for 2006 and 2007 under the Freedom of Information Act (their ban came in April 2 2007). This data has not been seen before. As you will see if you take a look at http://www.velvetgloveironfist.c....php?
page_id=59 there was no fall in heart attack incidence when the ban came into effect. In fact, incidence was higher in April, May, June, July and August than it had been the previous year. Wales has a similarly sized population as Scotland. Would you agree that the evidence from Wales casts considerable doubt on the Helena hypothesis that smoking bans immediately reduce incidence of acute myocardial infarction?
If you would like to see the raw data, e-mail me at author@velvetgloveironfist.com
Here is a comment from a Labour MP
The best you can do is suggest that the 17% drop in heart attacks was only 8%! ONLY? That's a very substantial drop. Your quibble again is self -destructive. An 8% drop is very impressive.
http://paulflynnmp.typepad.com/m...-of-a-
myth.html
Hopefully these very same MP's who scarcely ever represent anything other than their OWN views,will pay the penalty when the next General Election occurs.We should not forget that it was Tony Blair who breached the Party manifesto in the first place.It is also noted that those MP's who have their own blogs are often those who appear most pig headed and blinded by their own self righteousness.THEY ALL APPEAR TO HAVE THE TC AGENDA EMBLAZONED ON THEIR GREY CELLS,LOGIC DOES NOT EXIST,ONLY BLIND AND IGNORANT FAITH.
JP wrote:
"The best you can do is...Your quibble again is self -destructive. An 8% drop is very impressive."
Yes, but not as impressive as the 1999-2000 10.2% drop.
Jonathan Bagley asks:
"Please can somebody explain. On p3 of the paper it seems to be stated twice that acs is classed as ICD-10, code I21. On p9 we have "Only 52% of our patients received a clinical diagnosis of ICD-10 codeI21 (AMI)." Fiftytwo percent of what group of people? Is the classification as acs unique to this study or not? If it is, how can comparisons be made with the other studies on the incidence of AMI? Is AMI a subset of ACS or not. I'm obviously being a bit thick, and I'm getting frustrated trying to understand what's going on."
Jonathan, you aren't being thick.
I have made several postings now basically banging on about the same issue. Dr Siegel talks about comparing 'apples and oranges', I call it obfuscation.
There are two main category ICD codes for heart attack (Acute Myocardial Infarction);
I21 = First Acute Myocardial Infarction, and
I22 = Subsequent Myocardial Infarction
(I think 'subsequent' means in the same acute 'spell', not several years later).
If you look at most statistics, the numbers of I21s hugely outweigh the I22s. Having said that you have to check any published statistics on AMI to see if they mean I21 only, or I21 and I22. HES (English NHS) statistics provide data for both diagnoses separately, as do the Welsh (PEDW). The Scottish stats (ISD) however combine I21 & I22 together!
Still confused? it gets better!
Pell and her colleagues are obviously enthusiasts for the 'new' approach to diagnosing AMI, ie testing for Troponin T as opposed to conventional tests. She claims that they used this diagnostic approach on all patients admitted to the 9 hospitals with chest pain - ie suspected of having had a heart attack.
On page 9 of the report she comments that "We linked our data to the Scottish Morbidity Record 01 database. Only 52% of our subjects received a clinical diagnosis of ICD-10 code I21 (acute myocardial infarction)"
The SMR01 is the national inpatient record system (like HES in England), and I believe that she means that only 52% of the people admitted with chest pain went on to be diagnosed in the SMR01 system - ie using the conventional diagnostic method - as having an AMI. Note that she refers to the 52% being "1,966" diagnoses for the first study period - well 1,966 is 52% of 3,781, and she states that the number of cases of ACS in that period was 3,235 - which is 85% of 3,781.
So, my take on this is that she is trying to make a point about how much better her diagnostic method is than the conventional one (ie diagnoses more AMI - or brings more patients into the diagnosis of AMI, but under the 'vague' label of Acute Coronary Syndrome). This is why I have suggested that she is campaigning on two fronts simultaneously - Anti-Smoking and Pro-Troponin T testing!
The references to code 'I21' on page 3 of the report refer to the data that were used to show the previous trend (in Scotland) and the study 'control' sample (ha ha!) from England. But of course, both these two routine national sets of data will have been subject to the AMI diagnosis (I21) using mostly (if not exclusively) the conventional method of diagnosis!
