Something new in politics: the rational assessment of harm

[imomus]

Last week The Lancet, Britain's foremost medical journal, published a study into the harmful effects of drugs. "Professor David Nutt from the University of Bristol, Professor Colin Blakemore, Chief Executive of the Medical Research Council, and two colleagues developed a new drug ranking system that would class socially acceptable tobacco and alcohol as more harmful than cannabis, and considerably more dangerous than Class A drugs such as ecstasy and LSD," reported the AP.

Blakemore and Nutt said that the current UK government drug classification scheme "is not a rational, evidence-based method for assessing the harm of drugs". The one they've come up with, on the other hand, is. Here are the results:



Apart from making me want to trade my stock of Neumarkter Lammsbrau Weisse Bio for a big swatch of chewy khat, the report pleased me for a number of reasons.

First of all, I thoroughly approve of the idea that things which are considered normal and mainstream may be amongst the most toxic. This is absolutely central to my thinking, and it's one of the things that dismays me about our time -- the fact that "evil" is said to spring from deviant subcultures and "rogue nations" rather than from ourselves, or that "drugs" are defined as everything except that which resides in a cabinet minister's cocktail cabinet.

Secondly, I think the idea of a "rational assessment of harm" that looks also at "the things we do" is nothing short of revolutionary. For instance, we know George Bush has an alcohol problem. Can the casualties of his ill-considered Iraq invasion be counted amongst the victims of alcohol? This new logic needn't be confined to drugs -- can we have a rational approach to, for instance, WMDs? If the evilness of Weapons of Mass Destruction was Blair's reason for attacking Iraq, could Blair at least be consistent and declare that he's not, after all, going to renew Britain's Trident, which is, precisely, a Weapon of Mass Destruction?

I think you can see where I'm heading. This "rational" idea could be the biggest thing to hit politics since "targets". It could even apply to The Lancet itself. The medical journal came under attack last week too when, according to AP, "physicians from around the world urged the publisher of The Lancet medical journal to cut its links to weapons sales, calling on the editors to find another publisher if Reed Elsevier refused to stop hosting arms fairs".

Tobacco continues its path towards disgrace and humiliation, its transition from "things that are considered normal" to "things that are considered toxic and marginal". I'm delighted to say that even in Germany -- Europe's biggest tobacco market -- we non-smokers are about to enjoy the kind of protective legislation that'll allow us to come home from evenings out without smelling like an ashtray (and, later, dying of secondhand cancer).

The German government agreed on Thursday to ban smoking in restaurants and pubs, unless it happens in designated smoking rooms closed off by doors. Smoking is also being banned in discos and nightclubs, schools, old people's homes, public buildings, trains, taxis and all other public transport -- although trains will still be allowed to allocate smoking carriages.

The public smoking issue clearly fails the libertarian test that vices should be permitted "as long as they don't hurt anybody else", and a ban in Berlin -- the smoker's Mahagonny -- is long overdue. It's also very hard for me to refrain from saying Germany and Japan have been "behind" other nations in banning public fag fug, although I don't believe in declaring nations "behind" or "ahead of" others -- just different. Okay, Germany and Japan have been guilty of a "bad difference" here, and for once I can say the Anglo nations have led the world. Now we just need them to apply this newfangled "rational" idea to the other harmful stuff they do, like selling weapons and sending soldiers all over the world to kill people.

Comments

[intergalactim.livejournal.com]

it's crazy, nearly two and a half years after the ban on smoking in bars in new zealand, i still come home smelling like smoke! maybe those places just need a good clean... smoking carriages on trains sound evil!

rational assesment of harm would have something to say about cars too, i'd bet.

[schizo-robot.livejournal.com]

this reminds me of how sugarfree products are labeled as healthier and smarter, and how someone on a diet should consume them, when they're much more harmful to you in the long run. that bothers me so much, and working at a department store only makes it worse.

[blackmoth.livejournal.com]

And sugar is nowhere on the graph?

[purveyorofchaos.livejournal.com]

It's nice to know someone finally made a definitive graph of this. The raw info for this had been floating around for years and years and years.

[cap-scaleman.livejournal.com]

Any ban on the use of mobile phones on trains or such?

[neil-scott.livejournal.com]

There's a clearer graph here: http://mcgazz.livejournal.com/130996.html

Here in Scotland, it is now natural not to smoke inside public venues. When I see it happening in England, it is quite disorientating.

[scola.livejournal.com]

"For instance, we know George Bush has an alcohol problem. Can the casualties of his ill-considered Iraq invasion be counted amongst the victims of alcohol?"

Perhaps, if one can demonstrate he was drunk when he decided to invade. Of course, Bush claims he doesn't drink anymore. There doesn't seem to be much evidence to the contrary, but since you've just made a statement that suggests Bush continues to abuse alcohol... I assume you know something we don't. So, I'll bite: how do you figure the US President is back on booze? Please be specific.

