Public health policy in San Diego County isn't decided by a group of doctors or appointed health officials.
It's determined by a five member board of supervisors elected by the public.
Dianne Jacob chairs the board. She and her associates are proud of their conservatism on fiscal and social issues.
For example, the board recently sued the state in an attempt to overturn California's medical marijuana law.
So what about authorizing a clean syringe exchange program? Jacob says there's no way the board would do that.
"I think it particularly sends a wrong message to our kids," says Jacob. "It sends a message to our kids that as county government, if we gave out clean needles for illegal drug use, that we condone illegal drug use. And we don't. And it's wrong."
Jacob believes government should encourage people to stay away from drugs. And Jacob thinks those who are using illegal substances need to go into treatment.
"So, that's where I'd say we should put our money, and focus on those efforts, to stop the illegal drug use," Jacob argues.
In 2004, the San Diego Association of Governments evaluated the city of San Diego's pilot syringe exchange program.
SANDAG found clients who visited the exchange were much less likely to share a needle. They also reduced their drug use. In fact, one in five clients said they had entered treatment.
Jacob doesn't believe it.
"I think there's research on both sides," Jacob insists. "I don't think it's conclusive that a clean needle exchange program reduces drug abuse and solves problems in communities. There's also evidence on the other side that it encourages drug use."
"That's patently false," says Dr. Steffanie Strathdee. "I've been working in this field now for more than 20 years, and I can tell you that there's no scientific evidence that shows that needle exchange causes harm."
Dr. Steffanie Strathdee heads up the division of global public health at the UCSD School of Medicine.
She's evaluated clean needle exchanges in Baltimore, Vancouver, and other locations around the world.
"Needle exchange has not been associated with any negative outcomes, such as increased crime, increased discarded needles on the street," Strathdee points out. "It hasn't been associated with more people starting drug use at earlier ages, etc., etc. In fact, it's consistently been associated with reductions in high-risk behavior. And so there's really no reason not to support it on a broader scale."
But Strathdee says in the United States, many politicians just don't get it. They don't understand clean syringe exchange programs help curb the spread of hepatitis C and HIV.
Instead to some lawmakers like Dianne Jacob, the idea of giving out clean needles to drug addicts is like giving out heroin.
"What kind of information might make you reconsider your view on this whole matter?"
"I'm not sure any kind of information will, frankly," says Jacob, "because of the fact that philosophically, I believe it's wrong to in any way, encourage drug use. I think it's wrong for government to send that message."
As it stands now in San Diego County, thousands of drug addicts have no access to clean syringes.
Locally over the past ten years, the number of people infected with hepatitis C has more than doubled. County health officials say more than 4,100 people have the disease.
Dianne Jacob wasn't aware of those figures until we brought them to her attention.
