Jakob von Uexküll was a Baltic German biologist ahead of his time, intrigued by the idea that animals inhabit unique perceptual worlds quite unlike our own. In 1934, he described angling for flies by swinging an adhesive-covered pea on a thread, finding that male flies would dive on the pea and be caught. Within the perceptual world of a fly, the swinging pea was a potential mate.
We can’t be exactly sure what a fly’s perceptual world looks like, but we know it must be very different to our own. And learning about it can do much more than satisfy our curiosity. It could help keep people safe from disease.
While a human eye has only one lens, the main eyes of flies are compound eyes that each consist of hundreds or thousands of individual lenses. A fruit fly eye has about 700, and a blowfly eye 5,000. Each of these lenses is part of a sampling unit called an ommatidium, which also contains eight light-sensitive photoreceptor cells.
The structure of the compound eye affects a fly’s ability to make out shapes and patterns. In houseflies, light from a given point in its field of view activates seven photoreceptors in seven separate ommatidia through their respective lenses. Combined, that information is a bit like an image pixel.
Information about shape and pattern is generated when the visual system compares neighbouring “pixels”. The arrangement of lenses in the compound eye limits the minimum size of a “pixel” and thus a fly’s ability to make out spatial details.
As a result, a fly can only resolve relatively coarse spatial detail. If a housefly and a human with 20/20 vision were taking an eyesight test, the fly would need to be about 6cm from the chart to make out the detail that the human could at six metres. For the fly to achieve human-like spatial resolution, it would need larger lenses and a flatter eye, resulting in a compound eye about one metre in diameter.
This lack of spatial acuity is compensated for with speed. Some fly species’ photoreceptors respond much faster than human photoreceptors. This is true of day-active flies which have faster-responding photoreceptors than their more ponderous, nocturnal kin. For us, a flashing light blurs into a constant one at 50-90 flashes per second, but a blowfly’s photoreceptors can distinguish more than 200 separate flashes per second. Thus, we perceive motion in the fast sequence of static images comprising a cartoon, but a fly might not be fooled.
Given this, it’s no wonder that swatting an irritating fly can be a challenge.
When a scientist from Florida tried to photograph resting long-legged flies, he found that the flies were generally in flight, potentially startled by the flash, before the image was even captured.
Saying this, some fly eyes are specially adapted for both spatial and temporal detail. Male flies of many species have eyes that meet at the top and front of the head, whilst those of females have an obvious gap. The extra region of the male eye is the “love spot”, with larger lenses and faster-responding photoreceptors that give improved sensitivity to small and fast-moving objects needed for tracking females during high-speed airborne courtship chases.
Killer fly relatives of the humble housefly are also adapted for great visual prowess, here needed to catch small insect prey like fruit flies mid-flight.
Most people don’t consider perception as they try to shoo an annoying fly out of an open window, or whack it with a newspaper. However, understanding insect perception can inspire new ways of controlling pests, as von Uexküll’s fly “fishing rod” demonstrated. This is important because lots of flies transmit disease, so we need to control flies to prevent sickness in humans and animals.
Perception of colour is important in this context. The human retina has three kinds of cone photoreceptors sensitive to blue, green and red light, and our brains compare those three signals to create colour perceptions. By contrast, a typical housefly ommatidium has five types of photoreceptors including a couple sensitive to UV, but none that are particularly sensitive to red light.
In Africa, tsetse flies spread sleeping sickness, which has profound effects on the central nervous system that upset the sleep/wake cycle, cause confusion and sensory disturbances, and ultimately lead to death without treatment.
Coloured fabric targets doused with insecticide are often used to control tsetse flies and protect humans and animals, and normally these targets are blue. However, we modelled fly colour perception to develop a better colour for luring flies, which turned out to be purple to a human eye. We recently found that this colour attracts stable flies and houseflies as well, which are also vectors of human and animal disease.
In urban settings, we are combining colour and spatial vision models to understand how to better manage flies in these environments. A particular challenge is that artificial lighting is designed for human vision, and lacks UV wavelengths that flies are sensitive to. This gives the light an entirely different colour from their point of view, and potentially prevents flies from differentiating between colours that they otherwise would under natural lighting.
By delving into the fly’s perceptual world, we hope we can better understand their behaviour, and devise new methods to control them.
Roger Santer has received funding from the Global Challenges Research Fund delivered through the Higher Education Funding Council for Wales and distributed via the Centre for International Development Research at Aberystwyth. He has also benefitted from funding from the Biotechnology and Biological Sciences Research Council to Aberystwyth University.
Matt Sparks receives funding from a PhD studentship through an EPSRC UKRI Doctoral Training Partnership between Swansea University and Rentokil Initial under the name ‘Characterisation and manipulation of urban light environments for fly control’.
Being slightly overweight might not shorten your life, but being very thin might. A large Danish study tracking more than 85,000 adults has found that people with a BMI below 18.5 were nearly three times more likely to die early than those in the middle to upper end of the so-called “healthy” range.
The link between body weight and health is more complicated than often assumed. This new research, which is yet to be peer reviewed, suggests that the lowest risk of death may not sit neatly in the traditional “healthy” body mass index (BMI) range.
Instead, the findings suggest that people with BMIs that would normally be classed as “overweight” appear to have outcomes that are just as good as, or even better than, those with lower BMIs.
Researchers found a U-shaped curve when plotting BMI against mortality, meaning those with the lowest and highest BMIs were at the highest risk of death.
In the data, presented as a conference paper at the Annual Meeting of the European Association for the Study of Diabetes, being underweight carried the greatest danger. People with a BMI below 18.5 were nearly three times more likely to die prematurely than those with a BMI between 22.5 and 24.9.
Those at the lower end of the “healthy” range also faced higher risks, with BMIs between 18.5 and 19.9 doubling the likelihood of death. Even people with BMIs between 20 and 22.4 were at a 27% higher risk of an early death compared with the reference group. These findings seem surprising, given that the BMI range of 18.5 and 24.9 is usually considered optimal.
At the other end of the scale, carrying extra weight did not always translate into greater risk. In the study, people with BMIs between 25 and 35 (typically categorised as “overweight” or “obese”) showed no significant increase in mortality compared with the reference group.
Only those with a BMI of 40 or more saw their risk of death rise substantially, more than doubling (2.1 times).
Having some fat reserves can help the body cope with illness. For example, patients undergoing cancer treatments, such as chemotherapy, tend to lose weight due to factors such as appetite loss and changes to taste.
Those with more fat reserves at the start can draw on them, helping their bodies continue essential functions. In contrast, someone with very little fat may run out of reserves quickly, limiting their body’s ability to recover.
Unintentional weight loss is also often a warning sign of illness, with conditions such as cancer and type 1 diabetes often resulting in weight loss before diagnosis. This means a low BMI can sometimes be a marker of underlying disease.
Not surprising
Following on from the researchers’ conference paper, there have been headlines such as: Being too thin can be deadlier than being overweight, Danish study reveals. That might sound surprising, but it shouldn’t. We need food to survive, and without it, we will die. We know this, and have known this for hundreds, if not thousands of years.
Without food, the body enters a catabolic state, where it breaks down tissues to get the energy needed to keep the brain functioning. In this process, other important body functions, such as immune function, are put on hold to prioritise energy for the brain.
It is worth noting that the Danish participants in this study had all undergone body scans for health reasons. These scans are costly, so they are usually carried out for a good reason – when a health issue is suspected.
The researchers acknowledge that a possible reason for their findings is that participants could be losing weight due to an underlying illness, and so it could be the illness itself, rather than the associated weight loss that is increasing the risk of death.
