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0,0	6,7	8,6	okay.
0,0	15,6	17,1	okay
0,0	17,8	19,7	welcome to america.
0,0	19,7	23,0	it's like twenty fifth time.
0,0	23,0	25,2	twenty fifth time recently.
0,0	24,9	29,3	no i mean i was lost here in november actually.
0,0	28,5	34,8	yeah i was here in november and but i have you know my closest family outside my media family.
0,0	34,6	37,2	unfortunately we passed away now.
0,0	36,5	38,4	i'm in california.
0,0	37,6	44,7	so since i was a kid i'd probably come over and meet them and come out to san jose and like every other year
0,0	45,2	54,1	so for people don't know who you are and what you do could you please just tell us your credentials and what your occupation is?
0,0	53,2	56,3	yes so i'm a consultant cardiologist.
0,0	56,0	80,4	i qualified from edinburgh medical school in scotland two thousand and one so i've been a practicing physician now for whatever twenty years my initial early career joe as i specialized in interventional cardiology so in layman's terms as keeholh heart surgery stents if you like and then over the past few years for different reasons which we'll probably get into i focused more of my work on prevention
0,0	80,9	86,6	and how did you become this controversial covid character?
0,0	86,3	88,3	well it's interesting.
0,0	87,4	92,8	my i think controversy with me probably started much many years ago
0,0	93,5	97,6	probably i became sort of i broke into the mainstream
0,0	97,9	113,7	around twenty eleven initially because i wrote an article which was a front page commentary in the observing newspaper which was part of the guiding group in the uk basically as the cardiologist was saying why are we serving junk food to my patients?
0,0	113,2	126,6	hospitals and that was after i'd met with jamie oliver who i'd rent to so that's i kind of started campaigning on the issues around obesity at that point and not shortly after not long after that joe i then
0,0	127,9	190,2	sort of went into a deep dive to try and understand why we had an obesity epidemics of what was driving that what was the role of cholesterol and heart disease over prescription statins saturated fat and essentially that culminated me publishing a piece in the british medical journal in twenty thirteen october basically which was titled saturated fat is not the major issue and suggesting we should be focusing on sugar we got it wrong and saturated fat we're over medicating millions of people millions of people and stands cholesterol is not that bad as a risk factor of heart disease and that's really where i sort of broke into the major and that was bmj press released it it was front page of three british newspapers it was on fox news chicago cnn international and that's really when i started my kind of activism and to try and fight back against medical misinformation and a kind of deep understanding that what was driving poor health for many many people was biased and corrupted information that was coming from two big industries big food and big pharma.
0,0	189,9	196,9	and that's fairly controversial still today but backed up by data now like
0,0	197,5	213,6	talk about saturated fat and the fact that sugar's terrible for you now that we know because of the new york times excuse me new york times published that expose of those initial scientists that were bribed i believe it was in the fifties of sixty s.
0,0	212,7	214,9	do you know those stories?
0,0	214,0	231,1	yeah of course where they were basically given about fifty thousand dollars which is not that much money too ruin everyone's idea of what's good and bad for you because they demonized saturated fat in order to preserve sugar
0,0	231,4	238,1	they were paid off by the sugar and the sugar and this should do this yeah absolutely joe that's really the heart of the problem.
0,0	237,5	250,1	it's i would describe it as the corporate capture of medicine public health and it's been going on for decades yet i think only now and certainly we'll get into around the covid vaccine stuff.
0,0	249,1	253,1	i think only now more people are really becoming aware of it.
0,0	252,2	316,9	and i think one of the things i discovered when i looked into the whole issue about saturated fat and sugar etc is you know in the in the sort of fifty sixty and seventy s there were two scientists who were really at war around what was driving heart disease because heart disease really started to increase in the united states from nineteen twenty and peaked around nineteen sixty ninety seven terms of death rates from coronary artery disease and anselkeys was the american physiologist who's from minnesota who said that saturated fat was a culprit and then there was john yadkin who was a british endocrinologist nutrition scientist who basically said that it's sugar but because the sugar industry was so powerful they were able to put all of their resources and energy into supporting antoise who did take money from sugar and she later emerged and silenced john yadkin and for decades we were under its false belief that it was saturated fact there was a big corporate and heart disease and think to add into this which wasn't fully accepted or known at the time was the now acknowledgement of the impact of smoking.
0,0	316,4	317,5	so
0,0	318,3	329,1	you know it was it took about fifty years between the first and extreme smoking along cancer published in the british medical journal before we had any effective regulation on
0,0	329,4	334,6	tobacco control interventions government interventions and
0,0	336,1	338,9	now we know that when you look at the
0,0	339,2	362,6	decline in death rates specifically death rates and heart disease in the last four or five decades almost half of that joke can be attributed to reduction smoking so these are things that weren't really fully accepted or understood at the time and the reason for that and this is really interesting is the tobacco industry adopted a corporate playbook.
0,0	362,1	405,6	you know i call it a dirty tricks corporate playbook of planting doubt cigarettes were harmful confusing the public denial and even buying the loyalty of bent scientists so when there was people doctors and public health advocates saying smoking is a problem with a heart scientists were paid to write articles in medical journal saying it's not smoking its stress people who smoke are more stressed and it's going to be the cigarettes so you know this is history repeating itself in a way and denialism and this is another thing i find quite fascinating i mentioned this in some of my lectures as well as late on as nineteen ninety four ceos of every major tobacco firm went in front of u.
0,0	404,7	405,8	s.
0,0	404,9	411,0	congress and swore under oath they did not believe nicotine was addictive or smoking cosmonic cancer
0,0	412,2	416,3	right? so all of that was thrown into.
0,0	415,4	440,7	i once i kind of as a praxen cardiologist is a regular frontline jobing doctor who was seeing since i qualified more and more people getting sick more chronic disease i started to think of them is there something we're doing wrong as a medical profession are we giving the wrong advice what's actually going on here and when i did that deep dive and went into the recourse of it i then realized that the system unfortunately had become increasingly corrupted
0,0	441,2	459,0	over many many years by these powerful commercial entities that whose only interest for legal reasons is to be profit for shareholders not to look after your health yeah that's all they're really responsible for when you did this and you
0,0	459,5	469,6	started to talk about diet and health and the misconceptions or misinformation about diet and health what was the pushback like?
0,0	470,0	471,7	it was huge.
