Who passes the Clegg test?

How many of Nick Clegg's four demands do Labour and Tories meet?

So Vince Cable won't be the next chancellor after all. Today's Guardian reports that the Liberal Democrats are planning to rule out forming a coalition government with either the Conservatives or Labour in the event of a hung parliament. But they will be prepared to offer parliamentary support to any party that accepts their "shopping list" of four demands.

So who, as things stand, would pass the Clegg test?

1. "Investing extra funds in education through a pupil premium for disadvantaged children."

Conservatives: The Tories have already promised to introduce a pupil premium, with extra funding for schools that take children from the poorest homes. But the party has yet to say anything about how much it would spend, or where the money would come from.

The Lib Dems have said that the policy would cost £2.5bn a year, with the average school receiving roughly £2,500 extra for every disadvantaged child on its roll.

Labour: Ed Balls opposes a pupil premium, arguing that it would not guarantee that pupils with disadvantages or extra needs actually get the support that they need.

Verdict: A point to the Tories. None for Labour.

2. "Tax reform, taking four million out of tax and raising taxes on the rich by requiring capital gains and income to be taxed at the same rate."

Conservatives: A number of Tories are impressed by Nick Clegg's plan to raise the income-tax threshold to £10,000, but David Cameron has yet to poach the idea. Instead, he plans to focus on cutting inheritance tax and recognising marriage in the tax system. In addition, George Osborne has pledged to reduce corporation tax from 30 per cent to 27 per cent. The Tories have no plans to raise capital gains tax (CGT).

Labour: No plans to cut income tax, but Alistair Darling is said to be looking at raising CGT in the Budget to stop the wealthy exploiting a tax loophole by declaring income as capital gains. This would please the Lib Dems, who could claim to have led the agenda.

Verdict: In anticipation of a rise in capital gains tax, Labour wins half a point.

3. "Rebalancing of the economy to put less emphasis on centralised banking and more on a new, greener economy."

Conservatives: Osborne is sympathetic to calls to split investment and retail banking but has stopped short of calling for a complete separation. Cameron has promised a "localist green revolution" with companies such as Tesco and Marks & Spencer helping to make homes more energy-efficient. But will his backbenchers stand in the way? A ConservativeHome/ConservativeIntelligence survey revealed that reducing Britain's carbon footprint was the lowest priority for Tory candidates.

Labour: The government has so far refused to separate retail from investment banking and is unlikely to change its position. On the "green economy", Labour has promised to create a more than a million new green jobs and to cut UK greenhouse-gas emissions by 34 per cent by 2020.

Verdict: Half a point to the Tories on banking and half a point to Labour on the green economy.

4. "Political reforms, including changes to the voting system and a democratically elected Lords, that go further than proposed by Labour."

Conservatives: The Tories are opposed to any electoral reform and support the current first-past-the-post system. Cameron opposes proportional representation on the grounds that it hands power to the "political elites".

The Tory leader has said he supports a largely elected second chamber but is reluctant to challenge his own peers on the issue, as they are opposed to reform. In private, Cameron has described Lords reform as a "third-term issue".

Labour: Supports the replacement of first-past-the-post with the Alternative Vote and has passed legislation to ensure a referendum will be held. The Lib Dems support the move as a "step in the right direction", but are disappointed that Labour did not opt for a proportional system.

The government continues to favour a predominantly elected Lords. However, Jack Straw has warned campaigners that they will have to wait more than decade before this is achieved.

Verdict: Half a point to Labour.

Final score: Conservatives: 1½ out of 4

Labour: 1½ out of 4

Follow the New Statesman team on Twitter.

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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