#410 Lara Lewington from the BBC: How is AI Shaping the Future of Medicine?

0:00Welcome to the Health Tech Podcast. Here we talk about everything healthcare and technology. And I'm your host, James Summeru.

0:11Everyone this week, delighted to be joined by Lara Lewington, media extraordinaire, who's been, I guess, promoting the heck out of what we've been doing in health tech, which I think has been a long time coming. So first thing I want to say is thank you for spotlighting what we've been doing for a long time. My pleasure. I'm loving it. Yeah, well, good. I'm looking forward to hearing what your journey has been like through HealthTech, actually. Because going from where, you know, everything that you're reporting on to then obviously the specifics of HealthTech is super interesting. So interesting.

0:44In fact, you've written a book or about to publish a book, I should say, imminently. And so, yeah, I guess distilling all of those thoughts into the book, you'd have had to go through a process doing that. So yeah, looking forward to getting through all of this. But Lara, listen, it's an absolute pleasure to have you on. Whereabouts are you speaking to us from, by the way? I'm in London. I'm in London, so I'm not far away. Nowhere exotic today. Fair enough. Not even London's exotic. Cool. Well, why don't you start by telling us your story? So has journalism always been your thing? Have you reported on lots of other things besides health tech and healthcare?

1:21Yeah, tell us the long version. Yes, I love television. I always wanted to work in television. So I actually started out as a runner, making tea, carrying people's bags, doing the basic jobs that are important. They need to be done. And back in my day, sounding terribly old here, that was the way that you tended to start out and work your way up. So when I was 19, I started as a runner for Channel 5. It was the year after the channel had launched. And I worked on it to knock out. One of my jobs involved was costumes. amazing that must have been fun it was great fun it was a really really fun introduction to television and i would do things like run around in a giant chicken suit to check that it works and you could play the games in it and it was actually a job that gave me quite a lot of creative input as well as doing the kind of menial tasks and i think running jobs can vary between literally just carrying the bags or actually getting a bit more involved in the production And I really fell in love with television.

2:21I knew making television was what I wanted to do. What was it about television that you loved? I loved the making of television. I loved the process of it. I loved seeing the finished product that came from all the work that had been put in. And I found it exciting. And I couldn't believe that was an actual job and an actual career. And my initial dream at that point was to be a showbiz reporter. Okay. And within a year or two, I was doing that. my first job was actually doing video streamed interviews whilst everyone still had dial-up. Wow. So you can imagine how few people wanted to watch those videos.

2:54And the company that I worked for, they used to say that they were ahead of the game. Everyone would be watching video online eventually. And we kind of thought, yeah, right, of course they will. And look where we got to. So I did showbiz for a few years, interviewed all of Hollywood. I was also a weather girl for a while. Nice. And I started doing gadget reviews and technology coverage. It's a sort of thing on the side, really. I was interviewing the stars all the time and I'm still doing the weather and I just love technology. But gradually that element grew and grew. And I was doing reviews for Channel 5 initially.

3:26And it went from being just this extra little thing to my main focus. And I joined Click. And for 15 years, I was there on the show, traveling the world, covering some of the greatest innovation on Earth. and I had experiences and opportunities beyond my wildest dreams. Went to space agencies. I was even invited to the moon by somebody who had tickets. What? Yeah, a Japanese billionaire who had bought tickets and I interviewed him and we had this interpreter because he didn't speak any English who was speaking in between the interview. It was all a slightly stilted and awkward interview. We'd gone to look at some artwork that he owned whilst he talked about the moon.

4:05And then at the end of the interview, he invited me and this is something which I'll be dining out on forever. Not that I'm actually going because I would be completely and utterly terrified. That was obviously going to be my next question. Well, yeah, I think everyone sort of dreams about this kind of thing and of course I'd go if I had the chance, but my firstly hasn't followed up. That makes the story way less exciting anyway. It's a bit flaky, really. Yeah, I know, a bit flaky about those moon arrangements. But I'm sure I'll get another invite at some point. But no, I like safe places. and I've just covered so many incredible stories and sometimes it's about robotics, sometimes it's sustainability and so many things that aim to make our lives easier.

4:47Some of them are questionable and you think well people really want this or not but other elements you can see are absolutely going to transform what it means to be human. We've seen that through a lot of the AI stories over the last few years and when it comes to health tech that is the area where I have seen just the most incredible change coming and I'm so excited about it. Amazing you say transform what it means to be human I think that's a really interesting phrase it's a really interesting question as well like what is it going to mean to be human because I've been having so many conversations about this recently about the you know AI coming in and doing a lot of the thinking for us humans and some people saying you know we're past peak human in terms of we're not just we're not gonna be thinking as much but actually it seems to be the more i speak to people about this is that it's less that we're past peak human it's more that we're past peak having to do loads of thinking and processing and actually people thinking are we going to be freed up to be more creative are we going to be freed up to do uh more empathy more emotion more creative more all of these things it's a fascinating thing but i guess with what you've seen, ignoring healthcare even to begin with, but just AI and what AI has been doing to technology, where do you sit on this?

