28/02/2012 Newsnight


28/02/2012

Jeremy Paxman asks if metal artificial hips might be toxic, another company goes sour on 'work experience', the Barclays tax row, plus an interview with Herman Cain.


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Transcript


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Here we go again. First it was breasts, now implants routinely

:00:09.:00:15.

used by the NHS for hip replacements, may be leaking metal

:00:15.:00:21.

fragments into their hosts. 49,000 British patients with all-

:00:21.:00:26.

metal hip replacements will have to be monitored for life, with a view

:00:26.:00:32.

to taking them out again. I'm glad we got there in time, metal debris,

:00:32.:00:36.

front wall of the pelvis has been eaten away. I will be asking the

:00:36.:00:39.

regulator, who is supposed to keep us safe, how on earth this could

:00:39.:00:42.

have happened. He's the pizza millionaire who

:00:42.:00:46.

claimed he could deliver the White House for the Republican party, and

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found, he couldn't. Becoming President was Plan A, and before

:00:54.:01:02.

you get discouraged, today I want to describe Plan B. We will ask

:01:02.:01:07.

Herman Cain what Plan B is. Britain's biggest cake shop chain

:01:07.:01:10.

is the latest to query the ingredients of the Government's

:01:10.:01:15.

work experience scheme. Also tonight:

:01:15.:01:20.

In the City they call Barclays Bank the bald eagle, now the Treasury

:01:20.:01:25.

has decided to clawback the money from a perfectly legal tax dodge.

:01:25.:01:35.
:01:35.:01:36.

What other retrospective laws might they try out?

:01:36.:01:41.

We have given lots of people a new lease of life, seeming to free them

:01:41.:01:46.

from infirmity and pain. Tonight the regulator is saying anyone with

:01:46.:01:50.

an all-metal hip joint should undergo tests every year for as

:01:51.:01:54.

long as they have it inside them. Following an investigation by this

:01:54.:01:57.

programme and the British Medical Journal, which has uncovered

:01:57.:02:00.

serious side-effects in some people, and raises profound questions about

:02:01.:02:07.

whether this sort of surgery is properly regulated.

:02:07.:02:14.

Replacing a hip is about as physical as it gets for a surgeon.

:02:14.:02:20.

But as tough as the operation is, around 70,000 people a year have

:02:20.:02:24.

hip replacements. For most people this is life changing.

:02:24.:02:30.

Taking away years of pain and disability, but for some, there can

:02:30.:02:34.

be a down side. Surgeries are concerned that some

:02:34.:02:38.

metal hips are wearing down faster than they should. There are fears

:02:38.:02:42.

that metal debris from the joint is poisoning patients. Around 2,000

:02:42.:02:47.

patients a year are having to have their metal hips replaced.

:02:48.:02:54.

The UK regulator, the MHRA, announced that 49,000 patients,

:02:54.:02:59.

with all-metal, total hip replacements, like this one, with a

:02:59.:03:02.

large diameter, will have to have annual checks because of safety

:03:02.:03:06.

fears. Particles of metal debris have destroyed tissue around the

:03:06.:03:11.

joipbts in thousands of patients, we understand on Thursday, research

:03:11.:03:16.

will be presented looking at the risks of bladder cancer in these

:03:16.:03:19.

patients. No clinical trials were done before these hips were put in.

:03:19.:03:23.

One campaigning group is calling it a large, uncontrolled experiment,

:03:23.:03:27.

involving millions of patients around the world. Following on from

:03:27.:03:34.

the breast implants scandal, experts say the whole system, for

:03:34.:03:37.

regulating devices, is not protecting the public. Maureen

:03:38.:03:41.

laughed walking in the Yorkshire Dales near her home in Richmond. It

:03:41.:03:46.

was a surprise when the surgeon told her she needed to have two hip

:03:46.:03:49.

replacements. When I went to the hospital I was told I would get

:03:49.:03:54.

this new kind of hip joint, a state-of-the-art joint, it was

:03:54.:03:59.

metal and would last almost probably my lifetime. Maureen had

:03:59.:04:05.

two Pinnacle hips put in, they are mind by US giant, Johnson & Johnson.

:04:05.:04:09.

They were fitted in 2005, they have already failed. I have swelling in

:04:09.:04:14.

my lower abdomen, I had an ultra sound, and they said they are fluid,

:04:14.:04:19.

but obviously they shouldn't be there. They do concern me, lumps in

:04:19.:04:24.

my body, you don't want them. Nagel is Maureen's surgeon, he's

:04:24.:04:29.

about to replace one of her failed implants. There is nearly no other

:04:29.:04:34.

explanation, apart from the implant is wearing out abnormally. I'm glad

:04:34.:04:41.

we have got here in time. Metal debris everywhere. The front wall

:04:41.:04:46.

of the pel is -- pelvis has just been eaten away. But it really is

:04:46.:04:50.

quite significant the damage. is scooping out a mixture of

:04:50.:04:56.

rotting flesh and cobalt and chromium metal debris from around

:04:56.:05:00.

Maureen's hip joint. Surgeries are worried about the levels of these

:05:00.:05:05.

metals in patients' blood, because of the possible long-term damage to

:05:05.:05:12.

health. We are seeing patients of 10, 20, 50-times normal levels, the

:05:12.:05:18.

highest level is to nearly 300. Tony has removed the head of

:05:18.:05:22.

