Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 400-419)


26 APRIL 2006

  Q400  Chairman: When Brian Iddon raised this issue of the connect between a particular drug and crime the answer was that there is not a research base on which we can deliver the evidence in order to reform policy, and yet you have responsibility in many ways of delivering that research.

  Professor Blakemore: I think there are some correlations between drug use and behaviours and their social impact which are very well documented. I think the police are in the best possible position to provide evidence about those relationships. For instance, the effect of alcohol and its impact on families, the tendency to produce aggression and violence; the same with crack cocaine—the link between violent behaviour and crack cocaine is very well established. I think when we talk about assessing drugs according to their harm it is very important to emphasise that we should not just be talking about medical harm—toxicity, damage to the body and the user—but the general impact on society. I think if we look at the impact of drugs in the last forty or fifty years the biggest effect has been on society rather than users. We know that 90% of drug related deaths are attributable to alcohol and tobacco, and much of the remainder to methadone (prescribed methadone, at least initially prescribed and then illegally available methadone). We have to take into account the social impact of drugs when considering their harms.

  Professor Strang: One of the reasons you do not have answers to your questions is that the UK does not invest in getting the answers. We are junior players when it comes to funding research that studies impact. If you look at the US and Australia they are orders of magnitude greater in investment. Our investment of our expenditure is about 0.1%; they operate at between 1 to 4%. I am not just saying there should be a little bit more. It is an embarrassment and it means that people like myself and my colleagues get lured away. Australia is populated by ex-pat addictions researchers who created a critical mass because of a better research funding environment. Supporting Andy Hayman's point, it may seem strange that people this side of the table are saying that it has less significance than perhaps your attention to it, but our interest is in the law as it is applied; it is not the same as what the paperwork says. Let is look at the cannabis example, if I remember the figures correctly between the mid-80s and mid-90s cautioning became what happened with more than 50% of all cases. No change in the law occurred; it was how at a local level a change occurred. You ought to want to know and I ought to want to know whether that led to increased use? What did it lead to? There is not really any answer to that. Our interest needs to be in the law as it is applied, not some letter that is attached to it.

  Q401  Mr Newmark: To what degree is the lack of both medical and social evidence in this area a limitation in determining the appropriate classification of drugs? In your experience how well does the Advisory Council cope with the challenge of making decisions on the basis of inconclusive evidence?

  Professor Blakemore: I think I would challenge what you say about the availability of evidence on the medical effects of drugs. This is a rapidly moving, expanding field of knowledge. I am sure that John would say that because of funding this country is not in a position to make as big a contribution to that knowledge as we should. We know a great deal about how drugs act on the brain and how, in some cases they produce dependency or addiction, what their toxic impacts are and therefore what the medical implications are. There has, of course, also been a great deal of research on the social impact of drugs. I am no expert and I am not in a position to say whether that evidence is as full as the scientific and medical evidence. The problem is—and perhaps this is at the heart of your question—that evidence is never perfect; it is changing. That is the basis of science and the collection of data. For instance, five years ago I would have said that the evidence for a causative link between cannabis use and the precipitation of psychotic episodes was extremely low. I have changed my view; I think the evidence is overwhelmingly clear. The effects are small but definite.

  Q402  Mr Newmark: That is because cannabis itself has changed and people are making it stronger.

  Professor Blakemore: No, I do not think it is. We know the genetic basis of those effects now through work funded, I am glad to say, by the Medical Research Council at the Institute of Psychiatry, and we have a very good rational explanation for those effects. It is a very small effect but it exists. That, of course, gets to the heart of one of my concerns about the ABC system. Because it has these sharp boundaries between As and Bs and Cs it is quite difficult to move drugs around in the classification on the basis of new evidence; but science is constantly throwing up new evidence.

  Professor Strang: I would agree with much of what Colin Blakemore is saying. We do have an increasingly good picture for understanding drug effects and drug problems in the sort of classic high tech science way. However I would actually like to draw your attention to the potential danger of that. As we have increasingly impressive scientific techniques, what we are likely to lose out on is low technology science that looks at things like the impact of whether at a low level of policing, a change to cautioning, leads to an increase or decrease. I think we crucially need to know that. But that type of proposed research would not have a snowball's chance in hell of getting funded as a project compared with someone imaging some particular bit of the brain that helps you understand how it works. Even though, in terms of answering the question that alters how you apply the law and how you run society, in my view it is much more valuable. Some mechanism for protecting lower technology policy type scientific studies is urgently required and the funding pressures on science means that there is likely to be even more of a contrast between the things that do get funded at the high technology end.

  Q403  Mr Newmark: In order to improve the way we go about classifying we need more evidence; in order to get more evidence we need more money into doing the research. Is that what you are saying?

