Reacting too late: humanity’s greatest existential crisis

When existential crises come, they come not single spies but in battalions. Oppenheimer, the film of the moment, alongside Barbie, tells the story of the Manhattan Project and the nuclear bombings of Hiroshima and Nagasaki that hastened the end of the second world war. The monster of nuclear war has stalked us ever since, an existential crisis that has others for close company.

At The BMJ’s south Asia editorial board meeting last week an academic hypothesised that, although nuclear armament might not have prevented India and Pakistan from political and social turmoil, it did prevent them from military decimation by foreign powers, an outcome seen in some Arab countries and in Africa. The same argument might be made for Iran, Israel, and North Korea.

Is it, though, a risk worth taking? An existential crisis traded for national security? The calculus seems awry. The risk of nuclear war is growing, not receding, according to atomic scientists who moved the hands of the doomsday clock forward by 90 seconds in January (doi:10.1136/bmj.p1682).1 Tension between nuclear armed states, poor progress on nuclear non-proliferation, and many examples of near misses are some of the reasons why humanity is closer to the brink. The world has around 130 000 nuclear weapons, and a “limited” war would kill 120 million people immediately, trigger a nuclear famine, and place two billion people at risk.

Physicians have led the campaign for nuclear disarmament, and the responsibility is on us again to set national politics aside and put humanity first. Over 100 journal editors are doing just that with a jointly signed editorial urging the health sector to work “with renewed energy to reduce the risks of nuclear war and to eliminate nuclear weapons” (doi:10.1136/bmj.p1682).1

Many of the effects of a nuclear war would be mediated by an acceleration of the global climate crisis. We already have enough arguments, in terms of effects on human health and nature, to urgently prioritise our response to the climate crisis. By some estimates we are even now beyond the point of no return (https://press.un.org/en/2022/sgsm21173.doc.htm).2

With fossil fuel companies continuing to accumulate vast profits, accompanied by mixed commitments to renewable alternatives to oil and gas, the UK’s decision to support new investments and licences for oil and gas is shocking and contrarian (doi:10.1136/bmj.p1794).3 A BMJ investigation last year revealed how Exxon scientists concluded more than four decades ago that carbon capture, another of the planned UK investments, might work technically but fails economically because the “energy required to capture and transport the carbon to underground storage is too expensive” (doi:10.1136/bmj.o2095).4

A recent entry in the existential crisis race is artificial intelligence. Pace of change is quicksilver and the global market is said to be “booming.” The existential risk credentials of AI at this point seem unclear, however, although the danger to science and research is clear and present. At the very least, the genie of AI can no longer be bottled, and the only reasonable response, argue Jessica Morley and colleagues (doi:10.1136/bmj.p1551),5 is to ensure that the development and evaluation of safeguards is on a par with the “development and evaluation of generative AI models”

A major flaw in the existential crisis narrative is that it can be difficult to register with people who haven’t felt the impacts. For many of us, the existential crisis that matters is the one most personal to us, whether this be the cost of living crisis, perpetuated by social determinants of health (doi:10.1136/bmj.p1578),6 or the crisis in health and social care, worsened by the growing bottlenecks in specialty training (doi:10.1136/bmj.p1732),7 failures to retain staff (doi:10.1136/bmj.p1740),8 cancelled hospital appointments (doi:10.1136/bmj.p1747),9 and an inadequate government focus on population health (doi:10.1136/bmj.p1762).10

There is a reason why the nuclear bombs on Japan made it a prominent supporter of nuclear disarmament; why poor countries that are year after year victims of floods, fires, and droughts are some of the loudest voices demanding action on climate change; why some of the people closest to the latest wave of AI technologies are the loudest proponents of strict regulation. Perhaps, then, humanity’s greatest existential crisis is that we react only when we feel the crisis is on us, when the doomsday clock is mere seconds from midnight, when it is simply too late.