Danny Alexander at the Liberal Democrat conference in Glasgow last year. Photograph: Getty Images.
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How Danny Alexander is manoeuvring to succeed Nick Clegg

The ambitious Lib Dem is positioning himself as the "continuity candidate" in a future leadership contest.

When Nick Clegg challenged Nigel Farage to a debate on EU membership, many Lib Dems were hopeful that his stand would revive their party's fortunes. But Clegg's drubbing at the hands of the UKIP leader last week has prompted a new bout of despondency. "It's reminded us of just how unpopular he is," one MP tells me. With no improvement in the party's European election poll ratings, leaving open the danger that it could lose all 11 of its MEPs next month, murmurs of a leadership challenge to Clegg have begun. At the weekend the Sunday Times reported that "Peers, MPs and party activists have delivered a stark message to Clegg that unless the party delivers respectable results, he will have to step aside."

While it's figures from the left of the party who are quoted in the piece (with one anonymous peer clearly identifiable as Lord Oakeshott), a Lib Dem source suggests an alternative origin for the story. "This is Danny's team jockeying," he tells me. 

In recent months, the leadership ambitions of the Chief Secretary to the Treasury have become increasingly obvious. He has strengthened his team with the appointment of Peter Carroll, the founder of the successful Fair Fuel campaign, as his special adviser, and Graeme Littlejohn as his head of office in Inverness, and, a source notes, "has been popping up in places like the Mirror and chatting much more to MPs". The man frequently mocked as "Beaker" has also ditched his glasses, lost some weight and seemingly dyed his hair. 

With Alexander set to replace Vince Cable as the Liberal Democrats' economics spokesman at the general election, representing the party in the chancellors' debate, he is positioning himself as the "continuity candidate" in a future leadership contest (assuming he retains his seat). "Ed Davey's just not up to it," one Lib Dem said. As for Alexander, I was told: "He looks like a faithful paladin of Clegg but he's ambitious". 

For now, however, Clegg's position looks secure. Ahead of next month's elections, the Lib Dem leader's team are carefully managing expectations. "They're preparing for a wipeout and trying to bring everyone into the tent," I'm told. Sources point to Clegg's "canny" appointment of his mentor Paddy Ashdown as general election campaign chair as one reason for his continued survival. "Every time there's a crisis, Paddy's on the news channel", one notes. Just as Peter Mandelson shored up Gordon Brown's position in times of trouble, so Ashdown serves as Clegg's political life support machine. 

With a much-diminished Vince Cable unprepared to wield the knife, the Lib Dem leader, against expectations, is almost certain to be in place on 7 May 2015. 

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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