Human Nature: Science, Technology, and Life.

POTUS Smokes

In today's article on tobacco regulation, I wrote that President Obama was still apparently a nicotine addict. When a reporter asked yesterday whether Obama was still smoking, his press secretary answered, "He struggles with it every day."

This afternoon, shortly after the article was posted, Obama was asked at a press conference, "How many cigarettes a day do you now smoke? Do you smoke alone or in the presence of other people? And do you believe the new law should help you to quit? If so, why?" He replied:

The new law that was put in place is not about me. It's about the next generation of kids coming up. So I think it's fair, Margaret, to just say that you just think it's neat to ask me about my smoking as opposed to it being relevant to my new law. But that's fine. I understand. ... It's an interesting human interest story.

Look, I've said before that as a former smoker I constantly struggle with it. Have I fallen off the wagon sometimes? Yes. ... Am I a daily smoker, a constant smoker? No. I don't do it in front of my kids. I don't do it in front of my family. And, you know, I would say that I am 95 percent cured. But ... there are times where I mess up.

Two things in this answer are worth noting. One, the president denied smoking daily but didn't deny smoking. He said, "I don't do it in front of my family," not "I don't do it." It's reasonable to infer that he isn't just using some kind of smokeless tobacco or nicotine-replacement therapy. He's been smoking outright, albeit privately and infrequently.

Second, he's completely wrong to suggest that questions about his own tobacco use are irrelevant to the law he just signed. Drug policy has to be realistic. It has to work with human nature. If the president of the United States, blessed with all the quitting resources anyone could ask for, still can't control his addiction without the aid of nicotine gum, that's worth taking into account as he and others shape tobacco policy. And if he's still smoking cigarettes because gum alone isn't doing the job, that's just as important to know. We have to understand exactly what aspects of the smoking experience are addictive. Otherwise, we can't effectively modify or regulate it.

So stop pretending your smoking habits are nobody's business, Mr. President. You gave up that defense when you signed yesterday's bill.

Tobacco Regulation vs. The Drug War

If you want to know what Obama really thinks about tobacco, don't read his lips. Read his teeth. To relieve his addiction and protect his health, he's been chewing nicotine gum. The law he just signed authorizes the FDA to expedite approval of nicotine lozenges, gum, and patches. It encourages the agency to broaden the grounds for prescribing such products and to authorize their "extended use." It puts regulators smack in the middle of the nicotine business so they can turn it to better use. If only all our drug policies were this rational.

More here.

The Threat From Below

Will the next attack on the United States come from submarines?

When I asked that question seven years ago, the model I had in mind was the Tamil Tigers, a terrorist group infamous for naval suicide strikes. A Tiger supporter had recently been caught building a submersible vessel.

Last month, the Tigers were wiped out by the Sri Lankan military. But the technology they were developing, submersibles, has caught on. "U.S. law enforcement officials say that more than a third of the cocaine smuggled into the United States from Colombia travels in submersibles," the Washington Post reports. "U.S. officials and their Colombian counterparts have detected evidence of more than 115 submersible voyages since 2006," and "U.S. officials expect 70 or more to be launched this year."

Why submersibles? They're hard to detect and easy to sink. The Post explains:

Until recently, submariners caught by authorities could not be charged in the United States or Colombia if the cocaine was scuttled. "The vessels are built to sink. When they open the valves, tons of water come in, and in a minute, or a minute and a half, they sink," [a Colombian admiral] said. "There is no evidence, and what starts as a counterdrug operation becomes a rescue operation." ... "With no drugs found, we couldn't prosecute," said [an] assistant U.S. attorney. At least eight crews have been returned to Colombia after rescue, without being charged.

Is it expensive to sink your own sub? Not if you're a drug lord. Each sub costs about $1 million to produce. The crew gets $500,000 or less. A recent 6.4-ton payload of cocaine was worth more than $100 million. As a percentage of the gross, subs are so cheap that they're routinely scuttled anyway.

That's the genius of submersibility. Several months ago, during the Israeli invasion of Gaza, we explored the terrestrial underworld of the Gaza tunnels. The tunnelers were developing a three-dimensional way of thinking about land: While one side built walls and stationed soldiers above ground, the other side went down 60 feet and dug past those barriers.

The nautical underworld is even better. You don't have to dig. You just glide. Even the semisubmersible crafts built by the drug lords are low enough to evade radar. And underwater, you can do something else that can't be done on land: dump your contraband and let gravity take it beyond your enemy's reach. No evidence, no conviction.

To stop this tactic, Congress recently enacted the Drug Trafficking Vessel Interdiction Act of 2008, which declares that anyone operating "any submersible vessel or semi-submersible vessel that is without nationality ... with the intent to evade detection, shall be fined under this title, imprisoned not more than 15 years, or both."

Maybe that law will deter submarine drug commerce. But what about submarine terrorism? Ultimately, "U.S. officials fear that the rogue vessels could be used by terrorists intent on reaching the United States with deadly cargos," the Post reports. In fact, "Colombian officials say some former military personnel might be helping to design, construct and direct the vessels" used by the drug lords. If so, all that's needed is a financial lure from al-Qaida to build a vessel for a different mission.

It might not be a suicide mission, either. Drug submersible builders are "trying to develop a remote-controlled model," according to officials contacted by the Post. Two men were arrested last year, apparently while peddling this technology. No crew necessary. Just pack the radioactive bomb aboard your craft, slip it underwater, and hit any coastal target.

