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Margaret “Maggie” Williams' Subject Files
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PRINCIPLES/IDEAS FOR PRESIDENT TO EMPHASIZE ON VIOLENCE
I. Message
O Stop the killing
o Both
and: law enforcement and prevention. Law
enforcement can't do the job by itself. Law enforcement
officers are the first to say so.
o Violence is pervasive, not just on the street. It's in
families, it's against women, it's hate violence, it's
sexual assault.
o There is a continuity of violence. What children see
at home or experience themselves reflects itself all too
often in their later behavior.
o Guns are everywhere. More gun dealers than gas stations.
o Drugs and alcohol are closely interwoven with violence.
Massively associated with domestic violence, child abuse,
auto accidents. Killings on streets over drug turf. All
of this sends message to children that violence is the
best way to settle an argument. Immensely costly to the
health care system.
o Responsibility -- everyone has a responsibility: public
and private across the board, but also must instill a
sense of responsibility in citizens themselves,
especially young people.
O Must give people hope, have to have a reason for hope.
Can't build enough prisons to lock up all the
perpetrators unless we create real reasons for hope.
o Must say and teach, over and over, violence is not the
way to settle disputes. Stop the killing.
O This is a genuine national crisis. Everyone has to get
involved.
II. Policies
o Enforce the law. Lock up the bad people. (Pass the crime
bill.)
o Community policing to make the streets safe. (Pass the
crime bill.)
o Build antiviolence coalitions everywhere to strengthen
neighborhoods and communities. Support people in
neighborhoods coming together, working with elected
officials, business leaders, clergy, schools, police,
etc. to take back the streets. Mothers Against Drunk
Driving as model. Federal interagency response to help
build coalitions. (Examine all federal programs that
support community partnerships for prevention, e.g., in
the drug area, to consolidate and coordinate for
effectiveness. Build on Colorado and Nebraska test cases
to develop coordinated federal support for local
antiviolence coalitions.)
O Massive public education. Don't use violence to settle
disputes. Guns are dangerous. Real men don't beat up
women. Preventive health by controlling our own behavior
is the real cost containment for health reform: less
violence, less drinking, less drug abuse will save
billions in health care costs. (Fund Centers for Disease
Control to come up with effective messages.)
O Take guns away from bad people, educate everyone about
how dangerous it is to have a gun, and make guns a little
less dangerous. Assault weapon ban. Juvenile possession
ban. Regulate extra-destructive ammunition. Enforce
concealed weapon bans and take away guns from people in
the street. Tighten regulation of dealers. Ban laser
sights. Stop advertising campaigns directly at women and
young people. (Propose legislation as appropriate.)
O Urge media to be responsible. Cable and films as well
as networks. PSAs and proactive messages in shows as
well as reduction of gratuitous violence.
O
Schools.
Teach nonviolence.
Mediation and
conciliation. (Enact the Safe Schools legislation.)
O Keep kids constructively engaged -- after school and
summer. Build ties to labor market. (Enact pending
school-to-work legislation.)
O Lots of mentoring and adult role models. (Point to and
implement youth development initiatives in the crime
bill.)
O Strengthen families and parenting skills. (Implement
recently enacted Family Preservation legislation.)
o Drug and alcohol treatment. (Increase investment in
these activities.)
Opportunity.
O Hope for the future.
November 4, 1993
Memorandum to David Gergen from Peter Edelman
The President is being attacked from left and right,
literally, on his drug and alcohol abuse policy or lack of it. The
latest salvo was from Judge Bonner, a Republican Bush appointee,
who on leaving as head of the DEA blasted the President for
weakness on law enforcement. To my knowledge, no defense was
offered from the Administration, or at least none that appeared in
any prominent place, not even the defense that this man was a
partisan Republican. A couple of weeks ago the Administration's
so-called interim drug strategy was released to resounding yawns
and widespread criticism that it represented nothing new (i.e., it
was the "same old" law enforcement-dominated approach with vague,
nonspecific promises to emphasize treatment and prevention). We
are losing the argument in both directions. It may be great
campaign strategy to be attacked from both left and right, but that
works only when one has staked out a place to occupy in the center.
We urgently need a strategy, both a substantive strategy and
a communications strategy. I want to list for you some possible
elements of a strategy, but I want to emphasize at the outset that
none of it will be credible without a concrete investment of funds
in drug and alcohol treatment and prevention in fiscal 1995. Any
other combination of elements will be subject to the same criticism
we are now encountering.
1. The President needs to talk more about drugs, about
alcohol, and about the connection of both to crime and violence.
He has been talking, passionately and movingly, about violence. He
has visited trauma centers and talked about the unnecessary health
costs that multiply the human tragedy. Drugs and alcohol are
associated with a huge proportion of the violence that brings
people to emergency rooms. They are associated with a huge
proportion of the violence that victimizes women and children in
their own homes. The turf wars that are killing young men and
innocent bystanders in cities are about drugs. The car accidents
that snuff out young lives and other lives in head-on collisions
are heavily related to alcohol. Drugs and alcohol are costing us
thousands of lives and billions of dollars. (Some relevant
statistics are listed at the end of this memo.)
There is a larger theme here: prevention in relation to the
health care reform, especially violence prevention but also all
prevention of bad and costly health outcomes. If we can get people
to change their behavior in relation to many things -- eating fat
and cholesterol, smoking, and of course drugs, drinking, and
violence -- we can have a major impact on the cost of health care
David Gergen
Page Two
and therefore on the premiums that people are going to pay for
their health insurance. This is the true cost containment. We all
have the keys to cost containment in our own pockets if we will
just take greater responsibility for our own behavior.
A key part of this larger theme is the public health reform
portion of the health care reform, which is vitally important but
has received almost no public attention. As you know, guaranteeing
health security to individual Americans does not address the need
for additional capacity in underserved areas, the need to promote
the development of the health professions, and, especially relevant
here, health promotion and disease prevention activities. The
public health reform will provide support for the kind of broader
prevention activity that can help induce people to change their
behavior. The public education campaigns on smoking, seat belts,
and drunken driving show that it can be done. Presidential
leadership and public health reform go hand in hand to convince
Americans that prevention is vital to our economic, social, and
physical health.
2. We need a credible budget strategy which shows that we are
taking greater steps to reduce demand at the same time as we remain
committed to tough law enforcement. There needs to be an
immediate, tangible change in direction in drug and alcohol abuse
policy. The fiscal 1995 budget recommendations will be transmitted
from OMB to the President on December 1. In view of the continuing
negative public comment, the President might consider announcing
right now, in advance of the December 1 date, that he expects to
alter the balance by ending supply-reduction activities that have
proven ineffective and investing more in treatment. Even a $200
million reduction in interdiction (adequately defended) and a
similar increase in the treatment investment would help a lot.
Together with the investment of $300 million over three years in
drug treatment in federal and state prisons in the crime bill, the
President could then say he is adding over a quarter of a billion
dollars annually for drug treatment.
3. There is another message point that we have not made.
There is an important fact that critics fail to recognize. Large
elements of the President's program that are not specifically
denominated drug abuse policies are nonetheless absolutely on point
as drug and alcohol abuse policy:
O community policing (and 50,000 more police on the
street) will result in safer streets, more arrests of
drug dealers, and less drug dealing as a consequence.
o empowerment zones and enterprise communities will
strengthen neighborhoods (and directly increase substance
abuse treatment in some cases) and thereby reduce drug
dealing and drug abuse.
David Gergen
Page Three
o Head Start expansion, family preservation, and welfare
reform will strengthen families and prevent drug
addiction.
4. The health care reform contains a major new investment in
drug and alcohol treatment. The individual benefit which is
guaranteed to all Americans provides for residential care,
intensive day treatment, and counseling. Beginning when health
care reform becomes effective, this is a major step forward in
substance abuse policy. It deserves prominent mention and emphasis
as part of our drug and alcohol abuse strategy, although it will of
course not become effective until the health reform is implemented.
(This is separate from the public health reform mentioned earlier.)
There are two bottom lines here: 1) There is no reason for
silence in the face of attacks that we are doing nothing. We are
improving law enforcement, we are improving treatment, we are
investing in prevention. This is not just a matter for the
President, Everyone who communicates on his behalf should be able
to speak affirmatively and positively about our substance abuse
policy; and 2) We are missing some key elements of substance to
make our defense credible. Unless we find a way to invest more in
treatment in fiscal 1995 by reducing our budget for failed
interdiction activities and effectively moving funds from that area
to treatment, at a level of about $200 million, the entire rest of
our message will not hold together.
(Key Facts for possible use in remarks and responses are attached.)
11/29/93
This IS no longer
correct. The weakness
of he treatment benefit
makes greath attention
to F4 1995 all the
more impending
Peth Edelm
Key facts:
- Care related to or stemming from substance abuse and addiction
costs the health care system about $140 billion a year, something
like 1 out of every 7 dollars we spend on health care. The total
economic cost, including treatment and all indirect costs, of
alcohol and drug abuse and smoking is about a quarter of a billion
dollars a year. This is about $1000 for every man, woman, and
child in America.
- 75% of trauma victims test positive for drug use.
- Alcohol and/or drug abuse are implicated in something like 80% of
all domestic violence, 75% of all rapes and child molestations, and
75% of all homicides and suicides.
- In 1990, there were more than 370,000 drug-related emergency-room
episodes and the number has been going up since. At one major
teaching hospital 28% of all intensive care admissions and 40% of
all intensive care costs were attributed to substance abuse.
- With only 5% of the world's population, Americans consume 60% of
the world's cocaine.
- Prevalence of violence among alcohol abusers is 12 times higher
than general population, and 16 times higher among drug abusers.
- 75% of inmates in state prisons and jails have a substance abuse
problem serious enough to warrant treatment.
- A third of AIDS cases are directly or indirectly related to
injection drug use.
- Almost half of all traffic fatalities are alcohol-related. 2 out
of 5 Americans will be involved in an alcohol-related motor vehicle
crash in their lifetime.
THE
DEPARTMENT OF THE TREASURY
TREASURY
WASHINGTON
ASSISTANT SECRETARY
OCT 7 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
RONALD K. NOBLE BKN
ASSISTANT SECRETARY
(ENFORCEMENT)
SUBJECT:
Briefing Paper on Firearms Related Issues
Senator Moynihan has demonstrated considerable interest in several firearms
related issues.
0 He introduced a bill, S. 32, increasing to 1000 percent the excise tax on selected
calibers of handgun ammunition. The bill would also impose recordkeeping
requirements with respect to the disposition of ammunition by dealers.
- It is of note that the existing excise tax on firearms and ammunition is set by
statute at 10 percent for pistols and revolvers and 11 percent for other firearms
and ammunition. 26 U.S.C. 4181.
- Amounts collected under this statute are already earmarked for the Federal aid
to wild life restoration under the Pitman-Robertson Wildlife Restoration Act. 16
U.S.C. 669, et seq.
- In FY '93 the firearms and ammunition excise taxes resulted in approximately
$164 million in revenue. Traditionally, each of the three categories of taxable
items: handguns, other firearms, and ammunition, generate roughly equal
amounts of revenue.
- An amendment to the IRS code would be needed to increase the excise tax on
these items.
- If any or all of the revenue collected is to be earmarked for health care costs,
legislation would be required to amend or repeal the current earmark process.
0 Senator Moynihan also wishes to address licensing and related problems under the
current laws governing firearms and ammunition businesses.
- His concern relates to the fact that there is no licensing requirement at all for
dealers in ammunition.
- The Gun Control Act of 1968 was amended in 1986 to eliminate the Federal
licensing requirement for ammunition dealers.
- Although the Gun Control Act still requires that manufacturers and importers
be licensed, the 1986 amendment removed all recordkeeping requirements
relating to the acquisition and disposition of ammunition.
0 The Senator also has an interest in the current license fee structure under the Gun
Control Act. The amount of the license fee for various firearms and ammunition
businesses is set by statute. The statute currently provides for a fee of $50 per year for
manufacturers and importers of standard rifles, shotguns and handguns, and a fee of
$10 per year for dealers in these weapons.
- The statutory fee for manufacturers and importers of ammunition for these
weapons is also $10 per year. Currently, these fees do not even cover the cost of
processing the applications and they are deposited into the general fund without
earmarking Has not Deen in creased sinco 1968. $10 represents
stores
over 500 pli lecense to administer, we are actually subsidizing
- It should be noted that Senator Simon is working on legislation to increase the
license fees under the Gun Control Act.
- Senator Simon's measure is designed to simply offset the cost of administering
the licensing and regulatory process. This objective would require fees to be
raised to somewhere between $375 and $750, depending upon the level of
enforcement activity to be supported.
- There are currently over 286,000 licensees. It is assumed that an increase in
fees in the amounts under consideration would reduce this number dramatically.
The ultimate universe of licensees would probably be in the neighborhood of
50,000 to 70,000.
Similar to
S. 868 Senator Murray
Firearm Victims Prevention Act
Reynolds Sill
Section-By-Section Analysis
Section 1. Short Title.
Section 2. Findings and Purpose. Provides findings about the
increase in gun violence, particularly among youth, and the
resulting increase in medical costs. States the purpose of the
Act is to help alleviate the public health care cost resulting
from firearm-related injury and death.
Section 3. Increase in Tax on Handquns and Assault Weapons.
Amends Section 4181 of the Internal Revenue Code to impose a 25%
tax on each sale of a handgun, assault weit non, cartridge, shell
or large capacity magazine by a manufacturer, producer, importer,
wholesaler, retailer or private individual. (Current law imposes
only on manufacturers, producers and importers a 10% tax on
handguns and an 11% tax on other firearms and ammunition.)
Defines "handguns," "assault weapons" and "large capacity
ammunition magazine,' and specifically excludes firearms used for
hunting and sporting purposes. Makes the new tax effective 30
days after the date of enactment.
Section 4. Health Care Trust Fund. Amends Subchapter A of
chapter 98 of the Internal Revenue Code to establish within the
Treasury a Health Care Trust Fund to assist hospitals, trauma
centers and other health care providers in defraying the
uncompensated cost of medical care for gunshot victims. All
revenues from the 25% tax on firearms and ammunition and one-half
of the gun dealer license fee will go into the Health Care Trust
Fund. Non-profit hospitals, trauma centers and other health care
providers that are in compliance with Federal and State
certification and licensing standards and that have incurred
substantial uncompensated costs in providing medical care to
gunshot victims in the previous calendar year are eligible to
apply for a grant from the Health Care Trust Fund. The Secretary
of the Treasury, in consultation with the Secretary of Health and
Human Services, will issue regulations 60 days after enactment
governing the Trust Fund.
Section 5. License Application Fees for Dealers in Firearms.
Amends Section 923 of title 18 of the U.S. Code to increase the
license fee for firearm dealers from the current $30 for three
years to $2,500 for three years, and directs that one-half of the
license fee go into the Health Care Trust Fund.
