Too Much Medicine & The Great Statin Con - Dr Aseem Malhotra

[Music] our next speaker we've been we've been pretty close to the past few years and it all started off with a with a small meeting a lecture that Professor elastic Professor Robert Lustig was doing and from then on we've been weaving good friends and strong colleagues as well and he's such an inspirational guy the sticks to his guns knows the evidence inside and out and can have anybody bear to be an ambassador for this community it's doctorís Imahara [Applause] can you hear me at the back great well thank you Sam thank you everybody for coming making an effort what a great conference it's been hasn't it been fantastic and you know I want to take this opportunity because this could not have happened with all the hard work of Sam Felton so I think we've all [Applause] santé more serious matters Peter Bruckner just now he talks about the fact that he feels always felt at times to be ashamed of his profession and I empathize with Peter I have also felt the same and the reality is that the system has become so corrupted by vested interests that for me for on honest doctors can no longer practice honest medicine my father yesterday talked about national health services becoming a national illness service that's what it's become but how good is that illness service how good what are we doing for our patients how are we practicing the best way we possibly can practice medicine and I'm going to talk for the next 30 or 40 minutes on why I believe that we're not doing that and why we could do a lot better just to start I think it's important there's one slide just a try and you know we are we are here to try and practice evidence-based medicine David Sackett is considered probably the father of evidence-based medicine and this triad I think is crucial to for us to think about as we move forward are we actually fulfilling these components so individual clinical expertise when a patient comes in best available clinical external evidence and are we acknowledged in patients values and expectations if we do all of these feet together then we can have improved patient outcomes but the reality is we now have an epidemic of misinformed doctors and misinformed misled and unwittingly harmed patients and there are a number of factors behind this this is because of biased funding of research so research that's funded because it's likely to be profitable not because it benefits patients by its reporting in medical journals bias pain patient pamphlets bias reporting the media commercial conflicts of interest defensive medicine and last but not least is medical curricula that failed to teach doctors how to comprehend and communicate health statistics this is giving an example about financial interests so culture to do more so the system has within it a culture where there is an in financial incentive to carry out more investigations and procedures and that can often put profits before patients one extreme example in the United States one of us cardiologists was jailed for ordering nineteen million dollars worth of unnecessary investigations of procedures is this - sir tip of the iceberg absolutely yes in America they have a fee-for-service model that contributes to overuse in the UK it's not to the same level or extreme but certainly there is a similar fashion because we have something called payment by activity which is basically so repent by results which ultimately translates into payment by activity just to give you an example in the states is estimated because of unnecessary coronary stenting so this is putting heart stents into people with stable heart disease estimated to cost unnecessary scenting estimated to cost us healthcare around 2.4 billion dollars a year but what makes it worse is the fact that we have a very large accepted body of evidence from randomized control trials they're putting a stent in a patient to prevent a heart attack actually doesn't improve prognosis it doesn't prevent a heart attack or prolong life but 88% of patients undergoing the procedure thought they were having it done for that very purpose I trained as an interventional cardiologist I've done thousands of angiograms hundreds of angioplasties and you know I have when the evidence became apparent I did my best obviously and I will always do my best to tell patients the truth but that the reality is it doesn't happen it's not explicit as often as it should and perhaps more disturbing these 43 percent of cardiologists when anonymously asked said they would still go ahead and do the procedure even if they felt it wouldn't benefit the patient and obviously there are other drivers as well new technology comes in doctors get excited about using new technology that is stents for example and then obviously there's the asymmetry of information about what the docs are knows and what they translate to the patient so a few years ago in 2013 and early 2014 there were two editorials I wrote one was in the British Medical Journal initially and then later on in JAMA internal medicine and the first one in the BMJ I alluded to the fact that no demographic or individual was immune to this misinformation in fact the the article I started in the BMJ was pegged upon the fact that the ex president george w bush had been reported in the state to receive a coronary stent despite the fact he'd cycle 100 miles a week before there was no report of him having any symptoms and what was reported was essentially went for a routine check and then with a heart stent now I don't know the specific details about what happened but my guess is it was very unlikely that the ex-president was told it was not going to benefit him in terms of preventing a heart attack or prolonging life a few months later I wrote a similar editorial about some new technology being brought in being invited to write by Rita red Berg the editor abdominal medicine in that Journal that was press release and made some news headlines and picked up by the BBC here and I basically said that you know this procedure carries a risk and we