Tuesday, 29 September 2009

"Mandated lifestyle modification"

I'm not sure if this is a real blog or very elaborate satire, but its author appears to be taking the latest heart miracle reports very seriously indeed.

Do Smoking Bans Reduce Heart Attacks?

Apparently not - certainly not in the short term, otherwise we would have seen evidence of it in the United Kingdom.

The impressive data keeps on coming. Back in January I commented on the 41% reduction in heart attacks in a Colorado county after a smoking ban went into affect.

That would be the study that Dr Michael Siegel criticised for using inappropriate methodology and for making conclusions that were "biased and invalid."

The data "keeps on coming" because, as I have said before, repetition is being used as a substitute for evidence. The latest study does not contain any new evidence and is the third meta-analysis to be published in as many years. All of them have come from the pen of Stanton Glantz, founder of the hardline anti-smoking group Americans for Nonsmokers' Rights.

Now comes a report out of the journal Circulation (abstract) that continues to confirm the dramatic reduction on acute coronary events in districts that legislate public smoking bans.

The report is a meta-analysis of 13 studies in which researchers examined changes in heart attack rates after smoking bans were enacted in communities in the United States, Canada and Europe. The researchers found that heart attack rates started to drop immediately following implementation of the law, reaching 17 percent after one year, then continuing to decline over time, with about a 36 percent drop three years after enacting the restrictions.

A 36 percent reduction in heart attacks after three years is a phenomenal outcome. There isn't a single medical intervention I know of that has that immediate and profound effect on outcomes.

Indeed not. And the very fact that it is so unprecedented, "phenomenal" and - how to put it? - miraculous should, in itself, be enough to make anyone in possession of their critical faculties wonder whether if it is actually true. 

There isn't a quality initiative or payment initiative the feds could come up with to save the kind of money that lifestyle modification could do.

And it is 'lifestyle modification' that the Happy Hospitalist blog is all about, as you will see from the author's five point plan:

1. A nationwide ban on smoking in public needs to be enacted by Congress. That means all public places, indoors and outdoors. It's time that smokers are banned to their homes where they expose nobody but themselves and their family to the dangers of first, second, third and fourth hand smoke. [My emphasis]

I was fascinated to find out what the source for fourth hand smoke was, so I took a look.

Fourth-hand smoke: You see through the window somebody smoking.

The fourth and last exposure to smoke was added as a joke

A joke. Okay. So is this whole post a joke or does the author just link to the first Google link that comes up?

2. If Congress does not have the political will to ban public smoking in this country, they should immediately give a proportionate percentage increase in Medicaid funds to states that have instituted such a ban based on the actuarial dollar savings generated by the reduction in health care costs and ongoing morbidity related to acute MI and its associated heart failure diagnosis.

But acute MI (myocardial infarction - ie. heart attacks) have not been shown to fall significantly in any US state that has enacted a smoking ban. That's why heart miracle studies focus on places like Pueblo, Colorado and Bowling Green, Ohio. The smaller the area, the greater the chance of a dramatic fall (or rise) in the heart attack rate. They're fluke results blown out of all proportion by anti-smoking activists and credulous journalists. 

3. The tax on a pack of cigarettes should be raised immediately to $20.

That sounds a little, er, high. Wouldn't there be massive problems with smuggling and organised crime, as is the case in Canada? And since this tax hike is necessary to pay for the treatment of smoking-related diseases, those with private healthcare will presumably be exempt from paying the $20? 

No? Oh.

4. Medicare cost sharing arrangements should increase by 100% starting in calendar year 2011 for all beneficiaries abusing tobacco who fail to comply to a strict tobacco free compliance policy.

I don't fully understand the US healthcare system, but isn't this saying that smokers should pay twice as much than nonsmokers? Please correct me if I'm wrong.

5. All Medicaid beneficiaries will be required to go tobacco free to maintain their benefits or be subjected to the same cost sharing arrangements as their Medicare counterparts, regardless of their ability to pay, or lose their benefits entirely.

So smokers should have to pay an extra tax of $20 (plus existing tax) for every pack of cigarettes but they won't get any treatment unless they quit smoking. Bear in mind that all this is deemed necessary purely on the basis of bogus studies purporting to show miraculous drops in heart attacks as a result of smoking bans.

The data is compelling.

The data - the real data, as published by the hospitals - certainly is compelling. It shows no discernible change in heart attack admissions since the smoking ban.

As long as the government mandates health care as an entitled right and forces the burden onto the tax payer, they have an obligation to force the populace into mandated lifestyle modification.

Now we're getting down to business. And if the smoker refuses to have his lifestyle modified, he is refused treatment. And if he does not receive treatment then surely the government has an "obligation" to refund all those taxes he has paid. Otherwise the whole business amounts to extortion, no? 

Mandated lifestyle modification. Blimey. Has a more sinister piece of jargon ever been coined?


Anonymous said...

Excellent article. Why can't the politicians have the sense that this article portrays.

Unknown said...

Mandated Lifestyle Modification? This really has to be a joke. Either that or it is a very scary mind that it all came from. If all this was actually to happen, alcohol will be next then fatty foods followed by fun. We would end up with a very small population - the rest of us would be bored to death (although I expect boredom treatment would be covered by medical insurance to keep us alive to suffer at the hands of the puritans who think this is a jolly old jape)

I wonder how long it will take something like the 4th hand smoke joke to become reality...am counting....

a.welch said...

I was always lead to believe that 3rd hand smoke was "seeing someone smoking" how was I to know that it would fall to 4th place........

BTS said...

May I be the first to propose 5th hand smoke as the reading of blogs and articles about smoking..?

Anonymous said...

Point of information Mr Snowdon:

Does anyone know what premiums private health insurers add to smokers' premiums to counteract the extra cost (if any) of their unhealthy lifestyles?

Ditto drinkers and fat people?