Date: Sun, 23 Feb 1997 11:10:30 -0600
To: [iowanor m l] at [commonlink.com]
From: "Carl E. Olsen" <[c--l] at [commonlink.net]>
Subject: Re: McCaffrey says, "Screw controlled research!"

             McCAFFREY TELLS YOU WHAT TO DO WITH THE EVIDENCE

                               Stanton Peele

General Barry McCaffrey is a military man comfortable with
overseas interventions but illiterate -- and worse, opportunistic
-- about scientific/medical discourse.

This is most evident in his reference to research, to wit:

(1)  When fighting against state initiatives favoring medical use
of marijuana, McCaffrey repeatedly asserts that the clinical
research does not support such use for marijuana.  In staking out
this position, McCaffrey demands that MM meet the highest
research standard -- controlled clinical studies (that is, MM
versus placebo or alternate pharmacotherapy) that unambiguously
demonstrate marijuana to be a superior general treatment.  In
this case, he ignores individual medical and patient testimony
that marijuana provides relief for nausea and pain associated
with AIDS wasting, chemotherapy for cancer, and other conditions. 
     When McCaffrey was confronted by some serious medical
feedback that marijuana can play a significant therapeutic role,
he reasserted the need for strict summaries and evaluations of
the clinical research by funding a review of the scientific
literature on MM by the Institute of Medicine.  Such a review
will undoubtedly find both provocative clinical research and
powerful medical anecdotes, but will be unable to firmly
establish that marijuana meets FDA-type standards for approval of
pharmaceutical drugs that McCaffrey (and other Clintonites like
DHHS Secretary Donna Shalala) insists on.

(2)  NBC Dateline aired on February 21 a segment on the now
largely scientifically discredited school-based drug prevention
program DARE.  DARE is a Clinton administration favorite and,
according to Dateline, is used in 70% of U.S. school systems to
the tune of $700 million annually (largely tax funds).  In an
interview with Dateline, McCaffrey reiterated his strong and
undiminished support for the program despite a steady stream of
controlled research (i.e., outcomes for DARE students versus
outcomes for those not exposed to DARE) showing DARE to be
ineffectual.  No substantial long-term diminution of illicit drug
use has ever been established from the program, and the typical
result is no difference in usage between DARE and non-DARE
students.  
     McCaffrey in his on-screen interview cited in support of
DARE a University of Illinois study.  But when the interviewer
pointed out that this very study found a disturbing pattern of
increased drug use among suburban students exposed to DARE
relative to those without this exposure, McCaffrey sneeringly
labelled this result "twaddle."  The interviewer accused
McCaffrey of ignoring research that contradicted McCaffrey's (and
the Clinton administration's) support of DARE.  McCaffrey bore
down on the interviewer, saying that his experience and reports
by parents and children about the value of DARE made it clear
that results like those from the University of Illinois were not
to be taken seriously.  
     In fact, based on a survey of such results, the government's
own National Institute on Drug Abuse identified nine drug
prevention programs with promising results.  DARE was noticeably
absent from this list.  The NIDA report is the kind of summary of
research-based results that McCaffrey has called for in the case
of MM, but which he simply ignores -- or more accurately,
disparages -- vis-a-vis DARE.

(3)  McCaffrey not only supports the U.S. government's rejection
-- alone among Western nations -- of the harm minimization policy
of needle exchange, he has personally asserted his disapproval of
the program.  Yet, this is one of the few drug policies that has
been subjected to repeated systematic research evaluation.  This 
evaluation has established important benefits in the reduction (and 
almost entire avoidance in the United Kingdom) of the IV-drug-use 
spread of HIV, now the fastest-growing channel for dissemination 
of the disease in the U.S.  Nearly every major medical body in the
United States and internationally -- including the Centers for
Disease Control and Prevention, the AMA, and the very Institute
of Medicine to whom McCaffrey is turning for evaluation of MM --
has reviewed and endorsed the efficacy of needle exchange
programs.
     McCaffrey's reason for rejecting NE is that it is irrelevant
to the issue with which he is concerned -- continued drug use. 
In fact, the research has found that needle exchange does not
lead to greater drug use in the treated population, and may
instead establish contacts with IV drug users that can ultimately
lead to cessation of use.

What is critical in McCaffrey's attitudes toward research
revealed by this series of recent headline stories is that he
does not have a bona fide scientific approach to evaluating the
evidence.  Instead he summons, cites, and disregards evidence
entirely in the service of the goals of his office.  He is not in
the business of assessing evidence, or even of taking it
seriously when it stares him in the face.  All of this, of
course, makes doubly reprehensible the idea that the Harvard
Medical School will soon be presenting McCaffrey with a career
achievement award named after the distinguished Harvard drug 
researcher Norman E. Zinberg.