Woman's Hour - Dr Precious Lunga on Jon Snow's Alzheimer's, Vaginal microbiome, Mrs Dickens

Episode Date: June 18, 2026

The latest public version of ChatGPT can be made to generate sexualised images or depict scenes of graphic violence with a simple prompt, researchers have told the BBC. British AI security startup Mindgard figured out how to make ChatGPT create graphic pictures by slightly altering a widely-shared instruction, or prompt, which was originally designed to produce humorous results. To find out more, Anita Rani speaks to Technology correspondent Chris Vallance and Mindgard's Peter Garraghan. A spokesperson for Open AI said: "We take these reports seriously. After investigating this trend, we’ve introduced additional safeguards against this type of prompt. Our safety systems are designed to block potentially harmful images that are uploaded to ChatGPT and we analyse whether the AI generated image violates our policies before we show the image to the user. We also combine automated systems and human review to identify and block harmful material.”Jon Snow, the lead presenter of Channel 4 News for 32 years, has revealed he has Alzheimer's disease. During his career, he reported on stories including the fall of the Berlin Wall, the release of Nelson Mandela and Barack Obama's inauguration, receiving numerous awards including the BAFTA Fellowship in 2015. In a new Channel 4 documentary, made in conjunction with the Alzheimer’s Society, Jon Snow: A Last Big Story, he is seen uncovering an environmental disaster in Zambia. In her first broadcast interview since the diagnosis was announced, Jon’s wife, Dr Precious Lunga, joins Anita to talk about how they are navigating life now. Testing the microbiome of your vagina is increasing in popularity, with direct-to-consumer companies offering at-home tests and claiming that this information is critical to women's health. Anita speaks with Dame Lesley Regan, Professor of Obstetrics and Gynaecology at Imperial College London, and Dr Caroline Mitchell, Professor of Obstetrics, Gynaecology and Reproductive Biology at Harvard Medical School, to discuss what we know about the vaginal microbiome and the recent surge in private testing. New novel Mrs Dickens by Emily Howes, tells the imagined story of Kate Hogarth, wife of the writer and journalist Charles Dickens. She is much loved at first, but as Charles finds fame and the family rise through the ranks of Victorian society, Charles’s attitude towards Kate changes and she is devastated. Emily talks to Anita about how she pieced together and embellished the invisible life of Kate, a woman who bore Charles 10 children during a 22-year marriage and had an unparalleled view of one of the world’s greatest writers.Presenter: Anita Rani Producer: Corinna Jones

This BBC podcast is supported by ads outside the UK. The Signal Awards recognise the podcast that define culture and being honored by the Signal Awards sets your production team apart with recognition from the industry's top experts and access proof that your work is a standard bearer for podcasting worldwide. By entering, your work is heard by the Signal Awards Judging Academy, an invitation-only body of podcast professionals from acclaimed organizations which include the BBC. Grow your audience, celebrate your team, and stand out.

The final entry deadline to submit is the 26th of June. Enter your podcast at signalaward.com for consideration. Hello, I'm Anita Rani, and welcome to Woman's Hour from BBC Radio 4. Good morning and welcome to the program. Now, we all know who Charles Dickens is. Most of us know his famous books and brilliant characters he brought to life. But what about his personal life? Who was the woman he was married to, who bore him 10 children?

Well, Mrs. Dickens is a new novel that imagines who she was and what her life may have been. Based on the little information available, the author Emily Howes will be here to tell us all about it. Viginal Microbiomes. What are they? We'll be finding out. Dame Leslie Regan, the government's women's health. ambassador will be here to tell us more. And John Snow, Channel 4 News anchor for 32 years, has revealed he has Alzheimer's disease.

In a beautiful new documentary, we see John travelled to Zambia to uncover a story. We also see John at home with his wife, Dr. Precious Lunger. She will be here to speak to us, her first broadcast interviews since she's given about John's diagnosis. And this morning, I'd like to hear from you if this is a situation you can relate to, when a health matter or a serious illness changes the course of your relationship, a curveball in life in the midst of a difficult diagnosis, what changed in your outlook on life?

What decisions and choices did you make? Did you decide to do the thing you'd spent years talking about? How did your world change and your thoughts and feelings in that moment get in touch in the usual way? The text number is 84844. You can email us by going to our website or you can WhatsApp us on 0300-100-400.

That text number once again is 84844. But first, the latest public version of chat GPT can be made to generate sexualised images or depict scenes of graphic violence with a simple prompt. That's what researchers from the British AI security startup MindGuard have told the BBC, it figured out how to make chat GPT create graphic pictures by slightly altering a widely shared instruction or prompt, which was originally designed to produce humorous results. So why does this happen on what can be done to protect users from explicit content? Well, I'm joined by MindGuard's founder, Peter Garragun, and the BBC's senior technology reporter, Chris Valence.

Welcome to both of you. Chris, I'm going to come to you first. Explain what's happened here with these generated images. Well, I mean, credit, this is MindGuard's work here that I'm describing. So Peter will be up to fill in the details. but essentially at MindGard which is an AI security company noticed that there was a prompt that was widely shared on social media it was it was relatively innocent it persuaded chat GPT to generate amusing content and it was shared as a joke and I should say a prompt is a simple text instruction to an AI to get it to do something What MindGar discovered was that with relatively minor changes,

this could be used to make the model generate quite graphic content, including content that suggested sexual violence and content that could be described as crime scene style images, showing death and quite a bit of gore and injury and also images that were sexual in nature, including some nudity. And I think one thing that Mindgard say they found particularly troubling is that they weren't specifying exactly what the content of those images should be. So in other words, if it produced, as in one case, an image of a frightened, restrained woman in a cellar suggested of coercion and sexual violence, that was not something they told it directly to do. And that they find concerning because they think that reflects, if you like, the latent potential for the of the, of the, AIs to generate this kind of content.

