To lose one prime minister

Pakistan’s military are doing their damndest to prevent a civilian government reaching an unprecedented full-term.

On many levels the Zardari government, now less than a year away from full-term, has been doing quite well - with no will to solve the energy crisis but passing significant legislation that protects democracy, as opposed to military rule, in Pakistan.

The literal reporting by the international press of Pakistan’s prime ministerial woes – Yousuf Raza Gilani, after the longest PM-ship ever in Pakistan’s history was forced to stand down for refusing to write to the Swiss authorities over corruption charges relating to Zardari, his initial replacement Makhdoom Shahabuddin was blown straight out of the water when a judge ordered his arrest on illegal drug imports, but Raja Pervaiz Ashraf has now been appointed – has done nothing to tell the real story. 

For that you will have to read Mohammed Hanif in the Guardian, about the only voice of clarity available to UK readers. 

To lose one prime minister may be regarded as a misfortune but to have two headed off  looks like the military have been up to their old tricks. Caretaker governments were the stuff of military intervention after they had despatched civilian governments in what Musharraf called in his memoirs “that dreadful decade of democracy”. This is not quite a caretaker government, but as Hanif describes, the military are behind a revitalised supreme court that in the last six months has been in the business of attacking the Zardari government, while leaving military wrong-doings, such as questions over the assassination of Salmaan Taseer, governor of Punjab, and of Shahbaz Bhatti, Christian minister for minorities, and the death of journalist Saleem Shahzad, on the back burner.

In mid-June the judicial commission tasked with looking into Memogate, the “documentation” provided by nude wrestling adjudicator  Mansoor Ijaz that the Zardari government through its civilian ambassador to Washington Husain Haqqani had tried to move against the military upheld Ijaz’s spurious claims.

It is not a coincidence that a week before the commission was due to announce its findings Asma Jahangir, Pakistan’s leading human rights barrister, chief counsel for Husain Haqqani and contributor to the New Statesman, was made aware of a plan to assassinate her.

The background to memogate is here, Mansoor Ijaz’s track record of contributions to the Financial Times here.

Pakistan’s leading liberal daily, Tribune, ran the following editorial in mid-June:

It is in the nature of those [the military] opposed to civilian rule to change the subject from their misdeeds. In this case, the distraction was memogate and the scapegoat was Husain Haqqani.

Twittersphere followed up: “Shame on a country which declares its doctors, diplomats, poets and scholars as traitors, and garlands jihadist killers and eulogises them”. “Husain Haqqani is not a traitor he is a patriotic Pakistani. Real traitors are those acquit jihadis and penalise liberals”.

That, at present and until it does its proper job and brings the military under the rule of law too, looks like the supreme court. 


Yousuf Raza Gilani, the former Prime Minister of Pakistan who was ousted in April 2012. Photo: Getty Images
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Testing migrant children’s teeth for their age is not only immoral – it doesn’t work

Ministers have flirted with this idea for over a decade. It’s bad policy, as well as poor ethics.

This week, the Home Office finally ruled out the use of x-rays to establish the age of childhood migrants.

It’s welcome news, but this story predates the dispersal of the Calais “Jungle” camp. 

For over ten years, ministers in Conservative and Labour governments have flirted with these tests. And it’s been up to us – the practitioners who’d be expected to administer them – to pick holes in a policy that’s a great way of securing headlines, but simply cannot deliver on the claims made by its cheerleaders.

It goes without saying dentists are health professionals, not border guards. But our objections run deeper than that. And it’s worth revisiting the arguments, just in case future governments start grasping for silver bullets.

It’s ineffective

We can talk about philosophy later, but let’s start with a pretty fundamental objection: dental x-rays are simply not a reliable way of establishing age.

No two mouths are alike. I’ll add my own to that list, as I still sport two of my baby teeth.

Children and young people mature at different rates, so the level of accuracy in these tests changes with time. And these x-rays can estimate age in younger children much more accurately than in adolescents. So as children mature at different rates, the potential margin of error gets ever larger with age.

For example, the third molars, commonly known as wisdom teeth – the last permanent teeth to develop – can form any time between the ages of 16 and 23, and a small proportion of individuals never develop third molars at all (I’ll have to pop my name to that list too).

A 2010 study of 300 young people aged between 11 and 25, whose age was determined based on dental x-rays, showed this method of testing consistently over- or under-estimated age, with a two-year average difference between dental and known age.

So if you are searching for a litmus test that will tell you whether a subject is 17 or 19 years old you won’t find it here.

It’s inappropriate

A few MPs and pundits have found it hard to acknowledge the codes health practitioners sign up to, which make this test a no go.

We must always act in the best interest of our patients when providing a medical procedure. And it is beyond question that the process of radiography is a medical procedure that should be carried out only for medical purposes, and where the patient stands to benefit.

Now many people might not consider this test an invasive procedure. However, x-rays do carry a small risk of possible long-term physical impact, and current best practice in this area dictates that exposure to radiation should be kept as low as reasonably possible over a lifetime. They should be carried out sparingly and where there is a well-defined potential clinical benefit, which must always outweigh the potential clinical harm.

As taking x-rays to determine the age of an individual carries no clinical benefit, it frankly isn’t appropriate to expose a patient to the potential clinical harm it can cause.

It’s unethical

Our lawmakers cannot simply dispense with fundamentals like consent to show they are “taking action”.

It is a legal principle that before practitioners carry out any medical procedure, the recipient – or someone who can consent on their behalf – must be given a full understanding of the nature of the procedure, its significance, impact and potential consequences before signing up to it.

For the children arriving from Calais, this would be a difficult task without English as a first language. Consent may also be required from a suitable adult. Yes, these children may be unaccompanied, but it does not mean the need for valid consent and protecting the child’s best interests can simply be ignored.

The letter of the law might be inconvenient, but it is a requirement that can only be compromised where the urgency and necessity of the circumstances demand rapid action in a patient’s best interests. And even in these circumstances the validity of treatment has sometimes ended up being challenged in the courts.

Given that taking x-rays in order to determine age is not medically justifiable in the first place, the urgency justification really doesn’t come into play. And that means dental colleagues – in the absence of valid consent – could find themselves performing an act that constitutes a criminal battery.


In the past, ministers have debated whether there is a credible “public interest” case that might override these little legal or philosophical objections. But these practical and ethical concerns can’t really be separated.

But why bother constructing a case for a test that frankly isn’t much cop? Dentists can only hope the latest message from the Home Office marks the beginning of a consensus, which draws a line under a decade of wishful thinking.

Judith Husband, Chair of the British Dental Association’s Education, Ethics and the Dental Team Working Group.