Fact checking, misinformation, wildfires, and institutional memory
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Hello and welcome to The Lancet Voice. It's January 2025, I'm Gavin Cleaver and I'm here with Richard Horton, editor-in-chief of The Lancet, and Jessamy Baganal, senior executive editor of The Lancet, for another of our freeform chats about things in the news and on our minds. Today we're going to cover the recent news of Meta dropping fact checking from its platforms and what responsibilities we as scientific publishers bear going forwards.

as well as talking about the wildfires and climate change in the US, and thoughts about memory and remembrance sparked by Richard's recent visit to Argentina. If you have any ideas for things you'd like to hear us discuss, please do get in touch, and you can do that at podcastsatlancet.com. I hope you enjoy this conversation.

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

We can't escape the decision made by Meta to drop its professional fact-checkers from Facebook and the impact that's going to have on science, trust in science and scientific information more broadly. And in all the discussion about Meta's decision, the dimension of the impact of it on science and trust in science hasn't really been discussed.

thought about so much. It's really extraordinary that the idea that you can replace professional fact checkers and moderators with some user generated community notes, which is the plan that's outlined, similar to Twitter X, that that in some way is going to be able to

protect the validity of information that's on Facebook. It's really remarkable. We're going to see a worsening of misinformation. We're going to see exacerbations in far-right radicalization. We're going to see more anti-migrant and other kinds of hate speech. We're

we're just going to see a dramatic increase in the amount of toxic content on Facebook. We've seen all of those on X since Elon Musk has taken over and, in the name of free speech, removed the alleged censorship of content. Meta says that

the whole fact-checking culture has got too complicated, too bureaucratic, that it is indeed censoring content. But what it looks like, and I think what it most probably is, is the total capitulation to President Trump coming in at the end of January. And

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

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

hate, coercion, even violence with words. Words can be violent. We should all have a commitment to trying to strengthen trust and credibility. And we should all have a commitment to trying to improve the quality of public deliberation, not just the quantity of it. And this decision by Meta is such a catastrophic one, given its influence globally.

We're going to roll in an era of what is nothing less than chaos and anarchy into the information space. And part of that is going to be misinformation about science, whether we're talking about vaccines, whether we're talking about climate, whether we're talking about pandemics, whether

We're just opening the floodgates to an avalanche of indeed disinformation, which is going to really contaminate the public debate. And so I think we in the medical and scientific community need to be speaking out about this much more strongly than we have done. Do you think Meta ever had much of a commitment to fact-checking? Now we know obviously they're getting rid of the fact-checkers, but...

I think also it's worth arguing that Facebook and Instagram have long been vectors of misinformation. They have. I do believe that the Oversight Board has taken...

the idea of truth and credibility seriously. I do believe that within the limits of the fact that it's a business, Nick Clegg, when he was working there, was genuinely concerned about protecting the reputation of Meta by not allowing the extreme elements of misinformation to flourish. But, you know, Nick Clegg's

left or leaving. The Oversight Board hasn't exactly objected in the strongest possible terms to this change in policy. So I think they were committed, but I think it's the accession of Trump 2.0 who's just made everybody extremely nervous. And so they are bending to his will in the most frightening way.

I think, you know, they committed in the order of millions to Fact Checker. So that is a commitment for a, you know, financially based company that we know wants to make more and more profits. So I think, you know, regardless of how effective it was, you can certainly say they committed budget, money, personnel. They set up a whole organisation of Fact Checkers or worked with independent Fact Checkers. So

So I think you can, you know, that's definitely the commitment there. For me, the problem is, is that we now have a total divide from institutions like the Lancet or, you know, even the Department of Health in the UK, which is taking misinformation in health extremely seriously, or OECD or WHO, and massive, massive

unregulated, hugely powerful organisations that are saying actually no, misinformation, disinformation no longer matter to us. We are not about to stand by any type of regulation that might try and improve the quality of the information that we're allowing our users to see. That is a major problem. That is a huge division.

And the offshoots, the trajectories of those are massively divergent. And the following consequences are huge. So I don't think we should underestimate, you know, whether you quibble about whether it was effective or not affected. It's a big deal. I think partially the reasoning for it was what really stood out to me. And the idea that fact checking is in some way politically biased is,

The idea that countering misinformation actually particularly discriminates against Republicans was a lot of the undercurrent of the announcement. And it's just a really, it's a bizarre way of framing things because if you've got one side that is sharing, and studies show that Republicans share four times more misinformation than Democrats, for example. If you've got one side that is oversharing misinformation,

It's not then politically motivated to clamp down on misinformation just because one side is the one creating it all. It's a very bizarre set of priorities and that was really illustrated by, I think Mark Zuckerberg said that they're going to move

matters fact-checking away from California and had more in Texas, which isn't going for the middle. It's going from one extreme to the other. But also what scientifically we know about these algorithms. There was a great study in 2018 in science which showed that lies spread faster than truth in the order of thousands. And when you know that about your own platform...

