Tobacco consumption is believed to be one of the world’s greatest preventable health problems. According to the World Health Organisation, 1.1 billion people worldwide are addicted to nicotine with tobacco causing an estimated four million premature deaths every year. The development of a nicotine conjugate vaccine suggests that immunisation may hold promise as a future therapeutic and preventive strategy for tobacco smoking and nicotine addiction. Allowing parents to immunise their children against smoking could be an infringement of (...) children’s right to an open future, however, and is not ethically unproblematic. (shrink)

It was, until recently, accepted that the two classes of acetylcholine (ACh) receptors are distinct in an important sense: muscarinic ACh receptors signal via heterotrimeric GTP binding proteins (G proteins), whereas nicotinic ACh receptors (nAChRs) open to allow flux of Na+, Ca2+, and K+ ions into the cell after activation. Here we present evidence of direct coupling between G proteins and nAChRs in neurons. Based on proteomic, biophysical, and functional evidence, we hypothesize that binding to G proteins modulates the activity (...) and signaling of nAChRs in cells. It is important to note that while this hypothesis is new for the nAChR, it is consistent with known interactions between G proteins and structurally related ligand‐gated ion channels. Therefore, it underscores an evolutionarily conserved metabotropic mechanism of G protein signaling via nAChR channels.Also watch the Video Abstract. (shrink)

OBJECTIVE: To evaluate the association of nicotinic acetylcholine receptor single nucleotide polymorphism with 7-day point prevalence abstinence in randomized clinical trials of smoking cessation therapies in individuals grouped by pharmacotherapy randomization to inform the development of personalized smoking cessation therapy. MATERIALS AND METHODS: We quantified association of four SNPs at three nAChRs with abstinence in eight randomized clinical trials. Participants were 2633 outpatient treatment-seeking, self-identified European ancestry individuals smoking at least 10 cigarettes/day, recruited through advertisement, prescribed pharmacotherapy, and provided with (...) behavioral therapy. Interventions included nicotine replacement therapy, bupropion, varenicline, placebo, or combined NRT and bupropion, and five modes of group and individual behavioral therapy. Outcome measures tested in multivariate logistic regression were end of treatment and 6 month abstinence, with demographic, behavioral, and genetic covariates. RESULTS: 'Risk' alleles previously associated with smoking heaviness were significantly associated with reduced abstinence in the PLA pharmacotherapy group at 6MO [for rs588765, odds ratio 0.41 ], and at end of treatment and at 6MO [for rs1051730, 0.42 and 0.31 ], and with increased abstinence in the NRT PG at 6MO [for rs588765, 2.07 and for rs1051730, 2.54 ]. We observed significant heterogeneity in rs1051730 effects between PGs. CONCLUSION: chr15q25.1 nAChR SNP risk alleles for smoking heaviness significantly increase relapse with PLA treatment and significantly increase abstinence with NRT. These SNP-PG associations require replication in independent samples for validation, and testing in larger sample sizes to evaluate whether similar effects occur in other PGs. © 2013 Wolters Kluwer Health | Lippincott Williams &Wilkins. (shrink)

Although the efficacy of pharmacotherapy for tobacco dependence has been previously demonstrated, there is substantial variability among individuals in treatment response. We performed a systems-based candidate gene study of 1295 single nucleotide polymorphisms in 58 genes within the neuronal nicotinic receptor and dopamine systems to investigate their role in smoking cessation in a bupropion placebo-controlled randomized clinical trial. Putative functional variants were supplemented with tagSNPs within each gene. We used global tests of main effects and treatment interactions, adjusting the P-values (...) for multiple correlated tests. An SNP in the 3′ UTR region of the β2 nicotinic acetylcholine receptor subunit has an impact on abstinence rates at the end of treatment and after a 6-month follow-up period. This latter P-value is also significant with adjustment for the number of genes tested. Independent of treatment at 6-month follow-up, individuals carrying the minor allele have substantially decreased the odds of quitting. Effect of estimates indicate that the treatment is more effective for individuals with the wild-type compared with individuals carrying the minor allele, although this difference is only suggestive. Furthermore, this SNP demonstrated a role in the time to relapse and an impact on withdrawal symptoms at target quit date. Overall, while our results indicate strong evidence for CHRNB2 in ability to quit smoking, these results require replication in an independent sample. © 2008 The Author. (shrink)

