The Lancet Voice
The Lancet Voice is a fortnightly podcast from the Lancet family of journals. Lancet editors and their guests unravel the stories behind the best global health, policy and clinical research of the day―and what it means for people around the world.
The Lancet Voice
The World Health Assembly, adolescent health, and the pace of innovation
Richard, Jessamy, and Gavin reflect on developments at the 78th World Health Assembly, including the passage of the pandemic agreement and shifting dynamics in global health leadership. What's next for WHO without US engagement? How has WHA changed over the years?
We also address the importance of recommitting to adolescent health following our new Commission, and discuss a controversial recent study about the pace of scientific innovation.
You can read the second Lancet Commission on Adolescent Health & Wellbeing here:
This is the paper on the pace of scientific innovation discussed on the podcast:
https://www.nature.com/articles/d41586-025-01548-4
Read all of our content at https://www.thelancet.com/?dgcid=buzzsprout_tlv_podcast_generic_lancet
Check out all the podcasts from The Lancet Group:
https://www.thelancet.com/multimedia/podcasts?dgcid=buzzsprout_tlv_podcast_generic_lancet
Continue this conversation on social!
Follow us today at...
https://thelancet.bsky.social/
https://instagram.com/thelancetgroup
https://facebook.com/thelancetmedicaljournal
https://linkedIn.com/company/the-lancet
https://youtube.com/thelancettv
This transcript was automatically generated using speech recognition technology and may differ from the original audio. In citing or otherwise referring to the contents of this podcast, please ensure that you are quoting the recorded audio rather than this transcript.
Gavin: Hello and welcome to The Lancet Voice. It's June, 2025. I'm Gavin Cleaver, and I'm joined once again by editor-in-Chief of the Lancet, Richard Horton, and Senior Executive Editor at The Lancet, Jessamy Bagenal. In this episode, we're talking takeaways from the 78th World Health Assembly, which happened at the end of May, including the implications of the new pandemic agreement that was ratified at the assembly.
And the changing landscape of global health leadership. We'll also discuss adolescent health off the back of our new commission and the nature of measuring scientific progress. We hope you enjoy the conversation.
Richard, Jessamy, welcome back to the studio. Richard, you've spent the last few days at the World Health Assembly the, I've got it written down here, the 78th World Health Assembly. And I guess I'm I'm keen to know your observations, what happened at the World Health Assembly, your takeaways.
Richard: A funeral for global health is what I think a lot of people thought that they were going. That's a go. You've seen America pulling out of WHO, the massive cutbacks in overseas development spending, not just from the US but from many European countries too. So global health in crisis. Was this 190 plus countries coming to Geneva to really celebrate the death of global health.
And I went to Geneva thinking it was gonna be like that. And I've got to say I came back, I. Optimistic and reenergized about what we can achieve. Now, maybe I'm being naive and scratch the original headline, not a Funeral for Global Health. It's a funeral for global health question mark because Tedros the director general.
And we'll come onto this later when we launched our Adolescent health commission, he came and very kindly spoke at the launch. And although he mentioned adolescent health briefly at the beginning, what he mostly did was talk about WHO. And he said that this was a moment for a complete reset in Global Health.
Am for WHO. Yes, it was gonna be a smaller organization. Global health will have a smaller footprint in the world, but now we're going to be more focused, more empowered and this moment of reset is an opportunity. So he was really trying to mobilize and remotivate the audience to not lose heart. And although I think that one can argue with aspects of that diagnosis.
For example, Michelle Kaza Gene at one. Session that we were all at said. Don't talk about this moment as an opportunity when people are actually dying because of cuts to global health spending. And I think that's a very powerful statement. So let's not use the word opportunity, but there's a reset that is taking place currently.
Which should make us think much more carefully about what we're trying to achieve and why we're trying to achieve it. So anyway, I think Geneva was it. It was a moment to. Try and recommit oneself to some of the principles that guide us in in global health. And of course the big achievement, which was actually an achievement because the US delegation wasn't there, was the pandemic agreement.
