The Changing Face Of Cancer In The Bahamas
Tribune242 Insight
Nassau, The Bahamas
This year nearly 1,000 Bahamians will be told they have cancer. Today around 5,000 are living with the disease but this could soar to over 10,000 by 2020 because of the remarkable advances on the horizon. There has been an explosion in our understanding of cancer as a disorder of growth control of the body's cells and we are now poised to see some incredible advances in its prevention, detection and treatment.
Cancer is associated with age - the longer we live the more likely we are to get the disease. So as healthcare round the world gets better people live longer and so the number of people with cancer inevitably rises. Of course young people and children can get cancer too but fortunately it's much rarer. You can reduce your risk of getting cancer by not smoking and eating a healthy diet - eating plenty of fresh fruit and vegetables and avoiding too much fatty food. Exercise also reduces cancer risk. Going for screening tests such as mammography and cervical smears allows cancer to be detected at an earlier phase in its evolution.
If you get any of the following symptoms you should go and see your doctor.
* A lump somewhere on your body.
* Changes in a mole on your skin.
* A cough or hoarseness that won't go away.
* A change in bowel habits.
* Difficulty in swallowing or continuing indigestion.
* Any abnormal bleeding.
* A sore or ulcer that won't heal.
* Difficulty passing urine.
* Unexplained weight loss.
* Unexplained pain.
* Feeling very tired all the time.
Cancer screening is a source of much debate. At the interface between public health, specialist care, economics and policy, it creates tensions between professional groups, politicians, the media and the public. A screening test may be cheap, but applying it to a population (with rigorous quality control and effective processing of patients with abnormal results) creates a huge workload and therefore cost. Screening can also have profound psychological effects on individuals. People with false-positive results require investigation and yet are usually eventually found not to have cancer. Unless screening can be shown to reduce the death rate from a specific cancer, the resources used are better spent on improving care, and this has led to disparities in screening recommendations between countries.
The Human Genome Project is likely to provide both new approaches to cancer risk assessment and new challenges for developing screening strategies, by risk banding populations based on changes in cancer risk genes.
Cancer is classified by the tissue in which it arises. It is a disease caused by normal cells changing so that they start to grow in an uncontrolled way. The uncontrolled growth causes a lump called a tumour to form. If not treated, the tumour will cause problems in one or more of the following ways:
* Spreading into normal tissues nearby.
* Causing pressure on other body structures.
* Spreading to other parts of the body through the lymphatic system or bloodstream.
* Causing failure of a major organ system.
* Disrupting blood flow to critical parts of the body.
There are over 200 different types of cancer because there are over 200 different types of cells in the body. The four commonest types are prostate, breast, lung and colon cancer. The initial abnormality is called the primary cancer. But it can also spread - a process called metastasis - from two Greek words meta meaning change and stasis meaning place. When cancer spreads it can damage critical organs such as the liver, lungs and brain. This ability to spread to secondary sites makes cancer potentially lethal as it can then interfere with vital body functions. Each primary site has its own characteristic pattern of spread. So breast cancer goes to bone, liver and lung whilst colon cancer likes to spread through the veins draining into the liver. Each primary cancer has its own characteristic age distribution. So breast cancer is common in women between 40 and 60 whilst prostate cancer occurs two decades later. Cancer can also occur in children although it's rare. Many children's cancers can be effectively cured by a combination of complex treatments.
Doctors that specialise in treating cancer are called oncologists. Usually the diagnosis of cancer is made by a surgeon. A biopsy is the key to making the diagnosis. This is just a piece of tissue removed by a surgeon using either a needle or by removing a larger sample under an anaesthetic. Many symptoms can be caused by cancer - the most important piece of advice is to go to your doctor if you have any progressive problem that doesn't right itself after two weeks. The biopsy sample is sent to the pathology laboratory and examined under the microscope. The pathologist is able to recognise the characteristic cancer cells with their disordered growth pattern and classify them in a way useful to the oncologist.
Once a diagnosis is made the next step is to find out how far the cancer has spread - a process called staging. We have several classification systems to stage cancer. Put simply, stage I disease is confined to the organ in which the first abnormal cells arose, stage II usually involves spread to neighbouring lymph nodes, stage III to other organs locally and stage IV widely around the body. To determine the stage of a cancer a range of diagnostic tests are used. These include blood tests, ultrasound, CT and MRI scans and sometimes some special investigations that may require going to Miami or Fort Lauderdale. The reason staging is important is that it really makes sure that the best treatment plan for an individual patient can be determined. Once the diagnostic tests are completed the oncologist creates the treatment plan. This can involve one or several of the following:
Surgery
Surgery may be used to confirm a diagnosis, find out more about a cancer, as a treatment to remove the cancer or for reconstruction of part of the body. There are some excellent surgeons in the Bahamas who are able to carry out very effective treatments for most types of localized cancer.
Radiotherapy
Radiotherapy is the use of high energy rays to destroy cancer cells. It may be used to cure some cancers, to reduce the chance of recurrence or for symptom relief. There is a state of the art service run by The Cancer Centre, Bahamas using a very modern machine which provides a very effective service. Radiotherapy has to be given each day for several weeks. Going to the US for treatment is no longer necessary. Instead the Cancer Centre in Collins Avenue can provide the latest precision based techniques, including intensity modulated radiotherapy - the gold standard in terms of precision delivery. There are three radiation therapists working in Nassau, including Professor Arthur Porter who for several years was Director of the Radiation Therapy Department in Detroit.
Chemotherapy
There are over 150 different chemotherapy drugs that may be used alone or in combination. Different drugs cause different side effects and may be given in a variety of ways. Some cancers respond well to chemotherapy - others less so. Many of the drugs are given by infusion into a vein. Specialist nurses are usually responsible for giving chemotherapy although the oncologist decides on the exact prescription. In Nassau chemotherapy is given at Princess Margaret Hospital, The Cancer Centre, Bahamas, Doctors Hospital and in some doctors' offices. Most of the drugs can be given in a day unit without the need to be admitted to hospital.
Biological therapies
Biological therapies use substances that occur naturally in the body to destroy cancer cells. They include monoclonal antibodies, cancer growth inhibitors, vaccines and gene therapy. They are a very fruitful area for further research.
Hormonal therapies
Hormonal therapies alter the way hormones which occur naturally in the body affect cancer cells. They're most commonly used to treat breast and prostate cancer.
Supportive therapies
Supportive therapies can be given in addition to or as part of the main treatment. They include steroids, blood or platelet transfusions and bisphosphonates to strengthen damaged bone.
Clinical trials are medical research trials involving patients. They are carried out to try and find new and better treatments. Patients take part in trials in all areas of medicine, not just in cancer and not just to test treatment. For example, a clinical trial might be used to compare different ways of diagnosing an illness, or it might test techniques for preventing a particular cancer. Carrying out clinical trials is the only sure way to find out if a new approach to cancer care is better than the standard treatments currently used. Without trials, there is a risk that patients could be given treatments which have no advantage, waste resources and might even be harmful to them.
The Future
Dramatic progress is likely in surgery, radiotherapy and chemotherapy leading to increased cure but at a price. The completion of the human genome project will bring sophisticated genetic risk assessment requiring careful integration into screening programmes. And excellent palliative care to relieve pain and suffering must be a basic right. The next twenty years will be a time of unprecedented innovation.
Cancer will become a chronic illness, joining conditions such as diabetes, heart disease and asthma. These will impact on how people live but do not inexorably lead to death. Long-term survival will be normal even for many patients with cancers that have spread from their primary site. The political importance of cancer is huge, as voters perceive it as the most pertinent issue in health today.
Cancer treatment is undergoing a revolution. Within twenty years cancer will be a chronic disease, joining conditions such as diabetes, heart disease and asthma. These conditions impact on the way people live and not inexorably lead to death. The model of prostate cancer, where many men die with it rather than from it, will be common for most cancers. Progress will be made in prevention. Even greater progress will be made in understanding the myriad causes of cancer.
When a cancer does develop, refinements of current technologies - in imaging, radiotherapy and surgery - together with the availability of targeted drugs will make it controllable. Cure will still be sought, but will not be the only satisfactory outcome. Patients will be closely monitored after treatment, but fear that cancer will definitely kill, still prevalent today, will be replaced by an acceptance that many forms of cancer are a consequence of old age. Looking into the future is fraught with difficulties. Who could have imagined in the 1980s the impact of mobile phones, the internet and low-cost airlines on global communication? Medicine will be overtaken by similarly unexpected step changes in innovation.
More patients will benefit from better diagnosis and newer treatments, with greater emphasis on quality of life. Innovation will inevitably bring more inequality to health.
The outcome of the same quality of care differs today between socio-economic groups and will to continue to do so.
Governments will need to ensure health equity for all their constituents. Living long with good quality life even with cancer will be an achievable goal in this century.
May 02, 2011
Tribune242 Insight
An International Caribbean Online Log about the news and opinions in the Americas and World. This Caribbean Blog of global reach and appeal is maintained by Bahamian Blogger - Dennis Dames with all readers and subscribers in mind.
Thursday, May 5, 2011
Wednesday, May 4, 2011
African Guyanese have become second class citizens and political aliens
By Dr David Hinds
They have pounced on Tacuma Ogunseye because he called on African Guyanese to join marches in the villages to press for their inclusion in official decision making in a country they have inhabited for centuries. Marches by Africans are now Guyana’s weapons of mass destruction, according to our rulers.
Ogunseye’s critics conveniently ignore the gist of his message: Guyana cannot be a civil society if half of its population is treated as political aliens. Ogunseye is responding to the psychological, economic, cultural and political violence perpetrated on African Guyanese in the name of democracy. Yet he is the one who is being accused of racial violence.
Even some who profess to be friends of African Guyanese, including those who now sit in parliament because of African Guyanese votes, were quick to condemn Ogunseye. But as the calypsonian, Cro Cro, once told African-Trinidadians in song: “Black Man. Alyuh look fuh dat.”
All of this points to something in Guyana that does not inspire confidence that we could become a racially inclusive nation anytime soon. Three things have become clearer in the last few months. First, the East Indian cabal that controls the PPP is committed to the notion that never again will the representatives of African Guyanese get their hands on political power. Second, The African Guyanese people are being punished by this cabal for the excesses of the PNC when it governed. The message is clear: If African Guyanese want to survive in Guyana they must cooperate with and vote for the PPP. Third, the PPP cabal is confident that they have bought over enough African Guyanese from villages, towns, media and unions who are willing to engage in race-trading their fellow Africans.
My political outlook has been shaped in part by two currents in Guyanese political tradition -- black nationalism and multiracialism. For me the two are interrelated -- one is not a negation of the other. When Indian Guyanese were bullied by an African cabal, I joined with others in confronting that cabal.
As a young man, I, along with two fellow Buxtonians, walked into Freedom House and joined Gail Teixeira, Vibert DeSouza, Shirley Edwards and other PPP people in the Worker’s Stage, a PPP cultural group. We went to mainly Indian villages and performed for them. It was our way of showing our solidarity with a people under attack in their own country.
Like Tacuma Ogunseye, I joined the WPA -- not the PNC. We are Africans who once put our lives on the line in defense not just of African freedom but also the freedom of Indian Guyanese to live with dignity in Guyana. I am forever proud of that.
It pains me to witness what our once comrades-in-arms have done to our struggle. I am angered by their willingness to use Africans to do their dirty work. When Prime Minister Sam Hinds and President Jagdeo lecture Tacuma Ogunseye on multiracialism I scream to high heavens. What do these men know of multiracial struggle? They should be thanking Ogunseye every day -- they could not hold their lofty titles had it not been for Ogunseye's multi-racial struggle.
But we shall not be silenced. If I have a voice let me use it in defense of the vulnerable and the disrespected -- in this case African Guyanese. I am ready to say some things “without water in meh mouth.”
African Guyanese have been progressively reduced to second class citizens and political aliens in Guyana. The ethno-racial cabal that has governed Guyana for most of the last nineteen years are the worst rulers in our modern history. They have engaged in the worst form of ethnic politics. Ten years ago it was marginalization. Today I call it colonization-internal colonization of Africans.
I join Freddy Kissoon in declaring this government an elected dictatorship -- an elected ethno-racial dictatorship. They have given democracy a bad name. This PPP government is worse than anything Burnham ever dreamt of. They have not rigged elections. They have instead rigged the government, the treasury and the state of Guyana.
I end with this promise -- I will be at the front of those marches for power sharing. For therein lies the most viable possibility of ethno-racial wholeness in Guyana.
May 4, 2011
caribbeannewsnow
They have pounced on Tacuma Ogunseye because he called on African Guyanese to join marches in the villages to press for their inclusion in official decision making in a country they have inhabited for centuries. Marches by Africans are now Guyana’s weapons of mass destruction, according to our rulers.
