RAR hath wrought…Hobson’s choice?

Rapid Assessment and Response (RAR) is proposed as a useful tool to undertake rapid assessments of injection drug use and its adverse effects on health, and to suggest an appropriate action plan (World Health Organization, 1998). Friedman has presented a cautionary argument, emphasising that RAR is as yet unproven and asking some pointed questions about its merit (Friedman, 1999). We have piloted an RAR approach in a developed country setting (Ottawa, Canada) where a significant problem of injection drug use exists, especially regarding HIV infection among injection drug users (IDUs) (Alary et al., 1999). Although this setting likely has more resources and more pre-existing data than do many developing country settings, we learned some valuable lessons that are general and therefore pertinent to the points made by Friedman. Friedman’s first point is a most important one: does RAR lead to outcomes that improve public health? To answer this question, proper evaluation is indeed needed, but such evaluation is not easy for community-level interventions. Certainly, Friedman is correct in saying that this question has not yet been answered and more research is needed. However, more research is also needed on how best to use the type of information produced by RAR. In general, information derived from qualitative and from ethnographic studies is not used as much as it should be to inform health programmes and policies at the local, regional, and national levels. The rapid assessment methodology is able to generate relevant qualitative and quantitative information pertaining to health care and disease control, and we need to understand better how to best use these diverse types of information for improved prevention and care. Is RAR ‘‘second-rate science’’? Of course it is, or else it would not be rapid; after all, even a cake cannot be both possessed and eaten. First-rate science proceeds at a slow, * Corresponding author. Present address: Division of HIV Epidemiology, Brooke Claxton Building, Room 0108B, Tunney’s Pasture 0900B1, Ottawa, Canada K1A OL2. Fax: +1613-954-5414. E-mail address: chris–archibald@hc-sc.gc.ca (C.P. Archibald)