should just tell patients the truth there was a little bit of a backlash to British cardiovascular intervention society were quoted in the BBC news story saying there's no evidence of inappropriate procedures going on in the UK and the issues I raised were the one the way to combat this over treatment and potential harm is make it mandatory on the consent form when we consent patients for the procedure we have to tell them there's a risk but we don't tell them the true benefits or lack of benefits and what that would do is it would encourage a more informed decision-making process reduce anxiety and also it could encourage conversations about other things patients can do which is what I do when I speak to my patients in terms of lifestyle changes you've got a stable plaque in the and the artery it's not going to necessarily cause a heart attack there are medications that help lifestyle change it's probably more effective we can encourage a sort conversation I do it all the time it does not take long and it does not take long to tell patients that stents don't improve prognosis in stable disease the other aspects as well which can't be ignored is the procedure itself for me off top we have to tell patients this carries a 1 in 100 chance that it will cause a heart attack stroke or death and in my career and I've assisted in thousands and done many myself I have seen patients you know when you do so many procedures you see a complications happen who have died on the table overall had a stroke who if they were told the actual truth before they underwent the procedure may have made a decision not to undergo the procedure and would probably still be alive today so when I made this when I wrote central and John shown medicine there was a little bit of press around it and then you know there was this question about no evidence of inappropriate or no evidence that telling patients this will make a difference what I didn't predict was actually a few months later JAMA internal medicine carried out their own study and they actually put this scenario to patients see would it change the decision-making process and it did when you told patients there was a lack of prognostic benefit instead of about 70% of them elected to have the procedure it got reduced to forty five point seven percent and they calculated across US healthcare if every cardiologist had this conversation with their patient which I said is free doesn't take very long it would save us healthcare 864 million dollars a year just from this looking at the bigger picture about modern medicine more medicine is definitely not necessarily better so Jack Wennberg who's a research in the States has done a lot of work in this area basically found out from his own study that in areas of the United States where there was more medical care more expensive care actually there was actually worse mortality outcomes and we know that and there were a number of factors behind this and we know for example if you compare the NHS to to the US you know they spent more than twice their the GDP we do on healthcare it's about four point two trillion dollars a year that's spending how can you in the u.s. yet they have worse outcomes for health so it's quite obvious that too much medicine is causing a problem it's a wasteful and it's also harmful and there's also an issue of ethical considerations at end-of-life care so in America you know in terms of end-of-life care of almost two million elderly beneficiaries who died in 2008 of fee-for-service Medicare 30% when an invasive surgical procedure in their year before death almost 20 percent in the last month of life and a percent undergoing a procedure in the last week of life now is this ethical are we practicing ethical medicine you know it's and it's something we need a discussion it's a cultural problem and I think is about individuals to blame and pointing fingers it's a it's a system failure and what Jack Wennberg concludes in his research he says getting beyond the more medicine is better assumption will require national debate on the limitation of medicines power to heal and cure and more of a discussion on the quality of care at the end of life okay doctors misunderstanding of health statistics as well as a big problem so just to give you one example many doctors actually do not understand health statistics and therefore cannot evaluate evidence for and against the treatment so in a study 150 consultant Gynaecologists a third of those did not actually know the meaning of a 25 percent risk reduction created by mammography screening most of those third believed that if all women were screened 25% or 250 out of 1000 would less would die of breast cancer the reality from a Cochrane review is actually you have to screen 2,000 women to save one life it's a big difference there and a smaller study a few years later after the Cochrane review not a single person who was surveyed a consultant gynecologist was actually wherever the harms so for every one person that you saved from screening 2010 women will receive an over treatment either an operation or a drug they didn't need now what's the solution to this the solution is here why not have that transparent open conversation with the patient and help them make the decision patient might come back and say listen I'll actually decide I don't want to have a screening somebody may say I've got a lot of fear about it I'd rather go for it but at least have that conversation with the patient that's not happening and in my view that's completely unethical so there are many ways of presenting statistics so a little bit of a kind of a short lesson here it's actually much simpler than we think so it can either be relative risk absolute risk or NNT so communicating relative risks as opposed to absolute risk or the numbers needed Street can lead lay people and doctors to overestimate the benefit of medical interventions so let me give you an example based upon published research industry-sponsored randomized control trial data on using the tool status in ten milligrams in type 2 diabetes