A Counterblaste FOR Tobacco

A Counterblaste For Tobacco

Unsurprisingly, as a smoker (or nicopariah, which will probably enter the PC lexicon soon -- where PC stands more for Philologically Corrupt than Politically Correct, if examined closely, but that's another piece), I found the Salon review of Jacob Sullum's For Your Own Good particularly interesting.

First, a necessary disclaimer: My only connection to the tobacco industry is as a consumer. Since Salon 's readership presumably has access to "Web search engines", this can be confirmed straightforwardly by doing a little search engineering on me. For the lazy, what you'll find should be references to a number of ARPANET "RFC's", The Book (The Elements of Networking Style and Other Essays and Animadversions on the Art of Intercomputer Networking , Prentice-Hall, 1985, ISBNs 0-13-268129-3 (Case) and 0-13-256811-0 (Paper) -- which is out of print, so I can't be accused of trying to sneak a commercial in), and depending on the "engine" perhaps even the semi-famous Research Notes (on single malt Scotch, my self-proclaimed real field of research interest). And don't worry that you won't find any recent publications; I haven't become an undercover polemicist for Big Tobacco, which I detest as cordially as the NeoPuritan Health Establishment, for equal but opposite hypocrisy, in the interim, I merely retired seven or so years ago after leaving the second job in a row over not being allowed to smoke in my own office.

Unfortunately, I was interested more in what didn't appear to be in Mr. Sullum's book than what did. Several years ago, I happened to channelhop onto a C-SPAN, it must have been, program that Sullum was participating in, already espousing views quite similar to those the review tells us are in his book. Because he seemed to me to be a reasonable person, I wrote him a letter about an area he appeared to be ignorant of that I believed his argument would be strengthened by looking into. Unless the reviewer was extremely remiss, since the area is a rather incendiary one and if dealt with in the book really ought to have been mentioned in the review, apparently Mr. Sullum either didn't get the letter, didn't take it seriously, or isn't a reasonable person after all.

Well, perhaps it's just that he chooses to retain some sort of semi-Libertarian purity and only wants to argue on philosophical grounds rather than on scientific grounds as well. I feel no need whatsoever to go buy the book to see if I can work out why: for whatever reason, he doesn't seem to be willing to tackle the question of (brace yourself) the benefits of smoking.

The what?!?! The benefits of smoking!?!? Um, er, shuffle, shuffle, yeah. As I'll show you how to confirm for yourself, there are benefits; they happen to be psychopharmacological ones, and they are "in the literature" if you bother to look for them. (They're also arguably more provable than the risks, but that too is another piece.) However, for reasons that should become more or less obvious, neither the industry nor the anti-smoking bigot camp wants the public to be aware of them, and for whatever reason -- I like to think it's the lack of grounding in scientific thinking among the population in general and what I call the mediaocrities in particular, but then I also like to think my hard drive's still half empty -- the mass communications media haven't given them any ink or electrons. ("Never attribute to malice that which can be accounted for by simple incompetence" [approximately]: it's probably an inability to do their homework rather than any active suppression.) So let's hope that Salon will let me try to convey them to you; it would be a real shame if I wasted the wear and tear on my wrists and fingers, which do usually ache about as much as you'd expect once you know they're on arms attached to a body that's been working on and/or at computers for 35 years.

This, by the way, will be the short form. Not only am I not particularly Scholarly to begin with, but if I did a proper job, rife with citations, even I would begin to wonder if They weren't paying for it (which They're not, I hasten to re-assure you). The key fact, which has been known for around 30 years, is that nicotine boosts the user's norepinephrine levels. (I learned that from an article in M.I.T.'s Technology Review , a semireputable, semilearned, and certainly scientifically conservative, journal that used to come wrapped around my alumni notes before I got mad at the Alumni Association for not giving me a lifetime subscription after I yielded to their blandishments and "made testamentary disposition in the Institute's favor" and stopped paying them the token $10 a year I had been paying to get mainly the Review and incidentally the alumni notes. You can verify it in just about any modern book on the psychopharmacology of smoking, and/or nicotine, and I wouldn't be surprised if it's made it into good current encyclopedias.)

