Cameron tells MPs: British hostages remain unaccounted for in Algeria

PM says number of Britons at risk at Algerian gas plant has been "significantly reduced" but that operations are not over.

David Cameron has just finished delivering his Commons statement on the hostage crisis in Algeria. He told MPs that last night the number of British citizens at risk was "less than 30", adding that this number had been "significantly reduced" since but that he was unable to say more at this stage. In other words, there are Britons who remain unaccounted for.

With a hint of frustration in his voice, Cameron also revealed that he only learned of the operation by Algerian forces on Thursday morning "while it was taking place".

He said:

Mr Speaker, we were not informed of this in advance.

I was told by the Algerian Prime Minister while it was taking place.

He said that the terrorists had tried to flee, that they judged there to be an immediate threat to the lives of the hostages and had felt obliged to respond.

When I spoke again to the Algerian Prime Minister  later last night he told me that this first operation was complete but this is a large and complex site and they are still pursuing terrorists and possibly some of the hostages in other areas of the site.

But while clearly disappointed by the conduct of the Algerian government, Cameron also emphasised several times that the responsibility for the hostage-taking laid with the terrorists alone, who are believed to be operating under veteran jihadist Mokhtar Belmokhtar, described by Cameron as "a criminal terrorist and smuggler who has been operating in Mali and in the region for a number of years, and who was formerly affiliated with Al Qaeda in the Maghreb."

Cameron also reflected on the "heavy price" paid by Algeria over many years "fighting against a savage terrorist campaign".

David Cameron leaves Number 10 Downing Street to travel to the House of Commons to deliver a statement on the unfolding hostage situation in Algeria. 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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