Fact checking, misinformation, wildfires, and institutional memory

Richard, Gavin, and Jessamy return to the studio for another freeform discussion kicking off with the responsibilities of science and scientific publishing in a time where fact checking and moderation are going out of fashion. We also cover climate change in the US with the recent wildfires, and the importance of retaining institutional memory following traumatic experiences after Richard was particularly struck by a recent trip to Argentina.

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Transcript

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

Gavin: Hello and welcome to The Lancet Voice. It's January 2025, I'm Gavin Cleaver, and I'm here with Richard Horton, Editor in Chief of The Lancet, and Jessamy Bagenal, Senior Executive Editor of The Lancet, for another of our freeform chats about things in the news and on our minds. Today we're going to cover the recent news of Meta dropping fact checking from its platforms.

And what responsibilities we, as scientific publishers, bear going forwards. As well as talking about the wildfires and climate change in the US. And thoughts about memory and remembrance sparked by Richard's recent visit to Argentina. If you have any ideas for things you'd like to hear us discuss, please do get in touch and you can do that at podcasts at lancet.

com. I hope you enjoy this conversation.

Okay, so Lancet Voice 2025. Welcome back, Jessamy and Richard. It's pleasure to have you back in slightly different surroundings. We're outside of the Lancet recording studio this time. So, I guess, if we're looking forward in 2025, Richard, one of the things we might want to talk about is scientific publishing and the future of scientific publishing.

I think you had some thoughts you wanted to share on on that topic. 

Richard: Yes. Thanks. I think we can't escape the decision made by META to drop its professional fact checkers from Facebook and the impact that's going to have on science, trust in science and scientific information more broadly. And in all the discussion about Meta's decision, the dimension of the impact of it on science and trust in science hasn't really been thought about so much.

It's really extraordinary that the idea that you can replace professional fact checkers and moderators with some user generated community notes, which is the Plan that's outlined similar to Twitter x that that in some way is going to be able to protect the validity of information that's on Facebook.

It's, it's really remarkable. We're going to see a worsening of misinformation. We're going to see exacerbations in far right radicalization we're gonna see. more anti migrant and other kinds of hate speech. We're just going to see a dramatic increase in the amount of toxic content on Facebook.

We've seen all of those on X since Elon Musk has taken over and in the name of free speech removed the alleged censorship of content. Meta. It says that the whole fact checking culture has got too complicated, too bureaucratic that it is indeed censoring content. What it looks like, and I think what it, what it most probably is, is the total capitulation to President Trump coming in at the end of January.

And a capitulation to the influence of Elon Musk at this particular time. Meta should be doing much more to moderate content, not pulling back on moderating content. It seems to me that any media company, the Lancet, meta X, whatever it might be, what we should be trying to do, all of us is fostering a healthy public debate.

In a democratic society. And that means that all of us, and there's not really a distinction, I don't think, between a journal like the, journals like we have at the Lancet and a, and an organization like Facebook. We should all have a commitment to the truth. We should all have a commitment to protecting vulnerable groups such as children in society.

We should all have a commitment to penalizing, hate, coercion, even violence with words. Words can be violent. We should all have a commitment to trying to strengthen trust and credibility. And we should all have a commitment to trying to improve the quality of public deliberation, not just the quantity of it.

And that, this decision by META, is such a catastrophic one, given its influence globally, that we're going to roll in an era of what is nothing less than chaos, and Anarchy into the information space, and part of that is going to be misinformation about science. Whether we're talking about vaccines, whether we're talking about climate, whether we're talking about pandemics, we're just opening the floodgates to an avalanche of, indeed, disinformation which is going to really contaminate the public debate.

And so I think we, in the medical and scientific community, need to be speaking out about this much more strongly than we, than we have done. 

Gavin: Do you think Meta ever had much of a commitment to fact checking? Now we know obviously they're getting rid of the fact checkers. I think also it's worth arguing that Facebook and Instagram have long been vectors of misinformation.

Richard: They have. I do believe that the Oversight Board has taken the idea of truth and credibility seriously, I do believe that with, within the, within the limits of the fact that it's a business, Nick Clegg, when he was working there, was genuinely concerned about protecting the reputation of META by not allowing the extreme elements of misinformation to flourish.

But, you know, Nick Clegg's left or leaving the Oversight Board hasn't exactly objected in the strongest possible terms to this change in policy. So I, I, I, I think they were committed, but I think it's the accession of Trump 2. 0 who's just made everybody, um, extremely nervous, and so they are bending to his will in the, in the, in the most frightening way.

Jessamy: I think, you know, they committed in the order of millions to fact checker. So that is a commitment for a, you know, financially based company that we know wants to make more and more profits. So I think, you know, regardless of how effective it was, you can certainly say they committed budget, money, personnel.

They set up a whole organization of fact checkers or worked with independent fact checkers. So I think you can, you know, that's definitely the commitment there for me. The problem is, is that we now have a total divide from institutions like the Lancet or, you know, even the department of health in the UK, which is taking misinformation and health extremely seriously, or OECD or WHO and massive unregulated, hugely powerful organizations that are saying actually, no misinformation, disinformation, no longer matter to us.

We are not about to stand by any type of regulation that might try and improve the quality of the information that we're allowing our users to see. That is a major problem. That is a huge division. And the, the offshoots, the trajectories of those are massively divergent and the, the following consequences are huge.

I don't think we should underestimate, you know, whether you quibble about whether it was effective or not effective, it's a big deal. 

Gavin: I think partially the, the reasoning for it was what really stood out to me. And the idea that fact checking is in some way politically biased, the idea that countering misinformation actually particularly discriminates against Republicans was the was a lot of the undercurrent of, of the announcement.

