A close look at Drug Free Australia’s recent attack on research supporting Vancouver’s Safe Injecting Facility, Insite, suggests a long planned attack on individual authors, not evidence.

Recently I wrote a piece on Drug Free Australia’s selective and misleading use of peer reviewed publications, government reports and pseudoscience to mislead readers with the claim of academic fraud and professional misconduct in the Lancet.

Their target was Insite, Vancouver’s Supervised Injecting Facility. Yet more specifically three authors of the Lancet piece, Evan Wood, Julio S G Montaner and Thomas Kerr have earned the retributive ire of Drug Free Australia’s parent body, Drug Free America Foundation. DFAF’s “division”, the Institute on Global Drug Policy fund the Journal of Global Drug Policy and Practice, which is not a journal but a vehicle for lobbying against progressive drug policy primarily that which targets HIV control. The JGDPP was initially funded by the US Department of Justice, presently under investigation for corruption.

One of the co-authors of the paper was Robert DuPont. Present DFAF board member, past White House Drug czar and former first director of NIDA, DuPont’s history is “impressive” but shamefully controversial. A champion of drug war tactics, the long debunked random drug testing of kids in schools and suppression of individual rights suggest he’d be better suited to the role of a cat-stroking super villain in a Bond movie.

The scale of human rights abuses and the litany of egregious conduct orchestrated by the ultra-conservatives drawn toward DFAF and the morally bankrupt satellite groups they inspire, is impressive indeed. DFAF was founded by Betty Sembler. Betty and husband Mel, both lacking any qualifications founded Straight Incorporated in 1976. Over 15 years this “coercive” rehabilitation programme, based upon the infamous and crime riddled Church of Synanon‘s approach, racked up hundreds of accounts of abuse of clients and their families. Synanon called it a day in 1989, by which time tax evasion, civil suits and attempted murder cases had eventually outshone their claims of Divine Detoxification.

Neither Drug Free America Foundation nor it’s pretend “Institute” on Global Drug Policy is a scientific organisation. The purpose of the IGDP is spelled out on the DFAF website:

The Institute is charged with creating and strengthening international laws that hold drug users and dealers criminally accountable for their actions. It will vigorously promote treaties and agreements that provide clear penalties to individuals who buy, sell or use harmful drugs. […] The institute supports efforts to oppose policies based on the concept of harm reduction.

Over recent years some rather spectacular junk science was produced by Dr. Colin Mangham, (then) president of the Drug Prevention Network of Canada. Whilst harm reduction initiatives save countless lives per year Mangham’s DPNC claims it “leads to terror, degradation and the eventual death of the addict”. Consequently Mangham writes accordingly and publishes in the discredited Journal of Global Drug Policy and Practice. In volume 1, issue 2; Summer 2007, Mangham wrote a critique of Insite’s “parent philosophy”.

In a stunning display of self sabotage he churned through 20 peer reviewed articles from journals including The New England Journal of Medicine, the Lancet and The British Medical Journal. All articles had published positively on Insite’s potential. Primarily Mangham used largely belief, irrelevance, moral outrage and assumption to mount his criticisms. The Royal Canadian Mounted Police (at that time opposed to Insite) had commissioned the review and later dismissed it themselves because it “did not meet conventional academic standards”.

It’s impossible to miss Mangham’s primary evaluation targets on his self-annointed meandering journey to Super Scientific Autonomy. Evan Wood, Julio S G Montaner and Thomas Kerr.

Conservative health minister, Tony Clement, desperate for even a hint of science to uphold the government’s case against Insite seized upon it as validation. In Canada’s National Review of Medicine, September 2007, Clement is quoted as saying to the Canadian Medical Association:

There has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite.

The article continued:

But extensive research has shown Insite is successful at reducing crime and overdoses, getting addicts into treatment and saving money.

Asked what research Mr Clement still needs to see in order to make his decision, Erik Waddell, a spokesman for Mr Clement, answers, “To see if Insite is getting people to programs to help them get off drugs.” However, the NEJM study, published June 9, 2006, concluded that Insite increased admissions into detoxification programs and addiction treatment.

The piece, written by Colin Mangham, PhD, argues that the studies carried out by researchers from the BC Centre for Excellence in HIV/AIDS and elsewhere have been flawed and misleading. Questions about the article’s trustworthiness have arisen. Dr Mangham is the president of the Drug Prevention Network of Canada, an organization run by former Conservative MP Randy White, and has previously written commentaries criticizing the philosophy of harm reduction….