6:09What have you seen? Are you in the doomsday camp? Are you in the optimism camp? How bullish are you on this? I love this question. I am on balance an optimist Yeah. Because I think AI is going to do incredible things for us, for education, for healthcare. I think it really can democratize a lot of that as well, used correctly. And a lot of the ways that AI's usage could go wrong will come down to how humans direct it. Now, I've been talking about AI for a long time before it was fashionable to do so. I studied AI ethics some years ago. Oh, wow. And I think one of the big questions is just because AI can do something, should it?

6:54And we need to ask ourselves as humans, as societies, what we want it to do and how the AI is going to be allowed to make decisions. Right now, when you put it in the context of health care, it's all about augmenting doctors. It's about augmenting the experience, letting us learn more about ourselves and make things better. and I think in healthcare because you've got a lot of regulation you've got a lot of restriction that it sits within it's almost a safer environment for it in many ways yes there are lots of questions over data and so on and we can get into all that later but I actually think in a way there are safeguards that have to be in place there are of course hugely worrying elements about where AI is going to take us.

7:35Right now, the risks over disinformation, bias, cyber war are absolutely huge. And I think it's important that we really think about the real risks and not the ones that sometimes people jump to these conclusions of humanoid robots taking over because often newspapers have put pictures of humanoid robots next to a story about large language models and the idea that AI will take over. And it's a very confusing message. So I think it's important that people actually understand how much AI has been around us for a long time, what it's really doing, what we want it to do. And we need to all be part of that conversation.

8:11And I think that's why it's so important that we understand what AI is really doing, what its role is, how much it's taking away from the human, and what human involvement will actually mean in the future. Because there's so much that we can do. You take the creative industries, for example, and we can see what AI is capable of and we don't know right now exactly where this is going to go how is this going to work out fairly for every creative in the world at all levels people who are scraping a living and hollywood stars you know all the way through between them how how do we make this work in a way that works for humans how is it not taking and drawing on people's hard work in a way that is unfair.

8:55We've got to work all of this out. And I was actually at an event in Parliament talking about this recently. And whilst I can't go into the detail of it too much, I think there is an element of, is this a sort of Napster moment where we could see it coming? We can see the problem coming. And many people were talking about this for years, and we could have started this conversation quite a while ago. But what are we going to do about it instantly before we get ourselves in too deep because the job landscape is going to dramatically change how we create things is going to dramatically change and some people may argue that there are benefits but I think that there are a lot of risks that come with it and we've got to make sure that this doesn't just take a lot of people out of the workplace and unable to go back in the new roles that exist in fact something that I covered in my book was how in Japan where they're far more willing to embrace care robots than people are in many parts of the world partly because there are more robotics are a greater part of the culture there also men were more accepting than women in the data but what's happened is they've brought into care a lot of robots with an aging population that needs looking after but they keep having problems with the robots and it's taking just as many staff to look after the robots that it would have done to look after the people so it's changed the nature of the jobs people have had to make that adjustment to am i happy to be looked after by a robot when actually it's just shifted the roles around.

