Big Nicotine, Part II: Addiction and the “Cult of Pharmacology”

Last month, the U.S. Food and Drug Administration announced its intention to lower the nicotine content of cigarettes to, ideally, “minimally or nonaddictive” levels. Public health advocates celebrated the decision; on the other hand, Big Tobacco investors began dumping shares at the prospect of supplying an ever-more-elastic demand.

Cigarette critics and capitalists alike belong to what Richard DeGrandpre calls the “cult of pharmacology,” a system of belief that dominates American drug discourse. Rooted in modernist faith in understanding the world through scientific approach, by the early twentieth century many considered drug experience to be a straightforward process of brain and body chemistry, without regard for concepts we might recognize today as set and setting. Historically contingent forces divide drugs into “angel” and “demon” categories, but their effects are similarly reduced to biological mechanism: “‘soul’ was reinterpreted as ‘mind,’ and ‘spirit’ was reinterpreted as ‘biochemistry.’”

But cults are given to blind faith, so it is worth considering the extent to which substances are to blame for problem use.

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The Points Interview: J. J. Binder

Today’s Points interviewee is J. J. Binder, author of The Chicago Outfit (2003) and most recently Al Capone’s Beer Wars (2017).

519djtbjncl-_sy344_bo1204203200_Describe your book in terms your bartender could understand.

I would say that the subtitle—A Complete History of Organized Crime in Chicago during Prohibition—accurately describes the book. It examines all the bootlegging gangs and the fighting between them, much of which has not been covered previously.  It also covers all the other major rackets from 1920 to 1934, including narcotics, gambling, labor racketeering, business racketeering, and prostitution. Furthermore, it explores how the upperworld—federal agencies, local agencies, and citizens groups–fought organized crime.

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Review: Emily Dufton on Martin Torgoff’s “Bop Apocalypse”

Editor’s Note: This review of Bop Apocalypse: Jazz, Race, The Beats, & Drugs (De Capo Press, 2016) comes courtesy of Emily Dufton, Points managing editor emeritus.

5114moutnel-_sy344_bo1204203200_Martin Torgoff’s early experiences with drug history began as a family affair: he was first introduced to marijuana by his older sister on November 5, 1968, the night Richard Nixon was elected president. The 16-year-old got supremely stoned and experienced a new kind of ecstasy when his sister placed his head between the speakers of her stereo and played the Beatles’ “Blue Jay Way.” He “felt the music and the lyrics… to the very roots of my soul,” Torgoff explains in the introduction to his new book, Bop Apocalypse: Jazz, Race, The Beats, & Drugs (Da Capo Press, 2016), and this fascination with music and drug use has lasted the rest of Torgoff’s life, transforming itself, successfully, into a writing career.

Torgoff is the author of several previous works about music and drugs, including American Fool: The Roots and Improbable Rise of John “Cougar” Mellencamp and Can’t Find My Way Home: America in the Great Stoned Age, 1945-2000. Indeed, the seeds for Bop Apocalypse were planted in the second chapter of Can’t Find My Way Home (hereafter CFMWH), which carried the same name and explored the early rise of American marijuana and heroin use in Harlem and California from the 1930s to the 1950s. From Herbert Hunke shooting up William Burroughs to Charlie Parker’s saxophone and the rise of the Beats, Torgoff suggests that drug use in the first half of the twentieth century created a kind of secret society among users — a knowing, winking, self-destructive cabal of artists and musicians whose desire to pursue the “wild form” brought powerful elements of improvisation and mysticism to jazz and writing, many of which continue to wield influence today.

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The Points Interview: Benjamin B. Roberts

Editor’s note: Today’s Points Interview is with Benjamin B. Roberts, author of the forthcoming book, Sex, Drugs, and Rock ‘n’ Roll in the Dutch Golden Age, available December 2017. Mark your calendars!

Describe your book in terms your bartender could understand.

The main question of my book is: “What was it like to be a man coming of age in the early seventeenth century at the height of the Dutch Golden Age”. Rembrandt, who was born in 1606, grew up in this period. I wanted to know everything about being an adolescent and teenager in the seventeenth century. What did they think was cool to wear, how did they deal with their sexual urges, at what age did they start drinking alcohol, and what did they do for fun? Ultimately I wanted to find out if being a young man in the seventeenth century was any different than it is now.

One of the main conclusions from my research is that young men rebelled against the older generation with their physical appearance. They let their hair grow long (shoulder length), wore bright-colored clothing, and accessorized with ribbons, silk stockings, and high-heel shoes. Some young men even wore make-up to conceal smallpox marks they had from childhood.

