COVID-19, Ben Goldacre, and the planetary health diet

In a packed pilot episode of The Lancet Voice, our EBioMedicine Editor-in-Chief, Julie Stacey, reports on how SARS changed our approach to treating and tracking coronaviruses, The Lancet's Editor-In-Chief, Richard Horton chats with Ben Goldacre about researchers owing the US Government $7bn, and we discuss the planetary health diet – what’s the real link between food and the climate?

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Chapters

• 2:13 COVID-19
• 12:59 Ben Goldacre
• 26:01 Planetary health diet

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.

Jessamy: Hello,

welcome to the first episode of The Lancet Voice, a new podcast from all of us here at The Lancet. Every two weeks we'll be bringing you interesting tales from all over the world on the topic of health. 

Gavin: So this is a bit of a departure for us because traditionally we try to focus on the delivery of scientific research through peer review, but we're also passionate about what we do and the science that we put out there that we thought it might be a good time to try and talk directly about health to you.

the listener and we really do appreciate you listening and giving us a try. So I'm Dr Gavin Cleaver. I'm a doctor but not a kind of normal Lancet doctor. I'm a doctor of politics and policy who is completely useless in an emergency. 

Jessamy: And I'm Jessamy. I'm a medical doctor whose background is in general and breast surgery.

Yeah, and I guess we're gonna try and divide up the work between us. 

Gavin: Yes, absolutely. I'll be explaining the things that are perhaps easier for someone with my background to understand and Jessamyn will be explaining the more traditional Lancet things. Or more complex, 

Jessamy: depending on how you look at it.

Gavin: The way I look at it is that we work at the Lancet. It's a medical place. You have all the medical background and experience. I have a GCSE. 

Jessamy: Yeah, but you can help us with the grey areas and that's, that's the ones that we find real challenging. 

Gavin: Yeah, when it comes to philosophical grey areas, I'm your man.

If you want an indeterminate answer, 

Jessamy: yeah, 

Gavin: then absolutely, no problem whatsoever. 

Jessamy: And in this episode, our very first exciting pilot episode, we've got Dr. Julie Stacey talking to experts about how treating and tracking COVID 19 has changed since the 2003 SARS outbreak. 

Gavin: Yeah, we're looking forward to that.

We've also got the editor of The Lancet, Richard Horton, talking with Dr. Ben Goldacre about how researchers in the US owe the US government an awful lot of money for not obeying the law. And I'll be talking with Dr. Cassandra Coburn, a researcher with a forthcoming book about the Planetary Health Diet, and we're going to chat about climate change, about the food we eat, and how we can make a difference.

But 

Jessamy: we've also got a great team around us. We've got other Lancer editors helping out with the podcast one of whom you're about to hear soon. which is Julie, and she's the editor in chief of the Lancet journal Eobiomedicine, and she's going to be investigating how COVID 19 has risen to prominence, what's going on in Wuhan, China, and the different experience of people working in virology.

Gavin: Yeah, we thought it'd be really interesting to hear how progress has been made since the SARS and MERS outbreaks of a few years ago, which kind of came as a bit of a surprise at the time. But the impression that we get, and that hopefully Julie will be able to display to you, is that we're a little bit more prepared now.

Julie: Coronaviridae is a large family of RNA viruses that gets its name from the corona or crown like projections that decorate the surface of the virus particle. This family of viruses can infect humans and animals and is one of many different virus families that are thought to cause the common cold.

Occasionally, these viruses can cause more severe respiratory disease, which we saw with the SARS and MERS outbreaks in 2003 and 2012. We are now in the midst of another dangerous outbreak which has sickened thousands of people with those hardest hit at the epicenter of the disease in China's Hubei province.

Because of its genetic similarity to the virus that causes SARS, this new coronavirus strain has been named SARS Coronavirus 2. The disease it causes has been named COVID 2019 for the year in which it was first isolated. For this piece, we wanted to start by taking a look at how our response to coronaviruses has changed since the days of SARS in 2003.