0,0	472,0	474,5	i think for me
0,0	476,2	483,5	so when i publish a piece in the british medical john two thought so it's october twenty third two i'll never forget this twenty thirteen
0,0	483,9	486,0	it got a lot of attention.
0,0	485,1	505,3	at this stage i'm what we call a specialist registrar and cardiology so i'm not a consultant i'm not top of my gradient i'm still i'm finishing my training i'm almost a fully fledged cardiologist i'm doing intervention keyhole art surgery and the first thing that happened to me joe which i haven't really spoke about publicly before
0,0	506,2	518,1	imagine front page of three british newspapers a lot of attention and a lot of people are happy because suddenly you know the front page headline was butter is back cardiology says eating butter does not cause heart disease right?
0,0	517,2	550,7	i know that brings a smile to your face and i know why i mean who doesn't like eating butter but it was true it was what the facts told us at the time so i publish this stuff but i also what i did at the time is in that eight hundred word editorial i basically also went for one of the most prescribed drugs in the history of medicine which are statin drugs because i had to make the link of everything so if saturated fat doesn't cause heart disease but we know saturated fat can raise cholesterol that means cholesterol isn't that important and if cholesterol isn't that important why are we giving all these people statins?
0,0	549,8	555,4	so i was able to scientifically and rationally put that all that jigsaw together.
0,0	555,1	570,9	but in that piece one of the things i wrote is i said that the side effects of statins are underrepresented in clinical trials and the side effects usually are things like muscle aches and fatigue and this is also part of my clinical experience of the cardiologist.
0,0	569,9	577,2	i was seeing way more people anecdotally although you know i've managed tens of thousands of people in my career out into the patients.
0,0	576,9	596,6	i was seeing way more people with side effects and statins i diagnosed than what what was actually in the published literature what was coming through in the medical journals where doctors are being told side effects are rare less than one percent chance of getting fatigue on muscle symptoms i was seeing about twenty percent and there was a reference that i used in my article was suggested
0,0	597,1	616,7	recent study in the community in the united states which suggested that one in five patients probably get side effects and stands now you know that is is so we put on the paint in the past don't be perfect yes is it because those side effects fatigue muscle soreness things are fairly mild is that why they were underreported?
0,0	616,5	618,1	great question.
0,0	617,3	619,5	so now we know the reason.
0,0	618,6	626,9	so first and foremost when i ask a patient a patient complains about side effects i ask them is this interfering with your quality of life?
0,0	627,0	642,5	so if they say yes by definition from their perspective it's not mild it's something that's really just making them feel pretty upon my language shitty but the reason joe that they were not reported and that came up later on.
0,0	641,6	684,0	this is something i didn't know as a medical student as a qualified doctor as a specialist is until then is a lot of the clinical trials that are conducted the drive guidelines these randomized trials where you give patients one group gets the statin and one group gets a dummy pill and they don't know whether they're getting the dummy pill of the statin and then they're followed up and you see whether they have less heart attacks and what side effects they get is that there's something called the pre randomization running period so before the trial actually starts people are enrolled and then if you get side effects you are taken out of the trial before it starts so what happens is yeah
0,0	684,6	693,0	so what happens is the end result of those trials is therefore bias towards people who didn't get side effects and then and then even then
0,0	693,2	700,9	there's a big under reporting issue now and they have no responsibility to report the people that were removed that also got side effects.
0,0	700,0	702,8	well so what they do is very interesting.
0,0	701,9	717,3	they get around it slightly slightly sneaky they in one of these trials called the heart protection study thirty six thousand people were removed from the trial before it became among the largest bank trials and what they did was they mentioned this but they used the word non compliance
0,0	717,6	772,2	suggesting that the patients didn't take the pills but that doesn't make sense because if you're going to enroll into a trial joe you're probably going to be someone who's enthusiastic to be part of this trial so they use this broad and relative non compliance but and some of them may well have been on compliance you know people that are you know i'm gonna start i don't really want to take a pill taking this a week now whatever but actually later on when you look at real world data certainly the united states a larger study called a state and soviet and the united states basically reveals that within about a year of people being prescribed stands seventy five percent of them will stop taking it and when you ask them why sixty two percent of those seventy five percent are stopped taking it said they got my side effects so there's a huge discrepancy there so i was using my clinical experience understanding how the trials are run we wrote this piece and this is really fascinating joe so i'll get onto the second part of this in a second
0,0	773,0	774,9	at the same time
0,0	775,7	807,9	john abramson who i know you've introduced he wrote a piece in the bmj at exactly the same time as me which was specifically about should we be giving more people standards so people what we call low risk of heart disease which would essentially mean because there were muttering some guideline bodies saying you know maybe we should give more people stands to prevent heart attacks and what that would have meant in reality just it was taken up that would mean practically everybody over the age of fifty would suddenly be a risk that they would deem required these sustained drugs.
0,0	807,1	812,3	so john and his father prophylactic to prevent heart attacks absolutely.
0,0	811,8	833,3	so john wrote this piece with two of his colleagues from harvard and it was an analysis of the data proper rigor so you know and both our piece my piece was peer reviewed so was his and in his article he basically said listen if you lower risk of heart disease then your risk of the benefit of stadiums is really really negligible
0,0	833,6	857,3	about one in one hundred and forty chance of it preventing you having a heart attack or nonfill heart attack or non disabling stroke over five years based upon indus response and data still so there's still a biocep even when you look at that it's still very marginal will not belong your life but he also referenced the same reference i put in saying from a community study actually one in five people get disabling side effects.
0,0	856,6	860,7	i'm gonna come onto that story later because it's really disabling
0,0	861,3	880,6	disabling or debilitating maybe depilitating or serious enough for them to feel not well let's put it that way but yeah it's semantics but yeah it depends how you define it but i would say quality of life limiting i think is probably more accurate is that how they defined it as non compliant because these people experience these side effects and they're like i want to get out of trial?
0,0	879,8	881,9	well that was non compliant.
0,0	881,0	898,5	yeah i mean they didn't yes they didn't specifically say that but that clearly what probably what happened and most likely he writes this piece we both reference the same side effect profile which is massively more than all of what doctors have accepted or been told as gospel truth from all these big impact medical journals
0,0	898,8	926,3	but lots of things happen to him to push back so the first thing that happened to me is the very next day after i'm in the news i get well actually i'll tell something more interesting so i go and see an international so i'm a junior doctor at this point in the british national health service and i'm in the green room about to go live on air for cnn to debate with a professor who i won't name an imperial college who is a very big proponent of
0,0	926,7	943,4	and i'm about to go in there and he basically he meets me there and he's like super he's almost frothing in the mouth he's really angry i'm really angry with what you did i never met this guy before and he started repeating this mantra basically.
