Human Nature: Science, Technology, and Life.

Hooked on Soda Taxes

When taxes on cigarettes were first proposed, the revenue was supposed to be used to help smokers quit and to prevent others from starting. But it didn't take politicians long to siphon the money away for other purposes. Now state governments count on cigarette revenue to help fund their budgets. We've all become nicotine-dependent.

Like the tobacco-tax movement, the soda-tax movement began with a rationale of preventing and curing addiction. And like the tobacco-tax movement, it's evolving into a revenue addiction.

More here.

The Fresca Rebellion

It's the left that's turning conservative. Well, not conservative, but pushy. Weisberg put his finger on the underlying trend: "Because Democrats hold power at the moment, they face the greater peril of paternalistic overreaching." Today's morality cops are less interested in your bedroom than your refrigerator. They're more likely to berate you for outdoor smoking than for outdoor necking. It isn't God who hates fags. It's Michael Bloomberg.

More here.

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.

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.

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.

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.

The Gambling-Addiction Defense

Chalk up another victory for the gambling-addiction defense.

Yesterday, attorneys for Tim Donaghy, the former NBA referee who admitted to betting on basketball games he officiated, filed a psychological "evaluation" that blames his crimes on compulsive gambling. The author is Stephen Block, a gambling treatment counselor. Sample quotes from the evaluation, as reported by the Associated Press: 1) "In my professional opinion, Mr. Donaghy would never have committed these offenses if he was not a pathological gambler." 2) "His gambling history demonstrates the need to gamble to fulfill the underlying need for 'action.' " 3) "He could not stop himself from gambling." The Washington Post supplies one more: 4) "His judgment and insight were impaired by his gambling behavior."

The plea worked. Today, Donaghy was sentenced to 15 months in prison instead of the 27 to 33 months that had been expected. According to the Post, the judge "said she took Donaghy's gambling addiction into account, as well as his cooperation with the government's investigation." Reuters quotes the judge on Donaghy's gambling addiction: "Although it contributed to his criminal conduct, it does not excuse it." No excuse, but a nice contribution: His sentence gets halved.

I'm not going to sit here and claim that compulsive gambling doesn't exist. But disorders that are powerful and real for some people have a way of being diagnosed in other people who don't share many of the symptoms but just happen to need a legal excuse. In this case, all we have is an evaluation solicited and supplied by the defendant's attorneys.

More to the point—and this is the crazy part—in this case, the crime is gambling. If you plug that information into the evaluation, here's what it boils down to: "Mr. Donaghy would never have committed this gambling if he was not a pathological gambler." No kidding! He committed gambling because "he could not stop himself from gambling," because "his judgment and insight were impaired by his gambling." How do we know his gambling is compulsive? Because of his "gambling history." The circularity is shameless.

And don't even get me started on the idea that Donaghy had a "need to gamble to fulfill the underlying need for 'action.'" An "underlying need for action" pretty well describes the motivation for half the world's crimes.

If you really believe Donaghy's gambling was addictive, don't just make it a mitigating factor in sentencing for the crime of gambling. Abolish the crime. Because a crime can't excuse itself.

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.