Personality Dimensions and Nicotine Dependence and Withdrawal Symptoms: the Mediating Role of Self-Directness We analyzed the relationship between personality traits and smoking status and nicotine withdrawal symptoms using two comprehensive models of personality: the Five-Factor Model and the Cloninger's Temperament and Character Inventory. In total 295 people were examined, 149 smokers and 146 who have never smoked. To measure the severity of the nicotine dependence we used the Fagerstroem Tolerance Questionnaire and the DSM-IV criteria of nicotine (...) dependence and to measure the nicotine withdrawal symptoms the Nicotine Dependence History. The results showed significant differences between the groups in particular dimensions: Neuroticism, Agreeableness and Conscientiousness. The analyse of the TCI demonstrate, that smokers are higher in Novelty Seeking and lower in Reward Dependence than never smokers and show less Self-Directness and Cooperativeness. The mediation analyses showed that Self-Directness is the significant mediator between Extra-Introversion and nicotine withdrawal symptoms measured by NDHIS and between Neuroticism and DSM-IV criteria of nicotine dependence. (shrink)

Nicotinic acetylcholine receptors (nAChRs) are ligand‐gated ion channels that bring about a diversity of fast synaptic actions. Analysis of the Caenorhabditis elegans genome has revealed one of the most‐extensive and diverse nAChR gene families known, consisting of at least 27 subunits. Striking variation with possible functional implications has been observed in normally conserved motifs at the acetylcholine‐binding site and in the channel‐lining region. Some nAChR subunits are particular to neurons whilst others are present in both neurons and muscles. The localization (...) of subunits in non‐synaptic regions suggests novel roles for nAChRs. Genetic and heterologous expression studies have identified a subset of nAChR subunits that are important drug targets while the study of mutants has identified genes functionally‐linked to nAChRs. Future studies using C. elegans offer the prospect of increasing our understanding of the functional diversity of a complex nAChR gene family as well as addressing the role of nAChRs and associated proteins in human disorders. BioEssays 26:39–49, 2004.© 2003 Wiley Periodicals, Inc. (shrink)

© 2015 Society for the Study of Addiction.Background and Aims: A broadly mandated reduction of the nicotine content of cigarettes has been proposed in the United States to reduce the addictiveness of cigarettes, to prevent new smokers from becoming addicted and to facilitate quitting in established smokers. The primary aim of this study was to determine whether following 7months of smoking very low nicotine content cigarettes, and then returning to their own cigarettes, smokers would demonstrate persistently reduced (...) class='Hi'>nicotine intake compared with baseline or quit smoking. Methods: In a community-based clinic 135 smokers not interested in quitting were randomized to one of two groups. A research group smoked their usual brand of cigarettes, followed by five types of research cigarettes with progressively lower nicotine content, each for 1month, followed by 6months at the lowest nicotine level and then 12months with no intervention. A control group smoked their usual brand for the same period of time. Smoking behavior, biomarkers of nicotine intake and smoke toxicant exposure were measured. Results: After 7 months smoking VLNC, nicotine intake remained below baseline with no significant change in cigarettes per day or expired carbon monoxide. During the 12-month follow-up, cotinine levels in RNC smokers rose to baseline levels and to those of control smokers. Quit rates among RNC smokers were very low [7.5 versus 2% in controls, not significant). Conclusions: In smokers not interested in quitting, reducing the nicotine content in cigarettes over 12 months does not appear to result in extinction of nicotine dependence, assessed by persistently reduced nicotine intake or quitting smoking over the subsequent 12 months. (shrink)

