Oh no, Nutt again!

Viewers of BBC Breakfast were left in no doubt yesterday about which substance would win the award for Most Evil Drug – at least, according to academic and evidence-based-policy martyr, Professor David Nutt. ‘In terms of the cost to UK society today, alcohol is the biggest harm, and that’s the one I think that we should be putting a bit more effort into reducing the harms of.’

His appearance on the Breakfast sofa was related to the publication of a new paper by Nutt and other members of the Independent Scientific Committee on Drugs, a group set up in the wake of Nutt’s sacking from the UK government’s official Advisory Council on the Misuse of Drugs (ACMD) in October 2009. The paper, published in the Lancet, is based on a one-day workshop where 20 drugs were scored on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms caused to others. While drugs like heroin and crack cocaine were deemed to be the most harmful to individual health, alcohol came out on top in terms of harm to others.

The authors conclude: ‘Our findings lend support to previous work in the UK and the Netherlands, confirming that the present drug classification systems have little relation to the evidence of harm. They also accord with the conclusions of previous expert reports that aggressively targeting alcohol harm is a valid and necessary public health strategy.’ In other words, we could really do with a new way to classify drugs because some substances that are currently subject to the strongest penalties for possession or supply – like ecstasy – are really not that harmful while there should be a crackdown on alcohol consumption.

That Nutt and his colleagues are critical of the current drugs classification system is hardly news. Nutt was sacked from his ACMD post precisely because he aired such criticisms in public, provoking the then home secretary, Alan Johnson, to fire him because he could not be ‘both a government adviser and a campaigner against government policy’.

Nor does the methodology of the current paper – drug ranking by committee – inspire a great deal of confidence. Nutt’s views on the dangers of alcohol are well known and this method of comparing harms seems to open up plenty of potential for subjective interpretation of the evidence.

Moreover, there are problems with the criteria used, which are often not really intrinsic to the drug itself. For example, the individual harm of drugs will include HIV acquired from shared needles. But needle-sharing is as much a consequence of the criminalisation of heroin as the drug itself. If heroin was consumed in the same kind of civilised surroundings as wine, HIV would not be a problem. Road traffic accidents are caused by alcohol and other drugs, it is true, but measuring that effect is difficult; for example, just because one driver involved in an accident was over the drink-drive limit at the time does not mean alcohol caused the accident.

The criteria for harm to others include the potential to destabilise a drug-producing country. Colombia may have such problems, for example, but there’s no reason why growing coca plants should have such a consequence any more than growing barley for beer should lead to militarisation and dictatorship. These consequences are a product of the ‘war on drugs’. Harm to others also includes family breakdown, but cause and effect work both ways in this situation: separating family problems that cause dependence from dependence that causes family problems is, to say the least, a bit tricky.

The Lancet paper is part of a new drive for evidence-based policy. In recent years, politicians have been seeking new ways of justifying policy on a range of issues from health and education to climate change and crime. And there’s no better way to close down a debate – or conjure up a policy when you’ve run out of ideas – than by turning to the ‘evidence’.

There’s two major problems with this: firstly, expert evidence is useful, but it can only ever capture part of any significant social problem. So, in the case of drugs policy, Nutt and his colleagues have only told us about the harms relating to the consumption of particular substances; the experts tell us nothing about the benefits. We could, for example, keep records of everyone who turns up in the accident and emergency department of the local hospital because they have drunk too much or they’ve fallen over due to being three sheets to the wind. But even if we did so, we would know nothing about the far greater number of people who had a good night, who were able to unwind after a stressful day or kindled a romance thanks to a little Dutch courage.

More generally, the data on liver cirrhosis or drink-induced assaults can’t tell us whether we think that drinking is morally acceptable. Even if it were the case that a syringe full of heroin or a bottle of Smirnoff were completely harmless to both the user and others around them, we might still disapprove of the idea of people obliterating their consciousness for recreational purposes. More pertinently, we might recognise that drugs of all kinds can cause harm but that it should be our choice, not one made for us by the state, whether or not to get off our heads.

The second problem is that evidence-based policy sidesteps democracy. By declaring that ‘The Science says…’, politicians simply have no need to ask us what we think. The experts, we are told, have spoken and no further discussion is necessary. From that, it is easy to take one small further step by consciously or unconsciously manipulating the evidence relied upon to produce a suitably convenient outcome: evidence-based policy becomes policy-based evidence.

Alcohol is undoubtedly associated with considerable harm, but it is also associated with a lot of pleasure, too. You could say the same about almost every aspect of human life, from skiing to raising children. We cannot simply read a scientific report (or in the present case, a less-than-scientific report) and discover what to do. What we can do is to be critical of the obsession with evidence-based policy and those, like David Nutt and friends, who puff themselves up in its name.

Rob Lyons is deputy editor of spiked.