BMJ 2015;350:h2808 doi: 10.1136/bmj.h2808 (Published 27 May 2015)
Page 1 of 3
Observations
OBSERVATIONS BMJ CONFIDENTIAL
David Nutt: Champions off-licence prescribing What was your best career move? Getting a research fellow position at the MRC Clinical Pharmacology Unit in Oxford, where my enthusiasm for research was encouraged and supported. From then on my career flourished.
Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime? What was your earliest ambition? I decided that I wanted to be a scientist when, in junior school, my teacher showed how atmospheric pressure could crush a large tin can—amazing proof of something you’d never imagine without scientific inquiry and experimental evidence.
Who has been your biggest inspiration? Ignaz Semmelweis. He collected data on maternal deaths from different practitioners and concluded that puerperal sepsis was caused by doctors transferring something from mortuaries to birthing suites. This predated the discovery of bacteria, so he was ridiculed by the medical profession—yet he was ultimately proved right. A lesson to us all not to let establishment orthodoxy get in the way of facts. I found his example very helpful when, during my early research career, we discovered the inverse agonist concept at the GABAA receptor and met fierce opposition from the pharmacological establishment. This absolute requirement to hold firm on evidence has helped me during other similar episodes in my career—for example, being sacked as chair of the Advisory Council on the Misuse of Drugs for pointing out the fundamental scientific flaws in UK drug laws and policy, or when a health secretary tried to make the Committee on Safety of Medicines ban SSRIs [selective serotonin reuptake inhibitors].
What was the worst mistake in your career? Joking at a senior house officer interview that, as a doctor, I was the black sheep in my family. I got the job, but it was apparently a very close thing.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Correct analysis—I’m a passionate fan of the NHS. This dates back to the 1960s, when I discovered that my father had had to give up his ambition to go to university: he had to leave school at 16 to pay for the private treatment of his younger brother, who had polio. I consider the deceitful privatisation of the NHS that has taken place over my professional career to be one of the most damning legacies of our generation. Most addiction services are now privatised, and I see the rest of psychiatry going the same way. I fear not just for patient care but also for research and education. As trusts focus on costs and profits, research and education become excluded from their responsibilities.
Who is the person you would most like to thank and why? David Grahame-Smith (director of the MRC Clinical Pharmacology Unit in Oxford), who gave me my first opportunity to do research, from which I’ve never looked back.
To whom would you most like to apologise? My wife and children, for making science my mistress.
If you were given £1m what would you spend it on? Developing “alcosynth”—my safe alternative to alcohol. It would lead to a massive health gain as people switched from alcohol to this; alcohol currently causes over four million premature deaths a year worldwide. Some variants of alcosynth would also have antidotes—so you could go to a party, get intoxicated, and then rapidly sober up to drive home safely.
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2808 doi: 10.1136/bmj.h2808 (Published 27 May 2015)
Page 2 of 3
OBSERVATIONS
Biography David Nutt has a short name but a long title: Edmond J Safra professor of neuropsychopharmacology at Imperial College London. He is famous for claiming that riding horses is riskier than taking ecstasy and for losing his job as a government adviser after his public criticism of drug policy. Many sprang to his defence, and he established the Independent Scientific Committee on Drugs, now called DrugScience, which he chairs. He supports a public health approach to drug addiction and an end to the criminalisation of users, and he has written a book arguing this case, Drugs Without the Hot Air.
Where are or were you happiest? With my children and grandchildren on our annual summer beach holiday in north Devon.
What single unheralded change has made the most difference in your field in your lifetime? The growing limitations on prescribing medicines that are “off licence” and thus not evidence based. I see the ever increasing control by formulary committees and treatment algorithms as something that de-skills doctors: it limits their ability to understand and use drug treatments. This will result in doctors having to prescribe in line with fixed procedures dictated by pharmacists; our profession will eventually lose prescribing rights, and we’ll be just diagnosticians. Worse, it denies therapeutic innovation and so will ultimately be to our patients’ detriment. As I like to say when challenged for “off licence” prescribing, “I believe it’s the role of the academic doctor to prescribe off licence—how else will we get new ideas for clinical trials?”
Do you support doctor assisted suicide? Yes, if you mean euthanasia. People have as much right to a peaceful and pain-free death as they do to life prolonging treatments.
What book should every doctor read? Awakenings by Oliver Sacks. This is a magnificent account of applying science to revolutionise the medical treatment of Parkinson’s disease and is a paradigm case of the value of experimental medicine.
