#52 - John McKeon: Bridging Health and Environment - Indoor Air Quality Innovations, Historical Insights, and Collaborative Healthcare Approaches

The intricate relationship between health and the environments we inhabit, featuring insights from John McKeon, CEO of Allergy Standards Limited.

This episode discusses how improving indoor air quality can transform health outcomes, drawing fascinating connections with historical public health achievements. Discover the pivotal role of healthcare professionals in this evolving landscape and how a shift towards proactive patient education and environmental management could redefine modern medicine.

The challenges and breakthroughs in integrating environmental factors into healthcare decision-making. Uncover the delicate balance between anecdotal evidence and rigorous clinical data, and how this influences healthcare policies.

John McKeon shares real-world examples from innovative community-based healthcare programs across Ireland, the UK, and the US, showcasing the power of collaboration and holistic care.

From the Children's Hospital of Philadelphia's outreach initiatives to the broader implications of environmental health on medical practice, this episode is a compelling call to action for professionals across sectors to unite for better indoor environments and improved public health.

John McKeon - LinkedIn

Allergy Standards Ltd
iAir Institute

Chapters

• 0:00 The Intersection of Health and Environment
• 12:02 The Complexities of Environmental Health
• 23:53 Community-Based Healthcare Programs

Transcript

Simon: 0:00

Welcome back to Air Quality Matters. I believe we already have the tools and knowledge we need to make a difference to the quality of the air we breathe in our built environment. The conversations we have and how we share what we know is the key to our success. I'm Simon Jones and this is episode 52. Coming up a conversation with John McKeown, ceo of Allergy Standards Limited and Principal at the iAir Institute. John founded Allergy Standards Limited, an international standards and certification body, while working as an emergency room doctor in Dublin.

Simon: 0:59

His curiosity was sparked by the interplay between the built environment and asthma and allergy trigger factors within indoor spaces. Recognising his role as a clinician primarily addressing the downstream effects of poor indoor air quality through pharmaceutical intervention, john realised the necessity of shifting towards a proactive upstream approach centred on patient education and environmental control. This realisation marked the inception of John's journey into exploring the interconnectedness between the built environment and health outcomes and health outcomes. Initially focusing on individuals affected by asthma and allergies, john expanded his research endeavours to serve as a liaison between construction professionals, interior design experts and healthcare professionals. His mission is to facilitate collaboration and promote holistic solutions aimed at optimising indoor environments for enhanced health and wellbeing.

Simon: 2:07

Today, john works within a fascinating web of organisations, from allergy standards to academies, laboratories and more. He is also out there networking across the sector, joining the dots between silos of interest, and it is this holistic view of the sector, particularly from a medical and human-centered perspective, I wanted to discuss with him. John is a rare mix of clinician, entrepreneur and communicator, so I traveled to Dublin to sit down with John to discuss this intersection of human health and the built environment, his journey and his perspective of the sector. Thanks for listening. As always, do check out the sponsors in the show notes and at airqualitymattersnet. This is a conversation with John McKeown. If this is as serious a concern as we think it is in the built environment air quality is it time that certain sectors stepped up here, and one of those sectors that we have to ask that question of is the medical community, because ultimately, this impacts people, doesn't it?

John: 3:23

Yeah, well, you think the built environment we're talking about. What's the goal of the built environment is to keep us protected. You know, back in prehistoric times, the old saber tooth tigers or woolly mammoths. So, as humans, we construct dwellings and buildings to protect us from the cold, the elements keep us safe, and so forth. Protect us from the cold, the elements keep us safe, and so forth. And if you bring that into modern day, if it's about well-being and thriving in a school or in your home, then obviously healthcare professionals not just doctors, but all healthcare professionals need to be part of the conversation about how we develop the built environment, how we design buildings, how we construct buildings.

Simon: 4:14

Yeah, and that's that multidisciplinary element, isn't it? I think we're starting to join the dots on more than we ever have that between the air chemists, the engineers, the physicists, the medical community, the epidemiologists and the public health people. If, as the evidence is suggesting, there are public health outcomes to this problem of poor air quality, then it's not going to be fixed by one silo alone. And you've had some real experience of that coming from a medical background.

John: 4:45

Sure, looking at this landscape of the built environment and seeing all these disciplines and where they join and don't, yeah yeah, well, if I mean, if you look back historically, use the expression that public health and the discipline of public health, medicine is one of the earliest world colleges or what chartered forms of medicine way back in to say, orthopedics and the other professionals.

John: 5:09

And that rose from, say, the embankment in in London which was originally a water treatment and and sewage etc. And because water quality in London back in that time was impacting everyone in society, particularly the more well-off people, so something needed to be decided about water quality in the City of London and that was the first kind of early movements of public health. And I think you're going to see a similar trend to that around air quality. We saw it over 50 years ago when the EPA or the Clean Air Act gave rise to the formation of the EPA, and also around Earth Day as well. So that kind of legislative change around outdoor air and we've seen the impact that's had on city living smog and so forth Indoor air now is going to come under that level of scrutiny. Obviously, we've just come out of a pandemic. The pandemic is very much in the rearview mirror, but the changes in society, the cultural shift about that awareness of how indoor air impacts on our health outcomes. That's not going to go away.

Simon: 6:24

I suppose the question of the medical community stepping up or not. It's not that the medical community doesn't care about health outcomes, like clearly that's its raison d'etre. It's the fact that I don't know that the medical community links people's environment enough to some of the symptoms and the health outcomes that they're seeing. Would that be a fair accusations the wrong word. Would that be a fair read of the room that very often what the medical sector isn't seeing are people's environments enough in the pictures that they're looking at?

John: 7:09

I think so. I think it's been late to the conversation, and with good reason, because we've been dealing with the more acute, emergency front end of the problem. When somebody presents to emergency department when they're sick, it is not rescue medicine but it's dealing with a sick person. That's what we study as doctors in medical school. We study sick people, we study subjects like pathology and and it's the study of illnesses. We don't actually study as much the art of staying well and health and well-being. That's almost being seen as a different form of medicine, a less medical aspect of it. And the gritty front end of medicine has been around treating sick people, diagnosing illnesses, getting a differential diagnosis and then putting somebody on the path back to health and well-being rather than keeping them healthy.

John: 8:12

Preventive medicine and we're seeing that We'll get into a little bit later in the conversation we're seeing that now being revisited because of the economics of treating people purely with a medical lens access to healthcare professionals, complicated precision medicine, because the numbers just aren't stacking up. But traditionally I think yes, it's been felt. Look, I am a physician. I should spend my time in this quite technical and medical area of getting people better medical area of getting people better and it's been seen less medical and less being a real doctor inverted commas. If I look at the environment, if I look at air quality, if I look at those areas which are really seen in the realm of building engineers and maybe public health, but they're not certainly seen under the realms of clinical medicine, and I kind of get within healthcare that there's a process of diagnosis, of trying to figure out what somebody has as much as what's caused it.

Simon: 9:19

Often it's what am I actually looking at is a big enough challenge in its own right? What am I actually looking at is a big enough challenge in its own right. And then, as you say, putting somebody on the path to being fixed or helping them. It's that kind of bookend. I suppose the trying to intervene before it becomes a problem part. But also then out the other side of it, when you've diagnosed what something is, considering the environments that people are then going back into, that may have been the cause of some of those problems in the first instance.

Simon: 9:55

We see that a lot nowadays with elderly care and copd conditions and things like that, where we don't want this cycle of discharging people and then having to re-admit them a few weeks later because they're going back into the same damp and cold conditions that we got them from. So you can start to see those light bulbs go on. Can't you in the sector that hang on a minute? If I'm someone who's presenting with chronic illness conditions so potentially associated with their environment very likely to be their home environment much more so than an occupational problem. We've got to start considering the environments that people are living in as part of these sets of chronic conditions that could be associated with.

John: 10:42

Yeah, absolutely we have to conditions that could be associated with yeah, absolutely we have to. If future thinking or forward-looking thinking has to encompass those areas, there's no question about that. Historically, we're obsessed in medicine about and rightfully so what we call about evidence-based medicine, risk factors, and we can't flip-flop and pivot all the time in medicine and follow new fashions or new fads. Everything has to be deeply rooted in science before a policy decision or treatment guidelines or diagnostic guidelines can come out. We need a very high level of index of suspicion around something. You then need to run clinical trials. That have to be prospective, they have to be randomized, they have to be double blind and when you're really certain of a cause and effect and not just a correlation between something, then it becomes part of, say, the clinical or diagnostic or treatment pathway. I think that's right.

John: 11:47

If you're dealing with things very serious, complex medical conditions like diabetes or like cancers, you need to have that level of evidence-based, to make evidence-based decisions. The challenge for, say, the area that I'm working in, that you work in, is that it's hard to get that level of medical evidence around something that is clearly anecdotally true and seems like common sense. But then you've got to be very careful you're not walking down an old wives tale or a correlation, or my granny used to say this, and there's probably some Folklore truth in there. But for it to come medical or clinical, somebody has to take away something that may be anecdotally plainly correct and then develop medical evidence for it, and that's why we've been slow. I been slow. Everything that we're going to talk about is the way it's going in the future, but the reason why the medics have been slow to get there is because, rightfully, they need this very robust clinical trial data to make a new policy decision.

Simon: 13:00

No change is without consequence. So while you might argue the case that there's a do no harm element to this, that it's not that I'm prescribing a particular medication that would have an associated risk. If I'm just recognising that it might be an environmental factor that's causing some of these conditions, there may be less risk associated with that. But if that's diverting attention or funds away from another treatment, it isn't without consequence. So there has to be evidence behind everything in medicine. I get that and is that fundamentally where the challenge is? Is that drawing those straight lines between cause and effect in health care? You know I use this analogy yeah, um, yes.

Simon: 13:46

I was talking to tim sharp up in scotland and he was saying that the problem is is that we just don't know.

