A primer on the buffoonery of Simon Chapman for Australian IWT opponents (part 1)

I was recently reading about the fights over IWTs (industrial wind turbines) in Australia, and was surprised to learn that Simon Chapman -- who is a visible activist proponent of IWTs, despite apparently not understanding the relevant science -- creates a difficulty because he is considered a scientist and respected for his contributions regarding tobacco, and so has influence in halls of power.  I suspect that few people working on IWTs realize that his "contributions" to science and regarding tobacco are pretty much comical, and that he has undoubtedly done more harm than good for public health.

While I probably cannot do anything to help improve your government's willingness to trust in supposedly serious and technically-expert opinion leaders who are actually clueless hacks (if I knew how to do that, I would start here by doing something about Paul Ryan), I might be able to contribute some useful tools for fighting him.  He may well be able to leverage his supposed respect and accomplishments from tobacco to exert inappropriate influence about IWTs so long as people do not understand what he actually says in that realm, but once that is on the table he might do less damage to the world.  I think I can give you enough information to undermine Chapman's credibility as a respected international ...um... well, whatever the heck he claims to be.  I think this is up to me because I am, as far as I know, the only person I know with substantial expertise in the science and policy of both tobacco and IWTs.  I hope it becomes apparent that Chapman does not fit that description, though he works in both areas.

(For those who are not the target audience, but are interested in the tobacco politics, I expect you will find this interesting also.  As a bit of background: IWTs -- those giant bladed towers that generate electricity from wind -- cause terrible health and other problems for local residents.  While it might be possible to argue that this is a price worth paying for their benefits, the "benefits" of these monstrosities are a barely-positive net contribution to electricity generation at a cost that is ridiculously high.  But that cost-benefit argument is not the one that the industry and those working on their behalf, like Chapman, ever make; instead, they stick to the blatantly absurd claim that there are no local impacts.)

In this post I will address why Chapman does not deserve any respect for his "contributions" regarding tobacco.  In part 2 or maybe even 3, I will address how clueless he seems to be about IWTs and some of his other silliness.

First, it is not clear that anyone currently in tobacco control can claim credit for any major accomplishments; it has basically been a workaday affair for decades.  The reduction in smoking in rich countries began when 25 years of epidemiologic research finally resulted in the public health declarations of the 1960s and the education campaigns that started soon after that.  Since that time, smoking rates have steadily dropped toward their natural minimum, which they are close to now, like treacle (that is a word you use down there, right?) slowly running down a hill. 

The imposition of high taxes had some effect beyond the education.  Bans on indoor smoking in various places have reduced the impact (mostly aesthetic) of smoke on non-smokers.  But other than education, taxes, and substitution of low-risk (smoke-free) alternative products, nothing has had a measurable effect on smoking prevalence.  The substitution of smokeless tobacco or electronic cigarettes is a strategy known as "tobacco harm reduction"; it accomplishes appx 99% of the risk reduction of eliminating tobacco/nicotine use entirely, but leaves former smokers happier and allows for free choice.  Chapman is among those who oppose harm reduction; the motivation seems to be largely a desire to punish (both smokers and manufacturers) rather finding a way out of the current mess that makes everyone better off, and to exert control rather than allow free choice.

There are a few heroes of tobacco control, but they are the original researchers, who were also the core of those who did the first public health education.  Most everyone else who claims credit for reducing smoking basically just marched ahead of the treacle flow, carrying a flag, and claimed to be leading it.

Australia has among the lower rates of smoking in the world (though not nearly as low as the few places where substitution of low-risk alternatives has become popular), but it is not particularly exceptional given demographics and culture. Basically, that country just followed the lead of US, UK, and German researchers and early policy movers, and ended up just where you would expect it to be.  Nothing Chapman ever did made any substantial difference in the inexorable flow.

But "no major impact" is far too kind in this case.  I recently characterized Chapman as The Worst "Public Health" Person in the World.  He has done a lot to earn that title, but the standout contribution is that he

claims personal credit (i.e., blame) for the ban on low-risk alternatives to smoking in his country, making him the person responsible for the most pointless deaths of his countrymen since the guy who ordered the army to Gallipoli

So basically it might be that Chapman sometime contributed to raising taxes a month sooner than would have happened without him, or something of that magnitude (though, as will become apparent, if he had such an effect it must have been thanks to his skills as a bully, not as a thinker), but he also claims to have kept Australia from possibly getting the benefits of product substitution.  Since product substitution is the only proven method for getting smoking rates below about what they are now in Australia (or the US or Canada), this has to put him on the negative side of the public health ledger by a huge margin.