And it's just a really, it's a bizarre way of framing things because if you've got one side that is sharing and studies show that Republicans share four times more misinformation than Democrats, for example, if you've got one side that is oversharing misinformation. It's not then politically motivated to clamp down on misinformation just because one side is the one creating it all.

It's it's a very bizarre set of priorities and that was really illustrated by I think Mark Zuckerberg said that they're going to move matters, fact checking, away from California and heck, and have more in Texas, which is It isn't going for the middle, it's going from one extreme to the other.

Jessamy: But also what scientifically we know about these algorithms, there was a great study in 2018 in science which showed that lies spread faster than truth in the order of thousands. And when you know that about your own platform, you know that lies spread faster than truth, that they will get, you know, more attention, that they'll be spread more widely, and then you say, that's okay.

We're not going to try and even limit lies. That's such a huge problem in my view. 

Richard: Hmm. Yeah, there was a, there was another study that was published last year, actually, that was from Princeton that was looking at how misinformation sources provoke more outrage amongst users of social media than trustworthy information.

And that outrage, people are more willing to spread outrage from misinformation than they are to spread trustworthy content. So the, the propagation of outrage embedded in misinformation. Yeah, it, it spreads so much faster. That's why you have to have moderators to dampen that down. And if you take the moderators away, now, the argument for meta will be, well, we're just changing who the moderators are.

This is now going to be the community is going to moderate. But I don't, that, that's not good enough. I mean, We're all part of the community, and that certainly when I look at tend not to look at Facebook very much, but when I look at X then I don't spend my time, I don't have the time to, and I'm not employed to be a moderator, so I don't post user generated content to moderate what I, what I see.

You need professional moderators, a bit like, Our role as editors, professional editors, if we published every single article that was submitted to the Lancet, we would have chaos and anarchy in the way people thought about health and health and medicine. And we don't. What we do is we put everything through a peer review process, reject 98 percent of it, and publish a tiny, tiny proportion.

And we do that for a reason, because we're privileging quality over quantity. I'm not saying 98 percent of comments on Facebook should be moderated, but you'd certainly need to have some kind of oversight process so that you're improving the quality of public deliberation. And I really, you know, there is no qualitative distinction between a scientific journal and Facebook.

We're all in the business of publishing information. So what's the responsibility of the organization to Ensure the veracity or the quality of that information, surely that's the, the first priority. 

Jessamy: I completely agree. And responsibility was something, you know, that I was gonna bring up because we've seen meta or Facebook time and again, try and remove themselves from responsibility.

We are not publishers, we're not newspapers, even though the majority of people are getting there. You know, and when this comes down to it is what is dangerous and what is not dangerous, what's going to incite violence, what's going to actually physically harm people. We've seen that with the Rohingya crisis, there's good evidence to support any of that.

So there is also an issue of responsibility and governance here, which is going to be completely removed. And I take the point that Wikipedia, for example, I think is a good example where there, there, there are. Checkers. I don't really know the ins and outs of the business model or those people that are checking Wikipedia, but it is very factually correct.

And almost instantly, it seems people will change things on Wikipedia. And that's obviously a you know, a concept of community of people actively sort of embraced and committed to the project. And willing to dedicate and spend time on that. That's not Facebook. No. Or X. Or X. This is a different project, a different, it's a different, it's a different setup.

And then the other thing I wanted to segue to, which might be too far out there, but I started watching last night this documentary on Netflix about the Jerry Springer show. I don't know if you've watched it. 

Richard: I haven't seen it, but I remember the Jerry Springer Show. 

Jessamy: You remember the Jerry Springer Show.

So it's basically all about how they made the Jerry Springer Show so famous and how much people loved it. And it's all about lies, emotion, Outrage. And outrage. And. Although we can sit here and be surprised that mis and disinformation is such a huge problem when we've got social media, actually, when you look back at those Jerry Springer shows of the early 90s, we didn't have really mobile phones, no one was on social media.

There was, you know, the internet was just starting. The outrage, the human connection that was born out of these stories, lies, hatred. Human suffering was so huge and, and now we have this sort of amplifier of it, which nobody is willing to take responsibility of and actually wants to propagate. 

Gavin: Well, I think outrage has always engaged people, right?

And I think modern social media is bought, is, is built on this concept of engagement. An algorithm seeks out what people will engage with the most and promotes that to the top of their feed. And when you state it like that, it sounds neutral. But the thing that people engage with the most, and most often, are the things that outrage them or provoke an immediate response without thinking.

And so now we're stuck in this feedback loop of, of engagement. Social media sites want you to engage with them. They're built for you to engage on them, but the things that people engage with the most are the things that annoy them the most. And so now we're actually kind of stuck with these platforms that are actually built to annoy us, to wind us up and to give us this kind of weird false picture of how how the modern world is when actually a lot of the time it's not like that at all.

What concerns me as well is that a lot of the modern press has fallen into this same engagement loop. Because not only is social media built like that, but online publishing is built like that as well. It used to be that when you were working at a newspaper, I used to work at newspapers, and I was working at them in the The awful transition from newspapers being funded by print adverts to newspapers being funded by online adverts.

Now, not only is that a huge drop off in money, obviously, but it used to be that when you had a newspaper funded by print adverts, you could focus on the quality and the editorial content of a newspaper. Because as much as the circulation mattered, It was still, actually, people were buying it for the whole.

But now, when you're monitoring everything by how many clicks something receives you see things like Mail Online, which are built to be absolute, just outrage factories. And that's exacerbated by social media, because where do they go to post their content? They go onto Facebook, they go onto X to post those things.