You know that lies spread faster than truth, that they will get more attention, that they'll be spread more widely. And then you say, that's okay. We're not going to try and even limit lies. That's such a huge problem in my view. Yeah, there was another study that was published last year, actually, that was from Princeton that was looking at how misinformation

sources provoke more outrage amongst users of social media than trustworthy information. And that outrage, people are more willing to spread outrage from misinformation than they are to spread trustworthy content. So the, the, the,

propagation of outrage embedded in misinformation yeah it it spreads so much faster and that's why you have to have moderators to dampen that down and if you take the moderators away now the argument for meta will be well we're just changing who the moderators are this is now going to be the community is going to moderate but i don't that that's not good enough i mean

we're all part of the community. And certainly when I look at, I tend not to look at Facebook very much, but when I look at X, then I don't spend my time, I don't have the time to, and I'm not employed to be a moderator. So I don't post user generated content to moderate what I, what I see. You need professional moderators, a bit like

our role as editors, professional editors, if we published every single article that was submitted to The Lancet, we would have chaos and anarchy in the way people thought about health and medicine. And we don't.

And what we do is we put everything through a peer review process, reject 98% of it and publish a tiny, tiny proportion. And we do that for a reason, because we're privileging quality over quantity. I'm not saying 98% of comments on Facebook should be moderated, but you certainly need to have quality.

some kind of oversight process so that you're improving the quality of public deliberation. And I really, you know, there is no qualitative distinction between a scientific journal and Facebook. We're all in the business of publishing information. So what's the responsibility of the organization to ensure the veracity or

the quality of that information, surely that's the first priority. I completely agree. And responsibility was something that I was going to bring up because we've seen Meta or Facebook time and again try and remove themselves from responsibility. We're not publishers. We're not newspapers, even though the majority of people are getting their

you know, and when this comes down to it is what is dangerous and what is not dangerous, what's going to incite violence, what's going to actually physically harm people. We've seen that with the Rohingya crisis. There's good evidence to support any of that. So there is also an issue of responsibility and governance here, which is going to be completely removed. And I take the point that Wikipedia, for example, I think is a good example where they're, they're,

There are checkers. I don't really know the ins and outs of the business model or those people that are checking Wikipedia, but it is very factually correct. And almost instantly, it seems, people will change things on Wikipedia. And that's obviously a concept of community of people actively sort of embraced and committed to the project and willing to dedicate and spend time on that. That's not Facebook. No.

Or X. Or X. This is a different project. It's a different setup. And then the other thing I wanted to segue to, which might be too far out there, but I started watching last night this documentary on Netflix about the Jerry Springer show. I don't know if you've watched it. I haven't seen it, but I remember the Jerry Springer show. You remember the Jerry Springer show. So...

It's basically all about how they made the Jerry Springer show so famous and how much people loved it. And it's all about lies, emotion. Outrage. And outrage. And although we can sit here and be surprised that mis- and disinformation is such a huge problem when we've got social media, actually, when you look back at those Jerry Springer shows of the early 90s,

We didn't have really mobile phones. No one was on social media. There was, you know, the internet was just starting. The outrage, the human connection that was born out of these stories, lies, hatred, human suffering was so huge and powerful.

And now we have this sort of amplifier of it, which nobody is willing to take responsibility of and actually wants to propagate. Well, I think outrage has always engaged people, right? And I think...

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

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

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

newspapers being funded by print adverts to newspapers being funded by online adverts now not only is that a huge drop off in money obviously but it used to be that when you had a newspaper funded by print adverts you could focus on the quality and the editorial contents of a newspaper because as much as the circulation mattered it was still actually people were buying it for the whole

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

So we're all stuck in this engagement loop at the moment and we're treating the word engagement as if it's something neutral. But as you say, without Jerry Springer's point, it's never been neutral. Yeah.

And I suppose from an information integrity point of view, I do think it's, you know, we all use Google now. When you, when you, I was, the two mats, you know, I'm on that podcast. They were talking about this the other day. When you use Google and it gives you a summary at the top, if you ask it a question, it automatically now brings up a Gen I, I chat GPT or, you know, their equivalent Gemini summary of what it is. So like in preparation for this, I was looking at wildfires, right? Have wild. It brings up,

And for my children, that will be fact. But where is that algorithm finding that? And if we now have, you know, OpenAI have just donated to Donald Trump's campaign. And if we now have a tech world which says information integrity is not an issue for us.

