Spurious "research" and pseudo science in the combat against harm reduction policies

Förra veckan, i debatten om KRIS och deras hänvisning till en tveksam "forskningsrapport", nämnde jag den webbaserade tidskriften Journal of Global Drug Policy and Practise. För några år sedan skrev jag en debattartikel där jag berörde denna tidskrift, men tyvärr blev artikeln refuserad av Lancet Infectious Diseases. Eftersom artikeln anknyter en smula till KRIS-debatten tar jag tillfället i akt att publicera den här istället. Den som vill läsa mer om den sprutbytesöversikt som nämns i artikeln hänvisas till denna artikel, där jag diskuterar översikten mer i detalj.

In March 2008 Evan Wood, Julio S Montaner and Thomas Kerr published an article (1) in Lancet Infectious Diseases which disclosed an attempt by lobbyists to close down the carefully evaluated and effective safer injection facility (SIF) in Vancouver. The method used by the lobbyists was to disseminate misleading information in purportedly scientific form. A web-based journal, Journal of Global Drug Policy and Practice (JGDPP), published an article highly critical of SIF, which grossly misrepresented the research in this field. Through this article anti-harm-reduction activists nearly succeeded in persuading the Canadian government to ban such programs.

JGDPP claims to be a peer-reviewed medical journal, but as Wood et al. demonstrated it is in fact an organ of the Institute on Global Drug Policy (IGDP), which in turn is an arm of the strongly prohibitionist lobby group Drug Free America Foundation.

In his rejoinder (2) JGDPP’s editor-in-chief Eric A. Voth claimed that IGDP as an institute consisting of "physicians, attorneys, and other highly regarded international experts on drug policy". He goes on to say that the institute has "looked closely at the science and effect of [harm reduction] policies," and found that they did not stand up to closer scrutiny: "Much like the emperor’s new clothes, harm reduction policy has been blindly accepted rather than critically examined." In support of this sweeping generalization Voth quotes only one reference, a review article published in JGDPP which asserts that it clearly demonstrates "the questionable effect" of needle-exchange programs.’ (3)

However, the cited "review" must be scrutinized as it was written by three Swedish lobbyists, Kerstin Käll, Ulric Hermansson and Sten Rönnberg — and in fact there is quite a bit more to it than meets the eye.

In the spring of 2005, the Swedish parliament was considering legislation which would make permanent the (highly restrictive) needle-exchange program in Sweden, which had been run for years on a trial basis up to then. At that point all MPs received a pamphlet written by Käll, Hermansson and Rönnberg claiming that international research—in contrast to what had been the established view thus far—provided no support for needle-exchange. (4) What the MPs were not told was that the review upon which the pamphlet was based had been commissioned by four of Sweden’s most hard-line NGO’s in the drug policy field—among them The Swedish National Association for a Drug-free Society (Sweden’s equivalent to the Drug Free America Foundation).

This ought to have sent the alarm bells ringing in the Swedish parliament, but not so. Instead the "review" attracted widespread media attention, and contributed to one political party changing its stance on the issue.

Several months later five Swedish researchers were able to prove that the purported "review" of the research was fraudulent. (5) They demonstrated in detail that not only had Käll, Hermansson and Rönnberg employed questionable selection criteria, they had also misinterpreted and misrepresented data and doctored quotes. This resulted in Karolinska Institutet, where Hermansson was working at the time, referring the "review" to its Ethics Council.

Since the "review" had neither been published in a scientific journal nor in the name of Karolinska Institutet, the Ethics Council decided against instituting an inquiry of its own. The council did, however, issue a statement pointing out that "the articles forming the basis of the analysis do not constitute a systematic review of the literature, and therefore the review may mislead the reader. Consequently the review could harm the reputation of the Karolinska Institutet." (6)

The article published in JGDPP is an abridged version of that fraudulent "review". In conclusion, it is clear that harm reduction measures in drugs policies nowadays are being fought with spurious research results and references to pseudo science. Researchers as well as politicians should be made aware of this, and not allow themselves to be fooled by dishonest attempts at influencing future policy decisions.

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NOTES

(1) Wood E, Montaner JS Kerr T. Illicit drug addiction, infectious disease spread, and the need for an evidence-based response. Lancet Infect Dis 2008 vol. 8(3):142–43.

(2) Voth EA. Harm reduction drug policy. Lancet Infect Dis 2008 vol. 8 (9):528–29.

(3) Käll K, Hermansson U, Amundsen EJ, Rönnbäck K, Rönnberg S. The effectiveness of needle exchange programmes for HIV prevention: a critical review. Journal of Global Drug Policy and Practice 2007; vol. 1(3), http://www.globaldrugpolicy.org/1/3/1.php (accessed February 5, 2009).

(4) Käll K, Hermansson U, Rönnberg S, Bergvall B. Sprututbyte. En genomgång av den internationella forskningen och den svenska debatten. Stockholm: Fri förlag 2005 (in Swedish).

(5) Antoniusson EM, Kristiansen A, Laanemets L, Svensson B & Tops D. Sprutbytesfrågan. En granskning av en forskningsgenomgång om effekter av sprutbytesprogram. Lund: Socialhögskolan 2005 (in Swedish). http://www.soch.lu.se/images/Socialhogskolan/2005_1.pdf (in Swedish; accessed February 5, 2009).

(6) Karolinska institutet, Etikrådet. Angående fråga om vetenskaplig oredlighet. May 22, 2006 (in Swedish).