The Lancet Voice

Invisible women, COVID-19, and NASA

March 17, 2020 The Lancet Voice Season 1 Episode 2
The Lancet Voice
Invisible women, COVID-19, and NASA
Show Notes Transcript

Caroline Criado Perez discusses how cardiovascular health in women has been ignored by medicine, a doctor in Wuhan shares first-hand COVID-19 experiences, and NASA scientists explain how life on Mars might affect health on Earth. 

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spk_0:   0:02


Gavin:   0:08
Hello. Welcome to another episode of The Lancet Voice. I'm Gavin  

Jessamy:   0:12
and I'm Jessamy.

Gavin:   0:13
And we'll be your guide through the world of health research here at The Lancet. As always, we'd love to hear from you wherever you're listening to this from,

Jessamy:   0:20
and you can contact us on podcasts@lancet. com, that's podcasts at lancet dot com, and we would love to hear from you. We'd like to hear what you want to hear on what you think of the episodes so far.

Gavin:   0:34
es we would absolutely love to hear some feedback generally. But on this week's podcast, we've got Jessamy talking to Caroline Criado Perez and Roxanna Mehran about invisible women in cardiovascular disease, which is super interesting. And we'll talk about that in just a minute.to an interview with one of the doctors who is on the ground in with her in China and has just submitted a really interesting paper on. We've just published it. It's got lots of fascinating information, so I'm looking forward to hearing that

Jessamy:   1:05
There's an interview with one of the doctors who is on the ground in Wuhan, China and has just submitted a really interesting paper. We've just published it. It's got lots of fascinating information, so I'm looking forward to hearing that

Gavin:   1:06
Yeah, absolutely. Also on this episode, one of our editorial board poses a very interesting question. A few weeks ago, she said, Have you ever thought about NASA accidentally bringing back microscopic life from Mars and it damaging the health of everyone on Earth? I said No. I had never thought about that.

Gavin:   1:22
Thankfully NASA are running a whole program because they have thought about this eventuality. Amazingly, we got interviews with people running the program who have job titles like Mars Object Curator.

Jessamy:   1:32
I know I love this hypothetical world. It's just incredible.

Gavin:   1:36
But first of all, Jessamy, you've been thinking recently about women being ignored in health research, especially with International Women's Day being recently. But more specifically, it's really interesting facts about how women have been ignored in cardiovascular research.

Jessamy:   1:52
Yeah, it's a fascinating topic, and one which has been going on for decades, really. I mean, one of the most sort of famous example is the Harvard Physician Survey, which was started in the early eighties and basically has all male physicians on. This is what we base our evidence of aspirin being useful for cardiovascular disease, it's on 100% men. It's not on any women, and this kind of bias has continued through cardiovascular disease through the decades, really. So that when I was at medical school, you know, we learnt risk factors for men. Sort of the typical way that a man might present to A&E having chest pain, which, you know, spread your jaw and down your left arm. And those are male symptoms. Strangely enough, women have completely different symptoms.

Gavin:   2:41
So what are some of those symptoms?

Jessamy:   2:42
So their symptoms tend to be that they don't have any. They don't have any chest pain. Um, and so you miss 50% of the diagnoses in patients, you know, and they therefore have poor outcomes on that, then goes to other things like risk factors. You know, our classic understanding of what risk factors are, you know, smoking, obesity, diabetes. They are, of course, involved in women's risks as well. But women have additional risks, like if they have pre-eclampsia during pregnancy that, for some reason that we don't fully understand yet. But it's obviously due to sort of vascular charity of their arteries and veins means that they have more risk of cardiovascular disease. All of these things, which we've only really just started looking into over the past kind of 5, 10 years, you know, which hugely affect women's outcomes.

Gavin:   3:29
Are you just saying just then in ways we don't understand pre eclampsia? So we're still at this basic level of research?

Jessamy:   3:34
We still don't really understand why it is that pre eclampsia makes women have, uh, more cardiovascular risk.