What does that mean then for the algorithms that are trawling the internet for the next probability related word and content and for that statement of trust or truth where we're finding our information? I think it's extremely worrying. Yes, a lot of those AI summaries are literally false. Although a good tip for anyone listening to this podcast is if you type minus AI at the end of your Google query, it will not come up at the top. Oh, really? Yeah. That's good. The

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

with the goal of getting a very quick and easy publication, manipulating citations, and getting a PubMed indexed article under your name. And a lot of these are being published. And some journals have seen literally increases of more than 100% in terms of the number of letters and comments they've been publishing.

because they're not having sufficient critical scrutiny of these AI-generated, you know, bland, not really saying very much pieces.

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

So we have to be super careful because these letters and editorials that are literally flooding the scientific literature right now, we have to stop that because that is also, it might not be disinformation, but it is going to be misinformation because we don't know 100% whether these authors actually exist, whether they're institutions, whether they're employed at the institutions they say they're employed at, or anything at all. These are...

These are completely fabricated pieces of content that are getting through the net of journals. So you can see how the whole system is amplifying bad content. No moderation at social media companies.

journals not really functioning in the way they should be functioning. So allowing this avalanche of bad content to be published, you know, it's and then, of course, the AI processes themselves that generate this content. I mean, it's and the incentives within the academic system are

that encourages that because people measure the quantity of publications they've got. And even a letter in The Lancet is still seen as something that's, you know, positive on your CV. But if that letter in The Lancet has been generated by AI and that half the authors don't actually exist and don't work at the institution, you know, we're in a real mess here. I mean, the risks are huge, aren't they? I mean, I think we should just lay them out in terms of health, really. Yeah.

What do you see as the risks, Richard? You know, for your person listening who is a healthcare worker. Well, at the worst end, at the worst end, it's fabricated studies which get into the literature and then into systematic reviews. There's a very interesting, I think it's only a pre-print at the moment,

But there was a very interesting study done of a bunch of Cochrane reviews. Now, Cochrane

as everybody, well, as many people who are listening to this podcast will know, and the gold standard systematic review is a Cochrane review. They have books worth of details about how to, on methods about how to do a Cochrane review. And what this group did, they took 60 odd Cochrane reviews and they looked at all of the randomized trials in those Cochrane reviews. And they

flagged concerns in a quarter of those trials and serious concerns in about three or so percent of those trials and what that means is serious concerns means fake studies um so if you've got the the the world's most reliable database of systematic reviews already infected then

up to a quarter of trials in that reliable, so-called reliable database, already infected with potentially fraudulent or fake studies, then we've basically not just polluted the literature, but the decision-making, without wishing to be overly alarmist, but the decision-making that clinicians then make on the basis of what's meant to be the most reliable totality of evidence available,

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

clinical care. One thing I wanted to talk about before we moved on actually as well that's occurred to me while we've been talking is that we're talking obviously about moderation on what are public forums

So that's posts on Facebook or Twitter that are available for everyone to see. But actually quite a lot of dangerous extremism and radicalization occurs in these closed wall forums and we don't really have a solution for that. Apps like Telegram, which can be run by extremely nefarious people, have no oversight whatsoever but can have closed wall forums of thousands and thousands and thousands of people. And we saw the outcome of quite a lot of that in

in the recent riots in the UK, for example, lots of which were organized by telegram groups, some of which I have no doubt were infiltrated by foreign bodies, for example.

But Meta still has an issue with those as well, because Meta is full of closed groups of thousands of people that have no moderators, or if it does, it has moderators who are part of the community. When you say closed groups, just to expect, because I haven't heard that before, what is a closed group? You have to apply to join. And so the posts will not appear in your feed unless you're a member of that group.

But what that does is that everyone inside the group just starts winding each other up. And so they become more and more and more radicalized. And actually, this is where so many of the problems arise from. A lot of medical misinformation is

was shared during the COVID pandemic, for example, in closed groups that were called things like, you know, concerned parents for COVID, things like that. There's a children's defence fund as an example, which sounds very meritorious, but isn't. So the needs, not only should moderation not be walked back, we need to also find out a way of ensuring information isn't spread or kind of like...

I'm struggling to find a way to phrase this. This is not intrusive, you know what I mean? Yeah, yeah, yeah. Because people have a right to privacy, but also these large apps like Telegram or these closed groups on Facebook have a real issue with radicalizing people. I don't think radicalization is too strong a word. No, it's not. Absolutely not. I think that's right, Gavin, and I think also, you know, the argument is

or the counter-argument to many of our sort of hand-wringing and concerns is often, well, there's lots of groups, there's lots of things on social media that are really good for patients and people. You know, they connect about their diseases, their pathologies, they talk about, you know, their support groups, symptom control, there's family support. There's lots of beneficial things. And we always say when we have these discussions in our data meetings or elsewhere, we can't be too negative, we have to give the positives.