Think about that the next time you take off your shoes at an airport security gate. If we expect the next 9/11 attack to come from the sky, we may be looking the wrong way.

Illustration by Mark Alan Stamaty.

The Challenge of Electronic Cigarettes

Let's be blunt about what's going on here. We tolerated smoking until science proved it was harmful to nonsmokers. As momentum grew, the war on smoking became cultural, with disapproval and ostracism of anyone who lit up. Electronic cigarettes have removed the war's scientific basis, but our cultural revulsion persists. Therefore, so does our prohibition and condemnation.

More here.

Marijuana: Spray or Vapor?

Lots of readers responded to yesterday's piece on the transformation of marijuana. I had focused on the drug's evolution from an herb to a powder, a capsule, and finally a spray. But Bruce Mirken of the Marijuana Policy Project says the spray has already been eclipsed by a better way to filter and deliver the drug's therapeutic benefits: vaporization.

Mirken points to several recent studies exploring the vapor method. First, a 2006 article from the Journal of Pharmaceutical Sciences:

What is currently needed for optimal use of medicinal cannabinoids is a feasible, nonsmoked, rapid-onset delivery system. Cannabis "vaporization" is a technique aimed at suppressing irritating respiratory toxins by heating cannabis to a temperature where active cannabinoid vapors form, but below the point of combustion where smoke and associated toxins are produced.

Second, a 2007 report in Clinical Pharmacology & Therapeutics

on the absorption of THC from marijuana inhaled via the Volcanos vaporizer system compared to smoking marijuana cigarettes. We found that THC levels were generally similar over 6 h for the two types of delivery. The vaporizer was associated with higher plasma THC concentrations at 30 min and 1 h compared to smoking at each THC strength, suggesting that absorption was faster with the vaporizer.

Absorption rate is important because it helps you control the drug's effects. The more quickly you feel the effects of an initial dose, the more quickly and accurately you can figure out whether you need more to get the requisite pain relief and, if so, how much. Otherwise, you might overdose before you realize it (although, even in that event, a THC overdose isn't that bad).

The 2007 paper continues:

Whereas smoking marijuana increased CO [carbon monoxide] levels as expected for inhalation of a combustion product, there was little if any increase in CO after inhalation of THC from the vaporizer. This indicates little or no exposure to gaseous combustion toxins. Combustion products are harmful to health and reflect a major concern about the use of marijuana cigarettes for medical therapy as expressed by the Institute of Medicine. Although we did not measure other combustion products such as polycyclic aromatic hydrocarbons and oxidant gases, the observation of little or no CO exposure suggests little or no exposure to these other compounds. The vaporizer was well tolerated, with no reported adverse effects. Most subjects preferred the vaporizer compared to marijuana smoking, supporting its potential for medical therapy.

Finally, Mirken cites a 2007 study in the Harm Reduction Journal, showing

that respiratory symptoms like cough, phlegm, and tightness in the chest increase with cigarette use and cannabis use, but are less severe among users of a vaporizer. ... The odds ratio suggests that vaporizer users are only 40% as likely to report respiratory symptoms as users who do not vaporize, even when age, sex, cigarette use, and amount of cannabis consumed are controlled. The use of cigarettes in conjunction with cannabis exacerbated symptoms, as found in previous work.

So that's the case for vaporization. As to GW Pharmaceuticals' claim that its spray formulation helps patients "obtain symptom relief without experiencing a 'high,'" Mirken cites the spray's package insert, which says:

SATIVEX has two principal active components: THC and CBD. ...THC is a psychotropic agent which may produce physical and psychological dependence and has the potential to be abused. ... THC has complex effects on the central nervous system (CNS). These can result in changes of mood, decrease in cognitive performances and memory, decrease in ability to control drives and impulses, and alteration of the perception of reality, particularly altered time sense.

The company's argument is that Sativex

is composed primarily of a 1:1 ratio of two cannabinoids—CBD ... and THC. ... The CBD:THC formulation is believed to enhance the pain relief of THC while modulating the unwanted psychotropic and other THC-related side effects, such as tachycardia. The spray delivery system keeps THC from entering the blood too rapidly and also minimizes the development of unwanted psychotropic effects.

I don't see a claim here that the 1:1 ratio in Sativex has any direct effect on whether you get high. The effect seems to be through ad hoc dosage control by the patient, known as self-titration. And if that's the case, then preventing "THC from entering the blood too rapidly" is problematic, since, as we discussed above, it makes it more difficult to monitor and adjust your dosage.

I'll let science sort this one out. Thanks for the studies comparing marijuana vaporization to smoking. Vapor wins. Now let's see studies comparing vapor with spray.

Taking the Fun Out of Marijuana

GW Pharmaceuticals, a British company, has just requested European approval of Sativex, a "cannabinoid pharmaceutical product." ... Drugs can be, and are being, reengineered every day. Nicotine and caffeine appear in new forms. Cannabis is an herb, then a powder, then a capsule, and now a spray, with significant chemical adjustments along the way. How do you fight an enemy that keeps changing? How do you recognize when it's no longer your enemy?

More here.

Collective Drug Surveillance

Does surveillance of individual drug abuse bother you? How would you feel if the surveillance were collective?

Thanks to increasingly sophisticated detection methods, we can now track drug abuse city by city, simply by monitoring the air and water. Here's a report flagged in Human Nature two years ago:

The test ... seeks out evidence of illicit drug abuse in drug residues and metabolites excreted in urine and flushed toward municipal sewage treatment plants. ... Preliminary tests conducted in 10 U.S. cities show the method can simultaneously quantify methamphetamine and metabolites of cocaine and marijuana and legal drugs such as methadone, oxycodone, and ephedrine. ... "Because our method can provide data in real time, we anticipate it might be used to help law officials undertaking surveillance to make intervention or prevention decisions or to decide where to allocate resources. ..."

