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ABOUT “B.C. (BRITISH COLUMBIA) BUD
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METHAMPHETAMINE
RELATED ISSUES
2004
ELECTION INFORMATION
Tort
Reform Information
MISCELLANEOUS
ISSUES
SMOKING
ISSUE:
Sheridan
among the Elite Small Towns in America
Congratulations,
Sheridan! You’ve made a Top Small Town list.
You’ve
been named an Agurb®, published in Boomtown, USA: The 7 ½
Keys to Big Success in Small Towns.
What’s
an agurb®, you say? Let me explain the concept of agurbs®,
and then I’ll explain why I chose you as an agurb®.
I
use agurban to distinguish the Sheridans of the world from their
urban and suburban siblings. I coined the term agurb® to describe
a prospering small town outside of a Metropolitan Statistical Area
(MSA). An MSA has at least one city of 50,000 or more or is an urbanized
area with a total metro population of 100,000 or more.
The
key word in that paragraph is prospering. There are nearly 16,000
small towns in rural America; based on the data I studied, 397 of
those towns are alive and well – and, in fact, are typically doing
much better than their urban big brothers and sisters.
To
be an agurb®, a town has to be experiencing growth in population
or employment and in per-capita income. The vast majority of small
towns are striking out in all three categories.
But
not Sheridan. Here are current vitals for Sheridan County/Sheridan
and for the nation.
(Data source: US Census)
Sheridan County/ Sheridan US
Per Capita Income Growth 50.5% 50%
% change in employment 18.4% 13.8%
% change in population 13.7% 13.1%
% change in number of residents with a bachelor’s degree 24.1% 20.2%
I hinted at the 7½ keys in which agurbs® excel. Now let
me briefly describe each one of those keys:
1.
Attitude. Agurbs® adopt a can-do attitude. They see solutions
where others see problems.
2.
Vision. Agurbs® shape a vision for their town, a plan to make
that vision happen, and then they go after it.
3.
Resources. Agurbs® know their strengths and use their resources
to their advantage, leveraging them to build a strong economic base.
Resources include tourist attractions like your many historic places,
museums and theaters. Another resource you have a plethora of is
recreation such as rodeos, Indian wars, polo and Big Horn Mountain.
4.
Leadership. Agurbs® raise up strong leaders and come together
on essential issues. Leadership affects all facets of life in a
small town.
5.
Approach. Agurbs® encourage an entrepreneurial approach in their
business district.
6.
Control. Agurbs® maintain local control, not depending upon
large, bureaucratic organizations halfway across the country to
make their decisions for them.
7.
Brand. Agurbs® build a brand for themselves, so that communities
around them know what their strengths are, what their community
offers to others. Your slogan of “The West at its Best” defines
your corner of the country.
7½.
Teeter-Totter Factor. This is the fine balance between make and
break in a small town. Those towns that succeed are those that can
sense something shifting and can turn a negative into a positive.
You
have much to be proud of, Sheridan. You are one of the diamonds
in the rough, one of the top small towns in America, an agurb®.
Jack Schultz, CEO of Agracel, Inc. in Effingham, IL, is the author
of Boomtown, USA: The 7½ Keys to Big Success in Small Towns
(National Association of Industrial and Office Properties, 2004).
To order the book, go to www.boomtownusa.net.
Jack will be speaking at the Sheridan College C-Tel Center at 6:30
p.m. on Tuesday, March 22.
Analyzing
WyCas Results- Sheridan County School District One
Assessment
Results (My assistant Cara has a packet of assessment results –
graphs and charts - if you are interested in it)
We
are pleased with the recently released results of Sheridan County
School District #1 students on the WyCAS assessment. We are looking
at the results from several perspectives.
1. The state computes 3 year district averages of the percent of
students who are proficient or advanced on the various components
of the WyCAS test.
a. At the 4th grade level there were 3 districts with a higher reading
average, 8 districts with a higher math average, and 3 districts
with a higher writing average.
b. At the 8th grade level there were no districts with a higher
reading average, no districts with a higher math average, and 4
districts with a higher writing average.
c. At the 11th grade level there was 1 district with a higher reading
average, no districts with a higher math average, and 1 district
with a higher writing average.
d. These statistics indicate that our students are doing well when
compared to the state. Additionally, our kids tend to show improvement
as they progress from elementary to middle to high school.
2. We compared the scores of our 2004 11th graders to their scores
as 8th graders in 2001 and also compared the scores of our 2004
8th graders to their scores as 4th graders in 2000 to get a feel
for their progress.
a. 2004 11th graders demonstrated constant achievement in writing,
but did show significant improvement in math and reading.
b. 2004 8th graders showed significant improvement in reading, writing,
and math.
c. The most improvement was seen in math for both groups.
