"Doctored", plastics, and NCDs

Gavin, Richard, and Jessamy enter the studio once more for a Lancet Voice chat. A new book on Alzheimer's disease causes controversy across the Lancet team, we discuss the new Countdown on Plastics & Health, and a quick look at the problems facing the upcoming UN High Level Meeting on NCDs.

You can read the Lancet Countdown on health and plastics here:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01447-3/fulltext?dgcid=buzzsprout_tlv_podcast_August_25_lancet

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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. We're very pleased to have you with us. It's August, 2025 and I'm Gavin Cleaver. Today I'm joined in the studio once more by Richard Horton, Editor-in-Chief of The Lancet and Jess Bagenal, senior Executive Editor at The Lancet. And we're gonna discuss things that have caught our eye in the world of health recently, including a book that's caused disagreements here at The Lancet, our new commission on Plastics and health, and the upcoming UN high level meeting on NCDs.

We hope you enjoy the conversation.

Richard, Jessamy, welcome back to the Lancet Studios. Once more, been a couple of months since we put a podcast out. I hope you've both had lovely summers. Richard, have you had a nice summer? 

Richard: I'm having a lovely summer. Thank you. I'm going to spend a few days in Athens with one of our advisory board members bepi Rezi.

So I'm very much looking forward to seeing be. Do you ever have holidays that aren't Lancet related? I don't do anything that's not Lancet related. 

 Gavin: And how about you, Desiree? 

Jessamy: We have a very nice summer. We are homeless because our house is being demolished and renovated. 

 Gavin: I feel like there's two sentences.

Don't really, 

Jessamy: but we're having a very nice time spending PLA time in different places. 

 Gavin: Very nice. 

Jessamy: So it's good. 

 Gavin: Very nice. Wonderful to hear. One of the subjects we wanna talk about this week was, and we've had a pretty long conversation about it before the starting of recording of this podcast, is the book Doctored by Charles Pillar, which covers the amyloid plaque theory of Alzheimer's, the controversy surrounding recent retraction of a paper and various other.

Accusations. Before I say anything I regret on that front about Richard, you you tell me what it is that you wanna talk about when it comes to this book. This book has caught an absolutely furious controversy not just in the scientific community but in the editorial offices of the Lancet.

Richard: I admire AD it has. 

And we have editors looking at each other, daggers drawn because some are absolutely madly in love with the am amyloid hypothesis and think that it's the it's the. Core explanation of dementia while others, maybe myself included, are in the slightly more skeptical camp because I've read this book and do have a few questions that need to be asked, the book is a very extreme presentation of a particular point of view.

So just to backtrack. What is the cause of Alzheimer's disease? This theory about amyloid deposition is one of the leading ideas, and it's not just an idea because the whole therapeutic research paradigm around Alzheimer's is based on the notion of. Attacking amyloid and extracting amyloid from the brain.

And some of the monoclonal antibodies that have been designed and approved are all based on the amyloid hypothesis. The, what the book does is the book makes the. Really quite extraordinary claim that the amyloid hypothesis is all hype, all exaggeration, and based on fake and fraudulent science. And the author of the book talks about the idea of a scientific underworld of deceit and lies.

So this is drama of the highest order, and this journalist, I should say. It isn't some tabloid journalist who's just come along and written a bit of a Absolutely. He works for science. Yeah, exactly. That's the point. You should say 

 Gavin: science with a capitalist. The publication Science magazine.

He works generally science. 

Richard: Exactly. Science. He's a distinguished writer for Science magazine. A highly respected science journalist, knows the scientific community inside out. Draws on many reputable sources and a network of friendships and relationships to write this book. And it is, I've got to say, it is a gripping read.

It is a thriller. I found myself turning every page with a excitement when I first read this book. It's a real success story, but as I say, totally divided readership. Jasmine, were you similarly thrilled by this book? 

Jessamy: I enjoyed the book.

Richard: We're divided 

Jessamy: and I. I think that there are many interesting things to gain from it. As Richard said, it's an extreme version. One of the real take home messages for me, and I think that many people perhaps, who don't come from a science background will come away with, is that it demonstrates so clearly how scientists are just human beings.