Last year, Italian scientists found ways to detect metabolites for cocaine in the Po River, giving law enforcement officials more accurate estimates on cocaine use in the area. The U.S. Office of National Drug Control Policy has obtained samples from a dozen different waterways in an effort to assess illegal drug use, as well.

And here's an update posted Wednesday by Agence France Presse:

Spanish scientists have detected the presence of cocaine in the air of Madrid and Barcelona. ... The scientists looked for 17 components in five different types of illegal drugs—cocaine, amphetamines, opiates, cannabinoids and lysergic acid. The results revealed cocaine is the predominant drug in the air of the two cities, the CSIC institute said. ... The study is the result of the first use of a new method for the detection of drugs in the air. ...

Such mass sampling can reveal behavioral trends, as the AFP report notes:

The scientists also reported a higher concentration [of drugs in the air] during the weekend, "suggesting higher consumption this time."

... while at the same time "preserving the anonymity of individuals," according to water surveillance experts.

I don't see a problem with this. In fact, it strikes me as a welcome alternative to more intrusive detection methods. Do any of you libertarians disagree?

No Taxation Without Legalization

The latest on marijuana, courtesy of the Associated Press:

Gov. Arnold Schwarzenegger says California should study other nations' experiences in legalizing and taxing marijuana, although he is not supporting the idea. He says it's time to debate proposals such as a bill introduced in the Legislature earlier this year that would treat marijuana like alcohol. Assemblyman Tom Ammiano, a San Francisco Democrat, says taxing marijuana at $50 per ounce would bring more than $1 billion a year to the state. Schwarzenegger said during a Tuesday news conference that "it's time for debate" on the idea. But he warned against making harmful decisions just for the sake of raising money. He said some other nations have had negative experiences.

This is the logical next step toward legalization. As the Washington Post noted last month, pot is already "available as a medical treatment in California to almost anyone who tells a willing physician he would feel better if he smoked," and it's being "retailed over the counter in hundreds of storefronts" in Los Angeles alone. Furthermore, the state already "collects $18 million in sales taxes from marijuana dispensaries." But $1 billion? (Actually, state officials who support legalization estimate the take at around $1.3 billion.) Now you're talking.

You know how it is: Teenagers have trouble saying no to drugs; politicians have trouble saying no to money. But this is just another rationalization we're reaching for as we gradually concede pot's legality. By the time the "studies" invited by various governors are in, the revenue question will be less pressing, and the public will have become that much more used to the idea.

The Mainstreaming of Marijuana

Six signs that pot is being legalized de facto, courtesy of articles published this month by the Washington Post and New York Times:

1) 13 states have legalized medical marijuana. ...

2) [M]arijuana is now available as a medical treatment in California to almost anyone who tells a willing physician he would feel better if he smoked. Pot is now retailed over the counter in hundreds of storefronts across Los Angeles. ...

3) U.S. Attorney General Eric H. Holder Jr. announced that the Drug Enforcement Administration will no longer raid such stores.

4) [G]overnment surveys show that 100 million Americans have smoked pot or its resin, hashish, in their lifetimes, and 25 million have done so in the past year.

5) [A]dmission of marijuana use by the Olympic gold medalist Michael Phelps was largely forgiven with a shrug.

6) [W]ith the recession prompting bulging budget deficits, some legislators in California and Massachusetts have gone further, suggesting that the drug could be legalized and taxed ...

[I]n California, pot is such a booming growth industry that lawmakers are being asked to consider its potential as a salve to the state's financial woes. Betty Yee, chairman of the California State Board of Equalization, endorsed a bill in February to regulate the estimated $14 billion marijuana market, citing the state's budget problems. California currently collects $18 million in sales taxes from marijuana dispensaries, and Yee said a regulated pot trade would bring in $1.3 billion.

Together, these developments convey the steady demise of the pot taboo. We don't really think marijuana use deserves prosecution. We're looking for ways to rationalize its legalization. One rationale is medical, and we don't seem to care much that this is largely a fraud. Another is financial: We know pot smoking is ubiquitous, so we might as well get some public revenue from it.

My guess is that criminal laws against marijuana use have become culturally untenable. At this point, if you want to maintain criminal laws against more dangerous drugs, you're better off conceding the legality of marijuana, lest the public lose respect for drug laws in general.

Anti-Theft Drugs

Can a drug cure the urge to steal?

It looks that way. In the April 1 issue of Biological Psychiatry, scientists from the University of Minnesota School of Medicine report:

An 8-week, double-blind, placebo-controlled trial was conducted to evaluate the safety and efficacy of oral naltrexone for kleptomania. Twenty-five individuals with DSM-IV kleptomania were randomized to naltrexone (dosing ranging from 50 mg/day to 150 mg/day) or placebo. ... Subjects assigned to naltrexone had significantly greater reductions in ... stealing urges (p = .032), and stealing behavior (p < .001) compared with subjects on placebo. Subjects assigned to naltrexone also had greater improvement in overall kleptomania severity ... Naltrexone demonstrated statistically significant reductions in stealing urges and behavior in kleptomania.

It sounds like an April Fools' joke. But it isn't. In an interview with Reuters, the study's lead author explains that naltrexone "gets rid of that rush and desire" to steal.

