Fixed

How the Harper government wasted millions and alienated academe in its campaign to shut Insite

January 2, 2009

By Paul Webster / Photo: Raymond Biesinger

Thomas Kerr reached the top of the politics-laced field of addiction research at an age when he was still undimmed by academic apathy. Square-jawed and rapid-talking, the 41-year-old UBC epidemiologist has something of a boxer’s poise. When he talks about his research into hard-drug use in Vancouver’s Downtown Eastside, his anger surfaces in flashes of acerbic wit and penetrating knowledge. Among academics and street people alike, Kerr is usually the smartest guy in the room-and, perhaps, the toughest. But he admits that what he encountered last May on Parliament Hill in Ottawa was more than he’d bargained for: “It was like an event that makes you question your faith in God,” Kerr recalled over a burger and a beer at a Vancouver restaurant six months later. “It was absolutely, without a doubt, the lowest point in my career.”

Invited to talk to federal politicians last spring, Kerr jumped at the chance. He’d been to Ottawa a few months earlier to accept one of the country’s highest medical-science awards. Now he was being invited back for a rare chance to speak with lawmakers. “Federal taxpayers paid millions for our research into drug treatment,” Kerr reasoned. “So it made perfect sense MPs should know the results.”

Over the past decade, Kerr-who does most of the talking for a small team of scientists within UBC’s Centre for Excellence in HIV/AIDS-has co-authored hundreds of studies praised by AIDS researchers around the globe. Those studies not only made his scientific name, they helped propel the centre’s leader, Julio Montaner, to the presidency of the world’s leading AIDS research organization, the International AIDS Society. As the UBC team gained global fame, Kerr and Montaner began urging Ottawa to overhaul the way it looks at drug control. Those calls helped win federal support in 2003 for Insite, North America’s first government-approved and -financed supervised-injection facility. Since then, the UBC team has carefully studied its impacts on addicts. “I headed for Ottawa,” said Kerr, “thinking federal politicians wanted to know what we’ve learned.”

The House of Commons’ main committee room is normally a sedate place. But the meeting Kerr attended in late May quickly turned turbulent. Various Downtown Eastside experts besides Kerr were present, but Vancouver addictions doctor Donald Hedges sent his regrets. Lawyers had advised Hedges-who as a member of the Vancouver-based Drug Prevention Network of Canada lobbies for tougher drug-law enforcement-to avoid Ottawa due to “concerns for his physical health and safety,” explained Manitoba MP Joy Smith. “It troubles me gravely today to tell you,” Smith told the startled room full of politicians and scientists, “our democratic process has been subverted by physical intimidation and threats of violence.”

It was a rocky start for what was supposed to be a sober, science-based session with MPs. But for Kerr-who presented evidence confirming Insite prevents overdose deaths, reduces HIV risk, and boosts addiction treatment programs-it got worse when Health Minister Tony Clement took the microphone. Starting with a pointed attack on scientists who cross “the line between scientific views and advocacy,” the minister denounced Insite as an abject failure. According to work by scientists retained by the Tories to review Kerr’s work, said Clement, “researchers still aren’t sure if Insite makes any difference at all” or whether its benefits outweigh its costs. Nor was there evidence that Insite “influences overall death rates.” At most, said Clement, “Insite saves about one life per year.”

As for the work of Kerr and his UBC colleagues? “There are many different ways to look at the science,” Clement suggested, “and there are many different ways to look at the advocacy surrounding the science.” To Kerr, the health minister’s attack on the UBC team’s professionalism was tough. But the unkindest cut of all? Almost all the evidence used to discredit the UBC team had been produced by fellow members of Vancouver’s tight-knit research community-scholars from Simon Fraser University. In Vancouver’s clubby academic world, relations among scholars are unfailingly collegial, not cutthroat. The minister’s tactic cut deeply. “I don’t normally drink on airplanes,” Kerr recalled, “but, believe me, I needed one on the flight back to Vancouver.”