Gavin:   3:41
It is kind of amazing, really, isn't it that this way that how researchers treated men as kind of like the base model

Jessamy:   3:49
as the default, which is what Caroline's book is all about. You know, it's a fascinating, very well argued book, which basically sets out this default universal male that invades every aspect of our life and is completely pervasive from town planning to safety, planning for cars, jobs, media, education on health. Which is most surprising. You know, we've got it wrong in The Lancet. I sort of just looked through some of our papers and cardiovascular disease over the decades, and, you know, immediately we found one, which was published in the early nineties, um, and looks at blood pressure thresholds. And basically, this was when we were trying to decide whether if you give anti hypertensive medications, there's a threshold below which it doesn't matter if you get any lower than cardiovascular outcomes aren't gonna improve on. We publish this kind of systematic review of patience and studies on in that there are 500,000 individuals, of which 96% a male. Yet the conclusions that we draw from that are universal, that all individuals will have basically no threshold below which, if you keep on lowering their blood pressure, then you will improve their cardiovascular outcomes on the paper states that with almost certainty. And yet there are no women in it.

Gavin:   5:14
Yeah, it's kind of incredible. And I was reading one of our editorials from about 10 years ago where The Lancet was writing about this subject and they were saying that women with heart attacks and less like to receive aspirin, less likely to be resuscitated, and less likely to be transported to hospital in ambulances using lights and sirens than men, because all of these symptoms get missed. So I'm very excited hear you talk to Caroline and to Roxana about this.

Jessamy:   5:39
Yeah. And of course, Roxanna is leading our women in cardiovascular disease. And our goal is to try and, you know, bring move that move that forward. And so it's really exciting to see what comes out of that commission.

Gavin:   5:55
Well, take it away.

Jessamy:   5:57
So Caroline Criado Perez, you are an activist and the author of Invisible Women, which is a brilliant book. Where did the book start? And what was your kind of stimulus for writing it

Caroline Criado Perez:   6:08
Before I discovered about the gender data gap in medicine and how that's obviously is also connected to the default male bias, you sort of, I think, medicine is the one place where you really would be looking at all the bodies, you would be looking at male and female bodies. So to discover that, you know, researchers are saying that the female body was too complicated to study despite it being half the world population. The body, you know, that half the world has was incredibly shocking to discover that not only that, but that this gap meant that women were being misdiagnosed and were receiving drugs that caused some adverse drug reactions was incredibly shocking. I couldn't believe that women was so much more likely than men to be misdiagnosed in a hospital. You know, that was the first thing that I discovered, and I just found that incredibly shocking.

Jessamy:   7:09
So perhaps Caroline, you could tell

Jessamy:   7:10
us a little bit more about what you found out about cardiovascular health.

Caroline Criado Perez:   7:14
The sex differences in cardiovascular health have been known about for for two decades now. You know, we've known that women are more likely to die following a heart attack, in fact, since 1984. And it's one of the most well documented sex differences in medical health because we've known about it for so long, and we know that there are different risk factors for men and women. You know, diabetes is a high risk for women. Smoking is a higher risk factor in women.

Jessamy:   7:41
Obviously, there's so many reasons why this is relevant and important now. But what are your major concerns looking forward

Caroline Criado Perez:   7:49
for me, the major urgency is in in tech, because tech infects every single area. When I say tech I mean as it is being introduced into medicine. It's being introduced in criminal justice, it's being introduced into human results. And, you know, as I said that the capacity there are things to go horrifically wrong is absolutely enormous. And it also feels like the sector that certainly historically and seemingly still has been most blithely unaware of the social impact of the work that it does. There's still this this sort of heavy bias within the tech industry that it's just about numbers here. I'm not sure if listeners will be aware of James Dammold, the famous, or infamous I should say, Google memo guy who wrote a thing about how women are no good at tech because basically women are empathetic and men are, you know, numbers people. And what you need in tech is number people. That is such a telling and worrying attitude that is still far too prevalent in tech. Because tech is not actually about numbers. It's about people because it is interacting with people, and so you need to have a very high awareness of the social issues into which you are introducing your numbers.