I kind of am moving past that at the moment and feeling like actually that could be anywhere. That could be on any platform. The NHS could run its own signs for patient support groups or it could be on any different type of platform. These people that want to come together and support each other is excellent. But it isn't an argument for why meta or why X is so good, I don't think, anymore.

I think I said once in a leader meeting several years ago now that after the invention of the printing press, there were centuries of war. And what is social media if not the democratization of the printing press? Yeah, well, it's, you know, I always, I remember when Twitter, as it was then started, I really did buy into the idea that this could be a truly global conversation.

and be inclusive and marginalised groups would be able to join. And it was really just a question of getting an internet cable to everybody in the world. And we'd have this, you know, egalitarian paradise of rational debate. And I couldn't have been more wrong. And it's turned into something of a nightmare.

But that's where we then have a really important responsibility. And I wonder if this does say into the second issue we were going to talk about, which is around the wildfire. So we want to discuss the quite terrible situation in Los Angeles County at the moment. It's hard to believe that...

that a city as advanced as Los Angeles could have allowed, actually is the word, wildfires to kill and maim and destroy in the way that they have. But the question I want to ask is, could this be a watershed moment for America? Because America...

You know, it's the biggest polluter in terms of, you know, America and China are the two that we've got to really get to grips with if we're going to get global warming under control. We crossed the 1.5 degree threshold. It was according to the European Union Copernicus service in 2024. It's only one year, so it doesn't fulfill the Paris criteria of crossing the 1.5 degree threshold.

But it has been crossed in one year. Could the wildfires in Southern California be the trigger for America to be, instead of rather a sort of blushing bride at the cop party and not really being a great leader...

To really understand that this is a threat to their society, that the climate crisis is killing Americans very directly, destroying communities, having a massive economic impact. And therefore, they have to step up in a way that they just haven't stepped up before. Could it be a watershed moment?

You would so hope, but when you listen and look on Twitter, it's not because if you wanted to be

a conspiracy theorist about it, there is an avalanche of misinformation which is misdirecting people from why we're having more wildfires, which we are. We know that 2020, 2021 and 2023 were the fourth, third and first worst years for any wildfires. In 2023, an area the size of Nicaragua burned globally. So climate change is making forest fires worse and wildfires worse. But

Before we could ever get there, we first have to talk about the wakarati, the lack of water, the fish, the huge diversion that's going on in the US political landscape. But what is the misinformation then? Away from climate change. What is the misinformation? The fact that this is due to DEI budgets.

This is due to, you know, the fact that there are too many, that a couple of white male firefighters were fired and their DEI initiatives. And that's why these wildfires have started or because Gavin Newsom didn't sign a deal that Trump never made.

or that he's too worried about a bizarre fish in California. There's so much out there that is diverting away from the actual problem, which is that this is climate crisis here, now. Okay, you've obviously done a better job of surveying the misinformation than I have. Now, when we said we were going to talk about misinformation... But it's very extreme. But we didn't even read all the misinformation. On air.

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

So it's not like they don't know that this is a problem. This is why I wonder whether it could have been a watershed moment. But I think what you're saying is no way. I would so love it to be. And maybe there will be, you know, an elite group of people in California who are movie stars who have had their homes lost.

that will see this as a watershed moment. But there will be a whole load of people in America who are getting a different source of information, which is that this is because of diversity and inclusion projects. This is because of the Democrats being too soft on everything. This is because of a woke karate who, you know, wouldn't even talk about outside because they were worried about a fish project.

And they won't ever get to know that wildfires are getting worse because of climate change. Because wildfires is one of the indicators that we monitor in our wildfire countdown. And if you track it over the past several years that we've been doing it, it's been getting worse year on year. So nobody can say we didn't know this was coming. So I'm just thinking, what can we do to...

bolster the science around wildfires and the risks to try and counter this. I mean, this is, you know, I don't want to say this is because it's all terrible, the damage that has taken place and the deaths and it's not over. But there is an important moment here that we could, could we step in and try and help the

counter this, this tirade that you're describing. I'm just wondering whether, you know, our countdown initiative might be something that could, could make a contribution. Because with the Trump regime coming in later this month,

I don't know who's going to be their climate change czar, who's going to replace John Kerry, who did such a, you know, pretty fabulous job. Tireless. Unbelievably. It's really, really important because if America doesn't step up, nobody else will. China certainly won't. Other countries won't.

