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Does hosting the Olympics, the World Cup or other major sports events really pay off?

<a href="https://theconversation.com/profiles/ivan-savin-678930">Ivan Savin</a>, <a href="https://theconversation.com/institutions/escp-business-school-813">ESCP Business School</a> After a long battle, <a href="https://www.france24.com/en/europe/20240213-paris-booksellers-stay-olympics-macron-bouquiniste-france">Paris’s beloved bouquinistes will be staying put</a> this summer. The decision, announced on 13 February by the French government, came after considerable public backlash to the police prefecture’s original plan to move part of the iconic Seine booksellers elsewhere for the inauguration of the Olympics Games on 26 July. Meanwhile, less than six months away from the event, Parisians continue to grumble over a <a href="https://www.ouest-france.fr/jeux-olympiques/cest-aberrant-ce-maire-vient-dapprendre-que-sa-ville-accueillera-les-jeux-de-paris-ab1fa968-cfd1-11ee-89c0-6cefac77e04a">lack of consultations</a> with locals, warnings of <a href="https://www.rfi.fr/en/france/20231130-paris-vehicle-traffic-to-be-heavily-restricted-during-2024-olympic-games">gridlocked traffic</a>, closed metro stations, extensive video surveillance and other grievances. So for host countries, what was the point of the Olympics, again? In academia, the debate about the potential positive and negative effects of large-scale sporting events is ongoing. Although these events are often associated with substantial economic losses, the long-term benefits are the main argument in favour of hosting them. These include the development of material and soft infrastructure such as hotels, restaurants or parks. Big games can also help put the host region on the map as an attractive place for sports and cultural events, and inspire a better entrepreneurial climate. <h2>The pros and the cons of big sporting events?</h2> The cost of these benefits, as the Parisians have realised, is steep. Host countries appear to suffer from increased tax burdens, low returns on public investments, high construction costs, and onerous running cost of facilities after the event. Communities can also be blighted by noise, pollution, and damage to the environment, while increased criminal activity and potential conflicts between locals and visitors can take a toll on their quality of life. As a result, in the recent past several major cities, including Rome and Hamburg, <a href="https://www.dw.com/en/6-cities-that-rejected-the-olympics/a-46289852">withdrew their bids to host the games</a>. A common feature of the economics of large-scale sporting events is that our expectations of them are more optimistic than what we make of them once they have taken place. Typically, expenditure tends to tip over the original budget, while the revenue-side indicators (such as the number of visitors) are rarely achieved. When analysing the effect of hosting large-scale sporting events on tourist visits, it is important to take into consideration both the positive and negative components of the overall effect. While positive effects may be associated with visitors, negative effects may arise when “regular” tourists refuse to visit the location due to the event. This might be because of overloaded infrastructure, sharp increases in accommodation costs, and inconveniences associated with overcrowding or raucous or/and violent visitors. On top of that, reports of poverty or crime in the global media can actually undermine the location’s attractiveness. <h2>When big sporting events crowd out regular tourists</h2> In an <a href="https://doi.org/10.1177/1527002523120639">article published in the Journal of Sports Economics</a> with Igor Drapkin and Ilya Zverev, I assess the effects of hosting large-scale sporting events, such as Winter and Summer Olympics plus FIFA World Cups, on international tourist visits. We utilise a comprehensive dataset on flow of tourists covering the world’s largest destination and origin countries between 1995 and 2019. As a first step, we built an econometric model that effectively predicts the flow of tourists between any pair of countries in our data. Subsequently we compared the predicted tourist inflow in a hypothetical scenario where no large-scale sporting event would have taken place with the actual figures. If the actual figures exceed the predicted ones, we consider the event to have a net positive impact. Otherwise, we consider that it had a “crowding out” effect on “regular” tourists. While conducting this analysis, we distinguished between short-term (i.e., focusing just on the year of the event) and mid-term (year of the event plus three subsequent years). Our results show that the effects of large-scale sporting events vary a lot across host countries: The World Cup in Japan and South Korea 2002 and South Africa 2010 were associated with a distinct increase in tourist arrivals, whereas all other World Cups were either neutral or negative. Among the Summer Olympics, China in 2008 is the only case with a significant positive effect on tourist inflows. The effects of the other four events (Australia 2000, Greece 2004, Great Britain 2012, and Brazil 2016) were found to be negative in the short- and medium-term. As for the Winter Olympics, the only positive case is Russia in 2014. The remaining five events had a negative impact except the one-year neutral effect for Japan 1998. Following large-scale sporting events, host countries are therefore typically less visited by tourists. Out of the 18 hosting countries studied, 11 saw tourist numbers decline over four years, and three did not experience a significant change. <h2>The case for cautious optimism</h2> Our research indicates that the positive effect of hosting large-scale sporting events on tourist inflows is, at best, moderate. While many tourists are attracted by FIFA World Cups and Olympic games, the crowding-out effect of “regular” tourists is strong and often underestimated. This implies that tourists visiting for an event like the Olympics typically dissuade those who would have come for other reasons. Thus, efforts to attract new visitors should be accompanied by efforts to retain the already existing ones. Large-scale sporting events should be considered as part of a long-term policy for promoting a territory to tourists rather than a standalone solution. Revealingly, our results indicate that it is easier to get a net increase in tourist inflows in countries that are less frequent destinations for tourists – for example, those in Asia or Africa. By contrast, the United States and Europe, both of which are traditionally popular with tourists, have no single case of a net positive effect. Put differently, the large-scale sporting events in Asia and Africa helped promote their host countries as tourist destinations, making the case for the initial investment. In the US and Europe, however, those in the last few decades brought little return, at least in terms of tourist inflow.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/222118/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ivan-savin-678930">Ivan Savin</a>, Associate professor of quantitative analytics, research fellow at ICTA-UAB, <a href="https://theconversation.com/institutions/escp-business-school-813">ESCP Business School</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-hosting-the-olympics-the-world-cup-or-other-major-sports-events-really-pay-off-222118">original article</a>.

