Views & Reviews Personal View

The highs and lows of policy based evidence

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4564 (Published 04 November 2009) Cite this as: BMJ 2009;339:b4564
  1. David Colquhoun, professor of pharmacology, University College London
  1. d.colquhoun{at}ucl.ac.uk

    Remember George W Bush? For him it was simple. If a scientist told him an inconvenient truth, the messenger was fired, and someone more compliant got the job. In every area from global warming to the existence of weapons of mass destruction he chose to base policy on fantasy and wishful thinking. It seems that the UK home secretary, Alan Johnson, has something in common with Bush. When the Advisory Council on the Misuse of Drugs (ACMD) said something he didn’t like, its chairman, David Nutt, got fired (BMJ 2009;339:b4563, doi:10.1136/bmj.b4563).

    In a democracy there is no doubt that decisions must be made by politicians. Sceptical though one may be about politicians, I’m not sure that I’d want to live in a country ruled by scientists. Politicians have wider responsibilities than scientists, and they can be voted out if we don’t like the decisions. Why, then, the explosion of indignation when Professor Nutt got the sack?

    In the House of Commons Mr Johnson said, “I asked Professor Nutt to resign as my principal drugs adviser, not because of the work of the council but because of his failure to recognise that, as chair of ACMD, his role is to advise rather than to criticise government policy on drugs.” But Mr Johnson had it wrong. Nutt, unlike, for example, the chief scientific adviser, is not a civil servant. He is an academic. It is his job to be independent. He is paid nothing for all his hard work on the ACMD. He has a day job to do as well. It is his job to criticise whatever he thinks it right to criticise.

    The ACMD was set up by the Misuse of Drugs Act 1971[2]. Section 1 of the Act makes it clear that the duties of the council are to offer advice to ministers, “where either the Council consider it expedient to do so or they are consulted by the Minister.” They do not have to wait to be asked.

    Nutt didn’t wait, and he got fired. Twitter was ablaze, quickly followed by the mainstream media.

    This furore arose simply because Nutt said that cannabis was less dangerous than tobacco and alcohol (true) and that more people were killed and brain damaged from riding accidents than from ecstasy (also true). His Eve Saville lecture, for the Centre for Crime and Justice Studies at King’s College London, seems to have been the immediate problem. There is nothing in the paper that directly criticises the prime minister or the home secretary, and there is nothing in the rules that says his academic publications have to be cleared with the Home Office.

    Don’t worry though, we have a democratic system, with an opposition. But the shadow home secretary, Chris Grayling, didn’t oppose. On the contrary he said, “Let me start by reiterating my view that the home secretary’s decision on Friday regarding Professor Nutt’s future was the right one.”

    Luckily there was a doctor in the House. The Liberal Democrat MP Evan Harris said, “With every personal attack on David Nutt, and every piece of cod science [Alan Johnson has] produced, the home secretary deepens the crisis of mistrust between scientists and the government. The scientific community will not take this lying down—and sources of government advice are likely to dry up.”

    Harris hit the nail on the head: who on earth will want to spend years of unpaid work to produce the best evidence they can and then get abused and fired for their efforts? Politicians are apt to invoke the precautionary principle when discussing illegal drug use, but it isn’t quite as simple as that. The precautionary principle can result in harm to people. Perhaps the reason for including ecstasy with heroin in class A was to make people think that ecstasy was as dangerous as heroin (not true, but precautionary). But it is just as likely that people will conclude that heroin is as safe as ecstasy. That’s the danger of lying, however good the motives.

    In a sense, we owe Nutt a great debt. His problems have brought to a head the crisis in the relations between science and government. This is only the latest case in a long history of politicians basing their decisions on ideas that are simply untrue. That cannot be good for anyone. The Department of Health has for years ignored the evidence about alternative medicine. It is nothing short of surreal that the House of Commons Science and Technology Committee is now, in 2009, holding hearings to assess the evidence about whether pills that contain nothing whatsoever can cure diseases. The widely expected change in government is not likely to help, judging by the support given to Mr Johnson by the shadow home secretary. The Tories may not go quite as far as their MP David Tredinnick, who asked a parliamentary question about the need for research into homoeopathic borax as a cure for foot and mouth disease.

    It would be tragic if this sorry affair were to discourage honest scientists from trying to offer honest advice. I have the impression that we need a few more doctors in the House.

    Notes

    Cite this as: BMJ 2009;339:b4564

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