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How The Harper Government Wasted Millions And Alienated Academe In Its
Campaign To Shut Insite

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 Jurgen
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, Jurgen 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 naive," 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.