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Intelligence Squared
How Do Hormones Shape the Way We Feel, Think and Age? With Dr Saira Hameed
00:44:00
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IBM, a name synonymous with innovation for over 100 years. From typewriters to barcodes ATMs to PCs, we helped reach the moon. And we were in the AI game before it was cool. IBM has continually reinvented itself to do what it does best, solving the biggest challenges of the day through technology. Right now, we're putting hybrid, cloud and AI at the core of everything we do. We are champions of openness, infusing the greatest innovations from the community. We are pioneering responsible AI, leading governance and partnering with other institutions to advocate AI ethics. We're helping solve some of the biggest problems facing humanity, from climate change and sustainability to development and human rights in the future. Our global network of research scientists continues to be at the cutting edge of innovation. Whether it's in semiconductors or quantum computing, we're shaping the future one breakthrough at a time.
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Welcome to Intelligence Squared, where great minds meet. I'm producer Mia Sorrenti. How much of the way we feel, think and age is shaped by hormones? And why do we still understand so little about the complex chemical signals that govern our bodies and minds? On today's episode, Dr. Saira Hamid, consultant endocrinologist and author, joins Dr. Ganesh Taylor to discuss Hamid's new book, Signals, the Inside story of how Hormones are on what the latest science reveals about the hormonal system that influences everything from mood and metabolism to fertility and aging. Let's join our host, Dr. Ganesh Taylor, now with more.
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Welcome to Intelligence Squared. Dr. Saira Hamid, we are very, very honored to have you here today to talk to us about your new book, Signals. It's got a fantastic cover. I wish I had my copy on hand at the moment to show our listeners and. Well, to show our viewers and make our listeners envious. This is your second book, I believe, if I've got this right. Can I just start by asking you, Saira, why did you write this book now? Like, why now? Why this book? It's quite different to your last book as well. So what was your motivation?
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Well, firstly, Ganesh, so nice to be in conversation with you and thank you for inviting me on. It's lovely to be speaking to you. This book is really the synthesis of 30 years of my clinical work. So it really spans the time from right back to when I was thinking of applying to medical school to the. To the present day. Medicine in itself is a fascinating career. You get these glimpses of people's lives, their turn of phrase, the way they're dressed, the way they express themselves. They tell you their story. You see the impact of illness on their life. That in itself is a pretty great way to spend the day. There's also, I think what I've learned over the years is what medicine is about or my reflections on what it means to me. It's something that certainly evolved within me. My thoughts on it now very, very to when I was applying to Medical School in 1996. Gosh, I look back and I think, did I really know what I was letting myself in for? So sharing that aspect of medical memoir I thought was, was helpful. Endocrinology is the specialism concerned with the body's hormones and glands and the illnesses that occur when they go wrong. And hormones are having a bit of a moment right now. So definitely when I became an endocrinologist in 2006, I'd sit next to someone, I don't know, dinner. They say, what do you do? I say, I'm an endocrinologist. Can I talk to you about my hernia? I'll think, no, I'm not that kind of doctor. And they say, what does that mean? I say, it's hormones. Like, oh, right. People kind of knew about HRT then maybe a little bit. It wasn't as much discussed as it is now. And bit by bit, hormones have kind of infused into the public discourse and the public zeitgeist. Lots of people have questions about hormones. Sometimes as endocrinologists, you know, we'll come across things in the media or on social media, our patients will ask us things. I read, someone told me, and you think there's a lot out there that isn't quite sort of correct. And it would be great to have something expert written for the, for the public so we can dispel some of, some of the vibes that are going around at the moment. You know, some hormones have become like rock stars. Cortisol, testosterone, GLP1. So those are the ones I kind of wanted to major on. And what's interesting is when they go wrong, somebody really feels it. And so to be able to convey what those hormones do, not in a textbooky way, but in a. This is the story a patient would tell me. I think as humans we love stories. So that's the way I wanted to write about it. You, the reader, are sitting alongside me in the clinic room and we're listening to this story and now we understand, well, this is how a woman feels when her estrogen goes down at menopause, or this is how somebody feels if their cortisol level is running far too high. And I think we remember it far more, it's far more hard hitting when we can think, okay, well that's how that patient seemed when they came. Yes. I think the third thing that sort of I try to weave into the all the stories is where did all this settled science come from? So I can tell you with sort of great certainty, cortisol does this or estrogen does that, but where did this come from? And who were these amazing pioneers, our forebears, who did that work to come up with these conclusions? Now, I have to confess that before I started researching the book, I didn't know much about the history of endocrinology and I just thought that, you know, maybe some of these breakthroughs were sort of multi million pound scientific grants and, you know, big teams and, you know, glittering institutions. Yes, sometimes that's the case, but actually, maybe unexpectedly for me is that many of these breakthroughs, they were these plucky underdogs who had a really good idea and they saw the problem in a completely different way to other people. Sometimes really disparaged at the time. Great. In the end that they might have ended up with an eponymous syndrome or a Nobel Prize, but boy, did they have to put up with a lot to get to that point. So I thought those stories were really, really worth telling to give the public, give readers a sense of what does it mean to be a scientist or do science. Sometimes you think it means, you know, wearing a white coat and pipes ing things. And yes, it absolutely can mean that, but it can also mean, you know, different ways that these breakthroughs came about. So some of those stories were fascinating. I guess the tie that binds the whole book is it's really all about storytelling, whether it's my story or, you know, my patient stories or the stories of these sort of big scientific breakthroughs.
