thank you Gary for those very kind words
I'm really honored actually to be here
special thank you to Greg and the
CrossFit team for inviting me out here
to speak to you guys the wikipedia page
is interesting and I didn't expect Gary
to actually read it out today although
he did I thought when he asked his
permission
it was just kidding but hopefully you'll
get a gist of what the whether the
accuracy of that Wikipedia page on my
kind of bio from my talk today because I
do cover a lot of these areas and issues
first and foremost as gary said I'm a
cardiologist I qualified in 2001 from
Edinburgh for me this journey is really
just about doing the right thing by my
patient that's it it's my duty my
responsibility and everything I do I
always think about that patient in front
of me and the wider determinants of
health and I've done many different
things as well as being a cardiologist
and being an activist I try and
influence government policy as well as
as public health advocacy I do a lot of
private advocacy as well so I'll go
through some of those that journey with
you in the next hour or so and hopefully
we'll have some time for questions
afterwards but I want to start with
something called the 7 Noland principles
so 1995 the then Prime Minister John
Major set up her he set up a committee
called the standards committee for
standards in public life and they can it
was after a controversy that occurred in
the UK where two members of parliament
were found to be taking money from a
lobbyist on behalf of Mohammed al-fayed
to ask questions in Parliament and this
was covered by The Guardian newspaper an
investigation ensued in fact actually
probably the trigger for the bringing
down of the government of that stage and
then Tony Blair became prime minister
shortly afterwards but the committee
that made the review actually
concluded that there were certain
standards in public life that people who
deliver public services or people who
have a duty to the public should adhere
to and I'm also trustee of a health
think tank called the Kings fund and
when I became a trustee I was reminded
of these principles although I'd like to
think that I and I hope most of my
colleagues and doctors adhere to these
principles but it wasn't just for merit
medical doctors it's for people who are
who are teachers police officers and
politicians those whose duty is to serve
the public
so those seven principles are
selflessness objectivity integrity
accountability honesty openness and
leadership I think all of us would like
to believe and hope that the people that
serve us whether they're politicians or
doctors are dear to these but I think we
all have to look in a mirror and think
about actually are we are daring to
these principles when we go about our
day to day practice and I must ask I
mean how many of those principles do you
think Donald Trump it is two the second
thing I want to mention is and this is
part of my personal you know advocate
part of what I do with my advocacy role
is also what is my role as a doctor is
it just to my individual patient or is
it to the wider community and I think
we're missing a trick in the medical
profession by not thinking about what
goes on before the patient gets into the
consultation room because actually much
of the determinants of their health is
way before they get to us and Rudolf
Virchow is considered one of the
greatest physicians in the history of
medicine he was considered the father of
modern pathology he coined the term
leukaemia thrombosis and he said that
actually medicine is a social science
and politics is nothing else but
medicine on a large scale the physicians
are the natural attorneys of the poor
and social problems fall into a large
extent within their jurisdiction so
currently we're facing a major health
crisis certainly in the Western world
definitely in developing countries the
UK the US
you know we have a major healthcare
system failure the question is why and
GERD gigerenzer the director of health
literacy in Berlin Max Planck Institute
and Mueller gray actually talked about
the seven sins that contribute to
inefficient health care because of lack
of knowledge because of misinformed
doctors and misinformed and unwittingly
harm patients and those seven sins are
biased funding of research so resources
funded because it's likely to be
profitable not beneficial for patients
bias reports in your medical journals
biased patient pamphlets bias reporting
in the media commercial conflicts of
interest defensive medicine and last but
not least medical curricula that failed
to teach doctors how to comprehend and
communicate health statistics so I think
this is one of the slides that can kind
of help us understand why we have the
problems we face it in today's modern
healthcare system and why there is such
a huge burden of increase in chronic
disease that's not being addressed
properly I think this is for me than the
most important slide of my talk this is
the evidence-based medicine tribe
published in the BMJ 1996 by Professor
David Sackett
Canadian epidemiologist now passed away
and for me I think this explains a lot
of the problems we have so as doctors
obviously we want to improve our patient
outcomes this is in the middle of
doesn't works fine and we use our
individual clinical expertise our
experience over many years as physicians
the best available evidence and last but
not least taking into consideration
individual patient values and
preferences so if you accept that
concept as being you know true and I
think it's a I don't think so overly
simplistic and then acknowledge for a
second that if the best available
evidence is biased or corrupted and
you're not actually taking to
consideration patient values and
expectations you're gonna get bad
outcomes on your patients and that was
that's what we've got and this is a
separate talk but just to put things in
perspective certainly best available
clinical evidence according to Richard
Horton edits of The Lancet more than
half of the published literature may be
completely false
John I need his profession of medicine
and statistics at Stanford his own
analysis and I
describe this man is probably being like
the Stephen Hawking of Medicine in terms
of his academic prowess and his
scientific integrity his own calculation
suggests that 93% of all medical journal
publications are neither high-quality in
terms of a reliability nor are they
relevant to patients so if you're making
clinical decisions on biased information
you're going to get bad outcomes and
it's also unethical especially if you
know about it
what else did David Sackett say he said
half of what you learned in medical
school will turn out to be either
outdated or dead wrong within five years
of your graduation the trouble is nobody
can tell you which half so you have to
learn to learn on your own
let's start with a case study I think
especially many of the cost for this
they are going to enjoy this particular
case study so this is a patient that
came to see me a few years ago his
background is he was his name's Tony
Royal is a 55 year old international
airline pilot with Virgin Atlantic very
active you know he was doing triathlons
and marathons that kind of thing but
he'd followed the conventional dietary
advice followed a low-fat high-carb diet
he said to me it wasn't a particularly
high junk food diet scene but you know
he was he was kind of high carb lot of
starch BMI 28 overweight increased waist
circumference and then he has a routine
check in 2014 and his total cholesterol
HDL ratio comes back a 5.3 ideally
should be less than four even better if
it's less than three is his total
casserole is 247 not great and then he
gets a 10-year risk assessment for
having a heart attack or stroke which
comes out at twelve point eight six
percent according to risk calculations
that we use in conventional practice and
just actually a lot of physicians hear
this question I did in this in this
country I think you're cut off I think
you prescribe statins if it's over ten
percent is that right okay so we'll come
on to that in a little in a little while
now unfortunately Tony suffers a heart
attack a few months later luckily not
when he was flying a jet he got off the
plane he's experienced a bit of chest
pain he went to his primary care
physician had an ECG long story short
you know he survived it it wasn't
major heart attack but clearly it's a
life-changing event one of his vessels
was completely occluded he had a stent
to it and this is relevant to later on
in the talk but there was a bystander
disease we call it moderate narrowing or
stenosis of around 57% in his left
anterior descending artery anything over
70% is considered severe and may be
