Two years later, no heart miracle in Oregon

I have an op/ed up today at The Oregonian addressing the question, “Whatever happened to Oregon’s heart miracle?” Oregon’s statewide smoking ban took effect in 2009 and was predicted by many advocates to result in a steep decline in the rate of heart attacks of 17% or more. I contacted the Oregon Public Health Division to see if hospital data bore this out. Unsurprisingly, it didn’t.

For those who are curious, here is the age-adjusted rate of heart attack admissions for Oregon as provided to me by the state, with percentage change from the previous year in parenthesis:

2003 198.4
2004 181.2 (8.67)
2005 166.8 (7.95)
2006 166.6 (0.12)
2007 163.4 (1.92)
2008 152.5 (6.67)
2009 141.5 (7.21)
2010 137.1 (3.11)

And here is the same data in graph form:


As I explain in the op/ed, the drop in 2009 is on trend with those in previous years and can’t be reasonably attributed to the smoking ban, and even under the rosiest interpretation it is still less than half of what ban advocates predicted.

The task of explaining this discrepancy fell to Ty Gluckman, director of clinical excellence for Providence Heart and Vascular Institute. It was Gluckman who wrote in 2009 that “[…] it’s highly likely that Oregon’s heart attack rates are already dropping as we near the law’s one-year anniversary. If we reduce the number of acute heart attacks by 17 percent, there will be at least 1,100 fewer hospital admissions in Oregon in just one year.” I said at the time that there was no way this was going to happen. You can read his entire response here.

Undaunted by contrary data, Gluckman suggests that Oregon’s less than stunning decline in heart attacks is due to two factors. One is that many bars were already banning smoking voluntarily before the ban. Another is that over this same period Oregonians were becoming more obese. However these confounding factors hold to some extent just about everywhere, which is why the only way to test the impact of bans is by 1) looking for increased rates of decline after implementation and 2) comparing these results with control populations that were not under a ban. This is essentially the method of the RAND study cited in my article, which found no impact.

The story in Oregon is consistent with that of other large populations that experienced no noticeable decline in heart attack rates following implementation of a smoking ban. See for example this New Zealand study, omitted from the meta-analysis Gluckman cites, or the publicly available data from many national governments.

Today’s article is my third Oregonian contribution on the subject of the state smoking ban. In 2008 I argued that the ban wasn’t actually about saving lives. In 2009 I argued that the its exemptions were unduly restrictive. Finally, also in 2009, I wrote for Doublethink about the last night of legal smoking at my favorite cigar hangout, the legendary Horse Brass pub.


11 thoughts on “Two years later, no heart miracle in Oregon”

  1. Beautifully done Jacob! 🙂

    I just did a quick little additional calculation from your figures that’s interesting. The average drop in the five years previous to the smoking ban was just over 5% per year. And guess what the average drop was in the two years after the ban? Heh… you got it: just over 5% per year.

    The smoking ban had ZERO effect on heart attacks!

    Gluckman’s defense is nonsense: he’s supposed to be a professional. Someone actually PAYS him for this stuff, right? Is he claiming that he was so incompetent that he was not aware that many bars were already banning smoking before the ban? Wouldn’t that have been a fundamental part of his original research when creating his 17% figure? Is he planning to give back whatever money he may have been given since he’s now admitting his work was defective?

    If he’s planning to change professions, I would advise him against going into the appliance repair field. If he fixes someone’s washer and gives it a five year guarantee and it breaks down in six months because he didn’t figure in the fact that it would be doing hot washes in addition to cold washes I think a court would make him give the money back.

    Of course he may have simply been writing “off the cuff,” simply offering his opinion as director of clinical excellence for Providence Heart and Vascular Institute on a matter that could intimately affect the health of millions of their potential patients. Maybe the standards for that sort of thing aren’t as strict as for washer repairmen.

    The Maytag Man would be ashamed.

    Jacob, an extra note: The RAND study does not stand alone in debunking this nonsense. Dave Kuneman and I did a very similarly sized multi state study back in 2005 in response to the first Helena study and arrived at basically the same results. The BMJ, Circulation, and Tobacco Control of course all refused to publish them — the full story on that can be seen at:

    I believe as well that two other very recent and very large studies, the Seven State Study and the 72 City Study have ALSO arrived at conclusions similar to ours and RAND’s.

    Funny how none of this gets into the headlines, eh?

    Michael J. McFadden
    Author of “Dissecting Antismokers’ Brains”

  2. Wow, there are some really fancy numbers there.

    A 16% drop in the smoking rate. But, the population increased by 12% over the 10 years from 2000-2010; so, the actual number of smokers stayed about the same.

    Let ‘s see what happens when we get away from admissions for 100,000 and go to admissions per 100 adults.

    Now we go from 0.2/100 down to 0.14/100.
    An adult’s chances of admission have gone from 2/10ths of 1% all of the way down to 1.4/10ths of 1%.

    Actual risk is about the same.

  3. The more people like xxx speak, the more they show what quacks they are. Look at what the ‘gentleman’ said:
    Over the past decade, Oregon has seen a steady decline in its heart attack admission rate. During the same period, the percentage of Oregon adults who smoked dropped from 20.9 percent to 17.5 percent, with cigarette sales falling from 67.6 to 47.9 packs per capita. Given tobacco’s harmful cardiovascular effects, it’s hard to argue that these two findings aren’t inextricably linked.
    So the proof that the fall in heart attack admissions was a result of fewer people smoking was ‘…tobacco’s harmful cardiovascular effects’. A perfect example of a circular argument.

  4. Oops! These machines drive one crazy! The italics should, of course, have ended at the word ‘linked’ at the end of the penultimate sentence.

  5. These machines drive one crazy! The italics should, of course, have ended at the word ‘linked’ at the end of the penultimate sentence.

  6. Jacob its harleyrider aka John engles I was gonna post this over on the docs story but they wont let my links in if anyone can get them up it will definately back up your statements:

    Mr. Grier you will find the exact same downward trend over at the velvet glove ironfist blog by christopher Snowden on the english heartattack fraud claims by Jill Pell of ASH!

    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.

    Here the PROHIBITIONISTS tried to claim smoking bans reduced childhood asthma!

    You can probably guess the answer. If I told you that the Glasgow study was penned by the infamous Jill Pell, you would be in no doubt at all.

    Readers with a long memory will recall that Pell’s study was the sheerest junk science. There was no effect from the smoking ban on asthma admissions. In fact, the first year of the Scottish smoking ban saw the largest number of childhood asthma admissions of the decade. Asthma UK is correct. Pell is wrong. Again.

    How’s that Scottish heart miracle going?
    Being in the mood to look back on the effectiveness of tobacco control efforts (see Ireland’s Abject Failure below), let’s see how that Scottish heart attack miracle has been coming along. You’ll recall the professorship-winning study by Jill Pell which claimed that hospital admissions for acute coronary syndrome fell by 17% in the first year of the ban.

  7. Paul, VERY similar. They even have their own “hockey stick” graph in a study done by a Dr. Pope a few years back: a long parabolic curve based on studies of smokers of 2 packs, 1 pack, a half pack etc a day, and then rushing to the axis in a screwy clouded blur claiming that there’s “no safe threshold” for secondhand smoke.

    – MJM

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