Miliband's agenda lacks a whole lot more than an EU referendum

The Labour line that Europe is a needless distraction would sound better if the opposition had more to say on everything else.

The fury that some Conservative MPs feel towards the European Union and the contempt in which a hardcore of them hold David Cameron is now familiar. It is unusual but not surprising that 116 Tories last night supported an amendment to the Queen’s Speech, expressing regret that their government’s legislative programme didn’t include plans for an EU referendum. Arguably the more peculiar feature of last night’s vote is the fact that the motion was defeated by Labour. Conservatives who didn’t want to look actively disloyal to the Prime Minister abstained.

The opposition rode to Cameron’s rescue, marching through the “no” lobby in an expression of implicit satisfaction with the Queen’s Speech in the form read out by Her Maj. Of course that isn’t the point Labour was trying to make. Ed Miliband wanted to disagree with the specific view that there ought to be a referendum bill in this parliament. That doesn’t mean he endorses everything else the coalition plans. Quite a few Labour MPs are unimpressed by that subtlety. Parliamentary combat of the kind played out last night doesn’t lend itself to nuance. The opportunity was there to wound Cameron more than he ended up being wounded.

If Labour had supported the amendment it would have implied a screeching U-turn. Miliband has said he doesn’t think an EU referendum is currently a priority, so he could hardly start voting for one. We’ll come to the disputed wisdom of that position in a moment. Meanwhile, Labour could still have abstained, declaring that the whole soap opera was a private coalition grief in which the opposition felt no need to intrude. The line that Miliband would rather be thinking about ways to deliver jobs and growth than banging on about the EU and chasing alliances with Ukip would not have been contradicted by Labour MPs standing aloof from the Tory rebel amendment. Instead, they put their parliamentary muscle into opposing it. Had it passed, Cameron would now look close to crushed.

An old convention holds that a Prime Minister should resign if his or her Queen’s Speech is defeated. That notion has since been made obsolete by the fixed term parliament act, which makes more explicit the circumstances in which a government falls. But there is still a unique depth of humiliation contained in having a legislative flagship holed. As things stand, Cameron looks weaker as a result of last night’s vote but not, technically, defeated.

One Labour MP told me there were Tories laughing at the opposition trooping through the “no” lobby in defence of the Prime Minister, with only Lib Dems for company. The mischievous jeer from the Conservative side is that, had the roles been reversed, raw opportunism would have been embraced with glee. What is the opposition for if not to injure and eventually kill the incumbent government? It is a question that Tories posed in mockery and some Labour MPs asked themselves in despair.

The response from Miliband’s allies is that Labour should aim to look like a responsible government-in-waiting; that it should not be indulging distraction from the core questions of the economy and the rising cost of living and that, as one shadow cabinet minister likes to put it, “our problem is hardly that we don’t look opportunist enough.” It is a view with some merit. Indeed, I’ve blogged before in defence of Miliband’s position on an EU referendum. There are some voters who are obsessed with this question and who will stride into a polling booth with the express aim of facilitating a plebiscite on relations with Brussels so they might then vote to end them. But those people almost certainly aren’t voting Labour anyway and won’t be swayed if Miliband performs a desperate U-turn. According to this argument, authenticity – that most cherished of modern political virtues – resides in sticking with a principled position.

There are two problems. First, if Miliband’s principled position is support for British membership of the EU, he could just as easily say he agrees that a referendum has become inevitable and declare himself up for the fight to secure an “in” vote. Yes, it might be a distraction from more pressing matters and, yes, Labour shouldn’t have to customise its putative governing agenda to suit a neurosis on the right wing of the Tory party. But there is clearly some appeal to opposition MPs in having a leader who will come out and say: “Come on then. Bring it on! You want this bloody referendum so much, Cameron, so call it. You say you think Europe can be reformed and that the UK can stay on board. Let’s settle it. We’ll fight for the pro-European cause together and we’ll win.”

After all, it is clear that no amount of renegotiation of membership terms will satisfy Tory rebels. The ultimate question is whether or not Britain sees itself as inside the European project. Cameron doesn’t want to be the man to take Britain out of the EU; much of his party wants a leader who will do just that. By supporting a referendum sooner rather than later, Labour could force the Prime Minister to either campaign against his own party or share platforms with Ukip and announce himself as a wobbly facsimile of Nigel Farage. Miliband would have the quiet but sensible wing of the Tory party on his side along with the Lib Dems, the overwhelming majority of British business, trade unions and, for what it’s worth, Barack Obama.

