Category: The Conversation – UK

Source: The Conversation – UK – By Heba Ghazal, Senior Lecturer, Pharmacy, Kingston University

A dangerous new drug adulterant is spreading through America’s illicit opioid supply, and it’s making overdoses significantly harder to reverse. Medetomidine, a veterinary sedative normally used to sedate pets, is increasingly being mixed with heroin and fentanyl, creating a cocktail that experts warn could be far deadlier than previous street drug combinations.

Known as “flysky” on the streets, this animal tranquilliser has already been linked to at least two overdose deaths in Pennsylvania and represents a troubling evolution in the continuing opioid crisis. Unlike traditional opioid overdoses, those involving medetomidine can’t be effectively treated with naloxone, the medication paramedics use to reverse overdoses.

The emergence of medetomidine mirrors the earlier spread of xylazine, another veterinary sedative that earned the nickname “zombie drug” for its ability to cause severe, treatment-resistant skin wounds. The earliest confirmed detection of medetomidine as a street drug adulterant occurred in Maryland, where it was found in a synthetic opioid mixture probably containing fentanyl.

From there, the drug spread rapidly. Traces appeared across multiple US states and into Canada, and by early 2024, medetomidine was linked to overdose clusters in Philadelphia and other locations, following the same geographical pattern that xylazine had taken years earlier.

What makes medetomidine particularly concerning is its extraordinary potency. Medetomidine is an alpha-2 adrenergic receptor agonist – a type of drug that affects the nervous system. While approved only for veterinary use in the UK to sedate animals and provide pain relief for pets, experts estimate it may be 200 to 300 times more potent than xylazine when used as a drug adulterant.

This extreme potency means that even tiny amounts can have devastating effects. Users experiencing medetomidine-laced drug overdoses typically display extreme drowsiness, muscle twitching, dangerously low heart rate and blood pressure, and laboured breathing.

Chicago cases from 2024 revealed additional concerning symptoms: extremely high blood pressure, severe confusion and critically low blood oxygen levels – often dropping below 90%, a threshold that can cause organ damage.

Perhaps most alarming is medetomidine’s resistance to naloxone, the opioid overdose-reversal drug that has saved countless lives. While naloxone can counteract heroin and fentanyl by blocking opioid receptors in the brain, medetomidine affects the body through entirely different pathways. This means there is no approved antidote for medetomidine poisoning, leaving healthcare professionals with limited options when treating overdoses involving this adulterant.

The withdrawal process is equally tricky. Philadelphia health officials report that people withdrawing from medetomidine-laced drugs experience dangerous spikes in blood pressure and heart rate – symptoms severe enough to trigger a heart attack in some cases. Users also endure uncontrollable nausea and vomiting, intense anxiety, restlessness and violent shaking.

Understanding why dealers add these veterinary drugs to street opioids requires examining the economics of the illicit drug trade. According to a 2022 DEA report, a kilogram of xylazine powder can be bought from Chinese suppliers for as little as U$6.00 (£4.44). This rock-bottom pricing allows drug traffickers to increase their profit margins significantly while making weak or diluted opioid batches feel more potent to users.

These sedatives also serve as effective cutting agents (substances used to add bulk and weight to drugs without requiring expensive active ingredients). For dealers, it’s a win-win. They can stretch their supply while creating a product that feels stronger and lasts longer than pure opioids alone.

Managing new drug adulterants like medetomidine presents unique difficulties for both medical professionals and law enforcement. The drugs make intoxication and withdrawal symptoms more severe and complicated, while also making it harder to identify which specific substance is causing particular symptoms in a patient.

Medetomidine compounds these problems because it’s rapidly metabolised by the body, making it difficult to track the timing and duration of its effects. Additionally, these veterinary sedatives are not included in routine drug screenings or toxicology tests, meaning their presence often goes undetected by medical professionals and law enforcement, despite their potentially lethal effects.

UK response

While no cases of acute medetomidine toxicity have been published in the UK, the country has already experienced problems with xylazine, a similar veterinary sedative.

British health authorities have detected xylazine in 35 cases through toxicology tests and drug seizures. Of 16 people found to have xylazine in their systems, 11 cases proved fatal – deaths that occurred primarily during May 2022 and August 2023.

In response to the growing threat, the government has taken decisive action. Over 20 dangerous substances have been banned as part of efforts to combat synthetic drugs and improve public safety.

Xylazine is now controlled as a class C substance, carrying penalties of up to two years in prison for possession and up to 14 years for production and supply.

The government is also working to better equip police, healthcare workers and Border Force agents to tackle this evolving threat through improved training and detection capabilities.

The case of medetomidine highlights a disturbing reality about modern drug policy: the illicit drug supply continues to change in unpredictable and dangerous ways. Neither medetomidine nor xylazine was developed for human consumption, and there are no human studies examining their drug interactions, lethal doses or safe reversal protocols.

As these veterinary sedatives become more common in street drugs, the challenge for healthcare professionals continues to grow. Traditional overdose response protocols, built around reversing opioid effects with naloxone, become inadequate when faced with multi-drug combinations that affect the body through completely different mechanisms.

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Read more:
‘There has never been a more dangerous time to take drugs’: the rising global threat of nitazenes and synthetic opioids

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For users, families and communities already devastated by the opioid crisis, the emergence of medetomidine represents yet another layer of risk in an already dangerous landscape.

As the drug supply becomes increasingly unpredictable, the need for comprehensive approaches to drug policy – encompassing everything from harm reduction to treatment access to law enforcement – becomes ever more urgent.

