SCC ruling: Insite to stay open

waldo · October 3, 2011

Where the drug is in the possession of another and the recipient is injected by them.

by the by... who actually owns/possesses a passed-around doob... anyway?

hookah bar?

Edited October 3, 2011 by waldo

bud · October 3, 2011

hey look! More Science! The same doctor, the same city... long term trending analysis:

Trends in Human Immunodeficiency Virus Incidence and Risk Behavior Among Injection Drug Users in Montreal, Canada: A 16-Year Longitudinal Study

does this mean you changed segnosaur's mind about insite?

October 3, 2011

Where the drug is in the possession of another and the recipient is injected by them.

Not according to the definition of possession.

waldo · October 3, 2011

Not according to the definition of possession.

thought you were, errr... done! :lol:

segnosaur · October 3, 2011

Hey look! Science! http://aje.oxfordjou...12/994.abstract
Risk elevations for HIV infection associated with Needle Exchange programs attendance were substantial and consistent in all three risk assessment scenarios in our cohort of injection drug users.

hey look! More Science! The same doctor, the same city... long term trending analysis:

Trends in Human Immunodeficiency Virus Incidence and Risk Behavior Among Injection Drug Users in Montreal, Canada: A 16-Year Longitudinal Study

In conclusion, HIV incidence has declined in this cohort, with an acceleration of the reduction in HIV transmission after 2000.

First of all, I already admitted in my earlier post that the study I quoted was not the only one, and that some studies might actually show different results. The only thing we can say is that at this point the data is not clear, and anyone claiming "Needle Exchange prevents HIV" is making a claim that is not supported in reality.

Secondly, the study you quoted appeared to be mostly discussing HIV transmission in general (rather than dealing specifically with needle exchange programs). And even when it does address safe injection sites, it admits that in some cases any links are not statistically significant.

segnosaur · October 3, 2011

does this mean you changed segnosaur's mind about insite?

How can he change my mind when I've already pointed out that I haven't made my mind up in the first place?

Bad arguments (such as the ones I pointed out) should be challenged, regardless of what side of the debate you happen to fall on.

bud · October 3, 2011

First of all, I already admitted in my earlier post that the study I quoted was not the only one, and that some studies might actually show different results.

as it has been pointed out:

The same doctor, the same city... long term trending analysis

this means that the 1995 research you posted has been canceled.

segnosaur · October 3, 2011

as it has been pointed out:

The same doctor, the same city... long term trending analysis

this means that the 1995 research you posted has been canceled.

Ummm.... not really. That's not the way science works.

The more recent study was not specifically addressing the issue of needle exchange programs. It was examining the overall HIV trends among the drug using community (some who used needle exchange programs, some who were not.) It probably was accurate when discussing HIV trends, but it doesn't mean that those trends were due to needle exchange programs.

And even when it did address the issue of safe injection sites, the results were not clear.

bud · October 3, 2011

Ummm.... not really. That's not the way science works.

The more recent study was not specifically addressing the issue of needle exchange programs. It was examining the overall HIV trends among the drug using community (some who used needle exchange programs, some who were not.) It probably was accurate when discussing HIV trends, but it doesn't mean that those trends were due to needle exchange programs.

And even when it did address the issue of safe injection sites, the results were not clear.

During InSite's 3 years, a remarkable consensus that the facility reduces harm to users and the public developed among scientists, criminologists and even the Vancouver Police Department. Research, all positive, was published in 15 peer-reviewed journals, including the CMAJ (2004;171:731-4), Lancet (2005;366:316-8) and the New England Journal of Medicine (2006;354:2512-4).

link

there is more:

In 2003, the regional health authority in Vancouver, Canada successfully applied to the federal government for a legal operating exemption to pilot North America’s first medically supervised injection facility (SIF) – Insite. The exemption was granted on the condition the program undergo rigorous scientific evaluation. Given the controversial nature of SIFs, as will be described in this report, the Insite evaluation was designed to stand up to the highest level of scientific scrutiny.

The first several years of evaluation have yielded an array of scientific outputs, including more than 30 peer-reviewed studies describing the program’s impacts. These publications indicate that Insite provides a range of benefits to its clients and the greater community, including a reduction in public injecting, lower levels of HIV risk behaviours (e.g., syringe sharing), and an increase in uptake of addiction treatment among the facility’s clients. Furthermore, studies seeking to identify potential harms of the facility found no evidence of negative impacts. Studies were independently peer-reviewed and published in top scientific periodicals, including the New England Journal of Medicine, The Lancet and the British Medical Journal.

the research summary.

are you going to give up fighting a lost battle or are you going to accept that insite has been proven to be positive in every way?

TimG · October 3, 2011

are you going to give up fighting a lost battle or are you going to accept that insite has been proven to be positive in every way?