Writing in Open Medicine on September 7th, 2007 Thomas Wood noted the unscientific nature and discredited status of Journal of Global Drug Policy and Practice. He further highlighted that the non scientific conservative lobby group Drug Free America Foundation and it’s ill disguised front shop (the so-called Institute on Global Drug Policy) were behind this ambitiously named “new research”. Wood calmly observed:

We stand by the published findings from the evaluation and believe that the limitations of the research are well described in these published reports. We agree with Colin Mangham, however, that there are many instances where media reports go beyond what is described in scientific studies. A colourful example of this is the large amount of media attention given to Mr. Mangham’s recent essay in the Journal of Global Drug Policy and Practice which was funded by the Royal Canadian Mounted Police.

As scientists, we are strongly in favour of scientific debate and academic critique, but we believe what is contained in Mr. Mangham’s essay falls well short of this. The paper is fraught with a host of outright factual inaccuracies and unsubstantiated claims, which we would be happy to list should the readers of Open Medicine wish. We strongly encourage the readers of Open Medicine to read Mr. Mangham’s essay alongside the various reports examining Insite’s impacts and to judge for themselves the state of the science in this area.

Yet Dr. Colin Mangham was beyond saving. None would come to his aid. From mountain top to valley floor, from deep blue sea to desert sand, from darkened ghetto to opulent penthouse from… okay, you get the idea – his demise was complete.

By September 30th, 2007 Wood, Montaner, Kerr and Mark Tyndall had submitted to The Global Journal on Drug Policy, an article questioning the conservative Canadian government’s treatment of the scientific process and evidence. The abstract includes [bold mine]:

Although the recommendations of scientific review bodies have traditionally been free of political interference in Canada, there have recently been growing concerns raised about Canada’s new federal government’s treatment of scientific processes and evidence. This concern is relevant to the scientific evaluation of Canada’s first medically supervised safer injecting facility… […]

This commentary describes what may be a serious breach of international scientific standards relating to the Canadian government’s handling of the SIF’s scientific evaluation, and the circumstances which eventually led to a moratorium on SIF trials in other Canadian cities.

The genesis of such striking criticism was the government’s observance of a single cancer in illicit drug policy. One that had metastasised into Colin Mangham’s Drug Prevention Network of Canada, DFAF’s unscientific Institute of Global Drug Policy and the dumping ground for all conspiracy pieces by those opposed to progressive HIV control and human rights observance, the Journal of Global Drug Policy and Practice. The Australian arm of DFAF is Drug Free Australia.

Added to this was a petition signed by over 130 physicians and scientists. Released the day after Clement’s speech noted above, it condemned the government’s “potentially deadly” misrepresentation of evidence for harm reduction programs. This misrepresentation encompassed “the overwhelmingly positive evidence” of Vancouver’s Insite safe-injection site.

In September 2008 The Lancet Infectious Diseases, published Illicit Drug Addiction, Infectious Disease Spread and the need for an evidence based response, by Wood, Montaner and Kerr. It included:

To our knowledge, this is the first time a lobby group such as the Drug Free America Foundation has created for itself a venue for the dissemination of opinion essays, which to the untrained eye could easily be mistaken for a scientific journal

There is no doubt that in just a couple of years, Montaner, Wood and Kerr continually exposed and dismantled a politically driven, pseudoscientific ideology and it’s masters simply by addressing the evidence at hand. One could be forgiven for thinking these chaps might be upsetting a certain group of fundamentalists.

By this time a suit had been filed with the BC Supreme Court arguing closure of Insite would violate the Charter right of Insite patrons regarding “security of the person.” As late as May 2011 the federal government was still claiming indecision of whether to keep Insite open or not. As this was in contrast to Clement’s previous statements everybody had heard enough from the government. On May 12th the Supreme Court reserved it’s decision on whether the government could close Insite or not. On September 29th, 2011 the Canadian Supreme Court ruled unanimously to uphold Insite’s exemption from the Controlled Drugs and Substances Act, allowing indefinite operation.

A win for human rights, humane disposition and indeed for evidence based public health.

Almost certainly planning revenge for months prior was a team under Drug Free Australia’s Secretary, Gary Christian. Consisting of three Aussies of biblical repute: Joe Santamaria, Stuart Reece and Gregory Pike. Also included was present DFAF board member yet past White House Drug czar and former first director of NIDA, Robert DuPont. Finally, none other than one disgraced PhD holder, Colin Mangham.

The Lancet report, Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study published in April 2011 was compelling evidence on reduced overdoses in a vicinity around Insite, and accepted by the Supreme Court. The problem for DFAF was that three of the five authors were Kerr, Montaner and Wood. The same three who had demolished so much of the amateur ideologists and DFAF’s non scientific lobby groups.

On September 13th hoping to besmirch the reputations of these men, the team struck. They released a collection of misleading claims cobbled together in a free range “analysis” enveloped in thunderously accusatory tone. It was designed to rebuke harm reduction in general and injecting facilities specifically. In this light it inexplicably republished many of Mangham’s already debunked criticisms as if new, misrepresented existing reputable studies by comparing unrelated data sets and publishing outright falsehoods.

