GLANTZ: The Helena Heart Study: We know we got the industry's attention

Author: Stanton A. Glantz

From: Stanton A. Glantz glantz@MEDICINE.UCSF.EDU

Subject: The Helena Heart Study: We know we got the industry's attention

Jacob Sullum, a "journalist" who is a long time industry apologist that specializes in attacking scientific studies on secondhand smoke has written a column attacking the Helena Heart study.

Since the arguments he makes are likely to come up from other industry apologists, it is worth presenting some answers:

1. The study is "small".

There were over 500 cases included in the analysis. While this is smaller than many epidemiological studies, the effect associated with the ordinance was strong enough to detect with a high level of confidence.

It is also important to note that there was an effect in Helena, but not for people living outside the Helena area. These two facts combine to increase the confidence we can have in the findings.

2. No one reported an effect like this in other places.

The reason we could see the effect in Helena is that it is isolated geographically and there is only one hospital involved, so the whole ordinance effect appears at one time in one place. In places like California, ordinances were introduced over many years, so the effects on heart disease will be "smeared out" over time. There are also many hospitals and people do not necessarily live and work in areas served by the same hospital.

In fact, heart disease deaths fell in California faster than the rest of the country as smokefree policies were put in to effect.

3. The effect is too large.

The individual risk of heart attack associated with passive smoking is about 30%, which is within the "margin or error" of the 60% drop we saw in Helena. In addition, when you make workplaces smokefree, many smokers quit or cut down, which reduces their risks of heart attack. (Indeed, it is this drop in cigarette consumption that motivates the industry to oppose smokefree measures.)

4. The effect is too fast.

Secondhand smoke compromises platelet activity, endothelial function, and energy processing in the heart within minutes. The effects on platelets and the endothelium are as large as seen in pack-a-day smokers.