0,0	942,9	973,0	he basically said for every one milli mooring of ldl cholesterol which is what stands to do you have a twenty percent reduction in heart attacks and he comes and almost like a religious mantra kept saying the same thing again and again and i just said karma said listen you know i think this is merits debate i think this is a big problem of a prescription statin' i don't think everybody should think stance i think it has a role in some people and he kind of calmed down we went on air and the discussion really focused on the fact that you know cardiologist here is saying okay to have steak do you agree with him?
0,0	972,5	1011,9	and the discussion ended up being quite reasonable but i got a little bit of a kind of like you know i felt almost as a veil threat you know this guy's a very powerful guy you know in the cardiology community and the scientific community in london everybody kind of knows each other you know this kind of person things could happen where people like that could potentially have conversations and write your career but i was you know for me i'm just committed to the truth so i kind of you know but i didn't know what was coming the very next day in my hospital i get a phone call and i just started working that couple weeks earlier as what we call an interventional fellow so i was the main guy who was being trained up to be the next
0,0	1012,2	1034,4	what we call interventional cardiologist so they choose people i was selected in this university hospital to be the guy that essentially does the procedures and operations with supervision to become completely independent and i was doing you know i started doing stents and doing stuff independently and i was good at it so i get a phone call from the secretary of the medical director and she says
0,0	1036,7	1057,4	doctor so and so i would name him you know would like to meet you and i just got a feeling that it wouldn't be good and i spoke to you know when i published this piece because this hot school court in the university hospital went in the news a lot of the staff are really proud like i had you know the nurses and secretaries coming up to me and thank you well done.
0,0	1056,5	1063,0	it's so great to see this in the news and we're really proud of you and you represent a hospital and this kind of stuff.
0,0	1062,2	1067,8	and i said well the medical director wants to see me he said oh and i'm sure he wants to congratulate you
0,0	1068,1	1083,0	that wasn't quite sure so i got to his office i never met this guy before he opens the door doesn't shake my hand he's literally red in the face and he doesn't he says comment sit down
0,0	1083,7	1106,4	i sit down and he looks at me and he says do you know your duties as a doctor i've been speaking to the general medical council about you know just for the audience at general medical council are the regulatory body control doctors licenses to practice they can remove your license to practice right and i'm sitting there going okay he says
0,0	1106,9	1109,4	tell me what have you done?
0,0	1108,5	1124,4	you know i read this article and this is a tweet here you know saying that statin the rubber prescribed blah blah blah and i talked him through and he goes are you telling me that our nurses can tell our cardiac patients that they can eat butter?
0,0	1123,9	1144,4	now it sounds ridiculous joe now right but he was really serious about this so i call me this book said listen this is this is a thing that got my citizen i've written this in the british medical journal on the high impact medical journalists in the world this is peer reviewed and i think there is a scientific case here and i just talked to him you know
0,0	1144,8	1163,7	without getting emotional and it was really interesting by the end of the conversation he said to me he said i very much hope the ten years from now i can tell my grandkids that i sat opposite the man the cardiologist that busted the myth of saturated fat body.
0,0	1162,9	1177,8	not wow right so you turned him i did but i thought so i did i felt i did turn them i thought okay you know this is a power of the truth and you stand your ground and you and you talk respectfully to people and you can potentially turn them
0,0	1178,3	1188,3	what happened over the next few months though was something i never could have predicted but really shaped me in many ways to be the person i am today
0,0	1190,0	1227,1	this story had legs so it kept dragging on in terms of you know there was a lot more stories now and interest about butter and saturated fat in fact there was a front page i don't remember this time magazine there was a twenty fourteen there was a front page story his butterback and it was triggered by my article because a journalist called me and spoke to me i wasn't quote in the article in the end basically listen we're going to look into this and they got all of a different nutrition scientists and made the case that but it was fine probably okay in terms of heart disease but what happened after that was because i'd also attack statins and of course a huge industry i think well let's just try and give some context here joe
0,0	1228,3	1246,9	the state industry or the cholesterol learning industry i mean it's a trillion dollar industry there's a lot of money a lot of people make money from the fear of cholesterol and the prescription of status in fact there's estimates now that globally in terms of prescriptions up to one billion people prescribed starting drugs.
0,0	1246,0	1250,4	in the united states it's at least thirty million people taking them probably more.
0,0	1249,9	1255,5	so i had really said essentially that most of those people don't need to take this down.
0,0	1254,7	1255,9	and
0,0	1256,3	1295,7	more than that i said we should tell patients honestly and break down the information the way they can understand and say listen if your low risk of heart disease you haven't had a heart attack your benefit of stating is one percent right and when you tell people that most people joe don't want to take the pill anyway so i said this is about ethics and evidence based medicine so i kept that discussion going and then one of the cardiologists elite cardiologist in the department he came up to me one day a couple months later and said listen i think i was on california was talking about it or something and he said listen you know i respect your opinion blah blah blah however you can't keep saying this publicly and if you do then there may be an issue about your job here
0,0	1295,9	1307,3	so i kind of thought okay well and i'm not saying anything wrong something else came up i was quoted another article and then you know i had had a job in this place joe for one year.
0,0	1306,3	1314,0	this is my interventional fellowship you know being doing the specialist training final stages to being an intellectual cardiologist and
0,0	1314,4	1317,9	i then got a letter out of the blue
0,0	1318,4	1323,1	four months into the job saying that we have decided to discontinue
0,0	1323,3	1329,2	know your fellowship and you got too much notice was there any reason?
0,0	1328,6	1342,1	no but it was clearly because of because they don't have to give you a specific thing that you violated or no there was no reason because the thing is my you know my and i don't say this to blow me on trumpet.
0,0	1341,1	1347,3	i've always prided myself in my clinical care in over twenty years which is unusual and i'm sure some of its luck.
0,0	1346,4	1362,1	i've never received a single complaint from a patient and i got on with my colleagues and the staff and everything so there was no reason but he basically said to me you know of the record it was because of this and clearly someone higher up had had a conversation i suspect right?
0,0	1361,8	1372,2	a journalist who's a guardian journalist when he also when i told him about this at the beginning he said a scene you know just be careful because you know i've seen this happen before.
