The Ecstasy and the agony

There is an odd article in Times 2 today. Under the none-too-original heading The Ecstasy and the agony comes the subtitle As the first wave of Ecstasy users reach their forties, research suggests the drug can cause long-term brain damage. At last, one might be forgiven for thinking, conclusive evidence that Ecstasy is a harmful narcotic. Except that the bulk of the article paints a far more mixed and indeed contrary picture.

It begins by pointing out the deficiencies in most existing scientific research: the read-over from lab rats to humans is not applicable; the purported link to Parkinson’s disease was based on a confusion between MDMA and methamphetamine; most “drug casualties” have used a wide variety of legal and illegal intoxicants in massive doses, thus rendering it impossible to draw conclusive links between any single cause and an effect.

Instead, the article casts serious doubts on evidence of any long-term risk. While between one and two million people were dropping a pill a week in the UK, there were less than 20 deaths a year – and these from secondary effects rather than from the toxicity of the drug. According to Valerie Curran, Professor of Psychopharmacology at University College, London, “If you look at people who have given up for a year, there’s very little evidence of damage that persists”.

The problem is most tellingly captured by John Henry, Professor of Accident and Emergency Medicine at Imperial College, London. “I wanted to start research on the effects of Ecstasy years ago and they told me, ‘don’t be an idiot’. I really think that if we studied schoolchildren and found out who used E and then followed them up to see what happens, we’d have the answers by now.”

Professor Henry goes on to imply that there has been minor cognitive damage (“one or two or three IQ points”) which has effected in excess of a million users. This adds up to a lot of lost intellectual capital, but the real message here is that Government’s heavy-handed blanket ban on the drug has impeded research into the long term effects.

The truth is that thirty years after it was banned in the UK and twenty after it became the party-drug of choice for the all-night dancer, we continue to know very little about the risks. As with cannabis and other narcotics, prohibition has exacerbated rather than alleviated the problem. Scientific research is difficult as one cannot give willing volunteers the drug. It is not easy to find long-term users because they are inevitably covert about their use. Meanwhile, the criminals that feed the demand are unscrupulous; they do not have quality control, they are not regulated, and the customer has little come-back if s/he is harmed by their product. People who fear they are suffering a negative effect often hide their use from emergency services. Seeking help for long-term use is stigmatised and may leave a trace on medical records that will have other social and economic costs. Rather than protecting citizens, prohibition drives up to two million of them to deal with criminals every week – and this is just the Ecstasy users. The billions of pounds they generate feed organised crime on Britain’s streets and fund murderous civil wars in South East Asia and elsewhere.

Professor Curran sums up the domestic case for a more intelligent and liberal approach: “We should accept that people are gong to take drugs and say: ‘Here is the science. Here is the risk-benefit profile. It’s your informed choice.’ Instead we’re in this crazy world where everything is pushed underground and drugs are put in the hands of criminals. I’m not saying we should legalise – that’s a big step – but in Holland, where there are coffee shops [for cannabis use] there haven’t been any major disasters through making cannabis available”.

It is not in the character of Labour or Conservative governments to trust people to make informed decisions about their own desires and the risks they face. They tend instead to treat individuals like children, to be swaddled and protected from all risk. The result is a thriving criminal underworld, misery exported to the Third World, and a future public health situation about which the scientific and medical authorities have no knowledge. Prohibition has failed.

The lifestyle police are on the prowl again

Between the overweight, smokers and those who are fond of the sauce the social moralists are busy these days. Indeed, they’ve still managed to find time to berate parents, the indolent and various other groups too. It seems there is no rest for the self-righteous.

Today it is fat people whose lifestyles are under scrutiny. A team of public health professionals including Sir George Alberti, the Government’s national director for emergency care, and Laurence Gruer, director of public health science at NHS Health Scotland, have written in the British Medical Journal that large-sized clothes should have a fat-help line phone number printed on the label, sweets should not be available at checkout counters, fatty food should be taxed, urban roads should only be allowed if cycle lanes are built in, and a centralised agency should be set up to coordinate all aspects of obesity.

This is a shame. The issue that the report addresses is a serious one: while obesity is a sign of the success of our society – far fewer people die of diabetes than of malnutrition in the world – it is now one of the major health risks in Britain. Some of the proposals make a degree of sense but need thinking through better. Others, however, are misjudged, paternalist and judgemental.

Regular health checks for primary and secondary school leavers make some sense, but it would be better to ensure that children saw their GP regularly (and more than twice) than to send health inspectors to schools. Prohibiting all road building that does not factor in cycle lanes looks good on paper, but cycle lanes of the sort most common in Britain – a painted strip 18 inches from the curb – are unsatisfactory. Real cycle lanes need to be as distinct as the road is from the pavement, but this would incur huge costs. It is unlikely that the presence of a British-style cycle lane is going to tempt many out of the car and onto the bike; carbon taxes are more likely to achieve that!

While both these suggestions are worthy, however, others are less so. Creating a centralised agency is the knee-jerk reaction of the prominent bureaucrat, the professional expert and the righteously indignant. Far from centralising policy and decision making, what is needed is more focus on the individual and more tailored local provision. Taxing fatty foods is an example of nannying: the State’s role is to protect people from one another, not from themselves, and the taxes will be either ineffective or punitive, serving nobody but the Chancellor and probably hurting poor people who are best placed to decide how to allocate their own meagre resources.

As for sowing health advise into clothes above a certain size, one might as well print the word “Fatso” on the label, and ask the buyer to apologise for using up so much space as they hand over payment. The labels, far from providing useful information to those who do now know where to look for help (WeightWatchers and the family GP are both pretty well known), will act merely as a badge of shame, undermining people who are happy with their shape and further depressing those for whom it is a cause of upset.

The authors of this report are correct to say that “pull yourself together” is not an adequate response to obesity. Neither is finger-pointing. The responses that this problem requires are far more complex and far more subtle than can be achieved by a creating a new quango and handing down policies from the centre.