Hospital Admissions FAQ
Q: Would longer term absence of ETS after bans take effect ultimately cause heart attack declines? Was the time frame studied in both your study and the Helena study to short to really examine the health impact of smoking bans?
A: The only answer I've been able to come up with is that if the claim that ETS causes 35,000 heart attack deaths annually is true today, ETS must have been causing about 350,000 heart attack deaths annually, in the 1970s. This is because the best estimates are that population exposure to ETS has declined about 90% since the 1970s. However, I think if ETS were causing 350,000 heart attack deaths/year in the 1970s, it would be apparent simply by examining today's death tables compared to 1970s. Occurrence rates of heart attacks were about the same in the 1970s, as today.
Don't forget, about half of heart attacks are survived. If ETS causes 35,000 deaths/year now, it must be causing about 70,000 heart attacks. Then in the 1970s, ETS must have been causing 700,000 heart attacks/year. This number would explain nearly all annual heart attacks in the 1970s. It seems implausible to me that all 1970s heart attacks could be caused by ETS, because remember, twice as many of us smoked, and that should have been causing twice as many heart attacks among first-hand smokers. Add up the supposed 700,000 heart attacks from ETS, and the supposed 1,600,000 or so heart attacks from first-hand smoking, and the number clearly exceeds any actual possibility, based on the actual number of heart attacks the records reported, by a large margin.
Back to Helena and Pueblo, if the claim is true their bar and restaurant smoking bans caused a 30% decline in heart attacks, then how much heart attack decline should we have expected due to the voluntary adoption of nonsmoking policies in many of Helena and Pueblo's restaurants over the previous ten years before the mandatory bans? In addition, if many of Helena and Pueblo's nonpublic businesses adopted voluntary nonsmoking policies prior to the bar and restaurant bans, shouldn't we have expected substantial heart attack declines due to these policies? After all, exposed persons spend about 40 hours/week at work, and maybe most only spend 2 to 4 hours/week in bars and restaurants. I would think, if bar and restaurant smoking bans in Helena and Pueblo caused a 30% decline in heart attacks, then the combination of voluntary nonsmoking policies in nonpublic workplaces and many restaurants would have caused over a 100% decline in heart attacks, prior to the enactment of the bans. In summary if the proclaimed effect of smoking bans were real, nearly all heart attacks would have been eliminated in Helena and Pueblo before the bans were even enacted, and few would have occurred post ban to study in the Helena and Pueblo reports.
This approach, of course, is a very rough estimate, subject to variations due to many changes in other possible public health risk factors and treatment procedures which have also changed over the last 30 years. But it has to leave one wondering... How could the ETS risk factor which has almost disappeared still be causing 35,000 heart attack deaths annually?
David W. Kuneman