AI can answer any question. It cannot tell you whether you are asking the right one.

ASCO is in Chicago this week. The city exists because its foundations remained objects of governance long after they ceased to be objects of attention. The question is whether we apply the same logic to the biological foundations of modern medicine. #ASCO26 open.substack.com/pub/harpaldh...

Understanding confers obligation

I started writing about antimicrobial resistance to sharpen my own thinking and open it to critique. I did not expect the work to keep returning to the same underlying question.

Markets are very good at rewarding things that get consumed. They are much less comfortable rewarding capabilities whose value comes from continuing to exist. That may matter more than we realise.

Some capabilities become important enough that societies stop governing them through ordinary political cycles. Money is one example. Antimicrobial effectiveness belongs in the same category. And it will not be the last capability that requires this kind of preservation.

The AMR community has produced increasingly sophisticated analysis for decades They have not defined what preserving antimicrobial effectiveness actually requires, who owns that responsibility, or what authority it would need.

Some problems persist because the right institutions don’t exist, or lack authority But you can’t fail to protect something if nobody ever decided it should be protected in the first place That’s not institutional failure It’s a failure to define the job

Redirecting anger from wealth inequality to immigration is cheaper than addressing wealth inequality. One costs a headline. The other costs a tax structure. Every media cycle spent on immigration is a cycle not spent on the ownership class.

Apollo 13 produced a synchronising moment; three men, a visible crisis, a world that watched and waited. AMR produces no such moment. Its failures arrive diffusely. Its costs accumulate quietly. Waiting for the moment may itself be the mistake. harpaldhillon.substack.com/p/if-the-mom...

The World Health Assembly is meeting in Geneva this week. Global health governance operates through coordination, guidance, and consensus.

Have you ever wondered what happens when you finally step into the person you were supposed to become?

How do democracies preserve long-horizon systemic capability without drifting into unaccountable technocracy?

I never expected my writing on antimicrobial resistance to resonate so strongly with IT and AI communities. I’m starting to think it’s because the underlying problem is the same: how do you preserve critical capability before visible failure forces recognition?

I decided to write straight from the heart and see where it takes me. Interesting things seem to happen when you stop writing to fit into a conversation and start writing because you genuinely need to understand something.

Sometimes, when the world feels at its darkest, those are the moments we have to double down on ourselves and become the change we wish to see.

What does a society choose to preserve before it becomes obviously profitable or politically unavoidable to do so? That may be the real test of whether a civilisation understands risk at all.

I’ve been awake since 2:30am writing my next AMR article. At the moment, the work feels increasingly less about AMR itself and more about how societies recognise systemic risk before visible crisis arrives. When inspiration arrives like that, you just run with it.

Most institutions do not act when they see risk. They act when enough important people can no longer avoid feeling it.

Why does antimicrobial resistance keep producing advisory institutions for a problem that requires binding authority? The answer is historical. www.linkedin.com/pulse/why-do...

Antifungals offer something antibacterials have not provided in the same way: a resistance signal that precedes clinical failure. That signal has been obscured by decades of AMR governance shaped around the antibacterial case.​​​​​​​​​​​​​​​​

1/ The AMR community is gathered at #ESCMIDGlobal2026 this week. Much of the conversation is about doing more within the current system. That is the right question. It may be the wrong frame entirely.

The hardest career transition isn't between two jobs. It's between two identities. The gap in the middle is the point, not the problem.

Tom Kalil and Renaissance Philanthropy argue that philanthropy lacks the specialised institutional vehicles its hardest problems demand. They are right. But their framework exposes a deeper question.

Iterum got FDA approval. 18 months later, it shut down. Antibiotics that should be held in reserve are forced into volume markets. I call this the reserve transmission gap. Paper here: papers.ssrn.com/sol3/papers....

Working in Monaco has sheltered me from the realities of the real world...for a few days at least...

If you ever doubt whether you could be a great leader, remember that the global economy now depends on a 23-mile stretch of water. Structural failure rarely arrives as a mistake. It arrives as a system that was never designed with fragility in mind.

The science of racism with Professor Keon West

The thing about writing is that it never feels finished.

Active conflicts are creating conditions that accelerate antimicrobial resistance fastest. The institutions needed to govern antibiotics as a strategic asset are often the same ones driving those conflicts. That is not an accusation. It is a governance design problem with no ceasefire solution.

🎵in violent times, you shouldn’t have to sell your soul🎵

We are either becoming more resilient or complacent

Focus on controlling your controllables

Let myself down my saying “the science” 😔

Medicine is transitioning from: Therapeutic Era (products solve problems) → Capability Era (systems must preserve options)

My new working paper: Antibiotics as reserve assets. Diagnostics as monetary policy. The missing central banking architecture for AMR governance. I am sharing it to invite critique, discussion, and engagement papers.ssrn.com/sol3/papers.... #AMR #HealthPolicy #InfectiousDiseases

My new working paper: Antibiotics as reserve assets. Diagnostics as monetary policy. The missing central banking architecture for AMR governance. I am sharing it to invite critique, discussion, and engagement papers.ssrn.com/sol3/papers.... #AMR #HealthPolicy #InfectiousDiseases

The system doesn’t survive because of bad actors. It survives because good ones stop asking what they’re complicit in.

The deeper the thinking, the smaller the room tends to get.

Stepped away for a few months to focus on longer writing. Feels good to be back to shorter, unfinished thoughts again :)

I was invited to tour the new PHTA building in Birmingham yesterday. A great set up and an opportunity for Birmingham Life Sciences and healthcare sector to further their collaborative efforts. Unfortunately, attracting such opportunities is difficult when money is being sucked out of the UK

Yes. Global health is not a cost to cut, it’s a smart investment in keeping people (including in your country, including your own family) safe from danger. ➡️ www.telegraph.co.uk/global-healt...

“The decision to close the Fleming Fund was not accompanied by an official statement or press release.” www.thelancet.com/journals/lan...

We need to go back to the days when politics was boring, and no-one really cared

Most nights I reflect on how much humanity has changed since 2019. Absolutely crazy 🤯

For scientists who want to shift the public narrative, there are really only two paths: rebel or lead

The relocation of the EMA HQ from London quietly reshaped the landscape of UK science following Brexit and the ripple effects remain 😔

Monaco

Many a “career” is still relying on Covid opinion