Wikipedia talk:Requests for mediation/Needle exchange programme

Resolved:

For an explanation of why the case was closed, refer to the talk page or contact the Mediation Committee

This mediation case is closed. Please do not modify it. No further edits should be made to this case page.

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Welcome to mediation

This mediation will work best if we can establish a climate of collaboration. Participants each begin with different points of view. As mediator, my job is to facilitate discussion and point out common interests. On reading this, you might be thinking: Common interests? We are in dispute, how could we have common interests? So let me point out a couple. You are both editors of several articles on Wikipedia and have been around for awhile. You are both interested in this article. In fact, you are the top two editors of this article. So if we can come up with a framework you can both agree to, you will save yourselves some time that is currently being devoted to discussing the issues described in your summaries of the dispute.

How can that work? Well, the best articles are usually ones that show various perspectives on the subject. So if we can develop a framework in which you find ways to present particular aspects of the subject—even though they may not be your particular viewpoint. To that end, if we can agree on some guidelines, this could produce a better editing environment and, perhaps even a better article.

Guidelines for mediation tend to be a subset of the talk page guidelines, particularly the following:

• Be civil
• Focus on content, not the contributor
• Observe content policies, especially WP:NPOV and WP:VER
• Make decisions by consensus.

If you agree with the above, I will start by posing some questions to each of you. Meanwhile, if you have any questions, let me know. Sunray (talk) 20:16, 31 October 2013 (UTC)

When you are ready, would participants please signify your agreement with the above by signing below with ~~~~?

Stigmatella aurantiaca (talk) 21:01, 31 October 2013 (UTC)

Minphie (talk) 10:52, 6 November 2013 (UTC)

I note that Minphie was last on WP on October 5. I will keep an eye out for him, but it does take two to tango (or mediate) :) Sunray (talk) 18:51, 2 November 2013 (UTC)

As a courtesy to Minphie during this mediation period, I have not made any edits to Needle_exchange_programme#Research. Minphie added this section on May 9, 2013, and it requires considerable revision to convert into an encyclopedic contribution. Stigmatella aurantiaca (talk) 07:30, 3 November 2013 (UTC)

You have my agreement to proceed and will answer any questions you have. Minphie (talk) 11:12, 4 November 2013 (UTC)

Are you agreeing to the above guidelines? If so, please sign above. Sunray (talk) 17:44, 4 November 2013 (UTC)

Thanks. Sunray (talk)

Scope of mediation

A couple of other things we might want to consider are: 1) a protocol for adding to the article (and related articles) by participants during the mediation, and 2) guidelines for lengths of posts. We may not need this, but I find that brevity is usually an asset in making mediations more effective. Thoughts? Sunray (talk) 17:33, 6 November 2013 (UTC)

Sunray, I will aim to do my responses in dot-point form for the sake of brevity.Minphie (talk) 20:23, 6 November 2013 (UTC)

It would be nice if we could get a decent Research section out of these mediation proceedings. If we limit ourselves just to the narrow issue of how accurately the US IOM report has been summarized, Minphie and I will just find ourselves fighting over the the rest of this section after the mediation proceedings are over.

Unlike some of the other editors who have disputed with Minphie, and despite my being a strong proponent of needle exchange programs, I believe that it is important that the legitimate concerns of opponents of needle exchange be fairly represented. Back in July 2012, I made a point of this in "Talk:Arguments for and Against" not presenting Arguments for and Against, and on 20 July 2013, I made a significant enhancement to this section. Minphie was, I believe, pleased at the balanced treatment that I gave to both sides.

So far as editing protocols go, rather than our editing the article directly, I think that maybe I can present my proposal for a replacement of the Research section here on this talk page, and Minphie and I can duke it out under your supervision. When we reach a satisfactory compromise, we can replace the current Research section with our joint production.

Actually seeing and working together on a replacement Research section will, I believe, serve to shorten the lengths of our posts. Stigmatella aurantiaca (talk) 21:15, 6 November 2013 (UTC)

You're saying move the Research section here on a subpage of this page? Have I got that right? If so, Minphie, what do you think?

