[As it turned out, I was right and Stimmel was wrong. Since writing this article Kendler has gone ahead and disproven the gateway theory. Read that article on this web site at: http://www.nvo.com/hypoism/gatewaytheoryfinallydisproven/]

This article shows another good example of the agenda-based pseudoscience being passed off as science by the P/R Paradigm, in this case by the journal run by ASAM, the American Society of Addiction Medicine. I don't provide the article about which my letter to the editor, below, refers. Get a copy of the journal and read it. The reference is in the letter. This letter deals with the same pseudocience of association studies as does the one (11/9/00) I cite on page 11 of My Letters To The NY Times; demonization of drugs and false associations passed off as etiology rather than co-occurrance in hypoics. In fact, in my discussion of that study I predicted this one, "This study is much like the ones purported to show that marijuana is a "gateway drug" to cocaine or other "hard" drugs." And, "your findings are still consistent with the hypothesis of an underlying neurobiological entity causing both smoking and the "anxiety" symptom triad much like an underlying neurobiological mechanism causing both smoking and alcohol addiction, an association long known to be true but not causal. Smoking doesn't cause alcohol addiction, but both are associated and caused by an underlying neurobiological mechanism." You can be assured that this letter will be trashed by Dr. Stimmel. Send him a copy of this letter yourself to see if you get better results than I do.
The fact is that ASAM and its journal are in the pocket of and have been bought and paid for by NIDA, the major source of addiction research and practice money, the money that supports ASAM members' jobs and programs such as methadone clinics. ASAM is for ASAM, not addicts and the publishing of this article is more proof of this fact. Addicts are being deeply injured by pseudoscience like this because it invalidly supports the P/R paradigm, the paradigm that is responsible for the HYPOIC GENOCIDE currently happening in our country. Readers of this article should ignore it at your own and your children's risk.

12/07/2000
Editor, Barry Stimmel, M.D.
Editor of The Journal of Addictive Diseases
Dean for Graduate Medical Education
Mount Sinai School of Medicine
Annenberg 5-02G, Box 1193
One Gustave L. Levy Place
New York, NY 10029 USA

Dear Editor:

The article, The Association Between Cigarette Smoking and Drug Abuse in the United States, Journal of Addictive diseases, Vol. 19(4) 2000, is obviously biased towards its conclusion because: 1) There is no direct evidence for the concept of "Gateway Drugs," a fictitious concept, and 2) There is a simpler and more realistic conclusion to be found by this association study, based on the known neurobiology and genetics of addictions in humans and animals: deficient activities of genes involved in the reward mechanism, the mechanism known to be responsible for addictions; that people and animals with genetic deficiencies in the mesolimbic reward system are much more likely to use addictive drugs of all kinds, legal and illegal, and more likely to become addicted to them as well. Drug addictions of all kinds have been shown to be genetic (see Kenneth Kendler's and Ming Tsuang's definitive work including coexistence of behavioral addictions as well as drug addictions listed at: http://www.nvo.com/hypoism/recentgeneticstudiesonvariousaddictionsfromalargetwinregistr/) and unrelated to environment (twin studies and identical twin studies plus identical twins split at birth studies). The "gateway" concept flies in the face of all the science that points to neurobiological forces leading to addictive drug use, not that one drug addiction is a cause of another drug addiction. The complete neurobiological and genetic hypothesis that reconciles all this science is defined and discussed in my book, Hypoic's Handbook - The Hypoism Paradigm of Addictions. This hypothesis fits all valid science on addictions and clinical addictionology as well; that specific and genetic neurobiology present at conception causes all addictions.

It is not possible to reconcile all this definitive science with a "gateway" concept where it is proposed that a drug causes future addictions known to be caused by genetic factors. This makes no sense whatsoever. Additionally, all the environmental associations listed at the end of the article such as peer preferences and hiding behavior are either genetic (temperament) based or a result of the stigmatization of smoking and other drug use caused by the current incorrect paradigm of addiction etiology (environmental and psychological, conscious "stupid" choice) that ensures stigma and demonization of any and all drug use by children and adults alike.