[imomus.livejournal.com]

Well, let me put it this way. I don't see pretzels in that top 20 of harmful drugs. In fact, I doubt pretzels are even in the top 200. And yet we're expected to believe that a pretzel did this?



"He fainted due to a temporary decrease in heart rate brought on by swallowing a pretzel," White House physician Dr Richard Tubb said (http://news.bbc.co.uk/2/hi/americas/1758848.stm), adding that the president had complained of feeling "a little off his game" in recent days.

[cap-scaleman.livejournal.com]

And I who thought he was always off his game.

What's next? The red nose is due to falling asleep on the grass during the night?

[sarmoung.livejournal.com]

Despite some appeal, this new ranking fails for its unimaginative x/y axis approach. It needs a hyperdimensional representation, preferably in florescent colours.

I don't doubt that tobacco is harmful, but it rarely affects spatial judgement or motor skills. Would I rather the train was driven by a man with a gasper in the corner of his mouth or a bag of glue in hand? This table seems to have reordered drugs, but not addressed its definition of harm.

I was at an anarchist meeting some years ago when I can recall one of the people there making a reasoned (although possibly drug-influenced) argument that the movement should turn its attention to the various wholefood cooperatives, vegetarian movements and similar that we were nominally supposed to be in favour of. No, he argued, the working class had a right to meat pies and we should make a stand there and then against bourgeois interference in their culinary preferences. Except with more swearing.

Of course, while mental health patients in lock-up wards will be denied the opportunity (and in the case of some psychoactive medications, the temporary benefits) of smoking, one of the few places that smoking will remain legal is in bars of the House of Commons. Nothing is permitted, except for the permitters...

[(Anonymous)]

This seems to be another case of you wanting to have your relativist cake and absolutely eat it too. You can't have "rational, evidence-based" approaches to anything unless you believe in the power of, well, evidence, which you have professed repeatedly not to.

Moreover, shouldn't the fact that tobacco and alcohol have been treated differently in the cultures under discussion than other substances settle the matter? Shouldn't you ridicule such an attempt at ranking "cultural constructs such a drugs, or harm"? What would you make of a graph that plots "the pressure to conform" vs "harm", and lets Japan come up top?

der.

[scola.livejournal.com]

To be fair, pretzels are tricky foods. Compared to other snacks, they've got an usual shape and it is surprisingly easy for one to get lodged in your throat. Especially if you forget to CHEW them before swallowing, which -- let's be honest -- seems like the sort of error to which this president might be prone.

Seriously though, I despise George W. Bush, but I don't believe he's drinking again. The guy is out jogging all the time, from what I read, and actually appears to be in pretty good physical shape (despite the pretzel incident). If this was, in fact, an alcoholic who has been drinking in office, I think there would be quite a bit more evidence. To casually assert that Bush is (currently) a drunk makes you come off as a crank. There are plenty of accusations that can be made against this president without resorting to rumor or idle conjecture.

[imomus.livejournal.com]

Would I rather the train was driven by a man with a gasper in the corner of his mouth or a bag of glue in hand?

You're right that it's more complex than the chart allows. It's also more complex than your counter-example allows. For instance, a sleepy train driver might well be safer for his passengers on amphetamines than off them. Should we then say that speed (the drug) is actually a positive benefit to the population? And where are the benefits in this chart, if we want to do a "rational" cost-benefit analysis? Clearly, drugs have lots of benefits in terms of pleasure, creativity, performance, even mental health.

[imomus.livejournal.com]

Basically, see Sarmoung's objections above, and my extension of them. There are many ways to skin the cat of the "rational" and yes, the variations are cultural. But just as you want to hold me to my own standards of cultural relativism, I want to hold Blair et al to their own standards of the assessment of "evil", toxicity, etc.

[imomus.livejournal.com]

I really hope you're not saying that anything not confirmed by the White House press office is rumour or conjecture? You want mainstream press articles, comedy sketches, blog reports of Bush's drinking? They're everywhere. The more mainstream the article, though, the more likely it is to have been removed or recanted for after publication. Funny, that. Somebody wants the rumours to stay rumours. Could it be connected to the 25th amendment to the constitution, which would make documentation of a drinking problem grounds for rapid removal of a US president?

[(Anonymous)]

I haven't actually been keeping up with Click Opera for a few months now, and I'm quite amazed at how your recent entry regarding guilds is in sync with recent thoughts I've been having about work. Mostly, I've honed on this idea of there being 2 sorts of work. Work that needs to be done, that creates some sort of value, and work that positions itself between and around the first kind of work. Ok, well, really I just quit my retail management job that I've hated for along time, and I'm trying to nut out why I hated it so much. Trips me out how other people around the world can reach similar conclusions independently. :D

Liam (willyoucomeandfetchme@hotmail.com)

[sarmoung.livejournal.com]

Well, for the record, I'd prefer it if Click Opera continued to be written under the influence of yoghurt rather than khat!