As far as supervising you guys "duking it out," I don't really see myself as a referee. My role is to facilitate a conversation between you. If it is successful, it will most like be because you collaborated on solving the dispute. Sunray (talk) 06:04, 7 November 2013 (UTC)

1. Yes, you've got it right about having the Research section as a subset of this page.
2. Since the current wording of this section is mostly Minphie's, I believe that I should make the first move to present my alternative vision of this section. It would probably take me the weekend to put together.
3. No, I wouldn't really "duke it out" with my fists. Being trained in aikido, I prefer to use throws and joint locks, using my opponent's energy against himself. In aikido, we blend with our opponents and protect our attackers from injury. Stigmatella aurantiaca (talk) 07:55, 7 November 2013 (UTC)

I like the imagery of verbal aikido. I understand that the ultimate goal of aikido is elimination of conflict. In successful mediations this usually means moving from positions to interests and looking for common interests, such as improving the article. Sunray (talk) 22:18, 7 November 2013 (UTC)

Can I once again affirm Stigmatella aurantiaca's work on the Research section, but I am keen to maintain the Executive Summary, as it were, that was first added as part of the article's first paragraphs in 2010. That means that our discussion about the US IOM review is crucial to getting those first paragraphs of the article, which are outside the Research section, right. I believe that the article best maintains its Executive Summary-style first paragraphs on the effectiveness of NSP because many policy makers at government level world-wide will do the lazy thing and consult Wikipedia first, and like all busy policy makers will read the first paragraphs of the article to determine the status of the program re effectiveness without getting bogged down in the Research section. Minphie (talk) 14:09, 8 November 2013 (UTC)

Minphie, you are proposing that the article lead should be an executive summary for the article. Sa, do you agree with that? The article lead seems to be a key issue for this mediation. Would it make sense to work on an effective lead as part of this mediation? We could draft something here and then put it on the article talk page for consideration by other article editors. Sunray (talk) 19:43, 8 November 2013 (UTC)

I believe that, for the moment, we should stay focused on one achievable goal at a time. If we can come up with a mutually acceptable summary of the research, then and only then can we think of revising the lede. Stigmatella aurantiaca (talk) 20:05, 8 November 2013 (UTC)

The current lede is the product of years of consensus. I am OK with the first two paragraphs of the article as they currently stand, and would prefer that the current mediation discussions not touch these paragraphs. Too many other editors (Gabbe, Soulparadox, Steinberger, Jmh649, Ohiostandard etc.) have a stake in these opening paragraphs and would have to be invited to these mediation proceedings. Stigmatella aurantiaca (talk) 18:19, 8 November 2013 (UTC)

To clarify, I was not suggesting to add any other editors to the mediation. Only that, once we have some agreement here, we could initiate discussion on the talk page that would include other editors. It seems that you are both in agreement with the current article lead. Have I got that right? Sunray (talk) 20:33, 8 November 2013 (UTC)

The current second paragraph, as a summary of the current state of the science on NSP effectiveness, does require change though. It cites the Wodak/Cooney World Health Organisation review which has been thoroughly discredited (eg it counted as positive a study that was inconclusive by its authors' own admission, it cited a New Haven study by Heimer as positive which the IOM discounts as invalid, it counted as positive a Swedish study which was inconclusive on its own authors' admission, and counts two ecological studies as positive for reducing HIV incidence, which are discounted by the IOM). So the paragraph needs to reflect correct science, not discredited science. Minphie (talk) 21:11, 8 November 2013 (UTC)

OK it sounds like we should revisit the issue of the lead after we have completed the summary of research and worked through some of the discussion questions. Sunray (talk) 21:45, 8 November 2013 (UTC)

On the contrary, Wodak and Cooney remains a heavily cited and respected source, albeit a bit dated. Google Scholar reports 73 citations since 2012, and although I have not had a chance to review more than a dozen of these citations, none that I have examined have been in a negative context. Minphie also ignores the existence of more recent reviews (unless they present conclusions that Minphie likes), such as the comprehensive series of reviews on "people who inject drugs" by Degenhardt et al. which was published in Lancet. Stigmatella aurantiaca (talk) 22:40, 8 November 2013 (UTC)

This is fair comment, generally. However, there is no need to make statements such as "Minphie also ignores... more recent reviews (unless they present conclusions that Minphie likes)." S.a, would you be able to stick to content? If you want to make an observation about what another editor has done, it is best to stick to observable behaviour and facts (not criticism, judgements or speculation). "Editor X said... Editor Y did..." Sometimes it may be helpful to ask an open question (i.e, one beginning with What...? How...?) such as: "I see a need to include recent reviews. How can we get agreement on that?" Sunray (talk) 23:20, 8 November 2013 (UTC)