We took a closer look at the research being done on therapies, the technology behind how outbreaks are tracked, and how international responses to outbreaks are evolving. We first chatted with Tim Sheehan and Matt Freeman, who both study coronaviruses in the lab, in order to get an update on some of the therapeutic approaches under development for this family of viruses.

I asked Tim about a small molecule called remdesivir. Remdesivir is currently being tested in China as a potential therapeutic for patients suffering from COVID 19. We asked Tim how remdesivir is thought to work against other coronaviruses like SARS and MERS and preclinical models, and whether it might inhibit viral replication of SARS CoV 2 in the laboratory.

Speaker 4: Remdesivir targets the RNA dependent RNA polymerase, which is the enzyme that the virus encodes that allows it to replicate its RNA in the infected cell. And if you look at The RNA, dependent RNA polymerase sequence for this new coronavirus as compared to SARS, MERS, and all these other coronaviruses that we know about, there's very high conservation.

So it's about 99 percent similar to the SARS version of that same protein. And as we know, remdesivir works great against SARS. 

Julie: Vaccine and therapeutic antibody development against COVID 2 are also both well underway. This research is also based to a degree on previous studies on the coronaviruses causing SARS and MERS.

Matt Freeman talked to us about how our ability to study coronaviruses is evolving and why it's so important for us to keep researching this family of viruses. 

Speaker 5: I think the important part for the vaccine development is that for SARS before something was In animals and in humans it took a while to get that developed It was faster and much broader and many more people were involved at different companies and labs for MERS And now for this new coronavirus, we know what works and what didn't work for SARS and MERS And so all of those processes are really sped up.

The hope is that this really speeds up the development for this virus And these viruses are certainly not going away. This family of viruses are in bats and in animals, spilling over all the time into people. We only catch them when they cause disease. And I think that while we know a lot about these viruses, there's a lot that we do not know.

And we need to figure out how they work and which will tell us what kind of therapeutics to use against them. 

Julie: We next wanted to get a sense of how recent advances in sequencing technology have improved our ability to detect and track outbreaks. We posed this question to Ian Mackay, who is an expert in emerging viruses and public health.

Speaker 6: In terms of diagnosing viruses, we're still using PCR based methods and that hasn't changed for quite a long time, but that's, because they're pretty effective, but whole genome sequencing, sometimes called high throughput sequencing or next generation sequencing has really revolutionized the last few.

Virus emergences, Ebola, Zika, and now in particular, it's really being useful here for this coronavirus. We were able to get full genome sequences instead of just a small little bit sub genomic sequence or region, and that lets us follow where a virus may have been, where it's come from. It's great for contact tracing and great for looking at how it's evolving in real time.

And really there's some experts that are doing a lot of this for us on the internet. So the sequences come out and there are certain groups around the world like Trevor Bedford and Andrew Rambo that just are expert at breaking that down and analyzing the sequence. 

Julie: How are new infectious agents typically first identified and tracked?

Speaker 6: Okay, two big things. So in terms of first identified and tracked, we need disease. So once we have patients and cases, we start to look at samples. If we don't know what it is, we have no idea what that virus or bacteria might be. We have to go right back to first principles and that's where these new genetic genome sequencing tools are quite handy because they're unbiased.

They don't lead us down a particular path. We don't have to know something about that virus or bacteria first. We're able to just find out stuff. So we put these patient samples through this process. We have to extract and purify them, amplify them, and then get lots and lots of sequence data. And then that's just the beginning.

The hard part is taking that huge amount of data we get, the sequence data, breaking it down and looking at whether it's similar to any other thing we might have seen before, whether it's virus or bacteria. Let's stick to viruses, if it's not the same, then we might find something novel. That doesn't happen very often now because we have.

A lot of viruses in our catalogs, we've got something we can compare to usually. So in this case with the coronavirus, they would have seen that it was similar a little bit at least to bat coronaviruses initially, and that would give them a hint and help them build the sequence, build the genome, and then investigate further.

Labs that conduct molecular epidemiology then can trace that. Further, by getting more samples from more patients, seeing if they're related or different, seeing if the virus is changing and start tracking backwards in time to see if they can work out when the virus might have first appeared. 

Julie: Finally, we spoke briefly with Peter Harby from Oxford University, who has expertise in global health and emerging respiratory viruses.

