Evidence Based Medicine Has Been Hijacked - Dr Aseem Malhotra | PHC Conference 2019

[Music] our first speaker with his opening remarks it's been he's I've got the most amount of admiration for this guy um having been working with him for several years now probably the the amount of things he's had to gone through and he's been so resilient with it all and being persistent it's it's actually inspiring doesn't need anymore introduction that it's doctorís Imahara [Applause] so before I start I just want to I think you know it's really great to be presenting again fourth year in a row public health collaboration it's just growing and growing and I think this is just the beginning of something really special that's good that is gonna revolutionize health care and that we wouldn't have been able to even get this far if it wasn't for Sam so I think a special round of applause for right so here two visits back to business evidence-based medicine has been hijacked that's my talk for today a declaration of interest I've written a book called the PRP diet that many of you know about I give all personal royalties from sales of the book to charity right so many of you know this I think it's important to reiterate this and it will make a lot more sense towards the end of the talk but really the reason that we have our health care crisis is because we have this epidemic of misinformed doctors and misinformed patients and the root causes behind that need to be understood and recognized so we have biased funding of research that's research that's funded because it's likely to be profitable not beneficial for patients in fact two-thirds of research now in the UK in medical science comes from industry does not it's not publicly funded so that's a problem bias reporting in medical journals biased patient pamphlets bias reporting the media commercial conflicts of interest defensive medicine and last but not least medical curricula failed to teach doctors how to communicate and in fact comprehend and communicate health statistics really important slide that I think explains a lot of why we have this problem in healthcare is that we're not actually able to improve patient outcomes as best we as we can because the best available clinical evidence unfortunately is not very high quality so some estimates suggest that maybe 10 15 percent of all published research is actually high caller quality and beneficial for patients John I need Asst professor of medicine at Stanford his own predictions you know his own his own predictions suggest and his own analysis suggests that 85% of published research findings are false so that's a big problem and there are many reasons behind that some of its poor quality of research but a lot of it is because of influence of commercial interests and and the bias that comes in with that and last but not least patient values and expectations are not taken to consideration very often we think they are but they're not and without informed choice you're not going to make good decisions for patients you're not going to make good decisions together with patients and actually that it's actually a relatively simple concept but and if we stick to this then we can genuinely improve patient outcomes of course we have our individual expertise that informs us over the years as health care practitioners or as doctors but I think one thing we can all acknowledge is that clearly something is very very wrong if our health care system now is or has already collapsed it's not on the brink of collapse it is collapsed we are not able to provide our patients with the best quality care because of the rising burden of chronic disease and too much medicine and of course David Sackett who is the founding father behind that concept professor David Sackett is now passed away you know this is a really important you know a statement that he made is that science evolves and and we need to evolve with the evidence and with the science and if we don't do that again we're selling our patients short so I'm going to start with an interesting case study and this is a patient that came to see me in my most of my work as NHS but I do some ad hoc private work so this patient came to see me his name's Tony royal he's given me permission I published on on his case as well to share his details with you but Tony came to see me a few years ago his background was he was a 55 year old very active international airline pilot with Virgin Atlantic you know he had followed a traditional low fat diet but not something that was particularly unhealthy in the sense he wasn't eating lots of junk food but I'd follow the dietary advice very active but still had a BMI that was 28 putting him overweight more important his waist circumference was increased he had a routine cholesterol check done and in September 2014 as part of his annual review as a pilot and his cholesterol showed it was Toth 6.4 more importantly his cholesterol total cholesterol HDL ratio there's 5.3 which is high ideally it should be less than four but and he also got an assessment for his cardiovascular risk at that stage I came up as twelve point eight to six percent so that means there was a roughly thirteen percent chance he's gonna have a heart attack or stroke in the next ten years based upon this risk calculator should he be taking a statin with that risk we'll put your hands up anybody know okay well the guidance suggests certainly in the US and over here if you've got more than 10% risk patients should be offered or perhaps coerced into taking a statin with that risk profile and unfortunately a few months later Toni suffered a heart attack we call this a non-st elevation my column function and luckily you know didn't cause any significant damage to his heart muscle but obviously it's a major life-changing event he had a heart attack he had a stent inserted he had some what we call bystander disease so his left anterior descending had a 57% narrowing stenosis we don't consider it significant or needing further stenting unless it's at least 70% with symptoms so he had a stent because one of his arteries was completely