If we dig up Clement referring to Mangham, from the National Review of Medicine September 2007, we can almost hear the echo:

There has been more research done, and some of it has been questioning of the research that has already taken place and questioning of the methodology of those associated with Insite

Fortunately history did not repeat. This re-choreographed material has been addressed more than once and found to be entirely baseless on each occasion. Despite the pollution of the material by Colin Mangham’s unprofessional accounts it becomes stranger when we note the “analysis” was conducted for Mangham’s Drug Prevention Network of Canada and REAL Women of Canada (the only supporting interveners for the government during the Supreme Court hearing).

Predictably published in the DFAF funded opinion rag Journal of Global Drug Policy and Practice, it’s accompanying media release included:

Three Australian doctors are part of an international team which has exposed major, inexcusable errors in a highly influential 2011 Lancet study on Vancouver’s Insite injecting facility, errors which nullify the study’s claim that it has demonstrably reduced overdoses in its immediate surrounding area.  The international team’s analysis has been sent by the Drug Prevention Network of Canada to the Ethics Committee of the agency which funded the Lancet study with questions regarding research fraud and professional misconduct.

The article was influential in the Canadian Supreme Court hearings of May 12 this year, where the court reserved its decision on whether the Canadian Government is rightfully able to close the facility.  The Canadian government has been trying to close Insite since 2006, but has been hampered by court action by harm reduction activists.

A full two more paragraphs are spent attacking the individual researchers for acting dishonestly, much of which relies on the already debunked material from Mangham 2007. Using bitterly crude figures to inflate “overdose” deaths – including suicides and homicides – they maintain the authors “knew” they were acting dishonestly. They challenge the findings by increasing the sample area by a factor of 10, and hold this against the original sample area.

Christian’s team selectively quote the Lancet authors earlier work on displacement of users from the area due to an increase in policing. This would be a splendid point were it not that “this policing initiative ended within weeks of Insite’s opening and was not ongoing throughout the study period”. This claim was also a resurrection of Mangham’s still unpublished and disgraced 2007 academic corpse. The vicious “media release” finished:

Drug Free Australia’s Research Coordinator, Gary Christian, said, “…. Inexplicable errors and memory lapses is the price the Canadian government has paid for entrusting injecting facility lobbyists with its scientific evaluation. Activists are never likely to provide objective science and there are dozens of other Insite studies that must now be under a cloud as a result.”

A complaint was lodged with the University of British Columbia by Mr. Christian. This and the JGDPP piece were independently reviewed and found to be “without merit”.

Yet so many questions arise as to why this apparently devastating material was not presented in court. When I first asked Mr. Christian on December 2nd he took a superior tone claiming that they could not because they did not have it available until September 2011. “It would have been a good point but for you not checking your facts”, he replied. Let’s review these facts I supposedly failed to check.

On June 8th, 2011, the (new) President for Colin Mangham’s Drug Prevention Network of Canada, Gwendolyn Landolt insisted that data supporting Insite is flawed. In an extraordinary claim (for June) she asserted in a letter to Canada’s National Post that OD’s had actually increased around Insite in most years since it had opened and thus, Thomas Kerr was in error for accusing DPNC as presenting misinformation (as he had earlier done):

Mr. Kerr tried to discredit a report from the B.C. government — which stated that since the site opened, the area has seen an increase in drug-induced deaths every year — by claiming that it included deaths unrelated to drug use

I say! That claim seems to be lifted straight from Christian’s September debacle. The one they didn’t have… until, er… September. And what do we read on page 2 of Christian’s piece about “a report from the B.C. government”, also mentioned above?

The claims of this article are very curious from the outset, simply because a review of the statistics by the British Columbia Coroner’s Service, found at clearly indicates the contrary – since Insite commenced operations on 21 September 2003 illicit drug deaths have very clearly and unmistakably increased, not decreased.

Okay, the same claim. So they had access to this data 2 1/2 years before the Supreme Court sitting in May 2011. Every other accusation – the impact of policing, the supply of drugs, criticisms from Mangham go back to 2007. Other papers and studies used are also well before 2011. That the president of the Drug Prevention Network of Canada is shooting off unpublished material in response to a May 30th statement by Kerr suggests they were keeping their powder dry.

I put this to Mr. Christian on the same day he dismissed my poor fact checking (December 2nd). He replied on December 10th as follows:

I have received an e-mail back from Gwen Landolt of Real Women of Canada explaining that Colin Mangham’s work was not admissable to the Supreme Court because it was not available for lower court hearing. The truth, Paul, is that there were court-imposed limitations on evidence which have nothing to do with your fanciful fabrications here.

