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Letter to University Senate

March 25, 1999

Dear University Senate Member:

For the past four semesters Columbia University NORML communicated with the Senate regarding the activities of the Center on Addiction and Substance Abuse (CASA). Our goal is to persuade the Senate to reconsider the terms of CASA's association with Columbia. We do not seek to have Columbia's ties with CASA severed, but rather that the Senate use its influence to encourage CASA to adopt standards of research and rhetoric that are more in line with the traditions and dignity of the University.

To that end, we ask that the Senate convene a sub-committee to review CASA's research, publication practices, and public relations work. CU NORML would present its case to that committee, which presumably would also hear from CASA.

We are also writing you to respond to Dr. Herbert Kleber's letter Vice President and Medical Director of CASA) to the Senate dated February 11, 1999. In that letter he wrote: "First, they [CU NORML] state that CASA is 'foremost a political advocacy organization that presents itself as a scientific research institute to the national media and policy makers.' Although they state this, they do not demonstrate it."

Examples of CASA's political activities abound, as most often seen in the activities of the organization's President, Joseph A. Califano. Here are a few specific examples:

**In October 1996 CASA paid for a public opinion poll to be conducted on the issue of medical use marijuana, which CASA adamantly opposes. The results of this poll were used by CASA in a public relations effort it undertook to erode voter support for a pro-medical marijuana ballot measure in California that year.

**On December 4, 1996 and September 30, 1997, Califano had op-eds published in major newspapers across the U.S. attacking the supporters of several medical marijuana ballot initiatives. These op-eds relied on CASA's research that promulgates the "gateway" theory of marijuana use leading to harder drug use, as an argument to persuade voters to vote against these initiatives. Califano also personally attacked George Soros, one of the financial backers of the initiatives.

**According to a feature article in the Washingtonian Magazine published in 1998, which itself referred to a Washington Post article, Califano was instrumental in pressuring President Clinton to continue the ban on federal funding of needle exchange programs, despite the overwhelming support of the scientific and public health establishment for such funding.

The principle mission of CASA is to influence national policy on illicit drugs, rather than to conduct research. The materials it publishes are designed to justify its political positions, and to provide a hook for the media coverage that gives CASA's views a nationwide audience. However noble CASA's goals may ostensibly be, is it an appropriate thing for an organization to be using Columbia University's name and reputation to lend weight to such activities?

Dr. Kleber is correct in stating that we find CASA's promotion of the so-called "gateway theory" to be galling. This is because that fallacy has been debunked repeatedly by authoritative scientific and government commissions, including President Nixon's National Commission on Marihuana and Drug Abuse (1972), The National Research Council (1982), and the National Task Force on Cannabis (Australia, 1996).

Just last week, the federally funded Institute of Medicine released their study on the utility of medical marijuana. In an embarrassing contradiction to CASA's public pronouncements on marijuana, the IOM report stated "that although marijuana use often precedes the use of harder drugs, there is no conclusive evidence that marijuana acts as a 'gateway' drug that actually causes people to make this progression."

In this Wednesday's Spectator, Dr. Kleber took issue with the IOM report's findings, saying that CASA's research was not taken into account by the IOM study because "CASA is conducting drug policy research, not biomedical research." The IOM commission did not limit itself merely to medical research though, examining data from a wide variety of sources. In addition, Dr. Kleber himself was a member of an Advisory Committee that reviewed the report prior to publication, and must have had an opportunity to present CASA's research to the IOM. The Institute of Medicine commission seems to have found CASA's evidence unpersuasive.

On the important issue of whether or not CASA participates in the peer-review process, CASA once again responds with obfuscation. In his letter to the Senate, Dr. Kleber writes, "credible peer review takes many forms. CASA's work is reviewed by distinguished Scientific Advisory Boards made up of nationally known experts in the particular field relative to the study."

Why does CASA prefer this mode of review to the normal process of peer-review? Dr. Kleber explains that the bulk of CASA's work is in a format that is "too long" to be reviewed through the publication process. This excuse recalls their previous rationalization (in the September 30, 1998 edition of the Columbia Spectator) that the peer-review process is not "timely" enough for them.

As we understand it, academic peer review involves critique from professional researchers anonymously, not a review by hand-picked professional colleagues who are known to those being reviewed. What Dr. Kleber described does not in fact appear to be anything like peer review.

Dr. Kleber also claims that CASA has numerous peer-reviewed publications published or in press. A review of CASA's web site reveals a recently added section that includes the abstracts of some of these articles. We would offer two observations. First, all of these publications originate in 1997 or later, mainly in 1998. CU NORML has coincidentally been raising these criticisms of CASA since spring of 1997. Second, none of these articles are in fact the monographs that CASA relies on for all of its press conferences, releases, op-eds, and media appearances by CASA staff.

However sound these articles may be, they are irrelevant to CASA's public advocacy (the bulk of CASA's work), and thus fail to address our concerns with their research. We have concluded that CASA has pulled together this material in an effort to deflect criticism, not out of a sincere desire to participate in the peer-review process.

Despite the uphill battle that we face, CU NORML shall continue to work to focus the Senate's attention on the credibility issues CASA is creating for itself and Columbia. We are confident that when the Senate decides to look into this matter itself that it will come to share many of our concerns.


CU NORML Executive Board

(CC 1999)

Gerard Honig
(CC 2000)

Richard Seymour
(SEAS 2001)

Benjamin May
(SEAS 2000)

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Letter to University Senate from CASA

February 11, 1999

Columbia University

Senate Members

Dear University Senate Members:

This is in response to the letter sent to you on November 16th from members of the local chapter of NORML. It is not surprising that this small group is opposed to CASA's activities, denigrating our work, and aggressively attempting to confound our relationship with the university. NORML, as you know, is a political advocacy organization with small local chapters throughout the country that for over two decades has been trying to change the legal status of marijuana in the United States. CU NORML is a reflection of this same agenda. Consequently, they take issue with those CASA statements that clarify that marijuana is not the harmless substance that CU NORML wishes the public to believe it to be. Increasingly, the scientific community is coming to the conclusion that marijuana is not a benign substance, but can cause a variety of problems, physical and psychological, including dependence and withdrawal.

This letter, however, is no the place to debate the issue of marijuana's legal status or pharmacological effects, but to put CU NORML's anti-CASA stance in perspective. I would urge you not the let the University Senate be the vehicle for this harassment. In addition, I cannot let certain of their most recent statements go unchallenged.

First, they state that CASA is "foremost a political advocacy organization that presents itself as a scientific research institute to the national media and policy makers." Although they state this, they do not demonstrate it. Any serious review of the corpus of CASA's work serves as a counterpoint to the veracity of CU NORML's posturing that CASA is a "political advocacy organization." Our publications make a number of recommendations to policy makers, recommendations based on careful analysis of findings. One of the consistent "positions" running throughout our publications is that the cost of all forms of substance abuse, both that of licit drugs such as nicotine and alcohol and illicit ones such as heroin and cocaine, is extraordinarily high in human, social and financial terms and compels the need for serious public and private investment in prevention and treatment of this public health problem. For example, our study on the cost of substance abuse to New York City, Substance Abuse and Urban America: Its Impact on an American City, New York, (1996), found that, although the total direct and indirect cost approaches $20 billion a year, only a tiny fraction of that expense is attributable to an investment in prevention and treatment. The research and analysis in this monograph is based, not on "a rehash of federal drug survey data" as CU NORML claims, but on a number of innovative approaches to primary and secondary data analysis that CASA developed to do this cost/benefit analysis. The New York analysis has become a model, methodologically, for studies by cities such as Baltimore and San Francisco on the cost that substance use and abuse imposes on those cities.

CASA's paper, Substance Abuse and the American Woman, (1996), points to the often undiagnosed, but intrusive role, that substance abuse plays in the lives of many women, urging better training of physicians in prevention, diagnosis and treatment of these disorders. Again, contrary to CU NORML's claim of "rehash..." that publication alone reviewed and analyzed over 100 published references.

