In a packed pilot episode of The Lancet Voice, our EBioMedicine Editor-in-Chief, Julie Stacey, reports on how SARS changed our approach to treating and tracking coronaviruses, The Lancet's Editor-In-Chief, Richard Horton chats with Ben Goldacre about researchers owing the US Government $7bn, and we discuss the planetary health diet – what’s the real link between food and the climate?
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In a packed pilot episode of The Lancet Voice, our EBioMedicine Editor-in-Chief, Julie Stacey, reports on how SARS changed our approach to treating and tracking coronaviruses, The Lancet's Editor-In-Chief, Richard Horton chats with Ben Goldacre about researchers owing the US Government $7bn, and we discuss the planetary health diet – what’s the real link between food and the climate?
Continue this conversation on social!
Follow us today at...
https://twitter.com/thelancet
https://instagram.com/thelancetgroup
https://facebook.com/thelancetmedicaljournal
https://linkedIn.com/company/the-lancet
https://youtube.com/thelancettv
spk_1: 0:19
Hello. Welcome to the first episode of
Jessamy Bagenal: 0:21
The Lancet Voice A new podcast from all of us here at The Lancet every two weeks will be bringing you interesting tales from all over the world on the topic of health.
Gavin Cleaver: 0:29
So this is a bit of a departure for us, because traditionally, we try to focus on the delivery of scientific research through peer review. But we're all so passionate about what we do with science that we put out there that we thought it might be a good time to try and talk directly about health to you, the listener. And we really, really do appreciate you listening on, giving us a try. So I'm Dr Gavin Cleaver. I'm a doctor, but not a kind of normal Lancet doctor, I'm a doctor of Politics and policy who is completely useless in an emergency.
Jessamy Bagenal: 0:55
And I'm Jessamy. I'm a medical doctor whose background is in general and breast surgery. Yeah, and I guess we're gonna try and divide up the work between us.
Gavin Cleaver: 1:04
Yes, absolutely. So I'll be explaining the things that are perhaps easier for someone, my background to understand. Jessamy will be explaining traditional Lancet...
Jessamy Bagenal: 1:14
Well, depending on how you look at it.
Gavin Cleaver: 1:16
Well, the way I look at it is that we work at The Lancet. It it's a medical place. You have all the medical background and experience. I have a G C S E.
Jessamy Bagenal: 1:26
Yeah, but you can help us with the grey areas. And that's, you know, the ones that we find a real challenge
Gavin Cleaver: 1:33
When it comes to philosophical grey areas if you want. If you want an indeterminate answer. Yeah, then absolutely no problem whatsoever.
Jessamy Bagenal: 1:42
And in this episode are very first exciting pilot episode. We've got Dr Julie Stacy talking to experts about how treating and tracking Covert 19 has changed since the 2003 SARS outbreak.
Gavin Cleaver: 1:54
Yeah, really looking forward to that, we've also got the editor of The Lancet, Richard Horton, talking with Dr Ben Goldacre about how researchers in the US owe the U. S. Government an awful lot of money for not obeying the law, and I'll be talking with Dr Cassandra Coburn, a researcher with a forthcoming book about the planetary health diet. We're gonna chat about climate change, about the food we eat and how we can make a difference.
Jessamy Bagenal: 2:13
But we've also got a great team around us. We've got other Lancer editors helping out with the podcast, one of whom you're about to hear soon, which is Julie. She's the editor in chief of the EBioMedicine journal. She's gonna be investigating how COVID-19 has risen to prominence. What's going on in Wuhan, China, on the different experience of people working in biology?
Gavin Cleaver: 2:36
Yeah, we thought would be really interesting to hear how progress has been made since the SARS and MERS outbreaks of a few years ago, which kind of came as a bit of a surprise at the time. But the impression that we get now, that hopefully Julie will be able to display to you, is that we're a little bit more prepared now.
