Madan, Jason: So we lose all of our health economic capacity, you know, in one fell swoop.
Madan, Jason: But, you know, a big welcome to everybody to today's
Madan, Jason: inaugural lecture, Professor Jason Madden, family, friends and colleagues,
Madan, Jason: welcome to this inaugural lecture. An inaugural lecture is a significant
Madan, Jason: milestone in an academic's career, marking their promotion to the rank of
Madan, Jason: professor. And this title is not something that is
Madan, Jason: conferred lightly. It follows a rigorous and reflective
Madan, Jason: process.
Madan, Jason: Acknowledges not only outstanding achievements,
Madan, Jason: but also the deepest respect and admiration of peers and the academic
Madan, Jason: community.
Madan, Jason: Becoming a professor on as an individual's exceptional contribution and
Madan, Jason: the meaningful impact that they've made both within their field and across the
Madan, Jason: wider landscape of health education, it also sets a high bar for the future as
Madan, Jason: the title carries with it responsibilities to uphold the values of
Madan, Jason: collegiality, academic freedom and the relentless
Madan, Jason: pursuit of knowledge and impact and the benefits of society.
Madan, Jason: At Warwick Medical School, our vision is to transform health through
Madan, Jason: innovative education and research excellence,
Madan, Jason: and we're incredibly fortunate to have Jason as part of our professori at an
Madan, Jason: academic community.
Madan, Jason: Jason joined Warwick in 2012, following roles in Bristol and Sheffield,
Madan, Jason: and since then we've witnessed his career flourish progressing from the system to
Madan, Jason: associate and now on to full professor. As director of the Centre for Health
Madan, Jason: Economics, Jason leads by example. He embodies the very best of academic
Madan, Jason: life, combining excellence in research with a
Madan, Jason: deep commitment to education.
Madan, Jason: His leadership and mentorship continues to inspire students and colleagues alike.
Madan, Jason: Jason's research and health economic evaluation addresses critical challenges
Madan, Jason: in cancer, infectious diseases and mental health,
Madan, Jason: both locally and globally, informing health policy and practise
Madan, Jason: exemplifies the power of applied interdisciplinary research to make a real
Madan, Jason: world impact. I'm really looking forward to your
Madan, Jason: presentation. If I were the money man, the challengers and joys of a career in
Madan, Jason: health economics.
Madan, Jason: It promises to offer fantastic insights into the rewarding and often complex
Madan, Jason: world of health economics.
Madan, Jason: Contribution to both the local and international stage.
Madan, Jason: Looking forward to talk Jason. Thank you.
Madan, Jason: And thank you.
Madan, Jason: So I'd like to thank you all for coming today.
Madan, Jason: I'd like to thank Gavin in the medical school for those very kind and generous
Madan, Jason: words.
Madan, Jason: For the chance to stand up here and talk about myself and my discipline for almost
Madan, Jason: a whole hour, but most importantly of all, for giving me a professional home for the
Madan, Jason: last 13 years. And if you were to ask my family,
Madan, Jason: and you can. They're here today. Welcome.
Madan, Jason: I hope you're to ask me if I've they thought they're gonna stick anything out
Madan, Jason: for that long. I'll bet they'd say no way. And the fact I have reflects not just how
Madan, Jason: great it is to work at what medical school. I can say that.
Madan, Jason: I'd say that even if you weren't here, gap and I promise,
Madan, Jason: but also how health economics is is a fascinating and rewarding field to work
Madan, Jason: in. And so I want to share with you my
Madan, Jason: colleagues and family today.
Madan, Jason: Why it's such a joyful thing to work in, but in the interests of balance.
Madan, Jason: I'm also going to share some of the frustrations and the challenges of being
Madan, Jason: a health communist. Luckily, as often as the rain life,
Madan, Jason: the things that make health joyful are also the source of those frustrations and
Madan, Jason: challenges. So I can cover both of those without
Madan, Jason: running over time. So don't worry about that.
Madan, Jason: So the risk of sounding like a petulant teenager,
Madan, Jason: I'm going to start with the frustration that's being misunderstood sometimes,
Madan, Jason: and some of the people that you come across almost seem to view health
Madan, Jason: economists as Oscar Wilde view cynics as people who knew,
Madan, Jason: know the price of everything but the value of nothing.
Madan, Jason: And I'm sure that isn't true of any of you here today.
Madan, Jason: All the people I get to work with.
Madan, Jason: In the projects that I've had a chance to work with over my career.
Madan, Jason: But every so often I'll stand up to present my healthy confidence results as
Madan, Jason: part of a project dissemination event. And I've been introduced several times as
Madan, Jason: the money man. Now it's time to hear from the money man,
Madan, Jason: and I know it's kind of meant jokingly, but I stand up and I go and I think
Madan, Jason: something about some of my colleagues from university days who did maths and
Madan, Jason: economics. They've gone to places like the city and
Madan, Jason: they really are the money men and the money women and I think, yeah,
Madan, Jason: I wish I had some of that but actually.
Madan, Jason: My my title is a bit of lie today because I don't really wish I was a money man.
Madan, Jason: I think what I wish what I want to be, what I hope I am,
Madan, Jason: and I think my colleagues speaking for you today hope that you all are value men.
Madan, Jason: And value women. And to illustrate what I mean by that,
Madan, Jason: I wanted to talk to you about a couple of projects I could have talked about many.
Madan, Jason: The first one is sort of, which is sort of illustrated by the
Madan, Jason: picture on the left here. Is that a trial we'd recently completed
Madan, Jason: here at the clinical trial unit called Pippa. So Pippa was evaluating.
Madan, Jason: An online parenting support training course,
Madan, Jason: several modules and we found in Pippa that parents felt from doing this course
Madan, Jason: that they felt more confident as parents. They felt they showed they would show
Madan, Jason: that they were kind of up skilled. If you give that ugly word.
Madan, Jason: And and it was really rewarding to see that we were benefiting parents in that
Madan, Jason: way and helping them to look at, to manage,
Madan, Jason: to help their children manage that very tricky period in life between the ages of
Madan, Jason: 11 and 15. So a wonderful project have been involved.
Madan, Jason: So the second project I want to kind of get talk about to get us thinking about
Madan, Jason: this is that kind of illustrated by these pictures on the right.
Madan, Jason: And the picture there, you can see.
Madan, Jason: It's like a beauty parlour. There's a barbers, a nice canteen,
Madan, Jason: some good food there, and it might not be obvious to all of you
Madan, Jason: where those pictures were taken.
Madan, Jason: They're actually taken in what I believe is South Asia's largest inpatient mental
Madan, Jason: health hospital, which is in Nagpur in India and I was
Madan, Jason: there. The reason I was there as part of this
Madan, Jason: group was because I was supporting supervising APHD student called Tasneem
Madan, Jason: Raja. And OK aside here, having put this talk together,
Madan, Jason: I realised that most of what I'm going to talk about today is not stuff I've done
Madan, Jason: myself directly, but stuff that PhD students I work with
Madan, Jason: has done.
Madan, Jason: And I don't think that's an accident. I think the and I was thinking about the
Madan, Jason: the thing my career probably found most rewarding is supporting students and
Madan, Jason: supervisors both myself as a supervisor, but also the time I spent as head of our
Madan, Jason: PGR programme here at the medical school and through that experience I've learned
Madan, Jason: as I think many of you will know that our PhD students, our PGR students are.
Madan, Jason: And you can kind of pick your metaphor here. They are the the engine room.
Madan, Jason: They are the foundation. They are the greenhouse in which.
Madan, Jason: So much of our innovative research flourishes,
Madan, Jason: develops and and and and becomes impactful.
Madan, Jason: So and this example just to sneeze work, Tasneem was running a project called Uran,
Madan, Jason: which I believe correct me Mum and Dad. If I'm wrong,
Madan, Jason: I believe it means flight in Hindi and the aim of Iran was to improve the
Madan, Jason: dignity and well-being of people living what can be quite a challenging
Madan, Jason: environment.
Madan, Jason: A mental hospital in a place like India. So with both these projects and many
Madan, Jason: others.
Madan, Jason: They're clear, very, very valuable and impactful things.
Madan, Jason: Things that we as academics want to support and get involved in.
Madan, Jason: Some of you may wonder what? Why do you need a health economist to get
Madan, Jason: involved in these sort of things and others more knowledge,
Madan, Jason: more knowledgeably will say.