S. 868 SENATOR Morray
Discussion
There are an estimated 160-200 million guns, including more than
66 million handguns, in the United States. More than 135,000
students carry handguns to school everyday; an additional 270,000
students have carried a gun to school at least once. A survey of
eleventh-graders in Seattle's public high schools last year found
that 34% of the students said guns were easily accessible. A
1990 CDC survey found that 20% of the students surveyed had
carried a firearm to school at least once in the month prior to
the survey. Nearly 3,200 teenagers fatally shoot each other
every year.
The overall annual cost of firearm injury to our health care
system is more than $4 billion. The estimated Lifetime costs of
firearm injuries in 1985 alone are expected to be $14.4 billion.
The government pays about 85% of the hospital costs of firearm
victims.
By significantly increasing taxes on guns and license fees on gun
dealers, the bill seeks to reduce the accessibility of guns,
particularly to our young people. Escalating gun violence,
especially among our youth, is placing a severe strain on medical
care providers. The bill would use all of the revenue from the
increased tax and one-half of the increased license fee to help
offset the public cost of medical care for gunshot victims.
I. The bill will impose a 25% tax on each sale of a handqun, an
assault weapon, or the ammo used in them. The 25% tax on the
value would be levied each time a handgun, assault weapon or ammo
for them is sold, as opposed to the current tax that applies only
once to the manufacturer, producer or importer, but not to
dealers or others selling guns. The bill would not affect
sporting/hunting guns or those sold for law enforcement or
military purposes. The current excise tax (set in 1919) on
handguns is 10% (=$32 million in FY 90); 11% on other firearms
(=S46 million) ; and 11% shells and cartridges (=$25 million).
The tax can be expected to raise at least $400 million annually
(counting the tax on the sale by the manufacturer/ producer/
importer and the tax on at least one sale by the dealer who
purchased the gun from the manufacturer/producer/importer) This
compares to $103 million raised from the excise tax alone in $ 6.5m
1990.
II. The establishment of a Health Care Trust Fund within
Treasury, funded from the 25% tax and one-half of the increased
qun dealer license fee, would help reduce public health care cost
from gunshot victims. The government pays about 85% of the
medical cost of all gunshot victims, increasing insurance rates
and placing a severe strain on medical service providers. Non-
profit hospitals, trauma centers and health care providers that
incur substantial uncompensated costs treating gunshot victims
could apply for grants from the Treasury's Health Care Fund;
no single entity could claim more than .18 of the funds (making
up to 1,000 hospitals and other care providers eligible for the
funds).
III. Raise license application fees for firearm dealers from the
current $30 to $2,500. There are currently more than 280,000
licensed dealers in the U.S., including more than 5,600 in
Washington. In licensed dealers per capita, King County is
second in the nation at 90 dealers per 100,000 residents. If
one-third of the license holders renew their license annually
(93,771 were renewed in 1992), @ $2,500 per license, the
increased fee would produce at least $225 million a year, one-
half of which would go into the Health Care Trust Fund. The rest
would go into the Treasury's general fund to help reduce the
deficit. There are currently more than twice as many licen ed
gun dealers as car dealers or service stations in the U.S.
DEPARTMENT OF THE TREASURY
WASHINGTON
ASSISTANT SECRETARY
OCT 7 1993
MEMORANDUM FOR HILLARY RODHAM CLINTON
FROM:
RONALD K. NOBLE BEN
ASSISTANT SECRETARY
(ENFORCEMENT)
SUBJECT:
Briefing Paper on Firearms Related Issues
Senator Moynihan has demonstrated considerable interest in several firearms
related issues.
0 He introduced 8 bill, S. 32, increasing to 1000 percent the excise tax on selected
calibers of handgui ammunition. The bill would also impose recordkeeping
requirements with respect to the disposition of ammunition by dealers.
- It is of note that the existing excise tax on firearms and ammunition is set by
statute at 10 percent for pistols and revolvers and 11 percent for other firearms
and ammunition. 26 U.S.C. 4181.
- Amounts collected under this statute are already earmarked for the Federal aid
to wild life restoration under the Pitman-Robertson Wildlife Restoration Act. 16
U.S.C. 669, et seq.
- In FY '93 the firearms and ammunition excise taxes resulted in approximately
$164 million in revenue. Traditionally, each of the three categories of taxable
items: handguns, other firearms, and ammunition, generate roughly equal
amounts of revenue.
- An amendment to the IRS code would be needed to increase the excise tax on
these items.
- If any or all of the revenue collected is to be earmarked for health care costs,
legislation would be required to amend or repeal the current earmark process.
0 Senator Moynihan also wishes to address licensing and related problems under the
current laws governing firearms and ammunition businesses.
- His concern relates to the fact that there is no licensing requirement at all for
dealers in ammunition.
- The Gun Control Act of 1968 was amended in 1986 to eliminate the Federal
licensing requirement for ammunition dealers.
- Although the Gun Control Act still requires that manufacturers and importers
be licensed, the 1986 amendment removed all recordkeeping requirements
relating to the acquisition and disposition of ammunition.
0 The Senator also has an interest in the current license fee structure under the Gun
Control Act. The amount of the license fee for various firearms and ammunition
businesses is set by statute. The statute currently provides for a fee of $50 per year for
manufacturers and importers of standard rifles, shotguns and handguns, and a fee of
$10 per year for dealers in these weapons.
- The statutory fee for manufacturers and importers of ammunition for these
weapons is also $10 per year. Currently, these fees do not even cover the cost of
processing the applications and they are deposited into the general fund without
earmarking Has not been in creased sinco 1968. $10 represents
stones
over 500 per license to administer, we are actually subsidizing
- It should be noted that Senator Simon is working on legislation to increase the
license fees under the Gun Control Act.
- Senator Simon's measure is designed to simply offset the cost of administering
the licensing and regulatory process. This objective would require fees to be
raised to somewhere between $375 and $750, depending upon the level of
enforcement activity to be supported.
- There are currently over 286,000 licensees. It is assumed that an increase in
fees in the amounts under consideration would reduce this number dramatically.
The ultimate universe of licensees would probably be in the neighborhood of
50,000 to 70,000.
Similar to
S. 868 Senator Murray
Firearm Victims Prevention Act
Reynolds Sill
Section-By-Section Analysis
Section 1. Short Title.
Section 2. Findings and Purpose. Provides findings about the
increase in gun violence, particularly among youth, and the
resulting increase in medical costs. States the purpose of the
Act is to help alleviate the public health care cost resulting
from firearm-related injury and death.
Section 3. Increase in Tax on Handquns and Assault Weapons.
Amends Section 4181 of the Internal Revenue Code to impose a 25%
tax on each sale of a handgun, assault weapon, cartridge, shell
or large capacity magazine by a manufacturer, producer, importer,
wholesaler, retailer or private individual. (Current law imposes
only on manufacturers, producers and importers a 10% tax on
handguns and an 11% tax on other firearms and ammunition.)
Defines "handguns," "assault weapons" and "large capacity
ammunition magazine," and specifically excludes firearms used for
hunting and sporting purposes. Makes the new tax effective 30
days after the date of enactment.
Section 4. Health Care Trust Fund. Amends Subchapter A of
chapter 98 of the Internal Revenue Code to establish within the
Treasury a Health Care Trust Fund to assist hospitals, trauma
centers and other health care providers in defraying the
uncompensated cost of medical care for gunshot victims. All
revenues from the 25% tax on firearms and ammunition and one-half
of the gun dealer license fee will go into the Health Care Trust
Fund. Non-profit hospitals, trauma centers and other health care
providers that are in compliance with Federal and State
certification and licensing standards and that have incurred
substantial uncompensated costs in providing medical care to
gunshot victims in the previous calendar year are eligible to
apply for a grant from the Health Care Trust Fund. The Secretary
of the Treasury, in consultation with the Secretary of Health and
Human Services, will issue regulations 60 days after enactment
governing the Trust Fund.
Section 5. License Application Fees for Dealers in Firearms.
Amends Section 923 of title 18 of the U.S. Code to increase the
license fee for firearm dealers from the current $30 for three
years to $2,500 for three years, and directs that one-half of the
license fee go into the Health Care Trust Fund.
S. Discussion 868 SENATOR Murray
There are an estimated 160-200 million guns, including more than
66 million handguns, in the United States. More than 135,000
students carry handguns to school everyday; an additional 270,000
students have carried a gun to school at least once. A survey of
eleventh-graders in Seattle's public high schools last year found
that 34% of the students said guns were easily accessible. A
1990 CDC survey found that 20% of the students surveyed had
carried a firearm to school at least once in the month prior to
the survey. Nearly 3,200 teenagers fatally shoot each other
every year.
The overall annual cost of firearm injury to our health care
system is more than $4 billion. The estimated lifetime costs of
firearm injuries in 1985 alone are expected to be $14.4 billion.
The government pays about 85% of the hospital costs of firearm
victims.
By significantly increasing taxes on guns and license fees on gun
dealers, the bill seeks to reduce the accessibility of guns,
particularly to our young people. Escalating gun violence,
especially among our youth, is placing a severe strain on medical
care providers. The bill would use all of the revenue from the
increased tax and one-half of the increased license fee to help
offset the public cost of medical care for gunshot victims.
I. The bill will impose a 25% tax on each sale of a handqun, an
assault weapon, or the ammo used in them. The 25% tax on the
value would be levied each time a handgun, assault weapon or ammo
for them is sold, as opposed to the current tax that applies only
once to the manufacturer, producer or importer, but not to
dealers or others selling guns. The bill would not affect
sporting/hunting guns or those sold for law enforcement or
military purposes. The current excise tax (set in 1919) on
handguns is 10% (=$32 million in FY 90); 11% on other firearms
(=S46 million); and 11% shells and cartridges (=$25 million).
The tax can be expected to raise at least $400 million annually
(counting the tax on the sale by the manufacturer/ producer/
importer and the tax on at least one sale by the dealer who
purchased the gun from the manufacturer/producer/importer): This
compares to $103 million raised from the excise tax alone in $ 61.5m
1990.
II. The establishment of a Health Care Trust Fund within
Treasury, funded from the 25% tax and one-half of the increased
qun dealer license fee, would help reduce public health care cost
from qunshot victims. The government pays about 85% of the
medical cost of all gunshot victims, increasing insurance rates
and placing a severe strain on medical service providers. Non-
profit hospitals, trauma centers and health care providers that
incur substantial uncompensated costs treating gunshot victims
could apply for grants from the Treasury's Health Care Fund;
Daniel Patrick Moynihan
New York
United States Lenate
Washington, D.C.
September 30, 1993
Dear Mrs. Clinton:
PAM OCT 1 1993
You were magnificent this morning! The Committee is hugely in your
debt and I am especially grateful for your interest in bullet control.
We are currently experiencing an epidemic of morbidity and mortality
associated with handguns. We attempt to combat this by controlling the supply
thereof. This strategy can have no effect, as there are some 50 million
handguns in circulation. A two century supply, as you might say. On the other
hand, we have about a four year supply of bullets (some 7.5 billion rounds).
Bullets are the pathogen. If that supply is sharply reduced, an epidemiologist
would hypothesize that morbidity and mortality would also be reduced.
Under the Federal Firearms Act of 1938, a Federal license is required to
manufacture or import ammunition.
The license, issued by the Bureau of Alcohol, Tobacco and Firearms,
costs $10 per year. No stipulation is made as to caliber or quantity, and no
reporting is required. BATF guesses that some 2 billion cartridges are
manufactured or imported each year. There are currently 284,000 BATF
licenses either to sell firearms or to manufacture or import ammunition. The
latter number some 7,000.
This last number would immediately attract the attention of the
epidemiologist. When we were working out the epidemiology of automobile
crashes, the plainest first fact was that it would be easier to change the behavior
of three automobile manufacturers than of 90 million automobile drivers. Go
for the weakest link! Don't swat the mosquitos, drain the swamp.
There are probably no more than 10 major ammunition manufacturers.
Naturally, the BATF doesn't know which.
d
The power to tax is the power to destroy. By picking and choosing
rounds, exempting police, possibly dispensing ammunition to legitimate sports
clubs and such other controls no different than those we use for prescription
medicine, we could effectively disarm a huge proportion of those individuals
now ravaging our streets in a mode not conceptually different from any other
plague.
Thus, a calibrated tax scheme could most likely eliminate the use of 9
mm. handguns in drive-by-shootings in, say, five years.
I have been working at this for a decade and have passed one bill banning
one round (armor-piercing, "cop-killer" bullets). But the precedent is
established, and the taxing power has been there for more than half a century.
There is no guarantee that we would succeed, but I can attest that in the field of
automobile safety, public opinion changed from incomprehension/hostility to
easy acceptance in the matter of a decade.
As it happens, I spoke with the President about this on Sunday evening in
New York, and at his request have sent a similar letter.
Best,
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
THE NEW YORK TIMES EDITORIALS/LETTERS SUNDAY, AUGUST 29, 1993
Letter: On Gun Control
Seat Belts, Bullets and American Lives
To the Editor:
note that since 1981, when James S.
ernment already controls, through li-
In a letter you published in 1960, I
Brady, President Reagan's press sec-
censing, the manufacture of bullets.
wrote to say that epidemiologists
retary, was shot, "Americans have
Mind, the Bureau of Alcohol, Tobacco
were trying to redefine automobile
bought nearly 50 million new guns,
and Firearms, which issues the li-
safety as a public health problem
including more than 20 million hand-
censes (for derisory sums with no
with greater attention to "passive"
guns." Americans may own some 200
record keeping), isn't much interest-
measures such as vehicle design.
million firearms. Would a waiting pe-
ed. There is no reference to this re-
Such views were then generally
riod for purchasing new weapons,
sponsibility in the bureau's job de-
greeted with skepticism, if not deri-
which I surely support, even so make
scription in the Government Manual.
sion, since conventional thinking then
much of a difference?
The publications of the National
saw the problem as driver behavior
You cite criminologists who are
Safety Council in 1960 did not mention
and the solution as law enforcement.
skeptical. And ought not they be? We
automobile design. But this can
Yet by 1966 Congress had enacted
have a two-century supply of hand-
change. John D. Graham, who is di-
legislation establishing the National
guns. These things last forever. Dr.
rector of the Injury Control Center at
Highway Safety Bureau, headed first
Haddon used to say that when a car
the Harvard School of Public Health,
by William Haddon Jr., M.D., who had
hit a tree nobody got hurt. It wasn't
from which Dr. Haddon graduated,
begun his career in the New York
until the passenger hit the car that
writes: "Bullet-related injury is
State Department of Health. Automo-
injury or death occurred. Therefore,
bile safety is now a recognized field of
think seat belts.
barely a field of respectable scientific
endeavor." But neither was vehicle
scientific research and technological
In the same analytic tradition can
innovation with results to show for it.
we not bring ourselves to see that
design a third of a century ago.
guns don't kill people? Bullets do. And
DANIEL PATRICK MOYNIHAN
I relate this in the context of "What
Can the Brady Bill Really Do? A
at most we have a four-year supply of
Pindars Corner, N.Y., Aug. 17, 1993
Little Gun Control, a Lot of Guns"
ammunition, albeit some can be
The writer is United States Senator
(The Week in Review, Aug. 15). You
hoarded. Moreover, the Federal Gov-
from New York.