Heba Ghazal 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. An animal sedative keeps turning up in opioid deaths – what you need to know about medetomidine – https://theconversation.com/an-animal-sedative-keeps-turning-up-in-opioid-deaths-what-you-need-to-know-about-medetomidine-264080

Source: The Conversation – UK – By Audrey O’Grady, Associate Professor in Biology, University of Limerick

Imagine a mum who can have children from two different species. Family gatherings would be interesting, to say the least. In the insect world, this is no joke. A new study published in Nature shows that queens of the Iberian harvester ant (Messor ibericus) routinely lay eggs of not just to their own kind, but also of males of another species, Messor structor.

The researchers even coined a word for it, xenoparity, meaning “foreign birth”. It pushes the boundaries of what we mean by “species”. And this is the first known case in the animal kingdom of this happening as part of an animal’s life cycle.

The most typical reproduction strategy in the natural world involves a mother and father of the same species who breed and produce sons and daughters, also of the same species.

However, there are exceptions to the rule. Social insects, ants in particular, are known to violate it. A 1999 study found that 17 out of 164 central Europe ant species are known to create hybrid offspring.

Typically, in ant colonies, fertilised eggs develop into workers and queens and unfertilised eggs develop into males. All the ants that we usually see foraging are females who cannot reproduce (workers), but do all the other work. Ants that breed, female queens and males, normally have wings and can be seen during mating flights. Afterwards, males often die while the females found new colonies.

However, in some ant species, unfertilised eggs develop into female clones of the mother. This process is called parthenogenesis.

Generally, ant colonies which include different ant species may contain either one or several queens that can mate with either single or multiple males. Some ant species produce only wingless males that mate inside the nest and never participate in nuptial flights.

In 2002 an even more interesting reproduction strategy was found in two seed harvester ant species, common in southwestern US, whose queens lost their ability to produce female workers of their own kind. They need to mate with a male from a different species to lay eggs that develop into hybrid species female workers. This cross-species mating is essential for the survival of both species.

The new discovery

The article provides startling insights into ant reproduction. Workers (females) in these colonies are hybrids. Like the seed harvester ants, the Iberian harvester queens can’t make workers on their own. They need sperm from M. structor, and the daughters are half M. ibericus, half M. structor. This is similar to social hybridogenesis documented in other harvester ants, where only cross-species daughters become workers.

But the fascinating part is that Iberian harvester queens produce ordinary M. ibericus sons as well as M. structor sons. These males aren’t hybrids. They’re clones, carrying only their father’s DNA. Iberian harvester queens act almost like a rental womb. This resembles male-only cloning known from some clams and a stick insects.

The researchers sequenced the DNA of hundreds of Iberian harvester ants and repeatedly found this same pattern.

M. ibericus and M. structor split from a common ancestor millions of years ago. They look and behave differently in the wild, with M.ibericus having smaller queens. Yet one is now literally producing the other. Multiple colonies of M.ibericus live together in habitats ranging from pastures to suburban areas. But M.structor ants are a mountain species and their colonies live separately. The two ant species can live close together in overlapping habitats in lanes and fields near mountains.

The cloned M. structor sons raised inside M. ibericus colonies don’t just differ genetically, they even look odd. Compared with their wild cousins, they appear almost hairless.

The most probable explanation of how this reproduction strategy evolved is a phenomenon called sperm parasitism. This is when females of one species use sperm of the males of another species to stimulate asexual reproduction or even partially incorporate the male’s genome into their offspring.

Over time, they cut out the middleman (adult M.structor males) and started making their own supply of cloned M. structor males. Instead, they mate with these clones that hatch in the colony nest.

It shows that evolution can re-engineer reproduction in radical ways. People sometimes like to think nature follows straight paths. Parents make their own species. Colonies stick to one lineage.

But evolution doesn’t care about our rules. So the next time you see ants marching across a path, remember, somewhere in southern Europe, there’s a queen casually running a two-species household. And you thought your family tree was complicated.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. One queen ant, two species: the discovery that reshapes what ‘family’ means in nature – https://theconversation.com/one-queen-ant-two-species-the-discovery-that-reshapes-what-family-means-in-nature-264384

Source: The Conversation – UK – By Tomas Jernberg, Professor, Clinical Sciences, Karolinska Institutet

As a cardiologist, I frequently meet patients who have stopped taking medicines that could keep them alive. Often it’s because they’ve seen a dramatic headline or a worrying TV report about a drug they rely on. But sometimes, patients are right to pay attention: new studies really can overturn decades of medical practice.

Few drugs illustrate this tension better than beta blockers. Long prescribed after heart attacks, these medicines can be life-saving for some people, helpful for others and useless – or even harmful – for the rest.

Beta blockers have been used for more than 40 years in almost all patients with heart attacks. But this practice was based on studies done before modern treatments were available, and before we could detect very small heart attacks that do not affect the overall function of the heart.

Recently, two studies on beta blockers in patients with heart attacks were reported in the news. The Spanish-Italian study received the most attention. Media reports suggested that most heart attack patients did not benefit from beta blockers, and that in women the drug might even increase the risk of hospitalisation and death.

Reports like this can make people stop taking their medication.

At the same symposium in Madrid, the second study – which got less attention – showed almost the opposite. Patients with heart attacks did benefit from beta blockers. And if there were differences between the sexes, women might actually have had more benefit than men.

The heart of the matter: ejection fraction

A key to understanding the different results is something called the left ventricular ejection fraction. This is the percentage of blood in the left chamber of the heart – its main pumping chamber – that is pushed out into the body with each heartbeat. Normally, ejection fraction should be at least 50%.

If we look at all the studies together, including one I led and presented last year, the picture becomes clearer. Patients with an ejection fraction of 50% or higher after a heart attack do not benefit from beta blockers. But patients with an ejection fraction below 50% do benefit. And this is true for both men and women.

The European guidelines from 2023, as well as the recently published American guidelines, still recommend beta blockers after most heart attacks. Many doctors are therefore reluctant to change a therapy tradition that has been in place for 40 years.

