7 Apr, 10 | by BMJ
With seven members of the Advisory Council on the Misuse of Drugs (ACMD) resigning in the last few months, and its chair, Professor David Nutt, being sacked, there must be something very wrong with the circumstances in which this group of experts find themselves. But clearly it is not just the committee members who are unhappy with their lot, ministers too think something is seriously awry, witness the announcement by the Home Office late last year of a review starting in October 2009 and being undertaken by Sir David Omand aimed at (I paraphrase) ‘satisfying ministers that the ACMD is discharging the functions that it was set up to deliver’. In detail, the enquiry is charged to review – the roles of ACMD members, officials and its secretariat; the process by which its agenda is set; how it decides on the topics to be investigated; how it arrives at its decisions; questions of transparency; and finally how it provides advice. Importantly, the review will not touch on the ACMD’s terms of reference, which, since the ACMD is a statutory body, would be difficult to change anyway.
The review process is now well under way (Omand’s completed report was to be with Home Office Ministers ‘by early 2010’). Here, based on my readings of the reasons given for the resignations and the sacking, together with some experience as a drug policy watcher and as a one-time member of a government advisory committee (albeit for Ministers of Health), I offer some observations which ministers might like to take into account.
1) Expert committees, such as the ACMD, are invaluable commodities for government in a democracy, but to be effective they must be allowed to make their decisions independently and free from political interference. Clearly, such committees must work within their terms of reference, but in coming to their conclusions Ministers (or their agents) should make no attempt to influence the committee’s scientific analysis, the ensuing discussion or the contents of any resultant advice.
2) Ministers have every right to reject part, or all, of the advice of their expert committees. However, the primary reason for any such rejection should be political rather than scientific. In practice, rejection by ministers should be very rare. For the most part, Ministers should trust their expert advisors and should accept their advice. If ever rejection becomes commonplace an enquiry is needed to discover where problems are arising.
3) Being the chair of an expert committee is an honour and a privilege, but it carries with it key responsibilities which may mean curtailment of the chair’s former activities. In the area of the committee’s remit the chair must remain (and be seen to remain) neutral, and work to help the committee reach a (scientific) consensus and then to represent this consensus to others. In no circumstances should the chair be involved in activity that might be, or be seen to be, an attempt to lobby or persuade the committee to a particular point of view. Furthermore, chairs should not be susceptible to persuasion by ministers, and should protect members from any such pressure. Finally, in their dealings generally, chairs would be wise not to attempt to prejudge the advice that the committee might give. ‘Telling’ a group what it should decide is a sure way to undermine members’ morale.
4) Members are very different from chairs. They are often chosen exactly because of their particular views and standpoints. Their positions as such with regard to their activity in the public sphere can generally remain unrestrained. Be that as it may, in committee they will need to recognise the validity of the consensus view reached whatever that consensus might be. Moreover, they need to recognise that whatever the advice given, ministers have a right to reject it.
It strikes me that if these four general rules of engagement, which would apply equally to all expert advisory committee, had been followed by the ACMD and its ministers, resignations and sacking might have been avoided and an enquiry by the Home Office rendered unnecessary.
Joe Collier is emeritus professor of medicines policy at St George’s, University of London