1
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This is Derek quoting Chris Redmond, 13th of November 2006, Chris, I think it came from a Cambridge family.

2
00:00:13,390 --> 00:00:17,650
Did your people live in Cambridge and then switch to Oxford for clinical?

3
00:00:17,650 --> 00:00:24,520
That's right. I went to Cam, went up to do my B.A. at 1960 and came here in 1964.

4
00:00:24,520 --> 00:00:29,620
And how much of a love I was getting into the Oxford Clinical School.

5
00:00:29,620 --> 00:00:35,650
It was completely straightforward. There was no palaver whatsoever at that time.

6
00:00:35,650 --> 00:00:43,840
My brother had been here before me and I just followed in his footsteps, as indeed my brother did after me.

7
00:00:43,840 --> 00:00:53,620
So there were three of us in succession. You had an interview and you that I really I think I did, but it's not clear in my mind.

8
00:00:53,620 --> 00:00:57,100
It wasn't a big event in my life at that time.

9
00:00:57,100 --> 00:01:02,900
And that's a question that occurred to me coming along after you've been here, you know, for a little three months, six months.

10
00:01:02,900 --> 00:01:06,300
How did you feel you compared with the Oxford class?

11
00:01:06,300 --> 00:01:12,760
Because, well, they were six months ahead of us. So there were there were always two intakes.

12
00:01:12,760 --> 00:01:18,070
And the Oxford Group came in in the spring, late spring.

13
00:01:18,070 --> 00:01:22,270
And then there was a remnant coming in in September, October.

14
00:01:22,270 --> 00:01:26,080
And I was part of the remnants of everybody but Oxford.

15
00:01:26,080 --> 00:01:33,730
Yes. So you never had a real chance to compare your education to the media that the would be, um.

16
00:01:33,730 --> 00:01:44,170
Not at all. Um, and it wouldn't have been appropriate even if there had been that chance, because my arrival into medicine was very indirect.

17
00:01:44,170 --> 00:01:50,350
I came to Cambridge to study physics. All right. And I did not get on with physics.

18
00:01:50,350 --> 00:01:56,470
And during my natural sciences tripa, I drifted towards the biological sciences.

19
00:01:56,470 --> 00:02:04,600
And what really converted me was biochemistry. A it was much better taught than the physical subjects.

20
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And B, I came across the medical students in biochemistry and they were just so much more

21
00:02:09,760 --> 00:02:15,790
lively and interesting that I decided after taking my B.A. to transfer to the B.

22
00:02:15,790 --> 00:02:19,660
M and. And your brother was already doing medicine. Yes.

23
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And was the younger brother known to be able to do medicine? No, not at that time.

24
00:02:24,880 --> 00:02:29,320
And tell me about your clinical years. How did you enjoy them?

25
00:02:29,320 --> 00:02:34,720
Um, they were fun.

26
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They were in parts interesting and in part not.

27
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The problem for our intake, which I think constituted six or eight people, was that we were small enough to ignore when convenient.

28
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And there were the committed teachers and there were the uncommitted teachers.

29
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And the clinical teaching from people like John Ledingham was absolutely superb.

30
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Alex Cooke, I remember as a wonderful teacher, um, but, uh, no, I think you see, he retired when Nottingham came.

31
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Yes, it has. He went on teaching. No, he was he was there when I arrived right before it was my first student firm.

32
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Right. And I couldn't have done better. Such a wise, thoughtful person.

33
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One piece of advice that he gave me, which I've always followed until today,

34
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is that if somebody is standing in the hospital looking lost, always stop and direct them.

35
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And I still do that to the stage as part of the courtesy of the man which was in men's health, as well as being a very wise clinician.

36
00:03:44,300 --> 00:03:49,280
Um. So were you just one student on that firm? Oh, no, no, no, no.

37
00:03:49,280 --> 00:03:55,060
The group was six and I think we were divided three and three between two.

38
00:03:55,060 --> 00:03:58,990
Yes. So then it was 65 and 64.

39
00:03:58,990 --> 00:04:02,680
64 is. And I'm worried about surgery.

40
00:04:02,680 --> 00:04:06,700
How did you get over that? It was less well thought.

41
00:04:06,700 --> 00:04:18,010
Alex, what was his name. Afghan erm and Philip Allison were in the NDIS, but Alf Gunning had no interest in teaching whatsoever.

42
00:04:18,010 --> 00:04:26,260
As I remember it, Philip Harrison was a rather untypical surgeon, quiet and retiring as I remember it,

43
00:04:26,260 --> 00:04:32,470
always thoughtful but never very talkative senators that cries and retired with time.

44
00:04:32,470 --> 00:04:36,330
But rather than retiring for the Americans.

45
00:04:36,330 --> 00:04:43,690
Yes. Um, and when you're bored during the clinical years, um, to an extent, yes.

46
00:04:43,690 --> 00:04:51,370
The the medical side was fun and we did pathology at the end of the second year.

47
00:04:51,370 --> 00:04:59,950
And that really, really stood me up because I realised how much I didn't understand which was coming in late in the day.

48
00:04:59,950 --> 00:05:05,060
And it was the insight I gained from doing the the.

49
00:05:05,060 --> 00:05:06,880
The pathology exam came early,

50
00:05:06,880 --> 00:05:14,950
and the insight I gained from preparing for that led to my decision to take up an offer to go to the pathology department

51
00:05:14,950 --> 00:05:23,410
in Baltimore immediately after graduating and doing an internship there before coming back to do further work here.

52
00:05:23,410 --> 00:05:27,970
So you would have approved of the business plan that brought pathology much earlier?

53
00:05:27,970 --> 00:05:35,920
Oh, yes, it's very nice. And I, I think that it just it must be the way my mind works.

54
00:05:35,920 --> 00:05:42,580
But I like to understand what's going on rather than just look at what they now call phenotypes.

55
00:05:42,580 --> 00:05:50,330
But you know, the signs and symptoms. Did you get some sort of travelling scholarship to Baltimore?

56
00:05:50,330 --> 00:05:55,540
No, no, no. That I applied for a service internship and was accepted.

57
00:05:55,540 --> 00:05:59,090
It was an arrangement that came through for Besom.

58
00:05:59,090 --> 00:06:07,060
And his friend was he was had a very close arrangement with the pathologists there and Johns Hopkins, Walter Shelton.

59
00:06:07,060 --> 00:06:10,690
And, um, I went and worked with children.

60
00:06:10,690 --> 00:06:19,410
Now, in this days where people have asked about qualification and registration because you would have qualified but not registered in modern times,

61
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um, they were a little bit fast, but nothing like I mean, now everything is so rigid that I think that people are very limited in their choices.

62
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When I went to the United States, I had to take the easy FMG.

63
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And so for the first until I had done that, they they kept me on as a fellow.

64
00:06:43,720 --> 00:06:48,280
So I didn't I didn't join this. I didn't do any service work.

65
00:06:48,280 --> 00:06:51,970
But I took part and was trained how to do the work.

66
00:06:51,970 --> 00:07:01,780
And then it was always in a supervised manner. And and the teaching there for the the resident staff was superb.

67
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And it was on a completely different level from what existed in Oxford at the time.

68
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But that's all changed now. And that was happening in pathologies.

69
00:07:10,490 --> 00:07:15,820
I mean, how would you, as it were, did you have students attached to pathology or what would happen?

70
00:07:15,820 --> 00:07:19,930
Um, there were medical students there, but the training, um,

71
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I was an intern and I was trained to do autopsies and I did, I think, 84 autopsies in that year.

72
00:07:27,160 --> 00:07:28,930
And it was a very thorough job.

73
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You have to work your way through, write a report and then present it to your supervisor, who then signed it off later.

74
00:07:36,790 --> 00:07:43,120
It was I discovered at the end of that time I wasn't a natural pathologist, but I learnt an awful lot.

75
00:07:43,120 --> 00:07:48,610
And chemical pathology. And with your interest in biochemistry, that got your fancy.

76
00:07:48,610 --> 00:07:54,370
Um, it I didn't know chemical pathology and and Johns Hopkins.

77
00:07:54,370 --> 00:08:00,700
This was classical morbid anatomy, if you like. Um, I no, I didn't.

78
00:08:00,700 --> 00:08:08,740
I biochemistry interested me because the people were so different rather than the subjects and it was well taught in Cambridge,

79
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Northcote and people like that. And uh they, they just made it extremely interesting and relevant.

80
00:08:16,420 --> 00:08:21,850
But when I changed to medicine, I really wanted to work with people.

81
00:08:21,850 --> 00:08:28,180
Um, I had no vision. I had no vision of becoming an academic physician or researcher at all.

82
00:08:28,180 --> 00:08:34,450
I wanted to go out and be a doctor. What made you come back from America?

83
00:08:34,450 --> 00:08:37,510
Oh, well, it was a one year, one year.

84
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But you would stay the course and they they would have I think they had hoped that I would continue, but I knew that pathology wasn't my métier.

85
00:08:48,520 --> 00:09:01,120
I had found it extremely interesting. Um, and, uh, but I don't think I would have wanted to stay with my family, um, links and so on.

86
00:09:01,120 --> 00:09:05,050
Brought us back to Oxford. So we came back. We married when we went out.

87
00:09:05,050 --> 00:09:13,300
Oh yes I am. We married when, um, I started the clinical course in 1964.

88
00:09:13,300 --> 00:09:18,640
And so that coincided with the onset of our married life.

89
00:09:18,640 --> 00:09:22,660
And then you came back. What has jobe's that you do then.

90
00:09:22,660 --> 00:09:26,570
Um, I first with John letting him and Brian Prout.

91
00:09:26,570 --> 00:09:33,490
Yeah. Um um what a what a great introduction to, to put my ground.

92
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He was on that and he was. Yes. Um what can I say about Gurantee.

93
00:09:39,640 --> 00:09:48,010
You always knew he was there. He was always sharp and acidic and he always had um a contribution to make.