Yeah. And if you'd asked me a year ago whether the pan there would've been a signed pandemic agreement, I would've said, no way. No way. Because the US government always blocks everything. Yeah. And they would've blocked this. But they weren't there and they didn't block it. And so it went through, admittedly, a lot of people didn't turn up for the votes.
But in reality, it got through. And that was a huge success for WHO, for multilateralism, more importantly. And it's a great. Foundation for looking ahead. If you ask me, is the world a safer place today than it was yesterday? When we didn't have the pandemic agreement. We're not there yet, but we're on the way to having to being in a better place.
Gavin: Yeah, do you have any kind of like headline thoughts about the pandemic agreement apart from that?
Richard: The thing that's really key about it is really the next step. So there's this thing called the pathogen access and benefits system, PABs and that benefit sharing system, and that. Is the bit that has to now be negotiated, and that's in some ways the most difficult bit because it's all about, so you identify a bug in Country X and now what?
Who has access to that bug? And let's say a vaccine is developed, which makes a company a gazillion dollars. Who should. Benefit from that back vaccine? Should it be just the company in probably a far-flung high income country, or since you found the bug in this country X, which may not have been that far-flung high income country, should some of them money and benefits go back to them?
These are all very complicated diplomatic issues where there's a lot of bad feeling about the way high income countries have treated low middle income countries. That has to be negotiated. And then in 2026, there's going to be a high level meeting at the UN General Assembly where all of this is gonna be discussed and where.
We hope real progress will be made. You'll have the pandemic agreements as the foundation. You've hopefully have got the pathogen access benefit sharing system agreed. And then we can go into a discussion about, okay, now how can we make the world a safer place? So a year of intensive work ahead, but a good first start.
Jessamy: Can I ask a question? And I, it's not meant to be controversial as, and I'm not meant to, I'm not trying to criticize global health at this very vulnerable time. Lemme just preface, you're, lemme just preface this question with that, and I've never been to WHA, but I get all of the invites for different things and it looks like there are some very interesting different events on and, full of incredible people.
But my perception as someone who hasn't been, and I see it on social media a lot, is that it's very performative and it's essentially a sort of jamboree. So I guess my question is, from all your years of going to WHA at its best, what is it?
Gavin: How many years And its, yeah.
Jessamy: At its worst, what is it and where did this year sit in that spectrum?
Richard: So your question is. Why the hell are you wasting your time and the Lance's time going to Geneva for a week of a jamboree? I think that, that's a very good question. I think
Gavin: that's an unfair reading of
Jessamy: Jesse's question. I did preface it with lots of caveats.
Richard: So that is the RFK junior point of view.
Yeah. He was beamed in at one point and gave a zoom talk to the assembly in which he called the organization moribund. And this bloated bureaucracy. So I think I must introduce you to RFK. I think you and he would get along well. You've got a lot to talk about. You've got a lot, you've got a lot in common.
A lot in common. And it's true. There is a lot of backslapping and some of it is performative but I think that what we're trying to save here. At the heart of this is an idea. It's not just a resolution or a pandemic accord. And the idea is that countries, by working together can make some sort of progress.
It might be so incremental as to be invisible. It might drive you crazy because of the politics of it, and everything goes at the pace of the lowest common denominator. All of that is true, but the idea that you can only solve. The world's problems by countries working together is one that is at the heart of the UN system and still needs to be fought for.
And if you look at some of the big successes, everybody quotes smallpox, so I won't, but if you look at framework convention on tobacco control reductions in under five child mortality, the slow but definite progress on making non-communicable diseases taken more seriously. You can see that there has been that incremental progress, which has come from countries coming together, agreeing an agenda and recognizing that they need to do something.
And WHO plays a key role, not because of the assembly. You are right. The assembly, a lot of it is performative. I will concede that to you but the who's technical guidance, it's a scientific agency. And the technical guidance that its committees provides by convening experts that really does help countries.
The U United Kingdom where we're sitting now. It doesn't need WHO. Yeah. But in a low income country where the Ministry of Health has no budget and no people, and is not paid serious attention to by a president or prime minister, WHO fulfills a really critical role of providing that normative guidance.