Of course, I realize that if you try to explain this, it will probably exceeds the attention span of anyone who thinks that listening to Chapman is a good idea.  Explaining to most people that what they thought they knew about tobacco policy is wrong is probably not a promising tactic in political rhetoric, though I think it might be helpful perspective for those who are most invested in the IWT fight.  I think much more promising approach is on the theme of "whatever he once did, now he is clearly a buffoon who spouts one false, hateful, or silly thing after another":

Recently, his public focus has been the campaign to ban branding or artwork on cigarette packages, which legally basically means abolishing even the most basic rights of free communication, confiscating brand equity, and seizing the packages as conduits for anti-smoking advertising.  This is a violation of international trade treaties, and I have seen arguments that it violates Australian law also, though I have no way to judge that (and, indeed, will bet that the court now hearing arguments will let it pass, given the national trend toward being nanny-state; the international tribunals will undoubtedly find it to be illegal).  On top of that, it is clear that this policy will lead to more counterfeiting and smuggling because it both facilitates it (generic packages are much easier to fake) and increases demand for it (if all packaging is ugly, there is one less barrier to buying the cigarettes in plastic bags off the back of a truck).  Among the effects of such smuggling are much cheaper cigarettes, sold through channels that are not too picky about ages limits and such, enriching of organized crime enterprises, and loss of tax revenue.

So it must be that the benefits of this policy are so great that it is worth the fight against law and norms, right?  Well, no.  This will not have a measurable effect on smoking.  It has never been tried before (and thus Chapman's and others' claims that they have evidence it will be effective are clearly blatant lies), so it theoretically might have some impact.  But "theoretically might", when there is absolutely no basis for believing it will happen, is not a legitimate basis for radical policies -- which the proponents must understand, or they would not lie about the impact being proven.

It will however hurt smokers (making their lives a little bit less happy due to the ugly health graphics rather than pleasant looking branding) and especially major tobacco companies (because it helps the smugglers they compete with, and also because it makes it harder for them to profit from prestige premium brands since smokers will probably shift toward the cheaper brands if they all look the same).  Since hurting smokers and hurting the industry are the goals of pseudo-public-health anti-tobacco people like Chapman, this works out just fine.  For people like him, it is not about public health, and definitely not about helping smokers.  It is about perpetuating his gravy train and punishing people who dare disobey him when he declares the Right Thing To Do.

If that sounds familiar to those in the IWT fight -- an action that does not fulfill any of its ostensible goals, and merely helps the rich get richer at others' expense, but attracts a cadre of useful idiots supporting it because they think it is good for society -- then you are catching on.

For those who are interested in digging deeper into why Australian tobacco control, even the non-buffoons in it, is pushing for an illegal move that has no apparent upside:  I speculated that those who are pulling the strings behind tobacco control are intentionally setting up this useless policy to fail so that they can claim that Evil Big Tobacco thwarted their plan that would have ended smoking once and for all, and thus ensure a continuing funding gravy train for another decade.  Chapman does not seem to have the skills to come up with a clever plan like that, nor the discipline to keep quiet about it.  So if that story is true, Chapman is probably just one of the useful idiots who is playing naive foot soldier.

So, the choices about him are either:  A leader of an activist cadre that has accomplished nothing of value, but does some really stupid things.  -or-  A dupe of the real leaders of that cadre.  Neither one is exactly a qualification to branch out and hurt people in other areas too.

But this flat assessment can never present the picture of him that you get if you look at the details of what he actually writes.  I have listed a few choice examples, and I recommend following the links to fully appreciate them.  I should note that I did not do any active research to gather this information.  I did not do a web search and I do not follow him on Twitter.  I cannot even imagine what you would come up with if you put in that effort.  Instead, these items are mostly those that came across my desk just during the few weeks since I started thinking about writing this guide (really! you would be astonished how often stupid things Simon Chapman has written come across my desk without any effort on my part), along with a few particularly amusing ones I recalled from past months.  Also, these are just the ones about tobacco -- I will include some others in a later post -- and I left out a couple of recent posts that tried to analyze him because I wanted to focus on him condemning his own intellect and integrity with his own words:

• Here he is citing some random bravado by cigarette counterfeiters as the basis claiming that plain packaging will not facilitate counterfeiting.  Actually, the funny part is that it mis-cites the counterfeiters' claim, translating it into something that is utter nonsense -- it is a hilarious read. 

