Michael Mosley in conversation

Sally Wilkins: Thank you for a wonderful talk, Michael and welcome to Melbourne. Welcome to the Library and welcome everybody and thank you all for coming. What's going to happen now, we're going to have a bit of talk to you. In about a half an hour, we're going to pass the microphones around, I'm sure there are people who want to ask Michael lots of questions and you'll have that opportunity to do that. But first of all, we thought we'd like to find out a bit about you, because we're both psychiatrists, which means we're pretty well professional sticky beaks, really. So we'd love to find out a little bit about your fascinating background, how you came to be where you are now from medicine. I believe that when you went through medicine you wanted to do psychiatry at one point and then you changed your mind…

Michael Mosley: I did, yeah.

Sally: …and went into broadcasting, was that a good idea or a very good idea?

Michael: It was very curious at the time because I was kind of agonising. I had trained in medicine with Claire over there, and I was feeling a bit tired. I wanted to go into psychiatry and I got frankly disillusioned when I was doing my psychiatry rotation as a medical student.

Sally: Now what was the solution? That was fascinating.

Michael: And I saw an advert in the paper for a training scheme at the BBC, so I kind of randomly applied for it. And they offered me it, and I was kind of torn. So I went to those people in sort of medicine and they all said yeah, get out of medicine, go into telly, and then I talked to the people in telly and they said, oh no don't go into telly, stay in medicine. So I agonised about it for a long time and then I thought I'd go into telly for a bit and then I'll go back and be a more mature and reflective individual.

Sally: So you were obviously always interested in the human side of medicine.

Michael: Yes.

Sally: You did some philosophy at university when you were there.

Michael: I did a first degree, I actually was a bit of a nerd when I was young, so I was absolutely passionate about, I actually did at one point plan to become a chemist. And that moment passed, and I spent some time doing work in a sort of, or visiting a cracking plant up in the north of England. And I decided this was not a gorgeous way to spend my life, apologies to any chemists out there. And so I decided to do something completely different and I did politics, philosophy and economics at Oxford because I kind of wanted to see the world from a different perspective. And so I then went on from there to become a banker. And then after that I went into medicine, and then after that I went into telly.

Steve Ellen: What's next? What you've got planned for next year?

Michael: I thought I would write a few books and see how that went down. So no, I think I probably arrived where I want to be. I have to say becoming a health guru was not anything I ever imagined. In fact I said to Claire the other day, did you in your wildest dreams, ever imagine I would be doing this? And she said, Michael you do not feature in my wildest dreams.

Steve: Because interestingly, though the arc of your career in journalism, from what I can tell, was behind the scenes, then in front of the scenes, all reporting and then moving into this more clinical role. I mean, you're now actually giving health advice rather than telling them about other people's advice. You've got a website, you've got your books and all that sort of stuff. Are you tempted to go the full circle and start seeing patients one to one again?

Michael: I don't think so. I think it's been so long that it would be rather dodgy. Claire kind of puts my theories into practice largely, and reports back to me how it's going.

But actually, it was an Australian who changed my life. I was making the first science documentary I ever made, which was about a guy called Barry Marshall. Has anyone heard of Barry Marshall? The only person born in Western Australia to ever win the Nobel Prize for medicine. There you go. So this is back in the early '90s, and Barry Marshall is working in Perth with a guy named Robin Warren, and at the time the firmly held belief was that stomach ulcers are caused by stress. And Berry said, not true. In the stomachs of patients who had had burst peptic ulcers, they had found these little previously unknown organisms called helicobacter pylori, because there were a sort of helical shape. And so he was convinced and they were convinced that this was actually what was causing peptic ulcers. And at the time Glaxo was producing the best-selling drug of all time which was Zantac. This was the perfect disease. It affected people in rich countries. You took the drug, your ulcer got better, you stopped taking the drug, it came back. And Barry was saying, I can cure you for $3.