94
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But, um, it was it was like living with a knight in the room where it was going to fall,

95
00:09:56,140 --> 00:10:05,050
whereas John Ledingham is was then, as he is now, a very affable, uh, thoughtful, um.

96
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Teaching sort of person, he's a natural teacher. And you did that, he has tried to do the surgery job on obstetrics?

97
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Um, no, no, I applied to do surgery,

98
00:10:15,250 --> 00:10:22,360
but I didn't get a position in Oxford probably reflecting my lack of interest in the speciality when I was a student.

99
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So I then went to the Jessopp hospital in Sheffield and did a six months in paediatric surgery.

100
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And then I did another six months in neonatal and paediatrics at the end of which I decided I wanted to be a paediatrician.

101
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And then I was. I forget how it worked out, but I got I think I was still doing the paediatric surgery and it was after I'd gone into the neonates,

102
00:10:51,320 --> 00:10:57,790
I got a call from Laurie Bailen on behalf of Richard Doll saying they had a junior lectureship

103
00:10:57,790 --> 00:11:02,860
and would I be interested in and applying for it or coming down and talking about it.

104
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A lectureship in what? In general medicine? Yes and no.

105
00:11:07,660 --> 00:11:11,470
I'm sure it was a moving target.

106
00:11:11,470 --> 00:11:18,780
The surgeon knew I could have shounen shift. And the the name of the man you worked for in Sheffield.

107
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And I know Sheldon was the pathologist and Johns Hopkins.

108
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Yes. And then it was, um, Hinderer that they there were two surgeons and their speciality was spinal surgery.

109
00:11:34,510 --> 00:11:42,760
And there was one who was I think his name became with Z, but I just can't remember.

110
00:11:42,760 --> 00:11:51,670
And they that it was so most of the time I was involved with the care of of the babies and the children,

111
00:11:51,670 --> 00:12:14,930
the survivors of spinal and hydrocephalus, who, of course, hardly exists now because then then then terminated.

112
00:12:14,930 --> 00:12:23,660
Well, I remember it well, it's not show, so then you turn to paediatrics, but got the message from Richard, though, what made you accept it?

113
00:12:23,660 --> 00:12:33,850
Um. I knew that to do, um, to to get progressive paediatrics,

114
00:12:33,850 --> 00:12:39,880
I had to get my MCP and there was no no paediatric channel that had to do some adult medicine.

115
00:12:39,880 --> 00:12:47,170
And I thought it was interesting to, um, to get that opportunity, which was part of the job.

116
00:12:47,170 --> 00:12:52,540
But also they were talking with Margaret and said, I don't know if you do it.

117
00:12:52,540 --> 00:13:03,250
So do who had approached Doll because she wanted to do what nowadays, um, would be called a cohort study.

118
00:13:03,250 --> 00:13:10,060
But in those days, she just wanted to study the children of women with hypertension, the offspring.

119
00:13:10,060 --> 00:13:17,230
And Laurie Bailamos was the hypertension man so rich you don't pass the issue to Laurie Balen,

120
00:13:17,230 --> 00:13:20,720
who being who he was, just didn't want to do an observational study.

121
00:13:20,720 --> 00:13:30,430
He wanted something more interesting. So he proposed a trial of the treatment of women with chronic hypertension, a randomised controlled trial.

122
00:13:30,430 --> 00:13:35,410
And he said, well, this is the nearest you're going to get to paediatrics.

123
00:13:35,410 --> 00:13:40,360
So the unborn child. So that's what we can do.

124
00:13:40,360 --> 00:13:46,810
We can offer you. So it sounded interesting and it seemed that I could kill two birds with one stone, get the MCP,

125
00:13:46,810 --> 00:13:56,320
which I did quite quickly, and, um, complete this study and get a name and an M.D. with the equivalent.

126
00:13:56,320 --> 00:14:01,600
And that's what that's what I did. So you got there must be a yeah.

127
00:14:01,600 --> 00:14:08,350
Six months after the intercourse with two years of growth and during that time you'd have been doing routine takes.

128
00:14:08,350 --> 00:14:13,480
And so I was as a registrar, therefore, yes, I could hear just fine.

129
00:14:13,480 --> 00:14:23,560
And then how did you enjoy that? Um, well, uh, I certainly, uh, I found it challenging.

130
00:14:23,560 --> 00:14:28,660
I found that, um, you know, I learnt a lot.

131
00:14:28,660 --> 00:14:34,930
I found that the people I was working with were amazingly supportive and helpful.

132
00:14:34,930 --> 00:14:38,530
That was Glynn Williams by then with, um, John Ledingham.

133
00:14:38,530 --> 00:14:41,920
People like him, you know, who you couldn't want better, really.

134
00:14:41,920 --> 00:14:47,770
So, I mean, you start with Larry Bird. And was there another consultant with Laurie?

135
00:14:47,770 --> 00:14:54,880
Um, there must have been better. Uh, you know, I don't see how you switch to Germany and if you see what I mean.

136
00:14:54,880 --> 00:15:02,020
Well, I did a text for everybody. Yeah. Oh, right. It must have been some sort of invitation, you know.

137
00:15:02,020 --> 00:15:06,250
Um, but so I wasn't just doing the the of IBM.

138
00:15:06,250 --> 00:15:14,830
Yes. As I remember it, I did take as of when they wanted people to take it because I wasn't part of the firm.

139
00:15:14,830 --> 00:15:19,090
I was on the academic side. Yes. No, I understand.

140
00:15:19,090 --> 00:15:26,140
And how long did your thesis take? Uh, my thesis was an interesting experience.

141
00:15:26,140 --> 00:15:35,530
It, uh, it was a trial. Uh, it was the world's worst trial as best I can, uh, document.

142
00:15:35,530 --> 00:15:43,120
Uh, there was no, um, on Richard Dolz advice, he said, uh, you can't do it double blind.

143
00:15:43,120 --> 00:15:50,590
You can't you don't need ethics. There was no need for a protocols of calculating the power of what was needed.

144
00:15:50,590 --> 00:15:57,670
They just said, you want to get lots and lots and lots of recruits and you will be working with

145
00:15:57,670 --> 00:16:02,110
this person in the obstetrics department who was a man called Peter Bailey.

146
00:16:02,110 --> 00:16:09,910
And you won't ever remember him. He was a South African research fellow employed by John Stallworth.

147
00:16:09,910 --> 00:16:13,180
He was the then professor of obstetrics.

148
00:16:13,180 --> 00:16:22,630
And he was very, very, very highly rated as being the finest star that had ever worked in obstetrics and Oxford.

149
00:16:22,630 --> 00:16:26,650
Um, and he talked the talk.

150
00:16:26,650 --> 00:16:36,070
And I couldn't understand a word that he was saying, um, and I thought he must be brilliant because it's way beyond me.

151
00:16:36,070 --> 00:16:40,840
It was only after he left that I realised I couldn't understand it because it was incomprehensible.

152
00:16:40,840 --> 00:16:47,890
He was talking gobbledegook. He was a.

153
00:16:47,890 --> 00:16:58,480
And during this time, I was trying to recruit these patients and they'd all assured me that there'd be no problem, I could recruit anybody I liked.

154
00:16:58,480 --> 00:17:05,170
Edward Cope, adding the proviso, providing they got the treatment he wouldn't accept.

155
00:17:05,170 --> 00:17:09,280
And they, um. So you didn't recruit his people?

156
00:17:09,280 --> 00:17:14,200
Oh, no, I did. Should I learn to ignore them because they weren't helpful.

157
00:17:14,200 --> 00:17:23,500
Um, and and also it was quite clear that getting the target amount, which was of the order of six or seven hundred, simply wasn't going to work.

158
00:17:23,500 --> 00:17:33,550
So Richard Peto, whom I was sharing an office with at the time, I shared an office with him for five years, who I know Richard very well said.

159
00:17:33,550 --> 00:17:37,060
Well, you've got to make it multicenter. But there was no funding for this study.

160
00:17:37,060 --> 00:17:46,840
There was absolutely no it was me and me and how could I go out to North Hampton, Redding and so on and and manage it out there and collect the data.

161
00:17:46,840 --> 00:17:52,270
The deal with Peter Bailey was that I would collect the strictly the trial information.

162
00:17:52,270 --> 00:17:58,570
He would collect the ancillary obstetric data at the started.

163
00:17:58,570 --> 00:18:03,100
The first patient was recruited in April 1970.

164
00:18:03,100 --> 00:18:12,910
And at the end of 1970, on December the 24th, I had a wrap up session with Peter Bailey in preparation for 1971.

165
00:18:12,910 --> 00:18:20,650
We agreed that recruitment was slow. We need to find methods of improving it and that it wasn't quite running as it should.

166
00:18:20,650 --> 00:18:28,600
It was not running at all as it should. And in his pocket, unbeknown to me, he had his return ticket to South Africa.

167
00:18:28,600 --> 00:18:35,260
And on Boxing Day, he met Margaret Anstead on the platform of Oxford Station,

168
00:18:35,260 --> 00:18:39,940
saying that he was going back to South Africa and he left and never came back.

169
00:18:39,940 --> 00:18:43,330
He didn't notify stoneware that he didn't notify me.

170
00:18:43,330 --> 00:18:48,520
The first we heard of it was via Margaret said on Boxing Day he did make an appointment to meet her.

171
00:18:48,520 --> 00:18:51,880
It was an accident that they met. But, well, when they met.

172
00:18:51,880 --> 00:18:56,200
And by chance. By chance. By chance.

173
00:18:56,200 --> 00:19:33,970
And so he just disappeared, leaving me.

174
00:19:33,970 --> 00:19:42,010
My project was in tatters, and I then had to make a decision as to whether to give it up and go away and be a GP,

175
00:19:42,010 --> 00:19:49,270
which in those days was a very low grade aspiration, or leave Oxford and go and find something else,

176
00:19:49,270 --> 00:19:54,670
um, or get in a head and shoulders and just do it all myself.

