WEBVTT 00:00:00.000 --> 00:00:02.799 Welcome back to the Deep Dive. Today we're tackling 00:00:02.799 --> 00:00:06.200 a really fascinating figure, someone whose career 00:00:06.200 --> 00:00:09.880 journey takes us from the microscopic world of 00:00:09.880 --> 00:00:12.679 immunology right through to the big picture of 00:00:12.679 --> 00:00:15.060 national health policy. That's right. We're looking 00:00:15.060 --> 00:00:17.100 at the life and work of John Michael Dwyer, an 00:00:17.100 --> 00:00:20.359 Australian doctor, professor, and, well, a really... 00:00:20.559 --> 00:00:23.059 Tireless public health advocate. Exactly. And 00:00:23.059 --> 00:00:25.679 this isn't just about listing achievements. What 00:00:25.679 --> 00:00:27.719 we want to do for you, the listener, is really 00:00:27.719 --> 00:00:31.039 trace how a top clinical immunologist became 00:00:31.039 --> 00:00:34.920 this major public voice. A voice really dedicated 00:00:34.920 --> 00:00:37.759 to demanding rigor. fighting for evidence -based 00:00:37.759 --> 00:00:40.820 medicine, and taking on misinformation and, frankly, 00:00:40.899 --> 00:00:43.039 unproven practices. It's quite a transformation. 00:00:43.100 --> 00:00:45.479 It really is. So we'll follow his path, starting 00:00:45.479 --> 00:00:47.259 with some pretty cutting -edge research, actually, 00:00:47.280 --> 00:00:49.659 at Yale University. And then right into the thick 00:00:49.659 --> 00:00:52.020 of the AIDS crisis in the 80s. That experience 00:00:52.020 --> 00:00:54.840 seems absolutely central. Definitely. And then 00:00:54.840 --> 00:00:56.679 we'll see how that leads him into advocating 00:00:56.679 --> 00:00:59.359 against health fraud, tackling pseudoscience, 00:00:59.380 --> 00:01:01.439 even within universities and government policy. 00:01:01.560 --> 00:01:03.929 It's quite the story arc. And I think the key 00:01:03.929 --> 00:01:05.650 question running through it all, the thing we 00:01:05.650 --> 00:01:08.469 really need to figure out, is how managing a 00:01:08.469 --> 00:01:12.670 massive public health crisis like HIV AIDS, how 00:01:12.670 --> 00:01:15.560 did that shape his conviction? His conviction 00:01:15.560 --> 00:01:18.879 that you absolutely need both solid, rigorous 00:01:18.879 --> 00:01:21.959 evidence and a respect for human rights to build 00:01:21.959 --> 00:01:24.819 any kind of effective health system. Precisely. 00:01:24.819 --> 00:01:26.640 That seems to be the thread connecting everything, 00:01:26.739 --> 00:01:28.959 doesn't it? From the hospital wards to the halls 00:01:28.959 --> 00:01:31.400 of parliament, decades later. Okay, so let's 00:01:31.400 --> 00:01:32.859 lay the groundwork. Where did this all start? 00:01:33.060 --> 00:01:35.700 He was born in Melbourne, 1939, but his medical 00:01:35.700 --> 00:01:37.719 journey kicked off in Sydney. Yeah, University 00:01:37.719 --> 00:01:40.920 of Sydney, got his medical degree, the MB. BS 00:01:40.920 --> 00:01:44.200 back in 1964. Standard path initially. But he 00:01:44.200 --> 00:01:46.079 didn't just stop there, did he? He pushed on 00:01:46.079 --> 00:01:48.439 pretty quickly towards specialization. No, definitely 00:01:48.439 --> 00:01:51.340 driven. By 1968, he'd earned his fellowship of 00:01:51.340 --> 00:01:53.439 the Royal Australasian College of Physicians, 00:01:53.540 --> 00:01:56.879 the FRACP. Which, for listeners, means he's gone 00:01:56.879 --> 00:01:59.540 through significant extra training, passed tough 00:01:59.540 --> 00:02:02.819 exams. He's a specialist physician now, operating 00:02:02.819 --> 00:02:05.219 at a high level already. Right. But then comes 00:02:05.219 --> 00:02:08.389 this. Well, this fork in the road. While he was 00:02:08.389 --> 00:02:10.710 doing his residency work at St. Vincent's Hospital, 00:02:10.889 --> 00:02:13.449 he landed a scholarship. From the Australian 00:02:13.449 --> 00:02:15.909 Asthma Foundation. And this seems to be the moment, 00:02:16.030 --> 00:02:18.990 just one year of research at the Garvin Institute. 00:02:19.409 --> 00:02:21.750 Yeah, it was maybe just meant to supplement his 00:02:21.750 --> 00:02:24.009 clinical work, but it completely changed his 00:02:24.009 --> 00:02:26.469 direction. It sort of hooked him. Hooked him 00:02:26.469 --> 00:02:28.689 on research. Exactly. It seems he realized that 00:02:28.689 --> 00:02:31.870 understanding why the fundamental mechanisms 00:02:31.870 --> 00:02:34.590 of disease was where he could make the biggest 00:02:34.590 --> 00:02:37.169 difference, not just treating symptoms. So that 00:02:37.169 --> 00:02:39.629 led him away from a purely clinical path. Pretty 00:02:39.629 --> 00:02:42.219 much. He moved into academic research, ended 00:02:42.219 --> 00:02:44.340 up at the Walter and Eliza Hall Institute in 00:02:44.340 --> 00:02:47.500 Melbourne in 69, really digging into immunology. 00:02:47.699 --> 00:02:50.139 And that led to his PhD. Yep. Finished in 72, 00:02:50.360 --> 00:02:52.580 University of Melbourne. Clinical immunology 00:02:52.580 --> 00:02:55.719 and the thesis title. It's quite telling, isn't 00:02:55.719 --> 00:02:58.159 it? Cellular interactions with antigens in the 00:02:58.159 --> 00:03:01.099 immune response. It sounds incredibly fundamental. 00:03:01.580 --> 00:03:03.560 It is. He wasn't just looking at treatments. 