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Amazing. Well, I mean, you're bang on the money, obviously, the fact that there is a lot more conversation these days about hormones and in the wider media and you already, even in your explanation of why you wanted to write this book, now touched upon two of the things that really were very apparent to me as a reader. So I can confirm I received the messages in that I really felt for the first time ever while reading a book, like I was actually sat in these consultation rooms along alongside you and the experience was a bit like when you go to an art gallery and you have somebody who really knows the pieces, sort of pointing out different facets of the stories as they went along. Now, I'm not going to claim that I feel like I could do any doctoring having read your book now, but there was something about it that I found really quite interesting and compelling from that perspective. But then, of course, exactly as you said. I'm not sure quite why I wasn't expecting it, but I found that the sort of historical elements you explaining the history of who discovered these things and why and the stories that they went through really also added to this and added to an appreciation of a condition or of conditions that are already kind of difficult to grasp. So to zoom right back out for a second, you said very casually at the start that you're an endocrinologist, you're a consultant endocrinologist, and that this book is about hormones. And I think a lot of people think that hormones are just something that happen to women or that people have hormonal fits or there are hormonal moments. And actually, I think the first thing that's worth saying is everyone has hormones all of the time. And yeah, absolutely it is, right? It's males, it's females, it's children, everybody has hormones all of the time. I think what I wanted to ask you just at the start, before we sort of deep dive into some of the little stories that you told in the book is just for like, really big picture stuff. Okay? So everyone has hormones. Like how many hormones exist out there and how many organs are producing them? Because they all feature throughout the book, but just like approximately. This is not a test, just to be clear.
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Okay, So I variable part. We might have about 50 hormones, 5, 0 clinically, the ones that we see commonly, let me say, misfiring in some way and causing illness. And those patients will come to our clinics. There might be a top 10. There might be a top 10 things like thyroid, cortisol, testosterone, the pituitary hormones and so on. There are going to be more discoveries for sure. And you know, one of the biggest discoveries has happened in my lifetime, the discovery of leptin hormones secreted by body fat. Because you asked such a question, you said, well, you know, is everybody things secreting hormones? And the point is, really before leptin was discovered, that was 1994, that's a signal from body fat to brain that tells your brain how much fat you've got stored. The body fat on the whole was sort of seen a bit like we might see fat on a ribeye steak, this sort of inert, slightly lump and thing. And actually now we know it's hugely dynamic tissue. And then of course, it makes perfect sense that your brain is stuck up here in the skull and your body Fat is down here. Well, the two need to communicate. It's a bit like the fuel gauge on your car, right? You've got to be able to understand how much fuel you've got on board. Your brain needs that same information. So that was discovered in 1994. Obviously, the gut hormones are having a bit of a moment right now. GLP1 and, you know, others coming through. So, so, so that there are. There are ones that are sort of very, very actively being worked on at the moment and. And others, I'm sure will, will be discovered and suddenly will say, oh, I get that now. And maybe there have been patients out there who, you know, it wasn't clear what was going on with them. As I make the case in my book that historically people with hormone conditions were misunderstood, it's only because we didn't have the knowledge at the time.
