The World Health Assembly, adolescent health, and the pace of innovation
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Hello and welcome to The Lancet Voice. It's June 2025, I'm Gavin Cleaver and I'm joined once again by Editor-in-Chief of The Lancet, Richard Horton, and Senior Executive Editor at The Lancet, Jessamy Baganul.

In this episode, we're talking takeaways from the 78th World Health Assembly, which happened at the end of May, including the implications of the new pandemic agreement that was ratified at the Assembly and the changing landscape of global health leadership. We'll also discuss adolescent health off the back of our new commission and the nature of measuring scientific progress. We hope you enjoy the conversation. ♪

Richard, Jessamy, welcome back to the studio. Richard, you've spent the last, well, few days at the World Health Assembly, right? I've got it written down here, the 78th World Health Assembly. And I guess I'm keen to know your observations, what happened at the World Health Assembly, your takeaways. A funeral for global health is what I think a lot of people thought that they were going to go. You know, you've seen America pulling out of WHO. The

the massive cutbacks in overseas development spending, not just from the US, but from many European countries too. So global health in crisis, was this 190 plus countries coming to Geneva to really celebrate the death of global health?

And I went to Geneva thinking it was going to be like that. And I've got to say, I came back optimistic and re-energized about what we can achieve. Now, maybe I'm being naive. Scratch the original headline. Not a funeral for global health. Well, it's a funeral for global health question mark because Tedros, the director general,

and we'll come on to this later, when we launched our Adolescent Health Commission, he came and very kindly spoke at the launch. And although he mentioned adolescent health briefly at the beginning, what he mostly did was talk about WHO. And he said that this was a moment for a complete reset.

in global health and for WHO. Yes, it was going to be a smaller organisation. Global health will have a smaller footprint in the world. But now we're going to be more focused, more empowered. And this moment of reset is an opportunity. So he was really trying to mobilise and re-motivate the audience to not lose heart. And although I

I think that one can argue with aspects of that diagnosis. For example, Michelle Kesak's gene at one session that we were all at

said, don't talk about this moment as an opportunity when people are actually dying because of cuts to global health spending. And I think that's a very powerful statement. So let's not use the word opportunity. But there's a reset that is taking place currently,

which should make us think much more carefully about what we're trying to achieve and why we're trying to achieve it. So anyway, I think Geneva was, it was a moment to try and recommit oneself to some of the principles that guide us in global health. And of course, the big achievement was

which was actually an achievement because the US delegation wasn't there, was the pandemic agreement. And if you'd asked me a year ago, whether there would have been a signed pandemic agreement, I would have said no way, no way, because the US government always blocks everything. And they would have blocked this. But they weren't there. And they didn't block it. And so it

it went through. Admittedly, a lot of people didn't turn up for the votes, but in reality, it got through and that was a huge, huge success for WHO, for multilateralism more importantly, and it's a great foundation for looking ahead.

If you ask me, is the world a safer place today than it was yesterday when we didn't have the pandemic agreement? We're not there yet, but we're on the way to having to being in a better place. Yeah, I guess. Do you have any kind of like headline thoughts about the pandemic agreement apart from that? Well, the thing that's really key about about it is really the next step.

So there's this thing called the Pathogen Access and Benefits System, PABS, and that benefit sharing system. And that is the bit that has to now be negotiated. And that's in some ways the most difficult bit because it's all about, so you identify a bug in country X and now what? Who has access to that bug? And what?

let's say a vaccine is developed, which makes a company a gazillion dollars, who should

benefit from that vaccine? Should it be just the company in probably a far-flung high-income country? Or since you found the bug in this country X, which may not have been that far-flung high-income country, should some of the money and benefits go back to them? These are all very complicated diplomatic issues where there's a lot of bad feeling about the way high-income countries have treated low-middle-income countries.

That has to be negotiated. And then in 2026, there's going to be a high-level meeting at the UN General Assembly where...

All of this is going to be discussed and where we hope real progress will be made. You'll have the pandemic agreement as the foundation. You hopefully have got the pathogen access benefit sharing system agreed. And then we can go into a discussion about, OK, now how can we make the world a safer place? So a year of intensive work ahead, but a good first start.

