>> GOOD AFTERNOON, EVERYONE AND WELCOME TO THE ANNUAL ADVANCES IN CANCER PREVENTION LECTURE. I'M THE ASSOCIATE DIRECTOR OF THE CANCER PREVENTION FELLOWSHIP PROGRAM. EVERY YEAR, THE CANCER PREVENTION FELLOWSHIP PROGRAM HOSTS AN ANNUAL ADVANCES LOCATURE TO BE GIVEN BY A GUEST SPEAKER WHO HA HAS CONTRIBUTED SIGNIFICANTLY TO THE FIELD OF CANCER PREVENTION. THIS YEAR'S IN THE PROGRAM, WE ARE CELEBRATING OUR THIRGTTH ANNIVERSARY. AND THIS IS WHY WE ARE EXTREMELY PLEASED AND VERY HONORED TO HAVE AS OUR ANNUAL ADVANCES GUEST SPEAKER SIR RICHARD PETER, 1 OF THE MOST INFLUENTIAL EPIDEMIOLOGIST AND HEALTH STATISTICIAN IN THE FIELD AND PROBABLY NEEDS NO INTRODUCTION FOR US TO WORK IN THE CANCER FIELD. SIR RICHARD PETER IS A MEDICAL STATISTICS AND METHODOLOGY AT OXFORD IN THE UK. ALSO CO DIRECTOR OF THE CLINICAL TRIAL UNIT DISP EPIDEMIOLOGICAL STUDIES AND HE COLLABORATED ON CANCER EPIDEMIOLOGY AND IN 1981, THEY CO-AUTHORED AN INFLUENTIAL REPORT, THE CAUSES OF CANCER, QUANTITATIVE ESTIMATES OF AVOIDABLE RISKS OF CANCER IN THE U.S. TODAY. THIS U.S. REPORT FIRMLY ESTABLISHED THAT SMOKING CAUSES FAR MORE CANCER DEATHS THAN ALL OTHER RELATED CONSERS COMBINED. HIS WORK TRANSFORMED PUBLIC POLICY AND POPULAR ATTITUDES IN MANY COUNTRIES TOWARDS THE EVENTUAL HAZARDS OF SMOKING AND THE LARGE BENEFITS OF STOPPING SMOKING. SINCE THEN HIS CLOSE ATTENTION TO THE DETAILS OF HOW EPIDEMIOLOGICAL EVIDENCE IS TRIAL EVIDENCE IS INTERPRETED HAS SHOWN THAT THE IMPORTANCE OF FACTORS SUCH AS TOBACCO, BLOOD PRESSURE AND CHOLESTEROL HAVE BEEN MUCH UNDERESTIMATED AS WE ACTUALLY KNOW MORE THAN WE THOUGHT WE DID ABOUT THOSE MAJOR OVOIDABLE CAUSES OF CANCER AND OF VASCULAR DISEASE. IN 1989, SIR RICHARD WAS MADE A FELLOW OF THE ROSE SOCIETY OF LONDON FOR INTRODUCING META-ANALYSIS OF RANDOMIZED TRIALS. HE WAS KNIGHTED IN 1999 BUYER SERVICE IN EPIDEMIOLOGY AND RECEIVED MANY OTHER AWARDS THE KASP A R PERUK AWARD AND IN 2011 THE BRITISH MEDICAL JOURNAL LIFETIME ACHIEVEMENT AWARD. PLEASE GIVE'S WARM WELCOME IN WELCOMING SIR RICHARD PETER. [ APPLAUSE ] >> OKAY, I HAVE TO TURN THIS ON. WELL, ANYBODY WITH ALL THAT STRING OF HONORS MUST HAVE SOLD OUT TO THE ESTABLISHMENT. [LAUGHTER] WHAT HAPPENED WAS, BACK IN ABOUT 1980 THERE WAS THE USUAL ARGUMENT ABOUT YOU KNOW THIS, THAT, THE OTHER AND ENVIRONMENTAL POLLUTE ABTS AND THERE WERE ABOUT 10,000 CHEMICALS AROUND THE UNITED STATES, ANYONE OF WHICH COULD CAUSE CANCER AND AS PEOPLE GOT MORE AND MORE SENSITIVE TO TESTS AND WHAT CHEMICALS MIGHT DO IN MUTATING BACTERIA AND LABORATORY ANIMALS AND OTHER THINGS, YOU CAN'T EVER PROVE ANY CHEMICAL IS INNOCENT. SO THEY PRODUCE THIS THING CALLED PRECAUTIONARY PRINCIPLES WHICH WE SHOULD CONSIDER THEY'RE ALL GUILTY AND YOU KNOW THERE WAS JUST 1 THING AFTER ANOTHER, AFTER ANOTHER, AS A HYPOTHESIZED CAUSE OF CANCER AND 1 THING THAT PARTICULARLY OFFENDED ME IS THAT THE HEALTH WARNING WAS STRONGER THAN THE HEALTH WARNING ON A PACKET OF CIGARETTES. THERE WASN'T ANY PERSPECTIVE ON WHAT WAS QUANTITATIVELY TRUE AND YOU KNOW THE EXAGGERATION OF VARIOUS POSSIBLE SARSIN O GENS WAS SO--CARCINOGENS WAS SO EXTREME THAT YOU GET 1 AFTER ANOTHER AFTER ANOTHER THAT YOU WOULD BE SO LUCKY TO GET OUT OF THIS WORLD ALIVE AND PEOPLE HAVE BEEN--IN FACT THE CHIEF OF THE TOBACCO COMPANY WAS SAY NOTHING 1981 THAT SALES ARE PICKING UP AGAIN BECAUSE SO MANY THING VS BEEN LINKED TO CANCER NOW THAT PEOPLE ARE TAKING A MORE OBJECTIVE VIEW OF THE HEALTH EVIDENCE, THAT WAS THE COMMENT OF THE TOBACCO INDUSTRY. AND IN THE MIDDLE OF THIS, I GOT INVITED BY MIKE GOFF WHO IS IN THE AUDIENCE TO TRY--WHO'S WORKING FOR THE OFF OFFICE OF TECHNOLOGY OF U.S. CONGRESS TO REPORT TO THEM FROM OUTSIDE AMERICA ON WHAT REALLY WAS KNOWN ABOUT AVOIDABILITY OR NOT OF CANCER AND IT WAS REALLY TOO BIG A JOB FOR ME TO TAKE ON. I KNEW SOME THINGS BUT I DIDN'T KNOW ENOUGH TO DO THAT AND I SAID RICHARD DOLE AND ME, SO THEY SAID OH YEAH, IT'S GOOD. SO I STARTED WORKING WITH RICHARD DOLE THE CANCER EPIDEMIOLOGIST BACK IN 1967 AND I'M STILL WORKING WITH HIM NOW EVEN THOUGH HE DIED IN 2005. YOU KNOW THIS IS RICHARD DOLE, THAT'S NOT BAD. HE WAS 91 THEN AND HE HAD DONE SOME OF THE ORIGINAL WORK ON SMOKING. IT WAS GOOD WORK DONE AROUND THE MIDDLE OF THECEPTORY AROUND BRITAIN AND AMERICA ON SMOKING AND LUNG CANCER AND IN FABLGHT THERE HAVE BEEN REASONABLE WORK DONE IN GERMANY, NEGLIGENTER LANLDS AND ARGENTINA BEFORE 1950 BUT IT ALL GOOF GOT LOST. GERMAN SCIENTIFIC LITERATURE GOT WIPED OUT BY THE SECOND WORLD WAR AND THE DUTCH GUY MADE A PUBLISHED PAPER IN DUTCH WHICH IS NOT A BIG WAY TO WIN IN ACADEMIC LIFE. SO THEY REALLY SHOWED IN 1952 BRILLIANT PAPERS 1 FROM THE U.S. AND 1 FROM THE UK THAT SMOKING WAS THE MAIN COULD YOU SAY OF LUNG CANCER. IT WAS A REEL BOMB SHOW, PEOPLE SHOULD HAVE KNOWN IT BUT THEY DIDN'T. IT WASN'T IN MEDICAL TEXTBOOKS, WASN'T IN MEDICAL KNOWLEDGE AND CURIOUSLY ALTHOUGH THE EVIDENCE WAS CLEAR, PEOPLE DIDN'T BELIEVE IT AT FIRST. THEY JUST COULDN'T BELIEVE THAT SOMETHING AS NORMAL AS SMOKING, I MEAN IN SOME POPULATIONS THEY SHOULD BE SENT THAT THE MAN SMOKED, SOMETHING SO NORMAL COULD HAVE THIS DEVASTATING EFFECTS AND ALSO THE IDEA OF CAUSALITY WAS NOT THE SORT OF IDEA OF CAUSALITY THAT PEOPLE HAD. YOU KNOW CAUSALITY IS LIKE SMALL BOX, YOU GET SMALL POX, YOU GET THIS TERRIBLE ILLNESS EYOU DIE OR RECOVER, OR EVEN TB, IT TOOK TIME BECAUSE IT'S A LONG CHRONIC INFECTION, BUT YOU GOT THIS, AND THIS CAUSE OF ALL DEATHS FROM TB BUT THE IDEA IS SOMETHING THAT JUST MADE LUNG CANCER MORE PROBABLE AMONG PEOPLE OF A GIVEN AGE. THIS IS WHAT PEOPLE THOUGHT CAUSALITY WAS. YOU KNOW IT'S NOT A CAUSE. I MEAN, SOME PEOPLE CAN GET LUNG CANCER WITHOUT SMOKING, YES, BUT IT MAKES LUNG CANCER MORE PROBABLE. MOST SMOKERS DON'T GET LUNG CANCER, NO THEY DON'T BUT EVEN FOR A SMOKER WHO SPECIFIC DETAILS ON GET LUNG CANCER THAT SMOKE OF THE OTHER LUNG CANCERS, ALL THE OTHER STEM CELLS IN THEIR LUNGS DIDN'T GET LUNG CANCER, ONLY 1 STEM CELL THAT DID. THAT WAS THE UNLUCKY 1. SO YOUR GENETICS WILL DETERMINE THE PROBABILITY OF LUNG CANCER. YOUR SMOKING HABITS WILL DETERMINE THE PROBABILITY OF LUNG CANCER, FREE TO THE STEM CELLS IN YOUR LUNG AND THEN JUST THE PLAY OF CHANCE WILL DETERMINE WHETHER ANY 1 OF THOSE MANY, MANY STEM CELLS ACTUALLY DOES TURN INTO THE SEED OF A GROWING CANCER AND KILL YOU. SO IT'S SORT OF NATURE, NURTURE AND LUCK. ANYWAY WHEN HE WAS LAFUL WAY THROUGH COLLECTING RESULTS BEFORE HE PUBLISHED THEM, HE WAS LOOKING AND THINKING MY GOD, THIS IS TERRIBLE AND HE STOPPED SMOKING AT THE AGE OF 37. HE PUBLISHED RESULTS AT 38 AND HERE HE IS AT THE AGE OF 91 AND HE WOULDN'T BE ALIVE IF HE HADN'T STOPPED AT 37 BUT MORE IMPORTANTLY MILLIONS OF OTHER PEOPLE WOULDN'T BE ALIVE IF THAT GENERATION OF EPIDEMIOLOGISTS HADN'T DONE THAT WORK. I ASKED HIM ONCE, YOU KNOW HOW MANY LIVES HE THOUGHT HIS 1950 SMOKING LUNG CANCER SAVED AND HE SAID NONE. IT WAS BOUND TO BE DISCOVERED ABOUT THEN. FIVE PAPERS WRITEN ON SMOKING LUNG CANCER IN 1950, 2 OF THEM WERE GOOD 1S, 3 WEREN'T SO GOOD BUT THE 3 WEREN'T SO GOOD THEY WERE SUFFICIENT TO RAISE THE ALARM AND IT WAS ONLY THE CHAOS OF THE SECOND WORLD WAR THAT DELAYED THE DISCOVERY SO LONG HAD IT NOT BEEN FOR THE CHAOS OF THE SECOND WORLD WAR, WHEN YOU HAVE A HUGE CANCER GETTING COMMONER AND COMMONER AND DOMINATING EVERYTHING AND YOU HAVE SUCH AN EASILY IDENTIFIABLE CAUSE. YOU KNOW IT WAS BOUND TO GET DISCOVERY AND IT WAS SURPRISING IT GOT DELAYED AS LONG AS IT DID. IT