eligible for stenting for symptoms but
certainly not to prevent a heart attack
so that was left alone but he had his
major artery opened up and his left
ventricular function his heart was still
in pretty good shape there wasn't
significant damage and he gets
prescribed the usual cocktail of drugs
now I've been obviously a practicing
cardiologist for many years and this is
standard practice that we go around in
the ER or in the coronary care unit and
we tell patients take these drugs
religiously they will save your life and
you get put on a cocktail of an aspirin
another blood thinner for a year
high-dose statin beta blocker this is a
standard practice so he gets put on
these pills he gets turfed out not
really any you know lifestyle advice to
be honest not surprisingly and then just
over a year later he starts to feel not
very well he's gone back to doing
exercise you know he's starting to he
wants to go back to you know running etc
but he gets all these symptoms lack of
energy erectile dysfunction
you know he's notices his memories going
a little bit I mean it you know all
these sorts of different things now
because Tony Rawls suffered a heart
attack he could no longer go back to
flying that's the rules as an
international pilot but what he did then
what he did was to go back to his old
job before that which was a maths and
physics teacher so tony is a relatively
smart guy he's very good with statistics
he teaches high school math and physics
and he starts actually looking the
literature all these drugs that he's
taking he looks at the journal articles
on those drugs he looks at their
absolute benefit he works out that he
and he thinks at the site that he's
getting side effects from one of his
pills in particular the statin so
without speaking to his doctor having
looked at the actual benefits he decides
he's gonna stop the beta blockers on a
low dose of that and the atorvastatin
lipitor 80 milligrams and February 2016
within weeks having suffered and felt
pretty crappy for quite some time
literally he feels like a new man he's
back to his old self his symptoms have
resolved around the same time he
actually starts you know he's still
overweight and he starts leading reading
up on you know here
about Tim Noakes he read some of my work
and the newspapers he starts looking
he reads on Gary's work he starts
looking at the whole low-carb diet and
thinks okay let me give this a go and
see what happened so he decides he's
gonna cut out all his starchy
carbohydrates all the sugar he increases
his intake of non starchy very fair
shares for fat dairy nuts etc meat and
within three months he's not changed as
exercise level one bit within three
months he's lost three stones three
stones he's lost eight inches off his
waist
now his total cholesterol has gone up
okay so it's about probably about 20 18
to 20 kilograms times by 2.2 about 50
pounds okay 50 pounds okay sorry okay
fine 14 pounds a stone is that right
okay apologies okay so so he's lost what
42 weight okay I was close so he's lost
about 42 pounds and although this total
cholesterol has gone up as many of you
know when you go low-carb for some
people the cholesterol go up the actual
ratios got better so triglycerides have
gone down eh dogs gone up and his total
cholesterol HDL ratio was 5.3 if you
remember before it's gone down to 4.4
within three months all his metal boy
markers are healthy now he's done all of
this on his own he then contacts me and
sees me privately most of my work is NHS
but I do Bev occasional private work and
he comes to see me privately and he
walks through the door he tells me his
story and in all this time he's also now
looked to all of the drugs he's on he
has made an informed decision to stop
all of his pills so this is a guy's got
a stent had a heart attack over a year
ago he's off all of his pills he never
felt better in his life in metal Bach
markers are great and I had this
conversation with him he's well informed
no issue I have no issue with it but
then he goes doc the real reason I came
to see you is I wanted to ask whether
it's safe for me to do Ironman
now okay now most cardiologists would be
you know pretty horrified and certainly
wouldn't you know first of all he
stopped all his pills but then he's
asking about doing Ironman and I said to
him I said listen you know you've had a
heart attack there probably is a
slightly increased risk of you having
not unnecessarily hard aside put an
arrhythmia or something that's going to
was a problem if you go for very high
levels of exercise but if that's what
you want to do then you know go for it I
would prefer you did less intense
exercise but so he said okay I'm going
to think about it doc and I also serve
us and consider going back on a low-dose
statin because you may get some benefit
unless like to get side effects and I'd
like to think about going back back on
aspirin again he says okay I'll think
about it calls me up two weeks later and
he says listen it seemed I've thought
about it I really appreciate the
consultation it's been very helpful but
I've decided I'm great as I am I'm going
to keep off the pills and Karen you know
in this fashion
okay well we'll come back to this is a
few years ago we'll come out so late
Tony Roy later so let's just take a step
back and let's talk about this issue
about cholesterol so cholesterol is a
risk factor came from the Framingham
Heart Study which was carried out in
Framingham Massachusetts started in the
40s and 50s and went on for several
decades and we several publications came
from Framingham including high
cholesterol being associated with the
development of coronary artery disease
but if you look back at that original
data what's very interesting is if you
look at so the ideal risk factor should
be able to tell you what a normal range
is healthy and not going to give you
disease versus a range that's going to
give you disease but from Freddie's look
at the top right chart there and there
are two kind of you know those pyramids
if you like that tell you from
Framingham who develop heart disease and
who didn't depending on their
cholesterol levels and what's
interesting is only people at the
extreme ends was there a significant
association with heart disease so if
your total cholesterol is essentially
over 300 you know those people by the
way who interestingly tend to be people
who have a genetic condition called
familial hyperlipidemia those are the
ones that develop heart disease
prematurely and at the other end with
the people of a total cholesterol of
lesson 150 those people tended not to
develop heart disease although
interestingly they didn't live any
longer than people with higher
cholesterol levels and William Castelli
actually concluded specifically about
LDL from that in in publishing Natha of
cirrhosis in 1996 the unless LDL is over
300 it is essentially useless as a
biomarker and think about that for a
second we as for
very rarely see people with LDLs at high
and we are treating people with LDLs
much lower and scaring them and telling
their a high risk now to understand how
that happened the mindset at the time
was we should shift the whole population
into that low level their thinking was
if we get the whole population as many
people as possible to get their total
classical levels less than 150 then we
will be able to significantly combat
heart disease and it was plausible it
makes sense doesn't it but there's a
missing component to all of this is that
most of our cholesterol is genetic
individually about 80% of his genetic we
can influence a profile of course a
little bit but total cholesterol even
LDL most of its genetic very likely that
it was a jinn it wasn't the cholesterol
itself but a genetic association with
those levels so were protecting people
but more important we will come unto
what that has done that whole mindset
and the mass prescription of Stan's
cholesterol-lowering has it actually
curbed cardiovascular disease and I'll
come on to that in a second and what was
found actually from Framingham is we use
a total cholesterol to HDL ratio so
that's the most important way of
measuring risk when you look at
cholesterol and so I was studying all of
this over a number of years and the
reason I got involved in interest in all
of this is that I was working as a
clinical doctor and I noticed over a
period of 10 years since I started my
career in 2001 on the coalface working
in hospitals I was seeing more and more
people with more chronic disease more
stress on the system more complicated
patients and and there was more obesity
and I wanted to try and work and figure
out what was going on how do we stop
this problem and one of the studies I
came across which is very interesting