3. While we believe that we are providing an outstanding education
for our students, we understand the need to continually strengthen
our programs. We believe that all teachers must be reading and writing
teachers. Last year we adopted a new reading series at the elementary
level and trained all staff in reading and writing strategies that
will be implemented across the curriculum this year. This year a
new assessment management program will enable us to use data on
student achievement more effectively. We will continue to closely
monitor student progress in the area of language arts.
The Board hired Maryann Foster as the new gifted and talented teacher
for the Big Horn Campus. The Board approved a second gifted and
talented position for the district to enable us to expand the program
Mrs. Foster and Mrs. Maze, our current G/T teacher, will be able
to provide more services both for our enrichment students as well
as for our accelerated students.
Report
of 2004 Special Session
of the Wyoming State Legislature
The Legislature
agreed that Wyoming’s medical care crisis was in need of immediate
attention, thus warranting the recent special session. A major factor
related to the medical malpractice insurance crisis, when the largest
company in Wyoming providing malpractice coverage announced it would
cease business in our state. The medical care crisis includes a
shortage of physicians and availability of certain medical services
affecting access to health care for Wyoming citizens.
By an overwhelming vote of 48 to 12, the House has voted to place
on the November election ballot a question of whether the Wyoming
Constitution should be amended to allow future legislatures to place
a cap or limit on the amount of non-economic damages a person can
recover from a health-care provider in a case of medical malpractice.
The Senate has agreed, and the Governor has firmly stated he is
in favor of placing this issue on the ballot. We are confident this
will happen.
With trust in the voters of Wyoming, we voted for the resolution
which will place the Constitutional question on the ballot. Amending
the Constitution should be a rare and carefully considered decision
to be taken when we, as voters, feel strongly enough to change our
basic laws. We encourage all voters to inform themselves on this
issue and to study how it will affect them.
Many people have said that this proposed change will contribute
to the predictability of awards in malpractice lawsuits and reduce
or stabilize medical malpractice insurance premiums. If so, this
will help keep doctors in Wyoming and help recruit new doctors.
It could mean an eventual reduction in health-care costs.
The Wyoming Legislature has now taken two major steps addressing
the requests to reform our tort system. In March we passed a resolution
placing a question on the ballot as to whether to change the Constitution
to provide for medical review panels, consisting of experts who
would review medical malpractice cases before they might be filed
in court. Prior experience in Wyoming when review panels were used
years ago, as well as experience in other states, indicates that
a review panel can be effective in controlling unnecessary lawsuits
and costs. We believe this is one of the methods to address the
current medical malpractice insurance issue.
The Legislature initiated several other changes including studying
a medical errors commission to decide compensation for malpractice
cases outside the court system, passing bills to improve doctor
and patient communication with the “I’m sorry” bill, increasing
Medicaid payments to nearer market costs for obstetrics, and funding
additional medical students from Wyoming who agree to practice in
Wyoming. Time and scope of what we could consider has been limited
in the short special session.
In the long-term, we will continue to address the basic needs of
Wyoming citizens to have high-quality, affordable, health care available
throughout the state, while ensuring those injured by medical errors
will have the ability to be compensated. We will continue working
to strengthen Wyoming’s health care system to serve the current
and future needs of all citizens.
July 16, 2004
Representative
Rosie Berger, member of Judiciary Committee
Representative
Jerry Iekel, member of Labor, Health and Social Services Committee
Representative
Jack Landon, member of Judiciary Committee
Representative
Doug Osborn, Chairman of Labor, Health and Social Services Committee
Senator John Schiffer,
Chairman of Appropriations
Sheridan
Area Housing Survey Results 2004
Back in March the Sheridan Housing Action Committee (SHAC) distributed
1200 surveys throughout Sheridan County. 785 surveys were returned.
The goal of the survey was to gain a better understanding of annual
income, age, housing needs, and opinion of affordable housing in
Sheridan. To follow is a summary of the topics that need to be further
addressed, along with reoccurring comments from the surveys.
When trying to determine what type of housing is needed in Sheridan
you must first obtain how much income people generate in a year.
The average age of the citizens in this survey was between 26 and
54. According to the survey, 69% of the people in Sheridan have
annual incomes between $25,000 and $60,000. Probably the most important
question on the survey, “Your opinion of affordable housing in Sheridan”
showed 62% of those surveyed said that affordable housing would
be between $80,000 and $120,000.
Along with the questions of income and the prices of affordable
housing, the survey also asked a true, false question of whether
“Sheridan County has enough affordable housing.” The results revealed
that 97% of the people surveyed felt that Sheridan did not have
enough affordable housing. Not only do the people of Sheridan think
that there is not enough affordable housing, but 72% think that
city government does not encourage affordable development, and 78%
of residents feel that county government does not encourage development.