A recently released report by Dr. Steve Belenko, Behind Bars: Substance Abuse and America's Prisons Population, (1998), revealed the extraordinarily high percentage of prisoners who, as inmates, have serious alcohol or drug-related problems and lack access to quality treatment, or often any treatment. As a result of this analysis, CASA rejected mandatory minimum sentences and strongly pushed for more treatment in prison, after prison, and instead of prison. This study has been cited by a number of federal and state agencies in their policy debates on this matter and has helped to galvanize efforts at change including a major initiative by the federal Office of National Drug Control Policy to review and modify our nation's approach to prison-based substance abuse treatment.

CU NORML does not take note of these or other examples of our work, such as our national demonstration projects or our treatment evaluation research. Such an acknowledgment would seriously dilute the thrust of their narrow, politically motivated attack. In their continuing attempt to cast aspersions on CASA, they point only to that portion of our work having to do with marijuana and legalization, areas that constitute a tiny fraction of CASA's body of work, but a portion that is most galling to CU NORML. CU NORML may disagree, for example, with the "gateway" theory involving alcohol, tobacco and marijuana, even though ironically it relates to the pioneering work of a Columbia professor. However, to cite CASA's monograph on this topic as a simple "rehash of federal drug survey data" is a political polemic, that ignores the serious scientific work that has been done on this topic. A shortened and updated version of our Gateway monograph has been submitted for publication and we believe will be accepted shortly.

Another of their complaints is that CASA fails " participate in the academic peer review process or publish any of its studies in peer review journals, it's research is of dubious validity." Credible peer review takes many forms. CASA's work is reviewed by distinguished Scientific Advisory Boards made up of nationally known experts in the particular field relative to the study. The intellectual capacity and credibility of these individuals are certainly equal to those of professionals doing peer review work for various journals. On these grounds alone, it is scurrilous of CU NORML to so casually claim that our policy analysis and research is "of dubious validity." But to expand CASA's challenge to this particular point, I would simply note that CASA does participate in the peer review publication process with 18 articles published or in press and seven book chapters since 1997, and eight articles under review in peer-reviewed journals.

Another point must be made. CASA is not "...coming under increasing scrutiny and criticism from the academic and mainstream press for it's fast and loose playing with its facts." A critical analysis of this assertion leads to a quite contrary conclusion. This criticism is based on public statements made by a small cadre of individuals who disagree with CASA's work on marijuana and legalization. In fact, there is little public criticism of CASA's work from "mainstream academia or the press". Critical individuals are primarily associated with NORML, the Lindesmith Center, or the Drug Policy Foundation, all aggressive political and policy advocates of pro-legalization or decriminalization policies. They are certainly not representative of the mainstream. They may dislike our carefully crafted refutation of their policy preferences, but that is not a justification for their ill-informed carping.

While CASA's work is not without mistakes (there have been occasional errors made or lack of clarity of interpretation), that is also the case in many scholarly and peer-reviewed efforts. Our work is readily available for scrutiny and comment by the academic community through our publicly available papers, our website, and through our participation in the peer review process. For example, our white paper, Legalization: Panacea or Pandora's Box, (1995) is based in part on an article of mine in the New England Journal of Medicine and is available in a revised version as a chapter in a highly respected text book on substance abuse, [Clinical and Societal Implications of Drug Legalization, in Substance Abuse: A Comprehensive Textbook, edited by Lowinson, et al, 1997].

CASA's publication practices are not dissimilar to those of many of Columbia's faculty who publish monographs, book chapters and books, as well as peer-reviewed and invited journal articles. The length of our monographs, usually well over 100 pages does not readily lend itself to the format of an academic peer-reviewed journal. We have therefore chosen to issue these documents ourselves, with scientific oversight by our various Advisory Boards.

The description of the publication practices of other drug abuse research centers cited in CU NORML's letter to the Senate is typical of their misleading assertions. While I am not familiar with all of the listed biomedical centers, carrying out narrowly defined, controlled studies on prevention or treatment. They seldom, if ever engage in policy-related work and use primarily journals as an outlet for their work, rather than lengthy monographs.

When CASA professionals discuss drug issues in the media, it is similar to academics or others publicly discussing policy issues in such forums. The op-ed pieces noted by CU NORML, as with all op-ed pieces, are the opinions of specific authors, not of CASA, and are labeled as such when published. Typical of the propositions of their political motivated letter, the one such statement CU NORML cites is an op-ed on marijuana, date for which ironically was taken from peer reviewed articles readily available for their or anyone's analysis.

CU NORML's claim that we dismiss "competing positions as those of legalizes" reveals their singular concern. Apart from our Gateway monograph, and our white paper on the topic, legalization is rarely if ever mentioned in any of CASA's work. One wonders whether the CU NORML members have actually read our numerous monographs. CASA's one paper and chapter on legalization discusses a variety of positions using facts and appropriate references, not by summarily dismissing "competing positions."

CU NORML also criticizes CASA for "using the rhetoric of children." When CASA publications refer to children, [see, for example, our most recent study No Safe Haven: Children of Substance Abusing Parents,(1999)], it is because one of CASA's major policy conclusions is the detrimental effect of substances of abuse, both legal and illegal, on children, our most vulnerable and susceptible population. We would disagree strongly with any attempt by CU NORML to avoid focusing on that reality. We know that the younger a person begins to use illicit drugs or nicotine, or abuse alcohol, the more likely they are to get into trouble with such substances and to continue to use for years. Thus, a credible prevention program must focus on children.

It seems clear, however, that no matter how we or the Senate respond, CU NORML will continue to put forth charges as part of their overall political campaign to discredit CASA's work as a means to advance their cause. CU NORML is a narrowly focused, political advocacy organization - an advocacy organization based on personal values and preferences. In contrast, CASA chooses to craft its findings through careful analysis, translating those findings into policy recommendations and useful models of clinical practice. Our recommendations are neither liberal nor conservative, but flow from our honest analysis of data and theory. CASA has not engaged in political advocacy in any federal, state or local venues. CU NORML avoids this reality and uses simple accusation to discredit those with whom they disagree.


Herbert D. Kleber, M.D.

Executive Vice President and Medical Director

The National Center on Addiction and

Substance Abuse at Columbia University

Professor of Psychiatry

Director, Division on Substance Abuse

College of Physicians and Surgeons

Columbia University

New York State Psychiatric Institute

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December 2, 1998

Letter to the Editor

To the Editor:

I am writing regarding Christian Kaufholz's article on the Washington, D.C., medical marijuana initiative ["Activists Demand Results of D.C. Marijuana Initiative," Dec. 1].

The medical marijuana movement is the work of many dedicated advocates of patient rights. Their work has allowed patients with prescriptions to purchase small amounts of marijuana for medical use without fear of incarceration at the state level. Although medical marijuana laws have been lauded by local law enforcement and civil rights groups, some moralists in national government consider them direct attacks against the current war on some drugs.

Politicians, such as Georgia Republican Bob Barr, passed legislation which has so far stopped the D.C. votes from being tallied. To authorize such an encroachment on the voters' civil liberties, Mr. Barr invoked the name of medicine. But how can Mr. Barr back up the claim that "From a medical standpoint, there is no legitimate use for marijuana," when the New England Journal of Medicine and the British publication Lancet have openly supported the usefulness of marijuana in the treatment of glaucoma, AIDS wasting syndrome, nausea related to chemotherapy, and other ailments? Easy, just use information from the National Center on Addiction and Substance Abuse (CASA) at our very own Columbia University. Of course, their studies have less procedural write-up than a sociology class project and wouldn't pass the peer review process of scientific journals, but their results are a treasure trove of anti-medical marijuana rhetoric.

While Congress silences the voice of the people with legislation, Columbia silences the voice of science with CASA. As a proud Columbia student, I implore my administration to maintain the University's integrity as a research institution and examine its current association with the CASA's questionable work.

Richard Seymour, SEAS '01

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December 01, 1998

Activists Demand Results of D.C. Marijuana Initiative

Spectator Staff Writer

Results of a recent vote on an initiative in Washington D.C. designed to legalize the medicinal use of marijuana are being kept secret from its supporters, as a result of an appropriations bill recently passed in Congress.

The proposed law, known as Initiative 59, would legalize the medicinal use of marijuana, allowing seriously ill persons in the city to use the drug upon recommendation by a physician.

In late October, just before the vote in Washington D.C., Congress passed an amendment that bars the District from allocating money to any measure which could facilitate the legalization of marijuana including the disclosure of the recent election results.