That technical assistance, which just simply isn't there in the country. That's what I think we were going there to celebrate and and to try and save in some ways it is, I tell you, it, one thing that's interesting it has become more of a commercial lobbying place, I started going more decades ago than I care to remember, and it was very much for global health aficionados and of course the delegations from countries.
Now you'll see that pharmaceutical companies will hold champagne, breakfast in fancy hotels, five star hotels and evening events. Similarly designed in order to. If not present their product, then certainly to present their brand and their, and to gloss their reputation. So we, we've talked about the commercial determinants of health in the past.
The World Health Assembly is now a very good example of a meeting that has been colonized and is colonized more every year by those commercial determinants. And that's certainly something to be concerned about
Jessamy: and it's tricky, isn't it? And maybe we'll come onto it at the end when we talk about our final topic, but this sort of public private partnership, I often see documents and policy things coming up from WHO about the aspiration of how they're gonna make this work.
And they try and do it in different sectors and fields and it. And it never really seems to be a fair playing field for both sides in terms of what they're getting out from it and the quality of what is produced.
Richard: It's a very divided debate because on the one hand people will say you, you should not have the private sector in the room.
They shouldn't be there to influence policy. They might be helpful in terms of implementation, but you really need to keep them away and then. Ano on the other hand. And it is a reasonable argument. These big private sector companies, they do have a part to play and some of their leadership can be really powerful.
Unilever, Merck in the past just to name, but two, had a really powerful, important role at the, in the MDG era, Merck, particularly around maternal mortality. The Merck for Mothers program, Unilever, with its commitment to water and sanitation. And their CEOs would come to the meetings in New York, the UN General Assembly, and to have the CEO of Merck and the CEO O of Unilever there on the stage with the UN Secretary General or the director General of WHO.
Yeah, it's a bit performative. Yes, it's a little bit symbolic, but it's actually quite important to see those people throwing their hats in the development ring, and I'd rather have them there than not there. And I think today one of the concerns is we don't have enough of those people. Yeah.
I don't see enough CEOs also stepping up. And if you had more CEOs stepping up, maybe you'd have more politicians stepping up too. We need more energy around, around global health and development. So I'm with my NGO brothers and sisters who are skeptical of the private sector and I understand why, but in reality we are trying to.
Build a movement here and we need everybody to take part, and let's not be too exclusive about it.
Gavin: What do you think on that front? It means about China sending one of the largest delegations to this year's World Health Assembly. On one hand you've got America completely absent. On the other hand, you've got 180 Chinese.
Delegates. So what do you think that says about the kind of balance of global health at the moment?
Richard: That's one of the, I think one of the mistakes that the US has made that by stepping away from a multilateral organization, they've left it open to other countries to fill the vacuum. China sent a large delegation.
But in reality, I wish China would do more, particularly on the financing front. China is not just a superpower in science and global health science. But it's a rich country now, and I don't think is playing its full part in financing global health in a way that is consummate with its political power.
With power comes responsibility and. China should be stepping up to that, not just for WHO, but we have two Replenishments this year. One for Gavi and one for the Global fund. It is always the US and Europe who's expected to be major donors along with countries like Japan. But why not China? Why China should be a full player in financing for global health.
But it's not, and so there is an imbalance. You could say maybe it's going through a transition in the fullness of time. But at the moment, I, I. I'm, I welcome China's participation, but I want them to do more.
Gavin: Do you get the sense they're gearing up to do more? No,
Richard: I don't, unfortunately. I think that they're quite reticent.
The way China operates, at least from my observation, is it's very bilateral so that they work, the government works with other governments. If you look at the way that they have launched their infrastructure projects in Africa, it's very much, china's relationship with Tanzania or whichever country.
And they're less good at representing themselves in multilateral institutions, but I hope that they, I hope that they will.
Gavin: No, that's really interesting. I was gonna say one of the other big outcomes from the World Health Assembly was their recommitment to global nutrition targets and the marketing regulations around those as well.