What poem, song, or passage of prose would you like mourners at your funeral to hear? The Water is Wide, sung by Renée Fleming. As a west country folk song this reflects my origins as a Somerset boy, but it is also a haunting melody about love and hope. What more could you want at a funeral?
What is your guiltiest pleasure? A (small) single malt at bedtime.
If you could be invisible for a day what would you do? Explore the Daily Mail offices to see whether they really believe what they write or whether it’s all a sophisticated parody of the worst of the English.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Clarkson or Clark? Would you rather watch Top Gear or Civilisation? What television programmes do you like? Clark. My schedule is too chaotic to allow regular TV, but I love box sets for a quiet Sunday evening. I highly recommend Breaking Bad, The Wire, and Brothers in Arms.
What is your most treasured possession? My 1960 Austin-Healey 3000 Mark 1.
What, if anything, are you doing to reduce your carbon footprint? I hardly drive any more; I use trains and buses and walk where I can. I also get great satisfaction from planting trees.
What personal ambition do you still have? To get United Nations drug conventions rewritten and based on underpinning principles. Currently—unlike the newer conventions, such as the rights of people with disabilities—the drug conventions are not based on any principles other than that drug use is unacceptable. They do not even define what a drug is—hence excluding alcohol and tobacco—or what harms they are trying to prevent by reducing use. Worse, they pay no attention to the collateral damage they do, such as how the conventions impede research on “illegal” drugs and block access to opioid medicines in much of the world. This omission of basic principles has allowed the UN Commission on Narcotic Drugs to wage the war on drugs unrestrained and unchallenged, with devastating consequences for many poor countries.
Summarise your personality in three words Enthusiastic, caring, humorous.
Where does alcohol fit into your life? As a target for elimination and replacement by my alcosynth.
What is your pet hate? Politicians who dissemble—which is most of them.
What would be on the menu for your last supper? My mother’s faggots, with mushy peas and cheesy mash.
Do you have any regrets about becoming a doctor? None. I’m where I always wanted to be, so I’m very fortunate.
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2808 doi: 10.1136/bmj.h2808 (Published 27 May 2015)
Page 3 of 3
OBSERVATIONS
If you weren’t in your present position what would you be doing instead?
Cite this as: BMJ 2015;350:h2808 © BMJ Publishing Group Ltd 2015
Campaigning for social justice.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
Page 1 of 3
Observations
OBSERVATIONS BMJ CONFIDENTIAL
David Nutt: Champions off-licence prescribing What was your best career move? Getting a research fellow position at the MRC Clinical Pharmacology Unit in Oxford, where my enthusiasm for research was encouraged and supported. From then on my career flourished.
Bevan or Lansley? Who has been the best and the worst health secretary in your lifetime? What was your earliest ambition? I decided that I wanted to be a scientist when, in junior school, my teacher showed how atmospheric pressure could crush a large tin can—amazing proof of something you’d never imagine without scientific inquiry and experimental evidence.
Who has been your biggest inspiration? Ignaz Semmelweis. He collected data on maternal deaths from different practitioners and concluded that puerperal sepsis was caused by doctors transferring something from mortuaries to birthing suites. This predated the discovery of bacteria, so he was ridiculed by the medical profession—yet he was ultimately proved right. A lesson to us all not to let establishment orthodoxy get in the way of facts. I found his example very helpful when, during my early research career, we discovered the inverse agonist concept at the GABAA receptor and met fierce opposition from the pharmacological establishment. This absolute requirement to hold firm on evidence has helped me during other similar episodes in my career—for example, being sacked as chair of the Advisory Council on the Misuse of Drugs for pointing out the fundamental scientific flaws in UK drug laws and policy, or when a health secretary tried to make the Committee on Safety of Medicines ban SSRIs [selective serotonin reuptake inhibitors].
What was the worst mistake in your career? Joking at a senior house officer interview that, as a doctor, I was the black sheep in my family. I got the job, but it was apparently a very close thing.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Correct analysis—I’m a passionate fan of the NHS. This dates back to the 1960s, when I discovered that my father had had to give up his ambition to go to university: he had to leave school at 16 to pay for the private treatment of his younger brother, who had polio. I consider the deceitful privatisation of the NHS that has taken place over my professional career to be one of the most damning legacies of our generation. Most addiction services are now privatised, and I see the rest of psychiatry going the same way. I fear not just for patient care but also for research and education. As trusts focus on costs and profits, research and education become excluded from their responsibilities.
Who is the person you would most like to thank and why? David Grahame-Smith (director of the MRC Clinical Pharmacology Unit in Oxford), who gave me my first opportunity to do research, from which I’ve never looked back.
