Human Nature: Science, Technology, and Life.

Outdoor Smoking: A Compromise

Last month, I went ballistic over New York City's plan to ban smoking in parks and public beaches. My argument was that you don't have to ban smoking on every square inch of park land to protect nonsmokers from the person next to them. You can chalk off spaces where smoking is prohibited. Just figure out how much clean breathing room people need, and draw a line.

It looks like I may get my wish—not in New York, but in Los Angeles. L.A. already forbids outdoor smoking in parks and beaches. But yesterday, the city council advanced a proposal to ban outdoor smoking at restaurants. And this time, the ban isn't comprehensive; it's spatially circumscribed. Maeve Reston of the Los Angeles Times spells out the details:

A Los Angeles City Council committee voiced support today for a ban on smoking in the city's outdoor dining areas, but ordered several changes to the ordinance before sending it to the full council for approval.  ... The legislation ... would ban smoking within a 10-foot radius of outdoor dining areas. The proposed no-smoking area around mobile food trucks and food kiosks would extend for 40 feet.

Ten feet sounds about right. After I attacked the New York plan, an anti-smoking researcher challenged me to examine studies of outdoor secondhand smoke. So I did. Among other things, the studies noted that smoke exposure levels from outdoor cigarettes were "very localized." One study reported:

We observed a clear reduction in OTS [outdoor tobacco smoke] levels as the distance from a tobacco source increased. Generally, average levels within 0.5 m [meters] from a single cigarette source were quite high and comparable to indoor levels, and OTS levels at distances greater than 1 or 2 m were much lower. ... At distances larger than 2 m, levels near single cigarettes were generally close to background.

Roughly translated, this means that if you're downwind of an outdoor smoker, standing within two feet subjects you to exposure comparable to being indoors with that smoker. Move seven feet away, however, and you're breathing normal air. Accordingly, a city that prohibits indoor restaurant smoking to protect nonsmokers should extend this policy to smoking within two feet of an outdoor dining area. Beyond seven feet, the restriction loses its logic. I don't see any harm in extending the radius to 10 feet, just to play it safe.

The Los Angeles proposal is still being haggled over. For all I know, the buffer zone will end up being 15 or 20 feet. The important thing is that it'll be clear and limited. If we're lucky, it will set a precedent for regulating outdoor smoking based on science, not revulsion. And you'll be free to light up and enjoy your cigarette, as long as you keep your butt out of my face.

Mini Soda: The New Light Cigarette?

You'll drink Coke mini for the same reason you already drink Coke: to sate your addiction. And if you don't get enough "sparkle" from the smaller can, no problem. Just open a second 7.5-ounce can, and you'll get 20 percent more sparkle than you used to get from a 12-ounce hit.

You'll also get 20 percent more calories. But you'll feel better about yourself, because now you're practicing "portion control" and "a healthy lifestyle." Just like you felt better about smoking light cigarettes.

More here.

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.

No Smoking in Your Apartment

No smoking if you share a floor. No smoking if you share a ceiling. No smoking if you share a wall. That pretty much covers it.

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.

How Dangerous Is Outdoor Smoke?

If you want to argue for parkwide smoking bans based on asthma or on an analogy to noise pollution, go ahead and make that case. But let's not cloud that debate by invoking the general harm of secondhand smoke. Studies of secondhand smoke have indeed moved outdoors. Their findings support restrictions on lighting up within a few feet of other people. But they don't warrant more than that.

More here.

No Smoking In My Atmosphere

When tobacco fighters began to outlaw smoking in elevators, buses, restaurants, bars, and public buildings, their stated rationale was to protect nonsmokers trapped inside. Then the crusade moved on to apartment buildings, extending the same theory: You can't smoke in your apartment, because the smoke seeps under your door into hallways and other people's apartments.

Now this rationale has moved outdoors. Way outdoors.

More here.

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 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.

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.

The Tax War on Soda

The food police are closing in on their next target: a soda tax.

Writing in the New England Journal of Medicine, they propose a penny-per-ounce excise tax on "sugared beverages." That's nearly $3 per case. Why so much? Because this tax, unlike the petty junk-food taxes of yesteryear, is designed to hurt. Its purpose is to discourage you from buying soda, on the grounds that soda, like smoking, is bad for you.

More here.

No Tears for Salt

First they came for the cigarettes. Then the soda. Then trans fats. Then fast food. Now salt.

Reuters brings the news from across the Atlantic:

Alarmed by high death rates from strokes in Portugal, deputies from the ruling Socialist party submitted a bill to parliament Friday to slash the use of salt in bread ... The bill calls for salt content to be cut to a maximum of 14 grammes per kg, or by about 25 percent, introducing fines of up to 5,000 euros ($6,435) for exceeding this. ... Socialists have the majority of seats in parliament and the bill is likely to pass without a hitch.

Yes, the socialists. Cue Rush Limbaugh.

The rationales are the same ones we've already used to legislate against trans fats and fast food. Saving lives:

According to the Portuguese Society of High Blood Pressure, a reduction of salt intake by one gramme a day on average would save 2,650 lives per year.

And saving money:

The document links excessive salt consumption to high blood pressure, which in turn causes strokes, generally reduces life expectancy and means high medication costs for the state.