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Smoking Cessation Dissertation Roundup

Editor’s Note: In light of the U.S. Food and Drug Administration’s recent attention to nicotine levels in cigarettes as an anti-smoking measure, today’s post features a selection of relevant dissertations on smoking cessation. These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen, which was formerly published in the Social History of Alcohol and Drugs journal but is now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

A Unique Tobacco Cessation Service for Cancer Patients at Roswell Park Cancer Institute: Acceptance, Participation and Impact

Author: Amato, Katharine Ann

Abstract: Problem under Investigation: Smoking cessation amongst cancer patients is often thought of as less important because the patient has already developed cancer. However, increasing evidence suggests that continued tobacco use during cancer treatment reduces the effectiveness of treatment, increases negative side effects of the treatment, decreases the quality of life, and increases the risk for tumor recurrence, second primary tumors or death. To date, limited research has been conducted to improve cessation efforts among cancer patients or measure the impact of smoking cessation on survival. Most studies rely on an opt-in randomized control design impacting a limited number of patients or on retrospective chart review with smoking status collected in an inconsistent manner. More data are needed to better understand the impact of smoking cessation among cancer patients. Roswell Park Cancer Institute Tobacco Assessment and Cessation Service: Patients seen in all clinics at Roswell Park Cancer Institute (RPCI), including the thoracic clinic, have tobacco use assessed every thirty days; an automatic electronic referral is generated to a free opt-out telephone based cessation support service for all patients who indicate current or recent (last 30 days) tobacco use, which offers up to eight cessation support telephone calls. Specific Aims: The goal of Specific Aim 1 is to describe the reach and potential impact of the RPCI Tobacco Assessment and Cessation Service (TACS) by describing the patients who participate in the service and by examining the initial quit rates of participants in the current program. The goal of Specific Aim 2 is to conduct a 3-month follow-up of all participants to determine their self-reported quit rates for the previous seven days, as well as patient satisfaction with the RPCI TACS. The goal of Specific Aim 3 is to examine survival rates with relation to smoking status for lung cancer patients referred to the RPCI TACS. Research Methodology: The majority of patient information was extracted from the electronic medical records, finance records, and tumor registry at RPCI for all three specific aims. Mailed surveys, along with follow-up telephone interviews for non-responders or to obtain any missing information, were conducted to obtain self-reported quit status 3-months after the first contact by the RPCI TACS for Specific Aim 2. Univariate and multivariate statistics were used to examine the factors associated with and predictors of quit rates at 1-month and 3-months for Specific Aims 1 and 2. Stratification by patient gender, tobacco use status at referral, disease characteristics, and other health behaviors were explored. Specific Aim 3 was evaluated using univariate and survival analysis statistical methods to determine predictors of other health outcomes associated with thoracic cancer. Results: For Specific Aim 1, 78.3% of 942 thoracic clinic patients referred to RPCI TACS were successfully contacted and participated in the first call; among those who participated in the first call and were called for a follow-up, 88.7% (401/452) participated. Among current users at referral, 26.0% (89/342) reported cessation at follow-up. Among those contacted twice, lung cancer patients were statistically more likely to quit at follow-up compared to other thoracic clinic patients (OR=1.78; 95% CI: 1.02-3.11) and thoracic clinic patients in poorer health (as indicated by a higher ECOG performance score (≥1)) were less likely to quit at follow-up compared to healthier patients (ECOG PS=0; OR=0.43; 95% CI: 0.34-0.77), while controlling for other demographic, health and disease characteristics. For Specific Aim 2, 55.5% (142/256) reported being smoke-free for at least the previous 24 hours at the 3-month follow-up; 86.4% reported being very or mostly satisfied with the service they received from RPCI TACS. For Specific Aim 3, after controlling for age, pack-year history, sex, performance status, time between diagnosis and last contact, tumor histology and clinical stage; a statistically significant increase in survival was associated with quitting compared to continued tobacco use at last contact (HR=1.79; 95% CI: 1.14-2.82), with a median 9 month improvement in overall survival. Conclusions: Thoracic cancer clinic patients are receptive to a free opt-out telephone-based cessation service following a cancer diagnosis, negative biopsy, or participation in a high risk screening program, as indicated by the high participation rates. Patients are interested in participating, are making efforts to quit, and are satisfied with the service they have received. Lung cancer patients who quit show improved survival compared to those who continued using tobacco. Potential Significance: This unique RPCI Tobacco Assessment and Cessation Program will benefit from evaluation and improvement. Results from this dissertation can be applied to making future improvements within RPCI TACS (i.e. by determining optimal timing, frequency, duration, and framing of cessation support messages), can guide the development of a framework to evaluate and improve the cessation service for all other cancer sites, and can offer an example for other comprehensive cancer centers intending to implement a similar program with mandatory tobacco use assessments and automatic referrals to an opt-out cessation support service.

