Podcast transcript: EY Change Happens Podcast – Dr James Muecke

Intro: Change happens how we respond to change can make or break us and our careers. Join us for an intimate insight in to how senior business leaders face change. The good, the bad, and everything in between because whether we like it or not, change happens.

Jenelle: James, hi and welcome to the “Change Happens” podcast.

Dr James: How are you today.

Jenelle: I’m pretty well thanks, but more importantly how are you and how have you been personally managing throughout the last few months.

Dr James: Yeah, its been an extraordinary few months. You know, Scott Morrison said this is the worse year of our lives, so here I am, Australian of the Year, and the worse year of our lives so [laugh].

Jenelle: Quite the rollercoaster for you as you say. Over the last few months, you have the high of being named the Australian of the Year in late January and then like the rest of us, plummeting into everything that’s Covid-19. No doubt that changed your outlook of what you’d planned for the year.

Dr James: It sure did. In fact there’s not ever been a year like this in the course of history of the Australian year programme so I’m a bit of a pioneer in this process as well so I’m really sort of paying attention to what's going on and I’m hoping to communicate that by the end of the year so that they have a real understanding of what's happened. So of course, the Australia Day weekend this year was full of excitement and I won the award, it was just this flurry of requests to speak. All sorts of really really fascinating things that suddenly arrived in that first or two after receiving the award. I had something like 60 speaking engagements even at that point were booked out for the year then a month or so later the virus struck and one by one all of those engagements were struck off and I was left feeling pretty dejected. I was feeling dejected for a number of reasons. One of which was this was an opportunity to really tell Australia about work the science world was doing which suddenly was no longer there and the other of course, was I was using the platform to raise awareness of the toxic impact of sugar in our society and in particular the linkage to type 2 diabetes. So this was going to be a great opportunity to talk about that and raise awareness amongst the Australian public and again I saw that dissolve away because no one wanted to hear about type 2 diabetes or a poor diet [laugh] and I was the same. You were watching, glued to the TV set for those first few weeks of the pandemic. So yeah, it was a really tricky time for me. I had to do some pretty quick thinking, you know, how was I going to continue to get the messages out there, how was I going to make most of the platform and so I did a number of things. I started being more active on social media, on a number of social media platforms that I have, hoping ultimately by the end of the year they would have had more reach and if I’d been jet setting around Australia delivering my presentations. So that’s why I’m really interested in seeing how this year pans out, that actually going forward, depending on what happens of course with the pandemic, the next Australian of the Year, you know, there’ll be some good learnings to be had and the best way to continue getting the message out in this very different time that we’re experiencing.

Jenelle: Now I believe that you’re in a national Covid-19 health and research advisory committee and that was established, I think, about April this year to provide advice on Australia’s health response to the pandemic and that’s advice to the Commonwealth Chief Medical Officer. What does it actually involve and what's that experience been like.

Dr James: Yeah, its been a fascinating experience. Very lucky to be on that committee and know some extraordinary brains that are involved in that process from across Australia, from a number of different fields and so I feel very privileged to be a part of that and its fascinating because of course, you’re getting firsthand information that others are not exposed to. So hopefully in some small way contributing to it. So what happens is that when the Chief Medical Officer is wanting some information or some answers or solutions to a particular element of the pandemic, he will reach out to the group and then we’ll form working groups and then discuss those elements and then feed back that information to the Department of Health. So it’s a really important process which is informing the Department of Health and the NHMRC how to progress through this process. At times I feel its going over my head because the extraordinary knowledge of many of these people that are involved, its quite overwhelming actually. Sometimes I wonder whether I’m actually able to contribute at the level I’d like to but its certainly a special experience to be a part of.

Jenelle: I’ve no doubt you’re holding your own. I’d be interested in … what are the good and bad health behaviours that you’re seeing people exhibit during the pandemic and does being at home and people working from home en masse, do you see that being an opportunity or a threat around good and bad healthy behaviours.

Dr James: I think perhaps a little of both. You know, in those early weeks when all the toilet paper went flying off the shelves, what I did notice was it wasn’t just the toilet paper, it was also the pasta, the white flour, the soft drinks. All of those food stuffs which I suppose, in many way you can store, many of these products such as … well obviously the sugary drinks and the confectionary chocolates and so forth are high in sugar but these other products such as your foods made of flour, such as white pasta, you know what we call refined carbohydrates. So refined carbohydrates are simply starch in many respects pretty much pure starch and starch is long chains of glucose which are then broken down in glucose when they reach the gut. So when we’re eating refined carbohydrates such as products made from white flour and also white potatoes. White rice was the other one I was trying to think of. You know, you’re pretty much eating pure sugar so people are stocking up on these products and no doubt consuming these products which probably unwittingly, they don’t realise they’re inherently [5.32] unhealthy for us, particularly when they’re consumed in large amounts. So that’s one thing that worries me, that people will be, particularly during lockdown periods, that they will be consuming products which are inherently unhealthy. Probably also during the lockdown they’ll be utilising takeaway services and you know that takeaway services, particularly for some of the fast food chains, foods are inherently unhealthy. As well, during the lockdown as well, perhaps people won’t be exercising as much and the other thing that people do with sugary products and again, unwittingly they may be actually ingesting sugary products to relieve stress in their lives and make themselves feel better when they’re down and of course, during the pandemic and during the lockdown, mental health is suffering in many many people and so often using sugary treats to make themselves feel better to counter that cortecell reaction and flooding the body during those anxious times. So I do worry that people’s health will decline and what's interesting in sort of normal times, we’re seeing about 250 new cases of type 2 diabetes every single day which is quite extraordinary, isn’t it. What we don’t know yet is whether there’s been a surge or not because I think what's happened is what and I’ve noticed this with my own patients during the lockdown and during the sort of significant threat, patients with chronic diseases who are at bigger risks during such times as pandemics, they are at greater risk of morbidity and even death, particularly when they have conditions such as type 2 diabetes, if they have obesity or significantly overweight or have hypertension, they are at serious risk. So, people haven’t been coming for their medical appointments and so we, as eye specialists, were encouraging our patients to come. We were doing everything to keep both our patients and our staff protected as much as we could and yet during the height of the first virus wave and in March/April, my patient numbers dropped to about a third and so it really worried me that people were going to be losing their vision during that time and we’re certainly seeing examples of that. It will all come out eventually how this all pans out but my worry is that there’s been a surge in type 2 diabetes during these periods of social isolation and lockdown.