We asked him whether international collaborations to global outbreaks have improved since the days of SARS. Thank you 

Speaker 7: They've absolutely changed. I think it's completely different. We've seen mobilization of international collaborations at regional and global levels. The area I work in, clinical and population based research in emerging infections, there's now an extensive network of researchers and clinicians, so a sort of grassroots network that has evolved with a buildup of trust over, over years.

So now we've seen excellent collaboration between investigators. For example, ISARIC, which is the International Severe Acute Respiratory and Emerging Infections Consortium was set up after the 2009 pandemic precisely to Facilitate international collaboration on clinical research. And what we've seen is that, ISERIC members in China have contacted the Global Support Center for advice.

They've been put in touch with other researchers, such as the researchers in Saudi Arabia, who've been working on Middle East respiratory coronavirus, and with other researchers who are working on remdesivir, Ebola, et cetera, and together, at a peer to peer level of work together to get these.

Clinical trials up and running very quickly in China. 

Julie: What has surprised you the most about this outbreak? 

Speaker 7: This outbreak is looking like the one we've all been preparing for. And I think perhaps when you're preparing for something, you never quite expect it to happen. But we have a novel virus that is spreading rapidly.

It seems to be quite severe in some patients. And for which we have, at the outset, no diagnostics, no treatments, no vaccines and little information about how it behaves. And so it surprised me that we've. Actually encountered what we were waiting for, but also it's surprised me that the things we've put in place have generally worked.

Julie: Although we have made some progress, and although previous outbreaks are clearly helping inform our response to this one, we still have so much to learn about this new coronavirus and how best to help those affected by it. 

Gavin: So thank you Julie Stacey there, editor of eBioMedicine, for that section on COVID 19, the novel coronavirus.

Potentially governments should look a little bit more to clinicians for advice before jumping to conclusions, but that's the hope in the wider sense of things when things like this happen, but we still have so little information about this virus that it's difficult for that collaboration to happen.

Jessamy: Yeah, because it's difficult, isn't it? Because on the one hand you've got the who are giving kind of broad brush, statements. And At the same time, you've got individual researchers, people who have been gearing up to this kind of problem for the last 10 15 years. This is what they've been expecting.

And yet it doesn't feel like there's any kind of clear cut guidance on what, the whole of Europe should be doing right now. 

Gavin: Very much very much recently the Lancet published a paper from Dr. Ben Goldacre, who, pretty much everyone listening will be aware, he's the author of Bad Science, former Guardian columnist, very famous generally.

Ben has an awful lot going on professionally so we thought we'd invite him to sit down and have a chat with editor of the Lancet, Richard Horton, to talk a little bit about openness in science, his career, and his new paper as well, which has some fascinating information about how the US government is currently owed over 7 billion by researchers in the US.

Jessamy: Extraordinary amount. 

Richard: I'm really delighted to be here with Ben. You're very well known, famous, even for all the work you've done on bad science. Incredibly, I'm sure you know the figure, how many books have you sold? 

Ben: Oh, I don't know, coming up for a million. 

Richard: Exactly. Incredible. I think it's fair to say that single handedly you've done more to educate the public about what we professionally call evidence based medicine than any other single person that I've known in my entire life.

time. I think your contribution to public education, understanding about what is good evidence is absolutely second to none. And I would defend that statement to anybody. This work is a very logical. continuation of that. Where are you going? 

Ben: Firstly my skin crawls but you're very kind.

So writing and showing off in general has only ever been a hobby. I've always had either a full time clinical post or an academic post. And I CCT'd in psychiatry a while ago. I run a small research group in Oxford in the Department of Primary Care called the Data Lab. And there's 10 or 15 of us, depending on how you draw the perimeter.

And we are quite unusual. We're a mixture of clinicians, researchers, and software engineers, all pooling skills and knowledge to turn health and scientific data sets into live, interactive, data driven tools and services, rather than just academic papers on their own. So this paper that you've very kindly published is a good example of that.