Jessamy:   9:10
So, Caroline, what can we do about this?

Caroline Criado Perez:   9:12
So it's slightly chicken and egg. Everything sort of needs to happen at the same time, the data collection needs to get a lot better on. Do you know the people designing the algorithms need to be a lot better at recognizing that there is an issue with the data they're using to train the algorithm.

Jessamy:   9:28
I also spoke with Roxana Mehran. She's leading our cardiovascular Health in Women Commission from The Lancet. She has lots and lots of names and roles, but the way she described herself is someone that cares about women's health and cardiovascular outcomes on it was a real pleasure to speak to her. So Roxana, you've obviously worked in the field of cardiovascular disease for a very long time. And it's one of the major killers around the world. Where are we now? With cardiovascular disease and women's health?

Roxana Mehran:   10:03
Of course in the field of cardiovascular disease, the plot thickens in a very, very interesting way. First of all, cardiovascular disease is the number one killer of women around the world, and then it's expected to increase because of the global increasing rates of obesity and diabetes, as well as the fact that we're not paying as much attention to it as we perhaps could in developing countries.

Jessamy:   10:30
So, Roxana, how have we got ourselves in this situation, why do we have this problem with cardiovascular disease and women?

Roxana Mehran:   10:36
The other major issue about cardiovascular disease in general is that the cardiovascular, health care professionals are often men. Of the medical school graduates now in the United States, we have over 51% of women. Get into, um, internal medicine training, we start to see about 47% or so women, which is still a really good number. But as soon as we go into the field of cardiovascular medicine sub specialty, that number dwindles down to under 20%. So what is this? Why is this happening? And it's kind of the same as like, if you look in the corporate world seeing not enough women in leadership positions and not enough women being recognized and the talents really, really getting lost in the pipeline, you know? And we call it sort of a leaky pipeline. And what happens is that, you know, there aren't many women in those leadership places, and so the mentorship is lacking, and women don't get the opportunities. They do not have the important recognition that they deserve.

Jessamy:   11:49
What effect does this sort of lack of women in cardiovascular medicine had on patients?

Roxana Mehran:   11:55
For as long as I've been in cardiology, and it's over two decades, we've known that women with cardiovascular disease are under recognized, understudied, under diagnosed, underserved, undertreated in every female specific areas, like in the post menopausal women and women, um, who are having pregnancy related complications. We have very little data because the data are mostly on men, and we don't understand what that means. If a woman has a pregnancy related complications such as, you know, having diabetes, gestational diabetes and pre eclampsia. So what does that mean for her cardiovascular health? What about the woman who presents with breast cancer, receives chemotherapy lives and survives her breast cancer, which is what's happened beautifully with the cancer initiatives? These women will die of cardiovascular disease because we do know that radiation effects cardiovascular health of these women. So there has to be initiatives in the oncological world, and it's a whole new field of cardiooncology, a whole new field of cardio obstetrics. These are old male-specific areas that we have to pay attention to.

Jessamy:   13:09
So how can we overcome this problem?

Roxana Mehran:   13:13
Well what's nice to see is that there is this global and kind of universal recognition that this is going on everywhere and that we have to make changes to our social context of how we, the societal way of how women are, are looked at, you know, are perceived and what we need to do to make those changes happen. So I founded an organization called Women Are One that's focusing on promoting talent in medicine. And we're starting with cardiology because it's the most broken house, as I call it. And we're working really, really hard to promote and and seek the talented women and making sure they're there. We just have to see them. We have to put different glasses on. We have to start thinking about understanding what the obstacles are for these women and trying to make it a little bit better for them and pull them up. And that's really what we're doing in Women As One, and I think working with a lot of the societies hand in hand, ah, to be sure they're recognized.

