Drug and Alcohol Dependence,
221
25 (1990) 221-224
Elsevier Scientific Publishers Ireland Ltd.
The irrelevance
of research to government drugs
policies on
David S. Bell P.O. Box 553, Neutral Bay Junction, NS W 2089 fAustralti
Introduction The understanding and management of drug addiction have advanced little in modern times ]l]. Drug addiction, together with crime and sexual licentiousness, follows cycles which coincide with the swing of the pendulum between permissiveness and conservatism. Untrammelled freedom and prosperity provide ideal conditions for the spread of addiction. The nation or culture, which does not respond effeetively, succumbs. Alcohol consumption undermined the Holy Roman Empire [2]. The first emperor of China credited his success to the drinking of his opponents [3]. Modern research has not generated further insights. At best it provides a means of assessing the efficacy, or more often the lack of efficacy, of specific approaches. It shares with society the endless argument over a confusing range of radically opposed solutions. Remarkably, despite these serious failings, addictions research enjoys a respectful audience. Government has learned how to pay a token respect and use research techniques for its own ends. From within the babe1 of conflicting claims the politician or bureaucrat can choose studies to fit their preconceived notions. Should none be found, facts may be misrepresented or reference may be made to studies which do not exist. Howard’s classification of dishonest testimony covers the many possibilities [4]. By turning to the techniques of marketing research, government has developed an 0376-8716/90/$03.50 OElsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
approach, which has more in common with the television director or the selling of detergent than the university and the laboratory. Commonly this achieves nothing of practical value to prevent or treat addiction, but rather serves to promote an organisation or political party. The anecdotal evidence which follows of two personal experiences illustrates the use of research by government, the first to sidetrack a demand for action and the second to obtain favourable publicity for the ruling party. Both illustrate research as a pawn in the power game. Observations My interest in the addictions began in 1957 when amphetamine abuse was spreading in Australia [5]. The problem increased to major proportions until it was aborted in 1968 through the simple device of preventing its prescription by medical practitioners. Blackmarket heroin took its place. By early 1970 the public clamoured for measures to contain heroin addiction. My foray into the planning of drug dependence services had as bizarre a beginning as its ending. I first learned about the initiative from the morning newspaper. Without any prior warning or request to me, the Premier had announced to the press that following a decision of Cabinet he had appointed me to prepare a plan for the creation of drug dependence services for the State. Months later, after the Plan
222
had received an enthusiastic reception by the media, I learned about the end of the initiative equally abruptly. I arrived one morning at headquarters to find that a typist had been moved into my office. In retrospect the reasons became machiavellian clear. Years later I learned that the responsible public servant had advised the Minister against making any significant change to the existing health services or to his plans for their future. The decision remained secret while the semblance of action was mounted. For government always beset with funding problems, my first qualification resided in the fact that I was already on the payroll. Naturally I had to continue my other responsibilities. My research studies on drugs had given me a high profile which made my appointment politically credible even though my experience had no relevance to the administrative task entrusted to me. My inexperience qualified me ideally as the man least likely to succeed in disturbing the status quo. The bizarre manoeuvres ensured that I had no time for second thoughts, that the government made no personal commitment to me or any implied contract and in the end no definitive act of dismissal. The details of the Plan matter not at all. It followed the conventional wisdom of the day [6] and required as the first step the formation of an operational research unit to monitor the results of any action [7]. While the Plan was being developed, I collected a research team. The administration allowed the charade to proceed as far as the search for permanent premises. The National Health and Medical Research Council funded the first project [8,9]. We formed an advisory committee of influential people. To my surprise and consternation the Minister insisted on announcing the rough draft of the Plan to the media immediately. In retrospect his unseemly haste makes sense. It terminated the token exercise rapidly with a burst of favourable publicity. The Department had won respite for a time, during which the electorate had become numbed to the escalating tragedy. Misinformation spread within his own service
secured a protest [lO,ll] which served as the justification for discarding the Plan. Fortunately the research programme could not be terminated so ruthlessly. In its wisdom the Council awards funds to the research worker and not the institution. The passage of time revealed more. In 1985, the erstwhile chairman of the advisory committee, the chief stipendiary magistrate, was convicted of corruption. Also in 1985 the chairman of the largest NGO, concerned with treating addicts, a businessman who had kept closely in touch with our efforts, was convicted of the large-scale importation of cannabis resin. Time also exposed corruption in the police force. My qualification as a research worker had endowed me with one other attribute, an unsuspecting innocence. Drug addiction continued to burgeon. Public outcry forced the Department to develop some facilities, which remained of token proportions until the Federal government began its Drug Offensive. Thereby