00:03:03.659 --> 00:03:06.370 He was down at the cellular level. figuring out 00:03:06.370 --> 00:03:08.689 how the body's defense system actually works, 00:03:08.830 --> 00:03:11.750 how it recognizes threats. And you can see how 00:03:11.750 --> 00:03:14.150 that deep fundamental knowledge would become 00:03:14.150 --> 00:03:16.909 his benchmark later on, right? Absolutely. If 00:03:16.909 --> 00:03:18.590 you're going to claim something affects the immune 00:03:18.590 --> 00:03:21.210 system, you'd better have evidence that stacks 00:03:21.210 --> 00:03:23.270 up against that level of understanding. Yeah. 00:03:23.349 --> 00:03:26.090 It kind of baked in an intolerance for claims 00:03:26.090 --> 00:03:29.229 without solid data. That scientific grounding 00:03:29.229 --> 00:03:32.490 then catapulted him overseas to the U .S. Yeah, 00:03:32.530 --> 00:03:35.969 the American phase. A scholarship to Yale. And 00:03:35.969 --> 00:03:37.770 he didn't just pop over for a year. He stayed 00:03:37.770 --> 00:03:40.689 for 14 years, a really significant chunk of his 00:03:40.689 --> 00:03:43.259 career. And it wasn't just any posting. He got 00:03:43.259 --> 00:03:45.500 major recognition, didn't he? Oh, definitely. 00:03:46.139 --> 00:03:48.099 Support from the Howard Hughes Medical Institute 00:03:48.099 --> 00:03:51.219 pretty early on in 73. That's a huge deal. And 00:03:51.219 --> 00:03:53.259 consistent funding from the NIH, the National 00:03:53.259 --> 00:03:55.340 Institutes of Health. These are the big players 00:03:55.340 --> 00:03:58.060 in U .S. medical research funding. They back 00:03:58.060 --> 00:03:59.819 people they think are going to lead the field. 00:03:59.979 --> 00:04:03.080 And he did. Climbed the academic ladder at Yale, 00:04:03.240 --> 00:04:05.680 became professor of medicine and pediatrics. 00:04:06.159 --> 00:04:08.419 And he headed up clinical immunology there for 00:04:08.419 --> 00:04:11.479 seven years. That's right. So by the early 80s, 00:04:11.479 --> 00:04:14.319 he's established himself as a, well, a global 00:04:14.319 --> 00:04:17.300 authority in his field, based at a top institution 00:04:17.300 --> 00:04:20.240 backed by serious funding. And that's right when 00:04:20.240 --> 00:04:21.959 the world is about to face something completely 00:04:21.959 --> 00:04:24.240 unprecedented. Yeah, this is where his academic 00:04:24.240 --> 00:04:27.180 expertise crashes headfirst into a terrifying 00:04:27.180 --> 00:04:30.279 reality. His time leading immunology at Yale. 00:04:31.079 --> 00:04:33.800 It lines up perfectly with the emergence of AIDS. 00:04:34.019 --> 00:04:36.959 The early 80s. Just think about it. Total mystery, 00:04:37.139 --> 00:04:41.560 fear, panic, stigma. And he's right there at 00:04:41.560 --> 00:04:43.860 the epicenter in the U .S. He wasn't just observing. 00:04:43.879 --> 00:04:46.319 He was actively involved from the very beginning, 00:04:46.439 --> 00:04:49.620 trying to understand this new disease. And not 00:04:49.620 --> 00:04:51.579 just treating patients, though he did that too. 00:04:51.720 --> 00:04:54.000 His research background was crucial. He was digging 00:04:54.000 --> 00:04:56.040 into the mechanism. How was this virus actually 00:04:56.040 --> 00:04:58.439 destroying the immune system? The source material 00:04:58.439 --> 00:05:01.500 mentions his work on T8 cells specifically. Right. 00:05:01.560 --> 00:05:03.500 T cells are like the generals of your immune 00:05:03.500 --> 00:05:07.759 army. T8 cells, or cytotoxic T cells, are the 00:05:07.759 --> 00:05:09.879 specialized soldiers that kill infected cells. 00:05:10.500 --> 00:05:13.540 Understanding how HIV disrupted them was critical 00:05:13.540 --> 00:05:15.399 to figuring out why the immune system collapsed 00:05:15.399 --> 00:05:18.110 so catastrophically. So... You really needed 00:05:18.110 --> 00:05:20.310 an immunologist like him with that deep cellular 00:05:20.310 --> 00:05:23.269 understanding on the front lines. You absolutely 00:05:23.269 --> 00:05:26.250 did. His work provided some of those early vital 00:05:26.250 --> 00:05:28.889 clues about how the virus worked. But the need 00:05:28.889 --> 00:05:31.230 wasn't just scientific, was it? No, the human 00:05:31.230 --> 00:05:34.230 crisis was escalating. And in 1985, he comes 00:05:34.230 --> 00:05:36.350 back to Australia. Bringing all that frontline 00:05:36.350 --> 00:05:38.810 Yale experience with him, right when Australia 00:05:38.810 --> 00:05:41.290 was grappling with its own rising fear and uncertainty 00:05:41.290 --> 00:05:44.209 about AIDS. And he steps into massive roles, 00:05:44.389 --> 00:05:47.189 not just one job, but several key leadership 00:05:47.189 --> 00:05:49.930 positions at once. It's quite something. Professor 00:05:49.930 --> 00:05:51.790 of medicine and head of the medical school at 00:05:51.790 --> 00:05:55.129 UNSW. Plus, director of medicine at the big teaching 00:05:55.129 --> 00:05:57.610 hospital complex, Prince Henry and Prince of 00:05:57.610 --> 00:06:00.339 Wales. So he's leading medical education and 00:06:00.339 --> 00:06:02.699 overseeing clinical care for a huge part of Sydney. 00:06:02.920 --> 00:06:06.180 Yeah. Talk about pressure. And inevitably, HIV 00:06:06.180 --> 00:06:08.399 AIDS remained his immediate focus back in Australia. 00:06:08.720 --> 00:06:12.060 He was central in getting the early antiretroviral 00:06:12.060 --> 00:06:14.949 drugs into use here. But the job quickly became 00:06:14.949 --> 00:06:16.889 about more than just medicine, didn't it? The 00:06:16.889 --> 00:06:19.810 fear, the panic. Oh, the moral panic was overwhelming. 00:06:20.089 --> 00:06:21.870 That's why his role on the National Advisory 00:06:21.870 --> 00:06:24.529 Committee on AIDS, Nick AIDS from 87, was so 00:06:24.529 --> 00:06:27.089 important and so difficult. Because they were 00:06:27.089 --> 00:06:29.149 recommending policies based on public health 00:06:29.149 --> 00:06:31.689 evidence, but those policies flew in the face 00:06:31.689 --> 00:06:34.589 of public fear. Exactly. Things like needle and 00:06:34.589 --> 00:06:37.829 syringe exchange programs, even in prisons. and 00:06:37.829 --> 00:06:41.009 arguing against segregating HID -positive prisoners. 