patients if they take that drug every day for four years you can say to the patient there's a 48% relative risk reduction in you taking this statin in you having a stroke that's almost a 10/10 what does it actually what what's the more transparent way of actually interpreting that and having that discussion well the reality is if you look at that RCT data from where that's come from what happened was instead of twenty eight and a thousand people having a stroke fifteen and a thousand did from taking a talk stand ten so an absolute risk reduction of one point three percent or another way of saying this is an NT of one in seventy seven so the other way of having this conversation with patients which is what I do when I can when I've got information available to me is saying okay if you take the statin ten milligrams every day for the next four years there's a one in seventy seven chance it will delay or prevent you having a stroke how different is that to forty eight percent relative risk reduction it's completely it's so now it's not just an abstract thought the misinformation goes all the way to established and reputed reputed medical journals so mismatch framing and medical journals also makes this situation worse so if treatment a would use the risk of developing disease from ten to seven in a thousand but increases the risk of the harm of disease B occurring from seven to ten in a thousand the Medical Journal article report the benefits as a relative risk reduction of 30% but the harm is 0.3% absolute risk one third of all medical journal articles published in the lancet the BMJ but and Jarmo between 2004 and 2006 actually is mismatched framing in a reporting of the results and doesn't take a rocket scientist to work out obviously that's going to lay and that's going to lead people to feel there's an exaggerated benefit and there's a minimization of harms so don't just take my word for this the the man who's probably considered the world leading research on health literacy GERD gigerenzer in a bulletin that you can see online you can go to it really available in 2009 a World Health Organization bulletin says it is an ethical imperative that every doctor and patient understand the difference between absent relative risk to protect patients against unnecessary anxiety manipulation so in other words I would argue that unless you have this conversation with the patient we are practicing on ethical medicine we're also using bias information to make clinical decisions which I'm going to come onto next and therefore it makes it very difficult for us to truly practice ethical medicine let me give you a case study and this is where one of a journey for me on the whole statins controversy I'm about to come on to an excellent show a lot of you are very interested in started so give me an example 49 year old man comes into outpatients having had a stent emergency stent in for our dessert which is life-saving and he basically reports disabling chest pain which was atypical it wasn't typical of what we think his cardiac it's didn't think you know when he when he saw when he saw me he didn't you know it didn't sound like it was cardiac I discuss it with my colleague our specialist registrar at the time with my consultant we made sure obviously there's no acute problem no heart attack happening but just to be on the safe side let's repeat the angiogram okay let's just have a look and make sure the stents not blocked off or there's no new blockage angiogram go takes place stents fine everything's fine he's on the table I do the angiogram but doc what's causing my pain I'm reassured there's no new blockage typical you know reaction often is over this could be something else it could be a bit of acid reflux giving you the chest pain here's a proton pump inhibitor okay off you go to your GP will see you in clinic and I'll write to GP and your GP can follow you up and see what's going on patients reassured comes back with a review in six weeks and he comes back in and at this point he's now also got muscle pains but the pain is still there in his chest he's very is actually very depressed with it the GP can't get to the bottom of it either and is now referred him for an endoscopy and upper GI endoscopy a camera to look look at the esophagus and see whether it's an ulcer or something else so I speak to my colleague again and he said to me said it seemed you know this could be a long shot but I have come across patients occasionally the get chest pain above the muscle aches as well it could be the statin so we make a decision okay well I chat to the patient say listen why don't you just stop your statin for a couple of weeks and let's see what happens if the statins causing the side-effect you'll get better if not then just go back on the statin so he's a advice to stop the stats and he's now in outpatients you can't see the patient much more quickly obviously GP can look after him so he's got an appointment to come back another three months but he actually turns up a week later uninvited comes he knows I'm in the clinic locks on the door he's elated Thank You Doc's he's been depressed for months because of this disabling pain after months of misery my pain has disappeared but now I'm worried my GP said you must never stop your statin or you could die now what do you think is risk of death from stopping a statin is for two weeks someone who's got established heart disease had a heart attack if we accept this benefit there which I'll come on to a little bit more later what do you think a risk of death is from stopping Stein for two weeks any guesses zero okay somebody knows something I don't obviously it's very it's very small best worst case scenario one in ten thousand maybe okay so but again you know the misinformation there I'm sure the GP felt genuinely that this is this was potential harm but but no so he's better okay so let's move on October 2013 myself and John Abramson from Harvard published two articles in the British Medical Journal now the BMJ John Abramson and colleagues in Harvard had done a reanalysis of