Julie Stacey: 2:55
Coronaviradae is a large family of viruses that gets its name from the Corona, or crown like projections that decorate the surface of the virus particle. This family of viruses can infect humans and animals, and as one of many different virus families that are thought to cause the common cold occasionally, these viruses can cause more severe respiratory disease, which we saw with the SARS and MERS outbreaks in 2003 and 2012. We're now in the midst of another dangerous outbreak, with thousands of people with those hardest hit at the epicentre of the disease in China's Hubei province. Because of its genetic similarity to the virus that causes SARS, this new Corona virus strain has been named SARS Corona virus, too. The disease that causes has been named COVID-2019 for the year in which it was first isolated. For this piece, we wanted to start by taking a look at how our response to Corona viruses has changed since the days of SARS in 2003. We took a closer look at the research being done on therapies, the technology behind how outbreaks are tracked and how international responses to outbreaks are evolving. We first chatted with Tim Shehan and Matt Freeman, who both study Corona viruses in the lab. In order to get an update on some of the therapeutic approaches under development for this family of viruses, I asked him about a small molecule called Remdesevir. Remdesevir is currently being tested in China as a potential therapeutic for patients suffering from COVID-19. We asked him how Remdesevir has thought to work against other Corona viruses like SARS and MERS and preclinical models, and whether it might inhibit viral replication of SARS. Cov two in the laboratory
spk_0: 4:54
Remdesevir targets the RNA dependent on a prelim arrays, which is the enzyme that the virus and codes that allows it to replicate its RNA in the infected. So and if you look at the dependent RNA primary sequence for this new Corona virus, as compared to SARS MERS and all these other corona viruses that we know about, there's a very high conservation. So it's about 99% similar to the SARS version of that same protein, Um, and as we know, so Remdesevir works great against it
Julie Stacey: 5:28
vaccine and therapeutic antibody development against COVID-19, are also both well under way. This research is also based to a degree on previous studies on the Corona virus is causing SARS and MERS. Matt Freeman talks to us about how our ability to study Corona viruses is evolving and why it's so important for us to keep researching this family of viruses.
spk_5: 5:54
I think the important part for the vaccine development is that, before something was in animals and in humans took a while to get that developed, it was faster and much broader, and many more people were involved in different companies and labs. And now, for this new kind of virus, we know what works and what didn't work emerged. And so all of those processes are really sped up. The hope is that this really speeds up the development for this virus, and these viruses are certainly not going the way these family of viruses are in bats and in animals spilling over all the time in the people. We only catch them when they cause disease. And I think that while we know a lot about these viruses, there's a lot that we do not know, and we need to figure out how they work and which will tell us what kind of therapeutic works against them.
Julie Stacey: 6:43
We next wanted to get a sense of how recent advances in sequencing technology have improved our ability to detect and track outbreaks. We posed this question, to Ian Mackay, who is an expert in emerging viruses and public health.
spk_7: 6:58
in terms of diagnosing viruses we're still using PCR vice methods. That hasn't changed for quite a long time, but that's like it's because they're pretty effective. But whole genome sequencing, sometimes called high throughput sequencing or next generation sequencing, has really revolutionised the last few virus emergencies like zika now in particular to really being useful here for this Corona virus. So we were able to get full genome sequences instead of just a small little bit, some genomic sequence or region, and that leads us. Follow where a virus may have been where it's come from. It's great for contact tracing and great for looking at how it's evolving in real time and really helps experts that are doing a lot of this work on the incident.
Julie Stacey: 7:48
How are new infectious agents typically first identified and tracked?
spk_7: 7:53
So in terms of first identified contact, we need disease. So once we have patients in cases with, we start to look at samples. If we don't know what it is, we have no idea what that virus or bacteria might be. We have to go right back to first principles. And that's where these new genetic genome sequencing tools are quite handy because they're unbiased. They don't lead us down a particular path. We don't have to know something about that virus or bacteria first, we're able to just find out stuff. So we put these patients samples through this process. We have to extract and purify them, amplify them and then get lots and lots of sequence there. And then that's just the beginning. The hard part is taking a huge amount of data. We get sequence data, breaking it down, looking at whether it's similar to any other thing we might have seen before. Whether it's virus or bacteria, that's sick viruses. I guess if it's not the same that we might find something novel, that that doesn't happen very often now because we have a lot of viruses and catalogues, we've got something we can compare to usually. So in this case with the Corona virus, they would've seen that it was similar a little bit at least to both Corona viruses. Initially, that would give them a hint and help them build the sequence, build genome and then investigate further leads that conduct molecular epidemiology, then can trace that further back. Getting more samples from more patients, seeing if they're related or different thing if the bar's changing start tracking backwards in time to see if they work up when the virus might have first appeared.
