It all began in June of last year, when the people of Helena, Mont. went to the polls and voted to ban smoking in bars, restaurants and casinos.
The ban received more than 60 percent of the vote, but no sooner had Helena residents begun putting out their cigarettes, than doctors at Saint Peter's, the town's local hospital, began to notice a dramatic drop in the number of heart attack patients coming through the emergency room's doors.
"We had predicted to see 56 heart attacks in the six months that the ordinance was in effect," says Dr. Dick Sargent. "We, in fact, saw 24."
The tremendous size and speed of the drop, greater than 50 percent in just over a month's time, even came as a surprise to Sargent, on the chief proponents of the Helena Smoking Ban.
"We turned an ordinance on and the heart attack rate went down," Sargent says. "Nothing else changed. Nothing else changed. If you look at the surrounding communities, the number of heart attacks didn't wiggle. It wasn't an environment thing. Something changed in Helena."
But the ban's skeptics were quick to doubt this phenomenon. To them it seemed incredible, even impossible, that a simple change in the law could have such an immediate impact on public health, so Sargent and his colleagues decided to analyze the numbers they were seeing.
Rather than focus on long-term harm caused by smoking, such as lung cancer or emphysema, their study tracked the fast-acting effects tobacco smoke can have on smokers, and the people around them.
They discovered that just 30 minutes of exposure to secondhand smoke can make the cells in your bloodstream more sticky, so you're more prone to blood clots, and once an artery is totally blocked, a heart attack quickly ensues.
While Sargent acknowledges that the study is only a preliminary indicator of the impact of Helena's smoking ban, he and his colleagues still firmly stand behind their findings and turned to other medical professionals to back them up.
"In Helena you had this nice, crisp situation," says Stanton Glantz, head of the Center for Tobacco Research and Education at the University of California, San Francisco. "It's what scientists call a 'natural experiment.'"
You might expect the story to end there, with Helena's smoking ban firmly in place and the number of heart attacks sharply reduced, but just as soon as the smoking ban hit the books, it caught fire. Helena residents quickly found themselves consumed by a debate over what matters most — saving lives, or saving livelihoods.
"It was awful," says Greg Straw, manager of the Montana Nugget Casino, of the day the smoking ban went into effect. "It was an immediate loss of business…huge…it was…it was your worst nightmare come true."
Greg's business dropped 30 percent in the first month of the ban, and he wasn't alone. Across town, bar owner Laura Fix was reporting losses of her own.
"Sales were down $57,000 in the five-and-a-half months (the ban) was in effect," Laura recalls. "But we couldn't pack it in. We have debts to repay."
Mark Staples, a lobbyist for the Montana Tavern Association, came to the defense of bar owners like Laura Fix and Greg Straw.
"[The tavern owners] shouldn't be the arbiters of social conduct that is otherwise permissible," Mark says. "Why stick it on these people? Customers are there on their own free will. The health thing is optional.
"It's optional whether somebody goes in, exposes his or herself to something that people are telling them is unhealthy. On the other hand, the loss of money is not an optional. It's immediate and it carries a lot of impact."
"At some point, you have got to have some ethics," he says. "It is not alright to murder for profit. It's not right to poison people for profit, and that's their argument. They have to be allowed to continue poisoning people, even when we've demonstrated an immediate effect of it."
After facing legal challenges from business owners, the City of Helena suspended its ban on smoking. Then, in April, the Montana legislature passed a bill overturning the Helena ordinance. It was as if the whole thing never happened. Or was it?
Just weeks after the ban was suspended, doctors say they saw the number of heart attacks bounce back to levels they hadn't even seen before the ban.
"[Heart attack rates] stayed down until after the ordinance was suspended," says Sargent. "And then almost as soon as it was suspended it went right back up to exactly where we predicted it would have been."
Montana Governor Judy Martz finds these numbers difficult to believe.
"I don't believe that statistically you can create a fact, a good solid fact, in six months," she says. "Maybe a year, two years, three years down the road, if you've got more than one group of people doing the studies, then I think you've got some solid scientific evidence."
"We'd have been happy to have an ordinance for two years and compare those numbers," Sargent retorts. "We wanted a year. We didn't get it. We took advantage of what we got."
So now it's the smoker's turn. Chances are it won't last because while the law books may soon need hinges attached their spines, for Helenains, choosing life or livelihood is no open and shut case.
For Further Information:
The American College of Cardiology
Stanton Glantz's TobaccoScam website
Homepage for Montana Governor Judy Martz
City of Helena
Protect Montana Kids
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