Tuesday, October 20, 2009

Smoking bans, heart attacks & scientific fraud

“Smoking ban benefits come swiftly,” read the headline, “A new study at Kansas University found that smoking bans reduce the number of heart attacks each year by as much as 26 percent.”

But as noted in a previous blog, that “scientific study” by Dr. David Meyers at Kanas University was, er . . . somewhat less than credible. In that blog post, I quoted Dr. Michael Siegel of Boston University School of Public Health: “The rest of the story is that anti-tobacco researchers and groups are making ridiculous, highly exaggerated, and scientifically unsupported claims in order to try to justify smoking bans.”

That's tough talk from an anti-smoking advocate like Dr. Siegel. In fact, some people might refer to studies such as Meyers' as unequivocal scientific fraud and propaganda.

Then, on October 15, Siegel reported some serious misgivings with a new report on the same subject matter; this time from a committee of experts at the Institute of Medicine (IOM) in the US. In that article, he asserts that the conclusions reached by the experts contradicted the contents of the report itself; noting that most of the studies looked at by the committee were not only badly flawed, but that the committee was aware of the flaws.

Said Dr. Siegel: “The committee recognizes that the existing studies are so seriously flawed that one has no confidence in being able to judge the effect size. But, instead of concluding that the evidence is insufficient, they go ahead and conclude that smoking bans significantly reduce heart attacks anyway.”

What the committee did, in fact, was draw conclusions which were not supported by the evidence. And, what was even more egregious, they distributed their unwarranted assertions to the public as fact.

Staunch anti-smoking advocate that he is, Siegel stopped short of criticizing the committee of experts: “Finally, I want to make it very clear that I am not impugning the integrity of the committee or any of its members. I don't think they've done anything wrong. I just think that the report is biased and that subconsciously, there was some sort of pressure operating which led to the report drawing conclusions that were not appropriate given the report's own assertions and review of the evidence.”

So, the report issued by the IOM was biased, drew inappropriate conclusions and misled the public, but the experts who compiled the report did nothing wrong? The disingenuous report was merely the result of some unstated, subconscious pressure being exerted by some unidentified force. I wonder what a deliberate attempt to mislead would look like?

On October 16, Siegel commented on the subject again, noting that the IOM report failed to include data that found no effect of smoking bans on acute coronary events in three countries; England, Scotland and Wales. In other words they ignored data which was contrary to the unsupported conclusions of the committee.

Said Siegel: “These data are all national data which include all hospital admissions at all hospitals in these countries. Thus, they represent a better source of data than what was used in some of the published studies (which only included a sample of hospitals). Moreover, they cover large populations, with a sample size greater than that of all other studies combined. Thus, the data from these countries are critically important and carry much weight in the overall analysis.”

An oversight perhaps? The committee could hardly be expected to be aware of unpublished studies, especially if they failed to make the morning news. And, that's essentially what the IOM committee claimed in their report: “"no such (unpublished) studies were identified."

Unfortunately, those studies did make the news; big time. And then there's this from Dr. Siegel: ”I find this difficult to believe, especially since I was a reviewer of the report and I made the committee aware of several unpublished analyses which documented no significant effect of smoking bans on heart attacks.“

Whoops. Nothing like a little inside information to set the record straight.

One of the most definitive studies to date, an NBER (National Bureau of Economic Research) working paper, “Changes in US Hospitalization and Mortality Rates following Smoking Bans,” found no statistical evidence that smoking bans reduced heart attacks. “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.”

This study was also ignored in the IOM report.

But then, presenting both sides of the argument might have detracted from the anti-smoker message.

How could the experts at the Institute of Medicine ignore all the contradictory data and conclude that smoking bans result in fewer heart attacks? How could a committee of experts acknowledge that they couldn't confirm the extent of any positive effect from smoking bans, yet insist that the effect exists nonetheless? Why the compulsion to manipulate scientific studies and data to score political points? Is this what science has become: an exercise in political propaganda devoid of honesty?

Could it be that science has become subordinate to the anti-smoker crusade in the Orwellian world of tobacco control? More and more, it seems, scientific integrity is being sacrificed to further the cause of smoker denormalization. Bullshit and bafflegab are the order of the day.

It's unfortunate. Science and medicine were once such noble professions.

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