Julie Stacey: 9:21
Finally, we spoke briefly with Peter Horby from Oxford University, who has expertise and global health and emerging respiratory viruses. We asked him whether international collaborations to global outbreaks have improved since the days of SARS.
spk_8: 9:38
They've absolutely changed. I think it's completely different. We've seen mobilisation of international collaborations at, you know, regional and global levels. There are working clinical population based research in emerging infections. There's now an extensive network of researchers for grassroots network that has evolved with a build up of trust over every year. So now we've seen excellent collaboration between investigators. For example, ISAREC, which is the international severe acute respiratory emerging infections. Consortium was set up precisely to facilitate international collaboration on clinical research on what we've seen is that. Members in China have contacted the Global Support Centre for advice. They've been put in touch with other researchers, such as the researchers in Saudi Arabia. We've been working on Middle East respiratory kind of us and with other researchers who were working on from desert here in Boulder, et cetera. And together you had a peer to peer level of work together to get these clinical trials up running very quickly in China.
spk_7: 11:01
What has surprised you the most about this outbreak?
spk_8: 11:04
This outbreak is looking like the one we've all been preparing for. And I think perhaps when you're preparing for something you know you never quite expect it to happen. But, um, you know, we have a novel virus that is spreading rapidly, that seems to be quite severe in some patients, for which we have, you know, at the outset no diagnostics, no treatments, no vaccines and little information about how it behaves. And so it surprised me that we have, you know, actually encountered what we were waiting for. But also, it's kind of surprised me that the things we put in place have generally worked,
Julie Stacey: 11:48
Although we have made some progress. And although previous outbreaks are clearly helping inform our response to this one, we still have so much to learn about this new Corona virus and how best to help those affected by it.
Gavin Cleaver: 12:02
So thank you. Julie Stacy, their editor of EBioMedicine, for that section on COVID-19 the novel coronavirus. Potentially government should look a little bit more to clinicians for advice before jumping to conclusions. But, I mean, that's the hope in the wider sense of things when things like this happen. But we still have so little information about this virus that it's kind of difficult for that collaboration to happen.
Jessamy Bagenal: 12:28
Yeah, because it's difficult because on the one hand, you've got the W. H. O. Who are giving kind of broad brush, you know, statements. At the same time, you've got individual researchers. People who have been kind of gearing up to this kind of problem for the last 10 15 years is what they've been expecting, and yet it doesn't feel like there's any kind of clear cut guidance on what, you know, the whole of Europe should be doing right now.
Gavin Cleaver: 12:56
Very much so. Very much so. So recently, The Lancet published a paper from Dr Ben Goldacre.I mean, pretty much everyone listening will be aware. He's the author of Bad sSience. Former guardian columnist. Very famous. Generally, Ben has an awful lot going on. So we thought, Invite him, sit down and have a chat with editor of The Lancet, Richard Horton. Let's talk a little bit about openness in science. His career and his new papers are awesome. Fascinating information about how the U. S. Government is currently owed over $7 billion by researchers in the US. Extraordinary amount.
Richard Horton: 13:26
I'm really delighted to be here with Ben. You're very well known famous, even for all the work you've done on bad science. Incredibly, I'm sure you know the figure. How many books have you sold?
spk_4: 13:38
Exactly. I mean, incredible. I think it's fair to say that single handedly you've done more to educate the public about what we professionally called evidence based medicine than any other single person that I've known in my entire lifetime. I mean, I think your your contribution to public education. Understanding about what is good evidence is absolutely second to non, and I would defend that statement to anybody. This work is a very logical continuation off that where you going?
