Welcome, everybody. It's interesting. We're going to talk about the news.
This gentleman here actually has a newspaper. Many people don't know what one of them is, actually, I'm pretty sure.
So I'm going to talk about I do a lot of work in evidence based medicine and I do a lot of work with the media.
And I'm going to talk about why you all should do a bit more yourself.
So this is all aimed at you to get involved. Okay. So first thing is, there's a lot of out there.
These are the views per month individual three shooting fans and four.
But 80 million people, the number one paper in the UK, The Daily Mail, followed by the Sun, The Mirror and down here.
And then you get to the express. And in the middle is all the for the Sunday Times and in pen for lots of news.
Our consumption of news is actually going up.
To talk about how it was 20 years ago with much more print and with the advent of computers and their mobile phones,
how we consuming more news than ever. But my some of my favourite paper paper if I start with the Daily Mail and the Daily Mail's a
great paper for health care headline loads of really interesting stories about processed meat,
heavy web use harms a child's health poisoned by everyday life from bad, lethal cigarette.
Now, it's interesting to note, why does this appear and why does it keep happening?
It's incredibly prevalent to have health care news headlines is the editors know that you will click on these headlines.
So you are part of the problem in that you know what it's like.
You know, you know this is fake, but you can't wait to get in there and find out.
So on the portable on the phone, we all go in and this increases in go zone.
And even in Oxford we contribute to some of these these stories that obesity in women is dangerous.
The terror threat and this is an Oxford study don't drink more than three glasses of wine a week.
And so what's also interesting is how do these stories get interpreted?
And I'm very fascinated by health care headlines.
And when I first did this talk, I even sent out on Twitter a request for people for their favourite headline.
And this is David who's running this week, his David favourite health care headline and so together.
So David has an interest in exercise and lifestyle and this is a sort of evidence that he spends his time looking up about this.
But, you know, it's interesting, isn't it, as we look at this stuff, you think, well, how does this impact on the decisions we make?
And as I've shown you, he's my favourite.
Your fridge is a major killer. You just don't know it.
But here's my other favourite paper in the whole world. The Daily Express.
The Daily Express definitely trumps the Daily Mail,
and I'll show you what I'm going to come to a headline, which I know, but this is just about dementia.
I started collecting news stories about dementia from the Daily Express, thinking, What could I learn?
Simple way to fight off dementia. Actually, it's a stressful lifestyle.
And then I started to think, Well, this is a bit odd. Chocolate can halt dementia, but lose weight to beat dementia.
So how can anybody know you can eat lots of chocolate and lose weight?
It's quite an interesting issue. You know, actually, you don't eat anything else,
so you're going to go on the chocolate diet to stave off dementia and it keeps going daily drink aspirin,
new way to fight dementia and even red wine pills stopped dementia.
And so I was going I was getting really excited. You know, what you're like is a researcher.
You like collecting data, don't you? We like to collect things.
But what happened is this started to get a bit of a series addiction for me in that they started to increase it increase.
Now the qualitative research is in love.
This I thought, well, actually what we'll do is we'll take the headlines and try and create some themes.
So I started putting them into theme.
So here there's something about healthy living over here in lifestyle, something about drugs and chocolate, simple ways and to fight dementia.
It's somewhat about tests and spicy diet.
So started to organise them into is it a female tick analysis?
Is that fair? What would you call that? Is that it's the beginning the beginning of being a qualitative.
And when it did that I noticed is started to be able to fill in the.
Even more and ended up like this with these eight different ways of looking at how we're going to beat dementia so you can lose weight,
eat chocolate, keep busy, and have a healthy life. You can do puzzles, take some drugs and have some tests and watch your diet.
And the Daily Express tells you how to do that. But, you know, this is all [INAUDIBLE].
When you look at all of them and you know this is what's going to happen in ten years time.
And that's the issue here, isn't it? You start to go and this is how this is mine.
Anybody can add in another one. There are loads of really interesting headlines that we're all, all the time looking at and pressing.
Let's have a look. And I know that because the editor of The Express, his favourite topic is statins.
His wife took a statin and his wife then got some muscle pains and decided to stop taking the statin.
And so he became obsessed by statins.
And what happened in doing that is a I think about tripled their readership when they put a story about such things on the front page.
So they're always looking for statins, but what interested me is the circularity of all this.