One section on the survey asked people to rate certain topics, they
rated these topics 1-5: 1 being the most important to 5 being the
least important. On the topic of whether Sheridan has a lack of
good paying jobs, 68% answered with a 1 or a 2. Also, 66% of Sheridanites
rated a 1 or a 2 on the question of whether rising real estate costs
were a concern to them. Interestingly, almost three-quarters of
the people in Sheridan do not feel that interest rates are a real
concern right now.
There was also a comment section on the survey that asked the surveyors
what they felt was the biggest obstacle to affordable housing in
Sheridan. Here are some of the reoccurring responses found throughout
the surveys:
? “Get businesses
to move to Sheridan to create jobs. Get City and county to work
with developers to simplify and quicken the development process.”
? “Not enough available (affordable housing) and lack of good paying
jobs.”
? “Lack of recognition, it is needed. Lack of concern. Probably
not funds available.”
? “Good paying jobs. If you can get into a house, afford the house
payment; you can’t afford the utilities and the rise in fuel prices.
If you make less than $10 an hour, even then you can only exist
month to month.”
? “Inflated price of homes.”
?“The biggest obstacle to affordable housing is the influx of out
of state (California) retirees coming in and buying up anything
they want at any price.”
? “ Lack of good paying jobs, there is nothing for college graduates
to come back for. We need more industry!
Attached are the
results from the survey. If you have any questions or comments please
contact:
Marie Lowe marie@eracrc.com
Dixie See dixie@eracrc.com
Janet Hoffman cityplanner@city-sheridan-wy.com
Ray Pacheco rpacheco@sheridancounty.com
Steve Carroll scarroll@fib.com
Lola Lucero lola.luchero@wy.usda.gov
Ten
Reasons To Oppose Medical Malpractice "Reform"
http://www.atla.org/ConsumerMediaResources/Tier3/press_room/FACTS/medmal/tenreasons0504.aspx
Medical
malpractice reform would not reduce the cost or increase the availability
of medical malpractice insurance for doctors. History shows that
limiting the rights of patients injured by medical negligence devastates
patients and their families, but it does nothing to lower malpractice
insurance rates. Even insurers are refusing to promise rate reductions
if Congress passes the bill. If Congress is truly interested in
reducing the costs of medical malpractice premiums, Congress should
regulate the insurance industry.
Arbitrary and discriminatory caps on non-economic damages hurt those
patients with the most serious injuries. Proponents of medical malpractice
reform want to limit non-economic damages to $250,000 in the aggregate,
regardless of the number of parties responsible for a patient"s
injury and regardless of the number of parties against whom an action
is brought. Non-economic damages compensate injured patients for
very real injuries " such as the loss of a limb, the loss of
sight, permanent infertility or even the loss of a child. Damage
caps have a tremendously negative impact on the permanently or catastrophically
injured who are most in need of financial protection for only the
most seriously injured receive damage awards greater than the cap.
Even the AMA has testified that caps affect only those cases involving
severe injury where the victim faces the greatest need for compensation.
When damage caps leave such victims unable to meet the costs associated
with their injuries, the government is often left footing the bill
with taxpayer dollars.
A restrictive statute of limitations cuts off legitimate claims.
A reduced statute of limitations shortens the time that injured
patients and their families have to file claims. Reducing the statute
of limitations is designed to eliminate claims for diseases with
long incubation periods. That means, for example, that if a patient
contracted HIV from tainted blood, but the symptoms of HIV did not
present for at least five years " which often is the case "
there would be no remedy if Congress enacted a two-year statute
of limitations.
In an astonishing display of an arrogant "Washington Knows
Best" philosophy, medical malpractice reform would enact sweeping
preemption of state laws in areas of local responsibility that have
been subject to state autonomy for two hundred years. Medical malpractice
reform would override state laws that protect patients and their
families, while at the same time allowing states to keep in place
their laws that favor doctors, hospitals, nursing homes, HMOs, drug
companies and the makers and sellers of medical devices. Picking
and choosing which state laws to preempt leads to confusion and
litigation over which law, federal or state, applies in individual
cases.
Medical malpractice reform also applies to product liability actions
against the makers and sellers of defective drugs and medical devices.
Even reform proponents can"t argue that limiting product liability
cases against pharmaceutical and medical device manufacturers will
reduce the cost of malpractice insurance.
Medical malpractice reform limits liability for irresponsible owners
and operators of nursing homes. State regulation of the nursing
home industry, including laws that allow patients and their families
to hold nursing home operators accountable for negligent and callous
abuse of the elderly would be preempted and severely undermined.
Medical malpractice reform could apply not only to medical malpractice
actions but to actions against health insurers and HMOs. Since 1997,
eleven state legislatures have passed strong and effective managed
care laws that protect patients and their families from arbitrary
decisions by HMOs that put profits over patient care. Medical malpractice
reform would preempt those laws and say to state legislatures considering
passing similar laws -- "Forget it!"