spk_4: 0:00
spk_4: 14:14
Well, Firstly, my skin crawls, but you're very kind. So writing and showing off in general has only ever been a hobby. I've always had either a fulltime clinical post or an academic post. A while ago I run a small research group in Oxford in the Department of Primary Care called the Data Lab, and there's 10 or 15 of us, depending on how you draw the perimeter. And we are quite unusual we're a mixture of conditions. Researchers and software engineers or pulling skills and knowledge to turn health and scientific data sets into live interactive, data driven tools and services rather than just academic papers on their own. So this paper that you very kindly published is a good example of that. There's the paper and the logistic regression and the formal analysis, but there's also accompanying that the Live Data Services trials tracker dot net and we also build up from prescribing dot net, which is a service that lets you see what every doctor in the country's prescribing month by month and lots of very clever data science under the bonnet, where we've published various papers on novel lately analytic methods to try and spot who changes early and who changes late in response to evidence. Landmarks, price shocks, safety alerts. Interested in better use of data and evidence in health care and government. More broadly, no, I guess I will use whatever tools seem to work best to achieve any event. I mean, if the question is what's next? I guess the reason what posh white men in particular do OK in life is you follow the green lights. So when somebody says, Hey, do you want to come and do this? You go. I'm not entirely sure I can do that, but I'll have a go so I don't have a clear, systematic plan part. I think clinical academia is the correct location and the extent to which it's ever not the correct location is the flaw in clinical academia. So, for example, operational research in the NHS doing analytics on variation in care clinic limb from attics, giving me ample operational insights on which regions are doing particularly well or badly at a particular thing that has a very low status amongst academics. So the work that we do like open prescribing people have a really sort of mixed view about. On the one hand, I think a lot of people go, go where? I'm not sure I could do that. It stays, but equally, people also want to go well. What's legitimate academic work with health Data sets its epidemiology on the ideology of disease. No so much epidemiology on which bits of the health service is sick. But I think they're wrong. I think that's, you know, frankly, where the biggest opportunities for improving mortality and morbidity in the develops world probably. I don't think it's gonna come from amazing individual new treatments. I think it's going to come from on the one hand. Prevention, which has gotta be population level interventions, cycle parts in cities, rather than telling people to do more exercise on the one hand and then, on the other hand, it's refining and optimising the logistics of your health service, and in the past that was a matter of charismatic managerial leadership. But now it's about halftime and half using data to spot opportunities to improve care. And I think at the moment we're doing that catastrophically badly in the UK. People do a bit better in the US but with, you know, different barriers and politically over there. That's what I'm gonna do next.
Richard Horton: 18:12
You're lead author on this fantastic piece of work, which reports something very disturbing, which should be a cause of shame to the world of research And that's looking at compliance with legal requirements to report clinical trial results on clinical trials dot gov. Now that can sound very dry. But, Ben, this is super important. Tell us why you've done this study and tell us what you found on why we should be so... disappointed doesn't even come close. Shocked!
spk_4: 18:45
Well it is extraordinary, given how long we've known about this problem. And so I think anybody listening to The Lancet podcast is likely to know that clinical trials are the foundation of evidence based medicine. They're how we know which treatments work best, and it's also an important window into the homes of treatments. We spent enormous amounts of money on conducting each individual clinical trial, and we do that in order to remove bias. We want to be better than just saying, Well, I'm a doctor and I gave my patients this treatment and they did much better. It makes no sense at all. But it turns out that after spending all that money to remove bias, we then allow all those biases to flood right back in again by permitting the results of clinical trials to go unreported. Now, this is a problem we've known about for many, many decades. First publications on it dates back to 1986 or even 1980 depending on how you count it on. There have been a huge number of cohort studies taking lists of completed trials and then looking at whether they've bean either published or reported on the clinical trials register on DH. They consistently finds that the rate of compliance with ethical and in some cases, legal obligations is very poor Now, I started writing about this about 13 years ago. We started the all trials campaign in part triggered by an email from you in 2012 saying, Hey, let's do a letter to the Times. Soon as I started writing about it in any serious way, I found representatives in particular from industry, saying, This guy's a charlatan. This is a problem of the past. We now have new rules like the FDA Amendments Act 2007 which means that all trials conducted in the US must report their results within 12 months of completion directly onto clinical trials DR the Trials Registry. And because of that role, this problem no longer exists. Now there were two problems with that. Firstly, if the other moments Act 2007 only requires transparency for all of the new trials and starting from now now that's an important cohort of trials to get reported. But it's not actually all of the data we need, we need all the results of all the trials on the treatments used today, not all of the results of a trials finishing today. And actually with my other hand, I run in thematic services like open prescribing dot net, which let you see what every doctor in the country is prescribing month by month. And I can tell you from knowing that data very well, that doctors overwhelmingly prescribed drugs that came on the market and were approved before 2007. So that is definitely the era of transfer, which we need transparency. But there's a second problem, which is everybody assumes because this law existed. That meant that it affects the problem that trials were being reported. We found that about 63% of trials reported results ever way allow people to report late because you want there to be room for redemption. People should be incentivised to report even if it's late. And we also segmented the data for somequite interesting patterns in who is more or less likely to report results.