0,0	1371,5	1397,4	you know the former company is very powerful and someone will just needs one phone call to the ceo and they'll say shut this guy up right and we'll get onto other stuff later then please by similar but yeah sorry goin' but can you please tell us like what is the mechanism how does that work and what does it do to lower cholesterol yeah so for many years there's been this misconception that high cholesterol is one of the most
0,0	1398,7	1407,7	one of the most important risk factors in divine parties so i broke down the data and i published a lot on this stuff to look at it properly and joe this
0,0	1408,0	1430,3	the association of cholesterol and heart disease came from something called a framingham study which was in massachusetts started in nineteen forty eight carried on for several decades where they followed five thousand people and many risk factors for heart disease came from their correlations which were then validated like things like type two diabetes and high blood pressure even smoking and high cholesterol
0,0	1430,6	1465,7	now what's interesting about framing it is when you look at the associations of total cholesterol and heart disease it was only there when your total cholesterol the significant association was only there if it was over three hundred milligrams per deciliter very few people have total pressure on that high and we have to also understand that most of your cholesterol is genetic eighty percent of cholesterol is genetic eighty percent since it's since i've because cholesterol is a really important molecule in the body it's not just it's you know important for maintaining cell cell membranes it's important role in the immune system
0,0	1466,4	1470,2	hormones vitamin d synthesis all of that stuff right?
0,0	1469,4	1477,1	so it's genetic you can alter with your diet the components of it something called triglycerides and htl so called good question right?
0,0	1476,3	1479,9	but so the total cholesterol was not a very good indicator.
0,0	1479,1	1488,5	so if it was very very high there was association but that's what's interesting about that is though almost all those people had a genetic condition which gave them very very high levels of question.
0,0	1487,5	1493,2	it was called familial hypolipidemia affects one in two hundred and fifty people right?
0,0	1492,6	1506,1	and then at the very other end from framing them the very low levels of cholesterol less than one hundred and fifty milligrams of deciliter or four milligram terminology there was almost no heart disease so again there's genetic factors there.
0,0	1505,5	1511,2	so basically people with genetically low cholesterol tend to not develop premature heart disease.
0,0	1511,1	1533,5	another interesting caveat most of that data on the development heart disease was only up to people who were fifty or sixty and what wasn't publicized is that once you hit fifty as your cholesterol dropped in framingham your mortality rate increased never really discussed so i looked at all of this or that's interesting but i think the thing that really
0,0	1533,8	1565,8	sort of was a nail in the coffin for me and understanding the association of classroom heart disease was very weak was william castelli who was one of the co directors of framing cardiologist in nineteen ninety six did a full summary of framing them and he said this he said unless you're because you know you're going to talk about you may be thinking okay hold on there's good cholesterol and bad cholesterol so he specifically focused on what we call ldl bad cholesterol and he said unless your ldl cholesterol is above seventy eight millimoles per liter which is something like
0,0	1566,2	1586,4	so it's probably at least three hundred pretty much three hundred milligrams per deciliter it has no value in isolation and predicting heart disease so what they determined from framing them was your risk of heart disease as one of the risk factors was something was your total cholesterol divided by your hdl the good question or the ratio.
0,0	1586,7	1589,6	so that's the first thing.
0,0	1588,7	1593,1	so the association of question hotness is quite weak first and foremost.
0,0	1592,2	1624,5	the second question is when you try and prove that there is a biomarker that is causal in heart disease you want to show that if you lower it then there is a difference in heart attacks and strokes for example and only in twenty nineteen more recently i co authored a paper in bmj evidence based medicine with two other cardiologists and what we did was we looked at all the drug trials lowering cholesterol to find out is this true when you look at in totality not cherry picked evidence?
0,0	1623,7	1630,4	is there a correlation with lowering ldr cholesterol and teleplastural and preventing card attacks and strokes?
0,0	1629,4	1632,6	and this is based upon randomized control trial data.
0,0	1631,7	1634,7	so this is the most robust evidence you can get.
0,0	1633,9	1646,3	joe no clear correlation it was bs the whole thing was bs in that sense like it's a very weak if anything so that means so then the next question is well hold on how does that end work?
0,0	1645,4	1683,9	and that's a question you asked me earlier and it's a great question it's a really important one statins do have a small benefit but one of the properties of standards which isn't talked about is they have anti inflammatory and anticlotting benefits so even though they lower all the el cholesterol the real benefit in preventing heart attacks and strokes is through that mechanism but when you break it down as i said before your risk is you know the benefits are about one percent if your low risk of heart disease but if you've had a heart attack and many patients i see have had heart attacks and they get automatically bought in statins and the cardiologists really even checked their cholesterol because in the cardiology community we kind of knew that was like it doesn't matter what cholesterol is.
0,0	1683,0	1689,8	let's put them on the stand because the trials show there are benefits but what are those benefits when you break them down in absolute terms?
0,0	1688,8	1691,9	this is really crucial and important.
0,0	1690,8	1693,3	and this isn't cherry pick stuff.
0,0	1692,3	1696,8	this is what all the evidence shows when it's being peer reviewed etc.
0,0	1696,2	1714,3	if you've had a heart attack patient comes to me doctor i carry on this statin i've been putting this data and i'm getting side effects i said to this and this let's explain to you the benefits first so that you're not you don't have an exaggerated fear stopping a stat and you also don't go around with the illusion of protection thinking that's the only thing i need to do now
0,0	1715,9	1731,9	over a five year period if you take your statin religiously and don't get side effects right because remember the trials took out people with side effects so best case scenario your benefit of a statin is one in eighty three for saving your life
0,0	1732,2	1737,2	right? and one in thirty nine and preventing a further heart attack.
0,0	1736,9	1740,0	a lot of people find that quite underwhelming.
0,0	1740,0	1762,4	another way of looking at the statistics joe and this is important for populations looking at those trials and when i what i'm about to tell you when i talk at conferences to doctors and general practitioners and there's like a gasp from the audience right when i tell them this and this is published in the bmj so in the randomized trials you look at an average how much if i see that question right?