hangs quite a different tale. The new Prime Minister called together leading figures of industry and trade unions for a ‘Summit’ meeting. He achieved some consensus and reinforced his image. Other ministers set out to emulate him. The Health Minister called together the ‘Drug Summit’ in 1985 and announced a Drug Offensive, which began with the distribution to every household in the nation of a glossy paper, brightly coloured, tritely worded pamphlet. Experience has shown that mass media campaigns had not merely failed to achieve benefit, but could make matters worse [12]. In response to my criticism [13] the Minister replied with the promise that an extensive literature survey would ‘provide conclusive evidence’ to support his actions [14]. I continued to press for the evidence [15]. Years earlier it suited another government to present me as their expert. Now that I expressed my opposition to government, the Minister began his riposte [16]: ‘If ignorance is bliss, Dr. Bell must be in heaven’. By August 1988 the mass media campaign had expanded to a series of advertisements on national television. The members of the
223
Minister’s team who addressed the 35th International Congress on Alcoholism and Drug Dependence in 1988 spoke once again of extensive research, but to specific questions provided no data or references. By this time the media campaign had achieved international acclaim. I challenged the Minister once again to document his assertion or apologise [1’7]. His campaign manager responded with the assertion that ‘Australia’s national campaign is one of the most-extensively research campaigns that ever has been conducted in the drug-abuse-prevention area’ [18]. She appended 17 references, not one of which appeared in a scientific journal or an independent publication. In response to my request she sent 20 publications, which laid flat on the table stand six inches (150 mm1 high. The sheer bulk of the material ensures very few will read it. Were it not for the intransigence of the Minister and his advisers I would not have done so. Examination reveals that the literature survey on ‘Mass-Media Alcohol and Drug Campaigns’ does not contain the ‘conclusive evidence’ to support the Minister, but rather the contrary. The conclusions acknowledge that ‘one-off, one-shot’ mass-media advertising campaigns do not bring about useful results [19]. Contrary to the Minister’s claim, the first step of the campaign had not been assessed adequately. An opinion poll six weeks after the pamphlets were distributed established that 74% of respondents ‘could still recall having seen the booklet’ [20]. In keeping with its dominant philosophy of marketing, the survey did no more than establish that the public had noticed the brand name of the product, but not whether they had read it or responded favourably to it. More revealingly, a study directed towards framing a later step in the campaign [21] contained the brief comment that the target group had not read the Drug Offensive pamphlets. Ignorance does not explain the direction of the mass media campaign. The oration the Minister delivered in 1987 [22] cannot be faulted as a balanced informed view of the political
realities in the field of drug abuse. The standard of the research published by his Department compares favourably with any. The expert advisers had warned against the very measures introduced by the government. They had pointed out that anti-drug mass communication is ineffective, potentially counter-productive [23,24] and not likely to balance the highly professional advertising of the companies selling alcohol and tobacco. Instead they recommended more direct lines of action such as banning the advertising of drugs, raising the minimum age for drinking, separating the ages at which driving and drinking become legal, improving the surveillance of under-age drinking and making it more difficult for the young to buy alcohol [23]. Not one of these initiatives has materialised. Discussion Research workers discuss the politics and intrigue which invest most initiatives, but the observations remain oral knowledge, which rapidly disappears. These two case histories record some obscure events. As with all anecdotal evidence, they are burdened with unique aspects. The task remains to establish features in common with similar ventures worldwide and to explore whether these common features explain the lack of useful results from so much endeavour. These observations illustrate only one aspect of the misuse of research. Research has been used equally ruthlessly by research workers for their own advancement. In the unfortunate style of all professions, the insatiable thrust of expansionism [25,26] extends addictions research far beyond its justified limits. Government and the bureaucracy become the victims rather than the exploiters of expansionism. Modern history abounds with numerous examples of wasted expenditure on futile ventures, especially in the field of health and drug education [19]. The empirical approach still dominates the development of prevention and treatment
224
measures for the addictions. Few unifying principles exist and all have been recognised for eons. The research worker serving government has little to offer beyond reinforcing this established wisdom. By straying into what purports to be initiatives of government, the the research worker risks becoming instrument of political expediency. References
12 13 14 15 16 17 18 19
20 21
1 2 3 4 5
10 11
D.S. Bell, Drug Alcohol Depend., ll(1983183. E.M. Jellinek, J. Studies Alcohol, 37 (197611718. M. Chengyuan, in: The Great Bronze Age of China, W. Fong (Ed.), Thames and Hudson, London, 1980. L.B. Howard, J. Forens. Sci., 3lU9861337. D.S. Bell and W.H. Trethowan, J. Nerv. Mental Dis., 133 (19611489. D.S. Bell, Med. J. Aust., 10971) 569. D.S. Bell and A.J.E. Rowe, Med. J. Aust., l(19711569. D.S. Bell and R.A. Champion, Bull. Narc., 24/3 (1977121. R.A. Champion and D.S. Bell, Int. J. Addic., 15 (19801 375. C. Pritchard, Sun-Herald, Sydney, I7 May 1970. Wistaria House, In: Letters to the Editor, Sydney Morning Herald, 21 May 1970.
