August 19, 2011: We received an email a month or two ago from a guy in Wisconsin who said he owns a bar. He said he's on our side. He said his income went down as soon as the anti-freedom smoking ban was enacted in his state. He also suggested we might (or should, we can't remember) tone down our rhetoric. In our reply, we said, that suggesting folks tone down their rhetoric is a favorite tactic of the leftists and the no-smoke thugs in the United States to see their agenda come into being.

Here's how they fight: They know you'll try to counter them with a sense of decency and fair play, and honesty, and logic in debasing their not-true assertions. But they won't use the same, and they don't ever intend to. Their intent is to lull you quite covertly into believing they are decent people, when they're not. They won't tell you that though. And that's their trap: They don't represent themselves for what they are, that being authoritarian thugs. Not until it's too late anyway, and after their goals have been realized. Then they'll come out full-throttle. It's the same tactic all authoritarians and fascists have used in human history.

In other words, their game plan is to continue to deny common sense. Continue to marginalize and outlaw a bit more of freedom until people begin to believe it's useless to continue the fight. Get the masses to believe, via deceit and non-stop propoganda, that more people are against common sense and freedom than not, and that your beliefs will only result in your demise. And then the fight will be over. They will have won. It's ok by them for you to live your life in misery and shame. We saw it years ago.

In other words, truth and honesty have not ever been a part of their play books. All that's important with the no-smoke slobs is the almighty "Cause." They've lost perspective. They're out of control. They're addicted to drama. Freedom? Liberty? Personal ownership? They are acceptable casualties in the minds of the no-smoke zealots. And somehow, in their minds, if people refuse to back down from them and use terms such as "slob," or "un-American," or "nazi," or "fascist," in describing the no-smoke zealots in an honest manner, we're somehow unfair or over-the-top? See how it works?

It's all quite simple. And we have to admit it's a brilliant strategy even thou it's also dishonest and repugnant. Hitler & Stalin used the same.

Don't doubt it for a second: The no-smoke zealots in the United States will use any means to see their anti-freedom, un-American agenda come into being enforced nationwide. They know they're divisive, but they don't care. That's bad for all of us. And they don't stop. They've found allies in nearly every sector of American society, be it private citizens and industry, and in government. It's all quite terrifying. But unfortunately for them, the desire and yearning for freedom runs wild in the veins of most Americans. The no-smoke thugs don't have the power to change that. Nor do they have the power to deny the human desire to live free. They never will.

So the short reply is, everything written above set aside: We won't back down or tone down our "rhetoric." The best societies are borne out of freedom. The best thinking, the best writing, the best music, the best science and technology, the most content societies originate from freedom. It's worth fighting for.

          Aside: It's not fun doing this, updating this website and calling people out. We don't like it. It's a pain. We don't like being angry, nor do
          we have a need to be paid attention to. We don't get off on drama. Never have. That's not what this website is about. We want the no-
          smoke zealots to leave people alone and stay out of other peoples lives. Period. Seems a simple request, right? When that happens, this
          website will go down and we'll all start getting along again. Our neighbors who don't like smoking will have parties and request we don't
          smoke. No problem there. It's their property. If we want to invite the neighbors over and light up a ciggie or a pipe or cigar? They don't
          have to come. Their free choice. We applaud it. We only want common sense and freedom to prevail. So until the no-smoke
          zealots get a grip and regain a sense of composure and perspective, we're not going to stop. It's a matter of dignity. We resent having
          to take the time to keep this site updated. We wish it wasn't needed. But that's where we find ourselves today. In America.

Until sometime April, 2010, the article pasted below was shown on www.HawaiiSmokersAlliance.com   The site is down now, and typing in the URL leads to a pharmacy site. Hopefully the Hawaii site will come back up. It was one of the best on the internet.

