COMPARTILHANDO AS IDEIAS DE IÇAMI TIBA.

RECEBI ESTA MENSAGEM, RELACIONADA COM OS FILHOS...
PARA NÓS QUE SOMOS PAIS, AS VEZES É IMPORTANTE, RELEMBRAR ALGUMAS DICAS.
POR MAIS DIFÍCIL QUE SEJA A EDUCAÇÃO HOJE...

EDUCAR NÃO ESTÁ SENDO MUITO FÁCIL...
PRINCIPALMENTE, QUANDO AINDA TEMOS ADOLESCENTES EM CASA!!!

MAS O AMOR, SEMPRE FALA MAIS, ALTO. É A CHAVE DE TUDO....

Palestra ministrada pelo médico psiquiatra Dr. Içami Tiba, em Curitiba, 23/07/09.

O palestrante é membro eleito do Board of Directors of the International Association of Group Psychotherapy. Conselheiro do Instituto Nacional de Capacitação e Educação para o Trabalho "Via de Acesso". Professor de cursos e workshops no Brasil e no Exterior.
Em pesquisa realizada em março de 2006, pelo IBOPE, entre os psicólogos do Conselho Federal de Psicologia, os entrevistados colocaram o Dr. Içami Tiba como terceiro autor de referência e admiração - o primeiro nacional.

1. A educação não pode ser delegada à escola. Aluno é transitório. Filho é para sempre.

2. O quarto não é lugar para fazer criança cumprir castigo. Não se pode castigar com internet, som, tv, etc...

3. Educar significa punir as condutas derivadas de um comportamento errôneo. Queimou índio pataxó, a pena (condenação judicial) deve ser passar o dia todo em hospital de queimados.

4. É preciso confrontar o que o filho conta com a verdade real. Se falar que professor o xingou, tem que ir até a escola e ouvir o outro lado, além das testemunhas.

5. Informação é diferente de conhecimento. O ato de conhecer vem após o ato de ser informado de alguma coisa. Não são todos que conhecem. Conhecer camisinha e não usar significa que não se tem o conhecimento da prevenção que a camisinha proporciona.

6. A autoridade deve ser compartilhada entre os pais. Ambos devem mandar. Não podem sucumbir aos desejos da criança. Criança não quer comer? A mãe não pode alimentá-la. A criança deve aguardar até a próxima refeição que a família fará. A criança não pode alterar as regras da casa. A mãe NÃO PODE interferir nas regras ditadas pelo pai (e nas punições também) e vice-versa. Se o pai determinar que não haverá um passeio, a mãe não pode interferir. Tem que respeitar sob pena de criar um delinquente.

7. Em casa que tem comida, criança não morre de fome . Se ela quiser comer, saberá a hora. E é o adulto quem tem que dizer QUAL É A HORA de se comer e o que comer.

8. A criança deve ser capaz de explicar aos pais a matéria que estudou e na qual será testada. Não pode simplesmente repetir, decorado. Tem que entender.

9. É preciso transmitir aos filhos a idéia de que temos de produzir o máximo que podemos. Isto porque na vida não podemos aceitar a média exigida pelo colégio: não podemos dar 70% de nós, ou seja, não podemos tirar 7,0.

10. As drogas e a gravidez indesejada estão em alta porque os adolescentes estão em busca de prazer. E o prazer é inconsequente.

11. A gravidez é um sucesso biológico e um fracasso sob o ponto de vista sexual.

12. Maconha não produz efeito só quando é utilizada. Quem está são, mas é dependente, agride a mãe para poder sair de casa, para fazer uso da droga . A mãe deve, então, virar as costas e não aceitar as agressões. Não pode ficar discutindo e tentando dissuadi-lo da idéia. Tem que dizer que não conversará com ele e pronto. Deve 'abandoná-lo' .

13. A mãe é incompetente para 'abandonar' o filho. Se soubesse fazê-lo, o filho a respeitaria. Como sabe que a mãe está sempre ali, não a respeita.

14. Se o pai ficar nervoso porque o filho aprontou alguma coisa, não deve alterar a voz. Deve dizer que está nervoso e, por isso, não quer discussão até ficar calmo. A calmaria, deve o pai dizer, virá em 2, 3, 4 dias. Enquanto isso, o videogame, as saídas, a balada, ficarão suspensas, até ele se acalmar e aplicar o devido castigo.

