Restoring Science to Its Rightful Place: The UK Drugs Edition

The latest round of scientists being informed, rudely, that the political process does not march in lockstep with scientific analysis or information hails from the U.K. The Advisory Council on the Misuse of Drugs was first established under the Misuse of Drugs Act (1971). Under this Act drugs are to be classified as A, B or C category for harm with "A" being the most harmful category. MDMA (3,4-methylenedioxymethamphetamine, "Ecstasy") is in the most harmful category.
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The unfortunately named David Nutt, Ph.D., Professor of Psychopharmacology, Univ. of Bristol and current chair of the Advisory Council, believes that MDMA should be downgraded to a lesser harm category. He has issued opinion pieces comparing MDMA's propensity for causing harm favorably with alcohol and waxed enthusiastic about the current clinical trials. This was all well and good but what really got him into trouble was his attempt at the absurdist ploy.


Professor Nutt's latest opinion piece dissects the unfortunate harms to public health that are associated with addiction to "equasy".


The dangers of equasy were revealed to me as a result of a recent clinical referral of a woman in her early 30's who had suffered permanent brain damage as a result of equasy-induced brain damage. She had undergone severe personality change that made her more irritable and impulsive, with anxiety andloss of the ability to experience pleasure. There was also a degree of hypofrontality and behavioural disinhibition that had lead to many bad decisions in relationships with poor choice of partners and an unwanted pregnancy. She is unable to work and is unlikely ever to do so again, so the social costs of her brain damage are also very high.

Professor Nutt concludes that Equine Addiction Syndrome is about 28 times more likely to cause acute harm than is MDMA. Now, if you've been following along DearReader you know that I'm not particularly fond of these types of attempts to influence public policy with this sort of false-equation between risk categories. The reason, of course, is not that I dispute the stats but because this sort of analysis is used to deny that there are real, finite and hopefully definable risks associated with MDMA (or cannabis or other drug of abuse). I am, of course, fascinated by attempts to define those risks.
Nevertheless, whether I might have a debate with the position staked out by Professor Nutt in terms of recognizing risks, the potential changes that might attend de-classification or de-criminalization or clinical use, it is absolutely abhorrent for the political process to attack him for his position and accuse him of being willfully in error. Having a scientifically justified and argued position and rationale is not being in error in this way. He should not be castigated by major governmental figures. Of course, he was.
The Home Secretary was not pleased with Professor Nutt.

The home secretary has told MPs she was "surprised" and "disappointed" by a drugs adviser likening the dangers of ecstasy to the dangers of horse riding.
Jacqui Smith said Prof David Nutt had "trivialised" the dangers of the drug.
She said she had told him he had gone beyond his role as head of the Advisory Council on Drugs Misuse.
Ms Smith said Prof Nutt had apologised, but he later defended his comparison, saying it had been "useful" in showing the risks associated with taking drugs.

Now, from what I can tell from the additional coverage (Nature has some commentary), Prof Nutt actually submitted his "equasy" piece prior to becoming chair of the Advisory Council and this Council, while recommending a classification downgrade for MDMA, "distanced itself" from Prof Nutt's article. So this accusation (apparently taken up by some MPs as well) that he overstepped his role on the Advisory Council or did something incompatible with its role is nonsense. It is the fault of whomever appointed him Chair because he's been publishing like-minded opinions for some time.
The Guardian (who published the MDMA-user-in-coma story I covered earlier) covered the apology:

Ecstasy is the UK's third most popular illicit drug with an estimated 470,000 people using it last year, including 5% of 16- to 24-year-olds. Last night, Nutt apologised saying he had "no intention of trivialising the dangers of ecstasy".
"I am sorry to those who may have been offended by my article. I would like to apologise to those who have lost friends and family due to ecstasy use," he said.

The article also highlights the typical interplay of the Home Secretary doing what amounts to political grandstanding in Parliament at the expense of a scientist expressing his analysis and interpretation of data in a scientific venue.

Lib Dem MP Evan Harris complained to the Speaker at Smith's attack, describing Nutt as a "distinguished scientist" unable to answer back in parliament for what was set out in a scientific publication. His article in the Journal of Psychopharmacology was written before he became chairman, but picked up in the weekend press.

Colin Blakemore, Ph.D., Professor of Neuroscience, Univ. of Oxford, chimed in with an editorial in the British Medical Journal:

According to the Misuse of Drugs Act, classification has only one function--to guide sentencing for possession and dealing in drugs. However, it has been hijacked for political slogans, banner headlines, policing targets, and educational messages.

Gee, I wonder where he's headed with this one?

The results were startling: alcohol, tobacco, and solvents (included to provide familiar yardsticks) were ranked as more harmful than many controlled drugs; the class A drug ecstasy (MDMA) had the lowest harm rating among all the controlled drugs analysed; and the overall ranking of drugs did not even statistically correlate with the A, B, C classification

The growing concern about classification has been amplified by the government's rejection of two recommendations of the ACMD--that cannabis should remain class C and, very recently, that ecstasy should be downgraded from A to B. Ministers even announced the decisions in advance of the ACMD reports.
In refusing to downgrade ecstasy, the government said, "We do not dispute the ACMD's scientific findings on the harms of ecstasy based on current evidence" but "the government will not send a signal to young people and the public in general that we take ecstasy less seriously. . . We are concerned that its downgrading could lead to an adverse impact on patterns of use and attitudes.