00:06:41.290 --> 00:06:43.589 Why were those things so controversial? Because 00:06:43.589 --> 00:06:45.509 the public health logic, engage with reality, 00:06:45.810 --> 00:06:48.810 reduce harm, prevent transmission, clashed with 00:06:48.810 --> 00:06:51.689 the desire to punish or isolate. Segregating 00:06:51.689 --> 00:06:53.670 prisoners, for instance, sounds tough, but it 00:06:53.670 --> 00:06:56.009 drives the problem underground, increases risk. 00:06:56.250 --> 00:06:58.550 Same with clean needles. And the government didn't 00:06:58.550 --> 00:07:00.670 adopt those recommendations at the time. No. 00:07:00.910 --> 00:07:04.149 Too politically unpopular. Too much fear, not 00:07:04.149 --> 00:07:06.750 enough focus on evidence or, frankly, human rights. 00:07:07.009 --> 00:07:10.069 And this is where Dwyer's core principle really 00:07:10.069 --> 00:07:12.629 solidified. Which was? That effective public 00:07:12.629 --> 00:07:15.730 health policy cannot be driven by fear or moral 00:07:15.730 --> 00:07:18.759 judgment. It has to be grounded in evidence and 00:07:18.759 --> 00:07:21.300 respect the rights of the people affected. Otherwise, 00:07:21.360 --> 00:07:23.639 you alienate them and you lose control of the 00:07:23.639 --> 00:07:25.879 epidemic. It just doesn't work. That principle 00:07:25.879 --> 00:07:28.620 got tested in a very public, very painful way, 00:07:28.740 --> 00:07:31.620 didn't it? The Charlene Spiteri case in 1989. 00:07:32.120 --> 00:07:34.509 Oh, that's a powerful story. He was advising 00:07:34.509 --> 00:07:36.889 the NSW health minister, Peter Collins, at the 00:07:36.889 --> 00:07:39.750 time. And Spiteri, an HIV -positive sex worker, 00:07:39.930 --> 00:07:42.129 was forcibly detained by the government. Yes, 00:07:42.189 --> 00:07:44.629 despite Dwyer and others arguing strongly against 00:07:44.629 --> 00:07:47.050 it. It was driven by media frenzy and public 00:07:47.050 --> 00:07:49.230 pressure. The minister apparently felt he just 00:07:49.230 --> 00:07:51.649 had to be seen to be being tough. So politics 00:07:51.649 --> 00:07:54.329 trumps the medical and ethical advice. Completely. 00:07:54.629 --> 00:07:57.670 And the awful irony for Dwyer. He was the senior 00:07:57.670 --> 00:07:59.689 doctor whose unit was actually forced to hold 00:07:59.689 --> 00:08:02.449 her. In a locked room. Against his professional 00:08:02.449 --> 00:08:05.089 judgment. Against his ethical stance. Turning 00:08:05.089 --> 00:08:07.769 his medical ward into a temporary prison cell, 00:08:07.889 --> 00:08:10.370 essentially. Pretty much. And it blew up nationally, 00:08:10.610 --> 00:08:13.529 featured on 60 Minutes. Imagine the impact that 00:08:13.529 --> 00:08:15.829 had on him. It showed him in the starkest possible 00:08:15.829 --> 00:08:19.290 terms that leadership in health meant fighting 00:08:19.290 --> 00:08:22.569 political battles. Dealing with raw public emotion, 00:08:22.910 --> 00:08:25.310 not just science. You can see how that experience 00:08:25.310 --> 00:08:28.680 would... Well, change someone, harden their resolve, 00:08:28.860 --> 00:08:30.720 perhaps. I think it had to be transformative. 00:08:30.759 --> 00:08:33.899 Being forced to implement a policy you know is 00:08:33.899 --> 00:08:36.659 wrong and counterproductive. But even amidst 00:08:36.659 --> 00:08:39.139 all that local turmoil, his commitment to fighting 00:08:39.139 --> 00:08:42.029 AIDS globally continued. He founded the AIDS 00:08:42.029 --> 00:08:45.149 Society of Asia and the Pacific. Yes, ASAP. And 00:08:45.149 --> 00:08:47.789 that organization is still going strong, running 00:08:47.789 --> 00:08:50.289 major international conferences, ICAP, across 00:08:50.289 --> 00:08:52.809 the region. It shows this incredible capacity 00:08:52.809 --> 00:08:55.330 to act on multiple fronts, even under intense 00:08:55.330 --> 00:08:58.700 pressure. So after decades at the forefront of 00:08:58.700 --> 00:09:00.860 clinical medicine and research, including that 00:09:00.860 --> 00:09:03.600 intense period with AIDS, he retires from full 00:09:03.600 --> 00:09:06.200 -time teaching in 2006, becomes emeritus professor 00:09:06.200 --> 00:09:09.000 at UNSW. But retirement for him didn't mean, 00:09:09.039 --> 00:09:11.519 you know, slowing down. It really marked a shift, 00:09:11.679 --> 00:09:16.179 a pivot. From academic leader to... What? Full 00:09:16.179 --> 00:09:18.740 -time advocate. Pretty much. His focus became 00:09:18.740 --> 00:09:22.000 much broader championing evidence -based medicine 00:09:22.000 --> 00:09:25.100 across the entire system and pushing for major 00:09:25.100 --> 00:09:27.299 structural reform. And he had this quote about 00:09:27.299 --> 00:09:29.779 why he felt compelled to do this. Yeah, it's 00:09:29.779 --> 00:09:32.639 very telling. He said, as a doctor, I know that 00:09:32.639 --> 00:09:35.340 even the most intelligent of us, faced with a 00:09:35.340 --> 00:09:37.919 life -threatening situation, may suspend our 00:09:37.919 --> 00:09:40.440 normal good judgment and be easily exploited. 00:09:41.000 --> 00:09:43.580 So he saw a need to protect people not just from 00:09:43.580 --> 00:09:46.620 disease, but from systemic failures and exploitation. 