Cancer and Women Who Drink: A Flawed Study?

Taking a second look at the numbers.

Last week’s front page Washington Post story on the increased risk of cancer among women who drink shed more heat than light on the underlying conundrum: Are a few drinks good for you, or aren’t they?

A British study involving almost one and a quarter million women—a huge survey by any standards—found that just one drink of alcohol per day increased the statistical risk of contracting cancer. According to the Post story by Rob Stein, as little as 10 grams of alcohol a day elevated women’s risk for cancer of the breast, liver, and rectum in particular. “Based on the findings, the researchers estimated that about 5 percent of all cancers diagnosed in women each year in the United States are the result of low to moderate alcohol consumption,” the Post reported. “Most are breast cancers, with drinking accounting for 11 percent of cases—about 20,000 extra cases each year—the researchers estimated.”

But wait a minute. Wasn’t it just yesterday that researchers were confirming and reconfirming that a couple of drinks a day was good for your heart? Presumably, this included women’s hearts as well. What’s going on?

For starters, the conclusions of the study itself, published in the Journal of the National Cancer Institute, have some problems. In an article entitled, “Women: How Bad is a Regular Nip?” Janet Raloff writes in the Web edition of Science News that female participants were queried only about weekly alcohol consumption. To arrive at figures for daily intake, the researchers divided by seven. “However,” writes Raloff, “if someone averages seven drinks a week, those beverages might have been downed on weekends only—leading to consumption of three or more drinks at a sitting. That would be bad even for the heart. Also, in the long haul, for anyone’s liver.” Unless we know about daily drinking, the study “only offers fodder for speculation.”

There are other problems. As it turns out, nondrinkers have an elevated risk for certain kinds of cancers. Study author Naomi Allen and coworkers at the University of Oxford write that alcohol apparently confers some sort of protective effect when it comes to cancers of the pharynx, esophagus, stomach, cervix, and other sites.

In addition, Raloff, points out, “There’s the impact of smoking.” Some of the alcohol-linked cases of cancer in women—esophagus, liver, and larynx, for example—increased only among those women in the study who also smoked.

Specifically, Raloff recommends that women with a genetic predisposition for breast cancer might decide that “no alcohol is the best policy.” And for people at low risk for heart disease, it’s difficult to justify drinking because it’s good for your heart. However, “study after study has offered quantitative evidence that middle-age and older adults who take a regular nip—like that proverbial glass of sherry after dinner or at bedtime—suffer less heart disease and diabetes than teetotalers or people who consume more than two drinks a day.”

And that, at present, is where the matter still stands. As Raloff sensibly concludes, “Let’s not scare people with incomplete data. There will be plenty of time to hammer home a call for temperance if and when stronger data emerge.”

Photo Credit: www.injuryboard.com

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Tobacco Industry Loses Crucial Court Case

Jury awards $8 million to widow of addicted smoker.

In a court decision that attorneys for Philip Morris called “profoundly flawed,” a Florida jury last week awarded $8 million to the widow of a man who died of lung cancer, ruling that nicotine addiction was the cause of his death.

Attorneys for Altria, the parent company of Philip Morris, argued in Hess v. Philip Morris USA that the deceased man had been fully aware of the dangers of smoking, and had been fully capable of quitting, had he chosen to do so.

Philip Morris will most certainly lodge an appeal, given that the closely-watched “Hess case” is the first of an estimated 8,000 similar cases filed in Florida in the wake of a class-action suit against cigarette makers in 1994. In 2006, the class-action suit was overturned by the Florida Supreme Court, which ruled that smokers had to prove in individual court cases that cigarettes were the immediate cause of their health problems.

Attorneys for the widow, Elaine Hess, argued that Philip Morris sold cigarettes that were “defective and unreasonably dangerous,” according to a Miami Herald report by Patrick Danner. Phillip Morris attorneys argued that smoking had simply been a “lifestyle choice” for Stuart Hess. Hess, the tobacco lawyers asserted, voluntarily chose not to follow the advice of family members and doctors, who told him to quit smoking.