Still, the findings reinforce what other research has suggested: thinness is not always protective, and extra weight is not always harmful. The concept that you can be “fat but fit” continues to gain scientific backing.
Does this mean the “healthy” BMI range should be revised upward? The researchers suggest this, saying that modern medical advances, which help people manage obesity-related conditions such as diabetes and heart disease, could be shifting the safest weight range higher than before. A BMI between 22.5 and 30 may now carry the lowest risk of death, at least in the Danish population studied.
The trouble is, BMI has always been a blunt tool, as I have previously argued. It doesn’t take into account important factors for health, such as diet, lifestyle, and fat distribution, among others.
BMI can be misleading for people from different racial, ethnic, or cultural backgrounds. Critics say the standard cutoffs are based on white body types, which can make perfectly healthy bodies from other groups seem “unhealthy”.
Indeed, BMI was developed nearly two centuries ago using data from a small sample of white, European men. Although some efforts have been made to adapt ranges for certain ethnic groups, for example, NHS guidance lowers the BMI thresholds for increased risk of diabetes in Asian and black groups, BMI still fails to account for differences in body composition, fat distribution and baseline risk among individuals in our diverse society.
When significant healthcare decisions – such as access to fertility treatments and certain surgeries – are based on BMI, we should expect it to be an accurate and fair measure, developed and validated in populations that truly represent the people it is applied to.
In an ideal world, healthcare professionals would have access to more detailed measures such as blood tests, imaging scans, and detailed lifestyle information. These are costly and time consuming, but they reveal much more than a height-to-weight ratio ever can. Until better measures are widely available, BMI will continue to be used, but studies like this underline the need to refine how it is interpreted.
The Danish data is still preliminary. More details and further research will be needed before drawing firm conclusions. But the headline message stands: being very thin is dangerous, and carrying some extra weight may not shorten life. The real lesson is not that thin is bad and fat is good, but that BMI alone is a fragile measure of health.
Rachel Woods 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.
Source: The Conversation – UK – By Stephen Clear, Lecturer in Constitutional and Administrative Law, and Public Procurement, Bangor University
The US president and first lady, at the king’s invitation, are on a state visit to the UK and will stay at Windsor castle. The event is laden with ceremony and glitz, but it also carries great political potential – for the host nation in particular.
Formal visits by foreign heads of state are generally aimed at strengthening international relationships. The invitation for this visit was handed to Donald Trump in the Oval Office, on camera, by Keir Starmer at a time when the British prime minister was seeking to act as the bridge between the US and Europe over the war in Ukraine.
While many countries have state visits, their ceremonial style varies. In the US, ceremonial honours usually involve arrival on the White House south lawn, accompanied by a military band, 21-gun salute and then a state dinner. But it is the scale and grandeur of the UK’s carriage processions, state banquets, speeches in parliament and military pageantry, tied to the monarchy’s long history, which make them a powerful diplomatic tool for the UK. Trump has made no secret of his delight at being invited for an unprecedented second state visit.
Trump’s praise of the royal family is testament to the soft power at work here. An offer of an audience with the king can deepen diplomatic ties. In this instance, it’s a powerful tool for enhancing the UK-US relationship at a time when this is a priority for Britain.
How state visits work
In the UK, the procedures surrounding state visits are guided by conventions (traditions) and protocols. The prerogative – the government’s residue discretionary power – also comes into play.
The formal invitation for a UK state visit is issued in the name of the king, as head of state. However, in practice, the decision as to who receives them is usually based on another country firstly expressing an interest, and then the UK government offering ministerial advice to the king to extend an invitation. This advice usually comes from the foreign secretary in conjunction with the prime minister, as part of their prerogative powers surrounding foreign relations.
Once an invitation is issued, the Foreign, Commonwealth and Development Office, together with the royal household, will set the agenda for ceremonies, banquets, guards of honour and meetings with the king and prime minister.
Having arrived in London on Tuesday, September 16, Trump will spend Wednesday at Windsor castle with the royal family and attend a state banquet in the evening. He will leave on Thursday for Chequers, the prime minister’s country residence, where the two will hold a bilateral meeting.
Diplomatic immunity, costs and threat levels
To facilitate secure visits, the State Immunity Act 1978 affords heads of state the same privileges as are applied to the heads of diplomatic missions. The visits are further underpinned by customary international sources such as the Vienna Convention on Diplomatic Relations of 1961. While these do not make explicit reference to state visits, they establish practices surrounding immunities and the treatment of heads of state in the discharge of their public duties.
In reality, hosting the US president means the UK has to manage a high threat level – which also means paying a lot, mostly for security and policing. Trump’s last state visit in 2019 cost £3.9 million.
But state visits bring reward as well as expenditure. These are not just opportunities for ceremony: meetings take place around the pomp, and there are always vigorous diplomatic efforts to reach agreements that can be announced while leaders are delivering speeches during the visit.
Even before Trump had touched down, it had been announced that Google would invest £5 billion in artificial intelligence in the UK over the next two years. More announcements of this kind can be expected to follow.
This will go some way to meeting a call from the UK parliament’s Business and Trade Committee for Starmer to apply “maximum pressure” on Trump to secure a trade and technology alliance to rival China. Starmer will also be hoping to negotiate on tariffs during the Chequers meeting on Thursday.
What the king does
The UK is a constitutional monarchy, meaning the king’s powers are limited by law, and are largely used by the UK government rather than the royal family. While the king is able to “advise and warn”, decisions are ultimately taken by the government. In that sense, the king reigns, but does not rule.
Nonetheless, the monarchy is very useful in delicate diplomatic situations. Wielding significant soft power in international diplomacy and serving as a visible symbol of stability and continuity on the global stage as head of the Commonwealth, the king can promote shared values and cooperation across borders.
His role in awarding honours, celebrating the voluntary and charitable sector, and delivering speeches often makes him synonymous with officially recognising success and excellence. The demands made of the monarchy to remain politically neutral on all matters can lead to them being seen as a unifying force.
It is noteworthy that even during moments of intense geopolitical tension, such as after the Russian invasion of Ukraine in 2022 when significant economic sanctions were being placed on Russia by the UK, the Russian president, Vladimir Putin, still offered condolences to the new king upon the death of Queen Elizabeth II – describing it as a “heavy, irreparable loss” of an “authority on the world stage”.
In this context, the king’s capacity to act as a bridge in diplomacy is an asset. Starmer will be hoping that the cost of hosting this second state visit will translate into tangible outcomes for the UK.
Stephen Clear 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.
Being diagnosed with a serious mental illness like schizophrenia or bipolar disorder often brings an overlooked challenge: rapid and sustained weight gain. This side-effect can raise the risk of diabetes, heart disease and early death – widening an already stark life expectancy gap.
A new study my colleagues and I conducted, published in The Lancet Psychiatry, is the largest and longest to track these changes in real-world settings. Analysing GP health records of over 113,000 adults in the UK between 1998 and 2020, we found that weight gain is not only common but predictable.
A 39-year-old newly diagnosed with schizophrenia or bipolar disorder can expect to gain 2kg in the first year and roughly 5kg within five years. Fifteen years on, the average increase is about 5.5kg. In comparison, people of the same age and gender without serious mental illness gained barely 1.5kg over the same period, on average.
Initially, we wondered if some early weight gain might reflect recovery – a bounce-back effect. People typically regain their appetite after a period of acute illness once they begin treatment. But in our study, most people were already overweight at diagnosis, and then gained enough weight to become obese over time. That shows the rise is a sustained, long-term increase, not a rebound related to recovery.