The only trouble is all of the studies are done by advocates for the harm reduction approach. Therefore you cannot expect them to be unbiased assessments of its success.

Science is not some magical process that produces the truth. It is often politics by another name.

Edited October 3, 2011 by TimG

Shwa · October 3, 2011

The only trouble is all of the studies are done by advocates for the harm reduction approach.

Magical citation please, showing that all of the studies were completed by advocates of the harm reduction approach.

Therefore you cannot expect them to be unbiased assessments of its success.

Yes we can, since they are making the claim scientifically. However, even a biased scientist can produce unbiased results. Or, you could follow the links, read the datasets yourself and then come to your own, unbiased opinion. When you do, publish your results here. We'll review them for you.

Science is not some magical process that produces the truth. It is often politics by another name.

Who's biased again?

waldo · October 3, 2011

The only trouble is all of the studies are done by advocates for the harm reduction approach. Therefore you cannot expect them to be unbiased assessments of its success.
Science is not some magical process that produces the truth. It is often politics by another name.

all studies? All?

yes, clearly any opportunity for you to dredge up your proclivity to slag peer-review... is this but another of your favoured targets, a TimG "medical TEAM" to incessantly denigrate... "medical Mafia", as you say? Yes, indeedee, TimG has found another "advocacy" group spreading bias amongst the impressionable masses! Apparently, in your TimG world, anyone studying syringe exchange programs, HIV incidence and harm reduction are... "advocates"... biased advocates, no less!

waldo · October 3, 2011

First of all, I already admitted in my earlier post that the study I quoted was not the only one, and that some studies might actually show different results. The only thing we can say is that at this point the data is not clear, and anyone claiming "Needle Exchange prevents HIV" is making a claim that is not supported in reality.
Secondly, the study you quoted appeared to be mostly discussing HIV transmission in general (rather than dealing specifically with needle exchange programs). And even when it does address safe injection sites, it admits that in some cases any links are not statistically significant.

within the initial study (you linked to), even accepting caveats applied, I'd suggest you took some latitude with your broad-based conclusions. Yes, the initial study I quoted is more generalized... but does address harm reduction program/sites. Unless you have direct access to the study (beyond the abstract) your passed judgement on the degree of generalization is... questionable. In any case, ala TimG, here is another biased advocacy group reporting for duty:

Temporal changes in risk factors associated with HIV seroconversion among injection drug users in eastern central Canada

Since 1995, the SurvUDI network has conducted surveillance among IDUs recruited in harm reduction programmes in eastern central Canada. Among the 11 731 participants, 2903 repeaters were initially HIV-negative. HIV incidence was calculated and compared for two time periods (1995–2002 vs. 2003–2009). Multivariate Cox proportional hazard models with time-dependent covariates were used to assess risk factors associated with HIV seroconversion. Interactions between covariates and time periods were examined.

Results: The overall HIV incidence rate was 2.7 per 100 person-years [95% confidence interval (CI) 2.4–3.1]. It
significantly decreased from 3.1 per 100 person-years in 1995–2002 to 2.2 person-years in 2003–2009
.

segnosaur · October 3, 2011

The first several years of evaluation have yielded an array of scientific outputs, including more than 30 peer-reviewed studies describing the program’s impacts. These publications indicate that Insite provides a range of benefits to its clients and the greater community, including a reduction in public injecting, lower levels of HIV risk behaviours (e.g., syringe sharing), and an increase in uptake of addiction treatment among the facility’s clients. Furthermore, studies seeking to identify potential harms of the facility found no evidence of negative impacts. Studies were independently peer-reviewed and published in top scientific periodicals, including the New England Journal of Medicine, The Lancet and the British Medical Journal.

the research summary.

are you going to give up fighting a lost battle or are you going to accept that insite has been proven to be positive in every way?

I'm a skeptic. I believe in following the evidence, wherever that may lead.

I also recognize that its possible for science to be misused/misapplied. In general, a single study, covering a topic of interest, is more valuable than a dozen studies of no (or only marginal) relevance.

Your link certainly provided a lot of references to studies. And yes, may appeared in quite notable journals. I've gone over the ones that I think were most relevant to the situation and here's what I found...

- Many articles seem to just provide background (e.g. they talk about HIV in general, but not the effect of Insite or other similar programs)

- Some of them are about their use in preventing overdose deaths.... something I never disputed

- Some of the studies depended on self-reported statistics

- About the only one that seemed to deal with HIV and Insite was #19, and even then it didn't really compare HIV outside the Insite-using population.

In short, nothing answered the question: Will there be more or less cases of HIV/HepC due to the presence of Insite. To do so you need to be able to compare insite users with a control group of some type, which I have not found at this point in time.

