I've just sent the following email:
Dear [Daily Mail] Corrections editor
There appears to be a quite serious factual error in the piece 'More heroin for heroin addicts – is the Department of Health quite off its head?' by Kathy Gyngell online here:
"The last Cochrane Review on the matter concluded that, ‘No definitive conclusions about the overall effectiveness of heroin is possible’. The DoH, though, was persuaded that UK trials would prove this wrong."
Although not cited or linked directly (which, as an aside, would be useful - in fact I would suggest should be standard practice when referencing scientific literature) this appears to be quoted from the conclusion of July 2009 Cochrane study on 'heroin maintenance for chronic heroin dependents' which is available here:
Its conclusion in full:
"No definitive conclusions about the overall effectiveness of heroin prescription is possible. Results favouring heroin treatment come from studies conducted in countries where easily accessible Methadone Maintenance Treatment at effective dosages is available. In those studies heroin prescription was addressed to patients who had failed previous methadone treatments. The present review contains information about ongoing trials which results will be integrated as soon as available."
This study has, however, subsequently been updated twice. All Cochrane reports are subject to regular review, with any new study findings incorporated, and conclusions updated accordingly.
An updated version of the study was published in August 2010
In this updated version, the conclusion was also updated to:
"The available evidence suggests an added value of heroin prescribed alongside flexible doses of methadone for long-term, treatment refractory, opioid users, to reach a decrease in the use of illicit substances, involvement in criminal activity and incarceration, a possible reduction in mortaliity; and an increase in retention in treatment. Due to the higher rate of serious adverse events, heroin prescription should remain a treatment for people who are currently or have in the past failed maintenance treatment, and it should be provided in clinical settings where proper follow-up is ensured."
The statement quoted by Gyngell, that ‘No definitive conclusions about the overall effectiveness of heroin is possible’ is no longer in the conclusion.
It was reviewed/updated a second time in December 2011, and the conclusion did not change:
The quote used would therefore appear not be from the 'the last Cochrane review' - indeed the most recent two Cochrane reviews do not include this quote. Please bear in mind that Cochrane is regarded as the gold standard in evidence based analysis of health interventions, and thus particular care needs to be taken when quoting them in support of a particular view.
Given that the updated conclusions no longer include the quoted statement, and the meaning of the conclusion is now somewhat different to what is implied in the Gyngell piece, I feel a correction should be made and the piece updated (or removed), along with an apology to both Cochrane Library for misrepresenting their work, and to readers for potentially misleading them.
I look forward to hearing from you
Steve Rolles, etc...
Ive also pointed out the mistake in the online comments thread.
Just to note, there are certainly important debates to be had about the cost benefit analysis of heroin prescribing (Transform have made our own contribution here for example) and, as the Cochrane report makes clear - it is an intervention that current evidence only supports for a fairly small group of problematic injectors (although some newer evidence suggest wider applicability). The contributions of Kathy and others is certainly a valid part of the debate, whether you agree with them or not.
Clearly different interventions will work for different people, and these are decisions that need to be made by doctors and their clients based on the best possible evidence. That the Government has made this particular option more available based on new evidence (something you can obviously only get by doing the trials the Mail seems so critical of) is surely a welcome development. All other debates aside, making sure treatment providers should have the widest possible range of options available, informed by the best possible evidence, is unambiguously a good thing.
Anyway - this is really just to flag up that the Cochrane library has apparently been misrepresented in the Mail, and whatever one may feel about the heroin / drug policy debate, that is not a good thing.
Finally, if I've made a mistake about this - and these things do happen, Im happy to put up a correction and apology.