Everything You Need to Know About The Menopause!

0:00When I met you, you lit a fire in my belly. You have been fighting Women's Corner your entire life. If I get run over by a bus tomorrow, I shall be pleased that we did this work. Today I'm chatting with the incredible Kate Muir, someone who knows exactly how to turn life's toughest moments into something really powerful. I feel that I've been given a second life. She talked to me about her midlife crisis and how from pain comes growth. Very stupidly, I had an affair with a married man. It was about me being looked after, being loved by someone. We talked about how menopause played a huge part in all of it and the exact steps that she took to start feeling like herself again.

0:44One in ten women are leaving their jobs because of menopause symptoms. I had those peaks of madness which were not like me and that's when I started. Kate shared everything about why so many women are left in the dark during one of the most powerful transitions of their lives. Why is no one having this conversation? These women have done so much suffering with our periods and our childbirth. This is only a little bit of suffering added to the top. Kate's story is a reminder that it doesn't matter what you've been through, it's never too late to begin again. Kate Muir. Oh my God, I'm so happy to have you here.

1:26I feel like you have massively not just changed my life but I was just telling all the girls at the team here that what the work that you've spent your whole life doing has made our all of our lives better and I I never feel like you get enough credit for that but you are the OG you know you wrote a book about menopause way before I did and you have been fighting our corner women's corner your entire life I think well I feel we've done this together yeah well you know you just coming on board when we had the idea about the menopause and rocking it and exposing yourself in the way you did saying oh at 44 you know I had symptoms I had hot flushes in the makeup chair and you know mentioned vaginal dryness on telly i mean that changed so many women's lives when we talked about mental health and so you know if i get run over by a bus tomorrow i should be pleased that we did this work that we talked to women that you know a million more women are on hrt than were before this all and it was lots of people not just us but lots of people came to tipping point wait to hear about it I am I am just so I'm going to talk about this now good so um how to have a magnificent midlife crisis and I I love the fact that this is the book that's come now um I mean I guess you've had your midlife crisis very much so yeah and it's safe in a way to look back on it now as something you've been through yes yes indeed um and you um are going to help other women go through theirs because it is specifically really women-centered system.

3:18It's for women. It's not just a toolbox. I think of it as a large handbag with lots of different things in it. And, you know, it's got a digital detox. It's got hormones. It's got longevity. It's got how to avoid Alzheimer's. And it's just got how to throw all your toys out of the pram and kind of see what happens. And for me, I regretted some of the things that happened quite seriously, like getting divorced and moving out to a flat and leaving the family home. That was massive. And, you know, the pain of you think you break up from a person, but you break up from a family. Yes. And much as I'm with my kids again, my adult kids, and we're having a great time together, you're just sad that that institution and you must feel the same as me and someone's I do yeah institution no longer exists yeah although that institution like all institutions was not perfect yeah anyway um but that said I feel that I've been given a second life and a second adventure and indeed a second husband and you know that that has just been I just feel really really lucky you know that that just in this tide of trouble has come this positivity as well I think you talked about a big change and the pain and you know there is a knowledge now really that life is suffering like we all kind of understand that this idea of everybody being happy all the time and living a perfect life it isn't achievable and you shouldn't really want it to be achievable because suffering makes the wonderful moments better.

5:01If we just felt wonderful all the time, it would be boring. But leaving a marriage, which, do you know what the stats are on divorce? Well, they peak around 44 or 45 in perimenopause Yeah. And when kids are a certain age and, you know, there is this new word, menodivorce. And but it is the time when I mean, I think, you know, our loving mummy hormones go down, our estrogen is going down and up. And that's the other thing. So we're both sort of having these hormones taken away so that we see everything clearly. And it's all very, very raw. Suddenly we don't have those soft progesterone moments helping us to sleep at night.

5:44and we wake up and think, I'm going to do something about this. I'm angry. I'm going to change this. And I think one of the big things for me that sort of was a catalyst for this story was the perimenopause, the perimenopausal sex, which also when your hormones, when your estrogen goes to these huge peaks in perimenopause and then suddenly falls the day after. And lots of women experience, you know, this real kind of last minute out of the box moment in their sex. life and at the same time you mean you mean a really strong sex drive right i certainly like a a real boost in testosterone it's like your body going this is one last choice i think it must get as much shagging in as you can i don't know but it certainly explains those kind of midlife affairs for for women and and why and it's also i think we've worked so hard raising our children we Just for those of us who've had children, we just can't see beyond that.

6:46And that's all that matters. And you do it and you get on with it. And suddenly when you don't have to get on with it and, you know, empty nest syndrome is a word they use, but it's your nest and you're flying out of it. And one way or the other, you need to leave that nest too. And I don't mean getting divorced, but you need to find a new life, find new friends, find a new career, find a new adventure, travel the world, whatever it is. or, you know, start a charity. Just you need to do a new thing with that second half of your life because you've been a carer all that time and you don't have to be a carer anymore.

7:22You are free to create and do. And one of the things I've written about in the book is the sort of creative renaissance. And one of the people in it is, of course, our friend Karen Arthur, who was in our first menopause documentary together when we were still wearing COVID masks. and you know she talked about her menopause and she set up menopause whilst black instagram and she's the most amazing campaigner and presence and she's such a positive yeah she's such a positive energy karen that's what i love about her um she's all about wearing colors and brightening up kind of people's lives and when you meet her you immediately smile because of the colors that she's wearing and her energy she she's a gift yeah I think that she went from being a teacher that she walked out in a job in a hot flush in a depression got therapy changed her life eventually got HRT but eventually eventually and then ended up being this amazing fashion designer and far more than an influencer she's a changer of the world yeah she is and so I talked to her for the book and really you know menopause was just a switch that switched her in the other direction but we don't know who's turning the switch when it's being turned why it's you know what I mean it's this mystery moment but it is I think really important and I'm thinking you know our kids generation they know what's coming they know perimenopause they know what hormones do they're just going to they probably won't have a proper crisis actually having this kind of midlife crisis in a way yeah is essential to a smooth path post yeah I mean just to go back Yes.

9:03To anybody that isn't quite aware of when does perimenopause start? How long can it last for? Could you just give us a rough, quick synopsis of the peri and the meno? Yeah, I'm not a doctor. I've interviewed a lot of doctors. Yes, you have. um so perry anytime in your 40s but earlier if you've got early menopause um and hormones are really hopping around and changing throughout your 40s menopause at 51 um and that those particular hormones it's the fact that progesterone which is your calming you know sleepy lovely you know makes you lovely mom hormone is just going straight down like that tanking it and then oestrogen is going up and down in the roller coaster and at that point I must say myself I threw it I'm not an angry person and I threw a number of things against the wall in the kitchen and I um you know I had three kids I had a mum with Alzheimer's complex relationship and I chucked broccoli a butter dish that broke with all the bits of butter and china in it a butternut squash blue poster paint and a copy of Nigella's Christmas at the wall at all different times over a number of years and I only realized looking back that those peaks of madness which were not like me and sort of calmed everybody down because somebody had exploded what that was it that was the hormones doing and we've heard about this the rage in my head and actually now that we've taken the rage and turned it into a political rage.

10:42This is political. Women's health is absolutely political. It is political. And, of course, we've been to Parliament a lot with this. It's been really worth it, taking that sort of boiling kind of need to change things, which we were expressing domestically, but now we're expressing kind of internationally. Well, it's quite nice to have somewhere to take it. Yeah. You know, I hear a lot from women. publicly. I did a talk the other day and I talked a bit about rage and how ashamed or shameful it feels to display that when it's not really you. You said to yourself, I'm not that person. I'm not that person.

11:27I don't really get angry. I'm quite easy going. But God, when I got angry when I was perimenopausal, the shame I felt straight after. Bang! Fury! get in the car crying at the steering wheel just and then just going I'm really sorry this isn't mummy I didn't mean to you know because I was out of control yeah and I'm never out of control yeah it was so frightening your brain changes and that's one of the big things I talk about in this book that your brain changes three times in life and it's the three Ps pregnancy puberty and the other puberty, perimenopause. And literally your brain is rewiring.

12:10And if you're not taking HRT, which most of us are not at first, your grey matter is going down. So your big computer in your brain is going blue and it goes up again later on. But, you know, the white matter, all that sort of connective motorway in your brain is going down. And that's when you go, oh, it's the film that I saw last Wednesday that had Quentin Tarantino in it, but I can't remember. And, you know, it's all these kind of really, you know, rotten pathways in your brain. And I think one of the things I certainly realised was when I lost my own memory and I couldn't remember a domestic noun, you know.

