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Hello and welcome to the Oral Apothecary Podcast, authentic chat
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about medicines, pharmacy and healthcare in the UK.
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Pharmacists Jamie, Gimo and STC take on topical and controversial
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stories but keep it edgy yet light-hearted.
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Podcasts share their career-defining drug, song and book and also
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share their joyful patient stories.
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Welcome to the Oral Apothecary Podcast, my name is Jamie Hayes.
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For this episode we're joined by Adrian Childs. Adrian is
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a well-known British television and radio presenter, journalist and columnist.
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In 2023 he wrote a column for the Guardian newspaper,
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I'm on nine pills a day now and I'm not
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even what you might call ill. We will welcome Adrian
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in a moment as he shares a drug for our formery,
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his career anthem, and recommends a book for the Oral
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Apothecary Library. First, let me welcome my two fellow apothecaries.
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SDC is in Bournemouth and GIMO is in Cardiff.
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Welcome both. Evening.
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I just want to mention very quickly, one of our
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very early campaigns and things we used to get a
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bee in our bonnet about was the price of veterinary medicines.
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Remember our pets and pills series? Well, it was announced
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today that the government's finally caught up with it, or
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at least the competitions authorities finally caught up with us.
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And they're going to start to introduce price curbs on
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on medicines and and published price lists online so hopefully
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that's the first step into a bit more of affordable
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medicines for pets so i was quite pleased with that.
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Pretty good very good in fact yeah i was in
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wessex health innovation network today do you remember previous guest
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paul woodgate when we did a whole series on patients
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well he and i were asked to do some more
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filming about polypharmacy and structured medication review so i was
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there today with claire howard and her son jacob howard
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who used to do some of our social media stuff
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so that was cool And guess what happened today on
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the Dorset GP meeting was the public health director in
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Dorset talking about deaths due to psychoactive substances. So following
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our episode last week with Caroline Copeland. I was well
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placed to enter the intelligent debate about it. Nitazines were mentioned.
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And that's in the news today as well, isn't it,
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in Scotland?
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Look, I've just made it back from Reading. I was
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doing a prescript day at the University of Reading. Sue Slade,
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teacher practitioner, made a special effort of coming to say
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hello and tell us how much she loves the podcast.
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So that was nice.
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And then I forgot to say this last time. Oral
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apothecary team, Rex Hayes, our voiceover artist, and my niece,
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just want to give her Then we shout out, been
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starring in series four of Ted Lasso. So Rex has
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just appeared in, I think, five of the six episodes.
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They're one of the twins in the women's football team.
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There we go.
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Congratulations, Rex. OK, let's move on. Our great pleasure to
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welcome Adrian Childs to the Aura of Pothcree. Adrian has
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been broadcasting and writing since 1994. He started out on
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Radio 5 Live and BBC Two's Working Lunch. He's presented
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all manner of BBC TV shows, including The One Show,
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The Apprentice You're Fired and Match of the Day Two.
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And on ITV, he's presented Champions League football and two
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World Cups. Currently writing a weekly column for The Guardian
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and radio shows on Radio 4 and Radio 5 Live.
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He's also written a number of books, three of which
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I've read in preparation for this podcast. Welcome to the podcast, Adrian.
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That's a good effort, that is. I just had to
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interview James Elroy today, and he's a fascinating man. Unfortunately,
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I'd never read anything he'd ever written until about 10
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o'clock this morning, and I was interviewing him at 2 o'clock. So,
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you know, if you've made the effort to read all
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three books, I salute you.
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Is that LA Confidential, is it?
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L.A. Confidentially wrote, yeah. Anyway, I think he's used a
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few pharmaceuticals in his time, by the sound of it.
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So, yeah, Devoured the Good Drinker. Adrian and I remember
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watching it on the TV at the time. The columns
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was an easy read. I loved the column on Buddleia.
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Right, that's one of the very first ones I did,
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that is.
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Yeah, that's one, honestly, and you've made me... It's a
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cognitive bias now, but I spot Buddleia all over the
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country now after reading that one, and I'm halfway through...
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the west brom.
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One it's got a very unhappy ending okay don't worry about.
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That so agent look this is pub based cpd pub
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based chat if we bumped into you in the pub
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after a cardiff city you've just sneaked a last minute
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win against west brom and you were writing your column
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on meds today what what's changed in the last few
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years since it was three years ago that you wrote
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that column that attracted our attention on on i'm on
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nine meds what's changed.
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What's changed is I need to remind myself what I
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was on at the time. I think I'm on.
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Fewer.
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Oh, that's good.
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But not very many fewer. I don't know whether Cetalopram
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was on that list, but I gradually weaned myself off
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that because I need some convincing it was achieving anything
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in the first place.
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Yeah, quite right.
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And actually, I had stopped taking it before and I
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sort of cracked up completely. But I went from 20
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to 15 to 10 to 5, and that was just,
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I got a little pill splitter.
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Very good.
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So I took it. Well, very good. I got what
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amounted to a bollocking from my GP at the end
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of it, saying, well, you shouldn't have done that, blah, blah, blah.
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But anyway, I took control of my own situation and
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dropped that one. And I don't know whether I had
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any benefit in the first place. I certainly have never
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thought I ought to go back.
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But Adrian, just before you go any further, that is
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really what this podcast is all about, is about clinicians.
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And when I spoke to you on the phone in preparation,
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you were surprised when you said to me, gosh, I
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didn't know pharmacists could prescribe. So when we say clinicians, prescribers,
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this whole idea, the whole podcast and all the things
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that we talk about and all the people we have
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on is this idea that, you know, the patient is
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the patient. You're the project manager. You know, we need
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to support and trust you. because you're the one that's
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got to take them so you whatever you've however you've
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ended up why you did that you have safely reduced
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and stopped and therefore you've stopped any likelihood of withdrawal
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so whatever you did to do that that's that's good medicine.
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Yeah but i got i genuine genuinely got the feeling
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that from my gp who did quite a big practice
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don't see the same person twice generally but you know
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they've been you know good in different ways but when
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he came to Taking charge of my own medication, I
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got the definite feeling that they would have preferred if
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I didn't and just did what I was told. I mean,
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for example, I actually had a DVT about three or
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four years ago. And I was put on rivaroxaban, the
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blood thinner, 20 milligrams of Oh, it's a long story.
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It all seems to be bloody guesswork, the vein stuff.
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But I finally found a good vein specialist who wasn't
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trying to sell me some miracles treatment. And he was
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a really good guy. I had a proper conversation with him.
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And he said, I'd probably just go to 10 milligrams.
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I thought, I'm not going to bother going to the
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doctor about this. So I just cut the 20 milligrams
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in half and just... and then didn't bother ordering as many, obviously,
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when he came to the repeats. And again, I got
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another sort of gentle bollocking for that as well.
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You know.
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But I was, you know, I'm not the cleverest person
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in the world, but I was having an intelligent conversation
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with an interested and interesting vascular surgeon who told me
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to do this. So I'll just do it. Why would
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I take up anyone else's appointment?
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Yeah, yeah.
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Well, you've hit the nail on the head. So much
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of the health service time is wasted because we don't,
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trust patients enough to do the sort of things that
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you describe. I mean, I can see it from the
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other side. We worry about things like litigation and whether
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people get it wrong and stuff, but you've hit the
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nail on the head in terms of patients managing their
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own care.
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Yeah, but I mean, look, I can see the dangers
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because it's a small step to suddenly deciding you know
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what's what. Using Google or now AI, deciding what meds
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you need and start... and start juggling your other stuff
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and deciding you need more of this or less of this, then,
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you know, you could see where it would go wrong.
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I just think when you're taking less of something rather
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than taking more of something, they should take a gentle
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view of that, really.
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Yeah, it's co-production going one step too far. That's what
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they're worried about a little bit, aren't they? Less is
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more is the mantra of this podcast.
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Yeah, so apart from that... I think I'm probably still
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onâ I take six now, not nine. So I don't
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know what the other two were. I mean, I was
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taking a cod liver oil thing, which I do, because
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my mum, despite everything, has lived to a very grand
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old age, and she swears blind it's olive oil and
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strong Croatian brandy as well, actually, but not in the
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same cup every morning. But she swears blind by it.
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So it's almost sentiment, actually, taking olive oil. But I
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can'tâ I mean, she has it. She has the stuff
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in the bottle, which is still repeating on you when
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you go to bed at night, if you took it
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in the morning. So I have a capsule.
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You talk about your middle-aged maladies in your book. I
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read your book as well. And like you said, that
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would be really bad for your hiatus hernia if you
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were drinking fish oil out of the bottle. You'd know
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about it, let me tell you.
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Oh, is that right?