which was published in diabetes care
2009 reveal the insulin resistance when
they didn't a modeling study was the
most important risk factor for
development of heart disease and they
calculated that if you combat it or
approached or you know focus on into
resistance in people in their 20s and
30s you would prevent 42% of heart
attacks and then after insulin
resistance it was high blood pressure
then it was low HDL cholesterol
so-called good cholesterol then BMI then
L
and in fact the LDL probably is still
significant proportion people who have
familiar hyperlipidemia which affects
about 1 in 250 people the conclusion is
interesting insulin resistance is likely
the most important single cause of
coronary artery disease a better
understanding of its pathogenesis and
how it might prevent prevented or cured
could have a profound effect on coronary
disease in other words they're saying we
don't know how to combat insu resistance
okay we know that now you know low-carb
you know low refined carbohydrate diet
etc moderate activity stress reduction
etc but they're saying we don't know how
to combat it and of course drugs were
produced that we're trying to combat
into resistance didn't really have much
of a significant effect the date this
was Greg this was 2009
yeah 2009 now to muddy the waters even
further 2016 I co-authored a paper with
I think you know Malcolm Kendrick and a
number of other authors you know
international authors to actually look
at what was interesting from framing as
well which I didn't mention is that once
you hit 50 cholesterol didn't seem to be
associated with heart disease and in
fact as cholesterol drop there was an
increase in mortality so that was total
cholesterol and of course you know
cholesterol is made up of HDL
triglycerides LDL etc so what we thought
we'd do is let's just isolate the so
called bad cholesterol look at LDL and
see was there any association with
coronary heart disease in people over
age of 60 and what was that association
how strong with it etc and how does it
link to mortality and what we found and
we were a bit surprised actually there
was no association with coronary artery
disease if your LDL was high and in fact
there was an inverse association with
all cause mortality in other words the
higher your LDL if you're over 60
statistically less likely to die and I
remember when we published this and I
did my bit so get it into the news etc
and I wrote about this in The Telegraph
newspaper a patient had come to see me a
patient in her early 60s in the NHS and
she walked through the door and she
looked white as a ghost and I said
what's wrong and she said I'm really
worried my doctor my GP has said my
cholesterol is very high I said
congratulations
you've got probably gonna live longer
and I thought I talked her through all
of this and she left the consultation
room and she was reassured because that
was what the evidence was telling us
2013 October so this is for me where the
major major controversy started you know
I'd been spending a two or three years
reading up about the whole issue about
saturated fat cholesterol mass
prescription of statins etc and I wrote
this editorial for the BMJ that was
peer-reviewed and in it I tried to
really put all of the jigsaw together to
explain the obesity epidemic and I had
concluded that our obsession with low in
cholesterol through LDL had led led to
the whole low-fat diet low saturated fat
diet movement and it was clear that we'd
increased our consumption of refined
carbohydrates we had this explosion of
type 2 diabetes and obesity
but if I was saying that saturated fat
was not a major contributor to heart
disease I then also had to justify why
cholesterol was not that important which
I've already told you before and if
cholesterol is not that important than
how the statins work statins are
supposed to save lives they're supposed
to be life-saving drugs miracle drugs
one of the most prescribed drugs in the
history of medicine so I had to put it
all together and I wrote this editorial
and I was actually not even a full you
know fully fledged consultant by that
stage I was a specialist registrar and
the BMJ decided to press release it
which was fine because at the end of the
day you know unless this this gets more
attention than we're not really going to
try and change the paradigm and it
actually the timing etc it became the
front page of three British newspapers I
think you know The Times put butter is
back on the front they were happy and
our cardiologists suddenly saying that
you can eat butter again I was you know
it was BBC news headline I was up in
front of CNN international Fox News
Chicago you know really thrown in front
of their kind of headlights but it was
fun I knew my stuff and I was able I
thought I was able to handle it
BMJ were very happy you know God loved
international attention and then what
happened subsequently was also linked to
the fact that in the same issue and I
didn't know this Jon Abramson from
Harvard a primary care physician from
Harvard he published in the same issue
analysis of
the people at low risk of heart disease
would benefit from taking statins and in
it and the reason he published his paper
was there was a move over a number of 20
or 30 years and statins had first come
on the market and shown benefit in heart
disease patients more and more people
were being prescribed statins because a
threshold to prescribe them was getting
lower and lower and lower and what
Abramson did was he didn't you know he
took already published data on statins
which is industry sponsored data it's
not new data so this data that's already
published commercially confident and
reanalyzed it to look at in people who
have a less than 10% while less than 20%
risk of heart disease or stroke in the
next ten years number one are they gonna
live any longer the answer is no number
two what are the non mortality benefits
in terms of running heart attack and he
determined there was a one in 140 chance
from an industry-sponsored study if you
took a statin religiously for five years
it would prevent a non-fatal or minor
heart attack or a non disabling stroke
and his conclusion was essentially the
actually you know what for this problem
with obesity etc we should be focusing
on lifestyle not statins that was a hint
from the paper but this is where the
controversy happened which is something
that I wrote about as well is that he
said that one in five people taking
statins will suffer a significant side
effects certainly a side effect that
interferes with the quality of life and
that's what Abramson wrote and
interestingly by coincidence I said the
same thing in my editorial
we were both citing one community-based
study in the United States which is a
very large study I think it looked about
a hundred thousand people that revealed
that within one year being prescribed
statins
almost 20% of people had documentation
in the notes from the primary care
physician that they stopped their statin
so that was what we essentially both
concluded and actually I was also
reflecting on my own clinical experience
having treated you know thousands and
patients that actually the side-effect
profile was much higher certainly for my
own clinical experience so we wrote this
in these papers and then there was a
huge controversy that started that
became a big story that is still
escalating now before I tell you more
about that I just want to tell you about
misleading health cystic so when I
talked about the the seven sins that
contribute to misinformed doctors and
patients one of them is misleading
health statistics an inability to
understand and comprehend very basics it
sticks and it's not rocket science so
there are many ways of presenting a
benefit relative risk or something
called the NNT or absolute risk
reduction so if you communicate relative
risks as opposed to absolute risks then
it can lead laypeople and doctors to
overestimate the benefit of medical
interventions so let's take an example
of an industry-sponsored study or study
on statins in people with type 2
diabetes so if a type 2 diabetic patient
comes to me and says should I be taking
a statin I can say to him well the trial
date that says if you take a tox that's
in ten milligrams lipitor for the next
five years religiously there's a 48%
chance you're less like you know you're
going to have a less chance you can have
a stroke that sounds pretty quite a big
number for many people they'll take that
that sounds pretty pretty big what does
the actual trial data tell us or show us
it tells us that instead of twenty eight
and a thousand people who are on the
placebo suffering a stroke the ones that
took a statin reduce it to fifteen and