  Professor Strang: I think so, but in terms of gathering more evidence you could go on in this field forever about getting a portfolio of information. But the special missing element in the existing research is an exquisite series of experiments of opportunity. You can easily list a dozen things where, if you knew that the changes you had made with temazepam capsules in the late 90s had led to less use and less harm because rescheduling or reformulation took place then you would be more confident about making a similar change with another drug. If you knew it had backfired on you and had gone the opposite direction, you would be pretty hesitant about going the same way again. You do not have that partly because a lot of your research machines are in-house government department research where the vested interest is in making sure that the departmental decision or ministerial decision is propped up against criticism.

  Q404  Chairman: Do you think, yes or no, that ACMD is in fact coping with this agenda? Is it the right organisation, the right body, the right set up to actually deliver what is being asked of it?

  Professor Blakemore: In a single word, yes. It has the right range of expertise. It takes a lot of time and trouble in considering the evidence. If there is a deficiency in the system I would say it is in the mechanism for communicating.

  Q405  Chairman: It does not commission any evidence. It does not do any research.

  Professor Blakemore: It does not need to do research; research is available, published. It looks at the available literature. Perhaps it would be useful if it could feed better into policies and the setting of policy priorities and strategies. That might be a valuable role, but I think the principal deficiency is how that huge mass of knowledge in the Advisory Council is able to feed into policy. And that is a reflection I think on the Misuse of Drugs Act classification.

  Mr Hayman: My answer is yes. I do not know whether members have had the opportunity to go along and sit in and witness what goes on in the ACMD. I have been participating in workshops, weekends away and also the full meetings. I challenge the notion that you have to have them commissioning any research because actually they are blessed with the experts in the room.

  Chairman: I will leave it at that because we will be coming back to it.

  Q406  Mr Newmark: Professor Blakemore, you have been making presentations on the concept of a scientifically based scale of harm for some years. When did you first draft the paper with David Nutt and others proposing this scale? My next question is, why has there been a delay in submitting it for publication?

  Professor Blakemore: I did not draft the paper; David did; he is the first author and I think it must have been about 18 months ago.

  Q407  Mr Newmark: I am curious as to why it has not been done. There are these scales that are out there to do with physical harm, dependence and social harms and in some ways it struck me that you are trying to make a science out of an art, particularly when it comes to social harms. I am curious as to why this analysis has not been published yet.

  Professor Blakemore: It sometimes takes quite a time to get a scientific paper, particularly with four authors, into a form that everybody accepts is ready for publication. If I could explain the basis of the study, it did grow out of talks that I gave on the possibility of creating a sort of matrix in which numerical values could be given to assessments of harm in order to rank drugs, not just illegal drugs but also including the familiar, acceptable, legal drugs as a kind of calibrator for the scale as a whole. An 18 month delay in getting a paper ready finally ready for publication is not unusual, I am afraid, in science.

  Q408  Mr Newmark: Are you in favour of using a scientifically based scale of harm to determine the legal status of drugs?

  Mr Hayman: If I could see the detail of what that looked like I could give an opinion on it but I would be worried that we are just shifting from a classification process at the moment to a different style one which would still have the frailties that are currently in the present system.

  Q409  Chairman: The concern is that on that scale of harm alcohol, ketamine, tobacco and solvents are all incredibly high up on the categories and yet none of them appear in any of the classifications at all. That is a concern we would have.

  Professor Blakemore: I think the most striking conclusion from the study is that although it purports to do what the Misuse of Drugs Act says is the basis of its classification the result is not statistically correlated with the ABC classification at all. In the ranking of drugs according to nine categories of harm of the top eight most highly ranked drugs in terms of harm three were Class A drugs and two were legal (at the time legal—ketamine has just been classified as C). Of the bottom eight, in terms of harm, two were legal (khat and alkyl nitrites) and three were Class A drugs (LSD, ecstasy and 4-methylthioamphetamine).

  Q410  Mr Newmark: I have to come to the conclusion then that part of the delay in coming out with this publication is that having come up with these parameters they are not quite fitting with your argument because of these other drugs that have been mis-categorised based on historical evidence of the way they have been categorised.

  Professor Blakemore: I do not think that it is our argument. What it implies is that one of the ways of classifying drugs according to harm—the ABC system or ours—is wrong, or they are both wrong. They certainly do not agree with each other.

  Q411  Margaret Moran: Professor Strang, I think the point you are making about the lower level research is very important. The fact that that research has not been done, is that a reflection on the effectiveness—or lack of effectiveness—of ACMD? Who should be commissioning that research?

  Professor Strang: I think the lack of this type of research severely handicaps the ACMD and it severely handicaps government's process of making decisions. Personally I think it would be ill-conceived to expect ACMD to be the body that commissioned work of this sort ACMD needs that work to be done, but its membership is not the right kind of membership for trying to get good quality work done that feeds into it. I have had either the privilege or the curse in previous times of being on ACMD, and that type of research needs to be done—but ACMD is the wrong type of body to conceive, consider or commission the specific research.