Naltrexone is better known as a drug for alcohol or drug addiction. Many of us, while accepting these addictions as diseases, continue to regard theft as a matter of personal responsibility. Should we rethink that distinction? If the same drug relieves both conditions, should we take kleptomania more seriously as an illness?

The floor's open.

Chewers Don’t Quit

Can smokeless tobacco coax people away from cigarettes?

I've written several posts defending that possibility. But a new report from the National Survey on Drug Use on Health blows a huge spitball of chaw all over the idea. Here's the key paragraph from Smokeless Tobacco Use, Initiation, and Relationship to Cigarette Smoking: 2002 to 2007:

Combined 2004 to 2007 data indicate that, among persons who had used both smokeless tobacco and cigarettes in their lifetime, 31.8 percent started using smokeless tobacco first, 65.5 percent started using cigarettes first, and 2.7 percent initiated use of smokeless tobacco and cigarettes at about the same time ... Some initiates of smokeless tobacco use may be cigarette smokers who are substituting smokeless tobacco as a way to quit smoking. Among daily smokers who initiated smokeless tobacco use, 88.1 percent were still smoking daily 6 months later.

That's pretty damning. To begin with, smokeless tobacco seems to be luring people to cigarettes at nearly half the rate it's luring people from cigarettes. Not the world's greatest bargain. But the killer number is that 88 percent. If smokeless tobacco is just supplementing cigarettes instead of helping smokers quit, then it makes no sense as an avenue for improving public health.

Am I looking at the data the wrong way? Should I be more excited about the 12 percent who went smokeless and dumped the death sticks? Let me know.

I'm still open to alternative mechanisms for delivering nicotine and weaning people off smoking. But if the tobacco industry wants any slack in selling these products, it had better work on them until they show results in terms of smoking reduction. The fist of Big Brother is coming down on cigarettes all over the world. If you tobacco shareholders want a viable business model for the future, squeeze your company's executives harder to ditch the smoke and the carcinogens.

Bong vs. Bottle

Is pot worse than booze?

This AP story about the Michael Phelps brouhaha caught my eye yesterday. The Marijuana Policy Project is organizing a boycott of Kellogg's for dumping Phelps over his pot use. I'm tempted to join it.

Last summer, just after Phelps won eight gold medals in Beijing, Kellogg's announced, "HE'S GR-R-R-EIGHT! U.S. OLYMPIAN MICHAEL PHELPS TO BE FEATURED ON PACKAGES OF KELLOGG'S FROSTED FLAKES AND KELLOGG'S CORN FLAKES CEREAL." The company's vice president for global promotions gushed, "Michael embodies the values behind our Frosted Flakes Earn Your Stripes program. He knows that winning is not just about the glory that comes with gold medals, but about good sportsmanship, working hard and being your best."

Then, two weeks ago, Phelps got caught smoking marijuana at a party. Kellogg's promptly dumped him. "Michael's most recent behavior is not consistent with the image of Kellogg," the company declared.

Not consistent? The real inconsistency, MPP's Bruce Mirken argued in an AlterNet commentary, was in the company's treatment of marijuana and alcohol. "In 2004, Phelps pleaded guilty to drunken driving," Mirken pointed out. "But apparently that offense—just as illegal, and which actually could have resulted in someone being hurt or killed—was not an issue for Kellogg's." Mirken continued:

[M]arijuana is far safer than alcohol. Alcohol is more addictive. According to the Institute of Medicine, 15 percent of those who ever drink become dependent on alcohol. The figure for marijuana is just 9 percent. ... Alcohol is massively more toxic. Every year, people die from alcohol overdoses. ... And the chronic effects of heavy alcohol use—e.g. liver damage—kill thousands upon thousands more. There has never been a medically documented marijuana overdose. ... And unlike marijuana, alcohol tends to make users reckless, aggressive and violent. A review in the journal Addictive Behaviors explained, "Alcohol is clearly the drug with the most evidence to support a direct intoxication-violence relationship."

The man has a point, doesn't he? Isn't tobacco worse than pot? And isn't alcohol in some ways as bad as tobacco?

Here's the sign-up page for the Kellogg's boycott. Personally, I plan to salute the company's morals by sitting down with a bowl of Special K, floating in Jim Beam.

Tobacco Without Nicotine

For the last two days, we've been talking about how to take the smoking out of nicotine. How about taking the nicotine out of smoking? Can it be done?

Actually, scientists are already beginning to do it. The latest report, by Kazufumi Yazaki and colleagues, appears in this week's Proceedings of the National Academy of Sciences. They identify a gene, Nt-JAT1, that controls nicotine distribution in tobacco plants. "We will proceed now with experiments to raise tobacco plants that have no nicotine in their leaves," Yazaki tells the Daily Telegraph.

Great. But wait a minute. What exactly will this accomplish?

"There are a lot of people who want to quit and have tried to stop, but say they miss the sensation of having a cigarette in their mouth," Yazaki argues. Tobacco modified to block or eliminate the key transporter gene could produce nicotine-free cigarettes. These would give you the smoke you crave without further addicting you to nicotine. Yazaki thinks this will help people quit.

Really? Low-tar, low-nicotine cigarettes have been around for a long time. Smokers are now suing tobacco companies for marketing these cigarettes as relatively safe. The suit says that to get the same nicotine fix from low-nicotine cigarettes, smokers "unconsciously engage in compensatory behaviors" such as smoking more sticks, inhaling more deeply, or delaying exhalation. So nicotine reduction doesn't end up reducing the damage. And remember, these cigarettes are low-nicotine and low-tar. A low-nicotine, regular-tar cigarette would, on this theory, cause even greater damage, since you'd have to inhale more carcinogens to get the same fix.

