Hello and welcome from your friends at The Lancet Voice My name's Niall Boyce. I'm one of the editors here at The Lancet, joined as ever by my colleague and friend, Mariam Sabin. Hello, Mariam. Hi, Niall. Good to see you. Good to see you, Miriam. Now, if you are a Lancet reader, which I assume you, the listener, are, uh, you'll know that all of our journals aim to publish truly cutting-edge science that can transform human lives. But with innovation comes ethical challenge.
In the words of Professor Ian Malcolm, "Your scientists were so preoccupied with whether or not they could, they didn't stop to think if they should." So that's what we're here to do today. We're here, Miriam, to talk about the should, about the bioethical challenges facing us in the next decade of medicine, and who better to help us than Professor Ezekiel Emanuel. Professor Emanuel is the Vice Provost for Global Initiatives and the
Diane V.S. Levy and Robert M. Levy University professor, co-director of the Health Transformation Institute. From January two thousand and nine to January two thousand and eleven, he served as a special advisor for health policy to the director of the Office of Management and Budget in the White House. From nineteen ninety-seven to two thousand and eleven, he was chair of the Department of Bioethics at the National Institutes of Health.
He's also a breast oncologist, and he's also, and this is my favorite detail, author of Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life. Great title. Professor Emanuel, welcome to the podcast. Oh, it's my thrill to be here. Uh, thank you for inviting me. Well, we're really happy to be able to talk to you, and as always, as, as I like to do, I like to hear a little bit about how you became who you are, why this was of interest to you.
I know you, you, you were trained as a, a physician, as a breast oncologist, and I wondered if there was something about that work that piqued your interest in bioethics, or was it something, you know, that happened before medical school, or part of the reason why you even decided to go to medical school? Uh, it's the reverse. It, it wasn't oncology that brought me to ethics. It was more ethics that brought me to oncology. So in college, I was a double major, chemistry and philosophy.
I… For a very long time, uh, my mom was very active in the American Civil Rights movement and anti-war movement. We were a very politically engaged family. My father was very engaged in getting rid of lead paint out of houses in the early nineteen sixties, well before everyone else was on the bandwagon. And so we were a politically engaged family. And in college, I was very interested in ethics and wrestling with ethical questions, and I was a reluctant person to go to medical school.
I, uh, really battled with my father about going to medical school. I was very good in science, but I was interested more in social policy rather than treating a p- patients one-on-one-on-one. It's just a personality trait of mine. And after college, I went to Oxford to get a master's in biochemistry. I did pretty well. I came back to Harvard Medical School, and I was very frustrated by medical school. I liked the patient interaction.
I liked the challenges that were brought But I saw that we were not doing particularly well in many things, especially end-of-life care at that time. This is the, uh, early '80s, and I s- finished my clinical rotations at Harvard Medical School, and I took off and did a PhD in political philosophy and sort of looked at, at how values influence bioethics and medical decision public s- not personal values, but public values, uh, freedom of choice and things like that.
Uh, so then when I had to decide what part of medicine to go into, oncology, as I like to say, has all of the medical dil- uh, dilemmas. The, you've got informed consent. Do patients really know what they're getting into? You've got end-of-life care issues because so many patients, unfortunately, with cancer died, and that was certainly true when I was, more true when I was training than today. We've just done a much better job over the last 35 years. And then it's got money.
It's, uh, you know, probably the most expensive part of medicine. It even was the most expensive part back then. We were doing bone marrow transplants. Then it was at a, a, you know, an outrageous $100,000, and everyone was wringing their hands about, "How can we pay for this, uh, even if it's, uh, turns out to be extremely successful?" So it encapsulated all my interests. And the other thing from a practicing medicine standpoint, you get to know your patients incredibly well.
They are confronting an existential issues when you see them. Even if their cancer isn't, quote-unquote, "that bad," they feel like they've got a death sentence, and so they're wrestling with big, big issues. And it attracted me to sort of work through h- how are you thinking about this? What do you value? How do we take what you value and, uh, shape our, our recommendations for therapy around it?
And working that through with people, it was very gratifying, but it also illuminated lots of issues for me. So it was really the ethics that got me to oncology and then a, a lot of the cases that oncologists normally face, I mean, they're inescapable in oncology, I began to look at. Now, that, that's interesting because I think that a lot of people would think of bioethics as being sort of grand abstract concepts and themes, but in your case it, it starts with the individual.
