New review of Velvet Glove, Iron Fist

I'm honoured that Dr Michael Fitzpatrick has given Velvet Glove, Iron Fist a warm review for Spiked today. I've been telling anyone who'll listen to read Dr Fitzpatrick's The Tyranny of Health for several years now so it means a lot to me that he likes my book.

Fitzpatrick also reviews Geoffrey Kabat's Hyping Health Risks. Many readers will know Kabat as one half of the Enstrom/Kabat team who were subject to the most virulent abuse when the BMJ published their study showing that passive smoking "may not" increase lung cancer or heart disease risk. The personal attacks were so vicious (and unfounded) that they were more in keeping with a religious cult than a serious scientific debate. Kabat gives further examples of debased epidemiology and policy-based-evidence in his book and concludes that... 

The result of what Kabat dubs ‘the new McCarthyism in science’ is that epidemiology is reduced to propaganda.

Dr Fitzpatrick begins his review of my own book thus:

In his fascinating history of anti-smoking, Velvet Glove, Iron Fist, Christopher Snowdon (who was previously interviewed for the spiked review of books here) provides the wider context for the witch-hunt against Kabat and Enstrom. He shows how the campaign against passive smoking took off in the 1970s, long before the first studies that claimed to show its ill-effects.

An early campaigner’s statement that ‘we were just waiting for science to tell us what we already knew’ accurately reveals the subordinate role of science in the anti-tobacco cause. Snowdon also shows that the campaign against passive smoking has grown more strident and more influential in inverse proportion to the scientific evidence. Though large studies in the 1990s had shown all ‘those who had eyes to see that the passive smoking theory had unravelled’, the anti-smoking bandwagon rolled on regardless.

Please do read the rest...

Share

Tweet

Fresh nonsense

From the print edition of The Sun today:

ONE CIG IS DEADLY

Smoking one cigarette in your 20s can send heart attack risk soaring, researchers claim. Just one fag's fumes can stiffen arteries by 25 per cent, restricting blood flow and damaging the heart.

How many readers will interpret this as a clear warning that smoking just one cigarette in your youth makes your heart attack risk "soar"? How many readers will then think one of the following:

(1) They might as well keep on smoking if they've started. The damage has been done.

(2) People in their 20s have heart attacks as a result of smoking.

(3) The Sun doesn't know what its talking about.

Only one of these statements is correct. See if you can guess which one. 

As per usual, the "research" in question has not been published but it appears to confirm the less-than-earth-shattering fact that smoking increases arterial stiffness. The press release which The Sun reworded gives us enough of the facts for us to see that its news report is tremendously misleading. What the research actually says is:

The study compared the arterial stiffness of young smokers -- five to six cigarettes a day -- to non-smokers. Arterial measurements were taken in the radial artery in the wrist, the carotid artery in the neck and in the femoral artery in the groin, at rest and after exercise.

Clearly then, this was a study of regular smokers, not of people who had just one cigarette in a lifetime. The readings were taken after the participants smoked one cigarette, but that's hardly the same thing. 

So what are the implications of this unpublished research? As the lead researcher says:

"In effect, this means that even light smoking in otherwise young healthy people can damage the arteries, compromising the ability of their bodies to cope with physical stress, such as climbing a set of stairs, or catching a bus," Daskalopoulou said.

Ho-hum. This isn't particularly news-worthy information, which explains why most newspapers haven't reported it. Maybe if the study had shown that "smoking one cigarette in your 20s can send heart attack risk soaring" other journalists would have picked up on it. 

But it didn't. 

[The article has been substantially rewritten in The Sun's online edition, with a slightly less hysterical headline and with some of the more blatant mistakes removed (including the whole first paragraph).]

Share

Tweet

A little light reading

Some good articles around the web today. Patrick Basham and John Luik have a fine overview of the anti-smoking crusade at Spiked, in which they explain that science has never really been the issue.

Thanks to some unusual candour on the part of the anti-tobacco brigade in New York City, we now have official confirmation that banning smoking in public has absolutely nothing to do with protecting the health of non-smokers from second-hand smoke, but everything to do with stigmatising both smoking and smokers.

This is a reference to last month's proposed ban on smoking in parks, something that was demanded on the hideously Orwellian grounds that...