Jenelle: I think it’s a fair caution to us to be vigilant about our health there. I want to turn questions a bit more to you personally here. I actually can’t work out whether I describe you as someone who’s single minded in focus, or someone who has a massive breadth of interests, its probably both. On the one hand you’ve had this really science fact based depth of passion and focus on medicine and specifically in ophthalmology and surgery and you’ve spent nigh on 30 years in that space, so true dedication and singlemindedness and on the other hand, you’ve got this hugely creative entrepreneurial side of you, you know, I understand that you’ve been in the game of designing furniture, you’ve travelled off the beaten tracks, supported humanitarian causes, you’ve written books, you make music. How do you describe yourself.

Dr James: Well yeah its interesting isn’t it, because I’m definitely focused and when I set my sights on doing something, I always want to give it 100%, I always put my best into anything I do. That is one side of me which has allowed me to have some of the successes that I’ve had in my life but at the same time I’ve always had a huge breadths of interests and I’ve looked at opportunities to continue to foster those interests and one of the things I did when I came back from training abroad about 22 years ago now, I made sure I always kept a day off a week. I mean it was one of those things when you’re starting off a medical practice that you quite comfortably, you know, try and fill up your week as quickly as possible and to get things happening where I always kept that one day a week so that I could pursue other interests because I’ve always had these other interests and you mentioned some of them there because for me that makes my life more full, more colourful, more rewarding and something I’ve always made time for to have this breadth of interest in my life. One to satisfy my own curiosities, I think I’m inherently a curious person but also I think, I look back at myself, I spent so many years and so many hours studying through high school to get to medicine and through medical school, to get through ophthalmology training. I spent so many years studying that when I came out the other end I didn’t feel like I was a particularly interesting person so I started to pursue all of these others …

Jenelle: Made up for that …

Dr James: Yeah [laugh] there was always an active desire to make myself more interesting and look for other things to do with my life but listeners may not be aware, I’ve developed a neurological problem with my hand which I had to give up surgery back in 2013 and I didn’t … one of the things I didn’t do with all these other interests that I had was foster them to adhere to a life after medicine. I just did it to make my life more interesting as I went through medicine. Not that I didn’t love medicine, in fact I go off to work every day feeling fortunate and loving it and looking forward to my day but what its done, its just given me this breadth, lets say weapons for want of a better word, for … to prepare for a stage of life now where I am faced with an early … having to retire early from my career because of this problem with my hand. So now I have all of these wonderful things to be able to draw on to take me through to the next stage of life. So I feel I’m very fortunate about this step but at the same time, it’s something I would encourage other people to do, always to make the most of everything that life has to offer, make the most of the incredible adventures that are out there and make the most of all these things that will allow you to have a full and rich life but also prepare you in case things take a turn for the worse, such as what has happened to me.

Jenelle: Well I’m going to come back to some of those things you’ve just spoken about but for those who aren’t overly familiar with your story James, can you take us through how it came to be that you focused the vast majority of your history in medicine in the area of ophthalmology and specifically in the developing countries of the world.

Dr James: Sure. I mean I always had a curious nature as I mentioned, I have a love of adventure, I have a love of travel, I think probably my parents, when I was 9/10/11, we were living in the United States and every opportunity we used to go and travel, get a campervan and use to explore the length and breadth of the United States so I think that really, at that period of time, the very formative time for me and still this love of adventure and this love of travel. One of the things I also loved at that time of my life was using my hands. I used to just immerse myself in building scale models of world war two aeroplanes and tanks and things like that but I also had a desire to pursue a career in medicine and you know, it’s interesting, I look back, there was no one thing that drove me down that pathway. It just seemed to be something that I always had inside of this desire to do medicine and I also had a love affair of Africa, a desire for adventure and travel, an interest in medicine and a desire to use my hands, particularly the idea of surgery and particularly micro-surgery was something that was really appealing. So …

Jenelle: A great packaging up of all of those interest, you managed to do.

