Healthcare, Reinvented: How Dramatic Medical Breakthroughs Are Quietly Changing Your Life (Professor Sir John Bell)

26:36So that will take a big burden out of what you do. But the other thing where I think it's really powerful, if you set aside the drug discovery piece, which will be a place. But the other area is what I call predictive analytics. So when you're 25, it would be kind of nice to be able to say on the back of a blood test, actually, you don't have to worry about the following 10 things because your risk of that is close to zero. But you better be careful about that and that and that. And what can we do to help you reduce the risk factors for those diseases and as a result, prevent those diseases when they come along.

27:20And, you know, many of those bits of data are available. The algorithms haven't really been refined to understand how best you can make those predictive analytics, but you can be sure we're going to do it a lot better than we do now. But with AI, a couple of concerns often come up, right? So one is that everything you're describing here relies on having an enormous amount of data to feed into the models, both when you're training them and then when you're using that when people raise concerns about the amount of data that needs to be stored there digitally and the risk of security issues you know we had the uk biobank leak recently yeah how do you think or how do you suggest people should think about the trade-offs involved there yeah so first of all we live in a world of data and we live in a digital world and lots of our data is out there our finance data is out there and lots of our workforce activity in the workforce data is out there, all our educational data is out there.

28:18Healthcare data is a bit more sensitive, and I think we have to be really cautious about that. But at the same time, I think we've had a problem, and the healthcare system doesn't work very well, because we've siloed all the bits of data into multiple different data sets, and it doesn't talk to each other. And AI will be hugely effective at getting that information to talk to each other. So for example, GP data doesn't talk to hospital data, hospital data doesn't talk to NHS data. I mean, it's a mess, frankly. So the new legislation which is planned is to bring it all into a single patient record, which I think is a good idea.

28:50What does this look like in other countries? Because, again, there's a lot of discussion here about the risks of having it all in one place. And people are concerned about specifically the U.S. tech company Palantir's role here. What do other countries that do this well do? How does it work? The answer is that the countries that do it well are the Scandinavian countries. They do hold whole data sets and they use that to drive their health care systems really effectively. similarly you know the small asian countries like singapore do a pretty good job but i i think there is an issue about two big issues one is should we take uk people's data healthcare data and ship it offshore my view is no no no no we're not doing that it's a national asset people are sensitive about that and we shouldn't be sending it off to the u.s or china or anywhere else for people to play around with it we should be using it to generate algorithms for sure but in a secure environment in the uk and that a will create assets in the uk but it'll also bring jobs and people who are there's no point in pretending ai is not going to happen it is i just rather have it happen here in the uk and if you say keeping it in in the uk's borders does that mean it we shouldn't be the nhs shouldn't be working with firms like palantir so i don't know enough about the Palantir story to comment, I can say one thing, and that is in COVID, Matt Hancock introduced the COPE notice, which was basically a public health bit of legislation that allowed access to healthcare data from wherever it came from to bring it all together so we could work out what was going on.

30:32And so they introduced the COPE notice, and that was a massive change for the way we were able to manage the pandemic. We know who had a vaccine, we know who had a disease, who had a test, all that stuff. And it was all hooked up together. Palantir did a lot of the work to organize and orchestrate that, and it worked pretty well. Now, that was in an acute emergency, so that's a different set of circumstances. But I don't have a view provided the data is securely positioned and isn't exported and moved around. Because, you know, there are two things. Many of these companies, they don't actually really want the data.

31:10They want you to use their software. And that's a different setting. There is a big problem, though, and that is that most of this has happened in the U.S. Most of the developments in AI and machine learning happened in the U.S. and China. And that is not because we don't have some of the most talented people in those spaces in Europe, and in particular in the U.K. But we have singularly failed to grow any companies that could do it here on shore, which is a really big problem. DeepMind, of course, part of Google, but, you know, they are largely based in King Cross. I, you know, I think there is a, there's a strategic issue here about whether we want it all to be done somewhere else or whether we want some of it to be done in Europe.

