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Gavin: Hello, welcome to another episode of The Lancet Voice. I'm Gavin 

Jessamy: and I'm Jessamy 

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

Jessamy: And you can contact us on podcasts at lancet. com that's podcasts at lancet.

com and we would love to hear from you. We'd like to hear what you want to hear. And what you think of the our episodes so far. 

Gavin: Yeah, we would absolutely love to hear some feedback generally. But on this week's podcast, we'll get going with that. We've got Jessamy talking to Caroline Criado Perez and Roxana Moran about invisible women and cardiovascular disease, which is super interesting.

And we'll talk about that in just a minute. 

Jessamy: Yep, and also we're going to be listening to an interview with one of the doctors who's on the ground in Wuhan, China, and has just submitted a really interesting paper and we've just published it. It's got lots of fascinating information. So I'm looking forward to hearing that.

Gavin: Yeah, absolutely. And 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 

Jessamy: that.

Gavin: Thankfully, NASA are running a whole program because they have thought about this eventuality. And amazingly, we got interviews with people running the program who have job titles like Mars object curator. 

Jessamy: I know, I love this hypothetical world, it's just incredible. 

Gavin: But, first of all, Jessima, you've been thinking recently about women being ignored in health research, especially with International Women's Day being recently.

But more specifically there's really interesting facts about how women have been ignored in cardiovascular. Research. 

Jessamy: Yeah, it's a fascinating topic and one which has been going on for decades really. One of the most sort of famous example is the Harvard physician survey Which was started in the early 80s and basically has all male physicians And this is what we base our evidence of aspirin being useful for cardiovascular disease on it's on a hundred percent 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, we learned risk factors for men, the typical way that a male, that someone might present to A& E as being having chest pain, which, spread to your jaw and down your left arm, and those are male symptoms, and strangely enough, women have completely different symptoms.

Gavin: Really, so what are some of the symptoms that women have? So their 

Jessamy: symptoms tend to be that they don't have any, they don't have any chest pain. And so you miss 50 percent of the diagnosis for patients, and they therefore have poorer outcomes. And that then goes to other things like risk factors, our classic understanding of what risk factors are, smoking, obesity, diabetes.

They are, of course, involved in women's risks as well, but women have additional risks, if they have preeclampsia during pregnancy. That, for some reason that we don't fully understand yet, but it's obviously due to vascularity 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 five, 10 years which hugely affect women's outcomes. 

Gavin: So you were just saying just then, in ways we don't understand preeclampsia, so we're still at this basic level of research. 

Jessamy: We still don't really understand why it is that preeclampsia makes women have more of a cardiovascular risk.

Gavin: It is amazing, really, isn't it, that this way that health research has treated men as like the base model, if you 

Jessamy: will. As the default, which is what Caroline's book is all about. 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 and health, which is most surprising.

We've got it wrong in the Lancet. I just looked through some of our papers and cardiovascular disease over the decades and, immediately we found one which was published in the early 90s and looks at blood pressure thresholds. And basically, this was when we were trying to decide whether if you give antihypertensive medications, there's a threshold below which it doesn't matter if you get any lower, then cardiovascular outcomes aren't going to improve.

And we published this kind of systematic review. Of patients and studies. And in that there are 500, 000 individuals of which 96 percent are male. And 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.

And the paper states that with almost certainty. And yet there are no women in it. 

Gavin: Yeah, it's incredible, isn't it? I was reading one of our editorials from about ten years ago, where we, where the Lancet was writing about this subject. And it was saying that women with heart attacks were less likely to receive aspirin, less likely to be resuscitated, and less likely to be transported to the hospital in ambulances using lights and sirens than men.

Because all of these symptoms get missed. So I'm very excited to hear you talk to Caroline and to Roxana about these Yeah, and of course 

Jessamy: Roxana is leading our Women in Cardiovascular Disease and that kind of is our sort of aim and our goal is to try and, bring, move that forward.