12:47And can I just say, because I know you. Yeah. You are fiercely intelligent. You were a journalist for The Times for 30 years, foreign correspondent in God knows how many different countries. You are one of the smartest women I know. it must have been very hard for you, Mrs Memory Box. You know, quite frightening, right? Yeah. Yeah, and I was just like writing. I'd been forgetting people's names and I thought at that point I was a film critic. But then I forgot. I was writing a shopping list, thought, must shave my legs. And I wrote down the word shaver. And I thought, definitely another word for the thing in the bathroom.

13:24Yes. And I couldn't remember. I remembered 15 minutes later it was called Razor. And that's when I rang all my friends. And that's when I said, I've got Alzheimer's, everybody. What are we going to do? That's exactly what I thought. But really, I was so scared because my mum had died of Alzheimer's like the year before. So it was totally in my head that women of a certain age lose nouns very slowly, cover up for themselves. My mum, really smart, you know, being a, you know, a personnel manager and volunteered at the Citizens Advice Bureau. Proper person. and suddenly her losing her nouns, you know, I was really aware, and I thought, oh, that's me, this is going to happen to me, I've got Alzheimer's, and, you know, you just, it's really, really frightening.

14:12And then I rang all my friends who'd got HRT privately, and had, you know, because I'd been to the doctor twice, and that hadn't been of any use, and I'd had heart palpitations and all that, lots of menopause symptoms. Can you talk me through your symptoms that you had, just because, again, it's quite helpful for anybody watching or listening that might kind of go, oh, you know, you've just mentioned palpitations. Lots of people don't know that heart palpitations are a symptom of me. Huge. Our survey, which we did, as you remember, 44 % of women get heart palpitations in perimenopause and menopause as hormones fluctuate.

14:46So your hormones are going up and down and the electricity in your body is going haywire. Your heart goes a little bit haywire. It's not going to kill you. But, oh, my God, you're so frightened. And it happened to me all the time at four in the morning when my estrogen or whatever was at its lowest. And I'd wake up panicking, that anxiety at four in the morning and my heart doing the Tom and Jerry. I mean, literally. And I got all these, you know, tests on the NHS, which must have cost them a huge amount of money. And they said, you're absolutely fine. You're drinking too much coffee. I was like, I always have two cups of coffee.

15:18This is not different. And then I got HRT privately because I didn't get it off the NHS at first. And of course, my heart palpitations disappeared within a day. They just did not come back ever. And within about a week, I was remembering all the words I wanted to remember and all the faces and all the people. And then a few months later, I got really, really angry. and I began to think if I, as middle-class investigative journalist, have ended up having this struggle, which has sort of created a mountain of pain for everybody around me, what about the people who are not being informed and what about the mental health aspects of menopause?

16:01That was huge for me. I thought it's not the hot flushes, it's the fear, it's the Alzheimer's, it's the memory, it's the depression, it's the anxiety. It's the anger. Yeah. So the mental health thing, which I think, In that first documentary, when we had women going, I think I'm going, I thought I was going crazy. I just didn't understand. I was a changed person. And I think the mental health thing was the one thing that really talked to women out there. And I'm really proud we did that. Yeah. I also feel that it's such a lonely place. it was that I we all felt like no one else knew what was happening and no one was talking to each other because we were all embarrassed to be in this place um yeah even when you talk about shame there was this big ball of shame we were pushing away yeah kind of in front of us weren't we all the time and now that that's not the case but you you talk in other countries and you know I'm doing I'm doing the European Space Agency menopause talk and you've got to go in and talk quite differently because they are not talking in the down-to-earth, honest way that we are talking.

17:15And they want science. Yeah, menopause in space. But, you know, it is really interesting in Europe and elsewhere that the conversation has not exploded and it's so important that we continue doing this. And I also think in terms of sort of longevity, and long-term health. There's a whole new thing that I'm thinking about now and reading the science on which you know I wrote about in the book too. I mean we we touched on you've talked about your mum having Alzheimer's and as so just to give people a bit of context when we were filming our documentary and we were talking to Lisa Moscone who's the most amazing neuroscientist from New York.