The days leading up to Clement’s attack hadn’t been easy for the health minister. Three days earlier, the Supreme Court of B.C. had ruled that Vancouver’s estimated 12,000 addicts are entitled to use Insite as a humane, medical response to the epidemic of drugs, disease, and death that has given Vancouver a global reputation. The ruling suggested that expensive government legal efforts to shut down Insite-which operates in licensed violation of drug laws-were unreasonable. It was a triumph for Insite, and for the UBC scientists who helped persuade the court to keep it on life support for another year. But for Clement, the ruling spoiled two years of sustained efforts to use science itself to shut down one of the most outstanding scientific initiatives in Vancouver’s history.

Few institutions nourished by federal Liberals have more fully felt the wrath of Stephen Harper’s tough-on-crime Conservatives than Insite. Since winning power in 2006, the Tories have tackled Insite in court, in Parliament, in the press, in mass publicity campaigns, and on the international stage. Last summer, in a tirade immortalized on YouTube, Clement denounced Insite as an “abomination.” Some of the attacks were staged by the RCMP, which quietly funded research at SFU used by the government to refute the UBC studies, and some by a United Nations agency invited by Clement to attack Insite. But the brunt of the Tories’ battle was waged through a complicated Health Canada campaign aimed at checkmating UBC’s renowned HIV/AIDS team.

Clement was barely settled in office as health minister when he made his first move. He terminated funding for the UBC team, which had been approved for another three-and-a-half years. Kerr and Montaner reapplied to Health Canada and found funding from the Canadian Institutes of Health Research, at arms’ length from Health Canada and beyond the control of the ministry, Kerr noted. Clement revamped his attack. Officials at Health Canada were ordered to assemble a parallel team of Canadian experts to review the UBC work. Money was found for a separate scientific assessment of the facility-all under contractual terms that gave the government unprecedented control over the findings.

As more than a few scientists observed, the government’s decision to commission a team of researchers to duplicate, in months, the very research Kerr’s team at UBC was already being paid millions of federal dollars to conduct over a five-year span seemed wasteful, if not duplicitous. Many scientists reacted with suspicion, says Margaret Millson, a University of Toronto researcher and one of a small number of Canadian scientists outside the UBC team with experience researching the health impacts of supervised-injection facilities. In a letter to Health Canada, she and other experts declined to participate in the government’s new study. They questioned the government’s insistence on controlling the results. And why, they asked, was Health Canada in such a hurry? “We see no possibility whatsoever,” they wrote, “that any data or information which does not yet exist in some fashion can be collected in such a time frame.”

Other scientists contacted by the government were equally puzzled. “The request from Health Canada had unacceptable constraints attached and was inconsistent with Canadian academic research standards,” says Ahmed Bayoumi, a University of Toronto specialist on supervised-injection sites who objected to the government’s insistence on controlling public release of the results. “I’d looked through dozens of requests for scientific research of this sort over the last decade, and I’d never seen anything like it.”

Kerr and Montaner were also wary of Health Canada’s approach to controlling the results. But having already spent years studying Insite at great public expense, they offered their expertise. “We approached it in good faith, thinking they would in the end agree to normal contracts,” Kerr explains. Warned by UBC lawyers that the Health Canada contract did not meet the university’s standards, Kerr requested that the contract be altered to permit normal scientific freedom. “At that point, the government shut us out of the competition,” says Kerr. “They never wrote back.”

***

On an afternoon shortly after term got under way at Simon Fraser University last autumn, with footfalls and chitchat echoing along the corridors of the country’s largest criminology department, professor Neil Boyd, a frequently quoted specialist on drug laws, was watching the clock with a view to making the Bowen Island ferry to be home for dinner. He’d set aside a full hour to talk about the two studies Health Canada recruited him to do on Insite. But as he recounted the experience, he realized the discussion was going to take longer. “I’ll catch a later ferry,” he volunteered with a smile as dazzling as his crisp white shirt.

