The Nutt Sack Affair (part 493)

November 7th, 2009 by Ben Goldacre in bad science, drurrrgs, evidence based policy, politics | 74 Comments »

Ben Goldacre, Saturday 7 November 2009, The Guardian

Obviously it’s pleasing to see, in the storm of commentary over Professor Nutt’s sacking, that everyone outside of politics now recognises the importance of scientific evidence in devising laws. But a strange reasoning twitch has appeared, in the arguments of politicians and right wing commentators. Science can tell us about the molecules, they say, about their effect on the body, and the risks. But policy is a separate domain: a matter for judgement calls on social and ethical issues. Only politicians, they say, can determine the correct way to send out a clear message to the public. It is not a matter for science.

Interestingly this is wrong. Alongside research into the risks of drugs, lots of research has also been done examining the deterrent impact of different laws, classifications, and levels of enforcement. Since every piece of research has its own imperfections (and nobody has yet conducted a randomised controlled trial on drugs policy) you can make your own mind up about whether you find this research compelling.

One strategy is to compare different countries. A World Health Organisation study from 2008, published in the academic journal PLOS Medicine, compared drug use and enforcement regimes around the globe. It was clear: “globally, drug use is not distributed evenly and is not simply related to drug policy, since countries with stringent user-level illegal drug policies did not have lower levels of use than countries with liberal ones.”

Alternatively you can compare drug use between states within one country, if they have very different enforcement regimes, as happened when some parts of the US liberalised their laws a few decades ago. In 1976 Stuart and colleagues found that cannabis use in Ann Arbor, Michigan, wasn’t affected by reductions in cannabis penalties, when compared with three neighbouring communities which kept penalties the same. In 1981 Saveland & Bray looked at national drug use surveys from 1972 to 1977 and found that cannabis use was higher in the ‘decriminalised’ states, both before and after the changes in law, and when they looked at rates of change, although cannabis use was increasing everywhere, the most rapid increase was actually in the states with the most severe penalties. In the same year Johnson and colleagues used survey data on high school use and found decriminalisation had no effect on attitudes or beliefs about drugs. These studies are old, of course, but only because the liberalisations in the law which they rely on for data happened a long time ago.

Another line of evidence comes from “before and after” studies, when laws are changed. Cannabis use in the UK dropped, of course, after cannabis was moved from class B to class C. Prohibition of alcohol in the USA from 1920 to 1933 is the most famous example: here, alcohol use fell dramatically when prohibition began, and the price of alcohol rose to 318% of its previous level. But by 1929, this initial impact had begun to wear off, and rapidly: alcohol consumption had risen to 70% of pre-prohibition levels, was still rising when prohibition was repealed, and the price had fallen to only 171% of pre-prohibition levels. Notably, this reversion to old patterns of use occurred despite escalating expenditure on enforcement, which rose by 600% over the same period. There are many more examples.

This is not an unresearchable question. It is clear that there are many other factors at play in all of these studies, and if they are not sufficiently rigorous for the government, or a brief informal dip into the literature is not enough (it shouldn’t be) then they should commission more formal research: because it is a basic tenet of evidence based policy that if you discover a gap, you flag it up, and commission more work to fill it.

This is important for one simple reason. If you wish to justify a policy that will plainly increase the harms associated with each individual act of drug use, by creating violent criminal gangs as distributors, driving the sale of contaminated black market drugs, blighting the careers of users caught by the police, criminalising 3 million people, and so on, then people will reasonably expect, as a trade-off, that you will also provide good quality evidence showing that your policy achieves its stated aim of reducing the overall numbers of people using drugs.

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74 Responses

  1. skyesteve said,

    November 12, 2009 at 9:25 am

    @Richard Palmer and Psythe – heroin (diamorphine) – side effects include “nausea, vomiting, constipation, dry mouth, biliary spasm, muscle rigidity, hypotension (low blood pressure), respiratory depression, bradycardia (slow heart rate), tachycardia (fast heart rate), palpitations, oedema (swelling of ankles), hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headaches, sexual dysfunction, difficulty with micturition (peeing), urine retention, spasm of ureters, visual disturbances, sweats, flushes, rashes, urticaria, and itch” (source – British National Formulary); with diamorphine specifically there is also the possibility of anorexia, taste disturbance, raised intracranial pressure and myocardial infarction have also been reported.
    So it depends what you mean by harmful. Will it rot you live? No. Will it knacker your kidneys? Probably not. Will it give you stomach ulcers? No. But “harmless” it ain’t (and I’m not making any moral or value judgement here).
    As for cannabis, it’s true, as Prof Nutt said, that there are easier ways to kill yourself and the problems caused by cannabis are nothing compared to cigarettes and alcohol but, again, harmless it ain’t.

