"The very powerful and the very stupid have one thing in common. Instead of altering their views to fit the facts,
they alter the facts to fit their views...which can be very uncomfortable if you happen to be one of the facts that needs altering." - Dr. Who

Understanding
The Numbers

Studies

Smoking Bans
And Businesses

Odds and Ends

   

The Helena Study

In June of 2002 a smoking ban was implemented in the town of Helena, Montana. Six months later the ban was lifted due to a judicial ruling.

In April, 2003, two researchers made an astounding claim: the ban had lead to an immediate 60% drop in heart attacks. They further claimed that when the ban was lifted the number of heart attacks returned to normal levels.

This study has received widespread distribution and acceptance, and has been used to"prove" that bans improve public health. But it doesn't take much digging to see that the study was a complete fraud; a shameful exercise in junk science.

Fact: In 2002 the city of Helena, Mt. passed a ban on smoking for all business. Six months later the ban was overturned by a judge, and smoking was once again allowed in public places.

Fact: In 2003 Dr. Richard P. Sargent and Dr. Robert M. Shepard announced to the press they had done a study which showed a 60% decrease in acute myocardial infarctions (heart attacks) during the period the ban was in place.

Study results are usually announced when a study is published. "Science by Press Conference" is not highly regarded in the scientific community.

Fact: When the study was published in the British Medical Journal, a year later, they claimed a 40% reduction in heart attacks.

Why did they give one number to the press, and an entirely different, much lower number to the BMJ?

Their original PowerPoint presentation is available here (pdf). Note the 60% claim on the last page.

Fact: Sargent and Shepard enlisted the aid of Dr. Stanton Glantz (whose doctorate is in applied mechanics, not medicine or biology), an active and prominent leader of the anti-smoker movement in the US.

Fact: BMJs web site includes a "Rapid Responses" section, where respondents can comment on a study. Dr. Glantz posted there, ignoring all of the criticisms and questions that had been posted. He said their study "reported a 42% (95% CI 1% to 79%) statistically significant drop in hospital admissions for acute myocardial infarctions (AMI)"

Fact: The confidence interval cited by Glantz does not appear any where in the original study.

Studies with wide confidence intervals are suspect. Studies where the CI is close to 1.0 are very suspect. (See Statistics 101 for more details.) Assuming the CI Glantz cites is accurate, one less heart attack or one misdiagnosis could have pushed the lower boundary of the CI below 1.0, which would have made the results statistically insignificant.

Fact: The researchers claimed that the isolated community, which resulted in a very small sample size, was a positive factor.

Fact: In statistical studies, large sample sizes across various populations are usually considered desirable.

Fact: Compliance with SHS laws is an important factor in SHS exposure.

Fact: In the study the researchers reported, "We did not make any direct observations to measure how much exposure to secondhand smoke was reduced during the months when the law was in force. We do not know the prevalence of smoking in venues covered by ban, though the city-county health department reported that all but two businesses complied."

Fact: On April 7, 2003, Sargent and Shepard attended a meeting of the Montana Senate where they heard testimony from business owner Laura Fix that smokers were driving outside town to patronize venues that allowed smoking. The minutes from this meeting are available here.

Fact: At the same meeting Rich Miller of the Gaming Industries Association, testified that three of Helena's five casinos never complied with the ban.

Fact: It was well known that some of the casinos were ignoring the ban, and many bars (at least nine according to this article) were not in compliance.

Fact Worth Repeating: Sargent and Shepard were present at the meeting where the widespread non-compliance was discussed, yet still claimed, in their study, that only two business were non-compliant. At the same meeting they learned that smokers were making the short trip out of town to smoking venues, but ignored that fact in their study.

Fact: 38% of the patients in this study were smokers, 29% were ex-smokers, and 33% were life long non-smokers. This was mentioned in the study, but was not taken into account or used to adjust the final numbers.

Fact Worth Repeating: Only a third of the patients in this study were non-smokers.

Fact: Although the study claimed to be about the effects of second hand smoke, the researchers did not interview a single patient about their SHS exposure.

Not one! If they wanted accurate information, wouldn't they have interviewed as many patients as possible? There were only 40 of them.

Fact: A similar dip in heart attacks occurred in 1998. The researchers ignored this fact.

