A Study Delayed: Helena, MT's Smoking Ban and the Heart Attack Study
By Michael J. McFadden and David W. Kuneman
Near the end of 2005, we (David W. Kuneman, a retired pharmaceutical chemist, and Michael J. McFadden, author of Dissecting Antismokers' Brains) and the SmokersClubInc. Newsletter issued a press release and published the outline and results of a study (1) that should have made media headlines around the world while bringing the juggernaut of smoking bans, if not to a crashing halt, at least to a stumble.
Using a database of fully verifiable public data and covering a subject base literally 1,000 times as large as that covered by a previous and heavily publicized study in Helena, Montana (2), the new study showed clearly that claims -- ostensibly bolstered by that Helena study -- of drastic and instant reductions in heart attacks upon the implementation of smoking bans simply do not occur in larger populations. Such a result should have rocked both the media and medical worlds. Thousands of news stories, expert statements, and legislative testimonies based upon the Helena results had resulted in profound lifestyle and economic impacts upon the lives of tens of millions of people and had now been found to be in grievous error.
Instead, the study's announcement was greeted with virtual media silence.
A Journal Uninterested in Correcting the Record
Then we realized that a "medical study" not critical of smoking, even one carefully done and based upon open and sound data and analysis, would simply not be considered newsworthy unless it was endorsed by prominent medical and antismoking organizations or presented in the pages of an authoritative peer-reviewed medical journal.
It was at that point that Mr. Kuneman and I set out to formalize our findings for proper submission to the British Medical Journal, the home of the "Great Helena Heart Miracle" study. We were confident that our research would be considered dispassionately and that the journal that had served as a worldwide podium for the earlier limited and misleading study would support the publication of a corrective piece.
We were sorely disappointed. We submitted our study on April 22nd and received a rejection without the possibility of a rewrite or resubmission almost eleven weeks later on July 6th. An "appeal" of the rejection consisted of a review by a single editor who concurred with the initial rejection.
The primary reason given for the rejection was this: "Our main problem with the paper was that we did not think it added enough, for general readers, to what is already known about smoking and health." This statement was made despite the fact that a Google search on Helena smoking study produces over 400,000 hits and despite the fact that our results were clearly and diametrically opposed to the results of that study.
The rejection went on to note that the Helena study had "been pretty roundly criticised already" and then amazingly suggested that we simply post our study as a Rapid Response. If we had been truly naive, we might actually have believed that such a posting would carry as much weight in the medical and political world as a fully published peer-reviewed study.
The Helena Notion Spreads, Largely Unopposed
We politely declined and resubmitted our study to the journal Circulation in December of 2006. We chose Circulation, since it had just published a study similar to Helena's but based in Pueblo, CO. (3)
Oddly, the Pueblo authors emulated Helena's in refusing to provide a separate analysis of heart attacks in nonsmokers. As with Helena, this lack left the authors, media, and antismoking organizations free to infer that not only did the smoking ban "cause" a decline in heart attacks among smokers but that it also "caused" a reduction among nonsmokers. This research decision seemed particularly odd, since the Pueblo authors had conferred with their Helena counterparts and had to be quite aware that this deficiency in Helena had been strongly criticized in the BMJ's Rapid Responses. Such neglect seemed deliberately designed to create a "desirable" political impression that would simply not be supported by the scientific data.
In the face of such a seemingly egregious breach of research ethics, Dave and I believed that Circulation might be more concerned about setting the record straight than the BMJ had been.
We were wrong. Although this time our paper was dealt with in a timely manner, it was again rejected without a possibility for improvement or resubmission, and in this instance we were not even offered the full comments made by our lone and unidentified peer-reviewer but merely an edited summary.
Nonetheless we forged forward, once again re-examining our paper in light of that summary, and submitted it to a journal we thought might feel a particular sense of responsibility in this area: Tobacco Control. Tobacco Control is a journal formally committed to a fully open review process and, as in the case for our previous submissions, we were asked for and offered a list of qualified "recommended reviewers."