There's the paper and the logistic regression and the formal analysis, but there's also accompanying that the live data service at trialstracker. net. And we also build openprescribing. net, which is a service that lets you see what every doctor in the country is prescribing month by month and lots. of very clever data science under the bonnet, where we've published various papers on novel analytic methods to try and spot who changes early and who changes late in response to evidence, landmarks, price shocks, safety alerts, and so on.

I'm interested in better use of data and evidence in healthcare and government more broadly. And I guess I will use whatever tools seem to work best to achieve any of that. If the question's what's next, I guess the reason why Posh white men in particular do okay in life is you follow the green lights.

So when somebody says, Hey, do you want to come and do this? You go, I'm not entirely sure I can do that, but I'll have a go. So I don't have a clear systematic plan, but I think clinical academia is the correct location. And the extent to which it's ever not the correct location. is a flaw in clinical academia.

So for example, operational research in the NHS, doing analytics on variation in care, clinical informatics, giving people operational insights on which regions are doing particularly well or badly at a particular thing. That has a very low status amongst academics. And the work that we do, like open prescribing, people have a really mixed view about.

On the one hand, I think a lot of people go I'm not sure I could do that, because we just do logistic regressions in Stata. But equally, people also want to go what's legitimate academic work with health datasets? It's epidemiology on the etiology of disease, not so much epidemiology on which bits of the health service are sick.

But I think they're wrong. I think that's, frankly, where the biggest opportunities for improving mortality and morbidity in the developed world, probably. I don't think it's going to come from amazing. individual new treatments. I think it's going to come from on the one hand prevention, which has got to be population level interventions, cycle paths in cities rather than telling people to do more exercise on the one hand.

And then on the other hand, it's refining and optimizing the logistics of your health service. And in the past, that was a matter of charismatic managerial leadership. But now. It's about half that, and half using data to spot opportunities to improve care. And I think at the moment we're doing that catastrophically badly in the UK.

People do it a bit better in the US, but with, different barriers politically over there. So that's what I'm going to do next, for the next however long. 

Richard: Your lead author on this fantastic piece of work, which reports something very disturbing, which should be a cause of shame to the world of research, and that's looking at compliance with legal requirements to report clinical trial results on clinicaltrials.

gov. Now that can sound very dry. But Ben, this is super important. Tell us why you've done this study, and tell us what you found, and why we should be so disappointed. It doesn't even come close, does it? Shocked? 

Ben: It is extraordinary given how long we've known about this problem. And I think anybody listening to the Lancet podcast is likely to know that clinical trials are the foundation of evidence based medicine.

They're how we know. which treatments work best, and it's also an important window into the harms of treatments. We spend enormous amounts of money on conducting each individual clinical trial, and we do that in order to remove bias. We want to be better than just saying I'm a doctor and I gave my patients this treatment and they did much better.

It makes no sense at all, but it turns out that after spending all that money to remove bias, we then allow all those biases to flood right back in again by permitting the results of clinical trials to go unreported. Now, this is a problem we've known about for many decades. The first publications on it date back to 1986 or even 1980, depending on how you count it.

And there have been a huge number of cohort studies taking lists of completed trials and then looking at whether they've been either published or reported on a clinical trials register. And they consistently find that the rate of compliance with ethical and in some cases legal obligations is very poor.

Now I started writing about this about 13 years ago. We started the all trials campaign in part triggered by an email from you in 2012 saying hey, let's do a letter to the times. And as soon as I started writing about it in any serious way, I found representatives in particular from industry saying, look, this guy's a charlatan.

This is a problem of the past. We now have new rules like the FDA amendments act. 2007, which mean that all trials conducted in the US must report their results within 12 months of completion directly onto clinical trials. gov, the trials registry. And because of that rule, this problem no longer exists.

Now, there were two problems with that. Firstly, FDA Amendments Act 2007. only requires transparency for all of the new trials starting from now. Now that's an important cohort of trials to get reported, but it's not actually all of the data we need. We need all the results of all the trials on the treatments we use today, not all of the results of all the trials finishing today.

And actually with my other hat, I run informatics services like openprescribing. net, which let you see what every doctor in the country is prescribing month by month. And I can tell you from knowing that data very well that doctors. overwhelmingly prescribed drugs that came on the market and were approved before 2007.

