It's always nice when a local boy makes good in the big wide world. Many British neuroscientists and psychiatrists have been feeling rather proud this week following the enormous amount of attention given to Professor David Nutt, formerly the British government's chief adviser on illegal drugs.

Formerly being the key word. Nutt was sacked (...write your own "nutsack" pun if you must) last Friday, prompting a remarkable amount of condemnation. Critics included the rest of his former organisation, the Advisory Council on the Misuse of Drugs (ACMD), and the Government's Science Minister. The UK's Chief Scientist also spoke in favour of Nutt's views. Journalists joined in the fun with headlines like "politicians are intoxicated by cowardice".

Even Nature today ran a bluntly-worded editorial -

"The sacking of a government adviser on drugs shows Britain's politicians can't cope with intelligent debate... the position of the Labour government and of the leading opposition party, the Conservatives, which vigorously supported Nutt's sacking, has no merit at all. It deals a significant blow both to the chances of an informed and reasoned debate over illegal drugs, and to the parties' own scientific credibility."

They also have an interview with the man himself.


What happened? The short answer is a lecture Nutt gave on the 10th October, Estimating Drug Harms: A Risky Business? I'd recommend reading it (it's free). The Government's dismissal e-mail gave two reasons why he had to go - firstly, "Your recent comments have gone beyond [matters of evidence] and have been lobbying for a change of government policy" and secondly, "It is important that the government's messages on drugs are clear and as an advisor you do nothing to undermine public understanding of them."

Many people believe that Nutt was fired because he argued for the liberalization of drug laws, or because he claimed that the harms of some illegal drugs, such as cannabis, are less severe than those of legal substances like tobacco and alcohol. On this view, the government's actions were "shooting the messenger", or dismissing an expert because they didn't like to hear to the facts. It seems to me, however, that the truth is a little more nuanced, and even more stupid.



Nutt's lecture, if you read the whole thing as opposed to the quotes in the media, is remarkably mild. For instance, at no point does he suggest that any drug which is currently illegal should be made legal. The changes he "lobbies for" are ones that the ACMD have already recommended, and this lobbying consists of nothing more than tentative criticism of the stated reasons for the rejection of the ACMD's advice. The ACMD is government's official expert body on illicit drugs, remember.

The issue Nutt focusses on is the question of whether cannabis should be a "Class C" or a "Class B" illegal drug, B being "worse", and carrying stricter penalties. It was Class B until 2004, when it was made Class C. In 2007, the Government asked the ACMD to advise on whether it should be re-reclassified back up to Class B. This was in response to concerns about the impact of cannabis on mental health, specifically the possibility that it raises the risk of psychotic illnesses.

The resulting ACMD report is available on the Government's website. They concluded that while cannabis use is certainly not harmless, "the harms caused by cannabis are not considered to be as serious as drugs in class B and therefore it should remain a class C drug."

Despite this, the Government took the decision to reclassify cannabis as Class B. In his lecture Nutt criticizes this decision - slightly. Nutt quotes the Home Secretary as saying, in response to the ACMD's report -

"Where there is a clear and serious problem [i.e. cannabis health problems], 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."

Nutt describes this reasoning as -

"the precautionary principle - if you’re not sure about a drug harm, rank it high... at first sight it might seem the obvious decision – why wouldn’t you take the precautionary principle? We know that drugs are harmful and that you can never evaluate a drug over the lifetime of a whole population, so we can never know whether, at some point in the future, a drug might lead to or cause more harm than it did early in its use."

But he says, there's more to it than this. Firstly, we don't know anything about how classification affects drug use. The whole idea of upgrading cannabis to Class B to protect the public relies on the assumption that it will reduce drug use by deterring people from using it. But there is no empirical evidence as to whether this actually happens. As Nutt points out, stricter classification might equally well increase use by making it seem forbidden, and hence, cooler. (If you think that's implausible, you have forgotten what it is like to be 16.) We just don't know.

Second, he says, the precautionary principle devalues the evidence and is thereby self-defeating because it means that people will not take any warnings about drug harms seriously - "[it] leads to a position where people really don’t know what the evidence is. They see the classification, they hear about evidence and they get mixed messages. There’s quite a lot of anecdotal evidence that public confidence in the scientific probity of government has been undermined in this kind of way." Can anyone really dispute this?

Finally, he raises the MMR vaccine scare as an example of the precautionary principle ironically leading to concrete harms. Concerns were raised about the safety of a vaccine, on the basis of dubious science. As a result, vaccine coverage fell, and the incidence of measles, mumps and rubella in Britain rose for the first time in decades. The vaccine harmed no-one; these diseases do. We just don't know whether cannabis reclassification will have similar unintended consequences.

That's what the Home Secretary described as "lobbying for a change of government policy". I wish all lobbyists were this reasonable.

The Home Secretary's second charge against Nutt - "It is important that the government's messages on drugs are clear..." - is even more specious. Nutt's messages were the ACMD's messages, and as he points out, the only lack of clarity comes from the fact that the government and their own Advisory Council disagree with each other. This is hardly the ACMD's fault, and it's certainly not Nutt's fault for pointing it out.