177
00:19:54,670 --> 00:20:02,290
So I did I did that. I started managing the whole thing myself and I did one other very important thing in my life.

178
00:20:02,290 --> 00:20:11,500
I went to see John Boehner right now, the first assistant to stalwartly and John Boehner said, oh, no, I'm too busy, I can't help you there.

179
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But I said, well, do what you can. But he came on full on and he reorganised the whole department and he had a strong

180
00:20:19,540 --> 00:20:25,780
enough presence that people like Arthur Williams and Edward Koch did what he told them.

181
00:20:25,780 --> 00:20:36,400
And so and we and he and he he reorganised the the data collection on the obstetric side to introduce a flow sheet,

182
00:20:36,400 --> 00:20:47,770
which is, um, in its derivative form, has been in use ever since and on the clinical side and things began to go.

183
00:20:47,770 --> 00:20:56,750
So that was a relief. But then I found that, um, I was because I was a hypertensive expert, which I wasn't,

184
00:20:56,750 --> 00:21:02,500
I kept being referred people with pre-eclampsia, intractable pre-eclampsia.

185
00:21:02,500 --> 00:21:09,910
They weren't ideal for the study, which was about the long term management of hypertension.

186
00:21:09,910 --> 00:21:12,400
But they certainly were the most interesting.

187
00:21:12,400 --> 00:21:19,930
And they certainly I thought that, you know, out there, there were people who knew how to deal with and knew what the problem was.

188
00:21:19,930 --> 00:21:25,360
And it was my realisation during 1971, 72, 73,

189
00:21:25,360 --> 00:21:31,180
that these were the hard core of the hypertensive problems of pregnancy, not the women with hypertension.

190
00:21:31,180 --> 00:21:33,790
Most of them had very benign pregnancies.

191
00:21:33,790 --> 00:21:41,680
It's only a statistical thing that they have trouble more often, but it's like doubling to five percent to five percent.

192
00:21:41,680 --> 00:21:45,060
But these are severe pre-eclampsia were awful.

193
00:21:45,060 --> 00:21:54,100
And the belief in those days, believe it or not, was that because their problem was hypertension, the use of antihypertensive medication,

194
00:21:54,100 --> 00:22:01,780
which I was the bringer of, I was the first person to use them under Lawrie's direction in the department would solve the problem.

195
00:22:01,780 --> 00:22:11,980
So they would say, come and treat this woman expecting her blood pressure to normalise and then for her to go home and come back at it was that naive.

196
00:22:11,980 --> 00:22:18,250
And of course, it didn't happen. And and then I it just went from, you know,

197
00:22:18,250 --> 00:22:29,020
there's a whole vacancy area of torment and trouble and unhappiness and disease and destruction and death affecting this small group of women.

198
00:22:29,020 --> 00:22:34,090
And that obstetric department just walked around them. They were a delivery issue.

199
00:22:34,090 --> 00:22:38,080
And then when it became to any medical problems, they were a physician issue.

200
00:22:38,080 --> 00:22:44,330
Their job was simply to make sure she didn't get preeclampsia and survived the experience.

201
00:22:44,330 --> 00:22:52,150
Uh, and during this time, I developed a technique of managing these women,

202
00:22:52,150 --> 00:22:59,140
which in its it was probably one of the first to apply hypertensives aggressively because they had

203
00:22:59,140 --> 00:23:06,910
no idea how to administer 125 milligrams method over twice a day and expect something to happen.

204
00:23:06,910 --> 00:23:11,420
And I quickly learnt that you had to go, you know, quickly up to two or three grams a day.

205
00:23:11,420 --> 00:23:15,520
I taught myself basically, were you injecting something as well as a.

206
00:23:15,520 --> 00:23:24,880
Yes, something which was a standard treatment then. And and then I added an oral hydrazine into the mix with the method and worked extremely well.

207
00:23:24,880 --> 00:23:28,360
This is pre the calcium channel blockers.

208
00:23:28,360 --> 00:23:37,000
And so I could stabilise the women so they didn't have to be delivered or and they there they weren't at risk.

209
00:23:37,000 --> 00:23:43,480
But then the babies kept dying. They just kept dying. And there was no way of knowing how the babies were.

210
00:23:43,480 --> 00:23:48,250
They weren't all the gadgets that people have now, no ultrasound, no monitoring.

211
00:23:48,250 --> 00:23:59,080
And at that time, um, a, uh, an electronic foetal heart rate monitoring device was introduced into delivery suite from the United States.

212
00:23:59,080 --> 00:24:02,290
And this was the first time that it was used in labour.

213
00:24:02,290 --> 00:24:10,270
And it wasn't a very insightful thing for me to think, well, if this is useful and Labour can tell you when babies can die,

214
00:24:10,270 --> 00:24:14,680
since all my babies are dying, these are at twenty eight, thirty, thirty two things.

215
00:24:14,680 --> 00:24:18,730
Think I'll have a look with that. And it worked.

216
00:24:18,730 --> 00:24:26,710
And over the next five years I cut down the stillbirths about six or seven fold for the first half was bad news.

217
00:24:26,710 --> 00:24:30,490
Oh, there are specific patterns. It's not just a false start, it's the variation.

218
00:24:30,490 --> 00:24:40,650
It's decelerator active. It's quite complex. So by 1975, um, uh, I was well into that as a sub interested, I'll come back to that.

219
00:24:40,650 --> 00:24:48,060
You asked about my thesis in nineteen seventy four or thereabouts by the trial,

220
00:24:48,060 --> 00:24:52,800
reached a sort of a conclusion and Dole was getting impatient to move me on.

221
00:24:52,800 --> 00:24:55,800
And so he said, you stop it, you can write it up now.

222
00:24:55,800 --> 00:25:06,480
And I wrote my abstract for my M.D. in Cambridge and I had a phone call from the then Regius Professor of Medicine, a man called Mills.

223
00:25:06,480 --> 00:25:10,980
I don't remember him. And it was you won't believe this.

224
00:25:10,980 --> 00:25:22,140
It was quite bizarre. He said, we've just reviewed your submission and we can't accept it, I'm afraid.

225
00:25:22,140 --> 00:25:29,010
And I said, well, why can't you accept this, because essentially the outcome was negative, you didn't show a benefit.

226
00:25:29,010 --> 00:25:35,370
So, um, you can't mean that if you do an experiment, you have to accept those conclusions.

227
00:25:35,370 --> 00:25:44,730
Oh, no, no, no, no, no. I did not mean that. So I then tried to pin him down and we went out to the sample and then we got back ten minutes later.

228
00:25:44,730 --> 00:25:50,730
Well, he said it's because the result was negative. Um, and I couldn't deal with this.

229
00:25:50,730 --> 00:25:55,620
I really could not deal with this. Everything was happening in my life.

230
00:25:55,620 --> 00:26:02,610
They were we just we had four children, um, and and, uh, it's a domestic life was hard.

231
00:26:02,610 --> 00:26:12,240
And I submitted my first report on the trial to the BMJ and I got a personal letter back from the editor of the BMJ, which I should have preserved.

232
00:26:12,240 --> 00:26:21,330
But I've lost saying, dear Dr. Redmond, thank you for referring, uh, with, uh, for sending us your manuscript, which we cannot accept.

233
00:26:21,330 --> 00:26:30,640
I would just like you to know that this was the worst paid written paper that I have ever had to review.

234
00:26:30,640 --> 00:26:34,800
Yeah. Yeah. Um, and I thought what a way of boosting.

235
00:26:34,800 --> 00:26:41,940
Uh, well, I didn't think anything. I was just shattered. Yeah. And so I had a paper that was the worst written paper.

236
00:26:41,940 --> 00:26:46,020
I had a thesis that was turned down because it had a negative result.

237
00:26:46,020 --> 00:26:50,160
And I thought, well, I've just got to get my papers out and blow the thesis.

238
00:26:50,160 --> 00:26:55,820
Um. Um, and so I, I thought I had no advice from anybody on this.

239
00:26:55,820 --> 00:27:03,460
I have the most almost contempt for people who want to be babysat all the way throughout their careers as they do now.

240
00:27:03,460 --> 00:27:11,010
Then I went away and then dissected why it was badly written and I found it was the English language that he objected to,

241
00:27:11,010 --> 00:27:16,730
not the scientific structure, the content. Have they sent you a line by line of criticism or not?

242
00:27:16,730 --> 00:27:22,590
No, no. You had to do it. I got out Fowler's English language usage.

243
00:27:22,590 --> 00:27:32,580
I taught myself how to write properly and I could see what he was objecting to once I had studied this and I rewrote it for The Lancet,

244
00:27:32,580 --> 00:27:36,390
and that was when my research career started.

245
00:27:36,390 --> 00:27:45,750
And that was just about the time that, um, dog got this this job for me on the NHS, um, through Rosemary Rew.

246
00:27:45,750 --> 00:27:53,040
Right. Which led eventually to my consultant. Um, well, to begin with, you were a sort of senior registrar.

247
00:27:53,040 --> 00:28:00,060
Yes. Yes. Through all of this, while I was a lecturer, I moved up and after I was a CPA senior registrar.

248
00:28:00,060 --> 00:28:05,330
But then that was a major stroke through Rosemary Room and it was NHS funded.

249
00:28:05,330 --> 00:28:13,650
It was her academic, um, Dole and the thought that the NHS should have fun, some of the academia.

250
00:28:13,650 --> 00:28:22,440
And so I was funded in the Department of Obstetrics on the university, um, as a as a university lecturer.

251
00:28:22,440 --> 00:28:28,860
But the funding didn't come through. It wasn't funded there. That was it was an outside funding.

252
00:28:28,860 --> 00:28:34,710
So Islamic Turnbull and of those when I arrived in 1972.

253
00:28:34,710 --> 00:28:39,330
And what difference compared to still where they stood still?

254
00:28:39,330 --> 00:28:46,110
Well, he was always supportive, but he was primarily a clinician and he didn't really know what I was trying to do.

