To justify Smoking bans, we used flawed scientific evidence

The city of Helena in Montana, rarely gets into the headlines of international news, but in 2003 this little Metropolitan town gained short-term popularity due to the greatest triumph in the history of the struggle for public health. In July last year in Helena was adopted broad Smoking ban that has spread to workplaces, bars, restaurants and casinos. During the first six months after the ban the number of heart attacks in the city dropped by almost 60%. Equally miraculously, the number had soared to the same height after the lifting of the ban by the court in November this year.


For three wrestlers Smoking, local physicians Richard Sargent (Richard Sargent) and Robert Shepard (Robert Shepard), as well as activist and researcher Stanton of glance (Stanton Glantz), University of California, San Francisco — a sudden decrease in the number of heart attacks was proof of the incredible advantages and benefits of Smoking bans for public health. “These striking findings suggest that protecting people from the toxins in someone else’s tobacco smoke not only saves them from the associated with passive Smoking unpleasant feelings, but also saves lives,” said Glantz in a press release made by UCSF (The University of California, San Francisco — approx. transl.).


Exactly and reported it to the newspaper, trustingly assuming that the coincidence was indeed caused by Smoking bans. “The findings of the fallen, and then again soaring number of heart attacks in Helena is obvious, — warned readers writer New York Times. — Passive Smoking kills”. Bi-bi-si has predicted that “[the ban] Smoking in public places could prevent hundreds of deaths from heart disease”. The news media alerted the world about the results, and even so conservative a resource like the Wall Street Journal, pointed out the result as a significant discovery.


In the early years amid the struggle of the judiciary across the country for the dissemination of the ban on Smoking in bars and restaurants, fighters with Smoking have used conducted in the Helena study and related materials showing the influence of passive Smoking on the venous circulation, to spread public fear of passive Smoking. Various groups throughout the country said that “even half an hour passive Smoking cause heart damage, comparable to those in regular smokers”. Not wanting to be left behind, the Community-Minnesota published in a press release statement, that 30 seconds of exposure to passive Smoking can lead venous circulation non-smokers to a state indistinguishable from that of smokers”. The promise of Smoking were evident: even short term exposure to passive Smoking could kill them.

A decade later extensive bans on Smoking has spread worldwide. And now that I collected enough evidence, it became apparent that the fabulous results that promised a group of fighters with Smoking — an incredible boost heart health with the introduction of the restrictions — was never realized. A new, more thorough study has not found significant relationship between Smoking bans and short-term cases of heart attacks — it’s definitely nothing resembling shestidesyatiletie the reduction of the frequency, which was reported in Helena. Updated scientific evidence to refute speculation of alarmists, on the basis of which the public is convinced of the necessity of restrictions, and allow for a more sober analysis, leading us to the conclusion about excess of current prohibitions, in terms of dealing with the risks of Smoking.


By the time the publication spent in the Helena study in the British medical journal, the authors reduced the marked decrease in the number of heart attacks from 60 to 40% of result, though impressive, but significantly smaller than the one on which they are prematurely told the world’s press. The report immediately drew severe criticism from other scientists, pointing to the small size of the population of Helena, who formed at that time about 68 thousand inhabitants, and the medical impossibility of achieving such significant results in such a short period of time. It was impossible to establish with precision whether the decline is due to a ban or an accident.


Nevertheless, the report led to a series of studies seeking to replicate the results. Research, who noted similar reduction was held in places like Pueblo, Colorado; Bowling green, Ohio, and Monroe County, Indiana. All these places had one thing in common — a small population and therefore small sample size: the latest of these studies have considered only 22 heart attacks among non-smokers, which occurred almost four years.


When he finally appeared studies with larger sample marked reduction in the number of heart attacks began to decline. The study of the Piemonte region showed much smaller decrease of 11%, observed only among residents older than 60. In England, where a ban on Smoking across the country for the first time gave researchers the opportunity to consider this issue at the national level, the reduction in the number of heart attacks, which could be attributed to the ban, accounted for slightly more than 2%.


Critics also noted that the number of heart attacks in England has declined in the years preceding the ban, so the reasons for the decline were still in question. Anyway, there gathered information made it obvious how far from reality was implausible results obtained in smaller scale studies. However, despite the recognition of significant differences in the results of studies and limitations associated with their methodology, conducted by the Institute of medicine in 2009 meta-analysis led to the conclusion about significant impact of Smoking bans on the short-term the number of heart attacks. “Even brief exposure to secondhand smoke can… lead to heart attack,” reported the New York Times one of the members of the panel IOM (Institute of Medicine — approx. transl.), calling for “bans on Smoking as soon as possible”.


