Examination of Witnesses (Questions 160-179)
PROFESSOR SIR
MICHAEL RAWLINS
AND PROFESSOR
DAVID NUTT
1 MARCH 2006
Q160 Dr Turner: Of course one of
the other facets of work of the Advisory Committee, or regulatory
committees that we have come across before, is that sometimes
decisions are not necessarily consistent because they depend on
who is there on any given day, so out of your large membership
what is the quorum, how many people are normally there, and do
you take any steps to try and ensure consistency of approach?
Professor Sir Michael Rawlins:
I think consistency is obviously something that I as Chairman
and Professor Nutt as Chairman of the Technical Committee would
want to make sure that we did not make inconsistent decisions.
I quite agree with you, that is very important. I cannot tell
you what the average attendance is offhand but I can write to
you afterwards and let you know, but it is 75% plus most of the
time as far as I am conscious of it. There are a few critical
people particularly on various discussions, but they all almost
invariably attend and so it works reasonably well.
Q161 Bob Spink: And the quorum?
Professor Sir Michael Rawlins:
Is seven.
Professor Nutt: I think the point
you make is a very important one because when I joined the ACMD
and took on the Chair of the Technical Committee, I was very exercised
by the potential for random decision-making based on individuals
being present or not. That is one of the reasons I have set up
this system of a very systematic appraisal so that all drugs we
appraise we do in the same way. We have the same parameters and
we have the same process, where possible, of having a detailed
up-to-date, scientific report, in order to try and even out some
of the possible inconsistencies.
Q162 Bob Spink: Could I just come
in here, Des. The ACMD is there to benefit society at large. What
do you think society at large would think about the over-representation
of liberal elements within the 38 people making up your body?
Professor Sir Michael Rawlins:
People with liberal views towards drugs?
Q163 Chairman: It is an accusation
that is often made against the Council that the Council has liberal
views?
Professor Sir Michael Rawlins:
By the Daily Mail.
Q164 Bob Spink: No, Chairman, could
I just say that I am not talking about the Daily Mail,
I am talking about the 90,000 people in Castle Point whom I am
elected to represent, who take a very strong view about the liberal
attitude towards the illegal use of drugs and the damage that
it does to individuals and to society.
Professor Sir Michael Rawlins:
I cannot answer the question as to either whether the membership
is liberal or how other people would view it. We are basically
a scientific advisory committee and we have to give advice on
the basis of the science as we see it. I would hope that the 90,000
people you represent would understand, if they had the opportunity
to sit there and listen, the reasons why we come to the conclusions
that we do. I would accept that it is very difficult to produce
in reports the flavour of the judgments that have to be made because
although ACMD is a scientific body, all advisory scientific bodies
have to make judgments, and those judgments are very difficult
to explain in written words, but I would hope that if your constituents
(some of them anyway) attended they would realise that the decisions
we reached and the conclusions we reached were ones that they
would understand why we reached them.
Q165 Bob Spink: It would perhaps
help them to understand if the ACMD published the minutes of its
meetings, for instance. Why do you not do that?
Professor Sir Michael Rawlins:
We have not done it to date. Anyone who asks would get a version
of it. There is sometimes material in the minutes that we would
need to remove because they are based on intelligence that would
not be appropriate in the public domain.
Q166 Bob Spink: Would my 90,000 constituents
think it was perhaps a little loose that you had 38 members, that
the membership of the your body was over-representative of the
liberal attitude to drug-taking, and that you have a necessity
of only seven people in a quorum to make decisions?
Professor Sir Michael Rawlins:
Sorry, the quorum is laid out in our instruments and I do not
think it has ever met with a small group like that. The other
question was about the liberal elements. I do not know whether
you would call them liberal or illiberal or whatever. What we
have to do, though, is realise that over the last 30 years the
use of drugs has dramatically increased in this country, and that
the criminal justice system has not prevented that in any way.
Q167 Bob Spink: Nor has the ACMD.
Professor Sir Michael Rawlins:
We do not know because we do not have a scientific basis to make
that assessment, with great respect. We do not have a control
trial of half the country with an ACMD and half the country without.
We do not know what would have happened. All we do know is that
in every Western society drug use has increased astronomically
despite all sorts of different approaches. The Americans give
20 years minimum to life for a second offence of having cannabis
in your pocket and that still has not made very much difference.
Crack cocaine in America is widely used. Penalties and the criminal
justice approach has not worked very well. It may have been worse
if we had not got it. Where I think we are all at fault, not just
the ACMD but all of us are at fault, is not being better at explaining
to young people particularly the dangers of drugs.
Chairman: Which is what makes it even
more surprising that there is not a stronger link between your
organisation and the Department for Education and Skills.
Q168 Mr Flello: I just wanted to
pick up on a point that was made. You have referred many times
to the fact that it was a scientific committee and you are looking
at the scientific base. With the greatest respect to the judges
and senior police officers that are on there, do you feel you
have got enough scientists?