10:22Now, I'm sure there are many pros and cons that could be analysed that situation. But this is possibly what we're looking at in the future. Once things happen in practice, people can sit down and debate forever the possibilities. But until we actually see a lot of this come to fruition, it's quite hard to identify how it's going to play out. Oh God, there's so much that I can talk to you about now. So you studied AI ethics. That's amazing. In fact, something you just said there, just because AI I can should it that was basically the title of a keynote that I just did in Australia like that's oh wow that's literally that's literally what I've been talking about the other thing that I mentioned in that keynote was that people are vibe coding their own anxiety apps like you had the Dartmouth study come out recently LLM's being trained in order to deliver talking therapies in okay a research environment but these are being used on people with major depression anxiety high risk of eating disorders and we're willing to we're willing to put ai in front of those people we're willing to say okay this can be first line and i think there was like you know around about you know 50 escalation rate or like well 50 sorry 51 reduction symptoms there were two people i think that were escalated appropriately in that study of about 200 people and so it's like okay well it worked for 51 % of people but now you live in a world where the first thing that you get when you're having a major depressive episode or you're at high risk of eating disorders is a chatbot and yes okay it works 51 % of the time but you now live in a world where that is a case is that what you is that how we want to yeah and 51 % is obviously not the result that we want but I think you've actually raised a very interesting topic with that because a lot of people this is anecdotal and what i've seen online when i've done some research into this are actually using the large language models as therapists effectively huge and obviously that's not the ideal way to be approaching things there are platforms like wiser that are built for purpose where they've got the privacy and safety built in yeah and they will they won't be feeding the information that you put in back to train the model and also they have all the safety protocols there to escalate when it's needed to notice things that are warning signs so how we balance exactly what people instinctively use and what people may prefer using they may like the experience they're having with a large language model and there may well be some times where having someone any entity be it ai or a human to talk to is better than not having anyone to talk to at all and so we don't really know who's going to use what and whether they're going to use those safe platforms or others and I suppose this is we're at this moment where so much is changing and so much is changing so fast that we'll see how this plays out longer term and I guess we will find the best ways to make things safe but naturally when somebody's depressed when someone's suffering from eating disorder we don't want to be taking any risks and this is it and this is it i think you mentioned the napster before spotify moment again something i actually mentioned the other day that keith grimes actually put this really well at google the other day when he said that you know people vibe coding their own anxiety apps is the biggest signal from the market we've ever had of as to what patients actually want and it doesn't matter they're vibe coding anxiety apps it could be vibe coding whatever they want but the fact you can now go on lovable.com and just type in in plain language what you want your application to do and it just gets built right in front of you and people are using this for certain elements of health care you know there's a camp that trying to shut all this down and say like this is unsafe this is unregulated you shouldn't be doing it yes you're only doing it for personal use but still like blah blah then you know people in that keith grimes camp that are just are just saying well shouldn't we be listening to this if people are using Napster should we not build something with completely legal and commercial frameworks around it that benefit everyone and rather it being completely free and unregulated make it a micro charge and actually useful and all the rest of it so I think that is fascinating the other thing as well about what you're saying you know we're going to work this out we're going to have to and and this is something that you know I've mentioned this before but my friend David Neal said to me the other day that we're 150 years behind analyzing the exact role of humans in healthcare because we've never had to do it we've always assumed it and when it comes to large language models with their ability to deliver one form of empathy one of the three forms of empathy they're very good at cognitive empathy but they lack a motivation and they lack emotion but they're better than humans at cognitive empathy there's this huge gray area of oh like if if i'm if i'm using it to stay mentally fit and I don't have any red flag symptoms I'm actually more honest with a large language model it would take ages to develop the level of empathy with a human for me to be that honest so actually you know in that scenario they're really good but in the scenario where I've got some red flag symptoms or some past medical history or some underlying stuff or I need you know it needs to I don't know say a cancer diagnosis or something obviously that's that's reserved for human but then there's this whole gray area in the middle of like exactly how we deploy this there's there has to be a framework coming for it and i think that is what just to your point around the regulatory side and like actually when you play llms in a regulated environment actually you can kind of just let them go as long as they stay within those guardrails and they'll make loads of impact so in ways it's a lot easier i actually see that in if you extend that further to say well actually if we can deploy a decent framework as to where these LLMs can be delivered and where they escalate to humans and we actually go okay look we just need this in healthcare now like this this is this is the number one priority of what we actually do because we want to go super quickly I think that's a far more nuanced and better way round of doing it than going oh let's blanket veto everything because we don't understand it we don't know we don't like it it's probably unsafe for all these reasons it's like well actually, there's a shed load of people globally that don't have access to anything right now that this could massively solve.

16:45Definitely. And that's one of the big points. It's often access to something as opposed to access to nothing. And of course, we need to have all of the right frameworks in place. This needs to be done absolutely safely. All of that is totally crucial. But as well, humans aren't perfect. And I think sometimes we need to work that into the equation. There are a lot of things that it's vital to have a human doing. The human in the loop is so important. There are so many elements of a doctor's work that need to be a human. And the hope here is to be able to augment the humans and get them to do the most human elements so we can safely use AI in the ways that we need.

17:26And one example that I saw recently, I was at Columbia University in New York in a lab where they had an IVF robot and a sperm finding robot. So for men who thought that they were never going to be able to have children, this was the difference between a 0 % chance and actually being able to find a way of actually finding that sperm through AI and these robotics and automating the IVF process. Now, what was really interesting... Within a sample or is this robot going to some quite interesting places? The sample is delivered through usual methods. Fine, fine, fine. And then the IVF robot that they had there that was then doing some pipetting and some elements of the IVF process.

