Labour will want to keep its Trident options open

A half-hearted commitment to renewal would make an easy concession to Lib Dems in future coailtion talks.

As with so many policies, Labour’s official position on whether or not it is worth funding a like-for-like replacement for the Trident submarine-based nuclear missile system is under review. More specifically, the view is that the party supports Britain having a nuclear deterrent. (Of course it does. The party isn’t about to revisit early 80s-style unilateral disarmament.) But the question of whether or not that requires having big Cold War-design submarines lurking in the seas ready to retaliate against the Soviets remains undecided.

So it is naturally a matter of interest when Des Browne, a former Labour defence secretary, co-authors an article in the Telegraph suggesting Trident may have had its day; not least because he championed the opposite view in government.

At the moment, on the government side, the matter is also subject to a review, headed by Danny Alexander, the Liberal Democrat Chief Secretary to the Treasury. The very existence of that process is held up by Lib Dems as a mini-policy triumph, effectively thwarting the Tories’ hopes of prompt Trident renewal in this parliament. Scrapping the system is one of those totem Lib Dem policies in which activists take an especially vigorous interest even if the public is largely uninterested.

Labour, meanwhile, are ambivalent. There is still a whiff of CND around the party, but there is also a residual fear from the macho New Labour era of looking like a bunch of weak-kneed lefty pacifists. The Browne position is eminently reasonable: if there is a workable, cheaper alternative that retains some nuclear deterrent capacity, it would be perverse for a cash-strapped government not to take it.

That isn’t to say Labour is ready to adopt such a position. But it is worth noting that a final decision isn’t due before 2016 and it certainly won’t be taken this side of an election. That leaves Labour with the option of a manifesto pledge keeping all Trident options open. It probably hasn’t escaped the leadership’s notice that a vague, half-hearted commitment to Trident would also make an easy concession in the event of coalition negotiations with the Lib Dems in a hung parliament – a concession the Tories could not make.

A Trident submarine makes its way out from Faslane Naval base in Scotland. Photograph: Getty Images.

Rafael Behr is political columnist at the Guardian and former 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