Medical malpractice reform gives pharmaceutical and medical device
manufacturers a free ride. Medical malpractice reform could completely
immunize from the threat of punitive damages any FDA approved drug
or medical device. Some of the worst harm and most reckless misconduct
in the annals of product liability have involved harm caused by
FDA approved medical devices; many of them gender specific products
that have harmed women. Moreover, even the FDA admits it has fallen
short in "device inspection" and "post market surveillance"
of medical devices.
Non-economic damage caps are unfair to women. Capping non-economic
damages, while at the same time preserving full compensation for
economic loss (such as lost wages and lost salary), shamefully de-values
the worth of homemakers and stay-at-home moms. Moreover, by protecting
medical device manufacturers specifically, the bill favors the makers
of those very products " such as the Dalkon Shield and Copper
7 intrauterine devices " that have caused devastating harm
to women.
Medical malpractice reform makes punitive damages virtually unrecoverable.
Under the bill, plaintiffs would not be permitted to seek punitive
damages at all, except at the discretion of the court. Even when
allowed by the court to seek such damages, plaintiffs would be presented
with an almost impossible burden of proof that would be higher than
under any state law. Finally, even if a plaintiff is allowed to
seek punitive damages, and even if the bill"s heightened burden
of proof is met, punitive damages " even for specific intent
to injure the plaintiff " would be capped.
Updated May 2004
Recognition
Due to the Folks that Make Every Day Life in Sheridan Enjoyable…
Dear Editor:
Take a look around.
The world is full of heroes deserving – and receiving – our recognition.
We often sing the praises of the doctor who cures us, the fireman
who saves us, and the attorney who fights for our rights. But what
about the people that make everyday life enjoyable? What about the
people who watch over the things we all take for granted? I am talking
about your Public Works Department workforce…I call them our “everyday
heroes.”
Most of us do
not give second thought to simply turning on a faucet in order to
have quality drinking water delivered to our homes. Nor do we think
twice about flushing the toilet, or expecting that the bags of waste
we haul to the curbside will be whisked away. We enjoy well-groomed
lands within the City – whether for family barbecues or a few hours
of fun in the park with the kids. And while we are watching much
of our street infrastructure fall apart before our eyes, we have
people who work hard to get another year out of the road. They also
work while we sleep, plowing streets so we can get around in the
winter.
Here are a few
statistics on Sheridan’s Public Works Department. Our Street crew
maintains more than 115 miles of streets (not including alleys).
Our Utilities Maintenance crew maintains 121 miles of water mains
in the City limits of Sheridan (not including pipes serving the
rural water system or the transmission lines that bring water from
the canyon to the City) and 100 miles of sanitary sewer mains. In
2003, our Water Treatment crew treated 1,528,000,000 gallons of
water to provide you with safe reliable drinking water at your faucet.
In 2001, our Wastewater Treatment crew treated and discharged 1,133,400,000
gallons of water into Goose Creek, meeting permit limits to protect
the watershed that runs through and adds to the quality of life
in our community. Our Waste Collection crew consistently and dependably
hauled away 14,000 tons of trash from curbsides throughout the City.
Our Recycling crew handled 756 tons of recyclables in 2003. Our
Landfill crew saw 43,884 vehicles cross the scale in 2003 resulting
in more than 56,000 tons of garbage being discarded and more than
10,000 tons of material being recycled, all while ensuring that
we continue to comply with permit requirements and protect our environment.
Our Parks crew cared for 150 acres of parkland and the trail system.
Our Service Center Shop crew cared for 150 equipment items and vehicles
in the City fleet. Our Cemetery crew cared for 80.28 acres of memorial
grounds and assisted in more than 100 burials in 2003. The crew
at Kendrick Golf Course had the golf course grounds in excellent
shape in 2003 to support a record year of play.
In years of tight
budgets, a lot of pressure is on these crews to “do more with less,”
as if the work itself is not challenging enough. Help me thank Sheridan’s
“everyday heroes” during National Public Works Week. Keep up the
great work, Public Works – we appreciate all you do to improve the
quality of life in our community!
Jackie Flowers
Public Works Director
City of Sheridan
HOW
ACUTE AND REVERSIBLE ARE THE CARDIOVASCULAR RISKS OF SECONDHAND
SMOKE?