Edited October 3, 2011 by segnosaur

segnosaur · October 3, 2011

within the initial study (you linked to), even accepting caveats applied, I'd suggest you took some latitude with your broad-based conclusions. Yes, the initial study I quoted is more generalized... but does address harm reduction program/sites.

Yes it does address harm reduction programs. I even admitted it in my earlier post.

Unless you have direct access to the study (beyond the abstract) your passed judgement on the degree of generalization is... questionable.

As is any assumption that your study supercedes the study I referred to earlier.

In any case, ala TimG, here is another biased advocacy group reporting for duty:
Temporal changes in risk factors associated with HIV seroconversion among injection drug users in eastern central Canada

Problem with that study is again, it doesn't really address the issue of program users vs. non-users. It looks at HIV in a drug-using population, but doesn't do anything to say "Group A does better than Group B". It just says "This is what happens to Group A over time."

Again though, I want to stress that there are studies out there that show things like needle exchange programs work. But there are also studies that show they don't. I think its just wrong for those favoring things like Insite to claim "Science is on their side" when the science is, at best, fuzzy.

segnosaur · October 3, 2011

The only trouble is all of the studies are done by advocates for the harm reduction approach. Therefore you cannot expect them to be unbiased assessments of its success.

Keep in mind that studies are typically published in peer reviewed journals. That means that their results are examined by groups of people who were not involved in the initial study and may even be hostile to its conclusions.

The process of peer review is not perfect, but it tends to do a fairly good job at keeping science honest. I'm willing to accept the conclusions of a well-done relevant study concluding that Insite "works". I just haven't seen it yet. (The problem so far has been that so many studies have not been fully relevant.)

bud · October 3, 2011

The only trouble is all of the studies are done by advocates for the harm reduction approach. Therefore you cannot expect them to be unbiased assessments of its success.

Science is not some magical process that produces the truth. It is often politics by another name.

sometimes people become 'advocates' because they have proof that it works and believe in it.

lets say that the 10+ research that have been done, which show that insite is beneficial, are all biased. why hasn't the federal government, who is very much against the site, have not looked into doing research into it? where are all the opponents' research showing that it doesn't work?

TimG · October 3, 2011

That means that their results are examined by groups of people who were not involved in the initial study and may even be hostile to its conclusions.

That is an assumption. In narrow fields "peer review" is often "pal review" where the reviewers are collaborators with the authors on other papers. If you can point to specific papers that have been reviewed by qualified people who are sceptical of the harm reduction approach then I would like to see them.

The process of peer review is not perfect, but it tends to do a fairly good job at keeping science honest.

I no longer believe that given the abuses I have seen in climate science. I am no longer willing to give peer review the "benefit of the doubt". Any conclusions based on analysis of statistics are suspect unless they can be replicated by lab experiment or part of a double blind study. Edited October 3, 2011 by TimG

waldo · October 3, 2011

Temporal changes in risk factors associated with HIV seroconversion among injection drug users in eastern central Canada
Since 1995, the SurvUDI network has conducted surveillance among IDUs recruited in harm reduction programmes in eastern central Canada. Among the 11 731 participants, 2903 repeaters were initially HIV-negative. HIV incidence was calculated and compared for two time periods (1995–2002 vs. 2003–2009). Multivariate Cox proportional hazard models with time-dependent covariates were used to assess risk factors associated with HIV seroconversion. Interactions between covariates and time periods were examined.
Results: The overall HIV incidence rate was 2.7 per 100 person-years [95% confidence interval (CI) 2.4–3.1]. It significantly decreased from 3.1 per 100 person-years in 1995–2002 to 2.2 person-years in 2003–2009.

Problem with that study is again, it doesn't really address the issue of program users vs. non-users. It looks at HIV in a drug-using population, but doesn't do anything to say "Group A does better than Group B". It just says "This is what happens to Group A over time."

Again though, I want to stress that there
are
studies out there that show things like needle exchange programs work. But there are also studies that show they don't. I think its just wrong for those favoring things like Insite to claim "Science is on their side" when the science is, at best, fuzzy.

within the latest study I linked to, candidates were "recruited in harm reduction programmes"... by their very nature, it would be unrealistic to presume recruits would completely and absolutely utilize, over an extended years period, only within the confines of 'safe injection facilities (SIFs)'. Equally, how realistic is it to presume upon any control group of HIV drug users, outright... regardless of whether or not SIFs are engaged? So... there are inherent variable limitations drawing legitimate comment on how studies deal with these variables.

another: A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility

Through the use of conservative estimates, Vancouver's SIF, Insite, on average, prevents 35 new cases of HIV and almost 3 deaths each year. This provides a societal benefit in excess of $6 million per year after the programme costs are taken into account, translating into an average benefit-cost ratio of 5.12:1.

