Alzheimer's, liver cancer, and research in China

Gavin is joined once again by Richard and Jessamy as they examine key developments in global health and science.

This week's discussion features reflections on the launch of a new Lancet series on Alzheimer’s disease, highlighting advances in prevention, diagnosis, and care, as well as the ethical and practical challenges posed by emerging treatments.

We also explore the global landscape of liver cancer, demographic change, the shifting centre of scientific research, and recent studies on human longevity. Join us for a thoughtful, evidence-based conversation on pressing issues in health, policy, and research worldwide.

Read the full series: https://www.thelancet.com/series-do/alzheimers-disease

Read the full commission: https://www.thelancet.com/commissions-do/hepatocellular-carcinoma

Read all of our content at https://www.thelancet.com/?dgcid=buzzsprout_tlv_podcast_generic_lancet

Check out all the podcasts from The Lancet Group:
https://www.thelancet.com/multimedia/podcasts?dgcid=buzzsprout_tlv_podcast_generic_lancet

Continue this conversation on social!
Follow us today at...
https://thelancet.bsky.social/
https://instagram.com/thelancetgroup
https://facebook.com/thelancetmedicaljournal
https://linkedIn.com/company/the-lancet
https://youtube.com/thelancettv

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 October, 2025. I'm your host, Gavin Cleaver, and I'm joined today by Editor-in-chief of the Lancet, Richard Horton and Senior Executive Editor and The Lancet, Jess and me Bagnal for another episode recorded here in the Lancet Studios. In this episode, we're gonna discuss the recent launch of a major Lancet series on Alzheimer's disease and its implications for diagnosis, treatment, and health systems.

And we also turn our attention to the global burden of liver cancer, along with the evolving landscape of scientific research in China. We also have new insights into longevity via genomics. Thanks so much for joining us, and we hope you enjoy the conversation.

Richard Jess, welcome back for another episode of The Lancet Voice, uh, in, uh, the Lancet Recording Studio in the offices. Um, we've got a packed agenda today. Uh, we're gonna kick off by talking about [00:01:00] Alzheimer's and, uh, Richard, I believe you're at the launch of this new commission recently. So, uh, why don't you tell us about how that went?

Richard: Well, thanks Gavin. Yes. We launched, uh, this series of articles actually on Alzheimer's disease last week, uh, in Geneva at the University of Geneva, their main hospital. I should say. First of all, that it was my, uh, colleague Bayer who led this series, and she was the star of this show for us. Um, and she's been working on this project now for a couple of years, uh, with.

This guy called Giovanni Frisoni, who has put together these three papers, organized all the teams of authors. We've actually done a lot on dementia at the Lancet over the years. If you go back, um, six, seven years ago, we published a first commission on dementia. Um, which was led by Jill Livingston, and that was a real landmark project because for the first time it identified a bunch of risk factors [00:02:00] that if you address them, you could avert as much as a third of all future cases of Alzheimer's disease.

Gavin: Which, and, and even if our listeners. I haven't read that. They'll almost certainly have seen the very famous diagram. 

Richard: Exactly the beautiful diagram. And it's really an example of how one, you know, you've got 30,000 words of text, but really it was that one figure which shows the impact of all those interventions.

Really superb. And Jill has actually done two updates of the commission. The last one was published last year. But if I was being super self-critical about, um, that work. It does identify interventions for prevention, but we haven't done, and we have neglected areas around diagnosis and treatment, and some of the most important advances in the science of Alzheimer's disease have really come about in those areas of diagnosis and treatment.

So what Bayer and Giovanni Fr Zoni have done is [00:03:00] to really focus on that and, and the, the reason why I keep mentioning. My colleague Bayer, is that before she joined the Lancet, um, she was actually a postdoc scientist doing research in Alzheimer's disease, and she has published papers herself in these very areas.

So she is not just the editor who's an expert, but she's the scientist who's an expert working on this project. Anyway, the point is that this is a series of three papers that looks at the diagnosis and treatment of Alzheimer's disease, and then looks ahead and looks at some of the future scenarios about how you would design health systems to address Alzheimer's disease.