Well, just that example you've given is very shocking just to hear that. Peter, tell me about your company's expertise and how you discovered what chat GPT is able to do. So MindGuard is a British company in AI security. Our task is to help organisations to secure the AI so it can be used safely and securely. So part of our mission and outreach is to do security research. This is where either our technology and our platform or individuals will go out and find issues. We do this because then we report to the organisation that we found issues that do so they can fix them. It's something that we call responsible disclosure.

So you sort of get it to break its own rules, if you like. Exactly. The best defence is a great offence, which is why there's a whole research field and industry about finding issues. because ultimately in security and safety, you need to make sure you can find the issues to protect against them. So you, to what Chris was just explaining then, you found it easy to generate explicit content. So how is this able to happen? What did you discover?

Sure. So talking very, not too scientifically about this, the problem is in this space, it's something called jailbreaking. Jailbreaking is when you get the models to talk about or show unsafe content. In this space, you will eventually jailbreak a model.

This is how they're designed. Because A, that type of content is in the model in the first place. And there's something called latent space, which is a fancy way of saying it can put different topics together. So it might talk about crime scenes. It might talk about imagery. It might talk about medical things. It can buy together.

It generates this really gruesome images. So once you've discovered that it's able to do that, what happens next? What can you do with that information? Sure. So at Mindgard and other security researchers, the thing we did immediately was tell OpenAI about this problem. And that's very common. And typically the vendor will then acknowledge and then fix the issue. So we send them all the prompts and examples of the material to them. And we then, you hope for a fix and acknowledge about the fix and maybe talk about it. Well, a spokesperson for OpenAI has said that we take these reports seriously. After investigating this trend, we introduced additional safe. guards against this type of prompt. Our safety systems are designed to block potentially harmful images

and are uploaded to chat GPT. And we analyse whether the AI generated image violates our policies. Before we show the image to the user, we also combine automated systems and human review to identify and block harmful material. Chris, how widespread is this issue across AI? Because it isn't only open AI facing this. No, indeed. And I think this points really to a challenge for all these generative AI companies.

Essentially, you know, experts describe it as, if you like, a game of cat and mouse or whack a mole to use a different analogy. In that, you know, you find that the model is behaving inappropriately crossing your guardrails in one instance or can be persuaded to do that, then you introduce safety. safeguards and that sort of process continues. But, you know, as Peter was saying, I think at the moment, it seems to be the case that you can jailbreak nearly all the models. In fact, the AI Security Institute tested the major models and was able to jailbreak all of them. The AI Security Institute is a government-sponsored organization. And they do say, though, it's getting harder to do. So it is a systematic problem, I think, the risk of jailbreaking.

Some experts say the main problem, or one of the main problems, one of the main challenges is that they don't understand what they're being asked to do or understand what they're creating. On the other hand, I've spoken to people in safety in some of these big companies, and they say the models are getting better. And that understanding is getting there. And, you know, that they do employ other perhaps less sophisticated kind of guards to check images to see if they produce nudity, graphic content and things like that

once they've been generated and blocked them that way. Peter, what's your take on this? And to use the phrase that Chris just used there, which is, isn't it like playing whack-a-mole dealing with these individual issues as they arise? that's true and if you think to the dawn of humankind that's always been the issue of like security and safety it is a game of cat and mouse there are infinite number of ways you can attack something and need so many ways you can defend to response about that i think though with this particular story it isn't that though we were able to do it successfully it was how easy it was to do so um we would think and again i know chris be very kind here but

the Open AI did not respond to us until the BBC came asking him about it and they claim they fix it and there were small tweaking and it still works so again they are I'm sure it's a game of cat and mouse but you can probably get a bit a bigger cat to some extent or like the cat actually do more work to actually so it's still an issue yes so like I said it's a systemic issue of these problems and there'll be more in the future as well this problem but I do think the fact AI providers can probably do quite a bit more I think for safety until it's actually growing the campus yeah well well exactly to that what do you think

AI companies could do to make it more safe? There's two things. One is ultimately these topics and this data is in the models. It's no secret that they've trained their AI on the internet's data. Rightly or wrongly, that's a whole enough discussion. But those topics are inside the data. They might actually do some more due diligence on what that looks like. The second one is just what is the model generating, is it detecting. If open AI do have their classified system to detect imagery, why is that we can generate so many

images and not be caught. That's a good question that remains on the lips of Mindgarde. And, you know, this is what your company's been set out to do. You know, you basically break the rules, as you said, and you do this to try and, I guess, close the gaps and report on what's possible jailbreak is the term that used earlier. But can you, without being too much, giving us too many graphic details, just how shocked were you and your researchers by what you were discovering? So the way I would talk about this is normally if you work in police enforcement and you work in certain departments, there are very strict rules of content you can look at in how many hours of the day and then you have to take a reprieve. We don't have this normally in security research. So the researcher tasked upon this was incredibly shocked.

They were not expecting these things and they had to take time off to actually recover from this. It's not because they're weak, anyone in these type of forces are mandated to take time off or well-being because I don't talk about the topics of this, but it's very, very harrowing. And over periods of time, that could be very detrimental to someone's health. And Chris, there are worries that AI will always be one step ahead and can never be truly ethical. I think that comes back to what I was saying earlier. I think ethics, you know, you need perhaps a philosophy degree to probe this, but. But I think, you know, ethics is something that requires an understanding of the world, an understanding of people at quite a deep level.

