Generation Yes campaigners leaflet for the Scottish independence referendum on March 29, 2014 in Glasgow. Photograph: Getty Images.
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How close is the Scottish independence race?

The No side's average poll lead has fallen from 24 points in November to eight today. But the odds remain against the SNP. 

For those wanting to gauge the state of the Scottish independence race, today's polls present a particularly murky picture. A new Survation survey in today's Daily Record puts the Yes side 12 points behind (56-44, excluding don't knows), but a Panelbase poll has them trailing by just six (53-47). Even less helpfully, the discrepancy cannot be explained by methodological differences since both companies use weightings based on the 2011 Scottish election, rather than the 2010 general election. 

But despite the gulf in the figures, there are three common trends worth noting. The first is that the race has indisputably narrowed (whatever your pollster of choice). Back in November, the Yes vote stood at an average of 38 per cent, compared to 62 per cent for No. But so far this month, Yes is on 46 per cent with No on 54 per cent. The Unionists' lead has fallen by two-thirds from 24 points to just eight. This is despite the No campaign using what many regarded as its most potent weapon - the pledge to veto a currency union - and José Manuel Barroso's warning that it would be "extremely difficult, if not impossible" for an independent Scotland to join the EU. 

The second is that, for now at least, the Yes side's advance has stalled. The six-point gap shown by Panelbase is identical to that shown four weeks ago and the 12-point gap shown by Survation is a point higher than that in last month's poll. It's too early to say for sure, but the Yes vote may well have hit a ceiling. 

Finally, it's worth making the obvious but significant point that every poll continues to show the No side clearly ahead (as has been the case since the campaign started). While it's not impossible that this will change before 18 September, it is unlikely. A narrow defeat might allow the SNP to press for devo max (and even to revisit the independence question at some point) but a defeat it will be. 

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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