Madan, Jason: Well, you have to show things that these are
Madan, Jason: cost effective, don't you as well as effective.
Madan, Jason: And I'll come back to this idea of cost effectiveness later on in my talk.
Madan, Jason: But the point I want to make just now at the start of this talk is if you think
Madan, Jason: about it, we can certainly work out what investment
Madan, Jason: is required to do these things and that's useful.
Madan, Jason: But the real challenge if you're taking your work when you're working in these
Madan, Jason: constrained environment resource challenge environments,
Madan, Jason: is trying to advocate for independence like this.
Madan, Jason: Compared to all the other pressures that policymakers and services have.
Madan, Jason: And that boils down to trying to measure capture.
Madan, Jason: Compare something very intangible, which is the value of that you create in
Madan, Jason: people's lives are doing these things, and I think that is in fact the most
Madan, Jason: interesting part of health economics for me.
Madan, Jason: And I think probably for many of my colleagues. And that's why I say.
Madan, Jason: I want to be and I think we all want to be value men and women. Maybe not money,
Madan, Jason: men and women, to be fair.
Madan, Jason: When did you talk about this? See, it gives you a chance to maybe look back
Madan, Jason: and and how did you get where you are today?
Madan, Jason: How did you go from being this very fresh faced young lad?
Madan, Jason: And if you can spot me there. So at the back to this much older, grayer,
Madan, Jason: more wrinkled, very happy health. Member of Chew on the right and I'd love
Madan, Jason: to say it was a very straight and smooth path. But As for many people.
Madan, Jason: I didn't dream of becoming a health economist when I was at school,
Madan, Jason: I didn't even know what one was, of course.
Madan, Jason: So it was a bit more of a meandering path that I took.
Madan, Jason: With lots of sliding doors moments along the way.
Madan, Jason: I could have ended up as all sorts of things I could have ended up as a money
Madan, Jason: man potentially. I'm quite happy with how I how I end,
Madan, Jason: where I ended up though so.
Madan, Jason: Even if I didn't take as my family will will know with some frustration,
Madan, Jason: I didn't take the sensible, direct route to get there.
Madan, Jason: One thing when I was thinking back on this one thing that I realised was I do
Madan, Jason: love a university and in fact I've spent my pretty much my entire adult life
Madan, Jason: either studying or working in and for universities I've been involved,
Madan, Jason: I've been linked works of, housed by or found a home in seven across
Madan, Jason: the UK and you feel free to tune out. While I'm awfully on on this slide and
Madan, Jason: try and work out which ones they are.
Madan, Jason: I think the middle one, you'll get straight away, but mostly,
Madan, Jason: but if you can perk up the others too.
Madan, Jason: And that's, I mean, particularly in this time when in many
Madan, Jason: ways universities are under a lot of pressure, a lot of attacks.
Madan, Jason: I really feel this is something that we need to defend,
Madan, Jason: that they they produce huge amounts of value both for the people who studying
Madan, Jason: them and work in them, but also for the communities they serve
Madan, Jason: and support, which can be the global community as well.
Madan, Jason: We'll see.
Madan, Jason: Having you said that I would just mention before I don't talk about it anymore.
Madan, Jason: I did spend a bit of time in what you might call the real world for a few years
Madan, Jason: around Millennium back back in those days. And I did two very different things in
Madan, Jason: that time as as my family will remember.
Madan, Jason: Part of that was I I trained and worked as a teacher of English as a foreign
Madan, Jason: language and saw some wonderful places like this picture is timishwara.
Madan, Jason: If you've ever been in Romania, if you haven't, getting some.
Madan, Jason: Some people have, it's definitely worth visiting.
Madan, Jason: Wonderful place.
Madan, Jason: The other so then I did that for a while and then completely did a 180 and decided
Madan, Jason: panic decided to train as a chartered accountant.
Madan, Jason: So then I was the money manager, a while in a way.
Madan, Jason: But I managed, you know, I that didn't last.
Madan, Jason: I knew I was in the wrong place. I moved back into the world universities
Madan, Jason: and that's where I am today and.
Madan, Jason: I guess you know you could say that. Think about this.
Madan, Jason: I did realise quite early on, particularly the counter training quite
Madan, Jason: early on. It wasn't for me.
Madan, Jason: I did stick it out. I qualified as a chartered accountant.
Madan, Jason: I don't like admitting that. But I'll I'll admit it today.
Madan, Jason: So I was a qualified chartered accountant and I stuck it out.
Madan, Jason: Even though after a few weeks I realised it was the wrong thing to do.
Madan, Jason: So what lesson should we take from this? We could take the lesson away.
Madan, Jason: That don't be afraid to quit. But I don't feel like that's the lesson.
Madan, Jason: Really. I should be standing up here and giving.
Madan, Jason: So I'll try a different lesson. Which is even when you take a false path,
Madan, Jason: it's never a disaster.
Madan, Jason: You'll still find some scenic things to enjoy along the way. So for example,
Madan, Jason: teaching us the foreign language actually was really.
Madan, Jason: A real sort of insight. It was really helpful to have that
Madan, Jason: experience of taking something that you do very naturally,
Madan, Jason: like speak your mother tongue and try and teach it and communicate it to to to
Madan, Jason: others.
Madan, Jason: And I've benefited from that experience, undoubtedly, and Even so my time in,
Madan, Jason: in the firm Anderson. So I work with Arthur Anderson.
Madan, Jason: If you haven't heard of that, it was one of the biggest financial
Madan, Jason: companies in the world. If you haven't heard of it,
Madan, Jason: it's because they blew up because of something called Enron scandal.
Madan, Jason: Nothing to do with me, I promise. Firstly.
Madan, Jason: The statement I'm paper shredders, unlike many of the former employees,
Madan, Jason: but my job title then was assurance risk consultant and you know,
Madan, Jason: you might think what you know what a waste of no wonder you wanted to come
Madan, Jason: back to universities. That's a little bit more like a proper
Madan, Jason: job, a little bit more. But actually what I learned in that
Madan, Jason: experience was we we were trained to think about things like business risk.
Madan, Jason: So to understand processes in an organisation.
Madan, Jason: How they systematically or systemically might go wrong,
Madan, Jason: and what you might do to to mitigate those things,
Madan, Jason: or you know to pick them up early. And when you think about it,
Madan, Jason: that's actually a really good experience for working in clinical trials,
Madan, Jason: isn't it so?
Madan, Jason: So let's take the lesson from that experience of is don't worry if you take
Madan, Jason: a wrong turn now and again, it won't hurt you.
Madan, Jason: You'll still pick up things you didn't expect along the way.
Madan, Jason: None.
Madan, Jason: So. So my kind of routine to health economics
Madan, Jason: was I started off as a mathematician. That's why I started off doing at
Madan, Jason: university. I realised that was too hard. I switched to economics,
Madan, Jason: which I very much enjoyed. I stumbled across the concept of equally
Madan, Jason: and was intrigued and ended up in health economics by doing masters in York.
Madan, Jason: Like several of you here, that's kind of your we just want the
Madan, Jason: pictures just to give answers out. Now many of us go down that route and
Madan, Jason: York is kind of a mothership, isn't it? For many of us who are health economists,
Madan, Jason: but.
Madan, Jason: There are many routes into the field, actually,
Madan, Jason: and we've worked with many of us, James Mason,
Madan, Jason: who was recently offered this parish, was an engineer.
Madan, Jason: I think every nautical engineer or something like that.
Madan, Jason: He was some kind of engineer.
Madan, Jason: I think it was. It was an engineer anyway.
Madan, Jason: We work with clinicians, dentists, pharmacists.
Madan, Jason: Statisticians, people come from all sorts of backgrounds,
Madan, Jason: not just economics, to do health economics.
Madan, Jason: And it's kind of like, I think it's also like kind of the French
Madan, Jason: Foreign Legion of disciplines where we welcome people from.
Madan, Jason: We don't ask too much about your backgrounds to come in,
Madan, Jason: find a new home with us as long as you devote yourself to the fight for
Madan, Jason: allocative efficiency, you're welcome.
Madan, Jason: And I think partly that reflects the fact that we're very pragmatic and problem
Madan, Jason: focused.
