The myth of the smokefree health miracle

Spiked Online:

The evidence that bans on public smoking reduce the number of heart attacks is still woefully thin.

Recent reports of a ‘dramatic’ fall in the number of heart attacks in England after July 2007 represented the latest in a long line of attempts to find immediate health benefits from smoking bans. But a serious examination of this body of evidence suggests that the effect of smoking bans is either tiny or non-existent.

The worldwide search began in 2004, when the British Medical Journal reported a 40 per cent decline in ‘acute myocardial infarction’ (AMI), the medical term for heart attack, in the small town of Helena, Montana. Subsequent ‘heart miracles’ claimed drops in AMI of 47 per cent (Bowling Green, Ohio), 27 per cent (Pueblo, Colorado) and 17 per cent (Scotland).

As previously reported on spiked, the widely touted Scottish figure of 17 per cent was at odds with hospital admissions data showing an eight per cent drop in the first year of the ban followed by an eight per cent rise in the second year. When this inconclusive evidence is combined with hospital admissions data from Wales, Denmark, New Zealand and Australia showing smoking bans having no effect on the heart attack rate (1), the most striking aspect of this field of research is the tendency to find dramatic results in small communities and practically nonexistent effects over large populations.

The counterintuitive conclusion was that secondhand smoke was ferociously lethal in one-horse towns in the mid-West, but strangely benign in whole nations. The alternative, if more cynical, explanation was that obscure destinations like Helena and Bowling Green were brought to the world’s attention because anti-smoking campaigners had dredged the data for unusual blips that roughly coincided with provincial smoking bans.

That question seemed set to be resolved when The Sunday Times announced in September 2009 that the smoking ban in England (population 49million) ‘caused a fall in heart attack rates of about 10 per cent’. The source of this claim was never disclosed and the anti-smoking campaign Action on Smoking and Health (ASH) quickly downplayed it, insisting that the 10 per cent figure was ‘not based on any research conducted to date’ (2). Nevertheless, the research was underway and it finally bore fruit a fortnight ago in the form of another British Medical Journal study.

Led by Dr Anna Gilmore, a member of ASH and the director of the Tobacco Control Research Group, the study found a post-ban drop in AMI of not 10 per cent, let alone the 40 per cent found in Helena, but of just 4.3 per cent. A welcome decline, to be sure, but since the final years of ‘smoky’ England saw similar declines of 3.2 per cent and 5.2 per cent, the evidence for a heart miracle in the most populous nation yet studied was less than compelling (11)…

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