Rowell on Nicotine: Why Can’t We Be Friends?

March 25, 2005 1:12 am by Gene Borio

March 23, 2005

Defense witness Dr. Peter P. Rowell, Associate Dean for Research and a Professor of Pharmacology and Toxicology at the University of Louisville School of Medicine, is a bit thin, with a small head. From the side, his small chin and sloping forehead seem to focus his face to the point of his nose. And with his fine, light brown/grey hair, there was indeed something of the pet ferret about him (fashion tip: he should never consider sporting a large mustache). And if we analogize the physical to the mental, Dr. Rowell seems to have a similar lively, warm suppleness about his thought and demeanor. The mammalian, limbic cortex seemed more in evidence with Dr. Rowell than with previous Defense witnesses. Dr. Rowell’s relevant work on nicotine and smoking behavior had been done by the time the tobacco industry discovered him. Perhaps partly because of this, he did not seem so concerned about toeing the party line. (Perhaps this is also because there is less money at stake here. At a going rate of $300/hour, Dr. Rowell is certainly the most impoverished of industry witnesses. The holes in the knees of his pants left not a dry eye in the courtroom.)

Dr. Rowell’s spontaneous flexibility was a refreshing change from the previous defense witnesses, especially BATCo R&D head Graham Read, who seemed so canny, so armored, so thoroughly unwilling to deviate an inch from the legalistic purpose of his testimony. His slipperiness seemed almost Clintonian.*

Dr. Rowell would at times say, “yes you’re right” on important issues. At one point, Dr. Rowell was giving candid answers to DOJ questions comparing internal company use of addiction terminology with the industry’s public statements. He said he was not aware of instances where Defendants objected internally to cigarette smoking being called an addiction because it should properly be termed a “drug dependence.” Mr. Bernick objected to the questioning as being beyond the scope of what the witness had been proffered for. “He’s now a plaintiff’s witness,” Mr. Bernick lamented.

And DOJ attorney Andrew Goldfarb would reciprocate in turn. They seemed to be about to get together, have a beer, and call off the whole addiction aspect of the case. In fact, Mr. Bernick asked twice if the Government were willing to stipulate that it doesn’t allege Defendants knew more about nicotine pharmacology than the independent scientific community. “It would save us a lot of time,” he said.

Another point in Dr. Rowell’s favor: he never said he, and everyone he’d ever worked with, “did good science.” Funny how only tobacco industry scientists, with relatively minor accomplishments in the outside world, talk about how everyone at their lab, facility, company “did good science.” You never heard Dr. Samet, for example, shamelessly laud what “good science” everyone does at Johns Hopkins.

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The premise of Dr. Rowell’s testimony was that smoking was addictive–not nicotine. Or, at least, not as much as the behavior of smoking itself. As Judge Kessler clarified for herself at the end of his testimony,

“Is it your testimony that nicotine is slightly addictive pharmacologically; and smoking is substantially addictive behaviorally? Is that a fair summary of your testimony?

Dr. ROWELL: Yes.”

He said he is not aware of any studies that find nicotine, by itself, produces addiction. He did admit to Mr. Goldfarb, “There is no smoking without nicotine, and there is no nicotine without smoking.”

Whereas previous DOJ cross examinations spent an inordinate amount of time nailing down seemingly picayune points in documents, while leaving uncontested some of the larger issues in the witnesses’ written direct testimonies, Mr. Goldfarb did seem to concentrate on some of the important issues

By the time Mr. Goldfarb had finished, he seemed to have left Dr. Rowell teetering on the DOJ side, having acknowledged the dominant importance of nicotine in addiction.

Mr. Bernick, having a very good day**, reclaimed Dr. Rowell on redirect. Not that it was easy–Dr. Rowel often refused to swing at Mr. Bernick’s softball questions–but by the end, Mr. Bernick had made sure we all knew Dr. Rowell was on the Defense side.

The immediate questions that come to my mind about Dr. Rowell’s testimony on the addictiveness of nicotine vs. the addictiveness of the behavior of smoking, are:

Why don’t lettuce cigarettes work as a substitute? Or Philip Morris’ Next, or any legal smoking product at all sans nicotine? And what about chewing tobacco? What about those who are addicted to the nicotine gum they used to quit smoking–a small but recognized group? Is the mere act of chewing “addictive?”

None of these issues were addressed in Dr. Rowell’s written or oral testimony, nor in Mr. Goldfarb’s cross.

You imagine what the Defense would have done with such a witness, were they to suddenly take the other side. Big gaps in addressing the major issues of a witness’ testimony seemed the pattern for much of the DOJ’s response to Defense’s witnesses.