22 23 24 25
26
Editorial, Brit. Med. J., 290 (1985) 416. D.S. Bell, Med. J. Aust., 145 (1986159. N. Blewett, Med. J. Aust., 146 (19871117. D.S. Bell, Med. J. Aust., 147 (1987151. N. Blewett, Med. J. Aust., 147 (1987152. D.S. Bell, Med. J. Aust., 150 (19891109. F. Howarth, Med. J. Aust., 150 (19891408. M. Miller and J. Ware, Monograph Series No.9, National Campaign Against Drug Abuse, Canberra, 1989. National Campaign Against Drug Abuse 1985-86 Report, Canberra, 1987. AGB: Survey Research Group, Project Rebuff, AGB Research Australia, Sydney, 1987. N. Blewett, Monograph Series No.1, National Campaign Against Drug Abuse, Canberra, 1987. P. Shanahan, Adolescent Alcohol Abuse, Elliott & Shanahan Research, Sydney, 1987. I. McAllister and R. Moore, Drugs and Public Opinion, University of New South Wales, 1988. I. Illich, Disabling professions, In: Disabling Professions, I. Illich et al. (Eds.1, Marion Boyars, London, 1977, pp. 11-39. I.K. Zola, Healthism and disabling medicalization, In: Disabling Professions, I. Illich et al. (Eds.1, Marion Boyars, London, 1977, pp. 41- 67.
221
25 (1990) 221-224
Elsevier Scientific Publishers Ireland Ltd.
The irrelevance
of research to government drugs
policies on
David S. Bell P.O. Box 553, Neutral Bay Junction, NS W 2089 fAustralti
Introduction The understanding and management of drug addiction have advanced little in modern times ]l]. Drug addiction, together with crime and sexual licentiousness, follows cycles which coincide with the swing of the pendulum between permissiveness and conservatism. Untrammelled freedom and prosperity provide ideal conditions for the spread of addiction. The nation or culture, which does not respond effeetively, succumbs. Alcohol consumption undermined the Holy Roman Empire [2]. The first emperor of China credited his success to the drinking of his opponents [3]. Modern research has not generated further insights. At best it provides a means of assessing the efficacy, or more often the lack of efficacy, of specific approaches. It shares with society the endless argument over a confusing range of radically opposed solutions. Remarkably, despite these serious failings, addictions research enjoys a respectful audience. Government has learned how to pay a token respect and use research techniques for its own ends. From within the babe1 of conflicting claims the politician or bureaucrat can choose studies to fit their preconceived notions. Should none be found, facts may be misrepresented or reference may be made to studies which do not exist. Howard’s classification of dishonest testimony covers the many possibilities [4]. By turning to the techniques of marketing research, government has developed an 0376-8716/90/$03.50 OElsevier Scientific Publishers Ireland Ltd. Printed and Published in Ireland
approach, which has more in common with the television director or the selling of detergent than the university and the laboratory. Commonly this achieves nothing of practical value to prevent or treat addiction, but rather serves to promote an organisation or political party. The anecdotal evidence which follows of two personal experiences illustrates the use of research by government, the first to sidetrack a demand for action and the second to obtain favourable publicity for the ruling party. Both illustrate research as a pawn in the power game. Observations My interest in the addictions began in 1957 when amphetamine abuse was spreading in Australia [5]. The problem increased to major proportions until it was aborted in 1968 through the simple device of preventing its prescription by medical practitioners. Blackmarket heroin took its place. By early 1970 the public clamoured for measures to contain heroin addiction. My foray into the planning of drug dependence services had as bizarre a beginning as its ending. I first learned about the initiative from the morning newspaper. Without any prior warning or request to me, the Premier had announced to the press that following a decision of Cabinet he had appointed me to prepare a plan for the creation of drug dependence services for the State. Months later, after the Plan
222
