I often don't agree with her but Margaret Wente has been doing a series on Insite:
We still await the scientific proof of harm reduction's success
By MARGARET WENTE
mwente@globeandmail.comTuesday, July 15, 2008 – Page A13
Ten months before Vancouver's supervised-injection site opened in 2003, two young researchers gave a stirring presentation. They argued that such a facility was vital in order to reduce public-health problems and disorder in the city's notorious drug scene. The evidence from elsewhere was overwhelming, they insisted, and it was time to act. "I'm all for it," said Evan Wood, one of the presenters. "Get one open. Enough's enough already."
Neither Mr. Wood nor his colleague, Thomas Kerr, had a background in addictions medicine or public policy. Mr. Kerr was a PhD candidate in educational psychology, and Mr. Wood was a PhD candidate in health and epidemiology. Yet today, they and a small group of associates have made their reputation in the world of drug policy as the authors of nearly two dozen research papers - every one of which reports remarkably positive results for Insite, the controversial supervised-injection facility for which they themselves had lobbied hard.
It is this research - all produced under the umbrella of the B.C. Centre for Excellence in HIV/AIDS - that is repeatedly cited as scientific proof of Insite's success. It is this research that has persuaded politicians, policy-makers, editorial writers and much of the general public that Insite is a compassionate and progressive tool for harm reduction that saves lives and reduces suffering. After all, at least 22 peer-reviewed papers say so.
In fact, Mr. Wood, Mr. Kerr and their associates often act more like advocates than impartial researchers. They aggressively denounce anyone who even suggests that the value of Insite might still be a matter for legitimate study or debate. They accuse Insite's critics of being blinded by ideology and of willfully ignoring mountains of "peer-reviewed," "evidence-based" studies.
Yet even experts who think Insite is a worthwhile experiment say the case has not yet been made. Dr. Brian Conway, one of Canada's top experts on AIDS policy, is one of them. "How much has it done in terms of reducing the HIV-Hep-C infection rate, the rate of serious illness that results from drug use, in terms of saving lives? That hasn't been demonstrated." Nor is quantity the same as quality. The sheer volume of published research "is more of a tribute to the efficiency of the people who are writing the papers than anything else." And in public, the researchers "have tended not to present the limitations" of their findings.
Some people are not so diplomatic. "You can churn out all the research you like if you've got a vested interest," says addictions doctor Milan Khara. The B.C. Centre for Excellence receives millions of dollars worth of government contracts for research on drug issues. The tab for the Insite studies is well over $2-million. Yet none of these studies addresses the central issue in the public mind: Does Insite reduce overall drug use?
Garth Davies teaches research methodology at Simon Fraser University's school of criminology. He recently published an evaluation of all the research literature on safe-injection facilities, including Insite. He wasn't impressed. "[They] are too often credited with generating positive effects that are not borne out by solid empirical evidence," he wrote. "As a result of methodological and analytical problems ... all claims remain open to question."
Despite this fatal weakness, "there are very few other substantive areas of research where the debate is this one-sided," Prof. Davies said in an interview. The same small set of people peer-review each other's work, and even the drug journals are politicized. "It's very difficult to get a contrarian opinion published. If you're not on the side of supervised injection, you get marginalized."
In any event, researchers who want to analyze the data for themselves are out of luck, because the researchers refuse to share it. Steven Lehrer, who studies health economics at Queen's University, says it's frustrating. "They were reporting unbelievably large effects," he says. And that makes it especially important for independent researchers to validate the results. "They don't seem interested," he says.
Could it be that the fix is in? When researchers behave like advocates, it's hard to believe otherwise. "They act as if it's a done deal," says Prof. Davies. "It has become a professional mission for them."
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