My mom, like millions of others in the U.S., has been a smoker for decades. She’s tried to quit a few times, but it’s been hard for her. The thing that’s helped the most so far? The nicotine patch.
While the patch is not a universal cure – see the Mayo Clinic’s analysis here – physicians back them because, well, the long-term cost of remaining a smoker is too high (for the smoker, the smoker’s family, and society). We all know smokers, and love them, and want to help them quit. Right?
But there’s a huge double standard in the media, and in society in general, when it comes to drug abuse treatment. I spent two years as a AAAS Fellow at the National Institute on Drug Abuse, and it was both depressing and inspiring: I was deeply impressed with the dedication of the staff, and horrified by the immensity of the problem of addiction in this country. That’s why it upsets me that while research to help smokers quit is generally portrayed as necessary and important, increasingly, I’m seeing politicians complain that research to help other drug addicts quit is a waste of money.
Maybe it’s because these other addicts are meth addicts, or potheads, or heroin addicts – probably not people you relate to or approve of. That makes it pretty easy for the media to take cheap shots at crack, etc. addicts, and question whether we should waste money trying to help them. But we should get angry about these cheap shots. A crack addict will die faster than a smoker. A crack addict can rarely hold down a job or be a parent. His/her illegal addiction poses a bigger danger to society than a smoker’s does. Most importantly, a crack addict, like a smoker, can quit. Tobacco is still a significant public health problem, and I want to do all we can to help smokers (like my mom) quit, but crack, meth, etc. utterly destroys families and communities. We should be leveraging scientific research every way we can to help these people – not throwing them away or taking shots at them because they’re “bad,” or because we can’t relate to them. They’re real people. They have families.
Nevertheless, people routinely and cynically use drug treatment research as a political football. In just the latest example of this, today’s Louisville Courier-Journal has an article on a small pharma company that’s developing a THC patch – the equivalent of a nicotine patch, only for marijuana users. You’d expect that for those people who oppose any kind of drug use, including marijuana use, any new addiction treatment (especially one made by a smaller company) would be a good thing. You’d be wrong.
What are the folks at Health and Human Services smoking?” said Jim Waters, policy director for the fiscally conservative Bluegrass Institute in Bowling Green. “Why are we spending $2 million on a company to make patches for pot smokers when we have schools that are crumbling and roads that are breaking and unemployment payments which are skyrocketing?” Waters said. “Seriously, somebody’s been smoking something.”
Uh-huh. Who cares about potheads?
But here’s an even easier target than pot smokers: drug-using Thai transgendered prostitutes! Earlier this year, an NIH study to understand the spread of HIV among Thai prostitutes, and the role played by drugs in the spread of the virus, was absolutely excoriated in the media. The clear implication is the U.S. shouldn’t waste its money on these people. But of course there are scientific reasons for doing a study like this – the results are generalizable to other people who aren’t Thai prostitutes.
The NIH responded:
The research is easy to ridicule if it is taken out of its public health context. The fact is, we need to explore a range of research avenues in vulnerable populations around the world to learn the best ways to control the transmission of HIV. …
The toll from illnesses associated with sexual behavior is enormous. The epidemiological bridge for the spread of HIV and other sexually transmitted infections to persons at-risk involves multiple routes, including drug abuse and prostitution. Understanding the risk factors posed by prostitution and illicit drug use remain critical to controlling the HIV/AIDS epidemic in the United States and worldwide. The transgender community — which certainly exists in the U.S. — is complex, and has been understudied. It is urgent we understand more about social behaviors and HIV risk for all populations, including transgender individuals.
As much as some people may hate to admit it, there actually are prostitutes, transgendered people, and people with HIV in the US. They deserve treatment just like anyone else. But that’s not even the point. Drugs seem to contribute to the spread of HIV, maybe through promoting unprotected sex, maybe through other mechanisms – especially among young heterosexuals who don’t think they’re at risk. There’s a general public health problem here, and it’s important to understand it. The Thai cohort is a model system for studying a much bigger problem – one that certainly does affect the US.
Unfortunately, the American public, and especially our politicians, have a tenuous grasp of model systems and how small scientific studies are generalizable to a bigger public health context. Remember Sarah Palin’s comment about the uselessness of “French” fruit fly research, when we should be doing something about real problems like autism? Any geneticist could have told her that the fruit fly model system is used to identify proteins that are involved in human disease – including autism! But scientific illiteracy, combined with a knee-jerk lack of sympathy for drug addicts (or the French, as the case may be), makes it easy to take cheap shots (pot shots?) at these kinds of studies.
This is politics, and it’s absolutely nothing new. Back in 2003, there was a very close call in the House on a vote to de-fund four NIH studies that some members of Congress found distasteful. (It didn’t happen; you can read the debate here, and an article on it here.) Earlier this year, Darrell Issa (R-CA) succeeded in stripping the grant money for several studies involving Thai prostitutes from the NIH funding bill. Just a month ago, Joe Barton (R-TX) and Greg Walden (R-OR) complained about four more specific NIH grants, including one to study drug use among native Americans. You can find the letter at Walden’s website.
I know a lot of you are scientists, biologists, doctors, teachers, etc. I hope that you believe drug abuse treatment is important – even for people that aren’t much like you. So I’d like to ask that if this kind of thing is as frustrating to you as it is to me, say something about it. That’s why I’m writing this post, even though I fully expect to get a lot of angry comments. . . because I haven’t seen many science blog posts out there on this – even though it touches on peer review, parity, and so many other issues important to the scientific/medical community. (Some Scibling exceptions: DrugMonkey’s post on Barton and Walden; Orac on Issa.)
I don’t see how the heck we are going to get better drug abuse treatments unless we let doctors and scientists actually study drug abuse and test treatments out in the real world. Personally, I happen to think research works – not perfectly, but it works. What do you think?
I leave you with this Fox News interview with Walden. . . see if you’re okay with the way the studies (and their subjects) are described. “Eye-opening” indeed.