Tuesday, September 26, 2006

Editorial Criticizes Minnesota Anti-Smoking Groups for Withholding Data Showing Decrease in St. Paul Bar Patronage

An editorial in yesterday's St. Paul Pioneer Press criticized two Minnesota anti-smoking groups - ClearWay Minnesota (formerly known as MPAAT) and the Association for Nonsmokers - for withholding data that may indicate a drop in patronage in St. Paul bars following implementation of a smoking ban.

The details of the story are not entirely clear, but from what I can discern, here is my understanding of what happened:

On August 30, ClearWay Minnesota and the Association for Nonsmokers issued a press release announcing the results of a study they had commissioned which showed a dramatic 93% decline in particulate levels in a sample of 10 bars after implementation of St. Paul's smoke-free ordinance. The ban went into effect on March 31; apparently, the pre-ban samples were taken in March and the post-ban samples were taken in April. The 10 bars sampled represent a small proportion of the 200 or so bars and restaurants in the city.

These results were reported in several newspaper articles, including a Pioneer Press article by reporter Jason Hoppin ("Smoking Ban Clears Air in Bars, Study Says").

Apparently, the newspaper reporter had made a request for all of the data upon which the study conclusions were based.

But according to the paper, "it took a Minnesota Data Practices Act request and a Minnesota Department of Administration advisory opinion for the Pioneer Press to get a look at the raw data from the study, which ClearWay was none too eager to share."

This is where the details are unclear to me. It seems that a court decision of nearly a year ago had already made it clear that these type of data are public and subject to disclosure. So why would ClearWay "hide" the data? Equally confusing is the apparent fact that Jason Hoppin's article on the study appeared on August 30, but on the very next day, his blog entry appeared which reported the "other" data in the study, which revealed the lower levels of patronage in this sample of 10 bars.

So it's not clear:
(1) why Hoppin did not report all of the data in his August 30 article; did he feel that the patronage data were not worthy of including in the newspaper, but just in the blog?
(2) why the newspaper suggests that ClearWay hid the data, since it appears that they released the data immediately (if the press release was issued on August 30, and Hoppin reported the patronage results the next day).

At any rate, what is clear is that these data show a rather large difference in the number of customers present in the bars before and after the smoking ban went into effect, with a much smaller number of customers present in the bars afterwards (average of a 38% decrease in patronage).

The Rest of the Story

It's difficult to assess what occurred here without all the facts. Apparently, the newspaper got the impression that ClearWay was attempting to suppress some of the data from the study. In fact, the newspaper goes so far as to suggest that these anti-smoking groups were intentionally deceiving the public about the findings of their study:

"We also believe there is a clear line between exaggeration and purposeful deception; the Association of Nonsmokers and ClearWay Minnesota (formerly MPAAT) crossed that line. An Aug. 30 press release by the Association of Nonsmokers not only expressed a conclusion about the air quality in St. Paul bars and restaurants that was based on insufficient data, the Association and ClearWay, which commissioned the study, withheld data relevant to the issue but contrary to their pro-ban position. As reported on the Pioneer Press blog "City Hall Scoop," it took a Minnesota Data Practices Act request and a Minnesota Department of Administration advisory opinion for the Pioneer Press to get a look at the raw data from the study, which ClearWay was none too eager to share. Why? Perhaps because the disaggregated data showed a wide variation in air quality among the 10 bars and restaurants tested -— an insufficient sampling of the 200-plus in the city. The study also found a drop in patronage in seven of the 10 establishments tested. (Opponents of the smoking ban have consistently argued that the smoking ban has hurt business.) Interestingly, in the seven bars where patronage dropped, the air quality improved significantly more than in three bars where the customer counts went up. None of this data, however, was made public."

It's not clear to me whether the paper is accusing the anti-smoking groups of merely failing to report the data on bar patronage or whether the paper is suggesting that these groups actively hid the data, by failing to provide the data to the newspaper. Again, it appears that the newspaper was given the data, so I can only guess that the first accusation is the relevant one here.

Are these data important? I would argue that they are. One could make an argument that these data are not of much meaning because the sample was small (only 10 bars), the sampling conditions (e.g., days and times of sampling) from before to after the ban were very different, or that there are many other factors that affect patronage (such as seasonal variations).

