The Clinton Administration’s worst ongoing scandal is taking place in plain sight, as the most appalling derelictions of responsibility usually do. It has nothing to do with sex, lies or audiotape, which is probably why it has always failed to capture the pornographic imagination of the media. It does involve money, but no tainted campaign contributions or ancient land deals. And its effects ought to be reckoned first in lives, not dollars.
The White House malfeasance at issue is the April 20 announcement that no Federal funds will be used for needle exchange programs. What makes this decision so disgraceful is that the scientific evidence proves that needle exchange helps prevent the spread of H.I.V. and AIDS–a fact known at the Administration’s highest levels for more than three years.
The likely consequence of the Administration’s dithering was all too plain on the front pages of The Washington Post , which provided the best coverage. The day after The Post featured a backstage account of President Clinton’s characteristic last-minute reversal on needle exchange, the paper gave prominent space to bad news from the Centers for Disease Control and Prevention: Despite medical progress in the treatment of H.I.V., the virus continues “to spread through the population essentially unabated.” In other words, President Clinton’s vaunted war against AIDS has been a failure.
Although C.D.C. officials did not say so directly, an examination of the data collected during the past few years suggests strongly that most of the new cases result either directly or indirectly from infected needles. Perhaps it wasn’t pure coincidence that the C.D.C.–whose officials and scientists have favored Federal funding of needle exchange for years–released the damning statistics about the persistent H.I.V. epidemic the same week that the President chose the course of least resistance. No doubt the C.D.C. chiefs recall that after a comprehensive review of scientific studies which the Administration tried (and failed) to conceal in 1995, they stated: “We conclude that the ban on Federal funding of [needle exchange programs] should be lifted to allow communities and states to support [those programs] as components of comprehensive H.I.V. prevention.”
Politics clearly overruled science in this instance, a circumstance that provokes howls of protest from conservatives whenever they perceive such distortions by environmental or consumer advocates. Because they oppose needle exchange on “moral” grounds, however, conservatives in Congress scared the White House into backing down.
Assistance was provided by Barry McCaffrey, the retired general appointed by Mr. Clinton to run the Office of National Drug Control Policy. The drug czar, as he is known, told the President that needle exchange would somehow legitimize drug abuse. Aside from the ludicrous image of children across America suddenly shooting up because of a bureaucratic decision, Mr. McCaffrey claimed to possess hard information that lent weight to his prejudices.
In the closing weeks of the White House internal debate over needle exchange, Mr. McCaffrey sent a letter to members of Congress declaring that two field studies in Canada had proved the programs don’t work. His message made Congressional leaders feel secure in their enduring ignorance. They confidently repeated his citation of those studies as if they knew what they were talking about.
Unfortunately for the drug czar, the professors who authored those studies said publicly a few weeks ago that he had misunderstood their research. In an Op-Ed article in The New York Times , Julie Bruneau and Martin T. Schechter not only contradicted Mr. McCaffrey but endorsed needle exchange. While they found that addicts who participated in the Vancouver and Montreal needle exchanges showed higher rates of infection than those who did not, that proved nothing.
“Because these programs are in inner-city neighborhoods, they serve users who are at greatest risk of infection,” the professors explained. “Those who didn’t accept free needles often didn’t need them since they could afford to buy syringes in drugstores.” “They were also less likely to engage in the riskiest activities.” If anything, they suggested, the real problem in the two Canadian cities was too few free needles, not too many. Breaking the stereotype of jealous, competitive academia, they cited a competing study in the British medical journal The Lancet that showed that in cities with active needle exchange programs, H.I.V. infection fell by an average of 5.8 percent a year among drug abusers; precisely the opposite was true in 51 cities without needle exchange.
Yet Mr. McCaffrey won the decision while losing the debate. His obstinacy, along with Republican threats to cut AIDS funding, persuaded the President that the cost of courage would be too high. To preserve his image as a drug warrior, the President forced Health and Human Services Secretary Donna Shalala to humiliate herself and her colleagues by admitting that needle exchange saves lives and money, but the Government won’t pay for it.
That kind of behavior too often marred Mr. Clinton’s first term but may have won him a second. And a second term should be a time to take risks in the cause of compassion.
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