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So it's interesting. I'm following some of you.

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I know you've you know as well about the talk that we've got that even an expert in over overdiagnosed from the age of 18.

3
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No, I agree or disagree or shout from the back. But what's interesting is there are many aspects of infection control that you can think about.

4
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Well, I'm just interested in the disease and how we diagnose and treat it better, manage it better,

5
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or you can think about it like this, about the methodological approach we take to health care problem.

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Now, some of the work we do not get involved with lots of different organisations in the centre working in a sort of TARDIS effect way.

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And why do we say that there are vulnerable people in the centre. But we work with lots of people globally in particular.

8
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But when you're walking through the they get bigger because of all the people who contribute that you and I first went to in about three weeks ago,

9
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four weeks ago with a lady called Margaret McCartney, who's a Scottish me,

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that got really interested in this area and we want to solve and talk to you about it.

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And then I'm going to be taking it to the theme to Barcelona in September where I'm doing a keynote and overdiagnosed.

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So this is my own journey in thinking about overdiagnosed medicine.

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So when I was first thinking got invited to the keynote, I was actually in New York.

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And when you go down the street, the new library from the right there, they have the signpost, which of course you meet there.

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And then you can talk about the traffic growth of a carried on further down.

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What a thought that that it was actually I think it was caution for bands like this that existed near roll and at the side of the road.

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You can get a CT scan of your brain on the road to early detection.

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I come back to that think that's what the culture was really about. So I went back to my hotel.

19
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We got to take the, you know, go to the beginning of the.

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I want to go back to my hotel room. You only get one of these in America.

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You get really big dreams about America.

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Get Matthew Green back in the bedroom and let me in my face and then go to 23 me dot com.

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Welcome to all your kids today to get my genetic test kit because this is a real big issue in America.

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Okay. Back to the premise that the UK is everywhere and this is the news headline.

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In the U.K., 120 people tested for genetic heart failure.

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And this is in the Daily Mail. I tell you, affecting half a million people, but it's being made available in the U.K. to fly home.

27
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And then I got home. I've got this letter.

28
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And this letter were to me at my urgent medical.

29
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Let's do it now.

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The two year old, they left our accommodation, as we mentioned in our previous left, that you were due to have your your eye test 29th of 2014.

31
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Call is immediately all book online and for your local optician.

32
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Now, interestingly, I have a family history of glaucoma and it's got family history of glaucoma.

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And you aged over 40, you get pretty. So there's a sort of intensity that brings about every year.

34
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But the question then is if you to teach about these things in the question of if I should have the examination and why should I have the examination,

35
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and what's the evidence for that victimisation?

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And it can be people participating very, very you know, in the question, how much benefit do I get and how much harm?

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What can we do to stop them?

38
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Never know what do it without.

39
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So when I look at the evidence is the evidence of systematic review, the economic cooperation, relatively poor with the help of the evidence.

40
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And this evidence tells us that based on a few randomised trial you did in the very important case because you found

41
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the problem of not extrapolating from these and assuming accelerated progression with advancing disease severity.

42
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You have to stop at that point, don't you? What does that mean?

43
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What do you mean? Well, what I'm wondering is how you find the ACTU.

44
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How about. Yeah.

45
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So I think that's been done to get you know you get totally it became really simple like are they making people.

46
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Yeah. Do you think oh my God they really don't make an amazing model actually.

47
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Did you think what, we're going to go somewhere in the 20. For that committee.

48
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The 2030 is not something that's going to affect me now.

49
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It's out of it, but they're basically making it up.

50
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What does that mean when you stop and think, okay, what does that mean?

51
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Okay. Parents would have to be about 3 to 4% in fourth year old with a screen rental ten years to approach cost effective that.

52
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I'm going around the office every year, and every general population from any to this appears not to be cost effective,

53
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and selective screening approved by friendly family history might be worthwhile.

54
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This would only cover population screening and, you know, every year.

55
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So that's interesting. So then I think, well, I'll go back to the U.S. and screening in the America of the well-informed.

56
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They'll go to the U.S. Preventive Services Task Force and ask of their guidelines.

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What do they say they do to their own nation?

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And they come back and say, after reviewing all of the things they have not recommended for or against,

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routine global glaucoma screening grow a little bit, at least within this film.

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And so then I go, Well, okay, I'll come back to our informative website, which is NHS Choices,

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which is telling me that I should have regular on test for the problem which we talk about can be diagnosed and treated.

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Anybody feel reassured yet? What's going on? So do you feel informed that whether you should have an annual test or no?

63
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Well, I feel a lot more confident soon as I look at the evidence and hopefully not quite clear information like this.

64
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And look. And so when you look at the systematic review and then it's going to be but I think it's

65
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important to be able to understand some of the basic political or diagnostic to say,

66
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if I have a positive test, what does it mean to me? How much difference does it make?