Can I ask a question? And it's not meant to be controversial and I'm not trying to criticise global health at this very vulnerable time. Let me just preface this question with that. And I've never been to WHO, but I get all of the invites for different things and it looks like there are some very interesting different events on and full of incredible people. My perception as someone who hasn't been, and I see it on social media a lot, is that it's very performative

And it's essentially a sort of jamboree. So I guess my question is, from all your years of going to WHA, at its best, what is it? How many years? At its worst, what is it? And where did this year sort of sit in that spectrum? So your question is...

Why the hell are you wasting your time and the Lance's time going to Geneva for a week of a jamboree? It's a very good question. I think that's an unfair reading of Jess's question. I did preface it with lots of caveats. So that is the RFK Jr. point of view. He was beamed in at one point and gave a Zoom talk to the Assembly in which he called the organisation Moribund,

and this bloated bureaucracy. So I think, I must introduce you to RFK. I think you and he would get along extremely well. We've got a lot to talk about. You've got a lot in common, a lot in common. And it's true, there is a lot of back-slapping, and some of it is performative. But I think that what we're trying to save here, at the heart of this,

It's an idea. It's not just a resolution or a pandemic accord. And the idea is that countries, by working together, can make some sort of progress. It might be so incremental as to be invisible. It might drive you crazy because of the politics of it, and everything goes at the pace of the lowest common denominator. All of that is true. But the idea that you can only solve problems

the world's problems by countries working together is one that is at the heart of the UN system and still needs to be fought for. And if you look at some of the big successes, I mean, everybody quotes smallpox, so I won't, but if you look at Framework Convention on Tobacco Control, reductions in under five child mortality, the slow but definite progress on making non-communicable diseases taken more seriously,

you can see that there has been that incremental progress, which has come from countries coming together, agreeing an agenda and recognising that they need to do something. And WHO plays a key role, not because of the Assembly, you're right. The Assembly, a lot of it is performative, I will concede that to you. But the WHO's technical guidance, it's a scientific agency,

And the technical guidance that its committees provides by convening experts, that really does help countries. You know, the United Kingdom, where we're sitting now, doesn't need WHO.

But in a low income country where the Ministry of Health has no budget and no people and is not paid serious attention to by a president or prime minister, WHO fulfills a really, really critical role of providing that normative guidance, that technical assistance, which just simply isn't there in the country. So that's what I think we were going there to celebrate and to try and save in some ways.

It is. I tell you, one thing that's interesting, it has become more of a commercial lobbying place. So I started going more decades ago than I care to remember. And it was very much for global health aficionados and, of course, the delegations from countries. Now you will see that pharmaceutical companies will hold

champagne breakfast in fancy hotels, five-star hotels, and evening events similarly designed in order to, if not present their product, then certainly to present their brand and to gloss their reputation. So

We've talked about the commercial determinants of health in the past. The World Health Assembly is now a very good example of a meeting that has been colonized.

and is colonised more every year by those commercial determinants. And that's certainly something to be concerned about. And it's tricky, isn't it? And maybe we'll come on to it at the end when we talk about our final topic. But this sort of public-private partnership, I often see documents and policy things coming out from WHO about the aspiration of how they're going to make this work, and they try and do it in different sectors and fields, and it never really seems to be...

a fair playing field for both sides in terms of what they're getting out from it and the quality of what is produced. It's a very divided debate because...

On the one hand, people will say, well, you should not have the private sector in the room. They shouldn't be there to influence policy. They might be helpful in terms of implementation, but you really need to keep them away. And then on the other hand, and it is a reasonable argument, these big private sector companies, they do have a part to play. And some of their leadership can be really powerful.

Unilever, Merck in the past, just to name but two, had a really, really powerful, important role in the MDG era. Merck, particularly around maternal mortality, the Merck for Mothers programme. Unilever, with its commitment to water and sanitation programmes.

And their CEOs would come to the meetings in New York, the UN General Assembly, and to have the CEO of Merck and the CEO of Unilever there on the stage with the UN Secretary General or the Director General of WHO. Yeah, it's a bit performative. Yes, it's a little bit symbolic. But it's actually quite important to see those people throwing their hats in the development ring. And I'd rather have them there than not there. So...