So, we're all stuck in this engagement loop at the moment, and We're treating the word engagement as if it's something neutral, but as you say with that Jerry Springer point, it's never been neutral. 

Jessamy: And I suppose from an information integrity point of view, I do think it's, you know, we all use Google now when you, when you, I was the two Matt's, you know, I'm on that podcast, they were talking about this the other day, when you use Google, and it gives you a summary at the top, if you ask it a question, it automatically now brings up a gen II chat GPT, or, you know, their Equivalent Gemini summary of, of what it is.

So like in preparation for this, I was looking at wildfires, right? Have wild, it brings up and for my children, that will be fact, but where, where is that algorithm finding that? And if we now have, you know, open AI have just donated to Donald Trump's campaign. And if we now have a tech world, which says information integrity is not an issue for us.

What does that mean then for the algorithms that are trawling the internet for the next probability related word and content and for that statement of, of trust or truth where we're finding our information? I think it's extremely worrying. 

Gavin: Yes, a lot of those AI summaries are literally false. Although a good tip for anyone listening to this podcast is if you type minus AI at the end of your Google query, it will not come up at the top.

Oh really? Yeah. That's good. 

Richard: The AI issue is very relevant to, again, scientific journals and scientific information. Because quite a lot of journals, and I think we are as well, judging by the letters that I see are being flooded with AI generated what would be editorials, comments or letters from certain parts of the world.

With the goal of getting a very quick and easy publication, manipulating citations and getting a PubMed indexed article under your, under your name. And a lot of these are being published. And some journals have seen literally increases of more than 100 percent in terms of the number of letters and comments they've been publishing because they're not having sufficient critical scrutiny of these AI generated, you know, bland, not really saying very much pieces.

I don't know why they're publishing them. whether it's associated with article processing charges in some cases, whether, whether it's because they're trying to boost the diversity of their content in some well meaning way, but the result of which is they're just simply supporting the, this pretty nefarious practice.

So we have to be super careful because these letters and editorials that are literally flooding the scientific literature right now we have to stop that because that is also, it might not be disinformation, but it is going to be misinformation because we don't, we don't know 100 percent whether these authors actually exist.

Whether they're institutions, whether they're employed at the institutions they say they're employed at, or anything at all. These are completely fabricated pieces of content that are getting through the net of journals. So you can see how the whole system is amplifying. bad content no moderation at social media companies, journals not really functioning in the way they should be functioning.

So allowing this avalanche of of bad content to be published, you know, it's and then of course, the AI processes themselves that generate this content. I mean, it's and the incentives within the academic system that encourages that because people measure the quantity of publications they've got. And even the letter in the lancet is still seen as something that's, you know, positive on your CV.

But if that letter in the lancet has been generated by AI, and that half the authors don't actually exist and don't work at the institution you know, We're in a real mess here. 

Jessamy: I mean, the risks are huge, aren't they? I mean, I think we should just lay them out in terms of health, really. What, what, what do you see as the, as the risks, Richard, you know, for your person listening who is a health care worker?

Richard: Well, at the worst end, at the worst end, it's, it's, it's fabricated studies which get into the literature and then into systematic reviews. There's a very interesting preprint at the moment but there is a very interesting study done of a bunch of Cochrane reviews. Now, as everybody, well, as many people who are listening to this podcast will know, and the gold standard systematic review is a Cochrane review.

They have books worth of, of details about how to, on methods about how to do a Cochrane review. And what this group did, they took 60 odd Cochrane reviews and they looked at all of, all of the randomized trials in those, in those Cochrane reviews. And they flagged concerns in a quarter of those trials.

and serious concerns in about three or so percent of those trials. And what that means is serious concerns means fake studies. So if you've got the, the, the world's most reliable database of systematic reviews already infected up to a quarter of trials in that reliable, so called reliable database, already infected with potentially fraudulent or fake studies, then we've basically not just polluted the literature, but the decision making without wishing to be overly alarmist, but the decision making that clinicians then make on the basis of what's meant to be the most reliable totality of evidence available.

Well, It's got seriously big question marks over it. So this has direct, has potentially direct impacts on patient care. So that's at the very, very worst end of it. I mean, you know, the odd letter or editorial from somebody who does, it doesn't exist written by AI or not isn't good and does create chaos in the literature.

But my worry is at the other end where, where you could really screw up. Clinical care. 

Gavin: One danger I wanted to talk about before we moved on, actually, as well, that's occurred to me while we've been talking, is that we're talking, obviously, about moderation on what are public forums. So that's posts on Facebook or Twitter that are available for everyone to see.

But actually quite a lot of dangerous extremism and radicalization occurs in these closed wall forums and we don't really have a solution for that. Apps like Telegram, which can be run by extremely nefarious people, have no oversight whatsoever, but can have closed wall forums of thousands thousands of people.

And we saw the outcome of quite a lot of that in the recent riots in the UK, for example, lots of which were organized by telegram groups, some of which I have no doubt were infiltrated by foreign bodies, for example. But META still has an issue with those as well, because META is full of closed groups of thousands of people.

have no moderators, or if it does, it has moderators who are part of the community. When 

Richard: you 

Gavin: say 

Richard: closed groups, just expect, because I haven't heard that before, what is a closed group? 

Gavin: You have to apply to join. An 

Jessamy: invite only. And 

Gavin: so the posts will not appear in your feed unless you're a member of that group.

But what that does is that everyone inside the group just starts winding each other up. Yeah. And so they become more and more and more radicalized. And actually this is where so many of the problems arise from. A lot of medical misinformation was shared during the COVID pandemic, for example, in closed groups that were called things like, you know, concerned parents for COVID.