Ogunseye’s critics conveniently ignore the gist of his message: Guyana cannot be a civil society if half of its population is treated as political aliens. Ogunseye is responding to the psychological, economic, cultural and political violence perpetrated on African Guyanese in the name of democracy. Yet he is the one who is being accused of racial violence.
Even some who profess to be friends of African Guyanese, including those who now sit in parliament because of African Guyanese votes, were quick to condemn Ogunseye. But as the calypsonian, Cro Cro, once told African-Trinidadians in song: “Black Man. Alyuh look fuh dat.”All of this points to something in Guyana that does not inspire confidence that we could become a racially inclusive nation anytime soon. Three things have become clearer in the last few months. First, the East Indian cabal that controls the PPP is committed to the notion that never again will the representatives of African Guyanese get their hands on political power. Second, The African Guyanese people are being punished by this cabal for the excesses of the PNC when it governed. The message is clear: If African Guyanese want to survive in Guyana they must cooperate with and vote for the PPP. Third, the PPP cabal is confident that they have bought over enough African Guyanese from villages, towns, media and unions who are willing to engage in race-trading their fellow Africans.
My political outlook has been shaped in part by two currents in Guyanese political tradition -- black nationalism and multiracialism. For me the two are interrelated -- one is not a negation of the other. When Indian Guyanese were bullied by an African cabal, I joined with others in confronting that cabal.
As a young man, I, along with two fellow Buxtonians, walked into Freedom House and joined Gail Teixeira, Vibert DeSouza, Shirley Edwards and other PPP people in the Worker’s Stage, a PPP cultural group. We went to mainly Indian villages and performed for them. It was our way of showing our solidarity with a people under attack in their own country.
Like Tacuma Ogunseye, I joined the WPA -- not the PNC. We are Africans who once put our lives on the line in defense not just of African freedom but also the freedom of Indian Guyanese to live with dignity in Guyana. I am forever proud of that.
It pains me to witness what our once comrades-in-arms have done to our struggle. I am angered by their willingness to use Africans to do their dirty work. When Prime Minister Sam Hinds and President Jagdeo lecture Tacuma Ogunseye on multiracialism I scream to high heavens. What do these men know of multiracial struggle? They should be thanking Ogunseye every day -- they could not hold their lofty titles had it not been for Ogunseye's multi-racial struggle.
But we shall not be silenced. If I have a voice let me use it in defense of the vulnerable and the disrespected -- in this case African Guyanese. I am ready to say some things “without water in meh mouth.”
African Guyanese have been progressively reduced to second class citizens and political aliens in Guyana. The ethno-racial cabal that has governed Guyana for most of the last nineteen years are the worst rulers in our modern history. They have engaged in the worst form of ethnic politics. Ten years ago it was marginalization. Today I call it colonization-internal colonization of Africans.
I join Freddy Kissoon in declaring this government an elected dictatorship -- an elected ethno-racial dictatorship. They have given democracy a bad name. This PPP government is worse than anything Burnham ever dreamt of. They have not rigged elections. They have instead rigged the government, the treasury and the state of Guyana.
I end with this promise -- I will be at the front of those marches for power sharing. For therein lies the most viable possibility of ethno-racial wholeness in Guyana.
May 4, 2011
caribbeannewsnow
Tuesday, May 3, 2011
Haitian Shantytowns are a major problem in The Bahamas
The shantytown problem
thenassauguardian editorial
Tragedy hit a Haitian community again last week. This time it was in what is one of the largest Haitian communities in the country — The Mud in Marsh Harbour, Abaco.
A large fire destroyed an estimated 30 homes, leaving many homeless. Luckily, no one died as a result of the fire. It was the third major fire in the shantytown in recent years.
In New Providence, two shantytowns were destroyed by fire since late last year.
Shantytowns are a major problem in The Bahamas.
In 2009, then Minister of State for Immigration Branville McCartney said that 37 shantytowns had been identified in New Providence alone.
The government has commissioned various studies on the shantytown problem.
A recent report completed by the Department of Environmental Health Services on these so-called Haitian villages warned that they pose a tremendous risk to public health.
With houses having been built too close together, with some homes being powered by stolen electricity connected by low hanging wires, and with large communities with inadequate or no sewerage systems, these shantytowns are public health hazards.
For some reason, especially in New Providence, the agencies of the government responsible for policing this problem have failed.
More aggressive action on this problem is needed for the sake of the Haitians living in shantytowns and for the Bahamians who live nearby.
When proper sanitation and safety protocols are not followed, mass tragedy could ensue from fire or disease. Last week’s fire could have led to the deaths of hundreds.
For the Bahamians who live near shantytowns, their property values are reduced because of the unsanitary communities next door. This is unfair to hardworking, honest citizens of the country.
The problem is, in part, that governments of The Bahamas have been unable to regulate effectively the flow of people from the failed Haitian state. Those looking for a better life have just set up communities on any vacant land.
Once the illegal structures are built, for humanitarian reasons, it is hard to destroy them. Where do you send the poor and stateless once their homes are removed?
We must not let genuine concern for our brothers and sisters from the south to overrule commonsense, however. Illegally built shantytowns need to be removed.
Those migrating to The Bahamas must find legal and safe accommodation. We cannot continue to ignore this problem. It is a matter of law, order and public safety.
No one in this country should be allowed to ignore public health and town planning regulations. The laws exist to keep us safe and to protect property rights.
The government should next move to rigorously enforce the public health and property laws being violated by many who reside in shantytowns across the country.
5/2/2011
thenassauguardian editorial
thenassauguardian editorial
Tragedy hit a Haitian community again last week. This time it was in what is one of the largest Haitian communities in the country — The Mud in Marsh Harbour, Abaco.
A large fire destroyed an estimated 30 homes, leaving many homeless. Luckily, no one died as a result of the fire. It was the third major fire in the shantytown in recent years.
In New Providence, two shantytowns were destroyed by fire since late last year.
Shantytowns are a major problem in The Bahamas.
In 2009, then Minister of State for Immigration Branville McCartney said that 37 shantytowns had been identified in New Providence alone.
The government has commissioned various studies on the shantytown problem.
A recent report completed by the Department of Environmental Health Services on these so-called Haitian villages warned that they pose a tremendous risk to public health.
With houses having been built too close together, with some homes being powered by stolen electricity connected by low hanging wires, and with large communities with inadequate or no sewerage systems, these shantytowns are public health hazards.
For some reason, especially in New Providence, the agencies of the government responsible for policing this problem have failed.
More aggressive action on this problem is needed for the sake of the Haitians living in shantytowns and for the Bahamians who live nearby.
When proper sanitation and safety protocols are not followed, mass tragedy could ensue from fire or disease. Last week’s fire could have led to the deaths of hundreds.
For the Bahamians who live near shantytowns, their property values are reduced because of the unsanitary communities next door. This is unfair to hardworking, honest citizens of the country.
The problem is, in part, that governments of The Bahamas have been unable to regulate effectively the flow of people from the failed Haitian state. Those looking for a better life have just set up communities on any vacant land.
Once the illegal structures are built, for humanitarian reasons, it is hard to destroy them. Where do you send the poor and stateless once their homes are removed?
We must not let genuine concern for our brothers and sisters from the south to overrule commonsense, however. Illegally built shantytowns need to be removed.
Those migrating to The Bahamas must find legal and safe accommodation. We cannot continue to ignore this problem. It is a matter of law, order and public safety.
No one in this country should be allowed to ignore public health and town planning regulations. The laws exist to keep us safe and to protect property rights.
The government should next move to rigorously enforce the public health and property laws being violated by many who reside in shantytowns across the country.
5/2/2011
thenassauguardian editorial
Sunday, May 1, 2011
Big Money and Politics in The Bahamas
Big Money and Politics
The Bahama Journal Editorial
Nassau, The Bahamas
While practically everyone talks a good talk concerning the need for campaign finance reform in the Bahamas; practically no one wants to do anything real about the matter.
This is most unfortunate.
With but months to go before general elections must be called, there are some Bahamians who loath the extent to which politics in this country seems to be driven by money; and therefore by the men and women who are rich enough to buy practically everything their little hearts desire.
Today’s word on the street is to the effect that, some of these men and women of the deep pockets are sometimes minded to fund this or that party – evidently expecting some return on their ‘investments’.
Evidently, practically no one would ever step into the light and confess that, this is why they give; or for that matter, ever say that, when they give, they expect some return for the funds they dole out.
We could quite frankly speaking care less about what people say about the purpose to which their money might or might not be put; but for sure, we are fully cognizant of the fact that, we live in a very real world where talk is cheap and where [by the same token] money buys land.
And that there is an intimate relationship between money and power is – as they say a no-brainer; since this is just the way things are in a place where money always means so very much.
The problem that arises – as far as we can surmise – rests with the extent to which money [and especially Big Money] can and does on occasion go to great lengths to conceal itself and its ownership of this or that political party, individual or entity.
This leads [as day follows night] to a perception that, in such circumstances talk about free and fair elections is just so much high sounding hot air.
Nowhere is this truth as telling as it is in the realm of Bahamian politics where any numbers of political aspirants routinely tell themselves and their publics that, they are solely motivated by their desire for public service.
No one with an iota of common sense is ever fooled by these protestations.
We recount these facts as prelude to our contention that big money has played on extraordinarily large role in funding this nation's best organized political entities.
The truth of the matter is that money does talk.
It is true too that big money can be expected to 'talk big'. And so, no one should be surprised when large donors to political parties expect dividends on their investments.
What compounds this matter of the often illicit relationship between money and power is the nagging suspicion that deals are struck by politicians on the make.
When the day for payback comes, the public interest is itself vitiated and undermined. Again, what makes this matter of money even more troubling is that it is often used to create and embellish a notion that the electorate is in charge.
The picture is obviously more complex.
When millions of dollars can be secretly pumped into electoral contests, extreme questions arise concerning the integrity of the entire democratic project.
We note, too, that this problem is one which pervades politics worldwide. In the United States, for example, campaign finance reform is one of that nation's perennial problems. To their credit they have done something about it.
In The Bahamas, on the other hand, little has been done about the matter. Indeed, the record shows that the problem has gone from bad to worse, with the Progressive Liberal Party and its Free National Movement counterpart apparently getting set for an orgy of money-spending.
Big Money might yet prove pivotal in determining the outcome of general elections whenever the date arrives for Bahamians to do their thing in an environment where that thing is preceded by Big Money and its myriad of oily maneuvers.
Simply put, the elementary and undeniable fact of the matter is that the public interest cannot and will not ever be best served if money moguls can between them curry favor with political aspirants and political parties.
The public should be able to know who has paid what to whom.
The way ahead for this country is for its political leaders to so conduct themselves that no one could expect favors in return for money contributions or any other consideration.
If such were to become principled policy in The Bahamas, there would be an ensuing liberating effect on the entire political process.
Debate would be more honest and genuine leadership would be given an opportunity to have its voice heard.
For the moment, the voice of Big Money continues to drown out others, including some which have a genuine contribution to make to this nation's economic, social and political growth and development.
April 28th, 2011
The Bahama Journal Editorial
The Bahama Journal Editorial
Nassau, The Bahamas
While practically everyone talks a good talk concerning the need for campaign finance reform in the Bahamas; practically no one wants to do anything real about the matter.
This is most unfortunate.
With but months to go before general elections must be called, there are some Bahamians who loath the extent to which politics in this country seems to be driven by money; and therefore by the men and women who are rich enough to buy practically everything their little hearts desire.
Today’s word on the street is to the effect that, some of these men and women of the deep pockets are sometimes minded to fund this or that party – evidently expecting some return on their ‘investments’.
Evidently, practically no one would ever step into the light and confess that, this is why they give; or for that matter, ever say that, when they give, they expect some return for the funds they dole out.
We could quite frankly speaking care less about what people say about the purpose to which their money might or might not be put; but for sure, we are fully cognizant of the fact that, we live in a very real world where talk is cheap and where [by the same token] money buys land.
And that there is an intimate relationship between money and power is – as they say a no-brainer; since this is just the way things are in a place where money always means so very much.
The problem that arises – as far as we can surmise – rests with the extent to which money [and especially Big Money] can and does on occasion go to great lengths to conceal itself and its ownership of this or that political party, individual or entity.
This leads [as day follows night] to a perception that, in such circumstances talk about free and fair elections is just so much high sounding hot air.
Nowhere is this truth as telling as it is in the realm of Bahamian politics where any numbers of political aspirants routinely tell themselves and their publics that, they are solely motivated by their desire for public service.