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Yes, absolutely. I mean, that's a message that came through quite a lot in the book. I mean, I just want to take a moment to actually just appreciate the fact that you just said that there are casually, casually mentioned that there are about 50 hormones. I mean, that's wild, right? Most people, I don't think, know that. And also the fact that these hormones all tend to interact with each other. Right. This is a very complicated landscape. And again, you know, a picture that sort of emerged from listening to your stories was in the book was that none of these sort of tend to work that much in isolation. There might be one that's really causing the biggest issues, but they're all sort of seemingly interrelated. So, for example, let's hop into it. You know, I sort of started noticing that insulins and thyroid hormones and the sort of GLP ones from the gut, all of that stuff was sort of related to, you know, this idea of somebody being heavier or too, too thin. Right. And to your point about fat, right. I think most people don't think about fat as being an organ. And so there's clearly these very different hormones and they have very different effects. And I just sort of wondered, how do you bring sense to the fact that these things are so important and yet somehow seemingly so much in the background that they don't get picked up so often? You know, like, I think a lot of your patients turn up quite a while after they've had symptoms. Right. That was something that I got.
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So there can be some dramatic presentations, a few of which are sort of discussed in the book, but on the whole, hormone illness can be very stealthy. It can creep up on you. It's Hard to know how long I've been tired for. Not quite sure how long. My periods have been erratic. Yeah, the way it's been creeping up for a while. But you know, I put it down to sort of, you know, wear and tear, this and that. So it often is a bit of an insidious onset. One of the quotes I use in the book is the French, the 20th century French surgeon, Rene Leriche. And he says health is life in the silence of the organs. So this idea that when everything is working beautifully, you don't notice. So that for example, you know, when we ate our lunch earlier today, the blood sugar goes up, my pancreas would have released the hormone insulin. Insulin would have cleared the sugar from my blood. I ate lunch a few hours ago. Now my blood sugar wouldn't be now back to normal. I haven't thought about that. I haven't done anything. I just ate my lunch and packed away my lunchbox and got on with my day. And so because that's working beautifully, I don't think about it. But if I have diabetes and that insulin signaling is not working correctly, that's when it becomes very apparent something that was working absolutely fine is now not not working well. So I think it's a tribute to the body's hormones that we don't really think about them or credit them very much because they, by sort of pinging their messages around the body all day, every day. I mention in the book they are our idea of what a normal life looks like. So it's only when something goes wrong that we suddenly say there's something is really amiss here.
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So there's a couple of directions that I could take this, but I actually, the first thing I want to ask you in direct relation to that is is that why people kind of assume that a lot of things that may eventually end up being actually hormone related or endocrinological of disorders can just be attributed to quote unquote, bad lifestyles. Right? There's, you know, are you tired all the time because you are working too much or you aren't sleeping enough, you're on your phone too much or weight gain. Like all of these kinds of things I think, you know, are sort of attributable and judged by others by as being reflections of our lifestyle rather than necessarily about our biology. In the book you talk actually very interestingly at one point about the solutions ranging from the lifestyle to the medical to the surgical. And I thought that was a really interesting sort of spectrum to present because I suddenly found myself Thinking that's right. I think a lot of judgment is placed on the lifestyle and a lot of pressure on that. And so, you know, and you do talk about it a good amount in the book. So what would be a sort of endocrinologist approved lifestyle? Paint me that picture. And then maybe you can explain why also you think that it's so tricky for people or what's the information that's missing in there that people should be made aware of.
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Yeah, so I think you're absolutely right to say and then I will give you the prescription for the endocrinologist, you know, a plus alpha lifestyle. Because hormones control really every aspect of day to day life from your energy to your stress to your sex drive to your thirst to how hungry you feel, to whether you feel full. Does my, you know, do my trousers fit me today? You know, whatever, whatever it is, it can be hard to disentangle when something goes off a little bit. Are we talking about life like, oh yeah, my trousers are feeling tight. Yeah. But that's because I've been having takeaways the last two weeks because I'm really like, you know, sprinting towards a deadline. That could be an endocrine problem. That makes the detective piece really fascinating by the time the patient comes to the clinic. So life hormones, they can be, they can be tricky to untangle. So what can you do to sort of live considerately, I suppose, alongside your hormones? Well, this would be a sort of short checklist and these are, I guess it's kind of like the age old wisdom as well. So there's not going to be, you know, there's nothing here that I don't know if that would get you clicks or get you followers or whatever because none of it's very, none of it's very well. But for example, getting enough sleep, right. Trying to wake up roughly the same time every day, you know, to be, you know, fanatical about it. But something along those lines, doing a little bit of intermittent fasting if you can, if that works for your life, works with your overall health and so on. Eating protein with your, with your meals, getting enough fiber, trying to manage your stress as best as you can, getting UV light every day, getting movement in every day, getting into a relaxing retreat mode by, I don't know, unig. As the evening is winding down. So I can go through sort of why some of those things will be, will be helpful. So, or, or not, I mean it's up to you, but those. And everyone's going to say, yeah, I could have Told you that you didn't need to train as an endocrinologist for 20 years to, to. To. To know that. But actually, I suppose what I would say is if people is kind of playing around with that advice and they're thinking, you know, is that something I should do? I would say there's kind of good hormonal backing to it.