Conclusion
- Vancouver's SIF appears to be an effective and efficient use of public health care resources, based on a modelling study of only two specific and measurable benefits—HIV infection and overdose death.

waldo · October 3, 2011

That is an assumption. In narrow fields "peer review" is often "pal review" where the reviewers are collaborators with the authors on other papers. If you can point to specific papers that have been reviewed by qualified people who are sceptical of the harm reduction approach then I would like to see them.
I no longer believe that given the abuses I have seen in climate science. I am no longer willing to give peer review the "benefit of the doubt". Any conclusions based on analysis of statistics are suspect unless they can be replicated by lab experiment or part of a double blind study.

your biases are showing! :lol: What... no gate-keeping charges against medical doctors/scientists? Don't make me link to the Spencer grouping of 'skeptical' papers published in mainstream journals... you know... the post that trumps your fallacious charges of gate-keeping Spencer's papers!

TimG · October 3, 2011

sometimes people become 'advocates' because they have proof that it works and believe in it.

Or they are blind to its flaws because they have invested so much of their personal energy into it.

lets say that the 10+ research that have been done, which show that insite is beneficial, are all biased. why hasn't the federal government, who is very much against the site, have not looked into doing research into it? where are all the opponents' research showing that it doesn't work?

You are assuming there are researchers that have an interest in debunking the claims. Science is a field of a self-selected specialists. People who go into an a particular discipline tend to share a world outlook. Consensus may often be because no one working in the field wishes to believe otherwise.

Bottom line: consensus means nothing in the absence of results that can be verified in a lab.

Edited October 3, 2011 by TimG

segnosaur · October 3, 2011

within the latest study I linked to, candidates were "recruited in harm reduction programmes"... by their very nature, it would be unrealistic to presume recruits would completely and absolutely utilize, over an extended years period, only within the confines of 'safe injection facilities (SIFs)'.

You're right, there is no guarantee that anyone will completely utilize SIFs. (Of course, that was the point I made in my first post... the problem with SIF is that it might encourage disease by giving a medium for people to meet who might not otherwise, who may then engage in unsafe practices elsewhere.)

And even if they can't guarantee any user uses a SIF each and every time, that doesn't prevent at least some analysis from being done. They could compare a group of people who never use Insite (or needle exchange programs, or whatever) with people who use them at least once a week, and compare the prevalence of HIV/HepC in those 2 groups.

Equally, how realistic is it to presume upon any control group of HIV drug users, outright... regardless of whether or not SIFs are engaged? So... there are inherent variable limitations drawing legitimate comment on how studies deal with these variables.

Not sure what the problem here is. Its probably fairly easy to identify a group of people in Vancouver with similar demographics who just never use InSite. I can't really think of a motivation people would have for lying.

another: A cost-benefit and cost-effectiveness analysis of Vancouver's supervised injection facility

Problem with that article is that it claims to use the "number of HIV deaths prevented", but it doesn't state where it derives that number. (At least not in the abstract... maybe the main article goes into details about where it gets that value from, but if they're using faulty data for figuring the number of HIV deaths prevented, then it will give faulty conclusions.

bud · October 3, 2011

Or they are blind to its flaws because they have invested so much of their personal energy into it.

You are assuming there are researchers that have an interest in debunking the claims.

you're the one who said the scientists who advocate insite are biased. i'm asking you to show me a research that you wouldn't call biased which shows that insite is not working.

what do you suggest should be done about insite? about the research?

guyser · October 3, 2011

Keep in mind that studies are typically published in peer reviewed journals. That means that their results are examined by groups of people who were not involved in the initial study and may even be hostile to its conclusions.

The process of peer review is not perfect, but it tends to do a fairly good job at keeping science honest. I'm willing to accept the conclusions of a well-done relevant study concluding that Insite "works". I just haven't seen it yet. (The problem so far has been that so many studies have not been fully relevant.)

Does this help?

http://bigblog.dukechronicle.com/backpages/supervised-injection-injecting-the-facts/

waldo · October 3, 2011

You are assuming there are researchers that have an interest in debunking the claims. Science is a field of a self-selected specialists. People who go into an a particular discipline tend to share a world outlook. Consensus may often be because no one working in the field wishes to believe otherwise.
Bottom line: consensus means nothing in the absence of results that can be verified in a lab.

riiiiiiiight! Which also plays into your favoured conspiracy angles... you know, where thousands of world-side 'researchers/scientists' will turn a blind eye to presenting science that would/could overturn the consensus... because, wait for it... wait for it... they are anti-science by nature, would abhor world-wide 'fame/fortune', are protecting their jobs/grants/funding, etc. Ah yes, it's a masterful conspiracy that just can't be penetrated... notwithstanding it assumes "skeptical/scientists' are simply dullards and incompetent for not being able to penetrate the insurmountable consensus... even with all that industry backing/funding! TimG conspiracy is always worth a chuckle.