Category: English

Source: The Conversation – UK – By Stefan Stern, Visiting Professor of Management Practice, Bayes Business School, City St George’s, University of London

For all of Keir Starmer’s undoubted abilities, steady nerve and top-level experience in the legal profession, his tenure as prime minister has been fraught with difficulty. This is no doubt partly due to his limited enthusiasm for the (at times banal) realities of political leadership.

It is also due to his reluctance to engage sufficiently with the details of important decisions. At key moments, he has chosen to look the other way and defer to others to execute.

The most recent and consequential example of this is the appointment of Peter Mandelson as ambassador to Washington DC, which we now know was driven primarily by former chief of staff Morgan McSweeney. A quick refresh on recent Labour party history should have been enough to deter this decision. Instead, Starmer outsourced political judgment to others. Now that it has backfired, he is attempting to deflect the blame for his own misjudgments, perhaps not realising – or not accepting – that the buck ultimately stops with him.

He has lost goodwill by removing a range of colleagues, including two cabinet secretaries, two chiefs of staff, and now a top civil servant. He has not focused enough on the detail of policy, but has rather made broad and vague calls for change and asked others to deliver it. Good leaders delegate with clear instructions to people who are capable of fulfilling specific tasks.

A strong sense of leadership from the centre is needed to make the UK government system work. This was understood by the last Labour government with the introduction of the Delivery Unit, a mechanism to provide performance management across key departments.

The Starmer government got off to a false start in the summer of 2024 and has never really recovered. There was misalignment, to put it mildly, between Starmer’s original (and short-lived) chief of staff, Sue Gray, and other colleagues. A clumsily introduced cut to winter fuel allowance had to be reversed, raising no extra revenue but costing a good deal of political goodwill.

There have been other missteps. Starmer sparked anger among some MPs with his speech warning about the UK becoming “an island of strangers”, only to concede subsequently that he was uneasy with that phrase. He was opposed to his own speech.

Welfare reform was necessary until backbenchers rebelled. A harsher line on immigration did nothing to halt Reform’s rise. A seeming reluctance to criticise Israel’s assault on Gaza cost the Labour party support and helped drive the Green party’s new popularity.

And while Starmer did not know and had no particular fondness for Mandelson, he was persuaded McSweeney that he would be the right person to send to Washington DC as a new ambassador. Hence the rushed process to appoint him, and the subsequent political mess that afflicts Starmer now.

All of these suggest a disengagement with the nitty gritty of politics, the consequences of which are now being made clear.

Understanding the job

Amanda Goodall, a professor of leadership at Bayes Business School, has long argued that “domain knowledge” (or professional expertise) is a vital requirement for those in a leadership position. It pays to have someone in charge who understands and has a profound feel for the world in which they are operating.

Credibility among colleagues is established by being good at the core elements of a job and having proven experience. This was always going to be difficult to achieve for a latecomer to politics like Starmer.

In Westminster, Starmer has always been a fish out of water. He has only been a member of parliament since 2015. He emerged as a viable leadership candidate in the aftermath of Labour’s 2019 election defeat. He succeeded as a figure with calm authority, in contrast to the uncertainty created by Boris Johnson and Liz Truss.

Even under the steadier figure of Rishi Sunak, and undermined by the rise of Reform, the Conservative government was doomed to defeat. In July 2024, the quirks of the UK’s voting system gifted Labour a massive 170-seat majority on a vote share of 34% – a “loveless landslide”. The government was never really all that popular even at the outset. A more politically savvy prime minister might have recognised this and led the new government differently.

Starmer became prime minister without ever having established a distinct political identity or programme. He proudly said that there was no such thing as Starmerism, and never would be. That sort of modesty may have been authentic and appealingly British, in a way. But it left the new government without a song to sing.

Politics, it has been said, is “show business for ugly people”. Charisma is overrated, and after Boris Johnson I suspect the country has had enough of performative prime ministers. The PM does not have to be a stand-up comedian or a “celebrity”. But there should be a purpose to what he or she is doing. A more politically engaged prime minister would have weighed up the risks in appointing Mandelson more carefully, and been aware of warnings that the appointment was being “weirdly rushed”.

