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A call to health policy researchers: have you examples of government gags?

(PostScript: Croakey is taking a week’s leave. See you around Oct 11 or so…)

A recent Croakey post reported on moves by the Canadian Government to stifle scientific contributions to public debate.

Daniel Vujcich, a University of Western Australia graduate who is currently on a Rhodes Scholarship to the University of Oxford, is investigating the level of government suppression of academic inquiry in Australia.

He is keen to hear from Croakey readers who may be willing to share examples of gag clauses in health policy research, even if this must be done anonymously.

Daniel Vujcich writes:

The rather unfortunately-named ‘Nutt sack affair’ dominated British news headlines in late 2009.  Its namesake, Professor David Nutt, was the chairman of the UK’s Advisory Council on the Misuse of Drugs (ACMD), a statutory body established with a mandate to provide Ministers with advice on drug-related issues.

In early 2009 the ACMD prepared a report recommending that ecstasy be downgraded from Class A (most harmful) to Class B (intermediate) in the Misuse of Drugs Act, having reviewed evidence of harmfulness to individuals and society.

Prior to official release of the report, Nutt published an article in the Journal of Psychopharmacology in which he argued that “equasy” (an addiction to horse-riding) was more harmful than ecstasy use, partly on the basis that it resulted in higher rates of acute and chronic harm to person.

The article, which Nutt wrote in his personal capacity, was intended to demonstrate that “the drug debate takes place without reference to other causes of harm in society, which tends to give drugs a different, more worrying, status.”  It concluded by pressing the need for more open debate about “how harms are tolerated by society and policy makers”, and called for greater use of rational evidence in assessing drug-related harms.

Nutt was pressured by the Home Secretary to apologise for the contents of the article on the basis that it went beyond the scientific advice that the government expected of him, and was insensitive to the families of ecstasy addicts.

His fall from ‘government grace’ was completed in October 2009 after a briefing paper was published containing the text of a lecture he had given to King’s College, London.  In the lecture, Nutt questioned the Home Office’s decision to “err on the side of caution” and upgrade cannabis from Class C to Class B, saying, “I think, the precautionary principle misleads. It starts to distort the value of evidence and therefore I think it could, and probably does, devalue evidence.” Those comments led the Home Secretary to conclude that he had lost confidence in the ACMD chair and Nutt was asked to resign from his post.

In response to Nutt’s forced resignation, a number of academics drafted the Principles for the Treatment of Independent Scientific Advice as a guide for future relations between government and expert advisors (an almost unrecognisably revised version of which was later adopted by government).

The original Principles centre on three core pillars – academic freedom, independence of operation and proper consideration of advice. 

Most relevant to the Nutt affair was the statement that members of independent advisory committees should be “free to communicate about their interpretation of evidence … subject to normal standards of professional conduct and restrictions to existing Codes of Practice, notably:  respecting confidentiality, not claiming to speak for Government, and making clear whether communication is on behalf of their committees.”  To the extent that advisors are required to sign non-disclosure agreements, the Principles recommended that they should be “confined to specified areas of committee work, objectively justified, publicly acknowledged and regularly reviewed.”

At the time of the controversy, Greg Barns posted a piece on Crikey suggesting that the Nutt affair had parallels to the CSIRO’s dismissal of Dr Staaper for his public views on GM crops in 2007.  Health economist Gavin Mooney’s response to Barns’ post suggested that academic and scientific censorship in Australia is perhaps more prolific than the high profile cases would suggest:  “I too have suffered from having my academic freedom threatened. I also resigned from an NHMRC committee because other members wanted our recommendations to be ‘acceptable’ to the then Howard government.”

It is, of course, difficult to assess the full extent to which expert comment is regulated or stifled by government representatives and agencies.  The very nature of gag clauses and cultures of silence is that they are designed to keep information out of the public realm.

Anecdotal evidence such as that provided by Mooney suggests that many Australian experts are constrained in their ability to weigh into important debates due to non-disclosure agreements with government agencies, fear of professional reprisal or concerns about funding cuts.  Such evidence is, however, relatively sparse and often speculative.

Until we amass a broader evidentiary base concerning the way in which academic freedoms are impinged upon by government authorities, we cannot understand the scale of the problem, nor effectively advocate for change.  High profile cases like the Nutt and Staaper affairs are important, but they do not necessarily provide a representative insight into the way in which expert knowledge is used or valued by decision makers in the context of smaller advisory groups, government service contracts or funding arrangements.

If we accept that health policies are improved by frank and informed exchanges between professionals, policy makers and the public, barriers to that exchange process at all levels must be made transparent – within reasonable limits – and subjected to open scrutiny.  Relevant evidence and expert knowledge should not be withheld without good cause when it comes to decisions which affect the way in which individuals live and die in our society.

The more experts are prepared to expose the constraints which bear upon them in the policy making process, the greater is their collective capacity to negotiate for greater academic freedom in their dealings with government.

