UCSF launched its new “Center for the Neurobiology of Addiction” —an accounting entity described by its founders, poetically, as “a building without walls”— with a symposium May 7-8 at Cole Hall.
The keynote speaker was Alan Leshner, PhD, the director of the National Institute on Drug Abuse. He began by promoting a book published by NIDA entitled Prevent Drug Use Among Children & Adolescents: A Research-based Guide.” Leshner showed a slide of the cover and said modestly, “It’s becoming a bible.”
Eight speakers described their addiction-related research to an almost full house of neuroscientsts, postdocs and graduate students. Two very rich men named Wheeler and Samuelson have pledged millions to underwrite addiction-related research at UCSF. The actor Carol O’Connor and his wife attended the session. Their son was an addict who committed suicide.
Haile Debas tried his rhetorical best to make it seem as if UCSF has done something other than join forces with the Drug Warriors. He said addiction is a brain disorder, not a character flaw, and doctors should treat it and scientists should seek to cure it. But even in separating the role of biomedical science from the role law enforcement, Debas accepted and repeated the basic political premise that addiction is a threat to society and eradicating it should take top priority as we allocate our time, energy and resources.
Readers may recall Alan Leshner as the federal bureaucrat who for years sabotaged Donald Abrams’s attempt to study the safety and efficacy of marijuana as a treatment for wasting syndrome in HIV patients. NIDA occupies some middle turf between law enforcement (the DEA et al) and biomedical science (NIMH, from whence Leshner rose to his present position). Indeed Leshner combines a prosecutor’s perspective with a scientist’s vocabulary. He was quoted in the New Yorker recently, “My belief is that today, in 1998, you should be put in jail if you refuse to prescribe SSRIs for depression… I also believe that five years from now you should be in jail if you don’t give crack addicts the medications we’re working on now.”
This man is not a medical doctor —he has a PhD in psychology from Bucknell— yet he has the gall to say that some experienced physician who might have concerns about the side effects of Prozac belongs in jail… And he’s so sure of the drugs now being contemplated that doctors who won’t give them to crack addicts belong in jail… This was UCSF’s honored guest.
Debas came on as if he was questioning the conduct of the Drug War, but in fact he was accepting its basic premise: that the eradication of addiction is an imperative goal and we should all stop whatever else we’re doing and focus on it.
The experiments the Addiction Experts described ranged from the self-evident to the bizarre. Most proudly showed photographs of their lab set-ups —the rat at the lever, microelectrodes inserted, ready to do some speed for science. Some of the slides showed really cute, content-looking Disney-style rodents. Dr. E. London, PhD, showed a photo of one of her test subjects and said, “You’ll see he’s wearing a little hat…”
When the scientists give the test animals shocks or “uncomfortable heat” to signal disapproval of drug-seeking behavior, they are introducing an artificial element into the experiment. They are creating a situation that has nothing to do with rodents in the wild. They are trying to create a situation analogous to that faced by the human drug user. The unpleasant heat applied to the animal in the lab is analogous to the prosecution of the “drug abuser” in society (they too feel “the heat”). But why should health scientists replicate that factor in their experiments? Why shouldn’t they question the need for it on behalf of patients?
Physicians individually should do what’s best for their patients, and physicians collectively should advocate what’s best for the general populace. During the course of the UCSF symposium only one voice —a woman’s—questioned the dominant paradigm by raising the question of legalization.
Roy Wise, visiting professor from NIMH, then missated her fundamental challenge to the Addiction Experts’ approach, narrowing it to “Should cocaine be legalized?” He responded, quite sensibly, that if one were going to consider legalizing drugs of abuse, cocaine would be low on his list.
Methylphenidate (Ritalin) was not on Wise’s list at all. The hypocrisy of not studying the effects of Ritalin —which millions of American schoolchildren take every day— while railing ominously about the long-lasting brain alterations caused by amphetamine… If this is a harmless stimulant that can be given regularly to millions of schoolchildren, why should adults go to prison for the mere possession of it? For many years the high priests of psychiatry held that there was a “paradoxical effect” that made it okay for kids to take methylphenidate and/or other stimulants (Cylert, amphetamine). This was the prevailing wisdom taught in the medical schools; I wouldn’t be surprised if there’s reference to it in the DSM-III…
In ‘86 I asked a number of doctors what change in the brain occurred during adolescence that would make Ritalin okay for kids but not for adults? The honest ones said, “That’s pharmacological nonsense.” Nowadays the high priests don’t talk about the paradoxical effect, in fact they’re into marketing Ritalin to adults. Was there ever a mea culpa? Of course not.
The War on Drugs was from its inception, three things:
1. a means of social control (a way to bust Chinese workers, Mexicans, Indians and blacks)
2. a jobs program for bureaucrats and law enforcers.
Most of the speakers discussed rats and addicts in the same terms and tone. Roy Wise, describing an experiment in which rats who had to work harder to get their fix did indeed work harder, noted a “policy implication”— that “the addict would steal that many more hubcaps. “ These are not human beings he’s dealing with, they’re addicts. As in “hoodlum.” As in “inner city.” As in…
An area of research Leshner wants neuroscientists to pursue involves the genetic changes caused by chronic drug use. This is how he put it: ADD QUOTE
NAME London, PhD, the second speaker, has made a specialty of brain imaging, the phrenology of our time. “Depression” makes this part of the amygdala blue, and “Addiction” makes this part of the CVR yello, and “Violence-Prone” makes this part of the hippocampus green…
Leshner was a wiry, super-salesman type with a kind of wolfish look; unclassy, but his clothes were worth plenty. I think he used some kind of light pancake make-up. A namedropper and a peacock—he said he took a certain slide from some Addiction Expert because “after all, I’m the director of the Institute.”
After the session I went up to Leshner and told him I was a journalist covering the ongoing Prop 215 story and wanted to know his line on the addictiveness of marijuana. He told me in professorial cadences that I was asking two questions that had to be kept separate. (Immediate male ranking…) One, he said, was the question: “is marijuana effective as a medicine?” and this, he said, was an open question, the science had yet to be done. The second was the addictiveness of marijuana, and on that the sciencific verdict was unambiguous: marijuana is addictive. “Eight to 10 percent of experimental subjects become addicted.” And eight to 10 percent of the American people were clinically depressed —until the NIMH “cohort study” put the number at 17%… and they’d all qualify for Prozac if only they would come into our offices.
Addiction, according to Leshner’s bible and UCSF Magazine’s cover story released in conjunction with the Center’s inauguration, involves “behavior that becomes compulsive and persistent, despite the negative consequences that result from the drug’s continued use.” The “negative consequences” are mainly those imposed by society —stigmatization unto incarceration. Leshner wants neurobiologists to identify the types of biochemical changes —”genetic alterations”— caused by the various “drugs of abuse.” Whatever the neuroscientists come up with will then be defined as “signs of addiction,” and “science” will have established the “scientific basis” for the manufacture and sale of other drugs —good drugs, NIDA-approved drugs designed to “treat” addiction— for which there is a market of 30-40 million Americans.
And if you won’t prescribe ‘em… you belong in jail. And if you don’t want to take ‘em… you belong in jail.
The chancellor should reconsider his commitment to this Center and should refuse to allow federal bureaucrats and self-interested pharmaceutical companies set the agenda for our medical research. UCSF’s leaders should set their own agenda, deciding what studies need to be done to advance the public health. Neuroscientists should be encouraged to study all aspects of brain and nervous system function —memory, pain, mood, whatever they in their wisdom deem significant. We shouldn’t let the scientific agenda be set by federal bureaucrats and the drug companies into whose employ many will go the minute they leave “public service…” When Alan Leshner is telling UCSF faculty members, postdocs and graduate students how to focus their work, the tail is wagging the dog.
Where are the people with public health training? UCSF is supposed to be the institution where the clinicians and researchers are always interacting. How come nobody stood up for cannabis? Doesn’t anybody take seriously the existing evidence —in the pre-prohbition literature and in the anecdotal evidence provided by patients— that marijuana is safe, effective medicine for people with a wide range of conditions? Why isn’t there a movement of clinicians and researchers to approach this subject without bias? Is everybody so timid? Is it a matter of everyone in Cole Hall being addicted to a certain income level? I suppose we should console ourselves with the thought that honest investigators like Basbaum will get a little more support in the name of “understanding the neurobiology of addiction,” and maybe some of the basic mechanisms will be elucidated and applications developed that really do reduce human suffering.
It’s not worth the fundamental intellectual compromise involved. It’s not worth lending the name of this institution to what is basically a political position. To study addiction from an unbiased medical perspective means questioning all —not accepting any— of the prevailing paradigms. That’s science, isn’t it? Questioning?….
Alan Leshner is a drug marketer. He is marketing “anti-addiction medications.” He doesn’t quite know what they’ll consist of, or what their side-effects might be, but people should go to jail for not taking them… This is the voice of “science” talking…
“We declare that addiction is a brain disease,” intoned Chancellor Debas. We denounce the “fundamental mistake that addiction is a character disorder… We can play a major role in lower the stigma to families through our discoveries…” (In promoting the SSRIs, the NIMH in the ‘80s declared that Depression was a brain disease, not a chracter disorder, and sought to lower the stigma associated with Depression. The result was that millions of people went to their doctors and wound up with prescriptions for Prozac.) Many phrases in Leshner’s pitch for the coming Addiction medication (still a gleam in his very gleamy little eyes) echoed those used by his mentors who were pushing the drugs for Clinical Depression a decade ago: “A new generation of research based medications…” “The ultimate answer lies in biology…” “Drug Addiction is a treatable disease” (and we happen to have the treatment in the pipeline and five years from now you better be prescribing it or, you know….)
Leshner began by promoting a book published by NIDA entitled Prevent Drug Use Among Children & Adolescents: A Research-based Guide.” He showed a slide of it and said modestly, “It’s becoming a bible.”
Many of the slides Leshner showed were very simple, the first words in capital letters.
He was actually crass, saying things like “I grew up in the mental health business, as you heard…” He really looks and sounds like a salesman, and his appearance at UCSF and his offer of support for the new “Center” —an accounting entity poetically described by its founders as “a building without walls”— was part of a long-range marketing campaign, the kind that helped launch the SSRIs a decade ago. It’s noteworthy that Leshner came to NIMH in ‘88 when its main focus was pushing the concept of clinical depression to doctors and the general public… A few years later the NIMH’s assistant director, Steve Paul, became Eli Lilly’s director of research.