Opinion: The Nutt affair – or, the thin line between evidence and policy

Firstly, a disclaimer: I am a scientist, who is also interested in governance and politics, so the following post may come across as somewhat heated. Apologies, but I do feel that the recent furore over Prof. David Nutt’s sacking as Chair of the Advisory Council on the Misuse of Drugs (ACMD) goes right to the heart of why I took up both science and politics as profession and interest respectively.

We begin with Prof. Nutt’s most recent criticism of the government’s drugs policy, which attracted headlines for claiming that alcohol, despite being legal and freely available, was more harmful than the Class A narcotic ecstasy (MDMA). At first sight this may seem like an outlandish statement to make, but the evidence, collated by Prof. Nutt, suggests otherwise; granted, the recent publication from Nutt’s The Centre for Crime and Justice Studies (CCJS) at King’s College London wasn’t peer-reviewed, but the methodologies used to calculate his ‘harm index’ were so, and published in one of the most respected medical journals, The Lancet in 2007 (the full article is behind a paywall, contact me if you want the pdf…). Just to repeat this – using what seems to me to be a robust method, taking into account everything from physical harm to the user to social harms at large, ecstasy does indeed seem to be less dangerous than alcohol, and it’s using this tried and tested method of enquiry that Nutt used to conclude that cannabis should remain a class C drug.

I thought it worthwhile to go into the details of how Nutt came to his conclusions because this process – of evaluating evidence and coming to a conclusion based on objective data where possible – is familiar to me as a scientist, indeed it’s the bedrock of the profession. Often, evidence on emotive issues such as drug use can be counter-intuitive, strikingly odd, perverse even. But that’s the point – evidence trumps pre-suppositions, guesses, intuition, anecdotes, the lot. And here’s the choice policy-makers are faced with – claim that your policy is evidence-based, in which case you take the evidence as presented and fit your policy around it, or base your policy on any number of considerations other than evidence, from morals to popularity.

Fair enough – unless you want it both ways, which appears to be the current government’s position. On a host of policy issues, from military to medical, high-profile government advisers are appointed, meetings are arranged, reports are published and… well, not much else really happens, as the policy which emerges from this process, given the veneer of respectability, authenticity and objectiveness by the independent advisers, all too often flies in the face of the very advice they offer. Which brings us back to Prof. Nutt. He had the temerity to reinforce his stance (a stance based, lest we forget, on objective evidence) on both the classification of cannabis and the harm caused by alcohol and tobacco – and was dismissed (or ‘asked to leave’) by Home Secretary Alan Johnson. His predecessor, Jacqui Smith, had already clashed with Nutt earlier in the year over the ecstasy non-reclassification, and this latest (perceived) foray into politics provoked his removal as the head of the government’s drugs advisory council. Johnson’s justification for sacking Nutt was that the latter had” “crossed the line between offering advice and then campaigning against the government on political decisions”.

Nutt is understandably aggrieved – in an interview with the journal Nature he expresses his disappointment at how he came to be sacked, and at how the government has overtly ignored advice the ACMD has provided. But the repercussions of his sacking may well stretch beyond even the ‘mass resignations’ of the rest of the ACMD reported to be planned – two have already quit in anger – into so many fields of policy-making.

Having a respected scientist, military man, economist or some such expert report on the evidence in a given field could, could, add much-needed legitimacy, ‘stardust’ even, to government policy – provided said expert is not hounded out and banished for daring to publish inconvenient truths deemed to be politically uncomfortable. Indeed, given Jacqui Smith’s maxim, enunciated on last week’s Question Time (‘advisers advise, Ministers decide’), it’s all the more vital that good advice based on solid evidence is provided to them so that Ministers can in fact make the right decisions. For if we are to ensure that policy decisions are not made on emotive hunches, on opinion polls in newspapers or on some other arbitrary reasoning, but rather is based on evidence of what works, we need the best advice to be heeded and acted upon – and at this rate no self-respecting expert will ever volunteer to be a government adviser again, for fear of being silenced for publishing what is ostensibly the truth.

In sacking Nutt, Johnson said “What you cannot have is a chief adviser at the same time stepping into the political field and campaigning against government decisions. You can do one or the other. You can’t do both.” With respect Mr. Johnson, what you cannot have is a government claiming that its policy is based on evidence, then sacking its advisers for not agreeing with policies which defy said evidence. You can have one or the other, you can’t have both.

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9 Comments

  • I agree enitrly. If the gorvernment want to decide drugs policy by basing it on daily mail campaigns or by using astrologers and a ouija board then that’s fine as long as they make it clear so that the electorate can disembowel them (figuratively speaking) at the next election.

    If they claim scientific advice as the basis of their decisions then it’s obvious that they are lying if the same scientists disagree with them.

    I firmly believe all the advice ministers receive to make their decisions should be in the public domain immediately (barring privacy/national security issues, where a delay is appropriate) to justify their decision to the voters.