While proponents of marijuana legalization and the American Civil Liberties Union have protested what they regard as a clear violation of voters' rights, opponents fear that the initiative, if passed, will lead towards the legalization of marijuana for recreation.

Initiative 59 was recently passed by other states, including Alaska, Arizona, California, Colorado, and Nevada.

------------, CC '99, president of the National Organization for the Reform of Marijuana Laws at Columbia University (NORML), a student group that promotes the legalization of marijuana, said he is angered by the events in Washington.

"It's un-American what's going on," he said, criticizing Congress for silencing public opinion. "The drug warriors cannot stand the public debate."

Congress has not released the results of the vote because it is dissatisfied with the outcome, --------- said.

"They know the results of the elections. That's why they're not publishing them," he said. "If the results were the opposite, they would run around publicizing them."

Money should not be an excuse for muting the people's voices, --------- said.

"The voice of the people is beyond all cost. It's priceless."

Richard Seymour, SEAS '01, and treasurer of NORML, agreed. The controversy over Initiative 59, like the Kenneth Starr investigation, shows that "Congress is not in touch with the public," he said.

According to Seymour, the success of Initiative 59 in some states is proof of a changing opinion about the perceived dangers and myths about marijuana.

However, Seymour said that he is confident that Initiative 59 will also be passed in Washington D.C.

"I have faith that Congress will take a more realistic approach to the drug war and stop silencing the voice of the people," Seymour said.

Opponents of Initiative 59 argue that the medicinal use of marijuana has not been proven effective and does not justify the initiative.

According to the New York Times, Representative Bob Barr, a Georgia Republican who sponsored the appropriations amendment, said that marijuana is not the answer for the seriously ill.

"From a medicinal standpoint, there is no legitimate use for marijuana," Barr said.

Initiative 59 is a "thinly veiled attempt by recreational marijuana proponents to circumvent drug laws," he said.

On Nov. 7, the Washington Post quoted Representative J. Dennis Hastert, an Illinois Republican, saying that he agrees with Barr's amendment and that the District "should not and shall not make marijuana a legal substance."

Benjamin May, SEAS '00, vice-president of NORML, said that the medicinal advantages of marijuana have not been proven because marijuana is a "Schedule I" drug, which means that testing it on humans is illegal.

In New York State, the use of marijuana for any purpose is illegal. The New York State Charter does not permit public votes on initiatives such as Initiative 59.

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November, 1998

Where Califano Stands

ALYSE LYNN BOOTH, The National Center on Addiction and Substance Abuse at Columbia University, New York, New York

"Thou Shalt Not" in your October issue misrepresents the positions of the National Center on Addiction and Substance Abuse at Columbia University.

We have issued more than 25 publications on topics ranging from adolescent drug use to the impact of alcohol and prescription drugs on women 60 and over. To focus attention on our role in the legalization "drug debate," as your author does, is to discuss less than 10 percent of our work.

To accuse Mr. Califano of "scolding" Joseph D. McNamara of the Hoover Institution for arguing for shifting "the front of the war on drugs from prisons and border interdiction to prevention and health care" completely distorts CASA's true positions. Our 1998 prison report calls an overhaul in treatment of addicts behind bars -- for drug treatment and job and literacy training for all prisoners, aftercare for ex-offenders, and expansion of alternatives to incarceration programs and drug courts.

To say that CASA doesn't view the drug problem as a health and social issue and that we demonize drug users is equally ridiculous.

Despite what the author says, CASA has focused as much work on alcohol and tobacco as we have on marijuana and other illegal drugs. However, unlike the author and the "scholars" he quotes, we do not believe that marijuana is a benign drug, and we fear the message marijuana legalization sends to our children.

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October 14, 1998

Beltway Article Starts New Wave of Research Criticism

Spectator Junior Staff Writer

In an article in this month's edition of The Washingtonian, the National Center on Addiction and Substance Abuse at Columbia University (CASA) was the target of harsh criticism concerning its research methodologies and publishing practices.

The article said that the "political clout" and media influence of Joseph A. Califano, chairman and president of CASA, as well as the "luster lent by his Columbia University title sit uneasily with many scholars who have spent their careers studying the drug issue."

CASA denounced the article written by Chronicle of Higher Education senior writer Christopher Shea for being biased and insisted on the soundness of the organization's research.

Nancy Kearney, a CASA representative, said Shea's article was unfair. "The article unfortunately misrepresents CASA's stance on drug policy" and clearly serves to convey the author's opinion. The article is a misleading portrayal of the organization and does not consider the breadth of issues that CASA deals with, Kearney said.

Shea cited several scholars of drug policies that disagree with CASA's practices. Joseph D. McNamara, a researcher at Stanford University's Hoover Institution, said CASA's work is similar to that of the government's. "What CASA does is present information in kind of hysterical crisis mode, which is very similar to what the government does," McNamera said.

Shea also quoted Craig Reinarman, a professor of sociology at the University of California at Santa Cruz, who said Califano "is not playing by the same rules that all other faculty and research centers have to play by," meaning he allegedly uses his research for explicit political purposes.

The controversy over CASA has also become a central issue for the National Organization for the Reform of Marijuana Laws (NORML), a student group at Columbia University.

------------, CC '99 and NORML's president, has repeatedly complained to the Columbia University Senate about CASA's research practices and demanded its work to be peer reviewed.

---------- said CASA's "research is directed toward political aims. We at NORML are concerned that [Columbia] would have such a mechanism of communication to the community. [CASA] is not adhering to the academic protocol which all other departments are held accountable to." --------- said peer reviewing is essential to publishing research and expressed concern that "CASA does not do that."

Donald M. Topping, president of the Drug Policy Forum of Hawaii shares ---------'s concerns. "The publications and news releases from CASA are widely quoted, even though the research methodologies are flawed and are not peer reviewed," Topping, said. "In my judgment this reflects very badly on Columbia University's reputation as a research university."

In an internal report from last March that has only been made available to the Spectator last month, CASA states, however, that its "missions stem from a firm conviction regarding the importance of sound research and effective prevention, treatment, and law enforcement strategies to combat substance abuse and addiction."

CASA has a "rigorous system in place that controls the outflow of information," Kearney said. Advisory committees and editorial reviews make sure that the organization's publications are founded," she said.

On the question of CASA's affiliation with Columbia, Kearney said that University President George Rupp is a CASA board member and that the University faculty is also represented on advisory committees.

"CASA's affiliation with Columbia has been rewarding and productive," CASA's internal report said. "Columbia deans and faculty have helped us shape and design our research."

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October, 1998

Thou Shalt Not

BY CHRISTOPHER SHEA; Christopher Shea is a senior writer at the Chronicle of Higher Education.


EVEN BY WASHINGTON STANDARDS, the drug debate is uncompromising and partisan. President Clinton claims that the number of Americans using drugs has declined by 50 percent since 1979, and earlier this year he laid out plans to cut drug use in half again over the next ten years.

House Speaker Newt Gingrich scoffed at the Clinton proposals, which he called a "hodge-podge of half steps and half truths." He wanted all drug use eliminated in four years.

Amid all the posturing and confusion, one voice suffers no doubt. When politicians or journalists need information about drugs, they often turn to a university-based "expert" who is certain where others are cautious and who compares drug policies he dislikes to "playing Russian roulette with our children."

The expert is Joe Califano, former heavyweight Washington lawyer and adviser to two presidents, now reborn as the scourge of drugs -- and of anyone who dares to disagree with him.

STARTED FIVE YEARS AGO, CALIfano's drug-research center, the National Center on Addiction and Substance Abuse (CASA) at Columbia University, has become the loudest voice in the drug debates.

If you've heard that marijuana is a "gateway drug" that opens the door to cocaine and heroin, that's CASA and Califano. If you've read that marijuana is far more harmful now than it was when Al Gore, Newt Gingrich, and other politicians dabbled with it -- so deadly that it should now be considered a "hard drug" -- that's probably because of Califano.

Every few months, Califano sends a fresh series of statistics coursing through the press. Examples include the claim that the proportion of female college students who get drunk on weekends has tripled over the past few decades.

But it's on the Washington Post op-ed page that Califano gets his biggest play -- and achieves something close to Old Testament thunder.

