Author Topic: Safe Injection Sites in Ontario and the Idea of 'Evidence'  (Read 623 times)

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Offline MH

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Safe Injection Sites in Ontario and the Idea of 'Evidence'
« on: August 14, 2018, 07:04:33 am »
I believe and trust in officials who tell me that safe injection sites are a good idea.  But I'm one of the liberal elite.  In fact, my unthinking trust is what proves I am one of those people the populists mistrust so much.  As such, I don't trust my own subjectivity so I try to be media literate and look a little more closely at what is being said.

The Ontario government has now said they will be shutting down safe injection sites:

https://www.cbc.ca/news/canada/toronto/ontario-safe-injection-sites-limbo-1.4760002
Quote
"Health Minister Christine Elliott said Tuesday the government is reviewing evidence on the sites to see if they "have merit" and are worth continuing."

""We need to take a look at the evidence and understand what the experts are saying, so I want to hear that. The premier wants to hear that. He wants to know that continuing with the sites is going to be of benefit to the people of Ontario," she said."

""We're going to be looking at all of the sites, and we're going to be making a decision based on the evidence relating to the individual sites as well as the situation overall," she said."

"During the spring election campaign, Premier Doug Ford said he was opposed to safe injection and overdose prevention sites, though his party says Ford has since committed to reviewing evidence on the issue."

"There is overwhelming evidence from experts and from other jurisdictions around the world that supervised consumption sites save lives and help people dealing with addiction connect with other types of support when they are ready, he said."


FIVE mentions of evidence, but the CBC deigns to not give us the specific evidence being discussed because "the" public doesn't need to know that. (?)

How are we supposed to make decisions ourselves without the data ?  Can we blame the rise of populists when media refuses to educate ?

Let's check around some more:

https://globalnews.ca/news/4384804/ontario-overdose-prevention-sites/

Quote
"Elliott said she believes there is “contrary evidence” that suggests the sites are not as effective as believed."

"NDP Leader Andrea Horwath said the Tory government is ignoring evidence that suggests the sites save lives while it tries to please supporters.

“Look, it’s not an easy thing,” she said. “But to suggest that somehow the evidence isn’t there is wrong.”"

“We’re going to look and see what the best course of action is,” said James Hutt, an organizer with Overdose Prevention Ottawa. “We’re going to be … telling (the government) to listen to science and evidence and to not deny health service.”


Again five mentions of 'evidence'.  One slight improvement Global News has over the CBC is that they give general statistics on overdoses, ie. "Statistics Canada data shows that in the first six months of 2017, there were 1,460 opioid-related deaths in the country and that count is expected to rise as data becomes available."

City TV doesn't do much better, although I browsed it quickly: https://toronto.citynews.ca/2018/08/13/ontario-pauses-opening-three-overdose-prevention-sites-conducts-review/

Only The Star (!) puts something on paper we can look at objectively:

https://www.thestar.com/opinion/editorials/2018/08/13/fords-government-starts-its-misguided-moves-against-safe-injection-sites.html

Staff at The Works, a supervised injection site operated by Toronto Public Health, for example, have reversed 213 overdoses since it opened a year ago. And in just nine months staff at a temporary facility in Toronto’s Moss Park reversed more than 200.

Now, I know people are going to take this thread and talk about the content of the issue and that's fine.  But please, if you can, make a separate post about our shitty information ecology and how our political media have lapsed into idiocy.  It's almost like the journalists' biases make them think it's unnecessary to explain WHY safe injection sites are effective, because they themselves believe it.  It's a different take on liberal media bias but it seems apt to me.

Thoughts ?

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Offline TimG

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It's almost like the journalists' biases make them think it's unnecessary to explain WHY safe injection sites are effective, because they themselves believe it.  It's a different take on liberal media bias but it seems apt to me.
Good observation. The problem with scientific evidence is not all evidence is equal yet the media seems to treat it as the same. i.e. the evidence supporting the theory a gravity is much better than the evidence supporting the tobacco cancer link which, in turn, is much better than the evidence that says alcohol is good for you in small quantities. The hierarchy of evidence is exacerbated by the self selection problem in science: only scientists that choose to dedicate their careers to a topic choose to research it which makes it very unlikely that they will discover anything that renders their chosen field less important.

When it comes to injection sites I believe almost all of the studies are being done by people who wish to see the government spend money on harm reduction research which means they set up their studies in a way to make injections sites look as good as possible by emphasizing the positive while minimizing the negative. So it comes as no surprise that the "evidence" says they work. Whether they actually work or the evidence is a simply a reflection of the biases of the researchers is open question. A lot depends on who gets to set to criteria that are being used to judge if they are effective. For example, the only criteria I think are important are the number of addicts who get clean as a result of their interactions with professionals at these clinics. If addicts are not getting clean then the clinics are a failure that may be prolonging addictions by enabling addicts.

