Government Bans and Health Statistics

Classic journalism entails a pyramid structure for articles whereby readers can always stop because the most important information is already behind them.  The headline, lede, and first paragraph convey the critical information, with widening circles of detail and explanation thereafter.  One of the flaws of this method is that it is prone to the perception of bias, while increasing the centrality of the reporter’s underlying beliefs and assumptions.  After all, he or she must decide what the key aspect of the story is, and those who disagree with the conclusion that a particular fact implies will find it suspicious that all of the limits and contrary arguments are aired only after it has been fully explained and justified.

Felice Freyer’s recent article, “Smoking ban followed by fewer heart attacks,” is an excellent example, not because Ms. Freyer has an especial bias, but because the fact that this particular information is handled as news points to a pretty significant conclusion.  Here are the lede and first paragraph (relevant link added):

Study looks at hospitalization rate after smoking banned in public places

The rate of hospitalizations for heart attacks in Rhode Island declined by almost 30 percent in the years after the state banned smoking in public places in 2005, according to a Health Department study.

The natural conclusion for anybody who stops reading there is that the ban on smoking was a good thing (one might even begin to ponder what other health-related bans might continue the progress).  Even readers who continue on will find such caveats as “the study does not prove that the law caused the lower heart-attack rate” to be little more than disclaimers.  It isn’t until about two-thirds of the way through the article that one finds this:

The study has several limitations. It could not separate the smoking ban from other factors that might have also contributed to the decline in heart attacks. In fact, the heart attack rate had started to decline in the two years before the law took effect. Additionally, the researchers were not able to determine how many of the hospitalized people were smokers.

The truly surprising finding would have been that increasing the barriers to smoking — by tax or by ban — had no effect on the health of the affected population.  Studies aren’t needed in order to reasonably predict that would.  The question of primary concern in a representative democracy is how much effect the ban, by itself, had on health and whether that effect was worth the encroachment of government authority. The study’s limitations, that is, elide right past the crucial information.

In an American Heart Association editorial titled “Is Acute Myocardial Infarction Disappearing?” Russell Luepker and Alan Berger show that hospitalization rates for heart attacks across the nation have been decreasing, with a precipitous drop around the same time that Rhode Island issued its smoking ban.  Whatever its positive effects, the ban cannot be seen as having that far of a reach.  Indeed, Luepker and Berger expand the credit beyond smoking itself:

What might underlie this change? During this period, there have been major improvements in the control of cholesterol, smoking, and blood pressure. For example, the proportion of Minnesotans 65 to 74 years of age taking statins to lower cholesterol was 22% among women and 27% among men in 2000 to 2002. This is a sizable fraction of the population. Similarly, there were major reductions in saturated fat and dietary cholesterol over time associated with declines in blood cholesterol levels in the population. Smoking rates have plummeted; the National Health Interview Survey found that 42.4% of adults smoked cigarettes in 1965 and 19.8% in 2007.

Americans are improving their health habits across the board.  Government action may be catalyzing or accelerating some of that change, but simple correlation is far from enough to justify accelerating regulation in turn.  In the absence of further studies, we cannot dismiss the possibility that the largest influence on people’s behavior has been doctors’ increased ability to show direct links between cigarettes and french fries and potentially fatal diseases, as well as the increased ease of disseminating that information to every corner of public awareness.