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Interview
101 David Matthews
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Professor of Diabetes MedicineBorn in Rainham, Kent in 1947.
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Overview:
David Matthews is Professor of Diabetes Medicine at Oxford and Medical Tutor at Harris Manchester College. His research interests include mathematical modelling of insulin resistance, homeostatic model assessment of beta-cell function and insulin resistance, therapeutic agents in type 2, and the global diabetes epidemic. In 2010 he retired from clinical practice and from Chairmanship of the Oxford Centre for Diabetes, Endocrinology & Metabolism. He continues to be Director of the Oxford Health Alliance and Co-Director for the UK Diabetes Research Network. He is now Director of the Tseu Institute at Harris Manchester College. He was Principal Investigator for Diabetes Stories
Please note that Overview relates to date of recording Monday, June 14, 2010
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1 After qualifying in 1975, he did house jobs in Oxford and Swindon. He worked long hours, but believes that this was much better for his medical education and for the patients` welfare than the much shorter hours worked by junior hospital doctors today [ 67 secs ] |  | 2 At the end of his career in the NHS, he is very positive about the contribution that research has made to the welfare of people with diabetes and hopeful about the future [ 63 secs ] | |
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| 01 Father senior manager. Mother teacher - polymath. Brothers scientists. Childhood experiments. Liberal education. Decided to become doctor aged 9/10 - Parents amused as blood made me faint - continued into medical training. | |
| 02 Chigwell School. Didn`t pay fees. Was Head Boy - absolute authority. Learnt to use power carefully - proved useful.
Corpus Christi College: contemporaries Donald Moir & Philip Home. `Sconcing` in 1966-9 - I was teetotal. JCR Presidency. Acted in drama, part-produced by Mark Davies - I married his sister.
Good enough degree to do DPhil with Roy Kay, Keble physicist - technicalities of human hearing. | |
| 03 Undergraduate education: tutorials, voluntary lectures, classes. Morbid anatomy - didn`t learn much. 4 students per cadaver - Moir, Home, John Nash. Learnt anatomy from books. After 5 terms, BM & BCh. After 3 years, BA in Physiology. (Then pathology - but in my case after DPhil).
Physiology theoretical. Learnt re neurology, then DPhil in auditory psychophysics - on path to become neurologist. | |
| 04 After DPhil - clinical medicine, Oxford - married undergraduate, Clare, 1970. Lived in St Bernard`s Rd - near Radcliffe Infirmary. Was keen medical student - attended firms. Many didn`t attend due to demands of new continuous assessment - formal mini-exams. Lecturers tried to reduce marking by half-page restriction: students used tiny writing!
`Tingewick` - medical student drama - I imitated neurologist. | |
| 05 Small medical school, lots of clinical experience. Enough knowledge when qualified, 1975, to be safe as houseman.
Learning better with intelligent people. Chigwell competitive, but shouldn`t appear to work. At Corpus, acceptable to work - & at medical school, impatience with time-wasting ignorance. Bad lectures unacceptable. Contemporaries now eminent. Privilege of having clever associates. | |
| 06 Houseman, Nuffield Dept. of Medicine, with Tony Windebank & George Hart. Run by David Weatherall. Reader, Robert Turner.
Surgical house jobs, Swindon: worked whole weekend - continuity ensured good knowledge of patients. European Working Time Directive bad for medicine.
Swindon surgeon Mr. Huddy. With Tony Windebank, refused to join strike, 1975/6.
(Before qualified, 1975, went to Indian hospital, with wife & brother.)
After surgery, infectious diseases, then neurology - Peter (in fact, Brian) Matthews & John Spalding.
Became Registrar, Central Middlesex. Registrars ran hospital. Patients got good treatment - staff shared information over lunch. Incompetent consultants given few cases! Did teaching, for Membership.
Before C. Middlesex, months of diabetes with R. Turner, using mathematical tools. After C. Middlesex, returned to Turner`s lab - became diabetologist instead of neurologist. | |
| 07 With Turner 1979/80 to 1992 (when became consultant physician): insulin secretion, resistance & pulsatile delivery, using mathematical tools learnt with Roy Kay. Junior Research Fellowship, Balliol, 1982. Senior Research Fellowship, Green College. Work re homeostatic model published, 1985 - much cited.