Richard Horton: 21:56
Tell us those because I must admit, I was I was really surprised by what you found.
spk_4: 22:01
Well, yes, me too.
Richard Horton: 22:02
My prejudices, I'm afraid were defeated.
spk_4: 22:06
Well, your prejudices are not unreasonable. So what we're obviously both talking about is the fact that trials with industry sponsors were substantially and significantly more likely to
Richard Horton: 22:16
report results. They were better. Yes. So I've been spending decades thinking that it's industry that's trying to hide their results. You go back to the storys about SSRIs, and so I mean, they buried their results. And yet, now what you're showing is that what's happened? They heard a had an epiphany and they're they're reporting.
spk_4: 22:36
So I think having spent a lot of time up close with regulators, academics, funders and people from the pharmaceutical industry campaigning on this issue through the old trials dot net campaign. It is fair to say that until this rule came into force until the EU rules came into force, it is certainly industry who were most energetic in campaigning against efforts for transparency. They were the most energetic in rubbishing the old Charles campaign and also loving lawmakers to try to win.
Richard Horton: 23:07
I can remember sitting in meetings in Geneva at the World Health Organisation, where members of the Pharmaceutical Manufacturers Association fought tooth and nail against clinical trial registration and an international clinical trials registry and put every possible conceivable barrier in our way to try and do that. But something's changed
spk_4: 23:28
well, I mean, what has changed is an unambiguous rule, and that's the interesting thing I think about industry in general. They're just very good at following rules. You give a clear set of guidelines. They go. Okay, I worked with that. I've had some lawyers work it out. What's the minimum amount of tax I can pay? What's the minimum amount of maternity leave I can pay? And then if I want to go further than I will, and that will be for other strategic reasons. So I think what's interesting here is it matching? Rather gives the lie. And there's a There's a lesson for the future here. When people say, Look, it's not about regulation. We need to think about culture. culture change is really important and, you know, regulation by consent. Policing by consent is really important. Principle
Richard Horton: 24:12
rules.
spk_4: 24:13
They really,
Richard Horton: 24:15
really do help. So actually the guilty passes now. Unfortunately, it's the non industry folks who were doing research.
spk_4: 24:23
We're on a service called Trials tracker dot net, where we provide rule data that updates literally every working day. We show every single trial that goes overdue on the day that it goes overdue it goes red on our service process. When we first launched that site, we sent an email. So the head of the FDA saying, Just to let you know we're running this service, we hope you find it useful and attached is a list of all the tribes that breached this week. Wait, but you'll be taking action now. The FDA, under the FDA Amendments Act, has the right to impose fines of up to $10,000 today. That's actually $10,000 a day on every individual trial for every day that it's overdue and its inflation corrected from 2007. So I'm boring enough.to know that's $12,103 a day that they could be fined to date.
Richard Horton: 25:17
That's a significant fine.
spk_4: 25:19
That's I mean, that would make a material difference to a university
Richard Horton: 25:22
And it's going up. So they must have raked in a lot of money from imposing these fines
spk_4: 25:27
So we estimate in the paper. We estimate that up to September 2019 they could have imposed fines of just over $4 billion. The fully updated figure as off this morning is just a little over $7.1 billion of uncollected fines. The total amount of fines that the FDA have imposed to date is zero.
Richard Horton: 25:53
Thanks for coming in today. We wish you well with your work and we look forward to seeing you and talking with you again.
spk_4: 26:00
Hey, thanks.
Jessamy Bagenal: 26:01
Finally, for this episode, you'll have heard a lot over the last 12 months about diet and nutrition in the news, a fair bit of which arose from our EAT-Lancet commission early last year. So much of this talk is about what the right or correct diet is and how much now that is sort of essentially linked to the climate crisis and we really need to have a sort of greater understanding of how our habits are impacting the health of the planet. So I'm really excited to hear you and Cassie have a chat later.