occluded he gets put on his usual cocktail of drugs which I have prescribed to thousands of people in my career which is you know two blood thinners high-dose statin beta blocker and about over a year later he starts feeling quite poorly he's got lack of energy he reports lack of Drive generals got erectile-dysfunction he's he's got muddled speech poor mental acuity now what's interesting about Tony which makes him quite a unique patient is two things one is Tony could no longer fly anymore as an international airline party had a heart attack though with the rules out you can't fly anymore so he went back to what he did before this which was he's a math and physics teacher a level math and physics teacher so he's very good with statistics and he's good with maths so he actually starts looking into some of the drugs he thinks this could be a side effect of his medications and he also then teaches himself about the absolute individual benefits of these drugs and realizes that they are quite small when of the reality is most patients taking these medications are not going to benefit you know this Court will call the N in T I'm gonna come on cert in a minute so he realized all that stuff and a few months later because he's still feeling pretty rubbish he decides to stop his beta blocker and the one drug which clearly seemed to resonate with him and he looked at the side-effects was his high-dose statin so having felt pretty miserable and suffering the symptoms for a few months within a few weeks he feels like a new man all his symptoms disappear he notes a marked improvement in every in health in every respect he tells me at the same time he starts you know looking at research into low carbohydrate diets you know he's still overweight and he's still active but he's wondering why am i overweight and he starts looking into all of this stuff and he decides to go low cop so around this time when he stopped his you know he started feel better but he wants to change his diet so he cuts out the classic foods as we know that are high glycemic index carbohydrate foods high sugary foods and he increases consumption of non starchy vegetables or the fish eggs for fat dairy and mixed berries within three months of doing this alone Changez exercise it's exactly the same he's lost three stones his waist circumference has gone from 38 inches to 30 inches his total cholesterol has gone up by his total cholesterol to HDL ratio has actually improved it was 5.3 before but now it's 4.4 but this was a bit that so this is the reason he came to see me having told me all this story and I'm a cardiology is also now when he's come to see me few months later stopped all of his medications so he's a heart attack patient he's Alice dent he's not an aspirin he's not kepada girl he's not a statin and he says listen I just wanted to ask youdo is it okay for me to do an Ironman now he came to see me saying you know I've read about you you seem a progressive cardiologist I don't think any other cardiologist would even have his conversation with me and you know and he'd made an informed decision had he knew exactly what he was doing from my perspective just to emphasize this you know from when it comes to coronary artery disease and you look at the data there it doesn't seem to be after a certain level of exercise there is no incremental benefit from a heart disease perspective in preventing heart attacks so moderate activity you know is just as good as doing yeah you know endurance athletics you know endurance athletes don't live lot longer than golfers or cricketers so I I did explain that to him and I thought well you know we don't know but it's possible given your history that if you really do a lot of intense activity you may be increasing your risk of a cardiac event slightly but I couldn't really point to any hard you know hard evidence on this but this was my kind of clinical intuition and I said listen Tony I think at the very least maybe you should consider going back on aspirin and let's try you on a low-dose statin you know people get side effects at much higher doses a lot of people do well on lower doses and there is some you know some Dayton that should benefit on statins integrity prevention which I'll talk about shortly Tony went away he we we had our conversation or email exchange a few weeks later and he said listen you know I've made informed decision I'm feeling great I'd rather to stay off all the meds and that's absolutely fine and that was the end of that conversation then we'll come back to tell me later so let's just take a step back so let's talk about cholesterol it's it's feared it's a it's a big risk factor for heart disease if this comes from the Framingham study and what's interesting about Framingham is that when you look at the data it was only at the very extremes of cholesterol either being very low total class for less than 3.8 or very hi more than ten where there was a very significant strong association with the development of heart disease or not developing heart disease but cholesterol most of it is genetic you can influence a profile from dietary changes but most of it is genetic and you know we have a condition called familial hyperlipidemia affects about one in 250 people where there is a strong association with heart disease but if you look at the most most people in Framingham the total cholesterol did not tell you who was going to develop heart disease and who wasn't and what's interesting is William Castelli the co-director of Framingham actually in 1996 published in atherosclerosis and he said unless LDL so called bad cholesterol was very high more than seven point eight and you know we rarely see patients with LDL that high you know most of our patients don't even come close to that it is basically has no value in isolation in predicting who has heart disease and who doesn't but what does what is a better predictor is your total cholesterol to HDL ratio which is why we use certain risk calculators and that's crucial and important to understand now where discuss will fit into the whole risk factors for heart disease or where