My colleagues and I are now planning to pool data from the recent large studies on patients with heart attacks and an ejection fraction of 50% or more. The results, expected later this year, will probably give definite answers about beta blockers in this population and change future guidelines.

But many patients clearly benefit from beta blockers, including those with heart failure and reduced ejection fraction (with or without a prior heart attack), angina pectoris (chest pain caused by reduced blood flow to the heart), or various heart rhythm disturbances.

Beta blockers can also be prescribed for other reasons, such as high blood pressure, migraine prevention, tremors, as well as off-label use for stress and anxiety. For patients, it’s not easy to know all the reasons why beta blockers are prescribed, and in some cases, they may not be suitable at all. So I’ll end with a good, if not very novel, piece of advice: always consult your doctor before making any changes to your medication.

Tomas Jernberg’s employer (Karolinska Institutet) has received a grant from MSD for a research project performed by Dr. Jernberg but not related to this article.

– ref. Heart attack patients: do you still need beta blockers? A cardiologist explains – https://theconversation.com/heart-attack-patients-do-you-still-need-beta-blockers-a-cardiologist-explains-264409

Source: The Conversation – UK – By Thomas Caygill, Senior Lecturer in Politics, Nottingham Trent University

Angela Rayner has resigned as the UK’s deputy prime minister after a report found she had breached the ministerial code by not paying enough stamp duty on her second home.

In her resignation letter she said she deeply regretted what she maintained was an error, and the report from the prime minister’s ethics adviser said she had “acted with integrity” despite the breach. However, it was still enough to force Rayner, who was also housing secretary, to step down, prompting a cabinet reshuffle.

We asked Thomas Caygill, senior lecturer in politics at Nottingham Trent University, to explain what was likely to happen next and what the affair could mean for the government.

Why did Angela Rayner have to resign?

At the 2024 general election, Prime Minister Keir Starmer promised the British public that any government he led would work to clean up politics after years of Tory sleaze. When in opposition, both he and Rayner took a very firm line in response to scandals among Conservative ministers, including Boris Johnson and Rishi Sunak.

So the Labour pair have, in a way, made a rod for their own backs. Rayner had no choice but to resign after the findings of the report prepared by the prime minister’s independent ethics adviser (Sir Laurie Magnus) concluded that she did not meet the “highest possible standards of proper conduct”. If you set high ethical standards, you have to meet them without exception.

What happens now?

Rayner’s resignation leaves a gap around the cabinet table. She served as both secretary of state for housing, communities and local government and deputy prime minister. The first post will need filling and has triggered a wider cabinet reshuffle.

Starmer does not necessarily need to appoint a new deputy prime minister as the role is technically a mere honorific, given to a member of the cabinet to signify seniority. The office was vacant between 2015 and 2021, for instance. However, Starmer may feel the need to shore up his position after recent rebellions amongst his own MPs.

Rayner has also resigned as deputy leader of the Labour party, a position she was directly elected to by party members and which is unconnected with the position of deputy prime minister. She did not have to resign this post as a result of the Magnus report – since it related to her conduct in ministerial office – but she presumably did so to avoid being a further distraction for the government and party.

The cabinet does have the power to appoint a temporary deputy leader or leave the position vacant until the party conference (starting on the September 28). There are some rumours that justice secretary Shabana Mahmood could be appointed as temporary deputy leader.

However there will need to be a new election with a timeline set by Labour’s National Executive Committee. There is no set time so it could be over in weeks or it could take months. It is unlikely that the NEC will meet before early next week to make that decision.

We can expect Labour’s conference (September 28 to October 1) to become a showcase of potential candidates for deputy leader. Nominees must be a Labour MP.

They will also need the support of 20% of Labour MPs and either 5% of local Labour parties (CLPs) or at least three affiliates (at least two trade unions) amounting to 5% of affiliated supporters. There will then be a vote of all party members and affiliated supporters.

Who might replace Rayner in either role?

We can probably expect the winner of the deputy party leader contest to be a big challenger to Starmer’s authority – most likely from the left of the party. Names currently being touted are Emily Thornberry (current chair of the House of Commons Foreign Affairs Committee) and Rosena Allin-Khan. Both MPs served as shadow ministers while Labour were in opposition but were not invited to join the government last July after Labour’s election victory.

A challenger to Starmer is most likely given the mood of the parliamentary and wider party following poor poll ratings and recent rebellions over welfare reform. Anneliese Dodds is another potential contender. She resigned from government last year over cuts to international development.

Why is this situation so damaging for Keir Starmer?

Starmer is now in a more perilous position without Rayner. She was popular with the left of the party and seen as a key bridge between him and the wider party. Monday saw the launch of the phase two of Starmer’s government which has now been overshadowed by Rayner’s tax affairs and subsequent resignation.

Rayner was a rival to Starmer and no longer having her in government bound by collective ministerial responsibility will mean she is able to criticise the government and Starmer more vocally. She has also been key to the development and introduction of the employment rights bill, although this is now in its final stages and expected to become law in the coming months. It is undoubtedly one of her achievements in office.

She is also a northern working-class woman and her departure is symbolic in this regard, especially as Lucy Powell has also now left government as part of the wider reshuffle.

The only upside for Starmer is that he can now reshuffle his cabinet to cement phase two of his government. However, reshuffling as a result of a scandal could project government instability – something Labour promised to stop ahead of the 2024 general election. Reshuffles can be a chance to turn a moment of weakness into a moment of strength but that will be far harder in this case.

What should we expect for Rayner now?

We can expect Rayner to take a step back for now. However she remains an MP and is a vocal member of the party. In time she will likely become an active backbencher and a potentially vocal critic of the government (now that she is not bound by collective ministerial responsibility).

With just under four years left of Labour’s term, if she avoids being a critic, she could re-enter government in the future. What happens will depend on how she sees her own future.

How damaging is this for Labour?