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Yeah, that's very wise. But can I just say, it
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was funny as hell when you were on the Jeremy
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Vine show going through your medication. And the two of
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you were like sort of fumbling through going, and Jeremy
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Vine kept saying now I must point out neither of
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us are medically qualified but it was incredibly the reason
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why we were so attracted to asking you to come
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on is that you know and we didn't ask you
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on now to come through and go through your list
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line by line but you are very open to to
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discussing it and obviously it's a bit like when if
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anybody talks about their mental health or depression people say
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And I've spoken about my own on this podcast. And
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people have stopped me afterwards and said, I'm really pleased
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that you did that because I think I'm alone. And
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it's really important to hear that people say that they've
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got these problems.
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You see, I mean, on that, I've got a slightly
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different view because, you know, people say, oh, you're brave.
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You're open about it. But I just, I don't really
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see it like that. I think, you know, the truth
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sets you free. And I spent all day on and
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off air, listening to people, being open about their mental
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health issues. Nobody stops banging on about their flipping mental
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health issues now. You know, I think it's slightly gone
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the other way. And then, you know, we're constantly inviting
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people to be open about it, getting people to talk,
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and then we don't give them anyone to talk to,
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you know, anyone sort of qualified to talk to. That's
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my issue. That's sort of my issue. And then suddenly everyone,
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you know, if everyone's neurodiverse, then nobody's neurodiverse. So I'm just,
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I'm conflicted on it.
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You're sharing it in a way that we're all sitting
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there reading it thinking, yeah, that's me. I mean, I'm
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reading about you and your medicines and thinking, yeah, that's
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exactly the same issue. So we have over, I think
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you're right about mental health is there's a line, isn't there,
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about talking about it that sometimes I think we've crossed.
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But with medicines, we don't talk about it. I'm sure
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there's millions of people. This is what I was going
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to ask you, you know, as a broadcaster, is anything
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in your experience and as journalists change your view about
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how the how the media talks about medicines and stuff,
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because it's the biggest intervention in the NHS. You know,
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it's part of your daily life now and it's part
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of most of your listeners' daily life. It's not something
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we really talk about in an interested way.
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I think you're onto something there. I mean, you talk medicines,
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in terms of news stories, it sort of focuses on
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miracle doctors you know new miracle drugs my least favorite
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stories to do are the ones when you know there's
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a major breakthrough in alzheimer's or pancreatic cancer or something.
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Yeah they're always nearly rubbish not only.
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That but then you know you end up doing the
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story and it's it's not nothing but it's it's nothing
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that's going to come on stream in the next five
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years and i just yeah yeah And I just imagine, like,
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you're sitting home with pancreatic cancer and you hear that,
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you perk up and you think, oh, I'm saved. There's hope.
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And then you go, oh, no, there isn't. It will
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come too late for me. I'm always sort of a
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bit squeamish about that. A lot about, you know, as
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far as the kind of the basic drugs, you know,
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the blood pressure stuff, statins, this probably isn't talked about enough.
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You know, I don't think I've done a single thing
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in my long career covering this kind of thing where
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we've discussed the pros and cons of blood pressure drugs
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roughly how they work why we take them or don't
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work you know etc you know but you know i
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suppose i don't know i don't know why we don't
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do that i mean sometimes i think well perhaps we
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don't talk about it because there's not a problem you
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know people started dropping dead of it because they were
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using a certain you know or growing horns because they
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were using a certain kind of blood pressure drug then
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we'd be doing it straight.
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Away but i think Isn't that's what you know, the
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recent Sunday Times articles, which is called the prescription trap.
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And it's really started through the British Geriatric Society. I
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think speaking to Sean Linton, who's from the Sunday Times
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and saying, can you run something on this? Because like
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you said, and when I spoke to you on the phone,
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you know, and I gave you the big numbers, you know,
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1000 pills a second we consume in England.
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Right.
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One one million people on 10 more 10 or more
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medicines one million people admitted to hospital in england due
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to non-elective admissions and 40 of those are probably preventable
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and due to five classes of medicines so it's not
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it's not like you're saying it appears hidden but actually
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it's sort of it's for us and those of us
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that work in health care and as people are getting
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older and got more conditions and more medicines it's becoming
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more more front of center and i think when I
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spoke to you about when we wanted to talk to you,
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was that how do we cut through to get the
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public on board so that they understand that? And, you know,
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I don't know if you've seen any of the stuff
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from the Sunday Times, but there's been quite a lot
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of things. It was on BBC Morning Live again this week,
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a long session about it, and a GP on there
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talking about, you know, be sensible, talk to a health
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professional before you do it. But these are the sorts
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of things we are causing problems.
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I mean, that's a good story. It's often, I mean,
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it's an interesting test case that if I, you know,
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I'm doing my radio programme tomorrow on Five Live, which
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is absolutely the kind of story we do. What we
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get wrong is that often, you know, we wait for
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a newspaper to do it before we do it on
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the BBC. But if I went in, you know, the
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production meeting tomorrow morning and said, we're going to do
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this story, they'd go, well, what is it? Then you
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need some pretty simple facts to get it past the
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editor and the team. And, you know, so I don't
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know how you'd phrase it. I mean, what comes to
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my mind is that, I don't know, it's a I
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don't want to reduce it to a sort of, so
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simple it's an absurdity, but, you know, of all the
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pills taken in the country, how many are unnecessary? How
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many could you do without taking? And how many are
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actually harmful? Yeah. You know, those, you know, you can
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come with those two, you can come with, you know,
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a couple of metrics along those lines. Then that's the
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story then.
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How we might answer that is looking at the list
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of medicines that you're on and say, you know, do
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you know actually how effective the drugs that you're on
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are and what the risks are and that's that's the
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point because i think you're right there they'd be lovely
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to have that answer that question but you probably can't
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but what but what you can answer is saying to
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people do you actually understand you know you're on a
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statin how likely that is to stop you having a
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heart attack and actually what the risks are with it
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and that's but i suppose that's quite difficult to get
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across in a short news piece isn't.
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It well that is except with all of those things
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it comes down I mean, you not only need some...
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It's not so much that you need some specialist sort
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of medical knowledge. It's that you need sort of some
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understanding of risk.
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Yeah.
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And taking the leaflet out of the statin box and
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reading it, it's like all those leaflets, to cover themselves,
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everything is on there. So, I mean, how are you
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supposed to.
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So, for example, when you were prescribed rather than offered...
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So what should happen is you should be offered a
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statin and you should be advised. And there's very good,
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we call them smiley faces, okay? So it's 100 faces.
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And it says if we had 100 people roughly like you, Adrian,
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from all the data that we know about statins, your
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risk of having a heart attack or stroke in the
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next 10 years is, let's say, 20%. And if you
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take a statin, it'll reduce that by about a third, okay?
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So go down to, you know, about 14 or whatever.
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So so that's the benefit. And then on the other side,
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there's two sides to every coin. And then, you know,
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muscle pain is not as common as people think. It
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may only be one or two people out of 100.
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And there are some more serious ones like affecting your liver.
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But you'd know about it because you'd go yellow and
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you'd feel pretty unwell. But people, if you give it
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to them like that, you'd be. maybe you wouldn't be surprised,
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but there's a very varying degree of people who say, well,
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that's not very good odds. I'm actually, you know, thanks
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very much, but I don't want to take those. And
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that's fine from a clinician point of view. If you've offered,
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you've offered, but you've given some informed, like you said,
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you've got to know something about the risk and the benefit.
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But that's part of the skill these days is trying
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to explain that to people so that they decide themselves
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whether they want to take the medication. But it sounds
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like that didn't happen to you.
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I don't remember so much with the static ones. I
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remember prescribed, I think, the blood pressure ones by a cardiologist.
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I don't end up how I ended up in front
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of a cardiologist. But I had an ECG and whatnot,
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and he gave me a percentage, you know, what your
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percentage chance of a cardiac event in the next 15
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years was.
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Okay, so you did, yeah.
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And then he said, you know, that falls... bit if
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you take the blood pressure it reduces your risk but
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so obviously i said well what's the downside and it
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said well this that and the other whatever it was
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and then i said well i don't know if it
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was your son or your brother what would you tell
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me to do and he goes i think you'd probably
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take him that's good enough for me and i assume
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i had a similar a similar thing with the statin
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then i mean the omeprazole is another You know, it's
386
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another kettle of fame. That's quite simple. If I don't
387
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take it, then I'm, you know, for a couple of days,
388
00:19:15.710 --> 00:19:18.250
it feels like I've got battery acid coming up through
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00:19:18.289 --> 00:19:20.069
my esophagus.
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00:19:20.670 --> 00:19:24.279
So, Adrian, in amongst that discussion there, it's something we've
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mentioned on the podcast many times over the last 90-odd episodes.