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I mean, the reason why I flagged it is because I like the idea of the fact that lifestyle is within our control. And so, you know, some of these stories were pretty scary sounding. And I guess one of the takeaways that I got from the book at least, was there are things that you can actually be doing that will help mitigate potentially the onset of certain types of endocrinological disorders, at least, you know, within reason. But. But having that sort of sense of. Of there can be things that can be done is, I felt kind of important to fly.
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I think my lifestyle really can impact, you know, hormones and, and is the insulin resistance piece that it can. And you know, the way so much of that advice I just gave was about reducing insulin resistance, staving off insulin resistance, because insulin resistance kind of as it says on the 10, if insulin's message cannot get through to your cells, Many different illnesses, including prediabetes, type 2 diabetes, so many, many of the lifestyle bits that I went through will help with that. But as you say in the book and in endocrine practice, there will be many illnesses that no matter how great your lifestyle, healthy you are, and if you're doing everything to an A plus level, that illness will still come about. And I think the reason, I can say, and we don't know what's causing a lot of these illnesses. So if you develop an overgrowth of the pituitary gland, we call it an adenoma. Sometimes there are genetic reasons. So there's some cases that very clearly run in families, and you can do the genetic testing for that. But most of them, what we say is sporadic, they've come about by chance, they've just been picked up with no family history, et cetera. So a lot of endocrine conditions are autoimmune in origin, meaning the immune system has turned on the body, so it might be directing its firepower against the thyroid gland or the adrenal glands, rather than directing its force against a virus or a bacteria, as it. As it should. But with autoimmunity, yes, we can say certain things like, oh, yes, it tends to run in families, tends to run down the female line, the age. It tends to come on, might be between 20 and 50 and so on, but we can't tell a patient why did this happen? You know, and therefore then it's hard to sort of then go one step beyond that and then say, well how could we have prevented it? Or how can we treat this at the root cause? Because if we're saying the cause is autoimmunity, can we treat that Autoimmunity in certain specialties, there's a lot of expertise in treating autoimmunity, the root cause of the condition. In endocrinology, we tend to be treating the end damage rather than trying to either prevent or dampen down the autoimmune attack.
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There's so much in this, but the bit that I'm going to pick up on is the fact that you just mentioned the pituitary. So not everybody knows what a pituitary is, nor that it sits within what's called an axis within the body, an axis of three key organs, the hypothalamus, the pituitary and the gonads. I always thought that they were the centerpiece of hormones within the body, but I'm slightly biased because I really like ovaries in my own research. But, but why don't we talk about the HPG axis as it's called, the hypothalamus, the pituitary and the gonads. So hypothalamus, what is this organ? Where is it? Tell our listeners what's it do?
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The hypothalamus. In the book, I call it the brain's master gland. This is essentially the conductor of the hormone orchestra. And the hypothalamus will set the tempo on what many of the hormones are doing. And if you think of the hypothalamus as sort of raising its baton, and the way it does it is it will send out its own hormone signals. Those hormone signals are destined for the pituitary gland. It's another gland in the brain. So essentially the hypothalamus is the master strategist. The hypothalamus will give its instructions via hormone signals to the pituitary gland. And then the pituitary gland is like the enforcer. So it will then send out its own signals, ovaries in women, testicles in men. It will also send out signals to the adrenal glands, the thyroid gland and so on. So the communication between the master gland, the hypothalamus and the pituitary is absolutely key. And then the pituitary being able to forward on those instructions is the next step. So listeners, viewers can already see that the endocrine system has these amazing levels of checks imbalance. So that really lets. If we talk about the ovaries, you actually need three glands to be working correctly for female fertility and correct a varying function. The hypothalamus has to be working well, the pituitary has to be working well. So the brains, two glands and the ovaries themselves have to be responsive and so on. So three things have to go right in order for, as you call it, the whole axis to be ticking along correctly.