Effective political leaders have a coherent and compelling story to tell. They strengthen and give credibility to this story when they make important political decisions with conviction and a sense of ownership. This is what Starmer has lacked all along, and it will be his undoing.

Stefan Stern does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Mandelson vetting: Starmer’s reluctance to engage with the details shows a lack of political leadership – https://theconversation.com/mandelson-vetting-starmers-reluctance-to-engage-with-the-details-shows-a-lack-of-political-leadership-281191

Source: The Conversation – UK – By Gerald Mako, Research Affiliate, Cambridge Central Asia Forum, University of Cambridge

The limit of what artificial intelligence can achieve, known as frontier AI, has crossed another threshold. AI can now plan and execute sophisticated cyber operations with minimal guidance at speeds far beyond human capability.

That, at least, is the evidence from an independent test of Claude Mythos Preview, the latest and most advanced model in the Claude family of AI systems, developed by US tech firm Anthropic. Similar to ChatGPT, these can understand and generate human-like text, analyse information, and solve complex problems.

The finance sector is alarmed. It relies on highly interconnected digital systems that are especially attractive targets for sophisticated cyber-attacks. A successful breach could disrupt payments, freeze access to funds, and erode public trust in the banking system.

Major UK and US banks are preparing controlled trials under strict safeguards. They will be granted secure, supervised access to the Mythos Preview model in isolated environments, to evaluate its ability to detect vulnerabilities in their systems while minimising any risk of misuse. It’s a bit like dangerous viruses being examined in high-security laboratories.

The UK’s AI Security Institute, a research organisation within the government’s Department for Science, Innovation and Technology, has already tested Mythos Preview on a demanding benchmark known as The Last Ones. As the name suggests, this series of challenges has been designed as the final hurdle AI systems need to complete before being deemed able to fully automate complex, real-world cyber-attacks from start to finish.

In the controlled test, Mythos Preview autonomously surfaced thousands of “zero day” vulnerabilities – flaws unknown even to the software’s own developers – across every major operating system and popular web browser. Some of these had remained undetected for up to 27 years, even though the software had been carefully checked millions of times.

Under controlled conditions, a skilled human operator would typically need around 20 hours to complete the exercise. In ten independent runs, Mythos achieved full success three times, making this preview version the first AI model to solve the entire attack chain end-to-end.

The results show genuine autonomous chaining of complex sequential actions. Mythos Preview thus represents a major leap in the ability of an AI to act as a truly autonomous agent, planning and executing complex, multi-step tasks over extended periods with minimal human intervention.

But the significance of this technological breakthrough extends well beyond cyber-attacks. The same capability could soon allow AI to autonomously manage software development, scientific research, supply chains or financial operations. Mythos Preview signals a shift from powerful assistant to genuinely autonomous operator, with wide-reaching implications across many industries.

The dual-use dilemma

Rather than releasing it publicly, Anthropic has so far restricted access through its Project Glasswing, an initiative that gives selected technology companies and critical infrastructure providers including Apple, Google, Microsoft, Cisco and Amazon controlled access to the model.

Anthropic’s stated idea is to “to secure the world’s most critical software” by identifying and fixing security weaknesses in the operating systems, browsers and critical libraries that underpin virtually all modern digital systems, before they can be exploited. Only after that will Mythos see wider deployment as a general-purpose AI system.

Traditional vulnerability management is the process of identifying, assessing and fixing weaknesses in software and systems before attackers can exploit them – a slow, labour-intensive task performed by experts. Mythos could change this process dramatically – in both positive and negative ways.

Its emergence creates a classic dual-use dilemma: the same breakthrough that strengthens cyber defence can also lower the barrier for offensive operations.

On the positive side, it could enable defenders to discover and patch thousands of previously unknown vulnerabilities at unprecedented speed and scale, potentially making critical software far more secure and reducing the window for attacks.

Many current cybercrimes such as ransomware succeed by exploiting known or easily discoverable weaknesses in unpatched systems. These could be significantly reduced if Mythos-class models are widely used for defensive vulnerability discovery.