WAS AN INTERESTING ANSWER BUT WHAT HE DID DEWAS CONTRIBUTED TO GETTING IT TAKEN CESSORLY. HE UNDERSTOOD THE TIME COURSE. IF YOU WANT TO KILL YOURSELF WITH SMOKING, NO USE WAITING FOR YOUR 30 BEFORE YOU START, YOU NEED TO START BEFORE YOU'RE 20 AND IT'S NO USE JUST SMOKING FOR SAY 10-20 YEARS AND STOPPING, THAT'S NO GOOD. WHAT YOU WILL DO IS KEEP SMOKING, IF YOU DON'T START EARLY OR IF YOU GO AND STOP, THEN YOU'LL PROBABLY FAIL TO KILL YOURSELF BUT IF YOU DO START EARLY AND KEEP SMOKING HAVE YOU ABOUT A 50% CHANCE OF SUCCESS. AND HE GOT THAT TIME COURSE RIGHT. AND WHAT THAT MEANS IS THAT WHEN THE YOUNG PEOPLE IN A COUNTRY, TEENAGERS, THE YOUNG ADULTS START WITH SMOKE, IT TAKES A 20 YEAR-OLD 50 YEARS TO REACH THE AGE OF 70. SO YOU'RE NOT GOING TO SEE THE MAIN EPIDEMIC AMONG 70 YEAR-OLDS FOR ANOTHER HALF CENTURY AND OLD AGE IT WILL TAKE MORE THAN A HALF A CENTURY, SO THERE'S A DELAY OF MANY DECADES, NOT A FEW DECADES, MANY DECADES BEFORE YOU SEE THE PHOTO MPLEGHTS, BUT EVEN TO GET THE MAXIMUM RATES AT AGE 50, YOU WILL HAVE TO WAIT 30-ODD YEARS TILL THE TEENAGERS START TO GET, SO THERE'S SMOKING SERIOUSLY SO THERE'S A LONG TIME SCALE, FORTUNATELY WHEN PEOPLE STOP, THE EFFECTS ARE QUICKER, BUT IT'S A VERY ODD DYNAMICS AND IT WAS THAT CAUSED A LOT OF MISUNDERSTANDING. YOU KNOW PEOPLE WERE SAYING AFTER THE SECOND WORLD WAR, WELL IF IT IS SMOKING HOW CAN THAT BE THAT THE RATES ARE SHOOTING UP IN MEN AND NOT IN WOMEN. BECAUSE THE BIG INCREASE HAS BEEN IN WOMEN, BECAUSE WOMEN STARTED PARTICULARLY IN AMERICA, ROUND ABOUT THE TIME OF THE SECOND WORLD WAR. AND YET, YOU KNOW STILL IN THE EARLY 50S, THE FEMALE LUNG CANCER RATES WERE PRETTY WELL DONE AT SMOKEER RATES BECAUSE THEY WEREN'T KILLING THEMSELVES. SO HE GOT CLARITY DURING THE 1950S IN WHEN THAT THE STORY TELLERS WAS AND IT'S STILL TRUE AS HE DESCRIBED IT 60 YEARS AGO. SO,--I STARTED WORKING IN 67. IT WAS JUST AS EXTRAORDINARY IN THERE, THE BRITISH MALES HAD THE WORST DEATH RATES SUPER SMOKING IN THOSE DAYS AND IT WAS JUST ODD TO SEE PEOPLE STANDING IN THE STREET SMOKING AND SAY 1 OF 4 OF YOU WILL BE DEAD BY MIDDLE. THIS IS NORMAL, MORE THAN HALF THE DEATHS WERE DUE TO SMOKING IN BRITAIN AND THEN THERE WAS THE AVALANCHE OF OTHER STUFF, NOT ALL OF IT WAS REAL BUT MOST OF IT WAS--OH THIS COULD BE A CAUSE OF HUMAN--WELL, YOU KNOW, YES, THE NET EFFECT WAS DIVERSIONARY. SMOKING WAS MORE IMPORTANT THAN EVERYTHING ELSE SO WE WANTED TO BE QUANTITATIVE ABOUT THE RISKS AND THAT'S THE KEY, IT'S THE KEY NOW, IT WAS THE KEY THEN. BE QUANTITATIVE. HOW BEING A RISK ARE WE TALKING ABOUT. AND IF YOU ARE TALKING ABOUT LOTS AND LOTS OF POSSIBLE RISKS THEN LET'S THINK, WHAT IS THE RANGE OF REASONABLE UNCERTAINTY. NOW, YOU KNOW SUPPOSE YOU'RE DIRECT FOR THE NATIONAL CANCER, YOU SAY THAT IT'S A CAUSE OF CANCER AND YOU CAN'T PROVE IT ISN'T SO ON THE PRECAUTIONARY PRINCIPLE WE OUGHT TO BAN IT AND WHAT DO YOU SAY? AND 1 THING I THINK MIGHT BE USEFUL IS TO ASK WHAT IS THE RANGE OF REASONABLE UNCERTAINTY ABOUT THAT SUPPOSED CAUSE? NOW FOR SMOKING THE RANGE IS PRETTY NARROW, NEARLY AS DANGEROUS AS IT SEEMS TO BE AND IT MIGHT BE A BIT MORE DANGEROUS THAN IT SEEMS TO BE AND WE KNOW WHAT IT IS. SAME WITH RADIATION, WE KNOW HOW IT IS. QUITE SMALL UNCERTAINTY. BUT FOR MOST OF THESE SUPPOSED CAUSES, THE LOWER LIMITS OF WHAT OF WHAT IT MIGHT DO IS 0. AND YOU KNOW SO, YES, THE UPPER LIMIT IS SO BIG THAT IF IT WAS UP WITH THAT UPPER LIMIT YOU HAVE TO DO SOMETHING ABOUT IT. BUT YOU KNOW THAT'S TRUE FOR SO MANY THINGS. IT'S JUST IMPOSSIBLE, I MEAN WHAT ABOUT EVERY PLANT PRODUCES TOXINS, PLANTS CAN RUN AROUND AND FOR THE LAST HUNDRED MILLION YEARS THEY'VE BEEN TRYING TO KEEP MAMMALS OFF SO THEY PRODUCE LOTS OF THINGS THAT ARE BAD FOR MAMMALS. YOU KNOW THEY CAN'T MOVE SO THEY HAVE TO PRODUCE, THEY BREATHE THESE NASTY CHEMICALS AND THEY'VE BEEN EATEN BY INSECTS, THEY PRODUCE ALL KINDS OF TOXINS. TEST THE COMPONENTS OF ANYPLANT AND YOU WILL FIND TOXINS THERE. THESE CAN HAVE NASTY EFFECTS AND WE AREN'T NECESSARILY PROTECTED AGAINST THEM BY EVOLUTION, WE HAVEN'T BEEN EXPOSED TO KIWI FRUIT, THEY COME FROM NUCLEOTIDES ZEALAND, LONG TOUGH PROTECTED SO EVIDENCE SO FAR SHOWS THE MORE PLANTS YOU EAT THE LOWER YOUR CANCER RISK IS ALTHOUGH IT'S A BIT IFFY. SO IT'S JUST--IF YOU TAKE--IF YOU TRY AND RANK THE POSSIBLE HAZARDS, ACCORDING TO WHAT WE KNOW THEY DO, WHAT CAN YOU TELL THAT YOU KNOW THAT POLITICIAN WOULD ACHIEVE IF THAT POLITICIAN COULD GET RID OF THIS RISK? THEN THERE'S NOT VERY MANY THINGS THAT ARE REALLY KNOWN TO DO ANYTHING AT ALL AND THE LOWER LIMITS ON WHAT THEY MIGHT CAUSE, THERE'S LOWERITS RUN DOWN TO 0 AND YOU WOULD HAVE A FEW THINGS THAT YOU WOULD BE CONCERNED WITH AND YOU WOULDN'T HAVE A RIDICULOUS JOB IN TRYING TO SORT OUT SOME SENSIBLE PRIORITIES. SO I THINK WHEN THE FDA TRIES TO SAY, CAN WE APRUF A GNAW DRUG, THEN THEY'LL SAY, WHAT DO WE KNOW, IT DOES. THEY WANT RANDOMIZED TRIALS THAT MOVE IT'S GOT A WORTH WHILE BENEFIT. IF WE WERE TALKING SAME ABOUT STRATEGIES FOR DECIDING WHAT TO TAKE SERIOUS ACTION ON, THEN WE WOULD HAVE A MUCH MORE MANAGEABLE LIST OF THINGS, OF THINGS TO CONSIDER AND YOU KNOW THAT WOULD BE PREFERABLE. SO, WE WANT TO BE QUANTITATIVE AND WE PRODUCE THIS REPORT SAYING BASICALLY THAT SOME SMOKING WAS ABOUT 30% OF ALL U.S. CANCER DEATHS AND IF YOU--THAT OTHER THINGS MIGHT WELL BE SUBSTANTIALLY IMPORTANT. WE SAID ALSO DIET MIGHT BE POINTS OF TOBACCO BUT THE RANGE OF UNCERTAINTY WAS MUCH WIDER AND IT WASN'T CERTAIN WHAT FACTORS WE WERE TALKING ABOUT EXCEPT FOR OBESITY WHICH IS A FEW PERCENT AND WE WANT TO BE QUANTITATIVE. NOW, THE REPORT WE WROTE, WE ACTUALLY WROTE 2 REPORTS IN 19811 OF WHICH GOT PUBLISHED IN JNCI AND GOT FAMOUS ANOTHER WAS PUBLISHED IN OXFORD MEDICINE AND NEVER WAS READ BY ANYBODY. AND IF YOU WANT TO MAKE IT BIG IN ACADEMIA, DON'T PUBLISH IN DUTCH OR TEXTBOOKS BECAUSE NOBODY READS THEM. BUT ANYWAY, I WROTE AN ARTICLE IN 1981 WHICH I JUST CALL IT WHY CANCER? I DON'T KNOW IF THAT'S READABLE AND IT'S WHY CANCER AND IT'S A SUMMARY OF WHAT WE WERE SAY NOTHING OUR 2 ARMS AND IT WAS WRITTEN FOR NEWSPAPER READERS. SO WHY THE CAUSE OF CANCER DEVELOPED COUNTRIES, RICHARD AND PETER PREPARED A DETAIL REPORT RECENTLY FOR THE U.S. CONGRESSOT RELATIVE IMPORTANCE OF DIFFERENT CAUSES OF CANCER IN THE U.S. AND THE MAIN CONCLUSION IS A SIMPLE PRIDE AS WELL. IT'S DEFINITELY ABOUT A THIRD OF ALL CANCER DEATHS, 10 TIMEs AS MANY TO THE NEXT KNOWN CAUSE, ALCOHOL AND OF THE MANY CAUSES OF CANCER, THUS FAR ADENTIFIED ONLY TOBACCO CONTRIBUTED TO THE CANCER DEATHS IN DEVELOPED COUNTRIES. HOWEVER MANY OTHER CAUSES DO APPEAR TO AWAIT DISCOVERY ALTHOUGH THESE PROBABLY INVOLVE SOME LONG-ESTABLISHED ASPECTS OF OUR WAY OF LIFE SUCH AS CERTAIN DIETARY HABITS RATES AMONG NON-SMOKERS OF THE LAST HALF CENTURY OR SO. AND THERE WERE ALL THESE OTHER CLAIMS THAT AREN'T TRUE BECAUSE THE STATISTICS WERE BADLY ANALYZED. EITHER PEOPLE DIDN'T STAND IT OR THEY DIDN'T ALLOW FOR THE INCREASES IN NUMBERS OF CANCERS THAT YOU GET WHEN YOU INTRODUCE SCREENING OR TEST FOR PROSTATE CANCER. BUT YOU KNOW, THE WORLD WAS DOMINATED BY THIS SORT OF THING. THIS IS JUST A JOKE, CARTOON OF SOMEBODY, BUT IF YOU--HERE WE ARE, HERE'S THE RING, ACCORDING COFFEE, SMOKING, EXERCISE, FATTY FOOD, RED WINE, DAY CARE COMPUTER TERMINALS CAN CAUSE HYPOTHERMIA, HEART DISEASE, GLAUCOMA, BEING 2 INCOME FAMILY, ARTHRITIS SUFFERS, RATS, ON AND ON AND YOU WOULDN'T REALIZE IT WAS JUST 1 