It was like that. 

Richard: There's the Children's Defense Fund is an example, which sounds very meritorious, but isn't. 

Gavin: So the needs, not only should moderation not be walked back, we need to also find out a way of Ensuring information isn't spread or kind of like, I'm struggling to find a way to phrase this, this is not intrusive, you know what I mean?

Yeah, yeah, yeah. Because people have a right to privacy. But also these large apps like Telegram or these closed groups on Facebook have a real issue with radicalizing people. I don't think radicalization is too strong a word. No, it's not. Absolutely not. 

Jessamy: I think that's right, Galen, and I think also, you know, the argument, or the counter argument to many of our sort of hand wringing concerns is often, well, there's lots of groups, there's lots of things on social media that are really good for patients and people.

You know, they connect about their diseases, their pathologies, they Talk about, you know, their support groups, symptom control there's family support. There's, there's lots of, there's lots of beneficial things. And we always say when we have these discussions in our leader meetings or elsewhere, we can't be too negative, we have to give the positives.

I kind of am moving past that at the moment and feeling like actually that could be anywhere. That could be on any platform. The NHS could run its own signs for patient support groups, or it could be on any different type of platform. These people that want to come together and support each other is excellent.

But it isn't an argument for why Meta or why X is so good. I don't think anymore. I 

Gavin: think I said once in a leader meeting several years ago now that after the invention of the printing press, there were centuries of war. And what is social media, if not the democratization of the printing press? 

Richard: Yeah, well, it's, you know, I always I remember when Twitter, as it was then started, I really did buy into the idea that this could be a truly global conversation and be inclusive and marginalized groups could, would be able to join and it was really just a question of getting an internet cable to everybody in the world and then we'd have this, you know, egalitarian paradise of rational debate.

And I couldn't have been more wrong. And it's, it's, it's turned into something of a nightmare. But that's where, that's where we then have a really important responsibility. And I wonder if this does say into the second issue we were going to talk about. Which is around the, the wildfire.

Gavin: We want to discuss the quite terrible situation in Los Angeles County at the moment.

Richard: It's hard to believe that a city as advanced as Los Angeles could have Allowed, actually, is the word wildfires to kill and maim and destroy in the way that they have. But I, I, the question I want to ask is, could this be a watershed moment? for America because America, you know, it's the biggest polluter in terms of America and China are the two that we've got to really get to grips with if we're going to get global warming under control.

We crossed the 1. 5 degree threshold. It was according to the European Union Copernicus service in 2024. It's only one year, so it doesn't fulfill the Paris criteria of crossing the 1. 5 degree threshold, but it has been crossed in one year. Could the wildfires in Southern California be the trigger for America to be instead of rather a sort of blushing bride at the, at the cop party and not really being a great leader to, to really understand that this is a threat to their society, that climate, the climate crisis is killing Americans very directly, destroying communities having a massive economic impact.

And therefore they have to step up in a way that they just haven't stepped up before. Could it be a watershed moment? 

Jessamy: You would so hope, but when you listen and look on Twitter, it's not because if you wanted to be a conspiracy theorist about it, there is an avalanche of misinformation, which is misdirecting people from why we're having more wildfires, which we are.

We know that 2020, were the fourth, third, and first worst years for any wildfires. In 2023, an area the size of Nicaragua burned globally. So climate change is making forest fires worse and wildfires worse. But before we could ever get there, we first have to talk about the Wokorati, the, the lack of water, the fish.

The huge diversion that's going on in the U. S. political landscape away from climate 

Richard: change. What is the misinformation? 

Jessamy: The fact that this is due to DEI budgets. This is due to, you know, the fact that there are too many, that a couple of white male firefighters were fired and they're DEI initiatives and that's why these wildfires have started or because Gavin Newsom didn't sign a deal that Trump never made or that he's too worried about a bizarre fish in California.

There's so much out there. That is diverting away from the actual problem, which is that this is Climate crisis, here, now. 

Richard: Okay, you've obviously done a better job of surveying the misinformation than I have. When we said we were going to talk about misinformation, I didn't, I didn't, But 

Jessamy: it's very extreme.

But we 

Richard: didn't even read all the misinformation. 

Jessamy: On X, on, on, on, even in the Washington Post yesterday. There was a reporter talking about how, you know, this is all basically forest mismanagement and diversion of funds and Californians haven't been paying attention to this, you know, which is nuts. So I mean, between 2017 and 2021, the cost of California's wildfires was 117 billion.

So it's not like they don't know that this is a problem. 

Richard: This is why I wonder whether it could have been a watershed moment. But I think what you're saying is. No way. 

Jessamy: I would so love it to be and maybe there will be, you know, an elite group of people in California who are movie stars who have had their homes lost that, that will see this as a watershed moment, but there will be a whole load of people in America who are getting a different source of information, which is that this is because of diversity and inclusion projects.

This is because of. The, the Democrats being too soft on everything. This is because of a woke Rati who, you know, wouldn't even talk about outside because they were worried about a fish 

Richard: and 

Jessamy: they won't, they won't ever get to know that this is what the wildfires are getting worse because of climate change.

Richard: Because wildfires is one of the indicators that we monitor in our wilds at Countdown. And if you track it over the past seven or eight years that we've been doing it, it's been getting worse year on year. So nobody can say we hadn't, we didn't know this was coming. So I'm just thinking, what can we do to bolster the science around wildfires and the risks to try and counter this.