"We don’t think children should have to watch someone smoking."

Basham and Luik see such puritanical authoritarianism as an inevitable and intended consequence of 30 years of militant activism.

What the evolution of the debate over public smoking shows is how little science has to do with the anti-tobacco crusade, how disingenuous that crusade is about its real motives and goals, how easily the crusade on tobacco can be extended to other causes (most notably the war on obesity), and how fundamentally dangerous it is to a society both free and democratic.

I can only concur (I made similar points to the NY newspaper Westside Spirit last month).

You may have read this weekend about a World Health Organisation study that has found an association between mobile phones and brain cancer. I haven't had time to look into these claims in any depth but Dave Hitt has and it seems to be another case of 'if you torture the data it will confess to anything'.

As Dave says at the Quick Hitts blog, it has all the hall-marks of junk science - it's unpublished, it's a meta-analysis, it cherry picks the data and, finally, comes up with a barely significant risk ratio of 1.18 (and 18% increase in risk). 

They start with 465 articles and cherry pick 23 studies, but were still unable to extract any scary numbers. Their odds ratio was .98. (1.0 signifies no effect.) But then they cherry picked it even more, down to 13 studies, and were able to concoct an 18% risk.

This sounds remarkably similar to the Environmental Protection Agency's notorious meta-analysis of secondhand smoke studies (which I discussed in The Untouchables). Please do read the rest of Dave's article, and if you haven't subscribed to his excellent podcast yet, you really should.

Last but not least, Dr Michael Siegel discusses the Australian heart attack data that I recently dug up over at the Rest of the Story blog.

These results are in accordance with the observations of several tobacco researchers in Australia who have previously told me that they failed to see any significant effect of smoking bans there on heart attack trends...

It pains me to see the scientific integrity of the tobacco control movement imploding like this.

Share

Tweet

People who liked that, liked this...

From Digg, I thought this was an interesting juxtaposition of articles.

For those who like a bit of science fiction to go with their fictitious science.

Speaking of fictitious science, I'll be on Free Radio Santa Cruz today (7 pm GMT, noon PDT) talking to Robert Norse about the justification for outdoor smoking bans. You can listen live here.

Share

Tweet

No heart miracle in any Australian state

Yesterday I discussed Australia's hospital admissions data which show that a series of smoking bans have done nothing to reduce that nation's heart attack rate. Far from resulting in a 40% fall - as claimed by the infamous Helena study - rates of acute myocardial infarction have continued to rise. 

Since each Australian state acted independently, it is useful to look at them individually. The graphs below show rates of heart attack admissions in Australian public hospitals between 2000 and 2008. The date of the smoking ban is shown with an arrow in each case.

Of most interest is the data from Western Australia, Tasmania and Queensland. These three states were the first to introduce comprehensive smoking bans (in January 2005, January 2006 and July 2006 respectively) and so have the longest follow-up time in which a fall in heart attack incidence could manifest itself. As you can see from the graphs below, that did not happen.

Western Australia

Tasmania

Queensland

In every case, heart attack admissions rose over time and there was no positive effect from each state's smoking ban. If one adopted the post hoc ergo proptor hoc rationale of Stanton Glantz and the other "smoking bans slash heart attacks" advocates, one might even say that the smoking bans of Western Australia and Queensland resulted in even more lives being lost. This would be abject nonsense, but no more so than the conclusions of studies from out-of-the-way places like Helena, Pueblo and Bowling Green (which, incidentally, have far fewer people living in them).

Hospital admissions statistics from the other Australian regions follow much the same pattern. Again, there is a long-term rise and, again, the introduction of smoking bans had no discernible effect on the year-on-year fluctuations that are inevitable in such data. In fact, if one were feeling uncharitable, it would (again) be technically true to say that 3 of these 4 regions saw the heart attack rate rise more sharply after the ban than before it. Of all the Australian states, only South Australia saw a fall in the rate, albeit by only 1.5%.

Australian Capital Territory

New South Wales

Victoria

South Australia

These figures, I think, speak for themselves. The arrows might as well have been placed there in a game of pin the tail on the donkey for all the relevance they have to the number of people suffering heart attacks. There is no correlation whatsoever. In this respect they are entirely in keeping with the data from England, Scotland and Wales. 