                                                         Hawaii Department of Health debacle

The Hawaii Smokers Alliance is very pleased by the admission of the State Department of Health that “there is no evidence that partially enclosed restaurants/bars had any dangerous level of particulate matter either before or after the law”. Also that an enclosed bar with its doors open had lower PM levels than a partially enclosed bar near and intersection. What is extremely astonishing to us all are two main factors:
1) Why did the department of Health stand by an impact study that claimed no financially harm to an industry when this very report shows that after the law took effect, the patron levels had dropped in all but one location from anywhere between 2 to 85%? If that is not inarguable and undeniable proof of a negative economic impact, then what else would you call it
2) Why do the minions at the Department of Health continue to demand any outdoor or partially enclosed space regulation of Tobacco consumption?
FACT: Partially enclosed restaurants/bars were all well below the EPA’s 24 hour average limit both before and after the law.
FACT: A bar with its doors open has lower PM (Particulate Matter) levels the a partially enclosed bar near an intersection.
FACT: Any partially enclosed or outdoor restrictions on smoking are superfluous and or just plainly discriminatory in nature.

Their study just proved that point.
FACT: Even their touted 90% drop in PM is laughable as the highest reading they were able to get were only at the 18% level of acceptable PM exposure as defined by the standards of OSHA (The occupational Safety and Health Administration) so even the enclosed spaces are well within acceptable guidelines and deemed to be a safe working environment.
FACT: Customer numbers are down severely. Where are all the promised non-smokers who swore they only stayed away from these venues because of the smoking?
FACT: Liquor revenue is down enormously. Oh sure sales are up at 7-11 and Costco, but the adult venue revenue tanked a whopping $47 million dollars in 2007 alone.
FACT: This study is biased in nature due to the participant’s well documented personal aversion to tobacco use in general. They tried stacking the deck and fell flat on their faces... Good work CFTFH, DOH...
FACT: No other businesses were included in this study, we suggest they do the same indoor air quality check at Camelia Buffet, HY’s Steak House or Ruth’s Chris and see where their PM levels come in.

Article below appears at www.jacobgrier.com, dated April 9, 2009.

A smoking ban study you won’t see in the news

by Jacob Grier on April 9, 2009

Michael Siegel takes note of a new study [pdf] examining the effects of smoking bans on heart attacks. Published by RAND, the CBO, the University of Wisconsin, and Stanford, the study examines much larger data sets than previous research. I can’t access the full paper so I’m going off of Siegel’s summary. (If anyone has it, please send. Update: I have it now, thanks.) Here is what the authors find:

1. “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.”

2. “An analysis simulating smaller studies using subsamples reveals that large short-term increases in myocardial infarction incidence following a workplace ban are as common as the large decreases reported in the published literature.”

Siegel puts this study’s methodological superiority into perspective:

To give you an idea of the scope of this study compared to previous ones, the Helena study involved a total of 304 heart attack admissions in one community over a period of six months. This study examined a total of 217,023 heart attack admissions and 2.0 million heart attack deaths in 468 counties in all 50 states over an eight-year period.

The authors on how publication bias favors pro-ban results:

We also show that there is wide year-to-year variation in myocardial infarction death and admission rates even in large regions such as counties and hospital catchment areas. Comparisons of small samples (which represent subsamples of our data and are similar to the samples used in the previous published literature) might have led to atypical findings. It is also possible that comparisons showing increases in cardiovascular events after a smoking ban were not submitted for publication because the results were considered implausible. Hence, the true distribution from single regions would include both increases and decreases in events and a mean close to zero, while the published record would show only decreases in events. Thus, publication bias could plausibly explain why dramatic short-term public health improvements were seen in prior studies of smoking bans.

In January uncritical reporters breathlessly spread the news of a study in the small town of Pueblo, CO, that found a 40% reduction in heart attacks over three years following the imposition of a smoking ban. We can expect equally fervent coverage of this new study debunking that claim, right? Right?

I explained the myriad flaws in the Pueblo study in this post. So simple, even a New York Times reporter could understand it!

Lazy reporting and the Pueblo ban study

by Jacob Grier on January 3, 2009

The Centers for Disease Control have issued a new report about the impact of the smoking ban in Pueblo, Colorado. The study has the media breathlessly repeating claims that the ban dramatically saves lives. “A smoking ban caused heart attacks to drop by more than 40 percent in one U.S. city and the decrease lasted three years, federal health experts reported Wednesday,” writes Reuters reporter Maggie Fox, who doesn’t bother quoting any dissenting sources. Mary Engle at the LA Times health blog says uncritically that whatever the mechanism behind the fall in heart attacks, “Pueblo’s smoking ban can take the credit.” Bill Scanlon at the Rocky Mountain News throws science to the wind and extrapolates that Colorado will see a statewide “sharp decline” in heart attacks in 2009 — more than two years after its ban went into effect.

