Energy transitions, sharing vaccines, and making research accessible for non-English speakers

In something of a bonus episode, Gavin, Richard, and Jessamy sit down for an informal chat about what's going on in the news, in health, and in the world of The Lancet, covering healthcare emissions, solar power, and the challenge of global co-operation on vaccines.

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Transcript

This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.

Jessamy: Hello and welcome to this episode of The Lancet Voice. I'm Jessamy Baganal, a senior executive editor at The Lancet, and I'll be joined today by my co host Gavin Cleaver. And by Editor in Chief of The Lancet, Richard Horton. Today we're going to try something new. I say it's new, it's not really new for the rest of the world because many other podcasts are taking a more conversational and relaxed approach to how they are formatted.

But it's new for us. Each month, Richard, Gavin and I will get together to discuss some of the biggest news in health. What we've been doing in the global, public and clinical health space and what we're looking forward to in the coming month. We hope you find this enjoyable and informative. We'd love to hear from you with any suggestions you have.

For how this might work better topics you'd like us to cover or guests you'd like to hear from. Please connect with us on any of your social media platforms. Our handles are rather uninspiringly just our names. You can hear this podcast on all your usual platforms.

Gavin: Reggie, I see you brought a folder of newspapers with you. 

Jessamy: I saw you launch the new collaboration with Jack and I saw on Twitter you giving a speech in a garden it looked like. 

Richard: Yes, we were at the Excel Center is so awesome. Unpleasant. It was so nice to go to a decent place in Knightsbridge, which is like another planet and so we went to Knightsbridge into this pavilion It was called and then onto this very nice terrace With all of these cardiologists and who are exceedingly well dressed 

Jessamy: always 

Richard: It is especially the 

Jessamy: european cardiologists.

Oh my god They have the different color like the different color of their collars and they're it's so it's different from the global 

Gavin: health community What do you mean different color of that? 

Jessamy: You know You can have a blazer But they have a very fitted blazer in brown and then they'll have this bit will be orange and then they'll have some sort of amazing lining inside and You They wear these nice brown.

They look amazing. 

Richard: Yeah, whereas if you go to the global health meetings, I mean it looks like people I don't even want to say it looks like people have just woken up in a tip. Everyone looks like me I've been to a few of them. Yes, exactly. Exactly. It's dirty jeans and a t shirt and they haven't had their hair cut for about three years.

And it's and that's global health. That's what you wear on your There's no private 

Jessamy: practice in global health, that's the 

Richard: problem. There's no, you can't do a few extra angiograms on the side. You can't have a certain, look. Exactly. So I did actually have to put a jacket on for these people.

So no, it was very nice. We had the Jack launch and it was very friendly actually. And we've known them for a long time. The Jack folks. Back in the early 2000s, we were super friendly. And then we went through a period of being not quite so friendly, which will pass over quickly. And now we're back to being good friends again.

And so Harlan Krumholz, the editor of Jack and ourselves we're working out how we can exchange manuscripts, do commissions together and other projects. So it's great actually, it was a very nice event. And then also we had a session at the meeting where all of our cardiovascular commissions were presented.

Yes. Yes. The ones. That we published and the updates on those, and then ones that are being, Yeah, exactly. So that was also and that went well. It went super well. It went super well. Flavia chaired the whole thing, did a brilliant job and Chloe was there in support and did a brilliant job and it was it was a very lovely warm event actually.

So yeah, the ESC was good. So come on, what have you two been doing? 

Jessamy: Mine is not going to sound as interesting as yours, but it's been August. So I think it's been quiet. I think that's allowed an 

All: excuse. 

Jessamy: I joined a very interesting working group lead meeting for our sustainable healthcare commission.

So that's led by Andrea McNeil and Jody Sherman. And it's been going for about a year and a half. And as we know, healthcare. I think the sort of everybody quotes this, contributes 5 percent of global greenhouse gases. And if it was to be, if the whole sector was to be a country, it would be the fifth largest emitter of greenhouse gases.

