Dr Louise Newson: [00:00:01] So Neil, I'm super excited about this podcast, I've been excited for a while actually because I reached out to you after watching a programme that really shocked me, like really shocked me and I'm not easily shocked, but it was about the Primodos scandal which we'll talk about in a minute and I don't know how you managed to reply to my email, it was just wonderful and we had a quick conversation because you're a researcher, you're an academic, you are a scientist. And I'm a medical doctor who has prescribed hormonal preparations for years, and I'm really just waking up over the last 10 years or so to the huge difference between what people call hormones in contraception and what I now call hormones, which is what we naturally produce in our body and the two are very different, which we will talk about. But many years ago, women weren't used in experiments. We didn't have to be in scientific experiments at all. There was a real shock with the Thalidomide scandal where people realised that if they were taking medications that hadn't been tested on women who were pregnant, it could have a massive detrimental effect on unborn babies when they're born. And that did really shock the world. But then there was this other scandal that happened. And now it is a scandal. And I watched the programme in horror, and then I read a lot about it. And I reflected a lot about it because it just doesn't feel very comfortable what happens. So let's just talk about what happened so Primodos was a pregnancy test and before they had this it was quite hard to diagnose pregnancy, wasn't it?  [00:01:39][98.1]
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Professor Neil Vargesson: [00:01:39] Yeah well, before the Primodos test you had this, they called it the Hogben test, which was where you used toads and you would inject the urine of a potentially pregnant lady into the toad and then if that toad ovulated, because the toad, and the humans used the same sort of mechanisms, then she was pregnant. But if it didn't, then you weren't. But because that's classified as an animal test, you'd get through an awful lot of frogs and toads a year. With something new that didn't use animals... [00:02:12][32.7]
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Dr Louise Newson: [00:02:14] And it took a bit of time, didn't it? It was like you'd have to send it off and whatever.  [00:02:18][4.0]
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Professor Neil Vargesson: [00:02:20] It cost quite a bit of money because you've got to look after the animals and things. So the hormone pregnancy test was born because of that. It was trying to come up with a way of not using animals in a much more simpler way that would give an answer quickly.  [00:02:31][11.1]
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Dr Louise Newson: [00:02:32] So and it sort of did but just explain what Primodos was or is I mean it's still a hormone that's used now. [00:02:38][6.2]
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Professor Neil Vargesson: [00:02:40] Primodos is two hormones put together, and they're synthetic estrogens and a synthetic progesterone, so it's man-made. And you would do this twice and if you didn't have a menstrual bleed over two different days you were classified as pregnant. But if you were not pregnant, you'd have a menstrual bleed the next day. You do it twice. If you had two menstrual bleeds or two spottings, you were classified as not pregnant. Very messy and you know not, not an accurate test whatsoever but that's how it worked and that was that was the plan of it if you didn't bleed you were pregnant if you did you were not. [00:04:03][83.1]
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Dr Louise Newson: [00:04:04] So just to be clear, this was something that doctors prescribed, and they often got money obviously for it. So it contained ethinylestradiol, so it's a synthetic form of estrogen and it also contained norethistrine, which is a synthetic progestogen, which it's not progesterone. So they've both got very different chemical structures of the natural estradiol and progesterone that women produce regularly anyway, but produce in high amounts when they're pregnant. So had this been tested on women before to test whether it was safe to give in pregnancy?  [00:04:40][36.6]
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Professor RNeil Vargesson: [00:04:42] It's not clear what the testing procedures were, and in that particular, you know, it first came out in 1958, we had just, the Thalidomide disaster was just happening at that particular time point, and in those days, testing of drugs, there was no consensus. Each country had its own regulations, each company had its regulations, so there was no guideline that said you had to do this in every single country, which we now have today and that's thanks in part to the Thalidomide disaster. So it was, I don't believe it was ever tested in humans, I don't know what animals it would have been tested on, but it was because it was a synthetic progestogen based and a synthetic estrogen based it was believed to be safe because it was mimicking what was seen with the normal hormones. The problem is, and as you say, the chemical structure is slightly different, and it is not progesterone and it's not estrogen, they are synthetic versions of it. How they act in the body is not 100% known, even to this day.  [00:05:51][68.7]
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Dr Louise Newson: [00:05:51] No and that's really interesting because I sometimes think about basic chemistry and chemical structure and I've often said to people if you think of a graphite pencil that's made out of carbon it's got three carbon atoms together. If you add another carbon atom and change the structure so it still all just contains carbon but it's a different bond it becomes a diamond. Now everyone knows there's a big difference between with a graphite pencil and a diamond so sometimes a very small chemical change can make a big difference to the structure and in the body, the biological action of something can't it? [00:06:29][37.8]