31:49Because I guess that the specific concern that's been raised with Palantir is that almost by necessity, by definition, you have to give U.S. software engineers unlimited access to this data. that that's something that's been confirmed by reporting by the financial times yeah for example so even if there is not an intent to go in there and fiddle with things there is exposure there there is risk and are you are you basically saying that that is unavoidable unless we have a british palantir equivalent that can keep everything access the entire thing on shore well i first of all it i think whatever anybody does it's got to be on shore and that you can control so shipping this stuff around is not necessary whether it's being done by an american or a chinese or whatever company on shore or a uk or european country that you can control and we do need a we do need a european or a uk champion to actually take that forward in my view i think it's a real strategic mistake not to have one yeah so there are many many many multifaceted things going into this and i should just interject at this point and adds NHS England's statement on Palantir is that the NHS has strict policies in place for managing access to patient data and carries out regular audits to ensure compliance, including monitoring the work of engineers, helping to set up the central data collection platform that will track NHS performance and help improve care for patients.

33:14Anyone external requiring access must have government security clearance and be approved by a member of NHS England staff at director level or above. Yeah, I think that in fairness to the NHS, they are pretty good at this, actually. And they take this really, really seriously. And the reason I know that is that, as you know, I set up this large cohort, which is five times bigger than Biobank called Our Future Health. And we've got almost 3 million people in that, consented people with their data. and the NHS, even though the people have consented to let us have access, the NHS have been really, really rigorous about checking all the security conditions that we've got.

33:55Where is it stored? How is it stored? What are the security capabilities that we've built to secure the data?

34:09I hope you're enjoying my conversation with Professor Sir John Bell. If you are, then you can subscribe to this podcast on BBC Sounds so you don't miss future episodes. Also, if you do subscribe, make sure you've got push notifications turned on, and that way you'll get an alert whenever we publish a new episode so you'll never miss out. And now, back to Sir John.

34:30It strikes me that a lot of these technologies and solutions have been generated to a large extent on the back of US financing, that a lot of medical innovation comes out of America. But in the last year to 18 months under Donald Trump's second term, we've seen the US pull out of the WHO. We've seen under RFK Jr. as well, this withdrawal or cancelling of investment in mRNA vaccines, which we talked about the importance of earlier. How do you view what we're seeing here in terms of the, we're really seeing revealed the vulnerability or reliance of a lot of this stuff on the US. You've worked yourself quite closely with Larry Ellison in the past.

35:08Should we be concerned that there's a sort of fickleness or capriciousness here that puts a lot of these gains at risk? Well, so first of all, you're absolutely right to highlight this. It's been one of the most rapid and transformational changes in the global biomedical arena and ecosystem that I've ever seen in my career. And it's happened really, really quickly. Don't you remember? you know, he's only been in post for 18 months and it has completely and dramatically changed the environment in America. And I know people are optimistic that it'll get back on its feet, but it won't immediately.

35:48It's going to take 10 years to get it back on its feet. And that's a really big problem because these innovations, which have had such a profound effect on society and our wellbeing, were driven by America largely. That was by far the most successful arena for doing this. So I think that two things we need to think about. One is that produces the rise of China. So at the moment, the dominant force in biomedicine is China, and no one will dispute that. They've got great stacks of new interesting molecules that people are, and the pharma industry are now piling into China to find their next drugs.

36:24So that's, it's not a bad thing, It's fine, but you do have to realize that America has kind of lost the upper hand in that whole space. Now, in AI, China, it's hard to tell where China is, but China and America, again, are level pegging, in my view, in terms of their capabilities. The Chinese AI capabilities and algorithms are not as widely used because there's a security issue about using them because you tend to lose all your data. Sorry to interrupt. Does this mean that countries like the UK or parts of Europe should be thinking, rethinking their approach to working with China in this space?

37:02Yeah. That's where the money and the tech is. So I think we've got to get around to thinking about how we do work with China in this space, because that's a real force. But I also think that, you know, Europe broadly and the UK specifically needs to sort itself out, actually, because, you know, we've always been able to compete. We're not we haven't been the biggest, but we've done some terrific things across the whole of the biomedical space. And, you know, in the last 10 years, we've become a less and less desirable place to do life sciences. As you know, most of the industry said, we've had enough, we're out.

