Sitting 3000 miles away from London in Washington DC, I’ve been following the dismissal of Professor David Nutt as the UK government’s senior scientific advisor on the misuse of drugs, with interest. Not being steeped in British drugs politics, I was only vaguely aware of the tensions between the Advisory Council on the Misuse of Drugs, which Nutt chaired until Friday, and UK policymakers. So as the story broke, I found it tough to disentangle whether this was a case of a respected scientist demonstrating a blindingly naive understanding of policy, or a government forfeiting science in favor of ideology. But the more I dig into the situation, the more it seems to highlight a worrying disdain for science and evidence* amongst policy makers.
Nutt’s dismissal will undoubtedly have long-term repercussions on the effectiveness with which UK policies prevent people’s lives being destroyed by drug abuse. But it also calls into question how science and evidence are used in making policy decisions. And this is what really worries me – in a science and technology-based society, where information is no longer controlled and constrained by an elite few, playing fast and loose with “evidence” is a politically and socially dangerous game that threatens to marginalize experts and undermine legitimate authority.
David Nutt’s case struck a particular chord with me. In my day job I work with people who advise on, advocate for and formulate policy. And I’m constantly surprised at how hard it is to ensure that recommendations and decisions are informed by “evidence,” rather than the evidence being cherry picked and massaged in support of predetermined ideas. Even in a supposedly science-savvy administration, this is a very real challenge. For a whole host of reasons, the system is biased towards people who see knowledge as a tradeable and malleable commodity, and who have a startlingly loose attitude toward evidence. Even well-meaning players in the policy arena sometimes seem to struggle with listening to what the evidence says, rather selectively using it to make a point.
But the grounds for Nutt’s dismissal also struck a more personal chord. Having a son at middle school and a daughter at high school, I have been dismayed at how “evidence” is sometimes misused in the push to prevent children from abusing drugs (both legal and illegal). My evidence is largely anecdotal, but it seems that in their “drugs education,” there is a tendency for inconvenient facts to be avoided and, on occasion, information to be “massaged” in the effort to steer the kids toward a safer and healthier lifestyle.
Both of these examples speak to a systemic disdain for evidence – and the science on which it is often built – that results in it being a political tool, rather than a policy foundation. And this I find truly worrying – whether dealing with drug policy or a number of other issues, we’re in danger of building a foundation-less house of cards that will collapse at the slightest touch if evidence isn’t handled with integrity and respect.
To be very clear here, I am appalled at the horrific damage caused by drug abuse to individuals and society as a whole and, like most people, I see this as a social problem that desperately needs solutions. But I struggle to see how the problem can be solved by ignoring the evidence, and promulgating what can only be described as “un-truths.” Certainly, policy decisions need to take into account far more than just the current state of knowledge. But without transparency, honesty, and a foundation of truth, how will people be empowered to make wise and informed decisions?
In an effort to understand whether David Nutt’s dismissal was a product of this culture of evidence-disrespect, or simply down to his political naivety, I actually took the time to read the paper that led to his removal. It was presented to the Center for Crime and Justice Studies in the UK last week, and can be read in full here.
Given the fuss that it led to, I was expecting an outspoken and ill-considered attack on current drugs policies in the UK.
I couldn’t have been further from the truth.
Nutt’s paper – “Estimating drug harms: a risky business?” – is authoritative, insightful, pertinent, and cognizant of the broader context in which policy decisions are made. His arguments – and the science and investigations on which they are based – were sound and well-presented. And I found the conclusions he drew to be reasonable.
It is very clear that Nutt understands the broader social context in which policy decisions are made, and that evidence is just one of a number of factors that need to be addressed. But he makes it very clear that this evidence should be foundational – and as a consequence, needs to be robust, available, listened to, and not distorted.
I would strongly recommend anyone tempted to weigh into this debate to read Nutt’s paper first, including Home Secretary Alan Johnson.
Especially Alan Johnson!