We were again rebuffed without the possibility of resubmission. And while Tobacco Control provided the verbatim reviews of our paper, their "open review process" broke down completely as far as identifying even a single one of the three reviewers: none of the three were willing to sign their name to their work. Without such identification, there is of course no way of really knowing, but the overall tone of the reviews was such that it is highly unlikely that any of them came from our recommended list. Indeed, they seemed more like reviews written by those we had noted as specifically not suitable, as they contained many points that were quite negative but seemingly groundless or irrelevant.
Bans Based on a Palatable Misconception?
We believe our study is both scientifically sound and quite important to both the medical research community and to the wider public community that such research affects. While we are continuing to submit our work to other medical journals, such a process simply does not address the political need for the information to be made available to the public in a timely manner. This is a time in which far-reaching political decisions are being made based upon the imperfect -- perhaps deliberately imperfect -- data and interpretation of the previously published studies.
Even as we were considering our next best step after Tobacco Control's rejection, a third "copycat" study resembling the original Helena study found publication in Preventive Medicine (4). This study, based in Bowling Green, Kentucky, blithely repeated the imperfections of the previous two and is also being used to bolster political support for smoking bans, based upon an urgent need to protect nonsmokers from heart attacks caused by secondary tobacco smoke. It was the publication of this study that prompted the current article.
Medical journals have come under criticism in recent years for being influenced by large pharmaceutical corporations, putatively publishing research that favors expensive and profitable drug interventions while selectively suppressing contrary research. While we have not researched that question, our experience with having valid but "politically undesirable" research rejected by three journals (which should have felt a particular sense of responsibility to publish it) makes accusations of politicized publishing decisions at journals seem more plausible to us than it once did.
How much more research might be out there, unfunded, unpublished, or simply unrecognized, that goes against the body of accepted thought regarding the supposed "deadly threat" of exposure to secondary smoke and benefits of smoking bans?
The answers to these questions may never be known, but for the sake of the integrity of science, as well as to repair the damage that politicized science can do to people's lives, the questions need to be addressed. As a start, the Kuneman/McFadden study needs to be given recognition and prominence comparable to smaller and contradictory studies, and the criticisms of the failings of those studies need to be revisited by researchers, journals, and the media. (5-9)
Science should never be distorted to fit political goals. Physicians, the public, and society depend upon the integrity of medical journalism to fairly present scientific facts, regardless of their political desirability, in order to reach the best decisions about our lives and our world. Science bent to the service of politics is no longer science.
Statement of competing interests:
Michael J. McFadden (Cantiloper[at]aol.com; http://pasan.TheTruthIsALie.com) is the author of the book Dissecting Antismokers' Brains.
David W. Kuneman (sharz28hus[at]aol.com; http://kuneman.smokersclub.com/) is a retired pharmaceutical chemist who worked for several years in the 1980s as an analytical chemist for 7-Up at a time when that company was owned by Philip Morris.
Both authors smoke and both are quite active, completely without compensation of any kind, with various smokers' rights and free-choice groups.
(1) Kuneman DW, McFadden MJ. "Do smoking bans cause a 27 to 40% drop in admissions for myocardial infarction in hospitals?" http://kuneman.smokersclub.com/hospitaladmissions.html
(2) Sargent, R et al. "Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study." BMJ 2004;0:bmj.38055.715683.55v1
(3) Bartecchi, C et al. "Reduction in the Incidence of Acute Myocardial Infarction Associated With a Citywide Smoking Ordinance." Circulation. 2006;114:1490-1496.
(4) Khuder, SA et al. "The impact of a smoking ban on hospital admissions for coronary heart disease." Preventive Medicine, April 4th, 2007.
For a suggestion from ACSH on one way smokers might be helped, see our brochure on smokeless tobacco as a means of harm reduction.