And I think today, one of the concerns is we don't have enough of those people. I don't see enough CEOs also stepping up. And if you had more CEOs stepping up, maybe you'd have more politicians stepping up too. We need more energy around global health and development. So I'm kind of with my NGO brothers and sisters who are sceptical of the private sector, and I understand why. But in reality, we're trying to build a movement here

And we need everybody to take part. And let's not be too exclusive about it. What do you think on that front it means about China sending one of the largest delegations to this year's World Health Assembly? You know, on one hand, you've got America completely absent. On the other hand, you've got 180 Chinese delegations.

delegates. So what do you think that says about the kind of balance of global health at the moment? I mean, that's one of the, I think, one of the mistakes that the US has made, that by stepping away from a multilateral organisation, they've left it open to other countries to fill the vacuum. And

China sent a large delegation. But in reality, I wish China would do more, particularly on the financing front. China is not just a superpower in science and global health science, but it's a rich country now. And

I don't think is playing its full part in financing global health in a way that is consummate with its political power.

With power comes responsibility. And China should be stepping up to that, not just for WHO, but we have two replenishments this year, one for Gavi and one for the Global Fund. You know, it's always the US and Europe who's expected to be major donors, along with countries like Japan. But why not China? China should be a full player in financing for global health, but it's not.

And so there is an imbalance. You could say, well, maybe it's going through a transition in the fullness of time. But at the moment, I welcome China's participation, but I want them to do more. Do you get the sense they're gearing up to do more? No, I don't, unfortunately. I think that they're quite reticent. The way China...

operates, at least from my observation, is it's very bilateral so that they work, the government works with other governments. If you look at the way that they have launched their infrastructure projects in Africa, it's very much China's relationship with Tanzania or whichever country. And they're less good at representing themselves in multilateral institutions. But I hope that they will.

No, that's really interesting. I was going to say one of the other big outcomes from the World Health Assembly was the recommitment to global nutrition targets and the marketing regulations around those as well. There were some really interesting outcomes from the 2030 targets that were put forward at the World Health Assembly, which was a 40% reduction in the number of children under five years of age who were stunted compared to the 2012 baseline, a 50% reduction in anemia in women of reproductive age, a 30% reduction in low birth weight, and to reduce and maintain overweight in children under five years of age.

It's great to see that sort of commitment. You know, you were talking about previously how one of the big achievements of the World Health Organization is the huge cut in child mortality. So it's great to see that as an ongoing commitment. It is. And to remind oneself that progress is always reversible. That's, I think, the big worry right now, that if you see...

maybe a fifth to a quarter of all investment in global health literally disappearing over a matter of days or months.

How do you sustain those gains? Because countries, I mean, the mantra is, well, this is going to, you know, this ends aid dependency. Now countries are going to have to think about domestic resource mobilization. They're going to have to take responsibility, pay for things themselves. Well, that's great if you're a middle income country. And I agree.

couldn't agree more. But there are a collection of very, very poor countries, resource poor countries, that there's absolutely no way that they're going to be able to fill that gap. And there are some countries that are not so resource poor that have programs that have been supported by organizations like USAID, which are now not going to be able to

pay for those programs. So I do worry that, yes, we've seen these great gains, but how sustainable are they? You know, in five years time, we could be having a very different conversation. Well, I mean, this leads us on to talking about the second Lancet Commission on Adolescent Health and Wellbeing, which came out a couple of weeks ago on May the 20th.

Of course, it's building on our commitment from the first commission. One of the key messages is the investments required, as you were just talking about. Yeah, I was thinking about this this morning, and I think we've done so many of these series that really look at windows of opportunity in a child's life all the way up to, you know, 24, really, when we're sort of saying they become adults.

We did the first thousand days last year. We did the first 2000 days. Now, you know, this one is about adolescence. And it's really about these critical junctions in a young person's life where we can make interventions that will totally change their long term trajectory of health. And for adolescents, it really seems like this is the last opportunity that you're going to be able to make those interventions that are going to set healthier patterns. And I think the overall message of the commission that,

the adolescents of today are living through such a uniquely challenging set of circumstances in terms of the external forces of climate change, the commercial determinants of health, but also some of the very internal ones about mental health and obesity. Obviously, these two things have a sort of bi-directional connection.