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Professor Neil Vargesson: [00:06:30] Totally. Thalidomide is a great example. You can break that drug down into slight changes, completely changes the different products. So it looks the same, but it's got a slight change and it changes its entire behaviour. And so that's the idea that these synthetic hormones in Primodos act like progesterone and estrogen, well... they've got similar qualities, but they're doing different things, in the half-life, so that's the activity that they spend in the body that's active, is different. So, depending on which textbook you read, you know, a progesterone can have a half-life of between five and 15 minutes, depending which textbook, whereas these synthetic ones can last hours. So, if they are lasting hours, they're in the body longer than you would normally have them. And so what's the impact of that? That's the question I've got and others have got.  [00:07:24][54.3]
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Dr Louise Newson: [00:07:26] Yeah and we know that ethinylestradiol has got a lot greater affinity to the estradiol receptor but it also blocks the action of natural estradiol working because it's like a magnet once it's stuck over the receptor it's very hard to get the natural estradiol there. So anyway people were given it in good faith the doctors thought they were doing the right thing because that's what they were taught and then there were some problems weren't there? [00:07:50][24.1]
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Professor Neil Vargesson: [00:07:53] Yeah, children were being born with problems and there was, you know, a lot of people were complaining that their babies had these issues or were being born with issues. And because Primodos was deemed safe because it was based on naturally occurring hormones but they were synthetic, and that probably wasn't realised at the time, it was deemed how can a hormone cause these problems? So they were ignored. They still are.  [00:08:22][29.5]
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Dr Louise Newson: [00:08:23] Yeah and this was a real problem with the Primodos scandal because it did unmask the history of it because no-one, and even sadly now, not many people listen and believe women but women were saying, and it was a pattern recognition thing, so there were a lot of cleft lips, cleft palates, limb deformities, heart deformities in a way that hadn't really been seen before and the common denominators, if you like, were these women had been given Primodos and it had been given to probably millions of women as well by the time they actually thought there might be an association.  [00:08:55][32.4]
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Professor Neil Vargesson: [00:08:57] The real issue here was unlike Thalidomide, where the babies were assessed and doctors looked for common signs of problems between these babies to see, okay, yes, there is a common denominator here so therefore this drug could be doing this. That was never done for Primodos because the medical community decided it couldn't be Primodos causing it. This must be something else, which is this famous phrase you're told, oh your son's got, your daughter's got a problem. It's just one of those things. Well, yes, it might be one of these things, and we can't explain 60% of all birth differences that are born today. We can't. But that's probably more than it was 10 years ago, and it's certainly more than what it was 35 years ago. What we failed to do, or what the community failed to do, was take seriously those womens' concerns that this medicine that they were prescribed in early pregnancy could have been causing a problem. And because those children were never assessed, we don't know what the common factors this drug may or may not have caused. Could it be that actually the limb malformations that you refer to and some of the facial issues, are they linked in some way? You see these with people that were exposed to Primodos, and you might see individually, you might facial problems or limb problems in other conditions. We don't know that, and so that's a failing, particularly when it was occurring well after the Thalidomide disaster as well. You think that we might have put two and two together. So, they're my questions as to why we... why the community hadn't looked at it and said well actually we need to look at this a bit more. People are saying, women are saying my kids have been born with problems, why aren't we taking it more seriously and this is a problem of that particular era and we still don't have an answer.  [00:10:52][114.3]
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Dr Louise Newson: [00:10:52] So one of the things that really concerned me about this is that the drug company were alerted that there was a potential problem and the drug company tried to hide that there was a problem and they were prepared for some people pursing legal action against them with babies with deformities but they weren't prepared to look into it properly. It was very sort of reactive and one of other problems is one of the medical advisors was really trying to push out the synthetic progestogens as contraception. And I read somewhere that one of the messages was that he was saying you mustn't put any warnings out because all women will then be scared of progestogens. And it was in the early 60s so there were all the synthetic hormones being marketed as contraceptions and they were worried it was going to have a negative effect on the impact of contraception. And