Friday 17 June 2011

Another pathetic heart miracle study: Kanawha County

As featured on a few crappy local news outlets in America, the latest attempt to show that smoking bans reduce heart attacks is up to the usual standard. You can read it here but the picture below tells the story.

The graph shows hospital admissions for acute coronary syndrome in Kanawha County, West Virginia. It's pretty unexciting, I think you'll agree. As in many parts of the world, including England, heart disease is declining at a steady but constant rate.

Can you guess when the smoking ban started? Well, actually there were two. A full smoking ban, including bars, was enacted in January 2008. That doesn't seem to have had any effect, although it is right at the end of the timeline. Prior to that, there was what the authors of this paper call a 'comprehensive' ban that included restaurants and all public places, but not bars. That started in January 2004.

Can you see how the 2004 ban affected the heart attack rate? That's right. It didn't. And the authors* admit as much...

We did not find additional significant change between, before, and after the removal of smoking areas in restaurants (the key change in the [Clean Indoor Air Regulation] revision that took effect January 1, 2004) after accounting for the sustainable decline of ACS hospitalizations since the 2000 regulation revision.

So how is this evidence of smoking bans reducing hospital admissions for acute coronary syndrome?

To answer that, we need to go all the way back to 1995, when Kanawha County introduced what the authors admit was a 'modest smoking regulation'. Modest indeed, it covered public buildings, but not bars or restaurants, or—I dare say—quite a few other places. Restaurants were, however, obliged to have a designated nonsmoking section of 50% of the floor space.

This is not what anyone today—let alone people in tobacco control—would describe as a smoking ban, but then in 1995, even California didn't have a full smoking ban.

But what—I hear you cry—has the 'modest smoking regulation' of 1995 got to do with the heart attack rate of 2000-08? If you're a true student of voodoo science you'll pay attention, because this is a belter...

In conclusion, our results demonstrate that from 2000 through 2008, the rate of hospital admissions for ACS has consistently declined in Kanawha County in the presence of an existing [Clean Indoor Air Regulation].

Yes, you read that right. Heart attacks declined "in the presence of" a very mild smoking regulation that came into force five years before the timeline of the graph begins. Therefore, post hoc ergo propter hoc, smoking bans reduce heart attacks.

Was the rate rising before 1995? We don't know, because they haven't bothered to get the data. Did the appearance of a real smoking ban lead to an acceleration of the decline? No it didn't. Is it true to say that the heart attack rate declined "in the presence of" absolutely anything that began prior to the year 2000? Yes it is.

This is beyond sad. This 'research' was published by the Centers for Disease Control, America's most prominent public health organisation. Don't they feel just a twinge of shame at being associated with this cow-pat of a study?

Probably not, because, as ever, godawful pseudo-science is fine so long as its for a good cause.

* One of whom is Juhua Luo, a perennial grant recipient from tobacco control who has an uncanny ability to find epidemiological associations where no one else can. In the past she has authored several studies that tried to show a link between snus and pancreatic cancer, as well as a recent attempt to link smoking to breast cancer.

Thanks to Michael McFadden for the tip.


Michael J. McFadden said...

Beautifully done Chris! I'd add a few things and also want to thank you for catching a few points that went totally by me.

Thanks first: I hadn't recognized Luo's name but it doesn't surprise me: both the snus and breast cancer things were frustrating hot-button issues for the Antis (Particularly our favorite mechanical engineer, "Dr." Grantz... er... Glantz) At least now we can understand how the new "links" were found. I'd also missed the importance of that whole 1995 thing: there's obviously no excuse for them not to have made at least a cursory attempt to graph the numbers from 1995 to 2000, or, preferably, 1990 to 2000 to show the "effect" -- except of course we both know there wasn't likely to have been one.

A final point that had flown by was the ending date of the study. What possible excuse can there be for not including figures for 2009? They would have been completed 18 months ago. The *ONLY* excuse I can imagine for not including them was if they went UP instead of down. If indeed that was the case then we have a clear instance of researchers willfully and unarguably presenting misleading data to a government body (the CDC) and the general public that will result in almost irrediable harm to people's lives and livelihoods.

My addtions: Note how the study cites the "bounce back" of Helena, the Pell study, and the IMO/Glantz/whichever meta-analysis without noting that it was corrected in the med journal itself an issue or two later to show no effect. It cites all of these, as well as a study in NY that seems to be totally irrelvant, in its Introduction, and somehow ALL of these seem to have slipped by an irresponsible and identity-secret panel of "peer-reviewers."

As I just said over on Siegel an hour or two ago, if my educated guess as to what has gone on is correct, then I think those researchers should be stripped of their university positions, be put on a "black list" for future funding of such research since they've shown their irresponsibility, and possibly even be held criminally and financially liable for conducting and disseminating research that has caused deep personal and material harm to millions of individuals and thousands of businesses.


Spike said...

Every day that I think about becoming a researcher... I wonder if, for myself, there is a price that could be put on telling the truth. I wonder what happened to the people doing this junk science research that their parents raised them to put their names on the deceptive trash they publish. I know I have friends and colleagues who would call me out if I ever tried to pull that. Why don't they? Oh... nevermind :)

Anonymous said...

Can you imagine this trash being presented in a court of law?

Gary K.

Michael J. McFadden said...

While it's not a major factor, it should also be noted that the general population of Kanawha County decreased by 3.5% during the 2000 - 2010 decade.


Anonymous said...

Hi,ASH Australia have been spruiking about a "heart attack miracle" in a town in Switzerland.Apparently a 21% drop in heart attacks.Would anyone here be able to check this one out as it smells of more bullshit from ASH!
PS. Sorry about no links but I am not very computer savvy.

James Higham said...

The Centers for Disease Control is known for its shoddy methodology, e.g.