Five years I spent in that swamp of a city and this is how I end up in Politico? I knew that photoshoot would come back to haunt me.
Speaking of heart attack miracles, a new one has been discovered to justify a possible statewide smoking ban in Mississippi:
A ban on indoor smoking has paid big dividends for the health of Starkville residents.
In the three years after the ban was enacted in 2006, Starkville had 27 percent fewer heart attacks than in the three years preceding the ban, based on the results of a Mississippi State University Social Science Research Study released Monday.
Of course none of the reporters covering the story bothered to include of a word of skepticism, and dramatic results like this don’t appear in large samples in the UK, Australia, and US states. But hey, Starkville!
Last week the Oregonian ran an op/ed about lottery revenue that turned out to really be primarily about the Oregon smoking ban. I missed it at the time, but it’s worth rebutting now. The piece is by Ty Gluckman, director of the coronary care unit at Providence St. Vincent Heart and Vascular Institute and a board member for the American Heart Association’s Portland chapter. In short, he’s someone who ought to know better than to write this:
In the midst of the messy process of health care reform, it’s refreshing to see one particular health policy, smoke-free workplace laws, having a documented impact. But despite two recent studies clearly linking the laws to a decrease in heart attacks, the laws continue to be a scapegoat for declines in video lottery sales — with no evidence of this link.
In the first study, published in Circulation: Journal of the American Heart Association, researchers James Lightwood and Stanton Glantz looked at 10 cities in the U.S., Italy and Scotland that have adopted laws restricting smoking in public areas. Their conclusion was astounding: The rate of hospitalization for acute heart attacks was reduced by 17 percent after one smoke-free year.
Even better, the bans continued to reduce heart attack rates over time, with about a 36 percent drop three years after the laws took effect. These results are consistent with the fact that nonsmokers exposed to second-hand smoke at home or at work have a 25 to 30 percent increased risk of developing heart disease. In fact, Lightwood believes that the new findings suggest that the increased risk may be even higher. [...]
The two studies released this month should give comfort to our state legislators that the smoke-free workplace law will help make Oregon a healthier place to live. In fact, according to the studies, 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. At a cost of more than $35,500 per admission, the savings will be substantial: $40 million.
Before getting in to what’s wrong with this reasoning it’s worth taking a look at Oregon heart attack rates. These are conveniently listed on the state DHS site for the years 2000-2006:
2000 — 36
2001 — 36
2002 — 37
2003 — 36
2004 — 33
2005 — 32
2006 — 31
There are two things to notice here. One is that, as is the case in many regions, there’s a secular downward trend in the rate of heart attack admissions. It’s dropping for reasons other than the imposition of smoking bans. Secondly, there can be significant fluctuations from year-to-year with no clear cause. From 2003 to 2004 there was a decrease of more than 8%. I’m sure there were several laws that took effect on January 1, 2004, but it would be silly to credit them with the drop in heart attack rates just because they occurred contemporaneously.
It’s also worth looking at the county-by-county break down of heart attack rates. Multnomah County, home to Portland’s large population, is very stable, with rates never going up or down by more than two points each year. Baker County (population 16,000+), the first on the list, varies much more wildly:
2000 — 39
2001 — 53
2002 — 31
2003 — 38
2004 — 23
2005 — 20
2006 — 16
Heart attack rates in Baker County jumped nearly 36% from 2000 to 2001. Just as miraculously, they then dropped more than 40% the next year. Does this mean anything? No, of course not. These are just the kinds of fluctuations you get when you examine a small sample. Yet an unscrupulous researcher could take the years 2001 to 2006 and make it look like a change in policy in 2002 brought about dramatic health results. Clearly, if you want to get an accurate view of the effect of a smoking ban on heart attacks, you’d want to look at studies with large sample sizes. Fortunately this data is easily available and there are dozens of states and countries than have implemented comprehensive smoking bans. (Incidentally, the city of Baker passed a partial smoking ban in February of 2000, just prior to the dramatic rise is heart attacks. For some reason anti-smoking researchers don’t include Baker in their studies.)