It is not inconceivable that in the next few months we shall see some researcher come forth clutching a study showing that heart attacks fell by 30 or 40 per cent in Eucla or Katoomba or God knows where after the smoking ban. It is even conceivable that news of this miracle would sweep around the world like the notorious Helena and Scotland studies did. 

It would, however, be nice to think that journalists might ask themselves whether data collected by professional tobacco control advocates from obscure towns really trumps genuine hospital admissions data collected by professional statisticians from entire nations.

But that, I fear, may be too much to hope for.

[All figures come from the Australian government's 'Australian hospital statistics' series]

Share

Tweet

Smoking bans have not reduced heart attacks in Australia

Hospital admissions statistics from Denmark recently confirmed evidence from England, Scotland, Wales and the USA that smoking bans do not significantly reduce rates of acute myocardial infarction (heart attacks). This contradicts several widely reported epidemiological studies which have claimed a dramatic reduction in the heart attack rate as a result of smokefree legislation.

I have recently been looking at hospital admissions data from Australia to see if there is any evidence to support the "smoking ban slashes heart attacks" hypothesis. With the exception of the sparsely populated Northern Territory, the whole of Australia has now adopted comprehensive indoor smoking bans and so, if the hypothesis is correct, we should see signs of rates of acute myocardial infarction declining.

Unlike much of Europe and the US, there is a long-term upward trend in heart attack admissions in Australian hospitals. The reasons for this are not clear. Australia's rising population (of around 1.5% a year) will have been one factor and there will have been changes in methods of diagnosis. Whatever the cause, it is quite obvious from the graph below that smoking bans in Australia have done nothing to change that upward trend.

All the data is shown as financial years (April to March). Australia's states introduced their bans independently between January 2005 and November 2007. The coloured arrows indicate when each ban was implemented.

Black: Western Australia (population: 2.22m)

Yellow: Tasmania (population: 0.5m)

Blue: Queensland (population: 4.18m)

Green: Australian Capital Territory (population: 0.34m)

Red: New South Wales and Victoria (population: 6.89m and 5.40m)

White: South Australia (population: 1.16m)

Although a third of Australia's population was covered by smoking bans by the end of 2006, the two most heavily populated states introduced their bans in July 2007. South Australia was the last to follow suit in November 2007.

There is no hospital admissions data yet available beyond March 2008. The statistics for 2008/09 will complete the picture, but what we can see from the data already available is that there was no decline in the heart attack rate, nor was there even a decline in the rate of increase. Indeed, the rate of increase accelerated slightly in 2007/08, despite this coinciding with bans covering the densely populated states of New South Wales and Victoria.

The Australian data lacks the simplicity of Wales and Scotland, where the authorities helpfully introduced their bans at the start of the financial year. Nevertheless, if the Helena hypothesis is correct, some positive effect on the heart attack rate should be visible, and there should be a cumulative effect as more and more states implemented their bans. There is absolutely no evidence of any such effect. 

Note that the Helena hypothesis specifically claimed a drop in heart attacks of 40% within the first six months of the ban. Although Victoria and New South Wales introduced their bans towards the end of the time-frame, there was still nine months between July 2007 and March 2008 for a drop in heart attacks to occur. Instead, the rate rose from 51,667 to 55,676 between 2006/07 and 2007/08.

Australia's hospital records provide further evidence that the "smoking bans slash heart attacks" hypothesis is incorrect.

This data comes from the Australian Institute of Health and Welfare website (click 'Diseases of the Circulatory System', then 'Ischaemic heart diseases'). There is also a report (Australian hospital statistics 2007-08) which breaks the admissions down by public and private hospitals (page 218).

Share

Tweet

A race against time

I mentioned in a recent post the extraordinary influence of San Francisco-based tobacco control advocate Dr Stanton Glantz in all areas of tobacco control, and particularly with regards to the smoking ban/heart attack hypothesis.

Glantz is the founder of Americans for Nonsmokers' Rights, the director of SmokeFree Movies, the director of TobaccoScam and director of the Center for Tobacco Control Research and Education. I doubt that even he would describe himself as wholly impartial on the smoking issue.

He co-authored the original "heart miracle" study and has co-authored no fewer than three meta-analyses at a rate of one a year, all of which concluded that smoking bans immediately brought about a dramatic - if implausible - reduction in heart attack rates. 