I realize times are tough in newsrooms, but there’s no excuse for such biased, lazy reporting. Journalists should treat the claims of ideologically driven anti-smoking groups with just as much skepticism as they would junk science coming from big tobacco companies.

Since the CDC’s report is going to be cited constantly by smoking ban advocates it’s worth taking a look at its methodology and limitations. Fortunately it’s straightforward enough that any moderately intelligent person can understand it. The following is my layman’s reading of the results, with the caveat that I’m approaching this without formal training. Nonetheless, it’s clear that one shouldn’t take this study’s conclusions at face value. Its use by anti-smoking groups, researchers, and the press to promote smoking bans is a case study in the abuse of science for political ends.

The study examines rates of heart attacks (acute myocardial infarctions, “AMI” for short) in three areas: the city limits of Pueblo, which implemented a smoking ban in bars and restaurants, and the unincorporated parts of Pueblo County and all of El Paso County, which did not have smoking bans. The researchers compare the rates in the 18 months prior to the ban’s implementation on July 1, 2003 (pre-implementation), and the two 18 month periods in which the ban has been in effect (Phases I and II). The researchers estimate the impact of the smoking ban by comparing the rate of AMI in Pueblo to the control areas. On the surface, the results are striking:

The rate of AMI hospitalizations for city residents decreased 27%, from 257 per 100,000 person-years during the 18 months before the ordinance’s implementation to 187 during the 18 months after it (the Phase I post-implementation period).* This report extends that analysis for an additional 18 months through June 30, 2006 (the Phase II post-implementation period). The rate of AMI hospitalizations among city residents continued to decrease to 152 per 100,000 person-years, a decline of 19% and 41% from the Phase I post-implementation and pre-implementation period, respectively. No significant changes were observed in two comparison areas.

That’s a huge impact. If smoking bans really do reduce heart attacks by 41% in just three years, even ardent libertarians might be tempted to support them. But before we do that, let’s look at two obvious questions. The first is whether this reduction occurs because non-smokers are no longer exposed to secondhand smoke or because smokers light up less frequently or even quit entirely due to the inconvenience. The second is whether the effect is truly that large or if it’s exaggerated by problems with the sample.

Let’s start with the question of who benefits from the ban. The authors of the report write:

These findings suggest that smoke-free policies can result in reductions in AMI hospitalizations that are sustained over a 3-year period and that these policies are important in preventing morbidity and mortality associated with heart disease. This effect likely is mediated through reduced SHS exposure among nonsmokers and reduced smoking, with the former making the larger contribution.

The authors do not have a good basis for claiming that non-smokers are the primary beneficiaries. Their data do not track the smoking status of AMI patients. Nor do they rigorously control for secondhand smoke exposure; city residents could be working or socializing in smoking bars outside the city limits and vice-versa, or residents within the ban area could be smoking more in their homes. At best, the distribution of reduced heart attacks is a matter of speculation based on other studies. You don’t have to take my word on this. The CDC’s own editorial accompanying the report states:

Smoke-free policies have been found to prompt some smokers to quit smoking (1); because active smoking is a major risk factor for heart disease and AMI, this effect also would be expected to reduce heart disease and AMI rates at a population level… [Because] no data were available on whether study subjects were nonsmokers or smokers, determining what portion of the observed decrease in hospitalizations was attributable to reduced SHS exposure among nonsmokers and what portion was attributable to increased quitting among smokers was not possible.

This is the least of the study’s problems. Let’s talk now about its samples. The trend within the city of Pueblo is based on just three study periods.* To know if the declines in the two post-ban periods are meaningful we have to know if the AMI rate in the pre-implementation period is normal. If those 18 months just happened to have an abnormally high number of heart attacks due to chance variation, then the decline in the two following periods might be a figment of the data. To conclude that the decline is real the authors would have to look at multiple periods before the ban. At the very least they would have to go back beyond 18 months. Failing that, they should examine AMI rates in similarly sized towns to see how much random variance to reasonably expect. They don’t gather any of this data.