thousand so therefore thirteen out of a
thousand people from taking the statin
didn't have a stroke because of the
statin from a randomized control trial
which translates into 1.3 percent or
well how I tell my patients when I have
this conversation with them and this is
what Tony Royal also understood from his
case with heart attack patients is that
in this particular case you need to
treat seventy seven people to prevent
one stroke so what I say to my patients
is okay in this conversation there's a 1
in 77 chance based upon this data which
is again commercially confident I'll
come on Saul in a minute and if you
don't get side effects there's a 1 in 77
chance of remotely having a stroke now
to be honest most patients when you tell
them that don't really not very keen on
taking the drug and I don't coerce them
by the way some of them will say listen
I'm worried and I'll take that chance
but this is the ethical way of actually
what we should be doing when we
prescribe these drugs mismatched framing
and medical journals has not helped you
know doctors for many years
rely have relied on medical journals as
the biblical truth it's published in The
Lancet published in Nature it's
published in the BMJ it's published in
JAMA
it must be scientifically robust and
true and we should follow what the
conclusions of that paper tell us so if
treatment a reduces a risk of disease
from 10 to 7 in a thousand but increases
the risk of harm from 7:00 to 10:00 in
2011 the journal were
the benefit is a relative risk reduction
but the harm is an absolute risk
reduction okay so they will say this
drug benefits you by 30% relative risk
reduction but the harm is 0.3 percent
now how often is that so a sample taken
looking at JAMA BMJ and The Lancet
between 2014 and 6 found that one-third
of all articles surprise-surprise drug
drug industry sponsored research used
mismatched framing so you can imagine
even the doctors are exaggerating their
own minds of benefit of a drug and
minimizing the harms don't just take my
word for in terms of ethical practice
this is a bulletin from the man who's
considered the world leading research on
health literacy in the Max Planck
Institute in Berlin GERD gigerenzer in
the World Health Organization bulletin
you can google this it's free open
access he said it is an ethical
imperative that every patient understand
it is an absolute relative risks to
protect patients against unnecessary
anxiety and manipulation in other words
and I would argue that us as a medical
profession by not telling patients in
these absolute terms and data says you
can you can work it out than we are
actually not being ethical this is non
transparent communication of risk
remember that evidence-based medicine
tried about patient values and
preferences this is something that it's
so important that we are not doing
routinely right let's come back to the
statin controversy now so BMJ published
his article from Ian Abrams in 2014 at
13 October great news headlines etc etc
now what was happening behind the scenes
is the lead research on statins in the
world professor Sir Rory Collins of
Oxford who got his knighthood from his
work on statins probably the yeah the
lead researcher in the world on this who
is a co-director the Oxford clinical
trial service unit who's or whose
department is received one in two well
in excess of 200 million pounds from
drug companies that manufacture statins
over the years he wasn't very happy with
our articles and he said that we
specifically he didn't challenge about
the lack of the benefit issues
he was said that we've exaggerated the
side effects this will cause
considerable harm because of the
publicity that went around it and it's
you know this will cause many this will
result in many deaths from people at
high risk people with heart attacks
people like Tony Award for example
stopping their statins and not lots of
people will die and he wrote an email to
the editor of the BMJ Fiona Godley and
said you need to retract these articles
she said why would I retract them we
will publish a rebuttal from you he
didn't want to do that he said no
retract retract retract this went back
and forth
she said no he then goes to the Guardian
newspaper and he basically this became a
front-page story I got a phone call from
the BBC and the Guardian in March saying
that you are you and John Abramson are
basically being accused of murder
essentially and how do you because there
are errors you're you know you've made a
major error by saying one in five people
taking statins suffer significant side
effects this is not in keeping with
professor Collins's data you know
eminence from Oxford you know how do you
respond to this so he started this and
what happened at the end of this media
publicity and this is what Collins said
by the way he said one in 10,000 people
get significant side effects this is
quoted in The Guardian newspaper this is
what he said now we were essentially
then on trial the BMJ editor I think did
the right thing she said okay I'm biased
in this I'm gonna send these articles
for an independent view for calls for
retraction they weren't for independent
review I think there was I think John I
need this actually was on the panel as
well in reviewing this and they came
back unanimous saying there was
absolutely six people in the panel
saying there was no cause for retraction
but we should put a correction or caveat
and saying that the citation that we
used about side effects was not from a
randomized trial it was real world and
that was essentially you know that was
what we what we did and that would that
correction was put in I then decided
this stage I think there was an element
of trying to scare us from you know
being outspoken about this I said this
is a distraction this is all about
transplants transparent communication of
risk I then started getting invited
editorials from various journals I
started writing stuff and kept pushing
this message was varied with many
different people many different
respected scientists who were on my side
and said yes we need to just make sure
that patients know exactly what benefit
they're getting but also let's emphasize
life style so I kept writing stuff and
getting stuff in the news so this kept
going on now after this after we were
exonerated and then what happens is Rory
Collins comes out because of all this
media publicist says ok we're going to
reanalyze our own data and in Oxford and
tell you what the true side effects are
which I thought was a bit
range because you know this commercially
confidential information that they will
not release the raw data for independent
analysis but we're gonna analyze it
ourselves and then another big news
story happens in September 2016 where
The Lancet published a paper saying you
know 27 author's quarry Collins a lead
author science starting to find side
effects are rare we were let's just put
this to bed end a story let's not
discuss it anymore essentially they
wanted to close down the debate and I
was actually over at a conference in the
state I was in Arizona about two weeks
later I was asked to comment for BBC
News and I said well again this doesn't
this isn't really in keeping with art
with clinical experience and actually
these guys should have released the raw
data why are they not releasing their
raw data for independent artists and
people actually really find out how
those trials were conducted and why is
it there is a huge discrepancy between
the real-world data where by the way up
to 50% of people will stop taking a
statin within a couple of years of
prescription even heart attack patients
when you ask patients why they say they
got side effects okay I get a phone call
from the chief investigative reporter of
The Sunday Times newspaper I'm in
Arizona at a conference and he says it
seems named John I'm friendly with him
he said it seemed you won't believe this
I said what he says guess what I found
out and this is actually an excerpt from
The Sunday Times newspaper in September
2016 after professor Collins had
published in The Lancet saying side
effects are whatever one in a hundred at
maximum tsavorite Collins Press of
Medicine epidemiology Oxford letter
ravine stands published in The Lancet
earlier this month which found not more
than 1 in 50 people will suffer side
effects said you know very rare and
reversible fine collins who believes
millions more Britons could benefit by
taking statins there's also co-inventor
of a test that indicates susceptibility
to muscle pain from them that test
branded as statins my sold online in the
United States for $99 on a website that
claims 29 percent of all statin users
will suffer muscle pain weakness or
cramps the marketing material also