00:09:47.080 --> 00:09:50.190 Exactly. He saw the vulnerability. And he turned 00:09:50.190 --> 00:09:52.350 his attention squarely onto the structure of 00:09:52.350 --> 00:09:54.730 Australian primary care. He was deeply critical 00:09:54.730 --> 00:09:57.210 of it. What was his main criticism? Fundamentally, 00:09:57.210 --> 00:09:59.450 that it was set up to treat sickness after it 00:09:59.450 --> 00:10:01.549 happened rather than keeping people well. It 00:10:01.549 --> 00:10:04.250 lacked the focus, the investment in preventative 00:10:04.250 --> 00:10:07.029 strategies, especially for chronic lifestyle 00:10:07.029 --> 00:10:09.070 -related diseases which were just exploding. 00:10:09.289 --> 00:10:11.230 And that failure in primary care had knock -on 00:10:11.230 --> 00:10:13.210 effects. Massive ones. He talked about his own 00:10:13.210 --> 00:10:15.570 hospital, Prince of Wales, having to turn ambulances 00:10:15.570 --> 00:10:17.529 away because the emergency department was constantly 00:10:17.529 --> 00:10:20.720 choked. Why? What was filling up the ED? Often, 00:10:20.799 --> 00:10:23.559 problems that should have been managed much earlier 00:10:23.559 --> 00:10:26.159 in the community. Patients who couldn't get a 00:10:26.159 --> 00:10:28.399 nursing home bed, people who couldn't afford 00:10:28.399 --> 00:10:32.740 ongoing GP visits. The hospital became the disastrously 00:10:32.740 --> 00:10:35.840 expensive safety net for a failing primary system. 00:10:36.059 --> 00:10:37.720 It sounds like a system under incredible strain. 00:10:37.860 --> 00:10:40.259 So what was his proposed solution? He championed 00:10:40.259 --> 00:10:42.220 this idea called the medical home. What does 00:10:42.220 --> 00:10:44.320 that involve? It's about moving away from the 00:10:44.320 --> 00:10:47.379 solo GP model towards multidisciplinary teams. 00:10:47.980 --> 00:10:50.600 Doctors, nurses, allied health professionals, 00:10:50.799 --> 00:10:53.559 mental health experts, all working together in 00:10:53.559 --> 00:10:56.000 primary care settings. And the focus shifts. 00:10:56.320 --> 00:10:58.779 Completely. The focus becomes proactive, keeping 00:10:58.779 --> 00:11:01.259 communities healthy, managing chronic conditions 00:11:01.259 --> 00:11:04.000 effectively before they become acute crises that 00:11:04.000 --> 00:11:06.139 land people in hospital. investing upstream, 00:11:06.419 --> 00:11:08.960 basically. It makes logical sense, preventative 00:11:08.960 --> 00:11:11.440 care to reduce the burden on expensive acute 00:11:11.440 --> 00:11:13.620 care. Exactly. It echoes his AIDS experience, 00:11:13.779 --> 00:11:16.080 too, doesn't it? You need a population -focused, 00:11:16.200 --> 00:11:19.139 proactive strategy, not just reactive treatment. 00:11:19.379 --> 00:11:22.240 But changing a whole system like that, that requires 00:11:22.240 --> 00:11:25.460 serious political will. And that's what he realized 00:11:25.460 --> 00:11:28.679 was missing. Around 2003, the federal and state 00:11:28.679 --> 00:11:30.480 governments were locked in negotiations about 00:11:30.480 --> 00:11:32.960 health funding. But what were they arguing about? 00:11:33.200 --> 00:11:36.559 Hospital beds. Budgets. Pretty much just hospitals. 00:11:36.700 --> 00:11:39.019 They were completely ignoring how hospitals depend 00:11:39.019 --> 00:11:41.840 on everything else. Prevention, primary care, 00:11:42.080 --> 00:11:45.200 mental health, aged care, indigenous health. 00:11:45.519 --> 00:11:48.700 It was all siloed. So he saw a need to force 00:11:48.700 --> 00:11:51.620 a broader conversation. Precisely. That's why 00:11:51.620 --> 00:11:53.639 he founded the Australian Healthcare Reform Alliance, 00:11:53.919 --> 00:11:58.039 AHCRA, in 2003. What was the goal of AHCRA? To 00:11:58.039 --> 00:12:00.419 create a unified voice, to bring together all 00:12:00.419 --> 00:12:02.519 the disparate groups who knew the system needed 00:12:02.519 --> 00:12:05.379 fundamental change but weren't being heard individually. 00:12:06.220 --> 00:12:08.600 to coordinate their message and put real informed 00:12:08.600 --> 00:12:10.899 pressure on the politicians. And who was involved 00:12:10.899 --> 00:12:12.820 in this alliance? It wasn't just doctors, was 00:12:12.820 --> 00:12:15.120 it? No, that was the key. It was broad. The Australian 00:12:15.120 --> 00:12:17.659 Medical Association, yes, but also the Nursing 00:12:17.659 --> 00:12:20.559 Federation, Catholic Health Australia, the deans 00:12:20.559 --> 00:12:22.700 of all the medical schools, specialist colleges, 00:12:23.039 --> 00:12:26.009 consumer groups. a really powerful coalition. 00:12:26.230 --> 00:12:28.470 So they could speak with one very loud voice 00:12:28.470 --> 00:12:31.250 on the need for reform. And it worked pretty 00:12:31.250 --> 00:12:34.730 quickly. AHCRA became recognized as a, quote, 00:12:34.789 --> 00:12:38.350 powerful force. Government had to listen. They 00:12:38.350 --> 00:12:40.269 were pushing for those fundamental changes to 00:12:40.269 --> 00:12:42.610 structure and funding, pushing towards that more 00:12:42.610 --> 00:12:45.769 integrated, preventative medical home model. 00:12:46.059 --> 00:12:48.759 OK, so he's tackled the big structural issues 00:12:48.759 --> 00:12:51.759 in the mainstream system with AHCRA, but then 00:12:51.759 --> 00:12:54.539 he turns his attention outwards towards practices 00:12:54.539 --> 00:12:56.940 outside conventional medicine. Yeah, towards 00:12:56.940 --> 00:12:59.120 what he saw as a rising tide of health fraud, 00:12:59.320 --> 00:13:03.139 dodgy cures and pseudoscience. This led to him 00:13:03.139 --> 00:13:05.159 chairing a key committee in New South Wales back 00:13:05.159 --> 00:13:07.779 in 2002. The Health Care Complaints and Consumer 00:13:07.779 --> 00:13:10.809 Protection Advisory Committee. Quite a mouthful. 