In the studies cited by Gluckman, where do the authors look? The first, by Lightwood and Glantz, includes such giant metropolises as Helena, MT and Pueblo, CO. Not only that, but because the authors found two studies each for Pueblo and Piedmont, Italy, they double-counted the same data and treated them as independent observations. (For a critique of one of the Piedmont studies, see here.)
The Helena and Pueblo studies are notorious examples of junk science, akin to taking the wild fluctuations in Baker County as significant findings (see my earlier post on the Pueblo study here). No impartial researcher would give them such weight when there is so much other data from larger samples available.
The second study from the IOM isn’t much better. I won’t get into it here, but suffice to say that it too ignores data that show no dramatic declines in heart attack rates following a smoking ban. See, for example, the United States, New Zealand, Australia, and the United Kingdom.
It’s possible that smoking bans do have some small effect on heart attack rates but it’s clear that the “heart miracles” claimed by Glantz and other researchers are illusions of the data created by small sample sizes. It will be important to keep this in mind as Oregon’s data for 2009 come in. Will there be a drop in heart attack rates, maybe even a drop comparable to that seen statewide in 2004? Will there be a few places the size of Baker County that experience not a mere drop by a full-blown miracle? Both outcomes are possible, but it would be foolish to attribute them solely to the smoking ban.
As Gluckman himself writes, the conclusions in the papers he cites are “astounding.” I’ve come to expect that reporters will take such claims at face value, but I hope for better from professional cardiologists like Dr. Gluckman. Those astounding claims should have aroused some skepticism in him. I’m sure he’s an intelligent man and perhaps he just didn’t look into the studies as thoroughly as he should have. As so often happens, confirmation bias can lead smart people to believe outlandish things.
Last weekend’s beer event at Cassidy’s was another successful night for the Oregon Bartenders Guild and Schoolhouse Supplies, with the latter receiving a little over $700 from the proceeds. If there’s a more fun way of raising money for kids than by drinking beer cocktails, I’m not aware of it. I’d like to thank all the brewers who contributed beer to the event, and especially thank McClaskey’s Spirits for providing some excellent products for us to mix with.
There were some interesting cocktails made that night with one of the most unique being Chris Churilla’s crowd-favorite Second Deadly Sin made with Buck bourbon, Maraska maraschino liqueur, Oakshire espresso stout vermouth (pictured above), and Oakshire IPA orange bitters. I didn’t have a chance to taste the vermouth separately, but the cocktail was delicious and proved the versatility of beer as an ingredient.
With my own participation in the event decided so late in the game I didn’t have time to do anything quite so transformative with beer but I still managed to turn out a tasty cocktail. Alex Ganum from Upright Brewing came through big time offering his beer on short notice. On the day before the event I visited Upright for what was supposed to be a brief tasting; however a power outage put Alex’s work to a halt and we ended up spending two hours trying everything on tap and talking beer. It was one of the best, most informative beer tastings I’ve ever had. I left with a case of his Flora Rustica, an aromatic saison brewed with yarrow and calendula flowers. Absolutely delicious on its own, and also quite nice in this simple beer cocktail:
.75 oz Bellringer gin
5-6 oz Flora Rustica
toasted thyme sprig for garnish
The Farigoule thyme liqueur complements the floral notes of the beer, as do the botanicals in the gin. Toasting a thyme sprig over a candle during the drink’s preparation adds even more aroma that drifts across the entire bar.
For more cocktails and photos from the event, go visit Ron’s coverage at PDXplate (the source of the photo above).
Drambuie is one of those bottles of liquor that’s a staple in many bars, including my own, that most bartenders don’t know what to do with. Recently my friend Lance Mayhew has been promoting it around Portland by hosting Drambuie Dens, encouraging bartenders and patrons to experiment with the spirit. They’ve been a lot of fun and while hosting one at Carlyle I was able to try it out in a few new cocktails. One of these is now on my menu as The Curse of Scotland:
.75 oz Ardbeg 10 Scotch
.75 oz Drambuie
.75 oz maraschino liqueur
.75 oz lemon juice
Shake and strain over ice into a chilled Martini glass. Ardbeg is my preferred Scotch here, but feel free to substitute another smoky Islay.
