Drugs are bad, m’kay.

April 26, 2007

A recent paper by Donny and Dierker entitled “The absence of DSM-IV nicotine dependence in moderate-to-heavy daily smokers” and the recent update of the Monitoring the Future (MtF) survey of drug use and attitudes seemingly have little in common. Stick with me.

The essential point of Donny and Dierker is captured by this from the abstract:

RESULTS: Approximately 39.4% of daily smokers never reached nicotine dependence. While the probability of remaining non-dependent decreased with smoking quantity and duration since the onset of daily smoking, a substantial portion of individuals (37.7%) who reported smoking >/=10 cigarettes per day and began smoking daily >/=10 years prior, remained never nicotine dependent.

The overwhelming majority of animal research in the area is based on the self-administration and drug-discrimination paradigms- each of which focus on the animal equivalent of “how (good) does this drug make me feel right after I take it?”. On a design basis, the vast, vast majority of studies are predicated on the notion that what is important is the group result derived from the mean of the whole subject population. I’ve often wondered how can this be relevant to issues of drug dependence? The people smoking 10 cigs a day in the Donny sample are certainly getting some acute reinforcement from the nicotine yet this “drug liking” doesn’t really explain dependence. This paper shows that what is important is distinguishing individual traits or liabilities that dictate which of the population exposed to a given drug will go on to develop dependence.

This also shows what is so hard about convincing people that addictive drugs are going to suck them into a cycle of destructive use…because they are generally NOT going to do so. I.e., for the majority of people who get “acute reinforcement” (aka, pleasure) from using a given drug. (Not to mention their college chums “My friend Joe used to snort cocaine every day in college but got a job and never used again after graduating…” . Everyone has similar anecdotes.) Wouldn’t we do a lot better at convincing people to be wary of drug use if we pursued models that addressed questions related to who will become addicted rather than questions related to “how good does this drug make me feel”?

Ah, says the scientist. I don’t have to worry myself with some sort of PR mission to convince people. I’ll just publish my great papers and eventually this will solve the drug use problem. Ha. The single biggest contributor to population drug exposure is…..PR. (Loathe as I am to acknowledge this.)

From the recent MtF 2006 overview section on Ecstasy:

The figures on the facing page show little change in 12th graders’ perceived risk of ecstasy until
2001, when it jumped by eight percentage points…

…Significant increases in perceived risk occurred again in 2003 for all three grades. This very sharp rise likely explains both the deceleration and the turnaround in use, as we had predicted it would. In 2004 and 2005, perceived risk continued to increase among 12th graders, though at a much decelerated rate. The 10th grade has shown a leveling in perceived risk, while 8th grade has shown a slight decline—perhaps an early sign of generational forgetting. In 2006 the 8th graders’ perceived risk of using ecstasy dropped sharply (down seven percentage points).

Is attitude everything? Does a “scared straight” approach really work best? Examine the data in the MtF 2005 full report and you will find that, in general, attitudes toward health risks of a given recreational drug are remarkably stable, even across decades. (You will also find that drug use follows broad trends unlikely to be explained by specific events. This is a caveat to my main thesis.) There is one other notable case in which the perceived risk for a drug (e.g., for “trying it once or twice”) was initially low in comparison with most other drugs and underwent a rapid increase in the proportion of people thinking it “risky”. For cocaine between 1986 and 1987. Unsurprisingly, the shift in attitudes led to a drop from about 20% of 20-somethings endorsing annual use in the early-mid eighties to about 7-8% in the early nineties. The “why” is material. Two words, Len Bias. It also seems very likely that MSM publicity surrounding the entirety of The Ricaurte Affair explains the Ecstasy use data. I would suggest that in each case the existing scientific evidence played a minor role, that is, the totality of evidence before and after Len Bias’ death and before and after the publication/retraction of Ricaurte’s Science paper was essentially unchanged. The scientific interpretation of risk should have been essentially unchanged. What differed, was the scope of reach of the information. I would so argue anyway.

Is there a point here for drug abuse science? That depends. Do you really want to have a “translational impact”? Do you really want to serve the public health mission by helping to avoid or ameliorate the detrimental impact drugs of abuse have on the public? Then perhaps scientific paradigms that are relevant and understandable to the public should be prioritized. Stop asking which drugs feel good and how good they feel. We know this. Ask rather, what is special about the circumstances of that subset of your sample that is most likely to develop compulsive drug use…

To recap, Shelley Batts blogged on a recent scientific paper, including figures from said paper. Some annoyances from the publisher, Wiley, with respect to use of copyrighted material resulted. John Pieret links to a series of blogo-sponses on the subject.
There are a couple of points of interest to me. First, the blogger Batts did not go through the usual process to request permissions to use published material in advance. It is not clear that had this been done that she would have been refused and indeed permission may eventually be extended. Certainly whenever I have used the publishers’ procedures to request permission to re-publish figures in subsequent papers, I have received prompt permission. In essence by return mail in the pre-Internet days and within a day or two more recently. Calls for Wiley boycotts seem premature.
I had a recent experience in publishing a paper that was unusual and I realize I don’t really understand the ins and outs of copyright permissions in scientific publishing. My prior understanding was that it is basically the finished product, so to speak, that was under copyright. The exact figures / text / layouts as published. I figured that there had to be some rational thought here as well so that one couldn’t simply take a figure and reproduce it almost exactly except for cosmetic changes such as shading or graphical format. On the other hand I also thought that if one wanted to take some portion of the data and re-present it in the context of an entirely new comparison that was OK. Particularly when it is your own work, of course, but presumably OK anytime the original authors are OK with the use (yes I realize the authors have no legal position on this but science IS a community business). In my recent situation I was including the underlying data set (with appropriate citation) from a previously published study in entirely new statistical analyses and data presentation. Obviously there were new data involved. Nevertheless I received a note from the (academic) editor that I was to obtain permission from the original publisher. It was no big deal since it took about 10 minutes to submit the request and permission was granted before I finished revising the manuscript. But I don’t like the precedent one bit. It suggests an assertion of ownership over my research data to an unbelievable degree. Now, I think it likely this was a misunderstanding. The request was from an academic editor, not someone who necessarily is tied into the intricacies of the Elsevier (oh, yeah it was Elsevier) legal department. It may have been that the publisher would have never extended such a request. In the meantime I’m polling my colleagues to see if they’ve experienced anything similar…

UPDATE: Of course, once the appropriately senior person at Wiley was involved, the situation was resolved. This is not a “win”. This is a “loss” in which the blogos look like emotional nutcases willing to go ballistic before all the facts are in and/or considered rationally. That may be okay for the political ranters but surely scientific bloggers can do a bit better?