Bush's Drug Czar: The Anti-Science Gift That Keeps on Giving

The Examiner has a piece up decrying the fact that "Federal Programs Gave Addicts Street Drugs" (Bill Myers, 03-26-09).
OMG! That sounds horrible! Why on Earth would the US government be doing that?

The federal government is giving crack and powder cocaine, morphine, and other hard-core drugs to taxpayer-funded researchers for testing on addicts, The Examiner has learned.

Oh. This article is complaining about scientific research on drug abuse topics that involves human subjects. Oh Brother. Where to start, where to start? There are at least three interesting topics here and I may eventually get to all of them. First there is the question of the ethical use of human subjects.

"What the critics seem to be implying is that because there's addiction, there's coercion," said Kathleen Neill, a bioethicist with Georgetown University Medical Center. "This has brought up all kinds of ethical concerns, but that's not to say there isn't an answer to them."

This is important and it should not get lost in the shuffle. As it happens Isis the Scientist was just discussing whether it is ethical to use what may constitute coercive compensations to motivate research participation in vulnerable populations. I'm not the best on these kinds of questions but if I can't get Janet or PalMD fired up on this, I may take a whack at it later. [Update: Janet's post]
The second obvious point to address is the value and validity and rationale for doing human subjects work in this area at all. I may get to that if I can't get scicurious to take it on. [Update: scicurious' post]
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Today's topic is, however, the intersection of politics and science. It turns out that this article is connected to an effort of the now-departed head of the Office of National Drug Control Policy, John P. Walters (Wikipedia). Back to the article:

Most government officials are not aware of the experiments, even though they have been going on since at least the 1970s.
But at least one former cabinet member found out about them and wants them stopped.

Wait, hold on. Are you kidding me? "Most government officials are not aware...". Really? This is a journalistic statement? My friend, the US government is HUGE. I'm entirely certain that "most" government officials are not up on the minutia of the operations of the rest of the government. This statement, which is clearly designed to imply that there is some unusual secrecy surrounding these activities, is disingenuous, yellow journalism.
Ok, well at least some random Cabinet official is paying attention, right?

John Walters, drug czar during both terms of George W. Bush's administration, said he learned about the studies near the end of Bush's term. "It's not only questionable ethically, but probably -- given the science -- it may not be able to be defended at all," Walters told The Examiner recently.
In July 2008, Walters wrote a letter to Michael O. Leavitt, then secretary of health and human services.

The Drug Czar who was appointed in 2001 as the Bush Administration's Cabinet level official whose office focuses on substance abuse-- only found out about what sort of scientific research is funded by the government in 2008? This has got to be a joke, but sadly I fear it is not. If we credit this claim on the face, it points to yet another reason why we need to get good science back at the table. Because how can we come up with a comprehensive and useful approach to "Drug Control" if we remain entirely uninfluenced by the best available evidence with respect to objective reality? The fact that a Drug Czar can go for at least 6 years supposedly ignorant of the basic fact that we derive much of our knowledge about drug abuse from administering recreationally-abused compounds to users...well, it suggests he is not really interested in knowing anything. (As I covered before, his position against using opiate antagonists to save overdosed heroin abusers was not encouraging.)
But wait! He made a heroic effort to learn, it was just those dang researchers that stonewalled him!

In that letter, obtained by The Examiner, Walters said that finding treatments for addictions was a "compelling" goal.
"But what are their proper limits?" Walters wrote.
He still hasn't gotten a response.

ooooo.

Walters told The Examiner. "I think that when you bring someone in and say, 'Well, they're not seeking treatment yet and therefore it's OK to use them as an experimental subject' -- that's not the understanding that the current science gives us about this disease."

What the heck is that supposed to even mean anyway? But lest we get too distracted, the journalist from The Examiner managed to get responses from several investigators. Including one Herbert Kleber M.D. who served in the ONDCP under a prior Republican Administration! And yet this head of the ONDCP was satisfied with not getting a response to some random (and no doubt politically boobytrapped from start to finish) request to the head of HHS (instead of, say, NIDA directly)? Hmm, one wonders how hard he tried to get answers....or perhaps he did get answers? Just not the right answers?


"The question is whether the results justify using these individuals as disposable subjects," Walters said.
-snip-
Ex-drug czar Walters says he's willing to be convinced.
"I'm trying to listen to the best science possible. But I haven't gotten an answer," he said. "It's all the bureaucracy protecting itself here on the grounds that the scientists know best. It's not a trivial matter."

This last bit is very suspicious, is it not? "The scientists know best" is a dead giveaway. It tells us that Walters did get a response from the scientists who focus on substance abuse issues....he just didn't like it.
So instead of thinking to himself that perhaps what he is hearing is in fact a scientific consensus that comports with ethical decisions made by numerous local Institutional Review Boards-- he substitutes his own personal (pre-existing?, political?) opinion. IRBs, I will note, are the ones tasked with evaluating each and every research proposal involving human subjects and deciding that the potential outcome justifies the use and treatment of the human subjects in question. Each University which conducts human subjects research has one. If this Drug Czar had really been interested and open to education, some staffer from NIDA could have brought him up to speed on the process in an hour or two. If he was further interested, his staffers could have rounded up information from local IRBs in a matter of a week or two.
The fact that after a 6 year term spent heading the ONDCP this Czar remained ignorant suggests that he did not really have any interest in listening to "the best science possible". It suggests that his goal in trolling this reporter into publishing his viewpoint is to further a political agenda that has nothing to do with science.
That's wrong. It is harmful to our Nation's public policy on drug control and substance abuse to run roughshod over the scientific information in this way. It is specifically harmful to drug abuse science to misrepresent the studies in this way. It really, really is time to push back against this mistreatment of science when it comes to the political arena.
I hope the new Drug Czar is a little more receptive to understanding the science.
[h/t: BioE!]

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