Madan, Jason: And we we drawn lots of disciplines. I mean obviously economics is the obvious
Madan, Jason: one and we draw across many fields of economics. And what we do.
Madan, Jason: But actually you know the we draw maths on stats on operational research and
Madan, Jason: modelling, we've drawn drawn lots of clinical
Madan, Jason: specialities, you know psychology, lots of qualitative methodologies as many
Madan, Jason: will know actually some people may be surprised to hear.
Madan, Jason: A part of of healthy comics too, so I think that's one of the things joys
Madan, Jason: of what? Why it's such a rewarding careers is if
Madan, Jason: you like that sort of thing. And I've just thought the person who,
Madan, Jason: when I was at Uni, couldn't go and revise in the library
Madan, Jason: because I'd be reading everyone else's books rather than my own because I'm just
Madan, Jason: obviously more interesting. So you have that kind of mindset and I
Madan, Jason: think a lot of us in health economics do. That's why it's a very rewarding place to
Madan, Jason: be because you can satisfy that curiosity and that breadth of interests that a lot
Madan, Jason: of us have.
Madan, Jason: So another aspect as as Gavin mentioned, was the fact that as health commissions
Madan, Jason: had a chance to see the world again, a bit like the French Foreign Legion I've
Madan, Jason: got, I've had the chance to see the world and
Madan, Jason: I was actually through joining Quarry before I joined Warwick.
Madan, Jason: I'm very much focused on on UK health economics and methods stuff,
Madan, Jason: but since joining work, I had a chance to to visit many wonderful
Madan, Jason: places. This is just a handful.
Madan, Jason: I've got many, many photos like this. I could have used here and all these
Madan, Jason: photos were taken on work trips.
Madan, Jason: I won't try and pretend that all of them are directly work related.
Madan, Jason: And there are definitely joys in just be able to travel. I mean,
Madan, Jason: their joys in hanging out with beach in Brazil and I can't recommend highly
Madan, Jason: enough if you ever get the opportunity to go wine tasting with Martin Underwood.
Madan, Jason: Take it. It's a wonderful thing to do. That's Stellenbosch in the top right.
Madan, Jason: But it wasn't all like that before you get to, you know,
Madan, Jason: sort of two sort of frustrated with me. And I think I'm complete skydiver.
Madan, Jason: It was. It was actually really incredibly useful
Madan, Jason: to my work to be able to do that.
Madan, Jason: And think about one of the first experiences I had.
Madan, Jason: Back me up. Probably 2013. I got to visit.
Madan, Jason: A large TB tuberculosis hospital in Blataire in Malawi,
Madan, Jason: which was a huge eye opener for me.
Madan, Jason: So many differences and a lot of challenges, as you can imagine.
Madan, Jason: And one of the things I remember going around the tour and around the back,
Madan, Jason: I looked out the window and there were all these,
Madan, Jason: some tents up and there's like washing lines,
Madan, Jason: it kind of reminded me of almost there when we did our Duke of Edinburgh
Madan, Jason: expeditions as a as a teenager.
Madan, Jason: All set up there, very sort of ramshackle, and I sort of asked the person who's
Madan, Jason: taking me around what's going on there, what's that doing in the back of your
Madan, Jason: hospital?
Madan, Jason: And maybe I should have worked it out what that was and what they told me it
Madan, Jason: was, is. That's where the Guardian stayed. So the point is that as I had no idea
Madan, Jason: until you know, you really get on the ground to
Madan, Jason: understand this, they really have a massive shortage of
Madan, Jason: funding and nursing staff available. So a lot of the in the basic nursing care,
Madan, Jason: the people need their families to do it so often.
Madan, Jason: Bring someone with you when you have to stay in between length of time.
Madan, Jason: TB treatment can be months.
Madan, Jason: As many of you will know, so you have a guardian with you who does
Madan, Jason: lots of sorts out your meals and lots of basic nursing stuff.
Madan, Jason: I wish I would never have understood or realised, you know,
Madan, Jason: unless I've seen it for myself. And actually a lot of the work I've gone
Madan, Jason: on to do in global health economics has been trying to understand and measure the
Madan, Jason: impact that being ill and seeking care has on on, on household poverty,
Madan, Jason: creating or or further driving people into creating poverty.
Madan, Jason: Or further driving people into it. That's been a big part of what I do.
Madan, Jason: And even in this age now with of teams and and we're all we're all working
Madan, Jason: offline, a lot of the time, it's still there's no substitute for
Madan, Jason: getting on the ground and seeing how Healthcare is delivered in facilities and
Madan, Jason: communities across the world. It really does bring a lot of insight and
Madan, Jason: direction to your research. So the wine tasting is fun,
Madan, Jason: but actually the experience will be able to see how Healthcare is delivered and to
Madan, Jason: understand that impact in communities across the world.
Madan, Jason: Is a wonderful privilege and one of the things I've really loved about this this
Madan, Jason: role.
Madan, Jason: So.
Madan, Jason: I was talking to about things that are the joys,
Madan, Jason: and they're also the frustrations, and I could have said that about the
Madan, Jason: global travel and how frustrating it is to have to live out of the suitcase every
Madan, Jason: often, but I could see you all pulling out your
Madan, Jason: world's smallest violins if I tried that. So I won't claim that's frustration.
Madan, Jason: But one of the things that's a huge joy and also can be quite a challenge.
Madan, Jason: It goes back to this idea of how we work. So we we we're quite interdisciplinary in
Madan, Jason: how we work.
Madan, Jason: And it's not a subject to working. If you like being in your own bubble in
Madan, Jason: your own space with like minded folk, because inevitably in trials, in in,
Madan, Jason: in Policy Studies, you work with large multidisciplinary
Madan, Jason: teams. You work with clinical experts, you work with methodologists, astitons,
Madan, Jason: sociologists, anthropologists, decision makers, health, health managers.
Madan, Jason: Members of the public.
Madan, Jason: Which is a joy. Definitely. I think for me,
Madan, Jason: I've really enjoyed having that kind of diversity of views and learning from that.
Madan, Jason: But it can also be a challenge and a frustration and.
Madan, Jason: It does, and it's something that I've thought
Madan, Jason: about more and more working through projects and I get to use a bit of
Madan, Jason: foreign language now, which I love. So economics is almost as bad as medicine
Madan, Jason: when it comes to loving Latin, to confuse and distract people.
Madan, Jason: So in economics, when I've moved from math,
Madan, Jason: I learned terms which I love, like, mutatis mutandis, cetiris paribus.
Madan, Jason: And my personal favourite, degustibus, non S disputandum.
Madan, Jason: Of that phrase, I won't translate them for you now I'm
Madan, Jason: afraid if you've done laughing, you'll know what they are. If not,
Madan, Jason: I'm going to preserve that mystique for a few minutes. But actually,
Madan, Jason: I'm going to use a French term. Even better. Therefore,
Madan, Jason: Massell professor now. And as you can probably guess,
Madan, Jason: because French is not that hidden language for us,
Madan, Jason: it kind of refers to the way in which your professional training shapes and
Madan, Jason: often distorts the way you see the world.
Madan, Jason: And I think this concept originally sort of came across in quite a physical way.
Madan, Jason: So you can imagine how your job might lead to calluses or Stoops,
Madan, Jason: but that actually became a way to think about how.
Madan, Jason: The way you're trained, the way you work, the way the way that you kind of kind of
Madan, Jason: work things, you do shape a lot of in a lot of sort of
Madan, Jason: unchallenged and unconscious ways, how you see the world.
Madan, Jason: And then when you bring bring these things together.
Madan, Jason: You find there's this mutual incomprehension because we don't have the
Madan, Jason: shared understanding anymore.
Madan, Jason: So one way that manifests itself is definitely through language.
Madan, Jason: So there are lots of examples of this when,
Madan, Jason: as you'll know from your work where we'll use words and not realise that they're
Madan, Jason: either being misunderstood or or creating completely wrong impression.
Madan, Jason: And I remember.
Madan, Jason: You're meeting a few months ago where STAP stations start talking about matrix
Madan, Jason: decomposition and the commissions were like, no, you can't.
Madan, Jason: You can't say that you can't decomposition.
Madan, Jason: You can't talk about decomposition. It's not healthy, you know,
Madan, Jason: and force that decision hasn't, you know, it was just a very technical term in
Madan, Jason: mathematics, hadn't really thought about that,
Madan, Jason: but has a very different meaning to a non statistician. But I think, I mean,
Madan, Jason: there are many examples of that and I'm sure a lot of you can come up with those.