OF EDUCATION
UNITED STATES DEPARTMENT OF EDUCATION
UNITED STATES OF AMERICA
THE DEPUTY SECRETARY
October 7, 1993
Memorandum to: Hillary Clinton
From: Madeleine M. Kunin
Re: Violence
I was very pleased to hear you say that violence, children's
issues, and welfare reform will be high on your agenda, following
health care reform. We would be happy to work with you in this
effort, which, as you know, is becoming of increasing concern to
the public.
Linking the epidemic of violence with the health care issue, as the
President has done, also strikes a very resonant chord with the
public.
Not only is violence shifting the focus away from achieving high
standards and overall school reform, but the prevalence of violence
also heightens the public's sense of insecurity and reduces
confidence in the government's ability to provide protection.
Our Safe Schools Act is a first step to help schools cope with
these problems. We have also held a successful conference on
school violence with the Justice Department and the Department of
Health and Human Services. Through Bill Modzeleski, the department
has built up considerable expertise in the area.
In addition, we are meeting with Peter Edelman, Phil Heymann, and
an inter-agency working group on violence. I look forward to
continuing to work with you on this difficult but critical issue.
cc: Richard Riley
Carol Rasco
Melanne Verveer
400 MARYLAND AVE., S.W. WASHINGTON, D.C. 20202-0500
Our mission is to ensure equal access to education and to promote educational excellence throughout the Nation.
cc Shinley
Melame
Daniel Patrick Maynihan
New York
United States Senate
Washington, D.C.
July 12, 1993
.PAM
?
0
Dear Mrs. Clinton:
Not without a measure of temerity, I
enclose a copy of the Summer issue of The
American Scholar in which I have an article,
"latrogenic Government". It began as the
Norman Zinberg lecture at the John F. Kennedy
School, and concerns the degree to which our
present, devastating drug problem is a
consequence of our own actions in trying to deal
with it.
Most sincerely,
Mrs. Hillary Rodham Clinton
The White House
Washington, D.C. 20500
Enclosure
RESEARCH
JOHNS HOPKINS
MEDICINE
Michael M.E. Johns, M.D.
James A. Block, M.D.
Dean of the Medical Faculty
President
Vice President for Medicine
Chief Executive Officer
The Johns Hopkins University
Johns Hopkins Health System
School of Medicine
The Johns Hopkins Hospital
Baltimore. Maryland 21205-2196
Baltimore, Maryland 21287-1160
(410) 955-3180 / FAX (410) 955-0889
(410) 955-0428 / FAX (410) 955-1885
September 21, 1993
President William Jefferson Clinton
The White House
1600 Pennsylvania Avenue, N.W.
Washington, D.C. 20500
Dear President Clinton:
We are pleased to send you the attached information you requested
on Dr. Snyder's proposal for developing a treatment for cocaine
addiction. We encourage you to make this your "Manhattan Project." If
we can supply you or your staff with additional information or answer any
questions, please contact us.
Sincerely,
Mehael
Michael M.E. Johns, M.D.
Dean of the Medical Faculty
Jan James A. Block, M.D.
President
Vice President for Medicine
Chief Executive Officer
The Johns Hopkins University
Johns Hopkins Health System
School of Medicine
The Johns Hopkins Hospital
A "Manhattan" Project for Drug Addiction
There is no greater domestic threat to the United States of America than the
drug abuse epidemic. Victims include not only the addicts but also the innocent
people who are robbed and burglarized by addicts to support their habits. The
economic fall out from the drug abuse epidemic reaches into every facet of life in
America including health care, law enforcement, education, and employee
performance.
Enormous sums have been spent to reduce the supply of illegal drugs but the
epidemic continues to grow. In contrast, there has been relatively little spent on
reducing demand for illicit drugs. While the National Institute on Drug Abuse has
significant funding for basic research into the mechanisms of drug addiction, there is
little spent on developing these discoveries into effective treatments. One approach
that has been effective for reducing craving for heroin is the use of long acting opiate
such as methadone. For cocaine abuse an even more effective eminently feasible
approach is to develop antagonists. Dr. Solomon H. Snyder, Distinguished Service
Professor of Neuroscience, Pharmacology and Molecular Biology and Psychiatry at
Johns Hopkins has outlined in the attached paper the way in which cocaine blockers
could be developed in a relatively short time frame.
The development of a cocaine blocker is but one of many targeted demand
reduction projects that could be activated with sufficient financial support. An
authorization of $95,000,000 for FY'94 for a Medication Development Program has
been approved but funds have not yet been appropriated. The House of
Representatives has approved an additional $20 million in funding for NIDA in FY'94,
but action in the Senate is still pending.
Program to Develop a Cocaine Antagonist
By
Solomon H. Snyder
The Johns Hopkins University School of Medicine
Departments of Neuroscience,
Pharmacology and Molecular Sciences, and Psychiatry
725 N. Wolfe Street, Baltimore, Maryland 21205
(410)955-3024
2
Most authorities agree that the current epidemic of cocaine abuse is
responsible for a major portion of crime in the United States Together
with intravenous use of heroine, cocaine abuse also accounts for many
instances of blood borne transmission of AIDS. Between the destruction
of human potential, vast quantities of drug related crime, and the
expansion of the AIDS pandemic, the costs to the United States are
conservatively estimated in many tens of billions of dollars. Were it
possible to develop a safe and effective cocaine antagonist to reduce
significantly the extent of cocaine dependence, the resultant benefits to
society would be considerable. This essay will describe the scientific
facts which make the development of a therapeutically effective cocaine
antagonist a straightforward extension of our current scientific
understanding of the mechanisms whereby cocaine exerts its behavioral
effects. Expenditure of a relatively modest amount of monies would, with
a high degree of probability, results in clinically effective agents ready
for clinical use in five to six years.
- How Cocaine Acts -
First, let me explain how cocaine exerts its behavioral effects.
Like almost all drugs that influence the brain, cocaine acts via
neurotransmitters. Neurotransmitters are the chemical messengers released
by the 10 billion neurons in the brain which account for information
transfer amongst this large population of neurons. Neurotransmitters
released by one neuron act at specific receptor proteins on the surface
of adjacent neurons which bind the neurotransmitter with great specificity
3
like a lock recognizes a key. Abundant scientific evidence indicates that
cocaine exerts its effects by facilitating the actions of the
neurotransmitter dopamine in parts of the brain that regulate feelings of
well being. How does cocaine enhance effects of dopamine? Dopamine, like
most other neurotransmitters, must be inactivated quickly after it acts
at receptor sites. The most common mechanism for inactivating
neurotransmitters, which applies to dopamine, involves a system in which
the dopamine is pumped back into the nerve endings that had released it.
Cocaine inhibits this pump for dopamine so that larger amounts of dopamine
are available to act at receptor sites. Evidence that this mechanism
accounts for the actions of dopamine comes from experiments using numerous
derivatives of cocaine. The relative potencies of these cocaine
derivatives in blocking the dopamine uptake pump closely parallel their
relative potencies in causing behavioral stimulant effects.
Based on the above description, one could develop drugs to block the
effects of cocaine by identifying chemicals that selectively influence
either the dopamine uptake pump or dopamine receptors. A drug that blocks
the effects of dopamine at its receptors would be expected to decrease
the euphoric effects of dopamine. The drugs currently used in the
treatment of schizophrenia, called neuroleptics block dopamine receptors.
Why are they not useful in treating cocaine abuse? The reason has to do
with the fact that dopamine acts at a number of subtypes of dopamine
receptors. The current available neuroleptics block all or most of these
so that one gets many side effects in addition to the blockade of
euphoria. The modern tools of molecular biology have resulted in the
cloning of genes for at least five distinct dopamine receptor subtypes.
4
These dopamine receptors can now be made by recombinant DNA technology so
that one could readily evaluate drug candidates at each dopamine receptor
subtype. Accordingly, agents could be developed that would selectively
block one or the other subtype. In this way, one could tailor make a drug
to block only dopamine actions at receptors associated with euphoria.
One can also develop cocaine antagonists by targeting the dopamine
uptake pump. Cocaine blocks this uptake pump. It should be feasible to
design drugs acting at the same site as cocaine but in an opposite
fashion, hence stimulating the dopamine uptake pump so that there will be
less dopamine to act at receptor sites.
- Drug Development -
How would one proceed from a drug candidate that is acting in the
test tube to a therapeutic agent? Once the combined work of chemists and
neuroscientists has resulted in the identification of agents that exert
the molecular actions predicted to block cocaine effects, then these drug
candidates would be administered to intact animals. There exists
excellent behavioral models of cocaine abuse in numerous animal species.
Thus, drugs that block the effects of cocaine on animal behavior would
have a very high likelihood of doing the same in humans. Promising drug
candidates would then be subjected to toxicology analysis, a conventional
process in drug discovery in which the effects of drug candidates are
evaluated on many different tissues of several animal species. Drug
candidates that pass this toxicologic screen would then be brought into
clinical trial. In Phase I of clinical trials agents are administered in
5
gradually increasing doses to normal volunteers to identify the optimal
dose and to look for possible toxic side effects. Agents that are
effective and safe in Phase I screening are brought into Phase II studies
in which cocaine abusers would be treated and the drug compared against
placebos. Phase III studies involve increased numbers of patients to look
for potential adverse effects that wouldn't be identified in the fewer
number of subjects studied in Phase II trials.
How would a cocaine antagonist work in the treatment of drug abusers?
A cocaine antagonist will block the perception of the euphoric effects of
cocaine. One would utilize a system of drug administration to produce
long-lasting effects from a single dose, preferably about a month. This
is feasible with the current state of drug delivery technology. The most
likely route of administration would be by injection such as a
subcutaneous implant of the drug in a vehicle that releases it gradually
over the period of a month. Individuals continuing to use cocaine would
not receive any euphoric, behaviorally reinforcing effects and would
gradually lose interest. Besides the treatment of chronic cocaine abuse
by cocaine antagonists, such drugs would have lifesaving effects in
treating individuals who are acutely intoxicated. In this instance one
would want a short acting version of the drug administered intravenously.
- Costs -
What are the costs of such a drug development program? It is
difficult to provide a precise cost estimate. However, an efficiently
designed program might be targeted to produce effective agents after five
6
or six years of research effort. The first two years would be devoted to
the chemical synthesis of drug candidates and their evaluation in
biochemical and behavioral studies in animals. Hopefully by the end of
two years of effort there would be agents that were candidates for human
trials. Toxicology analysis would occupy up to a year. Phase II and III
clinical trials would occupy two to three years. A rough estimate would
be a total cost of about $60 million spread over six years. This figure
is less than half the cost estimated by the Pharmaceutical Manufacturer
Association for the development of drugs currently on the market in the
United States. The lesser cost is related to the highly targeted nature
of the cocaine antagonist project as well as the considerable likelihood
that a cocaine antagonist will in fact block the euphoric effects of
cocaine in humans.
If development of a cocaine antagonist is that straightforward, why
haven't the major drug companies in the United States already developed
such agents? There are two major reasons. Most major drug companies are
not likely to initiate large research programs to develop agents if their
annual sales are estimated to be under $100 million annually. Drugs with
lower sales do not justify the large costs of drug development. Secondly,
the large drug companies are loathe to become immersed in drug development
in highly controversial areas such as abortion producing drugs or agents
that would be used in drug abusing populations. If this is the case, who
would do the drug development of a cocaine antagonist?
It is our feeling that the most effective attack on this problem will
come from a consortium of a university, a Federal effort such as the
Addiction Research Center of the National Institute on Drug Abuse, and a
7
relatively small biotech-type drug company. The anticipated market for
a cocaine antagonist would be of interest to the biotech industry, though
only with governmental subsidy assistance. The need for subsidy has to
do with the inability of the drug abusing population to pay for drug
treatment at levels that will cover the costs of drug development.
Biotech-type companies are accustomed to working closely with
universities, since most biotech companies are founded by university
professors. One would want university research involved, as the
technology being proposed for cocaine antagonist development involves the
forefront of molecular neuroscience research. The Addiction Research
Center might be a valuable resource at two levels. Researchers at the
Addiction Research Center have been involved in studies of the molecular
actions of cocaine. Additionally, the Addiction Research Center provides
a valuable resource of drug abusing patients for initial clinical trials.
In summary, it is our strong sentiment that a targeted program for
developing a cocaine antagonist is eminently feasible, would involve
modest costs when compared to the benefits to society, and could be best
approached by coordinated efforts of university research, the National
Institute on Drug Abuse, and the biotech-type drug industry.
2 copies
Scientific Breakthroughs
South exclusive
Brain Waves
How a UM doctor may soon unveil the ultimate cure for addictions,
and uncovered the mystery surrounding sudden cocaine deaths
By Nina L. Diamond
Photograph by Jane Mitchell
Cocaine overdoses had become more common in
talk about their landmark findings and continued research, and
South Florida than frostbite in Alaska. At the peak of cocaine
the state of chemical addiction. At least twice a month, Mash is
deaths, about seven years ago, Dr. Lee Hearn, laboratory
gone for days at a time, traveling the world to deliver research
director of the Metro-Dade Medical Examiner's Department,
papers, conduct studies and touch base with the National
was at a loss to explain why so many people were dying of coke
Institutes of Health (NIH) in Bethesda, Maryland, where she is a
overdoses when the blood-levels of the drug were much lower
consultant. For three months we spoke weekly, between her
than what was usually considered a lethal dose.
airport adventures. "Cocaine is one of the primary substances
The bodies came in, fluids and tissues were studied, and it
people here use and abuse. Not heroin, like elsewhere. And we
was more of the same. Why were all these people dying?
have a high number of cocaine emergencies and overdoses."
