The battle for hearts and lungs: Transplants in trouble.

This BBC podcast is supported by ads outside the UK. On Big Lives, we take a single cultural icon. People like Jane Fonda, George Michael, Little Richard. And we pull apart the story behind the image. And we do this by digging through the BBC's vast archives. Discovering forgotten interviews that change exactly how we see these giants of our culture. We're here for the messy, the brilliant, the human version of our heroes. I'm Emmanuel Jochi. At Kai Wright and this is Big Lives. Listen to Big Lives wherever you get your podcasts. The left flank will come out first and then we'll bring the lungs to theatre. It's 3.30 a.m. and Maria's Burman, a surgeon at Papworth Hospital in Cambridge, is about to perform a life-changing operation. Left flank, right flank, so we're going to start separating between the right and left. Four, six, please. The patient, a 65-year-old man, is about to get a new set of lungs. Producer, Ida Mealy, has been allowed into the operating theatre alongside Maria's. The new lungs have just been wielded in before us in a toolbox and taken out to be split. The light-pinned intola, they look light, airy, malleable as a surgeon moves them between his hands. This is the disease lung. The left flank, you see, it's very small, it's shrunken and there's about all the pathology. It's all disease, so it's all very robbery, so this patient is lucky to have the new lungs. As Maria's and his team continue the operation, it's worth considering how lucky this patient is. Each year, just 300 people or so receive a heart-along transplant in the UK. The NHS used to be world-leading at this type of surgery, but it's fallen well back, which means there are far more people waiting for a transplant than ever receive one. We've gone to the bottom of the pile. Our transplant rates against our population numbers are one of the very lowest. That's Robbie Burns. He's a heart transplant patient. He's been studying the UK's heart and lung performance for the last few years as part of his role on an NHS transplant patient group. Our outcomes in terms of how long people survive after transplant are below what others can achieve. We can do much better. I'm Michael Bekennen, the BBC's social affairs correspondent. And this file on four investigates will assess the state of the UK's once prestigious heart and lung transplant service, hearing from those who've spent years monitoring its shortcomings. There is a lack of understanding that transplantation is an urgent emergency, life-saving procedure. Sojourns frustrated by the NHS's failure to invest. Transplantation is going to shrink and shrink progressively. And it may be that you are going to end up with only a couple of units and the patients strive to protect their second chance of life. You appreciate it more and you live a different type of life because you live in a life to a gift. The question is this, can the UK regain its lost status and how? Hi, baby. Can you see me? It is muttering no. Come on then. Here we go. Good girl. Judy Cantal lives in South Devon with her mum and Willow, her tortoise. The 34-year-old was born with cystic fibrosis, a genetic disorder that causes mucus to become thick and sticky. Over time, my lungs have just got damaged after infection. My lung function dropped significantly. I think the last reading was 9%. So after trying numerous medications that weren't working, they then think transplant may be the best option for me. And how long have you been waiting for the transplant? Seven and a half years. How often have you had a call for lungs? Seventeen times. On two occasions, the operation was cancelled before she even left the house. But every other time, Judy, her mum and the oxygen tanks she relies on to breathe have set off on the five-hour drive to Hairfield Hospital on the outskirts of London, usually getting there before being told that the transplant isn't going to go ahead. Once, they didn't have a spare theatre, each other time she was told the lungs were not suitable for transplant. It's been so long you're just getting used to it. It's just my way of life now. You always go after a phone on hand, phone calls for the hospital appointments. If they get a match for lungs, I've got to drop every phone and leave immediately. So it is trying not to take over your life, but it does. It can do. Judy stresses that she's happy with the care she receives at Hairfield and the hospital says it considers very carefully what is right for each patient, but Judy is understandably frustrated at the time it's all taking. Have you thought about what it would be like to have new lungs? Yes, it would be so nice. I couldn't carry on being a 30-year-old, 34-year-old, like anyone else. I can go on holiday, I can get another job. It's just be a whole new way of life. I've got seven and a half years to make up first. And then I carry on. Must be a little bit like you almost feel as though your life's on pause. It does 100%. And I feel like everyone in the world is moving on without me. Getting a new set of lungs, indeed any organ, starts of course with donation. In this respect, the UK doesn't do too badly. Its organ donation rate per million people is equal to or better than much of Europe with the exception of France, Italy and Spain, which do have higher rates. Over recent years, the UK has moved to an opt-out system where in theory adults have to choose not to donate. But as George Mascaro, the former head of Heart and Blonde Transplant Services and Birmingham told