• But don't worry, because counterfeiting is no problem: Here he is claiming that smuggling (of illegal cigarettes) cannot possibly be a problem because if customers know where to buy illegal product, then the police can easily know too, and thus stop it.  Gee, he should probably tell the drug enforcement authorities about that clever bit of sociological analysis.  Maybe he just doesn't want to make the cop dramas really boring ("Chief, we heard some people were selling crack, so we went to where it was happening and stopped it.  So can we get back to directing traffic at the construction site?"

• And, besides, he assured us that "Smuggled tobacco is a major issue in nations with high corruption indexes and open borders. It has never been a major problem in Australia."  Apparently it is all about corrupt nations like Canada and non-island nations like Ireland (which both have enormous cigarette smuggling).  Wait, what?  You say that a major Australian newspaper reported, one week after he published that comment, that Sydney is flooded with black market cigarettes. Interesting.

• Here he is espousing the fallacy that what is bad for industry must be good for public health, but then in the same material admitting that he really understands the truth and thus was mostly lying or such a poor thinker that he does not see the contradiction.

• Here he declares that the many countries who are challenging the seizure of trademarks and such are all just corrupt and basket cases.  Perhaps he was reading the list from the back end of the alphabet and got as far as Zimbabwe before his limited attention span fell off; he apparently did not get to Turkey, Indonesia, Chile, and numerous other, or even as far as Zambia.

• When a member of the UK parliament analyzed his plain packaging plan and pointed out that the costs exceed the benefits, did he respond with analysis?  Of course, not -- he does not do analysis, and does not pursue causes that are supported by analysis.  Instead, he claims that any opposition to his pet policies from the UK reflects that country's support for the slave trade.  I am not kidding.  Read here and here.

• In response to the legal challenges about trade rules and intellectual property, he argues that it must be just fine since Islamist countries ban alcohol sales, overlooking minor points like (a) banning a product category is totally different from confiscating a brand and (b) if your argument is "this is not unacceptably illiberal; Saudi Arabia does something almost as extreme", then you have a problem.

• But plain packaging is only the next of several steps he has planned.  His deep knowledge of sociology leads him to suggest that Australia will shortly embrace a system where smokers have to obtain a government permit that controls how much smoking they can do (more here).

• And just in case you were under the impression that he was trying to help smokers, his hatred of them is apparent here, in his accusing them of absurd acts of bad parenting.

That is long enough for now, because to really appreciate this message, you will need to follow the links.  And it is worth reiterating that compiling this list required no effort or searching, and I am sure it is possible to lengthen it ten-fold.

One of the comments on one of the above-linked posts read:

I have to admit that I love to read about Chapman fails, even though the thought of this man makes me feel ill. He’s a tyrant, using health care issues as a guise to destroy everything he does not like. ... In the fullness of the time, the world will see him as one of the most hateful beings to have lived. He deserves far more scorn than he has yet received. Although, it does feed his enormous ego when we criticise him.

No doubt that last point is true.  The man is apparently so unaware of both himself and the world that he will probably see something like this as a tribute to his importance.  I don't really care.  I am trying to help the many people he is wantonly hurting, and the impact on him does not matter.

So, though he can see this as a validation of his impact, I trust that others will actually understand it, and realize the message:  If he is influencing policy about IWTs by coasting on his reputation from tobacco, it might be useful to know that that reputation in that arena is as a junk scientist, a failed thinker, either a liar or incredibly clueless about what he claims expertise on (which is just another form of lying), and an international running joke.

I will take up further spectacular Chapman fails, probably in a week or two.

Unhealthful News 213 - More on "addiction", and understanding why NRT does not work

This posts finishes off my recent mini-series on the nature of addiction and related concepts, in the concept of smoking and other tobacco use.  It started with a post about the implications and ethics of a "vaccine" that prevents someone from getting any effect from nicotine.  I then wrote about a new study that provided some interesting insight into the role of addiction in quitting smoking.  In those posts I introduced the notion of second-order preferences (preferences about changing your preferences) and the Chicago School definition of addiction (focused on someone having increasing marginal returns to consumption, rather than the standard diminishing marginal returns), the only candidate for a legitimate scientific definition of "addiction" that exists in the scientific literature so far as I am aware.  I then suggested that second-order preferences offer an alternative definition of addiction, or at least characterize what is often being thought of when the word is used.

I wanted to tie this together a bit in the context of news reports about a new study that shows that use of nicotine replacement therapy causes approximately zero increase in the success of smokers who are trying to quit.  Actually, I am not sure there are such news reports right now, but since there is such a study result every few weeks, I am just going to say there are. 