Travel Tips

Teen with Down Syndrome sets new world record

A 19-year-old teen with Down Syndrome has conquered the London Marathon and became a Guinness World Record after just five months of training. Lloyd Martin from Cardiff completed the 42.1 km course across the capital with his mother cheering him on. Guinness World Record has awarded him the certificate for becoming the youngest person in his learning disability category to finish a marathon. "I'm so excited to run London. I love being fit and healthy and I want to make my family and friends proud," the teenager said. Mum Ceri Hooper also told the BBC how proud she was of her son's accomplishment. "In Lloyd's words, it's achieving his dream," she said. "Really anything is possible if you put your mind to it. With a bit of work, you can achieve it." Recalling the experience, the proud mum said: "He ran continuously for 14 miles which is the longest he's ever run before." Although Lloyd walked for a bit after his 14-mile-long streak, the crowd cheered him on every step of the way, and despite the challenge the mother-and-son duo had "a ball". The pair were at a loss for words when he finally crossed the finish line and they both "burst into tears." Lloyd is also now the third Welsh Special Olympics athlete to compete in the London Marathon. Prior to completing the world-famous marathon, Lloyed had completed an astonishing 30 Parkruns. Until last Christmas the teenager had never run further than three miles, but his mother was determined to get him marathon-ready. Ceri, who has taken on the London Marathon four times, created a specialised training regime for her son which included weekly runs. Lloyd managed to secure a spot in the marathon thanks to the help of the Special Olympics GB, where he is also a footballer and a gymnast. Images: Facebook/ Twitter

Caring

World's most expensive house up for sale

A French chateau, once owned by a member of the Rothschild family and, later on, the King of Morocco, has gone up for sale with a £363 million (AU$699) price tag. Chateau d’Armainvilliers located at Seine-et-Marne, 48km east of the Eiffel Tower, is the world's most expensive home. Built upon the foundations of a 12th century castle, the sprawling mansion boasts 1,000 hectares of land, 100 rooms across 2,500 square metres of living space, a private lake, and plenty of sequoia trees - the largest trees in the world. Ignace Meuwissen, a self-acclaimed "real estate advisor to the global elite" described the property as a display of "opulence and grandeur". "It is the most expensive castle in France and perhaps in the world. The price of €425million is justified by the property itself but also by the 1,000 hectare land which offers numerous possibilities," he told Paris Match magazine. "An investor could build thousands of apartments there if he wanted." The chateau was first bought by the Rothschild banking empird in the late 19th century, before King Hassan II of Morocco bought it in the 1980s. He then made the chateau more fit for a king, adding a hammam spa, a beauty and hairdressing salon, and a fully-equipped medical and dental facility. The Moroccan King also added a basement level, which has a network of tunnels, kitchens, cold rooms, storage spaces and staff quarters. The lucky owner will also find Moroccan mosaics and wall tiles decorating the home, and for any avid equestrians, the home also has a stable big enough for 50 horses. However, some luxury property agents have expressed their doubts on whether the property would sell with its nine-figure sum, with one saying it was an "unrealistic" price tag. "It doesn’t make sense, it’s absurd Properties of this type could sell for 20-25 million, or even 30 million if we really fall in love with them. I’m not even sure that Vaux-le-Vicomte (a Baroque French château), which has no marketing plans, would sell at this price," one agent told French real estate publication Le Figaro Immobilier. Others were unsure whether the changes made by the King in the 1980s would suit modern tastes. Images: Whisper Auctions

Real Estate

The most boring tourist attractions in the world revealed

Nobody wants waste their time and energy visiting a boring attraction while travelling, so a new study has analysed 66.7 million Google reviews and compiled a list of the top 100 most boring attractions across the globe so you can enjoy a holiday free from the mundane. The study conducted by Solitaired, was based on 3,290 popular tourist attractions worldwide spanning 384 cities across 71 different countries. A boredom score was calculated for each site, based on 11 keywords indicative of tiresome, lifeless and boring impressions. At the top of the list was Branson Scenic Railway in Missouri, with a boredom score of five out of five. The heritage railroad departs from an old depot in downtown Branson and travels through part of the Ozark Mountains on a 40-mile round trip. While some praised the beautiful foliage, others were unimpressed by the views "limited to trees on both sides of the train." Illuminarium Atlanta, in Georgia U.S. came in second place, with a boredom score of 4.5, with one reviewer saying that it was "cool for about the first 15 minutes" and "after that… just boring." In third place is Tennessee's Jurassic Jungle Boat Ride, an indoor attraction that takes visitors through a river passing artificial cave sets, waterfalls and mechanical dinosaurs, which scored 3.7 on the boredom scale. Australia's least interesting attraction, which came in 16th on the list and scored 2.5 on the boredom scale, is the WA Museum Boola Bardip in Perth, which tells stories of WA through interactive exhibits. This is followed by the Legoland Discovery Centre in Melbourne, which ranked 24th on the list and had a score of 2.3 The Museum of Sydney came in 32nd place, with a score of 2.2, while the Museum of Transport and Technology in Auckland, New Zealand came in 54th place with a score of 2.1. Check out the full list <a href="https://www.dailymail.co.uk/travel/article-13310853/Most-boring-attractions-world-Shrek-Adventure-London.html" target="_blank" rel="noopener">here</a>. Image: Getty