So there's an enormous amount and everybody's working on how do we make healthcare, near carbon neutral, incredibly difficult, such a complex system. I joined a two hour meeting of all the working group leads and there's some amazing work going on there. Really interesting, exciting work.

And I think it's important on two levels. So it's not just about reducing the emissions for healthcare, but it's also the fact that healthcare can be a kind of vanguard for other very complex health systems. Not just healthcare, everybody's looking at how we can be more sustainable and I really think this commission will lead the way in that.

That was very exciting. 

Richard: But there is a paradox, isn't there? Because on the one hand, you've got Tedros saying we've got to have a drive for universal health coverage. 

All: Yeah, 

Richard: which means rightly expanding our health systems and strengthening them and having more facilities and all the rest of it.

And how do you make when he makes that case and when others make that case indeed when we make that case We don't also then have a little codicil saying ps make it sustainable And what does make it sustainable mean? It doesn't mean I don't want to trivialize it But it doesn't you can't have Every hospital has its own windmill or every hospital has its own solar panels on the roof how do you make it?

What does sustainable mean in that context? I think 

Jessamy: the aim is to go to carbon neutral as we do for all systems, you know Globally, we have to get 

All: there. 

Jessamy: I'm not sure that it's a paradox, but it's definitely a tension. But when you look across the world, you know that when you look at the I think there are a couple of interesting points to raise.

One is on prevention. There's a huge prevention aspect to this. Like actually if you're not using as much health care because you're having more public health interventions, then you can reduce the cost you can reduce the carbon emissions But also when you look at what countries are using if you look at america and england the waste that we have the use of interventions so much greater than other countries who already, there are There are healthcare community settings in pakistan who are totally off the grid Because they have to be because they're in the middle of some, mountain region.

And actually they have to be able to have continuous electricity. And we published a trial recently about. Different healthcare settings in Sub Saharan Africa and access to continuous electricity and to continuous water. And it was based on the fact that actually if you've got solar panels or you've got something that is more sustainable, then at least.

You're in control of it. You're not part of a national grid where you might be having power cuts the whole time. I 

Richard: think the point about waste you make is really important because the amounts of waste especially plastic waste is enormous 

Jessamy: And also, you know wasted interventions all of these sort of different, fields of medicine or Kind of shoot offs of medicine, you know choosing wisely Different things that people have been thinking about for the last 20 years.

I think they're culminating in a What are we actually doing with health care right now? What's important for health care? What do we, who do we need to treat? How do we treat them correctly and appropriately using the right things rather than, throwing 50 million things at them in the most inefficient way or finding things that are irrelevant and then treating them 15 years, which is totally unnecessary.

So I think there's a whole, there's a whole group of people that are coming together from lots of different fields that have been, you Perhaps working in silos over the last 20 years around some similar crossing themes. And I really think that this commission is going to bring them all into the same tent.

Richard: So is that for next 

Gavin: year? 

Jessamy: We hope so. 

Gavin: We hope so. 

Jessamy: It's an ambitious timeline. 

Gavin: It does make me think as well the extent I read an amazing article yesterday about the extent to which solar power is coming on. I've got some I've got some amazing facts. 

Jessamy: Let's hear them, Gavin. 

Gavin: In 2023, the world installed more solar capacity than it did between the invention of the photovoltaic cell in 1954 and 2017.

All: Yeah. 

Gavin: The amount of solar capacity in the world has increased tenfold in the last ten years, and solar power is now essentially approaching free. 

All: Yeah. 

Gavin: In the article, they were talking to an expert who said that, if you asked him ten years ago, If it would look like this, you would say you were in a dream world.

Apparently, the extent to which it's coming on, by the mid 2030s, Solar is projected to provide 60 percent of the world's electricity, whereas it currently provides 8%. And in that time, the amount of solar power that will have been installed I can see you've got a skeptical face, but let me finish.

