Sunday 7 August 2011

The heart miracle scam revisited

One of the more blatant scientific scams of recent years has been the heart miracle phenomenon, in which tobacco control campaigners create studies showing a dramatic fall in heart attacks after smoking bans. It began when Stanton Glantz of Americans for Nonsmokers' Right announced the 'Helena miracle' in 2003, claiming a 60% drop in heart attacks after the smoking ban in this small town in Montana (later revised to 40%). It continued through places like Bowling Green, Ohio (47%) and Pueblo, Colorado (41%).

These places are not exactly major conurbations, you may have noticed, and the numbers of heart attacks are so low—often single or double figures—that large fluctuations are common. When whole countries have been studied, advocates have been forced to resort to methodological jiggery-pokery (Scotland, 17%) and bald, unverifiable assertions (England, 2.4%).

Stanton Glantz has produced two meta-analyses in an attempt to shore up his hypothesis, claiming that heart attacks fall by 27%, and then 17%, after smoking bans are enacted.

But when the actual hospital admissions data are made available, they invariably fail to provide any evidence of an effect of smoking bans on the heart attack rate. The statistics from Denmark, Wales, Australia, England, ScotlandNew Zealand and the United States have all failed to support the smoking ban/heart miracle hypothesis.

What should we trust? The evidence from places like Bowling Green, Ohio or the evidence from the entire USA? It has been obvious from the very beginning that anti-smoking campaigners have been mining the data to find big drops in heart attacks that roughly coincide with smoking bans. A study recently presented to an American Heart Association conference illustrates how easy this cherry-picking can be.

The study's finding are very interesting. The researchers looked at 74 US cities and found that the heart miracle effect has now fallen to just 3% (0.97 (0.95-99)). When the sample was limited to cities where the smokefree law was "meaningful"—ie. where there was a full smoking ban, rather than just restrictions—the effect disappeared entirely (0.99 (0.96-1.02). (Meaning that cities with lax smoking bans saw a bigger fall in heart attacks than those with "meaningful" smoking bans. Once again, the evidence fails to fit the theory.)

A drawback of the study is that there is no indication of how much the heart attack rate was falling before the ban, nor do the researchers compare rates to those in the cities which didn't have a smoking ban. When the study is published—if it is—hopefully the researchers will use a control group and look at the long-term trend.

What we do know is that rates of heart disease are falling in the USA, as they are in the UK and Europe. Even if one picks the more generous 3% figure, a modest decline of this order is likely to be in line with the secular trend. In other words: the smoking bans didn't make any difference.

If you look at the cities which brought in full smoking bans, you can see there is a great deal of variation in the heart attack rate with some going up, some going down and some going nowhere.

The variation is so great that no honest statistician would claim that there is any trend to be found amongst the data. But notice that four of the cities showed a statistically significant reduction in heart attacks and that the reduction was quite strong (at around 25%-30%). Now put yourself in the shoes of the tobacco control advocate who wants to show that smoking bans have a major effect on the heart attack rate. Which city would you choose to write your paper about? Evanston or Flagstaff?

The question, I think, answers itself. This is how they have been doing it. This is how we end up with 'news stories' like this from the BBC in 2003:

Town slashes heart attacks

Banning smoking in public places could prevent hundreds of deaths from heart disease, according to a study in a small US town.

Heart attacks in Helena, Montana, fell dramatically when smoking in public places was banned for six months last year.

The number of admissions dropped to fewer than four a month - a fall of nearly 60%.

From "nearly 60%" to nearly zero in just 8 years. What a ridiculous fraud this whole thing has been and how pathetic that so many have fallen for it.

Thanks to Michael J. McFadden for the tip.


Going Like Sixty said...

This just in: Liars figure and figures lie.

Truth: Tobacco is the only legal product which will kill you when used as directed.

westcoast2 said...

Truth: Tobacco is the only legal product which will kill you when used as directed.

Is this a sarcastic remark?

If not do you have a view on Chantix?

Pat Nurse MA said...

Lifelong smokers and those who live to very great old age would entirely disagree with this statement : "Truth: Tobacco is the only legal product which will kill you when used as directed."
Sarcasm or a smokerphobic pushing the same old, same old trash we've hard for years and found to be completely untrue? *Yawn* Change the record chaps.

Simon Cooke said...

Just a random thought - I've long felt the same about attributions of road casualty reductions following the introduction of gatso cameras. The numbers of recorded accidents at any given location are (thankfully) very small. So it is perfectly possible for a reduction from an average of say 2.3 a year to almost none to occur without any intervention.

Michael J. McFadden said...

To Going Like 60: Actually, your "Truth" is not true at all. McWhoppers 'n Fries will "kill you when used as directed" fully as much as tobacco. One of the Appendices in "Dissecting Antismokers' Brains" was titled "Deaths Due To Eating." I applied a very loose SAMMEC type analysis to diet-related deaths (e.g. using stats from the American Cancer Society stating that 1/3 of cancer deaths were diet related) and came up with a total figure of over 900,000 "Deaths Due To Eating" per year -- as opposed to the 400,000 "Deaths Due To Smoking" per year (data all for US #s).

Chris's other observations are right on the spot, although he's being far too polite. E.G. the cherry-picking effect of choosing Evanstons over Flagstaffs for analyses is likely to be OVERWHELMINGLY important. The people doing these studies are almost ALL likely to be antismoking in their personal orientations to some degree, they ALL recognize that studies showing an effect are more likely to be published than those showing no effect, they ALL recognize that a study showing a protective effect will end up being a black mark on their record as they will be suspected of being "a Big Tobacco Ally" and as such will have a harder time making a living and feeding their families in the future.