One of the things that I, I do in my bioethics and i- is to try to create a general ethical framework and to see how individual cases, whether they're policy choices or individual patients, how that framework helps us understand what the right thing to do is in those. And I think those general frameworks, what are the values that are at stake? How do we balance the values?
Because almost invariably, it's not one value, it's three or four, and I think that's, that's what I, I bring to bioethics, I think the best. So it's, it's an interplay. You know, John Rawls, a famous Am- American ethicist, talked about reflective equilibrium. You go back between the particular case and the general framework, and you modify each, uh, to see what the right answer is.
And so I think that that's a skill I learned from, uh, Rawls and, uh, I think it, it very helpful in medicine because you have a lot of cases. I mean, you know, we have a, a million, uh, more than a million people diagnosed each year in America with cancer and ev- as I say, every one of them has at least two and usually three ethical dilemmas in their own patient.
But one, one thing which I was interested in was to see this paper you published in The Lancet in 2009, which was called Principles for Allocation of Scarce Medical Interventions. Um, so I've got two questions really. The first is, can you just tell us what these principles were? And then secondly, what, what about when these principles collided in your life with reality i- in a very big way when you were a member of President Biden's COVID-19 advisory board? So let's go back.
For all of my career, beginning in the mid-'80s when I entered bioethics, allocation of resources was the hardest problem. If you look at the classic textbooks from the '80s and '90s of bioethics, you know, the famous Georgetown four principles, justice is like lots of hand-waving. There's no substance to it. It, it doesn't help you with resolving allocation issues, and it was the hardest problem.
In 2005, the Secretary of Health and Human Services in the United States, he, he came in as Secretary Mike Leavitt. He was governor of Utah, and then under George Bush became the, uh, Secretary of Health and Human Services. He says, "Look, we need better pandemic preparedness. You know, if a flu pandemic comes, which we're expecting, we're, we're overdue for it, how, how are we gonna respond?" And he had a whole report, and part of that report was we're not gonna have enough resources.
We're not gonna have enough ICU beds. We're not gonna have enough, uh, vaccines initially. How are we gonna respond? How are we gonna allocate? And the report had an allocation scheme, and I was running something called Ethics Grand Rounds. We'd create a case, or not create, but take a case and have an expert talk about it, and then all the clinical staff at the NIH would engage in question-and-answer discussion of the case.
So we invited one of the authors of that report to come in and talk about pandemic preparedness for a flu. This is 2005. And they, uh, gave their allocation scheme for if they had a vaccine and there wasn't enough, and the allocation scheme was that older people should get priority And as we're leaving that presentation, I turned to a colleague of mine and I said, "That allocation has to be wrong.
That can't be the right answer to give it to old people, especially since we knew that in 1918, in the flu pandemic of 1918, it was young kids who had a disproportionate high mortality rate." I said, "It's gotta be to prioritize young kids." So we walked back and, you know, we began talking about it, and in about two weeks we had a, a paper that we published about the fact that the priority ought to be for young people.
And then, and here I go back to my point about frameworks, is there a general framework? What are all the ethical values that might impact allocation? And can we talk about how you allocate what we call absolutely scarce resources, where the issue isn't money, the issue is we just don't have enough of the stuff, whether it's vaccines or ICU beds, uh, organs for transplantation.
And then we literally spent about three years working on The Lancet paper, which I think is one of the most important papers I've ever published. And, you know, I, I wanna thank The Lancet over and over again because I think the paper's, like, 10 pages long. You gave us a lot of space because it was… it's such a complicated issue. But what we out- did is outline that there are four fundamental values, we called them.
Uh, maximize benefits and minimize harms, equal moral concern Prioritize the disadvantaged and reward contribution, social contribution. And then under each one, we said, you know, there are different ways you can realize maximizing benefit, right? You can save the most lives or you could save the most life years. Those are two different ways of maximizing benefit. Or equal moral concern. Well, everyone could be treated equally or you, you could prioritize people who are young.
And, you know, prioritizing the disadvantaged. It could be the sickest, right? They're the most disadvantaged. They come into an emergency room, who do we jump on? The, the sickest person because they're the most disadvantaged. Or it could be the youngest who've had the least life to live. Similarly, equal moral concern could be first come first served, or it could be a lottery. Anyway, we outlined eight ways of realizing these four principles.
And then we said, you know, no single principle is gonna be enough. You have to have a multi-principle allocation scheme. And one of the things we know humans are bad at is balancing different principles. This is where pluralities come in, where people have different priorities. And one of the-- I think the, the big-- one of the big points of that paper is when you prioritize a disadvantage, it's the youngest that you care about.