00:13:10.909 --> 00:13:12.570 Informally known as the Quack Watch Committee, 00:13:12.750 --> 00:13:14.730 which tells you pretty much what its focus was. 00:13:14.970 --> 00:13:16.730 Tightening the rules around wonder drugs and 00:13:16.730 --> 00:13:19.610 miracle cures. Exactly. But what they found wasn't 00:13:19.610 --> 00:13:22.950 just a few bad apples. It was systemic. The regulations, 00:13:23.190 --> 00:13:25.710 the enforcement. They just weren't strong enough 00:13:25.710 --> 00:13:27.649 to protect people. What were some of the specific 00:13:27.649 --> 00:13:30.509 problems they identified? Well, first, the medical 00:13:30.509 --> 00:13:33.529 boards often lacked the teeth, the power, or 00:13:33.529 --> 00:13:36.620 maybe the will. to really clamp down on practitioners 00:13:36.620 --> 00:13:38.879 promoting stuff that just didn't work. Okay, 00:13:38.940 --> 00:13:41.779 what else? Advertising was a huge one. Claims 00:13:41.779 --> 00:13:43.919 being made that had, as they put it, no basis 00:13:43.919 --> 00:13:47.059 in reality. And the voluntary codes of conduct 00:13:47.059 --> 00:13:49.860 that industries often rely on. Totally ineffective. 00:13:50.320 --> 00:13:52.840 Basically useless. So self -regulation wasn't 00:13:52.840 --> 00:13:55.179 working. Not at all. Then there was the issue 00:13:55.179 --> 00:13:57.600 of training. Among alternative practitioners, 00:13:57.759 --> 00:13:59.600 there was often a complete lack of standardized 00:13:59.600 --> 00:14:02.840 training or advice. Consumers were left incredibly 00:14:02.840 --> 00:14:05.399 vulnerable. without the basic protections you'd 00:14:05.399 --> 00:14:08.100 expect. And the penalties for fraud. Often trivial. 00:14:08.519 --> 00:14:10.600 Fines so small they were just the cost of doing 00:14:10.600 --> 00:14:12.919 business, not a real deterrent. And what about 00:14:12.919 --> 00:14:16.100 the official government watchdog, the TGA, the 00:14:16.100 --> 00:14:18.580 Therapeutic Goods Administration? They found 00:14:18.580 --> 00:14:21.460 the TGA was seriously under -resourced. It just 00:14:21.460 --> 00:14:23.379 didn't have the capacity to be the effective 00:14:23.379 --> 00:14:26.399 watchdog it needed to be. Which, again, creates 00:14:26.399 --> 00:14:28.419 a low -risk environment for people selling dodgy 00:14:28.419 --> 00:14:30.700 products. So the overall picture was pretty grim. 00:14:31.240 --> 00:14:33.840 Lack of power, poor advertising standards, inconsistent 00:14:33.840 --> 00:14:36.960 training, weak penalties, under -resourced regulator. 00:14:37.299 --> 00:14:40.100 Yeah, a perfect storm, really. And their key 00:14:40.100 --> 00:14:42.620 recommendation was about coordination, getting 00:14:42.620 --> 00:14:45.080 all the different agencies, federal, state, consumer 00:14:45.080 --> 00:14:48.000 protection, health complaints, TGA, to actually 00:14:48.000 --> 00:14:50.840 work together. Stop the fraudsters falling through 00:14:50.840 --> 00:14:53.179 the cracks between jurisdictions. This concern 00:14:53.179 --> 00:14:55.419 about weak regulation then feeds into another 00:14:55.419 --> 00:14:59.360 big issue for him, public money. Yes. He became 00:14:59.360 --> 00:15:02.000 very focused, almost relentless, on the issue 00:15:02.000 --> 00:15:05.500 of public funds effectively subsidizing unproven 00:15:05.500 --> 00:15:08.600 therapies, particularly through tax rebates for 00:15:08.600 --> 00:15:10.879 private health insurance extras. Why was that 00:15:10.879 --> 00:15:13.080 such a big deal? Because taxpayer money was going 00:15:13.080 --> 00:15:15.370 towards things that didn't work. And the scale 00:15:15.370 --> 00:15:17.870 of it was shocking. He highlighted data showing 00:15:17.870 --> 00:15:20.970 that between 2005 and 2015, the amount paid out 00:15:20.970 --> 00:15:23.210 by private insurers for natural therapies jumped 00:15:23.210 --> 00:15:26.009 by something like 345 percent. Wow. So public 00:15:26.009 --> 00:15:28.730 policy was actually driving growth in this sector. 00:15:28.950 --> 00:15:30.929 That was his argument. He was inadvertently propping 00:15:30.929 --> 00:15:33.230 it up. Homeopathy was the classic example. Right. 00:15:33.289 --> 00:15:35.889 The NHMRC, the National Health and Medical Research 00:15:35.889 --> 00:15:38.450 Council, did that big review. Yeah. A massive, 00:15:38.570 --> 00:15:41.830 comprehensive review of all the evidence worldwide. 00:15:42.470 --> 00:15:46.610 And the conclusion was. Unequivocal. Homeopathy 00:15:46.610 --> 00:15:48.990 is no more effective than a placebo. There's 00:15:48.990 --> 00:15:51.129 just no reliable scientific evidence it works 00:15:51.129 --> 00:15:54.370 for any condition. So Dwyer's response was? Logical. 00:15:54.370 --> 00:15:56.389 If it doesn't work, why are we subsidizing it? 00:15:56.409 --> 00:15:58.570 Stop the government financial support. Stop the 00:15:58.570 --> 00:16:00.769 private health insurance rebates for it. Public 00:16:00.769 --> 00:16:03.190 money should fund things that are proven to be 00:16:03.190 --> 00:16:05.409 effective. Now, it's important to clarify here, 00:16:05.509 --> 00:16:09.080 he wasn't necessarily anti -all. alternative 00:16:09.080 --> 00:16:11.940 or complementary therapies, was he? No, not inherently. 00:16:12.100 --> 00:16:14.919 His position was nuanced. He advocated for integrating 00:16:14.919 --> 00:16:17.820 orthodox medicine with other approaches if, and 00:16:17.820 --> 00:16:20.470 only if, Those other approaches had solid evidence 00:16:20.470 --> 00:16:22.809 behind them. So evidence was the key criteria. 