15. Se o filho não aprendeu ganhando, tem que aprender perdendo.

16. Não pode prometer presente pelo sucesso que é sua obrigação. Tirar nota boa é obrigação. Não xingar avós é obrigação. Ser polido é obrigação. Passar no vestibular é obrigação. Se ganhou o carro após o vestibular, ele o perderá se for mal na faculdade.

17. Quem educa filho é pai e mãe. Avós não podem interferir na educação do neto, de maneira alguma. Jamais. Não é cabível palpite. Nunca.

18. Se a mãe engolir sapos do filho, ele pensará que a sociedade terá que engolir também.

19. Videogames são um perigo: os pais têm que explicar como é a realidade, mostrar que na vida real não existem 'vidas', e sim uma única vida. Não dá para morrer e reviver. Não dá para apostar tudo, apertar o botão e zerar a dívida.

20. Professor tem que ser líder. Inspirar liderança. Não pode apenas bater cartão.

21. Pais e mães não pode se valer do filho por uma inabilidade que eles tenham. 'Filho, digite isso aqui pra mim porque não sei lidar com o computador'. Pais têm que saber usar o Skype, pois no mundo em que a ligação é gratuita pelo Skype, é inconcebível pagarem para falar com o filho que mora longe.

22. O erro mais frequente na educação do filho é colocá-lo no topo da casa. O filho não pode ser a razão de viver de um casal. O filho é um dos elementos. O casal tem que deixá-lo, no máximo, no mesmo nível que eles. A sociedade pagará o preço quando alguém é educado achando-se o centro do universo.

23. Filhos drogados são aqueles que sempre estiveram no topo da família.

24. Cair na conversa do filho é criar um marginal. Filho não pode dar palpite em coisa de adulto. Se ele quiser opinar sobre qual deve ser a geladeira, terá que mostrar qual é o consumo (KWh) da que ele indicar. Se quiser dizer como deve ser a nova casa, tem que dizer quanto isso (seus supostos luxos) incrementará o gasto final.

25. Dinheiro 'a rodo' para o filho é prejudicial. Mesmo que os pais o tenham, precisam controlar e ensinar a gastar.

Frase: " A mãe( ou pai), que leva o filho para igreja,não vai buscá-lo na cadeia..."

PASSE EM: Meus Mimos!
GANHEI UM LINDO PRESENTE DA MINHA MADRINHA MARCIA.

VIM RAPIDINHO ....

.....DIZER QUE AMO CADA UM QUE PASSA POR AQUI E QUE MUITO EM BREVE ... RETRIBUIREI OS RECADINHOS MUITO ESPECIAIS....

VIM POSTAR A COLETIVA DO DIA 09.11.
Blog Coletivo-Uma Interação de Amigos
PASSE LÁ E CONFIRA.

APÓS A CIRURGIAS FIQUEI COM MUITA DOR DE CABEÇAS E FORTE. NÃO ESTOU CONSEGUINDO FICAR NA FRENTE DO PC...
DESCULPEM. MAS PROMOTE RETRIBUIR TODO ESSE AMOR RECEBIDO.
PESSOAS ESPECIAIS NÃO ESQUCEMOS.
AMO VOCÊ!!!
POR ISSO DEIXO UM CARINHO

The Needle and the Damage (Not) Done

You may already have heard about Desiree Jennings.

If not, here's a summary, although for the full story you should consult Steven Novella or Orac, whose expert analyses of the case are second to none. Desiree Jennings is a 25 year old woman from Ashburn, Virginia who developed horrible symptoms following a seasonal flu vaccination in August. As she puts it:

In a matter of a few short weeks I lost the ability to walk, talk normally, and focus on more than one stimuli at a time. Whenever I eat I know, without fail, that my body will soon go into uncontrollable convulsions coupled with periods of blacking out.

For some weeks the problems were so bad that she was almost completely disabled, and feared the damage was permanent. Vaccines had destroyed her life. You can see a video here - American TV has covered the story in a lot of detail (the fact that she is quite... photogenic can't have put them off). Desiree and the media described her illness as dystonia, a neurological condition characterised by uncontrollable muscle contractions. Dystonia is caused by damage to certain motor pathways in the brain.

However, Desiree Jennings does not have dystonia. The symptoms look a bit like dystonia to the untrained eye, but they're not it. This is the unanimous opinion of dystonia experts who've seen the footage of Jennings. A blogger discovered that it was also seemingly the view of the neurologist who originally examined her.