All of this is doubly ridiculous because of one easily-forgotten fact - cannabis was downgraded from Class B to Class C in 2004 by the present Labour Party government. Nutt's "lobbying" therefore consists of a recommendation that the government do something they themselves previously did. And if the government are worried about the clarity of their message, the fact that they themselves were saying that cannabis was benign enough to be a Class C drug just 5 years ago might be somewhat relevant.


Nature (2009). A drug-induced low Nature, 462 (7269), 11-12 DOI: 10.1038/462011b

Daniel Cressey (2009). Sacked science adviser speaks out Nature

Which is more dangerous, taking ecstasy or riding a horse?

This is the question that got Professor David Nutt, a British psychiatrist, into a spot of political bother. Nutt is the Editor of the academic Journal of Psychopharmacology. He recently published a brief and provocative editorial called "Equasy".

Equasy is a fun read with a serious message. (It's open access so you can read the whole thing - I recommend it.) Nutt points out that the way in which we think about the harms of illegal drugs, such as ecstasy, is unlike the way in which we think about other dangerous things such as horseriding - or "equasy" as he dubs it:

The drug debate takes place without reference to other causes of harm in society, which tends to give drugs a different, more worrying, status. In this article, I share experience of another harmful addiction I have called equasy...

He goes on to describe some of the injuries, including brain damage, that you can get from falling off horses. After arguing that horseriding is in some ways comparable to ecstasy in terms of its dangerousness he concludes:

Perhaps this illustrates the need to offer a new approach to considering what underlies society’s tolerance of potentially harmful activities and how this evolves over time (e.g. fox hunting, cigarette smoking). A debate on the wider issues of how harms are tolerated by society and policy makers can only help to generate a broad based and therefore more relevant harm assessment process that could cut through the current ill-informed debate about the drug harms? The use of rational evidence for the assessment of the harms of drugs will be one step forward to the development of a credible drugs strategy.

Or, in other words, we need to ask why we are more concerned about the harms of illicit drugs than we are the harms of, say, sports. No-one ever suggests that the existence of sporting injuries means that we ought to ban sports. Ecstasy is certainly not completely safe. People do die from taking it and it may cause other more subtle harms. But people die and get hurt by falling off horses. Even if it turns out that on an hour-by-hour basis, you're more likely to die riding a horse than dancing on ecstasy (quite possible), no-one would think to ban riding and legalize E. But why not?

This attitude raises the critical question of why society tolerates –indeed encourages – certain forms of potentially harmful behaviour but not others, such as drug use.

Which is an extremely good question. It remains a good question even if it turns out that horse-riding is much safer than ecstasy. These are just the two examples that Nutt happened to pick, presumably because it allowed him to make that cheeky pun. Comparing the harms of such different activities is fraught with pitfalls anyway - are we talking about the harms of pure MDMA, or street ecstasy? Do we include people injured by horses indirectly (e.g. due to road accidents?)

Yet the whole point is that no-one even tries to do this. The dangerousness of drugs is treated as quite different to the dangerousness of sports and other such activies. The media indeed seem to have a particular interest in the harms of ecstasy - at least according to a paper cited by Nutt, Forsyth (2001), which claims that deaths from ecstasy in Scotland were much more likely to get newspaper coverage than deaths from paracetemol, Valium, and even other illegal drugs. It's not clear why this is. Indeed, when you make the point explicitly, as Nutt did, it looks rather silly. Why shouldn't we treat taking ecstasy as a recreational activity like horse-riding? That's something to think about.

Professor Nutt is well known in psychopharmacology circles both for his scientific contributions and for his outspoken views. These cover drug policy as well as other aspects of psychiatry - for one thing, he's strongly pro-antidepressants (see another provocative editorial of his here.)

As recently-appointed Chairman of the Advisory Council on the Misuse of Drugs - "an independent expert body that advises government on drug related issues in the UK" - Nutt might be thought to have some degree of influence. (He wrote the article before he became chairman). Sadly not, it appears, for as soon as the Government realized what he'd written he got a dressing down from British Home Secretary Jacqui Smith - Ooo-er:

For me that makes light of a serious problem, trivialises the dangers of drugs, shows insensitivity to the families of victims of ecstasy and sends the wrong message to young people about the dangers of drugs.

I'm not sure how many "young people" or parents of ecstasy victims read the Journal of Psychopharmacology, but I can't see how anyone could be offended by the Equasy article. Except perhaps people who enjoy hunting foxes while riding horses (Nutt compares this to drug-fuelled violence). Nutt's editorial was intended to point out that discussion over drugs is often irrational, and to call for a serious, evidence-based debate. It is not really about ecstasy, or horses, but about the way in which we conceptualize drugs and their harms. Clearly, that's just a step too far.

[BPSDB]

D. Nutt (2008). Equasy -- An overlooked addiction with implications for the current debate on drug harms Journal of Psychopharmacology, 23 (1), 3-5 DOI: 10.1177/0269881108099672