These patterns are not just statistical quirks; they reflect well-known physiological and social factors. Antipsychotics can trigger metabolic and appetite changes, and most people with a serious mental illness take these medications. In our study, people taking antipsychotics showed the greatest weight gain, an average of 5.9kg over 15 years.
But people who had never been prescribed them still gained substantial weight, averaging 2.5kg over the same period. Other factors also play a role, from social isolation and poverty to poor access to healthy food, exercise and regular routines – but our study could not monitor them because this data is not held in GP records.
We also examined whether people were getting help to lose weight. People with schizophrenia or bipolar disorder who were overweight or obese were around 10% more likely than the average overweight or obese person to be told to lose weight. Yet, despite their much higher risk of diabetes and heart disease, they were no more likely to be offered a place on a weight-loss programme. Only 4.5% had any record of a referral, compared with about 3% of people without mental illness.
The people most at risk of chronic conditions like diabetes and heart disease are being warned to lose weight, but not given help to do so. Community weight-loss groups can be effective – but without a referral, many people don’t know they exist or can’t get to them.
Mental health staff often have to focus on immediate psychiatric care: managing crises, stabilising symptoms, and keeping people safe. That leaves little scope for preventive physical healthcare. Meanwhile, in GP practices, staff may feel unsure how to approach weight loss with people who have complex mental health needs.
The result is a gap between policy and practice. National plans like the government’s recently launched 10-Year Health Plan for England emphasise cardiovascular prevention for people with serious mental illness, but in everyday care many still slip through the cracks. This is not a uniquely British problem; health systems worldwide are struggling to deliver integrated physical and mental healthcare.
What needs to change
This pattern is not inevitable. Weight gain after a diagnosis of serious mental illness is predictable, measurable and, with the right action, preventable.
Our findings show that the years immediately after diagnosis are a critical window to act. Intervening within the first five years could reduce the risk of long-term obesity, diabetes and heart disease, improve quality of life, and narrow the life expectancy gap. It could also ease the strain on health systems already crumbling under rising rates of chronic disease.
Despite this potential, the common belief that people with schizophrenia or bipolar disorder cannot lose weight persists, and it is wrong. Effective support means intervening early with evidence-based care and regular follow-ups. Community weight-loss groups should fit the person, adapting to their changing mental health, medication side-effects, and everyday difficulties like getting to appointments.
People with mental illnesses deserve the same chance of good physical health as everyone else. If potential benefits are to be realised, primary care and mental health services must check weight at diagnosis, and refer patients with schizophrenia or bipolar disorder to tailored weight-loss programmes before rapid gains set in. This is essential to delivering on the ambitions of national plans for cardiovascular prevention in our most underserved communities.
Charlotte Lee 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.
Source: The Conversation – UK – By Alexandra Consterdine, Senior Lecturer in Sociology of Sport, Exercise and Health, Liverpool John Moores University
Olympic swimmer Ben Proud has become the first British athlete to join the Enhanced Games – a controversial new event that allows athletes from all over the world to compete using performance-enhancing drugs. The prize money on offer can hit US$1 million (£730,000). But the swimmer, who won a silver medal at last year’s Paris Olympics, has sparked sharp criticism from sporting bodies after announcing he would be taking part.
In essence, Proud’s decision challenges the core values of fair play and athlete safety. While he frames it as a pursuit of human potential, motivated by financial reward, critics argue it undermines clean sport, poses health risks and is very likely to damage his legacy.
It also leaves him unable to compete in future Olympic Games and raises questions about his suitability to receive public funding.
The Enhanced Games will debut in Las Vegas in May 2026. The event offers prizes of US$250,000 per event and US$1 million for breaking the world record. It was created as an alternative to sport controlled by the International Olympic Committee, with athletes being permitted to use substances approved by the US Food and Drug Administration (FDA). These could include steroids, testosterone and growth hormones.
Athletes will compete in swimming (50m and 100m freestyle, 50m and 100m butterfly), athletic events (100m sprint, 100m/110m hurdles) and weightlifting (snatch, clean and jerk). So far, five elite-level swimmers have signed up, including four-time world champion Megan Romano. She is the first American and the first woman to commit. Australian Olympic swimmer James Magnussen has indicated that he will come out of retirement to compete in the 50m freestyle.
The event has had to look to alternative sources for funding. International venture capitalists and private investors have provided a multimillion-dollar investment into the project – reportedly Peter Thiel (co-founder of PayPal) and German entrepreneur Christian Angermayer are among those backing the project.
But outside the world of venture capitalism, the World Anti-Doping Agency (Wada) has labelled the Enhanced Games “dangerous and irresponsible”. The governing bodies Aquatics GB and UK Sport have condemned Proud’s decision.
As well as his Olympic success, Proud is also a former world and European champion in the 50m freestyle. So you might think he has little left to prove. But in an interview, the swimmer said his goal is to test the limits of human potential, and become the fastest man on the planet.
But, of course, the question of money is looming large. Proud has also admitted that this played a major part in his decision. Elite-level swimming, compared to sports like men’s football, rugby and tennis, does not offer big financial wins for athletes.
Proud claimed that prize money of US$250,000 would take “13 years of winning world championship titles” to earn. A gold medal at the world championships in 2025 would have earned a swimmer US$20,000 at most.
Inequality in sport
Within sport, there are deep divisions in terms of how it is financed and supported, with variations in sponsorship, commercial investment and viewing figures. At the high-performance level, this inequality is most keenly felt in minority sports such as swimming, where even highly successful athletes struggle for financial rewards.
In fact, the British Elite Athletes Association (the independent representative body) has warned that the majority of athletes funded by the World Class Programme from UK Sport will not be able to afford to stay in their sport until the 2028 Los Angeles Olympics without a funding increase.
According to a survey done by the association last year, two thirds of the 87 respondents who travelled to Paris in 2024 said they would be forced to quit before 2028. This could put British sport in a precarious situation with potentially serious ramifications.
It would mean that the number of athletes representing the UK would fall, with consequences for the longevity of sports programmes, community initiatives and grassroots schemes to get people more active. At a time of rising obesity levels, sedentary lives and declining health, the UK cannot ignore the positive effects of getting more exercise, bolstered by sporting role models.
So while it could earn him serious prize money, Proud’s decision is a direct challenge to clean sport values. And it risks normalising drug use in sport, undermining decades of anti-doping efforts. Experts have defined clean sport as being free of “drugs and other forms of artificial enhancements”.
What’s more, it pits athlete autonomy against their responsibility to the public. There is a tension between Proud’s decision to test his limits and the responsibilities he has as a role model – and a recipient of public funding.
And the health risks of performance-enhancing drugs is a problem. Even if FDA-approved, the use of otherwise-banned substances in competitive sport introduces unknown long-term health consequences, especially when used in extreme training environments.
This highlights the inherent contradiction of sport as a desirable, healthy activity, while at the same time promoting potentially dangerous practices.
And the impact on an athlete’s legacy and reputation cannot be overstated. Proud’s Olympic achievements are now likely to be overshadowed by his association with a movement widely condemned by sporting bodies. Regardless of his success at the Enhanced Games, his presence there could shut him out of the many opportunities that sporting heroes can enjoy long after they’ve retired.
Alexandra Consterdine 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.
Source: The Conversation – UK – By Siobhan Keenan, Professor of Shakespeare and Renaissance Literature, De Montfort University
How did Shakespeare become the world’s greatest playwright? It’s a question that has long fascinated scholars and fans alike. My latest research suggests that one answer lies in the Bard’s close collaboration with his leading man, Richard Burbage.