So they really have the decisive role coming into Brazil for later this year. I think one of the interesting things for me is going to be probably a knock-on of what started to happen in Florida. And that's that insurers are going to start refusing to insure homes. So there's already talk about insurers refusing to insure homes in areas in LA that have burnt down.

In the same way that insurers are now refusing to insure homes around the shore in Tampa, for example, which is repeatedly hit by hurricanes flooding pretty much every single year by this point. So that is sort of the interesting tipping point for me. If it comes to the point where business stops,

making people sure that they can get redress in these cases, is that the point at which people go, OK, we have to do something here because actually we're going to start having entire districts and cities abandoned? And what will happen in Tampa? That means people won't have homes constructed, presumably. No, well... They're not going to get insured. Yeah, people won't have homes constructed, but it almost needs...

a few years to work itself out because you're going to have people stuck there who can't sell their houses or the land that the houses are on because people won't buy it if they don't have the possibility of getting insurance then subsequently. So it then becomes a question of what do we do with these places? And then you'd hope that that was followed up by a larger investigation as to why these things keep happening. Well, I mean, the Republican, you know, are already saying that they'll withhold money.

aid and funds to California because it's a democratic state, even though they've got six million votes, six million people that voted for Republicans in California. So there's going to be a lot of that. Trouble is, you know, I mean, I don't know if you've seen the film Civil War. It's a film, I think. It's a California breaking away. Well, it's basically, it's America splitting into two

Canada, Greenland, and even California. The film is very careful not to settle on a particular political side of the split. So in the film, it's the combined forces of California and Texas. It's the Western states. The White House. Yes, the Western states is the way. And it starts off with the president at the time preparing to give an address to the nation. And he's...

And he's trying to practice his words and fumbling them a little bit. But he's declaring the fact that they have had this great victory over the Western states. And, you know, the role of a political leader is,

In a country like America, where half of the country, 70 plus million votes went to Kamala Harris, 70 plus million votes went to Donald Trump, you've basically got a split nation. And either you try and heal that nation and bring people together under a common agenda, or you continue to exploit the polarization. And

I think you know which way. But you know, there is a logical end point to this. It's not just polarisation on social media and these closed groups who don't talk to each other and who foster hate speech. But if you have it in your politics as well, then...

you know, the fabric of democracy starts to unwind. And it's pretty frightening. It is. I think it's been a rapidly terrifying start to 2025. So these wildfires, then, they're not going to be a moment in future. Honestly, I really hope that we're sitting here in a few months' time and that's the case. But I just, not from the social media outpouring that I've seen. Would you agree, Gavin? Yeah.

Funnily enough, recently I've been going back through old Lancet Voice episodes to add transcripts in. Right. Which for our listeners, many of our old episodes now have transcripts. Yeah. Oh, that's good. But, um...

it strikes me with a lot of the covid era episodes that you and i worked on the hopeful tone that we strike that this would be a turning point for uh dealing with that first episode dealing with um key workers for example or kind of building a better and fairer society from the depth of the lockdowns you know kind of looking at things in a different way and um you

You'd think if anything would be a turning point, it would be a global pandemic that affected, that touched literally everyone on Earth. So I guess I'm not particularly hopeful that this will be the turning point. I think America still has a long way to go before it embraces the sort of radical action that tackling climate change would require. Yeah.

In the meantime, talking about downstream actions that everybody's probably going to start getting excited about with technology. I was looking this up. So it's all about detection monitoring. So you're trying to detect wildfires from space, having networks of cameras and sensors to detect early wildfires. So each tree has a sensor on it.

And then you basically have a whole forest which is sensorized. And as soon as a spark happens, drones are sent out to immediately extinguish them. What science fiction? This is real, isn't it? This is where the research is going for forest fire management and technological innovation. Firefighting robots, right?

and mobile phone data for evacuation. I think, you know, we're seeing that already. So there you go. What's more likely? America tackles climate change or it builds 10,000 roads with 10 million sensors that go on trees? That's actually...

This is more likely. But from a healthcare facility point of view, there was a study in 2022 that documented half of California's total inpatient capacity is within 0.87 miles of a high-risk fire protection threat zone. So I was trying to find out some more information about the healthcare facilities. From yesterday, it looked like more than 700 people have been evacuated from care homes and hospitals and a few clinics have been totally shut down or even... But...

you know, that study from 2022 suggests a much bigger problem, 0.87 miles of a, you know. It all feels a bit depressing, doesn't it?