All of these people, they've got vanity and ego and hubris and pitfalls, but that doesn't necessarily mean. They are conducting fraudulent research and at times I got slightly tired with the book painting these caricatures of people without them ever really. Knocking in the final nail of saying, and they conducted this awful thing, or they did this awful thing.

There are examples, like there's the retracted nature paper, but then there were also examples where a sort of caricature is built up and we're led to believe that perhaps there were some things that were not done as well as they could have done. And then we move on to the next chapter very quickly.

And I got a bit, I got a bit tired of that I have to say, but I thought it was a very good book and some very interesting things to be taken from it. And I think for me, the things were about this people and I think that's interesting in the world that we are in at the moment where there's a very much a sort of anti-science and anti expert agenda that the acknowledgement that scientists are such human beings is.

A tricky one for us to navigate. The second thing I think is obviously about academic incentives that you know so many people in this book are driving towards a publication in our journal or in nature or another premium luxury journal and how that makes their career full. I'm not sure the word 

Gavin: luxury will be approved by our.

Jessamy: Excellent. An excellent journal. An excellent journal. I've 

Richard: heard that word used actually about journals like Nature, new England Journal, actually I have heard it used. And that is what they're striving for and that you are working in a system which only rewards that. And so at some point in your career, that becomes your main focus.

Jessamy: And regardless of how you get there, you will. You will get there. And then the third thing I think, and we see it in medicine all the time, and we've written about it in the past, is this sort of complicit web of silence that there always is about bad actors. And there are many characters in the book who now come outta the woodwork and say, actually I always thought that person was a bit dodgy, but they didn't whistle blow.

They stopped working with them. Yeah. And they removed themselves. And then that person moves to another institution and we see that in medicine all the time. They move to another institution and all of a sudden they are reborn and there's no history and experts, scientists, medics, we tend to have that.

We can appreciate where people might be bad actors, but the actual whistle blowing rarely happens. It's more of a sort of quiet. Withdrawn and really that results in complicity rather than anything else. 

Richard: I think what Jessee says is fair. What? What? It's an extremely entertaining book to read. Because of the way he writes this, his style of writing.

But if you actually look at the evidence against the amyloid hypothesis, what he does is he takes some very extreme examples of where things have gone badly wrong in research and there really have been some bad actors. And he points the finger at with reasonable cause at a group of other people as well, and he names them.

But what he does, then he puts all of that together to then say, so you see, that's why the amyloid hypothesis for Alzheimer's is wrong. And there's a huge gap, leap in the logic there because he's gone from a bunch of people who is indicting in terms of the quality of their work or outright fraud.

And then making the jump to say that's why the amyloid hypothesis doesn't work. And you can't do that. You can't draw a causal relationship. Between the two. I do think he's fair though, and we've certainly seen that here in the papers that get submitted to us, that there is an under investigation of alternative hypotheses.

 To take one example, a viral hypothesis of. Alzheimer's the connection between viral infection and maybe inflammation. What does that contribute to our thinking of the etiology? I think there are good arguments here that need to be taken more seriously in some ways. Maybe what. The author does is he takes his argument to such an extreme and then gets the scientific community so upset with him as he has done in the book reviews that I've seen about doctored that actually he's not created the space for some constructive dialogue.

Because people have reacted so negatively. But I would say, just coming back to Jesse's final point, to me, one of the reasons why the book's important is less to do with the specificity of Alzheimer's disease and more the charges that he makes against science. Broadly. He says very clearly that science has a research integrity crisis.

Now that's a very big claim, and it's a time when we, in this era of disinformation and somewhat broken trust between the public and the scientific community, this book, to make that claim, it is not helpful at one level and trying to rebuild trust between the public and. The science community. On the other hand, looking at into, at ourselves in the mirror, we should ask ourselves that ques question, does science face a research integrity crisis?

And if so, what do we do about it? And the book does raise questions about responsibilities, for example, of lab heads, the responsibilities of journals. Who takes responsibility when there is an allegation of research misconduct? Is it the university? Is it the funder? Is it the journal? Do we take it seriously?