Their partnership lasted more than 25 years, and as my new book, Richard Burbage and the Shakespearean Stage, reveals, the creative chemistry between writer and actor transformed their art and elevated their respective profiles – a bit like an Elizabethan Martin Scorsese and Robert De Niro.
Shakespeare and Burbage’s careers likely started in the 1580s. But the first time we hear of them being members of the same acting company is in 1595.
In March that year, the pair was paid £20 (about £8k today) alongside the famous Elizabethan clown, Will Kemp, for performing two plays at court before Queen Elizabeth I with a troupe known as the Lord Chamberlain’s Men (named after the lord chamberlain, Henry Carey). At this stage, Shakespeare and Burbage were newcomers on the flourishing Elizabethan theatrical scene. But they soon made their mark.
By the turn of the century the Lord Chamberlain’s Men had moved to the legendary Globe theatre, and the pair had become famous. Shakespeare was being praised by contemporaries as “the most excellent” writer of comedies and tragedies in English, while Burbage had become the Elizabethan stage’s newest star, with a breakout performance as Shakespeare’s witty and wicked tragic hero, Richard III.
One fan apparently admired Burbage’s Richard III so much that she even arranged a secret off-stage rendezvous with him, only for Shakespeare to get there first, sending word to Burbage that William the Conqueror was before Richard III – or so claimed gossipy lawyer John Manningham in 1602.
There aren’t any contemporary reviews of Burbage’s Richard III, or his other early performances, but we know that he was especially admired for his versatility and the authenticity of his acting.
This included an ability to portray powerful emotions convincingly and to immerse himself in his roles completely, “putting off himself with his Clothes” as contemporary Richard Flecknoe put it in 1664 – like an early modern Daniel Day-Lewis. These qualities were to prove a source of powerful inspiration to Burbage’s fellow actor and company playwright, Shakespeare.
Writing for Burbage
When Shakespeare became a member of the Lord Chamberlain’s players, it marked a significant new phase in his career as an actor and writer. For perhaps the first time, he found himself writing regularly for the same group of players – a position he would enjoy for the rest of his career.
It’s not surprising that he started to tailor his plays for the men and boys he knew would act in them. Sometimes he even mistakenly wrote their names instead of their characters’ names in his scripts.
But in Burbage’s case the collaboration proved an especially rich and enduring one, the mutual talents of writer and actor inspiring the creation of a series of memorably complex and believable tragic heroes of a kind not seen not known before on the English stage.
These range from tragic kings, such as King Lear and Macbeth, to murderously jealous husbands, such as Othello and Leontes (A Winter’s Tale). They also include roles shaped by another of Burbage’s talents – the ability to feign madness convincingly. The most famous example of this is Hamlet.
The story was not new when Shakespeare created his updated Hamlet play around 1601, probably a star vehicle for Burbage. The role is famously demanding in length – 1,338 lines in the edition published in 1604. It also requires incredible versatility in its performer, who must play several roles in one: grieving son, bereft lover and revenger.
Perhaps most memorably of all, Hamlet must put on an “antic” or mad disposition, as he seeks to conceal his plans of revenge from Claudius, the uncle who murdered his father and married his mother.
Hamlet’s feigned madness can be found in Shakespeare’s source, but Shakespeare’s late Elizabethan reworking of the play gives more room to Hamlet’s performance of madness – including his sudden changes in speech and behaviour – and it creates more uncertainty about whether the madness remains a performance or becomes the real thing in the character.
Implicitly, Shakespeare made these changes influenced by his experience of working with Burbage and to give his star more room to show off his versatility and his aptitude for playing men who had gone mad. The result was a hit for both: Hamlet became one of Shakespeare’s most famous plays and its hero one of Burbage’s most memorable roles.
For many years, the conversation about Shakespeare’s authorship has focused on his work with other playwrights. But Burbage also helped shape Shakespeare’s plays, and his role in the Bard’s creative process deserves more recognition.
Siobhan Keenan received funding from the Society for Theatre Research.
The Middle East is experiencing a period of intense political and economic turbulence, with several countries in the region embroiled in conflict. These conflicts are taking place against the backdrop of an escalating climate crisis.
In 2023, global thinktank the Carnegie Endowment for International Peace concluded that Middle Eastern countries “are among the world’s most exposed states to the accelerating impacts of human-caused climate change – including soaring heatwaves, declining precipitation, extended droughts, more intense sandstorms and floods, and rising sea levels”.
The capacity of a society to receive, process and act upon climate-related information is at the heart of an effective climate change response. Media plays an important role: it is central to advancing public understanding of climate change and its connection to individual, communal and national security.
Yet over the past two decades or so, media coverage of climate change in the Middle East has been among the lowest in the world. According to the University of Colorado Boulder’s Media and Climate Change Observatory, media organisations in the Middle East each produced an average of around one article about climate change in August 2025 – compared with 66 articles for North American media in the same month.
Wars and climate change are inextricably linked. Climate change can increase the likelihood of violent conflict by intensifying resource scarcity and displacement, while conflict itself accelerates environmental damage. This article is part of a series, War on climate, which explores the relationship between climate issues and global conflicts.
The lack of climate coverage in the Middle East is because media outlets there face a number of structural problems. How does one talk about climate change when armed conflicts are spiralling out of control, or when public discourse is monopolised by what are perceived to be more pressing issues?
Jordan presents a useful example to help us understand these challenges and how to overcome them.
Media in Jordan
Jordan has long played a stabilising role in the Middle East. It has accepted large numbers of refugees from neighbouring conflicts and has acted as a mediator and peace broker between Middle Eastern rivals. However, climate change is threatening Jordan’s stability.
Raed Abu Soud, Jordan’s minister of water and irrigation, said in May 2025: “Jordan is grappling with one of the most severe water crises in the world, with per-capita water availability dropping to just 60 cubic metres per year.”
A host of other factors are worsening the situation. Economic underdevelopment in Jordan is leading to persistent unemployment and public unrest, while regional conflicts are undermining social cohesion.
How Jordan responds to the risks presented by climate change, and preserves its stability, is extremely important for the Middle East and beyond. Public understanding of this challenge is going to be pivotal to an effective response. And here enters the role of media.
Our research on climate change in Jordan has involved analysing more than 2,500 news articles in the country’s major print media and carrying out extensive interviews with local people. We have found that, while climate change is becoming a more important topic in the country, there are still many barriers preventing a coherent climate change discussion there.
It is common in Jordan, as in many other countries affected by conflict, for conversations related to climate change to be pushed to the background when other crises emerge. Since 2023, when the war in Gaza began, Jordanian media outlets have understandably been drawn to covering the humanitarian crisis there at the expense of climate change.
This has been exacerbated by the fact there are very few journalists in Jordan who work consistently on climate-related issues and can offer accurate and timely coverage. The shortage of climate journalists is a common problem across the Middle East.
When climate change is covered by Jordanian media, it is often discussed as a secondary consideration relative to geopolitical threats – not as a challenge in its own right. Due to the country’s policy of hosting refugees, Jordanian media outlets have often portrayed their country as a “second victim” of the civil war in Syria and the intractable Israel-Palestine conflict. Refugees are depicted as another strain on scarce resources.
Climate change discourse in Jordan tends to be heavily influenced by international partners including foreign governments, charities and funding bodies.
There are numerous externally funded educational and vocational courses focused on climate change available in Jordan for various audiences, including media professionals. While this facilitates the advancement of climate change discussions, it can distance climate coverage from the local context and knowledge. This is particularly true if external partners merely “teach” Jordanians what they believe is necessary, without fully understanding the specific challenges Jordan faces.