However, more sophisticated or targeted ransomware attacks – especially those using stolen credentials, social engineering, or already-compromised accounts – are far less likely to be affected, as they often bypass traditional software vulnerabilities altogether.

On the negative side, the same capabilities could dramatically lower the barrier for malicious actors, allowing them to find and chain weaknesses much faster than human teams. This would accelerate sophisticated cyber-attacks if the technology spreads beyond controlled environments.

There is no public evidence that Mythos Preview has reached criminal groups or nation-state adversaries – yet. But the history of cybersecurity technology suggests that well-resourced actors, either state-sponsored or criminal, may develop comparable systems or gain indirect access within the near future.

The future of cybersecurity

In the short term, governments are likely to revise their cybersecurity protocols and incident-response frameworks to incorporate mandatory AI-assisted vulnerability scanning. This would require organisations to continuously scan their systems using AI, rather than relying on occasional human checks.

While this could dramatically improve security by finding flaws faster, it is likely to raise costs significantly and carries the risk of system slowdowns, false alarms, or brief operational disruptions when fixes are applied.

Cyber insurers will almost certainly begin demanding evidence of such defences as a condition of coverage, driving up insurance premiums, while critical-infrastructure operators accelerate deployment of automated monitoring and response systems. This change will impact not only banks and financial institutions, but also critical infrastructure operators in energy, healthcare, telecoms, and transport.

Of course, Mythos is not the final chapter. Future models developed by Anthropic and other leading AI companies are being designed to function as highly autonomous AI agents, capable of independently planning, adapting and executing long, complex sequences of tasks. As well as discovering vulnerabilities, this could mean coordinating large-scale operations or managing sophisticated real-world workflows – all with minimal human guidance.

Moments like this demand both urgency and measured action. Careful governance, international cooperation, and sustained investment in defensive applications will be essential. The genie is out of the bottle – the challenge now is ensuring it serves security rather than chaos.

Gerald Mako does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. AI has crossed a threshold – what Claude Mythos means for the future of cybersecurity – https://theconversation.com/ai-has-crossed-a-threshold-what-claude-mythos-means-for-the-future-of-cybersecurity-281308

Source: The Conversation – UK – By Gemma Ware, Host, The Conversation Weekly Podcast, The Conversation

A little after 2pm on April 8, the Israeli military hit more than 100 targets in Lebanon in just ten minutes. Israel called the attack Operation Eternal Darkness and said it struck Hezbollah command and control centres across Lebanon. The Lebanese government said at least 300 people were killed and 1,000 injured.

The scale of the attack on Lebanon was reminiscent of the early days of the Gaza war in 2023 when Israel retaliated for the October 7 attacks, which killed more more than 1,200 people, with waves of aerial bombardment of Gaza.

Israel has a powerful and lethal army, and it’s been defending itself against attacks from Hamas, Hezbollah and Iran.

But why has it chosen such brutal military aggression?

One historian, Yaron Peleg, believes the answer to this question lies in the early days of Zionism in the 19th century when many Jews who arrived in Palestine were fleeing antisemitism in Europe. In defiance, they began a cultural revolution, emphasising military strength and honouring Biblical Jewish heroes.

Peleg, who is a professor of modern Hebrew studies at the University of Cambridge in the UK and author of the book New Hebrews: Making National Culture in Zion, thinks Israel’s view of itself began to change in the wake of the Holocaust. “There started a really problematic combination of defiance, aggression, and a sense of victimhood  and it’s a very explosive and lethal combination,” he says.

In this week’s episode of The Conversation Weekly podcast, Peleg tracks how he sees Israel’s self‑image changed from self‑reliance to aggressive militarism, and how that history helps to explain the way it wages war today.

This episode of The Conversation Weekly was written and produced by Gemma Ware and Mend Mariwany. Mixing by Eleanor Brezzi and theme music by Neeta Sarl.

Newsclips in this episode from Sky News.

Listen to The Conversation Weekly via any of the apps listed above, download it directly via our RSS feed or find out how else to listen here. A transcript of this episode is available via the Apple Podcasts or Spotify apps.

