President of Australian Skeptics Victorian branch, Terry Kelly, chats to host of The Skeptic Zone podcast, Richard Saunders about this years National Convention.
You can listen by visiting the AuSkepCon chirbit page.
Download the MP3 here.
Or listen by clicking the pointy red triangle bit below:
In all cases, those infected were not fully immunised
– The Cambelltown measles outbreak –
Are antivaxxers “nutters” or “freaks”?
So disastrous has the denial of vaccination for vulnerable infants and children been, that such frustrated descriptions come up time and again. Parents who seek reputable information are left in no doubt that vaccine denial is ill informed and a mistake of significantly high risk.
As the consequences of the anti-vaccine movement more and more take the form of outbreaks of entirely preventable disease, a greater percentage of Aussies looks upon vaccine denialists with disgust. Regrettably the fierce combative stance of vaccine denialists is probably feeding the rising disdain across the community.
The measles outbreak which began in Cambelltown NSW in May led to this article in the Herald Sun on August 15th. Sydney Schools on Disease Alert:
The health scare involving 40 cases concentrated in the Campbelltown area comes as new medical research shows a record number of parents are refusing to immunise their children.
Ten of the reported cases in the South West Sydney Local Health District (SWSLHD) have put sufferers in hospital in the past two months.
The majority of those affected have been school-aged children and babies under 12 months old. The Department of Education confirmed four high schools and a number of primary schools had circulated letters of warning to parents.
In all cases, those infected were not fully immunised.
According to Australian Doctor 30,882 parents have objected to the immunisation of their children. 6,000 of the 2 million children on the Australian Childhood Immunisation Register have no vaccine history at all.
As I’ve noted before, enjoying a standard of health that allows the luxury to worry about improbable, irrelevant or indeed, imagined responses to vaccination is truly a marker of their success. In addition the drive and confience for individuals to take control and make decisions about their health is also a positive trend.
The problem, indeed the absolute sabotage of both these trends, are the wild conspiracies aimed at vaccination and the outrageous scams on offer for those who do explore management of health. Regrettably, hand in hand, these two factors have cultivated an anti-science mentality that carries the power of indoctrination.
Today, towering ignorance reigns for many when it comes to “health choices”. Thanks to an industry of stupidity, we are left with parents screeching and snarling for the right to harm their children and to treat them with snake oil. The results can be seen above.
On the same day the above piece was published Tracey Spicer filled in for one of the Murrays on 2UE’s The Two Murrays.
“That terrific group Stop The AVN…”. (Tracey Spicer)
Tracey and Murray spoke to Dr. Jason Cooke on the vexed issue of vaccine denial. Tracey mentions, “that terrific group Stop The AVN”. Here here!
Listen below or visit chirbit here.
Access the MP3 directly here.
On January 30th this year Radio National Breakfast aired a lively discussion between Professor John Dwyer, co-founder of the newly formed Friends of Science in Medicine and Professor Kerryn Phelps, President of the Australasian Integrative Medicine Association and prior AMA head.
As it so happened the AVN were delighted with the interview, discussing it on February 3rd. They immediately set to work sculpting an armour for Dr. Phelps to wear into battle for “Health Freedom”. The AVN had no doubt. If you support alternatives you would never vaccinate, their president reasoned.
In answer to an anti-medicine anecdote, Meryl Dorey commented at the time:
It just shows you [redacted], that people will pay for health but you can’t give them sickness for free no matter how hard you try. Doctors hate the competition. They know that people like yourself have left mainstream medicine because you have found something that works better. But that can’t be allowed so the scientocracy that we live in will try to control the situation so you no longer have the choice. This is what we are fighting against and it has to be all of us – healthcare consumers and healthcare organisations. If you use a natural health practitioner, get in touch with them and ask them to find out what their national organisations (CAA, ATMS, etc) is doing about this situation. It’s not the time to sit on their hands and hope it goes away. It’s time to fight!