67
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How would that be true or not? So one of the things we do is use a natural frequency.

68
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If we can talk it through that, I could be a lot more willing to take a thousand people.

69
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The chances of me having glaucoma are about 5% right.

70
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The chances of me not of glaucoma becoming 95.

71
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That will happen. But we've got people I know whether that's in my family, my family history, about 45.

72
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If we take the word test that we say some of the tests that we use in the eye or in to the pressure,

73
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if I take just the sensitivity of 10%, that means that 50 people with only 550 of 81 really important people, including the.

74
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You couldn't do that well because I think the proportion without that.

75
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Does that mean if I use the test with a better sensitivity 10%,

76
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which is the worst test you can find in 58, 186 positive test, only five will have the disease.

77
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So that's miserable, isn't it? No, I think that if you go back to maybe some of the tests have better sensitivity,

78
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but let's assume the best ten people go to my screening in restaurant and all the paper things, the prevalence of the say, the sensitivity is now 90%.

79
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That gives me about 40% of positive is much better.

80
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Yeah specificity here of 90% really good test ability to tell you that.

81
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So I have 140 positive test. Only 45 people have anything.

82
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If I have a positive test tomorrow, glaucoma. There's one third chance I have low tumour two thirds.

83
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Can I do if I have a positive test or different lifelong treatment?

84
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Done. Now before we go,

85
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you know in the open here about how you use that information and think about what you should do for yourself and whether you

86
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should have the test doesn't tell me about that one test and then you realise you should have never be employed to do it anyway.

87
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But one woman came up after a prevented that. She said, oh, you were wrong. No, I had a test negative and three years later I had to go home.

88
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But what? She didn't. You've got to become symptomatic and then have it's a completely different screen.

89
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But at some point, the pressures of her life started to become she looked away with care and she

90
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noticed that and then got a text from the president with a different test.

91
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So people my age coming in and I'm still five or £10 off.

92
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And you can get them in pound favour for like a pound. And if I don't sure what to do.

93
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And you might want to think about that, though, for me, but that's not the end of my friendship, because I seem to be now at the age of 45,

94
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is now in the age group where you are a target for anybody who thinks they can do something for you.

95
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So here's me from the health screening apartment, the invitation to miss the call.

96
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Did Mr. HANNITY invite you to a health clinic and have no comment?

97
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That was and I'm really privileged to say fly by night and drive that.

98
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We write to a small number of people in your area for your service.

99
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I tell you, it is a simple system that keeps our administration costs low,

100
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meaning we can offer extensive health screening at a fee that is exceptional value.

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Rest assured, we have no other information about you.

102
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But you don't know the whole process. What I'm going to people are going to find out about it that I do.

103
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If you wish to take up this time and just let know what time is best for you, or if you prefer a different day to be able to change your appointment.

104
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And look at that. We continue to come back and talk to you about that theme.

105
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The people are pretty happy that we didn't want you in town.

106
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Now you're not allowed to have an annual cost.

107
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How much do you think it costs to have a GP for a year in the UK?

108
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If you want a GP for the whole year, that then ensures the funding to get everything but how much to put that in the UK and allows you access to them.

109
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They have a fee when you want them for any condition or at the time of delivery, I guess.

110
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Yeah. But how much do you think that that you won't be able move in 2019.

111
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You can go, but you have to underpin that within 30 days.

112
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So one point the one 355 year quality GP.

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No health care can really get out of hand.

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But how little money goes into in fact, we don't really know what the real money that's injecting any of this stuff is.

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I'm talking to everything defence manager every with my. And course started giving you my surgery and I got one for my third year.

116
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You want to come for a health check. And he tells you here, we're going to let you put your family history, your height, weight and blood pressure.

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Simple blood test to measure your cholesterol levels when you go back in the thought of implementing that.

118
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Why are you having to test or the benefit?

119
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And when you get to get the thought that information like this, which I have to say is at best useless and you can see it.

120
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This is it. What? Why do I need this check?

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It's not the intensive help that helps you identify potential with fear of having this check and following the advice of your health professional.

122
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You improve your chances of living a healthier life. Oh, that for now.

123
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When you go to look at the evidence and we look at this general health check in reducing morbidity.

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Mortality for me. No.

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Note find that health checks are in effect in the number of admission to hospital disability worry the number of referrals.

126
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The special edition of visit are up and improve. So now that we can put forward people take to it.

127
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Yeah, we are putting in word where we say have this on an annual basis and the evidence that we

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know idea of whether your health care will increase the number of people with new diagnoses,

129
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it will increase the number of people on medication. Whether that translates into any benefit is not clear.

130
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And when you think about these things, what many of these big ideas are not new.