This is damaging for the party, it has already seen a rapid decline in its poll ratings over the course of the past year. It harms the party’s reputation further, after promising change and promising to bring an end to scandal, they have been tinged by it again.

This plays into Reform UK’s hands who are trying to argue that the two main parties are cut from the same cloth. Nigel Farage will be filled with glee that this has all exploded during the Reform UK conference, where he is seeking to cement himself and his party as the real opposition to Labour.

This of course doesn’t mean Labour will lose the 2029 general election, however it is feeding a narrative that Labour will find hard to break unless it can prove to the British people that it is delivering on its promises. Starmer said on Monday that the government was moving into its delivery phase, and it’s not a moment to soon.

Thomas Caygill is currently in receipt of a British Academy/Leverhulme Small Research Grant for research on post-legislative scrutiny in the Scottish Parliament and has previously received funding from the Economic and Social Research Council.

– ref. What will Angela Rayner’s resignation mean for Keir Starmer’s government? Expert Q&A – https://theconversation.com/what-will-angela-rayners-resignation-mean-for-keir-starmers-government-expert-qanda-264714

Source: The Conversation – UK – By Ben Mayfield, Lecturer in Law, Lancaster University

The debate over former deputy prime minister Angela Rayner’s tax arrangements demonstrated that there are few topics more complex than the law of trusts. It was politically awkward, to say the least, when a deputy PM and housing secretary had to admit getting it wrong, and underpaying £40,000 in stamp duty.

Rayner has resigned after being found to have breached the ministerial code in the wake of the stamp duty row. That erupted after she was said to have put her share of her constituency home in Greater Manchester in trust for her son, and to have bought another home in Hove, East Sussex, paying a lower rate of stamp duty than should be owed by a second homeowner.

In Rayner’s case, a probable oversight and a trust created with legitimate intentions got caught up in legislation designed to discourage tax avoidance and ownership of a second home. Of course, it also left her open to accusations of hypocrisy, as a member of a government that championed higher taxes for second homeowners.

Earlier in the week, Rayner had said she took legal advice on the purchase. But her conveyancers then claimed not to have advised her on any additional tax liabilities that might have arisen due to the existence of a trust for her child.

So what is a trust – and why are they controversial for tax purposes?

Trusts have a long history – it’s claimed that they were established to protect the property of knights who left England to join the Crusades. But despite these medieval origins, the modern trust still has a range of uses. For most people this will be as a mechanism for the ownership of land. All land has a legal title (the paperwork held by the Land Registry proving who owns the property in law).

But in addition to the legal title there will be what’s called an equitable interest in the land – this is, the right to the financial value of it. When two or more people buy a house together they create a trust. Both names appear on the legal title and both will be entitled to a share of the equity too. Because there is a trust, one party cannot sell the house without the agreement of the other.

The case of Rayner’s constituency home is an example of how trusts are commonly used – for the protection of family assets. Children below the age of 18 are unable to own land, so if parents want to gift them land they need to use a trust. The legal title is held by a trustee such as a parent, lawyer or friend and the child is entitled to the value of the property as it is held for their benefit.

Rayner and her ex-husband are said to have created a trust which bought her share of the constituency home for the benefit of their disabled son. This followed a payout for damages in the son’s medical negligence claim.

She retained no legal ownership of the house by the time she bought the Hove flat. A parent who creates a trust like this puts the financial value beyond their own reach and would be unable to sell the land to benefit from it personally.

Where Rayner came unstuck

But the Rayner case throws up an important question. Why, in the eyes of the law, is a parent who has given their only house away to a child in trust still considered a homeowner for stamp duty purposes? This introduces another use of the trust – the legal avoidance of tax. Trusts have been used to protect family assets from taxes such as inheritance tax – and so the government has tried to close loopholes and limit these opportunities.

This is what makes this situation so damaging for Rayner. As well as raising funds for the government, property taxes have also been used to nudge behaviour. For example an additional 5% rate of stamp duty is meant to discourage homeowners from tying up a second home. House price inflation has of course made this an increasing source of revenue for the government.

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Read more:
Housebuyers hate stamp duty. Why hasn’t it been reformed before now?

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The law taxes the buyers of second homes more heavily than those who own only one house. This is aimed at avoiding problems such as housing shortages in holiday destinations, and the kind of social disruption seen in places affected by the ownership of second or holiday homes in areas such as Wales and the Lake District.

In his time as chancellor of the exchequer, Gordon Brown made many such trusts subject to inheritance tax. If a homeowner was able to avoid the higher rate of stamp duty by putting their property into trust for their children, this could open a new loophole similar to that of inheritance tax, but for stamp duty.

Before her resignation, Rayner’s political opponents also noted that, as deputy prime minister, she already enjoyed the use of Admiralty House. This is a grace-and-favour apartment in Whitehall which she did not, of course, own herself.

But perhaps the biggest question the controversy has raised is this. If a housing secretary, deputy prime minister and a team of experienced land lawyers are unable to accurately divine the correct rate of stamp duty, what hope is there for the rest of us?

Ben Mayfield 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 Angela Rayner managed to underpay stamp duty – family trusts and tax avoidance explained – https://theconversation.com/how-angela-rayner-managed-to-underpay-stamp-duty-family-trusts-and-tax-avoidance-explained-264706

Source: The Conversation – UK – By Beth Nichol, Post-Doctoral Researcher in Disease Prevention, Northumbria University, Newcastle

Have you ever visited your GP for something specific – perhaps a sprained ankle or a routine check-up – only to find yourself receiving unsolicited advice about your weight, drinking habits or smoking? Sometimes this guidance feels supportive and timely. Other times it can feel intrusive, judgmental or irrelevant to why you’re there.

These increasingly common experiences aren’t accidental. Since 2016, NHS staff in England have been required to follow a policy called Making Every Contact Count, which mandates that healthcare workers use interactions with patients as an opportunity to encourage healthier lifestyles.