Aside from a discredited study from Iceland, there has been no fresh evidence to support the smoking ban/heart attack hypothesis for some time and yet it is rarely out of the news. It has been kept there purely on the basis of press releases which promote new reviews and meta-analyses which, in turn, rely on old data, none of which stands up to scrutiny on its own merits.

The "smoking bans slash heart attacks" story was in the newspapers last month as a result of another of Stanton Glantz's meta-analyses. It was in the newspapers again this month as a result of a review from the Institute of Medicine. This latest paper, somewhat unusually, does not credit Glantz as a co-author but, as Michael Siegel has revealed today, he once again played a key part in the process.

The Committee held a public meeting in which it heard presentations by experts in the field covering various topics. According to the report, the topic of smoking bans was only presented by one expert: Dr. Stan Glantz.

And, as Dr Siegel, points out:

Dr. Glantz has a very particular view of the smoking ban studies

This is putting it mildly. In fact it would be true to say that the whole hypothesis is Glantz's baby. He, more than anyone, has a great deal invested in seeing the idea lodge in the public consciousness. Not only does it help in the campaign for more smoking bans in public places, but it implicitly suggests that passive smoking is even more dangerous than advocates like Glantz have previously claimed. It supports the notion that, as one of Glantz's research papers once stated, "even a little secondhand smoke is dangerous".

If, on the other hand, the public saw that the heart attack rate has not fallen dramatically as a result of smoking bans in England, Scotland or Wales, and that there has been considerable cherry-picking in the studies that suggest otherwise, it would damage Glantz's reputation considerably. It may even put the whole tobacco control movement under the spotlight.

Sure enough, the Institute of Medicine's study did not include the hospital data from the UK, nor did it include a study of the entire US which showed no association between the introduction of smoking bans and declines in heart attack rates. 

The absence of this data from the IoM's report is troubling, since Dr Siegel had made the committee aware of this contradictory evidence:

The report claims to have reviewed unpublished data and to have attempted to identify unpublished studies that might have found no effect of smoking bans on heart attacks. The report states that "no such studies were identified." 

I find this difficult to believe, especially since I was a reviewer of the report and I made the committee aware of several unpublished analyses which documented no significant effect of smoking bans on heart attacks.

The fact that this data was omitted, and that Stanton Glantz was given another starring role in the creation of the IoM's report, should be of concern to anyone who expects impartial research from such organisations. 

What I think we are seeing now is a frenzy of activity to establish the smoking ban/heart attack hypothesis in the public's mind before more national hospital data exposes it as a myth. 

In my view, the anti-smoking movement has bitten off more than it can chew by creating a hypothesis that can so easily be disproved. Junk science thrives in the darkness. So long as the raw data cannot be viewed, it is difficult to comprehensively debunk it. But that is not the case here.

Perhaps they did not realise that hospital admissions data was publicly available when they set out with this hypothesis. Perhaps they thought that nobody would check it. Whatever the case, it is crucial that they make the public believe that the evidence for their hypothesis is "overwhelming". Once it takes hold in the public's mind, any evidence to the contrary can be dismissed as the work of the tobacco industry, "flat-earthers" or "tobacco harm deniers".

And it's working. Thanks to a well-drilled PR machine and an unquestioning media, the latest report - based on no new data at all - has been picked up worldwide (517 articles, according to Google). Last month's report - also based on no new data at all - generated around 300 articles. 

And yet, new data keeps coming along - complete data from whole nations, rather than selected data from small communities. In the last few days, the Danish Health Department has released a comprehensive report [PDF] using data from the National Hospital Register showing that there was no decline in the heart attack rate after the smoking ban was introduced in August 2007. It concludes:

In none of the four studies was there an effect from the law for men and women in the two age groups. We could not detect any difference in hospitalization rates after the Act came into force. The expected greater effect among younger than among older people could not be found.

The graph below shows the heart attack rate amongst the two age groups (35-49 and 50-64). As usual there is a gradual decline over time which is not accelerated at all by the smoking ban (marked by the black line):



Number of news articles on Google about these findings (at the time of writing): zero.

(Thanks to Klaus K for the tip and for the English translation)

Share

Tweet