Tuesday 20 October 2009

A race against time

I mentioned in a recent post the extraordinary influence of San Francisco-based tobacco control advocate Dr Stanton Glantz in all areas of tobacco control, and particularly with regards to the smoking ban/heart attack hypothesis.

Glantz is the founder of Americans for Nonsmokers' Rights, the director of SmokeFree Movies, the director of TobaccoScam and director of the Center for Tobacco Control Research and Education. I doubt that even he would describe himself as wholly impartial on the smoking issue.

He co-authored the original "heart miracle" study and has co-authored no fewer than three meta-analyses at a rate of one a year, all of which concluded that smoking bans immediately brought about a dramatic - if implausible - reduction in heart attack rates. 

Aside from a discredited study from Iceland, there has been no fresh evidence to support the smoking ban/heart attack hypothesis for some time and yet it is rarely out of the news. It has been kept there purely on the basis of press releases which promote new reviews and meta-analyses which, in turn, rely on old data, none of which stands up to scrutiny on its own merits.

The "smoking bans slash heart attacks" story was in the newspapers last month as a result of another of Stanton Glantz's meta-analyses. It was in the newspapers again this month as a result of a review from the Institute of Medicine. This latest paper, somewhat unusually, does not credit Glantz as a co-author but, as Michael Siegel has revealed today, he once again played a key part in the process.

The Committee held a public meeting in which it heard presentations by experts in the field covering various topics. According to the report, the topic of smoking bans was only presented by one expert: Dr. Stan Glantz.

And, as Dr Siegel, points out:

Dr. Glantz has a very particular view of the smoking ban studies

This is putting it mildly. In fact it would be true to say that the whole hypothesis is Glantz's baby. He, more than anyone, has a great deal invested in seeing the idea lodge in the public consciousness. Not only does it help in the campaign for more smoking bans in public places, but it implicitly suggests that passive smoking is even more dangerous than advocates like Glantz have previously claimed. It supports the notion that, as one of Glantz's research papers once stated, "even a little secondhand smoke is dangerous".

If, on the other hand, the public saw that the heart attack rate has not fallen dramatically as a result of smoking bans in England, Scotland or Wales, and that there has been considerable cherry-picking in the studies that suggest otherwise, it would damage Glantz's reputation considerably. It may even put the whole tobacco control movement under the spotlight.

Sure enough, the Institute of Medicine's study did not include the hospital data from the UK, nor did it include a study of the entire US which showed no association between the introduction of smoking bans and declines in heart attack rates. 

The absence of this data from the IoM's report is troubling, since Dr Siegel had made the committee aware of this contradictory evidence:

The report claims to have reviewed unpublished data and to have attempted to identify unpublished studies that might have found no effect of smoking bans on heart attacks. The report states that "no such studies were identified." 

I find this difficult to believe, especially since I was a reviewer of the report and I made the committee aware of several unpublished analyses which documented no significant effect of smoking bans on heart attacks.

The fact that this data was omitted, and that Stanton Glantz was given another starring role in the creation of the IoM's report, should be of concern to anyone who expects impartial research from such organisations. 

What I think we are seeing now is a frenzy of activity to establish the smoking ban/heart attack hypothesis in the public's mind before more national hospital data exposes it as a myth. 

In my view, the anti-smoking movement has bitten off more than it can chew by creating a hypothesis that can so easily be disproved. Junk science thrives in the darkness. So long as the raw data cannot be viewed, it is difficult to comprehensively debunk it. But that is not the case here.

Perhaps they did not realise that hospital admissions data was publicly available when they set out with this hypothesis. Perhaps they thought that nobody would check it. Whatever the case, it is crucial that they make the public believe that the evidence for their hypothesis is "overwhelming". Once it takes hold in the public's mind, any evidence to the contrary can be dismissed as the work of the tobacco industry, "flat-earthers" or "tobacco harm deniers".

And it's working. Thanks to a well-drilled PR machine and an unquestioning media, the latest report - based on no new data at all - has been picked up worldwide (517 articles, according to Google). Last month's report - also based on no new data at all - generated around 300 articles

And yet, new data keeps coming along - complete data from whole nations, rather than selected data from small communities. In the last few days, the Danish Health Department has released a comprehensive report [PDF] using data from the National Hospital Register showing that there was no decline in the heart attack rate after the smoking ban was introduced in August 2007. It concludes:

In none of the four studies was there an effect from the law for men and women in the two age groups. We could not detect any difference in hospitalization rates after the Act came into force. The expected greater effect among younger than among older people could not be found.

The graph below shows the heart attack rate amongst the two age groups (35-49 and 50-64). As usual there is a gradual decline over time which is not accelerated at all by the smoking ban (marked by the black line):

Number of news articles on Google about these findings (at the time of writing): zero.

(Thanks to Klaus K for the tip and for the English translation)


Anonymous said...

Stanton Glantz shares his office with Mitch Katz out of Harvard, another anti-smoking fanaticical healthist-fascist.

Mitch Katz was hand picked by Getty Billionaire Heir Mayor Gavin Newsom to serve as top medical advisor to provide all the concocted evidence necessary to implement any and all fascist smoking bans in San Francisco, one of the NWO's "model city" programs.

So we have Stanton Glantz in bed with Mitch Katz in bed with Gavin Newsom in bed with Nancy Pelosi and there are connections that can be found.