0,0	1761,5	1805,8	you've had a heart attack they say for example and statin to one of those prescribed drugs of the miracle cure whatever one of the most potent beneficial drugs in the history of medicine if you take those if you take statin for five years having had a heart attack in that five year period how much would you think or hope it would add to your life expectancy you've literally survived a heart attack right and now you've been given this pill which your doctor is telling you this is you must never stop this is going to save your life how much would you hope would add to your life expectancy over five year period over that period we can increment to one five percent thirty percent yeah okay so a few years about a few years ago yeah one answer yeah just over four days
0,0	1807,3	1809,5	four days four days
0,0	1810,2	1812,4	there was a great day
0,0	1812,6	1841,8	so no fair enough absolutely and you know but but you know this is so and the reason i mentioning that is when you look back over the last few decades and people talk about what has driven down death rates and heart disease there's this assumption it's been the mass prescription of states many people think stands but the evidence suggests there's a separate analysis done they looked in european countries high risk and lowest people of heart disease over twelve years was there a difference in was there a reduction in heart disease death rates because of stanton?
0,0	1840,9	1869,0	and the answer was no and that doesn't mean that the data is fraudulent it's been misrepresented but if you accept safely for a four day increase right but these are in people who didn't get side effects who were a deer at the and real world data tells us even people who've had heart attacks maybe fifty percent of them will stop taking it just within a few years mainly because of side effects you can understand why that hasn't had an impact on the population but think about that.
0,0	1868,1	1870,8	this is one of the most powerful
0,0	1871,1	1876,3	lucrative drugs in the history of medicine and this is how
0,0	1877,2	1882,5	marginal let's be polite here how marginal the benefits are.
0,0	1881,8	1896,2	now once this information has been out there and it's been published and you've had these talks and people are aware of this what has been the reaction and has there been any change in how it's prescribed?
0,0	1896,3	1924,7	so i then so after this publication the bmj initially and then i know i had to get another job right so i lost that job in that hospital i then ended up working for free briefly in another nhs hospital cardiod department i worked for free doing one day a week because i had another role with health policy which i come onto they were paying me so many and i didn't want stop seeing patients so i was working for free in one hospital for a year in a cardiology department.
0,0	1926,8	1929,8	in sort of march twenty fourteen
0,0	1930,6	1936,7	i got a phone call from an email initially from the editor of the british medical journal.
0,0	1936,5	1938,6	and she said a theme
0,0	1939,2	1968,4	let's have a meeting i think went to meet and she said there is a man called professor sorori collins professor rory collins is probably considered in the world the lead staten researcher at oxford university he got his knighthood from the queen because of his work on stand he has said that you need to attract abramson and malhatras papers because there was a significant error on the side effect issue and this is going to cause harm people can stop their stance.
0,0	1967,9	2025,0	and she said straightway no i'm not going to retract it but we're very happy if you would like to publish it send a critique and then we'll publish it but for some reason he decided to one do that so this back and forth was going on and then out of the blue he decides whether it was him or somebody else to go to the guardian newspaper and i got a phone call from the guardian and the bbc which again was headline news that what abramson and a lot of my hotter was had done it's become a new story frontpated guardian was so damaging in terms of their error on the stat inside effects issue that people will die essentially this is almost as bad as they were trying to make parallels with andrew wakefield and the whole measlemont rubella issue that happened many many years ago that was the scientist the loss is licensed because he linked the mmo vaccine so they were trying to create that kind of frenzy and i'm like whoa this is okay so i went on bbc and i stood my ground and
0,0	2025,5	2049,6	that i think put the bmj under pressure and then the next thing that happens is i remember i was with my cousin in new york and i forget this and i get an email a press release from the bmj which i knew was going to you know and this is to be honest it's an attack on one's credibility but the bmj then decided they were going to send our articles for an independent review whether or not they should be retracted.
0,0	2049,1	2084,9	joe just to put things in context here that's potentially career destroying in a sense that if my article got retracted it got so much publicity and i genuinely believe what i said was correct but it gets retracted then your credibility is undermined pretty much forever and your careers you know it would be careerist going for me under the beginning of my career so i was on trial essentially for two months if you like and you know that was it was tough it was very very tough there was a panel they convened they asked me to send in responses and then whatever else i didn't know what was going to happen then i think it was august twenty fourteen.
0,0	2083,9	2093,4	i remember it broke the news and it was you know i got an email and basically the panel had come back six zero unanimous in our favor.
0,0	2092,7	2121,8	wow there was no call for attraction because john abramson went through a lot during that period as well i know you interviewed him yes and we talked and whatever else when that happened joe there were two things i could have done one was wow this is like too much i don't think i can handle this i'm just gonna you know i'm going to hide away and just keep a low profile but i thought no you know well this is about ethical evidence based medical practice there were some corrections that needed to be done some caveats that they added in into the papers around the side effect issue.
0,0	2121,1	2123,6	so i carried on this campaign.
0,0	2122,7	2130,1	i carried on publishing other journals kept on that transparent communication ethical evidence based medicine stand over prescription.
0,0	2129,2	2146,1	there are other things we can be doing into lifestyle right which are going to be more powerful whether it's low carb mediterranean diet exercise or why we're not focusing our attention there rather than just giving people all these pills that they think is going to protect them from heart attacks in most cases it doesn't.
0,0	2145,8	2149,6	and in that journey and this went on for a few years
0,0	2149,9	2153,3	this is where things got really interesting.
0,0	2153,6	2159,5	so there was a twenty question yes there was a lot of backlash it was tough there was a bit smearing going on
0,0	2159,7	2164,8	but i realized then as a public health advocate that
0,0	2166,0	2170,5	you've got to have a thick skin and grow rhinoceros side.
0,0	2169,6	2177,8	and those are the words from a man called simon chapman simon chapman is professor psychology in australia.
0,0	2177,2	2188,4	he was considered the lead campaigner in making sure there was tobacco control in australia and he wrote a paper talking about his thirty eight year career in public health advocacy and gave ten lessons.
0,0	2187,9	2204,8	and one of those lessons is this as soon as your work threatens an industry or an ideological cabal you will be attacked sometimes unrelentingly and viciously so grow a rhinoceros hide and i thought you know what?
0,0	2203,8	2205,4	i'm up for it.
0,0	2204,5	2206,3	i'm up for it.
0,0	2205,4	2210,4	so many more people came out the woodwork to support me other doctors said you're right you know?
0,0	2209,5	2218,5	and i thought this is about truth and transparency and about ethical medicine and highlighting all the corruption in the conflicts of interest.