Dr James: [laugh] yeah that’s right and so towards the end of medical school, we had the opportunity to do our medical elective so then I went to Kenya, it was really to satisfy all of those elements of travel, adventure, medicine and surgery and I came across this little hospital while I was there and I met some young Australian medical students who were working in a hospital two hours north of Nairobi in a village called Toomu Toomu and I went and spent a weekend with them and I just had a love for this place and I thought so one day I would love to come back and work here, after my internship. I was becoming a little disillusioned and I was really just over this grind, I’d had so many years as I mentioned of studying. I just needed a change and as soon as I finished my internship, I packed my bags. In fact I’d saved my entire internship so that I could volunteer as this general doctor in east Africa and as soon as the year finished, I headed across to Africa to work and that really did, for me on so many levels, reinvigorated this love for medicine which was beginning to wane a little bit during my internship and it really instilled in me a desire to then pursue a career in public health and so then that combined with the idea of using my hands for micro-surgery. It’s a critical or core part of ophthalmology and then curing blindness in poorer communities, once again, all of those elements conspired to lead me down the pathway of ophthalmology. So I headed back to Adelaide after my time in Africa to undertake ophthalmology training so yeah, that’s kind of the way it panned out and its all really expanded from there, you know, wanting to continue to work in poorer communities and to give back and to use that public health platform and to use my hands and I love teaching really has allowed me to continue this pathway.

Jenelle: And then as you say, you kind of then headed back, not just to Africa but to all sorts of amazing places and I think, you know, you’ve encountered the kinds of things they make movies about, James. You were captured by rebel soldiers when you were in Uganda, you were chased by wild animals, you’ve worked in refugee camps on the Gaza Strip. I think we could talk all day about any one of those experiences, but what did you learn about yourself in that time.

Dr James: I think, you know, I was in my early 20s when I headed off to Africa and I just wonder what my mum and dad thought because I had some pretty extraordinary experiences and you mentioned this getting captured by rebel soldiers in Uganda and that experience was quite extraordinary. Before I started work actually at Toomu Toomu hospital at Kenya, I wanted to go and visit the rivers in Rwanda which is sort of landlocked country southwest of Kenya and I didn’t have a lot of money and I couldn’t fly to Rwanda but I was desperate to see the gorillas because I’d just seen Gorillas in the Mist, you might remember the film was about, Diane Fossey and so I wanted to go and visit the gorillas before I started the work and to actually get there, I had to go via land, via southern Uganda and southern Uganda, much of the country was actually still in civil war at the time. I arrived at the southwest corner of the country before crossing into Rwanda when Idi Amin, who you might remember, was this horrific brutal dictator of Uganda who at the very time I arrived in this village was attempting to come back into Uganda to try and stake his claim again and he’d actually sent a band of rebel soldiers to really pave the way of his return and so I was with a travelling companion, the guy from New York City who had never left New York before. So we arrived in this village, literally the minute we set foot in this village, we were surrounded by these guys who were very very frightening, they were drunk. They were filthy and they were seriously menacing. They torn apart our backpacks, they were looking for weapons and of course we were just tourists, we didn’t have weapons but they found our binoculars in our packs so then they said we were spies and they’d actually seen us in the fields, looking out over on them, spying on them, which of course we weren’t’ and then they marched us away at gunpoint and they locked us in this hut at the edge of this tiny little village and they said to us, behave yourselves if you want to stay here and then they just past and left us alone there. So we were seriously seriously petrified and this guy from New York was completely freaking out and I said to him, come on we’ve got to get out of here, we can’t stay here, if we stay here we’re surely going to die, these guys will come back in the night because they were completely unpredictable. So we broke out of the back of the hut and escaped into the jungle behind the village and then found a road from there and went on but of course I eventually made it to Rwanda and I did see the gorillas which are fantastic and I wrote a letter to mum and dad and at that time, letters would take at least a couple of weeks to arrive and so as soon as I had the chance and again, its not easy at the time. Communication was no internet, no emails. It was very expensive to make phone calls and quite often it was difficult to make phone calls and when I eventually had the opportunity to phone mum and dad, I said you’re about to receive this letter from here, I had this really really terrifying experience but don’t worry I’m alive and I set off and continued on my way and I just felt that was enough of reassurance for mum and dad but you can only imagine what they were thinking. What those experience did, I think, was ultimately build this element of resilience in me and this is why I say that, you know, making the most of adventures. Of course, not everyone is going to be comfortable with their kids trekking across or backpacking across Africa and potentially landing themselves in life threatening situations but … and I know, I think probably for a good year or two after I came home there wasn’t a day I reckon when I didn’t wake up in the morning, almost in a cold sweat reliving one of these experiences that I had and I suspect on retrospect and I didn’t realise at the time, I’ve only just thought this recently, maybe I did have an element of post traumatic stress disorder, PDSD, because it really was so vivid, you know, a day after waking up and reliving these experiences but I think ultimately they do build a degree of resilience in you and I think that’s one of the things I look back on that time, at that experience and the time, in your 20s and you’re invincible and you’re just having the time of your life, the adventure of your life and I certainly don’t believe I was considering at the time “hey this is great, I’m building resilience for the next stage of my life” but certainly looking back, that was definitely what was happening and it certainly allowed me to handle a number of the confronting experiences that I’ve had since that time in my life.

Jenelle: Now James what about then working with others. So if you think about the nature of the experiences that you’ve had. Now obviously you’ve worked with teams in local communities or even back in Adelaide etc, what … how has that impacted your leadership style would you say.