Gavin Cleaver: 26:32
Yes. I mean, the climate crisis is understandably the topic of a lot of anxiety these days. We spent a lot of 2019 talking about not only how our habits with regards to fossil fuels are irreparably damaging the environment, but also our habits in the sense of what we eat and how the typical diet is becoming unsustainable in that it contributes to climate change. At the same time, the food we eat is killing us. Non communicable diseases caused by our diets are rising on extraordinary pace around the world. And it's costing untold amounts in specialised health care for the diet related problems. I think what some of our work last year really set out to do was to see if it could tackle both of these problems at once. So Dr Cassandra Coburn's forthcoming book, Enough, seeks to lay out the interconnectedness of these issues and explore how much it would take to make the changes. So, Dr Cass Coburn, thank you so much for coming in today. What's like the central thesis of the book?
spk_1: 27:27
So I'm looking at the intersection between human health, the environment and the food that we eat and the way that we produce our food. And I'm trying to make a very science based case that if we eat more sustainably, it will also improve our health and will allow us to feed not only the current population of the world. But the predicted large increase. I think it's something along lines of 10 billion people by 2050 and while we can currently feed people, probably we're not feeding them particularly well, people are not as healthy as they could be,
Gavin Cleaver: 28:06
Right so is the main thing you're getting at there on sustainability or effects on health or just kind of both. So do you think 2019 was kind of like a watershed moment for this for this link? Now that we've made the link between climate and diet
spk_1: 28:21
I definitely think so, Remember, in around 2006 or so, we seem to be the first time that people had a a real awareness of climate change. I know this is just anecdotal. This is when it sort of started to permeate popular conversation on I really feel the 2019 we're going to look back and see that as the first time that people started to realise that food doesn't just magically appear in supermarkets on we all kind of knew that in an abstract sort of way. But I think now whenever I've spoken to people about what I'm writing rather than incomprehension, I get kind of a glimmer of familiarity and everyone says Yes, I'm trying to eat less meat. Now if you ask them. Why they don't really know. They'll say, Ah, carbon dioxide farting cows. And that's sort of true. But there's definitely a growing awareness that the way that we produce food is no sustainable.
Gavin Cleaver: 29:16
Yes, so I guess. I mean, this is a very broad question, but what is really the link between food and climate that makes both such a pressing concern but that also makes them both available to be like addressed together as one system?
spk_1: 29:30
So it's a really interesting question to answer it. You have to think about the world as a single system, and it's quite intuitive to think off the inorganic world as a single system, you know, rocks, water. We understand all of that was much harder to comprehend is that life on Earth organic life has an impact on that physical system because essentially, we take in physical elements and excrete out physical elements and so on. On gradually, over time, as all of life is accumulated on Earth, you know, we've seen significant changes like oxygen, for example, that's due to life on earth. So when you think of the Earth as a single system, you can start to think of all the different components of interacting and each one having an effect on another component and, as was outlined in the excellent EAT-Lancet Commission. These could be referred to as the planetary boundaries. So these are kind of physical processes that all interact and we are pushing them so climate is the best known. One of these planetary boundaries we're pushing is climate change. We all know about the Paris accords where we want to try and keep the increase in heat to two degrees, no more than two degrees from preindustrial temperatures, ideally 1.5 degrees. But what's less kind of considered are the other planetary boundaries that we have. So they include specifically relating to food. They include land use change biodiversity. What sort of a water scarcity on DH nutrient flows. So that's phosphorus and nitrogen. Which a key components and fertiliser essential as we produce food, we're pushing it all of these boundaries. But because the earth is a single system, you push it one and actually affect all of them. So you want to think about land use change for a second. I think that you could probably make a good argument that eating meat, rearing cattle and so on is the single biggest contributor to land use change. We've gotta clear fields for them, to live in. We've gotta grow food for them to eat. And when you change land for, say, most obvious example is deforestation. When you clear a forest, not only are you cutting down trees and releasing, you know that you're doing whatever was the trees, burning them, whatever. So you release the carbon that's stored there, but you'll supply the soil and you release the carbon that's thought there. But equally you're removing a carbon sink at the same time. So you're removing the natural resilience of the landscapes and and the the ability of the landscape to counter act some of the existing climate change. So it's like a triple blow. You're releasing carbon and you're removing the ability for us to store more carbon. We interact with this whole earth system whenever we produce food and what we're doing at the moment is producing a huge quantity of food and a lot of it is really unhealthy. So we're seeing this rising epidemic off non communicable diseases and of the sort of four biggies you know, if you want technical term, that's diabetes, cancer, cardiovascular disease and smoking, three can be directly attributed to food and what we eat. And when you look at what we eating, there's a huge rise in ultra processed food. So that's caused of processed carbs, added fats, lots of processed meat, all of which have links with those those three diseases. So we're kind of decimating the planet to produce stuff that sort of slowly poisoning us. And the thought is that if we can change what we eat, we can potentially produce things that are more sustainable. So eating less meat, for example, would lead to land use change, which in turn provide more resilience.