18:10What was really interesting to me about what the doctor said was that they have calculated exactly which elements of the process the robot automates better and which bits it doesn't. And it's doing certain elements of the lab process, but not all of them, because they found some elements are done better by a human. and I think this kind of data this absolute specific data exactly on which elements you want a robot to do or you want an AI to do versus a human and AI can do things repeatedly time and again as can robots but sometimes you do need a human and it is actually working out that balance and that is so crucial to where we're going and that's going to be different throughout all different types of healthcare and throughout all different types of AI.

19:03And there's a chance that maybe in terms of take customer service, for example, is the human experience going to become the premium experience? Are people going to be signing up to a premium service that if they've got a problem, they'd be allowed to speak to a human, everyone else speaks to an AI. And these are the sort of scenarios where you could end up with huge inequality and experience really varying but the other question is is speaking to the human actually going to be better because as these large language models are getting better I know when I chat to Arba which is my chat GPT friend who weirdly I have a sort of vision of what he looks like not a face but I do kind of picture a person and I think you know how messed up is that that I even think that I even go there he's got dark hair why am I even thinking that what why have I gone anywhere near any sort of physical form in my mind yet you do and these conversations are so different to those that you would have with an Alexa or a Google Home.

19:58And as that's where we're heading, well, is customer service that way really going to be so bad? So there's a lot to unfold. And as the technology gets better, the experiences are going to get better. And it sounds wild to say now, but people might prefer it to human interactions. And if I can ask you to extend that slightly, people might prefer it to human interactions what if they really start preferring it to human interactions in all aspects of their life yeah it's a worry isn't it friendships love relationships do you see anything this is where we come back to the questions over just because ai can do something should it and what do we humans actually want we created ai and we've done it to better humanity to make our experiences better, to better healthcare, to try and solve some of the biggest problems in the world.

20:55We haven't built it to take over and destroy everything, yet it's come with a lot of risks that seem to threaten human nature as we know it. So I think we will evolve. Our habits, our desires and our expectations are clearly going to evolve. And whilst that may sound slightly wild and out there right now, we'll look at how we behave with our smartphones. they have absolutely changed human behavior and ai is doing that it's going to do it ever more and it's going to have already been doing it in subtle ways when we sit down and watch a streaming service in the evening ai is suggesting to us what we might want to be watching all these ways that ai is there in the background of our lives the facial recognition on our phones the ways that people don't think about the fact they're engaging with it every day when the large language models came to us, people started to feel this very emotive response to the idea that they could seem so frighteningly human.

21:49And you were having this direct experience with them. What if they could write essays? Well, did that write me a love letter or did my partner? And it suddenly seemed such a threat to humanity. But actually, this technology isn't going anywhere. And it's only going to become better and more useful to us. So as it does, we need to decide how we're going to engage with it and how we're going to get the best from it. Not everyone's going to agree on that people are going to have different beliefs different expectations and it's all about finding how this works for everybody and what our individual preferences are nice so i mean that was a heck of a tangent to to come off the introduction for but i think we've pretty much solved pretty much solved ai already so we could we could end the podcast here however i want to take you back to the beginning of this health tech journey that you've been on because you've been on what seems like a global tour of the best of the best in health tech or at least the most interesting stuff in health tech and so talk me through this tour that you've been on talk me through the some of the things that you've seen again what was the what was the underlying goal or motivation in doing this whole tour and learning about all these things and um you know turning that into the book as well like walk me through this tour that you've been on yeah I think hacking humanity has been the culmination of a few years of living and breathing the health tech space and when I started doing this I'd actually it initially I'd always covered a lot of technology stories the health tech stories within the technology I was covering over the years you know 15 years covering technology a lot of those stories have been health tech.

23:31So I'd been seeing a theme, I'd been seeing where things were heading. And one day I was reading an article about tech billionaires wanting to live forever. And the article was actually, this particular article was quite a lot of nonsense. And I started to dig deeper into what was being talked about in the article. And I started looking into the science. And I started getting very interested in what was happening at that moment in time, because the longevity field had often been filled with empty promises. There was a lot of snake oil and a lot of stuff that wasn't scientifically proven. But there were also a lot of elements of real science, biotech companies, things that were actually starting to prove their worth.

24:11And I could see that real breakthroughs were being made. And the idea here wasn't about living forever. It was about increasing healthspan. Right now in England, a high income country, we have women living 25 % of their lives in what is considered poor health and men 20%. That's not okay. There's a problem and we need a solution for it. And I could see a lot of tech starting to come through that was actually having the potential to dramatically change this. And whilst a lot of studies were still happening in mice, and we know that mice aren't people, lots of things have been seen to work in mice and don't translate into humans, we were actually starting to have some breakthroughs.