MD
The day Dr. Phelps and Dwyer were on air Dorey published on healthcare choice, falsely accusing FSM of seeking to shut down alternatives to medicine and drive consumers into the prison of her imagined Scientocracy. I didn’t expect to revisit this article so shortly. Nonetheless… In what may be mistaken for a description of Mordor under the whip of Sauron she began:
There is an organisation in Australia which hates every natural therapy. They hate the healthcare practitioners and they hate the healthcare consumers who ‘turn their backs’ on Western medicine in favour of a range of other modalities which put no money in their pockets and take away their prestige. Worst of all, they hate anyone who chooses not to use vaccines! That is the ultimate heresy, as far as they are concerned.
But it’s OK – because they have a plan and they have the money and media backing, they think, to bring this plan to fruition. This group, the Australian Skeptics, has been instrumental in setting up the organisation, Stop the AVN.
Now, they are working on a new initiative – and this one is more ambitious then just stopping a small, parent-run community support group. Now, their goal is to stop anyone in Australia (today Australia – tomorrow the world as far as this bunch of ratbags is concerned) from learning about or using natural therapies. Their mad campaign is getting plenty of publicity too!
They have just set up a new front group called Friends of Science in Medicine (FSM) which is behind the new effort to outlaw the teaching of any natural medicine course in University. This organisation ultimately wants to shut down homeopathy, chiropractic, acupuncture, naturopathy, herbalism, ayurvedic therapies and on and on. In their unspeakable arrogance, they claim that there is no evidence for therapies which have been used safely and effectively, in many cases, for thousands of years. Instead, they say, we should all be forced to exclusively rely on mainstream medicine with its dreadful record of poor safety and effectiveness!
By February 17th, Dorey was using Kerryn Phelps as a proxy figurehead for this nonsense. As someone who uses the term “alternatives to medicine” and cringes at the “integrative” semantics, I don’t agree with Dr. Phelps on many non conventional medical issues. Yet Dr. Phelps’ Uclinic is unmistakably professional. Was Dorey serious or just ripping off Dr. Phelps’ image? Was a prior head of the AMA honestly backing Dorey’s new attack on FSM? On conventional medicine? On vaccination?
I tweeted, and seven minutes later received an honest, slightly baffled reply:
Oops. Rather tactless of me. But, as Meryl had written on February 8th:
Excellent observation. It continued to come true.
Predictably, Meryl Dorey had forged a fiction around Dr. Phelps’ role as President of the Australasian Integrative Medicine Association. It must have chafed somewhat to be reminded Dr. Phelps is a GP, supporter of vaccines, proponent of necessary vaccination rates and “diametrically opposed” to the activities of the AVN.
A close follower of the #StopAVN tag, this must have shattered Meryl’s very black and white world view of health care and practice. One is either against the evil of medicine or a skeptic and actively involved in a plot to enslave humanity to illness. At least that’s the battle cry we see in place of actual evidence to challenge evidence based medicine.
Could it possibly get any worse for Dorey? Dr. Phelps wouldn’t retweet anything from strident Dorey critic, that nasty Mia Freedman would she?
Oh.
Poor Meryl has to absorb someone with extensive experience could be a GP, proponent of non conventional medicine and conventional medicine, opposed utterly to the AVN whilst actively supporting and promoting vaccination. Still Dorey peddles homeoprophylaxis and is fanatical about the long dead association between autism and vaccination.
Last night Dr. Phelps happened to tweet in conversation:
@Havenr64 is convinced vaccines do cause autism and took umbrage to an article Dr. Phelps had written in Medical Observer ♣. Entitled It’s time we objected to conscientious objectors, it is a splendid article with excellent timing. Most importantly however is that Kerryn Phelps is a real doctor, with actual research and a life time of genuine experience backing her.
Health consumers who are cautious of conventional medicine or interested in “alternatives” would do far better to seek similarly well balanced advice. Those questioning vaccination, and not trusting their GP, would also benefit enormously from seeking advice through the Australasian Integrative Medicine Association.
The last person to trust is Meryl Dorey or her Australian Vaccination Network. Dorey profits from ensuring you will not trust vaccination. In truth your “health freedom” or choice is abused from the moment you make contact. If you believe the path to making sound choices on vaccination is to donate money to fund a “fight” between imagined forces, you have been conned handsomely.