I mean, this is, you know, I don't want to say this is because it's all terrible, the damage that has taken place in the deaths, and it's not over. But there is an important moment here that we could, could we step in and try and help counter this. Yeah, this trade. That you're describing, I'm just wondering whether, you know, our Countdown initiative might be something that could, could make a contribution because with the Trump regime coming in later this month, I don't know who's going to be their climate change czar, who's going to replace John Kerry, who did such a, you know, pretty fabulous job.

Tireless. Unbelievably. It's really, really important, because if America doesn't step up, nobody else will. China certainly won't. Other countries won't. So they, they really have the decisive role Absolutely. coming into Brazil for later this year. 

Gavin: I think one of the interesting things for me is going to be a, probably a knock on of what started to happen in Florida.

And that's that insurers are going to start refusing to insure homes. So, there's already talk about insurers refusing to insure homes in areas in L. A. that have burnt down. In the same way that insurers are now refusing to insure homes around the shore in Tampa, for example, which is repeatedly hit by hurricanes, flooding pretty much every single year by this point.

So that is sort of the interesting tipping point for me. If it comes to the mind where business stops making people sure that they can get redress in these cases, is that the point at which people go, okay, we have to do something here because actually we're going to start having entire districts and cities abandoned.

Richard: And what will happen in Tampa? That means people won't have homes constructed, presumably. 

Gavin: No, well They're not going to get insured. Yeah, people won't have homes constructed, but it almost needs a few years to work itself out, because you're going to have people stuck there who can't sell their houses, or the land that the houses are on, because people won't buy it, if they don't have the possibility of getting insurance then, subsequently.

So, it then becomes a question of what do we do with these places? And then you'd hope that that was followed up by a larger investigation as to why these things keep happening. 

Jessamy: Well, I mean, the Republican, you know, are already saying that they'll withhold aid and funds to California because it's a democratic state, even though they got six million votes.

There's six million people that voted for Republicans in California. So there's going to be a lot of that. 

Richard: Trouble is, you know, I mean, I don't know if you've seen the film Civil War. It's a, it was a film, I think it's basically, it was, it's America splitting into two. And it's done 

Jessamy: Canada, Greenland, California, 

Gavin: the film, the film was very careful not to.

Settle on a particular political side of the one. Yes, the split. So in the film, it's the combined forces of California and Texas It's the West inside the White House. Yes, 

Richard: the Western states is the way and it starts off with the president at the time Preparing to give an address to the nation and he's and he's trying to practice his words and fumbling them a little bit.

But he's declaring the fact that they have had this great victory over the Western States. And you know, the, the role of the political leader, you know, in a country like America, where half of the, half of the country, 70 plus million votes went to Kamala Harris, 70 plus million votes went to Donald Trump.

You've basically got a split nation and either you try and heal that nation and bring people together under a common agenda. Or you continue to exploit the polarization and 

Jessamy: I think, you know, which 

Richard: But you know, there is a logical end point to this It's not just polarization on social media and these closed groups who don't talk to each other and who foster hate speech But if you have it in your politics as well then you know you you the fabric of democracy starts to unwind And it's, and it's pretty frightening.

Jessamy: It is. I think it's been a rapidly terrifying start to 2025. 

Richard: So these Wi Fi's then, they're not going to be 

Jessamy: a moment in 50 degrees. Honestly, I really hope that we're sitting here in a few months time and they, and that's the case. But I just not from the social media outpouring that I've seen. Do you, would you agree, Gavin?

Gavin: Funnily enough, recently I've been going back through old Lancer Voice episodes to add transcripts in. Right. Which for our listeners, many of our old episodes now have transcripts. Yeah. That's good. But, it, it strikes me with a lot of the COVID era episodes that you and I worked on. The hopeful tone that we strike that this would be a turning point for dealing with 

Jessamy: Remember that first episode.

Gavin: Dealing with key workers, for example, or kind of building a better and fairer society from the depth of the lockdowns. You know, kind of looking at things in a different way and you think if anything would be a turning point, it would be a global pandemic that affected, that touched literally everyone on Earth.

So I guess I'm not particularly hopeful that this will be the turning point. I think America still has a long way to go before it embraces the sort of radical action that tackling climate change would require. 

Jessamy: In the meantime, talking about downstream actions that everybody's probably gonna start getting excited about with technology.

I was looking this up. So it's all about detection, monitoring, so you're trying to detect wildfires from space, having networks of cameras and sensors to detect early wildfires. So each tree has a sensor on it and then you, you basically have a whole forest, which is sensorized, and as soon as a spark happens.

Drones are sent out to immediately extinguish them. 

Richard: What science fiction. But this is real. This is 

Jessamy: where the research is going for forest fire management and, you know, technological innovation, firefighting robots and mobile phone data for evacuation. I think, you know, we're seeing that already. 

Gavin: So there you go.

What's, what's more likely? America tackles, America tackles climate change, or it builds 10, 000 roads with 10 million sensors that go on trees. 

Jessamy: Exactly. This is more likely, but from a health care facility point of view, there was a study in 2022 that documented half of California's total inpatient capacity is within 0.

87 miles of a high risk fire protection threat zone, which so I was trying to find out some more information about the health care facilities from yesterday, it looked like more than 700 people have been evacuated from care homes and hospitals and a few clinics have been totally shut down or even COVID 19.

But you know, that that study from 2022 suggests a much bigger problem North Point eight seven miles of the, you know, 

Richard: ITIL feels a bit depressing, doesn't it? Well, I mean, you know, 

Gavin: up striking a slightly more upbeat tone with the 

Jessamy: technological innovation, 

Gavin: technological innovation and solution 

Jessamy: that that could.