We utilized a cohort of 828 treatment-seeking self-identified white cigarette smokers to rank candidate gene single nucleotide polymorphisms associated with the Fagerström Test for Nicotine Dependence, a measure of nicotine dependence which assesses quantity of cigarettes smoked and time- and place-dependent characteristics of the respondent's smoking behavior. A total of 1123 SNPs at 55 autosomal candidate genes, nicotinic acetylcholine receptors and genes involved in dopaminergic function, were tested for association to baseline FTND scores adjusted for age, depression, education, (...) sex, and study site. SNP P-values were adjusted for the number of transmission models, the number of SNPs tested per candidate gene, and their intragenic correlation. DRD2, SLC6A3, and NR4A2 SNPs with adjusted P-values <0.10 were considered sufficiently noteworthy to justify further genetic, bioinformatic, and literature analyses. Each independent signal among the top-ranked SNPs accounted for ∼1% of the FTND variance in this sample. The DRD2 SNP appears to represent a novel association with nicotine dependence. The SLC6A3 SNPs have previously been shown to be associated with SLC6A3 transcription or dopamine transporter density in vitro, in vivo, and ex vivo. Analysis of SLC6A3 and NR4A2 SNPs identified a statistically significant gene-gene interaction, consistent with in vitro evidence that the NR4A2 protein product regulates SLC6A3 transcription. A community cohort of N=175 multiplex ever-smoking pedigrees provided nominal evidence for association with the FTND at these top ranked SNPs, uncorrected for multiple comparisons. © 2009 Nature Publishing Group All rights reserved. (shrink)

BACKGROUND The Food and Drug Administration can set standards that reduce the nicotine content of cigarettes. METHODS We conducted a double-blind, parallel, randomized clinical trial between June 2013 and July 2014 at 10 sites. Eligibility criteria included an age of 18 years or older, smoking of five or more cigarettes per day, and no current interest in quitting smoking. Participants were randomly assigned to smoke for 6 weeks either their usual brand of cigarettes or one of six types of (...) investigational cigarettes, provided free. The investigational cigarettes had nicotine content ranging from 15.8 mg per gram of tobacco to 0.4 mg per gram. The primary outcome was the number of cigarettes smoked per day during week 6. RESULTS A total of 840 participants underwent randomization, and 780 completed the 6-week study. During week 6, the average number of cigarettes smoked per day was lower for participants randomly assigned to cigarettes containing 2.4, 1.3, or 0.4 mg of nicotine per gram of tobacco than for participants randomly assigned to their usual brand or to cigarettes containing 15.8 mg per gram. Participants assigned to cigarettes with 5.2 mg per gram smoked an average of 20.8 cigarettes per day, which did not differ significantly from the average number among those who smoked control cigarettes. Cigarettes with lower nicotine content, as compared with control cigarettes, reduced exposure to and dependence on nicotine, as well as craving during abstinence from smoking, without significantly increasing the expired carbon monoxide level or total puff volume, suggesting minimal compensation. Adverse events were generally mild and similar among groups. CONCLUSIONS In this 6-week study, reduced-nicotine cigarettes versus standard-nicotine cigarettes reduced nicotine exposure and dependence and the number of cigarettes smoked.. (shrink)

This commentary reviews the effects of nicotine on mood and cognition in support of the drug utilization concept of Müller & Schumann (M&S). Specifically, it amplifies the concept with the nicotine utilization hypothesis (NUH), which opposes the nicotine withdrawal hypothesis (NWH). Evidence against NWH comes from changes in mood after abstinence and the performance effects of nicotine supporting drug utilization.

Australia does not allow adult smokers to buy or use electronic nicotine delivery systems that contain nicotine without a prescription. This paper critically evaluates the empirical and ethical justifications provided for the policy by Federal and State governments, public health advocates and health organisations. These are: that ENDS should only be approved as products for smoking cessation when there is evidence from randomised controlled trials that they are effective; that as a matter of precaution we should not allow (...) the sale of ENDS to smokers as consumer products because we do not know what their long-term effects will be; and that allowing ENDS to be sold as consumer goods will enable the tobacco industry to market ENDS to young people which will also lead to an increase in youth smoking. We show that the arguments and evidence offered in support of all these claims is very weak. We also argue that even if the evidence were stronger, it would not justify denying adult smokers the right to use ENDS either to quit smoking or as a long-term alternative to smoking cigarettes. We outline ENDS policies that would more ethically address the public health concerns that motivated the current policy by allowing adult smokers to access ENDS for smoking cessation or tobacco harm reduction under tight regulations that discourage commercial promotion and adolescent use. (shrink)

