INJECTIONS OF HOPE

Carla Spartos's stimulating article "Injecting Big Brother" [July 18] helped
enhance the perception that addiction is both a disease and a significant
public-health issue. However, her report, based partly on my article
"Immunization for Prevention and Treatment of Cocaine Abuse: Legal and
Ethical Implications," in the journal Drug and Alcohol Dependence, may give
premature hope to the community of cocaine-addicted individuals.
Furthermore, I believe that it significantly simplified, overstated, and
even misrepresented some of my views.

Spartos implied that an end to cocaine addiction "would come at the hands of
pharmaceutical companies and biotech labs, which are about to unleash the
ultimate weapon--the antidrug vaccine." However, it will be years before a
vaccine will be available. The required FDA studies will not be completed
until well into this decade. Spartos also stated that "Cohen argues everyone
should get the shots." In contrast, my goal was to present a panoply of
viewpoints and engage in ethical analysis. I emphasized that "while it might
be more satisfying to the reader were I to provide firm 'truths,' such an
absolutist approach would be inappropriate." Specifically addressing the
question of universal immunization, I wrote:

"In view of the [potential benefits of universal immunization], why not
institute universal mandatory immunization once a cocaine vaccine is
available? There is ample legal support for the state's application of
police power when necessary to act in the interests of public health.
However, just because society has this power does not mean that such an
approach is ethically justified. . . . In any case, there are certainly a
number of persuasive reasons not to initiate mandatory immunization with a
cocaine vaccine."

I hope that this communication will help those addressing the scientific and
ethical problems inherent in dealing with substance abuse.

Peter J. Cohen, M.D., J.D.
Adjunct Professor of Law
Georgetown University Law Center
Washington, D.C.