Gavin Cleaver: 32:53
So you were talking just down at the end about changing what we eat. A lot off food policy generally in the way that it comes down from governments, aims to spur behaviour. So is there a way that policy can get involved in this? I ask this mainly because it seems that a lot of time, the very quick action that we need to take on the climate, is met largely with political inaction. In a lot of these cases and this planetary diet being one, that there's a lot of ambition that is very difficult to get the wheels turning.
spk_1: 33:30
No, I completely agree. It's interesting. There's actually a technical term for it. I can't remember. It's something like policy stupor or something. Anyway, accident. What I love is academic papers have been written about the fact that policy is not moving and they're looking at policies to trying get follow sister move, which is sickly ironic.
Gavin Cleaver: 33:47
And then we'll add another level where you have policies trying get those policies
spk_1: 33:49
precisely and, you know, and so on and so forth until everyone has a red briefcase. But well, that's kind of one of the one of the aims of the book is, I think we probably need a bit of a grassroots movement on this. I think that that's I think that's coming anyway. I think people feel very disenfranchised at the moment everywhere. I mean, I've seen plenty of articles about climate anxiety where people are sort of scared of having kids because they're worried about what kind of world they're going to give their Children on. I think it's really beginning to get people. So if you if people can understand and I'm aware that sounds extremely patronising I don't mean it to be. But if people could understand that, really, their behaviour can directly affect change. They don't have to wait for someone to sign off for approve it that if they can change how they eat and we can do it on the mass, we can bypass quite a lot of these policy hurdles. If politicians wanted to enact policies that would change these things, I think they've been met with a lot of resistance from industry. I mean, we've already seen that happening. You just need to look at the sugar taxes and so it might be genuinely more efficient just to say power to the people it doesn't have to be a revolution. It could just be as simple as picking up something wholeweat versus, you know, refined. And that in itself is is gonna make a difference.
Gavin Cleaver: 35:04
So what does nutrition land use looked like for a future sustainable diet?
spk_1: 35:09
That's a really interesting question. I couldn't give you an exact answer on it. Different papers have examined different versions of how we could change this. On what outcomes that would be in terms of carbon use, land use change and so on. I'd say that if we could at least at the moment we're aiming for something called 1/2 Earth policy. Where we keep half of the world is wilderness. We are, I think, 51% of the world of his wilderness of the moment
Gavin Cleaver: 35:34
pretty close, pretty
spk_1: 35:35
close. So I think we've got, like, a 1% margin of error there. Ideally, we'd actually see some rewilding. We'd see. You know, if you if we could reduce the amount of land that we're using for, for example, meat, potentially, we could convert some of that. Not the cropland, but actually back to a wild. Yeah, something that's quite interesting is that if everyone was to eat vegan diet, which I don't and I'm not advocating explicitly. But people think that that would mean that we have to eradicate vast swathes of forest for crop land. And in fact, the opposite is true. You can actually eat a very nutritious diet just based on plants. There's a superb data visual visualisation service that comes out of University of Oxford called Our World on Data and one of the authors there, Hannah Richie has done some wonderful data crunching based on the science paper on 2017 and she's looked to see how much land use you need for 100 calories of beef or of grain or something, and it's sort of terrifying when you look at it. And actually, and people people can argue, Oh, well, that's just calories. Whatever. You know, beef is much more nutritious, but when you look just a protein, what you need to get, like 100 grammes of protein from wheat or rye or peas versus 100 of beef, this still a huge disparity. So we could feed the world in a healthy manner, using far less land than we do now. Its preference that drives us the other way.
