November 02, 2009

Please, just give us *nice* independent advice

Leaf litter 2Practical Ethics: Speaking truth to power - about the affair caused by the sacking of professor David Nutt from the Advisory Council on the Misuse of Drugs since he had criticised how the government has been systematically ignored or distorted the scientific evidence on drug harms.

It is an interesting demonstration of how the political sphere is less interested in truth and evidence and more in maintaining the social and political structure. "Independent" advisers should ideally provide trustworthiness but not challenge government policies, and should definitely stay loyal to whoever appointed them. At the same time scientists may be less able to do politics well: it requires skills of negotiation and compromise. Scientific results are not open to negotiation or compromise (at worst, they are open to interpretation - but then they are not very good results).

Nutt has written quite a few interesting papers and made fun points.

He has considered whether we could re-engineer alcohol to retain the good effects while limiting the bad ("Alcohol alternatives a goal for psychopharmacology?" Journal of Psychopharmacology 2006 20: 318-320 - see also the discussion in this issue).

He has warned against the scourge of Equasy addiction, causing far more harm per exposure than ecstasy yet completely ignore by lawmakers. (
Equasy a harmful addiction with implications for the current debate on drug harms Journal of Psychopharmacology, 23(1) (2009) 35 )

He has pushed for evidence-based harm scales for drugs, which of course do not fit with current legal scales. Especially since he doesn't treat tobacco and alcohol any differently from heroin and LSD. (David Nutt, Leslie A King, William Saulsbury, Colin Blakemore, Development of a rational scale to assess the harm of drugs of potential misuse, Lancet 2007; 369: 104753)

In one of the papers causing the flurry, Estimating Drug Harms: a risky business there is a very revealing table of how often deaths from different drugs are reported in the news:

Drug Toxicological statistics Newspaper reports Toxicology to newspaper ratio
All cases 2255 546 4:1
Asprin/Salicylate 12 0 -
Paracetamol 265 1 265:1
Diazepam 481 10 48:1
Temazepam 369 25 15:1
Morphine 431 6 72:1
Amphetamines 36 13 3:1
Cocaine 30 4 8:1
Heroin/Diamorphine 342 75 5:1
Methadone 460 29 16:1
Ecstasy/MDMAa 28 26 1:1

(data is from Alasdair J.M Forsyth, Distorted? a quantitative exploration of drug fatality reports in the popular press, International Journal of Drug Policy, 12:5, p. 435-453 (2001))

While every death from ecstasy was reported in the press, none of the deaths from aspirin and just one in 265 from paracetamol were reported! Clearly it is big news that somebody dies from amphetamine or heroin, while diazepam (also known as Valium) deaths are uninteresting.

I wonder whether there is a harm reduction strategy for governments?

Posted by Anders3 at November 2, 2009 09:48 PM