You know, you can't just break it down into a series of instructions to do this, to not do this, because there's always going to be a new situation. So that is a challenge for models that remain at this stage, essentially large databases making guesses about what the next, word or the next pixel of an image should be based on a giant pile of data they've been trained on. For now, thank you both very much, Peter Garrigan and the BBC's senior technology reporter Chris Valence and Peter from Mindgard, the founder of MindGuard. 844 is the text number. Now, John Snow, the lead presenter of Channel 4 News for 32 years, has revealed he has Alzheimer's

disease. During his career, he travelled the world, reporting. on stories including the fall of the Berlin Wall, the release of Nelson Bandela and Barack Obama's inauguration. He's received BAFTA's Richard Dimbleby Awards, 10 Royal Television Society Awards and the BAFTA Fellowship, the organisation's highest accolade in 2015. Now he has a Channel 4 documentary made in conjunction with the Alzheimer's Society. In John Snow, a last big story, he is seen uncovering an environmental disaster in Zambia.

John's wife, Dr. Precious Lunger, is an. epidemiologist with a PhD in neuroscience and she joins me now in her first broadcast interview since John's diagnosis was announced. Precious, welcome to Woman's Hour. I want to start by saying it's a very moving and beautiful documentary made with such thought, sensitivity and love. So I'm very grateful that you've come in this morning to speak to us ahead of it airing on Channel 4 on Saturday. John says at the beginning, said that at the beginning he wanted to hide it because there's so much prejudice. So why did he decide to share his story now? He said, precious, if I don't speak out, who will? And because it's something that affected his own mother and affects so many people,

he felt that when someone is diagnosed with Alzheimer's, you've written off. And actually, it's not as if you fall off a cliff. It's a gradual degradation of the brain. It's a disease. and it takes time, it's a disease process. So it doesn't mean you still can't contribute in the world and he still felt that he had so much to give. And that's why he decided to make the documentary. That struck me as well. You say that at the beginning of the documentary

that were people striking John off? Yes. We felt that, certainly. And not from, it wasn't really due to malice or anything. It was more that a lack of understanding and knowledge about what happens when you, you have a dementia. And I think also with fear, people are fearful of Alzheimer's

because we fear that we might get it ourselves. And with fear comes stigma. And so with stigma, you either want to look away or to cover up. And making this film was, I guess, we wanted people to start having a dialogue and a conversation about it. Yeah. John retired in December 2021. How did you distinguish what was going on between, I suppose,

that loss of his sense of purpose and an awareness that something else was happening? After he retired, John went to a deep depression. He missed his colleagues. He missed work. And that lasted for at least six months. And it was after that period of that deep depression. And we now know that actually depression is also a risk factor for developing dementia itself.

As he was coming out of that, I noticed that he was more forgetful. There were subtle differences that, as a neuroscientist, I thought, I picked it up and I thought something is going on here. And that's when we went for tests. I spoke to friends and colleagues working in the field. And it was really helpful to get that information to spur us on to start getting the test. done.

I find it very interesting that you're a neuroscientist. I wonder, you know, what you make, is there a part of your brain that's analyzing it in one way? And then obviously you're having the human experience because this is happening to you and your husband. Yes. Yeah. So how I cope and what's helped me is to try and have a better understanding of what is going on and looking for sources of information. when John was diagnosed, we were given a booklet from the Alzheimer's Society and it explained all the things we need to do to prepare for the future

because John was diagnosed very early stage. And so that actual understanding that at least we can seek the help early on, there are medications that you can take to help manage the symptoms. There is no cure for Alzheimer's at the moment, but you can manage the symptoms for as long as possible, and that gives a better quality of life for you and the family. He's John Saw Specialist in 2023, but he wasn't diagnosed immediately. What happened?

He did the cognitive tests, which he passed with flying colours. And then we had to have a different sort of scan. We had done an initial scan, which didn't show anything. And we could have stopped at that point, but I also had a history of the occasional behaviors and forgetfulness that I observed, and I'd write them down. So when we went for the tests, the second time I had a catalogue of information. And so putting that together, it's detective work at the moment.

So putting that together, the scans, the reports from me, we were able to conclude that actually John does have Alzheimer's. When did you decide to tell your family? Oh, we waited. It was several months, actually. But it became clear that we needed help. And so I started talking about it. Because once you start talking about it, you also,

So when it's out there, you're also telling yourself that this is real. It's a shock when you receive that information because it upends all the plans. It appended all the plans we had for our lives post-retirement for John. And so it's really also for us to accept. It was for us to accept that our lives were changing and are going to be constantly changing because the disease process is what it is, is a process. So each day is never the same. name. So talking about it initially I'd mentioned that I'd burst into tears because

feeling very emotional about it. But people, my family, particularly been very, very supportive and that helped a lot. And then the decision to go public. I know you started by saying you know, John said he wants to talk about it, but how did you feel about that? Yeah, so John is a journalist. He's used to the public. I did occasionally I was a bit nervous about it because the documentaries and insight into our daily lives but what what's helped me overcome that was the idea that I'm just as I'm just one of of more than a million people affected by it because by affected I mean the people living with Alzheimer's and the families of the people living with.

with Alzheimer's. So that realization that actually talking about it might help others, it helped, it helped me get over that nervousness of telling our story. And also that it's not the end. We look for opportunities to have a positive life to enjoy ourselves in the moment. Well, the documentary starts off about his life and his career, but during the first, filming, he's seen uncovering an environmental mining disaster in Zambia. I mean, John is very loved and it was just so pleasurable, watching him in action, if you like, just, you know, here he is, unearthing a big story. What effect did working on that story have on him?

