David Cameron and Ed Miliband before the Queen's Speech at the State Opening of Parliament on June 4, 2014. Photograph: Getty Images.
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PMQs review: Cameron's tax attack throws Miliband off course

The Labour leader struggled after the PM twisted a Harriet Harman quote on middle earners and tax.

With Michael Gove demoted after he became too toxic for the Tories, and wage growth at its lowest level since ONS records began in 2001, Ed Miliband arrived well-armed at the final PMQs before the summer recess. He had the best of the opening exchanges on these subjects, asking Cameron why he had moved the Education Secretary after previously promising to keep him in his post for years.

But midway through the session, Cameron produced a far more potent weapon in the form of a Harriet Harman quote on tax. During her new LBC phone-in show on Monday night, she said: 

Yes, I think people on middle incomes should contribute more through their taxes.

As Labour sources have been quick to point out, Harman was referring to the principle of middle earners paying more than lower earners in a progressive tax system, but the comment was easily spun by Cameron as a call for a tax rise on the "squeezed middle". 

He declared: "One of the things that wasn't noticed and happened yesterday, the Deputy Leader of the Labour Party, on the radio said this, and I want to quote it very precisely: 'I think people on middle incomes should contribute more through their taxes.' That is what she said ... There we are, that is their policy. The squeezed middle will be squeezed more. Now he needs to tell us which people are going to pay which taxes."

Miliband, who was clearly unaware of the remarks, was thrown off his stride, while Harman responded by shouting "It's true!", only adding to the Tories' glee. From that point onwards, the PM was in control, with Miliband left only to accuse him of "desperate stuff". The session ended with a boisterous Caemeron declaring: "Everyone can see the contrast, in this party, the leader reshuffles the Cabinet. In his party, the shadow cabinet desperately want to reshuffle the leader."

After the session, Miliband's spokesman (who was also unaware of the quote) accused Cameron of being "deeply dishonest", adding that "he knows this is not our party's position". He reminded journalists that Labour has pledged to cut taxes for 24 million middle and low income earners by reintroducing a 10p rate of tax, and made it clear that it is not proposing any tax rises for this group. 

But while true, this fall shorts of the categoric pledge - "we will not raise taxes on middle earners" - that Miliband will now be pressed to make. Unless he does, this will remain a potent attack line for the Tories. 

George Eaton is political editor of the New Statesman.

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When it comes to the "Statin Wars", it's the patients I pity

Underlying the Statin Wars are two different world-views: the technological and holistic.

September saw the latest salvos in what has become known in medical circles as the Statin Wars. The struggle is being waged most publicly in the pages of Britain’s two leading medical journals. In the red corner is the British Medical Journal, which in 2014 published two papers highly critical of statins, arguing that they cause far more side effects than supposed and pointing out that, although they do produce a modest reduction in risk of cardiovascular disease, they don’t make much difference to overall mortality (you may avoid a heart attack, only to succumb to something else).

In the blue corner is the Lancet, which has long been the publishing platform for the Cholesterol Treatment Trialists’ (CTT) Collaboration, a group of academics whose careers have been spent defining and expounding the benefits of statins. The CTT was infuriated by the BMJ papers, and attempted to force the journal to retract them. When that failed, they set about a systematic review of the entire statin literature. Their 30-page paper appeared in the Lancet last month, and was widely press-released as being the final word on the subject.

A summary would be: statins do lots of good and virtually no harm, and there really is no need for anyone to fuss about prescribing or taking them. In addition, the Lancet couldn’t resist a pop at the BMJ, which it asserts acted irresponsibly in publishing the sceptical papers two years ago.

Where does all this leave the average patient, trying to weigh up the usefulness or otherwise of these drugs? And what about the jobbing doctor, trying to give advice? The view from no-man’s-land goes something like this. If you’ve had a heart attack or stroke, or if you suffer from angina or other conditions arising from furred-up arteries, then you should consider taking a statin. They’re not the miracle pill their proponents crack them up to be, but they do tip the odds a little in your favour. Equally, if you try them and suffer debilitating side effects (many people do), don’t stress about stopping them. There are lots more effective things you could be doing – a brisk daily walk effects a greater risk reduction than any cholesterol-lowering pill.

What of the millions of healthy people currently prescribed statins because they have been deemed to be “at risk” of future heart disease? This is where it gets decidedly murky. The published evidence, with its focus on cardiovascular outcomes alone, overstates the case. In healthy people, statins don’t make any appreciable difference to overall survival and they cause substantially more ill-effects than the literature suggests. No one should be prescribed them without a frank discussion of these drawbacks, and they should never be taken in lieu of making lifestyle changes. Smoking cessation, a healthy diet, regular modest exercise, and keeping trim, are all far more important determinants of long-term health.

Underlying the Statin Wars are two different world-views. One is technological: we can rely on drugs to prevent future health problems. This perspective suffers substantial bias from vested interests – there’s a heck of a lot of money to be made if millions of people are put on to medication, and those who stand to profit make huge sums available to pay for research that happens to advance their cause.

The other world-view is holistic: we can take care of ourselves better simply by living well, and the fetishising of pharmaceutical solutions negates this message. I have great sympathy with this perspective. It certainly chimes with the beliefs of many patients, very few of whom welcome the prospect of taking drugs indefinitely.

Yet the sad truth is that, irrespective of our lifestyles, we will all of us one day run into some kind of trouble, and having medical treatments to help – however imperfectly – is one of mankind’s greatest achievements. In arguing for a greater emphasis on lifestyle medicine, we must be careful not to swing the pendulum too far the other way.

Phil Whitaker’s latest novel is “Sister Sebastian’s Library” (Salt)

This article first appeared in the 20 October 2016 issue of the New Statesman, Brothers in blood