I am properly castigated. I won't do it again. (I hope) Stigmatella aurantiaca (talk) 23:50, 8 November 2013 (UTC)

Nice, thanks. I will try to give feedback every once in awhile (hopefully not castigation :) Sunray (talk) 17:55, 9 November 2013 (UTC)

There are two issues raised in S-A's response of 22:40, 8 November. The first is the issue of misrepresentation of the US IOM report in the lead text which commenced with this Talk entry here dating back 4 months and for which two Third Opinions were sought. It is from this unresolved discussion that the appropriateness of the Wodak/Cooney text as replacement has arisen. The second issue raised in S-A's text above is the question of the success of multi-component programs which include NSPs in reducing Hep C transmission, which s/he first raised on 19 August here well after the need for mediation was raised by other contributors in regards to the dispute about misrepresentation of the IOM review. My response to these new 19 August questions by S-A was, "Stigmatella, you have largely addressed issues here other than the central disagreement"[1] and was not an attempt at evasion but rather an attempt to stick to the previous substantive disagreements for their resolution. I wonder if it is best to resolve the long-standing dispute over my alleged misrepresentation of the US IOM review which is in the lead text before we get onto an issue which had never before featured in the lead text, ie the success or otherwise of multi-component programs re Hep C (and not their success or otherwise with HIV which had already been covered by me in the lead text). Minphie (talk) 12:44, 9 November 2013 (UTC)

Dealing with the way the IOM report is addressed in the lead seems like an important objective of the mediation. How about we add that as a question? Because I'm going to be away in RL for the next several hours, I will add it, subject to S.a's agreement. Sunray (talk) 18:49, 9 November 2013 (UTC)

I propose to add questions in the section below as they come up in our discussion. I welcome both of you to do likewise. I suggest that we modify the questions, as needed, and agree on the wording of each. Sunray (talk) 18:56, 9 November 2013 (UTC)

Research page

S.a has suggested a research page. It could be a subpage of this page. Do we want to do this? Sunray (talk) 22:20, 7 November 2013 (UTC)

Sounds practical. Minphie (talk) 14:09, 8 November 2013 (UTC)

Here's a subpage for that: Wikipedia talk:Requests for mediation/Needle exchange programme/Research Sunray (talk) 17:47, 8 November 2013 (UTC)

Discussion

Summary of dispute

I like the tone the two of you have set in the summaries on the mediation page. You have signalled that you will be evidence-based in your discussion here, which is great. I get the sense that WP:WEIGHT will be an important policy to guide us. One thing I would appreciate is to get Minphie's response to Stigmatella aurantiaca's response. Minphie, would you be able to specify what aspects of S.a's response you agree or disagree with? Sunray (talk) 17:33, 6 November 2013 (UTC)

Sunray and Stigmatella Aurantiaca, work pressures have prevented an early reply, but here are my thoughts on your question, Sunray.

There are two issues between us – A. Stigmatella Aurantiaca’s (henceforth S-A) contends that I have misrepresented the US IOM conclusions with the text I contributed here and B. I contend that s/he has misrepresented the US IOM review by inferring that their ONLY consideration for finding the science on NSP limited and inconclusive is due to a lack of ‘statistical power’ inherent in all current studies to demonstrate any positive effect.

Taking Issue B first,

• While we both agree that there are many limitations in the NSP studies acceptable to the IOM I cannot possibly accept S-A’s proposed article-text here which appears to assume that a lack of ‘statistical power’ inherent in all non-RCT studies is the ONLY driver for the US IOM ‘inconclusive’ conclusion. This is simply incorrect for the following reasons:
  • Six out of the ten IOM paragraphs discussing all acceptable studies are spent discounting a number of Canadian studies which found HIV increased amongst NSP clients. These six paragraphs are not remotely addressing STUDY design limitations or their inadequate ‘statistical power’ as S-A proposes (all results were statistically significant), but rather focus on PROGRAM limitations, something very different.
  • The Van Ameijden case control study yields an inconclusive result despite studying a population with NSP AS WELL AS pharmacy provision (where pharmacy provision was an important confounder elsewhere) but along with the Patrick case control study does not lack ‘statistical power’ in attaining an inconclusive result.
  • The IOM review and the Kall et al review contrast with the other two of the four reviews acceptable to Palmateer’s review of reviews, where Gibson et al. and Wodak/Cooney, in the words of the latter, agree that “There is COMPELLING evidence that increasing the availability and utilization of sterile injecting equipment by IDUs reduces HIV infection substantially.” Kerstin Kall, who along with Alex Wodak presented the evidence on the studies to the US IOM Geneva session, found the majority of studies ‘inconclusive’, some on the basis of result and others on the basis of methodology (ie the ecological and cross-sectional studies).

