Cable positions himself as the man for a Lib Dem-Labour coalition

Forecasting a hung parliament at the next election, the Business Secretary looked to life after the Tories.

Vince Cable used his speech to the Lib Dem conference to present himself as a free radical, a man who was prepared to work with the Tories and Labour when they were right and to criticise them when they were wrong. He restated the original rationale for the coalition - to provide national government at a time of "permanent crisis" - but added that he made no apology for maintaining "good communications with politicians across the spectrum", before motioning as if he had just received a text, "Please Ed, not now, this is not the time". Cable's political motives became clear at the end of the speech, when he suggested that the most likely outcome of the next election was another hung parliament (the British people, he said, would not want to "entrust their future to any one party"). If you want someone who can lead the Lib Dems into coalition with Labour, he implied, I'm the man for the job; messrs Miliband and Balls already having ruled out working with Nick Clegg.

Throughout the speech, the Business Secretary was careful to combine attacks on both parties with references to those areas where they could work together. So he derided the Tory "headbangers" who wanted a "hire-and-fire culture" and the "backwoodsmen" who opposed a mansion tax, but offered a strong endorsement of George Osborne's deficit reduction plan and declared that he had "considerable personal sympathy" for the Chancellor, who was attacked both for "borrowing too much" and "borrowing too little". In a notable jibe at Andrew Mitchell's expense, which was left out of the original text, he also joked that he was a "mere pleb". As for Labour, he mocked Ed Balls's plan to eliminate the deficit over seven years, rather than the coaliton's six ("wow!"), but nodded to Ed Miliband's agenda when he called for a culture of "responsible capitalism".

Cable, who has openly declared that he is prepared to stand for the Lib Dem leadership, was astutue enough to avoid anything resembling disloyalty to Nick Clegg, praising the Deputy PM early on for proving that "coalitions work". But he also deftly positioned himself as a social liberal ("this is no time for the state to be stepping back"), who, unlike Clegg, continued to command respect across the centre-left. While conservative columnists write paeans of praise to the Lib Dem leader (see Boris Johnson's piece in today's Daily Telegraph), Cable reminded activists of a Telegraph poll showing that he was the cabinet minister who Tory activists most wanted to evict from the government. The message to the party's base - "I'm one of you" - could not have been clearer.

Vince Cable gives his speech to the Liberal Democrat conference in Brighton. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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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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