How Many People Does a Health Policy Kill?
Sometimes we can specify the people killed by one person's policy, sometimes not
Posted Jul 22, 2013
I quoted Ethan Nadelmann, drug policy reform advocate extraordinaire, on these pages:
Why was it that Australia and England and the Netherlands were able to stop the spread, and keep the number for injecting drug users under 5-10 percent, and the U.S. was not? It's that notion that abstinence is the only permissible approach, that we are not going to "enable" a junkie by giving him a clean needle. There has to be a kind of owning up to that role in hundreds of thousands of people dying unnecessarily. . . . (emphasis added).
The "hundreds of thousands" Nadelmann claims is vague; but we can actually specify quite exactly the deadly role played by former Republican New Jersey governor Christie Whitman. (Disclosure: I was a resident of New Jersey during Whitman's tenure as governor, 1994-2001.)
After beginning as a gay male problem, by the late 1980s, AIDS had became a major inner-city and African American (and Hispanic) killer via IV drug use. In 1993, AIDS became the leading cause of death for young Black men and women. In 1994, as the HIV/AIDS epidemic grew in New Jersey, Christine Todd Whitman assumed the governorship of the state and appointed a Governor's Advisory Council on AIDS. She selected a man whom she thought of as a safe candidate, known as a loyal Republican, to head the council -- David W. Troast.
But Troast seemingly took his role more seriously than Whitman imagined he would, and he led the council in a direction Whitman didn't want to go. Thus, in 1996, Troast told the New York Times that "he was initially opposed to needle exchange programs, but was persuaded after visiting a similar program in the Bronx and by recent studies showing that easier access to clean needles slows the spread of the virus that causes AIDS." So the council -- comprising religious and community leaders, health care professionals, social service providers, state legislators and administration officials -- voted overwhelmingly in support of such a program.
Whitman ignored her Advisory Council and nixed support for needle exchanges. More than this, New Jersey actively stamped out the distribution of clean needles. New Jersey law enforcement used decoy addicts to arrest activists who distributed needles, killing all organized needle exchange efforts in the state by 1998. Observers were surprised by the virulence of such a campaign led by a "moderate" Republican:
The needle-less campaign, and the unusually aggressive tactic of using sting operations to snare advocates for AIDS victims, has made New Jersey the most active front in the nation's fierce political battle about the merit of needle exchanges. The state's unrelenting opposition to the programs also places Gov. Christine Todd Whitman in the uncharacteristic role of hard-liner.
Republican governors in New York, Connecticut and Pennsylvania use state money to pay for the programs, arguing that they save lives and spare taxpayers the high cost of treating AIDS victims, which can top $20,000 per patient per year. Mrs. Whitman lauds the county prosecutor who arrested Ms. McCague for ''enforcing the law.''
The Centers for Disease Control and Prevention, the National Institutes of Health and the Surgeon General have all released studies concluding that needle exchanges significantly decrease the spread of H.I.V. without increasing drug use. Mrs. Whitman dismisses their research as ''dubious, at best.''
Whitman is the perfect embodiment of Nadelmann's statement: "I am continually stunned by the lack of humanity and the disrespect for science and public health that I see." Ironically (or not), throughout Whitman's tenure, New Jersey's prestigious Robert Wood Johnson Foundation funded research that established conclusively that such programs significantly decrease the spread of H.I.V. without increasing drug use. Yet Whitman, who was so disdainful of the U.S. government's leading public health bodies and officials ("dubious, at best"), never accessed this expertise in her own state.
Whitman also embodied Nadelmann's description of the "notion that abstinence is the only permissible approach, that we are not going to 'enable' a junkie by giving him a clean needle." Whitman wanted to be clear on this "just-say-no" message:
And when Governor Whitman was asked recently to explain the factual basis for her unflinching belief that needle exchanges send the wrong message to children, she grew frustrated, as if the hypocrisy of the programs were so obvious it needed no explanation.
''As a mother, I know that it sets a bad example,'' she said during an interview last month. '' 'Do as I say, not as I do' is a lousy way to lead, whether you're running a family or running a state.''
For his part, Troast projected the numbers of people who would be saved by a state needle exchange program:
In New Jersey, intravenous drug use accounted for 51 percent of the state's 28,125 reported AIDS cases from the early 1980's through December . The state ranks fifth in total number of AIDS cases. Mr. Troast said needle exchange programs could save an estimated 650 lives a year by reducing the transmission of the H.I.V. virus, which causes AIDS, among the state's estimated With 200,000 intravenous drug users.