Terry
F Pechacek, associate director for science1, Stephen Babb, coordinator,
secondhand smoke work
Correspondence to: T Pechacek TPechacek@cdc.gov
Could eating in
a smoky restaurant precipitate an acute myocardial infarction in
a non-smoker? As unlikely as this sounds, a growing body of scientific
data suggests that this is possible. In this context, the results
of the observational study in Helena, MT are provocative: hospital
admissions for acute myocardial infarction declined by about 40%
during the six months in which a comprehensive local ordinance on
clean air was in effect, and rebounded after the ordinance was suspended.1
Given the small
size and observational design of the study, these findings might
be discounted or even disregarded altogether. However, the study
focuses attention on an interesting subset of literature on secondhand
smoke and its consequences. We now have a considerable amount of
epidemiological literature and laboratory data on the mechanisms
by which relatively small exposures to toxins in tobacco smoke seem
to cause unexpectedly large increases in the risk of acute cardiovascular
disease.2-7
Secondhand smoke
causes coronary heart disease
Exposure to secondhand
smoke increases the risk of fatal and non-fatal coronary heart disease
in non-smokers by about 30%.2 5 8 9 Because coronary heart disease
is a leading cause of death in many countries, even relatively small
increases in risk from this one factor can result in a large population
burden of disease attributable to exposure to tobacco smoke.10 11
While the substantial cardiovascular risks posed by active smoking
are now almost universally accepted, the tobacco industry and some
other observers continue to question the idea that secondhand smoke
can cause cardiovascular disease and death.12-15 Notwithstanding
the substantial clinical and experimental evidence regarding the
adverse cardiovascular effects of exposure to secondhand smoke,
some have argued that an association between low level environmental
exposures and health outcomes should be more critically evaluated,
particularly when the relative risk for the exposure is below 2.0.14
15 In addition, the risk of coronary heart disease associated with
the typical self reported level of exposure to secondhand smoke
(for example, that of a non-smoker living with a smoker) can seem
disproportionate. It is more than one third of the risk associated
with smoking 20 cigarettes a day, even though the measured exposure
to tobacco smoke among non-smokers is only about 1% of the exposure
from smoking 20 cigarettes a day.2 4 5 16 This observation differs
from the case for lung cancer, where the excess risk for exposure
to secondhand smoke reflects a more linear dose-response effect
in comparison with the risk from smoking 20 cigarettes a day.2 4
5 17 While the epidemiological pattern of risks for coronary heart
disease might seem inconsistent with the data on measured exposures,
the emerging understanding of the mechanisms by which exposure to
toxins in tobacco smoke increases the risk of acute myocardial infarction
provides a biologically plausible explanation of the data.3-7 16
18 19
Even small exposures
to tobacco smoke rapidly increase the risk
A substantial
body of epidemiological and laboratory data indicates that, unlike
the case with lung cancer, the risk of acute myocardial infarction
and coronary heart disease associated with exposure to tobacco smoke
is non-linear at low doses, increasing rapidly with relatively small
doses such as those received from secondhand smoke or actively smoking
one or two cigarettes a day.3 4 5 At higher levels of exposure from
active smoking (for instance, five to 20 cigarettes a day), the
risk of coronary heart disease increases more slowly and in a more
linear way.2 8 9 Consistent with the epidemiological findings both
for active smoking at lower numbers of cigarettes a day and for
exposure to secondhand smoke, laboratory data suggest that even
small exposures significantly and rapidly increase platelet aggregation
and induce other arterial and haemodynamic changes.5-7 16 18 19
An acute myocardial infarction is commonly precipitated by the activation
and aggregation of platelets and the resulting formation of a thrombus
or clot that obstructs the arterial blood supply to part of the
heart.4 5
Other mechanisms
that increase the overall risk of acute myocardial infarction and
coronary heart disease, such as reduced high density lipoprotein
cholesterol and increased carboxyhaemoglobin concentrations, have
been shown to have a more linear dose-response relation with exposure
to tobacco smoke.5 Secondhand smoke has a small effect on several
of these other mechanisms, but the risk they impart is much more
substantial for the dose of toxins delivered by active smoking (for
example, from smoking five or more cigarettes a day).
Law and Wald have
produced a conceptual model that integrates epidemiological risk
data for ischemic heart disease or coronary heart disease for active
exposure and exposure to secondhand smoke (figure).5 In this model,
it is estimated that a large proportion, and particularly the more
acute aspects, of the risks from exposure to the toxins in tobacco
smoke come close to peaking at relatively low levels of exposure,
increasing little with exposure to higher levels of active smoking.5
Research has identified the likely mechanisms, including thrombosis,
endothelial dysfunction, and inflammation, by which smoking causes
acute cardiovascular events.