Simon: 13:55

In a lot of cases it's very easy for us to say objectively this is true, yeah, but actually drawing straight lines between an environmental space and a health outcome is incredibly difficult. And I was trying to press him on it and say I understand that, in the same way that I can understand that a 60 year old who's been smoking for 40 years, 40 cigarettes a day, and is presenting with lung cancer. There is always the chance that it's not the cigarettes that's caused lung cancer, right, but objectively, that's the elephant in the room. Similarly, if, if, if it walks like a duck and quacks like a duck and it's presenting like a duck to you and you've got a patient with chronic respiratory conditions living in damp and moldy conditions, you know there's a fair to medium chance that the environmental conditions are at least a contributing factor to outcomes. And this is the trouble. We can let perfection be the enemy of the good, sometimes in medicine as well, can't we?

John: 15:04

Yeah, I mean there's a lot in that to try and unpack it. You're right, because if you make medicine too algorithmic, if this, then that, and you're seeing it now within AI, clinical support, diagnostic algorithms, if the blood pressure's this, try this, and then you're just running algorithmic medicine. But likewise, you can't just go back to the old Victorian doctor of just laying on of hands, and it's an art form, it's not a skill, it's a craft. And because you went to medical school, you suddenly now this innate sense of well--being of people. I mean, you do you get you do get.

John: 15:46

You've a very excellent clinical doctors who do have a sense and what they're doing is they're running the maths in their head but also running the art form in the head, if you, if you want to think about left brain, right brain, thinking um, and it does become that science that is artfully done. And medicine is that slight alchemy where you're balancing the two. But, as you also say, there are resources. Whether we like it or not, you can no longer, as a clinician, say I'm going to follow this line of treatment and have that complete clinical independence, because if you're in hospital medicine, you have to answer to pharmacy. You've got certain drugs you need to use in certain cases. You've got certain financial parameters, you've resource constraints. There is a whole load of other areas that come through that that blurs the line between clinical and just this diagnostic art form.

John: 16:42

And then following the science, what does the science say? But to go back to your point about we cannot ignore the patient's environmental condition, where they live. An environmental risk factor obesity for diabetes, cigarette smoking, for lung cancer there's clearly behaviors that will bring a risk and there's environmental exposures that will bring a risk and there's environmental exposures that will bring a risk. And if we are going to become complete doctors and look at the whole patient, you need to look well where are they living, where are they working, what's their lifestyle like? There's genetic dispositions and there's other factors you need to look into. But as we're balancing that whole patient, if we're not considering where they're living, where they're going to school, what are they doing, whether it's what they're drinking, what they're eating, what exercise they're doing, their behaviours, the environment and where they're living and the air they're breathing, has to be part of that conversation going forward.

Simon: 17:44

Yeah, the air they're breathing has to be part of that conversation going forward. Yeah, and I think one of the things that perhaps the the, the medical sector rather than doctors per se or nurses or medical personnel, but the sector as a whole what it can perhaps do is communicate better, because perhaps what's not being communicated in the other direction is are those risks, are those associated risks? Because unless you ask the question or you raise that awareness, people aren't necessarily going to join that dots either. You know, you don't know as a general practitioner, that the patient that's in front of you is living in a damp, moldy home or living in a home where there's lots of cooking or open fires or something that some pollution source.

John: 18:33

If they haven't thought to raise that with you either, yeah, you know well, I mean let's let's let's talk about that, because recently you and I were both at the AIVC conference in Dublin and a lot of that looked at retrofitting homes from an energy point of view, particularly around social housing, and it's a great opportunity. When we retrofit homes for energy efficiency can we improve indoor air quality, and one of the cases was described that they actually had challenges retrofitting some social housing around particulate matter going up and mold because of the ventilation dynamics being changed in the home. With energy optimization You're now getting mold, which is a real interesting—you're pursuing this kind of planet-friendly agenda for operational carbon and energy, but you're then having a negative impact on society. So it was planet-friendly but it wasn't people-friendly. So I think that's a really interesting debate where there is this crossover between construction, design, ventilation professionals and clinical professionals. But one case I was particularly struck with is part of a deep energy retrofit is they will put in sensor technology into your homes and that will have tracking VOCs and gases and particulates and radon and other things. But it will be looking at byproducts of cooking and in this particular home they were picking up cigarette smoking and one of the children who lived in the home suffered from asthma and she was bouncing into the clinician with exacerbations of asthma.

John: 20:19

And if that patient I used to work as an ER doctor and the patient would be coming in bouncing into the emergency room and we would be scratching our chin and going, okay, I need to increase the medication, or I need to change the medication, or I need to put you on steroids, and then they may have obesity and stop playing sport and missing school. And then two years later that child's life is in a completely different situation. Because the clinician in front of the patient looked at the clinical parameters of asthma exacerbation uncontrolled and said, well, I've got to do something. I've got to. You know, as a doctor I've got to give this patient medication to help them do the best they can. But you could have had access to the air quality data in the home and not simply. But one massive thing you could have done as a clinician is said, look, we know somebody's smoking Now that opens up ethical and privacy and behavior and freedom of choice and let's just park all that for the moment. But if we said, look, the one best thing I can do as a clinician for this child is to make sure she's not exposed to environmental tobacco smoke at home and I know that's happening because I have a sensor in that home Maybe the clinical treatment plan and the clinical outcomes could have been completely different.

John: 21:37

So that's just a really interesting. It opens up, unboxes, a whole load of ethical considerations. But imagine having that insight, which is what the Victorian doctor I was talking about at the beginning would have anyway, because he used to do house calls. So he would go physically go to the house, walk around the house scanning socially what's going on, maybe seeing some mold in the bedroom, maybe looking at cigarettes smoking. So we have lost that kind of connectedness with patients by not doing house visits.

Simon: 22:10

Yeah, and I think that really speaks to the potential of interdisciplinary approaches. And you know, interdisciplinary approaches is well understood in medicine, but I don't think it's well understood between sectors. Um, I was with a housing authority a couple of days ago up in glasgow and one of the housing officers was telling me a story of a house that he went into because there were some complaints of damp and mold and they were complaining that it was making their kids sick. Uh, waving the smoke away from the cigarette smoke. They had the vent shut, they were smoking. Yeah, the guy had to refuse to go in because of the level of smoke in the property. Because it was that they have a policy of not entering houses where people are smoking because of occupational health concerns.

Simon: 23:10

It was that bad in the property and the concern of the resident was mold. Yeah, you know, and you've got kids and families with asthma and people missing school. Yeah, um, but there's a, there's a, there's a, there's a professional who has that exposure to those environments, a bit like public health nurses that are accessing you know, there are plenty of other disciplines that are in people's homes, spotting some of these dots. Yeah, that can be joined to create better outcomes for people, and I think that's the interesting challenge here, and data is another one of those things, if we can see, see data I mean there are.

John: 23:53

There are good examples of community medicine. Um, in ireland, in the uk, and particularly where I've won in america, around children's hospital of of Philadelphia, and they will have community nurses, particularly in underserved communities that are disproportionately impacted by asthma and allergies, and they have a policy that if a child is coming into the emergency room over a certain reoccurrence or exacerbations of an asthma attack, they will start this community nursing outreach program which will include an asthma nurse going out to the home. It could be physiotherapists, it could be occupational hygienists. It's done in line with the hospital doctor in the emergency room and the family doctor, the general practitioner, and they have this whole of patient.

John: 24:42

The word holistic medicine has been slightly hijacked but let's call this whole of patient.

John: 24:44

The word holistic medicine has been slightly hijacked but let's call it whole of patient where you're looking at lifestyle, obviously, their clinical management, but also their lifestyle and their home and their social support and all those other things that go into being a human being, and they will, as you said, joining those dots, all those clues of an asthma nurse going out.

John: 25:05

It will involve patient education, it will involve environmental control, mold and pest remediation and the fascinating thing is when you run the numbers on that, the return on investment is 100 to 1 on what it would cost to manage that child on a medical-only, emergency room, visit-only approach, particularly when you look at the society burden costs of the mum or the dad having to take the day off work to bring the child to the emergency room, or in the middle of the night so they can't go to work the next day.

John: 25:42

The child misses school, they fall behind on their education, they can't go to work the next day. The child misses school, they fall behind on their education, they can't play sports, they get childhood obesity and on and on and on. When you really roll up your sleeves and do that whole of patient and that community interventions, which are behavior, education, patient empowerment they're not medication per se and that does include where they're going to school, where they're living and they're what we would describe as the social determinants of health, when you really get those right, it sounds complicated but the the impact on society and the saving of medical costs, as I said, are 10 to 100 to 1 and what those initiatives cost yeah, and do you think that kind of kind of roi translates to this part?

Simon: 26:32

because you can get some pretty phenomenal rois in the states with the cost of healthcare so so yeah 100 to 1.

John: 26:40

It'd be interesting to see how that translates over here, but I get completely it's certainly on the positive side of the ledger, uh. But interesting though, even though we and we've we've done studies like this, uh, we've done health economic assessments on on these interventions, on these treatment plans, and it is very difficult to get those type of um programs to take off because, bluntly again, in the US there isn't a reimbursement or a billing code for those programs. There are very rapid billing codes that if a patient comes in and they require a medicine, there's a prescription and a billing code and there's a reimbursement pathway to do that, actually doing a whole educational plan about what's their bedroom like, what's their home like. Let's do an occupational hygienist visit, let's do a healthy home audit. It's very difficult to get currently in America to have a reimbursement pathway for that. I think it's going to come because people are looking at that. I think it's going to come because people are looking at it.

John: 27:47

I mean just to throw out some numbers. They're spending about $4 trillion a year in the US at the moment. It's about 20% of their GDP. It's actually becoming a competition issue. America is going to struggle to be competitive as a country if you're spending 20% of your GDP on healthcare. And their ex-surgeon, general Jerome Adams, he ran or attended an event that we ran. His own words, not my words. His words in America they don't have a healthcare program. They have a sickness reimbursement program and the evidence and he has some Jerome had his own research on this that about 80% of that $4 trillion I'm talking about goes on access to healthcare professionals and access to medication.