[It turns out that between the time I wrote the previous sentence and when I posted, a new example came across my desk.  I am not going to bother with details of it because the key point remains that this is a roughly semi-weekly occurrence.  I will note that the authors -- pharma industry flacks -- tried to sell the story that NRT was effective, when their results showed quite the opposite; this is typical, so it is useful to realize that most new studies that claim to have demonstrated effectiveness are really part of the long list that show so little benefit.  Honest researchers would never claim they observed any effect worth mentioning.  For more on the dishonesty of the new study, see this post by Michael Siegel.]

So, what explains the strange combination of "NRT does not help to a measurable degree" with "people are sufficiently convinced that NRT will help that they keep trying it" and "researchers are are unwilling to accept the evidence that it does not help so keep thinking it will be different next time".  Of course, big money has a lot to do with it:  NRT is obscenely profitable, and so like everything from soda to mobile phones, it is heavily advertised with promises that it will improve your life, and most "public health" researchers I know will do any research someone offers them money to do.  But people would not be vulnerable to the advertising, and the news that it does not help would not be so interesting, if there was not some intuition that the products ought to help.  After all, there are no news stories reporting the shocking discovery that, say, wearing your underwear inside-out turns out to not make it more likely you quit smoking.

It seems pretty clear that most would-be quitters use NRT based on the belief that it will fulfill their second-order preference, "I wish I did not want to smoke."  That is how the products are marketed, as a way to fulfill that wish.  But there is an important nuance in the sales pitch:  It talks about some immediate "urge" or temporarily "taking the edge off" because these products are not supposed to be substitutes, but only tools for making the transition to abstinence easier.  (Of course, the pharma is happy to sell most of the product to former smokers who are using it as a harm reduction substitute, just as long as they can keep pretending that is not their main market, but that is another story.)

The nuances of the message and the wish highlight differences between the two candidate definitions for "addiction", and make it clear why it is obvious that NRT will not work.  If the reason someone has the characteristics "chooses to smoke" and "believes he would rather not smoke" is because it is too tempting to relapse before getting through some transition, then NRT or something with similar properties will help.  NRT is designed to lower that supposedly irresistible high marginal return that results from addiction (in the Chicago School sense of the term) until a few days of abstinence lowers it.  (Arguably the products are woefully bad at providing even this benefit, but that is another story still, so let's ignore that complication for now.)  But then again, most people who are really committed to quitting are quite capable of getting through that transition without aid, at least for smoking and even for the likes of heroin.  This was an implication of the Penn State study.  Still, on-label use of NRT can at least theoretically help with this.

So NRT maybe helps the small minority who only keep smoking because they are not able to avoid starting again after a brief period of abstinence (and so benefit from the aid) but are happy to remain abstinent once they get there (really were motivated by an Chicago School addiction).

But for many among that minority (in the West) of people who smoke, the combination of characteristics "chooses to smoke" and "believes he would rather not smoke" is something different entirely.  It really represents a realization that, all else equal, not smoking would be better, but not all else is equal.  In particular, such individuals have substantially higher utility (econ-speak for "are better off") when smoking compared to not in the medium term.  By "medium" I refer to the period that is longer than just the short weaning off period, but for which some resulting serious health problem has not occurred yet, and so is only a possibility.  For them, there is no reason to expect that NRT would help in quitting, unless it was used as a long-term substitute.  The reason they smoke again after being abstinent is not some failure to escape the short-term high marginal utility, but because of the assessment "I would be better off smoking again".  Perhaps this assessment is often made without fully considering the consequences, but often it is made in fully recognition of the health risks.  (I suspect it is seldom made with the realization that low-risk substitutes that are better nicotine source than NRT -- smokeless tobacco and electronic cigarettes -- offer the best of both worlds, but that it yet another story.)

In other words, if we use the word "addiction" to describe this phenomenon, it is not the Chicago School definition.  The apparent difference between "willing to pay the price to consume something" and "addicted to it" is the second-order preference "I would prefer to not be willing to pay the price to consume it".  That creates the interesting situation, wherein anyone who prefers to smoke and says "I am ok with my preferences/choice" is not addicted, whereas if they change their mind about that, they are.  It also creates a situation where the dedicated quitter must either alter his preferences (as with the vaccine, that leave you no better off when using nicotine as compared to not) or forever fight them.

