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The still-tiny medical student blogosphere is composed mainly of beleaguered twentysomethings posting their disconnected thoughts on what they're learning in the classroom, experiencing on the wards, and hearing from the media.

Then, there's Trent McBride, who seems well on his way toward writing the book about paternalism in medicine. The third installment is up now. Once again, it's meticulously researched, well reasoned, and forces readers to challenge some basic assumptions.

I'm not agreeing with his conclusions about the War on Drugs and its relation to prescriptions and infectious disease, but I find myself arguing from the position of, well, inconsistently applied paternalism and intuition-based medicine and policy.

If I were to research an evidence-based reply, it might start with the BMJ series in 1996 and the running NEJM series throughout 1994 (search "war on drugs" in pubmed). In a NEJM book review on "Illicit Drugs in a Free Society", edited by Bayer and Oppenheimer (registration required), Ernest Drucker wrote:

A chapter by Harry Levine and Craig Reinarman (both sociologists) examines the lessons of the prohibition of alcohol, our earlier "great experiment" in drug policy. It was claimed at the time that Prohibition was needed because alcohol was "so addicting and dangerous . . . that it could never be regulated." But 60 years later, we do regulate alcohol (and tobacco), and more effectively each year, judging from declining rates of death in alcohol-related auto accidents. Levine and Reinarman suggest that "most if not all psychoactive substances could be similarly regulated." Twelve major scientific commissions on drug-policy reform (in the United States, Great Britain, and Canada) have recommended regulatory alternatives to drug prohibition, but all have been ignored.

Legalization, in other words, does not imply deregulation. Could McBride abide an end to the war on drugs if it meant increasing the range of the D in FDA?

Looking at it another way: this weekend's click-it-or-ticket checkpoints haven't done anything for my appreciation of government regulation. I've vacillated on seatbelts before, even though the data on this issue seems clear.

The lesson from this weekend's checkpoint gridlock is that Americans will put up with infringements in personal liberties if they think it's saving lives. Evidence trumps principle in a lot of these cases. So until there's a better-designed experiment than 1920s Prohibition, drug legalization will still seem like a risky proposition. A slow roll-out of legalization, maybe one drug at a time, with emphasis on data collection and new safety regulations, could go a ways toward easing fears.

But this is just the disconnected musings of a beleaguered med student. Check out Trent McBride's earlier installment on paternalism, and its responses. I'm especially looking forward about the upcoming sections on HIPAA and Organ Donation.