So this is the one headline Take Statins to Save Your Life, and then you go, Oh, let's put that in a health alert.
Interesting. And part of that is the next one is it causes diabetes.
However, in causing diabetes, we're going in that direction.
It's going to cause chaos.
But in causing chaos, we back to prove statins save millions and we come back in a circularity again and we'll get the whole thing.
And this is what happens in about a year.
And these news headlines keep getting recycled in a way if a piece of evidence emerges that actually fits this narrative.
And you can keep going. You can upload the form with the express. You can do cancer, you can do whatever you want in headlines.
And some of these are verging on the ridiculous drug to cure.
Nine in ten cancers, rhubarb can save your life and they will feel a bit like fun until you meet the first patient who says,
I stopped taking treatment and now I'm taking rhubarb instead.
And I was describing a patient I've seen who basically came off his chemotherapy because his real life case started to take coffee enemas instead.
And that will not anybody in medical care at some point is involved,
will find somebody who goes on on one of these news headlines to take an alternative path.
And I can come back to what I think issues usable. So it's interesting.
So Google's official blog, about 1% of all searches on the Internet now.
And that's you know, you don't have to think that's millions. If not, God knows how many that are about people just looking at symptoms.
And that includes you. When you have a symptom, you go, ooh, I'm going to look it up and see if there's a miracle cure or what's going on.
But interestingly, they sort of started to take a position to start to think about their role in health care.
Now, you think it's because they're going to do health care for they want to do the right thing.
They've realised like the Daily Express, this is a business and in doing it better you'll come to Google more often.
But again, the evidence of the self-check is and there is this paper which is in the BMJ, that shows when you look at the symptom checkers,
there were 23 symptom checkers provided the correct diagnosis was only available a third of the time in these online forums.
And you start to think, what's going on here?
If you think about the drivers of health care, when is this appropriate for people to check something and go,
Well, that means I need to go and see my doctor.
Or actually I can stay at home interested in its own right, the potential to carry off more work or inappropriate work.
So I'm going to take you back in time. Here's my guilt again. Those in the MFC told them this here.
This is going back to 2009 and 2009.
There are move people when we're all going to die. Okay.
Remember that Daily Express, we're on alert for the new super flu.
Don't know. It's not about Jonathan Ruffin. It is swine flu already here now the battle to contain.
It starts, then it gets really serious.
Now, you really interested in the news? Because it's going to kill 350 people every day.
Yeah. We are in panic mode and you can't go on your holidays.
It's just like when you think about Brexit, you won't be able to go on holidays.
You couldn't go the holidays in 2009. What was the problem? And then if you really think about it, it got even worse.
When are you going to go? We're all going to die. It's interesting.
So what's happening now?
Interestingly, some of that was based on fake and some of it's based on real experts and what we do now going back to the swine flu,
remember, some of you should now be dead. Donald Rumsfeld, remember the known unknowns and unknowns, whatever you know, you don't know.
Well, he actually this is an article in The Independent.
He actually had shares in a company called Gilead who had the intellectual property to Tamiflu.
And he this is an article about him saying he ordered this UN report into how many predicted death would bird flu cause now.
You'd like to have a go? A number? How many deaths do you think would be by bird flu?
You can go either UK based or worldwide. 1020.
A couple of hundred. A couple of thousand. You're going to go 5000.
That feels pretty high, doesn't it? And would you like to go higher or lower?
Because this is important. If you're going to think about stockpiling drugs and thinking about we're all going to die.
How many people in a UN report were predicted to die?
We have 5000. How many of you think lower? And how many of you think higher?
Oh, you're all a bit higher. How many lady there with a green scarf?
170 million. 170 million.
Bloody [INAUDIBLE], man. I knew it.
Not too bad, actually. In fact, we were some of the 700,000 deaths that might be expected in the UK alone.
So it was 700,000 deaths worldwide were predicted.
So you actually although it sounds laughable, you weren't that far out.
Yeah. So we predicted so. No wonder everybody goes into panic mode, but this stuff really gets into our psyche and have impact on policy.
So you can calculate what's called the news to death ratio.
So in the first 24th of April, 2009, in the first 15 days of the swine flu outbreak, you can look at the number of deaths in terms of swine flu.
So there were 31 death for swine flu in the same 13 days for TB, there were 63,066 death.