Because there's no question we're seeing an absolute massive increase in numbers of cases with a older society. Um. Increase in number of disability adjusted life years, but we just are not adapting our health systems fast enough to deal with this. What will [00:04:00] become, if it's not already, to be honest, in some, some areas of society, a care crisis.

So there are issues around, yes, diagnosis, issues around access to these new treatments, um, these new monoclonal antibodies that strip the brain of amyloid. Um, but still. It's not a cure for Alzheimer's and you're still gonna have people with Alzheimer's who are going to need care. Um, and that's where our health systems need to be redesigned.

So that was the launch last week in Geneva and we got great coverage. It made the front page of the Daily Express and the Lance, it doesn't usually make front page of the Daily Express. So we were very proud. Unless we've 

Gavin: said something bad, 

Richard: unless we said something bad. Um. Especially about Nigel Farage.

But, um, so, so we got, we got great coverage, but it's a very optimistic series. It's a very hopeful series. Um, the science is really, really, really astonishing. Um, so [00:05:00] yes, it was, it was a, it was a great day last week. 

Jessamy: It was, and I liked the way the authors and, you know, led by Bayer really carefully laid out the evidence and explore the different issues.

Because as we discussed in our last podcast, there is some controversy around these new drugs and whether they really work. There's a real divide in the field. And, you know, remember when FNI came into the office actually and what, what they're really saying is that. Alzheimer's is incredibly complex.

Even those that are diagnosed with Alzheimer's, probably 85% of them have some kind of other pathology going on, and we are not gonna find a silver bullet, and we have to look at it as a much more holistic disease where we try and target different areas. We look at the science, we say, okay, well we know that amyloid is playing a part.

We'll use that and we'll use other things that this isn't the end. But this is very much part of the story. Towards finding some way of managing this. [00:06:00] And you know, as you were saying, 57 million people globally set to triple by 2050. I mean, you know, those are scary figures. When you think that 90 to 80% of those are institutionalized, you know, what does that mean for long-term care?

What does that mean for carers? There's so many parts to this that need to be explored and broken down, and I really think this series. Is the sort of first step in doing that. 

Richard: Yeah. The, the, the controversy that you are alluding to, of course we've had a lot of discussions about that in the editorial office of, of the Weekly Journal.

Um, this book that was published earlier this year called Doctored, um, by a science magazine journalist. Very respected science magazine journalist. So that's 

Gavin: actually what I put here on my notes is 'cause we, we started off. Last podcast. Yeah. By talking about that book. And I, I'm aware that you have all had your summit since to discuss the book.

Richard: Oh, book club. Yeah. Book club. Oh, 

Gavin: book Club [00:07:00] Summit is possibly two grand. A word for the book club, but I really wanted to give it some grandiose feel, you know, so I, I'm interested to hear how your book club stroke summit went. 

Richard: Yeah, well there were two parts to it. Um, and I think the last time we might have talked about the research integrity, we did the general research integrity.

Yeah. Crisis. Is there one or isn't there one? And we're a bit divided on that. Some people felt strongly that there was definitely a crisis. Others felt less so. But the, but the first part of our, um, book club summit was devoted to this question of the amyloid hypothesis because what, what, what this journalist does is to take two cases of clear.

Clear examples of research misconduct and from those cases, build this edifice of argument to undermine the amyloid cascade hypothesis of Alzheimer's disease. Um, and it's, uh, you read the book and it is very compelling the way he's put it all together. Um, but [00:08:00] in fact. It doesn't convince, because when you set what he's done against the past 20, 30 years of work into Alzheimer's disease, it's just not right to conclude that amyloid has nothing to do with with, with Alzheimer's at at all.

It. It's not to say that there aren't other associated pathologies, infection, inflammation, things we don't, other things that haven't explored fully haven't worked out Exactly. And what was very interesting at the launch, uh, last week was that, uh, one of the speakers said, um, well, there are over a hundred new drugs.

That are currently in development, um, and only a small proportion of those are related to amyloid. So there are other mechanisms involved, which might be relevant for initiation, might accelerate or slow the disease process or exacerbate it. We don't know. It's much more complicated than just amyloid, but [00:09:00] amyloid is still pretty fundamental to the pathology.