There were some really interesting. Outcomes from the 2030 targets that were put forward at the World Health Assembly, which was a 40% reduction number of children under five years of who are standard compared to the 2012 baseline. 50% reduction in anemia and women of reproductive age, 30% reduction in low birth weight, and to reduce and maintain overweight in children to five years of age.
It's great to see that sort of commitment. You were talking about previously how one of the big achievements of the World Health Organization is the huge cut in child mortality. So it's great to see that as an ongoing commitment.
Richard: It is. And to remind oneself that progress is always reversible.
That's I think the big. Worry right now that if you see. Maybe a fifth to a quarter of all investment in global health literally disappearing over a matter of days or months. How do you sustain the, those gains? Because countries, the mantra is this is gonna. This ends a dependency.
Now countries are going to have to think about domestic resource mobilization. They're gonna have to take responsibility, pay for things themselves. That's great if you're a middle income country, and I couldn't agree more. But there are a collection of very poor countries, resource poor countries, that there's absolutely no way that they're going to be able to fill that gap.
And there are some countries that are not so resource poor that have programs that, have been supported by organizations like U-S-A-I-D which are now not gonna be able to pay for those programs. I do worry that, yes, we've seen these great gains, but how sustainable are they, in five years time we could be having a very different conversation.
Gavin: And and this leads us on to talking about the second Lance Commission on Adolescent Health and Wellbeing, which came out a couple of weeks ago on May the 20th. Of course it's building on our commitment from the first commission. One of the key messages is the investments required, as you were just talking about.
Jessamy: Yeah. I was thinking about this morning and I think we've done so many of these series that really look at windows of opportunity in a child's life. All the way up to, 24 really when we are saying they become adults. We did the first thousand days last year, we did the first 2000 days.
Now, this one is about adolescents and it's really about these critical junctions in a young person's life where we can make interventions that will totally change their long-term trajectory of health. And for adolescents, it really seems like this is the last opportunity that you're gonna be able to.
Make those interventions that are gonna set healthier patterns. And I think the overall message of the commission that the adolescents of today are living through such a uniquely challenging set of circumstances in terms of the external forces of climate change of the commercial determinants of health, but also, some of the very internal ones about mental health and obesity.
Obviously these three things have a sort of bidirectional connection, but. It's a, there are lots of very difficult challenges that are facing them, and it's difficult to see. And we don't really have the data. Like I, I was trying to look this morning, a big focus of the commission is on the number of adolescents that are gonna be obese in high and middle income countries.
And we don't really have the data of what that long-term implication for obesity in adolescence is. What is your increased risk of mortality? By the time you're fifties, and we don't really know that because we haven't had that, long term follow up data. Yeah. But we know it's gonna be bad.
Gavin: Yeah, I was gonna say, the commission predicts that in twenty thirty, four hundred and sixty 4 million adolescents globally will be overweight or obese, which is 143 million more than in 2015.
And it very
Jessamy: clearly lays out not only what the health consequences are during adolescence, of course we think about the long-term consequences of obesity, that you've got increased risk of cardiovascular disease, that you've got increased risk of diabetes. But it's also very clearly lays out what the difficulties are during adolescence and the relationship with mental health in the long term.
Richard: It's worth just reminding ourselves. Just a basic thick number to keep in your head that there are 1.8 billion adolescents, young people in the world. That's a quarter of the global population. This is a very, this is a huge group of people who we pay almost no serious attention to.
Why do we pay no serious attention to them? Is it because they don't vote? So politicians don't have to pay attention to them, and it's only because of a very valiant group of physicians and scientists who come together around. We did a series first, then we did a first commission, and now the second commission, as you say, jessee, who really put adolescent health on the map.
And I just want to say I in this podcast and paid tribute to the work of George Patton who we so sadly lost during the course of this commission. But George was a great personal friend, a great friend to the Lancet, a great friend to many of us. And really. George and with his partner Susan Sawyer.
They have been the wellspring of energy that has driven this process with a great team. I absolutely want to say, but if it hadn't been for those two people, we wouldn't be where we are now. So they definitely deserve some credit, but 1.8 million billion adolescents. And yet. Something like only two to 3% of all overseas development assistance.