« Last Edit: August 14, 2018, 07:35:38 am by TimG »
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Offline cybercoma

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When it comes to injection sites I believe almost all of the studies are being done by people who wish to see the government spend money on harm reduction research which means they set up their studies in a way to make injections sites look as good as possible by emphasizing the positive while minimizing the negative.
This is total bullshit. You're claiming people are fabricating results without any evidence whatsoever of that happening.
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Online kimmy

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Quote
FIVE mentions of evidence,

Premier Dug wants to review the evidence before closing SIS's.  Christine Elliot says she's reviewing evidence. Andrea Horvath says the evidence shows they work.  Expert-guy from an advocacy group says there's overwhelming evidence they work.

The article is about whether the Ontario PCs close safe injection sites, not whether SIS's actually work.  Hence a bunch of politicians referring to evidence.  Some politicians say they are basing their decision on closing SIS's on what they find when they look at "the evidence".  Other politicians are claiming that "the evidence" shows closing SIS's would be a bad decision.  I think those politicians might have more success in making their case making a specific claim like "it's been proven that SIS's save lives" or "it's been proven that SIS's safe money in the long term."  Referring to "the evidence" to support your claim without actually saying what it is just sounds like an appeal to authority type argument... citing the view of unspecified "experts" is the kind of thing that rubs voters the wrong way.

Claiming that SIS's "work" is not a compelling argument if you don't even define what "working" actually means in this context.  Specific claims to demonstrate what good SIS's have been demonstrated to do in other communities would be helpful in convincing voters they are valuable.

"Working" in this context could have numerous meanings.  It could mean:
 -saving lives
 -saving money
 -getting people into treatment programs to get off drugs

Providing specific reasons why safe injection sites are good is a lot more persuasive than telling people that anonymous experts think they're good.  If you're inclined to think that SIS's are just a comfortable spot for deadbeats to get high, then maybe you're not inclined to care whether they "work" or not.  If you tell people specific things that will be achieved, they're more likely to support your position.

 -k
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Offline ?Impact

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Specific claims to demonstrate what good SIS's have been demonstrated to do in other communities would be helpful in convincing voters they are valuable.

Which has been done countless times in the past. It is the PCs that are claiming new evidence to the contrary and providing nothing. It is the PCs that are pretending to have authority because they know that authority sells, so they either have evidence or are a bunch of liars.

Offline cybercoma

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Who's responsible for digging deeper into it? You've got a 5 min segment on the news. Interviewees get 15-30 seconds at best to answer each question. If you want details on the effectiveness of safe injection sites, you need to take responsibility for your own edification and look up the studies and data. These sites have been talked about for ages and there is tons of information on them. Hell, Ontario didn't even set them up until they were proven effective in British Columbia and there's mountains of data from those sites. I'm sorry, but I have no patience for people who willingly remain ignorant and complain that they're not being spoon-fed information that's readily available.
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Offline cybercoma

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Which has been done countless times in the past. It is the PCs that are claiming new evidence to the contrary and providing nothing. It is the PCs that are pretending to have authority because they know that authority sells, so they either have evidence or are a bunch of liars.
They're liars. It's not either or. We have the data and have seen the results.

Online kimmy

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Which has been done countless times in the past. It is the PCs that are claiming new evidence to the contrary and providing nothing. It is the PCs that are pretending to have authority because they know that authority sells, so they either have evidence or are a bunch of liars.

It doesn't even matter.  If Horvath only has time for a 5 second sound bite, she should say "Safe injection sites save money and lives" instead of "the evidence shows safe injection sites work".

 -k
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Offline TimG

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This is total bullshit. You're claiming people are fabricating results without any evidence whatsoever of that happening.
Yawn. Yet another complete misrepresentation of what I said which you insist on doing because being dishonest is easier than acknowledging the limitations and biases inherent inherent in the research process that exists today.

A little hint: scientists are human and all humans are biased therefore all scientists are biased. Get over yourself and try to understand how the real world works.
« Last Edit: August 14, 2018, 09:39:20 am by TimG »
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Offline cybercoma

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Yawn. Yet another complete misrepresentation of what I said which you insist on doing because being dishonest is easier than acknowledging the limitations and biases inherent inherent in the research process that exists today.

A little hint: scientists are human and all humans are biased therefore all scientists are biased. Get over yourself and try to understand how the real world works.
Thanks for your utterly useless hint. Here's what you need to do. If you're going to suggest that studies are biased at best and imply that they're outright fabricated, then you need to provide evidence of such a thing happening. Otherwise, your claim is bullshit.

Your assumption is predicated on the notion that everyone is biased, so we can't really know anything. It calls on us to abandon all research and just rely on our own opinions and biases to draw conclusions.

Now if you have actual concrete evidence that supports your claim that all of the data and results on the effectiveness of SIS is garbage, then provide it. Otherwise, you're just spreading bullshit partisan propaganda with not a single shred of support.

Prove your claim.
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Offline TimG

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Your assumption is predicated on the notion that everyone is biased, so we can't really know anything. It calls on us to abandon all research and just rely on our own opinions and biases to draw conclusions.
Spare us the melodrama. All humans are biased and interpret evidence in ways that maximize the personal benefit and minimize the personal harm. This is self evident fact that should be obvious anyone paying attention. That does not mean that we 'can't know anything'. It means any discussion of "evidence" must also include a discussion of biases of the people collecting the evidence.