Maureen's hip implant, and it is clearly damaged. That is where the

:05:22.:05:25.

wear starts, and it goes right down to the floor. That is the wornout

:05:25.:05:31.

part, it goes right the way round. This is mechanical wear, that is

:05:31.:05:35.

the problems you get with mechanical. Maureen's hip has now

:05:35.:05:38.

been sent to experts at Newcastle University, this is one of several

:05:38.:05:42.

centres around the country trying to figure out what is going wrong,

:05:42.:05:49.

let's see what they find. Maureen's hip joint is put on to a scanner

:05:49.:05:54.

which maps the damage. Mechanical engineers then analyse how much

:05:54.:05:58.

metal has worn away. We can see damage from the head, we can also

:05:58.:06:05.

see damage from the metal cup. So whether we have metal surfaces in

:06:05.:06:08.

contact, potentially that can generate metal wear that will go

:06:08.:06:14.

inside the patient. Tom Joyce is an engineer, who has analysed hundreds

:06:14.:06:20.

of tip joints. There is evidence that these large metal-on-metal

:06:20.:06:23.

hips are failing at a rate we wouldn't expect. We are trying to

:06:23.:06:27.

get the bottom of that and explain what is happening. Surgeries

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decided to use metal-on-metal hips, because old versions, made of

:06:33.:06:36.

plastic, were wearing down in active people. They thought metal

:06:36.:06:42.

would be a more durable option. Some times of metal hips work well

:06:42.:06:46.

in young, active men. How have these failing metal hips been

:06:46.:06:51.

allowed to get on to the market? The scandal of PIP's breast

:06:51.:06:55.

implants, expose the failure of regulators to protect patients and

:06:55.:07:02.

cause a public outcry. The same failure of regulation has led to

:07:02.:07:06.

thousands of patients needing their hips replaced. It is a long, costly

:07:06.:07:11.

process to get drugs on to the markets. They have to be tested in

:07:11.:07:14.

test-tubes, animals and large clinical trials by people, before

:07:14.:07:17.

they are used on you and me. You would think it is the same for

:07:17.:07:21.

artificial breast and hip implant, but it is not. Doctors are

:07:21.:07:25.

concerned there is not enough regulation to stop harmful devices

:07:25.:07:29.

being put into hates. Carl Henegan has studied the way medal devices

:07:29.:07:35.

are regulated in Europe. We realise with drugs like thalidomide we

:07:35.:07:39.

can't carry on with the current system, it is catastrophic. The

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data can be eight to ten years of development and drug trial, then

:07:43.:07:47.

you have to have on going trials for safety and efficacy. With

:07:47.:07:52.

devices it couldn't be more different. My estimate is you could

:07:52.:07:56.

get a device through with a two to three day literature review, and no

:07:56.:07:59.

clinical data requirements at the current time. You are telling me

:07:59.:08:04.

you could get a hip to market with two to three days work looking at

:08:04.:08:09.

the literature? Yes, and 7 0hips have gone through the system in the

:08:09.:08:14.

US, only three have clinical data, that is in the world. If you want a

:08:14.:08:17.

new drug on to the market in Europe, you have to go to a central

:08:17.:08:21.

regulator to get approval. But for a new, artificial hip or breast

:08:21.:08:24.

implant, the manufacturers can choose who they want to approve it.

:08:24.:08:29.

They can go to any of dozens of companies who are all competing for

:08:29.:08:37.

their business. DePuy use the British standards institution,

:08:37.:08:42.

which is better known for giving Kite Marks to such things as

:08:42.:08:46.

toasters and baby buggies. DePuy wouldn't tell us what tests they

:08:46.:08:50.

had done on artificial hips because of client confidentiality. They

:08:50.:09:00.
:09:00.:09:01.

Governments around the world have been very lapse in checking the

:09:01.:09:07.

implants. An e-mail from a senior manager at DePuy and says it is a

:09:07.:09:11.

"fun fact" that in South Africa you could implant a tent rod if you

:09:11.:09:16.

wanted to. It is astonishing that DePuy could tweak the design

:09:16.:09:20.

without testing how it works with patients. The head became bigger

:09:20.:09:25.

and the stem shorter. The head of the MHRA has known since 2006 that

:09:25.:09:31.

there were concerns about the hips. The data tells us since 2006 that

:09:31.:09:37.

there were metal lines being -- increases in the replacements.

:09:37.:09:45.

There was enough data to make the certain in 2006. As early as 2005,

:09:45.:09:49.

internal DePuy documents show they were aware of the damage that could

:09:49.:09:54.

be done to patients for metal-on- metal implants. They are being sued

:09:54.:10:00.

by patients who have had to of the hips replaced. They have put

:10:00.:10:03.

millions aside to cover potential costs.

:10:03.:10:07.

Tony Nagel is an expert witness in the legal case against DePuy.

:10:07.:10:11.

Originally he was paid by the company to train surgeries in the

:10:11.:10:17.

use of their implants. Now his hospital trust has recalled call

:10:17.:10:21.

patients with metal-on-metal hips. We have brought back all the

:10:21.:10:26.

patients with Pinnacle caps, nearly 1 though, tested, screened them and

:10:26.:10:31.

scanned them, we know exactly what is happening. We have out of 970

:10:31.:10:37.

patients, 75 failures related to metal debris, that is high. DePuy

:10:37.:10:41.

told Newsnight and the BMJ, that patient safety is their top

:10:41.:10:46.

priority, and clinical data showed the Pinnacle was safe. Tony Nagel

:10:46.:10:56.
:10:56.:10:56.

first told the company about damage to tissue in Pinnacle in 2008?

:10:56.:11:06.
:11:06.:11:10.

But the metal-on-metal Pinnacle is still on sale. The UK regulator,

:11:10.:11:17.

the MHRA appointed a committee to decide the fate of metal-on-metal

:11:17.:11:22.

hips, it included representatives of the manufacturer. The committee

:11:22.:11:26.

decided there was no need to stop the metal-on-metal hips, and

:11:26.:11:30.

patients should be told about the risks. No I a lert was issued to

:11:30.:11:37.

patients or surgeries. Today the MARA said all patients with large

:11:37.:11:41.

diameter metal-on metal hips would receive checks because of the

:11:41.:11:48.

evidence about them. Tony has fitted Maureen with a new hip, made

:11:49.:11:54.

of ceramic and plastic. How are you feeling? Fantastic. The operation

:11:54.:12:01.

went well, there was quite a lot of damage there, but we got there in

:12:01.:12:05.

time before there was damage beyond repair. I'm glad it's out.

:12:05.:12:10.

operation cost the NHS �12,000, if it is widespread it will cost the

:12:10.:12:13.

cash-trapped health service tens of millions.

:12:13.:12:17.

Our science editor is here. How worried should people be? According

:12:17.:12:22.

to the regulator, the MHRA, there are some 49,000 people out there,

:12:22.:12:26.

who have this larger diameter metal-on-metal type hip implant.

