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- This Sax Institute research award for impact
means a great deal to me,
because it draws attention to the work I've been doing,
and the message that I'd like to take to the public.
The message that they have the most power
to prevent their own stroke,
by adopting healthy lifestyle practices, healthy habits,
and using medication appropriately
for things like high blood pressure, high cholesterol,
and if they can stop smoking.
All those things that we know are healthy,
but the combined impact of doing that
is very effective in stroke prevention.
So my research over the last 20 years
has been focused on how to better improve stroke prevention.
In particular, associated with disease
of the carotid arteries.
So the carotid arteries are the main brain arteries.
We have one on each side of the neck,
and arterial disease often builds up.
If it's going to build up anywhere,
it often builds up at the beginning of those arteries.
So by the time people are about 80 years old,
about 10% of people will have significant narrowing
of the beginning of those arteries,
and we call that carotid stenosis.
And standard practice for decades now has been
to operate on that narrowing.
So make an incision in the neck,
go in and find the artery,
and take out the narrowing,
and stitch it back up again.
That surgery is called carotid endarterectomy.
That's been standard practice
to reduce the person's risk of stroke,
even if they've never had symptoms
in relation to that artery,
they've never had stroke symptoms before.
But my work is changing that
because I've shown that without surgery,
without procedures like stenting,
you can reduce your risk of stroke by at least 65%,
compared to how it was three decades ago,
by adopting healthy lifestyle habits
and using medication appropriately.
This means that we can do away with a lot of procedures.
We don't need to operate on carotid artery stenosis,
that is symptom-free anymore.
And we certainly don't need to stent it,
because stenting is even more dangerous than surgery.
So this is good news for the public,
because it means not only has stroke prevention
become more effective,
it's also become safer,
and it's also cheaper,
which is good for affordability of our health services.
My research has been changing practice,
so it wasn't good enough just to publish my results
in a journal in 2009,
which did happen,
which was a major achievement.
But that really had no impact.
Our impact has required new efforts,
different types of efforts to change practice.
And I've engaged a number of methods to change practice.
They've involved lobbying my peers.
They've even involved contacting the U.S. president
at one stage in 2011,
because in America there was a big push
for the government over there
to fund carotid artery stenting, for just about anyone.
Whether you'd had symptoms or no symptoms
associated with that narrowing.
And guidelines were being written to make these procedures,
surgery and stenting of the same.
And guidelines were being written without any regard
to improvements in medical treatment,
and it looked like America was going to go that way
and it would be very easy for anyone to have stenting,
let alone surgery on their asymptomatic,
symptom-free, carotid stenosis, when I knew that was wrong,
and it was completely the wrong way.
And if America went that way,
that would mean it's highly likely that other countries,
including Australia, would follow.
So the situation looked quite desperate,
because the whole movement was funded by industry,
and I just had my research results,
and no funding and no resources.
And in the end, I thought I'll contact the president,
and let him know about this situation.
And that led to contact with U.S. Medicare officials,
and that led to an invitation to present or testify
at their meeting in 2012,
when they were going to decide whether or not
they were going to fund widespread carotid stenting.
So I went there and presented my research results,
and also I published my advice to U.S. Medicare,
with 40 other opinion leaders from around the world.
So I had to mobilize people in a joint voice,
and we managed to prevent U.S. Medicare
from funding widespread carotid stenting over there.
And I'm sure that's not only had an impact there,
it's helped other countries decide what's best
and prevent spread of even more
useless and harmful procedures.
Well, it has been 20 years of effort,
and a lot of institutions have been involved.
And I'm very grateful that we actually have
independent research institutes around,
and that they continue.
And I hope that they continue to flourish,
they certainly need to be supported more,
so that we can do this sort of thing,
and improve standards of care.
So initially, there was the Aster Hospital,
and then there was the National Stroke Research Institute,
which is now part of the Florey Research Institute,
in Melbourne.
And then there was the Baker IDI Research Institute,
also in Melbourne.
And most recently there's been
the School of Public Health and Preventative Medicine,
at Monash University.
So without key support, at key times,
I wouldn't have been able to do this work
and see it used from proved standards of stroke prevention.
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