And so it's really exciting to see what comes out of that commission. 

Gavin: Take it away. 

Jessamy: 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: Before I discovered about the gender data gap in medicine and how that obviously is also connected to this default male bias, you think of medicine as the one place where you really would be looking at all the bodies.

You would be looking at male and female bodies. You wouldn't expect it to be like this. And so to discover that, researchers were saying that the female body was too complicated to study, despite it being half the world's population, the body, the half of the half the world has was incredibly.

Shocking. And to discover that not only that, but that this gap meant that women were being misdiagnosed and were receiving drugs that caused them adverse drug reactions was incredibly shocking. And really, I couldn't believe that women were so much more likely than men to be misdiagnosed if they had a heart attack.

That was the first thing that I discovered. And I just found that 

Jessamy: So perhaps Caroline, you could tell us a little bit more about what you found out about cardiovascular health. 

Caroline: The sex differences in cardiovascular health have been known about for two decades now. 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, diabetes is a higher risk factor for women, smoking is a higher risk factor for women. 

Jessamy: Obviously, there are so many reasons why this is relevant and important now, but what are your major concerns looking forward?

Caroline: For me, the major urgency is in tech. Because tech infects every single area. When I say tech, AI. It's being introduced into medicine. It's being introduced into criminal justice. It's being introduced into human resources. And, as I said, the capacity there for things to go horrifically wrong is absolutely enormous.

And it also feels like the sector that sort of, certainly historically and seemingly still, has been most blithely unaware of the social impact of the work that it does. There's still this sort of heavy bias within the tech industry that it's just about numbers. I felt that I'm not sure if listeners will be aware of James Damore.

I'm not entirely sure how to pronounce his name, but the famous or infamous, I should say, Google memo guy who wrote a thing about how women are no good at tech because they, basically, women are empathetic and men are You know, numbers people and what you need in tech is numbers people and 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. So Caroline, what can we do about this? So it's slightly chicken and egg. Everything needs to happen at the same time.

The data collection needs to get a lot better. And, the people designing the algorithms need to be a lot better at recognizing that there is an issue with This data that they are using to train the algorithm. 

Jessamy: I also spoke to Roxana Marin, who's leading our Cardiovascular Health in Women Commission from the Lancet.

And 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. And 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 in women's health? 

Speaker 4: Of course, in the field of cardiovascular disease, the plot thickens in a very interesting way. First of all, cardiovascular disease is the number one killer of women around the world. And it's expected to increase because of the global increasing rates of obesity and diabetes, as well as the fact that we are not paying as much attention to it as we perhaps could in developing countries.

So Roxana, 

Jessamy: how have we got ourselves in this situation? Why do we have this problem with cardiovascular disease in women? 

Speaker 4: The other major issue about cardiovascular disease In general, is that the cardiovascular healthcare professionals are often men. Of the medical school graduates now in the United States, we have over 51 percent who are women.

Get into internal medicine training, we start to see about 47 percent or so women, which is still a really good number. But as soon as we go into the field of cardiovascular medicine subspecialty, that number dwindles down to under 20%. So what is this? Why is this happening? And it's the same as if you look in the corporate world of seeing not enough women in leadership positions and not enough women being recognized and the talent really getting lost.

in the pipeline, and we call it a leaky pipeline. And what happens is that 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: Roxana, what effect has this sort of lack of women in cardiovascular medicine had on patients?

Speaker 4: 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, under studied, under diagnosed, under served, under treated. In every female specific areas, like in the post menopausal women, in women 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 complication such as, having diabetes, gestational diabetes and preeclampsia. What does that mean in, 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 affects cardiovascular health of these women. So there has to be initiatives in the oncological world. And it's a whole new field of cardio oncology, a whole new field of cardio obstetrics. These are all female specific areas that we have to pay attention to.

So how can we overcome 

Jessamy: this problem, Roxana? 