Dr James: Yeah, I don’t often think of myself as a leader but I suppose I sorted of landed myself in this position a few years ago when I, in those early years of coming back to Adelaide and setting up a practice here and working as a consultant for Adelaide Hospital, a women’s and children’s hospital, but I wanted to keep this love of adventure, this love of travel, this love of teaching and being involved in public health in poorer communities. I wanted to keep this alive so I then became involved in some research and teaching projects in Asia so that for me, was my outlet, my release to be able to continue doing that and so that then ultimately evolved into Sight For All which as you said I co-founded, that’s back in 2008. So I kind of landed myself in this position, suddenly to lead this organisation forward and I really had no business skills and I had to learn on the job and I learnt quite quickly on the job how to run and grow a not for profit and certainly there’s been some interesting experiences from that but one of the tings that I’ve always been, I suppose, passionate about in what I do is leading by example. I think that’s a really important thing so you know, when you’re expecting your team to give a 100%, I think it’s very important for them to see that you’re also giving 100% so whenever I, and again it probably harks back to me, always wanting to do my best and to give my everything. You know, my team see me very much hands on, whether it be a research project, whether it be teaching, whether it be setting up an eye clinic in one of our partner companies in Asia. You know, I’m right there hands on and I think that’s really important for people to see that. Again it probably harks back to wanting to be involved, wanting to learn, having fun, being part of the team, having an adventure. So I think when you’re a part of that team, one, people respect you and people are drawn by that enthusiasm, that energy, that passion and just I think makes for a much more vibrant experience for everyone.

Jenelle: James, you and I come from two entirely different worlds. I’m trying to imagine what it feels like to do something like restore someone’s sight. Do you remember the first time you restored someone’s sight. What was that like.

Dr James: Its intriguing. I don’t have a memory of that and occasionally I do get asked that question. I don’t have a memory of that and what's interesting in ophthalmology training, well these days you have what we call wet labs where you might be practicing on a pig ear or you might have, these days we have artificial intelligence training programmes but again, you have to train on humans but you would start by putting one stitch at a time and then make your incision and then … so it would slowly build up so there was in a sense, no one kind of hallelujah revelationary moment that you would have and so I think that’s medicine and that’s surgery, you know, you’re slowly conditioned to these things. So for me, I think, what we do with sight, we’re not a fly in-fly out organisation where [23.52] organisation so we teach our colleagues so that they can continue to do the work. So it’s a sustainable model and for me the thing that I find endlessly satisfying and what it is, is just seeing the results of the people that we’ve trained in our partner companies and one example which is really really powerful to me and it actually was built on the back of a research study that I was involved in in 2007. We were conducting a study in Mymmar in southeast Asia to determine the causes of blindness amongst children in the country and the results were absolutely staggering. We found that nearly half of the kids that had blindness that could have been prevented or treated and the thing that was really profoundly disturbing for me and in fact the whole teams, the leading cause of blindness that we discovered which was measles to be surrounded in multiple schools of blind across the country that we visited, we were assessing the kids at these studies, surrounded by kids that were blind from measles, it sounds on the surface to be pretty confronting but when you actually quite literally there and these children who would have had the most horrendously painful experience as young kids but also the disfigurement that is caused by measles as it destroys the eyes, was absolutely devastating for myself and it really made me look at medicine in a completely different way. I mentioned that during my internship, I was getting a little bit over chronic medicine which is largely preventable related to lifestyle factors and self-inflicted things. You know, here was kids across the country, the leading cause of blindness which was an entirely preventable disease in measles, so that really drove home to me how important prevention is in medicine. So it was this experience and actually a number of experiences that we had in a number of other countries in Asia. We also found that measles was a leading cause of blindness in Cambodia in 2008, Laos in 2013 and what those experiences did was, one – instil a passion for me to do something about it but two – to then use the results of those studies to persuade health authorities to train children’s eye specialists for each of those countries. So just to tell you about the experience in Myanmar, we arranged for a young eye specialist to come out from Myanmar. His name is Doctor Tan [26.24] and he spent a year training with myself, my colleagues at the Women’s and Children’s Hospital in Adelaide training to be a children’s eye specialist, what we call a paediatric ophthalmologist and he went home at the end of his hands-on year of training in 2010. We set him up in the country’s first children’s eye unit in the capital city, Yangon, the major institute there and in fact I was there in February this year filming a documentary about his work and I was so proud and so overwhelmed by his dedication. He is providing close to 30,000 treatments every single year which is astonishing, almost difficult to comprehend but I think what's even more impressive in this story is that he is training his own colleagues. So in 2015, he was training a second paediatric ophthalmologist for the country. He now trains at least two every year, so that just really shows you the power and the sustainability of the training programmes that we run and to go back and just to sit back and capture this on film as part of this documentary at the time I’m producing was just one of the most proud experiences of my life and for me, that is so much more powerful than taking someone’s bandage off and seeing a smile on their face, which of course is very special, very rewarding, its particularly wonderful for them but the power of that, its almost difficult to comprehend that the reach …

Jenelle: It so much broader reaching when you’ve kind of got this ripple effect that just keeps going on and on as a result of you training one, one training two, two treating 30,000 to 60,000 to [28.03]. I think you have an impact of around a million people a year. Is that right.