John: 28:35

But the studies show that about 70% of what actually determines your health outcomes is your behaviors and your environment where you live, what we're talking about, the built environment of your school, of your home, but very rare. About 8% of the USA healthcare budget goes on, what impacts 70% of your health outcomes. And they realize they've got to flip that equation. They've got to move some of that $4 trillion down to the green, preventive end of medicine rather than the reactive end, because they're getting physician burnout, physician overload and, despite spending all this money, their health metrics, their life expectancy, they're ratcheting down, they're ratcheting down.

John: 29:20

So there's going to be a what you're talking about? The shift in thinking, or how do we broaden the health and well-being conversation to include not just doctors and medication? Because we've got to rebalance that $4 trillion. Dr Gupta he gave the keynote at the American Institute of Architects annual meeting in Washington DC this year and he spoke exactly on that. How do healthcare professionals become part of the conversation that the people who design our buildings, the architects who have changed their society's constitution to now say it's part of being an architect to design buildings for health and well-being outcomes? Dr Gupta describes it as that in medicine, there's too much focus of heroically pulling people out of the fire with precision cancer medicine and precision medicine and personalized medicine, rather than spending more money on stopping people falling into the fire in the first place than spending more money on stopping people falling into the fire in the first place.

Simon: 30:28

And there is going to be a big paradigm shift in healthcare in the US, based on the numbers alone. But, as you've described to me before, one of the challenges in healthcare is that, whether the perception is correct or not, it all gets a little bit woolly and wishy-washy. When you move into preventative health care and health and well-being, yeah, you're almost into that category of alternative medicine in a lot of ways. And there's this, there's this reluctance, and you know that's very similar to a lot of other professions where they move out of the fixing stuff mode, which is, you know, the reactive space, because there's a problem, you either fix it or you don't, and it's all quite linear.

Simon: 31:16

Where you start moving into this proactive space in all sorts of sectors engineering and public health and medicine People get nervous, don't they? Because it becomes harder to. We only have to look at the healthy building movements, right, and I imagine you've got some thoughts on that. We've tried very hard over the last half a decade or so to start creating these links to the positive outcomes of healthy buildings, but it's all just a little bit woolly, yeah, and relies on surveys and things like that, and I think people get nervous.

John: 31:59

Yeah, that's the challenge yeah, well, doctors certainly get nervous because we like to be seen as experts. As you said, we're domain experts. That linear, I've got the answer. Here's a problem? I've got the answer. Linear line job done, as it were. And you even see that within the medical specialities.

John: 32:20

If you think of a surgeon or emergency room doctor, that is very linear. There's an orthopedic surgeon. There's a broken bone or something you do. There's an x-ray before, there's an x-ray after. You couldn't walk because you broke your leg playing rugby. I've done an operation. Now you can walk. You know that's linear, reactive medicine.

John: 32:40

Even as you move down to more medicine, general medicine, to general practice, you are getting much more into conversations with your doctor. How are you doing, how's your work, how's stress and those things. So medicine does itself become less and less linear and more conversational, and that's the art, I think, of being a really good GP. Yeah, looking at a child and knowing that, well, there's something not right with the child, but also looking at the mum and asking the mum well, what do you think? So now you're not taking somebody's blood pressure anymore, you're having conversations. So we can do that in medicine. So why can't you bring that on a bit further. You've seen that with, say, stress in the workplace and certainly now the insurance companies realise that. Well, look, if we pay for yoga and if we pay for mindfulness and meditation and you have your app on your phone, people won't need to be on tranquilizers and sleeping tablets and nerve tablets. So all the stuff we used to do years ago and antidepressants and it was a move to medication cynically, probably driven sometime by the pharmaceutical industry and there's a lot of debate around that. But we've moved that way in psychological health and moved away from doctors having to realize there's more to this conversation than just a tablet and and society has culturally moved into that people completely now embrace mindfulness and meditation and yoga and pilates stuff. That if a guy, 50 year old guy, said I'm off to my Pilates class 20, 30 years ago, you would have laughed. But that that's, that's, that's normal now. And people say, well, I do Pilates, I don't need to take the painkillers for my, for my chronic back pain, and so people are more proactive, they're voting with their feet, they are having a two-way direction with their doctor about staying well and it's not just command and control. You go to your doctor and he tells you what to do. You go to your doctor and you have a consultative conversation about health and well-being. And that particularly accelerated during the pandemic because there was video appointments and things that doctors said we can never do then became in the pandemic and then now a video teleconference, nhs Direct. These now are all things that are seen as part of normal medicine.

John: 35:12

At the American Academy of Allergy, asthma and Immunology they presented a paper. It was interesting. They had to slightly make it more complicated. They call them bidirectional feedback loops. Digital bidirectional feedback loops we're basically talking and listening to a patient and they're showing.

John: 35:31

There's now evidence with digital bidirectional feedback loops ie doing laptop or online consultations that they're getting better clinical outcomes because there's more engagement and it was more access to your doctor without having to physically leave work and go in. You're getting more of a coaching relationship. But also one of the other things fascinating with the laptop consultation say, go back with kids with asthma is the doctor can say well, can you pick up your laptop and walk me around your home and I look at all that clutter and the harbouring dust and issues in your bedroom and is there mould and pest remediation. So there is a big shift in the delivery of medicine, and a lot of that will be driven by patients wanting to say well, look, is there an alternative to just being on tablets? Doctor, can I do something so we can have a wellness plan together?

Simon: 36:29

yeah, and you wonder if some of that is transferable over into the built environment, this kind of patient-centered or occupant-centered holistic approach to healthy buildings yeah that somehow still the the person isn't at the center of the outcomes for buildings and you know I I hear this in the echoes of the conversation, as I have with other parts of the industry around the air quality still got to ride the coattails of sustainability for a while. It can't quite stand on its own two feet yet. It's too tied to energy outcomes still.

Simon: 37:11

And I do get this sense that we're looking at building performance a lot, and I understand that because there'd be some big gaps in performance of buildings. We're not at the human part yet and looking at people at the centre of buildings and going why does that building exist? How do we create a metric that determines outcomes for people? And I think that's an interesting idea, but it's full of grey areas and it requires experience. It's not something you're necessarily going to measure with an energy monitor. Yeah, you know it requires somebody to be able to have a conversation. Yeah, I only had this conversation with somebody the other day about giving people the confidence and the time when they're in a building to stop and sense how that building makes them feel, because actually, as human beings, we're quite good if we take a moment to stop and think about the spaces we're in, of interpreting whether that space feels safe or healthy or comfortable. You know you've been into enough properties as I have.

Simon: 38:39

You can sense almost immediately in some properties that something isn't right. You may not know what it is and that may require further investigation, but if people have enough experience and are in and out of enough properties, they know. Very often they know that they've just learned to kind of ignore or not think or stop, and I I've been saying this to people much more frequently um, give yourself a moment, give yourself five minutes in a building to walk around and sense the spaces that you're in. Yeah, because the the likelihood of discomfort rule which comes from ashray and a lot of the standards that we have is there for a reason. We're very poor at sensing quality of our space deteriorating around us, but we're actually quite good at coming in from outside of that space, being in that space and being able to assess the risk. Yeah, it's why we're still around as a human species so many millennia on is that we're quite good at sensing when a space isn't good for us.

John: 39:45

Well, that's what you're. Yeah, your reptilian brain, as it were, is always sensing danger. Our brains are programmed not to be happy, their brains are programmed to keep us safe. So we have that innate ability. Yeah, I think we're kind of drifting into some of the reasons why it makes the medical community intangible, because what you're saying I I 100 believe, believe. But how do you get those metrics? Um, and we're drifting into multiple chemical sensitivity and and stuff that then then then the medics start to glaze over and we start to lose them and that's the bridge which is the difficulty, because something that is gonna going to have to be tackled, because he said it can be sensed and people behave differently. As he said, we know a good building where it's the lighting or the sound.

John: 40:38

The Victorians were very good at this. They would look at the microclimate. They would look at the microclimate. So if you go to the various old villages where there's old houses, they would build where there was natural, not a lot of wind or places, areas where they built, where they were naturally dated. You put the scullery or the food store at the back of the house, which was north facing, so it'd be naturally cooled, and they designed homes looking at the microclimate and the climate and the geographical positioning of it, where light was, and those things.

John: 41:12

We kind of lost that a little bit in modern technology, particularly in America. They say, well, I'm going to build a building here, it's going to be a big glass box and if I get a whole lot of solar gain on one side, that doesn't matter, because I'm going to crank up the air conditioning and I'm going to burn a load of fossil fuels because I can cool it, I can beat nature or I can drive against the natural ecosystem environment of the building and in fact you don't, because the canary in the mine or the human being that goes in there goes, I'm freezing, I'm too hot, so I'm getting blasted by light or there's something not right with the building. So there's definitely a connection there between what can be a good and healthy building. But then how does that become measurable? Because if you look at anything, it was like ESG many years ago. It was all talk and words and it was aspirational and it was vision and, yeah, it's the right thing to do. We kind of knew what we were talking about, but there was no numbers on it and you'll see in any CEO statement or any business statement. When there's words around something, they're not really serious about it, it's just talk and it's aspirational. But then when there's words and there's numbers come into it, there's measurable, and they've got benchmarking and trends and KPIs and dashboards you go, oh, now that company is serious about it.

John: 42:31

The issue here is that building metrics they call them the hard metrics operational carbon, embodied CO2, operational CO2. They're all hard metrics. And then if we talk about, well, what about the people in the building? Well, they're soft metrics. They're like, yeah, it kind of feels like a good building or yeah, I was comfortable there, I felt it was a good building, and that's not to say dismiss the words, but they're still seen as soft metrics.

John: 43:01

And until that flips and they go look, actually the hard metrics are what are the human outcomes in that building? People live in those buildings and can we measure that? And is there a metric Now? Whether that's, say, the stuff that Joe Allen is doing, where he's talking about cognitive gain in a high performanceperformance building and this one's like a strategic HR issue, where we've really got this best-in-class IEQ, ieaq building and therefore people want to come and work in that company because it's a great building, it's got great food and they can cycle to work and it's got great indoor air quality. Or it's say underserved communities where we've got unhealthy buildings and people getting sick, and you can measure that. And until you can get metrics into that slightly intangible thing you're talking about, it will all seem just a bit too wordy and everybody will default to the energy hard metrics because I can measure it before and after yeah, yeah, but it.