:12:27.:12:30.

They have said today that these people should have annual checks

:12:30.:12:33.

because of the safety concerns over the device. They are saying people

:12:33.:12:36.

should go to their GP if they are worried, find out what type and

:12:36.:12:40.

size of implant they have had, to see if they might require blood

:12:40.:12:44.

tests or perhaps an MRI scan, to look for any possible problems, to

:12:44.:12:49.

see if there is sign of leakage of these small metal particles. There

:12:49.:12:53.

are parallels, there seems to be, to a layman, parallels with the

:12:53.:12:58.

whole PIP breast implant thing? Common sense would tell us, in both

:12:58.:13:04.

cases the current system has failed patients. The MHRA's own website

:13:04.:13:08.

says it is responsible for ensuring that medicines and medical devices

:13:08.:13:14.

work and are acceptably safe. Yet, in both instances, it has seen

:13:14.:13:19.

reports for many years and outside pressure, and then the regulator

:13:19.:13:25.

acts. It is raising broader questions about how medical devices

:13:25.:13:29.

are regulated here and across Europe. The question is whether or

:13:29.:13:32.

not there needs to be safety tests before the devices are implants,

:13:32.:13:36.

and better safety evidence. So we are not relying on reporting by

:13:36.:13:40.

patients and healthcare professionals, but a more rigorous

:13:40.:13:45.

set-up. There is concern over the kite mark system. The notified

:13:45.:13:49.

bodies which have a contractual relationship with the makers, the

:13:49.:13:53.

certify a device does what the manufacturer says. They don't

:13:53.:13:58.

release data routinely, they can claim client confidentiality, over

:13:58.:14:02.

any data they hold. Some argue they might have a vested interest in

:14:03.:14:06.

aproving a contract, hoping for follow-on business from

:14:06.:14:09.

manufacturers, for approval for further products. All of this is

:14:09.:14:13.

increasing calls for perhaps a central European body to replace

:14:13.:14:20.

the 70 or 80 notified bodies, and the ace sem ought to look more --

:14:20.:14:25.

the system ought to look more like the system for aproving drugs, but

:14:25.:14:30.

the system for clinical trials is much less rigorous, and then there

:14:30.:14:34.

is the cost to the NHS of picking up things when they go wrong.

:14:34.:14:38.

us is the chief executive of the MHRA, the regulator of medicines

:14:38.:14:43.

and medical devices. How many clinical trials were

:14:43.:14:52.

conducted on this hip joint before it was implanted in 40,000 people?

:14:52.:14:55.

Standardised medal trials were not required. There were no clinical

:14:55.:15:00.

trials? There are clinical studies required before a joint is approved

:15:00.:15:06.

by the notified body, or it receives the Kite Mark. The nature

:15:06.:15:09.

of the study depends on the nature of the device. Do you want to

:15:09.:15:12.

apologise to all of the people for whom the operation has gone wrong?

:15:12.:15:17.

I think the agency has acted with great thoroughness in recent years.

:15:17.:15:21.

We have a situation in the UK where we are essentially concerned about

:15:21.:15:26.

the patterns of wear of these joints which, have been widely used.

:15:26.:15:31.

There are 500,000 metal-on-metal joints implanted worldwide. We were

:15:31.:15:35.

the first agency to put out a safety notice. That safety notice,

:15:35.:15:40.

for example, the advice that you gave today about people having an

:15:40.:15:44.

annual check-up, what was the new information on which that advice

:15:44.:15:49.

was based? The UK is fortunate in having the world's biggest national

:15:49.:15:53.

joint registry, which contains over a million operations of knee and

:15:53.:15:56.

hip replacements. When did you discover there was a problem?

:15:56.:16:00.

problem has emerged over the last couple of years. When the first

:16:00.:16:03.

five years of experience. You were warned six years ago, weren't you?

:16:03.:16:10.

No. If you look at the data from the National Joint Registry between

:16:10.:16:14.

2003-2008. Metal-on-metal joints were no more likely to fair than

:16:14.:16:19.

alternative manufacture. It is only in the last couple of years that

:16:19.:16:23.

the wear patterns and failure rates have diverged as they have done.

:16:23.:16:27.

it not true that there were meetings held in 2006, in which

:16:27.:16:32.

these dangers were discussed? meetings concerned the significance

:16:32.:16:36.

of the metal irons that were released, as you have heard. That

:16:36.:16:40.

the extent to which metal irons are released varies greatly from joint

:16:40.:16:44.

to joint. In some patients the levels are high, in some patients

:16:44.:16:48.

they are very low. Indeed and the patients in whom it is higher are

:16:48.:16:52.

the ones we are worried about? is precisely why we gave out advice,

:16:52.:16:56.

two years ago now, that patients with this type of advice, should

:16:56.:17:00.

have the metal irons measured in their blood, if the levels are

:17:00.:17:07.

raised, they have further investigations with images --

:17:07.:17:11.

Imaging. What has happened between that advice and today when you are

:17:11.:17:15.

advising an annual check-up? were advising all that for patients,

:17:15.:17:19.

what we have done now, with further information from the Joint Registry,

:17:19.:17:25.

this is longer experience with the joints, is we can focus the

:17:25.:17:30.

monitoring on those who need it most, the ones that have the larger

:17:30.:17:35.

head metal-on-metal device. These joints were put into people without

:17:35.:17:39.

any clinical tests, you already conceive. Were you made aware of

:17:39.:17:44.

the fact that the design of the joint had changed? You asked me

:17:44.:17:49.

were there clinical trials, I said clinical studies, but not

:17:49.:17:55.

randomised, controlled trials, of the type you might expect with the

:17:55.:17:58.

pharmaceutical industry. We are talking about the rate of wear,

:17:58.:18:02.

which can only be observed over many years, in use, over large

:18:02.:18:07.

groups of patients. There were no such tests? It would be difficult

:18:07.:18:11.

to devise randomised trials. can do it with drugs, can't you?

:18:11.:18:14.