Apples and oranges! Obfuscation - it certainly causes confusion, notwithstanding it destroys all statistical credibility in my view.
But it does make it much harder to argue against her findings. We know, beyond all reasonable doubt, that the decline in (conventionally diagnosed) AMI admissions in all Scottish hospitals was at most 8% between 2005/06 and 2006/07 (whole years) - a large, but not atypical change. That her study measured a 17% decline in ACS (or AMI diagnosed by troponin tests) doesn't demonstrate a miracle at all. It just casts a huge doubt over the statistical validity of her recording methods, and/or the quality of the data collected.
I wouldn't get too frustrated if I were you. I've spent a 35-year career working with NHS statistics - so imagine how I feel!
Apologies (to all) that my posts go on a bit - but I do feel that all of this detail is necessary at times to strengthen the understanding of what is going on here.
.
Thanks, Brian, for the valuable insight you provide. Quite enlightening.
We probably wouldn't have smoking bans in the U.S. or in Europe if Senator Thomas Bliley's testimony about his Oversight Committee's investigation into the EPA had received media coverage... but it didn't, so the fraud continues.
The public would realize that the alleged danger of secondhand smoke was a fraud perpetrated by anti-smoking activists working within the U.S. government as EPA employees.
By 1986, the EPA had been deeply infiltrated by them.
Sen. Bliley's testimony completely outlines the Committee's two-year investigation, and the fraud that was uncovered. And there's still no media coverage even now because the media was conned into being a blind spokesman for the fraud -- media must protect itself from the appearance of guilt by association.
Media honesty dies a quick death.
http://www.pipes.org/Articles/Bl...les/
Bliley.html
Is this accurate? If so, why are we talking about this?
http://www.velvetgloveironfist.c....php?
page_id=59
Kent, where the hell has this little gem been hiding for the last oh, say, almost two decades?
And why the HELL aren't we plastering this all over the public?
http://www.pipes.org/Articles/Bl...les/ Bliley.html
Cathy Bell has left the building [Rumor has it, she just ducked outside for a quick smoke]
http://communities.canada.com/
MO...ead.aspx#228019
"What you fail to recognize is, by whining about the smoke on your clothes you admit you are supporting policies and laws based in nothing more than personal hypocrisy, bigotry and lies, anti smoker bigots don't even believe yourself. If you go home with the tobacco smoke smell on your clothes you are obviously visiting venues where smoking is allowed. Your not running away in fear of that smoke, rather you are hanging around long enough to find offense in the smell.
The promoted "fear" of second hand smoke is convenient for those who don't like the smell, however it remains a lie no one ever believed. Not even the paid lobbyists, selling smoking patches and addictive chewing gum in child friendly flavors.
Anyone who really believes any level of harm exists which could draw concern, are naive fools victimized by deceptive marketing campaigns, operating without restriction.Your tax dollars at work.
The Emperor really has no clothes, too bad so many of us are living in the dark.
If you deny the rights of others, you deny your own. The same people who would agree to disagree with an opinion, while defending a right to state that opinion understand what what human rights mean and how important they remain. The pitchfork and lantern crowd selling smoking bans are the criminals denying the rights of others, we should be rejecting the bigots, who are determined to divide formerly peaceful communities as not normal.
A sign on the door would be sufficient to protect anyone who is concerned about the smoke, just like the nut warnings on the door at Tim Horton's, protecting hundreds of times more of those legitimately at risk, than the true number of those affected by cigarette smoke.
Smoking bans express nothing more than hatred, are you on board with those promotions, or are you simply paying the rent as a salesperson? Nothing more than those two reasons, would have kept this thread alive as long as it has survived.
Normal people know the truth of the situation."
Brian- your posts are always illuminating. Keep it up. No apologies.
The Welsh stats are also interesting. Perhaps Dr Siegel will comment?
As to Bliley, many of us have known about it for years. The press was never interested; nor in fact was Congress itself. And by now it's ancient history, not likely to get the slightest attention. Alas.