00:16:23.070 --> 00:16:24.970 Always. He talked about wanting a converging 00:16:24.970 --> 00:16:27.649 pathway, taking the best evidence -based elements 00:16:27.649 --> 00:16:29.629 from different approaches, maybe mindfulness, 00:16:29.870 --> 00:16:32.269 specific exercises, certain nutritional advice 00:16:32.269 --> 00:16:34.830 backed by data, and incorporating them into unified 00:16:34.830 --> 00:16:37.169 treatment plans, not keeping them as separate, 00:16:37.269 --> 00:16:40.149 often conflicting systems. Okay, so he's identified 00:16:40.149 --> 00:16:44.129 these deep systemic issues in policy, in regulation, 00:16:44.470 --> 00:16:47.509 in funding. It seems like the next logical step 00:16:47.509 --> 00:16:50.419 was to create a dedicated group to keep fighting 00:16:50.419 --> 00:16:52.759 for that evidence -based approach. Exactly. In 00:16:52.759 --> 00:16:55.659 2011, he was a key figure in founding Friends 00:16:55.659 --> 00:16:58.919 of Science and Medicine, or FSM. He brought together 00:16:58.919 --> 00:17:01.620 this group of prominent Australian doctors, scientists, 00:17:01.860 --> 00:17:04.339 researchers. He was their first president, stayed 00:17:04.339 --> 00:17:06.920 in that role until 2019. And their mission was 00:17:06.920 --> 00:17:08.920 pretty straightforward, wasn't it? Crystal clear. 00:17:09.380 --> 00:17:12.390 Their mission statement says it all. To emphasize 00:17:12.390 --> 00:17:14.289 the importance of having health care in Australia 00:17:14.289 --> 00:17:17.089 based upon evidence, scientifically sound research, 00:17:17.309 --> 00:17:19.670 and established scientific knowledge. It's a 00:17:19.670 --> 00:17:21.750 direct defense of the scientific method in health. 00:17:21.930 --> 00:17:24.309 And did FSM gain much traction? Oh, absolutely. 00:17:24.490 --> 00:17:27.289 Within a few years, they had over 1 ,000 supporters. 00:17:27.670 --> 00:17:29.529 And these weren't just anyone. They included 00:17:29.529 --> 00:17:31.549 Nobel Prize winners, several Australians of the 00:17:31.549 --> 00:17:34.450 year, really high -profile, credible figures. 00:17:34.630 --> 00:17:37.150 That gave them significant clout. Where did they 00:17:37.150 --> 00:17:39.089 focus their efforts initially? What was the main 00:17:39.089 --> 00:17:41.890 battleground? One of the biggest. and maybe most 00:17:41.890 --> 00:17:44.910 controversial, was academia, the universities 00:17:44.910 --> 00:17:48.289 themselves. Why universities? Dwyer and FSM were 00:17:48.289 --> 00:17:50.890 deeply concerned about universities offering 00:17:50.890 --> 00:17:54.109 courses in things like naturopathy, homeopathy, 00:17:54.250 --> 00:17:57.190 traditional Chinese medicine, and teaching them 00:17:57.190 --> 00:17:59.309 as if they were science -based health degrees. 00:18:00.000 --> 00:18:02.119 often under the banner of health science. What 00:18:02.119 --> 00:18:04.599 was the problem with that in their view? Several 00:18:04.599 --> 00:18:06.720 things. They argued it was a misuse of public 00:18:06.720 --> 00:18:08.880 funds, that it lowered the academic standards 00:18:08.880 --> 00:18:11.200 and reputation of the university, and critically, 00:18:11.400 --> 00:18:14.220 that it gave these practices a veneer of legitimacy 00:18:14.220 --> 00:18:16.980 they hadn't earned through evidence. It misled 00:18:16.980 --> 00:18:19.559 students and the public. And this ties into the 00:18:19.559 --> 00:18:21.880 issue of professional registration too, right? 00:18:21.980 --> 00:18:24.279 Yes, that was a crucial point. In Australia, 00:18:24.319 --> 00:18:26.359 many alternative practitioners are registered 00:18:26.359 --> 00:18:29.460 under the National Scheme, AHPRA. That's the 00:18:29.460 --> 00:18:31.819 same body that registers your doctor, your dentist, 00:18:31.980 --> 00:18:35.200 your nurse. So for the public, seeing that registration 00:18:35.200 --> 00:18:38.980 implies a certain standard? Precisely. It gives 00:18:38.980 --> 00:18:41.200 an appearance of respectability, as Dwyer put 00:18:41.200 --> 00:18:44.180 it. But the catch is, for many of these alternative 00:18:44.180 --> 00:18:46.940 fields, the registration requirements are different. 00:18:47.460 --> 00:18:50.859 Because they're deemed low risk, the focus is 00:18:50.859 --> 00:18:53.700 more on basic safety standards, maybe insurance. 00:18:54.240 --> 00:18:56.940 rather than demanding rigorous proof that their 00:18:56.940 --> 00:18:59.519 core therapies actually work. So registration 00:18:59.519 --> 00:19:02.619 without proven efficacy. That was the concern. 00:19:02.740 --> 00:19:05.759 It grants credibility without necessarily guaranteeing 00:19:05.759 --> 00:19:08.220 effectiveness based on scientific evidence. Did 00:19:08.220 --> 00:19:11.160 FSM get involved in specific university disputes 00:19:11.160 --> 00:19:14.380 over this? Oh, yes. There was a well -publicized 00:19:14.380 --> 00:19:17.519 instance where they organized about 34 prominent 00:19:17.519 --> 00:19:20.660 Australians to write an open letter to Central 00:19:20.660 --> 00:19:22.960 Queensland University. What was the issue there? 00:19:23.390 --> 00:19:26.069 CQU was planning to expand its offerings in alternative 00:19:26.069 --> 00:19:28.970 medicine, presenting them as science. The letter 00:19:28.970 --> 00:19:31.009 argued this would diminish the academic reputation 00:19:31.009 --> 00:19:33.710 and give credibility to pseudoscience. It was 00:19:33.710 --> 00:19:35.529 a direct challenge. So they weren't afraid to 00:19:35.529 --> 00:19:37.589 call out institutions directly. Did they also 00:19:37.589 --> 00:19:40.470 look at commercial interests? Definitely. Dwyer 00:19:40.470 --> 00:19:42.569 was quite critical of the pharmaceutical industry 00:19:42.569 --> 00:19:45.440 itself. especially the big companies that also 00:19:45.440 --> 00:19:48.579 sell homeopathic products or nutritional supplements 00:19:48.579 --> 00:19:51.339 alongside their evidence -based medicines. Why 00:19:51.339 --> 00:19:53.480 criticize that? Business is business, right? 