THING THAT DOMINATED EVERYTHING BECAUSE IT ISN'T NEWS, I MEAN NEWS PAPERS HAVE TO WRITE NEWS AND THE FACT THAT THE BIGGEST CAUSE OF CANCER IS STILL THE BIGGEST CAUSE OF CANCER ISN'T GOING TO SELL NEWSPAPERS, THEN OR NOW. SO IN OUR NEXT, NEXT. WHY WON'T IT DO NEXT. GOD YOU HAVE A TOBACCO COMPANY CONTROL THANKSGIVING THING. [LAUGHTER] RIGHT. I WANT TO GO TO THE NEXT. >> OKAY. OKAY, STOP. GREAT. THANKS. YEAH. OKAY. SO, THIS TABLE ON THE LEFT IS WHAT WE PUBLISHED IN JNCI AND YOU PROBABLY CAN'T READ THE DETAILS AND I'M NOT GOING TO READ DOWN ROUGHLY, TOBACCO ABOUT 30% OF ALL CANCERETH DAILY BASISS, NOT CANCER CASES, CANCER DEATHS. ALCOHOL 3% BUT ALCOHOL'S NOT GOOD AT CAUSING CANCER IN NONSMOKERS IT'S MAINLY ALL CANCERS IN SMOKERS, NOT ALCOHOL, WIDE UNCERTAINTY IS 10-70. FOOD ADDITIVES WE PUT DOWN LESS THAN 1 BECAUSE ACTUALLY IT MAY WELL BE THAT FOOD ADDITIVES ARE PROTECTING AGAINST STOMACH CANCER BUT WHO KNOWS BECAUSE STOMACH CANCER RATES ARE GOING DOWN, DOWN, DOWN, PRESUMABLY BECAUSE OF BETTER DIET. HORMONAL FACTORS, HAVING BABIES EARLY REDUCES YOUR RISK OF BREAST CANCER, THERE WILL BE LOG OF IT. OCCUPATION, MOSTLY DUE TO ASBESTOS, POLLUTION, THE FAST EFFECTS, THE PAST EFFECTS OF ASBESTOS, ASBESTOS IS ESSENTIALLY 0 NOW BUT WE'RE GETTING DEATHS AS A DELAYED RESULT OF PRE-1980 EXPOSURE. QUITE A LOT OF THEM. MEDICAL PROCEDURES, YOU KNOW RADIO THERAPY X-RAYS, NATURAL BACKGROUND RADIATION, INFECTIVE PROCESSES, WE PUT 10% MAYBE, AND OF COURSE SINCE THEN, SOME CHRONIC INFECTIONS HAVE BEEN DISCOVERED, HPYLORI, WAS DISCOVERED IN 1983. HEPATITIS C VIRUS WAS DESCRIBED IN 1989. HIV WAS DISCOVERED IN 1983, THERE'S VARIOUS CHRONIC INFECTIONS HAVE BEEN DISCOVERED SINCE THISSEN AND THE CHRONIC INFECTION DOES CAUSE CANCER AND THERE'S RATHER CURIOUS LIVER FLUKEsA WELL AND THERE ARE OTHER THINGS WHERE IF YOU DON'T COOK YOUR FOOD PROBABLY, IF THE EGGS ARBITRATE COOKED PROPERLY, THEY GET INTO YOUR LIVER AND CAUSE PROBLEMS WITH YOUR LIVER AND'S MOSTLY IN CERTAINTY AREAS OF THAILAND AND NORTHEAST CHINA B. NUCLEOTIDES THAILAND THE 1 HABIT NOT COOKING THE FOOD ENOUGH TO KILL THE LIVER FLU, SO THE DOMINANT THING WOULD BE EITHER COOK YOUR FOOD OR TAKE MEDICINE TO KILL THE LIVER FLUKES IN YOUR LIVER. THAT WAS PUBLISHED IN JNCI. THAT BECAME WELL KNOWN, WHAT WE PUBLISHED IN THE MEDICINE WAS BOTH TABLES ARE CALLED THE TABLE 1, THE FUTURE PERFECT AND I'LL CALL THE OPPOSITE SIDE TO PRESENCE IMPERFECT. THIS IS THE PERCENTAGE, THIS IS RELIABLY ESTABLISHED AS OF 1981 AND PRACTICAL WAYS OF AVOIDING ONSET OF LIFE THREATENING CANCER AND THIS IS THE PERCENT OF ALL CANCERS KNOWN TO BE AVOIDABLE. TOBACCO IS THE SAME, AVIDDANCE OF TOBACCO AVIDDANCE, ALCOHOL THE SAME 3%. DIET STOPPED BEING 35%. GOES DOWN TO ABOUT 2%, MAYBE IT SHOULD HAVE BEEN 2 OR 3%,A VOIDANCE OF OBESITY. THAT'S NOW. ABOUT 6% IN THE UK AND 8% IN THE U.S., MORE OBESITY WE BOTH HAVE MORE OBESITY THAN WE DID BUT IT'S A SMALL PERCENTAGE AND WE DON'T KNOW WHICH ASPECTS OF DIET ARE IMPORTANT AND PROTECTIVE DESPITE ALL RESEARCH SINCE THEN AND THE INFECTION NOT 10%, BUT REGULAR HYGIENE, HPV HAS NOT BEEN DISCOVERED YET, I KNOW WE HAVE SOME HPV EXPERTS IN THE FRONT ROW OF THE AUDIENCE NOW. UF NEED SOME MEDICINE, AVOIDANCE OF INESSENTIAL USE OF HORMONES YOU CAN GET SOME,A VOIDANCE BUT NOT MUCH. YOU CAN'T,A VOID ALL SUN LIGHT, EVEN IN BRITAIN, SO UNUSUAL SETTING OF SUN LITE AND IF YOU UNLESS YOU LIVE UNDERGROUND YOU GET COSMIC RAYS AND WHAT ABOUT CURRENT LEVELS OF EXPOSURE, BY THIS ASBESTOS HAD GONE DOWN, GET RID OF WHAT REMAINS, YET DO IT BUT IT WILL NOT MAKE MUCH DIFFERENCE. THE DEATHS ARE DUE TO EXPOSURES THAT LEVELS OF THE PAST OF 1970, 60, 1950. OF THE 1940S SHIPPING INSULATION. SO GETTING RID OF LEVELS THAT REMAINED WOULDN'T HAVE DONE MUCH. AND GETTING RID OF CURRENT LEVELS EXPOSURE IN URBAN AIR, FOOD, WATER, URBAN AIR, LESS THAN 1%. IF YOU LOOK AT KNOWN EFFECTS AND ACTUALLY TODAY, 1 OF THE MAIN SOURCES, I THINK OF EXAGGERATED CLAIMS ABOUT CANCER AVOIDANCE OR THE AVOIDANCE OF PRIMITIVE DEATH ARE CLAIMS OF POLLUTION, AND THEY'RE RISING TO 2 MILLION BY THE 20S OR 30S AND PEOPLE ARE CLAIMING 1.3 MILLION DEATHS FROM AIR POLLUTION, BUT ON A VERY, VERY FLAKY GROUNDS AND TRUTH COULD BE 10 TIMES SMALLER, I THINK. IT'S--I MEAN, SURE DOMESTIC AIR POLLUTION, YES, THAT'S A PROBLEM, BUT ENVIRONMENTAL? NOT CLEAR. ANYWAY, SO IT'S A VERY DIFFERENT TABLE, AND IT REALLY WAS--WE'RE STUCK WITH THIS IS A SOCIETY IN WHICH THERE'S 1 MONTHS THAT CAUSE OR GOMINATE. WE DON'T KNOW MUCH ABOUT PREVENTION THAT MATTERS. YOU KNOW YES THERE ARE VARIOUS CAUSES, MAJOR CAUSES, CHRONIC INFECTION, HEPATITISB, YOU DOWN ABOUT THE RIVER AND STOP AT THE COUNTY ON THE LEFT AND 10% OF THE WOMEN, AND FEW% OF WOMEN WILL BE DEAD FROM LIVER CIRRHOSIS BEFORE THEY'RE 70 AND IT'S ALL DUE TO CHRONIC HEPATITIS E B INFECTION. SO ANYBODY WHO IS LESS THAN 27 YEAS OLD GOT VACCINATED AT BIRTH IN THAT COUNTY BUT ANYBODY'S MORE THAN 27 YEARS OLD DIDN'T SO THEY HAVE THE HIPREVALENCES. THEN THE OTHER THING THAT CAUSES IT IS ATHLATOXIN AND IN THAT PARTICULAR COUNTY, LAST COUNTY ON THE LEFT DOWN THE [INDISCERNIBLE], THEY USED TO USE MAZE, THEY WOULD STHOR IT IN WAYS THAT THE RAIN COULD BLOW IN ON IT AND MAKE MOLD GROW AND THEY DIDN'T LIKE IT AND AS THEY GOT A BIT RICHER, WHEN THE COMMUNISM WAS ABOLISHED THEY WOULD GET RICHER AND THEY COULD EAT RICE AND IT'S EVER SO EASY TO STORE RICE IN WAYS THAT DON'T GROW AFLATOXIN, IT WENT BY BY A FACTOR OF A HUNDRED THERE. AND LIVER CANCER DEATH RATES IN EARLY ADULT LIFE HAVE GONE DOWN BY A FACTOR OF 10 BETWEEN 1985 AND 2005. IT'S, YOU KNOW NOT IN MIDDLE AGE BUT THAT WILL COME. ANYWAY, COMING BACK TO HELICO BACTERIAER PYLRI, STOMACH CANCER, BEING IT IS ALSO WITH ENDOMEETRIOL CANCER AND BREAST CANCER AND RENAL CANCER AND OTHER CANCERS AS WELL. ENVIRONMENTAL, MAYBE THE WORST IS SMOKE, IS COAL SMOKE, MAYBE WORST OF RADIATION, RADIATION IS,A ROUND IN VARIOUS PLACES, MOSTLY NATURAL. ASBESTOS WAS THE WORST OCCUPATIONAL CARCINOGEN, THEN ALCOHOL AND PARTICULARLY TOBACCO. NOW, UNFORTUNATELY, DESPITE THE BIG DECREASE IN SMOKING, SMOKING IS STILL CAUSING ABOUT 30% OF ALL U.S. CANCER DEATHS. YOU THINK HOW CAN THAT BE? WE HAD A HUGE DECREASE IN SMOKING SINCE 1980 AND WHAT YOU HAVE IN 1980, IT WAS 30% OF ALL CANCER DEATHS AND RISING, NONAPOPTOTIC YOU IT'S 30% OF ALL CANCER DEATHS AND FALLING. THE MAXIMUM IS AROUND 1990 THERE ABOUTS SO AT THE MOMENT IT'S 30 PRT OR FALLING BUT IT'S STILL THE MOST IMPORTANT CAUSE AND IT'S STILL MORE IMPORTANT THAN ALL RELIAISONNABLY KNOWN EFFECTS PUT TOGETHER. OTHER THAN THAT. AND IT'S A QUARTER OF ALL DEATHS IN MIDDLE AGE AS WELL. I MEAN THE U.S. MOST PEOPLE DON'T DIE BEFORE MIDDLE AGE UNTIL THEY GET POISON OR SOMETHING. BUT, YOU KNOW IF YOU TAKE MIDDLE AGE, WHERE CHRONIC DISEASE DOMINATES, STILL A QUARTER OF ALL MALE DEATHS AND A QUARTER OF AWE FEMALE DEATHS IN U.S. AND MIDDLE AGE ARE CAUSED BY SMOKING, IT'S A CAUSE OF THEM. IT'S A RIDICULOUS SITUATION AND I THINK THE KEY THING FROM NOW IS JUST PRICING INCREASES. I'LL COME BACK TO THAT. OKAY, SO HOW DO YOU SEE IT? WELL, I WANT TO SHOW YOU RESULTS. I MEAN, I'VE TALKED ABOUT IT, I'LL SHOW YOU RESULTS. THIS IS FROM WHAT'S CALLED THE THE--YOU KNOW THIS THING IS TRYING TO OUTWIT ME SUCCESSFULLY. GOOD. GOD IT. ANY BACK. DONE IT. OKAY SO THIS IS THE UK MEN AND WOMEN'S STUDY, A STUDY OF A MILLION WOMEN, THE MILLION WOMEN'S STUDY BECAUSE IT'S A SNAPPIER NAME. YOU KNLT CALL SOMETHING A 1.3 MILLION WOMEN