29 November 2009

Medical students who wave

What will we do with Google Wave? Will it be an important part of our lives or will it be one of those things we don't need? Will we use it all the time or just for special applications? It's difficult to know. It's hard not to be excited by it but just whether it will be useful or not is unclear. Dr Grumble thinks that it might be good for developing ideas - planning a research project, for example. But it might not. It remains to be seen. Others have suggested that it might be useful for meeting notes made by everybody at the same time. But would that be manageable? We don't yet know.

Below is a public wave for medical students:

It's not clear yet to Dr Grumble how you can link to these things. Perhaps you can't. But you should be able to find it if you search the public waves. But whether you will find it of any use is quite another matter.

21 November 2009

Who can adumbrate the meaning of "polysystem"?

It's a shame that Dr Grumble has had to turn off the comments because he needs your help. You see Dr Grumble has encountered a new word. The word is "polysystem". Where it came from Dr Grumble has no idea. What it means also eludes poor old Grumble. But it does sound worryingly close to "polyclinic". Dr Grumble is very suspicious of new words - especially when he does not understand them.

People who coin new words without obvious meanings do so with a purpose. The purpose is to bamboozle and obfuscate or even confuse and conceal. This sort of thing happens quite often in healthcare. Do you remember when "contestability" and "plurality" perplexed Dr Grumble? These words were used as a sort of private code in the belief that the likes of Grumble wouldn't understand what was going on. It didn't work. When Dr Grumble finds a word he cannot understand he is immediately suspicious. And if he doesn't find it in his albeit old dictionary he is even more suspicious.

So, applying that test, let's see what the dictionaries have to say when it comes to the word "polysystem":

Not much help from the dictionaries then. So Dr Grumble is now very suspicious. He was minded to set his readers the challenge of finding out what a polysystem is. It is generally a good idea to get people to think for themselves rather than be spoon fed. But the comments are off so maybe that is not such a good idea. Or maybe it is?

20 November 2009

Comments are off

Dr Grumble is being beseiged by spam yet again. They seem to wait for Dr Grumble to go to sleep.

Comments are off and blogging will stop for the time being.

14 November 2009

The Nutts and bolts

Dr Grumble is a jobbing doctor. Until recently he knew very little about the 1971 Misuse of Drugs Act. It doesn't affect jobbing doctors. If doctors like Grumble do not know the details of how individual drugs are classified it is unlikely that those who use illicit drugs take much interest either. The penalties for just being in possession of the least harmful of these substances (Class C drugs) could be 2-year imprisonment. For supply it could be 14 years. That's a long time. Many would think that would put people off taking or trading drugs. But it doesn't seem to. pdf

Patients often tell Dr Grumble they take recreational drugs. Given the penalties he thinks they are unwise. Patients think their notes are confidential. They are. We wouldn't tell the police. We wouldn't tell the patient's employers. We wouldn't even tell the patient's nearest and dearest. But we would tell others with the patient's permission.

Once Dr Grumble had a young solicitor as a patient. He told Dr Grumble's staff that he had taken cannabis. It was recorded in his notes. Which was fine until the young solicitor applied for life insurance and the life insurance company insisted on seeing his records. And then they spotted the single entry recording that he had once smoked a joint. The cat was out of the bag. The patient denied he had ever smoked cannabis and insisted on seeing the original written entry in the hospital records. There it was in black and white. Taking illicit drugs is a serious matter if you are a solicitor.

What is the point of this tale? It is to point out that what Home Secretaries admit to having done in their youth without apparently having suffered any harm can be very damaging to professionals. It is not the drug effects that cause the damage. It is the legal consequences. But whether these potential consequences actually stop the average punter is quite another matter.

What anyway is the point of locking up somebody who is found in possession of a small amount of cannabis? Who are they harming? If they are harming themselves isn't that their own affair?

There was a time when homosexual acts were illegal. Why? Those involved did no harm. The objections were moral. What are the objections when it comes to drugs? Why do we lock these people up? Does it make any sense?