Gavin: Okay. And I need a 

Jessamy: very downstream, 

Gavin: I feel like quite a lot of hope on tackling climate change by this point is fixated on technologies that don't yet exist. Do you know what I mean? Like Yeah. Everyone's sort of hoping that we'll get to the brink and then someone will have a massive breakthrough and somehow pull us back.

Richard: We can suck the carbon dioxide outta the atmosphere. Yeah. And that's gonna solve our problem. Yeah. 

Gavin: Yeah. That's the most upbeat thing I can probably say about climate change, although the other thing that strikes me a lot is that Dumourism is quite a tactic, isn't it, used by people who don't want you to talk about climate change.

Jessamy: And 

Gavin: so The 

Jessamy: whole book. Remember, we interviewed him. 

Gavin: Yes, Noam Chomsky and Robert Pollin. 

Jessamy: No, the other one, Michael, Michael, 

Gavin: the 

Jessamy: man, I think. 

Gavin: Michael Mann, yes, you're right. Yes, I do remember that. And this is interesting, isn't it? Because he was extremely cheerful about 

Jessamy: I don't think he was cheerful. But he was saying we can't become Doomerism, delayism and denialism are all on the same spectrum as narratives and tactics that are used by people who don't want to engage in conversations.

It has Hannah 

Richard: Rich's argument about not being doom and gloom about it. It's not a t having talked about a threshold of 1.5 degrees that might be in the Paris Accord, but we shouldn't think about it as if we cross it, then it's the end of the world and catastrophe. And we're all annihilated. We should be fighting for a point fighting where we 0.11 of a degree.

And I think that, that it's, it's not an, it's not a book that is wholly optimistic. It's completely her argument and, you know, she's the. Head of or deputy head of data. Our world in data. Our world in data, exactly. So it's not that she's sweeping the problems under the carpet, but she's saying that we need to be much more optimistic about the struggle that we need to engage in, whether we're talking about atmospheric pollution.

microplastics in the ocean, carbon dioxide in the atmosphere. There are things that we can do and we, we, and rather than pull the covers over our head, which is the tendency sometimes. We, we need to really be much more engaged, you know, In, in the Lancet's Climate Countdown, we have people who argue very passionately that we've got five years and if we don't solve it in five years, then we might as well all go home.

And, it's a very dramatic statement to say that, but it's, it's, I think it's a strategic mistake to, to approach the argument like that. I much prefer Hannah Rich's approach. 

Jessamy: I agree. And I think it is, it's a more inclusive approach because there are so many people around the world who, you know, are very international, are extremely well educated, are up to date on Not necessarily the latest science, but you know, they're looking at finance, they're in ESG or, and they're not feeling like that.

They're not about the, the, the political winds are not about to change. So no magnificently Yeah. That things are gonna happen in five years because those people in those worlds are, are not on the same page. Mm 

Richard: mm Absolutely. Absolutely. 

Jessamy: Are you going to lift us up with Argentina? I feel like having read your offline last week, I'm 

Richard: unsure.

So I wanted to, it's relevant to our conversation about memory. Yeah. And you've mentioned about Gavin, you've mentioned about the pandemic. And in your early podcasts, you were thinking, well, you know, given what's happened, surely we're going to Provide a better, we can create the conditions for a better society and we, and remembering what happened in the pandemic is so important and not letting that memory disappear.

But just as we're saying, every 0. 1 degrees Celsius is a ship we should fight for. So we need to fight for the men, for memory, for the memories of our society and our culture and what. what counts as part of our memory and the meaning of that memory. And it was really brought home to me over the holidays because I went to Argentina to actually meet up with my daughter who's traveling in a gap year.

And we went to a, what is effectively a museum of remembrance. It's called ESMA. I won't destroy and vandalize the Spanish by trying to repeat it. But it's, it was essentially, in English, the Navy Mechanics School in Buenos Aires. And During the period of really astonishingly violent dictatorship between 1976 and 1983 so only 40 odd years ago, not that long ago it was a center for detention, torture, and extermination under the military junta.

You can go into this building. This was the building where torture and extermination took place. And it's now been converted into a museum of remembrance under the name of one of the, of a, of an Argentinian writer called Geraldo Conti who was disappeared. So, you know, disappeared becomes a verb. In 1976, and his body was never found.

This is a museum that catalogues the events of the dictatorship and the impact on on the whole of the country. It's relevant to medicine because, unfortunately, as often happens in moments of You know, human bestiality, doctors are there aiding and abetting. So there's one particularly horrible aspect of this period where.

And you only have to, had to have written a poem for a vaguely left of sense magazine. And you, the, the, the forces of the junta would come round and take you and abduct you and take you to Esma. So there are a substantial number of women young women who were abducted, kidnapped. And taken there, and some of them were pregnant, and so what happened was that doctors would deliver their babies, and then the children were then given to allies of the dictatorship and then the women were murdered, and murdered often in the most horrific ways.

arms tied behind their back and taken over the ocean and literally just dropped in the ocean. And they actually have one of the planes which did this in the, in the grounds of the museum. So there was a organization after 1983 created called the Grandmothers of the Pas de Mayo. And they set out to identify these children, and to try and reunite the children with their original families.

And, in, just in the last couple of weeks, the 138th child has been named, and reunited with his real family. I mean, you can just you can't actually imagine how awful this would be. You've grown up as a child thinking you're part of a family. And then the grandmothers of plasma come along and say, Well, actually, your mother and most likely your father, were kidnapped and killed by the dictatorship, and then you were given to this pro dictatorship family, who are not your real family, and here are the, because they're the grandmothers of the children, you know, because the parents were killed and now here's your real, real family.