the published data on statins in low risk to assess what the true benefits were based upon already published data on people at low risk of heart disease with a 10% risk of cardiovascular disease in the next ten years taking a statin and what they concluded from their analysis was basically that statins do not prevent death or serious illness if you're in that category there's a one in a hundred forty chance 140 chance that taking a statin every day for five years will prevent a non-fatal heart attack or stroke non-fatal but what he also said is a risk of potential harm as well as we now know there's about one in a hundred chance if not slightly more of type 2 diabetes developing from taking a statin he had written and actually we both cited the same observational study the around one in five or twenty percent of people taking a statin will have side effects that include muscle symptoms muscle pain cataracts a liver information all that kind of thing I had written an article in the BMJ which made a lot of news headlines around the world it's quite overwhelming because the BMJ press release my editorial but not John Abramson's I'd said something similar about statins we've edited millions of people I said we need to be discussing numbers needed to treat be more transparent with patients this this article was mainly focused however on the fact that we we've overly focused on saturated fat as a cause of heart disease and we should be placing the blame on sugar and that was really the main headline but I had also cited by coincidence exactly the same study that Jon Abramson had cited about statin side-effects and said about one in five will have unacceptable side effects unacceptable not to the doctor unacceptable to the patient because that's what's most important so this got a lot of press coverage as you probably aware October 2013 and leading up to March 2014 professor Sir Rory Collins of Oxford considered probably the leading statin researcher or one of the leading statin researchers in the world had actually contacted the editor of the BMJ I was made aware of this and he basically had asked for both our articles to be retracted because of our our claims on statin side effects were not evidence-based and the editor of the BMJ Fiona Godley had quite correctly said well listen we're very happy to publish your critique most people don't get the opportunity we will publish it in our journal publish a full critique and then you know well that's that this debate continued for some reason professor Rory Collins didn't want to do that he just kept saying retract retract retract so any emails to Professor to dr. godly so this was ongoing in the meantime you know there was a rapid response in the BMJ and and actually when we look back at that paper there was a few caveats perhaps we should have mentioned but really you know it was a distraction in my view so the study that we cited looked at over a hundred thousand people in the community who would prescribe statins by their family practitioner and 17.4% in the notes had documented that they'd stop their statin because of side effects there was over there was a considerable number maybe about thirty percent who had not gone and seen their doctor and stopped the statins who don't know and a lot of patients within that one year period had to either change a statin a gun buck and a lower dose and we only know up to about one year but this was what was taken out proportion and we made that correction or caveat you can judge for yourself whether you think we'd exaggerated considerably and we're going to move on a little bit more and you make your own conclusions in in a few minutes but basically that's what he was having an argument about so we made those Corrections made those caveats but that wasn't good enough for professor Collins so in March 2014 the front page of The Guardian I get a phone call from Sara Bosley the health editor the guide in a few days before this made front-page news as well as a BBC and this was a quote that was written in The Guardian newspaper in March 2014 calling for retraction and basically suggesting that what me and Abramson had written would could cause considerable harm far worse than the MMR scare by Andrew Wakefield okay and this is what was quoted he said they want only one or two well-documented problematic side effects from statins myopathy and muscle weakness occurs in 1 in 10,000 people and there's a small increased increased risk in diabetes ok statin controversy continues so while all this was going on it's called for retraction myself and a number of prominent doctors wrote a letter to the secretary for health so it's included the then president of the Royal College of Physicians - Richard Thompson there's also the Queen's doctor for 21 years personal physician to the Queen Chair the Royal College of General Practitioners and basically we wrote that what had actually happened in the interim is nice had come out with a guidance to say that we should now be prescribing statins in essence GP should be financially incentivized to give statins to people at low risk of heart disease after all of this was happening about this whole you know that even though and in what's interesting professor Collins did not challenge the claim that was made by Abramson that there was no decrease in mortality based upon his analysis that wasn't challenged it was all about the side effects issue so we wrote a kind of letter of protest which got widely publicized and we made a few points you can look that up online if you want to look in more detail but these are the issues that we had with a nice guidance most of the people in the guideline panel had direct financial or institutional ties with the drug companies that produce statins the side effects will not take into account the issue about type 2 diabetes if you're going to basically subject millions more people in the population to taking statins increased GP appointments as well cholesterol check coming back I mean systems ordering a lot of pressure and now we're prescribing a statin with