So that's what we were really. Talking about, um, because to be able to treat on a population level, um, the people who have got early Alzheimer's disease, 'cause that's the indication for these new monoclonals. You've got to have very early diagnosis. These. Monoclonals are not cheap. They're not easy to administer you.

They have side effects, which mean you mean that you have to have regular MRI scans. So you know, to organize your primary care, secondary care, and even tertiary care and diagnostic facilities to be able to take on this, this initiative is just huge and we haven't really even begun. To think about it is kind of this little secret that we have in medicine that we know we need to do it, but [00:10:00] nobody can quite have the courage to step forward and do it because it's just so transformational.

Gavin: So what are the issues around diagnosis? 

Richard: Well, how do you diagnose Alzheimer's early and who's at risk of Alzheimer's? Um, because people often have mild cognitive impairments, but. Do they go and see their gp and then even if they do go and see their gp and they've had a few memory issues and we, I think we all had sort of memory issues.

I forget things, um, and have to ask people what happened with the this and, and I mean, we all do it. We all do. 

Gavin: We had, we had to start this podcast three times.

Richard: So what's the threshold at which you say. Something becomes potentially pathological. And then even if you think it has, what's the actual diagnosis? You can't do a brain biopsy to see if somebody's got amyloid. So there are a whole load of new biomarkers [00:11:00] that are coming along, um, that are very, very exciting.

Uh, but, but it's quite interesting. Um, are they ready for prime time yet? There's a big controversy about that. Some people are more optimistic that biomarkers are ready for clinical use. Others say, be careful. There's a whole load of commercial interest involved in promoting these biomarkers, which.

Renders them absolutely not ready for clinical application. So the, the, the, the issue at the moment, these new monoclonals, they're being tested in trials. They are available in some geographies, um, for, for use in, uh, clinically. But to be honest, we're not set up for their widespread use at all. 

Gavin: Yeah, I mean, I have a family member who's a kind of perfect case study of what we're we're talking about.

He was diagnosed with what turned out to be Lewy body dementia in his early seventies, but since his [00:12:00] mid to late sixties, he had been treated for a sleep disorder. That now in retrospect, was obviously part of early onset. Dementia, but he lived quite rurally and the GP was convinced it was a sleep issue.

He couldn't stay asleep. He was constantly kind of like sleepwalking. Mm-hmm. Um, he was only treated for that center specialist, sleep clinics, everything. Mm-hmm. And funnily enough, they moved rurally to the casement area of the John Radcliffe in Oxford. And as soon as he went in there for further up follow up with the sleep study study, they gave him a cognitive assessment and they were like, oh, okay.

Actually let's. Something that's something completely different. Right, 

Richard: right, right. Oh, that's very interesting. So yeah, I mean your, the awareness for a gp, you know, you've, you've got to. Before early diagnosis, you've gotta actually think of the diagnosis before you make the diagnosis. And if you are, if you are not fully aware.

And, and to be honest, um, certainly when I was, it was, uh, many decades ago, but, uh, I mean it may have been the case for you too, Justin. Um, when we're at medical school, you know, [00:13:00] Alzheimer's disease didn't get the attention that, that we're trying to give it today. Um. And there wasn't, you know, part of the reason it wasn't given the attention was that there wasn't much that 

Jessamy: anybody could do, medics 

Richard: could do about it.

So, uh, medics never 

Jessamy: like that? No. No. There was, 

Richard: you couldn't operate on it and you couldn't give some fancy drug for it. Right. So it's only been in, in relatively recent years that you can actually do something. Um. So we're not really the, the health workforce isn't really set up to deal with Alzheimer's, so we are really, really behind the curve.

I mean, the science is. You know, moving ahead so fast, but I think the health professions are really behind that. 

Jessamy: I agree. And I forget the figure, but there's a figure in here about the percentage of people that die without a diagnosis of Alzheimer's. Um, and, and it's, it's a very high proportion, you know, there are a lot of people that have Alzheimer's that never get diagnosed, and I think that's interesting about the biomarkers because [00:14:00] it, it comes with so many.