“The history of the contracts was odd,” Boyd recalled. The federal government, he said, failed to find half the researchers it said it needed. After months of dithering before commissioning the SFU study, it demanded results in a headlong rush. “In the end,” said Boyd, “there just wasn’t enough time to do it.”

Working with SFU colleagues Martin Andresen and Bryan Kinney, Boyd undertook a $60,000 study of public order and a second, for $15,000, assessing whether Insite was a cost-effective way for the public health system to tackle overdose deaths, hospital admissions, and the spread of HIV and other diseases among the Downtown Eastside’s 5,000 or more injection-drug users.

By this time, studies of Insite had become a preoccupation for SFU’s criminology faculty. Two other professors, Ray Corrado and Garth Davies, had also been hired-with RCMP funding-to write about Insite. Although Corrado reached a positive conclusion about the facility, Davies charged that the studies of supervised-injection facilities done at UBC and elsewhere were “compromised by an array of deficiencies”-words Tony Clement later quoted verbatim in his attack on the UBC work.

From the start, Boyd and Andresen had trouble finding information. Ambulance records proved impossible to obtain. Nor were hospital records easily accessible-partly, said Boyd, because the government’s politicized approach to Insite was now viewed with suspicion by Vancouver Coastal Health, which operates Insite. The SFU researchers asked Kerr and Montaner for access to their enormous data holdings but were rebuffed. So lack of time wasn’t the only problem bedevilling their research, said Boyd: “We also didn’t have the data to do it properly.”

Constrained by these barriers, Boyd and Andresen assessed Insite using mathematical models and numbers derived mainly from other researchers’ work in vastly different contexts. And to forestall being attacked for using figures possibly biased in Insite’s favour-a worry Boyd said was influenced by his awareness that “the Harper government is not predisposed towards Insite”-the SFU researchers chose conservative figures to estimate Insite’s impacts. “I didn’t want to give them room to move,” Boyd said of his efforts to hedge against government spin. “To lie. To misrepresent the general thrust of the research.”

In the end, Boyd and Andresen concluded that Insite was preventing about one overdose death per year and one AIDS death. That was enough, they reasoned, to justify the cost of the facility’s operation. In reports submitted to the government last February, the SFU researchers called Insite “one of many beneficial approaches” to drug addiction-faint praise, which was ultimately used to damn the facility. The reports were forwarded to a committee of independent experts hired to study Insite by Health Minister Clement.

***

As holder of the RCMP Research Chair in Crime Reduction at the University of the Fraser Valley, Darryl Plecas routinely fields calls from national media. So when the federal Tories promised to toughen sanctions against teen offenders during last autumn’s election campaign, Plecas was asked to stop by CTV’s Granville Street studio to tape an interview. On his way, he sat down over coffee at the Hotel Vancouver to recollect his stint as one of Tony Clement’s independent expert advisers on Insite.

Plecas has long been outspoken on policing in Vancouver. As well as teaching at UFV, he’s lectured at police colleges and is on the board of the Canadian Centre on Substance Abuse. Sporting the mustache and pressed-and-polished attire of a man accustomed to police circles, Plecas holds unconventional views on drug control-some deeply conservative, others radical. In criminology, he explained, contradictions come with the terrain.

Although Plecas believes heroin should be provided to addicts as a prescription drug to cut crime, he thinks a good place to treat addicts is in federal prisons, where the government pays for some treatments. He’s of two minds regarding Insite. Supervised-injection rooms may represent “the best way to reach out to addicts and get them into treatment,” but he also thinks that Insite facilitates illicit drug use. “This is something that deserves further study.” And while he’s puzzled that the Tories have attacked Insite in the face of opinion polls backing the facility, he understands the position of a government that spends five dollars enforcing drug laws for every dollar it spends on treatment. “I’m not sure I would have a different position in light of the legal implications,” Plecas explained. “If I was the minister, I would have a huge worry about what this is going to cost Canadians. If we start pouring the kind of money into drug treatment that we need to-we don’t have deep enough pockets. There are 10,000 addicts in Vancouver. Who’s got the money?”