Well, I mean, you know, they're striking a slightly more upbeat tone with the technological innovation and solutions that could be very downstream. I feel like quite a lot of hope on tackling climate change by this point is foreseen.

fixated on technologies that don't yet exist. Do you know what I mean? Everyone's sort of hoping that we'll get to the brink and then someone will have a massive breakthrough and somehow pull us back. We can suck the carbon dioxide out of the atmosphere and that's going to solve our problem. Yeah. Yeah.

I don't know if that's the most upbeat thing I could probably say about climate change. Although, the other thing that strikes me a lot is that doomerism is quite a tactic, isn't it, used by people who don't want you to talk about climate change. Yeah. It's the whole book. Remember, we interviewed him. Yes, Noam Chomsky and Robert Pollin. No, the other one, Michael Mann, I think. Michael Mann, yes, you're right.

Yes, I do remember that. That is interesting, isn't it? Because he was extremely cheerful about... I don't think he was neutral, but he was saying we can't become... Doomerism, delayism and denialism are all on the same spectrum as narratives and tactics that are used by people who don't want to engage in conversations. It has Hannah Rich's argument about not being doom and gloom about it. Exactly.

It's not a threshold. Having talked about a threshold of 1.5 degrees, that might be in the Paris Accord, but we shouldn't think about it as if we cross it, then it's at the end of the world and catastrophe and we're all annihilated. We should be fighting for 1.1 of a degree. And I think that it's not a book that is wholly optimistic. It's completely...

her argument and you know she's the head of um or deputy head of uh data our world art of our world in data exactly um

So it's not that she's sweeping the problems under the carpet, but she's saying that we need to be much more optimistic about the struggle that we need to engage in, whether we're talking about atmospheric pollution, microplastics in the ocean, carbon dioxide in the atmosphere. There are things that we can do and we can do.

And rather than pull the covers over our head, which is the tendency sometimes, we need to really be much more engaged. You know, in the Lancet's climate countdown, we have people who argue very passionately that we've got five years. And if we don't solve it in five years, then we might as well all go home. And it's a very dramatic statement to say that.

But I think it's a strategic mistake to approach the argument like that. I much prefer Hannah Rich's approach. I agree. And I think it's a more inclusive approach because there are so many people around the world who, you know, are very international, are extremely well educated, are up to date on everything.

not necessarily the latest science but you know they're looking at finance they're in ESG or and they're not feeling like that they're not about the the political winds are not about to change so magnificently that things are going to happen in five years because those people in those worlds are are not on the same page absolutely absolutely

Are you going to lift us up with Argentina? I feel like having read your offline last week. I'm unsure. I wanted to, it's relevant to our conversation about memory. Yeah. And you've mentioned about, Gavin, you've mentioned about the pandemic and in your early podcasts, you were thinking, well, you know,

given what's happened, surely we're going to provide a better, we can create the conditions for a better society. And remembering what happened in the pandemic is so important and not letting that memory disappear. But just as we're saying, every 0.1 degrees Celsius we should fight for. So we need to fight for memory, for the memories of our society and our culture and what

what counts as part of our memory and the meaning of that memory. And it was really brought home to me over the holidays because I went to Argentina to actually meet up with my daughter who's traveling in a gap year. And

we went to a what is effectively a museum of remembrance it's called ESMA I won't destroy and vandalize the Spanish by trying to repeat it but it was essentially in English the Navy Mechanics School in Buenos Aires and

During the period of really astonishingly violent dictatorship between 1976 and 1983, so only 40-odd years ago, not that long ago, it was a centre for detention, torture and extermination under the military junta. And you can go into this building...

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

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

And you only had to have written a poem for a vaguely left-of-centre magazine, and the forces of the junta would come round and take you and abduct you and take you to Esmer. So there are a substantial number of women, young women, who were abducted, kidnapped and taken there. And some of them were pregnant.

And so what happened was that doctors would deliver their babies and then the children were then given to allies of the dictatorship. And then the women were murdered.

and murdered often in the most horrific ways. Arms tied behind their back and taken over the ocean and literally just dropped in the ocean. And they actually have one of the planes which did this in the grounds of the museum. So...

There was an organization after 1983 created called the Grandmothers of the Place de Mayo. And they set out to identify these children and to try to reunite the children with their original families. And just in the last couple of weeks, the 138th child has been named and reunited with his family.

real family. I mean, you can just, you can't actually imagine how awful this would be. You've grown up as a child thinking you're part of a family. And then the grandmothers of Plozomai come along and say, well, actually, your mother, and most likely your father, were kidnapped and killed by the dictatorship. And then you were given to this pro-dictatorship family who are not your real family. And here, you're

are the because they're the grandmothers of the children you know because the parents were killed um and now here's your real real family and so they've got to the 138th child that they've identified just around um christmas and just after christmas uh president javier mille has um fired half of uh uh

who work in these remembrance sites, in these museums, the sort of National Memory Archive. And indeed, I visited the Geraldo Conti Centre on December the 27th. And no, December the 26th, it was Boxing Day because it was closed on Christmas Eve and Christmas Day.