Speaker 4: What's nice to see is that there is this global and 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 looked up are perceived.

And what we need to do to make those changes happen. So I founded an organization called Women as 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 hard to promote and seek the talented women and making sure they're, and 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 try to make it a little bit better for them and Pull them up and that's really what we're doing at women as one and I think working with a lot of the society's hand in hand To be sure they're recognized.

So 

Gavin: listen to interviews. It's Staggering the lack of basic research that's gone into women with cardiovascular disease it seems Incredible to me, although I know it shouldn't. It's one of those things that's both surprising and disappointingly unsurprising at the same time. 

Jessamy: 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 walk through life as a woman.

Not really recognizing things and then you read something like Caroline's book or you talk to someone like Roxana And you suddenly realize it's everywhere and that medicine has really done a disservice to patients And to you know 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 and yet that hasn't been implemented in actual medical practice and it's a sad situation that, I really hope that the Atlantic commission can, try and add some important research to.

Okay. 

Gavin: Yeah, as bad as we've heard things are, we did hear a note of optimism there from Roxana at the end. Do you personally feel that, so going beyond cardiovascular disease now, do you feel like a consideration of women is something that's becoming far more obvious as a pressing concern in science and health and medicine?

Jessamy: I think that there is, I think it's sort of part of the time as well, the Me Too campaign and every, all the other sort of movements that have happened over the last two years have culminated in this focus on this particular issue and I guess there are lots of different aspects to it You know Jocelyn who's one of our editors and Liz who have been running the sort of Lancet women's gender series and 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, these very driven and male orientated careers find it difficult to progress, even if they start off.

They might not necessarily finish up with a big job. And then it's a sort of self perpetuating cycle. There's that issue which Roxana spoke to. But then there's also the problem that it's actually embedded in the actual You know the whole way that medical research is set up and what we look into so It's a very difficult one to untangle and I do think that there is hope but I echo Caroline's concern that now we're moving into this AI period, there is this risk that these biases and this assumption of a universal male default can 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: Our Asia Executive Editor, Dr. Helena Wong, managed to grab some time with Professor Ben 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 comorbidities for COVID 19.

So just me. Just briefly unpack that little bit of jargon for me. What is a comorbidity? 

Jessamy: A comorbidity is essentially a health problem that is an added extra. You are a man, you might be 35, and you have a comorbidity 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, Other surgical or medical procedures. 

Gavin: In terms of something like COVID 19, it's a bit like a multiplier, almost.

Jessamy: Exactly, and I think, what's really important about this particular paper is that it's 813 patients that were sent to the two, largest hospitals in Wuhan that were the referring centers. If a hospital couldn't deal with a patient, then they'd send them to those two places. And of those 813 patients, 613 patients were taken out, and that was because they hadn't got an outcome yet.

And 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 has been on patients that are 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 this is that the results show that what we know, which is 97 percent of people present with a fever and with some shortness of breath or a cough, and that tends to last for 12 to 13 days. 

Gavin: Yeah, absolutely. It's really Amazing to get to speak with Professor Kao on the ground here in Wuhan.

I will hand over to Helena. 

Helena: Hello, I'm Helena Wang, Asia Executive Editor of The Lancet. In this podcast, we're discussing one paper about clinical cause and the risk factors for mortality of adult inpatients with COVID 19 in Wuhan. Joining me today is Professor Bin Tao, the Correspondence Author of the paper.

Hello, Professor Tao. 

Bin: Hello, Helena. 

Helena: I'm aware that you have been working so hard in the frontline Wuhan for almost two months, and this is also the second time for you to publish in the long search regarding COVID 19. Would you please tell us how can the results of this study be helpful for the future control of COVID 19 in China, and are there any lessons for other countries?

Bin: There are three main findings in our study. Firstly, we investigated the clinical cause of the disease, including duration of fever, dyspnea, and cough. The median duration of fever was about 12 days in survivors, which were similar in non survivors. But the cough may last for a long time. There are 45 percent survival cases still had cough on discharge.

