So first of all, tell me about your background. How did you first get interested in science?
Ever since I was at school, I was better at sciences than technology or art or music.
And so I was that way inclined. And I did maths, biology, chemistry and history at A-level.
So in the anomaly of history, I ended up in medical school here in Oxford.
Hmm. And so were you thinking of being a doctor at that stage up till the age of 16?
I hadn't really thought much about it. And then beyond then, there didn't seem to be much else that I could do.
I did work experience in a nursing home.
I really liked it. Social work has always seemed appealing, but less effectual than medical work, such that it can improve someone's quality of life.
And did you have medical people in the family? No. No. And surprisingly, for an only child of two Bengali Asian parents.
Neither of my parents were medical. No one in my family was medical, and both of my parents were mildly resistant to me doing medicine.
That logic had been that most of the doctors they knew, having come to England in the sixties and seventies had at least had one period of depression,
and they didn't want their only son to go down a pressured field that might impact that way on me.
I have said to others, It seems that that was unexpected for me when I made my career choice,
that neither my parents would be delighted that I made it.
So you came and did your medical studies here at Oxford, but at some point you got interested in research?
Yes, that was partly playing the system.
So I came I did medicine here in Oxford, like many doctors who qualify from Oxford.
I then went to London to do my back. Then it was called Senior House Officer Jobs in the US.
It would be called internships and early training residency.
I loved my time in London and decided I want to do cardiology and internal medicine and was lucky
enough to get a place on a registrar training programme to train in cardiology and internal medicine.
After a couple of years I wanted to get married and my wife was a haematology trainee.
She's now a haematologist here and I wanted to go on honeymoon to Costa Rica for three weeks.
Perversely, the only way you can get a three week period of holiday from the NHS is to fill out a series of papers for an out of programme experience.
And it is easier to get three years off to do a PhD than it is to get three weeks off to go on honeymoon.
So I ended up filing for a PhD with very little actual interest in doing a PhD, but mainly to facilitate a trip to Costa Rica.
I got the period off. I managed to win British Heart Foundation funding for a PhD, and so I managed to have my cake and eat it, as it were.
That's the most strategic reason for doing a book.
Well, I'm still married, so seems to have had some fruit, so it kind of worked out.
So where did you do the picture and what is it you came here to?
It's one of those things I say now to people considering a Ph.D., many people will come into an interview and say,
You know, I've always been interested in diet dilated cardiomyopathy since I was 12.
I kind of look at them and I share this story with anyone.
One can be honest and say, you know, there's more to life than just the genetics of dilated cardiomyopathy.
And at the same time be highly successful in researching dilated cardiomyopathy.
Was that what you did? You know, I did my Ph.D. on basically whatever was on offer.
And what was on offer at the time was cardiac MRI to discover whether or not obese people or people with excess body
weight accumulated fat in their heart muscle and whether that fat impaired the function of their heart muscle.
We knew at that stage this is back in 2008 that if you accumulated fat in your liver effectively for growing yourself,
some people would get inflammation and subsequent serious liver disease.
And the hypothesis was, did this also happen in the heart?
If you accumulated fat in your heart, would some people develop very bad heart disease as a consequence?
And in some ways, it turned out to be a negative study because it turns out that you do accumulate some extra fats in your heart,
but it's not massively relevant or active.
And so if you look at my Ph.D. from the perspective of what did I attempt to show and did I show it,
I showed that big people accumulate a little bit of extra fat in their heart, but it doesn't really matter.
When I tried to explain this to my grandmother, who knew that the some of the funding involved was about half million dollars, she's now passed on.
But back then she really couldn't understand why people thought the British education system was so much more advanced than rural India.
When she repeated to me. So you're spending three years trying to find out if fat people have more fat in their heart, I'd say, yeah.
So that you weren't involved with biometric.
Oh, yes, you were. So that was that. It was biomedical engineering.
A thing at that stage had didn't no, I didn't know what biomedical engineering was, nor at that stage I had come to do a PhD in cardiac imaging.
And it had, apart from my number one goal, which was the trip to Costa Rica, I had to use this to me.
One, if you wanted to get a hospital consultant job in a teaching hospital,
it's useful to have a Ph.D. or an M.D. and obviously one from Oxford is more valuable perhaps than from other institutions.
Secondly, it provided the opportunity to have excellent training in cardiac MRI,
for which Oxford is probably one of the five best places in the world.
And both of them factored into my career choice.
But I was very much intent at that stage of being a hospital medical consultant.
Yes. And so both of those benefits would go into my NHS career rather than to anything else.
If you'd asked me back in 2008, what is biomedical engineering, I would have told you it was,
you know, people trying to make new hip replacements and material science and so on and so forth.
I had absolutely no idea that it would pertain to what would go on to be my current career.
Hmm. Mm hmm. So what kind of quality of image we were getting in those days?
So the brilliant thing about Oxford is Oxford is a methods development centre for Siemens.
And Siemens make the best MRI scanners in the world. And there is a beautiful arc of history with oxygen MRI.
So if you start with the very first University of Oxford Spin out company, which became Oxford Instruments, they made superconducting systems.
And these big magnets. Exactly. Those superconducting systems were absolutely critical for magnets.
And so the original spin out thesis and you perhaps know this even better than I teach you,
but the spin out thesis was back in the fifties and sixties.
It was normal for a physics department.
If they designed a new piece of equipment to almost gift it to another physics department that wanted to replicate those apparat apparatus.
But when that became sort of a physics department that was effectively industrialising, literally industrialising academia.
And so a gentleman who Martin would develop to spin out companies to do exactly that.
They then went on to make effectively the first commercial MRI systems for patients
in the 1980s and listed on the London Stock Exchange at the time successfully.
If you look at that heritage, people ask me, now, you know, why can we be so sad?
How can we be so bold as to say that we can reinvent MRI from Oxford?
And I sometimes say, Well, it's easy to reinvent something from the place where it was invented to start with.
So back. Yes. So the next step, I'm just trying to get to the next step in your career where you presumably became more interested in this question
of either improving the image or finding better ways of interpreting the images that you were getting from them.
All right. Absolutely. So in 2008, you would effectively get beautiful images from MRI scans,
but you can get lovely anatomical images from CT scans and even from a competent ultrasound operator.
The difference with MRI's is that you can do effectively a virtual biopsy,
you can characterise the tissue so it becomes less of a question of your liver is so big and looks
like this and more a question of your liver has X percent fat and 1% inflammation and Z percent iron.
And from that you can infer diagnoses that have no visible change on the liver,
but profoundly affects the future of that patient, or at least that patient's liver.
So you can, for example, diagnose fatty liver disease or hemochromatosis or things like that.
And this came out of our study because we developed all these wonderful methods, but they had absolutely no medical purpose.
So I could measure to the second decimal place the amount of fat in someone's heart.
But as I told you earlier, that has no clinical utility whatsoever, much to my grandmother's consternation,
but at the same time, in the same hospital, in fact, on the same area of the hospital,
because pathology is on the same level as as the Oxford Centre for Magnetic Resonance Research,
people are analysing biopsies and biopsies are painful liver biopsies taken with an 11 centimetre needle, which is called a true cuts needle.