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As healthcare professionals, we overestimate the benefits of medicines. And
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as patients, we overestimate the benefits of medicines. And as
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healthcare professionals, we underestimate the harms. And as patients, we
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underestimate the harms. And there was a pharmaceutical executive many
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years ago that came in with a lovely line that
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would fit on the morning show most of our drugs
398
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don't work in most of our patients most of the
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00:19:58.539 --> 00:20:03.660
time okay so most of our medicines don't work in
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00:20:03.740 --> 00:20:05.759
most of our patients most of the time. And they
401
00:20:05.779 --> 00:20:08.220
were correct. And they were preparing us for this new
402
00:20:08.339 --> 00:20:14.269
world of pharmacogenomics and precision medicine, which still hasn't fulfilled
403
00:20:14.640 --> 00:20:20.069
its promise, but is work in progress. But yeah, that's
404
00:20:20.089 --> 00:20:23.849
the backdrop to some of your conversations. Are you using
405
00:20:23.890 --> 00:20:26.109
a dosit box still? That was mentioned in the column
406
00:20:26.710 --> 00:20:29.569
a few years ago. How are you actually managing the meds?
407
00:20:30.470 --> 00:20:33.759
Well, I don't. Well, I've got strong feelings about those
408
00:20:33.819 --> 00:20:38.339
boxes because my dying, you know, my dad's last couple
409
00:20:38.380 --> 00:20:41.980
of years, you know, he was on 14 pills a day.
410
00:20:42.039 --> 00:20:45.759
And the boxes you got from the chemists were absolutely useless.
411
00:20:46.859 --> 00:20:50.579
You know, they were quite flimsy. You peel the plastic off.
412
00:20:51.519 --> 00:20:54.299
You know, it was just difficult. You had to take
413
00:20:54.339 --> 00:20:56.240
them out of the box and put them in a
414
00:20:56.279 --> 00:20:59.519
better box, a plastic thing, you know, with the days
415
00:20:59.559 --> 00:21:01.880
of the week on it. so what's the point of
416
00:21:01.920 --> 00:21:05.309
sorting them in the box in the first place, you know, so,
417
00:21:05.490 --> 00:21:07.390
I mean, that's so, you know, I just get them,
418
00:21:07.430 --> 00:21:09.890
and then I get my meds, and I put them
419
00:21:09.950 --> 00:21:12.589
in a, well, I've got, I take some in the morning,
420
00:21:12.650 --> 00:21:14.470
and some in the evening, and I sort them into
421
00:21:14.509 --> 00:21:17.099
the boxes, and then, and then take them, I mean,
422
00:21:17.119 --> 00:21:19.579
I think the DVT is another one, I don't know,
423
00:21:20.980 --> 00:21:23.779
you know, I mean, I think that was potentially quite serious,
424
00:21:23.859 --> 00:21:26.220
as DVTs are, and then suddenly, you know, you didn't
425
00:21:27.430 --> 00:21:29.630
I know when it happened and he wasn't really diagnosed
426
00:21:29.650 --> 00:21:31.190
at the time, it was only a couple of months later,
427
00:21:31.269 --> 00:21:35.329
it transpired that I had, you know, got a post-thrombotic leg.
428
00:21:35.930 --> 00:21:39.339
So then it makes sense to take a blood thinner.
429
00:21:40.220 --> 00:21:42.619
You know, so... I mean, with all of them, the
430
00:21:42.660 --> 00:21:46.859
only one where I think, hang on, what is going
431
00:21:46.920 --> 00:21:49.640
on here is the ADHD one, the LVADS one. That's
432
00:21:49.700 --> 00:21:54.160
the one that I'm totally conflicted on. But anyway, I'm
433
00:21:54.200 --> 00:21:57.289
happy to talk about that. But, I mean, the others...
434
00:21:57.589 --> 00:22:00.250
I don't know what I'd change unless you told me, well,
435
00:22:00.710 --> 00:22:03.990
you know, the lisinoprine and amlodipine, I should have that
436
00:22:04.069 --> 00:22:07.710
re-looked at. But I do monitor my blood pressure as well,
437
00:22:08.029 --> 00:22:11.829
mainly because the LVADs, they start giving me the third degree.
438
00:22:12.230 --> 00:22:14.230
Yeah, they will. They want to know what your weight
439
00:22:14.329 --> 00:22:17.539
is and your heart rate and your blood pressure. And
440
00:22:17.579 --> 00:22:21.640
that's right. And in some respects, you see, that's good medicine.
441
00:22:21.720 --> 00:22:25.650
So there are four stages to prescribing. There's consider... where
442
00:22:25.690 --> 00:22:28.250
you discuss with the patient, here are the benefits, here
443
00:22:28.269 --> 00:22:29.789
are the risks, do you want to take it? Or
444
00:22:29.829 --> 00:22:32.369
do you want to try a non-pharmacological option, for example?
445
00:22:32.829 --> 00:22:36.410
Then there's start, but then there's review and stop. And
446
00:22:36.470 --> 00:22:42.569
so what the prescription trap backstory is, is that the
447
00:22:42.710 --> 00:22:47.470
whole of medicine is basically just considering starting all the time.
448
00:22:47.509 --> 00:22:50.089
And it's not as good as dealing with review and stop.
449
00:22:50.589 --> 00:22:53.309
So the ADHD medicines is quite a good example of,
450
00:22:53.690 --> 00:22:56.930
where actually they know that it's really important to check
451
00:22:57.009 --> 00:22:59.990
that people aren't losing weight and that their heart rate
452
00:23:00.019 --> 00:23:03.880
hasn't gone too fast because of the nature of the drugs,
453
00:23:03.920 --> 00:23:07.519
they're amphetamine-like. So that's a good monitoring process, but lots
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00:23:07.539 --> 00:23:09.940
of people get put on drugs and they never get
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monitored at all.
456
00:23:12.180 --> 00:23:12.980
I understand that.
457
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This whole point is trying to get across that it's
458
00:23:16.160 --> 00:23:19.009
okay for people to ask for a review of their
459
00:23:19.049 --> 00:23:21.109
medication and that's what's going to come out of all
460
00:23:21.130 --> 00:23:25.700
of this. And the practices, you know, most practices now
461
00:23:25.740 --> 00:23:29.569
in England, contain a pharmacist, somebody like me who works there,
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00:23:29.609 --> 00:23:32.130
whose job is to basically be the medicines expert and
463
00:23:32.210 --> 00:23:34.730
answer the questions. And for people on lots of medicines,
464
00:23:34.829 --> 00:23:37.269
they get an annual review. And then we get time
465
00:23:37.309 --> 00:23:39.269
to go through all of those things. So, you know,
466
00:23:39.309 --> 00:23:41.089
as I said before, we weren't expecting you to come
467
00:23:41.150 --> 00:23:43.609
on and be and go through each of your medicines
468
00:23:43.650 --> 00:23:46.400
line by line, what we're really interested in is How
469
00:23:46.440 --> 00:23:48.400
do you think we could get that message across? And
470
00:23:48.460 --> 00:23:50.359
I think what you're telling us is that we're still
471
00:23:50.400 --> 00:23:52.500
not managing it very well, I think is what I'm hearing.
472
00:23:52.880 --> 00:23:56.569
Well, let me tell you something. In terms of just
473
00:23:56.609 --> 00:23:58.829
going back to, I'll address that, but just going back
474
00:23:58.869 --> 00:24:04.829
to the risk, you know, having talked through why you are,
475
00:24:04.950 --> 00:24:07.890
you know, what the pros and cons are. I found
476
00:24:07.910 --> 00:24:10.269
with all you were talking, I get what you're saying.
477
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But as I said to you, I'd slightly say to you, well, okay, look,
478
00:24:14.410 --> 00:24:17.690
you're the expert. I like you, I trust you. I'll
479
00:24:17.710 --> 00:24:20.829
just do what you think. If I was your relative,
480
00:24:21.230 --> 00:24:24.380
but was you, I'll just do that. Honestly, just tell
481
00:24:24.410 --> 00:24:26.240
me what to do and I'll do it. And I
482
00:24:26.259 --> 00:24:28.819
think that's fine if you like and trust somebody. And
483
00:24:28.839 --> 00:24:31.000
also this, well, on one hand, on the other hand,
484
00:24:31.420 --> 00:24:33.680
it reminds me a bit of the conversations which get
485
00:24:33.720 --> 00:24:35.440
on my tits, no way, that you have with a
486
00:24:35.700 --> 00:24:41.569
financial advisor. Because of a compliance, you get all this paperwork.
487
00:24:42.529 --> 00:24:43.769
I can't tell you what pensions are.