Basically, he said I can cure you because it's essentially caused by a bacteria and I have a mix of antibiotics that will do it. And to prove his point, he basically mixed it up and swallowed it. So he'd had an endoscope beforehand, his stomach was normal, he swallowed it, and three days later he's vomiting in the toilet, and he's absolutely delighted. He was absolutely thrilled. He had blood, he didn't think it was going to happen that damn fast. And his wife said that he had killer halitosis, you know really bad. And after about a week of this, he took triple therapy, he had himself endoscoped again – sorry after he'd had the vomiting, he then had himself biopsied, put a gastroscope down and they found all this bacteria down there. So I made a film about Barry, and about this whole thing. And I'd love to say it went down with the medical profession well, it did not. I got a review in the British Medical Journal which described it as one-sided and tendentious. But I was very pleased, I wrote back to the reviewer when Barry and Robin won the Nobel Prize –ha! But that's what got me interested in self-experimentation.

Steve: But medicine is like this giant steam liner that takes ages to stop or turn around. And you know, it took ten years for that ulcer research to change practice, even in Australia where we heard about it in the newspapers and read about it in journals. They became Gods, especially once they won the Nobel Prize, in the medical circles. But the nutrition industry is the same. It takes 10 years to turn anything around.

Michael: I would have said ten years was a remarkably short period of time, because as I said, the evidence around the benefits or otherwise of the whole fat–carb thing has been around for 20 possibly 30 years. And as we were saying beforehand, the odd thing is that in medical school you get almost nothing about nutrition. Did you learn anything?

Steve: I honestly don't think I even heard the word nutrition hardly. And embarrassingly, I was saying, people will laugh and they might say it's just me and not doctors, but I had to look up carbohydrates again when I read the book. That's how little I've found useful.

Sally: That's just you, Steve.

Steve: It's just me. That's probably true, sadly.

Michael: So when I was writing the book, I was looking at some studies, and there's a fantastic study out of the US where they interviewed cardiologists on a sort of nominalised basis. And what they found is the vast majority of cardiologists did not offer any advice to their patients because A: they knew nothing, and B: it was probably just as well, because most of what they thought they knew was completely wrong. And it's really weird, it doesn't actually stop, obviously, doctors spouting on about diet, despite the fact that they know nothing about it, but that is quite frustrating.

Steve: You've obviously covered a million different health topics over the years, I've seen a whole lot of them myself. And you've really made nutrition and diet your big cause, you've done it for a number of years now. I wonder, did you enter this field with any apprehension? Because I know I do, because a lot of the things I see about the nutrition industry, there's a lot of moneymaking, it's a big industry. And two, sometimes, not you, you've focused on health benefits as we just saw, but there's a lot of fat shaming, there's a lot of nutrition that focuses on the aesthetics of body shape rather than the health benefits. I wondered if you had any trepidation, did you go into it with any sort of…did you have to think about all that?

Michael: I didn’t intend to ever go into it and the majority of the films I make have nothing to do with diet, nutrition or anything like that. I’m currently making a film, for example, about history of chemical and biological warfare, which is a fairly long way away from fat.

But it was accidental, so in 2012 I discovered I'm a Type 2 diabetic, before that I had absolutely no interest in nutrition. I had made no films about nutrition and it wasn't a subject I was going close to. And then intermittent fasting came along. I genuinely found the science incredibly exciting and so I wanted to do something about it. I made the film, I had no intention of writing a book about it. It went out in the UK against the 200-metre final of the Olympics, so I thought this is going to disappear without a trace, I thought I am doomed, somebody does not like me. But it actually did very well and then people started to contact me, other people started to write books about it and I ended up writing a book about it and then the book became a phenomenon. So that kind of launched me off, but I have been extremely cautious about it.

As you say, you know there's a lot of dodgy stuff out there. And the latest book, for example, The Blood Sugar Diet, is not based on my research. I don't do this stuff, I don't make this stuff up on the back of a Cornflakes packet. I actually talked to a lot of people, I spent two years talking to experts all over the world. And Professor Roy Taylor, who is actually the person behind all of this, he's been working on it for 20 years, he is one of the world's foremost experts on diabetes. I had that book read by serious experts in the field, so I don't want to put anything out there that is nonsense. I think what the truth is, is there is an enormous gap between what the people who study the thing really know, what doctors know, what dieticians know and what the general public know. And frankly, the gap between these two is probably much greater than the gap between these two. And I do love exploring those gaps if you like, so I am, and Claire has said this, I am probably my greatest critic. So she reads all this stuff and she goes, that's nonsense or can you possibly justify it or, you know, if you say this…