This report, however, missed one of the largest conducted to date of studies investigating the relationship between passive Smoking and heart attacks. The 2008 survey covered the whole of New Zealand, whose population is inferior to the British, but superior to those you have studied before. This study found no significant changes in the number of heart attacks and cases of progressive angina over the subsequent bans on Smoking. In fact, the number of hospital admissions in connection with a sore throat only grew.


Conflicting studies continue to appear. Researchers at the RAND Corporation held a curious work, examining the likelihood that a significant reduction in the number of heart attacks reported in small settlements, was an accident. They gathered abundant information that allowed them to repeat studies like those that were held in Helena, Pueblo, and Bowling green, but in a much larger scale. While those studies compared a couple of small towns, RAND compared with each other in all the cities, subjected to restrictions, with all possible control variables finally received more than 15,000 pairs. They distributed the results by age groups in case of different effects of restrictions on young people, working age adults and the elderly. In addition, unlike many other studies, the RAND has taken into account existing trends in the number of heart attacks.


The research found no statistically significant reduction in the number of heart attacks in any age group. The information gathered also showed frequent jumps in the number of heart attacks: therefore, the comparison of small populations with a high probability of showing a significant reduction for random reasons. Significant increase in the number of heart attacks occurs equally often. This explains the sensational results in places like Montana or the County of Monroe, the repetition of which was not in the larger jurisdictions. The study’s authors bluntly concluded: “We found no evidence of a link between restrictions in the US on Smoking and short-term decline in the number of appeals to hospital because of acute myocardial infarction or other diseases among children, the elderly or adults of working age”.


In a 2012 study of six American States that have introduced bans on Smoking, led to similar conclusions. To the same conclusions and has led research 2015, noticeable for the reason that his conduct involved some of the researchers previously published a report on the reduction in the number of heart attacks in the cities of Pueblo and Greeley, Colorado, after the introduction of Smoking bans. When Colorado imposed a ban throughout the state, the authors had the opportunity to see repeat their earlier findings in a larger group of the population, a number almost 5 million people. The results are not repeated. As an additional check they had re-examined the collected information, omitting the 11 jurisdictions in which already was introduced an extensive Smoking bans: results of the ban throughout the state still was not detected.


In honest wonderful comments to the report, the authors analysed the reasons why previous studies, including those conducted themselves, overestimated the impact of Smoking bans. First, a smaller amount participating in studies of the population led to the confusion of random and real results. Second, most previous studies did not take into account already existing trends toward reduction in heart attacks. Third, the present systematic error: because no one believes that Smoking bans increase heart attack risk, few published studies demonstrating a positive relationship between the bans and heart attacks, or the lack of any connection at all. Thus, among the total number of publications with high probability creates an unintended bias in favor of demonstrating a more significant effect bans than there actually is.


According to the medical explanation of the link between secondhand smoke and heart attacks, short-term exposure to passive Smoking leads to slower blood flow, increases platelet aggregation and cause endothelial dysfunction. All this increases the risk of heart attack. However, if you look at most properly conducted studies, we can conclude that the real effect of passive Smoking is exaggerated. In cases where the number of heart attacks has indeed decreased, this could not occur due to limitations: the authors published in August 2016, the report suggested that the decline could be caused by other neglected factors. Based on information gathered in 28 States between 2001 and 2008, the main author of the report Vivian Ho (Vivian Ho), an economist at rice University, compared rates of hospitalization for heart attacks in areas where they were banned, in areas where bans were not.


Using the methodology of previous studies, she and her co-authors found a statistically significant decrease in the number of hospitalizations due to heart attacks and congestive heart failure after the introduction of Smoking bans (which have been observed, however, only among people older than 65 years). However, when they went a step further and took into account in its analysis differing among different provinces variables such as access to hospitals and an increase in the tax on cigarettes, results of Smoking bans disappeared. Ho and her co-authors suggested that a modest improvement of cardiac health, previously associated with Smoking bans, in fact, was caused by changes in access to health services and a reduction in the consumption of cigarettes by the population after the growth of koreniatzite taxes on tobacco products (negative impact of Smoking on heart health is not proven).