18:00Is she from New York? Yes, Italy, but then she lives in America and she's doing amazing research into the brain and perimenopause and menopausal hormones. And I was going to interview her about what she'd discovered. And the day I was going to interview her, my dad died of Alzheimer's and it was such a you know it was such a mad mad thing but so I was always I've always been nervous and afraid of um getting Alzheimer's as you know we know it can be a genetic kind of gift that um relatives leave you um but also our um hormones play an enormous part in our brain health and HRT recently there's been new science that's come out new research could you tell us a little bit about that and I know that you're not a doctor but I know that you have interviewed yeah I'm just giving you a little I've talked to Lisa Moscone and Dr Roberta Brinton who are the two big brains behind thinking about hormones in the brain and when we were doing our documentary we were showing those pictures of the brain pre pre-menopause and post-menopause and you could see literally the change in the energy level in the brain just by looking at it and I think that visual sort of told us a lot.

19:23Lisa Musconi's book The Menopause Brain is terrific and quite simply oestrogen helps your brain work. Oestrogen is really good for protecting you against neuroinflammation and it just and by also keeping you in good health elsewhere in your body in terms of sleep, in terms of relaxation, in terms of ability to exercise, that whole package helps prevent you getting Alzheimer's. Now, it doesn't work completely for everybody, but what we have is a huge study of the American database, which has got about 400 ,000 women in it. And Dr. Roberta Brinton, who's been studying this for 30 years, then found out that if you are on HRT for basically any decent length of time, even five years, you're 58 % less likely to get Alzheimer's.

20:17And if you're on it for six or more years, you're heading up to 79%. Can I just park the car there just for one moment? That is nuts. Yeah. And I feel like that is not out there enough. I still feel like there are so many people that have no idea about that statistic and that's why it's so important what you do yeah I call myself an amplifier and I really think that you're the same that you know all the experts and you amplify their message and how valuable that is because that is you know how many women are out there feeling like we did that they they've lost their memory they they can't even find the neural pathway but also being a carer as you know as someone without yes worst thing the sort of thing that nearly broke me was and I wasn't there all the time we had carers but you know occasionally it would all fail and I'd be up there feeding my mum in hospital because she didn't want to feed herself anymore and when when your mum thinks you're her mum.

21:22I mean, it's absolutely awful. And if I can prevent one person going through that and their kids going through that looking after them, then that's really, really important. And I don't think it's necessarily as simple as just oestrogen. Oestrogen isn't a cure for Alzheimer's and testosterone may have a part and progesterone may have a part. But what we know is another statistic for you. Women who go into early menopause are 35 % more likely to get Alzheimer's. So what is missing in their lives? Yes. That there's 25 years or 20 years or whatever where they're high and dry with no hormones. And the hormones mean you sleep and you don't get hot flushes.

22:05And people who sleep four hours a night, like Margaret Thatcher, are more likely to get Alzheimer's than people who sleep eight hours a night and that's basically your brain doing the recycling so it's the whole health package but hormones are part of getting you into that package and not everyone can take hormones and if you can't then you're working really hard on your health and yes exercise and your diet like west you know mcdonald's diet or you know burgers and milkshakes you can see in the brain scans of the diet of someone who's been eating ultra processed food and you can see the Mediterranean diet with fiber and vegetables and olive oil they are different brains within months yes and so the ultra processed brain we do not want you know and and we want hormones so I think the Alzheimer's thing is huge and two-thirds of Alzheimer's patients are women why is that because of hormonal yeah because we we run out of hormones first and men are hanging on to testosterone until they're about 80 quite and we have nothing and that's why we suffer this more and we only notice as we live longer that that's what's happening and we can make a big difference just by talking about it and i've been talking to alzheimer's research who are really beginning to take an interest in all this um you you mentioned testosterone there and um men sort of they do a very very gradual decline and we're kind of plummeting.

23:41There's something quite big has happened in the UK recently regarding testosterone and being able to get a licensed testosterone for women, hasn't it? Could you just explain what's happened? Well, there's the testosterone. We were all using the male testosterone, those of us who could get testosterone as part of our menopausal hormonal package. Just for clarity, you did, I did. I did, we've got it. So there's a new pink tube. It has to come in a pink tube. It's called androfem. And it looks like a tooth post, actually. And you can just squirt. Well, you just need a little pea-sized blob and it's fine.