claims that 58% of patients on statins
stop that's true taking them within a
year but mostly because of muscle pain
royalties from licensing of the patent
can be used to fund university research
but Collins had denied any personal fees
and Boston this is interesting so Boston
heart Diagnostics who had the license
for this they stood by their claims and
they said that they cited a u.s. Task
Force on starting safety that said that
randomized control trials such as those
used in The Lancet study led by Collins
had major limitations because patients
with standing tolerance were often
excluded I then John then actually did a
Freedom of Information request sir did
they make any money out of selling this
because it's all very bizarre very
puzzling I think and basically they
found an Oxford received about three
hundred thousand pounds and professor
Collins Department all very puzzling I
can't quite figure out what's going on
there now have statins actually reduce
cardiovascular mortality in the
population now this paper in the BMJ
looked at increase in statin utilization
across different risk groups low risk
and high risk and interestingly they
found no reduction in cardiovascular
mortality from taking stands over twelve
years across several European countries
now how can you explain that
scientifically let's say there is I'm
not suggesting there is fraud I do think
that you know to play devil's advocate I
think these randomized trials and the
drug companies very specifically wanted
to show statins worked and when they
figured out which patients I like to get
side effects say this will not enrolled
in those trials and then they're you're
basically making conclusions on very
selected people but those conclusions
then drive guidelines around the world
and I think this is a major problem this
is why there is such a huge discrepancy
on statins but let's just think about
their absolute benefits now if you look
at the statistics differently and don't
look at the NNT one in so many people
benefiting you can look at its citizens
if early and work out on average how
much longer are people going to live
from taking statins let's just take the
heart attack patients or high-risk
patients
okay people like Tony Royal if you've
had a heart attack and he's take a
statin religiously I'm sure many of you
probably know the answer to this anyway
because I've written about anything I'm
sure you've read Malcolm's work as well
but if you take a statin religiously for
five years you know how much longer are
people expected to live
if they take a statin and they don't get
side effects and had a heart attack and
the answer is just over four days okay
and this is based upon this is still
based upon industry-sponsored selected
trials now if 50% of patients in the
real world are stopping their statin
even people with heart disease within a
couple of years you can scientifically
explain why there is no reduction in
mortality in the population or reduction
in cardiovascular mortality so this has
been our biggest weapon in the fight
against heart disease for last several
decades and it has still failed there is
good evidence there's a good argument
show that is failed to reduce population
cardiovascular mortality we talked about
best available evidence another thing
that's interesting when it comes to
cholesterol lowering there's been this
was published in the BMJ evidence-based
medicine couple years ago really good
editorial and it showed that almost four
dozen randomized control trials some of
them involving statin trials some of
them on new lower clustering alone drugs
showed absolutely no mortality benefit
most of them had no reduction in heart
attacks and some showed harm so this is
the evidence that's being ignored in our
approach to cholesterol lowering across
the population I personally really don't
care about link cholesterol I care about
insulin resistance and the cholesterol
profile make it better and that's great
but I do not have that approach my
colleague who's at UCSF professor Rita
Redbook editor John know medicine we've
had conversations about this she even
thinks it seems she's been public about
it we should actually even probably stop
even measuring cholesterol okay because
it is a very poor surrogate for your
risk of cardiovascular disease so what
are the unintended consequences this
whole focus myopic focus on LDL going
back you know several decades is that we
have now prescribed data loss people a
low risk of heart disease okay
statin uses this seminal statin gluttony
many patients actually think they can
eat what they want because they
understand their cholesterol has been
lowered even that's not going to benefit
them we know statins now increase the
risk of type 2 diabetes about one in 50
to one in a hundred people will get type
2 diabetes just because of the statin
and of course the whole low fat high
sugar high carbohydrate food that's come
on the back of this so-called you know
which has evolved has you know
contributed in my view is a root cause
for type 2 diabetes and obesity and of
course you know more importantly as well
it's distracted us for more important
measures or ways of tackling coronary
artery disease this is what we're facing
now this is a you know this slide it's
that the figures are very similar United
States that we've got this huge problem
with people being overweight or obese
and more worryingly one in three
children by the time they leave primary
school by the age of eleven are in the
same category and the trends are still
increasing they have not plateaued or or
reduced and you know the food
environment you know we talk about the
you know the wider determines of health
is to blame it's at the root cause
because these sorts of highly processed
or you know carbohydrate protein
carbohydrates sugary foods are
everywhere and for me as well when I
started my campaign one of the things I
started doing was saying that actually
we as doctors should set the right
example because even our hospitals have
become a branding opportunity for the
junk food industry which is absolutely
crazy you know how could we talk about
tackling this problem when we ourselves
are basically selling junk food and also
grounds and you know there are one point
the largest employer in the UK is the
NHS one point four million employees
fifty percent of doctors and nurses are
now overweight or obese and it's not
surprising when the food it's not about
education it's about the food
environment education of course is
important but the bigger driver of our
food behavior is our food environment
and of course you know this picture
speaks a thousand words this does not
help now some people will contest this
but you know in the modern so the
biggest decline of cardiovascular
disease deaths over the last few decades
most of it can be attributed to smoking
reduction about 50% of it can be from
smoking reduction and it wasn't
education it was more about policies
that public smoking bans raising the
price of cigarettes etc those are the
big winners but when it comes to chronic
disease and death now poor diet appears
to be more responsible for chronic
diseases and death and physical
inactivity alcohol and smoking combined
and this is Tom Friedman's health impact
pairing which is basically dispersing
zinc
context if we're looking at the bigger
picture about how we're going to help
improve population health we need to
really make the context of the inferred
environment better because that has a
much bigger impact on population health
and counseling or education and of
course socioeconomic factors of course
poverty poor housing these have a much
bigger effect than anything else on
people's health and the reason for you
know having these population public
policy type strategies are more
effective because they will be reach all
parts of the population and are not
being dependent on a sustained
individual response now one of the
debates going on at the moment about
low-carb versus low-fat vs. veganism etc
etc is about sustainability people
falling off the wagon my understanding
it for so long and many people are able
to sustain it but many people aren't and
I think one of the reasons of lack of
sustainability is that you're constantly
still combating this food environment
which is high in sugar and processed
foods and I think it makes it more
difficult more challenging some people
are more strong-willed and can do it and
other people can't but it is a big
factor on why you know I think this
approach on education alone will be
ineffective in the water term and that
means in terms of changing even the
Dietary Guidelines okay so we're not got
that much time left so I will just talk
a little bit about sugar so I've been an