The makers of NRT (and their subsidiaries in government, clinical medicine, and "charities") try to sell people on the idea that NRT will adjust their first-order preferences to better conform to their second-order preferences.  Perhaps it sort of does that in the very short run.  But it does nothing to change a person from someone who benefits substantially from nicotine to one who does not.  Medium term preferences are not changed.  Since the ANTZ who dominate the discourse like to pretend that no one benefits substantially from nicotine, and NRT merchants are happy to play along with this, understanding of this fundamental phenomenon is rare.

If research on smoking cessation was a science, rather than being a marketing and political activity, the overwhelming evidence that NRT does not work would have led to the rejection of a hypothesis.  The hypothesis about behavior that leads to the conclusion that NRT will be helpful is something a bit more general than the Chicago School notion, though it encompasses it -- something along the lines of "people only do this because they cannot break themselves free of it, so something that aids in that breaking free should lead to substantial quitting."  But lots of people start again after a successful break, so obviously that story does not explain everyone, and indeed near-uselessness of all short-term aids suggests that it explains only a very few current smokers.

Having proposed it as a definition, I will conclude by saying that I think a definition of addiction that is based on second-order preferences is a lousy one.  It seems to be what a lot of people mean when they use the term, but a phenomenon whose existence is determined by what someone wishes is not a very robust one.  So we return to the situation where the term, as generally used, is just noise, and the intriguing possibility that to the extent that it is well-defined, it is the addicted smokers that are most likely to successfully quit.

Unhealthful News 212 - Second-order preference as a candidate definition of "addiction"

Yesterday I posted about a new study that seems to shine some light on addiction to smoking, if "addiction" is defined based on the only clean definition I have seen in the literature, the Chicago School economic definition that focuses on increasing marginal(*) benefit from consumption.  I noted that most of the time when "addiction" is used in scientific contexts, it as if it actually means something, but on closer inspection it does not.  This facilitates the very anti-scientific behavior of using a word to mean one thing while letting the reader think it means something else.

[(*)As in "at the margin"="at the edge".  It means the next bit, so in this context, it means the additional benefits from consuming the next bit.  This should not be confused with other meanings of the word like "small" or "fringe".]

An alternative way to use the term misleadingly is to define it to mean something that is idiosyncratic and absurdly different from what people normally interpret it to mean.  This is typical in, for example, studies of youth smoking, where it is often defined as something like "indicates in a survey that he intends to smoke in the future", which can mean that someone who has never smoked, or who smoked once and never did it again is "addicted".  (No, really, I am not kidding.  The "research" by DiFranza et al. does exactly this, as described in this article and the commentary I wrote about it.) 

Today, the New York Times decided to help me out with a great example of this method of misleadingly using the term.  The asks "can exercise help curb addictions?", which is pretty hard to answer if you do not know what the word means in this story.  Fortunately, they define it.  In this case, after providing the background -- "according to an eye-opening new study of cocaine-addicted mice, dedicated exercise may in some cases make it even harder to break an addiction" -- we learn that "break an addiction" means "stop bothering to come back to where the cocaine used to be offered once it is apparent that no more is coming".  It is explained that they are defining addiction in mice to mean "displayed a decided place preference for the spot within their chamber where they received cocaine".

By that standard, I am addicted to the seat I usually take at the cafe, to say nothing of my desk chair.  And the "addicted" mice might just be the ones who are slower to figure out that the world has changed, and so maybe it is common sense that is affected by exercise.  In short, so far as addiction goes, this study only shows that your willingness to hang around and wait for cocaine seems to vary based on your exercise history, assuming you are a mouse.  The only thing that seems particularly "eye-opening" was the effect of the cocaine on the mice.

The fatal flaw is that mice do not display sufficiently complex economic behavior that "addiction" makes sense for them.  Thus, we end up with a lame metaphorical use of the term, in which it means nothing more than "demonstrates a desire to consume by waiting for the next delivery".  Trying to draw conclusions about addiction in mice is like trying to do experiments on mice to inform people about how to have a happier marriage.  The conclusions from critter psych research often end up being right, but only because the truth about people is so clear that it creates a bias such that the researchers declare they are seeing evidence in the mice that supports the obvious facts about humans.