131
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The very interesting people are either free or growing pains and they evacuated.

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In 1939. You went to work for all these individuals in the workplace.

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Have you got hypertension and all have followed them up and noticed how many people then had increased psychological distress?

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They have work in that same period in 1970 on both general type of thinking about the rational for what you do is not always straightforward,

135
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like you wrote in the book, but about 5 to 10 million inches market that you're going to get a positive outcome.

136
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Well I through maybe there's one when it when I was in Scotland I thought well maybe maybe if I go there I might be able to lose a few pounds and my.

137
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Eight, £10. I've always wanted to lose £10 and I've done it for the money.

138
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Pretty much, obviously. The truth of the world. We can help.

139
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Now, when I asked this question, I asked this question about two way.

140
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Most interventions don't apply to the. So you feel free.

141
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Have you ever prescribed Weight Watchers to anybody because it's freely available, isn't it, when prescribing it?

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What have you thought about the benefits of that intervention when you're given it?

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Pessimistic on. How did better or then they were different.

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But I would argue that if you I think you know what the chances of actually using intervention to get what intervention do,

145
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are they actually going to turn up or are they going to walk out at that point giving me a referral to slimming world due to the pig here.

146
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Yeah. So if you take out the people at the top here and this is based on the evidence that if

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they give out an indication at the trials is that your weight will continue to weigh,

148
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you know, this is the people at risk overweight and you go 250 will take up the intervention and 85 don't take up the injection.

149
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Yeah, the immediate 8.5%. But if you take the onion 15, take up the intervention that this is a good idea.

150
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Yeah. Then of them, 62 will attend all the classes.

151
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Fitz won't even attend the first class because it'll get in the way of the way that.

152
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What an open thing. Yeah. And of the 53.

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But come back to the fifth thing of the 53, do not attend all the classes for an epic fail with about 2.5.

154
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Some people felt three or four and then they go off of it, but they are still two on five.

155
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Okay, come back do you 60 to attend all the packages generally 12 week or if you follow them off the end of that plus 50,

156
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they'll bring about five of you come back in two years,

157
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only 15 people of 19 and go away about five 3010 have maintain go away with nine will be a woman and one will be in that that time.

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So in the health care crisis, if you do it one year for one person,

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you 4000 people and the people go and the one who like CrossFit Pro and like going

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to Weight Watchers and in the first place would have probably paid for it anyhow.

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And people tend to be older, no work, no have all the other responsibilities that get in the way.

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Because at the end of the day, partly and a huge proportion of people in the period which are the general population,

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when you probably went pessimistic, I don't think this person's even going to go what we're wasting my money for.

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So the public health information, this is you.

165
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But what you see this figure all the time, this word, 5.4 kilo.

166
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Great. Now it's been around for 40, 50 years it to the point the benefit of solving the problem.

167
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Why the reason to do that in fact you can argue the perfect in fact given that in fact

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in fact when we take charge more money and going to charge itself more and more money,

169
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just like we do with Europe, we think that is the thing. And I think that's useful for it's not about the developing world.

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Oh, well, go to the demographic change.

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And also just there are lots of effective interventions and you can see banana compliant clothing without it, but a pro flu.

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Because I thought this was interesting about eight weeks ago I was really well with

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the flu detective even now working with in theory for a month and I was not a well

174
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before we go to the doctor but before of you don't go on doing which is the period you

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could rule out physical cause of different no normal bereavement of manic hypomanic.

176
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So this is a page, you know, and I was not feeling well, so I screwed myself.

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So for a little interest or pleasure in doing things, I gave myself a school of woe,

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feeling trouble, falling asleep, staying asleep, sleeping too much.

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I got all great. Feeling tired of having my full energy again, self-pity and poor appetite or overeating, depending on which part of the day I was in.

180
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I was either had a poor appetite or I was overeating.

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So I've got to give myself a three, but probably about two trouble concentrating things and reading the newspaper.

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After the war. And by the end of it, what happened is if you talk about school,

183
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I actually had a school of 5 to 9 on the you know, so that means I had minimal content for education.

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Call it worth returning one mom.

185
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But it is interesting to see how her school friend waited until the profit from 5% to be brought in to where again, things happened.

186
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Conversation to the. What do they mean? Why do we get them?

187
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And then you can very easily prepare to hit. Now we have about 3 million people, an antidepressant in the UK and I can't quite understand that.

188
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It doesn't seem to help people. How do we stop the depression?

189
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But actually from our premium, people go again.

190
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And it's interesting again when you go to look at some of the evidence,

191
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really interesting to look at the evidence about the false positives and negatives and the validity of the diagnosis of depression in primary care.

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What's interesting about that is the identification of depression strongly felt

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increased familiarity with the patient and the presence of subjective clinical view.

