Shadow health secretary and Labour leadership candidate Andy Burnham speaks at the party's conference in 2014. Photograph: Getty Images.
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Burnham confirms frontrunner status as he gains eight new MP supporters

Labour leadership candidate becomes the first to formally pass the nominations threshold of 35. 

Andy Burnham has cemented his status as the frontrunner in the Labour leadership election by gaining eight new backers. The endorsements, all from MPs elected in 2015, mean that the shadow health secretary has become the first candidate to formally pass the nominations threshold of 35. His latest supporters are Peter Dowd, Louise Haigh, Harry Harpham, Rebecca Long-Bailey, Rachael Maskell, Justin Madders, Angela Rayner, Nick Thomas-Symonds. An aide to Burnham pointed to the endorsements from the newest generation of MPs as evidence that he was "the real change candidate" in the contest and emphasised their political diversity. Earlier this week, two other 2015ers, Anna Turley and Conor McGinn announced their support for him in a piece on The Staggers. 

Burnham's main opponent Liz Kendall currently has 21 public endorsements, while Yvette Cooper has 31 and Mary Creagh has five. Both Kendall and Cooper are certain to make the ballot but Creagh is unlikely to do so unless she is lent supporters by rival camps. Speaking on the race, Burnham said:  "We need to go straight to the difficult issues as to why Labour lost the election. I'm not just running a leadership campaign, I'm building a campaign for Labour to win in 2020. If we're going to do that we're going to have to face head on those difficult issues around spending, immigration, benefits and our relationship with business.

"Don't copy the Tories, we need to develop Labour answers in those areas. We've got the looming European referendum, it's time for Labour to get off the back foot on immigration and challenge David Cameron to develop a package that the British public can support, where people are free to work but not free to claim." His warning that Labour must not "copy the Tories" is a veiled attack on Kendall, who has supported free schools, backed higher defence spending and strongly defended the use of private providers by the NHS. On the Andrew Marr Show earlier today, Cooper similarly cautioned Labour against "swallowing" the Conservative manifesto. 

While it's MPs' nominations that will receive most attention until the deadline of 15 June, Labour's newly adopted one-member-one-vote system means that their support counts for much less than in the past (when they accounted for a third of the electoral college). If she wins over activists, Kendall could yet triumph with the backing of only a small minority of her colleagues.  

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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