Disturbances of consciousness, including fluctuations in attention and awareness, are a common and clinically important symptom in dementia with Lewy bodies. In the present study we investigate potential mechanisms of such disturbances of consciousness in a clinicopathological study evaluating specific components of the cholinergic system. [3H]Epibatidine binding to the high-affinity nicotinic receptor in the temporal cortex differentiated DLB cases with and without DOC, being 62–66% higher in those with DOC. The were no differences between DLB patients with or without DOC (...) in 125I-labeled α-bungaratoxin binding to the low-affinity nicotinic receptor, [3H]pirenzepine binding to the muscarinic M1 receptor, or in choline acetyltransferase activity. These findings provide support for the hypothesis that cholinergic activity is an important neural correlate if consciousness and suggest a mechanism of DOC in DLB involving alterations in the nicotinic receptor, composed of predominantly α4 and β2 subunits. (shrink)

An examination was made of the differential effects of the anticholinergic compounds, scopolamine and mecamylamine, on response inhibition under two different reinforcement schedules. Rats were trained on a multiple-schedule DRL-DRO. Each subject was then run under each of six different drug-dose combinations. All dose levels of both scopolamine and mecamylamine had significant disruptive effects on responding during the DRO schedule when compared to control injections of saline. Only high dose levels of scopolamine tended to disrupt responding during the DRL schedule. (...) The peripheral action of methyl scopolamine and hexamethonium, on the other hand, had no measurable effect. (shrink)

Despite worldwide efforts to reduce the consumption of tobacco, legislative and educational measures have failed to eradicate the practice of cigarette smoking. Indeed, in many populations, particularly in the developing world, its prevalence is increasing. Consequently were alternative strategies to become available to address the problem, they would deserve serious consideration. One potential strategy which may become a real possibility in the future might be the vaccination of children against the pleasurable effects of nicotine. Were such a vaccine to (...) become available, children who had been inoculated would be less likely to start smoking, and even if they did, would be able to quit more easily. However, as Hasman and Holm discussed, vaccinating against a behavior rather than a disease is not ethically unproblematic, and they concluded that inoculation of infants and young children with a permanently effective nicotine conjugate vaccine should not take place, as it robbed children of the right to a smoking future. In this article, I will re-evaluate some of their arguments, and will conclude that in fact the private and public goods that inoculation with a ‘smoking vaccine’ would produce, outweigh the possible impingements on future autonomy that may result from such vaccination programme. (shrink)

Health behaviors such as tobacco use contribute significantly to poor health. It is widely recognized that efforts to prevent poor health outcomes should begin in early childhood. Biomedical enhancements, such as a nicotine vaccine, are now emerging and have potential to be used for primary prevention of common diseases. In anticipation of such enhancements, it is important that we begin to consider the ethical and policy appropriateness of their use with children. The main ethical concerns raised by enhancing children (...) relate to their impact on children’s well-being and autonomy. These concerns are significant, however they do not appear to apply in the case of the nicotine vaccine; indeed the vaccine could even further these goals for children. Nevertheless, concerns about broadly applying this enhancement may be more challenging. The vaccine may be less cost-effective than alternative public efforts to prevent tobacco use, utilizing it could distract from addressing the foundational causes of smoking and it might not be publically acceptable. Empirical research about these concerns is needed to ascertain their likelihood and impact as well as how they could be minimized. This research could help determine whether behavior-related enhancements hold promise for improving children’s health. (shrink)

