A Sad Day

My favourite Radio 2 program had its last show today. After 23 years of mellow afternoons with Jurgen Goethe, DiscDrive ended today. It was a good show, with excerpts from past ones, but I was definitely more than a bit sad to hear the "Fanfarinette" theme for the last time on air. The CD is available here; I just ordered it.

As for DiscDrive's replacement, well, I'm not all that enthusiastic:

Radio 2 Drive, hosted by Rich Terfry. Airing weekdays from 3 p.m. to 6 p.m., Radio 2 Drive, is hosted by innovative Canadian funk/hip hop artist and passionate music fan Rich Terfry (he performs as Buck 65). The country’s premier destination for new music and emerging Canadian talent, Radio 2 Drive boasts 75 per cent Canadian content from a range of contemporary musical genres with a focus on singer-songwriters. From time to time, Rich will be joined in-studio by artists for interviews and live performances.

Given that I pretty much hate or am at best indifferent toward "funk/hip hop", I can't say this description appeals to me. A focus on singer-songwriters? Like who? I guess we'll see soon enough.

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.