And you you do a biopsy by inserting this needle into local anaesthetic and then twisting it through 180 degrees and then pulling it out.
And I see you take a sharp intake of breath and you don't even have to have one.
So it's a painful, horrible thing to do.
And in cardiology, if you want to do a biopsy, it's even harder because you have to get the needle into the heart.
And so we've done lots of work in cardiology to remove the dependency on on biopsy, to remove the dependency on the tissue diagnosis.
The problem is historically that many people consider a tissue diagnosis the best diagnosis,
and as you probably aware in medicine, history has a disproportionate weighting.
So to define a new paradigm where you could assess a liver without having to stab, it became something that we could try and do.
It fitted beautifully with a Ph.D. because we had all these lovely methods to assess tissue characteristics,
but we had no tissue validation of them, and I wasn't going to start stabbing hearts again.
So the idea was that if I wrote out my cardiac chapters,
we could do the first liver biopsy study in the Oxford Centre for Magnetic Resonance Research to see if MRI could predict the biopsy results,
and that would be the first step on the way to removing the need for liver biopsy.
It was one of those brilliant studies where in the first four patients and I remember it very clearly in the library of ICM opening up the
pathology samples and we'd already analysed the MRI findings and I predicted what we'd find on the pathology and it felt like a game show.
Matt Robson, who was the professor of physics at the time, who had a healthy disregard for the scientific credibility of doctors.
He basically thought all doctors fake their results and there is some truth in his fears.
He he did the the blinded pathology delivery and we opened them up and someone that we
thought would have simple fatty liver disease without inflammation delivered just that.
And patient number three, who we thought would have fatty liver disease but with inflammation, tumour had just that and it was one of 45.
Now it's one of my few truly eureka moments where we just we just got it.
And and so was that a turning point? Yes, that was a turning point.
You said you've done the Ph.D. because you saw that apart from the honeymoon as a route to getting a consultancy post.
Oh, did you go for the consultancy post? I did in the end, but at this stage I was still a registrar.
So at this point we didn't I didn't think that this would necessarily pull me out of medicine.
I thought this would be where my research went. Yeah.
So instead of doing just heart disease work, I would do liver disease and heart disease or liver disease,
a risk factor for heart disease, because most people with liver disease end up dying of heart attacks anyway.
So the two are very similar. What I didn't realise was there would be considerable scalability in this.
So the next step of this fairly serendipitous journey was we started to do more and more liver work and we
filed a couple of patents to show that we developed a new method that could potentially replace a liver biopsy.
And when we did this, I didn't really think where it would go, but on a completely different track.
In the same year 2012, the UK chief medical officer was Sally Davis,
and she announced that liver disease was one of the biggest threats to UK National Health and Wellbeing and UK Biobank,
which was run by Rory Collins at that time, wanted an assessment of liver health and obviously they couldn't do biopsy.
You can't biopsy 100,000 people,
but they just heard or someone had heard the wonderful Oxford grapevine about this new scan that could effectively replace a liver biopsy.
And so I was called into a couple of slightly difficult survivor type interviews to evaluate this technology,
and it was decided to put quantitative, multi parametric magnetic resonance of the abdomen into UK Biobank.
That then went on to show many things and many different companies, not just perspective but also GRAIL.
And many academic institutions have used that because it's the world's largest study looking
UK biobank I'm talking about now looking not just at heart health and brain health,
but also abdominal health, such as it pertains to the others.
So just this year we've published that, you know, there's actually a heart, brain, liver axis.
So people with inflammatory disease of their liver are more likely to get dementia in the future.
People with liver disease are more likely to get heart attacks, which is how I came into this research.
And so we are again, going back to my grandmother for slightly connected.
You know, the hip bone really is connected to the like by. And so what did you do next?
Well, the problem with getting in to buy a bank is we we'd have to become an accredited service.
So the only way to to satisfy that need and John Powell was brilliant in articulating this in sort of 20 minutes,
was to form a company and productize what we developed and then deliver that to Biobank, which we duly did.
The only problem for him was that I had no idea what he was talking about, but at least I was honest in that.
And so he paired me with Sir Michael Brady, Mike Brady.
And the brilliant thing was Mike already knew Matt and had a mentoring relationship with Matt.
So Matt, Mike, myself and Stefano Noble, my PhD supervisor, founded Perspective in September 2012.
Mike, just to go into Mike's background a bit more. So he already had work done with doing work on breast cancer, so right on.
Yeah. So the reason Matt Robson and John Bell thought he'd be the perfect addition was he
knew how to develop technologies from a laboratory so that they were patient ready.
So we talk a lot about bench to bedside, we talk a lot about translational medicine, but there are very few people.
And certainly back then 2012, there were very few people who'd taken a technology that had shown some academic
promise and turned it into something that could be procured by the NHS.
So, you know, I have a blood test that can detect cancer. Brilliant.
Can you do it in hope? And if the answer is no, when you don't have a blood test that can detect cancer, that kind of approach to it.
And, you know,
the rationale also of bringing Mike in is to me who'd come into medicine on a basically scientific background and who basically knew nothing else.
All the aspects of starting a company, finding early stage investors, finding mentors, finding friends.
All of that was brought in by Mike, who has no peer within 250 miles of where we're sitting at doing this.
But you were going to continue your clinical career at the same time as being.
Yeah. So Mike's condition and coming on board is that someone had to go full time
and I said I would do it because this was a way of scaling a technology that.
I thought back then would be useful,
even if the only thing it did was replace liver biopsies as as you as you'll find out there's many other applications for it.
But in order to do that, I would have to curtail my medical ambitions.
So rather than completing as a consultant in cardiology and general medicine, I completed just as a consultant in general medicine.
So I keep one generality and I did one day's work for the NHS a week for the first few years of the company's life.
And so and so. How did the company do in this take us up from 2012 to 2019?
Well, this will be in the Bodleian, so I don't know what time someone will be listening to it.
That's years from now. We'll see if the company still exists. It's been ten years, and the company is what?
Just get us up to the end of 2019, because that's going to be a pivot point.
Okay. Yeah, I know that. So from 2012 to 2019, so we founded we raise an early investor money.
People were wonderfully talking to us at the beginning and we took up some offices in the Oxford Centre for Innovation,
which is owned by lots of trust, and we began to develop what would been effectively a medical physics prototype.
If you take an MRI image and analyse it like this, you get a virtual biopsy and turn that into software that was checked and quality assured
and could go in front of regulators and get cleared and be CE earmarked for European use.
And back then that was also you case an FDA cleared for use in the United States.
We achieved that in 2015, So we had a regulated product in 2015 on Siemens scanners and at that point that was a real,
you know, sort of eye opener for us because there weren't many commercial software offerings in medical imaging in 2015.
And we had one here and we knew we could do it. We knew what the regulatory hurdles were.
At that point, we decided to make a proper company.
So we brought software engineering in-house. We hired a guy called Kevin Dixon who built a software team.
It must have been crazy for him at the start to build a software team with a doctor who knew nothing about software engineering.
And we grew probably doubling in numbers every year until until 2019.
By 2019, with not just made our liver scan available, we developed another scan that looked at the bile ducts,
which are the ducks that connect the gallbladder and the pancreas and and the main GI channel.