0,0	2217,7	2249,5	one of the things that professor collins hadn't been made apparent is his department had taken over two hundred million pounds at oxford for doing research into stance from the drug industry and they also kept the data commercially confidential so most of the publications and guidelines are coming statins are coming from emanate from that department where no one had been able to independently verify the data and he is quoted in the guardian saying only problematic side effects and stats affect one in ten thousand people
0,0	2250,2	2263,6	so i thought this something this doesn't add up i think these are biases conflicts of interest i'm not saying that he was deliberately malicious but i think there's a huge conflict of interest there is clouding his judgment.
0,0	2262,7	2269,7	plus he's not clinician he doesn't see patients so there's all of those things that i think limit his ability to really look at the evidence properly.
0,0	2269,3	2279,6	and twenty sixteen you really couldn't make this up twenty sixteen so he's campaigning things side effects almost non existent i get a phone call from the sunday times journalist.
0,0	2278,7	2281,4	guy called john and got thomas great guy.
0,0	2281,2	2295,0	and he said a theme you never believe you know won't believe what i found out because by two the reason this came out in twenty sixteen they decided to republish so what colin said he says there's a lot of discussion by stan and side effects.
0,0	2294,0	2298,0	so we're going to re analyze our own data again and look into this.
0,0	2297,2	2361,2	so they publish this piece in the lands in twenty sixteen and the bases had the same thing again side effects signs of rare less than one percent maybe get you know some wild muscle aches that kind of thing a week later this journalist calls me and he says we found something really interesting what is he said in the united states there is a genetic test called statinsmart which is the company boston heart diagnostics as a company that is marketing this has a license to market this product and on their website but they oh the genetic test the co inventor of this genetic test is professor sorori collins and on their website they're selling this test to basically try and figure out who's likely to get side effects so you do this test and it tells you whether or not your lights like to get side effects from specific stands or not and it says twenty nine percent of all state users are likely to get significant muscle symptoms or side effects and stands and he did freedom of information request oxy university.
0,0	2360,5	2366,0	i published on this with john abramson actually we did this in one of the paper we wrote later on and
0,0	2366,3	2383,3	fox university came back and basically said that yes and how much money have you taken from selling this device and it was something in the order of the university had received three hundred thousand pounds and professor connor's department had received about one hundred thousand pounds.
0,0	2383,4	2395,7	this doesn't make any sense so in one sense he's saying side effects are non existent yeah he's co invented a test to try and detect his light to get side effects and on the website it got taken down after that interestingly.
0,0	2394,7	2406,1	you know we published it and we highlighted this but it's like hold on they're kind of making money from both sides here and for me it just highlighted know
0,0	2406,4	2432,1	this was all really for me like a symptom of a system failure where there are all these concealed conflicts of interest people are being selective with information they put out and ultimately at the root of the problem joe is that these big powerful pharmaceutical companies these corporations have more and more control and uncheck power over these institutions or conflicts of interest but people don't know about it right?
0,0	2431,2	2443,7	and when you tell people that story when i skip talk some lectures and they bring that up it's just pin drop silence people are just shocked some of them are angry they feel they've been deceived like how is this how is this acceptable?
0,0	2443,4	2445,8	yeah how is it acceptable?
0,0	2446,0	2449,1	so what has been the response after that?
0,0	2450,2	2453,6	so i think there's been a big shift.
0,0	2452,6	2547,2	i think more doctors are aware now something unprecedented happened around that time our health watchdog national institute clinical excellence had recommended that with all after all this publicity that we should general practitioners should be financially incentivized to prescribe statins for people at the risk of heart disease even though this data was very clear and i'd been on the tv and carried on the campaign and talking about this stuff and the union of general practitioners the british medical association's general practitioners committee actually revolted this had never happened before and they said no we're not going to accept this and they had to make a u turn so that for me was a victory based upon this sort of campaigning that i had been part of but now more recently with all these excess deaths are happening our chief medical officer a few months ago came out suggested that one of the reasons there's been his excess cardiac debt is it because people aren't taking their stance which was then refuted because carl hennegan who's a director of center of evidence basements in oxford he's non conflicted they don't take any money from ministry very rigorous guy in terms of the weight of his analysis and his department showed that that wasn't the case and you know i think that maybe was part of a distraction but there is still now a push again to get more people and statins and i suspect a lot of it is because you know if you think of the business model of the drug industry it is to get as many people taking as many drugs as possible for as long as possible
0,0	2549,3	2550,5	twenty
0,0	2550,9	2573,0	eighteen i am asked to go to the cambridge university union by the bmj to be part of a team to debate with astrazeneca and i ended up debating with the ceo of assad seneca and the motion put forward which was debated in cambridge university was from them we need more people taking more drugs that was their motion
0,0	2573,2	2574,4	and
0,0	2574,9	2576,8	it was just yeah
0,0	2577,0	2583,4	so that's their business model joke people need to understand what we're up against here but that isn't the solution to good health.
0,0	2582,6	2640,7	in fact over medicated population now is a big piece of public health crisis even pre pandemic one estimate from peter goshar who is a co founder of the very prestigious independent cochrane collaboration in the bmj suggest that the third most common cause of death now globally after heart disease and cancer is prescribed medications what your doctor prescribes for you mainly because of avoidable side effects and these are avoidable because the decision making in the prescription often isn't involved in form consent and when you tell people the full benefits and harms in absolute terms of drugs mostly they're more conservative they're less likely to take the pills but also the information that doctors are using to make clinical decisions based upon these industry sponsored trials where they keep their data commercially confidential which ultimately means that the safety and the benefits are grossly exaggerated
0,0	2641,3	2657,7	john abramson explained to me how peer review is done on trials that are coming straight from pharmaceutical drug companies that you don't really get access to the data itself you get access to the pharmaceutical companies analysis of that data
0,0	2658,1	2662,2	yes that's absolutely true so that sounds insane.
0,0	2661,4	2669,2	it is completely insane completely and that sounds so obviously compromised it's not scientific really?
0,0	2668,3	2673,5	it's not ethical right right and i'm a believer in true democracy.
0,0	2672,5	2674,2	it's not democratic.
0,0	2673,3	2680,1	you know if i when i tell my patients i have conversations my patients about this stuff all the time and this that's not what they think and they just they're shocked.