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That's so remarkable, isn't it? I mean, I always find myself thinking of the hypothalamus as being a bit like a CEO and the pituitary like a coo, like Operations is what the pituitary is about, getting things done. Even though it's like the world's tiniest little gland, right? It sits right between your eyes at the base of your brain.
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The pituitary is the size of a pea. And yet the control it has over the body's hormones is utterly fundamental. So I agree with you. It wasn't until the 1930s that that it was worked out that it did anything of any importance. There was a time that, because exactly as you say, it sits at the base of the brain, actually surgeons can access it sort of through the nose. So there was this idea that it was just a waste chute at one point, that it was just secreting phlegm through the nasal cavities. And it was, you know, so what is less than a century that we've understood that this pea sized gland is, as you say, the COO of the body systems?
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That's pretty wild. I didn't know that actually, about the historical perspective. That's really fun. And just goes to show that size is not all that matters. Very true. So let's talk a little bit about gonads. And one of the hormones that's been getting a lot of attention online is testosterone, right? So the testes are the primary site of producing testosterone, I believe. And so there's this thing online, at least that I've heard about, called TRT or testosterone replacement therapy, I think. What even is that? What are they talking about?
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And TRT is a medically recognized term. So if we are treating a man with testosterone, we will call it trt. So it's a valid term, really. What's happened is we talked about a woman's access being hypothalamus, pituitary, ovaries. And in a man it's the same, aside from the fact that his will be hypothalamus, pituitary, testicles. And as we said in a woman that all three of the glands have to be working correctly for her to have fertility, reproductive function and so on. Same with a man. Hypothalamus has to be firing right, Pituitary has to be firing right. Testicles have to have to be okay. And when that happens, testicles will produce adequate testosterone. Now, there are conditions in men where there will be either a congenital cause or more commonly, pathology affecting the hypothalamus, the pituitary or the testicles. And that man is definitely testosterone deficient. And we can check that and we can make a very robust diagnosis. And those men, we will prescribe trt testosterone Replacement therapy. People are much more aware of this HRT in women to replace estrogen. Same premise. We'll replace the testosterone in a man who is deficient. Where testosterone has become a bit of a kind of social media superstar is the idea that testosterone is so important to men's health that, well, you know, if a man is feeling under par or sex drivers going through a bit of a fallow patch, or he's not as buff as he once was, or maybe he's gaining weight and so on, could this indicate testosterone deficiency? Now, I very clearly want to say to listeners, it might take. If you're worried, definitely speak to your gp, get checked. Like, we don't want to, we don't want to miss you, we don't want to miss your diagnosis, but there is. There's no male menopause, so there's not going to be a midlife point for a man where his testicles stop producing testosterone in the way that women's ovaries in midlife, at menopause stop producing estrogen. In health, men produce testosterone lifelong. Yes, dilemmas will decline in the later decades. But remember, it's not uncommon to open a newspaper and see that somebody's fathered a child in his 80s and we say, okay, good luck, mate. But we don't think that's, we accept that that can happen biologically. So, so there. So the, the amount of, you know, pathological testosterone deficiency, isn't that that common? And the real concern would be that if a man starts using TRT testosterone replacement without specialist oversight, without robust diagnostics, the body is really, really smart. If you're putting testosterone into your body, right, your hypothalamus and pituitary, those glands in your brain will go, great, tons of testosterone here. You can just switch off like, nope. Why are we going to waste our resource internally making testosterone if there's all this testosterone swilling about already? So you, what happens is you turn off natural testosterone production. And if your natural testosterone production is absolutely fine, well, that's a problem because now you're dependent on the TRT that you may not have needed when you stop the trt, let's say you say it's too expensive or I'm having side effects, or I'm not sure this is safe, or the turn off of your own natural testosterone production can last up to a year sometimes. So you might have been in a situation where there wasn't really anything wrong with your testosterone before and maybe you had retired or your sex drive was bit off, but that was Nothing to do with testosterone. Your testosterone production was fine, but then you took testosterone and now your testosterone production is not fine because the TRT turned off your testosterone production. So, you know, I think the body is really, really precious. And I think my key message to listeners is if you owned a 1 million pound sports car and somebody at the gym or somebody online said, oh, you know, why, why don't you just sort of put this supplement in the engine, I'm sure it will make it work better. You'd say, well, this car is my pride and joy. It's million pounds. Not going to take some random advice from somebody. Now, if it was the top, top sports car expert in, in your town, who gave you that advice, well, maybe that's different. But the body is so precious. I mean, sometimes I think we're more a team sometimes to material possessions and understanding that, you know, lets people really, really careful about what advice we're taking and what doing we're putting into the body. And does the body actually need it?
