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Too much "this is how it is", too little discussion of actual evidence
on 1 September 2012
I bought this book for two reasons: It received a favourable review in The Economist and the title is an allusion to the superb "Sustainable Energy - Without the Hot Air" of the same publisher (picking the right title obviously sells). The two books, however, have little in common in terms of approach, structure and style.
The broad message of "Drugs - Without the Hot Air" is that whether a drug is legal or not has little to do with how harmful it is. Alcohol and tobacco impose large social and public health costs while other (illegal) recreational drugs which may or may not be as harmful are portrayed as an evil to mankind. Meanwhile the `war on drugs' and policies of drug use criminalisation in their current forms are ineffective and often cause harm that may well be greater than the harm they are set out to prevent society of.
This broad message appears plausible to me. Yet, if the author weren't a reputable expert in the field much of what's in the book wouldn't appear very credible. I felt that the book lacks discussion of real evidence (it does contain plenty of references, though). The second chapter presents a study performed by the author and other experts to assess the overall harmfulness of the most common legal and illegal drugs which finds that alcohol is the most harmful drug, more harmful than heroin and crack. Yet despite a 20 page explanation I still find it unclear what is actually being measured. Would I do myself and society less harm by having a fix of heroine tonight rather than a pint of beer? Or is it just that alcohol is a greater absolute cause of health and social problems in Britain than heroine, presumably since it is consumed far more widely despite being less harmful at the margin? Would this finding be sufficient evidence to claim that alcohol is more harmful? Assessing the harm caused by different drugs especially in the social context should be an extremely complex challenge with plenty of uncertainties and occasionally value judgements involved. These should be made explicit and discussed. How do I compare a "unit" of heroine to a unit of alcohol? How do I control for the fact that heroine users tend to have different social backgrounds, personalities and lifestyles from cocaine users, with different health implications? And to what extent does drug use affect these aspects? Perhaps there are good arguments to judge the relative harms and benefits of different drugs in the way the book has done but I couldn't really find them in the book.