255
00:28:46,110 --> 00:28:51,510
But he was hugely supportive then. Uh, and Turnbull was also.

256
00:28:51,510 --> 00:28:58,710
Did Boehner leave? No, no, not yet. As I went over to Cardiff to before he had arrived from Cardiff, Alec,

257
00:28:58,710 --> 00:29:05,370
and to tell him about what I was doing, I had a most charming hour with him in which I didn't say anything.

258
00:29:05,370 --> 00:29:10,380
He just talked about all the things that he was doing and then got out, said Chris.

259
00:29:10,380 --> 00:29:16,500
It's so nice to hear what you're having. Um, but he came and he was totally supportive.

260
00:29:16,500 --> 00:29:23,250
And he, uh, he was a remarkable man, as you know, and he really, truly liked everybody.

261
00:29:23,250 --> 00:29:31,380
Everybody was worth knowing. And so he transformed the department immediately into a really friendly department.

262
00:29:31,380 --> 00:29:37,170
And I was still working with John Boehner, who was looking for pastures new,

263
00:29:37,170 --> 00:29:42,810
and he eventually left for Dublin about nineteen seventy five, seventy six, I think at the end of seventy six.

264
00:29:42,810 --> 00:29:51,330
He was gone just after I took up my new position. And after that, did you work with any particular obstetrician to begin with?

265
00:29:51,330 --> 00:30:00,360
I try to work with Gordon Stewart, who replaced John Farmer, and he was very nice and he was very supportive.

266
00:30:00,360 --> 00:30:06,960
And, uh, but he didn't have, um, John Boehner's ruthless streak.

267
00:30:06,960 --> 00:30:15,780
He was too nice. Um, and he eventually moved on to become the head of department about nineteen eighty one, I think.

268
00:30:15,780 --> 00:30:21,520
But he was a very nice guy. But by this time several things had happened first.

269
00:30:21,520 --> 00:30:30,820
I had had realised that I needed to have my own pairs of hands in the department, and so I was now working with research midwives.

270
00:30:30,820 --> 00:30:39,100
In fact, it was a research midwife who was appointed in 1973 or something who just transformed the way I work

271
00:30:39,100 --> 00:30:47,620
because she she was wonderful and she would go around and find suitable people to recruit for this trial.

272
00:30:47,620 --> 00:30:57,640
And if she when she was stumping the clinic, Edward Clinical could be seen running away into his room to hide from her because she was tough.

273
00:30:57,640 --> 00:31:04,660
But she was the daughter of a naval officer and she brooked no, no, no consternation.

274
00:31:04,660 --> 00:31:10,450
And so I had these and there was a constant succession after those that.

275
00:31:10,450 --> 00:31:14,740
And so I became more independent of any one clinician.

276
00:31:14,740 --> 00:31:23,210
And, you know, Arthur Williams and Edward Cope sort of tolerated me without liking what I was doing.

277
00:31:23,210 --> 00:31:28,420
Douglas Ellis was very practical. We set the borders between what we did and what we didn't do.

278
00:31:28,420 --> 00:31:32,410
And until he left, we could work together.

279
00:31:32,410 --> 00:31:37,300
And John Boehner and muscle memory in those days were highly supportive.

280
00:31:37,300 --> 00:31:41,290
But then Gordon Stewart and Austin and so on and so forth.

281
00:31:41,290 --> 00:31:48,670
So I think and this was the time when I began to realise that there was a future in obstetric medicine.

282
00:31:48,670 --> 00:31:58,630
And, um, this position that I got in 1976 was the first full time academic position in obstetric medicine in the world.

283
00:31:58,630 --> 00:32:06,190
Indeed. Uh, Michael, the suite had preceded me. You know, I had been in Oxford together in 1971, 72.

284
00:32:06,190 --> 00:32:11,320
Then he went off to work at Charlottes as a physician. But that was always part time.

285
00:32:11,320 --> 00:32:21,100
You knew he had a full time commitment, I think, at UCL. And, um, it was and as an NHS appointment to mine was an academic appointment.

286
00:32:21,100 --> 00:32:30,610
And there was no question and there still is no question that in that terrain between complicated medicine and complicated obstetrics,

287
00:32:30,610 --> 00:32:39,790
there are these women in the middle who have both the complicated problems that they have, medication that is rarely tested in pregnancy.

288
00:32:39,790 --> 00:32:47,230
They have issues that are life threatening. And they and those days and to some extent, even nowadays,

289
00:32:47,230 --> 00:32:53,140
neither the obstetricians or the the general or specialist decisions were comfortable with the issue of pregnancy.

290
00:32:53,140 --> 00:32:56,140
It's changed a bit as they have become more super specialised.

291
00:32:56,140 --> 00:33:01,480
Someone like all of whole world now is perfectly comfortable with managing women in pregnancy.

292
00:33:01,480 --> 00:33:04,900
And so but it does raise the question and I fill that gap.

293
00:33:04,900 --> 00:33:11,070
So how a patient referred to if their blood pressure was above a certain limit was the indication?

294
00:33:11,070 --> 00:33:15,820
Well, um, while I was running the trial, they weren't referred and we went out.

295
00:33:15,820 --> 00:33:19,510
Yes, but you found what, people above a certain number?

296
00:33:19,510 --> 00:33:26,080
Yes. And it was all very tightly controlled. And and then we randomised them and then we stopped.

297
00:33:26,080 --> 00:33:33,130
And after that, people would, by word of mouth, they would say with this woman, we want your advice.

298
00:33:33,130 --> 00:33:39,130
And then the others came in, the people with renal disease, with autoimmune disease, diabetes.

299
00:33:39,130 --> 00:33:42,790
I steered clear of because my Gilma Yes.

300
00:33:42,790 --> 00:33:46,870
Arrived and he took those over and he, he was very good and he was very good.

301
00:33:46,870 --> 00:33:54,520
And um and then there are always the oddities people with, with conditions that you rarely rarely see,

302
00:33:54,520 --> 00:33:58,720
but because they become pregnant I couldn't describe them, I wasn't.

303
00:33:58,720 --> 00:34:06,760
But I could describe something quite incredible cases which even to this day I don't think it was clear what was wrong with them.

304
00:34:06,760 --> 00:34:15,820
Then they and they died. There were this is the terrain where maternal deaths happened and there were maternal deaths.

305
00:34:15,820 --> 00:34:20,860
And it wasn't because of neglect so much.

306
00:34:20,860 --> 00:34:28,500
And but some of them were avoidable because there was no proper joint between complicated obstetrics and complicated medicine.

307
00:34:28,500 --> 00:34:33,100
So what did they do? What was the eclampsia or hypertension itself?

308
00:34:33,100 --> 00:34:37,190
But the other ones were dying of renal failure.

309
00:34:37,190 --> 00:34:46,150
Uh, there was one woman who just kept getting kidney infections and then she would recover and then she got another kidney infection.

310
00:34:46,150 --> 00:34:52,810
She recovered and then she came into some sort of terminal state and went off to the

311
00:34:52,810 --> 00:34:58,150
medical world world wards and couldn't feed herself and had a nasogastric tube.

312
00:34:58,150 --> 00:35:02,020
And then she vomited and inhaled and, um. Yeah.

313
00:35:02,020 --> 00:35:08,410
And she died of lung disease. And that's I mean, it was one ofthe things there wasn't any trend.

314
00:35:08,410 --> 00:35:13,900
There was a one maternal death from eclampsia in 1971.

315
00:35:13,900 --> 00:35:19,990
And then the next one was about 25 years later in the 1990s.

316
00:35:19,990 --> 00:35:29,790
Uh. And so in I think in the whole of of my association with department, there were four deaths.

317
00:35:29,790 --> 00:35:33,720
Were they maternal deaths being reviewed then? Oh, yes, I thought so.

318
00:35:33,720 --> 00:35:38,940
I mean, just announced with the national system. And how did that impinge on you?

319
00:35:38,940 --> 00:35:49,350
Do have to give evidence to somebody who can you the notes had to be made available, um, in a in a anonymise form.

320
00:35:49,350 --> 00:35:54,480
The first death I happened to be on annual leave at the time, so I wasn't involved at all.

321
00:35:54,480 --> 00:36:05,500
The next one, I certainly had to make a written comment, but that was in 2000 and something was that did you feel an educational process?

322
00:36:05,500 --> 00:36:12,660
So I and I think first of all, yes, of course.

323
00:36:12,660 --> 00:36:18,360
Um, and if this process goes on and it is within the hospital every year,

324
00:36:18,360 --> 00:36:25,170
event is subjected to quite close scrutiny and people spend their souls and try to learn from it.

325
00:36:25,170 --> 00:36:34,120
I think it was the confidential enquiries were one of the most wonderful audit, um, activities ever.

326
00:36:34,120 --> 00:36:38,730
I mean, it always amazes me. Demonstrations, you know, great.

327
00:36:38,730 --> 00:36:44,280
And they were reliable figures on what was going on over a 30 year period.

328
00:36:44,280 --> 00:36:48,750
And you could learn such a lot just by looking at them.

329
00:36:48,750 --> 00:36:53,220
And they continue to work on it and not quite so thorough as they were,

330
00:36:53,220 --> 00:36:59,220
but they've been eating away at the edges and and the situation is always better.

331
00:36:59,220 --> 00:37:08,720
Triennium on triennium. Were you involved in doing it to me and Roseanne Anderson coming in the department, which is separate from you?

332
00:37:08,720 --> 00:37:15,520
She came in with Alec Turnbow from Cardiff and she ran his research lab.

333
00:37:15,520 --> 00:37:21,990
He had to NRC programmes whilst he was up there.

334
00:37:21,990 --> 00:37:29,910
And, uh, when the second one needed to be renewing her, he failed to get the third.

335
00:37:29,910 --> 00:37:38,940
And this coincided with Anderson's illness. She got breast cancer and then died at a very young age and early 1980s.