International Travel

The world reacts to OJ Simpson's death

The news of OJ Simpson's passing at the age of 76 brings a mixture of emotions for those who remember the electrifying running back, the celebrated athlete, and the central figure in one of the most infamous trials of the 20th century. Simpson, who passed away in Las Vegas, had been battling prostate cancer. His family announced the news in a statement on Twitter (X): “On April 10th, our father, Orenthal James Simpson, succumbed to his battle with cancer. He was surrounded by his children and grandchildren. During this time of transition, his family asks that you please respect their wishes for privacy and grace. – The Simpson Family.” In 2023 Simpson said on X that he had been diagnosed with a type of cancer and in February he said he was undergoing chemotherapy for prostate cancer. <blockquote class="twitter-tweet"> On April 10th, our father, Orenthal James Simpson, succumbed to his battle with cancer. He was surrounded by his children and grandchildren. During this time of transition, his family asks that you please respect their wishes for privacy and grace. -The Simpson Family — O.J. Simpson (@TheRealOJ32) <a href="https://twitter.com/TheRealOJ32/status/1778430029350707380?ref_src=twsrc%5Etfw">April 11, 2024</a></blockquote> Simpson's life was a narrative of triumph and tragedy, marked by soaring highs on the football field and plummeting lows in the court of public opinion. Born in 1947, Simpson overcame early health struggles to become a football sensation at the University of Southern California, where he captured the prestigious Heisman Trophy as college football's top player. His prowess on the gridiron led to a record-setting career in the NFL with the Buffalo Bills and the San Francisco 49ers, cementing his status as one of the era's most beloved and iconic athletes. Off the field, Simpson's charm and charisma propelled him into the realms of sportscasting, advertising, and Hollywood, where he starred in films like the Naked Gun series. His magnetic personality endeared him to fans and advertisers alike, making him a household name beyond the realm of sports. However, Simpson's life took a dark turn on June 12, 1994, when the bodies of his ex-wife, Nicole Brown Simpson, and her friend, Ronald Goldman, were discovered in a brutal scene outside Brown's Los Angeles home. What followed was a media frenzy and one of the most sensational trials in American history. In a trial that captivated the nation, Simpson stood accused of the double murder, a crime that shook the foundations of celebrity culture and racial dynamics in America. The prosecution painted a picture of a jealous ex-husband driven to violence, while the defence argued that Simpson was framed by a corrupt and racist police force. The trial's climax came with the now-iconic moment when Simpson struggled to put on a pair of blood-stained gloves found at the crime scene, leading defence attorney Johnnie Cochran to famously declare, "If it doesn't fit, you must acquit." Despite overwhelming evidence presented by the prosecution, Simpson was acquitted by a predominantly black jury, sparking debates about race, justice and the power of celebrity. While Simpson walked free from the criminal trial, he faced a different fate in civil court. The families of Brown and Goldman pursued a wrongful death lawsuit against him, resulting in a verdict that found Simpson liable for the deaths and ordered him to pay millions in damages. The civil trial, with its lower burden of proof, delivered a measure of closure to the victims' families but left a stain on Simpson's legacy that would endure. Simpson's legal troubles didn't end there. In 2008, he was convicted of armed robbery and kidnapping in a separate incident in Las Vegas, stemming from an attempt to reclaim sports memorabilia he believed was rightfully his. The irony of a man once celebrated for his athletic prowess now facing the consequences of his actions was not lost on the public. Despite his legal battles and personal demons, Simpson remained a polarising figure until the end. His life story was revisited in documentaries and TV dramas, serving as a cautionary tale of fame, wealth and the consequences of one's choices. Reactions to Simpson's passing have been varied. Fred Goldman, the father of Ronald Goldman, who was murdered alongside Nicole Brown Simpson in 1994, expressed his sentiments succinctly, stating, "It’s no great loss to the world. It’s a further reminder of Ron’s being gone." Similarly, Caitlyn Jenner, with personal ties to the case through her ex-wife Kris Jenner's previous marriage to Robert Kardashian, offered a terse "Good riddance" on Twitter, highlighting the deep-seated emotions surrounding Simpson's life and deeds. Gloria Allred, who represented Nicole Brown Simpson's family during the infamous trial, took a broader perspective, pointing out that Simpson's death serves as a reminder of the failures of the justice system, particularly in cases involving gender violence. “Simpson’s death reminds us that the legal system even 30 years later is still failing battered women," she said to TMZ, "and that the power of celebrity men to avoid true justice for the harm that they inflict on their wives or significant others is still a major obstacle to the right of women to be free of the gender violence to which they are still subjected." Legendary basketballer Magic Johnson took a different approach, extending his prayers to Simpson's surviving children and grandchildren: "Cookie and I are praying for O.J. Simpson’s children Arnelle, Aaren, Justin, Jason, and Sydney and his grandchildren following his passing. I know this is a difficult time🙏🏾". Images: Getty

Caring

People in the world’s ‘blue zones’ live longer – their diet could hold the key to why

<a href="https://theconversation.com/profiles/justin-roberts-1176632">Justin Roberts</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a>; <a href="https://theconversation.com/profiles/joseph-lillis-1505087">Joseph Lillis</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a>, and <a href="https://theconversation.com/profiles/mark-cortnage-438941">Mark Cortnage</a>, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Ageing is an inevitable part of life, which may explain our <a href="https://time.com/4672969/why-do-people-want-to-live-so-long/">strong fascination</a> with the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726954">quest for longevity</a>. The allure of <a href="https://pubmed.ncbi.nlm.nih.gov/26566891/">eternal youth</a> drives a <a href="https://www.alliedmarketresearch.com/longevity-and-anti-senescence-therapy-market-A14010">multi-billion pound industry</a> ranging from anti-ageing products, supplements and <a href="https://www.everydayhealth.com/diet-nutrition/longevity-diet">diets</a> for those hoping to extend their lifespan. f you look back to the turn of the 20th century, average life expectancy in the UK was around 46 years. Today, it’s closer to <a href="https://population.un.org/wpp/">82 years</a>. We are in fact <a href="https://pubmed.ncbi.nlm.nih.gov/27706136/">living longer than ever before</a>, possibly due to medical advancements and improved <a href="https://www.health.org.uk/publications/reports/mortality-and-life-expectancy-trends-in-the-uk">living and working conditions</a>. But living longer has also come at a price. We’re now seeing higher rates of <a href="https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death">chronic and degenerative diseases</a> – with heart disease consistently topping the list. So while we’re fascinated by what may help us live longer, maybe we should be more interested in being healthier for longer. Improving our “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632858/">healthy life expectancy</a>” remains a global challenge. Interestingly, certain locations around the world have been discovered where there are a high proportion of centenarians who display remarkable physical and mental health. The <a href="https://pubmed.ncbi.nlm.nih.gov/15489066/">AKEA study of Sardinia, Italy</a>, as example, identified a “blue zone” (named because it was marked with blue pen), where there was a higher number of locals living in the central-eastern mountainous areas who had reached their 100th birthday compared with the wider Sardinian community. This longevity hotspot has since been expanded, and now includes several other areas around the world which also have greater numbers of longer-living, healthy people. Alongside Sardinia, these blue zones are now <a href="https://www.netflix.com/gb/title/81214929">popularly recognised</a> as: Ikaria, Greece; Okinawa, Japan; Nicoya, Costa Rica; and Loma Linda, California. Other than their long lifespans, people living in these zones also appear to share certain other commonalities, which centre around being <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874460">part of a community</a>, having a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4224996/">life purpose</a>, eating <a href="https://pubmed.ncbi.nlm.nih.gov/33514872/">nutritious, healthy foods</a>, keeping <a href="https://www.nature.com/articles/s41398-021-01735-7">stress levels</a> low and undertaking purposeful daily <a href="https://pubmed.ncbi.nlm.nih.gov/30202288/">exercise or physical tasks</a>. Their longevity could also relate to their <a href="https://pubmed.ncbi.nlm.nih.gov/9010380/">environment</a>, being mostly rural (or less polluted), or because of <a href="https://pubmed.ncbi.nlm.nih.gov/22253498/">specific longevity genes</a>. However, studies indicate genetics may only account for <a href="https://pubmed.ncbi.nlm.nih.gov/8786073">around 20-25% of longevity</a> – meaning a person’s lifespan is a complex interaction between lifestyle and genetic factors, which contribute to a long and healthy life. <h2>Is the secret in our diet?</h2> When it comes to diet, each blue zone has its own approach – so one specific food or nutrient does not explain the remarkable longevity observed. But interestingly, a diet rich in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662288">plant foods</a> (such as locally-grown vegetables, fruits and legumes) does appear to be reasonably consistent across these zones. For instance, the Seventh-day Adventists of Loma Linda are <a href="https://pubmed.ncbi.nlm.nih.gov/10641813/">predominately vegetarian</a>. For centenarians in Okinawa, <a href="https://pubmed.ncbi.nlm.nih.gov/20234038/">high intakes of flavonoids</a> (a chemical compound typically found in plants) from purple sweet potatoes, soy and vegetables, have been linked with <a href="https://pubmed.ncbi.nlm.nih.gov/11710359/">better cardiovascular health</a> – including lower cholesterol levels and lower incidences of stroke and heart disease. In Nicoya, consumption of locally produced rice and beans has been associated with <a href="https://pubmed.ncbi.nlm.nih.gov/34444746/">longer telomere length</a>. Telomeres are the structural part at the end of our chromosomes which protect our genetic material. Our telomeres get shorter each time a cell divides – so get progressively shorter as we age. Certain <a href="https://pubmed.ncbi.nlm.nih.gov/21102320/">lifestyle factors</a> (such as smoking and poor diet) can also shorten telomere length. It’s thought that telomere length acts as a <a href="https://pubmed.ncbi.nlm.nih.gov/31728493/">biomarker of ageing</a> – so having longer telomeres could, in part, be linked with longevity. But a plant-based diet isn’t the only secret. In Sardinia, for example, meat and fish is consumed in moderation in addition to locally grown vegetables and <a href="https://journalofethnicfoods.biomedcentral.com/articles/10.1186/s42779-022-00152-5">traditional foods</a> such as acorn breads, pane carasau (a sourdough flatbread), honey and soft cheeses. Also observed in several blue zone areas is the inclusion of <a href="https://www.jacc.org/doi/10.1016/j.jacc.2021.10.041">olive oil</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/33669360/">wine</a> (in moderation – around 1-2 glasses a day), as well as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830687/">tea</a>. All of these contain powerful antioxidants which may help <a href="https://ncbi.nlm.nih.gov/pmc/articles/PMC10049696/">protect our cells</a> from damage <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6273542/">as we age</a>. Perhaps then, it’s a combination of the protective effects of various nutrients in the diets of these centenarians, which explains their exceptional longevity. Another striking observation from these longevity hot spots is that meals are typically <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232892">freshly prepared at home</a>. Traditional blue zone diets also don’t appear to contain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6538973/">ultra-processed foods</a>, fast foods or sugary drinks which may <a href="https://pubmed.ncbi.nlm.nih.gov/32330232/">accelerate ageing</a>. So maybe it’s just as important to consider what these longer-living populations are not doing, as much as what they are doing. There also appears to be a pattern of eating until 80% full (in other words partial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9036399/">caloric reduction</a>. This could be important in also supporting how our cells deal with damage as we age, which could mean a longer life. Many of the factors making up these blue zone diets – primarily plant-based and natural whole foods – are associated with <a href="https://pubmed.ncbi.nlm.nih.gov/35706591/">lower risk of chronic diseases</a> such as <a href="https://pubmed.ncbi.nlm.nih.gov/28728684/">heart disease</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/37589638/">cancer</a>. Not only could such diets contribute to a <a href="https://pubmed.ncbi.nlm.nih.gov/37836577/">longer, healthier life</a>, but could support a more <a href="https://pubmed.ncbi.nlm.nih.gov/33397404/">diverse gut microbiome</a>, which is also associated with healthy ageing. Perhaps then we can learn something from these remarkable centenarians. While diet is only one part of the bigger picture when it comes to longevity, it’s an area we can do something about. In fact, it might just be at the heart of improving not only the quality of our health, but the quality of how we age.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/221463/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/justin-roberts-1176632">Justin Roberts</a>, Professor of Nutritional Physiology, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a>; <a href="https://theconversation.com/profiles/joseph-lillis-1505087">Joseph Lillis</a>, PhD Candidate in Nutritional Physiology, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a>, and <a href="https://theconversation.com/profiles/mark-cortnage-438941">Mark Cortnage</a>, Senior Lecturer in Public Health and Nutrition, <a href="https://theconversation.com/institutions/anglia-ruskin-university-1887">Anglia Ruskin University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/people-in-the-worlds-blue-zones-live-longer-their-diet-could-hold-the-key-to-why-221463">original article</a>.

