Wednesday, 6 September 2017

Spanish smoking ban miracle

It is with a heavy heart that I must inform you that someone's written another yet smoking ban miracle study.

This time it comes from Spain where a partial ban was introduced in 2006 followed by a 'comprehensive' ban in 2011. The authors look at these two dates and study two types of hospital admission (for asthma and COPD), thereby giving themselves four bites of the cherry to find a correlation.

They pooled a bunch of hospitals together and came up with this mess of inconsistent and contradictory results:

Can you see clear evidence of hospital admissions falling after either of the bans? Neither can I, but the authors claim that the following findings emerged:

The partial smoking ban was associated with a strong significant pooled immediate decline of 14.7% in COPD-related admission rates...



There was no subsequent effect of the comprehensive ban on COPD-related admission rates...


But for asthma, it was the other way round...

Asthma-related admission rates increased by 12.1% immediately after the partial ban...


...but decreased by 7.4% after the comprehensive ban.


This is pretty much the definition of a mixed result. Can you guess how it was written up in the abstract?

The partial ban was associated with an immediate and sustained strong decline in COPD-related admissions, especially in less economically developed provinces. The comprehensive ban was related to an immediate decrease in asthma, sustained for the medium-term only among men. 

If you guessed they would ignore the null and negative findings and focus only on the positive findings then give yourself a pat on the back. You know them too well.

Let's try to get our heads around this, shall we? The underlying assumption here is that smoking bans reduce hospital admissions by reducing exposure to secondhand smoke. If so, it seems that the partial ban was so successful in reducing secondhand smoke exposure that it reduced COPD admissions by 14.7 per cent. This is pretty bloody impressive when you consider that COPD is a chronic disease that takes decades to develop and which mostly affects smokers.

But despite the miraculous effect on COPD, the partial ban had the weird effect of increasing admissions for asthma by 12 per cent, although you can see from the graph above that there were about the same number of admissions after the 2011 ban as there had been in 2003 when there was no ban of any kind. And when it came to the comprehensive ban, asthma rates fell but COPD rates didn't.

Does any of this seem plausible? Does it make a lick of sense? I would suggest not.

It is sheer garbage. Manifestly so. The best result these jokers can produce is a fall in COPD admissions during a partial ban. That ban must have done a hell of a job of reducing secondhand smoke exposure, huh?

Well, no. Not according to the authors of the Tobacco Control Scale who celebrated the introduction of 2011's comprehensive ban by saying:

The 2005 so-called Spanish model (weak smokefree legislation in bars and restaurants), praised by the tobacco industry, is finally dead. In 2010 Spain adopted far reaching and comprehensive legislation on smokefree bars and restaurants.

The same authors had previously described the 2006 ban as 'weak and ineffective, and a study of it published in 2009 concluded that:

Among nonsmoker hospitality workers in bars and restaurants where smoking was allowed, exposure to SHS after the ban remained similar to pre-law levels.

And yet this 'weak and ineffective' legislation had a massive effect on COPD admissions whereas the 'comprehensive legislation' five years later did diddly-squat. The miracle becomes more confusing when you consider that the ban which reduced COPD admissions somehow increased the number of asthma admissions.

This data-dredging bilge makes no sense on any level. Even if you accept the authors' prior beliefs about secondhand smoke, it defies all logic. The authors don't even attempt to explain the contradictions and yet this utter drivel got published in a peer-reviewed journal, just like all its ludicrous predecessors got published in peer-reviewed journals. It is beyond a joke.

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