24:20Or you can measure it out very carefully. But you get the exact amount. It's very hard to measure out the male gel. Very hard. And getting it right is great because, guess what? We have not grown a moustache. No. And I love the level of fear-mongering around testosterone. I think it's hysterical and incredibly old-fashioned and incredibly set in its ways. Even from the high end of the medical establishment, the medical establishment, I mean, you know, this is a hormone that we've got receptors for all over our body. And especially in some places like our brains and our vulvas. And, you know, the idea that it's just been there as a joke for all these years and it's not an essential female hormone.

25:04I mean, you know, do the maths kids, you know, it's like, it's like they're almost unable to see the kind of building blocks of a female body. And they're talking about it as a fun extra full libido. And indeed it is. But some of us had a libido, you know, without it. But it is really interesting for brain, for muscle. I feel when I and I remember you saying to me, sometimes I've got a big meeting and I put on a bit of test. What did you say? No, basically what I had, my libido didn't suffer too much. But the difference that happened for me when I took testosterone was I got me boss bitch me back.

25:51so I walk into a meeting and I remember three months after I started taking testosterone I walked in and I was like hi sit down sit down I'd prepped I sat down I knew what I was doing I knew what I wanted to say and I was like like yeah I thought oh god I felt like I had disappeared that thing that women say when they have perimenopause yeah when they go I don't feel like myself anymore yeah I've lost something I can't I'm invisible I'm invisible I don't feel joy anymore I can't what yeah I'm just gone and I was like oh I'm firing on all cylinders that's what I got back and it was the missing link for me and I mean I know that's dangerous saying that because it's not always that for everybody yeah and if you don't get low testosterone mine was quite low yeah I'd not and um it did make a difference because it had dropped so much yeah and once you once you get your estrogen and your progesterone sorted it is as simple as a blood test to see if you need it or not right yeah and also the amount of testosterone we're talking about it i mean you're making it sound like superpowers it's what you would have had when you were 40 yes so it's it's not there's nothing shocking about this but there is this huge fear out there in the world and you know it is part of our next little bit of liberation is liberating our hormones and the truth around those sort of hormones.

27:18And I think also, you know, I mean, if you take it correctly, you don't get any side effects because like you said, you're just revisiting where you were at when you were 40, 45. Yeah. So it is available, but not on the NHS yet, but the cream is available in the right amounts and hopefully the NHS will take it off. And there are some amazing doctors out there who who are fighting everywhere for us and talking about it and really, really thinking. And then there's a sort of institutional fatberg of people who just want to keep everything the same. And there's a sense also that the idea that HRT is a kind of happiness juice that we just do for our skin kind of thing.

28:01You get a lot of that. People say, oh, yeah, do you take it to look good? No, we don't. We take it to feel good inside and look after our brains and look after our muscles and look after our bodies and look after our thermal regulation. Yes. And the idea that this is a decadent little extra, rubbish. Well, it's insulting. And it's slightly treated still like that by the medical establishment when the question should be, I think, why are you not taking HRT? And I absolutely understand because I've got lots of friends with breast cancer, what they're doing and why. And it's really complicated. But for the majority of women, this is so protective.

28:41Transdermal HRT now, the safer kind, the body identical. That goes through the skin, doesn't it? Transdermal. Super safe. And, you know, why not have it back? Why have a creaky older life? Why be sad? You know, why struggle? And I'm really interested in osteoporosis because this is huge. and I suddenly realised we did a big campaign called Give Your Bones a Break where we wandered around with skeletons and things like that and did a lot of daft stuff. But, you know, simply this, I want to tell the government, can we do this? Can we trap Wes Streeting here for five minutes and tell him, yeah, we'll do that.

29:21So we need to tell him, one, you know, the majority of osteoporosis patients are women. Why is that? Because their hormones run out. What happens at menopause? well whereas our hormones go down by 20 percent 10 to 20 percent our bone density goes down by 10 to 20 percent and that's when women start breaking their wrists at 60 when they trip over and that's when people start needing hip replacements and that's when you know they start dying of terrible injuries and we don't need to do it hormone replacement therapy and all these big studies you can get around 7 % to 10 % increase in bone density.

29:59Start early, protect early. We can throw our Zimmer frames away. Why is no one having this conversation? Why are we giving women drugs after they break a bone? Why are we giving them Dexter scans after they break a bone? It's daft. I mean, it's just silly medicine. And they could save billions a year just by getting women on HRT early, particularly those at risk. And we're not doing it. And it's just a no brainer. You know, hormones make bones end of government listen, you know. I mean, and you talked about the cost, right? Right. And I think it's also really interesting to look at the economic cost of perimenopause and menopause on women and Britain.

