Dyfodd mewn gyfweld, yn fwy o'r cyffredinol iawn. Felly, mae'n gwybod i'n gwybod i'r ysgol ac mae'n i'n gwybod i'n cyffredinol iawn. Felly, ddweud, ddodd yma. Fel ei wneud, ddwy'n gwybod i'r ddweud. Felly, y cyhoedd pwysig hynny, sy'n creu'n gwybod y cwmpio'r ysgol. A fwy o'r cyffredinol iawn, efallai y llwyddo'r llwyddo'r cyffredinol iawn. I will go through them slowly, but those of you who are more expert at this than I am, I apologise that some of you may not be technical enough. So, personalised medicine, let me just think it through what is going on at the moment in terms of the NHS. Alan said that I've been interested in drugs and the study of drugs. Drugs are using drugs and drugs represent the second biggest cost to the NHS after staffing costs. At the moment, in the whole NHS, we spend £16 billion per annum on drugs, which is a huge, huge budget. And if the drug were working perfectly in everybody, that would be worth it. But unfortunately, drugs are costing more and more and not only working perfectly. As you can see, this list of the top 10 most expensive drugs in the NHS, I won't go through each one of them in terms of what they use and what they use them in. But the top four drugs cost the NHS £1 billion per annum. And this is only likely to increase in terms of costs for the NHS and the cost is increasing year on year. And part of the problem is that as we move into the future, the cost of developing a drug increases. At the moment, it has been estimated that to take a drug from the first time it is discovered in a test tube, to working in patients and being able to be prescribed by a general practitioner or a hospital specialist, costs £1 billion. And the reason for that is that there's quite a lot of attrition. Only one of the drugs that a pharmaceutical company makes in a test tube out of 5,000 different drugs it may produce, only one of those will actually make it a market. So there's a huge attrition rate. And that was the answer to the cost of failure. Part of the problem is that not every drug works in every patient that we give it to, first of all, some of the physicians. I think I've practised personalised medicines to do all of the physicians. But what we do is rather crude. We do it on the basis of population-based studies, random mass control trials, in which you look at thousands of patients in a random mass control trial, and that tells us what may be the best drug to use. However, when I have a patient in front of me in my surgery, what I'm trying to do is to extrapolate from the thousands of people in a random mass control trial to that individual in front of me. And that is a relatively crude way to be able to treat a patient. Or it's not surprising not all the drugs work in every patient that we use in the first time, and we need to be able to improve on that. Unfortunately, there's also the issue that some patients have outside of their drugs. No drug is without risk. We try to prescribe drugs on the basis of benefit, but unfortunately some drugs also have a risk associated with it. And anti-drug reactions are common, unfortunately, in the NHS. 6.5% of all the admissions to our hospitals are caused by anti-drug reactions. At this very moment in time, if you take all the beds in the NHS, including Scotland, Wales and England together, 8,000 NHS beds, that's 10 800-bed hospitals. If you consider that each hospital has 800 beds, 10 800-bed hospitals are offered by a patient with side effects to drugs. And we need to be able to overcome that cost to NHS £1 billion per annum. And we need to be able to improve on that. So these are issues in the centre of prescribing drugs, and the way to be able to solve that there are many different ways people are trying, but personal medicine is one of those. A personal medicine is not the answer to everything, but it is at least a step forward in the right direction. And really if you go to buy something for yourself, as this person tried to do, you're not going to buy clothes that are not going to fit you.  You want clothes that fit you perfectly. And so we should be expecting the same thing of the drugs that your doctor prescribed to you.  That's what we should be able to do. And that's a tall order. Now I'll show you why that's a tall order, but nevertheless that's what we should be able to do. And that's what personal medicine tries to do. Now at the moment we've got some fantastic tools, technologies, knowledge that's been generated in this century that allows us the ability to progress the potential for personal medicine. Obviously one of the biggest, if not the biggest, advance in science has been the sequencing of the human genome project. Now that was completed at the first draft in 2001, the final draft in 2003. And the one thing is that all that knowledge is now made freely available to anybody in the world who wants to study it. We've gone from the era of actually producing, finding advances and keeping it secret. The internet has been fantastic in terms of allowing us to be able to share that knowledge for lots of people who can look at it. And the work that's been done since the human genome project was sequenced is that we know that 99.9% of our human genome is exactly the same. Almost all of you are in this room. Now the 21% is different. Now if it's a 21% isn't very much, actually if you consider that the human genome has 3 billion bases, 3 billion codes, 0.1% of that is 3 million. So if you consider how many random variations you can make from 3 million, you can see that's why you all look different from each other. And that's the reason for why this kind of diversity and human progress is so important for survival. But also unfortunately it means that some people have pre-dysmysgian disease because of this 0.1% difference. But also different people react differently to the drugs we give them because of this 0.1% difference. And this variation in the human genome is present in every population in the world, in this country, in the world, including in Liverpool and Anflu. Honestly, don't believe the internet. This is only what they can use. At the same time as the fact that we've got this advancing knowledge on the human genome project, there's been advances in technologies as well. So the first human genome project took 13 years to complete. At a cost, as you can see there, of 3 billion dollars. A huge amount of 13 years. But now we can actually get a whole human genome sequence for less than $1,000. It's taking less than two weeks and in fact it's coming down. I got an email from a company saying that for my research if I wanted to sequence some human genomes, they would do it for people $600. In the next five years, ten years, it would be down to $500 to the old sequence of human genomes. The problem is when you sequence it, there are 3 billion letters in there. You need to know how to analyse a string in bed. And that's where the challenge lies as well. So people say that although the human genome sequence is costing less than $1,000, the analysis is probably taking $100,000 at the moment. However, it's improving all the time. The ambition of the 100,000 genome project, which is going on in this country, is to be able to rapidly plan around the whole human genome sequence within the week or so. Which is a fantastic achievement as well. At the same time, what we're doing is producing huge amounts of data. And there's a data revolution going on. And I think that's also the driver of that nice mess in there. At the moment, we're producing 5 exabytes of data every two days. And if you don't know what exabytes are, that's 5 times 10 to the 18. 5 centillion. And that's 500 to 3,000 times the content of the Library of Congress. So we're producing so much data and we need to be able to utilise it. And obviously, big data is the thing that everybody talks about. I'm not sure what most people know what that means. But it is coming along. There's huge amounts of things going on. And that is something that we need to be able to learn how to use. So that we can actually take into all areas of medicine. And personalised medicine is certainly taking advantage of that. And some of the drivers of personalised medicine are seen on this slide. So the first one is more slow, which relates to what I showed you before. That the fact that computational capacity is doubling every two years. And that's continuing and that's important. Cooper's Law says that the amount of data we transmit doubles every 30 months. So that's a huge, huge increase as well if you think about it. And also, Metcalf's Law about networking and so on. The networking, the enormous improvements in the internet, etc. is again a portion of the square of the number of connected users. Imagine the number of users there are at the moment in the whole globe. And unfortunately, Erin's Law is also about drug cost doubling every nine years or so. And these are all drivers for personalised medicine. And we need to be able to utilise the technologies, the advances that are occurring, really to help us drive forward personalised medicine. So one of the things that you will also see in the papers, and certainly within medical literature, is that people could really use different terminologies. Personalised medicine is one thing. Who's had the personalised medicine?  