I've only got one more fact. The amount of solar power that will have been installed is currently 8 times the world's nuclear power capacity. Over the next 10 years risk skepticism. 

Richard: I'm not skeptical of your facts that your facts. I don't dispute My worry is that the fossil fuel industry is working like crazy to undermine Your vision of where we are that 60 percent figure because We are still investing.

They are still investing trillions of dollars To find new oil fields new gas fields and to build up the fossil fuel You energy market, there's no sign being the whole time Yeah, there's no sign that they're trying to roll that back and move into Renewables at all and some political parties The reform party which campaigned in our election in the uk in its advertising it explicitly stated its opposition to net zero and there is a growing look at the results in germany just this week with the afd there are political movements that are gaining ground Which are explicitly positioning themselves against the efforts to get to net zero.

So it's the next populist Exactly 

Jessamy: Right in Pennsylvania just recently was saying, let's drill drill. It's all about 

Gavin: being Republican motto for decades 

Jessamy: now. It feels like, yeah, that's not. 

Richard: So how do you stifle the disinformation campaign from the fossil fuel industry?

To allow your 60 percent figure to be realized which would be a dream. Absolutely. I just feel like we're up against Some pretty evil forces here. 

Gavin: Oh, absolutely up against it But I feel like the only way to do it is to make the economic argument unarguable. Yeah If your governments are obviously subject to an extreme amount of lobbying from these things that you're talking about, but if you're a government looking at installing new capacity that's based on fossil fuels or new capacity that's based on nuclear, but then you look at the price drop over the last few years in renewables to the point where It's no longer something you're doing because it's good to have renewables.

It's something you're doing because the economic argument is actually unarguable. It's cheaper. It's so much cheaper. It's so much cheaper. It's so much cheaper. 

And the 

Richard: Yeah, that would win, wouldn't it? 

Gavin: I think that's the only way. Yeah. And I It feels like that balance is finally starting to tip into actually, renewables are not only the best way for the planet, which is one completely separate argument that we've, that we seem to keep losing, but the other side of the argument is actually now they're the economic way to go.

Jessamy: But to your point, I think there's a few different things going on there, isn't there? Because on the one hand, I think it is becoming, and it already has been over Two years much more of a kind of populist movement and we see that because of poorly implemented policies like ule's You know around london, which actually often impact the poorest people and when you've got an economic system Which is not necessarily working for everybody then that's an easy thing to hold on to.

You know these Wanting to go green, but actually that's making me, not being able to drive my taxi to around London or whatever. So I think there's that kind of offshoot in opposition to that. I do think there's the financial, there's the financial markets who are just massively excited about sustainable.

They're going all in the investment there, like Mark Carney's book. Yeah, 

It's all happening. That is all being pushed by some pretty visionary. financial leads. But 

Richard: in the background. 

Jessamy: In the background, I'm sure are the fossil fuels, but I actually don't, I think your point is right, Gavin, that if you make the economic case, then it's an unarguable, but I don't think that it helps this divide.

Because actually, the fact that the financial market and all of these incredibly wealthy, rich people are investing in solar panel and are really excited about sustainable energy now. That plays into the fact that there's this sort of divide between the two people. So I think from an economic point of view, I think you're right, but I still think that there's a huge Political aspect to this where people are feeling incredibly disenfranchised and net zero is becoming or, being less carbon heavy or more sustainable is becoming a kind of tool for people to say look at these guys, look at these, middle class people who are investing in sustainable healthcare and there's a divide there.

Gavin: Yeah. We need to make sacrifices. This is the hardest message that you can politically. put forward because you'll always be met by someone in the opposition who is we don't need to make these sacrifices. Actually, if we carry on as things are, everything's going to be fine. In fact, even better because you won't have to give up any of the things that you like.

Jessamy: Often it's not even made in those terms, is it? There's even not an argument that we don't have to. It's just they're doing that and we don't like them. It's just polarization and people saying, let's just drill. Let's just, we love oil. We want oil. We want to do this. It's not even made. Or it's the woke agenda, right?