So what's wrong with her? The answer, according to experts, is that her symptoms are psychogenic - "neurological" or "medical" symptoms caused by psychological factors rather than organic brain damage. It's important to be clear on what exactly this implies. It doesn't mean that Jennings is "making up" or "faking" the symptoms or that they're a "hoax". The symptoms are as "real" as any others, the only thing psychological about them is the cause. Nor are psychogenic symptoms delusions - Jennings isn't mentally ill or "crazy".

Almost certainly, she is in her right mind, and she sincerely believes that she is a victim of brain damage caused by the flu shot. The belief is false, but it's not crazy - in 1976 one flu vaccine may have caused neurological disorders and today many, many otherwise sane people believe that vaccines cause all kinds of damage. (It could well be that this belief is actually driving Jennings' symptoms, but we can't know that - there could be other psychological factors at work.)

*

One of the hallmarks of psychogenic symptoms is that they improve in response to psychological factors. Neurologist blogger Steven Novella predicted that:

I predict that they will be able to “cure” her, because psychogenic disorders can and do spontaneously resolve. They will then claim victory for their quackery in curing a (non-existent) vaccine injury.

They being anti-vaccination group Generation Rescue who were swift to offer Jennings their support and, er, expertise. And this is exactly what seems to be happening: Dr Rashid Buttar, a prominent anti-vaccine doctor who treats "vaccine damage" cases, began giving Jennings (amongst other things) chelation therapy to flush out toxic metals from her body, on the theory that her dystonia was caused by mercury in the vaccine. It worked! Dr. Buttar tells us - 15 minutes after the chelation solution started entering her body through an IV drip, all of the symptoms had disappeared (on the podcast it's about 6:00 onwards).

It's completely implausible that mercury in the vaccine could have caused dystonia, and even if it somehow did, it's impossible that chelation could reverse mercury-induced brain damage so quickly. If you are unfortunate enough to get mercury poisoning the neurological damage is permanent; flushing out the mercury wouldn't cure you. There's now no question that Jennings is a textbook case of psychogenic illness.

*

On this blog I've often written about the mysterious "placebo effect". A few weeks ago, I said -

People seem more willing to accept the mind-over-matter powers of "the placebo" than they are to accept the existence of psychosomatic illness.

We certainly seem to talk about placebos more than we talk about psychosomatic or psychogenic illness. There are 20 million Google hits for "placebo", just 1.6 million for "psychosomatic", and 500,000 for "psychogenic". (Even "placebo -music -trial" gives 8.7 million, which excludes all of the many placebo-controlled clinical trials and also hits about the band.)

Why? One important factor is surely that it's very difficult to prove that any given illness is "psychosomatic". Even if a patient has symptoms with no apparent medical cause, leading to suspicions that they're psychogenic, there could always be an organic cause waiting to be discovered. Just as we can never prove that there were no WMDs in Iraq, we can never prove that a given illness is purely psychological in origin.

But occasionally, there are cases where the psychogenic nature of an illness is so patent that there can be little doubt, and this is one of them. Watch the videos, listen to the account of the cure, and marvel at the mysteries of the mind.

[BPSDB]

The Needle and the Damage (Not) Done

You may already have heard about Desiree Jennings.

If not, here's a summary, although for the full story you should consult Steven Novella or Orac, whose expert analyses of the case are second to none. Desiree Jennings is a 25 year old woman from Ashburn, Virginia who developed horrible symptoms following a seasonal flu vaccination in August. As she puts it:

In a matter of a few short weeks I lost the ability to walk, talk normally, and focus on more than one stimuli at a time. Whenever I eat I know, without fail, that my body will soon go into uncontrollable convulsions coupled with periods of blacking out.

For some weeks the problems were so bad that she was almost completely disabled, and feared the damage was permanent. Vaccines had destroyed her life. You can see a video here - American TV has covered the story in a lot of detail (the fact that she is quite... photogenic can't have put them off). Desiree and the media described her illness as dystonia, a neurological condition characterised by uncontrollable muscle contractions. Dystonia is caused by damage to certain motor pathways in the brain.

However, Desiree Jennings does not have dystonia. The symptoms look a bit like dystonia to the untrained eye, but they're not it. This is the unanimous opinion of dystonia experts who've seen the footage of Jennings. A blogger discovered that it was also seemingly the view of the neurologist who originally examined her.