:
As to Bliley, I wish I had this on Repace three years ago when he pushed a smoking ban before the St. Louis County Council. I wrote to the Council warning that Repace was a zealot and no ventilation expert. Then County Councilman Skip Mange, a mechanical engineer, called me and asked that I provide a ventilation expert to answer his questions. Mange told me that he wanted someone local who had nothing to do with Big Tobacco. Every ventilation person I called in St. Louis agreed that ventilation could handle secondhand smoke in St. Louis bars and restaurants. All also agreed that the real problem was that many ventilation systems in restaurants were very poorly designed. One said that if the smoke from the smoking section was pulled thru the nonsmoking section, not much was accomplished.
I remember Mange saying something like: "A lot of people are saying a lot of stuff. It can't all be true. I want someone who will answer my questions."
A few days ago, someone commented that he'd received notice that 30 new comments had been posted but that they didn't appear. Apparently something was technically wrong with Haloscan at the time.
I'm asking because the question implies that we can find out place when going back to the comments section of an article. Is this so and, if so, how? I've already tried Trackback to see what it does, but the answer is always that Trackback isn't available.
Would appreciate any tips!
NB: All the teenagers I know who have started smoking in the last couple of years do not smoke menthol (3 girls - there may be a boy but he hasn't admitted it yet). They smoke Parisienne "yellow" - about one step down from "super". 8mg tar, .7 mg nicotine, 8 mg CO (I checked it on my own package). These are very similar in flavor to Marlboro lights and, being Swiss, are cheaper.
Brian, Thanks for answering my questions. As I suspected, it seems the authors have hit upon a new tactic to get around the ridiculous scenario whereby a statistical inference is made about a population, from a sample; but by waiting a few months, the facts could be obtained just by looking at population records. This tactic is foolproof: choose a criterion which is never recorded for the whole population and nobody can contradict you as the total picture is never revealed.
I am strongly against the use of statins to reduce cholesterol, It can be done much more safely using magnesium, water, and exercise. I would highly suggest any one worried about this topic to check out this article Magnesium and Walking Will Always be Superior to Lipitor
Statins,the next must have drug.The pharma industry is laughing all the way to the bank.As i understand though magnesium needs to be taken with calcium since their is balancing and absorption co-relation.
matt
An Old Cholesterol Remedy Is New Again
"Pfizer Inc., the pharmaceutical giant, halted late-stage trials of a cholesterol drug called torcetrapib after investigators discovered that it increased heart problems — and death rates — in the test population"
"Many scientists still believe that a statin combined with a drug that raises HDL would mark a significant advance in the treatment of heart disease. But for patients now at high risk of heart attack or stroke, the news is better than it sounds. An effective HDL booster already exists.
It is niacin, the ordinary B vitamin."
http://www.nytimes.com/2007/01/2...38cd650&
ei=5088
I've found out that while magnesium is necessary for calcium absorption (as well as good on its own), if supplements are taken, the mag and cal should be taken at least 4 hrs. apart.
Matt,
Garlic is also a very good cholesterol weapon. It is also natural and inexpensive. Kyolic Garlic tablets or capsules are the purest outside of fresh garlic.
Garlic is also a very natural and very powerful antibiotic. It will kill those super bugs that are resistent to pharma antibiotics. I know as I know someone who did that, just in the nick of time too.
Turns out that Garlic is an excellent source of "medicine" for so many ailments it's not funny, not just as a blood cleanser. These are facts proven throughout the centuries that the medical profession doesn't want you to know about. Just use it in as many foods as you can, or supplement with the Kyolic garlic tabs/caps.
You'd think doctors would be aware of this, and offer the advice to their patients as well. They ARE supposed to be so concerned with the health and well-being of their patients after all. Instead they are shills for the pharmaceutical industry whether they know it or admit it or not.
Jonathon
You're dead right.
If such 'researchers' would just stop at the quite benign concept of "statistical inference", instead of always having to turn their findings into lurid body counts, and completely implausible 'certainties', then they would deserve to have their work taken more seriously.
The problem they are creating, though, is not that they are bringing the anti-smoking lobby into disrepute (its already there), but they have tainted the whole discipline of epidemiology - besmirching the good name, and work, of John Snow among others.
Furthermore it increasingly casts public health practitioners in the role of bad guys - when so many are just trying to do an honest job.
You can see why Dr Siegel is at the forefront when it comes to carrying out rapid rebuttals of such nonsense.
.
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