Where There's Smoke, By Sally Satel, MD.
                  May 7, 2004, The Wall Street   Journal, Page A16
                  Activists have rushed to embrace a new study that seems to prove, at long   last, that secondhand smoke is life-threatening. The British Medical Journal   reported that after a smoking ban in Helena, Montana, the heart-attack rate   dropped by almost half. In an accompanying editorial, researchers from the   Centers for Disease Control heralded the finding. And that prompted the   Washington Post to blare, "Second Hand Smoke Poses Heart Attack Risk, Warns the   CDC."  
                     In truth, the study is woefully unreliable; but its compatibility with   widespread anti-tobacco animus gave it status as "fact." Meanwhile, other solid   data that tobacco products can improve the health of smokers go largely ignored.  
                     In June 2002, Helena banned puffing in public places. The prohibition was   overturned in December. In the six months it was in effect, there were four   heart attacks per month. From June to December of the pre-ban years, the rate   was about seven per month. After December 2002, when the ban was lifted, the   monthly average jumped back to seven in June-December 2003.  
                     The study has the ring of plausibility. We know that in the laboratory,   components of cigarette smoke can cause blood clotting and damage to the lining   of blood vessels.   
                     But the drop in Helena heart attacks was too dramatic to be explained by   reduced exposure to environmental smoke. The reason is that airborne smoke has   been shown to have only a weak relationship to heart disease. Moreover, it is   difficult to draw meaningful inferences from just a handful of adverse events   like heart attacks in a small town over just a half-year.  
                     Still, it would be worth replicating these observations on a much larger   scale -- in New York or LA. My guess is that a big-city study would not show   such a massive decline in heart attacks. If smoking bans produced such a rapid   fall, wouldn't we have noticed by now? With secondhand smoke having declined 75%   between the early '90s and 1999, why didn't the national heart-attack rate   plummet as it did in Helena?  
                     The stampede to embrace the flimsy Helena study provides an illustration of   the double standard surrounding scientific evidence about tobacco. One striking   example concerns the virtues of smokeless tobacco. Smokers can dramatically   reduce health risks by switching to smokeless products. Consider a Swedish   experience: Although 40% of men in Sweden use tobacco products, Swedes have the   lowest rate of lung cancer in the EU. Why? Largely because of moist snuff (or   snus), which represents half of all the tobacco that Swedish men use. (The other   half smoke.) Risks of mouth cancer, depending on the smokeless product used,   range from negligible (with snus) to half the risk associated with smoking, for   products like chewing-tobacco.  
                     Compare this level of evidence with the study from Helena. Yet anti-smoking   advocates embrace that idiosyncratic study while rejecting the growing   scientific consensus -- based on replicated, large-scale studies -- that   smokeless tobacco can be an effective strategy for harm reduction. A researcher   at the National Cancer Institute wrote that "we know little" about "transition   to other tobacco products (such as smokeless tobacco) as methods for reducing   cancer risk." The surgeon general told Congress that "there is no significant   scientific evidence that suggests smokeless tobacco is a safer alternative to   cigarettes." Both are patently false.  
                     Assuming that steering people toward better health is the goal here, we need   a clear-eyed view of the data -- not a wishful guide to policy that overlooks   strong evidence.  
                     Dr. Satel is a resident scholar at the American Enterprise Institute.   |