Has Danny Alexander really been boycotting Starbucks?

The Chief Secretary to the Treasury's mixed messages on the tax avoiding chain.

Danny Alexander attempted to burnish his radical credentials yesterday when he revealed that he had been boycotting Starbucks. After the chain promised to review its UK tax arrangements, he said: "I might be able to buy a coffee from Starbucks again soon".

But asked by John Humphrys on the Today programme this morning whether he had been boycotting Starbucks, Amazon and Google, all of whom have been accused by the Commons public accounts committee of "paying little or no corporation tax", Alexander offered a notably different response. "I’m a tea drinker, so I don't tend to go to Starbucks or other such places," he said, adding: "I do use Amazon from time to time, or I have." So was the "tea drinker" ever going to Starbucks to begin with?

But regardless of his spending habits, as Chief Secretary to the Treasury, Alexander can and should be doing more to prevent corporate tax avoidance. He boasted today that the £154m of funding announced by George Osborne would give "HMRC the resources they say they need to do this." But what he didn't say is that the extra funding will barely begin to compensate for the £2bn of cuts Osborne has made to HMRC and the 10,000 staff due to be laid off. A report earlier this year by the public accounts committee found that job cuts among revenue officials meant the government collected £1.1bn less in tax than it would otherwise have done. "We are not convinced that the decision to reduce staff numbers working in this area in the past represented value for money for the taxpayer," it said.

Asked by Humphrys whether she had been boycotting the unholy trinity, Labour MP and public accounts committee chair Margaret Hodge said that she was avoiding Starbucks and no longer used Amazon. "I’m a Kindle fanatic, so that’s a difficult one," she said. "Google I find more difficult." It says much about Google and Amazon's dominance of their respective sectors that even the indefatigable Hodge struggles to avoid them.

Police form a line outside a Starbucks coffee shop as demonstrators participate in a protest against the government's spending cuts. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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When it comes to the "Statin Wars", it's the patients I pity

Underlying the Statin Wars are two different world-views: the technological and holistic.

September saw the latest salvos in what has become known in medical circles as the Statin Wars. The struggle is being waged most publicly in the pages of Britain’s two leading medical journals. In the red corner is the British Medical Journal, which in 2014 published two papers highly critical of statins, arguing that they cause far more side effects than supposed and pointing out that, although they do produce a modest reduction in risk of cardiovascular disease, they don’t make much difference to overall mortality (you may avoid a heart attack, only to succumb to something else).

In the blue corner is the Lancet, which has long been the publishing platform for the Cholesterol Treatment Trialists’ (CTT) Collaboration, a group of academics whose careers have been spent defining and expounding the benefits of statins. The CTT was infuriated by the BMJ papers, and attempted to force the journal to retract them. When that failed, they set about a systematic review of the entire statin literature. Their 30-page paper appeared in the Lancet last month, and was widely press-released as being the final word on the subject.

A summary would be: statins do lots of good and virtually no harm, and there really is no need for anyone to fuss about prescribing or taking them. In addition, the Lancet couldn’t resist a pop at the BMJ, which it asserts acted irresponsibly in publishing the sceptical papers two years ago.

Where does all this leave the average patient, trying to weigh up the usefulness or otherwise of these drugs? And what about the jobbing doctor, trying to give advice? The view from no-man’s-land goes something like this. If you’ve had a heart attack or stroke, or if you suffer from angina or other conditions arising from furred-up arteries, then you should consider taking a statin. They’re not the miracle pill their proponents crack them up to be, but they do tip the odds a little in your favour. Equally, if you try them and suffer debilitating side effects (many people do), don’t stress about stopping them. There are lots more effective things you could be doing – a brisk daily walk effects a greater risk reduction than any cholesterol-lowering pill.

What of the millions of healthy people currently prescribed statins because they have been deemed to be “at risk” of future heart disease? This is where it gets decidedly murky. The published evidence, with its focus on cardiovascular outcomes alone, overstates the case. In healthy people, statins don’t make any appreciable difference to overall survival and they cause substantially more ill-effects than the literature suggests. No one should be prescribed them without a frank discussion of these drawbacks, and they should never be taken in lieu of making lifestyle changes. Smoking cessation, a healthy diet, regular modest exercise, and keeping trim, are all far more important determinants of long-term health.

Underlying the Statin Wars are two different world-views. One is technological: we can rely on drugs to prevent future health problems. This perspective suffers substantial bias from vested interests – there’s a heck of a lot of money to be made if millions of people are put on to medication, and those who stand to profit make huge sums available to pay for research that happens to advance their cause.

The other world-view is holistic: we can take care of ourselves better simply by living well, and the fetishising of pharmaceutical solutions negates this message. I have great sympathy with this perspective. It certainly chimes with the beliefs of many patients, very few of whom welcome the prospect of taking drugs indefinitely.

Yet the sad truth is that, irrespective of our lifestyles, we will all of us one day run into some kind of trouble, and having medical treatments to help – however imperfectly – is one of mankind’s greatest achievements. In arguing for a greater emphasis on lifestyle medicine, we must be careful not to swing the pendulum too far the other way.

Phil Whitaker’s latest novel is “Sister Sebastian’s Library” (Salt)

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood