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A critique of nicotine addiction
  1. University of Vermont, Burlington, Vermont, USA

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    A critique of nicotine addiction. Hanan Frenk, Reuven Dar. Boston: Kluwer Academic Publishers, 2000.

    Although there have been comprehensive reviews of the evidence for the existence of nicotine dependence (for example, the 1988 Surgeon's General report and the 2000 Royal College of Physician's report), and there have been brief articles citing evidence contrary to the existence of nicotine dependence (for example Robinson, Psychopharmacology1992;108:397), I am unaware of a prior comprehensive review of evidence contrary to nicotine dependence as done in this book. The book is the work of two PhD scientists at Tel-Aviv University. It lists no acknowledgment of funding and does not specifically state whether tobacco industry funding was or was not involved.

    The book does not waste time on peripheral matters but focuses on the central tenets of nicotine dependence—that is, nicotine reinforcement, withdrawal, compulsion, and regulation. Much of the book is a methodological critique of the studies cited as evidence of nicotine dependence. For example, the book states animal self administration studies are inadequate because they did not show unfacilitated initiation of self administration, excluded negative results, and failed to control for non-specific increases in lever pressing due to the stimulant effects of nicotine. It also criticises human self administration studies for inadequate blinding, excluding negative results and small sample sizes. The book also maintains that nicotine abstinence has not been shown to be aversive and thus cannot be a motivator.

    The major asset of the book is that it describes in detail the most common criticisms of nicotine dependence and their rationale. The major liability is that the book seems to me overly critical—for example, a study is often entirely dismissed if it has any flaw to it. Thus, by this method, a position can only be advocated when the perfect study is done. Unfortunately, the book becomes polemical enough to interfere with one's reading pleasure. Nevertheless, I would recommend reading this book as I think it important to force ourselves to listen to criticisms and think hard whether there is any truth to them.

    Editor's note: On receiving this review from Dr Hughes, I asked him to enquire from the authors of the book whether its production had been sponsored by the tobacco industry. They replied: “Several years ago we were approached by a law firm and consequently were paid for our time reading and evaluating some of the literature summarised in the book. Although the law firm refused to reveal its client's identity, it seems obvious that the client is from the tobacco industry. It is important to stress, however, that this law firm was strictly opposed to our publishing the book, and in fact warned that its publication might end our engagement as experts. We surmise that this reaction was for two reasons. First, the material in the book would pre-expose antagonists in law suits to arguments the law firm might use. Second, our critique might compel researchers to do a better job in attempting to establish the role of nicotine in smoking. We decided to publish our book for similar reasons. We believe that our engagement as experts has had no bearing on the conclusions we reach in our book.” (reply truncated)—Hanan Frenk and Reuven Dar.