I feel that's quite irresponsible of that doctor who was working for the government because surely he should have thought maybe this is a public health issue. How much research have we really done on these synthetic hormones, the ethinylestradiol and the norethisterone, because we know a lot of the experiments that were done by Pincus and so forth were just looking at the lining of the womb to try and stop women having periods. And contraception actually hadn't been tested as a contraception, it was pushed out and marketed just for periods and then a year later they changed the licence without any evidence but there was, still there's very little evidence to show the safety of these synthetic hormones and I say 'hormones' in inverted commas because they're not hormones but these synthetic substances throughout the whole body and obviously in pregnancy anything is exaggerated because you've got highly dividing cells, haven't you? And that's where, you know, it's sort of magnified, if you like. But we've got the cells dividing in our bodies all the time. It just means that you don't somehow know what's going on. And it can take a lot longer to see a detrimental effect than inutero in the foetus.  [00:13:02][130.0]
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Professor Neil Vargesson: [00:13:03] The embryo and the adult are two very different things. So you're taking synthetic hormones to control periods, for example, in an adult female. Well, that's one thing, but if that's exposed to the early embryo, which has got all these different signalling systems and all these different processes going on, it's very different. And cancer in adults is a recapitulation of the embryonic scenario, and it's uncontrolled. So, you know, you've got... Yeah, I mean, I don't know what the testing was that was done, if any, in a pregnant situation. And we're only just starting to learn and understand how these synthetic versions of progesterone are working in the embryo and in the adult itself anyway. We're talking 2025, 2026 now, right?  [00:13:52][48.6]
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Dr Louise Newson: [00:13:52] I know. And this scandal was 1958, you say it was started at this time? [00:13:57][5.6]
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Professor Neil Vargesson: [00:13:57] It started in 1958 and they withdrew it in 1978, they'd put on warning signs in 1974 which were mysteriously removed after a couple of years. The warning signs being don't take if you're pregnant. And there's no records as to why the warning was put on and then why the warning was taken off. And if you ask the company to supply the safety data they don't have that data anymore, they claim because it's so long ago. Which might be true, and it might be true, I don't know how long they keep the records for. [00:14:26][29.4]
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Dr Louise Newson: [00:14:27] It's quite something it took 20 years to withdraw something and in the programme one of the things that really struck me what I really wanted to reach out to you was that you were pipetting some of the synthetic progestogen. Can you just explain what you were doing? What you were putting it on? [00:14:45][17.7]
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Professor Neil Vargesson: [00:14:47] So we, I've been bombarded by, with emails and telephone calls from various Primodos survivors asking, you know, there's no research on this for years and the research that's out there is contradictory. There's a paper that says it does cause problems and there's a paper that says that it doesn't cause problems. So what do we do? And we need something definitive. So at that point, I was working with Thalidomide. So we would just, we used the same assays we used to test Thalidamide. We made some Primodos ourselves. So we just, we got the two components that makes up Primodos. We made them up and we put them onto zebrafish embryos and found that the zebrafish have problems. Now, a zebrafish embryo isn't a human, of course, but it does share 70% of its genome or genes, and it does share 87.5% of it's disease-causing genes. So it's a good interpreter, if you like, about what a drug or a chemical or a synthetic hormone might do if it was exposed to a human. So it caused problems. I'm not surprised, I mean you're taking in a synthetic hormone that shouldn't naturally be there and you're putting it into an embryonic situation where there's lots of things going on and it causes issues. So would that happen in a human? I don't know because a human's got a placenta and it's a very different situation. But if you put that mix of hormones onto human cells, it affects those cells as well. So the chances are that it could cause a problem. But it's taken a long time to find that information out.  [00:16:34][106.9]
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Dr Louise Newson: [00:16:35] Well it's quite striking because in the picture you can see the drops going on the zebrafish and you can see the spine, just see the development of the spine changing very quickly. And these are obviously rapidly dividing cells but like you've actually said just now, if someone has a cancer you have rapidly dividing cell and what we don't know if someone has a cancer and they're on a synthetic hormone, does that make a difference to it? But the other thing is, with a lot of these synthetic hormones, people often don't feel great on them, and I've written a lot about it in the book. There's been very few studies, or published studies, at least, with people on hormonal contraceptives, but we know that there is a risk of clot and heart attack and stroke and cancers with them. It's a small risk, and I was always taught as a medical student, Louise, the risk is so small, these women are young, they're otherwise fit, don't worry about it. But