Monday 20 December 2010

Vast study finds no heart miracle but lots of publication bias

In light of my recent posts about post-smoking ban 'heart miracles', it is timely that a new study of heart attacks rates in the United States has just been published. This study—by far the biggest ever conducted— confirms that smoking bans have no significant effect on either the incidence of, and mortality from, acute myocardial infarction.

Published in Journal of Policy Analysis and Management, the study looked at more than two million heart attack deaths over the course of 16 years, making it by far the largest exercise of its kind ever conducted. The researchers found a great deal of fluctuation in heart attack rates but concluded that:

...large short-term increases in myocardial infarction incidence following a smoking ban are as common as the large decreases reported in the published literature.

The crucial four little words here are 'in the published literature'. The large increases get ignored while the large decreases get studied, written up, published and press released. The widely-reported studies that have found drops in heart attacks after smoking bans are—as regular readers already know—the result of straightforward cherry-picking and publication bias. We know that in most Western countries there is a long-term trend of declining heart attack rates. We also know that there is substantial variation in heart attack rates and that smaller communities (like the Isle of Man or Helena) are more likely to see bigger fluctuations because the average number of cases is already very small (single digits per month, in those instances).

As such, it is child's play to mine the hospital data and find places which have seen large drops in heart attack admissions following a smoking ban. It's not a coincidence that such studies usually rely on obscure towns in Montana or Ohio, and not the huge populations of Wales, Australia or New Zealand, where we know smoking bans have had zero effect on the number of heart attacks. And on the odd occasion when researchers get carried away and agree to do a heart miracle study for an entire nation before they've had a chance to look at the data, they can always ignore the actual hospital records and cook the books to create the illusion of a large drop in heart attacks, even though the real data show nothing of the sort.

What this latest study shows is that if you look at vast populations, there is far less chance of a fluke result and, if the findings are honestly reported, there can only be one conclusion:

"In contrast with smaller regional studies, we find that smoking bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases."

For more comment on this, see Michael Siegel, Jacob Sullum and Mr Puddlecote. The latter also has the news about regular commenter Junican winning a year's subscription to Tobacco Control after entering a competition to come up with new terminology for the anti-smoking movement to employ. His spoof suggestion turned out to be less risible than the real submissions. Junican is currently buying pornographic magazines to wrap around his issues of the world's foremost anti-smoking journal so he can read them in public without embarrassment.


Rollo Tomassi said...

There you go again, Snowdon, cherry-picking the, err, biggest and most comprehensive study available. You're not fooling anyone, you know.

By the way, Dick Puddlecote says thanks for the link. ;)

Anonymous said...

I was not as fortunate as Junican. I came in last, winning a 10-year subscription to Tobacco Control.

Anonymous said...

I live not far from Helena and remember when this study came out.

I can't remember all the details, but it was later exposed as a fraud. If I recall, one of the reasons had something to do with the community studied. There are two areas of Helena -- one is Helena, then there is a little community nearby called East Helena. I don't recall how, but they skewed and mixed these communities together in an unscientific manner.

There was a decline in heart attack in Helena, but, there was also a decline in East Helena, which is more working-class and has an even higher rate of tobacco use, and no ban at the time of the study). Then (if I recall rightly), following the study, an increase in heart attack occurred. It was a usual, seasonal increase. Anyway, it was revealed to be flawed, but very few spoke of this.

And the state of Montana is very much a pharmaceutically run state with all of the universities being turned into biomedical and genetics centers for the raising of grains mixed with animal DNA and other interesting things, which will mix nicely with our local farmer's crops and with our wild grasses, eventually to the detriment of our beautiful landscape.

Each study conducted in Montana equals millions of dollars for the scientists, universities, and the state government (but not for the common person) from the pharmaceutical industry -- and extra regulation and laws upon us.

It's about money, recognition, and greed; not health or education. Our English departments are falling into disrepair while giant state-of-the-art labs are sprouting up -- all of which will benefit the profits of the pharma industry, but do nothing to educate literate or free people able to question what is really behind the "science" and the bans upon our freedom -- science degree or not. A good English Literature degree also makes for a good and critical reader of scientific study too, for they know jargon and double-speak.

Anonymous said...

Yo rollo up yours.....I can see rollo wrapping his porn mag with and anti-tobacco mag so he can read it down at the local tobacco control oxygen bar!


Anonymous said...

More third hand smoke in bmj tobacco control

Anonymous said...

Hello Chris.

I tried to post a copy of my 'gracious acceptance speech' on your blog last night. Unfortunately, when I clicked on you, all I got was a black page.