Very few. And who's had a precision medicine? And precision medicine is term which was introduced recently, more recently, and Obama has probably made it famous. But personalised medicine is what people know or heard of. Stratified medicine is a very UK-based term. How the entity elsewhere in the world uses it. But in a way, they're all interchangeable, and there may be subtle differences, but people do use them interchangeably. And what they basically mean is the tailoring of medical treatment, the characteristics of individual patients. So you can classify people into either small groups or the individual setting in front of me in my surgery, so I can give them the right drug at the right time, at the right dose, for the right outcome. And this will hopefully improve outcomes. People worry about that, is that you should start treating individuals in front of you. But there's something over all population. Are you going to reduce public health? And we know that public health is hugely important. The major advances that have happened in terms of improving our lifespan when it relates to public health interventions, vaccines, clean water, et cetera. But they're not competitive. Our personalised health and public health are actually complementary. And we need to be able to do both of those at work and really take that forward for the population. So the way I look at personalised medicine is that at the moment what we do in medicine is really rely on things that came out in the 19th, 20th century. We have very gross descriptions of diseases. That is that a disease such as Crohn's disease or ulcerative colitis is just called ulcerative colitis. But in fact what we are learning when we move into the newer era of genomic medicine is that each individual disease is many subtypes of disease. And we are really starting to invent a new taxonomy of disease. So in the next 20 years I think we're going to have a completely new taxonomy of disease which says that this is ulcerative colitis, subtype B, subtype C, subtype D, et cetera. And that also allows us to be able to then treat individuals with different subtypes of disease. Unfortunately, even though we have some strata of disease when we define this, there is still going to be variability on how each of us individually respond to a drug. And this is the area of pharmac genetics which is where I have been particularly working and I'll show you some examples of why this is probably the most advanced state in terms of trying to introduce the precision of personalised medicine into clinical practice. The final aspect which is the most difficult is what you do in your life and so on. All of you will be different in terms of the amount of exercise you do, the amount of drink, the amount of eats, and other things as well. Smoking, et cetera. And all of that can affect how you react to a drug. And so that's going to be the most difficult to capture to be able to intersect with the genetics, et cetera, and how we can then integrate all of that to be able to tell us how we treat people better than we do at the moment. So to go from the bottom of this pyramid to the top, there's going to be long journey, there's huge opportunities, there's huge challenges as well. And that's what a lot of work that's going on in this country and worldwide is really trying to tackle. So what I'm going to do is in order to talk to you in theoretical concepts, but I thought it might be better if I give you some specific examples of diseases where it's actually working, where things are, and you can see from that what the challenges are as well. So I'm going to start off with cancer. And obviously the cancer, one in three people in this country will get cancer at some point. Cancer is a genetic disease. We're born with a genome and we live with that genome for the rest of our life. Unfortunately cancer is a second genome that develops in some of us, and cancer is a genetic disease. So somebody who has cancer has two genomes, a cancer genome and the genome that they're born with. The cancer genome has lots of mutations in it. Those mutations are things which are driving the cancer forward. And in some cases, and I know you may not be able to read all of this on the slide, in some cases, people will find that those particular mutations are the drivers for that cancer and you can develop drugs for that particular mutation and therefore try to treat that particular cancer. So here's an example. Malignant melanoma. Most cases of malignant melanoma if captured early can be resected and patient is fine. But unfortunately in some cases, melanoma does metastasise. It goes over to the bones, to the liver, et cetera. And on this of the first PET scan, this is a PET scan, Poster and Mission Traumographies scan. And what you can see are these red spots, which are all the metastasises. And investigators in the Saga Centre, in the Cambridge, were able to see tons of patients metastasises like that. And they found that there was a gene called BRAF, and they found there's a mutation in that gene. And that mutation was driving that cancer forward. And so what they did was to work with a drug company and they were able to develop a drug called Beryratholib, but the name doesn't matter, which was able to actually interact with that particular mutation in BRAF. And when they gave it to a patient like this, with two weeks later the cancer disappeared. You can see in this one, the cancer has completely dissolved the way, which is a fantastic result. And there are many examples of that in different cancers. Unfortunately cancer is a hugely complex disease, hugely complex biology. And what happens is that you get secondary mutations occurring after you give the drug and the cancer comes back after six months. So the next challenge in this area is how you give two or three drugs in combination to prevent those mutations from occurring in a long lasting survival after developing cancer. But interestingly, this is the way that most cancer drugs have been developed now. Most companies have this huge amount of programs going on in all pharmaceutical companies throughout the world. And they are really focusing on this way of being able to treat cancer. And there are benefits as well because if you can actually show in a small trial that a drug such as this works in that way, then you can actually have to take a very small trial which doesn't cost you as much as taking a large trial and you can get it approved by Drug Regulatory Institution's FDA. So this drug that I talked about was the fastest RFDA approval in history. And so there are benefits for the pharmaceutical industry in trying to develop this. So people talk about a pharmaceutical industry and actually about blockbusters. But actually for some of the stratified indications on personal medicines, they actually have benefits because they have to do smaller studies and get it to market quicker as well. But it's not only important for cancer this new way of developing drugs based on genetics. It's already beginning to make inroads into 65 roses. 65 roses is a commonest autosomal recessive disease in the Caucasian population. It occurs in 1 in 2500 people. We've known since 1987 what the mutation was on chromosome 7. But it's only in the last couple of years that people have started to do drug therapies come through which is specific for mutations. So there is a particular mutation in the 65 roses gene which is called G551D which is only causing 4% of the 65 roses patients. And these two individuals working in a company called Vertex with 200 scientists were able to identify particular compounds which were able to affect this particular mutation. They screened 600,000 compounds. They did screening on the computer of 2.7 more million compounds and they came out with a drug called Ivercaftor. Now Ivercaftor works on this particular mutation and starts making it function normally. And this has been a fantastic innovation in those patients kids who have this particular mutation in that their respiratory functions include that life has completely been transformed, they've worked to school, they have fewer hospital admissions, etc. And that's innovation for you in terms of amazing drugs like that. Unfortunately, this comes at a price. It costs the NHS £150,000 per patient per year to treat this particular drug. So that is an issue that maybe we can debate later on. How are we going to be able to form all these expensive drugs coming through? That's not a matter. However, it doesn't necessarily need to be expensive drugs. So here's another example. And when I was a medical student I loved acronyms. I loved names of syndromes. So I had to put this one on brand, brand, brand, brand, brand, brand. It sounds fantastic, doesn't it? It is a childhood motor neurone disease. Kids are born with this initially defined that at the age of 102 they start in developing some problems. By the time they have speech which doesn't develop, they develop swelling problems and so on. Unfortunately, it used to lead to death. And when diseases like that come out about Gone breeding was like that. It's like that, Kamara, about rare diseases. A few people don't know what they are. They're diagnostic odyses. Unfortunately, young kids born with a rare disease go from hospital to hospital, doctor to doctor, having multiple investigations, and nobody knows what's going on. But the ability to sequence a human genome is actually transforming that and for us to know that we're able to identify diagnosis and their potential treatments. In this particular case, Byddwch chi'n gweithio'r gynhyrch a fyddwch chi'n gweithio'r gynhyrch yn y gynhyrch, ac mae'n gweithio'r SLC5203, ond byddwch chi'n gweithio'r gynhyrch sy'n gweithio'r riboflavin. Y rhai riboflavin yw bitwyn B2. Rwy'n gweithio'n gweithio'n gweithio'n gweithio'n gweithio'n gweithio'n riboflavin, bitwyn B2, a oedd yn menlyg yw yn bynnig yn ei wneud wrth yn amlŷwren. Mae'r interested yn gallu allu ei ddangos. A os prison iawn yn gweithio'r cosiwn gweithio'n gweithio'n gweithio'n gweithio'n gweithio'r gynhyrch, oedd yn bwysig yr öllun tŷ, yw ddwy'r ddau ffordd rhan. Mae'n amlŷfyrdd sy'n gweithio'n gweithio'r bwysig o'r ddau gweithio'n gweithio'n gweithio'n gweithio', aoli arall mae'r cyfrifiadau saith, mae'n lle'r bwysig yn deall. Felly, mae'r hoffwyr yn ymdyn nhw'n 100,000 genomes fydd yn ysgrifennu, y projec fydd yn ysgrifennu, sy'n 70,000 rhai o'r hoffwyr yn ysgrifennu, ac mae'n ddatblygu'n ei ddweud i'r NHS, i ddoddau yn y clynyddiadau hosedau, i'r genocraptio ac os ymddangos.  Mae'r ddiogel yn gwneud hynny'n bod yn cael ei ddefnyddio i'r ddefnyddio. Yn ychydig yw'n ddarparu cyfathau sydd yma, yn fawr ei ddechrau sy'n ddweud. Yn y clywodraeth, mae'n mynd i ymddangos sydd yma, oherwydd yna yma yng nghymru. y cyfnod yw'r hyn yn ymddangos cyfodol o'r necrolwys. Mae'r cysylltu yn ymddangos yng Nghymru, a'r cyfnod cyfnod cyffredigol, a'r cyfnod cyffredigol yn ymddangos cyfnod cyffredigol a'r cyfnod cyfnod cyffredigol, y 60% o'r bodyserfysgau cyffredigol. Mae'r clywed o'r mawr a'r cyfnod cyffredigol, yw ddwy'r gwneud, yw ddwy'r gwneud. Na dweud o'r ychydig ond yw 30% o adeg y buddig arwag 60% oherwydd niferodiadau eich ddweud o'r ddweud. Aw, ychydig yn amlwg iawn am dwy'n ddリfwch o'r ddylch iawn. Gweithio'r ddwyf yn 500 million o ddwyf yn cyflant o'r ddweud o'r ddweud o'r cyflant o'r ddweud. 