Saturday, March 24, 2007

In Support of Minding One's Own Business

The Lancet is in the headlines once again - this time for a highly "revised" ranking of recreational drugs by harmfulness.

The last time it was in the headlines was last fall - for its publication of a hugely flawed population survey estimation of excess deaths in Iraq. The trouble there was that the population sampling method used - while superficially similar to those used in other epidemiological surveys - was biased toward overreporting deaths. (Rather than starting with a randomly-chosen household within their randomly-selected clusters and then surveying, in linear fashion, each house at a pre-selected offset from the starting point, they simply surveyed all the neighbors of the house at the starting point. Obviously this will overestimate the deathrate in times of war - which is why most population surveys are careful to skip a fixed number of households between their survey points. If a bomb goes off in a given location, say, then all the neighbors are also affected by the bomb, whereas the other clusters will simply average out to reproduce the baseline. So you're pretty much guaranteed to get a number that's much higher than the actual deathrate. If you skip houses at a predetermined offset, however, then the effects of the hypothetical bombing incident make it into your survey - as they should - but are not overcounted.) Conveniently, it came out just before the midterm elections.

This is a similarly politically-motivated article. Unfortunately for me, I find myself agreeing with it, and so I no longer have a uniform opinion on the political bias at The Lancet. Heh. Such is life.

The "controversy" here is that cannibis and ecstasy are apparently less "harmful" than alcohol and tobacco on their revised survey. But from me that just gets a "well, DUH!"

I mean, it really ought to be obvious to everyone that marijuana is less harmful than either tobacco or alcohol. The only reason people continue to think alchohol is "safer," honestly, is because of a sustained (and hugely expensive) 70-year propaganda and police campaign against marijuana. I don't know that much about ecstasy, but the few people I know who have been regular users seem to think it's less harmful than alcohol.

Of course, it all depends on what you mean by "harmful," and here's where the Lancet report gets a bit sketchy. They've deliberately redefined "harmful" to take into account the drug's effect on people around the user:

The classifications were based on individual drugs' so-called "harm scores" -- the physical damage to the user; how likely the drug was to induce dependency; and the effect of its use on families, communities and society.

Actually, for purposes of public policy, I think this is a better method. What's always struck me as particularly ridiculous about the War on Drugs is that its proponents claim to be "helping" the people they beat up and throw in the slammer. Preposterous! All other things being equal, adult citizens have a right to decide for themselves what they consume and in what quantities. Leaving aside the question of whether throwing someone in jail can ever be "for his own good" (which is hugely implausible at least in the US, where prison is a veritable hell that doesn't even attempt to reform), it just isn't, or shouldn't be, the government's job to police peoples consumption habits! The only time that "all other things are NOT equal" is if you can make the case that citizen X's drug abuse somehow violates citizen Y's rights - or at least poses some kind of danger for or puts some kind of burden on the polity at large. In other words, public policy about drugs should never consider harm to individuals - it should only ever be concerned with harm to the larger community.

By this standard, it's fairly clear to me that alcohol and tobacco are bigger culprits than marijuana. Naturally, we'll want to have laws that prevent people from smoking marijuana in public where others can't avoid it. But aside from that minor point, marijuana poses no danger for the general public that I can see. Marijuana users are mellow, don't generally beat people or start fights or cause major injuries on the job. In fact, given that it's such a great stress reliever, I think the country would in general be better off if more people smoked it, but that's me.

However, I'm not sure that "damage to society" is an appropriate measure for "harmfulness" in a medical journal. Now, to their credit, "harmfulness to society" is only one of the factors that the Lancet considers. They take damage to the individual into account too. Nevertheless, medical journals should stick to the medical facts. Deciding how relatively harmful marijuana and alcohol are is more properly the realm of Sociology (though, naturally, medical science should inform the Sociologists' conclusions).

I think this kind of thing is in general an unfortunate trend in science these days. It seems like people are becoming more and more concerned with the political implications of their studies and are, as a result, paying less attention to whether they are scientifically appropriate. Division of labor is a beautiful thing; it's what makes a modern economy vibrant. People specialize, and then we are able to trade expert-produced goods between experts (rather than homemade stuff between households). So - in some important sense people should stick to their specialties.

I'm not saying, mind you, that doctors aren't allowed to have political opinions. Just that in their capacities as medical researchers they should publish research that is, well, medical.

The weak link in this chain, really, is the politicians. I think science wouldn't need to be so political if politicians were in general doing their jobs better. Ideally, "politician" should be one of the divisions of labor like any other, and politicians should concern themselves with public policy in the same way that medical researchers concern themselves with medical research. Unfortunately, there is no appropriate training program for politicians. It's not something you major in or specialize in. And so we end up with a nation run by people who aren't experts at what they're doing. If they were, then presumably they would understand the important distinction between private rights and public conerns - but they do not. It is to their shame that medical researchers feel the need to lecture them on this point.

But back to science. I think the Global Warming controversy is probably the best example of scientists overstepping their bounds. It's one thing to report that the world is warming and speculate about what the consequences might be. It's quite another thing to presume that your capacity as a climatologist qualifies you to decide which public policies are appropriate to the problem. Where it becomes a major concern is when climatologists start exaggerating their findings and/or harassing other climatologists who don't toe the party line out of frustration with (what they percieve to be) the inactivity of politicians. We seem to be well past that point.

In any case, as much as I personally agree with the "findings" in The Lancet on the relative dangers of drugs, I'm not convinced, I guess, that they're really medical "findings." More's the pity.


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