So what's wrong with her? The answer, according to experts, is that her symptoms are psychogenic - "neurological" or "medical" symptoms caused by psychological factors rather than organic brain damage. It's important to be clear on what exactly this implies. It doesn't mean that Jennings is "making up" or "faking" the symptoms or that they're a "hoax". The symptoms are as "real" as any others, the only thing psychological about them is the cause. Nor are psychogenic symptoms delusions - Jennings isn't mentally ill or "crazy".

Almost certainly, she is in her right mind, and she sincerely believes that she is a victim of brain damage caused by the flu shot. The belief is false, but it's not crazy - in 1976 one flu vaccine may have caused neurological disorders and today many, many otherwise sane people believe that vaccines cause all kinds of damage. (It could well be that this belief is actually driving Jennings' symptoms, but we can't know that - there could be other psychological factors at work.)

*

One of the hallmarks of psychogenic symptoms is that they improve in response to psychological factors. Neurologist blogger Steven Novella predicted that:

I predict that they will be able to “cure” her, because psychogenic disorders can and do spontaneously resolve. They will then claim victory for their quackery in curing a (non-existent) vaccine injury.

They being anti-vaccination group Generation Rescue who were swift to offer Jennings their support and, er, expertise. And this is exactly what seems to be happening: Dr Rashid Buttar, a prominent anti-vaccine doctor who treats "vaccine damage" cases, began giving Jennings (amongst other things) chelation therapy to flush out toxic metals from her body, on the theory that her dystonia was caused by mercury in the vaccine. It worked! Dr. Buttar tells us - 15 minutes after the chelation solution started entering her body through an IV drip, all of the symptoms had disappeared (on the podcast it's about 6:00 onwards).

It's completely implausible that mercury in the vaccine could have caused dystonia, and even if it somehow did, it's impossible that chelation could reverse mercury-induced brain damage so quickly. If you are unfortunate enough to get mercury poisoning the neurological damage is permanent; flushing out the mercury wouldn't cure you. There's now no question that Jennings is a textbook case of psychogenic illness.

*

On this blog I've often written about the mysterious "placebo effect". A few weeks ago, I said -

People seem more willing to accept the mind-over-matter powers of "the placebo" than they are to accept the existence of psychosomatic illness.

We certainly seem to talk about placebos more than we talk about psychosomatic or psychogenic illness. There are 20 million Google hits for "placebo", just 1.6 million for "psychosomatic", and 500,000 for "psychogenic". (Even "placebo -music -trial" gives 8.7 million, which excludes all of the many placebo-controlled clinical trials and also hits about the band.)

Why? One important factor is surely that it's very difficult to prove that any given illness is "psychosomatic". Even if a patient has symptoms with no apparent medical cause, leading to suspicions that they're psychogenic, there could always be an organic cause waiting to be discovered. Just as we can never prove that there were no WMDs in Iraq, we can never prove that a given illness is purely psychological in origin.

But occasionally, there are cases where the psychogenic nature of an illness is so patent that there can be little doubt, and this is one of them. Watch the videos, listen to the account of the cure, and marvel at the mysteries of the mind.

[BPSDB]

AGRADEÇO A TODOS PELAS ENERGIAS POSITIVAS!!!

MEUS QUERIDOS AMIGOS!!

SAI DO HOSPITAL, ONTEM PERTO DO MEIO DIA.
MINHA CIRURGIA COMPLICOU UM POUCO. O QUE ERA PARA SER 45 MINUTOS, VIROU QUASE DUAS HORAS. OS MÉDICOS OPTARAM POR QUEBRAR UM DOS OSSINHOS, PARA CONSEGUIR TIRAR O PARAFUSO DE LÁ.
FOI BEM COMPLICADO.

ANTES ERA UM. AGORA É UMA PLATINA E QUATRO PARAFUSOS.
VOU FICAR 45 DIAS SEM PISAR NO CHÃO.

ESTOU ME LOCOMOVENDO SOMENTE, COM A CADEIRA DO COMPUTADOR. DURANTE ESSES DIAS ELAS SERÃO MINHAS AUXILIADORAS. NÃO SERÁ FÁCIL. MAS, PRECISO RESPEITAR ESSES MOMENTOS.