While you may never have heard of this term, if you’ve received unexpected health advice during a medical appointment, you’ve probably encountered this policy in action. Similar initiatives exist in other UK nations and in healthcare systems worldwide.

Making Every Contact Count has persisted for nearly a decade because the underlying principle appears sound. Research shows that brief advice – sometimes lasting just minutes or even seconds – can genuinely help people quit smoking, increase their physical activity, or reduce their alcohol consumption.

For the NHS, this approach offers particular appeal. It’s low-cost and allows the health service to demonstrate that it’s moving beyond simply treating disease towards actively preventing it.

When good intentions go wrong

However, the reality often falls short of these noble intentions. Many readers will recognise scenarios where this approach backfires.

A typical example involves someone seeking help for a minor injury who leaves the consultation clutching an unwanted leaflet about weight loss, despite not having mentioned weight at all. Receiving unwanted advice can leave patients feeling lectured to rather than supported, creating feelings of guilt and judgment instead of empowerment.

The frustration intensifies when patients lack the resources to act on the advice they’ve received. Being told to exercise more or eat better foods becomes particularly galling when you’re struggling financially, working multiple jobs or living in an area with limited access to healthy food or safe exercise facilities.

This resource gap reveals a fundamental flaw in the Making Every Contact Count approach. The policy claims it can help reduce health inequalities by encouraging discussions about broader issues like housing and employment, yet, in research my colleagues and I conducted, we found no evidence to support these claims.

Instead of addressing structural inequalities, these conversations risk reinforcing them by placing responsibility on people who may have limited power to change their circumstances.

This problem is compounded by the NHS’s broader shift towards patient “empowerment” through increased choice and responsibility. The latest NHS strategy promises patients unprecedented choice over where they receive treatment, supported by league tables ranking healthcare providers. Patients will even influence provider payments through their feedback on care quality.

While these changes sound progressive, they rest on the false assumption that all patients have equal capacity to exercise choice. Those with internet access, education and flexible schedules may thrive in this system, navigating league tables and travelling to optimal providers.

Yet others may struggle to access or interpret the information, juggle appointments with work and childcare commitments, or face limitations imposed by public transport links. Without careful consideration of how to level this playing field, this policy risks widening rather than narrowing health inequalities.

The challenge lies in distinguishing between true empowerment and victim-blaming disguised as patient choice. Genuine empowerment in healthcare requires several key elements that are sometimes missing from current approaches.

First, conversations about health and lifestyle must be approached with tact and timing. Research my colleagues and I conducted shows that these discussions should occur at appropriate moments and focus on changes patients actually want to make. The interaction should be characterised by empathy, leaving patients feeling heard and motivated rather than criticised or overwhelmed.

Crucially, studies show people resist being told what to do, particularly when it feels like preaching. Instead, they prefer collaborative, two-way conversations that acknowledge their expertise about their own lives and circumstances. This means healthcare workers need skills in motivational interviewing and behaviour change, not just medical knowledge.

Beyond individual responsibility

However, improving the quality of these conversations alone isn’t enough. Making Every Contact Count and similar “empowerment” initiatives must work alongside – not instead of – strategies that provide people with the actual resources needed to live healthier lives. This means addressing housing quality, food security, employment conditions and access to recreational facilities.

True empowerment recognises that health choices occur within social, economic and environmental constraints. A person living in temporary accommodation, working zero-hours contracts or caring for elderly relatives faces different challenges to someone with stable housing, regular income and family support. Healthcare policies that ignore these realities risk perpetuating a cycle where those with the least power are held most responsible for their health outcomes.

The goal should be creating conditions where everyone can be genuinely empowered, because they have the capability to make choices about their life. This requires systemic change that goes far beyond brief conversations with a healthcare professional, acknowledging that individual behaviour change and structural reform must work hand-in-hand to create meaningful improvements in population health.

Beth Nichol receives funding from the National Institute for Health and Care Research (NIHR) Three Research Schools Prevention Research Programme (Grant Reference Number NIHR 20400 – Prev) and Policy Research Unit Behavioural and Social Sciences (project reference NIHR206124). The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.

– ref. When healthcare advice feels like blame – the problem with ‘Making Every Contact Count’ – https://theconversation.com/when-healthcare-advice-feels-like-blame-the-problem-with-making-every-contact-count-263594

Source: The Conversation – UK – By Paul Whiteley, Professor, Department of Government, University of Essex

A recent voting intentions poll from YouGov, completed on August 26, puts Reform on 28%, Labour 20% and the Conservatives on 17%.

The poll identifies the remarkable lead that Reform has built up over the other parties. The party is leading Labour by 8%, the Conservatives by 11% and the Liberal Democrats by 12%. The Liberal Democrats are now snapping at the heels of the Conservatives, and the Greens are doing much better than they did before the general election.

YouGov Voting Intentions Survey Responses 26th August 2025:

Reform has been ahead of all the other parties since the end of April in successive surveys, so their current lead in the polls is not just a blip. However, there is an important qualification to be made about these results. They are more of a reflection of how people view national level politics than a reflection of how they would vote in their own constituency.

No less than 31% of respondents in the YouGov survey did not identify which party they supported when it applied to their constituency. Some said they would not vote; others that they would vote for another party. Yet more said they didn’t know how they would vote; and finally, some refused to answer the question. It appears that voting intentions are rather uncertain at the present time – something that is true for all parties.

The next election could be four years into the future so a lot can change between now and then. That said, by looking at how voting played out at the constituency level in the general election of 2024, we can get a better sense of which parties are most challenged by Reform as things currently stand.

Competition between parties

If we examine correlations between vote shares for parties in the 632 constituencies in Great Britain at the last election, this indicates how much competition there was between them. If, for example, the correlation between Reform voting and Conservative voting was -1.0 it would mean that on average a 1% increase in the Reform vote was associated with a 1% decrease in the Conservative vote.