So that is definitely the era of trials for which we need transparency. But there's a second problem, which is everybody assumes because this law existed, that meant that it had fixed the problem, that trials were being reported. We found that about 63 percent of trials reported results. ever. So we allow people to report late because you want there to be room for redemption in a quality improvement and audit project.

You want people to be incentivized to report even if it's late. But we also segmented the data and found some quite interesting patterns in who is more or less likely to report results. 

Richard: Yeah. Tell us those because I must admit, I was really surprised by what you found. 

Ben: Yeah so me 

Richard: too. My prejudices I'm afraid were defeated.

Ben: Your prejudices are not unreasonable so what we're obviously both talking about is the fact that trials with industry sponsors were substantially and significantly more likely to report results. 

Richard: They were better. Yes. So I've been spending decades thinking that it's industry that's trying to hide their results.

You go back to the stories about SSRIs and so I mean they buried their results. Yeah. And yet now what you're showing is that what's happened they've had a, they've had an epiphany and now they're reporting. 

Ben: So I think having spent a lot of time up close with regulators, academics, funders and people from the pharmaceutical industry campaigning on this issue through the alltrials.

net campaign, it is fair to say that Until this rule came into force, and until the EU rules came into force, it is certainly industry who were most energetic in campaigning against efforts for transparency. They were the most energetic in rubbishing the all trials campaign and also lobbying lawmakers to 

Richard: try to avoid things like that.

I can remember sitting in meetings in Geneva at the World Health Organization, where members of the Pharmaceutical Manufacturers Association fought tooth and nail against clinical trial registration and an international clinical trials registry and put every possible conceivable barrier in our way to try and do that.

But something's changed. 

Ben: What has changed is an unambiguous rule. 

Richard: And 

Ben: that's the interesting thing I think about industry in general, they're just very good at following rules. You give a clear set of guidelines and laws and they go, okay. I'll work with that, I've got some lawyers, I'll work out what's the minimum amount of tax I can pay, what's the minimum amount of maternity leave I can pay, and then if I want to go further, then I will, and that will be for other strategic reasons.

So I think what's interesting here is it actually rather gives the lie, and there's a lesson for the future here. When people say. Look, it's not about regulation. We need to think about culture change. Culture change is really important and, regulation by consent, policing by consent is a really important principle.

Yeah, 

Richard: but rules help. 

Ben: Rules really help. 

Richard: They really do help. So actually the guilty parties now, unfortunately, it's the non industry folks who are doing research. 

Ben: So we run a service called trialstracker. net where we provide raw data that updates literally every working day. We show every single trial that goes overdue on the day that it goes overdue, it goes red on our service.

Richard: Impressive. 

Ben: When we first launched that site, we sent an email to the head of the FDA saying, just to let you know, we're running this service, we hope you find it useful, and attached is a list of all the trials that are breached this week. We hope that you'll be taking action. Now the FDA, under the FDA Amendments Act, has The right to impose fines of up to 10, 000 a day.

Now that's actually 10, 000 a day on every individual trial for every day that it's overdue. And it's inflation corrected from 2007. So I'm boring enough to be able to tell you that it now stands at 12, 000, I think 103 a day that they can be fined to date. 

Richard: That's not an insignificant fine. 

Ben: Oh, that's, that would make a material difference to a 

Richard: university.

Absolutely. So they must have r rates in a lot of money from imposing these fines. 

Ben: So we estimate in the paper, we estimate that up to September, 2019, they could have imposed fines of just over $4 billion. The fully updated figure as of this morning is just a little over $7.1 billion of uncollected fines.

Whoa. The total amount of time of fines that the FDA have imposed to date is zero. 

Richard: Ben, thank you for coming in today. We wish you well with your work and we look forward to seeing you and talking with you again. 

Ben: Thanks. 

Jessamy: Finally for this episode, you'll have heard a lot over the last 12 months about diet and nutrition in the news, a fair bit of which arose from our Eat Lancet commission early last year.

