The middle of the line

I’ve read a few differing views of the saga over the sacking of Professor Nutt, and both sides put forwards points I can agree with. The hardcore ‘we must use science to determine public policy’ crowd are up in arms about it, and it’s of course a convenient stick with which to beat the government with.

On the other side, Hopi Sen says that Prof Nutt is both right and wrong.

He is absolutely right on the scientific evidence. He is right that some legal drugs are worse than illegal ones in their harm profiles and that this leads to apparent glaring contradictions.

Yet he is equally wrong to argue that the government should classify drugssolely according to the medical harm evidence.

There are many other factors in play and they are not irrational. We are not starting from a blank sheet – we are dealing with a society with certain existing norms of behaviour, and with other behaviours that are not widely spread, and policymakers must consider the impact of changing that.

This is pretty important, really. And it goes wider than just science as well. Politicians are there to make decisions on our behalf. In a democracy, they are going to have to include public opinion as part of their decision-making process. In a decent state, they should look at the social effects of policy, not just the dry theory.

Personally, I support the decriminalisation (combined with regulation) of soft drugs, and included in that would be cannabis. Of course, I know that this is not a particularly popular idea, and also that it is not as simple as just declaring it done. Still, I was in favour of the downgrading of cannabis to a level C drug, and not happy about the reversal of that policy earlier in the year. A report like that produced by Professor Nutt’s committee does give a lot of support on the medical side of the argument that the risks of the drug are low.

However, there are still a fair number of unknowns. Alcohol and tobacco have been subject to a far wider range of studies covering their use and abuse than cannabis ever has. Nutt’s report does not really come to a conclusion on the correlation between cannabis use and increased rates of psychological problems – because there is no real conclusive evidence on whether there’s a causal link.

So the confidence level of the health risk assessments on cannabis should be treated as having a bit more of a margin for error than those for our ‘legal’ drugs. When it comes down to it, cannabis is still rated as about as dangerous as tobacco.

The measure that Nutt used was to suggest that drugs more dangerous than alcohol be Grade-A, and those less dangerous than tobacco be Grade-C, with those in between being Grade-B. Cannabis comes out just below tobacco in terms of health risks, and so the decision is actually marginal on that measure.

However, even if the medical evidence is unequivocal, there is still the wider dimension of the social impact of various drugs, and the effect of their grading in the first place. For example, even though alcohol is apparently about as dangerous as methadone or ketamine, and not much safer than the Grade-A drugs like heroin and cocaine, it would be a massive political and social issue to even consider bringing it under the Misuse of Drugs Act. The USA tried prohibition of alcohol, and it failed miserably.

In the briefing that came along with the speech by Prof. Nutt which started this whole furore – Estimating Drug Harms: A risky business? (pdf 367KB) – he himself does acknowledge that the part that the Advisory Council on the Misuse of Drugs that he chaired plays only one part among many in the factors of deciding how to grade each substance. There’s a picture on page 3 showing just how many other feeds there are into the decision.

What Nutt appears to have done, however, is to go close to the line that advisors are not supposed to cross in terms of going from giving expert advice to lobbying for a political position. Did he cross it? I’m not sure – but he certainly didn’t back away from it either.

And to bring the issue to a wider context, the issues about ‘expert advice’ or recommendations affect all sorts of policy. A prime example is in planning. Councillors will be presented with a planning application, and a report from the Planning Officers detailing the issues around it, with a recommendation either to allow or turn down the development.

If politicians are only supposed to accept the expert report, then every application recommended for approval will be passed. However, I’ve quite often seen contentious and marginal cases where there’s a lot of public interest and where the officers’ recommendations have not been followed. Quite often the officers themselves will recognise the closeness of the decision, and there is latitude for refusal on a range of grounds.

That’s not ‘ignoring’ the evidence. It’s considering it, weighing it up against other factors, and coming to a decision.