Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Yeah. Hi, guys. Um, so I may May. And I'm introducing Citrus Green, who is an internationally recognized academic in public health and primary care, as well as a fellow in green term. But in college a day, University of Oxford, she is a program in research. Her role is co director in the interdisciplinary research in health sciences unit working. It hasn't had the interface between social sciences and medicine, her workers a strong emphasis on the organization and delivery of house science is but in primary and secondary care. And she's going to give a talk on acreage collecting. Yeah. Oh, your trash. Great. Well, thank you very much and thanks everyone for joining. Um, So I was asked to speak about a career like a dummy Run, resume, oblique. My, you can see my screen which says the career and someone say yes, that my power points up. Brilliant girl. Really great stuff. So just to just to set us up. What? What do we mean by academia? I Why don't buy academia reason, wants you to be a professor, and you want to get a job in the university. I I actually think it's really quite important for us to think about what but academia really isn't. And I wanted to get back to this gentleman. Well, von Humboldt to actually set up the both first university. Um, and he went off to potential funders. And they asked him, Well, what are people going to get out? Or often academic education that that they couldn't already do? And he came up with the four what I'm calling the traditional academic skills. This is what you go to university to learn, to think constructively, to argue coherently, to judge dispassionately on to solve problems creatively. So those of you who are still medical students, hopefully you're learning some of those things. And that's what you've been doing A university. But also if you then go into academia is a career. Research really is based on these full traditional academic skills, which you then get better, teach others to get better at. That's what I'm talking about when I about being an academic. Now. When I first started teaching post graduate level, I realized that Humboldt's four academic skills were enough for the contemporary world, and I added in form or academics pills. The first isn't only management Well, well, no. The the world's kind of full of knowing full of information, much of it of anything did assess its quality storage share. Cytotec little that kind of thing. But I'm sure you know all this. We also need to be able to work in multi disciplinary teams. That's not the same as multiprotection similarities. You need to be able to, um, thirdly, you need to be able to communicate with the non expert. In the last couple of years, I've done a lot of television appearances, radio appearances, and, of course, you're not then working with fellow academics. You've got to communicate with the lay person on with someone from outside your discipline on finally lifelong learning meeting your own lifelong learning needs so before traditional academic skills. Plus, these four are what academia is all about. And if that floats your boat, then maybe you want to do. I did, which was work you way off and become a professor in the university. So I'm going to talk a little bit about the first, probably about the 1st 20 years of my career, because I'm very old now. I've been in academia oh, since 1986 or 36 years. I don't know, constrict mainly on how I got there rather than what I've done more recently s Oh, why did I go? How did I get that? But I thought I'd start off with the 19 sixties. I was born in 1959 on they're down in the bottom. Left hand corner is the house my parents were living in when I was born. Actually, it's probably No, I got this one off Google Maps and it might be the house next door, But we my parents then lived on the Counselor state in Coventry. Andi hears me and my street brother's In the 19 sixties, we had pretty humble origins and actually this these four pictures of me in every single one of them. Five picture of me I'm in a dress on, boys air in, in short, on do the expectations, being the only girl in the working class family that particularly that one with me and the white dress and white hat. I'm going to Sunday school there. That was that was the expectation that you're going to be ah, really quite traditional and 70. You can see I've got my tongue out. I wasn't too enamored by that. I've put the American flag in the Australian flag up because I actually spent quite a to my child to the broad a couple of years in the US couple years in Australia. My father was basically unskilled, but quite like traveling. And so we, uh, traveled all over the place, actually, on d catcher the UK in 1969 just before the moon landing on DWI lived in this flat above Joe Thompson's Garrigues. There was six of us in that flat on D. What if I put in here on the message that the reason why I got where I am is largely because off the education I had that folks to grammar school, I drifted my way to see cool to this rather nice all where I studied