Do we act fast enough? And the answers to some of those questions are not always good for us. 

 Gavin: And these are big questions. They are big questions. 

Gavin: Yeah. 

Richard: Yes. Okay. Let's put the amyloid argument to one side for a moment and just shine a mirror. Who we are and be honest. And that, yeah, that I think is one of the greatest contributions is books making.

I completely 

Jessamy: agree. And it makes that very powerfully and it does ask difficult questions. 

 Gavin: Let's pose one of those big questions now then. How do we as a journal deal with allegations like this? 

Jessamy: If it was for us for a research in integrity issue. Yeah, for example, so we obviously have Sabina Kleinert, who's our deputy editor, and she's also our research integrity lead across the Lancet Group.

And she oversees all of our different research integrity allegations and issues, and we have a research integrity tracker. And I don't know. I can't speak Richard for how things were in the past, but I think we have made very real progress in this sort of organizational approach that we have to this and the speed within which we respond and the internal processes that we have.

Richard: Yes it has been a journey. If I go back to. When it was Richard Smith, Michael Fathering, and myself, who were the ones who, goodness knows how many years ago, 30 years ago or so, set up something called the Committee on Publication Ethics. And the reason why we set that up was that as editors we were seeing these.

Allegations of misconduct, but we didn't have any forum. We didn't have any roadmap to know how to handle them. Universities didn't want to handle them. They didn't have research integrity officers or officers. They didn't have policies, journals didn't have policies. This issue wasn't taken seriously by anybody.

And indeed, when we created code, we were very much criticized by some of the scientific establishment because they said. By drawing attention to these issues, you are going to damage public trust in science. So they would rather have swept these. We used to have some very difficult discussions from past presidents of some very really That's so interesting.

Academies of medical sciences that I can think about. And they were really against it. They really thought that this was this might have been the dirty little secret of science, but it wasn't very helpful of us to make the dirty little secret public. So we weren't too popular in those days, and it's taken literally 30 years for us to now say, actually, you know what?

We really do need to address this. Seriously. I think journals have improved their processes, but not all journals. No. And. Still, a lot of journals would prefer not to retract papers or to issue expressions of concern when they should. And this book unfortunately does show that all too clearly, even at some prominent journals.

Universities certainly don't like to admit that there might have been fabrication or falsification of research because they're worried about their reputation. But I would say overall, the community does. Handle these questions better. I think in this in this book the questions that he asks are whether we are too slow to retract papers that are clearly fabricated.

And I think the answer there is often we are too slow. If I can think back to the cases we've had. There are definitely examples of where we've been too slow. I would just say that there does need to be due process. Sometimes we get called on to retract papers because people don't like the paper, they don't like the result of the paper, and sometimes that's true.

The results of paper. Are inconvenient and they don't always chime with the conventional wisdom. And so people would like us to retract that paper. We had a, it wasn't at the Lancet, but it was at one of the Lancet family journals and somebody wrote me a very angry letter demanding, we retracted a very unhelpful paper as far as he was concerned, but I had to point out to him.

Yeah, I don't like the result of this paper either. But just because you and I don't like the result, doesn't mean to say we retract the paper. And then even if there is an allegation of misconduct, the authors still have the right to be able to put their point of view. There has to be some due process and I feel that occasionally critics don't like that answer, but I think on balance over 30 years, yeah, we have got better.

Jessamy: I think it's interesting, isn't it? Because there are no real, as with all of these complex systems, there's no, there's not really an easy intervention. I dunno whether you saw that India now. Gonna start using the number of retractions that an institution has as a sort of ranking method? No, 

Richard: I haven't seen that, which.

Jessamy: To some's people. You would say, great, this is an answer to research integrity issues because there's too much falsification of data and we are now in know age, but that's gonna be a 

Richard: disincentive to retract, but 

Jessamy: Exactly. Yeah. But the actual consequence is probably gonna be quite difficult, quite different.

And 

Richard: so yeah, you're never gonna retract the paper Exactly. If you're. Be judged for it, whereas actually we should be probably retracting more papers. But you, but then you see, that's interesting. If, and this is where, again, one has to be thoughtful about it, even if you know a paper's wrong, maybe five years later or 10 years later, does that mean you should retract the paper because you know it's the wrong result?