The number of news articles were for swine flu were two five 250,036 and 8000 for TB.
So that gives you a news to death ratio of 8176 news articles for one death.
But actually, every time you see a news article on TB, there'll be ten death.
Now, that was done by a guy called Hans Rosling.
I pinch that often, but it's got a very important message in the distortion about how the news comes at you,
because this is a major killer and it's really important in terms of its health impact.
But nobody gives. A monkey study about it.
Nobody cares about it in any way. And I think all of us go into this area and think where the excitement.
But this is a huge killer. Now, we published the Cochrane Review in this area,
got the unpublished data and did lots of fun and published all sorts of stuff that says, I wouldn't give this stone to 12.
It's got huge problems.
We published all of the research and I thought we would change practice and we ended up in 2014 £550 million we spent on stockpiling this drug.
And it's a waste of time. The reason it's a waste of time, it does have a symptomatic effect, a bit like paracetamol.
The evidence shows it reduces your temperature, reduces some of the symptoms of flu,
but it doesn't reduce the important complications of flu like bacterial infections,
hospital admissions, all of the things you would want it to do if you were going to stockpile it.
It doesn't actually prevent you from getting fully when you look in the back of the evidence.
I went to a parliamentary committee in 2014 and this is when it hit home and we spent about 2 hours laying all this out and leaving that committee,
thinking all of the people in the government get this issue.
And a week later, we spent £50 million more stockpiling it because the stockpile we had was going out of date and they said, we can have it cheap.
You can have it at the half price if you renew your stockpile.
So I also think there's a huge agenda with our policy people thinking about how we inform policy in an evidence based way.
That's part of our job in research is to think about how do we arm the next generation of policy people to look at evidence.
So some people with money will have been on the MSE course and seen this graph where there are thoughtful steps to evidence based practice.
Ask a question, acquire some evidence, appraise the quality and apply it in practice.
Now, when I'm thinking about applying this to the media and thinking about how we go about a
process of informing the news and what we do in health care is finally flip that round.
And I use this in a different way. I have an extra step, so I focus.
You can see instead of asking questions here, this is an extra step that's going in.
So I think about acquiring the best evidence and assessing the effect all the time.
When I get asked about media questions or healthcare evidence, I think, is this the best evidence and what's the size of the effect?
This step is deliberately smaller because we never get to the biases,
often because by the time you're in the biases, most people don't understand what we're on about.
If I'm having a discussion in a newspaper about confounding and indication, bias confounding by indication,
and the people going, We're not interested, nobody's going to understand this.
So I focus on these two areas and I'll show you how I do it.
So the first step is I always think about is when I see some evidence,
I ask a general question, Is this the highest level of evidence to answer this question?
That's my first step. And often what you'll see is, for instance, within the sort of process of evidence, you'll see lots of news headlines.
But down here it might actually be just an animal study, but if it's an animal study,
it'll take 20 years to get into practice and only about one in ten of them will get into practice.
So when they say we've got a new cure for dementia and it's in mice, you're thinking, well, one in ten chance in 20 years.
There's a quote where if what you're thinking is, where are we in the evidence hierarchy?
And to do that and inform that you generally want to be hierarchy, don't you want to be open to the systematic review?
And and to do that, you need a very good understanding of this one table, which is the levels of evidence.
What type of question is it and where are we in this matrix?
And if we down here, we know we've got some issues where if I want to be at the higher end of the evidence, to think about the systematic reviews.
So I'll give you an example of how we applied that. We did this for evidence for what's called IVF add ons.
We was approached by the BBC who said We're going to do a story about all of these add on treatments that you can get in addition to IVF.
So we did two things.
The first thing is we said, Well, let's look at the websites and look at what the claims are and how many times they actually when they stake a claim,
they cite a bit of evidence and then ask a question is, is it the highest level of evidence?
Is it actually a systematic review? Because if you were having a new treatment, you would.
I want to be saying, is backed up by a systematic review. And in doing that, we showed that actually they were all miserable.
That actually they often on the websites didn't find any evidence.
And when they did, they actually went to lower quality or opinions.
And when we went searching for the evidence, we could only find evidence five times where there was some evidence backed up by systematic reviews,
where you think there might be an effect and then discussed the effect sizes.