When the billionaire philanthropist George Soros contributed $ 650,000 to the campaigns to make medical marijuana legal in California and Arizona, Califano crowned him "the Daddy Warbucks of drug legalization." He accused Soros of manipulating compassion for the terminally ill as part of a scheme to make marijuana, cocaine, and heroin as available as tobacco and beer.

When parents told pollsters that they thought their kids might try marijuana at some point in college, Califano responded with a Post column that called the parents' attitude "infuriating," adding, "Instead of chorusing 'We're mad as hell and we're not going to take it anymore,' too many boomer parents utter a sigh of resignation that is becoming a self-fulfilling prophecy for their children."

So deep is Califano's loathing of tobacco that he rejects any deal between state attorneys general and the tobacco industry as the devil's work. The resulting compromises, he writes, represent a "sordid piece of money-changing in the temple of the American bar."

"Big Tobacco knows that the way to the hearts of Washington and plaintiff's lawyers," he said, "is through their pocketbooks."

JOE CALIFANO NOW LIVES IN New York, but he's still very much a Washington operator. Until the late 1980s, Califano was a fixture here. A Harvard Law graduate, he did a Defense Department stint under Robert McNamara during the Kennedy years and then became Lyndon Johnson's chief domestic-policy adviser and a co-architect of the Great Society. He would later write one of the sharpest memoirs of the period, The Triumph and Tragedy of Lyndon Johnson.

After Richard Nixon's election, Califano settled in at the powerhouse Williams & Connolly law firm, where he replaced a lockstep compensation system with an "eat what you kill" approach that rewarded the partners who brought in the most business -- notably himself. Eventually he would become known as the "half-million-dollar man" -- a reference to his then-stratospheric salary.

It was as Jimmy Carter's Secretary of Health, Education, and Welfare that Califano made his biggest splash, especially for his opposition to tobacco, which he deemed "slow-motion suicide" and "Public Health Enemy No. 1."

Charlie Rose, a former Democratic congressman from the tobacco-growing state of North Carolina, responded by saying, "We need to educate Mr. Califano with a two-by-four."

President Carter fired Califano in 1979, mostly because even when he was right on the issues, Califano's blunt, high-profile, self-promoting approach cost Carter too many political allies.

Califano returned to the law, first at his own firm, then at Dewey & Ballantine, which was dusty when he arrived but grew to be one of the most profitable firms in Washington. In 1992 he left to found CASA. "I'm not made to practice commercial law, really," he said at the time. "I've made money at it, but now I wake up every morning ready to roar."

DRUG RESEARCH IS an unglamorous field that doesn't usually attract the kind of donations that go to cancer treatments or AIDS work, but Califano's CASA hums along on a $ 8-million annual budget. Unlike white-coated researchers and scholars in elbow patches, Califano can pick up the phone and call buddies like Michael Eisner, chairman of the Disney company, to help underwrite a fundraiser featuring Liza Minnelli, the pop star Brandy, and a keynote speech by President Clinton.

CBS, Chrysler, and Mobil have contributed heavily to CASA, and the board of directors sparkles with such names as Nancy Reagan and Betty Ford.

"For decades I have followed the field of substance-abuse research, and I have never seen a phenomenon like the rise of CASA," said David Hamburg, president emeritus of the Carnegie Corporation and a Califano supporter. "In a few years it has become one of the most respected and significant sources of information and policy advice. There is nothing like it."

Last spring, Califano may have pulled off his biggest policy coup. According to the Post, just as President Clinton was preparing to place the government behind efforts to slow the spread of AIDS by distributing clean needles to addicts -- a plan long urged by health officials and backed by the Department of Health and Human Services -- Califano sent Clinton a letter pleading with him not to.

That letter, together with the opposition of Califano's like-minded ally, drug czar Barry McCaffrey, sunk the plan and led to a backpedaling press conference by Donna Shalala, secretary of HHS.

CALIFANO'S POLITICAL CLOUT, the forum that the Washington Post has given him, and the luster lent by his Columbia University title sit uneasily with many scholars who have spent their careers studying the drug issue.

"I view his work with the utmost amusement," says Joseph D. McNamara, who served as a New York City cop before becoming police chief of Kansas City, Missouri, and then San Jose, and who now studies drug policy at Stanford University's conservative Hoover Institution. "What CASA does is present information in a kind of hysterical-crisis mode, which is very similar to what the government does."

McNamara got a typical Califano scolding after he argued, on the Post's op-ed page, for shifting the front of the war on drugs from prisons and border interdiction to prevention and health care. McNamara said the United States could benefit by looking at Europe, where drug use is viewed more as an endemic health problem than as pure crime.

A week later, Califano weighed in with a blistering defense of the status quo in a Post op-ed. "The first casualty of most pro-legalization arguments is reality," he wrote. "If these ideas ever became policy, the next would be America's children."

McNamara's views went beyond playing Russian roulette with children, he wrote. They were the equivalent of "slipping a couple of extra bullets in the chamber."

McNamara calls the response "pharmacological McCarthyism."

"It's as rotten and dangerous as the original McCarthyism," he says. "What he is trying to do is cut out any kind of objective debate by labeling people who are critical of current drug policies as 'legalizers.' . . . It's hard to call a guy who's been a cop for 25 years a pothead."

Califano "has so much corporate money that he bought himself a place at Columbia, but he's not playing by the same rules that all other faculty and research centers have to play by," says Craig Reinarman, a sociologist at the University of California at San Cruz. "It seems to me that he wants to have it both ways. He wants to be the anti-drug ideologue, to go out there and make impassioned speeches, and to some degree be a star, but he gets his money and his connection to Columbia on an entirely different basis.

"If he wants to do that, fine; but don't pretend you're a Columbia University scholar when you're not -- you're Ralph Reed."

Other researchers complain that Califano's take-no-prisoners approach to the drug debate has created a climate in which raising questions about zero-tolerance arguments, or the likelihood of a drug-free America, are seen as little short of treason.

I HAD A CHANCE TO TALK WITH Califano last fall at CASA's headquarters. He's now ensconced in the Carnegie Towers, a postmodern edifice on 57th Street in Manhattan, on the same block as Carnegie Hall and 50 blocks south of Columbia's campus.

Califano's office is decorated with emblems of past glories. A THIS IS A NON-SMOKING WORKPLACE sign sits on his desk. On the wall to his left is a framed letter from President Johnson, commemorating the day he left public service for the law: "You were the captain I wanted, and you steered the ship well."

At 67, Califano still looks fit and powerful, with a demeanor that carries a hint of the streets of Bedford-Stuyvesant and Crown Heights, where, before he went off to college at Holy Cross, he and his friends used to brawl with gangs from rival neighborhoods. He is sharp, with a gruff voice and a no-bull tone.

"I don't think there's any right or left in the drug war, or if drug war is even the right term," he says. "Basically, I think substance abuse and addiction is one of the greatest threats to this country. You know, Toynbee said of the great civilizations -- he studied 16 civilizations -- he said that the only thing that ever happened from an enemy without is that they gave the coup de grace to an expiring suicide.

"This is a really internal problem for the United States, and it's an enormous threat to our young people, and it's also an enormous threat to our political system because of the corruption issues."

He brushes off the idea that his center's work is colored by ideology or personal predisposition -- or anything but research. "The first step here is to get the facts out and to get people to understand the facts, and where they lead, they lead," he says. "I have absolute conviction that if we can get the facts out, and if we can get enough bright people interested in this subject, we can deal very successfully with it.

"The field is full of very dedicated people, counselors and others, but it's not full of the kind of brilliant people who are working on cancer and heart disease, or the kind of brilliant people who are selling automobiles or cereals or what have you. I think we have here at CASA the brightest group of people that have been ever put under one roof on this planet to deal with this problem."

CALIFANO'S COLUMBIA DRUG center has 55 staff members, but only one is a tenured member of the Columbia University faculty -- Herbert Kleber, a psychiatrist with a top research record, who served as a drug-policy adviser under William Bennett. Other university professors and administrators sometimes advise on projects.

The official line at the center is that editorializing and policy advice amount to only a fraction of what CASA does.

