Future Outlook for Cancer Detection

This BBC podcast is supported by ads outside the UK Self directed investing Trading Full service wealth management, automated investing, financial planning, thematic investing, retirement planning few and to think That's just a small taste of what Swab offers The Geschwab knows that when it comes to your finances Choice matters. No matter your goals, investing style, life stage, or experience, Schwab has everything you need, all in one place So you can invest your way Visit Schwab. com to learn more ODU, providing tools for businesses across industries into one fully integrated platform, whatever your business needs, Odu is committed to providing it. Learn more at OdWo. com I am back, or at least I will be very, very soon. Look J just before you hear this episode, which was fronted not by me by the brilliant John Berne Murdoch from the Financial Times, one of the preeminent data journists of our age. I wanted to tell you about a guest we've got coming up on radical called Ben He's a rather famous ben because he opened an ice cream shop in nineteen seventy eight with his childhood friend, Jerry Greenfield And so one of the world's most recognizable brands, Ben and Jerry's was born What makes him radical is that Ben and Joees aren't just famous for their flavors, they've also staked their reputation on their activism turning ice cream into a vehicle for values, fromrom campaigning on climate issues, criminal justice and corporate power to taking on their parent company over their social activism on the Israel Gaza War. Ben Cohen has spent decades arguing that running a business should mean more than just profit We'll be asking. what radical business activism really looks like, whereether big brands should pick sidize and whether his philosophy could withstand the corporate climate in Donald Trump's America. As always, we want your radical questions, please do send us a voice note for Ben Cohen on WhatsApp zero three three zero one two three nine four eightzo or you can email radical at bbc. co dot uk. Thank you, and now ont to this week's episode Hello, I'm John Bern Murdock and welcome to Radical I'm stepping in for a mole this week while he's away in Scotland filming the traraitors, but I will stay one hundred percent faithful to the ethos of this podcast, where we explore the global trends reshaping our world and the radical ideas that will define our future. Outside the studio, I'm a columnist and chief data repeporter for the Financial Times where I specialize in using data and evidence to make sense of the big changes happening in the world So for this episode, I wanted to explore one of the most profound and often overlooked transformations of our time the revolution happening in medicine In just a generation, diseases that were once considered a death sentence have, in many cases, become treatable, manageable and increasingly survivable. These advances are having a huge knock on effect on our lives, and I really want to find out more Joining me today is Professor Sir John Bell, emeritus Regis prorofessor of medicine at the University of Oxford He's advised the UK Government on life sciences, pharmaceutical strategy and COVID testing played a pivotal role in the development of the AstraZeneca COVID nineteen vaccine during the pandemic He's currently a partner at Population Health Partners, a firm focused on investing in and advising life science companies previously served on the board of pharmaceutical compomany Roche Together, we're going to explore the technological and organizational breakthroughs driving this extraordinary progress and what these changes mean not just for healthcare, but for the future of society itself Before we begin, a quick reminder If you subscribe to Radical on BBC Sounds, you won't miss future episodes, including Y RadicalQestions, our listener Q and A released every Monday. Now onto this week's episode with Professorir John Pell I Professor Sir John Bell, welcome to Radical. It's a real honor to have you with us. My pleure. If some of our listeners today have no idea about what has been happening in medical science and technology over the last decade What have they missed Well, they've missed a lot. I'm afraid. and actually it's not their fault. because I don't think we do a very good job of telling the story of what's happened in the last fifty years So I started training in medicine in nineteen seventy five. and since then, which is sort of roughly fifty years, There has been absolutely dramatic changes in the way we manage all forms of different disease. And you know, there's a long list of things that we've achieved, but just to give a few highlights Cardiovascular disease when I was a child used to kill all my parents' friends. They all used to die of coronaries or strokes There's been an almost seventy percent reduction in cardiovascular mortality A cardovascular disease mortality in that timeframe. I mean, seventy percent, that's massive. That seven out of ten people who would have died are not dying from that disease. And that was the single commonest killer Where does that come from? that gain? That has largely come from prevention. interestnterestingly, and I'll come back to that later in our talk because the availability of therapeutics to reduce the major risk factors of those diseases, which are blood pressure Bood sugar and lipids has really dramatically caused a fall in mortality and morbidity. So hu huge impact Similarly, cancer Diagnosis of cancer In those days, almost nothing you could do with almost every form of cancer It was basically a death sentence, some were fast, some were slow, but it always produced the same outcome. We've had this terrific change in our approach to cancer, which has focused recently on using the immune system to tackle cancer. and I think what we've now come to realize is that A lot of the early approaches to cancer, which was basically trying to stop cells from proliferating quickly They worked a bit, but the truth is they probably had their effects by stimulating the immune system to slow down the cancer and control it. Sorry, can we talk a little bit more about that? So an example that struck me was with childhood leukemia, right? So when I was growing up in the eighties and early nineties, this was really seen as a death sentence. If you heard that someone had leukemia thought , what a tragedy Now the survival rates have dramatically improved just over the last couple of decades Can you talk us through what's happening behind the scenes there There are three or four major types of leukemia. And