It's not even made in the context of a greater argument about planetary health. It's just, we don't like them. And we believe in, Oil, we believe it not being woke 

Gavin: a bit like the kind of pretty meaningless phrase woke as it's used across the media now by this point. Net zero is also turning into one of those terms that can essentially mean what you want it to mean.

Jessamy: Yeah. There's been a lot of greenwashing for sure. You 

Gavin: know, back to Richard's point, 

Jessamy: even in America, there are hospitals who say that they're net zero. No, there's a lot of 

Gavin: problem with the carbon credits market, for example. Yeah. Yeah. But you also see things in politics now, at one point in the local elections last year, the conservatives were campaigning on people not having seven bins.

Jessamy: Yeah, as 

Gavin: part of their environmental strategy. 

Jessamy: Small and big problems. Yeah. 

Richard: I tell you, I wish I had one bin. Where I live in London, you 

Jessamy: wouldn't believe, I've gotta tell 

Richard: you, I am the least green person in this room. Do you know how we deal with rubbish in North London? I have a plastic, I have an orange plastic bag into which I chuck everything, glass, metal, recycling, whatever it might be, and then I literally tie the bag up and drop it on the street.

I can drop it on the street at 11 o'clock at night or 6 I 

Jessamy: think you should cut all of this. 

Richard: And then along comes a trash truck from Camden and picks up my rubbish. I joke not that Do they then sort it? No, Oh, they just throw it away. That's it Gavin, that's it. All of my neighbours, what we do is we literally throw our rubbish onto the streets of North London and then In the hope and expectation that our cancel tax will indeed allow a trash truck to come along and pick it up And of course i've put take my trash out at 11 o'clock at night when I go and buy my newspapers It's 6 45 every morning from the nearest tube station Inevitably a fox has come and opened my thing all my last week's rubbish That I have assiduously collected in this orange bag is strewn across the pavement for everybody to see.

It is the worst system. We are living in London, one of the most advanced capitals in the world. And I tell you, France does it better. France does everything better, but France does trash better. You actually have holes dug into the ground with metal containers and you take your black plastic bag and you open it up, you put it in, and then every day a trash truck lifts up the metal container, empties it, there's no trash 

Gavin: on the street.

Germany has a large container for every single street that you just go to the end of your streets and put it in. It's a lot more straightforward. What have I done this week? I hear you ask. 

All: That is what I'm asking. That's what I'm 

Gavin: asking. I've largely been I've been editing podcasts as you would expect from my role of the Lancet in which I am the producer of 20 plus podcasts.

So that takes up most of my time. But there's been a few really interesting ones this week. We have two podcasts coming out on M Pox. One is coming out on The Lancet Weekly's In Conversation With, which is quite a technical, clinical talk about the difference between the different clades and what clinicians should be looking out for.

And we have one coming out on Because 

Richard: they present differently? 

Gavin: Yes. Yes. And we have one coming out on The Lancet Voice, which you're listening to right now about the global health concerns and what the situation looks like from Africa with, Salim Abdul Karim who is one of the best placed people to know about those things.

That's been really fascinating. What really struck me about talking with Salim, which I did about an hour ago, was that he talked about how the world has learned zero lessons since the COVID pandemic, how European countries are sitting on stockpiles of vaccines that would work but they're refusing to send them to Africa to cut a potential pandemic off at the source.

So he is baffled about that essentially, because he feels like you can't just wait for a pandemic to come to you. You have to cut it off where it starts, you have to contain it in the first place. By the time it gets to all the countries that are stockpiling the vaccines, it's already too late.

Richard: And there's nothing anybody can do about that. There's no instrument, whether it's the international health regulations, the non existent pandemic treaty, there's no lever that exists in the international, in international law. Or through the United Nations that can actually 

Jessamy: I was looking at this before and here's something that I read in the New England Journal that's written by our friend Lawrence O'Gostin and colleagues.