I don’t have that data either, but I do have the study’s own comparison of rates within the three geographic areas. Here’s the handy graph presenting them:

Pueblo smoking ban study

Notice anything? The first bar, representing the city of Pueblo’s pre-ban rate of AMI, is freakishly higher than all the others. Maybe that was normal for Pueblo. Maybe that time period was a particularly bad year for heart attacks. Based on the data in this study, we simply don’t know.

Look also at the changes between Phases I and II. Within the city the number of heart attacks falls from 291 to 237, a change of 18.6% that the study authors credit to the smoking ban. Within the county, heart attacks rise from 76 to 92, a change of 21%. If random variance in a control group is larger than variance in the sample, that’s a problem for the study. It suggests that the large effect touted by the researchers could plausibly be due at least in part to random variation. That’s why samples based on short time frames and small populations need to be taken with very big grains of salt. (The county sample is smaller than that of the city, but this much random variance should still be of concern.)

The only reason the authors can claim the Phase II decline is significant is because the pre-implementation rate of AMI in Pueblo is so high. But again, we have no idea if that rate is an outlier or not. Nor do we have a good explanation for why the initial decline continued. The CDC’s editorial states:

The continued decrease in AMI hospitalizations observed in this study might be a result of a combination of 1) the immediate reduction in SHS exposure among nonsmokers that occurred when the city of Pueblo smoke-free ordinance was implemented, 2) further reductions in this exposure that occurred because of increased compliance with the ordinance and increased adoption of smoke-free home rules over time, and 3) increased quitting among smokers as a result of the ordinance and associated changes in social norms.

That’s true, it might. But the study provides no evidence that non-compliance was ever a problem or that patterns of smoking at home changed. These are purely ad hoc explanations. The decline might just be random.

Notice too that the rate of heart attacks in the city is higher than the rate in the control groups even three years after the ban has been in effect. Does this mean that if Pueblo County and El Paso County implemented smoking bans (which, thanks to the state legislature, they have), then 3 years later their AMI rates would also fall by 41%? Is there something about the residents in the city of Pueblo that, all else equal, makes their hearts seize up at nearly twice the rate as residents of nearby areas? It seems more likely that those first 18 months in Pueblo just happened to be an outlier period.

To test the accuracy of the control group we can also look at state data as a whole, as Michael Siegel did in his similar critique of the original Pueblo study. The authors claim that their data show no existing trend toward declining heart attacks, but the much larger sample of statewide data suggests that a downward trend does exist. If their small control groups don’t pick up the statewide trend that we suspect is happening, then they need to consider the possibility that their control groups are too small. Similarly, they have to consider that part of the decline in Pueblo might be explained by existing trends.

We can also ask why we hear so much about health miracles in Pueblo, CO, Helena, MT and other small towns, but not in California, New York, Washington, or other large populations that have lived under comprehensive smoking bans for many years. If we could really expect smoking bans to reduce heart attacks by 41%, wouldn’t we have noticed the effect on millions of people by now?

None of this means that smoking bans don’t reduce the rate of heart attacks. Given what we know about tobacco and smoking behavior, it would be surprising if they didn’t. But, as they say in the diet plan commercials, Pueblo’s results may not be typical. This study does not show conclusively that Pueblo’s smoking ban is responsible for the drastic reductions, that the primary reduction in heart attacks accrued to non-smokers, or that other jurisdictions should expect similar declines. It is at best suggestive. Further studies based on larger populations are necessary to accurately gauge the effects and it appears so far that they are not nearly as large as implied here.

The study itself is not terrible. It’s not particularly good either. The real problem is its abuse by lazy reporters and ideologically driven anti-smoking organizations, which the researchers seem all too happy to abet. Given that the study’s conclusions will inevitably be used to restrict smokers’ and business owners’ rights, all of these groups have an obligation to act more responsibly.

Update 1/5/08: Michael Siegel is back from vacation and has posted his own critique of the study. We cover much of the same ground, but there’s one key finding I missed:

…this is exactly what this study does: it knowingly uses a comparison county in which it has been documented that the smoking prevalence over the study period has increased from 17.4% to 22.3%.