This article, rather than adding to our understanding of addictions, subtracts from it (because its conclusions are upside down from reality) and only supports an antidrug ideology at the expense of damage to addicts. Demonization of drugs, legal and illegal, as this article attempts to do unscientifically, rather than resulting in the acceptance of the biological and genetic etiology of drug use and the positive implications this knowledge would lend to the drug debate, does not diminish drugs overall use, does not increase recovery from addictions, and even worse, perpetuates and magnifies the problem of addictions instead of solving it. Besides, the article's conclusions are superficial, intuitive and thus not science-based, ignore all good science in addictions, and are presumptuous rather than proven (as the author admits in the article).

In conclusion, I find it incomprehensible that this article was published in a journal that presumes itself to be based on scientific integrity.

Sincerely Yours,
Dan F. Umanoff, M.D.

As it turns out, Dr. Stimmel answered my letter. I place it here and discuss it afterwards.:

Dear Dr. Umanoff.

I am writing in response to your letter expressing your concern with the article "The Association Between Cigarette Smoking and Drug Abuse In The United States" that appeared in the most recent issue of the Journal of Addictive Diseases.

It was realized that the article might be controversial and, in fact, two of the reviewers who are well respected clinical pharmacologists had differing views of this paper. However, a third reviewer sided with the review that felt this was a well done study and was of interest to readers of the Journal.

Whereas I realize that the concept of a "gateway theory" may be controversial, this term appears regularly in the literature and has been given "stature" in the recent text of the American Society of Addiction Medicine Principles of Addiction Medicine. As you note in your letter in the last paragraph of the paper the authors' discuss the limitations of their findings, leaving the reader to decide for him/herself whether there is any validity to their final conclusions.

The Journal does not have a "Letters" section. However, I have taken the liberty of forwarding your letter to Dr. Lai, the first author. In addition, if you would be willing to devote some time to preparing a scientific review paper, specifically addressing the concept of "Gateway Drugs" in the style of the Journal, I would be delighted to send it for peer review in consideration of publication.

Best regards.

My discussion of this letter:

He first admits that publishing this article was "controversial." What exactly does this mean? Does it mean it's valid? No. Does it mean its conclusions are based on science? No. So what criteria does his "journal" use to publish articles? Controversy? Would he publish an article that states the obvious reality that the sun goes around the earth because it's controversial? No. What difference does it make that it's a controversial article. It should only be published because the methods used to arrive at the study's conclusion are valid scientifically. He doesn't show this to be true anywhere in his letter, but, instead, uses two poor substitutes for scientific validity, the opinions of supposedly "respected" scientists and a group of addictionologists. 1) ASAM used the term in a non peer-reviewed textbook, and, 2) one out of three reviewers "felt" the paper was well done and was of interest to the readers of the "journal." Stimmel went with the minority based on a "feeling" about the paper. These are the criteria a journal like Time or People Magazines use for publishing an article, not the criteria a science journal should use. Reason one doesn't make the "gateway" theory valid any more than jesus was the son of god, and reason two is a sham, not based on standard science, but by feelings and opinions, topics destructive of science I discuss in other articles on this site. Then, he goes on to challenge me with having to write a paper, peer reviewed by his hand picked reviewers, proving the "gateway" theory wrong with science. You may think this is a magnanimous gesture, but it is an invitation to do the impossible. How is it possible to prove an incorrect theory wrong unless I can prove someother theory right, something that's not possible today for addictions? It's not my job to disprove the gateway theory, it's incumbent upon the ones stating the gateway theory to prove it correct. Until then it is not a valid theory. Stimmel says it's a valid theory by dint of its existence and I must prove it wrong to get rid of it. This is backwards science and it is a fraud; The same fraud as the rest of his journal and reviewers. Thus, the purveyors of the P/R paradigm continue to scam themselves and the public at the addict's expense but to their benefit (see http://www.nvo.com/hypoism/11conflictofinterestinaddictionresearch/) [Anyway, since this page was written, Kendler et al have disproven the gateway effect. see: http://www.nvo.com/hypoism/gatewaytheoryfinallydisproven/]

Here's a letter from the author of the original article, Dr. Lai, in response to Dr. Stimmel sending him my letter objecting to the article. I think it's pretty obvious how dismissive Dr. Lai is without even having read my book! Moreover, how arrogant he is about his nonsensical and useless article. Here goes.