you're absolutely right thirty years ago, they were mostly all a death sentence Very tragically, a couple of them occurring veryious young kids, which made it even worse because these are kids who never really had a chance But then there are other forms that occur in later life and Um, and people in middle age Of those, there's only one left, which has really not been tackled by novel therapies. But this happened, I think it's really important to realize that these breakthroughs in medical science They usually don't come in a single jump. They usually come with a series of iterative improvements in what you do building on what the previous guys have done to actually steadily improve survival and in some cases, completely eliminating the disease So the early therapies in childhood leukemia were mostly drug that leukemias replicate they turn over very quickly. The cells replicate very, very frequently And so if you could stop that, you could actually put a hold on it And then of course there was the development of Bone marrow transplantation, which has been hugely powerful. And then more recently, the development of sales immune cells, which have been engineered to go in and fight the leukemia on site So that's been a very long journey, but Most children with the commonest form of childhood leukemia, which is called A LL acute lymphyitic leukemia They do really well and they're effectively cured Similarly, adult leukemiia used to be a death sentence now multiple drugs available and it's really turned into a chronic disease. CLL is another adult leukemia really terrific new therapies for that disease as well. Not everybody gets managed perfectly, but it does really well It's only acute myeloid leukemia. which is still problematic, but there are some forms of that go into the detail of the names, but there is a subtype of that disease. where possible to treat the disease highly effectively and most people go into remission and when they're in remission, they're cured, it never comes back again. So in leukemia, we're winning. But those cancers were the sort of forerunner of now what's happening in other types of cancers, solid tumors. And there we're seeing some quite long life expectancies in those patients. Right. So an example that I came across recently was the prospect of a vaccine for pancreatic cancer Now, one of the reasons that seems to be so significant is that pancreatic cancer has been so deadly. But can you talk a bit about that and what's going on behind the scenes with this one? Yeah, So pancreatic cancer is kind of the worst or the worst of the solid cancers has a very long gestation period. develops over Some people suspect fifteen years. So there's a long period of time which just grumbles away bit of the body where it doesn't produce a lot of symptoms until late And it's very difficult to detect And as a result, it gets diagnosed late and it historically is carried a very very high mortality. It's essentially with only a few exception it's a fatal disease So the biggest two breakthroughs in that area are one There's an enzyme called RAS. which seems to be mutated in a lot of people with pancreatic cancer And the drug discovers are busy trying to develop small molecules. People thought it was undruggable. It turns out to be druggable So there's great excitement about getting that to work. And just quickly on that, what are the technological changes that have made that drug discovery process faster and where are they headed at the moment? Yeah, so much better structural data on the proteins you're trying to tackle Because what you try to do with some of these things is to find bits of the protein which you've got little nooks and crannies into which you can slip chemicals or small molecules which end up being drugs or therapies. So we're much, much better at that. And it was that that scientists discovered that there was a little crack in rass that they could get at So that was that was really the breakthrough, but In addition to that, of course, there is the advent of AI in that space, which I think is hasn't yet transformed that space, but it's moving in that direction. For proteins, it's definitely made a big difference for small molecules not yet, but it will in the end. So And these things are moving really, really quickly So would it be fair to say there are almost two things going on here, but two things that are going on is drug discovery And then you mentioned the word engineering earlier, the fact that We're talking here less about these general one size fits all medicines and more tailored to the individual exxactly. So I think what we've come to realize and of course behind all this has been a remarkable revolution in our understanding of canancer and what passes it And in particular, an understanding of the genetics that underlie cancer pathogenesis. So what we do know is All forms of cancer driven by genetic changes And they occur in people as they get older They also occurr in people when who are exposed to carcinogens that actually cause the DNA to break. And u and reassemble. And that and that we understand creates the biological process that actually leads to uncontrolled growth of cancers. So So that understanding of genetics has been very powerful And then the other thing which is also really interesting is that We also now understand the role of the immune system in cancer And that's again been going on in the background. So when I started training in medicine It was pretty rudimentary. The understanding of immunology and particularly immunology and cancer didn't exist But there's been this huge expansion in our understanding, both of the immune system, what are the things that make it work but also how it impacts on diseases like cancer And so what we now believe to be true is that all cancers in the end turn out to be recognized as foreign by the immune system and the immune system in many early cancers. So in guys my age, we're probably popping up with a brand new cancer every week or maybe even every day And our immune system comes along and goes, Bing, we're not having that and it gets rid of it. So I've got a surveillance system that keeps me cancer free And it's only when I break through that and get tumors that have expanded a bit that the immune system has a hard time dealing with it So this combination of our understanding of the immune system and our understanding of the genetic changes that cause that are really the things that sit behind One of the biggest advances in pancreatic cancer, which is that you can go into a pancreatic cancer and identify the new genetic