Among the recent scientific literature the most important study that established the link between Smoking bans and heart attacks — report 2012 in Health Affairs. It is probably the most convincing study demonstrating a decrease in the number of heart attacks, however, it applies only to the elderly population, and it was not taken into account the amendments in connection with the increased taxation of cigarettes, the above. Even those who are inclined to believe that Smoking bans lead to lower numbers of heart attacks, was forced to admit that the scope of the study a larger population leads to a reduction of the intended outcome. The authors of the meta-analysis of 2013 noted that “conducted in the U.S. studies covering a lesser number of the population generally demonstrated a greater reduction… while a broader study showed a relatively small reduction.” In other words, to be exact, most large-scale studies demonstrated the absence of any reduction at all.


In his blog, which he leads at the University of California in San Francisco Stanton Glantz challenged the results of a recent report Vivian Ho, suggesting that the statistical model for calculations. However, the decline promised Glanza and other supporters of the bans was so much that needed to be seen regardless of the models used. The fact that from the time of the alleged Miracle of Helena, they moved from statements about shestidesyatiletie reduction in the number of heart attacks to discuss whether there is any effect or is he just too small to be reliably set, by itself, says how much lower everyone’s expectations. It’s like the old cigarette commercial “you’ve come a long way, baby!”


Fighters with Smoking often argue that the impact of cigarettes on health, arbitrarily small, arbitrarily justify extensive bans. If the importance and validity of the alleged health risks is irrelevant, bans on Smoking becomes easy to justify: Smoking the majority thinks Smoking is nasty and a little worried about the Smoking preferences of the minority. Establishing such low requirements, prohibitions provides a convenient basis for the further constraint propagation. The question, however, should be put differently: we must not only ask whether passive Smoking with any risks and how they are significant. If panicky statements of fighters with Smoking was fair, we would have reason to avoid passive Smoking like the plague. However, we know that these statements were exaggerated, so we should be asking is not stopped if adopted today, bans too far.


The number of heart attacks is not the only negative consequence of passive Smoking, although the majority believes the improvement in coronary health the main positive result of the bans. Perhaps the positive impact of bans on the respiratory health and, of course, reduce the chance of lung cancer, although the impact of passive Smoking on lung cancer is likely much lower than you might think. The report of the surgeon General, U.S., 2006 — the most reliable document on this issue — the risk of non-smokers regularly exposed to second-hand smoke, getting lung cancer is only 1.12-1.43 times more than that of not exposed to passive Smoking people. (For comparison, smokers themselves are at risk 12 times more than nonsmokers)


Not that it was very very slightly, but more recent research has led to even more surprising conclusions. “The obvious connection between passive Smoking and lung cancer could not be found” was the headline of a 2013 report published in the journal of the National cancer Institute, which is hardly a publication of the tobacco lovers. The report was based on the observation of 76 000 women in which the connection between disease and passive Smoking has not been established. This result coincides with the one already described in the scientific literature, leading us to the conclusion that the effects of passive Smoking how much only for those who are exposed to it for a long time.


Despite the growing amount of evidence that short-term exposure to passive Smoking is more a source of irritation than a threat to life, prohibitions on Smoking has spread widely and become part of the political everyday life. According to the latest report of the organization “Americans for non smokers rights” that publishes quarterly reports on the topic of smoke-free laws, more than 80% of the us population lives under the umbrella of Smoking bans, covering workplaces, restaurants or bars. In 3400 jurisdictions, Smoking is prohibited even on the streets, in such places as parks, beaches and stadiums. More than 400 cities and counties prohibit Smoking in eating on the street. More than 1,700 colleges turned into a Smoking-free territory. Almost 600 jurisdictions spread anti-tobacco laws to electronic cigarettes. Some jurisdictions make limited concessions for cigar and hookah bars, while the rest of them completely prohibit or restrict the ban only to institutions founded before the entry prohibitions.


Payment of these laws lies almost entirely on the shoulders of smokers, increasingly vulnerable minority populations. Their preferences are seldom taken care of. The exception is the article published in the journal “Sociology of health and illness” under “All seats are occupied”. This article stands out among the others by the sympathy with which the authors treated the victims of Smoking bans. They note that most devoted to tobacco research ignores the opinion of smokers, and this lack of interest in their views “suggests that the Smoking researchers are increasingly expected to support anti-Smoking campaigns”.


The article is based on interviews with a diverse sample of smokers in Vancouver, British Columbia. One of the common interview themes was the fact that Smoking is increasingly considered on a par with using illegal drugs. Smokers also report that the condemnation is directed not only on their behavior but applies to them personally. “Even if you can’t get how should it be formulated, you probably feel it unconsciously — the same as I feel is directed against them, discrimination against blacks and women,’ said one Respondent to the reporter. And even if you do not get to prove it in the Commission on human rights, you know that this is really happening”.