On the other hand, there's some evidence that smokers wouldn't compensate this way. And, as we discussed yesterday, nicotine replacement therapy operates on the principle that some addicts can gradually reduce their nicotine consumption till they're off the drug altogether. But nicotine replacement products don't just deliver the drug. They change the delivery system. They get rid of the cigarette.

That's where the nicotine-free tobacco project really breaks down. Yazaki's team thinks "it would also be good for nonsmokers if tobacco smoke did not contain nicotine." Well, maybe. But what really endangers and angers nonsmokers is the smoke, not the nicotine. If you just block the nicotine gene in tobacco plants, you aren't touching the delivery system or the carcinogens. Smokers are still smoking, the rest of us are still inhaling the smoke, and we're still getting sick. It's great that you're taking away the product's chemical addictiveness. But that's just another reason to ban smoking everywhere, as we're already doing. Smokers won't need it, and the rest of us can't stand it.

In short, nicotine-free cigarettes don't make sense as a business plan. Yazaki says that his research grant is about to run out and that he's thinking of asking Japan Tobacco to sponsor him. Good luck with that. Addiction is what makes tobacco such a profitable business. Eliminate the nicotine, and the pusher loses his grip on the "consumer." That's why tobacco companies are trying to do exactly the opposite: keep the nicotine while eliminating the cigarette.

Nicotine-free tobacco may end up doing the world a lot of good. But if so, that good won't come from cigarette production. It'll come from the use of tobacco plants to make medical products such as insulin and vaccines. Take out the nicotine, take out the carcinogens, and tobacco is a different animal—or, rather, a different plant—altogether. Put that in your pipe. And don't smoke it.

Drugs vs. Drugs

Yesterday we talked about the tobacco industry's escape from the anti-smoking movement. The escape relies on two factors: that tobacco can be engineered into new, smokeless forms, and that the core of the tobacco business is addiction, not cancer.

One way to defeat the industry is by using the same factors. You isolate tobacco's addictive ingredient, nicotine, and engineer it into new forms. But instead of engineering the dose to sustain addiction, you design it to gradually liberate the addict.

Case in point: Barack Obama. Last week in the Wall Street Journal, Melinda Beck advised him to break his cigarette habit by turning to alternative nicotine products.

Nicotine soothes the primitive fight-or-flight response while focusing attention, and it releases dopamine like a pleasurable reward. Nicotine withdrawal can make it harder to think, concentrate and remember, as well as causing irritability, impulsiveness and aggressiveness. ... Nicotine-replacement therapy—with gum, lozenges, a patch or an inhaler—can alleviate those withdrawal symptoms, provided you're getting enough. You've been chewing nicotine gum for months now, but researchers have found that some smokers need more nicotine replacement than others to stop their cravings.

Nicotine alone is better than any tobacco product with residual carcinogens. As Beck points out: "Overdosing on nicotine replacement can make you feel nauseous and light headed and raise your heart rate, but it doesn't appear to cause cancer; it's the tar and various additives in tobacco that do that."

Does nicotine replacement work? Sometimes yes, sometimes no. A study of 3,300 smokers, published in the February issue of the American Journal of Preventive Medicine, found that quitting rates were low but that nicotine gum helped significantly. The study was double blind, randomized, and placebo-controlled.

Subjects were instructed to gradually reduce their smoking while increasing their gum use over the course of up to 8 weeks. Once they had achieved initial abstinence (no smoking for 24 hours), gum was to be used in accordance with the current FDA-approved directions for cessation. The study was conducted under over-the-counter conditions, with no counseling provided.

The results:

Though most study participants failed to quit completely, those who used the nicotine gum were more successful—with 26 percent achieving total abstinence within eight weeks of treatment, compared with 18 percent in the placebo group. Among those quitters, nicotine-gum users were more than twice as likely to stay continuously abstinent for a month afterward—10 percent, versus 4 percent of those in the placebo group. ... Six percent of nicotine-gum users were continuously abstinent for six months, while the same was true of 2 percent of smokers in the placebo group.

Guess who funded the study? GlaxoSmithKline. Why? Because it engineers and sells nicotine replacement products. This is the drug war of the future: the addiction industry vs. the pharmaceutical industry. Both sides sell drugs. Both design their drugs to work with the physiology of addiction. If we're lucky and the tobacco industry continues to move away from cigarettes, the nicotine war won't be about cancer anymore. It'll be about liberation from addiction.

Tobacco's Great Escape

The war on tobacco is advancing. Smoking is losing. But tobacco is escaping.

How? Look at two articles published yesterday. A front-page story in the New York Times examined a new smoking ban in Belmont, Calif., which forbids lighting up even in your own apartment. The rationale: Smoke from your apartment drifts into your neighbors'. Studies have shown that secondhand smoke harms others. Science is dissolving the distinction between your space and mine.

So tobacco is doomed, right?

Wrong. Smoking may be doomed, but tobacco is evolving into more elusive prey. Or, perhaps I should say, a more elusive predator. As Kevin Helliker reports in the Wall Street Journal, the industry is going smokeless.