A recent epidemiological
study found that, compared with unexposed non-smokers, non-smokers
exposed to secondhand smoke had higher blood chemistry values related
to these types of mechanisms—including white blood cells, C reactive
protein, homocysteine, fibrinogen, and oxidised low density lipoprotein
cholesterol concentrations—and that the values for these biomarkers
of inflammation were similar to those observed in active smokers.20
Additionally, laboratory data suggest that even 30 minutes of exposure
to a typical dose of secondhand smoke induces changes in arterial
endothelial function in exposed non-smokers of a magnitude similar
to those measured in active smokers.21 Finally, data on smokers
indicate that the risks of sudden death and acute myocardial infarction
decline within days or months after smoking cessation.2-3 5 22 Hence,
these data and reviews of the laboratory findings on mechanisms3-7
16 18 19 indicate that short term reductions in acute myocardial
infarction events after reductions in exposure to low doses of toxins
in tobacco smoke are biologically plausible.
Smoke-free policies
effectively reduce exposure
The US Surgeon
General has concluded that exposure to secondhand smoke is a common
public health hazard that is completely preventable.23 Exposures
can be dramatically reduced by eliminating smoking in all enclosed
public places and workplaces 24-27 and by encouraging smokers to
adopt smoke-free rules in their homes and cars.28 Primarily due
to the changes in smoke-free policies in the United States, cotinine
concentrations (a tobacco specific biomarker of exposure) decreased
substantially among non-smokers from 1991-4 to 1999-2000, dropping
58% for children, 55% for adolescents, and 75% for adults.29 However,
even with this reduction in exposure, the current estimate is that
in the United States secondhand smoke still causes over 35 000 deaths
from coronary heart disease each year.30
Need for replication
of results
Although the results
of the study by Sargent and colleagues1 are consistent with the
literature on the risks of acute myocardial infarction associated
with secondhand smoke, the study has some important limitations.
Firstly, it contains no data on actual exposures to secondhand smoke
among residents or cases, and thus no data on the changes in exposure
to secondhand smoke that may have occurred after the policy was
implemented. It might be reasonable to assume that levels of important
smoke toxins within public places in Helena covered by the ordinance
dropped dramatically. This effect has been observed in other locations
where similar policies have been implemented, with air quality measurements
showing 80-90% declines in public places.25-27 Even if such declines
also occurred in Helena, some proportion of non-smokers would still
have been exposed in their homes, cars, or other enclosed places
not covered by the ordinance. Thus, without more data, the proportion
of non-smokers in Helena among whom exposures were significantly
reduced during the six months that the ordinance was in effect cannot
be known.
A second concern
is that the geographical isolation of the city, while making this
type of study feasible, also resulted in a small number of admissions
for acute myocardial infarction. As reported elsewhere, the typical
number of acute myocardial infarction events per month before the
ordinance was only about six or seven and was highly variable, with
the actual number per month ranging from none to about 10-12.31
Although conservative statistical analyses were applied to these
data, due to the small number of events and the lack of data on
changes in active smoking, random variation and factors other than
secondhand smoke exposure may have contributed to the findings.
Finally, the observed
effect (a decline of an average of 16 admissions for acute myocardial
infarction for a six month period) was substantially greater than
what might be expected. With smokers accounting for 38% of the admissions,
we can estimate that about 25 admissions (40x0.62 = 24.8) were among
former and never smokers during the equivalent six month period
before the ordinance. Even assuming that the proportion of acute
myocardial infarction cases among smokers was fairly constant across
time, that all non-smokers were frequently exposed to secondhand
smoke in public places, that virtually all this exposure was eliminated
by the ordinance, and that all coronary heart disease risk related
to this exposure was immediately reversed among non-smokers (that
is, that risk dropped from 1.3 to 1.0), the maximum impact on admissions
for acute myocardial infarction would be predicted to be about 18-19%
(0.30x24.8 = 7.44; 7.44/40 = 18.6%) during the six months that the
ordinance was in effect. Taking all of the above assumptions and
issues into consideration, a more conservative estimate of the predicted
reduction in acute myocardial infarction events might be 10-15%.
The authors suggest that the smoke-free ordinance may also have
reduced exposure to secondhand smoke among smokers, as well as encouraging
smokers to stop smoking or reduce consumption. No data are provided
to support this suggestion, but such changes in active smoking could
have contributed to some declines in admissions for acute myocardial
infarction. Recent reviews and studies have found that the implementation
of smoke-free policies typically reduces consumption and promotes
cessation among smokers.23-25 32-34
The small number
of acute myocardial infarction events in this study produced a wide
95% confidence interval in the analysis that includes the conservative
estimate of a 10-15% reduction. The width of the confidence interval
underscores the importance of additional, larger studies that could
replicate the findings of the Helena study1 and provide more stable
estimates of the effect size. Because it would be unethical to conduct
a randomised trial that assigned adults at high risk of cardiovascular
disease to either frequent exposure to secondhand smoke or no exposure
and then compared their rates of acute myocardial infarction, we
must rely on observational studies. Sargent et al's study suggests
that future observational studies should be conducted in larger
geographical areas where "before-after" trend analysis
and the comparisons with "control" areas can be performed
with adequate power to detect even a 10% reduction in acute myocardial
infarction events. Additionally, future observational analyses should
seek to obtain data on actual exposure to secondhand smoke before
and after policy changes in order to document how much exposures
have declined among residents overall and among non-smokers admitted
for acute myocardial infarction.