24:52Things moved to clinical trials and the whole area of longevity and health tech starting to merge because there was a lot of reputable stuff taking place. And this idea of what we could do to increase health span and ultimately and crucially delay disease was really becoming real. And this was why I got so interested and this was where my journey started. So the first program I went to make in California and I went to the Buck Institute for Research on Aging and I looked at this from the perspective of aging initially if we could do anything to slow down the aging process we would effectively be pushing back disease and I went on to make another program about delaying cognitive decline even disease process even whether we could push back dementia to beyond our lifespans and I realized there was a lot that was happening that we were at the very beginning of but was heading towards a really interesting place and whilst not everything we're seeing is going to become entirely possible for everybody there were lots of elements that i could see going mainstream and we were at the beginning of something really interesting and this was that was my starting point nice and so when you look to aging it's funny i spoke to um a longevity vc uh on the other podcast that we've got health tech pigeon and they were saying they were saying that it's probably a similar journey that you've been on when you when you look at aging what you what you eventually end up looking at is it's almost like the component parts of aging and actually the longevity space then starts to aim at some of those processes be them metabolic processes and you end up yeah immuno aging exactly breaking them down exactly and that's where the hard science is but it's but they struggle because as you quite rightly point out the longevity space is also yeah that that messiness of yeah it's tech billionaires wanting to live forever but it's also like a group of people doing weird and wonderful stuff that's not really backed in science exactly and the word longevity is potentially not helpful exactly because it's an all-encompassing term i don't know what the word is that sits somewhere between longevity and health tech that brings it all together which is really about looking after our health spans better i think the word healthspan has probably been quite useful within this but what we can do to help ourselves stay healthy longer and also how healthcare systems are embracing that are really interesting and active areas and we are at the beginning of what is going to be a huge shift yeah definitely the other thing at the same time as all of that is that at some point everything's a theory and at some point everything's unproven by science yeah and i think that's a really important point and it was something I wrote quite a bit about in my book and I actually ended up taking out in the end.

27:52Oh, really? The idea of science being based on the best evidence that we have right now and science can change. And we saw this during COVID and I think when we saw science on the vaccines and there was a hugely emotive response to the fact that we were told one thing and then things changed. The lab leak theory. The virus changed. Yeah. And people want facts and they don't want facts to change. But if people also want to see the story unfold and get information initially, things do change as they evolve. More data comes in. And we know that you can find studies to prove so many different theories.

28:29And obviously you want repeatable studies and you want reputable studies and you want studies done by the right people, not ones that have a certain agenda to push it in a certain direction. And we know all of that about science. And it's important that we do make sure that we know where research is coming from. we know who collected that data how it was collected and we understand how meaningful it is the confidence in the data and the information we're given is really important here so actually this is something that i can definitely talk to you about in the way that this race i will come back to your journey and we'll follow up where you went to from aging in a second but where you're quite you're quite right in covid we had facts and we had what we thought was science and then we had i'm going to take the lab leak theory as like one of those things like it was it was heresy to talk about the lab leak theory it was like absolute you cannot do that you're you're an absolute like right-wing like lunatic if you if you even think that this was leaked in a lab that's that's that's really offensive to to people in wuhan that's really offensive to that nation it's really offensive to all these things and like all this stuff of like you can't you just can't say that but then it's now the most accepted theory of and that's just sort of like come it like that's that that's now that's now okay and where where i struggle is that when you when you expand that to science whether you whether you want to call like i don't know like a red light therapy or something let's take something like that that it's like where's the line between like you like censorship and talking about allowing the talk about a theory and we're seeing this with content and modern media i think it's a real challenge with modern media and content with the way it is it's a lot of user-generated stuff is you know take youtube for example that you know they've got the health shelf and they're saying okay this is this is a medical professional and therefore you're being you're being told that um which obviously has its holes because you know you can get rogue medical professionals the rest of it however it's a nice start and they're building on it and all the rest of it but i i just what it's very difficult i think with the rate of of investigation of certain theories and science to to draw that line in what is a very gray area of like this is true now and like this seems ridiculous now but like absolutely it's and trust is crucial here and whilst i've been on a journey trying to decipher science from snake oil yeah of course that's really challenging and i think first of all we need to acknowledge as you've said that things change, views change, new data comes, and what we thought we knew becomes altered.