So what's the big deal? It turns out that norepinephrine is an extremely important neurotransmitter. It's related to adrenaline, and is a stimulant in the autonomic nervous system -- which presumably accounts for the "biphasic response" (of stimulation followed by relaxation) the older psychopharmacology of smoking literature was fond of talking about -- but has far more significant roles in the central nervous system that you'll probably have to look elsewhere for, though since I've been lazy about searching out recent psychopharmacology of smoking books I can't swear to that ... and besides, I'm about to tell you where elsewhere to look, anyway.

One place to look is Harrison's Principles of Internal Medicine , which I'm given to believe is the standard text on the topic. There you can find the Biogenic Amines Theory of Depression, and discover that norepinephrine depletion either causes or is caused by depression (depending on whether a good editor has had a shot at the latest edition; which way 'round isn't clear in the old one I found in a used book store), but in any event you'll realize that boosting norepinephrine levels must be good for combatting depression, although the details of the argument are a bit involved. (Indeed, the newest antismoking / smoking cessation product turns out to be an antidepressant medication; see your -- or somebody's -- PDR.) (Oh, sorry. Physician's Desk Reference , the more or less standard compendium of prescription drugs most doctors, dentists, and public libraries will have on their shelves.)

Time out for some anecdotal evidence, but don't worry, it'll lead to a fascinating datum nobody else appears to be aware of: I only came across the Biogenic Amines Theory after I'd tried to keep my last job by cutting my smoking rate in half and wound up getting depressed. So my then-doc suggested I try Prozac, which was "hot" at the time. Not having an up-to-date PDR, I violated a principle, because I was really feeling rotten, and took a med I hadn't read up on. "Sure enough, things got worse." Then a chance conversation led me to go to my dentist's office to look at his PDR (he was a high school classmate, so I get the occasional perk -- but no discounts, dammit) and I discovered the solution to the "Prozac Controversy" before it had even been named: It says right there in the PDR that 15% of the test subjects were made so "anxious" by it that they discontinued treatment.

Now you see why I say that the mediaocrities aren't grounded in science. And why in a different context (the "risks" as opposed to the benefits) I also say that most physicians aren't either. Not only was it clear from the literature that depression was a likely consequence of smoking withdrawal (and I'm astounded it took so long for an antidepressant to be touted as a smoking cessation med; I was calling for it seven or eight years ago, just based on reasoning from first principles, but had no entre' to Big Pharmaceuticals and none of the docs listened -- I'm only a grad school dropout, after all), but it was also clear from the very volume the prescribers were supposed to be prescribing from that one particular antidepressant had a rather treacherous side-effect. So treacherous, indeed, that when my then-doc told me to try increasing the dose when I said I wasn't feeling better and was indeed feeling worse, I wound up feeling downright horrible. What a good thing my best friend's brother had been a Pharm. D. before he became an M.D. and had mentioned to him that Prozac looked pretty good except it made some people anxious and he mentioned it to me, so I took myself off it before I became another anecdote about how Prozac drove people to suicide, homicide, or ... roadside, eh? But neither docs in general, nor "investigative journalists", noticed. Apparently. The alternative hypothesis that it was noticed and not publicized because of unethical behavior by the "ethical houses" doesn't commend itself to me. Really. It violates Occam's Razor: the simpler hypothesis is that people just don't read very well.

Nor, as mentioned, do they think very well about scientific matters, although what we're doing here should actually show how relatively easy it can be to do so. But we digress. The real point is that norepinephrine is important in the neurochemistry of depression, and that it's made available in measurably greater quantities by smoking than non-smokers have it in (unless they've just been out jogging, by some accounts). Score one benefit.

For the next, you'll probably have to waste some bandwidth with Medline if you want to confirm it; I don't have any citations handy because I learned about it at a public lecture by the head of the Learning and Memory Center at the Irvine campus of the University of California, and being lazy.... (His name, if Early MiddleAge Memory, or EMAM, to make it sound Sciency, doesn't serve a fault, was James McGaugh; but you could just search on norepinephrine and learning and memory if that doesn't work.) I went just because I noticed an announcement in a local throw-away newspaper and thought Learning and Memory was an interesting topic, not knowing that his whole theme was the centrality of ... what else? ... norepinephrine to the neurochemistry of Learning and Memory. Based on some rather elegant experimental evidence, by the way, and I'm not easily pleased by what most psychologists seem to think is good evidence. Quite similar to the neat work done on the endorphins earlier.

