Source: Los Angeles Times
Author: BARBARA MARSH, Times Staff Writer

Contact: letters@latimes.com
Fax: 2132374712

A VOICE from the TRENCHES
Addiction Expert Max Schneider Has Been a Key Figure in the Battle
Over Tobacco Regulation

Years from now, when they write the definitive history of the war on
tobaccowhich is shaping up as the biggest, costliest battle ever
between government and businesslook for Max Schneider's name in the
index. He won't be listed under "state attorneys general," "tobacco
industry executives" or "whistleblowers." Schneider is simply an
Orange County physician, one who has spent decades in the trenches
treating chronic smokers, alcoholics and other casualties of
substance abuse. Five years ago, the Food and Drug Administration
called Schneider, a national expert on addiction medicine, to serve
on its powerful advisory committee on drug abuse. It was that panel
of outside experts whose 1994 findings on the dangers of nicotine
underlie the agency's current campaign to regulate tobacco products.
His testimony during one key committee meeting in August of that year
helped set the tone for the panel's finding that nicotine is
addictive. Schneider concluded that science had yet to prove whether
nicotine is nonaddictive at any daily dosage. "It is the best thing
I've ever done in my life. One good public health decision can save
more lives than a hundred doctors seeing 50 patients a day for their
entire career," says Schneider, who recently stepped down as
committee chairman but remains an advisor. Tobacco industry
executives today won't comment on the results of the committee's
findings that day, or on the individuals involved, including
Schneider. They are loath to say anything that might disrupt
effortsboth in the courtroom and in settlement talks with the
governmentto thwart the agency from regulating tobacco, industry
sources say. However, tobacco company scientists were outspoken at
the committee meeting. John H. Robinson, an R.J. Reynolds Tobacco Co.
scientist, reportedly stated that nicotine isn't addictive "by any
meaningful definition of the word," and that to conclude otherwise
"actually endangers" the credibility of scientists. Schneider says
tobacco industry scientists impugned their own credibility that day.
"Is nicotine addictive?" he asks. "It's as obvious as the nose on my
face." As with everything in his life, Schneider seized his FDA
duties with passion, savvy and an outrageous wit that can both disarm
the dignified and offend the occasional medical student. The
75yearold Schneider, who is homosexual, is an advocate for gay
physicians at UC Irvine Medical School, where he teaches. Retired
from medical practice, he sees only a few patients now, but
frequently serves as an expert witness in legal cases. His main
source of income these days comes from the sale of films he's made on
the treatment of addiction. Nationally, Schneider is known among
treatment professionals as a medical pioneer in the field of
substance abuse. When he speaks, people listen. "Max is an important
figure in the effort to get to the heart and soul of the truth" about
addiction, says Curtis Wright, an FDA official. At the FDA and
elsewhere, Schneider has distinguished himself by reminding drug
policymakers of the people who countthe patients. Of the hundreds
of chronic smokers he's treated, he recalls none more clearly than a
man with obstructive pulmonary disease he treated years ago. While on
rounds one Thanksgiving Day, during his medical training at Buffalo
General Hospital in New York, Schneider stopped at the man's bedside,
examined him through the oxygen tent, then moved on to other
patients. When the doctor reached the end of the ward, he heard an
explosion. "He had lit up a cigarette inside an oxygen tent. And it
killed him," Schneider says. The man had been warned repeatedly about
the dangers, but, says the doctor, "the compulsion to smoke is
tremendous."