They've had the least of the most valuable thing, which is the least years to live. And we also said there are certain principles we should never use. We should never use sickest first Prognosis is important, and sickest first doesn't take that into account. First come, first served always invariably benefits the rich, which should never come into account, and only in special cases like emergencies should you, uh, bring in social contribution.
So th- those were-- we could exclude certain principles and bring in others under only select circumstances. I think we made a big advance. And then we have what has come to be called the whale graph in the paper. And again, I, I think you guys were just so generous. Lancet was so generous. So we said, you know, in general, there's a, a whale considerations. Very young kids, low priority.
When you get to 20, that's probably 25, that's the maximum priority you get because society's invested a lot in you, you've invested a lot in your own life, and you're all potential and no actual, and the rest of life is about realizing all that potential. And I have to say, I've gone around the world, and I mean the world, everything from China to Australia to the United States to England to, uh, Scandinavia, and asked groups, "All right, you got one liver. You got a 2-year-old, a
20-year-old, and a 70-year-old. Who gets the liver?" Invariably, more than ninety percent of people, it's the 20-year-old. So fast-forward to your second question. Yeah, so here we are in COVID, and COVID hits, and we've got worldwide allocation problem. And so we take our framework and say, "Can it help?" And lo and behold, it can help.
You know, older people, while you wouldn't have thought necessarily should get priority in ours, because they got the maximum benefit, they were at the highest risk, so the prognosis was best for them if you gave them a vaccine. We also, you know, prioritized healthcare workers to get the vaccine because they were gonna save more lives, so, you know, rewarding social value.
Almost everyone used our framework, and we specified in some, a lot of papers how that worked and how that would work or should work So it, it's, it's a, it's a universal theme, allocating scarce resources. Do you think it's a future theme as well? Do you think this is something which- Oh, it's only gonna become more intense. The, the reason is we're now butting up against the issue of drug evaluations. Drug are evaluated by their cost-effectiveness.
So how many quality adjusted life years, so here you get it's not just saving lives, it's saving life years, do you get for the, the cost of the drug? And there are various thresholds. Almost some countries are explicit, but most everyone like Britain are not explicit about it. They have variable cost thresholds for different kinds of patients. You know, you're somewhere between 20,000 and 100, $125,000 per quality adjusted life year.
What we're finding, and GLP-1s bring this to the fore most explicitly, but, you know, if we get a effective Alzheimer's disease, it'll bring, bring it to the fore in some ways even more. You have a cost-effective intervention that is so costly because so many people need it that it's breaking the bank, as they say, and society may not be able to afford to cover it, at least at the price that is being sold at that moment.
And I think that challenge of, yes, it's cost-effective, but yes, its overall total cost is too much, you're gonna just see lots more of that. And again, somewhere in the next 10, 20 years maybe, I don't know how fast the ner- the research will go, uh, in Alzheimer's you're almost invariably gonna have something about that coming to the fore, even if it's only marginally effective, but it is truly effective.
I think the current drugs we have, a lot of people are like, "They don't even look effective in the wild." Maybe in a very narrow research study, but in the wild, uh, under normal, you know, practice. But if you have one that, you know, say, s- stalls a progression for two or three years, that you'll have tens of millions of people who will need it, and, uh, it's gonna be costly So the obvious question here is, you know, I'm sitting in South Africa today. I'm normally based in New York City.
I'm in Sub-Saharan Africa and have heard a lot of discussions today, you know, including at the, the, the meeting that, that I'm attending around the issue of allocation of resources. It could be GLP-1s, it could be lenacapavir for HIV. That was being talked about. Of course, the COVID-19 vaccines came up as well. And so it's hard for me to imagine that the issues will get much, much easier for the Global South as compared to the Global North.
And, and I wonder, you know, in think- in thinking about your, your work and going back to that, is, is there part of considering how emerging economies, how strong economies, how fragile states, you know, the whole, the whole mix of what's available in terms of one's own government being able to provide these services in, in more constrained settings, how does that come into play? How is that gonna come into play in the next years going forward?
So I, I think buried in your question, Miriam, are two questions. Um- Probably … one question is, so, like, in a country of, in South Africa, how do you allocate within the country? You know, for better or worse, and I think inherently, and we could, you know, lots of people discuss it We have people who are cosmopolitans, but fundamentally it's our government, wherever you're a citizen, that, uh, is entrusted with taking care of your needs. And we're still a country-based world, as it were.