Taking issue A,

• S-A alleges that my text contributed here on the limited and inconclusive science somehow misrepresents the US IOM review. Yet S-A fails to elucidate on just how my text gives the reader a wrong impression of the real state of the science. This I need to know and discuss.
• Regarding my text in the first two paragraphs of the Wikipedia article which essentially is the executive summary for the article, S-A has charged me with removing the context of an IOM statement re NSP effect on Hep C (HCV) where I was told that I should have added the IOM’s suppositions on why NSPs have failed to demonstrate effectiveness. Yet I was simply giving a summary that followed precisely the same formulation as the Palmateer summary of its findings. I must add that the Palmateer ‘executive summary’ was added long ago by another contributor here.
• S-A charges me with failing to record that that there is a science that supports the effectiveness of NSP in a multi-component setting re HCV [2]. S-A cited newer studies suggesting such effectiveness, however I have relied in this article on reviews of journal studies because such reviews discard three out of every four peer-reviewed journal studies due to inadequate methodology or other issues. In relying on reviews in this article I believe I am more in accordance with Wikipedia Reliable Sources than S-A.

Please see my comments below S-A's suggestions on process above. Minphie (talk) 13:57, 8 November 2013 (UTC)

Thanks. Having read both of your summaries, I am optimistic that we will be able to make progress. Some questions arise, which I will post below. If my questions seem naive, or to repeat material that you have hashed out before, please bear with me. I need to try to get my head around the key issues. Sunray (talk) 18:17, 8 November 2013 (UTC)

Questions

In this section, our aim should be to make responses and explanations as succinct as possible. If one participant responds, and the other agrees with what has been said, it will be helpful to indicate agreement. Sunray (talk) 21:41, 8 November 2013 (UTC)

1. What are the circumstances that lead the US IOM to conclude that the evidence is insufficient to determine the effectiveness of NSPs in reducing sex-related risk?

My view is that the US IOM conclusion gives a very complete answer to this question, and it is a conclusion I believe that absolutely adheres to the evidence. It says, "Conclusion 3-3: Needle and syringe exchange is not primarily designed to address sex-related risk behavior. In two early prospective cohort studies, NSE participants reported decreases in sex-related risk behavior. However, this issue has not been well studied, and the existing modest evidence is insufficient to determine the effectiveness of needle and syringe exchange in reducing sex-related risk." Minphie (talk) 22:01, 9 November 2013 (UTC)

Given that the US IOM report was published seven years ago, how do we address the fact that its findings are now dated? Referring to "Improper study design" begs the question: How have studies addressed issue of inadequate design since publication of the IOM's findings? How should the article address this? Sunray (talk) 01:12, 11 November 2013 (UTC)

The US IOM review is indeed 7 years old, but it is the most authoritative of all the reviews to date, which amount to just four since 2000. It is highly authoritative due to the rigor of their process - 24 researchers and medical practitioners along with reviewers involved in the process. The four reviews since 2000 are by Gibson et al (whom Palmateer dismisses as unreliable), Wodak/Cooney (the WHO review which appears to also be dismissed by Palmateer for its categorizing errors), the US IOM review and the 2007 Kall et al review. These are each reviewed in 2010 by the Palmateer review of reviews which in the end is not a new review - just a review of the four extant reviews. S-A has referred in the Needle Exchange Programme Talk text to a review by Degenhardt, but her paper is only relying on the US IOM and Palmateer, so is not a new review at all. But that is the current state of the reviews on NSP. Reviews are not done every day. Minphie (talk) 05:07, 11 November 2013 (UTC)

You're saying that there have been no authoritative reviews of NSPs since the US IOM report? I think we need to address that. What has prevented effective reviews of NSPs? From my reading of discussions on the talk page, I could venture an answer, but I think we need to get agreement on this between participants. Would you both agree? Sunray (talk) 19:39, 11 November 2013 (UTC)

There are considerable costs to doing studies on NSP and HIV incidence, and I guess until we have a whole new crop of new studies there is nothing really which can be added by another review of the ones already there (unless of course someone spots a glaring error that escaped everyone else before). Minphie (talk) 10:41, 13 November 2013 (UTC)