0,0	2679,7	2741,6	most doctors even i was not aware of this joe until they really looked into it properly you know i was this the conventional doctor doing his job who took the publications in the lancet in the new englandian of medicine you know as gospel truth biblical gospel truth never questioned it and now you know i look to people like john einides who you may be familiar with so he's a professor of medicine at stanford he's the most cited medical research in the world you know he's considered a medical genius very high in scientific integrity and he wrote a paper two thousand and six and it was in plus one which was entitled why most public research findings are false one of the things he writes in there with his own mathematical modeling of the reliability of research and this is fascinating he says the greater the financial interests in a given field the less likely the research findings are to be true wow
0,0	2742,8	2792,0	so in your estimation is this just a fundamental aspect of unchecked power and influence where the industry exists primarily to make money they provide these drugs many of them are beneficial but their overall goal is not public health their overall goal is making exorbitant amounts of money they have a responsibility to their shareholders their responsibility to the corporation and that responsibility is to make more money and they will do what it takes to do that including compromising physicians compromising researchers compromising journals and that this is just
0,0	2792,5	2810,8	there's not a lot of recourse for the person like yourself that steps out you stick your neck out there and you get attacked and fortunately for you you had all your bases covered and the data was so obvious that you were able to survive this
0,0	2811,0	2820,4	but for the most part most physicians most doctors most clinicians they don't want to get involved in that and so they tow the line.
0,0	2820,1	2826,3	yep i think even if they had had an lm hat let's give it some context here as well.
0,0	2826,1	2843,6	so yes legal responsibility for by profit for shareholders not to give you the best treatment but the real scandals are those with a responsibility joke to scientific integrity academic institutions doctors medical journals collude with industry for financial gain
0,0	2844,5	2846,3	and the
0,0	2846,6	2861,6	off quite often and i know you discussed you know in detail around the whole vioxx scandal with john but quite often the way that these big corporations operate as legal entities are not pointing fingers at people within them.
0,0	2860,9	2866,7	you know i met pascal sortaists i'd dinner with him who's a sea of assadinica you know
0,0	2867,6	2886,0	even sent me a book afterwards to my home address he knows why i live so i better be careful but he seemed like a nice guy right but in their roles they have they are only responsible to their shareholders but the problem is and we see this historically it's quite often and dr.
0,0	2885,2	2893,7	robert hare is a forensic psychologist who was behind the original international we called dsm criteria for psychopathy.
0,0	2893,3	2929,2	and he says that as these legal entities quite often in the way they conduct their business actually fulfill the criteria for psychopaths so callous and concern for the feelings of others in capacity to experience guilt deceitfulness conning others for profit and we have precedent we have history of that you know between two thousand and three and twenty sixteen most of the top ten most of the top ten drug companies paid fines totalling about thirty three dollars billion dollars for illegal marketing of drugs hiding data on harm some manipulation of results and
0,0	2930,1	2937,5	when those crimes were committed in most cases end up making more profit from sales of drugs than they do from defined like that.
0,0	2936,6	2948,4	so there's no incentive to stop doing what they're doing and ultimately you know the patient suffer but i don't want to throw the baby out with a bathwater here because someone might say well hold on dr.
0,0	2947,5	2955,6	mahatra but under drug industry response to before these life saving treatments and blah blah and yes they are but the question is what is the net effect of them?
0,0	2955,2	2980,8	so if you look at in the last twenty years i'll just give you some examples here between two thousand two thousand and eight of the six hundred and sixty seven drugs approved by the fda only seventy five percent of them were found to be copies of old ones so the drug companies will change a few molecules here and there on an old drug rebrand it rename it payton ticket make lots of money and then they move on and they move on to the next one right?
0,0	2979,8	2987,8	so there's huge waste only eleven percent of them are found to be truly innovative as in a therapeutic clinical benefit over the previous drugs.
0,0	2986,9	2996,8	so there's all this waste in france something similar between twenty twenty eleven of almost one thousand drugs were approved by their regulator
0,0	2997,1	3009,4	again most in the copies of old ones but about double the amount of drugs jerk fifteen percent of those drugs were approved were found to be more harmful than beneficial compared to about eight percent of their therapeutic benefits.
0,0	3008,5	3012,8	so what does that mean when you look at it in the totality with the waste and harm?
0,0	3012,1	3020,9	the overall net effect of the drug industry in my view on society in the last two decades has been a negative one
0,0	3022,3	3023,4	wow
0,0	3024,1	3054,7	that's hard to swallow and you know one of the reasons it's hard to swallow there's something sociocultural which we don't talk enough about so a lot of people believe in medicine and think it's an exact science but it's not exact science it's an applied science it's a science of human beings to social science it's a constantly evolving science we're taught in medical school fifty percent of what you learn it's gonna turn out to be either outdated or dead wrong within five years of your graduation.
0,0	3054,1	3065,8	the trouble is nobody can tell you which half so you have to learn to learn on your own any other stick your neck out because you're going against whatever the narratives do but that's
0,0	3066,2	3072,7	ultimately for me everything i do is motivated by that patient in front of me in the consultation room.
0,0	3071,8	3091,2	you know that persons are suffered unnecessarily who didn't need to be there all of these external factors infants' health whether it's an ultra process food environment whether it's a pill taking a pill they don't need and and we see that you know we now see that in the world united states have you lost two years off your life expectancy
0,0	3091,7	3106,0	in the u k since two thousand and ten joe we've had a leveling off a stalling of life expectancy and an increase in people living with chronic disease so for me as a doctor i think to myself hold on a minute.
0,0	3105,6	3120,6	you know find this is a multifactorial but if we as a profession collectively we're doing everything right according to the best available evidence why are our patients getting sicker don't we have responsibility to understand why and then do something about it?
0,0	3121,4	3137,0	don't imagine you do so that's for me that's what drives me and you know one of the things i was thinking about as well if you i've come up with this new term and it's a derivation of something called commercial determinants of health right?
0,0	3136,0	3148,0	so i like this definition commercial determinants health of this strategies and approaches adopted by the private sector to promote products and choices that are detrimental to health.
0,0	3147,9	3149,1	right?
0,0	3148,0	3150,7	and that can apply to medications.
0,0	3149,8	3154,3	it can apply to autoprose's food which is addictive for a lot of people right?
0,0	3155,2	3159,3	but what i've come up with when you think about the drug industry and what dr.
