McCaffrey tells you what to do with the evidence
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:
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.
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.
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.