This study examined the relation between professional affiliation and the framing of expert congressional testimony about nicotine's addictiveness. Experts were chosen from three different types of sponsoring organizations: the tobacco industry, government, and independent research organizations, both pro- and anti-tobacco. The study sought to identify common technical biases and policy concerns that could define an overall “expert” attitude, as well as differences where the experts’ framing of nicotine addiction would reveal attempts to favor their own institutions. Semantic network (...) analysis was applied to each group's discourse, thereby clustering associated words that represented major themes in each type of expert group. Clusters revealed a common preoccupation with narrowly defined, lab-based evidence, but more locally, each group framed the issues to support its sponsor's strategy. (shrink)

Elevations in brain stimulation reward (BSR) thresholds have been observed in rats undergoing nicotine withdrawal and have been proposed as a sensitive measure of the negative affective state associated with nicotine withdrawal. mGluR are presynaptic autoreceptors that decrease glutamate release when stimulated. The aim of this study was to examine the role of glutamate neurotransmission in nicotine dependence. The mGluR agonist LY314582 (2.5–7.5 mg/kg) precipitated nicotine withdrawal as measured by elevations in BSR thresholds in nicotine-treated (...) rats but not in controls. It was hypothesized that LY314582 precipitated nicotine withdrawal by decreasing glutamatergic tone at postsynaptic glutamate receptors. Therefore, the effects of MPEP (0.5–2 mg/kg), an mGluR antagonist, and MK-801 (0.01–1 mg/kg), an NMDA receptor antagonist, were examined. MPEP elevated BSR thresholds by an equal magnitude in control and nicotine-treated rats. At low doses, MK-801 (0.01–0.2 mg/kg) lowered BSR thresholds to a similar extent in control and nicotine-treated rats. At higher doses, MK-801 (0.25–1 mg/kg) disrupted performance in nicotine-treated and control rats. These data indicate that mGluR and NMDA receptors regulate BSR in opposite directions in non-dependent animals, and chronic nicotine treatment does not alter these effects. Most importantly, the data demonstrate that the mGluR is involved in nicotine dependence, but mGluR and NMDA receptors do not mediate mGluR actions in nicotine dependence. (shrink)

This article examines the efficacy of an ethics discernment process in the organizational context, a practice referred to in the paper as "mission due diligence." This type of ethics discernment is a structured process intended to awaken the ethical concerns that a particular issue raises within moral agents and to give voice, directly and indirectly, to those who will be impacted by, and responsible for, strategic decision making. The efficacy of this particular ethics discernment practice is contingent upon several realities, (...) including, but not limited to 1) the timing in which it is undertaken, 2) the degree of importance and relevance attributed to it, and 3) the skills of the person leading it. This case report examines how this process was used to highlight and address the ethical issues related to a new hiring policy, namely, a mandatory nicotine screening test for prospective employees in the healthcare context. (shrink)

Background: Recent federal legislation gives the U.S. Food and Drug Administration authority to regulate the nicotine content of cigarettes. A nationwide strategy for progressive reduction of the nicotine content of cigarettes is a potential way to reduce the addictiveness of cigarettes, to prevent new smokers from becoming addicted, and to facilitate quitting in established smokers. We conducted a trial of progressive nicotine content tapering over 6 months to determine the effects on smoking behaviors and biomarkers of tobacco (...) smoke exposure and cardiovascular effects. Methods: One hundred and thirty-five healthy smokers were randomly assigned to one of two groups. A research group smoked their usual brand of cigarettes followed by five types of research cigarettes with progressively lower nicotine content, each smoked for one month. Acontrol group smoked their own brand of cigarettes for the same period of time. Results: Nicotine intake, as indicated by plasma cotinine concentration, declined progressively as the nicotine content of cigarettes was reduced. Cigarette consumption and markers of exposure to carbon monoxide and polycyclic aromatic hydrocarbons, as well as cardiovascular biomarkers remained stable, whereas urinary 4--1-- 1-butanol excretion decreased. No significant changes in biomarkers of exposure or cardiovascular effects were observed in controls. Conclusions: Our data support the proposition that the intake of nicotine from cigarettes of smokers can be substantially lowered without increasing exposure to other tobacco smoke toxins. Impact: These findings support the feasibility and safety of gradual reduction of the nicotine content in cigarettes. ©2012 AACR. (shrink)

A Hasman and S Holm have evaluated in a recent article in this journal1 the arguments in favour and against the preventive use of an antinicotine vaccine. This has been a timely article in view of the fact that at least three companies ….