changes that have occurred to cause that cancer. You can take them out. you can make usingsing the same technology as we used for the COVID vaccine, the RNA vaccine So you make an RNA, which you can do very easily And then you put that back into the same person. So it's an individualized vaccine that then stimulates an immune response to those antigens which are unique to that cancer, to that person So Not everybody with pancreatic cancer can access the therapies. Do we know quite how to use them? Not yet, not yet, but that's progressing. So I think even the toughest cancers are going to be tractable with that. Yeah, which is amazing. And that raises a couple of interesting questions though. So something you mentioned early on is how the the medical Community, shall we say, has not done an amazing job of communicating these successes Part of what's going on here as well, that these are quiet games when people stop dying of things or live a bit longer. it's not a dramatic striking thing. Can you talk for a minute about what the impacts of these have been at the population level? Yeah. so this this is a central issue. And again We haven't really told the story properly and it's gone sort of unrecognized in my view. But since I was a medical student to now We have in the UK added twelve years to life expectancy On average for every person in the country. Now I just people go,, what does that number mean? Well, twelve years is a lot. You know, if average life expectancy is seventy five, twelve years is about an additional eighteen percent of life That means that lots and lots and lots of people, in theory, everybody on average, is getting twelve more years to enjoy their retirement, to spend time with their kids, to maybe stay and work longer and be productive contributors to society. Telve years is a very long time. And those are all attributable to the developments that we've seen in biomedical science Now the problem with that, of course, is Because we haven't recognized it and we haven't waved a flag around, you know, when Elon Musk sends a rocket up, comes down and land somewhere Everybody shouts and says all terrific. We're going to the moon That, in my view, is a trivial contribution compared to adding twelve years of life to everybody And basically everybody on the planet And in fact, in developing countries, it's more like fifteen or eighteen years. So this is something that we haven't made a lot of noise about The Problem is that as soon as you've done that It's hugely disruptive. It's disruptive to everything So people say, we don't understand why the health carere system doesn't work Well, hello. If you've added eighteen percent of activity to a healthcare system that was designed for treating acute disease in the nineteen sixties and seventies which is now having to manage all these chronic diseases in people growing old Don't be surprised if the old model doesn't work, and that's essentially what's happened in. So it's fallen over. So because the most expensive period of someone's life in terms of healthcare is those later years. Yeah It's now almost the number of expensive late years people have has doubled. Exactly, exactly. You know, when we're young and in fact, even when we're middle age onn the whole don't cost the healthcare system for much. There be a few cute things that people have to deal with, but mostly and this is evident by the fact that people in their twenties and thirties never go see their GP and pine so let's not worry about it Um As soon as you start to get into your late forties and fifties, you start to accumulate These major chronic diseases that are all driven by a set of risk factors, all of which are controllable But we don't control them. we don't control any of the risk factors. We wait u till people get a bit of chest pain a stroke, get diabetes And one of the things which has become really apparent is that you don't just get one of these diseases, you get multiple diseases. So this issue of multiple co morbidities, which is peopleeople having one, two, three, four different diseases all at the same time then arrives at the door of the healthcare system Guess what? The GPs all go, Ohh my God, I can't do this. There too many elderly people with all these diseases. How am I going to do it? And then the ANA departments all fill up with exactly the same people. And so that healthcare system basically collapses. and that's what we've seen in this country reallyally over the past fifteen or twenty years, it's just been growing steadily. And it's true in almost all countries is that their healthcare systems don't work because it's a very different model. It's a you know, if you disrupt the system by adding twelve years of life Don't be surprised if the old system doesn't work. And the problem is we haven't said Oh my go, the old system doesn't work. Let's pull the handle and see if we can fix it some other way Now one thing that I was thinking while you were talking through this is that prevention sounds quite low tech. But then you mentioned obesity, and I thought, well,ve one thing that our listeners probably have heard of is the GLP O's, these weight loss drugs. What's your view of that? The GLP Oes essentially a miraculous way to scale prevention Yeah what do they do to move the needle? So this is a really interesting inflection point, I think, in our whole approach to prevention And it's partly because the drugs are really powerful. They do I mean, there are a million ways people have tried to lose weight. Most of them don't work The standard approach of healthcare systems, when you go see somebody and you've got a BMI of thirty five or forty, they say We think you should join a gym and eat less food Well, honestly. Anyway, that I promise you that does not work and there's lots of evidence that it doesn't work and the numbers have been getting worse. And it doesn't work basically because it's really hard for people. It's really hard, it's really hard. And you got to have some sympathy because first of all The medical profession for many years did not treat obesity as a disease They treated it as a sort of social problem. You know, you see Molly over there, she's a bit too big. she probably doesn't exercise. She sits in front of the TV, blah blah. So you know, there was a sort of overhang of social prejudice saying, you know That's her problem, not anybody else's. The truth is, we now know there' massive drivers of obesity that are largely genetic that actually have to do with how much food you take in, but also what you do with that and how you metabolze it. So it is a disease, just