What's the base? What are the criteria for retraction? Sure. Academic misconduct and typically research misconduct is FFP, fabrication, falsification, and plagiarism. But what beyond that for example, when we publish papers that have a major error in them, we now have this mechanism we call retraction and republication.

Because what we're saying is there's nothing fundamentally wrong with the methods of the paper. A formula's been misapplied. Exactly. Some. Something in the computer program went wrong and the results got all skewed. But the basic message of the paper is exactly the same, which is very 

 Gavin: different from dishonesty.

Totally. 

Richard: Yeah. And so you don't want to condemn the researcher with a retracted paper, so you give them the chance to represent their paper. So that's, I think, very useful. But what about if a paper's been shown to be wrong? Should you then retract the paper? And this was the case in this particular paper published in The Lancet Sister Journal.

A paper had been published. It had come up with a result. Subsequently, some years later, the same research group tried to replicate the finding and they couldn't replicate it. So in a sense, they disprove the finding. Therefore, what do you do? Do you retract the first paper? I don't think you do. I 

 Gavin: think you add it to the body of scientific.

I think 

Richard: that's right. I think that's right. But that's not a consensus. That's not a consensus. No. And some people would prefer that you did actually retract the paper, 

 Gavin: which is interesting, isn't it? Because it's it speaks to, we were talking a few weeks ago about those sort of. Black swan events. Do you remember?

 The idea that scientific progress had almost stopped because no, nothing was being overturned anymore. It's quite entertaining to me, I guess to think of a paper being published, say for example, completely, fundamentally disproving the amyloid plaque theory. Yes. That would then, in the opinion of the people you were talking about, result in the rera, subsequent retraction of every single previous paper, which doesn't feel right.

 No, there's the body of scientific literature. No. 

Richard: Sometimes people use misconduct also as a sort of way to pursue vendettas against individuals. And sometimes in this book, it felt a bit as if this author who's, who has done a magnificent job in many ways, but he'd so focused in on the person Yeah.

Person that it had become almost a sort of a campaign against an individual. Yeah. And I see that quite regularly actually. People get very upset with the behavior of somebody. Yeah. And then they really want to laser in on that person in a way that feels like you're playing the person, not the issue.

Jessamy: Yeah. I think that's right. And anybody listening to this podcast will know that academics. Yeah. And not always the nicest, no fairest people, they have feuds, they have enemies. And all of these types of issues are often brought in as weapons and in, in different types of conflicts. 

 Gavin: I've thought of a good segue to our second topic.

Which was that accusations of academic misconduct tend to live with someone forever. And another thing that lives with someone forever is often microplastics in the body. So we want to talk about the recently published Lancet Countdown on Health and Plastics, which was published in the leadup to a.

Treaty that occurred last week and did not go particularly well. But the countdown itself is full of really fascinating facts, I think. So Jess, why don't you kick us off on this particular one. I just wanted to raise it because I think it's an issue that people are becoming increasingly concerned about, and we see that reflected in the amount of interest and coverage that these types of.

Jessamy: Papers get we recently were looking at different highly cited papers and one of the most highly cited papers in the New England Journal. It was one of the first studies that looks at the clinical results of microplastics in atheroma, in people's neck veins, and neck arteries, and showing that their clinical outcomes were worse.

It was a very small study. And one that you might not think would attract such a huge amount of interest, but I think. It's interesting how these types of issues, there's a tipping point, and I think that's where we are now. People have suddenly understood and recognized what an enormous problem this is and how little we know about the consequences that it could have on our health.

 Gavin: Yeah, and the tipping point was, one of the things that was really incredible to me from reading through this publication was that we are doing relatively well. In converting the world to renewable energy, but at the same time, there's this huge amount of fossil fuels that are being still brought out the ground by fossil fuel producers that need to be put to use somewhere, and they're all 

Jessamy: diverting into plastic.

 Gavin: This countdown makes the point that actually all of those fossil fuels are now being diverted into the creation of plastics. Readers can read it online, but I recommend looking at figure one and the annual plastic production graph to see the exponential increase in plastic production. And so that is something that I definitely hadn't appreciated before reading this work.