Food & Wine

The world's most promiscuous countries revealed

An analysis of the world's sexual habits has revealed the top 10 most promiscuous countries in the world and Turkey came in first. The average Turk has slept with more than 14 people according to the World Population Review, with Australia coming in a close second with the average Aussie having slept with more than 13 people, according to the New York Post. “The average number of sexual partners can vary significantly from country to country, as cultural norms can have a significant impact on the number of people someone has sex with,” the website declared. Their figures were based on a compilation of “datasets from multiple third party sources.” Turkey's top spot may be surprising to some, with most residents being muslim and the country is widely conceived to have traditional views when it comes sex and relationships. New Zealand came in at third, with a similar number to Australia, followed by Iceland and South Africa. Countries thought to have more liberal views on sex, such as Brazil and France, were lower down the list, with the average Brazilian sleeping with nine people putting them in 25th place, while France clocked in 29th position. The United States clocked in 13th place, with Americans sleeping with an average of 10.7 people. Here's the Top 10 most promiscuous countries: 1. Turkey (14.5 people) 2. Australia (13.3) 3. New Zealand (13.2) 4. Iceland (13.0) 5. South Africa (12.5) 6. Finland (12.4) 7. Norway (12.1) 8. Italy (11.8) 9. Sweden (11.8) 10. Switzerland (11.1) Image: Getty

International Travel

World's oldest woman turns 117

One of the world's oldest living person has turned 117. Maria Branyas Morera born on March 4, 1907 in San Francisco, lived through the 1918 pandemic, the two World Wars, Spain’s civil war and fully recovered after contracting Covid just days before her 113th birthday. She was one of the world's oldest Covid survivor's in 2020 and is now the 12th oldest verified person in history. Maria, who moved to Catalonia, Spain when she was eight, proudly announced her age on X, formerly known as Twitter in a post that read: “Good morning, world. Today I turn 117 years old. I’ve come this far.” Maria, who has lived in a nursing home for the past 23 years, is healthier than ever aside from hearing difficulties and mobility issues, and scientists are studying her to find out the secrets to a long life. “She remembers with impressive clarity events from when she was only four years old, and she does not present any cardiovascular disease, common in elderly people," Scientist Manel Esteller told Spanish outlet ABC. “It is clear that there is a genetic component because there are several members of her family who are over 90 years old.” Scientists and Maria are working together to gain further insights into living longer, and researchers hope that studying Maria’s genes will help with the development of drugs which could combat diseases associated with ageing. Maria had three children with her husband a Catalan doctor named Joan Moret. Her husband passed away 1976, and Maria also outlived her only son, August who tragically passed away in a tractor accident when he was 86. Maria now has two daughters, 11 grandchildren and 11 great-grandchildren. The oldest person ever established was a Frenchwoman named Jeanne Calment, who lived to the age of 122 years and 164 days. Image: news.com.au/ Guiness Book of Records