a financial incentive attached to it that's only gonna make situation worse is what we felt as a group of doctors and we still don't have access to the raw data you know this is this is a drug that's been prescribed for what thirty years hundreds of millions of pounds of research funding gone to various institutions including Oxford University to fund this to fund this research and we they hold on to the raw data and they're lots of questions being asked we don't have access to it again what happened only very shortly after the General Practitioners committee also took heed and they said that actually in light of the fact that we when we got access to raw data on Tamiflu which was a drug that we spent you know considerable amount of money hundreds of millions on stockpiling to basically for a flu outbreak which we then found out actually wasn't that beneficial when they reanalyze the data they were able to get access to the raw data until we have access to the raw data GP said GP c said from statins then we asked nice to refrain from recommending a reduction to the current treatment threshold until we have access to the raw data the articles editor of BM j fiona gaudy then sent both articles she said there was a lot of media attention around it okay let's send this for an independent review because we haven't she was very honest and a respect will fall off a lot for that she said we have a vested interest because we publish these articles by Abramson and Malhotra and therefore we're going to send it to an independent review and it went for an independent review in a sense myself enables some more on trial for about two months but actually in that two months I was still helping and coordinating this letter tonight because I knew there was something not right going on here this was this is a distraction this is trying to silence critics they wanted to shut us down and as far as I'm concerned I could see very clearly that's what was happening that's what I thought was going on and we came back there was six nil in our favor in dependent review no need for retraction okay [Applause] so this was time to start actually where we going to sit back and keep quiet now we were scared we don't know push this any further note absolutely not now around the time of the BMJ Pete pace that was published in October 2013 what was very interesting by complete coincidence a lot of you will be aware of this in Australia there were two programs that happened in conjunction by an investigative science journalist called Marion Demasi and they were called heart of the matter one was about saturated fat and cholesterol and heart disease easier than one was about statins and there was a lot of overlap and similarities with what both myself Abram and Abram Stern had written in the BMJ Amundsen was actually featured in one of these in one of these documentaries I got a lot of attention in Australia and around the time of that going out at the same time as our pieces there was a reaction from some of the establishment figures I won't name them individually you can look it up if you like to but basically suggesting that as a result similar to what Professor Collins had suggested as a result of the scare mongering about stand side effects you know people will die many people may die stop there statins you know high risk patients etc and in June 2015 Sumerian Demasi actually you know they what end up happening was they end up retracting one of her documentaries not because of any factual inaccuracies because you know that the industry and various vested interests had really put pressure on the ABC and they said there was too much bias in favor of our view versus the industry view and they end up getting retract see there was no ground for retraction everything was factually correct in that her documentary so it's really quite scandalous in my view that happened anyway so this gots retracted things move on a ABC in Australia aware of what's going on in the UK and the fact that we're winning a battle over here about transparency and about the fact there is a backlash from certain sections of the medical profession establishment figures respected figures saying that this is a wrong wrong approach and they then commissioned another documentary which obviously you know didn't happen and a few days before Marian de Massey was due to come over and interview various people in the UK the Medical Journal of Australia the the number-one medical journal over there put out a press release and a paper and they concluded from this paper as a result of the documentary in Australia up to two thousand nine hundred people in Australia may have suffered a heart attack or died as a result of stopping their statin guess what this was all extrapolations there was not evidence from any registry data no noise that you see in hospital admissions or anything of a single person suffering a heart attack or dying and stopping the stands because of this and even if there was very difficult to prove that it was because of media scare stories what else is going on but there still wasn't a single wasn't in an anecdote and something similar happened here and I was predicting this I thought this is going to happen here there are people are going to try and put some user medical journal you know often a marketing vehicle really that's what the reality is medical journals are often just marketing vehicles for the pharmaceutical industry be no under no illusion the landset are very culpable of this to be under an illusion this is this is actually the reality but anyway I predicted this was happen over here and actually this is what happened as well over here they predicted all these thousands of people may be dying etc there isn't evidence of a single antidote now in cardiology circles everybody talks so you always hear a story of something and want to cardiology circles believe me I would be the first person to hear about it if that happened I haven't heard anything now that isn't to say we should stop taking statins but you know let's use evidence here let's have a