It's quite incredible to think that this amount of plastics produced could increase from well. As it says, two megatons in 1950 to 475 megatons of plastic in 2022. But with that tipping point, it's now projected to be 1200 megatons of plastic for 2060. Quite amazing. Yeah. When you link it to the health farms talked about in this paper.

Richard: But the first thing to say is. If you want to meet new people and you lead a lonely life, what you wanna do is read this paper sitting on the tube. I was sitting on the tube this morning. 

Jessamy: Really reading this paper 

Richard: is which line? Because I feel like it buried the northern line, Northern. I was sitting on the northern line reading this paper with my pen out underlying.

Various sentences. And this extremely nice lady was standing above. I had actually offered her my seat. I should say first before you think I was very un, but she had her ear things in and didn't hear me. And then she was looking, obviously over my shoulder and then I got up to get off to come to work and she said.

I've just been read where? Where is this publication published? Really? 'cause I was just reading about the 30,000 plastics workers who died. And I said, oh, it was published in The Lancet actually. And then we had this very brief, but animated, but somewhat passionate conversation as I was jumping off the tube at Morgate.

 Did 

 Gavin: you tell her, you editor in chief of I didn't tell her that. No, I 

Richard: didn't. I didn't feel that would be very appropriate. It could be a very strange miscon in the Metro. Anyway. Anyway, the point is this is clearly a way to meet people. I won't do it again. It's just something old metric can't capture, exactly. The old it's a, it is a person metric. For reading. Lance papers on the Chew. When you read this page, I was shocked by some of the numbers. Because I was not aware of some of the basic data here. First of all, 475 metric tons. I'm an imperial person, so I'm not quite sure I can envisage what a metric ton is, but it's a lot of plastic produced and more importantly.

And it's that graph you are referring to Gavin tripling by 20 20 60. Yeah. That is unbelievable. But here's another fact that blows you away completely. How can it be that half of all plastics that have been made in the world, in human history have been made since 2010? 

Jessamy: I know that 

Richard: is like 

Jessamy: mind blowing 

Richard: compute.

That that is like half of all plastics that we've ever made. As a species have just come in the last 15 years, that's enormous. I thought we'd actually done a great job of single use plastics. We haven't. No, 

Jessamy: we 

Richard: haven't. No, we haven't. 35 to 40% of all plastics are still single use plastics. What the hell are we doing?

Gavin: Yeah. 

Richard: Why aren't we getting rid of, I thought all this plastic bag stuff that we don't use anymore, we are not even making a dent. No 

 Gavin: opposite. 

Richard: Yeah, exactly the opposite. Exactly the opposite. China is the largest producer. 208 metric tons. So what are we doing about China? Come on, China, get your act together.

5% of all greenhouse gas gases come from plastics. So we should be doing governments. What is, why are governments giving 43 billion US dollars to plastics manufacturers? Yeah. Why do they need $43 billion in subsidies when they're churning out 400 plus million metric tons and making everybody sick? This is impossible to understand.

 I think there are some pretty shocking and amazing facts in this paper, which convinces me that it's the right thing to do, that we set up this new Lancet countdown on health and plastics, which is going to be like the Lancet Countdown on Climate and Health, where this amazing team led by Phil Landrigan, who led our pollution commission a few years ago, is gonna put together all the data and monitor.

And review where we're at. So it's a really urgent and important issue, and it's a great paper. And the fact that the Global Plastics Treaty has failed is a tragedy. 

Jessamy: Is a tragedy. 

 Gavin: Yeah. Some of the stats are unbelievable, like you said. The other one that stuck with me was that. 80% of all plastic ever made is still with us here on the planet.

 Yeah. So degrading somewhere exactly. Often in the ocean destroying marine life. 

Richard: I know. You will see if you waste your evenings as I do trawling social media when I'm not sitting on a tube reading Lancet papers, then you will see the number of videos of animals caught up with, especially in the ocean caught up in plastics.