The way that drugs give rise to problems are fundamentally

:18:15.:18:20.

different from the way that medical devises do. These people were being

:18:20.:18:26.

used as Guinea pigs? I dispute that phrase. You don't like it?

:18:26.:18:31.

cannot test the wear patterns of human joint replacements on any

:18:31.:18:34.

animal species. No you can test them on humans, which is what has

:18:34.:18:40.

happened? What we have done, and it is an essential part of all medical

:18:40.:18:43.

devise regulation, is to ensure there is -- device regulation, is

:18:43.:18:47.

to ensure there is good follow-up long-term analysis. Were you told

:18:47.:18:51.

of the change in the design? change of the design would be a

:18:51.:18:56.

matter for the notified body. that you? No. That is somebody else

:18:56.:19:01.

is it? We are the notified -- we are the competent authority, the

:19:01.:19:05.

notified body would assess the procedures. You are not aware of

:19:05.:19:09.

the changes in design? We are aware of the changes of the design, it is

:19:09.:19:17.

up to us to assess each change of design. Three of the committee who

:19:17.:19:22.

did check the design were on the payroll of the manufacturers?

:19:22.:19:26.

committee who have helped with the guidelines we are talking about

:19:26.:19:29.

today, was composed of representatives from the British

:19:29.:19:33.

orthopaedic organisation and the Hip Society, they were not

:19:33.:19:36.

manufacturer representatives, they were experts in the field. They

:19:36.:19:40.

worked with data from the National Joint Registry, which is

:19:40.:19:44.

independent, to devise the best help for patients now. When the

:19:44.:19:49.

Americans decided that these joints should not be implanted in women of

:19:49.:19:56.

childbearing age, why didn't you do the same? The evidence on that is

:19:56.:20:00.

extremely equivocal. Did you think they were being hysterical or

:20:00.:20:05.

something? The metal-on-metal joint replacements are the most widely

:20:05.:20:10.

used in the United States. The data on the effects of the metal irons,

:20:10.:20:15.

to the extent they get into blood, and secondly on the women of

:20:15.:20:19.

childbearing age, do not allow people to make firm conclusions.

:20:19.:20:23.

You tried to stop pregnant women from eating certain kinds of cheese,

:20:23.:20:27.

I suggest you that having a foreign body implanted inside your own body,

:20:27.:20:31.

with the possible, catastrophic consequences that we know about,

:20:31.:20:34.

would have been on the precautionary principle, a sensible

:20:34.:20:38.

thing to do? What we are seeking to do, by monitoring, is to detect

:20:39.:20:43.

those patients that do generate a raised level of cobalt and chromium

:20:43.:20:46.

in the blood. Those patients will go on to have further investigation

:20:46.:20:50.

with a view to removing the joint if it is necessary. We are intent

:20:50.:20:54.

on protecting patients from the effect of raised metal irons in

:20:54.:20:58.

blood. This monitoring is with a view to the NHS then paying to have

:20:58.:21:01.

the things taken out of people, is it? The purpose of the monitoring

:21:01.:21:06.

is to make sure that in that minority of patients, in whom there

:21:06.:21:10.

is accelerated wear, the detection of that wear early ensures the

:21:10.:21:14.

joint can be replaced at a time when it is most satisfactorily done.

:21:14.:21:18.

What is the costs of removing one? I honestly haven't examined the

:21:18.:21:24.

costs. We are talking about many thousands of pounds. We are, it is

:21:24.:21:28.

hugely expensive? Hip joints wear out, it is a general phenomenon of

:21:28.:21:32.

all hip joints f you look at the types of joints developed, most

:21:32.:21:37.

have been driven by the attempt to reduce the rate that they wear out.

:21:37.:21:41.

They don't all wear out while poisoning the patient, do they?

:21:41.:21:44.

point you are raising about poisoning the patient, is exactly

:21:44.:21:49.

the reason we are setting in place this monitoring arrangement for

:21:49.:21:58.

patients with this particular type of hip. This time tomorrow night we

:21:58.:22:01.

will hear from the Health Secretary, as we devote the whole programme to

:22:02.:22:05.

the controversy surrounding the Government's health bill. The

:22:05.:22:08.

latest stage of the steeplechase to become the Republican candidate

:22:08.:22:11.

tole cha eing Barack Obama this year is taking place in Michigan.

:22:11.:22:16.

Each of the four men left in the race say they will stay the course

:22:16.:22:20.

until the party convention in the summer. In the meantime they have

:22:20.:22:23.

all amplely demonstrated that no- one is meaner to a politician, than

:22:23.:22:28.

one who claims to be on the same side. In a moment I will talk to

:22:28.:22:34.

the man who thought he could turn his experience in running a pizza

:22:34.:22:38.

parlour empire to running the United States, but has had to bow

:22:38.:22:45.

out of the race. Herman Cain was the early Republican pace setter,

:22:45.:22:51.

who inspired the bumper sticker "the pizza man always delivers".

:22:51.:22:56.

And deliver, in many ways, Herman Cain did.

:22:56.:23:02.

After announcing his presidential cadidacy in May last year, he

:23:02.:23:07.

quickly earned the accolade of most covered candidate in the race. His

:23:07.:23:10.

unorthodox tendencies had everything the media could ask for.

:23:11.:23:17.

Whacky, viral ads. We can take this country back.

:23:17.:23:27.
:23:27.:23:32.

Foreign policy stumbles. When they asked me who is the President of U-

:23:32.:23:35.

bek-ebek-beck-stan I will say I don't know, do you.

:23:35.:23:43.

There was even singing. But he was propelled from businessman to the

:23:43.:23:48.

frontline. His proposed 9-9-9 tax plan, along with debate

:23:48.:23:52.

performances confirmed him as the Republican front runner, he briefly

:23:52.:23:57.

led President Obama in the polls. A stellar record had made his name.

:23:57.:24:01.

Herman Cain grabbed the opportunity to turn around two floundering

:24:01.:24:06.

businesses. First, transforming the fortunes of 400 Burger King stores

:24:06.:24:11.

in Philadelphia, from the least, to the most profitable in the company.

:24:11.:24:17.