00:19:53.700 --> 00:19:56.480 His point was about integrity and mixed messages. 00:19:56.799 --> 00:19:59.720 How can a company built on scientific research 00:19:59.720 --> 00:20:03.559 simultaneously profit from selling things that 00:20:03.559 --> 00:20:06.839 lack that same scientific basis? He suggested 00:20:06.839 --> 00:20:09.799 pretty bluntly that commercial reasons dominate 00:20:09.799 --> 00:20:12.079 those decisions, undermining their credibility. 00:20:12.970 --> 00:20:14.869 Next to that case with Ken Harvey at La Trobe 00:20:14.869 --> 00:20:17.289 University. That was another key moment FSM weighed 00:20:17.289 --> 00:20:19.930 in on. Ken Harvey, another strong advocate for 00:20:19.930 --> 00:20:22.109 evidence -based medicine, resigned from La Trobe. 00:20:22.170 --> 00:20:24.490 Why did he resign? He was protesting because 00:20:24.490 --> 00:20:27.730 a major vitamin company, Swiss, was funding a 00:20:27.730 --> 00:20:29.250 research center at the university specifically 00:20:29.250 --> 00:20:32.009 set up to study, well, Swiss's own products. 00:20:32.269 --> 00:20:34.450 The potential for conflict of interest seems 00:20:34.450 --> 00:20:37.609 pretty obvious there. Extremely. Dwyer and FSM 00:20:37.609 --> 00:20:40.799 publicly supported Harvey. They questioned why 00:20:40.799 --> 00:20:43.000 university resources were being used essentially 00:20:43.000 --> 00:20:46.779 to validate products for a commercial sponsor, 00:20:47.099 --> 00:20:49.640 potentially biasing the research outcomes, or 00:20:49.640 --> 00:20:52.220 at least the perception of them. It highlighted 00:20:52.220 --> 00:20:54.119 how these commercial pressures could compromise 00:20:54.119 --> 00:20:57.279 scientific integrity even within respected academic 00:20:57.279 --> 00:21:00.660 institutions. Given this incredibly active and, 00:21:00.700 --> 00:21:02.980 let's face it, often controversial career spanning 00:21:02.980 --> 00:21:05.819 decades, it's no surprise he received significant 00:21:05.819 --> 00:21:09.180 formal recognition. No, not at all. Back in 1991, 00:21:09.579 --> 00:21:11.579 he was made an officer of the Order of Australia, 00:21:11.700 --> 00:21:14.519 the OA. That's a very high honor. The citation 00:21:14.519 --> 00:21:16.619 specifically mentioned his service to public 00:21:16.619 --> 00:21:19.220 health, particularly around infectious diseases, 00:21:19.400 --> 00:21:21.579 obviously reflecting the AIDS work. And he holds 00:21:21.579 --> 00:21:24.440 the emeritus professor title at UNSW, and there's 00:21:24.440 --> 00:21:26.299 a lecture theater named after him at the Prince 00:21:26.299 --> 00:21:29.200 of Wales Hospital. Right. Plus his medical fellowships, 00:21:29.200 --> 00:21:32.039 FRACP in Australasia, and also a fellow of the 00:21:32.039 --> 00:21:34.579 Royal College of Physicians of Ireland. Standard 00:21:34.579 --> 00:21:36.759 high -level professional recognition. But there's 00:21:36.759 --> 00:21:38.759 another kind of recognition that perhaps captures 00:21:38.759 --> 00:21:40.940 the latter part of his career even better. You 00:21:40.940 --> 00:21:43.480 mean the Skeptic Awards? Exactly. Named Skeptic 00:21:43.480 --> 00:21:45.700 of the Year by the Australian skeptics way back 00:21:45.700 --> 00:21:49.180 in 2000, and then won it again jointly in 2012 00:21:49.180 --> 00:21:51.920 with the other founders of FSM. Yeah, that really 00:21:51.920 --> 00:21:54.099 highlights his role as a public intellectual, 00:21:54.460 --> 00:21:57.759 fighting for critical thinking, for rationality, 00:21:57.759 --> 00:21:59.819 not just within medicine, but in the public sphere 00:21:59.819 --> 00:22:02.049 generally. But as you said, when you take such 00:22:02.049 --> 00:22:05.269 a strong, often uncompromising stance, especially 00:22:05.269 --> 00:22:07.509 against things people believe in strongly or 00:22:07.509 --> 00:22:10.509 things that are commercially successful, you're 00:22:10.509 --> 00:22:13.230 going to attract criticism. Oh, absolutely. Controversy 00:22:13.230 --> 00:22:15.390 is almost guaranteed. And while the criticism 00:22:15.390 --> 00:22:18.349 was often aimed at FSM as an organization, it 00:22:18.349 --> 00:22:20.809 definitely reflected the friction Dwyer himself 00:22:20.809 --> 00:22:23.069 generated. Who were some of the critics? What 00:22:23.069 --> 00:22:25.140 were their arguments? Well, Karen Phelps, for 00:22:25.140 --> 00:22:26.779 example, she's a former president of the Australian 00:22:26.779 --> 00:22:29.079 Medical Association and also someone who's been 00:22:29.079 --> 00:22:31.059 quite supportive of integrating complementary 00:22:31.059 --> 00:22:34.799 therapies. She described FSM pretty sharply. 00:22:34.960 --> 00:22:38.519 What did she say? She called FSM an ultra -conservative 00:22:38.519 --> 00:22:41.259 group with an alarming and far -reaching agenda. 00:22:41.720 --> 00:22:44.359 They actually debated publicly about what level 00:22:44.359 --> 00:22:46.759 of evidence should be required before universities 00:22:46.759 --> 00:22:49.720 teach something or doctors recommend it. So a 00:22:49.720 --> 00:22:51.519 fundamental disagreement about the threshold 00:22:51.519 --> 00:22:54.579 for evidence. Exactly. Phelps seemed concerned 00:22:54.579 --> 00:22:58.960 that FSM's strict insistence on things like large 00:22:58.960 --> 00:23:02.200 randomized controlled trials might unfairly dismiss 00:23:02.200 --> 00:23:05.619 therapies that patients find helpful, even if 00:23:05.619 --> 00:23:08.299 they don't fit that specific evidence model neatly. 