Wednesday, December 23, 2015

Is the "one in five" campus sexual assault statistic a myth?

As someone who frequently watches CollegeHumor videos, I became interested into the apparent backlash against one of their recent videos about college sexual assault, entitled "What If Bears Killed One In Five People?" At the end of the video we are informed that by the time they graduate college, one in five women will be sexually assaulted. In this post I will try to answer the following questions:
1. Is the survey on which that claim is based flawed to the point where its conclusions are invalid?
2. To what extent, if at all, can its results be generalized to every college in the US?
3. What do more recent studies suggest about the prevalence of sexual assault in college women?

The answer to the first and second questions can be found in an excellent Washington Post article by Glenn Kessler. Other criticisms can be found here and here. With respect to flaws in the study (which was called the "Campus Sexual Assault Study" (or CSAS) and released in 2007), they include:

a) The survey's high non-response rate, which may have led to a bias where those who had been victims of sexual assault were more likely to complete the questionnaire.
b) Using an overly broad definition of sexual assault that includes "attempted forced kissing” and intimate interactions while intoxicated. (See the Time story for both of the above criticisms.) Two researchers who worked on the study also said that if you only consider "unwanted sexual penetration", the number drops to about 1 in 7
c) Overly broad wording that defines "incapacitation" too broadly, so that it includes not just being unconscious or barely conscious, but also being under the influence to the point of impaired judgment. This matters because 70% of the reported assaults in the study involved incapacitation by either alcohol or drugs.

With respect to the second question, the study in question only surveyed two (large) colleges, which makes it difficult to generalize to every college in the country or even to all other large colleges, as James Fox has pointed out. In fact, even two of the researchers involved in this study acknowledged that it was "
not a nationally representative estimate of the prevalence of sexual assault".
3. A more recent survey by the Association of American Universities suggests the actual figure is 23% for unwanted sexual contact, or, for the more narrow category of such contact including penetration or oral sex, 11% of female college students. However, this survey has also been criticized by, among others, James Cantor, its co-principal investigator, who told Slate that the 27 colleges (hey! more than two, that's an improvement) it surveyed are not nationally representative. This problem is one it shares with the CSAS (see b) above). It also has some other problems in common with the CSAS, such as a low response rate (19%), which, as Cantor himself points out, may lead to just the type of bias discussed above under a). This survey has also been criticized for, like the CSAS, using a too-broad definition of sexual assault--it included in this category “sexual touching: touching someone’s breast, chest crotch groin, or buttocks—grabbing, groping or rubbing against the other in a sexual way, even if the touching is over the other’s clothes.”

Another more recent pair of surveys from both Rutgers and the University of Michigan also reached conclusions on par with "one in five": Rutgers' survey found that exactly this proportion of female undergrads had experienced "unwanted sexual contact" since arriving on campus, while UMich's found that "22 percent of female students said they had been assaulted in the last year." Notably, the Rutgers survey also found that almost 1/4 of its undergrad women were victims of "sexual violence" before they even arrived at college. However, it is worth noting that this survey also defined "sexual violence" very broadly: besides the obvious, um, actually violent stuff, it also included "persistent sexual advances or unwanted remarks about their physical appearance."

In conclusion, what we should all be able to agree on is that citing only the CSAS as proof that 1 in 5 American women is sexually assaulted while in college, as both Obama and Biden have done, is completely unjustified. Now, it is also clear that the available data from other surveys suffers from many and, in some cases, all of the same methodological problems as the CSAS (not being nationally representative, low response rates, and broad definitions of sexual assault). Unfortunately it seems that data that exists is too flawed to support claims about how often women in US colleges in general are sexually assaulted.






Friday, December 11, 2015

The US criminal justice system: fundamentally flawed or working just fine?

I am posting about the criminal justice system--a non-medical subject--simply because it interests me, which overrides the medical focus of this blog. In fact, the sex offender post suggests this blog should be viewed more as about science & public policy than medicine specifically.