But there are lots of very difficult challenges that are facing them and it's difficult to see and we don't really have the data. Like I was trying to look this morning, a big focus of the commission is on the number of adolescents that are going to be obese in high and middle income countries.

And we don't really have the data of what that long-term implication for obesity in adolescence is. What is your increased risk of mortality by the time you're 50s? And we don't really know that because we haven't had that, you know, long-term follow-up data. But we know it's going to be bad. I mean, yeah, I was going to say the commission predicts that in 2030, 464 million adolescents globally will be overweight or obese.

which is 143 million more than in 2015. And it very clearly lays out not only what the health consequences are during adolescence, you know, of course we think about the long-term consequences of obesity, that you've got increased risk of cardiovascular disease, that you've got increased risk of diabetes, but it also very clearly lays out what the difficulties are during adolescence and the relationship with mental health in the long term. So...

I mean, it's worth just reminding ourselves, just a basic number to keep in your head, that there are 1.8 billion adolescents, young people in the world. I mean, that's a quarter of the global population.

I mean, this is a very, you know, this is a huge group of people who we pay almost no serious attention to. Why do we pay no serious attention to them? Is it because they don't vote? So politicians don't have to pay attention to them. And it's only because of a very valiant group of physicians and scientists who come together around politics.

we did a series first, then we did a first commission, and now the second commission, as you say, Jessamy, who've really put adolescent health on the map. And I just want to say in this podcast,

and pay tribute to the work of George Patton, who we so sadly lost during the course of this commission. But George was a great personal friend, a great friend to the Lancet, a great friend to many of us. And really, George and with his partner, Susan Sawyer, they have been the

wellspring of energy that has driven this process with a great team I absolutely want to say but if it hadn't been for those two people we wouldn't be where we are now so they definitely deserve some credit but 1.8 billion adolescents and yet

Something like only two to three percent of all overseas development. Yes, there's 2.4% Isn't that shocking? It's totally shocking And we were all adolescents once ourselves and yet somehow when you grow up to be an adult You forget so

I think the Commission, there's a lot of data in the Commission and there are a lot of recommendations there. But in some ways, there's only one recommendation that I think that's really, really important. Because we're in a critical moment now, 2025, and the world's thinking about what's going to come after the Sustainable Development Goals after 2030.

So the really, really, the thing we have to win for young people is a specific, not just mention, but a specific target and indicator for adolescent health in the post-2030 framework. Because there's no question that unless you have that target in there,

the world will not pay any attention to adolescent health. It was only because you had a target for under five mortality and maternal mortality in the MDGs that we made such progress because suddenly countries were held accountable for that progress. We need to get adolescent health in the post 2030 framework. And if we can do that, then we've got the next 15 years beyond 2030 where we can really start to

start to make progress so my call to the community that produced this commission is

What's the pathway? What's the trajectory? How do we get inside the room for that post 2030 goal? It needs to be absolutely central to the post 2030 goals, doesn't it? Absolutely. If you're talking about the health of one quarter of the global population, it seems to me pretty damn obvious that it should be there. But the reason why we've got the commission is that it's not obvious to the people who have the power to make these decisions.

Why do you suppose that is? It is because I think young people have not been given a voice. And when they are, it always seems quite tokenistic. Yes, one of the messages of this commission is that you can't... Because there was a youth commission that ran jointly with the...

with the official commission. And unless you provide a platform for young people to speak and integrate the voices of young people into all of your policy discussions, then it's very easy to forget about them. And what was great about the launch was that, you know, in the planning of it, young people's voices were absolutely central and present. And

How could how can you scale that up? So we had a side event, the launch of the commission, how could you scale up the voices of young people to the to the main events, which is the World Health Assembly, or to the UN General Assembly or within national parliaments? I mean, that's, again, if you take the UK,

we have a parliament, young people aren't represented in that parliament. So if they're not represented, therefore, nobody pays them much attention. So

The whole system we have of governance is in a sense as a byproduct designed to exclude the voices of people up to 19, 24 years of age. Yeah, I agree. And I think one of the very meaningful things that I often hear people in this community say is that when adolescents are valued, they're valued for their future capital. They're not valued for what they are right now.