STUDY. AND SHE ASKED A MILLION WOMEN WHAT THEY SMOKED AND A HALF OF THEM DID NOT SMOKE AND A FEW HUNDRED OF THEM GOT LUNG CANCER SO A FEW NONSMOKERS DO GET LUNG CANCER BUT, IF THEY WERE LIGHT SMOKERS, THE LIGHT SMOKERS 5 OR 10 A DAY, THEY GOT 10 TIMES AS MUCH LUNG CANCER. THE AVERAGE SMOKER GOT 22 TIMES AS MUCH, SAME IN THE U.S. AND UK. THEY WERE GETTING 36 TIMES AS MUCH LUNG CANCER, HISTOTYPE AND MORE YOU KNOW EXTREME FOR SCWAIMOUS BUT IF YOU LOOK AT SCWAIMOUS IT'S HUNDRED TIMES AS COMMON IN THE HEAVY SMOKERS AS IN THE NEVER SMOKERS AND EVEN ADENO CARCINOMAS ABOUT 10 TIMES AS COMMON. SO MASSIVE HAZARD. EMPHYSEMA, AGAIN A MASSIVE HAZARD. YOU KNOW 20 TIMES, 30 TIMES AND 60. LIGHT SMOKING IS A DANGEROUS HABIT. LIGHT SMOKING IS. LET ME SEE IF I CAN MAKE THE ARROW STAY ON PERMANENTLY. RIGHT CLICK. ARROW OPTIONS. THAT SHOULD STAY ON. OKAY. SO, NEXT, VASCULAR MORTALITY. HEART ATTACKS AND STROKES, MANY WOMEN AGAIN, EVEN LIGHT SMOKING 3 TIMES THE RISK OF HEART DISEASE, TWICE THE RISK OF STROKE. AND IF YOU YOU'RE A LIGHT SMOKER IT'S DAIMPLEGEROUS. SO THERE'S HEART ATTACK DEATH, SMOKE DEATH AND THE YOU CAN TAKE THE NEXT 1 ALL-CAUSE MORTALITY. AND THE NEVER SMOKERS, LIGHT SMOKERS 15 A DAY, THE AVERAGE SMOKER HAD 3 TIMES THE DEATH RATES. THAT WAS 200% INCREASE. SO, YOU KNOW IT'S STILL A MASSIVE CAUSE AND THAT'S BECAUSE THE WOMEN IN BRITAIN NOW BEING DOWN NOW, THIS PUBLICATION COMES IN 2013, THESE ARE DEATHS THIS CENTURY, THESE ARE 21st CENTURY HAS ORDER--HAZARDS OF SMOKING WOMEN. THEY'RE BIG. THE EARLY STUDIES THE 1960S STUDIES ENORMOUSLY UNDERESTMADED BECAUSE THEY HAD NOT BEEN SMOKING ENOUGH TO KILL THEMSELVES. SO WE HAVE CLAIMS CAUSING DEATHS OR HEART ATTACKS, STRESS, YES, STRESS, AND UNHAPPINESS. WELL, YOU KNOW HAPPINESS, TO UNHAPPINESS, AND YOU KNOW YOU CAN ASK PEOPLE IF THERE'S CLAIMS ABOUT BEING STRESSED AND BEING UNHAPPY AND YOU KNOW NOT FEELING CONTROL CAUSING SO THE MEN AND WOMEN PEOPLE WOULD ASK IF THEY'RE HAPPEN OR NOT, AND COMPARE THE RESULTS WITH THE HAPPINESS OF THE RESULTS OF SMOKING. THAT'S IT. HAPPY MOST OF THE TIME, USUALLY HAPPY, RARELY OR NEVER HAPPY. AND HERE'S SMOKING. AND STILL, THE HAPPINESS BRIGADE CLAIM THEY HAVE T. IT'S STRESS THAT DOES IT, NOT SMOKING THAT WE'RE BLAMING THE VICTIMS THAT WE'RE TALKING ABOUT SMOKING AND WE BLAME THEM AND PUT THEM INTO STRESS, WELL, OKAY, IF ANYBODY'S STUPID ENOUGH TO BELIEVE THAT. OKAY, SO BIG RISK IN SMOKERS BUT THE KEY THING IS, THAT WHAT ALL THESE STUDIES SAY, IS WHAT HAPPENS IF YOU STOP? IF YOU WAIT UNTIL YOU HAVE LUNG CANCER OR SOME SORT OF OTHER FATAL DISEASE WHEN YOU STOP, IT'S A BIT LATE BUT IF YOU STOP BEFORE YOU HAVE DISEASE, IF YOU STOP BEFORE THE AGE 40, WELL BEFORE 40, THEN YOU'LL AVOID MORE THAN 90% OF THE RISK. AND IF WE WANT TO ACTUALLY DO ANYTHING ABOUT TOBACCO DEATHS THIS SIDE OF 2050 IT WILL BE BY ADULT CESSATION NOT BY PREVENTING INITIATION, SURE IT WOULD BE BETTER IF KIDS DIDN'T START BUT THAT WOULD REDUCE THE NUMBER OF TOBACCO DEATHS IN THE FIRST HALF, BUT THE SECOND HALF, THOSE WHO ARE GOING TO DIE IN THEIR 20S AND 40S, IT'S NOW, IT'S SMOKING CESSATION. SO HERE'S THE RECULT. SO THIS GRAF IS SHOWING THE RISKS, IT'S SHOWING EX-SMOKERS STOPPING AT 30, STOP AT 50, HERE'S THE 1 WHO IS STOP AT 40. THEY GET A RISK OF 1.2, 20% EXCESS. UP THE TOP HERE IS THE CURRENT SMOKERS WITH 200% ACCESS, YOU ARE AVOIDING 90% OF THE RISK, IF YOU STOP AT 30, YOU AVOID 97% RISK. SO HOW DO YOU GET CESSATION? THIS IS DRIVING THE QUALITY IN BRITAIN. MORE THAN HALF OF 1990S IN THIS PRIMITIVE DEATH RATES WAS TOBACCO SAME IN CANADA AND POLAND. HERE'S AMERICAN CIGARETTE COMSUMPTION. THIS IS A WONDERFUL TELEGRAPH FROM THE SURGEON GENERAL, THE BLACK BIT AT THE BOTTOM IS CIGARETTES, 1910, MIDDLE IS 1950, 1990, 2010 AND THIS BLACK, YOU CAN SEE THE GREAT DECREASE, THERE'S A HUGE INCREASE IN THE FIRST WAR, THEN SECOND WAR IN CIGARETTE SMOKING AND THEN IT'S FLAT AND THEN HERE IN 1970 WHEN IS YOU START GETTING BANS ON TV ADVERTISING AND IT GOES DOWN, DOWN, DOWN. AND THE LUNG CANCER RATES NOW FALLING, THE OTHER THING TECHNICAL IS ON THE OTHER SOURCES MUCH TOBACCO SNUFF AND OORLGT BLUE IS CIGARS. SO THAT'S SUCCESS, MORE SUCCESSFUL THAT NOT DISCOVERING THESE THINGS, IT'S CANCER RATES. YOU KNOW THE FULL BENEFIT HASN'T YET BEEN SEEN, BUT, HERE WE HAVE, FROM 1950, THE LEFT IS 1950, THIS IS 1970, HERE WE SEE THE 2015 AND HERE'S LUNG CANCER. THIS IS MEN GOING UP AND THEN DOWN, SO WE DID HAVE A SITUATION WHERE WE HAD 5% OF THE MEN DIES FROM LUNG CANCER IN MIDDLE AGE NOW WE'RE DOWN TO 2% AND IN THE NONSMOKERS, IT WOULD BE DOWN HERE ABOUT THE SAME AS STOMACH CANCER. SO A FRACTION OF 1% DYING BEFORE. AND HERE'S COLO RECTAL CANCER, LEVEL AND THEN DRIFTING DOWN DUE TO BETTER TREATMENT, PROSTATE. ALL OF THESE ARE DRIFTING UP BUT THEN GOING DOWN DUE TO BETTER TREATMENT. STOMACH GOING DOWN FOR NO REASON THAT ANYBODY UNDERSTANDS. IT'S GONE DOWN BY 85% AND YOU KNOW VARIOUS PEOPLE CLAIM IT'S IN THE DIET BUT THERE'S NO REASON WHY IT SHOULD BE BE THE USE OF ANTIBIOTICS. IT MAY BE BUT NOW, THIS SCALE GOES UP TO A RATE OF SOMETHING LIKE 140. SO, 5%. AND WHEN WE LOOK AT FEMALES BECAUSE FEMALE CANCER RATES ARE SO MUCH LOWER, I WILL STRETCH THE SCALE, SO THE SCALE FOR THE FEMALES IS TREACHED BY A FACTOR OF 2--STRETCHED BY A FACTOR OF 2, NEAR A 3 OR WITH A STRETCHED SCALE. SO IT GOES UP TO 70. HERE'S BREAST CANCER, HERE, GOING UP, UP, UP, DRIFTING UP, WOMEN GETTING MORE PROSPEROUS AND FACTOR, AND HAVING KIDS LATER AND SUDDENLY WE GET TREATMENT, TREATMENT GETS BETTER, HERE IN THE 1980S, YOU START TO USE TREATMENTS THAT WORK, THAT REDUCES THE 1990S DEATH RATE AND THE FURTHER IMPROVEMENTS IN TREATMENT AND THE 2010S, THEY WILL KEEP THESE BREAST CANCER DEATH RATES GOING DOWN WELL INTO THE 2020S. BUT THEY'RE DOWN IN THE UK, U.S. AND THEY'RE DOWN TO ABOUT HALF OF WHAT THEY WERE AT 1980S DEATH RATE RATES BUT HERE'S LUNG CANCER HAS OVERTAKEN IT SO IT'S RIDICULOUS, THE PROBABILITY IN MEN IT WILL REACH MAXIMUM AT 5%. HERE IT'S LESS THAN HALF THAT. AND COLORECTAL GOING DOWN AND THE TREATMENT DIDN'T START UNTIL 1990S. UTEROUS GOING DOWN AND STOM AG GOING DOWN IN WOMEN AS IN MANY. ABOUT HALF THE RATES BUT THE OVERALL PATTERN IS FAVORABLE CANCER IS FAVORABLE SINCE 1990 BUT IT SHOULDN'T BE HERE ANYWAY. IT'S FAVORABLE WITH 1990. IT'S NOT FAVORABLE COMPARED TO NONSMOKERS. AND IF WE TOOK ALL CANCER IN THE U.S., CANCER DEATH RATES IN MIDDLE AGE, SO U.S. CANCER, TOTAL CANCER THEN, THIS--THIS IS MENOT LEFT, MENOT RIGHT. THIS HORIZONTAL LINE HERE IS WHAT TOTAL CANCER MORTALITY IN MEN SHOULD BE LIKE IF NOBODY EVER SMOKED AND THIS WAS ADDED TO IT BY SMOKING SO BACK IN THE 1980S, HALF OF ALL U.S. MALE CANCER DEATHS IN MIDDLE AGE WERE CAUSED BY SMOKING. NOWADAYS IT'S ONLY A THIRD. SEE, WE HAVE 3% HERE, 5% THERE, IF THAT WAS 2 ASK HALF% AND 5%, THAT WOULD BE A THIRD. BUT THEN YOU HAVE 2015, WE'RE NOW AT 2017. SO IT'S STILL A THIRD WHICH IS RIDICULOUS AND IT IS SURE BETTER THAN IT WAS BUT IT'S WORSE THAN IT SHOULD BE. HERE'S THE FEMALE CANCER MORTALITY TREND. GOING DOWN ANYWAY, AND THEN HOPPED ON DOWN IN CANCER TREATMENTS IN 1990 AND THAT WAS ADD TO IT BY SMOKING AND IF WOMEN KEPT SMOKING BY NOW, THE TOBACCO DEATHS WOULD HAVE OVERTAKEN TOTAL DEATHS. IT WOULD HAVE BEEN UP TO HALF OF ALL CANCER DEATHS IN WOMEN. HAD THE WOMEN KEPT SMOKING BUT THEY DIDN'T FORTUNATELY. AND THESE DECREASES LRTD HAPPENED BUT YOU KNOW--SO YOU CAN--SO, IT'S A THIRD--36% OF ALL MALE CANCER, 32% OF ALL CANCER