I have recently become engrossed with the subject of the criminal justice system in this country. This includes everything from whether it is racist, to whether mass incarceration is bad or not, and, by extension, whether we need to change it. If we do, presumably we need to do so by letting more prisoners out, especially drug offenders, as the US government did just two months ago. (1) But if not, then the increasing push to release more prisoners to undo the "damage" purportedly caused by mass incarceration is misguided, because, as Heather Mac Donald put it, "mass incarceration isn’t the problem. Rising crime is." (2)


First of all, to address MacDonald's claims, we need to answer the question of whether there is something wrong with our system of mass incarceration, which gave us the highest incarceration rate in the world beginning in 2002, (5) until we were surpassed by the Seychelles. As of this February, our incarceration rate was the second-highest in the world. (3) Our prison population more than quadrupled from 1980 to 2014. (4) 


As I mentioned before, many claim that the war on drugs has made a huge contribution to this phenomenon--even Obama said this July that "Over the last few decades, we’ve also locked up more and more nonviolent drug offenders than ever before, for longer than ever before, and that is the real reason our prison population is so high.” (6) This contention has been criticized, though, for overstating how important the War on Drugs has been in the incarceration rate increase in this country. 


As of this July, there are 207,847 people incarcerated in federal prisons. Roughly half (48.6 percent) are in for drug offenses. (6) However, there were, at the time, way more people in state prisons than in federal prisons--1,358,875, of whom about 16 percent had a drug offense as their most serious offense. (6) If you released all these offenders, the incarceration rate in the US would drop from 725 to 625 per 100,000 people. This is a big drop, but our country's incarceration rate would still be an outlier even then. (6)


So what did cause it? The 
National Research Council said in 2014 that the answers are "increases both in the likelihood of imprisonment and in lengths of prison sentences". (6) They also said, contrary to Mac Donald's claim that the US' incarceration rate is high because our crime rate is high, "changes in crime trends or in police effectiveness as measured by arrests per crime contributed virtually nothing to the increase in incarceration rates over the 30-year period. Rather, the growth can be attributed about equally to the two policy factors of prison commitments per arrest and increases in time served." (6) page 53 One scholar proposed that from 1975 to 1991, a major factor was the increasing crime rate, saying that "about half of prison growth during that period was due to rising crime." After that, he argues that we are sending a higher proportion of people to prison, and that this caused the incarceration rate to rise after 1991, when the crime wave ended. (7) 

The problems with mass incarceration include spending: "state spending on corrections increased 400 percent between 1980 and 2009." (4) A 2014 NRC report recommended that "
Given the small crime prevention effects of long prison sentences and the possibly high financial, social, and human costs of incarceration, federal and state policy makers should revise current criminal justice policies to significantly reduce the rate of incarceration in the United States." (8) According to the New York Times' editorial board, "From 1980 to 2000, the number of children with fathers in prison rose from 350,000 to 2.1 million." (9) Similarly, a 2012 study found that 51% of black fathers had been incarcerated before their child's 5th birthday, (10) and this makes it more likely that their children will become delinquent. (18) Other research has also shown that the effect of incarceration (and booking) on parents being engaged with their kids does disproportionately affect black people. (19)


Is this phenomenon racist? A 2004 study found that at the end of 2002, there were more black men in US jails and prisons with sentences longer than one year than either white men or Hispanic men. The same study found that the main reason for both the rise of the prison population and its racial disparity is the War on Drugs, stating this with surprising clarity despite the evidence noted above. (11) 


The question of whether the War on Drugs is racist is most simply answered by asking two questions: 

1. Who uses/deals illegal drugs more, whites or blacks?
2. Who gets arrested/sent to prison for drug offenses more, whites or blacks?