  Q412  Margaret Moran: Who should be commissioning it if not ACMD? They are supposed to be the body who advises on it; surely they should be making the very point that you have been making.

  Professor Strang: I think if you looked around the room at ACMD you would see very few people with a research pedigree. It would be an unfair request to ask ACMD members to adjudicate between a good proposal versus a poor proposal. I think they need that to be done just like Parliament needs it to be done, but then that is different from it being the commissioner of it. You would like to say that government departments with interest and responsibility in the area were the obvious people. However we must have serious doubts about that because I think they become pre-occupied with just blindly defending the decision that was made yesterday. What you want, what we need, is an investigation that has enough integrity and independence to be able to say that it was a well-intentioned decision but actually it has backfired and that is completely missing. I do not think the ACMD would achieve that; it would still have that heavy hand of the civil service on it.

  Q413  Margaret Moran: What you are suggesting then is that ACMD is not sufficiently independent of the Home Office secretariat. Is that what you are telling us?

  Professor Strang: I do not think that was what I was saying but I would have thought that probably is a correct observation.

  Q414  Margaret Moran: What about the other members of the panel? Would you say that ACMD is not sufficiently independent of the Home Office?

  Mr Hayman: I am not in a position to be able to comment on that; I just do not know.

  Q415  Chairman: You are on it.

  Mr Hayman: I might be on the ACMD but I do not have a clue what the secretariat of the Home Office does so therefore I am not in a position to be able to comment.

  Q416  Margaret Moran: I am talking specifically about membership of the ACMD.

  Mr Hayman: I am independent of the Home Office and I am on it.

  Professor Strang: I was not referring to the members as individuals; I was referring to the body of this operation. I am sure the individuals have independence and integrity outside the process.

  Q417  Margaret Moran: There is a suggestion that as currently constituted there is insufficient breadth of experience on ACMD. There is a suggestion that the breadth of expertise on ACMD is not sufficient to address the questions that it is being asked to deal with. Is that your view?

  Professor Blakemore: It is a very big committee with a wide range of expertise. You are raising a very important issue about whether ACMD should be in a position to commission research. It is music to my ears that John would say that history shows that the best way of getting good research done is to do it independent of ministerial control. We know of examples in which research commissioned by a government department has produced the results that the department has wanted—there is an understandable tension. On the other hand if, in the research councils—which is where the independent research is done—there is no response to policy needs then there is a kind of disconnect between where the high-quality work is done and what government needs to know. It is joining up those two things which I think we need to think about carefully. We have a very good opportunity to do so in the medical field with the proposal that the funding of the Department of Health R&D and the Research Council funding of medical research might be conflated in some new way. This not only would increase the money for addiction research and other areas of research, but also perhaps give us a way to re-think the input of policy questions into independent research.

  Professor Strang: It seems to me that you need to recognise the vulnerability of the field and where you look at countries that have deliberately pump primed the process (the US went from zero in the 1960s through to producing an amazing addictions research machine, so did Australia in the 1980s) you would have to protect the operation of that otherwise it just gets trampled underfoot with the bigger research players. That would be resisted because you would normally say: Throw it in the market place and the best researchers and topics will win. But with this one you would have to say: We have a special need to make sure that we support this. With the drug addiction research machine in the US we are talking of just over $1 billion per annum for NIDA (the National Institute on Drug Abuse), so where I say we are of a different order of magnitude, we are several orders of magnitude out and what we end up with in the UK is a Mickey Mouse operation compared with others.

  Professor Blakemore: Could I say that I was glad you introduced me as being both from Oxford and being from the MRC. What I have said so far has been, as it were, as an independent academic but what I can talk about on behalf of the MRC are the figures for spend. In 2003 to 2004 we spent £2 million in total out of a £450 million budget on addiction research. The total budget of the three NIH institutes that work in this area is $2.9 billion so even if one takes a conservative estimate of how much of that is actually devoted to addiction research it comes out to about five hundred times higher than in the UK—in other words about a hundred times more per head of the population.

  Q418  Chairman: If you take an issue like young people and drugs and the effect, for instance, that it has on young people's learning, I would have thought that the MRC or indeed something which would be commissioned through the ACMD ought to be looking at that specific area rather than just saying "we think" and yet we do not. I am sure you would agree with that.

  Professor Strang: The current position in which the MRC and any funding body operates is: Does that compete with some other high technology bid? It will not, and your choice is then to leave it in the market place and say that if it sinks we will have to do without it or to say that it has such importance to our societal process that we must protect it. There are special themes in all sorts of research initiatives and that would be a proper way of addressing it and that is currently absent.

  Q419  Chairman: I just think perhaps that ACMD ought to have a budget or at least the power to be able to commission some of that research.

  Professor Strang: They should certainly be able to identify areas where they felt handicapped by not having answers.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2006
Prepared 31 July 2006