We all depend on trade unions

What is one day of paralysis compared with a lifetime of poorly-funded and under-staffed services?

Who knew that a student blogger with a pet peeve for public sector workers could incite so much anger? Sara Malm, a journalism student at the University of Kent, probably had no idea when she ranted against "disgraceful, selfish and, quite frankly, passé" industrial action.

Her post, published on the Independent's iWriters section on Friday, has inspired 300 comments, as well as a response from blogger Lucy Snow denouncing her "vitriol." And while anyone sympathetic to workers' rights should denounce Malm's insulting article, you have to wonder why people are surprised.

Britain is seething with anti-union sentiment. Be it Michael Gove proposing to abolish teachers’ staff rooms in order to save money, or the right-wing press attacking “Red Len” McCluskey’s call for strikes during the Olympics. Thatcher used all she had in her to curb the power of unions, but the return of a Conservative-led government is reflected in our media, our fellow citizens and, now, our youth.  

Criticise the cash-for-access scandal that erupted last month and the ensuing revelations of the power of big businesses over the Conservative Party, and you will be met with claims that the Labour Party is just as reliant on its union funding. Well, yes. But unions speak for thousands of ordinary people who share similar stakes in society – which, forgive me if I’m wrong, but I don’t think necessarily appeal to the chairman of the world’s largest interdealer broker (Michael Spencer, who enjoys Downing Street dining so much he paid nearly £4m for the luxury).

But the problem is that many of these ordinary people don’t recognise the beneficial nature of unions – including Malm, who doesn’t seem to realise that she has the right to union support herself. The very fact that Boris Johnson prides himself on his pledge to limit the power of the transport unions shows how far this has gone. If elected next month, he promises to make key underground lines driverless within two years. Rather than arousing concern for the inevitable job losses this will create, the move is hailed as somehow freeing commuters from the constraints of irritating tube drivers and their endless demands; the picture painted of tube unions is not unlike the terrorising hostage-takers that Malm describes. And Boris, saying “I want to be the Mayor who does that” (create more driverless trains), has tapped into the public contempt that his own party has helped to fuel.     

A lot of the time, people who moan about industrial action don’t understand the reasons behind it. And this is something that Malm fails even to address. The strikes that the NUT proposes for later this year are about defending national pay rather than a performance-related salary – akin to much of the private sector – that Gove is suggesting. The education secretary wants teachers’ pay to be more “market facing” – a flagrant example of the creeping veil of privatisation with which this government is stifling public services.

But performance-related pay works both ways: bright young graduates should be attracted to a career in teaching with decent salaries, pensions and working conditions. Otherwise, what is to stop the best potential candidates preferring professions that don’t immediately benefit society? Don’t we want our children, Britain’s future, to be taught by people who are intelligent and enthusiastic rather than worn out and grumpy? Ironically and perhaps unknowingly, Malm hints at what the NUT is complaining about, claiming that strikes have “no place in a market economy, especially not one four years into a recession.” But that is the very problem: that the recession is incessantly taken out on people like teachers. It’s no good creating – and maintaining – a consumer-driven society that conditions people to be motivated by success, only to devalue on so many levels the careers that really matter.

Of course a strike across the London transport network is devastating on any day, let alone during the Olympics. Thousands of ordinary people will not be able to get to work, children won’t be able to go to school and the capital’s economy will dip – for a short period. But people strike to make that very point: we are all reliant on public sector workers. We need to stand by them while they protest job cuts, pay freezes and pension reforms. After all, what is one day of paralysis – to borrow from right-wing rhetoric – compared with a lifetime of badly-organised, poorly-funded and under-staffed services?

Workers at Unilever's Port Sunlight factory picket outside the main gates of their factory on the Wirral. Photograph: Getty Images.
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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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