like cancer, just like cardiovascular disease So as soon as you get a novel therapy that actually breaks that open and can actually give people an opportunity to lose weight at scale then that becomes a population health intervention. And what will drive that, of course, is that the we've already seen dramatic reductions in the price of the drugs moving from injected to oral drugs then we'll have orals and generic orals. And this will be like statins. People will take these things routinely, they'll keep their weight down and that has Huge benefits across multiple different diseases. I think not even I, I mean, I've been on this for five, six years now, but I didn't actually even recognize that it would have such profound effects across many different aspects. Just to clarify, when you say you've been on this, you mean working on itather than it's very interesting because I've been debating going on it myself as you know because you're looking at me. I'm not exactly a big overweight guy but its benefits in things that are not got anything to do with how heavy you are, but it has benefits for people BMIs of twenty five, for example My BMI is twenty two, so I keep thinking, maybe I should be on these drugs. And it's interesting because I think the NHS has finally realized that actually it's a very powerful prevention tool as well as allowing people to lose weight So I think That is a really good example If we're going to use those powerfully, we have to use them across the whole population Do you think we're far away from a place where essentially GLP wants are just universally available on the NHS or other other healthcare systems and when I'd say far away maybe ten years. But do you think that's where we should end up if we're taking this? I think that's the inevitable consequence of this. I think these will be used hopefully by very large numbers of people. It'll reduce the risk of these diseases, It'll flatten the morbidity curves. I mean We are really a sick country. and unless we get on top of that All the economic drag associated with that's going to be really problematic. All those factors are much worse in deprived populations. It's a really big problem. So in a sense, we've got these two families of technological breakthroughs. One is extending life and the other is now extending the health health and the quality of life. Yeah, exactly. What are some of the other big society wide economic productivity, What are the impacts? What does this new world look like Well so you've written very coherently about the impact of ill health on productivity and GDP growth. And we have another problem in the UK. And just be crystal clear, I'm a massive advocate of single payer public funded health care systems. so there's no intention to suggest there's a better system because I don't think there is But I think the system, because they're Very big and very old They tend to get ossified in the model and they haven't really shifted the model to something that's focused on these particular aspects of trying to keep people fit and healthy longer And when you get a population which starts to tail off in the early fifties in terms of their health peopleeople leave work They have many sick days. The healthcare costs go up through the roof the drag of that in terms of National ivity and national GDP. is huge. And you may or may not have seen the recent McKinsey's report, which I think gives put some numbers to this and that is, By twenty fifty, the drag on economies from that chronic disease burden That means people out of work, people not as productive as they could be, as well as the healthcare costs, which are actually the smallest bit of that will be about seven percent of GDP Well, you can explain it to him because you talk about this language all the time. Sven percent of GDP is a very, very, very big number And in fact, by twenty fifty, that adds up to ten and a half trillion dollars cost that is entirely attributable to this massive burden of chronic diseases across the planet. So I was referring to the NHS because the NHS had a model whereby They relied on health economics to decide what they were going to spend money on And that was really to decide is this pill better than that pill when it's used in the healthca system, and how much money does it cost the healthcare system That in my view, is completely outdated. What we need to do is say what is the overall cost to society from these illnesses? And how do we tackle them to deal with that GDP drag, productivity drag that we're seeing? When we're talking about that seven percent figure, is that assuming population health looks like it does today It's assuming not only that it looks like it does today, but it continues on the trajectory that it's on today. But the trajectory there, if we're talking here about productivity, presumably we're talking about people in their fifties. Yeah Exactly. Yeah. Are we saying that productivity has been worsening and health worsening It has. And you know, the major factors in that are obesity, which has been a big factor. and you will have seen in the papers this week Taking the people who are at the extremes of obesity and putting them on GLP ones reduces the time off work by fifty percent. It's a massive number and also reduces the time that they're in the GP surgery by fifty percent. So these have quite big effects over time Mental health is another big problem, and you know, we haven't really tried to tackle that in a systematic way, But that's another reason why people are off work Now a word that came up earlier or an initialism that came up earlier was AI. What role is has AI been playing in whether it's on prevention or extension? and what Do you see coming down the pike over the next decade from that area as well? Yeah. This is pretty interesting because I think We can say it as read that it makes systems work better. So you could develop a prevention system, which was driven by AI that would actually know when to call you in to get your lipids tested would know whether your blood pressure need control all that stuff. And that you can automate a lot of that using AI because you can use that as a as a basically a coach to actually manage people in the system. So that will take a big burden out of what you do But the other thing where I think it's really powerful If you set aside the drug discovery piece which would be a place. But the other area is what I call predictive analytics So When you're twenty five It would be kind of nice to be able to say on the back of a blood test Actually, you don't have to worry about the