We also observed that in part of the non survivors, the dyspnea even occurred after the fever had disappeared. disappeared. So defibrillation may not indicate the recovery of the disease, especially in critical air patients in survivors. This manual would relieve after about 13 days after the occurrence of shortness of breath while the symptom would last until death in non survivors.

We also illustrated the time of occurrence of different complications. such as sepsis, ARDS, acute cardiac injury, acute kidney injury, and secondary bacterial infection. The clinical course showed a whole picture of the progression of the disease, which could help physicians to predict. What will happen in the next second, we found the median duration of virus shedding was about 20 days from onset of illness among survivors, but the virus was continuously detectable until death in non survivors.

It is the first time to review the duration of virus shedding in COVID 19 pneumonia patients. The information was very important. For antiviral treatment and for the strategy for isolation and discharge. Thirdly, the factors including elderly, age, higher ER and higher sofa score on mission could help clinicians identify the patient with high risk of death.

Besides this, we found that. Lymphopnea will recover from 10 days after onset of illness in survivors, but last until death in non survivors. Similarly, dynamic change we observe in lactate dehydrogenase, we also observe a genetic increase of L6. and serum pharyngitis in non survivors along with the deterioration of the illness in non survivors.

We think the dynamic monitoring of these markers will help clinicians to identify cases with high risk of death as soon as possible during hospitalization. Thank you. 

Helena: Thank you. And that's very helpful to learn, especially the viral shedding time. And you have given us very good explanation on the implications 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 rate of this cohort in this study? 

Bin: Actually the the 28 percent in our study is not really a fatality ratio of COVID 19. According to a recent national survey, the case fatality ratio outside Hubei province is less than 1%, and 3 percent in Hubei province without Wuhan.

And in Wuhan city, the fatality ratio is around 4 to 5%. Why the the ratio of 28 in our cohort is because that we only include patients in the two designated hospitals, Jinhai Hospital and Wuhan Primary Hospital. Both hospitals were the only designated hospital during the month of that December and January And all the severe cases from other hospitals were transferred to these two designated hospitals So our cohort only include the severe and critical patients So in our cohort, we do not include mild or moderate cases.

This is why in our cohort We have very high fatality ratio is around 28. But when we look at all the cases, the fatality ratio is not so high. 

Helena: Thanks so much for the explanation. Thanks so much for spending time to elaborate on the important findings of your latest publication alongside Professor Cao.

And we also would like to use this opportunity to express our sincere gratitude to all the Chinese frontline house workers as well as researchers who have combat against COVID 19. 

Gavin: Yeah, fascinating, like I said, to hear from a doctor on the ground there in Wuhan, and absolutely amazing to think what they must all be going through, trying to keep this outbreak in check, in Wuhan.

Jessamy: Exactly, and some real, clinical Nuggets that I think come from this paper the important ones are that the median age range is 56, and 62 percent are male. And half of all those patients have comorbidities, and those most important comorbidities are hypertension and diabetes.

So that just gives some kind of an idea of the type of patients that are potentially more susceptible to this disease. What's interesting is that not so many patients had respiratory problems like COPD, which you would expect for a primarily respiratory disease. And that might be because, it's not so well recorded.

There might be issues there, but it's a sort of it's an interesting potential. And then some of the other really interesting things that I thought from that conversation came through where. That, that the illness onset 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 going to be in hospital for 22 days.

Gavin: Yeah, it's a lot to think about, isn't it? Because 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: Exactly, which is why this paper is so important, because it does show us the end of these people's journeys.

Some other interesting things with this viral 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, which is one of these other issues that we're still unsure about, is why patients are able to test positive for COVID 19 for such a long time.