However, it does seem to me that whatever arguments there are to suggest that the patronage data are not valid would also hold for the exposure data. Apparently, an attempt was made to sample the bars at the same times and days of the week. Apparently, the sample was deemed large enough to draw a definitive conclusion about exposure levels in St. Paul bars. So it seems to me that if the study was good enough to obtain meaningful data on exposure, perhaps it was also good enough to obtain meaningful data on the number of patrons. Moreover, the number of patrons present is an important variable in assessing the reasons for the decline in smoke levels.

While the difference in month of sampling is quite significant, it seems to me that if anything, one would expect to see more bar patrons in April than March, not fewer. Bar and restaurant sales data do confirm that spring is the season in which patronage is the highest.

Am I arguing that these data provide conclusive evidence that bar patronage decreased in St. Paul due to the smoking ban? No. I think the sample is too small to make such a determination and also, it appears that only one sample was taken in each bar. Nevertheless, I do think these data are relevant, especially given the importance that was attributed to the exposure data based on the same sample and sampling conditions.

Do I think the anti-smoking groups hid anything? I don't think they actively withheld the data, although it's not exactly clear why the newspaper got that impression.

One thing is clear about ClearWay, however. They are actively deceiving the public about important information regarding secondhand smoke. Specifically, I believe they are deceiving the public about the acute cardiovascular effects of secondhand smoke. In their smoking ban manual on their web site, they claim that a brief exposure to secondhand smoke decreases coronary blood flow in young, healthy individuals:

"Blood flow in the coronary arteries is decreased in healthy young adults exposed to secondhand smoke."

I think this claim is wildly misleading and deceptive. The truth is that exposure to secondhand smoke has been found not to affect basal coronary blood flow in healthy adults. In fact, the same study upon which this statement is based is the one that actually reports no difference in the blood flow in the coronary arteries of exposed adults.

Sure, the coronary reserve flow is reduced in exposed nonsmokers, but this reserve flow reduction is simply an indication of endothelial dysfunction, and it has no acute clinical significance.

I think it is irresponsible to mislead healthy young adults and to scare them by thinking that if they are exposed to secondhand smoke, the blood flow in their coronary arteries is going to decrease. It is not, and the claim is therefore wildly misleading.

Unfortunately, this is not the worst of it. Elsewhere in the same manual, ClearWay claims that eating in a smoky restaurant increases your risk of heart disease by 30%. Not eating in a smoky restaurant every day of your life, I might add. Just eating (presumably once) in a smoky restaurant:

"Current scientific data suggest that eating in a smoky restaurant can precipitate myocardial infarctions in nonsmokers and increase the risk of fatal and non-fatal cardiac events in nonsmokers by about 30 percent."

There is no evidence that eating in a smoky restaurant causes heart attacks in nonsmokers, but that's not the part of the claim that I'm most concerned about. The part I'm concerned most about is the claim that eating in a smoky restaurant increases your heart disease risk by 30%. Because that's not just a misleading or deceptive claim, it's completely fallacious.

The scientific evidence shows that chronic exposure (over many years) may increase your risk of heart disease by 30%. But eating once in a smoky restaurant? Obviously, this claim is false.

Let's give ClearWay the benefit of the doubt and assume that this is just a careless mistake and not an intentional lie. It needs to be corrected immediately, in either case.

I don't happen to think that there is any foul play in ClearWay's failure to disclose the data on smoking patronage; however, looking at the deceptive and fallacious health claims they are making doesn't add a whole lot to my contention.

If we are going to assume that ClearWay is being open and objective and scientifically careful and honest in all of its dealings, then we can certainly expect them to be accurate in their public communications. But a wildly misleading claim and a completely fallacious one don't qualify.

The rest of the story is that whether it's true or not, the public is getting the impression that we as anti-smoking groups have something to hide, and that we're exaggerating data or actively deceiving the public because the actual science doesn't fully support our position. The dissemination of deceptive health claims and the refusal to respond appropriately to the criticism of the invalidity of those claims (unless ClearWay is different from the 86+ other groups which have failed to correct their inaccurate health claims) are not going to help this situation.

Actually, I'm not quite sure what the rest of the story is here: withholding information from the public or making the claim that eating in a smoky bar increases your heart disease risk by 30%. Given the absurd claims this group is making, I'm not sure I wouldn't call it a public service for them to withhold information from us!

(Thanks to Marcus for the tip).

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