Muir Gray

This has got to be a collaboration that we create health in partnership with each other.

And my colleague, Sir Muir Gray, who was chief knowledge officer for the NHS in the United Kingdom for many years, has often said that patients are the single biggest missing piece in modern medicine.

And they shouldn't be.

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So as estrogen's declining, more leaky gut, more leaking food particles into the bloodstream, more triggering those, you know, inflammatory cytokines you mentioned, more likely to trigger an immune response to certain foods that you're consuming.

And so, you know, that little domino effect.

And yet there's a lot of good research suggesting this is incredibly beneficial, not just for upregulation of autophagy, which is, I think in many instances, my prior discussions around spermidine with colleagues was, "Oh, it upregulates autophagy.

That's great." But it isn't the only thing that it does, and I think that's quite significant.

And obviously tools like, um, tandem mass spectrometry and genomics allow us to look for lots of things at the same time, and that's another reason why people are saying, "Well, the way we've done it up until now might not really work." But no one's really got to consensus yet on what it might be replaced with and how we should do that while at the same time not causing more harm than good.

So, uh, we were at a, a workshop yesterday and our colleague Angela Ballentine mentioned a really famous quote from Muir Gray.

It's from a paper Muir Gray co-authored in about 2008, and it's, "All screening programs do harm.

Of those, some do good as well.

And of those, some do more good than harm at a reasonable cost." And that's kind of what screening is all about.

Or indeed, people might choose not to take all four or five of those medicines for completely legitimate reasons, because there is the law of diminishing returns here as well, and the more things that you add into people's therapies, the reduced benefit or in absolute terms that people obtain from each additional medicine.

And I'm, I'm a massive fan of the, of the value curve that's used by Muir Gray, the Donabedian value curve that says, "The more medicines you add in, you do get benefits, but then it tails off, and g-- you get to, to the point where you're not adding any more benefit." But of course, the risks keep going up, and there comes a point in time for that individual when adding in further medicines is actually doing more harm than good.

So it's a long-winded way of a- of answering your question to do searches and not think about it and just say, "Right, okay, let's write letters to people and put them on these medicines." I don't think that's the best way of doing this, and the evidence would suggest it isn't either, because that isn't shared decision-making.

If you explain to people what the risks and benefits of treatments are, people will make their own decisions.

So what chance have you got to be able to recall the vast quantity of information that's out there? But I tell you what can recall all the information that's out there, and that's computers and certainly large language models and, and, and artificial intelligence based on large language models.

They already know vast amounts more than we can ever do due to our bounded rationality in our brains.

So the existential question comes on, comes from, okay, so how do we best use that then? 'Cause I, I think there's-- the role for clinicians in the future is to provide that reassurance to that, as Muir Gray said, that lonely, anxious individual who comes to seek our help.

And by using AI, we can officially get...