Pubdate: August 17, 1997 
Source: Los Angeles Times
Contact:  2132374712

  This from the front page of today's LATimes Business section. 

Author: BARBARA MARSH, Times Staff Writer

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 

Copyright Los Angeles Times