Plecas’s report on Insite was released just in time for government lawyers to use it in efforts last spring to have the B.C. Supreme Court outlaw the facility. Despite the massive body of UBC research validating Insite, Plecas and other advisers to Clement concluded that little was known. Not even Boyd and Andresen’s cautious suggestion that the facility was working could be trusted, they said. The overall thrust, says Jürgen Rehm, an addictions specialist at the University of Toronto-affiliated Centre for Addictions and Mental Health who worked with Plecas on the review, was that Boyd and Andresen’s assumptions, though ultra-cautious, “were a little bit too optimistic.” Insite might be working to a limited degree, they concluded, but-despite the reams of evidence from UBC’s extensive investigation-there was really no way of knowing for sure.

For government lawyers charged with shutting down Insite, this review seemed made-to-order. Despite the UBC team’s solid science unequivocally supporting Insite, the government’s lead lawyer, John Hunter, relied on the alternative research: “This is the research that is hot off the press,” Hunter told Justice Ian Pitfield. “There is no direct evidence that [Insite] influenced overdose rates.” The expert report “dampens” the UBC team’s findings to the point, Hunter argued, that there really “isn’t any direct evidence” that Insite works.

At the Hotel Vancouver, Darryl Plecas said he was surprised to learn that government lawyers had used his work to try to kill Insite. “That’s not a fair reading of our report,” Plecas said. “He’s taking our comment about inconclusiveness as evidence.” In Toronto, his co-author, Jürgen Rehm, was equally astonished. “Our report was misused by the government. The discussion went astray.” In Rehm’s view, the way different actors picked out lines from the report to support their opinions, without looking at its overall conclusions, calls into question whether scientists should undertake contracts for the current government. He found it so upsetting that he’s launching a new study. This one, he said, will focus on the role of government in independent research.

***

On a sunny autumn morning, five years after the federal Liberals approved Insite and pledged millions of federal tax dollars for UBC’s studies, Thomas Kerr, Julio Montaner, and Neil Boyd sat elbow-to-elbow in front of a bank of reporters and cameras in the main injecting room at Insite. The mirrored cubicles used by addicts were postered over by blown-up photographs of children’s faces with the slogan “Before They Were ‘Junkies’ They Were Kids”-a riposte to Conservative election flyers asserting that “junkies” don’t belong “near families and kids.”

To reporters, Boyd stressed the message Kerr and Montaner had hammered home before him-that Insite works for public health, public safety, and human rights, and that the government’s attacks had deliberately mangled millions of dollars’ worth of publicly financed science. “We have a government today in Ottawa that is driven by dogma,” Boyd said. “For the Conservatives to put the spin they did on that report is mind-boggling.”

Since completing their rushed studies for Health Canada, Boyd and Andresen have suffered a series of indignities. After the government rejected the SFU criminologists’ core assumptions, it used their findings to mount a political attack on the work of their colleagues at UBC, a highly embarrassing skirmish in Vancouver’s science community. And shortly after their studies were released, Boyd and Andresen became aware of new data revealing that they had dramatically underestimated Insite’s cost benefits. Health Canada had thus published inaccurate information about Insite (which, to date, remains uncorrected on government websites).

New studies published in leading science journals by the UBC team and a second, Toronto-based team confirm that Insite’s contribution to death prevention and cost savings is many times greater than the minimal impact Boyd and Andresen reported. Meanwhile, the SFU pair saw their efforts to publish their study rebuffed by leading science journals in Canada and the U.S. Both SFU researchers feel badly bruised. In part, Boyd criticizes Plecas, Rehm, and the other expert authors of the alternative report for failing to see the larger context. “They were politically naïve,” he said. “Their scientific caution was used against them. If I was Montaner or Kerr,” he added, “I’d be pretty upset with the Harper government.”

As for Tony Clement? In October he was shifted from the health portfolio-the government’s highest-profile science-based department, with a budget of $3.8 billion-to Industry, a ministry with a budget about a quarter of Health’s, little public profile, and no known platforms for antiscientific cant

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