Now, in just doing that very simple bit,
we got to a point where most of the Royal College of OBS in Guinea and there are some people in here went mad at us and said,
you have no idea what you're on about. Well, remember, my job is I'm a GP, I am a GP.
So my job is to try and inform people. If they come in and say, I'm thinking of having some IVF.
What do you think about embryo glue? Well, I can tell you moved GP's have no idea what to do in that situation.
So there has to be some way of saying where's the evidence? And said, what do you think you're doing?
Explaining what the evidence is when you're not an obstetrician or a gynaecologist.
When I said I thought, That's what we're trying to do. And all we do is say, What's the evidence in terms of its level?
I'm not even gonna into the effect sizes. Two years later when you think about different this has been really interesting.
So for about two years went round in circles and then early at the end of just the end of last year, the FDA,
who the Human Fertilisation and Embryo Authority did a whole review where they brought
together a system which I think is a huge step forward based on the research.
And what they did, they said here we're going to provide you with the evidence.
But they did some really smart, which I quite like. They have a traffic light system which is their traffic light system is red, amber, green.
And the red there is this is assisted hatching. It talks.
You are the rest. What's the evidence? And it says there is no evidence.
You can't see that you need know that this ad is effective and safe.
That's a red light.
When they have a green, they say there is evidence from at least two randomised controlled trials and in the amber they go it's uncertain.
The evidence is conflicting and it needs reducing in certain and I quite like
that system because the traffic light system helps you really simply think,
okay, what's the evidence? What's it like? Is there any evidence?
If the answer is no, you've got a red. If there's more than two trials, at least you're on the pathway to somewhere.
And you can start to filter out a lot of evidence really simply by just asking
what type of evidence is it and is it appropriate to answer this question?
Now the second step then is assessing the effect, and that's difficult because you're really thinking about patient benefit.
So I often think about this is an equation in my mind that I think about, and each patient benefit is directly proportional to the outcome.
The bigger the outcome, the more benefit, the better the outcome, the more benefit, the more relevant the outcome, the more patient benefit.
So if I say you get a two year reduction in mortality, you might think, well, that's an important outcome.
However, it's inversely proportional to the bias. The more bias, the less patient benefit.
And if you introduce biases, you're overcoming the patient benefit.
Now, that's really important in your thinking because if there's only a very small outcome benefit, any small bias will overcome the patient benefit.
It is a rather large outcome and a big outcome.
You might accept more bias. So it's a simple way.
And then the third thing is you need the optimal information size.
That's what systematic reviews are about, having sufficient information to be able to say with some certainty.
This is a true effect.
It's not the big data, you know, not it's not all the information because people get overwhelmed with we've got 3 million patient years.
What you're interested in, have I got the right amount of information?
And so one of the things to think about is to start with,
I optimise the outcome and this is my second step and I ask a very simple question all the time Does this make a difference?
And if it doesn't make a difference, why do you even need to care about the biases?
Why do you even need to care about whether you've got optimal information?
Why not just stop and you can stop and filter out a lot of information really quickly?
Now is not quite there are there are bits of to does it make a difference?
Oh yeah. And I think about three questions to that when I'm doing that.
Yeah. And is assessing the effect I have these, these three questions.
Who does. It applies to. Does it apply to the actual people we see or the patients we see?
Does it make an actual difference? Both positive and negative.
The benefits and the harms. And is it actually feasible?
Yeah. And so you have to think of the three questions I'm often putting in at this step.
So if we come back to the IVF example.
Yeah. The first thing you would expect to happen is that anything that makes a claim for an intervention will be backed up by some evidence.
Some of these treatments are of no benefit whatsoever and some of them are harmful.
And that's going into the state. But it's going to. For instance, which ones?
And only one treatment called an endometrial scratch was supported by moderate quality evidence.
It would help it involve the procedure to scratch the womb lining to help an embryo successfully implant,
although the evidence for this treatment was not itself beyond doubt.
In fact, what's happened is this was the only one that was a moderate evidence of benefit.
A large randomised controlled trial has come out in the last month that says it's of no benefit.
So we often get this early stage where things look promising, but as you go along, nobody.
So you get by asking, here's another one. I'm thinking about the outcome.
Does it make a difference? So this is an interesting paper came out in the BMJ.
I got us to quote on this so I don't know anybody here.