No one with an iota of common sense is ever fooled by these protestations.
We recount these facts as prelude to our contention that big money has played on extraordinarily large role in funding this nation's best organized political entities.
The truth of the matter is that money does talk.
It is true too that big money can be expected to 'talk big'. And so, no one should be surprised when large donors to political parties expect dividends on their investments.
What compounds this matter of the often illicit relationship between money and power is the nagging suspicion that deals are struck by politicians on the make.
When the day for payback comes, the public interest is itself vitiated and undermined. Again, what makes this matter of money even more troubling is that it is often used to create and embellish a notion that the electorate is in charge.
The picture is obviously more complex.
When millions of dollars can be secretly pumped into electoral contests, extreme questions arise concerning the integrity of the entire democratic project.
We note, too, that this problem is one which pervades politics worldwide. In the United States, for example, campaign finance reform is one of that nation's perennial problems. To their credit they have done something about it.
In The Bahamas, on the other hand, little has been done about the matter. Indeed, the record shows that the problem has gone from bad to worse, with the Progressive Liberal Party and its Free National Movement counterpart apparently getting set for an orgy of money-spending.
Big Money might yet prove pivotal in determining the outcome of general elections whenever the date arrives for Bahamians to do their thing in an environment where that thing is preceded by Big Money and its myriad of oily maneuvers.
Simply put, the elementary and undeniable fact of the matter is that the public interest cannot and will not ever be best served if money moguls can between them curry favor with political aspirants and political parties.
The public should be able to know who has paid what to whom.
The way ahead for this country is for its political leaders to so conduct themselves that no one could expect favors in return for money contributions or any other consideration.
If such were to become principled policy in The Bahamas, there would be an ensuing liberating effect on the entire political process.
Debate would be more honest and genuine leadership would be given an opportunity to have its voice heard.
For the moment, the voice of Big Money continues to drown out others, including some which have a genuine contribution to make to this nation's economic, social and political growth and development.
April 28th, 2011
The Bahama Journal Editorial
Friday, April 29, 2011
Legalising marijuana: An exit strategy from the war on drugs
By Zoë Amerigian, COHA Research Associate
Few topics of debate are as stigmatizing and polarizing as the legalization of marijuana. For the majority of the U.S. population, the idea invokes one of two reactions: a firm guffaw at the ridiculousness of it, or a tenacious, almost blind, support of it. Regardless of their stance, most people derive their opinions from personal beliefs and unsubstantiated myth rather than unassailable fact. Disinformation on marijuana is rampant and several U.S. presidents have been stubbornly opposed to any serious discussion about marijuana legalization. National interest in the subject is evidenced by the myriad of legalization-related questions directed at the White House, yet President Obama cannot stifle his laughter every time the topic is brought up. Secretary of State Clinton brushes off the idea, vaguely dismissing the subject with “[T]here is just too much money in it,”—the implication of this statement is uncertain—while countless lawmakers simply cite “morality” in disregarding it. If the federal government is going to firmly oppose legalization, they must first establish that they have given significant consideration to the idea. Many Latin American nations, including Mexico and Colombia, the greatest victims of the drug trade, have already had serious debate about legalization. It is time for the U.S. to do the same.
There are a few “unknowns” when it comes to the marijuana industry—its effects on productivity and drug-related violence, for example. Experts need to examine these effects, and policymakers must open their ears to these experts. A government-sponsored marijuana commission is not a new idea; in fact, Nixon established one in 1972 when he formed the National Commission on Marihuana and Drug Abuse. When the commission opposed Nixon by supporting decriminalization, he ignored their recommendations and instead intensified his efforts on the “War on Drugs” campaign. This tradition of adhering to popular and personal beliefs instead of scientific facts is still common today. With the U.S. federal debt sky-high and drug-related violence in Mexico mounting, legalization is more relevant than ever and the topic is ripe for debate. Here we explore the domestic costs and benefits that the legalization of marijuana would incur, how it might affect the marijuana industry in the Americas (particularly in Mexico), and aims to debunk the multitude of popular falsehoods that surround marijuana.
Why Current Policies Are Not Working
Despite assurances from the Drug Enforcement Agency (DEA) that the current drug policy is making headway, there are clear signs that prohibition has not succeeded in diminishing drug supply or demand. Lowering demand for illegal drugs is the most effective way to lower illegal drug production—while vendors may not respond to the threat of legal repercussions, they certainly respond to market forces. As the largest consumer of Mexican drugs, it is the responsibility of the U.S. to address its own demand for marijuana. But American demand and accessibility to marijuana are not decreasing. In fact, marijuana use is currently on the rise and, although usage has oscillated in the past decades, the proportion of use among 12th graders is only a few percentage points below what it was in 1974. Eighty-one percent of American 12th graders said marijuana was “fairly easy or very easy” to acquire in 2010. In a 2009 survey, 16.7 million Americans over 12 years of age had used marijuana in the past month—that’s 6.6 percent of the total population. While the U.S. may be unable to control its own demand for marijuana, it could stop its contribution to drug cartel revenues by allowing a domestic marijuana industry to thrive, shifting profits from cartels to U.S. growers.
While figures on marijuana smuggling into the U.S. fail to provide conclusive evidence of how much of the drug is entering the country, marijuana seizures have been steady throughout the Americas in the past decade. However, this says nothing certain about actual production numbers. Domestically, the task of restricting U.S. production is becoming more difficult. Indoor crops that use efficient hydroponic systems are becoming more popular in the U.S. but pose a challenge to law enforcement agencies for a number of reasons. According to the United Nations Office on Drugs and Crime (UNODC), indoor systems:
“[have] the benefit of having lower chances of detection, high yields with several harvests per year with high potency cannabis and elevated selling prices. The equipment, knowledge and seeds for indoor growing have become very accessible… [and] The costs of building an indoor growing site can be quickly recovered.”
Cultivating high-quality marijuana is becoming easier, less risky, and more profitable even for the casual grower. The rise of indoor crops will pose a new obstacle to drug enforcement agencies in stopping marijuana production in the U.S.
The UNODC outlines other negative “unintended consequences” that have resulted from the illegality of drugs. The first is obvious; when a good is forbidden, a black market inevitably rises. Black markets inherently lack safety regulations and often finance other criminal activities. A second consequence is that treatment programs are often underfunded when the bulk of any drug policy budget is spent on law enforcement. Two other consequences have been termed “geographical” and “substance” displacement. Both terms involve the idea of the “balloon effect”: when an activity is suppressed in one area, it simply reappears in another area. Geographical displacement can be illustrated by events in Colombia, the Caribbean, and Mexico: as the U.S. cracked down on Colombian drug trafficking, smuggling routes were shifted to Mexico and the Caribbean. Drug trafficking was not eliminated, but simply moved from one site to another. Substance displacement is an even more disturbing repercussion: as availability of one drug is mitigated through enforcement, consumers and suppliers flock to alternate drugs that are more accessible. While marijuana is not a harmless substance, most would agree that it is the least harmful of illicit drugs. Some drug users may be pushed toward more dangerous substances, or “hard” drugs, because marijuana is too difficult to or dangerous to obtain. Conversely, raising the accessibility of marijuana could pull users away from hard drugs. These ramifications of the current drug control system need to be taken into account in the debate over legalization.
A critical shortcoming of U.S. drug policy is that it treats drug addiction as a crime instead of a health matter. Almost 60 percent of the overall economic cost of drug abuse is due to expenditures spent on “drug crime”—the sale, manufacture, and possession of drugs. There seems to be a wide consensus that at the very least, drug policy must shift its focus to treatment. Tarnishing someone’s record for drug use makes no sense; it encourages criminal activity by obstructing job opportunities and it does nothing to address the factors that cause drug use. Additionally, treatment is not readily accessible to those seeking help despite its efficacy in preventing future drug use. In 2009, 20.9 million Americans (8.3 percent of the total population over age 12) who needed treatment for drug or alcohol abuse did not receive it in a specialty facility—a hospital, a rehab facility, or a mental health facility. This is an unacceptably high number. The U.S. overinvests in its prohibition strategy while severely underfunding treatment options. Marijuana legalization’s potential role in improving treatment options for all drugs will be discussed later in this article; for now, suffice it to say that the status quo is not producing the desired results and requires modification.
Legalization and The Mexican Drug War
The issue of legalization has been brought to the forefront in recent years because of numerous calls by Latin American leaders to discuss the matter as a viable policy option. Presidents Juan Manuel Santos of Colombia and Felipe Calderón of Mexico, while not personally advocating legalization, have publicly called for serious discussion of the concept. Former Mexican President Vicente Fox, who previously took a hard line against drugs, has altered his public stance and now supports legalization of all drugs, especially marijuana. He argues that prohibition does not work, that drug production ends up funding criminals, and that it is the responsibility of citizens to decide whether to use drugs or not. Former Presidents Fernando Henrique Cardoso of Brazil, Ernesto Zedillo of Mexico, and César Gaviria of Colombia all supported in a report by The Latin American Commission on Drugs and Democracy that the U.S. decriminalize marijuana use (Colombia and Mexico have already done so). The U.S. has ignored these requests to place drug legalization or decriminalization on the policy agenda. Drug trafficking is not a national problem; it transcends country borders and needs to be approached from a hemispheric perspective. Therefore, the United States needs to work with its southern neighbors to formulate a comprehensive drug policy. However, it is also telling that every Latin American leader who has formally supported legalization or decriminalization has done so only after leaving office, indicating that such policies are not politically “safe” stances.
The difference between decriminalization and legalization is in their degree of leniency towards drugs; decriminalization permits drug use while legalization permits both drug use and production. Those that favor decriminalization maintain that it would enable law enforcement agencies to shift resources from prosecuting drug users to prosecuting drug suppliers. Decriminalization would also free up resources for effective drug treatment programs. Those that favor legalization go one step further than decriminalization: in Vicente Fox’s words, “[W]e have to take all the production chain out of the hands of criminals and into the hands of producers—so there are farmers that produce marijuana and manufacturers that process it and distributors that distribute it, and shops that sell it.” Legalization would include the benefits of decriminalization, while also depriving gangs and cartels of a lucrative product; if both the supply and demand sides are legitimate, a black market would become obsolete. Legalizing marijuana in the United States, the largest buyer of Mexican drugs, could potentially weaken drug cartels by limiting their sources of revenue. The UNODC has acknowledged that this is a plausible way of reducing gang and cartel profits.
Mexican and American Marijuana Markets
Eliminating the marijuana market share of Mexican cartels would hit them especially hard because it serves as a steady, reliable source of income and carries relatively little risk for them to produce. The percentage of total cartel drug revenues from marijuana is greatly debated—Mexican and American official figures range from 50-65 percent, but a study by the RAND Corporation suggests closer to 15-26 percent. Even the most conservative of these estimates—roughly a fifth of revenue—would strike a blow to cartel profits if eliminated. Marijuana is particularly valuable to cartels because they control the entire production line; they both grow and distribute it themselves, making it more reliable and less risky. Conversely, cocaine is imported to Mexico mostly from South America, heightening the risk of smuggling it. More troubling is that cartels are now even growing marijuana on U.S. public lands, mostly throughout national parks and forests, in order to avoid the task of smuggling drugs across the U.S.-Mexican border.
If Mexico were to reach the point of legalizing marijuana, the U.S. could continue to buy the drug legally from south of the border, like many other consumer goods. But even if Mexico did not implement its own legalization, recent data indicates that a domestic U.S. industry could fill the role of the supplier and eliminate the need for Mexican marijuana. The drug is increasingly grown domestically and U.S. growers are already posing a threat to Mexican market share. Exact numbers are impossible to assess, but figures of American domestic marijuana production range from 30-60 percent of the total consumed in the U.S. Additionally, a report by the RAND Corporation found that legalizing marijuana in California alone (and a subsequent rise in state-wide marijuana production) could lower Mexican cartel marijuana revenues by 65-85 percent. This could occur if Californian marijuana were smuggled to the rest of the U.S. where the drug would still be illegal. The marijuana’s projected high quality and low price would make it an extremely competitive product. It seems reasonable to assume that if the drug were legalized in all fifty states, the domestic market could easily overwhelm the Mexican market share.
In terms of tangible effects on Mexican drug violence, the RAND Corporation and UNODC agree that removing U.S. demand for illegal marijuana would increase violence in the short run because Mexican cartels would be fighting for dominance in a shrinking market. But in the long run, once U.S. demand is met by domestic supply, cartels would be financially debilitated and, most likely, some of the violence quelled. The U.S. population is by far the largest drug market for Mexico, making our action necessary for any transnational legalization to be effective. While cocaine, methamphetamines, and heroin are still funding cartels, drug violence will not be completely eliminated; but any move to starve their resources is a step forward in weakening them and, ultimately, saving lives.