Dr James: That’s right. Well that’s probably being conservative actually because what we’ve done. We have projects in nine countries in Asia, two in Africa as well as locally here in Australia, we have also trained across all of the sub-speciality areas, there’s about nine sub-speciality areas, paediatric ophthalmology is just one of those. Collectively they’re impacting on such a huge number of people every year and if you think of yourself, lets say if you’re a parent, some of the listeners are parents, if your child is hurt, both parents are impacted by that. You know, something as simple as a minor stubbing of the toe an upset a parent. So you can imagine when a child is faced with a vision threatening disease or blindness, how devastating that is for a parent. Now if you were able to reverse that, how impactful that is, not just on the child and the child’s future, but the parents, the family, the community, the country. You know, it is far reaching and we know that for every dollar spent on fighting blindness, four dollars comes back to the communities. So you’re not only fighting blindness, you’re also fighting poverty, so it has a really really profound impact. So it’s a special thing.

Jenelle: You’re talking about it from a vantage point of seeing that success come through now but no doubt there were a ton of challenges in the early days of setting Vision Myanmar programme which then evolved in Sight For All. Based on those experiences James and looking back on it now, you’re still in it I know, what do you think are the ingredients that are essential to creating a social impact organisation that is capable of making the kind of impact that you’ve talked about.

Dr James: I think if you call what I’m doing social entrepreneurship and if you call myself a social entrepreneur, then to me, there are three key elements to that. There’s the spirit of adventure, particularly if you want to take this to poorer parts of the world. You have to have the spirit of adventure. I think, my story earlier on shows that something that’s deeply ingrained in me. The second is a humanitarian spirit and I think humanitarian spirit may be partly genetic but I think its probably more environmental and its related to life experiences and powerful life experiences that can then ultimately result in a deep passion within yourself to want to make change, to want to ultimately change the world and again I think, showing you that experience of that research study, that Myanmar work did instil me with this incredible passion to do something about it and in fact I’ve had a number of experiences like that which is … continues to fire that passion and continue to give me that drive to keep on doing what I’m doing and the third thing is the entrepreneurial spirit which to me, as I mentioned before, I didn’t have any exposure to business and it’s something that I think I’ve learnt on the job and there are a number of core ingredients to an entrepreneurial spirit. You have to be a creator, a communicator, a leader, an innovator, a problem solver and a risk taker, just to name a few and a leader of course. So those things are really core to an entrepreneurial spirit which allows you then to take your passion and then use it to do good or to change the world at whatever level you want to but then ultimately, as you say, you have to create a vehicle that is going to allow you to deliver the passion that is going to ultimately impact on your social vision and change the world and again, there are a number of ingredients to that which we can talk about. Literally, one of the first things I did when I decided, okay to establish Sight For All. We have come up with a name that is going to be memorable. You have to come up with a brand so I immediately went to a graphic designer who I was recommended to and coming up with a brand because you need that brand then to, I suppose, ultimately to sell what you’re doing and then you have to surround yourself with people who you’re able to take on board on this ride. So it continues to grow from there. I mean we could talk about this for hours really but it’s, you know, those early years, I remember back and I had no idea. I had never been on a board before and here I was, the founding chairman of an organisation and that, as I say, a lot of learning on the job and I think when you surround yourself with people and tap into that diverse fuel set. You know, in those early years I had to … the first director on the board were people with financial skills, with legal skills, with marketing skills. All of those skills that I didn’t have. We of course had the ophthalmetic skills which were really important to what we were doing but we needed those diverse skills that we could tap into and the learnings that I had from those early directors was just invaluable. So you know, surrounding yourself with good people, people who are prepared to roll up their sleeves and get stuck into. You know, you don’t want people who are just coming along for the ride. So again, that was some of the early learnings that, you know, you soon realise who are there and are wanting to be there to help, its important. Not a fascinating process for me to learn that. The creation mentioned, I have this creative interest, this creative streak and the creation of this [33.30] was one of the most satisfying things that I’ve ever done.

Jenelle: You know, you started earlier on sharing some, [33.37] decided pre Covid days, 250 new cases of type 2 diabetes each day, perhaps understated now, not so sure. There’s many many horrifying stats when it comes to disease and related diseases. Situation maybe … it seems to be getting worse, not better or at least not improving so what do you think we need to do to make change happen here.