If, on the other hand, the correlation between the two was zero, it would mean there was no competition between them at all. The reality lies somewhere in between these extremes.

Correlations only look at support for two parties at a time, and this can give a misleading picture because interactions between support for all five parties can change things. For example, the Labour vote share in constituencies depends in part on the rivalry between the Conservatives and Reform.

If Reform took a lot of votes from the Conservatives, this would help Labour, since Labour and the Conservatives are strong rivals. So, we really need to look at relationships between voting for all parties at the same time to get an accurate picture of party competition.

To untangle these relationships, we need to use a technique which identifies the correlation between Reform voting and support for other parties, while taking into account these interactions. This can be done using multiple regression, the most widely used statistical technique in social science. It adjusts the correlations to deal with this problem.

How Reform votes relate to other party votes:

The chart shows the relationships between Reform voting and support for the other parties in the 2024 election derived from the multiple regression analysis. All the adjusted correlations are negative, which means that the parties were all competitors to Reform. When the Reform vote increased, their vote shares decreased and vice versa.

There were big differences in party competition in the election. It turns out that the sharpest competition was between the Liberal Democrats and Reform, with an adjusted correlation of -0.72. When the Liberal Democrats did well in a constituency the Reform vote was hammered. Essentially this means that Reform just doesn’t appeal to voters in constituencies where the Liberal Democrats are strong.

The second most important competition was between Labour and Reform with a correlation of -0.52. Roughly speaking, when the average Labour vote increased by 1%, the Reform vote declined by half a percent. The third most important competition was between Reform and the other parties (the nationalists and small parties) with a correlation of -0.34. The Greens were in fourth place with a correlation of -0.28.

Further analysis shows that constituencies with many economically deprived voters who are male, define themselves as “English” rather than “British”, and who are more likely to spoil their ballots to protest about politicians are more likely to support Reform.

There are important social and political forces related to deprivation and voter grievances behind the party’s current political success. The Tories and Reform are at each other’s throats in Westminster, but this does not necessarily apply to voters at the constituency level.

The surprise is the weak negative adjusted correlation of -0.13 between Reform and the Conservatives. This means that once all the party contests are taken into account, the rivalry between Reform and Labour was four times greater than between Reform and the Conservatives.

This is because right-wing supporters of the Conservative party see Labour and the Liberal Democrats as their enemies whereas they see Reform and the Conservatives as potential allies. The Tories lost votes to Reform but fewer than many people think.

These results are likely to be a poor guide to what will happen at the next election in 2028 or 2029 since so much could change. But if the current support for Reform holds up, Labour is likely to face a greater challenge from Reform than the Conservatives in that election.

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Paul Whiteley has received funding from the British Academy and the ESRC.

– ref. Constituency-level data reveals which parties are most threatened by Reform – https://theconversation.com/constituency-level-data-reveals-which-parties-are-most-threatened-by-reform-264422

Source: The Conversation – UK – By Leonie Fleischmann, Senior Lecturer in International Politics, City St George’s, University of London

The Israeli prime minister, Benjamin Netanyahu, has ordered the Israel Defense Forces to step up the offensive on Gaza City, despite internal and international condemnation.

Amid accusations by the International Association of Genocide Scholars that Israel is committing genocide, some 40,000 reservist soldiers were called-up to report for duty on Tuesday, August 2. An additional 90,000 are due for mobilisation by the end of the first quarter of 2026. But reports suggest that the numbers willing to accept their orders are dwindling.

Israel has mandatory national conscription for those leaving high school for a period of 18 to 36 months, with some exemptions. This is followed by compulsory reserve duty for some units, normally until the age of 40. In the wake of the October 7 2023 attacks on Israel by Hamas, 360,000 reservists were reportedly called up for duty, alongside the 100,000 high-school leavers on active duty.

This was one of the largest mobilisations in Israel’s history. There was an unprecedented 120% response rate, as Israelis rallied around the flag and other people not subject to the call-up opted to serve.

After almost two years of fighting, reports suggest that commanders are now struggling to find enough reservists willing to serve. Some calculations show a 30% downturn in reserve deployment. Kan, Israel’s national broadcaster, puts the decline closer to 50%.
Reasons vary among those who choose not to fulfil their reserve duty. A report from left-wing Israeli media outlet, +972mag, calculates that only about 1,500, roughly 1.5%, of soldiers who refused between October 2023 and April 2025 did so out of ideological and ethical concerns.

The majority have refused because they have grown weary of a war that has failed to achieve a resolution nor succeeded in returning the Israeli hostages taken by Hamas. Many are suffering from exhaustion, both physical and emotional.

Whatever their motivations, the unwillingness of a proportion of Israeli reserve soldiers to continue to fight poses a potential problem for Netanyahu in his pursuit of eradicating Hamas in Gaza or in conducting wars on other fronts. Simply put, the IDF cannot carry out its operations without sufficient soldiers.

Even if refusal numbers do not reach such a tipping point, their public declarations of refusal carry political clout. Historically, Israelis have refused to serve as a means to challenge the policies of the Israeli government.

A distinction should be made between the smaller numbers of Israeli teenagers who refuse to enlist in the IDF altogether and those who have refused their reserve duty. Some high-school refusers declare themselves as “conscientious objectors”. They tend to do so out of ideological contempt for the IDF and in rejection of the Israeli occupation of Palestinians.

A 2021 refusal letter by a group of high school students spelled it out: “It is our duty to oppose this destructive reality by uniting our struggles and refusing to serve these violent systems – chief among them the military.”

As I discovered in my research on Israeli peace and anti-occupation activism, these teenagers tend to be dismissed as radical anarchists. Reservists who refuse to return to serve are also not well received by the majority of Israeli society, but they are given a degree of support and sympathy because they have already served in the IDF, thus fulfilling their national duty.

