Annabel Bentley: Evidence of drugs and alcohol down the pub

A debate on the harms of drugs and alcohol hosted in a pub – surely not?

This week I was lucky enough to visit the epicentre of drinking and critical thinking at what claims to the be the world’s largest regular pub meeting.  An open invitation to join a garrulous group of sceptics at a forum hosted by the Westminster branch of Skeptics In The Pub promised to be loud, messy, and disorganised – and very democratic – according to the Economist. As an opportunity to escape the contrived debate generated by the X-Factor and join a real debate with real scientists, lawyers and people probably proud to be identified as geeks, it was a pull too hard to ignore.

The evening started with Professor David Nutt, Imperial College’s Neuropsychopharmacology Chair and the ex-chairman of the UK government’s Advisory Council on the Misuse of Drugs (ACMD), giving his views on the state of evidence about drug harms, from legal drugs such as alcohol to illegal drugs cannabis and ecstasy. He pointed out that there are various ways to define what a drug is … such as “something taken by a rat that results in the publication of a paper” (which got a ripple of laughter from the scientists in the room) or “something taken by an MP that they later deny” (which got a laugh from the cynics in the room). Professor Nutt then argued for drug policy to be based on evidence of relative harms, a view he previously gave at this year’s Eve Saville Lecture, including his opinion that harm from alcohol is probably the biggest drugs challenge we face. So to me it seemed somewhat ironic that the debate was being held in a pub, with many participants clutching gently-warming glasses of bitter and a few hardened addicts even daring to pop outside to smoke tobacco legally.

We then heard from Dr Evan Harris MP, who opposes the sacking of Professor Nutt from the ACMD, and has recently written to the Home Secretary about this (the letter and response are posted on his personal blog). Dr Harris also added a light-hearted comment about scientific understanding “MPs don’t understand peer-review. They think it’s when a baroness casts an eye over a press release.”

Despite Professor Nutt’s argument for evidence-based drug policy I can’t help worrying that it’s not that simple – evidence is rarely black and white, and almost always comes in nuances of grey. However, getting better evidence on relative harms of all drugs is a worthwhile common goal for scientists, policy makers, drug workers and health professionals to help reduce the burden of avoidable harm.

Annabel Bentley (MBBS FRCS) is interested in evidence that matters to patients and health risk communication. Originally trained as a surgeon, she is now assistant medical director at Bupa. The views in this blog are her own and not of any organisation she works for.