us, families are always consulted first and is not led to a flood of new organs being donated. Organ donation is a very sensitive activity. It is always preferred just to let those organs go, not to retrieve them if there is a negative of the family. Essentially, the NHS could push harder for more organs but understandably doesn't want to put pressure on families at a point of extreme distress, namely an impending bereavement. Surgeon Arran Ronesenga, speaking on behalf of NHS Blonde and Transplant, says legislation alone is not enough. One of the things which needs to happen in tandem with this kind of legislation is there needs to be education, there need to be campaigns to make people aware of the current system. And one of the things which I think is helpful is for people if they put themselves on an organ donation register to have what might be a very difficult conversation with family to say these are my wishes. But what about the organs the Health Service does get? Well, the starting point for explaining the problems in the UK is that the NHS uses far fewer of the heart and lungs that are donated than virtually all other similar countries. Data from 2025 shows the NHS used just one in ten of all lungs that were offered in hearts just one in seven were transplanted. Put another way, pet head of population, the UK does fewer heart transplants and half as many lung transplants each year as most of Europe. Robbie Burns says the blame lies squarely with the commissioners of transplant services NHS England which oversees all but one of the UK centres. It's been a lack of focus and a lack of oversight at a national level. So other things have taken priority and there's been a lack of planning and a lack of coordination and a lack of funding for how the services are organised. So I don't in any way blame all the teams working hard across the country but they are not supported to deliver the level of service with the complexity of patients that we are. Numerous surgeons have told us that working in that system can be asked for a straighting as being a patient. Dr George Mascaro left barming him in 2024. I've been worth there for two decades. It's like always say you recording service. We're having to speak to him via a video call because he now works in Wisconsin and the United States. From the moment you get a donor, do you feel that you are better able to serve your patients in the United States than you were in the United Kingdom? I think the answer is yes. Because there is a better way to investigate better information that I can get from the donor, I have a better system to transport and to preserve the organ. There is no cancellation in the intensive care unit. It never used to be like this. The UK was born supioneer and transplant surgery in the 1980s and 90s. The patients from Europe would travel here for their operations. The operation was carried out at the National Heart Hospital by Britain's foremost heart surgeon, Mr Magde-Yakub. A spokesman for the hospital, sir. One of the key figures was Professor Sir Magde-Yakub. He performed the UK's first combined surgery. heart and lung transplant in 1983 at Hairfield Hospital and amazingly at 90 years of age still contributes to work at the research institute named after him. You're still excited by pushing the science. Absolutely, it keeps me younger because I work with young people. The question then is what made the UK so successful? Sir Magdhis is one aspect was being willing to take more risks in using imperfect donated organs with a view of helping more patients. We were not frightened to accept marginal donors and try and resuscitate them because we had a long waiting list and we knew that we could benefit more patients. Given the amount of tools that are available now that weren't available 20-30 years ago, why do you think that so many surgeons are still more risk of worse than they were in your day? I think what's happening now that everybody is worried about their own results and not taking risks because they are being audited all the time when we use the problems and we try very hard to find solutions. Now there is a separate players of people evaluating other people. Can I ask, do you know how many heart transplants you have done? I think roughly I can give you an estimate, 3,600, between hearts and lungs. We could do 17 to 20 transplant in a weekend, between Friday and Monday and that was just working around the clock. No one is advocating for such a punishing workload today, but Sir Magnus' insight gives a vision as to how the UK became so prominent that transplants his team didn't know again. Whole centers now take six months to do. Everything is closed so we can start ventilating the lung in just give me a few seconds. Okay, you can ventilate. Okay, so then should I change? Bucket power on the lung transplant is continuing successfully. The patient is fortunate to be treated here. I met the UK's lagging performance that is one decision that can significantly boost a patient's chances which hospital they end up in and Papworth does more lung transplants than any of the other four special centers in England. It's ventilating, very good inflation for the parts of the lung. Producer Adam is still alongside Maria's Varmann too. We're now two hours into the operation and the left lung has now successfully been transplanted into the patient and soon the right lung will be transplanted. The heart is comfortable, the lung are perfusing, the patient is very stable so they're very pleased. We are halfway. Here at Papworth in Cambridge