This chapter discusses the ethical issues faced by whistleblowers as seen in the film _The Insider_ (1999). The film tells the story of whistleblower Jerry Wigand (Russell Crowe) who decides to go public with one of Big Tobacco's closely held secrets—that they have been manipulating nicotine levels to keep their customers addicted to their product. It illustrates Wigand's struggle to decide between doing well by his family and doing well by society. His story can be described as one of (...) depth and pathos. He wins, but his victory comes at a heavy cost: he loses his family, his lifestyle, and his reputation. (shrink)

Different immunotherapeutic approaches are in the pipeline for the treatment of drug dependence. “Drug vaccines” aim to induce the immune system to produce antibodies that bind to drugs and prevent them from inducing rewarding effects in the brain. Drugs of abuse currently being tested using these new approaches are opioids, nicotine, cocaine, and methamphetamine. In human clinical trials, “cocaine and nicotine vaccines” have been shown to induce sufficient antibody levels while producing few side effects. Studies in humans, determining (...) how these vaccines interact in combination with their target drug, are underway. However, although vaccines can become a reasonable treatment option for drugs of abuse, there are several disadvantages that must be considered. These include i) great individual variability in the formation of antibodies, ii) the lack of protection against a structurally dissimilar drug that produces the same effects as the drug of choice, and iii) the lack of an effect on the drug desire that may predispose an addict to relapse. In addition, a comprehensive overview of several crucial ethical issues has not yet been widely discussed in order to have not only a biological approach to immunotherapy of addiction. Overall, immunotherapy offers a range of possible treatment options: the pharmacological treatment of addiction, the treatment of overdoses, the prevention of toxicity to the brain or the heart, and the protection of the fetus during pregnancy. So far, the results obtained from a small-scale experiment using vaccines against cocaine and nicotine suggest that a number of important technical challenges still need to be overcome before such vaccines can be approved for clinical use. (shrink)

BackgroundThe use of electronic nicotine delivery systems, also known as vaping, is becoming popular among young adults. Few studies have explored the psychological factors that predict ENDS use and susceptibility in young adults, in addition to known demographic predictors.MethodIn a cross-sectional survey design, 521 young adults, ages 18–25 from the United States, were recruited via Amazon’s Mechanical Turk in 2019, to answer an online survey measuring demographic characteristics and psychological characteristics related to mental health and the Big Five personality (...) traits. The survey also included measures of ENDS ever-use, current use, and susceptibility, which we predicted from the demographic and psychological measures using independent and multiple binary logistic regression analyses.ResultsOf those surveyed, 282 were ENDS ever-users, 93 were current ENDS users, and 61 were ENDS susceptible; 62 were current smokers. Demographically, young adults lower in adulthood socioeconomic-status, not pursuing education further than high school, and current smokers were more likely to be ENDS users. Psychologically, young adults higher in anxiety and lower in conscientiousness more likely to have ever-used ENDS. Lower conscientiousness further predicted current ENDS use and ENDS susceptibility.ConclusionIn this sample of MTurk workers, young adults with experience in vaping were more demographically and psychologically vulnerable than young adults with no experience in vaping. Young adults interested in vaping, but without prior experience, were less conscientious than their non-interested peers. Interventions to target vaping use should focus on economically disadvantaged young adults and those lower in conscientiousness. (shrink)

4E approaches to affective technology tend to focus on how ‘users’ manage their situated affectivity, analogously to how they help themselves cognitively through epistemic actions or using artefacts and scaffolding. Here I focus on cases where the function of affective technology is to exploit or manipulate the agent engaging with it. My opening example is the cigarette, where technological refinements have harmfully transformed the affective process of consuming nicotine. I proceed to develop case studies of two very different but (...) also harmful affective technologies. Casinos and electronic gambling machines deploy computationally intensive scaffolding to shape the onset and continuation of gambling episodes. High-heeled shoes affectively engineer wearers’ relationships to their own embodied capacities and are predominantly expected to be worn by women. I conclude with a discussion of the need for study of affective technology to focus other-directed applications, some of which will serve competing or antagonistic interests. (shrink)