194
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If you keep the body French patient, what you would hope that really interested, isn't it?

195
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You don't want to spend more time kicking off the psychotherapy.

196
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My school of knowing. Now you probably tell me to go away for a little bit of work that you might have a view.

197
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I'm going to give you the treatment. Just be familiar with it and move it on.

198
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If you look at the evidence, it's really interesting. The team,

199
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if they identify things which we've both positive and negative that the people with the positive test be doing

200
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and the false negative one to tell you what indistinguishable in their clinical characteristics impairment,

201
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distress or mental health history.

202
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So there's a whole swathe of people in the middle who get a positive diagnosis or a negative and could, could or could not have disease.

203
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And we have no idea how we do things. And it looks like familiarity.

204
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Of the most important for the more targeted know, the more likely you are to get a diagnosis.

205
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So again, how we can get you involved on this basis.

206
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And so this middle ground between two of the most clinical characteristics and

207
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they discriminate these two groups and the basis of their knowledge of the

208
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patient clinical practice and everybody felt about what we need in primary care

209
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more of your own GP who you have familiarity with because that's a good thing.

210
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Which is in effect for it. Recording according.

211
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That might not be the case, and I think it's a really good thing because they're really not working hard.

212
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Try to work out what is really going on because it is okay to suggest, you know, to make sure next time you don't move the thing.

213
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And that's what we're doing, boys and young people. And we're doing it in the past with the benzodiazepine.

214
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And we may look again and think, Oh, my God, oh, again.

215
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This is the bit which really pains me that when you go look at the evidence, okay, they would say, let's take that away.

216
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Let's you think everybody who has died of depression in primary care.

217
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So it's true.

218
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If you are able to look at the evidence, look at the evidence that exist around mood interventions to determine if they are effective of this.

219
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This was in 2009 14 to 16 comparative can them to try to assess the rise and to include both public and private to people.

220
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So not a lot of information about what we use will one day 3164 in the with 919 we will go over typically 6 to 8 weeks.

221
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There was no dose information and we're able to comment on the. I'm going to come back to that in a minute.

222
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Well, I thought, okay, well, you know, and everybody's been working like Madeleine on this, working to solve this issue.

223
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So this paper, published in 2014, is an update to 15 January, February, the acceptability summit working for 1550.

224
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But if you go to the primary care, systematic review and network meta analysis, we right now are trying to compare one treatment to the other.

225
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The evidence with mediocre wheat because there was a small number of studies with observation period of longer than 12 weeks.

226
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Reliable comparative analysis of long term effects with no profile.

227
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How many people do we only need to go to the president for? 12.

228
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We know of all the evidence, health and welfare, and we put people on it for you to use.

229
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Like what? And we have no idea what's going on beyond 12 and 15.

230
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You know, we have to prove that by doing the right thing to meet that goal.

231
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So we put people to three, 12 weeks. We should be going. I don't quite know what actually happened.

232
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The problem with the people, people who do the Cochrane review that say the problem with stop the side effects of the drug

233
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from the we drove it into so bad really difficult for anybody off the job so stop it about

234
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two weeks from now when the drug could end up going back some self interest interest in the

235
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very thing that many prevention won't be solved because nobody entered into the long term.

236
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In fact, we have lots of people doing it and on treatment.

237
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And so I think it is a form of treatment to depression and probably yeah,

238
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although we compared to Finland specifically in terms of the number of trials in terms of this important effect.

239
00:28:01,010 --> 00:28:08,059
Yeah, despite guideline recommendations and widespread ongoing discussion of the extent

240
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to which antidepressants have clinically relevant effects compared with placebo,

241
00:28:12,470 --> 00:28:22,129
that's right. Now in the method of the effect that is kraepelin considered rather small yet findings

242
00:28:22,130 --> 00:28:27,020
from published trial of at these effects because of publication and report in both.

243
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So this issue of bias though not only within the effect of more, they only go to 12.

244
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We got the real core bias that you're learning about, thinking about the fact that they're already, oh, we don't think that.

245
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And I think we have a discussion about the problem with medical school and the

246
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benefit of the 11 or 12 year old boys are low performing and actually contract.

247
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And we think about it and I'm thinking about it because remember, you know, 21 but really, you know what actually?

248
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What is the impact of this on not treating impact?

249
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Not high quality, low quality of what you saw.

250
00:29:10,570 --> 00:29:14,320
But now we don't think, okay, is this enough to overturn the effect?

251
00:29:17,720 --> 00:29:22,040
And this is what you get from clinical evidence. Many of the fifth treatment for you.

252
00:29:23,060 --> 00:29:28,280
Oh, no. But the ones that have real importance don't do that for you.

253
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And part of the treatment now, in effect, from what we used to, there's only 11%, but it's definitely beneficial in about 24%.