And obviously, that's because it's easier to make an argument to governments that these are going to be an extremely economically active group that are also possibly going to be a burden to different systems because of various different health issues. But there is something also there about valuing young people for who they are now and the contributions that they can make for now rather than what they're going to become in the future.

Yeah, because there's a danger of just kind of seeing them as future economic units of activity. Absolutely. That's right. And also, we should be thinking that this is not just the health system that's important here. This has been an argument that's gone through all of our series and commissions on young people. And that is the education system has to be seen as an equal partner to the health system.

And we have to work much more closely with the education system. I mean, it feeds back to what we were talking about last time a little bit, to an extent, right, about well-being. Absolutely. Sort of multi-sectoral approach. Exactly. You mentioned nutrition, Gavin. So nutrition, education and health, they're very, very much linked together.

I really thought a striking sentence from the Commission was, and you touched on it, Jessamy, earlier, was talking about how today's adolescents are going to be the first human cohort who will live their entire lives under the shadow of climate change. You know, we're all getting on a bit now. We might not see the worst effects of climate change in our time, but adolescents, young people today, are going to be living with what are already the very serious effects of climate change for their entire lives. And the impact...

mental health is very easy to underestimate that or to not give it the priority or seriousness, the importance that it deserves. You know I've had conversations with some people in mental health professions, some quite senior people who are really quite dismissive of mental health issues in children and younger people.

And they don't see them as serious and that we're probably over-diagnosing problems and creating a crisis when there isn't a crisis. But I can tell you from my N equals one experience as a parent that the people who I've met in a very different generation to mine, these issues around identity,

and the future that they have and the world in which they live, these are clear and present dangers to them. We ignore that at our peril. You know, when I was growing up, not only did I not have

an iPhone. But I lived in a small community, didn't really think about world problems as being a threat to me. And now, if you're growing up, you can't not think about war. And you mentioned climate and pandemics and

All of these other transnational threats. There is almost a curse, isn't there, of having to know all the news all the time. Exactly. You can't escape it. Before the internet, you could escape this stuff. You could. But it's completely inescapable now. And you could live in the little cocoon of your family and feel very, very safe.

And I don't think that's the case for any young person today. It's almost impossible to just wrap yourself up in that little ball of cotton wool and feel completely, completely safe from the world. And when you realise that there is no safe place to go and that you are very exposed, that's a pretty frightening place for a sort of 12, 13, 14, 15 plus year old person to be.

So what do we do about it? We need to take that much more seriously. Well, one of the key conclusions, isn't it, of the recommended actions is to promote healthy use of social media and online spaces for adolescents. Easier said than done. I mean, this is a whole separate episode, isn't it? You really need to do a good... Because there's more and more evidence, and I think it's... And very interesting experiments going on around the world in different places, from St Albans to Australia, you know? LAUGHTER

But you can't disinvent a technology, can you? You can't disinvent it. You can't. So do you try and adapt to it? Well, despite that Guardian survey, right, where, what was it, two-thirds of teenagers wished that the internet had never been invented in the first place. I think you will probably find those findings across all of society by this point. Do you think that would have passed peer review at the Lancet?

Sample sizes. But I think on the climate anxiety, I do also think that it's not unsurprising when we look historically, human beings' connection to nature, really when you're a child and you're a teenager, that is where it's at its strongest. And you see that borne out in art, in literature, in poems. Our connection to nature and our surroundings is deeply meaningful and spiritual and it's very formative in

in those young early ages, perhaps before you get busy thinking about lots of other things. Then you have to go to a job and it grinds you down. Exactly. And when you speak to young people about that, the way we deal with these things is totally unfathomable to them.

Because it's so obvious and clear what is important. And what do you say to, you know, normally a parent can be in a degree of control of the environment of their children. And so you can give reassurance and confidence to your children about, you're fine, I'm here, I'll protect you, all's good. But in a world where...

