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Eric Lombardi: The death of merit, the birth of aristocracy, and Canada’s quiet descent into neofeudalism

Commentary

Throughout Canada’s history, a humble yet profound dream has resonated: the belief that through diligent, honest work, one could secure a decent living and ensure a brighter future for their children. In the last few years, this dream has rapidly evaporated for countless young and new Canadians who find themselves on the wrong side of a housing crisis that saw prices nearly double between 2015 and 2022. Rents exploded by over 11 percent in 2023, continuing a decade-long trend of growth at twice the rate of inflation.

In the same timeframe, Canada’s real GDP per capita, a measure of economic activity per individual, has barely budged—and may be lower at the end of 2024 than in 2015. It means Canada has the poorest performance in the G7 and the second lowest among 35 OECD “wealthy” countries. Grimly, in 2022 the OECD predicted a generation-long stagnation, estimating this country would have the slowest per capita growth rate of members through 2060

It should be unsurprising that Canada’s housing crisis and economic stagnation have occurred at the same time. The escalating cost of housing takes disposable income from the economy and stifles entrepreneurial activity by reducing risk-taking. No wonder Canadians are starting businesses at the lowest rate in decades.

These facts underscore a painful truth many Canadians already know: the diminishing hope among those left behind is a story of falling living standards. Canada faces a growing divide as society is segregated into two distinct classes: the affluent, property-owning class with considerable political and economic influence, and a new class of permanent tenants, for whom homeownership and long-term economic progress are out of reach. 

Caught in a housing trap

The malaise plaguing Canada’s economy stems from a deep-rooted socioeconomic shift, simmering slowly for decades, and reminiscent of an era long past. While political discourse is mired in the dichotomy of progressivism versus conservatism, the nation is actually confronting challenges more archaic and insidious in nature, akin to a resurgence of the plague. This shift, increasingly evident, is towards a “neofeudalism” that eschews the overt symbols of aristocracy for a subtler yet potent form of elite dominance.

Feudalism, prevalent in medieval Europe from the 9th to the 15th centuries, was characterized by economic stagnation and a social system defined by personal relationships among the aristocracy, where legal status and rights were anchored in hereditary positions. Unlike this historical feudalism, where monarchs and the privileged nobility subjugated the masses through land ownership and serfdom, today’s “neofeudalism” operates through covert manipulations of regulatory frameworks and economic policy by a new class of aristocrats.

The chasm between property owners and everyone else left behind by the housing crisis has been driven by the actions of affluent residents and major landholders. These interests have for decades exerted their significant political influence over local and provincial land-use policies and usurped property rights. Engaging in NIMBYism, these elites have sought to inflate their property values and maintain neighbourhood exclusivity, leading them to advocate for restrictive development policies. Their decades-long sway over policy via deep political relationships has resulted in stringent growth regulations, rendering new housing development slow, prohibitively expensive, and dominated by big businesses. Consequently, the housing market has become increasingly inaccessible for younger and newer Canadians, furthering the growing chasm between owners and a burgeoning class of permanent tenants.

While provincial and local governments throttle supply, the federal government’s recent management of immigration (despite a recent shift in policy) has dramatically boosted demand for housing and accelerated rents. The last two years have seen an unplanned entry of over a million net temporary residents, particularly students, who have been exploited in low-wage work and by fraudulent educational institutions. The policies that led to this outcome were strongly advocated by influential business interests as a solution to labour shortages. The influx created a pool of low-wage labour for them to draw on, enabling them to forgo wage increases and investments in improved workforce productivity. While this benefits these businesses, it harms existing workers, undermines confidence in the immigration system, and hinders economic progress. 

The intersection of economic and political power as common in feudal systems is highlighted by the increasing dominance of political dynasties like those represented by Justin Trudeau, Doug Ford, and Olivia Chow (Layton family) that manifest the emerging “neofeudalistic” structure of Canadian society. Doug Ford’s recent Greenbelt scandal, involving an opaque regulatory decision that conveniently favoured properties of a well-connected billionaire family is a blatant example of the entanglement. Their actions created an $8.3 billion dollar land value uplift, and while reversed due to public outcry, it demonstrates how politicians and economic winners covertly use the regulatory system against public interest.

Apartments are seen lit up in downtown Vancouver on Thursday, Dec. 3, 2020. Marissa Tiel/The Canadian Press.
The housing crisis: A symptom of Canada’s disease

This dark economic shift extends beyond the housing sector, permeating across Canada’s economy in areas such as finance, wealth management, insurance, telecom, agriculture, grocery, natural resources, and media. The terms “The Big 5” or “The Big 3” could refer to almost part of Canada’s oligopolized private economy and allude to our great socioeconomic challenge. Significant interests in too many of our national oligopolies are held by a select group of billionaires, centimillionaires, and their agents who use their extensive networks, associations, relationships, philanthropy, and political influence to gain regulatory favour. 