254
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What is doing right down here in effect for me, only about one in 20.

255
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Right. That I'm pretty clear.

256
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For that. He said it would be going okay and printed up a lot.

257
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That could be beneficial. We haven't said we'd go that until away, but everything else he should be going in for.

258
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About 70 to 7% of everything is not going to be quite a few already.

259
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Now interestingly, when I had my flip, I've got work to do to get this.

260
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If I had to go hiking, I called an appointment for.

261
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Really well, Martin. All right.

262
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But we keep. And then they'll be there for about a year.

263
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And I walked in and she said, Hi, how are you? I said, Look, I'm really well.

264
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And just as about to tell it before I said anything else, she said.

265
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We've got pretty great people across the board. I know that they're going to go.

266
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I've come into some really clinical symptoms and I'm feeling unwell and I'm being asked to do something which is about

267
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system wide health check and for their need because they haven't had much blood pressure for the last five years.

268
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And they'll get paid for that with plastic when they talk about what they feel like when you come in again,

269
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get the idea that my blood pressure will be the only thing reliable.

270
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When we've done well is clearly we could have.

271
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How would you? I'm going to tell them more about what you've got coming through in front of me.

272
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I'll be smiling to the level by the diagnosis and the other to that.

273
00:32:06,320 --> 00:32:08,360
But by the time we get there as well, I've got.

274
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But what a group of people they come from and they thought about it because it's looking like cardiovascular risk.

275
00:32:19,180 --> 00:32:25,600
There's no evidence for that evidence for improving if you've cardiovascular risk as a chart for diagnosis and treatment.

276
00:32:26,200 --> 00:32:34,960
No, I've been promoted for a long time, not a single one or any morbidity reduction authority figure.

277
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There was another example from what we've done here with the group.

278
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And to that end, over and above you report on.

279
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You know, for the ultimate market, because the offering is very interesting, you know.

280
00:33:03,790 --> 00:33:11,529
So if you take all 3 minutes, we call it a demand opportunity for our phone and then for people.

281
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My resources will be spread thin and I might not get round.

282
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Some of you will be like the way for if you don't take treatment as prescribed and you can think, well, okay, I'm.

283
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And over here, I just go all the way. Maybe I'll get one vote and we do the hard work.

284
00:33:28,340 --> 00:33:33,080
But you if you forfeit for the high rate and everybody else here to go.

285
00:33:35,200 --> 00:33:43,150
Our information. Maybe every five years and we'll see how we go.

286
00:33:44,560 --> 00:33:48,160
That's the argument. We just don't know which one the better.

287
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That one's going to cost a lot more revenue for that. They want a lot of benefit from that approach.

288
00:33:52,600 --> 00:34:04,860
But you might do the day tough if you want to. You know, I really think absenteeism become ingrained in the culture of coming to the world.

289
00:34:05,920 --> 00:34:09,850
You get glaucoma treatment, you get all that. And that's what you end up with over and over here.

290
00:34:09,850 --> 00:34:12,910
You're going to die and you may live.

291
00:34:13,240 --> 00:34:19,520
Die on average. Know provider forgave the mystery for the problem on all that treatment.

292
00:34:20,670 --> 00:34:30,820
Then they below. Know the argument that comedy could not be beneficial for all these playing golf going on.

293
00:34:31,670 --> 00:34:43,400
We just don't know anybody in particularly low for the village thing where I'm about 75 my age, I will hit 10% some point in my age I'll hit 20%.

294
00:34:43,730 --> 00:34:51,550
But you could argue I treat everybody when I from.

295
00:34:54,980 --> 00:35:06,490
Interesting concept move to the senator Marco Rubio in the hope of doing the right thing did work for it because if more people in ten years,

296
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not five days. Do you think that.

297
00:35:17,940 --> 00:35:24,340
If you haven't seen it, you look at it, it's basically saying to you that you think the information you act on is also.

298
00:35:24,800 --> 00:35:30,379
So do. You walk through a certain about few in the next few verses.

299
00:35:30,380 --> 00:35:39,730
If you're if we're not below 5% or 2% in 20% risk over the next ten years, you act more certain, you matter to you,

300
00:35:39,730 --> 00:35:45,430
make you make a bigger action and a more impactful action on the one you set the bar as you move up to 20%.

301
00:35:45,950 --> 00:35:49,780
But of the probability of something happening in the next ten years, you move that up,

302
00:35:50,290 --> 00:35:58,310
you start switching over from the one you set to a longer period of time to as long as the probability of that said, if it goes up five.

303
00:36:01,720 --> 00:36:07,440
The effect is the most important thing of probability. So all those CBT structures you're talking about, you can almost drop.

304
00:36:07,450 --> 00:36:07,990
That was one of the.