Madan, Jason: But the word actually, I was thinking about for this.
Madan, Jason: Was an assumption.
Madan, Jason: And what I kind of realised was.
Madan, Jason: For a lot of people I work with an assumption. Something you have. If you,
Madan, Jason: if you really have to. If you haven't got data,
Madan, Jason: you must get data as soon as possible, and it's kind of the thing you say what?
Madan, Jason: You know, what you do when you assume, right?
Madan, Jason: That's the kind of I think that's the kind of assumption.
Madan, Jason: But actually coming from a maths and a modelling background,
Madan, Jason: assumptions are part part of what you do and they're very important and valid.
Madan, Jason: You set out your assumptions first.
Madan, Jason: And then you build on those for your analysis and then you see where your
Madan, Jason: assumptions take you, and there's nothing, nothing derogatory about making
Madan, Jason: assumptions. It's just part part of what you do and
Madan, Jason: actually thinking about this. It's not just that we use the same word
Madan, Jason: in different ways, but we have all these connotations to the
Madan, Jason: word.
Madan, Jason: But you don't realise until you try and discuss that.
Madan, Jason: And I've had people say to me doing modelling health comics, for example,
Madan, Jason: modelling model based health economics for example research.
Madan, Jason: I guess and I sort of see where they're coming from after a while,
Madan, Jason: it just isn't kind of research they're expecting to see.
Madan, Jason: So another example of this then is another background thing.
Madan, Jason: As an economist and a modeller is you're very much thinking about decision theory.
Madan, Jason: A lot of the time when you work with people who come from different
Madan, Jason: backgrounds, say, people are interested in open space
Madan, Jason: medicine or or hard science.
Madan, Jason: They have a there's a whole kind of framework around scientific inquiry which
Madan, Jason: is different. It is a different way of seeing the world
Madan, Jason: and then we do have some contrast about that and I think where that becomes quite
Madan, Jason: interesting is how we think about uncertainty and those of you who know me
Madan, Jason: well will know about my love of Bayesian methods and some of you are horrified by
Madan, Jason: that, I know.
Madan, Jason: And I, but I think it just reflects the kind of
Madan, Jason: problems that we think we're dealing with and I kind of almost one time I thought
Madan, Jason: the difference here is.
Madan, Jason: A lot of the statistians I work with in in the scientific inquiry there.
Madan, Jason: They're like uncertainty is like an infestation.
Madan, Jason: They're like pest controllers. We need to eliminate it.
Madan, Jason: We need to eradicate it. But from a decision size point of view,
Madan, Jason: we're more like kind of wildlife photographers.
Madan, Jason: We love studying uncertainty in the world around us. We seem we have to have it.
Madan, Jason: So I think. But that's all kind of comes to your
Madan, Jason: training and the kind of problems you're used to dealing with.
Madan, Jason: But we come together with these perspectives,
Madan, Jason: these different perspectives and have lots of arguments about something where.
Madan, Jason: Actually the the underlying math is all correct and true.
Madan, Jason: It's just the way it kind of fits with how we see the world is slightly
Madan, Jason: different.
Madan, Jason: So a couple of examples, because I've thought about this a lot and
Madan, Jason: I find it really interesting, fascinating and as well as challenging.
Madan, Jason: And there are many other examples of this. So another one is I think one thing that
Madan, Jason: happens when you do, if you with my background in training in
Madan, Jason: kind of model based evaluation and operational research management science,
Madan, Jason: lot of it is about developing models that are simplifications of the of the of the
Madan, Jason: world, right.
Madan, Jason: And a lot of you will have heard the famous saying we all Strat out with,
Madan, Jason: which is all models are wrong, but some are useful.
Madan, Jason: But so, but to build those models you have to
Madan, Jason: engage with the experts because you're not the expert or the model builder and
Madan, Jason: often so working with clinicians, for example,
Madan, Jason: to try and understand the National History of a disease or how treatments
Madan, Jason: work. You'll try and get past some of the
Madan, Jason: detail because you think you can. You know it's it's not seeing the wood
Madan, Jason: for the trees, but actually for the Commission that
Madan, Jason: detail is hugely important for that core role of being a diagnostician.
Madan, Jason: So you're kind of coming out from a very different point of view and that can lead
Madan, Jason: to lots of frustrations. Well, you just kind of recognise that over time.
Madan, Jason: And finally I the last thing I'd say about this topic is.
Madan, Jason: We are researchers, but we don't even know I love
Madan, Jason: universities. I love, I love the ivory tower.
Madan, Jason: I don't live in an ivory tower and we don't live in an ivory tower.
Madan, Jason: We work with people delivering care on the front line. We work with managers,
Madan, Jason: we work with the public. But actually with academics,
Madan, Jason: we have a certain way of thinking about things and certain way certain sort of
Madan, Jason: expectations around processes and rigour which maybe don't sit with how people
Madan, Jason: outside that bubble think.
Madan, Jason: And again, that can be a huge challenge in in
Madan, Jason: running these large multidisciplinary studies.
Madan, Jason: So this can be frustrating I think, and the definitely day-to-day I'm I'm
Madan, Jason: hopefully some people will recognise this. We get these mutual frustrations through
Madan, Jason: mutual gaps in understanding but we have to work past that and I think you can
Madan, Jason: think about the you'll you'll probably know the story of the the blind men and
Madan, Jason: the elephant and each of those blind men they're holding on to bit of the elephant
Madan, Jason: and they're not unsaning the elephant one's feeling a tree.
Madan, Jason: One's feeling a rock. One's feeling, you know.
Madan, Jason: I kind of I kind of what they're all feeling,
Madan, Jason: but none of them are feeling the elephant. But if they can talk to each other.
Madan, Jason: We can work out what an elephant looks like,
Madan, Jason: and I think that's what makes this fascinating and important as well as
Madan, Jason: frustrating.
Madan, Jason: OK.
Madan, Jason: Because this is, I think, really, I'm so fascinated by this topic,
Madan, Jason: I wanted to give you an example of a project where we're we're looking at this
Madan, Jason: explicitly. So in Atara, which is a project that started last year.
Madan, Jason: Several of us are looking at the integration of TB and lung health
Madan, Jason: services across three countries. Nigeria, Tanfania and Kenya.
Madan, Jason: And the background to this is TB is globally recognised health concern,
Madan, Jason: huge amount of attention by bodies like who and most countries will have quite
Madan, Jason: relatively well funded and and well monitored and effective TB programmes.
Madan, Jason: But there are other conditions that actually do cause a huge and growing
Madan, Jason: problem in those countries. COPD, asthma, so on,
Madan, Jason: they don't have their own programmes, they get treated alongside everyone else
Madan, Jason: in the hospitals and the clinics locally.
Madan, Jason: And actually that not only is that maybe an imbalance, but it's.
Madan, Jason: It it it's, it's it's. It ignores the fact that these things are
Madan, Jason: related. So if you have TB, if you have quite lung health,
Madan, Jason: you're more likely to develop TB. If you develop TB, even if you're cured,
Madan, Jason: you're left with lung damage. That leaves you vulnerable to these
Madan, Jason: chronic health lung health conditions. So there's a real there's the motivation
Madan, Jason: is to look at kind of joined up thinking about these conditions,
Madan, Jason: but that creates lots of questions. What do we actually mean by integrating
Madan, Jason: them?
Madan, Jason: Why has it not happened yet? What are the patient perspectives on this?
Madan, Jason: As economists, you know what? What the resources available and what
Madan, Jason: what's the impact on poverty and how can they be be addressed.
Madan, Jason: So as you can see this is this is an elephant kind of problem and it can't be
Madan, Jason: tackled in silos.
Madan, Jason: And one thing that's quite rewarding about this is.
Madan, Jason: And if you've explicitly recognised that and I'm in the project,
Madan, Jason: so we work with a multidisciplinary team, we have clinicians, experts,
Madan, Jason: young health from, from imperial and from the three African
Madan, Jason: countries, we have myself as a health economist,
Madan, Jason: we have statistician, we have a social scientist,
Madan, Jason: anthropologist, and we've thought from the start about
Madan, Jason: how we're going to work together. So the project funds three PhD students,
Madan, Jason: health economist, a social scientist and a clinician.