The Health Effects of Marijuana
UNODC executive director Antonio Maria Costa has said that drug legalization, “may reduce the profits to criminals, but it will certainly increase the damage to the health of individuals and society.” The executive director was referring to the damage of legalizing all drugs, but the argument still stands—what are the health effects of marijuana and are they severe enough that prohibition is imperative? While legalization may seem like an attractive option to subdue Mexican drug violence, marijuana is still a drug and can have harmful effects.
Short-Term Effects
The short-term effects of marijuana are mild when compared to other drugs. These effects can last anywhere from an hour to several hours after consuming the drug, and can include increased passivity, fatigue, loss of motor skills, memory impairment, increased heart rate, an altered sense of time, delayed reaction time, loss of motivation and, more commonly found in inexperienced users, paranoia. A marijuana overdose has never been recorded in humans, even at extremely high doses. Additionally, the concept of “second-hand smoke” does not apply to marijuana; the density of marijuana smoke required to affect a bystander is so great that discussion of it is irrelevant.
Based on these effects, one of the societal dangers of marijuana could be outright laziness; however, reliable data to support whether marijuana actually lowers productivity is not currently available. The greatest danger posed by short-term marijuana effects is the risk of injury from an accident. The Drug Abuse Warning Network reported 308,547 emergency room visits due to marijuana in 2009 (by comparison, bicycles accounted for roughly 500,000 visits). The true risk of accident lies in operating a vehicle, because reaction time and motor skills are both impaired. A French survey showed that drivers who tested positive for marijuana were three times more likely to cause a fatal accident, with the likelihood increasing with blood concentration of marijuana. (The study also found that marijuana was responsible for 2.5 percent of fatal accidents, while alcohol was responsible for 28.6 percent; these results may cannot be generalized to the U.S. but are nonetheless interesting to note). Unlike alcohol breathalyzers, a highly accurate and instantaneous method of testing whether a person is “high” has yet to be developed. Some law enforcement officers have been trained to recognize signs of drug use in drivers with high rates of accuracy, but blood tests are still the most precise tool for detecting the presence and potency of marijuana in the blood stream. However, even if a driver has drugs in their system (marijuana can stay in the bloodstream for up to a month), such individuals are not necessarily impaired. A practical procedure for detecting impairment due to marijuana would be necessary to prevent driving under the influence, as well as a formalized threshold level determining at what blood content level of marijuana a driver becomes impaired.
Long-Term Effects and Questionable Experimental Methods
There are also studies linking marijuana to a myriad of long-term health disorders, including schizophrenia, reduced cognitive function, behavioral issues, lung cancer, bronchitis, brain shrinkage, infertility, memory loss, increased susceptibility to other drugs (the “gateway” effect), and addiction. This array of medical studies is probably the largest source of disinformation and myths about marijuana. They often interpret results presumptively and derive data from experiments that do not represent real life situations. Moreover, popular belief about marijuana is often based on sensational experimental results that have not been replicated—a problem that pertains especially to marijuana because, as an illegal substance, it is tricky to conduct experimental research on. In 1999, the White House Office of National Drug Control Policy commissioned the Institute of Medicine (IOM) to assess scientific studies that examined the effects of marijuana. The study has been cited as “[t]he most rigorous review of studies of smoked marijuana” by the DEA. The IOM report shed light on many of the holes in marijuana research and what conclusions could be made based on the data available at the time.
The most common mistake made in marijuana studies was the assumption of causality when only a relationship of correlation was apparent. The IOM report identifies several cases where this has occurred. One allegation is that marijuana leads to “conduct disorders” or behavioral problems. The report nullified this in pointing out that conduct disorders were usually the cause of marijuana use, noting that they were present before drug use began. Another case of assumed causality is the claim that marijuana causes psychiatric disorders, including schizophrenia; again, the report nullified this by concluding that marijuana did not cause psychiatric disorders, but had the potential to induce premature psychotic episodes in people already susceptible to such disorders. More recent evidence has shown that marijuana users develop these types of disorders roughly three years earlier than non-marijuana users. A third case of false causality, and possibly the most egregious and widespread in relation to marijuana, is the “gateway drug” theory; that, upon using marijuana, a person becomes more at risk to use other drugs. The IOM report concluded that, while correlative data supports the theory, “the legal status of marijuana makes it a gateway drug.” This statement supports the findings in the 1972 report commissioned by Nixon, which concluded that marijuana could lead to other drugs because “[the user] may eventually view himself as a drug user and be willing to experiment with other drugs which are approved by his peer group.” Marijuana has been stigmatized as an illicit drug like any other, creating the impression that its use is a small step away from, say, cocaine use. The image that marijuana is the same as hard drugs is not only false but potentially harmful. The IOM report further exonerated marijuana as the gateway drug by saying, “because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, ‘gateway’ to illicit drug use.” These cases do not illustrate the full extent to which causality is misused to vilify marijuana.* Many people point to correlations between marijuana and, for example, heroin use or education levels, as “proof” of its degenerative effects. But correlation does not signify causality; there may be a third factor causing both marijuana and heroin use, or education levels may in fact be causing drug use. A causality mechanism must be established before making conclusions about the effects of marijuana based on correlative data.
Another error that is commonly committed in marijuana studies is relying on experimental designs that do not mimic actual drug use. Specifically, experimental subjects commonly use amounts of marijuana that are extremely high and not at all representative of typical marijuana usage. For example, one experiment linking marijuana to adverse mood and paranoia was based on subjects smoking 10-22 marijuana cigarettes, or “joints”, every day. In another experiment studying withdrawal effects of marijuana, subjects smoked 9-10 joints a day as a “high dosage.” These results were then compared to other “low dosage” results where subjects smoked 6-7 joints a day. These quantities are extremely large and would indicate that typical marijuana users are “stoned” all day every day (for readers unfamiliar with marijuana, one joint is enough to make the user high for 1-3 hours). Using huge doses in experiments appears to be a routine practice with little attention being given to moderate or casual use, possibly because in smaller doses these effects are not observable. The result is that these studies may be hugely exaggerating the effects of marijuana.
Another concern about marijuana use is its potential for addiction. Abstaining marijuana users do experience some withdrawal symptoms including restlessness, irritability, insomnia, nausea and cramping but, according to the IOM report, they are “mild and subtle compared with the profound physical syndrome of alcohol or heroin withdrawal.” Marijuana (including hashish, a more potent form of marijuana) also has, at 9 percent, a relatively low percentage of users who have ever become dependent. The comparative rates of other drugs are: 32 percent for tobacco, 15 percent for alcohol, 9 percent for anxiolytics (anti-anxiety drugs), 17 percent for cocaine, and 23 percent for heroin. While there is risk of marijuana addiction, the risk is lower and the withdrawal effects less severe than those of almost all other drugs.
The only proven long-term effect of marijuana, having been extensively observed, is an increased risk of bronchitis and other pulmonary disorders. One study found that in marijuana users who smoked three to four joints a day (again, a very high dosage), symptoms of chronic bronchitis were present in roughly a fifth. These symptoms are equivalent to those of tobacco users who smoke twenty cigarettes a day. Studies linking marijuana to lung cancer have been inconclusive, and some have even shown that marijuana usage has been effective in diminishing cancerous tumors.
Marijuana is Distinct from Hard Drugs
Next to other drugs, the short-term effects of marijuana are comparatively tame. Stimulants such as cocaine, ecstasy, and amphetamines can all induce erratic behavior. Far more dangerous is alcohol, which lowers inhibitions, impairs judgment, impairs motor skills, and can induce violent tendencies in many users. More importantly, it is possible to overdose on almost any other drug besides marijuana. The long-term effects of marijuana are even more starkly different from other drugs. Long-term use of hard drugs can cause severe brain damage, cancer, and various types of organ failure; most hard drugs are also more addictive than marijuana, making it more likely that effects associated with long-term use will occur. Placing marijuana in the same category as hard drugs is a grossly inaccurate characterization.
The most important implication to draw from the IOM report is that most current studies on marijuana have used exaggerative methods and liberally interpreted conclusions. This must be given due significance when discussing legalization. The possible negative effects of marijuana that are strongly supported by science include: an increased likelihood of an accident when operating a vehicle, a premature triggering of psychosis, bronchial damage, and dependence. U.S. authorities must ask themselves if these effects are substantial enough that individual freedom should be impeded and citizens stripped of the right to use marijuana—especially while far more dangerous substances are condoned and legal.
The Economics of Legalization
The biggest fault of U.S. drug policy is that the government has spent considerable sums of money on the “War on Drugs” without getting the desired results. Proponents of legalization argue that it is not only a logical but also a highly economical policy; marijuana could be a valuable source of tax revenue if legalized and the government would save billions in law enforcement costs. But the cost of any possible repercussions must be acknowledged as well. The following calculation of legalization costs and benefits is based on government expenditures in enforcing marijuana prohibition, the societal costs of marijuana use, and the projected economic returns of legalizing marijuana.
Government Expenditures
Marijuana offenses constitute a significant portion of law enforcement activities in the United States. While it is not true that marijuana-related offenders are filling the nation’s prisons (most marijuana arrests do not result in incarceration), the court system and law enforcement agencies are hugely burdened with marijuana offenses. In 2009, 6.3 percent (858,408) of all arrests in the U.S. were because of marijuana charges; they constituted the third most common source for arrest after driving under the influence and theft. Marijuana arrests number vastly more than all violent crimes combined. Of all drug arrests, over half were for marijuana; 45.6 percent of all drug arrests were for marijuana possession alone. This is an overwhelming proportion of law enforcement and legal resources being allocated to a relatively benign crime. Exact figures of how much the government spends on marijuana prohibition do not exist, but one assessment from Harvard University, the Miron report, estimates annual government expenditures related to marijuana in law enforcement, the courts, and incarceration to be around USD 7.7 billion. Over five hundred American economists, including the late Milton Friedman, have publicly endorsed the findings of the Miron report.
Economic Costs to Society
The second part of the cost-benefit analysis is to calculate the economic costs to society of marijuana use. While society is already incurring the costs of marijuana use, there is the possibility that legalization would increase consumption43 and thus exacerbate these costs. Multiple studies have shown that decriminalization does not result in increased consumption (the commonly cited example of Alaska in the 1970s has been effectively debunked), but legalization is notably different. In addition to removing penalties for marijuana use, legalization would make the drug highly accessible and would likely decrease the price, ultimately resulting in an increase in consumption. A RAND Corporation study found that marijuana prices would be markedly lower even with substantial taxation, but that projected consumption increases varied significantly and were therefore impossible to calculate. However, the study did find with certainty that consumption would increase by some amount, so it is important to understand what societal ills might increase as well.
The Office of National Drug Control Policy (ONDCP) published a study in 2004 determining that the overall economic costs of all illicit drug abuse in 2002 totaled to about USD 180.9 billion, the third most costly health problem in the U.S. While the report did not delineate which costs are attributable to which drug, a deconstruction of the report roughly reveals which of those costs can be traced to marijuana use. The ONDCP report divides all drug abuse costs into three categories: health costs, productivity losses, and “other” costs.
ONDCP Report: Productivity Losses
Productivity losses due to drug abuse constitute the largest chunk of economic costs, coming in at 71 percent. The four primary sources of productivity losses are incarceration for drug-related charges (23 percent), drug-abuse related illness (18 percent), “crime careers” (25 percent), and premature death (29 percent).
Two of these areas, premature death and “crime careers”, hardly apply to marijuana. Premature deaths are attributable to overdose or poisoning, homicide, HIV/AIDs, and hepatitis B or C; marijuana overdose is essentially impossible and the latter diseases are attributable to injected drugs. “Crime career” is the term for when a user turns to crime to pay for their drug addiction, but these careers are usually motivated by very expensive drug habits like heroin and cocaine. The third part of productivity losses, incarceration, includes both direct drug charges and crimes committed because of drug use or addiction. Incarceration costs are largely irrelevant because legalization would eliminate marijuana arrests and because “crime careers” generally do not correlate with marijuana. Marijuana contributes little to these three areas, which make up 77 percent of all productivity losses.
The fourth major source of productivity losses is drug abuse-related illness, which is the only area that may pertain to marijuana use. However, in the “medical consequences” area of the report, the medical conditions “drug-exposed infants”, HIV/AIDs, Hepatitis B and C, and effects of violent crime are the primary cost-inducing items listed, with HIV/AIDs being the largest contributor by far. Neonatal care for drug-exposed infants is largely associated with maternal cocaine use, violent crime pertains to users addicted to expensive drugs, and, again, HIV/AIDs and hepatitis are both caused by injected drugs. Health costs caused by marijuana use would probably involve, for example, cases of bronchitis, but this was not significant enough to appear in the report. Thus, while some drug abuse-related illnesses, and productivity losses in general, could be nominally caused by marijuana use, they are overwhelmingly due to other drugs.