336
00:37:38,940 --> 00:37:52,050
She was absolutely lovely. And she ran a she ran gynae clinics and er and she got me involved with menopause clinic, um,

337
00:37:52,050 --> 00:37:57,330
because in those days little was known about the menopause, except that it was uncharted territory.

338
00:37:57,330 --> 00:38:01,410
And I went and did consultations with her.

339
00:38:01,410 --> 00:38:34,990
And I must say I could see this was a trait unique to rate and I couldn't understand any part of it.

340
00:38:34,990 --> 00:38:43,210
But anyway, um, she she did that and then she got ill and wasted away, and then after that,

341
00:38:43,210 --> 00:38:55,870
Alec had his first brain tumour and he that was successfully treated and but he hadn't he'd lost his research funding, his major research assistant.

342
00:38:55,870 --> 00:39:03,520
So he was he focussed on keeping that happy department happy, which he did so beautifully.

343
00:39:03,520 --> 00:39:07,510
He was just such an artful, nice person.

344
00:39:07,510 --> 00:39:16,930
And having seen different heads of department store and the store where they and he and then latterly David Barlow,

345
00:39:16,930 --> 00:39:21,070
who succeeded Turnbull and now Steven Kennedy and John Bell.

346
00:39:21,070 --> 00:39:27,670
And so you can see how different heads of department have different impacts.

347
00:39:27,670 --> 00:39:31,900
And what about your original trial? What was happening to them?

348
00:39:31,900 --> 00:39:40,270
Well, it was published in The Lancet. There was a marginal improvement in in second trimester, uh, deaths, which I didn't believe in.

349
00:39:40,270 --> 00:39:54,010
But so I played it down. It established that the treatment with method data was safe and it still remains the best documented and,

350
00:39:54,010 --> 00:39:59,080
uh, most, uh, best known for that reason, the safest.

351
00:39:59,080 --> 00:40:04,960
And it Margaret Downstair then did her bit and she followed these children up at the age of two and

352
00:40:04,960 --> 00:40:10,990
seven and published the follow up story that makes it almost unique in a drug treatment trial.

353
00:40:10,990 --> 00:40:17,620
And she showed that it was safe for the babies because they were and the children were just fine.

354
00:40:17,620 --> 00:40:22,510
They had not suffered as a result of exposure to methadone, but the two groups were the same.

355
00:40:22,510 --> 00:40:24,900
The children in the group. Yes.

356
00:40:24,900 --> 00:40:36,650
And, uh, and so in the world, um, it's always had a very, very high status, even though, uh, by current trial management protocols,

357
00:40:36,650 --> 00:40:41,950
it would be considered to be primitive, but in those days that it was the best that could be done.

358
00:40:41,950 --> 00:40:46,000
And, you know, people still refer to it quite highly cited.

359
00:40:46,000 --> 00:40:51,490
No. Great. Um, did you ever meet Chris Ansted? Harris Oh, yes.

360
00:40:51,490 --> 00:40:57,180
Oh, yes. Yes, yes. I mean, did you work with him? No, I did.

361
00:40:57,180 --> 00:41:02,780
I guess. I met them quite a lot and they were fine.

362
00:41:02,780 --> 00:41:08,900
Oh, they're still two sorts of pre-eclampsia. So what were you inhabiting your first pregnancy?

363
00:41:08,900 --> 00:41:16,990
And they have always had babies. Uh, that was to an extent, both say it's moved on enormously.

364
00:41:16,990 --> 00:41:26,880
Um, it's, um. And now the heterogeneity is seen in terms of early and late onset disease early in pregnancy,

365
00:41:26,880 --> 00:41:31,460
the sort that was worrying me right back in the 1970s and women at 30 weeks

366
00:41:31,460 --> 00:41:37,010
with intractable problems and then the late onset disease which comes on it.

367
00:41:37,010 --> 00:41:42,740
And the it's all both of these conditions are thought to be secondary to placental mal

368
00:41:42,740 --> 00:41:49,460
perfusion from the mother so that the placenta is relatively or absolutely toxic.

369
00:41:49,460 --> 00:42:00,050
Oxidative stress often infarct it. And the origins of the perfusion are different in, um, early onset disease,

370
00:42:00,050 --> 00:42:05,210
its failure to to form the placental circulation properly for presentation.

371
00:42:05,210 --> 00:42:10,850
And this was a subject where John Boehner did a lot of work. And so there was a natural link up there.

372
00:42:10,850 --> 00:42:18,620
We did some very nice stuff together. But Plantation is finished by 18 weeks, 20 weeks.

373
00:42:18,620 --> 00:42:24,590
And is the preeclampsia, which starts happening in the third trimester,

374
00:42:24,590 --> 00:42:35,270
is the sequel to that with the what is essentially and structurally abnormal uterine placental circulation just isn't coping with late pregnancy.

375
00:42:35,270 --> 00:42:38,660
But then there is the late onset disease, which is when,

376
00:42:38,660 --> 00:42:46,490
not because the European central circulation is okay, but because the placenta is growing to its limits.

377
00:42:46,490 --> 00:42:52,070
The uterus can provide so much and when the placenta begins to outgrow the uterus,

378
00:42:52,070 --> 00:43:00,810
it becomes more diffuse and then you get pre-eclampsia from the same placental insult but of a different origin.

379
00:43:00,810 --> 00:43:06,350
And it's very interesting. Um, and then did you get some medical help?

380
00:43:06,350 --> 00:43:12,040
I mean, you got your research midwife, but did you get a registrar or whatever, you know?

381
00:43:12,040 --> 00:43:20,310
Um, no, not for ten years. Well, actually, from 1976 to about nineteen eighty eight, I was essentially single handed.

382
00:43:20,310 --> 00:43:24,080
Yeah, I remember that. And it was a burden too much.

383
00:43:24,080 --> 00:43:32,390
And then Sue Sellers was appointed as a new consultant specifically to the high risk clinic.

384
00:43:32,390 --> 00:43:38,930
Should she and I were together and I thought God help at last.

385
00:43:38,930 --> 00:43:45,590
And the first thing she did as they always do and she arrived, she says, I have something to tell you.

386
00:43:45,590 --> 00:43:51,060
She's going to have a baby. And so the help I was to make it arrived again.

387
00:43:51,060 --> 00:44:00,860
Yes. And she was great because and then then it began to improve and the and the whole thing became formalised within the obstetrics service.

388
00:44:00,860 --> 00:44:05,780
And they developed the speciality of foetal maternal medicine, which was long overdue.

389
00:44:05,780 --> 00:44:17,030
So for the first time, there were men and women who weren't gynaecologists just doing obstetrics because they had to they were not doing gynaecology.

390
00:44:17,030 --> 00:44:20,720
They were focussing on the obstetric problems and they were much better trained.

391
00:44:20,720 --> 00:44:24,800
So when did that start? And you said nineteen ninety. Yes.

392
00:44:24,800 --> 00:44:31,100
How old were you when you became a consultant level. Uh, in nineteen seventy six.

393
00:44:31,100 --> 00:44:35,030
I was uh forty, thirty five years. Yeah.

394
00:44:35,030 --> 00:44:43,710
That's good. Um and you asked what, what stage as it were, did you begin to be called on your back shows around the country.

395
00:44:43,710 --> 00:44:51,050
In the world I suppose, um, around about the 1930s, early 1980s.

396
00:44:51,050 --> 00:44:58,940
And um, I began to be known and, um, this was facilitated by a man called Marshall Lindheim,

397
00:44:58,940 --> 00:45:10,100
of whom you will never have heard, who was a renal nephrologist in Chicago who, uh, focussed on pregnancy related problems.

398
00:45:10,100 --> 00:45:17,100
And he got to have a meeting organised in nineteen seventy five of.

399
00:45:17,100 --> 00:45:25,080
The sort of workshop meeting in Chicago where people were invited from around the world to contribute

400
00:45:25,080 --> 00:45:32,130
and John Boehner was asked and he suggested that I was also invited that put me on the map.

401
00:45:32,130 --> 00:45:37,020
And, uh, from then on, it increased.

402
00:45:37,020 --> 00:45:43,770
And I was asked to be to attend meetings and, um, both clinical and research.

403
00:45:43,770 --> 00:45:53,620
We were asked to give a lecture. And Oxford, uh, really than meant the Oxford Medical Society asked me to give one.

404
00:45:53,620 --> 00:46:05,720
Um, and, uh. I presented to the grand rounds from time to time, but I don't think they found it and there was the medical.

405
00:46:05,720 --> 00:46:14,070
Yes, it's not good. Um, and what as it were, do you feel you've done since that's a two thousand.

406
00:46:14,070 --> 00:46:20,040
What did you tend to work on after that then? Oh, it's become more and more and more interesting.

407
00:46:20,040 --> 00:46:26,070
I have about 30 years of research left in me and about three years to do it.

408
00:46:26,070 --> 00:46:35,340
And so it's a hopeless situation. But, um, in 1991, I published a paper which just reiterated what had been known for many,

409
00:46:35,340 --> 00:46:40,510
many years, that, um, preeclampsia derived from the placenta.

410
00:46:40,510 --> 00:46:48,000
It's a it's a placental condition and the hypertension is secondary. And that has become quite a well cited paper.

411
00:46:48,000 --> 00:46:55,560
And it brought in a previous paper, which was published in 1989 by Jim Roberts, who's now in Pittsburgh,

412
00:46:55,560 --> 00:47:00,750
um, who pointed out that the maternal problem was essentially endothelial dysfunction.

413
00:47:00,750 --> 00:47:11,190
You could explain every single clinical feature of preeclampsia in the mother by her endothelium being dysfunctional for the baby.

414
00:47:11,190 --> 00:47:19,570
You couldn't it was a different issue. And my contribution was to to point out that there were two steps to the process.