According to the Miami Herald report, Hess “tried various means to quit smoking, including hypnosis, Nicorette gum and even going cold turkey. But all of his attempts failed.”

While technically the Hess case has no bearing on the individual court cases to come, attorneys said it was expected to serve “as a template for the other cases,” Danner wrote in the Herald article. Murray Garnick, a senior vice president and associate general counsel for parent company Atria, said in a press release that the verdict was the result of “an unconstitutional and profoundly flawed trial procedure. Fundamental fairness requires the plaintiff to establish basic liability before a jury can award damages.”

Photo Credit: http://snus-news.blogspot.com/2008_01_06_archive.html

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Raise the Bottom--Book Review

Recognizing alcoholism in the workplace.

In addition to all the other damage they do, alcoholics can literally cost businesses a fortune, says marketing consultant Arthur M. Jackson in his new book, Raise the Bottom. As a means of helping employers identify the problem, Jackson offers a checklist of early, middle and late-stage alcoholic behaviors, from drinking everyone under the table, to blame games, to personal financial problems.

The litany is at times simplistic, and the book is written in the Kenneth Blanchard “One-Minute-Manager” style of easily digestible business books, with a fictional senior consultant doling out data to his fictional protégé. Nonetheless, the author manages to impart some useful information, and draws attention to a problem most people choose to avoid or ignore—the toll active alcoholism takes on workplace efficiency and trust.

Physical early warning signs to watch for, Jackson writes, include a family history of alcoholism, “pre-drinking” before social functions, frequent lying, and cigarette smoking (a majority of alcoholics smoke cigarettes). These are all valid potential red flags, but often difficult to discern in a workplace setting.

Alcoholism is more likely to show itself in the middle stage, when “quotas go unmet, goals unachieved, and promises not kept.” At this stage, bosses and managers are likely to help the alcoholic with his excuses, agreeing that he or she is having an “off year,” or “problems at home.” Indeed, multiple divorces and increasing financial difficulties often accompany the progression of addictive disease.

The author leaves no doubt about where he stands on the disease debate: “We don’t punish someone for having a disease. We separate the alcoholic behavior from the alcoholic... The maladaptive and negative behaviors, and the poor business results following from them, must face direct consequences or they will continue.”

Two other maladaptive behaviors characteristic of the middle stage are “sexual exploitation” and “road rage,” writes Jackson. As odd as this may sound, I think the author is right here. Both behaviors—compulsive promiscuity and episodes of instinctual rage--can be seen as impulse control problems, which alcoholics often exhibit.

As the middle stage increasingly leads to poor job performance and declining results, “the downward slide of the progression begins to be noticeable to others, although the cause—alcoholism—is still well hidden most of the time.” The presence of the “pink elephant in the office” goes unaddressed—and things get worse.

Sensibly, the author notes that a single DUI or DWI does not prove the case for alcoholism. However, landing a second DUI, or continuing to regularly drink while driving, may be another matter entirely.

Jackson is a firm believer in early intervention on the part of friends, family, and coworkers. Moreover, “The job lever—the risk of losing his job because of alcoholism—can have a crucial effect.” Jackson’s two-word prescription: “Stop enabling.” By recognizing potential alcoholism and moving toward treatment rather than turning away, workers can break through the conspiracy of silence and help “raise the bottom” for alcoholics--saving their jobs, their relationships, and often their lives.

Photo Credit: http://www.freshknowledge.co.uk/

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Obama Set to Name New Drug Czar

Seattle police chief gets the nod.

Drug reformers, hoping for the appointment of a public health official, expressed initial dismay at the news that President Barack Obama will nominate Seattle Police Chief Gil Kerlikowske as the nation’s new “drug czar.”