And no one had really done that before. No one had really imaged the bile ducts properly.
And so we had a new angle there and we're starting to see some cancer work.
But my favourite project in 2019, just before the pandemic hit, was a multi-organ scan that had the prototype named Atlas, which was for diabetes.
And the the origin story for this is we knew that a lot of diabetic patients had liver disease and so they would have our scan.
I also knew from my cardiology background that lots of people with heart disease end up getting multiple scans in different clinical settings.
So you'll have a scan of your aorta, you'll have a scan of your feet.
If you have diabetes, you'll have a scan of your eyes to look at vascular disease in your eyes separately,
you'll have a scan of your kidneys to see how your kidneys are doing and of course, a scan of your liver.
And I knew from my father, who's diabetic and retired,
that his social schedule in London is determined by his Charing Cross and other imperial appointments.
So [INAUDIBLE] know that, you know, and plot out his holidays and who he has lunch with by how often [INAUDIBLE] have
to go in for this appointment and that appointment and alert socially pleasant.
It is ridiculously inefficient. And so the idea was could we make one scan that looked at all of these organs and integrated the data so
you wouldn't have to flick through a set of notes and find where is your ultrasound of your kidneys?
And can I compare that to your ultrasound of your heart? And oh, but I don't know what your aorta looks like, so I've got to look for a third report.
And they're all done by different people and different machines.
It's it's organisationally very bad and the output is very bad because you end up with one patient,
several doctors and several scans, and they don't all agree with what to do with any of them.
So you can have a kidney doctor telling you to take more ACE inhibitors and you can have
a heart doctor telling you to take less because he's worried about your blood pressure.
You know, my dad's fairly savvy so he can integrate all these different bits of information and decide who he's going to ignore.
But it's a challenge when you have all this wonderful medical expertise clashing with
each other because no one's actually got an integrated balance scorecard of the patient.
And so Atlas was supposed to do that. You know, we had the world's best heart scans because we knew how to do them.
The world's best liver scan intellectual property on developing a pancreas scan.
And we knew how to do the aorta as well. So we starting out at a good point. And that was the product that we were developing when COVID hit.
Right? So let's let's get to it.
So can you remember where you were or under what circumstances you first heard that there was something going on in Wuhan and how long it
took before you the light bulb moment happened that made you realise that this was something that perspective could get involved with?
Yeah, so I'm generally quite an early riser and to avoid waking up the rest of the family,
I tend to flick through the news on different newspapers and the BBC, usually on my phone, sometimes on a laptop.
And if, if you recall once more for me,
I guess this was just after the Christmas period and there were stories of the first story I
clearly remember was of Chinese people in a city I never heard of building a hospital in a week.
And I remember thinking, That's quite impressive.
And I didn't really think twice about why or how or the implications for it.
I'd heard a lot about I'd heard a little story about restrictions of movement, but not not much else.
But I remember very clearly at the turn of the year before, people had fully got back to work in January being quite concerned because.
I think maybe it'd take me a few weeks, but to put two and two together, you had rapid hospital building at a site of a new pathogen.
Either of those by themselves we'd had before. Right. Some people can build stuff really quickly just for the sake of it, just to show that they can.
And we've had new pathogens every year or two for the last few well, last two decades, I would say.
But when you put the two together, that is a very, very sinister omen.
And the role of a CEO is to act early on data points.
If you wait till the line is fully drawn, then you have no additional value in strategic planning for your company.
And that's important because it's almost the opposite of traditional academia.
Traditional academia. We haven't got enough evidence, we haven't got enough evidence.
You never have enough evidence. And certain people, perhaps the likes of me, it makes it slightly stultifying.
But when you put those two together, new hospital building and a new pathogen, that became quite worrying.
But it didn't really seem to feel full into my zone. It was something that I watched out for but didn't think would impact me.
It did curtail my holiday planning and it made me read the news more assiduously.
Okay. But that changed. That changed once there seemed to be international.
I wouldn't say I was ahead of the curve in any way thereafter.
I was moved. Some cases were turning up in Italy in huge numbers.
Yeah. When I saw the cases in Italy and when I saw I mean, I like many people at that stage,
we had very little faith in the UK government and the UK government response.
I think there are some people in the UK who probably didn't do their roles as well as
they perhaps could have in terms of early detection of pathogens and early notification.
I know there's a review currently underway. I don't I'm not sure what it will say, but certainly when the when the when the history books are written,
excuses like I had a poor zoom connection or something like that will be will be given fairly short shrift, I hope.
But you know, what's done is done. A pathogen was let loose, possibly with some mistaken experiments at the origin of it,
and possibly with insufficient sharing of data at the early stage to try and contain it.
And there was a global response, and I think the vast majority of people involved in the global response can be very,
very proud of what they did, and that's probably the best way to look at it.
If you believe in human endeavour and this was a challenge for human endeavour, most people did really, really well.
So that you had a product which I mean, it can't have taken you very long to realise that.
Well, you have to. How,
how long was it before it became apparent that people who were catching this and being seriously sick with this were having multi-organ involvement?
Well, it wasn't apparent at all at the beginning that we would have any role in it.
It was clear that people, people who go to intensive care with a disease have multi-organ involvement.
That's almost the raison d'etre of going to intensive care.
You know, if it's single organ failure, you can usually manage that outside of an intensive care.
But if you have multi-organ failure, you're almost always admitted to an intensive care unit.
And if you look at people with bad COVID, yes, they have respiratory failure, but they also get kidney failure.
They become unconscious. They get, you know, heart failure and so on and so forth.
But the same would apply in sepsis or. Correct? Severe influenza. Exactly.
So all of these patients end up in intensive care. Yeah. What you can then say is all of these patients therefore have multi-organ involvement.
Yep. Now, we had a brilliant scan for multi-organ disease that was already being productized, but before we got to using our product,
there was me just as a worried dad, the worried husband as a worried hospital practitioner,
thinking, Geez, if I get exposed to it, what's going to happen? And if you go back to that February and March,
I remember doing many of the things that perhaps some of some of your readers or listeners will consider nuts.
You know, I would make sure that all the family shopping was done just by me wearing sort of semi disposable slash,
washable clothing, and I'd wipe it down and stick it in boiling water and all that sort of stuff.
I was genuinely worried that troops would be deployed and stop people moving around.
I wasn't necessarily opposed to it. I remember one massive discussion with a very close family of ours where I felt
that lockdown was instituted too late and it should have already been done.
I went to their house for lunch and I was saying I wasn't sure we should be there, but, you know, I felt reasonably safe.
But the signals that it was sending out were difficult. And the following week or within two weeks, I think we did have lockdown.
The other issue we had was we lived in a terraced house and we just had our second child in 2017.
So I had two young kids under the age of five.
And I didn't know how long this would take to play out, but I knew it was measured in double digit months.
And so that the thing that my wife did super smart me, she bought a house very quick.
So between January and March, we actually purchased a bigger house with a garden.
And that was probably the thing that really saved us because it meant that both myself, my wife, could work in that period.
And obviously we're incredibly privileged to be able to do that so quickly and we can raise our
children safely without the social impediment of being in a very closed and confined environment.