Turner`s achievements recognised belatedly - he`d run Richard Doll`s lab. Turner charming; sometimes didn`t listen; persistent re UKPDS funding; trained key people - Steve O`Rahilly, Andrew Hattersley, Jonathan Levy, Rury Holman, Tim Davis.
Research procedures more amateur - easier to start research - harder now, due to bureaucracy.
Error - gave e coli to medical student. People fainted. (I`d stopped fainting since one anatomy demonstration.) Turner anaemic through giving blood for insulin-free plasma. I felt faint when giving blood, but lay down. | |
| 08 United Kingdom Prospective Diabetes Study (UKPDS) conceived by Robert Turner, 1979, to see if sulfonylureas or insulin best for Type 2 diabetes. Turner raised funding despite opposition. UKPDS established importance of blood sugar control. Rury Holman essential to success.
Punch cards. Melanie Burnett could read ticker tape!
UKPDS published 1998 - acclaim. My involvement a privilege. Model trial.
Turner died 1999. He was competitive - useful for academic, but I learnt when Head Boy that managers don`t need to win. | |
| 09 Worked with R.Turner until 1992. Succeeded Derek Hockaday as NHS consultant. Had had clinical experience with Turner - was accredited endocrinologist & diabetologist. Endocrinologist Chris Burke retired. By 1993, I was clinical director for endocrinology & metabolism. Burke replaced by John Wass.
Raised half million to open Oxford Centre at Infirmary in 1995. Open every day. Secretaries on reception - knew patients. Service less impersonal, more integrated. Under Hockaday, diabetes in big Friday afternoon clinic. I allocated times. Infirmary investigated waiting times. We ran late if patient needed time, but provided coffee.
Plan for Oxford Centre for Diabetes, Endocrinology & Metabolism when Infirmary moved to John Radcliffe - needed £14 million. Help from Novo Nordisk, Takeda, NHS, Merck, Sainsburys. Need large donations. | |
| 10 Im 1990s - OCDEM planned; 2000 - begun & I became Chairman; 2003 - moved. Aim to unite clinical care, research & teaching. `Alpha males` resist collaboration, but convinced by arguments that collaboration competitive.
Hard to unite university & NHS. NHS thinks research distracts. University thinks clinical care distracts. University & NHS think teaching distracts.
Need for consensus. Hard to balance teaching, care & research. Good staff: Mark McCarthy, Patrik Rorsman, Rury Holman, Jonathan Levy, John Wass, Keith Frayn, Andrew Neil, Anne Clark, Raj Thakker, Anna Gloyn, Andrew Farmer, Paul Johnson.
DRWF funded islet isolation centre. | |
| 11 Building designed by Gordon Kirtley - good. Regret: 3 to 4 years ago, 26-bedded ward taken over by chest physicians: reduced to 3 beds for diabetes, 3 for endocrinology, though we`d done fund-raising - NHS ignores history.
Wonderful building. DRWF islet isolation facility added. | |
| 12 I`m Senior Investigator in National Institute of Health Research - NHS research with more accountability than previous Culyer funding, but NIHR must ensure money goes to clinical research.
I`m co-director of UK Diabetes Research Network - trials. Drawback: UKDRN created superstructure first - but good at recruiting for trials. Must invest in recruitment. | |
| 13 PPI involves Patients & Public in recruitment for trials. Public have responsibility. Most enjoy participation in trials - people sad when UKPDS ended. We`re concerned re advocacy.
Oxford Health Alliance started 6/7 years ago to tackle epidemic chronic disease. Why Type 2 epidemic now? | |
| 14 Diet & exercise addressed by O.H.A. OCDEM`s staircase encourages exercise. From O.H.A, Global Alliance for Chronic Disease. World Health Organisation talks of Non-Communicable Disease. Better to say `epidemic`.
Tutorial Fellow, Harris Manchester College, since late 1990s - admitted first medical students. Set up Tseu Institute - medical exchanges with developing countries.
Lucky to stay in Oxford. Medicine worthwhile. | |
| | 15 Diabetes shame less nowadays - still exists. Monitoring & insulin delivery easier. Clinics better organised. Mostly primary care, but still need hospital specialists. Specialist nurses essential. Need more dietetics. Patients now happier to come to clinics. Better medications. Patients` treatment improved. I`ve just retired from NHS. Still need to minimise complications, but outlook better, thanks to research, therapeutics & changes in attitudes from care-givers. | |
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