Before saving Godfather's Pizza from bankruptcy. Initial low Cain

:24:17.:24:21.

managed to dismiss those who criticised his lack of political

:24:21.:24:26.

experience, he, he said, was part of the solution, and professional

:24:26.:24:31.

politicians, part of the problem. But ultimately, uncomfortable

:24:31.:24:38.

allegations of sexual harassment tightened the noose around his name.

:24:38.:24:46.

The charges and accusations are absolutely rejected. They simply

:24:46.:24:51.

didn't happen. Finally, in December last year, off the back of sliding

:24:51.:24:56.

poll results, in spite of his numerous public denials of

:24:56.:24:59.

wrongdoing, Cain announced he was suspending his run for the

:24:59.:25:07.

presidency. With a lot of prayer, and soul searching, I am suspending

:25:07.:25:15.

my presidential campaign. The Godfather of common sense fell

:25:15.:25:20.

foul of what Thomas Jeff son dubbed the painful and thankless office,

:25:20.:25:23.

before even assuming the office himself. Leaving others to fight it

:25:23.:25:33.

out for the White House. In his first interview as the former

:25:33.:25:39.

candidate for the Republican party presidential campaign, Herman Cain.

:25:39.:25:45.

Did you enjoy your runnout for the presidency? I did enjoy it, the

:25:45.:25:48.

best part was the feedback and response of the people, and

:25:48.:25:52.

secondly, their response to the bold solutions that I presented as

:25:52.:25:57.

part of my campaign. But I did enjoy it. You sounded pretty bitter

:25:57.:26:05.

when you quit? I wasn't bitter, I was angry, because the false

:26:05.:26:09.

accusations could not be proved, and how do you prove you didn't do

:26:09.:26:12.

something, or that you weren't somewhere that someone said. The

:26:12.:26:16.

bottom line was, it was my word against someone else, and they had

:26:16.:26:20.

absolutely no proof. That was the part that angered me. I might add,

:26:20.:26:24.

that I was going to stay in the race. But because of the coverage

:26:24.:26:28.

of the false accusations on the part of the media, it was causing

:26:28.:26:34.

undue pain on my wife and my family. And I made a decision, family first,

:26:34.:26:38.

rather than stay in, and allow them to continue to present these

:26:38.:26:43.

accusations as if they were true, when in fact they were not. Why do

:26:43.:26:53.
:26:53.:26:53.

you think you couldn't cut it in that race? On the contrary, I did

:26:53.:26:58.

believe I could cut it in that race. I did believe my appeal to the

:26:58.:27:01.

American people was number one. I proposed common sense solutions to

:27:01.:27:06.

our problems. Secondly, I didn't speak in political speak, I had

:27:06.:27:10.

specific solutions. I cut it in the race, that wasn't the issue, the

:27:10.:27:16.

issue was the constant spinning and respinning of unfounded allegations

:27:16.:27:20.

that became a distraction, not only to me and my campaign, but it

:27:20.:27:25.

became very painful to my family. I wasn't going to put them through

:27:25.:27:29.

that. What did you make of things like, you know, your boast that you

:27:29.:27:33.

couldn't name the President of Uzbekistan, that was a pretty silly

:27:33.:27:38.

thing to do, wasn't it? I don't think it was silly, I think it is

:27:38.:27:43.

silly to ask a candidate to know the head of every small country in

:27:43.:27:47.

the world, without some reference. I was driving home a point, that is,

:27:47.:27:51.

you don't have to be an international expert, in order to

:27:51.:27:54.

be able to make the appropriate decisions, once you have the right

:27:54.:27:57.

information, once you have the right intelligence information, and

:27:57.:28:02.

once you have an opportunity to analyse the situation. It is

:28:02.:28:07.

impossible, Jeremy, to answer thousands of hypothetical questions

:28:07.:28:11.

about hundreds of countries without knowing exact low what it is that

:28:11.:28:14.

you are supposed to talk -- exactly what it is you are supposed to talk

:28:14.:28:21.

about. I called those questions, "goch cha questions", I wasn't

:28:21.:28:24.

going to worry about answering those questions. An American

:28:24.:28:28.

President has to know that sort of stuff doesn't he? You don't have to

:28:28.:28:32.

know the head of every state in the world, before you become President.

:28:32.:28:42.

That was my point. Yes you would need to know it if it was a

:28:42.:28:46.

relationship you were going to cultivate or analyse. But to pick a

:28:46.:28:49.

random country and expect a candidate to know off the top of

:28:49.:28:55.

his head is unrealistic. The thing is, the American people agreed with

:28:55.:28:59.

me. When you say the American people agreed with you, you made a

:28:59.:29:02.

distinction in one of your comments about how there was a political

:29:02.:29:07.

class in the country, a media class, and then there was "the people",

:29:07.:29:16.

can youamify that? Sure, the politic -- political establishment

:29:16.:29:19.

has a certain tendency as far as candidates they want to support.

:29:19.:29:24.

Secondly, the political class, just about everybody currently holding

:29:24.:29:29.

office in Washington DC, including the President, they make decisions

:29:29.:29:37.

and proposals to sustain the status quo. The media class cover politics

:29:37.:29:42.

and everything else. They also sometimes are very biased in their

:29:42.:29:48.

coverage of stories. They do, what I call, fly-spec everything you say

:29:48.:29:53.

as a candidate, especially if you get the lead in some of the primary

:29:53.:29:59.

results. Then the people are every day normal people, trying to take

:29:59.:30:04.

care of their family, save for the kids education, they have a job and

:30:04.:30:07.

working hard. They see in the United States Washington is broken,

:30:07.:30:10.

it doesn't solve things, it continues to move problems down the

:30:10.:30:15.

road, and secondly, we have a serious financial challenge that

:30:15.:30:20.

right now they are not adequate low addressing. It sounds as if your

:30:20.:30:25.

system is pretty broke? It is broke, that is the word I use when

:30:25.:30:31.

decribing it to someone. When you have got a $16 trillion national

:30:31.:30:36.

debt, and over $5 trillion occurring in the last three years,

:30:36.:30:40.

we have a serious problem. We have a serious problem because we have

:30:40.:30:44.

to borrow from other countries to service the debt. If you look at

:30:44.:30:49.

the fact we are now spending $10 billion a day in order to be able

:30:49.:30:53.

to just service the debt, we are broke, and we have a serious

:30:53.:31:01.

financial issue. The Employment Minister has his work cut out these

:31:01.:31:05.

days, trying desperately to restore some credibility to the

:31:05.:31:08.

