Examination of Witnesses (Questions 180-199)
PROFESSOR SIR
MICHAEL RAWLINS
AND PROFESSOR
DAVID NUTT
1 MARCH 2006
Q180 Dr Harris: Has there been a
delay? If you have done it, why not publish it?
Professor Nutt: Because it takes
some time. It is an iterative process. There are four authors
and it has taken some time. It is not trivial writing a quality
paper for The Lancet.
Professor Sir Michael Rawlins:
David is more than willing to share a draft (I have not been party
to it) with the Committee.
Q181 Mr Newmark: Professor, you discussed
the importance of science, yet to what extent can an assessment
of the parameters that are used in the assessment matrix be objective
and how much of it ends up being more a judgment call or subjective?
I raise that question because the ACMD told us that social harms
tended to be "the weakest data set because of the inherent
problem of gathering relevant information." For example,
there is often little reliable evidence—and again I quote
here—"about the quality and potency of material used
by consumers, their pattern consumption, and the social consequences
of their use". That is not scientifically based. That comes
down to as much to a judgment call or a subjective decision.
Professor Sir Michael Rawlins:
Absolutely. I think it is very important that the Select Committee
understands that scientific advisory committees look at science
but they also have to make judgments. I have been on scientific
advisory committees for 25 years and I have been very conscious
that there are judgments that have to be made, and they really
fall into two groups. There are scientific judgments that you
have to make. There are judgments that you have to make about
the reliability of the evidence, how generalisable it is, how
good it is, is it flawed in some way, and so on, because the scientific
evidence is never perfect, it has always got gaps it in. Bodies
like the ACMD also have to make social judgments, and that is
the difficult part in many respects. Many scientific committees
have difficulties over this and over the years I have become more
and more uneasy about social judgments because I am not sure that
scientists are the right people to make them. The ACMD, I think,
is very fortunate in having at least a broad range of views so
that those sorts of judgments do have some sort of resonance,
but I think it is an area which is not just confined to the ACMD
because almost every scientific advisory committee that I have
ever been on has had to make these social judgments too, and in
another organisation called NICE we have set up a Citizens' Council
to help us in getting that, but it is a difficult area and I am
very grateful to you for raising the judgment bit.
Q182 Chairman: I think that is exactly
what this inquiry is about—actually seeing in terms of making
critical judgments (which in fact can take away somebody's liberty
for a long period of time) that we have a situation as to where
is the balance of evidence between, if you like, the scientific
evidence, which I accept is always flawed at the margins at any
rate and indeed the sociological evidence which you have got to
make decisions on, and that is why we are having this inquiry
because I think it is absolutely crucial that we get to that.
In terms of the participatory committee which NICE have set up,
why do you not do that yourselves?
Professor Sir Michael Rawlins:
Maybe we should. The NICE Citizens' Council is very much an experiment.
I do not think any other organisation in the country has done
anything quite like this. Dr Harris is giving one of those old-fashioned
looks.
Q183 Dr Harris: It is a focus group.
Professor Sir Michael Rawlins:
It is not, no, it is much more than a focus group.
Q184 Dr Harris: Do you think that
the people who make decisions like citizens' juries in the case
of NICE, about whether you let older people die because you want
to treat younger people first should be made by elected representatives
who are accountable rather than, let me be more polite, a glorified
focus group?
Professor Sir Michael Rawlins:
Yes except, by and large, elected representatives find those sorts
of decisions very difficult to take and over the years they have
not really done it, with great respect.
Q185 Dr Harris: We can agree that
it ought to be done and if they are cowards then you are forced
to go down a less satisfactory path. On this issue of the social
harms, let us just deal with this point about science. Is what
you are saying because it is harder to measure social harms because
social scientists would claim they are scientists it is a softer
outcome?
Professor Sir Michael Rawlins:
No, I am not saying that at all. I am saying the work has just
not been done for all sorts of logistic reasons. This is a very
difficult area. For example, on the strengths of tetrahydrocannabinol,
THC, the main active ingredient of cannabis, the strengths that
we know of is from that which has been seized by law enforcement
officers. Whether that relates to what people are actually using
is a different matter. We have no idea and collecting what people
are using is not so easy. I have never bought cannabis so I do
not know where you would buy it from, but you have really got
to go to the consumers and find out what they are using, not what
the law enforcement officers have seen. That is just an example.
Chairman: We are going to return to that
when we are dealing with cannabis.
Q186 Dr Harris: You said you did
not think scientists were best placed to measure social effects.
Professor Sir Michael Rawlins:
No.
Q187 Dr Harris: I was not disagreeing
with you. I just think what you are saying is that it is harder
to measure and you would rather scientists did it than artists.
Professor Sir Michael Rawlins:
There are two aspects. One is social sciences and the sociology
and of course they can measure that. It is the values of a community
and a society which are much more difficult to capture.
Q188 Dr Harris: In this matrix you
include under "social harms" intoxication, health care
costs, and other social harms. Included under "other social
harms" do you include the harm that stems from criminalisation
itself?
Professor Sir Michael Rawlins:
Yes.
Q189 Dr Harris: You do not spell
that out but that is understood?