Family & Pets

Surprising Aussie beach crowned best in the world

An iconic Australian beach has been named the best in the world in a prestigious list of the most picturesque coastlines on the planet. Each year, <a href="https://www.cntraveller.com/gallery/best-beaches-in-the-world" target="_blank" rel="noopener">Condé Nast Traveler</a> ranks the beaches from around the world to curate a list of 34 locations that every beach lover needs to visit. In the top ten list, five beaches from both Australia and New Zealand feature, living up to the countries reputations of stunning coastlines. With a “combination of leaning palm trees on powdery sand”, the publication crowned Palm Cove Beach as the best beach in the world, describing the spot in Queensland as “the epitome of a tropical paradise”. Located north of Cairns, the publication shared that Palm Cove is relatively “crowd free” and home to a range of unique wildlife. While many on social media were quick to agree with the winning location, others argued that there are beaches around Australia more deserving of the crown. “The only way you rank Palm Cove as the best beach in the world is if you have never been to Palm Cove or don’t like beaches,” one wrote. “Eyre Peninsula beaches leave Palm Cove for dead,” another added. “Best beach if you don’t ever want to go in the water. What about all the magic in WA?” one questioned. Check out the top 10 list of the world’s best beaches below. 10. Die Plaat, South Africa 9. Awaroa, South Island, New Zealand 8. Noosa Beach, Australia 7. Dune du Pilat, France 6. Mona Vale Beach, Australia 5. Ora Beach, Indonesia 4. Wategos Beach, Australia 3. Brekon, Shetland 2. Honopu Beach, Kauai, Hawaii 1. Palm Cove Beach, Australia Image credits: Shutterstock

International Travel

Young boy beats rare brain cancer in world first

A 13-year-old boy from Belgium has become the first person in the world to be cured from a deadly brain cancer. Lucas Jemeljanova was only six-years-old when he was diagnosed with diffuse intrinsic pontine glioma (DIPG), a rare and aggressive brain cancer which kills 98 per cent of sufferers within five years. He was randomly assigned to receive everolimus, a type of chemotherapy drug during a clinical trial. The drug is commonly used to treat kidney, pancreas, breast and brain cancer, but up to this point has not been successfully used to treat DIPG. Seven years later, Lucas has responded well to the treatment and has no trace of cancer, and has officially been in remission for five years. His doctor, Jacques Grill said that Lucas "beat the odds" and his case "offers real hope". Lucas was one of the first few people enrolled in the BIOMEDE trial in France, which was testing potential new drugs for DIPG. The drug works by preventing the cancer cells from reproducing and decreasing blood supply to the cancer cells, and it is an FDA approved prescription drug for cancer. Doctors were initially hesitant to stop the treatment until a year ago and a half ago. "I didn’t know when to stop, or how, because there was no reference in the world," Dr Grill told the AFP. "Over a series of MRI scans, I watched as the tumour completely disappeared," he added. Seven other children who were also in the trial have been considered "long responders", as they haven't had any relapses for three years after their diagnosis, but only Lucas was cured. The reason behind his complete recovery is still unknown, but it could be because of "biological particularities" in his tumour. "Lucas' tumour had an extremely rare mutation which we believe made its cells far more sensitive to the drug," Dr Grill added. DIPG is typically found in children between ages five and nine. The cause of the tumour is unknown but some of the first symptoms include problems with eye movement and balance, facial weakness, difficulty walking and strange limb movements. Researchers are currently trying to reproduce the difference seen in Lucas' cells. "Lucas is believed to have had a particular form of the disease," Dr Grill said. "We must understand what and why to succeed in medically reproducing in other patients what happened naturally with him." However Dr Grill said that this process won't be quick. "On average, it takes 10-15 years from the first lead to become a drug – it's a long and drawn-out process." Images: Facebook

Caring

Arrests made over record-holder's sudden tragic death

Arrests have been made after Kelvin Kiptum's father claimed that four men had attended his home looking for the Kenyan superstar before his death. The marathon world record holder tragically <a href="https://www.oversixty.co.nz/health/caring/world-record-holder-dies-tragically-at-age-24" target="_blank" rel="noopener">passed away</a> at the age of 24, after a horrific collision that occurred in Western Kenya on Monday killed both him and his coach Gervais Hakizimana. Kenyan police have arrested four unidentified men after Kiptum's father, Samson Cheruiyot, called for an investigation into a visit that he said occurred just before the accident. "The four were taken to Elgeyo Marakwet for further investigations," Keiyo South Sub County commandant Abdullahi Dahir said. "They all come from Uasin Gishu County." Kiptum's devastated father broke down as he spoke about the death of his own child. "There are people who came home a while back who were looking for Kiptum, but they refused to identify themselves," Cheruiyot recalled. "I asked them to provide identification, but they opted to leave. It was a group of four people." He also recalled the moment he found out about his son's death. "I got the news of my son's death while I was watching the news," Kiptum's father said. "I went to the scene of the accident but the police had taken the body to Eldoret." Kiptum broke the marathon world record that was previously held by Eliud Kipchoge, after storming through the race in Chicago in just two hours and 35 seconds. Cheruiyot said that he last spoke to his son a day before his death. "He told me someone will come and help us build a house," he said. "He said that his body is now fit and he can now run for 1:59. "Kiptum was my only child. He has left me, his mum and his kids. I have no other child. His mum was sick for a while. Right now I'm deeply saddened." Images: Getty

Legal

World record holder dies tragically at age 24

Marathon world record holder Kelvin Kiptum has tragically died at the age of 24. The Kenyan athlete and his his coach, Rwanda's Gervais Hakizimana, both passed away after a horrific traffic collision on Monday, that occurred in western Kenya. The crash happened on a road between the towns of Eldoret and Kaptagat, where a noted high-altitude training centre for long-distance athletes is located. In October 2023, Kiptum set the world record of 2 hours and 35 seconds at the Chicago Marathon. The record was only made official by World Athletics on February 7th, just five days before his untimely death. Kenya's Sports Minister Ababu Namwamba spoke out on Kiptum's death, writing on X, "Devastatingly sickening!! Kenya has lost a special gem. Lost for words." Former prime minister Raila Odinga described Kiptum as a "Kenyan athletics icon" in a statement on social media, writing, "Devastating news as we mourn the loss of a remarkable individual." "My deepest condolences to his loved ones, friends, and the entire athletics fraternity." <div data-component="EmphasisedText"> "Our nation grieves the profound loss of a true hero." After making his marathon debut just over a year ago, Kiptum ran three of the fastest seven marathons in history during his brief career. The Kenyan athlete had declared his goals to take home a gold medal at the 2024 Paris Olympics in the weeks before his death. Image credits: Getty Images </div>

