Monday, 27 February 2017

Revealed preferences: a case study

A photo tells a thousand words. This one was taken by Michael F. Cannon at the 'Creating a Culture of Health' conference last week, hosted by billionaire nannies of the Robert Wood Johnson Foundation.





Saturday, 25 February 2017

Peter Hitchens on drugs

Peter Hitchens has written a blog post titled 'Stupid arguments for drug legalisation examined and refuted'. For the most part, the arguments are not silly and Hitchens hasn't seriously examined, let alone refuted, them. 

I won't respond to all his points because some of them are not really arguments for drug legalisation at all - they are just arguments he has with legalisers from time to time. In particular, he spends a lot of time arguing against people who say 'what about alcohol, tobacco, motorcycles etc?' That line of attack can expose the double standards of some prohibitionists but it cuts no ice with Hitchens because he would happily ban these products too if it were feasible. I shall therefore pass over that argument and address some of his other points.

'WHY ALLOW CRIMINALS TO CONTROL THE TRADE? MAKING IT LEGAL WOULD DRIVE THEM OUT'

This is demonstrably untrue. Alcohol and tobacco( see above) are legal. Yet in Britain, HM Revenue and Customs use huge resources trying to combat the criminal gangs which smuggle illicit cigarettes into the country, or who manufacture and distribute illicit alcohol. This is because they are very heavily taxed, just as legal marijuana would be very heavily taxed. In fact it is already being taxed in Colorado, on the US states which has legalised it. Illegal sellers still operate there, trading at well under the taxed price in legal outlets.

Nobody claims that prohibition is the sole cause of black market activity. Britain has a thriving black market in alcohol and tobacco because it has taken the advice of people like Peter Hitchens and introduced every measure short of prohibition to deter the sale of these products. Taxation, in particular, has created demand for illicit goods because, as John Stuart Mill once wrote, 'every increase of cost is a prohibition, to those whose means do not come up to the augmented price.' 

If Britain had a less punitive system of sin taxes, criminals would be driven out of these markets. Criminal manufacturers will never be able to produce products more cheaply than legal corporations. The only reason there is a price gap between the licit and illicit product is that paternalistic governments have set taxes too high.

By contrast, if we had full prohibition the market would be entirely run by criminals. The fact that there is a significant amount of criminal activity in a market that has several characteristics of an illicit activity, as tobacco does (artificially high prices, no advertising, and now no branding) is an argument for less regulation in that market, not prohibition in another. 

As with tobacco and alcohol in Britain, the tax on cannabis is Colorado is so high that it is cheaper to buy it on the black market. It should be lowered.

All crime is caused by law

In any case, no thought has gone into this. All crime is caused by law. To have law means to have crime. If you have no law, you will have no crime. But think what this means in reality. If we banned nothing, we’d need no police, courts or prisons. But we’d also live in much worse, more dangerous and unpleasant world. We ban things because they are dangerous or have other evil effects.

It is trivially true to say that there would be fewer crimes if there were fewer laws, and it is true that this is not an argument for repealing laws. The real question is whether cannabis is sufficiently 'dangerous' to justify prohibition and whether the costs to the 'police, courts or prisons' are justified given that smoking cannabis is a relatively benign self-regarding behaviour. The costs of enforcing prohibition are real and they fall on the general taxpayer. Prohibition, in other words, creates negative externalities for everybody in society. 

'Evil effects' are not sufficient to justify prohibition. People should be free to impose costs on themselves. Prohibition can only be justified if there are negative externalities which exceed the negative externalities of prohibition, and which cannot be captured with a Pigouvian tax. In general, however, smoking marijuana is a victimless crime that does not tick these boxes, although Hitchens disagrees...

'MARIJUANA USE IS A VICTIMLESS CRIME'

Only if you do it on a desert island, quite alone, and nobody loves you. In all other cases, the user runs the risk of doing himself serious harm ( see below on correlation between cannabis use and mental illness). And if he does, his family will be terribly grieved and quite possibly forced to look after him, and pay for his upkeep for the rest of this natural life. They are victims. Alternatively, the user may end up in a mental hospital, expensively cared for at the charge of the taxpayer, who is also his victim. Even so his family’s grief and distress will last for as long as they live.