Nicola Roxon and Jenny Macklin announced the Stronger Immunisation Incentives last November. It was a poor read of the antivaccination movement. Dorey seized immediately upon the option of conscientious objection not being promoted as the primary variable by the government. Claiming details weren’t present at all in Roxon’s announcement, they were actually prominent in the centre of the text. Still, today Dorey has exhaustively promoted how to receive the immunisation incentive without having children immunised.
Kerryn Phelps writes:
HOW far are you prepared to go to engage with so-called “conscientious objectors” to childhood immunisation?
Everyone has a line they will not cross. The line for informed consent gets very blurry when it comes to the proxy consent provided by parents on behalf of their children. […]
As GPs we are convinced of the merits of immunisation against the vaccine-preventable infectious diseases that were so feared by previous generations who did not have the benefit of effective treatments or prevention. […]
I hesitate to even mention groups such as the Australian (Anti-)Vaccination Network.., but… I feel I can mention the harm they are doing to public health with their misinformation campaign aimed at scaring parents away from immunisation.
Parents have been encouraged through various government incentives to have their children fully immunised before starting school.
However, from 1 July the system changes. The PIP incentive for doctors has been scrapped and parents will need to document that they have fully vaccinated their child in order to receive the Family Tax Benefit Part A Supplement of $726.35 per child. […]
If parents want to claim the money, they have to demonstrate that their child is fully immunised, or have their doctor complete documentation that they are a conscientious objector.
One of my colleagues told me last week that she intends to be a conscientious objector to conscientious objectors. I must say the idea appeals to me.
When parents request that she fills in the government form indicating the child is exempt on the basis of parents being conscientious objectors, she will politely indicate that is against her principles and advice, and will refuse to provide the documentation. […]
It is a convincing argument. Ethically doctors wish to support their patients’ choices. Yet with vaccination, rejection of this nature is not a choice, but a clear mistake. A cursory grasp of the manipulation at play to scare parents off vaccinating their children is alarming. An understanding of the entire abusive scam should be regarded with concern and disgust.
Presently parents are objecting because many feel there is this attack on their freedom of choice. A read of Dorey’s material finds the same theme over and again. Forces seek to control. Why is the default position vaccination? You are being told what to do. Health fascism. Loss of health choices… etc. It’s an appeal to emotion, not intellect. Vaccination is cast as a mockery of individuality, of democratic freedom.
Fortunately Dr. Phelps is a voice of reason at a time when false dichotomies are used to fool those who seek more natural choices, to also fear vaccination. A wedge has been driven into Meryl Dorey’s fictional scheme. No longer is it simply “us and them” as her members pay dearly to hear. False balance need no longer be the only choice.
This isn’t unique. Most natural therapy organisations recommend conventional vaccination. Chiropractic and homeopathy are two that mislead clients about vaccination. What we certainly lack is a public voice bridging the unnecessary gulf between vaccination and non conventional medicine. It is certainly time to detach the choice of alternative medicine from refusal to vaccinate.
I for one am very grateful to Dr. Phelps for making her views known.
– ♣ Subscription to Medical Observer is free.
The Global Commission on Drug Policy recently released yet another report condemning illicit drug prohibition and the War on Drugs.
Entitled The War on Drugs and HIV/AIDS – how the criminalisation of drug use fuels the global pandemic the report lists 6 key dynamics behind the trend.
1.) Fear of arrest drives persons who use drugs underground, away from HIV testing and HIV prevention services and into high risk environments. 2.) Restrictions on provision of sterile syringes to drug users result in increased syringe sharing. 3.) Prohibitions or restrictions on opioid substitution therapy or other evidence based treatment result in untreated addiction and avoidable HIV risk behaviour. 4.) Conditions and lack of HIV prevention measures in prison lead to HIV outbreaks in incarcerated drug users. 5.) Disruptions of HIV antiretroviral therapy result in elevated HIV viral load and subsequent HIV transmission and increased antiretroviral resistance. 6.) Limited public funds are wasted on harmful and ineffective drug law enforcement efforts instead of being invested in proven HIV prevention strategies.