does LDL fit in it's actually much further down the line the one the most important risk factor is Insur resistance and this paper published in diabetes care in 2000 level they concluded in so resistance is likely the most important single cause of chrony artery disease a better understanding of this pathogenesis and how it might be prevented or cured could have a profound effects on heart disease what they're saying is we don't know what causes it and we don't know what to do about it that's essentially what they're saying but it is clearly the number and most people admitted with heart attacks have metabolic syndrome synonymous with insulin resistance now to muddy the waters a little bit I was involved in this systematic review published in 2016 and what we found is if you're over 60 there was no association with LDL cholesterol and heart disease in other words and also there was an inverse association with all course mortality in other words a high your LDL if you're over 60 they're less likely to die I remember seeing a patient shortly after when this was published and I wrote about in Telegraph newspaper a 66 earlier a lady in early 60s come to see Mian in NHS hospital she was very scared looked very worried I said what's wrong said I'm really worried my GP is told me my cholesterol is high I said congratulations you're probably gonna live longer and I had an informed decision you know making conversation with her and she left the consultation very reassured now 2013 having studied a lot of this evidence I'd realized that we'd really exaggerated the role of cholesterol and it had neglected us from concentrating on the real culprit driving metabolic syndrome which is refined carbohydrates and sugar I wrote this piece in the BMJ I also decided it was a good opportunity to have a go statins which is now going to be a lot of the rest of my talk is gonna be based upon the statin controversy and I wrote this and you know obviously BMJ press released it I was suddenly thrown into the limelight as a cardiology registrar having to talk about this having to defend myself against some dietitians from public health England and you know it became a big story they concentrate mainly on saturated fat actually but at the same time there was awesome media attention of the fact that I said one in five people taking statins suffered significant side effects unacceptable side effects when I say unacceptable what does that mean I ask the patient is this symptom interfering with the quality of your life if they say yes it's unacceptable it's not it's not you know that does and my own observation seeing patients looking at observational data in the real world suggested about one in five patients had significant side effects John Abramson in from Harvard published a similar paper just looking at statins in the same issue and what was interesting is he also mentioned that one in five patients get side effects and these include something exactly similar to what Tony all had experienced as well you know in muscle symptoms increased risk of diabetes cataracts sexual dysfunction exertional fatigue etc but the main point of this paper was do people at low risk of heart disease benefit from statins and they do not have increased life expectancy there's about 1 in 140 chance they may prevent it may prevent a non-fatal heart attack or stroke if you take it over five years now on this and some of you heard this before but it's important to reiterate this is that we have this problem with misleading health statistics so we have different ways of presenting data we can use relative risk or absolute risk or numbers needed to treat so if we communicate relative risks as opposed to the absolute risk it can lay late it can lead laypeople and doctors actually so a resume the benefit of medical intervention so if you look at data for example looking at type 2 diabetics taking a statin over four years that the data from a relative risk perspective says there is a 48% relative risk reduction in it preventing you having a stroke this is a kind of conversation that's going on all around the world and it's been going on for decades when doctors cardiologists or primary care physicians have conversation with their patients it sounds very impressive doesn't it 48 percent relative risk reduction if you take this pill but actually what that means is it reduces a risk from the data of 28 in a thousand people and per Sieber having a stroke to 13 in a thousand which means there's an absolute risk reduction to 1.3 percent in other words a very simple way of understanding this is what should be said to the patient's is if you take this pill based upon this data or be industry-sponsored which again is not part of the conversation either which I'll come on to there's a 1 in 77 chance that you take this pill religiously every day for the rest of the unifor the next four years it will prevent you having a stroke it's not been helped by the fact that medical journals have been co-opted into this mismatched framing so for example if a treatment a shows a read it reduces the risk of developing disease from 10 to 7 in a thousand but increases the harm from 7 to 10 in a thousand so exactly the same the journal article will report the benefits and relative risks in the harm in absolute risk so this actually from a sample showed that one-third of all papers published in the BMJ JAMA and The Lancet between 2004 and 2006 showed an use mismatch framing when their prism so to prevent presenting the benefits of a drug in relative risk and the harms it's absolutely it's it's it's ridiculous I mean it's it's actually quite scandalous to be honest if you think about it you know completely distorts our understanding of what these been what the risks and benefits a remember that slide at the beginning patient preferences and values inform decision making it has to be based upon transparent communication of risk and don't just take my word for it the the world most respected scientist in health literacy GERD gigerenzer who I've had the pleasure and opportunity to meet a few years ago at the Max Planck Institute