And, so they've got to the 138th child that they've identified, just around Christmas, and, Just after Christmas President Javier Millet has fired half of workers who work in these remembrance sites in these museum, the sort of National Memory Archive and indeed, I visited the Geraldo Conti Center on December the 27th, and no, December the 26th, it was Boxing Day because it was closed on Christmas Eve and Christmas Day, and they closed it just a few days later.

And the plan is not to reopen it. They're talking about it's going through some internal reorganization, but essentially it's now closed. And Millet, who's an anarcho capitalist, self described, who used to carry a chainsaw in the campaign and wants to do all these public sector cuts, is trying to rewrite the memory.

of his country to eliminate this from the national consciousness. It's, it's, it's a way. And since, since then, there have been protests in the streets, but in Argentina right now, there is this real social struggle for the memory of the country. And What counts as the memory? What lessons do we learn from this dictatorship?

The Malay argument is that it's called the two demons, that there were guerrillas who were anti government and the government was simply trying to bring order to the situation, but this argument, there was a investigation after 1983 which showed that this was completely false, that the that the military dictatorship was, is one of the most violent military dictatorships in the history of humankind.

But that even 40 years on now is being fought for. So memory is an incredible and, and the medicine bit's important because some of these doctors who aided and abetted the dictatorship and the deaths of people, they did actually end up going to trial, were convicted, but some didn't. So You know, the complicity of our profession, which we feel so much for, is really central to this, to this debate about the struggle about, about memory.

So it's really interesting, this concept of, of, of how we think about the past and how we bring the past to the present. In the context of human rights, health and the responsibility of health professionals. And. You know, our professional so called moral codes, which we seem to very easily give up in times of crisis.

So, yes, I, I just, I only wanted to bring it to the table because I do think that it's very relevant to all countries. Every country has a history. And how we take that history into the present is so important for us to think about those lessons. I mean, for us, we can talk about it as our history of imperialism, or more recently, the pandemic, and what lessons are there for our for our society.

And it's really important not to take that for granted. And I, and I guess I hadn't really seen it up. So it took going to another country and seeing the, the literally the terror that existed between 76 and 83. And still there's this fight over what it means to really bring home that that's, you know, we all face that in whatever, whatever nation.

Jessamy: I think it's so relevant for now because it's It does also feel that we're at a slight inflection point in that we've, there was so much remembrance about World War II and the whole multilateral organization and structure of our world was set up to geared towards that. We all acknowledge that it's by no means perfect and it needs to change, it needs to move into the 21st century.

But what we have at the moment are people like Elon Musk speaking to ADF in Germany, roots in Nazism, wanting to erase that memory. As a reaction to the fact that these structures are not working for a 21st century, rather than constructively saying we need to keep that memory that doesn't, you know, the things that have happened in the past are still relevant, which party, whether, you know, where you have come from is still important, it's just that we need to move forward to a new time and I feel that there's There are lots of people who are trying to rewrite the last 70, 80, 90, 100 years because we all acknowledge that things do need to change.

We're facing all of these major global crises. We've had a, you know, systems that have not been as fair as they could have been, but it's the way that, that different strands are doing that, that I think is very concerning. And that particular example seems quite symptomatic of a lot of actions that are, that are going on globally.

Richard: Yeah, I mean, really, every country history is living you know, France, Jean Marie Le Pen dies, and you've got Marine Le Pen, she's got a third of seats in the, in the, in the parliament And Jordan Bardella is leading Rassemblement Nationale, and could be the next Prime Minister or President rather, next President.

I mean, it's, it's, you know, absolutely frightening where, where we're at. And if you don't Take the history, you know, a party that was born out of being a Nazi and keep it alive Really really keep us alive And again, I think that you know, I feel very much that you know, we've been around for 200 years We're part of that National Memory Archive that every country has and so in a way, it's partly our responsibility to remind people of what that memory is is and what lessons we draw from it.

And actually the pandemic is a very good example because I've, I felt the same that this was again could have, could be a watershed moment to recognize people in our society that had traditionally been pretty much invisibilized and silence and to reorder our priorities. And that hasn't taken place not yet.

It's still only a few years after the end of it. The long term impact could, could be great, but it will only have an impact if those of us who are, in a sense, stewards of the memory archive, and we are, modestly, in one very, very small corner of, of, of, of that memory, if we, if we promulgate those messages.

Gavin: Do you remember we had Laura Spinney on this podcast to talk about the 1918 flu pandemic and her superlative book about it? And it, it struck me talking to her in that interview. How little institutional memory was retained of the 1918 flu pandemic, coming as it did off the back of World War I. But it, it just makes me wonder if we will retain any lessons from the pandemic.

I wanted to say actually, Richard, I had quite an analogous experience to yours. I visited Vilnius, the capital of Lithuania, last year. Lithuania as many tour guides impressed on us, used to be the biggest country in Europe. And then, it had a history in the 20th century of, first, after World War I, it was occupied by the Soviets.

World War II, it was taken by the Nazis. And then just after World War II, they were liberated, in inverted commas, by the Soviets again. And then, did not retain, did not regain independence until the early 90s. And there are many museums to the lost Lithuania in, in, in Vilnius. But the one that struck me the most was the former KGB headquarters in central Vilnius, which is now a museum to the, the horrors inflicted by the KGB occupation.

And the room, I think, that will stick with me always, is there was an execution chamber. And obviously, this is still happening up until 1991, which is incredible to think of. Yeah. Where people were lead in, and then unceremoniously shot in the back of the head by someone who was hiding behind the door.

