Day 206: A long way from Strathclyde

"I have made it quite clear earlier that my motive is not to support the tobacco industry. I am here to defend good science and to try to persuade you that some of the things we have been looking at is bad science in a good cause. Bad science in a good cause is still bad science." - John B. Davies, January 29, 2014

After two and half days testifying at the Montreal tobacco trials, social psychologist John Booth Davies will return to Scotland with a deeper understanding of the differences between presenting novel and unconventional scientific theories in a faculty club and having them thrashed out in a court of law.

Given his fondness for Attribution Theory, I wonder how he will describe his first public outing as a tobacco industry witness. This morning, he gave a colourful illustration of attribution: "If you win the case you are more likely to go home and say 'I did well today'. If you lose you will go home and say circumstances conspired against you."   

Plaintiff lawyer Philippe Trudel did what he could to make circumstances conspire against Mr. Davies' giving any credence to the industry's position that "Neither 'addiction' nor 'dependence' deprives anyone of their free will or impairs their ability to stop smoking." (Citation from RBH's statement of defence).

The kid gloves come off

After two days of relative congeniality, the courtroom atmosphere stiffened this morning in the home-stretch of the cross-examination. Mr. Davies was no longer allowed to wander off-topic, and Mr. Trudel no longer disguised his intent to cut the ground out from under the anti-addiction views of this 69-year old social psychologist.

In some of the more captivating hours of exchange at this trial, Mr. Trudel launched a two-pronged credibility attack. The first was aimed at exposing the weaknesses in the philosophical plynth that Mr. Davies had constructed beneath his expert report. The second was an attempt to debunk the vision of Mr. Davies' as an iconoclastic authority in the addictions field, and to replace it with a picture of a man who is eccentric, a contrarian, and very likely a bit of a nutter.

Paper tigers and philosophers of science

John Stuart Mill. Ludwig Wittgenstein. Karl Popper. A.J. Ayer. Thomas Khun.  There were a lot of big names thrown about as Mr. Davies answered some warm-up questions about his views on tobacco control by appealing to a broader philosophy. "The right of people to do to themselves things they wish to do."  "A good scientific theory will not involve concepts that I can't see." "Science never proves anything, it only moves forward." "You never find truth, you only find better theories." "Old guys like me die and new people come along with different ideas."

And on this broad philosophical terrain, Mr. Davies continued to portray himself as a champion of the individual drug user against a "reductionist pharmacological model" of addiction.

Yet, when asked, he could not identify who, exactly, was on the other side of this dialectic. Who said that smokers smoked only for nicotine? Who said that it was not possible for smokers to quit? Other than Dr. Negrete, he could not name names.

Facing sustained questions for the first time, Mr. Davies began to back down. He acknowledged that the pharmacology of a drug was indeed a hurdle to quitting. He agreed that with a few wording changes ("difficulty in quitting" instead of "erosion of will") his own view was not so far from that of Dr. Negrete. He attributed the "reconceptualization" to Dr. Negrete.)

Concern for the young

Mr. Trudel stripped the philosophy away and put Mr. Davies' common-sense views on addiction on record by asking him how he would counsel a "strong-willed" teenager who wondered about using crystal meth. The iconoclast sounded like a worried uncle: "I would be telling the young lady 'don’t do it! It is dangerous. You may well develop a habit, you would be much better to leave it well alone'."

Nonetheless, he would not use the word addiction. "I would say there is a good chance that with this drug you might get into trouble. You might want to use it more and more and you might get into a state where it is doing no good at all. I would never tell her that she would get into a position where she could not stop."

Mr. Trudel showed him the results of focus groups that had been commissioned by Imperial Tobacco in which the researchers concluded that the prospect of losing autonomy was one of the more powerful messages that could be used to discourage young people from smoking. (Projet Jeunesse - Exhibit 301). Mr. Davies was doubtful, saying this was "counter to the research I have done myself." 

Twenty years of non-disclosure

During the voir dire on Monday, Mr. Davies had been asked about his refusal to agree with the 1997 Farmington Consensus (Exhibit 1686) that would require authors to disclose their sources of funding. He said that he had refused to do so out of concerns that such requirements were "unfair"  and  "a precursor to censorship."

Philippe Trudel today revealed another possible motive: Mr. Davies himself would have been caught up in the obligation to report the work he had done for tobacco industry lawyers starting in 1994. (He was recruited by the notorious Shook, Hardy and Bacon, but said today he had never done background research on the firm.)