in Berlin he in a World Health Organization bulletin said it's an ethical imperative that we tell patients at the absolute risk so in other words to not have this conversation with your patient and understand the absolute benefits of an individual drug is unethical if you've got the data there and you do not use it it is unethical it's unwitting most doctors are not doing this deliberately but it is unethical now the controversy over statins when Professor Sir Rory Collins who's considered the the world leading researcher on statins and the clinical trial service unit in Oxford he contacted the the editor the BMJ Fiona Godley in 2004 13 after both myself and Abramson John Evans wounded publishes articles and said that we were going to do considerable harm to British medicine much worse than the MMR scandal because we had exaggerated the side effects of statins and it became a front-page story in the in the in the Guardian newspaper run by the health editor Sarah Bosley and this was actually from the a quote from the article and professor Collins and by the way I have to mention Zooey Holcomb written about this and I became first most aware about these major conflicts of interest the clinical trial service unit in Oxford has received well over 200 million pounds in research funding from statin manufacturers from drugs at mineva so I think there may be a bit of a bias there possibly it may biases view but this is what he said in The Guardian in quotes hasn't been changed or corrected he said there really only wanted to problematic problematic effects of sites of statins one in 10,000 people he said would get significant and a small increased risk in diabetes now back and forth this controversy went on I was heavily involved in this and we move forward several years 2016 and professor Collins you know we went this as many of you know the papers went for an independent review about whether there should be retracted there was no call for retraction six nil in our favor professor Collins wasn't happy he then reported the editor of the BMJ Fiona Godley for editorial misconduct to the committee and publication ethics for the way that she'd handle the papers because of the delay in looking at all of this stuff unfortunately a Fiona Connelly obviously came out okay but many people in the BMJ who I know well thought this was an attempt to get her sacked but luckily that didn't happen she's been a shining light on the too much medicine campaign so I'm very glad that she's still the editor there and then Rory Collins said okay we're gonna look at the data again and come out with the you know because of the controversial side effects this has we analyzed it and what do we think about statin side-effects and they published a review in The Lancet which became big news story around the world that basically statins cause more benefit than harm the harms of very muscle symptoms maybe 1% and irreversible the reversibility is certainly true but whether it's 1% I think that's that's very very dubious in my view so what I didn't predict his two weeks later The Sunday Times chief reporters John and katanas calls me up and he says to me Seema got something interesting to tell you we're doing a story who found something really quite fascinating and and this is excerpts from their Sunday Times article and basically wrote about the fact that professor Collins had read this led this review from Oxford University on Lancet in The Lancet showing that very few people get start statin side-effects Collins who believes millions more Britons could benefit by taking statins is also co-inventor of a test that indicates susceptibility to muscle pain from them the test branded as statin smart was being sold directly to consumers in the United States for $99 on a website that claimed 29 percent of all statin users experience muscle weakness cramps and pain they also claimed that the marketing tour also actually which is correct a 58 percent of patients top statins and that when you ask patients is mainly because of muscle pain royalties of the patient go to professor Collins's department he waived any personal fees he also said this this claim was misleading but Boston hot Diagnostics had the license for this for this device they actually stood by their claims in this row and they said that the randomized control trials such as those using The Lancet study led by Collins had major limitations because patients was statin intolerance were often excluded and this is just the the Freedom of Information requests of Professor Collins's department received 120 6,000 pounds Oxford University received over 300 thousand pounds but of course you know at the very least I think it's a major conflict of interest it certainly looks very dubious to me what's going on and of course it doesn't help when you know the public or doctors to try and get to the bottom of actually what the true rate of side effects are so a broad perspective on the issues around the drug industry and their role in in modern medicine you know these divided these companies are there to make profit that's their their primary motive they're not there to sell you the best treatment and that's what you know we would like to think that we're the case but it suddenly is not the case and pizza will sauce in the center of evidence-based medicine Oxford in lecture points out that the real issue the real scandal is that there is failure to prevent misconduct by industry by regulators and there is a collusion of sorts for financial gain between academic institutions doctors medical journals with industry for financial gain and that is a big problem that is part of our system failure now they're going some more detail Peter also sent submitted evidence to the Science and Technology Committee in parliamentary science a technology committee that were looking into research integrity and he points out these issues I think these are really important to try and understand the system failure so he says academic academic institutions bear responsibility for pressure to publish for career advancement that can result in research misconduct