It can also erode trust between Jordanians and these foreign partners. In some of the cases we studied, journalists in Jordan saw climate change as part of a western-imposed agenda aimed at controlling developing countries.
Jordan is highly important for the Middle East, Europe and beyond. Without effective climate adaptation, it risks losing its role as a refugee haven and regional stabiliser.
Media can play a vital role in advancing climate change discourse in the Middle East, both by holding governments to account and raising awareness of climate issues. Some studies suggest that public concern correlates with the volume of media coverage, and attention can fade when other issues dominate the media space.
Sustained, inclusive coverage is essential to ensure long-term engagement and informed public participation in climate action, even during times of political and economic turbulence.
Marianna Poberezhskaya received funding for the associated research project from the Climate Social Science Network.
Imad El-Anis receives funding from the Council for British Research in the Levant and the Climate Social Science Network.
Marwa Mustafa received funding from Climate Social Science Network.
At the end of our conversation, Nathan (a pseudonym) kept repeating, almost to himself: “Perhaps we should have done more. Perhaps we could have done more. Perhaps there was something we could have done about the camp itself. About the dogs. We kept on hearing the dogs. Every night.”
Nathan, a senior surgeon in one of Israel’s bigger hospitals, was talking about the Sde Teiman camp, an army camp in the Negev desert in southern Israel which, following the October 7 2023 attack on Israel, was turned into a holding facility for detainees from Gaza.
Initially, this camp served to imprison members of the Nukhba force, the Hamas unit which led the massacre in southern Israel. But since then, and throughout Israel’s subsequent assault on Gaza, Sde Teiman has been a “black site” in which Palestinians captured by the Israeli army inside Gaza were held, including many who say they were not involved in the fighting.
Nathan never stepped foot in the camp. But he was one of a small number of Israeli doctors who volunteered to work in a medical facility which operated next to it, where some of the most badly injured detainees from Sde Teiman received medical treatment. This facility was set up after many Israeli hospitals refused to admit anyone suspected of taking part in the October 7 massacre, many of whom were severely injured.
Nathan’s decision to serve in this facility was not a simple one, he explained to us. While he had no reservations about treating detainees from the camp, and saw it as his duty as a doctor to treat patients no matter who they were (especially if no one else would treat them), his work at Sde Teiman’s medical facility – which he has kept secret from family and colleagues – continues to haunt him. “Ultimately,” he said, “it made me into a war criminal.”
The Insights section is committed to high-quality longform journalism. Our editors work with academics from many different backgrounds who are tackling a wide range of societal and scientific challenges.
We interviewed Nathan for a book we have been writing on torture in Israel. In our research, conducted over the past five years with the Israeli human rights organisation, the Public Committee against Torture in Israel (Pcati), we investigated the extent to which healthcare systems and other civic institutions have become complicit in the processes of torture that have become more widespread and brutal since the October 7 attacks.
After harrowing accounts also began to emerge from the medical facility, we set out to investigate it. Stories from this facility told of patients held in humiliating and degrading conditions, of sub-standard medical care leading to medical complications (including unnecessary amputations due to constant handcuffing), and of patients dying due to neglect.
Nathan, and two other doctors we interviewed who worked there, provide new insights into the conditions inside the medical facility – and more generally, the conduct of the Israeli healthcare system in the wake of the October 7 attacks. Their stories allow us to see, as they all made clear in various ways, how even people with the best intentions can become complicit in war crimes.
‘They were all in unbearable pain’
Shortly after the October 7 2023 attacks, Nathan got a call from the Israeli Ministry of Health asking him if he would be willing to treat some of those who had committed the atrocities. The ministry approached a small number of doctors after many Israeli hospitals and some doctors had refused to treat people widely regarded in Israel as savage terrorists.
Doctors have an ethical obligation to care for all patients, regardless of who they are or what they have done. Indeed, the Israeli healthcare system had prided itself on its long record of treating all patients equally, including enemycombatants, suicide bombers and Hamas leaders. But after the October 7 attacks, for reasons we explore below, hospitals started turning such patients away.
The medical facility at Sde Teiman was set up so detainees held in the main camp could receive medical treatment without having to be admitted to public hospitals. Recalling the first time he visited the facility, Nathan told us: “I had no idea where I was going or what to expect.” He did not expect it to be anything but a temporary fix – and certainly did not imagine himself working there for many months.
BBC News report on treatment of prisoners in the Sde Teiman detention centre, August 2024.
In the first few weeks, without adequate equipment, suitable medications, a functioning logistical apparatus and even a proper institutional affiliation, the doctors had to improvise and rely on their resourcefulness. “By the end, this facility was well-equipped compared to a field hospital … But the point is,” Nathan insisted, “a field hospital should be temporary; you cannot really perform operations in a tent in the middle of the desert.”
When we met at the end of 2024, Nathan was not at ease and seemed very worried. Several times during our conversation, he told us that “no one can know who Nathan is”. Seeing how concerned he was at being exposed, we were surprised he had agreed to be interviewed at all. But unknown to us, a few days before we contacted him, he had attended a public talk we gave about our research on torture being conducted by Israel. This is probably why, when we reached out, he immediately agreed to meet us.
In addition to Nathan and the two other doctors who worked in the facility, we also interviewed others who were involved in its operation in some way: two members of the Israel Medical Association’s ethics board, a medical ethics expert who advised doctors working in the Sde Teiman facility, and human rights practitioners who investigated it. We also interviewed medical staff and healthcare professionals from seven of Israel’s largest hospitals, as well as several Israeli government officials working in the healthcare system and Ministry of Justice.
While most interviewees spoke under condition of anonymity, Nathan was particularly guarded. He was mostly scared that he or his family would be targeted by rightwing Israeli activists if they knew he had treated “terrorists”. But he was also concerned about his colleagues’ reactions – even his direct line manager had no idea what he had been doing, beyond that he had been called up for military reserve duty.
Furthermore, Nathan wanted to protect himself from criticism from members of the leftwing community who saw anyone involved with the Sde Teiman facility as a war criminal. Yet it was clear that he too saw the very existence of the medical facility as a crime – even though he always tried to provide the patients there with the best possible care.
Indeed, Nathan told us that while working there, he had tried repeatedly to get the medical facility shut down. “The patients there could not receive the treatment they needed. They all needed to be admitted to a normal hospital.”
After many months, once “it was no longer an emergency situation” – and when Nathan realised his efforts to shut the facility down were futile – he felt he could not “be there any longer”, and quit.
Cuffed, blindfolded and wearing diapers
We approached Ben (also a pseudonym) for an interview because of his involvement with another human rights organisation, to ask about the medical treatment of Palestinians in Israeli prisons after the October 7 attacks. It was only during our conversation, when he heard that we were writing about the medical facility at Sde Teiman, that he told us he, too, had been called late in 2023 to serve there.
Ben, a much more junior doctor than the other doctors we interviewed, works in one of Israel’s public hospitals. He recalled being asked by a colleague if he would help perform a procedure on a patient from Gaza he had previously treated. He immediately got in his car and drove to Sde Teiman, following the directions he’d been given over the phone – not knowing exactly where he was going.
Once he got to the medical facility, Ben said he was astonished by what he saw. Even though this was late December and the place had been operational for more than two months, “patients were still wearing nothing but diapers”. He told us they were still cuffed to their beds and blindfolded at all times, including while receiving medical treatment. They were not allowed to get out of bed, so had to defecate in bed when they needed to relieve themselves.