So I'm still yes, I keep asking you questions, which I think you're going to get to.
So how did you get involved in it? All right.
Okay. In turning the semi productized development that you had going for diabetes into long term, into skin.
Yeah. So I didn't cover that. Yeah.
So covers companies. Is it specifically long-covid?
Is it. It's not. It's no, it's it's multi-organ disease. Yes. But one of the first applications as opposed to take me back to the beginning.
Yeah. Okay. So there were there was us moving into our new house just before we were told we couldn't move.
Quite scared, but a little bit prepared, stocked up the cupboards, etc., etc.
I've spoken to my dad and said, What's this going to be like? And he said, Your kids will be fine.
It'll be incredibly stressful for you.
I asked him because he'd lived through World War Two, so but as a child, so you know, the concepts of restrictions on movement,
living in perpetual fear, all those kind of things, as usual, is incredibly insightful.
And then it came to us. So, you know, for all academics at that stage or in any discipline, there was an, a sharp lens put on you.
Were you doing anything that was even vaguely useful?
And everyone, of course, would argue that they were in our case, you know, we had the ability to diagnose disease better than almost anybody else.
But was it useful? No. The medic in me couldn't lie.
I was like, You don't need like super sophisticated MRI for acute COVID.
If someone comes in breathless and panting, treat them.
That's that's how prevalent it is. You don't need to put them in an MRI scanner.
So our technology was redundant. Totally redundant at the beginning.
Where we came in is as people began to recover and as the government wanted a good news story,
we can we could answer and probably only we could answer the question of does acute COVID have long term effects on your organs?
And we could do that because we're incredibly sensitive.
So I could scan you after you're over COVID and say you have fully recovered or you haven't fully recovered.
And that's where we decided to try and be useful.
We would do the first deep phenotyping study to determine if patients who recovered from COVID were fully recovered, and it was called COVID scan.
Play on COVID overall coverage and scan.
And one of my colleagues here marries you designed that study with me in a long weekend.
We submitted it for ethics and we got it approved and started it.
I can never remember whether it was the last week of May or the first week of June,
but I think we had our first patient definitely in the first week of June.
And who were your collaborators on with the. No, this was it. Yeah, this is a tricky one.
We collaborated with Oxford University Hospitals Trust, where I also have an appointment and we collaborated with the Mayo Clinic.
But as this became the clinic is in the Mayo Clinic is in London but is centrally managed.
There's a mayo Clinic in London. I didn't know there was one in there, but it's centrally managed from Minnesota.
Yeah, Yeah. So they, you know, argue leading health care institutions.
But there was a lot of, uh, and with hindsight I understand more why there was a lot of territoriality around this,
because there was a massive funding pot coming for this and basically only this.
And so people were trying to protect their rights to access that funding.
But where was that funding coming from?
The central government in the UK, you know, the National Institute for Health Research and other bodies like that?
And was that something you applied for as part of the competition? We did, yeah.
And for which we were not successful, I suspect were probably blackballed.
But, um, but we know many of the reasons why, you know, people kind of donate grants to people they know and so on and so forth.
But that has systemic problems that we can come to with long COVID in a bit.
However, we were lucky in that we already had several European grants.
We actually got the EU to repurpose some of our existing European grants for this.
As I say, most people during the pandemic did brilliantly, but there were some clear now do well players as well.
What we found is that as we did this study, people didn't want us to do the study because we were doing it much faster than other people
were doing their studies and we were sort of stealing into areas that would block them out.
It was a very competitive area at the time. Not everyone was super collaborative and so patients from Oxford weren't being
sent to our study because they wanted to be involved in the different study.
So we worked initially just with the Mayo Clinic and with people with COVID in the community.
So before there really were decentralised studies, this was a decentralised patient led study.
If you had COVID and you'd heard about us, you could just come have a scan.
It was also one of those studies I hope wouldn't be very long because what I wanted
to show is that everyone who's had COVID got completely better and that was that.
But in July, when we did our first data read out, we could clearly see a lot of people had problems.
Some people had heart disease, some people had liver disease, some people with pancreatic disease.
And this is where it became really contentious. I knew we were onto something big here, and because I'm not a full time academic,
I contacted one of my friends at UCL who was at medical school with me, who is a proper leading epidemiological academic called Ammi Biology.
Not related. Not related. Biology is a very common name in Bengal.
I'm a bit like, I guess Smith or Jones in Wales and how he looked at it and he said,
well I'm more sort of cardiovascular outcomes and things like that, that I'll look into this for.
You hit the time he was working in one of the Nightingale hospitals in East London and as he dug into it
he could see that there was a lot going on here and he published in The Lancet on the impact of COVID,
the disproportionate impact of COVID on black and ethnic minorities and on public service workers.
And he published risk calculators and so on and so forth. So he was already established in the field and he reported into Sage.
So as he started digging into this, it became clear by the end of the year that long a condition that at that stage hadn't yet been
called long COVID existed and it affected people who may not have had any previous disease.
This is a question I was going to ask. These people presumably had never been scanned before.
So is it possible they could have had underlying undiagnosed disease?
Yeah, and a lot of academic sceptics had this. Are you just picking up undiagnosed disease from before, etc., etc.
But if you do enough of these and you look at the population prevalence,
it becomes wildly unlikely that, you know, 16% of people with long COVID have.
Pancreatitis, for example, versus less than 3% in the natural community.
If it's, you know, you can say, wow, maybe this is the 16% to start with.
But that's a bit like saying, you know, if you did it with diabetes and you scan diabetics where you suspect that there's
something wrong with their pancreas and you found the same level of pancreatic damage,
you wouldn't say, oh, well, these people got do you see what I mean?
So there was a lot of and I understand why people are getting fed up with COVID.
You don't then want to think, Oh my God, we're almost getting through this. We're getting to the vaccines being available.
Now there's this whole new thing called long COVID, you know, And what are you looking at?
I don't know what you call it. I mean, obvious symptoms like fatigue and fatigue, Brain fog.
Yeah. The one that I was most interested in was myocarditis, because the best way of diagnosing myocarditis is with quantitative MRI.
And that's where we had expertise.
And how does that manifest itself in It manifests itself as chest pain, breathlessness, heart failure and rhythm disturbances.
So famously, those many, many more cases of young people with heart palpitations requiring hospitalisation.
And these people had long-covid. Right. And they probably had myocarditis before they got this.
And the heart disease had manifest itself by presenting with these rhythm disturbances.
The way I describe is if you have wiring in your house and you damage the house, you're more likely to have problems with your wiring.
You know, if you if there's an earthquake, you're not that surprised afterwards if you then get some short circuits.
Yeah, but it's you know, the problem with Long-covid is it's not as severe as acute COVID in that nanosecond.
You know, if two people walked into this room and one of them had a key COVID and was breathless and about to need ventilation,
and one person had had long COVID and been out of work for six months,
I'm pretty sure both of us would concentrate on the person who is about to expire.
And so in any given instance, long COVID is relegated.
The problem then is long COVID gets relegated and ignored persistently.
And you you you have to set up separate services to evaluate long COVID on its own merit as opposed to in competition with acute COVID.
And that was the real challenge at the end of 2020 and the beginning of 2021, because most academics just did not want to acknowledge it.
