David Cameron, Nick Clegg and Ed Miliband attend a ceremony at Buckingham Palace to mark the Duke of Edinburgh's 90th birthday on June 30, 2011. Photograph: Getty Images.
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The opportunity for Cameron to avoid the TV debates is growing

The more parties, broadcasters and papers pile in, the greater the danger of a non-agreement. 

If David Cameron was confident that he would win the TV debates, he would have already signed up for them. That he is not even willing to begin negotiations until October is evidence that he is reserving the option to avoid them. By the same measure, Ed Miliband would not be pushing for an agreement if he did not believe that he would emerge the victor. 

It is the fear that the debates would advantage one or more of his opponents that explains Cameron's hesistancy. Labour figures rightly regard them as an opportunity for Miliband to speak directly to the country, unmediated by a hostile press, and as a means of countering the Tories' financial advantage. Having performed credibly against Cameron at PMQs in his three-and-a-half years as leader of the opposition, they are confident that Miliband would surpass expectations. As the papers demonise him as the most dangerous man in Britain, voters may warm to the moderate figure who wants to freeze their energy bill and build more homes. It is Cameron, as both the Tories and Labour recognise, who has the most to lose. 

The latest attempt to inject momentum into the discussions is a joint proposal by the Guardian, the Telegraph and YouTube to host an online debate. The aim is to engage young viewers for whom the internet is the main source of news and who are alienated by traditional broadcasters. It is a worthy one. But by adding a new element to the negotiations (and encouraging others to make similar proposals) it increases the possibility that Cameron will find an excuse to avoid them altogether. A Miliband source told me: "This shows why we need the talks to begin now, with 3-3-3 as our starting point." 

Both Labour and the Lib Dems regard a repeat of the format used last time - three debates between three party leaders over three weeks - as their best hope of securing an agreement. Cameron's alternative proposal of a "2-3-5" format with a head-to-head debate between himself and Miliband (before the campaign proper begins), another with the addition of Nick Clegg, and another with the addition of Nigel Farage and the Greens' Natalie Bennett is regarded with suspicion as an attempt to muddy the waters. As Labour's Michael Dugher has pointed out: "It’s nonsensical for Cameron to say he wants to start the debates early, but the negotiations late." 

The more parties, broadcasters and papers pile in, the greater the chance that Cameron will eventually announce with faux sincerity that "We tried really hard, we really did, but it just hasn't been possible to reach an agreement." 

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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