Tuesday, 17 November 2009

Westminster Skeptics in the Pub: Evidence-Based Policy or Policy-Based Evidence?

Professor David Nutt, Dr. Evan Harris MP, & Dr. Ben Goldacre
at Westminster Skeptics in the Pub

“This talk has been approved by the Home Office and so may be damaging to your health” started Professor David Nutt last night at a crowded Skeptics Westminster. For such a serious subject, the evening produced a lot of laughs with the Professor, his fellow guest Dr. Evan Harris MP and visitor Dr. Ben Goldacre.

Professor Nutt started by restating the basics of the area: there are different legal classes of drugs (medical etc) and whether their use was restricted. And that the original intent of restricting drug use was to reduce harm by having a system of relative based harm and appropriate penalties.

He spoke specifically about ecstasy and cannabis, reminding us that neither of them was harmless, but that we needed an empirical approach to measure precisely what harm they caused. Both substances seem to be good case studies of how political fervour can trump empirical evidence. Queen Victoria used cannabis for pain during childbirth, and “MDMA only got banned when people started having fun with it”.

Government implementation of drugs policy has changed significantly over the years. In what many people regard as an ideologically driven era, even the Thatcher government of the 80s was in fact more evidence based in this area: it implemented needle programs, for example.

In fact, prior to the issue of cannabis being reclassified, the advice of the ACMD had only been rejected once since 1971. But in modern times, we appear to have other motivators for policy. Two seemed particularly important.

The first is the undoubted power of the tabloid press.

The second is the attitude of the police, which appears to have changed since the ‘90s when they seemed interested in downgrading MDMA (E) and cannabis because of a lack of public disorder consequences. This has changed and it’s not entirely clear why.

In fact, there are other (than health) serious consequences to using drugs, and getting a criminal record is prime among them. Professor Nutt cited an Australian program where cannabis was decriminalised: it apparently improved users’ relationships with the police, made them more able to seek help for substance dependency and (perhaps most importantly of all) improved users’ employment prospects.

Dr. Evan Harris MP started his presentation deeply abashed:
“I never smoked pot. It’s embarrassing … I was never offered it. It wasn’t big in my chess club”

So clearly inexperienced, but with nerd credentials intact (chess?!), Dr Harris continued by describing himself as a “yappy dog around the ankles of, usually, health secretaries”. His forays into evidence-based health policy had started with questioning the two-week referral time for a possible cancer (apparently, the money spent this way doesn’t produce the best outcomes). Since then he has tackled emotive, polarising and tabloid-friendly subjects, such as drug-induced early-stage abortion and prostitution.

With prostitution, for example, the ‘demand for prostitution’ offence in which police target potential clients has been cited as a concern in the NHS (I’m afraid I didn’t catch the specific citation). There is good reason to suspect that legal measures which alienate the women and their profession further will increase their vulnerability.

Dr. Harris freely admits that governments have many, and often good, reasons for certain policies, ideology, public opinion and financial considerations among them. But when these are the real motivations, a government must admit to that, rather than attempting to dictate or discard scientific advice & evidence. Although there are notable exceptions (he cited Dr. Lynne Jones MP, Paul Flynn MP and Charles Clarke MP), he feels that this government doesn’t really understand evidence based policy: do they think a peer review is “A Baroness casting an eye across something”?

His reports of conversations with members of the government sounded frustratingly meandering and circular. And he was clearly appalled at the timing of Professor Nutt’s famous rebuke from Jacqui Smith, the then Home Secretary, which coincided with her expenses scandal. Anybody trying to knock herself off the front pages, by any chance?

As a member of the Science and Technology committee, it is to be hoped that Dr. Harris can help to make a change. Next week, a set of principles for the treatment of independent scientific advice will go to Lord Drayson for his consideration. See Sense About Science for more.

The evening was fascinating and funny: did you know that you are statistically more likely to suffer a reaction to peanuts than to MDMA? We were all tickled by the complaints of a Dutch cannabis researcher in the audience who complained bitterly that her subjects had scoffed all her biscuits. And Professor Nutt dispelled some of the softer attitudes to heroin use by reminding us that it is a potent respiratory depressor which causes many inadvertant deaths.

For me, one of the most interesting aspects was the role that the media, especially the tabloids have to play. Both speakers managed to convey a sense of how the government is driven by fear of the tabloids and it is, to a certain extent, understandable. Newspapers clearly have an idea of what they regard as a sexy subject, there being a massive weighting of fatality reports toward the narcotic ‘bete du jour’*.

One the other hand, surveys reveal that the public are often considerably more liberal than those ministers running scared of newspapers. So who buys the news and votes as they’re told? “Who is the constituency for stupid drug laws?”, as one audience member asked.

We were all stumped.

I think that last night’s proceedings managed principally to convey that science mangled to provide a justification for policy dishonours both government and science. As Evan Harris always says to Anne Widdecombe about sex education:

“Never more ignorance”

See also Revolutions & Drugs Policy

And Dave Cole at WSitP

* Alasdair J. M Forsyth ‘A Qualitative Exploration of Drug Fatality Reports in the Popular Press’

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