Just a few minutes from Hearn's office near Jackson Memo-
Mash notes it's only fitting that, "as a transit point for cocaine
rial Hospital, west of downtown Miami, neuroscientist Dr.
entering the U.S.," Miami should also be home to the most
Deborah Mash, who'd known Hearn since their grad school
promising research.
days at the University of Miami, was busy running the UM
"We were trying to understand the toxicology. Many died from
School of Medicine's Brain Endowment Bank, teaching neurol-
what should have been safe levels of cocaine in their bodies,"
ogy' and pharmacology, and keeping up with a full schedule of
she recalls. "We thought maybe there was a processing con-
brain research. In her mid-30s then, Mash had already made a
taminant, a toxic by-product created when cocaine was made
name for herself in Alzheimer's and Parkinson's disease re-
in labs. But that didn't explain it. We noticed that most people-
search, and, as a specialist in pharmacology, she routinely
five million Americans-combine cocaine with alcohol. It's the
played detective, studying the body's response not only to
most frequent two-way drug combo. Could cocaethylene be
outside chemicals, but also to the ones the body itself created.
the culprit? We measured it in specimens of blood, brain and
By 1989, Hearn had noticed something quite unusual in the
liver tissues and found it higher in some instances than the
blood of fatal coke overdose cases. "As I reviewed cases, I saw
levels of coke itself! Then we demonstrated that it's pharmaco-
that cocaethylene was often present in the blood. But nobody
logically active. And we found that it packs the same 'reward
knew what it did."
punch' on the brain as cocaine and alcohol do separately, but
Cocaethylene, discovered about 10 years ago, is manufac-
cocaethylene gives a longer and stronger high and has a much
tured by enzymes in the liver when cocaine and alcohol are
longer half-life than cocaine."
mixed. It was thought to only be present in the urine, and to be
This extra kick was often the last kick. "It's more potent than
of little consequence. So, when Hearn called scientists at Yale
cocaine in causing deaths," says Mash. "It's more lethal than
University and asked if they knew about any cocaethylene
cocaine."
studies, he was told that this third drug, created by our own
Her work, she says, is "like reading chapters of a very good
bodies, doesn't make its way into the blood stream. "Yes it
detective story." The much-published 41-year-old scientist
does," Hearn replied. "We see it all the time." He sent samples.
shies away from the term "workaholic." Instead, she likes to say
Yale verified them.
that "science is a way of life. You don't walk away from this."
With proof in hand that he wasn't imagining things, Hearn
Despite the fact that she's married to prominent Dade Demo-
went to his old pal Mash at UM. Backed by a National Institute
cratic party leader and attorney Joe Geller ("Joe who?" she
on Drug Abuse (NIDA) grant, Mash and her colleagues had
quips. "I hardly ever see him."), and has been a commissioner
already embarked on a study of the cocaine overdose epidemic.
for the City of North Bay Village since 1988, Mash's life is
"Sometimes there's more cocaethylene in these people than
otherwise consumed by her scientific crusade. "Intellectually,
cocaine," Hearn told Mash.
I never grow weary of it., I love the
Convinced that cocaethylene was the
discovery. Every day I'm faced with
culprit in the majority of these surpris-
"Cocaethylene gives a
something new. I learn every day."
ingly deadly overdoses, Mash was de-
longer and stronger high
Mash grew up in Hollywood, where
termined to prove that it was not a
her teachers fast-tracked her in math
harmless by-product, but a killer. She
than cocaine. And it's more
and science when she showed both
and Hearn joined forces, bringing their
lethal than cocaine."
interest and tremendous talent. A com-
staffs at UM and the Metro-Dade Medi-
petitive kid, she won science fairs with
cal Examiner's office together in the
-Dr. Deborah Mash
her biochemistry projects, and, as a
name of science.
senior in high school, she "discovered
They worked on little else for the last part of 1990, and in
brain science while studying psychology." She knew then, she
record time-less than six months-Mash, Hearn and their
says, that it would be her life's work.
team not only were the first to prove that cocaethylene is an
"I briefly toyed with being a medical doctor," she recalls. "But
active drug, they also had their breakthrough findings published
I wanted to devote 100 percent of my life to research."
in the January 1991 Journal of Neurochemistry.
Mash has never fit the stereotype of the stuffy scientist who's
"Miami is a unique place to do this research," says Mash,
quiet, prim and unaware of life outside the lab. Far from it. In
grabbing a precious 60 minutes out of her 12-hour work day to
college at FSU, she looked like Cher, with waist-length black
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Brainy lady: Dr. Deborah Mash in her headline-making lab at the UM School of Medicine's Brain Endowment Bank.
curls, an exotic aura, and eye-catching, funky leather outfits.
scientists and treatment people," she says. "Classic treatment
Ever the crusader, Mash spoke out against the Vietnam War and
approaches have largely failed. It's an illness, and we have to
whatever other social causes stirred her passions. At his law
design new treatments based on what we're learning about how
school graduation, her husband, Joe, blurted out an impromptu
these chemicals change the brain. We're also studying the long-
plea to stop the death penalty while on stage receiving his
term effects of drug and alcohol abuse."
diploma. They were-and still are-quite the couple.
She's now researching how cocaine and alcohol accelerate
Now, her crusade is to understand, prevent and treat drug and
cardiovascular disease. "Cocaine and alcohol do major dam-
alcohol addiction, both scientifically and sociologically. "I pore
age to the heart and brain. We're looking at heart disease and
over research at home, I design experiments in the car on the
cognitive and behavioral problems in people. Cocaine may
way to the lab. To combat abuse, we have to understand brain
cause depletion of dopamine in the brain, which may lead to
changes and dependency. Then we can design specific thera-
Parkinson's disease. We already know this is true of amphet-
peutic intervention. When we understand craving, we can know
amines. People taking them over time were stricken with move-
how to block it," she says enthusiastically. "We want to stop the
ment disease not unlike Parkinson's."
progression, to keep people off drugs and alcohol. We all pay,
Combining cocaine and alcohol takes an even higher toll on
and it's a hefty price tag. Just look at the crack babies."
the body. "The dual addiction is a harder addiction to break.
Mash and her colleagues approach the problem from all
We're looking into that. And it causes thickening of the arteries.
angles. "We now have the Comprehensive Drug Research
We think the deterioration is happening quickly, too. Hearts that
Center at UM to study and bridge the relationship between
are 30 look like they're 70. We may see a young generation die
OCTOBER 1993
SOUTH FLORIDA
29
off from heart disease."
grips with it, perhaps under-
Cocaethylene also plays a
Deliberation and
standing it for the first time. All
role in AIDS. "It may give the
rationalization
Body sensation
neuroses are solvable this
HIV virus a boost," Mash re-
Organization
way, not just the ones that
veals. "And our discovery that
of thought
lead to addiction."
cocaethylene is active in the
Visual
Using ibogaine, then, helps
body has helped spawn this
sensation
address the cause of the ad-
new angle in HIV research."
diction. "Drug addiction is an
But the most exciting, most
illness of the spirit," says
mind-boggling development in
Hearn. "If you're going to cure
the history of drug and alcohol
it, you have to cure it at that
treatment is the new drug
level."
ibogaine. And guess who may
Scientists and treatment
get to introduce this bona fide
professionals have long
cure for addiction? That's
known that trauma, insecuri-
Hearing
right-Mash and her col-
and
ties, fears and the like are the
leagues at both UM and the
speech
very foundations of psycho-
Metro-Dade Medical Exam-
logical distress, which in-
iner's department. As we go to
Recognition of body image
cludes addiction. "With ad-
press, she's awaiting approval
and individuality
diction, people feel good be-
from the Food and Drug Ad-
cause it fills a gap in their
ministration (FDA) to conduct
lives," notes Hearn. "The drug
safety trials. This is the first step-testing ibogaine on people in
or alcohol substitutes for something lacking, and it's used to
a controlled scientific setting-in the official process that makes
cope, too."
a drug legal for use in the United States.
So, when you literally "trip down memory lane" with ibogaine,
"The FDA has been very responsive on this one," Mash says,
you come to grips with all those experiences you swept under
feeling 99 percent certain that they will grant her request. "We
your emotional carpet so long ago. This miracle drug also
have a congressional mandate to help people get off drugs. And
"cures the anxiety of detachment from a long-term habit," says
we know that drugs are co-factors for HIV."
Hearn, whose Metro-Dade Medical Examiner's lab will be in-
Mash is just the latest link in the ibogaine story, but the one
volved in Mash's FDA safety trials by analyzing the long-term
that will bridge the gap between anecdotal evidence and the
blood concentration of ibogaine.
scientific proof needed for FDA approval. Ibogaine is derived
So far, no one has ever had a "bad trip" on ibogaine, and the
from the roots of Tabernathe iboga, a shrub native to equatorial
only side effect reported is slight nausea at the beginning of the
Africa, where tribes have long used it in small doses to remain
36-hour treatment. Mash has used ibogaine on monkeys and
alert while hunting, and in larger doses during sacred rituals.
found that "it's not toxic to the brain," she says. "And there were
Back in 1962, Howard Lotsof, then "part of the New York film
no adverse effects in the people who took it in Holland. Toxicity
scene at NYU's film school, and a heroin addict, was looking for
only showed up in a study at Johns Hopkins University, and it
a new high, when he discovered ibogaine," says Mash. "After
was only toxic in ridiculously high doses."
his 36-hour 'trip' on ibogaine, he found he had completely lost
While it's evident how ibogaine works psychologically, physi-
his desire for heroin, and had no withdrawal symptoms."
ologically "it's still a mystery," Mash admits. "It doesn't bind to
Lotsof gave the substance to other addicts, and they, too,
any known receptor in the brain." It has been shown to have an
were instantly un-hooked from the drugs that previously had
effect on dopamine, causing the brain to release less of this
controlled their lives. "The International Coalition for Addict
chemical, which in turn lessens the effects of cocaine.
Self-Help ran underground trial testing on ibogaine," Mash
Mash and her colleagues will test ibogaine on cocaine addicts
says, "and it was found to cure addictions to heroin, cocaine,
during the FDA safety trials. Her team includes two medical
amphetamines, alcohol and nico-
doctors-one is a neurologist and
tine." This so-called anecdotal evi-
the other a psychiatrist specializ-
ILLUSTRATION FROM THE RANDOM HOUSE ENCYCLOPEDIA, PUBLISHED BY RANDOM HOUSE, NEW YORK
dence has shown that ibogaine
"Ibogaine puts you into a
ing in addiction-and a social
cures addiction almost 100 per-
36-hour waking dream state. It's
worker who is an expert on inner-
cent of the time. In 1986, Lotsof
child work.
formed NDA International and se-
a psychoactive drug, but not
"Unfortunately, a negative bias
cured a use patent on ibogaine for
has evolved surrounding the use
treating drug and alcohol addic-
a hallucinogen like LSD.
of psychoactive drugs," Hearn la-
tion. Scientific study began in the
During this altered state of
ments, "because of the recre-
Netherlands three years ago, with
ational use of drugs like LSD. But
more than three dozen addicts as
consciousness, you relive your
it's a mistake to label them as bad
test cases. Mash was among the
childhood experiences and get
just because they're mind-active.
U.S. scientists and doctors invited
We need to distinguish among
to Leiden, Holland to witness
to the roots of your addictions."
them. Different drugs are different
ibogaine in action.
in their activities. This is not LSD.
-Dr. Deborah Mash
"It puts you into a 36-hour wak-
There are no bad trips, flashbacks
ing dream state. It's a psychoactive
or people wanting to jump off build-
drug, but not a hallucinogen like LSD. During this altered state
ings to see if they can fly. Maybe ibogaine will change some of
of consciousness, you relive your childhood experiences," she
the misperceptions and open the door to research with psycho
says. "You get to the roots of your addictions."
active drugs."
One trip on ibogaine is like 30 years on a therapist's couch.
Mash agrees, adding, "Treating drug dependence with a drug
"Ibogaine was used as a rite of passage from childhood to
is still considered by people to be ironic."
adulthood in Africa," says Hearn. "And now it can be used to
But, summing up both ibogaine and her non-stop work
reprogram the addict's life. He's detached from childhood
delving into the brain, she sighs: "God works in strange and
recollection while on Ibogaine, but is reexamining it, coming to
mysterious ways."
30
SOUTH FLORIDA
OCTOBER 1993
Miami
SCHOOL OF MEDICINE
September 17, 1993
Hillary Rodham Clinton
Office of the First Lady
The White House
West Wing, Second Floor
Washington, DC 20500
Re: Ibogaine HCI (Endabuseᵀ
SEP 2 0 1993
Dear Mrs. Clinton:
Enclosed please find a copy of the ABC News DAY ONE tape entitled
"Ibogaine Report", which my husband, Joe Geller, discussed with you during
your recent visit to Miami. We have previously given a copy of the tape to
Hugh. We are delighted by your interest in this project, and believe that you
will be excited about what you see. I would be more than happy to provide
you with additional information should you so desire, including information
about the status of our pending clinical trials.
Thank you for your interest in this project.
With best wishes.
Sincerely yours,
an C. mosh
Deborah C. Mash, Ph.D.
Associate Professor of Neurology
and Cellular and Molecular Pharmacology
Associate Director, Comprehensive Drug Research Center
Department of Neurology (D4-5)
P.O. Box 016960
Miami, Florida 33101
(305) 547-6731
Miami
SCHOOL OF MEDICINE
September 17, 1993
Hillary Rodham Clinton
Office of the First Lady
The White House
West Wing, Second Floor
Washington, DC 20500
Re: Ibogaine HCI (Endabuseᵀ
JEP 2 0 1993
Dear Mrs. Clinton:
Enclosed please find a copy of the ABC News DAY ONE tape entitled
"Ibogaine Report", which my husband, Joe Geller, discussed with you during
your recent visit to Miami. We have previously given a copy of the tape to
Hugh. We are delighted by your interest in this project, and believe that you
will be excited about what you see. I would be more than happy to provide
you with additional information should you so desire, including information
about the status of our pending clinical trials.
Thank you for your interest in this project.
With best wishes.
Sincerely yours,
an C. mosh
Deborah C. Mash, Ph.D.
Associate Professor of Neurology
and Cellular and Molecular Pharmacology
Associate Director, Comprehensive Drug Research Center
Department of Neurology (D4-5)
P.O. Box 016960
Miami, Florida 33101
(305) 547-6731
2 copies
Scientific Breakthroughs
Brain Waves
How a UM doctor may soon unveil the ultimate cure for addictions,
and uncovered the mystery surrounding sudden cocaine deaths
By Nina L. Diamond Photograph by Jane Mitchell
Cocaine overdoses had become more common in
talk about their landmark findings and continued research, and
South Florida than frostbite in Alaska. At the peak of cocaine
the state of chemical addiction. At least twice a month, Mash is
deaths, about seven years ago, Dr. Lee Hearn, laboratory
gone for days at a time, traveling the world to deliver research
director of the Metro-Dade Medical Examiner's Department,
papers, conduct studies and touch base with the National
was at a loss to explain why so many people were dying of coke
Institutes of Health (NIH) in Bethesda, Maryland, where she is a
overdoses when the blood-levels of the drug were much lower
consultant. For three months we spoke weekly, between her
than what was usually considered a lethal dose.
airport adventures. "Cocaine is one of the primary substances
The bodies came in, fluids and tissues were studied, and it
people here use and abuse. Not heroin, like elsewhere. And we
was more of the same. Why were all these people dying?
have a high number of cocaine emergencies and overdoses."