Gavin: Yeah, as we said in the first episode, there's still So much to understand about this disease and obviously we're seeing Restrictions being put in place all across the world at the moment. It's a it's definitely a very interesting quite scary time I think 

Jessamy: it is a scary time You know from kind of That paper, it's scariest for people who are older for people who have comorbidities and that was the kind of, the risk of mortality increases if you're older, if you have increased D dimers at admission, and if you have a higher SOFA score, which is a score basically that shows how unwell your different organs are when, from a kind of intensive care point of view.

Gavin: Finally this week, Dr. Helen Brooks, one of our editors here at the Lanza Voice, had a very interesting question she posed us in, I think, actually the first editorial meeting we had about this podcast. Helen, tell us a little bit about how this interview we're about to hear came about. 

Helen: NASA has been flying to Mars as part of its Space Exploration Programme 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 of microbial life. And later this year, NASA is planning to launch the Mars 2020 R emission, 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.

And the evidence that they've collected in the past has suggested that Mars had wet conditions billions of years ago that could have. Possibly sustained life microbial life, indeed. And in this mission, they are hoping to collect and store a set of rock samples and bring them back to Earth. And In that context, a key question is, could anything that they bring back to Earth from Mars theoretically adapt to living on our own planet and possibly cause harm?

Gavin: Yeah, that's a really fascinating idea, isn't it? How do people kind of plan for something that they have no idea even exists. 

Helen: Yeah, exactly. And we imagine bacteria living at body temperature, but work's been done on Earth where we've seen that actually so called extremophiles which are bacteria that can exist in quite harsh conditions.

For example, they found bacteria that live in mines, in acid pits, and also in, um, minus 20 degrees Celsius under ice layers in Greenland and things. Perhaps some of these similar conditions might be seen on Mars, and might also harbour extremophiles, and we might see some of that there as well.

Gavin: Yeah, and I guess it's fascinating to think how they might interact with human health, or with biodiversity on the planet, ecosystems, all that kind of stuff. 

Helen: Yeah, 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 as substrates and therefore.

There's an outside possibility that they could if they got out damaged building structures or even natural features on there's an even more outside chance. But this would be a high risk thing to occur would be if small polypeptides existed, such as prion like proteins, and they would have the capacity to maybe even infect small mammals or even large mammals like humans.

Gavin: Yeah, it's a lot to think about. I'm glad NASA have thought about it though. Oh yeah, 

Helen: me too. 

Gavin: But yeah, I'm excited to hear this interview. Yeah, take it away. 

Helen: So I'm joined today on the phone by Lisa Pratt, Aaron Regberg and Andrea Harrington to discuss some of these things and Lisa, why don't you tell me a little bit about yourself?

Speaker 8: Sure. I am NASA's Planetary Protection Officer. Very much engaged in backward planetary protection, which is protecting Earth from inadvertent contamination by a possible extraterrestrial organism or biological agent, and we really haven't worried much about that since the Apollo era, but with Mars sample return now on the horizon black, backward planetary protection is a major topic in the office right now.

Speaker 9: Hi. Yeah. So my name is Aaron Regberg. I am a astro materials curator. at NASA's Johnson Space Center, and I'm also the Planetary Protection Lead for the Center. 

Speaker 10: I am the NASA's Mars Sample Curator in the Astro Materials Acquisition and Curation Office at Johnson Space Center. 

Helen: What type of life do you imagine we might see on Mars?

We think it 

Speaker 8: might not be exactly the same as what we know on Earth, but it's underlying chemistry, the kind of molecules that it's made up of will be from the same classes of compounds that we know and it'll be, that we will be able to identify it. If it's a completely separate origin of life with a separate evolution if it's one origin and it's in two places, Earth and Mars then it'll be, 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 to gain resources for metabolism or molecules that would help protect it from an environment that's harsh in a very different way from Earth.

Speaker 10: It's happened in the past where there can be a false positive. 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. 

Helen: How would we prepare and protect ourselves from organisms that we don't yet know exist? 