The situation in New Jersey under Whitman allows for some remarkably exact calculations, to wit: (a) after Whitman vetoed this life-saving policy in 1996 only in 2007 did New Jersey became "the final state in the United States to adopt a needle exchange program," (b) we have a detailed estimate by the man Whitman appointed head of her AIDS Advisory Council that this policy would save 650 lives per annum, (c) and we know Whitman and Whitman alone stood in the way of the adoption of this policy while other nearby governors of her party implemented needle exchange programs.
Taken together, Whitman's campaign against needle exchange led to 11 years' delay involving about 650 deaths/year for a total of about 7,000 dead (this does not include transmission to children -- NJ was also a leader in pediatric AIDS cases). Whitman never indicated any regrets about this delay and its consequences. Nor did it hurt her career in the least -- she was re-elected, and remains a revered figure in the Republican Party. It seems that there is no penalty for sacrificing the lives of minority drug addicts (and their children) to make a "no-use" statement about drugs.
Jenny McCarthy, a former Playboy pin-up, a model, and a television personality who was recently selected to co-host ABC's influential women's show "The View," beginning in September, has no official authority to do anything. Nonetheless, according to The New Yorker's science editor, Michael Specter, "McCarthy is the person most visibly associated with the deadly and authoritatively discredited anti-vaccine movement in the United States."
McCarthy's son developed autism, and -- like other parents, but not such visible ones -- McCarthy concluded this was due to metallic pollutants in the vaccinations her son received, from which he was then cured, McCarthy claims, by a gluten-free diet and chelation therapy, which extracts metals from the body. Specter asserts: "There has never been a verified scientific report that chelation therapy, a gluten-free diet, or anything else can cure autism." (I demur from Specter here. I know that children have recovered from autism and I'm glad that McCarthy's son has. I commend her for her energetic efforts on her son's behalf. But I agree with Specter that there is no evidence, but actually the contrary, that a gluten-free diet and chelation therapy are a cure.)
I have reviewed the evidence that this vaccination "theory" is nonsense -- and dangerous nonsense -- for such reasons as that autism rates weren't affected when thimerosal (the mercury preservative claimed to cause autism) was removed from vaccines, every relevant clinical and epidemiological body that has evaluated the evidence (the CDC, American Academy of Pediatrics, the National Academies' Institute of Medicine) rejects the vaccine-autism connection, and -- more recently -- The Lancet withdrew the article originally used to buttress the case against vaccines both as fraudulent and because of its negative impact on public health, while the chief author of the research, Dr. Andrew Wakefield, was censured and lost his medical license in Britain. (He has come to the U.S. to carry on his work.)
What McCarthy brings to this dispute in the absence of relevant scientific or medical training or background -- or really any professional training and background other than her good looks and quick wit -- is a brassy personality and threatening manner. As described by Specter: "McCarthy once essentially threatened the actress Amanda Peet, who has often spoken out about the obvious benefits of childhood vaccinations, by warning Peet that she had an angry mob on her side. When people disagree with her views on television, McCarthy has been known to refute scientific data by shouting 'bullshit.'"
McCarthy and her supporters have an instant advantage over academic scientists and physicians in such debates -- they have no intellectual boundaries in a discussion. McCarthy's reference group isn't health professionals. Her main supports are fellow comedic TV host Chelsea Handler and McCarthy's former boyfriend, zany comedian Jim Carrey, both of whom (like Whitman) join McCarthy in dismissing the conclusions of the leading medical and epidemiological bodies in America.
The anti-vaccine movement is having a measurable impact on public health, since so many parents are refusing to inoculate their children against serious -- but preventable -- childhood and adult diseases (now including cervical cancer). Here, Dr. Paul Offit, Professor of Vaccinology and Chief of Infectious Diseases at the Children's Hospital of Philadelphia, discusses recent outbreaks of preventable diseases. As a result, a Website has been created (with the URL jennymccarthybodycount.com) to track the "body count" of illnesses and deaths due to the movement. But its hard to attribute any single illness or death to McCarthy or anybody else. Still, McCarthy -- already the most influential critic of vaccines and who is soon to assume a legitimizing, national media role -- must be held accountable for the consequences of her views.