ONDCP Report: “Other” Costs and Health Costs
“Other” costs constitute the second-largest portion of overall economic drug abuse costs at 20 percent of the total. This category overwhelmingly consists of law enforcement and corrections expenses and thus warrants little discussion when imagining a hypothetical situation where marijuana is legal. The costs would simply disappear if marijuana were legalized. The last section, health costs, comprises only 9 percent of the total costs. This section of the report only speaks in general terms about treatment costs, so there is little information indicating how much of it comes from marijuana use. However, recalling that marijuana has much lower rates of dependence and less severe overall health effects, it could be concluded that treatment costs are moderate at most.
This analysis of the report provides evidences that, although drug abuse is an extremely costly health problem, marijuana is not a significant contributor to total drug abuse costs. There is nothing in the report that unquestionably incriminates marijuana use; the same cannot be said for other drugs, which can be blamed for drug-related illnesses, drug deaths, drug crime, and drug violence. A more marijuana-specific assessment of the economic costs would be a useful reference in the debate about legalizing marijuana (such a report, funded by the National Institute on Drug Abuse, is currently in the works). However, based on the available information, marijuana appears to be responsible for a small part of the economic costs of all drug abuse, a fraction that would likely grow if consumption increased with legalization.
Economic Benefits
The most commonly proponed benefit of legalization is the tax revenue that would be generated if marijuana were treated like any other commodity. The Miron report estimates that legalizing marijuana could generate USD 2.4 billion in annual tax revenue if taxed like other consumer goods, and USD 6.2 billion if taxed like alcohol and cigarettes. Combined with the money saved in government expenditures, that makes USD 10.1-13.9 billion in funds likely to be generated. While this is highly relevant to the dire fiscal situation in which the U.S. finds itself, it also has implications for drug policy overall. The funds from marijuana could be concentrated on drug treatment programs and lower overall drug consumption, especially of more harmful narcotic drugs that have drastic health consequences (consider that all drug abuse health costs totaled USD 16 billion in 2002). It is unknown how much treatment programs would decrease consumption. The example of Portugal, the country with the most liberal drug laws in the developed world, sets an optimistic example. After just five years of decriminalizing all drug use and putting more funding into treatment programs, the country saw astoundingly less drug use, higher treatment rates, and lowered HIV/AIDs rates. These results all point to lower overall societal costs of drug abuse. Better treatment options will certainly bring these results and legalization could be used to fund these programs.
This analysis does not exhaust every cost and benefit of marijuana legalization. There are two economic factors that have not been considered: the cost of control, regulation, and distribution of marijuana, and the economic gains of a legitimate marijuana industry. Discussion of these factors is far beyond the scope of this article, but there is one tantalizing fact to reflect on in relation to the marijuana industry: merely USD 100 of investment in equipment and seeds can produce roughly USD 9,000 of marijuana. It is an extremely lucrative product and the jobs and businesses generated by the marijuana industry could make a huge contribution to the formal economy.
There are positives and negatives to legalizing marijuana from an economic standpoint. Marijuana misdemeanors continue to place a disproportionate burden on the justice system, ensuring wasteful use of money and resources. Marijuana would bring in substantial revenues that could be diverted to treatment programs for more harmful substances. While marijuana consumption would almost certainly increase with legalization, it appears that marijuana is not responsible for most of the economic drug abuse costs of the United States. This is the haziest aspect of the cost-benefit analysis that has been tabulated; hopefully the pending marijuana report funded by the National Institute on Drug Abuse will clarify these numbers.
Conclusion
The example of Portugal’s success reminds us that counterintuitive policies might be the most effective. The federal government cannot allow myths and personal feelings to obscure what might be the right policy for the United States. Marijuana is unique from other substances in that the effects are not as severe and it remains highly popular despite the “War on Drugs.” Nation-wide use makes its prohibition expensive and possible tax revenues huge. But the discussion on legalization does not simply revolve around a cost-benefit calculation. Freedom is at issue here as well: U.S. citizens are being deprived the right to use a substance that is less harmful and has higher potential for responsible use than its legal counterparts. All of these factors need to be balanced to make a rational policy, keeping in mind that this particular issue has far-reaching implications for Latin America as well. It would be wise for U.S. policymakers to discuss legalization with Latin American leaders and to truly listen, instead of discounting their proposals. Most importantly, empirical evidence needs to be an integral part of U.S. drug policy; personal beliefs should not keep experts and data from being heard.
*One example of mistaken causality is the commonly cited statistic that 6-8% of drivers in motor accidents test positive for marijuana. Testing positive does not mean that the driver is “high”, only that they have used marijuana in the past weeks or month, depending on the user. Since roughly 7% of the population uses marijuana on a monthly basis, the 6-8% statistic, far from proving anything about the effects of marijuana, simply affirms what would already be expected.
The Council on Hemispheric Affairs, founded in 1975, is an independent, non-profit, non-partisan, tax-exempt research and information organization. It has been described on the Senate floor as being "one of the nation's most respected bodies of scholars and policy makers." For more information, visit www.coha.org or email coha@coha.org
April 28, 2011
caribbeannewsnow
Few topics of debate are as stigmatizing and polarizing as the legalization of marijuana. For the majority of the U.S. population, the idea invokes one of two reactions: a firm guffaw at the ridiculousness of it, or a tenacious, almost blind, support of it. Regardless of their stance, most people derive their opinions from personal beliefs and unsubstantiated myth rather than unassailable fact. Disinformation on marijuana is rampant and several U.S. presidents have been stubbornly opposed to any serious discussion about marijuana legalization. National interest in the subject is evidenced by the myriad of legalization-related questions directed at the White House, yet President Obama cannot stifle his laughter every time the topic is brought up. Secretary of State Clinton brushes off the idea, vaguely dismissing the subject with “[T]here is just too much money in it,”—the implication of this statement is uncertain—while countless lawmakers simply cite “morality” in disregarding it. If the federal government is going to firmly oppose legalization, they must first establish that they have given significant consideration to the idea. Many Latin American nations, including Mexico and Colombia, the greatest victims of the drug trade, have already had serious debate about legalization. It is time for the U.S. to do the same.
There are a few “unknowns” when it comes to the marijuana industry—its effects on productivity and drug-related violence, for example. Experts need to examine these effects, and policymakers must open their ears to these experts. A government-sponsored marijuana commission is not a new idea; in fact, Nixon established one in 1972 when he formed the National Commission on Marihuana and Drug Abuse. When the commission opposed Nixon by supporting decriminalization, he ignored their recommendations and instead intensified his efforts on the “War on Drugs” campaign. This tradition of adhering to popular and personal beliefs instead of scientific facts is still common today. With the U.S. federal debt sky-high and drug-related violence in Mexico mounting, legalization is more relevant than ever and the topic is ripe for debate. Here we explore the domestic costs and benefits that the legalization of marijuana would incur, how it might affect the marijuana industry in the Americas (particularly in Mexico), and aims to debunk the multitude of popular falsehoods that surround marijuana.
Why Current Policies Are Not Working
Despite assurances from the Drug Enforcement Agency (DEA) that the current drug policy is making headway, there are clear signs that prohibition has not succeeded in diminishing drug supply or demand. Lowering demand for illegal drugs is the most effective way to lower illegal drug production—while vendors may not respond to the threat of legal repercussions, they certainly respond to market forces. As the largest consumer of Mexican drugs, it is the responsibility of the U.S. to address its own demand for marijuana. But American demand and accessibility to marijuana are not decreasing. In fact, marijuana use is currently on the rise and, although usage has oscillated in the past decades, the proportion of use among 12th graders is only a few percentage points below what it was in 1974. Eighty-one percent of American 12th graders said marijuana was “fairly easy or very easy” to acquire in 2010. In a 2009 survey, 16.7 million Americans over 12 years of age had used marijuana in the past month—that’s 6.6 percent of the total population. While the U.S. may be unable to control its own demand for marijuana, it could stop its contribution to drug cartel revenues by allowing a domestic marijuana industry to thrive, shifting profits from cartels to U.S. growers.
While figures on marijuana smuggling into the U.S. fail to provide conclusive evidence of how much of the drug is entering the country, marijuana seizures have been steady throughout the Americas in the past decade. However, this says nothing certain about actual production numbers. Domestically, the task of restricting U.S. production is becoming more difficult. Indoor crops that use efficient hydroponic systems are becoming more popular in the U.S. but pose a challenge to law enforcement agencies for a number of reasons. According to the United Nations Office on Drugs and Crime (UNODC), indoor systems:
“[have] the benefit of having lower chances of detection, high yields with several harvests per year with high potency cannabis and elevated selling prices. The equipment, knowledge and seeds for indoor growing have become very accessible… [and] The costs of building an indoor growing site can be quickly recovered.”
Cultivating high-quality marijuana is becoming easier, less risky, and more profitable even for the casual grower. The rise of indoor crops will pose a new obstacle to drug enforcement agencies in stopping marijuana production in the U.S.
The UNODC outlines other negative “unintended consequences” that have resulted from the illegality of drugs. The first is obvious; when a good is forbidden, a black market inevitably rises. Black markets inherently lack safety regulations and often finance other criminal activities. A second consequence is that treatment programs are often underfunded when the bulk of any drug policy budget is spent on law enforcement. Two other consequences have been termed “geographical” and “substance” displacement. Both terms involve the idea of the “balloon effect”: when an activity is suppressed in one area, it simply reappears in another area. Geographical displacement can be illustrated by events in Colombia, the Caribbean, and Mexico: as the U.S. cracked down on Colombian drug trafficking, smuggling routes were shifted to Mexico and the Caribbean. Drug trafficking was not eliminated, but simply moved from one site to another. Substance displacement is an even more disturbing repercussion: as availability of one drug is mitigated through enforcement, consumers and suppliers flock to alternate drugs that are more accessible. While marijuana is not a harmless substance, most would agree that it is the least harmful of illicit drugs. Some drug users may be pushed toward more dangerous substances, or “hard” drugs, because marijuana is too difficult to or dangerous to obtain. Conversely, raising the accessibility of marijuana could pull users away from hard drugs. These ramifications of the current drug control system need to be taken into account in the debate over legalization.
A critical shortcoming of U.S. drug policy is that it treats drug addiction as a crime instead of a health matter. Almost 60 percent of the overall economic cost of drug abuse is due to expenditures spent on “drug crime”—the sale, manufacture, and possession of drugs. There seems to be a wide consensus that at the very least, drug policy must shift its focus to treatment. Tarnishing someone’s record for drug use makes no sense; it encourages criminal activity by obstructing job opportunities and it does nothing to address the factors that cause drug use. Additionally, treatment is not readily accessible to those seeking help despite its efficacy in preventing future drug use. In 2009, 20.9 million Americans (8.3 percent of the total population over age 12) who needed treatment for drug or alcohol abuse did not receive it in a specialty facility—a hospital, a rehab facility, or a mental health facility. This is an unacceptably high number. The U.S. overinvests in its prohibition strategy while severely underfunding treatment options. Marijuana legalization’s potential role in improving treatment options for all drugs will be discussed later in this article; for now, suffice it to say that the status quo is not producing the desired results and requires modification.
Legalization and The Mexican Drug War
The issue of legalization has been brought to the forefront in recent years because of numerous calls by Latin American leaders to discuss the matter as a viable policy option. Presidents Juan Manuel Santos of Colombia and Felipe Calderón of Mexico, while not personally advocating legalization, have publicly called for serious discussion of the concept. Former Mexican President Vicente Fox, who previously took a hard line against drugs, has altered his public stance and now supports legalization of all drugs, especially marijuana. He argues that prohibition does not work, that drug production ends up funding criminals, and that it is the responsibility of citizens to decide whether to use drugs or not. Former Presidents Fernando Henrique Cardoso of Brazil, Ernesto Zedillo of Mexico, and César Gaviria of Colombia all supported in a report by The Latin American Commission on Drugs and Democracy that the U.S. decriminalize marijuana use (Colombia and Mexico have already done so). The U.S. has ignored these requests to place drug legalization or decriminalization on the policy agenda. Drug trafficking is not a national problem; it transcends country borders and needs to be approached from a hemispheric perspective. Therefore, the United States needs to work with its southern neighbors to formulate a comprehensive drug policy. However, it is also telling that every Latin American leader who has formally supported legalization or decriminalization has done so only after leaving office, indicating that such policies are not politically “safe” stances.
