Secondhand Smoke

A few weeks ago I happened across a news release from the American Heart Association that caught my attention. On an annual basis the AHA publishes its own top ten list (who doesn’t?) of the most influential research publications of the year. This year’s registry included the usual basic science papers with names that range from the arcane (“Circulating transforming growth factor-ß in Marfan syndrome”) to the nearly unpronounceable (“Functional cardiomyocytes derived from human induced pluripotent stem cells”). In case you missed the purpose of the latter study, the authors package it up for you in a tidy soundbite: “The aim of this study was to characterize the cardiac differentiation potential of human iPS cells generated using OCT4, SOX2, NANOG, and LIN28 transgenes compared to human embryonic stem (ES) cells.” Oh, so that’s it?

I’m not knocking these studies—I’m not sure I’m even smart enough to read them—I just found that I gravitate more toward research that has direct application to my daily patient interactions.  One study in particular caught my eye and I was pleased to see it make the AHA’s top ten.  I had read it when in was published in September and was somewhat surprised at the findings.

Researchers studied the rate for heart attacks in three separate communities in the United States: New York state, Bowling Green, Ohio, and Pueblo, Colorado.  As far as I can tell, the only thing these three locales had in common was the precise reason they were put under the microscope: within the last few years their local legislators had passed strong laws that limited smoking in public places such as restaurants and places of employment.  The authors observed a 15% drop in the number of heart attacks in the first year after the smoking ban was put into effect and this decline only steepened with time.  After three years the rate of heart attacks among the general population had plummeted by 36%.

Didn’t we already know this?  Is this really news?  After all, the National Health and Nutrition Examination Survey measured nicotine levels among nonsmoking adults and found that only 13% of those living in regions with smoking bans tested positive compared to 46% living in jurisdictions without smoking legislation.  In 2006 the Surgeon General’s office devoted an entire annual publication to exposing the deleterious effects of secondhand smoke.

What’s different about this study, and why it is so important, is that this is the first real proof we have directly linking treatment (banning smoking in public places) to effect (decreasing heart attacks).  Yes, indeed, curbing the freedom of smokers to light up within the confines of an office or a restaurant not only enhances the pleasantness of the environment, it also directly impacts the health of those nearby.  And passing a law that pushes the smoker into the well-vented outdoors produces a real, measurable, and immediate effect on the risk of heart attack among the broader population.  It’s this kind of direct evidence that really moves the opinion of those in a position to enact public policy.

In June of last year Omaha enacted its own ban on smoking in public confines.  The local paper’s editorials were filled with tirades about the loss of freedom imposed by this draconian edict.  These letters came from tobacco’s most valued customers who vow to never give up the habit and don’t see the problem with the rest of us sucking in a few fumes now and again.

But I maintain that freedom from undeserved heart attacks and death is more important to our society than is the freedom to light up whenever and wherever you’d like.  It sounds like communities in New York, Ohio and Colorado believe the same and are now reaping the rewards of their decision.