Sunday, June 27, 2010

Jace Smith's Misstatement in News-Leader

Dear Springfield City Council,

Jace Smith, director of Missouri State Advocacy for the American Heart Association, in his News-Leader June 26th op-ed, "Support Workplace Smoking ban in Springfield", cites a study published last October in Journal of the American College of Cardiology which found that smoking bans cut heart attack rates 17 percent in communities that impose them. But the Kansas University researchers who conducted that study now admit they made a mistake and have published a correction of their study in the Journal of the American College of Cardiology. The corrected rate of decline is 8 percent. Boston University researcher Dr. Michael Siegel points out that 8 percent is "a rate of decline not significantly different from the levels of decline in heart attacks that are being observed in the absence of smoking bans, which have varied between 5 percent and 10 percent per year in many communities."

Springfield Councilmen, smoking ban proponents in both St. Louis and Springfield argue that only strict smoking bans should be passed in order to cut heart attack rates. I wanted to let you know that the most comprehensive study yet conducted concerning the public health effects of smoking bans has found that smoking bans do not decrease mortality rates, hospital admissions orheart attack rates in communities that impose them. The study was conducted by researchers from the Rand Corporation, Stanford University, the University of Wisconsin and the Congressional Budget Office. The National Bureau of Economic Research has already circulated this study, CHANGES IN U.S. HOSPITALIZATION AND MORTALITY RATES FOLLOWING SMOKING BANS, as a working paper, and it will soon be published in a major medical journal. Please find this study attached.

The researchers summarize their study:

"U.S. state and local governments are increasingly restricting smoking in public places. This paper analyzes nationally representative databases, including the Nationwide Inpatient Sample, to compare short-term changes in mortality and hospitalization rates in smoking-restricted regions with control regions. In contrast with smaller regional studies, we find that workplace bans are not associated with statistically significant short-term declines in mortality or hospital admissions for myocardial infarction or other diseases. An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature."

I also want to alert you to the October publication of a major heart attack study in the European Journal of Epidemiology. The study also found no association between heart attacks and smoking bans. Please find this study, ON THE RELATIONSHIP BETWEEN SMOKING BANS AND INCIDENCE OF ACUTE MYOCARDIAL INFARCTION, attached to this e-mail. Dr. Michael Siegel of the Boston University School of Public Health says of this study:

"Importantly, this published study was not considered by the Institute of Medicine committee which reviewed this issue and released its report in October of last year. It was also not considered in published meta-analyses on this topic. Because of the high sample size of this study, it is likely that inclusion of this study in the previous meta-analyses would have negated their results."

Councilmen, when St. Louis City and County were considering a smoking ban last summer, we asked Dr. Geoffrey Kabat, PhD, Senior Epidemiologist at Department of Epidemiology and Population Health at the Albert Einstein College of Medicine, who conducted the largest secondhand smoke study ever done, completed too late to be included in Surgeon General Carmona's 2006 Report, to summarize his secondhand smoke research as it relates to smoking bans. Dr. Kabat wrote to the St. Louis County Council:

"Yet, since the available evidence suggests that the effects of environmental tobacco smoke, particularly for coronary heart disease, are considerably smaller than generally believed, lawmakers may therefore have greater latitude than generally believed to consider the segregation of smokers and nonsmokers and the use of air filtration as adequate and responsible ways to address the health concerns of ETS in workplaces such as bars and restaurants. If it is possible, through segregation of smokers and
nonsmokers and the use of air filtration, to reduce all components of environmental tobacco smoke in establishments where smoking is permitted to the level of the air in non-smoking establishments, there is reason to believe that any risk would be undetectable."

Bar owners across Missouri fear the 11 percent business loss experienced by bars in Columbia. The best science does seem to indicate that workplace smoking can be tolerated by lawmakers if proper ventilation and air filtration is in place.


Bill Hannegan