415
00:47:19,570 --> 00:47:23,970
First of all, there was the placental dysfunction. And then as a consequence of that,

416
00:47:23,970 --> 00:47:31,860
there was the theory of dysfunction and then the middle there were factors which were yet to be discovered connecting the two.

417
00:47:31,860 --> 00:47:35,760
And then, um, and it's just gone on from there.

418
00:47:35,760 --> 00:47:48,660
And so in the early 2000s, some of the factors were discovered to be the the antiangiogenic factors which are, uh, inhibit the action of Jeff.

419
00:47:48,660 --> 00:47:57,570
And these were discovered because VEGF inhibitors given to cancer sufferers give some of those sufferers preeclampsia,

420
00:47:57,570 --> 00:47:59,700
that they get hypertension and proteinuria.

421
00:47:59,700 --> 00:48:07,080
And due to the renal biopsy and they've got glomerular endothelium, which is the better mnemonic lesion, preeclampsia.

422
00:48:07,080 --> 00:48:12,870
And so they found that the placenta is a rich source of antiangiogenic factors,

423
00:48:12,870 --> 00:48:19,770
particularly the patch for one receptor, which is released and acts as a decoy,

424
00:48:19,770 --> 00:48:29,130
sucking the life out of the system when the mother is deprived and she gets that's the cause of part of the cause of her endothelial dysfunction.

425
00:48:29,130 --> 00:48:41,880
But I published another paper showing that a more profound problem for all pregnant women is activation of the innate immune system in pregnancy.

426
00:48:41,880 --> 00:48:46,320
I published that at nineteen ninety nine. We were the pioneer of that.

427
00:48:46,320 --> 00:48:49,770
Were you the pioneer? These are all ideas that I know. No, great.

428
00:48:49,770 --> 00:48:53,430
Because that's a terrific idea. I mean, which is been born out of the area.

429
00:48:53,430 --> 00:48:58,440
And I was absolutely pilloried for people because this isn't sensible.

430
00:48:58,440 --> 00:49:07,290
It just doesn't make sense. Um, but since then, not a single piece of evidence has been found to disprove it.

431
00:49:07,290 --> 00:49:16,200
And I've been developing that theory. And so the the latest one where I've linked it to a placental dysfunction is to

432
00:49:16,200 --> 00:49:22,800
point out that the vital part of the placenta in pre-eclampsia is the in situ.

433
00:49:22,800 --> 00:49:29,610
And this is a remarkable cellular structure. It's an epithelium in the blood system.

434
00:49:29,610 --> 00:49:37,470
So it's you know, the mother temporally has 12 square metres of epithelium contacting her blood.

435
00:49:37,470 --> 00:49:43,260
And it has a it is always damaged in pre-eclampsia.

436
00:49:43,260 --> 00:49:49,440
And it's the damage, the danger alert signals the damage, the various molecules falling off,

437
00:49:49,440 --> 00:49:56,340
dead and damaged in situ that can account for everything about preeclampsia that are published in 2015.

438
00:49:56,340 --> 00:50:02,040
I mean, there I can see that the fact is coming out damaged epithelium at large.

439
00:50:02,040 --> 00:50:04,720
Yes. And do you think of the hypertension because of that?

440
00:50:04,720 --> 00:50:12,660
Yeah, it's the and it's endothelium dependent, but it's one of the few sort of hypertension we're circulating.

441
00:50:12,660 --> 00:50:21,570
Endothelium is increasing. But in general, medical hypertension, you don't see high chrysanthemum and smoking affected.

442
00:50:21,570 --> 00:50:24,960
Oh, yes. Oh, yes. This is just so interesting.

443
00:50:24,960 --> 00:50:33,510
Smoking is one of the only activities that pregnant women can take to reduce their incidence of pre-eclampsia.

444
00:50:33,510 --> 00:50:42,030
And that may well be because the carbon monoxide, which comes with smoking, stimulates the enzyme.

445
00:50:42,030 --> 00:50:49,560
Homogenise, which is very is an important activator of endothelium health.

446
00:50:49,560 --> 00:50:53,950
But then smoking brings all sorts of other penalties, the tyres and the poisons and so on.

447
00:50:53,950 --> 00:51:03,640
So the baby suffers. Motherson is relatively protected and as Peter Redcliffs system coming doing this, yes, um, yeah,

448
00:51:03,640 --> 00:51:12,970
he he discovered the Heferen Alpha kind of thing and that's very active in that since the overclass.

449
00:51:12,970 --> 00:51:19,600
Um, but it's quite interesting and this is where my theory is kind of builds on what he produced,

450
00:51:19,600 --> 00:51:25,600
because if one alpha is not just a hypoxia sensor, it's a danger sensor.

451
00:51:25,600 --> 00:51:30,010
And so if you get other cellular stresses like, um,

452
00:51:30,010 --> 00:51:37,240
which there are here on Alpha is no normal actually activated because it's part of the stress response system.

453
00:51:37,240 --> 00:51:43,180
So the the evolution of the idea that I'm promoting that, um,

454
00:51:43,180 --> 00:51:49,600
it was innate immune cells and the inflammatory system, which is the part of the problem.

455
00:51:49,600 --> 00:52:00,340
Preeclampsia is now generalised to the fact that it's all part of the stress response system activated by the placenta.

456
00:52:00,340 --> 00:52:07,820
And you can then, you know, it's like the theory of everything in relativity.

457
00:52:07,820 --> 00:52:12,970
It's I mean, totally preposterous that this is on a very small thing.

458
00:52:12,970 --> 00:52:22,690
But, you know, having journeyed the journey and started seeing these cases with preeclampsia that nobody could make any sensible comment on,

459
00:52:22,690 --> 00:52:31,760
to get to the point where you can identify systems which you think can explain everything that you see, I mean, the proof is there.

460
00:52:31,760 --> 00:52:36,940
Yeah, it's it's really quite exciting. The prolongation of pregnancy with steroids.

461
00:52:36,940 --> 00:52:41,250
Right. Is that because of the effect on the autoimmune? Uh, no.

462
00:52:41,250 --> 00:52:53,410
Um, it's, um, the steroids are given to to activate maturation of the foetal lungs and they temporarily damp down the inflammation.

463
00:52:53,410 --> 00:52:57,070
So if you've got low platelets, they will temporarily rise.

464
00:52:57,070 --> 00:53:05,860
But they're they can't put back the damage that the nooner since nothing can people still can't learn.

465
00:53:05,860 --> 00:53:13,060
Once the system is damaged, it's damaged. It's like and and, you know, you're you're stuck with it.

466
00:53:13,060 --> 00:53:19,240
So how many papers are emerging as the sort of vulgar question? How many papers published?

467
00:53:19,240 --> 00:53:25,880
Depends what you mean by papers. Yes. I mean, everything that's cited in PubMed, it's about 300 deaths.

468
00:53:25,880 --> 00:53:37,690
And if you talk about papers that matter with me as the first or the last of which are cited, say, more than 50 times, they're probably 20 or 30.

469
00:53:37,690 --> 00:53:44,890
That's great. Widespread. And my my largest citation is about seventeen hundred.

470
00:53:44,890 --> 00:53:52,890
And that's a review I did for science about 2000 and are used to working with the same clinician.

471
00:53:52,890 --> 00:54:05,350
Was she moved on? Oh, no. Sue moved to Bristol with her husband, Andres Lopez by now, um, round about 2000 and she's since retired.

472
00:54:05,350 --> 00:54:11,610
You see, I'm 74. I want to ask how old you are, but you're probably about seventy six.

473
00:54:11,610 --> 00:54:17,720
It is what it is. You're eighty seven of you are doing well.

474
00:54:17,720 --> 00:54:22,390
That's an excellent. And um. So yes.

475
00:54:22,390 --> 00:54:28,780
And so a lot of the people I've worked with have now retired and uh and the clinical

476
00:54:28,780 --> 00:54:33,180
activity has been taken over by people that no one should be who you probably don't know.

477
00:54:33,180 --> 00:54:42,910
No. Um and the kind of and I have a successor who's someone called, um, Lucy McKillip,

478
00:54:42,910 --> 00:54:49,360
who trained as an obstetric physician with Katherine Nelson Piercey and the Thomases.

479
00:54:49,360 --> 00:54:56,920
And so she she is doing what I used to do clinically, but she has no academic appointment.

480
00:54:56,920 --> 00:55:07,540
And those and I, I left clinical activity in 2008 when I was found to have a and just a non functional pituitary adenoma,

481
00:55:07,540 --> 00:55:09,910
which was causing these symptoms.

482
00:55:09,910 --> 00:55:22,690
And, um, you can imagine, James, what's his name, the medical director, absolutely did not want me doing clinical work with a lump in my head.

483
00:55:22,690 --> 00:55:26,830
So he said, get Ms. Morris. Joan James Morris. Yes. He told me to go.

484
00:55:26,830 --> 00:55:30,850
Um, so I went to have my operation and I was within a year of retirement,

485
00:55:30,850 --> 00:55:36,160
my recuperation took about three months at the end of which I had the returned to work programme.

486
00:55:36,160 --> 00:55:45,670
And I realised by then, having stopped clerical work, that not only did I not miss it, but life became enjoyable.

487
00:55:45,670 --> 00:55:51,310
And so I had only one year to go. And Lucy McKillop was already my temporary locum.

488
00:55:51,310 --> 00:55:55,510
I just said, look, I'm not coming back to do both jobs. I will do other.

489
00:55:55,510 --> 00:56:04,180
My university research and teaching job, I do the NHS job, each demands 50 percent more of what I'm contracted to give.

490
00:56:04,180 --> 00:56:05,350
I'll do one or the other.

491
00:56:05,350 --> 00:56:14,860
And, um, Steven Kennedy, who was then head of development, negotiated for me to come back, only doing my academic job, which was wonderful.

492
00:56:14,860 --> 00:56:22,170
And I so I lost, um, did any clinical work in March 2008.

493
00:56:22,170 --> 00:56:29,230
And then once I had retired, I just registered myself with the GMC.