488
00:24:43.789 --> 00:24:45.230
What do you want to do? I said, look, mate,
489
00:24:46.029 --> 00:24:49.009
simple right i'll give you some money right you make
490
00:24:49.069 --> 00:24:51.859
it into a bigger amount of money okay and you
491
00:24:52.119 --> 00:24:56.359
know that that's all okay keep it simple i'll just
492
00:24:56.440 --> 00:24:58.900
i'll just do what you do so i mean i'm
493
00:24:59.059 --> 00:25:03.160
slightly feel a bit like that about it the review
494
00:25:03.339 --> 00:25:09.740
thing so i'm not aware i've been reviewed about anything
495
00:25:09.779 --> 00:25:12.259
i think i'm what what i can what i'm concerned
496
00:25:12.319 --> 00:25:17.089
about is some review might start giving me the third
497
00:25:17.150 --> 00:25:20.450
degree about the LVANS. Now, I'm not particularly proud of
498
00:25:20.490 --> 00:25:23.150
that because I need that LVANS now. And I don't
499
00:25:23.190 --> 00:25:26.990
know whether I need it because of ADHD or I
500
00:25:27.029 --> 00:25:30.650
need it because I'm just addicted to it. I honestly
501
00:25:31.460 --> 00:25:33.880
don't know. I don't know which it is. As I've
502
00:25:33.900 --> 00:25:35.819
said to you, I got diagnosed about in 2019 before
503
00:25:35.900 --> 00:25:44.920
everybody did. And it was a real light bulb moment
504
00:25:44.960 --> 00:25:48.000
for me. And I took that out. And the LVANs,
505
00:25:48.039 --> 00:25:50.130
I went through all this ECG and everything. And then
506
00:25:50.170 --> 00:25:54.829
my blood pressure, it actually lowered my blood pressure. So,
507
00:25:55.250 --> 00:25:59.230
you know, settled on LVANs, 50 milligrams. But I had
508
00:25:59.250 --> 00:26:02.769
a conversation at the time with a guy who was
509
00:26:02.829 --> 00:26:06.930
a merchant banker, an Irish guy. This was in 2019,
510
00:26:06.910 --> 00:26:09.420
I had this conversation. And he said about five years before,
511
00:26:10.759 --> 00:26:15.740
He'd had a conversation, a merchant banker type conversation. I51200:26:15.759 --> 00:26:19.680
was with a pharmaceutical firm. And the boss of this51300:26:19.740 --> 00:26:22.440
pharmaceutical firm, I assume, was talking through his business plan51400:26:22.480 --> 00:26:25.500
and stuff. I don't know whether they were doing acquisition51500:26:25.519 --> 00:26:28.220
or whatever. But anyway, he remembered the head of this51600:26:29.380 --> 00:26:33.039
pharmaceutical firm going, oh, yeah, ADHD is going to be51700:26:33.079 --> 00:26:37.970
really big for us. Oh, yeah. Well, I mean, how51800:26:38.009 --> 00:26:40.250
did he know? I mean, how did he know? He said,51900:26:40.269 --> 00:26:42.630
are we going to start pushing these drugs? Or have52000:26:42.690 --> 00:26:46.490
we got a drug in development that's really good? Or52100:26:46.609 --> 00:26:49.599
have we got a drug in development that is or52200:26:49.630 --> 00:26:52.279
isn't good? But I know one thing, once people are52300:26:52.319 --> 00:26:53.720
on it, they're not going to want to get off it.52400:26:54.079 --> 00:26:56.980
Or, Adrian, have they got a disease in development?52500:26:58.420 --> 00:27:04.160
Well, yeah, absolutely. Or a diagnostic push in development. Or52600:27:04.220 --> 00:27:07.809
maybe they know that, you know, modern society, social media,52700:27:07.869 --> 00:27:12.150
everything is such a, a vector for ADHD that everyone's52800:27:12.190 --> 00:27:14.309
going to want to get. I don't, I just don't know,52900:27:15.069 --> 00:27:17.799
but you know, I can't, I slightly feel as if53000:27:17.859 --> 00:27:21.940
I might be getting played a bit, but then I53100:27:21.960 --> 00:27:23.759
don't know. I don't know whether I'm addicted or not.53200:27:23.819 --> 00:27:25.700
You know, you know, the feeling I get when I53300:27:25.740 --> 00:27:28.119
take it in the morning is precisely the same feelings53400:27:28.160 --> 00:27:30.240
I get when I have a large black Americana.53500:27:31.440 --> 00:27:31.700
Yeah.53600:27:31.759 --> 00:27:34.500
I know the feeling I'm getting there, the feeling I'm53700:27:34.519 --> 00:27:36.660
getting from that Americana, as I understand it, is because53800:27:36.700 --> 00:27:40.769
my body's gone into withdrawal overnight. because I'm addicted to53900:27:40.809 --> 00:27:43.710
caffeine at some level, and then, you know, I have54000:27:43.759 --> 00:27:47.220
my big, large black Americano, often in the Cafe Nero54100:27:47.319 --> 00:27:51.059
in Cardiff by the market, and then, you know, suddenly54200:27:51.079 --> 00:27:53.240
it all was well in the world. I mean, it's54300:27:53.339 --> 00:27:55.519
not far off the feeling that I get when I54400:27:55.539 --> 00:27:58.160
take the L-Vans, but, you know, I wouldn't be without it.54500:27:58.180 --> 00:28:00.910
I mean, I've been a better place since I've been54600:28:00.970 --> 00:28:03.710
taking it, but sometimes I do wonder what I'd be54700:28:03.750 --> 00:28:06.230
like without it. But, I mean, actually, with the review,54800:28:06.430 --> 00:28:09.450
if there's a review, suddenly I've somebody took it off54900:28:09.509 --> 00:28:12.470
me then it'll be a right ball like getting it55000:28:12.809 --> 00:28:13.890
back i suppose.55100:28:13.650 --> 00:28:16.150
But it's an interesting point because i can remember you55200:28:16.470 --> 00:28:21.660
know i don't practice with patients anymore but i can55300:28:21.680 --> 00:28:24.240
remember even when i did that people would be scared55400:28:24.259 --> 00:28:25.700
to come in for an asthma review because they were55500:28:25.720 --> 00:28:28.339
worried we were going to take their inhalers off them55600:28:28.359 --> 00:28:30.180
so i think it's a real thing and i think55700:28:31.299 --> 00:28:33.740
it's because we we just have to get these reviews55800:28:33.819 --> 00:28:36.019
right at the end of the day is i think55900:28:36.559 --> 00:28:39.160
They need to become a normal part of practice. So56000:28:39.180 --> 00:28:42.160
it doesn't feel unusual being called in for a medication review.56100:28:43.339 --> 00:28:46.279
It's more of a conversation. We can't do a medication56200:28:46.319 --> 00:28:49.299
review on air now, but having that conversation with someone56300:28:49.380 --> 00:28:51.720
and just discussing those concerns, that's what the review would56400:28:51.759 --> 00:28:54.920
be really, rather than we're looking at this drug to56500:28:54.940 --> 00:28:56.009
see if we can take it off you.56600:28:56.829 --> 00:28:58.509
Or save money or all that kind of stuff.56700:28:59.309 --> 00:29:01.789
Well, with statins, it would never be saving money because56800:29:01.809 --> 00:29:02.829
they cost buttons, don't they?56900:29:02.849 --> 00:29:05.960
Exactly, yeah. Yeah, I think, you know, to wrap this up,57000:29:06.000 --> 00:29:10.200
maybe you have a particular view of medicine. And for57100:29:10.220 --> 00:29:11.619
a lot of people, and a lot of the patients57200:29:11.640 --> 00:29:12.940
that we have on here, or a lot of the57300:29:12.980 --> 00:29:16.059
patients that I see in practice, you perhaps still have57400:29:16.119 --> 00:29:20.059
quite a paternalistic view of medicine and doctors in that,57500:29:20.099 --> 00:29:23.220
like you said, what would you do, doc? And lots57600:29:23.279 --> 00:29:27.119
of patients don't think like that anymore. And like you said,57700:29:27.200 --> 00:29:29.940
even just now about, you know, in a conversation with57800:29:29.980 --> 00:29:33.009
a merchant banker or knowing about you don't know who57900:29:33.009 --> 00:29:35.089
that you don't know who that prescriber is paid by.58000:29:35.109 --> 00:29:35.710
Okay.58100:29:36.039 --> 00:29:38.400
Or, you know, whether or not they receive funding from58200:29:38.440 --> 00:29:41.000
a pharmaceutical company. And I'm just using that as an example,58300:29:41.339 --> 00:29:44.619
but there are all sorts of things where actually the58400:29:44.680 --> 00:29:48.200
modern way in medicine is that it should be. And58500:29:48.240 --> 00:29:49.900
I get what you've said about, you don't want the58600:29:49.940 --> 00:29:52.390