As the president’s evident choice to head up the White House Office of National Drug Control Policy (ONDCP), Kerlikowske is not known for highlighting drug issues in national law enforcement circles, notes the Drug War Chronicle. “While we’re disappointed that President Obama seems poised to nominate a police chief instead of a major public heath advocate as drug czar,” said Drug Policy Alliance’s Ethan Nadelmann, “we’re cautiously optimistic that Seattle Police Chief Gil Kerlikowske will support Obama’s drug policy reform agenda.”

According to the Seattle Post-Intelligencer, “He’s likely to be the best drug czar we’ve seen, but that’s not saying much,” Nadelmann said. “At least we know that when talk about needle exchanges and decriminalizing marijuana arrests, it’s not going to be the first time he’s heard about them.”

For those worried about a radical change in the nation’s drug policy, Seattle City Councilman Nick Licata sought to assure citizens that Kerlikowske is “not on a platform arguing for decriminalization of drugs or radical drug reform measures.”

A spokesperson for the American Civil Liberties Union (ACLU) told the Post-Intelligencer: “I would imagine that being a chief law-enforcement officer makes it very difficult for someone to speak out in favor of more progressive drug laws and drug policies.” However, former Seattle Police Chief and drug reform advocate Norm Stamper insisted that Kerlikowske was more inclined to support “research-driven and evidence-based conclusions about public policy.”

In “Advice for the New Drug Czar,” an article for the online edition of The American Prospect, drug policy experts Mark Kleiman of UCLA and Harold Pollack of the University of Chicago laid out their recommendations for Kerlikowske. Here is an example of their thinking:

--“You’ll be told that we have a national strategy resting on three legs: enforcement, prevention, and treatment. Don’t believe it. There is no coherent strategy. Enforcement, prevention and treatment are the names of three quarrelling constituency groups whose pressures you will sometimes need to resist....”

--“There are some real ‘drug wars’ raging: in Afghanistan, in Columbia, and in northern Mexico. Those wars matter terribly to the countries involved, but no outcome of those wars is likely to make the drug situation in the United States noticeably better or worse.”

--“Treatment needs to be more accessible and more accountable. Good news: even lousy treatment has benefits greater than its costs. Bad news: much of the treatment actually delivered is, in fact, pretty lousy. Demand to see results, and insist on rigorous evaluations. Focus resources on effective programs. It’s an outrage to have addicts dying of overdoses while on waiting lists for methadone treatment.”

--“Most primary care providers never perform highly cost-effective screening and brief intervention, because they’re neither trained for it nor paid for it. Many don’t think that dealing with drug abuse is in their job description; it needs to be.”

--“’Drug Czar’ is a silly title.”


Photo Credit: www.pbs.org

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Compulsive Gambling [Guest Post]

14 hours at the roulette wheel.

[Editors Note: Addiction Inbox has not covered the so-called behavioral or non-traditional addictions--Internet addiction, video game addiction, compulsive shopping and compulsive gambling--because I am not yet convinced that such behaviors show the same chemical and often inheritable propensities associated with alcoholism and other drug addictions. From time to time, however, I offer up an alternative view. The following excerpt has been taken from www.utahstories.com with the kind permission of the author.]


Guest Post by Leo Dirr

If you eat one meal a day and it's a buffet, you might be a compulsive gambler.

That odd, little nugget of wisdom dawned on me while I was wallowing in misery in front of an overloaded plate of tamales and tacos and taters and gravy. Gambler, me? A compulsive gambler? Hmmm.

I guess it takes one to know one. Yep. I had to lose thousands of dollars and countless hours of sleep before I could finally come to grips with my addiction. And at the buffet table, no less. At least the hot chocolate refills were free.

Oh, I had me some grand times. Vegas, Reno, Elko, Mesquite, Wendover. Nevada casino towns that called my name. I played roulette for up to 14 straight hours at a stretch. I never even left the table to take a leak.

I was too zoned in on the game. One time a busty babe sitting next to me at the blackjack table was literally rubbing her hands all over my body, and all I could think about was my next bet. Nothing personal. But while I was gambling, sex never crossed my mind.