And they closed it just a few days later. And the plan is not to reopen it. They're talking about it's going through some internal reorganization, but essentially it's now closed.

And Millais, who's an anarcho-capitalist, self-described, who used to carry a chainsaw in the campaign and wants to do all these public sector cuts, is trying to rewrite the memory of his country to eliminate this from the national consciousness.

And since then, there have been protests in the streets. But in Argentina right now, there is this real social struggle for the memory of the country. And what counts as the memory? What lessons do we learn from this dictatorship? The Malay argument is called the two demons, that there were...

guerrillas who were anti-government and the government was simply trying to bring order to the situation but this argument there was a investigation after 1983 which showed that this was completely false that the that the military dictatorship was is one of the most violent military dictatorships in the history of humankind but that even 40 years on now is being fought for

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

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

So, yes, I just I only wanted to bring it to the table because I do think that it's very relevant to all countries. Every country has a history and how we take that history into the present is

It's so important for us to think about those lessons. I mean, for us, we can talk about it as our history of imperialism, or more recently, the pandemic, and what lessons are there for our society. And it's really important not to take that for granted. And I guess I hadn't really seen...

seen it up so it took going to another country and seeing the literally the terror that existed between 76 and 83 and still there's this fight over what it means to really bring home that that's you know we all face that in whatever whatever nation I think it's so relevant for now because it it does also feel that we're at a slight inflection point in that we've

There was so much remembrance about World War II and the whole multilateral organisation and structure of our world was set up to, geared towards that. We all acknowledge that it's by no means perfect and it needs to change, it needs to move into the 21st century. But what we have at the moment are people like Elon Musk speaking to ADF in Germany, roots in Nazism, wanting to erase that memory forever.

as a reaction to the fact that these structures are not working for a 21st century, rather than constructively saying we need to keep that memory. The things that have happened in the past are still relevant. Which party, where you have come from is still important. It's just that we need to move forward to a new time. And I feel that there are lots of people who are trying to rewrite history

the last 70, 80, 90, 100 years because we all acknowledge that things do need to change. We're facing all of these major global crises. We've had systems that have not been as fair as they could have been. But it's the way that different strands are doing that that I think is very concerning. And that particular example seems quite symptomatic of a lot of actions that are going on globally. Yeah, I mean...

Really, every country. History is living. You know, France, Jean-Marie Le Pen dies. And you've got Marine Le Pen. She got a third of seats in the parliament. And Jordan Bardella is leading Roussel de Monde National and could be the next prime minister.

or president rather, next president. I mean, it's, you know, absolutely frightening where we're at. And if you don't take the history, you know, a party that was born out of being and keep it alive, really, really keep it alive. And again, I think that, you know, I feel very much that, you know, we've been around for 200 years. We're part of that National Memory Archive that every country has. And

And so in a way, it's partly our responsibility to remind people of what that memory is and what lessons we draw from it. And actually, the pandemic is a very good example because I felt the same, that this was, again, could be a watershed moment to recognize people in our society that had traditionally been pretty much invisibilized and silenced.

and to reorder our priorities. And that hasn't taken place, not yet. It's still only a few years after the end of it. The long-term impact could be great, but it will only have an impact if those of us who are in a sense stewards of the memory archive, and we are modestly in one very, very small corner of that memory,

if we if we promulgate those messages do you remember we had um laura spinney on this podcast to talk about the 1918 flu pandemic and her superlative book about it and it struck me talking to her in that interview how little institutional memory was retained of the 1918 flu pandemic coming as it did off the back of world war one um

But it just makes me wonder if we will retain any lessons from the pandemic. I wanted to say actually, Richard, I had quite an analogous experience to yours. I visited Vilnius, the capital of Lithuania last year. Lithuania, as many tour guides impressed on us, used to be the biggest country in Europe.

And then it had a history in the 20th century of first after World War I, it was occupied by the Soviets. The World War II, it was taken by the Nazis. And then just after World War II, they were liberated in inverted commas by the Soviets again, and then did not regain independence until the early 90s.

And there are many museums to the lost Lithuania in Vilnius. But the one that struck me the most was the former KGB headquarters in central Vilnius, which is now a museum to the horrors inflicted by the KGB occupation. And the room, I think, that will stick with me always is there was an execution chamber. And obviously, this is still happening up until 1991, which is incredible to think of, where...