What, then, of the claim that Labour would be better off talking about something else? That is the strongest argument for Miliband’s current position. Europe is not most voters’ number one concern. It isn’t usually in the top ten. If swivelled-eyed fixation on Brussels makes the Tories look out of touch, Labour should certainly not be swivelling its own eyes in pale imitation of fringe mania. Rise above it, goes the argument, and concentrate on a programme for sensible government that meets the concerns of the masses.

That position would be a whole lot stronger if anyone really knew what Labour’s programme for government might involve. This isn’t a question of specific policy. (The case for not revealing that hand a full two years before polling day has been made ad nauseam, but it remains sound.) The shortage is not in detail but direction. Not enough people can say with certainty what kinds of things a Labour government would prioritise. There is some clarity about what the opposition is against – tax breaks for millionaires, cutting “too far, too fast”. It is less obvious what Miliband is for. The One Nation message describes a vague aspiration towards solidarity, with an implicit attack on the government for pursuing nasty policies of social division. It tells voters that Labour wants everyone to get along. It hasn’t been fleshed out with an account of how Labour would make everyone better off.

Meanwhile (as I wrote a couple of weeks ago) Miliband isn’t making much progress winning big arguments on the economy, public spending and welfare, which are sure to be the fields of battle at the next general election. How does this relate to the debate about how to handle Euroscepticism? The way one Labour MP described it to me after last night’s vote, there seems a lot less to lose from being mercenary and opportunist when there isn’t much of a responsible government-in-waiting image to sabotage. It may sound defeatist, but there is a feeling in some quarters for the party that if Miliband doesn’t really look like a lofty statesman poised to serve as Prime Minister he might as well get down into the trenches and start hurting the Tories any way he can and at every available opportunity.

According to this view, no-one will care or even remember what Labour’s exact position on a Queen’s Speech amendment was one Wednesday night in 2013, but if the outcome of that vote is to hasten the coalition’s demise, the opposition is winning. Or, to put it another way, the strategy behind last night’s vote springs from a kind of delusion that Miliband can soar above the dirty business of parliamentary game-playing because his mission is loftier. That would be a more plausible approach if the mission was comprehensible beyond his most loyal supporters.

That is a pretty bleak account of Labour’s prospects for the rest of this parliament. With two years to go, Miliband might yet supply the missing parts of the picture and become the candidate of visionary, optimistic change and national unity that he and his closest allies are sure he is capable of being. It is true that consistency and authenticity are political commodities of more enduring value than an appetite for short-term tactical sabotage. There is still time, but not much and the ticking clock provokes anxiety on the Labour benches. If the party felt it had a whole bunch of popular, election-winning things to say, it wouldn’t be sweating the absence of an EU referendum in its offer to the country. Miliband’s problem isn’t his reasonable refusal to follow a Conservative/Ukip agenda on Europe. It is his difficulty in articulating a Labour agenda on everything else. The line that a Brussels fixation is a pursuit better left to a Tory party marching blindly into opposition would sound more authoritative from a Labour party that looked confident in its march towards government. 

Ed Miliband walks through Hyde Park after addressing TUC members at the end of a march in protest against the government's austerity measures on October 20, 2012. Photograph: Getty Images.

Rafael Behr is political columnist at the Guardian and former political editor of the New Statesman

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Why does the medical establishment fail to take women in pain seriously?

Women with mesh implants have been suffering for years. And it's not the only time they have been ignored. 

Claire Cooper’s voice wavered as she told the BBC interviewer that she had thought of suicide, after her mesh implant left her in life-long debilitating pain. “I lost my womb for no reason”, she said, describing the hysterectomy to which she resorted in a desperate attempt to end her pain. She is not alone, but for years she was denied the knowledge that she was just one in a large group of patients whose mesh implants had terribly malfunctioned.

Trans-vaginal mesh is a kind of permanent “tape” inserted into the body to treat stress urinary incontinence and to prevent pelvic organ prolapse, both of which can occur following childbirth. But for some patients, this is a solution in name only. For years now, these patients – predominantly women – have been experiencing intense pain due to the implant shifting, and scraping their insides. But they struggled to be taken seriously.

The mesh implants has become this month's surgical scandal, after affected women decided to sue. But it should really have been the focus of so much attention three years ago, when former Scottish Health Secretary Alex Neil called for a suspension of mesh procedures by NHS Scotland and an inquiry into their risks and benefits. Or six years ago, in 2011, when the US Food and Drug Administration revealed that the mesh was unsafe. Or at any point when it became public knowledge that people were becoming disabled and dying as a result of their surgery.

When Cooper complained about the pain, a GP told her she was imagining it. Likewise, the interim report requested by the Scottish government found the medical establishment had not believed some of the recipients who experienced adverse effects. 