Of course if these strict penalties were to prevent people using drugs that might possibly damage them or others then perhaps the penalties could have some justification. But what is the evidence that this is the case? What, for example, happened in Portugal in the five years after possession of drugs for personal use was been decriminalised? These are the facts:

  • illegal drug use by teenagers declined
  • the rate of HIV infections among drug users dropped
  • deaths related to heroin and similar drugs were cut by more than half
  • the number of people seeking treatment for drug addiction doubled
The Nutt case has opened Dr Grumble's eyes to these issues to the extent that he is beginning to think this is a no-brainer. Many, perhaps most, will not agree. But that is not a reason for silencing those who have the relevant facts. And it is not a reason for stifling debate.

If you are interested in this topic Dr Grumble recommends this article. It is the one that lost Professor Nutt his 'job'.

08 November 2009

The trouble with our time

Politicians' twaddle

Will politicians learn from the Nutt case? Dr Grumble doubts it. They do not want to listen to scientists when formulating their policies on the misuse of drugs. They want to do what they believe the public wants. That is their prerogative. They don't have to accept scientific advice but they should be prepared to meet head on the fact that their policy is not evidence-based. It is wrong for them to try and silence those who wish to point out when the scientific facts do not support policy . It is even more wrong for them to ask for scientific opinion to fit their policy. That is not what science is about.

Politicians can do damage with their misguided policies on drug misuse but it won't be disastrous. They know that. That's why they went against advice. Anything for a few votes from the Daily Mail reader who believes that tougher policies on drugs will make his children safer. The fact that there is not much evidence for this never enters the argument.

Scientific facts often get in the way of what is politically expedient. The public often ask for the impossible. The politicians want to give it to them so start making promises. People begin to believe the impossible can happen. We all want it to be Christmas.

You see this sort of thing in advertising. The adverts for the enormous glossy four-wheel-drive SUVs with a hybrid engine. The electric motor is just there to make the purchaser feel good. The car is no greener. But the buyers don't question it. They don't consider a smaller car. Or a bike. They don't want the truth. They want it to be Christmas. They want that car and they want to feel good about it. They are never going to let facts get in the way of what they want.

In the same way as advertisers, politicians dupe the public. They rarely get found out. Here today and gone tomorrow their misguided policies damage not them but their successors. Does any of this matter? Does it matter that inconvenient scientific facts get brushed aside?

07 November 2009

Where's the problem?

Drug-related deaths in England and Wales 2000 to 2004

Where is Central London?

Date: 11 November 2009
Venue: Central London
Time: 6.30pm

Dr Grumble hopes to go to this. The audience will follow the meeting between the Home Secretary and the remaining members of the Advisory Council which should make things rather interesting.

If you would like to book a place email your name, job title/profession and contact email to: events@crimeandjustice.org.uk


05 November 2009

The Nutt case: Downing Street march

Apparently there is going to be a march of scientists on Downing Street in order to call on the Government to back evidence-based drug policy by respecting and upholding the independence of the ACMD.

Does anybody have any details? Do we just turn up? If so, when?

Here are the details which keep changing so check the latest on facebook (with thanks to Bendy Girl):

Rally for Professor David Nutt and Evidence Based Drugs Policy.

We are calling on members of the academic community, parents, young people, students and concerned members of the public to join us at 1pm on Saturday the 7th of November outside Downing Street. We will be there to show our support for Professor Nutt and to call on the government to back evidence based drugs policy by respecting and upholding the independence of the ACMD.


PS Yes we do have police permission.

03 November 2009

Who has broken the code?

According to the Code of Practice for Scientific Advisory Committees:

“Rules of conduct need not affect a member’s freedom to represent his or her field of expertise in a personal capacity. The committee's rules however should generally oblige members to make clear when they are not speaking in their capacity as committee members."


02 November 2009

Open letter to the Home Secretary

Open letter to the Home Secretary from Richard Garside, director, Centre for Crime and Justice Studies

Dear Home Secretary,

I am writing to you about your decision to dismiss Professor David Nutt as chair of the Advisory Council on the Misuse of Drugs.