The answer to the first question, if you look at surveys of use, appears to be either neither (with both races using them at about the same rate) or white people (with respect to both using (12) and dealing (13)(14)). However, these numbers have been called into question because it has been shown that black people are much more likely to underreport their own illegal drug use than white people. (20)


As for the second question, the answer is clearly blacks, with some studies finding them ten times more likely to be arrested for drug crimes than whites. (12)(14) With respect to marijuana, one study found that black people were nearly 4x as likely to be arrested for marijuana possession than white people in 2010, "even though the two groups used the drug at similar rates." (15) However, this study used data from a survey (the 
National Survey on Drug Use and Health), (21) which, as noted above, calls its validity into question.


Even if the War on Drugs is not racist, it is still clear that black people and other minorities tend to receive longer sentences than white people, a finding common to numerous studies. One study found that black men received sentences that were almost 10% longer than those of comparable white men arrested for the same crimes. (22) In response, it is often claimed that black people commit more or worse crimes than white people do, but in fact, although this is part of the explanation for the racial disparity in prison populations, another point is worth noting: to quote from a 2008 study, since the late 1980s, "black involvement in violent crime has declined substantially, but racial disproportions have not." (23)

Other factors that make it more likely that your sentence will be longer include being male and having a low level of education or income. (29) Other research, however, suggests that although black prisoners receive longer sentences than white prisoners, Hispanic prisoners receive the longest sentences of all. (28) In any case, numerous studies have shown that Hispanics, Native Americans', and black people's sentences are longer than those of white people, and these differences can't entirely be explained by characteristics of the offenses. (30) (31)

If we return to the issue of incarceration, the main reasons it happened, according to the aforementioned NRC report, were the following changes that happened in the 1960s and 70s: "...prison time was increasingly required for lesser offenses; time served was significantly increased for violent crimes and for repeat offenders; and drug crimes, particularly street dealing in urban areas, became more severely policed and punished." (8) (see page 3) 


Ultimately, we must answer the question of what, if any, are the benefits from continuing mass incarceration when it has already come this far. First of all, it is worth pointing out that, at least at first, increasing the prison population does reduce crime rates, according to research by Steven Levitt, he of "abortion reduces crime" fame. (24) However, it's worth noting that this study was published almost 20 years ago, in 1996, so it's quite possible that incarceration is not as effective now as it was then. Why? Well, the University of Chicago explains that "We expect the benefits to society from locking up each additional criminal to decline as the number of people imprisoned increases, assuming that the criminal justice system is at all good at its job and prioritizes the most criminally active or dangerous people for imprisonment first." (24) Thus, it should be no surprise that a report released this February by the Brennan Center for Justice found that mass incarceration played only a small role in the crime decline that has occurred since 1990: from 1990-1999 it contributed to about 5% of the decline, and from 2000-2013 it contributed to essentially none of it. (25) Another study, published in 2012, found that the effects of increasing the prison population on reducing crime were much smaller from 1991 to 2004 than they were from 1971 to 1990. (28) Other recent studies have found that at this point, locking more people up may actually increase crime rates, (26) which may be because, according to another study, longer prison sentences make it more likely that prisoners will reoffend and less likely that they will get jobs after they are released, "Any benefit from taking criminals out of the general population is more than off-set by the increase in crime from turning small offenders into career criminals." (32)

In short, Heather Mac Donald and the other defenders of mass incarceration are vanishingly small and dwindling for a reason: they're flat wrong. The system does need to be reformed, and it's good that our government is taking a step in the right direction.
Sources:

1. http://time.com/4072182/prisoners-release-6000/
2. http://www.wsj.com/articles/obamas-tragic-let-em-out-fantasy-1445639113
3. http://www.politifact.com/punditfact/statements/2015/feb/23/john-legend/fact-checking-john-legends-claim-we-live-most-inca/
4. https://news.vice.com/article/the-mass-incarceration-problem-in-america
5. http://www.prb.org/Publications/Articles/2012/us-incarceration.aspx
6. http://fivethirtyeight.com/datalab/releasing-drug-offenders-wont-end-mass-incarceration/
7. http://www.slate.com/articles/news_and_politics/crime/2015/02/mass_incarceration_a_provocative_new_theory_for_why_so_many_americans_are.html
8. http://www.nap.edu/read/18613/chapter/2#9
9. http://www.nytimes.com/2014/05/25/opinion/sunday/end-mass-incarceration-now.html
10. http://www.ncbi.nlm.nih.gov/pubmed/22239385
11. http://www.jstor.org/stable/40040178
12. http://healthland.time.com/2011/11/07/study-whites-more-likely-to-abuse-drugs-than-blacks/
13. https://www.washingtonpost.com/news/wonk/wp/2014/09/30/white-people-are-more-likely-to-deal-drugs-but-black-people-are-more-likely-to-get-arrested-for-it/
14. http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.300699
15. http://www.nytimes.com/2013/06/04/us/marijuana-arrests-four-times-as-likely-for-blacks.html
16. 
17. http://www.nationalreview.com/corner/417539/no-war-drugs-not-forcing-black-men-out-society-roger-clegg
18. http://onlinelibrary.wiley.com/doi/10.1111/j.1745-9125.2011.00253.x/abstract
19. http://tpj.sagepub.com/content/88/2/179.short
20. http://link.springer.com/article/10.1093%2Fjurban%2Fjti065
21. https://www.washingtonpost.com/news/wonk/wp/2013/06/04/the-blackwhite-marijuana-arrest-gap-in-nine-charts/ Figure 21. Note that the image says its data is from the "National Household Survey on Drug Abuse and Health", which appears to be the wrong name.
22. http://www.jstor.org/stable/10.1086/677255?seq=1#page_scan_tab_contents
23. http://www.jstor.org/stable/10.1086/588492?seq=1#page_scan_tab_contents
24. http://pricetheory.uchicago.edu/levitt/Papers/LevittTheEffectOfPrison1996.pdf
25. http://www.usnews.com/news/articles/2015/02/12/mass-incarceration-didnt-lower-crime-but-can-congress-be-convinced
26. http://scholarworks.umass.edu/open_access_dissertations/636/
27. http://qz.com/458675/in-america-mass-incarceration-has-caused-more-crime-than-its-prevented/
28. http://www.jstor.org/stable/2657543?seq=1#page_scan_tab_contents
29. http://www.jstor.org/stable/10.1086/320276
30. http://onlinelibrary.wiley.com/doi/10.1111/j.0038-4941.2004.00255.x/abstract?userIsAuthenticated=false&deniedAccessCustomisedMessage=
31. http://link.springer.com/article/10.1023/A:1015258732676
32. http://www.jstor.org/stable/10.1086/664073

Tuesday, December 1, 2015

Do Sex Offender Laws work?

In 1994, states in the US were required to create sex offender databases. Then, two years later, Megan's Law allowed these databases to be made public. (1) Besides having your name visible to the public, being listed on such a registry also includes your address and photograph, as well as what you were convicted of (though this often lacks context). (2) But surely those on these registries have all committed some horrible crime against a child? Not so: actually, according to Human Rights Watch, "at least five states required men to register if they were caught visiting prostitutes. At least 13 required it for urinating in public (in two of which, only if a child was present). No fewer than 29 states required registration for teenagers who had consensual sex with another teenager. And 32 states registered flashers and streakers." (2) So, surprise, surprise, the number of sex offenders in the U.S. has increased dramatically recently: in December 2008, there were 674,000, (1) and by October 2014, there were 760,000. (1)

In addition to being listed on a registry, some convicted sex offenders are denied access to the internet, (1) and (in my home state of Georgia), all such offenders "are barred from living within 1,000 feet of anywhere children may congregate, such as a school, a park, a library, or a swimming pool. They are also banned from working within 1,000 feet of a school or a child-care centre." (2)

What are the effects of these laws on the offenders themselves? Research shows that "social stigmatization, loss of relationships, employment, and housing, and both verbal and physical assaults are experienced by a significant minority of registered sex offenders." (4) Also, offenders often get harassed, and in some cases have been killed (which is easier when you can find out where they live). According to Jill Levenson of Lynn University, half of offenders also have trouble finding jobs. (2)

All these laws are based on the premises that:

1. having committed a sex offense means you will be likely to do so again, and that
2. sex crimes committed against children are commonly committed by strangers.