TEREI QUE FICAR COM A PERNA LEVANTADA, PARA FUNCIONAR BEM A CORRENTE SANGUÍNEA DO PÉ.
TEREI QUE CANCELAR TODOS OS MEUS COMPROMISSOS.

INCLUSIVE MINHA VIAGEM PARA GRAMADO. SEI QUE TEREI TEMPO MAIS TARDE. O IMPORTANTE AGORA É FICAR BOA DE VEZ. NOSSOS PÉS SÃO OS NOSSOS GUIAS. ELES QUEM NOS LEVAM. ENTÃO VAMOS CUIDAR BEM DELES.

BEM QUERO ACIMA DE TUDO AGRADECER O IMENSO CARINHO DE TODOS.
PELAS ENERGIAS POSITIVAS AQUI DEPOSITADAS E ENVIADAS PARA MIM. POIS ESTAVA, COM MUITO MEDO MESMO.

OBRIGADA PELA LUZ QUE VOCÊ ME ENVIOU.
AO ABRIR ESSE BLOG HOJE, VEJO O QUANTO É IMPORTANTE A SUA AMIZADE. PODE TER CERTEZA QUE ELA É CORRESPONDIDA COM MUITA SINCERIDADE.

OBRIGADO A TODOS.
ASSIM QUE EU ESTIVER MELHOR EU OS VISITAREI. POIS FIQUEI COM MUITA DOR DE CABEÇA, DEPOIS DA CIRURGIA. NÃO DÁ PARA FICAR FORÇANDO.
UM GRANDE ABRAÇO A TODOS.
AGRADEÇO AS PRECES E OS CARINHOS DE FLUIDO POSITIVOS.
AMÉM.

TE ESPERO AQUI TAMBÉM: Poetas-Um Vôo Livre

Sinal de Liberdade-uma expressão de sentimento

Blog Coletivo-Uma Interação de Amigos

The Politics of Psychopharmacology

It's always nice when a local boy makes good in the big wide world. Many British neuroscientists and psychiatrists have been feeling rather proud this week following the enormous amount of attention given to Professor David Nutt, formerly the British government's chief adviser on illegal drugs.

Formerly being the key word. Nutt was sacked (...write your own "nutsack" pun if you must) last Friday, prompting a remarkable amount of condemnation. Critics included the rest of his former organisation, the Advisory Council on the Misuse of Drugs (ACMD), and the Government's Science Minister. The UK's Chief Scientist also spoke in favour of Nutt's views. Journalists joined in the fun with headlines like "politicians are intoxicated by cowardice".

Even Nature today ran a bluntly-worded editorial -

"The sacking of a government adviser on drugs shows Britain's politicians can't cope with intelligent debate... the position of the Labour government and of the leading opposition party, the Conservatives, which vigorously supported Nutt's sacking, has no merit at all. It deals a significant blow both to the chances of an informed and reasoned debate over illegal drugs, and to the parties' own scientific credibility."

They also have an interview with the man himself.

*

What happened? The short answer is a lecture Nutt gave on the 10th October, Estimating Drug Harms: A Risky Business? I'd recommend reading it (it's free). The Government's dismissal e-mail gave two reasons why he had to go - firstly, "Your recent comments have gone beyond [matters of evidence] and have been lobbying for a change of government policy" and secondly, "It is important that the government's messages on drugs are clear and as an advisor you do nothing to undermine public understanding of them."

Many people believe that Nutt was fired because he argued for the liberalization of drug laws, or because he claimed that the harms of some illegal drugs, such as cannabis, are less severe than those of legal substances like tobacco and alcohol. On this view, the government's actions were "shooting the messenger", or dismissing an expert because they didn't like to hear to the facts. It seems to me, however, that the truth is a little more nuanced, and even more stupid.

*

Nutt's lecture, if you read the whole thing as opposed to the quotes in the media, is remarkably mild. For instance, at no point does he suggest that any drug which is currently illegal should be made legal. The changes he "lobbies for" are ones that the ACMD have already recommended, and this lobbying consists of nothing more than tentative criticism of the stated reasons for the rejection of the ACMD's advice. The ACMD is government's official expert body on illicit drugs, remember.

The issue Nutt focusses on is the question of whether cannabis should be a "Class C" or a "Class B" illegal drug, B being "worse", and carrying stricter penalties. It was Class B until 2004, when it was made Class C. In 2007, the Government asked the ACMD to advise on whether it should be re-reclassified back up to Class B. This was in response to concerns about the impact of cannabis on mental health, specifically the possibility that it raises the risk of psychotic illnesses.