Professor Sir Michael Rawlins:
Yes and whether it leads to acquisitive crime.
Q190 Dr Harris: You think it should
feature more highly in your parameters or not because it is not
scientific?
Professor Sir Michael Rawlins:
It is scientific. It is a matter of weighting.
Q191 Dr Harris: I am just asking
the question.
Professor Sir Michael Rawlins:
I know it is something that David has been thinking about. One
of the reasons why they have not published their paper is whether
one should weight certain aspects more than others in the matrix.
Bob Spink: I am becoming a little worried,
Chairman, about the way in which the ACMD arrives at its decisions
within this rather big body of 38 people. On crystal methylamphetamine,
for instance, I notice that Judge Joseph felt that the evidence
had grown since it had last been considered by the ACMD and yet
Professor Nutt felt that nothing much had changed.
Chairman: We are coming back to that.
Q192 Bob Spink: On this particular
point, the thing that worries me is whether in fact the members
of the ACMD are able to withstand the pressure from strong individuals
like, for instance, Professor Nutt, the Chairman of the Technical
Committee, or whether certain key individuals are able to push
through this action rather than the body taking the right action?
How are they actually considering the evidence?
Professor Nutt: We are clearly
not the right people to answer that question, that is all I can
say.
Q193 Dr Harris: Can I come back to
what is a key issue with the social harms thing and you will see
where I am coming from in a minute because there are a couple
of questions I want to go through. In this matrix you have got
"other social harms", which I think contains a lot of
stuff and I am somewhat surprised that it is not spelt out for
our benefit, but is one of those the impact of criminalisation
and acquisitive crime, and do you think that should be one-ninth,
as it appears to be, or should it be of greater consequence than
one-ninth? You have got three under "physical harm",
three under "dependence" and three under "social
harms". It seems to me for my constituents it matters hugely
whether everyone is shoplifting because you cannot get it legally
or the price has gone up because it is criminal.
Professor Nutt: This is a very
fair point and we have discussed it a lot and we do not know what
the appropriate weightings should be. What we have done is we
have come up with probably the most sophisticated way of assessing
drug harms that there is available in the world. What we would
like to do is move to the next stage, get it published, then have
informed feedback, but then modify it into an instrument that
really does capture those sorts of concerns.
Q194 Dr Harris: I think if this had
been published quickly the work you are doing would have been
better. Were there any influences on deciding that it would be
not be a good time to publish because of the Government's reaction
to the paper you are talking about being published in The Lancet?
Professor Nutt: No specific restrictions
but obviously the individuals who worked with us have had some
concerns as you have raised. Some of the sociologists themselves
have said, "We are not sure we fully can endorse that particular
element of the social harm", for the reasons you have raised.
Q195 Dr Harris: Your recommendation
recommending classification into a particular class creates social
effects, does it not?
Professor Nutt: Indeed it does.
Q196 Dr Harris: Because obviously
it brings criminal justice along with it and that affects the
price and availability and so forth. Do you recognise that? Your
own actions impact on the evidence. Did you feed that back in
before you made the recommendation?
Professor Nutt: We know it might
happen but you can never be sure how big an effect that might
have. I suppose the best example we might have now is cannabis.
The natural experiment is happening. Cannabis has been reclassified.
We will be able in a few years' time to answer that question for
cannabis because it has changed its classification.
Q197 Dr Harris: Do you see any tension
between the government's desire to send out messages with its
drugs policy and its aspiration to use an evidence-based approach
to policy development? Brooks also was seeking to ask this question.
Professor Nutt: I very much support
what you are trying to do because I have been trying with my colleagues
on the ACMD to develop evidence based assessment for the last
five years. I guess what you are trying to do today is help us
do that. I believe the educationalists on our committee would
say the same, that in education the message has to be evidence
based. If it is not evidence based, the people you are talking
to say it is rubbish.
Q198 Dr Harris: What if the government
say that by changing its drugs policy—let us say, making
it tougher—we are sending out a message and there is evidence
that sending out a message is a good thing and, secondly, there
is evidence that it works, do you get into that?
Professor Nutt: We would if the
evidence was there, yes.
Dr Harris: I do not think you say in
your report how strong the evidence is for any conclusion. Your
report says there is evidence and you give a reference but you
do not make a judgment, which you have done in your evidence today,
about the relative strength of that evidence. Is that something
you might consider doing?
Q199 Mr Newmark: Specifically with
different categories of drugs. There is a linkage between evidence
and the perceived strength of those drugs, but there seems to
be no stronger message with what may be a stronger drug. The message
seems to be a fairly blunt instrument at the moment.
Professor Sir Michael Rawlins:
In our two cannabis reports we have indicated areas where the
evidence was not strong or where it was strong, so we have given
a view but again it is judgmental. Going back to what Dr Harris
was saying about the scoring system, the things he is raising
indicate the reasons why in the foreseeable future it will be
informed decision making, but it is not just arithmetic and mathematical.
The science has not developed that far.
Chairman: We will look at some of these
issues now with specific drugs. You see the Committee is very
excited at having you here today and they are becoming very unruly.
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