what should the community do about discarded syringes? What Would Calvin Do (WWCD)? What Would Scientists Do (WWSD)?

A sharps disposal box. Like a mailbox/postbox, once you put something into it, it's almost impossible to pull it out again. The whole box goes straight from the discard site to a safe process of disposal, usually incineration.

Letter to the Editor submitted to the San Francisco Chronicle (San Francisco, California USA).

I don't know if The Chronicle has published it.

The RAND Corporation is perhaps the world's first private (non-government) "Think Tank," and remains America's most prestigious "Think Tank." RAND stands for Research And Development.

Shortly after RAND founded itself in the early 1950s, they published a famous primer and introduction to the new mathematics branch called Game Theory, a really nifty book called "The Compleat Analyst."

("Compleat" is a joking reference to Izaak Walton's 1653 classic about the sport of fresh-water fishing, "The Compleat Angler.")

Ever since, RAND has built its reputation by using (and in some cases inventing) the most advanced frontiers of mathematics to study and answer complicated social, military and government questions, from the strategy of thermonuclear war, to discarded syringes in alleys and playgrounds.

(The USA's strategy in playing our side of Superpower Thermonuclear War during the Cold War was largely based on Game Theory, and was heavily influenced by RAND.)

There are two schools of thought about what to do with needle injection addicts in a country where heroin and other needle-injected drugs (and often the very possession of a syringe) are crimes.

School 1. The Television Clown "Judge Judy" told an Australian newspaper reporter that the government should distribute used, dirty syringes to addicts to give them AIDS and kill them. Since that news story, she hasn't denied saying that. She just refuses to talk about it. (Judge Judith Sheindlin is a retired judge from New York State's family court.)

School 2. Governments should develop and support policies and programs that diminish the volume of health damage to the community associated with drug use and needle addiction.

This letter discusses a highly controversial political Flashpoint: Discarded needles/syringes.

In every medical office there's a "sharps" disposal box (highlighted in red with biohazard symbols), so once a needle has been used -- once a needle has contacted blood or body fluids -- it goes immediately to a secure disposal process, segregated from all other trash which is not bio-hazardous.

Where else should the community set up sharps disposal boxes? Public and restaurant bathrooms? Bathrooms in high schools and colleges? Bathrooms on commercial airplanes? Prisons and jails?

In other words, this Policy recommends setting up bio-safe disposal boxes anywhere that addicts are likely to discard a used syringe. So in a very real sense, Addicts themselves develop and focus this public policy.

In most American cities where this question has arisen, Judge Judy's wisdom has prevailed, and the elected leaders consistently vote NO NO NO NO NO, OVER OUR DEAD BODIES, NO SAFE DISPOSAL BOXES IN PUBLIC PLACES.

Oh, I forgot to mention: When there aren't any safe disposal boxes, needle addicts discard their used syringes haphazardly. Children find them on playgrounds and think they're nifty toys. Trash collectors and emergency workers (police, fire, paramedic) are put in constant jeopardy of being stuck by haphazardly discarded dirty needles.

Since Puritanism began, Puritanism Kills. Early death free of Sin is preferable to a long sinful life.

And wherever Puritans are in political control (most of the USA most of the time), Sin = Crime, and your First Stop on the Road to Hell, which you chose for yourself by your own wickedness and disobedience, is a Prison on Earth.

btw, a person in prison or jail is ten times more likely to contract the blood-borne diseases HIV/AIDS and hepatitis than a non-prisoner. Prisons are America's institutional pressure cookers to spread HIV/AIDS and hepatitis. Almost all prisoners eventually are released and return to the community. While in prison, almost none of them receive any medical treatment for their addictions.

Dr. Blumenthal very kindly gave his permission to reprint his and Dr. Kral's letter.

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To the Editor,

Recent articles in The Chronicle (July 24, 25, 29, August 2, and 3) have discussed public health concerns in San Francisco related to dirty syringes from illicit drug users. In these articles concerns were raised about the syringe dispensing policies of local syringe exchange programs, suggesting these programs should not give out more syringes than they receive from participants.

Our federally funded research over the past 15 years proves not only that these programs reduce HIV transmission, but that programs that give out more syringes than they collect are the most successful at reducing HIV risk. Our research also shows that safe disposal is as likely from participants of programs that give out more syringes than they receive as from strict one-for-one programs.

The problem is not the dispensing policies of syringe exchange programs, but rather the need for pragmatic approaches to safe syringe disposal. The August 3rd article notes that other cities have installed syringe disposal boxes in public areas. We applaud City officials for proposing to install these tamper-proof, large metal boxes in San Francisco. We agree that installation of these boxes is a worthwhile investment to prevent even one child being accidentally stuck with a dirty syringe.

Ricky N. Bluthenthal, Ph.D.
Senior Social Scientist, RAND Corporation

Alex H. Kral, Ph.D.
Director, Urban Health Program, RTI International