Addicts and homeless perceived as objects

Addicts and homeless perceived as objects

Not surprisingly, there isn't much help for them

Peter McKnight

Vancouver Sun

Saturday, November 22, 2008

Last summer, Stephen Hwang of the University of Toronto and St. Michael's Hospital wrote a commentary, endorsed by more than 130 other scientists and health professionals, which began by asking the reader to consider the following hypothetical scenario:

"An innovative new intervention for people with diabetes is developed. Health Canada provides funding to a highly accomplished group of academic health scientists, who have no financial conflicts of interest with respect to the new intervention, to conduct research on its effectiveness.

"Their work shows that the new intervention significantly reduces the incidence of a variety of diabetic complications. Despite a careful search for possible adverse effects of the intervention, none are detected. Over a three-year period, the group's research findings are published in leading medical journals, including the New England Journal of Medicine, The Lancet and BMJ [British Medical Journal].

"In response, the federal government calls the research inconclusive and states its position that the only acceptable therapies for diabetes are those that either prevent or completely cure this condition. Two national organizations state their opposition to the intervention because they fear that the availability of an intervention that reduces the risk of diabetic complications will cause people with diabetes to eat more food and become more obese.

"The government indicates that, unless additional research can address its concerns within a year, it will likely move to ban the new intervention. Meanwhile, institutions other than the one at which the research was initially conducted are forbidden to provide the intervention."

With developments over the last year, we can now update this scenario by adding the following: The government did move to ban the intervention, and decided to spend millions of dollars appealing a court decision that prevented it from doing so. And it continued its attacks on the intervention, and on physicians who provide it, despite recent evidence that it is not only effective, but cost-effective.

Hwang's thought experiment was, of course, intended to highlight the disconnect between the way the government addresses drug addiction and the way it treats other medical problems. For as Hwang says, the scenario "becomes true to life if one substitutes 'drug addiction' for 'diabetes,' 'drug-related harms' for 'diabetic complications,' and 'supervised injection facility for injection drug users' for 'new intervention.' "

This disconnect has led many people in the health care professions, including Hwang, to charge that the government's position is driven by ideology rather than evidence. But thanks to a commentary in the current issue of the Canadian Medical Association Journal, a much more disturbing hypothesis now presents itself. And as disturbing as it is, it is a hypothesis for which there is substantial evidence.

In commenting on a study in the CMAJ which suggested that Insite might lead to a cost savings of $14-20 million over a decade, New York researchers Don Des Jarlais, Kamyar Arasteh and Holly Hagan state that "humanity and the right to optimal health for all [should] be the framework for assessing the effectiveness of public health interventions."