Caring

World's most powerful women come together to mark the end of an era

A group of the most powerful and influential women in the worlds of fashion and entertainment have joined forces to appear on a legendary cover of British Vogue. The iconic cover shoot occurred to celebrate the magazine's editor Edward Enninful, who is stepping back from the role after six years at the helm. Enninful gathered his muses for the history-making "Legendary" edition, featuring the likes of Oprah Winfrey, Jane Fonda, Selma Blair, Salma Hayek, Victoria Beckham, Miley Cyrus, Dua Lipa, and many more. "To get one of these women on a cover takes months. To get 40? Unheard of," Cyrus remarked in an on-set video. In a post to social media, Selma Blair remarked that she "didn't want the day to end". <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/C3FtXApL8_O/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/C3FtXApL8_O/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by British Vogue (@britishvogue)</a> </div> </blockquote> The shoot also included models Kate Moss, Cara Delevingne, Karlie Kloss, alongside the original '90s supermodels – Naomi Campbell, Iman, Linda Evangelista, Christy Turlington and Cindy Crawford. Evangelista said of the iconic shoot, "I've met so many people today on my bucket list". Hayek also posted about the experience on Instagram, saying, "So honoured to be part of this legendary cover of British Vogue and Edward Enninful's muses, especially because they are my muses too!" Jane Fonda summed up the energy of the day on set, saying, "Women understand the importance and power of the collective." Image credits: Instagram

Beauty & Style

The stunning winners of the 2024 Sony World Photography Awards

From mist-covered jungles and hilarious animals, to bustling cities and stunning mountain ranges, the 2024 <a href="https://www.worldphoto.org/sony-world-photography-awards" target="_blank" rel="noopener">Sony World Photography Awards</a> have showcased the best of every corner of the globe. The annual competition has named the winners of both the national and regional competition, with over 395,000 entries submitted from more than 220 countries. The Sony World Photography Awards run each year and aim to elevate the careers of photographers to the next level, while also championing inclusivity for entrants. This year's entrants hail from countries such as Singapore, Japan, Bolivia, Myanmar, Macedonia, Saudi Arabia, China, Ecuador and many more. Running for its 11th year and featuring topics such as nature, landscape, architecture, portraiture and sports, the organisers of the awards praised the “unique styles and approaches to the medium” in the 2024 competition. All image credits: Sony World Photography Awards

International Travel

Tourist arrested for disgusting act at sacred UNESCO World Heritage Site

A tourist has been arrested after he committed this disgusting act on top of the Leshan Giant Buddha, a sacred UNESCO World Heritage Site in China. The man allegedly found a blind spot away from CCTV cameras, climbed over the security fence and on top of the statue. Once he reached the top of the monuments head, he proceeded to pull down his pants and urinate in front of horrified visitors who filmed the act. Security guards quickly removed the unidentified man and handed him over to police, after being informed of his actions. It is reported that the man was taken to a nearby hospital for psychiatric evaluation. The UNESCO World Heritage Site itself is a 71-metre-tall monument, which is considered to be the largest and tallest stone Buddha statue in the world. The Leshan Giant Buddha monument is located in the Sichuan Province of China, and was carved out of a cliff face between 713 and 803 AD. The statue and surrounding Mount Emei Scenic Area have been listed as a UNESCO World Heritage Site since 1996. This act is one of many incidences of tourists behaving badly across the world. In June 2023 a German tourist was detained after <a href="https://www.oversixty.com.au/travel/travel-trouble/tourist-accused-of-causing-over-8-000-in-damages-to-iconic-roman-statue" target="_blank" rel="noopener">climbing up</a> a 16th-century Fountain of Neptune, and was accused of causing over $8,000 in damages to the iconic statue. Prior to that, an Irish tourist landed himself into <a href="https://www.oversixty.com.au/finance/legal/tourist-busted-for-carving-name-into-world-s-most-famous-roman-relic" target="_blank" rel="noopener">trouble in Rome</a> after carving his and his girlfriend's name onto the walls of the Colosseum. Images: News.com.au

Travel Trouble

The most welcoming cities in the world revealed

Travel experts at booking.com have shared the top ten most welcoming cities in the world for 2024. In their 12th edition of of the Traveller Review Awards, booking.com shared their picks for the most inviting countries, giving eager travellers new destinations to add to their 2024 holiday bucket list. To determine what cities made the list, nooking.com used more than 309 million verified customer reviews from their site, with the frontrunners of the list boasting exceptional hospitality in all areas. Coming in at the coveted first place is Arraial d’Ajuda in Brazil: a charming beach town known for its calm and serene atmosphere. According to Booking.com’s report, Arraial d’Ajuda is the perfect destination for 67% of travellers who want to rest and recharge when traveling. One small Aussie town made the list, with Daylesford, Victoria coming in at the number four spot. The sleepy but lovely town in the foothills of the Great Dividing Range offers plenty of nature nearby to explore for those looking to switch off. With classic Aussie pubs, great local food, fun shops to explore, and welcoming residents, it's an ideal weekend getaway spot. Check out the entire top 10 list below. 1. Arraial d’Ajuda, Brazil 2. Ermoupoli, Greece 3. Viana do Castelo, Portugal 4. Daylesford, Australia 5. Grindelwald, Switzerland 6. Moab, United States 7. Uzès, France 8. Mazatlán, Mexico 9. Jaisalmer, India 10. Fujikawaguchiko, Japan Image credits: Getty Images / Shutterstock

International Travel

World's oldest dog has title suspended amid doubts about his age

The world's <a href="https://www.oversixty.com.au/lifestyle/family-pets/miraculous-meet-the-world-s-oldest-dog" target="_blank" rel="noopener">oldest dog</a>, Bobi, who was reportedly 31 years and 165 days old when he died in October, has provisionally lost his title as Guinness World Records investigates his age. Bobi, a purebred Rafeiro do Alentejo, was a livestock guardian breed with a life expectancy of anywhere between 12-14 years, which meant that he lived over double his age. His age was initially confirmed by the Veterinary Medical Service of the Municipality of Leiria, which said he had been registered in 1992, which was then verified by Portuguese government-authorised pet database SIAC. He was crowned the world's "oldest ever dog" in February, and his owner Leonel Costa claimed that there were many reasons behind the dog's extraordinary age. Costa said that Bobi always roamed freely, lived in a "calm, peaceful" environment and ate human food soaked in water to remove seasonings. But now, Bobi's true age has been question after suspicions about the evidence that proved his true age were raised not long after his death. "While our review is ongoing we have decided to temporarily pause both the record titles for oldest dog living and ever just until all of our findings are in place," a spokesperson told CNN. The GWR is now conducting a formal review, which involves analysing existing evidence, seeking new evidence, and reaching out to experts and those linked to the original application. The previous record for the world's oldest dog was held by Australian cattle dog Bluey, who was born in 1910 and lived to be 29 years and five months old. Image: Youtube