The downside of the evening is that after an hour of so of being thrilled by learning that my favorite neurotransmitter was even better than I'd known, I asked during the question period whether he knew of any ways of boosting one's norepinephrine levels that didn't involve combustion or leaving the meeting to go for a jog (after explaining that it was already my favorite neurotransmitter because I was a smoker, and confirming that he already knew of the experimental work in Britain about smoking being useful to Alzheimer's sufferers -- which he did, and even told me the same guy had done a paper showing that most air traffic controllers smoked to maintain their alertness, so I thought we were buddies). He replied that he didn't want to get involved in moral issues. End of buddiness.

And there's the rub. It's also the other major psychopharmacological benefit: my favorite neurotransmitter had been my favorite neurotransmitter for a fairly long time because when the first employer that I left over a smoking ban announced the ban in advance, by now 10 or more years ago, I discovered in the Britannica article on the brain that norepinephrine was central to the neurochemistry of ... oh, dear ... pleasure. Now, I don't know the evidence on which the assertion was based, having been lazy then, too, but Britannica's even more conservative than Technology Review so I scarcely think it was a Big Tobacco propaganda plant. Indeed, when we consider that as far back as the turn of the 17th century the original Puritans objected to tobacco (EMAM says that James the First, of England, and Sixth, of Scotland's "A Counterblaste To Tobacco" was published in 1607, but it's not worth looking up; I merely wanted to clear up the funny title of this thing for anybody who's gotten this far and happened to be puzzled), we realize that if there is a legitimate "everybody knows" about smoking it should be that everybody knows it's pleasurable. And there's enough psychopharmacological and/or molecular biological evidence that even "the" encyclopedia says so, now.

I submit that that explains why everybody is being told that everybody knows how "risky" smoking is, by the way. Smoking is considered a vice by those who believe in Vice. How did that bumper sticker go? "Puritanism is the fear that somebody somewhere might be enjoying himself" I think. And/or herself, of course. Or as I like to put it, the Puritan -- and NeoPuritan -- motto is "No Pleasure Without Punishment". So there's a clear-cut, deep-seated bias against tobacco that's centuries old. Is it any wonder that the risks should be exaggerated and the benefits suppressed?

Clearly, looking at the risks is for another time. This started as a Letter to the Editor, after all, and I don't even know if Salon does accept unsolicited e-MSs so I'm not going to subject my poor paws to much more repetitive stress this time around. But let me conclude with one other point that I assume Mr. Sullum didn't address: one of the most important things I learned as an undergraduate at M.I.T. (where one of my fields of study was Philosophy of Science, by the way, so at least I knew something about Causality 40 years ago and might well remember some of it, EMAM or not) is that not only is it easy to lie with statistics, advertantly, it's hard not to lie with statistics, inadvertantly. The risks, being based on statistical studies almost exclusively, are exaggerated.

Note very carefully I'm not saying they don't exist; I'm just saying they aren't as severe as the public is being led to believe, and that in an intellectually honest society the emphasis would be on maintaining the benefits while eliminating the risks, not on throwing out the vice-ridden baby with the leaf-strewn bathwater . Here's an easy check: there are reputable-seeming "studies" from reputable-seeming organizations which assert that 2/3 of all cancers are caused by diet; there are others claiming 2/3 of all cancers are caused by smoking; and there's another that says that 2/3 of all lung cancers are caused by radon. Ain't science grand? We now know the cause of 6/3 of all lung cancers.

Y'know, the one PC term I could actually get fond of is "innumeracy"....

P.S. Here's another easy check, this one for confirming that there are benefits: Look at the PDR writeup for the nicotine patch and think about all the "withdrawal symptoms" it's supposed to relieve. (Loss of concentration, irritability, depression, etc., but don't just take my word for it.) Then ask yourself whether there's something else They haven't told you about in the nicotine patch, or whether it's the nicotine that's helping you concentrate, be unirritable, undepressed, etc. If you're not a fanatical conspiracy theorist, you pretty much have to concede the benefits, don't you?