It is hard to imagine that no one anywhere in the world has found the money for such a study since 2006. Has a thorough literature search been done? If so, what are the results? If not, should we do one? Sunray (talk) 17:38, 14 November 2013 (UTC)

If you read the 4 recognized reviews of NSP you find that they discard as many as 30 other studies as methodologically inadequate or lacking sufficient quality for inclusion, ie three out of every four reviewed are discarded. My view has been that decisions on specific studies in this case are best left to the reviewers rather than Wikipedia contributors. Minphie (talk) 11:32, 15 November 2013 (UTC)

We always look at reliable sources in accordance with WP:MEDRS. We need to address the fact that the US IOM report is now dated. How should we do that? Sunray (talk) 16:47, 15 November 2013 (UTC)

2. What changes are needed to the way the IOM report is addressed in the lead?

The original unresolved differences between us that led to uninvolved parties suggesting mediation were (and I hasten to add that S-A may well be able to add other relevant questions that clarify our original differences):

1. What does the IOM mean when they say the science on NSP re HIV effectiveness is "limited and inconclusive"?
2. Does the citing of this conclusion in the lead, without added commentary, give the Wikipedia reader a false impression of the actual state of the science on HIV as described by the IOM?
3. Is my use of the statement from p149 of the IOM review that "Multiple studies show that NSEs do not reduce transmission of HCV" giving a false impression of the current state of the science as the IOM found it at time of their review?
4. In stating that there are critics of the Palmateer upgrading of the US IOM conclusion on NSP and HIV incidence from 'inconclusive' to 'tentative', is there something here that is in any way incorrect?
5. Are the conclusions of the Wodak/Cooney study currently summarised in the lead an accurate rendering of the science on NSP re HIV incidence?
6. The question that S-A introduced after mediation was suggested is, What is the science on multi-component program effectiveness which includes NSP on HCV transmission?

Hope this adds clarity rather than muddying the waters. Minphie (talk) 22:32, 9 November 2013 (UTC)

I need to add a comment addressing S-A's appeal to the Wodak/Cooney review as suitable for the lead. S-A's appeal is to the number of citations that can be found in later literature. However it will not be known to any who cites the Wodak/Cooney review that there were major categorizing errors in the review, and so the number of citations of a flawed study is no indication that it is a good study. Categorizing errors are objective errors, while citations by journal studies of another journal study is a subjective issue. Science is adjudicated on objective and not subjective grounds. Minphie (talk) 05:21, 11 November 2013 (UTC)

How do we know that there were "major categorizing errors" in the review? Sunray (talk) 17:38, 14 November 2013 (UTC)

In December 2005, the US Institute of Medicine held their Geneva session in which they examined the evidence for the effectiveness of needle exchanges re HIV here among other interventions. They had two reviewers present the evidence from their reviews - Dr Alex Wodak from Australia and Dr Kerstin Kall from Sweden. Dr Kall's presentation, which came after Dr Wodak's, detailed the categorizing errors here. Dr Wodak had found in his 2004 WHO review that there were 6 studies which demonstrated the effectiveness of NSP, 3 which were negative, and 2 which were 'indeterminate'. Dr Kall pointed out to the US IOM panel that 2 of the 6 'positive' studies for Wodak were ecological studies, which address HIV prevalence, but not HIV incidence, which is the focus of such a review of NSPs, and of course causality cannot be attributed to NSPs from ecological studies. The 'positive' study by Heimer et al was found by Kall, with whom the IOM subsequently agreed, to not be measuring cohort HIV at all, while the Monterosso study was on its own admission inconclusive but Drs Wodak and Cooney had labelled it 'positive'. The 'positive' Swedish Ljungberg study found decreased HIV in Sweden's Lund, where needle exchange had been trialed, but at the end of the study the authors had noted that Stockholm had similar decreases without implementing needle exchange at all. The Kall PowerPoint presentation referenced above also is instructive on how the word 'inconclusive' was being applied to studies by Dr Kall who had found the majority of studies in her review to be 'inconclusive' (see the slides at the end of the presentation), which is instructive in our present controversy over the US IOM's statement that "evidence regarding the effect of needle and syringe exchange on HIV incidence is limited and inconclusive. Thus the Wodak/Cooney review had 5 categorizing errors where all 5 were 'inconclusive', according to Kall's presentation, only one 'positive' and two others correctly found by Wodak/Cooney to be inconclusive. Minphie (talk) 11:26, 15 November 2013 (UTC)