Family & Pets

Cancer survivor becomes world's strongest great-grandmother

An Australian great-grandmother has become a world-record holder for an impressive feat in the gym. Heather Maddern, 80, found a new love of weightlifting after she decided to hit the gym to regain strength after beating cancer three times. Now, she is officially the world's strongest great-grandmother. "I hold the Australian and world record for an 80-year-old lady. It's amazing," she told <a href="https://9now.nine.com.au/a-current-affair/great-grandmother-strongest-powerlifting-world-records/ffe9aa0e-9fc9-40b5-b8ff-d8744b37de0c" target="_blank" rel="noopener">A Current Affair</a>. "I just absolutely love the life I am living and I put it all down to powerlifting." Maddern, who suffers from Parkinsons, lifted the record-breaking 80kgs in Brisbane at a powerlifting competition, saying she is "absolutely chuffed" to break the world record for her age group. Reflecting on the moment she broke the record, Maddern said, "I just put it [the bar] down and went through the crowd with a big smile on my face, I was absolutely chuffed." Before the great-grandmother discovered her love for lifting weights, she was barely able to walk up and down stairs due to extensive chemotherapy and radiation to treat her cancer, and decided to make a change. "I was very weak, my posture wasn't very good. I was extremely tired. I knew I had to do something to change it, otherwise it would keep getting worse and worse," she said. Her coach, Jill Cox, said, "We had to help Heather walk down the stairs to get into the gym. She is inspirational. what she can do, anybody can do." Heather's life has changed drastically since she regularly started going to the gym, and despite being 80 years old, she has never felt better. "My son six months ago thought I was totally crazy, now they are all so very proud of me," she said. "I just feel so fit. Mentally I feel clearer headed and happy all of the time." Image credits: A Current Affair

Body

Extraordinary snaps from around the world for the Nature Photographer of the Year awards

Every year, the <a href="https://naturephotographeroftheyear.com" target="_blank" rel="noopener">Nature Photographer of the Year</a> awards showcase the best that Mother Nature has to offer. For the 2023 competition, photographers from all around the world have captured beautiful snaps of wildlife in their natural habitat, picturesque landscapes and much more. The annual competition is an initiative of Nature Talks, the organisation responsible for the Nature Talks Photo Festival that takes place in the Netherlands. This year, the competition saw entrant from South Africa, Germany, the USA, England, Finland, France, Luxembourg and many more corners of the globe. This year's winner is a photographer hailing from Canada, Jacquie Matechuk, who stole the show with her photo of the Spectacled Bear. Chairman Marco Gaiotti explained why her photo was chosen as the winner, "The Spanish moss hanging from this centuries-old fig tree gives an incredible sense of three-dimensionality while the soft light filtering through the colours highlights the profound connection between species and habitat in this image." "Finally, the pose of this spectacled bear fits perfectly into the texture of the photograph. Congratulations to Jacquie Matechuk for this outstanding photograph of the spectacled bear." All image credits: Nature Photographer of the Year

