Aseem Malhotra: Lessons in Public Health Advocacy
Articles,  Blog

Aseem Malhotra: Lessons in Public Health Advocacy

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


  • pleiades

    What is a stone in lbs. I started eating once a day without any carbs including fruits and I lost one stone or 14 lbs. No pasta, rice, breads, grains and legumes.

  • Morgan Cuff

    I came to learn more about health not to have some non-American take a cheap shot against our president (like Trump or not).

  • Malcolm Achtman

    I watched a video some time ago where Dr. Thomas Dayspring said we need not worry unless LDL is above 200. Now, Dr. Aseem shows us we don't have to worry unless LDL is over 300. Bottom Line I guess is when it comes to heart disease, LDL isn't the culprit your doctor and cardiologist make it out to be.

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