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Nutt damage - Author's reply

by David Nutt
The Lancet ()

Abstract

Presumably William Cullerne Bown agrees that harm-based drug ranking for the determination of punishments is, in a just society, both desirable and necessary. The Misuse of Drugs Act 1971 requires such a system, but has never explicitly defined how ranking should be done—hence the unsatisfactory and, in places, arbitrary state of the current classification system.\nOur attempts at improved ranking used a systematic and transparent analysis based on nine parameters of harm derived from knowledge of addiction and rated by many of the UK's top experts in the field by use of a Delphic process. We pointed out in our paper1 that the lack of weightings was a weakness that could be rectified. Fortunately, over the past year, with support from the Home Office and Medical Research Council, the Advisory Council on the Misuse of Drugs (ACMD) undertook a more sophisticated approach using multicriteria decision-making. From first principles we derived 16 independent parameters of harm and weighted each. The report was in the process of being finalised just before the ACMD went into meltdown, but I can safely say that the conclusions of this analysis strongly support the arguments for which I was sacked. Certainly they make the harms of alcohol even more stark and hopefully they will soon be made public.\nThe repeated claims by Gordon Brown's government that it had scientific evidence that trumped that of the ACMD and the acknowledgment that it was only interested in scientific evidence that supported its political aims2 was a cynical misuse of scientific evidence that breached the principles of the 1971 Act and was insulting to Council.\nSince my sacking and the resignation of five members (all scientists), the council is now fatally depleted in scientific expertise. Given that the subsequent Drayson report3 and the Home Secretary's answer to a parliamentary question4 both affirm the current government position that chief scientific advisers can be sacked at the will of ministers, I doubt whether the ACMD will be able to recruit adequate scientific expertise to replace that it has lost.\nFor these reasons we are setting up an Independent Scientific Committee on Drugs that will comprise most of the ACMD scientists and another dozen or so leading scientific experts. This group will provide a truly independent and authoritative voice of science in relation to drug harms for the benefit of the public, the media, and other scientists. Perhaps the government will also take our outputs as the best available scientific evidence, so the ACMD can then focus on sentencing and treatment guidelines, education, and drug policy.

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