And plastic meshing is really no. That 

 Gavin: was the original fight back against plastics, wasn't it? Some of the first kind of anti plastic things appearing on the news was always animals getting caught up in having bits of plastics stuck in the gullets, that sort of thing.

 It's not like we haven't been aware of those environmental limb impacts of plastic for a very long time now. No. But also I think as well as this paper so well lays out is the effects on humans are also shocking. 

Jessamy: Shocking. This is such an important step to be able to really monitor those health impacts because, 

Richard: totally shocking, but again, how little we know, so 

Jessamy: little, 

Richard: like two thirds of all plastics, chemicals we have.

How much data? Nothing. 

Jessamy: Nothing. How can that be? I know 

Richard: that for two thirds of all chemicals that are related to plastics, we have absolutely no data. 50 of those that we do have data on, 1500 of them are carcinogenic, and we're quite happy to have them kicking around the environment. What are we doing? 

Jessamy: I know.

It's so sad, isn't it? Because also when you look back at the history of this type of topic and you look at Rachel Carson's Silent Spring and there was an appreciation and also an opening at that time, 30 years ago, 40 years ago, where action could have been taken and people were very receptive to that.

Gavin: Yeah. But 

Jessamy: there has definitely been a political and commercial. Move to any action. Yeah, 

Richard: but it's, again, I'm so sorry to say, but it is back to the fossil fuel industry. It's, and that we do not regulate the fossil fuel industry, and that's why the Global Plastic Treaty failed because our lovely fossil fuel driven nation states.

Have said it is got nothing to do with production. It's got all to do with, we need to do a bit more recycling. Yeah. And you know what, if you think recycling is gonna solve this problem Exactly. 

Jessamy: How many tons do we need to recycle? Exactly. Let's just to really look at that. Come on. This is a nonsense.

Richard: How are you gonna persuade them? They're economists are completely dependent upon fossil fuels. 98% of plastics come from fossil fuel carbon. We're stuck. We are stuck. We are stuck, 

 Gavin: but the human health case is overwhelming. I just wanted to read out some of the stats that were in this because it really blew me away.

Just one of the chemicals involved in the production of plastic bisphenol is associated with 5.4 million cases of ischemic heart disease. 346,000 cases of stroke resulted in 237,000 cases of ischemic heart disease deaths, and 194,000 stroke deaths. And then it goes on to talk about its effects on prenatal on child health.

 It's absolutely mind boggling. That's one of the chemicals involved in the production of plastic. That's actually it is a great point you make, Gavin, because I think one of the goals of this paper is to say, and this is the, this is what happened with climate 20 years ago. This is plastics are not just an environmental issue, it's a health issue.

Richard: Yeah. That's what there was a time when Nick Stern's report came out and climate change was seen as an economic issue or an environmental issue and the rich polar bears and all the rest of it. But then it's been made very convincing, a health issue. And I think once you win that argument, you do put this issue into a slightly different kind frame and yeah.

 Gavin: When I was a kid, my dad was always like, turn the lights off, because the polar bears, yeah, they're gonna struggle and 

Richard: I love polar bears, but. 

 Gavin: And now with my son, I can be like, turn the lights off, because 

Richard: yeah, 

 Gavin: there's a lot more serious things going on with climate 

Richard: change 

 Gavin: right now. 

Richard: Exactly. Exactly. So if we, and we're not gonna do it in the first year, but.

We've done it over 10 years with the climate and health countdown. And so if we think about the next 10 years for plastics, I really think that we can make a big impact. I don't say we, Lance hasn't done it. We've been part of a movement of people we've been, the data part of a movement of people with our colleagues who've run the countdown at UCL and elsewhere.

That is, is what we can do with this this countdown too. A hundred percent. So we should be very optimistic about what we can achieve. 

Jessamy: Yeah. Yeah, agreed. Should we finish off with another meeting, which is being influenced by industry and what is that? You, 

Richard: cynic, you're such a cynic. 

Jessamy: This high level meeting on NCDs.

Richard: As a friend of mine once said to me, have you ever heard of a low level meeting? Nobody ever says I've organized a low level meeting in non diseases. I've invite really 

Jessamy: unimportant people just once. 