And so much of this talk is about what the right or correct diet is and how much now that is essentially linked to the climate crisis. And We really need to have a sort of greater understanding of how our habits are impacting the health of the planet. So I'm really excited to hear you and Cassie have a chat later.

Gavin: Yes, the climate crisis is understandably the topic of a lot of anxiety these days and we spent a lot of 2019 talking about not only how our habits with regards to fossil fuels are irreparably damaging the environment, but also our habits in the sense of what we eat and how the typical diet is becoming unsustainable in that it contributes to climate change.

At the same time, the food we eat is killing us. Non communicable diseases caused by our diets are rising at an extraordinary pace around the world, and it's costing untold amounts of specialized healthcare for these diet related problems. I think what some of our work last year really set out to do was to see if it could tackle both of these problems at once.

Dr. Cassandra Coben's forthcoming book Enough seeks to lay out the interconnectedness of these issues and explore how much it would take to make the changes. Dr. Cass Coben, thank you so much for coming in today. What's like the central thesis of the book? 

Cassie: I'm looking at the intersection between human health, the environment, and the food that we eat, and the way that we produce our food.

And I'm trying to make a very science based case that if we eat more sustainably it will also improve our health and will allow us to feed not only the current population of the world but the predicted large increase. I think it's something along the lines of 10 billion people by 2050. Yeah. And while we can currently feed people, probably we're not feeding them particularly well.

People are Not as healthy as they could be 

Gavin: So is the main thing you're getting out there on sustainability or effects on health? Or just both really both actually. 

Cassie: Yeah 

Gavin: So do you think like 2019 was like a watershed moment for this link now that we've made between climate?

Yeah, I 

Cassie: definitely think so I remember in around 2006 or so, it seemed to be the first time that people had a real awareness of climate change. This is just anecdotal. This is when it started to permeate popular conversation. And I really feel that 2019 is good. We're going to look back and see that as the first time that people have started to realize that food doesn't just magically appear in supermarkets.

And we all knew that. in an abstract sort of way. But I think now, whenever I've spoken to people about what I'm writing, rather than in comprehension, I get a glimmer of familiarity and everyone says, yes, I'm trying to eat less meat. Now, if you ask them why they don't really know, they'll say carbon dioxide, farting cows.

And that's true, but there's definitely a growing awareness that the way that we produce food. is not sustainable. 

Gavin: Yes this is a very broad question, but what is really the link between food and climate that makes both such a pressing concern? But that also makes them both available to be like addressed together as one system.

Cassie: So that's a really interesting question. To answer it, you have to think about the world as a single system. And it's quite intuitive to think of the inorganic world as a single system. Rocks, water, we understand all of that. What's much harder to comprehend is that life on earth, organic life, has an impact on that physical system.

Because essentially, we take in physical elements and excrete out physical elements and so on. And gradually, over time, As all of life is accumulated on Earth, we've seen significant changes, like oxygen, for example, that's due to life on Earth. So when you think of the Earth as a single system, you can start to think of all the different components of it interacting, and each one having an effect on another component.

And, as was outlined in the excellent Lancet e commission, these can be referred to as the planetary boundaries. So these are physical processes that all interact and we are pushing them. So climate is the best known one of these planetary boundaries. So we're pushing climate change. We all know about the Paris Accords where we want to try and keep the increase in heat too.

two degrees, no more than two degrees from pre industrial temperatures, ideally 1. 5 degrees. But what's less considered are the other planetary boundaries that we have. So they include and specifically relating to food, they include land use change, biodiversity, water scarcity and nutrient flows.

So that's phosphorus and nitrogen, which are key components in fertilizer. And essentially, as we produce food, we're pushing at all of these boundaries. But because the earth is a single system, you push it one and it actually affects all of them. So if you want to think about land use change for a second, I think that you could probably make a good argument that eating meat, rearing cattle and so on, is the single biggest contributor to land use change.

We've got to clear fields for them to live on. We've got to grow food for them to eat. And when you change land for say, most obvious example is deforestation. When you clear a forest, Not only are you cutting down trees and releasing, and doing whatever with the trees, burning them, whatever.

