A study by a pair of Helena doctors showing that the incidence of heart attacks in Helena dropped measurably during the six months the city's smoking ordinance was in effect was to be published today by one of the world's most respected medical journals.

The British Medical Journal, the journal of the British Medical Association, was to release today on its Web site, www.bmj.com, results of the study by doctors Robert Shepard and Richard Sargent of Helena, along with Stanton Glantz of the University of California-San Francisco, showing that from June through November of 2002, heart attack admissions at St. Peter's Hospital dropped 40 percent among Helena residents.

The paper will be published in the weekly journal itself in about three weeks. The BMJ reaches around 100,000 doctors in Britain and another 14,800 around the world.

The study cautions that while the sample size is small, the drop in heart attacks was significant.

"We thought all along this was a really big deal, and the fact that a worldwide, top-flight journal took it speaks to two things," Shepard said. "One, the statistics are important, and two, the topic is so timely, with so many communities and countries around the world looking at smoke-free ordinances."

The final paper used a different method of statistical analysis than the original study released by the doctors a year ago, and shows a smaller drop in the number of heart attacks -- 40 percent, versus the 60 percent originally reported.

"I've said all along that it doesn't matter whether the drop is 60 or 80 or 40 percent," Shepard said. "The important thing is, the drop isn't zero."

"What's the exact right answer? I don't know," Sargent said. "I can tell you with confidence that it's between 24 and 87 percent. It will take four or five more studies to figure that out, and they will have to be done in communities bigger than Helena."

The BMJ peer reviews all the material it receives, according to spokesperson Emma Dickinson. She said around half the submissions are rejected after an initial in-house review by two medical editors. Papers getting through that stage are sent to one or more external reviewers selected from the journal's database of some 4,000 experts.

Papers that still appear publishable after outside peer review are subject to further screening by a committee consisting of two practicing clinicians, one or two editors and a statistician.

The publication comes days after the Republic of Ireland banned smoking in all workplaces, including restaurants and taverns. Shepard said he hopes doctors there will try to repeat the Helena study on a larger scale.

Helena's ordinance was shelved by a city court decision in December 2002 claiming that the enforcement mechanism was unconstitutional. The doctors' research showed that the number of heart attacks here dropped when the ordinance was in place, then returned to previous levels when the ordinance was suspended.

For both local doctors, the publication was personally satisfying.

"It's thrilling," Sargent said. "If you had told me, when I graduated from medical school, that I would have a paper published in the British Medical Journal, I'd have laughed at you."

John Harrington can be reached at 447-4080 or john.harrington@helenair.com.