following ten things becauseisk your risk of that is close to zero. But you better be careful about That and that and that And what can we do to help you reduce the risk factors for those diseases? And as a result, prevent those diseases when they come along. And you know, many of those bits of data are available. The algorithms haven't really been refined to understand how best You can make those predictive analytics, but you can be sure we're going to do it a lot better than we do now. With AI, a couple of concerns often come up. Yeah right. So one is that everything you're describing here relies on having an enormous amount of data to feed into the models when you're training them and then when you're using them When people raise concerns about the amount of data that needs to be stored there digitally and the risk of security issues, you know, we had the UK Bioank up recently. Yeah. How do you think or how do you suggest people should think about the trade offs involved? Yeah, so first of all, we live in a world of data and we live in a digital world and lots of our data is out there. O finance data is out there and Lots of our workforce activity and the workforce data is out there. All our educational data is out there. Ealthkay is a bit more sensitive and I think we have to be really cautious about that But at the same time, I think we've had a problem and the healthcare system doesn't work very well because we've siloed all the bits of data into multiple different data sets and it doesn't talk to each other and AI will be hugely effective at getting that information to talk to each other. So for example, GPD doesn't talk to hospital data, hospital data, doesn't talk to NHS data. I mean, it's a mess, frankly. So the new legislation, which is planned is to bring it all into a single patient record, which I think is a good idea. What does this look like in other countries? Because again, there's a lot of discussion here about the risks of having it all in one place and people are concerned about specifically the US tech company Calanti's role here What do other countries that do this well? Do How does it work The answer is that the countries that do it well to Scandinavian countries They do co whole data sets and they use that to drive their healthcare systems pretty effectively Similarly, you know, the small Asian countries like Singapore do a pretty good job I think there is an issue about twoo big issues. One is Should we take UK people's data, healthca data and ship it offshore My view is no, no, no, no, no, no, we're not doing that It's a national asset peopleeople are sensitive about that and we shouldn't be sending it off to the US or China or anywhere else for people to play around with it. We should be using it to generate algorithms for sure, but in a secure environment in the UK. And that A will create assets in the UK, but it'll also bring jobs and people who are there's no point in pretending AI is not going to happen. It is. I'd just rather have it happen here in the UK. But if you say keeping it in the UK's borders, does that mean we shouldn't be the NHS shouldn't be working with Firms like Palant here So I don't know enough about the Palanter story to comment I can say one thing and that is in COVID, Matt Hancock introduced the Copy Nice, which was basically a public health bit of legislation that allowed access to healthcare data from wherever it came from to bring it all together so we could work out what was going on And so they introduced the Coping Nice and that was a massive change for the way we were able to manage the pandemic. We know who had a vaccine, we know who had a disease, who had a test, all that stuff. And it was all hooked up together Palanter did a lot of the work to organize and orchestrate that, and it worked pretty well. Now that was in an acute emergency, so that's a different set of circumstances But I don't have a view provided the data is securely positioned and isn't ered and moved around because you know, there' two things. Many of these companies they don't actually really want the data. They want you to use their software and that's a different that's a different setting. There is a big problem though, and that is that Most of this has happened in the US, mostost of the developments in AI in machine learning happened in the U.S. and China. And that is not because we don't have some of the most talented people in those spaces in Europe, and in particular in the UK. But we have singularly failed to grow any companies that could do it here and on shore, which is a really big problem. Deep mind, of course, part of Google, but you they are largely based in King Cross. I, you know, I think there is a There's a strategic issue here about whether we want it all to be done somewhere else or whether we want some of it to be done in Europe. Be I guess the specific concern that's been raised with Palantir is that Almost by necessity, by definition You have to give U.S software engineers unlimited access to this data, That's something that's been confirmed by reporting by the Financial Times For example. So even if there is not an intent to go in there and fiddle with things, there is exposure there. there is risk. Are you basically saying that that is unavoidable unless we have a British palanter equivalent can keep everything access the entire thing on shore. Well, first of all, I think whatever anybody does it's got to be on shore And that you can control. So shipping this stuff around is not necessary Whether it's being done by an American or a Chinese or whatever company on shore or a UK or European country that you can control. And we do need we do need a European or a UK champion to actually take that forward. In my view. I think it's a real strategic mistake not to have one Yeah So there are many, many, many multifaceted things going to this. and I should just interject at this point and add NHS England's statement on Palant here is that the NHS has strict policies in place for managing access to patient data and carries out regular audits to ensure compliance, including monitoring the work of engineers helping to set up the central data collection platform that will track NHS performance and help improve care for patients Anyone external requiring access must have government security clearance and be approved by a member of NHS England staff direct to level or above. Yeah, I think that in fairness to the NHS They are pretty good at this actually, and they take this really, really seriously. And the reason I know that is that As you know, I set up this large cohort, which