999,000 o'r ddweud o'r ddweud arweig o fod yn cant i gynnwys, ond mae'n ddweud o adeg. Mae'n 100 million o ddweud o'r ddweud o'r ddelch i'r methu? ac dyma'r rhaid i'r cyffredinol y gwirio allan gerdwyr i'r gwahodau a'is ychydig yn gweithio eich mydag rhagorau gyda'r hynny eich ddyn nhw. Ac unrhyw ni'n defnyddio y'm ddefnyddio ddyloedd o'r cyffredinol yw eu cyfwyr. Nid yw'r drwg hefyd o eichwallydd i'ch bwysig, yw'r bosib ydy gwaith i wahanol cynydol yn gweithio arbennig ym 7% ymen. Mae yw'r ceisio bwysig yw'n defnyddio'r ceg... arall, i'w tyfnod o'r gen i'r gen i ddod yn y cyflogol, ac yn ymgyrchu'r gweithio'r gweithio'r gweithio, ond mae'n meddwl i'w ddysgu'r drwsgol. Yn y cymryd yw'r gweithio, yw'n meddwl i'w ddweud y cegau'r gweithio'r hwnnw, mae'r wneud o ddyn ni'n gwneud o'r gweithio'r hwnnw? Yn y cwylwyd gan ddylch chi'n unid yw'n meddwl i'w ddwylo'n gweithio'r gweithio. Ond wedi gwpeth idydd gael o'r cymdeithas wedi gweldio'r cyflom a gwyddwch eich cyflom yn ei ddweud o'r ddall Scotiaeth yma fel eu perthyn i yw'r gyflom yn Yn Gwlad场 mewn Yn Gwlad Nadu Gwlad Rhaglion Unedig. Na dwi'n meddwl arall y Cymru, bod yw'r cyflom yn y Gwlad Rhaglion Unedig yn y ddweud o'r cyflom lleol ein cyflom yn y dystau'r cynnig aeth yn eu ddweud. Dyna ydych chi'n yn dweud? Yn y ddu... pan mae'r test yn ymweld, mae'r reacio'n ysgrifennu yn rhan o'r 70% i'r unig. Mae'r test yn ymwylltio ar y 2006, y reacio'r rhath honno yn ymweld yn ymweld yn 1%. Felly, rwy'n meddwl y cwymod yw'r bach o'r hefyd yn ymweld yn y ffrifos five yma. Yn yw'r genetig yn ymweld yn ei hun, yn y NHS. And there are many other genetic factors that should be identified all the time in relation to these serious adverse stress reactions. And I'm showing you just three of them and in fact since the beginning of the century, twenty-four different HLA aliens, which are the genes which we are looking at, have been identified with different serious types of adverse stress reactions. Those that may cause bone marrow suppression, those which cause blistering of the skin, those which limit failure, those which affect the muscles and cause your muscles to necrose. And we've now got the tools to be able to really try to prevent these particular reactions. And the way we're doing that at the moment is to try to get these HLA tests being better available within our NHS hospitals. At the moment, if I wanted to get an HLA test, I would have to get each individual HLA test done. It would cost me, it would cost a hospital. I worked for about 100 pounds to do that test. It would take me two weeks to get the test through for my patient. But two weeks is a long time. I don't want to wait two weeks before I give the drug I need to give to the patient while waiting for the test result. And so what we've done recently is to work with the company and we've developed another technology which allows us to be able to type all of those different genes that you saw in the previous slide very quickly with a turnaround time of less than 48 hours. And the cost of that panel is going to be about 20 quid, which is much less than the 100 quid activity for each individual test at the moment. And so while technology is improving, it is also becoming cheaper and that's the reason for showing you this particular example. The important thing is also that most doctors out there will not know how to interpret that kind of very, very complex test that we are developing. So in order to help them, we've also developed a clinical decision support system. And what that means is that when a test result comes through, the doctor can click on his computer to a link. He'll be taken to a website which he'll have these kind of data. He can then press on a drug that he wants to look at that will tell him what that particular gene that is important is for that particular drug and will tell him what to do if a patient is positive for that particular gene. And that kind of clinical decision support system is going to become very important in the future. Nobody will be able to hold 3 million data points in their head and remember what each one correct did. So we will need to use information technology in a much better way so that we can actually utilise it to be able to give the best drugs to the patient in front of us. It's important to note that our general practitioner has 10 minutes to see a patient in this country. If I give him 3 million data points and say, interpret that, you can see that 10 minutes is going to go out the window, right? It's either going to say, well I'm going to interpret that and I'll see if my next patient is 3 years from now or you just throw it away. More likely he's just going to throw it away. So we need to use computers to be able to help us to interpret that so that we can actually improve on the way we treat patients. I'm just going to do something which is very important I think in terms of how we treat patients, the dose. Everybody knows that every drug that you take has a dose on it. It will be 10 milligrams, 50 milligrams, etc. And how selfless was a polymath? 500 years ago he said, poison isn't everything. No thing is without poison. The dosage is what makes it either a poison or a remedy. And you may have thought that we've learnt in 500 years to be any better than we have at the moment, but unfortunately not. We still don't actually do dosing properly and so on. Because we assume that the dose that we give to the patient is equivalent to what actually gets into the bloodstream and into the area where the disease is. And that's not correct. It varies. So if I, again, each of you is 10 milligrams of the same tablet, I will be able to find a 54 variation in the amount of drug you have in your bloodstream. And we need to get better at actually making sure you're getting the right dose at the right time. And in fact, this is happening with every drug. Here's an example of a drug which is used in inflammatory bowel disease in osteoclitis. It's called infliximad. It's a biologic. It's given by injection. And people have been trying to find out why infliximad works in some patients and doesn't in others. And the best indicator at the moment seems to be the amount of infliximad you have in your bloodstream is a determinant of why it works better. And I will know that there was something called therapeutic drug monitoring, which people have used it, and he was the exponent of this. And therapeutic drug monitoring has gone out of fashion in this country. And in fact, I can promise you that therapeutic drug monitoring is going to be the major component of precision of personalized medicine in the next decade. And this is what's called reinventing the wheel. Great. We've tried to look for very complex solutions. In fact, some of the simpler solutions are, but we've already tried them before and started them when we're coming back to those. And in fact, this is exactly what we do at the moment. If I see a patient with kidney failure, kidney impairment, I know from the drug label that I need to be able to reduce the dose of a certain drug. So he is an example of an antibiotic. In patients who have a form of kidney failure, I need to be able to reduce the dose. So I don't cause any side effects in them. But at the moment, when we have a genetic factor in a patient, which causes the same magnitude of change as you see with kidney failure, we ignore it. We don't change the doses. And that can lead to problems as well. And so can we actually tackle that and can we actually improve that as well? And that is also happening. And that's something that happens, for example, with drugs such as warfarin. Now, many of you will have heard of warfarin. Some of you may be on warfarin. And warfarin is a drug that's used by 1% of the UK population. The problem with warfarin is that we don't know what dose you'll require. Some people require half a million pounds a day, some people require 20 million pounds a day. And we're trying to identify why it is that there's this variability in 44 variability in dose requirements. The problem is if we get those wrong, we think we're bleeding as in these patients. And we want to avoid that bleeding. So warfarin has been undertaken by us, but also by other people. And this is a very complex diagram. And basically, this was a single study undertaken in 714 patients. And we got a million different data points on each of those 714 patients. So the 714 million data points on that one slide. That's the complexity of studies which are being undertaken now. And what this shows, and this is the most important part to focus on, it says that as one gets older, you need lower doses of warfarin. And you're a very young audience. And this is something for you to look forward to. As you get older, you'll never get smaller, so you need lower doses of warfarin. As one gets heavier, you need a higher dose of warfarin, which is what you'd expect. But actually, the most important factors determining the dose requirement for warfarin are two genetic factors, which is shown there. This one calls CYD2C9, and this one called DECO C1. And those are the most important factors that determine why one requires different doses of warfarin. And in order to determine whether we can actually introduce this into clinical practice, and I'm sorry, I'm getting a bit technical now and go through this a bit more slowly, we undertook a randomized control trial. Because my physician colleagues are pretty skeptical, conservative, and they need to be, they don't want to introduce innovation without showing that it is working in clinical practice. And so I undertook a randomized control trial with my collaborators. And what we did was to say, if we compared genetic base dosing to what we do look around in NHS, would it be better? And we did this randomized control trial in both the UK and in Sweden. And what we were able to show was that genetic base dosing was 7% better than standard dosing. Now, 7% doesn't seem a lot, but because you're looking at a coagulation system, which amplifies its effect, it is actually clinically significant. And so we've shown the 7% difference. But when then I go and show it to commissioners in England, we have to talk to the clinical commissioning groups. That's how we get funding for hospitals and so on. They say, well, actually we haven't shown it to be cost effective. So we don't have to do cost effectiveness study. That is to show that if we introduce a new innovation to the NHS, it will be affordable to the NHS. And again, we went and showed that it was cost effective to the NHS, which is shown on this particular slide here. And you can see the UK curve shows that by the time, and the threshold for cost effectiveness is about £50,000, and 90% probability to be cost effective at that kind of threshold. So then once you've done that, people come and say, well, actually, we're still not building new. You need to do more studies. Okay, we'll do more studies. So the next thing we did was to actually go and work with the company and develop a