This was a financial relationship he did not reveal -- even when he wrote about tobacco litigation as a disservice to smokers in a book he published the same year as the consensus. ("Drugspeak: the Analysis of Drug Discourse, Exhibit 21060.63A)

It seems likely that quite soon another example may take centre stage, in the form of litigation against tobacco companies. Smokers experiencing health problems will seek compensation in the courts, on the basis that due to the "addictive" properties of nicotine, they were unable to stop smoking. This David and Goliath scenario can only be seen as the little man or woman fighting the might of the international tobacco giants. But if the little man/woman wins, it will give credence to a view of smoking as an addiction which will actually make it less likely that others will be able to stop.

He expressed no misgivings about his decision to side with the companies. A victory for the plaintiffs would "send a disastrous message to the world. It will rubber-stamp the idea that you cannot control your smoking habits and you can get paid for continuing to smoke. ... This is where the battle has to be fought and this is why I am here."

"An outlier and not very credible from an historical point of view"?

Mr. Trudel closed his cross-examination by suggesting to Justice Riordan that Mr. Davies' views were so far from mainstream that they were not a safe hook to hang a ruling on.

He pointed to Mr. Davies admitted tendency to conclude that "when everyone agrees about something it must be wrong."  Why, even the "too comfy" theory of evolution was one Mr. Davies wanted to see challenged. (Preface to Drugspeak: Exhibit 21060.63)

He pointed to the conclusion of another expert witness for the defence - historian Robert John Perrins who had said that after the 1989 consensus on the use of the word addiction, "anybody who would say the contrary would be an outlier and not very credible, from an historical point of view."

Last of all, he pointed to Mr. Davies' rambling tirade against a government measures to control tobacco.  "I start seeing gas chambers!" Mr. Davies had told the camera. (Exhibit 1692)

(I stumbled across the same video last weekend when I was looking at material in advance of Mr. Davies' appearance. I decided against making reference to it in the blog, as I thought it unlikely that Imperial Tobacco would have chosen a witness as out of touch with normal public health discourse as the clip made Mr. Davies appear.

Mr. Trudel must have conducted a similar web-search. By the time he showed the video at the end of this morning, I had come around to the opinion that the video was fair to Mr. Davies.)

What more could be said?  Mr. Trudel thanked Mr. Davies, and sat down.

Tellingly, Imperial Tobacco's lawyer, Sonia Bjorkquist, decided against putting any further questions to her witness. Justice Riordan had none either.

Back to other matters

The afternoon session was spent discussing - inconclusively - a few important trial issues. These will be reported later.

Tomorrow, JTI-Macdonald's Mr. Lance Newman is expected to complete his testimony in the morning. In the afternoon some procedural matters. 

Day 205: Like a farmer: out standing in his own field

The second day of testimony at the Montreal tobacco trials by the emeritus professor of psychology, Mr. John Booth Davies, continued to be marked by an unusually high level of courtesy among those in front of the bar.

Something about this witness seems to elicit the kid-glove treatment. Even under cross-examination by the plaintiffs, Mr. Davies was exposed to nothing but simple questions, gently put.

One reason may have been that this is a witness who does not align himself with either the tobacco companies who hired him for his views on addiction, nor with the plaintiffs who are suing on behalf of the everyday smokers for whom Mr. Davies expresses concern.

Another reason might have been his tendency to ornament his answers with off-the-cuff comments. This creates a challenge for lawyers who seek specific answers to specific questions - and no more!

Mr. Davies wandering off script created colourful moments. "I am not here to defend the tobacco industry," said Mr. Davies in reply to a question from Imperial Tobacco's lawyer. This may have surprised her, given his role as a paid witness for her client. "I am quite sure that we would be better off if it [the indusry] did not exist."

Also unhelpful to his clients might have been his assessment that "in terms of public health, the [drug use] which is the most damaging in terms of associations with disease is smoking."

A careful dance

No wonder, then, that Imperial Tobacco Counsel, Sonia Bjorkquist, exercised the same deferential caution she had shown yesterday. Many of the dozen or so questions she put to her witness required little more than a "no" answer.

Does the number of cigarettes someone smokes relate to the likelihood they will attempt to quit? Is there any evidence that the Hooked on Nicotine Checklist will measure the outcome of a quit attempt? Does the number of years a person has smoked affect their likelihood of successfully quitting?

In several forms, Mr. Davies he repeated his view that the pharmacological properties of nicotine gave pleasure to smokers, but did not affect their ability to quit smoking. Smoking behaviour, like other forms of drug use, was driven by "drugs, set and setting". Difficulties in quitting smoking were "not due to pharmacology or Fagerstrom scores - they were due to individual differences in the value that people attach to the smoking of cigarettes and the extent to which other attractors are available to them."