Yeah. 2.4% total development systems. Isn't that shocking? Yeah, it's totally shocking. It is totally shocking. And we were all adolescents once ourselves, and yet somehow when you grow up to be an adult, you forget. So I think the commission there are lots, there's a lot of data in the commission and there are a lot of recommendations there, but in some ways there's only one recommendation that I think that's really important.
Because we're in a critical moment now 2025 and the world's thinking about what's going to come after the sustainable development goals after 2030. So the really. The thing we have to win for young people is a specific, not just mention, but a specific target and indicator for adolescent health in the post 2030 framework, because there's no question that unless you have that target in there.
The world would not pay any attention to adolescent health. It was only because you had a target for under five mortality and maternal mortality in the MDGs that we made such progress because suddenly countries were held accountable for that progress. We need to get adolescent health in the post 2030 framework, and if we can do that, then we've got the next 15 years beyond 2030 where we can really try start to.
Start to make progress. So my core to the community that produced this commission is what's the pathway, what's the trajectory? How do we get inside the room? For that post 2030 goal,
Gavin: it needs to be absolutely central to the post 2030 goals, isn't it?
Richard: Absolutely. If you're talking about the health of, one quarter of the global population, it seems to me pretty damn obvious that it should be there, but.
The reason why we've got the commission is that it is not obvious to the people who have the power to make these decisions.
Gavin: Why do you suppose that? Is
Richard: It's, it is because I think young people have not been given a voice
Gavin: and when they are, it always seems quite tokenistic.
Richard: Yes. One of the messages of this commission is that you can't, and 'cause there was a youth commission that ran jointly with the, with the official commission. And unless you provide a platform for young people to speak and integrate the voices of young people into all of your policy discussions, then it's very easy to forget about them. And what was great about the launch was that they. In the planning of it, young people's voices were absolutely central and present.
And how could, how can you scale that up? So we had a side event, the launch of the commission. How could you scale up the voices of young people to the main event, which is the World Health Assembly, or to the UN General Assembly or within National Parliaments? That's, again, if you take the UK.
We have a parliament. Young people aren't represented in that parliament, so if they're not represented, therefore nobody pays them much attention. So the whole. The whole system we have of gov governance is in a sense as a byproduct designed to exclude the voices of people up to 19, 24 years of age.
Jessamy: Yeah, I agree. And I think one of the, very meaningful things that I often hear people in this community say is that when adolescents are valued, they're valued for their future capital. They're not valued for what they are right now.
And obviously that's because it's easier to make an argument to governments that these are an gonna be an extremely economically active group that are also possibly gonna be a burden to different systems because of various different health issues.
But there is something also there about valuing young people for who they are now and the contributions that they can make for now, rather than what they're gonna become in the future.
Gavin: Yeah, because there, there's a danger of just seeing them as future economic units of activity, right?
Jessamy: Absolutely.
Richard: That's right. And also we should be thinking that this is not just the health system that's important here. This has been a argument that's gone through all of our series and commissions on young people, and that is. The education system has to be seen as an equal partner to the health system.
And we have to work much more closely with the education system.
Gavin: It feeds back to what we were talking about last time, a little bit to an extent, right? About wellbeing.
Richard: Absolutely. Exactly. Multi sexual approach. Yeah, exactly. So you mentioned nutrition Gavin, so nutrition, education and health.
They're very much linked together.
Gavin: I really thought a striking sentence from the commission was, and you touched on it, Jess earlier, was talking about how today's adolescents are gonna be the first human cohort who will live their entire lives under the shadow of climate change. We're all getting on a bit now.
We might not see the worst effects of climate change in our time, but adolescents, young people today are going to be living with what are already the very serious effects of climate change for their entire lives
Richard: and the
Gavin: impact.
Richard: On mental health is. It's very easy to underestimate that or to not give it the priority or seriousness the importance that it deserves.
