Cameron and Brown hire the Obama magic

Parties prepare for the TV debates.

The Times and FT report today that Camps Brown and Cameron have reached across the Atlantic to borrow a little of Barack Obama's election-winning know-how to help them get into shape for the leaders' television debates.

The Tories have hired Anita Dunn, a former White House communications director (name-checked on this blog yesterday for praising the Daily Show's Jon Stewart), and Bill Knapp, in the form of Squier Knapp Dunn Communications (check out the flag-waving website). Brown, not to be left behind, has employed the services of Joel Benenson, Obama's lead campaign pollster and strategist.

Shipping in American expertise is a good idea -- they are experts at the TV debate format, which is new to British politicians, and the subject of apparently lengthy wrangling between the parties about structure, style and protocol. Perhaps they will import a little professionalism to their speaking styles: the Brits are schooled in the art in the House of Commons, more of a conker-bashing playfight than a forum for serious policy debate.

And it makes sense to turn to the Obama team -- they won, in a legendary campaign, in spectacular fashion.

But I can't help but suspect that the real motive is that Teams Brown and Cameron simply want a magical injection of Obama's qualities (in his vote-winning election incarnation, as opposed to his present embattled state). Hiring his people is one way of getting the fix.

It's like the photo-opportunity fight, the who's-better-friends-with-him tussle, all over again. Remember those cringing pictures of Brown clinging on to Obama's handshake with a pleading look in his eyes (see above)? Or the news that when they met, Cameron gave Obama gifts including a box of CDs by some of the Conservative leader's favourite British musicians, among them the Smiths, Radiohead, Gorillaz and Lily Allen. Translation: "I'm hip; I'm cool; just like you! BE MY FRIEND."

NB: Of course, Cameron now deems poor old Allen "unsuitable" (watch her career crumble before your very eyes). And all this proves is that the Dave U-turn is alive and well and affecting all the great issues of the day.

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Sophie Elmhirst is features 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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