the waiting times for lungs are a lot shorter than elsewhere. For a heart the differences are stark. Here the average weight is eight months for a heart transplant and Birmingham it's four years longer. The data shows that Birmingham doesn't do as many transplants. It told us it hasn't got the funding to expand its services unless patients do their own research that unlikely to know that such differences exist. What also helps Papworth so as his clinical lead for transplants, Steve Pettit, is its culture. There's a lot of pride in our transplant service. We really bend over backwards to make transplants happen, to try and ensure that we say yes to every good donor organ that we get offered and to try and make sure that we have suitable recipients for donor organs on our waiting lists. Papworth's performance is helped by a number of factors. It's a specialist heart and lung center so it can focus on transplants without competing demands from other health services. It pushes scientific research and invented a technique for retrieving hearts from donors whose life support system had been switched off. It's called DCD but it had to turn to its charity for funding. In our hospital we've been exceptionally lucky in that the hospital charity has often supported us to bring new techniques and new technology into practice before those things have been commissioned nationally. DCD heart transplantation is a good example of that. That's something that was pioneered in the hospital that we couldn't roll out because of a lack of funding. The charity supported to the tune of excess of £1 million demonstrated that it worked and now it is funded. As good as it strives to be even papworth recognises that it could be better. Like every other centre in the UK it doesn't have routine access to technology used in other countries. Coordinary angiograms and hearts would give a much clearer picture of the health of the organ. Without this surgeons have told us more organs get turned down including healthy ones as clinicians cannot be sure they're safe to use. In some instances surgeons have gone ahead and transplanted an organ. We wanted to find out later it was diseased. This happened to Dr. Mascaro when he led the team in Birmingham. I can't remember personally heart that was transplanted was a very good heart reported as no Coordinary artery disease. And eventually it had Coordinary artery disease. And the non-giogram would have spotted that. Yeah definitely definitely. There's another issue too ice boxes. In the UK there's decades old way of transporting organs are still regularly used and they can have a damaging effect increasing the likelihood of complications in the first 72 hours. If the heart drops to the bottom of the bag then it will be in direct contact with the ice. That contact with the ice breathes that part of the heart that is in direct contact. And that may increase the possibilities of a primary graph dysfunction. A heart that doesn't work properly from the beginning will require more intensive care unit. Modern alternatives are available which also assess a donor heart's viability that are expensive and only part funded by the NHS. In Glasgow where the technology is used more often thanks to additional financial support from the Scottish government. The hospital there told us it had substantially improved its ability to accept donor hearts. Pop words are finding other options creating their own refrigeration system that works better than ice box. And Steve Pettit says they hope other investments will come too. Many aspects of transplant services have existed in the way that they've existed for 20 or 25 years and 20 or 25 years ago UK hospitals didn't do coronary angiography in the middle of the night. This is an example of something that's being explored in great detail at the moment as a result of the drive to improve organ utilization and sometimes in transplantation these developments that are in use in other countries. Don't have the strength of evidence to support them that maybe I would need to persuade the commissioners of health care in this country that these are things worth funding but that is changing. On Big Lives we take a single cultural icon. People like Jane Fonda, George Michael, Little Richard and we pull apart the story behind the image. I'm Emmanuel Jochi. I'm Kai Wright and this is Big Lives. It's worth remembering the extraordinary nature of what is happening here. A heart for instance being removed from one person transported possibly hundreds of miles and then implanted giving someone a new shot at life. Little wonder when a recipient call it the gift. I actually had the transplant without knowing about it. I was actually in the age I when a donor became available. So you didn't know you were going to get a heart transplant that day? No, I went down for a new life support system and then woke up the following Thursday. In 2009 a congenital heart problem left minor Evans seriously ill. Dr. Streatinger and Birmingham feared she wouldn't live to see a transplant so decided to implant a mechanical heart device. But while she was undergoing that operation a heart became available so the surgeons changed tack. Miner spent 23 hours in surgery and when she gained consciousness a week later she had a new heart. It was so real to be honest the recovery process. It was literally you get out of that bed and you get out of this hospital and you get back and start living your life. Miner who lives in Kürfeli did just that she got married built a career. She obviously needed