The difference between decriminalization and legalization is in their degree of leniency towards drugs; decriminalization permits drug use while legalization permits both drug use and production. Those that favor decriminalization maintain that it would enable law enforcement agencies to shift resources from prosecuting drug users to prosecuting drug suppliers. Decriminalization would also free up resources for effective drug treatment programs. Those that favor legalization go one step further than decriminalization: in Vicente Fox’s words, “[W]e have to take all the production chain out of the hands of criminals and into the hands of producers—so there are farmers that produce marijuana and manufacturers that process it and distributors that distribute it, and shops that sell it.” Legalization would include the benefits of decriminalization, while also depriving gangs and cartels of a lucrative product; if both the supply and demand sides are legitimate, a black market would become obsolete. Legalizing marijuana in the United States, the largest buyer of Mexican drugs, could potentially weaken drug cartels by limiting their sources of revenue. The UNODC has acknowledged that this is a plausible way of reducing gang and cartel profits.
Mexican and American Marijuana Markets
Eliminating the marijuana market share of Mexican cartels would hit them especially hard because it serves as a steady, reliable source of income and carries relatively little risk for them to produce. The percentage of total cartel drug revenues from marijuana is greatly debated—Mexican and American official figures range from 50-65 percent, but a study by the RAND Corporation suggests closer to 15-26 percent. Even the most conservative of these estimates—roughly a fifth of revenue—would strike a blow to cartel profits if eliminated. Marijuana is particularly valuable to cartels because they control the entire production line; they both grow and distribute it themselves, making it more reliable and less risky. Conversely, cocaine is imported to Mexico mostly from South America, heightening the risk of smuggling it. More troubling is that cartels are now even growing marijuana on U.S. public lands, mostly throughout national parks and forests, in order to avoid the task of smuggling drugs across the U.S.-Mexican border.
If Mexico were to reach the point of legalizing marijuana, the U.S. could continue to buy the drug legally from south of the border, like many other consumer goods. But even if Mexico did not implement its own legalization, recent data indicates that a domestic U.S. industry could fill the role of the supplier and eliminate the need for Mexican marijuana. The drug is increasingly grown domestically and U.S. growers are already posing a threat to Mexican market share. Exact numbers are impossible to assess, but figures of American domestic marijuana production range from 30-60 percent of the total consumed in the U.S. Additionally, a report by the RAND Corporation found that legalizing marijuana in California alone (and a subsequent rise in state-wide marijuana production) could lower Mexican cartel marijuana revenues by 65-85 percent. This could occur if Californian marijuana were smuggled to the rest of the U.S. where the drug would still be illegal. The marijuana’s projected high quality and low price would make it an extremely competitive product. It seems reasonable to assume that if the drug were legalized in all fifty states, the domestic market could easily overwhelm the Mexican market share.
In terms of tangible effects on Mexican drug violence, the RAND Corporation and UNODC agree that removing U.S. demand for illegal marijuana would increase violence in the short run because Mexican cartels would be fighting for dominance in a shrinking market. But in the long run, once U.S. demand is met by domestic supply, cartels would be financially debilitated and, most likely, some of the violence quelled. The U.S. population is by far the largest drug market for Mexico, making our action necessary for any transnational legalization to be effective. While cocaine, methamphetamines, and heroin are still funding cartels, drug violence will not be completely eliminated; but any move to starve their resources is a step forward in weakening them and, ultimately, saving lives.
The Health Effects of Marijuana
UNODC executive director Antonio Maria Costa has said that drug legalization, “may reduce the profits to criminals, but it will certainly increase the damage to the health of individuals and society.” The executive director was referring to the damage of legalizing all drugs, but the argument still stands—what are the health effects of marijuana and are they severe enough that prohibition is imperative? While legalization may seem like an attractive option to subdue Mexican drug violence, marijuana is still a drug and can have harmful effects.
Short-Term Effects
The short-term effects of marijuana are mild when compared to other drugs. These effects can last anywhere from an hour to several hours after consuming the drug, and can include increased passivity, fatigue, loss of motor skills, memory impairment, increased heart rate, an altered sense of time, delayed reaction time, loss of motivation and, more commonly found in inexperienced users, paranoia. A marijuana overdose has never been recorded in humans, even at extremely high doses. Additionally, the concept of “second-hand smoke” does not apply to marijuana; the density of marijuana smoke required to affect a bystander is so great that discussion of it is irrelevant.
Based on these effects, one of the societal dangers of marijuana could be outright laziness; however, reliable data to support whether marijuana actually lowers productivity is not currently available. The greatest danger posed by short-term marijuana effects is the risk of injury from an accident. The Drug Abuse Warning Network reported 308,547 emergency room visits due to marijuana in 2009 (by comparison, bicycles accounted for roughly 500,000 visits). The true risk of accident lies in operating a vehicle, because reaction time and motor skills are both impaired. A French survey showed that drivers who tested positive for marijuana were three times more likely to cause a fatal accident, with the likelihood increasing with blood concentration of marijuana. (The study also found that marijuana was responsible for 2.5 percent of fatal accidents, while alcohol was responsible for 28.6 percent; these results may cannot be generalized to the U.S. but are nonetheless interesting to note). Unlike alcohol breathalyzers, a highly accurate and instantaneous method of testing whether a person is “high” has yet to be developed. Some law enforcement officers have been trained to recognize signs of drug use in drivers with high rates of accuracy, but blood tests are still the most precise tool for detecting the presence and potency of marijuana in the blood stream. However, even if a driver has drugs in their system (marijuana can stay in the bloodstream for up to a month), such individuals are not necessarily impaired. A practical procedure for detecting impairment due to marijuana would be necessary to prevent driving under the influence, as well as a formalized threshold level determining at what blood content level of marijuana a driver becomes impaired.
Long-Term Effects and Questionable Experimental Methods
There are also studies linking marijuana to a myriad of long-term health disorders, including schizophrenia, reduced cognitive function, behavioral issues, lung cancer, bronchitis, brain shrinkage, infertility, memory loss, increased susceptibility to other drugs (the “gateway” effect), and addiction. This array of medical studies is probably the largest source of disinformation and myths about marijuana. They often interpret results presumptively and derive data from experiments that do not represent real life situations. Moreover, popular belief about marijuana is often based on sensational experimental results that have not been replicated—a problem that pertains especially to marijuana because, as an illegal substance, it is tricky to conduct experimental research on. In 1999, the White House Office of National Drug Control Policy commissioned the Institute of Medicine (IOM) to assess scientific studies that examined the effects of marijuana. The study has been cited as “[t]he most rigorous review of studies of smoked marijuana” by the DEA. The IOM report shed light on many of the holes in marijuana research and what conclusions could be made based on the data available at the time.
The most common mistake made in marijuana studies was the assumption of causality when only a relationship of correlation was apparent. The IOM report identifies several cases where this has occurred. One allegation is that marijuana leads to “conduct disorders” or behavioral problems. The report nullified this in pointing out that conduct disorders were usually the cause of marijuana use, noting that they were present before drug use began. Another case of assumed causality is the claim that marijuana causes psychiatric disorders, including schizophrenia; again, the report nullified this by concluding that marijuana did not cause psychiatric disorders, but had the potential to induce premature psychotic episodes in people already susceptible to such disorders. More recent evidence has shown that marijuana users develop these types of disorders roughly three years earlier than non-marijuana users. A third case of false causality, and possibly the most egregious and widespread in relation to marijuana, is the “gateway drug” theory; that, upon using marijuana, a person becomes more at risk to use other drugs. The IOM report concluded that, while correlative data supports the theory, “the legal status of marijuana makes it a gateway drug.” This statement supports the findings in the 1972 report commissioned by Nixon, which concluded that marijuana could lead to other drugs because “[the user] may eventually view himself as a drug user and be willing to experiment with other drugs which are approved by his peer group.” Marijuana has been stigmatized as an illicit drug like any other, creating the impression that its use is a small step away from, say, cocaine use. The image that marijuana is the same as hard drugs is not only false but potentially harmful. The IOM report further exonerated marijuana as the gateway drug by saying, “because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, ‘gateway’ to illicit drug use.” These cases do not illustrate the full extent to which causality is misused to vilify marijuana.* Many people point to correlations between marijuana and, for example, heroin use or education levels, as “proof” of its degenerative effects. But correlation does not signify causality; there may be a third factor causing both marijuana and heroin use, or education levels may in fact be causing drug use. A causality mechanism must be established before making conclusions about the effects of marijuana based on correlative data.
Another error that is commonly committed in marijuana studies is relying on experimental designs that do not mimic actual drug use. Specifically, experimental subjects commonly use amounts of marijuana that are extremely high and not at all representative of typical marijuana usage. For example, one experiment linking marijuana to adverse mood and paranoia was based on subjects smoking 10-22 marijuana cigarettes, or “joints”, every day. In another experiment studying withdrawal effects of marijuana, subjects smoked 9-10 joints a day as a “high dosage.” These results were then compared to other “low dosage” results where subjects smoked 6-7 joints a day. These quantities are extremely large and would indicate that typical marijuana users are “stoned” all day every day (for readers unfamiliar with marijuana, one joint is enough to make the user high for 1-3 hours). Using huge doses in experiments appears to be a routine practice with little attention being given to moderate or casual use, possibly because in smaller doses these effects are not observable. The result is that these studies may be hugely exaggerating the effects of marijuana.
Another concern about marijuana use is its potential for addiction. Abstaining marijuana users do experience some withdrawal symptoms including restlessness, irritability, insomnia, nausea and cramping but, according to the IOM report, they are “mild and subtle compared with the profound physical syndrome of alcohol or heroin withdrawal.” Marijuana (including hashish, a more potent form of marijuana) also has, at 9 percent, a relatively low percentage of users who have ever become dependent. The comparative rates of other drugs are: 32 percent for tobacco, 15 percent for alcohol, 9 percent for anxiolytics (anti-anxiety drugs), 17 percent for cocaine, and 23 percent for heroin. While there is risk of marijuana addiction, the risk is lower and the withdrawal effects less severe than those of almost all other drugs.
The only proven long-term effect of marijuana, having been extensively observed, is an increased risk of bronchitis and other pulmonary disorders. One study found that in marijuana users who smoked three to four joints a day (again, a very high dosage), symptoms of chronic bronchitis were present in roughly a fifth. These symptoms are equivalent to those of tobacco users who smoke twenty cigarettes a day. Studies linking marijuana to lung cancer have been inconclusive, and some have even shown that marijuana usage has been effective in diminishing cancerous tumors.
Marijuana is Distinct from Hard Drugs
Next to other drugs, the short-term effects of marijuana are comparatively tame. Stimulants such as cocaine, ecstasy, and amphetamines can all induce erratic behavior. Far more dangerous is alcohol, which lowers inhibitions, impairs judgment, impairs motor skills, and can induce violent tendencies in many users. More importantly, it is possible to overdose on almost any other drug besides marijuana. The long-term effects of marijuana are even more starkly different from other drugs. Long-term use of hard drugs can cause severe brain damage, cancer, and various types of organ failure; most hard drugs are also more addictive than marijuana, making it more likely that effects associated with long-term use will occur. Placing marijuana in the same category as hard drugs is a grossly inaccurate characterization.
The most important implication to draw from the IOM report is that most current studies on marijuana have used exaggerative methods and liberally interpreted conclusions. This must be given due significance when discussing legalization. The possible negative effects of marijuana that are strongly supported by science include: an increased likelihood of an accident when operating a vehicle, a premature triggering of psychosis, bronchial damage, and dependence. U.S. authorities must ask themselves if these effects are substantial enough that individual freedom should be impeded and citizens stripped of the right to use marijuana—especially while far more dangerous substances are condoned and legal.
The Economics of Legalization
The biggest fault of U.S. drug policy is that the government has spent considerable sums of money on the “War on Drugs” without getting the desired results. Proponents of legalization argue that it is not only a logical but also a highly economical policy; marijuana could be a valuable source of tax revenue if legalized and the government would save billions in law enforcement costs. But the cost of any possible repercussions must be acknowledged as well. The following calculation of legalization costs and benefits is based on government expenditures in enforcing marijuana prohibition, the societal costs of marijuana use, and the projected economic returns of legalizing marijuana.