Ethical questions because how do you use them? Do you use them for disease to monitor disease progression? Do you use them for diagnosis? Do you use them for screening? You know, these are the types of questions that we are gonna have to grapple with as a medical profession, as a society over the next 10 to 20 years.

And there's something very different about. Cancer and, and Alzheimer's. People are scared of cancer and it's a terrible diagnosis, but, but there is also a generalized fear of Alzheimer's and, you know, you'd struggle to meet someone who didn't say, 

Richard: but the good thing about cancer, if. Fucking put it as a good thing about cancer is that there are health services Yes.

That are very well designed. Very well designed to deal with cancer and very well funded. And there's a phrase used in this series, which we don't use widely in the NHS or anywhere, and it's brain health services. And we talk about cancer health services or. [00:15:00] You know, services for cardiovascular disease or stroke clinic clinics, but we don't talk about brain health services.

We don't talk about brain health. And in fact, that's a, that's another one of those issues that we've had some discussion. Amongst the editors about, because brain health is a, is a, is a, is an emerging concept. Yeah. Um, again, what is it, how does it relate? Is it a fusion of neurology and psychiatry? Is it something that's more about prevention?

Um, having the capacity to prevent diseases of the brain by doing certain interventions? A little bit like Jill Livingston's commissions have shown. What is it? So we're, we're actually launching a commission on Brain Health to try and understand what this concept is. We know when you talk about cardiovascular health people.

Have a clear idea of what a healthy heart is, but I don't think we have any idea of what a healthy brain is. Um, and we certainly don't design [00:16:00] our health systems, um, to deal with a healthy or slightly unhealthy brain, for example, we don't have many in, at least in the uk. I couldn't tell you where an NHS memory clinic was.

Um, you know, they're in the private sector, but they're not very widely distributed in the NHS sector. So I think there's a get as, as we're saying, there's a long way to go here and this series is trying to far a little bit of a starting gun to get people interested. Um, in these questions and we, but we need to follow up.

As we always say, this series needs to have an after afterlife. Um, and we were very fortunate to have somebody from the World Health Organization since we were in Geneva, um, uh, as part of the team launching this. And we're, we've, I've already written to a following up to see could we have an event at next year's worth World Health Assembly, um, to represent this series to member states.

To have some further discussion. 'cause there's so much good work in here that we really need to promote [00:17:00] it more assertively. 

Gavin: I'd say the public perception of cardiovascular health versus brain health is quite different as well. One's developed cardiovascular health, you know that you have to exercise, eat healthy, generally treat yourself well.

Brain health, so do co question marks. Right, exactly. 

Richard: What's the equivalent? What's the equivalent? I know that's precisely. I, I don't know the answer to that. Is it reading, not watching your name? Television, not doom scrolling on your phone. Yeah. Um, but there's really not much science. There's a lot of opinion, but there isn't much science, whereas there's an enormous amount of science about what a healthy heart or a healthy liver, um, is.

So 

Gavin: my wife is a neuroscientist, probably listening to this and groaning. So 

Richard: yeah, she should be on the podcast. She can come and tell us about brain health. Yes, exactly. What is a healthy brain? I think that's, um, 

Gavin: nepotism, isn't it? So, uh, we'll, we'll move on. Um, from one thing that's very difficult to treat to another thing that's historically been quite difficult to treat to the liver.

Richard: We, we [00:18:00] love the liver. Um, the liver was, my, was was, if, if I go back, it was your first love. It was my first love. It is the most beautiful organ in the human body, um, by a long, long way. Uh, and, uh, so I, I wanted to be a liver doctor many, many years ago, and people think the liver is this horrible organ. It's all about cirrhosis and, you know, um, in fact it's, it's absolutely the most beautiful.

Organ in the body, it is the only organ that can regenerate itself. What a, what an amazing, astonishing. 

Gavin: Have you read an article along these lines? 'cause I would definitely read it, you know, the, the, the underappreciated beauty of the liver by Richard s 

Richard: Okay. I, I will think about, I will think about that. I, I, I definitely, um, am in love with the liver.

Definitely. Definitely. And it's beautiful when you look at it, it 

Jessamy: is under the mic, it's shiny and under the 

Richard: microscope as well. You know, I think, in fact, I tell you one thing I do want to write [00:19:00] about, and that's the aesthetics of disease. Because people think disease is awful and it is awful and often tragic.