Others might see the fact that smokers relapse after quitting as an indicator of how difficult it was to quit - but not Mr. Davies. He said the fact that about 50% of smokers could eventually quit meant that it was not very difficult to do -- certainly not as difficult as learning to play the violin well.

Nor did smoking leave any lingering pharmacological effects."The brains of people who have been heavy smokers and who have quit after returned to normal after about 12 weeks."  Smokers should be seen as "thinking human beings"  whose behaviour could not be explained by "physiological pharmacological data."

The loneliness of the long-distance anti-addiction theorist

Pierre Boivin

Mr. Davies' dense testimony included many believable observations (such as the influence of social context on drug use, or the benefit of moments in life, like marriage, that help drug users redefine themselves in drug-free ways). But even when his ideas on addiction were not made opaque by academese, they sounded out of touch with the lived experience of those in the court-room.

At the beginning of the plaintiffs cross-examination, Mr. Pierre Boivin looked like he was trying to underscore Mr. Davies' isolation from mainstream opinion by passing under his nose a number the conclusions of many eminent health and legal authorities who have come to an opposite position, and who define smoking as an addiction.

Mr. Davies' did not seem to understand why he was being asked - repeatedly - to state a view that he had already explained at length. It looked like no one had told him what to anticipate during the second half of his testimony here.

There is no-one less intimidating on the plaintiff's team, and Mr. Boivin's laid-back style only contrasted Mr. Davies' increasingly defensive and emotional tone. In that polite British way, he began to sound more than a little impatient: "I am going to sound like a broken record." ... "We are going over the same ground."  The situation was not helped by the absence of a common language between the questioning lawyer and the expert witness - they both speak a heavily accented version of English unfamiliar to the other.

Among the conclusions about the addictiveness of smoking shown to Mr. Davies were reports by the U.S. Surgeon General (Exhibit 601-2010), by the U.K. Royal College of Physicians in 2000 (Exhibit 1587) and in 2007 (Exhibit 1588), by the Royal College of Pyschiatrists (Exhibit 1688), by the Royal Society of Canada (Exhibit 212) - and by even the Supreme Court of Canada.

BAT Nicotine Explained

Exhibit 1689

He scoffed a little when shown that even the tobacco companies now acknowledge that smoking is addictive. (Rothmans, Benson and Hedges' web-site claims that "All tobacco products are addictive" (Exhibit 834) and British American Tobacco's recent booklet Nicotine Explained (Exhibit 1689) acknowledges that "nicotine at all concentrations has potential to cause addiction." )

"I am not used to being asked to comment on PR material from commercial organizations. I am somewhat at a disadvantage."

Mr. Boivin showed Mr. Davies that his views on the factors associated with successful quitting were not supported by research conducted by other social psychologists (Exhibits 1690, 1691), who found that "volitional control" was not enough. 

Against this weight of evidence, Mr. Davies' look increasingly isolated by his views. I recalled the plea of the defence's first expert witness, Jacques Lacoursière:  "I am alone in my thoughts."

Unhooking the red herring

Mr. Philippe Trudel changed tack when he began his cross-examination questions towards the end of the day. 

He led Mr. Davies to reveal how truly extreme his views on addiction were, and that he was not willing to use the term in association with any form of drug use. "Is there such a thing as addiction to drugs?..." "We are going around in circles - without knowing what you mean by addiction, I can't answer your question."

In what felt like the climax of the day, Mr. Trudel challenged the witness to say who, exactly, held the view that nicotine addiction meant it was impossible to quit smoking. And which part of the report by the plaintiffs expert witness, Dr. Negrete, made this claim?

Mr. Davies referred only to Mr. Negrete's use of the terms "enslaved," the “compulsion to smoke" and "the incapacity to abstain" as illustrations this view. Other than that, he was unable to identify any other proponent of the idea he had spent two days attacking. "I cannot offhand demonstrate that this is the case."

Was that the sound of the strawman leaving the room?  

Mr. Davies' testimony did not finish today, as it had been expected to do and will continue tomorrow morning. The parties will later debate motions to allow the plaintiffs to introduce some additional evidence. 

Day 204: The Myth of Addiction

This morning, Eastern Canadian highways demonstrated that a small amount of very cold snow, if mixed with a large amount of wind, can remove meaning from an inter-city bus schedule.

And so it was that I arrived late to the Montreal tobacco trials today -- too late to witness first-hand how a small amount of indignation, if mixed with a lot of hot air, can liven up a Monday morning.

I am told that Mr. Simon Potter, who represents Philip Morris' Canadian operation, expressed his displeasure with the report published in Saturday's Montreal Gazette that the Non-Smokers' Rights Association was asking the Quebec college of physicians to review the appropriateness of Dr. Bourget's testimony at this trial.

