Tony Clement has Jumped the Shark

I said a while back that our erstwhile federal Minister of Health, Tony Clement, should resign. I stand by that statement, particular in light of this and this. In fact, I'd say Tony has simply jumped the shark, and like a TV series that undergoes major cast changes to ill effect, it's time that he was cancelled. In fact, it may be necessary to disband the whole network. Exhibit A:

MONTREAL - Health professionals who support Vancouver's safe injection site are unethical and immoral, federal Health Minister Tony Clement suggested on Monday.

"The supervised injection site undercuts the ethic of medical practice and sets a debilitating example for all physicians and nurses, both present and future in Canada," he scolded in an address to the Canadian Medical Association general council meeting in Montreal.

He called providing a safe injection site to drug addicts tantamount to offering palliative care to a patient with a treatable form of cancer.

So, we have the spectacle of health minister calling some 79% of Canadian physicians (and, one would presume, nurses too) "unethical" and "immoral" since they are doing the equivalent of witholding treatment from cancer patients.

Or so he claims - it is, of course, quite right that witholding care from patients for spurious ideological reasons would be profounding unethical, but that is exactly what Clement is calling for. The entire purpose of a supervised injection site is to prevent deaths due to overdose, limit the spread of blood-borne diseases through the sharing of needles, and provide access to treatment programs and counselling... and that's exactly what Vancouver's InSite does. In fact, Clement's position is all the more ridiculous since he supports needle exchange programs, in which intravenous drug users are provided with clean needles, with the aim of - wait for it - limiting or even preventing ths spread of blood-borne diseases through the sharing of used needles. A supervised injection site does exactly the same thing, except that there are nurses around to prevent fatal overdoses. Oh, and such a site provides an access point for referrals toward drug treatment, something that Clement putatively wants to see happen more.

And that's great - we absolutely should support expanded drug treatment programs - so when is Minister Clement and his government going to start funding them properly? Clement asks:

Is it true that supervised injections offer 'positive health outcomes?' I would not put it this way. Insite [Vancouver's safe injection site] may slow the death spiral of a deadly drug habit, but it does not reverse it. I do not regard this as a positive health outcome.

It's rather important to point out that intravenous drug users - assuming they don't contract and die from AIDS or Hepatitis - often die following a fatal overdose. Of course, Insite exists explicitly to prevent fatal overdoses.

Which is better, preventing a heroin user from overdosing, shooting up on the street, and subsequently referring him to treatment, or letting him OD and die in an alley?

In short, Clement's position is nonsensical and, at worst, downright unethical. The real motivation is clear enough, though:

The new Conservative ad campaign picks up where Mr. Clement's message leaves off with its call to "keep junkies in rehab and off the streets." It includes pictures of the party leaders and asks which of them is on track to fight crime.

The text reads: "Thugs, drug pushers and others involved in the drug trade are writing their own rules. For too long, lax Liberal governments left gangs and drug pushers to make their own rules and set their own criminal agenda. Those days are over."

My head is spinning from such dazzling rhetoric! Anyway, I don't know about anyone else, but I tend to agree that "junkies" ought to be off the streets. Rehab is an excellent alternative, but the facilities are not currently sufficient to the task, and since all "junkies" will not be able or willing to enter treatment immediately, it's better that they use clean needles and, say, not die due to an overdose. I'd think that's pretty obvious.

Unless you're a federal Conservative, that is.

Time Passes Quickly

I'm rather amazed that this year in Waterloo is nearly over. It's really flown by, especially since April. I suppose that shouldn't be surprising - the summer always flies by (though it's not quite over yet!). In exactly one month I'll have my first classes of med school at Dalhousie, with orientation beginning a few days before that. I think that's a bit surreal, not least because of how much stuff I still have yet to do (coursework is done; research paper and marking, not so much). Aside from work, there's the small matter of moving to Halifax.

I expect to keep this blog, but the title might become somewhat problematic. As much as I have complained about Waterloo in the past, the summer has been nice, and I can point to at least a few things I like, most especially the park-like area where I live, the ready availability of bike and walking trails, and some areas like Uptown which make for pleasant daily excursions. While I can't say that the selection of restaurants is all that great, the variety of different fast food outlets in the Plaza is pretty nice. And I like the Williams coffee shops, though they are admittedly not unique to Kitchener-Waterloo.

I've also really enjoyed taking the train to travel back and forth between here and Toronto. Via Rail is not anywhere near as unreliable as it's made out to be, and the trains themselves are comfortable and spacious. With my ISIC card, it's no more expensive than the bus, but much more comfortable. It's unfortunate that I won't be taking the train much come September, but that speaks to the inadequacy of the passenger rail system across the country. Ah well.