Ben carried out the procedure he was called to perform. But once he got home, the reality of what he’d witnessed dawned on him: “I decided not to step into that facility ever again.”
Because they were cuffed, the nursing staff had to do everything for the patients. They washed them, changed their diapers, and even had to feed some of them liquid food through straws. These accounts were confirmed by the other two doctors we interviewed who had worked in the facility.
Doctors describe conditions inside the Sde Teiman medical facility: BBC News, May 2024.
Nathan told us several times: “You must emphasise the care and dedication of the nurses” who bathed, fed and cared for people few others were willing to care for. Yet while this was undoubtedly noteworthy, especially under those circumstances, most of these patients would have been able to go to the toilet, shower and feed themselves had they not been restrained to their beds 24 hours a day. Using such restraints indiscriminately on patients violates Israeli law, and is considered a form of torture according to ethical codes both in Israel and internationally.
“At first, [the cuffing] may have been necessary because we treated very dangerous people” who had just carried out a brutal massacre, Nathan explained. He described a severe attack on one female staff member which he witnessed, confirming: “We had several instances in which patients assaulted staff.”
But, he continued: “They had no justification after the first few weeks. By then, other precautions could have been introduced, and assessments could have been conducted to determine who might pose a danger to staff and still needed to be cuffed.”
Nathan said that eventually, many of the patients seen by the doctors and nurses were not dangerous. “Arrangements should have been made so those patients could be cared for in a general hospital in Israel.”
After visiting the Sde Teiman medical facility in late February 2024, members of the Israeli Ministry of Health’s ethical committee reported that all patients were still chained to their beds by all four limbs – despite the fact that, by the Israeli army’s own admission in December 2023, many Sde Teiman detainees were by then not suspected of being related to Hamas or other militant factions. Many of those incarcerated in Sde Teiman, including some who had been held for many months and were chained to their beds, would eventually be released without charge.
‘We did everything we could’
Nathan’s account was supported by our third interviewee, Yoel Donchin – a senior anaesthesiologist who also served in the medical facility for many months. Donchin described some of the patients he treated to the New York Times in June 2024, explaining that one was paraplegic, another severely obese, and a third had needed to use a breathing tube since childhood. Donchin concluded it was “highly unlikely” that any of them were involved in the fighting. “They take everyone,” he said, referring to the Israeli army’s actions in Gaza.
Since he had already spokenpubliclyabout his experiences in the facility, Donchin was easy to locate. Unlike Nathan and Ben, he was happy for us to use his real name, and had no reservations about his involvement there.
After he publicly defended his decision to serve in the facility, Donchin and the rest of the medical team working there was criticised by human rights organisations including members of Pcati’s board. Treating patients there, they claimed, was “a moral disgrace and a violation of every ethical principle” to which doctors must commit.
But, a couple of hours into our long conversation in his quiet home in a suburb of Tel Aviv, we began to reconcile the facts we knew about Sde Teiman with Donchin’s account of his time working in the medical facility. He equated the situation in Israel immediately after October 7 to “a multi-casualty event”, explaining that in such conditions, “medical ethics is different”. In the chaos of the first few weeks after the attacks, he told us, “no one knew what they were doing. The hospitals were swamped with patients and the system was overwhelmed.”
Donchin said that even some Israeli soldiers wounded in the Hamas attack could not get the full care they needed. In the aftermath of October 7, he told us: “The entire [Israeli] healthcare system was in complete disarray. In the first month, there was no state to speak about whatsoever.”
Within this chaos, Donchin told us: “We did everything we could.” He explained that when the nutrition patients needed was not supplied, staff would buy it themselves. When a patient needed to be seen by a specialist, they would use their personal networks to bring in colleagues with the needed expertise – either having them come to the facility or, when that was impossible, having them provide advice over a video call.
Yet while these may have been effective emergency measures, “they should not have been the solution”. Ultimately, Donchin said, these “compromises and improvisations” meant the doctors were operating under “a black flag of illegality”.
According to the medical ethics expert who advised doctors working in Sde Teiman: “In this first month, treating those who’d just taken part in the massacre posed particular challenges”, because some were very dangerous and aggressive. “General hospitals are not set up to treat patients who pose such risks to staff.”
However, he also said that “Israel had detailed contingency plans in place for such a scenario, which included preparing a dedicated ward for enemy combatants in one of the main hospitals. But those were never implemented.”
‘He should be left to rot’
Many of the nearly 200 Hamas militants who took part in the October 7 attacks and were captured inside Israel were wounded in the fighting. At first they were taken to general hospitals, but word quickly got out – leading to widespread reports of mobs raiding hospital wards, attacking staff and patients they suspected of being Palestinian.
To protect the safety of both patients and staff, Israeli hospitals began refusing to admit these patients. But some medical staff also expressed their “difficulties” with treating those whom they suspected of having committed the October 7 atrocities.
On October 11 2023, Moshe Arbel, Israel’s health minister at the time, officially endorsed this reluctance by issuing an ordinance stating that general hospitals should not treat “terrorists from Gaza”. This guidance also enabled Israeli hospitals to refuse treatment to any Palestinian arriving from any incarceration facility.
Staff working in some of these hospitals told us in the aftermath that they had regularly heard colleagues making statements such as “Gaza should be erased” or “as far as I am concerned, all babies in Gaza are terrorists and can die” – sometimes in formal staff meetings and in front of Palestinian colleagues.
We also heard stories of medical staff demonstrating explicit disregard to the injuries and wellbeing of those they suspected were part of Hamas’s Nukhba force – and in some cases, Palestinian detainees from Gaza more generally.
For example, Nathan described calling a senior specialist when he needed urgent advice about treating one of the detainees in Sde Teiman, only to be told: “As far as I am concerned, he should be left to rot.” And according to Ben: “On October 8, I witnessed a doctor inserting a tube into the lungs of a patient from the Nukhba force without anaesthetising him. There were likely other such cases.”
“Paradoxically,” Ben told us, “the doctors in Sde Teiman’s medical facility had a much deeper commitment and understanding of their responsibility to provide care to these patients.” It was in the general hospitals, he said, that he had found more “verbal violence, less care” – and some cases of physical abuse.
As an underequipped and understaffed makeshift facility, according to those who worked at Sde Teiman, if a patient needed urgent treatment that could not be provided on site, they would sometimes be taken to one of Israel’s general hospitals. Nathan described spending long hours on the phone each time, calling different hospitals until he could find one willing to admit a patient. But it was the very existence of the Sde Teiman medical facility that allowed many hospitals to shirk their responsibilities, since these patients were apparently already receiving treatment.
And when a hospital procedure was performed, the patients were quickly sent back to the Sde Teiman medical facility, as described in this leaked letter to Israel’s Ministry of Health from a doctor working in the facility:
Patients after major operations, such as abdominal surgeries for intestinal resections, are brought back after about an hour of post-op observation to the Sde Teiman medical facility, which is staffed most of the day by a single doctor, accompanied by a nursing team, some with no more than medic training.
Eventually, staff at the Sde Teiman medical facility managed to get some patients released from being handcuffed to their beds by all four limbs, and to enable them to wear hospital robes rather than diapers. But regardless of their effort to provide better care, and regardless of their important struggles and partial successes, to treat people in the Sde Teiman medical facility was, in the view of many observers as well as some of the doctors themselves, to become complicit in violations of international and Israeli law.
The anonymous letter submitted to Israel’s Ministry of Health claimed conditions in the facility often resulted “in complications, and sometimes even in the patient’s death”:
This makes all of us – the medical teams and … those in charge of us in the health and defense ministries – complicit in the violation of Israeli law, and perhaps worse for me as a doctor, in the violation of my basic commitment to patients, wherever they are – as I swore when I graduated 20 years ago.
