Tweedehands grap
Gelukkig zijn er nog artsen die nadenken…
Hoewel de pers massaal, zowel in de VS als in Engeland, meeging in het ongelooflijke verhaal van het ‘Helena Wonder‘, zijn er gelukkig ook medici die zich publiek tegen het onderzoek én de reactie van het CDC uitspreken.
But then, the world has become a cruel place for smokers. Not only must they huddle outside at work to indulge, they increasingly must also huddle outside when they’re enjoying a night on the town. Over a hundred cities in the have banned smoking in public places such as bars and nightclubs. Last month, Ireland banned smoking in pubs. Now Scotland is under pressure to do the same, and the EU is flirting with its own ban.
Volgens het onderzoek, ondersteund door top-anti Stanton Glantz (goed voor 12 miljoen dollar farmaceuten geld voor anti-rokenonderzoek in drie jaar), zou het rookverbod in Helena dus het aantal opnames in het kleine ziekenhuis gehalveerd hebben. De schrijver is het hier niet mee eens:
First of all, the number of patients that St. Peter’s serves is very small, and the smaller the patient population the more likely disease rates will fluctuate just by chance. Take, for example, my own medical practice. I have around two thousand active patients. Most of the time, I have one or two people in the hospital on any given day. But for the past month, for some reason, I’ve been averaging four to six patients a day. Is it something about the way I’m practicing medicine? No. I’m practicing the same way I do when I have no patients in the hospital. It’s just the nature of illness and populations. Every doctor experiences good months and bad months that are more or less random, (except for bad viral seasons, when patient influx is predictable.) It’s not far fetched to think that the same thing is going on at St. Peter’s, and if the study had compared heart attacks year to year, rather than six-month period to six-month period, there might not have been such a large difference.
In het artikel wordt overigens nog iets interessants opgemerkt wat nog niet eerder bekend was. Het ziekenhuis waar de wonderbaarlijke vermindering van opgenomen hartpatiënten plaatsvond had in dezelfde periode haar methode van diagnosticeren van hartaanvallen veranderd, waardoor er logischerwijs minder hartziektes geconstateerd zouden moeten worden omdat deze methode nauwkeuriger was en veel foute diagnoses zou voorkomen:
Another problem with the study is that during the six months of the smoking ban, the hospital changed the way it diagnosed heart attacks. Before the smoking ban, heart attacks were diagnosed by testing for an enzyme called creatine phosphokinase. When the heart is damaged, this enzyme leaks into the blood. However, other muscles can leak this enzyme, too, so relying on it exclusively can result in a certain degree of false positives. During the smoking ban, the hospital began testing for another enzyme, called troponin, and enzyme which is specific to heart muscle, and which improves diagnostic accuracy considerably.
It’s quite a stretch to look at the data from Helena and conclude that thirty minutes of second hand smoke exposure will kill your heart. It’s just too small a sample to make such sweeping conclusions. If banning public smoking really reduced heart attack rates by forty-percent, wouldn’t New York city cardiologists have noticed by now? A forty-percent decrease in business is hard to overlook. And wouldn’t the city’s health department, which believes strongly in the benefits of smoking bans, have noticed, too?