Government's work experience scheme. One company after another has

:31:08.:31:11.

pulled out of the scheme, embarrassed by accusations that

:31:11.:31:19.

unpaid work is being forced on to them with the threat of withdrawal

:31:19.:31:29.

of benefits. The head of the chain greings invited us Gregg invited us

:31:29.:31:34.

to look at how it works there. Look at the rather thing, expanding

:31:34.:31:41.

business, creating jobs, no wonder the Government took comfort when

:31:41.:31:46.

Gregg's bakery signed up to its work experience scheme. In these

:31:46.:31:50.

unassuming offices in Newcastle, support can no longer be taken for

:31:50.:31:54.

granted, posing a threat to a big part of the national welfare-to-

:31:54.:31:57.

work programme. They have told us they have frozen the offer of

:31:57.:32:01.

unpaid work placements, they may go further. There shouldn't be a

:32:01.:32:04.

question about whether companies should be offering work experience

:32:04.:32:08.

opportunities to the young unemployed, but inevitably, when

:32:08.:32:12.

there is criticism, as a company you have to review the scheme and

:32:12.:32:15.

decide if you still believe it is right for the company to offer

:32:15.:32:18.

those opportunities to the young. We still believe very much in the

:32:18.:32:21.

scheme, but there is one part of it the Government needs to review.

:32:21.:32:25.

That is the part that if, having taken up a placement, somebody

:32:25.:32:29.

decides they don't want to complete the placement, we don't feel they

:32:29.:32:34.

should lose their benefits. Atticus tomorrow mer care, the usual

:32:34.:32:39.

concerns about -- at customer care, the usual concerns about sandwich

:32:39.:32:44.

deals, they have been overcome by customer complaints about the

:32:44.:32:49.

scheme. It has put Matthew Nelson in a difficult position, he's in

:32:49.:32:54.

the office that is handling the calls, despite being on a work

:32:54.:32:59.

placement himself. It is his first sniff of a job opportunity since he

:32:59.:33:02.

graduated from Newcastle University last summer. I'm getting the most

:33:02.:33:06.

out of this, because I'm getting the experience, the company isn't

:33:06.:33:09.

getting that much, other than the work I'm doing, they are not

:33:09.:33:11.

getting enticements from the Government or anything like that,

:33:11.:33:17.

or financial support, just for me to be coming here. Well just me

:33:17.:33:21.

getting the experience is really helpful in my development, and

:33:21.:33:24.

personal development. You think you are getting the most out of it?

:33:24.:33:31.

Definitely, yes. Since last June, Gregg's has offered more than 40

:33:31.:33:34.

placements, 14 have led to permanent jobs. The scheme is

:33:34.:33:39.

voluntary, but if, after a week, a jobseeker pulls out, they risk

:33:39.:33:44.

losing benefits. It is this threat that means future placements with

:33:44.:33:51.

Gregg's, between 50-100 per yor, are all now at risk. -- a year, are

:33:51.:33:55.

now all at risk. The company says it is very sad. Gregg's is very

:33:55.:34:00.

positive about the scheme it says is helping young people, they are

:34:00.:34:06.

waviering, -- wavering. The tide of public opinion is pushing a

:34:06.:34:11.

Government policy dangerously close to the rocks. Other companies have

:34:11.:34:18.

already jumped ship. While others, like Matalan, Argos, and now Greggs,

:34:18.:34:22.

are taking to the lifeboats. For 19-year-old Daniel Kelly, the

:34:22.:34:26.

scheme rescued him from unemployment. He has been taken on

:34:26.:34:30.

permanently by Greggs, in the payroll team. When I signed up for

:34:30.:34:34.

a wage, I signed up primarily for the experience, that is all I

:34:34.:34:38.

wanted from it. You don't think people in your position are being

:34:38.:34:42.

exploited? I think we have people currently on it, I'm working with

:34:42.:34:46.

someone on the scheme, they love it, they don't think it is exploiting

:34:46.:34:49.

people. It gives awe bit of purpose. It is something to wake up and do

:34:49.:34:54.

in the morning. This is a recent edition to the chain, it might be

:34:54.:34:58.

because the firm is growing that existing staff have no problem with

:34:58.:35:03.

the idea of unpaid placements. think most people when they are

:35:03.:35:06.

working here would see it from the positive and see them as another

:35:06.:35:10.

member of staff, that is finding a different path into the company,

:35:10.:35:14.

rather than anything negative. scheme, run through the Jobcentre,

:35:14.:35:20.

first attracted big business, but now risks losing it under the tide

:35:20.:35:27.

of bad PR. Greggs tells us the threat of job seekers losing

:35:27.:35:30.

benefits was never explained. wasn't clear enough at the

:35:30.:35:34.

beginning. Even now it is not clear just how many people have actually

:35:34.:35:42.

been penalise Ford not completing their placement. So I think --

:35:42.:35:45.

penalised for not completing their placement. It was always going to

:35:45.:35:48.

be an issue that affects a very small number of people, and it

:35:48.:35:51.

wasn't briefed very clearly as a big part of the scheme. It was

:35:51.:35:54.

always intended to be for one or two individuals, if indeed it was

:35:54.:35:58.

required at all. But that should have been much clearer and up front

:35:58.:36:02.

with employers, at the very beginning. Tomorrow, the minister,

:36:02.:36:06.