actually I do worry about it, because so many millions of women are taking these drugs, a small risk still means quite a few thousand of women that could be potentially harmed. But when you look at some of the studies looking at the brain, and how it can block some of other neurotransmitters in the brain and affect our natural estradiol, progesterone, testosterone, which are important neurotransmetters that are made in the brain. A lot of people go on antidepressants, then they become quite low, then they go on hormones, or contraceptive hormones, then they on antidespressants. And there's this cycle going on, and I see it so much in my daughter's friends that it really concerns me, because if it's having effect on their brain, where else in their body is it having an effect? And I can't understand how little research we have on these synthetic substances, when they've been around for so long.  [00:18:32][116.9]
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Professor Neil Vargesson: [00:18:33] Yeah, I would agree. Okay, so if you look at your typical hormones, progesterone and estrogen, they probably act largely on the brain and on the gonads because that's where the receptors for them are. But we haven't studied the synthetic versions of those hormones, so we don't know where they act. What we do know is that the damage that they cause in a zebrafish embryo is far wider than the gonads and the brain. It's affecting multiple tissues. So that tells you already that if these synthetic hormones are working through the same receptors that progesterone and estrogen are, they're probably doing more than that because they're affecting other tissues of the zebrafish. So again, that tells if you're taking synthetic hormones to treat a hormonal condition, you're probably going to have side effects, yes. And we don't know what they are because they've not been studied properly. And this this will go down to what are the tests that were done on these synthetic hormones, when were they done, and are they repeatable? And have they been repeated and do they show the same effects? And I'm not aware of those sort of testings and I'm not aware of those data. [00:19:43][70.3]
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Dr Louise Newson: [00:19:44] No, and they don't need to be done because these products are now out in the market, so they don t need to do so much post-market surveillance. But I'm very interested in the immune regulating effects of progesterone, estradiol, testosterone, our natural hormones. I love the macrophage, I like mitochondria, I'm a bit geeky really. But we know that inflammatory conditions are so common, you know, cardiovascular disease, diabetes, dementia, osteoporosis even schizophrenia and depression are thought of as neuro-inflammatory diseases, also Parkinson's disease, multiple sclerosis, motor neurone disease, inflammatory bowel disease, cancer is an inflammatory disease and autoimmune diseases is a dysregulation of our immune system. So when we have our hormones as women we have less of those inflammatory diseases. We've known that for years because women who have a surgical menopause or women who become menopausal have an increase, they have an acceleration of inflammation in their bodies. But what really interests me is that when people are on these synthetic hormonal contraceptives, there's likely to be more inflammation because you're blocking those receptors. And whether these chemicals, if you like, increase inflammation more, that's what hasn't really been studied. But it's a concern when you're looking at long-term health and you know, I took the contraceptive when I was younger, and I sort of wish I hadn't really, because I didn't understand what I was doing. I was just not wanting to get pregnant, really, but I know it affected my mood a bit, affected my weight a bit. You know, had it had any long-term effects, I don't know, but I do know that I wouldn't want to be on them now, and I'm really cautious with my children. But it's very limiting, because we don't have a natural, body-identical hormonal contraceptive. We have one in the UK called Zoely, which contains estradiol, but it contains a synthetic progestogen. So it's really difficult actually, isn't it?  [00:21:47][123.2]
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Professor Neil Vargesson: [00:21:48] Yeah, and I'm assuming that's because, you know, using natural progesterone, the half life is so short, you'd need to take a lot of it.  [00:21:56][8.3]
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Dr Louise Newson: [00:21:56] Well it's interesting because when we give the natural progesterone, so we usually use it orally or we can use it as a pessary, vaginally, or rectally, when it's given continually every day, people then stop their periods often. And so then I sort of think, maybe a bit too naively, but if someone isn't having their periods and the lining of the womb is thin, the chances of them getting pregnant are actually very slim because you haven't got, you know, a thickened endometrium for any fertilised egg to implant in. So we just don't know, but quite often if someone is on a contraception or they're having a hormonal coil, which again is a synthetic progestogen, I will give them natural hormones on top so then their own receptors will have some of the natural hormones, or they'll use a non-hormonal coil for example. Because a lot more younger people are thinking about the effects of these hormones and non-hormones, if you like, in their bodies. But if you don't know about it, and they're called hormone contraceptives, so everyone just presumes, doctors as well, that they just contain natural hormones.  [00:23:04][68.1]