Mr. Potter apparently felt that this was a form of "witness intimidation." 

Dr. Bourget has already testified, so I don't quite see how she could have been intimidated after the fact. Mr. Potter, on the other hand, has not. (In defiance of regular legal practice, he is slated to be both witness at this trial even though he is defence counsel in it.) Perhaps he felt that having the world learn that he was "inordinately fond” of roast beef, as the Gazette reported, was a way of intimidating him from making further such disclosures.

Nor is there any sign that 'witness intimidation' was the reason that two other Canadian medical professionals have been pulled from the defence list of  "addiction" witnesses. Mr. Potter recently informed the court that plans had changed and that Montreal psychologist Kieran O'Connor will no longer be testifying later this week. Dr. Alex (Dooley) Goumeniouk, a psychiatrist based in British Columbia, had been dropped from the list several weeks ago.

Pulled from the defence schedule:
Psychologist Kieran O'Connor
& Psychiatrist Alex Goumeniouk

The expert opinions they wrote for the trial remain public documents, as far as I know, although they are currently hard to access. Those who are interested in receiving a copy of their reports can contact me.  

Let's try again!

Today's witness, Mr. John Booth Davies, is thus the tobacco industry's second and the last chance at expert opinion to support their position that almost 1 million Quebec smokers do not suffer from addiction. 

Although his position is not that different than that expressed by Dr. Bourget last week (his conclusions are pasted to the end of this blog), in every other respect Mr. Booth left a very different impression than she did. 

Professor Emeritus
John Booth Davies

To begin with, Mr. Davies is very personable - like one of the eccentric-but-loveable characters in a British comedy like Marigold Hotel or Quartet. Although he is not much older than many other witnesses (he is not yet 70), his manners suggested he came from earlier distant times. (The accent didn't hurt!)

The choice of lawyer assigned to him accentuated this quality of old-worldliness. Ms. Sonia Bjorkquist has a charming and youthful affect. She put her questions to her witness with the same soft kindness that I have watched in social workers interviewing the frail elderly and journalists interviewing aging veterans. 

Justice Riodan echoed this deferential and sympathetic tone, addressing the witness as "sir" and making sure that his physical needs - like a handkerchief - were seen to. By their relaxed body language and gently-phrased questions, the plaintiffs also signaled their acceptance of this witness. I am sure that I was not the only one who thought Mr. Davies would make a fine dinner companion! 

During the voir dire, Ms. Bjorkquist and then Mssrs. Pierre Boivin and Philippe Trudel gave Mr. Davies the opportunity to outline his career as a psychology professor and addiction specialist at Glascow's Strathclyde University, including his many published books and articles. (His CV is Exhibit 21060.1). His most central view on the topic is laid out in his book the "Myth of Addiction", whose message is described by the bookseller Amazon as "addicted behaviour is therefore a form of learned helplessness, not an effect caused by narcotic intake."

Not exactly a friend of industry

Mr. Davies told the court that he was recruited to this trial because the "Myth of Addiction" had brought him to the attention of Mr. Dennis Neutze, a lawyer assigned to witness development for Imperial Tobacco's parent company, BAT. It was only after he finalized the paper commissioned by Mr. Neutze that Mr. Davies was put in contact with Imperial Tobacco's defence lawyers at Osler's. Left hanging was the question of how many other papers from other witnesses-in-development might have been commissioned before this one was selected.

The retired professor said he "had to think about it a long time," before agreeing to testify. His reasons for doing so suggest that he was motivated by end-of-career feelings of tasks not completed. "This case promises to be extremely influential," he said, and a way to "send a message to the world" which challenged the "deterministic pharmacological model on drug use."

Mr. Davies seemed startled by suggestions that his clients might have had any influence on what he wrote. "If there had been, I wouldn't be here."  "I would not wish to be any closer to the tobacco industry than I am at the moment."

Mr. Trudel  pointed out that this is not the first time he has been embroiled in questions about industry influence. As editor of a journal on addiction, Mr. Davies had declined to agree to the Farmington consensus (Exhibit 1686) developed by other addiction journal editors that they would require their authors to disclose their sources of financing. Mr. Davies repeated today the views he had earlier expressed (Exhibit 1687) that such requirements blurred the line between science and morality.

He hinted at strong reservations about the influence of the pharmaceutical industry on tobacco research. He pointed to the long line of pharmaceutical consultancies declared by Karl Fagerstrom and John Hughes (Exhibit 1682), but seemed reluctant to put on record his views on what impact this might have had on their conclusions. "You can read it for yourselves."