Yaron Peleg does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. How Israel’s history has shaped the way it wages war – https://theconversation.com/how-israels-history-has-shaped-the-way-it-wages-war-281194

Source: The Conversation – UK – By Christian Emery, Associate Professor in International Politics, UCL

One of the US and Israel’s justifications for launching the war on Iran was to ensure the regime in Tehran could never possess nuclear weapons, the ultimate deterrent against external attack. But the main lesson that has been taken from the war, according to some commentators, is that Iran’s own geography already provides it with all the deterrent it needs.

The US-Israeli strikes have inflicted massive damage on Iran’s leadership and have destroyed billions of US dollars worth of military and civilian infrastructure. However, this display of force has proved unable to stop Iran from controlling who enters the Strait of Hormuz, a maritime chokepoint through which around 20% of the world’s oil supply flows.

This has led to the suggestion that Iran could emerge from the conflict with a new blueprint for shielding itself against future threats, regardless of whether it agrees to US demands to dismantle or severely limit its nuclear programme.

Geography is arguably Iran’s greatest strategic asset. The Strait of Hormuz is shallow and narrow, with just two-mile-wide navigable shipping channels. There are also a huge number of coves and inlets along Iran’s southern coastline, providing cover for launching small boats to attack shipping or lay mines, as well as anti-ship missiles and drones.

And there is a vast belt of rugged mountains running from Iran’s north-western border with Turkey all the way down to the Strait of Hormuz. Iran can store, conceal, produce and launch more drones and missiles here than it would ever need to threaten Gulf shipping.

However, Iran’s capacity to close the strait is not new. For decades, Iran has repeatedly threatened to respond to any external attack by closing the strait. It has also, albeit in a more measured way, demonstrated the capability to make the strait commercially unusable.

In response to Donald Trump’s “maximum pressure” policy across both his first and second terms as US president, Iran has harassed shipping with fast boats, rehearsed loading mines on to vessels, test-fired anti-ship ballistic missiles and even seized a British tanker. These are all classic forms of deterrence signalling.

Multiple analysts had warned of the catastrophic economic consequences of full-scale war with Iran precisely because of Iran’s ability to close the Strait of Hormuz. The only person who seems not to have understood this is Trump.

When pressed in March on whether Trump had been briefed before the war that Iran would seek to block Hormuz, his director of national intelligence, Tulsi Gabbard, would not be drawn. But she acknowledged that it “has long been an assessment of the intelligence community that Iran would likely hold the Strait of Hormuz hostage”.

Another challenge to the claim that geography may replace nuclear weapons as Iran’s primary source of deterrence is that its nuclear programme was never a core part of its deterrence. A 2019 report by Chatham House determined that Iran saw its asymmetric capabilities – particularly ballistic missiles and its ability to mobilise its proxy groups in the region – as essential to its national security. Iran’s ability to exercise control of the Strait of Hormuz is another pillar of this strategy.

There is ample reason to believe Iran was engaged in nuclear “hedging” – preserving the option to build a weapon at some point without crossing the line in a verifiable way. But if nuclear deterrence was the core aim, it is unlikely that Iran would have committed to a 2015 nuclear deal that most of the international community argued blocked its path to a bomb.

Regional implications

If a country is attacked, by definition its deterrence has failed. But the perception of restored deterrence can help create conditions for deescalation by justifying an end to the fighting and convincing an adversary that costs can still be imposed. In this sense, Iran’s control of Hormuz may help bring the current war to an end.

Iran’s confidence in having proven its ability to blockade Hormuz may also provide cover for dialling down its nuclear ambiguity posture. And it could compensate for the degradation of its network of proxies that has enabled Iran to project influence across Lebanon, Syria, Iraq, Yemen and Gaza.

The weakening of this so-called “Axis of Resistance” in recent years has reduced (though far from eliminated) Tehran’s ability to raise the regional cost of any direct attack on Iran. And Hezbollah, which is widely considered the strongest group in this proxy network, has paid a high price for defending Iran since the start of the war.