financial person to say, you make the choice, Adrian, I'll58700:29:52.410 --> 00:29:54.690
give you the information. You make the choice. But for58800:29:54.710 --> 00:29:57.349
a lot of people, they want to be involved in58900:29:57.390 --> 00:30:00.430
that decision. It may be just our age group. It59000:30:00.490 --> 00:30:02.130
may be that you're quite happy with that. It may59100:30:02.150 --> 00:30:05.309
be just the way that you've accessed healthcare. But for59200:30:05.329 --> 00:30:07.180
a lot of people, that's not how they see it.59300:30:07.690 --> 00:30:09.230
And I think that the bit that we're trying to59400:30:09.269 --> 00:30:11.529
get across, and when I spoke to you about how59500:30:11.609 --> 00:30:14.190
to help us is, get people to realize that it's59600:30:14.349 --> 00:30:17.809
okay to ask and having a review doesn't mean that59700:30:17.869 --> 00:30:19.509
people are going to stop stuff and they're trying to59800:30:19.549 --> 00:30:23.750
save money. It can be really in your interest and59900:30:23.829 --> 00:30:25.849
may actually stop you from, you know, from having a60000:30:25.910 --> 00:30:27.960
serious reaction that could end you up in hospital and60100:30:27.980 --> 00:30:30.059
at very worst could be potentially fatal.60200:30:30.279 --> 00:30:32.160
Yeah, I think that makes sense. I mean, I wouldn't,60300:30:32.680 --> 00:30:35.920
I wouldn't say I haven't got a paternalistic view so60400:30:35.960 --> 00:30:40.119
much as I think on balance, I would, you've got60500:30:40.140 --> 00:30:42.559
to put your trust in who's been medically trained and,60600:30:43.140 --> 00:30:46.329
I want the discussion, but on balance, if I'm not sure,60700:30:47.029 --> 00:30:48.809
then they sort of get the casting vote.60800:30:49.250 --> 00:30:51.690
Yeah, casting vote, I think his fasting vote is fine.60900:30:51.970 --> 00:30:55.309
Yeah, but I mean, you know, if you take another view,61000:30:55.369 --> 00:30:59.170
then in the end, that leads to people not taking,61100:30:59.210 --> 00:31:02.660
you know, the MMR vaccine or, you know, not taking61200:31:02.799 --> 00:31:05.660
the COVID vaccines or stuff. If everybody thinks they know61300:31:05.720 --> 00:31:08.940
better and thinks anything you put in your body is poisoned,61400:31:09.000 --> 00:31:13.289
it's just, you know... So generally, I mean, I'm inclined61500:31:13.329 --> 00:31:17.690
to trust. I take on board what you say. So61600:31:17.750 --> 00:31:21.109
I should perhaps go back and get my blood pressure reviewed.61700:31:22.269 --> 00:31:24.049
But I don't see what the point would that be61800:31:24.069 --> 00:31:25.410
because the first thing I'd do when I got in61900:31:25.450 --> 00:31:28.200
there would take my blood pressure. Well, who knows what62000:31:28.259 --> 00:31:32.700
reading you get when you're in the GP surgery, white coat, hypertension, everything.62100:31:33.539 --> 00:31:35.480
So unless they're going to go to bother and put62200:31:35.519 --> 00:31:37.910
me in that, what do you call it, parambulatory, the62300:31:37.930 --> 00:31:40.250
thing when you're that I've done that on air, by62400:31:40.289 --> 00:31:42.750
the way. I've had that for 24 hours while presenting62500:31:42.789 --> 00:31:45.809
a radio programme. And I was having to time going62600:31:45.849 --> 00:31:49.119
into the tapes, telling them, right, there's one, you know,62700:31:49.130 --> 00:31:52.660
there's a pom-pom coming in about sort of seven minutes.62800:31:52.680 --> 00:31:55.640
Can we try and hit the news early so it62900:31:55.660 --> 00:31:59.319
can happen while I'm not on air? Also, just incidentally63000:31:59.339 --> 00:32:01.839
with that, the day I had that one on, West63100:32:01.880 --> 00:32:05.160
Brom got into their first penalty shootout for bloody years63200:32:05.559 --> 00:32:09.410
in a cocktail at Peterborough. So that was, that was,63300:32:09.599 --> 00:32:11.319
it was all over the place when he looked at63400:32:11.380 --> 00:32:13.539
the graph. Then he goes, well, you know what, what63500:32:13.559 --> 00:32:15.960
happened here? But so I don't see how they, but63600:32:15.980 --> 00:32:17.279
what I'm saying, I don't see how they can make63700:32:17.319 --> 00:32:19.960
a judgment on whether the blood pressure is working. If63800:32:20.789 --> 00:32:23.369
you know, if I went to that, but for that reason,63900:32:23.390 --> 00:32:25.750
I take my blood pressure most mornings actually. So I'm64000:32:25.769 --> 00:32:27.490
a good boy and I'm keeping track.64100:32:27.890 --> 00:32:29.569
I go back to what we said at the beginning about,64200:32:29.589 --> 00:32:31.470
and the patients that we've had on this, on this64300:32:31.799 --> 00:32:34.880
podcast about, we have to trust and support people. So,64400:32:35.650 --> 00:32:37.549
what you would do quite honestly is what we would64500:32:37.589 --> 00:32:39.450
do is we would ask you to, yeah, fine. Do64600:32:39.470 --> 00:32:40.930
your own blood pressure reading at home. As long as64700:32:40.970 --> 00:32:43.170
we know you've got a recognized blood pressure machine, we'd64800:32:43.210 --> 00:32:44.970
ask you to do a week off and we would64900:32:45.049 --> 00:32:46.730
use that. We don't want to do it unnecessarily because65000:32:46.759 --> 00:32:48.119
we know it will be up when you come in65100:32:48.180 --> 00:32:50.519
because you'll be worried about it. So it's just working65200:32:50.559 --> 00:32:53.559
together really to, to try to help people, but it's not,65300:32:53.859 --> 00:32:56.500
we're obviously still not landing the message, but for a65400:32:56.500 --> 00:32:58.220
lot of people, I have to say we are okay.65500:32:58.240 --> 00:33:00.859
For people who are in their seventies, eighties and nineties65600:33:00.920 --> 00:33:03.130
are very worried about being on 10 plus medicines. A65700:33:03.150 --> 00:33:05.309
lot of them are quite happy to come forward. and65800:33:05.349 --> 00:33:07.829
want to get a review. So, well, look, I think65900:33:07.849 --> 00:33:10.430
we probably, we best move on and we, we, we, um,66000:33:10.609 --> 00:33:13.549
we really appreciate you coming on. I can't move on though, without,66100:33:13.710 --> 00:33:16.769
without saying this, given that you're in a metaphorical pharmacy66200:33:16.789 --> 00:33:19.599
and there's no other people in the waiting room. How66300:33:19.730 --> 00:33:20.759
are your Adriens?66400:33:21.240 --> 00:33:23.900
How are my Adriens? They're actually not going to have66500:33:23.980 --> 00:33:24.839
trouble to report.66600:33:27.049 --> 00:33:28.769
I loved it when I read that. I don't think66700:33:28.829 --> 00:33:29.589
I actually realized that.66800:33:29.690 --> 00:33:31.890
He sent me, the bloke from Vid sent me the66900:33:31.930 --> 00:33:35.109
original artwork for that. And I bloody lost it. I've got,67000:33:35.710 --> 00:33:38.339
that's genius. Very, very proud moments.67100:33:38.440 --> 00:33:40.519
That was, I had to ask you that. I just,67200:33:40.619 --> 00:33:41.859
I just felt I had to ask you.67300:33:42.079 --> 00:33:46.740
The oral apothecary is sponsored by Jamie Hayes, executive coaching67400:33:47.079 --> 00:33:48.819
and one less pill.com.67500:33:49.420 --> 00:33:51.500
Okay. So before you go, then there are three things67600:33:51.539 --> 00:33:54.000
that we'd like from you. If you don't mind. And67700:33:54.059 --> 00:33:56.079
these are three things for the oral apothecary. The first67800:33:56.180 --> 00:33:58.130
one is a desert island drug. And I know you67900:33:58.170 --> 00:34:00.150
work for the BBC, but we did get into trouble68000:34:00.190 --> 00:34:02.430
with the BBC. We had a cease and desist letter68100:34:02.950 --> 00:34:05.349
about this. So it's not something to save you on68200:34:05.390 --> 00:34:07.750
an island, but it's something that has a powerful memory68300:34:07.809 --> 00:34:09.730
for you. So what would you like to offer us68400:34:09.869 --> 00:34:10.309
and why?68500:34:12.239 --> 00:34:14.090
I mean, it could be any prescription drug, can it?68600:34:14.110 --> 00:34:16.340