I've had conversations with some people in mental health professions, some quite senior people who are. Really quite dismissive of mental health issues in, in children and younger people. And they don't see them as serious and that we're probably over diagnosing problems and creating a crisis when there isn't a crisis.
But I can tell you, I. From my n equals one experience as a parent. The people who I've met in a very different generation to mine, these issues around identity and the future that they have and the world in which they live. These are clear and present dangers to them. We ignore that at our peril.
When I was growing up, I didn't, not only did I not have. An iPhone, but I lived in a small community. Didn't really think about world problems as being a threat to me. And now if you're growing up, you can't not think about war. And you mentioned climate and pandemics and all of these other transnational threats.
Gavin: There is almost a curse, isn't there? Of having to know all the news all the time. Exactly. You can't escape it. Before the internet, you could escape this stuff. You could, but it's completely inescapable now. And you
Richard: could live in the little cocoon of your family and feel very safe. And I don't think that's the case for any young person today.
It's almost impossible to just wrap yourself up in that little ball of cotton wool and feel completely safe from the world. And when you realize that there is no. Safe place to go and that you are very exposed. That's a pretty frightening place for a sort of 12, 13, 14, 15 plus year old person to be.
So what do we do about it? We need to take that much more seriously.
Gavin: One of the key conclusions, isn't it, of the recommended actions, is to promote healthy use of social media and online spaces for adolescents.
Richard: Easier said than done.
Gavin: Lot easier said,
Jessamy: done. This is a whole separate episode, isn't it?
It really, you really need to do a good, because there's more and more evidence, and I think it's, and very interesting experiments going on around the world in different places. From St. Albans to Australia.
Richard: But you can't dis invent a technology, can you? You can't dis
Jessamy: it. You can't.
Richard: So do you try and. Adapt to it or despite that
Jessamy: guardian survey where, what was it? Two thirds of teenagers wish that the internet had never been invented in the first place.
Gavin: I think you'll probably find those findings.
Yeah. Across all of society by this point. Do think that
Richard: would good past peer review at the answer? I'm not sure Sample
Jessamy: sizes.
Richard: But
Jessamy: I think on the climate anxiety, I do also think that it's not unsurprising when we look historically at human beings connection to nature. Really when you're a child and you're a teenager, that is where it's at, its strongest.
And you see that born out in art, in literature and poems. Our connection to nature and our surroundings is deeply meaningful and spiritual and it's very formative in those young early ages. Perhaps before you get busy thinking about lots of other things, then you have get a job
Gavin: and it grinds you down.
Know exactly
Jessamy: And. When you speak to young people about that, the way we deal with these things is totally unfathomable to them because it's so obvious and clear. What is important
Richard: and what do you say to. Normally a parent can be in a degree of control of the environment Yeah. Of their children.
And so you can give reassurance and confidence to your children about, you'll find I'm here, I'll protect you. All's good.
Gavin: Yeah.
Richard: But in a world where you are not able to, mum and dad can't control the climate. Yeah. So what do you say in, in that situation, it's very very perplexing parents and they're no longer the sort of agents in control of their children's future
Jessamy: and their environments.
Yeah, absolutely. Quite iPhones and social media. Let's do, I think that would make a good episode
Gavin: and a good episode. It also feeds handily back into the final thing we were gonna talk about. Which is how research is essentially ground to a halt. That's the headline there, right? Groundbreaking Science discoveries are becoming harder to find.
I had not seen this one, but when Richard emailed it around, I've read it voraciously. And I'm quite excited to discuss. Essentially the argument is that 20th Century was a series of scientific explosions. We got the light bulb, the flushing toilet at the 21st century. Nothing has happened. That's, that's a pretty controversial way of stating it, but it's not too far from what the article is arguing,
Richard: yeah. So all this money that we're investing into science is right 11
Gavin: fold increase in real terms since 1915, but it's actually,
Richard: Yielding fewer innovations fewer discoveries slower progress, and as you say diminished economic growth. So what is science really contributing to society?
And suddenly you've got a big question mark over science. And then maybe that's why. President Trump is is cutting back science funding because it's not delivering is, but this is such an important question. So is that premise right? Is science slowing down that? We're working at a scientific journal.