Gavin:   14:20
So listening to that interview, it's staggering the lack off basic research that's gone into women with cardiovascular disease and it seems incredible to me, although I know it shouldn't... you know, it's one of those things that's both surprising and disappointingly unsurprising at the same time.

Jessamy:   14:36
Yeah, I think it is a major failing in medicine. And it's one of the interesting things that really comes through in Caroline's book is that, you know, you sort of walked through life as a woman, not really recognizing things. Then you read something like Caroline's book. You talk to someone like Roxanna and you suddenly realize it's everywhere and that medicine has really done a disservice to patients and to women in particular in having just not being alive to this topic, not being focused enough on the different physiology between men and women, which we're all aware of. We all know anatomy. We were all taught basic science. Um, and yet that hasn't been implemented in actual medical practice, and it's it's a sad situation that, you know, I really hope that the Lancet Commission could, you know, try and add some important research to

Gavin:   15:32
Yeah. I mean, as bad as we've heard things are, we did hear a note of optimism from Roxanne or at the end, do you personally feel that... so, going beyond cardiovascular disease, now, do you feel there's a greater consideration of women? And that it's becoming far more obvious as a pressing concern in science and health and medicine?

Jessamy:   15:51
I think that there is. You know, I think it's it's sort of part of the times as well. You know, the Me Too campaign and all the other sort of movements that have happened over the last two years of kind of, you know, culminated in this focus on this particular issue. And I guess there are lots of different different aspects to it. You know, Jocalyn, who's one of our editors and Liz, who have been running the series on Lancet Women, on gender series and on issues they've, you know, really focused and highlighted the importance of women in STEM and in medicine. And you know, that is part of the problem is that women in you know these very sort of driven and male orientated careers find it difficult to progress even if they start off, they might not necessarily finish up with with the big jobs. And then it's a sort of self perpetuating cycle. So you know, there's that issue which Roxanna spoke to. But then there's also the problem that it's actually sort of embedded in the actual you know, the whole way that medical research is set up on what we look into. So it's a very difficult one to entangle, and I do think that there is hope, but I sort of echo Caroline's concerned that now we're moving into this AI period. There is this risk that these biases and this assumption of a universal male default very easily be amplified because we're using big data and we're assuming that what we put in is good. And for the most part, what we've put in is not recognizing women.

Gavin:   17:29
Asia executive editor Dr Helena Wang managed to grab some time with Professor Bin Cao recently. Now, Professor Cao was the first researcher to release findings on the original 41 patients in Wuhan, China, who were diagnosed with COVID 19. His follow up research, which was released on March 9th, looks at co morbidity for COVID 19 . So Jessamy, just briefly unpack a little bit of jargon for me. What is a comorbidity?

Jessamy:   17:56
Well, a comorbidity is essentially a health problem that is an added extra. So you are a man. You might be 35 you have a co morbidity, which is diabetes and hypertension. So it's a kind of an extra disease that, for the most part, is chronic. That means that you can't treat it to just go away. It needs to be managed and that management is either through medication or lifestyle implementations or through potentially, you know, other surgical or medical procedures.

Gavin:   18:31
So in terms of COVID 19 a comorbidity is a bit like a multiplier.

Jessamy:   18:35
Exactly. And I think you know what's really important about this particular paper is it's 813 patients that were sent to the to sort of largest hospitals in Wuhan that were a referring center so if a hospital couldn't deal with a patient and they'd send them to those two places on of those 813 patients, 613 patients were kind of taken out, and that was because they hadn't got an outcome yet. What's particularly important about this particular study is that we don't have any research where there is a definite outcome. So all of the research so far is being on patients in hospital where their treatment is ongoing, whereas this is at the end of the story. So it's patients who either died or were discharged. So the important kind of clinical things, I think, to take away from there so that the results show that what we know, which is 97% of people present with a fever or with some shortness of breath or cough and that tends to last for 12 to 13 days.