Madan, Jason: And there's also a postdoc whose background is in qualitative health
Madan, Jason: systems research, and we've set up a joint working group.
Madan, Jason: There was junior researchers. They come together.
Madan, Jason: Show each other's research plans, comment on each other's findings so they
Madan, Jason: get that outside perspective from the start,
Madan, Jason: and we're also running workshops and meet our disciplines where we share what we're
Madan, Jason: doing and we get feedback on whether it makes sense.
Madan, Jason: So what's my life about this project? A lot is that it's it we're trying to
Madan, Jason: explicitly as a priority from the start and hopefully we'll be able to see in a
Madan, Jason: few years time that it's really helped us become more insightful and effective.
Madan, Jason: So here's another joy of being able to call Miss is that you can actually make a
Madan, Jason: difference, as Gavin kindly mentioned you know we we
Madan, Jason: the work we do as health economists it directly influences UK and international
Madan, Jason: guidance and guidelines.
Madan, Jason: It it it's also happened globally and that's one thing I've really,
Madan, Jason: really been really motivated to be involved in with lots of other health
Madan, Jason: policies to push The Who to recognise the problem of.
Madan, Jason: Impoverishment in TB and they've made WH have made the elimination of TB related
Madan, Jason: catastrophic costs to policy goal.
Madan, Jason: And I've played a very small part in that with lots of our promise,
Madan, Jason: and that's a real a real source of pride and and sense that you're making a
Madan, Jason: difference and it's wonderful working in a in a trials unit where as you'll know
Madan, Jason: that the trials that we do directly then go in and feed in these national
Madan, Jason: international guidelines and change the day-to-day realities of patient care.
Madan, Jason: And that is very rewarding.
Madan, Jason: But with every joy comes a challenge. That's my theme today.
Madan, Jason: So actually the flip side of health of healthcare research,
Madan, Jason: I think is inevitably and rightly it's a very political topic.
Madan, Jason: You can't just put your research out there and have your peers applaud it.
Madan, Jason: At conferences, you'll find you may have a very strong
Madan, Jason: view about what should happen, but the role in the real world decision
Madan, Jason: making is very complex.
Madan, Jason: There are various different special interests that lobby together or against
Madan, Jason: each other against each other. There are all sorts of issues around.
Madan, Jason: How budgets get allocated and you find that you need investment in one part of
Madan, Jason: the system, like a local authority. But the benefits are actually accruing to
Madan, Jason: the NHS or many examples like that. So it makes it very difficult to to
Madan, Jason: advocate advocate for something when someone's bearing the pain,
Madan, Jason: the other one's sort of half seeing the fruit and there's a more general problem
Madan, Jason: with that leads from that, which is we live in a world where there's
Madan, Jason: a lot short termism a lot of the lot of the benefits that we measure and want to
Madan, Jason: abdicate for.
Madan, Jason: There are a few years or decades down the line,
Madan, Jason: and that's a challenging thing to get people to to buy into.
Madan, Jason: So what can we do about this? As health economists,
Madan, Jason: particularly for the the row at the back question for you to tomorrow? Well,
Madan, Jason: my my suggestion is I think there's two ways two different ways to do this.
Madan, Jason: One is to stand your ground and advocate for what we do.
Madan, Jason: So you know that if we believe that the certain decision to adopt or not adopt an
Madan, Jason: intervention or to adopt policy is the right one overall for maximising health
Madan, Jason: and improving health.
Madan, Jason: We should try and explain how we got to that.
Madan, Jason: Conclusion. So it's it's, it's honest to explain our kind of our
Madan, Jason: ideas as best we can.
Madan, Jason: But we shouldn't just assume that that is that we should never obviously assume
Madan, Jason: that the problem is we're right, but we're just not understood.
Madan, Jason: We need to just shout louder. Maybe the problem often is,
Madan, Jason: is that we're answering the wrong question.
Madan, Jason: So that's the thing we probably need to think about a lot more S economists,
Madan, Jason: and I'm going to spend the rest of this lecture delving into that challenge of
Madan, Jason: what are we saying and what should we be saying?
Madan, Jason: Again, coming back to some of the many wonderful
Madan, Jason: PhD students I've worked with. So one student was Megan was based in
Madan, Jason: Kenyon, and I worked with Megan on a project
Madan, Jason: called Reach Out looking at investing in community health workers in East Africa
Madan, Jason: who often seen as cheap labour or free labour because they're volunteers.
Madan, Jason: But actually a little bit of investment. We found we argued for and found a little
Madan, Jason: bit of investment in their training and motivation.
Madan, Jason: Could make their contribution so much more effective.
Madan, Jason: One question Megan was asking, I think very good question was OK.
Madan, Jason: If we can show this, can we convince people to do something
Madan, Jason: about it? So she went and she'd come back. This idea that we do need a lot of
Madan, Jason: qualitative methods in the health economics. She went and talked to,
Madan, Jason: you know, people of ministries, local decision makers in the countries
Madan, Jason: and asked them, is this analysis useful to you?
Madan, Jason: They basically said no, not really. And she wrote a paper with us about why
Madan, Jason: and the kind of reasons were things like we tended to take as health economists
Madan, Jason: working on the global scene, we tended to sort of take a perspective.
Madan, Jason: Of global bodies, like who the Gates Foundation and those
Madan, Jason: ways of thinking about resource allocation problems work quite different
Madan, Jason: to the way the sort challenges that the more local decision makers had.
Madan, Jason: There was a focus on finance. We weren't maybe being too much.
Madan, Jason: The money meant the money wasn't, and we weren't thinking about other
Madan, Jason: issues that were mattered locally, like access coverage of services,
Madan, Jason: quality of those services and the challenge you always find is you can say
Madan, Jason: something is cost effective.
Madan, Jason: I'll come back to that term.
Madan, Jason: Cost effective, but that doesn't create any more money to
Madan, Jason: fund it, does it? So you sometimes find that there's an
Madan, Jason: implicit, very tough decision about what do you
Madan, Jason: stop doing to fund it and stopping doing things. You know,
Madan, Jason: if they're not cost effective is really hard to do politically.
Madan, Jason: Consoled easily, but it was useful for her to, I think,
Madan, Jason: identify these challenges and similarly an at another PhD student I worked with
Madan, Jason: is now at LSC, was interested in investment in
Madan, Jason: intergenerational mental health, so basically supporting.
Madan, Jason: Particularly mothers who'd given birth recently and try and protect their mental
Madan, Jason: health. And she was showing that there's.
Madan, Jason: Huge long term benefits both of the mums but also to their children from doing
Madan, Jason: this, but she was running into some of the
Madan, Jason: problems I've mentioned and she tried to address that in her PhD again through
Madan, Jason: through, through dialogue with people rather than
Madan, Jason: just saying it's cost effective, you need to listen to me.
Madan, Jason: And again she found that the challenge here was around trying to think about how
Madan, Jason: you advocate for long term benefits in the short term world,
Madan, Jason: but also the importance of grounding your assumptions to use that word. Again,
Madan, Jason: if you'll forgive me.
Madan, Jason: Ground those assumptions in the way that stakeholders think what they find
Madan, Jason: incredible.
Madan, Jason: So it's that constant reinforcing what you're doing based on what the people
Madan, Jason: you're trying to influence think and make sure what you're assuming doesn't lose
Madan, Jason: them. You don't want to lose people's credit
Madan, Jason: credibility. Somewhere along the line then you lose it
Madan, Jason: completely. So again, to really insights about some of the
Madan, Jason: practical issues that you face. And so this is a leading to an area
Madan, Jason: really interesting area, I think of health economics recently
Madan, Jason: around participatory health economics. People are calling it.
Madan, Jason: We're actually trying to engage with decision makers and involve the right new
Madan, Jason: start rather than.
Madan, Jason: Doing our thing and then putting our results out there in a conference and so
Madan, Jason: shout out people like Harris at Birmingham who've set up a network of
Madan, Jason: both health economists and people working in integrated care boards and civil
Madan, Jason: service to think about well, what kinds of work do we do to health
Madan, Jason: economists and is it what you need to hear?
Madan, Jason: So that's the last bit I want to talk about today.
Madan, Jason: Actually, what is the kind of evidence we're
Madan, Jason: producing and is it the right or residence? And now I think about this.