People were led in and then unceremoniously shot in the back of the head by someone who was hiding behind the door. And you can look on the far wall and still see all of the bullets encased in the wall. But now Lithuania is facing down an expansionist Russia again, a warlike Russia on the border and Belarus assisting at its other border neighbour.

I think the talk about memory is... Do they hold that memory as very much part of their current identity? I'd say it's the central part. I only spent a week in Lithuania, so I don't speak for the people of Lithuania, but I'd say it's the central part of their identity and a sort of fury as to what was lost for almost the entirety of the 20th century. Yeah.

There was a study, which I'm going to misquote, that said that the population of Lithuania would be more than twice the size if they hadn't been occupied in the 20th century. So many Lithuanians were forcibly deported to Siberia, to the gulags out there.

that the population has never really recovered. And as our tour guide in Vilnius was telling us, there's not really anyone left that called themselves Lithuanian who lived in Lithuania in the 1950s and 60s. They're all now people from other countries who call themselves Lithuanians. So it's quite a striking example and something, the memory that they hold extremely close and is a central part of their identity. But

now is obviously threatened again yes so they have good reason to fear russia yes i know all the baltic states i've also visited talin which has some very similar um museums and exhibitions in in the center and uh these huge gigantic sprawling prisons that there are the soviets built in these in these baltic states it's um it's incredibly striking i had

It sometimes makes me think of, there was the philosopher George Hegel who used to say that...

societies eventually lost their memory and went sterile. And that's the point at which war comes onto the agenda again. You said that societies needed the rod of war to stir them up and to create these institutional memories. And then at that point, everyone is so horror-struck by the war and the inhumanities of man that peace can descend, we'll build the institutions properly, and everyone's nice to each other again.

I'd like to apologize from my PhD supervisor for that reading of George Hegel. Professor Haddock, if you're out there, I'm sorry. Yeah. But it's very interesting to look at the role, and again, also in health, of a country like Japan. After the dropping of the bombs in Hiroshima and Nagasaki, a very, very aggressive nation

with a very, very aggressive and brutal army, very quickly turned into one of the chief advocates of peace in the world. And also, there has been an incredibly strong and valuable tradition of promoting health

and universal health coverage. Universal health coverage was achieved in Japan in 1961. The commitment of a country coming out of war, turning its side, you know, using its memory to

to, in a sense, recreate its identity in the world, both at home and also in the rest of the world, is remarkable. And certainly in global health, people from Japan have been some of the leading advocates

for universal health coverage because of their achievement. They've been one of the most innovative nations in terms of building a social care system with a long-term health insurance. And that memory of war is still very, very much informs the way they see themselves in the world and the contribution that they wish to make in the world is very much informed

by that history. So it really does have an influence in the present day. And one really can respect that.

And I think learn from it, actually. And in the UK, I'm not always sure that we do as good a job as we could there, as we talked about most recently with the pandemic, but also historically. You know, the creation of the NHS in the 1940s post-war, an incredible achievement. And I'm not sure...

You know, whether we now face the challenge of building a social care system, but where's the political leadership to do that? Actually, I mean, there had been a lot of work that had gone on in the run-up to creating the NHS.

But, you know, Attlee didn't say, well, let's wait four years for, have a report, commission a report and wait four years to build the NHS. He came into power in 1945 and started pretty much straight away to build the NHS. We need the same for social care today. A DNAI solution, Richard.

Now that we're going to be the souls here, maybe, you know, we could just do that. Well, it's funny you mentioned the care system because Wes Streeting has just turned down my offer to come on this podcast. So Wes, if you're listening, our doors are always open for you to come on and discuss the care system on this podcast. Richard, one word you used earlier.

Just to sum up there, in the end, I think what was super important and I think is a good kind of like ties everything together that we've been talking about is advocacy. And I think we can advocate for greater engagement with scientists, with fact-checking and making sure correct information is out there. We can advocate for stronger action on climate change and we can advocate for...

the retention of institutional memory as we've been talking about and I think we're in an important position to do all of those things to constantly advocate and it's the passivity that really actually does you in isn't it the passivity is what allows malign actors to run roughshod over everyone else yes passivity and allowing people to act with impunity you know that nobody holds them accountable

And again, I think that's another very important function of science. Because science is the system we have to produce the most reliable knowledge we have in the world.

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

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

as a force for social advance, which that ties all three together. There you go. That'll be a good spot to end on in that case. And I'd like to advocate that our listeners join us again next time. Thank you, Richard and Jess for this chat. Thank you. Thank you. Thank you.

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