DEATHS SOMETHING LIKE THAT IN 2010. ABOUT 30% NOW. AND IF WE LOOK AT ALL DEATHS, YOU KNOW YOU CAN DO TABLES. I HAVE JUST MARKED THE CANCER AGAIN BECAUSE IT'S AN NCI LECTURE BUT YOU KNOW ACTUALLY YOU GET MORE PEOPLE DYING FROM OTHER DISEASES, KILLING PEOPLE BY OTHER DISEASES THAN IT KILLS BY CANCER. SO 48,000 MEN KILLED IN MIDDLE AGE BY CANCER OUT OF 124,000 MEN KILLED--SORRY BY SMOKING. OUT OF 124,000 TOTAL KILLED BY SMOKING. THIS IS A GRAPHIC SHOWING ALL-CAUSE MORTALITY, THIS IS THE LEFT OF THE PROBABILITY OF DYING FOR U.S. MEN, THIS IS 1950, 8% WOULD DIE BEFORE THEY'RE 35, NOWADAYS IT'S 3%. SO YEAH, WE HAVE INCREASING ACCIDENT RATES, POICHING RATES, SURVEYS SIGH RATES AND SO ON BECAUSE OF MORTALITY GOING DOWN. SO THIS WAS A CAUSE, BUT OVERALL THINGS ARE GETTING BETTER BUT HERE'S WHAT HAPPENS WEAN THE AGES OF-46 BETWEEN THE AGE OF 35-60, THEY LOOK LIKE CIGARETTES BUT THEY'RE NOT. SO THESE BARS, WHAT'S THE PROBABILITY OF THAT I 35 YEAR-OLD MAN WOULD DIE BEFORE 70. AND BACK IN HAD THE 1950S IT WAS 33-44%. AND THE GRAY IS THE TOBACCO DEATHS IN THERE. SO IT WAS GOING UP AND THE INCREASE IN TOBACCO DEATHS WAS SO GREAT THAT IT WAS OUTWEIGHING ALL THE MEDICAL PROGRESS BETWEEN 1950 AND 1970. AND HERE'S THE OVERALL PROPERTY COMING DOWN, IT'S NOW DOWN TO ABOUT HALF WHAT IT WAS AND THE MAIN CREASE WAS 17 OR 17% OF ALL MEN KILLED IN MIDDLE AGE. DOWN TO 6%. AND THERE'S THE SAME THING FOR WOMEN. THE INCREASE THAT WOULD HAVE HAPPENED HAS BEEN STALLED. SO ANYWAY, THAT'S THE U.S., BUT I'M A STATISTICIAN AND THE MOST IMPORTANT STATISTICS IS THAT, WHETHER I'M A BRITISH STATISTICIAN ACTUALLY AND 99% OF THE WORLD IS NOT BRITISH. AND IN FACT, 95% OF THE WORLD AND NOT AMERICAN. SO, I WANT TO ACTUALLY GO TO WORLD WIDE MORTALITY. AND SO, IF WE LOOK WORLD WIDE. I'VE BEEN LOOKING AT DEATHINGS IN RICH COUNTRIES WHERE CHILDHOOD DEATH IS MOSTLY GONE, WHAT ABOUT THE WORLD? I WANT TO THINK ABOUT, COULD WE ACTUALLY HAVE PRIMITIVE DEATH WORLD WIDE. I'LL DEFINE PREMATURE AS DEATH BEFORE 70 AND I LIKE TAKEN--THEY BECAUSE I AM SAFE, ALL YOU LOT CAN DIE BEFORE 70, BUT I CAN'T, I'M SAFE. BUT DEATH IN OLD AGE IS INEVITABLE, BUT DEATH BEFORE OLD AGE IS NOT. RICHARD AND I GO BACK AND FORTH ABOUT THIS WHEN WE WERE TRYING TO GET PEOPLE TO TAKE TOBACCO SERIOUSLY. I WANT TO GO BACK TO 1910. I WANT TO GO BACK A HUNDRED YEARS AND I'LL DO IT IN BRITAIN BECAUSE IN BRITAIN YOU CAN GO BACK TOINE 60 AND STILL GET--BACK TO 1860 AND GET REASONABLY RELIABLE RATES. AND I IN 1910, 1960 AND 2010, WHAT'S CHANGED OVER THE LAST HUNDRED YEARS AND I WANT TO NOTE THE RISKS BY AGE 5 AND I WANT YOU TO NOTE THE RISKS BY AGE 70. SO, HERE'S IN NEW WALES 1910 DEATH RATES, A CURVE, SO AT 1910 DEATH RATES WE WOULD HAVE 1 IN 6 DEAD BEFORE THE AGE OF 5 SO YOU STILL HAVE--THIS IS JUST PERCENT STILL ALIVE VERSUS AGE. AGE, 10, 30, 50, SOVENT, 90 AND OF COURSE BY AGE HUNDRED EVERYBODY'S DEAD. AND IF YOU AREN'T IT DOESN'T MATTER BECAUSE WHEN YOU GET TO THE AGE OF A HUNDRED, WE'RE NOT GOING TO GET LOADS AND LOADS OF SEN ILLEGALSENNENARRIANS LIVING LIVING--CENTARIANS, AND OF THE PEOPLE WHO REICH--REACH A HUNDRED, 99.9% WILL BE DEAD BEFORE THEN, SO WE WILL HAVE BIG INNERCREASES IN THE NUMBER OF PEOPLE STILL ALIVE AND IN GOOD HEALTH IN THEIR 70S AND 80S, BUT THIS IS NOT--WE'RE NOT TALKING ABOUT INDEFINITE PROLONGATION OF HUMAN LIFE. FROM WHAT WE KNOW WE DON'T EXPECT THAT TO BE UNESSENTIAL ON PRESENT KNOWLEDGE BUT WHAT WE CAN DO IS LOOK AT PROBABILITY OF DEATH BEFORE 70. I WANT TO TALK ABOUT THAT. SO HERE WE HAVE 1 IN 16% DEAD BEFORE 2017, VASTLY WORSE, NOT WORSE THAN THE WORST COUNTRY IN THE WORLD [INDISCERNIBLE]. AND WE HAVE 2/3RDS DEAD BEFORE 70 SO WE HAVE 1 IN 6, 2/3RDS DEAD BEFORE 70. BY 2010 YEAR WELL UNDER 1% DEAD BEFORE 5, AND WE'VE ONLY GOT 21% DEAD FOR WOMEN IT'S BETTER SO FOR MEN AND WOMEN TOGETHER IT'S 18%, DEAD BEFORE 70. I'VE DONE MEN BECAUSE THEY WERE THE 1S WORST HIT BY TOBACCO, SO IF WE LOOK HERE, SO IGNORE 1910, SO IN THE FIRST HALF OF THE CENTURY, WE GOT RID OF CHILD MORTALITY AND MORTALITY IN LIFE. SO WE HAVE 90% LIVING UNTIL THEY'RE 50. BUT STILL, YOU LOOK THEA THE DIFFERENCE BETWEEN 1960 DEATH RATES IN 2010 DEATH RATES, 10 YEAR'S. THERE'S 10 YEARS EXTRA SEPARATION AND LIFE, ON AVERAGE IT'S 10 YEARS GOOD LIFE BECAUSE THE AMOUNT OF DISABILITY BEFORE DEATH IS NOT MUCH DIFFERENT NOW, THE AMOUNT OF DISABILITY IS DEATH, IS SIMILAR BETWEEN A SMOKER AND NONSMOKER. THE WHOLE THING FINISHES UP 10 YEARS ON, SURE SOME PEOPLE ARE ALIVE, THEY WOULD BE BETTER DEAD EITHER BECAUSE OF ILLNESS OR CHARACTERS BUT YOU KNOW--ON THE WHOLE IF YOU'RE IN REASONABLE HEALTH IT'S NICE TO ENJOY THE SUNSHINE, SOMETHING TO BE SAID FOR BEING ALIVE AND FIT AND WHAT WE'RE TALKING ABOUT IS AN EXTRA 10 YEARS OF GOOD LIFE ON AVERAGE, NOT AN EXTRA 10 YOURS OF LIVING WITH ALZHEIMER'S DISEASE. OKAY AND THE MAIN REASON FOR THAT IS THE DECREASE IN TOBACCO DEATHS YOU'VE SEEN. THAT'S THE MAIN REASON FOR IT. NOW I WANT TO LOOK AT CHILD MORTALITY AND ADULT MORTALITY NECESSARILY. SO I WILL LOOK AT MORTALITY BEFORE AGE 5 AND THEN MORTALITY BEFORE AGE 50 AND MORTALITY BEFORE AGE 70. SO I WANT TO LOOK SEPARATELY IN MORTALITY ADULTHOOD AND LATER IN LIFE AND MIDDLE AGE. SO HERE'S CHILD MORTALITY WORLD WIDE. NOW WHAT BRITAIN DID, WHAT THE RICH COUNTRIES DID IN THE FIRST HALF OF THE CENTURY, THE WORLD HAS DONE IN THE SECOND HALF OF THE CENTURY, YOU KNOW WE HAD GONE DOWN BETWEEN 1910 AND 1960 WE WENT FROM 16% UNDER 5 MORTALITY DOWN TO 4%. LET WORLD HAS GONE FROM, WELL, THAT'S ROUGHLY WHAT THE WORLD DID BETWEEN 1970 AND 2010 AND WE DON'T REALLY KNOW CHILD MORTALITY IN 1950 FOR THE WORLD. IT WAS ABOUT 25%. THE STATISTICS GET QUITE REASONABLE AND ABOUT 14% UNDER 5, MORTALITY AND HUGE NATIONAL EFFORTS, COLLABORATION BETWEEN INTERNATIONAL AGENCIES AND GOVERNMENTS HAS BEEN BROUGHT DOWN FROM 14% TO 5% AND THAT'S A HUGE CHANGE. LIKE 2/3RDS OF THE UNDER 5 MORTALITY IS GONE SINCE 1970. AND YOU CAN SEE THIS, YOU WILL SHOW THE SAME CURVES I'VE SHOWN BEFORE BUT UPSIDE DOWN. SO HERE WE HAVE--THIS IS THE MORTALITY BY AGE. SO HERE WE ARE, WE START OFF ALIVE DOWN HERE AND THEN WE WILL FINISH UP AT THE RIGHT HAND SIDE. SO WE'RE GOING FROM AGE NOT TO AGE A HUNDRED AND THIS IS THE PROPORTION WHO HAVE DIED AND YOU SEE IN THE FIRST 5 YEARS OF LIFE, 14% VERSUS 5%, THE TOP LINE IS WORLD 1970 DEATH RATES, THE BOTTOM LINE IS WORLD 2010 DEATH RATES AND YOU PROBABLY CAN'T SEE THEM BUT THESE ARE THE RED CROSSES, THEZ IS ENGLAND JOURNAL--THIS IS ENGLAND AND WALES AT 1910 AND THIS ENGLAND AND WALES AT 2010. THE WORLD AS A WHOLE NOW. ANYWAY, AND THERE'S THE SAME THING AND HERE'S AGE 70. SO YOU SEE AT AGE 70, 1970 DEATH RATES, 54% WILL BE DEAD, NOW IT'S ONLY 36%. BUT IN ENGLAND IT'S 18%. SO MY QUESTION IS CAN WE HAVE WORLD WIDE--CAN WE GET THE WORLD WITH 36% DEAD, AND WITH 18% DEAD BEFORE 70 AND I THINK THE ANSWER IS YES, CERTAINLY WE CAN HAVE THE UNDER 50 MORTALITY, PROBABLY BY 2030 OR THE EARLY 2030S AND THIS I THINK WE CAN HAVE BY SOMETIME IN THE 2030S OR 2040 WHICH WILL BE JUST IN TIME FOR A HUNDREDTH BIRTHDAY. SO WHAT ARE THE TRENDS? I WANT TO LOOK AT TRENDS IN THESE AGE RANGES SEPARATELY. UNDER 5 MORTALITY. WHAT'S THE PROBABILITY IF YOU'RE 5 DYING BEFORE 50, AND WHAT'S THE PROBABILITY IF YOU'RE 50 DYING BEFORE 70? SO LET'S LOOK AT THESE TRENDS. OKAY, THE BLUE LINE, SO EACH OF THESE LINES STARTS AT 1970 AND FINISHES AT 2010 AND YOU CAN SEE THEY HAVE A LITTLE HEAD ON THEM, SO YOU THINK OF AS A