Why the arts matter

Politicians are right to make this an election issue.

You'd expect the tabloids to belittle the government's commitment to the arts, but from the Guardian it just sounds weird. In a blog headlined "Don't vote for 'arts policy'", Jonathan Jones argues: "At these kinds of times, when the nation's future is held in the electoral balance, you realise exactly how silly and trivial the media fiction of 'the arts' actually is." He concludes his piece with the dismissive assertion that: "There are bigger things at stake than a new paint job for the National Theatre lobby."

Do the arts really amount to "the cultural comforts of the middle classes", as Jones says? Is the issue so trivial? I don't think so, and neither do the politicians.

In 2001, the then culture secretary Chris Smith wrote (PDF) that "our creative industries . . . are a real success story, and a key element in today's knowledge economy". These sectors, of course, are sustained by the "lifeblood" of what Smith called "original creativity", which in turn depends upon a healthy attitude to the arts in Westminster to fund institutions, programmes and so forth.

The costs are small, especially when set against their rewards -- the UK's major museums and galleries produce annual profits of £1.5bn; music brings in £5bn a year and theatre £2.6bn. According to Charlotte Higgins in the Guardian, when Liverpool was the European capital of culture in 2008, "£800m was generated for the local economy and 27 per cent more visitors were attracted than in previous years".

This is why the first British Inspiration Awards, scheduled to take place on 23 April in London, has the vocal endorsement of all three major political parties. "I am enormously proud of the talented people in this country who, through their creative and entrepreneurial gifts, illuminate their lives and enrich ours," said Gordon Brown, while David Cameron offered: "We should be proud of that heritage. I welcome the opportunity this event brings to celebrate our many creative successes."

In purely fiscal terms, the arts sector is a major employer and earner for the UK. It's more important than ever to insist upon its upkeep.

Yo Zushi is a contributing writer for the New Statesman. His latest album, It Never Entered My Mind, is out now on Eidola Records and is on Spotify here.

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The surprising truth about ingrowing toenails (and other medical myths)

Medicine is littered with myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery.

From time to time, I remove patients’ ingrowing toenails. This is done to help – the condition can be intractably painful – but it would be barbaric were it not for anaesthesia. A toe or finger can be rendered completely numb by a ring block – local anaesthetic injected either side of the base of the digit, knocking out the nerves that supply sensation.

The local anaesthetic I use for most surgical procedures is ready-mixed with adrenalin, which constricts the arteries and thereby reduces bleeding in the surgical field, but ever since medical school I’ve had it drummed into me that using adrenalin is a complete no-no when it comes to ring blocks. The adrenalin cuts off the blood supply to the end of the digit (so the story goes), resulting in tissue death and gangrene.

So, before performing any ring block, my practice nurse and I go through an elaborate double-check procedure to ensure that the injection I’m about to use is “plain” local anaesthetic with no adrenalin. This same ritual is observed in hospitals and doctors’ surgeries around the world.

So, imagine my surprise to learn recently that this is a myth. The idea dates back at least a century, to when doctors frequently found digits turning gangrenous after ring blocks. The obvious conclusion – that artery-constricting adrenalin was responsible – dictates practice to this day. In recent years, however, the dogma has been questioned. The effect of adrenalin is partial and short-lived; could it really be causing such catastrophic outcomes?

Retrospective studies of digital gangrene after ring block identified that adrenalin was actually used in less than half of the cases. Rather, other factors, including the drastic measures employed to try to prevent infection in the pre-antibiotic era, seem likely to have been the culprits. Emboldened by these findings, surgeons in America undertook cautious trials to investigate using adrenalin in ring blocks. They found that it caused no tissue damage, and made surgery technically easier.

Those trials date back 15 years yet they’ve only just filtered through, which illustrates how long it takes for new thinking to become disseminated. So far, a few doctors, mainly those in the field of plastic surgery, have changed their practice, but most of us continue to eschew adrenalin.

Medicine is littered with such myths. For years we doled out antibiotics for minor infections, thinking we were speeding recovery. Until the mid-1970s, breast cancer was routinely treated with radical mastectomy, a disfiguring operation that removed huge quantities of tissue, in the belief that this produced the greatest chance of cure. These days, we know that conservative surgery is at least as effective, and causes far less psychological trauma. Seizures can happen in young children with feverish illnesses, so for decades we placed great emphasis on keeping the patient’s temperature down. We now know that controlling fever makes no difference: the fits are caused by other chemicals released during an infection.

Myths arise when something appears to make sense according to the best understanding we have at the time. In all cases, practice has run far ahead of objective, repeatable science. It is only years after a myth has taken hold that scientific evaluation shows us to have charged off down a blind alley.

Myths are powerful and hard to uproot, even once the science is established. I operated on a toenail just the other week and still baulked at using adrenalin – partly my own superstition, and partly to save my practice nurse from a heart attack. What would it have been like as a pioneering surgeon in the 1970s, treating breast cancer with a simple lumpectomy while most of your colleagues believed you were being reckless with your patients’ future health? Decades of dire warnings create a hefty weight to overturn.

Only once a good proportion of the medical herd has changed course do most of us feel confident to follow suit. 

This article first appeared in the 20 April 2017 issue of the New Statesman, May's gamble

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