As one recent refuser wrote in an opinion piece in the New York Times, “refusing to serve is not betrayal of the state. Refusing is the only way to save it”.

Israel’s history of military ‘refuseniks’

The first significant wave of reservist refusal came with the outbreak of the first Lebanon war in 1982. Almost 3,000 reservists signed a petition stating that they did not join the Israeli Defense Forces to “solve the Palestinian problem by warfare”. Some 160 were jailed. A movement called Yesh Gvul (There is a Limit) emerged and has promoted subsequent waves of reservist refusal, and supported those who are imprisoned.

The movement encouraged selective refusal to serve in the Occupied Palestinian Territories in response to the Israeli army’s brutal repression of the first Palestinian uprising in 1987. As Israeli scholar, Benjamin Kidron, noted in his book Refusenik!, they marked a difference between “legitimate” duties of the IDF in defending Israel and “unacceptable” assignments in the occupied territories.

During the second Intifada, beginning in 2000, there was a further wave of selective refusal, with the reservists gaining some legitimacy by “speaking with the authority of having come directly from the field”.

Threats of refusal have also been used as leverage for other issues dominating Israeli society. At the height of the protests against the proposed judicial reforms in summer 2023, 1,000 elite Israeli combat pilots refused to serve until the reforms were abandoned. They cited the government’s plans as a threat to Israeli democracy.

With an increasing number of Israelis taking a public stand against the Israeli government, the wave of soldiers refusing to serve could affect the ability of Netanyahu to continue his assault on Gaza as planned. But as the past two years have shown, Netanyahu has not been persuaded by either domestic or international pressure to abandoned his war on Gaza. It is unlikely that he will change course now.

Leonie Fleischmann 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. Israel’s ‘refuseniks’: a growing number of soldiers are refusing to serve in Netanyahu’s war on Gaza – https://theconversation.com/israels-refuseniks-a-growing-number-of-soldiers-are-refusing-to-serve-in-netanyahus-war-on-gaza-264707

Source: The Conversation – UK – By Will Shüler, Vice-Dean of Education and Senior Lecturer, School of Performing and Digital Arts, Royal Holloway University of London

Currently playing to enthusiastic reviews at London’s Wyndham Theatre, Born With Teeth imagines a historic moment in playwriting in which Liz Duffy Adams illuminates how history can be presented from a queer perspective, while revealing precisely how a play actually functions.

Starring Edward Bluemel as the Bard and Ncuti Gatwa as his contemporary Christopher “Kit” Marlowe, Adams’ play imagines the process of the two co-authoring Henry VI Parts 1, 2 and 3 – which historically have always been attributed solely to Shakespeare.

As the programme note makes clear, linguistic analysis points to Marlowe very likely having contributed to these plays – though of course, there is no hard evidence for the conversations that take place in Adams’ Elizabethan writers’ room.

This imagined collaboration is more than professional, as the sultry poster for the play reveals. While Marlowe is widely thought to have been gay, Born With Teeth builds on the knowledge that Shakespeare was probably interested in both female and male affections. The play contributes to a long line of queer Shakespeare work, including most recently Will Todd’s history, Straight Acting: The Many Queer Lives of William Shakespeare.

Bluemel and Gatwa display a magnetic chemistry and engaging physical presence on stage. The two young actors lead the audience through a rollercoaster of emotion, prompting them to root for the pair to kiss, fight, shake hands and ultimately write a classic trilogy of plays.

By creating this possible past, the imagined sensual co-writing of the Henry VI plays contributes to a queer retelling of history. Queer lives and experiences have traditionally been subject to erasure by historians; imagined pasts are a way of answering this homophobic practice.

My research looks at how imagined narratives provide a way of understanding queer experience and questioning what is “normal”. To queer something in an academic sense means to question any notions of dominance, legitimacy and normality in society. By foregrounding the homoerotic aspects of Shakespeare and Marlowe’s lives, Born With Teeth challenges presumptions of a dominant version of history.

Alongside exploring queer lives, the process of collaborative writing, and the tense religious environment of Elizabethan England, Adams’ play is also about plays themselves. This is an example of “meta-theatricality” – an artistic device of calling attention to the performative nature of a production. Born with Teeth does a clever job of employing meta-theatricality in three ways.

The first instance occurs as Will and Kit discuss their approach to writing the history of King Henry VI. Will is keen to rely heavily on a historic account provided by English chronicler Rafael Holinshed. Marlowe, on the other hand, doesn’t want the truth to get in the way of a good story. Of course, what a historian writes is always a version of the truth (at best), but this early disagreement between the two wordsmiths cleverly functions as almost a prologue to the play.

Will and Kit’s dialogue about writing Henry VI tells the audience the play will not necessarily be providing an accurate history of events – that while this is a play about the past informed by historical accounts, it is nevertheless a piece of theatre whose function is to entertain and invite contemplation.

So any Shakespeare enthusiast ready to call into question the veracity of the play’s events is immediately put right by the very meta-theatricality of Will and Kit’s conversation.

A second example occurs as the arrogant Kit, disdainful of his lesser-known contemporary throughout, begins to acknowledge Will’s artistic talent. In particular, Kit finds it quite powerful that Will has a way of endearing his villains to the audience.

In many ways, this is exactly what is happening within Born With Teeth. Kit is obnoxious, lecherous, threatening and petulant. And yet, his pride becomes him. His flaws are winsome and undeniably charming. In the same way that Kit commends Will’s ability to craft a lovable baddie, he himself achieves by enchanting the audience.

The third and most subtle bit of meta-theatricality – attributable to both Adams and director, Daniel Evans – is the way the characters play to the crowd. During one of their many intellectual sparring matches, Kit critiques Will’s comedic pandering to the pleasures of the pit – the part of the theatre inhabited by “groundlings”, who paid the least to stand and watch the play. Again, this is an instance of Born With Teeth commenting on theatrical practice while employing it.