Chris Grayling, will meet employers like Greggs, to keep their support

:36:06.:36:11.

he may have to sacrifice a central principle of the welfare-to-work

:36:11.:36:15.

programme, that the unemployed must fully engage with it, or face

:36:15.:36:22.

sanction. The Treasury has found �500 million

:36:22.:36:28.

down the back of the sofa, well, it has stopped banks not paying �500

:36:28.:36:32.

million in taxes. Barclays says it is perfectly happy to pay tax, it

:36:32.:36:35.

had been planning to dodge. They hadn't done anything illegal, but

:36:35.:36:40.

trying to avoid paying taxes when banks have had to be bailed out by

:36:40.:36:45.

the taxpayer, at enormous cost, is about as popular as a flat lent man

:36:45.:36:49.

in a lift. What were these schemes? There were

:36:49.:36:54.

two schemes Barclays was use to go minimise tax bills. It was claiming

:36:54.:36:57.

tax credits on a flow of income that hadn't been taxed in the first

:36:57.:37:03.

place. The second one I will refer to a graph involving corporate

:37:03.:37:09.

bonds, IOUs. This is when a company sells bonds in itself to the market

:37:09.:37:14.

t promises to pay the market a certain amount of money by a

:37:14.:37:18.

certain date, we will call that A, in terms of the source of money,

:37:18.:37:23.

last December Barclays decided to buy some of those bonds back from

:37:23.:37:28.

the market, which garn earned an amount of money called B, so B

:37:28.:37:33.

minus A is a profit, under the old loophole not subject to corporation

:37:33.:37:37.

tax, so they didn't mention anything to it. Of that lop hole,

:37:37.:37:41.

it was closed yesterday, -- loophole, it was closed yesterday,

:37:41.:37:46.

it was backdated to December last year. It applies retrospectively.

:37:46.:37:51.

But I thought financial legislation wasn't supposed to apply

:37:51.:37:54.

retrospectively? Normal low that is the case. The key thing is the --

:37:54.:38:00.

normally that is the case. The key thing is the retrospective part of

:38:00.:38:04.

it. There are groups out there saying doing it for that group, why

:38:04.:38:10.

not for our group. One tax consultant said you only lose your

:38:10.:38:16.

virginity once, so serious is the precedent. Overseas companies might

:38:16.:38:19.

think they will invest in Britain because of the stable tax regime,

:38:19.:38:26.

but nas not necessarily the -- that is not necessarily the case now.

:38:26.:38:31.

The Treasury wants to yield �500 million, Barclays are in the

:38:32.:38:36.

picture for �300 million, �200 million is unnamed. Will it be

:38:36.:38:42.

named? We hope so, we think the Conservative chairman of the all-

:38:42.:38:45.

party Parliamentary Committee on taxation, he will write to the

:38:45.:38:48.

Chancellor, asking him, the Chancellor, to name these companies,

:38:48.:38:53.

if the Chancellor can't, because they are on going cases, so he

:38:53.:38:56.

can't, he says why don't you put it in the parliamentary record, in the

:38:57.:39:00.

library, then we will get a look at the names, when the loopholes are

:39:00.:39:05.

closed and the tax cases are closed too. That may take a year. David

:39:05.:39:09.

Gauke, the Treasury minister, with responsibility for the tax system

:39:09.:39:15.

is here. �300 million of it is Barclays,

:39:16.:39:19.

�200 million is company else's liability, is that right? I think

:39:19.:39:27.

what I should say, on the numbers, is that as far as this particular

:39:27.:39:31.

scheme, the debt buyback scheme is concerned, if a bank or other

:39:31.:39:37.

entity is engaged in it, they should notify HMRC, under the

:39:37.:39:42.

disclosure of tax avoidance set of rules, and nobody else has. Are you

:39:42.:39:47.

getting back �300 million or �500 million? There is an amount, which

:39:47.:39:51.

we think is, if you like, the retrospective element, that has

:39:51.:39:55.

already happened, which is coming from the one entity, for example,

:39:55.:39:58.

Barclays, they have declared themselves it is them. The rest of

:39:58.:40:01.

the calculation. I know it is complicated, but let me make this

:40:01.:40:05.

point. The rest of the calculation is about behavioral r ral change,

:40:05.:40:10.

and that may be -- behavioural change, and that may be some

:40:10.:40:13.

entities or those who have already taken advantage of it. I'm being

:40:13.:40:19.

slow, I expect, but the figure is �300 million, that is what Barclays

:40:19.:40:28.

say they think they are on the hook for, the other �200 million is the

:40:28.:40:32.

speculative thing? It is the estimate HMRC have made. These are

:40:32.:40:40.

preliminary estimates, and they will have to be run past the budget

:40:40.:40:44.

of -- office of budget responsibility. With future bank

:40:44.:40:49.

activity, so. Why can't you tell us who you might think might owe the

:40:49.:40:53.

money? There is only one entity at the moment we are aware of, that is

:40:53.:40:57.

doing this. The only bank you know about doing this was Barclays, and

:40:57.:41:04.

bark close say the extent of their liability is �300 million not �500

:41:04.:41:08.

million. That is what they say. believe Barclays are on the hook

:41:08.:41:15.

for the full �500 million. We think the �300 million is up to now, and

:41:15.:41:21.

the �200 million is the future. We can get hung up on the two figures.

:41:21.:41:26.

It is a lot of money? It is, this was a very aggressive scheme and we

:41:26.:41:32.

have closed it down. This question of retrospective legislation, it

:41:32.:41:36.

has been a principle of financial legislation in this country, has

:41:36.:41:40.

had not, that it isn't retrospective. If you are going to

:41:40.:41:44.

do it in this case, why don't you just declare that the rate of

:41:44.:41:48.

income tax last yor, shouldn't have been what it is, it should -- last

:41:48.:41:53.

year, shouldn't have been what it is, it should have been 7 %, you

:41:53.:41:58.

can do anything? There is a concern about how retrospective legislation

:41:58.:42:01.

is used, if you misuse it creates uncertainty. I would be the first

:42:01.:42:04.

to argue that point. There are particular circumstances that apply

:42:04.:42:08.

in this case. There are always particular circumstances, look at

:42:08.:42:12.

the Vodaphone deal, and the Goldman Sachs deal, any of those? If you

:42:12.:42:17.

look at this particular case, what you have got here is that you have

:42:17.:42:20.

got a taxpayer, that has signed a Code of Practise, saying it will

:42:20.:42:25.

not engage in aggressive tax avoidance activity. You have also a

:42:25.:42:29.

particular area, Joe described it very well, the debt boyback

:42:29.:42:34.

arrangements. Actually the previous -- buyback arrangements. The

:42:34.:42:38.

previous Government in 2009 made statements and legislated in 2010,

:42:38.:42:41.

to try to prevent abuse of that, and try to close a loophole. This

:42:42.:42:45.

was an area, if you like, where there was a very clear sign, keep

:42:45.:42:50.

off the grass, I think everybody knew that this was an area where

:42:50.:42:55.

there had been a loophole, it was closed and, and nonetheless, one

:42:55.:42:59.

taxpayer went back into this area, in a way that was very aggressive,

:43:00.:43:03.

very contrived, and clearly against what the spirit of the law was.