regular checkups. The body is constantly trying to reject a new organ and the drugs to overcome that resistance kind of toxic repercussions. In 2024 she went back to Birmingham as our fetid swollen. She couldn't believe what the medics told her. We think the swelling of your feet is being caused now by kidney disease because your kidney function no as dropped. I was like well, Oh, don't know when to that happen. Oh, it's been going on. for a while. So, nobody at all would be for the last four years, now my kidney function was declining. Worse still, she says, the team didn't offer her any hope. There would be no referral to a kidney specialist to try and slow it down, or find out what the cause was. What they said to me in our meeting was, you won't meet any further treatment with us. And if you're transplanted, our continued to decline, you will then have to have conversation with them in clinic about where you go from there, because that would basically be the end of it. Politics care. Yeah, that would be the end. Having a transplant makes patients more vulnerable to a range of conditions from skin cancer to renal failure. An adequate wrap-around care can lead to poor results. The percentage of people alive five years after a heart-along transplant in the UK is noticeably lower than in the world's leading countries. Jess Jones is a heart-along patient advocate who's been reserving transplant services for over a decade. Having a transplant is a huge thing, but it's not just about the surgery. It's about the longer-term follow-up, because that has a very direct impact on outcomes. We can see elsewhere in the world, Australia, for example, has astonishing outcomes 20% above what we do when it comes to five years of evil. If somebody starts to have renal failure, then obviously that's going to have a huge, deleterious effect on their heart or their lung transplant. So there's no point doing incredible life-saving, magical operations with incredibly skilled surgeons, and then not investing longer-term in what's really needed to keep these people well and to have good longer-term outcomes. Investing in transplant services is much harder when a hospital is big and busy. The Quin Elizabeth Hospital in Birmingham, where minor was treated, is huge with more than 1200 beds, but it offers much more than transplant care from an alcohol care team to a genomic care center. Each department competes for a share of the trust's overall budget, and George Mascaro says that when he was there, hearts and lungs often lost out. We always argued that transplantation brought revenues to the hospital. We never saw those revenues or even part of those revenues reinvested in making the unit to grow in what we were asking for. We needed more pieces that appears. We needed more psychologists. We still need nutritionists, for example. We still need dietitians and we still need other supporting services. His former hospital in Birmingham told us its level of funding from NHS England is no longer sufficient. Its cases had become more complex and more economically burdensome it told us than when its funding was first allocated by NHS England, and it said it would welcome open dialogue with the NHS, but introducing new technologies that are not currently funded. Prompted by our husband, minor Evans decided to get a second opinion and transferred her care to Hairfield. She says the specialists there told her the problems with the drugs the QE in Birmingham had put it on. Just no thriving. We've now got a situation of it. I have now what this moment got to pay skinny jeans on and a pair of boots because the swelling in the feet has gone. Now if I was still at the QE I would still be suffering from that condition and my kidneys would probably be gone. My kidney function is now stabilized. And so every year husband hadn't insisted on a second opinion. I'm not being funny, I'm probably dead. Try me. The Kunalisabeth hospital said it wasn't permitted to speak about minor's case, but told us that its transplant teams are fully aware of the risks of kidney disease in their patients and actively refer those they have concerns about in line with national guidelines on renal failure. Minus experience highlights once more that where you are treated in the UK really does matter. Transplant care is not consistent. The five-year survival rate for lung transplant patients for instance is far worse than Manchester and Birmingham than elsewhere. Manchester told us it cares for a broad and complex set of patients. The Birmingham said its long-term outcomes were improving. Patient advocate Jess Jones believes the UK must more to prioritise transplantation. For me there is a lack of understanding that transplantation is an urgent emergency life-saving procedure when it comes to heart and lungs. And there are even hospitals where there's difficulty getting theatre space for transplantation because transplantation is viewed as an elective procedure. So if something else comes in that's an emergency that will get prioritisation above a heart that is sat on the side in a theatre having been donated by a family in the most awful day of their life. Indeed data that file and four investigation is obtained shows that around a hundred times each year hospitals say they are unable to transplant a heart or lung because of a lack of theatre space intensive care beds or stuff. Life-saving organs potentially go into waste due to a lack of resources. Some leading medics have had enough. George Mascaro is not the only senior clinician who's left the NHS. Half