The problem is that research suggests that these premises are both false. First of all, one study found that, unlike the seemingly baseless 75-90% rates often cited by politicians advocating tougher sex offender laws, about 5% of sex offenders in the US get rearrested for sex crimes within 3 years. (2) The US DOJ has also found that the recidivism rate is between 3 and 14 percent within "the several years immediately following release, with those numbers falling further over time." (3)

As for the assumption that lots of sex offenses are committed by people the victim did not know, research also suggests that that's false: among child victims, 93% of such offenses were committed by someone the victim knew. (3)

Given the above, it should be no surprise that studies have failed to find evidence that these laws work. For instance, a study by Kristen Zgoba found that the New Jersey sex offender registration/warning system did not affect the number of sex crimes in that state. (2) Another study, published in 2008, looking at Megan's Law found that it "showed no demonstrable effect in reducing sexual re-offenses." (1) Yet another study (this one from 2011) concluded that its results "do not support the hypothesis that sex offender registries are effective tools for increasing public safety." (5)

Therefore, it is clear that these laws need to be reformed to bring them in line with evidence. What should be done, specifically, is: 

  1. abolish registries, at least until such time as it becomes possible to tell which offenders will reoffend, 
  2. tighten the requirements for being listed as a sex offender
  3. eliminating the bullshit rules prohibiting offenders from living within a certain distance of a school or other places children may congregate, which as discussed above is based on the false premise that they are likely to abuse more children. 
Not that they shouldn't be punished, of course--but jail time is enough.



Sources:

1. http://america.aljazeera.com/articles/2014/10/17/challenges-to-sexoffenderregistries.html

2. http://www.economist.com/node/14164614

3.http://www.slate.com/articles/news_and_politics/jurisprudence/2014/08/sex_offender_registry_laws_have_our_policies_gone_too_far.html

4. http://ccj.sagepub.com/content/21/1/67.short

5. http://www.jstor.org/stable/10.1086/658483

Wednesday, November 18, 2015

Would gun control work in the U.S.?

There are lots of studies that have been done looking at the effectiveness of gun control when it was implemented in the past. I will look over some of these below.

The first type I will discuss looked at what happens to death rates after gun control laws are passed. One such study design looks at trends in gun deaths before and after such laws are passed, as happened in Victoria, Australia from 1979 to 2000. During this time, two mass shootings occurred there, in 1988 and 1996, both of which led to gun control laws being passed. A 2004 study found that "Dramatic reductions in overall firearm related deaths and particularly suicides by firearms" occurred after these laws were passed. Another similar study found that after the gun control law Bill C-51 was enacted in Canada in 1977, gun suicide rates fell significantly. Similar results were found in yet another study of New Zealand's 1992 gun control law on gun suicides in that country. The study concluded, "Following the introduction of legislation restricting ownership and access to firearms, firearm-related suicides significantly decreased, particularly among youth." 


Some gun-rights advocates argue that people who want to kill themselves "often find a way to do so — guns or no guns." The implication is that gun control won't work because suicidal people will just switch to another means if they can't find a gun. However, a 2006 study of Australia's gun control laws found "No evidence of [a] substitution effect for suicides or homicides," and a 2003 study 
in the U.S. looking only at suicide, and a 1998 review, reached similar conclusions. A 2005 review also said that "the risk of substitution or displacement towards other methods seems small." 

Other studies have looked at the correlation between gun availability and homicide/suicide rates. Without citing any studies, the Cato Institute claims that "the facts show that there is simply no correlation between gun control laws and murder or suicide rates across a wide spectrum of nations and cultures." So does the evidence support this claim? A 2000 study found that "Across developed countries, where guns are more available, there are more homicides." Another study from 2002 found that "A disproportionately high number of 5–14 year olds died from suicide, homicide, and unintentional firearm deaths in states and regions where guns were more prevalent." There is also a more recent study which looked at 4 handgun laws (waiting periods, universal background checks, gun locks, and open carrying regulations) in the United States. This study found that "Each law was associated with significantly lower firearm suicide rates and the proportion of suicides resulting from firearms. In addition, each law, except for that which required a waiting period, was associated with a lower overall suicide rate."