Actually, if you work at it, you can get some economic behavior out of mice and other critters.  By forcing them to pull a lever a particular number of times to get a payoff, we can create a price, and thus with multiple levers and finite time, we have relative prices of various goods and a budget, the essential features of economic behavior.  With that, adding in manipulation of the prices, it would theoretically be possible to measure whether the mice were displaying increasing marginal returns from consumption, a meaningful notion of addiction.  But this would be quite difficult, and would require that the mice understood how the price was changing and other complications.  It would also mean assuming that critters normally share the human trait of getting satiated with a good after consuming some and wanting to next consume something else instead, which runs contrary to my knowledge (i.e., arguably, they are addicted to everything they are positively disposed toward because they keep coming back to the same things).

So the mice researchers do not even bother trying to really measure economic behavior.  However, it is interesting to note that their metaphorical use of "addiction" is still based on a behavior that is about as close to consumer economic behavior as is possible in the absence of prices.  That is, they are implicitly recognizing my point from yesterday, that addiction is clearly a matter of economics rather than biology or epidemiology.

But let us imagine that a mice experiment with prices was created, and the mice displayed a willingness to "pay" (pull the lever) more for cocaine when they had used more recently, rather than getting less interested in it, whereas for goods that we assume are non-addictive, their willingness to pay followed the normal human pattern of dropping off as they consumed more.  Would we still want to say they were truly addicted, as opposed to something like "acquired a very strong taste for it".  Something seems to be missing.

The colloquial notion of addiction has some element of the consumer not wanting to be in that state.  After all, if you have gotten in the habit of doing something, and are experiencing increasing marginal returns, but are loving it and see no reason to stop, how is that addiction?  The Chicago School definition addresses that by including a negative effect on welfare from "addictive stock", defined as how much you have consumed in the past.  This is the "running fast to just stand still" effect.  An addicted smoker gets more benefit from each cigarette than someone else would because of past use, this story goes, but a lot of that benefit is used up just getting out of the hold, back to the neutral state she would be in if she had not smoked anytime recently.  That is something that is theoretically measurable in people (though it is functionally nearly impossible -- you have to ask them about well-being, and then figure out how to calibrate the answers and control for confounding), but not even theoretically measurable in mice.

But there seems to be one other candidate for addressing the "not wanting to be in the state" feature, the concept of second-order preferences. 

(Actually, I can think of another candidate -- it is a terrible concept, but so common it is worth mentioning:  The "and also it is somehow bad" aspect can be defined in terms of the consumption hurting oneself.  The problem with this is that every consumption choice involves hurting yourself, because you are giving up resources and other opportunities.  So this always involves an implicit declarations that some harms that you inflict on yourself are fine, but others are not, which just plays into paternalists' or collectivists' pet notions.  So it is common, but ugly, both politically and scientifically.  Some will merely say you are not allowed to damage your body (because it belongs to the society, not to you), and thus addiction is anything with particular economic/behavioral properties that does any physical damage.  Others will go further and effectively assert ownership over your productivity or even mental state, declaring that a choice to make those go badly is something you should be protected from -- as in "sure smokeless tobacco produces trivial health risks, but it still means that someone is addicted to nicotine, and that is bad in itself, so we cannot allow that."  Even if you do not find that politically repugnant, it should be obvious that it is scientifically useless.)

I wrote about second-order preferences a few days ago (though I have yet to settle on whether it has a hyphen).  I explained that they are a preference about preference, usually discussed in the context of a preference to have a different preference than you do not, as in "I want a cigarette, but I want to not want a cigarette."  This is another economic concept.  Some would argue that it is better seen as a proto-economics concept because, though preferences are at the heart of economics, economics starts with preferences as a fixed point and works from there, and so anything that discusses the source of preferences or wanting to change them exists just before economics.  Others disagree.  Either way, it is in the neighborhood.

Mice may not be even be capable of having second order preferences, but people are tortured by them.  A second order preference could make concrete the negative vibe in "addiction":  You experience increasing marginal returns, and so are best off consuming the good (i.e., you prefer to consume it), but you wish that things were different and you did not prefer to consume it.  This is compatible with wishing you were not in the "running to stand still" hole, but that aspect is not necessary.

A defensible definition of "addiction" could have at its core "like it a lot, but often wish you could stop liking it".  I think this needs some element of varying preference, though maybe not specifically the increasing marginal returns.  After all, if you like the experience/feeling/high and choose to do it, there must be something different about its appeal at the times you wish it did not appeal.  Maybe it is just a moment before you start when you say "I shouldn't do this", but once you are doing it, that feeling is gone; that might be (rapidly) increasing marginal returns once you start.  But it could be that you get satiated, like with a normal good, and that is when you wish you would not want more later. 

