Sentencing Crack-down

An editorial in the Washington Post applauds new guidelines drafted by the U.S. Sentencing Commission for offenses related to possession of crack cocaine. These more lenient sentences bring the penalties for crack cocaine closer to parity with those for powder cocaine, although still subject to mandatory minimum sentences.

These statutes mandate a five-year sentence for someone caught with five grams of crack; an offender would have to be caught with 500 grams of powder cocaine to trigger the same sentence. There are good arguments for why crack should carry tougher sentences than powder cocaine, including the fact that crack is ferociously addictive and destructive. But a 100-to-1 disparity is irrational. Lawmakers should act quickly on one of the several bills pending in Congress that would narrow that gap.

The deliberations on this subject were featured in an earlier article by the Washington Post, which noted the effect that current guidelines have on sentencing disparities.

The commission is taking up one of the most racially sensitive issues of the two-decades-old war on drugs. Jurists and civil rights organizations have long complained that the commission’s guidelines mandate more stringent federal penalties for crack cocaine offenses, which usually involve African Americans, than for crimes involving powder cocaine, which generally involve white people. The chemical properties of the drugs are the same, though crack is potentially more addictive.

The Sentencing Law and Policy blog notes that some members of Congress have expressed their opposition to making these guidelines retroactive, and has posted a letter from some members of the House Judiciary Committee to that effect.

The Bush administration also opposes making these new guidelines retroactive, citing the potential to place additional burden on the judicial system and to jeopardize public safety. But, this problem is, at its core, a public health issue. Rather than fighting a war against its own citizens, it’s time to confront the root causes – whether cultural, socioeconomic, or educational – that contribute to the abuse of crack cocaine and spawn a vast criminal enterprise.

Women and Children First?

The U.S. Department of Health and Human Services recently posted its Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine.

Given that influenza vaccine supply will increase incrementally as vaccine is produced during a pandemic, allocation decisions will have to be made. Such decisions should be based on publicly articulated and discussed program objectives and principles. The overarching objectives guiding vaccine allocation and use during a pandemic are to reduce the impact of the pandemic on health and minimize disruption to society and the economy.

DHHS notes that public and stakeholder meetings did not yield a single, overriding objective for pandemic vaccination, where one target group was granted preference over all others. However, an important and consistent emphasis from these meetings was the desire to designate healthy children (as opposed to those at increased risk) as being of inherently higher priority than the general population of adults aged 19-64.

Obviously, first priority must be given to protecting those who 1) are essential to the pandemic response, 2) are involved in critical infrastructure, 3) provide health care and community support services, or 4) are involved in national security. Less clear is the rationale of giving preference to otherwise healthy children to the exclusion of productive adults, especially in light of the stated goal to “minimize disruption to society and the economy.”

The response to protect our children is visceral – an inborn emotional reaction that is nearly universally shared. At the level of the family, the person, or the selfish gene this seems eminently sensible. But, does it really make for rational public health policy? Infants and small children have great potential, but little actual, societal value. Why, then, are we so willing to hold youth so dear and experience, ability and wisdom in such comparatively low regard?

Taken to absurd extremes, such an outlook leads to the placement of the “unborn” on a par with autonomous adults insofar as moral regard is concerned. Potential value is given greater purchase than actual value. Yet if we set aside emotion for a moment, it should be clear that this is exactly the opposite of the outcome we should desire. If a crude phrase will be forgiven, the replacement cost of infants and small children is considerably lower than that of an adult of working age, in whom our society has invested in education and training.

The allocation of scarce vaccine resources during a pandemic poses an important conundrum, and DHHS is to be commended for grappling with the issue before the a pandemic is upon us. But, we need to be more coldly rational in deciding who will share this lifeboat. Sound public health policy demands it.

The Homeopathy Journal Club

Dr. Ben Goldacre, at Bad Science, has posted a number of recent academic (?) articles from the journal Homeopathy on the subject of the memory of water, a principle at the center of debates over the validity of homeopathy. In addition, he considers the initiation of a journal club on the subject of homeopathy, to provide a forum for critical evaluation of peer-reviewed research in this area.

I don’t want you to feel inhibited, but I do have a bit of a fantasy about setting up an entertaining online journal club (although a formal one already exists), and I was hoping this could be some kind of dry run, although obviously these aren’t mass appeal clinical papers, which are the kind that I’d aim to do in the future.

Even those who do not wish to be active participants in such an effort might benefit from lurking on the sidelines, observing what will hopefully be a good, critical assessment of these seemingly spectacular claims.

Crime Statistics: Regular or Unleaded

On Sunday, 8 July 2007, the Washington Post reports that decreasing crime rates may be the result of lowered lead levels.

The theory offered by the economist, Rick Nevin, is that lead poisoning accounts for much of the variation in violent crime in the United States. It offers a unifying new neurochemical theory for fluctuations in the crime rate, and it is based on studies linking children’s exposure to lead with violent behavior later in their lives.

Although presented by the Post as a contrarian view to claims by presidential candidate and former New York City mayor Rudy Guiliani that his policies (see “Broken Window Theory”) were the proximate and primary cause of the decline in violent crimes, the data is by itself – stripped of any political intent – intriguing.

As the Post article explains, others have sought similar explanations for the downward trend in violent crime in certain jurisdictions. It seems almost certain that there are many relevant variables. But, it’s noteworthy that from a strictly materialist, cause-and-effect perspective this is yet more compelling data that to seriously address crime, the root causes – environmental, economic, social, as well as individual – must be considered.

A version of Rick Nevin’s study is available online. For additional information about the link between lead exposure and crime see Crime Times. To get information about reducing childhood lead exposure visit the Coalition to End Childhood Lead Poisoning.

The Provenge Decision

The Washington Post article “FDA Delay In Cancer Therapy Is Attacked” reports that researchers Howard Scher and Maha Hussain feared for their safety at the recent ASCO meeting.

The two doctors have been at the center of an unusually bitter debate over an experimental therapy for prostate cancer, ever since they helped persuade the Food and Drug Administration to delay approving it, enraging both patients and investors. The first-of-its-kind therapy, called Provenge, is a “vaccine” designed to extend the lives of patients with advanced prostate cancer by stimulating their immune systems.

Dr. Scher’s letter is reprinted and discussed on the PSA Rising Blog.

Welcome to Alexipharmacopeia!

Welcome to Alexipharmacopeia, a blog dedicated to public understanding of science and rational decision-making with respect to medicine and public health. Posts on this blog will cover a wide range of topics, including adult science literacy, childhood science education, resource allocation, and public health issues.