05 November 2009

Update on David Nutt, Formerly of the ACMD

It is a rough week to be an advising expert. David Nutt, chair of the UK Advisory Committee on the Misuse of Drugs (ACMD), was relieved of his duties earlier this week, as I mentioned here. Simon Jenkins at The Guardian has a valuable perspective:

Researching drug use is pointless since policy on the subject has nothing to do with evidence, only emotion. It has to do with fear of the unknown, the taboo of other people's escapist narcotics (or worse, those of one's children). Politicians could not care less what experts say – witness this week's smattering of support for Johnson. They care only for the rightwing press, whose editors suffer a similar taboo.

The test was how the Tories reacted to Nutt's sacking. Faced with a home secretary gasping for air, Cameron and his home affairs spokesman, Chris Grayling, rushed forward with oxygen. Parting company with half the cabinet and the weight of scientific opinion, Cameron had a bad attack of funk. He refused to defend Nutt, and asserted his conviction that ecstasy was as harmful as heroin and crack cocaine. This was the same Cameron who, as a backbench member of the home affairs select committee in 2001, had supported Nutt in taking the opposite view. He must know what he said this week was rubbish.

All these politicians accept in private that the law is in chronic need of reform. Yet should they dare murmur so, they seem terrified of being assailed by the Mail, the Sun and the Telegraph. They could handle the House of Commons. They could even carry their constituents. But the rightwing press holds them in thrall, perhaps because they feel powerless before its lash. Might their youthful indiscretions be discovered, or the antics of their children pursued?

Politicians can stand the pressure of corpses piling up in Helmand, but one corpse at a rave would be too much for their consciences. Whenever I have tackled Home Office ministers, from Jack Straw and Charles Clarke to recent, less distinguished holders of the office, the response is the same. Don't even think about it, they cry. We would be crucified by the press. Just say no to drugs reform.

The situation here is a bit more complicated than that of Clive Spash. My view is that the ACMD needs to be constituted as -- and here I'll slip into the jargon of The Honest Broker -- either a Science Arbiter or an Honest Broker of Policy Alternatives. If the former then the task of the committee would be to answer specific, fact-based questions posed by policy makers, like, is taking ectasy more or less dangerous than riding a horse? If the latter then the ACMD would present the pluses and minuses of a wide spectrum of policy options. In both cases the notion that advisors advise and decision makers decide would be preserved. If current policies don't allow either role to exist, then policies need to change.

Martin Rees gets this:
Scientific advisers are not there to rubber-stamp policies. Advice should reach ministers before decisions are taken; and when ministers want to reject it, they should discuss it first. Where government does reject scientific evidence, it must explain why openly.
Nature gets this about half-right when they call for independence:
The government, meanwhile, badly needs to restore its credibility on this issue. One good way to do that would be to follow Nutt's suggestion to turn the advisory council into an independent body reporting to parliament as a whole, not to any individual official. An independent, scientifically run drug-regulation system would also free politicians from having to politick over who is toughest on drugs, something that would spare them and scientists much unnecessary future trouble.
Greater independence from the home secretary makes good sense, but it is not sufficient. Greater attention needs to be paid to the actual work of the committee and its role in decision making. If it is to answer narrow technical questions then this needs to be made clear, and a process needs to be put into place to elicit questions from policy makers. I much prefer an "honest broker" approach that allows the committee to lay out a wide range of policy options for policy makers to consider. Independence helps in both cases, but an options committee would fill a very different role than a committee that arbitrates technical questions.

If issues about the provision of scientific advice are raised and debated because of this situation, a good outcome will result. However, it is hard to see anything other than a negative political outcome for Gordon Brown and UK Labor.

Finally, in the FT, Robert Shirmsley explains the real lesson here:

Prof David Nutt was ditched after asserting that riding horses was more dangerous than taking ecstasy.

The sacking provoked immediate uproar and howls about the sanctity of scientific advice (as if the entire discipline was not based on one scientist disproving the theories of his forerunners).

But why is no one focusing on the real menace? Killer equestrianism is obviously the new scourge of our society. Ten families lose loved ones each year due to horse-riding accidents and dozens more people sustain serious injury. Yet this is a pastime frequently pushed on to children. Indeed horse riders speak openly about grooming.

Given the tyranny of health and safety legislation it seems remarkable that more has not already been done to tackle the new menace of "equasy" or Horse.

Many of the warning signs about the equestrian community have long been obvious. Like so many other misfits they have set themselves apart wearing their own distinct uniform, including skin-tight trousers and polished boots, and often carrying threatening weapons such as whips.

10 comments:

  1. Roger, you say that
    "the ACMD needs to be constituted as ... either a Science Arbiter or an Honest Broker of Policy Alternatives. If the former then the task of the committee would be to answer specific, fact-based questions posed by policy makers, like, is taking ectasy more or less dangerous than riding a horse?"

    This is what the remit was. Nutt came upo with a ranking of the most dangerous drugs, with alcohol and tobacco being higer ranked compared to cannabis and ecstasy. The government did not want to hear the message, but Nutt went on about it in public and got the sack.

