Wikipedia:Requests for mediation/Needle exchange programme

Needle exchange programme

 * Editors involved in this dispute
 * 1) – filing party


 * Articles affected by this dispute


 * Other attempts at resolving this dispute that you have attempted
 * Talk%3ANeedle-exchange_programme

Issues to be mediated
Failure of informal mediation process where the involved editor/mediator found issues of content too intertwined with behaviour issues to proceed, but I, as a single user, cannot initiate a RfC/U on these claims against me where I believe the claims have been raised only for the purpose of obscuring the content issue.
 * Primary issues (added by the filing party)

Summary of dispute by Stigmatella aurantiaca
User:Minphie posts exclusively in opposition to Harm Reduction.

Regarding the current dispute on Needle Exchange Programs, Minphie has selectively quoted, on multiple occasions and out of context, single words and sentence fragments from Chapter 3 of a 2006 US Institute of Medicine study, stating that "the evidence for the effectiveness of NSPs in preventing HIV was 'inconclusive' and that 'multiple studies show that NSEs do not reduce transmission of HCV(Hepatitis C).' "

Through such selective quote mining, Minphie makes it seem that the report concludes that NSPs are valueless in the fight against blood-borne disease. In reality, the authors carefully note that the inconclusiveness of available studies is due to unavoidable deficiencies of the study designs. It is practically and ethically impossible to conduct randomized controlled trials, and researchers must rely on study designs of far lower statistical power, such as cohort studies and ecological studies.

The following is a revised version of an alternative chapter summary that I offered, which Minphie rejected:
 * The available evidence shows that multi-component HIV prevention programs that include needle and syringe exchange have clear beneficial effects in reducing drug-related risk behaviors, although the statistical power of the available studies (mostly cohort studies) have been inadequate to actually prove that NSPs reduce HIV incidence rates. Multiple ecological studies show a positive correlation between implementation or expansion of NSP programs and a reduction in HIV prevalence, although it should be noted that correlation does not prove a cause-effect relationship. The statistical power of cohort studies have been inadequate to prove that NSPs reduce rates of HCV transmission and acquisition, although a single case-control study reported a dramatic reduction. Not enough studies have been performed examining the possibility of NSPs having undesired unintended consequences; the few existing studies on this point do not point to NSPs having unintended negative effects. Overall, although many of the studies have design limitations, the consistency of these results across a large number of studies supports the conclusion that NSPs have an important beneficial role in the fight against HIV and HCV. Stigmatella aurantiaca (talk) 02:25, 11 September 2013 (UTC)

Summary of dispute by Minphie
It was User:Gabbe that first placed the science on the effectiveness of NEPs front and centre of the Wikipedia Needle Exchange Programme article, a prominence given to the science that I believe is aligned with the need for evidence-based drug policy internationally.

User:Stigmatella aurantiaca has alleged on the Talk page, and backed this by constant deletions of my text, that I misrepresent, in the relevant Wikipedia article, the most authoritative review on needle exchange effectiveness completed in 2006 by the US Academies of Science's Institute of Medicine (which had backed NEPs since the 1990s before the current science was in). To this charge I assert that: In summary, I have not misrepresented the US IOM report but rather given a verbatim rendition of its conclusions on the science. Stigmatella's interpretation leads to a more optimistic rendition of the science than is actually the case which will only open Wikipedia to the charge of being a source of biased rather than neutral or balanced information for the public. Minphie (talk) 13:10, 13 September 2013 (UTC)
 * 1) Stigmatella's suggested replacement wording could not possibly be acceptable because it implies, inadvertently or otherwise, that the 11 journal studies rigorous enough to meet the US IOM criteria for review are individually not statistically significant or somehow individually lack 'statistical power'. This is certainly not the case. The discredited 2004 WHO review which had concluded that the science did indeed demonstrate NEP effectiveness re HIV incidence found 3 studies which were negative for NEP effectiveness, all of which were statistically significant. The 2004 WHO review found 6 studies which they said demonstrated NEP effectiveness, however three were discarded by the IOM - one did not even study comparison populations, and the other two were inconclusive on their researchers' own admissions in-article. Two of the remaining 3 WHO positives were (statistically significant) ecological studies, which the IOM clearly says are unable to demonstrate any causality. But this is a far cry from lack of statistical power or lack of statistical significance for individual studies - it is rather that the studies positive for NEP are balanced equally against studies which are negative making any conclusion other than that the science is inconclusive inevitable. Questions on the validity of case-control studies vs RCTs, for instance, are not irrelevant, but neither are they determinative for the 'inconclusive' finding by the IOM.
 * 2) The two 2010 Palmateer-initiated reviews of reviews found (correctly) that "there is insufficient evidence that NSP prevents transmission of the Hepatitis C virus", yet Stigmatella's wording suggests that this is wrong, and that the US IOM, which concurs with the Palmateer finding, is somehow the result of lack of statistical power in journal studies when in fact the balance of the studies do not demonstrate effectiveness (only one does) and that lack of demonstrated effectiveness is universally bemoaned, in print, by some of the world's most recognised proponents of NEP. Stigmatella's wording is optimistically misleading.
 * 3) At no place have I ever stated or implied, as Stigmatella asserts, that "the (IOM) report concludes that NSPs are valueless in the fight against blood-borne disease." In fact I additionally quote verbatim their conclusion that multi-component programs which include NEPs have demonstrated effectiveness. Stigmatella charges that I have not referenced the IOM recommendations re NEP, but this is simply because I am addressing the science - their recommendations are a separate matter and can be covered in the Research section.

