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Joe Collier: The unseemly goings-on at the ACMD and how they might have been avoided

7 Apr, 10 | by BMJ

Professor Joe Collier

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

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  • http://transform-drugs.blogspot.com/ Steve Rolles

    I dont really agree on point 3: David Nutt was already widely published, and his views well known, when he was appointed as ACMD chair – indeed he was arguably appointed on the basis of his track record on the technical committee and his external work. He was then, on a number of occasions, invited to give oral evidence based on both his personal expertise, and in his role as Chair. Likewise he was invited to lecture and write on his areas of expertise, being clear as to under what banner he was speaking, as per the guidelines.

    That he repeated his long published analysis (re relative drug harms) does not constitute ‘lobbying’ merely because it was politically inconvenient to the Home Secretary. That he also defended the ACMD, and, when the government ignored their recommedations for transparently political reasons, stated clearly (and with the support of the council) that the government was making decisions based on politics and not science was also fully within his remit as chair.

    Whatever you might think about his views – and there scientific debate to be had around that (although the tabloids in an election rrun up are certainly not the best forum) – this whole debacle was the making of the Government, not the chair or the council members. The problem is that when science and drug war populist politics (by its nature anti-science) clash, there are inevitable tensions. When these tensions are constrained by the machinations of the Home Office and the creaky old Misuse of Drugs Act, something has to give. That inevitable implosion is what we are now witnessing.

    Punitive prohibitionist drug policy is not evidence based, however we might wish it, and independent expert bodies on drugs will not be party to endless rubberstamping of what is effectively drug war propaganda for the government. Ultimately The government will have to either abandon the policy, or abandon the pretense that it is informed by science, and dissolve the council.

  • Andy Bellenie

    On point two, I think your language is a little too weak: “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.”

    I would change that to “However, the primary reason for any such rejection MUST be political…” as politicians have absolutely no place making scientific judgements – even the rare breed that have at least a basic concept of what science actually is.

    If they are unhappy with the scientific position, that’s not their fault. They can order a review, or an inquiry, but a politician must NEVER be allowed to say they disagree with their experts on the science itself – and if they choose to ignore it then their reasons should be made clear.

  • http://twitter.com/dahaigh Dominic Haigh

    Prof Nutt was not lobbying anyone, he certainly wasn’t paying Stephen Byers £5000 per day to distort democracy. He gave a lecture explaining scientific facts. The fact that this is politically inconvenient for the government is not his fault.

  • http://www.drugequality.org Darryl Bickler

    Your demand for impeccable neutrality from the chair is to impute a dialectic into the issue – the ideology of prohibition is political in origen; scientists and experts just want to present the facts. Of course these facts do translate into policy ideas and this is something that the ACMD are there to advise on. The ‘politicians decide’ mantra has been taken too literally of late – the decisions politicians make about how they administer laws are not just about political discretion, they have to be within the four corners of the providing legislation and in accordance with the general principles of administrative law.

    If the evidence is pointing towards the benefits of a fresh perspective, surely it is the duty of the chair to do some flag waving for this initiative? So, what are the Council’s duties? What discretions must the Council exercise?

    f. Section 1(2) – Whether or not involving alteration of the law

    “(2) It shall be the duty of the Advisory Council to keep under review the situation in the United Kingdom with respect to drugs which are being or appear to them likely to be misused and of which the misuse is having or appears to them capable of having harmful effects sufficient to constitute a social problem, and to give to any one or more of the Ministers, where either the Council consider it expedient to do so or they are consulted by the Minister or Ministers in question, advice on measures ( whether or not involving alteration of the law) which in the opinion of the Council ought to be taken for preventing the misuse of such drugs or dealing with social problems connected with their misuse, and in particular on measures which in the opinion of the Council ought to be taken – (a) for restricting the availability of such drugs or supervising the arrangements for their supply; (b) for enabling persons affected by the misuse of such drugs to obtain proper advice, and for securing the provision of proper facilities and services for the treatment, rehabilitation and after-care of such persons; (c) for promoting co-operation between the various professional and community services which in the opinion of the Council have a part to play in dealing with social problems connected with the misuse of such drugs; (d) for educating the public (and in particular the young) in the dangers of misusing such drugs, and for giving publicity to those dangers; and (e) for promoting research into, or otherwise obtaining information about, any matter which in the opinion of the Council is of relevance for the purpose of preventing the misuse of such drugs or dealing with any social problem connected with their misuse”.

    Section 1(2) charges the Council with the “duty” of: (1) keeping the drugs “situation” and relevant law “under review”; (2) giving ministers advice on exercising the Act’s powers; and (3) giving ministers advice on any measure or measures thought necessary by the Council to achieve the Act’s purpose, “whether or not involving alteration of the law”.

    Again, the Act’s purpose and object is to prevent, minimise or eliminate the “harmful effects sufficient to constitute a social problem” that may arise via any self-administration of “dangerous or otherwise handful drugs”. The Act contains various mechanisms for doing this. The foremost is the creation of the independent Advisory Council whose “duty” is to give ministers (and the public) advice on any measure or measures thought necessary “whether or not involving alteration of the law”.

    But what law? The phrase “whether or not involving alteration of the law” does not say “the Act” nor does it say “this law”, “this section”, or even “these regulations”. If, in the opinion of the Council, a clause in the Medicines Act 1968 needs changing, the Council can and should say so; so too with other relevant legislation, including regulations re alcohol and tobacco.

    Obviously, the phrase “whether or not involving alteration of the law” applies to the Act. Thus, it is the Council’s “duty” to provide advice to the SSHD, and other ministers on regulations, regulatory strategies and regulatory options. This is supported by s31(3) which shows that the Council’s advice is not limited to scientific matters, e.g. drug risks, drug harms, drug classification; nor to the regulatory option of “prohibition”.

    Thus, I believe that Alan Johnson was wrong to censure Dr Nutt for criticising Government policy. It was indeed the entire Council’s duty to criticise Government policy, if “the Council consider it expedient to do so”. All the more so because the Council is one of three procedural safeguards on arbitrary and unreasonable government; the other two are Parliament, in ss2(5), 7(6) & 31(2), and the Judiciary via judicial review.

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