Altria Group Inc., the nation's largest cigarette maker, this month completed its $10.3 billion purchase of UST Inc., the biggest smokeless-tobacco maker and owner of the Copenhagen and Skoal brands. Reynolds American Inc., which owns Conwood Co., a discount smokeless purveyor, this month announced that the Camel Snus brand has performed well enough in test markets to warrant national distribution.

Consumers—heck, let's just call them what they are, addicts—seem to be going with the transition. According to Helliker:

[M]ore Americans are continuing to give up smoking, helping to push cigarette consumption down about 3% each year. ... Morgan Stanley estimates that U.S. consumers spent $4.77 billion on smokeless tobacco in 2007 versus $78 billion on cigarettes. Smokeless-tobacco sales have been increasing about 5% or more a year. ... "There are probably in excess of 400,000 adults switching to smokeless each year," says Seth Moskowitz, a spokesman for Reynolds American.

Two months ago, I called smokeless tobacco "carcinogenic, addictive, and gross." But guess what? It's becoming less gross:

For many people, smokeless tobacco conjures up an image of a wad of chewing tobacco bulging from the cheeks of users who spit brown juice. Instead, recent products consist of dissolvable pellets or tiny pouches of tobacco that reside invisibly in the mouth and induce no spitting.

And it's becoming less carcinogenic:

One recent study showed that some newer brands, with names like Ariva, Camel Snus and Marlboro Snus, have sharply lower levels of a dangerous carcinogen than do older varieties of smokeless tobacco, such as Copenhagen and Skoal. Britain's Royal College of Physicians, which sets health standards in the United Kingdom, has said smokeless tobacco is between one-tenth and one-one thousandth as hazardous as smoking, depending on the specific product.

So now we're down to addictiveness. And that, too, is adjustable:

The December study also found that Marlboro Snus contained a very low level of nicotine. By contrast, Camel Snus offers a jolt of nicotine that "has the potential to satisfy those smokers who are looking for a substitute to smoking, and to keep them addicted to this product," the authors said.

Which leaves us with two very tough questions. First, does society have any business restricting tobacco products purely on grounds of addiction? New regulations in Boston protect "the younger population" by forbidding the sale, at colleges and professional schools, of "any substance containing tobacco leaf, including but not limited to cigarettes, cigars, pipe, tobacco, snuff, chewing tobacco and dipping tobacco." Does that make sense, even when the products are dissolvable pellets increasingly purged of carcinogens? And if addiction per se is evil, what about caffeine?

Second, should we even want to purge the nicotine from tobacco? The aforementioned study (which, according to Helliker, was federally funded and performed by scientists with no financial connections to the tobacco industry) implies, sensibly, that the less nicotine you put in a smokeless product, the less likely it is to "satisfy" nicotine addicts and lure them away from cigarettes. We permit and even encourage the use of nicotine gum and lozenges to wean people from smoking. What exactly is the moral difference between a lozenge and a pellet?

Tobacco is evolving and escaping for two fundamental reasons. One is that it can be engineered into new forms. The other is that the problem targeted by legislation—the weed's tendency to cause cancer—isn't essential to the tobacco business. What's essential to the tobacco business is addiction. Addiction is a nasty business, deliberately enslaving people while pretending that they "choose" the product. But if you're going to target that practice, then you'd better come and take all the coffee and Diet Coke from Slate's Washington office. We have some "younger" folks here.

Slate V's Grand Unified Weekly: A NASA scientist's dire warnings, prenatal screening for autism, and measuring virtual gravity

Unsmoke

Be careful how you justify a war on drugs. Drugs can be modified so that your arguments no longer apply.

That's what the anti-tobacco movement is now learning. In state after state and country after country, smoking has been banned in public places: bars, restaurants, even apartment buildings. Everywhere, the rallying cry for these measures is that other people have a right not to breathe your smoke. Smoking is harmful to them, so you have to stop.

Except now you don't have to. You can keep using tobacco, but in a way that doesn't get into other people's eyes, throats, and lungs. The Associated Press reports:

[T]he folks who created Joe Camel are hoping Camel Snus will become a hit with tobacco lovers tired of being forced outside for a smoke. ... Snus—Swedish for tobacco, rhymes with "noose—is a tiny, tea bag-like pouch of steam-pasteurized, smokeless tobacco to tuck between the cheek and gum. Aromatic to the user and undetectable to anyone else, it promises a hit of nicotine without the messy spitting associated with chewing tobacco. ... With more public bans on puffing, [tobacco companies] say smokers need socially acceptable alternatives. ... "There's no secondhand smoke. There's no spitting. We see it as a win-win," says [an R.J.] Reynolds spokesman.

Undetectable to anyone else. No secondhand smoke. There goes your rationale for ordering people to stop using tobacco. "At least two tobacco companies besides Reynolds are also test-marketing snus," says the AP. What are you going to about it? What can you say?

In the AP article, public health advocates try to make a case against snus. It's "a second addiction," they argue. It can cause cancers of the mouth and pancreas. It's just an industry scheme to find "replacement smokers" for the millions of customers its death sticks have killed.

Well, good luck with those arguments. Of course snus is addictive, but that alone isn't sufficient grounds for banning things. As for its health effects, even the top scientist at the American Cancer Society tells AP, "If all smokers switched to snus tomorrow, in a few years we'd certainly see less heart disease, less lung disease and fewer cancers." And why exactly should we be upset if the tobacco industry has figured out a way to keep itself alive by keeping its customers alive?

I'm not endorsing snus. It's carcinogenic, addictive, and gross. I'm just not sure those are good reasons for restricting it the way we've restricted cigarettes. And I say this as a lockstep fascist for laws against smoking in public. If you aren't smoking—if you're just sucking, or whatever it is—I don't really see what basis I have for making you take your bad habit elsewhere.

