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Cookies, Cocaine, and Culture

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For those who follow health news, there was no way to avoid tripping over the combination of Oreos and cocaine this week. The relevant headlines, of which there are many, suggest in essence that Oreos are as dangerous and addictive as cocaine.

Are they? The answers are: of course not; and yes, but more so. We'll come back to that.

For starters, let's consider the study in question and how odd it is that it has made literally thousands of headlines, some of which state emphatically that Oreos are more addictive than cocaine. One might account for just such headlines if a randomized, double-blind, placebo-controlled study in actual human beings, published in the New England Journal of Medicine, had administered Oreos vs. cocaine to parallel groups, and tested the relevant array of responses relevant to addiction: brain chemistry, cravings, tolerance, and withdrawal.

Nothing remotely like that happened here. The study was conducted in rats, not people. Thus far, it has not been published, nor even presented at a conference -- although that is reportedly pending. The onslaught of headlines making hyperbolic assertions is the product of a press release issued by Connecticut College, where the research was done.

I am not faulting the research or the press release; the investigators, and the college, are at liberty to share news they find exciting with the world. But the world's reaction is nothing less than bizarre. Why are we so desperate for hyperbole that news, either good or bad, is distorted beyond all interpretability?

The study in question showed two basic things, as far as I can tell from the limited information available thus far. First, rats in a maze are about as inclined to go to Oreos as to cocaine or morphine. And second, the Oreos trigger the same kinds of chemical responses in the rat brain as the drugs.

As for the first finding, rats might like Oreos as much as cocaine either because Oreos are intensely pleasurable to rats, or because cocaine isn't. A headline that would make just as much sense as those we actually got is this: "Cocaine no more harmful than cookies."

In humans, the most compelling effects of drugs like cocaine are the psychological effects, not any direct physical response we are likely to share with rodents. A small, as yet unpublished study in rats can tell us almost nothing truly relevant about the effects of psychoactive substances in humans for the very reason that they are psychoactive. While we may acknowledge the similarities of basic brain structure between mice and men, the mind of a person and the mind of a rat are clearly not comparable.

As for the second finding, the common chemical responses evoked by cocaine and cookies in the rat brain, this is to be expected. This is like noting that a sheet of paper can cut our skin, and a Samurai sword can cut our skin, so therefore paper is just like a sword. There are only so many ways skin can respond to a sharp edge -- and if you cut it, it bleeds. The magnitude of the cut, however, matters enormously. Similarly, there are only so many ways the pleasure centers in the brain can respond to any stimulus. The magnitude of that response, however, varies, and that matters. And what matters even more is what happens over time.

While even one-time use of cocaine could be dangerous, most people harmed by such drugs are harmed over time. The addictive properties of drugs result in increasing use over time, cravings, tolerance, and a potentially devastating withdrawal syndrome. To my knowledge, the new study examined none of these. There is no evidence that rats need and eat more and more Oreos over time, or that they suffer withdrawal. Such information would be essential before any valid claim could be made about the comparability of cookies and cocaine. If rats, or people, gravitate to a caress, and if that caress evokes a pleasure response in the brain, are we inclined to assert that caresses are more addictive than cocaine?

Neither of the study findings, therefore, says much about Oreos and people, and neither indicates even remotely that Oreos are "more addictive" than cocaine -- and in fact, common experience indicates quite clearly that they are not.

But let's be clear: I am not here to exonerate the Oreo. The Oreo is, and has long been, something of a standard-bearer for a highly-processed diet of pseudo-food and junk. It does limited harm by itself to be sure, but it does do harm together with the company it keeps -- and it certainly isn't doing health any good.

And, yes, in all the ways that matter, Oreos are addictive. Why do we need to hear this again? We have already heard from Michael Moss, and others before him, that processed foods are willfully designed to be irresistible and to maximize the calories it takes before we feel full and stop eating them. We should not be surprised that food can be addictive; food and sex are the reasons the capacity for addiction exists in the first place. Addiction is an unintended consequence of a system laid down to reward and encourage behaviors that foster survival. In a modern world of junk food and mind-altering drugs, a system that uses pleasure to promote survival is all too readily co-opted and corrupted.

Oreo cookies are not cocaine. They are not as acutely dangerous, and not addictive in all the same ways. And, frankly, an occasional Oreo in the context of an otherwise healthful diet is apt to be a bit of fairly harmless fun.

But the need for Oreos to be indicted of war crimes before we acknowledge we are eating too many of them, and foods like them, says something profoundly disturbing about our culture. How bad is bad enough?

Illicit drug use is a big problem, but only affecting a relatively small portion of the total population. In contrast, junk food constitutes some 50 percent of the calories in the typical American diet, affecting virtually everyone. We are looking on complacently as we construct the growing bodies of the children and grandchildren we profess to love out of junk. As a result of this travesty, nationally representative data suggest that in the aggregate, children growing up in America today will suffer more harm over the course of their lives from the adverse effects of poor diet and lack of physical activity than from alcohol, tobacco, and illicit drugs, combined.

Given what we already know about the harms of a junk food diet, what makes the response of a few rats to Oreos so titillating? Why do we even care about the comparison between cookies and cocaine? What is the basis for a deluge of hyperbolic headlines in response to a press release? To me, this all seems symptomatic of a culture with an addiction problem far bigger than cocaine or cookies. We are addicted to scandal and scintillation, and utterly disinterested in solutions. Rome burns, and we fiddle.

What, exactly, are we waiting for before we decide there is enough information to tell our children: Step away from the box of glow-in-the-dark pseudo-foods, and nobody will get hurt?

-fin

Dr. Katz' new book, Disease-Proof, which may be addictive based on a comprehensive survey of three chipmunks, is available at bookstores nationwide and at:

Dr. David L. Katz; http://www.davidkatzmd.com/

www.turnthetidefoundation.org

http://www.facebook.com/pages/Dr-David-L-Katz/114690721876253

http://twitter.com/DrDavidKatz

http://www.linkedin.com/pub/david-l-katz-md-mph/7/866/479/

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