    You continue:
    "In both cases the notion that advisors advise and decision makers decide would be preserved."

    The problen is that the government could not live with the public criticism of one the chief advisors. Simple as that.

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  2. I have a bit of a different take on this.. once again, if the policy makers don't frame the question, then scientists do. Usually what scientists then do is research the way they (the scientist) framed it, then if policy makers don't pay attention, claim "they are against science."

    (I have actually heard someone say "we can't wait for you policymakers to frame the questions, otherwise Agency X will get all the research funds first).

    So let's talk about some of the questions we might examine if we were to look at a framing of the issue as "horse vs. ecstasy", economic, social and environmental impacts.

    1. How many people are hurt per year during each activity?
    2. Is there a difference between experiences in terms of adding to positive human values? For example, is learning to care for a horse yield to better outcomes for society than taking ecstasy?
    Going to shows?
    Training, physical fitness?
    3. What is the relative contribution of these activities to the tax base? To creating jobs?

    4. Would 3) change if ecstasy were legalized? How so?
    5. Social values: eWould you rather your child had a horse habit or an ecstasy habit?
    6. Environmental impacts- horses eat grain (bad) people drive to ride them (bad for carbon) may keep land in open space (good), and so on..

    It appears to me that Mr. Nutt did not do a holistic analysis of the issue; and can't claim that his analysis is "science", since it is a combination of his own (fairly restricted) framing of the issue coupled with relevant facts.

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  3. Are you assuming, Roger, that Professor Nutt has been acting as an Honest Broker or a Science Arbiter? In my comments to your previous post I've made an argument that he's a stealth advocate.

    I think the Advisory Committee on the Misuse of Drugs is an odd duck in the U.K. science advisory landscape, in part because it is not composed entirely of people with scientific expertise. First, the remit of the Council, per it's website (http://drugs.homeoffice.gov.uk/drugs-laws/acmd/about-us/terms-of-reference/):

    "It shall be the duty of the Advisory Council to keep under review the situation in the United Kingdom with respect to drugs which are being or appear to them likely to be misused and of which the misuse is having or appears to them capable of having harmful effects sufficient to constitute a social problem, and to give to any one or more of the Ministers, where either Council consider it expedient to do so or they are consulted by the Minister or Ministers in question, advice on measures (whether or not involving alteration of the law) which in the opinion of the Council ought to be taken for preventing the misuse of such drugs or dealing with social problems connected with their misuse, and in particular on measures which in the opinion of the Council, ought to be taken."

    The horse riding question is arguably outside the remit, and really wasn't Professor Nutt's underlying point, which was to advocate for changing the classification system under the guise of rational risk comparisons. If he thought that was a reasonable thing for the Council to consider and recommend, why did he make his arguments in his capacity as an individual? Nobody's going to ask him that question, as it goes against the predominant media narrative.

    A part of the ACMD does deal with technical questions, but it's not the whole focus of the committee. Has risk of harm been determined as a strictly scientific question in this context? I don't think so, for reasons that include what Sharon mentions.

    The list of members is available online and includes police and school officials, along with legal officials and others engaged in studying and/or dealing with crime and/or the treatment of consequences from drug use. I'm not sure that this is a scientific advisory board in the same way that the U.S. National Science Board would be, but would fit the descriptions of more general advisory boards in the U.S., and presumably the U.K.

    So I continue to maintain that both sides screwed up here, and that steps need to be taken to resolve the situation. Nature gets it mostly wrong, in my opinion, because it seems to consider the ACMD a strictly scientific advisory group. If it were, Nature's recommendations would make more sense. What probably should happen to better reflect current considerations of the issue is to more strongly acknowledge the social problem angle in the committee's remit, that the committee is not out just to advise on technical issues, and to make a more definitive statement about members declaring when they are making statements in their private vs. public capacities.

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  4. One difference between ecstasy and horse riding is social class. The working classes take large quantities of drugs and the upper classes ride horses.

    They also take large quantities of drugs. Cocaine rather than ecstasy.

    Drugs are illegal due to the connection between extra legal government security agencies and organised crime. Non approved military action can also be funded this way. For example Iran Contra.

    Ecstasy is a manufactured drug. However it still has that crucial international element that allows profits to be skimmed off. That is probably why it is class 'A' rather than amphetamine which is class 'B' and often manufactured locally.

    Israelis at center of ecstasy drug trade

    http://www.haaretz.com/hasen/pages/ShArt.jhtml?itemNo=280827&contrassID=2&subContrassID=1&sbSubContrassID=0&listSrc=Y

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  5. Ah yes... the Guardian gets to the heart of the matter. The right-wing press makes the Labour government do it. Just like the New York Times made George W. Bush legalize marijuana.

    Oh, wait, that makes no sense.

    I think David Bruggeman made some very perceptive points above. In any case, drug legalization may be informed by scientific research, but it's a social question, and not one that lends itself to science in any case.

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  6. -3-David

    Belatedly, thoughtful stuff, thanks ...