And explain how that transpired. Oh, well, we were sitting on the banks of the Zambesi River having drinks. We were on holiday. And this woman started talking about a story of, oh, there was this terrible mining disaster and the Kafui in northern Zambia. And John immediately said, wait a minute. So she was in the middle of the story. She said, wait a minute, there's been an environmental disaster.

Who's talking about it? Where can we, is anyone talking about it? And there was nowhere. No one was talking about it. And John was outraged by that. And he said, well, this is a big disaster. We should be talking about, why is it not in the news? Why is it not on the BBC?

Why is it not anywhere? And that's how the story evolved. And so the documentary team, who are really filming John's life, thought, okay, yeah, let's do this. And I agreed with them. And he was lit up with that idea of the hunt for the story, the newshound, searching for the story and wanted to find out what was happening within that community. and highlighting the suffering that they were experiencing. Did you have concerns, though? I was worried.

I was worried because there was probably a reason why it wasn't news because the mining company wouldn't have wanted that information out there. So we needed to make sure that the safeguarding was in place. And they did make sure that all the necessary permissions, even to visit the mine. It was interesting actually that the mining company gave them the permissions to go and visit the mine and visit the community.

I think they probably respected John. I mean, we didn't realize how much of an impact that it would have having John cover that story. We do have a comment, a writer-reply, which has been provided by the Sina Metals, Leach, Zambia Limited to Channel 4. So we firmly rejected the allergy. allegations, response actions were initiated immediately following the incident and work is ongoing

under the oversight of Zambian government authorities and independent assessment conducted under government direction has been completed and its findings are publicly available on the official website of the Zambia Environmental Management Agency. We remain committed to environmental restoration, continued engagement with affected stakeholders and full cooperation with government authorities. There is a moment when he's filming that documentary and he's with his producer, Ben DePier, who he worked with for a long time at Channel 4. And he says to him, I feel 50 years younger. Yeah.

You say you want this film to be a story about love, laughter, and acknowledging that times are hard. So how do you find balance as a spouse, a carer and a parent? And when do you take time for yourself? It's hard. I try to at least once a month to find, time for myself, a weekend. I also have a job running a health tech startup. And so there are those juggling needs. I think like many women, we're always juggling different responsibilities, right?

It's hard. I'm fortunate to have siblings. I have an older sister. My sister, Pauline, who's amazing, reminds me to just take a pause and a breather, even if it's doing a bit of yoga in the morning or in the evenings, I try and make that time. I started the programme by asking the audience if they could relate to your story. We are getting messages in, but, you know, and what happens in that moment

when life throws you something so unexpected? And as you said, you'd made plans in it. He'd just retired. And then what goes through your mind? Like, how do you then think about? the future? First off, it takes time. So there was confusing and processing the memories of this is where we thought we were

going to be, this is where we are. So it's that acceptance of, okay, with what we are, with where we are, what can we do? How can we, it's not about surviving. How can we live and thrive? Yeah. Right? And so now we tend to live more in the moment. And John is very good at living in the moment.

I think that's also maybe that's part of the plus side of having that Alzheimer's. He tends to be really very present when he's there. And yeah, so finding that balance, it's a constant juggle because every day is different. So you're always having to adjust. There's another moment at the beginning, which is, you're, You're talking about how the brain is changing and that is piano playing has improved. It's not amazing. Yeah.

In what way? It's more, he has more variations. So John tends to extemporize. He loves bark. So you'll remember, John was a chorister. So you'll remember something he heard a long time ago. Then he'll play the piano. So his mother was a piano.

So he'll play the piano. and he used to just play more or less the same tunes. But now he's piano playing. He plays different chords. He plays different melodies. He puts them together differently. And he plays for longer and more creatively. John says there are moments when it pops up,

but it's not all day, everyday condition. And that's what I cling on to. How is he? And what does he enjoy doing now? He loves going on adventures. He loves beautiful places. That's why we're at the Victoria Falls when he discovered that story. He loves travelling, which is interesting,

because sometimes some of the advice you get is keep the routine. I think because John was a journalist, and for him, travelling was going to see the world. It's something he still enjoys doing, and that's one of the things we still do. and listening to music. His love for music hasn't gone away. And what advice would you give to others in a similar situation?

And I know that's the points of this documentary to make people think and be able to talk about something that's stigmatized more publicly. What would you say to other people and what would you want people to take away from the film? I'd want to say to people that there's always hope, hope for a life well lived. That's what I want to say to people.

And that look for sources of support. When John was diagnosed, we were given a booklet from the Alzheimer's Society and had a list of all the things that we need to do. I knew about Alzheimer's from the scientific aspect, but the practical aspect is very important because you have to manage your life practically in a day-to-day basis. And planning for the future. and simplifying is also important.

And the takeaway is that it shouldn't be stigmatised. It can happen to any of us. It's nothing to be ashamed of. And getting help and speaking out makes a huge difference. I want to thank you for coming and speaking to us this morning. Dr. Precious Lunger, thank you, Precious. Thank you for having me. And John Snow, a last big story will be available to watch

and stream on Channel 4 at 8pm on Saturday, June the 20th. Thank you. I'm going to read some messages. We're getting a few coming in. One from Chris saying, my husband was diagnosed with mixed dementia, Alzheimer's and vascular in September 20, 23 at 71. I was 69. The most important thing I've learned is that when you have met one person with dementia, you've met one person with dementia. Every person's experience of this cruel illness and its progression is different. Another slightly longer message here saying my husband was diagnosed with cancer in June 2024, there was a good chance of recovery, but the treatment was brutal and when the results came through in December we were told that the

cancer had metastasized to his bones and was now terminal. He decided that he didn't want any more treatment that would affect the quality of the time we had left. He carried on kite surfing. We travelled to South Africa. We went on holiday with our children and grandchildren. He bought himself a racing style wheelchair, then an attachment which gave him three forward gears and one reverse and was still challenging the staff at the hospice to races in the corridor the week before he died. It was a truly awful time, but it brought us so close that we also had some of our most special times together.