  2. skyesteve said,

    November 12, 2009 at 10:15 am

    oops! “Will it rot you live?” – meant to say “will it rot your liver?”! Sorry for my typos, poorish grammar, etc.

  3. irishaxeman said,

    November 12, 2009 at 10:37 am

    Anyone with half a brain knows that alcohol is the most utilised drug and by any method the most costly and damaging to society. Most cases that come before the magistrates courts after a weekend involve drink influenced behaviour. It is the rocket fuel of assaults. It is, apart from power, the preferred drug of politicians.

    I have absolutely no faith in politicians since I was deeply involved in local and national politics in the 1970s and 80s. I walked away in disgust after some twenty plus years having encountered in all parties the most venal, fraudulent and ignorant people, virtually none of them fit to go an errand to the corner shop, let alone run a country. Ex-student politicians such as Clarke and Straw were amongst the worst, Straw being primus inter pares.

    Very few elected politicians have any real experience of life as most of us know it, and even if they have, the posturing and dissembling they indulge in to ascend the political ladder divorces them from ordinary realities.

    My wife is always amused when I let fly at the TV with some ripe insult or anecdote, usually prefaced by ‘bloody life-long liar’ or some such.

  4. Terry Hamblin said,

    November 12, 2009 at 12:09 pm

    Unlike many of your correspondents I have not tried most of the drugs referred to, apart from alcohol, and I am not very keen on that. If I want my mind stimulated I read a good book.

    In trying to assess physical harm, it took a very long time to detect the harm done by tobacco, and very few believed it when there was clear scientific evidence for it. I doubt very much whether other drugs have had the same scrutiny applied to them.

    The harm that alcohol does is plain for all to see. Prohibition in America did not prevent it from harming people, but neither has the subsequent policy of allowing it to be a licensed drug. When a drug is illegal, criminals make a lot of money by supplying it and addicts commit crimes to obtain it. At least legalising it reduces this, though not completely – eg the white vans being ferried to Calais and returning with far more than can legitimately be for ‘personal use’.

    Education and propaganda, together with price increases, have reduced the proportion of the population smoking tobacco, but it is still a substantial proportion. We really have no idea how prevalent the use of drugs is for the simple reason that people lie when asked – either out of guilt or bravado.

    I would welcome a good study on the harm caused by drugs, but I doubt that it will be possible. We know that 20 years of tobacco smoking leads to lung cancer; what population base could you use to find a long term study of cannabis use, and how would you disentangle the effect from that of other drugs?

    One could, of course, adopt the libertarian view that what someone does to their own body is his/her own affair, but while we have the NHS everybody has to pay for that indulgence. Furthermore, the social harm done may impact on all of us. Few drugs do as much social harm as alcohol, but is someone fit to drive under the influence of cannabis? How would one masure what is a safe level? How about cannabis plus another drug? Would we have to resort to devices that measure reaction time?

    My point in arguing like this is to stress that there is not a simple scientific answer. Having spent 30 years as a scientist I have come to realise that the scientific method is useful for answering a well-formulated question, but unless a good question can be formulated it can lead investigators into a jungle. Scientists often know an awful lot about very little. My knowledge of astrophysics is probably no better than Alan Johnson’s but get me on chronic lymphocytic leukemia and I could wipe the floor with Professor Nutt. Only some of my genius is transferable to other fields.

  5. Jessica said,

    November 12, 2009 at 12:25 pm

    Green beliefs was recently ruled to be protected as “Religion” and therefore protected against discrimination sackings. Now this woo-woo is arguing the same case for his belief in psychics:

    Could Nutt, in theory, argue succesfully that his “belief” in science means that he was discriminated against?