International Travel

The rise and fall of antibiotics. What would a post-antibiotic world look like?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> These days, we don’t think much about being able to access a course of antibiotics to head off an infection. But that wasn’t always the case – antibiotics have been available for less than a century. Before that, patients would die of relatively trivial infections that became more serious. Some serious infections, such as those involving the heart valves, were <a href="https://pubmed.ncbi.nlm.nih.gov/20173297/">inevitably</a> fatal. Other serious infections, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070694/">tuberculosis</a>, weren’t always fatal. Up to a <a href="https://www.biorxiv.org/content/10.1101/729426v1.full.pdf">half</a> of people died within a year with the most severe forms, but some people recovered without treatment and the remainder had ongoing chronic infection that slowly ate away at the body over many years. Once we had antibiotics, the outcomes for these infections were much better. <h2>Life (and death) before antibiotics</h2> You’ve probably heard of Alexander Fleming’s accidental <a href="https://www.acs.org/education/whatischemistry/landmarks/flemingpenicillin.html">discovery of penicillin</a>, when fungal spores landed on a plate with bacteria left over a long weekend in 1928. But the <a href="https://www.ox.ac.uk/news/science-blog/penicillin-oxford-story">first patient</a> to receive penicillin was an instructive example of the impact of treatment. In 1941, Constable Albert Alexander had an infected scratch on his face that had become infected. He was hospitalised but despite various treatments, the infection progressed to involve his head. This required removing one of his eyes. Howard Florey, the Australian pharmacologist then working in Oxford, was concerned penicillin could be toxic in humans. Therefore, he felt it was only ethical to give this new drug to a patient in a desperate condition. Constable Alexander was given the available dose of penicillin. Within the first day, his condition had started to improve. But back then, penicillin was difficult to produce. One way of extending the limited supply was to “recycle” penicillin that was excreted in the patient’s urine. Despite this, supplies ran out by the fifth day of Alexander’s treatment. Without further treatment, the infection again took hold. Constable Alexander eventually died a month later. We now face a world where we are potentially running out of antibiotics – not because of difficulties manufacturing them, but because they’re losing their effectiveness. <h2>What do we use antibiotics for?</h2> We currently use antibiotics in humans and animals for a variety of reasons. Antibiotics reduce the duration of illness and the chance of death from infection. They also prevent infections in people who are at high risk, such as patients undergoing surgery and those with weakened immune systems. But antibiotics aren’t always used appropriately. <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/fulltext">Studies</a> consistently show a dose or two will adequately prevent infections after surgery, but antibiotics are <a href="https://irp.cdn-website.com/d820f98f/files/uploaded/surgical-prophylaxis-prescribing-in-australian-hospitals-results-of-the-2020-surgical-national-antimicrobial-prescribing-survey.pdf">often</a> continued for several days unnecessarily. And sometimes we use the wrong type of antibiotic. <a href="https://irp.cdn-website.com/d820f98f/files/uploaded/antimicrobial-prescribing-practice-in-australian-hospitals-results-of-the-2020-hospital-national-antimicrobial-prescribing-survey.pdf">Surveys</a> have found 22% of antimicrobial use in hospitals is inappropriate. In some situations, this is understandable. Infections in different body sites are usually due to different types of bacteria. When the diagnosis isn’t certain, we often <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13334">err</a> on the side of caution by giving broad spectrum antibiotics to make sure we have active treatments for all possible infections, until further information becomes available. In other situations, there is a degree of inertia. If the patient is improving, doctors tend to simply continue the same treatment, rather than change to more appropriate choice. In general practice, the issue of diagnostic uncertainty and therapeutic inertia are often magnified. Patients who recover after starting antibiotics don’t usually require tests or come back for review, so there is no easy way of knowing if the antibiotic was actually required. Antibiotic prescribing can be more complex again if <a href="https://www.mja.com.au/journal/2014/201/2/antibiotic-prescribing-practice-residential-aged-care-facilities-health-care">patients</a> are expecting “a pill for every ill”. While doctors are generally good at educating patients when antibiotics are not likely to work (for example, for viral infections), without confirmatory tests there can always be a lingering doubt in the minds of both doctors and patients. Or sometimes the patient goes elsewhere to find a prescription. For other infections, resistance can develop if treatments aren’t given for long enough. This is particularly the <a href="https://pubmed.ncbi.nlm.nih.gov/11971765/">case</a> for tuberculosis, caused by a slow growing bacterium that requires a particularly long course of antibiotics to cure. As in humans, antibiotics are also used to prevent and treat infections in animals. However, a proportion of antibiotics are used for growth promotion. In Australia, an <a href="https://www.mja.com.au/journal/2019/211/4/antibiotic-use-animals-and-humans-australia">estimated</a> 60% of antibiotics were used in animals between 2005-2010, despite growth-promotion being phased out. <h2>Why is overuse a problem?</h2> Bacteria become resistant to the effect of antibiotics through natural selection – those that survive exposure to antibiotics are the strains that have a mechanism to evade their effects. For example, antibiotics are sometimes given to <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30279-2/fulltext">prevent</a> recurrent urinary tract infections, but a consequence, any infection that does <a href="https://academic.oup.com/cid/article/73/3/e782/6141409">develop</a> tends to be with resistant bacteria. When resistance to the commonly used first-line antibiotics occurs, we often need to reach deeper into the bag to find other effective treatments. Some of these last-line antibiotics are those that had been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202707/">superseded</a> because they had serious side effects or couldn’t be given conveniently as tablets. New drugs for some bacteria have been developed, but many are much more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955006/">expensive</a> than older ones. <h2>Treating antibiotics as a valuable resource</h2> The concept of antibiotics as a valuable resource has led to the <a href="https://pubmed.ncbi.nlm.nih.gov/8856755/">concept</a> of “antimicrobial stewardship”, with programs to promote the responsible use of antibiotics. It’s a similar concept to environmental stewardship to prevent climate change and environmental degradation. Antibiotics are a rare class of medication where treatment of one patient can potentially affect the outcome of other patients, through the transmission of antibiotic resistant bacteria. Therefore, like efforts to combat climate change, antibiotic stewardship relies on changing individual actions to benefit the broader community. Like climate change, antibiotic resistance is a complex problem when seen in a broader context. Studies have linked resistance to the values and priorities <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30186-4/fulltext">of governments</a> such as corruption and infrastructure, including the availability of electricity and public services. This highlights that there are broader “causes of the causes”, such as public spending on sanitation and health care. Other <a href="https://academic.oup.com/jac/article/74/9/2803/5512029?login=true">studies</a> have suggested individuals need to be considered within the broader social and institutional influences on prescribing behaviour. Like all human behaviour, antibiotic prescribing is complicated, and factors like what doctors feel is “normal” prescribing, whether junior staff feel they can challenge senior doctors, and even their <a href="https://www.nytimes.com/2016/10/07/upshot/your-surgeon-is-probably-a-republican-your-psychiatrist-probably-a-democrat.html">political views</a> may be important. There are also issues with the <a href="https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/value-assessment-of-antimicrobials-and-the-implications-for-development-access-and-funding-of-effective-treatments-australian-stakeholder-perspective/D45758CFB95520DA4FF06E46135E0628">economic model</a> for developing new antibiotics. When a new antibiotic is first approved for use, the first reaction for prescribers is not to use it, whether to ensure it retains its effectiveness or because it is often very expensive. However, this doesn’t really <a href="https://academic.oup.com/cid/article/50/8/1081/449089?login=true">encourage</a> the development of new antibiotics, particularly when pharma research and development budgets can easily be diverted to developing drugs for conditions patients take for years, rather than a few days. <h2>The slow moving pandemic of resistance</h2> <blockquote> If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine – <a href="https://amr-review.org/">David Cameron</a>, former UK Prime Minister </blockquote> Antibiotic resistance is already a problem. Almost all infectious diseases physicians have had the dreaded call about patients with infections that were essentially untreatable, or where they had to scramble to find supplies of long-forgotten last-line antibiotics. There are already hospitals in some parts of the world that have had to carefully <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">consider</a> whether it’s still viable to treat cancers, because of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276316/">high risk</a> of infections with antibiotic-resistant bacteria. A global <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext">study</a> estimated that in 2019, almost 5 million deaths occurred with an infection involving antibiotic-resistant bacteria. Some 1.3 million would not have occurred if the bacteria were not resistant. The UK’s 2014 <a href="https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf">O'Neill report</a> predicted deaths from antimicrobial resistance could rise to 10 million deaths each year, and cost 2-3.5% of global GDP, by 2050 based on trends at that time. <h2>What can we do about it?</h2> There is a lot we can do to prevent antibiotic resistance. We can: <ul> <li> <a href="https://www.marketingmag.com.au/news/film-picking-gonorrhoea-wins-tropfest-prize/">raise</a> <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7258-3">awareness</a> that many infections will get better by themselves, and don’t necessarily need antibiotics </li> <li> use the antibiotics we have more appropriately and for as short a time as possible, supported by co-ordinated clinical and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437704/">public policy</a>, and <a href="https://www.amr.gov.au/">national</a> <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00796-4/fulltext">oversight</a> </li> <li> <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/about-aura-surveillance-system">monitor</a> for infections due to resistant bacterial to inform control policies </li> <li> reduce the inappropriate use of antibiotics in animals, such as <a href="https://nam.edu/antibiotic-resistance-in-humans-and-animals/">growth promotion</a> </li> <li> <a href="https://pubmed.ncbi.nlm.nih.gov/11971765/">reduce</a> cross-transmission of resistant organisms in hospitals and in the community </li> <li> prevent infections by other means, such as clean water, <a href="https://apps.who.int/iris/bitstream/handle/10665/204948/WHO_FWC_WSH_14.7_eng.pdf">sanitation</a>, hygiene and <a href="https://www.who.int/teams/immunization-vaccines-and-biologicals/product-and-delivery-research/anti-microbial-resistance">vaccines</a> </li> <li> continue developing new antibiotics and alternatives to antibiotics and ensure the right <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00124-2/fulltext#:%7E:text=We%20consider%20four%20incentive%20options,exclusivity%20extensions%2C%20and%20milestone%20payments.">incentives</a> are in place to encourage a continuous pipeline of new drugs. </li> </ul> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor in Infectious Diseases Epidemiology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-rise-and-fall-of-antibiotics-what-would-a-post-antibiotic-world-look-like-213450">original article</a>.

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