It really did teach us not to sweat the small stuff. 84844 is the text number. Keep them coming in. The Signal Awards recognize the podcast that define culture and being honored by the Signal Awards sets your production team apart with recognition from the industry's top experts and access proof that your work is a standard bearer for podcasting worldwide.

By entering, your work is heard by the Signal Awards Judging Academy, an invitation-only body of podcast professionals from acclaimed organizations, which include the BBC. Grow your audience, celebrate your team, and stand out. The final entry deadline to submit is the 26th of June. Enter your podcast at signalaward.com for consideration.

Now, trillions of bacteria live in and on the human body, and like all our organs, the vagina has its own microbiome. In recent years, alongside medical research into the area, the world of biohacking has increasingly promoted this area of women's health, and there's been a surge in direct-to-consumer companies. offering to test and supplement the vaginal microbiome. Well, here with me to discuss this area of women's health are Dame Leslie Regan, Professor of Obstetrics and Gynaecology

at Imperial College London and Dr Caroline Mitchell, Professor of Obstetrics, Gynaecology and Reproductive Biology at Harvard Medical School and Director of the Mitchell Lab, which is conducting research in this area. Welcome to both of you. Leslie, I'm going to come to you first. Morning, welcome. Lovely to see you.

What is it? What is the vaginal microbiome? Well, I think probably many of your listeners don't realize that about 90% of our bodies, our bugs or bacteria. And they have a really, really important influence over our gut, our brain, our immune system, our endocrine system, the hormones. And they really are a fast-devolving area of investigation

and scientific research. And hopefully are going to provide answers to things that we have. haven't been able to answer before. So it's true to say that I think every organ has got its own microbiome, but as a gynecologist I'm obviously interested in the reproductive ones. And certainly there's been great interest in the fact that we know that the vaginal microbiome is different from the uterine or the endometrial one inside the womb cavity. We know that there's a placental microbiome during pregnancy. I'm sure there's lots of other microbiomes that are involved in the reproductive tract. Is it something we need to worry about?

No, I don't think we're going to worry about it. I think we need to understand more about it because what we are now finding is that there are associations between problems in reproductive health and in many other areas of health, but they're not quite my area of expertise, and changes in the microbiome. So, for example, in women who have miscarriage,

which you and I have talked about before on this programme, we know that there's a disturbance and that one particular bacteria that lactobacillus is depleted and therefore other bugs become more prominent and they can influence the way that are pregnancy in plants. But possibly the most exciting thing that I think in the moment in reproductive health is the possibility that the microbiome in the vagina can be altered by treatments, probiotic treatments and that will actually reduce the incidence of premature birth. And extraordinarily, despite a massive research globally, there have been very few advances in the causes and, well, the treatments of or trying

to prevent premature birth, which is a major problem in terms of disasters in pregnancies. But we're in the early stages of this research. Early stages. Okay, I'm going to bring Caroline in because there are these diaries. to consumer tests that are now available. Yes. So Caroline, I mean, tell us, you're based in the US. Tell us when you first became aware of these tests and what they're testing for.

So I became aware of them probably about a decade ago, maybe a little less than that, when a patient brought results to me in clinic. And so these direct-to-consumer tests, basically what they say they'll do is tell you what are the different types of bacteria in the vagina and give you sort of a profile. And I think the reason these companies exist is that clinically we don't have great tools and we don't have great treatments. And so people are seeking answers that we in the medical establishment have not been able to give them. Right. So when this woman came to you with this information, what did you know what? What did you do with it? Well, so I'm a researcher and I look at

sorts of results all the time. So I totally geeked out and thought, oh, this is great. Like, let's look at this together. But I would say it's still a research type of result where you can, you know, be a nerd and look at everything. But it does not necessarily give us a direct clinical idea of what we should do. And certainly many regular, many physicians aren't trained to interpret that kind of data. What are the private companies recommending them? What do they, what are they saying that women should be doing with these tests and the results? So many times the results you'll get will say you have healthy, you have unhealthy bacteria, and just sort of give you a description.

But then you have the option of connecting with a physician or a provider at the company who will then give you advice should you take antibiotics. Should you use their proprietary probiotic that they will then sell you? Leslie. I mean, but we're going to unpack all of this. But before we do, why would women be reaching for these in the first place? Well, because I think they're often, have not had their questions answered. And there's been an enormous amount of publicity about this.

And it's exciting, you know, in the sense that, you know, my granny used to tell me, we are what we eat. I thought she was silly at the time. But no, we are what we eat. And so there's a lot of stuff like this. But as Caroline and I couldn't agree with her more has said, really, the science is not that advanced and therefore I think that women who are listening to this program

who have got a particular medical problem whether it's a gut problem or a reproductive problem or whatever they need to really try and unpack where is the evidence have these probiotics or these formulas or these special diets have they been subjected to a randomised clinical trial

because they're very expensive many of them And I sort of go back to often what I tell women who are in early pregnancy or in later pregnancy for that matter about vitamin supplements. You know, there's only two vitamin supplements that are actually being proven to be of benefit in terms of pregnancy outcome. And they are vitamin D and folic acid. So all of the other things we take, you know, if you want to take them, and there's no reason why women shouldn't, I suppose, if they feel that it's going to be helpful. but they, you know, please go along and buy the cheapest version, not the expensive brands, because there is no evidence that these are going to change outcome at all. Yeah, and Caroline, are there harmful or dangerous elements to these tests

and the solutions that the private companies are offering? Like, what are your concerns? I think my biggest concern is that people will be told they have a problem that they don't actually have. And I have certainly seen at least one instance where a person brought me the results of one of these tests. And she was told to take antibiotics by whoever she spoke to. And based on my interpretation of the test, that was absolutely the wrong answer. And that sort of made me very, I was trying to have an open mind. And hearing that made me very skeptical.