This is a reference to the alleged link between cannabis and schizophrenia. Given the widespread use of cannabis and the relative scarcity of schizophrenia, we might assume that the risk to any individual cannabis smoker - if it exists at all - is not great. Hitchens nevertheless wants people who smoke cannabis to be thrown in prison pour encourager les autres on the basis that the hurt or cost to third parties is intolerable. 

Since people can be 'terribly grieved' about all sorts of things, and since taxpayers foot the bill for most health and welfare costs, it is difficult to think of many activities that are truly victimless (and therefore permissible) under Hitchens' definition. It is a principle that, as Mill might say, 'acknowledges no right to any freedom whatever, except perhaps to that of holding opinions in secret'.

In any case, it is not clear why Peter Hitchens cares more about an individual's loved ones than the individual does. If the friends and family of a cannabis user have a self-interested stake in his well-being, they can argue and reason with him. Ultimately, however, they must accept that his life is his own and that there is no duty on an individual to minimise every risk in case they wind up upsetting their friends or visiting an NHS doctor.

Nor should we assume that parents who have suffered as a result of their children taking drugs necessarily support Hitchens' position. The Anyone's Child campaign is run by dozens of parents who believe that their children would still be alive if drugs were re-legalised and regulated.

Why are cynical businessmen so much better than criminal gangs?

Why exactly are cynical businessmen better than criminal gangs?, who can wrap their dangerous products in pretty packets and sell them in shops and on the internet, and advertise them on TV and in cinemas, so much more desirable than criminals? Criminals cannot do these things, and can reach many fewer people than cynical businessmen.

'Cynical businessmen' generally don't settle their disputes by shooting one another, for a start. They don't blow up aeroplanes or employ hit-men. They abide by product regulation and pay taxes. They don't finance terrorism. They don't corrupt whole countries. They don't torture people, they don't burn down casinos and they don't throw grenades into crowds of innocent people. They don't need to do any of this because they can settle their disputes through a court of law.

On the other hand, Hitchens is right to say that 'cynical businessmen' try to make their products look attractive and tell people that they exist, subject to statutory limits on commercial speech, up to and including total prohibition. Manufacturing 'pretty packets' hardly seems comparable to mass murder, however.

In any case, this is what the UK's best selling cigarette looked like before plain packaging was introduced:



And this is some Ecstasy:



He continues:

Just because it’s regulated, doesn’t mean it’s safe.

Does the fact that cigarettes and alcohol are sold openly and ‘regulated’ mean they are safe to use and will not harm you?

Why then would it mean that legalised drugs were safe to use and would not harm you? By ‘regulating’ them, society and the state would be offering a reassurance they were not entitled to give. They would be looking the other way while something inherently dangerous was put on open sale. I can see why a greed merchant might accept this argument. But most marijuana legalisers regard themselves as being opposed to corporate cynicism. Why are they outraged at the sale of sugary drinks and greasy burgers to innocent children, but happy to ally themselves with the mighty lobby of Big Dope?

It is highly doubtful whether people interpret the legality of tobacco, alcohol or even sugary drinks as a 'reassurance' that they are totally without risk. Very few things are wholly safe. The question is whether regulated products are safer than unregulated products. Tobacco and alcohol are undoubtedly safer than they would be if they were only available from criminals on the black market. Illicit alcohol was vastly more dangerous in America under Prohibition and it continues to be vastly more dangerous wherever it is consumed today. Illicitly produced cigarettes are also more dangerous than the real thing. If sugary drinks were only available on the black market it would not be long before we had our first spate of sugary drink-related poisonings.

Unless Hitchens believes that product regulation is totally useless and unnecessary, he must accept that unregulated products carry extra risks. This is undoubtedly true of drugs like heroin and Ecstasy which require the police to give users special warnings when unusually strong or adulterated batches hit the streets.