I am interested in collecting examples of gag clauses/cultures in the sphere of health policy making.

If you have any examples that you can legally disclose, please email Daniel.VujcichATuniv.ox.ac.uk.  Requests for anonymity will be respected; alternatively, you can send the email from the following account, taking care to delete your email from the ‘Sent Mail’ folder so that others cannot view the contents:  gagclauseATgmail.com (Password:  gagclause1).

Comments 7

  1. Miss Eagle says:

    Would just like to draw attention to, if it could be useful, philosopher Miranda Fricker’s book, ‘Epistemic Injustice – Power and the Ethics of Knowing’
    Oxford University Press, 2007, ISBN 978-0-19-823790-7

  2. Gavin Mooney says:

    It is not just government who seek to ‘gag’ – in my experience it is a more general phenomenon in Australia and I have been “leant on” in the past by senior staff at a university to shut up and by the state AMA (who even issued a media release specially in my honour to try to get me to be silent). These events occurred late in my career. What I do not know is this. Had I been younger and still ‘making my way’ in my career would I have shut up? I might have.

  3. daniel.vujcich@univ.ox.ac.uk says:

    As a researcher at the start of my career, I certainly thought long and hard before writing on this subject. If the empirical evidence that I am seeking (or, indeed, Croakey readers’ own private experience) suggests that the public health landscape is marked by ‘cultures of silence’, researchers with the advantage of seniority on their side might consider advocating for a set of Principles for the Treatment of Independent Scientific Advice similar to those that I have referred to in my post. The Principles as originally drafted only apply to government agencies, although they could conceivably be revised and adapted so that private institutions whose professional mandate bears on the public interest could also become signatories.

  4. ron batagol says:

    I’m not sure about gags, but if you want to look at another variation, namely stuff-ups by Governments and goivernment Agencies, The link to “News.com.au”5/10/10, referred to a story which did the media rounds yesterday, regarding a follow-up to a previous study of the same research Group, published in the British Medical Journal, which provided some hard evidence, to support what we already know, namely that light or occasional alcohol consumption in pregnancy is not harmful to the developing infant, as distinct from heavy, or binge, drinking, which we know can have devastating effects on the fetus, and result in fetal alcohol syndrome spectrum of physical and mental defects.

    Why are we so concerned with this distinction, and why is it so important ? Well, as I have written many times, it is important because there is abundant anecdotal evidence that, quite tragically, women are inappropriately “advised” by family members and sometimes doctors and other health professionals, to opt for a termination when they have had occasional or light episodic exposure to alcohol either before they knew they were pregnant, or if they have had the odd social drink during early pregnancy…..

    Indeed, as I have indicated many times in various articles, myself and also Groups such as Aust College of O&G and other individual obstetricians brought up this important issue with the NHMRC when they released their Draft Guidelines, and to be fair, they did incorporate additional advice in.their Final Document, advising that “women who drank alcohol before they knew they were pregnant or during their pregnancy should be reassured that the majority of babies exposed to alcohol suffer no observable harm. The risk to the fetus from low level drinking is likely to be low”.

    Quite frankly, since the prevailing studies relating to low level alcohol exposure in pregnancy, which Advisory Bodies like the NHMRC rely upon, are based on quite shonky and unreliable data from poorly-designed studies, one can but fervently hope, (probably in vain), that this latest Study may finally give impetus to the NHMRC to stop being so stubborn and to take the step of modifying its recommendations, to reassure pregnant women that indvertent or low-level occasional social drinking by a pregnant woman does not pose a teratogenic risk to her fetus.

    On the other hand if they don’t “bite the bullet” and appropriately modify their recommendations, I’ll at least be charitable in judging between gags, scientific conspiracies or a simple long-standing advisory stuff-up, and opt for the latter!

    Ron Batagol

  5. Becky says:

    I agree with you Ron, in the fact that those pregnant women drank a time or two before knowing they were pregnant should not beat them up, however I think that they should completely refrain once they know they are pregnant. Jeff Herten, M.D., author of “The Sobering Truth” A gives a thorough explanation of the mechanism of Fetal Alcohol Syndrome. The book explains how the introduction of alcohol to fetal brain development creates a variety of disabilities.

  6. TracyS says:

    It is not just a government phenomenon. If you look at the fine print in the contracts for drug trials, there will often be clauses which give the pharmaceutical company control over use of data. Whilst there is good reason for this in a commercial in confidence sense, these clauses may also restrict publication of negative or adverse outcomes.

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Equally Well
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Acknowledgement
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Uluru Statement
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PIJ Commissions 2021
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#PreventiveHealthStrategy
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air pollution
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Health in All Policies
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Media Doctor Australia
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National Preventive Health Agency
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Summer reading 2020-2021
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Testing Croakey News category 1
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
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Population Health Congress 2015
2016 conferences
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2017 conferences
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