new way of genotyping, which is more efficient than we did in the randomised control trial. So we worked with a company called LGC. And basically what this test does is that we take a mouse swab, we put it into this machine here, and within 45 minutes we can give results on those two genes that I showed to you before. And this can be done by nurses in the clinic. So the next step we're supposed to share, well, actually, if we can give the machine to the nurses, they'll see the patients and they can dose them based on the genetics they do in the clinic. Will that work? So we did the randomised control trial, as I said, and so what we then did with the new machine was implementation study. And the implementation study has just been completed. It's now published. And what this shows is that the implementation study is that nurses undertake doing a mouse swab, doing the genetic test, doing the dosing themselves based on the algorithm on the web, while able to improve dosing with orphan by 7% as they were with the randomised control trial. So this actually shows you that it is working as well. It can work in a real world setting, such as NHS with the complexity of the NHS. Now, I'm just going to the last part of the talk. So, unfortunately, we do have changing demographics, and our population is getting older. And as one gets older, once kidney function goes down, once liver function is not so good, once respiratory function declines as well. I'm sorry, I don't know how to give you the rest. And unfortunately, you need multiple drugs to be able to control those diseases at the time when all these kidney function, liver function and so on is going down. So the big challenge that's facing personalised medicine, I think, is how are we going to be able to improve the way we treat our elderly so that they can have better lifestyle, better quality of life, stay out of hospital and have an independent life in the community. And there are many things that one can do, and not just personalised medicine, and obviously those are all on-going, but there are ways of being able to look at this with personalised medicine as well. And this is one particular study which has been done in the States, and what they did was to say, well, if you had a genetic profile on all your patients and they were able to dose-space on that genetic profile, would that improve various outcomes, such as hospital admission, emergency room attendances, et cetera, and death as well? And they did this in a group of patients who were over 50 years old, who were on multiple drugs at more than five drugs each, and then they did a small trial of 57 patients versus 53 people. And they introduced this genetic profile first of all in a group of patients, 57 patients, and they compared them with the 53 who didn't have genetic profile. And what they were able to show was that in those people who were untested, they all had worse outcomes. So you could see the death rate was higher, the hospitalisation there rate was higher, et cetera, based on genetic profiling. So what was happening for here was that doctors were using the genetics in the patients to be able to modify the doses they were giving, and I again come back to dosing being important, but also drops they were giving as well to be able to improve the outcomes of these patients. Unfortunately, this is a very small study. It's only 57 versus 53. So what's going on at the moment and is funded by the European Commission is a 15 million euro study in 10 EU countries with seven different countries recruiting patients. Two, see whether genetic profiling, before you see a doctor, improves things for you in terms of the outcomes. And the only site in the UK is in the local whereabouts of you are leading that study. And what we're trying to do is to see whether we can actually improve outcomes in terms of reduced side effects of patients and making genetics available the first time to see the doctor rather than as a reactive response. So it's preemptive genatagin. And this is really a foreigner to when everybody has a more genuine sequence. And if you have a more genuine sequence, you need to be able to take that into account and not ignore it. And this study will tell us whether we can do this in a clinical and cost-effective manner to be able to improve outcomes of our patients. So just the very last part of the talk is really patients and public empowerment. I think one of the major drivers for genomics will actually be the public. And some people have already gathered genome partly, and no sequence, but tight. Has anybody had a 23 AB test down here? Well, it's available for 110 pounds. Now, you just said before, it goes off to the company in the States and you get the result back and you get that interpretation. And this is exactly what happened with this particular individual. This was in mid Wales on a Saturday morning. This patient was having an anesthetic procedure. And this patient handed the 23 AB result to the anesthetist and said, I've got a genetic deficiency in this particular enzyme. Please don't give me this an anesthetic. And I've had patients coming to the in my clinic handing me those genetic test results. And that's going to become more and more common. And this is really patient empowerment. And as general practitioners, doctors, et cetera, we need to get ready for this so that we can actually answer our patients because I think it's terrible if a doctor said, I have no idea what you're talking about. And they need to be able to interpret it and actually say, well, this is useful or not useful or if it is useful, now I'm going to change your therapy because of that. So that's really important. A patient empowerment is coming through. Some patients are going much further in terms of what they're doing. So has anybody heard of microbiome? Yeah? Microbiome is the bacteria we carry. There's more bacteria in our body than there are in cells. That's something else we use at the point.  If you're really rich, you can do it four times for $400. And you can see whether your microbiome changes from week to week. And some people have done that and some people, particularly in the sense that they're going into extreme. They had an interpretation saying that microbiome is not very healthy so that they've given themselves a fecal transplant. This is patient empowerment. Now, if you don't know how to do fecal transplant, go to YouTube. There's a video there of how to do it. Honestly. And this person from NIH said that some lay people have taken this idea of fecal transplants that perform in their own fecal transplants at home. Folks are finding to provide them with stool making stool smoothies. I hope they use it from London when they use the truth smoothies. And then they give themselves stool and I was without medical supervision. And then she said, ends up by saying this is a bit bizarre for a culture where people smear hand sanitizer of the handles of the shopping carts. So that's anemoginomics. So the last thing I want to let you with is to come three of our sensors. Who has the thick bits?  Yeah, I've got thick bits and so on. And I think sensors are going to be a major part of what we do as well. If you look at what a conventional engine does at the moment, new cars are out there, it's collecting data all the time. A flight data recorder will collect and go by some data from the flight. Yes. In Newborn baby, we use the same five data points that we use in 1952 at the moment. Which is crazy. And with the technology in other areas why are we still using these five data points in the baby that was divided between the after in 1952. And that is going to change with the sensors and so on. And this is already happening. And patience again, the power is very important. Now by sensors, which can actually record their own ECG on a live phone. Okay. And this has actually been asked of medical consequences as well. Because many patients will go have been to see me and the cardiologists and they say I've got palpitations. So we do a recording for 24 hours. We don't find any arrhythmias. We do a recording for five days. We don't find any arrhythmias. It's just that you can give the sensor and many cardiologists now do give the sensor to their patient. They can put it on the back of the iPhone. When they get palpitations, they just put both fingers on that sensor and that gives you an ECG recording like that. And from that ECG recording you can tell whether you've got an arrhythmias or not. And these are really patients helping themselves with their treatments and so on. And those kind of sensors are going to get more and more common. And the reason for that is the digital revolution. And it says the number of smartphones is going to cost about 6.1 billion by 2020. And apparently that at the moment we carry about 1.8 devices per person. I'm not sure what the price is. And by 2020 you're going to carry 6.6 devices. What will be overloaded with iPhones now? But that is true. We are in the middle of the digital revolution which is going to be very important. So let me finish. For some areas, I think for example in cancer NHS is already delivering personalized medicines. How access to medicine is diagnosed is required to practice personalized medicine can be patchy. It's important that we actually make sure that it's available to everybody so we don't exacerbate health inequalities. Genome sequences will become more common and everybody will have genome sequences at birth eventually. We need to learn how to be able to interpret that and use it effectively. I think an important aspect of any kind of delivery of personalized medicine is going to be the education training of our workforce to make them more skilled in delivering that. Also important is the education of the public in terms of what they can expect to practice medicine, what are the benefits but also what are the limitations. Personal medicine is not a panacea. It's a refinement of what we do in medicine and everything we do in medicine apart from occasional revolutions is a refinement. It's an evolution of the way we practice medicine and that's important to understand that. So what I'm going to do is to cover some aspects of that. There's only small aspects of COVID. There are an enormous number of things going on that you are interested in. There's lots of different sources that you can read on the internet but please be aware of fake news. So I'm from Liverpool and I'm going to give you a quote from John Lennon. It will all be okay in the end. If it's not okay, it's not the end.