    Obviously no-one really wants this, for the simple reason that science is not religion and should not be treated like religion – but here are two people whose cases kind of drive home the point that the protected status of religion is kind of a problem in a democracy.

    A lot of people in Britain are firm believers in allmighty Argos, for whom there is a lot more evidence than any other contemprorary deities. You say your prayer to one of the priests or priestesses in the holy temple, make a small offering of a size appropriate to the size of your prayer and lo, you will be heeded. I myself once succesfully prayed for a bean bag, and two weeks later – there it was, delivered to my door. His earthly appointed wore blue and cursed my stairs.

    Can I argue that as a member of Church of Argos, I have to get special time off to observe the holy deliveries?

    I am torn though, because Church of Tesco delivers food as well, but tends to demand larger offerings. Swings and roundabouts I guess.

    Kind Regards,

  6. git said,

    November 12, 2009 at 3:05 pm

    A week old, but this is still worth reading:

    On the 3rd November, there was actually a photo of Hitler in the article, though it seems to have been removed now 🙁

  7. TD said,

    November 12, 2009 at 3:09 pm

    Terry, you “would welcome a good study on the harm caused by drugs” – what about a study of the risks associated with prohibition, too? Surely only by weighing up the pros and cons of legalisation, regulation and prohibition, can we come to a reasonable drugs policy?

    There appears to be very little research on the risks associated with prohibition.

    Here is something that may be of interest from Transform.

    One could, of course, adopt the libertarian view that what someone does to their own body is his/her own affair, but while we have the NHS everybody has to pay for that indulgence.

    I agree that externalities ought to be paid for – it is worth nothing that taxes on alcohol and tobacco more than cover the economic and social costs associated with these two legal drugs.

  8. elvisionary said,

    November 12, 2009 at 4:37 pm

    It may seem a bit odd on the bad science website to fall back on anecdote and “folk wisdom”, but it strikes me that we could benefit from listening to the views of the many people in the population who have experience of cannabis, either through their own use or the use of others they know.

    Cannabis is something of a rite of passage for many young people – taken sociably, in relative moderation. Most of these social, moderate users revert gradually to alcohol as their preferred drug – and not just because of legality, but because they enjoy alcohol more. It’s only a fairly small minority who use cannabis very regularly, and continue for many years – and most people believe that those who do will ultimately do damage to their brains. Ask any student, and they’ll give you an anecdote about someone who’s fried their brains through overuse, and have suffered psychological problems. Therefore many students and ex-students will believe, quite consistently, that the classification of cannabis is over the top (because it was fundamentally harmless for them), but at the same time that it can be dangerous in excess.

    In other words, the folk wisdom is probably that both Professor Nutt and his critics (who’ve pointed to risks of schizophrenia etc.) are correct in some respect. You can argue, therefore, that public policy can not rest purely on the science, but will ultimately depend on how much you want to infringe the rights of the majority by protecting the minority from themselves. Or, to put it another way, how nannyist you want to be. Yes, the same argument can be applied to alcohol – but the dividing line is different there because alcohol is so culturally ubiquitous that any prohibition would be more aggressively nannyist.

  9. mikewhit said,

    November 12, 2009 at 5:57 pm

    … more aggressively nannyist …

    Yes but I thought nannies were better at “tough love” than parents – see this week’s report !!

  10. ChrisRoberts said,

    November 12, 2009 at 6:19 pm

    There is a fundamental incongruity right at the heart of drugs policy: the government wants to accrue the cachet of scientific expertise for decisions which are purely political and pragmatic. So the populace is supposed to believe that the government is legalising or criminalising their actions on the basis of presumptions about harm, while knowing full well that they are barely based on that at all. Drugs policy seems to be largely based around the trends of most media outlets that basically perpetuate the “fears” about drugs without ever dealing with the wider social context. On last week’s Question Time a perfect distillation of this was present. All the panellists were feigning disagreement but all ended up saying similar things, namely that “drugs kill” Almost all the experts agree that it is the illegality of drugs that contribute most to this “killing” because the quality is inconsistent – drugs mixed with brick dust and powdered soap etc – and the fact that in order to obtain the ‘products’ one has to enter an underground and potentially dangerous world. This, as far as I can ascertain, is the general trend of drugs advisory panels and was the kind of advice given to the Govt on the issue. That they chose, not only to ignore the advice, but went further and sacked the chief scientist responsible for researching and communicating this advice, ably demonstrates that governments are not particularly interested in expert advice. That is unless of course this advice offers a series of populist “easy answers”. These “easy answers” are anything but actual answers, they are instead knee jerk, short termist soundbites that are perfectly palatable to a media with little or no interest in wider contextual analysis. In the end nothing will change precisely because the needs of politicians will always take precedence over and above the needs of those addicted to drugs.

