Junkie Science

In science or in economics, one occasionally comes upon a "natural experiment" -- a real-world event or confluence of events that fortuitously allows for the testing of one key variable. In a sense, "natural experiments" occur within the realm of politicized science as well.

You might say that we witnessed one recently when the Bush administration revealed its approach to an issue that had also confronted the Clinton administration: the question of whether to support needle-exchange programs to reduce the spread of HIV among (and by) intravenous drug users. Ultimately, neither administration had the guts to back these controversial programs. However, one administration felt compelled to twist scientific information to justify its stance, while the other did not. Can you guess which was which?

In a typical needle-exchange program, addicts can swap dirty needles for ones that are sterile. Such programs originated in the 1980s to combat AIDS, and within a decade many industrialized countries had adopted them on the national level. Evaluations by the National Institutes of Health, the World Health Organization, the Centers for Disease Control, and other respected health bodies have found that these programs not only work, they don't encourage more drug abuse. As a report from the National Academy of Sciences put it in 1995, "well-implemented needle exchange programs can be effective in preventing the spread of HIV and do not increase the use of illegal drugs."

Yet despite this evidence, needle-exchange programs have faced an uphill battle in the United States. In large part, that's because "war on drugs" hard-liners have persisted in denouncing the public-health-oriented, "harm reduction" approach of needle exchange, arguing that giving addicts fresh needles encourages and condones illegal drug use. Accordingly, the U.S. government has long refused to fund these programs.

The situation came to a head during the Clinton years, when the president's very own advisory council on HIV/AIDS slammed him for failing to release funding for needle exchanges. "Tragically, we must conclude that it is a lack of political will, not scientific evidence, that is creating this failure to act," the panel declared, continuing, "This political treatment of a public-health issue is killing people, and it must cease." Yet, in a sense, one could hardly blame Bill Clinton for stalling. Endorsing needle exchange would have given Republicans a huge political opening to criticize the president for not being tough enough on drugs.

Given these political realities, then-Health and Human Services Secretary Donna Shalala ultimately took what can only be described as the honest route. "We have concluded that needle-exchange programs, as part of a comprehensive HIV-prevention program, will decrease the transmission of HIV and will not encourage the use of illegal drugs," Shalala explained in 1998, fully acknowledging the science up front. Nevertheless, she continued, the Clinton administration would not support these programs at the federal level. "We had to make a choice," Shalala said. "It was a decision. It was a decision to leave it to local communities."

And as you can imagine, the Clinton administration took plenty of flack for its stance. One AIDS activist even likened the decision to "saying the world is not flat but not funding Columbus' voyage." But viewed in another light, the Clinton position on needle exchange underscores an important distinction between what science says and what politicians ultimately choose to do. "They said, 'This is a political decision; we're not pretending it's anything but,'" observes David Michaels, a professor of occupational and environmental health and epidemiology at George Washington University.

Granted, I still think the Clinton decision was a bad one. But though I personally disapprove of the outcome, I'm at least glad that the Clinton team had the courage to accurately represent the verdict of mainstream science on needle exchanges.

Now fast-forward to the Bush administration. The Washington Post recently ran an extraordinary editorial revealing that, in justifying the decision to oppose needle-exchange programs (which are especially disliked by religious conservatives), a Bush official directed the paper "to a number of researchers who have allegedly cast doubt on the pro-exchange consensus." So the Post actually called up these scientists and found that, lo and behold, they think no such thing. The Bush administration peddled other questionable evidence to the paper, too, which the Post also skewered. It was just the latest case in which the Bush administration has sought to distort scientific information in order to justify a policy stance -- precisely what the Clinton administration had avoided doing on the issue of needle exchange.

I find this contrast extremely revealing. Last year, when a group of distinguished scientists (including Michaels) accused the current administration of an unprecedented politicization of scientific information, George W. Bush defenders quickly countered that other administrations have also distorted and abused science in the service of politics. And that's certainly true -- to an extent, anyway. However, the case of needle exchange shows that on at least one crucial public-health issue, the Bush administration has clearly stooped much lower than its predecessor.

Chris Mooney is a Prospect senior correspondent whose weekly column will appear each Monday. His book on the politicization of science will be published later this year by Basic Books. His daily blog and other writings can be found at www.chriscmooney.com.

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