THESE DAYS it is hard to find an authority that is not struggling with the high price of drugs. In England, the authorities are fighting Vertex, a drug business enterprise, over the value of a drug for cystic fibrosis, Okami. In America, diabetics have died because of the excessive value of insulin. In the Netherlands, the authorities for a time stopped shopping for the immuno-oncology drug, Keytruda, as it was too high priced—even though it had helped to develop it. The listing charge of Orkambi is about $23,000 a month in America, and Keytruda is about $13,600 month (for as long as treatment continues). It has taken such wealthy-world dramas to pressure the unaffordability of medicines to the top of the worldwide health schedule, even though poorer international locations have complained about it for decades.
On May twentieth governments started tackling the issue at the World Health Assembly (WHA), an 8-day policy discussion board in which health ministers define the desires for the World Health Organisation for the coming yr. There is a lot for them to talk about, which includes the expansion of everyday health care, antimicrobial resistance, the impact of weather change on health and the deepening disaster of Ebola within the Democratic Republic of Congo. Yet the hottest topic is the high charge of new drugs, particularly most cancers tablets. The dust jacket of Michael Massing’s The Fix summarizes his thesis in bold red letters: “Under the Nixon Administration, America Had an Effective Drug Policy. WE SHOULD RESTORE IT. (Nixon Was Right).” That is a pretty extraordinary claim to make regarding an administration that gained office in large part through the “Southern Strategy” that had at its heart Nixon’s declaration of a “War on Drugs” and whose policies created the cocaine epidemic that caused so many new concerns a decade later. At most, I would agree that the Nixon administration’s pursuit of a fundamentally bad policy included some worthwhile efforts that have been devalued by every subsequent administration. This was not because Nixon or his closest advisers were right about drug policy but because Nixon was more interested in foreign policy issues and his benign neglect of domestic policy allowed a number of positive developments to blossom in the midst of the mire of incompetence and corruption that characterized his presidency.
Perceptively concluding that “policies being formulated in Washington today bear little relation to what is taking place on the street,” Massing attempts to depict the real effects of drug policy at the street level. Unfortunately, he doesn’t rely on the epidemiologic evidence or read the careful analyses conducted by researchers like myself who have systematically examined what is truly taking place on the street. Instead, he relies on the journalist’s usual — and usually misleading — tool of dramatic anecdotes.
Massing’s anecdotal case is presented through the stories of Raphael Flores and Yvonne Hamilton. Flores runs Hot Line Cares, a drop-in center for addicts in Spanish Harlem. Hot Line Cares, which Flores founded in 1970, is essentially just a cramped office in of an otherwise abandoned tenement where Flores and his staff advise and assist addicts who want to get into treatment. Given the fragmented state of drug abuse treatment in New York City, and in most other American communities, it is no easy task to connect addicts with appropriate care and even harder to connect them with adequate aftercare. Massing writes, “If a Holiday Inn is full, it will at least call the Ramada down the street to see if it has a vacancy. Not so two treatment programs”
Yvonne Hamilton is a crack addict trying to get her life together. Massing describes her trials and tribulations as she copes with her illness and makes her way through New York City’s treatment non-system. It is an affecting story and well told. The author presents it as an argument for treatment and perversely as an argument against decriminalization or legalization. But she is one of the many examples that show that prohibition does not prevent addiction. And improvements in her drug problem seem to have less to do with the treatment she did receive than with changes in her life situation.
These two lives provide a touchstone to which his narrative will later return. The middle third of the book shifts dramatically in tone as Massing chronicles the evolution of the war on drugs in Washington. During Nixon’s tenure, the government spent more money on treatment (the “demand” side) than on stopping drug trafficking (the “supply” side), which he argues led to declines in both drug overdoses and crime rates. As successive presidents felt pressure to emphasize the “war” rather than treatment, he asserts that the number of chronic addicts skyrocketed. In the third and last section Massing returns to Spanish Harlem, where Hamilton continues a difficult struggle to remain drug-free and Flores struggles to keep his center afloat and to keep from falling into addiction himself.
It is the second part of the book that is the heart of Massing’s thesis. It is a tale that is familiar to those of us who are active in the field of drug policy and, in addition to scholars, other journalists have told it before — Dan Baum (1996) and Mike Gray (1998) doing so particularly well — but I will summarize (with some details Massing missed or left out) the history of drug policy under Nixon for the reader who is not familiar with the story.