Hello everyone, my name is Kari Knudsen and I work for NDSU Extension in Grand Forks County as the Horticulture Agent. Today we're going to be discussing how to thin those ceilings that you started a couple weeks ago. Generally when we start seeds we tend to plant a little bit thicker than we need because germination is not always 100% and this will allow you extra ceilings to only pick out the healthiest ones for your garden. We want to make sure that we thinner seedlings because overcrowding will lead to plants whose root systems and stems are intertwined. The plants might also be leggy and they're just not very vigorous and won't do well in an outside garden setting. So there are two ways to thin your ceilings. When you start thinning seedlings you want to make sure they have at least two or have at least their true leaves. So here I have some broccoli ceilings I've been growing for a couple weeks. They are just starting to get their second true leaf so I'm going to thin them out. The first way is simply with the scissors. Just picking out the ceilings that are the strongest and healthiest and keeping them and then using the scissors to cut off the stem at the soil surface. So I'm going to thin out this pack right here and you don't want to just rip off the ceilings. You don't want to pull them out by the roots because this will disturb the roots and the soil of the ceilings you want to keep and you might have some unintended plant loss. So there we go. Easiest way I've thinned out that cell right there of my broccoli plant. Now another way to thin your ceilings especially if this is a little bit painful for you after you've spent all that time caring for other ceilings you can transplant those ceilings. So simply take the ceilings out of whatever container you use to start them in. Keep them in a moist paper towel so that the roots don't dry out and you're just going to gently separate the seeds. Now I am using a craft stick but you can also use a pencil as well so you're going to go in there and you're going to separate out the ceilings so only picking out the healthiest ceilings to transplant. So this I believe is a cabbage ceilings, the great healthy root system and I'm going to use my pencil or my craft stick to make a nice hole or divot in my cell and use the tip of the pencil or the craft stick to gently push in the roots of my ceiling. Now you want to put the ceiling in a little bit deeper than the roots are and that should help you with the ceilings becoming leggy. Then use your fingers to firmly press the ceilings so it's in close contact with the soil and there you have your ceilings transplanted. So two ways to thin out your ceilings either using a scissors to cut off the ceilings that you don't want, keeping only the healthiest or you can transplant the ceilings into new containers as well. Thanks!


So, I wanted to share a story with you out of the state of Alabama. It's a really encouraging, inspiring story, and it really demonstrates what's possible if political leaders actually listen to the will of the people. Of course, I'm just kidding. It's Alabama. It's a train wreck. The story's depressing. It speaks to how morally depraved our late stage capitalist society is. And I mean, I don't even know what to say about it. I can't really supplement this article that I'm about to read to you with much commentary because I think it kind of speaks for itself. The details here, they're gross enough to where there's not much to be said about this. But still, I can't not talk about this because it's just it's so it's so egregious. It's so gross. So CNN's Rebecca Reese and Devon M. Sires reports. Alabama Governor Kay Ivey signed into law Friday, a number of prison infrastructure bills that will use coronavirus relief funds to build new prisons in the state, calling it a pivotal movement for the trajectory of our state's criminal justice system. How inspiring. Ivy, a Republican, had convened a special session of the Alabama legislature to discuss how to fix what she has called a decades-long problem of prison infrastructure challenges. The governor said Friday's bill signing was the culmination of hard work and conversations between lawmakers on both sides of the aisle. I like to personally offer my thanks to the legislative leadership who are standing behind me right here for a successful special session. And what we believe will yield untold benefits to all Alabamians in the days ahead, Ivy said. You can't be serious. Earlier this week, Ivy defended her proposal to use the state's allotment of COVID-19 relief funds to build prisons after receiving criticism from Democrats. Their proposal included using up to 400 million of federal COVID-19 relief money, up to 785 million in bonds, and no more than 154 million from the state general fund to add prisons and renovate others. The state legislature gave the package final approval on Friday. Yeah, that's the story. Now, I shouldn't have to say this, but there are virtually endless possibilities for that money. I mean, she should actually be using it for COVID relief. Alabama has one of the lowest vaccination rates in the country with only 43 percent of residents fully vaccinated and 53 percent with at least one dose of the COVID-19 vaccines. So she could have used this money to set up mobile COVID vaccine sites in the most rural areas of the state. You could do that. You can do a lot of things. You can put it towards education, housing. You can set up a fund for low income residents to give them health care if Medicaid isn't doing the trick. There's so much that you could do. She's using it to build prisons. I just, what do you even say? That really speaks to her priorities as a governor. And this is kind of just microcosm of a bigger issue. We always spend more money when it comes to killing people, at least when it comes to what we're allowed to change, right? The discretionary budget in Congress, most of the time, more than half of that is spent on killing people and blowing up people. And in Alabama, they're using it to send people to prison. When are we as a society going to stop accepting this from politicians? When are we gonna stop electing politicians that prioritize locking people up and killing people over actually helping people? I don't know, but there's not much left to say about this. I just wanted to share it because this is kind of not the most shocking story to see out of a late-stage capitalist society, and it's never been a shocking story as it relates to Alabama because it's Alabama.  What a ridiculous thing to use COVID-19 relief funds while the pandemic is still going on to build prisons, just Jesus Christ.


Just kind of was just going to do that. Thank you, Kayle. So welcome everyone to China is Not Our Enemy, another episode with our amazing guest. First, I want to just talk a little bit about the campaign. As I was setting it up, as I hear we watch, we watched with the war in Iraq, we watched with Vietnam, we watched with Korea, that the first casualty in war is the truth.  And so we saw smoke. I say smoke, you know, when we start watching lies driven towards China, lies that make people hate.  When we really, as people on this planet need to love and care for each other, we need to be in cooperation, especially when we have a planet that's suffering so much. It's like love is what we need right now. So we launched the campaign, China is not our enemy because we wanted to get in the way of the propaganda, as I call it, the smoke before it turned into a fire, before it turned into a war, because the war on terror, the lies that drove us to war in Iraq cost US taxpayers $20 trillion of taxpayer money to murder 6 million innocent people in the Middle East. And I say innocent because there wasn't anyone in the Middle East that did anything. We invaded an innocent country and killed innocent people that has spread across the Middle East, and that's 6 million people dead. Now, as we watch these horrors in Palestine, I want you to understand it's like 20,000 probably dead already, horrible, horrible that we have watched this as a crime against humanity, but just think about 6 million dead from the US war on terror. That was 25,000 people on average per month. So what we are watching is like we haven't stopped the violence of the empire. We haven't stopped creating more weapons. If we watch right now, what we must do is all stand together and all say no, not in my name, not with my money, this violence is horrendous and it must stop. So we're here together to create that piece to across the ocean, across the Pacific Ocean with our dear guest today, Ding Ding. She has been a journalist for more than 10 years, traveling across China and reporting on poverty alleviation, ethnic diversity in Xinjiang and Tibet. She's also traveled around the world to explore what the Belt and Road Initiative looks like outside of China. Well, she recently came to the United States to cover the Xi Biden summit in San Francisco during which she was able to interview a lot of other people here. And I got to see her before she flew back to China. I was flying in from China, she was flying back to China. And I just thought what she had seen and heard I wanted to share with all of you. At CGTN, she hosts Talk It Out With Li Jing Jing and JJ On The Road. You can catch these on YouTube and her Twitter at Jing Jing underscore Lee, don't miss them. Because the one thing that I just love about this adorable woman is that she has a commitment just like those of Code Pink. She wants to build bridges between the peoples for peace. So she travels and she brings to her audience what she learns, not only what she learns but the voices of those in the region she's visiting. She reaches out to experts to learn more and raises their voices and shares them with her audience. I see her work, the Bunking the Lies and it makes me cry with joy, more sisters in peace and love. Jing Jing says when we know each other the narratives won't work anymore which is what we believe it could pink which is why we travel around the world and why we bring people with us too. So Jing Jing, thank you so much for joining us early in the morning in Beijing. I just want to say to everyone she's 16 hours ahead of us, our tomorrow morning. It was so lovely to see you on your recent visit to the US. Can you tell the audience like why you came to the US and maybe some of your first impressions when you arrived in San Francisco? Thank you, Jodi, for your kind introduction and hello everybody. Thanks for joining me. It's 9 a.m. in Beijing, greetings from Beijing and I already saw some friends that I met in San Francisco in this group already, KJ. I'm just very happy to see you again. So I went to the United States during the APEC meeting. I was among one of the reporters from CGTN and from Ho China that went to San Francisco to cover the APEC meeting and also the meeting between Chinese President Xi Jinping and also US President Joe Biden. So this time I went to the United States for work but before also before COVID I traveled to the US just for tourism before in San Francisco as Angeles and also New York. So I also wonder how many things changed during the past few years. So I was very excited to go to the United States this time to meet all of you, my friends and also just to see on the ground because we know when you hear some stories from media it not necessarily represents everybody. So I'm very keen to know how the American public feel about China. Does everybody look like China as an enemy? So I just want to do my own research as well. So my impressions about the United States first I have to say the United States is really beautiful. It's a great country and San Francisco is really beautiful and it'll be super comfortable to live there if you are rich. So I understand why there are a lot of people when they go to the United States they were like fascinated by everything. It is fascinating but what's shocking me is the stark contrast of the rich and poor because we were very fortunate to live in downtown San Francisco where everybody told us don't live there. There are a lot of danger. There are a lot of like overdose people that they may rob you. So we were told not to stay there. Well, we were lucky just to stay there and we were arrived a few days earlier ahead of APAC meeting before they clear out all the homeless people. So we saw another side of San Francisco and you know San Francisco many parts of the city is so pretty like scenic spots, like the beautiful houses, the area where rich people live and we also went to fancy restaurant it's so fantastic. But then how come the downtown area can be, I don't, I lack of the words to describe the region. For example, how can the sidewalks become public bathroom and how come there are so many homeless people and hopeless