We don't have a viable Socialist Party in the United States. But could salt restrictions happen here? Sure. Little more than a year go, the FDA held a hearing to consider regulating salt as a food additive. Proponents argued that we eat too much salt, that reductions could save 150,000 lives a year, and that we could lower health-care expenses.

Then, a few months ago, New York City health commissioner Thomas Frieden, with the asserted support of health departments in other cities, summoned food-company executives to the mayor's residence and urged them, in concert, to cut the salt content of high-sodium foods by 25 percent in five years, and then to cut the same percentage again in the next five years, for a total reduction of nearly 50 percent. He told the New York Times, "If there's not progress in a few years, we'll have to consider other options, like legislation."

Can Frieden and his allies deliver on the legislative threat if the food industry doesn't cooperate? I don't know. In some ways, the more interesting question is what happens if the industry does cooperate. The plan is essentially collusion between the government and an all-encompassing alliance of corporations. The aim is to deprive consumers of the targeted food item, beyond a specified limit, through "quiet, mass reduction." Frieden's team calls it "stealth health":

He wants to get most of the major food and restaurant companies to do the same thing at the same time ... Key to the plan is a gradual reduction in sodium levels. The theory is that if the salt disappears slowly enough, consumers will not notice. Dr. Sonia Angell, director of cardiovascular health for the city, said: "We've created a whole society of people accustomed to food that is really, really salty. We have to undo that."

I'm supposed to be a raving libertarian. But I like the collusion plan. My six-year-old daughter is a total salt fiend (she's been that way since birth, unlike my son), and even she couldn't finish the can of Progresso vegetable soup she requested for lunch yesterday. Why? Because it has 990 milligrams of sodium—41 percent of the recommended daily allowance. So I poured out the "broth" and substituted hot water, and she gave it the thumbs-up. That's how salty the soup was: The vegetables alone made water taste like broth.

Corn chips are the same way. The number of grocery stores near us that offer unsalted chips has dwindled to one. But that's what I keep in the house, so our kids are used to it. A month ago, we were served Fritos on an airline flight, and we could barely stand them. That's what happens when you dial down the salt volume in your life: You start to notice how absurdly oversalted most prepared foods are.

Dr. Angell is right: Today's unhealthy salt levels have been commercially manufactured. It's now much harder to escape salt than to find it. And nobody's talking about taking away your table salt. If you want to dump 990 milligrams into your soup, it's your funeral.

So here's to you, Dr. Frieden. I hope you and your captains of industry get away with your hush-hush salt-fixing scheme. I want to see whether people really miss all that sodium, or whether they get used to a saner level and don't miss a thing. And I want to see whether we can pull this off without legislation. I'll keep quiet about it if you will.

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.

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

Tobacco: Banned in Boston

The health police have crossed another line. Four months ago, they banned new fast-food restaurants in a 32-square-mile area of Los Angeles. In that case, they crossed the line from restricting food for kids to restricting it for adults. They also extended the practice of health zoning from liquor to food.

Now they've breach another line between paternalism for children and paternalism for adults. The Boston Public Health Commission has just banned the sale of all tobacco products at colleges. Not high schools. Colleges.

Anti-smoking activists are ecstatic. "Boston has taken another step that puts it in the forefront in the United States in protecting people against secondhand smoke," says the president of the Campaign for Tobacco-Free Kids. But the Boston regulations don't just restrict smoking. They forbid the sale of "any substance containing tobacco leaf, including but not limited to cigarettes, cigars, pipe, tobacco, snuff, chewing tobacco and dipping tobacco." Last I heard, there's no secondhand smoke from chewing tobacco. And the tobacco industry is constantly developing new products that confound the equation of tobacco with smoking. That's not because tobacco companies care deeply about public health. It's because secondhand smoke has become a political problem for them—and because, while addicting customers is good business, killing them isn't.

In a press release, the executive director of the Boston commission says the new regulations "will help reduce young people's exposure to tobacco products." Young people? That phrase used to mean minors. Now, apparently, it includes the targets of the new rule: students at "any public or private college, normal school, professional school, scientific or technical institution, university or other institution furnishing a program of higher education."

On what grounds do college students—not to mention students at professional schools—deserve the kind of paternalism previously reserved for minors? The commission offers two reasons. First, "educational institutions in the City of Boston also sell tobacco products to the younger population, which is particularly at risk for becoming smokers." Second, "the sale of tobacco products is also incompatible with the mission of educational institutions which educate the younger population about social, environmental and health risks and harms."

In other words, college students (henceforth known as "the younger population") are so vulnerable to smoking and to deception about the harms of smoking that their access to any tobacco products on campus must be legally forbidden.

It's true that laws across the United States set the legal drinking age at 21. But those laws are based on the argument that alcohol makes people aged 18 to 20 drive dangerously. Where's the evidence that chewing tobacco makes these people drive dangerously?

To repeat: I detest smoking. But if there's no secondhand smoke and no secondhand driving effects, what are the grounds for telling a 20-year-old college student—let alone a 25-year-old professional-school student—that tobacco is off-limits? And if that kind of paternalism can be extended so easily from minors to 25-year-olds, who's next?

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.

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.