0,0	3158,4	3164,5	robert hart talks about psychopathic is something called the psychopathic determinants of health and
0,0	3164,8	3190,2	you know richard horton who's the editor of lancet actually came to one of my lectures in london recently and then he referenced me talking about this in one of his pieces it wasn't a completely positive piece on me i'll be honest with a little bit of a subtle hatcher job but he talks about you know my hotter talks about the psychopathic determinant of health if you think conceptually joe we talk about these very powerful entities that have a big influence on our lives and if they are psychopathic
0,0	3190,5	3199,4	you know it doesn't take a rocket scientist to figure out that's going to have a downstream effect on society that's going to be negative culturally.
0,0	3198,8	3202,6	you know people staying silent when they should be speaking up.
0,0	3203,2	3209,1	you know i've been contacted by doctors who agree with me privately but say i wouldn't say that or
0,0	3209,3	3210,5	and
0,0	3210,8	3218,8	this is what we're having to do with now and this is they've got more power than they've ever had i think joe overall lives and influence.
0,0	3217,9	3219,0	and
0,0	3219,4	3232,3	if a psychopathic entity has so much power and control over our lives of course it's going to be negative and we need to basically fight back so this sort of established your
0,0	3233,2	3240,4	hesitancy to just believe whatever the narrative that's being described by
0,0	3240,7	3255,2	the industry by the medical industry so you had questions now coming into covid did you have those initial fears or questions about the vaccine?
0,0	3258,4	3321,2	at the very beginning i had a little bit of skepticism about the efficacy of the vaccine because we know traditionally vaccines for respiratory viruses like influenza are not that great but i didn't so with all of this knowledge and background knowledge i honestly treated vaccines for the word vaccine like holy grail despite all of this stuff around over medicaid population all these pills people are taking with as blood pressure pills they don't need or statins or even diabetes drugs they don't have much benefit for them and come aside effects for me still within all of that vaccines or amongst the safest so i never conceived of the possibility at all actually of a vaccine doing anything even knowing that this is a completely different vaccine that does nothing's ever been distributed like this yeah yeah this number so i know that now but at the time you know i hadn't focused my attention specifically on the vaccine at all so what you're saying makes sense but at the very beginning you know
0,0	3321,6	3334,6	i was i deferred to vaccine specialists and immunologists and people i thought that you know didn't probably have conflicts who were all saying this is fine so i hadn't looked at it in that much detail and i just made the presumption that this was gonna be safe.
0,0	3333,9	3337,4	i don't know how effective was going to be but was going to be safe.
0,0	3336,8	3378,2	and as a result and some of it was also you know so during the covid pandemic i was very outspoken making the link between obesity and poor covid outcomes in fact at the point where you know i was getting pretty mad there was enough coverage on this like we've got this pandemic that affects disproportionally affects the elderly there's no doubt about at the very beginning it was particularly devastating for all the people but there was like a thousand for gradient difference in risk if you were young versus all like even now even early on john eighty s jay ballet chariodia they did his analysis essentially suggesting that for younger people it was actually less lethal on the flu but for older people very old people it was quite bad at the beginning.
0,0	3377,6	3397,0	so i noticed this link with obesity and i said listen you know this is my work over many years one of the things that i also advocate for is that for people to understand if you change your diet just within a few weeks any way you're starting from you can potentially even send your type to diabetes into remission you can reverse the most important risk factors for heart disease.
0,0	3396,7	3420,4	so i knew that if people were told that when this virus was when the pandemic started this is an opportunity actually we already had this slow pandemic of chronic disease which we hadn't effectively coped anyway this is a great opportunity for going to say listen guys now this is a time to saw your diet out take vitamin d you know really just optimize your immune system and it wasn't happening.
0,0	3419,9	3424,5	so but in all of that i looked at all of the risk as well and
0,0	3425,4	3434,6	it was clear that this was you know not very risky for people who were at my age you know twenty five now so what i was forty three
0,0	3435,7	3441,1	forty three when the whole vaccine role i started my father who was a
0,0	3441,4	3446,2	reside general practitioner but vice president of british medical social is very prominent.
0,0	3445,2	3446,4	dr.
0,0	3445,7	3446,9	uk
0,0	3447,7	3463,0	and this gets into the emotional side a little bit because you know i think this is relevant he was very keen that i think the vaccine and i think it was because he had an exaggerated fear for me right like many people had
0,0	3463,3	3466,4	we lost our mother just a few years earlier.
0,0	3465,5	3472,5	i lost my brother when i was young so i was his only surviving immediate meme and he had this and he was caught the same.
0,0	3471,5	3477,3	he needs like a vaccine no please please please i said dad you know i don't really need it you know no no no take it.
0,0	3476,5	3510,1	this went back and forth i said okay fine i'll have it but i thought anywhere as a doctor i'm going to take it i'm going to protect my patients you know let's see what happens so i took the vaccine and then about a month later a film director friend of mine grinder chanda you might be familiar with some of the work benditlight beckham movie she did blinded by the lights about breed springsteen it acquired over here so she was sending me all this stuff saying i see him a lot about the vaccine and it was kind of blogs and it was stuff saying like you know microchips depopulation agenda fertility problems i said going out to be honest outside i said i don't think there's any real good evidence here.
0,0	3509,1	3515,7	i think there's a scam on green and i said you know i think you're high risk you typed it i bet it you're overweight etcetera.
0,0	3514,8	3516,7	i think you should have it.
0,0	3516,2	3519,0	so she said great you know she trust me.
0,0	3518,0	3521,5	so she took the vaccine and then she tweeted it out.
0,0	3520,6	3547,8	and the next thing i'm on good morning britain in february twenty twenty one asked to tackle vaccine hesitancy which was higher amongst people from ethnic minority backgrounds so i think it's probably similar in the states as well and one of the reasons for that as well by the way joe is that a lot of people from those backgrounds are from poorer backgrounds and understandably they have less trust in government they're the neglected people in society in many ways so you can see why they felt that way.
0,0	3547,1	3573,9	and i went on good morning britain i didn't point fingers and said my god these people are crazy whatever else i said listen let's understand that there are rational reasons why people don't want to take the vaccine look at the history of the drug industry for us several decades anymore fraud i think they won't expect me to say this right i said think about all the fraud they've committed i understand that but i said having said that when you look at traditional vaccines they're some of the safest and that's kind of pretty much where i left it at a time joe when we were only in the uk
0,0	3574,3	3596,1	at that point there was only the recommendation for the vaccine to be given to people at high risk i never expected even then like friends were calling me and the young person no you don't need to take it during the fiftieth and healthy no no even at that time but this is just for high risk people so i took it i swallowed the pill and then yeah i mean things changed very dramatically within a few months