No heart miracles in six US states

A new study published in the Journal of Community Health provides more evidence that smoking bans do not have a measurable effect on incidence of acute myocardial infarction (heart attacks). Rodu, Peiper and Cole looked at heart attack mortality in six US states in the first year after smoking bans were enacted and found that they did not vary significantly from the long-term decline in the rest of the USA.

The white dots show the first full year of the state's smoking ban. The bans took place between 1995 and 2004, at a time when the rest of the USA did not have smoking bans, and so the national decline cannot be attributed to smokefree legislation. Two of the six statewide bans included bars. The others covered all or most other 'public' places.

Five of the states saw declines which were in line with the national decline. The much talked about statewide ban in California—the first in the world—was followed by a fall in heart attack mortality of 2.0%, which was a slower rate of decline than had been seen in the three years prior to the ban (3.0%), and was less than the national decline (3.9%).

The rate fell by 9% in Florida, but rose by 9% in South Dakota. The total smoking ban in New York was followed by a fall in AMI mortality of 12%, but this was not significantly different from the 10% decline seen nationwide.

Overall, the results show no effect on AMI mortality from smokefree legislation. Five of the six states saw a fall in mortality, but this is no surprise since the nationwide rate fell by half over this period. A national decline in heart attack mortality from nearly 300 per 100,000 to less than 150 per 100,000 is of major public health significance, but if smoking bans had any role in this long-term decline, the effect was too small to measure.

The researchers conclude:

Smoke-free ordinances may serve public health objectives by providing non-smokers with indoor environments that are free from irritating and potentially harmful pollutants. However, this study does not provide evidence that these ordinances result in a measurable immediate reduction in AMI mortality of the magnitude claimed by reports based on very small incident numbers.

This is just the latest piece of evidence that discredits the widely reported 'heart miracles' of Helena, Bowling Green, Scotland etc. As I have said repeatedly on this blog, all reports of a significant effect on heart attacks from smoking bans have been based on shoddy evidence, biased methodology and blatant cherry-picking.

The methods employed by tobacco control advocates in this instance have been childishly simple. They chose to look only at places which saw a fall in AMI incidence—as most places have—while ignoring the long-term decline. They have typically chosen places with very small populations where small changes in absolute numbers represent large changes in percentage terms. This is how ridiculous claims about smoking bans cutting the heart attack rate by 40% were manufactured.

As junk science goes, it's at the more facile end of the spectrum, but it should be remembered that the fraud has only been exposed because hospital admissions data is (often) publicly available. This is just the tip of the iceberg. Below the surface is a swamp of hidden data and twisted statistics that anti-smoking researchers vehemently refuse to allow the public to have access to.