You 

Gavin: two are so well prepared for this. And here they 

Jessamy: say, okay so there are currently two Mpox vaccines, which we know about. On August 9th, the WHO invited Mpox vaccine manufacturers to apply for an emergency use listing, an EUL, which African countries and supporting partners such as Gavi could rely on in deploying vaccines.

The United States and other high income countries have substantial Mpox vaccine supplies, but affected African countries have not had affordable access, an enduring indicator of inequity. And then it stops there. So I feel like perhaps there was more there that was cut. 

All: Yeah. 

Jessamy: But the WHO has tried to invite, so that's different to an instrument.

Richard: But invite is too polite. I completely agree. So what about name and shame? 

Jessamy: Absolutely. So they've invited people and obviously they've refused 

Richard: that invitation. Tedros, Tedros is the master of communication. You know every day almost there's a video of Tedros saying something I saw him cooking 

Jessamy: the other week.

Really? Yeah for his grandkids. It was very charming. It was 

Richard: very sweet I don't know 

Jessamy: what he was doing with a sort of like a food processor and it looked quite no He's 

Richard: very good. He's very good But he needs to apply his communication his brilliant communication skills to holding some of these countries accountable for their They're back the vaccine inequity that we're struggling with mpox as you're describing Gavin and we're too polite as again once again as we were with COVID.

Jessamy: Inviting isn't going to work. 

Richard: Yeah, inviting ain't going to work. It isn't going to do that whereas if people come out whether it's Gutierrez or whether it's Tedros come out and actually say look this is unacceptable. This government this government is sitting on this amount of mpox vaccine and they will know what it is.

Then they need to say, and then our friend Sanya Nishtar, who is You know, new at Gavi. 

All: Yeah, 

Richard: doing a great job getting to grips with how to evolve Gavi for his next replenishment. But again, she has an absolutely fantastic platform to hold countries accountable. And as somebody coming from Pakistan and so has enormous moral authority to be able to hold those countries accountable I do think these leaders need to that's why they're in these jobs that's why they get paid the not so big bucks That they need to put themselves a little bit of risk and and speak up.

All: Yeah 

Gavin: Compel is the scariest word in international relations, isn't it? 

Richard: There? There is no it is shocking, isn't it? I remember looking at all of the I've got this huge book on international humanitarian law, which I have read some of, not all of. And the most shocking thing about international humanitarian law, It's that it's not law in the sense that it can compel anybody to do It's basically just a set of it would be very nice if we didn't bomb civilians 

All: Yeah, 

Richard: it would be very nice if we only proportionately attacked cities It would be very nice if we didn't target health care workers.

That's it 

All: Yeah, 

Richard: And it really is it is powerful through its moral authority But in terms of it's the legal instruments that we have, as we see around the world that we are completely unable to stop atrocities, particularly in our field in healthcare, where health workers and health facilities are deliberately targeted.

And we can do nothing about it. 

Jessamy: And as we saw with a pandemic treaty, Even though the general principles are there, as much as language matters, even the language is being watered down over the last, 20 to 30 years to more shoulds And we saw that in the pandemic treaty, over and over from the first draft onwards.

And people have commented on that a lot. So even though then none of this is binding, and it's all it would be really nice. We, a lot of, high income countries won't even accept that. They want even more grayness. They want even more cloudiness and weakness in the language so that it really does become completely meaningless.

Richard: Yes. You could almost mount a case that it's not only have we not learned the lessons from COVID, but we've learned, countries have learned lessons. That mean we're in a worse position because they now know how to gain a system and they've learned the way to act purely nationally and not in global concert at all.

So I It really feels like we've gone backwards rather than forwards and with impulse. 

Gavin: They yes They do seem to have learned that essentially look at it this way. You've got a series of rational actors, you know existing individually One of them goes I'm going to keep all the vaccines that I have And the other one goes he's keeping all the vaccines that he has.