If, on the other hand, you're a nonsmoker who's aggressive enough to wage a cigarette-like war on snus, where will you stop? Do you imagine that tobacco and its core product, nicotine, won't be engineered into new forms? Already, AP reports that Reynolds is "developing dissolvable tobacco strips, orbs and sticks that it will start test-marketing early next year in Portland, Indianapolis and Columbus, Ohio." Are you going to ban strips and orbs?

Look, I'm no fan of drugs. I don't even drink coffee. My advice is to stay away from all tobacco products. But if you choose a tobacco product that basically leaves me alone, I'll show you the same courtesy.

The Future as We Don't Know It

I just got back from a talk by David Friedman at the Cato Institute. Fascinating guy, thinks a mile a minute. He must have spat out 100 provocative ideas in his half an hour or so. I can draw you a mental picture of him pretty quickly: bubbly, balding, not much over five feet tall, wears a backpack over his tweed jacket (did I mention the "recreational medievalism"?) and asked the audience whether anybody could give him a ride to Charlottesville tonight. There's still time--if you're going from D.C. to Charlottesville, try him at DDFr@DavidDFriedman.com.

Friedman touched on a range of topics covered in his new book, Future Imperfect. I haven't read the book yet, but he gave a pretty good sense of it. Here's the Cato summary (the podcast will be up later):

[Friedman] looks at a variety of technological revolutions that might happen over the next few decades, their implications, and how to deal with them. Topics range from encryption and surveillance through biotechnology and nanotechnology to life extension, mind drugs, virtual reality, and artificial intelligence. One theme of the book is that the future is radically uncertain. Technological changes already begun could lead to more or less privacy than we have ever known, freedom or slavery, effective immortality or the elimination of our species, and radical changes in life, marriage, law, medicine, work, and play. "If it can be done, it will be done," David Friedman has said. "So the interesting thing to me is not what should you stop but how do you adapt." We do not know which future will arrive, but it is unlikely to be much like the past.

In short, the book covers nearly everything Human Nature covers but with a libertarian bent. Which is sort of my bent, too, except that I'm less theoretically confident than Friedman is--or, to put it the other way, I'm more daunted by practical developments. Three years ago, for example, I wrote a series based on the idea that scientists would try to grow embryos beyond the conventional two-week limit, raising icky possibilities. The scenario made sense to me at the time, but in the three years since, it hasn't happened. A theorist would say, well, it'll happen eventually. I'm not so sure. My reaction is: Maybe I was just wrong.

So this is what I asked Friedman: Is there a contradiction between his technological optimism and his premise of radical uncertainty? When I say optimism, I don't mean a belief that technology will be good; I mean a belief that it will work. His talk was full of bold scenarios: conquering aging, developing artificial intelligence 100 times smarter than us in the next 30 years, and administering mind-control drugs that induce credulity. I agree that these scenarios are fascinating, and when I first came into this field, I took them very seriously. But everywhere I look, the news is telling me another story. The story is that in many fields, and in biology in particular, causality is turning out to be way more complex than we anticipated. The immediate manifestation of that complexity is that even our most conventional attempts to manipulate biology are producing unexpected and often decisive ill side effects.

Take the most obvious case: drugs. Friedman talked about three classes of mind drugs: those for pleasure, those for performance, and those for controlling other people. I've been to visionary or bioethics conferences where theorists have talked up these drugs and how cool or scary they'll become in the near future. But look at the news: Drugs are being restricted or pulled off the market because they're inducing ugly side effects. Not just drugs for the body, like Vioxx, but drugs for the mind, like Chantix. Steroids are boosting athletic performance but causing violence and circulatory trouble. Marijuana is being linked to heart attacks, brain shrinkage, and psychosis. I had high hopes for Bremelanotide, a new sexual-dysfunction drug, aka aphrodisiac. But last year its developer, Palatin Technologies, had to abandon that project due to "blood pressure increases" in some study participants. The company now touts the drug for "organ protection." It's turning out to be very hard to tinker with one function of the mind or body without affecting others.

Friedman's reply to all this was that we do better off "on net" by encouraging biotechnology than by limiting it, and that proposals to restrict it should be subject to the same skepticism that we might apply to the technology itself. That makes sense to me. Still, it's just a political answer. It doesn't address the underlying question of how soon--or even whether--biotechnology will achieve its promises.

I agree with Friedman that the future is radically uncertain. Too uncertain, in fact, to count on its arrival in the form that he envisions--or I do--anytime soon.

Is Food Addictive?

The war on junk food is forging ahead. New York, Philadelphia, and Boston have banned trans fats. New York is forcing restaurants to post calorie counts. Britain has outlawed junk-food ads during kids' TV shows. South Korea's capital has banned soda from schools. Berkeley and other jurisdictions have prohibited new fast-food restaurants in certain neighborhoods, and last year, Los Angeles considered doing the same.

When I first outlined this crusade, I said it would rely on three arguments: that we should protect kids, that fat people are burdening the rest of us, and that junk food isn't really food. All of those arguments are certainly in play.

But a fourth argument has joined the mix as well: Junk food, like cigarettes, is addictive and should be similarly regulated. Initially, this was just a metaphor. Now it's becoming more than that. Scientists are trying to show that food literally addicts you like drugs.