    The committee charge and make-up looks to me more like an "honest broker" type committee, that is, one that discusses problems and solutions. But the charge does not explicitly explain how it is to deal with problems and solutions (i.e., to expand options -- HB -- or reduce them -- advocate).

    In this context Nutt's comments outside the committee as a citizen should be irrelevant. A good HB committee will have a diversity of views and the government should respond in such a situation:

    "Of course members of this committee have strong individual views, that is what make s the committee strong. it is the diversity of views that makes the advice valuable."

    I don't fault Nutt -- he was placed in an impossible situation. I see his actions very much as issue advocacy, not stealth advocacy.

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  7. But as chair (an aspect of this whole debate either downplayed or ignored), part of Nutt's responsibilities (see the ACMD Code of Practice) is to make sure, among other things, that the diversity of opinions are represented (Item 12). It's entirely possible this is happening, but if all the larger public is privy to are Nutt's utterances as a private citizen, it's hard to see - or trust - that he's able to temper his strong policy perspective enough so that those who disagree with him feel they can contribute and be heard. There's no reason for me to trust him more to be an effective and impartial chair just because he's a scientist.

    So, Nutt may not have done anything wrong under current guidelines for advisory committee members, but his actions have the appearance of pushing his own agenda (that only the scientific/rational evidence matters - a value judgment), and making it look like he's just following the science. He should be more explicit about what he thinks should happen about drug policy compared to what the evidence says about the technical questions before the ACMD.

    Johnson needed to be much more transparent and clear about why he sacked Nutt. Draw out the explanation beyond the terse one page letter. Make the case that Nutt failed to adapt his behavior since the last Home Secretary chewed him out and the top U.K. science adviser had to counsel both of them. Part of the consequences of this is that the outcry will likely prompt the ACMD to be treated like it's just a scientific advisory committee, when it isn't. The advisory guidelines for committees in general need to be clearer about public/private communications, and the intent of the ACMD - that it doesn't consider simply scientific matters in its deliberations - needs to be described more as well.

    As for the issue advocacy vs. stealth advocacy debate, this is also confounded because of Nutt's participation (and chairmanship) in ACMD. Had he said what he did without his government appointment, it's a lot closer to issue advocacy. But because he was a government scientific adviser, his arguments for a more 'rational' policy have the appearance of being a scientific recommendation, and he's done nothing to dispel the appearance. Sure, he's done little to encourage it, but this is an area where being passive doesn't clear the air. The press and other U.K. scientists (and the U.K. Parliament Committee that will stick its nose into it) are certainly painting this debate as ignoring scientific advice. And it's really not, and in a much stronger way than is typical with most science advisory bodies.

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  8. David

    As I mentioned in another of thread, David Nutt and his colleagues advised the government to ban BZP and jwh018 recently.

    If they had one ounce of scientific integrity, they wouldn't have done that. The ban was based on the ridiculous evidence of the death of one man while taking a massive cocktail of alcohol and other drugs.

    BZP was created as a harm reduction solution by a New Zealand man who's friends had died of methamphetamine addiction. It was incredibly popular and more or less free of even invented fatalities.

    The reason they did that is that every other country did it first. That was an automatic decision based on the fact that ALL psychoactive drugs are illegal throughout the world.

    Here is a very good story in the Guardian yesterday about legal drugs in the UK.

    Britain is 'designer drugs' capital of Europe, says EU agency.

    http://www.guardian.co.uk/world/2009/nov/05/designer-drugs-spice-legal-highs


    Here is an example of one of the shops.

    http://www.herbalhighs.com/index.asp?


    Most of the evidence against ecstasy is concocted in order to justify its illegal status. Fifteen years ago, I took it in clubs with millions of other people. I never knew anyone who had ill effects while taking it and I never heard of anyone who had ill effects. That would extend to thousand of individuals.

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  9. -7-David

    I agree that Nutt's behavior would serve to undercut the committee's (and his) own legitimacy. In this regard it is a bit like what happened with Leon Kass and Bush's Bioethics Advisory Cmte. Kass went around lobbying for conservative causes while also trying to be an "honest broker." That didn't work out so well.

    Issue advocacy and honest brokering don't mix so well!

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  10. Roger

    The real reason why Nutt complained is that the government overturned 'his' decision to move cannabis from class 'B' to class 'C'.

    The decision wasn't really his. It came about because the police said they had better things to do and the climate against cannabis improved when a number of politicians admitted to taking it etc., etc. The media stance substantantially altered.

    Cannabis possession became a non criminal offence which attracted first a warning then a small fine. In other words it was decriminalised and de facto legalised for possession. I see teenagers smoking it semi discreetly in public places. The decision was signalled by the re-classification of the drug.

    In other words, it had very little to do with science at all and nothing to do with Nutt and his committee beyond a rubber stamp.


    When reports came in about cannabis psychosis caused by strong skunk, the climate moved. The government changed the classification and Nutt felt he had been snubbed.

    The reality is that policing and the criminal justice aspects haven't changed at all. It's a storm in a teacup.

    If Nutt hadn't been a tame scientist, he would never been appointed. He is no longer tame and has been removed.

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