people on the streets and like drug overdose people. I mean, I'm not trying to pull down on the United States but that scene, even I come from China, a developing nation, I would never cease, I have never seen such scene in any city of China. Even if I go to the most remote or poorest region in China I wouldn't see that. And I've been to some of the world's least developing nations in the world. They were empowered people but they are not as hopeless as those homeless people I saw on the street in San Francisco. So I think the first impression to me is the stark contrast of the rich and the poor in the United States. And also, I think the second my experience I found is shocking that people because there are people know China like you guys like those who have long time relationship doing business, doing cultural coefficients with China but that probably 5% of the American population is a very small group of people that really are friendly and knows China very well or whether they're friendly to China or not they know what China is like, the history, the politics. So I want to ask people outside of that circle what the general public feel and know about China and to my surprise, most people know absolutely nothing about China even if they can bring up some of the lighthearted things like kung fu or noodles, I can live with that but most of the people, especially young people I approach, when I ask them what's the first thing pops up in your mind when thinking about China, there are no answers they seriously know nothing about China. Now I'm not saying everybody should know China I'm not that arrogant it's just because if I do this research in China if I ask college students or people on the streets what's the first thing pops up in your mind when talking about the United States how do you feel about the United States? I'm sure everybody can give a pretty good answer some will say freedom, diversity is a great country or some TV dramas like Friends or Starbucks because most people, they already know America through learning a language through learning the culture through reading news and if they read politics, they will know even better so I'm just shocked how and if I do this research in other developing nations like Africa or Latin America I'm sure people will give good answers to China and the United States very well because I've found people in China or other developing nations they have very good sense of knowledge about the world, about world politics about what's going on in the world or what the current affairs of different countries cultures so it's a little bit shocking to me that people absolutely know nothing and there are some students give some words to describe China but I also find it interesting whether Chinese students or American students when they talk about the United States they will give positive words to describe United States such as diversity, such as freedom and all the students when they describe China they will use words like COVID, competition well, and there are some words they're probably too shy to bring it to my face but they always tend to use very negative words to describe China so it's shocking how come there's a huge gap of knowledge about each other's countries so that's why I think it's so important that we all have a people-to-people connections more Chinese people travel to the United States study in the United States even though now it's still already a large number of Chinese people traveling, leaving a study in the United States but we also need more people from the United States to come to China, either for travel either for studying either just sightseeing come here, interact with the people because the people-to-people connection is the key to build a bridge, to build a basic understanding when we know each other person-to-person when this country, this race of people is not like stringent to you there will be no space for fear so that's why I think what Chinese President Xi Jinping said this time, I totally agree is that we need more people-to-people connections and the future of China's US relationship lies in the people, lies in the youth and I'm so happy that he's inviting 50,000 young people in America to study in China in the next five years so I think that will be a good start for better relationship between China and the US I totally agree with you I could think it's all about the people-to-people so if we were to come and China's a very big country what are your favorite places? We have many members of China is not our enemy and one of the really sad things is that inside the United States it's almost like you're not allowed to love China because oh my God, if you love China then you work for the CCP it's just like very McCarthyist you're not allowed to have your true feelings kind of like with Palestine you're not allowed to love Palestine and say no genocide so we know Chinese Americans I saw in your interviews where you're interviewing Chinese Americans and they're witnessing the president of their two countries come together their culture and their place where they live so pair with us some of your favorite places because you travel all over the country what should we not miss? What are your favorite things about China? Wow, there are so many places you know like just like the United States China is huge and wide and each province is different from another province so I cannot pick one favorite place because I feel there's different places are so... Okay, so how about we start from the Southwest because I think when you come to China you definitely should come to Beijing and Shanghai and Guangzhou and Hong Kong this first tier city is metropolitan but you won't see the other side of China because the rest of China is nothing like Beijing and Shanghai and Guangzhou and so I would recommend go to Northwest and East West and Southwest it's more England and also with the different ethnic groups living in there for example, how about we start with Xinjiang Uyghur Autonomous Region, Tibet and also Yunnan Guangxi Yunnan Guangxi is in the Southwest of China so those regions also probably around 30 or 40 ethnic groups live there but you're ready to hear from them because you know like probably the CIA don't see those regions worth investing because they don't see any problems in this region to travel wedge between different ethnic groups in China but I would recommend go to Yunnan and Guangxi in Southwest China because the majority of ethnic groups live there Guangxi, Zhuangzu, Miaozu so when you go there you will realize the Chinese culture is not just this kind of culture the stereotype Chinese image its Chinese culture is very diverse Chinese culture is the combination of 56 different ethnic groups and there the population of ethnic minorities actually all numbered Han Chinese and they all have their own holidays their own languages their own ways of celebrating different cultures so you will see the other side of China but I think also worth you know I love I got deeper understanding about my own country my own culture is exactly because I travel to different parts of China when you go to these regions you realize how difficult poverty alleviation project was to any governments I can give you a few examples each province has a different geopolitical of geography sorry geography conditions and the reasons that led to those regions into poverty is also different in Guangxi Guangxi is just like Xinjiang its nature-blast province it has everything has wonderful trees had wonderful agricultural products but Guangxi is isolated from the rest of the province because it has steep mountains and most of the tribes couldn't leave their regions just because there were no roads it was almost impossible to build bridges and roads in such steep mountains but nowadays we'll go to Guangxi everybody can get out and the roads have built right into each household not just roads linking different villages different cities the roads are built into the mountains into the village and into each household so the farmers can bring their fruits their tender rings from their backyard to the street and let different companies to transport those products to the rest of China it made their life their business much easier so that's one thing that got helped them got out of poverty and I also recommend people go to Tibet Xinjiang in Mandarin because when I go there I realize oh my god how could anybody build anything there the Tibet is the lowest point is 4,000 meters above sea level and the rest of part you know it's probably 6,000 so it's very high so the low oxygen is a major problem for everything so in that condition it's almost impossible for anyone I only want to work for a long time but they build railways and highways you know in Tibet in the winter it's super freezing no one could work in the winter time so only four or five months that humans can work do high labor work it's during the summer like for example from April to July only those few months you can work for a long time but then you have to rest constantly because of the low oxygen and high altitude but even with the majority of the land of the earth in Tibet in the winter it's frozen earth means during nighttime it's frozen but in the nighttime it becomes mud so it poses great challenges for anyone who wants to do constructions to build any foundations for railways for highways so when you see that and you see the magnificent rows and highways I got to wonder how did those workers go to those railways so when you go to those regions you actually understand see what it is like and understand how difficult it was to for the government to come out with a very specific poverty alleviation policies that suits each province because China here we use the targeted poverty alleviation policies means each household each city each province has a different policy because their conditions are different so there's no one-size-fits-all projects that can help everyone so the government workers go to those places to investigate what's the reason that led to this region into poverty is that because of roads is that because of the climate is that because of maybe this household just unfortunate that many family members experience natural disasters and the high cost of treating them in hospital is the major reason that led this household went into poverty so they have very specific plans in each province and when you go to the province and you see that it helped me to realize and have a deeper admiration for all those CPC staffs it requires a huge dedication of serving the people to come out with such a plan so I really recommend everybody to go to this region to see for yourself and you realize how much it changes it has brought the country has has made it like to itself in the past four decades so um oh sorry it's okay I thought it went away so then what you talked about the culture and you know we find out in the U.S. that we're told in the U.S. that China wants to go to war on the United States I wonder if you could comment about that the last thing Chinese want is war I can assure you I can assure anyone who think China wants to go to war China is not interested in war at all what China Chinese people or Chinese government want is just develop we want to develop we don't want to do business we want to get rich we want to have a better life I say that because for one this country experienced so many wars on this land so even though the young generations don't know haven't experienced wars themselves but they know from their parents their grandparents from our history books what this country went through no one wants war and you know I think especially now when Chinese people see what's happening between Israel and Gaza first Chinese people know both sides of the story and they understand what they've been through the first thing comes to their mind if you go to social network to see Chinese netizens comments everybody is saying it just reminds them of the war when Japanese invaders came to China and it just reminds them of that how young children how Chinese people or Chinese women were being slaughtered but imperial Japanese soldiers so and also Syria went through war and when Syrian president came to China all the netizens saying we all sure the roses of Damascus will bloom again and we used to be under the rain so we want to give others umbrellas now and those comments those are not just one or two it's like massive amount of comments during Syrian president was here during this Israel-Palestine conflict Chinese people sympathize them because they experienced war and they're seeing other people going through the similar experiences they don't want to see that happen again now so the last thing Chinese want is instability because instability with instability you cannot develop there's no economic