In recent years, health warnings on tobacco products have become compulsory through legislation introduced by the Australian government. This approach shows a lack of concern for tobacco consumers while allowing government to abdicate responsibility without jeopardising profit. The decision to warn people of inevitable addiction and disease fails to recognise previous research into adolescent attraction to deviance and the role of suggestion in cure and illness. The Australian government makes millions of dollars each year by taxing tobacco products—as long as (...) these profits continue to be directed almost exclusively into consolidated revenue, smokers will remain victims of a system unconcerned with exploitation. (shrink)

To deepen understanding of efforts to consider addiction a “brain disease,” we review critical appraisals of the disease model in conjunction with responses from in-depth semistructured stakeholder interviews with (1) patients in treatment for addiction and (2) addiction scientists. Sixty-three patients (from five alcohol and/or nicotine treatment centers in the Midwest) and 20 addiction scientists (representing genetic, molecular, behavioral, and epidemiologic research) were asked to describe their understanding of addiction, including whether they considered addiction to be a disease. To (...) examine the NIDA brain disease paradigm, our approach includes a review of current criticism from the literature, enhanced by the voices of key stakeholders. Many argue that framing addiction as a disease will enhance therapeutic outcomes and allay moral stigma. We conclude that it is not necessary, and may be harmful, to frame addiction as a disease. (shrink)

New Zealand and Malaysia have abandoned plans to introduce a generational smoking ban because of concerns that such a policy is incompatible with liberal democracy as it undermines autonomy. This paper challenges this claim by showing that smoking is not an autonomous act. Autonomy requires a deliberation of preferences, wills and inclinations. This does not occur in smokers because of three related factors: nicotine addiction, cognitive biases and psychosocial development in addiction. Nicotine addiction results in strong physical and (...) psychological desires to seek pleasure and to avoid withdrawal. This is further potentiated by conditioned behaviour. Cognitive biases explain why smokers act in ways that are detrimental to their health. Psychosocial development explains how the brains of smokers are unable to make rational decisions. This combination renders smokers unable to reflect on their actions and thus act autonomously. This stance is compatible with Mill’s view that actions that devalue autonomy cannot be considered autonomous. Defenders of liberalism should not be quick to dismiss a smoking ban and can instead foster autonomy by supporting it. (shrink)

Grounded in ethical theories of manipulation, autonomy, and informed choice, this research examines whether asymmetric health warning schemes distort consumers’ comparative risk judgments across substitutable harmful products. Four experimental studies demonstrate that cigarette graphic health warnings reliably evoke smoking-related fear that, through contrast-based spillover effects, positions e-cigarettes as comparatively less harmful, generates more favorable attitudes, and increases purchase and trial intentions. These effects operate through a serial mediation process in which fear increases motivation to quit smoking, which in turn directs (...) behavioral intentions toward e-cigarettes rather than toward the cessation of nicotine use. Study 4 further reveals that asymmetric warning conditions in which only cigarettes carry graphic warnings maximize psychological reactance by signaling selective regulatory targeting, whereas extending graphic warnings to e-cigarettes attenuates both the contrast-based and reactance-driven spillover effects. The results support warning congruence as an ethically preferable regulatory design that better preserves the conditions for informed comparative judgment, and carry implications for ethically responsible policy design, corporate conduct, and consumer welfare in markets involving harmful but legally available products. (shrink)