We don't have universal government, and there's no chance, at least in my and your lifetime, in all the, the listeners' lifetime, we're gonna get there. So if we're country-based, there's an internal allocation in countries, and I think our framework works for all those resources where we e- either don't have enough money or we have absolute scarcity. And I think w- we have a pretty good framework for that. We… And again, doesn't mean it, it's like a machine where you can crank out the answer.
And part of the reason is the different principles you have. If you have four or five principles you're balancing, different people are gonna balance them differently, right? Some might emphasize prioritizing the disadvantage more than overall benefit. Some might want equal concern more, uh, find that more important.
I, I was thinking that, you know, connected to this is this tangential question related to it, which is that many of, of the countries in the Global South and in Sub-Saharan Africa have lost funding from the United States or had lost a lot of funding from PEPFAR.
The US was the largest global donor, of course, to global health, and there's a lot of… there were a lot of questions around should the US be the primary funder for, for example, antiretroviral therapy for people who are already on it, but also other interventions, malaria and so forth.
Uh, I guess I wonder also if you could help to contextualize some of these questions given, you know, the moment we're in right now where the countries, you know, here are thinking about how they will allocate with, with smaller means to, uh, on a, on a whole variety of medical interventions. Um, so the, the, the first part of that is a question about the allocation of resources among countries. So you've got within a country and then among countries.
And one of the things COVID raised was the whole question of how do you allocate a common pool of resources? And let's be clear. Why was the COVID vaccine a common pool of resources? Well, to actually identify the virus, to get the genome sequence, and then to develop the mRNA vaccine required all sorts of resources from all sort part of the world. We were all in it together, and the real question is, in that kind of circumstance, how do we allocate a resource?
And again, we looked at this and I brought together, uh, ethicists, people who had never done medicine, by the way, ethicists from all over the world, because I could see that, you know, as April 2020, we were gonna have a new vaccine. There was inherently gonna be a shortage. We had eight billion people in the world. It takes time to manufacture even the fastest pills, much less a vaccine. So we were gonna have an allocation question, and we addressed or, or analyzed that.
It took us about, uh, four months, but it was pretty quick, and people were really intent on trying to solve this conundrum. And one of the things we emphasize is we have to treat all the people equally. That was, you know, a major principle. And allocate the two countries based upon the health need of a country. How bad were they being hit or were they likely to be hit?
You have to prioritize by health need to maximize health benefits and minimize, uh, health risks, and that was the, the right principle. It wasn't we should allocate, like, peanut butter and just spread it out over all countries, which was what actually the WHO and others were proposing. Um, so again, the ethics tells you things that you might not go to with your own intuition right at the start, and that's very important to listen, I think, to listen to the principles.
I went in thinking that we have to make it much more uniform around the world, and it turned out that that was the wrong answer. And I think having a group like The Lancet Commissions think about these problems helps because it, it's important to get different perspectives and people who are expert in different areas of thinking about the problem.
The current issues, and I think especially the tragedy of Trump and Elon Musk killing USAID, is the fact that we're on the cusp of really being able to get rid of HIV I remember I was in the White House in 2010, and one of the things I had, I was at the Office of Management and Budget, the, the equivalent of the Exchequer in the UK, and I had in that arrangement, responsibility for global health. I was the doctor. I knew something about global health.
I had written about global health, and I had written about, you know, the importance of prioritizing women and children first in that framework. And in my last few months, I said, "You know, we have to think about how we can bend the HIV curve so that we're getting fewer new cases, and the people who are dying are more than the new cases, because then we can see we'll be on the bottom end of the curve, and we can get rid of this disease."
I think it was sort of novel thinking to a lot of people inside the White House, the policymakers. And I said, "You know, that, that is our key. Stop new cases." We gotta find something that'll prevent the transmission and reduce the transmission. And now here we are, 15 years later, 16 years later, and we actually have those interventions. You know, almost eliminate the transmission.
We have to focus therefore, in my opinion, you have to focus on how can you get babies not to have HIV and then grow up HIV-free, especially when they become sexually active. That is the key, and I think that's gotta be the way we think about the allocation for the most, uh, uh, life years, getting the youngest and progressing out.
And that obviously means, you know, we're gonna have to control the HIV in people who could transmit it to reduce the risk of transmission generally, but also particularly about, uh, for children. So, so a somewhat more subtle approach than I think the quote was, "Feeding it into the wood chipper." Yes. I mean, w- and, uh, Ebola's bringing it up even more, right?