Perhaps Nutt’s greatest crime is that he sincerely – and altruistically I believe – tried to speak truth to power. He attempted to provide decision-makers with a sound scientific and evidence-based foundation on which to base policies that would improve people’s lives. Contrary to my earlier fears, it is clear that he did this with a full understanding of the the broader framework within which policy is made. His downfall was that he was working with a government that seems to believe in speaking power to truth rather than truth to power – deciding what is right first, then bolstering this up with evidence!
Sadly, this is a model of government that is not sustainable in this day and age – I’m not sure it ever was. Without a doubt, policy decisions need to be evidence-informed, not evidence-dictated. But you still need to start with the evidence. Corrupt this, and you end up harming the people you are trying (supposedly) to help.
Hopefully the rather unfortunate case of David Nutt’s dismissal will shake people up, and lead to renewed attempts to place evidence – and science – at the heart of policy making.
If it doesn’t, I’m afraid we’re in for some rough times ahead!
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*It’s common to talk about science-based decision making in policy. But here I decided it was more appropriate to use the idea of evidence-based decision making – reflecting the language and discussions that tend to occur in policy circles. “Evidence-based decision-making” encompasses science, but is sufficiently broad to encompass the use of multiple sources of robust, quantfiable and verifiable information.
You have really drilled down to the core of the issue here. It is much wider than drugs policy (important though that is), and goes to the heart of how policy is made. The other serious aspect of the case the effect it is likely to have on scientists and other evidence-led professionals to engage with the policy making process, which is ultimately to the detriment of all.
I think this question of “why bother” is going to be a big one. We’re already beginning to see the first follow-on resignations from the Advisory Council on the Misuse of Drugs. But more broadly, why would an expert give up considerable amounts of time for free, just to be ignored, reprimanded and dismissed. It’s not much of a reward for doing your bit!
I am rather shocked if I am honest. I rather hoped I had missed something in looking briefly at David Nutts report, but your excellent blog confirmed my worst suspicions. How on earth did this happen, who on earth was party to this ridiculous decision? Interested to see what Lord Drayson has to say in response, obviously not consulted. A real vote loser if I ever saw one.
I can’t quite get my head round how someone can believe this serves ‘the people’ better or the democratic process.
What’s to be done? At least call for his reinstatement, though he probably won’t accept.
Very interested to see what Lord Drayson says on this one. The ACMD is outside his jurisdiction, but an awful lot of people are looking to him to ensure science is supported and used wisely withing government, and not abused.
For me, the key is the Home Secretary’s reason for not accepting ACMD’s recommendation about reclassification:
‘My decision takes into account issues such as public perception and the needs and consequences for policing priorities. There is a compelling case for us to act now rather than risk the future health of young people. Where there is a clear and serious problem, but doubt about the potential harm that will be caused, we must err on the side of caution and protect the public. I make no apology for that. I am not prepared to wait and see.’
Here, the Home Secretary is fulfilling his duty as a politician in recognising risk management as an inherently political act and hence in his statement he invokes the Precautionary Principle. The Precautionary Principle is a device that enables cost-effective action to proceed in the absence of conclusive scientific evidence where there is sufficient evidence of potential harm. The Principle sits at the heart of European policy and Commission guidance on its application makes clear that it is a politician’s job to make judgements about acceptable levels of risk, and that politicians have a duty to take account of uncertainty, public concern and scientific evidence at the same time. The guidance also ups the political ante by making clear that there is no such thing as purely ‘objective’ science.
In the cannabis case, it would be helpful to examine the extent to which there is widespread understanding of the goals of policy and the meaning of the various aspects of evidence. If the goal of policy is simply to reduce harm, then on David Nutt’s reading of the evidence (i.e. that there is a strong argument that cannabis is not a major health hazard) then the situation is relatively straightforward and an appropriate response would then be a yes/no regulatory decision (i.e. class B or C). However, where there are multiple, and contested goals of policy and where evidence is inconclusive, the situation is (at best) complicated and (at worst) chaotic…but probably sits in the middle realm of complexity.