Two days ago, Alain Dagher and colleagues from the Montreal Neurological Institute published a study in Cell Metabolism on the effects of ghrelin, a hormone associated with appetite. They concluded that "metabolic signals such as ghrelin may favor food consumption by enhancing the hedonic and incentive responses to food-related cues." The word addiction never appears in the journal article, but it's all over the spin and the coverage. Here are excerpts. Keep an eye on the phrases I've bolded.

First, the press release from Cell Metabolism:

The reward centers linked to ghrelin in the new study are also those involved in drug addiction. "That shows it's reasonable to think of high-calorie food as having addictive potential," Dagher said. If so, he suggests that the results could provide the basis for new policies aimed at treating fast food more like cigarettes—for instance, banning its sale in school cafeterias.

Here's the press release from MNI:

The study supports the view that obesity must be understood as a brain disease and that hunger should also be looked at as a kind of food addiction. Obese individuals may eat too much largely due to excess hunger. Dr. Dagher and colleagues found that ghrelin worked on regions of the brain known to be involved with reward and motivation, the same regions implicated in drug addiction. ... "These areas work together to assign incentive value to objects in the world and to actions, and exert very powerful control over our behavior. They are all targets of addictive drugs (like cocaine and nicotine), and are also targets of feeding signals like ghrelin," explains Dr. Dagher. ... This research may also inform public policy. If food is thought of as potentially "addictive," this would support action to limit or ban fast food from schools and junk food advertisements geared toward children, in the same way that results proving nicotine to be addictive spurred the current public policy toward nicotine.

In the Telegraph of London, Dagher links tobacco, cocaine, and chocolate:

Interestingly, the brain response to smoking pictures (in smokers) is very similar to the brain response to food pictures. In a previous study from our research unit, the brain response to eating chocolate was similar to the response to cocaine (in cocaine addicts). Finally, the evidence that high calorie foods are, in a way, addictive (something soft drink and fast food merchants have known for years) provides a justification for public policy.

In fact, Dagher suggests that food addiction may be the basis for drug addiction, rather than the other way around. Here's his interview with LiveScience:

"One theory is that addictive drugs act on brain systems designed to control food intake," Dagher said. "Our brains didn't evolve to make us vulnerable to addictive drugs." Neuroscientist and psychologist Dana Small at the John B. Pierce Laboratory affiliated with Yale University, who did not participate in this study, said these findings suggest it might make sense "to use what we know about drug addiction to understand and treat obesity." It may be reasonable to think "of high-calorie food as having addictive potential," he added. "If food can be thought of as 'addictive,' this supports doing things like banning fast food shops from schools, or advertising junk food to children. Note that public policy aimed at tobacco was really spurred by the science showing that nicotine was addictive."

In a HealthDay wire story, Dagher combines the addiction and harm arguments to make a direct case for regulating food like tobacco:

[I]t makes sense to think of appetite as a kind of addiction. So, if we want to address the fact that obesity is now the number one killer in the world, we're going to have to tackle the problem in the same way that we tackle cigarette smoking.

Scientifically, the evidence for food addiction isn't nearly this simple. Endocrinologist Barbara Kahn points out:

Overeating and drug addiction may converge on some of the same neurons. But other pathways are also involved. And from a biochemical point of view, the two are not the same thing. Drug addictions are much stronger. So to suggest that they are the same makes people feel that they can't do anything about overeating. That it's out of their control. So, I don't really buy that parallel. There may be aspects of overeating that may be related to aspects of addiction. But overeating is not just another addiction.

As a scientific matter, I suspect that Kahn is right and that Dagher is overselling the data. But as a media matter, simplicity beats complexity, and a good metaphor wins every time. Just look at the headline on New Scientist‘s report: "Stomach hormone turns hungry people into junkies."

As neuroscientists focus their attention on obesity, you can expect to see more studies comparing food cravings to drug addiction. As these studies accumulate, you can expect to hear them cited in campaigns to regulate junk food. But the people pushing this analogy had better hope the science is exaggerated. Because if we really do crave junk food the way addicts crave drugs, good luck prying those cheeseburgers from our hands.

Condoms, Needles, and Iranian Moderates

This morning's news brings a face-slapping AFP story from the land of the mullahs: Iran is setting up vending machines to sell condoms and syringes. The country's drug czar tells its state news service that the machines will be in shelters for addicts: "Condoms, syringes, bandages and plasters will be easily accessible just by inserting a coin. This protects addicts from acquiring AIDS and hepatitis." Cost per item: about 5 cents.

Yes, you read that right: The country that brought you fundamentalist theocracy, Middle East proxy wars, presidential Holocaust denial, an implacable nuclear weapons program, and hundreds of days of Americans held hostage is practically throwing needles and rubbers at junkies.

Why? First, because living under a fundamentalist theocracy evidently doesn't make you any less likely to get hooked on drugs. Iran estimates that some two million of its 71 million people are regular users. We're talking pot, heroin, morphine, and opium. The country consumes some 700 tons of drugs from Afghanistan alone.

Second, because even a fundamentalist theocracy has to deal with reality. According to the AFP report:

Condoms are freely available in Iranian pharmacies. The Islamic republic in the 1990s started actively promoting contraception as it encouraged families to have just two children to prevent the country's population growth increasing further. Iran has tried to change its approach to drug addicts by treating users as "people who need help" rather than throwing them into already overcrowded jails.

How do you like that? On drugs and HIV, the United States has been out-liberalized and out-pragmatized by the right wing of the Axis of Evil.

No moral equivalence intended, but ... speaking of holocaust denial ...