January 8, 2001
Dan F. Umanoff, M.D.
163 Hendrickson Ave.
Rockville Centre, NY 11570
Dear Dr. Umanoff:
Dr. Stimmel forwarded us a copy of your letter questioning conclusions presented in our article, " The Association between Cigarette Smoking and Drug Abuse in the United States." We frankly find your reading of the article exceptionally puzzling, in a reductionist way. Our paper was based on one of the largest databases on drug abuse in this country and the associations between cigarette smoking and drug abuse were extremely strong. Based on the data, we concluded that (1) cigarette smoking is a better "predictor" for illegal drug use in young persons; and (2) cigarette smoking may be a gateway drug to illegal drug use. Our paper documented an epidemiologic study. In epidemiology, we rarely make any causal inferences. You misread our paper and accuse us of asserting that cigarette use causes addiction to "hard" drugs, and we make no such assertion. We are aware of the work by Cloninger et al. and Tsuang et al., among others, exploring genetic implications of drug use in its most problematic forms. In all cases the models forwarded by behavioral geneticists find about half of the encountered variance to be explained by genetics and half by environmental factors, such as the ones mentioned in our article. Some of our groups have spent time deconstructing the paradigms that underlie drug policy in history, and we have written papers on the role of racism and xenophobia in the formation of drug policy and its maintenance. In the article in question, we presented some intriguing associations, based on very large data sets, between history of tobacco smoking and use of cocaine. Then, with full recognition of the limitations of this kind of secondary analysis of data, we offered some explanations of our findings in terms of behavioral factors that we have personally observed over three decades of research.
We do not fundamentally disagree with the search for genetic predisposing factors in the investigation of addiction's etiology. In fact, we toyed with mentioning the findings of Tsuang et al. as potential explanations of our statistical findings. We decided not to do so, because we could not link our analyses and those studies in any convincing way. We do, however, strenuously disagree with all assertions that addiction is determined purely by genetics, as would the authors that you mention in support of your case. We took the liberty of visiting your website and examining your "hypoism" paradigm. It's too simplistic for our taste, and we would suggest, in the interest of seeking truth, that you examine more closely the work of the so-called "anti-drug warriors" to appreciate more fully the work and rigor that go into their research. You might also find that at least a segment of the "scientific establishment" of which you are so wary shares your views of drug policy and has been working to change it through their work.
Finally, we enjoyed reading your comments, and thank you for your interest in this fascinating topic.

Sincerely,
Shenghan Lai
Johns Hopkins Epidemiology
615 N Wolfe ST, E6141
Baltimore, MD 21205

Here's my response to their letter, a copy of which I sent to Dr. Stimmel:

Dear Dr. Stimmel:

Thank you for forwarding my letter to the authors. I assume they sent you a copy of the letter I am now responding to.

Dear Dr. Lai:
I appreciate your reply to my letter to Dr. Stimmel, but I think you misread it. I agree with your data completely and I'm not disputing their validity. I disagree with your conclusions based on them though. I think you misread my web site as well. Hypoism is too simplistic? It's the only addiction hypothesis that suggests an existing evolved brain mechanism, complete from gene through behavior, that actually exists for the purposes of instinctive decisions being altered by genetic alleles, into an addiction machine. All animal and human addiction neurobiology points to this kind of mechanism. Addictions can't come out of a vacuum! You might try reading my book, Hypoic's Handbook, that more fully details my hypothesis and shows how it is in the midst of being proved although tangentially only because no one will use the Hypoism Hypothesis as a basis of real research. As far as addictions being part genetic and part "environmental," I think you're deeply mistaken. You are confusing two things with your use of heritability numbers: 1) that specific addictions are found to have something like 60-80% heritability. 2) that the remainder must be environmental. As for 1., addictions aren't what are being inherited, an addiction causing mechanism is. So the heritability of specific addictions is fairly irrelevant except to show there are strong genetic influences on them. As for 2., the remainder between 60-80% and 100%, 20-40%, is unknown, not necessarily environmental. Environmental etiology has never been proven, only assumed to be this difference. It isn't. I contend that the addiction causing mechanism is 100% heritable but is not being studied so no one realizes this fact. Out of this inherited mechanism comes different addictions in different people, not always the same one, and thus, one must study the inheritance the mechanism and its functionality to determine its true inheritance, by studying the presence or absence of any addiction, including behavioral addictions, in offspring, not merely one specific addiction such as alcohol addiction. The absence of these kinds of studies is why the % inheritance is not found to be 100%. The heritability of the wrong thing is being studied. We need to study the heritability of the underlying mechanism rather than the heritability of any one specific addiction, a behavior. Behaviors can't be diseases, they can only be symptoms of diseases. The heritability of the disease itself must be studied. It hasn't because it hasn't been defined yet.

