Public health involves 'political science'
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By introducing a measure two weeks ago to suspend a needle exchange program, Allegheny County Council member Vince Gastgeb tugged a strand of one of American culture's Gordian knots.
It's the giant tangle of scientific research, political ideology, private morality and big money that exists in so many public policy debates -- including AIDS treatment, global warming and, coming soon, childhood vaccines for sexually transmitted disease.
It's a tangle that the title of a recent New Yorker article dubbed "Political Science." In this article, as so often happens, political conservatives tend to be on the losing side of the public relations battle. Sometimes they lose the p.r. battle because the science community's certitude meshes with leftists' penchant for social engineering, but sometimes conservatives lose because their position is morally wrong.
Mr. Gastgeb's ordinance offers a neat case study. The county's privately funded needle exchange aims to slow the infectious diseases spread when drug addicts share dirty needles. It was launched in 2002 on an "emergency basis," and the health department sidestepped normal procedures.
On other health issues, such as the 2004 ordinance to reduce school bus diesel emissions, Mr. Gastgeb says, "the health department formulated a policy, they brought it to us and we passed an ordinance. Somehow this isn't following that lawful process. Some due diligence is needed. Is it working? Is it needed?"
If the research data are provided and demonstrate both need and good results, the program could resume. That's the science part. Here's the political/moral aspect of the tangle: Mr. Gastgeb says his ordinance allows for this seamless continuation "because I don't want anyone to think I have an ax to grind."
Some program opponents do. Some anti-drug advocates oppose needle exchanges as institutionalized enabling. Some small-government conservatives insist such efforts belong in medicine's private sector, as do some religious conservatives because of the moral ambiguities.
"I knew I'd be caricatured as some homophobic Republican from the suburbs," says Mr. Gastgeb, "but even if you're for [the program], you shouldn't want it done this way."
Does he support the needle exchange? "I don't know what I'd want," Mr. Gastgeb says. "Does the county give addicts needles, but they continue being addicts? That leaves a lot to be desired."
While conservatives are accustomed to harsh criticism for opposing some measures introduced ostensibly for society's betterment, scientists and activists don't cotton to having their own motives questioned. When council members began to ask about the needle exchange program's continuing lack of due diligence, Mr. Gastgeb notes, its proponents "got really defensive."
The looming national health controversy concerns a vaccine to protect women from the sexually transmitted human papillomavirus. Two strains of HPV cause cervical cancer and claim 5,000 American women's lives each year and many thousands more elsewhere.
A vaccine just submitted to the Food and Drug Administration could prevent those deaths, but for it to be effective, it must be administered before the age at which sexual activity begins. Since that age varies widely, proponents want the vaccine to be made mandatory before puberty.
Some conservatives oppose this, fearing it will make promiscuity seem safe and resenting that it usurps the family's primacy in making health and moral choices.
Clearly, "political science" cannot be avoided. There is no Alexandrian sword to slice through the whole culture's enormous Gordian knot, but if each issue were understood as its own smaller knot, we could approach the tangle together, peaceably.
First, do no harm: The Hippocratic ideal should apply to both scientists and lay people enjoining a debate. But it's equally important for us to do whatever good we can. If clean needles don't foster addiction, then shouldn't we actively prevent disease?
The same principle applies to the HPV vaccine. In the worldview of religious conservatives, humans are free to eradicate as many of the consequences of the Fall (e.g., disease) as our intellects empower us to. If all that encourages our children to live chastely is fear of death, haven't we failed? (Our teenagers sometimes drive dangerously; we wish they wouldn't but provide seat belts just in case.)
The only issue for debate, once the vaccine is proven safe, is whether it should be mandatory, or just highly encouraged. And if the needle exchange prevents disease without encouraging addiction, the only question is what the public's role should be. We need an open, well-informed debate to find the right answer.
First Published April 3, 2006 12:00 am