I'm going to keep all the vaccines I have. That's the lesson they learned from COVID 19. And now that is an implied action that happens in the case of a pandemic, unless something very drastic changes, it's just going to be what happens every single time. It really It exposed the sort of world cooperation order for what it is, I think, and now everyone's in it for themselves.

Yeah, exactly. 

Jessamy: I think that's the media's, the media's been part of that as well, because they framed politicians and countries during COVID 19 who had quick access to vaccines, either because they were doing, deals, or they were setting things up internally, or they were as, haven't they been so efficient?

Haven't they been great? Canada's done this. America's done this. The UK has done this. And of course, there's a precedent there now where everybody wants to be that person who's got quick access to vaccines because that is the success internally within a country rather than thinking about it more globally.

Richard: I think that also just, it's great sort of setting the world to rights here. In this discussion, but just to be a bit self critical for one moment One of the things I before I went on holiday I was looking at all of the material that we published on impact mpox over the years Which has been a lot and one of the consistent themes that comes out unfortunately Is that journals like the lancet have?

Often way too often privileged voices from high income countries commenting on M PoX and not done enough to seek out voices from the countries where M PoX is actually operating and is a threat. And so if we don't seek out those voices and if we don't give those voices a platform, To hold these countries accountable in some ways.

It's not surprising that those these countries don't listen because then it just becomes a conversation amongst us and We need to, how many times have we actually gone out to, to say, DRC and find health workers there and give them the space to tell their story? And the answer is not enough.

So I think that, we have, this is where we have a role in democratizing the conversation more than we have done. It's not easy and we can come up with many reasons why we might not have done, but that's not good enough. We need to do a better job of that. Completely agree.

Yeah, and you're doing that with the podcast. 

Gavin: Yes I mean I do think one of the points of this podcast as we've been doing it you know coming up on the five year anniversary now Is we try and get as many diverse voices in as possible And I think it's a really good way of doing that under the umbrella of the lancet in places where those voices might not necessarily Get published we can have them on and also when you have them on for a podcast You can have all these kind of nuanced discussions that often get lost in scientific writing And writing short form comments that sort of thing So I think it's been one of the joys of doing this podcast for the last few years is actually getting to hear Those voices from around the world as well We've we've had an amazing spread of countries on, haven't we, over the last five years.

So it's yeah, I, it's been it's been fantastic. The other thing I've been doing this week has been trying to edit podcasts in Portuguese. 

Richard: Okay. 

Gavin: I don't speak any Portuguese. I know. We have 

Richard: a few Portuguese speakers on this, on our 

Gavin: team, don't we? We do. I go as far as Obrigado, and after that, I've got nothing.

And I've probably pronounced that very badly. But it's actually the amount of. A podcast that we do in different languages. It's actually really quite joyous. We've often talked, haven't we, about the need to spread science and scientific research beyond the English language. And this, again, is one of the easiest ways to do it.

We have so many staff at the Lancet who speak a different language than English and they go and talk to the authors who submit the research, who also speak the same language as them. So what was the podcast in Portuguese about? The problem with not speaking the language is that You don't actually know 

Jessamy: what it is.

How do you even 

Richard: edit it? Who was the editor? 

Gavin: Gustavo from the Lancet Global House. 

Richard: Gustavo was at the ESC meeting. 

Gavin: Yeah so he did the podcast. The issue is I'm not speaking Portuguese. I'm not quite sure what he was talking about. 

Richard: Hopefully it's okay. Yeah. 

Gavin: But what we do, and this is very boring for the listeners, is I send it back to the editor and they send across timestamps for the bits that need to be removed.

Because, if you say in Portuguese, Oh, the producer will definitely remove this part. So I've got nothing. Yeah. 

Richard: So this is reaching out to principally Brazil and yeah, 

Gavin: fabulous. Any Portuguese speakers. It's a global health podcast. So hopefully they will all find it interesting depending I guess on what the topic actually is, but Yeah, it's something that's it's always really fun.

Do you have 

Richard: any other languages lined up? 