Let’s forget “drug war” and call this problem what it is. Treating drug use as a criminal offence. Now, just by raising that image we’re into different waters entirely. Pointing to problems with the criminal model immediately evokes suspicion of compulsory promotion of illicit drug use. We’re conditioned to assume if we don’t punish drug use, it will be everywhere and bring about a host of nasty outcomes.
Mostly, we’re well conditioned to associate drug use with crime and to see it as criminal. Stitched on to this is the pop culture image from which we draw stereotypes. My favourite is one I often refer to as Quinn Martin. Quinn Martin Productions brought us Streets Of San Francisco and a host of other unrealistic 1970’s TV Cop shows. If you wanted a crime – it was drug related. A bad guy or a weak willed loser? Toss in a druggie.
Of course, I’m not suggesting we imagine this. The reality is criminals are made from associating in criminal circles and from being incarcerated, regardless of the reason. How this fits in with the drug-crime punishment model was addressed recently by eminent Australians who authored the Australia 21 Report. They state:
The prohibition of illicit drugs is killing and criminalising our children, and we are all letting it happen
Rather than legalisation alone, that report discussed regulation, decriminalisation and de-penalisation. Far from being an open slather free ride these measures involve control, certain losses of freedom, the need to demonstrate responsibility and a major focus on rehabilitation back to a productive and useful lifestyle. What they don’t involve is the destruction of lives and sustaining criminal enterprise at huge cost to the community.
Yet in Australia we do very well managing HIV/AIDS in injection drug users [IDU]. 16 million use IV drugs globally. Almost 20% live with HIV. Fortunately, Australia managed to keep that level at 3%, and a significant number of that sample were at higher risk statistically from acquiring HIV from another high risk behaviour. This level remained stable for decades.
So the question does arise. Apart from acknowledging shocking human rights abuses, tragedy in many nations and an ongoing source of disease and corruption, what policy aspects need we mull over?
Since the Howard years Tough On Drugs initiative and emergence of groups like Drug Free Australia lobbying against expanded protective measures, the level of HIV in IDU jumped to 4%. It remains an exquisite example of how just a few years of delayed and abandoned Harm Reduction responses, increased punishment and disinformation about Harm Reduction efficacy has an immediately devastating impact on HIV control in Aussie IDU.
The fact that this collective undermining of Harm Minimisation occurred during a period when Harm Reduction services, research and supporting evidence expanded rapidly in Australia is testimony to how effective disinformation and intuitively themed attacks on evidence can actually be.
Still, as of April this year we remain extremely fortunate thanks to Harm Reduction:
HIV in IV Drug Users matched to Harm Reduction
The single greatest sabotage of Harm Reduction initiatives under the auspices of John Howard, was the suppression of a heroin on prescription trial in 1997. This had strong bipartisan support and the Federal Health Minister, four States and the ACT were excited about the decision to go ahead. Under instructions from then ANCD head Major Brian Watters – later to become a Board member of Drug Free Australia – Howard immediately vetoed the decision.
Exactly how many HIV cases, ruined lives and deaths this led to is impossible to estimate, and I would err toward a minimal estimate. Still, 15 years later we can assume the body pile is now somewhat impressive. In what is unique insight into how Howard in turn manipulated the zealots who tried to manipulate him, he never flinched on needle exchange.
To his credit he continued to fund over a thousand outlets across Australia, with some specialising in bulk dispensing, others in hard core risk management. Abandoning these programmes was insanity, despite conservative lobbyists being convinced he might do so. Yet to Howard, being seen to usher in heroin prescription – “free heroin” – as shock jocks called it was political suicide.
Despite strong support for our official policy of Harm Minimisation, which accommodated extreme spending against smuggling (Supply Reduction), this is how he presented his thoughts in 1998:
The policy of zero tolerance of drug taking in this country is a wholly credible policy and policy that ought to be pursued more vigorously by government and by people who are concerned about the problem.
Of all the lies he told, this remains one of my favourites. There was no such policy beyond words. He seemed to despise everyone equally. Which was essential for the politician he became. All that mattered to Howard was Howard, and securing votes. Manipulating drug workers, users, science advisers, policy experts and voters over what was a social crisis at the time was pure business.