Simon: 44:01

But it strikes me if, if not the medical community, then who you know? At the end of the day, if this is a human-centered endeavor supported by the built environment, um, which is the right way around. Yeah, you know, we build buildings for people. Ultimately. Somebody said to me the other day, like, the right measurement tool for a building isn't the building, it's the person. So the better we get at measuring the response of the human in that space, the better those buildings will be.

John: 44:37

Why do we have buildings? I mean James McGrath. As we know, at the AIVC conference there was a kickoff evening drinks reception and I was saying to James, tell me about, like what's the next two days, what type of stuff are we going to cover? And he said well, it's quite interesting this year because they're going to focus a lot more on air quality. In fact, maybe almost 50% of the talks will be related to indoor air quality. And I was going well, buildings for people who breathe air, surely 100%. It's like how can you talk about air in a building and it not be about indoor air quality? But it was funny. The mindset is, oh, it's a building on air, but we're talking about energy metrics and ventilation and air exchange and technical engineering. And I said, but surely the buildings are for people? Surely a hundred percent of the talk is going to be about healthy air and air quality well, I mean this.

Simon: 45:29

That's one of the fundamental challenges of the. The built environment is often a lot of the legislative and regulatory drivers for that sector are born out of the wrong departments for human outcomes. You know, the reality is like we take ireland as a good is a good example of that. All of the funding and monetary mechanisms for changes in the built environment stem from departments of building and departments of energy. That's it. That's where they come from. So all of the incentives abound in how many buildings you can make and how energy efficient they are. Yeah, principally, all of the kpis of those departments abound within those metrics.

Simon: 46:19

Fundamentally and it's always been one of the, the kind of the tropes that I've spouted around ventilation in this space is that nothing beats energy efficiency like no ventilation at all, and that's that's kind of the, the objective logic of the fight that we have that ultimately there's no, there's no benefit to the people that are holding the purse strings of us trying to increase ventilation rates in buildings, you know, which is often one of the things we have to do.

Simon: 46:49

So it's not that they don't understand that it's a problem that there's there's no driver for it like financial driver for it, and then, of course, all of the mechanisms that support that then are based around that basic principle, that basic logic, and that's one of the fundamental problems we had. If, if the built environment was centered around public health and health care and education, um, then we might have very different metrics. And I think that's, and I think that's one of the really interesting things that the medical community is bringing to the built environment are different KPIs, because it's been very hard for engineers to reimagine KPIs without the medical community bringing those to them, without the medical community bringing those to them. Okay, and we see that within the social taxonomy and the taxonomy that the development of these new metrics of what a good built environment is, you know, and that's a really big shift.

John: 47:54

Yeah, I think it is. And again, I don't want to fall out with the ASHRAE folks. In fact, as you know, I'm on the ASHRAE Environmental Health Committee but there is often this debate around adequate air or appropriate air. It's almost like a minimum, good enough and we don't need to be better than that because it could be seen as wasteful. Why overventilate? And we did see the CDC come up with a blanket air exchange guidelines five air exchange per hour where in some situations you clearly were overventilating and it was wasteful for energy etc. So you can overventilate and be wasteful.

John: 48:33

But sometimes when you speak to some building professionals you get that they are trying to go as low as possible. That's adequate and anything above that would be a waste of energy. And how can I configure it so I can just hit my target and do that as efficiently as possible? And we did see it's not quite the same. But we've seen it in, say, fast food industries where they're trying to configure a food product and reduce it as much protein down to make it as cheaply as possible with as many fillers, where people will still consider it as edible as food. But how? How can we decrease and make this thing as cheaply as possible that people will still eat it and buy it. But we've actually stripped out all the cost of it.

John: 49:19

And sometimes there has been in some buildings saying well, well, look, I've got to hit code. So there is a code and I need to ventilate that code, but no more. And how can I battle it down to as little as possible? And maybe that's the wrong way when it only has one energy or operational or the cost of operating the building. You're only looking at that single metric or a small set of engineering metrics and you're ignoring of the unintended consequences. If you had a rounder set of metrics to include health and well-being and performance and things like that.

Simon: 49:54

Yeah, no, I couldn't agree more. And it's the eternal problems of standards and codes is their interpretation of the intent behind them, and it's always been thus, and I don't know that there's an answer to that. I'm beginning to think that there might be, in a different way of thinking, a different way of thinking, but the challenge has always been organizations that have to develop standards and codes of practice, to provide guidance for typical scenarios. Where that guidance becomes the design guide, yeah, where you, you set a parameter to say, look, in any given scenario, if we consider this building to be quote unquote normal, this will prima facie, on the face of it, mean that you're compliant with the law and the industry goes great, I've got to build 50,000 whatnots. That's the design. Then You're telling me that's the target and you're going no, no, we're not telling you that's target, we're just saying, on the face of it, if you build to these, you're going to broadly be in compliant with the law. Yeah, but that's got nothing to do with outcomes, that's just saying that you know, with a very broad set of assumption, this is your target, target, great, bang, there you go. And it's very hard to win that argument. But because you, you're, you're having that conversation in the context of an industry that's under price pressure, resource pressure, time pressure. You know it has to build faster, lighter, quicker, cheaper, more profitably and so on, but of course its eyes are going to be drawn to where's the? The line that I've got across?

Simon: 51:49

Yeah, and the point that I've always been making but and its ventilation is particularly vulnerable to this is that when that, when you get that culture creep, when that becomes the culture, if your target is a minimum, any failure in the supply chain, any break in any one of those many links from product through design to install to operation, the default position is going to be failure to comply. Just by the nature of it, you won't reach that because you set your bar. Yeah, at the minimum, yeah, and that's a really hard place. So the way, the way engineering is typically compensated by that is to over engineer. Yeah, you know there's that kind of joke engineers work out exactly what the load is and then double it.

Simon: 52:37

Yeah, right, so that's kind of how we've protected ourselves, but ventilation has never suffered from that. Strangely, we've never overcompensated with ventilation design, as far as I can see, which means every time we go out and look at ventilation, particularly in the residential sector. The default position seems to be non-compliance, because something will have gone wrong somewhere in the supply, always will. Yeah, right, and if your target was the minimum, you are always going to be non-compliant. Yeah, maybe not by much, yeah, you're seeing a little bit.

John: 53:12

I mean it's maybe slight variation and again I'm not a building engineer so I need need to stick my lane here. But the ASHRAE 241 may be a little bit like that. We say, look, we have your normal ASHRAE standard for a building, but if you can increase the equivalent clean air rate by adding in an additional method of getting equivalent clean air in method of getting equivalent clean air in, but boosting your system, and that may be adding in an air cleaner device or adding in some additional technology to your existing system not that you have redundancy in your system and that, but you have an ability to go to an increased threshold at a time of increase, say potential pandemic outbreak, for example. So that's the only time I've seen where they're kind of gearing in a redundancy or ability to kick up a grade. The question then goes well, should we not set them at the new ashrae 241 standard more of the time, say allergy season or just normal flu season or or whatever? And if you, if you can go that extra level, maybe that should be the new reset. He said there's a minimum threshold value but just as you said, there's a challenge If you're going to build home, we have it in Ireland at the moment building houses at scale.

John: 54:29

We have a housing crisis, so these guys want to sit down and say, ok, put me to work, I'm going to build houses. They need a target. Or they need to say if that's the code, I'll build it to that code. If that's the code, I'll build it to that code. So that's kind of where it suffers. But it goes back to the question you were asking about who's going to be part of this conversation. If you look at the breakthroughs over the last few years Airbnb doesn't have any hotels, uber doesn't have any taxis, stripe isn't a bank the big breakthrough is going to be a break with traditional thinking and it's going to be new people coming into the conversation. Maybe that's bringing in into the doctors into the conversation, maybe it's bringing other groups into it, but the breakthrough in thinking is going to be new voices or, if not new voices, new conversations. So the type of things that you're doing in your podcast series is bringing disparate voices architects, key opinion leaders, thought leaders, researchers, academics together and have some joined up thinking in those conversations. Because quite often I said I was at the American Institute of Architects. We had a full educational track on healthy buildings sensor technology, with the same at the Consumer Electronics Show in Vegas early in the year. We've had the same with the American Society of Interior Design, boma, the building owners and managers association. Have a healthy buildings, have a BOMA best program. You have ASHRAE, the building ventilation professionals, and then you have the facilities managers, the people who clean the buildings and and then lead and the energy raters. The well building Institute, the National Institute of Building Sciences all have produced papers about healthy buildings, ventilations, wear, sensor technologies, but very few of them are talking to each other. So the breakthrough is not only getting those people to talk to each other, but also bringing that patient voice, that healthcare professional voice, into the conversation. I think when they all come together and have conversations, when they all come together and have conversations, that gives us a chance of a breakthrough.

John: 56:44

What one of the big thoughts is? You mentioned earlier about the green movement, sustainability movement and the indoor air quality movement. It was always thought that if I'm going to build a planet friendly or a sustainable, a good building, that was going to be expensive. If it's good for the environment, that's going to cost me. So if it's good for the P of planet. It's going to be bad for my P of profit and you can't reconcile the two. With novel technologies and novel materials, I've actually shown you can actually improve your bottom line and improve the planet. The third P is people. So can I be good for the planet, good for people and good for my profit if I'm a construction professional or a building owner or a building operator and I think that's what's coming that people realise? Yes, I can do the right thing by the planet. I can actually keep people healthier and I can operate the building more efficiently and make more profits. When those three Ps come together, they'll be the big breakthrough.