of course if you have prominent publications it will track future funding which institutions demand and of course good publicity which obviously institutions desire he said there are other pressures for misconduct come from the association of academic institutions with industries such as when investigators or institutions hold patents or shares so they're all they receive payments from industry so the financial pressure to publish research that would be profitable for the company and to suppress negative findings he says some publications are basically just organized criminal activities which may be the best of the sponsors when prominent academics are paid a large sums of money to publish false data by industry or a sponsor maybe one of the victims when payments for conducting research are made to investigators who simply fabric data medical journals also have a conflict because they have financial pressures to publish positive findings and many of these journals will receive sometimes hundreds of thousands of dollars or pounds from drug companies when they publish their research to you to get reprints from the journal that they can then distribute amongst their drug reps to doctors so this is basically part of the marketing material so there's a huge financial conflict of interest in including you know journals like The Lancet for example JAMA and we need to know about this you know Jonah Jonah white Anita says that we have this medical misinformation mess part of the reason is lack of knowledge of the system doctors 70% of doctors don't fail the very basic test in their understanding of evidence-based medicine so we have to understand there's a lack of knowledge as well that prevents exchanging this system just moving on you know the journals are reluctant to admit that they may publish flawed research and therefore you know that they will and also fail to publish failures to replicate and there is a problem of fear of libel action so if there are whistleblowers out there and people want to want to highlight this problem then those people are you know are in fear of what may happen to them as well and he says Peter Holmes has said the best way to address these problems would be Mike but would be by making serious forms of research misconduct criminal offences with meaningful sanctions which isn't the case at the moment one example of how things can go very very badly wrong one Dutch researcher was sacked when he was found to manipulate data regarding the use of beta blockers for non cardiac surgery and it was estimated as a result of this and this was also recommended by the European side of Cardiology this resulted in about 800 excess deaths over ten years in Europe one bit of fabricating or you know manipulating data caused 800,000 deaths this is absolutely scandalous why are we not talking about this why is this not the main headline news why are we not doing something about this to stop it and the drug companies as well you know they they have been most of the top 10 drug companies would be found guilty for committing fraud mainly in America for illegal marketing a drug hiding data on hands manipulating research results and pizza Gosha who his own estimates he's a co-founder the Cochrane Collaboration that the third most common cause of death after heart disease in cancer now is prescribed medications he says we need to have some serious sanctions nobody got fired in any of these companies who were all the people no CEOs were fired nothing and there was no meaningful sanctions brought against this so of course we've got the problem of the illusion of innovation and several journal editors have also highlighted their own concerns about published research let's just come back to statins now just thinking about how statins fit into all of this so I have published saying that statins have reduced mortality in the population in secretary prevention but I think I was wrong and I may need to go back to the journal and get that corrected because I just took it as gospel truth and people with heart disease in the population statins have reduced mortality this paper published in BMJ open showed that actually there is no clear evidence for that in fact they looked at uptake of statins in different risk groups in the population and they found there was no reduction in mortality over 12 years in the population now why may that be one of the reasons may be that if you take the industry sponsored trials which is a selected group of patients and you look at the increased life expectancy over five years what would you expect and a lot of you may know the answer to this but most people don't the increased life expectancy in secre prevention is about four days if you take a statin religiously for five years you look at as a whole group the increased life expectancy is median and median is about four days and if you think that most people talk and stop their statins within a year or two you can understand from a scientific perspective not because it's fraud okay people have different definitions of fraud I don't think this is fraud but you can understand how it can be scientifically explained why there's no reduction in the mortality in the population and of course there is ignoring a multitude of randomized control trials about cholesterol that show lowering cholesterol including LDL has no impact on any cardiovascular events knowing Pat's our sorry on most of those trials no impact on cardiovascular events in all the trials no impacts on mortality and several trials showed harm so this is being ignored we have we've got publication bias we've got selecting selective reporting of research results and papers that suits and and of course the problem is this indirect focus or this misleading reductionist approach online cholesterol has distracted for more important issues and of course you know this picture speaks a thousand words because many patients have the illusion of protection that they think they can eat what they like if they take a statin and I've seen many patients like this who under that false belief now I wrote this paper to try and shift