Just a few minutes from Hearn's office near Jackson Memo-
Mash notes it's only fitting that, "as a transit point for cocaine
rial Hospital, west of downtown Miami, neuroscientist Dr.
entering the U.S.," Miami should also be home to the most
Deborah Mash, who'd known Hearn since their grad school
promising research.
days at the University of Miami, was busy running the UM
"We were trying to understand the toxicology. Many died from
School of Medicine's Brain Endowment Bank, teaching neurol-
what should have been safe levels of cocaine in their bodies,"
ogy and pharmacology, and keeping up with a full schedule of
she recalls. "We thought maybe there was a processing con-
brain research. In her mid-30s then, Mash had already made a
taminant, a toxic by-product created when cocaine was made
name for herself in Alzheimer's and Parkinson's disease re-
in labs. But that didn't explain it. We noticed that most people-
search, and, as a specialist in pharmacology, she routinely
five million Americans-combine cocaine with alcohol. It's the
played detective, studying the body's response not only to
most frequent two-way drug combo. Could cocaethylene be
outside chemicals, but also to the ones the body itself created.
the culprit? We measured it in specimens of blood, brain and
By 1989, Hearn had noticed something quite unusual in the
liver tissues and found it higher in some instances than the
blood of fatal coke overdose cases. "As I reviewed cases, I saw
levels of coke itself! Then we demonstrated that it's pharmaco-
that cocaethylene was often present in the blood. But nobody
logically active. And we found that it packs the same 'reward
knew what it did."
punch' on the brain as cocaine and alcohol do separately, but
Cocaethylene, discovered about 10 years ago, is manufac-
cocaethylene gives a longer and stronger high and has a much
tured by enzymes in the liver when cocaine and alcohol are
longer half-life than cocaine."
mixed. It was thought to only be present in the urine, and to be
This extra kick was often the last kick. "It's more potent than
of little consequence. So, when Hearn called scientists at Yale
cocaine in causing deaths," says Mash. "It's more lethal than
University and asked if they knew about any cocaethylene
cocaine."
studies, he was told that this third drug, created by our own
Her work, she says, is "like reading chapters of a very good
bodies, doesn't make its way into the blood stream. "Yes it
detective story." The much-published 41-year-old scientist
does," Hearn replied. "We see it all the time." He sent samples.
shies away from the term "workaholic." Instead, she likes to say
Yale verified them.
that "science is a way of life. You don't walk away from this."
With proof in hand that he wasn't imagining things, Hearn
Despite the fact that she's married to prominent Dade Demo-
went to his old pal Mash at UM. Backed by a National Institute
cratic party leader and attorney Joe Geller ("Joe who?" she
on Drug Abuse (NIDA) grant, Mash and her colleagues had
quips. "I hardly ever see him."), and has been a commissioner
already embarked on a study of the cocaine overdose epidemic.
for the City of North Bay Village since 1988, Mash's life is
"Sometimes there's more cocaethylene in these people than
otherwise consumed by her scientific crusade. "Intellectually,
cocaine," Hearn told Mash.
I never grow weary of it. I love the
Convinced that cocaethylene was the
discovery. Every day I'm faced with
culprit in the majority of these surpris-
"Cocaethylene gives a
something new. I learn every day."
ingly deadly overdoses, Mash was de-
longer and stronger high
Mash grew up in Hollywood, where
termined to prove that it was not a
her teachers fast-tracked her in math
harmless by-product, but a killer. She
than cocaine. And it's more
and science when she showed both
and Hearn joined forces, bringing their
lethal than cocaine."
interest and tremendous talent. A com-
staffs at UM and the Metro-Dade Medi-
petitive kid, she won science fairs with
cal Examiner's office together in the
-Dr. Deborah Mash
her biochemistry projects, and, as a
name of science.
senior in high school, she "discovered
They worked on little else for the last part of 1990, and in
brain science while studying psychology." She knew then, she
record time-less than six months-Mash, Hearn and their
says, that it would be her life's work.
team not only were the first to prove that cocaethylene is an
"I briefly toyed with being a medical doctor," she recalls. "But
active drug, they also had their breakthrough findings published
I wanted to devote 100 percent of my life to research."
in the January 1991 Journal of Neurochemistry.
Mash has never fit the stereotype of the stuffy scientist who's
"Miami is a unique place to do this research," says Mash,
quiet, prim and unaware of life outside the lab. Far from it. In
grabbing a precious 60 minutes out of her 12-hour work day to
college at FSU, she looked like Cher, with waist-length black
28
SOUTH FLORIDA
OCTOBER 1993
FUJI RDP
RDP
Brainy lady: Dr. Deborah Mash in her headline-making lab at the UM School of Medicine's Brain Endowment Bank.
curls, an exotic aura, and eye-catching, funky leather outfits.
scientists and treatment people," she says. "Classic treatment
Ever the crusader, Mash spoke out against the Vietnam War and
approaches have largely failed. It's an illness, and we have to
whatever other social causes stirred her passions. At his law
design new treatments based on what we're learning about how
school graduation, her husband, Joe, blurted out an impromptu
these chemicals change the brain. We're also studying the long-
plea to stop the death penalty while on stage receiving his
term effects of drug and alcohol abuse."
diploma. They were-and still are-quite the couple.
She's now researching how cocaine and alcohol accelerate
Now, her crusade is to understand, prevent and treat drug and
cardiovascular disease. "Cocaine and alcohol do major dam-
alcohol addiction, both scientifically and sociologically. "I pore
age to the heart and brain. We're looking at heart disease and
over research at home, I design experiments in the car on the
cognitive and behavioral problems in people. Cocaine may
way to the lab. To combat abuse, we have to understand brain
cause depletion of dopamine in the brain, which may lead to
changes and dependency. Then we can design specific thera-
Parkinson's disease. We already know this is true of amphet-
peutic intervention. When we understand craving, we can know
amines. People taking them over time were stricken with move-
how to block it," she says enthusiastically. "We want to stop the
ment disease not unlike Parkinson's."
progression, to keep people off drugs and alcohol. We all pay,
Combining cocaine and alcohol takes an even higher toll on
and it's a hefty price tag. Just look at the crack babies."
the body. "The dual addiction is a harder addiction to break.
Mash and her colleagues approach the problem from all
We're looking into that. And it causes thickening of the arteries.
angles. "We now have the Comprehensive Drug Research
We think the deterioration is happening quickly, too. Hearts that
Center at UM to study and bridge the relationship between
are 30 look like they're 70. We may see a young generation die
OCTOBER 1993
SOUTHFLORIDA
29
off from heart disease."
grips with it, perhaps under-
Cocaethylene also plays a
Deliberation and
standing it for the first time. All
role in AIDS. "It may give the
rationalization
Body sensation
neuroses are solvable this
HIV virus a boost," Mash re-
Organization
way, not just the ones that
veals. "And our discovery that
of thought
lead to addiction."
cocaethylene is active in the
Visual
Using ibogaine, then, helps
body has helped spawn this
sensation
address the cause of the ad-
new angle in HIV research."
diction. "Drug addiction is an
But the most exciting, most
illness of the spirit," says
mind-boggling development in
Hearn. "If you're going to cure
the history of drug and alcohol
it, you have to cure it at that
treatment is the new drug
level."
ibogaine. And guess who may
Scientists and treatment
get to introduce this bona fide
professionals have long
cure for addiction? That's
known that trauma, insecuri-
Hearing
right-Mash and her col-
and
ties, fears and the like are the
leagues at both UM and the
speech
very foundations of psycho-
Metro-Dade Medical Exam-
logical distress, which in-
iner's department. As we go to
Recognition of body image
cludes addiction. "With ad-
press, she's awaiting approval
and individuality
diction, people feel good be-
from the Food and Drug Ad-
cause it fills a gap in their
ministration (FDA) to conduct
lives," notes Hearn. "The drug
safety trials. This is the first step-testing ibogaine on people in
or alcohol substitutes for something lacking, and it's used to
a controlled scientific setting-in the official process that makes
cope, too."
a drug legal for use in the United States.
So, when you literally "trip down memory lane" with ibogaine,
"The FDA has been very responsive on this one," Mash says,
you come to grips with all those experiences you swept under
feeling 99 percent certain that they will grant her request. "We
your emotional carpet so long ago. This miracle drug also
have a congressional mandate to help people get off drugs. And
"cures the anxiety of detachment from a long-term habit," says
we know that drugs are co-factors for HIV."
Hearn, whose Metro-Dade Medical Examiner's lab will be in-
Mash is just the latest link in the ibogaine story, but the one
volved in Mash's FDA safety trials by analyzing the long-term
that will bridge the gap between anecdotal evidence and the
blood concentration of ibogaine.
scientific proof needed for FDA approval. Ibogaine is derived
So far, no one has ever had a "bad trip" on ibogaine, and the
from the roots of Tabernathe iboga, a shrub native to equatorial
only side effect reported is slight nausea at the beginning of the
Africa, where tribes have long used it in small doses to remain
36-hour treatment. Mash has used ibogaine on monkeys and
alert while hunting, and in larger doses during sacred rituals.
found that "it's not toxic to the brain," she says. "And there were
Back in 1962, Howard Lotsof, then "part of the New York film
no adverse effects in the people who took it in Holland. Toxicity
scene at NYU's film school, and a heroin addict, was looking for
only showed up in a study at Johns Hopkins University, and it
a new high, when he discovered ibogaine," says Mash. "After
was only toxic in ridiculously high doses."
his 36-hour 'trip' on ibogaine, he found he had completely lost
While it's evident how ibogaine works psychologically, physi-
his desire for heroin, and had no withdrawal symptoms."
ologically "it's still a mystery," Mash admits. "It doesn't bind to
Lotsof gave the substance to other addicts, and they, too,
any known receptor in the brain." It has been shown to have an
were instantly un-hooked from the drugs that previously had
effect on dopamine, causing the brain to release less of this
controlled their lives. "The International Coalition for Addict
chemical, which in turn lessens the effects of cocaine.
Self-Help ran underground trial testing on ibogaine," Mash
Mash and her colleagues will test ibogaine on cocaine addicts
says, "and it was found to cure addictions to heroin, cocaine,
during the FDA safety trials. Her team includes two medical
amphetamines, alcohol and nico-
doctors-one is a neurologist and
tine." This so-called anecdotal evi-
the other a psychiatrist specializ-
ILLUSTRATION FROM THE RANDOM HOUSE ENCYCLOPEDIA, PUBLISHED BY RANDOM HOUSE, NEW YORK
dence has shown that ibogaine
"Ibogaine puts you into a
ing in addiction-and a social
cures addiction almost 100 per-
36-hour waking dream state. It's
worker who is an expert on inner-
cent of the time. In 1986, Lotsof
child work.
formed NDA International and se-
a psychoactive drug, but not
"Unfortunately, a negative bias
cured a use patent on ibogaine for
has evolved surrounding the use
treating drug and alcohol addic-
a hallucinogen like LSD.
of psychoactive drugs," Hearn la-
tion. Scientific study began in the
During this altered state of
ments, "because of the recre-
Netherlands three years ago, with
ational use of drugs like LSD. But
more than three dozen addicts as
consciousness, you relive your
it's a mistake to label them as bad
test cases. Mash was among the
U.S. scientists and doctors invited
childhood experiences and get
just because they're mind-active.
We need to distinguish among
to Leiden, Holland to witness
to the roots of your addictions."
them. Different drugs are different
ibogaine in action.
in their activities. This is not LSD.
-Dr. Deborah Mash
"It puts you into a 36-hour wak-
There are no bad trips, flashbacks
ing dream state. It's a psychoactive
or people wanting to jump off build-
drug, but not a hallucinogen like LSD. During this altered state
ings to see if they can fly. Maybe ibogaine will change some of
of consciousness, you relive your childhood experiences," she
the misperceptions and open the door to research with psycho
says. "You get to the roots of your addictions."
active drugs."
One trip on ibogaine is like 30 years on a therapist's couch.
Mash agrees, adding, "Treating drug dependence with a drug
"Ibogaine was used as a rite of passage from childhood to
is still considered by people to be ironic."
adulthood in Africa," says Hearn. "And now it can be used to
But, summing up both ibogaine and her non-stop work
reprogram the addict's life. He's detached from childhood
delving into the brain, she sighs: "God works in strange and
recollection while on Ibogaine, but is reexamining it, coming to
mysterious ways."
30
SOUTH FLORIDA
OCTOBER 1993
Miami
SCHOOL OF MEDICINE
September 17, 1993
Hillary Rodham Clinton
Office of the First Lady
The White House
West Wing, Second Floor
Washington, DC 20500
Re: Ibogaine HCI (Endabuseᵀ
DEP 2 0 1993
Dear Mrs. Clinton:
Enclosed please find a copy of the ABC News DAY ONE tape entitled
"Ibogaine Report", which my husband, Joe Geller, discussed with you during
your recent visit to Miami. We have previously given a copy of the tape to
Hugh. We are delighted by your interest in this project, and believe that you
will be excited about what you see. I would be more than happy to provide
you with additional information should you so desire, including information
about the status of our pending clinical trials.
Thank you for your interest in this project.
With best wishes.
Sincerely yours,
an C. mosh
Deborah C. Mash, Ph.D.
Associate Professor of Neurology
and Cellular and Molecular Pharmacology
Associate Director, Comprehensive Drug Research Center
Department of Neurology (D4-5)
P.O. Box 016960
Miami, Florida 33101
(305) 547-6731
2 copies
Forida
Scientific Breakthroughs
Brain Waves
How a UM doctor may soon unveil the ultimate cure for addictions,
and uncovered the mystery surrounding sudden cocaine deaths
By Nina L. Diamond
Photograph by Jane Mitchell
Cocaine overdoses had become more common in
talk about their landmark findings and continued research, and
South Florida than frostbite in Alaska. At the peak of cocaine
the state of chemical addiction. At least twice a month, Mash is
deaths, about seven years ago, Dr. Lee Hearn, laboratory
gone for days at a time, traveling the world to deliver research
director of the Metro-Dade Medical Examiner's Department,
papers, conduct studies and touch base with the National
was at a loss to explain why so many people were dying of coke
Institutes of Health (NIH) in Bethesda, Maryland, where she is a
overdoses when the blood-levels of the drug were much lower
consultant. For three months we spoke weekly, between her
than what was usually considered a lethal dose.
airport adventures. "Cocaine is one of the primary substances
The bodies came in, fluids and tissues were studied, and it
people here use and abuse. Not heroin, like elsewhere. And we
was more of the same. Why were all these people dying?
have a high number of cocaine emergencies and overdoses."