growth so I think this time when Chinese president and US president met my takeaway okay my takeaway is at least first both sides want to agree to stabilize their relations and and I think both sides realize for a long time the relationship between China and US probably will be negative they are not blindly naively believe it will be all nice and BFF forever but for a long time it will be negative but they have to learn how to coexist I think both sides through the past few years of tech wars and trade wars both sides realize decoupling and military conflicts is no one wanted both sides doesn't want it and also I think through the years both sides realize the limitations of the US sanctions on China China's economy and is quite resilient doesn't mean China doesn't suffer harms from the US sanctions and trade wars and chip wars but it cannot destroy China immediately but also China doesn't want to see this damage so both sides I think just agree okay we cannot change each other but we also cannot afford decoupling and have military conflict with each other so let's just just have a ceasefire just learn how to coexist and if you read Chinese government's comments the message is always just let us develop let us have the right and space to develop and we don't want war so I think that's the major takeaways I'm sure Chinese no one want from China want work with China China's message is just to develop is to achieve its next centenary goal is to build China into a modern socialist country where everyone can have a much better life that's a simple goal so um yeah that's a simple goal that I think you know every person in the world would like to be able to live their lives and so you know you've also traveled not just to the United States and around China but you've also traveled around the world to some of the Belt and Road countries and I wonder you know if you could share with us what you've learned is you've gone to see what does the Belt and Road Initiative look like in Africa and some of the other places you've been you tell us about your adventures well um where to start let me think so I really think that the Belt and Road Initiative is something that will change the world world order completely doesn't mean one country defeat another it's a project that will eventually give the majority of the world a right to develop it will finally allow the developing nations the global south to have the right to have infrastructures to develop that they have been denied for centuries during the western imperialism so when you go to Africa when if you only read Western mainstream media you'll think what China is doing in Africa is horrible but if you go to Africa and talk to African people they have a completely different view they will see the completely different things doesn't mean there's no problems among like the different Chinese companies or with local companies they have they will have conflicts but it's not what the western media described as the new colonialism and the first thing is as a Chinese when I go to those regions everybody treated me so well they treat me as family they welcomed me for example I went to Tanzania the local people when they will ask you where are you from are you Chinese when I told them I'm Chinese they were the first thing they said oh Chairman Mao we love Chairman Mao you are Chinese so they showed so much appreciation and welcomed my hospitality to me when they found out I'm Chinese well and why this show me such a great time not because I'm some like some fancy person or diva or whatever not because of me it's because of the all the Chinese companies factories and engineers there have built the reputation for Chinese people because they saw the difference between Chinese investors and the western investors when Chinese investor came they brought ports water system roads railways and improved their living standards so that's why they like Chinese people and also speaking of Tanzania Tanzania is the starting place of I would say daughter road initiative or China's foreign aid program because the the first railway that China built Africa is the railway called Tazara railway is a railway that linked Zambia and Tanzania and that was built in the 1970s initiated by Chinese chairman Mao and also Zambia's I forgot his full name Kawinda and Tanzania's Nere so these three president chairman talk it out and built this railway and you know during that time Tanzania and Zambia also went for help went asking for help from the United Kingdom from the United States from Soviet Union they asked all those great powers back then but no one came because they even refused to send researchers to do on the ground research because they found it's cost so much money and with little payback so they don't think it's worth investing and so those countries came to China for help and China provided all rounds of help like investigation, exploration design, construction and interest-free loans in the 1970s and it's kind of like what is happening now when you ask those developed nations why they accept China's investments and Western like United States they keep demonizing China's investment is so horrible don't trust China don't work with China but but why didn't you help them they went to you went to you to ask for help but you refused because you don't think it bring enough benefits for you you don't think it's worth investing so China was the only country that provided help I got the same answer in Pakistan I got the same answer in Greece I got the same answer in Tanzania every country I go I asked them how do you think China's assistance that China was the only country that came to help us when we were desperate Pakistan was the same when Pakistan was experiencing this huge debt crisis that's how the CPAC China Pakistan Economic Corridor was built China was the only country to help Greece was the same many European countries are upset that China is the main it controls the port Paris port because China's company bought it they are unhappy with it but when Greece was went through a debt crisis no country went to help so China's company Costco was the only country that invested in it so and then that's that but then you see also the difference because when you go to see those those Chinese or when one of the Chinese is like about a road projects some just think China controls all of that but when you go to those companies you see the employees you see how it worked them actually is the locals that controls this company for example in the I went to a copeland in Pakistan in the copeland how are they helping the local people to be able to run energy plants when the company first went to Pakistan they found out many staff didn't have enough trainings and knowledge of running a huge plant so at the initial stage is probably mainly Chinese engineers and to help that but during that time they also brought hundreds of Pakistani employees engineers to China to be trained and now several years later those who receive the trainings have become have received senior positions in this power plant they've been promoted as a leader in the company so gradually they are giving those key positions to locals once they were got enough training and this copeland itself created so many hundreds of thousands of jobs and when you have a company that creates jobs and generate electricity for the village all the nearby villages has less crimes we went to the nearby villages ask how the villagers feel about this plant near you is there any pollution to to your river to your farmland they all said no and you know what just because there's a plant and all of the men in the village working the plant and there's no crimes anymore so I think that's the fundamental difference between the bottom row initiative and western imperialism is through economic development you can forever have peace and stability and that's the thing many regions wanted in the in the middle east west asia in africa latin america caravans they went through so many wars expectations they never have the rights to develop but this this bottom road is the hope for them to forever change that and hence I want to mention since we talk about the bottom road initiative that's why we hear the lies about Xinjiang because why all of a sudden a few years ago people in the west who have never met any Uyghurs who have never heard about the word Uyghur suddenly talk about Xinjiang talk about Uyghur's rights there's a reason because Xinjiang is the gateway of the bottom road initiative if you look at the map Xinjiang located in the northwest of China it shares borders with eight countries these eight countries are mongolia russia kazakhstan kirkistan tajikistan afghanistan pakistan and india this region itself connects borders with eight countries and you take a look at these countries you know it's in central asia so it also accrued region that many railways connecting Eurasia went through many railways starts from Xi'an in central China goes through Xinjiang and then connect with entire central asia west asia and europe so it's the gateway for the bottom road initiative to expand westward if it worked the bottom road initiative worked in this region it will connect whole Eurasia it will bring peace and stability to Eurasia you know this region has been seen as a geopolitical transport for major powers in the past decades big powers came here for their geopolitical gains and brought forever chaos and wars and insubilities to this region but if this region is connected through economic development through the bottom road initiative it would destroy the major powers geopolitical game and it actually beneficial to the people living in this region so that's why all the lies about Xinjiang were created but you know the lies I'm happy to see the lies are falling apart it doesn't work anymore first is because they never cared about Muslim people's rights except Muslim people in China's rights they don't care about people in Palestine's rights they don't care about people in Gaza's rights I feel the whole world is seeing their hypocrisy and second despite all the lies that the western media western governments has been spreading no Arab nations no Muslim nations believing this narrative Islamic leaders from all around the world different leaders of Arab nations have came to Xinjiang to see for themselves and they all praised China's anti-terrorism method it's it's so funny when you see western countries are crying out loud for Muslim people in China but Muslim leaders are saying oh China's anti-terrorism method is so great how did you do it they want to learn that and they totally support what China is doing in Xinjiang and there's definitely no genocide to the people or to the culture and now Xinjiang has been turned into a pilot free trade zone means more international business corporations cultural technology corporations will take place in Xinjiang so this region will definitely be a hub for international corporations for Central Asia for West Asia for Europe and I think about a road if we all come together and work towards it probably this is give us a chance to develop and rise up peacefully oh my god it's like so you know just so beautiful the vision and how much you embody it yourself I mean the joy you have from you know what you're talking about what you're experiencing and what you see you know one of the things that always shocks me is when you talk about China they're like oh it's a dictatorship and everyone in China just must be a robot listening to the leadership and not knowing how to think and I say you know I think why don't you say that to a person in China directly like what would what would be like to say that to someone you take that like when someone says something like that I find it so insulting and racist you know you must you've experienced all this kind of silliness that people are really even unconscious about what they're saying and what it means to the listener if you do think to share what's that like to listen to some of that information that you get from people in the US I think when I was younger when I hear people say that to my face I was shocked and don't know how to fed back now they say to me I'll just laugh in their face it that they're just very racist I think I also had this experience recently in the United States when some of the American people telling me uh China benefited from the real from the world trade you became rich because you stole the IPs from us it was like that's very American centric thinking if we forever poor and we are always underdeveloped you will say see those lazy awful stupid people cannot develop themselves but if we succeed you will say oh because we made you succeed everything is about you oh why why can it be because we work hard and we design good policies that we finally develop ourselves