In fact, most UK academics thought that long COVID was a psychological disease,
and I referred earlier to the prejudices of some people in the National Institute of Health Research.
All the allocated funding was to people with a history of examining psychological disease.
Now, the first rule of psychiatry is you must rule out physical disease.
So. It's it seemed to go against itself.
If you haven't ruled out physical disease, how can you describe this as a neurological condition without physical bearing?
Does that make sense? Yes. Yes. So once the study came out, did you find that the technology was adopted clinically?
Well, the MHRA cleared the technology by the end of 2020.
So at the same time that the vaccines were cleared, we had emergency use authorisation in the UK for COVID scan to be used clinically,
and that had incredible impact for UCL and their plans for long COVID clinics because they now had a tool that they could use.
They needed to evaluate the tool. It was new, maybe it's useless, but at least they had something they could use.
And the idea was instead of several different scans, you know, if your heart, your lungs,
your kidneys, your pancreas, a bit like my dad's diabetes, you can have one scan.
And the important thing is we're still in pandemic times, then 20, 20, 21.
So the idea of a vulnerable person coming into hospital five different times for five different scans, it's no longer just an inconvenience.
It's a safety risk to everyone because you're increasing transmission within a closed environment.
So there's several things you can do about that.
You can have one scan, you can move that scan out into a better ventilated, less crowded environment like a community diagnostic centre.
You can make these scans efficient by bringing them closer to a patients and they have to travel less far into a city.
So for example, Ucl's base next to Warren Street Underground Station in London to get to UCL,
even for just one scan, you almost certainly have to take a tube or a bus.
You see the exposure element here. And so all of these things made it an attractive technology to clear specifically with long COVID in mind.
Does that make sense?
And so once this technology was cleared, we tried to publish the first papers and there was incredible resistance to it from many luminary,
mainly London based cardiologists, many of whom had private practices seeing the same patients.
They didn't necessarily want a competing technology or a scan coming out that made them somewhat redundant with a smaller butts.
The paper was eventually published in BMJ Open,
and Amy subsequently went on to win a big and a nice grant for a study he designed called the Stimulus Integrated Care Pathway Study,
where he basically said, I'm going to evaluate people with long COVID across the country and determine what
organs are affected and see if we can do drug trials to treat some or all of this,
because the big problem we are recognising is that long COVID is not one disease.
It's several different manifestations of of ill health from COVID.
So some people will have bad pancreas is some people have bad lungs, some people had bad hearts,
some people have impaired brain function and we can't fix all of it with one approach.
And that's what your. Yes. The scan was able to show. And do.
Some people have everything and some people.
Yes. So the people I worry about most are the ones who have a little bit of impairment in several organs.
There's a very famous story about the spitfire from the from World War Two.
There was a people recorded the bullet wounds on Spitfires.
And you may know the story as they came in after missions.
And they remembered very clearly that basically, if you if you had a spitfire who's cocktail a cocktail cockpit or motor was hit, it would.
Those ones never seem to come back. But planes with bullet holes in the wings or the tails or the ailerons, they would come back.
And so initially the engineers were like, we'll just put more armour on these areas because these are where our planes tend to get hit.
And a mathematician said maybe the fact that the planes got back despite the fact they could get hit, that tells you something.
And actually what we're missing is the dog that didn't bark.
Yes. Yeah. The fact that these planes that got hit in other areas, they never came back.
And that's where you need to focus. So it's similar to me.
We never see someone or hardly ever see someone with really bad multiple organs because we suspect those patients aren't doing well in the community.
They're either in hospital or not leaving hospital. The patients we see a lot of on our scans are patients with multiple slightly impaired organs.
So if you were to grade your organs on a scale of 1 to 10, what ten is perfect health, you know, Olympic standard and one is really sick.
You know, if it's a transplantable organ, you a transplant,
it sometimes will come across someone with sort of a four out of ten on one of their organs and everything else is great.
But the ones we worry about as someone who's sort of six out of ten and three organs, these are the patients who will do bad.
These are like my father and his diabetes, right? He's got lots of things wrong with different organs.
And it's a balanced scorecard approach. You don't want to make your kidneys go up from six out of 10 to 8 out of ten.
But in doing so, you've depressed your heart from the same 6 to 4, you know,
and that's where we think we have added value because we can see the patterns of disease in someone's body rather than focus on just one organ.
Again, if you look at this through the arc of medical history, initially medicine, the art and medicine was very much integrated care.
If you look at the John Radcliffe acute medicine was delivered by people who trained effectively across specialities.
Now, as medicines become in 2023, more and more super specialised, you don't just have respiratory physicians as opposed to internal physicians.
You have respiratory physicians who only focus on plural disease or only on pleural disease from a certain indication.
And the problem with that is if you have multi-organ disease, who's going to look after it?
Yeah, we've lost that country of specialists who are comfortable looking at rashes as well as urine,
as well as blood results, as well as brain scans and so on and so forth.
And that's where I think technology can help us, because if you can produce the results in an integrated way,
almost like a tumour board where you see all the different results you need for an oncologist,
if we can do that for a diagnostic physician, that's where we can help direct a patient not.
Well, yeah. Better in a more safe, better and faster, more cost effective way to the right solution.
Even if the solution is nothing more than there's nothing more we can do for you at this point.
I think just soldier on. That's an okay answer.
But let's not spend thousands and thousands and thousands of pounds and months and months of time to get that.
So how many? This is probably an unfair question.
I don't know how many MRI units around the country have got your software installed in the UK is probably about 40.
Mm hmm. Yeah, but it's not so much a case of installed MRI.
So MRI machines can send the data to us here in city.
We process it. Yeah, just down the corridor. Yeah. And then we send the results back, usually within a day.
And in the United States, we do it out of Dallas. In Europe we do it out of Portugal and in Asia, we do it in Singapore.
So it is, yeah, it is operating in all those countries. And so, I mean you develop this at speed.
Yeah, that that was the story I think Mike wanted wanted me to get you to tell.
How did that impact on the company, the fact that you, you what?
Pivot. Yeah, the pivot, yes. So the fact that we went from diabetes to long COVID in less than a year and the fact that
we showed that multi-organ disease could be detected and scanned and measured and assessed,
and the fact that the company grew sort of the political muscle and will to take on detractors,
both economic and academic and institutional, it had profound impact.
We're we're a tougher company, we're tougher people.
We have a more direct connection to what we can do.
But what did it mean for your day to day working of your team here sort of hours where
they put together day to day working during when we were running a cover scan trial.
We've come in for sort of eight, 830 work till about seven in the evening.
Some people would drive many people, people would cycle, I would walk because I'm not a very great cyclist.
But the biggest thing was it gave us purpose.
My biggest concern at the beginning of 2020 was the company had no purpose.
You're faced with a you know, you're faced with a pathogen with at that stage, you know, unknown potential impact.
And we're a sophisticated diagnostics company in a variety of indications, but we're not useful for acute COVID.
If acute COVID was all there was, you know,
we used the UK government's furlough scheme for a couple of people that may have stayed there
after the fact that we could show that we could create almost a different kind of medicine,
different style of medicine. You know, think of the things we've discussed, decentralised trials, direct patient contacts,
sidestepping institutions and hesitant academics running a study at scale.