I have gotten tired of writing this, because there are so many studies available on this subject, so I'll end it with a systematic review which concluded that "Access to firearms is associated with risk for completed suicide and being the victim of homicide." So much for guns making us safer. 

This post was originally going to be much longer, and address more arguments about both why (according to gun rights activists) gun control wouldn't work and whether it is constitutional. But then I got tired of doing research on this, and later of doing research on gun control's effectiveness, so I cut it short.
























Sources:



http://www.businessinsider.com/why-guns-are-a-divisive-issue-in-america-2015-7

http://www.usnews.com/debate-club/did-the-sandy-hook-shooting-prove-the-need-for-more-gun-control
http://www.usnews.com/debate-club/should-high-capacity-ammunition-magazines-be-banned
http://injuryprevention.bmj.com/content/10/5/280.short
http://www.amsciepub.com/doi/abs/10.2466/pr0.1993.72.3.787
http://www.tandfonline.com/doi/abs/10.1080/j.1440-1614.2006.01782.x
http://www.nationalreview.com/article/423192/gun-control-suicide-rates-ezra-klein
http://injuryprevention.bmj.com/content/12/6/365.short
http://www.wsj.com/news/articles/SB10001424052970203764804577059841672541590
http://www.sciencedirect.com/science/article/pii/S0001457505000400
http://journals.lww.com/jtrauma/Abstract/2000/12000/Firearm_Availability_and_Homicide_Rates_across_26.1.aspx
http://www.newyorker.com/magazine/2012/04/23/battleground-america
https://www.law.cornell.edu/wex/second_amendment
http://www.cato.org/publications/commentary/gun-control-myths-realities
http://www.ncbi.nlm.nih.gov/pubmed/26270305


Saturday, November 14, 2015

The case for and against legalizing marijuana (Part II: Economics)

Note: If you haven't read the first part of this series, do so now by clicking here.

A study by the ACLU found that enforcing marijuana possession laws cost the 50 states in the US $3.6 billion in 2010. (1) Even the White House's Office of National Drug Control Policy (ONDCP) (which opposes legalization) acknowledges this, but responds by saying that "While Federal, state, and local laws pertaining to marijuana do lead to criminal justice costs, it is important to understand how decriminalization or legalization might further exacerbate these costs.  Alcohol, a legal, carefully regulated substance, provides useful context for this discussion.  Arrests for alcohol-related crimes, such as violations of liquor laws and driving under the influence, totaled nearly 2.5 million in 2010 — far more than arrests for all illegal drug use, and certainly far more than arrests for marijuana-related crimes. It is therefore fair to suggest that decriminalizing or legalizing marijuana might not reduce the drug’s burden to our justice and public health systems with respect to arrests, but might increase these costs by making the drug more readily available, leading to increase [sic] use, and ultimately to more arrests for violations of laws controlling its manufacture, sale, and use." (2) The problem is that not only did this not happen in Colorado after marijuana was legalized in 2012, marijuana arrests dropped there by 95%. (3)


As discussed in the previous post in this series, marijuana legalization would lead to increased use. (4)(5) As also discussed in the previous post, marijuana is not harmless, so there would be adverse public health effects if marijuana use was legalized. So how bad would they be? One way to answer this, or at least try to do so, is look at the economic cost of such effects.