305
00:36:11,860 --> 00:36:19,590
If you want to know what my chances of a stroke and how much benefit to the type of treatment, cardiovascular health doesn't do that for you.

306
00:36:21,250 --> 00:36:30,870
Yes, you have. You know, it's still people coming out of cities and nationalities 21% cent corruption by.

307
00:36:34,040 --> 00:36:43,720
That's right. And you know, we just saw the trial results transferred to the top.

308
00:36:45,440 --> 00:36:52,089
Right. So if you have a probability of around about 10% cardiovascular risk in acute vascular event,

309
00:36:52,090 --> 00:37:02,410
not mortality, just an event event, it could be an idea if left alone, you can reduce that by about 1%.

310
00:37:02,990 --> 00:37:10,220
Yeah, about half percent increase with diabetes and be aware that everybody thinks.

311
00:37:10,240 --> 00:37:13,300
Oh and you didn't collect all the adverse event data, did you?

312
00:37:13,670 --> 00:37:18,860
Mm hmm. So we don't we did go through adverse event that looked at that.

313
00:37:19,010 --> 00:37:22,600
And after that you go over and you could go.

314
00:37:23,350 --> 00:37:30,020
You know, I've talked about everybody doing a primary prevention of aspirin and we got rid of the idea for it.

315
00:37:30,040 --> 00:37:44,050
If we haven't at least having sufficient data in the hall to say the reduction in heart attack of 1% without outweighed by the increase of geography.

316
00:37:45,130 --> 00:37:53,350
So the net benefit is probably I'll be better off knowing that long term 1995 and then for,

317
00:37:53,350 --> 00:38:01,300
you know, for, for imagine if you have the day 3.1% reduction that you don't find on the long term,

318
00:38:02,320 --> 00:38:13,450
you don't quite know whether the Vanguard lead at the moment that's the model might be quite interesting when you think about it.

319
00:38:13,460 --> 00:38:17,210
When I show you that example, you suddenly go, Hey, maybe we should step back.

320
00:38:17,770 --> 00:38:27,250
Go back to our ability to do something in medicine is overpowering and overwhelming.

321
00:38:28,090 --> 00:38:30,970
And I'd be think about what I'm doing the good Right. Okay.

322
00:38:32,050 --> 00:38:39,520
When did anybody in the room when was the first point ever you came into contact with something that affected,

323
00:38:39,520 --> 00:38:44,770
you know, in a patient view, an overdiagnosis or too much medicine in your life?

324
00:38:45,880 --> 00:38:50,180
You'd like to have to go out. No.

325
00:38:50,360 --> 00:38:53,440
Go on. Forever.

326
00:38:53,560 --> 00:38:59,400
That happened. We having allergies? We went to the US and they said, oh my gosh, you need corticosteroids, okay.

327
00:38:59,620 --> 00:39:03,940
Because your asthma hasn't responded this way to your or it hasn't been responding to it, you don't normally do.

328
00:39:04,150 --> 00:39:07,180
So we were getting the diagnosis from all the new treatment.

329
00:39:07,180 --> 00:39:11,490
Nothing. Not that I didn't think I was allergy symptoms.

330
00:39:11,500 --> 00:39:14,620
That's okay. I wanted to hold you then.

331
00:39:15,280 --> 00:39:23,260
38. 38. But. Three.

332
00:39:23,580 --> 00:39:36,560
It's pretty much over the. I can.

333
00:39:39,660 --> 00:39:44,410
I really don't seem to be happy with that.

334
00:39:46,810 --> 00:39:49,840
Oh. And never met him before. And.

335
00:39:50,640 --> 00:39:53,040
And you got worried because of this constant threat.

336
00:40:05,050 --> 00:40:14,380
Because you tend or another GP the pre-test prior probability to be the reason in his mind had gone beyond one or 2%.

337
00:40:14,410 --> 00:40:18,820
He probably thought, Oh, why do you have more chances of you having.

338
00:40:21,000 --> 00:40:29,420
I don't want to go together that litigation anybody who be the first a number of you I'm going to pull over the school.

339
00:40:30,740 --> 00:40:37,330
One of the things that I want my daughter to return to after.

340
00:40:38,970 --> 00:40:46,320
And I've no idea how I ended up in the hospital and had a term for it at the time in the seventies.

341
00:40:50,800 --> 00:40:59,640
One of the things we the. Now we don't do it hardly at all within the ceremony.

342
00:41:00,570 --> 00:41:03,600
You have to have very clear criteria, and I'm not sure what you'll be able to do with it,

343
00:41:05,970 --> 00:41:12,470
but I'm interested to see where that can come down to the fact that we're going.

