I’ve worked for more than a decade in the field of HIV prevention. That means working with sex and drugs — two areas where there is no shortage of good science, and an abundance of ideology.
The science tells us, for example, that making clean needles universally available to drug injectors can more or less wipe out HIV transmission in this group. The ideology tells us that providing such services for injectors is tantamount to condoning an illegal behavior that wrecks lives and families and increases crime. If you were running for election, faced with the choice of paying for clean needles and health services for injectors or with putting more cops on the streets and cells in the jails, which do you think would play best with the voters..?
The fact is that many of the most effective public health policies have been put in place by governments that Americans think of as ideological, even undemocratic.
Iran has one of the world’s better prevention programs inside its jails, and sterile needles are available to injectors from dispensing machines around Tehran. The Kyrgyz Republic gives clean needles to prisoners. China makes needles available to injectors through pharmacies at subsidized prices…
At the local level, though, things often look different. Many cities, realizing that they would have to pick up the pieces of the nation’s failed war on drugs, have scraped out their pockets and provided services to injectors. The result has been a huge decline in new HIV infections among drug users and their sex partners; the burden on the health system has of course fallen, too…
This disconnect between national and local policies is instructive about the way democracy works. At a national level, politicians seem to respond to what they think the electorate wants to hear. Ideology and rhetoric rule. At the local level, however, they are more likely to respond to what the electorate really needs — workable solutions to real problems. The only workable solutions are the ones that are based on good, solid, scientific evidence.
In my little corner of public health, the Obama administration is following through on its promise to put the science back into policy. Since the ban on federal funding for safe injecting programs was dropped in December, the sky has not fallen, and if the government falls, it certainly won’t be because of this small piece of pragmatism.
Yes – when science goes up against ideology, Ideology usually wins!
At least, when you’re in a nation where religion trumps reason, superstition cranks up more votes than knowledge, sophistry overrules scientific research.