The doctors’ dilemma
Ben only visited the Sde Teiman medical facility once, yet the regret stayed with him. “I should have turned around the moment I saw the patients were treated while naked and cuffed to their beds,” he told us. “To treat patients there was not only a violation of our ethical codes as doctors – it was to take part in war crimes, if not crimes against humanity. This was not something I was willing to consider.”
He continued: “To serve there effectively mediated the crisis that would have been caused had no doctor agreed to do so. The medical staff allowed the facility in Sde Teiman to continue operating, and the existence of the facility allowed the hospitals to refuse treating those patients.”
While the Sde Teiman detention camp held many hundreds of detainees over long periods, its medical facility could treat no more than 15 patients at a time. Usually, only detainees identified with acute injuries were received – often only after their condition had already deteriorated. This meant lesions would frequently get infected, according to our interviewees, leading to amputations of limbs that could have easily been prevented.
In the main detention camp, untreated illnesses led to complications, debilitation and, in some cases, death. The most recent public data shows that between October 2023 and July 2024, at least 36 detainees died inside Sde Teiman. To a slightly lesser extent, the withdrawal of care has also become the standard in other prisons and detention facilities where Palestinians are held. According to the most recent (still unpublished) data we have received from Physicians for Human Rights (Israel), from October 2023 to July 2025, 52 Palestinians have died within military facilities and 41 inside Israeli prisons.
Denying medical care to an imprisoned person may itself amount to torture. While commonly imagined as breaking someone’s bones, pulling out their fingernails or applying electric shocks, torture can take many other forms. When someone is sick or injured, denying them the treatment they need and preventing them from getting any pain relief can be a way of causing unbearable pain and unnecessary suffering.
For Donchin, to refuse to treat patients would have meant becoming an accomplice in this crime. “For me, the alternative – to provide no care at all, to show no compassion – was impossible,” he said, adding that it is one thing to think about these questions in theory, a completely different thing when you see a person suffering right in front of you.
In contrast, for Ben, the only right thing to do was to refuse to work inside Sde Teiman’s temporary medical facility – especially when state-of-the-art hospitals were only a short car drive away. “Treating patients there doesn’t save them, since it leaves them outside the healthcare system that could have given them the lifesaving treatment they so needed,” he told us.
But as we were concluding our conversation, he added: “There are no right answers here. It is a huge tragedy, no matter which way you look at it.”
The Sde Teiman medical facility was finally shut down in October 2024 when, following a petition to Israel’s High Court of Justice by several human rights organisations including Pcati and Physicians for Human Rights, the population of the main detention camp was significantly reduced.
By the time Nathan sat down to talk to us, the medical facility had been shut for a good few months. But the man we met was still utterly defeated, visibly broken. He kept asking himself if he had done enough – or if he should or could have done more. This is when he concluded: “Perhaps there was something we could have done about the camp itself.”
While he never stepped foot inside the main camp, he told us he could hear very clearly the yelling and the barking of the dogs. “Maybe we could have done more about the camp itself.”
Whereas Ben and Donchin seemed to draw some comfort from their belief that they had done the right thing (despite reaching opposite conclusions), Nathan did not share that conviction. On the one hand, it was clear to him that he had become complicit in crimes. The conditions in the medical facility failed even to comply with what he called the “stripped-down law” that Israel had adapted to treat these people – let alone international human rights law and all medical codes of ethics.
Yet at the same time, Nathan felt he could not abandon these patients. When we met him, he was still torn about what he had done, still wondering whether he had made the right decisions.
Comparing our findings with testimonies that have emerged over the last two years, we can say with confidence that the use of torture by the Israeli security forces has increased both in scale and severity since then – though this has been denied by the Israeli government and military.
According to numerousverifiedreports, many of the detainees in Sde Teiman were subjected to sexual violence ranging from forced nudity and humiliation to rape; constant cuffing that led to injuries and in some cases the amputation of limbs; and beatings using batons, metal bars and the butts of guns and boots, sometimes until detainees lost consciousness.
Similar practices were reported in almost all Israeli prisons and detention facilities where Palestinians were held after the October 7 attacks.
The stories of the doctors working at Sde Teiman should not distract from the gravity of this wider story of abuse and torture. But the dilemmas the doctors faced, and the impact it has had on their lives, show the complexities, if not impossibilities, faced by Israelis who are trying to resist the atrocities Israel has been committing in Gaza (and the West Bank) in the aftermath of the October 7 attacks.
A Palestinian hospital worker inspects damage to a bombed pharmaceutical warehouse in Khan Yunis, southern Gaza, May 2025. Anas Mohammed/Shutterstock
In its July 2025 report, Physicians for Human Rights Israel claimed that the “broader targeting of Gaza’s healthcare system” amounts to a dismantling of the “existing conditions of life with effects into the future”, and should therefore be seen as a violation of the UN’s 1948 Convention On Genocide.
The doctors we met, alongside the other medical staff in the Sde Teiman facility, attempted to counteract the dehumanisation and abandonment of life that allows genocides to happen. In different ways, they tried to stop the atrocity that was evolving in front of them and to remedy the conditions that made it possible. Yet they still, in their view, found themselves complicit in the very crimes they tried to prevent.
As much as their story is a story of the impossible dilemmas these doctors faced, it is also a story of people who at least did what they could to counter this almost-inevitable complicity. Not only by insisting on the humanity of the people in front of them, and therefore also of their own, but also by refusing to remain silent.
Response to this article
The Israeli Medical Association (IMA) was contacted by The Conversation during the editing of this article. Its response, which is reflected in the final article, included the following comments:
According to Israeli Ministry of Health guidelines, all patients in the Sde Teiman medical facility were treated according to conventional Israeli medical standards, meaning the level of care there was higher than what they would have received in Gaza.
The IMA has continuously spoken out on humanitarian issues throughout this war and will continue to do so. On August 5 2025, we reaffirmed our long-standing policy on the assurance of medical care during armed conflict.
The destruction of Gaza’s healthcare is tragic, but there is no “mass killing, detention, torture and abuse of medical personnel” [as was stated in the Physicians for Human Rights Israel report, July 2025]. There have been some medical personnel that were suspected or proven terrorists. The IMA has made it very clear that all patients are to be treated equally.
The Israeli military was contacted by The Conversation about the findings in this article, but did not provide a response. When previously contacted by the BBC about allegations of abuse and torture in the Sde Teiman medical facility, it said it “completely rejects accusations of systematic abuse of detainees”.
Economists have argued for years that council tax in the UK was rushed in and badly thought out. After the poll tax fiasco of the early 1990s, a substitute was urgent. The answer was council tax, but this was almost as unfit for purpose as the poll tax it replaced.
So if the experts know council tax is an unfair mess, why has there been no reform? There seem to be three main reasons. First, while everyone can think of big improvements, there is no consensus on what exactly should replace it. So although almost any sensible reform would be better, nothing changes.
The second reason is politicians’ and policymakers’ fear of rocking the boat. There would certainly be losers as well as winners from any decent reform – and those losers would complain vociferously.
Finally, council tax is cheap to collect and yields a lot of revenue. Perhaps there is also the fear that if the stone is lifted, we would also need to address the problem of paying for local government.
Historically “domestic rates” were the main source of local government income in the UK, but their contribution to local spending had fallen to a low of about 10% by 2010.