of the UK's six transplant centres have lost their top surgeons in the past two years. Several other experienced clinicians have also had it overseas. Birmingham's surgeon Arun Ronesenga, speaking on behalf of NHS Blood & Transplant, says it could have a profound effect on services. I think it's potentially been devastating in some centres. I can speak from personal experience from Birmingham where we lost a single surgeon. It's disruptive to lose one surgeon is easier than if you lose lots of surgeons as I know other centres have done. What I've seen is that there have been support mechanisms within those centres to build up surgeons again to build up the teams that perform the transplants so that those centres become more robust. Dr George Mascaro, however, believes less experienced surgeons are more likely to air on the side of caution when deciding whether or not to use an organ that is not of near-perfect quality. That means more organs are declined and ultimately fewer patients receive transplants. The differences of acceptance and the rate of acceptance of donors is very variable between surgeons. The less experienced you have, the more risk averse you are going to be. I think that this drill is getting worse. Far higher pay is clearly one attraction of moving overseas, but so are the resources available to serve patients. His George Mascaro investment is necessary. You need to invest in technology, you need to invest in manpower, the UK, if they don't introduce some sort of incentives to surgeon to dedicate themselves to transplantation. Transplantation is going to shrink and shrink progressively and it may be that you are going to end up with only a couple of units. 25 years ago, Tony Blair's government had a plan to have just three heart transplant centers in the UK. The argument was that it was right on clinical grounds to have fewer units doing more operations. A quarter of a century later, the argument remains unresolved. Official data suggests Birmingham, Newcastle and Manchester struggle to offer as good as service as the other centers. Birmingham and Newcastle told us their services continue to develop and improve, while Manchester said it met clinical standards. Arguably, the UK's best performing centre, Popworth, would be rated average internationally. For patient advocate Robbie Burns, the number of units matters less than their performance. We need to double our number of heart transplants. We need to travel our number of lung transplants. So these are substantial improvements. For more than a decade, commissioning and overseeing transplant services in England has been the responsibility of NHS England. Patients and whales in Northern Ireland are typically sent to England too. In resourcing this programme, we've spoken to more than a dozen experts who've worked within transplant services across the NHS and internationally. Most of them are pointed to the finger at a lack of interest at NHS England for the current state of heart and transplant services. Robbie Burns said a loud but some others had said in private. I think it's a combination of having not being the oversight in the past, a little bit of not wanting to look there. I think it's a lack of resources to be able to do it. And I think they probably don't have the right skills in the right places to do it. And I think there's a big skepticism and that's what I've found in willingness to engage with patients. NHS England know about all these problems. In 2024, the Department of Health and Social Care published a report into heart and lung transplant services. It was written by three international experts and page one sets out the problem in stark terms. It says, "The UK has one of the poorest rates of heart and lung transplantation in the world." So what's happened since? Patient advocate Jess Jones has been heavily involved in the discussions. Chydyn yw'nherndor」, pegu cyfardu'n ffordd, Mynd i dodgynd midd所以呢 fel o��, cael hunor i llwfr i hodill gallu endself cymaint, cwciaichstyn os Mae Oper a yw'n help lacking crow y όmbig ddylwan yr mat Does sy'n fer��wfle i fyryda. Caad bitchraeth trynd i waffle ramenat Oy 👌 🦾 🦑. Digglas Chif ryfr Chifre Eu yn ei'n adeworddyn Welfredig? Ychажд marni ddinkach yn ti dallo Fyrgyff downstream talging A ei wyford gres rei'w pethn�iraeth Pialdedd unwbanydiad Drofioeddion danyfar Sidder test easy i wedi hi, Al ndywedd yn felly rhaidu I wedi'n cyfyniad I wedi'n cyfyniad I wedi'n cyfyniad Ychажд marniadio I wedi'n cyfyniadio I wedi'n cyfyniadio I wedi'n cyfyniadio I wedi'n cyfyniadio We have all the expertise to do it but we have slipped back in applying it to the community which is a great pity and the drawback which has to be corrected. Applying the resources you have and the expertise to the community is the name of the game. There's no point in doing the science if you don't actually help the community. Exactly. What's your assessment of the transplant system in the UK at the moment? I think it needs more resources. It is going, but it needs to be accelerated. We need to have more people, human resources, more money, physical resources. Now with NHS England being abolished oversight of the system will become the responsibility of government and doctors to be arming the health minister and Westminster. Westminster was in charge of transplantation and by the way is a kidney transplant surgeon himself. He agreed to be interviewed by us, but when the press team of the Department of Health and Social Care became involved, the offer was withdrawn. We then sent them a series of questions