* * *
Three years ago, Schneider got the chance to put his experience
to work on federal policymaking on nicotine.
A 1964 surgeon general's report warned about the health
hazards of tobacco use. A 1988 report concluded that nicotine is
addictive.
And in February 1994, David A. Kessler, then FDA
commissioner, asserted the agency's authority to classify nicotine as
a drugnow the issue in the industry's litigation against the agency.
Kessler turned to the agency's advisory committee on substance
abuse for expert opinion on the status of research on nicotine and its
effects.
The committee is one of many such panels on which the agency
increasingly relies for expert opinion on highprofile issues involving
sales and regulation of drugs and medical devices.
The expertsoften physicians and scientistsaren't paid, and the
agency takes pains to make sure members don't represent special
interests.
To prepare for that August 1994 meeting, Schneider pored
through a banker's box stuffed with tobacco industry reports that
sought to discredit the research on smoking hazards.
"The more I read, the angrier I got," he says.
The committee met first to consider a nicotine spray being
proposed for sale as a stopsmoking aid. Research included reports
of people trying the product who'd ended up using it for months,
taking higher doses than reported to doctors and making off with
others' suppliesbehavior suggesting that the product itself was
addictive.
* * *
Schneider directly challenged the manufacturer's representatives,
asked what steps would be taken to make sure the product would
not end up in the hands of small children and wouldn't be capable of
being altered to deliver cocaine or other addictive drugs. The
product is now available only by prescription.
He also was the first panel member to assert that while some
minimal daily dose of nicotine is probably nonaddictive for some
people, researchers haven't discovered what that minimum is.
In an analogy between nicotine and the unpredictable effects of
alcohol, he noted that for the nonalcoholic person, two drinks a day
for a man and one for a woman "may even be beneficial. But to
select who is susceptible to the tragedies of developing alcoholism
out of that daily [use] is a very difficult thing."
The committee underscored scientific findings that remain at the
crux of the FDA's campaign to regulate tobacco products.
Earlier this year, a federal court in Greensboro, N.C., upheld the
agency's jurisdiction over tobacco products. The U.S. 4th Circuit
Court of Appeals, which is hearing appeals from both sides, has yet
to rule.
Likewise, the agency's attempt to regulate tobacco is a critical
issue in the industry's proposed $368.5billion settlement of
litigation brought against it by numerous states and in private class
actions.
The settlement, subject to congressional approval, permits the
agency to regulate tobacco products. However, it places tough
restrictions on its ability to exercise that authority, requiring, for
instance, that it prove that if nicotine is reduced in tobacco
products, blackmarket demand will not increase.
In hindsight, Schneider says, his panel "lit the fuse for further
action."

* * *
Schneider, who grew up in Buffalo, N.Y., stumbled into
addiction medicine accidentally.
As a Harvard Medical School fellow in gastroenterology, he
discovered that most of his patients were hospitalized for
complications of alcohol abuse. What's more, some of their doctors
had drinking problems too.
"My boss and another senior medical officer would drink
copious quantities of alcohol to the point where both of them were
in their cups," he says. "They kept pouring drinks for me and I kept
tossing them under the couch I was sitting on."
Shortly thereafter, Schneider briefly took over a practice for a
physician who was an expert in treating alcoholism. "His practice
was made up of a crosssection of people, including many members
of the higher society of Buffalo, and they were all recovering
alcoholics."
"I saw the joy and the happiness of these people and the
wonderful senses of humor that recovered people develop," says
Schneider, who says he got "hooked" on recovery.
Meanwhile, Schneider also had to find a place for himself as a
physician who was homosexual. After some halfhearted dates with
women, he had decided to accept his sexuality.
"I decided that the single most important thing for being a
physician is integrity. Integrity has to start with me. I have to be
honest to myself," he recalls.
While in medical school in the late 1940s, and figuring he was
the only gay medical student and the only gay Jew in the world, he
went to his first gay bar"absolutely petrified," he says.
"I went into the bar and the first person I run into is the brother
of one of my classmates, who happened to be Jewish," Schneider
says.
"I froze and panicked. He froze and panicked, and then we
stood there looking at each other and burst out laughing."
Such stories have provided inspiration to other gay physicians.
One Laguna Beach physician, Dr. G. Steven Kooshian, recalls
hearing Schneider talk with a group of gay physicians years ago. At
the time, Kooshian was feeling anxious about his homosexuality and
starting a career in medicine.
Schneider urged the gathering to see experiences with
homophobia, or prejudice of any kind, as a source of insight and
tolerancequalities that would give them unusual sensitivity in their
daytoday interactions with patients. Kooshian says he left the
meeting "unafraid of walking out into a community in which I wasn't
sure I'd be accepted, and with my head held high."