There are things I don't say and wish I could say about Type 2 diabetes in public but I don't say, for example, that actually the evidence that the drug that diabetics are put on, Metformin, we don’t know if it works. The basis of our belief in it is based on the study in 1998, which has never been replicated, it may work it may not work. But in the UK, you just get dumped on it. And in many places in the UK you basically get paid, if you're a GP like Claire, you get paid to put people on Metformin, you do not get paid to help them lose weight. And I was at another meeting and a guy from the Diabetes Association told me with a straight face that Australian doctors would never do that, they would never, ever put you on a drug without giving you proper dietary advice first. I just wanted to say bollock, but it was in public, I felt I couldn't. But I was just amazed at his ability to look me in the face and tell me that, because he must know it's not true, I know it's not true, so why is he bothering to tell me that? He was also telling me that the low-fat diet is not something endorsed by the Australian Diabetes Association. It's the first thing you see on their website, so there's a strange dissonance there.

But I do, a short way of answering that is, yes, I am aware there is a risk that I could come across as a con-man, which is kind of slightly—

Steve: That's not what I'm suggesting.

Michael: I am aware that you have to put things in parentheses. I am also aware that if you put it out there in a book and you do things like that, then people may take it up who shouldn't be doing it and it keeps me awake sometimes, honestly.

Sally: Michael you mentioned Dr Marshall before, you've said that some of your scientific heroes are the self-experimenters, the people who through history have experimented on themselves like Dr Marshall did. We've seen you swallow tapeworms, we've seen you take photographs of the inside of your colon, we've seen you jab needles into your hands, and on a recent documentary you did we saw you undergo what used to be called an abreaction with sodium thiopental. Now, for those of you that don't know, this is a drug that used to be called, the truth serum, which probably is a very ill-conceived name, but it was thought in the old days, particularly the early days of psychiatry, that if you were blocked and you couldn't speak about things that were troubling you, you had a dose of the truth drug in a safe situation, and you opened up and you could talk about things. I remember as a young psychiatric registrar seeing the older doctors do it, you know this was 30 or 40 years ago, it's long since been dropped, but you went through it, and when you went through it you cut the sound feed, you said you weren't going to show what happened.

Michael: Yep.

Sally: And now that we're on our own, perhaps you can tell me, I don't know. I've always wanted to find out what that felt like from somebody who went through it. What was it like?

Michael: It was actually just like being unbelievably relaxed in the company of people you trust and so you just want to tell them stuff. So the fact is, actually, that was probably a very unwise thing to do. So yeah, it was just a muscle relaxant, ultimately it's an anaesthetic, and so it's got a bad name now, obviously, A: because of the truth drug bit, and B: because they use it to kill prisoners in the US. It's used just before they electrocute you, so this is not a very lovely drug. But I have to say, just as an experience, it was absolutely fascinating. It's the number third best experience I've had. The best experience I've ever had was laughing gas, which I have to say was hilarious. The second best was psilocybin, I don't know if any of you have eaten magic mushrooms in your youth, obviously not, but they injected me with that and that really was fantastic.

Sally: You felt like you were levitating.

Michael: And the third was this, and I have to say, terrific.

Sally: But has your sort of gonzo style of medical journalism ever got you into trouble? Is there anything you regret doing?

Michael: There was one I regretted doing, which was when I was doing a series about experimental psychology, and the first program was about fear and so naturally the producer said, what are you afraid of? And I said, I'm afraid of confined spaces, so he said, great, let's go caving. And so we went caving, and then I got stuck underground and then I really, really freaked. And then when they stuck me in an MRI machine, I found I couldn't do it. It actually seriously aggravated my claustrophobia, so that's one I regret doing. But most of them have been challenging but absolutely fascinating and some of them have been life changing. And I would categorise obviously going through the MRI machines, discovering I had that, doing the intermittent fasting, most of them have been hugely interesting, even the tapeworm was really, really interesting.

I did that in part – did anyone see it? It festered – the agreement I had with Claire was I would get rid of it or them before we got to 10 weeks, because then what happens is the segments break off and they crawl out and you might find yourself sharing a bed with them. But what we did was we went to Kenya and we got a hold of a dead cow, which was infected in the tongue, we removed three cysts, I swallowed three, I didn't know if I had triplets, twins or singles. And then about eight weeks later I swallowed a pill cam and you could kind of see them down there. And I have to say, that was a hugely exciting moment, it was in an Indian restaurant of all places. Because I've got my iPad here, which is directly connected to my pill cam in my stomach, so you could see the moment when the pill camera goes around the corner and suddenly there's a little tapeworm staring at you. So, I jumped out. See, it would have been really disappointing to have done all that and nothing there. But it was actually part of a really interesting study because this was done at the University of Liverpool, and they have no way of telling whether people are infected with tapeworm or not in places like Africa, so what they needed was volunteers so you our freezer was full of my faeces for many months after that.

