Needle exchange programs and drug use
CMAJ 1998;158:170
See response from: M. Gold and associates
Reading and rereading the article "Needle exchange programs: an economic evaluation of a local experience" (CMAJ 1997;157[3]:255-62 [full text / résumé]), by Michelle Gold and associates, reduces my confidence in the quality of articles published in our beloved CMAJ.
I am incredulous that respected researchers would not only publish an article about the incidence of HIV and AIDS but also speculate about the number of cases they are preventing and the amount of money that they are saving without once mentioning the word "homosexual." Neither do they mention the number of homosexual intravenous drug users!
The article involves incredible speculation and a voluminous repetition of other people's experiences. The article's most telling statement — "It is clear that if more drug users than we first estimated used this service, then the program would prevent an even greater number of HIV cases" — clearly reveals the authors' bias. In fact, the more cases of HIV infection that are diagnosed, the more cases of HIV prevention you will believe have been achieved.
I am more impressed by the speculation in the second-last paragraph: "Research is under way to determine whether the program could be playing a causative role." I encourage much more research in that area, since the authors are obviously giving our population the message that intravenous drug use somehow has the approval of the medical community, along with government funding.
William D. Gutowski, MD
Psychiatrist
Chilliwack, BC
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