nine subjects. What was then oh level. And they were very traditional grammar school subjects. Latte in English, English language and literature, French maths on then chemistry, physics, biology, which I then went on to do for a level on drily. It was quite straightforward in those days that if you pass the 11 plus, you can go to grandma's school and you don't need to be from a, well, our family. The swimming pool is there because I spent a lot of my time there very keen on that. And the only picture I have of me and my teenage years is this one that old friends sent me recently in those photo booth. So nothing, nothing glamorous about my background. Um, and I think I wanted to just tell you about some research. I did much later of what gets kids from deprived backgrounds into mental. I don't think my background was quite deprived, but it was certainly pretty humble. We in the mid two thousands midnight or teas we looked. We, um, interview 45 16 year olds from London, all from so called failing schools were fewer than five through. Fewer than 30% of kids got five G C. S E. S A. 2 80. They were all came to study medicine. They came on a whitening access course that I was running at the time on. We did life narrative interviews. We just said, Tell us about your background, the kind of things that I've shown you in the first few slides on What did we find? Obviously you in in a London in the early two thousands, Many, many of the kids. In fact, most of the kids from these feeling schools who were heading for med so many were from minority groups. So that was a difference when I was growing up that there weren't many minority ethnic groups. So what did we find? We found five influences on the development of academic identity on medical ambition. The first was home what we called the private sphere on, particularly for immigrant kids. What I've called a family metanarratives of immigration to secure a better future. We got this quote from one of our interviewees. I was looking for a better future. My family. We're looking for a better future for me. Um, and and many of you will have that in your family backgrounds if if your family came from abroad on education was a really big thing. The second was the school, and particularly the input of particular teachers who believed in in the child and said, Look, you're going to do what you're going to go far. Thirdly, friends and peers that people the youngsters who were ambitious, picked friends on. They will work together. Um, fourthly, some psychological resilience. The tough kids made it on. Finally, past experience is actually meeting the challenge of immigration and and in fact, me moving around a lot in different countries and having to kind of pick myself up when we moved and start all over again. I think that tough on me up actually. So interesting research. Snip it there. Okay, so let's go back to my university years. I went to university Claire College, Cambridge, on my first two years of medicine 1 1977 to 79. You can see how different this is from that flattened off the Garrett. And how earth did I get there? We'll this chap in the top, right is Tim Hunt. Certain Hunt, who interviewed me when he was quite a young post doc. I was a 17 year old. I'd never been to Cambridge before I had. You could see the stars in my eyes. That's sparkly bits on the gates of Claire College. My goodness, I was terrified on I sat down. Then Tim was wearing a pair of jeans and the lumberjack shirt. I'll never forget that I was in a borrowed suit on, he said, I'm going to ask you seven Westchester on. But he asked me, various, You know, bits of science sort of thing you get interview on in The last question he asked me was, What kind of doctor do you want to be when I said I want to be a brain surgeon? Um, Andi said Okay, So he said, If you got any questions for me on, I said yes. Could you tell me A If I got the answers right to move seven questions that you asked me. So he said, No, no, you didn't get the right. You got them all wrong. Have you got any other questions? I said yes, What were the right answers? Because, of course I assumed that I then hadn't got in eso. We went through the first six questions and he said, Well, you did this, You You went down that track that actually should it Unless and I then got very interested in having this conversation with Tim Hunt on We chatted away. So now I see where I went wrong. Oh, right, okay. And we chatted. And then he said, by the way, you got the seventh question wrong as well. Uh, you said you would be a brain surgeon, but you, uh you won't be a brain surgeon. You will end up in research on day. I went home thinking I wasn't going to get in. And then the next day, I got a telegram offering me a scholarship to college. There is, um I tell you that Is that what he was looking for was not whether I knew the answers, but what we called teach ability on those traditional academic skills. Think constructively, argue coherently, judge dispassionately solve problems creatively. He could spot those, even though my absolute content knowledge