How many medical researchers applying for a grant from the "Tobacco Free Kids" or "ASH" and hoping to get more grants in the future are going to examine a town, find a big drop, and then decide, "Heck, maybe I should pick another town instead."? Now... how many would do such a switch if they found a ban increased the death rate instead?

Without any examination at all of individual studies, it should be clear to any fair-minded observer that such an effect must come into play at least SOME of the time. After all, many researchers have sold their "scientific soul" simply in order to get money from Big Pharma companies etc. Think how much that problem increases in THIS area when the scientists in question can salve their conscience by saying, "Hey, I'm doing it for a good cause: my jiggling the #s a bit will SAVE LIVES!"

Chris's point about cross-city comparisons and general heart attack reduction rates independent of bans is also quite valid, although the former is simply a weakness inherent to this type of meta-analysis. The latter however COULD have been corrected for in by the meta-analysts by taking figures for general heart attack reductions in the general wider geographic area observed and subtracting them within the observed time periods for the particualar communities covered by the studies. It is likely that at least SOME of the studies did this sort of thing (Even Helena made a weak stab at it although their very limited data pool actually supported the argument -- if analyzed correctly -- that angry Helenians were going out of town to party and have heart attacks at the town next door.)

Chris's MAIN point is that these studies, taken in whole or in part, are nonsense and little better, if any, than outright lies. Sure, there may be a few exceptions, but my money would lie on them being a small minority.


timbone said...

As a smoker, I am fully aware that if you inhale anything other than fresh air you risk a COPD or even worse. In my experience however, this heart thing was never mentioned when I began enjoying the benefits of tobacco. I am a 60 year old man with a healthy heart and healthy lungs, both of which work very well when pursuing one of my musical activities, playing the trombone. I can buy the risk to the lungs for an active smoker, but the heart thing has no evidence as far as I am concerned.

Michael J. McFadden said...

Tim, in terms of direct smoking there's at least some reasonable level of argument for an effect: the lifetime of increased heartrate due to constant nicotine stimulation (Although it just now occurred to me: shouldn't that disappear with tolerance??? The increased rates seem to be well documented though?), the effects of nicotine vasoconstriction (again with the question I just raised), the extra heart strain due to increases in COPD (which I believe is actually something MOST people develop to some extent as they age, smoker or not), and the increased levels of CO in the blood that make the heart work harder. For all those reasons I think there's at least a reasonable argument to support an effect from primary smoking.

ADDENDUM to my previous post: I'm not sure if it was the Glantz/Lightwood study or the other main Meta one that was done around the same time, but one of them committed such an egregious error that a correction had to be actually printed in a following issue of the medical journal. The correction however was woefully inadequate: it simply mentioned an error in figures without saying a word about the EFFECT of that error: the error basically totally invalidated the conclusion of the study! The "correction" should have been headlined: instead it received one small note that almost no one even noticed.


timbone said...

OK Michael...and hello by the way...yes, I can see the evidence you state, the only one I had heard previously was 'hardening of the arteries', another old age thing? Of course, once again it raises the issue of one of the biggest health frauds, epidemiology to create an epidemic when it is meant to research an epidemic, ie Second Hand Smoke.

Mark Wadsworth said...


One thought occurs to me, where there is a draconian smoking ban and people are forced to go outside to smoke in all weathers, they are more likely to catch colds etc which are not good for the heart, so to some extent the extra heart attacks might negate the small deccrease in heart attacks of those who give up or cut down (and again, you have provided plenty of evidence to show that smokers don't give up or cut down anyway).

Michael J. McFadden said...

Tim, yepper, that's another thing they blame on smoking, although I don't know if they have as good a causal thread beyond the very initial arterial wall injury.

Mark, actually, if "science" actually returns to being "Science" in this area in some distant future, they may discover that bans actually increased heart attacks overall. The factor you point out is one, but another biggie is the increased social isolation caused when the pub system is broken down. Yes, a few nonsmokers may go to the pubs more often, but most of them are probably ones who wouldn't have been avoiding the pubs in the first place if they hadn't been terrorized by the Antismokers to begin with! Having grown up in the 60s/70s I knew lots of nonsmokers and NEVER knew a single one who ever said, "Go to the bar? No thanks. Too smoky."

Meanwhile, now you've got the factors of both pubs closing and of previously happy social smokers and their friends staying home because they get too angry about being thrown out of their favorite pubs for no good reason.


dearieme said...

Put me down as someone put off pubs by the smoke. But I still don't like lies passed off as science, nor the Triumph of the Puritans.

Michael J. McFadden said...

Dearie, while I was over in Holland for the Hague conference we visited a good number of Dutch pubs. I can remember a few where the smoke even got to ME! And I smoke roll your own nonfilters! LOL!

But when you say you were "put off" by the smoke, weren't there at least some pubs you found that were ventilated well enough that it generally didn't bother you?

Generally those of us in the Free Choice movement strongly support the idea of smoking pubs being well-ventilated and also having the freedom to ban smoking on their own if they want. Most of us would even be quite comfortable with reasonable mandated government standards on ventilation and smoke. It's quite possible, I'd say even quite likely, that there are some pubs out there today where the air is LESS "healthy" after the smoking ban because with the obvious pollutant removed the owners have saved money by lowering the ventilation. That lowered ventilation allows other hazards to build far beyond the levels they ordinarily would have during the smoking years. So far we haven't really gotten hit with a really bad airborne pandemic, but when we do... it'll certainly be fueled by the smoking bans on airplanes and in pubs.