Nick Clegg gives a speech on International Development at The Village Hall in Hoxton Square yesterday. Photograph: Getty Images.
Show Hide image

Will Clegg suffer death by a thousand cuts?

The Lib Dem leader has avoided a palace coup but party activists are circling. 

If Nick Clegg's position as Lib Dem leader is more secure than it was at the start of the week (largely thanks to the ineptitude of his enemies), it is also clear that he is not safe yet. While he has the support of a majority of his party's MPs (who have the power to trigger a leadership election through a vote of no confidence), he could still face a contest if at least 75 constituency associations and student groups demand one.

It is significant, then, that Clegg is coming under increased activist pressure. In a letter to today's Times, the well-organised Social Liberal Forum writes that "It’s right that the party re-examines its strategy, how we deliver it, and what we will be offering the electorate at the general election in 2015 — and it is right that this debate should include who leads the party. The membership will hold the key to this re-examination, and we acknowledge that views differ on how to approach these issues within the party — as they do within the Social Liberal Forum (SLF)."

But while it's unsurprising to see the left-leaning SLF challenge Clegg's leadership (its co-chair Naomi Smith is an aide to Lord Oakeshott), it's the intervention of Liberal Democrat Voice editor Stephen Tall that will most trouble the party's high command. The usually loyal Tall, who has edited the activist website since 2007, argues persuasively that Clegg should resign on the grounds that the party "needs a leader who can negotiate the best deal possible to advance the Lib Dem manifesto". 

He writes: "I don’t think Nick will be able to secure a Coalition deal with the Conservatives that Lib Dem members will be prepared to sign up to: there is too much suspicion lingering from the current deal. Nor do I think Nick will be able to do a deal with Labour that he will be able credibly to communicate to the voters as anything other than a complete about-turn on the previous five years of cohabitation with the Tories.

"In short, Nick is one of the impediments (not the only one, but a not insignificant one) to the Lib Dems being free to negotiate a second Coalition if that’s the hand we’re dealt."

He adds that Clegg could remain as Deputy Prime Minister until May 2015, allowing the new party leader to "present the party’s manifesto unencumbered by the compromises of coalition." 

It's the kind of pragmatic argument that could quickly gain ground among party members (39 per cent of whom currently want Clegg to resign). While the Lib Dem leader has avoided a palace coup, the danger is that he now suffers death by a thousand cuts at the hands of his activists. 

George Eaton is political editor of the New Statesman.

Getty
Show Hide image

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

0800 7318496