Iran is highly unlikely to abandon its proxies completely. However, it may now conclude that using them as a form of forward deterrence to avoid being directly attacked has manifestly failed and roll back on the strategy. This would be an extremely positive move for regional stability.

Iran’s demonstrated capacity to close the strait is likely to shape the regional order for some time. But Iran is unlikely to be willing to rely on this single pillar of deterrence.

Its sustained missile strikes on neighbouring Gulf states, and damage to critical infrastructure, had already created an appetite for a negotiated end to the conflict among the US’s Arab allies. Trump himself admitted he did not anticipate this reaction.

This makes forcing Iran to suspend its ballistic missile capability extremely difficult in upcoming negotiations, which will leave its neighbours nervous and anxious about their own lack of any deterrence capacities.

Christian Emery does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Has the Strait of Hormuz emerged as Iran’s most powerful form of deterrence? – https://theconversation.com/has-the-strait-of-hormuz-emerged-as-irans-most-powerful-form-of-deterrence-281284

Source: The Conversation – UK – By Iuliana Hartescu, Senior Lecturer in Psychology, Loughborough University

Insomnia may have been torturing humanity since ancient times, but over the last 20 years scientists have made progress in their understanding of chronic sleep deprivation.

Today, sleep deprivation is one of the most widespread reported psychological problems in Britain, with about a third of the adult population in England reporting frequent insomnia symptoms.

Insomnia rarely occurs on its own, which brings us to one of the biggest changes scientists have made in our understanding of chronic sleep deprivation. The vast majority of people with insomnia often have other mental and physical health conditions, like diabetes, hypertension, chronic pain, thyroid disease, gastrointestinal problems, anxiety or depression.

In its diagnostic history, insomnia coupled with another illness or disorder was called secondary insomnia. That meant that insomnia was considered a consequence of those other underlying conditions. As such, until fairly recently clinicians did not generally attempt to treat secondary insomnia.

But in the early 2000s, both research and clinical practice evidence started to indicate that this approach was wrong. Scientists argued that insomnia could precede or long survive a primary condition. Abandoning this distinction between primary and secondary insomnia was a major advance in acknowledging that insomnia frequently was an independent disorder, requiring its own treatment.

What’s more, researchers have been accumulating strong evidence that helping people with their sleeping problems could actually lead to improvements in their other health conditions. Chronic pain, chronic heart failure, depression, psychosis, alcohol dependency, bipolar disorder, PTSD, can all improve for patients if they address their sleeping problems.

Who gets insomnia?

Over the past two decades, we have acquired more rigorous and international data illustrating how ubiquitous insomnia is. Insomnia affects almost everyone, though women, older people, and people of lower socio-economic status are more vulnerable to it.

These groups experience a combination of biological, psychological and social risk factors that expose them to long-term sleep-disruption. For example, women often experience acute hormone fluctuations, pregnancy and birth, breastfeeding, menopause, domestic violence, caregiving roles, higher prevalence of depression and anxiety – all of which can lead to more opportunities for prolonged sleep disruption.

Some current issues in insomnia research include the need to understand different types of insomnia symptoms, and their relationship to health and performance risks. For example, there is evidence that difficulty initiating sleep (as opposed to difficulty staying asleep, or waking up too early in the morning) is associated with an increased risk of depression. Similarly, scientists still have questions on changes in things like brain activity, heart rate, or stress hormones that accompany insomnia. In common with all other mental health disorders, we are still yet to find biomarkers of insomnia.

However, research has helped us understand some things people can do to prevent insonmia episodes progressing to chronic insomnia, which is harder to treat. When insomnia symptoms happen more nights than not, and last for more than three months, then a diagnosis of insomnia disorder, or chronic insomnia, can be made.

One of the most common and harmful habits that develop during periods of insomnia is lying in bed, trying to sleep. Scientists have learned that lying in bed awake leads to perpetual cognitive arousal and, in time, it teaches your brain to stop connecting bed and being asleep.

Thus, if you cannot sleep at night, get up and do something else absorbing, but calming – read, write a list for the following day, listen to calming music or do some breathing exercises. When you feel sleepy again, get back to bed. If you are tired the following day, a well-placed short nap is fine, in the afternoon, for a maximum of 20 minutes. However, one must be careful with daytime sleeping, as it may reduce sleepiness at nighttime, and going to sleep may become even more difficult.