wasn't very high at the time. Eso really, really important. It's not all about cramming. Okay, So what happened when I started, it came out in 1997. In the top left, I saw this advert on the notice board wanted adults ages 18 to 60 for research on amblyopia brackets. Lazy eye. Well, I've got a lazy eye s with all weight research. I like the sound of that. I was told I was going to end up in research, so I answered that add and I said What I didn't know the time was that they were asking me to be a research subject and not a researcher. I thought they were the same thing. Really. I thought Be a good idea for amblyopia people to do research on amblyopia. So been too long to a laboratory run by Colin Blakemore, who actually died last week on Deacon. See on the bottom left. By the time I was 19, I had in fact joined the Amblyopia research team. And I got my name on a paper on. I did being involved in doing experiments, obviously not on myself, but on others on. But I was just so excited to be doing research and you can see hear his daughter, Sarah Jane Blakemore, just a couple of days ago, sadly announced that Colin had died on day, I said, Yes, he would. He let me work in his lab when I was an 18 year old undergraduate who went knocking on doors. Please, can I learn about research on? He had told me. Sure, just hang out and have ago, but tidy up after don't leave the lab in a mess got me my first academic paper on I've tried to welcome in turns ever since. And in fact, we've got three interns working for us this summer because these early opportunities, I think, are absolutely crucial, not necessarily because they it's a line on your CV, but because if you'll the salt person who's passionate about research um, you're you're know if if research doesn't float your boat, you'll also find that out. And that's quite a useful piece of information. Toe have. So what did I do in my third year in Cambridge? I died, my hair blue. I got Doctor Martens and dungarees. I went on. March is feminism was quite big there I I studied something called social and political. Science is the SPS. Try pausing Cambridge on anyone who's done that some of you may have done. I think it's it's now human, social and political science. We changed a bit, but it was very, very radical. Antony Giddens. There's a picture of him he was my tutor on. He at the time was developing a really key theory called Structure. A sh in theory didn't call it that. Initially, they called it the Constitution of society. Very in interested in these big social forces that shape, ah, shape our identity shape who we are on about how we believe we should act. Also studied something called women's studies with she Robot. Um, studied Freudian is, um, and other psychoanalytic theories on D actually critical theory critical theory being a kind of rag bag of different social theories that says things aren't quite what we think they are on This just blew my mind. This was so much more interesting than medicine, frankly, because it was about the way society works the way language works. But also, it seemed to me, to underpin ah, lot off social differences in the way of health and illness plays out. Here is a paper that we published in 2000 and six, where we applied critical theory, the work of Yoga Harbor, Mass. To look at interpreted consultations in primary healthcare. And I haven't got time to talk you through the detail of this, but one of harbor Mosses things is that there are two ways of communicating. One is openly and honestly, which is communicative action on. Then there's something called strategic action. So, for example, if it's my husband's birthday coming up, I might pretend I'm going shopping for bananas, but actually, I'm going to get him a birthday present. But I strategically convey to him that I'm going to to buy bananas instead. That's a silly example. But in in the clinical consultation, the patient often comes in with an agenda they want to referral. They want a prescription, etcetera, etcetera. But the way they're communicating with you is not fully open and honest because they can't just walk in and say I want a prescription. So what we did was we looked at the interpreted consultation on said that the preconditions for communicative action for open and honest communication are rarely met in the interpretive Constitution. For reasons which, if you would like to find out, you can go and read the paper. But this is just a next couple of the way. My social science training even that was only one year of it profoundly influence the kind of research I subsequently did. Okay, we're at the end of my undergraduate sun between preclinical and clinical. I've got a place in Oxford to do my third mites clinical three years. Eso I rode a motorcycle across Africa that was quite a fun thing to do on back. You convict this out of the archives if you'd like. It was it was a fun trip to do. I thought you'd like that. So what did I do it when I got to Oxford? Um, well, I was having a bit of an extension crisis because I'd rather like being a social scientist. And now here