Anyway, here is the post I was going to make, if it is ok:

""I have to split this into two parts because of the 'characters problem....

The first that I knew about this silliness was your report, DP. Isn't chance the most amazing thing? Day after day, I have looked at the VOTE and waited for the result, and been surprised that the thing is still going on! And then you beat me to it! Swine!

Anyway, here is my reply to the 'BMJ Editors' who signed the the admission of defeat:

""I thank you for the award of the prize of a subscription to 'Tobacco Control' magazine. I am much gratified, since the last thing that I won, without much effort, was an Easter egg when I was 17 years old.

Oh, by the way, there is a misconception in your above statement.

Your statement suggests that I have ‘colleagues in the pro-smoking lobby’. This is not true. I have no ‘colleagues’. I am merely a little, old man of 71 years caring for a little old lady of 69 years who has MS, whose occasional trip to our local pub has been ruined by the catastrophic effects on our pubs of the smoking ban, and I am merely a commenter on various blogs, on which ‘pro-freedom’ matters are discussed. I also have no significant political associations, or any other similar associations other than ‘signing up’ to newspapers and such in order to comment. I comment on many of these sites about a multitude of things.

Further, you say that my ‘colleagues’ on these blogs ‘tipped my idea over the top’. Erm.. 70% as opposed to the nearest, about 9%? Tipped over the top? No. There is a clear indication that your members, on the whole, are not interested and are probably not in agreement with your demonisation of smokers. Also, it may be that some other commenters on other blogs voted for my idea for fun, but it is also true, and something that you do not know, that a young man who is a relative of mine, put out the message to his friends on the internet to vote for my idea. They did not have to – they did it of their own accord. They did it because my relative suggested that they do. IS THIS AN ENORMOUS CONFOUNDER? Of course it is! In any study or survey, CONFOUNDERS can have an ENORMOUS effect.

Anonymous said...

Furthermore, at no time did I state my full name in your blog comments. In the BT phone directory there are only 20 ‘J Watson’ s in the area in which I live (which you must know since you have been trawling various blogs for information about me) and only one specifically named. I may well, therefore, receive an amount of nasty correspondence. Now, it may be that your employees receive nasty correspondence, BUT THEY ARE PAID A SALARY! I am not. You should not have published my full name. The fact that, in a different context on a different blog, I told people who I was is no excuse.

Furthermore, you say that my ‘idea’ was a good idea. It was not. Everyone with any sense knows that THE PROFITS of tobacco companies are spread all over the world among the shareholders, many of which are pension funds in the UK of the very organisations which promote Tobacco Control. Do the BMJ pension funds have investments in Tobacco Companies? Have the BMJ pension funds EVER had investments in Tobacco Companies? When did that cease to be the case, if it has?

As for the HEALTH COSTS (of the enjoyment of tobacco) in my idea, I can only say that the idea of ‘Health Costs’ is ephemeral. The complexities are too great for proper science to come to any definite conclusion. The complexities of a mere three constituents in Electromagnetic Effects are huge - only THREE multivariables, the electric current, the electric field and the magnetic field – and no one has really bottomed it. It is obvious from the recently issued ‘Report of the Surgeon General 2010 re Smoking and Health’ that there are HUNDREDS of multivariables in the human genome - just too many multivariables to draw any specific conclusions. This fact cannot be hidden by bluster.

Also, IT CANNOT BE TRUE that you knew about my little wind-ups (the ‘propaganda’ thing) before you chose my idea to be one of the six contenders for the prize. Not even tobacco control zealots could come up with any sensible or logical reason for choosing an idea from a person who is ‘a known colleague of people on pro-smoking blogs’ when there are others to choose from (no matter how silly they may be).

Finally, it simply is not true that I, as a person who enjoys tobacco, have ever, in all my life, harmed in any way or caused the death of any other person in whose presence I have enjoyed my tobacco. Where is your proof? (And don’t say Roy Castle, because it is well known that Roy (God Bless Him) smoked cigars).


Jwatso (aka Junican).""

Since the BMJ published my full name, it would not surprise me if there are not those fanatics who might try to get at me, but I HONESTLY SWEAR THAT I HAVE NEVER RAPED ANY SWEDISH PERSONS, EITHER MALE OR FEMALE, AND I ALSO SWEAR THAT I WAS ELSEWHERE AT THE TIME, M'LUD.

I am also posting this on Leg Iron and Frank D and Subro. I know that they are interested.""

Needless to say, the BMJ failed to publish my acceptance speech.