To whom would you most like to apologise? My wife and children, for making science my mistress.
If you were given £1m what would you spend it on? Developing “alcosynth”—my safe alternative to alcohol. It would lead to a massive health gain as people switched from alcohol to this; alcohol currently causes over four million premature deaths a year worldwide. Some variants of alcosynth would also have antidotes—so you could go to a party, get intoxicated, and then rapidly sober up to drive home safely.
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2808 doi: 10.1136/bmj.h2808 (Published 27 May 2015)
Page 2 of 3
OBSERVATIONS
Biography David Nutt has a short name but a long title: Edmond J Safra professor of neuropsychopharmacology at Imperial College London. He is famous for claiming that riding horses is riskier than taking ecstasy and for losing his job as a government adviser after his public criticism of drug policy. Many sprang to his defence, and he established the Independent Scientific Committee on Drugs, now called DrugScience, which he chairs. He supports a public health approach to drug addiction and an end to the criminalisation of users, and he has written a book arguing this case, Drugs Without the Hot Air.
Where are or were you happiest? With my children and grandchildren on our annual summer beach holiday in north Devon.
What single unheralded change has made the most difference in your field in your lifetime? The growing limitations on prescribing medicines that are “off licence” and thus not evidence based. I see the ever increasing control by formulary committees and treatment algorithms as something that de-skills doctors: it limits their ability to understand and use drug treatments. This will result in doctors having to prescribe in line with fixed procedures dictated by pharmacists; our profession will eventually lose prescribing rights, and we’ll be just diagnosticians. Worse, it denies therapeutic innovation and so will ultimately be to our patients’ detriment. As I like to say when challenged for “off licence” prescribing, “I believe it’s the role of the academic doctor to prescribe off licence—how else will we get new ideas for clinical trials?”
Do you support doctor assisted suicide? Yes, if you mean euthanasia. People have as much right to a peaceful and pain-free death as they do to life prolonging treatments.
What book should every doctor read? Awakenings by Oliver Sacks. This is a magnificent account of applying science to revolutionise the medical treatment of Parkinson’s disease and is a paradigm case of the value of experimental medicine.
What poem, song, or passage of prose would you like mourners at your funeral to hear? The Water is Wide, sung by Renée Fleming. As a west country folk song this reflects my origins as a Somerset boy, but it is also a haunting melody about love and hope. What more could you want at a funeral?
What is your guiltiest pleasure? A (small) single malt at bedtime.
If you could be invisible for a day what would you do? Explore the Daily Mail offices to see whether they really believe what they write or whether it’s all a sophisticated parody of the worst of the English.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Clarkson or Clark? Would you rather watch Top Gear or Civilisation? What television programmes do you like? Clark. My schedule is too chaotic to allow regular TV, but I love box sets for a quiet Sunday evening. I highly recommend Breaking Bad, The Wire, and Brothers in Arms.
What is your most treasured possession? My 1960 Austin-Healey 3000 Mark 1.
What, if anything, are you doing to reduce your carbon footprint? I hardly drive any more; I use trains and buses and walk where I can. I also get great satisfaction from planting trees.
What personal ambition do you still have? To get United Nations drug conventions rewritten and based on underpinning principles. Currently—unlike the newer conventions, such as the rights of people with disabilities—the drug conventions are not based on any principles other than that drug use is unacceptable. They do not even define what a drug is—hence excluding alcohol and tobacco—or what harms they are trying to prevent by reducing use. Worse, they pay no attention to the collateral damage they do, such as how the conventions impede research on “illegal” drugs and block access to opioid medicines in much of the world. This omission of basic principles has allowed the UN Commission on Narcotic Drugs to wage the war on drugs unrestrained and unchallenged, with devastating consequences for many poor countries.
Summarise your personality in three words Enthusiastic, caring, humorous.
Where does alcohol fit into your life? As a target for elimination and replacement by my alcosynth.
What is your pet hate? Politicians who dissemble—which is most of them.
What would be on the menu for your last supper? My mother’s faggots, with mushy peas and cheesy mash.
Do you have any regrets about becoming a doctor? None. I’m where I always wanted to be, so I’m very fortunate.
Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h2808 doi: 10.1136/bmj.h2808 (Published 27 May 2015)
Page 3 of 3
OBSERVATIONS
If you weren’t in your present position what would you be doing instead?
Cite this as: BMJ 2015;350:h2808 © BMJ Publishing Group Ltd 2015
Campaigning for social justice.
For personal use only: See rights and reprints http://www.bmj.com/permissions
Subscribe: http://www.bmj.com/subscribe