Professor Sir Michael Rawlins:
The Council itself is broadly based. The Technical Committee is
much more focused on scientists, particularly clinical scientists
and social scientists.
Q169 Mr Flello: How many scientists
have you got on the Committee overall as a percentage?
Professor Sir Michael Rawlins:
I will have to write to you with that. I have not got it on me.
Q170 Dr Turner: Coming back to the
minutes, obviously if you did publish the minutes then any concerns
that people have about the transparency of your operations would
be greatly diminished. You said that you could not publish the
full minutes because some of the information was not suitable
for the public domain. The only circumstances I can think of for
that is if it concerned specific individuals or named specific
individuals. Is that the case? If so, can you not report it anonymously
in the minutes?
Professor Sir Michael Rawlins:
Yes, there are also some intelligence matters that would be inappropriate
to be in the public domain, but it is a couple of lines, that
is all. It would not be a major issue.
Chairman: Can I move on to you, Brooks.
Q171 Mr Newmark: An important part
of everything that we are doing and that you are doing comes down
to the evidence and hard evidence—and I will go into what
I would define as hard evidence a bit later on. As a start, do
you see the role of the ACMD to contribute to the evidence base
or merely to review it?
Professor Sir Michael Rawlins:
It is primarily to review the existing evidence base, although
individual members professionally are involved in capturing information
and data. Primarily we are there to examine the evidence that
is available.
Q172 Mr Newmark: You are both intelligent
individuals and you are clearly going to find gaps, I suspect,
in that evidence. Do you have the power to commission any academic
research or any study to fill that gap that you and your team
might well identify?
Professor Sir Michael Rawlins:
To some extent, yes.
Professor Nutt: We do not have
the resources to do extensive novel research. I think the point
you are hitting on is an important one and linking with organisations
that might have those resources is, I think, something we should
be looking to do. I am particularly concerned that the ACMD is
embedded in the Home Office and the Home Office does not have
any particular representation at the MRC. I have written to Colin
Blakemore about that. Obviously the Department of Health has representation
but the Home Office does not. I think that is a possible reason
why there is a mismatch between research needs in addiction and
research outcomes.
Q173 Mr Newmark: That is something
you maybe could take away to your Committee and try and achieve
that objective? It seems fairly common sense to me.
Professor Sir Michael Rawlins:
We will also talk to Colin Blakemore about it and ESRC as well.
Q174 Mr Newmark: To Professor Nutt:
when did you develop the risk assessment matrix and what role
has it played in the ACMD's deliberations?
Professor Nutt: The matrix was
developed when I was working on the Runciman Report because it
became quite clear that we did not have any systematic way of
conceptualising the range of harms and any way of properly categorising
them and rating them, so that was very much a pilot. When I became
a member of the ACMD and Chairman of the Technical Committee,
we set in process this procedure of getting all the members of
the Technical Committee to work through in a systematic way the
drugs, doing about four or five drugs a meeting. We have two meetings
a year and we slowly worked through the drugs in the Act.
Q175 Mr Newmark: Is there a direct
relationship then between the scores given to a drug using your
matrix and the recommendations made by the ACMD about respective
classifications?
Professor Nutt: There are anomalies,
there is no question about that. One of the anomalies is buprenorphine
which we suggested was moved up. Another anomaly was cannabis
which we suggested was moved down. As you almost certainly know,
another anomaly was ecstasy. We have not progressed that at present
because, as Sir Michael said, the evidence on which to do a systemic
review in terms of the real harms of ecstasy has been a bit slow
in coming.
Q176 Dr Harris: Is it possible to
use a scientifically-based scale of harm to determine the illegal
status of a drug? I notice your matrix has "other things"
in there.
Professor Nutt: I think it can
inform. It depends how you want to make laws. I suppose you could
just add the numbers up and say that is how the law would be,
but I suspect you would always want to look at other factors,
particularly the prevalence of the drug in society, which obviously
is major factor in terms of the harm.
Q177 Dr Harris: I was intrigued—and
this maybe goes back to Dr Iddon's point—Professor Blakemore
has argued for a scientifically-based scale of harm for all drugs
with alcohol and tobacco included in some form of calibration.
I am curious as to your thoughts on that.
Professor Nutt: I think it is
a very sensible idea.
Professor Sir Michael Rawlins:
I think inevitably, as David says, it will inform the decision
but it will not determine it. These things cannot be entirely
algebraic.
Q178 Dr Harris: You have not done
that. You have got this matrix that you sent us, which you did
not send us originally but you kindly supplied it later, which
is very interesting and I think it is possibly among your interesting
memorandum the most interesting. If you did this scale and you
put in tobacco and alcohol then that would be a useful thing.
I cannot understand, since you have agreed it would be useful,
why you have not done it, unless it would show that the current
ABC would not—
Professor Sir Michael Rawlins:
We can send to you the paper that David has been preparing.
Professor Nutt: We have done this.
Q179 Dr Harris: Has it been published?
Professor Nutt: No, it has not
but the plan is to send it to The Lancet, get it peer reviewed,
and hopefully have it in the public domain.
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