Madan, Jason: It reminds me of you may remember there was this whole joke a while ago about how.
Madan, Jason: The Daily Mail had this campaign to label everything in the world as either causing
Madan, Jason: cancer or curing it, sometimes both at the same time.
Madan, Jason: And I was mad at that because sometimes it feels like we kind of do the same
Madan, Jason: thing with cost effectiveness. So sometimes either we see or people see
Madan, Jason: our world is coming in and saying it's cost effective. It's not cost effective,
Madan, Jason: it's cost effective. It's not cost effective and just a little
Madan, Jason: other aside to try and illustrate this, you'll note you'll probably guess that I
Madan, Jason: tried to use AI to get me a little stamp and I'd like to thought I thought this
Madan, Jason: isn't very good, something wrong with this.
Madan, Jason: And I thought spelling I've made spelling mistake. Have I?
Madan, Jason: It took me a few days to realise what you probably spotted,
Madan, Jason: which is this the stamped in the wrong place. It's supposed to be at the bottom,
Madan, Jason: is it? Why would you put it on the side? And so now I've left in the Polycarp
Madan, Jason: decision. Lovely illustration of don't panic about
Madan, Jason: AI just yet, people. Because it can be pretty stupid and tell
Madan, Jason: your students that too. I'm sure that the youngsters among you
Madan, Jason: will have been better at using it. But.
Madan, Jason: I think that that shows the sort of things that AI will do and do race
Madan, Jason: Jubilee, so I don't feel that we're going to be
Madan, Jason: replaced just yet.
Madan, Jason: Well, I've thought for a long time that I feel
Madan, Jason: a bit uncomfortable about summarising our findings as.
Madan, Jason: What's effectiveness and in sometimes when we work kind of enforces that we we
Madan, Jason: people phrase it as we we look at the clinical and cost effectiveness of a new
Madan, Jason: drug or treatment as if they're kind of similar things.
Madan, Jason: I think they're really not and I think what really gets hidden we we we produce
Madan, Jason: these wonderful ratios where we we take the difference in cost between the new
Madan, Jason: and the old we take how much better the new is than the old and if if you if it
Madan, Jason: if it's a certain amount of benefit costs you know if it costs a certain amount.
Madan, Jason: To get the benefit you want. If it's less than that, you're fine.
Madan, Jason: You're cost effective.
Madan, Jason: If it costs too much to get benefit, you want you're not cost effective and so
Madan, Jason: we use all these jog in terms like ISIS and we presented this stuff.
Madan, Jason: But actually what I think that sometimes hides quite importantly is the value
Madan, Jason: judgments involved because I think really what we mean when we say cross
Madan, Jason: effectiveness is we're trying to help people decide how to best use limited
Madan, Jason: resources we have.
Madan, Jason: And inevitably, actually, when you sit down and think about it,
Madan, Jason: this is a value judgement.
Madan, Jason: It's political. It has to be. It depends also depends on who's asking.
Madan, Jason: And we do know this as S economist. We'll always start by saying, well,
Madan, Jason: first you need to decide on your perspective. Your decision maker.
Madan, Jason: Then you can't and must forget, as we just go along and start doing ISIS
Madan, Jason: again.
Madan, Jason: So I think maybe we need to and this is this is on us as health economists to try
Madan, Jason: and make this a bit clearer in our discussions and and so in my last few
Madan, Jason: minutes I'm going to try and explore.
Madan, Jason: Some ways we might want to do that.
Madan, Jason: So you might think that even cost OK, well costs fine.
Madan, Jason: Surely cost is a is a technical and dry and boring,
Madan, Jason: but everyone can agree on what cost is right.
Madan, Jason: This is perhaps an example though of that kind of language issue I pointed out,
Madan, Jason: where as health economists, we know who the when we say cost.
Madan, Jason: Using that word as a synonym for input resources,
Madan, Jason: things you have that can do good, but I think a lot of people hear costs
Madan, Jason: and they think money in budgets.
Madan, Jason: And there's a difference that we need to flag up,
Madan, Jason: because often and you'll find the most important resource that you're looking at.
Madan, Jason: Allocating isn't money. It's time the time,
Madan, Jason: the valuable time of clinicians and others,
Madan, Jason: and the valuable time of patients and carers.
Madan, Jason: That's actually the usually the most important resource. Not many,
Madan, Jason: but also how you value that resource, how you measure value.
Madan, Jason: Depends on who's asking. Again, it does. So we could have example of this.
Madan, Jason: So one is there's a project called Milestone we did where we were looking at
Madan, Jason: psychiatrist managing the transition from adolescent services to adult mental
Madan, Jason: services. So I can take milestones, still a traumatic word for some of us.
Madan, Jason: So sorry to bring it up again, but you can ask afterwards as to why that
Madan, Jason: is. But I haven't got any days to go into
Madan, Jason: that now. But anyway, one thing we didn't master was.
Madan, Jason: We asked the psychiatrist, the child psychiatrist,
Madan, Jason: how much time do you spend assessing whether your patient needs to go to adult
Madan, Jason: services?
Madan, Jason: And if so, what kind of needs they have? And I don't want to put him back and said
Madan, Jason: the interview in Croatia, wherever it was said, the Commission said,
Madan, Jason: told us they spend as much time, but they usually do it when they're in
Madan, Jason: the shower, you know, a bit like Archimedes in the bath.
Madan, Jason: They did all their best thinking in the shower. Does that count? Is that a cost?
Madan, Jason: In some ways? No, because your trust isn't paying for that.
Madan, Jason: But actually it is a use of valuable time that could be done to use for many
Madan, Jason: different things. So it kind of maybe does it doesn't.
Madan, Jason: And another example. So there are many examples like this.
Madan, Jason: When you dig into it. So I've mentioned community health
Madan, Jason: workers. One problem is often they get seen as a
Madan, Jason: free resource.
Madan, Jason: And therefore, using the cost of 0. But actually that is a valuable resource.
Madan, Jason: Their time is valuable, but again, it kind of depends on who's asking.
Madan, Jason: So from a budgetary point of view, people might say, well,
Madan, Jason: I'm not paying for it, so why not worried about it?
Madan, Jason: Is it does evaluate in the cost as a value judgement,
Madan, Jason: and perhaps the most important of all, I think is we know that that a huge
Madan, Jason: amount of resource involves people caring for their loved ones when they're sick,
Madan, Jason: so informal carers, and again that isn't some of the NHS pays
Madan, Jason: for so often we might exclude that from analysis,
Madan, Jason: but there's growing recognition on how important it is and if an intervention
Madan, Jason: reduces the burden on families and how much they have to provide.
Madan, Jason: We shouldn't ignore that. Then we'll be we'll be doing an
Madan, Jason: intervention that benefits carers a deservice wouldn't we?
Madan, Jason: So even just you might think it was quite boring and technical,
Madan, Jason: like cost can have a loss of judgement and subjectivity in it.
Madan, Jason: But actually, as I keep coming back to my my theme of
Madan, Jason: today, valuing the real, the real challenge in health policy is
Madan, Jason: value. And again you have these sort of cliches
Madan, Jason: you you lean on when you're teaching off. You've been teaching for a while.
Madan, Jason: One of those is I say to new students in health economics. OK, imagine.
Madan, Jason: So you're buying something. It could be as simple as a pair of shoes
Madan, Jason: or it can be as, like a house. The price tag's the simple bit. Actually,
Madan, Jason: the hard bit is working out to drop the house a over here or house to be over
Madan, Jason: there.
Madan, Jason: Trying to balance those pros and cons balance those benefits,
Madan, Jason: values them against each other when they're so different and the same thing
Madan, Jason: is true in health economics.
Madan, Jason: And I want to talk a bit more about quality,
Madan, Jason: which we use every day as a way of trying to do this.
Madan, Jason: And the thing I want to point out.
Madan, Jason: As you may well know, there's a two step process involving
Madan, Jason: qualities.
Madan, Jason: So the first thing is you have a questionnaire,
Madan, Jason: a lot of you all know about this. You have.
Madan, Jason: It's not EQ5D which basically asked people to rate their health on five
Madan, Jason: dimensions. And the idea is that these 5 dimensions,
Madan, Jason: mobility, self-care, usual activities, pain and anxiety or depression,
Madan, Jason: no matter what your illness is, they just pick up your quality of your
Madan, Jason: life.