Since then, local governments have increasingly borne the burden of austerity, however, with the result that council tax now covers 30% of their spending. But the system is creaking. The Thatcher government’s deeply unpopular flat-rate “community charge” (poll tax) was a per-person levy supposed to pay for local services. Council tax was a hybrid – part property tax and partly a charge levied by local government.
These days, the house values providing the tax-base for council tax are still fixed at hypothetical 1991 values, even for new houses. But in the real world, UK house prices have increased, more than fivefold since 1991. And in London they have increased by a factor of eight compared to only 3.5 in the north, creating another problem of perceived fairness.
To make matters worse, the house values themselves were not used to calculate the tax, but rather eight value bands. These have not been updated, still stopping at £320,000 – reflecting the prices of a forgotten world. The result is the single occupant of a house worth £2.5 million may pay less than their married neighbours with a child in a one-bedroom flat.
The poll tax was supposed to represent a payment by residents for local services, so is levied on people not property. To retain an echo of this per-person charge, council tax has a 25% discount for single people. Paying is the liability of the occupier, not the owner.
So how could it be improved?
The most obvious reform for property taxes is to revalue all houses at current prices and wrap up stamp duty (another bad and unpopular tax) and council tax in a single payment. This could be charged as a percentage of a home’s value – a “proportional property tax” (PPT). Then all houses would be revalued every year.
There are objections and complications to such an obvious reform. It would be impossible to remove the government’s stamp duty revenues without replacing them. So a proportion of the total revenue from any PPT would go to the Treasury, with the rest helping to fund local government. The total revenues would still have to be divided between the two.
A second complication is older people who bought houses in the 1980s, for example, and who are now retired. For them, paying the same proportion of current values as those in work might be a stretch. One suggestion is that housing-rich, income-poor people could roll up their tax liability, so it was only paid when they sold the house or after they died.
However, some oppose such a delay since it removes the incentive to downsize (a move that would cost less if stamp duty had been abolished as part of the reform).
But could people suddenly find their liability leap fivefold if their house was revalued?. This fear is unfounded, since the tax would not be the assessed value of the house but some very small proportion – maybe 0.5%. Still, it might need strong and articulate political leadership to convince people of this.
As for the task of revaluing houses every year, these days AI can give accurate and almost instantaneous valuations. But homeowners should have a right to appeal the valuation. This would be free if experts judged the AI value was more than 5% out. If not however, the homeowner would be stuck with that valuation and would also have to pay the costs of the appeal.
To solve the problem of dividing the revenues of a PPT, there should be both nationally and locally set rates of tax on the value of houses. A recent calculation concluded that a rate of 0.11% of house values would offset the Treasury’s lost stamp duty revenue. On a £1 million house, that works out as £1,100 a year.
Councils would then set their own rates, with the receipts paying for local services. This would provide some incentive to permit new house building, as tax receipts would rise to cover the extra costs rather than disappearing into national coffers.
This would also resolve the problem of how to divide PPT revenues between local and national government and avoid imposing a sudden, massive jump in property tax liability for people in southeast England. This is where the majority of £1 million-plus houses are located.
Setting the local rate at a uniform national 0.51% – yielding the same national total as council tax – would mean the owner of the £1 million house suddenly being hit with an annual bill not of £1,100, but £6,200. This would create serious opposition. So where house prices were higher, the local rate could be lower and still yield the same revenue.
An advantage of the PPT is that it could also be an effective and collectable wealth tax. Houses are the biggest element in personal wealth so the national rate of PPT could even be set higher than the 0.11% rate, increasing Treasury revenues and addressing appeals for a wealth tax.
This article was co-published with LSE Blogs at the London School of Economics
Paul Cheshire receives funding from ESRC. He is affiliated with the Centre for Economic Performance.
A little blue pill is creating a stir in Hollywood – and no, it’s not Viagra. It’s propranolol, a beta blocker originally designed for heart conditions, that’s now making its way into dressing rooms, award ceremonies and even first dates.
At red carpet events this year, actors Kristen Bell, Rachel Sennott and Natasha Rothwell all mentioned taking beta blockers. But they weren’t the first.
In 2022, Khloé Kardashian admitted she borrows her mother’s pills to calm her nerves. And last year, at the Golden Globe awards, Robert Downey Jr. quipped: “I took a beta blocker, so this will be a breeze.” What’s behind this unlikely trend – and how did a drug for heart disease become a Hollywood anxiety fix?
To understand why A-listers are reaching for heart medication, we need to look at how these drugs actually work.
Beta blockers, such as propranolol and atenolol, were first developed in the 1960s to treat heart conditions such as high blood pressure, arrhythmias (irregular heart rate) and angina. Doctors soon discovered they also worked for other conditions, including migraines and an overactive thyroid.
The use of beta blockers for anxiety was first identified in 1965, when they demonstrated calming effects during clinical trials aimed at treating rapid heart rate associated with hyperthyroidism. Although licensed to treat anxiety in the UK, propranolol is increasingly prescribed off-label (prescribing a drug for a condition it’s not officially approved to treat, based on clinical judgment and available evidence) in the US as it remains unlicensed by the Food and Drug Administration.
So how do beta blockers help with anxiety? Adrenaline is a hormone that activates the body’s fight-or-flight response, often causing symptoms such as rapid heartbeat, sweating and trembling. Beta blockers work by blocking adrenaline’s effects on specific sites in the body called beta receptors.
When beta blockers attach to the beta receptors in the heart, they prevent adrenaline from exerting its usual effects. This leads to a slower heart rate and weaker heart contractions. This, in turn, lowers blood pressure by reducing the heart’s demand for oxygen. By blocking adrenaline, beta blockers help to reduce the physical symptoms of anxiety – racing heart, trembling hands and sweating.
But how well does it actually work for anxiety? The research paints a complex picture. In one study, patients who took propranolol had significantly lower anxiety and depression compared with those who received a placebo.
Another study looked at two different doses of propranolol (20mg and 40mg) and found that both doses led to noticeable improvements in anxiety levels compared with participants who didn’t take any anxiety medication.
However, a recent review of the evidence concluded that while propranolol may help with physical symptoms of anxiety, the evidence that it helps in comparison to other anxiety medication is limited – a lot of the clinical trials have few participants and are of low quality.
Unlike Valium (diazepam), the benzodiazepine known in the 60s as “mother’s little helper”, propranolol is not addictive. It doesn’t produce sedation or euphoria, and its risk of dependence is low. However, it’s not without risks or side-effects.
Common side-effects include dizziness, fatigue, cold hands and feet, and vivid dreams. More serious risks – though rare – include heart failure, breathing difficulties and allergic reactions.
People with asthma, diabetes or certain heart conditions need to consult a doctor or pharmacist as beta blockers are often unsuitable for them.
There have also been increasing cases of propranolol being used in overdose. It may cause your heart to slow down too much, lead to dizziness, shaking or seizures and make breathing difficult.
The prescription reality
Despite not appearing in national guidelines, doctors are increasingly prescribing propranolol for anxiety. Research shows doctors view it as a pragmatic, low-risk option – especially for patients on long waiting lists for counselling or reluctant to take antidepressants.
Propranolol targets the body’s response to anxiety, not the underlying psychological causes. It may help someone deliver a speech without shaking or take an exam without sweating, but it won’t address persistent worry or panic attacks. As such, it’s best seen as a short-term aid rather than a long-term solution.
Before you start raiding your mum’s medicine cabinet for a dose of red-carpet calm, remember it’s a beta blocker, not a bravery booster. It won’t fix your fear of public speaking or make you smoother on a first date – though it might stop your hands from shaking while you try.
Dipa Kamdar 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.