For those who do struggle with insomnia, there are effective treatments recommended. The story of the profound changes from secondary insomnia to insomnia disorder speaks of the power of clinical diagnosis in providing a pathway to treatment.

Cognitive behavioural treatment for insomnia (CBTI) is a package of techniques designed to maximise sleepiness at bedtime. It involves structured steps which aim to modify behaviour and mental activity. There are some predictors of treatment success: shorter duration of insomnia symptoms (years, rather than decades), less depression or pain and more positive expectations towards CBTI. But CBTI is broadly effective across all groups of people with insomnia.

Even so, only a tiny proportion of people reporting insomnia symptoms seek medical help. People may consider insomnia symptoms trivial or manageable, or they may be unaware of the options. It may also be due to the unavailability of treatment options. CBTI remains largely unavailable in clinical practice, mainly due to clinicians’ unfamiliarity with the treatment programme, and limited funding.

This pushes patients towards sleeping tablets, which are not an acceptable long-term solution. Sleeping tablets are associated with significant cognitive and motor impairment, increased risk of falls, dependence, tolerance and withdrawal symptoms, daytime lethargy, dizziness and headaches.

The main truly “new” class of sleeping pills are the dual orexin receptor antagonists (DORAs), which have shown a safety profile in many ways better than the traditional sedatives, especially around dependence concerns. But DORAs are not risk free or “mild” pills. They are relatively new to the market, first approved in the UK in 2022. So we lack long-term data to assess their safety for long-term use in people with insomnia.

A decent alternative is online self-delivered CBTI, on platforms such as Sleepful, which are free to access.

We have made great strides in sleep medicine over the past 20 years for people with insomnia, we just need to realise the potential of such profound changes by providing the right help for those suffering with it.

Iuliana Hartescu receives funding from the Medical Research Council; the Engineering and Physical Sciences Research Council.

– ref. How scientists changed their view of insomnia – https://theconversation.com/how-scientists-changed-their-view-of-insomnia-279585

Source: The Conversation – UK – By Steven W. Kerrigan, Professor of Precision Therapeutics, School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences

Antibiotics are one of the greatest breakthroughs in medical history. They turned once-deadly infections into treatable illnesses and made modern healthcare possible. But bacteria are changing, and some of the drugs we have depended on for decades are becoming less effective.

Around the world, infections are becoming harder to treat. This problem is known as antimicrobial resistance. It happens when bacteria evolve ways to survive medicines designed to kill them. It is estimated that drug-resistant infections already cause about 1.27 million deaths every year worldwide.

The World Health Organization has warned that we may be moving towards a “post-antibiotic era” in which common infections once again become dangerous, and even routine injuries or procedures carry serious risk.

A century ago, that was normal. A cut from gardening, a sore throat or childbirth could turn into a life-threatening infection. Doctors had few effective treatments, and infectious diseases such as pneumonia, tuberculosis and diarrhoea disease were among the leading causes of death. The arrival of antibiotics changed that dramatically.

Penicillin, discovered by Alexander Fleming in 1928, marked the beginning of one of the most important revolutions in medicine. Before antibiotics, tuberculosis was one of the world’s deadliest infectious diseases. In 1882, it killed one in seven people living in the US and Europe. Once antibiotics became available, many bacterial infections that had once been deadly could be treated effectively.

Antibiotics not only cured infections, but also made modern medicine far safer. Many procedures rely on them to prevent or treat infection, including caesarean sections, organ transplants, joint replacements and cancer chemotherapy.

Without effective antibiotics, these treatments would become much more dangerous. Fleming himself recognised that risk. When he accepted the Nobel Prize in 1945, he warned that misuse of penicillin could lead to resistance.

Living in a microbial world

The human body contains about 30 trillion human cells, but it also carries tens of trillions of bacteria on the skin and inside the body. Together, these communities form the microbiome, the vast collection of microbes that live in and on us. Many of them are not harmful. In fact, they help digest food, produce vitamins and support the immune system, the body’s defence system against disease.