Madan, Jason: And how the answer is affecting that and that's patient reported,
Madan, Jason: but then we apply a formula to then calculate a quality.
Madan, Jason: That isn't coming from the patient. It's a separate step,
Madan, Jason: and that's coming from people, subjective judgements about, for example,
Madan, Jason: how much is the value of taking someone paying from Level 3, for example,
Madan, Jason: which means.
Madan, Jason: About paying a lot of time to level 2, which is on a moderate amount of pain
Madan, Jason: compared to, say, going on your usual activities from two,
Madan, Jason: I'm having some trouble to 1 so we have a scoring system.
Madan, Jason: It's totally based on people's judgements. It's totally subjective.
Madan, Jason: Why is that? But again depends on who you're asking,
Madan, Jason: so I just want to illustrate this point by looking at how when you do that second
Madan, Jason: step, how it depends where you're asking. So let's take this health state.
Madan, Jason: I can see someone might fill in one of these EQ ID forms and said I've got no
Madan, Jason: problems with my mobility or self-care. I've got some problems with my usual
Madan, Jason: activities and I'm feeling a bit anxious and depressed. I'm in a lot of pain.
Madan, Jason: And they could be they could be suffering from cancer treatments.
Madan, Jason: They could have back pain. It doesn't matter.
Madan, Jason: The point is it's a genetic measure now.
Madan, Jason: How is? How is that state valued relative to full
Madan, Jason: health and it really depends on where you're asking. So in Japan, for example,
Madan, Jason: it gets a weighting of . 547 where one is perfect out of good
Madan, Jason: health, zero is dead.
Madan, Jason: Whereas down, say the UK is about 1. 157 and try and put that in a bit of
Madan, Jason: context, one way to think about this is if you
Madan, Jason: could.
Madan, Jason: Live for a year. Imagine going to live for a year in this
Madan, Jason: House. In this health state. Imagine how the treatment that shown your
Madan, Jason: life but brought you actual health. So your quality of life improved,
Madan, Jason: the quality went down. At what point would you think that was a
Madan, Jason: trade off worth making?
Madan, Jason: So for Japanese person, they've only made that trade off.
Madan, Jason: If you were to to give them around six or seven months of of.
Madan, Jason: Full health. If it was less than that, they'd say no thank you.
Madan, Jason: I'll live like this. I'll. I'll. I'll suck it up for auk person.
Madan, Jason: This implies that in fewer to just given two months of perfect health,
Madan, Jason: they'd take that. Compared to a year or something like this.
Madan, Jason: And I just mentioned because all these calculations are going on behind the
Madan, Jason: scenes when we presented with this cost quality ratios and how subjective they
Madan, Jason: are and how much they vary depending on who you're asking.
Madan, Jason: So I really want to put your attention on that and just the other thing that
Madan, Jason: quickly is the picture on the bottom left, which might look like a sun,
Madan, Jason: what sunspots, but the clinicians will recognise,
Madan, Jason: this is actually the back of an eye that's suffering from diabetic eye eye
Madan, Jason: damage. So one thing we did as well we looked at.
Madan, Jason: Screening for eye damage in diabetics in Malawi.
Madan, Jason: We found that the impact of having visual impairment in malaria is very different
Madan, Jason: to the UK. If you think about it as kind of you can
Madan, Jason: sort of see what that is because things like driving and reading are so much more
Madan, Jason: important than UK national Malawi for lots of contextual factors,
Madan, Jason: lots of subjective judgments.
Madan, Jason: So only that just the the problem we make about this is we can we can use this
Madan, Jason: things like EQ5D and we do them because we're thinking about very high level
Madan, Jason: decisions about do we prioritise cancer over mental health.
Madan, Jason: So we need something that expands those things.
Madan, Jason: But Even so the quality can miss so much of benefit and we don't want to do it.
Madan, Jason: We don't have the right as health economists to say if it doesn't fit in
Madan, Jason: our EQ5D we don't care about it.
Madan, Jason: So we need to think about capturing value properly and there's so many measures
Madan, Jason: like ice cap that have been developed and.
Madan, Jason: Couple web webs and we had a PhD student again another PhD student I worked with
Madan, Jason: who enabled us to use Wem Web, which is a well-being measure to do this.
Madan, Jason: So we need to make sure we're not missing out on things that are important to
Madan, Jason: people when we we we try and value the benefits of any treatment.
Madan, Jason: So there's all these things happening. There's comparison of the ratios and the
Madan, Jason: point I'm trying to make I think today is we can present these ratios.
Madan, Jason: We can present these lobby technical diagrams but we're hiding a lot of values
Madan, Jason: and behind us that we don't not because we shouldn't be making them but actually
Madan, Jason: maybe.
Madan, Jason: We do. We want people to be aware of them and to
Madan, Jason: challenge them and to work with us on them.
Madan, Jason: I think that that's the key thing we need to maybe be better at doing South
Madan, Jason: colonists.
Madan, Jason: And it's finally very and then very quickly just to flag up that we do
Madan, Jason: understand, it's not just how much health we're
Madan, Jason: creating, it's who benefits. So another thing we need to do and we are
Madan, Jason: doing better is understanding not just how a treatment effects health overall,
Madan, Jason: but is it particularly benefiting some groups over others.
Madan, Jason: So there's some really interesting innovations around what we call
Madan, Jason: distributive cost effect analysis. And I know that's something we're looking
Madan, Jason: to do more of in the trials in, in the, in tune here.
Madan, Jason: And we hope we're coming to some of the trials that we.
Madan, Jason: To really help us to show that we don't just care about maximising things we care
Madan, Jason: about who benefits as well. So this is again another exciting area
Madan, Jason: where we are trying to make ourselves more relevant.
Madan, Jason: I think it's the point I'm trying to make.
Madan, Jason: So to summarise.
Madan, Jason: The reason why I had problems is is fascinating and why I enjoy working on it
Madan, Jason: is because we are trying to. We are trying to maximise the health.
Madan, Jason: You can produce the society for giving resources that we have,
Madan, Jason: which are limited and this requires some difficult and challenging values.
Madan, Jason: It's not a technical thing to do and one thing maybe we need to do,
Madan, Jason: we need to be better at as health economists is making that a bit more
Madan, Jason: obvious.
Madan, Jason: And not being afraid of illustrating that and only way we can do that is through
Madan, Jason: engaging with others, with clinicians, with the public, with decision makers.
Madan, Jason: And that's when we we are we are doing, we continue to do loyal and I think
Madan, Jason: that's only going to make us more effective. So as I do finally wrap up,
Madan, Jason: so I've got a bit over time, but I don't want to seem like I'm not
Madan, Jason: quite ready to retire yet. I can't really afford to anyway.
Madan, Jason: We've still got quite a lot of years left in the mortgage.
Madan, Jason: So you've given me 13 wonderful years in the medical school maybe hopefully I'll
Madan, Jason: have a 13 more. There are lots of projects I'm working on
Madan, Jason: at the moment. There's that I'm really excited about.
Madan, Jason: There's the correct confederation of trials which.
Madan, Jason: Is looking at trying to do health economics and trials work across multiple
Madan, Jason: related trials in the same patient group.
Madan, Jason: Jobs working with the Institute of Employment Research here at Warwick.
Madan, Jason: There's currently working on transform, looking at using some of those health
Madan, Jason: point measures I've mentioned the broader ones to understand how we can improve
Madan, Jason: mental health in Nigeria and Bangladesh and as well as the entire project I
Madan, Jason: mentioned and then many more to come. But I think the main thing is the reason
Madan, Jason: why I want to stay here for another 13 years. It's all you guys,
Madan, Jason: the people I work with.
Madan, Jason: In chair and the CTU Cross University and all our collaborators.
Madan, Jason: With only the occasional very, very exception, the milestone.
Madan, Jason: Are wonderful people, and that's what makes us coming to work a
Madan, Jason: joy. So thank you all so much for for giving
Madan, Jason: me this satisfaction and letting me to find a home. I'm happy to take questions,
Madan, Jason: but it's a lovely day outside. I understand. If you want to get out,
Madan, Jason: then sun and enjoy your lunches. So I'll just say again.