So it would be helpful before condemning or condoning the decision to sack David Nutt to take a step back and make a reasoned judgement about the nature of the policy issue at stake: is the evidence clear and widely understood? Is the goal of policy clear and widely understood? What are the various lines of argument in the debate (coming from science, public opinion and political gut-reaction)? What ‘evidence-bounded space’ does this create in which the decision should be made? What is the appropriate ‘political’ response to be made in this bounded space? How, where and when should the precautionary principle be invoked and used in this situation?
We must be careful to avoid hitching ourselves too firmly to the evidence-based policy wagon that asserts (as a previous Chief Scientific Adviser had done) that evidence should drive policy. Similarly, we must avoid abandoning evidence as a useful input to inherently political decisions – clearly some evidence is better than none at all, but evidence should inform, not determine decisions. Rather, we need a way of characterising policy issues in relation to their goals and their evidence-base. Armed with this we will make better (but never perfect) decisions. But I refer back to my earlier quotation from Kerry Whiteside “all risk management is political”.
Thanks Gary,
I’ve always been wary of the evidence-driven approach to policy – in fact I think it’s untenable – hence my plea for evidence-informed policy. Most seasoned policy advisors – and I would include David Nutt here – realize that there are a whole raft of values and issues that need to be taken into account in addition to the evidence.
But, the real danger comes when the policy making process is not transparent, poor reasons are put forward for why decisions that are contrary to the evidence are made, and the evidence itself is suppressed or manipulated.
In this case, I think it’s important to distinguish between the policy decisions being made, and the process by which they are made. I’m not going to question Alan Johnson’s invocation of the precautionary principle – that’s a separate issue. but I would question his closing the door to evidence-based analysis and opinion.
Gary: this decision was in direct response to a week of headlines that followed the Nutt publication (that incidentally contained nothing he hadn’t said before in previous publications, including in the Lancet for example) , headlines that ran contrary to the Government’s propaganda and political program, specifically in the run up to an election, with an opposition party and hostile media waiting to nail them as ‘soft on drugs’.
This was cynical politics and nothing more, the hostile reaction it has engendered entirely appropriate. Hopefully it will be a cautionary tale for politicians in the future. Dont sack your advisors just because you don’t like the advice. And if you treat them with contempt (go and look at what really happened over the last two years) dont be surprised if they call you up on your reckless and unethical actions. If you prioritize politics over science and evidence the result is bad policy that can cost lives. If government advisors cant commetn on that, best resign before you are sacked.
Gary suggests that it’s OK to sack Nutt on the basis of the precautionary principle. He describes this principle well: make judgements about acceptable levels of risk … take account of uncertainty, public concern and scientific evidence … and then make policy. Unfortunately the policy was publicly articulated by the then Home Secretary long before any of the evidence was looked at. He was sacked because he was inconveniently noisy. The whole of the ACMD should have resigned 2 years ago when it was made clear thatttheir advice was irreleevant to policy.
I’m sorry if I gave the impresion hat I condoned David Nutt’s sacking!! I do not and agree wholeheartedly that it was raw politics that drove the decision. But as I said, neither an over-reliance on evidence nor an over-reliance of politics are a good idea. Andrew’s sense of evidence-informed policy is right.
Having worked inParliament for 9 years, I am fully aware of the notion of politcal tribalism and having seen it at first hand (e.g. when a politician of one party got into a lift with one from an opposition party and seeing both bristle at the very idea of both being in a small confiend space with each other was an eye=opener, but if got worse when a member from athird party got in and all of a sufdeen the first two were chums and they visibly collaborated in giving the third party guyth eveil eye!! )… I can corroborate Steve’s point about cynical politics nand woudl add hat ‘professionalism’ and politicians are not often seen walking arm in arm!!.