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Professor Neil Vargesson: [00:23:06] It's scary, actually. It's your long-term use of these things. What is the impact? I don't know. It's not been properly studied. We know that when the first oral contraceptives came out, they caused cancer. And so they've reduced the dose of the different... [00:23:23][17.4]
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Dr Louise Newson: [00:23:24] Yeah, I know.  [00:23:24][0.3]
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Professor Neil Vargesson: [00:23:25] ...components to the bare minimum now. But long-term use, yeah, I don't know. And again, it's women that we're, you know, the Pill is for women, it is not for men, they're, I think...  [00:23:35][9.5]
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Dr Louise Newson: [00:23:35] Why would men take it, for goodness sake?  [00:23:37][1.5]
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Professor Neil Vargesson: [00:23:37] No, why would men? Right, exactly. And, again, I don't know what the long-term consequences are. I know that if, we do know that, if you take, if your pregnant and you're still taking the oral contraceptive pill for a long period of time, it will have consequences for the forming baby, yes.  [00:23:52][15.5]
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Dr Louise Newson: [00:23:53] Yeah.  [00:23:53][0.0]
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Professor Neil Vargesson: [00:23:54] So, again, it's a risk-benefit ratio, right?  [00:23:58][3.9]
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Dr Louise Newson: [00:23:58] Yeah.  [00:23:58][0.0]
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Professor Neil Vargesson: [00:23:59] You give a medicine out based on is this going to solve the problem that you've got here's a risk but if you're prepared to take the risk this is the benefit. And the problem I've got with synthetic hormones is just that I don't think we know what the risks, the true risks really are. [00:24:14][14.9]
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Dr Louise Newson: [00:24:14] No, I mean we know like the Depo-Provera injection, we know is associated with meningioma for example and years ago when I used to give it I was worried about osteoporosis risk because they had an increased incidence of osteoporosis so I tried to avoid giving it but any of these long acting reversible contraceptions contain synthetic progestogens and you know I do sometimes think, why are so many women now having gallstones, benign brain tumours, endometriosis, breast cancer has increased despite HRT prescribing going right down. So we can't always blame HRT. You know, what else is going on in their bodies? And it's impossible to know and we'll never have the answers because no one's gonna do the studies. And there are new contraceptives coming out all the time because every time they bring out a new synthetic progestogen, it's got a new price label with it. Because the drug companies make money on the new drugs, don't they, till they go off patent.  [00:25:18][64.2]
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Professor Neil Vargesson: [00:25:20] It is what it is, in that respect. Everyone trusts what the medical profession or the drug companies tell us, that this is safe and stuff. But what interests me the most is when you look at, if you go to a supermarket and you buy a packet of headache tablets, when you get like four or five pages of information, and it tells you the contraindications, when not to take it, when to take, what happens if you've got dizzy spells. Nowhere does it say this has been tasted safely and it's been shown to be safe, nowhere does it say it's being done. Nowhere has it said what was done to show that this is safe in these certain conditions. Yet it must have been done because otherwise it wouldn't be on the market. And this is what concerns me is why is that information hidden? Why can't you find that information out? Why can you go onto the web, onto a drug company's website and say what is the evidence that this medicine is safe if I take it for X,Y and Z? [00:26:15][55.2]
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Dr Louise Newson: [00:26:16] So it's really interesting when you go on to some of the drug companies websites, which I have done, so it's in the open domain, and you see about handling of these drugs. So the people that work in the drug company actually making these synthetic hormones. There's a whole lot of warning and it's warning about the equipment that they should be wearing to protect themselves because they are carcinogens, as in they cause cancer. So they're protecting the workers and obviously they'll be exposed to higher doses I'm sure or whatever. But actually, I think a lot of people are understanding more about this when they're thinking about processed foods and natural foods. So if I was having, I don't know, some fruit, I couldn't eat too much of it. It's not going to cause harm. It would just make me feel a bit full and bloated or whatever, but it's not going to be harmful for my body. Whereas if I'm having some, I dunno, fruit juice or something that's highly processed or like I'm having some, rather than natural organic meat, I'm having some synthetic burger from a takeaway. Of course, the more I have, the more it's going to be detrimental. But even a small amount is not going to have the same effect as something that is processed in a better way. And so a lot of it is quite simplistic and people are understanding it's not always a dose response. It's just because it's a synthetic chemical, you don't need much arsenic to kill you. So it's looking at it and thinking what we're doing and recently my middle daughter was away travelling and her period came and she didn't want it. And so she went to see a doctor and was given some Norethisterone, a synthetic progestogen. And she just took it for a few days and then she came back and her skin had really broken out and she doesn't really