I'm Waas turning up these posh dosing Oxford having ta drink sherry with medics, as opposed to be a kind of left wing blue head. Randy Carter in, uh, in the social science department on those of you who studied in other departments will know that that the medical faculty has a very particular culture. It's quite hierarchical. There's a lot of suits and ties and things and the female equivalent warm. So what I do, I went off and lived in down the collar odor, which is a slightly alternative part of Oxford. The recent one, the you who whole food cafe is shown there is because I lived with the people who ran that cafe at the time, and we all sort of we were We were early vegans, actually, at the beginning of 19 eighties. I'm not vegan any longer, bird. You know, we did all that. I played water problem. That's why that's there. The swimming was still coming in on day. I was beginning to get my head round the social determinants of health on start to kind of plan a career, looking at the social and political on cultural influences on health and illness. But I hadn't quite gotten my act together. I did my house jobs one with and then there was only a half ones. They were called house jobs on that. It took six months off on Traveled around India. Onda gain Did a bit of research, actually got rid of money from the World Health Organization. The threat of the letter saying, Please did you fund on? Then I went and looked at over the counter sales of drugs in India, which is a big problem at the time. You could buy things that chloramphenicol in market stalls, and they're also it's problems. So I did that. Um okay, what did I do in my first three years as a doctor? Well, that top left picture is brain surgery. You remember I said I wanted to be a brain surgeon. I did do your afraid Surgery on the reason why I've put the clunk click seat belt thing there is that halfway through my time on the neurosurgical. I see you. The seatbelt legislation came in to say that if you're riding in the front seat because you have to wear a seatbelt on overnight, that hard to the number of patients coming into the neurosurgical. I see it was just extraordinary was a very busy job, and then see about legislation came in and it became actually quite a quiet job on day realized. Actually, that operating on people's brains after they've gone through a common screen is not nearly as effective at saving lives as changing policy and then became very interested in policy. I became much less interest in your surgery because of my amblyopia. I was never very good at things that require binocular vision. So I decided to train in general medicine. I passed my MRC pee, but I also got into sport. I told you much about sport. Yeah, that was shown you the swimming pool in the water polo are you started to cycle a lot on do run. So that made me a triathlete. Um, on dim fact, I made the British Triathlon team on D. Met my husband halfway around the Triathlon World Championships. A niece s o having moved from being a sort of casual athlete to being now in the national squad, that something became my priority on day. For that reason, mainly, I needed a research job that had less on call than being a medical registrar reading, which was one of the most one of the busiest acute medical units in the country. So I applied for a research job at the Whittington Hospital on move there in 1986. Here's my doctor research between 86 88. I was studying the impact off acute emotional stress on the control off diabetes type one diabetes on on the left, you can see this psychometric testing where you can see these colors which were the name of a color but colored in in a different color on. Then you had to call out a third color. I think something like that's very stressful, because it all gets flashed on very quickly on do. The idea was I was going to measure the hormones off diabetic people. A zit. They were doing this stress, but in point of fact, the stress I was seeing in the clinic where we was seeing mainly people with Type two diabetes, they were mainly Bangladeshis. They mostly didn't speak English. They were describing all sorts of different kinds of stress. Life, stress, lifelong stress. Ms. Picture Bangladesh with flooding, and this is something that they come from Bangladesh. But they also had family back home. They were struggling financially. They were from the center of the family economy, sending money back in that sort of transnational way on the course. This is all to do with the social determinant. So I was having a bit of a crisis because the way stress was framed in the biomedical um, study that I was doing didn't really seem to map on. Those of you who know your stress hormones will know that the kind of hormones that change on the left hand side are mainly the your adrenaline and you know your adrenaline, but with lifelong stress, it's mainly your cortisol levels, etcetera, etcetera. But also life stress isn't very easily reduced to two hormones on up. What I wanted to do is collect narratives. I wanted to hear the stories off the's Bangladeshi people