It could be anything. We've had people pick alcohol, by68700:34:16.380 --> 00:34:18.679
the way. We've had three guests pick alcohol.68800:34:18.760 --> 00:34:20.480
It's a medicine that you have an emotion, you know,68900:34:20.519 --> 00:34:23.559
that perhaps you have an emotional attachment to or you've69000:34:23.579 --> 00:34:24.559
had a story with.69100:34:24.440 --> 00:34:25.039
In the past.69200:34:25.119 --> 00:34:26.320
It doesn't have to be anything.69300:34:26.780 --> 00:34:29.559
I mean, your LVANS, as you've just given that, that69400:34:29.599 --> 00:34:30.940
sounds like it's pertinent to you.69500:34:31.460 --> 00:34:34.360
No, I mean, I would, I'd say, one that sticks69600:34:34.380 --> 00:34:36.079
in my mind is the one time I was, because69700:34:36.099 --> 00:34:38.539
I go, my mum's Croatian, so I was always going69800:34:38.599 --> 00:34:43.840
back and forth to Zagreb through various various my flow69900:34:43.860 --> 00:34:45.900
and I've done it every which way but walk I've70000:34:45.960 --> 00:34:51.360
cycled motorbike train plane whatever but I I it was70100:34:51.480 --> 00:34:55.969
one time and it was midwinter and when I went70200:34:56.030 --> 00:35:00.949
by train and I remember my auntie dropped me at70300:35:00.969 --> 00:35:03.849
the station and I was getting the sleeper to Munich70400:35:03.909 --> 00:35:07.269
and then on to Amsterdam the following day and even70500:35:07.329 --> 00:35:09.610
as she dropped me off I felt my throat was70600:35:09.809 --> 00:35:13.519
sore There was a real, I was starting to get sore.70700:35:14.480 --> 00:35:16.260
I went to sleep and then I woke up. And70800:35:16.280 --> 00:35:20.199
then the problem at the time, this was post Yugoslavia.70900:35:21.239 --> 00:35:24.800
But there was a border every 20 bloody minutes on71000:35:24.820 --> 00:35:28.639
the train. So it's first Slovenia, then there's going into Austria,71100:35:29.099 --> 00:35:30.760
then there was going into Germany. So I was on71200:35:30.800 --> 00:35:34.130
this sleeper. And every time the border guard woke me71300:35:34.190 --> 00:35:37.840
up to get the passport. this pain got worse. By71400:35:37.860 --> 00:35:40.239
the time I got to Munich, I was in absolute71500:35:40.429 --> 00:35:45.309
bloody agony. It was agony. It was brutal. And I71600:35:45.429 --> 00:35:48.210
sat there. I've had a temperature in Munich station, right?71700:35:48.449 --> 00:35:50.969
I've got to get to Amsterdam. So I get all71800:35:51.010 --> 00:35:54.429
day on the train to Amsterdam. Couldn't talk, could barely breathe.71900:35:55.260 --> 00:35:57.239
And then I had to get the effing boat from72000:35:57.340 --> 00:36:02.300
Amsterdam to Harwich. By which I was in an ecstasy72100:36:02.340 --> 00:36:05.860
of pain. Got the train to London. Then, it was72200:36:06.199 --> 00:36:07.920
and then it was a Saturday and I had to72300:36:08.000 --> 00:36:10.360
get back to the Midlands where my mate was getting72400:36:10.420 --> 00:36:12.780
married that day and he was a very close friend72500:36:13.559 --> 00:36:16.139
so I couldn't miss it I said I thought this72600:36:16.199 --> 00:36:19.360
wedding was going to last forever it was awful.72700:36:19.559 --> 00:36:22.039
What the wedding was awful or your throat was awful.72800:36:22.199 --> 00:36:24.079
What the way no the wedding was great but I72900:36:24.119 --> 00:36:30.619
mean just I just I felt terrible but then By Monday,73000:36:30.860 --> 00:36:33.530
the pain, I thought, I literally can't stand this anymore.73100:36:33.550 --> 00:36:35.650
I went to the doctor. It was my old family doctor,73200:36:36.050 --> 00:36:40.250
where my mum still lives. And he went, hmm, that73300:36:40.269 --> 00:36:43.570
looks very sore. I said, pharyngitis. And he said, oh,73400:36:43.590 --> 00:36:45.469
you need an antibiotic for that. And look, I don't73500:36:45.489 --> 00:36:46.690
know what it was he gave me.73600:36:47.010 --> 00:36:48.260
Was it a penicillin probably?73700:36:48.280 --> 00:36:49.539
Penicillin 250.73800:36:49.539 --> 00:36:52.199
And I remember I took it, I went to bed,73900:36:52.219 --> 00:36:54.559
I slept all day, woke up in the morning, and74000:36:54.579 --> 00:36:58.639
it had gone. I remember looking at this bottle, thinking, oh,74100:36:58.960 --> 00:37:02.469
thank you. thank you for this. I just never have74200:37:02.510 --> 00:37:03.670
I been more grateful.74300:37:03.909 --> 00:37:08.000
It sounds like a classic reaction to the wonders of penicillin.74400:37:08.260 --> 00:37:11.239
I had the same thing, probably a streptococcal A infection.74500:37:11.280 --> 00:37:12.639
I had the same thing. I drove all the way74600:37:12.679 --> 00:37:15.739
to France, felt terrible, terrible. I worked in a hospital74700:37:15.760 --> 00:37:17.659
at the time. I got a message when I got74800:37:17.719 --> 00:37:20.619
back because someone had swabbed my throat saying, Steve, you74900:37:20.659 --> 00:37:23.000
need to get straight to occupational health. You've got a75000:37:23.019 --> 00:37:25.739
streptococcal A infection. I said, I've just been on holiday75100:37:25.780 --> 00:37:27.480
for 10 days. I'm fine now, but thanks. I did75200:37:27.519 --> 00:37:30.760
feel awful for about 36 hours. Yeah. So the wonders75300:37:30.820 --> 00:37:31.440
of penicillin.75400:37:31.480 --> 00:37:31.699
Okay.75500:37:31.739 --> 00:37:32.300
We'll take that.75600:37:33.019 --> 00:37:33.239
Okay.75700:37:33.280 --> 00:37:35.809
Thank you. Now, the second thing we're after, and I75800:37:35.869 --> 00:37:39.170
know on your brilliant Saturday live program, you have the75900:37:39.210 --> 00:37:42.230
inheritance tracks. So this is probably a bit similar. So76000:37:42.250 --> 00:37:45.349
we asked people for a career or a life anthem76100:37:45.389 --> 00:37:47.349
that they would like to offer for the oral apothecary76200:37:47.369 --> 00:37:49.469
Spotify playlist. So what would you like to give us?76300:37:49.909 --> 00:37:52.690
I think I'd go for a, it's not so much76400:37:52.730 --> 00:37:57.800
a career one. It's, but it's just what's played when76500:37:57.840 --> 00:37:59.760
West Brom come onto the pitch.76600:38:00.519 --> 00:38:03.320
Oh, right. By the way, we have had a football-themed76700:38:03.860 --> 00:38:05.159
piece of music picked in the past.76800:38:05.239 --> 00:38:06.610
What was that? What was that?76900:38:06.769 --> 00:38:10.570
It was Mahindra Patel, and he picked it from Sheffield.77000:38:10.730 --> 00:38:12.130
No, Leeds. Leeds.77100:38:12.150 --> 00:38:14.510
It was the Leeds United song.77200:38:14.769 --> 00:38:18.070
Right, okay. So marching on together or something.77300:38:18.090 --> 00:38:20.190
That's it. That was it. Very good.77400:38:20.389 --> 00:38:23.039
Well, when West Brom... run on the pitch for a77500:38:23.300 --> 00:38:27.519
long time all my young life the liquidator by harry77600:38:27.539 --> 00:38:30.840
jay and the all-stars i don't think i know that77700:38:30.860 --> 00:38:34.480
song you you'd recognize you recognize it when you i77800:38:34.500 --> 00:38:36.960
mean that was like medicine for me whatever you know77900:38:37.000 --> 00:38:38.960
when i was a kid you're sitting there with my78000:38:38.980 --> 00:38:42.619
granddad and when they put that on that's when you78100:38:42.659 --> 00:38:45.510
knew the team was coming out of the tunnel And,78200:38:45.829 --> 00:38:48.039
I mean, that was better than any penicillin, whatever I78300:38:48.099 --> 00:38:49.519
was feeling at the time.78400:38:49.880 --> 00:38:50.699
That moment of hope.78500:38:50.800 --> 00:38:53.400
I mean, don't get me wrong. I invariably went home78600:38:53.440 --> 00:38:56.619
miserable at the end of the day. But at that moment,78700:38:57.519 --> 00:38:59.360
it was sort of only optimism.78800:38:59.559 --> 00:39:01.949
Music as medicine, agent. I was sure you were going78900:39:01.969 --> 00:39:05.510
to go with Led Zeppelin after reading the last, you know, that.79000:39:05.530 --> 00:39:07.590
I could have gone. I could have gone for, I79100:39:07.650 --> 00:39:11.820
could have gone for Led Zeppelin. But, um. Robert Plant's79200:39:11.889 --> 00:39:14.409
