Osborne in Scotland: right message, wrong messenger

The Chancellor is on strong ground when he highlights Scotland's difficult currency options but his toxic reputation could damage the unionist cause.

Which currency would an independent Scotland use? Alex Salmond's answer to that question used to be the euro. Back in 2009, the Scottish First Minister quipped that sterling was "sinking like a stone" and argued that euro membership was becoming increasingly attractive ("the parlous state of the UK economy has caused many people in the business community and elsewhere to view membership favourably"). But that, to put it mildly, is no longer the case and so Salmond has changed tack. The SNP leader's new preference is for Scotland to retain the pound in a formal currency union with the rest of the UK after independence is declared. 

But that isn't as simple as it sounds. As a new Treasury report makes clear, the UK would only agree to a currency union were significant constraints to be imposed on Scotland's tax and spending policies, the lesson of the eurozone crisis being that monetary union is inherently unstable without fiscal union. Were Scotland to reject such restrictions, it would be left with three options: to continue to use sterling unilaterally (rather like Panama uses the dollar and Kosovo uses the euro), but without any say over monetary policy, to adopt the euro (if it is able to join the EU) or to form its own currency, a hazardous path at any time for a small country but most of all during a global economic crisis. 

George Osborne, who will launch the Treasury paper in Glasgow today with Danny Alexander, made the essential point on the Today programme this morning when he remarked that "If Scotland wants to keep the pound, the best way to do that is to stay in the UK." Why, at a time when economic insecurity is hardly in short supply, create even more? The polls suggest it is an argument the voters readilty accept. But while this is the right message, one doubts if Osborne is the right messanger.

The reputation of the man who has presided over a double-dip recession and may yet preside over a triple-dip does not improve (nay, it worsens) if one travels north of the border, where the Conservatives still have just a single MP and typically poll around 15 per cent. A recent Ipsos MORI poll showing that support for the coalition's economic policies plummets when Osborne's name is mentioned was a warning to the "submarine Chancellor" to remain below the surface. His decision to take the fight to Salmond allows the First Minister to cast himself in his favoured role as the resistance to the English Tories. 

Since the independence campaign began, David Cameron has wisely taken a backseat as Alistair Darling and other centre-left figures have led the charge. If Osborne wants to help rather than hinder the unionist cause, he should do the same.  

George Osborne addresses the CBI Scotland annual dinner on September 6, 2012 in Glasgow. 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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