who'd come across from Bangladesh, you know, 15 years ago on day were now struggling with poverty and the works. So I chucked in my PhD. I didn't write it up. I went and had a baby. I had another baby on, but I was doing the juggle, as as many women and some men say, trying to sort the kids out trying to get a mortgage on D. E. So I put some picture of the kids there because those of you who got kids know that once you're at that stage with toddlers and babies and all the rest of it, actually it's pretty hard to hold it together. And the reason why I'm showing you that is I know what you've gone through. This's ending thesis. The influence of the cute emotional stress on the controller Type one diabetes did get written up thoughts. It didn't get written up the expense of my family or my kids. I moved into GP training. I did a couple of diabetes jobs because that's what I've been trained in. Onda. Slowly, slowly, slowly over a period of several years. I eventually got that bloody pieces written on diaper passed it. Ah, but that's not the interesting. But the interesting thing is I did get the grant to collect narratives from Bangladesh. She's in the clinic, actually, no. In the clinic, we visited them in their homes. I hired I got a welcome grant. The welcome trust loved all this. On we collected biographical life narratives in a dialect of Bengali called PSA letting. Some of you may speak it. It doesn't officially have a written form. And so it was very much this or or or narratives on D. I collaborated with to anthropologists Cecil Hellman on giving child re her Who did the interviews. He's he's Bangladeshi himself. Of course, on we found something really interesting here much more interesting than all those stress hormones that I was measuring. What we found. Waas that although our Bangladeshi interviewees hugely respected the doctor in the dieticians on other health professionals, nothing but the doctor said ever change their behavior. Whenever they talked about a change in their behavior, it was always linked to a story that was told by another bank the desk she person me show you these The's a direct quotes from our data. I heard about a man who smoked and had his leg cut off. So I gave up smoking. I heard about a woman who kept finishing off the food. The Children left and she got very fat. So I started to measure the proportions of my food. So there was something about the storytelling by fellow Bangladeshis that was really key. I'm going to come back to that at because not going to tell you about the other things going on in my life. But the time was evidence based medicine. Everybody was into EBM at this point. I was teaching it because I had a teaching job on Broke this book, which you may have a copy off. It's now into its sixth addition on pressure on me to write 1/7 addition. Um, this was a very much about you randomized trials, and you buy a medical framing, which SATs Slightly oddly, with the research that I was actually doing. I was also writing articles like this why storytelling was so important because this was the big discovery that we've made is that story's seem to be What change behavior on how do you pull them together? How do you do what I called narrative based medicine in an evidence based world? These were published in I think that they're late nineties 1999. So let me just tell you about one study We did that tried to square the circle between EBM Evidence based medicine and NBA M narrative basement. So this is about storytelling and diabetes in minority ethnic groups. It is clearly the case that in every human society, people tell stories. Whenever people are gathering his women gathering toe way, they're babies and they'll be stories being exchanged. The men sitting here, I'm not sure what they're doing, but that you could see they will be telling stories to on. I got to know I had the privilege of linking with Jerry Bruner. Uh, he carried on teaching till he was about 96 died when he was over 100 just a few years ago. He wrote this book acts of meaning about the narrative structure of experience, and he started his work as a psychologist working with John Piaget actually on does a lot of stimulus response psychology at the time very behaviorist, and he was a radical saying that the the narrative is really important. Narrative is about making meaning. It was very inspired by him. Stories tell about inch of risk, good and evil, that moral you trust and fear. Whoops. A daisy. Bye joy and sorrow, Um, but also about human virtues. Courage, loyalty, humility. Honestly, these are absolutely key. When patients tell you stories, they presenting themselves as a good patient and sometimes they're presenting a story of a doctor is a bad doctor and you're supposed to take sides. But also the story is the unit of learning. It's the way we gather experience. It's the way we find out what to do, what to do. Um, so we developed a complex intervention for sharing stories for diabetes education in minority ethnic groups who didn't speak English. We did seven years of action research with the