  • Andi Sidwell 4th Nov '09 - 5:15pm

    The Lancet article isn’t behind a paywall; you merely need to register at the Lancet’s website. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2807%2960464-4/fulltext#

  • Matthew Huntbach 4th Nov '09 - 5:52pm

    As I have argued, there is a case for saying putting all drugs on a one-dimensional harm spectrum is too simplistic. We are Liberal Democrats, we love drawing up two-dimensional charts and saying “oh no, you can’t view all politics as one spectrum”, so this should be second nature to us. Which is how Johnson could have handled this – “thank you very much for your evidence, Professor Nutt, it is useful but we need to consider other factors”. But he didn’t, which is why he has been shown up as a fool.

  • David Nutt’s guest editorial in the New Scientist:

    David Nutt: Governments should get real on drugs

    * 10:40 04 November 2009 by David Nutt
    * Magazine issue 2733.
    * For similar stories, visit the Editorials , Mental Health and Drugs and Alcohol Topic Guides

    IF THERE is one thing that politicians can and should do to limit the damage caused by illegal drugs, it is to take careful note of the evidence and develop a rational drug policy. Some politicians find it easier to ignore the evidence, and pander to public prejudice instead.

    I can trace the beginning of the end of my role as chairman of the UK’s official advisory body on drugs to the moment I quoted a New Scientist editorial (14 February, p 5). Entitled, fittingly enough, “Drugs drive politicians out of their minds”, the editorial asked the reader to imagine being seated at a table with two bowls, one containing peanuts, the other the illegal drug MDMA (ecstasy). Which is safer to give to a stranger? Why, the ecstasy of course.

    I quoted these words in the Eve Saville lecture at King’s College London in July. This example plus other comments I have made – such as horse riding is more harmful than ecstasy – prompted Alan Johnson, the home secretary, to say that I had crossed the line from science to policy. This, he said, is why I had to go.

    But simple, accurate and understandable statements of scientific fact are precisely what the advisory council is supposed to provide. Why would any scientist take up some future offer of a government advisory post when their advice can be treated with such disdain?

    As well as ignoring its own advisers, the UK is falling out of step with international trends. When Portugal softened its drugs laws in 2001, drug use remained roughly constant, but ill health and deaths from drug taking fell. Decriminalisation quietly crept up the agenda in Vienna this year at a meeting of the UN Commission on Narcotic Drugs, where governments heard new, independent evidence on how the harms of criminalisation were outweighing the benefits. In August, President Felipe Calderón of Mexico approved a law decriminalising possession of small amounts of marijuana and other drugs. And just last month, Eric Holder, the US attorney general, instructed federal prosecutors to stop hounding medical users of marijuana in the 14 states where such use is legal.

    No one doubts that heavy users of marijuana are risking trouble with their mental health. What I have simply pointed out is that we need a consistent policy, recognising that heavy users of alcohol and tobacco are more numerous and are causing themselves – and others – even more trouble through their indulgence.

    Policies that ignore the realities of the world we live in are doomed to fail. This is true for just about all the biggest issues that we confront, from energy and climate to criminal justice, health and immigration. I’m not arguing that science dictate policy; considerations such as cost, practicality and morality also have a role. But scientific evidence should never be brushed aside from the political debate.

    The current British government has said repeatedly that it wants its policies to be evidence-based, but actions speak louder than words. On ecstasy, for example, it made policy first, sought advice second – and cynically rejected the advice it was given. The result is shambolic policy-making which gives great cause for concern if that is how governments operate more generally.

    The results of a government inventing its own reality and acting on it can be seen in the appalling consequences the George W. Bush presidency had for world peace, the environment and human rights. The message for the British government is a simple one: don’t exclude rational argument in order to exploit a visceral public response. Politicians have to win the hearts and minds of their electorate. If your policy is informed by an underlying moral imperative, be open about what that is, and don’t try to disguise it with a veneer of pseudo-science. We ignore scientific evidence at our peril.

    David Nutt, professor of neuropsychopharmacology at Imperial College London, was chairman of the UK government’s Advisory Council on the Misuse of Drugs until he was dismissed last week by the UK home secretary

  • Andrew Suffield 5th Nov '09 - 5:02am

    As I have argued, there is a case for saying putting all drugs on a one-dimensional harm spectrum is too simplistic.

    Which is fine, but to justify that you’re going to need a firm proposal for a better way to measure things, and at least a demonstration of why it is better (such as an example where the ACMD’s system gets confused, and your proposal gives an answer that is clearly better).

    I’ve read the ACMD’s report, and I can’t think of anything that they’ve missed – it’s very thorough and their evidence is compelling. While there are multiple forms of harm that can be caused, they appear to have considered them all.

  • The most ridiculous thing about this whole episode is that, whoever is right, no one outside of westminster really gives the smallest shit whether cannabis is class c or class b anyway.

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