Government Expenditures
Marijuana offenses constitute a significant portion of law enforcement activities in the United States. While it is not true that marijuana-related offenders are filling the nation’s prisons (most marijuana arrests do not result in incarceration), the court system and law enforcement agencies are hugely burdened with marijuana offenses. In 2009, 6.3 percent (858,408) of all arrests in the U.S. were because of marijuana charges; they constituted the third most common source for arrest after driving under the influence and theft. Marijuana arrests number vastly more than all violent crimes combined. Of all drug arrests, over half were for marijuana; 45.6 percent of all drug arrests were for marijuana possession alone. This is an overwhelming proportion of law enforcement and legal resources being allocated to a relatively benign crime. Exact figures of how much the government spends on marijuana prohibition do not exist, but one assessment from Harvard University, the Miron report, estimates annual government expenditures related to marijuana in law enforcement, the courts, and incarceration to be around USD 7.7 billion. Over five hundred American economists, including the late Milton Friedman, have publicly endorsed the findings of the Miron report.
Economic Costs to Society
The second part of the cost-benefit analysis is to calculate the economic costs to society of marijuana use. While society is already incurring the costs of marijuana use, there is the possibility that legalization would increase consumption43 and thus exacerbate these costs. Multiple studies have shown that decriminalization does not result in increased consumption (the commonly cited example of Alaska in the 1970s has been effectively debunked), but legalization is notably different. In addition to removing penalties for marijuana use, legalization would make the drug highly accessible and would likely decrease the price, ultimately resulting in an increase in consumption. A RAND Corporation study found that marijuana prices would be markedly lower even with substantial taxation, but that projected consumption increases varied significantly and were therefore impossible to calculate. However, the study did find with certainty that consumption would increase by some amount, so it is important to understand what societal ills might increase as well.
The Office of National Drug Control Policy (ONDCP) published a study in 2004 determining that the overall economic costs of all illicit drug abuse in 2002 totaled to about USD 180.9 billion, the third most costly health problem in the U.S. While the report did not delineate which costs are attributable to which drug, a deconstruction of the report roughly reveals which of those costs can be traced to marijuana use. The ONDCP report divides all drug abuse costs into three categories: health costs, productivity losses, and “other” costs.
ONDCP Report: Productivity Losses
Productivity losses due to drug abuse constitute the largest chunk of economic costs, coming in at 71 percent. The four primary sources of productivity losses are incarceration for drug-related charges (23 percent), drug-abuse related illness (18 percent), “crime careers” (25 percent), and premature death (29 percent).
Two of these areas, premature death and “crime careers”, hardly apply to marijuana. Premature deaths are attributable to overdose or poisoning, homicide, HIV/AIDs, and hepatitis B or C; marijuana overdose is essentially impossible and the latter diseases are attributable to injected drugs. “Crime career” is the term for when a user turns to crime to pay for their drug addiction, but these careers are usually motivated by very expensive drug habits like heroin and cocaine. The third part of productivity losses, incarceration, includes both direct drug charges and crimes committed because of drug use or addiction. Incarceration costs are largely irrelevant because legalization would eliminate marijuana arrests and because “crime careers” generally do not correlate with marijuana. Marijuana contributes little to these three areas, which make up 77 percent of all productivity losses.
The fourth major source of productivity losses is drug abuse-related illness, which is the only area that may pertain to marijuana use. However, in the “medical consequences” area of the report, the medical conditions “drug-exposed infants”, HIV/AIDs, Hepatitis B and C, and effects of violent crime are the primary cost-inducing items listed, with HIV/AIDs being the largest contributor by far. Neonatal care for drug-exposed infants is largely associated with maternal cocaine use, violent crime pertains to users addicted to expensive drugs, and, again, HIV/AIDs and hepatitis are both caused by injected drugs. Health costs caused by marijuana use would probably involve, for example, cases of bronchitis, but this was not significant enough to appear in the report. Thus, while some drug abuse-related illnesses, and productivity losses in general, could be nominally caused by marijuana use, they are overwhelmingly due to other drugs.
ONDCP Report: “Other” Costs and Health Costs
“Other” costs constitute the second-largest portion of overall economic drug abuse costs at 20 percent of the total. This category overwhelmingly consists of law enforcement and corrections expenses and thus warrants little discussion when imagining a hypothetical situation where marijuana is legal. The costs would simply disappear if marijuana were legalized. The last section, health costs, comprises only 9 percent of the total costs. This section of the report only speaks in general terms about treatment costs, so there is little information indicating how much of it comes from marijuana use. However, recalling that marijuana has much lower rates of dependence and less severe overall health effects, it could be concluded that treatment costs are moderate at most.
This analysis of the report provides evidences that, although drug abuse is an extremely costly health problem, marijuana is not a significant contributor to total drug abuse costs. There is nothing in the report that unquestionably incriminates marijuana use; the same cannot be said for other drugs, which can be blamed for drug-related illnesses, drug deaths, drug crime, and drug violence. A more marijuana-specific assessment of the economic costs would be a useful reference in the debate about legalizing marijuana (such a report, funded by the National Institute on Drug Abuse, is currently in the works). However, based on the available information, marijuana appears to be responsible for a small part of the economic costs of all drug abuse, a fraction that would likely grow if consumption increased with legalization.
Economic Benefits
The most commonly proponed benefit of legalization is the tax revenue that would be generated if marijuana were treated like any other commodity. The Miron report estimates that legalizing marijuana could generate USD 2.4 billion in annual tax revenue if taxed like other consumer goods, and USD 6.2 billion if taxed like alcohol and cigarettes. Combined with the money saved in government expenditures, that makes USD 10.1-13.9 billion in funds likely to be generated. While this is highly relevant to the dire fiscal situation in which the U.S. finds itself, it also has implications for drug policy overall. The funds from marijuana could be concentrated on drug treatment programs and lower overall drug consumption, especially of more harmful narcotic drugs that have drastic health consequences (consider that all drug abuse health costs totaled USD 16 billion in 2002). It is unknown how much treatment programs would decrease consumption. The example of Portugal, the country with the most liberal drug laws in the developed world, sets an optimistic example. After just five years of decriminalizing all drug use and putting more funding into treatment programs, the country saw astoundingly less drug use, higher treatment rates, and lowered HIV/AIDs rates. These results all point to lower overall societal costs of drug abuse. Better treatment options will certainly bring these results and legalization could be used to fund these programs.
This analysis does not exhaust every cost and benefit of marijuana legalization. There are two economic factors that have not been considered: the cost of control, regulation, and distribution of marijuana, and the economic gains of a legitimate marijuana industry. Discussion of these factors is far beyond the scope of this article, but there is one tantalizing fact to reflect on in relation to the marijuana industry: merely USD 100 of investment in equipment and seeds can produce roughly USD 9,000 of marijuana. It is an extremely lucrative product and the jobs and businesses generated by the marijuana industry could make a huge contribution to the formal economy.
There are positives and negatives to legalizing marijuana from an economic standpoint. Marijuana misdemeanors continue to place a disproportionate burden on the justice system, ensuring wasteful use of money and resources. Marijuana would bring in substantial revenues that could be diverted to treatment programs for more harmful substances. While marijuana consumption would almost certainly increase with legalization, it appears that marijuana is not responsible for most of the economic drug abuse costs of the United States. This is the haziest aspect of the cost-benefit analysis that has been tabulated; hopefully the pending marijuana report funded by the National Institute on Drug Abuse will clarify these numbers.
Conclusion
The example of Portugal’s success reminds us that counterintuitive policies might be the most effective. The federal government cannot allow myths and personal feelings to obscure what might be the right policy for the United States. Marijuana is unique from other substances in that the effects are not as severe and it remains highly popular despite the “War on Drugs.” Nation-wide use makes its prohibition expensive and possible tax revenues huge. But the discussion on legalization does not simply revolve around a cost-benefit calculation. Freedom is at issue here as well: U.S. citizens are being deprived the right to use a substance that is less harmful and has higher potential for responsible use than its legal counterparts. All of these factors need to be balanced to make a rational policy, keeping in mind that this particular issue has far-reaching implications for Latin America as well. It would be wise for U.S. policymakers to discuss legalization with Latin American leaders and to truly listen, instead of discounting their proposals. Most importantly, empirical evidence needs to be an integral part of U.S. drug policy; personal beliefs should not keep experts and data from being heard.
*One example of mistaken causality is the commonly cited statistic that 6-8% of drivers in motor accidents test positive for marijuana. Testing positive does not mean that the driver is “high”, only that they have used marijuana in the past weeks or month, depending on the user. Since roughly 7% of the population uses marijuana on a monthly basis, the 6-8% statistic, far from proving anything about the effects of marijuana, simply affirms what would already be expected.
The Council on Hemispheric Affairs, founded in 1975, is an independent, non-profit, non-partisan, tax-exempt research and information organization. It has been described on the Senate floor as being "one of the nation's most respected bodies of scholars and policy makers." For more information, visit www.coha.org or email coha@coha.org
April 28, 2011
caribbeannewsnow
Tuesday, April 26, 2011
Bahamas: What makes Hubert Ingraham, Hubert Ingraham?
Portrait of Caesar
By Ian Strachan
Nassau, Bahamas
The 2012 election approaches. And Hubert Alexander Ingraham approaches what will in all likelihood be his last general election. Hopefully, win or lose, he will give the nation an opportunity to honor him for his contributions. He does not strike me as a man who cares much for ceremony, so I imagine it will be a struggle getting him to play along. (He has, thus far, refused the knighthood, for instance).
Ingraham appears more indispensable to the party than ever. I know he isn’t really indispensable, but many FNMs seem to think he is. The question is, who will lead the Free National Movement when Hubert Ingraham rides off into the sunset on his fishing boat? The contenders easily come to mind: Brent Symonette, Tommy Turnquest, Dion Foulkes, Carl Bethel, Zhivargo Laing, Hubert Minnis, Duane Sands.
What doesn’t come easily to mind is how any of them will win over the Bahamian voting public. The aforementioned gentlemen may not win in 2017 but, they won’t run the party into the ground either. However, can any of those aforementioned gentlemen re-fashion themselves in such a way that they can gain the confidence and more importantly, the affection of the public? Because say what you will, the people must not only trust your competence, they must identify with you, they must “feel” you.
What makes Ingraham, Ingraham? Well, let’s break it down.
Hubert Ingraham is either loved or hated. It’s hard for people to be lukewarm where he’s concerned. And though some may find it hard to believe, more people love him than hate him. And here’s the other thing about Ingraham: Most of the people who hate him, or think they hate him, respect the heck out of him. Ingraham did not come from Nassau middle class respectability; he did not attend “the old Government High”; he did not travel to the UK for law school and therefore doesn’t have that confusing pseudo-English accent so many barristers have been flaunting. What he does have is the confidence of a rhinoceros and the political instincts of a shark, a tiger or a jackal (take your pick).
Apparently he wasn’t Cecil Wallace Whitfield’s first choice to lead the FNM, but he was smart enough to take the job when Christie turned it down. It takes a special kind of man to stand up to Pindling and beat him twice. It takes a special combination of knowing where all the PLP bodies are buried (in a manner of speaking); speaking to the masses in a plain and unvarnished enough manner to gain their complete trust; and having the spine, the will, the toughness, the guts to face the thousands upon thousands who will rake your name in the muck forever for disrespecting and “betraying” the father of the nation.
Ingraham has maintained his spot atop the FNM because he has fashioned the party to his liking. He has dispatched his legitimate rivals (Dupuch, Turnquest, Allen, Bostwick) and surrounded himself with men ready and willing to kiss his ring. He has been able to keep the FNM’s diverse constituencies engaged, rewarded and fairly happy; he has managed to keep East Bay Street and East Street South satisfied. He has never lost his working class sensibility despite being the smartest man in almost any room he enters. He lacks humility, but he has simplicity, which is just as powerful in the world of fakes, opportunists, narcissists and thieves that politics can sometimes be. Most of all Ingraham knows what he has done for the FNM; he has made them winners. And he knows what every man sitting around his table wants. And once a man like Ingraham knows what you want, he knows what he needs to do and say to keep you motivated, keep you engaged and keep you in line.
I’ll tell you what Ingraham respects: Hard work and discipline. I’ll tell you what he cherishes: People who are prepared to work hard for this country, but have no desire for glory; no warping hunger for power. If you know anything about politics, you know it is a rare breed of man who is willing to serve and not be served. I believe Ingraham is searching diligently, tirelessly, for a successor. I believe he knows who he wants to succeed him. He wants someone who embodies what he thinks is best about himself: A capacity to think analytically and strategically, a capacity for hard work and discipline, a simple and unvarnished style, little interest in foolish pomp and puffery.
What plagues him, what haunts him, is perhaps the fact that those qualities, so vital and admirable in a man, are not enough to hold on to power. You see, Ingraham’s other traits: Obstinacy, pride, rage, misdirection, wit, and ruthlessness are also vital in this Machiavellian “game”. You cannot choose a successor and hope he learns ruthlessness; he reveals that quality naturally, and more than likely, is prepared to direct that ruthlessness at you at the very first opportunity. You cannot make a political leader; he reveals himself.