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C
Yeah, gosh, that's quite an example of the signals that are flying around in the body and the sort of miscommunications that can occasionally occur when interventions and whatnot are made. That's pretty wild. I mean, but it's quite different also to the hrt, which I think a lot of people, as you said, have heard about.
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Right.
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Which is when the female, when females go through the menopause, it's because they've run out of follicles basically in their ovaries and so they're not making as much estrogens anymore and so everything kind of slows down. And in your book, I think you said somewhere in the order of about, Was it about 15 or 19% of women are actually taking HRT, is that right? It was something like that anyway, probably
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in the UK around the 15% mark. And that represents quite a swift uptake probably over the last five years or so.
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And of course the thing with the HRT is, I mean, again, and to the point about complexity of signals. So on one hand you'd say, okay, well if your ovaries have stopped making estrogens, great that you can supplement it. But the flip side is there are certain concerns about how those signals can also be intercepted by other cell types, for example, cells that might turn into cancers. Is that ex Correct?
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Exactly right. One of the concerns that lots of women have and plenty of doctors have is really the question is HRT safe? That's, that's a huge concern. And some women are really quite Fearful to the point where even though they're having a really difficult menopause, they just say, well now I've read all these things or I've heard some scares or, you know, it's just, it's not for me. Now, estrogen is a hormone that will stimulate certain forms of breast cancer. So and some. A trial that was done in the 90s and then sensationally halted in 2002, a very large trial of HRT seemed to suggest that there were increased rates of breast cancer in women taking hrt. But that trial, the methodology has subsequently been quite significantly questioned. And now, you know, it's so important to look at this on a case by case, woman by woman basis. And there can even be questions, for example, the duration of treatment or what symptoms are we looking to address. What is your background breast cancer risk? And that's not just family history, because there can be other risk factors for breast cancer. You know, having a high body mass index and carrying extra weight and showing the amount of alcohol you drink. So various things can also feed into that decision making. I think it's important to say, you know, there's, there's certainly women who go through menopause whose estrogen will, will, will, will fall at that point in their life, they feel all right, they feel largely all right. So we don't want to over medicalize those women that they're absolutely fine. But it's important to say that women shouldn't worry about coming forward. It doesn't mean you will necessarily need hrt, but at least think about having that conversation with the GP or a specialist.
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C
I mean, it's just so nuanced, isn't it? I really enjoyed that aspect of the book. You know, there's this real feeling of like, oh, well, if there's a problem, we must fix it. But also what is a problem for one person might not be a problem for somebody else. And I thought you gave some really fantastic examples in the book of that. And you know, even just the experience of reading the book, I found myself sort of, you know, my interoception was sort of going a little bit. I was thinking, oh gosh, like how is my heart rate? Is it a bit higher or lower or you know, all these sorts of things. And, and I think it's really important and it's one of the important messages of your book, at least from my reading of it, was this idea that this is quite sort of, yeah, personalized. Where is your actual threshold for things is important, particularly in a diagnosis context where there are consequences of taking medications and there are consequences of taking surgeries. Right. People just think that these are silver bullets and there is actually no such thing, really, is there?
- [36:33]
D
No. Exactly right. One of the key questions I've learned, I've been so lucky to train where I've trained under some absolutely phenomenal mentors and senior endocrinologists. And one question I've very much learned from one of them is to say, what do you want? I can't always give you what you want. What you want my identity not be possible or safe, or I could counsel you that that wouldn't be the best next step, but that, you know, you can have 10 patients with the same condition and they might give 10 different answers.
- [37:09]
C
Yes. So, you know, we talked about this even earlier in our conversation here today about this idea that in the book you gave us this experience of sitting in the doctor's seat. And something I was not expecting of that experience was this idea of, was it called ice, the acronym ice C E, something like that, where you ask the patient what is it that you want? And the idea of the experience from the side of a doctor was quite a difference to obviously how I've lived my life. And so talk to me about that logic of this acronym, ice, ICE or whatever it's called, and about this idea of asking patience and why it's important.