This is Funny

Concerning the idea of mandatory minimum sentences for certain crimes, I rather liked the scenario offered by a letter in the Star today:

Bill: Let's rob the local corner store. I'm short on cash.

Joe: Great idea. Let's go after 8, as that's when they have the most cash ... wait a minute, didn't you read the paper, there are new minimum mandatory sentences brought in by the Tories and they're tough.

Bill: You're right, it certainly dissuades me from this criminal activity. I'm going home to start applying for college.

Ah, the fallacy that is rational choice theory. Anyway, I'll have a report on my latest Tanglewood escapades later tonight, hopefully.

Annoying Trends

The sheer randomness of Judy's latest post has inspired me. I'm coming to be annoyed by several related trends, as regards things that are trendy. In no particular order, current "trendiness" requires that one first of all purchase a white Macbook with corresponding iPod. Next, one must spend the afternoon/early evening at the local Starbucks/Second Cup/Timothy's or, better yet, an independent fair trade coffee shop. Ordering black coffee is not permitted; instead an elaborate latte with shavings of cinnamon atop the non-fat milk foam concoction must be obtained for no less than $5.95, accompanied by biscotti, of course. At this point, one must appear to be working or, even better, writing, creatively, for it is surely necessary not just to be creative, but to be seen to be creative (with apologies to Family Guy). Of course, such writing must be done via Macbook, and checking the news on www.nytimes.com or Le Monde is a perfectly acceptable as an alternative - one needs inspiration after all! (Note that being able to read Le Monde in French is not really required - if you can't, you're simply learning.) A further essential past-time is the keeping an "artistic" photo blog.

Finally, in order to be as trendy as possible, one must pack the Macbook away and jet off to Vancouver - somewhere in the West End, False Creek, or, even better, Kitsilano. Repeat the above, and make Vancity your home, except now you'll spend 70% of your after tax income to live in a 600 square foot condo (hopefully not a leaky one) and spend an equal amount of your time complaining about it.

*****

Okay, I admit I don't know where I was going with that, but it was fun to write. Please note that it was not intended on impugning the motives of all Mac users (just a sizable number of them... ahem) or, for that matter, the veritably creative among us. Actually, there is someone I have in mind who fits this profile or at least soon will (though I'm not sure about the Macbook part). In order to reach his level, however, you'd need to start posting videos of yourself (badly) playing (bad) songs on YouTube. Links available upon request. ;)

Tony Clement Should Resign

As an addendum to my previous post, consider this excerpt from the Globe's editorial today:

[...] Researchers from the B.C. Centre for Excellence in HIV/AIDS detail what appears to be a deliberate attempt to suppress positive reviews of Insite from being released while its future is being decided.

Rather than extend federal funding for continuing research into the (InSite) facility, which had produced 22 (overwhelmingly positive) peer-reviewed studies over the preceding three years, Mr. Clement reportedly rejected his own department's advice and abruptly changed course in 2006. Further research, the authors write, would be focused on whether Insite complied with international drug control treaties - presumably in hope of demonstrating that failure to do so justified its closure. And researchers had to agree to delay the release of their findings until after the facility's current legal exemption had expired - a requirement that prompted University of British Columbia researchers to decline participation on the grounds that it was ethically unacceptable.

Mr. Clement, by all appearances, does not want more research. He wants research that conforms to the current government's antipathy toward supervised injection facilities, and provides the impetus to shut down Insite or at least reject applications for similar facilities elsewhere. In the absence of that research, he would prefer to have no research at all. Oblivious to the plight of addicts who may needlessly lose their lives as a result, Mr. Clement is keeping his blinders firmly attached.

Clement claims that he's open-minded on the safe injection side; one wonders why anyone not blinkered by morally bankrupt ideology would conclude that InSite is anything but a positive development for the Downtown Eastside. Whatever Clement's actual motivations - whether he is simply incompetent (a sure thing, in any case) or if he is also misguided thanks to a juvenile "Just Say No!" philosophy - his waffling on this issue does not merit the confidence of Parliament much less anyone concerned about public health. He should resign, though a better solution would be the removal of his boss as well.

Update: I suppose a more inflammatory headline would be something along the lines of "Conservatives Oppose Reducing AIDS Transmission" or, more succinctly, "Conservatives Support AIDS; Oppose Access to Addiction Services". That would be par for the course given past claims by Harper that the Liberals and NDP support child pornography.