It quoted for the media part. When you're on the Science Media Centre list, anybody else get asked to make a quote?
Yeah. Do you actually quote? Yes, sometimes.
Is it difficult or do you do it really quickly and integrative? I spent that time and you say, yeah, yeah, yeah, yeah.
So it feels like sometimes it's going to take you forever. And that's why we don't participate.
This is a real I'm going to be quoted in the news. I'm going to spend half a day read the evidence.
Oh, my God. In fact, I haven't got a time to do that any more.
So I actually think, oh, this is really interesting. I'll have a quick read while I'm having a cup of tea and to think about my framework.
Okay. And I think I'm going to quote on outcome and here's here's me being quoted.
Here's what I actually said and that's what I said. I wonder if these make a difference.
And I wrote a quote back to the science media saying,
It's hard to understand why half the drugs were approved in the first place if they provide no clinical benefit, he said.
And that's it, Don.
That took me about 5 minutes reading it because they're going with a very structured approach to what I'm looking for in the evidence,
as opposed to just reading it and hoping some amazing quote will emerge.
I go in and say, Does this make a difference today? And as I said to you, if it doesn't make a difference, why would you carry on?
That's my quote. So there's this sort of approach to benefit.
And I think if you think about outcomes, we haven't touched any of the other two bits.
I've told you two things. Is this the appropriate evidence to answer this question and then these three questions?
Does it make a difference? Does this apply to my patients? And is the treatment feasible in my setting?
Okay. And you want to think about optimising them.
So sometimes I get things like research and I dismiss it immediately because I'm asking this is a question about does this apply to my patient?
And in thinking about it, I think does this apply to me?
So effective breakfast on weight and energy intake, a systematic review and meta analysis of randomised controlled trials.
This was a trial of whether you eat breakfast or should stop eating breakfast and how many people don't eat breakfast.
Okay. Do you actually care about whether you should or shouldn't and whether it has an impact on your weight loss?
Look, I don't care. I say it depends how much time I've got in the morning.
If I if I lie in too late and I'm running late, I might not have breakfast at the weekend.
I have breakfast. So I'm like, this doesn't even apply to the people I see.
Why would anybody even care about the effect of breakfast?
Nobody's ever come into my clinic and said, I talk to Hannigan.
I'm really thinking about whether I should give up breakfast or not. What's your advice?
I've never seen anybody, so it doesn't mean you.
But what I'm saying to you is this is a dramatic example of is this the sort of evidence that applies to the people you see in practice?
If it is, no, I wouldn't waste your time. I've moved on now.
You could read it if you're interested. Okay. Oral thought for a reason.
Now, at the moment I am feeling a little bit stressed actually at the moment because I got involved in that.
I'm not sure I should have got involved in what I have done because it's a really evidence based issue.
This is a piece I did a piece with Panorama, which was about gender dysphoria and the drug treatments in children.
And these things now in the world are incredibly emotive. And I don't my my question is not whether they're right or wrong.
The one thing I do is say, what does the evidence look like?
Have we got sufficient evidence for somebody to make an informed judge?
And in terms of children, you'd think, well, actually, you would want robust evidence, wouldn't you?
These are very powerful treatments we're going to use.
So if we're going to go down this route, this is a good example of how we should frame the whole of medicine, how we should think about what we do.
Now, the problem is in health care is, boy, do we jump on bandwagon.
There's a huge history of just trying treatments and going down a route because we think they can work.
And in this article I put I said, we've got ourselves into a complete mess here because about seven or eight years into this,
we have got in a position where we've given out these powerful drugs and now we're going more people want them,
and now we're going, Oh, what's the evidence? And I looked at the evidence and went, Oh, my God, this is abysmal.
It's worse than the IVF. Now I can handle with the IVF because of the problem in IVF.
If you get it wrong, it's okay. You don't you don't have a child. That's pretty bad.
But if you get it wrong and somebody is having really powerful drugs, wouldn't we as a society want to be thinking about the difference we make?
Now all I do is say what the quality of the evidence.
Now, on one side of this argument, people think I'm amazing.
On the other side of this argument, they think I'm an absolute nightmare, the devil himself.
And he feels like that because of the ideology. And all I'm doing is I not said anything apart from this should be done in a research context.
If we're going to go down this route, we have to develop the research evidence and we have to do it in a really robust way.