Bangladeshi community, which is where I started developing these story sharing groups. We weren't just working with the Bangladeshis, but we got good links. Um, so what's the sharing stories model? It's spontaneous, informal, unstructured storytelling. They can tell whatever stories they want in whatever order with no rules about what's important or legitimate. It's not structured, it's unstructured. There is non directive facilitation by binding your health advocate. Or indeed, a volunteer who is trained in the model on the input of the clinical professionals must be as a response to the story's not as a standard spiel or a set of flash cards on. The reason why that is, is we'd already demonstrated that nothing a health professional says changes behavior. The only thing that changes behavior is a meaningful story. So we trained facilitators who ran groups in a lot of different ethnic languages, including English. Actually, we have not for a Caribbean group who were wanted to obviously run their story sharing in English, and we did a randomized controlled trial off people referred for diabetes education on DWI, randomized them to either the story sharing intervention or the standard nurse said group education with an interpreter on DWI, measured various diabetes by markers and also something called in enablement score the patient enablement instrument on. We found that there were no significant differences between the group's on do had. We continued this study. What we would have done is joined those two together because actually, there was quite a lot of benefits with the structure education. But the story sharing groups appear. Learning groups were also important uncomplimentary on. In fact, we did continue that, but we what we didn't do was anymore randomized trials or off that intervention. But let me show you because I think this is really quite key On the left are what we call the evidence based facts what an expert patient needs to know. They need to know what diabetes is they need to know about diet, exercise, medication, self monitoring, foot care and how to access kept. So you could take each of those off when you educate your patient. But look at the ones on the left. The's were the things that made those evidence based facts meaningful. Entering the kingdom of the sick becoming sick, one was like to be diagnosed with diabetes. Secondly, rebuilding spoiled identity picking yourself up on d. Um, regaining your confidence even though you're now someone with diabetes, thirdly, becoming a practitioner, learning the tools and tricks and the practical skills, joining what we call the community of practice, fourthly, living a disciplined and balanced life. This was really key, the control and the discipline off. If anyone, any of you would suffer from diabetes, you will know that discipline is absolutely key. Mobilizing a care network, meaning involving members of your own family and neighbors and things in helping you look after your diabetes, navigating and negotiating in the healthcare system. Managing the micro morality of lifestyle Choices Often these, like lifestyle choices, involved ethical decisions like whether you're going to buy salad or whether you're going to give your door to some money to get a pair of shoes for her toddler. Because you haven't got very much money, that kind of thing and taking collective actions, jointly campaigning or, for example, some about story sharing groups started running walking groups together and walking around the park so they would censor that they were kind of enacting the narrative. So let me pull this together. I'll give you a couple of examples here. Story 93. Becoming a practitioner of self management, theatrical being group, which I joined because that they were speaking English. They had one man in it and seven women, and he listened very silently in number of groups because the women were talking about shopping and cooking, and he had no idea of this, but it gradually absorbed it and absorbed it. And then, in the later session, he came along on Brizin did the story of how he'd managed to go and buy food and cook it himself after his wife had died. So that's just one example I'll give you. One other example of the story line here is Ah, a story from a Bangladeshi group, one group member saying in the group. I'm going to die anyway, so why bother doing the tests or following a healthy life? So the kind of stereotypical fatalism that sometimes help professionals project on two Muslim patients but actually within the group are the Muslim patients criticized, showed him the Koran and said there is huge religious value in taking control that that the Karam actually talks about living a disciplined life, a balanced life and taking responsibility for your own health s. So you can't use that argument here. Eso the discipline and the balance within both Islam on decrease, Chanet E and Judaism will map across to the balance needed in chronic disease management. So this all came out in the stories. So let me just summarize here. These self care behaviors thean Vidin