Harm Reduction and Politics

Intravenous drug use has long been recognized as contributing to the spread of blood-borne diseases like HIV and Hepatitis - this results, of course, from the sharing of needles by drug users. The public health response to this specific problem - that is, infectious disease transmission via drug use - has been to set up needle exchanges where users can obtain clean needles. These have been in operation for some time, but the next logical step was to provide an environment where people can inject drugs safely and also access health and addiction services. The first such "safe injection site" in North America began operating in Vancouver's Downtown Eastside in Sept. 2003. According to Neil Boyd, a criminologist at SFU, it's been a resounding success:

"There is no doubt that InSite has made a positive impact for the individuals who use InSite, the residents, service providers and business operators in the neighbourhood, and for the greater public health of the community," said Professor Boyd.

Boyd's research, compiled for an advisory committee specifically selected by the Stephen Harper Government, highlighted many positive impacts of InSite's work, including:

• InSite is strongly supported by business operators, service providers and residents in the neighbourhood surrounding the facility.


• An intentionally conservative cost-benefit analysis demonstrated that there are significant savings to tax-payers as a result of InSite's work.


• InSite has proven to have a positive impact in reducing the spread of HIV/AIDS, and the consequent costs of its treatment.
  
• InSite prevents drug overdose deaths.


• There have been no adverse effects from InSite on drug use patterns, crime, or public disorder.

"The research presented re-confirms the kinds of results obtained from the other Health Canada funded evaluation," said Professor Boyd. "Mr. Harper should respect science and its principles -- the findings are demonstrated consistently in independently peer-reviewed scientific journals."

So, it seems clear enough that InSite is working: reducing the spread of disease and providing addiction and health services, i.e. reducing harm due to intravenous drug use. However, since heroin, to take one example, remains an illegal drug, InSite can only operate subject to an exemption from a section of the Controlled Drugs and Substances Act, an exemption which must be granted by Health Canada. One would think that a federal government which supports sound public health policies would have no problem with that. Well,

The federal Conservative government has allowed the clinic to operate under an exemption to the Narcotics Control Act, but Health Minister Tony Clement has refused to make the exemption permanent.

Clement has granted two temporary extensions to the permit, the latest of which expires at the end of June, but has not said whether he will grant a further extension.

In other words, Clement (who, in his previous incarnation as Ontario Health Minister, incompetently presided over the SARS crisis) evidently has some doubts about InSite, despite the rather obvious and substantive benefits. As his parliamentary secretary states:

Winnipeg MP Steven Fletcher, secretary to the health minister, has said science alone will not be the only factor in the Tory government's decision whether to extend Insite funding.

Mr. Fletcher said the science is conflicting, so Mr. Clement will have to assess what Mr. Fletcher calls the “realities of the situation.”

Mr. Clement himself said Monday that a decision on the fate of Insite will be made by the end of June. However, he rejected suggestions that the government has already made up its mind to say no.

“We're the government that actually wants more research . . . because we want to make sure that this decision is the right decision for Canada, the right decision for addicts the right decision for the community in Vancouver,” he told the Commons.

More research? It doesn't seem that way:

(BC) Provincial Health Officer Dr. Perry Kendall said ongoing research at the clinic is being jeopardized by the unstable situation.

"Closing down Insite would immediately put a stop to the research. Allowing Insite to continue would allow more valuable research to be done," said Kendall.

And just what will these other non-scientific factors be? Why, political ones, of course! As to Clement's putative support for research:

An article published in the International Journal of Drug Policy charges that the Conservative government interfered in the work of independent scientific bodies, attempted to muzzle scientists and deliberately misrepresented research findings because it is ideologically opposed to harm-reduction programs.

"From a scientific perspective, it's despicable," said Evan Wood, a research scientist at the B.C. Centre for Excellence in HIV/AIDS and lead author of the study. "Governments should not hand-pick grants based on ideology."

[...]

Since (2003), Dr. Wood said, there have been 22 peer-reviewed papers published on the program and they have all shown a positive benefit to users, such as reduced rates of transmission of HIV-AIDS and greater use of rehabilitation services.

An independent scientific review led Health Canada in the spring of 2006 to recommend that funding for the project be extended and that similar programs be tried in other cities.

But federal Health Minister Tony Clement intervened, saying there were too many unanswered questions and placed a moratorium on this type of research. The journal article says that was done at the behest of police organizations and based on political concerns, not sound public health policy.

Rita Smith, a spokeswoman for Mr. Clement, told The Globe and Mail yesterday this claim is "completely inaccurate." [Actually, it's entirely accurate.]

[...]

Ottawa subsequently offered money for additional research, but with the proviso that investigators refrain from disseminating their findings until after the exemption for the safe injection site expires. [In other words, they'll only fund further research (that will almost certainly reconfirm the public health benefit of InSite) if it's released after the centre is forced to close.]

