Evidence based policy takes another hit

Government proposal calls into question the role of science in drug policy making

It is self evidently logical that those best placed to advise government on a policy are experts working in that, or a closely related field; be they scientists, front-line staff or academics. This does not always happen in practice; thankfully drug policy is one area where it has for several decades, though it must be noted that it has not necessarily translated into evidence based policy. That presupposes that policy makers are predisposed to implement the recommendations of their advisors. This is best illustrated in the refusal by successive governments to move drug policy away from the criminal justice system to the realm of public health.

Worryingly, drug policy looks set to drift yet further away from the healthcare system.  It has been reported recently that legislation will be passed in the British Parliament that will remove the legal requirement for scientists to be appointed to the Advisory Council on the Misuse of Drugs (ACMD).  The ACMD is a body comprised of experts from several fields including vetinary, medicine, pharmaceuticals and chemistry.  Their remit is to conduct research and advise the Home Secretary on how to regulate and legislate controlled substances in the UK.

This apparent act of sabotage appears ideologically motivated and as such, represents a body blow for evidence based policy making. Removing the requirement for scientists creates the possibility that the panel could be repopulated with acquisecent individuals willing to support the governments approach, free from the constrains of evidence.  The Council provided a sustained challenge to New Labour and their pretensions of evidence based policy making; the coalition seems set to neutralise it before it creates the same problems for them.

There is evidence and support for policies that view problem drug usage as a public health, rather than a criminal justice issue.  Instead of putting drug addicts in prison - where drugs and boredom are both in plentiful supply - put them into care; rehabilitation and medical care is not only more humane but also delivers greater results.  A key step toward this is decriminalisation, a policy followed in other parts of Europe with success.  Decriminalisation paves the way for addicts to be channelled into healthcare rather than the criminal justice system thus removing problem users from the cycle of drug abuse and crime.  It should be noted that despite billions of pounds of investment prohibition of drugs has not only utterly failed, but continues to exacerbate the problem; their availability to end users continues to increase as their price continues to fall.
Unfortunately decriminalisation (a key step toward reform of drug policy into an issue of public health) has been unpalatable for British governments since the 1960s when the current classification system was introduced.  The punitive populism harnessed by Michael Howard in the 1990s (subsequently continued by New Labour) pushed drug policy further toward the criminal justice system and away from the control of health professionals.  The ACMD ran into trouble with a number of New Labour home secretaries for having the audacity to perform its primary role; advise the government on drug policy using scientifically researched evidence.  It represented a contradiction; an expert source of evidence based policy for a government whose primary concern was the consideration of public perception.

This contradiction was played out when it came to reclassifying Cannabis and other controlled substances.  A particularly interesting report in which the government had no interest was published in 2007 and sought to rank controlled substances by their harm (both physical and social).  The report suggested that under the current classification system Ecstasy should be a Class C drug, Alcohol Class A; this was summarily ignored.  The Advisory Council also opposed the reclassification of Cannabis from Class C to B in 2009, stating a lack of evidence on which to base the move.  Several public clashes involving the head of the ACMD professor David Nutt occurred; in a particularly controversial article he compared the death rates for equestrian sports and ecstasy usage conclusively concluding that the former was a significantly greater risk to public health.  This use of evidence to illustrate holes in government policy was not welcome and following a further clash over the classification of alcohol  professor Nutt was sacked.  Several other scientists resigned over the incident.

Removing the requirement for scientists to sit on the ACMD is still just a proposal, yet it serves to highlight two things.  First that support for evidence based policy making has diminished; secondly that explicitly ideologically motivated policy has very much returned.  Sadly, it also augurs badly for the treatment of problem drug usage becoming a public health issue, a development that might actually begin to tackle it.  Tackling problem drug usage and related crime as a criminal justice issue is 'treating the symptoms' at its best.  The causes of the symptoms are complex and diverse, some medical some social; it is no coincidence that the majority of problem drug use occurs amongst the poorest and least educated members of society and that thousands of educated, stable individuals indulge in recreational drug usage each weekend without harm to themselves or those around them.  But just because an issue is complex and difficult does not mean we should not take the hard road, take the difficult decisions and begin addressing it in a logical, evidence based way.

A brief introduction, Part 1 : Evidence Based Policy Making

Politicians treating the symptoms of a problem rather than its cause is as old as Politics itself.  Some may hold the belief that the status quo has prevailed since man first emerged from the primordial forest. Perhaps it has.  Yet a light to lead the way out of the darkness did emerge as recently as thirteen years ago and it is from this moment that my analysis proceeds.

New Labour were elected by an overwhelming minority of the British population, some 26% of those over eighteen years of age cast a vote for Tony Blair et al.  Our antiquated electoral system translated this into a large parliamentary majority, granting a real opportunity for real change and reform across all aspects of government, from electoral reform through to reform of public services.  With this came the promise of Evidence Based Policy (EBP), a determination to delivery reforms that really worked, that could be demonstrated through material results.

This represented a significant change in British politics, the dawn of the post-ideological era.  New Labour occupied the centre ground, bridging the gap between the desire from the left for a fair society and the aspirational consumer driven reality borne out through successive Conservative governments of the 1980s and 1990s.  Whether this was actually achieved is for the moment, a moot point.

In this post-ideological era government was to be about the New Managerialism, Tony Blair the CEO of Britain Plc.  He would lead the organisational change going forward, adhere to quality assurance principals in monitoring the outcomes of the policies they embraced.  No more would a government simply pursue a particular course because their ideology demanded it; New Labour would use what worked.  Policy would be based upon hard facts, visible evidence.

This largely positivist approach to politics did not last particularly long.  EBP it turned out, revealed some unpalatable truths.  Prison doesn’t work, privatisation does not necessarily improve public services, prohibition of drugs is counterproductive, there are no weapons of mass destruction.  The punitive populism of Michael Howard was continued as the number of offences mushroomed, the prison population soared.  Voters wanted to see a government ‘tough on crime, tough on the causes of crime’.  In reality they had little appetite for the causes, but an insatiable hunger to see punishments handed out to criminals.  EBP was quietly abandoned, though not all went quietly.  The Advisory Council on the Misuse of Drugs (ACMD) made it quite clear that there evidence on drug classification was both evidence based and ignored by the very government that appointed it.  

Though there were some positive results, many in the realm of education, proving that EBP has the potential to make some headway with some of the findings influencing policy on the shape of the national curriculum (this has since been shelved by the coalition).  The social mobility unit identified the issues of wealth inequality and lack of opportunity; the former was ignored the latter tackled in the Widening Participation agenda.  Some progress was made, some diseases at the heart of Britain were challenged, if not defeated. 

So where are we today?  The post-ideological era is over, though it can be easily argued that it never existed in the first place (More on this later).  David Cameron’s Conservative Party is, despite initial doubts, pursuing a deeply ideological path.  Its key facet is the redefinition of responsibility, the transfer of risk from the state to the individual.  It begins with students bearing the cost of their education, it logically concludes with individuals bearing the cost of everything else that the state provides (such as healthcare).  Thus far, EBP has had seemingly little influence on the Coalition government.

The result is that we return to an era in which policy and action is directed solely by ideological concerns with scant regard for any form of evidential base.  But it is this basis on evidence that helps to identify the causes of the problems that we face.  This isn’t to say that there is no place for ideology, one set of evidence can suggest a multitude of possible solutions, how does one decide?  Yet the decision to ignore evidence, whether qualitative or quantitive, is self defeating.  The flicker in the dark, the hope that our elected representatives might begin tackle the causes of society’s ills, rather than the symptoms, has been extinguished.