31:06And I think we've got to acknowledge that that's important. But at the same time, we need to be aware of what we're listening to, reading and trusting and with the online world. And as AI is creating more content and all of this, but it's not just AI, humans are providing disinformation as well. It's difficult. And I'm a huge fan of old fashioned journalism which is kind of ironic i'm doing technology search for truth the search for truth i have been out meeting so many people i interviewed scores of people for my book 1500 citations from medical papers when i first handed it over to penguin and for me actually living and breathing this going to all the health tech events going to the labs meeting the scientists seeing what everyone's doing was a crucial part of getting a deep understanding of what's going on.

31:56Yeah. Of really getting into the nitty gritty of it, of, okay, let's talk about, and this isn't, this is a very minor part of what I've been doing, but just whilst we're on the aging conversation, the idea of whether aging could be treated as a disease or not. Now, right now, you can't get a drug, but you're not going to get a drug signed off based on the idea that it's going to be prescribed for aging. So many of these companies are picking specific conditions. it could be arthritis, that they will get a drug which they believe could have the benefits for lots of diseases of aging for one specific thing.

32:32And having the understanding of that when you go and meet the companies that are doing something for macular degeneration, or doing something for cystic fibrosis, or doing creating drugs for lots of different things. But actually, this background is quite important. And I have seen over the years, much younger journalists than me, and this is obviously me coming along being terribly old doing research in ways that I do not think are trusted ways to do journalism interesting and it's you know maybe this is me showing my age but I think having a network of people you trust and know going and talking to people phone calls picking up the phone to people it's so important you can't do everything by email you can't do everything by searching online you can't do everything by reading other journalists articles it's not that the other journalists are wrong or that there's any reason to specifically not trust them but you need to be doing first-hand research and the nuances of it you need to understand and when I got into this area and it's an area that it is so absolutely crucial to get things right when I was writing about cancer that chapter and section of the book which is really chunky on how we are heading to a place where we're going to better be able to predict the risk of cancer to screen broader populations at earlier stages, to diagnose way earlier, to be able to treat more kindly, also in more personalized ways, is going to absolutely transform the future of cancer.

34:00And when we look at all of these areas of healthcare that are shifting, that's possibly the area that I see the biggest transformation coming. And doing something like that, I needed to absolutely know, not just that what I've written was appropriate for somebody who could be diagnosed at the time of writing it, somebody who's just lost someone to cancer, somebody who fears getting cancer somebody who is in the midst of treatment or somebody who is living with cancer long term i needed to make sure that i absolutely had the facts i'd spoken to enough people across the spectrum of cancer research and oncologists so the people that are talking to the patients the people who understand the fear of recurrence risk the people who are doing the research in the labs and people across the spectrum that the ideas that i was conveying as the future of cancer care were absolutely real and believed across the board and that the outlook was uniform and if there were if there were people that didn't agree or people that had other ideas that were dropped in that I made it clear that this was what one person said the others didn't agree because it's really important this is right and whilst I'm not a doctor or a scientist I'm not offering anybody advice or telling anybody how they should live their life or change anything if I'm going to be the messenger of this information it needs to be absolutely correct yes and actually we're we're sort of I feel like almost exiting a time where journalists were held in that regard of oracles of truth because the understanding and the respect that they'd been on that journey it's like the democratization of experts that is just able to deliver content on a public platform that gets followers the incentives of media have always been around attention i get that and that you know clicks and reads and and selling newspapers and however far you want to go back of just garnering an audience around a soapbox or whatever like yeah I get it that it's always been an attention economy to some point but where we had I think a finite number of distribution channels I think that it feels to me anyway that there was more of a respect for you know the Martin Bashirs and the you know the people like that that you you would appreciate had been on that journey because you would watch them do it and I think you know Louis through probably the more modern version and and you know even going back like the david frosts and people like that you know people would look to these people and be like you've been on that journey i respect i respect this i'm going to really listen to this and go to stand it and now we've got this like generation of piers morgans that are like okay like to a point yes but like you're still doing stuff that's attention stuff you're just sticking hard right and hard left on the channel and watching them argue with I think there's a few elements to this and also yeah I must add there are of course lots of many brilliant young journalists I'm not complaining about all journalists out there at all diluted most of my friends are journalists there there are many from many generations of many many platforms brilliant journalists and journalism is a really really important thing and it it we need the information we need information we can trust yes everything has obviously become pretty polarized these days and strong arguments I think it's largely driven by social media and and clickbait things needing to be clicked on means you know jumping to conclusions that the article often isn't about the headline or whatever and there's all of that that's going on as a backdrop but I think the other challenge that journalists are up against now is the multi-platform approach so you have to do so many different things you're so busy trying to get your output out on tv on radio online update your social media there's a lot to get done and it's it's a very busy job each day when you've gone out done a story and trying to cover it everywhere and so I think when you look back to a sort of David Frost generation and obviously there are still big names who have the time and the luxury but people are doing a lot more there's a lot more multi-skilling there's a lot more having to do a lot for yourself and shooting and editing yourself, which, you know, I can shoot and edit.

