UCSF Research: Some Accidental Truth-Telling About Nicotine ‘Addiction’
Of all the junk tobacco control research, the worst in some ways is the ongoing series out of Stanton Glantz’s UCSF shop that dredges through their “secret tobacco industry documents” library (materially illegally diverted from litigation discovery, a massive collection of memos, reports, notes and other documents from the late 20th century and first few years of the 2000s). Tobacco control’s epidemiology, toxicology and behavioral research are similarly dishonest and faulty. But at least those are published in the normal (bad) journals in those fields; they average no worse than about the 20th percentile for those fields in general. There are history journals that publish archival research, but there is no chance that one of them would publish any of this “secret documents” dreck.
The methodology used is basically always, “We searched through these documents to cherrypick bits that support our predetermined thesis, without any attempt to assess whether they were representative of anything; we treated random remarks in obscure memos by middle-managers as if they were accepted corporate policy; we made no attempt to triangulate what we found with other sources, let alone talked to anyone though many of the people identified in the documents are alive and could be found.” Change a few words and this is also their method for analyzing epidemiology data, but history journals have higher standard than health journals. History term papers have higher standards than that. Thus the latest entry in the series was published in PLOS Medicine. While it is usually best to just ignore these papers, this largely overlooked one, “Public versus internal conceptions of addiction: An analysis of internal Philip Morris documents,” turns out to be worth a look. The senior author is Pamela M. Ling, whose unethical research makes her a reliable Glantz minion. But one or both of the other authors, Jesse Elias and Yogi Hale Hendlin, appear to be aspiring to real scholarship and slipped some stuff past Ling and Glantz. Or perhaps they all just ran into the problem of trying to keep so many lies straight.
The core of their story is that in the 1990s and 2000s personnel at what they call “Philip Morris” were conceptualizing addiction as a complex interaction of biological, psychological and social/economic phenomena. (There were three related companies with that as part of their name — Philip Morris USA, Philip Morris International, and the umbrella company in which the other two were divisions, Philip Morris Companies Inc. — during some but not all of the relevant period. The authors make no attempt to differentiate among the companies, nor any effort to demonstrate that there were no relevant differences. They just muddle them all together without justification because the “secret documents” research is an exercise in creating innuendo, not historical knowledge.)
Unlike with most of the “secret documents” research, which consists of random sentences from random documents scattered across time and space, there actually were some working groups on this topic, and the history reported in the paper seems to be based on their notes. As with all of the industry document research, there is no evidence that anyone in corporate management ever saw these documents, let alone considered them when making policy. The paper authors presumably realize how absurd it would be to say that “UCSF knows Stanton Glantz is a liar because one professor there wrote something about it,” but their lack of experience in the world prevents them from understanding the same is equally true of a massive corporation. Thus, they engage in the error/falsehood of treating everything noted by one small group as corporate policy.
It is unclear what people in the working groups meant by “addiction,” or whether they even chose to use that slippery word. The authors accidentally report enough for us to know the working groups balked at the word, but then just continue their story as if it were accepted. This is a critical point because it suggests that these experts were uncomfortable with the biology-centric use of that word and also, perhaps, its lack of meaningful definition. In any case, they were ahead of the curve on understanding the complex psycho-social side. No serious research or analysis on concepts in and around (genuine) addiction treats the phenomena as purely biological anymore, which is a huge improvement over the conventional wisdom of the last few decades.
So what is the problem, according to the authors? It is that the companies did not actively push out this message at the time. Of course if they had, tobacco controllers would have ripped them to shreds for proactively trying to influence public thinking. If you have ever worked for or been an advisor to a certain type of boss — the type who will reject any new idea that comes from anyone else, or perhaps just from you personally — you can understand this. If you have a good idea, you might try to trickle it out so the boss catches on and thinks of it as his idea, but the last thing you want to do is just come right out and say it. That will doom it forever.
Specifically, tobacco controllers would have viciously attacked any company making such statements for trying to undermine their message that “addiction” is entirely about the chemistry of the products and biology. In the 2000s, tobacco control actually did start to drift in a more enlightened direction of recognizing the psycho-social aspects, though always lagging well behind the practical and honest thinkers found in other drug policy areas. To a large extent, though, they have reversed this trend toward enlightenment as part of their war on vaping, which is all about the evil powers of the nicotine molecule.
So what did the companies say publicly? The paper describes them as “denying” that smoking (etc.) was addictive through the 1990s. This is a gross oversimplification of a combination of litigation positions (that a plaintiff had not proven a particular extreme claim: “he was unable to quit”) and trying to not make simplistic statements that ignore the nuances.
The umbrella company eventually publicly issued a concession about “addiction” which basically made it all about the products and the nicotine. Why did they choose to say that rather than offering a more nuanced understanding? Because that is the “public health” party line that tobacco controllers were demanding they endorse. The paper — even as it is attacks the companies for not offering greater nuance — admits that the concession was part of the corporate “alignment” strategy, and that it did indeed align with the position of “public health.” Whether it was a tactical move to parry particular attacks or a misguided attempt to appease tobacco control is unclear. (Pro tip: When someone considers you their mortal enemy, with no common interests, attempts at appeasement are just unilateral concessions.) Perhaps some real historical research could answer that, but we are certainly not going to learn anything from UCSF researchers. But what is clear is that the company said it because tobacco control said it.
In short, this paper was written to condemn the Philip Morris companies, and “the industry” more generally, for hiding information. Except it basically admits that the reason they took a public position that underplayed their understanding was that tobacco control force them to. Moreover, that psycho-social insight that they were supposedly hiding (though perhaps it existed only among one small clique of scientists and not the decision-makers) is flatly contrary to the dominant tobacco control position of the late 2010s — particularly including that from their own UCSF shop — that the biological effects of nicotine are really all that matters. The authors further condemn the current tobacco control thinking:
The classification of a given substance as addictive depends as much on the contexts in which substances are used as on…neurochemical properties. Definitions and connotations of “addiction” continually change. Due to this changeability, addiction is best viewed not as a universal scientific truth to be unveiled or denied but a malleable concept situated in specific social, political and scientific contexts.
[some of the phrasing was attributed to cited sources (omitted)]
The game here is to attack the industry with whatever stick happens to be at hand. In this case it is condemning them for adopting tobacco control’s position on “addiction” from c.2000 and just letting it ride, even though they (apparently) knew better. As almost an afterthought, the authors try to spin this as somehow an active attempt to derail more effective anti-smoking measures (burying the absurd implicit premise that the companies’ public position somehow affected what anti-smoking measures were being pushed). But to condemn this position is to condemn the predominant (Glantz-wing) view of “addiction” from 2018. Perhaps the junior authors of this paper had enough integrity to do that, or perhaps everyone involved is just just so immersed in contradictory lies that they it did not occur to them to try to reconcile them. Either way, this may be the first time that the “industry documents” reports ever made an honest contribution to the debate.
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