37:39And I think it kind of misses the point that the discoveries that have come from that industry are the ones that have generated your 12 years of additional life expectancy, the benefits of cancer, cardiovascular disease. That's where the discoveries for Alzheimer's disease will come from. and we just seem to not recognize how important that component is of the whole story. And in prevention, prevention will come from therapeutics. It won't come from buying a pair of jogging shoes and going around the block three times, I promise you. That is going to be the driver of prevention and that's how we're going to flatten that morbidity curve.

38:15So I really do think we've got to get our act together and become much more of an engine for innovation in the biomedicates. And so what explains why, with Britain's history here, or look at some of the GLP-1s coming out of Denmark, what explains why Europe and the UK seem to be quite good at that side of things, but very bad at the scaling, the financial side of it? Yeah, so you're right. And if you look at discovery science, interestingly, what I think is probably the best GLP-1 is the one that was produced out of Steve Bloom's lab at Imperial, which was then developed by Clive Meanwell and those guys and sold to Pfizer recently.

38:54And it's an injectable which lasts for four weeks, not one week. It can be used as an oral. So it's a great GLP. And guess where it came from? It came from the UK. Steve Bloom was the original guy to work on all those peptides. So we do have this unbelievably powerful biomedical research base in the UK, which we really do need to exploit more effectively. And you've highlighted the problem because we've got a lot better at creating small companies. The university creates lots of companies and they compete like crazy. But the truth is they either get bought and moved to America or they fall over.

39:28and the absence of scaling capital to allow those to grow, to become real biotech companies. And by that, I mean, do they pay tax or not? And the answer is almost none of them pay tax because they never produce a product, they never sell a product, they never grow. It feels like there's a bit of a catch-22 here because when I hear about the calls to force or strongly encourage UK investors to invest in UK firms, the pushback is, well, UK firms have performed poorly if we've been doing that for the last 30 years, would be worse off than investing in the US. But maybe a catch-22 there, that growth in the UK, pharma and tech firms has been weaker because of that lack of investment as well.

40:06Yeah, I think, look, it's a circular argument. And it does require investors to make good choices. So, you know, if you make bad choices, you're not going to make a lot of money. But are there opportunities to make money out of tech firms in the UK? There absolutely are. Do we have the skill base to do that? We possibly do, but there's not a lot of experience in investing in those in the UK. And I do think there is another component of this which is really important, and that is when you go to Silicon Valley, you go to Boston, to the biotech sector, you have these fantastic entrepreneurs, innovators, entrepreneurs, scientists who actually really know how to take something and turn it into something really terrific.

40:54and that is what the American system has really brought. So the real question is, can we develop that more effectively here? And we may have to import a number of those people to make it all work, but I don't think this is beyond reach. And I think the Steve Blum story is a classic example. That really took off when some American innovators arrived and actually turned that into a really successful venture and then sold it for$10.5 billion. I mean, if investors don't think that's a good result, I don't know what they're thinking of. Another aspect of this that often comes up, and we'll get into this more in the Q &A section with listeners as well, is inequality.

41:28We're talking here about increasingly expensive and technologically and data intensive treatments and approaches. Is there a concern here that whereas previous general health care gains were distributed across the world, things like penicillin, we're now talking about things which are much more concentrated among wealthy countries and even within those countries, wealthy individuals? Yeah. So the inequality gap has got bigger, not smaller. And I think this is a clear criticism of the way people have approached the prevention agenda. So where are the big domains in the UK, for example, where the chronic diseases are the worst?

42:07They're in deprived populations, ethnically diverse populations, often in big northern cities where nobody's had a job for years. And that's where the burden of disease is. You know, if you go to Chelsea or you go to Kensington, you don't find a lot of really obese people. But if you go to the big northern cities, you find a lot of it. And I think the failure to grapple with this and to deal with it in a sensible and equitable way is going to just, it already has, increased the inequalities of health. So, as you know, there are tens of thousands of people in this country on GLP-1s. And they've done it all privately.

42:43They've just said, screw you, we're going to go buy some. and they're the people with money, people without any money haven't had that opportunity. So as I said earlier, I'm a real believer in the national health system because it should allow you to drive those equalities really effectively. And the complete and abject failure of the NHS to grapple with the GLP-1 thing is a sign that they don't really care about the people who are sitting in deprived circumstances and who have a massive obesity problem. You should say here, the NHS are not in the room with us now, and I'm sure they would say something differently.