Simon: 57:45

I'll have you back to the podcast in just a minute. I just wanted to tell you briefly about Imbiote, a partner of the podcast. I came across Imbiote a while ago and, in fact, completely unrelated to this was trying out one of their sensors here in my office and with a customer, and I was seriously impressed then and remain so. Imbiote are a multidisciplinary team with a common goal to promote healthy and sustainable interior spaces. They manufacture smart indoor air quality monitors and an exceptional cloud platform. I get to use and see many products out there and Imbia stands out the quality of the product, the innovation they bring with sensors and connectivity options with a platform with some unique approaches to reporting and integration with many of the reference standards out there, like Reset, well and Lead. Their devices can also integrate to any building to control and automate the operation of HEVAC systems, ensuring optimal air quality levels and energy savings. If you're interested in the performance of your indoor spaces and particularly its air quality, they are well worth checking out. Details, as always, are in the show notes at airqualitymattersnet and at inbiot. That's i-n-b-i-o-t dot e-s.

Simon: 59:13

Now back to the show and I I think, for people that don't know you, john, what's, I think, been astonishing with your work over the last year or two, but also anybody that follows.

Simon: 59:28

You will get an immediate sense that you're somebody that's coming perhaps from a non-traditional pathway into this sector pathway into this sector but you have had a an incredible journey over the last few years in that you've been involved across an amazingly broad set of institutions and structures. So I I think you must have an interesting perspective on the state of the art at a holistic level. Do you know what I mean? That? You know it's unusual for people that attend ISIAC conferences to be going to architecture conferences and vice versa, for engineering people to be going to academic conferences and life vice versa, for engineering people to be going to academic conferences necessarily, um, that you've seen these conversations happening in these silos, um, is it possible, like if I was to ask you like, what's your sense of where we're at with this healthy building movement as of today? Where? What gives you pause for hope when you, when you're having these conversations? Where are people joined up? Where they may not necessarily realize it and where's the friction potentially?

John: 1:00:58

okay. Well, let me take kind of on a micro and then a kind of a macro level. On the micro level, the history of how I got into this. I was an ER doctor an A&E doctor we call it over here in Ireland and I started being very curious the link between the indoor environment with kids with asthma and allergies, and parents bringing kids to the emergency room late at night flare up of asthma and asking me look, doctor, is there something we can do to stay well, rather than you treating us when we become sick? And when you're looking at asthma allergic asthma, allergic to indoor trigger factors we spend 80% of our time indoors, as we all know, or greater than that. I think Bill Banfield has the statistic that some whales are out of water more often than human beings are outside. I think the sperm whale breaches 10% of its time and we're indoors for 92% of our time. So if you're going to deal with allergic asthma, you've got to deal with the indoor environment. And I would say to the parents and the patients look, do you know what your triggers are? The trigger factors like dust, mite allergens, cockroach allergens, chemical irritants and other things that trigger your symptoms. Do you know? Are they in your home? Are you allergic to them, where are they showing up and what are you doing to avoid exposure to them? And did you know you can buy certain products, certain types of bedding, certain types of cleaning products vacuum cleaners, air cleaners to configure your indoor environment to be more suitable? And people love that idea and they love to be educated and that concept.

John: 1:02:39

We spoke earlier about patient empowerment and getting out of overwhelm and being proactive and participating in your own health and well-being plan. But they were completely confused. I would write down the information and they would come back and say look, doctor, you said something about when I'm buying bedding dust, my allergen. And then he said but make sure there aren't formaldehyde outgassing from the chemicals and the fabric. They were completely overwhelmed and one of the mums came back to me and said look, doctor, I get what you're saying, but wouldn't it be a great idea if somebody could test all these products and if they were free or low in certain triggers or they helped remove other triggers? You could put a symbol on them, if those people who are Irish would think of the guaranteed Irish symbol or look for the union label in America organic food certification. So that's, that's where we started was certifying.

John: 1:03:28

It was actually with Toys R Us and Disney a line of toys asthma friendly toys that wouldn't harbor dust mites and could be washed and didn't have harsh chemicals and that brought us on the journey to work with Dyson vacuum cleaners and LG washing machines and 3M furnace filters and Procter and Gamble and I saw how that that small joining the dots with people in that coaching, educational way of configuring indoor environment helped people in so many ways psychologically. They felt they were getting moving, they were doing something, they felt empowered. And then I said we worked with the Children's Hospital of Philadelphia and Dr Stevens there, tyra Bryant Stevens and we saw how you can really move the needle in one way. So that's how we kind of started. There is a connection can be made to make meaningful impact to the indoor environment and how people's health outcomes can be impacted. That's where I started.

John: 1:04:28

Then that brought us, say, on that macro journey and speaking to all those groups, we were brought there by our clients because we then started working with people who ventilated buildings and that brought us to the architects and to the ASHRAE and we were kind of brought there by our clients because we then started working with people who ventilated buildings and that brought us to the architects and to the ASHRAE. But we started small, just on testing consumer products to improve the indoor environment, and we saw there was a big, big connection and that led us to that kind of macro picture you're talking about as all the stakeholders in the built environment picture you're talking about as all the stakeholders in the built environment, but being left with a sense because I'm I'm asked to go and talk at all these conferences. Left with a sense that I would go to the american academy of asthma, allergy and immunology full day program about healthy buildings. Sensor technologies fly across the country to the american institute of architects same subject matter, but there was no architects at the doctors.

John: 1:05:21

Sensor technologies fly across the country to the American Institute of Architects Same subject matter, but there was no architects at the doctors' meeting. And there's no doctors at the architects' meeting, but they're both talking about the same thing and all these doctors talking about building and indoor air quality masquerading as architects, knowing nothing about it. And then you've got all these architects talking about clinical issues which they know nothing about, but they're not talking to each other. And that's my passion now is to join the dots. Not only get them to talking to each other, get the architects talking to the building owners, to the designers, to the facilities managers, but get them all talking through us, which is the voice of the patient and the voice of the healthcare professional Interesting.

Simon: 1:06:02

So it started effectively with allergy standards. Then the organisation as it stands today. What's the organisation today as a whole?

John: 1:06:14

the group, the IA group, Because, it's interesting, you've got a number of divisions within it that answer some of those questions don't yeah so the development of if you think on the timeline, it was just consumer products and just relevant to a subset of the population people's lives are impacted by asthma and allergies and then, as we work with with more and companies, say 3M, who do furnace filters, we're bringing you more into kind of ventilation. And then we work with Knaf, who are building materials. So rather than being consumer products, we then got into building materials, which brought you into the built environment. So you went from consumer products to spaces. And then we did some work with the Energy Efficient Building Alliance. That brought us into the whole energy ventilation area, which then brought us into the architects, into ASHRAE.

John: 1:07:09

So then, when we had the relationships with the various trade organizations, when lockdown came along, we developed our academy, which is essentially we've always felt that we're knowledge brokers, we're kind of in the expert industry. And how could we repackage what we had and get it out into the world? And that was through educational programs. It started with eber, the energy efficient building alliance. I did a lunch and learn a lot of the housing construction professionals felt you know this healthy building issue, we need to to know more about that. So then we developed a program for them. We did one with issa, the international facilities group, so that's the academy.

John: 1:07:54

And and then we have the institute, which is, as I said, a vehicle we've set up to join the dots between the architects and the design professionals and the construction professionals to talk to each other, but not only talk to each other, talk specifically with data that relates to health and well-being outcomes.

John: 1:08:13

So that's the ia institute, indoor air innovation and research. And and then last year we acquired this facility where we're in today, where we're doing this podcast, which is AirMid Health Group, which is a 20,000-square-foot facility over two buildings. We have 10 aerobiology chambers, exposure units which are climate-controlled, where we can introduce into those facilities contaminants or agents that can cause harm in the indoor environment so particulates, vocs, viruses, bacteria, mold and we can then access those chambers looking at novel air cleaning technologies, anti-surface, microbial technologies, all sorts of cleaning, both surface and airborne cleaning technologies, and validate their impact on the indoor environment. So that's the AirMid Health Group, and that all comes under the umbrella of the iAir Group. So started in consumer standards, allergy standards, consumer products moved into spaces and then spaces not relevant just to people with asthma and allergy, spaces that are healthy for everyone, and that's how we've broadened it into the Indoor Air Innovation and Research Institute.

Simon: 1:09:35

So physically for people to have a mental picture. That translates effectively to labs that can test things now, standards that can guide people and a comms process effectively to help people understand and identify products that are healthier or safer for them, depending on allergies. They might have education to people through the academy and then the institute with this idea to bring these cohorts together effectively and build this communication piece. How do you imagine, or how does that translate practically? Do you think, bringing people together? What's the conduit for that other than the institute itself? How do we get engineers and architects and surveyors and housing people and medical community the list is pretty big right. Medical community and like the list is pretty big right.

Simon: 1:10:44

What does that like in your head? What does that look like? How does that coming together happen? Yeah, because organizations like astray have got a mandate, aivc have got a mandate through the international energy agency. You know is he got a mandate through academia and medical research. Nobody's really got the mandate to bring everybody together under the umbrella of kind of healthy buildings. I suppose is that kind of the idea kind of.

John: 1:11:08

I mean I think the international world building institutes, um, and I spoke at their policy summit in in washington a couple of weeks ago they're doing a great job in that kind of platform. So we're not trying to replicate the International Well-Building Institute. Practically what we do is we think of ourselves as the Brookings Institute for not just healthy buildings but healthy people in healthy buildings and health outcomes.

John: 1:11:37

I did a paper recently in the ASHRAE Journal on biomarkers and what I was trying to get across there was we know some engineering or construction things we can do that should spec out a building to be a healthy building Material science, ventilation, air exchange. There's a recipe or a cookbook to say look, we've now built a healthy building. You can then get verifiers like US Green Building Council, the International World Building Institute, to verify you've done those things. You can then actually put sensors in that environment so we've done stuff. I you can then actually put sensors in that environment, so we've done stuff and then going to put sensors in to prove the stuff we've done has made the building healthy. Although buildings can't be healthy and buildings can't breathe and people say let the building naturally breathe. Buildings are inanimate objects. They can't breathe, and they can't be healthy.

Simon: 1:12:32

I heard somebody say the other day. There was a on one of the linkedin posts where somebody you know made the mistake of saying well, buildings need to breathe. And somebody commented if your building is breathing, run because it's probably going to eat you, you know if a building's breathing, you're either taking too much lsd or you need to start running absolutely, or you're in a whale or something yeah, yeah, yeah and.