The resulting ACMD report is available on the Government's website. They concluded that while cannabis use is certainly not harmless, "the harms caused by cannabis are not considered to be as serious as drugs in class B and therefore it should remain a class C drug."

Despite this, the Government took the decision to reclassify cannabis as Class B. In his lecture Nutt criticizes this decision - slightly. Nutt quotes the Home Secretary as saying, in response to the ACMD's report -

"Where there is a clear and serious problem [i.e. cannabis health problems], but doubt about the potential harm that will be caused, we must err on the side of caution and protect the public. I make no apology for that. I am not prepared to wait and see."

Nutt describes this reasoning as -

"the precautionary principle - if you’re not sure about a drug harm, rank it high... at first sight it might seem the obvious decision – why wouldn’t you take the precautionary principle? We know that drugs are harmful and that you can never evaluate a drug over the lifetime of a whole population, so we can never know whether, at some point in the future, a drug might lead to or cause more harm than it did early in its use."

But he says, there's more to it than this. Firstly, we don't know anything about how classification affects drug use. The whole idea of upgrading cannabis to Class B to protect the public relies on the assumption that it will reduce drug use by deterring people from using it. But there is no empirical evidence as to whether this actually happens. As Nutt points out, stricter classification might equally well increase use by making it seem forbidden, and hence, cooler. (If you think that's implausible, you have forgotten what it is like to be 16.) We just don't know.

Second, he says, the precautionary principle devalues the evidence and is thereby self-defeating because it means that people will not take any warnings about drug harms seriously - "[it] leads to a position where people really don’t know what the evidence is. They see the classification, they hear about evidence and they get mixed messages. There’s quite a lot of anecdotal evidence that public confidence in the scientific probity of government has been undermined in this kind of way." Can anyone really dispute this?

Finally, he raises the MMR vaccine scare as an example of the precautionary principle ironically leading to concrete harms. Concerns were raised about the safety of a vaccine, on the basis of dubious science. As a result, vaccine coverage fell, and the incidence of measles, mumps and rubella in Britain rose for the first time in decades. The vaccine harmed no-one; these diseases do. We just don't know whether cannabis reclassification will have similar unintended consequences.

That's what the Home Secretary described as "lobbying for a change of government policy". I wish all lobbyists were this reasonable.

The Home Secretary's second charge against Nutt - "It is important that the government's messages on drugs are clear..." - is even more specious. Nutt's messages were the ACMD's messages, and as he points out, the only lack of clarity comes from the fact that the government and their own Advisory Council disagree with each other. This is hardly the ACMD's fault, and it's certainly not Nutt's fault for pointing it out.

All of this is doubly ridiculous because of one easily-forgotten fact - cannabis was downgraded from Class B to Class C in 2004 by the present Labour Party government. Nutt's "lobbying" therefore consists of a recommendation that the government do something they themselves previously did. And if the government are worried about the clarity of their message, the fact that they themselves were saying that cannabis was benign enough to be a Class C drug just 5 years ago might be somewhat relevant.

*

Nutt has said that he was surprised to learn that he had been sacked. I'm sure this surprise was genuine because Nutt is an academic, and in academia, Nutt's "criticisms" would hardly even be considered as such. Here by contrast is an extract from a peer review comment I got a couple of days ago regarding a scientific paper I wrote:

The manuscript falls short of its goals in several respects: The basic phenomenon ... is barely presented... The style and language of the review leave a lot to be desired... The citations and reference list are appalling.

The same reviewer also criticized the basic argument of my article, implicitly branding the whole paper - all 10,000 words of it, which took dozens of hours to write - a complete waste of time.

Ouch. But as an academic, giving, and receiving, this kind of treatment is all part of the job, and that's just as it should be. I'm confident that my argument is sound, so I'm going to take the criticisms on board, rewrite the paper appropriately, and submit it to another journal. What I'm not going to do is bear a grudge against the reviewer. (Well maybe a little: the references weren't that bad.) To be fair, unlike Nutt's, this review was not made in the public domain, but then, I'm not a Government elected by the public.