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New History Dissertation Roundup: Marietta Holley, Lyman Beecher, and Drug Addiction on Stage

Editor’s note: In today’s post, we highlight a few recent dissertations on drug use among young people from around the world. These entries are part of an ongoing drug-related dissertation bibliography being compiled by Jonathon Erlen, which was formerly published in the Social History of Alcohol and Drugs journal but is now periodically featured on the Points blog. Contact Dr. Erlen through the link above.

Marietta Holley on Temperance and Women’s Rights: Framing and Interpreting a Legacy of Social Reform

Author: LaCoss, Joan Harkin

Abstract: The values of historical figures may be misconstrued when later scholars view the past through a perspective of newer facts and beliefs. Such revisionist research can apply new values to reshape understanding, but in the process may inadvertently marginalize or invalidate the original values at stake. Consequently, the interpretation of past events and cultural trends can be very different from the intended meaning of the principals involved. An examination of the life, work, and legacy of Marietta Holley exemplifies this type of skewed interpretation. As a writer, supporter of political rights for women, and advocate of social reforms in late nineteenth and early twentieth century America, Holley had ample opportunity both to express her personal values and to influence American society. Holley became a focus of twentieth century feminist scholars who framed her work to further a specific interpretation of feminist history – in the process these scholars displaced Holley’s values and the meaning of her legacy and niche in American culture. Studying Holley illuminates the creative ways through which a group can exercise freedom within a restrictive social environment, using that very creativity to challenge that environment. This thesis will address two major questions: how Holley constructed a unique personal legacy through the use of language and actions as a humorist, temperance and women’s rights proponent, and social reformer; and how a number of twentieth and twenty-first century researchers distorted her intended impact on American social and cultural development. The Holley analysts placed her within a frame of women’s rights and distanced the scholarship from an alternative interpretation that temperance was her main reform cause and the impetus behind her women’s rights stance. As this thesis will reveal, both life and literature reflected values that found expression in female involvement in the temperance and women’s rights movements. Holley believed in political and social empowerment for women, especially as that female power could be used constructively toward reform. With Holley as a focal point for the convergence of women’s history, culture, and literature, this study will explore her place in popular fiction and find alternative interpretations for the influence she hoped to have on society.

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The Points Interview: Chris Finan

chrisChris Finan is the author of the books Alfred E. Smith: The Happy Warrior (Hill & Wang, 2002), From the Palmer Raids to the Patriot Act: A History of the Fight for Free Speech in America (Beacon Press, 2008), and Drunks: An American History (Beacon, 2017). He currently serves as Executive Director for the National Coalition Against Censorship and was previously President of American Booksellers for Free Expression. Finan received his PhD. in American History from Columbia University in 1992 and has been involved in anti-censorship efforts for the past 35 years. He lives in Brooklyn.

Describe your book in terms your bartender could understand.

Actually, one of the first persons I described the book to was a bartender.  I was at a reception at book convention in Minneapolis, and he wandered over before it was time to start pouring drinks to talk about my book, which was on display.  He had been lucky enough to get sober in the “land of 1,000 rehabs.”  I told him that my book tells the stories of the people who have led the recovery movement since the colonial period and ultimately saved his life–and mine.

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Big Nicotine, Part I: Big Tobacco’s Drug Problem

Just over a week ago, the United States Food and Drug Administration announced what new FDA chief Dr. Scott Gottileb called “a cornerstone of our new and more comprehensive approach to effective tobacco regulation”: an initiative to reduce the nicotine content in cigarettes to “minimally or nonaddictive” levels. The 2009 Tobacco Control Act gave FDA authority to reduce any “additives, constituents…, or other component of a tobacco product.”

Obama Tobacco
President Barack Obama signing the Tobacco Control Act

Public health historian Robert Proctor was thrilled. “This is exceptionally good news for tobacco control, and for human health,” he wrote last week in the New York Times. Not so for companies like Altria and British American Tobacco, whose stock value fell within an hour of the statement (and recovered somewhat before the closing bell).

Big Tobacco was reeling for good reason: nicotine is the primary addictive component of cigarette smoking, not incidentally the leading cause of preventable deaths in the U.S. The addictive capacity of nicotine is now practically indisputable. For over sixty years, government regulators, independent researchers, and tobacco company scientists have investigated the extent of that capacity and the danger it poses when delivered via tar-laden cigarettes.

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