based stuff actually get converted through storytelling into acts of meaning. Okay, so we wrote, uh, lots of papers on this, Actually. Here's one example, uh, where we published in the Journal of Health Sciences, Research and Policy. Okay, so that's all I'm going to tell you about about my researcher have been doing lots of other research since. So how do you get into academia? Well, some of you may already be on the first step of the National Institute of Health Research. If you've never heard of it, don't worry. Write it down. Now Google it and look at the schemes. There's lots of other sessions. I think today on on this kind of thing. Find yourself a mental. I didn't have one. But the safety kind of need one, um, who advise you and support you on, do you that all sorts of things go wrong, But it doesn't mean that you're you're on the scrapheap. Um, read stuff. Read papers, reads get yourself an interest. I kind did Very early on. I was interesting. Social terminals publish published letters, publish editorials, publishing student BMJ on depressant it conferences get those are the kind of things you got to start doing. Don't get too competitive about it. Don't be too obsessed with your CV, do they? Do it for the love of it. Um, one final thought family still comes first. This is a picture. Just recently, I had both my son's back. They both live abroad. Now, Um, we hadn't been together for five years, But my goodness, if the family needs you, don't worry about taking a year out two years out, you know, people will have you back. Um, it's a lot easier now to take career break than it used to be. I've got, I think four PhD. So I've got 14 periods. Easier for the four of them are on NIH are a wards. Two of them are currently on a career break. One is a man on pattern. That he leave them on is a woman on matter. Nitty leave on its ulnar just joined up. Now you know that they'll come back and they'll be six months or a year behind. But the most important thing is that you know your your family life is front and center. The academic work is important, but it's not as important as that. So thank you on good luck. Could I please ask you not to email me for personal advice? And the reason is I already get more than 300 emails a day. I simply cannot deal with the volume of queries. And every time I give a talk, I get a deluge of people usually sending very long essay about themselves. I'm sure it's really interesting, but I simply don't have the time to do it. So thank you for respecting that on. Now I'm going to try and stop sharing my screen. Stop presenting on Take questions. Thank you so much for you to get. That was way. Just child questions. What would you say? You think it's of stations to change? I can't hear that book, and everybody is not speaking mute there. Mike's please, and they may. Can you repeat that? So I was just wondering, what would you say? The biggest, um, so social determinant of How would you say that because of impact, to help people, bits of diabetes and other non communicable diseases. So it's the beginning of target. You need Yeah, you need Mike. Mama here. My commode has a great list of things that you must do in order not to get these diseases that are linked to the social determinants. And he says a bubble don't be poor. Most important thing is don't be poor on, and particularly if you could live in a nice area that makes a big difference. Now I think this is This is really interesting way of putting it. Because, of course, at the moment we have a government that is quite what we call near liberal. They have a thing that that the reason why people get sick is because either they've got bad genes or they've got bad behaviors on. And suddenly, when I started out in diabetes, there was an awful lot of racial stereotyping in the clinic. And they say these weird Bangladeshis, they eat those weird kinds of food, and that's why they've got diabetes on. Actually, we did another study with Bangladeshis, and we found that Sure enough, if you eat the kind of beer Ianni Curry is the big sort of greasy supposes and things like that every single day, that's really not very good for you. But if you go back to rule Bangladesh and find what people actually eat in the traditional Bangladeshi diet, which is mainly boiled rice with mostly vegetable curry is much less greasy, much less meat. That's actually really healthy, especially if you do portion control. So what we did with that study was we stopped. We asked the dieticians to stop telling the Bangladeshis to start eating British food on day instead to go back to the food that they get when they were living in Bangladesh or when their families were living in Bangladesh. So moving back into the traditional healthy diet. But what? I'm going back to the question of social determinants, Um, but the overwhelmingly strongest determinant off these so called diseases of lifestyle is poverty, and that has multiple effects at multiple levels. But there's actually a study in Wales at the moment where they are literally giving out. I think it's 1000 lbs a month to