People at risk
of coronary heart disease should avoid exposure to secondhand smoke
Even without future
studies or replications of these findings1 the data are sufficient
to warrant caution regarding exposure to secondhand smoke.2 23-24
Clinicians should be aware that such exposure can pose acute risks,
and all patients at increased risk of coronary heart disease or
with known coronary artery disease should be advised to avoid all
indoor environments that permit smoking.3 5 16 Additionally, the
families of such patients should be counselled not to smoke within
the patient's home or in a vehicle with the patient. In addition
to its impact on heart disease, exposure to secondhand smoke causes
lung cancer in non-smokers, respiratory infections and asthma in
children, and even death in exposed infants.2 17 30 As the US Surgeon
General and the US Community Preventive Service Task Force have
noted,2 23 24 much of this important health risk is preventable
by the implementation of comprehensive smoke-free policies similar
to the policy that was implemented in Helena for six months. Additional
studies are needed to confirm how much the exposure to the toxins
in tobacco smoke among non-smokers at risk for acute myocardial
infarction and coronary heart disease can be reduced by the implementation
of such comprehensive smoke-free policies and to confirm that such
reductions in exposure can decrease rates of acute myocardial infarction.
If future studies replicate the positive results from the Helena
study, the public health implications would be dramatic; thousands
of acute myocardial infarction events among non-smokers in countries
around the world could potentially be prevented each year.
SMOKING
OUT BAD SCIENCE
By Lorraine
Mooney
Copyright 1998 Dow Jones & Co., Inc.
Wall Street Journal - European Edition (March 12, 1998)
http://www.junkscience.com/news/euwsjets.htm
For the past 15
years the anti-smoking lobby has pushed the view that cigarette
smoking is a public health hazard. This was a shrewd tactic. For
having failed to persuade committed smokers to save themselves,
finding proof that passive smoking harmed non-smoking wives, children
or workmates meant smoking could be criminalized. Last week the
science fell off the campaign wagon when the definitive study on
passive smoking, sponsored by the World Health Organization, reported
no cancer risk at all.
But don't bet
that will change the crusaders' minds. smoking, like fox hunting,
is something that certain factions want to ban simply because they
don't like it. It has slipped from a health crusade to a moral one.
Today, National No smoking Day in Britain will be marked by demagoguery
from the Department of Health, which has already set its agenda
to ban smoking. The U.K. Scientific Committee on Tobacco or Health
(SCOTH) report on passive smoking, due out Thursday, is headed by
a known anti-tobacco crusader, Professor Nicholas Wald of the Royal
London School of Medicine.
However, it is
now obvious that the health hazard of environmental tobacco smoke
(ETS) has been knowingly overstated. The only large-scale definitive
study on ETS was designed in 1988 by a WHO subgroup called the International
Agency on Research on Cancer (IARC). It compared 650 lung-cancer
patients with 1,542 healthy people in seven European countries.
The results were expressed as "risk ratios," where the
normal risk for a non-smoker of contracting lung cancer is set at
one. Exposure to tobacco smoke in the home raised the risk to 1.16
and to smoke in the workplace to 1.17. This supposedly represents
a 16% or 17% increase. But the admitted margin of error is so wide--0.93
to 1.44--that the true risk ratio could be less than one, making
second-hand smoke a health benefit.
This is what anyone
with common sense might have expected. After all, the dose makes
the poison. But in 1988, IARC decreed mainstream tobacco smoke as
a carcinogen, fully expecting that the second-hand product would
have a similar, lower effect which would be capable of measurement
by linear extrapolation. In anticipation of confirmation of this
belief many countries have been adopting anti-smoking policies in
the name of public health. The U.S. Environmental Protection Agency
has confidently stated that 3,000 Americans die annually from inhaling
environmental tobacco smoke, and the state of California leads the
pack with a total smoking ban in all public places enacted on Jan.
1, 1998. Although Iran did enact such a ban in 1996, this was overturned
as unconstitutional. The Indian city of Delhi has a smoking ban
and Britain is working toward one.
Before the IARC
study, no other reliable study on ETS was available. For the effect
of the modestly increased risk of ETS to be detected, the number
of cases in the study must be very high in order to distinguish
the effect from other background noise. Acting in the most unscientific
manner, the U.S. EPA decided to pool results of 11 studies, 10 of
which were individually non- significant, to arrive at a risk ratio
of 1.19. As is always a problem with this kind of meta-analysis,
the studies were all different from each other in various ways so
that they were not measuring the same thing.