This is not a rare phenomenon when it comes to women's health. Their health problems are repeatedly deprioritised, until they are labelled “hysterical” for calling for them to be addressed. As Joe Fassler documented for The Atlantic, when his wife's medical problem was undiagnosed for hours, he began to detect a certain sexism in the way she was treated:

“Why”, I kept asking myself, when reading his piece, “are they assuming that she doesn’t know how much pain she’s feeling? Why is the expectation that she’s frenzied for no real reason? Does this happen to a lot of women?”

This is not just a journalist's account. The legal study The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain found that women report more severe levels of pain, more frequent incidences of pain, and pain of longer duration than men, but are nonetheless treated for pain less aggressively. 

An extreme example is “Yentl Syndrome”. This is the fact that half of US women are likely to experience cardiovascular disease and exhibit different symptoms to men, because male symptoms are taught as ungendered, many women die following misdiagnosis. More often than should be acceptable, female pain is treated as irrelevant or counterfeit.

In another significant case, when the news broke that the most common hormonal birth control pill is heavily linked to a lower quality of life, many uterus-owning users were unsurprised. After all, they had been observing these symptoms for years. Social media movements, such as #MyPillStory, had long been born of the frustration that medical experts weren’t doing enough to examine or counter the negative side effects. Even after randomised trials were conducted and statements were released, nothing was officially changed.

Men could of course shoulder the burden of birth control pills - there has been research over the years into one. But too many men are unwilling to swallow the side effects. A Cosmopolitan survey found that 63 per cent of men would not consider using a form of birth control that could result in acne or weight gain. That’s 2 per cent more than the number who said that they would reject the option of having an annual testicular injection. So if we’re taking men who are afraid of much lesser symptoms than those experienced by women seriously, why is it that women are continually overlooked by health professionals? 

These double standards mean that while men are treated with kid gloves, women’s reactions to drugs are used to alter recommended dosages post-hoc. Medical trials are intended to unearth any potential issues prior to prescription, before the dangers arise. But the disproportionate lack of focus on women’s health issues has historically extended to medical testing.

In the US, from 1977 to 1993, there was a ban on “premenopausal female[s] capable of becoming pregnant” participating in medical trials. This was only overturned when Congress passed the National Institutes of Health (NIH) Revitalisation Act, which required all government funded gender-neutral clinical trials to feature female test subjects. However, it was not until 2014 that the National Institutes of Health decreed that both male and female animals must be used in preclinical studies.

Women’s exclusion from clinical studies has traditionally occurred for a number of reasons. A major problem has been the wrongful assumption that biologically women aren’t all that different from men, except for menstruation. Yet this does not take into account different hormone cycles, and recent studies have revealed that this is demonstrably untrue. In reality, sex is a factor in one’s biological response to both illness and treatment, but this is not as dependent on the menstrual cycle as previously imagined.

Even with evidence of their suffering, women are often ignored. The UK Medicines and Healthcare Regulatory Agency (MHRA) released data for 2012-2017 that shows that 1,049 incidents had occurred as a result of mesh surgery, but said that this did not necessarily provide evidence that any device should be discontinued.

Yes, this may be true. Utilitarian thinking dictates that we look at the overall picture to decide whether the implants do more harm than good. However, when so many people are negatively impacted by the mesh, it prompts the question: Why are alternatives not being looked into more urgently?

The inquiry into the mesh scandal is two years past its deadline, and its chairperson recently stepped down. If this isn’t evidence that the massive medical negligence case is being neglected then what is?

Once again, the biggest maker of the problematic implants is Johnson&Johnson, who have previously been in trouble for their faulty artificial hips and – along with the NHS – are currently being sued by over 800 mesh implant recipients. A leaked email from the company suggested that the company was already aware of the damage that the implants were causing (Johnson&Johnson said the email was taken out of context).

In the case of the mesh implants slicing through vaginas “like a cheese-wire”, whether or not the manufacturers were aware of the dangers posed by their product seems almost irrelevant. Individual doctors have been dealing with complaints of chronic or debilitating pain following mesh insertions for some time. Many of them just have not reported the issues that they have seen to the MHRA’s Yellow Card scheme for identifying flawed medical devices.

Shona Robison, the Scottish Cabinet Secretary for Health and Sport, asked why the mesh recipients had been forced to campaign for their distress to be acknowledged and investigated. I would like to second her question. The mesh problem seems to be symptomatic of a larger issue in medical care – the assumption that women should be able to handle unnecessary amounts of pain without kicking up a fuss. It's time that the medical establishment started listening instead. 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman

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