more transparent it's a distraction from actually having an honest and open discussion with patients in my view what's interesting is a month before the Medical Journal of Australia put this press release out its editor-in-chief was sacked for objecting to more commercial influence over the journal professor Stephen leader I spoke to him as well and clarified over all of this not only was he sacked what they didn't expect the board is that 17 out of 20 members of his editorial team after he was sacked resigned in protest now this should have been the main headline news in Australia but it was published in Sydney Morning Herald and you could read if you look it online this is a major issue this is a major issue this was not discussed in mass media which it should have been so I've always argued the case about the issue about statins in low risk and that's where I think the evidence saw the discussion should be more transparent I've handed out statins like Smarties and some degreased have still done for many years because I've treated thousands of people in my career with heart is and heart attacks and on Ward rounds you go around you put them on hydro statins and you basically tell them that you know this is a life-saving drug you don't talk about side-effects that rarely happens I still don't do that I only look for if they come back in with problems but we prescribe patients as this is a life-saving drug now Michelle DeLozier ill is a very reputed cardiologist in grenoble in France he was actually the lead researcher behind the Leon Heart Study he's also a nutritionist as well and this was really quite extraordinary and he wrote a paper in January 2016 and he put all the statin trials together look for various discrepancies how can you know he's understanding how data can be how should I put it massaged to look more impressive etc and his conclusion and he was very open about this is that he felt the evidence from the all the statin made major statin trials he believed that actually even in secondary prevention people may not benefit now I don't I'm not saying this but I think it's really quite extraordinary that somebody like him has come out and he has no vested interest in this to actually say he believes that the current claims about the actual true efficacy benefits not side effects and side effects of statins is not evidence-based Richard Thompson in response to to all of this as well what was going on in terms of the way Mary Ann Demasi had been really silenced and attacked over in Australia he actually supported her and he said that we need an independent inquiry because the situation has actually gone to such an extreme level especially around the impartiality of so-called medical experts that are funded by the pharmaceutical industry who have a lot of influence and power now let's just take a step back for a second Peter will first is as a cardiologist to I'm done all the work over a number of years who has have brought people to justice soon in the medical profession and reported a lot of doctors to the GMC for things like research misconduct a very brave man and he actually started off his career working with the pharmaceutical industry and realizing when one drug company tried to bribe him for not publishing results that showed harm about one of the drugs that he had been researching and he basically his career has really revolved around this and great transparency and he who gives a talk in the center of evidence-based medicine Oxford 2014 and he makes some very cold hard truths I think we should always just think about now as we move forward because we have to change the system and he says one farms all companies and medical device companies have a an a fiduciary comp obligation to shareholders to make a profit and make it and make a shareholder dividend but they're actually not required legally to sell consumers the best treatment although most of us would believe this to want this to be the case because the real scandals he says and I agree with him on this is that regulators failed to prevent misconduct by industry and their doctors institutions and medical journals that have responsibilities to patients and scientific integrity collude with industry for financial gain you see the only ones got concerns about this well let's talk about innovation which all these new drugs coming on you hear all the headlines some new drug coming you know new advances in heart disease treatment etc of the 667 new drugs that were approved by the FDA between 2000 2008 only 11% of them are truly innovative 75% were essentially copies of old once so drug companies change a few molecules here and there with the drug they paitent it people work out a little bit later on that actually is no better than the previous drug but they've spent a lot more money on it and the cycle continues and that's a problem and that's not surprising I mean there are there's also evidence to suggest that actually in some respects drug companies spell it spend almost even 19 times more on marketing than they do on research and development so when the financial model is like this how are we going to get new blockbuster great drugs if the system actually this perpetuates this this issue again this forget you know come back from to what Michele DeLozier and Peter Walter so this quote is from Marcia Angell former editor of New Zealand medicine says it's no longer possible to trust much of the clinical research that is published all rely on the judgment of trusted physicians or authoritative medical guidelines and I take no pleasure in this conclusion which I reached slowly and reluctantly over my two decades is editor of the number one impact medical journal in the world Richard Horton himself editor of The Lancet in 2015 in an offline editorial actually responding to a meeting he'd attended with some senior research scientist said possibly half the published literature is untrue from what they told him and obviously the lots of recent scandals as well that the format is of the BMJ reported and wrote an article and he was in a