John: 1:12:56

But talk about throwing a hand grenade into a conversation, is saying to somebody oh I like my building naturally breathes or whatever like that. So what you're talking about, you've got uncontrolled ventilation. Now I live in a very drafty victorian house that has uncontrolled ventilation. Maybe that's not a bad thing for us, but it doesn't mean the building's breathing and it could be a very bad thing for other people in a different climate zone and so forth. But if you're just saying it's naturally ventilating, actually the museum building in Trinity College Dublin does actually have a natural ventilation, but it's by design and they're venting and they have heat flumes and and uh, you know, solar chimneys and those type of things built in for that, and that's a deliberate natural ventilation strategy. It's not an accidental unknown just happening in uncontrolled way. Um but um. But to get back to my points, well, I've lost my points.

Simon: 1:13:56

Are they like good conversations we find ourselves down rabbit holes where you go. How did we end up here? I suppose that where I was kind of going with this was that risk is a funny thing. If we're talking about buildings in the context of risk, because a lot of health outcomes and well-being outcomes are a lack of risk often. You know it.

Simon: 1:14:22

Um, uh, kareem mandin introduced me to this idea and I still need to do some more reading about it, about this total exposome concept, this idea that our health and well-being outcomes in a way linked to our total exposure over our lifetime to risk, to pollutants or whatever they are. Um, but even that in itself is quite a complex piece because there's the you can tolerate some risks that you can have. You can be resilient to certain things. So I was having this conversation the other day about temperature with somebody. I can be resilient to low temperatures. Somebody else might not be.

Simon: 1:15:10

Somebody at the towards the end of their it will put stresses on their body that will have a medical outcome, have an impact on blood pressure and the potential susceptibility to illness, whereas somebody that's younger or fitter might not have that susceptibility. But then there are some pollutants that there's no tolerable risk to. It's an accumulative exposure problem over time. So this thing's very difficult to navigate in the whole. But what I'm fascinated in with the medical perspective on this is that that's a language that medicine is very used to talking in, and I think that's one of the problems that the built environment has struggled with. It's a very binary world. Something's either compliant or it's not. Something's either structurally integral or it's not. Something you know it tends to work.

John: 1:16:06

Subjectivity.

Simon: 1:16:07

When you bring in people.

John: 1:16:09

People, yeah, we were talking about buildings that breathe. But yeah, people, it's like what did Basil Forti say about his hotel? Fantastic hotel, if it wasn't for the guests? I could run this place brilliantly if it wasn't for the guests. When you bring people into the situation, things no longer. You build a building building's great. Now you're building their subjective beings buildings great uh, now you've got building that. They're subjective beings.

John: 1:16:38

Um, aivc, they a great paper on managing uh, heat in public buildings and they showed a photograph of um some 20 degrees in spring and everybody's sitting outside in a cafe tops off it's the first hot day of the year 20, 20 degrees and and whenever in september it's colder, he's got the jumpers back on first cold day. So that subjective, subjectivity of temperature that I may feel you may feel changes for people throughout the year as well. So you bring in that big, that big variation. And but you asked me about the manifestation of the Institute and how uniquely I like to always ask myself about a company that somebody set up. If your company didn't exist, what company would somebody have to set up to fill the gap that you're filling? And if you can't ask that question, then your company doesn't need to exist. Say, like your own podcast. If your podcast didn't exist, would somebody have to invent a podcast to fill the gap that you're doing? Obviously they would, because you wouldn't have the listenership that you have. So the Institute, uniquely, is trying to do events around health and well-being outcomes. So not only get the architects to talk to the construction professionals and the Consumer Electronics Society to come in on the conversation around sensors and the complete convergence of consumer technology with health technology. I mean that debate's over Our iPhones and our wearables are now very much a part of your consultation with your doctor. So we're trying to bring those communities together, but we're also trying to say we can uniquely bring.

John: 1:18:22

The piece that I think is missing from the conversation is not just have those binary engineering, code based conversations. We'll say, look well, if we do this and we design a building, as I was saying earlier, we can design a building that will do these things. We can put sensors in to show that what we've done is working, but there's very little data. Then say, okay, what about put people in those so-called healthy buildings with the sensors to prove, yes, it is healthy and what we did is working? Put people in there and there's very little data on that.

John: 1:18:56

Again, joe Allen's done some stuff on kind of cognitive enhancement, decision making of pilots with CO2. And you know. So it's good data but it's not, there's not a lot of it. And going back to that innate sense that this is a good building or I do better when I'm in that building, I don't like that building. Oh, that gives me headaches or whatever. That is still very loose. It's. How can we bring more science to that conversation? So the Indoor Air Innovation Research Institute is to bring all the people together but bring that new voice in and try and have that breakthrough to say, well, how can we stop just the engineering binary conversations and how can we bring a next level conversation for the health and well-being and healthy buildings of the future?

Simon: 1:19:41

And I get a sense, talking to you and your team here, that there's a real passion for this and I guess it goes back to that question I had for you about what's your perspective of where we're at. I'm guessing you do see hope in this that you're seeing you're seeing similarities in the conversation that just need connecting, that there's enough parallels here throughout the different sectors, because I can't think of a silo that you haven't been talking to or been in. So I'm guessing you've got a fairly good view, top down view, of the conversations that are happening at this stage. I get is that is there a sense that we're not all, we're not that far away from each other. Actually we just it just needs, yeah, that final pull together yeah, I think so.

John: 1:20:33

It's like that one one lock in the combination, you've got five out of the six and you only just need that tweak for the lock to burst open. Um, yeah, and is it a revolution? Is it an evolution? And what's going to be the next phase? I I don't know, but I think there's a couple of important ingredients that are around. Joe Allen speaks very well of this. I say that there's kind of five things that are moving it. There's the operational carbon Some people may use the word ESG but certainly the outdoor air planner issue, harmful climate events, forest fires, just so that they say the flooding in Spain and the flooding in Miami.

John: 1:21:20

So there's something going on in the planet. The outdoor air that people have switched on to. Operation of buildings, operation carbon. We've had a big shift post-pandemic. So people are now looking at indoor air quality and joining the dots on health and well-being. There is big policy shifts, again, a lot of it triggered by the pandemic. The White House Indoor Air Quality Summit, ashrae 241, aham have changed their guidelines. Iec are looking at microbial validation studies for air cleaners. So big, big policy shifts happening there. National Association of Home Builders have the Healthy Home Subcommittee.

John: 1:21:59

You've then got big technology shifts. You've got the new technology, breath biopsy, where you can actually just exhale and breathe out into something like you know, one of these breathalyzers, and it can not only diagnose infections and flu, it can diagnose cancers. You've heard dogs smelling people with cancer. So there is a VOC profile, a chemical profile that you can just breathe out. People bring the CO2 monitors, the Aronet CO2 monitors on planes. There's something in our lab down here would have been a very expensive piece of kit. So there's a lot of technology changing in air and people having aeronets and CO2 monitors and there's a lot of debate about that on their desks at work or giving them to their kids to go to school and so forth. And the other fifth big culture is a culture shift, which is that whole drive for health and well-being and taking control of staying well and not relying the doctor to be treated when you become sick.

John: 1:22:56

So I think there's some some big macro societal shifts that are happening. There's people like yourself. There's there's a bubbling up. There's definitely a bubbling up of this the change in the constitution of the american institute of architects. So there's movement and this purpose behind it, but probably more importantly and cynically, that the numbers are beginning to stack up behind it and people.

John: 1:23:24

Yes, it's the right thing to do by the planet and yes, it's the right thing to do by by people, and I should be doing it. But when the numbers come in and whether that's the four trillion I was saying about in the USA healthcare, and whether it's the insurance company, the reimbursement, the payment plans, when the, rather than taking a one-year capex conversation about building a school and a one-year capital expenditure costs, take a five-year actuarial view on the investment in your capex but say but the capex budget isn't going to pay for it. The savings are going to be on the healthcare budget in five years' time. When somebody actuarially runs that all the way through, well, then it will break open. I think you've got the purpose. Movement is happening, but also the numbers are going to stack up behind it and then everything will shift.

Simon: 1:24:17

And I think you know on that kind of money makes the world go round subject particularly when you start getting into investment structures, where you're moving into pension timeframes and asset timeframes, you move it out of political cycles and that's particularly where we've seen a lot of movement in ESG, ironically, has been the investment organisations going. Hang on a minute. I'm sitting on an asset here that's going to be up for renewal in 25 years' time. Hang on a minute. That's 2060. How's that building going to be evaluated in 2060? Shit. We need to divest rapidly here or we need to change that asset in a way that it's going to.

Simon: 1:25:05

Money. Markets are very unsentimental. It's just a risk business and if they see risk in assets, they'll get out of those assets. I think we've all got a sense that that's happening and I know.

Simon: 1:25:17

Speaking to developers, you made this point earlier before we kind of got away with vanilla ESG reports. You remember them, the kind of the glossy brochures from the developers saying we plant flowers and build communities and so on. Now they still exist, don't get me wrong. But behind those now the money markets are going great. Show me the numbers. You know. I need demonstrable truth that this building is carbon neutral or an A-rated home, and if they want access to that cheap money, they have to be able to demonstrate that. And you can see it's still on the horizon a bit, I think, but you can see on the horizon those same money markets going, the demographic that's going to be buying or living or working in these buildings. Are they interested in health and well-being? Yes, right, is this building going to be valued in that way by the, by that demographic? And I think that's. I think that's some of the hidden hope for me it is.

John: 1:26:19

Well, it means there's no. Where does health turn up in the esg environment, social and governance? There's no in that alphabet soup. And you've got diversity, equity, inclusion and that's kind of all in there as well. Um, but you're right, it is almost like it's another financial report. You've got your profit and loss, your balance sheet and your cash flow. You'll need to have another financial report, which will be esg and that is a metric and measurable, and portfolio managers and investment funds, the fanny mays who do lending and things like that for house building, that they're all looking at that fourth financial report and what's missing is health in that whole alphabet soup and somehow somebody needs to weave that in there.

