Asking students to catalogue the errors of fact and inference in the latest New York Times Magazine essay on addiction treatment would make a good final exam for a course on drug abuse.
1. NIDA has spent most of a billion dollars trying to develop an anti-craving drug for cocaine abusers, with exactly zero to show for it.
2. Brain imaging is fascinating science, but its practical relevance to the problem of diagnosing or treating substance abuse remains unproven.
3. Most substance abuse disorder is transient rather than chronic, and most recovery isn’t mediated by treatment.
But one terminological error stands out: calling the immunotherapies now under development against various drugs of abuse “vaccines.” It’s true that immunotherapy for addiction works on the same biological principle as vaccination for infectious disease: priming the immune system. But in ordinary usage a “vaccine” is something given before someone is sick as a preventive measure. Given that the immunotherapies will be moderately expensive, molecule-specific (an immunotherapy against amphetamine would have no effect on methamphetamine), and with limited periods of effectiveness, they won’t be useful preventively.
So calling the substance abuse immunotherapies “vaccines” against addiction gives exactly the wrong impression. Indeed, one of the concerns about developing immunotherapies in the substance abuse field is that parents will start to demand that their children be “inoculated” against one or another substance.
8 thoughts on ““Immunotherapy” vs. “vaccination””
Problem with the immunotherapies is that they ate only feasible for substances with unique enough structures. For substances which have endogenous analogous counterparts, the approach isn't viable.
Mark Kleiman wrote:
>So calling the substance abuse immunotherapies
> "vaccines" against addiction gives exactly the
> wrong impression. Indeed, one of the concerns
> about developing immunotherapies in the substance
> abuse field is that parents will start to demand
> that their children be "inoculated" against one or
> another substance.
Maybe that is a "concern" to a few academics who actually can think critically, but to the drug prohibition establishment it is a feature, not a bug.
Here's a contingent prediction. If FDA ever approves an "anti-addiction vaccine", the ONDCP, DEA, state equivalents, and every "parents concerned about drug abuse" group and political rabble rouser in the country will be clamoring to enforce "innoculation" of everybody at gunpoint. The THX1138 conceit of "drug evasion" crime will become a reality.
What academics don't get is that people who make careers of prohibition enforcement and popular rabble rousing about drugs share a characteristic worthy of a circle in Dante's Inferno: souls driven by compulsive desire to control everybody but themselves. Bill Bennett and Rush Limbaugh offer illustrative examples of the prohibitionist genus.
Bruce Alexander of Simon Fraser got a big component of general addiction right with his "rat park" experiments. Another big component is genetic, as M. Simon has pointed out in your comments section before.
But science, reason, and even direct experience will never convince prohibitionists of anything that contradicts their pathological mindset. Ballots may someday reduce their political power in a democracy, but reason and science will never persuade them to change, because they weren't persuaded by reason in the first place.
Food for thought
Interesting discussion of "vaccinations" against drug addiction at Mark Kleiman's place….
Not true about vaccines. The first vaccine was administered by Luis Pasteur to a child who WAS ALREADY INFECTED with rabies. The child had been bitten by a rabid dog but had not yet manifested the disease. Pasteur concoced the rabies vaccine himself on this ad hoc basis.
Incidentally, the word "vaccine" comes from the French "vache" for "cow" which was the animal originally used to be innoculated with the infectious agent in question in order to stimulate the immune response.
Besides, there are plenty of vaccines currently available (yellow fever vaccine, for example), which are risky and are not administed to the general public for that reason.
For what it's worth, in the world of immunology, the distinction you are raising does not contain a difference (or, more correctly, the term immunotherapy is the less apt one). A vaccine is exactly something that primes the immune system to produce a response (typically antibodies) against a particular challenge (exposure to the targeted thing). Ordinary usage is frequently as you describe, but the precise usage of vaccine is an artificial stimulation of the immune system to produce a protective immune response. So if the immunization makes a person less likely to become addicted to a given substance (something I am not aware of; these substances, based on my humble knowledge, are probably not very good at stimulating immunity), then it would be a vaccine. The term "immunotherapy" is generally a broader term. Vaccination may be a subset of this. Obviously, all of the above should be read with (IMHO)interspersed frequently…
Here's some late-breaking news- in the War on Drugs, a lot of words give exactly the wrong impression.
All part of how we have people who think marijuana is a "narcotic" that you can become "addicted" to.
Gonna be hard to put these wordhorses back in their proper stalls.
As someone who works in the drug industry, I'd say that the distinction you're making is between a preventative vaccine and a therapeutic one. Both of them, as the above comments point out, work the same way: by stimulating the immune system to respond against a given target.
Most people are used to the preventative type of vaccine, but the acute, therapeutic ones are growing in importance (in cancer therapy, especially). As these come on, the "ordinary usage" you mention will probably change. Perhaps the term "immunotherapy" will take over.
Immunotherapy has been an effective treatment for patients with certain types of cancer that have been resistant to chemotherapy and radiation treatment.
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