conference where he basically asked the audience of researchers how many of you are aware research misconduct going on have gone on in your own department or institution and a third to a half put their hand up he said how many of you have reported it all of them put their hand down okay let's move on a little bit so just going back to statins I think there are a lot of questions that need to be answered about side-effects I'm just going to state some facts so the lot its largest statin survey in the US which looks over 10,000 people found it in the community people prescribe statins this is before media hype so before so-called media scare mongering almost 75 percent of people who have prescribe statins it within a year stop them and side effects was the leading reason that they cited in America and 60 percent of them actually said it was because of side effects and three out of ten of those respondents said they experienced side effects and 34 percent of those will stop taking statin because without consulting their doctor so there's a lot that just feel afraid of going back to doctors saying I've stopped my statin you told me this is a miracle drug this will save my life you understand why doctor a patient might be a little bit anxious about having that conversation with a pet with their doctor they've stopped their statin statin controversy continues Sunday Times investigation September last year find something very interesting so we know professor Collins who's read learned a lot the research in Oxford had actually published a paper in The Lancet to you know again try and give bring more clarity to the statins issue and said that not more than 1 in 50 now will suffer side-effects I talked about muscle pain according to their review what Sunday Times had written is that you know professor Collins who believes millions more Britain should benefit by taking statins is also a co-inventor of a test that indicates a susceptibility to muscle pain okay interesting the test that was branded started smart was directly sold to the consumer in the United States with boss and heart Diagnostics who whether they have licence for it for $99 under the claim on the website twin 89% of statin users will suffer muscle pain weakness or cramps okay royalties of the license to the painting can be fund University can be used to fund real university research but Collins and his co inventors have waive personal fees okay Boston Heart diagnosis in this control see when the Sunday Times doing this investigation they actually stood by their claims because per circle and said this this was misleading this 29% figure and they actually said that a u.s. Task Force on statin safety had concluded that randomized control trials such as those using The Lancet study led by Collins had major limitations because patients were statin intolerance were often excluded okay so what do we know there's a patent for whatever reason you may have a good explanation for this this is evented several years ago okay by professor Collins on a test that tests for a gene that tells you whether you like to get muscle pain from statins apparently statin side-effects so don't even exist so I don't understand what that's what's going on there and money has obviously gone to talk to university so with permission John edgar Thomas investigative chief reporter for Sunday Times has allowed me to use this next slide to show you the in an FOI request to Oxford University the Oxford University has received a total of three hundred sixty nine thousand seven hundred seventy two pound seventy four pence from the sale of this testing kit and thus ETSU has received one hundred twenty six thousand pounds including ninety six thousand they would have okay now I find this very puzzling very very puzzling okay let's move on so we've got some obviously concerns and questions that need to be answered too much medicine is a problem I'm pleased to share the the Academy medical world colleges that represents essentially most oxygen UK also believe it's a problem and they've started a campaign called choosing wisely to wind back the harms of too much medicine I wrote a paper analysis paper in the BMJ along with now who's the current chair of the GMC Terence Stevenson in the chair of the medical real colleges Dame sue Bailey professor Dame sue Bailey to say that we RIBA leave this is a real problem in in in UK health care we need to do something about it to reduce the harms of too much medicine I'll just move on because time is short and I think one of the things that the medical world colleges say as well thinking about the big bigger picture is that we have an ethical responsibility as doctors to reduce waste of in resources because in you know in this in this finite Health Corps a healthcare resource system one doctors waste is another patients delay and we've made some call to actions and next steps to encourage also doctors and patients to have more transparent communication with patients to reduce harms and also to discuss you know other simpler safer options when they come in with certain chronic diseases whether it's type 2 diabetes or high blood pressure and specifically that's going to be lifestyle changes okay just almost getting to the end now just to put things in perspective a little bit about numbers easier to treat for common treatments for heart disease I'm a cardiologist so just looking at death if you take aspirin every day for five years and you've had a heart attack there's a one in a hundred chance taking an aspirin will prevent or delay or save your life for statins based upon the published research if you if you're somebody in the clinical trial who it is - a statin every day for five years obviously doesn't have side effects in that group selected group of people there's a one in eighty three chance that it will save your life will delay your death if you take a statin if you've had a heart attack so these are people who have had heart attacks or heart disease Aspen and Saturn's at low risk no benefit in terms of mortality not going to live one day