Response to Minphie's summary
The authors of the US IOM report wrote: "The Committee used caution in interpreting the results of studies reviewed in this chapter because of their generally weak designs and serious limitations. One limitation is that the studies identified do not randomly assign subjects to treatment and control groups—rather, participants deliberately choose whether to use NSEs and other services. This creates an unavoidable risk of selection bias, and means that differences in rates of risk behaviors and HIV infection may not be due to use of the service itself. Another limitation is that the study designs generally do not allow separate examination of program elements, so the independent contribution of improving access to sterile needles and syringes cannot be assessed. For example, NSE is often one component of a multi-component HIV prevention program, making it difficult to isolate the exact effects of NSE alone."

The gold standard study design is the randomized controlled trial (RCT), which is practically and ethically impossible for this sort of public health intervention because of its immediacy and the assumed efficacy of needle exchange. Suppose one wishes to design an RCT study. From a practical point of view, how can one possibly "blind" the study so that a program participant doesn't know whether or not he has been given clean needles? From an ethical point of view, how can one deny a person who wishes to participate in a needle exchange program access to clean needles?

The great majority of studies have instead been cohort studies which are subject to "confounding factors." In paticular, participants in NSPs tend to be from the most highly marginalized, high risk segment of the IDU population. This major confounding factor has resulted in cohort studies only infrequently being able to establish any ability of NSPs alone to reduce HIV, HCV, or HBC acquisition. In combination with other interventions, however, needle exchange can show dramatic synergistic effects. For example, see the discussion of this point in (Degenhardt et al. 2010), which is a WP:MEDRS-compliant review article published in Lancet.

Ecological studies consistently found that implementation or expansion of HIV prevention programs that include needle and syringe exchange were correlated with reduced prevalence of HIV, but the authors of the US IOM report noted that "a causal link cannot be made based on these studies."

The authors of the US IOM report were hence being properly cautious in not overinterpreting the evidence available in 2006. On the other hand, Minphie's intent in selectively quoting individual words and out-of-context phrases from the US IOM report is to convey to the casual reader a completely false impression of its Chapter 3 summary and conclusions. Stigmatella aurantiaca (talk) 18:47, 29 September 2013 (UTC)


 * The following link opens directly to the Chapter 3 conclusion of the US IOM report. Section summaries are spread throughout the chapter, but I have provided a partial selection of the most relevant of them here, along with a complete quote of the same conclusion to which I provided a direct link. One may easily compare what Minphie considers to be "a verbatim rendition of its conclusions on the science" with the actual Chapter 3 section summaries and overall conclusion. Stigmatella aurantiaca (talk) 18:26, 1 October 2013 (UTC)
 * My understanding, whether right or wrong, is that I should be waiting for the Mediation Committee to approve this issue for their mediation before I respond to the incorrect statement above.Minphie (talk) 07:03, 2 October 2013 (UTC)

Hi all. Just a heads up, there was a DRN thread filed about this dispute, it was closed after a few volunteers (myself included) felt that an RFC was the next best step, but there is a fair few conduct issues mixed in here. Steven Zhang (talk) 21:09, 25 September 2013 (UTC)
 * Comments by Steven Zhang
 * Additional issues (added by other parties)
 * Additional issue 1
 * Additional issue 2

Parties' agreement to mediation

 * 1) Agree. Minphie (talk) 19:26, 25 September 2013 (UTC)
 * 2) Agree. Stigmatella aurantiaca (talk) 10:58, 26 September 2013 (UTC)

Decision of the Mediation Committee

 * Accept. Mediator to be assigned. On behalf of the Mediation Committee, Sunray (talk) 16:15, 12 October 2013 (UTC)
 * I will take this case. Sunray (talk) 19:40, 26 October 2013 (UTC)
 * Thank you. How do these mediation sessions work? Stigmatella aurantiaca (talk) 21:45, 26 October 2013 (UTC)
 * I'm reviewing the case right now. Then, shortly, we will begin discussing it on the talk page for this case. I will contact you in a couple of days. Sunray (talk) 22:02, 26 October 2013 (UTC)