The study doesn’t try to hide this fact. It openly acknowledges that the reported smoking prevalence in El Paso County (the comparison group) increased from 17.4% in 2002-2003 to 22.3% in 2004-2005.

Given this finding, El Paso County simply cannot be used as a comparison population. You can’t take a population in which you know that smoking prevalence increased substantially and “pretend” that it represents a reasonable area in which to evaluate the baseline secular trends in heart attack admission rates that would have occurred in the smoking ban city in the absence of the smoking ban.

Siegel also notes that heart attack rates in Colorado and nationally dropped significantly during the study period, further casting doubt on the quality of the control groups. Whole thing here.

*Edited 1/4/09

I assume you saw this:

http://www.nytimes.com/2009/01/03/health/researc

Article shown at: http://antirust.typepad.com/my_weblog/2006/12/the_agony_of_an.html

The Agony of an Honest Anti-Tobacco Activist

Dr. Michael Siegel has spent his entire career warning about the dangers of tobacco, and a great deal of effort supporting anti-tobacco measures such as smoking bans in bars and restaurants. I disagree with him about a lot of things, but even he has finally come to terms with an uncomfortable reality: his "side" of the debate has given up any and all claims to the scientific high-ground in favor of overblown fear-mongering. Check out this devastating analysis:

By virtue of the widespread, coordinated, and intentional deceptive, misleading, and inaccurate statements being made by anti-smoking groups about the health effects of secondhand smoke, I believe that the tobacco control movement has unfortunately given up the scientific high ground that it previously could argue that it held above its opponents.

And this, I feel, is a great loss.

We used to be able to say, at the very least, that we had the science on our side. We used to be able to say that we had honesty, accuracy, and the truth on our side. We used to be able to say that while our opponents were cherry-picking data, misrepresenting or exaggerating the science, and misleading or deceiving the public by spinning scientific information in a favorable way, we were the carriers of the wholesome, unadulterated truth. ...

This has uncomfortably put me in an awkward position. I have to argue that on the one hand, secondhand smoke is hazardous and that a lot of what the anti-smoking groups are telling the public is true. But I also have to argue, on the other hand, that secondhand smoke is not as hazardous as we are saying it is, and that a lot of what the anti-smoking groups are telling the public is not true.

But this is where things get really interesting for me:

To anti-smoking advocates, there is no middle ground. By virtue of who we are, and by virtue of who the tobacco companies are, everything we say must be correct and everything they or their allies say must be wrong. To align oneself with a position that runs counter to the anti-smoking one, no matter how extreme, is tantamount to working for the tobacco industry. It automatically makes you a tobacco stooge, or at least a tobacco sympathizer. You have officially and irredeemably crossed over to the "dark side."

Sound familiar? It ought to if you read the Post-Gazette:

June 29, 2006: Lawmakers in Pennsylvania have too long listened to the bellyaching of restaurant and bar owners who contended they'd lose business if legislation prohibited them from exposing waitresses and child customers to toxic secondhand smoke. The legislators need to stop kissing the feet of these businessmen and tobacco lobbyists and focus on two points made by the surgeon general.

October 1, 2006: More important, it is immoral to contend that profits trump workers' health. The only thing dirtier than the cigarette smoke in this situation is the politics.

August 21, 2006: Did Dr. Carmona's bold stand get him fired? We wouldn't be surprised. After all, the business interests hard at work against real smoking bans are the same businesses routinely found on President Bush's list of influential campaign contributors.

June 8, 2006: Ten state representatives turned their backs on their Democratic roots this week, supporting the cigarette industry and businesses such as bars instead of defending the health of Pennsylvanians. ... It means 10 Democrats chose big business over the health of the state's residents. They chose the cigarette industry and restaurant lobby over Rep. Katie True, a Lancaster Republican, supporter of the bill and cancer survivor. It's one year for her this month.

This goes on and on and on and on. Anyone who opposes the ban is a lackey. A stooge. A pawn of Big Tobacco. A dishonest hack. On the take.

At least Dr. Siegel can see through that deception. Too bad one of America's "Great Newspapers" can't be as honest as a public health expert who actually agrees with them.