The Ebola response in 2014, for the American response, was b- led by USAID, and now we don't have that, and we, we don't have another alternative. You know, totally shortsighted until you have a d- a, a problem. And this goes back to, I think, the very first question you asked, is looking forward, what is our, what are our big ethical problems gonna be?
And I think how much you invest in preparedness for eventual problems is a, another allocation question which I haven't delved into, but I think is a very important… There are a series of questions around that which is very important. What do you do to prepare for an eventuality? How much do you invest? How much ins- basically insurance do we need to take out? Um, now clearly on pandemic preparedness, we're underprepared. There, there's no doubt about it. I don't know what the right number is.
I can tell you the number we're spending worldwide today is way too low, and here's how I think about it. I take out insurance on my house, my car, you know, and a… but my life. Uh, how much am I willing to pay? Well, you know, when you look at USAID, I think we were paying something like $100 per American for the world. That seems like a low number, really low number considering that our GDP is cranking out at, you know, I don't know, $80,000 per person, fif- $60,000 per person.
Similarly, it- Domestically, forget globally, just domestically in the United States, you know, what was the CDC budget? I don't know, seven, $8 billion in a country of 330 million people, right? We're talking at l- less than $100 per person in the United States to take food infectious outbreaks or, you know, chronic disease, all sorts of things. That seems like way too little.
So I, I, I like to think about, well, how much insurance would you buy in a circ- would I spend $50 for better pandemic preparedness in the United States, $50 per year? 100%. Just look at how many trillions of dollars the US lost and the world economy lost from COVID. So I, I think we have to think about this a little bit on an insurance model. I think the other thing is we don't have a good way of thinking about how to prioritize our research dollars.
You know, research could… I- is kind of… the kind of thing where we could spend an unlimited amount of money, and we're not. You know, the United States has, has the biggest research budget in NIH at 50 billion, roughly $50 billion. Um, we have the National Science Foundation at roughly $10 billion. First of all, how much should we spend? So $50 billion, about $150, $140 per American. Is that the right amount? I don't know. It do- and again, it does sound low to me.
You know, the question is, within that, where do we spend the money? I think we don't have a really great way of thinking that through, and I think that's an unsolved allocation question which is gonna become more acute the more we can do and the more our research, uh, shows us possibilities. Um, so that's for future generations. So, so speaking of future generations, well, actually, you know, it's 2026. We're on a podcast. We're not gonna get to the end of it without mentioning AI.
And I was wondering what excites you perhaps and what, what worries you as a bioethicist when you think about the collision between AI and human health? So let me begin by saying I am a big believer in AI, uh, uh, medicine. And I think the usual worries that you hear a lot of, "Well, there's bias and this," and those are gonna be solved. And I, I think, uh, that doesn't keep me up at night.
And I do think you're gonna see AI-- uh, you already have in a lot of simulations, and I think the data are pretty clear, you have very good at making a differential diagnosis. So you plug into, you know, one of the various AI things or open evidence, you get a pretty damn good differential diagnosis. Second, you get good advice about what's the next test. You then also get done the test, you've got it narrowed down to one diagnosis as the dominant one. What's the treatment intervention?
And we have evidence that, uh, a lot of AI is more empathetic than our average doctor. And the last thing is, we have, I think, evidence that in managing, autonomously managing chronic illnesses where there's good guidelines, like hypertension, hypercholesterolemia, diabetes, AI is as good or not, not better than physicians. And it's only getting better at a very rapid clip. I mean, there are what, now on average four updates for every AI thing every year. You're training it better.
You're-- we're figuring out how to put guardrails in, so s- so safety things don't happen. I think that's gonna be a big breakthrough. You know, I don't know the data in England. I can tell you the data in the United States, managing chronic illness, we suck, and there's no nicer way of putting it. So 120 million American adults have hypertension, 24% have it well-controlled. That's absurd. Absurd. It's easy. You, you can measure it without invading the body, without even taking blood.
You can follow it easily. Wireless blood pressure cuffs so people can get the data. There's guidelines for how to treat it, which drugs to use. Almost all the drugs are generic. Combination drugs are generic. There's no reason it shouldn't be 80, 90%. And we know there are many good programs in the United States that get to 80 or 90%, and yet we're at 24. AI's gonna do way better there. So it sounds to me like, like it's sort of cometh the hour, cometh the technology.