Speaker 8: It is it is an enormous challenge to try to think about risk from an organism or just a biological entity like a prion 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 manage. The sample will be robustly contained four, four layers of containment or five, depending on how you count the sample tubes, sterilization of some of the samples.

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, in additional earth containers. to a 

Helen: safe receiving facility. You mentioned prion proteins there, Lisa.

And in my mind, prions have a reputation for being very disruptive in mammals. And I wondered if you could tell us more about whether prion like proteins might be present in the samples that we bring back and what we might be able to do to mitigate any damage from them. 

Speaker 8: I think that's primarily an end member, the sort of the most extreme, strange thing one could imagine.

Would be just a molecular complex, a macromolecule that was made up of similar subelements to something terrestrial that could somehow interact with us, but again, that interaction would require it to be released and defined. host. So we primarily use prions as an indication of a type of molecule that would be very difficult to deactivate.

Or if you want to use the word sterilize, for just a molecule, I think I'll stick with deactivate. So we use it as an end member for thinking about how high a temperature for how long a period of time. With or without a second chemical modality, what would it take to denature and deactivate something like a prion if it was on a surface and not contained in the sample container?

Helen: So what are the chances that organisms that we bring back might be hazardous to us, hazardous to the ecosystem, or hazardous even to buildings, for example? 

Speaker 9: The idea that 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 exists on Mars currently but it's high risk, so if it happened, it would be very bad.

I, again, you'd have to be, Living continuously in in contact with all of the different organisms that we have in our ecosystems on Earth in order to become pathogenic or hazardous. It's not something that you evolve spontaneously as far as we know, not something that you evolve spontaneously.

So it's maybe a slightly higher risk than specifically being hazardous to human health. But I still think it's a very low probability event. There isn't, so to, to briefly describe the sort of systems that, that we're thinking about, Building toe to contain these samples.

They're going to be primarily constructed of materials like stainless steel and Teflon and glass. And these are pretty inert, non reactive materials from an abiotic or biological standpoint. There isn't a lot of energy to be gained from trying to degrade or alter those compounds. So it's certainly something to be concerned about and something to pay attention to.

But I think It's the likelihood of us something of us bringing something back that is already has the metabolic potential to, to oxidize or degrade stainless steel, for example is very low, just because they're. As far as we know, there's no stainless steel on Mars, except for what we put there.

And so there would be no sort of ecological pressure to force an organism to evolve to be able to interact with those type of materials. 

Helen: Thank you so much for talking to me today. I think that we can feel very reassured by your advice and it was a fascinating conversation. Thank you.

Thanks, 

Jessamy: Nasa for having these people do these incredibly interesting modelling of what might happen with all of these hypotheticals. 

Gavin: I wonder how you apply for this kind of job. 

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

Gavin: Very much 

Jessamy: which would not be good for me. 

Gavin: I think I would be into it.

With a kind of philosophical background. 

Jessamy: Yes, I think you could be, definitely. 

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

Jessamy: Yeah, the wide scale disaster that might incur, you would be okay with philosophizing about.

I think 

Gavin: 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, and what it might do to Earth. 

Jessamy: I know. Oh God, yeah. 

Gavin: And obviously they were very, they very much stressed that there is no risk, basically, to the Earth.

But, I'm glad that it's their job to tell us that there's no risk to the Earth, rather than it being a surprising sci fi moment. 

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

Gavin: Thanks so much for listening to this episode of The Lancet Voice. You're already listening, so this could be obvious to you, but you can find us anywhere, usually.

get your podcasts. If you want to subscribe and leave us a nice review, that would really appreciate that. And as we said in the intro, drop us an email on podcasts at lancet. com. Tell us what you think of the show, what you'd like to hear, and tell us about health where you are. What are your kind of concerns around the world?

It's something we're really interested to hear about. So yeah, thanks very much for listening. 

Jessamy: Yes. Thank you for listening.