CASA sponsors a program called "Opportunity to Succeed" that brings together parole officers and social workers to help prisoners with drug problems in four cities. It is undertaking a nationwide evaluation of 200 treatment programs, from intense residential regimens like Phoenix House to outpatient centers that offer a few hours of counseling weekly.

It is also exploring nontraditional alternatives, such as acupuncture, which has a large following among ex-addicts. A site director for the acupuncture study, a doctor at the University of California at San Fransciso, calls it "as good as anything funded by the National Institutes of Health."

The research process is a slow one, often with ambiguous results -- which makes it unsuited to Califano's style. CASA's big splashes in the press usually come from research reports that cobble together the most alarming data on drugs, which Califano then goes on the road to promote: Highschool students say marijuana is easier to buy than alcohol. Forty percent of 13-year-olds know someone who uses acid, heroin, or cocaine. Forty-five percent of college students go on drinking "binges."

In many cases, the findings aren't new, but drawn by Califano's star power, newspapers report them -- even though, in almost every case, they ignored the more-nuanced scholarly articles from which they are drawn. Only the New York Times occasionally ignores the CASA reports, frustrating CASA's PR people.

"Their usefulness has been that they have the capacity to take hundreds of studies and condense them," says one public-health professor at Columbia, who confesses some awe and envy of Califano's influence with the press. "But their condensing process has the tendency to throw out at least half of the baby with the bathwater."

AS HE DID WITH MCNAMARA, THE ex-cop, Califano often slams his critics as "legalizers," suggesting that they would like to see marijuana and cocaine sold from Good Humor trucks parked outside schools. But the debate, most protest, isn't really between those who want to protect children and those who don't care about them -- everybody's "for" children. The real debate is between two different ways of looking at the war on drugs.

>From 1980 to 1997, the federal drug-control budget rose from $ 1 billion to $ 16 billion, and the number of people imprisoned for drug violations rose from 50,000 to 400,000. The chief indication that we're on the right path, Califano says, is that the number of people who use illegal drugs regularly has dropped by half since 1979, from 25 million to 13 million. Marijuana accounts for almost all of the drop.

Over the same period, the number of hard-core cocaine addicts has stayed steady at about 2 million, and drug use has become far deadlier. "In 1980 . . . no one had ever heard of the cheap, smokable form of cocaine called crack, or drug-related HIV infection or AIDS," writes Ethan Nadelmann, the director of the Lindesmith Center, a drug-policy research institute in New York, in a recent issue of Foreign Affairs. "By the 1990s, both had reached epidemic proportions in American cities."

Half of all cases of AIDS -- the second highest cause of death in the United States for people ages 25 to 44 -- stem from injected-drug users sharing needles. Most researchers think that's a devastating problem, at least as important as the number of people who occasionally smoke marijuana. The American Medical Association, the National Academy of Science's Institute of Medicine, the National Institutes of Health, and President Bush's National AIDS Commission have all endorsed needle-exchange programs to attack it. The message they are trying to get across is that drug abuse is bad, but dying of AIDS is worse. Califano helped undermine the chance to put their proposals into action.

"The tragedy of Joe Califano," says Nadelmann, "is that his anti-drug fanaticism has made him indifferent both to the scientific evidence and to the broader consequences of demonizing drug users."

AS A LEADER OF THE WAR ON drugs, Califano sets himself apart from other experts who seem willing to step back from their political passions to point out where policies don't square with the research. In 1972, for example, Richard Nixon brought together a commission of experts to examine the US approach to the problem. Headed by Raymond Shafer, a former Republican governor of Pennsylvania, the commission was far from leftwing, yet it advocated pretty much what Califano now calls Russian roulette: acknowledging that drugs cannot be eliminated from society, treating drug use as a social problem as much as a crime, and recognizing that law enforcement sometimes has high financial and moral costs that bring few returns.

In the case of marijuana, the Shafer commission argued, the millions spent on law enforcement, the time diverted from investigating violent crimes, and the ruining of people's careers through prosecution outweighed the harm of using marijuana.

In the late 1970s, President Carter was still able to endorse that view, and in 1982, a National Academy of Sciences commission echoed it. Today, almost no politician on the national level would dare concede the validity of such views, and for that, Califano deserves a large share of credit.

After Califano wrote a damning book about the Carter administration, Governing America, Jody Powell, Carter's press secretary, called Califano's book the ultimate example of the "if only they'd listened to me" memoir: "His criticisms of others might have been taken more seriously if he had been somewhat more willing to acknowledge that somewhere along the way he, Joe Califano, might have made a mistake, a misstep, or even a judgment that could be reasonably questioned with the benefit of hindsight."

CALIFANO HASN'T BEEN IMMUNE to mistakes and missteps. Take his proposals to curb health-care costs -- a topic, like drugs, that has been a long-standing interest. In the 1960s, he hit upon the idea of driving down health costs by radically increasing the number of students graduating from medical school in the United States: from some 8,000 to 16,000. The more doctors, the more competition, his argument went. The move had the opposite from intended result. Since all those new doctors were getting reimbursed by insurance companies for whatever they did, the "reform" only increased the number of doctors doing expensive procedures.

Don't look for any apologies from Califano. His writing on health care, which he continued through the 1980s and '90s, has the same tone of confidence and scorn for enemies as his talk on drugs. He calls doctors "the medicine men" and blames high costs on their greed.

FORMULATING DRUG POLICY IS at least as complex as combating health-care costs. Often, the problem is oversimplification. Much of Califano's polemical fury is directed at marijuana because it is the most popular illegal drug and also the one that people tend to shrug their shoulders at.

There's also the fact that most of the people fighting the war on drugs or commenting on it -- Al Gore, Newt Gingrich, Dan Quayle, CASA's Dr. Kleber -- have tried it.

Teenagers who smoke marijuana, Califano argues, are 85 times more likely to try cocaine than those who haven't. Until a few years ago, he would note that this relationship is "only statistical," but then note that we used to think the connection between smoking and lung cancer was statistical, too.

Lately, he has dropped all equivocation. In a press conference last fall and in a Post column titled "Marijuana: It's a Hard Drug," he said that CASA's research had, at last, weeded out any confounding factors -- poverty, depression, single parents, grades -- and proved that marijuana leads people to crave other drugs.

Some 80 million Americans -- about a quarter of the population -- have used marijuana, and yet not many baby boomers moved on to mainlining. "The Great Pot Experiment produced millions of conventional, productive, upstanding citizens, plus a few journalists," Michael Kinsley once wrote. If that's an exaggeration, it's no more so than Califano's thesis that marijuana sends people down the road to cocaine addiction.

Califano also claims that cigarettes and alcohol are gateway drugs, but he doesn't take the step that should follow, given his logic: that smoking and drinking cause marijuana use.

"What's disturbing about his center is that there are certainly people who know better, who are experts, who will consistently lump correlation together with causation and lump all drug users together," says McNamara, the former police chief. "I don't know if Califano knows better or not, but the things they say and do are very hard to justify on a professional level. It's a propaganda war, and the motivation, I think, is that the ends justify the means."

A STRIKING EXAMPLE OF CALIfano rhetoric came in a 1995 paper on drug legalization, where CASA confronted the arguments made by libertarians such as William F. Buckley and Milton Friedman that government should take minimal actions against drug use, except where children are concerned.

Reasonable people can disagree about how far the government can go to protect people from themselves and from the harm that some drug users cause, and Buckley and Friedman represent one extreme. But CASA's dismissal of civil-liberties arguments was harsh. It pointed out that philosophers have said that freedom does not include the right to choose to place oneself into slavery. "Clearly," the report adds, "drug addiction is a form of enslavement."

When I asked Califano about civil liberties, he stressed his commitment to them but said drug laws were not an issue. "There are civil-liberty problems in every aspect of law enforcement, and I spent a lot of time when I was in government on those issues," he said. "In the Johnson years, we passed the first bail-reform acts. We did all that stuff. There are plenty of abuses, but it's not a question of this law or that law. It's a question of what kind of cops you have."

His overriding goal, he said, was to protect children, and every law, and in fact all of CASA's work, has to be evaluated by that measure. I asked him to set kids aside for a minute. Should a 45-year-old, I asked, have the right to light up a joint on his back porch with no one around?