We recruited 500 patients head for most people had recruited 50, uh, repurposing people so that they could do this study.
Finding our own PPE now want to give us PPE. So we saw story.
We were so worried about our employees health at the time. We actually got one of our investors to send us two ventilators.
Yeah, there's phenomenal resilience that came into this company because we had people who were great operators and we had obstacles,
and the things great operators need sometimes to really motivate them are obstacles.
That might sound counterintuitive, but anybody can drive down an easy road.
But it's only your best drivers that you need for the difficult roads, and they really shine when you put them on difficult roads.
And actually something with my fault I forgot to cover previously.
Is that you? I mean, you talked about the starting operations in the Oxford Centre for Innovation,
but you're now here in your own building on the Oxford Business Park.
Yeah. With a community diagnostic facility attached that.
When did that happen? Yeah, that came out of the pandemic as well. Oh right.
Yeah. With, with the, the lack of space is, is crippling for the American public.
Yeah. It was before the pandemic Green went on as soon as the pandemic had hit and you had like hot zones and cold zones and red zones and blue zones,
the jail just doesn't have any zone space for zones. So so I spoke to some of my colleagues and wonderful, wonderful Dr. Paul Sudhir Singh.
And I basically said, look, we can make a diagnostic centre downstairs.
You tell us what you need to do in it and we'll do it. And and this was in 2020.
BOTH When did you move to this site? Oh, we moved.
We moved coincidentally in December 2019. Oh nice.
Yes, we did. We just moved here. Again. Wonderful time.
And this building made built for you or it was fitted for us.
It existed before. This used to be the Oxford Magistrates Court and it was repurposed as a sort of a technology hub and
then some further repurposed so that the ground floor can be a community diagnostic centre right,
because very we had a waiting list back in 2019. It wasn't that bad, but we still had them.
What was very evident is if you reduce the flow of patients through the jail, plus you had to keep going.
This is even before long COVID came along, your waiting list would go up. Where would you see these people?
Still got COVID. Now it's 2023, right? So you have to see these people in a cleaner, faster throughput, closer to the patient, safer environment.
That's what we're having for liver scans. Any scans, your brain scans, cancer scans, follow up scans, blood tests doesn't have to be scans.
And a diagnostic a diagnostic test has some unique ethics around it.
You don't make most people better with a diagnostic test, right?
However, most diagnostic tests carry some degree of risk, even if it's just exposure to other people.
Right. So you have to make your diagnostic tests as safe as possible so you don't harm people while trying to diagnose them with something else.
And the worst scenario, this is why I live a biopsy is so that 20% of liver biopsies in the UK show minimal or no disease.
So you've stopped someone to tell them that they're not so bad.
Seems somewhat unethical to me. Yeah, the same applies to scans.
You don't want people to have difficult scans or have contrast injections and then say, Oh well, you don't have whatever I thought you had.
But in finding that out, you've got COVID. Does that make sense?
Yes. Yes. So, so therefore, you know, space, airflow and also comfort matter because there's also mental distress,
especially with things like suspected cancer clinics.
So it's a very simple example. We have plans to a breast cancer clinic here.
One, it should not be called a breast cancer clinic because 95% of people who go to that clinic will not have breast cancer.
It should be a breast clinic.
Secondly, you should set that up to reassure people that if they don't have malignant disease or cancer, they'll be well looked after.
And if they do have it, they'll also be well looked after, not just medically, but also psychologically.
So you'll notice that we set it up so that we have adequate waiting rooms and you can be dropped off by your nearest and dearest.
And if they want to stay with you, that's okay as well. Now, that flies in the in, you know, in the face of sort of infection control logic.
But, you know, you have to as with many things, you have to apply balance.
So the centre is staffed by your people or is it. Yes.
So we have and jointly with the NHS. So yeah.
So it's, it's, it's been difficult for the Care Quality Commission to understand, but it's what we call joint governance.
So you have the highest level of governance from each side.
So for example, the spectrum has a high level of information security than pretty much anyone else in the UK.
So the information security standards here are very, very high.
The John Ratcliffe has standards on moving and handling and infection control, so we adhere to those as well.
So it's effectively it's like doing the exam with the hardest bits from two separate
exam boards and how many people are coming through your community diagnostic centre.
And it's already, I think after the John Ratcliffe it's the second highest frequency place for people to come and have x rays in the county.
So it's already taken X-rays as well as MRI X-rays.
MRI CT scans are normal blood tests. Yes, all sorts.
So from spectrum. So the idea is instead of if you're in general, if you go to see your general practitioner again, which year this will be heard.
So your primary care provider in Oxford,
they can refer you for a diagnostic test here in the community diagnostic centre and that takes the workload and footfall off the John Ratcliffe site.
Hmm. Sorry. We went round a bit of a move there, but that's it's very it's a very interesting development for the company.
I think it's keeping you close to the clinical field.
Yeah, it's most of the company. You could be, you know, off thinking about business decisions all the time.
But you've got patients coming to your door every day.
Yeah. And also, if you're doing engineering, you have far more hard days than you have good days.
Right. And I told you at the beginning I didn't know what biomedical engineering was.
And ten years later I have some understanding of it.
I described also that your eureka moment when you, you know, open the open the blinded results and find out that you're okay or good.
Even you have far more bad days than good days.
And on those bad days, I see people usually on their bad days, right?
On the good days they're off celebrating. On the bad days.
I ask people just to look out the window and look at the people coming through the door.
It's a revolving door. I just say, that's what you're doing this for.
And if it was easy, everyone would be doing it.
And I said again at the beginning, most things that people conceive of as potentially translatable ideas never make it less than 3%.
We are really privileged to be an organisation that has many, many wins in that 3% level scam cover scan a bile duct scan, a liver cancer scan.
Lots of things we've done have worked and have become available to patients.
But to get there, people have to go through their own sort of dark glasses.
And there's many, many experiments that don't quite work out or the first one doesn't happen.
And on those days, being able to see a marker of the institution and many people's personal successes is a great, great motivator.
Yeah. Do that. You look out the window, you see people coming through the door, getting your scans,
and you think, okay, I'll try again and I'll do it this way this time.
Hmm. So, I mean, we're talking in March 2023.
So So it's three years since the lockdown came in, which seems astonishing in many ways.
And I think a lot of people go around thinking, Coke, it's gone. But actually levels of COVID infection are still quite high.
Yeah. And are you still getting a regular throughput of people with suspected long COVID?
Yes, absolutely. The problem is we've gone through a new cycle.
The the the buzz of innovation in that first, I would say 15 months when the first vaccines came out from vaccine attack,
AstraZeneca and Moderna and Pfizer and COVID scan came out with the MHRA and then subsequently with US clearance as well.
Now, what was interesting is in the US,
we didn't want emergency use authorisation because we knew that emergency use authorisation only lasts for three months and then has to be renewed.
So you can't really have a medical service that costs a lot of money to set up,
but you know, may be taken away from you at three months notice, right?
Yes. It creates a it's it's too short a notice period to actually build something lasting.
So we spoke to the FDA and actually got cover scan cleared as a general device and in perpetuity.
And the rationale is it's a new way of doing medicine.
