Carl Heneghan

And if this was a new drug and you said we've got 50% reduction in cardiovascular mortality strokes, there'd be all over the show marketing, it'd be out there, we'd be pushing it.

But because it's not a drug and it's just something we have to do, there's no marketing effect.

So what this shows to me is that there's a real need to push implementation research.

If we take this reporting problems, we explain the absolute effects and then we say, look, we're going to try this.

We're going to make it happen.

We could put it into practices.

We could monitor them to see if they get the actual effects that we observe.

Is this a true effect?

And if so, can we look at that in what we call a phase four post-marketing?

Well, this would be a post-nighttime study.

Do we get the actual effect?

Now, this is incredibly important, but we tend to, most drug trials out there, innovative studies are looking for effects that are far smaller than this.

No, they don't.

No, they don't.

But the thing is, when they come out, most of the trials just said, here's ACE inhibitors, angiotensin, here's their effect.

There's no benefit to anybody here.

Now, most of these drugs are off patent, they're generics.

And therefore, all of that margin's gone out.

Therefore, it's left to us as individual clinicians and the health system to now make this happen.

And it seems that there's no overwhelming force to push this forward.