Richard: I'd like to attend a low level meeting. 

 Gavin: Yes, exactly. It sounds nice. Maybe there'll be drinks. So what is the problem with this meeting?

Jessamy: Why is everybody upset about it? 

Richard: No the SDG 3.4, which is what this is all about, reducing premature mortality of noncommunicable diseases by. A third. Yeah. And promoting mental health and wellbeing. It's just been a nightmare to get NCDs taken seriously by the global development community.

And the general attitude is, look, you've gotta dive something. So what are you trying to do? You can't live forever and people die of heart disease. They die of cancer, they die of diabetes, they die of respiratory disease, and that's just life. So we need to be spending our money on infectious disease and maternal child health.

Of course, we need to be spending our money on infectious disease and maternal and child health. The point is that. Yes, you have to die of something, but you don't have to die prematurely of these things. And that's what the whole point of the NCD movement is. The premature death. And what is being missed out completely is that we are now in an era where we are not just talking about a group of people, say 50 to 70, we're talking about a group of people from 15 Yeah.

To 50. So you know, adolescents. Working age population who are being targeted by pernicious industries whether it be food, tobacco, or alcohol. And because we are the wonderful species that we are, we make choices given the environments that we live in. That unfortunately are health harming and what this declaration that, that needs to be agreed in September.

What they have to do is we need to be calling for the implementation of taxes on tobacco and alcohol and sugar sweetened beverages and a whole range of issues. And the drafting is going backwards? 

Gavin: Yeah. 

Richard: Is getting weaker, not stronger. So we're in the same places as we are with plastics. Yeah. The, once the governments of the world come together, they dilute any action.

Jessamy: Absolutely. And this, people are worried that this draft emits commercial practices. It doesn't focus on young people and children and the impact that advertising has on them. It doesn't talk about conflicts of interest. It doesn't really have enough about climate resilience and planetary health doesn't, it doesn't.

Talk about fossil fuels or air pollution very much. And as we know the evidence for air pollution having impacts on chronic disease is mounting all the time and very strong at the moment. And there isn't very much of a focus on obesity. So more than 1 billion people worldwide suffer from obesity, and it's the result causes it causes 43% of type two diabetes and 78% of hypertension.

Cases, which are also non-communicable diseases and 13 types of different cancers, it's obesity. Is plays a role in, and it costs 4.3 trillion or it will do by 2035. And yet there isn't really very much of a focus about obesity in this document. 

Gavin: No. When you think that it's a driver for all of those other non-communicable diseases, that does seem misplaced 

Richard: completely.

And where is the outrage? Where are you seeing the outrage about this? We're two months away from the no, we're one month away from the high level meeting, and there's no debate. So I urge every single one of you who, if you are listening to go to the website of the NCD Alliance, just type in NCD Alliance into your favorite browser.

And scroll through what they've got. They've got a fantastic set of resources so that you can deconstruct this appalling document and understand where we're going wrong, and they provide you with materials where you can write to your government and make the case for them to act in a more assertive way.

 The NCD alliances, the Act Up, like Act Up was to. HIV and AIDS in the 1980s. They do a brilliant job of bringing different movements together to try and bring pressure on governments, but this is urgent. This is really the issue of the 21st century on NCDs. 

 Gavin: How do we feel about this point, about the 2030 crossover?

Because obviously a lot of this is aimed at getting, keeping us on track for the goals that we set, the SDGs, but then. We seem quite some way off track on 

Richard: Oh yeah, 

 Gavin: on pretty much all counts. Everything. And then we're gonna get to 2030 and look at what comes after that. So how do you feel about the 2030 crossover at the moment?

Richard: We could, we should devote 

Jessamy: an 

Richard: episode a, an episode of our podcast to thinking about post 2030. 'cause you're absolutely right. We need to think about what is the framing that comes after that date. And I really think. We had what, six or seven goals for the MDGs? Or was it eight goals?

And then we went to 17. What are we gonna have 40 goals for the next period? This is ridiculous. We can't keep on just multiplying the number of goals. We need to think of a way of reframing the threats to the planet and the place of health in those threats to the planet. And I hope reduce the number from 17 to something which you can actually remember and is a bit more mobilizing.