Some opponents of legalization warn that it would lead to an increase in drugged driving. However, in Colorado, after marijuana was legalized, highway deaths actually dropped considerably. (6)  


Then there is the clearest economic benefit from legalization--tax revenue. Just this past June, Colorado collected $9.7 million in marijuana sales taxes. (7) The legal marijuana industry in Colorado has an estimated value of $700 million. (8) And yet the ONDCP still says that "research suggests that the economic costs associated with use of the drug could far outweigh any benefit gained from an increase in tax revenue." (2) They then go on to claim that illegal drugs cost America $193 billion in 2007, and although the link provided is dead, I was able to revive it through the Wayback Machine. (9) It seems that the word "marijuana" is used a total of 4 times in this document (which was produced by the now-defunct National Drug Intelligence Center, a division of the DOJ), and each time, nothing specific is said about this drug's impact as compared with that of other illicit drugs. Therefore, it seems misleading to conflate marijuana with other illegal drugs in this way as the ONDCP does. 


The ONDCP then cites a RAND Corporation report (10) which found that marijuana legalization in California would probably lower the price of marijuana (before tax) by more than 80%. Presumably, what they are arguing is that if the price drops, revenue will be much lower than expected as well because taxes are proportionate to price. They then say that "higher prices help keep use rates relatively low." In other words, a decrease in price, such as the one predicted by RAND, would, according to the ONDCP's logic, seem to lead to an increase in use. Sure, this might, conceivably, lead to more adverse health effects among the public, but it would also lead to more tax revenue being collected. 


But perhaps the most misleading argument advanced by the ONDCP is an implicit equating of marijuana with alcohol in the following analysis: "The tax revenue collected from alcohol pales in comparison to the costs associated with it.  Federal excise taxes collected on alcohol in 2009 totaled around $9.4 billion; state and local revenues from alcohol taxes totaled approximately $5.9 billion.  Taken together ($15.3 billion), this is just over six percent of the nearly $237.8 billion adjusted for 2009 inflation) in alcohol-related costs from health care, treatment services, lost productivity, and criminal justice." (2) The implication is that legalizing marijuana would lead to huge societal costs because of the harms of marijuana and their huge economic costs. Presumably, if marijuana is illegal and alcohol legal, the ONDCP would have us believe that, despite the evidence discussed last post, the economic cost of alcohol is less than that of marijuana! As mentioned above, this seriously undermines their credibility because the two drugs are quite different. 


Let's review: enforcing marijuana laws is expensive and way fewer people would be arrested for violating these laws if marijuana were legalized, as the Colorado experience shows. More people would use it, but Colorado's experience also suggests that the effects on driving wouldn't be as bad as some had predicted. Maybe we wouldn't make as much money from taxes because the price would go down, but if that does happen, use will go up, which would counteract the price decrease and make tax revenue go back up. Saying that it will be just like alcohol only makes sense if they are both equally harmful, but they aren't. And the boost to the economy independent of taxes would be significant as well. Economically, like medically, there doesn't seem to be a very good argument against keeping marijuana illegal.




Sources:

1. http://www.huffingtonpost.com/2013/06/04/marijuana-arrests-cost-racially-biased_n_3385756.html
2. https://www.whitehouse.gov/ondcp/frequently-asked-questions-and-facts-about-marijuana
3. http://www.ibtimes.com/marijuana-arrests-colorado-down-95-legalization-arrest-rates-still-twice-high-blacks-1866294
4. http://www.rand.org/pubs/working_papers/WR770.html
5. http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03561.x/abstract
6. https://www.washingtonpost.com/news/the-watch/wp/2014/08/05/since-marijuana-legalization-highway-fatalities-in-colorado-are-at-near-historic-lows/
7. http://time.com/4003262/colorado-pot-revenue/
8. https://www.washingtonpost.com/news/wonk/wp/2015/02/12/colorados-legal-weed-market-700-million-in-sales-last-year-1-billion-by-2016/
9. http://web.archive.org/web/20110526175318/http://www.justice.gov/ndic/pubs44/44731/44731p.pdf
10. http://www.rand.org/content/dam/rand/pubs/occasional_papers/2010/RAND_OP315.pdf

Sunday, November 8, 2015

The case for and against legalizing marijuana (Part I: health)

The issue of whether to legalize marijuana (recreationally, not medically, to be clear) is a depressingly politicized one, which I will try to get to the bottom of here (though this is of course a task far too daunting for one blog post, so I won't cover everything out of necessity). At least one politician has been caught claiming that marijuana is "infinitely worse" than tobacco. (1) But if you read the New York Times (which 1.87 million people do every day) (3) you may hear that in criminalizing marijuana the federal government has "inflict[ed] great harm on society just to prohibit a substance far less dangerous than alcohol." (4) The implication to all these statements is that legal drugs should be those that aren't that harmful compared to their illegal counterparts. So are there any studies comparing the safety of marijuana with that of legal drugs?