Meet The Real Mr Big - it’s You

These are the people who seek the dangerous, selfish pleasures of drugs. These are the real Mr Bigs of the drug trade. Without the cash they willingly hand over for their chemical joy, there would be no cartels, no smuggling, no mules, no gang wars.

This is why it is so astonishing that the people at the heart of the drug trade, the buyers and users, are the only ones in whom the law is utterly uninterested. If they were systematically arrested and prosecuted, the drug trade would rapidly dwindle, most of all in the places now enslaved by it.

No Mr Hitchens, The Real Mr Big is you and your fellow prohibitionists. Without drug prohibitionists, there would be 'no cartels, no smuggling, no mules, no gang wars.' There were none of these before the war on drugs started and there will be none of them when it is finally ended. It is fatuous to blame the victims of the drug war for the inevitable consequences of the prohibitionists' utopian fantasies.

'BUT YOU CAN’T PUT HUNDREDS OF THOUSANDS OF PEOPLE IN PRISON'

No, you can’t. The point of prison is to deter. Once it is clear that a crime is being taken seriously, its incidence falls ( see Japan and South Korea and pre-1971 Britain). A fairly small number of high-profile arrests and prosecutions, and the use by police of informers on a large scale so that nobody knew if they were in fact buying from a police nark, would rapidly persuade most people that drug abuse wasn’t worth the risk. And if everyone had heard of someone who *had* been jailed for drug possession, they’d change their behaviour. Drug abuse is a crime of affluence and choice. Anyone can stop committing it if he wants to. Nobody needs to do it.

Nice theory, but it hasn't worked in the United States where drug users are routinely sent to prison, nor in countries such as Russia or Iran which treat drug users even worse. The idea that people will stop taking drugs if word gets around that you can be sent to prison for it is naive. It is well known that large numbers of people are sent to prison for many years for the crime of dealing drugs, and yet drug-dealing continues.

Dictators love having stupefied subjects. They’re easier to fool, and to push around

Self-stupefaction is not some mighty freedom, like the freedoms of speech, thought and assembly. It is rather the opposite. Any tyrant would be glad to have a stupefied, compliant and credulous population, accepting what it was told and too passive and flaccid to resist. See Huxley’s ‘Brave New World’, inn which the masses are controlled by the pleasure-drug Soma.

This slightly conspiratorial theory is not borne out by experience. Nearly every government in the world has banned narcotics. Only a tiny handful have legalised cannabis. Even if we accept the idea that 'dictators love having stupefied subjects' it is a matter of historical record that the worst dictators have fought the war on drugs more savagely than anybody. Chairman Mao came close to wiping out opium use in China using the most brutal methods. Putin, like his communist predecessors, takes a zero tolerance approach. Rodrigo Duterte is currently massacring drug users in their thousands in the Philippines. And whilst it is true that Hitler dished out drugs to his soldiers, the Nazis' drug of choice - amphetamine - was hardly likely to stupefy them.

In short, if governments of any stripe want a stupefied population, they have a funny way of showing it.


Friday, 24 February 2017

Tobacco tax evasion - what's the story now?

I have written before about the sketchy guesswork used by the government to estimate the size of the illicit tobacco market. HMRC's current methodology is to...

... estimate how many smokers there are and multiply it by the estimate of how many cigarettes they each smoke. They then subtract the number of recorded sales - plus an estimate of how much is bought legally abroad - from the total and the figure that emerges is the amount of non-duty paid tobacco.

I have suggested that the decline in legal tobacco sales since 2009/10 - when tobacco taxes began to rise well above inflation - has been far greater than the decline in smoking prevalence would predict. In 2009/10, 49 billion cigarettes were sold. By 2014/15, this had fallen to 33 billion, meaning that sales had fallen by a third. Sales of hand-rolling tobacco, meanwhile, had remained the same at around 6.6 million kilograms. The graphs below show legal sales of cigarettes and other tobacco (mainly hand-rolling tobacco) since 1992. Note the big dip in 2000 when cross-border shopping from the EU began in earnest.




Over this period, the smoking rate has fallen by just 10 per cent (or two percentage points), from 21 per cent to 19 per cent, and half of that drop has taken place since 2010. Since 2010, the smoking rate has fallen by just five per cent but cigarette sales have fallen by more than a quarter. Moreover, the population has grown by four per cent.

