Sunday, January 27, 2013

One Life to Save

One Life to Save


President Obama, in his January 16 speech on gun control, quoted an old truism: “If there’s one life that can be saved, we have an obligation to try.”  This statement, like most folk wisdom, contains a kernel of truth, but is on the whole misleading. The major problem is that it ignores that even saving a life incurs some cost, and that cost may be measured in lives itself.

For instance, requiring pleasure boats to carry life preservers does save lives, but it costs lives as well.  Life preservers have to be manufactured, and manufacturing processes entail industrial accidents, some of them deadly.  The manufactured preservers have to be trucked from factory to boaters; every additional truck on the highways adds fractionally to the total of automobile deaths.  In the example the number of lives saved far exceeds the number of lives lost, thus the requirement of life preservers is justified.  But the calculus is often not that simple.  As the life preserver example suggests, determining the actual cost can become complex, indirect and confusing.

It can also be psychologically confusing.  One favorite experiment used, with many variations, by game theoreticians and social economists involves the following scenario.  The subject is told that he controls a railroad switch and a runaway train is speeding toward it.  If he does nothing, the train will run over and kill a group of five workers trapped on the track, but if he throws the switch, the train will be diverted onto the alternate track and run over only one person trapped there.  This dilemma should be a simple one for homo oeconomicus, the rational man so beloved by classical economists.  The sacrifice of one life to save five seems the only rational thing to do.  But real people have major problems reaching this conclusion.  They make a strong moral distinction between doing nothing, even if five people die, as opposed to some positive action that will intentionally kill one person, even if five are saved as a result.  (Dan Ariely, one of the pioneering experimental economists has several books explaining social economy to the general reader and both Freakonomics volumes contain information on these issues as well.)

A cost benefit analysis of the War on Drugs is complicated by all three of these problems.  Much of the pro-Prohibition argument hinges on the theme of saving lives at any cost.  The actual costs of Prohibition are hidden by long, complex, and indirect causal chains.  Psychological and subjective feelings greatly affect the weight of the prices assigned to actions taken to ban drugs and drug use.

The absolutism of “save one life at any price” shows up in the drug law debates in many guises.  The most common is the objection that a proposed reform will “send the wrong message to the children.”  Is it really true that telling a kid his grandmother uses marijuana to help treat her cancer will lead him to become a drug addict?  Does it matter that needle exchanges lead to precipitous drops in the rate of blood-borne infections and protect the families of drug users if they hypothetically encourage one user to continue his bad habit?

Tangled causation is also problematic in analyzing drug law problems.  What causes opioid overdose deaths?  In the pre-Harrison Act era, when most opiate users were middle class and with stable home lives, overdose deaths were so rare as to be unnoticed.  When Switzerland began distributing free medicinal grade heroin to addicts, their overdose death rate dropped to … zero.  On the other hand, in drug Prohibition America, overdose deaths are frequent; frequent that is until one looks closely.  The primary fact is that most street addicts – that stereotype most people have of drug users – don’t die drug-related deaths.  They die deaths of poverty and homelessness: starvation and malnutrition, exposure and hypothermia, infections, and muggings.  Even the drug-related deaths are usually casualties of the Drug War and not consequences of drug use.  They are deaths from drug adulteration (even strychnine has been used to cut heroin), drug substitution (fentanyl for heroin, heroin for cocaine), improper injection methods (embolisms, injected particles, infections), reduced tolerance after detox, or lack of medical assistance when friends fearing arrest refusal to take an overdosing companion to the emergency room (after all, overdose itself is rarely fatal, and it operates so slowly that time to get medical assistance is available).

The Drug War also adjusts the social and psychological costs to make the drug laws appear effective.  A century ago, middle-class housewives with opiate habits were perceived and treated sympathetically, but within a decade of passage of the Harrison Tax Act addicts were objects of scorn and fear.  Drug Prohibition grew from evil Chinese luring innocent white girls into their opium dens, to cocaine-fueled Blacks on rampages of rape, to violent Mexicans stoked on their loco-weed.  Later, marijuana smokers ranged from unwashed, Un-American dropouts and war protesters to coach-locked stoners.  In short, drug users became something outside toe pale of civilization, something non-human.  Their lives and well-being dropped out of the cost analysis entirely.

A proper study of the utility of the drug laws means that these complications must be accounted for.  The costs of action must be balanced against the usually overlooked or miscalculated costs of action.  Drug reformers must insist on a balanced and fact-based argument.

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