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January 7, 1998

Learning From Addiction—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(1):20. doi:10.1001/jama.279.1.17

In Reply.—Dr O'Connell takes me to task for "timidly taking issue" with Dr DuPont's book, The Selfish Brain. He also chides me, JAMA, and the American Psychiatric Press for not making more of the absence of references in the book. More seriously, he accuses "American medicine's institutions" of becoming "compromised by the drug war" because of the endorsements in the book and because of DuPont's and one endorser's activities.

For the interested reader who has not read the review, I would argue that I give a fair and balanced description of the book's content but, tactfully and forcefully enough, criticize DuPont's views about prevention, policy, and treatment as a "rigid approach [and] a shortcoming of the book." In my review, I make a plea for more flexible and integrative thinking for proponents of DuPont's perspective vs his narrow reductionistic views. As for my failure to note the absence of references, mea culpa, but I do not see the lack as so dreadful an issue as does O'Connell. I disagree that this book can presume to be a major scientific or academic reference. It mainly recapitulates and popularizes much that is known (or disputed) about the nature of substance use disorders and what we should do about them, especially from the perspective of DuPont's admittedly strong convictions.