It is possible that this can be explained by smokers sharply cutting down their consumption (perhaps because of e-cigarettes), but it is also possible that higher prices have pushed more people into the illicit market.

Or it could be a bit of both. Unfortunately, the HMRC estimates are so rough and ready that it is impossible to tell. Last time I wrote about this, HMRC figures showed a rise in the illicit market share since 2011/12 (from 7 per cent to 10 per cent in 2014/15), but no real change since 2009/10 when the estimate was 11 per cent.
 


It should be noted that any figure between 4 per cent and 12 per cent is possible in any of these years. Look at the confidence intervals. This is a broad guesstimate that depends on a lot of assumptions.

The importance of assumptions can be illustrated by looking at the most recent HMRC estimates which use an updated methodology. All the figures have suddenly changed. Whereas HMRC previously found no change between 2013/14 and 2014/15, they now find a four percentage point decline - from 11 per cent to 7 per cent - followed by a near-doubling of the rate, from 7 per cent to 13 per cent.


HMRC say that their new methodology takes into account evidence about people who 'falsely deny they smoke'. Rightly so, but estimating how many smokers claim to be non-smokers also involves a large element of conjecture. Does the new methodology get us any nearer the truth? It is hard to say. What is clear is that the figures are highly sensitive to changes in assumptions.

HMRC add their estimate of the illicit market to the legal sales data and conclude that the total number of cigarettes sold in Britain (legal and illegal combined) has fallen from 56 billion in 2009/10 to 38.5 billion. This is a drop of nearly a third (31 per cent) in a period when smoking prevalence has declined by just ten per cent and the population has grown by four per cent. And so the puzzle remains.

A reduction in the number of cigarettes smoked per person offers a partial explanation. The ONS says that average daily cigarette consumption in England fell by two percentage points between 2009 and 2012 (from 14 to 12 for men and from 13 to 11 for women). Its most recent dataset shows a figure of 11 per day (both sexes combined). This suggests an overall decline in cigarette-per-smoker consumption of 18.5 per cent since 2009.

This is a substantial drop but not enough to explain the overall decline in (legal) sales. There were 49 billion cigarettes sold legally in 2009/10. Reducing this by 10 per cent to account for the decline in smoking prevalence takes it down to 44.1 billion.

Reducing that 44.1 billion by 18.5 per cent to take into account lower consumption by smokers gives us 36 billion.

Increasing that 36 billion by four per cent to take into account population growth gives us 37.4 billion.

But HMRC records legal sales of 31 billion in 2015/16.* HMRC reckon that a further 1.5 billion cigarettes were brought in from the EU legally. This takes our 37.4 billion down to 35.9 billion, so we are still five billion cigarettes short of what we might expect, but this could be partially explained by a shift to rolling tobacco. Despite the decline in smoking prevalence, sales of hand-rolling tobacco remain the same as they were in 2009/10.

This is a rough and ready calculation, but it suggests that HMRC's estimate that the illicit trade makes up between 8 per cent and 17 per cent of the cigarette market can be justified, although the real figure seems closer to the high end than the low end. HMRC's mid-point estimate of 7 per cent for the previous year certainly looks implausibly low.

Even if HMRC's mid-point estimate of 13 per cent is correct, the number of illegal cigarettes on the UK market is mind-boggling. It suggests that six billion cigarettes were sold on the black market in 2015/16, along with ten million kilograms of rolling tobacco. That's in addition to 1.5 billion cigarettes and 3.2 million kilograms of rolling tobacco that avoid UK duty by being brought in legally from the EU.

And, to repeat, HMRC's estimates are incredibly sensitive to changes in assumptions. For example, if the average smoker consumes 11.5 cigarettes a day, as opposed to 11.0 cigarettes as assumed above, it leaves another 1.5 billion cigarettes unaccounted for.