Last October,
the British Medical Journal ran the results of a similarly flawed
study by SCOTH's Mr. Wald claiming an increased risk of lung cancer
from ETS of 26%. It was supported by an editorial and timed to coincide
with noise from the anti-smoking lobby and a Department of Health
press release, talking of "shocking" figures and alluding
to innocent victims. The Wald report has been dismissed as a "statistical
trick" by Robert Nilsson, a senior toxicologist at the Swedish
National Chemicals Inspectorate and a professor of toxicology at
Stockholm University. He says that there are so many unacknowledged
biases in Mr. Wald's analysis that the alleged risk figure is meaningless.
For example, Mr. Wald relies on data from the memories of spouses
as to how much their dead partner used to smoke. Survey bias is
often considerable, potentially far higher than the 26% estimate
of increased risk, but this is not even mentioned by the authors.
Mr. Nilsson also explains that Mr. Wald's meta-analysis has pooled
data from non-comparable studies. His most stinging criticism is
aimed at the BMJ editorial board, who he considers must be "innocent
of epidemiology" to have allowed publication of the Wald paper
in its existing form. Nevertheless the U.K. SCOTH inquiry into ETS
due to report on Thursday, with Mr. Wald at the helm, will probably
ignore the flaws of the Wald study and brand ETS a killer.
New Labour has
done a U-turn on fox hunting. Will it do one on Thursday when SCOTH
reports? Or will it ignore the best evidence and press on with public
smoking bans? My guess is that two climbdowns in a month is one
too many. It will remind us all this week that smoking is bad for
you and eventually ban it in public.
Ms. Mooney
is medical demographer for the Cambridge-based European Science
and Environment Forum.
BANNING
OUTDOOR SMOKING IS SCIENTIFICALLY JUSTIFIABLE
http://tc.bmjjournals.com/cgi/content/full/9/1/98
Repace JL. Tobacco
Control 9:98 (2000).
Simon Chapman
has argued that smoking should not be banned in outdoor public venues
such as hospital patios, beaches, and outdoor sporting areas, and
this might also encompass building entrances, waiting lines for
cinema tickets, and outdoor cafés. However, failure to ban
smoking in such venues may expose nonsmokers to secondhand smoke
(SHS) levels as high or higher than received in indoor spaces where
smoking is unrestricted. The reality of atmospheric dispersion of
SHS outdoors is this: Individual cigarettes are point sources of
air pollution; smoking in groups becomes an area source. Outdoor
air pollutants from individual point sources are subject to plume
rise if the temperature of the smoke plume is hotter than the surrounding
air; however if the plume has a small cross-section, as for a cigarette,
it will rapidly cool and lose its upward momentum, and then will
subside as the combustion particles and gases are heavier than air.
Thus, in the case of no wind, the cigarette plume will rise to a
certain height and then descend, and for a group of smokers, for
example sitting in an outdoor cafe, on a hospital patio, or in stadium
seats, their smoke will tend to saturate the local area with SHS.
In the case where there is wind, the amount of thermally-induced
plume rise is inversely proportional to the wind velocity -- doubling
the wind velocity will halve the plume rise. In this case, the cigarette
plume will resemble a cone tilted at an angle to the vertical. The
width of the cone and its angle with the ground will depend upon
the wind velocity: a higher wind will create a more horizontal cone,
a smaller cone angle, and a higher concentration of SHS for downwind
nonsmokers. If there are multiple cigarette sources, the downwind
concentrations will consist of multiple intersecting cones, i.e.,
overlapping plumes. As the wind direction changes, SHS pollution
will be spread in various directions, fumigating downwind nonsmokers.
SHS contains a large quantity of respirable particles, which can
cause breathing difficulty for those with chronic respiratory diseases
or trigger an asthmatic attack in those with disabling asthma. For
the rest of us nonsmokers, SHS causes eye, nose, and throat irritation,
just like any other noxious outdoor fume such as bus exhaust. Hospital
orderlies, sports spectators, outdoor cafe aficionados, and beachgoers
might have to be restricted to the ranks of the non-asthmatic. Have
you ever had a dinner in an outdoor cafe in Paris, Athens, Las Palmas,
or Salt Lake City spoiled by smokers at adjacent tables? Have you
ever had to move your blanket on a public beach because someone
suddenly started smoking upwind, replacing clean salt air with irritating
smoke? Smoking has no social value other than to create unnecessary
work for physicians, and windfall profits for morticians. Even if
outdoor secondhand smoke were no more hazardous than secondhand
dog excrement stuck to the bottom of a shoe, in many places laws
require dog owners to avoid fouling public areas. Is this too much
to ask of smokers?