* * *
In Southern California, as elsewhere, Schneider is known for his
oddball wit.
He promised coworkers at St. Joseph Hospital, where he's on
staff, that while on a Boston trip he would eat lobster until it came
out of his ears. Upon his return, he festooned a hanger with lobster
claws, positioned it over his ears and went to work.
Earlier this year, Schneider called to order an FDA panel
meeting by employing a trick he perfected as a child. He cupped his
hands and let out a wail that sounded like the blast of a passing
firetruck.
Kim Topper, an agency official, remarked shortly afterward, "I
believe that the reason this committee gets so much done is that he
allows and encourages them to put humor in with the serious work
that we do."
But Schneider's letitallhangout style can get the better of him.
His sense of humor strays into bawdinessand at times he's
downright tacky. He admits being humbled by recent complaints
from several Long Beach Memorial medical residents he's trained
that he made offhand remarks about his own sexuality and private
life in daily conversation.
Psychologist Maureen Rhyne, a director of Long Beach's
residency program, called to tell him she'd heard the complaints
from a female resident and two males.
"Some people might be offended by Max; others just say he's
eccentric," she says.
He thanked her for calling and apologized.
"Max is in a longterm committed monogamous relationship, and
he was surprised that his tasteless banter could be so offensive to
anyone else," she says.
Adds Schneider, "I'm still learning."
* * *
Sixteen years ago, Schneider retired from medical practice,
overwhelmed by exhaustion, a symptom of myasthenia gravis, a
slowly progressing autoimmune disorder that impairs nerve impulses
to muscles and causes weakness of the hands and legs, drooping
eyelids and problems in swallowing.
Deadpans Schneider: "It's the disease [Aristotle] Onassis had,
but I didn't get Jackie or the billions."
Schneider, proud of his past service to the FDA and on call for
more, sees big flaws in a government deal with tobacco interests
that would hamper the agency's plan for regulation.
He advocates high taxes on tobacco products, both to make
them harder for youth to afford and to fund antismoking ads and
treatment for medical complications stemming from tobacco use.
He believes all industry ads should be banned from the airwaves.

And he thinks the government should cut price supports to
tobacco farmers and stop any support of the industry's exports.
"We complain about other countries sending in heroin, and our
country is literally enabling the tobacco industry to enhance their
sales throughout the world," he says.
Does Schneider himself smoke?
"I used to smoke and inhale 12 cigars a day," he admits, noting
that he picked up the habit while serving as an Army Air Corps
radio operator during World War II. He smoked heavily for more
than 10 years. "Then I suddenly realized as I looked at autopsies
how stupid this was."

Profile: Dr. Max A. Schneider
CURRENT POSITIONS
* Clinical professor of psychiatry and human behavior,
California College of Medicine, UC Irvine
* Director of education, Positive Action Center, Chapman
General Hospital, Orange
* Consultant, Food and Drug Administration drug and alcohol
advisory committee
EDUCATION
* Fellowship, gastroenterology, Harvard Medical School, 1953
* Residency, internal medicine, Buffalo General Hospital, 1952
* Medical degree, School of Medicine, University of Buffalo,
N.Y., 1949
BACKGROUND
* Medical director, chemical dependency services, St. Joseph
Hospital, Orange, 198997
* At UC Irvine: clinical instructor in medicine, 196788; clinical
instructor in psychiatry and human behavior, 198389; clinical
associate professor, 198997
* Medical director, General Electric Co. ();
Goodwill Industries; Keystone Plating Corp.
* Consultant in medicine, North American Rockwell
(Autonetics), 196580
* Clinical instructor, School of Medicine, University of Buffalo,
N.Y., 195364
* Born: June 29, 1922, Buffalo, N.Y.
* Residence: Orange
Source: UC Irvine

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