This brings up another issue: the disparity in the resources and experience of the sides. DOJ clearly has no single law firm with decades of tobacco trial experience, let alone the multitude of Defense firms here; DOJ has no one with the years of study and battle-honed expertise of a Mr. Bernick, Mr. Minton, or Mr. Bierstecker in scientific issues. It surely takes far more than a year or two of boning up on some science books to trip up someone like David Kessler on nicotine. I’m sure no expense has been spared to tutor, with the best minds available, the already-astute Mr. Bernick.***

Despite the fact that Defense’s scientific witnesses had virtually nothing published–peer reviewed or not– on the subject of their testimony, the DOJ did not seem to attack them at the very heart of their testimony, did not try to find that chink in their knowledge or data which would call into question their entire testimony–a Defense specialty.

Mr. Goldfarb did well in finally answering the tobacco industry’s claim that smoking is not addictive because people can and do stop. He asked Dr. Rowell if the Defendants in their internal documents had ever expressed the belief that an addictive drug is one that a person is unable to quit using. No. Then he asked if Dr. Rowell had ever seen any scientific report that defines an addictive drug as one that users can’t possibly quit. No. Then he asked if it were true that among all drugs widely considered addictive, users can and do quit. Yes.

Mr. Bernick on redirect seemed to establish that people in the companies expressed differing views on “addiction” and/or “dependence,” and that, as today, the distinctions between the two terms often blurred. He discussed the Addison Yeaman 1963 memo, “We are, then, in the business of selling nicotine, an addictive product.” Then he showed a contrasting document one that called nicotine addiction into question (but nothing that directly refuted Yeaman’s assertion, nothing that read, “Oh, Addison, you nut! We all know nicotine’s not addictive. You screwball, you”).

Since Dr. Rowell had formally reviewed all available industry documents on nicotine for this case, Mr. Bernick asked him, “When [industry] scientists are talking among themselves, internally, are the scientists saying–some saying “addictive,” some saying “not addictive?” Dr. Rowell said, “Yes.”

Another important aspect here which was relatively unchallenged by the DOJ, was in Dr. Rowell’s written direct testimony:

“[I]t is clear from . . . . a record of the NIDA Working Meeting On Tobacco Use As An Addictive Process, that use of the term addiction was chosen . . . . for ‘its visceral effect on the public and the pressure on lawmakers that will result.’”

Ie, the decision to employ the term “addiction” in the 1988 Surgeon General’s Report, “The Health Consequences of Smoking: Nicotine Addiction” was a policy, or PR decision, and not a scientific one–a terribly damaging assertion.

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UNSTARTED BUSINESS

I tell you it kills me not to have time to address, in relation to Dr. Rowell’s testimony:

–the release of dopamine into brain tissue, especially the nucleus accumbens, the brain’s “pleasure center,” and how both drugs and behavior stimulate the release of dopamine.

–the quantitatively greater release of dopamine from other hard drugs, and the unaddressed question of duration, namely this: morphine, releases 3-4 times the dopamine as nicotine. Yet smokers release that dopamine 7-10 times every hour on the hour; morphine is taken far more infrequently. The study as shown, and the demonstrative, were unclear on how one should account for this. And is addiction all and exclusively dopamine?

–the discussion about how 90% of heroin-addicted Vietnam veterans quit once back in the US , Mr. Bernick’s equivocations about this established fact, and Dr. Rowell’s medical service in Vietnam, and his personal acquaintance with the issue.

–Dr. Rowell’s critiques of Dr. Henningfield’s testimony on ammonia’s effect on the release of “free” nicotine.

–The way Mr. Bernick can deconstruct a simple, seemingly self-evident notion like, “addiction involves substantial loss of control,” and turn it meaningless mush.

–The utter confusion between the use of dependence and addiction throughout the decades and even today, whether used interchangeably to mean roughly the same thing, or whether differentiated to mean different aspects of compulsive behavior–as the WHO does today, requiring “addiction” to include intoxication.

– The extensive literature review of published scientific articles on nicotine that Dr. Rowell did (with Dr. Lawrence Carr) over a 2-year period, “Historical Review of Nicotine’s Actions.”

–Dr. Rowell’s extensive review of all company documents concerning nicotine, and his conclusion, in tandem with the above-mentioned book, that the documents fail to show that “the defendants had knowledge of any “addictive” properties or mechanisms of nicotine, ahead of the public scientific community.”

There is so much rich material in this trial every day. About Edmund Kean, the great early-19th century actor, a critic famously said that watching his performance was like “reading Shakespeare by flashes of lightning.” Here, it feels as if the viewer must be trying to read a trial transcript by a sputtering bulb.