And there are so many unanswered questions and so many uncertainties.
We have to have a different approach and at the moment we seem to be going, it's alright,
nobody wants to go there because we're all a bit scared of the stuff we'll get happening.
But if we can't do it for this in children, what are we going to do in the whole of society?
And I think these are really interesting issues we now face.
We are bringing treatments and innovations and new devices and technologies in a way that we've never seen before.
Innovation is the word on the street. And in doing that, we want to ignore the evidence, apart from when it suits us.
So one thing is the debate now I've learned is when I'm going to go somewhere controversial, I always write a piece to go with it.
So I've had some pieces today that have gone You've said this, and I go, I didn't say that.
And so instead of trying to answer it back ago, here's what I said.
If you go here, you can read my review of the evidence and what my conclusions are at the end of the article if you disagree with them.
So some people right now disagree with systematic reviews are an important way of informing the public.
They think they're terrible. And I go, Well, okay, that's alright. But we use systematic reviews and here they are.
And in there I took the individual studies and said, What does it look like in terms of the effects and the quality?
And I think this is something I've learnt.
If you're going to join the media and have a go and say things, you should always have a backup where you go,
actually here's my viewpoint here are published in some blog or some place where actually this
is what I said and that helps you a lot because it gives you a if somebody misquoted you.
And I think that's what everybody's worried about. You join in and suddenly somebody will translate something.
You've said something into something so real or something.
You go, I didn't say that. And that's what happens.
So if I'm thinking I'm just going to end up now and then we can have a few questions is there's a book,
there's a whole new world out there, and that world is Facebook and social media and bypasses.
So the newspapers have sometimes put really good stuff up there, sometimes, as you've seen shocking stuff up there.
But a lot of the time they're sort of in the middle.
But this type of stuff has a huge impact because a large majority of health news shared on Facebook is fake, is fake or misleading.
And that's what everybody is in their ideology sharing information.
So the question is in health care is what's the role of researchers in informing the public?
And if you look last year in the ten most shared health articles on social media,
his his and this was in a way of just a simple measure of trying to say most of them are low are very low in terms of scientific credibility.
The three that weren't here were six, seven and eight.
And six is about cold or flu symptoms is how to tell the difference.
One about stem cell treatment and the other was about how cycling in old age can keep your immune system young shed a lot.
So we all like cycling in old age. The other ones are this one fine.
Marijuana is 100 times less toxic than alcohol and it's safer than tobacco.
That's a move shared story on social media last year.
That's because all the people, I guess, who want to take their marijuana quite like that message and want to pass it on to everybody else.
So it's a really interesting arena in terms of what our role as researchers in informing the public and how might you go about that.
And I think we do have a huge role to play. And this is Fiona Fox, who runs the Science Media Centre, who do a great job.
They have a system where they recruit people who will comment on news stories.
And David's on that list and I get stories. But what she said in there was really insightful and she was commenting on this lady, Jenny.
Ronnie said, I'm leaving the thought to world because you can't beat fake news with science communication.
And her arguments were trying to say that actually I am seeing plenty to reassure me that the public are more discerning.
The latest trust rating showed once again that scientists remain near the top of the list of most trusted professionals,
with 83% of the public trusting scientists to tell the truth, compared with only 17% who say the same about politicians.
So if you are involved in research, the public trust you to say the right things.
And in doing that, I think it's helpful to say what she said.
He's finishing it. Say no one said it was going to be easy. And I'm open to Roland's claims that it might be getting harder or at least more bruising.
I think that is true. The world is more breathing than ever now.
If you just try and put out a very clear message about here's the evidence.
But that's all the more reason for Roan and a fellow scientist to hang in there
now would be the very worst time for scientists to return to their ivory towers.
Now I'm just going to finish with something that it doesn't matter what I do.
I can't do anything about it. And it doesn't matter what you try, what your strategy is.
There are some things you just can't do something about, and there's one now, having finished that, just to say.
One of the things I'm having a bit of trouble at the moment is, is sleeping?
Anybody else got a problem with sleeping in the room?
Yeah, it's sort of like I'm alright with it. But what I do is I rely on the Daily Express to inform what I might do about it.
And those of you sleep too much, you say you're in trouble.
I'm alright, I'll be fine. But it's actually I'm using the Daily Express to help me out.
Thank you very much.