SPERM SWIMMING TOWARDS THE FUTURE. SO THERE YOU'RE GOING FROM 14% DOWN TO 5% UNDER 5 MORTALITY. AT AGES 5-49 WE WILL GO FROM 17% DOWN TO 10%, THAT KINK THERE IS THE HIV EPIDEMIC AND WITHOUT THAT IT WOULD HAVE GONE DOWN A LOT MORE. BUT LOOK EVEN IN LATER MIDDLE AGE, THE APPROPRIATE OF THE 50 YEAR-OLD WILL DIE BEFORE 70 HAS GONE DOWN FROM 36% DOWN TO 24%. THAT'S THE WORLD BUT THE WORLD CONTAINS RICH AND POOR, THE WORLD CONTAINS MANY DIFFERENT COUNTRIES WHAT HAPPENS SEPARATELY FROM THE RICH AND THE POOR, WELL, HERE'S WORLD BANK REGIONS, HERE'S LOW INCOME, 16th OF THE WORLD IS HIGH INCOME, AND 2/3RDS OF THE WORLD IS MIDDLE INCOME, SO THEY SPLIT IT INTO LOWER MIDDLE AND UPPER MIDDLE. SO HERE'S LOW INCOME AND OF COURSE THE GREATEST REDUCTION IN UNDER 5 MORTALITY IN THE LOW INCOME AND LOWER MIDDLE INCOME COUNTRIES. IT CAN'T BE IN THE HIGH INCOME BECAUSE WE'RE ALREADY DOWN TO 3% BUT THE LOW INCOME, LOOK THEY'VE GONE DOWN FROM 23% TO 10%, A GAIN OF 13, WE'VE GONE DOWN FROM 3 TO 0 GOING TO 3. UNDER 5 MORTALITY IS BETTER EVERYWHERE BUT IN ALL BANK REGIONS, THE RED IS UNDER 5. AS THE MORTALITY OF OUR LIFE, WHAT'S THE PROBABILITY OF A 5 YEAR-OLD WILL DIE BEFORE 50 AND THAT KINK IS THE AFRICAN HIV EPIDEMIC, AND YOU CAN SEE IN GENERAL IN HERE, RICH COUNSELEDRYS THAT KINK IS THE EPIDEMIC LIKE IN U.S. AND EUROPE. BUT THEN LOOK IN THE LOW INCOME, LOOK IN HIGH INCOME COUNTRIES, LOOK IN MORTALITY IN BETTER IN ALL THE AREAS. NOW OF COURSE, THE COUNTRIES ALL DIFFERENT. THEY HAVE 200 COUNTRIES AND THESE ARE DIFFERENT COUNTRIES, SO YOU KNOW WE CAN'T LOOK AT 200 COUNTRIES BUT I WILL LOOK AT 25 COUNTRIES, THE 25 MOST POPULOUS COUNTRIES CONTAIN 75% OF THE WORLD'S POPULATION. BRITAIN JUST MAKES IT IN, ANY COUNTRY THAT THE WORLD'S POPULATION OF 1% MAKES IT IN. SO BRITAIN IS IN AND SPAIN IS OUT. AND I WANT TO SHOW THE TRENDS IN 25 DIFFERENT COUNTRY, I WANT TO LOOK AT SEPARATE, 5-49, 50-69. OKAY, HERE WE GO. 25 COUNTRIES UNDER 5 MORTALITY. THERE YOU ARE. THERE'S DR CONGO, DEMOCRATIC REPUBLIC OF CONGO AND IF YOU HAVE WAR, THINGS DOANTS GET BETTER. EACH OF THESE LINES STARTS AT 1970 AND ENDS AT 2010. EACH SHOWS THE CHANGES HAND IN NIGERIA, SURE, 1970 EMERGES FROM THE CIVIL WAR, HERE'S ETHIOPIA, BLINDED BUT THE PROGRESS THERE, AND THEN YOU HAVE PROGRESS EVERYWHERE, LOOK AT INDIA, CHINA, LOOK AT THE U.S., AND THESE ARE THE RICH COUNTRIES OVERHERE AND RUSSIA DESPITE THE CRISIS AND ADULT MORTALITY IN RUSSIA BUT CHILD MORTALITY WENT DOWN VERY NICELY AND THIS KINK HERE IS THE EPIDIPPIC AND IT HOLDS THE DECREASE IN THE MORTALITY. MOST HIV KILLS AT OLDER AGES BUT IN AFFRIC AYOU GET SOME UNDER 5 MORTALITY AND THAT'S HIV. BUT OVER ALL, THERE'S WONDERFUL PROGRESS, EXCEPT WHERE YOU HAVE CIVIL WAR OR HIV. NOW LET'S TAKE THE AGE RANGE 5-49. WHAT'S THE PROBABILITY OF 5 YEAR-OLDS DIE BEFORE 50. LOOKOT LEFT AT SOUTH AFRICA, THAT'S HIV. IT WAS GOING DOWN AND THERE'S A HUGE INCREASE AND NOW THINGS ARE GETTING BETTER. THAT'S NOT QUITE FAR, THE LAST POINT I'LL SAY ABOUT 2010 IS THE AVERAGE FROM 2005-2015. SO BY NOW, THINGS ARE A LOT BETTER THAN THAT BECAUSE OF ANTIHIV TREATMENT WHICH AMERICA HAS ACTUALLY CONTRIBUTED A HUGE AMOUNT TO. THEN THERE'S CONGO, NIGERIA, REALLY NOT, NOT MAKING PROGRESS WITH THE VARIOUS CIVIL PROBLEMS. ETHIOPIA PROGRESSED IN THE LAST DECADE BUT INDIA, MOST PLACES, HERE IS THAILAND THIS IS ACTUALLY, I THOUGHT THIS WAS THE HIV EPIDEMIC IN THAILAND WHICH IT IS A BIT, BUT IT'S MAINLY TRAFFIC ACCIDENTS. THEY RIDE MOTORCYCLES, THEY GET DRUNK, USE DRUGS AND DIE. THE PROBABLE OF A MAN DYING BEFORE 50 FROM VIOLENCE IN THAILAND AND 5%, THAT'S--DON'T DRINK AND DRIVE MOTOR BIKES. AND THEN HERE'S IRAN. DON'T GET INVADED BY IRAQ. THAT IS--[LAUGHTER] --WELL THAT'S IT. IF YOU DO THE SAME THING FOR IRAN FOR IRANIAN WOMEN, THERE'S NO KING AND FOR IRAN MAN MING THE KINK IS TWICE AS BIG, BECAUSE THE IRAQIS INVADED EYE RAN AND KILLED A MILLION OF IRANIANS. SO HIV, CIVIL DISTURBANCE AND WAR AND TRAFFIC ACCIDENT AND U.S., CHINA AND THERE'S RUSSIA WHICH IS VODKA. IT REALLY IS. REALLY IS. I'LL COME BACK TO THAT. AND THE U.S., THE U.S. IS ACTUALLY NOT DOING VERY WELL IN THIS AGE RANGE. THERE'S BEEN NOT MUCH NET PROGRESS IN THE LAST 40 YEARS, IN AGE RANGE 5-49. CHINA HAS OVERTAKEN THE U.S. IN REDUCING MORTALGITY. AND WELL, YOU KNOW THERE'S SORTS OF REASONS AND THEY'RE MOSTLY EXTERNAL AND BY NOW ALSO HIV HAS REALLY DOWN. HIV DEATHS IN THE U.S. ARE DOWN DUE TO BETTER TREATMENT. BUT WHEN WE TURN TO LATER MIDDLE AGE THE PICTURE IS MUCH MORE UNIFORMLY FAVORABLE WITH 1 OR 2 NOTABLE EXCEPTIONS. OH GOD. I REALLY, REALLY WANTED TO KNOW WHAT TIME IT WAS. OKAY, SO HERE WE HAVE THE PROBABILITY OF 50 YEAR-OLD WILL DIE BEFORE 70. AND--AND AGAIN, NOT MUCH PROGRESS IN AFRICA. THINGS GOING SERIOUSLY WRONG IN RUSSIA, BUT INDIA, ETHIOPIA, YOU KNOW BASICALLY EVERYWHERE ANDENTIOUS JIPT AND THE PHILIPPINES DON'T SEEM TO BE TOO GOOD BUT OVERALL HERE'S CHIEN AHERE'S THE UNITED STATES, DESPITE THE INCREASE IN OBOESITY, THE DECREASES IN TOBACCO DEATHS AND IMPROVEMENTS IN MEDICAL CARE, AND THE MOST EXTREME 1S HERE'S IRAN CHRKS IS PERHAPS TOO GOOD TO BE TRUE AND THERE'S THE PHILIPPINES WHICH IS PERHAPS TOO BAD TOW BE TRUE, BUT, YOU KNOW THE OVERALL PICTURE IS GENERALLY NAIEVERRABLE--FAVORABLE. YOU TALKED ABOUT RUSSIA, THE VODKA IS THE MAIN CAUSE OF MORTALITY IN RUSSIA. IT'S QUITE SHOCKING. I WILL SHOW YOU FOR START, THE UK, THE UK, THE TOP LINE IS MALES, BOTTOM LINE IS FEMALES AND THE THIS IS THE PROBABILITY OF A YOUNG PERSON DYING BEFORE 55. I'M SORRY TO CHANGE THE AGE GROUP BUT I HAVE THIS AVAILABLE. SO THIS IS THE PROBABILITY OF DYING. SO WHAT'S THE PROBABILITY THAT A 15 YEAR-OLD WILL DIE BEFORE 55? HERE'S BRITAIN WHICH WAS 9% FOR BRITISH MEN AND NOW IT'S DOWN TO 6, AND IF WE DIDN'T SMOKE OR DRINK IT WOULD BE 4% LIKE WOMEN, GOOD, SO IT'S 6 AND SHOULD BE 4. SO NO 1 COMPARE THIS WITH RUSSIA, SO I WILL TAKE THE UK FEMALES AND COMPARE THEM WITH RUSSIAN WOMEN. YOU'LL SEE WHY. SO HERE WE HAVE, THE RUSSIAN STEPS SO HERE'S WHY GORBACHEV COMES IN AND RESTRICTS ALCOHOL AND WITHIN 2 MONTHS OF GETTING POWER IN RUSSIA, THIS IS JUST THE DATA FOR RUSSIA, HE ACTUALLY INTRODUCED STRONG ANTIALCOHOL POLICIES THAT RESULTED IN A REDUCTION OF 1 QUARTER OF ALCOHOL COMSUMPTION PUTTING LEGAL AND ILLEGAL TOGETHER AND BY THE END OF THAT YEAR, NEXT YEAR, THINGS ARE DOWN BY A QUARTER. SO THE FEMALE DEATH RATE WENT DOWN AND IT SLIPPED AGAIN IN THE LATE 80S, AND THAT YEAR THERE, THE SOVIET UNION COLLAPSED AND GORBACHEV'S POLICY WAS REPLACED BY YELTSIN, AND HE WAS FAMOUS LOW DRUNK AND WHEN THE PLANE STOPPED IN IRELAND, HE WAS SUPPOSED TO VISIT WITH THE IRISH PRIME MINISTER WAS LEFT AT THE STEPS BECAUSE THE YELTSIN WAS SO DRUNK THEY COULDN'T OPEN THE DOOR. IF YOU HAD A JOB, YOU WERE NONAPOPTOTIC GETTING PAID BECAUSE THE ECONOMY WENT DOWN, IT WAS 2500% INFLATION IT WAS TOTAL DEMORALIZATION AND COLLAPSE. AND EACH THE BIRTH RATE WENT DOWN BY HALF. THEY COULDN'T EVEN HAVE BABIES, IT WAS A DISASTER. œHAD THE ASIAN BANKING COLLAPSE, THE RUBLE COLLAPSED AND AT THIS POINT THE INDUSTRIES WERE TRADING WITH EACH OTHER. THIS IS WHERE PUTIN CAME TO POWER AND THEN IN 2005, THEY INTRODUCED--HE STAIRTSED TO PRODUCE ALCOHOL, PUTIN KNEW THAT GORBACHEV HAD BEEN UNPOPULAR SO THEY LET THEM TRY IT OUT AND WHEN IT WAS POPULAR, THEY WERE THED IT AND THEY ALSO SAID WE DON'T WANT TOO MANY PEOPLE SMOKING, EITHER, WE DON'T WANT THEM TO DIE YOUNG. SO THERE WE ARE, WE HAVE DECREASES IN ALCOHOL AND