the paradigm about the Indians signing of heart disease again if there's another paper which got a lot of interest it recently I was diving the editor of BDSM tweeted it reached a lot of interest more than 1 million views which is quite a lot for an editorial I written it with Pascal Maya and Rita red book both cardiologists and editors of medical journals and really focusing on that what we should be doing is focusing on incidence and chronic information through whatever means III personally from my own interpretation data think there is something in the Mediterranean diet it's not going to be the bread and the pasta though that's beneficial and if you combine that with lifestyle approaches you know this is one way of preventing heart disease and may well be a good way of managing heart disease as well and I wrote this book called the ah P diet which was mentioned in Parliament for me personally and I was public about this I said the by rather book sell ten thousand copies and it influenced health policy than it sell a million and that not happened and you know I I did my best to make sure because I knew there would be a backlash to get you know establishment on board chair of the medical or colleges Sir Richard Thompson form present Royal College of Physicians chair the national BC form time David Haslam but that didn't stop and and you know the mayor of Manchester forum sector state so a lot a lot of very good people to help support this message of the change towards evidence for lifestyle intervention improving people's health and probably the most prominent man who you'll hear from tomorrow Tom Watson who I did not know personally but concept didn't divide Twitter and said by the way I seem I've read your book and it's done all this great stuff for me and he lost a hundred pounds in a year from essentially falling a low carbohydrate diet and that's all great I didn't you know there was a documentary in the Netherlands which showed just followed three people four four four twenty eight days one with type-2 diabetes the other two with metabolic syndrome the man with type two diabetes sent his type 2 diabetes into remission in 28 days from following the PRP diet and this documentary which was aired the book came out over there and then I got sent this car I was quite amused by this that it was number one in Holland for about five weeks then the Dutch nutrition council came in and and basically said that this was dangerous because we were promoting eating more than ten eggs a week apparently that's dangerous coconut oil causes heart attacks you know things like that it was all distortions and nonsense of course that that's a bit of a challenge to put up with I'm very happy to debate people in science but how do you debate people who are distorting things that you're saying and then I I was invited to various places including my local hospital to give a keynote lecture about sugar reduction and my role in sugar reduction and a PRP diet but the chief executive of public health England Duncan Selby called the chief executive of the hospital and essentially was warning her that they shouldn't be giving me a platform to speak and and certainly there should be no recommendation endorsement association with a PRP diet and the Sunday Times exposed this story which i think was a good thing just to make people aware that this was this this was happening and Tom Watson he said it was extraordinary that a government agency responsible for helping people to get healthy has tried to close down a respected cardiologist who just wants to make people well if they disagree with him debate with him but don't silence him I talked about this briefly last year I was gonna raise it again we've got I've got a few minutes left as to speak I'm just going to finish just really with where we're going what we need to do to really sort this problem out in our health care system Simon Chapman to remind you is a professor of public health in Sydney in Australia probably the most prominent person in getting smoking reduction policies introduced in Australia over 38 years and he talks about various things that needs to be you know you need to know as a public health advocate and one of the things he says is that you know a sunlight you know it can be a very potent antiseptic for mal odorous health policy okay and there is no greater sunlight than getting an issue major media attention and it's interesting I read this paper having done the kind of things that I've been involved with I kind of warmly already knew this but it was very interesting to read his personal journey of this but one of the things that I always think about and share with friends and and other people involved in this space many people here you know is that you have to grow an asura site because you know we are really coming up again two very powerful vested interests unless you're an advocate for an utterly controversial policy as soon as your work threatens in industry or ideological Cabell you will be attacked sometimes unrelentingly and viciously and this many people may be aware of this was a front-page story in The Guardian featured on the front page October 2018 I got an email from Sarah bosey the health editor that was doing an article unfortunately at the time that she sent me the email my mother was very sick and was dying at the time so I wasn't able to respond I don't know whether I would have responded anyway her questions were very loaded but essentially I was front and center of this piece with other people saying that I was a cholesterol denier and you know she was using quotes from people such as sorority Collins professor Colin beige at home and talked about in a second and so basically say that we were causing a lot of harm by questioning the role of cholesterol in heart disease and this became quite a prominent story gets worse mail on Sunday a couple of months ago very prominent story attacked myself Zooey Holcomb is here and Malcolm Kendrick said essentially we were spreading deadly propaganda about statins I what you've heard today is no different to what I've been writing about