is five times bigger than BobBank called ourur Future Health And we've got almost three million people in that, consented people with their data And the NHS Even though the people have consented to let us have access the NHS have been really, really rigorous about checking All the security conditions that we've got, whereere iss it stored? How iss it stored? What are the security capabilities that we've built to secure the data I hope you're enjoying my conversation with Professor Sir John Bell. If you are, then you can subscribe to this podcast on BBC Sounds so you don't miss future episodes. Also, if you do subscribe, make sure you've got push notifications turned on and that way you'll get an alert whenever we publish a new episode so you'll never miss out. And now back to Sir John It strikes me that a lot of these technologies and solutions been generated to a large extent on the back of US financing, that a lot of medical innovation comes out of America. in the last year to eighteen months, under the Donald Trump's second term, we've seen the US pull out of the WHO. we've seen under RFK jr. as well this withdrawal or cancelling of investment in MRNA vaccines, which we talked about the importance of earlier How do you view what we're seeing here in terms of the We're really seeing revealed the vulnerability or reliance of a lot of this stuff on the US. You've worked yourself quite closely with Larry Ellison in the past Should we be concerned that there's a sort of fickleness or capriciousness here that puts a lot of these gaines at risk Well, I I so first of all, you're absolutely right to highlight this It has been one of the most rapid and transformational changes in the global biomedical arena and ecosystem that I've ever seen in my career. and it's happened really, really quickly. Don't remember you know, he's only been in post for eighteen months and It has completely and dramatically changed the environment America have And I know people are optimistic that it'll get back on its feet, but it won't immediately. It's going to take ten years to get it back on its feet. And that's a really big problem because these innovations, which have had such a profound effect on society and our well beinging We werere driven by America largely, that was by far the most successful arena for doing this So I think that two things we need to think about. One is produces the rise of China. At the moment, the dominant force in biomedicine is China, and no one will dispute that. great stacks of new interesting molecules that people are and the farming industry are now piling into China to find their next drugs. So that's It's not a bad thing. It's fine, but it You do have to realize that America has kind of lost the upper hand in that whole space Now in AI, China, it's hard to tell where China is, but China and America again are level pegging in my view in terms of their capabilities The Chinese AI capabilities and algorithms are not as widely used because there's a security issue about using them because you tend to lose all your data. Sorry to that. Does this mean that countries like the UK or parts of Europe should be thinking rethinking their approach to working with China in this space is that's where the money and the tech. So I think we've got to get around to thinking about how we do work with China in this space because that's That's a real force. I also think that, you know, Europe broadly and the UK specifically needs to sort itself out actually, because, you know, we've always been able to compete. We're not we haven't been the biggest, but we've done some terrific things. across the whole of the biomedical space and You know, in the last ten years, we've become a less and less desirable place to do life sciences. As you know, most of the industry said, we've had enough we're out And I think it kind of misses the point that The discoveries that have come from that industry are the ones that have generated your twelve years of additional life expectancy, the benefits in cancer, cardiovascular disease That's where the discoveries for Alzheimer's disease will come from And we just seem to not recognize how important that component is of the whole story And in prevention, prevention will come from therapeutics. It won't come from buying a pair of jogg and shoes and going around the block three times. I promise you That is going to be the driver of prevention. And that's how we're going to flatten that morbidity curve. So so we I really do think we've got to get our act together and become much more of an engine for innovation in the buman. And so what explains why with Britain's history here or look at some of the GLP ones coming out of Denmark? What explains why Europe and the UK seem to be quite good at that side of things is but very bad at the scaling. financial side of it. Yeah, so you're right. And if you look at discovery science, interestingly, what I think is probably the best GOP one is the one that was produced out of Steve Bloom's lab in Imperial, and which was then developed by Clive Minwell and those guys and sold to Pfizer recently. And it's got a it's an injectable, which lasts for four weeks, not one week. it can be used as an oral So it's a great job. And guess where it came from came from the UK. Steve Bloom was the original guy to work on all those peptides. So we do have this unbelievably powerful biomedical research base in the UK, which we really do need to exploit more effectively And you've highlighted the problem because we've got a lot better at creating small companies. We cre the university create lots of companies and they compete like crazy. But the truth is they either get bought and moveved to America or they fall over and the absence of scaling capital to allow those to grow to become real biotech companies. and by that I mean Do they pay tax or not? And the answer is almost out of they pay tax because they never produce a product, they never sell a product, they never grow It feels like there's a bit of a catch twenty two here because when I hear about the calls to force or strongly encourage UK investors to invest in UK firms, the pushback is, well UK firms have performed poorly if we've been doing that for the last thirty years, we'd be worse off than investing in the US But maybe a catch twenty two there that growth in the UK phmera and tech firms has been weaker because of that lack of investment as well. Yeah, I think look, it's a circular argument. and it does It does require investors to make good choices. So you know, if you make bad choices, you're not going to make a lot