As long as I had chips, nothing else mattered. I was completely in tune with my inner gambler. That sense of escapism must have been the draw, the thing that sucked me in again and again. It couldn't have been possible that I actually wanted to throw away all of my money.

Or did I? During my travels, I met a once-wealthy oil man who literally lost millions to the casinos. By the time I stumbled upon him, he was relying on the generosity of a well-heeled friend just to stay off the streets. His sad story did not save me.

I was hooked. I adored the casinos. The glitz of the lights, the sounds of the slots, the hope in the air. It all made me feel so alive.

Gambling thoughts monopolized my ADD-addled brain. Daily rituals that most people relish, or at least tolerate, were unbearably boring to me. The only excitement I could find was of the Ace-King kind. I used to calculate roulette payouts while I was brushing my teeth. It was bad.

Oh, I didn't always lose. Sometimes I won - and won big. But the casinos call their table areas "pits" for a reason. The more I won, the deeper my happy, little gambling hobby sank into a dark and dangerous compulsion.

I literally couldn't stay away. I always gave back everything I'd won, and then some. At one point, I was actually using my Nevada casino winnings to buy Idaho lottery tickets.

That sounds crazy, I know. But is it any crazier than eating all your meals at a buffet? Not really. The crazy part is that I don't really feel bad about any of it. I saw my share of weird things and weirder people along the way. And yes, I lost a ton of money.

But hey, what do you expect? I'm a compulsive gambler.

Some Sobering Statistics

* 15 million people display some sign of gambling addiction
* "Players" with household incomes under $10,000 bet nearly three times as much on lotteries as those with incomes over $50,000
* The average debt incurred by a male pathological gambler in the U.S. is between $55,000 and $90,000 (it is $15,000 for female gamblers)
* The suicide rate for pathological gamblers is twenty times higher than for non-gamblers (one in five attempts suicide)
* Sixty-five percent of pathological gamblers commit crimes to support their gambling habit

(Source: http://www.overcominggambling.com)

If you want to seek help, visit the National Council on Problem Gambling's Web site.

Photo Credit: Carroll College

How Brain Science Began

Civilization’s debt to opium.

The history of brain science probably began about 4,000 B.C., somewhere in Sumeria, when human beings first discovered the extraordinary effects of the unripened seed pods of the poppy plant. Modern neuroscience owes a great debt of gratitude to this tame-looking plant drug and its sticky, incredibly potent byproduct called opium. Neuropharmacology—the study of the action of drugs on the nervous system—would never have advanced so quickly without it.

Historically, the emphasis has been on opium’s cash value, not its value to science. A trade staple on the Silk Route for centuries, opium was very nearly the perfect business. The present-day drug companies, known collectively as Big Pharma, are not the first capitalists in the world to exert an unprecedented grip on drug retailing.

From roughly 1720 to the late 1800s, the merchants of the British East India Company ran a brisk and lucrative opium business with the Oriental “heathens.” In 1839, the British went to war with China to maintain unlimited trading rights. The British won the war, retained the right to market opium in the Orient, and picked up the island of Hong Kong in the bargain.

Opium’s effects are concentrated at specific receptor sites, while alcohol’s range of action is more diffuse. Nonetheless, the two drugs have similar effects along the limbic reward pathway. Morphine comes right from the source, isolated from the crude opium resin found on Papaver somniferum—the opium poppy. Morphine is known as a “pure mu agonist,” meaning it locks securely into the “mu” subset of endorphin receptors, and activates them. This alters the transmission of pain messages, and induces a contented, euphoric state of relaxation. Codeine, another natural painkiller, is found in opium in very small concentrations. Most medical codeine is synthesized from morphine.

The body’s own opiates are referred to as endogenous opioids. Endorphins and enkephalins are interchangeable terms for these chains of amino acids. An important mechanism of action in this process is morphine’s inhibitive effect on GABA. By inhibiting the inhibitor, so to speak, neurotransmitter levels increase down the line, particularly in the nucleus accumbens. Hence, feelings of pleasure.