that didn't answer most of them. What they did tell us was that the government acknowledges what it calls the systemic issues facing cardiothoracic transplantation that's heartened lungs to you and me. On the impact this is having on patients waiting for a life-saving transplant as well as the loved ones. It says the minister has informed the NHS in England of its responsibilities in urgently implementing recommendations to make these services fit for the future. But there is also a sense of chicken and egg here. The government wants urgent change, but NHS blood and transplants are in one asinger says hospitals need financial support to do that, which they haven't had. I think that they're telling us something which we already know. We're already trying to do better. We're already doing better in terms of numbers of transplants building year on year, but we need adequate funding to follow that to allow us to reach potential. Now, wondered if the problem is that the transplant clinical community hasn't made the argument properly for why its services should be properly funded. And if they got that into public consciousness that would seep into politicians consciousness and perhaps therefore they would be more inclined to accept your funding request rather than finding it seemingly rather easy to turn them down. Perhaps that is a failing of the transplant services that we haven't found the drum loud enough. Perhaps this is where we really need to work with our patients, our recipients, those people who have already been transplanted to make those cases. Because one of the best ways to get us into the forefront of the politicians' minds is to work with patients for the patients to tell their stories. Patient representative Jess Jones believes the service is worth prioritising. I've seen so many people who have been tethered to oxygen, been able to work with very little hope of having a future. And the glimmer of hope they've had is being listed for transplant and knowing that there was that possibility after many, many false alarms that they might actually get a second chance. And for those who have, they've gone on to do the most incredible things to contribute to society, to work full time, to go on and have families and bring them up and see them grow up. And they're actually able to invest, societally, economically, culturally, back into society. We are now approaching Cambridge. Three weeks on from the lung transplant in Cambridge on this impositive news. I'm heading back to the Papua Hospital to meet the patient. His name is Glen, he comes from Norfolk and I'm going to see how he's getting on. Glen, how are you doing? How are you feeling? Good? You look very well. He's got a pill myself up in there. Glen has been under the care of Papua since 2019 as a result of having pulmonary fibrosis, which causes the lungs to scar. I just short breath doing anything. I was pulling oxygen around with me or carrying oxygen. I couldn't go up the stairs, couldn't get in the bath without having an oxygen on. Couldn't put me shoes on. He was listed for transplant in January of this year and everything then happened within weeks. And after a seven hour operation, he's fighting fit. I'm getting stronger and stronger each day. I have little steps. My brain is used to taking little short breaths because it's all I could do. But now I can breathe deeply. You're just swiling and happily there, aren't you? Assuming everything goes as well as the past few weeks have gone, how well you could become. I suppose back to a normal person, I would think. Glen asked us to mention how grateful he is to the staff at Papua who, in the words of his wife, have now given them a future. Meeting him is also a reminder of the miraculous impact that a transplant can have. But it's what prompted so many patients, surgeons and experts to speak to us. They know how transformative such procedures can be and want the UK to strive to be the world leader it once was. Perhaps minor evidence sums it up best. I'm lucky enough to have had 17 years where I've gone married, I've traveled the world, I've got a full-time job, I still carry on as I am. But that would not have been possible without the gift. And when you receive it that way you appreciate it more and you live a different type of life because you live in a life to a gift. This file on 4 Investigates podcast was presented by Michael Buchanan and produced by Adam Eely. The technical producer was Nikki Edwards and the production coordinator was Tim Furnley. The programme was edited by Tarmac Dermott. It was a BBC long-form audio production for BBC Sounds where you can find many more episodes of our award-winning Radio 4 series by searching File on 4 Investigates. I'm Jamie Bartlett and for BBC Radio 4 I'll be looking at how fakery took over the world. No, no, hang on, hang on, sorry. You're not Jamie Bartlett, I'm Jamie Bartlett. Really? Well, who am I then? I'm afraid you're not real pal, you're just an imitation chap but I created to help me make this series on modern fakery and why it's everywhere. Sounds good. What's going to be in it? Well, there's a lot. 1980s professional wrestling, dodgy academics, AIS psychosis, COVID vaccine, skeptics, what's it called? Everything is fake and nobody cares with me, Jamie Bartlett and me, Jimmy Botlett. There's some first on BBC Sounds. Discovering, forgotten interviews that change exactly how we see these giants of our culture. I'm Emmanuel Jochi. And Kai Wright. And this is Big Lives. Listen to Big Lives wherever you get your podcasts.