have spots and her mood was a bit not the same. And obviously she'd come back from Australia to the winter so your mood isn't gonna be quite the same but her skin was really, and the skin is a window into the other organs. It's a very big organ, but I do think, and she looks at me, she goes, you're going to go mad with me when I tell you what I've been taking. And I said, no, it's your body. But she said, I've only taken it a few days. I said okay, I understand. Once she stopped taking it, her skin improved, her mood was a better. And that's only a short term, but it just also, I kept thinking about you as she was taking it because thinking, we haven't moved on. You know, like, wouldn't it be nice to her well you've got risk of XYZ. But only if you take it for this dose for this length of time and everything you have maybe is reversible. But we have no idea, we're just sort of chemically experimenting people.  [00:28:51][154.8]
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Professor Neil Vargesson: [00:28:53] Yeah, again it comes down to the doctors now sort of give you the risk-benefit analysis, you know the way they should, so here's the benefit I can give you this which will take away this but the side effects are XYZ and the problem is that everyone's different and so some people have much more severe side effects than others and again, we can't predict that. [00:29:15][21.9]
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Dr Louise Newson: [00:29:15] No, absolutely, and you know, when we're talking about cancer risk, usually when cancer occurs it's a multi-hit, it's not just one thing that's happened, there's genetic changes, there are environmental changes and whatever else as well. So before we finish, I don't want people to think we're saying absolutely no-one can be on contraception at all and all synthetic hormones are bad, but what we are really saying is that we just don't know and it's choices and about talking in a very grown up way really, to your healthcare professional, to think about maybe alternatives, to think what else is going on in your body and having that choice I think is so important because so much has been hidden from us as women for so long.  [00:29:57][41.5]
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Professor Neil Vargesson: [00:29:59] There's that, there's also just being aware and, you know, I'm sure a lot of people will say they've been on oral contraceptives for a long, long time and everything's fine, I'm sure that's true. But it isn't those folks that we're referring to. If you look at Primodos, the number of people that were given Primodos, the numbers of kids that were born, it wasn't every single child that had a problem, it's a very small number But there shouldn't be any and that's my concern. It's not, I think in the majority of cases these things are fine but there is a small minority that it isn't and that is what I'm interested in trying to find out is why does it do that? Can you make it safer? Can you it so that it doesn't affect anyone and no, you're absolutely right we're not saying that all contraceptives are wrong. They're not, but there's that small minority where there is a problem and I'm just as a scientist interested in how does it work, why does it do what it does and can you make it safer.  [00:30:56][56.9]
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Dr Louise Newson: [00:30:57] Yeah, absolutely. There's so much that we need to do and, you know, bearing in mind these drugs are prescribed so widely, we really need to be doing more and women should be asking for more as well to change things for future generations as well. So I'm really grateful for your time, Neil. It's been great. I could talk to you all day. But before I end, I always ask for three take-home tips. So three things that you would love to see happen over the next few years looking at research into synthetic hormonal contraceptives.  [00:31:31][34.0]
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Professor Neil Vargesson: [00:31:33] I think I would like to see a scheme where there's a funding pot where you can apply to get money to do proper research using modern techniques, modern methods to understand how these things work. Are they acting the same way as the hormone they're supposed to be replacing? If they are, brilliant. If they're not, that's fine, but what the consequences. The second thing is, I'd like to see Primodos survivors treated with a bit more respect and there's an awful lot of them and I don't believe all of them are crying wolf and they're all born in the same era, they all have birth differences. I can't explain them, others can't them, they're not going away so why would that be? If you're making this up, after a while you'd get sick of doing it, right? So there's clearly something there. It's not just in the UK, it's in Germany as well. Third thing, I would just like no rain for a couple of months and just lots of sunshine.  [00:32:39][66.4]
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Dr Louise Newson: [00:32:40] That's probably the hardest. Well, they're all pretty hard, actually. But it's been great because I think this conversation, we've spoken a lot. There's quite a lot of science in here. There's things that people will have been hearing for the first time. So you might need to listen to it more than once. But it is so important. Please listen to, share it with people, have conversations, have discussions, because the only way we can change things is being more open minded and discuss with others. So please share this episode with others and let us know what you think. Thank you so much Neil, and I've been, really, it's just been great. Thank you.  [00:33:10][30.3]
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Professor Neil Vargesson: [00:33:11] It's a pleasure, take care, thanks a lot.  [00:33:11][0.0]