Dr James: Well if we look at that first three months of the Covid-19 outbreaks, so from March to the end of June, we had something like 102 deaths from Covid-19 which of course is tragic but what is not widely known at that same time, that same three months, we had over 5,000 deaths from type 2 diabetes and when you look at it on that scale, it is quite staggering and this is a disease that just shouldn’t happen. Its in essence, a dietary disease and so if it’s a dietary disease it’s a preventable disease, its avoidable disease, so it really should not be here in our society. Yet it’s a growing epidemic. Its grown four fold in the last 40 years. Its impacting on, you mentioned at one point, two million, that’s 1.2 million that we know of and there’s an estimated, at least 500,000 more who have type 2 diabetes who have not been diagnosed as yet so we’re talking 1.7 million plus people with type 2 diabetes in our society and that’s kind of pushing close to 10% of the population but there are some areas of Australia and particularly poorer social economic areas such as greater western Sydney for example, where half of the population, half of the population have type 2 diabetes or pre diabetes and we know that in Australia, there’s about two million people with pre diabetes who basically on the pathway to developing type 2 diabetes and many of those will be going down that pathway because of their poor diet that they’re exposed to at the moment. So it’s a huge problem that we’re not seeing type 2 diabetes in kids. This is something we used to call maturity onset diabetes. We’re seeing it kids. We’re even seeing it in children as young as three and it is quite disturbing and its impacting on aboriginal people. There’s been an 80 fold increase in type 2 diabetes over the last 40 years and really this diet that we’ve been exposed to over the past 40 years which is really driving this poor health and it’s a diet which is rich in sugary foods, something like 75% of our food drinks have added sugar. It’s the diet that’s rich in refined carbohydrates that I mentioned, particularly foods made from white potatoes, white rice, white flour. It’s a diet that’s rich in highly processed foods, in junk food. So it’s this diet that’s really leading us down this terrible metabolic dysfunction and this terrible pathway as I mentioned again before, close to $15 billion spent every year in dealing with type 2 diabetes alone and that was back in 2012, so I suspect its possibly even double that in that time, at least $20 billion every year that the taxpayer is funding. So this is a huge huge problem and its only getting worse. So this is why we are using this platform to raise awareness and to lobby the government to implement change. This is a very very critical time, I believe, in our society, in the health of our society, you know, going forward. So I’ve come up with this strategy, which I’ve called “the five As of sugar toxicity” and there are a number of elements here which, I think, I certainly wasn’t aware of and I suspect the Australians wouldn’t be aware of but when you look back and think “gee, how did I not know that”. So the five As for me of sugar toxicity are, the first A is addiction. So sugar is highly addictive. Its as addictive as nicotine and so we often use it like drugs. It triggers the release of dopamine from the reward centre of our brain. So it really is acting like a drug. The second is alleviation. We often use sugar as an [37.49] to alleviate stress when we’re down, we’re certainly seeing that at the moment. The third A, accessibility. Sugar is cheap, sugar is absolutely everywhere in our lives. You can’t walk into a service station without being confronted by all of the confectionary. You certainly can’t check out from most supermarkets and stores without being enticed by half priced soft drinks and chocolates. The fourth A is addition. I mentioned this astronomical amount of that’s added to our food and drinks and the fifth A is advertising. You know, the lure of TV commercials and ads and this predatory marketing that is going on in our society which is really enticing and playing on our addictions. So these three things are really critical to our poor health and the other thing is, you know, the poor advice that we’ve been receiving through our dietary guidelines now for close to 40 years. So to me the solution is twofold. One is to raise awareness amongst the Australian public of the addictive nature of sugar. In fact, we’re using it to alleviate stress and the dangers of excessive sugar consumption and the other is accountability. So its accountability of businesses, industries and government to do the right thing by the Australian people for those other [39.02] sugar toxics that I mentioned, accessibility, addiction and advertising. So that’s a long winded answer but that gives you a broad strategy that I’m really approaching this year to try and make a difference in this space.

Jenelle: James, I think that’s really interesting and at the risk of on the spot, adding another A into your mix of [39.23] consideration. Going to give you the book “Atomic habits”, an accidental other A there but James, [39.30] a book around making change happens and one of the things that he talks about in changes that very often its hard to make change when the things that you did before are just easier. So if you can find an alternative that is equally easy to switch to, so I’m thinking about that as another A here [laugh], when there are alternatives to those refined sugars that are readily at hand. Maybe there’s a responsibility for supermarkets, [39.56], government and education but also responsibility for the individual to prepare beforehand to have something to hand when you’re feeling peckish or thirsty that’s an alternative could be another way to make some shifts in mind certain behaviours around healthy lifestyles.

