We’ll always have Helena

In 2004, physicians Richard Sargent and Robert Shepard published a study making the astounding claim that a six-month ban on indoor smoking in the town of Helena, Montana resulted in an immediate 40% drop in the city’s rate of heart attacks. Ever since then it’s become sport among anti-smoking researchers to search for similar “heart miracles” in other places that have implemented smoking bans. Curiously, the miracles tend to get smaller as the populations get larger. Big effects were found in Bowling Green, Ohio and Pueblo, Colorado, but they never carried over to state or national levels. A recent examination of England’s heart attack rates could claim at best a 2.4% reduction, and that with dubious manipulation of the data.

This has led many critics to allege that the heart miracles of Helena and elsewhere are statistical flukes that emerge from small sample sizes. There is new evidence to support this view: A comprehensive study led by the RAND Corporation used data from throughout the United States to see if there is a relationship between smoking bans and rates of heart attacks. It found no statistically significant effect. Further, it found that rates in populations comparable to those cited in previous studies are highly volatile and on average cancel each other out. This suggests that the many studies claiming large effects are the result of publication bias, not actual declines caused by smoking bans.

Tobacco researcher Michael Siegel, himself a supporter of smoking bans, sums up the significance of the study:

Without a doubt, this is the most definitive study yet conducted of the short-term effects of smoking bans on cardiovascular disease.

To give you an idea of the scope of this study compared to previous ones, the Helena study involved a total of 304 heart attack admissions in one community over a period of six months. This study examined a total of 673,631 heart attack admissions and more than 2 million heart attack deaths in 467 counties across all 50 states over an 16-year period.

The case for comprehensive smoking bans leading to immediate reductions in heart attacks has never been strong and now there is substantial evidence against it. Jurisdictions that have not yet imposed smoking bans have one fewer reason to do so; those that have should restore business owners’ rights to set their own policies, as the Dutch have recently done.

I would like to think that the anti-smoking movement and press would acknowledge these findings, but I’m not optimistic. As of now a Google News search for “smoking ban RAND Corporation” yields only one result, in contrast to the dozens or more that usually follow reports of sudden declines.

An Oregon heart miracle?