DRUG TRIAL: THE POLITICAL LEGITIMATION OF QUACKERY

The Washington State "Drug Medicalization and Prevention Act of 1997"
asserts that "we need to ... recognize that drug abuse and addiction are
public health problems that should be treated as diseases." The merits of
this claim cannot be intelligently debated without agreeing on the use of
the terms drug abuse, addiction, treatment, and disease, and on the kinds
of personal conduct that justify coercive state control by means of public
health measures.

>From ancient times until recent years, the term public health, as
distinguished from private health, was used to denote activities undertaken
by a government to protect individuals from disease-causing agents or
conditions in the environment, both physical and human. The principal
public health measures have been sanitation and the control of infectious
diseases, aimed at protecting the community from microbial diseases such as
cholera and typhoid. In this connection, the control of venereal diseases
illustrates an important consideration: The prostitute's behavior, exposing
her client to the risk of venereal disease, was and is viewed as a public
health problem, justifying the coercive control of her conduct, whereas the
behavior of her client, exposing himself to the risk of venereal infection,
was and is viewed as a private health problem, not justifying the coercive
control of his conduct. By defining the behavior of the individual who
exposes himself to the risk of "addiction" as a public health problem, we
radically expand the range of legitimate state coercion in the name of health.

Public health measures play a crucial, but neglected, role in modern
political philosophy. Interventions justified in the name of health -
defined as therapeutic, not punitive - fall outside the scope of the
criminal law and are therefore exempt from constitutional restraints on
state coercion. On the contrary, such measures - promoted as protecting the
best interests of "sick patients" - are viewed as valuable "services"
provided by the Therapeutic State (the polity uniting medicine and state,
much as church and state formerly were united). Presciently, John Stuart
Mill anticipated this insidious tactic: "The preventive function of
government," he warned, "is far more liable to be abused, to the prejudice
of liberty, than the punitory function; for there is hardly any part of the
legitimate freedom of action of a human being which would not admit of
being represented, and fairly too, as increasing the facilities for some
form or other of delinquency."

Mill could not have put it better had he been addressing present-day
American drug policy. It is self-evident that free access to a particular
drug, like free access to any object, increases our opportunities for using
and abusing it: Freedom of action means the opportunity to act wisely or
unwisely, to help or harm ourselves. It is also self-evident that, since
"no man is an island," any private act may be viewed as affecting the
economic, existential, or medical well-being of others, and hence be deemed
to pose a "public health problem"; and that if protecting people from
themselves falls within the sphere of public health, then no private
behavior is exempt from being categorized as a public health problem,
subject to control by means of medical sanctions.

It is ironic that, in 1997, Americans should recommend "drug
medicalization" as a cure for America's drug problem: It was the "drug
medicalization" act of 1914 - better known as the Harrison Narcotic Act -
that transformed widely used analgesics and sedatives into dangerous
"narcotics," specially monitored by the federal government, available only
by a physician's prescription. Horribile dictu, isn't it possible that
defiance of such controls is not a disease, and that coercive state
interference with the free market in drugs - like similar interference with
the availability of other goods - may be the root cause of the problem we
now try to solve by still further "medicalization"? Aren't we fools if we
fail to ask, cui bono?: who benefited from drug medicalization in the past
and who benefits from it today?

The die is now cast: Misbehaviors of all sorts are (defined as) medical
problems. Unwanted behavior, exemplified by the use of illegal drugs, is,
by fiat, a disease. The concepts of disease and treatment have thus become
politicized. The World Health Organization's definition of drug abuse as
the "use of a drug that is not approved by a society or a group within that
society" is illustrative. Thus, doctors, judges, journalists, civil
libertarians, everyone accepts - or pretends to accept - that
self-administering heroin is a disease and that a state agent administering
methadone to an "addict" is a treatment.

Some see the Therapeutic State as an instrument of compassion and science
in the service of "moral progress" and accordingly support "medicalization"
in all its many guises. Others see the Therapeutic State as an instrument
of cruelty and pseudoscience in the service of a new form of statism and
accordingly oppose "medicalization."

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