University of Virginia Library

I found Mr. MacDonald's article
in a recent Cavalier Daily excellent,
and was especially impressed by his
closing remarks regarding the need
for leadership on the part of your
own generation in the growing
social problems of drugs. If his
question "What do you think?" was
rhetorical, forgive my liberty in
replying to it.

Some years ago I was in the
general practice of medicine.
Among my patients were several
with advanced liver disease (chronic
alcoholics) and several with lung
cancer (chronic smokers). No
figures in the anti-promotional
literature, no warnings in the Public
Health ads against smoking, will
ever testify so convincingly as the
experience of witnessing, and trying
to alleviate, the unutterable misery
of these patients, prolonged over
months and often years, the former
with their yellowed skin, sunken
eyes, wasted extremities, their abdomen distended
with acidic fluid,
their minds largely out of contact
with reality, the latter cadaverous
with pallor and loss of weight,
gasping for every breath, wretched
with often intractable pain.

With no attempt to prejudge the
answers, I am forced to ask: is the
privilege of drinking alcohol without
legal restriction worth the seven
million lives directly affected (and
the 20 million indirectly affected)
by alcoholism? Is the prosperity of
the tobacco industry and imagined
need for cigarettes worth the social
cost of nearly a million lives
directly affected (and several million
indirectly affected) by lung
cancer? While we need not advocate
prohibition of either alcohol or
tobacco, can we condone the
attempt by the respective industries
to portray the use of these
materials as socially prestigious,
associated with personal attractiveness,
sexual prowess, and the like.
To persons highly vulnerable to the
seductions of such advertisement?

I know how my patients felt
about it, and I wonder whether this
experience has any relevance to
your thoughts about drugs. One
might say that, as in the instance of
tobacco and alcohol, marijuana,
LSD, and the amphetamines (I
would like to regard the hard
narcotics as strictly out of the
discussion; their non-medical uses
can scarcely ever be justified) can
almost certainly be used in moderation
and without harmful consequences
by some people. But both
the medical literature and the
popular press are replete with
evidence of what these drugs do
those not able to use them with
moderation.

Hence, it seems to me that,
before all other considerations, we
must answer this question. Some
people will use these drugs as
sensibly as most people use alcohol
and tobacco. But making these
drugs generally available will, with
inexorable certainty, entail the
social cost of the lives which will be
ruined by such drugs. If we are
willing to accept this social cost, as
we seem to be willing to do in the
case of alcohol and tobacco, then let
us move to have the use of these
drugs legalized, and remove the
matter from the province of the law
altogether.

But if we are not willing to pay
this cost, if we are reluctant to add
yet another indeterminate number
of lives to the already staggering
number of alcoholics and lung
cancer patients and their families,
perhaps we should encourage people
to refrain from the use of drugs,
and particularly to refrain from
carrying the argument onto the
plane of repression on the one hand
and rebellion on the other. The
rationalizations for the use of drugs
among those most vocal in their
defense are pathetically transparent
and will not bear dispassionate
examination. The loudest and most
insistent assertion of all is that the
user of a given drug is not
dependent upon it, that he exercises
freewill and unforced choice
in using it, that he can "take it or
leave it alone." Most people, even
the advocates of drug use, acknowledge
that dependency is an undesirable
consequence of drug use,
and hence are eager to prove
themselves not thus dependent. If
this is indeed the case, if the user
can, in fact, "take it or leave it
alone," then, all things considered,
let us urge him to leave it alone.