It's the balance scorecard approach to the patient. Right. And yes, it has applicability in long COVID, and we should work hard on that.
And we're getting a lot of a much more much more holistic approach is actually in the United States to this, partly because the cost is much greater.
But outside of long COVID, think of how it changes how we do medicine.
And what I talked about with the super specialisation.
It changes how we look at conditions like systemic lupus erythematosus, you know, lupus, which affects multiple organs.
It changes how we look at diabetes, which is how we originally developed it.
You know, can we pick up early diabetic changes and motivate patients to turn their red liver green?
Yeah. We know also that these wonderful new drugs for diabetes coming on the market, who should we give them to?
Should it be like nice? Just 65,000 people in the UK in March 2023?
Or should it be like the current UK government, you know, 12 million people in the UK potentially?
Well, the budgets for those two are very, very different.
Someone needs to do the maths, but we have the technology now to determine who should get the drug for any given budget.
So if you can only spend on 65,000, this is the 65,000.
If you can spend on 250,000, this is the next tranche that a sick that might benefit.
Do you see what I mean? So we've based partly on UK Biobank data.
We can now stratify the UK population incredibly accurately and work out without gaming and without prejudice.
Whether you or I would be better suited to getting one vial of medicine if there was one vial on the table.
And that has impact on the ethical distribution of health care resources across the country.
I said right at the beginning, you know, it's all great if it works in Oxford, but does it work across the country?
That's one of the most important things about Aimee's long COVID studies is that they are truly national and they set them up,
and that takes time and effort. So patients came from centres all over the world.
Exactly. So we weren't just treating patients in, you know, the Golden Triangle of Oxford,
London and Cambridge, where frankly health care outcomes are brilliant no matter what you do.
Yeah, because it's just a very, very nice part of the world to live.
You know, I say to people, what did we learn about Oxfordshire from the pandemic?
Well, Rupert Murdoch, who's Australian and at the time had a Texan wife and quite a lot of money and several houses.
He moved to Henley. So, you know, Fox, which is good enough for Rupert Murdoch, it's probably got something going for it.
And you partly answer this question, I think is where you go forward from here.
But I think you have you have answered that, that it's relevant to what?
Sorry. There's one thing that I didn't I omitted to ask earlier, which is what are the organs that covers can cover scan,
looks at the heart, the lungs, the liver, the pancreas, the kidneys and the spleen.
Yeah. Yes. I don't think we itemise that. No, no. It's one of the biggest areas of debate is should we also do the brain?
Because we could do the brain. And I've always held off doing the brain because, you know,
I don't think there are any treatable changes in the brain that one would manage differently if you had a covert scan approach to it.
But, you know, one of the first rules of medical policy development is you've got to bring in lots of stakeholders.
And many people want us to add the brain to cover scans. So we may well do that.
I may not think it's particularly useful in my approach to patients with long term results, so I would just put the microphone back home.
I may not think it's particularly useful to my patients with long-covid or patients that I see with long COVID,
but there's many, many doctors in the world. Many of them are much better than me.
If they want a brain scan, we can deliver them A brain scan.
Where I think this will get more interesting in the future is although it kind of happened in parallel with Long-covid,
our understanding of dementia is also changing.
And so how do you allocate resources with new dementia drugs coming to market?
We think that again, if we do the right kind of scan development, we can pick out which of the patients to treat,
which are the patients that are responding and which of the patients to stop treating with these drugs,
especially as some of those drugs have deleterious consequences.
So if you can prevent harm, that can sometimes be as good as doing good.
And yes, again, I said I said it on this earlier, but what what are the typical signs that you're looking for in the organs that should be looking at?
So if you go through the organs in terms of if you look at the heart, you can see myocarditis and heart failure.
So either inflammation of the heart muscle or a failure of the heart muscle to pump as well as it should.
Right. So those are the two big things you look for. So you're looking at inaction in action?
Yeah. We look at movies of the heart when we scan in the lungs.
Historically, MRI research in the lungs was basically minimal because you could get a patient to do a test cause spirometry,
where they blow out in front of you in a clinic and that's cheap and effective, and we know how to interpret the results.
That was brilliant. Until getting a patient to breathe out in front of you was, you know, almost negligent slash criminal.
So suddenly the space for MRI research is very good because an MRI is done in a
separate room so it's contained and so that we can do functional lung imaging.
So we make movies of you breathing and can determine whether or not you have fibrotic lung disease in the liver.
We've already established that we can effectively do a virtual liver biopsy and tell you if there's inflammation,
the same in the pancreas and the same in the kidney. So that's a very nice sort of, you know, if you find organs listed, they're working well.
And your spleens of the normal size, it's very unlikely that something really bad is going to happen to you if one or more of
those is not working quite as well as it should for your age and for your background,
then we may have a hint as to how we may need to treat you or what you may need to do to minimise the effect of the condition.
And that's not just in Long-covid, but also in diabetes and lupus and other conditions as well.
And the nice thing is in the past,
sometimes just for a person to find out what's wrong and which specialist they find to go to has taken and some people call a medical odyssey.
Yes, but it's now you can have one scan based on breathlessness, fatigue, chest pain, whatever.
And if that tells you, okay, yeah, everything seems fine apart from your kidneys,
at least you know now that what you need is a virtual consultation or whatever you need with your nephrologist.
But it's. How general is it likely to become?
You used the word expensive earlier. Yeah. So it's more expensive than just having it say a single M.R.I.
Of. Of. Yeah, right. Cover scan takes about 40 minutes.
So a single MRI of the heart without contrast is about 20 minutes.
With contrast, It's about 30 minutes. So it's a little percentagewise, a bit more expensive.
The advantage, of course, is because we analyse them centrally, there's less sort of like, Well,
he said he said she said, you know, yeah, I think this is 10%, you think it's 12%, someone else thinks it's 8%.
You know, it's all done centrally in quality, assured and whatnot.
Unit dynamics in the NHS are slightly warped the curve because it's sort of a national purchase in the United States.
And most systems, if you line up the costs of doing five separate scans, they will always come significantly higher than doing one cover.
Yes, I'm sure so. But the question is it's not is it cost effective?
If you do that, it's are doctors willing to change their practice to go from Well,
I've always done this to now I'll do this, or is it going to be almost a double whammy?
Do people do a covers? I've seen this you know, they do a cover scan.
They find out someone's got liver disease, then they send them for a liver ultrasound, which is adding almost no value to the diagnosis.
But it's what they're comfortable with. Does that make sense or heart failure?
You've diagnose heart failure, then they go for an echocardiogram. Well, that's a worse test than a cardiac MRI.
But at the moment, people feel more comfortable with this.
This is why this record so important, because in years to come, cover scan will be a I don't know how many years,
but I hope over the arc of time cover scan will be an antiquated technology.
And I hope maybe some of my colleagues here at Perspective will be involved in making the next generation tests that make, you know,
our 40 minute all over quantitative assessment of human health, something that was a historical archive and a stepping stone to something even better.
And what about Nice? I mean, has this nice have anything to say about Nice hasn't really opined on Long-covid at all.
Yeah, it's somewhat behind the United States and the United States.
The American Disabilities Act, as has enshrined legislation around long COVID.