British Columbia did introduce heroin on prescription in 2005. 5 years later the effects of the combined measures on HIV were compelling:
British Columbia: HIV infection matched to Harm Reduction initiatives
Similar success from heroin on prescription is found in every nation to usher in trials and programmes. Sadly, Australia was ready before the Howard years. We were in fact, world leaders. Now it’s a different story. We have one Medically Supervised Injecting Facility that ran as a successful trial for 11 years.
Seven of those 11 years were due to disinformation and sabotage from conservatives. In October 2010 the Kenaelly NSW State government passed a Drug Misuse and Trafficking Amendment bill to ensure the Centre became permanent. 11 years of moral panic was, at least legislatively, silenced.
Whilst actually attacking Harm Reduction initiatives, confusing methadone and buprenorphine with illicit drugs and muddling the lot in with AFL drug policy, Alan Jones delighted us with his wisdom on “Harm Minimisation”, in mid 2007 [MP3 here]. Obnoxious, offensive and completely ignorant of facts it is also somewhat representative of Aussie views today:
So today Australia has a long, long way to go before we do, if ever, fully recover from the rise of anti-drug conservatives under John Howard. They did far more damage than just raise HIV infection by 1% in injection drug users. Our fluency with progressive policy and public maturity has been undermined. Australia waits, on pause.
33 million people live with HIV today. Outside sub-Sahran Africa IV drug use accounts for 1/3 of new infections. For almost 15 years annual HIV infections have been falling on a global scale. Except for seven countries wherein HIV infections increased by about 25% primarily due to IV drug use.
The “drug war” is full on in Eastern Europe and Central Asia and unsurprisingly 5 of these 7 countries are in these boundaries. In the last decade people living with HIV in these areas has close to tripled. Russia has resisted Harm Reduction measures keeping methadone illegal and charging users for needle possession. As this demographic is actively abused by law enforcers the motivation to use needles based on access convenience and minimal time is heightened. The results are clear:
HIV infections – Russian Federation
Thailand has impressively cut HIV infection in workers in the famous tourist attracting sex industry from 40% in the mid 1990’s to around 5% today. This pulled male clientele infection rates down in parallel. At the same time fierce drug war tactics led to 2,500 “death squad” murders in 2003 and HIV is up to 1 in 2 IDU in some regions. A comparison of different demographics for HIV infection is compelling:
THAILAND: HIV infections per demographic
In a splendid example of stupidity the USA reinstated it’s 21 year ban on federal funding for needle exchange programmes only 2 years after ending it. A stark lesson for Australia, constantly under the assault of disinformation from anti-drug group Drug Free Australia, can be found on page 9 of the GCDP Report.
Recently in reviewing the history of Harm Reduction and HIV, I noted the stark difference between not just nations, but regions within nations favouring HR as a powerful controller of HIV spread. Similarly today it can be seen that in nations with extreme law enforcement, and regions within the USA with the most intense law enforcement that HIV levels are higher than those with low law enforcement.
For instance, a study of the 96 largest US metropolitan areas found that measures of anti-drug “legal repressiveness” were associated with higher HIV prevalence among injectors and concluded: “This may be because fear of arrest and/or punishment leads drug injectors to avoid using syringe exchanges, or to inject hurriedly or to inject in shooting galleries or other multiperson injection settings to escape detection.”
DFA fallaciously – and skillfully – report the exact opposite. Similarly DFA urge for dedicated Harm Prevention measures, described already on this blog as crude behaviour modification. Whether through blind or biblical force the aim is to do just that: force drug users to stop by changing behaviour. Forget the addiction and crush the symptom.
The easiest way to do this is control the environment. Enter compulsory detention. What DFA have called “compassionate detention”. The models they are considering are terrifying. Not only is HIV infection spread through these centres, they fail to offer any addiction treatment. Forced abstinence is associated with high fatality relapse.