a Wolves fan, and they beat us last weekend, so79300:39:14.449 --> 00:39:15.010
it's not that bad.79400:39:15.030 --> 00:39:16.809
Oh, there you go. We thought you'd get West Brom79500:39:16.849 --> 00:39:20.750
in at some point, so that's Liquidator by Harry J All-Stars.79600:39:21.010 --> 00:39:23.949
We'll go into the Spotify playlist. It's very, very eclectic.79700:39:24.429 --> 00:39:27.409
I think you're something like the 90 you're the 97th79800:39:27.739 --> 00:39:30.699
uh song in there anyway and the last thing then79900:39:30.760 --> 00:39:33.900
is a book recommendation for the oral apothecary library if80000:39:33.940 --> 00:39:34.760
you don't mind.80100:39:34.739 --> 00:39:36.239
I don't i was sort of thinking about i was80200:39:36.260 --> 00:39:38.219
thinking about my i was thinking about my dad doing80300:39:38.260 --> 00:39:40.980
this because i just remember trying to force feed him80400:39:41.019 --> 00:39:44.699
his 14 pills a day and i just thought what80500:39:44.719 --> 00:39:48.380
i think now what was i doing What was I doing?80600:39:48.739 --> 00:39:52.340
What were they doing prescribing him all that? And then80700:39:52.360 --> 00:39:56.000
you get into sort of a grey area about, you know,80800:39:56.019 --> 00:39:58.820
what are we sort of keeping him alive for now?80900:39:59.659 --> 00:40:02.679
But anyway, so there was a book he sort of81000:40:02.719 --> 00:40:04.920
gave me to read when I was 15. It was81100:40:04.980 --> 00:40:07.550
a famous one called How to Win Friends and Influence81200:40:07.610 --> 00:40:12.030
People by Dale Carnegie. And it kind of slightly changed81300:40:12.050 --> 00:40:15.639
my life. I mean, it's like, this sort of schmaltzy81400:40:15.940 --> 00:40:20.699
american self-help but it's got some codified truths in there81500:40:20.800 --> 00:40:24.440
you know some and that i yeah it's it's sort81600:40:24.460 --> 00:40:26.739
of got some truths in there which i just thought81700:40:26.760 --> 00:40:28.949
you know i built a lot on that in my81800:40:28.969 --> 00:40:31.429
life i think you know it's just about asking people81900:40:31.449 --> 00:40:36.349
themselves about about themselves and being curious and stuff which82000:40:36.750 --> 00:40:38.690
you know i just saw the value in that which82100:40:38.710 --> 00:40:41.550
were my natural instincts anyway i remember a friend of82200:40:41.570 --> 00:40:44.280
mine who went on to be a professor of orthodontics82300:40:44.300 --> 00:40:46.159
there's a bit of a misery at school and i82400:40:46.219 --> 00:40:48.539
gave it to him and he went yeah i mean82500:40:48.559 --> 00:40:50.860
it's quite good but the thing is it's about asking82600:40:50.920 --> 00:40:54.880
people about themselves and thing is you're interested in other82700:40:54.920 --> 00:40:59.000
people i'm just not really interested in anybody else so82800:40:59.019 --> 00:41:00.800
it doesn't really work for me you.82900:41:00.699 --> 00:41:02.519
Both went into the right job by the sounds of83000:41:02.579 --> 00:41:05.780
it so jamie's our is our resident bookworm he reads83100:41:05.840 --> 00:41:07.949
a lot of this kind of stuff i'm absolutely sure83200:41:07.969 --> 00:41:08.730
that he's read it.83300:41:08.769 --> 00:41:11.489
I have it's a classic and i don't believe it's.83400:41:11.369 --> 00:41:14.190
Been picked in all the guests that we've had. We've83500:41:14.210 --> 00:41:16.949
had lots of similar books, haven't we, James? But I'm83600:41:17.030 --> 00:41:19.210
pretty sure when I say that, that we have not83700:41:19.269 --> 00:41:22.010
had How to Win Friends and Influence People by Dale Carnegie.83800:41:22.199 --> 00:41:24.400
It's still relevant today, isn't it? It still stands the83900:41:24.420 --> 00:41:25.019
test of time.84000:41:25.039 --> 00:41:27.639
It still gets referenced, doesn't it? What's your dad's name, Adrian?84100:41:27.659 --> 00:41:28.739
We'll give him a co-reference.84200:41:29.039 --> 00:41:30.420
Peter Childs, yeah.84300:41:30.480 --> 00:41:32.219
And I did, I don't, you know, we won't go84400:41:32.260 --> 00:41:34.619
into it now, but I did, Joy's not the wrong,84500:41:34.800 --> 00:41:38.099
right word, but I thought your column about the A84600:41:38.099 --> 00:41:40.590
& E delay with your dad, the when he went84700:41:40.789 --> 00:41:44.090
into A & E, it really resonates because, because with,84800:41:44.170 --> 00:41:46.449
with a lot of the work I do about patient safety. So,84900:41:46.869 --> 00:41:50.150
so I think you writing that highlighted a really important issue.85000:41:50.170 --> 00:41:50.750
So thank you.85100:41:51.050 --> 00:41:54.050
You know, he's one of them, you know, somebody who's,85200:41:55.030 --> 00:41:58.889
you know, he was kept alive by, you know, this,85300:41:58.909 --> 00:42:03.219
this whole armory of drugs he took. And, you know,85400:42:03.340 --> 00:42:06.340
as are other, you know, aged relatives of mine, I think, well,85500:42:07.670 --> 00:42:10.269
We've worked out a way of keeping them alive long enough,85600:42:10.289 --> 00:42:14.809
but not keeping them going cognitively. And I'm not suggesting85700:42:14.909 --> 00:42:20.170
euthanasia or something. But what we've robbed people of, and85800:42:20.210 --> 00:42:21.829
I don't know what the statistics are on this, is85900:42:23.030 --> 00:42:26.489
the chance of a sudden death. You know, I mean,86000:42:26.530 --> 00:42:28.989
famous last words. Well, perhaps I'll pop my clogs tonight.86100:42:29.030 --> 00:42:32.090
But you don't hear of people just dying suddenly anymore.86200:42:32.150 --> 00:42:34.590
It's most, you know, I think about my mum a lot.86300:42:34.639 --> 00:42:36.510
I talk to my mum about it a lot, her mum.86400:42:37.469 --> 00:42:40.739
died of a massive stroke when she was 82. Her86500:42:40.820 --> 00:42:44.199
sister died of a massive stroke in her sleep when86600:42:44.260 --> 00:42:46.869
she was 84. And then, you know, my mum's 87.86700:42:46.860 --> 00:42:49.559
And I think, well, it's kind of what I wish86800:42:49.619 --> 00:42:51.360
for her. You know, I don't want to see her86900:42:51.400 --> 00:42:54.429
ending up in a home and just, you know, existing87000:42:54.510 --> 00:42:55.050
and stuff.87100:42:55.789 --> 00:42:56.050
Yeah.87200:42:56.110 --> 00:42:58.130
Do you know what I mean? I just, so I87300:42:58.170 --> 00:43:00.489
don't know whether that's modern medicine or that's the pills87400:43:00.630 --> 00:43:02.449
or whatever. We just, you know.87500:43:02.730 --> 00:43:06.820
And perhaps our part in shot is, is, Recommending that87600:43:06.840 --> 00:43:09.460
you read a book called Being Mortal by Atul Gawande,87700:43:09.480 --> 00:43:13.090
who's quite a famous American doctor. And the whole book87800:43:13.119 --> 00:43:18.949
is about that, really. It's about how modern medicine has87900:43:19.030 --> 00:43:22.710
so focused on extending life without focusing on the quality88000:43:22.750 --> 00:43:26.760
at the end as well. So he'd be a great88100:43:26.780 --> 00:43:27.860
guest for your radio show.88200:43:28.380 --> 00:43:29.280
What's he called?88300:43:29.539 --> 00:43:33.059
Atul Gawande. Gawande, Steve's got your WhatsApp, hasn't he? He's texting.88400:43:33.099 --> 00:43:34.510
Yeah, send it to me.88500:43:34.550 --> 00:43:37.869
I'll send you the details. But yeah, you're spot on there, Kimo.88600:43:37.909 --> 00:43:39.409
It is perfect. And the other thing I guess to88700:43:39.449 --> 00:43:42.389
say is that your dad is exactly the sort of88800:43:42.429 --> 00:43:45.570
person who should have had a medication review, you know,88900:43:45.590 --> 00:43:48.550
because that's where most of the value is for people89000:43:48.590 --> 00:43:50.739
who were on something that was a very good decision89100:43:50.739 --> 00:43:54.900
24 years ago, but now his liver's 24 years older89200:43:54.940 --> 00:43:57.480
and his kidney's 24 years older. So that's exactly the89300:43:57.519 --> 00:43:59.909
sort of people that need to have those reviews.89400:44:00.489 --> 00:44:01.929