One interesting feature of a definition that is partially built on second-order preferences might be that if you do not wish to not like the good, then you are not addicted, no matter what your behavior pattern is.  To someone gathering objective data about you (and thus who cannot see your preference), you cannot be judged to be addicted until and unless you try to quit and fail, and even then you would need more data not sufficient (e.g., a single quit attempt could be an experiment to see if you might be happier without, and the discovery that the answer was no).  But this kind of fits the colloquial usage.  On the other hand, there seem to be some behaviors and preferences that somehow feel like they out to be addiction, if the word is to take its colloquial meaning, but there is no desire to stop liking them, so I am not sure it is wise to tie too tightly to the notion. 

But it seems to play some role.  For example, second-order preferences offer an easy explanation for why the NRT approach is so often tried unsuccessfully.  I will try to get back to that point shortly.

Unhealthful News 211 - Study offers insight into how addiction makes it easier to quit smoking

I just realized that the state university system here (Penn State) might well be one of the best contributors to useful research about tobacco after the usual suspects (Rodu, Lund, Snowdon, BAT, etc.). A huge majority of research published on smoking and other tobacco use is either completely useless (telling us what we already know, or being so convoluted that it is impossible to translate into useful information) or is just pure advocacy disguised as research. So a few informative studies is enough to put a person or institution into the top ten. 

I have to say I did cringe when I saw this headline in the Penn State house-organ magazine/feed:

Mobile technology helps explore nicotine addiction

I was anticipating something that told us nothing about addiction, and was really just a glorified quit-line with someone gathering some useless noisy data and calling it research. Indeed, the reporter included some of the usual pablum in the article, but the research itself was interesting. The mobile phones were used to get instant feedback from smokers who were trying to quit about their emotions, desire to smoke, and smoking status, which likely give much better quality data than a long survey a week in. The reporting of the research included this gem:

"One thing that really stood out among the relapsers is how their urge to smoke just never dropped, in contrast to those who were successful in quitting for a month -- their urge dropped quickly and systematically -- almost immediately upon quitting," said Stephanie Lanza, scientific director of The Methodology Center at Penn State. "That was surprising to see."

That actually tells us something potentially useful about addiction, as promised by the title. However, it is necessary to think a bit about what addiction really means to see what it is saying.

I usually argue that the word "addiction" has no place in scientific discussions, at least not if it is not defined. As typically used, it is the worst kind of terminology: It seems like it means something significant, but if you start drilling down on it, it seems to not mean anything special after all. It is purely a "I know it when I see it" phenomenon in its common usage, and different "I"s definitely see it differently. This makes for terrible science, and use of the undefined term as if it is meaningful always strikes me as a convenient easy clue that an author really does not know how to think scientifically. 

Sometimes "addiction" is used as a synonym for "use", or for use with an element of condemnation (as in "use of something that I [the author] disapprove of"). Sometimes it invokes a theme of users not wanting to quit, though no distinction is offered that defines "addictive" as meaning anything other than highly desirable. Perhaps the most common use of the term is to refer to some overwhelming urge, but that is clearly not what it means (or else breathing, thirst, and wanting to see your child are addictions). A small minority of those who use the term do manage to get closer to some meaningful concept, that it has something to do with a non-typical pattern of preferences and behaviors, though they seldom nail it down.

The one group of researchers that I am aware of that have declared a meaningful formal definition are the Chicago School economists.  This should not be surprising, since the phenomenon clearly has to do with individual preferences and consumer behaviors -- the stuff of microeconomics, not of the biological or epidemiological side of the health sciences. (Note: Yes, in saying this I am declaring that the DSM-type wanderings do not constitute a definition of "addiction" (or "dependence" or the like). Take a look at them. They are just lists of vague considerations.  It is basically a technical-seeming way of saying, "you will know it when you see it; look for characteristics like...." There is no there there. It is much closer to something like "what makes a novel good" than a scientific definition.)

To simplify down to its essence, the Chicago definition of addiction focuses on how past consumption increases the marginal value (i.e., how much you want it) of later consumption. That is, most goods have diminishing marginal returns: if you have consumed a lot lately, you are not so interested in more right now (this is the standard mathematical assumption in economics, and is generally true so long as you choose "a lot" and "lately" right). So if you have just eaten, your desire to eat more is lower than it was before you ate. If you spent yesterday hiking, you are over it for a while and can settle in to work. But for some things, the desire is actually increased by recent consumption, contrary to the standard Econ 101 assumption. So if you did not smoke today, yesterday, or any time in the last decade (or ever), your desire to smoke is pretty low; but if you smoked a pack yesterday, your desire to smoke today is going to be pretty high.