He cut me off before I could get it out. "Should a 45-year-old have the right to shoot heroin in his backyard?" he barked. "Should a 45-year-old have the right to, you know, snort cocaine in his backyard? Should a 45-year-old have the right to put a bullet through his head? Okay?"

In some ways, Califano's style distracts from his genuine accomplishments in combating the abuse of alcohol and tobacco. He deserves credit for launching the anti-smoking revolution, and for pushing for steep taxes on cigarettes and alcohol long before it was trendy.

LAST FALL, A GROUP OF PROMInent drug-policy experts and law-enforcement officials sent representatives to Washington to call for a truce in the debate on drugs. The discussions, they said, had degenerated into shouting between two groups stereotyped as "drug warriors" and "legalizers." The 36 signers of the statement said that they, like most people who have studied the problem, fit in neither description.

"In this climate," said the group, "every idea, research finding, or proposal put forth is scrutinized to determine which agenda it advances." They decried the "symbolic" laws that get passed in place of policies based on scientific research and called for a period of calm in which reason could be heard.

Who could oppose this manifesto for common sense? "It's hard for me to imagine anyone at CASA signing our principles," said one of the researchers. "I think Califano's views are sufficiently wedded to the absolute commitment to the status quo that I suspect he would have found our statement to be more radical than it is."

Neither Joe Califano nor anyone else at CASA signed on to the truce.

GRAPHIC: Illustration, no caption, ILLUSTRATION BY NICK GALIFIANAKIS; Picture, Califano is rarely without a popular cause. Here he attacks student-loan defaulters while serving as HEW secretary; Photos 1 and 2, Whether he's discussing women and substance abuse with Betty Ford or appearing with Hillary Rodham Clinton at the Concert of Hope, Califano brings a formidable Rolodex to his fight against drugs. AP/WIDE WORLD

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September 30, 1998

Rupp, Senate Defend CASA, Fight Criticism

Spectator Associate News Editor

Despite criticism from scholarly journals and members of CU NORML, a student group that advocates the legalization of marijuana, the Nation-al Center on Addiction and Sub-stance Abuse at Columbia University (CASA) derserves praise for its research and methodoloy, according to last March's evaluation by a University Senate committee.

The Senate Committee's evaluation was recently made available to the Spectator.

Senate members drafted the review as an evaluation of an internal CASA report on its activities and financial status.

In the review, Senator Jack Gorman calls the reasearch presented in CASA's report "impressive, both in its range and potential public health value." He continued, "Furthermore, there appears to be a high level of quality control over the methods [of research] and data [collected]."

These findings came as a surprise to some skeptics who have denounced CASA for its inconsistent use of the peer review process.

An October 1997 article in The Chronicle of Higher Education reported, "CASA has been accused of playing fast and loose with statistics, skirting the academic peer-review process."

CASA submits its research for peer review only when necessary, for scholarly journal articles or research funded by foundations who request peer review, but not for articles such as op-ed pieces, said University President George Rupp, who is a member of CASA's board of directors along with Betty Ford and Nancy Reagan, among others.

CU NORML President --------------, CC '99, who questioned CASA's decision not to subject all its research to peer review, said CASA's practices do not reflect Columbia's high standards for conducting research.

"In all of our classes our professors insist that peer review is essential to the academic process. I guess they're wrong," --------- said.

But Rupp and CASA Vice President of Communications Alyse Booth stressed CASA's role as a shaper of public opinion, whose concern is to get information out to the public quickly.

Peer review, Booth said, is a timely process that is not required when research is included in pieces by the media, on television, and in newspapers, the context in which CASA's stats are most often cited.

"[CASA's Director] Joe Califano is a lawyer and a very astute shaper of public opinion," Rupp said. "[CASA] would rather influence public policy by having an op-ed piece."

"An academic institution should not be making soundbites to People magazine," --------- argued. "That's not how a university should be functioning."

Rupp and Booth said they think attacks on CASA are politically charged.

University Provost Jonathan Cole agreed.

"I think there are some people who disapprove of CASA because they have a difference in values, a disagreement over substance abuse," Cole said.

But critics said CASA's political leaning hinders its ability to do objective research.

However, Cole said CASA never claimed to be anything but a "policy-related institute."

"There's no doubt about it," Cole said, "you have to be careful that your values don't dictate what results you are going to present."

One critique of the Senate's report was that it did not address criticism about CASA and peer review.

Robert Jarvis, senator and political science professor, said, "I found [the review] insufficient to erase doubts brought on by critics. It did not meet the objections and did not rebut them."

Rupp said he valued Jarvis's point, but it is common for social scientists and researchers in other fields to do work that is not peer-reviewed because the research does not get published in major journals.

Richard Seymour, SEAS '01 and CU NORML treasurer, said CASA should submit all of its work to peer review to ensure its credibility.

"I think it sounds more like a propaganda machine than a research institute. Research is not a rapid process."

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September 23, 1998

Senate Completes Review of CASA

By Kaya Tretjak
Spectator Staff Writer

The University Senate education committee has completed a review of the controversial Center on Addiction and Substance Abuse (CASA) and found the organization is "fulfilling its mission." But some senators and students feel the review did not fully address allegations raised last year that CASA, a Columbia affiliate, uses suspect scientific research to promote an anti-drug political agenda. The Senate has not released its report to the public.

CASA is a non-profit drug research organization that has produced many high-profile reports, including studies on the "gateway drug" theory. At a Senate meeting last semester, concerns were raised that CASA is "an advocacy group whose studies were not based on scientific analysis and were not peer reviewed," according to the minutes of the Apr. 24 meeting.

For Robert Jervis, senator and political science professor, the Senate's review of CASA did not adequately address the allegations of CASA's critics.

"I found the [CASA review] insufficient to erase doubts brought on by critics. It did not meet the objections and did not rebut them," Jervis said. "Key criticisms are that CASA is not doing serious research and is not published in any major journals. I don't know if these criticisms are true, but the report did not rebut them."

Last semester, the Senate began a review of CASA because University policy calls for a review of affiliated institutions three to five years after they are founded, said Charles Donelan, administrative assistant to the Senate.

For the Senate investigation, CASA submitted an internal review to an ad hoc committee appointed by Vice President Dean Pardes at Health Sciences. The ad hoc committee evaluated CASA's internal review and reported to the Senate's education committee.

The education committee found that CASA, whose board of directors includes University President George Rupp, "is fulfilling its stated missions," according to their 1997-98 report to the Senate.

Last November, student group CU-NORML, which advocates the legalization of marijuana, sent a letter to the University Senate alleging that CASA uses its affiliation with Columbia to gain legitimacy for scientific research that is not peer reviewed.

"It is a political advocacy organization which says it is a research group, but they don't peer review their research. Their research is suspect and open to criticism that it should have received before ever being published," said CU-NORML President -----------, CC '99. "You can buy internally published reports from them. That internally published research is then sent off to influential people and passed off as Columbia University studies. As college students, we are concerned about the academic integrity of our institution."

--------- is angry that the ad hoc committee's report on CASA, on which the education committee based its evaluation that CASA is fulfilling its mission, is not available to the public.

CU-NORML has contacted individual senators and is currently awaiting response regarding the state of the report.

"It's almost an insult to have the education committee act as a filter between the ad hoc committee and the community," ---------- said. "The access of the ad hoc report is of great concern to us. We are eager to see what it had to say."

Pardes said that as part of standard procedure, all committee business is confidential.

However, Jervis said that he considers the issue still open. "The next step depends on the critics of CASA. If they're quiet, it's probable that nothing will happen. But if they make a rational objection, it should be looked into," he said.

Articles on CASA appeared last year in the Chronicle of Higher Education and Forbes Media Critic., which were cited in CU-NORML's letter to the Senate.

"CASA has also been accused of playing fast and loose with statistics, skirting the academic peer review process in favor of grand standing, and acting as an unskeptical cheerleader for the war on drugs, " Christopher Shea said in the Chronicle of Higher Education.

"We're trying to convince the faculty that this is a battle they need to pick. We aren't asking them to take our word for it," --------- said.

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October 3, 1997

In Drug-Policy Debates, a Center at Columbia U. Takes a Hard Line

Institute's studies grab headlines, but critics call its approach oversimplified

Christopher Shea

Whatever else you say about Columbia University's National Center on Addiction and Substance Abuse -- and drug-policy researchers have a lot to say about it, some of it unprintable -- it knows how to work the news media.