This trend is facilitated by the growing complexity of technological society and our governing bureaucracy’s reflexive reliance on increased regulation to superficially “fix” complex problems. It overlooks the need for a systemic understanding of issues and the political execution of challenging reforms that would produce better results. The outcome is a regulatory system developed in collaboration with existing economic winners that justify new rules as “in the public interest” but instead create barriers to entry for competition. This process, called “regulatory capture,” has far-reaching effects on the Canadian economy. It has led to an environment that is counterproductive to innovation, equitable growth, investment, and our long-term prosperity.

Canada’s innovation and productivity hurdles, often attributed to a “conservative business culture,” are more accurately the result of decisions by rational actors in sectors insulated from competition. This “risk-averse” attitude and reluctance to invest are not inherent but stem from a lack of competitive necessity. There’s little incentive for businesses to undertake risky capital-intensive investments when their peers are equally reliably cautious and the threat from new entrants is low. This also explains the hesitancy of large Canadian firms to partner with domestic startups, unlike their American counterparts who actively engage with new ideas to stay ahead competitively. 

Furthermore, the excuse of Canada’s “small domestic market” is similarly misleading. As the world’s 9th largest economy by nominal GDP with extensive trade agreements, Canada’s “small market” is instead a by-product of self-imposed constraints and regulatory barriers that protect domestic industries. For instance, inter-provincial trade barriers that exist due largely to the influence of special interest groups are estimated to raise the cost of goods by seven percent, impeding our economy’s full potential. Thus, Canada’s challenges in productivity and investment are not a result of a “conservative business mindset,” but rather a consequence of rational choices in private industry dominated by economic fiefdoms awarded by the government.

Daniel Edwards, a tenant of 2255 Weston Road in Toronto, joins a protest outside their building, in Toronto, Wednesday, Oct. 18, 2023. Chris Young/The Canadian Press.
A detour from liberalism

Our faltering liberal economy, besieged by escalating housing costs and a lethargic private sector, is accompanied by an eroding standard of living. In Toronto and Vancouver, our most productive cities, exorbitant housing costs fueled by crippling growth restrictions are severely hampering labour mobility. This has profound repercussions for national wealth and our collective prosperity.

One study by the University of California, Berkeley, found that restrictive housing policies in just New York City and the San Francisco Bay Area, home to a mere 9 percent of the American population, slashed national income by 36 percent over 45 years. Translated to Canada, it amounts to a staggering annual loss of over $19,000 for the average Canadian worker. Given that the Greater Toronto and Vancouver areas account for over 30 percent of Canada’s population, coupled with the accelerating exodus of top talent to the United States, the economic toll on the country could be more severe.

Canada’s gradual shift towards neofeudalism marks a fundamental departure from the liberal democratic system that once fostered prosperity and opportunity through economic freedom and effective governance. This transition, characterized by an increasingly burdensome regulatory landscape ostensibly for public benefit, paradoxically shields a new aristocracy and jeopardizes our socioeconomic vitality. The quintessential belief that hard work leads to a good life, including homeownership, is faltering as family wealth evolves from helpful to indispensable for the next generations’ prosperity.

Like a dark past era, success in Canada is increasingly a product of inheritance and connections rather than merit, challenging a deep national myth that Canada is a free nation of free people. It requires a deep reevaluation of our systems and commitment to substantive reforms aimed at rejuvenating the Canadian dream and upholding our core values as a nation. 

Adam Zivo: New ‘landmark’ safer supply study is junk science

Commentary

Last month, the B.C. Centre for Disease Control (BCCDC) announced it had conducted a “landmark study” showing that access to “safer supply” drugs—free, government-funded substitutes for potentially tainted illicit substances—reduces mortality rates among drug users. While the study has been widely promoted in the media and by harm reduction activists, some experts say it is actually inconclusive and misleading.

The study arrives at a particularly sensitive time for safer supply advocates, who claim that the government can reduce overdoses and deaths by providing safer supply.

Over the past year, dozens of addiction experts have said that not only are safer supply drugs being widely resold on the black market, but that there is no actual evidence that safer supply works given that supporting studies typically use weak methodologies that would be unacceptable elsewhere in health-care research.

Federal funding for over 20 safer supply programs is set to expire next month with no word of renewal. As criticism of safer supply continues to intensify, there has been increasing pressure to prove that the controversial strategy is worth supporting.

The BCCDC researchers behind the new pro-safer supply study, which was published in the British Medical Journal, examined the anonymized health data of 5,882 individuals over an 18-month period (between March 2020 and August 2021)—all of whom were diagnosed with opioid or stimulant use disorders.