  11. skyesteve said,

    November 12, 2009 at 6:24 pm

    @elvisionary – “Yes, the same argument can be applied to alcohol – but the dividing line is different there because alcohol is so culturally ubiquitous”
    And cannabis isn’t? Speaking from my anecdotal, non-user status cannabis looks pretty ubiquitous to me in the under 40s at least…

  12. Terry Hamblin said,

    November 12, 2009 at 6:48 pm

    TD: The risks of prohibition are well-aired. I fully accept them, but the risks of regulation and taxation of alcohol are all too apparent. Apart the removal of criminality, is society any better off by allowing alcohol to be available so freely? Wife-beating, road accidents, date-rape, assault, manslaughter, family breakdown, child neglect and poverty can all be attributed to ethanol. Perhaps the duty on booze does pay for the NHS, but I doubt that it funds the other consequences.

    Those arguing for a change in status for other drugs must demonstrate that things would be better if they were freely available. I just don’t think that the evidence is at hand. It’s not enough to argue that it would be beneficial to take them out of the hands of criminals, though I agree that would be a benefit.

    Look how long it took to establish the harm caused by tobacco and look how long it took before most people accepted the fact. We are decades away from having that sort of information on cannabis or ecstasy, let alone the newer formulations.

  13. paul8032 said,

    November 12, 2009 at 9:44 pm

    Hi quasilobachevski — sorry, it ran off the bottom of the mini-blog. Here is the url;

  14. quasilobachevski said,

    November 13, 2009 at 12:08 am


    Thanks for that! Though I wish I hadn’t asked now. Painful reading. Ouch.

  15. elvisionary said,

    November 13, 2009 at 8:55 am

    @skyesteve – agree, but it’s a question of degree. Alcohol is central to the culture, used by most of the adult population on most days an ingredient of most social interaction. Most people – even the under 40s – encounter cannabis less frequently, and might not even notice if it didn’t exist.

    On prohibition, when I was younger I went to school in the US for a short spell. (No, this wasn’t in the 1930s – I’m talking about the legal drinking age!). It was difficult for teenagers to get hold of alcohol, in stark contrast to the UK. The result was that cannabis was far more widely used than in the UK – virtually every teenager smoked weed. (The other result was that people became very good at forging driving licences). Young people need their escapes and vices, so perhaps the question for public policy is which poison you’d prefer our young people to be enjoying.

    @Terry Hamblin, to most of us the clear harm done by tobacco doesn’t mean it should be illegal. This is a fundamental point of liberal principle. I believe the same about alcohol, which may be responsible for many of the things you describe, but is also responsible for a huge amount of pleasure and enjoyment. Should those who enjoy alcohol in moderation and behave responsibly be punished for the actions of a minority of morons? But the “harder” that drugs become, the more difficult this question becomes.

  16. skyesteve said,

    November 13, 2009 at 12:26 pm

    @elvisionary – you’re right about alcohol and cannabis (and I was being a wee bit facetious – sorry).
    But to me there is also a difference between alcohol and tobacco. In addition not all “illegal” drugs are the same.
    As you point out alcohol is not the problem – it’s the misuse of alcohol that’s the problem. But alcohol used infrequently and in moderation has no real short or long-term health problems and has some definite social and psycho-social benefits. It may even be good for your heart (although that idea seems to go in and out of fashion somewhat).
    In contrast there is no safe smoking level and even one fag a day increases your risk of significant pathology. This is also an issue with cannabis since, as far as I understand (having never done it myself), cannabis is mixed with tobacco for smoking.
    Opiates could in theory be safe and enjoyable if used in purified form, in small amounts and in a safe environment. They are also starnge drugs in that whether or not you get a buzz from them depends to some extent on the circumstances in which they are used.
    In contrast, there is some evidence to suggest that even a single use of cocaine can result in permanent structural brain changes.
    The whole thing really is a messy business when you stop to think about it!