Thanks. I would like to get S.a's comment on what you have said thus far. Sunray (talk) 18:09, 15 November 2013 (UTC)

Notes re participation

This section (which we should perhaps keep at the bottom of the page) will be for the participants and mediator to keep one another apprised of our status and ability to participate in the mediation. Sunray (talk) 19:45, 11 November 2013 (UTC)

Wife in the hospital again

I just got back from the hospital. There will be some delays before I can respond. Sorry. Stigmatella aurantiaca (talk) 10:48, 11 November 2013 (UTC)

I'm sorry to hear about your wife's illness. Here's hoping she gets great care and recovers soon. Please take what time is needed. We will look forward to your return. Sunray (talk) 19:45, 11 November 2013 (UTC)

I'm happy to give S-A whatever time he needs, so will keep an eye on this page for his return. Minphie (talk) 10:34, 12 November 2013 (UTC)

Sunray, Stigmatella aurantiaca has not specified when he might be able to return to this issue, and should a lot of time go by with no word from S-A I believe there are enough previous statements by S-A and myself on the issue of misrepresentation of sources, the originating grievance, to go to arbitration without either of us needing to comment or clarify further. Of course we can return whenever we wish, with no great need for haste, to the Research section and any issues of whether there are later reviews etc to summarize, which were not an issue originally for mediation. Minphie (talk) 08:08, 21 November 2013 (UTC)

Mediation and Arbitration are two entirely separate dispute mechanisms. The scope of arbitration is restricted to conduct disputes. I've seen this as a content dispute and you have each confirmed that, above. Mediation is for content disputes and is the final step in the dispute resolution process for such disputes. So we are in the right place. I will ping S.a to see what his estimated date of return will be. Sunray (talk) 02:27, 25 November 2013 (UTC)

My wife is out of danger, but she is still being kept under observation. With luck I can bring her home in a week. Thanks for your patience. Stigmatella aurantiaca (talk) 22:31, 26 November 2013 (UTC)

I'll be bringing my wife home from the hospital today. Stigmatella aurantiaca (talk) 14:09, 2 December 2013 (UTC)

Blood test results were not quite satisfactory. She's in for another day. Stigmatella aurantiaca (talk) 00:32, 3 December 2013 (UTC)

By all means take what time you need, S.a. Would you be able to let us know your anticipated date of return, though? Sunray (talk) 04:08, 7 December 2013 (UTC)

Minphie is blocked indefinitely per WP:NOTHERE. Sorry. Steinberger (talk) 22:12, 8 December 2013 (UTC)

I was going to write that my wife was finally discharged from the hospital on Wednesday. Since then, I've been having to adapt at home. I've only had time to make a few edits here, a few there, but I was really determined to return to this discussion in earnest tomorrow with an extensive proposed Research section. Stigmatella aurantiaca (talk) 23:19, 8 December 2013 (UTC)

Closing mediation

With Minphie blocked, we will have to wind down this mediation.

Stigmatella aurantiaca, is there anything else you would like to do or clarify before we close? Sunray (talk) 17:57, 9 December 2013 (UTC)

No, not really. I'm sorry that Minphie got himself blocked for canvassing.

For whatever reason, Minphie never understood that I am much more conservative than most of the people that he has fought against, and that I empathized with his cause. I do not believe that the only valid approach to dealing with the problem of drug abuse is an evidence-based approach. Science is not the answer to everything. We humans are social, moral, religious, and political creatures, and because of that, social, moral, religious, and political arguments should bear due weight in determining drug policy, alongside the scientific evidence.

Where Minphie and I differed is my acknowledgement of the scientific evidence. Minphie did not want the scientific evidence to point unequivocally towards the effectiveness of needle exchange programs against the spread of HIV and other blood-borne diseases (when included as part of a comprehensive package of interventions ), and so therefore refused to believe the evidence. He would selectively pick and choose individual words and phrases from various scientific reports to distort their message.

My position is that just because the scientific evidence points in a certain direction, that does not necessarily mean that the direction it points represents an optimal social policy.

Stigmatella aurantiaca (talk) 21:24, 9 December 2013 (UTC)

Well said. I would add that scientific evidence is usually a necessary basis for good social policy. Necessary, but not sufficient. Sunray (talk) 07:10, 10 December 2013 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.