The play regularly makes Shakespearean references and in-jokes which garner knowing laughter from the audience. For example, when Will comes up with lines that end up in other Shakespeare plays, or mentions how Kit will inspire his King of Cats (Tybalt in Romeo and Juliet), the audience reaction demonstrates their understanding and appreciation of these in-the-know jokes.

One of the biggest laughs comes from dramatic irony, where the audience is aware of something that the characters are not. Kit analyses and critiques some of Will’s scenes, to which the Bard replies: “It’s not like people are studying my writing.”

Of course, the joke is that Shakespeare is indeed one of the most studied and appreciated writers of all time. And so the wink-wink, pandering humour that the play comments on, it also enacts. With its clever exploration of theatrical collaboration and queer desire, there is much to enjoy here. See Born With Teeth if you can.

Born with Teeth plays at the Wyndham Theatre until November 1.

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Will Shüler 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. Born With Teeth: queer imagining of Shakespeare and Marlowe tale is also a play about plays – https://theconversation.com/born-with-teeth-queer-imagining-of-shakespeare-and-marlowe-tale-is-also-a-play-about-plays-264061

Source: The Conversation – UK – By Mehmet Sebih Oruc, PhD Researcher in digital media and philosophy, Newcastle University

It feels like there are so many things constantly vying for our attention: the sharp buzz of the phone, the low hum of social media, the unrelenting flood of emails, the endless carousel of content.

It’s a familiar and almost universal ailment in our digital age. Our lives are punctuated by constant stimulation, and moments of real stillness – the kind where the mind wanders without a destination – have become rare.

Digital technologies permeate work, education, and intimacy. Not participating feels to many like nonexistence. But we tell ourselves that’s OK because platforms promise endless choice and self-expression, but this promise is deceptive. What appears as freedom masks a subtle coercion: distraction, visibility, and engagement are prescribed as obligations.

As someone who has spent years reading philosophy, I have been asking myself how to step out of this loop and try to think like great thinkers did in the past. A possible answer came from a thinker most people wouldn’t expect to help with our TikTok-era malaise: the German philosopher Martin Heidegger.

Heidegger argued that modern technology is not simply a collection of tools, but a way of revealing – a framework in which the world appears primarily as a resource, including the human body and mind, to be used for content. In the same way, platforms are also part of this resource, and one that shapes what appears, how it appears, and how we orient ourselves toward life.

Digital culture revolves around speed, visibility, algorithmic selection, and the compulsive generation of content. Life increasingly mirrors the logic of the feed: constantly updating, always “now” and allergic to slowness, silence and stillness.

What digital platforms take away is more than just our attention being “continuously partial” — they also limit the deeper kind of reflection that allows us to engage with life and ourselves fully. They make us lose the capacity to inhabit silence and confront the unfilled moment.

When moments of silence or emptiness arise, we instinctively look to others — not for real connection, but to fill the void with distraction. Heidegger calls this distraction “das man” or “they”: the social collective whose influence we unconsciously follow.

In this way, the “they” becomes a kind of ghostly refuge, offering comfort while quietly erasing our own sense of individuality. This “they” multiplies endlessly through likes, trends, and algorithmic virality. In fleeing from boredom together, the possibility of an authentic “I” disappears into the infinite deferral of collective mimicry.

Heidegger feared that under the dominance of technology, humanity might lose its capacity to relate to “being itself”. This “forgetting of being” is not merely an intellectual error but an existential poverty.

Today, it can be seen as the loss of depth — the eclipse of boredom, the erosion of interiority, the disappearance of silence. Where there is no boredom, there can be no reflection. Where there is no pause, there can be no real choice.

Heidegger’s “forgetting of being” now manifests as the loss of boredom itself. What we forfeit is the capacity for sustained reflection.

Boredom as a privileged mood

For Heidegger, profound boredom is not merely a psychological state but a privileged mood in which the everyday world begins to withdraw. In his 1929 to 1930 lecture course The Fundamental Concepts of Metaphysics, he describes boredom as a fundamental attunement through which beings no longer “speak” to us, revealing the nothingness at the heart of being itself.

“Profound boredom removes all things and men and oneself along with it into a remarkable indifference. This boredom reveals beings as a whole.”

Boredom is not absence but a threshold — a condition for thinking, wonder, and the emergence of meaning.

The loss of profound boredom mirrors the broader collapse of existential depth into surface. Once a portal to being, boredom is now treated as a design flaw, patched with entertainment and distraction.

Never allowing ourselves to be bored is equivalent to never allowing ourselves to be as we are. As Heidegger insists, only in the totality of profound boredom do we come face to face with beings as a whole. When we flee boredom, we escape ourselves. At least, we try to.

The problem is not that boredom strikes too often, but that it is never allowed to fully arrive. Boredom, which has paradoxically seen a rise in countries drowning in technology like the US, is shameful. It is treated like an illness almost. We avoid it, hate it, fear it.

Digital life and its many platforms offer streams of micro-distractions that prevent immersion into this more primitive attunement. Restlessness is redirected into scrolling, which, instead of meaningful reflection, produces only more scrolling. What disappears with boredom is not leisure, but metaphysical access — the silence in which the world might speak, and one might hear.

In this light, rediscovering boredom is not about idle time, it is about reclaiming the conditions for thought, depth, and authenticity. It is a quiet resistance to the pervasive logic of digital life, an opening to the full presence of being, and a reminder that the pause, the unstructured moment, and the still passage are not failures – they are essential.

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Mehmet Sebih Oruc 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. Put down your phone and engage in boredom – how philosophy can help with digital overload – https://theconversation.com/put-down-your-phone-and-engage-in-boredom-how-philosophy-can-help-with-digital-overload-262396