30:54And it's fascinating because women leave the workplace, women leave schools, nurses leave their profession because they just can't cope. The cost of that is so huge. And with just a little bit of support, it's that women are shamed about taking hormones still now. I can feel it often. If I say to somebody at every talk that I do, and I'm sure you get the same thing, have you thought about taking HRT? No. It's like literally that kind of embarrassment. Oh, no, I wouldn't do that. and we've got to change the story because not only would it be better for them but if people if government want to think about it the amount of money I mean can you tell us a little bit about in the workplace even so the statistics are one in ten women are leaving their jobs because of menopause symptoms and that's a survey of four thousand women around Britain all different ethnicities and economics.

31:56So it's a huge thing. And also the very places that women are leaving are things like the police, the health service, and they can get pensions. They've worked their time, they'll get their pension, they'll leave, and you lose a nurse at 50. You know, that is a genius of value, you know, and experience and knowledge. And you cannot replace her with a nurse of 22. great as that is and the cost is just extraordinary and we treat people so badly and I mean I've been in hospitals talking to nurses and they can't get a menopause appointment in their own hospital and you think this is so stupid you have just thrown you know hundreds of thousands down the drain by not listening to this one woman yeah who is saving lives every day and that's you know it's absolutely got to be called out all the time.

32:52I think as a really smart woman you must see solutions everywhere and it seems insane that people aren't doing it. I mean how frustrated do you get? It's odd that I'm not running the government. Yes. But I completely feel that you know you can see very clearly and we've discussed this with menopause mandate if we put HRT and this hormone conversation about longevity into the 45 40 something doctor's appointment that you go in to get, that would cost nothing and really maybe change a lot of people's lives. And it might stop hundreds and hundreds of thousands of people getting Alzheimer's and osteoporosis and, you know, diabetes.

33:34Because I feel like so many women don't even really know about it. Well, the doctor's appointment, you're supposed to get one around 45. Yes. But I don't remember getting one. I don't think I ever have it. And you're supposed to be told everything about, you know, your risks of osteoporosis and high blood pressure and diabetes and all those things and said, why don't you take more exercise, etc, etc. But hormones and menopause was not mentioned in it. And I don't think they've changed it yet. And it would be a very simple thing to do. And we have this huge resistance. And I just think it's because this knowledge isn't out there.

34:10And I love the science because the science is a joy because every time you pick up a book or a new paper, it says, wow, we can stop this. We can protect this. We can help this. We can lower the chances of diabetes. This is all new, isn't it? This is the last few years. When we did our documentary since then, we were kind of cowgirls talking about like take HRT. And actually, a lot of what you were talking about has been proved right. Yeah, well, the science was there, just people didn't know enough about it. And actually, there's even older science that looks really good. But it was mostly on the old synthetic HRT.

34:50It was basically like ultra processed food. And now we've got the goods kind of fresh organic food in terms of copies of our own hormones. And the medical establishment, the NHS, are still getting those two things muddled. You know, plastic apples, real apples. And, you know, it's that simple. and I ran it all through AI the other day for a piece I was writing and guess what what chat GPT doesn't know can't tell the difference well it can if you go into incredible detail but if you ask chat GPT about HRT it says it will give you blood clots here are the risks and of course we know that the kind of HRT the transdermal kind is like WD40 in your veins and is actually preventing you getting sort of vascular problems and things like that and it carries no risk of blood and and yeah So basically, there's this bulk of old evidence.

35:44Imagine how many people are asking, chat GBT. And the other thing, you just asked the basic question, you know, is it safe to take HRT? Well, you know, well, girls, no, because history tells us, you know, and that is what we're up against. So we're up against a whole new level of trouble. And also because people only go to that one kind of Google answer, perplexity answer, whatever it is. they don't look any further because they think oh that's right and you know you go through it and you think oh well wait a minute I think I'm really worried about that yeah the other thing that is terrible is how many women are so frightened of hormone replacement therapy and they're getting the symptoms and how many private doctors or people not I don't want to I don't want to kind of vilify or villainize private doctors, but some people will kind of come up with loads of other illnesses and things that you can, syndromes and things that you can have that will keep somebody in a cycle.