 I do think there are some frameworks that are interesting to pursue. I think the framework of One Health is very rewarding, bringing together human health, animal health, and the environment. The commission that we published just a few months ago. It's very interesting when you talk about NCDs because what that commission argued was that there is a direct line relationship between the NCD pandemic epidemic, if I can call it that, and one health.

Many of the risk factors and behaviors that we think about with NCDs are very much tied to environmental stresses, the way we treat animals, the food system. Then human health. So I think there are some quite radical, radically different ways of framing health that could be quite useful. But we're 20, 25, we're five years away.

 So we need to be having this discussion, have, get something ready. But at the moment, we were saying we have to have something ready. We're seeing WHO downsized by 50%. Yeah. The world run by a bunch of. Crazy people and not well, let's put not the best time for rational, constructive discussion about the future of the planet and our species.

So yeah, it's gonna be a rough few years. 

Jessamy: And I think the problem with non-communicable diseases in that context is just as you said, these are chronic conditions. And over the next five years, we are gonna see. Most likely an increasing issue of acute things like conflict. We just had two massive meetings about conflicts around the world.

We might see another pandemic or various other epidemics. So how. In this context where chronic diseases are so often difficult to create a dialogue or a narrative which is engaging and which people think they need to act on now when there's so many other competing pulls on resources, that's the challenge, isn't it?

And that's not gonna get easier over the next five years. I think that's actually gonna get. Harder when you look at the nexus between conflict and infectious diseases and climate. 

Richard: I think yes, I think that's right, but I do think the secret weapon that we haven't deployed. As successfully as we should have done is this, again, this radical reframing of NCDs as not being something that is in our beloved older populations.

 But is actually, we are setting up, we're creating the environment, our population. Yes. In the from, from the sort of. Age of five through to 50. And we need to be spending much more time thinking about children and young people and their contribution and health in relation to NCDs. And yeah, you can say somebody who's 60 or 70, they've had a great life, they've gotta die of something.

But you can't say that to a 15-year-old No. Or a 20-year-old. When, as soon as you're talking about a 15 or 20, 20-year-old, you think, oh my God, yeah, you're right. We need to be really thinking about what are the causes that are leading such a large number of these young people into very health harming situations.

Jessamy: Absolutely. That, and there was a very interesting survey that the OECD published earlier this year on primary healthcare around Europe, and there's this incredible statistic that has stuck with me. That they, in that survey, they found that 80% of over 40 year olds had one chronic condition. 

Richard: Wow. 80%. That's, yeah.

Yeah. But that's the sort of killer fact that should make politicians stopping their tracks and think, okay, maybe we need to be taking these things a bit more seriously. 

 Gavin: We're on the hook for treating these chronic conditions. We are. 

Richard: Yeah. It's a 

 Gavin: lifetime expense. Yeah. 

Richard: Yeah, exactly. Exactly.

And the, one of the reasons why our health systems are gonna become unsustainable is that our life expectancy increases, but our healthy life expectancy doesn't increase. At the same pace. So we're gonna be living longer, hip, hip, hooray, but we're gonna be sicker. So what a wonderful prospect to look forward to.

We're gonna be living these this wonderfully long life, and we're gonna be as sick as hell because we've created this environment which is leading to multiple morbidities. That is success. 

 Gavin: I think maybe for the next podcast we should. We should sell our own 2030 goals. We should bring five each. Yeah.

Okay. Post 2030 goals, we all agree that we don't Less, less than 17. We all agree that we don't want 40 or 70 goals, so we could just bring five each, argue them out, go away with 10, and we'll have solved all the world's problems. 

Richard: That's great. And we'll, I'll bring a bottle of wine. 

Gavin: Yeah, 

 Gavin: perfect. That'll help Keep this podcast on track.

Alright, thank you Richard. Thank you Justin. Thank you. 

Jessamy: Thank you.

 Gavin: Thanks so much for joining us here on The Lancer Voice. If you want to hear more from the Lancet, please do visit the lancet.com/podcasts where you can hear from all of our journals. Thanks again for listening and see you next. Time.