four poor families on the hands done randomized controlled trials of this to simply give people the money, bring them out of poverty. On day, we'll have a lot less connectivity. That's a medical trial. Um, and I'm just saying shots has put a question in the check and you see the chapter. Yes, I can. So what? She said Question about teacher bility. Current medical? Oh goodness, yeah, well, I did. I did. Interviewing for medical school for 30 years on diet Think it's all become rather ghastly. When my son, when my son's became a doctor and even when he was applying to medical school short 12 years ago or something, there was an awful lot of jumping through hoops. And these, whatever the equivalent of the Oscar is Theo entry. But the other thing they did was group tasks, and then you had to learn these tricks to shine at at a group task. When you're actually competing with all the other applicants in the group in the group scenario, I think it's rubbish. Actually, I I think we are far to technocratic, and I think actually it was much fairer when I went along on Dimply had a conversation with someone who was trying to find out whether I was bright, whether I was curious on do also whether I was a decent human being, you know, I'm sure there were some questions that. You know, I suppose ethical questions were thrown in a some point, but yes, I think we've gone way, uh, in the wrong direction on on some. It'll probably send me an email after saying, How dare you say that? But yeah, it's It's something I feel quite strongly about. I suppose it's the other thing is it's not necessarily the questions. It's what you do with the answers, because I remember when I was at UCL interviewing a lad from a Chinese restaurant. His parents are in the Chinese restaurant. I'm sure he's a doctor now on D. The only work experience you've ever had was working in the Chinese restaurant hadn't done the usual work experience, he said. I can't because it's a family business on. So we said, Well, what have you learned from working in the Chinese restaurant? That will help you as a doctor? And he then explained how you got drunks out to the restaurant or two o'clock in the morning. You said, I think that will help me in any and that was good. And then we said, Well, if we gave you half a million pounds, what would you do with it on, he said. I would give it to my parents because they work so hard in there. Chinese restaurant not quite like to reward them, and I thought, Yeah, that's fine. But if it had been another interview, it they might have said, Oh, well, that's not good. You're supposed to describe a piece of research that you do so in a way, it's no necessarily that we're asking the wrong questions. It's whether or not we take account of people's backgrounds when we, uh when we decide whether or not they're they deserve a place in medical school. We did give him a place, and I'm sure he's a very good doctor. Yeah, and then I feel it's just another question, um, chat as well. Um, our research internships, Yeah, we can't because we pay our interns. And the reason why we pay our interns is if you don't pay them. You just kept the middle class kids whose parents pay them, so we have paid internships. Eso people have to have a work permit because it's a natural job. Um, so if the person has is eligible to work in the UK, uh, then there's no reason why they shouldn't be in a week. We can't fly people too, you know, we don't have any. We don't have any budget for this. It's all done on the wing of prayer. So mostly what we're doing is we're we I often give some internships to people who applied to Oxford or Cambridge didn't get in. And then they went to one the other universities. But they really want to get the Oxford experience. So we have a nice blood from not eating and spent did it? Two years running, I think with us, we've got a chap has just started to use from the university of West of England doing by medical sciences. Wants to get into graduate tree medicine. Else we got can't remember now. But, you know, they're They're mostly from the sort of red brick universities in the UK on. Then what they do is they link with some. We put them in touch with Facebook group. So we tell them to find Facebook groups where a student wants to rent out there room for a month. Well, they go away on dot All gets done. Um, we just give him a project to do uh, in terms of doing this year, it's They're working out carbon footprints. They're working out a carbon footprint of a GP practice, a carbon footprint of a a drug. How much carbon is generated when you make a batch of, you know, to prevent inhaler or something like that come and what the third one's doing, but those kind of student projects. But I warn you, we don't have very many, but someone found I think someone's found our adverts for the internships. Do you have to be a student in the UK? No, I just answered that yet. Okay. Amazing. Thank you. So, so much for joining us. That was incredible talk. I know you've got lots of other things to do today, so we'll let you have it. You look like they're