So you release the carbon that's stored there, but you also plow the soil and you release the carbon that's stored there. But equally, you're removing a carbon sink at the same time. So you're removing the natural resilience of the landscapes and the ability of the landscape to counteract some of the existing climate change.

So it's like a triple blow. You're releasing carbon, and you're removing the ability for us to store more carbon. We interact with this whole Earth system whenever we produce food. And what we're doing at the moment is producing a huge quantity of food, and a lot of it is really unhealthy. So we're seeing this rising epidemic of non communicable diseases.

And of the sort of four biggies, if you want technical term there, diabetes, cancer, cardiovascular disease, and smoking, three can be directly attributed to food and to what we eat. And when you look at what we're eating, there's a huge rise in ultra processed food, so that's very carb processed, carb rich added fats, lots of processed meat, all of which have links with those three diseases.

So we're decimating the planet to produce stuff that's slowly poisoning us. And the thought is that if we can change what we eat, we can potentially produce things that are more sustainable. So eating less meat, for example, would lead to land use change, which in turn provides more resilience.

Gavin: You were talking just then at the end about about changing what we eat. A lot of food policy, generally, in the way that it comes down from governments, aims to spur behavior. Is there a way that policy can get involved in this? I ask this mainly because it seems that a lot of the time, The very quick action that we need to take on the climate is met largely with political inaction.

Cassie: Yeah. 

Gavin: In a lot of these cases, and this planetary diet being one that there's a lot of ambition, but it's very difficult to Get the wheels turning, so to speak. 

Cassie: No, I completely agree. It's interesting, there's actually a technical term for it. I can't remember it. It's something like policy stupor or something.

Anyway, what I love is academic papers have been written about the fact that policy is not moving and they're looking at policies to try and get policies to move. Which is sickly ironic. And then 

Gavin: we'll add another level where you have policies trying to get those policies to move. Precisely, and 

Cassie: so on and so forth until everyone has a red briefcase.

But that's one of the, one of the aims of the book is, I think we probably need a bit of a grassroots movement on this. I think that's, I think that's coming anyway. I think people feel very disenfranchised at the moment. Everyone, I've seen plenty of articles about climate anxiety, where people are scared of having kids because they're worried about what kind of world they're going to.

give their children. And I think it's really beginning to get to people. So if you, if people can understand and I'm aware that sounds extremely patronizing, I don't mean it to be, but if people can understand that really their behavior can directly affect change, they don't have to wait for someone to sign an offer, approve it, that if they can change how they eat and we can do it en masse, we can bypass quite a lot of these.

policy hurdles. If politicians wanted to enact policies that would change these things, I think they'd be met with a lot of resistance from industry. We've already seen it happening. You just need to look at the sugar taxes. And so it might be genuinely more efficient just to say power to the people.

You don't, it doesn't have to be a revolution. It can just be as simple as picking up something whole wheat versus. Refined and that in itself is going to make a difference. 

Gavin: So what does nutrition land use look like for a future sustainable diet? 

Cassie: That's a really interesting question. I couldn't give you an exact answer on it.

Different papers have examined different versions of what over how we could change this and what outcomes that would be in terms of carbon use, land use change and so on. I'd say that if we could at least, at the moment we're aiming for something called a half earth policy where we keep half of the world as wilderness.

We are, I think, 51 percent of the world is wilderness at the moment. So 

Gavin: pretty close. 

Cassie: Yeah, pretty close. So I think we've got like a 1% Margin of error there. Ideally, we'd actually see some rewilding. We'd see, if we could reduce the amount of land that we're using, for example meat, potentially we could convert some of that not to crop land but actually back to a wild environment.

Julie: Yeah, 

Cassie: something that's quite interesting is that if you were, if everyone on Earth were to eat a vegan diet, which I don't and I'm not advocating explicitly, but people think that would mean that we'd have to eradicate vast swathes of forest for crop land. And in fact, The opposite is true. You can actually eat a very nutritious diet just based on plants.

There's a superb data visualization service that comes out of the University of Oxford called Our World in Data. And one of the authors there, Hannah Ritchie, has done some wonderful data crunching based on the science paper. And she's looked to see how much land use you need for a hundred calories of beef or of grain or something.

