The Tories think they’re winning – but it’s the coalition that is beating Labour

With a Conservative majority almost certainly out of reach, Cameron must redefine as victory something the Tories have tasted once before as defeat.

The terrace of the House of Commons, overlooking the Thames, is full of basking Tories these days. As parliament goes into its summer recess, the mood in the Conservative Party has, like the weather, turned sunny with a fierce edge.

David Cameron’s troops feel they are winning battles. On a range of potent issues – the economy, immigration, welfare – the Conservatives comfortably control the debate. They boast that they will cut here and clamp down there, while defying Labour to prove its willingness to do the same. Doubting that those are even the right remedies has become a sideline lament. Labour’s lead in opinion polls looks flimsy.

A measure of the Tories’ confidence is the venom in their attacks on Labour’s record of running the National Health Service. Conservative MPs have used the publication of a review of hospital mortality rates to hurl charges of lethal neglect at Andy Burnham, the shadow health secretary, who ran the department under Gordon Brown.

Downing Street knows that the public is suspicious of Tory motives towards the NHS. In campaign terms, the best that No 10 can hope for is making it that little bit harder for Labour to occupy the moral high ground. So the attacks on Burnham are a tactic to trash the opposition’s credentials as champions of a cherished national institution. Cameron was once reluctant to be drawn into partisan warfare over the NHS. That squeamishness has gone. The plan now is simpler and applicable in every area, regardless of policy. As one Tory close to No 10 puts it: “We beat Labour to a pulp.”

This bloodlust reflects the influence of Lynton Crosby, the Australian campaign strategist who was hired for his mastery of bare-knuckle politics. It is working. Conservative MPs are given regular pep talks by Crosby, in which they are shown encouraging polling numbers and drilled in attack lines. They can see that Labour is under pressure and are happier and more loyal to their leader as a result. It is unclear whether this level of aggression can be sustained over two years without alienating the public. Some Tory moderates worry that Cameron needs to look like a reasonable man governing for the whole nation, not the alpha dog of a snarling pack. Crosby has made the Tories good at hammering but not everything in politics is a nail.

At least bashing Labour is something that every Conservative can agree on. Developing new policies risks reviving the culture war between the party’s “modernisers” and “traditionalists”. Besides, nothing can be enacted this side of a general election without seeking permission from the Lib Dems and granting concessions if they object. Few things animate the rebellious urges of Tories like a reminder of their subordination to Nick Clegg.

Loathing of coalition is deepening on the Conservative benches as more MPs of a certain age feel their chances of ministerial office slipping away for ever. Yet inside government, the power-sharing arrangement feels more stable than it has done in a long time. Insiders from both parties describe the completion of negotiations for last month’s Spending Review as a revelation. Lib Dems and Tories managed to coalesce around a shared set of tricky economic proposals, while fighting partisan policy battles – over deregulation of nursery places, over participation in European Union criminal justice co-operation, over internet surveillance. That choreography, Lib Dem ministers say, should kill off any doubts that the coalition will go the distance. Meanwhile, Cameron and George Osborne are determined to keep open the option of renewing the arrangement for a second term. Senior figures in the government say that the Prime Minister and the Chancellor have stared at the electoral arithmetic and realised that, even in best-case scenarios, their reliance on the Lib Dems may endure beyond 2015. To win a majority, Cameron needs to hold on to every voter he had in 2010 – a rare feat for an incumbent – and then win over a bunch of Lib Dem and Labour swing voters and also see off a challenge from Ukip. It is not impossible but it would need the opposition to panic and crumble.

Although the two governing parties will campaign against each other, they will both be defending the same record. That will revive the two-against-one dynamic that made it so hard for Labour to get its economic arguments across after the last election – a handicap from which Ed Miliband has yet to recover fully. If the next parliament is hung and Labour is not the biggest party, it will feel like an endorsement of the status quo and so a victory for the combined coalition forces. At that point, backbench Tory hatred of Clegg will become a big problem for Cameron. The pressure to go it alone would be immense. A former Tory cabinet minister tells me: “We are in danger of getting to where we are now in terms of seats, having persuaded people that it’s working, and then not being able to recreate the government that delivered it.”

The last election was kinder to Cameron than it was to his party. He got to be Prime Minister; they had to share power with the Lib Dems – an unforgivable affront. Given Tory misgivings about Cameron, he has done well in recent weeks to instil confidence in his MPs that Labour can be beaten. For his next trick, he needs to persuade them that they can win. That will be tricky, as it will surely require redefining as victory something the Tories have tasted once before as defeat.

"Although the two governing parties will campaign against each other, they will both be defending the same record." Photograph: Getty Images.

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

This article first appeared in the 22 July 2013 issue of the New Statesman, How to make a saint

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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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