My point was that the Home Secretary’s decision to ignore the advice was a political act based on the idea that PP is a political device in and of itself. I donot think that his decision to sack the chairman of the ACMD was (or should have been) based on the PP…that would have been a gross misuse of the PP.
Yet, politicians are in business to make decisions and if we the electorate don’t like ’em we can boot ’em out.
If any government is wondering why the majority of “their people” have no respect for their power, this is it. When an authoritative power makes rules based on their personal beliefs and feelings instead of any real reason, the people will find out and realize their government is idiotic. Once this happens, even the laws that should be obeyed are put into doubt. This leads to nearly the entire nation having no respect for its government or its supposed power. I’d venture to guess that 99% of the people in the US break at least 1 law every day. The only reason it’s not 100% is because I’ve met a couple of well behaved infants. (the screaming infants are breaking “noise pollution” laws)
If you enjoy irony, Les Iversen has replaced Nutt
Professor Les Iversen, Department of Pharmacology at Oxford University, author of: The Science of Marijuana (extracts from The Evening Standard, May 6, 2003)
“When I advised the House of Lords committee five years ago that cannabis was not as damaging as, for instance, regular smoking or drinking, no one wanted to know about our findings.
“Cannabis is simply not as dangerous as it is being made out to be.”
The National Commission on Marihuana and Drug Abuse commissioned by President Nixon tried to correct the US in their report, Drug Use In America: Problem in Perspective: “Alcohol is a drug. … confusion must be dispelled … Of the drugs which are most commonly associated with dependence or drug-induced behavior, alcohol produces the most clearly established and reproducible brain pathology…” Experts know it is alcohol that dose for dose is most likely to produce violent behavior (which marijuana and heroin tend to suppress), damage to the fetus (not crack) and the highest levels of intoxication (the loss of mental and physical control), but the public does not. Indeed, the Commission said the public had been “conditioned” not to know.
Alcohol today is responsible for 5 of 6 cases of drug abuse and addiction.
See
“Drug Use, Abuse and Dependence (Addiction) In America”
The line that Nutt was harshly treated does not stand up nor does the suggestion that the UK government ignored the evidence when it re classified cannabis. Professor Nutt has made clear since he was sacked that he is a campaigner for legalisation. In his case one of his drivers was a wish to invent a substitute for alcohol, to be made no doubt by his friends in the pharamceutical industry in which he had very substantial investments. I have put this to him twice in public, he does not and cannot deny it.
Professor Nutt’s campaigning was absolutely at variance with his public role for the government. He can have any views he wishes but an honourable person would not use his official position as a platform for his personal interests if they were so differrent to consistent government policies over 50 years. That is why he had to go.
Indeed I was the first person to call for him to consider his position, I also said if he did not the government should do it for him. They did.
Nutt also misrepresents the science around cannabis re-classification in the UK, the Advisory Council of which he was only an ordinary member at the relevant time was NOT unanimous, further the call for reclassification was led by another Professor, the UK’s Director of Mental Health. One leading scientist, arguably better informed than Professor Nutt, said that Nutt had played fast and loose with the statistics. Even Leslie Iversen who replaced Nutt was critical. Government chose caution when faced with strident competing views even from scientists. Nothing wrong with that. The clue is in the title “Advisory Council”. It gives advice, governments have wider issues to consider.
It is a fact that most reccomendations by the Advisory Council get accepted, there is more than a little humbug and arrogance in Professor Nutt’s display of ill humour when one marginal and difficult issue did not go his way. If scientists disagree, so fundamentally, as they did, somebody is wrong
Finally Professor Nutt’s hierarchy of harms and his new order for drugs (done with Professor Colin Blakemore & others). Was this scientific? It was done by “Delphic Analysis”, not much more than asking a selected list of people what they think. It is alleged that a majority did not reply. Of course to get anywhere near production of a replacement for alcohol, Nutt would have to change the current system. He tried and he failed. He will continue to fail