Do we think science is slowing down?
Jessamy: I don't think science is slowing down and I think we have to say it's a debate in the community at the moment and it all was spurred off by this 2023 paper, where they looked at all of these different database.
Gavin: Yeah. We shouldn't imply there's consensus in the community that science No, it's not.
Jessamy: It is a debate. Yeah. Big study published in 2023 and it used this new measure. Of cd, which is essentially looking at if you, if your science paper has been referenced and that's the only thing that's referenced, then you are thought to be more disruptive. But if it's referencing your paper and a load of other papers that came before, then it's a lower score.
So things like alpha Fold, which was won the Nobel Prize and was a huge innovation, scores low on that category. Which seems strange. There are debates around the scores and what it's really showing. I don't see a huge slowdown in progress of scientific and health innovations.
Gavin: It's a difficult metric, isn't it?
Because, the more and more scientific research that we pull off, the more we know about a topic. The harder it becomes to find a thing that disrupts decades and decades of scientific research. In the 20th century, we were still discovering quite a lot of things. There was no knowledge base for quite a lot of things.
So to use that metric to say, no one in, say 2015, published a paper that completely destroyed everything that came in front of it. I, you would feel that is less likely, right? Yeah. Than it was in 1955, for example.
Jessamy: Yeah. And actually that might be a good thing.
Gavin: Yeah.
Jessamy: Because it shows that we understood what was happening up to that point.
We don't have to throw decades of science out the window. Exactly.
Richard: And it changes, I think, discip. Different fields evolved differently. Exactly. I think this is the point. So lumping everything together as science is now slowing down or in some way that's such an overgeneralization. So if you take our little corner of the world in medicine and public health.
So I remember when there was a time in the seventies and eighties. When we were making huge strides in conditions like hypertension, so there were these big randomized trials looking at drugs like raffl reside and propranolol and metoprolol. Nobody understood that lowering blood pressure was going to dramatically save lives.
And I can remember coming to The Lancet and literally every Friday when we would, the journal would appear, there would be a. And the news programs here. And in the news papers, we would be publishing a paper about a new drug for hypertension or a new lipid lowering statin or a new kind of thrombolytic agent.
And we would be headline news. So there was a phase in cardiology, in heart disease broadly, where there were, there was an astonishing pace of discovery. But look, we've got more statins than we know what to do with. We've got more stents than we know what to do with. We know how to manage hypertension.
Now it's just an implementation problem 'cause we're not treating as many people as we should do. So those problems have been solved. So rather than seeing sciences having failed in some way science has been an unbelievable success and now it's up to society instead of criticizing science is about.
Making the most of what's been discovered and making sure that everybody's got access to those scientific discoveries. And then the innovation moves on into other areas. Immunotherapy for cancer, unbelievable. Completely transformed, transform the way cancer is treated in, say, the National Health Service.
And then it'll be something else. There'll be something in gastroenterology or. One day there'll be an artificial kidney that won't be dialysis. And you'll have some kidney organoid that you'll be able to transplant into somebody. I don't know, but the, I think this idea that innovation has somehow gone off the boil, misunderstands.
The discipline specific, the field specific nature of of progress.
Jessamy: I think that's right. I think there are three points that I wanted to make. One was. I think there are diff there, there's something about timing and fields and the fact that there are ebbs and flows to all of these different aspects of science where you'll have a major breakthrough that will then spur on lots of activity.
Then there might be a time of stalled progress and surely that's okay. That's nothing to worry about. The second thing is that I think it's, particularly when it comes to health and medicine. There is something which isn't measured through looking at bibliometric databases, which is about approaches. So you know, now we can take rectal cancer, 17 centimeters of someone's rectum out endoscopically.
That is an extraordinary feat. Yeah, but that's not gonna be, that's not gonna show up on this. But it doesn't mean that there isn't some kind of huge. Just transformational progress
Richard: going on in how that's incredible. I'm just thinking about that. That's really, I was occupied by the mechanics of that as well's a lot.