494
00:56:29,230 --> 00:56:33,560
So there was just no way of getting to get, um.

495
00:56:33,560 --> 00:56:38,290
And, you know, sometimes I dream about it and sometimes I think, you know,

496
00:56:38,290 --> 00:56:44,430
someone asked me the question in the corridor and I can see the old interests coming back.

497
00:56:44,430 --> 00:56:54,970
But I think the modern NHS, the way it works, the way it's fragmented with Rotor's and so the way it's all about tick boxes and not about brains,

498
00:56:54,970 --> 00:56:59,860
it's a trap of saying, you know, I mean, they're trying to degrade the profession.

499
00:56:59,860 --> 00:57:06,370
I mean, deliberately or accidentally, I don't know. But they do regret it to this checkboxes.

500
00:57:06,370 --> 00:57:11,470
I mean, you stop thinking you stop it. Is it is it is really so inappropriate.

501
00:57:11,470 --> 00:57:16,090
Is I. I talk to people and they they give the tick box responses.

502
00:57:16,090 --> 00:57:19,900
It makes me so angry and I have to not be angry.

503
00:57:19,900 --> 00:57:24,340
So your job, is it now funded by grants from, uh.

504
00:57:24,340 --> 00:57:28,150
Well, I'm actually tired, so I have no idea where you're working.

505
00:57:28,150 --> 00:57:35,320
I'm working. But that's because they give me an office and and I don't draw a salary.

506
00:57:35,320 --> 00:57:41,560
But I have had various consultancies and I'm involved with international collaboration.

507
00:57:41,560 --> 00:57:48,700
So there is one based in Pittsburgh, which is called CoLab, funded by the Gates Foundation.

508
00:57:48,700 --> 00:57:52,750
That's one based in Norway, which is funded by Norwegian money.

509
00:57:52,750 --> 00:58:03,970
And then, um, when I retired, um, I was working with the sergeant who is was a bench scientist who he had started working in 79.

510
00:58:03,970 --> 00:58:13,270
And we continued through and he was we were on our fourth programme by then and that's still running an MLC programme.

511
00:58:13,270 --> 00:58:17,240
He was one of the very, very, very few people to get a new programme here.

512
00:58:17,240 --> 00:58:22,230
He was the P.I. and, uh, this is.

513
00:58:22,230 --> 00:58:27,330
It's the tail end of this is just so this is why I say I want another 30 years.

514
00:58:27,330 --> 00:58:31,530
They're just discovering the things that we needed to know about them.

515
00:58:31,530 --> 00:58:35,160
They said the bench, the chequebook. So the bench isn't an orchestra? No.

516
00:58:35,160 --> 00:58:40,680
Yes. No, here he I got him as a welcome base post stopped in 1979.

517
00:58:40,680 --> 00:58:49,050
He was appointed to a permanent lectureship in the university in 1983 and the new blood initiative that Maggie Thatcher had.

518
00:58:49,050 --> 00:58:59,430
And he remained in the post until last year when.

519
00:58:59,430 --> 00:59:04,560
His work in as one I mean, the maternity ward, he was he was he stopped now.

520
00:59:04,560 --> 00:59:08,040
Yeah. You know, I was there as well where he was best he had.

521
00:59:08,040 --> 00:59:15,780
And he and he and I did a lot of pioneering things together. We were the first department in the world to have our own flow cytometer.

522
00:59:15,780 --> 00:59:23,700
In 1985, we were the first department in the world to discover the first unit anywhere

523
00:59:23,700 --> 00:59:29,670
to discover the blast circulating through the blast deprived motor vehicles,

524
00:59:29,670 --> 00:59:34,260
which we discovered in 1990. How did you discover them then?

525
00:59:34,260 --> 00:59:41,760
I mean, how does one do that? Um, in nineteen eighty eight, the Americans,

526
00:59:41,760 --> 00:59:47,730
they got this endothelium little damage theory and they said we can find a factor

527
00:59:47,730 --> 00:59:54,660
circulating in the plasma and when we put the plasma on the endothelium we see damage.

528
00:59:54,660 --> 01:00:03,600
So we try to replicate that and we just couldn't, we just had so I thought blow this factor is important.

529
01:00:03,600 --> 01:00:10,260
It must come from the placenta. What factor? How can we test something coming from the placenta?

530
01:00:10,260 --> 01:00:18,330
Now, there was a long standing method of preparing, um, purified and such a dreadful blast,

531
01:00:18,330 --> 01:00:23,080
microcephaly, um, called the Smith Prussian Lockette preparation.

532
01:00:23,080 --> 01:00:34,410
So at the end of it all, you had these micro physicals which had exfoliated off the syncytial in situ epithelium that sort of reformed the membranes,

533
01:00:34,410 --> 01:00:43,110
reform them, and they were in the right orientation inside, in and outside out so you could use them for transfer studies or whatever.

534
01:00:43,110 --> 01:00:45,940
So you got those from Presente from the result.

535
01:00:45,940 --> 01:00:55,260
So we had a research fellow from Iceland called Alex Marrison, and I said, well, why don't you just make a preparation,

536
01:00:55,260 --> 01:01:02,070
a Smith brush in preparation and apply it to cultured into Psyllium from the Bellocchio,

537
01:01:02,070 --> 01:01:10,650
uh, veins, which is a standard source of cultured and the theme Kubek psychology, human umbilical, venous epithelial cells.

538
01:01:10,650 --> 01:01:15,780
So he did that and he got a normal placenta, did a free market preparation,

539
01:01:15,780 --> 01:01:22,410
pure since the glass membrane popped it on the cultured membranes and he came in.

540
01:01:22,410 --> 01:01:27,210
It was one of those major, major moments. He was so excited.

541
01:01:27,210 --> 01:01:31,320
Just the morphology of the that was just ripped apart.

542
01:01:31,320 --> 01:01:40,410
They were so toxic. This is just the normal, um, the normal surface of the abnormal placenta.

543
01:01:40,410 --> 01:01:43,200
And so that kick started a process.

544
01:01:43,200 --> 01:01:52,050
And he and sergeant then, um, said, well, we've got to find them circulating in the in the in the blood if they're real.

545
01:01:52,050 --> 01:01:58,920
This was an artificial preparation. And so he set up another postdoc to to look into that.

546
01:01:58,920 --> 01:02:03,960
And they developed a preparation for finding them, measuring them.

547
01:02:03,960 --> 01:02:13,080
And, yes, they were there. And by then people were well acquainted with platelet micro vessels and red blood cell microbicides.

548
01:02:13,080 --> 01:02:19,320
This was the third time that was discovered, Trevor Glassmaker, and they were there in greater numbers,

549
01:02:19,320 --> 01:02:24,150
in pre-eclampsia, lesser numbers in normal pregnancy and everything fitted.

550
01:02:24,150 --> 01:02:36,780
And that's what we're working on now. And so but now what we've got our perfused placental globules, um, so much more, uh, physiological preparation.

551
01:02:36,780 --> 01:02:43,410
We perfuse the lobby and in the perfuse eight off the surface of the lobby, all these vessels are secreted.

552
01:02:43,410 --> 01:02:49,230
Then we can, um, purify them and they they form into three groups.

553
01:02:49,230 --> 01:02:53,370
There are what they call apoptotic micro recycles, which are dying.

554
01:02:53,370 --> 01:03:00,540
Then there are extrude expertise, micro vehicles which have a different origin.

555
01:03:00,540 --> 01:03:13,620
And then there are exosomes which are nano vesicles. And we've got preparation's of normal and pre-eclampsia, placenta after perfusion.

556
01:03:13,620 --> 01:03:19,200
And we've separated them into the different categories of micro vehicles and sent them off to the ER.

557
01:03:19,200 --> 01:03:27,900
Makes people, whether it's are they are people who do nonbiased assays of every single molecule in the whole thing.

558
01:03:27,900 --> 01:03:39,330
It's the modern fad where the name and they're in every university element is a huge this is what John Bowlsby developed right over in the church.

559
01:03:39,330 --> 01:03:40,890
There are people who do nothing else.

560
01:03:40,890 --> 01:03:50,010
And this has spawned, uh, something called bioinformatics, which is very sophisticated statistics to make sense of it all.

561
01:03:50,010 --> 01:03:56,700
And what you get there, about a million data points and then you start making you start digesting them through your computer.

562
01:03:56,700 --> 01:04:04,360
And we've got a shortlist of six or eight. Actors, which are some of them have been known before to report some of them.

563
01:04:04,360 --> 01:04:11,410
Nobody has ever heard them. And the most important, which is really is different between the pre-eclampsia and the normal,

564
01:04:11,410 --> 01:04:17,470
is a factor which has never been mentioned in relation to the strength of the Australian centre before.

565
01:04:17,470 --> 01:04:21,260
But previously, when we say talking about endothelium, were you doing that?

566
01:04:21,260 --> 01:04:27,190
By really mean I say or I mean, how did one do end up being an entertainer is a regular Venessa?

567
01:04:27,190 --> 01:04:31,710
Yes. No, no, it's Analisa now because they don't do radio.

568
01:04:31,710 --> 01:04:36,760
No, no. It's been abolished with no time marches on.

569
01:04:36,760 --> 01:04:41,350
How much teaching medical students did you do in Oxford? I do.

570
01:04:41,350 --> 01:04:49,110
Um, I think they come through every eight weeks or every 12 weeks.

571
01:04:49,110 --> 01:04:55,240
Gone are the days of the though were three months, no attachment,

572
01:04:55,240 --> 01:05:01,660
and they used to get to lectures on hypertension because it took me to lectures, then they didn't have time for that.

573
01:05:01,660 --> 01:05:11,140
So now I get one lecture on hypertension, pre-eclampsia, and I've been giving that and non-stop since about 1975.

574
01:05:11,140 --> 01:05:16,840
He started quite early. That's good. And then had to teach English and John Bell.

575
01:05:16,840 --> 01:05:20,740
Do you have anything to do with him or are you just facing towards obstetrics all the time?