As for your study, let me quote it, "This study suggests that cigarette smoking may be a gateway drug to illegal drug use." What does "a gateway drug" mean other than that it leads to illegal drug use? Meaning, if one doesn't smoke cigarettes, one won't be in the future addicted to illegal drugs. There's no evidence for that whatsoever. What you showed in your study is the same thing Tsuang showed, that people who get addicted to one thing are more likely to get addicted to many things. This conclusion would go with your data but not relate to any gateway phenomenon at all. It is absolutely consistent with, however, a genetically based altered mechanism, such as the decision-making apparatus, altered by low activity genes to cause those people having this altered mechanism to be susceptible to what I call "addictability," what is necessary to become addicted to anything and many things including legal and illegal drugs, behaviors, beliefs, and instincts, the complete picture of addictions as symptoms of an underlying disease of the decision-making apparatus, the first known disease of this brain mechanism. (Parenthetically, as discussed in my book, there are two additional manifestations of the disease of Hypoism seen in hypoics caused by the same mechanism which are totally unknown to you and other addictionologists.) This is exactly what is found clinically if it is looked for (addicts usually have multiple concurrent substance and behavioral addictions, not just one), which it is not being done today by anyone except possibly by the COGA study if the data is examined for it. In fact, because the COGA study wasn't designed to examine for these connections and associations, most likely they will be overlooked or, at least, minimized inappropriately and the necessary conclusions drawn from it will be missed. By the way, I have communicated with Dr. Begleiter about this deficiency in the COGA study many times in the last 5-6 years but have been rebuffed repeatedly.

I disagree with your calling the work done by the anti-drug warriors rigorous when they clearly ignore the place in the brain where addictions originate, the limbic decision-making apparatus, and its unconscious and powerful influences over the conscious mind. Answer this: How can a disease, not the specific addictions, but the disease that causes them, be genetic without working unconsciously from the get-go, from the "first use of the drug?" The drug warriors insist that the first use of the illegal drug is a conscious choice then followed by the addiction (hijacked brain hypothesis) which they then mislabel "the disease," thus the basis for criminalization of this action. Hypoism says, more accurately and more consistent with the reality of drug use and addictions, that the first use of the drug is unconsciously mediated by an overpowering neurobiological mechanism. In other words, according to Hypoism, hypoics become addicts against their will from the start, thus the need to decriminalize this behavior, symptomatic of an underlying disease unconsciously mediated. This association is exactly what your study depicts, not any "gateway" phenomenon.

I think that if you are going to out of hand refute Hypoism, you ought to do it objectively, one premise at a time, and not generally with a statement such as, it is "too simplistic for your taste." All seeming weird diseases become "simplistic" when fully understood. Please argue the issues point by point. I'd be happy to come down to Johns Hopkins, a teaching hospital appropriately started by a famous and productive drug addict, William Halsey, M.D., and argue each point with you one by one, and in a public forum.

Lastly, drug policy must be derived from the correct paradigm of drug use and addiction, not from a presumed and wrong paradigm. I appreciate your opposition to the drug war. Where have you published this and why is it not more vocal? The fact is, if you study the various implications of Hypoism, you will see that when this paradigm becomes known and accepted by the populous, it is followed by acceptance rather than stigmatization of addictions, and massive and effective recovery from the disease in hypoics, long before the late manifestations of addictions occur. This is the same kind of phenomenon found in other diseases. Early (self) diagnosis leads to early recovery. Thus, acceptance of Hypoism results in the only true "prevention" that is possible for this kind of disease. When this occurs, all the damaging societal difficulties associated with addictions disappear automatically much like what happens when the true paradigm appears and is utilized for any medical issue such as infectious diseases/bacteria, diabetes/insulin, stroke and kidney failure/hypertension and antihypertensive drugs, etc. These and many others were revolutionary rather than evolutionary, just like Hypoism will be if and when it is allowed to be studied and used.

Dan Umanoff, M.D.
Sincerely Yours,
Dan F. Umanoff, M.D.

Let's see if anything real comes out of this. Let's see if they agree to a MORE ACADEMIC AND THOROUGH discussion of the issues raised here, or if they'll just chicken out and go back into hiding behind their phoney credentials, bad science, and biased and insular journals.