And you can look on the far wall and still see all of the bullets encased in the wall. But now Lithuania is facing down an expansionist Russia again, a warlike Russia on the border, and Belarus assisting at its other border neighbor. I think the talk about memory is Do they 

Richard: hold that memory as very much part of their current identity?

Gavin: I'd say it's the central part. It's the central. I only spent a week in Lithuania, so I don't speak for the people of Lithuania, but I'd say it's the central part of their identity, and a sort of fury as to what was lost for almost the entirety of the 20th century. Yeah. There was a study, which I'm going to misquote, that said that the population of Lithuania would be more than twice the size if they hadn't been occupied.

In the 20th century, there's so many. Lithuanians were forcibly deported to Siberia to the gulags out there that the population has never really recovered. And as our, our tour guide in Vilnius was telling us, there's not really anyone left that would call themselves Lithuanian who lived in 60s.

They're all now people from other countries who call themselves Lithuanians. So it's quite a. striking example and something, the memory that they hold extremely close and is a central part of their identity, but now is obviously threatened again. 

Richard: Yes. So they have good reasons to fear Russia. 

Gavin: Yes, all the Baltic states.

I've also visited Tallinn, which has some very similar museums and exhibitions in, in the center. And these huge, gigantic, sprawling prisons that the Soviets built in these, in these Baltic states. It's it's incredibly striking.

It sometimes makes me think of, there was the the philosopher George Hegel, who used to say that societies eventually lost their memory and went sterile and that's the point at which war comes onto the agenda again. He said that societies needed the rod of war to stir them up and to create these institutional memories and then at that point everyone is so horror struck by the war and the inhumanities of man that Peace can descend, we'll build the institutions properly, and everyone's nice to each other again.

I'd like to apologize from my PhD supervisor for that reading of George Hegel. Professor Haddock, if you're out there, I'm sorry, but 

Richard: Yeah. 

Gavin: Yeah. 

Richard: But it's, I mean, it's very interesting to look at the role, and again, also in health of a country like Japan. You know, after dropping of the bombs in Hiroshima and Nagasaki, you know, a very, very aggressive nation with a very, very aggressive and brutal army very quickly turned into one of the chief advocates of peace in the world.

And also, there has been an incredibly strong and valuable tradition of promoting health and universal health coverage. Universal health coverage was achieved in Japan in 1961. The commitment of a country coming out of war, turning its side you know, using its memory to, in a sense, recreate its identity in the world.

both at home and also in, in the rest of the world is remarkable. And certainly in global health people from Japan have been some of the leading advocates for universal health coverage because of their achievement. They've been one of the most innovative nations in terms of building a social care system with a long term health insurance.

And, and that memory of war is still very, very much. informs the way they see themselves in the world and the contribution that they wish to make in the world is very much informed by that by that history. It's so it, it really does have a, have an influence in, in the present day. And one has, and one really can respect that.

And I think learn from it actually. And I'm, in the UK, I'm not always sure that we do as good a job as we could. And as we talked about most recently with the pandemic, but also historically you know, the creation of the NHS in the 1940s post war, an incredible achievement. And I'm, I'm not sure, you know, whether, whether we, we, we now face the challenge of building a social care system, but where's the political leadership to do that?

Atlee, I mean, there had been a lot of work that had gone on in the run up to creating the NHS, but, you know, Atlee didn't say, well, let's wait four years for have a, have a report, commission a report and wait four years to, to build the NHS. He came into power in 1945. started pretty much straight away to build the NHS.

We need the same for social care today. A DNAI solution, 

Jessamy: Richard. Now that we're gonna be the so's here, of AI, maybe, you know, we could just do that. 

Gavin: Well, it's funny you mention the care system, because Wes Streeting has just turned down my offer to come on this podcast. So, Wes, if you're listening, our doors are always open for you to come on and discuss the care system on this podcast.

Richard, one word you used, just to sum up there, in the end, I think was super important and I think is a good kind of like, ties everything together that we've been talking about is advocacy. Mm. 

Richard: Mm. 

Gavin: And I think we can, we can advocate for greater engagement with scientists, with fact checking and making sure correct information is out there.

We can advocate for stronger action on climate change. And we can advocate for the retention of, of institutional memory, as we've been talking about. And I think we're in an important position to do all of those things, to constantly advocate. And it's the, the passivity that really actually does you in, isn't it?

The, the, the passivity is what allows malign actors to to run roughshod over everyone else. 

Richard: Yes passivity and allowing people to act with impunity you know, the, the, that nobody holds them accountable. And again, I think that's Another very important function of science, because science is the system we have to produce the most reliable knowledge we have in the world.

That can be used as an instrument to hold people with power accountable. You know, if you, if you do a survey to look at child mortality in a particular country and whether it's changed from 20 years ago, that's holding the people with political power accountable. If you look at the progress in rolling out antiretroviral therapy in Sub Saharan Africa, that's holding.

that's holding people accountable. So, you know, it's thinking about science in a slightly different way. It is a political tool. It's not just, you know, papers published in journals and indexed in PubMed. But that's, I think that's how we as editors should be, should be thinking about it using the closest we can get to truth as a force for social Advance.

That ties all three together. There 

Gavin: you go, Don. That'll be a good spot to end on in that case. And I'd like to advocate that our listeners join us again next time. Thank you, Richard and Jess for this chat. 

Richard: Thank you. Thank you.

Gavin: Thanks so much for listening to this episode of The Lancet Voice. If you're interested in the other podcasts we do, you can go to thelancet. com slash multimedia, where you'll find all of our excellent videos and infographics as well as our podcasts. Remember to subscribe to The Lancet Voice if you're not already, and we'll see you again next time.