Professor Blakemore ends with the plea of the scientist.

Can't the scientific ranking of drug harms be decoupled from political decisions related to policies? It should be left to the experts, outside the glare of the political spotlight, to provide the best current information on each area of harm and devise ways of weighting and collating those indices of harm to inform each area of policy.

Hmm. But it was. The Advisory Council recommended downgrading of MDMA on the basis of the science (one assumes, generously given his string of published opinion pieces, that Prof. Nutt does not have other agendas at work here). The political process then chose to make a different decision based on other concerns. That is the way politics works people! Get it? This part I have no problem with. Well, I have a problem with it, just not the same one.
I'm not acutely offended when politicians assert decision making having to do with all sorts of political and even nonsensical ideas. I'm politically offended, don't get me wrong. I am happy to vote for those that are closest to what I think are rational policy makers. But not always. Sometimes I agree that it is better to win than to do so for the supposedly right reasons.
And this brings me back to the long term goals of restoring science to the proper place. If you want to shift the balance so that scientific rationale and analysis and data have greater influence over the political process, it doesn't help to ignore that process. Better to recognize and work within that process* than to complain and whine about how horribly insulting that process is to scientists.
Perhaps while you are banging on in the usual fashion in the comments about how drugs are less harmful than skydiving, you can also think about how we in the real, non-fantasy world can drive the science wedge back into the political process.
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Yeah, this whinging about the Nutt situation may actually be useful in the longer term goal. I recognize that this is an empirical question. Blakemore, for example, is a fairly influential scientist, having captained the UK research funding outfit MRC and having been a critical figure in some recent Acts of Parliment fighting back against the animal rights wackanut terrorists.

5 responses so far

  • In refusing to downgrade ecstasy, the government said, "We do not dispute the ACMD's scientific findings on the harms of ecstasy based on current evidence" but "the government will not send a signal to young people and the public in general that we take ecstasy less seriously. . . We are concerned that its downgrading could lead to an adverse impact on patterns of use and attitudes.

    The absurdity of this basis for public policy in relation to potentially harmful substances and activities is that the only logical outcome is that anything that can potentially be harmful must be classified as TEH WORST THING EVER!!!111!ELEVENTY!11!! And once you do that, people quickly realize that in many cases this is total bullshit, and thus discount the potential for harm of the truly most harmful things. People are not idiots, and when they are lied to, they know it and they discount things that known liars tell them, even if it turns out that they are true.

  • DrugMonkey says:

    Whether "sending a signal", the favored rationale of the opinion based political viewpoint in fact has basis is an empirical question. As we've discussed before, despite our personal viewpoints on the power of absurdly cartoonish or scientifically unsupportable "messages", it is still possible that they work. As I said before, if the JustSayNo messages did not work, I want some data explained to me

  • Curt Fischer says:

    The most common argument I have seen against the War on Drugs does not argue against educating kids on the dangers of drug use or say that such campaigns cannot be effective.
    Instead, the most frequent argument I hear from legalization proponents speaks to the effect of criminal prosecutions of drug crimes. Long mandatory sentences, three-strikes policies, the effect of very high incarceration rates among some American sub-communities, the perverse black market economic incentives that banning drugs can have, and so on.
    Whether drugs should be legalized is in my mind a question entirely distinct from whether we should spend government money to tell kids that drugs can screw them up. If D.A.R.E. or Just Say No worked in spite of people saying otherwise, great! But I'm not sure how this fact would have any relevance to the legalization debate. So if legalization people are trashing D.A.R.E or Just Say No programs, and "drug warriors" are defending them, it all seems like all it would be doing is adding heat, not light, to the legalization debate.

  • Jamie says:

    "Professor Nutt concludes that Equine Addiction Syndrome is about 28 times more likely to cause acute harm than is MDMA. Now, if you've been following along DearReader you know that I'm not particularly fond of these types of attempts to influence public policy with this sort of false-equation between risk categories. The reason, of course, is not that I dispute the stats but because this sort of analysis is used to deny that there are real, finite and hopefully definable risks associated with MDMA (or cannabis or other drug of abuse). I am, of course, fascinated by attempts to define those risks."
    Reading this in hindsight from your other more recent Nutt post, I'm struck by how you seemed to miss his point. I don't think it was intended to portray ecstasy as harmless; rather, to portray horse riding as more dangerous. Politicians often appeal to harm statistics as justification to ban substances; articles such as this place those statistics in their proper context. The point is that people shouldn't say "ecstasy causes x brain damage / year so it should be illegal" if they're not then willing to either say "horse riding causes x brain damage / year so it should be illegal", or come up with another reason ecstasy should be illegal and horse riding should not. To justify that the equation really is a false one, to use your phrase.

  • DrugMonkey says:

    I don't think it was intended to portray ecstasy as harmless; rather, to portray horse riding as more dangerous.
    I assure you I quite grasp Nutt's point. As I do the point of many of my commenters.
    My point, which you seem to be missing, is that this strategy of compare-n-contrast harms quite frequently runs roughshod over what the available science is telling us about the harms of one or the other drug or activity.
    Personally I think it is totally irrelevant to the determination of what harms Substance X might pose to continually natter on about Substance Y and Activity E.

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