Advances in immunotherapy pave the way for vaccines that target not only infections, but also unhealthy behaviors such as smoking. A nicotine vaccine that eliminates the pleasure associated with smoking could potentially be used to prevent children from adopting this addictive and dangerous behavior. This paper offers an ethical analysis of such vaccines. We argue that it would be permissible for parents to give their child a nicotine vaccine if the following conditions are met: (1) the vaccine is (...) expected to result in a net benefit to each individual vaccinated, (2) the expected harms from the side effects of the vaccine are lower than the non-voluntary harms of smoking, and (3) there are no less manipulative methods available that are as effective at preventing smoking initiation. Finally, we show how the framework developed here could be used to analyze the ethics of other chemical interventions designed to modify children’s behavior. (shrink)

This paper presents a novel view of the concept of cognitive enhancement by taking a population health perspective. We propose four main modifiable healthy lifestyle factors for optimal cognitive functioning across the population for which there is evidence of safety and efficacy. These include i) promoting adequate sleep, ii) increasing physical activity, iii) encouraging a healthy diet, including minimising consumption of stimulants, alcohol and other drugs including nicotine, iv) and promoting good mental health. We argue that it is not (...) ethical to promote or sanction the use of pharmaceutical drugs as putative cognitive enhancers without acknowledging the adverse effects on population cognitive health of failing to encourage the pursuit of healthy behaviours. We conclude with recommendations to increase the public health relevance of bioethical analyses of the cognitive enhancement debate. (shrink)

In this chapter, I summarize the most important facts about recreational drugs and drug use. I start with some basic numbers about use rates, addiction rates, and overdose fatalities, both in the United States and globally. I then go on to look at the different effects of different drugs. Not all drugs are the same, so we need to compare different drugs in terms of their harmfulness, especially their overdose potential, addictiveness, and acute and long-term health risks. This includes the (...) legal drugs alcohol and nicotine, which are more addictive and destructive than many illegal drugs. The chapter ends with important facts about addiction and its causes. Drugs are less addictive than people tend to think. Only about 25% of heroin users are dependent, and it is the most addictive drug besides nicotine. There are also good reasons to doubt the pharmacological model of addiction, which claims that addiction is caused primarily by repeated exposure to a substance. Though use is obviously a necessary condition for addiction, users who come to develop dependency typically suffer from traumatic upbringing or highly stressful environments. (shrink)

E-cigarettes are a uniquely close substitute to combustible cigarettes. Close not just in nicotine content, but also in shape, taste and even inhalation and arm movement. Their availab...

Tobacco use remains a critical global public health challenge, representing the leading preventable cause of morbidity and mortality worldwide. The World Health Organisation’s Framework Convention on Tobacco Control, ratified by 183 parties, includes Articles 9 and 10, which regulate the contents and emissions of tobacco products. Like many other WHO-FCTC articles, the implementation of these provisions faces significant challenges. These hurdles include tobacco industry interference, the proliferation of novel tobacco and nicotine products, the complexity of regulating product attractiveness, addictiveness, (...) and toxicity, inadequate testing infrastructure, legal and political barriers, and coordination challenges among the regulatory authorities of different countries. Overcoming these impediments is crucial, as robust enforcement of Articles 9 and 10 holds the potential to reduce the substantial global burden of over 7 million annual deaths attributable to tobacco use. Effective implementation will require integrating these articles into domestic tobacco control legislation, establishing well-equipped testing facilities, fostering multi-sectoral coordination, and bolstering international research collaborations and capacity-building efforts. By surmounting these challenges, countries can harness the full power of the WHO-FCTC to curb the tobacco epidemic. (shrink)

Philosophers rely on four double standards when arguing for prohibitive antismoking policies. First, they hold addictive nicotine products to more restrictive standards than other threats to individual autonomy. Second, they hold the tobacco industry to more restrictive standards than other potentially harmful industries. Third, they hold public health officials to weaker moral standards than they would apply to other citizens. Fourth, they hold their own proposals to standards of ideal enforcement while citing the non-ideal effects of a non-prohibitive system. (...) Many of the arguments in favour of restricting tobacco and nicotine products also overlook less prohibitive ways of preventing harmful use. -/- . (shrink)

While providing people with the same nicotine that forms the basis of their physical addiction, there is no available evidence that electronic nicotine delivery systems have carcinogenic eff...