Alcohol, drugs and science-based policy

By Bob Carling
9 Nov 2010

According to drugs expert David Nutt, alcohol is the most dangerous drug in our society, beating crack cocaine and heroin by a significant margin in “harm to others”. By publishing in the authoritative medical journal The Lancet, [1] Professor Nutt has again opened up the debate about public policy with respect to chemicals that humans use recreationally. [2]

He and his associates claim that the method they used “distinguishes between facts and value judgments about the facts”, and that the “process provides a powerful means to deal with complex issues that drug misuse presents”. Their results “accord with the conclusions of previous expert reports that aggressively targeting alcohol harms is a valid and necessary public health strategy”.

Moreover, they also said that their “findings [confirm] that the present drug classification systems have little relation to the evidence of harm”. Hence the political storm.

In 2009, Nutt was of course famously dismissed as the governments’ Drug Tsar by the then Home Secretary Alan Johnson, because he had dared to use his knowledge of scientific research to suggest that government policy on drug abuse needed to be changed.

The Advisory Council on the Misuse of Drugs (ACMD), which Nutt then chaired, suggested that cannabis should remain as a class C drug and that ecstasy should be downgraded from class A. Although the ACMD argued at that time that there was good quality evidence that cannabis and ecstasy were less harmful than other drugs, and hence the policy suggestion, it was claimed that such scientific evidence was overruled for political reasons.

The phrase “ecstasy is safer than alcohol” stuck somewhat in many throats. But because Alan Johnson had said that he was “big enough, strong enough, bold enough” to sack Nutt for saying such ‘soft drugs’ were less harmful than alcohol, Nutt bewailed politicians’ “desire for political machismo rather than evidence”. [3]

There have been previous calls to change alcohol policy on the basis of scientific research, following the Royal College of Psychiatrists’ report back in 1979 “Alcohol and Alcoholism” [4] in which it was argued that a reduction in the general consumption of alcohol generally in society leads to less prevalence of alcoholism.

Total prohibition clearly doesn’t work – it just drives alcohol consumption underground, as in the time of prohibition in the USA in the 1920s and 1930s. But Professor Nutt’s organisation, the Independent Scientific Committee on Drugs (ISCD), which he set up after he left the ACMD, says that there is a need for an independent body “to investigate and review the scientific evidence relating to drugs, free from political concerns … to provide accessible information on drugs to the public and professionals … [and to] address issues surrounding drug harms and benefits; regulation and education; prevention, treatment and recovery.” [5]

So when should scientists speak out on public policy? As Professor Nutt’s experience shows, it can be dangerous for one’s career if one speaks out about science policy in the context of such a public post such as the ACMD. But scientists are as much a part of culture as lawyers or teachers or politicians.

There is always a political dimension to science – even the most esoteric of science research is not done is a rational bubble, immune from culture’s influence, if only for funding reasons. But this does require that scientists have a responsibility to communicate clearly the reasons for their interests to the wider culture in which they live and work.

This of course, means getting involved in the murky world of public relations and journalism, areas for which scientists have generally not got the best reputation. Many have had their hands burnt previously and therefore choose not to speak to the press about their research.

The reasons for this are understandable. One has only to think of the sorry story of Dr David Kelly’s questioning of the reasons for going into the Iraq war, although the jury is still out on whether the pressure on him led him to suicide.

Within the medical fraternity the emphasis on evidence-based medicine (EBM) has arguably rooted medicine in culture more firmly in the layperson’s mind as being solid and reliable, despite continuing horror stories.

Although the equivalent rallying call of ‘evidence-based science’ does not exist, there are signs that science is developing a groundswell of expertise in handling the question of science communication. [6] And there are some high-profile scientists and science journalists who are getting good at science communication – for example, the physicist Brian Cox [7] and the trenchant critic of pseudo-science, Ben Goldacre [8] But truly science-based policy decision making is still struggling in such controversial areas as substance abuse.

Added to this is the pastoral element to substance abuse. How can a distinctively Christian voice contribute to this public policy debate, bearing in mind the personal cost to society? Derrett Watts, consultant psychiatrist and an expert on addiction, points out that alcohol has a huge cost: “Alcohol misuse is linked to 70 per cent of accident and emergency attendances between midnight and 5am, to 125,000 facial injuries per year, to 60–70 per cent of domestic assaults, and to 23 per cent of child neglect cases.” [9]

He goes on to talk about the effects of alcohol on hypertensive disease, mental and behavioural disorders, cardiac arrythmias as well as assaults, falls, epilepsy, spontaneous abortion and alcoholic liver disease. “Liver disease now ranks fifth for causes of death in the UK, and is rising, while the four causes of death above it have rates that are falling.”

While pointing out that “interventions in this field do work”, he also points out that there is a huge stigma attached to substance abuse sufferers, which he parallels to the stigma attached to leprosy sufferers in biblical times. Just as in the story of the man with leprosy who came to Jesus, Jesus was approachable, caring, responsive and effective in using the ability he had. “Surely these are the same characteristics we are called to use with all patients, including those with substance misuse?”

How these characteristics might translate into public policy is for those involved with addiction at the coal-face, as well as ex-drug tsars.

References

[1] Drug harms in the UK: a multicriteria decision analysis. The Lancet, Volume 376, Issue 9752, pp. 1558–1565, 6 November 2010. The full paper is available to read for free on the Lancet website.
[2] Alcohol 'more harmful than heroin or crack'. http://tinyurl.com/2bgycsv
[3] Macho madness over cannabis: flawed drug policies in both hemispheres. http://tinyurl.com/34ge7be
[4] Alcohol and Alcoholism, Report of a Special Committee of the Royal College of Psychiatrists. Tavistock Publications, London, 1979. 162 pp.
[5] From the ICSD website, http://www.drugscience.org.uk/about-us.html
[6] For example, the British Science Association (formerly the British Association), http://www.britishscienceassociation.org/web/AboutUs/index.htm, the Science Media Centre, http://www.sciencemediacentre.org and Sense About Science http://www.senseaboutscience.org.uk/
[7] http://www.apolloschildren.com/brian/
[8] Bad Science, http://www.badscience.net/
[9] Drugs and Alcohol: Why should we Care? http://tinyurl.com/26kkwar

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© Bob Carling is a zoologist/pharmacologist with 30 years' experience in science and medical publishing. He is a writer and speaker on ‘science in society’, philosophy/theology of science, and environmental ethics. Dr Carling advises Ekklesia on science-related issues (http://www.ekklesia.co.uk/BobCarling). His LinkedIn page can be found here: http://uk.linkedin.com/in/bcarling

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