And we should, as a caring profession, definitely minister to those with disease and families who have to, uh, have that lived experience of disease around them, but at another level. Disease has its strange beauty to it, especially when you think about it from a, a micro point of view. So I'd like to shine a light on disease in a slightly different way and rehabilitate our feelings about disease.

It's, um, there are many different dimensions to it and they're not all negative. Sounds like a commission to me. Yes. Or a bit. Now this commission that we launched in Shanghai, um. Last month, uh, a commission looking at liver cancer, um, and what to do about it. Um, it, we [00:20:00] had several commissions. From China, but they've usually been commissions about issues in China.

Within China. Within China. This was a commission led by colleagues from China, particularly from Udan University, but it's a commission that looks at the global burden of liver cancer. So it's the first time we've had a, it's the first time we've had a commission led from China about a global issue, and there's a reason for that.

Um, and that is that. The pattern of liver cancer definitely is, is biased towards Asia, the Asia Pacific region. Um, again, just as we've been talking about with Alzheimer's, the projections are that we're going to see. Uh, the number of new liver cancer cases, um, almost double between now and 2050, but there is a lot that we can do about liver cancer and again, [00:21:00] um, in enormous potential, not least vaccination against hepatitis B.

Um. By 2050, hepatitis B is gonna be the leading cause of liver cancer. And is that the main reason that this skews towards Asia? Exactly. Yeah, exactly. Exactly. Um, alcohol use and other metabolic causes are going to become more common. But we, what, what this commission estimates, which is actually when I first saw the figure, I thought it was a typo because I couldn't quite believe that this was the case.

You know, sometimes this is why these commissions become so interesting because they discover something and it stops you in your tracks when you see, when, when you see the figure. What they've estimated is that 60% of liver cancers are preventable, 60%. So if you think that there's gonna be 1.5 million new cases of liver cancer by 20 50, 1 0.5 million, that's a, that's a lot.

But [00:22:00] 60% of those are preventable. We could intervene and we're basically intervening around hepatitis B vaccination about addressing alcohol, um, and addressing these metabolic causes, um, of liver cancer. So, you know, this is a, again. It's a commission that, that, uh, rings an alarm bell, but should be seen as an amazing opportunity to, to do something of immense value.

I would just say that we launched this. Commission, um, all around the time when these question marks were, are being raised around vaccine safety, uh, and when evidence was being given around hepatitis B vaccination in the United States. Um, and, and this is a very, a very live issue. We should be absolutely supporting hepatitis B vaccination.

Um, [00:23:00] and the, the point about when you give hepatitis B vaccine. You're supposed to give it on the first date of birth. It's, it's, that's key. For all, all kinds of reasons. And what was being argued in the US was Hepatitis B is a sexually transmissible disease and you shouldn't have to give it to children until they're 10 or 12 years old.

And this is completely against all the scientific evidence, completely the wrong advice, that this is what was being said at these Senate hearing hearings. And even President Trump said it himself. This is misinformation. Some might even say it's disinformation. Um, and what this commission does is to show the absolute central importance of hepatitis B vaccination for the eliminate or the, the control of liver cancer, um, and giving it at the earliest possible opportunity.

Jessamy: Yeah, absolutely. And. [00:24:00] We've got another commission, a colorectal cancer commission, which is being led by a Chinese co-author and one of our other editors was there recently, and you've visited China many times over the past 20 years. I was listening to the news this morning. They're bringing out this China k.

Visa, have you heard of this? No. To try and attract scientists from abroad to China, so you don't, crucially you don't have to have a job offer. Um, and it essentially is, is aimed at scientists and, you know, AI researchers to try and draw people into China, not just Chinese who have. Immigrated and working in the us but anybody English, you know, from wherever you are to try and make it a much more international community.

Richard: Well, that is very interesting. I didn't know that. I have watched over the last 20 years China go from a, uh, and, and I think they would agree I'm not being unkind a sort of relatively underdeveloped scientific nation to now being a scientific [00:25:00] superpower. I mean, there's no question the. Velocity of development of scientific institutions and hospitals, which become academic centers, medical centers, um, has just been phenomenal.