Nutt's mistake was to think that it's possible to have a serious debate about a serious political issue. In fact, it was probably not such a bad mistake, since the job of the ACMD, as the Government sees it, is a fairly pointless one: their job is to give expert advice and then let it be ignored. As various ACMD members have noted, they work for free, in the public interest. If I were on the Committee, I would resign now, not just out of sympathy for Nutt, but because it's a crap job.

In his dismissal letter, the Home Secretary told Nutt, "It is not the job of the Chair of the Government's advisory Council to initiate a public debate on the policy framework for drugs". I would have thought he was exactly the person who should do this if such a debate was necessary, as it obviously is. Well, now we know better. It wasn't his job. Although, thanks to the government who sacked him, a drug debate is now going on in the British media for the first time in years. In the long run, Nutt's most important action as Chair of the ACMD may well have been getting sacked from it.

[BPSDB]

Nature (2009). A drug-induced low Nature, 462 (7269), 11-12 DOI: 10.1038/462011b

Daniel Cressey (2009). Sacked science adviser speaks out Nature

The Politics of Psychopharmacology

It's always nice when a local boy makes good in the big wide world. Many British neuroscientists and psychiatrists have been feeling rather proud this week following the enormous amount of attention given to Professor David Nutt, formerly the British government's chief adviser on illegal drugs.

Formerly being the key word. Nutt was sacked (...write your own "nutsack" pun if you must) last Friday, prompting a remarkable amount of condemnation. Critics included the rest of his former organisation, the Advisory Council on the Misuse of Drugs (ACMD), and the Government's Science Minister. The UK's Chief Scientist also spoke in favour of Nutt's views. Journalists joined in the fun with headlines like "politicians are intoxicated by cowardice".

Even Nature today ran a bluntly-worded editorial -

"The sacking of a government adviser on drugs shows Britain's politicians can't cope with intelligent debate... the position of the Labour government and of the leading opposition party, the Conservatives, which vigorously supported Nutt's sacking, has no merit at all. It deals a significant blow both to the chances of an informed and reasoned debate over illegal drugs, and to the parties' own scientific credibility."

They also have an interview with the man himself.

*

What happened? The short answer is a lecture Nutt gave on the 10th October, Estimating Drug Harms: A Risky Business? I'd recommend reading it (it's free). The Government's dismissal e-mail gave two reasons why he had to go - firstly, "Your recent comments have gone beyond [matters of evidence] and have been lobbying for a change of government policy" and secondly, "It is important that the government's messages on drugs are clear and as an advisor you do nothing to undermine public understanding of them."

Many people believe that Nutt was fired because he argued for the liberalization of drug laws, or because he claimed that the harms of some illegal drugs, such as cannabis, are less severe than those of legal substances like tobacco and alcohol. On this view, the government's actions were "shooting the messenger", or dismissing an expert because they didn't like to hear to the facts. It seems to me, however, that the truth is a little more nuanced, and even more stupid.

*

Nutt's lecture, if you read the whole thing as opposed to the quotes in the media, is remarkably mild. For instance, at no point does he suggest that any drug which is currently illegal should be made legal. The changes he "lobbies for" are ones that the ACMD have already recommended, and this lobbying consists of nothing more than tentative criticism of the stated reasons for the rejection of the ACMD's advice. The ACMD is government's official expert body on illicit drugs, remember.

The issue Nutt focusses on is the question of whether cannabis should be a "Class C" or a "Class B" illegal drug, B being "worse", and carrying stricter penalties. It was Class B until 2004, when it was made Class C. In 2007, the Government asked the ACMD to advise on whether it should be re-reclassified back up to Class B. This was in response to concerns about the impact of cannabis on mental health, specifically the possibility that it raises the risk of psychotic illnesses.

The resulting ACMD report is available on the Government's website. They concluded that while cannabis use is certainly not harmless, "the harms caused by cannabis are not considered to be as serious as drugs in class B and therefore it should remain a class C drug."

Despite this, the Government took the decision to reclassify cannabis as Class B. In his lecture Nutt criticizes this decision - slightly. Nutt quotes the Home Secretary as saying, in response to the ACMD's report -

"Where there is a clear and serious problem [i.e. cannabis health problems], but doubt about the potential harm that will be caused, we must err on the side of caution and protect the public. I make no apology for that. I am not prepared to wait and see."