Some readers are probably already picking holes in this construction. If you smoked five minutes ago, your desire to smoke right now is less than it was when you were lighting up that last one, not more. The eating example is mostly right, but if you just ate one bite of baklava (or whatever your favorite dessert is), your urge to eat more is probably increased. The "increasing marginal returns" definition has some complications and exactly when it starts and stops have to be defined ad hoc. Lots of things -- probably most any desirable consumption good -- are addictive on a short time scale after a small amount of consumption ("I just ate one bite of this and so want a second") or a long term scale after frequent habituation ("I had never wanted to try that restaurant, but I started eating there every Thursday and I don't plan to stop"), and nothing is addictive at every time and quantity ("since I did a couple of lines of coke five minutes ago, I don't want any more right now"). But for some values of time and quantity marginal returns are increased, and when that occurs more than is typical, it is interesting.

This makes it a potentially useful conceptualization and basic structure of a definition, but not a complete definition or anything you can push too hard on. (The attempts by Chicago economists and others to do empirical work based on the definition are, thus, pretty much a joke -- and I say this as someone who has done such work.)

Still, if you start with the concept, but do not take the details too literally, you can do some interesting science. Start by realizing that the nature of addiction, so defined, depends on the exact pattern of time and quantity that creates increasing returns, and probably the intensity of that increase. That makes it meaningful and worthy of empiricism. Then look back to the quote from the article. 

From that quote, I think we can conclude that those who have the easiest time quitting are the ones who were mainly motivated by addiction, and get an estimate of the parameters of that addiction. That is, the reason they wanted to smoke today as much as they do is because they smoked yesterday. Once that is gone -- once they have not smoked for just a few days -- the desire to smoke, which was caused by the increasing marginal returns effect, drops off, and quitting is easy.

Who does not quit? Those whose benefits from smoking are not mere addiction. For them, being abstinent for a few days or even a few weeks does not change the sign of their cost-benefit calculation, which says "I am better off smoking than not". It is, of course, possible that their marginal value did drop after a few days of abstinence, but not so much that they decided that quitting was better.

The basic point here is not news to those of us (an extremely small minority among those who study tobacco and such) who understand that smoking and other tobacco use is, first and foremost, a free consumer choice, and the departures from that are quite interesting but fundamentally secondary. But the value of this result is probably lost on the ignorant masses who claim that there is something fundamentally different about smoking compared to other consumption choices.  They are like the astronomers who assumed Earth was a fixed center or chemists before the discovery of isotopes, who generated enormous quantities of completely pointless study results.

Of course, it is possible the the Penn State researchers might have said something dumb, like declaring the non-quitters to the ones they found to be more addicted. But perhaps not. Perhaps they did the cleanest possible science, not even using the word addiction, and simply reported their results. Maybe they even got it right. I have to say that I have chosen to not go look at the actual research so that I do not have to burst this little bubble of believing that someone did some useful novel research about tobacco/nicotine use, and drew accurate conclusions from it.

There are reasons for optimism. The key researchers were methodologists, not public health people. This provided observations like:

"To me, the biggest innovation here is looking at how something like baseline dependence is predictive of that behavior over time or (specifically) the urge to smoke over time," said Lanza. "It's now expressed as a function of time. Instead of saying 'if you're higher on dependence you're going to have a higher urge to smoke over time,' you can now depict how that association between baseline dependence and urge to smoke varies with time in a very fluid and naturalistic way."

In other words, it is an attempt to measure addiction based on the one almost-concrete definition of it in the scientific literature, something that has to do with preferences over time as consumption changes. This is genuinely useful stuff, helping us understand people's motivations and thus (*gasp*) helping them make rational choices rather than treating them like agricultural research crops, an object to be manipulated. It would be over-interpreting this one bit of research to out-and-out declare "this confirms the conventional wisdom that the addictive component of smoking wears off in a day or two, and so those who are motivated to smoke mostly by addiction and who want to quit just need to get over that hump; those with other motives are an entirely different story, and their choice to smoke cannot be explained by addiction, at least not on this time/quantity scale". But it definitely points in that direction, and promises some interesting work to come.

"Our goal is to work hand-in-hand with tobacco (and other) researchers, to help them understand these really intricate processes that are happening," said Lanza. "We want to really understand addiction and how to break addiction, so that interventions can be targeted and adaptable."

Damn.

Well, maybe they will get another study or two out before they abandon science.