Some of these individuals received safer supply drugs while others did not. Those who received safer supply were given either opioids (i.e. hydromorphone, which is roughly equivalent to heroin) or stimulants (i.e. Ritalin and Adderall) or a combination of both. The opioids were intended to replace street fentanyl or heroin, whereas the stimulants were meant to replace potentially-contaminated cocaine or meth.

Upon analyzing this data, the BCCDC researchers determined that receiving safer supply stimulants had no significant associations with reduced mortality. However, recipients of safer supply opioids were 61 percent less likely to die (and 55 percent less likely to die of an overdose specifically) within one week of receiving their “safe” drugs. Individuals who received safer supply opioids for four or more days in a single week were 91 percent less likely to die over the following week.

The researchers thus concluded that safer supply is successful.

“This paper is the strongest evidence we have so far, by a large margin, supporting the idea that this can be an effective strategy for reducing overdose death risk,” said Paxton Batch, an expert in addictions medicine at St. Paul’s Hospital and a co-author of the study.

The study immediately received somewhat glowing media attention from several media outlets, including the Globe and Mail and CBC, which repeated the BCCDC’s conclusions and added positive quotes from associated researchers and harm reduction activists. No apparent attempt was made to include real critical voices or interrogate the study’s data and methodology.

Two weeks later, the Toronto Star’s editorial board published an op-ed arguing that funding for safer supply must not be discontinued—and cited the BCCDC study as strong evidence of success.

But had the journalists and editors behind these articles done their jobs properly, they would have noticed that something was off. When I forwarded the study to seven addiction physicians and a professional scientist with working knowledge in statistical analysis, they determined that it was misleading and that its conclusions were unsupported.

Dr. Meldon Kahan, one of Ontario’s leading addiction experts, noted that the study’s authors failed to adequately address the fact that half of the patients who received safer supply had also been co-prescribed traditional, evidence-based medications, such as methadone and Suboxone (also known as “opioid agonist therapy” or “OAT”).

It has been conclusively proven that OAT medications significantly reduce opioid overdoses and mortality among drug users. It would thus be incumbent upon any responsible researcher, when studying a population that is using both safer supply and OAT, to verify whether mortality reductions are caused by one or the other.

While the study made some attempts to use statistical analysis to filter out the effects of OAT medications, there were conspicuous gaps in these efforts. For example, no attempts were made to measure what dose of OAT medications study participants received, even though dosage has a significant impact on mortality.

Andrew Leavens, front left, and Carl Gladue, front right, carry an empty coffin during a march organized by the Vancouver Area Network of Drug Users in Vancouver, on Thursday, August 31, 2023. Darryl Dyck/The Canadian Press.

As safer supply patients are generally prescribed stronger doses of OAT compared to other drug users, this raises an obvious question: were they simply dying less often because they were receiving more OAT?

There are strong reasons to believe that the answer is yes.

The study data showed that safer supply patients who did not receive any OAT medications in the preceding 30 days showed no statistically significant improvements in mortality—which suggests that the benefits touted by the researchers were likely primarily driven by OAT, not safer supply.

This issue was actually flagged in the notes generated by the study’s peer review process (which are publicly available), where I found evidence that external evaluators had repeatedly raised concerns about unaddressed data bias. One reviewer, who had “major concerns” about the paper, worried that it was a “big issue” that safer supply seemed to actually shorten survival once OAT was removed as a confounding factor.

I emailed Bohdan Nosyk, the study’s lead public contact, with a list of questions about his team’s work. He provided a detailed response, which I forwarded to several experts for further review. Upon sending Nosyk a second round of questions and concerns, he declined to provide further answers, citing “a need to attend to our other obligations.”

Nosyk claimed that controlling for variations in OAT dosing was something his research team “couldn’t reasonably build into this initial study” given the complex and dynamic ways that OAT medications are used during treatment.

However, Dr. Kahan counter-argued that Nosyk’s comments “don’t make sense” given that administration of safer supply is similarly complex and dynamic. “If they could control for (safer supply) dose and frequency of pharmacy dispensation, then they could also have controlled for the (OAT) dose and frequency of dispensing,” he wrote to me in an email.

While Nosyk acknowledged safer supply appeared to provide no statistically significant improvement for patients who had not received OAT in the preceding 30 days, he pointed out this did not necessarily mean that there was no improvement at all.

In our correspondence, he linked to an article that argued that “statistical significance” is a harmful concept and that less stringent evidentiary standards should be normalized in science.

