Sunday, July 25, 2004

The UK Independent reports on suggested vaccines against various forms of addiction. Science and public health stories in newspapers often oversimplify complex issues, so this report needs to be taken cautiously. But the following quote seems pretty clear: Professor Nutt, head of psychopharmacology at the University of Bristol and a senior member of the Advisory Council on the Misuse of Drugs, said: "People could be vaccinated against drugs at birth as you are against measles. You could say cocaine is more dangerous than measles, for example. It is important that there is a debate on this issue. This is a huge topic - addiction and smoking are major causes of premature death." Indeed some debate is urgently needed. The main public health reason for vaccination against infectious diseases is that it radically lowers the probability of an epidemic. To make the same case for addictive substances, the proponents of this move would have to show that the probability that someone becomes addicted given a certain level of availability of the substance and contact with addicts is much greater than the probability of addiction given just that level of availability. I'm skeptical that this has been shown. Furthermore, susceptibility to infectious diseases is widely spread in the population, while all the evidence seems to suggest that susceptibility to addiction has strong genetic and social components. For both reasons, the calculus of risk and benefit for this kind of vaccination is very different than for infectious diseases. For the great majority who will never be addicted anyway, being vaccinated will be a net negative, not offset by the overall positive of preventing contagion that exists for infectious diseases. In addition, interfering with individual biochemistry may have significant consequences in the long run, for example preventing the use of opiates to alleviate extreme pain, as /. notes (If this seems minor to you, I hope you never have kidney stones). Anecdote: almost everyone I know from my generation who once smoked, even once heavy smokers, does not smoke now. They didn't for the most part need medical heroics to stop, just enough social pressure from peers and non-smoking signs. Thus I am rather skeptical about the need for a medical intervention whose negative side-effects may only be discovered in decades. Imagine that one of those "bad" chemicals turned out to be the best treatment for, say, Alzheimer's? 8:37:21 PM