Gavin:   19:33
Yeah, absolutely. So it's really amazing to get speak with Professor Cao on the ground there in Wuhan. So I'll hand over to Helena.

Helena Wang:   19:43
Hello. I'm Helena Wang, specialty editor at The Lancet. In this podcast we're discussing one paper about COVID 19 and the risk for adult inpatients in Wuhan. Joining me today is Professor Bin Cao, author of the paper. Hello.

spk_9:   20:02
Hello, Helena.

Helena Wang:   20:03
I'm aware that you have been working so hard in front line Wuhan for almost two months. And this is also the second paper for you to publish in the Lancet regarding COVID 19. But please tell us, how can the results of these studies be helpful? Are there any lessons for other countries?

spk_9:   20:21
There are three main findings of our study. Firstly, we medicated the clinical course of the disease, including duration of favor display near on a cough. The median duration of fever was about 12 days. East rivals which were similar it non survivors by the cough may last for long time. There are 45% survival cases. Derek had cough on discharged. We also observed that in part off the non survivors that this media even occurred after fever had disappeared. So different persons may not indicated that recovery off the disease, especially in critical care patients in survivors, is Nero would relieve after about 30 days after the curtain occurrence off softness of grass. Why are the symptoms would last at your desk in non survivors? We are so in last rated. The time of occurrence are different complications such as sepsis, areas. Acute cardiac injury, acute kidney injury on a secondary bacterial infection. The critical cars showed ah, whole picture off the progression of the disease, which could have physicians to predict what will happen in the next second. We found the media and the original brush. Aging was about 20 days from unsettle eagerness among survivors, but a virus was continuously detectable on check Tess in on survivors. It is the first time to revere. The original are setting in. Sylvia died in 19. You moan your paces. The information was very important for antiviral treatment on before the siege entity for isolation and it is stark. Thirdly, the factors, including early age, hired the timer on a hard sofa score. Our nation could herald conditions. Identifying the patient is miss high risk off death. Besides this, we found that live for opinion will recover from 10 days after unsettled nearness in survivors. But last out your destiny is in non survivors. Similarly dynamic change were observing elected the hydra tennis. We also observed, after naturally Christoph Air six and serum parenting in non survivors. Allow these the declarations off Earnestine on survivors. We think that the enemy monitoring off this markers. We have hair up clinicians to identify cases with high risk of tests as soon as possible during hospitalization. Thank you.

Helena Wang:   22:59
Thank you. And that's very helpful. Too long, especially the viral shedding time. And you have gave us very good explanation on the implications on practice on clinical practices. Also, we found that fatality rate about 20 of AIDS is extremely high in the cohort. So would you please explain why there are much higher fatality of wage of this cohort in the study?

spk_9:   23:21
Actually, the 28% of our study is not really a ah fertility issue off superyacht the 19 according to a recent national or sorry, the keys mortality. Reese, you Alcide hoop. A promise is less than 1% on 3%. Kobe province without a hat on you. Ha city, The totality re shoe is around 4 to 5%. Uh, why the the Reese you're 2080 hour Yoko Horie is because that we only include patients in the to death and dancing native arbiters. Jean Hobby Turner will have Armory Hospital. Both hope Peter's were the only designated hopinto during the mom's off that December and January, and all the Savior Key sees from other whole jitter but transferred to this to that ineighty hulk. It's yours. So I have a Cold war. Only include that severe and the critical patients. So you know, I'm cohort to not include mired in Monterey cases. This is why you have a call for we have very high fatality. Reshoot is Iran 28. But women look at all the cases. The fertility reshoot Not so Hi.

Helena Wang:   24:37
Thanks so much for explanation. Thanks so much for spending time elaborating the important findings of your latest publication alongside the professor's How on dhe. We also would like to use this opportunity to express our sincere gratitude to all the Chinese frontline House workers as well as researches and combat against Kobe. 19.

