Smoking in Minnesota

Today’s guest post is from Jacob Schor, ND.

Majoring in the minors

My friend Dave Macallen has an expression he uses, “Majoring in the minors.”  He is originally from Scotland and this probably why he occasionally needs a bit of help translating what he is trying to say.

By majoring in the minors he means to describe a habit that many of us fall into, of making a big deal over the little things, and by implication ignoring the big things that matter.

Dave and I first met in naturopathic school, a bit over a quarter of a century ago, so our discussions tend to be about the various things our colleagues are focusing on, and it seems that we all often fall into the habit of majoring in the minors.  I fear to give examples least I offend my various readers, but basically things that really won’t make that much difference in health, though admittedly thay may have a substantial impact on a particular patient’s life.  For example, identifying celiac disease in the one person in in 87 (or is it 78?) who has it will change their health but if our entire population were to adopt a gluten free diet, there won’t be a landslide change in overall public health.

What happens when you ban smoking?

I’m chewing on all this today after reading of the newly published Olmsted County study.  This Minnesota county banned smoking in public places in 2007.  The rate of heart attacks dropped by a third after the ban compared to the period just before restrictions were phased in. This is reported in the Archives of Internal Medicine, October 29, 2012.  Richard Hurt of the Mayo Clinic, one of the study’s authors, says it is the longest study done so far on the effect’s of smoking rules on public health.

Olmstead County prohibited smoking in restaurants back in January 1, 2002 and then expanded the ban to all workplaces, including bars on October 1, 2007.  Hurt and colleagues calculated the rate of heart attacks during the year and a half before the smoking ban went into place and then for the same period following.  After all the numbers were crunched, they summed  the data up in terms of annual heart attack rates.  Before the smoking ban went into effect the heart attack rate was 151 per 100,000 people per year.  After the ban went into effect the rate dropped to 101 per 100,000 people.

If these data are true, and at this point I see no reason to disbelieve them as they are consistent with other studies, then we can cut heart attack rates by a third simply by instituting and enforcing these smoking bans.  We can obviously cut them further by encouraging smokers to discontinue the habit.

Smoking bans pay off

Think of all the effort we make trying to reduce heart attacks, the diets and fads (egg yolks, coffee filters, etc) that are suggested as perhaps having an impact, the statin drugs, the supplements, the exercise,  all of them together don’t come close to making this sort of difference.  Worrying about egg yolks or a few points of cholesterol would be in Dave’s description, ‘the minors.’

Reducing exposure to second hand smoke may be  what he calls the ‘majors,’ making a change that really matters.

People don’t stop smoking because of these bans.  It’s not heart attack rates in smokers that decrease.  It’s the people around them.  It’s us sorts.  And it’s us sorts who should be most interested in promoting these sorts of smoking bans.

Long time readers will recall a similar study done in Montana  8 years ago that was widely criticized by smoking rights groups funded by the tobacco industry.  In 2004, I wrote about this earlier study :

“The number of heart attacks fell by 40% in Helena, Montana in the six months that an indoor smoking ban was in effect. Once the city repealed the ban, heart attack rates jumped back to prior levels. All the arguments our Honorable Mayor has put forth on the economic impact smoking bans would have on the economics of downtown Denver, fade quickly when faced with these numbers.

I expect we will hear about this study for years to come.  Tobacco company websites  under the guise of promoting patriotic freedoms are already astir trying to discredit this study.

Read the full text of the study published in the British Medical Journal

Dr. Jacob Schor, ND

Dr. Jacob Schor, ND

Guest post by Dr. Jacob Schor, ND, FABNO

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