John: 1:27:03

I suspect where it will start will be not indoor air quality, it will be the built environment, but it will be building sustainable communities. So you go in and build a new village or a housing community, access to playing fields, good lighting so people can get in and out safely, cycle lanes, you know, good stairs, green common areas and people start building healthy community built environments, that'll be very demonstrable as a good societal benefit. And if your investment funds and your mortgages go into healthy community building and then that will then trigger oh so the built environment now is very much connected to the health and well-being of that community, because they play sports and there's a town hall and you can cycle to school. And then they'll start to say, well, okay, now we've built the outdoor environment, the indoor, outdoor built environment, correctly. Then what about what's the air quality like in the bedrooms of the kit, where the schools, where the kids sleep, and things like that?

Simon: 1:28:07

so I think it's going to come that way into building well for society yeah, and I think organisations that can see the bigger picture also recognise that healthy communities also then contribute to society efficiently, which ultimately is their revenue. Often, you know, social housing is a good example of that, where the health of the tenants directly correlates to their ability to pay rent. Fundamentally, you know, regardless of what they're mandated to do in providing homes for people, bottom line is those organizations don't survive if tenants aren't paying rent. And guess what? If they're sick and ill and absent and or even worse, presenteeism and you know, struggling through and not fulfilling their best life that they can through health and wellbeing challenges, that affects your bottom line. It's hard to join those dots but objectively that's probably.

John: 1:29:01

Well, that is being I mean that's already starting voids.

John: 1:29:04

You know they're talking about social housing and public housing having voids and the last thing they want to do is need to move people out and you know it's very disruptive.

John: 1:29:12

So, building sports facilities, facilities, anti-smoking cessation, health and well-being we spoke about stress earlier on investing in people, again cynically you can say, not out of the goodness of their own heart, but out of the goodness that it the numbers add up, if I put on a stress clinic and a yoga clinic, people won't be sick, it won't cost me money. So cynically is when they can do the same thing for healthy indoor air quality buildings. So what, ultimately, is costing society more to build bad social housing stock with mould and issues like that, so kids are missing school, getting asthma, going to the emergency room, not playing sports. What problem are we stacking up for society down the line? And again, without getting too political about it, we did see this historically in the US with redlining. We're seeing with these isolated community food deserts, all that poor planning, and why should healthy buildings or good indoor air quality not be part of that conversation?

Simon: 1:30:17

yeah, I think you're absolutely right and there's. You know we've been great work. If listeners want to look up, born in bradford is a really good cohort study of kids that were born in bradford at a period of time where they followed their life and they have access to everything from their health records, their educational records to their police and social welfare records and they've been able to link data in a way that we've not been able to link data before and you can see the impacts of these things.

John: 1:30:44

You know we can, we understand the societal impacts of of poor housing in a, in a in a bad, in a bad way, or has anybody done that in a good way, where they've actually done something about it? Both, both, I think they've tracked every something about it, both. I think They've tracked every metric, yeah.

Simon: 1:30:56

It's been a phenomenal piece of work. It's called Born in Bradford and what it's shown is that one of the challenges obviously has been access to data and data being siloed, and GDPR obviously being a huge concern, epr obviously being a huge concern. But what they've recognised is that actually there are institutions that are very well trusted to manage people's private data. The healthcare industry is a very good example of that right. Generally speaking, it's trusted to hold your most personal data and that data can be used very effectively and securely to drive outcomes.

John: 1:31:37

But then that begs the question that if you can track and trace and correlate and all the things you're saying on the data, and then you invest to change that, you get a measurable outcome that is greater than your investment. Why are we not doing that all the time? To postpone not taking that approach to an underserved community? It's just not unjustifiable. You say, well, look, if it was some form of intractable problem, and say, well, then nothing can be done there.

John: 1:32:11

What we need is massive investment, which we don't have. We need a big ship building to come back in or whatever, something that can't happen. Well, then you get. Well, you have to cope with it. But if you're saying, well, hold on a minute, it's a false economy to put a group of people in a ghetto, forget about them and think it's not going to cost us, and say, well, look, but actually if we do the opposite and invest money now, we're going to get a return on the investment. So I think that's the mindset that it won't be acceptable anymore, going forward to not do something about it when the numbers show it's not going to cost you, it's going to save you.

Simon: 1:32:51

Yeah, well, here's hoping, I think so.

Simon: 1:32:54

Yeah, but before we finish up, I do want to talk to you about allergies, because I think the interesting thing was that was your entry point into this, and one of the things about allergies that's always struck me is it's very analogous to a lot of the other stuff in air quality, where conditions can be chronic, it can be complicated, it can be mixed up with other things. It's a messy world, the allergy world, as ibs is, as many chronic health conditions are. Um, and you, you found, you found yourself as a clinician looking down the barrel of allergies going there. There's some things missing here and clearly one of the things that resonated in that was well, hang on a minute, there isn't a comms piece here. That's being dealt with.

Simon: 1:33:43

We're not labelling stuff for people, giving people insight, talking to the consumer in the right way. We haven't got a process for testing and measuring that can be relied on. I wonder if there's things that can be learned from that process that we should be applying elsewhere in the market. That ultimately, some of the big gains here because, god, there's some low-hanging fruit that some of the gains that can be actually very simply dealt with, like you know, as complex as air chemistry can be. Ultimately, some of the things we might be able to do might be as simple as a flipping sticker on stuff. Yeah, like, do you get a little bit of a sense of that sometimes looking into this going? Are we we overcomplicating?

Simon: 1:34:33

this so sometimes can this be as simple as labels and badges and processes to give consumers the tools they need to have agency, because that's effectively what you did with allergy standards, which you gave agency to the consumer, didn't you?

John: 1:34:52

Yeah, I think that's. That's what agency, patient empowerment, a toolkit, you know those type of things through a visual logo, a communication and but it took a lot of work to get there and, like you know to to certainly credit the asthma and allergy foundation of america, who are the leading patient advocacy group in america, are our comms partner and they did a lot of work on the program to become our partners in. It's the only program they recognize in the world and they did physician activation strategy. They have nurses, they have chapter groups around America. So that agency and that buy-in, the toolkit, came with the backing of a patient advocacy group, so that was important to the success of that program. The other thing is that it was a cohort of people. So there are loads of eco logo programs and badges and label slaps and pay for plays. There's a plethora of those out there.

John: 1:35:49

We were able to pick a cohort in society, not just allergies but say allergic asthma. So people say, well, I'm allergic to this, or does my allergen triggers my asthma? How do I avoid it? It's a very motivated group within society, a cohort, and that something could be done, as you said, like an agency or an empowerment thing, could make a difference and we proved that and people liked it and they took to it. If it was too broad church like healthy product or generally well product or well for everybody product, you dilute the message. So we were able to take a cohort, as I said, have a very narrow message, deep but narrow message, to that group that had an effect. They could go away and do something about it. So I think that's important, the kind of agency piece. I think we can do a better job.

John: 1:36:47

And we looked at some of the allergy labeling or asthma labeling on products. It was either very technical stuff that consumers didn't quite understand. You know CE type marking or ISO standards and those type of things which are good scientifically but they don't resonate with consumers. Then there was other things, like the word hypoallergenic. You go to the FTC or the EPA website. It was made up by the cosmetic industry in the 50s and there's no scientific basis on it whatsoever. But people think a hypoallergenic toy or hypoallergenic pillow means it's gone through some testing. It hasn't. There's no scientific basis for that claim.

John: 1:37:25

And then you have food labeling. I have a good slide on this in one of my talks. It's a carton of eggs and the advice is allergy advice. May contain eggs, you know so it's just. Or may contain traces of egg, you know so it was just. It was these kind of nonsensical labeling out there, um, so we're able to, as I said, pick, pick a group. I mean there is.

John: 1:37:47

If you think of nutrition labels on food, you know you get this very simple nutrient how much salt, how much sugar, how much complex sugars, um, protein and those type of things. That's kind of helped in a way where I think labeling is going to go, and it's already gone. That way will be qr codes, and there are apps on your phone. You scan a barcode, you scan a qr code. We have our own app where you can actually overlay either triangulate product history that you can say when I use that particular sunscreen or whatever it may be, and I get a flare up. So you can then start to triangulate ingredient list what, what's in there, a common ingredient, and you can build up your own um kind of diarization of symptoms with products, and that that can be done very easily off QR codes and barcodes.

John: 1:38:37

Or if you've had a patch test and you want to pre-program something that you don't want in it before you buy it. You can scan the QR code. Oh, that's got sodium lauryl sulfate or something in there that you may have a sensitivity to. So I think that agency thing will be maybe customized to people going forward, so it won't be a one-size-fits-all that this is a good product for you. I think people will be able to customize product selection, but I think going things like air cleaner devices, those technologies will have to be validated in a meaningful way. About virus removal AHAM are doing good work in this area. They have the new AC5 or microbial clean air delivery rate, and we're doing some work with them on that. I think product claims around the impact on the indoor environment will have to have much more meaningful science behind it going forward.

Simon: 1:39:31

I was going to ask you about that actually from earlier on, so I'm glad you brought that up and you must have had some interesting insight into that over the last few years that, in the absence of the kind of the reactive part of the built environment as you move into proactivity and innovation and the space that we're in, it does also create the space for products that aren't well thought through, that may not be able to meet the claims that they have or are being demonstrated by private institutions and organizations, and I think most people, because the pandemic was so recent, felt that pain when it came to trying to understand whether an air cleaner was any good or not Right, you were looking into this void of of private testing and academic testing and claims about this product.

Simon: 1:40:25

Claims are very difficult for consumers to navigate that space, wasn't it Eventually? And I think there was a lot of pain created from the pandemic, from that process. So I imagine you had you must have had quite an interesting perspective and insight of that managing an energy standards organizations in that space, seeing seeing the world explode like it did with testing and innovation. Did you come out of that with a particular worldview on how this has got to change or what needs to happen.