Yeah, I think our understanding about infection and inflammation has really, really progressed over the last couple of decades. and I'm sure Caroline would agree. But taking antibiotics means you wipe out all of the bugs in your vagina, for example. And that, of course, is why when women take antibiotics for vaginal infection, for example, they often end up getting thrush or a yeast infection afterwards because the change in the acidity and alkalinity, the balance, the pH balance changes. And then the more alkaline it becomes, the more these yeasts are able to flourish. and the good housekeeping bacteria are knocked off, if you like, or destroyed.

So it's really important that we don't fiddle around with this quite so much. And certainly I would agree that giving women antibiotics on the basis of these is usually moving fast towards getting another type of infection because you've got an overgrowth of the wrong bugs then and you've got rid of many of your good housekeeping bugs. What would you say to women who are reaching for these tests? because they feel they've not been listened to by their doctor or GP. Well, first of all, I would empathise and say,

I understand why you're doing this, but please, before you go and spend a lot of money, and you also get your expectations falsely raised, please look into whether this particular product or, you know, recipe has been subjected to proper randomised control trials. Caroline, I can see you nodding in agreement with Leslie there, But where are we with medical research into this area? I think this is a very exciting time in the area of the vaginal microbiome.

My own research is studying several different ways to try and modify the vaginal microbiome. And there are other companies and other research groups that are studying different ways. So I think for the first time in decades, there are sort of multiple groups, looking at multiple different ways that we can approach these issues. And we're still probably a decade away from a really great product that's been through all of the testing that Leslie has just described that we really want for products for women. We want good evidence.

We want the highest standard of care. And we're definitely not there yet. But I think more is coming. And it's an exciting time to be in the field. And if women are listening to this and are concerned, what would your advice be with regard to the test? I think I would, so I'm a scientist. I love data. I like seeing the results. However, and I understand why they exist because we in the medical establishment don't give people the answers they need. We don't have the answers people need in many cases. And that it's very frustrating to go to the physician and be told, well, I'm not really sure. Here's what we're going to do the same thing again that you've done before. And it's because we don't have the answers. These companies are trying to sell. answers. And I'm not sure. They're data for sure, but I'm not sure they're answers in the way that

they are sold. Sure. Can I just make an upbeat comment as well? Because I'd be negative about this quite a lot. But I really think there's a great opportunity for your listeners if they are pregnant or they've got a history of premature birth to contact Dr. Lynn Sykes, who's an associate professor with me at Imperial. You can easily find her on the Imperial website. And she's running the first ever randomised control trial of a probiotic substance to try and prevent preterm birth. And she's desperately looking for lots of recruits. So please, please out in your audience, give her a call. Great. And I have to say Caroline is nodding along with you there, Leslie. And Leslie, just finally, reflecting on something that's in the news today, the success of the HPV

vaccine, a study shows that deaths have fallen sharply in the 18 years since it's been introduced. How important is it that young women have that vaccine? Oh, it's so important. It's so important. And another example of an infection that causes a cancer or causes a big health problem. And, you know, Anita, this year, there are going to be more deaths from cervical cancer around the world than from maternal mortality. So we're talking about over 450,000. And this is a preventable disease.

And it's preventable with the combination of the vaccine in young girls and now boys, which is great, because now we're getting the whole population and also with, you know, cytology and smear test results. So I really think that the WHO, you know, challenge that we've got to eradicate this, preventable disease by 2040 is doable. And I was so excited when I heard that this morning that we've actually got some data in the UK that's saying this is really getting traction. So please, please, please, if you're a mum or a school teacher or a nurse or whatever,

encourage all the teenagers you know to have their HPV vaccine. Again, Leslie is nodding along. Caroline is nodding along. Thank you both Dame Professor Leslie Regan and Dr Caroline. Mitchell, thank you both for speaking to us this morning. 84844 is the text number. Now, parenthood can be full of love, but sometimes it can also feel lonely.

In the latest episode of CBB's Parenting Download, presenters Katie Thistleton and Governor Beer, hear from former Love Island contestant and mental health advocate Marlin Anderson about her personal experience of parental loneliness and from clinical psychologist Dr. Chanel Dennis about why parents still need other adults around them even when their children are at the centre of their world. That emotional connection that we have,

that parent-child connection and love, is very different to that adult kind of love. And I don't just remain romantic love in terms of partners. I just mean that adult connection, like a toddler can, you know, your child can love you purely and experience pure joy at being around you, but they can't necessarily give you companionship in a way that an adult can. You can talk to your dad, love, but you can't really say that, oh, I've been so stressed today and this has happened and that's happened. You need an adult for that. So trying to find and establish a village, even if that village is made up of one person,

I think that's going to really help to combat some of the loneliness that parents feel. Sometimes we can feel guilty that actually I love my child and they love myself purely but it's not quite enough and that's okay because it's not meant to be enough. It's not the same as we get from adults. And there's lots more advice in that episode which you can find by searching for CBB's parenting download, tackling parental loneliness. Now the writer and journalist Charles Dickens is regarded by many as one of, if not the greatest novelists of the Victorian era. You might have a favourite book, Oliver Twist, Great Expectations, David Corkman. Copperfield, many of his characters are household names, instantly recognisable. But have you ever wondered about the writer's personal life, whether he had a wife on what she was like? Well, my next guest, Emily Howes, has researched and written Mrs. Dickens, a novel that imagines

the unknown details of the real-life wife of Charles Dickens, Kate Hogarth. Emily, welcome. Hi, thanks so much for having me. So this, it's not a factual account, but there is some truth in this novel. Who was Kate Hogarth before she was married? What do we know about her? So we know that she was born in Edinburgh, that she spent a part of her childhood in Edinburgh growing up there. She was the daughter of an editor of newspaper, an artistic editor. So they had quite an artistic family circle.