344
00:41:13,910 --> 00:41:18,559
But knowing that Romney would benefit by the time knowing with Graham you get

345
00:41:18,560 --> 00:41:22,220
back to your hearings normal they don't even have to go and get paid at night.

346
00:41:22,550 --> 00:41:25,490
They would do that without having knowing you back to everybody.

347
00:41:25,490 --> 00:41:30,040
I think there's a short term symptomatic benefit for the long term and the downstream benefit.

348
00:41:30,110 --> 00:41:41,360
One of the hopefully now not having to pay reform is that every time I get an infection now it goes beyond my control that I don't get by like that.

349
00:41:42,010 --> 00:41:45,020
Or do I get really well with the interesting question?

350
00:41:45,170 --> 00:41:50,970
That's an interesting question. Probably the patients want us to something as well.

351
00:41:54,890 --> 00:41:57,910
For better or worse, I feel like still have my mom or whatever.

352
00:41:58,270 --> 00:42:02,070
And you say, no, actually the evidence is equivocal. We don't have we don't like that.

353
00:42:02,860 --> 00:42:05,890
There's nothing I can do. You know, that's not how medicine works.

354
00:42:08,530 --> 00:42:15,460
But I think what we know is that globally, the big question, if you have Medicaid or people, you're going to do something.

355
00:42:16,160 --> 00:42:25,990
The real issue once you activity and if the real issue for people like physicians to go out in the market in a participating trial.

356
00:42:26,200 --> 00:42:37,300
And we've got at least 5 to 10 years from. One individual recalled the idea of putting a hole in somebody's bedroom and then looking at it.

357
00:42:37,360 --> 00:42:44,440
So in the short term, everything has a benefit there and then symptomatic where you'll get a short term benefit, something will happen.

358
00:42:44,470 --> 00:42:54,320
Well, in this case, you've got all your stuff going forward, but you do all these other things that you are making normally and someone you know well.

359
00:42:55,540 --> 00:43:01,000
And they return to a point whereby even on the things that we've seen in both groups, when you look at it.

360
00:43:01,300 --> 00:43:10,030
So what is it we're actually doing? You're doing that for treating individuals because we think we can do something for them.

361
00:43:10,030 --> 00:43:17,739
But you could think about of the fact that they imagine what's going to happen when you see what you said,

362
00:43:17,740 --> 00:43:22,180
that you were more excited for us to be saying, hey, we need to be doing less.

363
00:43:22,770 --> 00:43:26,890
We are starting to pick up on this, the news organisations that people are starting to pick up on this.

364
00:43:27,760 --> 00:43:28,150
You know,

365
00:43:28,420 --> 00:43:43,700
if you go back to the explosion of radiation that began in America and then it came to 1 to 1 and a half percent of all potential candidates,

366
00:43:44,290 --> 00:43:48,750
given the radiation dose from people for some point, somebody's going to go that way.

367
00:43:49,250 --> 00:43:57,610
That's like going back to Ray people when they were pregnant with the foetus in there that gave rise to double your risk of leukaemia in childhood.

368
00:43:57,610 --> 00:44:04,180
So what if I keep telling you flat repeatedly they would take no antidepressant.

369
00:44:04,570 --> 00:44:08,260
The old guy and the old.

370
00:44:09,760 --> 00:44:19,180
Then you got a 50. We know we're a bit worried, but we don't. I think we all like to know about the risk, you know, for yourself.

371
00:44:20,350 --> 00:44:26,620
And I think that in the fiction there are, you know, there are some harms of not doing something,

372
00:44:27,250 --> 00:44:30,700
but there are also harms of particularly in prevention of doing something.

373
00:44:31,150 --> 00:44:37,000
And we're in a bit of a pickle now, and Britain is a very good example of that.

374
00:44:39,220 --> 00:44:45,340
Can I finish the question? The where in time for one question to finish, we can have we can carry on from.

375
00:44:48,930 --> 00:44:53,270
Okay. We're living longer here.

376
00:44:54,040 --> 00:45:05,610
I will give you a living. Yeah.

377
00:45:05,670 --> 00:45:10,230
So, I mean, nobody really knows why we're living longer.

378
00:45:11,520 --> 00:45:18,630
There are some interesting stories that people want to know if this is a pretty pregnant issue that actually the people having babies are healthier.

379
00:45:18,690 --> 00:45:21,780
When you have a child, which gives a huge advantage to the child,

380
00:45:22,640 --> 00:45:28,380
it you if you have the early infection that more people arrive and then we've got rid of the war.

381
00:45:28,400 --> 00:45:34,320
So the biggest difference between male and female life expectancy is killing people in wars, male particular.

382
00:45:34,590 --> 00:45:43,200
So we get more thought now than we ever did when you get to sixth form a life expectancy,

383
00:45:43,590 --> 00:45:51,120
not about the economy, you know, actually not that we live in 20 years.