Okay. So the material was available (despite his earlier claims it wasn’t), but could not be submitted due to “court-imposed limitations on evidence”. My “inability to check facts” had disappeared in a puff of reality, but was now replaced with my “fanciful fabrications”. Oh dear!

Of course before the Court in May, the government was armed with the figures mentioned, but had stated it had “no evidence” to submit. So, a day later on December 11th, 2011 I replied in part to Mr. Christian:

The time to strike was in the Supreme Court. Exactly why information from 2007 (Mangham) and 2008 (BC report on OD’s) was not admissible for lower court hearing in 2011 is a question best answered by your colleagues, Mangham and Landolt. If there is a genuine technical reason I would be grateful if you could provide it.

Otherwise it must remain possible, indeed probable, that it was excluded due to a.) the paucity of evidence presented by Mangham in attempting to debunk 20 peer reviewed studies from esteemed journals, and b.) that the BC report on OD’s was irrelevant as a variable effecting the efficacy of Insite and thus the SC sitting itself.

If so, this renders Landolt’s comments to the media and your own use of both sources impotent.

Failing this, you must explain… exactly why it was unavailable given 4 and 3 years respectively to craft an effective rebuttal of Insite’s success with these figures.

What were those “court imposed limitations” and why were they not mentioned in your article or your media release which explicitly referred to the [Supreme Court] decision as influenced by the Lancet article and “harm reduction activists”?

As one may expect those points have never been addressed. No-one is any more the wiser as to why this apparently cutting edge demolition of the court accepted Lancet article, was not itself either in total or in substance, presented to the Supreme Court. Are we to believe an ambiguous and unmentioned “court imposed limitation” prevented the exposing of “research fraud and professional misconduct” by five authors in one of the world’s most prestigious journals, the Lancet? That these supposed academic crimes were overlooked by the Supreme Court of Canada, as they examined the material in question itself?

Or shall we accept the demonstrable trend and tone exercised throughout the ideological attempts to sabotage Insite, is now manifestly clear as an attempt to smear researchers and their work? As the media release claimed, “dozens of other Insite studies that must now be under a cloud as a result”.

The anti-drug brigade may be cruel but they are not stupid. I point this out to Mr. Christian very clearly above, and still await a cogent reply. An academic mirage supposedly good enough to undermine the work of five authors. But not offered in objection to their work. What then was it’s purpose?

It was clear any such opinion from known offenders would have no bearing against over 30 papers in 15 peer reviewed journals. The singular attack upon Kerr, Wood and Montaner is striking. Christian has never answered my queries, preferring to accuse me of “imaginations and suppositions” without facts. Exactly why this argument was not published anywhere until after the Supreme Court hearing has never been made clear.

Why it was not raised by DPNC or REAL Women of Canada (both for whom the final “analysis” was supposedly written) in court is unknown. “No evidence”, was the official position.

Yet Gary Christian gives the game away himself. On November 30th, 2011 I had written in response to his refusal to accept his ploy was found to be “without merit”:

You write as if Montaner and Kerr are under scrutiny. You had your chance. It and the complaint have been found to be without foundation.

He replied on December 19th suggesting conflicts of interest assumed on his part override the independent analysis of his attack. He offered two mundane sources and extraordinarily suggests intentional favouritism on the part of the University of British Columbia and independent reviewer, Dr. Mark Wainberg toward the Lancet authors:

Of course our complaint to the University of British Columbia was not progressed because Dr Mark Wainberg absolved Dr Montaner, Dr Kerr and Dr Wood of any errors in their Lancet article, claiming that it was exemplary science.

However, if you look at the relationship between Wainberg and Montaner, I think that you will find that the relationship breaches the most liberal guidelines in the corporate or political world as to who is qualified to conduct an independent inquiry. […]

Now tell me that the University of Britush Columbia’s ‘Independent Advice’ was absolutely according to the common understanding of independence.

More accusations of corruption. More suggestion of conspiracies. More of the same junk.

What were these devastating pieces of insight? At a meeting of the International AIDS society, 2009 Julio Montaner congratulates, “my friend and colleague, the esteemed Dr Mark Wainberg” on getting the conference to Durban in his capacity as IAS president. The other is a humdrum op-ed piece written with Stephen Lewis on urging the Canadian government to ensure HIV/AIDS therapies remain central topics.

To this day Gary Christian remains unapologetic and impervious to volumes of criticism and questions generated by his single opinion piece. There has been no apology, no explanation nor any correction of demonstrable falsehoods.

Attacks on Evan Wood, Julio S G Montaner and Thomas Kerr however, continue apace.

The “drug free” ideology is as free from compassion and evidence as it ever was.