Speed may certainly be held to be of benefit in the short-term and post-war recovery in Japan was in part the result of its prevalence among the population. Although this came at the cost of mental and physical health, not to mention the advantages provided to the black market once the drug was made illegal. It's not uncommon in medical situations for drugs with high levels of toxicity to be given for the benefits they're held to provide in crisis intervention.

One aspect to supposed harm or toxicity that does frustrate me is the inadequacy of over-the-counter pain relief. I can buy a reasonably powerful opiate like dihydrocodeine, but only if it's mixed with a dose of paracetamol. Large doses of the former might lead to a hefty apathetic euphoria whereas the latter will lead to liver damage and potential failure. Might not an interfering legislature at some point wonder whether people might not be protected from alcohol by similarly adulterating "the good stuff". Slightly merry will be sanctioned, but anything more will result in unpleasant side effects. (I'm tempted to trademark such a dissuasive alcohol additive as "Gainsbarre")

Curiously, the Japanese table tennis team appear ready to promote recreational drug usage:

(http://photobucket.com)

[imomus.livejournal.com]

Yes, that's all very well, Liam, but have you been practising your guitar? (Sorry, private joke!)

[zenicurean.livejournal.com]

To casually assert that Bush is (currently) a drunk makes you come off as a crank.

Not to mention it draws an immediate subliminal parallel to another booze-happy pro-war president, who, unfortunately, Mr Bush ain't.

[zenicurean.livejournal.com]

Okay, Germany and Japan have been guilty of a "bad difference" here, and for once I can say the Anglo nations have led the world.

A beautiful semantic save here. Heck, I'd use this somewhere, if it was mine.

[cerulicante.livejournal.com]

It is folly to use a study in the Lancet to back one's assertions unless one has read and understood the methodology behind the assertions. I won't say anything until I've read the actual article. You shouldn't, either. It makes you look like the same sort of credulous rube that the mainstream press likes to make a reporter.

[philentropist.livejournal.com]

I completely agree that the rational assessment of harm is a revolutionary idea, and a step in the right direction. However, in this particular case there is a major shortcoming in the method. It's based on the assumption that harm is a property of substances themselves. In fact the harmfulness is a property of the combination of substances and individuals, because substances can affect different people in different ways.

For instance, there are at least seven genes that affect the first step in the body's decomposition of alcohol. If there are only two variants of each gene, it would result in over 100 different variations on the way alcohol affects the body.

Of course it's possible that some substances do have similar effects on all of their users, but the point is that's just as important to determine as how they affect people on average.

[zzberlin.livejournal.com]

<< Can the casualties of his ill-considered Iraq invasion be counted amongst the victims of alcohol? >>

Last summer my Mom told me the tabloids said Bush was drinking again. I quasi-believed it. As an alcoholic, I can't imagine what it would be like to find myself running a hostile empire. I'd probably succumb to the lures of the bottle myself again.

Momus, you have no alcoholism in your family, do you? Otherwise, I think you would have more compassion in your heart for the problem. To blame the invasion of Iraq on a sober alcoholic who you suppose is drinking, when really, you don't know if he has been drinking, is, I think, inappropriate. Why not just blame HIM instead of his alleged boozing? What is there to gain, short of gossipy enjoyment, by saying he's drinking and that's why he is doing the stuff that he does.

As for recreational drugs and their level of harm, I wonder where caffeine is on the list? I've recently developed a bad habit for RockStar, a heavily caffeinated carbonated beverage that lets you "party like a rock star." But I've partied like a rock star enough! And now I'm addicted to RockStar and its nasty caffeine! I need a decaf RockStar, but somehow I don't see that product forthcoming anytime soon,,,

[mylifeismundane.livejournal.com]

[fishwithissues.livejournal.com]

Nutt and colleagues used three factors to determine the harm associated with any drug: the physical harm to the user, the drug's potential for addiction and the impact on society of drug use. The researchers asked two groups of experts — psychiatrists specializing in addiction and legal or police officials with scientific or medical expertise — to assign scores to 20 different drugs, including heroin, cocaine, Ecstasy, amphetamines and LSD. Source (http://www.msnbc.msn.com/id/17760130/)

Okay, so it's cool that common sense and some amount of medical evidence bear out the idea that alcohol and tobacco are bad news. It's always good to be able to point a laser pointer at a graph when somebody's point a cigarette in your face--but what gives these researchers claim to the word "rational"? Because they worked really hard on a "9-category matrix" and then asked an "expert panel"? Blah blah blah. This graph and the summary of the stuf i've read do not present a rational argument; they represent the results of a carefully-constructed rubric and a series of structured interviews with experts. Subjectivity in a labcoat. At best the study might be a beneficial social tool, a media blitz, but I don't see what makes this study "something new," and not business as usual.