:43:03.:43:08.

won't be doing this against Vodaphone and Goldman Sachs or

:43:08.:43:12.

anybody else on other arrangements? We would only use retrospective

:43:12.:43:16.

legislation in exceptional circumstances, where there was a

:43:16.:43:21.

very stkroing case, where it is very -- strong case, where it is

:43:21.:43:25.

very artificial and contrived. might do it again? Nobody will Raul

:43:25.:43:30.

it out. You have already said it is undesirable? It should only be used

:43:31.:43:35.

in very exceptional cases. Treasury's enthusiasm for

:43:35.:43:40.

maximising the tax makers motivated by the need to close a huge hole in

:43:40.:43:43.

the public finances f that goal will be met the economy will have

:43:43.:43:47.

to start growing. Today the cabinet met to look at the progress being

:43:47.:43:51.

made to promote growth ahead of next month's budget. Our political

:43:51.:43:55.

editor is here. What did they discuss? It was a review of the

:43:55.:43:58.

growth review. A year ago they said we need measures to get this

:43:58.:44:02.

economy going again, and three weeks away from the budget, they

:44:02.:44:06.

had to say where have we got to, in the words of one Downing Street

:44:06.:44:10.

person it is shaking the tree on existing measures, can we get more

:44:10.:44:15.

out of them. What was most striking is it was what we call, blue-on-

:44:15.:44:23.

blue, and yellow-on-yellow, across the benches sniping. It was a line

:44:23.:44:27.

that William Hague pushed, but today the Prime Minister pushed it,

:44:27.:44:30.

and it is this, at the moment some of the big infrastructure projects

:44:31.:44:37.

and the big things making a difference to UK Plc, appear to be

:44:37.:44:41.

blocked by EU rulings. Things people have been talking to me

:44:42.:44:44.

about, the Porton Down in Cornwall, if it got off the ground it would

:44:44.:44:49.

be big. In other parts of the country they don't talk it as

:44:49.:44:53.

gospel and sometimes they ignore them. The Prime Minister and the

:44:54.:44:58.

Environment Secretary, who has to lock at things like the EU Habitats

:44:58.:45:01.

Directive, says if there is a balance of risk and you might get

:45:01.:45:07.

something from it, go for it. It is extraordinary for the Prime

:45:07.:45:12.

Minister to say let's not err on the side of caution. Anybody else?

:45:12.:45:16.

Ken Clark, the Justice Secretary, weighed in on business, he made an

:45:16.:45:19.

intervention saying we are not doing enough for small businesses,

:45:19.:45:23.

which we know. Banks aren't lending to them, he said, there is too much

:45:23.:45:30.

red tape, how it was relayed to me is this is a guy, former Chancellor

:45:30.:45:35.

from pre-1997, who had there not been a coalition, he would have

:45:35.:45:40.

been the Business Secretary. It was interpreted as a shot across Vince

:45:40.:45:45.

Cable's Boug h, and some would say he's a Chancellor not that keen on

:45:45.:45:49.

business. The Chancellor wanted to know what was happening to another

:45:49.:45:53.

controversial piece of legislation, another things causing problems is

:45:53.:45:57.

how they are reforming planing. They think if they can unclutter

:45:57.:46:02.

the planing system they can get growth going. He wants to know from

:46:02.:46:05.

the community secretary if he will go forward on this. The National

:46:05.:46:09.

Trust hate it, we need the Government response. Pickwick said

:46:10.:46:13.

they will come forward with something -- Pickles said they

:46:13.:46:17.

would come forward with something. This time last night, the City of

:46:17.:46:21.

London police were readying themselves for removing the Occupy

:46:21.:46:24.

London Protest from outside St Paul's in London.

:46:24.:46:29.

There ain't no more # You have taken everything

:46:29.:46:37.

# My belief in mother earth # Can you ignore

:46:37.:46:47.
:46:47.:46:52.

# My faith in everything # Away away

:46:52.:46:58.

# And don't say neighbour Manage you will try

:46:58.:47:08.
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# Come up and see me Tuesday was a very cloudy but

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exceptionally mild day, particularly across the north and

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east. Keeping the cloudy mild conditions on into Wednesday, most

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of us will start off with rather grey and overcast skies, things

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will tend to brighten up into the afternoon. The north-east of

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England will be favoured, seeing some decent breaks in the cloud.

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Where we get these temperatures will lift to 14 degroos, that will

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feel pleasant in the sunshine. We could see limited brighter spells,

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the best of the breaks in the cloud are likely further west. A much

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sunnier day for South-West England, Wales, the West Midlands and on

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towards Greater Manchester, sunny spells reaching 11-13. In Northern

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Ireland a similar day to yesterday, rather cloudy but a few brighter

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spells. Western Scotland keeps the blanket of cloud, with a few spots

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of rain over the western hills. East of the Grampians sunshine into

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Aberdeenshire, it won't be as toastie as it was on Tuesday.

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Staying rather cloudy for most of us, particularly into the morning.

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Things turning a little bit brighter, in the London area,

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temperatures cooling off a touch as we go into Thursday. That is not

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just for London, it is a trend as we go on through the latter stages

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of this week, across much of the country. For Thursday a good dole

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With Jeremy Paxman. Following on the breast implant row, Newsnight investigates artificial hips accused of harming patients. Plus an interview with Herman Cain, the Washington outsider who was until recently running for President of the United States.


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