Dr James: That’s a really good point. I’ll ponder that another way, alternatives. Interestingly awareness and accountability are also As so we’re starting to build a book full of As here [laugh]. The interesting thing about that and people often say “well its about choice”. You know, you choose to drink or eat excessive sugary products but I would argue that its not often about choice particularly when we are unwittingly addicted to sugary and using it to alleviate stress. You know, we know people who are addicted to alcohol, to drugs, they don’t have a choice. So addiction is incredibly powerful thing and I suspect if we look at some poorer parts of country, at poorer parts of the world where people are using sugar to alleviate stress. There will be a deeper psychological component to this addiction, not simply a physical dependency, what we call a physical dependency. So for me, you know, I would say that I’m probably still addicted to sugar and many of us are addicted to sugar. Its really just a physical dependency, you get the withdrawal symptoms and you’re needing that sugary hit to counter that withdrawal that’s happening and it is quite literally a withdrawal symptom, cravings and headaches, [41.29], irritability that when you haven’t had your coffee hit or your sugar hit that day or your drink or your cigarette or your drug, you know, you do get withdrawal symptoms but you know, for many people there is a deeper deeper component to this and so I do strongly believe that addiction is playing a bit part and its often the thing that’s not talked about. So when you are seriously addicted to something, its not about a choice. So okay, you can go to the checkout counter and you might have a chocolate bar or you might have a bag of nuts but if you’re addicted to sugar, you’re not going to go for the bag of nuts, you’re going to go for the chocolate bar. So I think, you know, this draw of addiction, its very hard to overcome. Having said that, there is a strategy in detoxing from sugar and it takes a few days and its clearly something that we can get through but when you’re actually faced with a withdrawal symptom, its very hard to take the healthier alternative but being aware is one thing and then you can put in place steps to counter that addiction and to detox from sugar and for me it was quite simply just detoxing from the heavily sugared products. So the chocolates, confectionary, soft drinks and fruit juices, you know, cakes and biscuits and ice creams. Ice cream was one of my favourite things and just simply detoxing from those heavy sugar products gave me withdrawal symptoms, started day one, took a few days to get through but then I was in, once I got over that barrier, I was able to get on with life and not be constantly enticed by these sugary products. But the other really important thing here is alleviation. So being aware that you’re actually using it to alleviate stress. So if you’re addicted to something, being aware that you’re using it to alleviate stress, you can then put in place other things to counter that. So when we’re stressed, the brain is releasing some stressful hormone cortecells that I mentioned before and the brain needs to balance it up with feel good chemicals, serotonin, dopamine and so you can choose a healthy pathway, you can choose an unhealthy pathway. So you can choose to eat excessively sugary foods or to drink alcohol excessively or to take illicit drugs or to smoke too many cigarettes. You know, all of those things are actually quite effective in countering the cortecell reaction in the body and that’s why people do it but its important to know that there are other equally as effective things which are much healthier of course and quite simply some of those are going for a walk, cycle, a run, outside somewhere beautiful. So that’s a really important thing to be aware of, for people at the moment, is to get out and have their exercise, particularly if they can, go somewhere beautiful because that triggers the release of dopamine, it does make you feel good. Listening to your favourite music is really important, you know, and often just reaching out and doing a good deed for someone else because there’s always someone in a worse situation than yourselves and you know, scientifically all of these things have been shown to be as effective as sugar in countering that cortecell reaction. So you know, it’s important.

Jenelle: Thanks James, I think they are all important messages. You touched a little earlier, your own personal disruption where you were diagnosed a few years back with an inherited neurological condition. I can’t imagine how difficult that would have been, considering that its in your hand and considering that performing micro surgery was really the track that you were on. I’m interested in how you went about embracing what was … forced a changed upon you. How long did that process take to get your head around it. How did you sort of manage yourself faced with that news.

Dr James: Sure. Well the interesting thing is and so when you face adversity in your life, it can either lend suddenly, like you’re suddenly captured by rebel soldiers in Uganda, or it can happen I suppose sub-acutely, like pandemic we’ve suddenly found ourselves in or it can happen very slowly and quite often insidiously and so for me, this neurological disability in my hand is something that really slowly crept up on me and its, when I look back, it was slowly evolving for many many years and you know, I first noticed that I was holding the instruments in my right hand with increasing force and it was actually giving rise to a discomfort in my right hand and wasn’t impacting at that time on my surgical skills but it was, you know, concerning me in those early years and I was also noticing a similar problem with writing and over the years, the right hand function slowly and steadily deteriorated and it wasn’t actually until 2012 that I actually caught up with a neurological colleague and found out from him what was going on, when I explained my symptoms to him. So it was a process that even by the time I’d had my diagnosis, I’d already put in steps, little – what I call micro innovations, to deal with the progressive dysfunction. So you know, I was starting to hold the instruments with my right hand in different way so that I wasn’t having that cramping effect on my hand. So through this whole process, I just constantly was making little changes to deal with it and this was before I even knew what the diagnosis was. When the diagnosis came in 2012, again when this thing landed I thought “okay, its good to know what happened” and I actually realised that my dad had the same problem and it wasn’t until I had my diagnosis that we knew what was going on with dad. A year later, I actually had to move my writing to my left hand and because it was just becoming so difficult with my right hand. So then I had to use my left hand to write and I went cold turkey and then is started doing that with other things that I was doing in my day to day life such as, you know, using a spoon or using the computer mouse or the keyboard. So constantly adapting all the time. So for me and one of the really important things in, I suppose, forging resilience, building resilience, is innovating and so when we look back at the last three months, we see everywhere people innovating to get through this adversity that we’re all facing and so for me, here was an adversity that I was facing, albeit it in a slowly progressive manner where I was constantly innovating to get through this period. I think the other thing which is very very important to this is keeping a cool head and I realised, from my time in Africa when I was captured by these soldiers and put in this hut and awaiting our death sentence really, and my New York friend was freaking out and I somehow managed to keep a cool head. I think perhaps I have a cool head when I’m faced with these situations and maybe that’s just the way I was built but its also in a ways of also cooling your head, I would say, during times, during threatening times or during anxious times, its really important to just maintain a cool head and you know, again we look at those early weeks of the pandemic and people were not showing cool heads. They were racing out and buying up toilet paper by the dozen and so its important just to keep that cool head and when you’re faced with a difficult time in your life, its important to say to yourself “I’m going to get through this” and what happens is that you then start to forge a positivity. A positive mindset. You can then say to yourself “well I’m going to get through this, how am I going to get through this. Well, I’m going to innovate” and that’s the really the three elements for me to building resilience. So start with the cool head, you forge this positive mindset and then you innovate and that allows you then to get through things. You know forging a positive mindset, I think, is really the key element to all of this and again, to me, are several ways that we can help forge a positive mindset and I think again, in your introduction, you alluded to the fact that having good health is really important and so I’ve come up with this concept which I call “four good things for forging a positive mindset”. So having good health is critical. So when you’re suddenly captured by rebel soldiers in Uganda, you can’t suddenly have good health or when a pandemic suddenly arises, you can’t suddenly have good health so it’s really important for our resilience to ensure we eat well and exercise. The second thing is a good nights sleep. If we don’t sleep well, we’re not as resilient, we don’t cope as well. The third thing, surround yourself with good friends. So people who are positive and uplifting, who make you feel better about yourself, who are not trying to drag you down. I think this is absolutely vital in this process and we hear this social connectivity and social connections are really really important during these tough times and the final thing was good habits and we talked about those before. [50.12] some of those good habits in these times rather than taking the unhealthy option. So for me, a positive mindset is essential in this process but you start with the cool head and you work your way through to innovation and I’d like to think that would help people get through the most difficult times in their lives.