Just a few minutes from Hearn's office near Jackson Memo-
Mash notes it's only fitting that, "as a transit point for cocaine
rial Hospital, west of downtown Miami, neuroscientist Dr.
entering the U.S.," Miami should also be home to the most
Deborah Mash, who'd known Hearn since their grad school
promising research.
days at the University of Miami, was busy running the UM
"We were trying to understand the toxicology. Many died from
School of Medicine's Brain Endowment Bank, teaching neurol-
what should have been safe levels of cocaine in their bodies,"
ogy and pharmacology, and keeping up with a full schedule of
she recalls. "We thought maybe there was a processing con-
brain research. In her mid-30s then, Mash had already made a
taminant, a toxic by-product created when cocaine was made
name for herself in Alzheimer's and Parkinson's disease re-
in labs. But that didn't explain it. We noticed that most people-
search, and, as a specialist in pharmacology, she routinely
five million Americans-combine cocaine with alcohol. It's the
played detective, studying the body's response not only to
most frequent two-way drug combo. Could cocaethylene be
outside chemicals, but also to the ones the body itself created.
the culprit? We measured it in specimens of blood, brain and
By 1989, Hearn had noticed something quite unusual in the
liver tissues and found it higher in some instances than the
blood of fatal coke overdose cases. "As I reviewed cases, I saw
levels of coke itself! Then we demonstrated that it's pharmaco-
that cocaethylene was often present in the blood. But nobody
logically active. And we found that it packs the same 'reward
knew what it did."
punch' on the brain as cocaine and alcohol do separately, but
Cocaethylene, discovered about 10 years ago, is manufac-
cocaethylene gives a longer and stronger high and has a much
tured by enzymes in the liver when cocaine and alcohol are
longer half-life than cocaine."
mixed. It was thought to only be present in the urine, and to be
This extra kick was often the last kick. "It's more potent than
of little consequence. So, when Hearn called scientists at Yale
cocaine in causing deaths," says Mash. "It's more lethal than
University and asked if they knew about any cocaethylene
cocaine."
studies, he was told that this third drug, created by our own
Her work, she says, is "like reading chapters of a very good
bodies, doesn't make its way into the blood stream. "Yes it
detective story." The much-published 41-year-old scientist
does," Hearn replied. "We see it all the time." He sent samples.
shies away from the term "workaholic." Instead. she likes to say
Yale verified them.
that "science is a way of life. You don't walk away from this."
With proof in hand that he wasn't imagining things, Hearn
Despite the fact that she's married to prominent Dade Demo-
went to his old pal Mash at UM. Backed by a National Institute
cratic party leader and attorney Joe Geller ("Joe who?" she
on Drug Abuse (NIDA) grant, Mash and her colleagues had
quips. "I hardly ever see him."), and has been a commissioner
already embarked on a study of the cocaine overdose epidemic.
for the City of North Bay Village since 1988, Mash's life is
"Sometimes there's more cocaethylene in these people than
otherwise consumed by her scientific crusade. "Intellectually,
cocaine," Hearn told Mash.
I never grow weary of it. I love the
Convinced that cocaethylene was the
culprit in the majority of these surpris-
"Cocaethylene gives a
discovery. Every day I'm faced with
something new. I learn every day."
ingly deadly overdoses, Mash was de-
longer and stronger high
Mash grew up in Hollywood, where
termined to prove that it was not a
her teachers fast-tracked her in math
harmless by-product, but a killer. She
than cocaine. And it's more
and science when she showed both
and Hearn joined forces, bringing their
lethal than cocaine."
interest and tremendous talent. A com-
staffs at UM and the Metro-Dade Medi-
petitive kid, she won science fairs with
cal Examiner's office together in the
-Dr. Deborah Mash
her biochemistry projects, and, as a
name of science.
senior in high school, she "discovered
They worked on little else for the last part of 1990, and in
brain science while studying psychology." She knew then, she
record time-less than six months-Mash, Hearn and their
says, that it would be her life's work.
team not only were the first to prove that cocaethylene is an
"I briefly toyed with being a medical doctor," she recalls. "But
active drug, they also had their breakthrough findings published
I wanted to devote 100 percent of my life to research."
in the January 1991 Journal of Neurochemistry.
Mash has never fit the stereotype of the stuffy scientist who's
"Miami is a unique place to do this research," says Mash,
quiet, prim and unaware of life outside the lab. Far from it. In
grabbing a precious 60 minutes out of her 12-hour work day to
college at FSU, she looked like Cher, with waist-length black
28
SOUTHFLORIDA
OCTOBER 1993
FUJI RDP
RDP
Brainy lady: Dr. Deborah Mash in her headline-making lab at the UM School of Medicine's Brain Endowment Bank.
curls, an exotic aura, and eye-catching, funky leather outfits.
scientists and treatment people," she says. "Classic treatment
Ever the crusader, Mash spoke out against the Vietnam War and
approaches have largely failed. It's an illness, and we have to
whatever other social causes stirred her passions. At his law
design new treatments based on what we're learning about how
school graduation, her husband, Joe, blurted out an impromptu
these chemicals change the brain. We're also studying the long-
plea to stop the death penalty while on stage receiving his
term effects of drug and alcohol abuse."
diploma. They were-and still are-quite the couple.
She's now researching how cocaine and alcohol accelerate
Now, her crusade is to understand, prevent and treat drug and
cardiovascular disease. "Cocaine and alcohol do major dam-
alcohol addiction, both scientifically and sociologically. "I pore
age to the heart and brain. We're looking at heart disease and
over research at home, I design experiments in the car on the
cognitive and behavioral problems in people. Cocaine may
way to the lab. To combat abuse, we have to understand brain
cause depletion of dopamine in the brain, which may lead to
changes and dependency. Then we can design specific thera-
Parkinson's disease. We already know this is true of amphet-
peutic intervention. When we understand craving, we can know
amines. People taking them over time were stricken with move-
how to block it." she says enthusiastically. "We want to stop the
ment disease not unlike Parkinson's."
progression, to keep people off drugs and alcohol. We all pay,
Combining cocaine and alcohol takes an even higher toll on
and it's a hefty price tag. Just look at the crack babies."
the body. "The dual addiction is a harder addiction to break.
Mash and her colleagues approach the problem from all
We're looking into that. And it causes thickening of the arteries.
angles. "We now have the Comprehensive Drug Research
We think the deterioration is happening quickly, too. Hearts that
Center at UM to study and bridge the relationship between
are 30 look like they're 70. We may see a young generation die
OCTOBER 1993
SOUTH FLORIDA
29
off from heart disease."
grips with it, perhaps under-
Cocaethylene also plays a
Deliberation and
standing it for the first time. All
role in AIDS. "It may give the
rationalization
Body sensation
neuroses are solvable this
HIV virus a boost," Mash re-
Organization
way, not just the ones that
veals. "And our discovery that
of thought
lead to addiction."
cocaethylene is active in the
Visual
Using ibogaine, then, helps
body has helped spawn this
sensation
address the cause of the ad-
new angle in HIV research."
diction. "Drug addiction is an
But the most exciting, most
illness of the spirit," says
mind-boggling development in
Hearn. "If you're going to cure
the history of drug and alcohol
it, you have to cure it at that
treatment is the new drug
level."
ibogaine. And guess who may
Scientists and treatment
get to introduce this bona fide
professionals have long
cure for addiction? That's
known that trauma, insecuri-
Hearing
right-Mash and her col-
and
ties, fears and the like are the
leagues at both UM and the
speech
very foundations of psycho-
Metro-Dade Medical Exam-
logical distress, which in-
iner's department. As we go to
Recognition of body image
cludes addiction. "With ad-
press, she's awaiting approval
and individuality
diction, people feel good be-
from the Food and Drug Ad-
cause it fills a gap in their
ministration (FDA) to conduct
lives," notes Hearn. "The drug
safety trials. This is the first step-testing ibogaine on people in
or alcohol substitutes for something lacking, and it's used to
a controlled scientific setting-in the official process that makes
cope, too."
a drug legal for use in the United States.
So, when you literally "trip down memory lane" with ibogaine,
"The FDA has been very responsive on this one," Mash says,
you come to grips with all those experiences you swept under
feeling 99 percent certain that they will grant her request. "We
your emotional carpet so long ago. This miracle drug also
have a congressional mandate to help people get off drugs. And
"cures the anxiety of detachment from a long-term habit," says
we know that drugs are co-factors for HIV."
Hearn, whose Metro-Dade Medical Examiner's lab will be in-
Mash is just the latest link in the ibogaine story, but the one
volved in Mash's FDA safety trials by analyzing the long-term
that will bridge the gap between anecdotal evidence and the
blood concentration of ibogaine.
scientific proof needed for FDA approval. Ibogaine is derived
So far, no one has ever had a "bad trip" on ibogaine, and the
from the roots of Tabernathe iboga, a shrub native to equatorial
only side effect reported is slight nausea at the beginning of the
Africa, where tribes have long used it in small doses to remain
36-hour treatment. Mash has used ibogaine on monkeys and
alert while hunting, and in larger doses during sacred rituals.
found that "it's not toxic to the brain," she says. "And there were
Back in 1962, Howard Lotsof, then "part of the New York film
no adverse effects in the people who took it in Holland. Toxicity
scene at NYU's film school, and a heroin addict, was looking for
only showed up in a study at Johns Hopkins University, and it
a new high, when he discovered ibogaine," says Mash. "After
was only toxic in ridiculously high doses."
his 36-hour 'trip' on ibogaine, he found he had completely lost
While it's evident how ibogaine works psychologically, physi-
his desire for heroin, and had no withdrawal symptoms."
ologically "it's still a mystery," Mash admits. "It doesn't bind to
Lotsof gave the substance to other addicts, and they, too,
any known receptor in the brain." It has been shown to have an
were instantly un-hooked from the drugs that previously had
effect on dopamine, causing the brain to release less of this
controlled their lives. "The International Coalition for Addict
chemical, which in turn lessens the effects of cocaine.
Self-Help ran underground trial testing on ibogaine," Mash
Mash and her colleagues will test ibogaine on cocaine addicts
says, "and it was found to cure addictions to heroin, cocaine,
during the FDA safety trials. Her team includes two medical
amphetamines, alcohol and nico-
doctors-one is a neurologist and
tine." This so-called anecdotal evi-
the other a psychiatrist specializ-
ILLUSTRATION FROM THE RANDOM HOUSE ENCYCLOPEDIA, PUBLISHED BY RANDOM HOUSE, NEW YORK
dence has shown that ibogaine
"Ibogaine puts you into a
ing in addiction-and a social
cures addiction almost 100 per-
cent of the time. In 1986, Lotsof
36-hour waking dream state. It's
worker who is an expert on inner-
child work.
formed NDA International and se-
a psychoactive drug, but not
"Unfortunately, a negative bias
cured a use patent on ibogaine for
has evolved surrounding the use
treating drug and alcohol addic-
a hallucinogen like LSD.
of psychoactive drugs," Hearn la-
tion. Scientific study began in the
During this altered state of
ments, "because of the recre-
Netherlands three years ago, with
ational use of drugs like LSD. But
more than three dozen addicts as
consciousness, you relive your
it's a mistake to label them as bad
test cases, Mash was among the
U.S. scientists and doctors invited
childhood experiences and get
just because they're mind-active.
We need to distinguish among
to Leiden, Holland to witness
to the roots of your addictions."
them. Different drugs are different
ibogaine in action.
in their activities. This is not LSD.
-Dr. Deborah Mash
"It puts you into a 36-hour wak-
There are no bad trips, flashbacks
ing dream state. It's a psychoactive
or people wanting to jump off build-
drug, but not a hallucinogen like LSD. During this altered state
ings to see if they can fly. Maybe ibogaine will change some of
of consciousness, you relive your childhood experiences," she
the misperceptions and open the door to research with psycho
says. "You get to the roots of your addictions."
active drugs."
One trip on ibogaine is like 30 years on a therapist's couch.
Mash agrees, adding, "Treating drug dependence with a drug
"Ibogaine was used as a rite of passage from childhood to
is still considered by people to be ironic."
adulthood in Africa," says Hearn. "And now it can be used to
But, summing up both ibogaine and her non-stop work
reprogram the addict's life. He's detached from childhood
delving into the brain, she sighs: "God works in strange and
recollection while on Ibogaine, but is reexamining it, coming to
mysterious ways."
30
SOUTH FLORIDA
OCTOBER 1993
JOHN KERRY
MASSACHUSETTS
United States Senate
WASHINGTON, DC 20510
PERSONAL AND CONFIDENTIAL
MEMORANDUM
TO:
MRS. HILLARY RODHAM CLINTON
FROM:
SENATOR JOHN F. KERRY 96 K
DATE:
OCTOBER 5, 1993
RE:
CRIME AND VIOLENCE
Again, many thanks for inviting me to join you on the journey
to the United Nations. Per your suggestion, I am following up on
our conversation during the flight. I know how deeply you care
about this issue and also how committed the President is to
limiting violence.
My own involvement in this area goes back to the 1970's when
I was a prosecutor and chief administrator of one of the largest
District Attorney's offices in the country. I saw what worked then
and know we can do better today.
As I mentioned to you, I am deeply concerned that the national
response to our current epidemic of violence is anemic to say the
least. The risks for our party and for the country are enormous.
It is our watch now. For 12 years, I and others have been
critical of the phony Reagan/Bush war on drugs and response to
crime. Yet almost a year into the new Administration, we have
proposed and funded little that is different. I am deeply
concerned that our approach is too "Washington" -- too much
business as usual -- too distant from the real fears and concerns
of average citizens.
The Crime Bill, as it is currently drafted, will not
significantly alter our commitment or Americans' perceptions,
notwithstanding Joe Biden's good leadership and desire to do more.
He has simply been told the resources won't be there to do more,
leaving many of us to wonder why? And why aren't we fighting for
more resources? I dare say that after the strutting and the breast
beating in the Congress is over and the current Crime Bill is
passed, not many Americans will walk out of their homes with an
DETERMINED TO BE AN
ADMINISTRATIVE MARKING
PHOTOCOPY
INITIALS: Ry DATE: 8/26/2013
MISC. HANDWRITING
2013-0359-5
2
increased sense of safety or a new perception of real government
action that makes a difference to their lives. The Administration
should, at least, be pushing for significantly more than they will
get and, more importantly, for a real response to the issues that
concern people.
I believe we must summon a national program that is unlike any
past presidential effort. There must be a much greater sense of
urgency in the administration's response. We must mobilize not
just the government but the nation and its spirit.
Prosecutors, police, probation officers, victims, prison
administrators, judges, and, most importantly, the vast majority of
our citizens are waiting for leadership -- for something real to
happen that will make clear to everyone in this country we are
prepared to re-claim our communities that we are prepared to
assert a different set of values about how people protect and care
for each other in the context of community -- that we are prepared
to restore order where disorder has overwhelmed people's hopes and
aspirations.
How? By making a systemic commitment -- by treating the
criminal justice system as a system, where each component
understands its importance to other components, and an overall
resource commitment permits each component to make the rest of the
system work.
For instance -- police have no prayer of making deterrence
work or of diminishing peoples' fears, or even of maintaining order
or their own morale, if there is no place to put the people they
apprehend. A system that releases people early or never jails them
at all because no one will guarantee space is available or wastes
critical space on people who are non-violent, is a system doomed to
fail. That is precisely what we have today -- despite years of
warnings and countless celebrated incidents.
