Posted tagged ‘Treatment’

Bad Science Kills People: Bush administration/heroin edition.

January 27, 2008

I don’t know how much attention this post by Mark Kleiman is getting around the blogosphere, but it should be getting more. (h/t Kevin Drum in this post.)

Kleiman picked up on this story from NPR, which reported two facts:

Fact 1: public health officials around the country, including those in Cambridge, MA, the city where I now sit, are distributing rescue kits that save heroin users from overdoses. The kits cost $9.50, and they are credited with reversing 2,600 overdoses in 16 such local programs around the country. For context: NPR reports that “overdoses of heroin and opiates, such as Oxycontin, kill more drug users than AIDS, hepatitis or homicide.”

Most people would think that a cheap, simple tool that allows those on the sharp end of the drug wars to save lives would be an unalloyed good.

But then there’s fact 2: I’m just going to quote here the same comments Kleiman cites:

Dr. Bertha Madras, deputy director of the White House Office on National Drug Control Policy, opposes the use of Narcan in overdose-rescue programs.

“First of all, I don’t agree with giving an opioid antidote to non-medical professionals. That’s No. 1,” she says. “I just don’t think that’s good public health policy.”

Madras says drug users aren’t likely to be competent to deal with an overdose emergency. More importantly, she says, Narcan kits may actually encourage drug abusers to keep using heroin because they know overdosing isn’t as likely.

Madras says the rescue programs might take away the drug user’s motivation to get into detoxification and drug treatment.

“Sometimes having an overdose, being in an emergency room, having that contact with a health care professional is enough to make a person snap into the reality of the situation and snap into having someone give them services,” Madras says.

Read that again.

People in dire straits should not be empowered to help themselves (in a way shown to work). Instead, a dying person should hope to have the luck to make it to the E.R.

It gets worse. The essential claim Madras makes is that improving a user’s chance of surviving an overdose will encourage further drug use, while avoiding death under the care of medical professional will induce the lucky survivors to seek drug treatment.

These are at least nominally empirical claims. They can and should be tested. But as far as we can tell, Madras pulls these statements out of her gut (I’m trying to be polite here). To the extent that there is any real data, NPR’s story also reports that “one small study suggests that overdose-rescue programs reduce heroin use and get some people into treatment.”

That is, the Bush Administration’s point person on drug policy simply ignores the inconvenient knowledge that exists about the effect of this cheap, life saving program.

R

Why?

Why doesn’t the fact that readily available cheap (and cheaper-for-the-state) alternatives to life-destroying events exist affect this view? Because of a commitment to an unexamined assumption: Exemplary suffering helps focus one’s mind, it is claimed (how else can you read Madras’s comments) and so anything that might defuse the power of the demonstration is to be avoided. Science be damned.

This is, of course, precisely why the idea of good science matters. I’m going to post later on the debate at the Science Blogging Conference about why science has such problems articulating itself in the public square (see this post at Terra Sigillata for a run down of the state of play in that conversation.) But this story tells us why the issue is vital. Real science demands that theory be ratified by observation and defensible interpretation of the data. Bad science allows ideology to determine what facts, if any, are admitted into the conversation. Right now, bad science is winning.

I’ll stop here. I’m trying to stay reasoned in the face of my own mounting rage.

Update: A commenter over at Matthew Yglesias’s thread on this topic points out that the same reasoning that Madras uses above to reject distribution of overdose rescue kits applies to the right wing orthodoxy’s opposition to giving HPV vaccines to pre-sexually active girls. (See this or read this analysis for a more comprehensive public health introduction to the question.)

Update 2: See also this post and embedded link at commenter Lovable Liberal’s blog: he’s right — this whole thing is disgraceful, but unsurprising — which is, of course, the point. If repeated blows can overwhelm the public’s capacity for outrage, then the unforgivable becomes routine.

Update 3: Drug Monkey has taken this story and run with it here. Aside from the kind comments about this blog, the key idea I drew out of the post is what happens even to good scientists when they get absorbed into an institutional culture of politicized bad science. Madras is hardly the first scientist to face the worse-or-worser fate that comes whenever you have to weigh personal reputation vs. your job of putting makeup on ever uglier pigs. But she does provide one more object lesson in why an understanding of real science at the very top actually matters.

See also Tara C. Smith’s writing at Aetiology. She sees the Narcan/HPV vaccine connection and raises it by the anti-needle exchange folly. The take home from all of the above: this story cannot be read as single outrage. It is one more thread that leads into a much larger scandal, one that should be treated as such by both the science and the political blogosphere/press.

Update 4:  Click on this link to commenter Elizabeth Pisani’s blog for an amplification of her remarks below.  She’s been on the front line.  Reality does make a difference to one’s outlook, no?

Images: “Opium Smokers in the East End of London” Illustrated London News, 1874.

Franz-Eugen Koehler, “Opium Poppy” in Koehler’s Medicinal Plants, 183-1914. Both sourced from Wikipedia Commons.