So life is a finely balanced relationship between humans and the microbial world. But bacteria are ancient and extraordinarily adaptable. They have existed on earth for more than 3.5 billion years and survive in some of the harshest places imaginable, from deep-sea vents to polar ice.

Bacteria multiply very quickly and can also swap genetic material, meaning they can share useful survival traits with one another. Some produce substances that break down antibiotics before the drugs can do any damage. Others alter the parts of their cells that antibiotics are designed to attack.

Some develop tiny molecular pumps that push antibiotics back out of the bacterial cell. Others find alternative ways to carry out the jobs that the drug was meant to block.

Read more:
Bacteria ‘shuffle’ their genetics around to develop antibiotic resistance on demand

These changes happen through random genetic variation, which means natural differences arise as bacteria reproduce. But heavy antibiotic use creates strong evolutionary pressure. When antibiotics kill bacteria that are vulnerable to them, the resistant bacteria are left behind to survive and multiply.

Conditions for resistance

Antibiotics are among the most commonly prescribed medicines in the world, and they are often used when they are not needed. In some countries, they are still prescribed for illnesses such as colds and flu, even though antibiotics do not work against viruses. In the UK, prescribing is more tightly controlled, but inappropriate use and public misunderstanding remain a concern.

Large amounts are also used in agriculture and livestock production. This can further encourage resistant bacteria to emerge and spread.

Across Europe, antimicrobial resistance is now recognised as a major public health threat. The European Centre for Disease Prevention and Control estimates that antibiotic-resistant infections cause more than 35,000 deaths each year across the EU and European Economic Area.

Doctors are now seeing infections that are difficult, and sometimes impossible, to treat. Some of the most worrying include methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and carbapenem-resistant enterobacterales (CRE). MRSA can resist several commonly used antibiotics. VRE no longer responds to vancomycin, while CRE can withstand carbapenems, some of the most powerful antibiotics available.

What a post-antibiotic world could look like

If antibiotic resistance continues to rise, the consequences for healthcare could be severe. Many routine medical procedures depend on antibiotics to prevent infection. Without them, surgeries such as hip replacements, organ transplants and some cancer treatments may become too risky to perform.

Even common infections could once again become life-threatening. A simple urinary tract infection could spread into the bloodstream. A skin wound could develop into a severe invasive infection, meaning an infection that spreads deep into the body.

One of the greatest concerns is sepsis, a life-threatening condition in which the body overreacts to an infection and begins damaging its own tissues and organs. Early treatment with antibiotics saves many lives. But when bacteria are resistant, those treatments may fail. That makes sepsis much harder to treat, and in severe cases doctors may have very few options left.

Read more:
Why sepsis is becoming harder to treat in Europe

Healthcare could begin to resemble the pre-antibiotic era, when infection was one of the biggest dangers of everyday life.

Reasons for hope

The situation is serious, but it is not hopeless. Scientists are developing new ways to fight infection. Some researchers are exploring bacteriophages, often shortened to phages, which are viruses that infect and kill bacteria.

Others are working on anti-virulence drugs. Rather than killing bacteria outright, these drugs aim to disarm them by blocking the tools they use to cause disease. The hope is that this may place less evolutionary pressure on bacteria to develop resistance.

Another promising approach is host-targeted therapy. This means boosting the body’s own ability to fight infection, rather than attacking the bacteria directly.

Better diagnostic tests, stronger infection prevention and more careful use of antibiotics could also help preserve the drugs we still have. Antibiotics transformed medicine in the 20th century and saved countless lives. But they were never a permanent victory over microbes.

The challenge now is not just to develop new treatments, but to protect the antibiotics that still work. If we can do that, the post-antibiotic future many scientists warn about may never arrive.

Read more:
Antibiotic resistance could undo a century of medical progress – but four advances are changing the story

Steven W. Kerrigan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. What a ‘post-antibiotic era’ could mean for modern medicine – https://theconversation.com/what-a-post-antibiotic-era-could-mean-for-modern-medicine-278231