Care With Facts

Care With Facts

The New England Journal of Medicine is peeved at Supervisor Gavin
Newsom. The San Francisco politician's "Care Not Cash" campaign has
been using the prestigious journal's logo on its literature, implying
that journal articles uphold Newsom's central claim -- that reducing
General Assistance cash benefits to homeless people will reduce drug
use. "We do not permit anyone to use our logo," says a spokeswoman
for the Journal. "We have given the matter over to our legal
department to handle."

The logo appears on campaign literature captioned, "The New England
Journal of Medicine has found that cash-only systems cost lives."
Newsom says that he talked to the Journal and that using the logo
was "inappropriate, a mistake."

Apparently, that wasn't Newsom's only mistake.

Neither of the two Journal articles in question fully supports
Newsom's argument that stripping the homeless of cash is effective
medical or social policy. One of the articles seems to directly
oppose Newsom's thesis.

Andrew Shaner, M.D., authored one of the articles that Newsom says he
read as support for his Care Not Cash position. The 1995 study points
out that -- among cocaine-addicted veterans who are schizophrenic
and, largely, African-American -- drug use peaked after the arrival
of disability payments at the first of the month. It
concludes, "Simply discontinuing the disability payments will not
eliminate drug abuse and might exacerbate hunger and homelessness."

Shaner, who is associate director of mental health for the Greater
Los Angeles Health Care System and a professor of psychiatry at UCLA
Medical School, is not pleased that his study is being incorrectly
characterized in San Francisco. "It makes people think that I am an
archconservative," he complains in a telephone interview. "Of course,
some homeless addicts spend GA money on drugs. But taking the money
away is not the solution." He says that the people he studied have
very little in common with the diverse population of homeless people
in San Francisco; for one thing, his subjects were all chronic
cocaine users, all male, and mostly black. Not to mention 100 percent
schizophrenic.

A 1999 Journal article frequently cited by the Proposition N campaign
as supporting the Care Not Cash proposal does make a correlation
between disability payments (rather than General Assistance or
welfare payments) and deaths from substance abuse. But the study,
which reviewed 30 million death certificates, did not focus on
homeless people, or even poor people, because, "[i]nformation on
income was not available from the death certificates. However, race
was indicated on the death certificates, and in the United States,
nonwhites are considerably more likely to be poor than whites." In
other words, the study simply examined death rates of nonwhite
people, of all incomes, from substance abuse, in connection with
disability payments.

The strained use of social science to back the Care Not Cash effort
does not, apparently, stop with the New England Journal of Medicine.

Prop. N proponents, including Newsom, frequently refer to "Rand
reports" as evidence that reducing, or eliminating, biweekly checks,
and replacing them with housing, drug treatment, and other benefits,
will benefit homeless people. But a Rand organization report that
deals with the effects of the federal government's 1994 elimination
of Social Security payments for substance abusers in Los Angeles
completely contradicts Prop. N's main "scientific" prop.

The December 2000 report, available on the Web site of UC's
California Policy Research Center (http://www.ucop.edu/cprc/podus.pdf),
concluded that taking cash payments from substance abusers increased
financial burdens in other areas of government, including emergency
health care, and did not appear to help the addicts recover. "Loss
[of cash payments] was associated with more unstable housing, greater
incarceration, lack of stable employment, and decreased income."
Rand's researchers, who said they were surprised by the results of
their investigation, recommended that the federal government restore
cash benefits to people with "disabling substance abuse."
-- By Peter Byrne


sfweekly.com | originally published: September 18, 2002