Monday, August 4, 2008

I'm A Bit Skeptical

I'm A Bit Skeptical

The July 30, 2008 USA Today reports on an experiment in public health:
Scotland's smoking ban appears to have prevented hundreds of heart attacks in its first year, a study shows.
The number of people admitted to the hospital for heart attacks fell by 17% in the year after Scotland's smoking ban took effect in March 2006, according to a study in today's New England Journal of Medicine.
The study's author, Jill Pell of the University of Glasgow, says the size of the decline strongly suggests it was the smoke-free law and not some other trend or lifestyle change that prevented the heart attacks.
In the decade before the law was in place, heart attack admissions fell by an average of about 3% a year. And heart attacks fell by 4% in the same period in neighboring England, whose smoking ban took effect in July 2007.
Tobacco smoke causes immediate damage to blood vessels, increasing the risk of clots, Pell says, adding the law may protect non-smokers the most. Two-thirds of the decline in heart attacks were in non-smokers.
The ban on smoking indoors helped smokers, too, because it reduced their opportunities to smoke and spurred many to quit, Pell says.
And the law, which bars smoking in all enclosed public places, may keep many people from taking up the habit.
"This really demonstrates that smoke-free laws work," says Tom Glynn of the American Cancer Society. "They reduce disease and save money" in hospital costs.
Smoke-free laws also protect people from cancer, although it can take longer for cancer rates to drop, Glynn says.
Lung cancer rates in California, which began raising tobacco taxes in 1988 and banned indoor smoking in most workplaces in 1995, have been falling three times faster than rates in the rest of the country.
Glynn says the new study was "virtually flawless."
First of all, let me emphasize that I find smoking a vile habit. Only chewing tobacco makes smoking look sophisticated. (I was eating outside at a restaurant recently, and there were several businesswomen wearing power suits, trying to look sophisticated, while smoking cigars. Bizarre.)

Secondly, I am not at all comfortable with the liberal enthusiasm for exercising unlimited governmental power over all personal habits--with the notable exception of sex, where liberals believe that even governmental disapproval is legally wrong, and use of governmental power to stop public sex is equivalent to concentration camps.

I do find the connection that they are drawing here plausible--that making smoking in enclosed public places illegal might have reduced the number of heart attacks. What I find a little curious is that 2/3 of the decline in heart attacks supposedly caused by the new law were in non-smokers.

It is certainly plausible that secondary smoke (especially in enclosed public places) might have been causing heart attacks in non-smokers. But I would expect that smoking would be more dangerous to smokers than non-smokers--just because the smoker's exposure is far higher and more direct. According to this 2003 data, 31% of Scots smoke. Yet the non-smokers received just about as much benefit in heart attack reduction as the smokers! (The non-smoker decline was 66.6%, yet they are 69% of the population.)

What this says is that tobacco smoke is only slightly less dangerous to people that are simply in the same room than it is to people that are actively inhaling. Does anyone besides me find this implausible?

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