I ha I marvel actually at the investment that's been put into higher education and research. I think there's, it's quite interesting, the, the, there's a book that's been published recently that tries to analyze why has China become this scientific superpower? And the argument is who runs Western countries?

The answer is lawyers run Western countries. That's, I've heard this and, and, and of course, what do lawyers do? They write regulations, they write laws. Um, and what do laws do? Laws stop us from doing things. We need that. We can't all go around doing everything we want if it harms other people. So there's a place for lawyers, but that's basically our society.

Western [00:26:00] societies run by lawyers who write regulations. China. Completely the opposite. They're run by engineers. Yeah. And scientists. What do engineers do? They build things. They make things. So what does, what is China good at? Building things and making things so, so. So maybe what we need to learn the lesser of, we need fewer lawyers running our society and more engineers and scientists and maybe, maybe China needs a few lawyers as well running it society.

But, but what the advantage they've got is that they are just supremely brilliant, uh, understanding the centrality of science for development and for their economic growth. And we've kind of. You know, all the debates we have about manufacturing industry, even, you know, investment in the pharmaceutical industry or lack of, um, in this country anyway, uh, attest to the fact that we still don't really get, size is not just another.

Part of the economy, which is lobbying for [00:27:00] its own self-interest. There's something very fundamentally important about science. It's about discovery, and then it's about developing those discoveries and implementing those discoveries in our lives. And we've just forgotten those lessons. Mm-hmm. 

Jessamy: And it drives so much of other parts of the economy, you know, and you see that in China 

Richard: so much time because then it drives, you know, if you look at the.

I can't remember the actual number, but it's literally tens of thousands of engineers come outta China's universities every year. I mean, we have a trickle. Yeah, by comparison, but that all goes back through their school system, so right. From being at school, you know, it's seen as something rather admirable to do engineering.

When I went to university, all the people who were, who did civil engineering or. Or, or mechanical engineering. They, they were the ones with long greasy hair, um, uh, uh, who you kind of generally ignored in the student union, um, because they didn't wash very much. [00:28:00] Um, in China, those people are elevated to be the elite of the elite.

Yeah. And we, we just don't do that. So, you know, we, we need to, we need to give more credit to our engineers and our scientists than we do. Um, 

Jessamy: well, I thought it was very interesting that they're trying to draw scientists and engineers internationally in the asymmetry with the us, which makes perfect sense, right?

At this point to 

Gavin: try and attract us scientists is just the, the obvious play. 

Jessamy: But I don't know, I mean, would you, would you, what do you think it would be like? A UK scientist moving to China. Oh yeah. It's a China. The cultural culture? 

Richard: Well, what, well, I think it depends where, where, where you go. Um, so it's is, you know, they have done very well at bringing back Chinese talent from the United States.

Um. Would I want to go and work in Beijing for, for a, a secondment, for a short term? Yes. Absolutely. I mean, as with any country, if you don't speak the language [00:29:00] and you're not embedded in, you know, friendship networks, um, that there, then that's obviously gonna be challenging. But going there for a period of time, one or two years, um.

The, you know, English is now the language that's most commonly taught in the school system. So there's a generation of. Young people now where they are just incredibly fluent in English. We don't teach Mandarin in our schools very much. So it's definitely at a disadvantage there. But certainly if I wanted to go and work at a university like Shinga, it's a fantastic campus.

The investment in the research facilities is amazing. As I say, English is commonly used as the language, um, for teaching. I wouldn't think twice about spending a couple of years if I was. 20, 30 years younger than I. Mm-hmm. Mm-hmm. Um, uh, working, working in China, you know, 30 years ago I went to live in New York for two years for the Lancet.

Now somebody said [00:30:00] to me, well, if I rewind time back, and they said, would you go and live in Beijing or Shanghai for two years for and work for the Lancet? I'd absolutely snap it up. Are we secondments 

Gavin: to China? Because I think, I think I'm of roughly the right age, although I reckon getting my dog over there would be difficult.