advocate of sugar my my guru my mentor
on sugar is here today Robert Lustig he
published a paper in Nature that got me
really interested sugar I start
investigating myself and I one thing I
just wanted to work out and having
looked at the research I think 2009 the
American Heart Association had actually
said in Roberts obviously one of the
co-authors here I wanted to work out
once I'd realized sugar was harmful the
question is how much sugar is harmful
after what threshold and the eh-eh-eh
with Roberts help had basically
determined that six teaspoons for the F
for an adult was a maximum limit it's
now become sixties for average at all
and the average American citizen
interestingly was consuming at least
about 22 teaspoons a day so more than
three times what the limit is was
recommended after which you have adverse
consequences in metabolic health now in
Europe I'm gonna show you this coca-cola
can and this still existed this is
pretty extraordinary so I did my own
investigation here and I wanted to look
at what were people being told about
sugar when they go into the supermarket
how much should you be consuming and the
labeling here is a bit blurry says that
in this kind of
Kokkola 35 grams it contains 35 grams
this is a 330 mil a third of a liter
under what units use here but can this
shows 35 grams of racket this is 36 per
set throw so 39 percent of your
guideline daily amount this is across
the whole of Europe in other words it's
telling you if you calculus is about
eight and a half to nine teaspoons of
sugar in here that you should be
consuming 22 teaspoons of sugar a day
not a limit and this had been going on
for several years
oh well over a decade so I try to
investigate how did this all happen and
I went to the root of it and I basically
discovered that the food industry had
had an influence on these guidelines
surprise surprise in particular the
sugar industry and you know I wrote I
wrote an editorial in the BMJ just about
the whole issue about obesity I mean up
to a few years ago for many people they
thought and believed that it was all
about lack of activity it doesn't matter
what you eat as long as you exercise you
can burn it off et cetera et cetera but
you can't outrun your outrun your fork
or you can't outrun a bad diet as me and
Tim Noakes have written about and I
looked at what the food industry been
doing to try and hinder any progress in
terms of curbing their excesses and
manipulations and of course they were
following the corporate playbook of big
tobacco in many ways which was basically
planting doubt that cigarettes were
harmful of planning doubt the junk food
is harmful
denial confusing the public and even
buying the loyalty of scientists you
know whatever it takes to protect their
interests of profit and just to give you
an example of the level of denies and
denialism the CEOs of every major
tobacco firm as late as 1994 went in
front of US Congress and swore under
oath they did not believe nicotine was
addictive or smoking caused lung cancer
that's the extent of the denialism so
wrote about this in the BMJ this is
before the the saturated fat piece and
this whole investigators saying we need
to actually tackle sugar now this is a
big problem and look at this issue about
their labeling which is very misleading
and I went on BBC Breakfast primetime
and is interesting that you know I
explained all of this stuff around sugar
and we should be limiting it and all the
labeling being wrong and it was
interesting at the end the presenter
said we should ask we did ask 10
different companies organizations
associated with these you know sugar
essentially supermarkets etc to discuss
with dr. Malhotra all of them were
unavailable so
after this I got contacted by several
science service and we read your article
we think this is a really important
issue some very eminent people actually
the UK and said let's form a group
called action or sugar let's go for it
let's really highlight this problem
let's talk about policy change that's
highlight all of the corruption in the
system etc really linked to sugar
we formed action on sugar and I remember
I was I was over in the state I was
visiting my cousin here in Mountain View
and we were planning the launch in
January in the new year 2000 and 2014
and and it was basically you know I
wrote this press release and again this
was it was huge in the UK you may have
heard it over here but when a write a
relatively right-wing newspaper and the
government in power at the moment and
that time was a Conservative Party which
is you know a relatively right-wing
government when they put on their front
page sugar as a new tobacco I knew that
we were onto a winner here I mean this
was huge I mean up to that point there
was a buildup there were articles more
and more people writing about sugar but
suddenly 16 you know eminent scientists
in the UK suddenly say this is a big
problem and it went you know it went
viral I mean it was you know it was a
big a big event within a couple of days
you know we've actually called on
politicians now to do something about
this to curb sugar calling for sugary
drinks taxes and all that kind of stuff
within a few days though the former SEC
State for Health Andrew Lansley who
people some people described as a chief
destroy of the National Health Service
by starting privatization going he got
up in Parliament and he said well in
fact before he four he got up on the
opposition side there is a guy called
Keith Vaz who was a chair of the old
party diabetes group he supported us and
he got about 40 signatures from MPs
members of parliament across the whole
of Parliament to support our you know
our action of sugar essentially and
Andrew Lansley gets up and he gets up in
Parliament and he speaks and he says
basically that this analogy being sugar
in tobacco was not appropriate
sugar is essential to food he actually
said that sugar is essential to food so
the edits a common editor of The
Observer newspaper calls me up instead
of seeing what do you think of all this
by the way great work etc you want to
write a commentary you know will go
really big with it I said great so I
basically called that
now sugars you tobacco interesting was
robert lustig original he'd said that I
think the first button saved the simon
caper one of our experts had said it as
well in the press release and obviously
the media loved that and i basically
wrote this in the observer and i said
the lands the attempted to rubbish
respected public health expert Simon
capable statement shows you tobacco
lanzi then compounded his errors by
ignorance hurting the house that sugar
is essential to food it is not he would
have been more accurate in saying sugar
is essential to food industry profits
and lining the pockets of his co-opted
partners Lansley was a paid direct it's
a marketing company prefer o10 of 2009
prefers clients have included Pepsi Mars
Pizza Hut and DHS Guinness we didn't
hear from Andrew Lansley again sunlight
is a very powerful disinfectant and then
the following week we find out that
several members of the scientific
advisory committee of nutrition there
was investigation going on by Channel
four News and dispatches that they also
were taking money from sugar industry
etc and were basically being put in the
spotlight saying why have you had this
guidance for so long you need to change
your guidance it's not keeping the
evidence we should be combat sugar and
of course then what happened is I think
because of a lot of media pressure
really and this was pretty extraordinary
we got invited to meet the secretary for
health at that time who was Jeremy Hunt
and he said listen okay give us your
child obesity plan because of course
children the most vulnerable in this
situation and we said we need to bring a
sugar drink stats and a year later you
know we we get sugar drinks tax
introduced in the UK which is fantastic
but you know quite surprising from the
type of government that was in power at
the time now I think I've got a few more
minutes left okay let's move forward so
in all of this I've carried on with my
kind of private advocacy and I thought
listen this saturated fat messages were
still a problem what could I do
to try and get greater reach certainly
greater acceptance amongst my peers and
colleagues that we should not be
focusing on saturated fat to be the
primary focus of curbing cardiovascular
disease and also accept the new paradigm
that it should be in some resistance and
chronic inflammation which the data is
pretty strong on that this is actually
linked to those two conditions so Rita
red burger and Pascal Meyer are both
editors and medical journals they're
both practicing cardiologists and I