speaking about it's about transparent communication I'm not denying there's a role for statins but let's be honest with patients about their true benefits so this was written and they also said which is very interesting they use Matt Hancock the secretary for health as part of the story made the story a very prominent story who said that there is no room for people like us essentially who's spreading pernicious lies about statins in the NHS but what was really interesting he was only a few days earlier I had myself met Matt Hancock with David Onley one as well to discuss health policy and tackling obesity and I messaged Matt Hancock on Twitter directly after this story I said Matt did you know this was linked to me he said I seem I had no idea remember sunlight is a very potent disinfectant so the next thing that happened was I wrote two consecutive letters over a couple of weeks calling for retraction of Sarah Bozize article you can read it on lines a huge list of errors that she made do you know this dawson's essentially about what we were saying about statins and cholesterol and then a couple of weeks later I wrote to the editor of the melon Sunday calling for attraction and the the I newspaper reported on this which I was very pleased about that and you confirmed that this obviously had not happened a Melanson that Hancock had not known it and he was implying he would not have said it if he knew this was a link to me and he supports a lot of what I'm doing on in public health advocacy rollin on lifestyle and the editor of the chief of the BMJ couldn't get better than that edited about the Guardian article Fiona Godley said the debate about who should take statins is clearly still very much alive The Guardian article seemed to be a blatant attempt to suppress that debate by attempting to discredit those who questioned the merits of statins in people of low risk of heart disease the article was misleading and fell well short of the standards of act for accuracy or impartiality expected of a credible and trusted publication I believe it needs a very least a substantial correction now only a month ago only a month ago there was a big there was some headlines which I think went around the world that if you're over 75 taking statins saves about 8,000 lives a year okay was it based upon any evidence this was from Professor Colin Bajan who happens to be a colleague of Professor Rory Collins at the CTS you and sadly his own data didn't even say that you're not gonna live any longer that's all it was it was a he made it up okay so we're not even now in a situation where we're debating the science we've got these you know these vested interests that I don't know how why he made it up or where he got this from but his own data shows if you're over 75 without vascular disease there is no mortality benefit for taking a statin professor call Hennigan incentive evidence-based medicine Oxford has analyzed this himself and they pointed out that in that group by the way big caveat industry sponsored trials best case scenario there's a one in a 446 chance if you're elderly and by the way this is without talking about side-effects that you can benefit from preventing a non-fatal heart attack or stroke and no mortality benefit and interestingly very recently on the NT itself very interesting paper actually published in the British Journal of general practices showed that the overwhelming majority of patients at low risk of heart disease which is two-thirds of the 100 million people taking statins worldwide would not take a statin if they were told the absolute benefits and by the way this is without mentioning side-effects this is just on the earth small absolute benefit and many people in secondary prevention would also not take the statin so Tony Royal actually is not an isolated case he represents actually a would what would be a significant viewpoint and decision-making process for those patients even with heart disease but we have to be honest about that now where does it all come down to at the end of the day this is about shared decision-making you know if we want to improve quality care with patients then you know and improve the NHS and reduce costs inform decision making is an ethical decision making is the best one of the best ways to do that because actually when patients went fully informed most of them choose not to undergo an operation or sorry many of them which is not gone undergo an operation or take a medication and you know this was picked up this we publishers in the pharmaceutical Journal myself and professor Dame sue Bailey and it was picked up you know okay fine you know maybe a bit of a stretch in terms of the headline but you know making a point that you do not need to take medications essentially to be hot this is going to be through a lifestyle approach and you know I think the one thing to say here is yeah you know this is very challenging time but we do we really need a revolution in our healthcare it's not going to happen from evolution it needs a revolution I can't do this alone you can't do this alone you know but collectively we need to fight for our patients for the National Health Service to make our population healthier but it means we also need to make sure that we're not staying silent we need to shout about this problem we need we can't just do this you know sitting quietly I know many people here full of fully behind that and I'll finish with a quote from one of my inspirations that Mahatma Gandhi he said silence becomes cowardice when occasion demands speaking out the whole truth and acting accordingly and if we work together we will definitely revolutionize healthcare thank you very much [Applause]

Channel: Public Health Collaboration

Views: 18,722

Rating: 4.9163499 out of 5

Keywords: diabetes, diet, nutrition, health, public health, low carb, obesity

Id: DV9yQbNCE3E

Length: 38min 11sec (2291 seconds)

Published: Wed Sep 25 2019

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See also. https://youtu.be/z6IO2DZjOkY Dr Jason Fung on Financial Conflict of Interest and the end of evidence based medicine.