Madan, Jason: Thank you all so much for your attention today and for giving this opportunity to
Madan, Jason: have such an enjoyable career. Thank you very much.
Madan, Jason: Tech fantastic. Thank you. You know, Jason and some really great insights into
Madan, Jason: the work that you you've done, we've got about 5 minutes for questions
Madan, Jason: that people have questions and I will bring the microphone benefits of working
Madan, Jason: with people that are online and actually your your what people are thinking of
Madan, Jason: their questions, your summary.
Madan, Jason: About the team and the thing that makes you know Warwick, so special was actually,
Madan, Jason: you know, the call with the question that I was
Madan, Jason: going to ask because it was fairly clear through your talk.
Madan, Jason: That you've worked with some fantastic, you know,
Madan, Jason: teams and I think that's one of the things that strikes me about Warwick and
Madan, Jason: tune is the collegiality and how everybody, you know, pulls together.
Madan, Jason: And I guess it's a question for you to reflect on, you know,
Madan, Jason: what are the core ingredients that are brought together,
Madan, Jason: what you've described as really quite interdisciplinary groups to tackle a
Madan, Jason: whole, you know, range of subjects?
Madan, Jason: You know that enables, you know, people to, you know, to pull together and,
Madan, Jason: you know, work in that kind of team approach to
Madan, Jason: things.
Madan, Jason: I think my location a lot. I don't it's it's, you know,
Madan, Jason: there's so much to it. I think it boils down to shared respect,
Madan, Jason: communication. The fact that we all want to do this,
Madan, Jason: achieve the same thing. And I think, Jeremy,
Madan, Jason: the people that work in this field, they're motivated by need to make a
Madan, Jason: difference. And they're often not. It's not so much about personal success,
Madan, Jason: personal egos.
Madan, Jason: But also an openness to different points of view,
Madan, Jason: and I think almost there's bit of self selection that goes on.
Madan, Jason: That if you want to be a, you know a, you know, a big deal, you know,
Madan, Jason: you can do that in many ways, but if you enjoy being part of the team,
Madan, Jason: if you enjoy having impact, if you enjoy having, you know,
Madan, Jason: working with people that will think very differently to you, you'll stay.
Madan, Jason: So I think some of it's self selection we try and you know we try and be very
Madan, Jason: friendly. We try and be very commutative. I know that CTU is,
Madan, Jason: you know it stands for cake Trials unit because we do one for cakes.
Madan, Jason: And other things like that matter too. And I'll shout out to people like James
Madan, Jason: and your well-being initiatives. So I think it's a combination of self
Madan, Jason: selection and one being being on the same track and the fact we don't,
Madan, Jason: we don't just let it happen, we do actively care about people's
Madan, Jason: well-being.
Madan, Jason: Thank you.
Madan, Jason: Did anyone either online or in person have a question?
Madan, Jason: Hello I knew you would see. You know what?
Madan, Jason: Yeah. OK. Can you hear me now?
Madan, Jason: It's really lovely to hear about all your research. It hasn't yet likewise 13 years.
Madan, Jason: But understanding, understand please, what does the health monitor do?
Madan, Jason: What is the?
Madan, Jason: What, sorry.
Madan, Jason: What does it do? You mean that the the VAS?
Madan, Jason: I mean, I think that's a question for all the can.
Madan, Jason: I think if you ask who you ask, you'll get a different result.
Madan, Jason: The the people tend to use the vows that connect the vows and do we use it much?
Madan, Jason: And my experience and I've been to what other my colleagues think. Often we don't,
Madan, Jason: but we have found. Sometimes people do find the vas a lot
Madan, Jason: easier. So just for those of you who don't,
Madan, Jason: so you're you're filling your answer those five questions,
Madan, Jason: you'll say how your health is in five dimensions,
Madan, Jason: you have like a thermometer that says on scale,
Madan, Jason: naughty to 100 where 100 is wonderful. Naughty basically I'm dead.
Madan, Jason: I can't barely cross the line. How are you feeling today?
Madan, Jason: When we asked both of those, then we tend not to use the VAS as much,
Madan, Jason: but I think maybe we should be using that more because maybe it's a more it comes
Madan, Jason: down to what is what do people find more intuitive and maybe and maybe I don't and
Madan, Jason: this is my expertise. Colleagues may step in and say there's
Madan, Jason: gurvans to answer this question, but maybe actually the vast is what
Madan, Jason: people find, it's usually better so.
Madan, Jason: It's there. People should use it, but we often slips by and the key thing I
Madan, Jason: think to come back to my themes today is maybe we should asking our participants
Madan, Jason: what they think about the Vads. So over to your process evaluation guides,
Madan, Jason: what do they think about do they do they like the Vars,
Madan, Jason: do they like the thermometer? Do they find it silly?
Madan, Jason: Should do anything we should be using it more. Let them tell us what to do with it.
Madan, Jason: I think maybe I'll bring in my answer. Thank you, Alan. Great question.
Madan, Jason: I think that was coming.
Madan, Jason: Great. OK. Well, I think in the interests of.
Madan, Jason: Thank you very much, Jason.
Madan, Jason: Lovely to know where you disappear after what you do.
Madan, Jason: When we when we come.
Madan, Jason: Question is about time scales and.
Madan, Jason: Briefly, a lot of times.
Madan, Jason: Because if your PhD students who are working to a type of timescale producing
Madan, Jason: themselves to get their PhD on this original.
Madan, Jason: Trials taken by the trials, which you've got a separate time scale.
Madan, Jason: You know the governments have got time scales,
Madan, Jason: they must really in a sense frustrating your way to balance all these time scales.
Madan, Jason: How long does a project need to? And it's a very difficult question to
Madan, Jason: answer.
Madan, Jason: Project need to go on for before you can see an effectiveness coming out of the
Madan, Jason: work being done.
Madan, Jason: Changing in practise and benefits I mean how long do you keep?
Madan, Jason: So I'm reminded that when you ask that question, Peter, thank you. Again,
Madan, Jason: I didn't know what question you were going to ask. Like Helen, I had an idea.
Madan, Jason: I had no idea. So that I think of my feet the when I
Madan, Jason: started as training as an accountant, I was.
Madan, Jason: When someone said if your senior sends you an e-mail, then says this is urgent.
Madan, Jason: And you have to reply by I mean coming out of university, I said end of the week,
Madan, Jason: the great answer was like within the hour. So I think there's definitely part of it
Madan, Jason: is different ways of thinking but also balancing this rigour and this
Madan, Jason: effectiveness and there's no I mean there's a trade off I think inevitably
Madan, Jason: and I've been I think wolves will have different views on that trade off and
Madan, Jason: it's a mix because in some ways you do need years to run a definitive clinical
Madan, Jason: trial is my impression others will know it's better than me.
Madan, Jason: And there's a risk of getting it wrong.
Madan, Jason: But then if you talk to people in government or in in care boards,
Madan, Jason: they may need an answer like within a week.
Madan, Jason: So I guess part of it is knowing what we can do as academics.
Madan, Jason: We're not Tracy trained to do that, and there are people in state,
Madan, Jason: civil service or boards who can. So there's no,
Madan, Jason: there's no single answer to your question. I never give a straight on yes,
Madan, Jason: no answer to any question. People will tell you that.
Madan, Jason: But many of the things to do is think that we different different people can
Madan, Jason: tackle different different ways.
Madan, Jason: We can't. We can't do rapid artists of things,
Madan, Jason: but we do need to work with people who do.
Madan, Jason: The stuff we do, I think, does take years rather than months,
Madan, Jason: but that doesn't mean we can't engage with and talk to people who need answers
Madan, Jason: next week and see you know how much we can guide what they're doing and and how
Madan, Jason: much we might say, well, actually hold on here and how much we
Madan, Jason: might be willing to say.
Madan, Jason: OK. We think we're sorry you're coming from.
Madan, Jason: You need to do something now. Go ahead and do it. So we do need years,
Madan, Jason: I think. But we need to be able to talk to those
Madan, Jason: people who don't have years and see how we can help each other and how we can at
Madan, Jason: least provide you with some kind of insight and advice. But yeah,
Madan, Jason: I don't know. I mean, just not set up to do things like that,
Madan, Jason: are we? That's just not how we work.
Madan, Jason: Yeah. Thank you. Very lovely. Let's put our hands together and thank
Madan, Jason: Jason again for a fantastic.