Nutt describes this reasoning as -

"the precautionary principle - if you’re not sure about a drug harm, rank it high... at first sight it might seem the obvious decision – why wouldn’t you take the precautionary principle? We know that drugs are harmful and that you can never evaluate a drug over the lifetime of a whole population, so we can never know whether, at some point in the future, a drug might lead to or cause more harm than it did early in its use."

But he says, there's more to it than this. Firstly, we don't know anything about how classification affects drug use. The whole idea of upgrading cannabis to Class B to protect the public relies on the assumption that it will reduce drug use by deterring people from using it. But there is no empirical evidence as to whether this actually happens. As Nutt points out, stricter classification might equally well increase use by making it seem forbidden, and hence, cooler. (If you think that's implausible, you have forgotten what it is like to be 16.) We just don't know.

Second, he says, the precautionary principle devalues the evidence and is thereby self-defeating because it means that people will not take any warnings about drug harms seriously - "[it] leads to a position where people really don’t know what the evidence is. They see the classification, they hear about evidence and they get mixed messages. There’s quite a lot of anecdotal evidence that public confidence in the scientific probity of government has been undermined in this kind of way." Can anyone really dispute this?

Finally, he raises the MMR vaccine scare as an example of the precautionary principle ironically leading to concrete harms. Concerns were raised about the safety of a vaccine, on the basis of dubious science. As a result, vaccine coverage fell, and the incidence of measles, mumps and rubella in Britain rose for the first time in decades. The vaccine harmed no-one; these diseases do. We just don't know whether cannabis reclassification will have similar unintended consequences.

That's what the Home Secretary described as "lobbying for a change of government policy". I wish all lobbyists were this reasonable.

The Home Secretary's second charge against Nutt - "It is important that the government's messages on drugs are clear..." - is even more specious. Nutt's messages were the ACMD's messages, and as he points out, the only lack of clarity comes from the fact that the government and their own Advisory Council disagree with each other. This is hardly the ACMD's fault, and it's certainly not Nutt's fault for pointing it out.

All of this is doubly ridiculous because of one easily-forgotten fact - cannabis was downgraded from Class B to Class C in 2004 by the present Labour Party government. Nutt's "lobbying" therefore consists of a recommendation that the government do something they themselves previously did. And if the government are worried about the clarity of their message, the fact that they themselves were saying that cannabis was benign enough to be a Class C drug just 5 years ago might be somewhat relevant.

*

Nutt has said that he was surprised to learn that he had been sacked. I'm sure this surprise was genuine because Nutt is an academic, and in academia, Nutt's "criticisms" would hardly even be considered as such. Here by contrast is an extract from a peer review comment I got a couple of days ago regarding a scientific paper I wrote:

The manuscript falls short of its goals in several respects: The basic phenomenon ... is barely presented... The style and language of the review leave a lot to be desired... The citations and reference list are appalling.

The same reviewer also criticized the basic argument of my article, implicitly branding the whole paper - all 10,000 words of it, which took dozens of hours to write - a complete waste of time.

Ouch. But as an academic, giving, and receiving, this kind of treatment is all part of the job, and that's just as it should be. I'm confident that my argument is sound, so I'm going to take the criticisms on board, rewrite the paper appropriately, and submit it to another journal. What I'm not going to do is bear a grudge against the reviewer. (Well maybe a little: the references weren't that bad.) To be fair, unlike Nutt's, this review was not made in the public domain, but then, I'm not a Government elected by the public.

Nutt's mistake was to think that it's possible to have a serious debate about a serious political issue. In fact, it was probably not such a bad mistake, since the job of the ACMD, as the Government sees it, is a fairly pointless one: their job is to give expert advice and then let it be ignored. As various ACMD members have noted, they work for free, in the public interest. If I were on the Committee, I would resign now, not just out of sympathy for Nutt, but because it's a crap job.

In his dismissal letter, the Home Secretary told Nutt, "It is not the job of the Chair of the Government's advisory Council to initiate a public debate on the policy framework for drugs". I would have thought he was exactly the person who should do this if such a debate was necessary, as it obviously is. Well, now we know better. It wasn't his job. Although, thanks to the government who sacked him, a drug debate is now going on in the British media for the first time in years. In the long run, Nutt's most important action as Chair of the ACMD may well have been getting sacked from it.

[BPSDB]

Nature (2009). A drug-induced low Nature, 462 (7269), 11-12 DOI: 10.1038/462011b

Daniel Cressey (2009). Sacked science adviser speaks out Nature