And it's terrifying when you look at it and actually, and people can argue, Oh that's just calories, whatever, beef is much more nutritious. But when you look just at protein, what you need to get like a hundred grams of protein from wheat or rye. or peas versus a hundred grams of beef, there's still a huge disparity.

So we could feed the world in a healthy manner using far less land than we do now. It's preference that drives us the other way. 

Gavin: Perfect. Thank you so much for coming in to chat with me. It's been really interesting and it feels like there's. So much work to do that it's intimidating, but I think what you said about an individual's Opportunity to almost bypass the system, we give over so much of our lives to being like following the rules Yeah, and then letting our behaviors be guided.

Whereas actually this is a fantastic opportunity for widespread a small scale change in behavior that actually makes a really major difference? 

Cassie: I really believe it can. One of the things that's really struck me as I've been writing is how much my own behavior has changed. And that's not because I feel obliged to be sanctimonious and follow my own instruction.

It's just much harder to make different decisions when you understand the impact of it. It's much harder for an individual to, to ignore. Yeah, I definitely think it's, I definitely think we have an opportunity, a real opportunity here to change the world. 

Gavin: That's a very positive note to end on. Dr.

Coburn, thank you very much. 

Cassie: Thank you. 

Gavin: I think it's really interesting over the last year like me and Cassie were talking about how much nutrition has become linked to the climate. It's this kind of It's a kind of hyper awareness because so much to do with climate affects every area of our lives and every area of our lives in turn affects the climate and the planet that we're leaving to our future generations.

Jessamy: Exactly. And it's this sort of circle, which it's really difficult to break down and understand what we can do that's, useful and actually going to have an impact. And also what we can do, obviously sitting here from our kind of relatively well educated, middle class seat, it's easy to have these conversations about how we need to eat better for the planet and things like that, but how we can actually disseminate that across, different socioeconomic groups who are faced with incredibly difficult challenges.

In this country, let alone elsewhere in the world, is, seems to me the biggest kind of challenge about that, 

Gavin: yeah, it's a huge challenge, and I think it can feel quite overwhelming a lot of the time. But also I think that's where a lot of the negative politics surrounding climate change arise from.

I think we've gotten to the point now in the discussion where, we had many years of people denying the reality of the climate crisis. But now we've gotten to the point where the climate crisis is so obvious and overwhelming, and every single month that goes by, we hear about how it's the hottest of this particular month in the last however many decades.

We've now gotten to the point where the same cynical groups are going, Oh actually it's too far gone by this point to do anything about. So why bother doing anything about it by this point? 

Jessamy: And it's like that conversation that we were having about, where fear meets hope and how we kind of transition from this place of fear where it's all overwhelming to, to hope and how we can actually.

Actively do things. And I suppose this sort of nutrition aspect, this diet aspect is a really tangible way that everybody can do something to make a difference. 

Gavin: Yeah. Like I was talking about with Cassie, it is something that transcends policy. I think we rely a lot of waiting on politicians to have solutions because the ones that they're the only ones that can really affect the big picture, but this is a way that individual people can affect.

The big picture just by making different decisions. 

Jessamy: Yeah, and I think that people are hungry for that kind of information, if you're part of the punk. I see what you've done there. Exactly, right? And this is why these kind of conversations are so important because people can take that information and use it the next day.

Gavin: Yeah, absolutely. Just making little choices for a big effect, which sounds like a cliche But it is a it is something that has risen out of this kind of planetary health diet movement thanks so much for listening to this podcast. We really appreciate it We're gonna try and do this every two weeks.

So hopefully we'll see you back here in two weeks This show is available on all of your normal podcast spaces like Apple Spotify Stitcher. I think we're even on Alexa Which is, very technologically advanced. 

Jessamy: Yes, and we would massively welcome your feedback. You can send us any of your comments to podcasts at lancet.

com. And if you want to chat or maybe suggest what you'd like to see on the show or hear on the show, things to talk about, anything really, we'd really like to hear from you. So thanks again for listening and please do try and subscribe to us and like us and share us on social media. 

Gavin: Yep, we would really appreciate it.

We would really like 

Jessamy: that.