of money but are there opportunities to make money out of tech firms in the UK. There absolutely are. Do we have the skill base to do that? possibly do, but there's not a lot of experience in investing those investing in those in the UK And I do think there is another component of this, which is really important, and that is When you go to Silicon Valley, you go to Boston Bodech sector You have these fantastic entrepneurs, innovators, entrepreneurs, scientists who actually really know how to take something and turn it into something really terrific. and That is what the American system has really brought. So the real question is, Can we develop that more effectively here? And we may have to import a number of those people to make it all work. But I don't think this is beyond reach. And I think the Steve Bloom story is a classic example. That really took off when some American innovators arrived and actually turned that into a really successful venture and then sold it for ten and a half billion dollars. investors don't think that's I don't know what they're thinking of Another aspect of this that often comes up and we'll get into this more in the Q and A section with listeners as well is inequality, We're talking here about increasingly expensive and technologically and data intensive treatments and approaches. Is there a concern here that whereas previous general healthcare gains were distributed across the world, things like penicillin, we're now talking about things which are much more concentrated among wealthy countries and even within those countries, wealthy individuals The inequality gap has got bigger, not smaller And I think this is a clear criticism of the way people have approached a prevention agenda So we're the big domains in the UK, for example, where the chronic diseases are their worst They're in prived populations, ethnically diverse populations, often in big northern cities where nobody's had a job for years And that's where the burden of disease is. You know, if you go to Chelsea or you go to Kensington You don't find a lot of really obuse people, but if you go to the big Northern cities, you find a lot of it And I think the failure to grapple with this and to deal with it in a sensible and equitable way is going to just, it already has increaseed the inequalities of health So as you know, there are tens of thousands of people in this country on GLP ones. And they've done it all privately. They just said, screw you. We're going to go buy some. And they're the people with money People without any money haven't had that opportunity. So as I said earlier, I'm a real believer in the national health system because it should allow you to drive those equalities really effectively and the complete and abject failure the NHS to grapple with the GLP one thing is a sign that they don't really care about the people who are sitting in deprived circumstances and whoever am mass them be problem. We should say here you know the NHS are not in the room with us now, and I'm sure they would say something differently., they won't like that. I'll get beaten up for that for sure. so. But it is not a good that was not a good set of decisions, I have to tell you What should the NHS be doing with things like GLP ons? And isn't part of the problem here again that they are significantly more expensive than a lot of the treatments that the NHS has covered in the past and Is there something that maybe needs to look different in the funding model when we're talking about everything coming in at six figures and Yeah kind of so so these drugs first of all, they're falling in price rapidly But the other thing that the NHS needs to recognize, it's got massive purchasing power NHS England alone is fifty five million people It can drive unbelievable discounts on the drugs that it buys. Because remember, the cost of goods for many of these drugs ain't that great. So they can still develop really big margins, but at a very low cost. And of course, one of the great things about the NHS is that once it's been accepted in the NHS it doesn't need to be marketed. It just gets used because there's a requirement of people to use it at scale So I think speeding all that up will make a massive difference, both in terms of the cost base, but also the number of people who can get access to these drugs And I think It's not just those, but it's a system for trying to manage people's blood pressure and people's lipids. You know, that has to be done at scale. Thinking perhaps more broadly than the UK, when you look five years down the track, where do you think other games have come from? what Well, other gains, but also other impacts of the gains we're seeing today. What is this all going to look like in a few years time I think so there there's a big issue which I've alluded to before, which is one of the biggest drags on economic productivity, which is mental health And there is no magic bullet for mental health. There's no tablet you can take, there's none of that. So we've got ourselves in a bit of a pickle with mental health And again, there's no real system to deal with it, but there are lots of young people and these are the most productive people in society who actually are really disabled and unable to go to work and unable to function normally And I do think we have to lean into that and work out what we do. And you know, there are ways to actually help counsel and support people in that situation. and we don't really have a system for doing that systematically Some of the American states have developed that and it's interesting because they use UK suppliers to do that, but I think that's going to be a big drag. How do you think about AI in that space? Because it strikes me as interesting that cognitive behavior therapy and conversation based therapies. Do you think AI could help with this mental health problem? Yeah, so we're in this tricky place where People are anxious about turning it all over to an AI algorithm and a chatbot partartly because there is a history of Kids committing suicide on the basis of the information they got from the chatbot and how it gets interpreted. Soah I think you've got to be really careful before you do that. But having said that, there are some very responsible counseling services, which are now using these quite effectively. Don't forget what we said about AI a year ago is not true today. There's been this incredible inflection point, which occurred late last year where everything seems to work a heck of a lot better. So I think ruling that out would be a really big mistake because it can produce really