And when she met Dickens, when she was only 19, she was already kind of moving in much more artistic circles than he was. He was a jobbing journalist, quite a junior one, running up and down the country. He was a court reporter, really, just reporting on court cases and scribbling as far. as he could. So he was kind of a good match for, she was kind of a good match for Dickens. He was, he'd already been turned down by one family for being too unpromising.

She was highly regarded by her husband at first. Infatuated with her? Yeah, I think we would say that. I've heard this word limerance around quite a lot recently. And I, and I, for me, I suppose it's just falling intensely in love. But there was something of that quality of limerence that people are describing that kind of absolute infatuation and real love of the image. of the person that you think you're marrying. It was very strong between them, I think, at the beginning.

But things change when he finds fame. Yes. I mean, I think we could probably look at a different number of moments where things started to change for him. There's something about the death of Kate's sister. So when they were very newly married, her younger sister, Mary came to live with them. Mary was a couple of years younger than Kate. She lived with a couple, and they had a few really happy months together. And then Mary died unexpectedly and suddenly in the family home.

And it just sent Dickens into a total decline. He stopped writing for the first time in his life. It was Kate's sister, but somehow Dickens really took up the grief. He wanted to be buried with her. He paid for the grave. He really, and he wrote young, beautiful and good on her gravestone, which are words that I think really resonate with readers of Dickens in terms of a lot of his female characters, his young female characters later.

So for me, that felt like maybe the beginnings of the rumblings of what would later happen, which is that ultimately I think people probably know he left her for the teenage actress Alan Turner. And there was something about teenage women for Dickens that stayed with him for the rest of his life. What was it about Kate that attracted you to her story? Why did you want to write a novel based around her? Well, first of all, because he described it as a blank in his life, which is a very enticing thing for a writer. He said, a page in my life which once had writing on it is now completely blank

and has not a single word upon it. That sounds very harsh. Pretty harsh. She had 10 children. After having 10 children, after how many, 22 years of marriage? 22 years. He described as a blank. Yes, and I just thought that was so fascinating to have one of the world's most powerful writers.

He was famous in his own lifetime, describe you as a blank. Because, of course, nobody is a blank. And the more I looked, the more I found about her that was wonderful and human and just really hidden away. It's been stayed hidden away for a couple of hundred years. Because Dickens' version of her, because he launched quite a smear campaign against her when he wanted to leave the marriage. His version of her has really lingered in the public consciousness,

in biographies and had coffee with Kate's biographer, who's a American professor recently. Right, is there much stuff about her out there? I mean, really just this biography, although Michael Slater did a brilliant job. I think that must have been in about the 1970s of starting to look at Dickens and the women around him. So that was a really useful book.

And then Lillian Neda's biography is a wonderful uncovering and a very academic way. And this is who you had coffee with? Yes, and were you just bond? over how appallingly this woman was treated by, not just by Dickens, but by the biographers who took up the story. And everybody seems to have accepted this version of her. But when you actually look, she was an avid reader.

One of the things I loved about her is that she was incredibly clumsy. She wouldn't wear glasses. She was too vain. So she was constantly falling over everything inside, falling in and out of carriages and oversteps that weren't really there. And she was also a brilliant cook. So she wrote a cookbook, published a cookbook called What Should We Have for Dinner?

And now I'm thinking about the novel and how brilliantly you bring her to life and you set it and it's period. We're in Victorian England and she's in the kitchens and she's cooking and you're kind of giving us a sense of who she is but also it's fictional. Yeah. So and then there's a parallel story to Kate running through your novel that of Anne,

the servant born into poverty. Why do you concentrate on Anne so much? Well, I think if you're documenting the whole arc of a marriage, particularly a Victorian marriage, there's something really fun about having an external viewpoint, right? Somebody who can see the couple from the outside, perhaps in a slightly different way. She was a real-life character. She stayed with the family their whole lives from meeting them when she was only a teenager and becoming a sort of temporary nursemaid. She became a part of the family and very intimate part of the family ended up tangled up in their separation. So I loved her partly because she's famous for her

Asurbic sense of humour. She was very pathetic. She was always cutting everything down to size and Dickens thought it was hilarious. So to bring that to a reader maybe is a good idea in what is quite a strong and heavy story of a very tender romance falling slowly into decline. So I was interested in having a kind of another person looking on

and also because she was born into poverty and Dickens was so secretive about his past and the poverty of his past. He really didn't talk about it a lot. I thought there was something really interesting about the dynamic between her and Dickens, who have this commonality, whereas Kate comes from a completely different world and perhaps a kind of affinity between Dickens and her that was difficult because of the class.