I also gave a concrete example of how bias affects SIS research. Specifically, if the SIS do not increase the rate at which addicts get off drugs then they are failure. Yet most of the headlines are about how "lives are saved" by preventing overdoses. If all they do is prolong addictions by reducing the incentive to clean up then SIS would be very bad for society even if a few lives are saved. Different researchers could come up with very different conclusions by simply choose with  "evidence" to emphasize. There is no need to fabricate any evidence.

The reality is you know this, however,  you simply assume that scientists saying things which you disagree with biased and those that you agree with are paragons of objectivity. It is hypocritical nonsense. Researchers telling you what you want to hear are just as biased and those saying things you don't want to hear.



« Last Edit: August 14, 2018, 10:39:01 am by TimG »
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Offline cybercoma

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I don't think you understand what constitutes evidence and proof for your claim. You are saying that the studies which show SIS are effective are based on the biased judgments of the researchers. You have not: 1) clearly demonstrated that bias, 2) after establishing bias shown that it affected research outcomes, nor 3) provided any evidence whatsoever to the contrary, namely that SIS are ineffective.

All you're doing is throwing around ad hominem attacks (results of the studies are biased because the researchers are biased; yet, you've provided no evidence demonstrating that) to try to discredit the preponderance of evidence that supports the effectiveness of SIS.

You want people to buy into the idea that everyone is biased, therefore all results must be biased. Suffice it to say, that's a ludicrous position and it's based entirely on partisan bullshit.

If you want to have an actual discussion, then you need to do what I outlined above. You need to first demonstrate bias. Then you need to prove that the bias resulted in an alternative outcome from what would be expected were there no bias. Finally, you need to produce evidence that the alternative outcome is valid, unbiased, and demonstrates that SIS are ineffective. You've done none of that and have instead asked people to accept your wild ass claims about "faulty" science without actually having any evidence whatsoever to support such stupidity. What you are offering isn't evidence nor reason, but rather mush-brained propaganda.
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Offline SirJohn

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Claiming that SIS's "work" is not a compelling argument if you don't even define what "working" actually means in this context.

It's even less compelling when we've seen ample evidence of bias in reporting, and when most of the data on safe injection sites comes from activists and supporters of safe injection sites. I believe they probably do have a positive impact, at least for that tiny minority of injection users who actually go there (and it IS a tiny minority), but I'd prefer seeing a completely independent study with its own data by people who had no feelings one way or the other to validate that.


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Offline Omni

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I don't think you understand what constitutes evidence and proof for your claim. You are saying that the studies which show SIS are effective are based on the biased judgments of the researchers. You have not: 1) clearly demonstrated that bias, 2) after establishing bias shown that it affected research outcomes, nor 3) provided any evidence whatsoever to the contrary, namely that SIS are ineffective.

All you're doing is throwing around ad hominem attacks (results of the studies are biased because the researchers are biased; yet, you've provided no evidence demonstrating that) to try to discredit the preponderance of evidence that supports the effectiveness of SIS.

You want people to buy into the idea that everyone is biased, therefore all results must be biased. Suffice it to say, that's a ludicrous position and it's based entirely on partisan bullshit.

If you want to have an actual discussion, then you need to do what I outlined above. You need to first demonstrate bias. Then you need to prove that the bias resulted in an alternative outcome from what would be expected were there no bias. Finally, you need to produce evidence that the alternative outcome is valid, unbiased, and demonstrates that SIS are ineffective. You've done none of that and have instead asked people to accept your wild ass claims about "faulty" science without actually having any evidence whatsoever to support such stupidity. What you are offering isn't evidence nor reason, but rather mush-brained propaganda.

Here is some evidence which doesn't seem terribly biased to me about the SIS effectiveness in Vancouver.
One thing it does point out is that 70% of users of that SIS live within half a km. I guess hard core drug users don't like to travel. Maybe they need more sites.


Best evidence from cohort and modeling studies suggests that SISs are associated with lower overdose mortality (88 fewer overdose deaths per 100 000 person-years [PYs]), 67% fewer ambulance calls for treating overdoses, and a decrease in HIV infections. Effects on hospitalizations are unknown.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/

Offline TimG

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All you're doing is throwing around ad hominem attacks (results of the studies are biased because the researchers are biased; yet, you've provided no evidence demonstrating that) to try to discredit the preponderance of evidence that supports the effectiveness of SIS.
You seem to be completely missing the point. I will repeat what I have said above: the bias comes from the criteria chosen to define "effective". i.e. just because you decide that that reducing the number of drug overdoes deaths means the SIS is "effective" that does not compel me to to agree that your criteria are reasonable. As I also stated above: to be effective the SIS would have to increase the rate at which addicts get clean and there is little evidence of that.

So there no onus on me to prove anything. I simply do not agree with the criteria that you want to use. The onus is on you to provide an argument for why your criteria are more appropriate that mine. i.e. please explain why keeping addicts alive but addicted is defined as success when what these addicts really need is to get off drugs. How many resources are been taken away from detox centers and recovery homes because governments are obsessing about enabling drug addictions by reducing the incentive to clean up?