THE DEATH RATES GO DOWN A BIT. SO THAT'S GOOD. NOW WE WILL DO THE SAME THING FOR MALES. ON THE SAME SCEAL LOOK AT IT. IT'S ABSOLUTELY BLOODY MAD. THERE'S GORBACHEV'S ANTIALCOHOL. THERE'S THE COLLAPSE OF SOVIET UNION POWER THE ADVENT OF BLACK MARKET ALCOHOL. HUGE INCREASE IN VODKA COMSUMPTION, SUDDENLY IT WAS LEGAL AND IT WAS MANUFACTURED EVERYWHERE, THE PRICE OF FOOD WENT UP AND DRINK WENT DOWN. THERE'S THE RUBLE COLLAPSE, AND HERE'S WHERE WE STARLIGHT--START TO BE INTRODUCED AND AT 7% DEAD THERE AND THEY WERE AT 37% DEAD AND NOW THEY'RE DOWN TO DWIF% DEAD AND IN THIS PERIOD THEY WENT DOWN FROM DRINKING 9 TIMES AS MUCH OF THE BRITISH AS MUCH AS DRINKING 6 TIMES AS MUCH. SO IF THEY WOULD DRINK 3 TIMES AS MUCH, THEY WOULD BE DOWN HERE SO IT'S EXTRAORDINARY. YOU KNOW SO IN THE UK AND CHINA, IT'S JUCH RUSSIA IS DIFFERENT. IT'S JUST DIFFERENT IN THAT RESPECT AND IT'S--IT'S TRUE. THE 1 PLACE IT WASN'T TRUE WHERE YOU DIDN'T GET THE WEIRD SPIKES WAS WHEN IF YOU LOOK SEPARATE, IT'S THE MUSLIM REPUBLICS, IT DOESN'T HAPPEN BECAUSE THE MUSLIMS DIDN'T DRINK AND DIDN'T DO LITTLER THINGS AND THEY DIDN'T DRINK SO YOU DIDN'T GET THESE HUGE SPIKING CAUSED BY ALCOHOL. OKAY. AND THIS IS GOOD CASE CONTROL, AND SAYING ALCOHOL IS DRIVING IT, IT'S NOT STRESS, IT'S VODKA, IT'S STRESS CAUSING VODKA PROBABLY. IN CASE, IT'S VODKA, WHAT ABOUT OBESITY? OH GOD, GO AWAY. RIGHT. THIS IS JUST MALE. SO THIS IS THE GLOBAL BMI MORTALITY COLLABORATION, THE REFERENCES ARE DOWN THERE AND YOU HAVE THE SLIDES ELECTRONICALLY AND THIS IS FOR MEN, HERE'S BMIV, 20, 25 AND I'M 25, I WOULD PREFER TO BE 23, 24, BUT 25-30 IS WHAT'S CALLED OVERWHEAT AND THEN 30-35 IS GRADE 1 OBOESITY. SO, THE CLAIMS THAT THERE'S NO RISK IN OBOESITY AND IT'S JUST NOT TRUE, BUT IT WOULD DOUBLE YOUR RISK SO SO IF YOU LOOK, SAY, YOU KNOW ARE HERE ARE THESE GREAT MALES IN EUROPE AND NORTH AMERICA, IF THEY'D GOT THE SAME SORT OF MORTALITY AS THOSE IN THE DESIRABLE BMI RANGE THEN 40% OF THEIR MORTALITY WOULD HAVE BEEN AVOIDED. SO INSTEAD OF 1.7 IT WOULD HAVE BEEN AND OOM SORRY THIS ISN'T A TRUE SCALE IT SHOULD BE. AND OKAY, SO WORLD WIDE, WHAT'S HAPPENING? BAIRVEGLY THINGS ARE GETTING BETTER, EXCEPT FOR THE REASON FOR THEM GETTING WORSE. SO WORLD WIDE, YES, IN PLACES, TOBACCO, CHINA PARTICULARLY, RIFF, AFFRIC AALCOHOL, RUSSIA, ATIPOSSITY, MEXICO, UNITED STATES, SOME OF THIS GULF STATES AND SOME OF THE PACIFIC ISLANDS, WAR. WELL YOU KNOW RWANDA, SYRIA, WHERE THINGS ARE NOT CATASTROPHICALLY GOING WRONG, THESE ARE THE ONLY CAUSES OF DEATH THAT THEY WERE WORSE FROM 1990, AND THESE ARE GETTING BETTER, THE OVERALL PICTURE IS 1 OF IMPROVEMENT. AND IF YOU LOOK, THIS CENTURY, THAT'S STILL TRUE, IF YOU LOOK AT TRENDS IN DEATH RATES BETWEEN 202,010 WORLD WIDE, SO STRATIFY RATE, SEX IN THE FULL WORLD AND INCOME GROUPS WHAT'S HAPPENING TO MORTALITY, UNDER 50 AND 50 TO 69 WORLD WIDE FROM COMMUNICABLE DISEASES, THEY'RE GOING DOWN. THIS IS DISEASES MAINLY UNDER 50. UP HERE HAVE YOU PNEUMONIA, TB AND A BIT OF HIV. BUT BASICALLY IT'S GOING DOWN THROUGHOUT THE AGE RANGE NONCOMMUNICABLE DISEASE, IS ACTUALLY GOING DOWN, AND NOT UP. DOWN BY ABOUT 15% PER DECADE. WE TALK ABOUT THE EPIDEMIC OF NONCOMMUNICABLE DISEASE, BUT ACTUALLY NONCOMMUNICABLE DISEASE OF THOSE IN A GIVEN AGE RANGE FOR GOING DOWN, NOT UP, WHAT'S GOING UP AND THE POPULATION AND WHAT'S GOING DOWN FASTER IS THE DEATH RATE FROM OTHER COULD YOU SAYS. THESE ARE DEATH RATES FROM DISEASE IF I HAD A THIRD LINE HERE WHICH DEALT WITH DEATH RATES, AND VIOLENCE, SUICIDE, THAT WOULD BE GOING DOWN AT 10% PER YEAR ON AVERAGE, WITH HIDIOUS LOCAL EXCEPTIONS. SO HOW SOON CAN WE HAVE NONCOMMUNICABLE DISEASE MORTALITY? WELL IF WE KEEP ON AT THAT RATE IT WILL TAKE US BACK 50 YEARS TO HAVE IT, BUT WE CAN TAKE SERIOUSLY THE BIG CAUSES. WE CAN PARTICULARLY TAKE TOBACCO SERIOUSLY AND AND SO WE CAN TAKE TOBACCO SERIOUSLY AND WE CAN TAKE TREATMENT SERIOUSLY. WE HAVE DRUGS THAT WORK BUT THEY DON'T WORK IF THEY'RE NOT TAKEN AND A LOT OF PEOPLE AREN'T TAKING THINGS THAT ARE CHEAP, AVAILABLE AS GENERICS AND REDUCE VASCULAR MORTALITY. HERE'S THE U.S. VASCULAR TORTALLITY. AND THERE'S--I DARE SAY 2015 AND IT'S LAST BIT EXTRAPOLATION TO 2013 BUT LOOK THE CHANGES. IT'S WOBDERFUL AND BRITAIN IS BETTER. WE WERE NOT QUITE AS HIGH IN THE FIRST PLACE BUT LOOK THAT RED CROSS THERE IS THE AVERAGE OF MALE AND FEMALE FOR 1980. 9080 DEATH RATES, THEY WOULD HAVE DIED FROM VASCULAR DISEASE BEFORE THEY'RE 70 BUT AT 2010 DEATH RATES THAT'S 4%. WHERE'S THE EPIDEMIC OF NONCOMMUNICABLE DISEASE. YES, OBESITY IS ACCOUNTING FOR INCREASING FRACTION OF THE MORTALITY, IT'S AN INCREASING FRACTION OF MORTALITY, SLOWLY INCREASING FRACTION OF A RAPIDLY DECREASING TOTAL IN BRITAIN AND IN AMERICA, THIS IS SORT OF FLATTENING OFF NOW, THE OBESITY IS ACTUALLY GETTING TO THE POINT WHERE IT'S REALLY SLOWING THE RATES OF 4 JUST IN THE LAST FEW YEARS BUT THE OVERALL PICTURE IS EXTRAORDINARILY MUCH BETTER THAN I EVER THOUGHT IT WOULD BE WHEN I WAS LOOKING AT DEATH RATES IN THE 1970S. NOW, SURE, I TALKED ABOUT SMOKING, I WILL TALK ABOUT MEDICATION BEFORE I CLOSE. THE KEY THING IF YOU WANT TO REDUCE NIEWN COMMUNICABLE DISEASE WORLD WIDE, SURE, DO SOMETHING ABOUT SMOKING BUT WE NEED TO ACTUALLY USE DRUGS THAT WORK. WE NEED TREATMENTS THAT WORK, WE WANT TO GIVE THESE TO PEOPLE WHO ARE AT HIGH RISK, STATINS, BLOOD PRESSURE LOWERING DRUGS, ASPIRIN IF YOU ALREADY HAD AN EVENT, NOT OTHERWISE BECAUSE IT CAN CAUSE BLOODING, GENERIC DRUGS ROLLED TOGETHER IN 1 PILL THEN YOU ONLY HAVE 1 PILL TO TAKE AND DOCTORS CAN'T VARY WHAT THEY PRESCRIBE, TAKE AWAY THE DOCTOR'S FREEDOM, GOOD. SO WE WANT TO GET TO THE POINT WHERE WE WANT TO TREAT THOSE OF HIGH RISK OF LOSING A LOT AND IT'S REALLY AT HIGH RISK ARE THOSE WHO HAVE SOME DISEASE ALREAD AND THEY'RE NOT TOO YOUNG. YOU HAVE LESS TO LOSE, SO IF YOU SAY, YOU KNOW, DEATH OF AGE 60 ON AVERAGE MATTERS MORE THAN AGE 90, I'M 74, THIS IS PRACTICABLE IN MIDDLE INCOME POPULATIONS BUT AT THE MOMENT WE HAVE ALL THESE THINGS THAT WORK AND THEN NOT BEING USED, IT'S BETTER--I THINK WE SHOULD AT LEAST GET TO THE POINT WHERE THEY'RE TREATING THOSE HAVE SOME DISEASE INCLUDING 2 DIABETES, YOU KNOW IF YOU HAVE A HISTORY OF OCCLUSIVE STROKE OR HEART ATTACK, DIABETES, TYPE 2 DIABETES, YET, THEN DRUGS WILL REDUCE BY MORE THAN HALF, YOU WILL RISK A DISASTER OVER THE NEXT 5 YEARS AND THE QUESTION OF WHETHER THAT'S WORTH WHILE OR NOT DEPENDS ON YOUR QUALITY OF LIFE NOW, AND ON YOUR LIFE EXPECTANCY, WHAT'S THE EXPECTANCY OF GOOD LIFE BUT THERE'S A LOT. THIS SHOULD BE A MAJOR PART AND IF WE HAVE THAT HAPPENS WITH THE PEOPLE WHO HAVE DISEASE, YOU SEE PEOPLE WHERE YOU HAVE DISEASE, YOU ARE NOT MEDICALIZING THE POPULATION, YOU'RE NOT GOING OUT AND RUNNING EXPENSIVE SCREENING PROGRAMS THEY'RE COMING TO YOU SO IF YOU CAN RECOGNIZE THE VASCULAR DISEASE AND YOU CAN TREAT IT BUT DON'T TRY TO TITRATE BLOOD PRESSURE OR GUT CHOLESTEROL, GIVE THE PILLS, THEY WORK IF THEY GIVE THEM, DON'T VARY A TREATMENT, DON'T PUSH THEM TO THE LIMIT BUT DON'T VARY THE TREATMENT ACCORDING TO BLOOD PRESSURE OR CHOLESTEROL. IT'S WONDER HOW 1 GLETS COMPLIANCE. YOU KNOW MEDICATION AND BREAST CANCER, WELL HERE'S UK AND BREAST CANCER MORTALITY TRENDS THAT THAT'S TREATMENT, I AM RUNNING OUT OF TIME THAT'S WHY THE CLOCKS KEEP COMING UP. SO, IF THERE'S AN EARLY BREAST CANCER TRIAL, YOU PUT THE TRIALS TOGETHER AND IT'S BEEN DONE ACTUALLY, THE FIRST RESULTS WERE ANNOUNCED IN THIS AUDITORIUM