That's a lot of rectum to take out with an endoscope. Okay. Anyway, and the podcast is ground to a halt.
Gavin: We all think about the mechanics of that situation.
Jessamy: And now I've lost my train of thought. The third thing that I wanted to say though is that I do think that. The enormous feedback that study got from 2023, the fact that it resonated with so many people in the scientific community and spurred this huge debate, that is something to listen to because there is some interesting statistics in there about the fact that maybe top researchers are spending 25% of their time on actual research.
Yes, that was 75%. On all,
Gavin: There's some amazing points in this paper. There's a feeling within
Jessamy: the scientific community that the scientific enterprise is somehow skewed in the wrong direction, and that energy and activity is focused on things which are not necessarily. Where the priorities and the strategies should be, and we have to listen to that, I think.
So that
Richard: may be the most important lesson to come outta this debate, actually, to rethink the role of the scientist or what activities a scientist is doing. The other thing though, that drives me a bit nuts about this discussion is why does everything have to have some instrumental benefit? Anyway, so you don't say, you don't walk into a bookshop and think, okay, so what, are these books contributing to innovation in our culture, or what are they contributing to?
Economic progress?
Gavin: Everything has to be a disruptor now, Richard,
Richard: But somebody writes a novel and it has an inherent sense of value in and of itself. It doesn't have to be a disruptor. It doesn't have to have an economic value. It is just. An activity. Writing a novel is an activity that as a culture we place some value in because it's, we've recognized that as being good for our culture the harvesting of the human imagination.
You're not
Gavin: setting out to disrupt the romantic novel section
Richard: human experience. But my point is that why can't we see science. As a little bit like novel writing in the sense that it is a cultural activity that we value in and of itself. Not every piece of science, not every research grant, not every paper published, has to be some stunning disruption.
The mere act of doing research, in other words, asking a question, figuring out how to answer that question. Getting an answer and communicating it and discussing it. There is value, intrinsic value in that process, and that's why we need more science in society because science is a good thing. It's a good thing to be asking questions about the world in which we live and trying to answer them.
So let's not think. The only good science is disruptive science. The only good science is science that makes money. The only good science is science that has a paper in the Lancet. Science is good in and of itself, and that's what we should be valuing and we don't have that conversation. Yeah, I think this discussion about disruptive science.
Put science in a box that it needs to escape from.
Gavin: My partner is a researcher in neuroscience and she often talks about the joy in research of collecting data, putting that data in for analysis, and then she phrases it as receiving an answer from the universe as to your question.
Richard: That's beautiful.
And you used a word that I think is really important that joy. Why can't the activity of doing science be a joyous activity that we value for itself?
Gavin: Perhaps we're too focused on the commercial and business side of the scientific enterprise,
Richard: and that's where this disruptive element, then this paper on disruption.
And thinking about whether. Slow down in innovation is therefore slowing down economic progress. I think that puts science in a straight jacket that we need to resist.
Jessamy: I think that's right. And I do also think there's something there about where these innovations are happening. So when you look at generative ai, that was purely in the private sector.
Whereas if you go back and you look at some of these huge innovations, they were in universities, they were in the public sector. And this sort of dialogue does naturally lead to a place where you're saying private means less rules. Private means you know that there's less bureaucracy. That's the only way that we're gonna get innovation from now on. And I think there is something there that needs to be thought about and discussed, but also recognizing that the language that we are using about disruption and innovation and the sort of economic aspects naturally lead us down that road of thinking that private innovation is gonna be more disruptive.
Yeah. And I don't think that's the case.
Richard: No, I don't think there's any re reliable evidence to suggest that.
Gavin: I think that probably brings us nicely to the end of our discussion. Richard Jessee, thank you very much. I think next time the plan is to talk in depth about the us so join us for that one if you would.
But again, thank you very much for joining us. Oh, thanks
Richard: Kevin. Thanks Jessee. Thank you.
Gavin: Thanks so much for listening to this episode of The Lancet Voice. Remember, you can subscribe wherever you usually get your podcasts, and we'll see you again next time for another discussion about the world of health. Take care.