Source: San Francisco Chronicle (CA)
Pubdate: Sun, 26 Apr 1998
Author: Louis Freedberg


LAST WEEK, President Clinton appeared in the Rose Garden and made his
toughest comments yet about the tobacco settlement currently stalled in
Congress. ``We have the opportunity and obligation to put aside politics
and act in the interests of generations of our children,'' he said.

Yet just hours earlier the same day, he had made an entirely different
calculation when it came to providing federal funds to supply clean needles
to drug addicts at risk of getting AIDS.

Just before Clinton's Rose Garden appearance, Health and Human Services
Secretary Donna Shalala had gathered with the most distinguished public
health officials and scientists in the federal government.

They included luminaries such as Dr. Harold Varmus, director of the
National Institutes of Health, and Dr. David Satcher, the newly appointed
surgeon general.

For months the administration had led AIDS activists to believe that
science would drive its decision. To that end, Shalala had commissioned
Varmus and eight leading government officials to review the latest research
on the needle exchange.

They showed up on Monday morning with their 200 page report which came to
an unequivocal conclusion: needle exchange programs work in preventing
AIDS, and do not encourage drug use.

Then she unexpectedly -- and without explanation -- announced that the
administration would not lift the ban on using federal funds for needle
exchange programs, despite the fact that the conditions laid down by
Congress to lift them had been met. Clearly politics, not science, had
prevailed. The administration went to bat for children who are at risk of
dying of lung cancer, and stayed on the bench when it came to children at
risk of dying of AIDS.

It is true the issue presented a political minefield for the White House.
GOP lawmakers were poised to reinstate the ban on federal funding, and
conservatives threatened to turn it into a major campaign issue. Some
Clinton aides feared lifting the ban could jeopardize other AIDS programs,
including needle exchange programs initiated with local and private funds.

Nonetheless, leaders in the fight against AIDS felt that the science was so
incontrovertible that Clinton should take a stand on the issue. Even
Clinton's own AIDS ``czar,'' Sandra Thurman, had insisted that the decision
on whether to lift the ban should be based on science alone.

Some activists are wondering how Thurman can continue in her post, now that
the rug has been pulled from under her feet by none other than President
Clinton. The same could be asked of other public health leaders such as
Surgeon General Satcher, and even Shalala, whose charge it is to protect
the public health.

They now find themselves in the position of having to support policies that
run contrary to the very ones they recommended -- policies that protect
some children from lung cancer, but leave others at risk of contracting a
fatal disease called AIDS.

)1998 San Francisco Chronicle