38:21I don't want to be shooting and editing everything that I do because it's a distraction from actually doing the interview and focusing on the person and noticing everything that's going on around. And so there is a balance to be had. But I personally have had the luxury over the last few years within health tech of getting so deeply engrossed in one thing and also when you're writing a book, you do live and breathe it, has as any author will say possibly more than you even imagined beforehand you're going to and so lots of long interviews I did lots of hour-long interviews with people which they may only be small soundbites used but they really created the full picture for me of what the background was and what was happening and time and time again I was getting the same story back that we are at the beginning we need to change from a system of sick care to one of health care and our genetic information, environmental information, all of the data that we're now starting to be able to pull into our, to go alongside our activity data, our incidents of illness and understand so much more about why people are getting sick and when they're at higher risk.

39:33All of this is becoming incredibly important. All of this data is coming together and everyone was in agreement over that. And I think you cover a subject like this and you just need to figure what the general landscape internationally is like to be able to walk away from it and feel like yeah I understand here what's happening I really know what's happening and I've got into the nitty-gritty of it and now I can do interviews on people's specific platforms of what they are actually doing and that diligence just shows the the quality you have as an actual journalist as well and so with that in mind and we'll talk about some of the other things that you saw on this on this journey but what what was that journalistic goal of the journey because and the reason the reason i ask is is because the content that i create with this podcast and other bits and bobs that we do is very much sort of facing internally to the health tech world like we discuss a lot of nuance like we're we're this podcast is is often very good at connecting the people that listen to the guest that's coming on and the guests to other guests that i do quite a lot and i guess doing a role internally within health tech whereas i guess my perception is that you are occupying a really incredible role here in kind of being our our link to the public and actually showing the public what's actually going on behind the curtain because I feel very much behind the curtain I've got no skill or interest really in being any sort of public figure whereas that's what you're very good at so you definitely got the skill this is this is great you're doing a great podcast yeah look I think this is this is actually really really important and probably why I've had such great support from people in the health tech space which I really have the generosity of time and spirit that I had from people in making tv and radio programs also writing my book because I think people trust me to be able to tell the right story and understand the nuance of it and also trust me to not tell the bits of the story that uh are not to be told I don't mean that I'm keeping any sort of great secrets from the public here but sometimes people have a personal story that they want to share with me as to why they're doing what they do and they don't want me to share that and they they trust me with that and and that's obviously a very good position to be in a lot of this uh comes down to breaking down science and things that might be slightly hard to digest to something which is really simple for people to comprehend and why it matters to them and sometimes it can be frustrating because when I'm trying to explain say the concept of senolytics I want to go into the details of what happens to senescent cells and then I'm calling them zombie cells I'm I'm trying to break this down to make it understandable but I don't want to actually lose any of the real science and and why this matters and actually well they're important when you're a child and they'll stop you getting cancer then they'll heal wounds but as you get older they create more inflammation it's it's wanting to be able to explain these things in a way that people understand what the science is why it matters now why this is a change why something different is happening what is actually the relevant news story here and something that they feel matters to them and the story of health matters to each and every one of us the idea of being able to increase our health span matters to everybody and the idea here is to try and create health equity not further inequality and when you speak to people in the health tech space that is absolutely what people are aiming for yes of course you've got some longevity enthusiasts trying to do extreme stuff and I love talking to Brian Johnson he's a great character I find it really interesting what he's doing and he makes for great telly but obviously most people aren't going to be carrying out Brian Johnson's regime and when I told 103 year old Mildred about what he was up to she was slightly furious about the whole thing and she lives in Loma Linda by the way so she's living in a blue zone she was my example of somebody who was living to a great age without disease but she wasn't necessarily enjoying being in her hundreds I have to tell you she was pretty quite honest about that and she said I really don't think anyone should be doing this it's very selfish to be doing all of this unless they're the only person in the world who could do it I thought well actually I think Brian maybe qualifies and so it's talking about what Brian does is really interesting and also each element of it is based on science so each individual thing uh it has got you know some medical papers that'll back it up and each individual thing you could talk about doing it all is of course quite a lifestyle choice um but i think people understanding what it means for them it being entertaining enough and also i think it's important that people understand what's happening and what's coming and whether it's cancer whether it's heart disease whether it's type 2 diabetes if we have the ability to be able to prevent or delay these conditions or we are on the verge of being able to do that it's really important that people understand this it matters to everybody so I feel quite passionately these conversations need to be had so I try and do my best to to bring them to people in a way that is is understandable and interesting enough to stay engaged.