contact them said listen why don't you
write this edit or
for the original Sports Medicine of
course I went through peer review etc
you know and we published it and it got
a lot of attention I was glad about that
and and this is it simplistic but I
think an important diagram just to try
and explain that really you know if you
want to combat heart disease my personal
interpretation of all the evidence is
that it's a low refined carbohydrate
diet I think there are certain
components of the Mediterranean diet are
beneficial whether it's
anti-inflammatory whether it's good for
the gut microbiome but certainly
something that is nutrient-dense and
doesn't promote into resistance so my
own interpretation is that you know this
is what we should be following or
certainly one of the the best ice you
can follow and of course combined with
activity stress reduction etc and
smoking cessation and if we do that will
also combat about 50% of hypertension
and prevent type 2 diabetes as well as
combating heart disease so I wrote this
book and it's not to promote the book I
wrote the book football is policy change
but basically I wrote this book to try
and change policy and change dietary
guidance etc called the PRP diet and
again I you know I knew there was going
to be a backlash so I got some people
who are very eminent people including
the mayor of Manchester former secretary
for health the most important doctor in
the UK it's a base endorse and say every
household medical student doctor should
have this book I was going for it I mean
I was saying cholesterol isn't that
important saturated fat etc I didn't
talk about statins in this book I'll
come in the next one but yeah this is
what I did just because I knew when this
book comes out there's probably gonna be
a backlash and let me let armed myself
with as many people as possible in this
in this movement who are going to have
an impact an influence and you know Andy
Burnham mayor of Manchester you know he
he endorsed it Sarah Cox is a well-known
broadcaster BBC broadcaster she I don't
know her she heard me on a radio station
and you know she said she lost her
muffin top eight pounds of a muffin top
from going low-carb and she was very
happy about that and and this was
probably the most interesting one Tom
Watson was a deputy leader of the Labour
Party opposition party and he had always
been known as being extremely overweight
he contacts me on Twitter six months
after the book was published ed it
seemed listen I've tried every diet
Under the Sun but this low carb diet
actually for me is doing reading really
well and in within a year he lost 100
pounds and he was able to reverse his
type-2 diabetes and then he obviously
came out and said that this had helped
him as well
this is just the book got released in
Holland a little bit of self-indulgence
he of course but you know we've got PRP
duck number one Stephen Hawking books
number two there but but the reason I
put this slide up is there they did an
experiment N equals three I got called
by this documentary filmmaking health
program in Holland to say listen we've
heard about your book we want to put
three people with type two obesity etc
on your diet you claim that you can
reverse type 2 diabetes in 28 days in
fact I even said 21 days we want to try
it on these people and look would have
it the chap with type 2 diabetes 15
years was about to go an insulin within
28 days and they're getting their
results live on camera having done this
experiment and they really emotional
about it as you know when this happens
people obviously get very emotional and
patients get better and then he got to
number one for about six weeks until the
Dutch nutrition council came in and said
doctor Malhotra's telling people to eat
15 eggs a week that's dangerous so he
got purty got a knocked off the top
there but at least we had a little bit
of glory for a while now Gary mentioned
my Wikipedia page this is all the stuff
that I have and many of us here have had
to deal with behind the scenes I thought
I'm talking about it now but I've had so
many attacks on my career I've had to
change jobs a few times when I wrote the
saturated fat piece I got called up in
front of the medical director the
hospital says do you know your duties as
the doctor etc how can we tell are you
telling us that our cardiac nurses
should tell a heart patient sweet butter
is that a marjorine yes so all of this
stuff was going on but public health
England got very worried about the book
and Tom Watson's promotion of it and
they basically tried to stop me speaking
at my local hospital the chief executive
you know government agency essentially
so this was a Sunday Times ended this
story which is good to see exposes what
was going on Tom Watson supported me and
the reason they were angry with me was
because I was saying we need to really
cut out the amount of starch and sugar
where we're consuming now this is the
NHS England's eat well guide okay not
terrible but there's quite a lot of
starch as you can see there the thing
that I have the biggest issue I have
here is if you look here in the bottom
left corner
they've got junk food on there right
this is supposed to be the healthy
eating guide they just put it on there
they've got cakes they've got candy
they've got whatever and they say eat
less often and in small amounts now why
is this even on there
why is it on there now Zoey Holcomb as
you know you know she wrote an editorial
and British on Sports Medicine who found
out that the people involved in
designing the world guide most of them
had links to various companies that
profit from selling these products and
it's not a coincidence now I'm not going
to name this person but I bumped into
this in the street a few months ago with
one of the most senior people involved
in these nutrition guidelines okay I
won't name this person for obvious
reasons and I spoke to him or her and I
said why have you got a listen let's
there all these diet Wars going on I
think all of us can agree that ultra
processed food is a problem okay if we
agree that ultra processed food is a
problem whether you're vegan or whether
you're a carnivore or whether you're
your low carb or whether you're you know
local low fat why have you got these
foods on there and her his or her
reaction to me was a seem you've and I
was pretty shocked actually but I
remember the seven Noland principles
you've got to understand one of the
biggest contributors to the GDP of our
economy is the food industry this is
someone who you we would trust to be
giving us independent advice but set it
in such a sanguine blase way that in my
view obviously you know I think that you
know that these people perhaps across
the line a long time ago another problem
we have is lobbying on politicians and
all of this is linked the BMJ published
something earlier this year showing the
think-tank a free-market think tank
called the insta Economic Affairs had
given about four point three million
pounds to the conservative party since
2002 and specifically were lobbying
against public health interventions such
as sugary drinks taxes banning on junk
food advertising etc and I think that's
a big problem I wrote this other article
once we got the sugar drinks tax myself
and Robert Lustig and grant Scofield
from from New Zealand basically wrote a
very long paper essentially putting the
about the science of sugar was saying we
actually need to extend it to all sugary
foods now as well it's not just a sodas
it's a problem about all the other
processed foods and all the sugar in
them but we just we didn't mention the
IEA and said that they'd undisclosed
voluntary donations from a number of all
including big American tobacco coca-cola
and Tate & Lyle and the more lobbyists
tried to hijack the think tank label in
an attempt to master paid for spinners
research driven advocacy the more
important it becomes for the think tank
sector as a whole to fight back the best
weapon in that fight is transparency but
to finish
so Simon Chapman is considered probably
one of the most influential figures in
Australia in fact the most influential
figure in Australia in curbing in
bringing down consumption tobacco taking
on the tobacco industry and he wrote
this really great paper which when I
read I kind of resonated with me a lot
of it already resonated with me as if I
read it before by I hadn't and he talks
about his 38 year career about how you
really make change happen on a public
health level and he talks about
different things about use of the media
being very important because ultimately
for me and for many of us here I'm sure
you know this is what's going on right
now in one in healthcare whether it's a
food industry or the pharmaceutical