You're not able to, you know, mum and dad can't control the climate. So what do you say in that situation? It's very, very perplexing. Parents are no longer the sort of agents in control of their children's future. And their environments. Yeah, quite.

iPhones and social media, let's do another. I think that would make a good episode. It would be a good episode. It also feeds handily back into the final thing we were going to talk about, which is how, well, research is essentially ground to a halt. That's the headline, right? Groundbreaking science discoveries are becoming harder to find. I had not seen this one, but when Richard emailed it around, I've read it voraciously, and I'm quite excited to discuss. Essentially, the argument is that the 20th century was a series of scientific explosions. We got earthquakes.

the light bulb, the flushing toilet. At the 21st century, nothing has happened. That's a pretty controversial way of stating it, but it's not too far from what the article is arguing, right? Yeah, so all this money that we're investing into science is... Right, 11-fold increase in real terms since 1950. But it's actually yielding fewer innovations...

fewer discoverers, slower progress, and as you say, diminished economic growth. So what is science really contributing to society? And suddenly you've got a big question mark over science. And then maybe that's why President Trump is cutting back science funding because it's not delivering. But this is such an important question. So is that premise right? Is science slowing down?

I mean, we're working at a scientific journal. Do we think science is slowing down? I don't think science is slowing down. And I think we have to say it's a debate in the community at the moment. And it all was spurred off by this 2023 paper, right, where they looked at all of these different data. Yeah, we shouldn't imply there's consensus in the community. It's not a consensus.

It is a debate. Yeah, big study published in 2023 and it used this new measure of CD, which is essentially looking at if your science paper has been referenced,

and that's the only thing that's referenced, then you're thought to be more disruptive. But if it's referencing your paper and a load of other papers that came before, then it's a lower score. So things like Alpha Fold, which won the Nobel Prize and was a huge innovation, scores low on that category, which seems strange. There are debates around the scores and what it's really showing. I don't see a huge slowdown

In progress of scientific and health innovations. It's a difficult metric, isn't it? Because, you know, the more and more and more and more scientific research that we pull off, the more we know about a topic, the harder it becomes to find a thing that disrupts decades and decades of scientific research. In the 20th century, we were still discovering quite a lot of things. There was no knowledge base for quite a lot of things.

So to use that metric to say, well, no one in, say, 2015 published a paper that completely destroyed everything that came in front of it. You would feel that that is less likely than it was in 1955, for example. And actually, that might be a good thing. Yeah. Because it sort of shows that we understood what was happening up to that point. We don't have to throw decades of science out the window. Exactly. And it changes, I think, discipline.

Different fields involve differently. So lumping everything together as science is now slowing down in some way, that's such an overgeneralisation. So if you take our little corner of the world in medicine and public health. So I remember when there was a time in the 70s and 80s

when we were making huge strides in conditions like hypertension. So there were these big randomized trials looking at drugs like bendrofluazide and propranolol and metoprolol

Nobody understood that lowering blood pressure was going to dramatically save lives. And I can remember coming to the Lancet and literally every Friday when the journal would appear, there would be in the news programs here and in the newspapers, we would be publishing a paper about a new drug for hypertension or ADHD.

or a new lipid-lowering statin, or a new kind of thrombolytic agent, and we would be headline news. So there was a phase in cardiology, in heart disease,

broadly, where there was an astonishing pace of discovery. But look, we've got more statins than we know what to do with. We've got more stents than we know what to do with. We know how to manage hypertension. Now it's just an implementation problem because we're not treating as many people as we should do. So those problems have been solved. So rather than seeing science as having failed in some way, science has been an unbelievable success

And now it's up to society, instead of criticising science, it's about making the most of what's been discovered and making sure that everybody's got access to those scientific discoveries. And then the innovation moves on into other areas. Immunotherapy for cancer, unbelievable, completely transformed the way cancer is treated in, say, the National Health Service.

And then it'll be something else. There'll be something in gastroenterology or, you know, one day there'll be an artificial kidney that won't be dialysis. And you'll have some kidney organoid that you'll be able to transplant into somebody. I don't know. But I think this idea that innovation has somehow gone off the boil misunderstands

the discipline specific, the field specific nature of progress.

I think that's right. I think there are three points that I wanted to make. One was, I think there's something about timing and fields and the fact that there are ebbs and flows to all of these different aspects of science where you'll have a major breakthrough that will then spur on lots of activity. Then there might be a time of stalled progress. And surely that's OK. That's nothing to worry about. The second thing is that I think it's particularly when it comes to health and medicine, there is something which isn't measured regularly.

through looking at bibliometric databases, which is about approaches. So, you know, now we can take rectal cancer, 17 centimetres of someone's rectum out endoscopically. I mean, that is an extraordinary feat. But that's not going to be, that's not going to show up on this. But it doesn't mean that there isn't some kind of huge, just transformational progress going on. That's incredible. I mean, I'm just thinking about that. That's amazing.