Katz, who is MOST hated and despised by healthcare workers, unions, the elderly, etc. for running several hospital budgets into the ground and putting criminal elements among the elderly in old age facilities, has in fact conspired with Pelosi in the matter of throwing a very lucrative asbestos clean-up contract for Hunter's Point Shipyard to a company favorable to Pelosi's and Katz's (associated with Glantz mind you) benefit.

When resulting major illness came about from asbestos dust being mishandled and flung around the neighoborhood - the fascist machine used Katz (associated with Glantz and Pelosi) to claim that asbestos wasn't very harmful and not to worry about it - this coming from the same man who provided the Glantz/Katz backup evidence for Newsom's outdoor smoke bans, tobacco retailing bans, tobacco garbage tax, etc. and so on.

So investigate the name of Mitch Katz, uncover what you will about his association with Stanton Glantz and how it appears he is the middle-man between Glantz on one side, Pelosi on another and Newsom and his rubber-stamping city council on another side - and you can probably find enough filthy dirty political slime to in effect, nail Stanton Glantz on it - through his association with the others.

Otherwise, Glantz sits squeaky clean in his ivory tower on UCSF campus, which has gone to the length of cleaning him up on the UCSF website, making him out not only as saint but as "Best Actor Winner" - if you dig deep enough there.

There is dirt on Glantz.

You have to go through Katz to find it, by association, then tie them altogether.

Unknown said...

"In my view, the anti-smoking movement has bitten off more than it can chew by creating a hypothesis that can so easily be disproved."

Apologies in advance for being Mr Unrelentingly Negative Whiny Guy here, but doesn't the evidence provided in rest of the article conflict with this statement?

I mean, these heart attack studies have been doing the rounds for 5(ish?) years. Media, public and political confidence in them has increased, not decreased over time despite acute criticism from yourself and others before you. There's no coverage for unpublished reports that produce null results, you demonstrate this yourself.

I'm not sure Glantz et al are reeling from the sustained criticism they're receiving via blogs. Let's be honest. The net effect of (convincing)competing analyses reported by yourself and Siegal on the internet-using interested population has been modest, the effect on the mainstream media tiny, the general public nearly nothing, and the 'scientific consensus', zilch.

For the love of Jeebus, why can't somebody publish this?

(Err, not including your excellent book Chris, I mean journals of course!)

Ben said...
This comment has been removed by the author.
Ben said...

Blueblackjack, can you name a journal which will publish criticism?

Christopher Snowdon said...


It's true that this post does show the contradiction between my pessimism towards the media and my optimism that, at some point, there will be a reform of epidemiology with the worst offenders called to account.

The prospect of junk science continuing indefinitely is simply to much for me to contemplate. I have to believe that sanity will return one day and that, when it does, things like the heart miracles will be cast centre-stage. It won't happen tomorrow but all this is on the record now and there will be no hiding place for those responsible if and when the backlash begins. That's what I mean when I say they have bitten off more than they can chew.

Unknown said...

Chris, I certainly hope you're correct.

Ben, yes, of course but that depends what you mean by "criticism".

Most journals accept letters or critiques of studies like BMJ's rapid responses to Helena but these obviously have limited impact, especially if they don't appear in print editions and aren't subsequently pubmed listed and so on.

What I meant by can "somebody publish this" is not so much can somebody write a letter saying "x previous published study is s$%t for a,b,c reasons", rather getting a comprehensively analysed and quite elegant study like the NBER one which shows on a large scale that AMI rises are as likely as AMI falls following a ban(beware pdf) into circulation in medical journals.

...which hasn't happened to date. The only attempt I'm aware of is the McFadden/Kuneman one, which just wasn't a particularly great submission imo.

Anonymous said...

I share Blueblackjack's pessimism. In consecutive weeks the press ran articles about the heart attack claims. After the first one, I emailed Dr Anna Gilmour, who appeared to be connected in some way to the claims, asking her for more details, pointing out that the figures for the whole of England and Scotland were now available. I received no reply. Professor John Britton of Nottingham University was asked for a quote in the second article and gave the impression the claims were true. It is almost inevitable that both MPs and the public will believe these articles. Five years ago, I would have done. No ordinary reader is going to suspect that a professor at a decent university would fail to point out that academic research contradicted easily verified facts which are in the public domain and that he must have been aware of.
I can only hope enough people read this blog that those in power become aware of the facts or, if already aware, realise they cannot keep ignoring them. This will gradually happen if a link is supplied in correspondence with the great and good.

Klaus K said...

I was just told in a mail from an ex-smoking editor of one of the biggest Danish newspapers, how and why the media are not writing the truth about the science and the smoking bans.

He is an intelligent guy, that I respect very much. He said that these are "bad" stories, because the majority of the readers (inkluding himself) don't like the smell of tobacco, no matter how dangerous or not the smoke might be.

He is sure, this is why other mainstream media will not cover stories like these. These articles runs the risk of overturning the smoking bans (and thus the risk of the majority having to smell the "ugly" smoke again), if the newspaper publishes them.

He also said, he was perfectly aware, that a lot of claims from the public health authorities were junk science and even lies. He wrote critical articles about it himself, because he feels sure, that SHS does not kill anyone.

I read those articles, and they were in fact very good. But he will not continue to write about this issue as "a case" in the newspaper, he said.

He said, he always points out to anyone, that bothers to listen, that he thinks the whole issue of passive smoking should be regarded as a "nuisance" issue, rather than a health issue - and that the smoking laws should reflect this.

I agree with him on this point.