00:23:08.670 --> 00:23:10.690 She sort of painted them as wanting to shut down 00:23:10.690 --> 00:23:13.430 anything outside a narrow definition of science. 00:23:13.569 --> 00:23:15.670 Right, a clash of philosophies there. Was there 00:23:15.670 --> 00:23:17.789 pushback from the complementary medicine research 00:23:17.789 --> 00:23:21.150 community, too? Yes. John Wardle, who's a prominent 00:23:21.150 --> 00:23:23.250 figure in complementary and integrative medicine 00:23:23.250 --> 00:23:25.690 research in Australia, had a pretty memorable 00:23:25.690 --> 00:23:27.950 description of FSM. Which was? He called them 00:23:27.950 --> 00:23:30.089 the new poster child for CAM, complementary, 00:23:30.450 --> 00:23:32.630 and alternative medicine conspiracy theorists. 00:23:32.809 --> 00:23:34.910 Wow, that's strong language. What does that imply? 00:23:35.289 --> 00:23:37.869 It suggests that... From the perspective of some 00:23:37.869 --> 00:23:40.769 in the cam field, FSM wasn't just advocating 00:23:40.769 --> 00:23:43.190 for evidence but actively campaigning against 00:23:43.190 --> 00:23:46.109 them, perhaps unfairly, maybe driven by an inherent 00:23:46.109 --> 00:23:49.390 bias against anything non -Orthodox. It frames 00:23:49.390 --> 00:23:52.730 FSM as antagonists, as obstacles. So you have 00:23:52.730 --> 00:23:55.589 this real tension. FSM sees itself as defending 00:23:55.589 --> 00:23:58.210 scientific integrity, while some opponents see 00:23:58.210 --> 00:24:01.049 them as intolerant gatekeepers trying to delegitimize 00:24:01.049 --> 00:24:03.109 anything outside the mainstream. That's pretty 00:24:03.109 --> 00:24:05.069 much the core conflict, isn't it? His entire 00:24:05.069 --> 00:24:07.609 later career really was spent navigating that 00:24:07.609 --> 00:24:10.509 difficult line, constantly pushing for verifiable 00:24:10.509 --> 00:24:12.569 evidence, whether it was popular, politically 00:24:12.569 --> 00:24:14.890 convenient or commercially profitable or not. 00:24:15.089 --> 00:24:18.000 Hashtag tag outro. So looking back at John Dwyer's 00:24:18.000 --> 00:24:20.200 career, it's this remarkable journey, isn't it? 00:24:20.200 --> 00:24:22.660 From the intricate world of cellular immunology, 00:24:22.779 --> 00:24:25.180 fighting HIV in the lab and clinic. Yeah, where 00:24:25.180 --> 00:24:27.279 the science was literally life and death. Right 00:24:27.279 --> 00:24:30.660 through to these huge system level battles, fighting 00:24:30.660 --> 00:24:33.160 for structural reform and health care with HCRA. 00:24:33.259 --> 00:24:35.420 And then that very public fight against misinformation 00:24:35.420 --> 00:24:38.740 and pseudoscience with FSM. It's a lifelong commitment 00:24:38.740 --> 00:24:41.339 to evidence played out on vastly different scales. 00:24:41.579 --> 00:24:44.059 It really is. Yeah. And I think his career offers 00:24:44.059 --> 00:24:48.660 a kind of model. maybe, for how experts can engage 00:24:48.660 --> 00:24:51.079 publicly using that deep scientific authority, 00:24:51.299 --> 00:24:54.160 not just for research papers, but to provide 00:24:54.160 --> 00:24:57.119 moral and political leadership on really complex, 00:24:57.380 --> 00:25:01.000 messy issues. Like managing pandemics or deciding 00:25:01.000 --> 00:25:03.660 how health care should be funded or what should 00:25:03.660 --> 00:25:06.220 be taught in universities. Exactly. The common 00:25:06.220 --> 00:25:08.160 thread, the takeaway for you listening, has to 00:25:08.160 --> 00:25:11.200 be the absolute non -negotiable need for critical 00:25:11.200 --> 00:25:13.589 thinking in health. Whether you're facing a global 00:25:13.589 --> 00:25:16.230 virus or just trying to decide if a supplement 00:25:16.230 --> 00:25:19.549 claim stacks up, that rigorous questioning approach 00:25:19.549 --> 00:25:21.990 is vital. And throughout our discussion, we've 00:25:21.990 --> 00:25:24.049 seen these recurring vulnerabilities in the system, 00:25:24.150 --> 00:25:26.230 haven't we? We have. Financial pressures keep 00:25:26.230 --> 00:25:28.450 cropping up. Think about the insurance rebates 00:25:28.450 --> 00:25:30.829 potentially propping up unproven therapies. Or 00:25:30.829 --> 00:25:32.869 corporate sponsorship may be influencing research 00:25:32.869 --> 00:25:35.829 agendas at universities. Even our most trusted 00:25:35.829 --> 00:25:37.750 institutions aren't immune to these pressures. 00:25:38.029 --> 00:25:40.130 Which leaves us with a really important question 00:25:40.130 --> 00:25:43.339 to ponder, doesn't it? We rely on experts like 00:25:43.339 --> 00:25:45.920 Dwyer, on regulators, on universities to maintain 00:25:45.920 --> 00:25:48.759 standards. But what's our role in this? What 00:25:48.759 --> 00:25:51.539 role do we as citizens, as health consumers, 00:25:51.799 --> 00:25:54.240 have in demanding transparency and demanding 00:25:54.240 --> 00:25:57.019 evidence? That's the critical point. Where do 00:25:57.019 --> 00:25:59.579 we draw the line between respecting personal 00:25:59.579 --> 00:26:02.460 choice when it comes to health and upholding 00:26:02.460 --> 00:26:05.220 public safety or ensuring responsible use of 00:26:05.220 --> 00:26:07.980 public funds when those choices involve treatments 00:26:07.980 --> 00:26:10.740 lacking solid proof? It's a tough balance to 00:26:10.740 --> 00:26:12.380 strike. Definitely something to think about. 00:26:12.420 --> 00:26:13.900 Thank you for joining us for this deep dive.