Um, at least once every podcast, I have to mention this, I trained as a psychiatrist. And I see the future of a lot of healthcare really following the, the model of psychiatry, which is that you have people who have, uh, chronic conditions which are managed in the community, very often a lot of self-management.
And, you know, this is, this is quite similar to the picture you're describing with, with physical health conditions such as, as diabetes and, and that AI really provides a, a solution there to these issues of scale and scarcity, these, these issues that we've been talking about. Yeah. I, I, I, so I think three things. There's, uh, access, so scale and scarcity. Uh, there's cost because the marginal cost is trivial, and then there's quality Adhering to the guideline.
And, you know, one of the great things about AI is they can talk to a patient every day, multiple times a day, to help them. And especially with older patients who have more illnesses, that's actually quite important to them. So I am quite optimistic. Is it today? No. Is it 2030? In some cases, some of those aspects it will be, AI will exceed doctors.
By 2040, it's gonna be standard, and how we integrate the existing medical s- infrastructure, physicians, nurse practitioners, uh, pharmacists, all in with AI, no one knows, and I think that's gonna have to evolve.
And I do think that's less of an ethical challenge and more of an operational challenge, and I… But I think it's critical that we do it instead of, you know, you can see in Utah, uh, I don't know how much the listeners have followed, but there was autonomous medicine refills happen with AI, and the doctors there have gone to the legislature and say, "No, can't be autonomous." And it's like, you know, uh, that's just guild behavior. That is not what's best for our patients.
So I think we need to, uh, we need to be more open and think more, uh, uh, futuristically. What's… A- and where the primary goal of the medical profession is not to protect its own income, but what's best for our patients. W- we will do fine. We, we are gonna do fine, uh, um, regardless because of the access, quality, and cost issue. Um, but I think we're gonna be working with AI, and doctors already are, you know. 70, 80% consult AI every day.
You know, Niall, I know we need to, uh, to end, but, but just hearing, no, hear- hearing you, you talk about this, you know, I started thinking, well, okay, can you imagine if you have the AI to help, in particular as you were talking about various chronic conditions, at the same time that the United States had universal health coverage, an area that we are now going back on?
Would there be a synergistic effect there that would enable, you know, the lowering of prevalence of, of diabetes and hypertension and so forth, along with the AI? May- maybe there's a big opportunity. I, I think, I think AI, uh, has a possibility of lowering cost. I, I do. I'm a little hesitant to say overall costs are gonna come down, and one of the reasons is, you know, health needs are more or less unlimited, and so th- there will be more things we need.
And I'll, I'll just give you one example based upon my book that I'm pointing to back there, you know, Eat Your Ice Cream. One of the things you can't get in most developed countries is, I'm a 40-year-old person, and I, I don't have any problems. I don't have diabetes. I don't have hypertension, hypercholesterolemia. How do I stay healthy? You can't go to your healthcare system for that Right?
There's no… You can't go to a doctor in London and he, the, the doctor says, "Well, you know, you need a coach to make sure that the main things, eating well, your social relationships, your exercise habits, your sleeping, that you're doing the right things there." So we have to move, and I think this is w- your point, Miriam, to some degree. We have to move from a reactive system to much more preventative, proactive system.
And part of our healthcare system has to be, you know, I can refer you to coaches who can help you just make sure, you know. They're not gonna stay with you for years. They're gonna make sure, and if you, uh, that you're doing the right thing in each of these categories, making them habits. And if you have questions or problems, you can come back to them. We haven't built that into a h- Because we don't have healthcare system. We pay doctors, we pay hospitals for managing sick patients.
I think people are telling us by this wellness craze, we want people to help us with our wellness. The medical profession has, uh, and the whole health system hasn't done that, and I do think that's really, really important. One of the things we're actually studies, we're ac- we're doing two studies on that. We're looking at medical school curricula in the United States. How much do they actually educate kids on wellness? And we're also looking at physician-patient interactions.
How often do they talk about wellness? My guess is de minimis. So this, um, as, as Miriam said, sadly, we're running out of time. But we'd like to end with a, with a quick-fire question. And, and the quick-fire question this time is, should we try to live forever, or should we just eat our ice cream? Oh, you should definitely eat your ice cream. And you can eat chocolate too. I make a honey. Well, I'm very happy with that. I It sounds great. Sounds excellent. Fantastic.
Well, thank you very much, Professor Emanuel. Thank you, Miriam. And thanks to you, the listener, for downloading this podcast. Uh, you can check out all the great content at The Lancet and its sister journals at thelancet.com, and we hope you'll join us again next time. But for now, goodbye.