We are talking about a serious problem for the government and yet there does not seem to be any serious effort being made to establish the facts. For a relatively small outlay, the government could conduct empty pack surveys and get a better idea of what is going on. Unfortunately, there are perverse incentives at work because some people would rather live in darkness than light a candle. The customs agencies want to be seen to have got a grip on tobacco smuggling and the government (along with anti-smoking groups) wants to believe that it can raise taxes without fueling the black market.

Three things are clear, however. Firstly, that tobacco taxes hit the top of the Laffer Curve in 2012/13 when £9,681 million was raised. Revenues have fallen every year since and stood at £9,485 million in 2015/16, despite higher rates of duty.

Secondly, that whichever methodology is used, the illicit cigarette market has grown in recent years as a share of the overall market. The 13 per cent mid-point estimate in the most recent dataset is higher than it has been for a long time.

Thirdly, that there are reasons to think that even 13 per cent could be a significant under-estimate, but until efforts are made to measure the illicit market properly, no one will know for sure.


* The tobacco tax gap documents says 32 billion, but the tobacco bulletin says 31 billion (30,974 million, to be precise).

Thursday, 23 February 2017

A beer a day keeps the doctor away

You may have read this (now deleted) story at the Telegraph yesterday:

Just half a pint of beer a week increases risk of heart disease - new study

It is the sheerest of bollocks. A perfect storm of incompetence, credulity and incomprehension. I wrote about it for Spectator Health. Do have a read.






Friday, 17 February 2017

Rational alcohol taxation

This week I proposed replacing Britain's perverse system of alcohol duty with a flat tax on units of alcohol. A 9p/unit tax would pay for all the external costs of drinking to the government and would change the tax rates on a range of drinks as follows:


As you can see most - but not all - drinks would become cheaper. This is because drinkers are grossly over-taxed at present (ie. the tax revenue greatly exceeds the costs to public services). Cider, by contrast, is somewhat under-taxed.

You can read the short briefing paper here.

I also wrote about it for the Telegraph...

A new briefing paper from the Institute of Economic Affairs shows what a fair system would look like. British drinkers currently consume approximately 50 billion units of alcohol a year. To recover the £4.6 billion in costs, there should be a flat rate of tax of 9p on every unit of alcohol sold. That would mean a higher tax on some strong ciders and a lower tax on other drinks. Overall, it would mean lower taxes, but even after this reform most of our drinks would still be more expensive than the European average. In the EU-27, the average duty on a pint of lager is 14p (we currently pay 52p) and the average tax on a bottle of wine is 44p (we currently pay £2.08).

This is not the first time the idea of taxing alcohol by the unit has been suggested. Economic think tanks and temperance groups alike have called for the same thing. In 2011, the Institute for Fiscal Studies concluded that "it would seem desirable to treat different types of alcohol in the same way in the tax system" and, in 2016, the Alcohol Health Alliance called on the government to lobby the EU so that "drinks in all categories can be taxed according to their strength". This raises the salient point that EU regulation currently prohibits a sensible system of per-unit alcohol taxation. As luck would have it, this will not be an obstacle for long.

Do have a read.

Thursday, 16 February 2017

People believe poverty has increased because they are misinformed

The usually sensible John Rentoul has produced a very special sentence for the Independent...

So the solution to the puzzle is that, objectively, poverty hasn’t increased, but that people feel it has, which means that, in a way, it has. 

This could be read as the final, feeble pistol shot of the left after years spent predicting an epidemic of poverty due to 'austerity'/the Tories/the bankers that never appeared. In one line, Rentoul seems to have crystallised the left's preference for emotions over facts.

That is unfair, however. Badly worded though it is, Rentoul is making a point that is merely wrong, rather than insane.

It is a reference to the latest version of the Joseph Rowntree Foundation's Minimum Income Standard (MIS) which was published yesterday. JRF claims that 19 million people subsist on an inadequate income and are either in poverty or are 'at risk of poverty'. This is a rise of 4 million since 2008/09.

The MIS is based on what people in focus groups say they need to have an adequate standard of living. This is obviously subjective and, in practice, it is closer to an average standard of living than an 'adequate' one.