Dr. Wood said this amounts to "muzzling researchers." The University of British Columbia deemed that condition ethically unacceptable and so its researchers did not apply for the grants.

Now, Clement says that the government "cares about addicts and cares about those who would otherwise be twisted on to these very dangerous drugs", but I think Neil Boyd puts their ideological waffling on this issue in perspective:

The alternative is that they shoot up beside dumpsters. The alternative is that they cost us all more because there are higher rates of HIV, Hepatitis C, violence.

While it's true that InSite does not specifically combat drug addiction, it's not actually meant to do that; it does, however, provide a safe environment where people can inject drugs, so as to reduce disease transmission, overdoses, and, yes, even provide access to addiction services so that they might break the habit. As it stands, there is ample research that InSite is doing exactly that.

A Dream of Spring

Winter ended almost without notice. One week it was hovering near zero everyday, the ground was still snow-covered, and the sun had yet to warm the chilly winds that are omnipresent in Kitchener-Waterloo. The next week, well, the sun felt warm on my face, I could hear birds chirping, and the damnable Canada geese were more active than they've been in months. Spring has come at last.

Arguably, I should change the name of my blog accordingly, but it shall remain for the time being. In the meantime, I'm in the midst of exams (two down, one to go), and I have ample projects of various sorts to attend to as well. Sigh. This will also mark the first time that I've had a summer academic term: two courses + reseach + TA. I plan to do much of my work at home rather than in the office, so that I might benefit from (a) natural light, (b) fresh air from my window, (c) CBC Radio 2 while it remains (during the day at least) reasonably intact.

Yes, the bafflingly unresponsive and out-of-touch-with-their-listeners radio executives are planning to cut in half the current amount of classical programming on Radio 2, so that we might have more jazz and Joni Mitchell. This will entail, among other things, the cancellation of Disc Drive (a show which has for some two decades provided a mix of classical... and jazz, pop, and folk), along with the demise of Music and Company (what will I wake up to now??), Sound Advice, and the current incarnations of request show Here's To You and the ever intelligent Studio Sparks (which, also, frequently features jazz and other quality music). These changes follow up on the introduction of the syrupy mediocre pop jazz of Tonic from 6-8pm weekdays, the cancellation of the excellent jazz program After Hours, and the removal of In Performance in favour of the concert program Canada Live, the latter of which seems to feature largely torturous world music.

So, no, I'm not happy about these changes one bit. Nor are over 14,000 Facebook users. Oh, and the CBC Radio Orchestra is to be disbanded, with its current funding supposedly going to commissions.

Supposedly, those of us who are against these changes are elitists who cling to music which, though admittedly well-established, is simply old and, certainly, not altogether accessible for the great unwashed, who are assumed to be incapable of appreciating Sibelius and can't take anything more challenging than the best known Beethoven symphonies and Diana Krall. And Feist. Of course, I'm a good example of someone who was only exposed to many less "accessible" pieces via Radio 2, and the question must be asked whether the less "accessible" music which will now be downplayed is less "accessible" primarily because it's not played all that often.

I'll grant that much new "serious" music from the 20th Century and beyond has eschewed melody for abstract atonal structures and, of course, heaps of dissonance, but that doesn't explain why only "the most popular and accessible classical music, including Mozart, Beethoven and other favourites" should be emphasized. This would turn Radio 2 into nothing more than a commercial-free version of Classical 96, a station which plays little more than "classical pops" (and far, far too much Mendelssohn).

Supposedly, "the more challenging classical music — the new composers, etc. — will still be there on The Signal and on the Sunday afternoon program where we're playing pieces live with a lot of discussion". Now, I listen to The Signal, and 95% of it consists of new electroacoustic music and, for lack of a better way to put it, weird stuff. It's good. But it falls far short of exploring new concert music, much less new Canadian concert music. Indeed, will the new 10am-3pm classical show play anything by Christos Hatzis, whose music is arguably more immediate and accessible than any austere Handel symphony? Somehow I have my doubts - the new policy would evidently banish anything "challenging" or new to the abyss of the 10pm-1am slot or, worse, Sunday afternoon. It's bad enough that I can't listen to concert music (or decent jazz!) in the evening - now they'll take it away in the morning and afternoon as well.

Possibly the worst part of these changes (and the previous ones) is that most of the new shows play highly consistent styles and musical genres - Canada Live is particularly bad in this regard, as we may be treated either to an evening of traditional Persian music, Maritime folk, folk-rock/pop from Victoria, or Saint-Saëns. It really doesn't work. And neither will these new shows. With any luck, the highly grassroots movement against these changes will have some success - at the very least, when Radio 2 suffers another precipitous drop in listenership, the CBC big-wigs might have a change of heart. It's *possible* at least.