43:15No, they won't like that. I'll get beaten up for that for sure. But that was not a good set of decisions, I have to tell you. What should the NHS be doing with things like GLP-1s? And isn't part of the problem here, again, that they are significantly more expensive than a lot of the treatments that the NHS has covered in the past? And is there something that maybe needs to look different in the funding model when we're talking about everything coming in at six figures? and that kind of thing. So these drugs, first of all, they're falling in price rapidly. But the other thing that the NHS needs to recognize, it's got massive purchasing power.

43:52NHS England alone is 55 million people. It can drive unbelievable discounts on the drugs that it buys. Because remember, the cost of goods for many of these drugs ain't that great. So they can still develop really big margins, but at a very low cost. And of course, one of the great things about the NHS is that once it's been accepted in the NHS, it doesn't need to be marketed. It just gets used because there's a requirement of people to use it at scale. So I think speeding all that up will make a massive difference, both in terms of the cost base, but also the number of people who can get access to these drugs.

44:27And I think it's not just those, but it's a system for trying to manage people's blood pressure and people's lipids. You know, that has to be done at scale. Thinking perhaps more broadly than the UK, when you look five years down the track, Where do you think other gains have come from? Well, other gains, but also other impacts of the gains we're seeing today. What is this all going to look like in a few years' time? I think there's a big issue, which I've alluded to before, which is one of the biggest drags on economic productivity, which is mental health. And there is no magic bullet for mental health.

44:59There's no tablet you can take. There's none of that. So we've got ourselves in a bit of a pickle with mental health. And again, there's no real system to deal with it. But there are lots of young people, and these are the most productive people in society, who actually are really disabled and unable to go to work and unable to function normally. And I do think we have to lean into that and work out what we do. And, you know, there are ways to actually help counsel and support people in that situation. And we don't really have a system for doing that systematically. Some of the American states have developed that.

45:32And it's interesting because they use U.K. suppliers to do that. But I think that's going to be a big drag. How do you think about AI in that space? Because it strikes me as interesting that cognitive behavioral therapy and conversation based therapies. Do you think AI could help with this mental health problem? Yeah, so we're in this tricky place where people are anxious about turning it all over to an AI algorithm and a chatbot, partly because there is a history of kids committing suicide on the basis of the information they got from the chatbot and how it gets interpreted. So I think you've got to be really careful before you do that.

46:11But having said that, there are some very responsible counseling services which are now using these quite effectively. And don't forget what we said about AI a year ago is not true today. There's been this incredible inflection point which occurred late last year where everything seems to work a heck of a lot better. So I think ruling that out would be a really big mistake because it can produce really beneficial effects for people in the mental health space. So I think we do need to think quite hard about that and how you regulate that and manage that is a whole new world. But it's hard to imagine that we're going to get on top of this with a load of counsellors, you know, sitting on the telephone.

46:52Very big picture. If people are looking for things to get excited about, things that you see coming down the line in the next year or two, in the whole health tech space, what's keeping you awake at night in a good way? One of the really exciting things, so as you know, I'm an immunologist and a geneticist, and I was very involved with David Cameron and setting up Genomics England and all that. So I'm really au fait with that technology. and I think that has now been dramatically commoditized. So it is going to be so cheap that we can all have our genomes done, probably all have our genomes done at birth.

47:31But then other applications of that to detect, there's interest in detecting circulating DNA in the blood. Doesn't quite work yet. The GRAIL study didn't meet its primary endpoint. Tell us a little bit more about that. So cancer cells die and spill their DNA. And as I described earlier, the cancer cells have mutations in them and they have variations in their DNA. So there's DNA in your blood if you have a cancer, which you can detect that says, I think you've got a cancer. So, you know, the first company to actually spot that was a company called Grail, which is an American company. And they have done a very big study to look to see whether you could use that in the health care system.