So if you have long COVID with quantifiable lung, heart or kidney damage,
then you are covered under the American Disabilities Act if you have long COVID.
So if you have a cover scan that shows quantifiable kidney, lung or heart damage, you are covered.
In the UK, we haven't yet recognised Long-covid as a disability, let alone say what the diagnostic definition of it would be.
But you can see why in the United States quantitative definition has real merit.
Yes. Yeah, yes, yes. And that's, I mean, presumably partly a product of having an insurance based system where people have got two degrees.
I think it's also just good medicine.
Like you want to you know what, You don't want to know what something is, why you think it is, what it is and what you're going to treat.
And if you treat it what you want to get better, you know?
So if you think of something as simple as, you know, treating a breathlessness in the lungs,
you know, your breathless identify some lung fibrosis, your lung, fractional changes, 20%.
Let's say we give you a course of physiotherapy and some rest.
Six weeks later, your lung fractional change is 40%, which is now in the normal range.
You're less breathless. Quantifiably your lung lung movement has improved.
I feel good that you're better and maybe ready to go back to work.
Conversely, if you're still breathless, even though your lung fractional change has improved,
then maybe that breathlessness is less about lung fibrosis and more psychological or neuro, you know, neurologically driven.
This is what I meant earlier. I'm not saying that there is that all long-covid has pathology that can be measured below the neck,
but there is a lot of long-covid that does have pathology that can be measured below the neck.
And is there a I mean, are you involved in any patient groups?
Because there are a lot of patient support groups around Long-covid. I personally am not in any patient groups.
I know many patient groups and I strongly advocate that people join patient groups because my honest feeling is if you have a chronic disease,
you have to be your own expert and no one will know you or should know you as well as you, including your doctor.
And what we conceive of as the as the doctor patient relationship will change.
I'm 45 now by the time I retire. My choice and relationship with my doctor will be less of a source of information.
I'll be able to get plenty enough information without him or her, but more as a source of advice for decision making.
A bit like people may hate this now when I say this.
Lawyers, right? Lawyers don't tell you what the law is.
They can too expensive way of finding it out. You can just read it.
Lawyers tell you what you could or couldn't do given a certain set of circumstances.
And I think that's the same for a lot of chronic disease. You know, I have condition X and it's manifest is P, Q and all.
And I could take drugs A or B when you kind of know that without seeing a doctor.
Now, which one should you take? That's the discussion.
And for that discussion, what makes a good doctor? In the past, we've always selected our doctors.
When talks with the medical school.
I went through this based on intellectual ability and memory and the ability to retain information as a single entity.
Going forward, I suspect that's all going to be computer, air and cloud based,
and we should be training our doctors as people who can have dialogues, who can use information rather than retain information.
That's a personal view, though. I don't know if that will happen, but if it does happen,
that will tie in with effectively health care being much more patient driven and
consumer driven cool in some ways and less sort of physician paternalistic.
You can imagine there's a lot of doctors that don't like that. Yes.
Yes. Although that would exclude or appear to exclude that decades, however long of experience of it doesn't.
Isn't it? Because those decades of experience are exactly what go into smart conversations.
So, you know, if you in the example I gave you were where we're deciding between drugs and you're helping me decide between drugs A and B,
the fact that I've had decades of experience that drug B seems to cause a lot of, you know,
Syndrome Z or whatever at some stage may be the exact thing that I bring into the conversation.
Yeah. Or that many patients who are on drugs seem very happy in the short term, but not so happy in the long term.
So it makes sense, but it's less about learning, you know, the ten causes of X and the, you know, 12 causes of why?
Because it turns out there's probably thousands of causes of X and Y and a computer can list them all beautifully.
Mm hmm. Very interesting. Now, at this point, I usually go back to your personal experience, but you gave me quite a lot on that.
Oh, yes. I'm always backwards rather than high.
That. I mean, I don't think I asked you directly how scared you were to use that word of.
Of actually becoming infected yourself. Very scared.
Yeah, yeah, yeah. I'm a reasonably healthy 45 year old now and then 42 year old.
But one of our close family friends who who we had known since the age of 19 passed away during the pandemic.
He wasn't a health care worker, but that didn't happen until the end of 2021.
But I was very, very worried about that.
I'm a natural worrier when it comes to those things, and I believe firmly in making your own risk calculation.
I was incredibly proud of me for his work in the Nightingale hospitals, but also fearful just for my own wellbeing.
My kids were young, they'd have exposure through school, so we actually took them out of school for a bit longer than most people because we had
the luxury of being able to homeschool them a little bit and a new house with a garden.
Also, they were at the time five and three, so actually a tent.
And if you remember, 2020 was a very, very hot year.
So it was very easy to spend time outdoors, which wasn't a bad thing.
But yeah, and I was. Very scared. Very, very scared. And I had.
Very little faith in the institutions that were around me to protect me,
whether it was government or academia, or whether it was some some aspects of medical leadership.
I had very little faith. And that, in part, is what led us in the spectrum to found the community diagnostic centre.
We don't want to be dependent on other people going forward for everything.
It's what partly led us to making sure that, you know,
we kind of know who we want to consult with at the top end of dementia care, long COVID care, liver care, etc., etc.
Named Key opinion leaders are often not so much sources of expert knowledge, but sources of paid for knowledge.
And do you think the fact that you were able to work on something that was clearly
useful and and a direct response to the pandemic help to support your own wellbeing?
Absolutely. Yeah. Again, sense of purpose. Yes. Yes.
A person without purpose can very easily get lost and a medical professional without purpose during a medical catastrophe.
There's a lot of. Feeling of, Oh geez, if only I'd done infectious diseases or something like that,
which we all knew when we were training in medical school is probably the way as an individual
doctor in health care to deliver the maximum yield to global populations we all knew.
It's not like, oh, suddenly we're surprised.
But many of us chose not to do it because it didn't seem massively relevant to the UK at the time and always amused me.
In Oxford we've got like seven malaria professors and probably less than seven cases of malaria per year.
But you have to look at some of those people and what they've done to Oxford medical students.
You've got people like Professor Nick Day and Nick Whyte.
Yes, they're tropical disease doctors, but they're also just bloody good doctors.
But they teach the essence of medicine. So everything I'm talking about holistic care and balance school, they have it in their head.
This is the kind of experience that we will lack in generations going forward.
And I can honestly say it's been an absolute privilege.
As a medical student in the junior medical training just of what, the same corridors as the.
And finally, has your experience of working through COVID changed your attitude in any way to your work or life in general?
Yeah, I just think most days I walk into work, I come through those doors and I'm just incredibly proud and privileged to be here.
I'm just I have the luxury that most people don't have of coming to work with a group of people
who are incredibly capable and can solve new health care problems quickly and efficiently.
And you have to think, as I age, how does that make me feel?
Make you feel protected? You know, if something happens to me.
One of the guys in the surrounding rooms, you know, he or she will figure out what to do for me.
And they're not necessarily a health care worker. In fact, coming back to my medical engineering,
they're basically a problem solver who chooses to solve health care problems, whether their personal or population.
So, yeah, the biggest thing for me is pride and a feeling of protection for not just myself, but my family's health and my my social group's health.