576
01:05:20,740 --> 01:05:27,160
Very little. He doesn't think anything that, uh, matches up with what I'm doing.

577
01:05:27,160 --> 01:05:31,510
And John was a very focussed man, and it's not relevant to him.

578
01:05:31,510 --> 01:05:38,470
He's away doing something else. So who would be the informatic chap at the church of the to do?

579
01:05:38,470 --> 01:05:44,700
Um, he's he's a man called Adam Thrip. Um, he's, uh, relatively young.

580
01:05:44,700 --> 01:05:48,180
I mean, he's about 40 and he's quite hooked.

581
01:05:48,180 --> 01:05:56,020
I mean, he sees all these things happening and we can produce very, very clear discrimination between health and disease by looking at the placenta.

582
01:05:56,020 --> 01:06:00,820
Right. Because, um, it's the cost of tissue and you get it.

583
01:06:00,820 --> 01:06:05,010
You don't have to do a biopsy. It arrives at delivery. Yes.

584
01:06:05,010 --> 01:06:08,510
And there are 24 placentas delivered every day in the John Radcliffe.

585
01:06:08,510 --> 01:06:17,350
You can't complain about a shortage of biological material. I mean, is each of them examined nowadays and examined the pathology?

586
01:06:17,350 --> 01:06:22,090
You see, because it's a sensitive problem and because in situ or submicroscopic,

587
01:06:22,090 --> 01:06:27,250
the classical pathologists don't find it very interesting unless you've got an infarct.

588
01:06:27,250 --> 01:06:34,420
It's not not looking at that. They're using the wrong techniques to look for a lesion which is invisible to them.

589
01:06:34,420 --> 01:06:39,070
How early in pregnancy can you pick up your factors in the blood?

590
01:06:39,070 --> 01:06:42,670
Depends. Depends who you're working with.

591
01:06:42,670 --> 01:06:52,090
Um, if the woman's got very severe impairment of placental formation, um, it becomes apparent around 16 to 20 weeks.

592
01:06:52,090 --> 01:06:56,050
But that that's for pre-eclampsia. That's going to come on at 24 to 28 weeks.

593
01:06:56,050 --> 01:07:00,970
And you then treat the patient, you know, what do you do?

594
01:07:00,970 --> 01:07:03,550
The factors are raised before the blood pressure.

595
01:07:03,550 --> 01:07:10,360
And there's no way that anybody knows that the information is not clinically useful except to say watch out.

596
01:07:10,360 --> 01:07:14,630
Yes. So you would keep an arm here. You would watch, look for trouble.

597
01:07:14,630 --> 01:07:21,080
And that's what happens. That's been going on for 15 years. But you can't administer something and say that's the end of the problem.

598
01:07:21,080 --> 01:07:25,510
It doesn't work like that. It's like type two diabetes.

599
01:07:25,510 --> 01:07:30,040
It's a complex disease and all sorts of environmental and genetic inputs.

600
01:07:30,040 --> 01:07:33,790
And by the time people are aware of what's going on, it's too late.

601
01:07:33,790 --> 01:07:40,420
You never go around to diabetes. And then, um, I'm not in a clinical sense, research wise.

602
01:07:40,420 --> 01:07:44,180
It's very good, sir. I mean, you work on that, too. Oh, yes.

603
01:07:44,180 --> 01:07:52,000
As if obesity and type in our national obesity and glycaemic stress is very close to hypoxic stress.

604
01:07:52,000 --> 01:07:56,230
And and so the two are joining together. What sort of level is it?

605
01:07:56,230 --> 01:08:07,000
Glycaemic stress? Oh, well, it would be at the sort of levels that you would want to treat anyway in terms of what's going on in the lab and in vitro.

606
01:08:07,000 --> 01:08:13,150
Um, the arguments as to when you start worrying clinically about the blood sugar has gone out of control and

607
01:08:13,150 --> 01:08:20,080
they they are setting thresholds so low that the clinics can't cope with that is their maths slightly.

608
01:08:20,080 --> 01:08:27,250
And I think, you know, I came across that through there and it seems it's even more absurd.

609
01:08:27,250 --> 01:08:31,120
Right. And and so they have huge clinics. They can't manage that.

610
01:08:31,120 --> 01:08:36,220
I don't think they know whether or not they're doing any good. And I suspect they're not.

611
01:08:36,220 --> 01:08:42,740
Yeah, it's it's just it's hopeless. Um, they what happened last year that I should have.

612
01:08:42,740 --> 01:08:47,680
What do you want to tell me? Um,

613
01:08:47,680 --> 01:08:58,660
all I can say is that I came into medicine completely uninterested in research and I've ended up completely obsessed with the fruits of the research.

614
01:08:58,660 --> 01:09:01,870
I'm an absolute convert and I love it.

615
01:09:01,870 --> 01:09:08,780
And that's why I want another 30 years to get that. And how many times a year would you go abroad at all?

616
01:09:08,780 --> 01:09:14,500
Um, roughly about six or eight years. Now I'm still in demand for meetings.

617
01:09:14,500 --> 01:09:20,020
I'm sure I'm going to Sweden twice at the end of this month for two different events.

618
01:09:20,020 --> 01:09:28,240
I'm going to, uh, uh, Reproductive Immunology Conference in the Reunion Island in December.

619
01:09:28,240 --> 01:09:31,960
I'm going to, um, Norway in January.

620
01:09:31,960 --> 01:09:42,430
South Africa and being in Brazil, which just being in business, um, as you travel around, uh, probably impossible to get a real feel.

621
01:09:42,430 --> 01:09:47,980
But do you get a feeling of how the NHS compares with other countries now?

622
01:09:47,980 --> 01:10:00,680
Uh. Yes and no in America, they are absolutely bemused why the conservative government is privatising the services as quickly as they can.

623
01:10:00,680 --> 01:10:08,750
They said we've been fighting for years to get out of privatisation. It's very counterproductive, wastes money and and so on.

624
01:10:08,750 --> 01:10:15,380
The very intelligent positions over there who are not into profiteering know perfectly what it's all about.

625
01:10:15,380 --> 01:10:18,410
And they just wish they had more of an NHS.

626
01:10:18,410 --> 01:10:30,830
Um, I in in places like Norway, they still got enough money to run good systems, um, because they're very, very rich, much richer than ours.

627
01:10:30,830 --> 01:10:32,900
But they are, um,

628
01:10:32,900 --> 01:10:41,640
they've got all the problems of Rotor's and then nine to five Nixon and so even worse than in England and that's where it falls apart.

629
01:10:41,640 --> 01:10:47,240
I in the old days we did what needed to be done and stopped when it was done.

630
01:10:47,240 --> 01:10:52,580
Nowadays they say, Oh, I've done my best. I'll tell you about what the problem is.

631
01:10:52,580 --> 01:11:00,470
And, uh, and they could but anybody who's been in hospital and I have more than my,

632
01:11:00,470 --> 01:11:07,670
uh, what I'd like to be knows that you you get no continuity of care whatsoever.

633
01:11:07,670 --> 01:11:13,910
And when I was in after I had a quadruple bypass in 2012, um,

634
01:11:13,910 --> 01:11:20,750
and I was really well looked after until I came out of ICU, after that, I had to direct my own care and I was a doctor.

635
01:11:20,750 --> 01:11:26,210
So I was lucky what other people did. I wasn't getting my medication. I was getting the wrong medication.

636
01:11:26,210 --> 01:11:36,360
I was being asked to do things were inappropriate. And I had completely and they the nurses are not what they used to be.

637
01:11:36,360 --> 01:11:43,190
They they're very self regarding they they regard their activity as steps on a career ladder.

638
01:11:43,190 --> 01:11:50,360
They don't see any commitment, you know, very few of them to other enough midwives then.

639
01:11:50,360 --> 01:11:54,130
Mm hmm. But they're committed to this.

640
01:11:54,130 --> 01:11:57,950
Uh, they have change because they don't do any, um, general medical training now.

641
01:11:57,950 --> 01:12:03,020
So they don't do the nursing training, their direct entry into midwifery didn't.

642
01:12:03,020 --> 01:12:07,850
And so they are so ignorant. Oh, uh, and they are so small minded.

643
01:12:07,850 --> 01:12:12,590
They're only interested in getting a woman delivered this year. That's what they want to do.

644
01:12:12,590 --> 01:12:17,930
And if she happens to have hypertension or is dying of this or that, uh, that just spoils the fun.

645
01:12:17,930 --> 01:12:22,070
So they don't really want to have much to do with. And I'm exaggerating. Oh, sure.

646
01:12:22,070 --> 01:12:28,130
Sure. Gosh, anything else. So we finished, um, anything else.

647
01:12:28,130 --> 01:12:33,050
You've obviously enjoyed it over is uh. I've been all right with tough periods.

648
01:12:33,050 --> 01:12:41,210
I mean, you're I probably didn't enjoy the, uh, decade beginning 2000 until I got out of it by illness in 2008.

649
01:12:41,210 --> 01:12:43,400
Then I began to enjoy it again.

650
01:12:43,400 --> 01:12:53,510
Um, and, uh, I always thought that progress was incremental, that you got things better than people held wasn't better and got them even better.

651
01:12:53,510 --> 01:12:57,080
And what I hadn't realised is that you get to a point where people have lost,

652
01:12:57,080 --> 01:13:01,310
forgotten all the lessons of the past and just throw it away and say there's

653
01:13:01,310 --> 01:13:06,380
this element of going around in circles and getting back to square one again.

654
01:13:06,380 --> 01:13:11,520
And that's very much happens in medicine. Yeah, they, uh.

655
01:13:11,520 --> 01:13:16,220
Well, these people just have to learn the lessons and they go.

656
01:13:16,220 --> 01:13:19,590
Thank you very much for that interview. A really interesting book.

657
01:13:19,590 --> 01:13:21,265
OK, well, thanks for coming.