NICE’s latest proposal offers a salutory lesson for the expert lovers.

This post was written by Reuben Bard-Rosenberg on June 2, 2010
Posted Under: Uncategorized

The revelation that the two boys who made headlines a few months back did not in fact die from mephedrone has left a number of people feeling rather smug. A few months back, many people were outraged that the government had not heeded the advice of experts, and had pressed ahead to ban mephedrone regardless of evidence.

At the time I opposed the criminalisation of mephrodone, yet I also opposed the calls for an “evidence based drugs policy”. As I said back then, the regulation of drugs by the state is not simply a bio-chemical or evidential question, but a political question. Even where a drug or substance can be shown to carry risks, questions still remain about whether the state should intervene to protect people from themselves, or  whether adult citizens should be free to weigh up potential health risks against pleasure and enjoyment.  There are no prizes for guessing that I towards latter.

Back when mephedrone was being banned, the demand for evidence based policy was naturally appealing. Today, however, is a good day for those of us who are recalcitrant about bowing down before expert and ‘evidence based’ policy recommendations. And that’s because today the National Institute for Clinical Excellence have recommended a minimum price for  alcohol.

Such a move would be assymettical in it’s impact – restricting the lifestyle choices of the poor far more than the rich. It would financially punish people for what is still a legal lifestyle choice.  The evidence they upon which NICE  allegedly base their recommendation centres on two things: that alcohol consumption is currently generating harm and that minimum pricing could substantially reduce consumption. The serious political principles at stake –  liberty, paternalism, relations between state and citizen – are subsumed into health economics, and philistine utilitarian calculations.

A case in point: amongst the arguments NICE offer is that intitiatives to reduce alcohol consumption will increase productivity. I don’t dispute this. Yet the idea of pricing people out of drink to improve their productivity raises a whole number of questions: in particular how far should people be expected to gear their leisure time towards making sure they perform well at work. I mean optimum productivity might be achieved by the government setting peoples bed times.  What is at stake here, is the relations between capital and labour. The government should not be coercing us in our leisure time so as to maintain profitability.

So, if like me you would like to see a more permissive and free society then please, stop expecting the experts to do it for you, and have the balls to argue for it politically.

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Reader Comments

I’m pretty sure from this you don’t know what the term ‘evidence based’ actually means. As that term is central to your argument it has left the post rather thin I’m afraid.

The idea that people who want an evidence based policy don’t understand there are political questions involved does not, frankly, bear scrutiny.

All it means is that you need the facts in order to make a proper political decision, and that means independent expert advise, something that Labour completely opposed. People criticised Labour for rejecting evidence that did not suit its political agenda, and refusing to wait for evidence before leaping to conclusions, taking an essentially anti-science approach. Labour were not taken to task for the indisputable fact that the classification of drugs is a political decision.

An evidence based drugs policy would not mean banning everything that does people harm (or even, I suppose, not restricting substances that have no health ill effects), or leaving all decisions to an elite band of white coat wearers. It simply means that when taking decisions of this nature you need to do it based on facts so you actually understand the issue.

#1 
Written By jim jepps on June 2nd, 2010 @ 11:33 pm

Damn I just got pwned.

#2 
Written By Reuben on June 2nd, 2010 @ 11:41 pm
Dave

I’m not sure which way the whole ‘evidence-based’ thing swings, but unless I misunderstood as well, Reuben had it pretty much right to start with. Under an evidence-based policy, drugs are regulated based solely on their effects and dangers, rather than on extraneous cultural factors. It’s manifestly not something we have in the UK, when you look at the policies on tobacco and alcohol.

Of course, a policy can be evidence-based to a greater or lesser degree; it need not be absolute. I’d also note that whilst an evidence-based policy will prescribe the order of severity of regulation, it does not affect the degree of regulation as a whole, which remains a political decision.

#3 
Written By Dave on June 3rd, 2010 @ 12:17 am
Dave

Anyway, what I actually wanted to discuss was the minimum price for alcohol. I’m not sure exactly what the practical implementation would be, but before passing judgement on the idea as a whole, I was trying to work out the actual effects.

Consider a £2 bottle of industrial supermarket ownbrand cider. Assume that the minimum price for a bottle containing that quantity of alcohol is set at £3. What actually happens next?

Obviously, the supermarket could just put up the price of the cheapo trampjuice to £3, but in a competitive market that won’t wash. It would seem that what you end up with is a situation where the lowest quality drink isn’t sold anymore.

The difference between this policy and just increasing the tax on alcohol is that manufacturers have lowered the quality of their product to pay the tax. A tax and a minimum price would appear to avoid that.

Of course, we could just get rid of the tax…

#4 
Written By Dave on June 3rd, 2010 @ 12:27 am
Dave

P.S.

Out of pure pedantry, did you really mean your headline to refer to those well-versed in the erotic arts, or is ‘expert-lovers’ missing a hyphen?

#5 
Written By Dave on June 3rd, 2010 @ 12:40 am
RobertD

Jim Jepps,

I agree that where there is reliable evidence collected and presented in a non-judgemental way then it should be used to influence decisions. However where I strongly disagree is that it is always the role of governement and its multitudinous agencies to take action. In the case of alcohol, and many other drug, the people who can assess the relevance of the evidence to them, and to make their own choices, are the individual citizens.

The only time the state has a bais for getting involved is if, in exercising their individual choices, some citizens cause serious damage to other citizens. Reasonable action to prevent, or provide restitution for the damage, on an individual basis, is then appropriate.

NICE makes the same mistake in its primary function in healthcare. Identifying and published the best available evidence has value. However the application of that information to the particular circumstances of each individual patient is up to the patient and their doctors. Prescribing what can and can’t be done for each individual on the basis of an average of many different circumstances is cruel and inefficient.

We need experts to assemble the evidence, but only informed citizens can decide what to do on the basis of that evidence.

The role of experts is the same as the role of the Pope on contraception was once described, “He no play the game, he no make the rules”

#6 
Written By RobertD on June 3rd, 2010 @ 3:12 am

LOL at the missing hyphen.

Jim if “evidence based policy just means using the facts to make a proper political deision”, then I fail to see the point of people getting together and joining facebook groups etc to demand evidence based policy, given that they ciuld effectively be demanding diametrically opposed outcomes

#7 
Written By Reuben on June 3rd, 2010 @ 9:05 am

I mean put it this way, would you rather a PM who studies carefully the evidence of harm and banned tobacco, or a pm who reduced the tax on it because a magic 8 ball told him to. I would mist certainly prefer the latter.

#8 
Written By Reuben on June 3rd, 2010 @ 9:11 am

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