But, um, I mean, I would. I would happily go and, uh, spend a year or two in China. I think that sounds fantastic. All about the, 

Jessamy: I, I, I agree. I think it's such an exciting, um, development really. What an amazing opportunity it is for the country to try and internationalize their scientific community. 

Richard: Of course, they ha there, there is a demographic problem that China faces.

Yeah. Which is, which might be motivating some of this. That's true. You know, again, the projection is that. China's gonna go from 1.4 billion people to 700 million people by the end of this century. So that's, you know, 50% reduction in the population of China within 75 years. So it's 2025 now. So [00:31:00] somebody born now.

Will be alive hopefully in 75 years time, but by the time they're 75, their country will be half the size that it is. Yeah. Now that, okay, I, I'm sure AI is gonna be wonderful economically and drive productivity, but you need people to drive the economy and even more, you need people to drive the economy, to earn the money, to pay for the care of the older population, of which there will be an enormous number in so many in China.

So, and there, so there. Their workforce is going to contract massively. The number of older people requiring care will increase massively. There's a problem. Mm-hmm. And there's only two ways to solve that. One, have more children or two import people. Um, so. You know, they haven't solved the, the have more children part of that equation.

So can they solve it by getting people to move there? Mm. 

Gavin: I feel like when I was at secondary school, we were taught about the worldwide demographic [00:32:00] time bomb that's gonna go off. Yeah. And I was always taught when you get to peak working age, that's gonna, when the real problems are gonna start. And I was like, you know, 30 years back thinking to myself, well, someone would've done something about it by then and no one said anything about it.

Richard: No. And here we are. No. Well, it's, it's, it's, I, I think this demographic challenge, um, it's one of the most interesting but intractable ones that we face because there are many things that are gonna happen in the future, which are very difficult to predict. You know, it's, it's hard to know what AI is really, really going to do.

You know, I can't predict for sure whether an atomic bomb is going to go off in. 20 years time or not, I can't be sure when the, when the next COVID like pandemic is gonna happen. I can give a rough probability, but I can't be sure, but I can be sure that fertility rates are gonna be sticking pretty much to, there's not gonna be some magic bullet that's gonna solve this.

So we are going to see countries like Spain, Italy, Portugal. [00:33:00] Have their populations also contract by 50%. By the end of the century, countries like Poland and Germany are gonna see significant reductions in their populations. Um. A lot of the eastern block, former eastern block countries, um, are going to see similar reductions in population making their economies extremely fragile, and that indeed their societies extremely fragile if they're not able to support their older populations.

Um, so it's gonna be the countries that are very, very open, which is also bizarre given that we've got the sort of rhetoric against migration at the moment. It's gonna be the countries that are very open to mobile populations. Are going to succeed in the future. So, you know, this is where the politics of the demography, 

Gavin: the west, the west is not currently setting itself up to succeed.

It's 

Richard: not. It's not. It's absolutely not. We're setting ourselves up for a massive fail and we also need to embrace. The [00:34:00] where the population is going to grow from, which is going to be Sub-Saharan Africa, and we need to be welcoming that and preparing for it. Again, you're going to see the population in Sub-Saharan Africa grow from around 1 billion to 3 billion by the end of the century.

Well, that's 3 billion out of 9 billion. No one in three people on the planet will be coming from Sub-Saharan Africa. So. What are we doing today to prepare for that? How are we building good diplomatic relations with African countries? Are we investing in Africa, investing in education, investing in health services?

No, we're not. We're actually retreating, we're pulling back our development, which is completely contrary to the demographics of where we're, where we're heading. 

Gavin: I almost can't believe how perfect this link has become. I 

Jessamy: know, I know. I thinking that '

Gavin: cause you know, we're spending a lot of money researching longevity on what, what makes people live to the age 

Jessamy: longer and healthier and healthier for longer, 

Gavin: healthier, I think is the key there.

And so, Jess, you wanted to talk about a [00:35:00] piece in nature that looked at a woman that lived to 117 and some studies that were done on her. 

Jessamy: Yeah, it's this high throughput omics study that was done on the oldest living person confirmed, I think they call her something like M1 1 97 in the paper. I dunno why.