longer stents during a heart attack emergency procedure one in 40 chance stents at any other time you know now that will not reduce your prolong your life but based upon a no is limited information but based upon our CT data that we do have the most powerful Cori intervention tool in secondary prevention is the Mediterranean diet with an NNC of 30 and interestingly this trial which was done by Michelle DeLozier early on heart study compared the Mediterranean diet with a standard American Heart Association low-fat diet which is actually still probably much healthier diet than what a lot of people are consuming in terms of processed food so that benefit was comparison to still quite a healthy diet and showed her NNT of 30 but most people don't know this and this is part of the problem this is a lack of transparency in the system and we can only prove quality in health care when we have more transparency and where everybody knows a patient the doctor the nurse the health care system they're putting a stent in for stable disease is not going to belong but adopting a Mediterranean diet will probably do that so until we get this we cannot we can't have proper quality care now briefly just to move on this is the other bigger issue okay we have you know we have too much medicine at the same time we probably detracted from more important lifestyle changes and we have a major health care public health care crisis with obesity the cost of which are pretty astronomical type 2 diabetes itself is costing a lot more twenty billion to the economy due to lost productivity and NHS care from type 2 diabetes that's set to 40 billion pounds by 2035 if we fail to act but it doesn't matter because you know you can take a statin of course there's no matter what you eat this is not just a joke I know cardiologists and doctors who actually believe this one cardiologists I know who I respects a lot actually said very honestly he says if you can't be bothered to do exercise like me you can take a statin honestly but people actually generally believe that doctors believe that this is part of the problem but this is not evidence based at all this is complete nonsense it's unscientific nonsense ok processed food environment definitely is probably one of the major risk factors behind why we have this problem I think we sort the processed food environment out we will be of much further on you know it's very difficult to avoid wherever you go whether the high street even health clubs and gyms you go to the petrol station cheap sugary processed food is everywhere and because it becomes very difficult to avoid eating those when you've got just such a an avalanche if you like of processed food and it limits our ability make healthy choices now for me the biggest scandal where my journey began on my campaign to try and help tackle this obesity epidemic is the fact that we've even allowed our hospitals to become a branding opportunity for the junk food industry and for me when I started my journey I'd done an emergency stent in the middle of night on a 50 year old chap next morning I'm talking to him during the ward round about a healthy diet stopping smoking he gets served a burger and chips while I'm talking about this and he says doc how do you expect to change my lifestyle were you also serving me the same crap that brought me here in the first place bit of perspective poor diet now contributes to more disease and death than physical inactivity smoking and alcohol combined so really the the hierarchy in terms of where we should be focusing on if we're going to overcome this problem is going to be diet diet diet all the other things exercise of course is very important but in terms of obesity and rare diseases the biggest problem is gonna be poor diet but what constitutes our poor diets I've also been on an interesting journey of research and a lot of people that are here today you know that have also been part of this this movement and revolution if you like whether it's zoe who has not here right now and jason fong and andreas have all been part of this Sam or all of you coming together and sharing knowledge and information you know basically end up taking me and Donal O'Neil who produce serial killers to the original village where Ancel Keys conducted his research now this village in southern Italy has a lot of still has an average life expectancy for male and females of 90 years old and we went there to try and we made a film some of you may have seen call the big fat fix and we went there to try and look at what were the secrets from this village where an silkie spent a lot of time there have been forgotten or lost how does that tie in with what we know about independent scientific evidence around type 2 diabetes and carbohydrate intolerance etc so we made this film and in the next couple of weeks I'm pleased to announce that a book based him on this film is coming out and it's called the PRP diets and be out on June the 29th and what it does is it brings everything together in terms of the science and really produces a 21-day plan if you like to concentrate on health primarily but as a side effect it will also help obesity and many things that you're aware of already I'm preaching to the converted here saturated fat doesn't not clog the arteries who explain why that is eating fat does not make you fat and I think last but not least one more most importantly dietary changes are more powerful than any drug both for preventing and treating heart disease and type 2 diabetes now Christian Barnard perhaps regretfully towards the end of his career the pining heart transplant surgeon said I've saved the lives of 150 people with heart transplantation if I'd focus on preventive medicine earlier I would have saved 150 million turns out the PRP diets lifestyle is that medicine thank you very much [Applause] [Applause] [Music]

Channel: Public Health Collaboration

Views: 111,384

Rating: 4.882122 out of 5

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

Id: mAoTwfx1Sic

Length: 46min 17sec (2777 seconds)

Published: Sun Dec 31 2017