had received an enthusiastic reception by the media, I learned about the end of the initiative equally abruptly. I arrived one morning at headquarters to find that a typist had been moved into my office. In retrospect the reasons became machiavellian clear. Years later I learned that the responsible public servant had advised the Minister against making any significant change to the existing health services or to his plans for their future. The decision remained secret while the semblance of action was mounted. For government always beset with funding problems, my first qualification resided in the fact that I was already on the payroll. Naturally I had to continue my other responsibilities. My research studies on drugs had given me a high profile which made my appointment politically credible even though my experience had no relevance to the administrative task entrusted to me. My inexperience qualified me ideally as the man least likely to succeed in disturbing the status quo. The bizarre manoeuvres ensured that I had no time for second thoughts, that the government made no personal commitment to me or any implied contract and in the end no definitive act of dismissal. The details of the Plan matter not at all. It followed the conventional wisdom of the day [6] and required as the first step the formation of an operational research unit to monitor the results of any action [7]. While the Plan was being developed, I collected a research team. The administration allowed the charade to proceed as far as the search for permanent premises. The National Health and Medical Research Council funded the first project [8,9]. We formed an advisory committee of influential people. To my surprise and consternation the Minister insisted on announcing the rough draft of the Plan to the media immediately. In retrospect his unseemly haste makes sense. It terminated the token exercise rapidly with a burst of favourable publicity. The Department had won respite for a time, during which the electorate had become numbed to the escalating tragedy. Misinformation spread within his own service
secured a protest [lO,ll] which served as the justification for discarding the Plan. Fortunately the research programme could not be terminated so ruthlessly. In its wisdom the Council awards funds to the research worker and not the institution. The passage of time revealed more. In 1985, the erstwhile chairman of the advisory committee, the chief stipendiary magistrate, was convicted of corruption. Also in 1985 the chairman of the largest NGO, concerned with treating addicts, a businessman who had kept closely in touch with our efforts, was convicted of the large-scale importation of cannabis resin. Time also exposed corruption in the police force. My qualification as a research worker had endowed me with one other attribute, an unsuspecting innocence. Drug addiction continued to burgeon. Public outcry forced the Department to develop some facilities, which remained of token proportions until the Federal government began its Drug Offensive. Thereby hangs quite a different tale. The new Prime Minister called together leading figures of industry and trade unions for a ‘Summit’ meeting. He achieved some consensus and reinforced his image. Other ministers set out to emulate him. The Health Minister called together the ‘Drug Summit’ in 1985 and announced a Drug Offensive, which began with the distribution to every household in the nation of a glossy paper, brightly coloured, tritely worded pamphlet. Experience has shown that mass media campaigns had not merely failed to achieve benefit, but could make matters worse [12]. In response to my criticism [13] the Minister replied with the promise that an extensive literature survey would ‘provide conclusive evidence’ to support his actions [14]. I continued to press for the evidence [15]. Years earlier it suited another government to present me as their expert. Now that I expressed my opposition to government, the Minister began his riposte [16]: ‘If ignorance is bliss, Dr. Bell must be in heaven’. By August 1988 the mass media campaign had expanded to a series of advertisements on national television. The members of the
223
Minister’s team who addressed the 35th International Congress on Alcoholism and Drug Dependence in 1988 spoke once again of extensive research, but to specific questions provided no data or references. By this time the media campaign had achieved international acclaim. I challenged the Minister once again to document his assertion or apologise [1’7]. His campaign manager responded with the assertion that ‘Australia’s national campaign is one of the most-extensively research campaigns that ever has been conducted in the drug-abuse-prevention area’ [18]. She appended 17 references, not one of which appeared in a scientific journal or an independent publication. In response to my request she sent 20 publications, which laid flat on the table stand six inches (150 mm1 high. The sheer bulk of the material ensures very few will read it. Were it not for the intransigence of the Minister and his advisers I would not have done so. Examination reveals that the literature survey on ‘Mass-Media Alcohol and Drug Campaigns’ does not contain the ‘conclusive evidence’ to support the Minister, but rather the contrary. The conclusions acknowledge that ‘one-off, one-shot’ mass-media advertising campaigns do not bring about useful results [19]. Contrary to the Minister’s