industry is a gross injustice it's a
gross injustice on on the public on our
relatives on our friends on our families
you know because people are being misled
and deliberately misled for profit if
there's a gross injustice going on if
you want to revolutionize things what
you do you make the injustice visible
that's what you're doing and the best
way to do that that ideal platform is
mass media and when mass media get
behind it and you convince the media
everything changes but one of the things
he writes about is if you're going to do
this you must grow rhinoceros I'd says
because unless you're an advocate for an
utterly on controversial policy as soon
as your work threatens an industry or
ideological Cabell you will be attacked
sometimes unrelentingly and viciously
and I a number of people I was front and
center of this Guardian article being
called a cholesterol deny now everything
I've said to you today I've not said
anything different in the past you may
think god this guy's a cholesteral than
I are statin and I know I'm talking
about transparency but this is what they
want to do one label us as you know
these kind of you know spreading
misinformation causing harm etcetera and
then more recently myself
Malcolm Kendrick and Zooey Holcomb in a
front page linked article in The Mail on
Sunday were accused of spreading
basically deadly propaganda and the
editor the hell that
there is a special place in hell for the
doctors who claim statins don't work
I've never said they don't work I've
just said this is what their benefit is
and this is about ethical practice and
what was interesting about this so which
is quite amusing
the reason this article this story got
on the front page of the mail on Sunday
is they managed to get the then sex tape
for health
Matt Hancock to say there is no room for
people like this in our National Health
Service now I have met Matt Hancock a
few days earlier in Parliament before I
spoke about type 2 diabetes and I
messaged Matt and I said Matt did you
know this your statement that's now made
a front-page story calling these people
like me you know know praising you
notice he said I seemed I had no idea
this was linked to you this is how the
journalists had used the politician
with whatever lobbying was going on in
the background to create the story so
then the I newspaper where I hit back
and in fact I got the edits of the BMJ
even to call for a retraction of the
Guardian article and calling the
cholesterol that it was completely
misleading loss of errors and defamatory
statements of ours and I got the editor
the BMJ to come in as well and just say
that even this Guardian article it
should be corrected you know the problem
we've got is we've got a lot of eminence
based medicine at the moment so The
Lancet recently published something one
of professor Collins's colleagues Colin
Baden which became a big news headline
saying over 75 taking stands will save
8,000 lives a year the only problem was
which became the headline from Colin
Bayesian who was a lead author the only
problem was his own paper didn't say
that his own paper didn't reveal that
there was no mortality benefit no one's
know if you're over 75 taking a stand at
low risk you're not going to live longer
he basically made it up but that you
know what Winston Churchill saying a lie
can travel halfway around the world
before the truth has got a chance to put
its boots on what's going on here
I'm confused and what's interesting so
when you actually look at data and
evidence when you tell patients
transparently about their risk and
benefit at low risk and high risk the
overlying majority of patients would
choose not take a statin now it's
estimated about 100 million people
globally a prescribed statin so most of
these people are low risk and the data
tells
if you actually told them the truth
forget about side effects by the way not
even mentioning side effects just about
the small benefit most of them would not
take the statin and then you know
because of all this back and forth I
thought okay well you know let's let's
take this further let's get a
parliamentary inquiry so this has been
instigated I'm working on that I got
Rita red Berg Fiona godly a number of
doctors Oh many people to sign the
letter saying that we need actually a
full parliamentary inquiry now into
statins so that the ball started rolling
whether it happens or not is difficult
to say we've now got our new government
in power who've got an even larger
majority than they had before which is
obviously very worrying from a public
health perspective because they are
considered very right-wing so I don't
know whether it's going to happen in the
next few years but this this is not
going to go away so let's finish when
you actually tell patients the full
information about whether it's a
surgical procedure or a drug most of
them choose less treatment so they
choose less treatments you save money
you can use that in better areas and
redirect it you can talk about lifestyle
and I wrote this in the pharmaceutical
Journal with Professor Dame su Bailey
who's a former chair of the medical
oncologist and actually we said it's
just a very simple evidence-based
medicine practice if we practice that
all of us are did to it we can actually
improve people's health significantly
now something very personal to me that I
I wrote about and published about ten
days ago so just over a year ago I lost
my mother and in the most horrible
circumstances
my mother died at the age of 68 you know
my father is a doctor and she had you
know bad luck ultra-processed food
vegetarian diet all these things
contributed but what happened when she
eventually got into hospital was the
worst part because the system is failing
so badly because we have a lack of
funding into our national health service
because the chronic disease is
increasing and I personally predicted
this as a cardiology registrar 10 years
ago when I was working on the coronary
care unit I was seeing all these people
getting sick more sick and less staff
you know there was very little slack
left in the system and when my mother
got admitted and they missed a heart
attack for 11 days because they were -
we knew
doctors we this is our local hospital
they missed a heart attack she got
breathless they didn't realize with a
heart attack and then a heart scan
picked it up which was not reported on
for 11 days because they were so busy
she then went something called crashing
pond Redeemer heart failure
my dad was up with her I was going back
and forth and because the doctor was too
busy on a weekday seeing some of your
the patients for two hours she was
essentially drowning in pond Redeemer
this is something that should be treated
within minutes and can make somebody
comfortable and you know in my attempt
you know I it took me a while to write
this article and it was very difficult
for me to write it but I wrote it and I
sent it to the eye and they said listen
we you know we're gonna go with this as
a front page and this is actually two
days before the general election I was
hoping it would have some impact
hopefully because this particular
government is say here at the moment has
specifically deliberately in my view
reduced the resources and funding to the
National Health Service because many
people believe they actually want to
privatize the Health Service so I wrote
this article and you know it's this is
the I have personally now experienced
the end result of our failure to really
tackle tackle these system failures but
there is a message of hope and the
message of hope is people like tony
royal who several years later you know
we wrote this editorial and we talked
about the fact that you know he he did
do his ironman in fact he he he messages
me all the time he's breaking his own
records now he I think he came 17th in
the world and the world amateur ironman
championships another and this is an
amazing story whose almost 60 he's had a
heart attack several years ago he's not
on any pills everything from him has
been about lifestyle and in fact now his
this is three years of all pills his
cholesterol profile is actually
beautiful tell cholesterol HDL ratio
3.25 he's still low carb sometimes keto
sometimes low carb his performance is
better than it's ever been and I'll just
finish with one final sight I think you
know we can solve these problems
together but we have to speak up we
can't stay silent any longer because you
know so many people are suffering and
we're all ultimately affected by it and
one of my inspirations of Mahatma Ghandi
and he one of his quotes his science
becomes cowardice when occasion demands
speaking out the whole truth and acting
accordingly so let's be brave thank you
very much
you