Alcohol stimulates the mu receptor as well, so we are back to the same basic chain of limbic activation triggered by drinking. GABA is the bridge that connects the alcohol high and the heroin high.

Rapid cellular tolerance is the hallmark of opiate addiction. Brain cells quickly become less responsive to the same doses of the drug. “The body’s natural enkephalins are not addicting because they are destroyed rapidly by peptide-degrading enzymes as soon as they act at opiate receptors,” writes Solomon Snyder. “Therefore, they are never in contact with receptors long enough to promote tolerance…. As analgesics, the enkephalin derivatives developed by drug companies have not been superior to morphine, or even as good as morphine.” Even the brain’s own morphine is not as good as morphine. Nothing is as good as morphine.

Recent evidence for the heritability of opiate addiction looks strong. “Harvard did some really superb studies using a huge cohort of military recruits in the U.S. Army,” according to Mary Jeanne Kreek, a specialist in opiate addiction at Rockefeller University in New York. “Heroin addiction has even a larger heritable component than any of the other addictions, so that up to 54% of heroin addictions seem to be on a genetic basis or a heritable basis.” Estimates of alcohol’s heritability generally run to 40 or 50 per cent.

--Excerpted from The Chemical Carousel: What Science Tells Us About Beating Addiction. (Spring 2009).

Arguing About Ecstasy

U.K. professor says “E” no riskier than horseback riding.

Professor David Nutt of Bristol University and Imperial College, London, stirred up a hornet’s nest of controversy last week when he compared the dangers of the club drug Ecstasy (MDMA) to people’s addiction to horse riding. In an article titled "Equasy: An overlooked addiction with implications for the current debate on drug harms,” published in the Journal of Psychopharmacology, Professor Nutt wrote: "Drug harm can be equal to harms in other parts of life. There is not much difference between horse-riding and ecstasy."

What makes all of this interesting is that Professor Nutt serves as the chairperson of the Home Office's Advisory Council on the Misuse of Drugs (ACMD), which will rule next week on whether ecstasy should be downgraded to a Class B drug in the British drug classification system. Drug treatment activists and government ministers immediately called for his resignation, saying Nutt was on a "personal crusade" to decriminalize the drug.

The BBC News Service reported that a Home Office spokesperson said recently that the government believed ecstasy should remain a Class A drug. "Ecstasy can and does kill unpredictably. There is no such thing as a 'safe dose'," he said.

Horse-riding accounts for 100 deaths or serious accidents a year in the U.K., according to Nutt. “Making riding illegal would completely prevent all these harms and would be, in practice, very easy to do.” In contrast, recent figures indicate about 30 deaths attributed to ecstasy use in the U.K. last year. “This attitude raises the critical question of why society tolerates - indeed encourages - certain forms of potentially harmful behaviour but not others such as drug use," Nutt wrote.

In an article by Christopher Hope in the Daily Telegraph, Nutt said: "The point was to get people to understand that drug harm can be equal to harms in other parts of life.” He cited other risky activities such as “base jumping, climbing, bungee jumping, hang-gliding, motorcycling," which, he said, were more dangerous than illicit drugs.

An ACMD spokesperson said: "Prof Nutt's academic research does not prejudice the work that he conducts as chair of the ACMD."

According to the Telegraph article, there are 500,000 regular users and between 30 million and 60 million ecstasy pills in circulation in the U.K.

In a letter published by the Journal of Psychopharmacology two years earlier, Professor Nutt used a more apt comparison to make the same point:

“The fact that alcohol is legal and ecstasy not is merely an historical accident, not a science-based decision. Alcohol undoubtedly kills thousands more people each year than ecstasy.... Many relatively ill-informed and indeed innocent young people will continue to die and many more will end up with the destructive consequences of alcohol dependence or physical damage. If the same effort currently used to deter ecstasy use was put toward reducing alcohol misuse the situation might improve.”


Photo Credit: Foundation Antidote