Really, I was occupied by the mechanics of that as well. That's a lot of rectum to take out with an endoscope. Okay. Anyway. The podcast is ground to a halt. We all think about the mechanics of that situation.

Now I've lost my train of thought. The third thing that I wanted to say, though, is that I do think that the enormous feedback that that study got from 2023, the fact that it resonated with so many people in the scientific community and spurred this huge debate, that is something to listen to. Because there is some interesting statistics in there about the fact that maybe top researchers are spending 25% of their time on actual research and 75% on actual research.

I mean, there's some amazing points in this paper. There's a feeling within the scientific community that the scientific enterprise is somehow skewed in the wrong direction and that energy and activity is focused on things which are not necessarily scientific.

where the priorities and the strategies should be. And we have to listen to that. So that may be the most important lesson to come out of this debate, actually, to rethink the role of the scientist or what activities a scientist is doing. The other thing, though, that drives me a bit nuts about this discussion is

why does everything have to have some instrumental benefit anyway? So you don't say, you don't walk into a bookshop and think, okay, so what are these books contributing to innovation in our culture? Or what are they contributing to economic progress? Everything has to be a disruptor now, Richard, you know. But, but, but,

Somebody writes a novel and it has an inherent sense of value in and of itself. It doesn't have to be a disruptor. It doesn't have to have an economic value. It is just an activity. Writing a novel is an activity that as a culture we place some value in because...

We've recognised it as being good for our culture, the harvesting of the human imagination. You're not setting out to disrupt the romantic novel section. No, but hang on. But my point is that why can't we see science as a little bit like novel writing in the sense that it is a cultural activity...

that we value in and of itself. Not every piece of science, not every research grant, not every paper published has to be some stunning disruption. The mere act of doing research, in other words, asking a question,

figuring out how to answer that question, getting an answer and communicating it and discussing it. There is value, intrinsic value in that process. And that's why we need more science in society, because science is a good thing. It's a good thing to be asking questions about the world in which we live and trying to answer them. So let's not think,

The only good science is disruptive science. The only good science is science that makes money. The only good science is science that has a paper in the Lancet. Science is good in and of itself. And that's what we should be valuing. And we don't have that conversation. I think this discussion about disruptive science puts science in a box that it needs to escape from. Right.

My partner is a researcher in neuroscience and she often talks about the joy in research of collecting data, putting that data in for analysis. And then she phrases it as receiving an answer from the universe as to your question. That's beautiful. And you use the word that I think is really important there, joy. Why can't the activity of doing science be a joyous activity that we value for itself?

perhaps we're too focused on the commercial and business side of the scientific enterprise. And that's where this disruptive element, then, this paper on disruption, and thinking about whether...

Slow down and innovation is therefore slowing down economic progress. I think that that puts science in the straightjacket that We need to resist. I think that's right And I do also think there's something there about where these innovations are happening So when you look at generative AI that was purely in the private sector Whereas if you go back and you look at some of these huge innovations, they were in universities. They were in the public sector

And this sort of dialogue does naturally lead to a place where you're saying, well, private means less rules. Private means, you know, that there's less bureaucracy. So that's the only way that we're going to get innovation from now on. And I think there is something there that needs to be thought about and discussed.

But also recognising that the language that we're using about disruption and innovation and the sort of economic aspects naturally lead us down that road of thinking that private innovation is going to be more disruptive. And I don't think that that's the case. No, I don't think there's any reliable evidence to suggest that.

Well, I think that probably brings us nicely to the end of our discussion. Richard, Jessamy, thank you very much. I think next time the plan is to talk in depth about the US. So join us for that one, if you would. But again, thank you very much for joining us. Thanks, Gavin. Thanks, Jessamy. Thank you. Thanks so much for listening to this episode of The Lancet Voice. Remember, you can subscribe wherever you usually get your podcasts. And we'll see you again next time for another discussion about the world of health. Take care.