You need to meet my mom. You should get my89500:44:01.949 --> 00:44:05.909
mom on. She's, you know, the discussions over pills, you know,89600:44:06.010 --> 00:44:08.280
she says, the doctor told me to have this pill.89700:44:08.360 --> 00:44:11.739
I said, and I said, what happened? He said, she89800:44:11.780 --> 00:44:13.539
said in Croatian, he said, I told him to stick89900:44:13.599 --> 00:44:16.780
it up his ass because she just won't have it.90000:44:16.820 --> 00:44:18.139
We're back to your Adriens again.90100:44:19.199 --> 00:44:21.719
Yeah. Well, yeah. But I mean, she, she takes the90200:44:21.760 --> 00:44:25.019
opposite view and she's longer and healthier than my dad.90300:44:25.059 --> 00:44:28.570
You know, she just, You know, the doctor and me90400:44:28.710 --> 00:44:29.730
and the rest of the family are going to be90500:44:29.750 --> 00:44:32.309
on our hands and knees begging her to take something90600:44:32.710 --> 00:44:36.750
before she'll take anything. And she's, you know, lived longer90700:44:36.789 --> 00:44:37.949
and healthier than any of us.90800:44:38.250 --> 00:44:42.250
I'll mention another book from a previous guest as well, Adrian.90900:44:42.289 --> 00:44:44.590
It's a professor, Neil Musgrave, who wrote a book called91000:44:44.650 --> 00:44:48.469
Rebalancing Medicine along the lines of what we just spoke about.91100:44:48.510 --> 00:44:51.199
And he highlights and it fits in with your desert91200:44:51.260 --> 00:44:55.820
island drug, actually. he highlights that we were seduced by91300:44:55.860 --> 00:44:59.469
the impact of penicillins when they first came because they91400:44:59.510 --> 00:45:04.030
were obviously wonder drugs. And that has carried us all forward.91500:45:04.070 --> 00:45:06.670
And now we just, you know, that's an issue for91600:45:06.730 --> 00:45:11.119
us now because people think that the medicines we're producing91700:45:11.159 --> 00:45:14.639
are having the same impact and they're clearly not. The91800:45:14.679 --> 00:45:17.699
marginal gains that we get from some of these medicines91900:45:17.719 --> 00:45:20.400
are And right at the start, you said you get92000:45:20.460 --> 00:45:24.010
annoyed by the stories of wonder drugs and the promise92100:45:24.050 --> 00:45:25.789
of something. You look at it and it's five years92200:45:25.829 --> 00:45:29.130
down the track, if we're lucky. The story there potentially92300:45:29.230 --> 00:45:32.429
is actually that's a load of health care professionals that92400:45:32.449 --> 00:45:35.159
have been flown halfway around the world to go to92500:45:35.199 --> 00:45:40.679
a conference by a pharmaceutical company where they, and that's fine,92600:45:40.920 --> 00:45:43.760
but that's where these stories emerge from and then are92700:45:43.780 --> 00:45:48.070
covered in the press. And they give people hope. And92800:45:48.250 --> 00:45:53.500
there's a figure that only 25% of conference abstracts go92900:45:53.599 --> 00:45:56.000
on to become published research papers.93000:45:56.360 --> 00:45:56.860
Interesting.93100:45:57.260 --> 00:45:59.420
Right, well, Adrian, thank you so much for coming on.93200:45:59.460 --> 00:46:01.380
We've managed to keep you to a quarter to, so93300:46:01.400 --> 00:46:03.280
I really appreciate your time. I know you're a very93400:46:03.320 --> 00:46:04.719
busy man. No, not at all.93500:46:05.150 --> 00:46:08.650
Do you know what, Adrian? Reading your The Good Drinker book, okay,93600:46:08.670 --> 00:46:10.050
which is like, I just loved it.93700:46:10.110 --> 00:46:10.840
Yeah, we all did.93800:46:10.989 --> 00:46:12.909
All I wanted to do was go for a pint93900:46:12.949 --> 00:46:14.409
in you in the old arcade in Cardiff.94000:46:15.400 --> 00:46:18.739
Yeah, I'm available for that as well. Yeah, honestly. So94100:46:18.960 --> 00:46:20.639
reach out. Okay, thanks all.94200:46:20.659 --> 00:46:22.519
A big thank you to Adrian for joining us on94300:46:22.559 --> 00:46:24.980
the Oral Apothecary and for sharing his stories, his desert94400:46:25.039 --> 00:46:27.619
island drug, his career anthem, and his book for the94500:46:27.820 --> 00:46:30.800
Oral Apothecary Library. Coming up next time, we'll be joined94600:46:30.840 --> 00:46:34.610
by Michael Perry. Michael is a Principal Clinical Scientist at94700:46:34.690 --> 00:46:38.010
Public Health Wales. Michael is also Treasurer of the C.94800:46:38.070 --> 00:46:40.230
Diff Trust. Game on now with the final ingredients.94900:46:40.920 --> 00:46:43.119
OK, so thank you, Adrian. As a longtime listener and95000:46:43.179 --> 00:46:45.840
fan of your columns, it's been a real pleasure to95100:46:45.880 --> 00:46:48.920
talk to you. And thank you once again to the95200:46:48.960 --> 00:46:54.260
conversation for today's final ingredient. I can't recommend it enough.95300:46:54.889 --> 00:46:57.989
So Britain and Denmark's health care systems are often compared,95400:46:58.969 --> 00:47:02.969
usually to Britain's disadvantage. Denmark has the bicycles, the generous95500:47:03.010 --> 00:47:06.369
welfare state and a reputation for preventing illness before it95600:47:06.429 --> 00:47:10.170
reaches the doctor's door. But there's one contest Britain appears95700:47:10.210 --> 00:47:14.860
to win. And that's polypharmacy. So England dispensed around 2295800:47:14.860 --> 00:47:19.139
prescription items per person in 2024, 25, hopes that matches95900:47:19.159 --> 00:47:23.900
your stats, Steve, compared with 13 in Denmark. Yet among96000:47:23.940 --> 00:47:26.780
people over age 75, regular use of five or more96100:47:26.820 --> 00:47:32.539
medicines is almost identical. So amongst the Danish compared to96200:47:32.579 --> 00:47:35.389
the English, statin use is similar too. So where's it96300:47:35.449 --> 00:47:38.889
being prescribed? Well, the difference is not chiefly in medicines96400:47:38.929 --> 00:47:44.449
for cardiovascular disease, diabetes or ageing. The gap opens with antidepressants, opioids,96500:47:44.639 --> 00:47:48.760
sleeping tablets and treatments for anxiety and persistent pain. So96600:47:48.800 --> 00:47:52.119
Britain's not really prescribing much more for diseased bodies, it's96700:47:52.179 --> 00:47:56.579
prescribing for distress. The medicines are also concentrated in the96800:47:56.619 --> 00:48:01.650
poorest communities where sort of insecure housing, poor work and96900:48:01.690 --> 00:48:06.469
social isolation contribute to chronic pain and anxiety. So Medication97000:48:06.510 --> 00:48:09.849
might well be a rational response for the doctor and97100:48:09.869 --> 00:48:12.469
for the patient, but it can only manage the consequences97200:48:12.489 --> 00:48:16.849
of these conditions, not remove their causes. Denmark's advantage is97300:48:16.889 --> 00:48:20.260
not merely that the Danes cycle more or behave better.97400:48:20.659 --> 00:48:25.099
It reflects greater equality and stronger focus on prevention. And97500:48:25.119 --> 00:48:28.559
prevention is not simply persuading individuals to make healthier choices.97600:48:28.960 --> 00:48:31.639
It's preventing the conditions that make them ill. So yes,97700:48:32.079 --> 00:48:34.940
Britain beats Denmark at polypharmacy. But this is not a97800:48:34.980 --> 00:48:38.909
victory for British medicine, nor simply evidence of careless prescribing.97900:48:39.510 --> 00:48:43.590
It's medicine compensating for what society has failed to provide.98000:48:44.010 --> 00:48:47.210
The real lesson from Denmark is that health begins long98100:48:47.289 --> 00:48:48.869
before the prescription is written.98200:48:49.469 --> 00:48:52.389
You have been listening to a Three Apothecaries production. Sound98300:48:52.469 --> 00:48:56.909
engineer Jimbo Slough, original music Jamie Brewster, artwork by David98400:48:56.949 --> 00:48:58.469
Baker and Jacob Howard.98500:48:58.929 --> 00:49:04.039
Thanks for listening to the Oral Apothecary podcast. Warning, may colour.98600:49:03.880 --> 00:49:09.130
Urine This episode of The Oral Apothecary is sponsored by jamiehays.co.uk.98700:49:10.449 --> 00:49:10.989
Thank you.
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