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*THE TRUTH IS OUT THERE…WAY OUT THERE

With his youth and straight sandy hair, DOJ attorney Daniel Crane-Hirsch has a kind of geeky charm–a Fox Mulder (”The X-Files”) as if “Ol’ Spooky” really existed: ie, wasn’t played by a dashing movie star.

Smart? Yow! The back of his head is fairly protuberant, as if bursting with sheer brain-power, and in court he flashed a nerdy boldness, as if to say, in rapid passing, I’m just too damn smart, have too many other things of moment to think about right now, I’ve no time to start worrying about social graces, sorry.

To watch him in combat, aggressively trying to pin down the older, wiser, Dr. Read (whose large head, as opposed to Dr. Rowell’s, seemed to engirdle a hefty portion of reptilian cortex) was amazing. Dr. Read kept slip-sliding away in a British accent with hints of Cockney, a la Michael Caine. But when pressed too closely, he periodically flashed Mr. Crane-Hirsch a bug-squashing glare.

Why the very cheek of Mr. Crane-Hirsch’s aggressive, pointed arguments with Judge Kessler! Even though at times during his cross she had seemed to be giving him school lessons in plain old proper courtroom procedure. (This is not unusual, actually. And in fact, the DOJ team should watch Judge Kessler’s face more closely than they do. There are times her expression seems almost to shout, “You’re not letting that answer just sit there, are you?? Oh, well, it’s your cross.” Sometimes her questions to the witness seem to erupt because the questioning is taking so long to get to the point–and even shows signs of never getting there.)

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**WHY KANT WE BE FRIENDS?

Mr. Bernick’s first accomplishment this morning (I can envision Mr. Bernick telling the younger lawyers at Kirkland and Ellis, “Why, I impeach 3 witnesses before breakfast!”) was to frame a complex argument in elegant simplicity for Judge Kessler. The previous roiling, extensive argument concerned –don’t get excited now–Rules 602, 701 and 702, and how they applied to the testimony of the Freud doppelgänger, CTR consultant Dr. Harmon McAllister. 602, 701 and 702 are rules governing what a Fact Witness or Expert Witness may legitimately testify about. Basically, a Fact Witness testifies to what he experiences, his personal knowledge; an Expert Witness is a professional who testifies in his particular field of expertise–chemistry, statistics, etc. The problem comes when, in the course of a witness’ science-oriented job at a tobacco organization, he gains a perception and knowledge of company policy, history or documents. Here, the testimony may cross over and exist on both levels. But what about policies and documents that precede his employment? As Mr. Bernick said in his effort to focus the court on “the fundamental principles underlying the rules (602, 701 and 702, you’ll recall), “how do you put historical facts into evidence?”

Drawing upon Kant, Mr. Bernick claimed all knowledge is inferential, ie, if a witness is asked to comment on a document that originated before his arrival on the (CTR) scene, he would necessarily infer certain things about it, based on his learned knowledge of the company, subject matter, author, etc. His experience would inform his judgement of the document, and he could legitimately make inferences about it, make a knowledge-based comment on its import and meaning.

In a non-inference world, Mr. Bernick said, a witness confronted with a document he didn’t write or receive could only recite the text; he could make no informed comments about it–a kind of mental “Flatland” (1884).

Judge Kessler, of course, seems to see all, know all, and while taking Mr. Bernick’s potent argument under advisement, gave no inference about how she would rule, remaining impassive, 8-ball-like– clearly not as impressed as I.

At one point, Mr. Bernick promised the Court not to say any more about Kant, for which the Court was duly thankful. But thus it passed that he never told us if Kant were a real pis-sant, as elsewhere alleged, nor whether Heidegger was a boozy beggar.

(See The Philosopher’s Song)

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***By way of contrast, in the snarled and snarling discussion of remedies witnesses, when Judge Kessler suggested the parties may have to make use of the Special Master again, Ms. Eubanks said DOJ had “no budget–none” with which to hire a Special Master.

2 Responses to “Rowell on Nicotine: Why Can’t We Be Friends?”

  1. tobacco observer Says:

    Why don’t lettuce cigarettes work as a substitute? Or Philip Morris’ Next, or any legal smoking product at all sans nicotine? And what about chewing tobacco? What about those who are addicted to the nicotine gum they used to quit smoking–a small but recognized group? Is the mere act of chewing “addictive?”
    ****

    Why don’t most people drink decaf coffee? Same thing. Believe it or not, there are people so desperate for caffiene at times that they will suck on (or chew) roast coffee beans! The drug is what the users are after, but that doesn’t by itself mean that the substance is “addictive”.