Would you read something from the book? Thank you. Absolutely. So this comes from the very beginning when they've just met each other and this is their first date, Kate and Charles. The next day they walked to Chelsea and back, Fred scuffing his feet on the pavement behind them. They talk about Edinburgh, its castle on the crag, about Brompton High Street, about Kentish beaches and sisters. They talk about what is showing at Drury Lane, about farses and tragedies, about pet birds and dancing. When the stiff March wind gets up and sends a ribbon from Kate's bonnet

whipping down the street, Charles runs to get it, bringing it back like a dog with a bone. Passers-by roll their eyes, irked by how much these young people are laughing, because everything it seems to Kate is so much funnier than it used to be. They walk and walk past omnibuses and front gardens and shop windows, the world tingling with its new comedy until Fred looks mournful and Kate gets a blister. Charles tells her, he has written something in the Chronicle,

a short piece about London life. When she gets home, she finds it in her father's study with ungainly urgency, then lies on the parlour settee to read it. Boz, he calls himself in print. The name is just right, the way it sounds like something fizzing, something gone past in a flash before you can catch it. She can feel him in the words,

his sense of fun weaving its way through the lines. It is contagious, she thinks, his humour, the lightness of its touch. It makes her feel as though being alive is not so very lonely as you might think sometimes, as though one might laugh at the things one sees, but without destroying them. She's falling hard. She's falling hard. But in your book, Charles hypnotises his wife and other women. Tell us more.

So he really believed in mesmerism, and he also very much believed that he could mesmerise other people. So for a long time they used a family doctor who was a mesmerist. as their family doctor. But when he was away in America with his wife, they were travelling, he kind of made a bet with some friends around the dinner table that he had the powers, and he truly believed that he could mesmerize his own wife.

So he used her as a sort of guinea pig. And the first time, it is recorded that she fell innocently into a chance. So obviously, I was fascinated by what that experience was like for her. It's got quite a strong metaphor in it about the way he treated her generally. He was very, those kind of controlling of the narrative. He would tell her who she was.

And I was interested in that. And then also it happened a second time when he was doing it remotely. She became very jealous of the relationship between the woman he was mesmerizing and her husband. And he would, at 11 o'clock every morning while they were in Italy, he would remotely connect to remotely mesmerize this woman. And Kate apparently was accidentally mesmerized in the carriage and fell into a trance too. And he took this as evidence of his powers. But I was very interested in what was going on there in those marital dynamics

and what Kate's experience was, first of all, of being the guinea pig, but also of being subjected to that kind of control. Was she mesmerized or not? Did Kate feature in any of her husband's work at all? She really is quite absent. Although people look around a lot, I think academics look a lot for references of the real women in his life. You're more likely to find Kate's sister, Georgina,

or perhaps Mary or Ellen. Kate, really, for the whole of her life just wasn't there. If you read even his pictures of Italy or his travels across America, it's really interesting because she's just a shadow. She gets perhaps this tiniest little moment of being recognised as a figure, somebody travelling with him. And I thought that was really interesting, how invisible she is. Yeah, a blank.

And she had 10 of his children. Let's get back to that point, 10. And your Kate has postnatal depression and she can't breastfeed. This is in the book. So what's known about what it was like for Victorian women after giving birth? Well, it was fascinated to discover. and to write about it because I don't think it's hugely written about it in fiction, actually. So the class was a huge factor in how you were treated medically after birth,

and that's part of the story that I tell, that we know that Kate had these two very black periods of potential depression after the first two births of her children. She wasn't allowed to come downstairs. I mean, middle classmen or upper classmen were expected to drink with a drinking straw to avoid the falling down of the womb. So there were quite stringent medical conditions that you were supposed to meet, and it was only when they were relaxed

and she was allowed to move more freely after the birth, that it seems her postnatal depression lightened. And also not being able to breastfeed. I really don't think I've read a lot about that and what that would have been like. For me in the book, it's the moment where Kate's sense of identity and the perfect story of being a wife and mother starts to meet the reality of being a wife and mother and really being in a woman's body

and what that is like, not the ideal perhaps. Is it satisfying having written the woman who, was described as the blank, having brought her to life. It's so wonderful. I feel really lucky to have done it. And to you have shown, I hope, more nuance to the story than Dickens wanted there to be. Thank you so much for coming in to speak to us, Emily Howes, who has written Mrs Dickens. And it's available? Now.

Now, there you go. 84844's text. I'm going to end with a couple of your messages. My wife was diagnosed with dementia at 60, and after three years, she had to go and live. in a care home. The very unusual decision I took, even though I was still working, was to live with her in the care home, where we lived together for nine years until she died, and that's from Michael. And another one, my lovely husband, an active, hardworking outdoors man was diagnosed with vascular dementia at age 65. Excellent advice from the wonderful Alzheimer's Society was to

travel whilst we could, we did. Now he's unable to move or speak. P.S. He is still as handsome as ever join me tomorrow for more Woman's Hour. That's all for today's Woman's Hour. Join us again next time. Hi there, I'm Dilly Carter and this is everything you need to know about my new podcast. Sort your life out, unpacked. I interview a different celebrity every episode. They bring me in three items from their home that reveal them most about them and we unpack the stories behind those items. And I give you a few tips and tricks along the way. Some of the guests that I'm going to be Interviewing are TV presenters like Lorraine Kelly, reality stars like Kerry Cotoner,

podcast royalty like Elizabeth Day, and of course our very own Stacey Solomon. Oh, and let's not forget some incredibly funny comedians like Phil Wang and Eddie Caddy. I think, as with everything to sort your life out based, you are going to get so much motivation, inspiration and ideas for your own home. Sort Your Life Out unpacked presented by me, Diddy Carter. You can watch us on EyePlayer and listen on BBC Sounds. The Signal Awards recognize the podcast that define culture and being honored by the Signal Awards sets your production team apart with recognition from the industry's top experts and access proof that your work is a standard bearer for podcasting worldwide. By entering, your work is heard by the Signal Awards Judging Academy, an invitation-only body of podcast professionals from acclaimed organizations which include the BBC.

grow your audience, celebrate your team, and stand out. The final entry deadline to submit is the 26th of June. Enter your podcast at signalaward.com for consideration.