Obviously this is just a Scotch version of a Last Word. It substitutes Scotch for gin, Drambuie (an herbal liqueur) for Chartreuse (another herbal liqueur), and lemon for lime. It all came together on the first try; I wish all cocktails were this easy to make.
I’ll be serving this cocktail tonight at the 2009 Drambuie Den Bartender Showcase in Portland. Get the details and RSVP here if you’d like to attend. There’s a prize for best cocktail, too. With my drink using all off-the-shelf ingredients and having no fancy garnish it will be tough to win, but it is damn delicious.
Playing card enthusiasts will recognize the Curse of Scotland as a reference to the Nine of Diamonds, a card that has unique importance to many magicians as well.
I don’t know much about Virginia Governor-elect Robert McDonnell, but I already like him far more than his paternalist predecessor Tim Kaine. One of the first items on his agenda is privatizing the state’s horrendous liquor stores:
[...] the commonwealth currently only has about 300 ABC stores to serve nearly 8 million people, or about one per 27,000 people. The District, in contrast, has more than 500 stores. D.C. consumers are much better served with broader selection, greater convenience and lower prices. Many Virginians, particularly the half-million or so who live inside the Beltway, travel into the District to buy spirits, costing Virginia revenue.
Virginia’s ABC stores are a tower of mediocrity. They are centrally managed retail outlets that would have been palaces in the Soviet Union, but today they are anachronistic. They offer highly limited choices, often lacking exciting new brands or those with a cult following. Staff members generally aren’t knowledgeable about how to mix drinks or make cocktails. And the prices are artificially high because there is no competition: The state decides what to charge.
That’s from Garrett Peck, whose book The Prohibition Hangover arrived at my apartment last week. It’s now at the top of my to-read pile.
McDonnell was also an opponent of the Virginia smoking ban, believing that smoking policies were another issue best left to the free market. If he can weaken the ban and eliminate the ABC liquor monopoly I’ll gladly light a stogie and sip a rare bourbon in his honor next time I’m in the Old Dominion.
Update 11/9/09: It’s been pointed out that McDonnell has a paternalist streak too, at least when it comes to the bedroom. See this Washing Post editorial about his early conservative views, which though they may have cooled still have him opposing same-sex marriage.
Forget raw milk. The big new conflict is over raw oysters:
In an effort to reduce cases of a rare, but potentially fatal, bacterial illness contracted from raw oysters, the FDA announced new rules this month that will require any oyster served from April through October to undergo a sterilization process before it can be sold in restaurants or on the market.
The rule will essentially eliminate raw oysters — at least as Louisianans know them — from restaurant menus for seven months of the year. Even oysters that will eventually be cooked during those months would have to go through the same cleansing process before being added to any dish, a move some say would undermine the culinary integrity of some of New Orleans’ most famous delicacies.
The illness in question is serious but rare, and primarily affects only those with weakened immune systems:
The vibrio vulnificus disease, the target of the FDA initiative, affects about 30 individuals per year nationwide who eat raw oysters from Gulf Coast. About half of those who get the disease, which invades the bloodstream and can cause a severe fever and skin lesions, eventually die.
But those most at risk from vibrio are people who already have immune system disorders, such as AIDS, cancer, kidney disease, diabetes or alcohol abuse.
As is typical of the FDA, the agency is choosing coercion over education and ignoring the right of adults to take a calculated risk in pursuit of culinary delicacies. The new rules will also favor large oyster operations and hurt small businesses, due to the large capital investments required to sterilize the oysters. It will surely lead to a robust black market in unsterilized oysters too.
The rule won’t take effect until 2011, so there’s still some chance to save raw oysters from the FDA’s overreach.
[Via Ryan Young's excellent Regulation of the Day feature.]