That means Ingraham’s real successor (not his handpicked head of the party), is not in his cabinet. And if he is, that man must be prepared to desecrate the very image of his mentor to carve out his space as leader of the FNM. The FNM today is Ingraham’s party. It cannot remain so and live.
Does that strike you as ingratitude? Don’t be naïve. What do you think Ingraham himself did? He watched, he learned, and when his moment came, he stuck a knife in Caesar’s back. Any man who would succeed him must do the same.
Ian Strachan is associate professor of English at The College of The Bahamas. You can write to him at strachantalk@gmail.com.
4/26/2011
thenassauguardian
By Ian Strachan
Nassau, Bahamas
The 2012 election approaches. And Hubert Alexander Ingraham approaches what will in all likelihood be his last general election. Hopefully, win or lose, he will give the nation an opportunity to honor him for his contributions. He does not strike me as a man who cares much for ceremony, so I imagine it will be a struggle getting him to play along. (He has, thus far, refused the knighthood, for instance).
Ingraham appears more indispensable to the party than ever. I know he isn’t really indispensable, but many FNMs seem to think he is. The question is, who will lead the Free National Movement when Hubert Ingraham rides off into the sunset on his fishing boat? The contenders easily come to mind: Brent Symonette, Tommy Turnquest, Dion Foulkes, Carl Bethel, Zhivargo Laing, Hubert Minnis, Duane Sands.
What doesn’t come easily to mind is how any of them will win over the Bahamian voting public. The aforementioned gentlemen may not win in 2017 but, they won’t run the party into the ground either. However, can any of those aforementioned gentlemen re-fashion themselves in such a way that they can gain the confidence and more importantly, the affection of the public? Because say what you will, the people must not only trust your competence, they must identify with you, they must “feel” you.
What makes Ingraham, Ingraham? Well, let’s break it down.
Hubert Ingraham is either loved or hated. It’s hard for people to be lukewarm where he’s concerned. And though some may find it hard to believe, more people love him than hate him. And here’s the other thing about Ingraham: Most of the people who hate him, or think they hate him, respect the heck out of him. Ingraham did not come from Nassau middle class respectability; he did not attend “the old Government High”; he did not travel to the UK for law school and therefore doesn’t have that confusing pseudo-English accent so many barristers have been flaunting. What he does have is the confidence of a rhinoceros and the political instincts of a shark, a tiger or a jackal (take your pick).
Apparently he wasn’t Cecil Wallace Whitfield’s first choice to lead the FNM, but he was smart enough to take the job when Christie turned it down. It takes a special kind of man to stand up to Pindling and beat him twice. It takes a special combination of knowing where all the PLP bodies are buried (in a manner of speaking); speaking to the masses in a plain and unvarnished enough manner to gain their complete trust; and having the spine, the will, the toughness, the guts to face the thousands upon thousands who will rake your name in the muck forever for disrespecting and “betraying” the father of the nation.
Ingraham has maintained his spot atop the FNM because he has fashioned the party to his liking. He has dispatched his legitimate rivals (Dupuch, Turnquest, Allen, Bostwick) and surrounded himself with men ready and willing to kiss his ring. He has been able to keep the FNM’s diverse constituencies engaged, rewarded and fairly happy; he has managed to keep East Bay Street and East Street South satisfied. He has never lost his working class sensibility despite being the smartest man in almost any room he enters. He lacks humility, but he has simplicity, which is just as powerful in the world of fakes, opportunists, narcissists and thieves that politics can sometimes be. Most of all Ingraham knows what he has done for the FNM; he has made them winners. And he knows what every man sitting around his table wants. And once a man like Ingraham knows what you want, he knows what he needs to do and say to keep you motivated, keep you engaged and keep you in line.
I’ll tell you what Ingraham respects: Hard work and discipline. I’ll tell you what he cherishes: People who are prepared to work hard for this country, but have no desire for glory; no warping hunger for power. If you know anything about politics, you know it is a rare breed of man who is willing to serve and not be served. I believe Ingraham is searching diligently, tirelessly, for a successor. I believe he knows who he wants to succeed him. He wants someone who embodies what he thinks is best about himself: A capacity to think analytically and strategically, a capacity for hard work and discipline, a simple and unvarnished style, little interest in foolish pomp and puffery.
What plagues him, what haunts him, is perhaps the fact that those qualities, so vital and admirable in a man, are not enough to hold on to power. You see, Ingraham’s other traits: Obstinacy, pride, rage, misdirection, wit, and ruthlessness are also vital in this Machiavellian “game”. You cannot choose a successor and hope he learns ruthlessness; he reveals that quality naturally, and more than likely, is prepared to direct that ruthlessness at you at the very first opportunity. You cannot make a political leader; he reveals himself.
That means Ingraham’s real successor (not his handpicked head of the party), is not in his cabinet. And if he is, that man must be prepared to desecrate the very image of his mentor to carve out his space as leader of the FNM. The FNM today is Ingraham’s party. It cannot remain so and live.
Does that strike you as ingratitude? Don’t be naïve. What do you think Ingraham himself did? He watched, he learned, and when his moment came, he stuck a knife in Caesar’s back. Any man who would succeed him must do the same.
Ian Strachan is associate professor of English at The College of The Bahamas. You can write to him at strachantalk@gmail.com.
4/26/2011
thenassauguardian
Saturday, April 23, 2011
The growing risks posed by obesity in The Bahamas... [70 percent of the Bahamian population is overweight]
Chronic illnesses up demand on health care
By CANDIA DAMES
Guardia News Editor
candia@nasguard.com
Nassau, Bahamas
In The Bahamas, an estimated 500 people die annually from either heart disease or diabetes, which are both driven by obesity, according to health officials.
Diabetes, heart disease and strokes account for an estimated 1,700 admissions annually, notes Dr. Patrick Whitfield, a consultant in family medicine at the Princess Margaret Hospital (PMH), who recently completed a paper on the growing risks posed by obesity in The Bahamas. worsen as time goes by in the absence of any significant change in lifestyles and our increasing prevalence of obesity which is largely driven by poor diets and lack of exercise.
“But it is far more complicated than that,” Dr. Whitfield said in an interview with The Nassau Guardian yesterday.
“I think universally people have been focusing on advising people to lose weight, exercise regularly, eat healthier meals but it is far more complex than that because that does not equate to behavioral change. What we need is behavioral change. “And there seems to be no correlation
between passing information on to members of the public — not just here but universally — and that actually leading to change in behavior.”
Dr. Whitfield notes in his paper — “Breaking the culture of obesity requires an intersectoral approach” — that in 2005, the Ministry of Health conducted a Chronic Non-Communicable Disease Prevalence and Risk Factor Survey which revealed that obesity is a significant risk factor in the population.
That study found that approximately 70 percent of the population is overweight. “What we see is the back end of the problem,” Dr. Whitfield told The Guardian. “We’re seeing more and more people getting heart attacks, more and more people are going into renal failure requiring dialysis, that comes from increasing incidence of high blood pressure, increasing incidence of diabetes which is driven by obesity, which is in turn driven by lifestyle.
“And so what we’re seeing is a number of issues that are now arising. We’re seeing people getting sicker, staying in hospital for longer periods of time. “We’re seeing people sustaining far more complications of these diseases, which has proven to be very, very costly to us.”
Officials at the Princess Margaret Hospital said recently that violence and other trauma cases are placing increasing pressure on their resources. The high crime rate is helping fuel the problem, they reported.
Dr. Whitfield said, “In spite of the fact that we have such a high degree of trauma in our society — motor vehicles, homicides and assaults — you will probably find the leading costing item in our Intensive Care Unit is as a result of strokes and heart attacks and so we’re seeing a lot of that.
“We’re also seeing families who are being decimated in terms of financial security where the leading breadwinner will become disabled or heaven forbid have a premature death which leaves the family vulnerable of course to all these financial issues.
“We’re seeing increasing costs in the private sector of insurance premiums. We’re seeing employers having to look at their bottom line and trying to devise schemes whereby they can continue their employee benefits, that is insurance premiums, with the risk of affecting their profit margins.”
Dr. Whitfield estimated that about 80 percent of the 1,700 admissions at PMH is as a result of chronic non-communicable diseases.
He said about $200 to $250 is spent per day, per patient. “We’re having more and more patients who are undergoing dialysis which ballpark costs anywhere between $70,000 and $80,000 per year, per patient and we have in excess of 100 patients now on dialysis,” Dr. Whitfield added.
Dr. Duane Sands, consultant surgeon at PMH, pointed out that the Pan American Health Organization (PAHO) predicts that the impact of these diseases on this economy and all the economies in the Caribbean region will be phenomenal.
“More so than any single other concern, chronic non-communicable diseases will impact our economy negatively by not only a 300 percent increase in deaths (over the next 20 years) but loss of productivity, illness, disability etc.,” Dr. Sands said.
“We’re looking for innovative ways to reduce the bottom line charge to the taxpayers. But if you say you want to have good health and you also want to have education, national security, immigration controls etc. then the money has to come from somewhere.”
4/22/2011
thenassauguardian
By CANDIA DAMES
Guardia News Editor
candia@nasguard.com
Nassau, Bahamas
In The Bahamas, an estimated 500 people die annually from either heart disease or diabetes, which are both driven by obesity, according to health officials.
Diabetes, heart disease and strokes account for an estimated 1,700 admissions annually, notes Dr. Patrick Whitfield, a consultant in family medicine at the Princess Margaret Hospital (PMH), who recently completed a paper on the growing risks posed by obesity in The Bahamas. worsen as time goes by in the absence of any significant change in lifestyles and our increasing prevalence of obesity which is largely driven by poor diets and lack of exercise.
“But it is far more complicated than that,” Dr. Whitfield said in an interview with The Nassau Guardian yesterday.
“I think universally people have been focusing on advising people to lose weight, exercise regularly, eat healthier meals but it is far more complex than that because that does not equate to behavioral change. What we need is behavioral change. “And there seems to be no correlation
between passing information on to members of the public — not just here but universally — and that actually leading to change in behavior.”
Dr. Whitfield notes in his paper — “Breaking the culture of obesity requires an intersectoral approach” — that in 2005, the Ministry of Health conducted a Chronic Non-Communicable Disease Prevalence and Risk Factor Survey which revealed that obesity is a significant risk factor in the population.
That study found that approximately 70 percent of the population is overweight. “What we see is the back end of the problem,” Dr. Whitfield told The Guardian. “We’re seeing more and more people getting heart attacks, more and more people are going into renal failure requiring dialysis, that comes from increasing incidence of high blood pressure, increasing incidence of diabetes which is driven by obesity, which is in turn driven by lifestyle.
“And so what we’re seeing is a number of issues that are now arising. We’re seeing people getting sicker, staying in hospital for longer periods of time. “We’re seeing people sustaining far more complications of these diseases, which has proven to be very, very costly to us.”
Officials at the Princess Margaret Hospital said recently that violence and other trauma cases are placing increasing pressure on their resources. The high crime rate is helping fuel the problem, they reported.
Dr. Whitfield said, “In spite of the fact that we have such a high degree of trauma in our society — motor vehicles, homicides and assaults — you will probably find the leading costing item in our Intensive Care Unit is as a result of strokes and heart attacks and so we’re seeing a lot of that.
“We’re also seeing families who are being decimated in terms of financial security where the leading breadwinner will become disabled or heaven forbid have a premature death which leaves the family vulnerable of course to all these financial issues.
“We’re seeing increasing costs in the private sector of insurance premiums. We’re seeing employers having to look at their bottom line and trying to devise schemes whereby they can continue their employee benefits, that is insurance premiums, with the risk of affecting their profit margins.”
Dr. Whitfield estimated that about 80 percent of the 1,700 admissions at PMH is as a result of chronic non-communicable diseases.
He said about $200 to $250 is spent per day, per patient. “We’re having more and more patients who are undergoing dialysis which ballpark costs anywhere between $70,000 and $80,000 per year, per patient and we have in excess of 100 patients now on dialysis,” Dr. Whitfield added.
Dr. Duane Sands, consultant surgeon at PMH, pointed out that the Pan American Health Organization (PAHO) predicts that the impact of these diseases on this economy and all the economies in the Caribbean region will be phenomenal.
“More so than any single other concern, chronic non-communicable diseases will impact our economy negatively by not only a 300 percent increase in deaths (over the next 20 years) but loss of productivity, illness, disability etc.,” Dr. Sands said.
“We’re looking for innovative ways to reduce the bottom line charge to the taxpayers. But if you say you want to have good health and you also want to have education, national security, immigration controls etc. then the money has to come from somewhere.”
4/22/2011
thenassauguardian
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