Once infected with HIV criminal and punitive approaches act as a disincentive to testing and treatment. Requirements to be drug-free in order to receive treatment (as in Sweden) and denial of certain rights like child custody and employment correlate directly to higher HIV/AIDS fatalities. Confidentiality breaches and stigma impact frequently due to law enforcement regardless of country.
This leads to higher circulation of HIV in the community as treatment has been shown to reduce HIV transmitted via blood and body fluids. As such it is vital all demographics in all communities can be reached through treatment which ultimately leads to prevention.
Incarceration also increases HIV infection and Australia is heading toward a USA type model which has 25% of prisoners listed as HIV positive. Fortunately our initial lower levels in the IDU population will protect us significantly from such a nightmare. Unusually, prison needle exchange is resisted strongly. DFA play the key lobby role nationally and prison guard unions seem intent to deny evidence in favour of their health.
Australian prison guards profit enormously from selling syringes to prisoners. Secondary to money is the control of prison dynamics, control of prisoner behaviour and the essential control of these transactions in corruption entire. A syringe is power in the prison setting. The sooner we remove this tool from guards and protect prisoner health with clean exchanges, the better.
Resources spent on law enforcement are resources not spent on health initiatives generally, on a global scale. With drug crime and infection encouraged by the former and lessened by the latter, it is clear we face a major global challenge. Public health is the first principle of drug control.
Settings where HIV prevention measures have been curtailed as a result of economic concerns have been particularly vulnerable to increases in HIV risk among injection drug users. For instance, a greater than 10-fold increase in newly diagnosed HIV infections among injecting drug users has recently been reported from Greece during the first seven months of 2011.
Australia remains incredibly lucky and indeed most fortunate in this global picture. What cannot be ignored and what must be cautioned against is our slow morphing into a landing pad for USA styled conservative disasters. DFA is an arm of Drug Free America Foundation and act at their bidding. DFAF have their “division”, the Institute on Global Drug Policy who fund the Journal of Global Drug Policy and Practice.
This is no journal but a vehicle for lobbying against progressive drug policy primarily that which targets HIV control. All get together and play at the Swedish based World Federation Against Drugs which similarly is nothing like a “world federation”. What they strive for is patently out of this world.
As today’s most brilliant minds accept the evidence condemning prohibition, the global Drug Free Whomever groups seek to defend the UN Drug Conventions that originated in 1961.
Fortunate we may be, but complacent we cannot afford to become.
In 1985 before the introduction of needle and syringe programmes (NSP) 90% of Australian injection drug users reported sharing injection equipment. By 1994 following introduction of NSPs this figure had fallen to 20%. In 2009 this figure was around 15% possibly reflecting the constant number of distributions from NSP programmes over the previous decade.
One of the most powerful modes of resistance to the spread of HIV/AIDS is Harm Reduction (HR) measures.
In Australia, HR exists as one of three pillars of Harm Minimisation (HM) – our official illicit drug control policy. The other two pillars are Supply Reduction and Demand Reduction. Reduction in supply receiving the lions share of funding directs energy at reducing international and domestic supply. Reduction in demand receiving less funding delivers programmes and initiatives designed to reduce the demand for drugs within communities.
Harm Reduction receiving the least funding from the HM pile targets the harm to individuals that eventuates from behaviour. HR has always drawn condemnation from conservative groups because of the association with drug use and sex. Initially men who have sex with men (MSM). Then later through maximal exploitation of drug using pop culture. Nonetheless, study after study comparing countries and districts within countries to have implemented HR or not done so, show a stunning success in favour of HR.
This post will look almost exclusively at IV drug use. HR for Injection Drug Users (IDU) includes provision of clean needles and sterile water, swabs, sharps containers for disposal and specialised filters capable of removing bacteria. Opioid Substitution Therapy (OST) including methadone and buprenorphine and safe injecting facilities are pivotal aspects of HR. Heroin on prescription is not available in Australia but has shown unprecedented success as a HR measure where it has been implemented.
Despite the evidence supporting HM as an effective policy and the reality that Supply Reduction [law enforcement] is the most highly funded pillar, Aussies are still subject to notions such as “Tough on drugs” and code words such as Drug Free Australia’s Harm Prevention. Intuitively it sounds fine. Why minimise harm if you can prevent it?