The answer appears to be yes, but not as many as one would expect, given that this issue is so important with respect to drug laws and so widely discussed. Or at least, I would expect. One of the most highly publicized studies in this area was published earlier this year, to considerable media attention. (5) Its conclusions were that alcohol and tobacco are considerably more harmful than marijuana. In fact, at one point, the authors say that alcohol is the highest-risk drug, while pot is the lowest-risk one. They also point out that their results are in line with those of Nutt et al., (6) whose (also highly publicized) results found that marijuana was overall the 8th most dangerous drug, with alcohol and tobacco in 1st and 6th places, respectively. 

So what does this mean? If it is true that, as discussed above, marijuana is safer than tobacco or
alcohol, does that mean we have to legalize it? Not necessarily, because economic issues could arise that would make doing so unfeasible, and this will be discussed in the next post. Nevertheless, it suggests that our current drug laws don't really make sense, as Nutt et al. noted ("the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.") (6) So there are two ways to fix this: we could make alcohol illegal, or we could make the illegal drugs that are less dangerous than it legal (or both). The former, of course, has already been tried, and it failed--or at least that's what everyone thinks. Even the Times started out its pro-legalization op-ed by saying that "It took 13 years for the United States to come to its senses and end Prohibition, 13 years in which people kept drinking, otherwise law-abiding citizens became criminals and crime syndicates arose and flourished." (4) Since this post is about health, I will focus on three words in the previous quote: "people kept drinking". The problem with this claim is that it's not true: alcohol consumption plummeted during prohibition, as did death rates from cirrhosis and hospital admissions for alcoholic psychosis. (7) 

So this means that, presumably, making something illegal makes people use it less, and vice versa. For this reason, the White House argues that "
Increased availability and acceptability of marijuana would likely lead to increased consumption of the drug," which, in turn, "leads to higher public health and financial costs for society." (8)

The research suggests that marijuana is not harmless, but that it is nowhere near as harmful as tobacco or alcohol, both of which are, of course, legal. This in-between status makes it hard to decide what to do with it--legalization advocates want to drag it to the (almost) harmless side, but their opponents want to exaggerate its dangers.

I think that marijuana legalization is justifiable from a public health perspective only if we make alcohol and tobacco (which kill 3.3 million (9) and almost 6 million people per year (10)) illegal, in order to be consistent. At the very least, keeping it in the schedule I category is clearly unjustifiable.

Part 2 of this series will be titled "The case for and against legalizing marijuana (Part II: economics)".




Sources
1. http://www.chicagotribune.com/news/opinion/chapman/ct-marijuana-legalization-canada-mexico-perspec-1108-20151106-column.html
2. https://www.whitehouse.gov/ondcp/ondcp-fact-sheets/marijuana-legalization
3. http://www.bloomberg.com/news/articles/2013-04-30/new-york-times-leads-major-newspapers-with-18-circulation-gain
4. http://www.nytimes.com/interactive/2014/07/27/opinion/sunday/high-time-marijuana-legalization.html
5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311234/
6. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61462-6/abstract (full text http://www.sg.unimaas.nl/_old/oudelezingen/dddsd.pdf)
7. http://www.nytimes.com/1989/10/16/opinion/actually-prohibition-was-a-success.html
8. https://www.whitehouse.gov/sites/default/files/ondcp/issues-content/marijuana_and_public_health_one_pager_-_final.pdf
9. http://www.who.int/mediacentre/factsheets/fs349/en/
10. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/