and uh so and when you say we stole the technology IPs from you now China even have the technology the Americans don't have how can we still think that you don't even have do we steal the space stations do we steal the 5g do we steal all the like from you so that's condescending but also it's sad in a way because those people live in their own bubbles like frogs in a well you'll still think you are the greatest umpire in the world you don't need to look at the world you know that reminds me of the Qing dynasty of China that reminds me of the history during Qing dynasty the last dynasty of China at the ending stage when the united kingdom at the west went through industrial revolution got greater technologies really developed back then but the umpires then still think we are the greatest umpire in the world we we don't need to learn from them we're still great so when you're trapped in that well in living look what happened to China that dynasty it collapsed and China went through war for decades and I think China learned from that experience and China knows you cannot never isolated yourself from the rest of the world you have always need to learn from each from other people whatever they're doing great whatever works for you bring bring it to you learn from them make it a part of your culture um just develop always study and work hard and develop so um I feel maybe this sounds disrespectful to a lot of people in America but I do feel they need to look at the rest of the world look what's going on in the world don't just focus on the united states because I'm sure Chinese people are not doing that Chinese people are looking at the world and the rest of the world are also doing that when I go to the Africa when I go to West Asia go to Southeast Asia you will see people know much about the rest of the world they learn different languages I can share with you there's some observations about the young people I feel about like in China because in the past few months I've traveled to different top universities in China like Beijing Renmin University Peking University Tsinghua University Fudai University and those young students in China give me so much hope about the future of China for example many of them are multilingual not just speaking Mandarin and English many of them speak perfect Arabic perfect Spanish perfect French some of them only 18 19 but already doing different international communication exchange programs go to the UK go to different parts of the world to learn from different cultures some of the students I was told by my Iraqi friend who was giving lectures at universities in China he said those students not only do they speak perfect Arabic they also understand the world of politics and this student who speaks great Arabic also telling him I'm not just learning Arabic I'm also learning Swahili because I'm going to Africa I mean look at the world view of these young generations and another thing is it's very hilarious recently because a few months ago there's a viral video very viral on China's internet is a professor middle-aged professor go to a high school giving Chinese high school students a lecture but his speech was just it's just crazy he was telling the students you just need to work harder make more money and make more money and then go to America and then marry white people so and then upgrade your genes something like that horrible speech and then you know it was at a high school a middle school and the entire crowd was like what but the audiences are teenagers but one teenager stood out from the crowd walked to the stage grabbed the microphone from the professor telling all the audiences who are also teenagers Chinese teenagers like my fellow classmates don't listen to this crappy professor why are we learning where are we studying we are studying for the rejuvenation of a Chinese nation and he got the plot from entire audiences from teenagers imagine a 16 or 17 year the Chinese teenager woke up to the stage calling the professor out and telling his classmates we are studying for the rejuvenation of a Chinese nation that's the spirit on man's side of the young generations in China so I have so much hope for the young generations I mean they represent the future so I really like think the future of this country is very promising well we also have hope work for the young people because right now they're in the streets for Palestine it's definitely an age difference so I do look to the young people of the world to bring us to peace so by the way I also want to give credit to the American youth even though I said something maybe it sounds disrespectful but you know it's understandable they don't know much about China yet because there's no way for them to get information there's no media doing any stories about China there's limitations on China so I understand why they don't know so much about China or the rest of the world but I find what's amazing is those American youth are so open-minded so open-minded and open-minded to diverse cultures and they are very respectful to me and when I tell them I'm from China and they say welcome and I don't know much about your culture but I think your culture is really beautiful I heard your culture is very beautiful so they are very open-minded and I do met a group of students high school students they are super excited about going to China it's the Lincoln High School in Washington State I've got a way to city Lincoln High School those teenagers they are super excited and they want to come to China they want to study and travel to China they cannot wait they are super excited the excitement is like it's incredible and they're super friendly so you know why they're so passionate about Chinese culture and coming to China it's because many years ago Chinese President Xi Jinping and Madame Peng Liyuan visited that school so and they have people-to-people interactions those students in that school met Chinese people have good experience made friends with Chinese people so there's no prejudice there's no stereotypes they're excited about coming to China so maybe that's the thing we need to do just let people meet make friends right so that'll be a start of a better relationship so one of the things that always happens when I say I'm going to China they'll be like you know be safe is what they say and I've been in China with many women from around the world and what every single one of them has told me I mean not I mean every single one of them has said I have never felt so safe in my life no because it's like the water you swim in you don't understand the difference because it's just where you live but you know women from Africa from Latin America they've they've got a profound experience because also they didn't know the difference from where they lived but they were just like all of a sudden they realized I didn't realize how much energy I had to put into each day feeling safe and making sure I was doing the right thing and making myself safe so I'm wondering if you experienced anything in your coming to the United States that would help you understand how those people felt or if you're conscious of what a safe place it is to be in and I felt it in a different way I was there some of the early days right after October 7th and here I was watching hell on earth happen and yet I was in a place where it just felt like peace and harmony so how do you see it me and my friends always joke about when you live in China for too long it lowers your guard of of like means safety because we got used to the safety that we have for me as a woman living in a city like Beijing I can walk alone on the streets any time I want 12 p.m. 1 a.m. 2 a.m. I don't need to worry about a thing that's the safety you can get in most the cities in China seriously and and in many places for example if I go to a meeting go to a event I leave my bags my laptops my cell phone on the table on the tended and go to talk to other people and come back my stuff will still be there and don't worry about being stolen and my other friends said the same thing because recently they went to another country for a meeting and he got used to just leave his laptop and his backpack on the seat on the on the seat and unattended and the local people had to tell him you're not in China grab your stuff with you all the time so I mean so like like we and the nowadays you know because I haven't traveled abroad for like past two years and this year I went to different countries everywhere I go I was warned again and again by local people or by people from from China like be careful with your stuff don't go out at night don't do this don't walk alone don't do that don't do that a lot of warnings so like really in San Francisco it's oh well after seeing what like what's happening on the streets in the area where I live I don't dare to walk out of the door so um this this it's how when many western countries talk about human rights talk about freedom I find it hilarious you don't even have the freedom of safety you don't even have the human rights of just safety or just even just how about your you don't even have a clean city I mean isn't that human rights as well you don't have a safe and a clean city like where's the freedom where's the human rights of that yet in the developing nation in the like very backward China you can't have all the freedom so it's it's and also I think I talked to KJ about it as well I mean because this year we have many friends from different parts of the world like from New York from San Francisco from London from around the world coming to China to Beijing I asked them their impressions about Beijing how do they feel and the word they gave me are also just very simple words oh Beijing is so clean it shocked me I think clean is the basic is a very basic thing for a city to do but so many people came to Beijing said oh Beijing is so clean and how come there's no homelessness in Beijing in China it's like how come you still have homeless people you when you are the number one country in the world I mean there's so much culture shock but uh well I think if if but you know it's not just China many Asian countries are the same if you go to Japan if you go to South Korea if you go to Singapore you will also feel the same level of safety and also cleanness cities in Japan are also very clean cities in Singapore are very clean in general Asia I feel you will have the same level of safety and cleanness and I think that's something western civilized nation think about how come you cannot have the basic things when you look down upon Asia so uh I'm going to let you go even though I'd love to spend another hour with you thank you Jing Jing for sharing your heart and um you know if you want to continue the conversation with her she's got an amazing channel that you can watch she's going to take you around China she'll take you around the world you can follow her on YouTube at Jing Jing underscore Li or on Twitter and um thank you so much for being with us today thanks for sharing your heart and being so authentic and um you don't look like an oppressed person to me or talk like one even though we you know that's what we hear in the United States um so thank you for all you do thank you for building bridges for peace and love and connectivity that's what we need in the world today and you are brilliant at it with your open heart and your your brilliance at being able to see and share deepest gratitude thank you thank you so much Jody for having me all and thank you so much everybody for joining us today I would love to talk to all of you for if we have more time or if we have more chances feel free to reach out to me and I really think it's just we need to step out of our own comfort zone step out of our own bubbles and just to meet each other talk to each other talk to each other and visit each other's country and learn each other because when you actually just like I mentioned earlier when you actually meet the person that you didn't know before when you actually went to the country they didn't know before all the stereotypes all the stereotypes you had just just collapse and the during the COVID years when most people cannot come to China the media abuse that opportunity to spread all kinds of lies but all those lies are collapsing because people all come to China and see for themselves it doesn't work anywhere so just like I said in my video when you come here see for yourself have people to build about interactions all the narratives the media spreading won't be working so let's be friends let's make friends and come to China I will be here welcoming all of you and I want to go to the United States again and again to help more people build more people to people connections so thanks for talking it out with us Jingjing all right much love and peace peace thank you