- [37:57]
D
ICE was something my medical students taught me because it didn't feature in my medical training at all. ICE stands for the importance of seeking a patient's ideas, I. Concerns and expectations. And the premise behind it is that we encourage our students and hence our future doctors. And, you know, it's considered to be good practice at some point in the consultation, usually towards the end of the history, taking to seek that from a patient. So somebody comes with a headache and the ideas part would be, what. What do you think is going on? Or, you know, to. To. Or to understand more from them. So one person might say, my mother used to have terrible migraines and she sometimes she'd be in bed for three days and you know, and, and that's what I'm worried I might have. And the next person might say, I'm worried I had the brain tumor. So what's your idea? That also then feeds into your concern. What are your concerns around this? Well, it's really difficult having a headache all the time and it's impacting my home and my big kitchen and so on. And I suppose your expectations that also, that taps into where do we go next? What do you expect? And one person might say, I will feel very, very reassured if I can have an MRI scan. And the next person would say, well, I'd just like to try maybe a pain relief strategy for three months and come back and then see. Now, as I say, you can't be completely led by the patient. You're obviously the expert on the other side of the desk, you. But the importance of gathering that information really can't be overstated. And so much of the time those what I say in the book, the details end up not being the details at all.
- [39:38]
C
Yeah, I mean, there's some really. I don't want to spoil any of the book, but there's some really fantastic examples. One of them that really stuck out in my mind was the one about the poppy eyes with the sort of thyroid. The thyroid story that you talk about. I mean, yes, I was really struck by this idea of the sort of art of diagnosis and drawing information out from the patients. And I think that's really kind of important also for people to realize, particularly in a world where the relationship between a patient and a doctor is quite different. And, you know, as we're sort of reaching the end of our conversation here, unfortunately, let's sort of zoom back out again. At the start, I said to you, why this book? Why now? And what is it that you're trying to achieve? Which one of the stories that you told do you think was the most surprising to you at the time at which it was unfolding? Like, which one took you most by surprise?
- [40:38]
D
I think the story that informed me hugely, and maybe when you're early on and you're absorbing so much and growing so much, was the story in chapter one. Now, and maybe I don't want to give a spoiler too much, a little bit, but I think it's the idea that when a hormone glitches in some way and what we see clinically, either you have too much of a hormone or too little of a hormone, or the body's become resistant to it. Those are the three scenarios we tend to see. And perhaps what you don't see appreciate enough when you're student or early on until you are the one kind of in the driving seat and the patients are putting all their ice onto you, ideas, concerns and expectations. This idea that when you can fix one glitching hormone, the magical effect is revelatory and it's revelatory to the patient, but believe me, to the doctor, particularly
- [41:42]
C
when you were starting out, you.
- [41:44]
D
It's the next time the person walks into the consulting room and you're almost double checking the computer screen. Is that really you? You know, because the last time you came, you know, maybe you were so exhausted you could barely convey your history. Or the last time you came your weight was so high you were finding that the chair very uncomfortable or you know, and the transformation from resetting one hormone I still like. This is the 20 year anniversary of my practice, 2006-2026. Need a little plaque in here. Still to this day, when you see those transformations, you just say, wow,
- [42:30]
C
that's a fantastic note to end the conversation on. It's also the note on which I think you ended the book basically with this incredible transformation right at the end. Just felt really open ended and hopeful. And I think that that's what I would encourage our listeners today to take into reading your new fantastic book as it comes out. That of course there's all kinds of really fun and interesting science. You satisfy the curiosity of questions that you didn't even realize that I had when I was reading them, telling me about the history of where these things came from. But also that I felt at least that there was a real science sense of, you know, there is hope, there is certain, you know, there are things that can be done and that sort of pervades throughout the book. So thank you so much for writing that and thank you so much for joining us today here at Intelligence Squared.
- [43:19]
D
It's been my absolute pleasure. I've loved our conversation. Thank you for inviting me.
- [43:24]
B
Thanks for listening to Intelligence Squared. This episode was produced by me, Mia Sorrenti and it was edited by Mark Robinson for ad free episodes and full length recordings. You can become a member@intelligencesquared.com membership. If you'd like to join us at future live events, you can find our full program and buy tickets over@intelligentsquared.com attend. You've been listening to Intelligence Squared. Thanks for joining us.