I suggest this nation is rich enough and competent enough to
coordinate state, local and federal prison systems as well as boot
camps and surplus and existing federal properties to quarantee that
people who should be taken off our streets in one form of
restraint or another -- are, and that alternatives are available
for those who shouldn't be. But we don't do this -- because no one
has challenged us or lead us to undertake this task. It is an
absolutely achievable goal but only with vision, leadership and
resource commitment.
Another example is drug treatment. We have had 6 or 7
declarations of war on drugs. Some say we have lost this war. I
say we have never really waged it.
3
Currently, only 20% of the addicts in America receive
treatment. On its face, this is unacceptable after 6 years of so-
called commitment. Moreover, only 55% of our, children are educated
about drug use. Treatment, education and law enforcement at home
continue to suffer resource starvation while supply side efforts
draw a disproportionate share of our focus often in quixotic
enterprises. It's not that we don't know what to do. It's simply
that we haven't made the decision to do it.
The result is that you can go a few blocks from the Capitol in
the light of day and watch addicts shoot up. You can do this in
most cities in America, and most Americans know it. Recently, I
rode around in a cop car in Boston to watch drug deals going down
from corner to corner. The cops know who the offenders are but
feel powerless to do anything because of clogged courts and
prisons. Worse still, the addicts and dealers know that our lack
of commitment means they can operate with near impunity,
understanding that society is not really serious. When 80% of all
addicts know that they can't get help at a given moment, the street
message is clear -- the system is not serious. And so, they
continue to tear apart the fabric of communities -- not to mention
their own lives. In the 9 years that I've been in the Senate, this
has not changed.
Yet another example: The President committed to put 100,000
more police on the street. I am told the Crime Bill offers only
50,000 police over 5 years though, in reality, the money allocated
will produce far fewer police than that. This is a dangerous
reversal of a promise which threatens not only administration
politics but policy. To properly implement community policing we
must significantly augment our force level. Twenty years ago,
there were 3 police officers for every violent crime. Today we
have 3 violent crimes per police officer. We must keep the 100,000
commitment and struggle to do more.
The bottom line, I have come to believe, regrettably, is that
government and country are not really serious about these issues --
or leadership at the highest levels has been unwilling to show how
we can, in fact, do something about these problems. Either way,
unless something changes dramatically, the Administration will be
fairly attacked for having lost its moment and squandered the
opportunity to be different.
I believe the administration should offer a comprehensive plan
for re-claiming our communities. The five most important short-
term components of this plan should embrace: (1) sufficient
resources to guarantee adequate community policing throughout the
country, including the Police Corps; (2) emergency and, in some
cases, temporary measures for incarceration and detention so that
anyone who should be jailed is; (3) proposals for bail modification
4
combined with speedy trial capacity to avoid any flight of drug
dealers or other criminals who encourage people to treat our system
with disregard; (4) emergency court capacity to provide swift and
certain punishment; and (5) treatment on demand for drug addiction.
In addition to these five key components, there must be further
proposals for diversion for certain youth with adequate counseling
or boot camp availability; high school equivalency requirements for
parole or release; a major federal grant program to provide
incentives for state action and cooperation with bail, gun law and
other requirements; a set of emergency inner-city resources to
schools for tutoring, counseling and evening hours.
This is only the beginning -- but I believe the most important
place to start. I and my staff stand ready to help in any way
possible to develop and implement these initiatives.
I have enclosed a speech I delivered at Yale last year which
addresses this and related issues. I hope it is helpful.
JOHN KERRY
MASSACHUSETTS
United States Senate
WASHINGTON, DC 20510
EMBARGOED/FOR RELEASE UPON DELIVERY ONLY, APPROX. 8 P.M. TONIGHT
Race, Politics And The
Urban Agenda
Senator John Kerry
Yale University
March 30, 1992
This is, as you may have noticed here in Connecticut last week,
an election year.
We are, as we have been so often in the past, inundated with the
trivia of politics, but sadly we are deprived of its essence. For
politics at its best is not about media horse races, photo
opportunities or freeze-dried messages microwaved before each
primary; the politics that interests me and matters to you is not
trivial and not separable from the reality of life as it is lived
in this country today.
What is that reality? Well, for some- I expect for most of
you--it is the obvious- a reality filled with anxieties about
classwork, social relationships and future choices. But it is
also, for most of you, a reality shaped by high expectations, a
certain degree of confidence in self and the support of peers and
family. And while the horizons you see when you look ahead may
not be quite as cloudless as those that I and others perceived
when sitting in your place a few years ago, I sense the optimism
is still there, the almost boundless sense of possibility and the
impatience to experience the full measure of life and promised
success.
For the next few minutes though, I ask you to consider a
different part of the reality of America today; a violent,
drug-ridden, rat-infested reality; a reality in which the
institutions of civilized social life have broken down; of
disintegrated families; boarded up storefronts; schools that have
become armed camps and crackhouses replacing community centers as
the focus of neighborhood life.
I ask you to consider a reality where more than 80% of babies are
born to single mothers; where young men die violently at a rate
exceeding that of any american war; where only one child in three
finishes high school and even then, too often, can barely read;
where the spread of AIDS and homelessness rips so visibly at the
fabric of community; where far too many families are on welfare
for far too long; and where far too many children carry guns
instead of lunch boxes to school.
I ask you to consider a reality that is ruled not simply by
poverty, but by savagery; a tragic, inescapable and cruel reality
2
that increasingly affects all of us and that is eating away at
the American soul.
Sadly, we have always had poverty in this country. We have always
had violent crime. From the days of the first wayward Pilgrim, we
have had problems with alcohol and drugs.
But we have never seen in America the kind of problems that we
see in our worst urban neighborhoods today.
We have never seen children talk matter of factly about blowing
each other away or about living in a world where guns are as
common as water or about going to sleep at night and waking up
each morning with shooting or getting shot the first thing on
their minds.
We have never seen an America where a two-year old girl could be
found at a day care center with eleven vials of crack in her
pockets thinking that they were candy or where a kindergartner
could find a gun in a stroller and use it to kill his little
sister.
We have never tried to raise children in an environment where the
glorification of violence in movies and music has such immediate
relevance to so many; where Hollywood tries and tries but cannot
out-shock reality; and where some rap musicians celebrate murder
in cold blood while murder records are broken every year.
Today, this land of the free has the highest incarceration rate
of any nation in the world; we imprison black males at five times
the rate of South Africa; and a violent crime is committed in or
around one of our schools every six seconds.
Today, too many places in this land of opportunity have for many
become forbidden lands, deserted by working families and
functioning businesses; deserted by children's laughter; deserted
by hope; deserted by everything but the desperate desire to
survive and the grim realization that for too many survival
provides no escape.
So let us be honest. A lot of us would like to believe that this
is not happening. Or we hope that if we're careful, the urban
devastation just won't touch our own lives. Or we have concluded
that there is nothing that can be done about it. Or we believe it
is someone else's responsibility rather than our own. We have
adopted a national policy of rationalization and avoidance --
and worse, exploitation.
In this, regretfully, too many take a cue from a President and
Vice-President who ridicule welfare recipients and encourage
racial divisions, or we take a cue from any of the other
politicians in both parties who will tell us only what we want to
3
hear.
Before I say more, I want you to know that I have always agreed
with Mark Twain that it is sometimes better to keep one's mouth
shut and be thought stupid than to open it and remove all doubt.
Well, despite the risks, I am compelled to share with you my
conviction that America is not going to be liveable; it's not
going to be safe; it's not going to be the America we want it to
be unless we find a way to save our cities and to provide hope
and opportunity to the people who live in them.
Just a very few years ago, when I sat where you sit now, the mere
mention of poverty and suffering would have brought forth a
strong response not only from the young but from much of our
society. I remember how my own first real political commitment
came as a result of hearing an activist named Al Lowenstein speak
here at Battel Chapel about the massive injustice of segregation
and repression in Mississippi and all through the South.
We were not, in those days, embarrassed to feel guilty about
those who were less fortunate than ourselves; Ronald Reagan
hadn't legitimized selfishness yet.
We did not think it was vain to believe we could design and
implement programs that would generate real benefits for people;
we thought that was what government was for.
We had faith in America's promise of equal opportunity; we took
inspiration from the movement for civil rights; and we had not
yet shared an experience with American failure or frustration in
the post-war, pre-Vietnam world.
Today, we are a lot more cynical--all of us. We are fed up with a
government that is simply not working, paralyzed by the rivalry
between a Democratic Congress and a Republican President. We are
skeptical, after decades of scandal and waste, that any federal
program will achieve its goals, even if we agree the goals are
important. We have become fatigued by constant appeals to our
compassion and generosity, not only from within but from outside
our borders, and we are conscious that we lead the world not only
in military power and economic production--but we lead in debt,
as well.
Despite these concerns, we know most of us, deep down, that we
cannot continue on the road we are on. We understand that we are
not going to be competitive internationally if too many of our
young people cannot compete at all. We are not going to get out
of debt if we must allocate billions more each year to prisons
and prosecutions, emergency health care, drug rehabilitation,
added security and higher welfare. We know, even on this campus,
that no amount of locks, metal detectors or fancy suburban fences
can protect our families or our children from what has become by
4
far the most violent society in the industrialized world. And no
amount of rationalization can make us wholly indifferent to the
suffering and unfairness of what is happening in our cities
especially to the very young.
Twenty-seven years ago, my Senate colleague Daniel Patrick
Moynihan warned that: "from the wild Irish slums of the 19th
century eastern seaboard, to the riot-torn suburbs of Los
Angeles, there is one unmistakable lesson in American history: a
society that allows a large number of young men to grow up in
broken families
never acquiring any stable relationship
to
authority, never acquiring any rational expectations about
the future--that society asks for and gets chaos. Crime,
violence, unrest, disorder--most particularly the furious,
unrestrained lashing out at the whole social structure--that is
not only to be expected; it is very near to inevitable
Today, urban gangs literally seize the young from their mothers
before they turn ten. Why? How has it happened? The trends that
Pat Moynihan spoke of were barely beginning a quarter century
ago. How is it that in the short span of twenty-seven years,
this phenomenon of disintegration and violence has overwhelmed
whole communities and created new and dangerous cultures?
The questions themselves intimidate -- so much so people avoid
asking them? How is it, for example, that since 1965 the
percentage of black children living with both parents through the
age of 17 has gone from 50% to 6%? And this is not a trend
exclusive to the black community. Nor are any of these problems
exclusive to minority communities. They are simply exaggerated
there because the starting point is so much worse and because the
impacts of social change always seem to hit hardest at the most
vulnerable parts of our society.
But we must ask ourselves whether this social disintegration is
merely a symptom of deteriorating values that have struck all
sectors of our society to some degree. We must ask whether it is
the result of a massive shift in the psychology of our nation
that some argue grew out of the 1960s -- a shift from self-
reliance to dependence, from caring to self-indulgence, from
public accountability to public abdication and chaos.
I am neither a psychologist nor a social scientist. I'don't know
the answers to these questions, but as a public person, I know
that we must start asking the questions, that we must find
answers and that we must, at the very least, begin talking about
them openly and honestly at all levels of our society.
And as a public person, I also know that I have a responsibility
to do all that I can do to end this journey into despair, this
merry-go-round of murdered ambitions and wasted lives.
5
What is clear to me is that the bleeding has gone on so long
there is no single remedy, no magic wand. Our strategy must now
be to restore the entire institutional fabric of these
communities. No less than that will get the job done. That
means dealing with all aspects of community -- parenting, child
care, education, housing, youth sports -- all the threads in the
fabric.
But above all, there must be a starting point, a foundation, upon
which you can begin literally to create and lift the self esteem
of an entire population. The most obvious and undeniable
starting point can be summed up in three words spoken recently in
a different context by a certain, former first baseman for Yale -
- and those three words are "jobs, jobs and jobs."
For more than a quarter century, American cities have been losing
industrial jobs--the kind of jobs you can get with a high school
or even a grade school education--the kinds of jobs that were
available to our immigrant parents and grandparents. Six hundred
thousand of these jobs have been lost in New York City alone,
millions nationwide. Most are physical jobs, muscle jobs, in auto
plants and textile mills and shipyards and candy factories. And
at exactly the same time these jobs have been disappearing, the
population of teenage males in northern cities has been doubling
and the number of women entering the workplace has been
exploding. More people seeking fewer jobs means more people
without jobs; which means fewer people able to support families,
which means more people turning to crime, which means more
working families leaving the cities, and on and on down the
spiral of frustration to despair.
The only way I know to end this downward spiral, is to define a
beginning place and get to work. For me, that essential building
block must be the restoration of good jobs and of good job skills
and the restoration of public order in these communities. I
cannot think of anything that would do more for the future of our
country than for us to design such a program and make it work.
But all of us know that there are obstacles to this. Some
neighborhoods--and some people--are so wracked by drugs and crime
or so inured to the culture of dependence that they may be beyond
help; the economic forces that robbed our cities of industrial
and manufacturing jobs are growing stronger, not weaker; most
businesses don't want to invest in the poorest neighborhoods; and
we're up to our eyeballs in red ink. But towering above all these
there is another, even more serious obstacle and that obstacle is
america's unwillingness to confront the issue of race.
The fact is that the majority of the white majority in this
country doesn't want to invest more of their scarce tax dollars
in minority neighborhoods or in what many believe to be
predominately minority problems. Tragically, we have come all too
6
often to view the urban crisis simply as a question of "us" VS.
"them"; thereby preventing real dialogue and real progress.
It would be simple to blame all this on racism, and there is no
doubt that white racism persists in our society, that it is ugly
and insidious and present everywhere in housing and education and
employment.
But the issues and the reasons for our dilemma go deeper and are
more complex than that. They have their roots in the changing
nature of the movement for civil rights, in the turbulent history
of race relations and the persistence of racial stereotypes.
Thirty years ago, a supporter of the civil rights movement could
agree with John Kennedy that the proposition that "race has no
role in American life and law" is a "moral issue as old as the
scriptures and as clear as the constitution." But for the past
two decades, that same movement has depended on laws and rulings
that have, in fact, strengthened the role of race in American
life and law.
Where once Martin Luther King could depict the struggle for equal
rights as a mighty battle between good and evil; a battle where
pot-bellied sheriffs and attack dogs squared off against
hymn-singing children dressed in their Sunday best; today, the
civil rights arena is controlled by lawyers and the winners and
losers determined by rules most Americans neither understand nor
fully accept. This shift in the civil rights agenda has directed
most of our attention and much of our hope into one inherently
limited and divisive program--affirmative action.