It was the Centre for Crime and Justice Studies that asked Professor Nutt to present his analysis at a lecture at King's College London in July of this year. Following the lecture Professor Nutt agreed to our publishing an edited version, which we did last Thursday. A copy of this publication, along with the press release, can be accessed on our website here. The publicity material for the lecture can be viewed on our website here.

In your letter to Professor Nutt advising him that you were dismissing him from his role, you wrote that his contribution went `against the requirements on general standards of public life' required by his position as chair of the ACMD. You went on to write:

`As chair of the ACMD you cannot avoid appearing to implicate the Council in your comments and thereby undermining its scientific independence'.

I would like to make it clear that Professor Nutt gave his lecture, and agreed to its subsequent publication, in his capacity as the Edmond J Safra Chair of Neuropsychopharmacology at Imperial College London. This is stated clearly in the original publicity and in the subsequent paper. Professor Nutt made some references to the ACMD in his paper as it was relevant to his argument. At no point did he make reference to his role as chair of the ACMD, nor did he give the impression that he was speaking on behalf of the ACMD.

I have to conclude that the public confusion between Professor Nutt's academic role and his chairmanship of the ACMD has been sowed by the Home Office, not by Professor Nutt nor by the Centre for Crime and Justice Studies.

Academics who advise government should feel confident that they retain the freedom to act as independent researchers without the threat of political interference or undue pressure of any kind. It is in the public interest that you clarify your thinking on this matter and I look forward to receiving your response.


Richard Garside
Centre for Crime and Justice Studies

2 November 2009

Does Alan Johnson keep a gun?

The Home Secretary, trying to bale himself out of a quagmire of his own creation, has written to the Guardian:

......Professor Nutt is indeed a reputable scientist whose views on drugs policy are well known. However, his role as my principal adviser was to (unsurprisingly) present advice. It is the job of the government to decide policy.

Professor Nutt was not sacked for his views, which I respect but
disagree with (as does Professor Robin Murray, who wrote
in your newspaper on Friday

He was asked to go because he cannot be both a government adviser and a campaigner against government policy. This principle is well understood and long established.

As for his comments about horse riding being more dangerous than ecstasy, which you quote with such reverence, it is of course a political rather than a scientific point. There are not many kids in my constituency in danger of falling off a horse – there are thousands at risk of being sucked into a world of hopeless despair through drug addiction.

Alan Johnson MP
Home secretary

When Dr Grumble was a student he was told never to write 'obviously' in his exam answers. It's certainly a bad word to use in essays. Words like 'obvious' or phrases like 'of course' are calculated to stop you thinking. Alan Johnson uses 'of course'. He claims, it seems, to have sacked Professor Nutt because he compared the risk of drugs with the risk of riding a horse. He says this is 'of course' a political point. Dr Grumble doesn't agree. Even as a scientist you need a yardstick rather than a figure to put risk on a scale which can be understood. This is particularly true if you need to express levels of risk to politicians or the public. But the concept is useful for scientists too. In the assessment of risk this is not unusual. It was not something that was calculated to embarrass Alan Johnson. It was just an aid to understanding.

Professor Nutt chose horse riding because it happens to be very risky. Dr Grumble knew this. He has seen the consequences. Yet many parents - though maybe not in Alan Johnson's constituency - might encourage their children to take up horse riding. Few would do the same when it came to drugs. Yet the risk for horse riding is much greater. Both are probably done for some sort of excitement. One is a fulfilling activity the other probably is not. It doesn't matter. It is just a yardstick.

We need such yardsticks. Parents need to grasp how likely it is for their child to be murdered in comparison to being run over on the road. It's important. Do we need to invest in looking out for child murderers or slowing the traffic? Those are the issues.

The trouble, of course (!) is the Daily Mail. It is more likely to fill its pages with stories of horrific child murders than car accidents. The Mail is unlikely to report many of the deaths related to alcohol and tobacco. There are just too many. The differential reporting of drug-related deaths in the press is something that David Nutt has pointed out. The likelihood of the press reporting a drug-related death depends on the drug. Some drugs, it seems, are more newsworthy than others. But the consequence is that the public's perception of risk is warped. It is important to point this out. The public needs to grasp the real risk and not the risk they perceive from reading newspapers. So do politicians.