Gavin: We recently edited one in Chinese Yeah, okay. There is a second Portuguese podcast coming out, which is the other one that I'm editing which is for Lansing Regional Health America So I'm specifically at Brazil. Have we done anything in Spanish? Yeah, we've done several in Spanish, actually, if you remember Alaya Astudillo, who she had, she did two or three podcasts in Spanish for us.

I think by this point, we've done Portuguese, Spanish, German, French, Chinese. Yeah. I reckon that's it. But a good spread of languages 

Richard: now. It is the I don't know if it's right to say, but the it's getting close to the biggest language in the United States, I think. I 

Jessamy: think that is right. 

Richard: Clearly in the in South America, that is true.

It's outperforming in terms of western education, French and German in terms of popularity. Okay, we need to do more in Spanish, Gavin. I think that's a great idea. Yeah, we're all going to sign up to Rosetta Stone or Duolingo and start improving our Spanish. My husband does 

Jessamy: Duolingo, he's on his 780th day, I think, but it's he just really wants the streak, cause you get streaks.

And so sometimes he'll be like, can you do my Spanish? 

Richard: Yeah. So he's doing Spanish. So he doesn't lose his 

Jessamy: streak. 

Richard: He's 

Gavin: doing Spanish. He's doing 

Jessamy: Spanish. Oh, that's very good. 

Gavin: How is his Spanish? Would you say? 

Jessamy: I'd say it's okay. Porter Midland. Yeah. Porter 

Richard: Midland's pretty, eh, a lot better than my span.

Yeah, true. Oh, but I, it's true. I've tried all these Duolingo, it's 

Jessamy: hard. 

Richard: And seriously, you start off and how many times are you going to need to know that Philippe has a red bike? Yeah. 

Jessamy: And Exactly. And 

Richard: we're, which about learning. I know, but seriously, but you learn these.

Phrases all or Charlotte has a blue something else. I mean it's absolutely so frustrating 'cause, and you do this for hours and hours. It's true. And you still can't have a conversation with somebody at the end of it. 

Gavin: See, I thought that, but I got very far in German Duolingo and I was like I'm not gonna need to use any of this.

And then I came across the phrase, I'm in the mood to look at photos of my dog, which in German is, Ich habe Lust, denn Fotos von meinem 

Richard: Hund zu sehen. Fantastic. 

Gavin: And that is a phrase I use all the time. You 

Jessamy: use it all the time, of course you 

Gavin: do. Apologies to any German speakers listening for me mangling that last sentence.

Richard: Okay, 

Gavin: great. So what 

Richard: are you doing over the next week? 

Jessamy: I don't think I've got any external meetings. I'm very interested in our push. 

Richard: Yes, we're interested 

Jessamy: in that. And I'm understanding more about that. I'm looking forward to seeing some hope, research coming through more and more research coming through on that.

I'm obsessed with the American election. I've got a lot of podcasts myself to actually listen to, just to get through 

Richard: on 

Jessamy: a daily basis. And I'm looking forward to the NHS review, the Darzi review, which is coming out in September. At some point date to be confirmed. 

Richard: Yes some worrying things.

I see the news over the last week or so about, people switching to private health care, new schemes set up, Bupa set up a new scheme for just 20 something pounds a month. You can get a private GP at the click of a finger, which you NHS. So yes, I think that the sustainability of the NHS is a big concern.

And it'll be interesting to see what our. Darcy comes up with he did do a very good review of London a number of years ago when he was in the Labour government Tony Blair's government as a minister. But nothing ever came of that So it's going to be interesting to see now whether his blueprint for the nhs anybody pays any attention to it I hope they do.

He's a good guy and he's got some good ideas 

Jessamy: He is and I you know, I have huge amount of respect for him. I did just feel a bit Disappointed That we, as you say, he's done a lot of reviews and a lot of things for the healthcare system over the last 30 years. And I did think, oh, maybe we could have a fresh 

Richard: voice.