Let me be clear. I support affirmative action. Affirmative action
has opened doors for women, persons with disabilities and
countless minorities. It has helped create a large and growing
black middle class. It has helped minority businesses and opened
up bastions of prejudice like the Alabama State Police, which had
no black members at all in a state that is 30% black. It has
caused employers to re-think the standards and tests they use to
qualify people for employment. And it has given the benefit of
the doubt to diversity over uniformity on campuses and in
workplaces across America. This is the positive side.
But there is a negative side and we can no longer simply will
away the growing consensus of perception within America's white
majority. We must be willing to acknowledge publicly what we
know to be true: -- that just as the benefits to America of
affirmative action cannot be denied neither can the costs. Too
many politicians, particularly in my own party, have not
acknowledged these costs for fear of undermining the very goals
of affirmative action. By that failure, we send a message to
many of those who feel alienated or abandoned by their government
that we simply don't care about them, and that we don't realize
7
that it is they, far more than we, who have borne the burden of
compliance with the law. The truth is that affirmative action has
kept America thinking in racial terms and as Yale law professor
Stephen Carter has recently and so provocatively asked: "is it a
good thing, is it a safe thing, to encourage white America to
think in racial terms?"
In 1964, when the Civil Rights Act was being debated, Senator
Hubert Humphrey assured reluctant colleagues that nothing in the
bill would "require hiring, firing or promotion of employees in
order to meet a racial quota or to achieve a racial balance."
But the controversy Senator Humphrey sought then to put to rest
remains with us today. Not only by legislation, but by
administrative order and court decree, a vast and bewildering
apparatus of affirmative action rules and guidelines has been
constructed. And somewhere within that vast apparatus conjured up
to fight racism there exists a reality of reverse discrimination
that actually engenders racism. No question: this reality has
been exaggerated by subjective perception and by politicians
eager to exploit it, but out of that reality has come a
resentment that is real and widespread and dangerous. It is a
resentment fed by memories of court-ordered busing and images of
riots and looting and raised fists and by a sense of being
singled out to compensate for historical sins which today's white
workers did not commit.
This issue of white resentment cannot simply be dismissed. If we
truly care about racial progress and about our cities, we must
rebuild the consensus that will make a difference to those
cities. We cannot equate fear of crime or concern about
deteriorating schools with racism and then expect those we have
called racists to invest in the very neighborhoods they have
fled. We cannot lecture our citizens about fairness and then
disregard legitimate questions about the actual fairness of
federal regulation and law. We cannot deride as politically
incorrect the anger of taxpayers who work hard to support their
families and then find themselves supporting generations of
welfare families as well.
For all of these reasons, we must maintain affirmative action as
an indispensable remedy against past discrimination, but we've
got to work harder to end the perception that it must lead
inevitably to reverse discrimination. We cannot hope to make
further racial progress when the plurality of whites believe, as
they do today according to recent data, that it is they--not
others--who suffer most from discrimination.
We cannot make further progress if we continue to put all our
energies and emphasis into a remedy that in fact does relatively
little for the blacks and other minorities who are in the
greatest need of help. We cannot continue indefinitely to allow
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the debate over quotas to drive a wedge between white and black;
between white and hispanic; between white and Asian; between our
government and so many our government represents.
We must find a way--and we must find it soon--to escape once and
for all from the politics of resentment in which we are trapped
today; for if we do not, we will sign the death warrant for our
economic future and our social peace. We must stand up and say to
Bush and Buchanan, David Duke and Al Sharpton--that we are not
going to fall for this pandering and exploitation any more. And
we must reach out to each other, not on the basis of race, but as
Americans, to narrow divisions and begin a process of healing and
understanding and communication.
But even this does not answer the key question. Let's say we've
got Americans more comfortable with one another. Let's say we've
moved beyond the worst of the finger-pointing and blame-making.
So what? What does that mean for our cities? The drugs are still
there; the crime is still there; the poverty is still there--and
the jobs are still somewhere else.
I would forfeit all credibility with you if I were to say that I
have a surefire solution for all of what ails urban America. I do
not. But I would argue that we can begin by waging war on two
myths: the Democratic myth that merely re-distributing wealth
will create wealth, and the Republican myth that government
cannot be a force for positive change. In their place, I would
substitute a new version of the social contract, a covenant
wherein every right is matched with a responsibility; and where
rapid, inclusive economic growth is our overriding goal.
This new social contract demands an approach to investing in our
people that avoids the crippling perception of racial favoritism,
an approach that accepts William Julius Wilson's view that "in
the last few years of the 20th century, the problems of the truly
disadvantaged will have to be attacked primarily through
universal programs that enjoy the support of a broad
constituency.
This new social contract must be designed specifically to
reinforce the values of hard work both at school and on the job;
it must be aimed at ending, rather than prolonging, dependence on
welfare; it must minimize the potential abuses of political
patronage and bureaucratic waste; and its overriding goal must be
the restoration of American economic leadership in the world and
our social health at home.
So what does that mean specifically?
It begins, in my judgment, with the simple restoration of order,
a serious and sustained and stepped up battle to re-claim our
streets and apartment houses and neighborhoods from the criminals
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and gangs who now control so many of them, either physically or
by intimidation.
You know, the year before I came to this campus, the city of New
Haven experienced a grand total of 6 murders, 4 rapes, 16
robberies and 72 assaults. In 1990, it was 31 murders, 168 rapes,
1784 robberies--an increase of more than 100 times--and 2008
assaults. Let's not kid ourselves. We aren't going to rebuild our
cities if we're so worried about intended or random violence that
we're afraid to enter them.
The Department of Justice tells us that 83% of all Americans can
expect to be the victim of a violent crime at least once in their
lives. That is simply unacceptable; we can't live like that; and
we must understand that while crime affects all of us to a
greater or lesser degree, it hits poor, inner city neighborhoods
especially hard. Crime creates poverty. Each murder, each rape,
each burglary and each mugging makes it more likely that a
business will close, a working family will leave or an investor
will look elsewhere. In this sense, controlling crime is
virtually a precondition to any serious attempt at social or
economic reform.
Urban crime--although much of it is intra-racial--is also the
most deadly poison there is to improved relations between black
and white Americans. In shaping opinions and defining behavior,
fear will defeat fairness virtually every time.
That is why we need to have more police -- not simply to put
people in jail, but to reclaim the tranquility that is a pre-
requisite to any social reforms. A generation ago, there were
three times as many police officers as there were violent crimes.
Today, we have three times as many violent crimes as we have
police. In Boston, just to cite one example, budget cuts are
reducing our police to the lowest level in five years. That's
just crazy. In the face of a persistent and deadly assault, we
are literally disarming ourselves.
The anti-crime bill approved by Congress but opposed by the
President is far from perfect, but it does include a plan I and
others worked for to establish a Police Corps that could add
20,000 young people annually to police forces around the country.
That, plus increased federal support for state and local law
enforcement, would do far more to combat crime than the
President's demand for 57 flavors of the death penalty.
By putting more police on the streets, we can help reestablish
community order; we can help remove the most destructive force in
our cities today, which is fear; we can help the broad array of
urban ethnic groups gain confidence in each other; and by
deterring and detecting and punishing crime, we can help provide
a shield behind which communities in trouble can rebuild and kids
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in trouble can recover. Clearly our purpose is not to fill our
prisons more; but we must establish an environment within which
drug rehabilitation, teen centers, counseling programs and the
simple basics of family life have a real shot at success. That
will be good for minorities, for our cities and for our country.
The second thing we must do is help directly those we have the
greatest capacity to help--the infants and children who have not
yet assimilated the harshest lessons of the city and not yet
accepted the limits on their abilities or expectations. The time
has come, after years of delay, to make a real commitment to pre-
natal care, to infant nutrition, to child immunization and
finally, to fully fund Head Start. For those who say that costs
too much, I say that we'll get back every dollar three or four
times over in reduced costs for drug rehabilitation, law
enforcement and the construction of new jails. None of this is
to ignore the other education demands, but we must begin
somewhere.
Third, we must go into our cities and help the courageous people
who have never stopped struggling to rebuild the basic
institutions that support community life. Head Start or not, kids
without real families get crushed if there's no place to go after
school or at night or on the weekends or in the summer. They need
role models that are closer to them than the star athlete and
better for them than the local drug kingpin.
Before coming here tonight, I thought about simply repeating my
prior call for a new domestic Peace Corps; but that's not what
we need. We need an army of civilian volunteers to involve
themselves in these communities. We need a professionally
organized and run institution that serves to train and teach and
discipline its own recruits while carrying out public service
missions primarily in urban America. We could begin with a core
of experienced people from our down-sized armed forces. We've
been willing to spend billions to keep our troops deployed in
dangerous spots around the world. Now, rather than rewarding
them with unemployment, let's put them to work confronting the
new threat here at home. And we can build on that with recruits
from all walks of life who are willing to teach, to counsel, to
run academic and recreational programs and to help rebuild some
of the hardest-hit neighborhoods in our country.
There are no guarantees, but if anything would give disadvantaged
kids something real and good to emulate it just might be an
organization whose members themselves are tough without guns,
disciplined, drug-free, of diverse backgrounds and reaching out
to them every day on their own home turf.
Fourth, we need to continue replacing entitlements with
incentives in every state and federal program we can. We're
already requiring the able-bodied on long term welfare to seek
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work or to accept training that will give them the skills they
need to work--but we must fund that training more adequately and
do more to generate suitable jobs. We should also provide
incentives for corporations to find summer jobs for kids who stay
in school and stay off drugs. We should set strict standards for
participation in youth job training programs so that we can be
sure to help those with the strongest drive to help themselves.
And we should enact the legislation that is now pending in
congress to guarantee college opportunity to every child in
America who has graduated from high school and who wants to
continue his or her education.
Fifth, we need an all out integrated program of economic
development and growth. I, for one, do not accept the view that
America can never again hope to compete industrially; the fact
is--we haven't tried. Urban Enterprise Zones have been on the
drawing boards for decades, but never made a reality. The
President's capital gains proposal is a joke; but job-creating
incentives for the startup, modernization and expansion of
companies are urgently required. A Teacher Corps that will
encourage our most talented young people to work where they are
most needed is long overdue. Microenterprise loan programs can be
designed to help the jobless and other low income people
establish themselves as entrepreneurs. And partnerships between
American firms and their counterparts in Eastern Europe, Asia and
the former Soviet Union can open huge new markets for American
goods and services overseas.
As political leaders, parents, teachers or just plain friends, we
have to get the message across to all our citizens that the
barriers of poverty or unemployment or hard luck or even racism
do not excuse behavior that is both self-destructive and harmful
to our national community. Even the most disadvantaged of us have
choices. Explaining aberrant behavior on the grounds of poor
family circumstances is one thing; excusing that behavior is
another.
This may seem a hard line, but remember who suffers most when
children literally get away with murder because of their age; or
when students are allowed to drift through school without
learning or even trying to learn; or when teenage girls are- left
pregnant and alone; or when public housing tenants turn their
apartments into crackhouses. This hurts all Americans to an
extent; but it crushes the people who live next door.
It has long been known that poverty leads to crime; but recent
experience has confirmed that crime also leads to poverty. Make
no mistake, we do these families no favor when we are permissive
towards criminals or drug peddlers. We also do no favor to those
who are in trouble, for their only hope in the long run is to
change the kind of choices they make.
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I know from experience in Boston and the other large cities of my
state that there are thousands of decent, honest and struggling
families in what we call disadvantaged neighborhoods--families
too determined, too proud, or too poor to move. And there are
hundreds of organizations and individuals on the front line every
day, struggling against the tide.
If you are looking for true heroes in America, many of them are
right there, trying against all the odds to keep their kids
straight, working two and three jobs to make ends meet, trying to
hold communities together that have long since been declared dead
by a media more interested in the trauma of crime than the drama
of daily life. They desperately need our help - now.
To restore respect for values, we must restore respect for
authority and that is going to take some time. After a decade of
dozen digit deficits, government scandals, insider trading,
greed, callousness and the self-destruction of everyone from John
Sununu to the evangelist Jim Bakker--the question of who has a
right to preach to whom is in grave doubt. Lectures about sexual
responsibility, hard work, honesty and abstinence from drugs
impress few when given by representatives of institutions that
are thought to reflect none of those qualities. A government that
continually ducks hard choices can hardly blame adolescents for
doing the same.
I do not have the time tonight--or perhaps in what remains of
this millennium--to prescribe a full remedy for the public's
alienation from government, but a serious approach to the
problems of our cities and of race and racism would be an
important step in the right direction. That, alone, will require
a great deal more honesty, creativity, leadership and courage
than we have seen in recent years.
But the sole burden does not belong on government. As
individuals, we have to face our own responsibility-- a
responsibility, first of all, to understand that there is nothing
abstract or theoretical about any of this. We're talking about
real children dying, not halfway around the world, but literally
right next door, yesterday and today and tomorrow, and there is a
pretty strong impression out there that nobody really gives a
damn.
Your generation has real reason to hope that you will never be
called upon to go to war; that none of you will ever lie beneath
a white cross at arlington or face the gut-wrenching pride and
terror of combat in service to your country.
You may feel that your personal skills and experience and
character are not equal to the intimidating challenge of urban
violence and problems and hope accordingly that here, too, no
call to duty will ever come.
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Well, I think that call to duty is here tonight.
There is no higher law that says children must be gunned down by
children in the street, or that lives barely lived must be lost,
or that America's cities must die.
There are no problems that through neglect we have created that
by caring we cannot resolve. There are no divisions that
ignorance has created that understanding cannot erase. And there
is no better time than now -- when you are young-- to chart a
course of challenge and commitment and constructive rebellion at
the status quo.
So I call upon you to work ceaselessly to change and to rebuild
and repair the fabric of this society. I call upon you to
consider careers in law enforcement or teaching or drug
counseling or urban government that you may never have considered
before. I ask you -- if you are not already -- to reach out
within this very city to the educators and community
organizations and teenage kids who need your help. I ask you to
do this not out of altruism, but because it will enrich your
lives immeasurably and because you cannot afford to take with you
upon graduation from this campus not only a diploma but a
calloused heart.
More broadly, I ask you to join in the struggle that is now
ongoing for America's very soul. Do not cede that struggle to the
bitter or the bigoted or the morally blind. Do not accept or
tolerate or rationalize racism. Do not permit emotion to overcome
the voice inside you that reminds you every day how much we all
have in common and just how important it is to overcome
artificial divisions and how sometimes the most dangerous sound
there is is the sound of silence.
These are your communities; this is your country. And we have to
work to make the understandable pride we feel in our own ethnic
identities a generous, un-threatened and un-threatening pride, a
pride that shares and teaches and learns, rather than divides and
excludes.
There is not one among us who has the background or the
credentials to read a fellow citizen out of the American dream.
The minds that conceived this country; the muscles that built it;
and the blood that has so often defended and nourished its
freedoms is today so mixed in the soil of our history that we can
never forget--and should never try--to separate ourselves from
the collective and diverse "we" that defines the America of
yesterday and will inevitably determine the destiny of America
tomorrow.