claim, the first step of the campaign had not been assessed adequately. An opinion poll six weeks after the pamphlets were distributed established that 74% of respondents ‘could still recall having seen the booklet’ [20]. In keeping with its dominant philosophy of marketing, the survey did no more than establish that the public had noticed the brand name of the product, but not whether they had read it or responded favourably to it. More revealingly, a study directed towards framing a later step in the campaign [21] contained the brief comment that the target group had not read the Drug Offensive pamphlets. Ignorance does not explain the direction of the mass media campaign. The oration the Minister delivered in 1987 [22] cannot be faulted as a balanced informed view of the political
realities in the field of drug abuse. The standard of the research published by his Department compares favourably with any. The expert advisers had warned against the very measures introduced by the government. They had pointed out that anti-drug mass communication is ineffective, potentially counter-productive [23,24] and not likely to balance the highly professional advertising of the companies selling alcohol and tobacco. Instead they recommended more direct lines of action such as banning the advertising of drugs, raising the minimum age for drinking, separating the ages at which driving and drinking become legal, improving the surveillance of under-age drinking and making it more difficult for the young to buy alcohol [23]. Not one of these initiatives has materialised. Discussion Research workers discuss the politics and intrigue which invest most initiatives, but the observations remain oral knowledge, which rapidly disappears. These two case histories record some obscure events. As with all anecdotal evidence, they are burdened with unique aspects. The task remains to establish features in common with similar ventures worldwide and to explore whether these common features explain the lack of useful results from so much endeavour. These observations illustrate only one aspect of the misuse of research. Research has been used equally ruthlessly by research workers for their own advancement. In the unfortunate style of all professions, the insatiable thrust of expansionism [25,26] extends addictions research far beyond its justified limits. Government and the bureaucracy become the victims rather than the exploiters of expansionism. Modern history abounds with numerous examples of wasted expenditure on futile ventures, especially in the field of health and drug education [19]. The empirical approach still dominates the development of prevention and treatment
224
measures for the addictions. Few unifying principles exist and all have been recognised for eons. The research worker serving government has little to offer beyond reinforcing this established wisdom. By straying into what purports to be initiatives of government, the the research worker risks becoming instrument of political expediency. References
12 13 14 15 16 17 18 19
20 21
1 2 3 4 5
10 11
D.S. Bell, Drug Alcohol Depend., ll(1983183. E.M. Jellinek, J. Studies Alcohol, 37 (197611718. M. Chengyuan, in: The Great Bronze Age of China, W. Fong (Ed.), Thames and Hudson, London, 1980. L.B. Howard, J. Forens. Sci., 3lU9861337. D.S. Bell and W.H. Trethowan, J. Nerv. Mental Dis., 133 (19611489. D.S. Bell, Med. J. Aust., 10971) 569. D.S. Bell and A.J.E. Rowe, Med. J. Aust., l(19711569. D.S. Bell and R.A. Champion, Bull. Narc., 24/3 (1977121. R.A. Champion and D.S. Bell, Int. J. Addic., 15 (19801 375. C. Pritchard, Sun-Herald, Sydney, I7 May 1970. Wistaria House, In: Letters to the Editor, Sydney Morning Herald, 21 May 1970.
22 23 24 25
26
Editorial, Brit. Med. J., 290 (1985) 416. D.S. Bell, Med. J. Aust., 145 (1986159. N. Blewett, Med. J. Aust., 146 (19871117. D.S. Bell, Med. J. Aust., 147 (1987151. N. Blewett, Med. J. Aust., 147 (1987152. D.S. Bell, Med. J. Aust., 150 (19891109. F. Howarth, Med. J. Aust., 150 (19891408. M. Miller and J. Ware, Monograph Series No.9, National Campaign Against Drug Abuse, Canberra, 1989. National Campaign Against Drug Abuse 1985-86 Report, Canberra, 1987. AGB: Survey Research Group, Project Rebuff, AGB Research Australia, Sydney, 1987. N. Blewett, Monograph Series No.1, National Campaign Against Drug Abuse, Canberra, 1987. P. Shanahan, Adolescent Alcohol Abuse, Elliott & Shanahan Research, Sydney, 1987. I. McAllister and R. Moore, Drugs and Public Opinion, University of New South Wales, 1988. I. Illich, Disabling professions, In: Disabling Professions, I. Illich et al. (Eds.1, Marion Boyars, London, 1977, pp. 11-39. I.K. Zola, Healthism and disabling medicalization, In: Disabling Professions, I. Illich et al. (Eds.1, Marion Boyars, London, 1977, pp. 41- 67.