Not a disrespect to, maybe we can 

Jessamy: have a different perspective because we have That's perfectly 

Richard: reasonable. But this is the guy, remember, that when he went into the House of Lords, almost on his first day, somebody had a heart attack and he had to jump off the benches and save their lives in the middle of the House of Lords.

It's 

All: true. It's true. He's a 

Richard: hero. Yeah. Because Aradazi is a is a surgeon at Imperial, but he, when he was in the House of Lords, the average age being about 96, somebody collapsed and Aradazi literally had to jump out of his seat and jump on this bench. Poor man's chest to save his life in the middle of the hassles.

So he has magical fingers and everybody is like rather in awe of him because this is a lifesaver and in parliament and he does have the ear of government. He 

Jessamy: does. 

Richard: So and he's got a 

Jessamy: huge amount of resources people 

Richard: Exactly, 

Jessamy: Connections. 

Richard: So I think I totally appreciate your point about fresh minds and fresh voices, but he has a network, which he could lever, hopefully.

Jessamy: And I think it's also, it's difficult to know, isn't it? They're putting this together in two or three months. Yeah. Politically, from the Labour's perspective, is it just that? They want some documentation. This is the line drawn between what happened under the Conservatives and us. It's an independent review and anything we can now say anything from here this is us and everything before that is you.

So you know I think it's interesting to know I think they're commissioned to make a diagnosis. 

Gavin: They want to work it out before the budget. To see what they can actually afford to implement. They're not gonna have it, they're not gonna have solutions 

Richard: in a 

Jessamy: matter of a couple months.

It's just a diagnosis. Yeah. It's not, there's no, it's just a diagnosis really of what's going on. In fact, it's 

Richard: probably gonna be a differential diagnosis because there's not gonna be one thing that's a problem. No, exactly. So there's gonna be a long laundry list of problems. Exactly. 

All: Exactly. Which 

Richard: will then take two terms of government to even begin to yeah.

Address. 

Gavin: And they will need that because the current state of the government's finances for fixing absolutely anything whatsoever is dire. Yeah, exactly. 

Richard: Okay, so that's what you're doing. That's 

Jessamy: what I'm doing. What are you doing? 

Richard: i'm going down to brighton this afternoon Not for a holiday, but for the there's a conference on it's it's basically about early education for children So it links into early child development and they want somebody to get to tell them a bit about the state of global child health So i'm doing that on friday, but then I had this mysterious email last week from somebody who I will not name to keep it totally secret who said You That he is sitting on the most amazing amount of data that will completely transform healthcare.

in the most spectacular way that you couldn't possibly imagine. So how often do you get emails like that? We often get emails saying we've got the most amazing study that you really have to publish. Otherwise, you'll be completely stupid, or we'll send it to the New England Journal of Medicine. But I don't get emails that are quite so hyperbolic as this one.

So So, as you can imagine out of my emails after I came back from holiday, that was one I answered pretty quickly. And next Monday I'm going to trail off down to X somewhere. And sit down and see if his claims do indeed prove true. Bear out the excitement that I felt when I read his email.

What if it's a trap? What you mean he's going to offer us 10 pay well, I already said he's going to offer 50 of the world's population so he's he's going to offer I think there's going to be let's see for the next podcast, Gavin, for the next podcast. 

Gavin: Yeah, I'm just saying, if you don't turn up for the next podcast, we'll have some insight.

It'll be quite 

Jessamy: some time. 

Gavin: Maybe tell us offline what the name is so that we know the leads to follow. When you turn the record button. Thank you both for joining us. It's been great to chat with you on this podcast. I need to work out a better sign off. But an absolute joy as ever. And I hope that we can all do this again soon, and I hope that people are still listening.

Thanks so much for listening to this episode of The Lancet Voice. You can subscribe to The Lancet Voice wherever you usually get your podcasts, and for more information about this podcast and all of our other podcast channels, please visit thelancet. com slash multimedia.