  17. TD said,

    November 13, 2009 at 3:24 pm


    I’m a fan of John Stuart Mill when it comes to the proper limits of the exercise of power over others. ‘Society’ isn’t, ‘it’ thinks it is appropriate and right to interfere with our freedoms – well, I think it’s wrong but that’s where we are! But surely, if we are to interfere, then any interference should be based on evidence, a weighing up of the pros and cons, a cost-benefit analysis? Apparently there has been no such weighing up. You say the risks of prohibition have been “well aired”, but have they been well researched, and debated in Parliament?

    (Incidentally I think it’s pretty difficult for a non-technical person to find out the risks associated with consuming illegal drugs. Talk to Frank for example isn’t particularly clear.)

    Nick Davies on heroin may be worth your time. I’m not saying every single claim is correct but I think he raises some good points.

  18. skyesteve said,

    November 13, 2009 at 4:36 pm

    @TD – Nick Davies’ article is good but I think he needs to spend more time working with drug users me thinks.
    “Street buyers cannot afford to waste any heroin – and for that reason, they start to inject it, because smoking or snorting it is inefficient” – that’s not why street heroin users chose to inject or smoke or otherwise. In fact the effect is more rapid with smoking and that is certainly the preferred route in my part of the world (and the choice of route has as much to do with peer pressure and the current “drug culture” as any worries about limited supplies or blood borne virus infections).
    But otherwise a good article with some sensible comment.

  19. Soarhead said,

    November 14, 2009 at 9:13 am

    It’s about time that the whole concept of our approach to drugs got the “Bad Science” treatment. Never forget that the very existence of the ACMD is a function of the Misuse of Drugs Act 1971. In several hundred years time with the 20-20 view that history gives this may come to be seen as the worst error the British government ever made.

  20. Dr Spouse said,

    November 14, 2009 at 6:56 pm

    Although I am in complete agreement with both a) the need to look at research on prohibition/legalisation for the real answer and b) the shocking nature of the whole affair, I can’t help feeling Nutt has shot himself in the foot rather with failing to understand that “risk” is not the same as “probability”. Unfortunately medical, physical and biological scientists have a habit of forgetting that there exist behavioural scientists who have studied things like people’s perception of risk.

    Telling us that “horse-riding is more risky than taking cannabis” is not helpful. It is possible that the probability of death or serious disability is greater (I’m not quite sure which he was referring to), or the average reduction in DALYs for habitual horse-riders versus habitual cannabis users is greater, but the RISK, which is a subjective, perceptual concept is probably not greater – and it makes him look a bit misinformed to say that.

  21. adamk said,

    November 14, 2009 at 9:03 pm

    Surely , from an ethical point of view , we should let properly informed , competent people make the choice for themselves , as to whether they take any drug , or not – as long as it causes no harm to others.

    The same argument could be made against the law about forcing us to wear seat belts.

    by the way @skysteve – you can eat cannabis too! (and possibly even stick it up your bum!), so tobacco consumption is not necessarily involved.

  22. paul8032 said,

    November 14, 2009 at 9:08 pm

    OK — in response to Joanna Blythman’s article for the Sunday Herald (, I have started a blog about it.

    I’m not wholly pleased with myself as I decided to do it in a hissy fit, but I feel I need to follow it through now.
    It’s at I’d be very grateful if you’d have a look and make any comments for me.
    Sorry to hijack Ben’s blog for what amounts to self-promotion, but I have mention Bad Science on there to salve my conscience.

  23. quasilobachevski said,

    November 15, 2009 at 3:17 am

    Dr Spouse,

    … but the RISK, which is a subjective, perceptual concept is probably not greater – and it makes him look a bit misinformed to say that.

    First, I should admit that I haven’t read Nutt’s article. But I think you’ve completely misunderstood his intention in comparing horse riding and ecstasy: viz, to highlight the different ways we think about the risks of different activities. As I understood it, his thesis was that there are certain biases in the way we think about drug-taking, compared to other risky activities, which prevent us from having an honest public debate. In other words, the purpose of the article was to contrast risk and probability, as you define them.

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