Gavin:   24:57
So yeah, fascinating. Like I said, to hear from a doctor on the ground there in one hand, absolutely amazing to think what they must be going through trying to keep this outbreak in check in Wuhan.

Jessamy:   25:09
Exactly Any means in real sort of clinical nuggets that I think come from this paper. You know, the important ones are that that the median age range is 56 62% of male on behalf of all those patients have comb abilities, and those most important capabilities are hypertension and diabetes. So that just kind of give some kind of an idea of the type of patients that potentially more susceptible to this disease. What's interesting is that, you know, not so many patients had sort of respiratory problems like COPD, which you would expect for primarily resp you're a tree disease and that might be because, you know it's not so well recorded. Them might be issues there, but it's a sort of it's It's an interesting potential. And then

Helena Wang:   25:53
some of

Jessamy:   25:54
the other really interesting things that I thought that I thought from that conversation came through where you know that the illness on set to discharge is 22 days of the median time. That's an extremely long time for health systems to be having to deal with patients who are gonna be in hospital for 22 days.

Gavin:   26:10
Yeah, it's a lot to think about, isn't it, because you know it's such a it's so fast moving across the world at the moment, but we're seeing relatively little output at the far end because of how long this disease takes to run its full course.

Jessamy:   26:23
Exactly, which is why this paper is is so important because it does show us the end of these people's journeys. You know some other interesting things with this spiral shedding load, which is 20 days median. That doesn't necessarily correlate with infection or your ability to infect people. But it's a very long time to be having the virus multiplying in your body and to be testing positive. Just one of these other issues that were still unsure about why patients are able to test positive fork over 19 for such a long time.

Gavin:   26:54
Yeah, I mean, as we said in the first time, so they're still so much to understand about this disease on. Obviously, we're seeing restrictions being put in place all across the world. At the moment, it's a It is definitely a very interesting, quite scary time. I think

Roxana Mehran:   27:11
it is a

Jessamy:   27:11
scary time, you know, from from kind of that paper. It's scary. It's for people who were older, Um, for people who have comb abilities and and that was the kind of, you know, the the risk of mortality increases if you're older. If you have increased D timers admission and if you have a higher so for school, which is like a score. Basically, that shows how unwell your different organs are when from a kind of intensive care for interview.

Gavin:   27:40
So finally, this week, Dr Helen Brooks, one of our editors here, the man's voice had a very interesting question. She posed us, and I think, actually, the first editorial meeting we had about this podcast Helen, that tell us a little bit about how this interview about came out

spk_3:   27:53
Well, NASA has been flying to Mars. It's part of its space exploration program for the past 20 years, and on these missions they have gathered evidence that suggests that billions of years ago Mars had wet conditions that probably lasted long enough to support the evolution off microbial life. And later this year, NASA is planning to launch their Mars 2020 Rover mission, which will collect and store a set of rock and soil samples, and they're aiming to return them to the Earth in the future. On DDE, the evidence that they had collected in the past has suggested that Mars had wet conditions billions of years ago that could have possibly sustained life. Microbial life indeed on DDE In this mission, they are hoping to collect and store a set of rock samples on DDE. Bring them back to Earth. And in that context, a key question is, could anything that they bring back Thio Earth from Mars, theoretically adapt to living on our own planet and possibly cause harm?