Yet on examination “harm prevention” is the abandonment of HM for the reintroduction of Just Say No approaches. Known to have had deleterious effects on self esteem, no effect on lowering drug use and providing the field upon which drug use flourished, Just Say No quite simply failed, and failed Epically. Today of course, skeptics are well aware of how beliefs and behaviours are reinforced through attacking them. Harm Prevention even more so is code for punitive, custodial and forced behaviour control.
It is at times perplexing as to why so much energy is spent on attacking HM entirely. Supply Reduction however is based in part upon the reality that people want, seek, use and enjoy illicit drugs. Education to accompany this is open and honest – not promotion of illicit drug use . Yet to the conservative mind the idea that their children, friends or the community at large is the demographic from which drug demand comes, is morally untenable.
With HR it is aspects of this pillar that equally cannot be accepted. To the conservative mind, just as condoms cause AIDS and promote sexual promiscuity so too do clean needles, safe injecting facilities and safe injecting education encourage drug use. Drug Free Australia write:
We need to re-focus our drug policy and practice on an approach that prioritises primary prevention, if we are to see any real change in the health and wellbeing of our current and future generations of young people. We need to acknowledge that Australia has one of the highest rates of drug use, because of a priority on Harm Minimisation rather than Harm Prevention, and we now need to take a leaf out of the books of the policy makers in the UK and United States. Both these countries have given greater emphasis to prevention initiatives, while still aiming to help people who are drug dependent, to recover.
The towering dishonesty inherent in this nonsense is typical of the tactics used by DFA in what has become over just a few years, one of the most immoral lobbying groups on the illicit drug landscape. Australia has high levels of cannabis use and abuse. This is handy in arguing that we have high drug use generally. A synopsis of the above is simply: Harm Minimisation has caused Australia to have one of the highest drug use levels in the world. We should be doing what America and the UK do.
The UK get a mention because they reclassified cannabis to a Class B (like speed/other amphetamines) from a Class C drug and punish users accordingly. Of 2.3 million USA prisoners in 2010, over 65% or 1.5 million meet DSM IV medical criteria for substance abuse or addiction. On top of this another 458,000 have a history that meets DSM IV criteria for addiction, were under the influence when they committed their crime, committed a crime to finance the purchase of drugs or were incarcerated for a drug law violation.
Between 1960 and 1990 official crime rates in Finland, the USA and Germany were similar. Incarceration in Finland dropped 60%, remained stable in Germany and quadrupled in the USA, driven primarily by drug convictions.
Today around around 80% of USA prisoners are incarcerated due to illicit drugs. 11% are receiving some type of “treatment”. The last thing Aussies need is a dose of the USA nightmare.
What of the impact of changing our strategy on HIV and consequently other types of blood borne virus transmission? The graph below is from a TED talk by Sereen El-Feki, vice-chair of the Global Commission on HIV and the law:
HIV infection in Injection Drug Users
Whilst Thailand and Russia have ignored Harm Reduction and Australia and Switzerland have embraced it the USA and Malaysia employed only some Harm Reduction techniques. Should Australia embrace USA tactics our prison population will explode, HIV infection in IV drug users will increase by about eight times the present rate and treatment – presently some of the best in the world with plunge to 11%. The cost to the public health purse would simply gut present programmes and destroy any hope of improvement for say, dental, mental health, public hospital care, nursing home care etc.
There is a 4 minute out-take from Sereen El-Feki’s TED talk in April this year below. Or download MP3 here.
The first case of AIDS was reported in Australia in 1983. At that time morbidity rates to rival World War II were expected. Following the innovative approach of HR, levels of infection in all demographics fell from 2,500 per year to 500 in the decade following inception of HR. This infection rate has remained stable.
