Invited Commentary: Le Mystere de Montreal

Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.

Invited Commentary: Le Mystere de Montreal

American Journal of Epidemiology (12/15/97) Vol. 146, No. 12, P. 1003
Lurie, Peter

Abstract: Dr. Peter Lurie of the University of Michigan writes that the Montreal study--in which Canadian observational researchers found that the needle exchange program (NEP) participation was strongly correlated with higher incidence and prevalence rates of HIV infection--has long been a focus of debate regarding NEPs. In early 1995, the then-unpublished Montreal study became a pawn in the U.S. debate over needle exchange and used as evidence defending a ban of NEPs. But, Lurie explains, the original researchers involved in the study have even acknowledged that their efforts were purely observational; the study was not designed to examine or evaluate NEPs. In part, Lurie notes, the misuse of the Montreal study can be tied to its selection bias and observational nature, but the same can be said of other observational studies that show lower HIV seroconversion rates among NEP participants. In theory, Lurie postulates, the solution would be to conduct a randomized, controlled trial, such as the one in Anchorage, Alaska, funded by the National Institute on Drug Abuse. But, Lurie adds, the very nature of such a study violates principle five of the Nuremberg Code, which states: "No experiment should be conducted where there is an a priori reason to believe that death or disabling injury will occur." The realistic solution, says Lurie, is an examination of the issue from multiple lines of evidence from studies of differing designs.

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