For example, here are some of the clothes that a mother of two needs to buy for herself (new) every single year in order to avoid being 'at risk of poverty', according to the MIS:

5 vest tops
4 pairs of jeans
4 jumpers
4 pairs of leggings
1 pair of jogging bottoms
2 summer skirts
2 winter skirts
5 smart tops
2 summer dresses
1 hat
1 scarf
1 pair of gloves
1 swimming costume
1 night dress
1 pair of pyjamas
1 pair of slippers
1 pair of flipflops
1 pair of flat boots
1 pair of heeled boots
1 pair of trainers
1 pair of court shoes

There are other items on the list that need to be bought more or less frequently, but that gives you a illustration. I'm not suggesting that this kind of annual wardrobe change is unusual for a woman, nor am I suggesting that you have to be rich to afford it. But to claim that you need to replace all this stuff every twelve months in order to have an 'adequate standard of living' is a bit of a stretch, in my view. And yet if you can't afford this, you are on the 'brink of poverty', according to the Independent.

I've written about the MIS before and was on the radio talking about it yesterday, so I won't go on about it here. Suffice to say, I don't think it measures poverty. The Joseph Rowntree Foundation also doesn't think it measures poverty and they are happy to confirm this when asked. But they can't stop the likes of The Guardian referring to the MIS as the 'poverty line' and I don't suppose they lose much sleep over people misrepresenting it as such.

Rentoul also interprets the MIS as a poverty line and he cites their figures as evidence that poverty has sort of got worse even though all the official evidence shows the opposite. For instance, here is the Office for National Statistics data showing income growth since 2007/08 (adjusted for inflation). Incomes have grown by 13 per cent in the bottom fifth. Only the richest fifth has seen a decline.


Since the strongest income growth has been in the poorest two fifths, it is hard to believe that four million people have been pushed into poverty an inadequate standard of living. JRF say this is because the cost of their basket of goods has risen by more than the RPI and CPI measures of inflation. I have no way of checking this but it would be surprising if the MIS basket was so dramatically different to the general basket of goods used by the government. It seems to be a partial explanation, at best.

Another explanation is that the JRF report stops at 2014/15 and thereby ignores the sharp rise in incomes seen in 2015/16. It is a shame they didn't wait a bit longer so they could get a more up to date picture (the new figures were published by the ONS last month).

In any case, if I am forced to choose between inflation-adjusted income data from the ONS and a dubious measure of not-really-poverty from JRF, I'm going to stick with the ONS. We know that unemployment is almost at a 40 year low, incomes are at an all-time high and wages grew by 2.6 per cent last year. Relative and absolute poverty are both lower than they were in 2008.

In other words, there is very little supporting evidence for JRF's claims except - as Rentoul points out - people's intuition. Accepting all the ONS evidence, Rentoul asks the question:

So why do people feel that poverty and inequality have become worse?   

In Rentoul's mind, the MIS holds the answer. People are getting wealthier but our definition of poverty keeps changing...

It would seem that the income most people think is needed for an acceptable life has risen faster than incomes generally. So we would now think of someone as “poor” if they cannot afford, say, a dishwasher, when we wouldn’t have thought that was necessary in the 1980s. 

This is true over the long-term, but I don't think the MIS has become conspicuously more generous since 2008/09. Even if it has, I don't think this explains the common belief that there is an epidemic of poverty and inequality.

I think there is a simpler explanation. Since at least 2008, the middle class left - as epitomised by The Guardian and Independent - has been asserting that poverty (a) is getting worse, and (b) will get even worse very soon. At first this was because of the recession - a plausible supposition but one that, broadly speaking, turned out to be false. Then it was because of cuts to public services under the umbrella of 'austerity'. Then it was because of welfare reform. And now it is because of Brexit.

They have been wrong every time for reasons I discussed in this post. There has been no audit of previous failed predictions and it has been remarkably difficult to get the basic facts in front of the public. The people Rentoul is addressing don't 'feel' that poverty has got worse in the sense that they, personally, have been plunged into poverty. They believe poverty has got worse because that has been the implicit or explicit message of the Independent for years.