beneficial effects for people in the mental health space. So I think we do need to think quite hard about that. And how you regulate that and manage that is a whole new world But it's hard to imagine we're going to get on top of this with a load of Counselors you know, sitting on the telephone very big picture, if people are looking for things to get excited about things that you see coming down the line in the next year or two, in the whole health tech space. What's keeping you awake at night in a good way One of the really exciting things So as you know, I'm an immunologist and a geneticist And I was very involved with Daveid Cameron another other was setting up genomics England So so I'm really o fair with that technology I think that has now been dramatically commoditized. So it is going to be so cheap that we can all have our genomes done Probably all have our genomes done at birth But then other applications of that to detect There's you know, interest in detecting circulating DNA in the blood doesnn't quite work yet. the Grail study didn't meet its primary end. Tell us a little bit more about that. So cancer cells die and spill their DNA. And as I described earlier, the cancer cells have mutations in them and they have variations in their DNA So there's DNA in your blood if you have a cancer, which you can detect that says I think you've got a cancer So you know, the first company to actually spot that was company called Grell, which is an American company. and they I've done a very big study to look to see whether you could use that in the healthcare system. and They said some very demanding endpoints in their study, which they didn't make, so the share price crashed and so on But I think if you look at the data, there's enough information there to say that It may not be the Grail technology, but some technology is going to be able to detect those signals and particularly in people who are higher risk of cancer and who maybe have some early symptoms but they't know whether it's cancer. They'll be able to pinpoint that Because getting to early stage cancer, that is the solution to curing cancer And now with immune therapies, if you get into stage one and stage two disease, you'll cure it, I'm pretty sure. So that really gets me because that could transform the whole cancer paradm Really, really remarkable. So we've got these raid gains in early aate detection, rapid gains in treatment, and alongside with GLP on's, the potential for rapid gains in prevention as well. Yeah. And one other thing which is playing out There's a new type of drug called an SIRNA, which is a drug which goes in It blocks the genes, so the genes don't work properly. So if you find a gene that's causing trouble, you could block it quite easily And that comes out of a company in Boston, but has been developed to reduce people's cholesterol and to reduce people's blood pressure. Those are being coupled together So that with a single injection You're covered for cholesterol and blood pressure for a year Come back next year, get your fu vaccine and have a shot of the SIRNA I mean, these are remarkable innovations that are going to make this whole story just a lot easier to deliver and presumably again with a lot of this the life extension, sorry, there's going to be all sorts of interesting second order effects that we're only just starting to think about. like all things that are disruptive. If you get on top of this healthband thing, it's going to create all kinds of other issues that we're going to have to deal with That's why I think We just have to be a little bit more dynamic and and take a bit more risk. So you know we've become very risk averse in this country. You know I think we need to say, actually, why don't we have a go and see whether it'll work? Well, that's a wonderful note to end this on, Sir John. Thank you so much for joining us on Radical. It's been a real pleasure. Yeah. nice to talk So Professor Sir John Bell has just left the studio and one thing I found really, really interesting and it has just changed how I think about all of this is that The previous wave of medical technology gains, as it were were extending lives but not always making those extra years healthy years. People were living longer, but a lot of those years were lived in poor health. That was not good for them. It was not good for the healthcare system that had to spend huge amounts of time and money supporting them in those years. Whereas now we're looking between the breakthroughs in prevention in terms of the anti obesity drugs In addition to personalized medicine and that kind of thing, it feels like we're now talking about extra years, which will also be lived in good health I think that's really quite remarkable It's also worth, I think, taking a second to say that you know we always talk about radical change on this show, but there were also several things that Sir John said at certain points, which you might have felt were quite radical He touched on China, he touched on AI, he touched on the NHS, and all of those might not necessarily have sat well with yourselves On China, a lot of people have concerns about its human rights record and whether we should work with a country where those sort of things are happening. On AI, there's the question The related question of Palanter and its role in the NHS This is obviously a topic and a story that has been covered in huge detail in the UK recently, there are a lot of people with a lot of concerns about what the downstream consequences of working with a firm like this might be And on the NHS itself, obviously a lot of you will have strong positive feelings about the National Health Service And therefore, some of Sir John's suggestions and comments about how the NHS is currently running can be done differently. might not have sat comfortably with you. But probably well, surely the most striking thing from that conversation was that we had here One of the preeminent figures in this field who has been doing this stuff for decades. and who says that in all the time he's been working on this, He's not seen anything like what he thinks is only ten years down the track, which is that we could be on the brink of effectively curing. a large portion of cancers I just think that Astonishing. and I'm sure a lot of people listening today will have had a conversation at some point in their lives where they were told that someone they knew had cancer. And those conversations are always incredibly difficult and painful for everyone involved And this idea that we might be onlynly a decade away from a place where