Um. But it's interesting, isn't it, because they look at lots of different genetic variants and find that she sort of won the genetic lottery in terms of, you know, cardiovascular risks and indeed for, you know, genes for Alzheimer's. But then there's also a lot there about diet, um, and her microbiome, which is obviously a hugely.

I think under research and un under. Understood. I think we, we all, yeah. 

Gavin: I really feel like I'm upping my intake of yogurt after reading this article. Great. I mean, it's 

Jessamy: yogurt three times a day from now on. 

Gavin: Yeah. And that fixes the biome. Yeah. 117 low sugar yogurt. 

Richard: The, be careful. You gotta look. You like cherry [00:36:00] yogurt.

You gotta look on the, I have yogurt every morning, but then I read. In the newspaper that the yogurt, the brand of yogurt I have has too much sugar in it, which is why I enjoy it so much. So now I'm gonna have to go for the low sugar. 

Jessamy: But does it have a lot of bacteria? Because if it does, maybe, maybe that balances out you, maybe that balances it out.

Gavin: That's true. It's the most middle class thing we're gonna say on this class, but, but you could try making it an instant pot. It's very good. Um, I was struggling, Jasmine, with the pronunciation of this word here. 

Jessamy: Oh, telomeres, Tel Telomeres. There are these very interesting parts of the DNA that people are researching and there's some sort of association between the length of your telomeres and how old you are, and so people who are, you know, in San Francisco and Silicon Valley.

There's lots of sort of these startups looking at how can we try and lengthen omes. 

Gavin: It is amazing the amount of Silicon Valley investment, right? Oh my 

Jessamy: gosh. Extending 

Gavin: the lifespan. 

Jessamy: And I don't think [00:37:00] I'd want to extend my lifespan that much, actually. 

Gavin: No. I mean the, uh, the, the person featured in this nature article, Maria Braya Mera, to give her full name rather than her number, which feels more personable.

Richard: She, she was born in San Francisco, but then went to back to Spain. And I note that all the, a lot of the leading authors of this research paper was published in our, in, in a journal called Cell Reports Medicine. So by our sister. Um. Bit of Elsevier, um, cell press. Um, they all come from Catalonia. 

Jessamy: Yes. 

Richard: Um, well, anybody who's spent any time in Catalonia, I mean, it is a, a little micro paradise of the world.

It is actually. So it's not surprising that she's lived to a hundred and whatever she's lived to, because wouldn't we all in a place like that, which it has the most perfect weather. Mm-hmm. Beautiful sea. Amazing food. Yeah, it's true. I do wonder how many years 

Gavin: of my life bourbons it is taking 

Richard: on a regular basis.

Exactly. Precisely, [00:38:00] precisely, precisely. And, and they've done this wonderful multi blueprint, all this stuff in the lab, which is great. Look up, look around you, and wonder why she's lived so long. Because she lives in the paradise, which is Catalonia. And don't you think that has some, I mean, I, I don't know Berman Sea.

I am sure it's wonderful. Mm-hmm. But I exactly the point, exactly the point. 

Gavin: It's not Catalonia is there today. No, there's no, it's not Catalan. You're 

Richard: not having the Mediterranean diet in Berman Sea. 

Gavin: No, I'm watching stuff wash up on the Thas. Right. That doesn't look great. Exactly. 

Richard: Exactly. So, you know, I think this is, you know, a wonderful piece of science, but maybe they also need to balance it with the environmental, with thinking about the fact that this.

Is, um, not living in a bad part of the world. So is that your, that's 

Gavin: your key 

Richard: to, to long life. My key to long, yeah. Find my key to long life is find the right place to live. And, and then just go for it. Yeah. Enjoy, enjoy it when, when you found your, your perfect place. But no, I mean this [00:39:00] is, it's lovely there.

Gavin: Alright. That's probably a good place to stop as we found our, I think so. Our perfect place to live. Uh, Richard Jess, thank you both so much. Thank you for joining me again on The Lancet Voice.

Well, thanks once again for joining us here at The Lancet Voice. If you're interested in listening to More Lancet podcasts, you can go to the lancet.com/podcasts where you'll find all of our offerings. Thanks for joining us, and we'll see you again next time.