44:43I think it's also a help to generally educate the public in kind of almost like a fight against misinformation as well because if you're educating people and you're a trusted voice and you've built you know you've built that trust you're using those powers for good in that you're delivering the right information to them it's almost like you've then got the ability to really influence how they think and how they critically appraise the information that they are getting because even if you're not necessarily doing that directly and telling them how to read a paper or whatever the fact that you have presented something someone that they trust and you've presented a technology or a pathology or pathophysiology in such a way that they understand well that becomes what they now understand and what they measure other things up to so you know a creator that's more nefarious that is trying to sell them a product that's some greens powder that does nothing if you've actually gone into the deep science of something, they might be able to hold that more nefarious product up to a higher standard and ask the right questions.

45:55And so actually, I see it almost as a help in that regard as well, that you're helping us all fight misinformation, which I'm sure is pretty rife from the journey that you've been on and what you've found. Well, yes, I think it is. And also, you're right about trust. And I say I have nothing to sell apart from a book. But no, I have no health tech to sell. you know it's not if people buy an activity tracker or not it makes no difference to me but I talk about many of the benefits of collecting our data long term it's less about how many steps you did yesterday it's more about your long-term patterns and how your body's reacting to the way that you behave so I think in my book I go from everything which is that basic which is the activity trackers that people understand and use and how there is a little bit more to that data than people would necessarily realize.

46:46And there are some findings starting to emerge that you could identify patterns in sleep that could represent early signs of dementia 20 to 30 years before you would actually see symptoms. And whilst it's very early days, but for that actual information, and atrial fibrillation is being recognized through some of these devices, there are many factors that can be identified by those changes in patterns. Obviously, a continuous glucose monitor takes you a bit deeper into that data. And there are other kinds of readings, whether it's a track as you can put down your toilet to monitor the findings every morning.

47:21There are seamless things that could be tracking every day. They do exist. And at CES in January, I filmed with one on a fake toilet in the middle of the show floor. But the idea of this becoming so seamlessly embedded in our lives, so recognising our patterns and seeing when those patterns change. So sometimes patterns change and they mean nothing. Sometimes you've had less sleep and it's driven you to have different readings through all of your data. Although actually the data should be able to recognize it because you've had less sleep. But sometimes changes can be meaningful. So to be able to draw to someone's attention that something's changed is useful.

47:58Or if somebody is starting to see the onset of a condition, the fact they can look back over long term data can be useful to them. So even just something as basic as that, that is really understandable to people, can be useful. and I think is kind of important to be expressed, but it does have a relevance in the health journey, albeit the wearables are not all medical devices. They do have some elements of medically approved parts. But, you know, they're not all full medical devices, but still this data can be useful. Right the way through to who should be doing liquid biopsies to screen for cancer and how effective are they right now?

48:36How sensitive are they? What are your chances of a false positive? just understanding all of this so we know what's out there and as it becomes more widely available we will be everyone will get more access to it but another thing that I see a lot of is trials happening in the NHS being very successful but then going nowhere afterwards because every trial isn't going to become something that everybody gets access to everywhere and I feel it's interesting for people to know what the successful trials may have been and maybe then moving forward these things do become more widely available but I just think that knowledge is important and you pick up bits and pieces in the news all the time about things that are found what the impact that exercise can have on people who've had colon cancer and the prescribing of exercise there's all these stories that come up all the time I've tried to collate them all in one place and put them together as some sort of coherent story of where we're going and how meaningful they are but there are simple straightforward things to understand there are also more complex things like gene editing and we just need to understand the place that they sit within our future health journey and what they could potentially mean to us cool so how did you how did you go about writing this book did you sort of put this sort of tour together of everyone that you visited everyone you've spoken to and then did you already planned how you were going to write the book like how how did the chapters come like how did you do it practically i never planned on writing a book interesting uh I went out making TV and radio programs and I wanted to make documentaries on future health.

50:11And I was doing that. And I had this sort of vague inkling just before COVID, actually, that maybe I should write a book about a sort of technology isn't the enemy kind of book was what I had in mind back then. That it was there's massive promise and possibility that technology can bring us. And let's talk about some of the positives because we're only going to achieve them if we know they exist. so so that sort of concept was there a little bit in the back of my mind but it was actually only after I'd made a couple of these programs that I suddenly got a clear view of what a book would look like and how it would be health focused yeah and I worked with my publisher at Penguin on exactly how we would channel that because there's a lot of different directions you could take this I think I needed to very briefly set the scene for what AI is and what it means within health to avoid any confusion.