Sally: Thank you for improving our dinner experience later on.

Michael: Come to dinner in the Moseley household – you never know what you're going to get.

Steve: It almost reminds me of health journalism spliced with reality TV. You would be an ideal candidate for Big Brother, but why? Were you like this as a kid? Have you always been an adventurer?

Michael: I was fairly adventurous and when I was at medical school I used to subsidise myself if you like by doing experiments. There used to be a place in Smithfield meat market, you went up a little narrow passageway, and there was a dodgy French company who wanted volunteers and they would inject you with stuff and pay you $200 a day to basically be injected with all sorts of strange substances. And then they closed it down for obvious reasons. That kind of got me going, but it was actually Barry and the history of self-experimentation, because that got me interested, I started researching the history of medicine, and the history of self-experimentalists. And then I pitched that idea to every controller of every channel for 14 years. And I spoke to a guy called Alex Graham who came up with Who do you think you are? Are you familiar with that one? And Alex said he pitched that idea to every controller of every channel for 17 years. So you have to be persistent. You have to believe in the stuff. So anyway, I ended up in front of a controller of BBC4. I wanted the history of medicine told through self-experimentation, and she said who's going to present it? I said I have no idea. She said why don't you do it? That's how I came to be a presenter. That was about eight years ago.

Steve: Were you reluctant?

Michael: No, not at all. Yay! No, I thought it would be great fun. I was terrible to begin with. I've seen the audition takes for a load of people, and they're generally terrible. Jeremy Clarkson was appalling. Jamie Oliver was awful, I mean, really, truly awful. They shot him like he was Delia and they kind of put him in a kitchen, full on face. And he was dreadful, and rather than sack him, they sacked the director. They put him in a groovy loft. They got him to talk off camera, and the rest is history. So a lot about being a presenter is about kind of practice.

Sally: What was your audition tape like, Steve, did you have an audition tape?

Steve: Well you know, my tapes are all over the internet. They're not on those websites for some reason.

Sally: Can I come back to something you mentioned about decision making there? You said about what motivated you to get into this diet thing. If I said to everybody in this room, I'll give anybody who loses one pound this week $1000 next Friday, I reckon almost everybody would come back and collect their $1000. Clinically, one of the hardest things to do is to translate what's clearly a very sensible decision for your health into the motivation to change your behaviour. You know there are a thousand different reasons human beings do anything and ambivalence around important decisions is the expected norm. How do we as a profession or as a group of health workers encourage people to make that decision without having the scare of fat on the MRI or a diagnosis, how do we get people to think about this before that happens? That seems to be biggest challenge.

Michael: It is enormously challenging because, clearly the time you change is when you realise things are pretty bad. So, there is a moment when, for example, Professor Taylor found that Type 2 diabetics were prepared to listen, and that was the moment they were told they were a Type 2 diabetic. Now, the normal moment you're told that, your doctor reassures you, tells you it's fine, let's put you on the drugs, everything will be hunky-dory. They will probably also tell you this is an incurable disease, get used to it. There is a thread on the website bloodsugardiet.com which is hilarious. It's things my doctor told me. And they are told the most awful things. They are told to eat a tin of pineapple every day, there's a load of them. So if you are told you're Type 2 diabetic, that is a moment of motivation, I genuinely believe.