At the time, initiation of clean needle supply contravened the states Drug Offensive which, already highly criticised, had regrettably escalated drug use and criminalisation via the failed “Just Say No” approach. The pilot programme ran from St. Vincents Drug and Alcohol Service on November 13 1986. It was run in the suburb of Darlinghurst. An evaluation recommended they should be adminstered by social workers, drug agencies, pharmacies, medical professionals and urged:
The urgent widespread introduction of needle exchange programmes in all states and territories
There needed to be an amendment to the Drug Misuse and Trafficking Act following which NSW pharmacies sold “anti-AIDS kits”. By mid 1989 there were 40 public outlets run across Sydney. By 1994 there were 250 outlets run by NGOs, government agencies and pharmacists distributing 3.5 million syringes annually. For the year 1993-1994 10.3 million syringes were distributed across Australia. The USA with 15 times the population of Australia distributed 8 million syringes in 1994-1995.
More comprehensive analyses refuted the concerns of increasing drug use. No increase in drug use was seen in any country that had instigated needle exchange and more so, attendance at rehabilitation and abstinence programmes had increased. Australia’s Commonwealth Department of Health (now Dept. of Health and Ageing) estimated that 25,000 cases of HIV were averted in the 12 years from 1988 – 2000 due to needle exchange alone (page 10 – 3.5.3).
The infection rate among Aussie IDU sat at around 3%. Users who were also MSM had an infection rate of 27%. In Russia where HR for drug users was denied, the figure for IDU was between 75 and 90%. One study in 1997 looked at 81 European cities with and without needle exchange programmes. Seroprevalence (measured from the presence of HIV within blood taken from used syringes) increased 5.9% annually in cities without clean needle distribution, and decreased 5.8% in cities with needle exchange.
In an astonishing comparison, Edinburgh with no NSP experienced a 65% HIV infection rate amongst IDU. Glasgow, less than an hours drive away and with NSP experienced a 4.5% increase in HIV infection amongst IDU. The one issue Australia faced was return of used syringes. Users were placing them in sharps bins. Yet to return any syringes to Exchanges meant risking being questioned by police. A used syringe is evidence of illicit drug use and this acted as a disincentive to return items for safe disposal.
Of note however is that fears and front page headlines of beach goers and joggers stepping on syringes and undergoing “agonising waits” for blood tests to be cleared of HIV infection are out of proportion. HIV dies very quickly once outside the body and syringes on beaches have been discarded into drains, washed out to sea and then beached. Nonetheless despite the absence of actual transmission it is an unpleasant experience which can be lessened by removing all offences for possession of a used syringe.
Clearly, Australia’s decision to take the necessary steps and bring together members of drug using demographics, gay rights advocates and prostitutes collectives and allow them to consult upon and shape this programme was one of it’s greatest public health initiatives ever.
Between 2000-2009 NSPs have averted 32,050 new cases of HIV and 96,666 Hepatitis C infections. Needles distributed increased from approximately 27 million to 31 million in that decade. For every one dollar invested, four dollars have been saved. 140,000 Disability Adjusted Life Years were gained over the same decade.
Still, conservative biblical fundamentalist group Drug Free Australia boldly inform us that Return On Investment is quite wrong and should show an expense. In earlier posts you can access from the tag on the right, I highlight how they cherry pick phrases and select data out of context. At other times they simply dismiss WHO findings based solely on the reviews of just one Swedish researcher, Dr Kerstin Käll.
So to be very clear, Dr Kerstin Käll, working for the Swedish government who are dodging UN demands to establish more Needle Exchanges and accelerate HR or remain in breach of the international right to health, conducted no research but criticised methodology that was favourable of NSP success. Her own research argues regular testing for HIV is more of a prevention – yes prevention – than clean needle supply.
It’s easy to get confused because whilst Käll supports NSP programmes as reducing hepatitis C in prisons DFA refute any change in HCV attributable to NSP programmes… anywhere. They also lobby stridently against the establishment of needle exchange in Australian prisons. Of course, despite the evidence above they insist the impact of NSP on HIV is “inconclusive”.
Ultimately it’s irrefutable how successful Harm Reduction has been in controlling the spread of blood borne viruses. Paramount amongst these is HIV, Hepatitis C and Hepatitis B. The most significant and visionary measure to now apply would include steps to decriminalisation and regulation.
Today however, this is where Australia is falling behind.
Losing In The Lucky Country 