Take an August press conference in Washington, led by the center's president, Joseph A. Califano, a former heavyweight Washington lawyer and Cabinet member who has now devoted his clout, charisma, and workaholic habits to the goal of a "drug-free America."

Ten television crews showed up on that Wednesday morning, along with dozens of reporters. The president of the University of Notre Dame, the Rev. Edward A. Malloy -- as irrepproachable a figure as you can imagine to endorse a study -- introduced Mr. Califano by summarizing some of the headlines CASA has generated: "Binge" drinking among women tripled from 1977 to 1992. Anyone who makes it to the age of 21 without trying alcohol, cigarettes, or pot is unlikely ever to become a smoker or abuser.

Then Mr. Califano, tanned and resplendent in a dark pinstriped suit, stepped up to the microphone, his raspy voice booming through the room. "American children are smoking daily, drinking, and using hallucinogens at the youngest years ever in our history," he said. "We now have almost a million kids who play with the fire of cigarettes, increasing the risk of being burned by heroin, acid, and cocaine."

CASA, he announced, had nailed down its "gateway drug" theory: Teen-agers who try marijuana are 85 times more likely to try cocaine than teens who don't. New studies on rats prove that pot triggers a craving for more drugs because marijuana activates the same neurotransmitter in their brains that cocaine does -- dopamine. "The days of marijuana as a safe drug are over," he said. "This research has crowned marijuana a 'hard drug.'"

Reporters scribbled this down, and there were few skeptical questions. A typical one came from the ABC reporter on the scene. "I don't want to oversimplify this," he said, "but is the war on drugs being won or lost?"

ABC's lead story that night relayed CASA's findings without quoting a single critic of the group. Nor did dozens of articles in newspapers across the country. But as one young reporter left the press conference, she turned to a colleague and said, "The rhetoric they use is unbelievable. I mean, we all know people who tried marijuana a few times in high school, or even smoked it regularly, then gave it up and went on to good schools, and went on to lead normal lives."

More than a few drug-policy experts share the reporter's skepticism about CASA. From its start five years ago, the center has been one of the loudest voices in the drug-policy debates. It has substantial backing from the nation's blue-chip companies, and makes headlines whenever it issues a report.

Some drug-policy experts have nothing but praise for the center's hammering home of the cost to America of tobacco, alcohol, and illicit drugs, and its pleas for more money for treatment and research. At the press conference, Mr. Califano called drug-abuse research "the area of greatest neglect" in American public policy and proposed pumping up federal expenditures by $ 1-billion a year. He wins plaudits for taking on not only shadowy drug kingpins, but also alcohol companies and Big Tobacco. He has, for example, proposed a $ 2-a-pack tax on cigarettes.

But CASA has also been accused of playing fast and loose with statistics, skirting the academic peer-review process in favor of grandstanding, and acting as an unskeptical cheerleader for the war on drugs. It gets criticism both for what it says and what it doesn't say. Mr. Califano, for example, has railed against proponents of medical marijuana as charlatans who are trying to sneak full-scale drug "legalization" in through the back door -- even though advocates of loosening restrictions on marijuana for cancer and AIDS patients have included such respected scholars as the editor of The New England Journal of Medicine.

And although he is a frequent author of muscular op-ed pieces for various newspapers, he has been conspicuously quiet about needle-exchange programs, which many experts believe to be the most important drug-policy issue on the table today.

Several federal commissions have said such programs could save thousands of lives by reducing the spread of AIDS among users of injected drugs. But because needle-exchange programs would not necessarily reduce drug use, hard-core drug warriors say they "send the wrong message."

"Califano is essentially a reincarnation of the old temperance warriors," says Ethan A. Nadelman, director of the Lindesmith Center in New York, one of CASA's harshest critics. "It's 'demon alcohol,' 'demon cigarettes,' 'demon drugs.' It's Carry Nation and the old anti-alcohol warriors, given a gloss by his association with Columbia University and this 'sophisticated' research center."

Dr. Nadelman, a former assistant professor of politics at Princeton University, was lured to the Lindesmith Center, a drug-policy research institute on the same city block as CASA, by the philanthropist George Soros, who is using his fortune to broaden the debate about drugs.

CASA says the success of the war on drugs can be measured by the number of Americans who use marijuana and other illicit substances, which dropped roughly by half in the 1980s. Dr. Nadelman looks at the war through a different prism: As the federal budget on the war on drugs rose from $ 1-billion to $ 16-billion from 1980 to 1990, AIDS became pandemic among injected-drug users, and crack addiction and violence took over major cities. The number of hard-core drug addicts has not decreased, and courtrooms are overwhelmed by people accused of drug crimes.

Dr. Nadelman's focus is on "harm reduction" -- acknowledging that a "drug free" America is a fantasy, treating addicts rather than incarcerating them, and persuading those who can't quit to stop sharing needles. Because he has argued for the regulated decriminalizing of even hard drugs, Dr. Nadelman is considered far to the "left" in the drug-policy debate. But many scholars who balk at legalization agree with much of what he says about harm reduction.

Some 70 million Americans have tried marijuana -- including many of those leading the war on drugs -- so part of CASA's agenda is to convince baby boomers that the drug is not as innocuous as they remember.

The argument that marijuana is a "gateway drug" is key to that goal. Some scholars say the gateway theory -- a "risk ratio," in technical terms -- is a Statistics 101 kind of mistake. Sure, they say, most cocaine users have tried marijuana. But look at it another way: For every 100 people who have tried pot, 28 have tried cocaine, and only one uses cocaine weekly. "It's a hard job to convince people that marijuana is a hard, dangerous, highly addictive, gateway drug," says Lynn Zimmer, a professor of sociology at Queens College, the City University of New York, and co-author of Marijuana Myths, Marijuana Facts (the Lindesmith Center, 1997). "They are asking people to deny their own experiences."

CASA's medical director, Herbert D. Kleber, responds that the risk that a marijuana smoker will try cocaine is no different from -- and even greater than -- the risk that a smoker will get lung cancer. "The people who say most marijuana smokers don't try cocaine either don't understand risk ratios, or disingenuously pretend not to," he says. He is convinced that there is a biochemical trigger that leads marijuana users to seek other drugs. "We just haven't found it yet."

The Columbia center is an odd half-breed, trading on Columbia's prestige while remaining mostly independent. Located 50 blocks downtown from Columbia's main campus, in a vaguely postmodern skyscraper next door to Carnegie Hall, it has 50 staff members, only one of whom -- Dr. Kleber -- has tenure on the Columbia faculty. Its annual budget is $ 7.3-million, with the "core" financing coming from the Robert Wood Johnson Foundation, one of the nation's largest health-care philanthropies. It also gets checks from Mobil, CBS, Chrysler, Walt Disney, and dozens of other corporations. Nancy Reagan and Betty Ford serve on its board of directors alongside Columbia's president, George Rupp.

Sitting in his office 12 floors above 57th Street in New York, Joseph Califano explains how combating drug and alcohol abuse came to be his calling. "Basically, I think substance abuse and addiction is one of the greatest threats to this country," he says. "You know, Toynbee said of the great civilizations -- he studied 16 civilizations -- the only thing that ever happened from an enemy without is that they gave the coup de grace to an expiring suicide. Substance abuse is an internal problem for the United States. It's an enormous threat to our young people, and it's a threat to our political system because of the corruption issues."

A plaque reading "This is a smoke-free workplace" sits front-and-center on his desk. On the wall over his left shoulder is a framed statement announcing his appointment as a domestic-policy adviser to President Johnson. He takes special pride in a more modest memento, a letter Johnson wrote him when he resigned to re-enter private life. "You were the captain I wanted," it reads, "and you steered the course well."

Mr. Califano's story is a case study in how much American cultural attitudes toward alcohol, tobacco, and drugs have shifted in the past 30 years. In his years with L.B.J., he was the kind of smoker that is hard to imagine today. He smoked four packs a day, carrying two packs of Kents in one pocket, two packs of mentholated Salems in the other, "for when my throat got sore." Under Johnson, he helped push through the first Drug Rehabilitation Act, which set aside $ 15-million for treatment and research.