I also believe that actually, there are quite profound physiological things that happen to people when they put on weight. It's not all going on up there, right? I can see there's a lot going up there, but when you become insulin resistant, then you fundamentally change and that's why I think that things like the Mediterranean diet are so good. That's also why I think the low-fat diet is so bad. I think that actually the evidence is very clear that if you can bring down insulin levels then you can reduce hunger, you can reduce your risk of things like breast cancer and things like that, and the Mediterranean diet will help you do it. I also do believe that intermittent fasting will help you do it, that's what all the evidence shows, and I also believe that high intensity training will do it, because that's again what all the studies show, which is why I bang on about those things. I think there is the best diet, the best or at least the things that are most likely to reduce your insulin levels, and once you do that, it becomes easier to stick to a diet. But beyond that, I think it's mainly a matter of changing your physical environment. And then we move on to stress. So, I think we make a zillion decisions, and most of them are random and they go on without us noticing it. There is a lot of evidence that if you just change your built environment, by that I mean you clear the junk out. But basically, if you have cereal on the table, you will eat it. If there's chocolate on the table, I will eat it. Claire takes the chocolate and hides it away, otherwise I will eat it. Eleven o'clock at night, sorry Claire, I am prowling around the house looking for sugar, looking for chocolate. If it's not there, I don't eat it. If it's there, I eat it. I also have this habit according to Claire, if the chocolate's there, I do this – if I can't see myself doing it, I'm not really doing it.

Steve: It's like, if the biscuit gets broken in half, the calories fall out and it doesn't count.

Michael: Absolutely. So I think there are lots of very simple things you can do. I think governments could do an awful lot to change the built environment in ways that would be helpful. Not least by not subsidising the foods that make us fat. Governments subsidise corn, they do not subsidise artichokes, they do not subsidise broccoli, they do not subsidise any of the good stuff. They only subsidise the bad stuff and that is profoundly odd. Don't you think that's odd?

Steve: Well your graph had the very thing – sugar stops being taxed and off it flies. And if you're waiting till people get even pre-diabetes you haven't missed the boat, obviously, that's what your book's all about, but you'd want to do it a step earlier wouldn't you? You don't want 500 million Chinese people being at risk of pre-diabetes. You want to try and do something that'll either change the way people feel about their diet earlier or, and whether or not that's motivating them personally, or whether that's getting the government to make things more expensive or introduce some better farming subsidies or better food in schools or whatever it is, I don't know, but it's got to be something to be a step earlier surely.

Michael: The answer is always education, isn't it? It's all about education. Now, try this one: for true or false.

Steve: Okay, I love a test.

Michael: Being overweight or obese is primarily a problem of people who are less educated and have less money. True or false?

Steve: I would have thought a lot of obesity is related to the excesses of life like lots of money. So I would have thought false.

Michael: You would have thought false?

Sally: I would have thought it's the other way around because sometimes people in the lower socio-economic group have easier access to the higher…

Michael: Okay, so what do we think audience, true or false? Poverty and low income and ignorance are the drivers of obesity and overweightness. Okay, let me tell it. The answer is true and false.

Steve: My favourite sort of question.

Michael: So, it's true for women and not true for men. Basically, women who are better educated and have a higher income, weigh less. Men who are better educated and have a higher income are in the heaviest category. You have fat men and thin women at the top, and you have fat women and thin men at the bottom. So, there's something interesting going on there, isn't there?

Sally: We've got visual images to take home tonight, that's for sure.

Steve: I reckon we've probably only got time for about one, I'm just looking at the clock in terms of the half hour to open up to the audience. But I want to ask you something that I think is of relevance to anyone who's in the clinical field, doctors, nurses, everyone. Because you've interviewed a whole lot of people over the years, quacks, professors, people who inspire you, people who must drive you nuts. You're married to a doctor. Your son is studying medicine, you've studied it. You have an incredibly broad helicopter view of the whole industry. What makes good clinicians? What are you telling your son about how to be a good clinician?

Michael: First of all I was telling him not to do medicine but he ignored me. I think probably compassion. If you don't like people and you are not compassionate then you're really…become a pathologist. But probably better not even medicine because there are going to be appalling hours, people are going to frustrate you, you are going to be in a horrible hierarchy, they are going to treat you like shit. So you better like your patients.

Steve: Fair call. What should we do? Is there time for Q and A?

Michael: You see I always had this illusion that psychiatrists were nice people but sadly I'm not so sure.

Steve: No, we try. We just wanted to hold the conversation ourselves. Do we really need to include the audience, really? Firstly, thanks for chatting to us, that was fantastic and it's great to hear all of your thoughts. You've had an amazing career and you've had such a broad experience and you've obviously done so many things that you really do bring a unique perspective and it's wonderful to hear you talk. In Australia, we are very nonformal. In fact, when you said, you know, your son will go into hospital and have to put up with a lot of formality, that's not our thing. So audience?