Gavin:   28:59
Yeah, that's a really fascinating idea. Isn't that how do people kind of plan for something that they have no idea even exists?

spk_3:   29:06
Yeah, exactly. On dhe, we imagine bacteria living at body temperature. But work's been done on Earth where we've seen that actually so called extremophiles bacteria that can exist in quite harsh conditions. For example, they found bacteria that live in minds in acid pits and also in, um, minus 20 degrees Celsius under ice layers and Greenland and things. So perhaps some of these similar conditions might be seen on Mars on dhe might also harbor extremophiles, and we might see some of that There is Well,

Gavin:   29:51
yeah, I guess it's fascinating to think how they might interact with human health for with, like, biodiversity on the planet ecosystems, all that kind of stuff

spk_3:   29:59
Well, yes, exactly. So the thinking is that maybe some of these organisms might infect organisms in similar conditions in the sea, for example, where the temperatures are very low. Or perhaps bacteria in space might use minerals or metals or substrates, and therefore there's an outside possibility that they could if they got out damage building structures or even natural features on there's an even more outside chance. But this will be a high, high risk. Think to occur would be a firm, small polly peptide. It's existed, such as pry on like proteins on dhe. They would have the capacity to maybe even infect small mammals or even large mammals like humans.

Gavin:   30:45
Yeah, it's a it's a lot of things about I'm glad NASA have thought about it, though. No. Yeah, yeah, I'm excited to hear that interview. So, uh, think it away.

spk_3:   30:55
Eso enjoying today on the phone by Lisa Prats, Aaron, Rick Berg and Andrea Harrington to discuss some of these things on dhe Lisa, Wouldn't you tell me a little bit about stuff?

spk_6:   31:07
Sure. I am NASA's planetary protection officer, very much engaged in backward planetary protection, which is protecting Earth from inadvertent contamination by ah, possible extraterrestrial organism or a biological agent, and we really haven't worried much about that sense some. The Apollo era. But with Mars sample return now on the horizon of black backward, planetary protection is a major topic in the office right now.

spk_5:   31:41
Yeah, Aaron Rick Berg. I am a Astro materials curator at NASA's Johnson Space Center, and I'm also the planetary protection lead for the senator.

Caroline Criado Perez:   31:53
So I am the NASA's Mars sample curator in the after materials acquisition in curation office. Better

spk_3:   32:01
what type of life do you imagine we might see on Mars

spk_6:   32:04
Way? We think it might not be exactly the same as what we know on Earth, but its underlying chemistry, the kind of molecules that it's made up off will be from the same classes of compounds that we know. And it'll be, You know that we will be able to identify it if it's a completely separate origin of life with separate evolution. If it's one origin and it's in two places, Earth and Mars, Um, then it will be, you know, quite interesting to see how how evolution and the very different environmental factors on Mars might have put pressure on a Martian life form to evolve different kinds of mechanisms. T gain resource is for metabolism or molecules that would help protect it from environment. That's harsh in a very different way from Earth.

Caroline Criado Perez:   33:03
What happened in the past, where there could be a false positive. So that's one thing that we're also considering making sure that we not only protect the earth from the samples but the samples from the Earth.

spk_3:   33:17
How would we prepare and protect ourselves from organisms that we don't yet know exists?

spk_6:   33:22
It is. It is an enormous challenge to try to think about risk from an organism or or just a biological entity like a like a pry on molecule coming from another planet and arriving here in a sample that we've we've intentionally returned. But I think there's a very high degree of confidence that this is something we can we can manage. The sample will be robustly contained for four layers of containment or five, depending on how you count the sample tube. Sterilization off some of the external surfaces of those various compartment layers is something that's being considered right now to give us assurance of safety beyond containment and Then the samples will be immediately transported very safely in an additional earth containers to a safe receiving facility.

spk_3:   34:24
You mention prion proteins die ELISA. And in my mind, Prinze have a reputation for being very destructive in mammals. Andi, I wondered if you could tell us more about whether Prime like proteins might be present in the samples that we bring back on DDE what we might be able to do to mitigate any damage from them.

spk_6:   34:47
But I think that's primarily an end member. That sort of the most extreme. A strange thing one could imagine would be just a molecular complex of macro molecule that WAAS made up of similar sub elements to something terrestrial that could somehow interact with us. But again, that interaction would require it to be to be released and defined a host. So we primarily used pry ons as, uh, an indication of a type of molecule that would be very difficult to deactivate. Uh, or a few I want to use the word of sterilized. I mean, for just a molecule. I think I'll stick with deactivate, so we we use it as an end. Remember for thinking about how high a temperature for how long? A period of time with her without a second chemical modality. What would it take to de nature on deactivated something like a pry on if it was, um, on a surface and not contained in the sample container.

