Demystifying Medicine One Month at a Time

Indiana: 1 out of 2

Indiana passed a “Religious Freedom” law last week, signed by Governor Mike Pence.

Reaction to the law has been swift and furious. The law purports to enhance religious freedom by allowing business owners to cite their religious beliefs as a legitimate reason for discrimination. Many national organizations, both religious and commercial, have declared their intent to cease doing business in Indiana.

Judging by the news cycle and social media reactions to the law’s passage, you could say Governor Pence has made a very poor choice.

cleanneedlesInterestingly, the same week, he went against his own stated principles and made, from a public health viewpoint, a resoundingly good and evidence-based choice about another matter affecting his state.

Rural Scott County, in southeast Indiana, has reported more than six dozen new cases of HIV in 2015 alone. In public health terms, this is an epidemic spread, given the very low population density of the county. In a typical year, Scott County might see five new HIV cases. In just the first quarter of this year, the county’s reported a nearly 16-fold increase over the annual rate, leading Governor Pence to acknowledge that Scott County is facing a “Public Health Emergency.”

To combat the spread of HIV, which is due to the sharing of needles for injection drug use, Governor Pence’s emergency order permits public health officials to immediately begin a clean needle exchange as per CDC recommendations.

Pence has spoken out against a statewide or permanent needle exchange program, instead limiting the effort only to Scott County on a temporary basis. NPR quoted the governor as follows: “I don’t believe that effective anti-drug policy involves handing out paraphernalia to drug users by government officials,” he says. “I reject that.”

It’s easy to see why someone could reject clean needle programs on the basis of not wanting to subsidize or potentiate illicit drug use. Yet when faced with such an emergency, Governor Pence has yielded to experts wielding scientific evidence.

That’s what public health is all about. We may not like people’s behavior or habits, but in truth, preaching or punishing has shown to be of limited (if any) value. Acknowledging that there’s a problem without resorting to judgment, and designing programs to protect the public’s health, is sound medicine and policy.


  1. Joel Henning


    Great piece. . . . Re his bad legislation: I hope that next week’s Final Four in Indianapolis is totally besieged with demonstrators, many organizations cancel events in Indiana and/or totally pull out of the state.

  2. glasshospital

    thanks for the comment.

  3. Jeff

    In all fairness, the whole discrimination issue is significantly more complicated than you let on here. It’s a philosophical question of whether, when one refuses to provide some service, whether that refusal can sensibly stem from the rejection of a particular *activity* (ie. a gay marriage) without actually being a rejection of a person’s *inherent character* (ie. a gay person).

    The question of handing out needless for PH damage control is an interesting one. I tend to reject consequentialism, so if I came to the conclusion that to provide a needle to a drug addict is intrinsically immoral, I couldn’t in good conscience provide the needle, even if it resulted in saved lives. This is due in part though to my view that there is a real difference between “judgment” (pointing out someone’s, I don’t know, intrinsic/spiritual worth?) and pointing out that some action is wrong. More to the point though, I’m not sure the action in question here is actually wrong. Drug usage is a tricky subject for me. Hm…

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