48:12And they set some very demanding endpoints in their study, which they didn't make. or the share price crashed and so on. But I think if you look at the data, there's enough information there to say that it may not be the grail technology, but some technology is going to be able to detect those signals. And particularly in people who are at higher risk of cancer and who maybe have some early symptoms, but they don't know whether it's cancer, they'll be able to pinpoint that because getting to early stage cancer, that is the solution to curing cancer. And now with immune therapies, If you get into stage one and stage two disease, you'll cure it, I'm pretty sure.

48:49So that really gets me, because that could transform the whole cancer paradigm. Really, really remarkable. So we've got these rapid gains in early stage detection, rapid gains in treatment, and alongside with GLP-1s, the potential for rapid gains in prevention as well. Yeah. And one other thing which is playing out, there's a new type of drug called an SIRNA, which is a drug which goes and blocks the genes so the genes don't work properly. So if you find a gene that's causing trouble, you could block it quite easily. And that comes out of a company in Boston, but has been developed to reduce people's cholesterol and to reduce people's blood pressure.

49:30and those are being coupled together so that with a single injection you're covered for cholesterol and blood pressure for a year. Come back next year, get your flu vaccine and have a shot of the SIRNA. I mean, these are remarkable innovations that are going to make this whole story just a lot easier to deliver. And presumably, again, with a lot of this, the life extension, sorry, there's going to be all sorts of interesting second order effects that we're only just starting to think about. So like all things that are disruptive, if you get on top of this healthspan thing, it's going to create all kinds of other issues that we're going to have to deal with.

50:05That's why I think we just have to be a little bit more dynamic and take a bit more risk. So, you know, we've become very risk averse in this country. You know, I think we need to say, actually, why don't we have a go and see whether it'll work? Well, that's a wonderful note to end this on, Sir John. So thank you so much for joining us on Radical. It's been a real pleasure. Yeah, nice to talk.

50:34So Professor Sir John Bell has just left the studio. And one thing I found really, really interesting and has just changed how I think about all of this is that the previous wave of medical technology gains, as it were, were extending lives, but not always making those extra years healthy years. People were living longer, but a lot of those years were lived in poor health. that was not good for them. It was not good for the healthcare systems that had to spend huge amounts of time and money supporting them in those years. Whereas now we're looking between the breakthroughs and prevention in terms of the anti-obesity drugs, in addition to personalised medicine and that kind of thing.

51:14It feels like we're now talking about extra years, which will also be lived in good health. I think that's really quite remarkable. It's also worth, I think, taking a second to say that, you know, we always talk about radical change on this show, But there were also several things that Sir John said at certain points which you might have felt were quite radical. He touched on China, he touched on AI, he touched on the NHS, and all of those might not necessarily have sat well with yourselves. On China, a lot of people have concerns about its human rights record and whether we should work with a country where those sort of things are happening.

51:46On AI, there's the question, the related question of Palantir and its role in the NHS. This is obviously a topic and a story that has been covered in huge detail in the UK recently. There are a lot of people with a lot of concerns about what the downstream consequences of working with a firm like this might be. And on the NHS itself, obviously, a lot of you will have strong, positive feelings about the National Health Service. and therefore some of Sir John's suggestions and comments about how the NHS is currently run and can be done differently might not have sat comfortably with you. But probably, well surely the most striking thing from that conversation was that we had here one of the preeminent figures in this field who has been doing this stuff for decades and who says that in all the time he's been working on this he's not seen anything like what he thinks is only 10 years down the track which is that we could be on the brink of effectively curing a large portion of cancers.

52:47I just think that's astonishing. And I'm sure a lot of people listening today will have had a conversation at some point in their lives where they were told that someone they knew had cancer. And those conversations are always incredibly difficult and painful for everyone involved. And this idea that we might be only a decade away from a place where people find out they have cancer at such an early stage that it is a routine part of managing their health the treatment that they then have to undergo is routine is straightforward it's not intensive it's not dramatically changing their life worsening their quality of life that for me is just truly astonishing that the cure for cancer for all intents and purposes could be that close around the corner and look you know this is a program where we talk about radical change every week, but curing cancer in a decade?

53:41I mean, it doesn't get more radical than that, does it?

53:46That's it for this episode. To make sure you don't miss future conversations, you can subscribe to Radical on BBC Sounds. Thanks for having me. Goodbye.

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