Roxana Mehran:   35:56
So what are the

spk_3:   35:57
chances that organisms that we bring back might be hazardous to us, hazardous to the ecosystem or hazardous? Even two buildings, for example?

spk_5:   36:07
The idea that that's something that we bring back from Mars could be hazardous to the ecosystem is it's a low probability event because this is a very different ecosystem than what we think exist on Mars currently. Um, but it's high. It's high risk. If it happened, it would be very, very bad. Um, I again you'd have to be living sort of continuously in in contact with all of the different organisms that we have in our ecosystems on Earth in order to become, um, pathogenic or hazardous. It's not something that you sort of evolved spun least we as faras we know not something that you evolved spontaneously, so it's maybe a slightly higher risk than been specifically being hazardous to human health. Um, but I still think it's a It's a very low probability event. There isn't you? So Thio briefly describe the sort of systems that we're thinking about building toe. Contain these samples. They're gonna be primarily constructed of materials like stainless steel and Teflon and glass on these air. Pretty inert, non reactive materials from antibiotic or biological standpoint. There isn't a lot of energy to be gained from trying to degrade or alter those compounds. Um, so it's certainly something to be concerned about something to pay attention to. But I think it's it's the likelihood of something of us bringing something back that is already has the metabolic potential. Toe thio, oxidizer to grade stainless steel, for example, is very, very low. Just because they're as far as we know is no stainless steel on Myers, except for what we way put there. Um, and so there would be no sort of ecological pressure toe force an organism to evolve, to be ableto to interact with those types of materials.

spk_3:   38:17
Well, thank you so much for talking to me today. I think that we can feel very reassured by your advice on dhe was fascinating conversation. Thank you.

Jessamy:   38:28
Thanks. NASA um, having these people. D Day's incredibly interesting modeling. Sort of what might happen with all of these hypotheticals.

Gavin:   38:38
I want how you employ for this kind of job.

Jessamy:   38:40
Yeah, I think you've got to be okay with uncertainty

Gavin:   38:43
very much,

spk_3:   38:44
which would not be good for me.

Gavin:   38:47
I think I think I would be into it, you know, kind of philosophical background.

Jessamy:   38:52
Yes, I think you could be in any

Gavin:   38:54
relatively useless when it comes to actually understanding the science and the microbes involved. But I think it's an absolutely fascinating job. Tohave,

Jessamy:   39:02
yeah, wide scale disaster that my incur you would be okay with philosophizing about.

Gavin:   39:07
I think so. Yeah, until it all went horribly wrong. In which case I would deny all knowledge. But it's amazing that it's their job to go into the office and think about the completely unknown biology we might bring back from Mars on what it might do to Earth.

Jessamy:   39:23
I know. I mean, you

Gavin:   39:26
see, they were very they very much stressed that there is no risk basically to the earth. But, you know, I'm glad that it's their job to tell us that there's no risk to the rather than it being a surprising scifi kind of moment.

Jessamy:   39:42
Yeah, I think the precautionary principle definitely applies to this.

Gavin:   39:47
Thanks so much for listening to this episode of The Lancet voice. You already listening? So this could be obvious to you, but you can find us anywhere. Usually. Get your podcasts if you want to describe and leave us a nice review that would really appreciate that. Andi, As we said in the intro, drop us an email on podcast that lancet dotcom. Tell us what you think of the show. What you'd like to hear, Tell us about health where you are. What? Your kind of concerns around the world. Something really interested to hear about, So yeah. Thanks very much for listening.

Jessamy:   40:14
Yes. Thank you for listening.