Has the smoking ban reduced heart attacks?

Tessa Mayes draws on the latest research from the US to show that there is no necessary correlation between bans and declining heart-attack trends 1 t's four months since the smoking ban was imposed in England, and most smokers I've met in that time seem to be quietly adapting. A friend wants to buy Suck UK's unisex Smoking Mittens. If you have not come across them before, they are gloves that have a metal hole in them for your cigarette so you can keep warm when smoking outside in the winter. They cost £15 and, as my friend says cheerfully, 'You never know, if it gets really cold, Silk Cut may sponsor white and purple balaclavas with silver puff holes.'

But if many smokers seem to be adapting to the ban, there is still plenty of strong opposition. Groups like Forest continue to campaign for the right to smoke. In August a crowd of people including pub entertainers marched through Glastonbury in protest against the ban. Dave West, owner of the HeyJo nightclub in St James's, London, wants to 'eyeball the authorities' by taking the government to court over it.

It is not just the ban itself that angers smokers, however, nor the assumption by the government that it is a better guardian of our health than we are; the real fag end of all this is the way science has been misused by policymakers, in the first place to impose the ban, and then to justify it.

Few would deny that smoking can be harmful to the health of smokers. After decades of research, scientists have shown that smoking causes most lung cancers. Smoking is also a risk factor in heart disease, chronic bronchitis, emphysema and asthma.

Even so, it does not follow that smokers should be prevented from sparking up in public places. The science is one thing; how society should respond to it is another. Arguments in support of public policy should take scientific evidence into account but not be dictated by it, as many scientists would agree.

Yet the opposite is happening, thanks to socalled 'evidence-based' public policy-making Championed as long ago as 1999 in the government white paper 'Modernising Government', the evidence-based approach was supposed to offer a means of forming policies on the basis of a clear evaluation of evidence — and rational argument. But there's been precious little rational argument. What has happened is that the science has been allowed to determine and justify policy: political debate has had to yield to science, to the point almost where scientists have become policy-makers. In practice, the evidencebased approach tends to stress the scientific evidence at the expense of political debate.

Sometimes, however, the scientific evidence itself is flawed, or wrongly interpreted. According to a recent Scottish study, for example, there has been a 17 per cent drop in hospital admissions for heart attacks since the March 2006 smoking ban was imposed in Scotland. Gill Pell, consultant in public health at Glasgow University, found that this compared to a 3 per cent annual decline during the previous decade.

But these findings were not presented in an apolitical, scientific forum. Instead they were revealed at a two-day international conference in Edinburgh last month on the effects of the smoking ban. The conference was called 'Towards a Smoke-Free Society', and policymakers were quick to seize on the results. Peter Donnelly, the Scottish deputy chief medical officer, saw them as evidence that the ban caused 'significant' public health benefits. Sally Haw, principal public health adviser at Health Scotland (part of NHS Scotland), concluded that the results 'will help support countries worldwide in their efforts to develop and implement smoke-free legislation'. Shona Robison, Scotland's public health minister, told the conference that the research was 'impressive' and justified the smoking ban in Scotland — as if science is sufficient proof of the policy's correctness. No mention was made of the nine out of ten Scots who, last year, thought the ban had gone far enough, according to a Populus opinion poll for Forest.

What of the science itself? It is impossible to judge. The full results aren't even public yet. I asked the press officer at Glasgow University whether I could see a copy of the results, and he told me, 'They've not been published yet in an academic journal.'

The results presented at the Edinburgh conference have to be viewed alongside other evidence. For example, the rate of emergency admissions for heart attacks in Scotland declined by 14 per cent in the three months before the smoking ban. Rates of admission fluctuate.

In the scientific research on heart attacks and the effects of passive smoking, epidemiologists warn against reaching hasty conclusions about the alleged dramatic short-term effects of a smoking ban on health.

Last month a study published in the American Journal of Public Health on the effects of the July 2003 smoking ban in New York State concluded that it had resulted in 8 per cent fewer people being admitted to hospital with heart attacks in the first year and a half of enforcement. Since the number of smokers had not decreased, the researchers concluded that the fall in admissions was due to the declining exposure to second-hand smoke.

Yet others disagree with the conclusion. On his blog, Professor Michael Siegel, epidemiologist at the Boston University School of Public Health, points out that there was no control study and neither did the research establish heart-attack trends among New York smokers and non-smokers. He says that heart-attack rates have also decreased in all other US states (where data is available) during 200304, the same period under study in New York State, but that none of these states had introduced a smoking ban at that time. And in South Carolina and Nebraska, the rates decreased by more than in New York State — and they hadn't introduced a smoking ban then, either.

Siegel raises the question: if US-wide heartattack rates are declining anyway, can the decline in the rates of New Yorkers having heart attacks really be attributed to the smoking ban? He concludes: 'The point is that there are large year-to-year variations in heart attacks that have nothing to do with smoking bans.'

What makes Siegel especially interesting is that he is part of the anti-smoking lobby; he campaigns for smoking bans. He will not, however, condone weak science — even if it appears to support his political stand. As he writes on his blog: 'As much as we might like to believe that reducing secondhand-smoke exposure prevents thousands of heart attacks in a matter of months, the evidence is simply not there to support such a conclusion.'

What is the truth about heart-attack rates and the effects of passive smoking? That question must be answered by the scientists. But even if scientific studies did eventually lead to the conclusion that smoking bans actually caused a decline in heart attacks, what would the policy-mongers do next? Ban alcohol in pubs and restaurants on the grounds that all the ex-smokers must have upped their alcohol intake — and will therefore be blocking NHS beds with their alcohol-related illnesses?

It is bad enough that science should always trump political debate, as it now seems to. It is completely unacceptable when that science is itself — at the very least — inconclusive.