Nosyk’s argument was technically correct. An effect is only “statistically significant” if it is strong enough for us to be confident that it didn’t occur by chance. Typically, that means ensuring that there is a less than five percent chance that the effect was a fluke. While these evidentiary standards are the norm in most statistical analyses, they can lead scientists to dismiss very weak effects whose existence is unclear.

“This study is indeed a landmark, but not because it shows that safer supply works”

However, a debate about the meaning of statistical significance seemed to miss the point. Nosyk’s study had claimed that safer supply led to a 55-91 percent reduction in mortality—a huge effect. But now it seemed that, once an obvious confounding factor was fully removed, benefits were actually so weak that they were barely detectable if they existed at all.

Why weren’t the researchers more forthright about this tension in their paper? Why did they not flag this when speaking to the media? If the benefits of safer supply are so weak that we need to abandon normal evidentiary standards to accept their existence, that doesn’t bode well for the harm reduction movement.

The physicians I consulted with also noted that it was highly unusual that Nosyk’s study exclusively focussed on mortality rates after just one week.

“One-week mortality rates are an unusually short time period to study, and to not report on mortality rates for longer periods leaves one wondering if the data for longer periods did not show any difference between the groups; for example no difference in mortality at a month or year which would make the inferred benefits much less significant,” wrote Dr. Michael Lester, a Toronto-based addiction physician.

Two days after I received Dr. Lester’s note, the scientist who volunteered to assess the study’s statistical analysis confirmed that survival rates for all study participants appeared to have been more or less the same after 52 weeks, regardless if they had accessed safer supply, which suggested that “whatever effect (safer supply) had at the very beginning, hardly mattered at all after a year.”

I asked Nosyk why his team excluded long-term outcomes and only analyzed one-week mortality rates.

“It was important for us to capture the effects of (safer supply) while individuals were receiving it, and measure outcomes in the immediate aftermath of receipt. Just like OAT, or insulin for diabetes, or any number of other medications for chronic conditions, their effects dissipate after discontinuation,” he responded.

His comparison to insulin was illuminating, but perhaps not in the way that he intended.

If a team of researchers examined the impacts of a new type of insulin, it would obviously be preferable to measure both: 1) the immediate impacts of that insulin; and 2) the long-term impacts of its repeated administration. If a research team were to examine only immediate effects, despite having enough data to examine long-term ones, surely that would raise eyebrows?

And surely it would be strange for the researchers to argue, in this case, that this insulin is a promising intervention solely based on immediate impacts, especially if the data suggests hardly any long-term benefits at all.

And yet it seems this is exactly what Nosyk’s research team has done, in its own way.

A sign reading “Safe Supply Now” is seen at a gathering outside the Provincial Court of British Columbia in Vancouver, B.C., Tuesday, Jan. 16, 2024. Ethan Cairns/The Canadian Press.

The physicians I consulted, along with the notes generated by the peer review process, raised a number of other serious concerns regarding the study’s data and analysis.

For example, the British Journal of Medicine’s editors were “puzzled” by the fact that, after one week, safer supply was simultaneously associated with fewer deaths but not fewer overdose hospitalizations. “One would expect these results to be in the same direction,” they wrote.

Some experts I spoke with felt  Nosyk’s team failed to adequately discuss findings on safer supply stimulants—as mentioned earlier, providing such stimulants was associated with no improvements in mortality after one week.

Does this simply mean that safer supply only works for opioids, but not stimulants? Or does this reinforce the argument that the mortality reductions seen with “safe” opioids were actually caused by OAT, as OAT is not used to treat stimulant addiction and thus would not be a confounding factor with “safe” stimulants?

One might expect a fulsome discussion comparing the divergent results of opioid and stimulant safer supply, but that was largely missing.

Interestingly, the fact that safer supply stimulants had no apparent impact on mortality was omitted from the study’s conclusion, which focused exclusively on the benefits of “safe” opioids. As there is a responsibility to spotlight negative results alongside positive ones, one could argue that this omission is subtly misleading, especially considering that many people, including journalists, tend to skip to most studies’ conclusions to understand their findings.

One might ask: why does it matter that this study is misleading? Why does it matter that some researchers claim that safer supply saves lives when their data suggests that this is not actually the case?

The answer is simple: thousands of people are dying every year amid an unprecedented overdose crisis, and if this problem is to be solved, Canada must invest in addiction interventions that work. When bad science creates false hope, it costs Canadian lives.

Despite its flaws, the quality of this study is much higher than what is typically produced by harm reduction activists, so it is unsurprising that many of them are now aggressively promoting this “landmark” research, which they believe vindicates them. But it seems that, as is so often the case with safer supply, the truth is not entirely what it seems.

This study is indeed a landmark, but not because it shows that safer supply works—quite the opposite. A critical look at the data reveals that it is ineffective and that a new path is needed.