JUNKIE SCIENCE by David Tell, for the Editors
Copyright (c) 1997, The Weekly Standard

The Fourth Conference on Retroviruses and Opportunistic
Infections was held the last week of January in Washington.
An annual event, it is the probably the world's most
important scientific meeting of AIDS specialists. At one of
this year's sessions, Dr. Steffanie Strathdee, a Canadian
epidemiologist, presented preliminary data from a major
study of highrisk behavior underway in Vancouver. Since
May 1996, the Vancouver Injection Drug Use Study has
periodically bloodtested, interviewed, and counseled
roughly 900 intravenous cocaine and heroin users. After
only seven months, nearly 10 percent of initially
HIVnegative participants in the program had experienced
"seroconversion": They had become infected with the virus.
Overall, the Vancouver research subjects injected
themselves an average of 4.5 times each day. Forty percent
of those who knew they were HIVpositive nevertheless
reported having lent contaminated needles to other drug
users in the preceding six months. Fully 60 percent of the
test group, including those still clear of the virus,
reported having borrowed someone else's used needle in the
preceding six months.

All this, despite the fact that 95 percent of the drug
users under study in Vancouver routinely received sterile
hypodermic syringes, free of charge, from a wellfinanced
public " needleexchange" program. That program is
mammoth: The government of British Columbia distributed 2.3
million clean needles in 1996. "We always thought we were
lucky" to have "a great needle exchange program," one of
Dr. Strathdee's colleagues has ruefully acknowledged. "We
had a problem, but now we have a bigger problem."

Down here in the Lower Fortyeight, meanwhile, the
assumption is increasingly widespread that needleexchange
programs like Vancouver's are a practical necessity. AIDS
activists are virtually unanimous and many frontline
publichealth officials and professional medical
associations appear to agree that restrictive state laws
and a federalfunding ban on cleanneedle initiatives are
killing people. These proponents have won a receptive media
audience.

The New York Times editorial page, for example, has for
several years been evangelizing regularly on behalf of
needleexchange programs, which now number more than 100
around the country. According to the Times, the Clinton
administration's position on such programs Health and
Human Services secretary Donna Shalala approves their
adoption by state and local agencies but declines to allow
federal money to be spent on them represents a shameful
failure of "courage." Crude public arguments about "
politics and morality" must give way to science, the Times
pronounces. The available evidence is "unequivocal" and
"highly persuasive" that supplying clean needles to addicts
deters HIV infection without encouraging drug use.

We'll set politics and morality aside for a moment. The
available evidence most commonly cited by needleexchange
advocates the Times has yet to take note of Vancouver's
depressing results turns out to be, if you actually read
it, highly equivocal and therefore unpersuasive. To date,
the most comprehensive treatment of sterile needles as a
tool against HIV transmission is a twoyear investigation
organized by the National Academy of Sciences in 1993. The
NAS study, published in 1995, explicitly "does not
recommend" a national needleexchange program. It does
recommend caution, further research, and targeted federal
funding for local "communities that desire such programs,"
since they sometimes "can be effective in preventing the
spread of HIV" and "do not increase the use of illegal
drugs."

But NAS reached even this last, rather temporizing
conclusion by making " multiple assessments" of a "logical
network of evidence" in which it "may be possible" to
discern a "plausibility" that needleexchange programs
are " implicated" in a positive "change process." In
English, this means the academy employed criteria it admits
"would be classified as relatively weak" when measured
against "traditional" scientific standards. All the
previously published research on which NAS based its
assessment of needleexchange programs had, in the NAS
panel's judgment, obvious "methodological limitations":
inadequate sample populations, high dropout rates,
"improper" study controls, and "problematic" or
"incomplete" data and analysis.

In particular, the academy decided that the two most
widely heralded federal cleanneedle studies actually prove
very little. A 1993 General Accounting Office report
indicating that needle exchanges "do not increase
injection drug use" was, in NAS's jargondrenched
appraisal, "not fully characterized." GAO, it seems, had
excluded from its final review any needle program in which
drug use did increase or remained level. Another 1993
report, commissioned from the University of California by
the federal Centers for Disease Control, speaks for itself:
Thencontemporary data "do not . . . provide clear evidence
that needleexchange programs decrease HIV infection rates."

In addition to cloudy behavioral and epidemiological
data, all manner of practical and logical problems surround
cleanneedle programs. Even if one were prepared to
stipulate their immediate utility, there would remain the
question whether they need largescale public funding.
Sterile needles are cheap; they cost 50 cents or less
apiece, a minuscule amount of money to addicts who quite
commonly spend hundreds of dollars a day to maintain their
habits. And it is not clear such needles are otherwise
unavailable to addicts who want them. Fortyone states do
not even require a prescription for needle purchases in
pharmacies. Fortyfive states still criminalize possession
of syringes for use in the consumption of illegal drugs,
but those laws are rarely enforced and then only against
drug dealers, not users.

Then there is the matter of public order and safety.
Experience suggests that the insertion into American
innercity neighborhoods of millions more hypodermic
needles would result in some large number of them being
discarded on sidewalks where children run and play. And
experience also suggests that expanded needleexchange
programs might well become magnets for drug use, even if
they did not increase rates of addiction. Drugrelated
crime in the Downtown Eastside section of Vancouver, where
that city's cleanneedle initiative is headquartered, is
epidemic. "It's been getting progressively worse" since the
program began in 1989, according to one Vancouver police
detective. "Our problem is, that area is known nationwide
as a place to come for drugs."

It could certainly happen here. No one can tell for
sure. The "longterm effects of these programs on the level
of illicit drug use in communities are not yet known,"
concedes the National Academy of Sciences. Some imperfect
research suggests that needleexchange programs work.
Some imperfect research suggests they don't. But "sooner or
later," the NAS referees insist, "there comes a time for
decision on the basis of evidence in hand." So the academy
makes its call, favoring the "plausibility" that further
needle initiatives might reduce HIV transmission against
the real possibility that they will fail and make things
worse.

Finally we are back to politics and morality. The
practical question needle exchange programs involve is
essentially and only a political one: whether to legalize
and fund them, or not. And in the absence of conclusive
practical evidence one way or the other, it is a question
that can be answered only with reference to morality.

Two competing moralities are at issue here. There is
that oddly newish uppermiddleclass libertarianism which
has it that adults bent on self destruction should be
allowed and helped to achieve their goal in "safe, "
timely, and effective fashion. It is now respectable for
people to argue that cancer and glaucoma patients should
have access to " medical" marijuana cigarettes, though no
one has yet proved that smoking pot is ever necessary or
good for you. Worse, some of the nation's leading lawyers
and "ethicists," joined by two federal appellate courts,
have lately concluded that truly " moral" American laws
must permit doctors to euthanize their terminal or
chronically incapacitated patients when asked to do so.

Against this view stands the simpler, oldfashioned
morality that so frustrates AIDS activists and the New York
Times: Government should not, in principle, play
facilitator to any lifedenying impulse. In this particular
case, government should not make itself a technician of
cocaine and heroin addiction. Especially when there is
nothing but glorified guesswork with which to justify the
move.

The Clinton administration, for whatever reasons, is
right to deny federal funding to needleexchange
programs. Congress should support the president. And work
to ensure that he does not change his mind.