They are simply misinformed - and they are happy to be misinformed because it suits their view of how the world works. That is why they cling to any crumb of evidence from the Joseph Rowntree Foundation or the Institute for Fiscal Studies while ignoring the Office for National Statistics. They are just wrong. No other explanation is required. People are wrong about all sorts of things and the belief in immiseration is just one of them.

Tuesday, 14 February 2017

The smoking ban miracle hoax

Jacob Grier has written an excellent article for Slate about the junk science used to justify smoking bans. In particular, he looks at the ludicrous heart attack miracles than supposedly take place whenever people are prevented from smoking in pubs.

When studies sampling larger populations finally appeared, the reported declines in heart attacks began to shrink. A study of the Piedmont region of Italy found a much lower decline of 11 percent, though curiously only for residents under 60 years of age. England, which implemented a smoking ban nationwide, presented the first opportunity to study the matter on a national scale. Researchers there credited the ban with a heart attack reduction of just over 2 percent nationwide.

Critics noted that the rate of heart attacks in England had also been falling in the years prior to the ban and that the reason for the decline was still not clear. Regardless, the data there made it obvious that the miraculous reductions claimed in smaller studies were unrealistically high. Even so, despite acknowledging the wide variation in findings and the admitted methodological limitations of the studies, a 2009 meta-analysis conducted by the Institute of Medicine concluded that the impact of smoking bans on short-term heart attack rates was real and substantial: “Even a small amount of exposure to secondhand smoke… can cause a heart attack,” one member of the IOM panel informed the New York Times, urging that “smoking bans need to be put in place as quickly as possible.”
This report had, however, omitted one of the largest studies of secondhand smoke and heart attacks conducted to date. A 2008 study covering the entire country of New Zealand—a population smaller than England’s, but bigger than the American towns previously studied—found no significant effects on heart attacks or unstable angina in the year following implementation of a smoking ban; hospitalizations for the former had actually increased.

Contradictory research continued to come in. A clever study led by researchers at RAND Corp. in 2010 tested the possibility that the large reductions identified in small communities were due to chance. They assembled a massive data set that allowed them to essentially replicate studies like those in Helena, Pueblo, and Bowling Green, but on an unprecedented scale. Whereas those studies had compared just one small community to another, the RAND paper compared all possible pairings of communities affected by smoking bans to all possible controls, for a total of more than 15,000 pairings. They stratified results by age in case there were differential effects on the young, working age adults, or the elderly. And in an improvement on most other studies, they also controlled for existing trends in the rate of heart attacks.

The study found no statistically significant decrease in heart attacks among any age group. The data also suggested that fluctuations in heart attack rates were common, indicating that comparisons of small communities would frequently turn up dramatic reductions due purely to chance; large increases in heart attacks happened about as often. This explained the headline-grabbing dramatic results in places like Helena or Monroe County that eluded replication in larger jurisdictions. The conclusion of the study was blunt: “We find no evidence that legislated U.S. smoking bans were associated with short-term reductions in hospital admissions for acute myocardial infarction or other diseases in the elderly, children or working age adults.”

A 2012 study of six American states that had instituted smoking bans came to a similar conclusion. So did a 2014 study, which is notable for being co-authored by some of the same researchers who had previously published papers suggesting that the Colorado towns of Pueblo and Greeley had experienced reduced rates of heart attacks after implementing smoking bans. When Colorado enacted a statewide ban, the authors had an opportunity to see if their earlier results could be duplicated across the larger population of nearly 5 million people. No effect appeared. As an additional test, they re-examined the data excluding 11 jurisdictions that had already implemented comprehensive smoking bans: The statewide ban still showed no effect.

In the paper’s admirably honest commentary, the authors reflected on the reasons that earlier studies, including their own, had overstated the impact of smoking bans. The first is that small sample sizes allowed random variances in data to be mistaken for real effects. The second is that most previous studies failed to account for existing downward trends in the rate of heart attacks. And the third is publication bias: Since no one believes that smoking bans increase heart attacks, few would bother submitting or publishing studies that show a positive correlation or null effect. Thus the published record is likely unintentionally biased toward showing a larger effect than truly exists.


Do read it all.