The Next Fix


When I started preschool, I was still sucking my thumb. Concerned that this babyish behavior would damage my social adjustment and perhaps my teeth, my mother began painting my thumb with a foul-tasting solution. You could say she was trying to help me break a bad habit by making it less pleasant and less rewarding.

Or, if you think like a public health specialist, you could claim that my mother was treating the "disease" of thumb-sucking with a medicine designed especially for that purpose. And if thumb-sucking is something bad that happens to little boys, not something that little boys do because they like it, how could there be any objection to using a safe, effective cure?

Public health specialists routinely describe another "bad" behavior, tobacco use, not just as a risk factor for disease but as a disease in itself. They call smoking a "tobacco-use disorder"; writ large, it is "the man-made plague" (as the epidemiologist R. T. Ravenholt puts it) or "The Global Tobacco Epidemic" (the title of a 1995 article in Scientific American). The development of so-called nicotine vaccines, which are being tested by at least three companies in the U.S. and the U.K. (with Florida-based Nabi Biopharmaceuticals due to announce its highly anticipated Phase II trial results this fall), fits neatly into this paradigm.

By stimulating the immune system to produce antibodies that bind with nicotine, the vaccines render the offending molecule too large to pass the blood-brain barrier, thereby neutralizing its psychoactive effects. In 1999, Alan Leshner, then director of the National Institute on Drug Abuse, explained the theory underlying this approach to smoking cessation in a press release about early, NIDA-funded testing of Nabi's product, known as NicVAX.

"A nicotine vaccine may be useful for preventing and treating tobacco addiction, because vaccinated persons would not be able to get a 'kick' from the nicotine in tobacco smoke or chewing tobacco," he said. "Since they would find tobacco less rewarding, they would be less likely to continue using it."

This idea has a certain plausibility, but there are a few caveats. In tests on rats, NicVAX stopped only about two-thirds of the nicotine placed in their bloodstream from reaching the brain – which raises the possibility that people treated with nicotine binders, rather than being "cured," could end up smoking more to get the dose to which they're accustomed. In any case, smokers can already obtain products – gum, patches, and inhalers – that deliver nicotine without any smoke at all. That the availability of these alternatives has not led to a wholesale abandonment of cigarettes suggests another drawback to nicotine binders: Evidently, there is more to the appeal of smoking than nicotine. Former smokers know that changing the personalized rituals associated with lighting up can be the hardest part of quitting.

More troubling is the likelihood that similar vaccines developed for illegal drugs – dubbed "neurocops" by the Center for Cognitive Liberty and Ethics – could be forced on people, such as drug offenders required to choose between "treatment" and jail, in the context of the war on drugs (in which NIDA is a key participant). But in order for the drug warriors to succeed in taking the battle to our bloodstreams, they would have to go beyond "curing" the small fraction of drug offenders who happen to get arrested each year.

Enter NIDA's "prevention" agenda: removing the potential for addiction to drugs in people who have not yet tried them. And just as antismoking activists for years have been comparing tobacco to crack and heroin, the hopes of "vaccine" promoters move easily from nicotine to illegal drugs. A BBC News story about U.K.-based Xenova's nicotine binder, "which may also help cocaine addicts," explains that "it could also be given to young children to prevent them from taking up these habits." Indeed, in late July, members of the British Parliament revealed that they were considering exactly that kind of scheme as part of a nationwide antidrug immunization proposal from their Brain Science, Addiction, and Drugs committee.

Tobacco foes such as David Kessler, former head of the Food and Drug Administration, have prepared the way for this sort of solution by characterizing smoking as a "pediatric disease," along with mumps, measles, and rubella. Parents accustomed to viewing little boys' boisterousness and distractibility as a medical problem to be treated with drugs should have little difficulty accepting the idea that a battery of vaccines can protect their children from destructive relationships with psychoactive substances. But this answer to the problem of addiction denies, and therefore undermines, the human capacity for temperance.

The federal government's own statistics show that the vast majority of people who use drugs – even such reputedly powerful substances as heroin, crack, and methamphetamine – are not addicts, just as the vast majority of drinkers are not alcoholics. The one exception to this rule seems to be cigarette smokers, who typically are under the influence of nicotine throughout their waking hours. But even here, it is not the inherent addictive power of the drug that determines the pattern of use: Pipe and cigar smokers tend to consume tobacco much less frequently than cigarette smokers do (and face much less serious health risks).

For the most part, people manage to use drugs without disrupting their lives; they find ways to balance this particular pleasure with other things they value. These are important skills to learn, since almost any pleasure can be taken to excess and it's unlikely that NIDA-funded research will find a vaccine for them all. Even if it could, who wants to live in a world where the automatic response to pleasure is not only to abstain from it but to suppress the very ability to experience it? That chilling prospect is a logical consequence of viewing drug use as a disease instead of a behavior. By giving short shrift to individual values and choices, preventive antidrug vaccines send a dangerous, demoralizing message: that we are powerless in the face of temptation.

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