    I think what has become clear here is that ultimately the concept of “addiction” really does come down to a semantic argument. You can invoke dopamine levels, loss of “control”, self-administration in lab animals, “liking” (a la Dr. Henningfield), tolerance, mood-alteration, or multiple other concepts. Some apply to tobacco well, some don’t, and the same thing applies to coffee, marijuana, and a number of other pharmacologic agents. Some substances are clearly more “addictive” than others. Where do you draw the line?

    If you want to invoke “loss of control” or “dopamine stimulation” then gambling, overeating, and many other non-drug related behaviors are also “addictive”. I think in the end the word “addiction” is still emotionally loaded, and there is no universally accepted definition.

    I think the real question for trial isn’t so much whether or not tobacco falls under one or the other definition of “addiction”. Certainly its a habituating phamacologic agent, and certainly it does fit under some of the definitions if not others. The question is, what (if anything) did the tobacco companies know about this that wasn’t known to the scientific community and to the general public? Was there really a conspiracy that hid the “truth”? Were the tobacco companies really the only ones who knew that tobacco was “habit-forming”? I think there is abundant evidence that the scientific and medical community was aware of the habit-forming properties of tobacco decades before any of the defendants in this suit even existed.

    ****
    –the discussion about how 90% of heroin-addicted Vietnam veterans quit once back in the US , Mr. Bernick’s equivocations about this established fact, and Dr. Rowell’s medical service in Vietnam, and his personal acquaintance with the issue.
    ****

    That’s interesting, but somewhat of a red-herring. When people are in high stress situations, risking their lives constantly, and heroin is ubiquitous, unsupervised, costs negligible amounts of money, lots of people are going to use it. Conversely when heroin is illegal, carries severe criminal penalties to possess buy or sell, is extremely expensive, and relatively difficult to acquire, and when the stressful stimuli are removed, people formerly using it will quit. That doesn’t make heroin either non-addictive or addictive, again, that’s a semantic issue.

    Conversely, if you were to ban cigarettes, give people 15 year jail terms for possessing or selling them, force them to go into dank ghettoes to buy it, and charge $4 per cigarette, miraculously, most of the “addicted” smokers would quit too! But there would still be a few hardcore smokers who wouldn’t. The exact same thing could probably be said about coffee beans.

    The point is, there is a lot more to use patterns than simple pharmacology. Go to any busy metropolitan hospital and watch the employee “addicts” lining up patiently every morning in long queues to shell out $4 a cup for Starbucks coffee (which contain *outrageous* doses of caffiene), and your feelings about “addiction” might change a bit.

  2. David Gundersen Says:

    Just not sure of the point on this one…that since other products are addictive, we shouldn’t be concerned about nicotine/tobacco addiction? Or maybe that addiction is all semantics and not a worthy reason to regulate and/or control a substance? Let me address the point as I understand it.

    As Tobacco Observer mentioned, some activities are more addictive than others. Nicotine and the act of smoking are addictive by virtually any accepted medical and/or psychological definition. Unless you reject the entire notion of addiction, cigarettes are addictive.

    The next tier of the discussion is the all important question, “So what?” So what if nicotine and cigarettes are addictive? The “so what” is in the detrimental health effects of inhaling smoke, and the resulting death, disease, and health care costs. It’s that simple. Coffee and its addition doesn’t kill a third to a half of coffee drinkers. Just doesn’t happen.

    Finally, the “moral equivalency” argument of the Tobacco Industry to the government, scientific, and medical communities is simplistic at best in light of these two facts. When the tobacco industry discovered its product was addictive, they hid the facts. When they learned of the health impacts, they hid, and actively tried to undermine belief in the facts. When the government, scientific, and medical communities discovered the same, they began the modern era of increased regulation and taxation to address the health and economic costs. The Tobacco Industry lied and covered up. The government, scientific, and medical communities continue to lead the effort to prevent the death, disease, and health care costs caused by smoking despite political and economic pressures from the Tobacco Industry. There is no equivalency here.

    Finally, there’s a lot of road between treating cigarettes like heroine and a reasonable approach to regulation. FDA regulation, no advertising, not selling tobacco in the same places we buy milk, bread, and gas, and having access to affordable and evidence-based tobacco addiction treatment are reasonable alternatives to 15-year prison terms.

    Philip Morris is not Starbucks. Maybe if people were smoking coffee beans, you’d have an argument. Or maybe Starbucks can come up with drinkable tobacco. That would solve a lot of problems…

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