Editorials

Clashes between the government and its expert advisers

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b4662 (Published 11 November 2009) Cite this as: BMJ 2009;339:b4662
  1. Michael Gossop, head of research1,
  2. Wayne Hall, head of research2
  1. 1National Addiction Centre, Institute of Psychiatry, King’s College, London SE5 8AF
  2. 2School of Population Health, University of Queensland, Herston, QLD 4006, Australia
  1. m.gossop{at}iop.kcl.ac.uk

    Advisers need clearer rules on how to express contrary views

    In the United Kingdom, experts advise and government ministers make policy with no obligation to accept their experts’ advice. For example, ministers have often declined to accept expert advice to raise alcohol taxes as a way of reducing problem drinking.1 The recent sacking of Professor David Nutt from the chairmanship of the Advisory Council on the Misuse of Drugs (ACMD) occurred because a minister rejected the recommendations of an expert adviser who continued publicly to express a view that was contrary to government policy.

    The question of how science should be used to formulate government policy has been a problem on many occasions, in the UK and elsewhere. Disagreements between government and experts on the risks of bovine spongiform encephalopathy (BSE) from eating beef in the late 1990s prompted the reformulation of rules on the use of scientific evidence in developing policy. In the BSE affair, ministers discounted expert advice that the disease in cows might spread to humans, and the official BSE Inquiry subsequently recommended that the advice and the reasoning of expert advisory committees should be open and transparent.2

    The circumstances leading up to the sacking of Professor Nutt can be traced back to the request in 2007 by the home secretary for the ACMD to reassess the risks of cannabis use and its classification. The council’s response to the home secretary’s request was contained in its 2008 report.3 After a detailed review of the evidence, the ACMD advised against changing the classification of cannabis from a class C drug to a class B one (equivalent in its harms to amphetamines). This advice was rejected by the previous home secretary and the current one, Alan Johnson, as conflicting with what the government regarded as widely held public concerns about the risks of using cannabis and ecstasy. In January 2009, the government moved cannabis back into class B to avoid “sending mixed messages.” What has caused the trouble is that the ACMD chair subsequently continued to express views on the comparative harms of cannabis, alcohol, and other illicit drugs, even though his views reflect those of many other experts in the addictions field.

    Alan Johnson sacked Professor Nutt because he had “lost confidence” in him. The immediate cause was the publication of a lecture given by him to the centre for crime and justice studies at King’s College London.4 In this paper, Professor Nutt argued that ecstasy and lysergide (LSD) were less harmful than alcohol and cigarettes and criticised the decision to reclassify cannabis. Professor Nutt outlined the evidence for the ACMD’s advice on the reclassification of cannabis, which included a survey of expert opinion on the relative harms of different substances that he and colleagues published in a paper in the Lancet in 2007.5 Such views were seen by the home secretary as likely to confuse the public and to damage the government’s efforts to give clear messages about the dangers of drugs.

    What should expert advisers do when government rejects their advice? Some may argue that if experts strongly disagree with government policy then resignation is the best course of action because it frees them to express their views. But expert advisers are not obliged to resign or remain silent. They are scientists, academics, or clinicians who serve as advisers on a voluntary and mostly, as with ACMD, on an unpaid basis. They have independent careers, and their views are based on extensive knowledge and experience in their specialist fields. It is in the wider interests of society that they should be allowed, and indeed, encouraged to contribute to the public debate about these important matters.

    If a politician does not accept their views, experts cannot be expected to renounce these views or to maintain a vow of silence. Official guidelines for scientific committees recognise this. These rules explicitly state that members are free to express their views as long as they make it clear that they are speaking as individuals rather than as members of advisory committees.6 Richard Garside, director of the centre for crime and justice studies which hosted Professor Nutt’s lecture, has argued that Professor Nutt behaved in accordance with these rules in that he clearly spoke in his personal professional capacity rather than as chair of ACMD.7 Professor Nutt’s affiliation and the content of the published paper are consistent with this claim.4

    The dismissal of Professor Nutt raises important matters about the freedom of expert advisers to express opinions contrary to government policy. If these problems are not tackled, eminent scientists and clinicians will be deterred from serving as expert advisers to government. This cannot be in the public interest. Nor will it serve the public interest if the credibility of “independent advice” is undermined. This is a real risk if members of expert advisory committees are seen to be selected for their agreement with government policy or their willingness to remain silent when they disagree.

    Expert advisers must be able to provide advice to governments that remains free from political interference. To that end we need much clearer and agreed rules on how expert advisers can express contrary views if they disagree with government policy. Such rules are essential if governments are to have access to the best independent advice that is fully deserving of public confidence.

    Notes

    Cite this as: BMJ 2009;339:b4662

    Footnotes

    • Competing interests: MG was specialist adviser on drugs to the House of Commons Science and Technology Select Committee (2006) that looked at drug classification; he is also a member of the Ministry of Justice Criminal Services Accreditation Panel. WH advised the Advisory Council on the Misuse of Drugs (ACMD) on drug related deaths in 1999. He made a submission to the ACMD in 2008 about the proposed reclassification of cannabis and in 2008 he worked with Professor Nutt as part of a team of six ethicists and addiction researchers preparing a report for the European Monitoring Centre on Drugs and Drug Addiction on the ethical implications of neuroscience research on addiction.

    • Provenance and peer review: Commissioned; not externally peer reviewed.

    References