摘要：The legalized consumption of products with addiction potential, such as tobacco and alcohol, contributes in myriad ways to poor physical and mental health and to deterioration in social well- being. These impacts are well documented, as are a range of public health interventions that are demonstrably effective in reducing harm. I have discussed the capacity for the profits from these substances to be deployed in ways that block or divert resources from interventions known to be effective. Addiction industry studies constitute a new and previously neglected area of research focusing specifically on understanding the salient relationships that determine policy and regulation. This understanding will increase the odds of adopting effective interventions. Legalized products, such as tobacco, alcohol, and gambling, with a high potential for dependence (referred to here as “addictive products”) contribute globally in a multitude of ways to the social determinants of health (e.g., poverty, inequalities), to common risks to health (e.g., injury, disease), to mental health concerns (e.g., suicide, addictions), and to crime (e.g., violence, drunk driving). 1–4 Considerable research has focused on improving the understanding of how addictive products generate harm and on developing effective public health and treatment interventions to reduce such harm. This effort has assumed that when the evidence for a particular approach is sufficiently persuasive, government sector agencies, as a matter of course, will be persuaded to invest. However, despite the emergence of solid evidence and the combined energy of concerned citizens, researchers, and community agencies, the outcomes in terms of policy and regulation are by and large disappointing. 5,6 For example, counter to the mounting evidence of the effectiveness of changes in the promotion, pricing, and availability of alcohol products, recent reforms of alcohol legislation in countries such as the United Kingdom, New Zealand, and Canada have been weak from a public health perspective. 7–10 These experiences, plus many similar histories of disappointing policy reform for tobacco and gambling, speak loudly of the power of other influences. A key aspect to the commercialization of high-volume addictive products is the ability to generate profits beyond those that ordinary, nonaddictive products, such as gasoline, pizza, and televisions, generate. For example, a pivotal feature of addictive drinking is consumption that goes well beyond what is acceptable and sensible. Addicted consumers, by the very nature of addictive behavior, will consume to excess. Although there are fewer of them than nonaddicted consumers, they invest more heavily and, accordingly, contribute far more to profits. For example, Australian studies indicate that although the prevalence of problem gamblers is 1% to 2% of most adult populations, problem gamblers contribute 40% to 50% to expenditure (loss) on electronic gambling machines. 11,12 In addition, although a sizeable group of frequent and heavy consumers do not yet display signs of addiction, they can consume in ways that have a negative impact. For example, because nonaddicted heavy drinkers are more numerous than are addicted drinkers, they contribute significantly to harms such as road fatalities, unsafe sex, and impairment in the workplace. 13–15 This further reinforces the link between profits and harm. The profit surplus that addicted consumers generate—the addiction surplus—underpins not only the motive force for expansion but also the resource base for a range of proproduct initiatives that seek to guard against potential threats, particularly those associated with policy and regulation. 16–18 These initiatives bring together a wide range of key players to collaborate in protecting the profit yield. Such networks typically include the product industries themselves (e.g., tobacco corporations, breweries, casinos), industry services (e.g., advertisers, lobbyists, public relations companies, and law firms), government agencies (at local, state, and national levels), and community beneficiaries (through, e.g., grants, sponsorship, gifts). Moreover, ways of gaining favor and influence are not limited to paying for a service, such as advertising, 19,20 or paying political lobbyists. 21,22 Benefits can include appointments (e.g., nominating retired politicians for boards), cross-board memberships (e.g., putting company executives on government advisory committees), exchanges in kind (e.g., contributing to a hospital with the understanding that there will be looser regulations), and currying public favor (e.g., funding local sporting or cultural events). We know little about the specific details of these relationships and the overall processes by which such influence is exerted. Accordingly, something appears to be missing; some other area of inquiry is required in the mix to work out more effective ways of translating strong evidence into policy. This calls for the development of what might be called “addiction industry studies”: an area of inquiry in which the key questions are where are the proproduct influences occurring, on what scale, and how might they be moderated? Attempts at making sense of these proproduct influences call on the combined efforts of investigators from varying disciplinary backgrounds.