Fact: No confounders were considered, checked for, or used to adjust the results.

In any legitimate statistical study, confounders must be accounted for and used to adjust the data. (See Statistics 101 for more information.) In this case, confounders would have included the patients smoking status (smoker, ex-smoker, never smoker) exposure to any conditions, substances, physical activity or environments that could cause or contribute to heart attacks, and recent changes to those exposures.

Fact: The authors of this study claimed they had no competing interests.

Fact: Richard Sargent and Robert Shepard were anti-tobacco activists before conducting this study. When asked about this Shepard said, "They can say what they like. The bottom line is, the data speaks for itself. We don't have to apologize for our particular bias." (Emphases added.)

Fact: Stanton Glantz is one of the leading anti-tobacco and anti-smoker activists in the United States. He has brought millions of dollars of anti-smoking grant money to the University of California, San Francisco, which eventually awarded him a chair as Professor of Medicine despite his lack of a medical degree. He is the founder of Americans for Non Smokers Rights, Smoke Free Movies and has personally received hundreds of thousands of dollars in grants for anti-tobacco studies. In addition, he has generated tens of millons of dollars in anti-smoking grants for his university.

Fact Which Shows Fraud: Although the researchers claimed heart attacks dropped for the six months the ban was in place, the only drop was during the first three months. For the last three months the rate returned to normal. This can be seen in their own chart.

Fact Worth Repeating: "We did not make any direct observations to measure how much exposure to secondhand smoke was reduced during the months when the law was in force."

Fact: All of the funding for this study came from anti-smoking organizations.

Fact: The American Cancer Society awarded Sargent Shephard the Ted Marrs Award, which recognizes individuals that consistently demonstrate excellence in the area of public issues. They cited the 60% claim from their original press conference, not the 40% claim made in the actual study.

Responses to the Study

The following comments about the study were published in the BMJs Rapid Response page. (Note: Some of the original comments were quite long, and have been edited for space reasons. You can see the responses in their entirety here.)

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These numbers are far too small. The study surveyed at most 40 admissions across a six month, or 26 week period. So, even an increase/decrease of one per week makes a huge impact. It is also claimed that the increase of 5.6 in outside Helena admissions was insignificant, however it is a near 50% increase.

- Ben Hirsch, Research Assistant
University of Massachusetts

The attempt to make claims about the effects of smoking bans based on this very weak ecologic study raises disturbing questions about our ability to distinguish between sound science and wishful thinking.

- Geoffrey C Kabat
Epidemiologist

This is, in my opinion, gross misrepresentation designed to provide maximal public impact in furthering the biased and unscientific opinions of these authors. . . This so called study does not even come close to meeting the basic criteria of a properly executed scientific study.

- Henry F Mizgala
Emeritus Professor of Medicine
University of British Columbia

Smoke-free workplace legislation protects workers and the public from cardiac, respiratory, and cancer risks associated with second-hand smoke and facilitates cessation among smokers. However, unrealistic expectations can hinder efforts to expand smoke-free workplace laws. The 40% decline in acute myocardial infarctions (AMIs) associated with a smoke-free ordinance in Montana is neither biologically nor epidemiologically plausible.

- Farzad Mostashari, MD MSPH,
Assistant Commissioner
NYC Department of Health and Mental Hygiene

We previously presented data showing that the Helena observations are consistent with random variation because of the small number of observations on which they are based

Brad Rodu
Professor, Department of Medicine and Endowed Chair,
Tobacco Harm Reduction Research

 

Additional Information

The entire study is available here.

The Smokers Club Inc. has gathered hundreds of articles about the study.

Jacob Sullum responds to the preliminary announcement, and analyzes the numbers.

Michael Siegel, a tobacco control advocate, analyzes the study.

Steven Milloy tries, unsuccessfully, to get more information out of the authors.

An interview with Dr. Sargent

What happens when you examine the effects of bans on large populations? The Kuneman/McFadden study did just that. This is a preliminary version of their study. Trying to get it published has been, shall we say, an adventure.

Acknowledgements

Many thanks to Michael McFadden (author of Dissecting Anti-Smokers Brains) and Dave Kuneman who provided an enormous amount of help with this page. They provided many of the facts and did the research that made this page possible.

 

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