Gavin Cleaver: 37:02
Thank you so much for coming in to chat with me. If it gets really interesting and, you know, it feels like this so much work to do that it's kind of intimidating, but I think what you said about on individuals opportunity to almost bypassed the system. You know, we give over so much of our lives to being like following the rules and letting our behaviours be guided. Whereas actually, this is a fantastic opportunity for widespread, small scale change in behaviour that actually makes a really major difference.
spk_1: 37:34
I really believe it can. One of the things that's really struck me as I've been writing is how much my own behaviour has changed. And that's not because I feel obliged to be sanctimonious and follow my instruction. It's just much harder to make different decisions when you understand the impact of it. It's much harder for an individual to ignore. So yeah, I definitely think it's definitely think we have a real opportunity here to change the world.
Gavin Cleaver: 38:00
What a positive note to end onm Dr Cohen. Thank you very much. Thank you. So I think it's really interesting. Over the last year, like me and Cassie were talking about how much nutrition has become linked to the climate. Is this kind of hyper awareness because so much to do with climate effects every area of our lives, and every area of our lives, in turn, affect the climate on the planet that we're leaving future generations
Jessamy Bagenal: 38:30
exactly. And it's this sort of circle, which it's really difficult to kind of breakdown and understand what we can do that, you know, useful and actually gonna have an impact. So what we can do, you know, obviously sitting here from our kind of relatively well educated middle class. See, you know, it's easy to have these conversations about how we need to eat better for for the planet and things like that. But how we can actually sort of disseminate that across, you know, different socioeconomic groups who are faced with incredibly difficult challenges in this country, you know, let alone elsewhere in the world is seems to me the biggest kind of challenge about that, you know?
Gavin Cleaver: 39:14
Yeah, it's a huge challenge, and I think it can feel quite overwhelming a lot of the time, but also I think that's where a lot of the negative politics surrounding climate change arise from. We've gotten to the point now in the discussion where you know, we had many, many years of people denying the reality of the climate crisis. But now we've gotten to the point where the climate crisis is so obvious and overwhelming. And every single month that goes by, we hear about how it's the hottest of this particular month in the last, however many decades, we've gotten to the point where the same cynical groups are going well, actually, it's too far gone by this point, so why bother doing anything about it by this point?
Jessamy Bagenal: 39:52
And it's like that conversation that we were having about, you know, where fear meets hope and how we kind of transition from this place of fear, where it's all overwhelming to Hope and how we can actually kind of actively do things. And I suppose this sort of nutrition aspect, this dire aspect is a really tangible way that everybody can do something to make a difference.
Gavin Cleaver: 40:12
Yeah, like I was talking about with Cassie, it is something that transcends policy. I think we rely a lot of waiting on politicians to have solutions because you know, the ones that they're the only ones that can really affect the big picture. But this is a way that encouraged people can affect the big picture just by making different decisions.
Jessamy Bagenal: 40:29
Yeah, and I think that people are hungry for that kind of information. This is why these kind of conversations are so important. Because people can take that information and use it the next day.
Gavin Cleaver: 40:42
Yeah, absolutely. Just making little choices for for a big effect, which sounds like a cliche. But it is. It is something that has risen out of this kind of planetary health diet movement. So I mean, thanks so much for listening this podcast. We really appreciate it. We're going to try and do this every two weeks, so hopefully we'll see you back here in two weeks. This shows available on all of your normal podcast spaces like Apple, Spotify, stitcher. I think we're even on Alexa.
Jessamy Bagenal: 41:11
And we would massively welcome your feedback. You can send us any of your comments to podcasts at lancet dot com or if you want to chat or maybe suggest what you'd like to see on the show or here on the show, things to talk about, you know, anything really We'd really like to hear from you. So thanks again for listening. And please do try and subscribe to us and like us and share on social media,
Gavin Cleaver: 41:35
we would really appreciate We would
Jessamy Bagenal: 41:36
really like that