John: 1:41:00

Very much so. There was more of an impact on where we are, the research facility we're in today, airmid Health Group, because that concentrates on infectious airborne pathogens. If you think of pathogen something that is the ability to generate pathos, or Greek for illness, so pathogenic Allergens are non-infectious pathogens, so they cause illness through a non-infection, through an allergic response, and VOCs can cause illness through an irritation response, but then you've got infectious pathogens and that's your viruses and coronaviruses and so forth. So this research facility looks a lot more at airborne pathogens that are infectious agents and this place exploded. It was a gold rush at the stage and it was like the Wild West. There was unregulated, there was claims out there and there is now a catch-up. Iec, the International National Commission, now have claims on microbial reduction. I know the EPA have new standards around airborne cleaning products that reduce airborne pathogens in the air. Aham, the Home Appliance Manufacturers Association, have their clean air delivery rate for microbes. So there is a bit of catch-up on the industry on that.

John: 1:42:27

Boeing were involved in a class action around a novel technology. I know some of the folks in ASHRAE locked horns with some other industry people. There was a lot of out there. One of the big problems we saw was virus clearance studies being done with no control. So if you nebulize or introduce into a chamber environment an aerobiology exposure chamber, there will be a natural decay of that virus depending on how you've introduced it. If you haven't attached it to artificial saliva, what's the droplet size? It can dry out, it'll decay and you can report these log reductions or whatever. But that's just what happens when you aerosolize in a virus into a chamber and gravity takes over, it just dries out and people are saying the machine did that.

John: 1:43:17

Whatever the technology was, they weren't all media-based, they were the new types of technologies out there. But now people are beginning to realize that you've got to do it against the control. So regulation has caught up here. So AirMed Health Group is at the forefront of that. We're on a number of those committees and we're helping design those studies here and it won't be acceptable going forward. The Federal Trade Commission they've put out some papers there recently around germicidal, uv, bipolar ionization technology, the photocatalytics, the free radicals, all those new non-media, non-filtration-based technologies are all now coming under more scrutiny. Ashrae 241 is a good stand in the way. They haven't endorsed or recommended. They've steered away completely from any technology, technology agnostic. They're just looking at the outcome and the delivery and how you get there. But first of all you've got to be effective. Two things efficacy testing does it work? Safety testing is it safe?

Simon: 1:44:25

My experience of it from another sector that struggles to describe the performance of products, which is the ventilation sector, is that ultimately, often what people see, or the consumer sees whether they're the buyer, the contractor, the housing organisation, whoever they don't get to see those tests, nor will they ever be in a position to really understand them. What they tend to find themselves looking at is marketing material, and marketing material is outside of the control, largely, of those testing labs and what you find is results that are quite complex, even things like ventilation that are quite complex, even things like ventilation, definitely so. When it comes to log reductions of viruses and pathogens in testing labs and how you might apply that to the real world, what they see are glossy one pages that talk about 99.999% log reduction, blah, blah, blah and even cursory scratches at the surface. What you found was that it became very difficult to understand because a lot of these products would have filters and these innovative products in them and you couldn't differentiate between what the filter was doing and what the innovation was doing. And trying to work out what you were actually paying for for the product became really difficult through the testing, and I had that on many occasions being asked to look at various products going. Well, I can't actually tell whether that's the MERV 18 or the HEPA filter causing that log reduction, or the clever widget I'm not going to pick one for risk of being pilloried by somebody but you couldn't work out whether it was the thing or the filter causing it. You know, because it's presented through marketing and I think that's the challenge, you know.

Simon: 1:46:20

I think that's one of the brilliant things you did with the allergy standards thing is, most of that is about the control of how you display information as much as it is about the test itself. The thing that's got to follow the labs and the tests and the increasing standards are rules about how you display and what you say and what you can't say and what you can associate with. Because the what? Next question is that one. Yeah, when we get beyond the okay, we've got some nice rules now that we think we can put all these white goods through out the other side of it is what's people's interpretation of those? And you've seen that. You've seen that with allergies, that there's a rigor required in how you present information.

John: 1:47:09

Yeah, I completely agree, and that is one of the founding. Hearing you say like that is actually one of the founding principles of it. And following the medical or the pharma marketing, there's a lot published a paper, or look at their clinical trial data. There is fairly robust rules then about what they can bring to the market. It must be track and traceable to the clinical evidence. Now you've seen with DopeSick and things like that that they can play loose with that as well, but we call it our TT Soft approach here.

John: 1:47:51

Which stands for TT soft stands for to the shelf, off the shelf, and so we kind of, when we work with big companies, we look at the people responsible for getting the product to the shelf, so your product marketing managers or your new product development, and then the person's job was to get the product off the shelf and sold, which is your product marketing managers. So you've got your product managers and we're surprised in big companies I won't name them, but how? The product development? The guys in the white coats and the girls in the white coats who are there inventing this new stuff that has a scientific advantage in the laboratory. They then hand the product and a briefing document and literally throw it over the wall and they never actually meet those people and talk through look, this is what we did in the laboratory. So robust science in the lab turns into good marketing data in the marketplace. And we will operate through our client services portal but also through our innovation meetings.

John: 1:48:50

We work with companies. Those people have never met each other and we bring them in the room together and we do a page turn of the testing report and we will ask them to bring in their PR company and their content company and their ad buy company and say look, this is the technical heroes, the innovators in the science and this is how you should now bring it to market. And that rarely happens in companies. They just are given a new dossier to say this product does this, this and this and here's a test or whatever. And then if consumers can have that curiosity to be able to drill through a marketing claim and ask email in the company and say send me the scientific report that proves it does that.

John: 1:49:30

And I would encourage best in class companies who want to play the game where they can win it. So if they're competing with lower-cost competitors who are kind of copying them and they've never really done the science. It should be their job to say look, we've done the work. It shouldn't be a level playing field on marketing claims. They should educate customers to demand the science and then the better companies who are actually making the better products with the good science will win, as they deserve to win, because they're educating customers to ask for the science and to recognise.

Simon: 1:50:03

We're accessing information in ways we couldn't have even imagined even a few years ago, particularly with large language models. You know me and you have these conversations all the time, particularly with large language models. You know me and you have these conversations all the time. But the reality is the consumer has never been in a better position to be able to navigate technical information as they are right now. You know we can inquire in a way through AI now, in ways that we couldn't have even imagined even a few years ago. So marketing wonkery, or marketing without guide rails, which is what you're talking about, will fall off a ledge pretty rapidly, I think, moving forward.

John: 1:50:47

Which is good, which is good, it's good for everybody.

Simon: 1:50:49

Yeah, it creates an honesty, I think, in the marketplace. Yeah.

John: 1:50:53

I mean, even, as you were saying, AI has brought it to another level, but McKinsey brought out a paper on this a couple of years back, on what they call the loyalty loop, and the old way of buying something was a funnel. You get somebody's attention, interest and desire and then they act. Now we see it. On the holiday you'll loop around your purchasing decision and you'll look at peer review sites. You'll go to trip advisor, whatever it may be, and we loop around and we investigate and we investigate products and then we'll make our buying decision and then we bought the product. We'll then get on to another peer group influencer and we'll talk about it and then somebody else will talk about it and then, if it keeps his promise and they engage with us, we will be loyal and that's that's the win.

John: 1:51:38

The win is if your product doesn't keep the promise you made when they buy it, though as we should be on to peer review review sites saying this product didn't keep his promise and nobody will buy it. If you've done the science and your product worked and you keep your promise, people will be on loyal raving fans will be on that loyalty loop to tell other people and you'll win even more. So the stakes of either wonkery or getting caught out or found out have never been higher, but also the fact if you get it right, you will have loyal customers who will be your raving fans and I wonder if that's you know, to kind of bring it full circle.

Simon: 1:52:19

I wonder if that perhaps is one of the keys, um, to improving our indoor built environment. Is that understanding that? Um, yes, there's a need to change. I think everybody accepts that the buildings can have an impact on our health and wellbeing and there's some performance gaps we need to address. But we're able to see our buildings in ways that we've never been able to see them before and, whether we like it or not, those loops are closing. So this isn't a case of if but when. We've got some catching up to do, but the consumers and the customers are going to be catching up just as fast.

John: 1:53:00

It goes back to those five shifts I was talking about. There's the technology shift, the miniaturization. We will have something on our iPhones that will be able to tell us. We're already bringing those CO2 monitors into our places of work. We can then form communities and we can talk to each other in ways we haven't. So people are more concerned about health and wellbeing and you have a wearable device. You were talking about smoke pack years. I mean, they were done on what we would call declared data. As a doctor, you go and you ask somebody how much do you smoke and you tell the doctor that's your declared data. If I ask you how many times you go for a run this week, oh, I went for five runs this week.

Simon: 1:53:41

Okay, hand me your iWatch or your iPhone, I'll tell you how many you actually did.

John: 1:53:45

That's your use data, so there's a massive difference between declared data and use data. So we will have use data in technology. So, as you were saying, the ability to communicate the technology to measure wearables, that will bring that agency into people's hands. And we won't be at the mercy, just as we're not at the mercy of doctors in the way we used to be, unless it's A&E. My old game is that you had to. Medicine was there was an asymmetry of information. The doctor physically held your report and he had all the information on this side of the desk and you sat there and were told what happened and he wore his white coat and he had his defenses and his stethoscope and you were there and you had to physically go to the big intimidating place, the hospital, and you were whatever. Now you can be in your home, you can, you can google with chat, gpt, you can know more, the latest paper and you have that consultative. So the the shifts are happening all over the place, so why won't they happen within the healthy building movement?

Simon: 1:54:52

Yeah, no, fascinating to see how that translates. John, thanks so much for your time this afternoon.

John: 1:54:58

Thank you. As always, fascinating to have you here. I really enjoyed it.

Simon: 1:55:01

Brilliant. Thanks, a million Thanks for listening. Before you go, can I ask a favour? If you enjoyed this podcast and know someone else who might be interested, do spread the word and let's keep building this community. This podcast was brought to you in partnership with 21 Degrees, Lindab, AECO, Ultra Protect and Imbiote all great companies who share the vision of the podcast and aren't here by accident. Your support of them helps their support of this show. Do check them out in the links and at airqualitymattersnet. See you next week.