He did express concern about the promotion of varenicline (Champix) as a stop smoking medication, given its link with "suicide ideation and suicide attempts.”  I wondered if anyone had told him that the same lawyers who launched this class action are also fighting a class action against the makers of Champix for those same reasons. 

A defender of science

Mr. Davies made frequent suggestions that science was poorly served by other researchers in the field of addiction. 

An article by the head of the U.S. National Institutes of Drug Abuse ("Drug addiction: the neurobiology of disrupted self-control", Exhibit 21061) was denounced as a "sleight of hand." There was emotion in his voice as he claimed this paper "sacrifices science in the interests of making an argument that is ideological and not scientific."

He later pleaded that the rudiments of experimental science were being lost in modern times. "Science is not defined by long words we cannot spell. The principles of science can be written on the back of an envelope. I believe that sections of the population define science precisely in terms of those things -- here is a big machine and a man has a white coat on so it must be true!. That is a fundamental error."

He cautioned that others who researched addiction did not adequately understand the need for a measurable "outcome variable."  He included the opinion prepared for the plaintiffs by Dr.Juan Negrete, Exhibit 1470.1 and 1470.2, in this category. 

"You can't cross-reference addiction against dependence because they are both concepts – I can't see either of them." He also disagreed with Dr. Negrete's description of the impact on smokers. "Words are too emotional. It's not about feelings and emotions - science is about facts."

Attribution theory and the addicted state

At the core of Mr. Davies' views is a focus on "the explanations people give for their actions."  (Expert Report, Exhibit 21060)

He explains that Attribution Theory allows drug use to be examined in the context of the "discourse" that smokers offer as they explain why they use substances. To speak of addiction relieves individuals of the ability to quit, he argues, and to say someone "can't quit" is to be unscientific. "We cannot, however, observe that a person cannot stop; only that they failed to do so."

Mr. Davies suggested that there was no qualitative distinction between addicted and non-addicted substance use. "If we like a drink on occasion, we have something in common with those at the other end of the (alcoholic) spectrum."

It was not addiction or compulsion that drove smoking behaviour, he said, but the time-lag between the pleasure of smoking and its "negative reinforcers". "The satisfaction of smoking a cigarette now outweigh the possible valence of lung cancer late in life." 

He acknowledged the neurological properties of nicotine, and described the chemical bonding of nicotine to receptors in the brain. But such "brain changes" were not a form of disease. Going down the street would result in brain changes, he said, "but this does not mean that I can't stop going."

He qualified that such changes were very localized, and not a form of intoxication. "it is not as if the whole brain is subverted ... attitudes, beliefs, motives stay much the way they were before."

He looked to memory, not brain activity, as a reason that people returned to the behaviour. "Like a cat that has tasted fish, a human who has tasted cocaine may be reluctant to give up." 

He said that the suggestion that smoking resulted in loss of autonomy was "helpful if you are trying to sue the tobacco industry." It was not very beneficial to those who might as a result lose belief that they could stop smoking, and harmful to "youngsters in deprived parts of cities,"  who might otherwise "change their self damaging behaviour."

A philosophical hold-out

Although the word "existentialist" was never used, I felt that underpinning Mr. Davies' opinion was the heady humanism that defined the social sciences in the 1960s. 

Like other products of that era, he spoke with compassion and concern about those who were economically or socially deprived. He identified the gap between upper-class academics (although his accent suggests he could be considered one) and disadvantaged drug users. No other witness has brought class into this trial so acutely. 

He rooted his distinction between voluntary and involuntary actions in philosophy. "The philosophical difference between something that is impossible and something that is difficult to do is fundamental. ... difficulty is in a different phenomenological realm than impossibility."

Mr. Bjorkquist is expected to finish her questions for Mr. Davies tomorrow morning. The cross-examination will follow. On Wednesday, a few procedural issues will be discussed. 

John Booth Davies' conclusions

• Smoking can be a difficult behaviour to quit, but not an impossible one.

• Smoking is action. That is, it is goal directed and purposive; it does not simply 'happen to' people.

• The idea of smoking behaviour as deriving from a pharmacologically-driven compulsion over which there is no control does not fit the facts.

• Smokers have quit the smoking habit in very large numbers and continue to do so.

• By far the largest majority of smokers who quit smoking do so without help (e.g. psycho-therapy, counselling, nicotine replacement therapy, etc.) of any kind.

• Not all smokers experience withdrawal symptoms, and such symptoms do not predict either relapse or successful quitting.

• The pharmacology of nicotine explains brain processes, but does not explain the reasons why people smoke, nor does it predict future behaviour (i.e. continuing to smoke or quitting) with regard to smoking