Sometimes reporting of crime has a counterproductive effect. It has been claimed that reporting of knife crime increases the number of knives being carried by children. Why do you think that is? It is because the reports frighten children who then carry knives to protect themselves.

Similarly in the US people have guns to protect themselves. Yet, if you look at the data, they or their family are more likely to be shot as a result - because having a gun in the house is dangerous. You won't shoot yourself in the foot if you don't have a gun. Does Alan Johnson keep a gun?

01 November 2009

Marion Walker resigns

Marion Walker is the second to resign from the
Advisory Council on the Misuse of Drugs.

Margaret Thatcher said “Advisers advise and Ministers decide”. But ministers should not completely ignore science and they certainly should not expect scientists to make the evidence fit a predetermined policy.

Dr Les King resigns

Leslie King spent nearly thirty years in the Forensic Science Service (FSS). His responsibilities included examining items submitted for the analysis of alcohol, drugs and other substances in cases of suspected fatal poisonings or those involving offences under the Misuse of Drugs Act or the Road Traffic Act. As a result, he has given evidence in the Criminal and Coroners' Courts as an expert witness on many occasions. Before retiring from the FSS in 2001, he was Head of the Drugs Intelligence Unit for ten years. In that role he was responsible for maintaining a UK drug seizure database, providing technical advice on the chemistry and legislation of drugs and their precursors to law enforcement agencies, forensic scientists and UK Government as well as international organisations such as the United Nations Office on Drugs and Crime and the European Commission.

Before joining the FSS, Leslie King spent eight years in the pharmaceutical industry both in the UK and in Germany. At Loughborough University he carried out research on the analysis of barbiturates and on fluorescence and phosphorescence spectroscopy leading to MSc and PhD degrees.

Leslie King is author/co-author of over eighty papers on analytical chemistry, spectroscopy, toxicology, risk assessment, forensic science and the epidemiology of drug abuse and is also a member of the Editorial Board of 'Substance Use and Misuse'. He continues to work part-time as an advisor to the Department of Health and the European Monitoring Centre for Drugs and Drug Addiction on matters concerning synthetic drugs and risk assessments, as well as providing training to newer Member States of the EU on drug legislation and chemistry.

Sir Liam speaks

"These things are best sorted out behind the scenes so that the government and their advisers can go to the public with a united front."
Sir Liam Donaldson

Which all seems a bit odd to Dr Grumble because the views of the advisers are clearly in the public domain having been published by the government. How can you have a united front when the government decides something that is plainly not consistent with the published evidence? And why have they picked on Professor Nutt because Sir Michael Rawlins said exactly the same? Below is what Sir Michael said as reported in the Daily Mail:

Professor Sir Michael Rawlins, the advisory council's chairman, said drug users did not care whether a substance was in Class A, B or C.

The council's review acknowledged some link between cannabis and mental illness, but said the evidence was 'uncertain', and the connection was 'probable but weak', with the drug playing only a 'modest role' in causing mental health problems.

Prof Rawlins said: 'We estimate we would have to prevent 5,000 young males or 20,000 young females from ever smoking cannabis in order to prevent one case of schizophrenia.'

The advisers accepted skunk was becoming more common, but said there was some evidence users adjusted their intake - smoking less if the drug was stronger.

Prof Rawlins said: 'It's like alcohol - whisky is stronger than beer, but people don't drink pints of it.'

The experts also dismissed claims that cannabis is a 'gateway drug' leading to cocaine and heroin abuse - which they said was based on 'very weak evidence'.

Dr Grumble has seen people die from the effects of alcohol. He has seen people die from the effects of tobacco. He is yet to see a patient die from an overdose of cannabis. He is yet to see a patient even admitted to hospital as a result of the effects of cannabis.

When the government is arguing that black is white what are their advisers supposed to do?