IN 1985 AND ALL THE TRIALS HAVE BEEN MET IN 1995, 2000, 2000 AND YOU KNOW IT WOULD BE AGAIN 2018. AND YOU HAVE THE CHEMO THERAPY YES IT DOES AFFECT SURVIVAL. HERE'S COLLABORATORS, HERE'S THE COLLABORATORS. I HOPE YOU TOOK NOTES ON THAT. ENDOCRINE THERAPY, YOU KNOW 5 YEARS OF ENDOCRINE THERAPY WILL REDUCE 15 YEAR MORTALITY IN THE BREAST CANCER BY ABOUT A THIRD AND 10 YEARS OF ENDOCRINE TREATMENT IS BETTER, CHEMO THERAPY, CRUDE THEME O THERAPY IS WITH THE NEGATIVE DISEASE BUT THE POSITIVE DISEASE BUT OUR NEGATIVE DISEASE IS BENEFITS WITHIN 2 OR THROW YEARS, AND THEY WAIT FOR THE 10 YEAR OUTCOME BUT THEY GAIN 10 YEAR SURVIVAL IS SIMILARLY SOME ARE NEGATIVE, SOME ARE POSITIVE. RADIO THERAPY, [INDISCERNIBLE] IT DOES HAVE A REAL EFFECT ON THE SURVIVAL. HAS REAL SIDE EFFECTS. IT WILL INCREASE YOUR RISK OF GETTING LUNG CANCER OR HAVING A HEART ATTACK OR FOR A SMOKER WHO HAS A, YOU KNOW IF YOU GET A 50% INCREASE IN LUNG CANCER AND NONSMOKER THAT MIGHT TAKE .4% OR .6%, YOU CAN FINISH UP DOING MORE HARM THAN GOOD. SO THE WOMAN'S SMOABLGING HABITS MAY BE A DETERMINANT WHETHER RADIO THERAPY DOES MORE HARM THAN GOOD IN LIFE OR DEATH. ODDS AND INS BUT IT'S WORTH GETTING THE DETAILS RIGHT. WE HAVE THESE MAJOR CAUSES. IT'S STILL THE BIGGEST OF ALL, TOBACCO AND HERE'S THE REAL SHOCKER, HERE'S THE SAME SHOCKER, THIS IS WHAT SMOKING DID IN THE UK, WELL, MORTALITY AND THAT'S WHAT'S ADDED TO IT CSR THERE'S UK FEMALE. THAT'S WHEN HAD SHOULD HAVE BEEN WITH A NICE IMPROVEMENT IN BREAST CANCER TREATMENT AND THAT'S WHAT WAS ADDED TO IT. SO WHAT DO WE DO? I'D LIKE TO SHOW 3 MORE SLIDES THAT WOULD BE QUICK, IS THAT OKAY? WHAT'S GOING TO HAPPEN THIS CENTURY IF CURRENT SMOKING PATTERNS CONTINUE? WHAT IS HAPPENING WITH CURRENT SMOKING PATTERNS WE HAVE 50% OF THE YOUNG MEN IN THE WORLD START TO SMOKE NOW, MORE THAN 60% IN CHINA, AND 10% OF THE YOUNG EMPLOYMENT PROGRAMS, SO 30% OF THE ADULTS START TO SMOKE. SO IF YOU GET 100 REACHING ADALT HOOD, THAT'S 30--ADULTHOOD THAT'S MORE THAN HALF A MILLION SMOKERS. THIS IS WHAT MOST COUNTRIES ARE DOING THEY DON'T STOP IN AMERICA AND BRITAIN A LOT STOP. MOST PARTS OF THE WORLD THEY DON'T. ONLY THE EDUCATED STOP. SO, IF YOU GET 30 MILLION, THAT ARE DOING SOMETHING THAT WILL KILL HALF OF THEM OR MORE THAN HALF OF THEM AND MOST DON'T STOP, WE WILL FINISH UP WITH MORE THAN 10 MILLION DEATHS A YEAR IN SMOKING IN THE LURK RUNG AS THEY GO ON TO MIDDLE AND OLD AGE. 10 MILLION A YEAR IS A HUNDRED MILLION PER DECADE. AT THE MOMENT WE'RE RUNNING 5 OR 6 MILLION DEALGTS SO A HUNDRED MILLION TO TOBACCO DEATHS, MOST OF WHICH HAPPENED. WHAT ABOUT THE 2020S? ABOUT WHAT ANOTHER 250 MILLION AND THEN, BY THE MIDCENTURY, WILL BE AT THAT POINT WE'LL BE GETTING A HNTD MILLION, MORE THAN A HUNDRED MILLION TO BACKEES AND WE'RE TALKING ABOUT A BILLION TOBACCO DEATHS THIS CENTURY, A LOT OF THEM BEFORE AGE 70 COMPARED TO A ABOUT A HUNDRED MILLION IN THE 20th CENTURY. SO, WHAT CAN WE DO TO AVOID HUNDREDS OF MILLIONS OF THESEETH DAILY BASISS. THE U. N. TARGETING SYSTEM SET 130 REDUCTION IN SMOKING. GOOD. THEY WANT 1/THIRD REDUCTION IN BY 2030. VERY GOOD. BUT AT THE MOMENT CHINESE SEGCIGARETTE PRODUCTION IS RISING. IT WAS 1.6 TRILLION IN 1999. IT WAS 2.6 TRILLION AT 2014 AT A WORLD PRODUCTION OF 6 TRILLION. THEY'RE HEADING FOR THE 50% MARK. THAT'S NOT WINNING. SO WHAT CAN WE DO? THE U. N. TARGETING SYSTEM SET 1 LESS SMOKING, YOU COMPARE TO 2010. TO YOU WORLD WIDE, THE TOBACCO COMPANIES ARE A WORLD OF BAD PEOPLE BECAUSE THEY MAKE 50 BILLION DOLLARS A YEAR, 50 BILLION DOLLARS A YEAR AND WE HAVE 5 MILLION TOBACCO DEATHS A YEAR, SO $10,000 PER DEATH BUT THE GOVERNMENTS MAKE 300 MILLION A YEAR IN TAXES AND CIGARETTE PRODUCTION. NOW IF WE DO GET A REDUCTION, IF THE PRICES STAY THE SAME, AND SMOKING GOES DOWN BOY A THIRD, THE GOVERNMENTS OF THE WORLD WILL LOSE LIE A HUNDRED MILLION DOLLARS A YEAR. THAT'S NOT BIG MONEY BUT IT'S NOT SMALL MONEY. A GOVERNMENT'S VERY INTERESTING, IT'S NOT AS BIG AS THE FINANCIAL CRASH BUT IT'S DIG ENOUGH TO BE INTERESTED IN GOVERNMENTS. IF HOWEVER, THE GOVERNMENT'S WERE TO INCREASE EXCISE TAXES SO THAT THE PRICE IS OF ALL CIGARETTES INCLUDED THE CHEAPEST 1 GOES UP AND THE REAL PRICE DOUBLES THIS OF ITSELF WILL REDUCE COMSUMPTION BY ABOUT A THIRD. IF YOU LOOK BETWEEN FLEEN 90 AND --1990-2005 THE REAL PRICE OF CIGARETTES IN FRANCE DOUBLED. SO WE WILL GET FEWER TOBACCO DEATHS IN CANCER IN FRANCE. BECAUSE THEY'RE COMING DOWN. BUT THE FRENCH GOVERNMENT DOUBLED TAX TAKE IN REALEUR OS. THEY WENT FROM SICK BILLION IN 1990 TO 12 BILLIONEUR OS IN 2005 AT CONSTANT 2007 YEAR OS. SO TRIPLE THE PRICE, HALF COMSUMPTION DOUBLE GOVERNMENT TAX TAKE, TRIPLE HALF, DOUBLE. GOOD SLOGAN BUT IF WE COULD JUST WORLD WIDE, IF WE COULD DOUBLE THE PRICE THEN WE WOULD GET OUR ONE-THIRD REDUCTION AND THE GOVERNMENTS OF THE WORLD MAKE AN EXTRA HUNDRED BILLION A YEAR, NOW WITCH OF THESE 2 THINGS HERE IS PLAUSIBLE. WHICH IS MORE PLAUSIBLE. I THINK THE BOTTOM IS PLAUSIBLE AND I THINK THE MIDDLE 1 IS NOT PLAUSIBLE. SO I WANT PRICE INCREASES. THE CHINESE GOVERNMENT AT THE MOMENT MADE 7 OR 8% OF ITSELF INCOME OF TOBACCO. AND THE--I'M PUTTING MY LAST SLIDE UP HERE, THEY MAKE 7-8% OF THEIR INCOME FROM TOBACCO IF THEY WOULD DOUBLE THE PRICE, THEY WOULD REDUCE CONEXPUSMGZ GET MORE MONEY. THEY MIGHT MAKE 10% TO INCOME FROM TOBACCO. SO I WANT THE CHINESE GOVERNMENT TO MAKE MORE MONEY FROM TOBACCO BUT THE PRICE INCREASE VS GOT TO INCLUDE THE LOWEST PRICED CIGARETTINGS OTHERWISE YOU JUST CHANGE BRANDS. OKAY, SO BASICALLY THINGS ARE GETTING BETTER. I WANT--LOOKING BACK TO THE CAUSE FROM CANCER, I WANT TO LOOK AT MORTALITY IN GENERAL IN AMERICA, AND IN DEVELOPED COUNTRIES AND WORLD WIDE, AND IF WE DO THAT, OVERALL, THINGS ARE GETTING BETTER WITH SOME HORRIBLE EXCEPTIONS AND AND DEATH AND OLD AGE IS INEVITABLE, AND IF I--BUT DEATH BEFORE OLD AGE IS NOT SO IF I GOT MY REFERENCES RIGHT, THERE YOU GO.& THANK YOU ALL INDEED. [APPLAUSE ] >> ANYBODY WANT TO DISAGREE? [LAUGHTER] >> SO WE HAVE TIME FOR 1 QUESTION, AND 1 QUESTION ONLY. WE ARE OVER TIME OTHERWISE WE ARE GOING TO MOVE ON. >> I JUST WANT TO SAY 1 THING IF THERE'S NO QUESTION, IF I ACTUALLY GOT A MUCH BETTER BALANCED TALK I WOULD HAVE CONCENTRATED MORE ON THE THINGS THAT NEED TO BE DONE TO REDUCE DEATH FROM NEONATAL DEATH AND DEATH TO INFECTION IN POOR COUNTRIES. AND A LOT IS BEING DONE BUT INTERNATIONALLY THE COLLABORATION BETWEEN PARTICULARLY THE U.S. GOVERNMENT AND INTERNATIONAL INSTITUTIONINGS AND COUNTRIES WHEN BOTH COUNTRY GOVERNMENT AND THE INTERNATIONAL COMMUNITY INVOLVED IT REALLY WORKS. DEATH FROM FACTS IN FREE RADICALS VENTABLE DISEASES WENT DOWN BY 2/THIRDS, THE VACCINES WENT DOWN BY 2/THIRDS BETWEEN 2010 BECAUSE WE TOOK ACTION, HIV DEATHS ARE GOING DOWN, BECAUSE WE'RE TAKING ACTION. YOU KNOW A LOT OF THINGS ARE GOING DOWN BUT THEY DON'T GO DOWN SPONTANEOUSLY, THEY ARE A RESULT OF A HUGE EFFORT AND WHEN YOU GET COLLABORATION BETWEEN INTERNATIONAL AGENCIES AND NATIONAL GOVERNMENTS, THEN YOU GET PROGRESS. BUT BOTH NEED TO BE INVOLVED. PEOPLE SAY THAT THE [INDISCERNIBLE] DOESN'T WORK BUT IT DOES. THEY ARE GETTING BETTER. DEATH BEFORE 50, YES, THAT'S IT. I WANTED THAT TO BE THE SUSTAINABLE DEVELOPMENT GOAL HAVE IT UNDER 50 MORTALITY. IT IS ALL BLOODY WELL BEING. WELL, YOU KNOW. >> THANK YOU VERY MUCH. >> [ APPLAUSE ] . >> THIS IS A CERTIFICATE OF APPRECIATION FOR A WONDERFUL TALK. APPRECIATE YOU COMING HERE, THANK YOU SO MUCH. THANK YOU.