384
00:45:51,450 --> 00:45:53,700
It's actually four or five years longer.

385
00:45:54,390 --> 00:45:59,640
So it's not like when you start to look at to get more people to not die prematurely, the number one that I agree with.

386
00:46:00,330 --> 00:46:09,210
So there are people that we might be testing time on every day or that not people would try to get rid of them.

387
00:46:10,390 --> 00:46:17,400
Those are people you can't get more people that when you get these people, then this is a real dilemma.

388
00:46:19,020 --> 00:46:22,110
And I know people on personal people, for instance.

389
00:46:22,500 --> 00:46:27,540
Should we be investing our money into, say, for instance, when you've got cancer,

390
00:46:27,870 --> 00:46:37,769
you've got £20,000 on treatment that might send your life back to a premium and monitor, you know what?

391
00:46:37,770 --> 00:46:42,360
You spend our money on really super high quality palliative care.

392
00:46:42,690 --> 00:46:51,620
Quality care. That said, we've really got to look at the theory of your time and move away from some of the medical things that have been dealt.

393
00:46:52,730 --> 00:46:57,240
Probably could get. From the evidence we get what is really interesting.

394
00:46:57,240 --> 00:47:01,800
Counterintuitive, isn't it? So where do you want to know?

395
00:47:02,620 --> 00:47:08,970
Do we want to know where the really important evidence is and say that's what we do really well?

396
00:47:09,420 --> 00:47:20,850
And a very good example. For instance, one of the best example, if you want to reduce mortality from heart attack, is the golden rule.

397
00:47:21,780 --> 00:47:26,340
We've got to get people within an hour of healthcare, even from born.

398
00:47:27,330 --> 00:47:30,780
And if you do that within an hour, you take about 60 hours to happen.

399
00:47:31,140 --> 00:47:34,500
Within 1 to 2 hours, it comes down to about 30 lives, 2000.

400
00:47:36,270 --> 00:47:42,629
So you want to look at the intervention. Now we monitor non-judgmental minutes fit for the best way to have a heart attack.

401
00:47:42,630 --> 00:47:45,720
You've been reading for a year. Nobody will hear that. But you know.

402
00:47:46,200 --> 00:47:52,470
But we don't know. We don't look at that really strongly.

403
00:47:52,650 --> 00:47:57,420
Well, and I think that's our position now of trying to understand the best we should.

404
00:47:58,740 --> 00:48:08,490
This is the bits that we have to provide more evidence from in terms of the things that might actually be.

405
00:48:08,490 --> 00:48:15,300
You have to accept. I think we might need to do a trial for five or ten years in this area to really see if it's going to be a benefit or not.

406
00:48:16,270 --> 00:48:21,639
And we may have to come back and go watch it. Should we revisit the cholesterol argument?

407
00:48:21,640 --> 00:48:30,910
Because one of the practical problems is that we are not the same population of the evidence that there are in the active.

408
00:48:33,270 --> 00:48:37,290
And so really interesting times in the dollar.

409
00:48:37,590 --> 00:48:42,940
But we cannot afford to spend like $500 million on treatment.

410
00:48:43,180 --> 00:48:51,749
Actually have no benefit whatsoever. So based on the simple criteria that you alluded to in the course, the quality of evidence,

411
00:48:51,750 --> 00:48:56,010
the biases and the effect size, and who do they apply to be understood?

412
00:48:56,010 --> 00:49:00,920
Any of them and how many? Never. You have to put them.

413
00:49:07,250 --> 00:49:11,030
There's also the fact that the public also don't know what many people.

414
00:49:20,480 --> 00:49:25,580
Yeah. I've been astounded at the number of 25 year olds you've met. So why you wanted to come to the press?

415
00:49:25,580 --> 00:49:28,610
And I said, Well, it turned up one day, and it was doing a bit down.

416
00:49:29,090 --> 00:49:36,049
I feel that you not it and ended up on anti-depressants kind of what we call up in the in

417
00:49:36,050 --> 00:49:39,380
when I'm a and I think that's called the real world when you turn up you come out of it,

418
00:49:39,390 --> 00:49:44,240
you get a job and you can go to work and be miserable and lots of it depression you go

419
00:49:44,290 --> 00:49:51,139
you got a little that and it takes up 20 years and then you know it takes you nothing

420
00:49:51,140 --> 00:49:55,430
it but if you turn up a couple of times that your GP in that scenario they're going to

421
00:49:55,430 --> 00:50:00,890
intervene and that that's somewhat about the experience and learning that might go.

422
00:50:04,530 --> 00:50:08,270
What's that mean, Colonel? Chances are you'll get better based on this.

423
00:50:08,390 --> 00:50:08,590
That.