According to some of the fighters with the Smoking, this condemnation, is useful because it motivates smokers to quit Smoking. The authors are of this opinion with skepticism, noting that such condemnation may soon lead to feelings of helplessness. They come to the following conclusion:


“Participants in our study noted growing restrictions on their ability to smoke, and some of them indicated that legislative measures went much further protect non-smokers from exposure to passive Smoking, infringing on the right to smoke as such. Thus, although many of the respondents had nothing against limits in General, they noted that the marginalization of tobacco has led to the fact that all public places were “occupied” non-smokers, which made it impossible for Smoking in public without the condemnation of the other. It should be noted that the study participants complained not only on the Smoking-related stigma, but also open to censure and discrimination.


Experience smokers in Vancouver raises an important question about the ethics of the strategy of marginalization. Should the liberal state to participate in the persecution of its own citizens?


Early arguments in favor of Smoking bans at least in words was justified by the necessity of restrictions to protect the health of strangers. However, with the extension of the prohibitions even after their underlying views were refuted, it was clear that this justification was merely a polite lie, which replaced the non-smokers on the margins of society. The case was never limited to the fight for saving lives.


When exploring Helena followed him, such work had just been published, some scientists have noted a low probability of their results and shortcomings in methodology. Agreed with this, several journalists, including James salloum (Jacob Sallum), writing for Reason magazine (which includes me), and Christopher Snowdon (Snowdon Cristopher) in England. However, their criticism did not pay attention. Studies that have reported wonderful reduction in the number of heart attacks has hit the international headlines. When there were more worthy research refutes these results, they hardly flashed in the media. As Jonathan swift in a suitable to the case of the aphorism: “the Rumor is flying on the wings, though, limping, lagging behind the sun”. Too late to help exiled from the social life of the smokers.


From the very beginning was good reason to doubt that the Smoking bans will be able to bear the promised fruit, but of a group of fighters with Smoking readily accepted the spread of panic as a tool to influence public opinion. The modern movement for the suppression of tobacco are guided by ideology in the same way that science, and therefore tend to exaggerate confirming their point of view of the study, regardless of their actual merits, and to expose all who disagree are ostracized.


This has led to significant consequences for journalism. When writing about health journalists to take on such topics as bans on Smoking on the street, discrimination against smokers in hiring or adoption, as well as the deepening restrictions on Smoking electronic cigarettes, they should consider that no matter how good the intentions of the movements for the fight against tobacco, the willingness of participants of these movements to sacrifice valuable scientific evidence for the imposition of bans requires the most careful scrutiny.


With regard to the ban on Smoking, few people are ready to resume the battles of the last decade. It is unlikely that we will back in the days of Smoking in airplanes, waiting rooms of hospitals or in the corridors of the supermarkets. We recognize that withdrawal of social norms from the view that Smoking is allowed almost everywhere, — in General a positive phenomenon, even if this required more serious measures than would prefer some of us. However, the Smoking bans don’t necessarily have to go to extremes. Now they go further to protect people from the effects of regular passive Smoking.


You can cite several recent examples: the city Council in Washington passed a law limiting the use of electronic cigarettes, which emit vapor and chewing tobacco, which generally do not emit. In England the fighters for a healthy lifestyle require a ban on Smoking on the street, to protect children from the sight of Smoking people. “The contaminated… smokers body smokers emit toxins,” said Harvard researcher article Scientific American 2009, warning about the dangers of “indirect Smoking” when you are closer to clothing and hair of smokers. The authors Vox has reached the requirements of the Smoking ban in private homes. The list is endless. Is it any wonder that smokers feel stigmatized?


Although science really can justify, albeit imprecisely, the extent to which people may be allowed to smoke, exposing the wonderful improvements in the past decade, heart health should teach us to show restraint. Turn the clock back and allow Smoking without restrictions is impossible and perhaps undesirable, but the laws of a free society can address the rights and preferences of smokers and businessmen much better than they do now.


So relax the prohibitions on Smoking on the street. Let people smoke e-cigarettes. Allow capable adults to smoke in designated areas. This requires respect for the right to dispose of his body. After many years of reductions in the rights of smokers, it is time to return some of them back.


Disclosure: Nearly a decade ago, I worked at the Cato Institute at the time when he received donations from tobacco campaigns. In addition, during his career as a bartender, I was mixing cocktails for the event in 2016, organized the Diamond Crown. The work was unpaid, but in return, I received the humidor and cigars.