Mr. Califano quit smoking in 1975 as a birthday present to his son, Joe, now an ear, nose, and throat doctor at the Johns Hopkins University. He still drinks, slightly undercutting the Carry Nation analogy. ("Sure I drink. Yeah, every day I drink. I usually have a scotch at night, one or two scotches all the time.") President Carter called him back from legal work to head the Department of Health, Education, and Welfare, where he became intrigued by studies showing that few people start smoking after age 21. He set in motion what The Washington Post called in 1978 "the most energetic anti-smoking blitz ever," ferociously attacking ads aimed at children. This earned him the hatred of politicians from tobacco-growing regions, and planted the seeds for the federal regulation of cigarettes, a movement that gains momentum every day. "The passion is real," even Dr. Nadelman concedes. Mr. Califano's outspokenness did him in, politically: President Carter fired him in 1979, and he went back to law.

Later, serving on the board of the Chrysler Corporation, which was trying to cut its health-care costs, Mr. Califano was unable to make a dent in the company's losses from alcoholism and drug abuse. "I began to see, you know, it's everywhere," he says. "This problem is just affecting everything." He needed little prodding when James Burke, the chairman of the Partnership for a Drug-Free America, approached him to found a research center. At CASA, Mr. Califano says, his goal was to assemble "the brightest group of people who have every been put under one roof on this planet" to deal with the problem.

By consensus, the brightest academic star at CASA is Dr. Kleber. Mild-mannered and self-effacing -- in an interview in his office he comes off, at first, like a kindly family doctor -- Dr. Kleber spent most of his career in Yale University's psychiatry department, studying the biophysiology of addiction, before he went to work for William Bennett, the first U.S. "drug czar," in 1989. He spends half his time at CASA, half in Columbia's psychiatry department. He is courtly, polite, uncondescending, with unruly graying hair and rimless glasses framing a pale face. Bring up criticism of CASA, however, and you see another side: He's got the debating chops of William F. Buckley, and will follow you out the door to shoot down the arguments of the harm-reduction camp.

Public policy, he says, should concentrate on keeping drugs as expensive and difficult to obtain as possible, while social opprobrium and criminal sanctions are necessary to combat the "psychological" lure of drugs. Criminal penalties can also persuade abusers to seek treatment -- which is why both he and Mr. Califano oppose mandatory sentences, which reduce the leverage judges can exert on drug offenders.

CASA has devoted much of its work to documenting the cost to the American economy of drug use. In a 1994 report, it announced that smoking, alcoholism, and illicit drug use would cost the Medicare system $ 1-trillion over the next 20 years -- most of it from smoking. In spring 1996, it announced that substance abuse was costing the city of New York $ 20-billion a year.

In the summer of 1994, CASA took on the subject of drinking on college campuses. "What was once regarded as a harmless 'rite of passage,'" the report said, "has in the 1990s reached epidemic proportions." The news that binge drinking among women had tripled made news nationwide. But the report also caused trouble for the center when Forbes MediaCritic, a now-defunct journal, said the rhetoric of the report was wildly overblown, its statistics were all drawn from other people's work, and some of its numbers were fudged.

The report, MediaCritic noted, buried the inconvenient fact that, over all, binge drinking at colleges had remained steady for decades. The journal also caught CASA out on a few statistics. One federal study, for example, had found that 55 per cent of female rape victims on campuses, and 74 per cent of male rapists, said they were under the influence of drugs or alcohol during the assaults. CASA translated that to say that 90 per cent of all rapes involved alcohol, a strange bit of math.

"I wasn't inclined to leap to their defense," says William DeJong, a lecturer on health communications at the Harvard School of Public Health. The MediaCritic charges, he says, were "pretty serious allegations, and in my view gave the alcohol industry an opportunity to undermine their overall effort, which I think has been very constructive." Henry Wechsler, also at Harvard's public-health school, on whose work the CASA report was largely based, says that "the gist of CASA's report was absolutely accurate."

In 1995, CASA issued a "white paper" on drug legalization, which took on the arguments of such groups as the American Civil Liberties Union. The A.C.L.U. has pointed out that the drug war has turned the United States into the nation with the highest incarceration rate in the world, and that widespread urine testing and seizure of "drug-related" property represent a drastic curtailment of basic rights.

CASA dismissed civil-rights concerns by quoting John Stuart Mill, a favorite of libertarians who oppose drug laws. Mill said individuals did not have the right to enslave themselves. "Clearly," CASA's report said, "drug addiction is a form of enslavement."

"Very thin," is the verdict of Peter Reuter, a professor of public affairs at the University of Maryland at College Park who studies drug policy. "It was hard to distinguish that paper from something put out by the Drug Enforcement Administration."

He and others say that CASA's estimates of the costs of drug use are pretty good guesses, but not much more than that. "They've released a number of studies that ought to have been peer-reviewed," Dr. Reuter says.

As hard-hitting as the CASA reports can be, Mr. Califano turns up the volume in his op-ed pieces. In December 1996, he said that voters in Arizona and California who had voted to give doctors the right to prescribe marijuana had not exercised informed judgment on the topic, but were "bamboozled" by "a moneyed, out-of-state-elite" that paid for advertising promoting the referenda. He described George Soros, the philanthropist who gave $ 550,000 to the cause in California, as "the Daddy Warbucks of drug legalization." Mr. Soros has since said he does not favor legalization, although he thinks penalties for marijuana possession are too severe.

Last February, in another opinion piece, Mr. Califano compared medical marijuana to laetrile, a quack cure for cancer in the 1970s. Hundreds of people were taking laetrile, despite no evidence that it worked. The government reluctantly tested it and, to no one's surprise, found it to be ineffective. "As with laetrile, we should count to 10" on medical marijuana, Mr. Califano wrote.

William London, the director of public health for the American Council of Science and Health, based in New York, says he was "outraged" by the analogy. Laetrile didn't work at all, he notes, but as early as 1982, the National Academy of Sciences said marijuana "has shown promise in the treatment of a variety of disorders." The only question is whether medical marijuana works better than existing drugs.

"I think CASA does some impressive presentations," he says. "They collect data that are important to consider. But my bottom-line concern is that this is a group that is interested in painting the most alarming picture possible about the drug menace, and I don't think that's the most constructive approach to dealing with the problems of drug abuse."

Mr. Califano has also come down hard on those who propose that the United States try some of the experiments of Western European countries, such as the Netherlands's allowing the sale of cannabis in coffee shops, under tight restrictions, to separate it from the "hard" drug trade. CASA notes that marijuana use by teens has risen in Amsterdam -- a statistic that others dispute. Its critics counter that, whether or not there's been a rise in Amsterdam, many more American than Dutch teen-agers smoke pot. "They go around attacking people with other points of view," says Craig Reinarman, a professor of sociology at the University of California at Santa Cruz. "As if we don't need a more pluralistic debate about drug policy! The reason we need a more robust debate is that we've had the most punitive form of drug prohibition in the industrialized world for most of the 20th century, and levels of drug abuse don't go away."

Last month, 36 drug experts and policy makers made a plea for just such an open-ended discussion. "The current drug-policy debate," they wrote, "is marked by polarization into two positions stereotyped as 'drug warrior' and 'legalizer.'" The statement calls for a drug policy, rooted in science, that weighs the risks of drug use against the equally real risks of overzealous law enforcement.

CASA, which most scholars would place firmly in the warrior camp, complains that calling it a polarizing force is unfair. Much of CASA's work is in the field, not on opinion pages. Dr. Kleber, for example, is overseeing a comparison of 200 treatment centers, drawn from a nationwide sample of 5,000, ranging from long-term residential programs like Phoenix House to outpatient programs that counsel patients only a few hours each week. CASA is also evaluating the efficacy of acupuncture in curbing addiction, a popular treatment that has sketchy scientific support.

The University of Maryland's Dr. Reuter credits Dr. Kleber with building up a credible research program. "The combination of Califano's fund-raising ability and Kleber's competence is a powerful one," he says. "Whether this justifies the lavish institution and a simplified message, I'm not sure."

"There's a lot of noise that comes out of there that seems unrelated to any research activity."

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Thu Jul 15 03:41:44 1999