Having changed the definition of sex, gender, marriage, pronouns, speech, health, victory, defeat, money, bullying, poverty, success, dress, fake news, children, and height, I thought a few ruminations on smoking, addiction, and whatever free association could bring to mind might fill a few paragraphs.
On Friday July 28 the FDA announced a comprehensive regulatory plan to shift the trajectory of tobacco-related disease and death. The press picked up the story and disseminated it apparently without reading past the headline. The stock market reacted like Lady Bracknell to the handbag. Altria, America’s largest tobacco company, lost 20% of its value in the rumble of a borborygmus.
It recovered half of its loss before the next intestinal barrage could be heard. Someone made a lot of money in a very short time – the few minutes it took for Altria to move back up 10%. This $10 billion loss of market capital followed by just a day the announcement that Altria’s earnings had surpassed expectation causing its stock price to rise by about 4%. Gyrations like these give the lie to the efficient market hypothesis. If traders had read the FDA’s announcement they would have realized that it contained no new information that would negatively affect the tobacco industry.
Instead of the efficient market hypothesis, I think the market operates under a variant of the infinite monkeys hypothesis. That theory holds that if an infinite number of monkeys had access to an infinite number of typewriters (we could substitute computers to update it) they would eventually type out the complete works of Shakespeare. Of course, like all theories that include infinity it becomes gibberish as these busy simians would type out everything written or yet to be written. But because it is ridiculous it perfectly fits the stock market.
The market doesn’t have an infinite number of ape-like traders, but it still is a very large barrel of monkeys – almost all of whom are acting on incomplete or inaccurate information. Their errors are random and go in every conceivable direction such that when averaged the market tends with occasional seismic hiccups to move up. I hope this makes you feel good about your retirement account.
So what did the FDA say. They started by stating that nicotine is an addictive drug and then implied that if the amount of nicotine in tobacco products could be lowered that cigarette smoking might decrease with a concomitant decrease in smoking related deaths. The document did not impose new deadlines or new restrictions on smoking. In fact, the FDA’s previously announced timelines were extended. The FDA’s goal is to allow those who want access to nicotine to get it from less harmful sources than cigarettes. Thus, the market’s response to the FDA’s news release was an overreaction. But that’s its default action. Also, I’m not sure that craving for nicotine is the main reason people smoke. If it were, taking nicotine in another form should eliminate the craving for tobacco, which it often doesn’t.
The FDA thinks tobacco use is the leading cause of preventable disease and death in the US. The Cleveland Clinic thinks it’s food. When you try to get the raw data about the bad health effects of smoking and overeating you fall into a statistical black hole. The number of deaths posited to tobacco and overeating are filled with selection bias. If a smoker or glutton dies from a heart attack, his death is attributed to smoking or overeating. But he might have had the heart attack even if had never smoked. Nevertheless, everyone agrees that smoking is really harmful. But is it addictive and if so is nicotine the addictive component?
To begin with, there is a vast enterprise that is dependent for its continued existence on defining addiction to include just about everything including water. There is a National Institute on Drug Abuse that has a budget more than $1 billion. Here is its definition of drug addiction: Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to many harmful, often self-destructive, behaviors.
When I said water fit the fashionable definition of drug addiction, I meant the statement to be taken literally. Primary Polydipsia (ICD-10 code R63.1) is a disorder in which water is compulsively consumed to the point where convulsions and brain damage ensues.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5)— is a diagnostic manual used by clinicians that contains descriptions and symptoms of all mental disorders classified by the American Psychiatric Association (APA). I urge readers to obtain a copy as it makes for great bedtime reading. It’s an excursion into the weird and bizarre. Amazon sells it.
“In 2013, APA updated the DSM, replacing the categories of substance abuse and substance dependence with a single category: substance use disorder. The symptoms associated with a substance use disorder fall into four major groupings: impaired control, social impairment, risky use, and pharmacological criteria (ie, tolerance and withdrawal).
The new DSM describes a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:
1. The substance is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
4. Craving, or a strong desire or urge to use the substance.
5. Recurrent use of the substance resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued use of the substance despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
8. Recurrent use of the substance in situations in which it is physically hazardous.
9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
a) A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
b) A markedly diminished effect with continued use of the same amount of the substance.
11.Withdrawal, as manifested by either of the following:
a) The characteristic withdrawal syndrome for that substance (as specified in the DSM- 5 for each substance).
b) The substance (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.”
The above list and paragraphs take from The Science of Drug Abuse and Addiction: The Basics – an article that contains virtually no science. Note That the APA doesn’t use the term “drug addiction” substituting “substance use disorder” and you only need two to suffer from this malady. Primary Polydipsia, and hence water, makes it with the first two criteria. Water also satisfies #4.
I use an older and more exacting definition of drug addiction. A drug or substance is addictive if it associated with all four of the following: habituation, dependence, tolerance, and withdrawal. By these strict pharmacological criteria, both nicotine and cocaine are not addictive drugs. They may be habit forming and very hard to abandon, but they are not addicting. Scores of millions of people have voluntarily stopped smoking. Thus they have made up their mind to stop having a “disease” – a clear contradiction in terms. The NIDA attempts to defuse this criticism with the following: “The initial decision to take drugs is mostly voluntary. However, when addiction takes over, a person’s ability to exert self-control can become seriously impaired. Brain-imaging studies from people addicted to drugs show physical changes in areas of the brain that are critical for judgment, decisionmaking, learning, memory, and behavior control. Scientists believe that these changes alter the way the brain works and may help explain the compulsive and destructive behaviors of an addicted person.” This declaration is a non-explanatory response to people voluntarily stopping the chronic use of habituating drugs. Tobacco use is not a disease; it’s a bad and dangerous habit that commonly causes real diseases.
The reality of redefining things, is that it works. No matter how much we say we distrust the government and its congeners, we believe what they tell us, no matter how outlandish the utterance, if they tell it to us often enough. But it’s getting harder by the day to distinguish science from science fiction. Maybe it’s better to be a rodent on the run or on the wheel.
Abe Lincoln: If a gerbil’s tail were a leg, how many legs would it have?
Abe Lincoln: Wrong. It’s 4, because a tail is not a leg.