Jenelle: Fantastic James and you know, I actually have heard you speak about the four good things in the past and it might surprise you to know this but I actually got your four bullet points written up on my whiteboard above my desk. So I literally have a tick list, good health, good sleep, good friends, good habits and it’s amazing what a difference it is. Every day I come in and look up, glance at that and sort of maybe frown at myself with my sleep measure but it has been really helpful. You know, just to wrap up this interview James, I do like to finish each interview with three fast questions, much more on the light hearted side of things. What's a misconception that most people have about you.

Dr James: Ah, very good question, very interesting question [laugh]. I think people think I fill my time up, I never rest and I don’t a moment where I take a breath and relax, whereas I love, more than … well I wouldn’t say more than anything, but I do love … I love holidays of course. I do love travelling but I also love lying by a pool, just relaxing and reading a book. People don’t … I think they probably don’t believe that I actually ever stop, that I ever rest and probably also think that I don’t have a lot of tie for my family. I actually … you know, the family is incredibly important and particularly during these last two weeks, having the family around has just been magnificent.

Jenelle: And what's one guilty pleasure James, you have.

Dr James: Oh I think I mentioned that before, is ice cream and …

Jenelle: That’s right [laugh].

Dr James: … and the hardest part of detoxing from sugar was giving up my ice cream. The worse punishment I could receive as a child was to be sent to my bedroom after dinner without ice cream. I would bawl my eyes out. So my parents knew how to really hit me when they needed to punish me and I would say there’s rarely been a day since when I hadn’t had ice cream and when I went through my sugar detox earlier this year, I did give up ice cream. When I say give up, you know, I used to have it literally every night, it was just a ritual and not a healthy ritual but I’m not willing to be evangelical about this. I want to … I still want to be able to enjoy an ice cream, just not every night.

Jenelle: What's one thing you’re hopeless at. I’m suspecting it might be the gardening but what would you say is one thing you’re hopeless at.

Dr James: I’m actually quite good at gardening if I put my mind to it. I would say that the one thing that terrified me more than anything in my life is public speaking and still to this day, the thought of public speaking, sort of speaking publicly like for example on the podcast, terrified me. I woke at, after two hours sleep, at 1.30 this morning …

Jenelle: Oh my god

Dr James: … anxious leading into this morning, so yeah, I talk about having a good nights sleep as being a pillar of resilience and good health. Okay, so here it is, so one thing I’m hopeless at is sleeping. Definitely there’s no doubt about it. Sleeping has been, for me, the one bane in my life that I think you find. If I was able to get more sleep. It’s almost without fail, if I have something next day … I was on Sunrise TV on channel 7 last week and again I woke at 1.30 in the morning after two and a half hours sleep and you go into these things with your brain kind of in second or first gear. So it drives me mad. In fact from this very podcast, I’m going off to the sleep psychologist so hopefully [laugh] work out what I can do with my sleep. So yeah, sleep is to me the thing that I just haven’t mastered. I’ve tried everything. I’ve even started writing a “how to sleep” book but I haven’t finished it because I haven’t found the final piece to the puzzle. I think its quite simply I’ve just got too much going on in my brain, going on in my life, yeah, so maybe I would say that I’m not hopeless at saying no, but I’m very good at saying yes and I just love filling my life with too many things.

Jenelle: Well good luck with your sleep challenge. Its one of your four good things so its definitely a critical one to nail. James, I wanted to say a massive thank you for, not just for your time today, but for the incredibly important work that you do. I really haven’t formally congratulated you on being awarded Australian of the Year, most deserving title and recognition. Its really clear that you don’t do anything by halves and James, you know, its really clear in talking to you that your inherent curiosity, your unbelievably positive mindset and your willingness to make the most out of everything that life has to offer, has been, you know, what has allowed you to have the kind of impact that you have globally on something that is so critical and one of the things that’s really stood out to me is that, you know, in embracing all the opportunities that you have, these are where, you know, we don’t all have to be captured by rebel soldiers or being attacked by wild animals but the kinds of experiences you pick up by just embracing them, allows you to form the element of resilience, even if you don’t realise it at the time. [55.17] tend to kick into place at some point in your life and it all seems to make sense. So your spirit of adventure, your humanitarian spirit, your entrepreneurial spirit, the things that you said make, are the makings of, you know, strong social entrepreneurship. Its incredibly evident in you and serves as a great inspiration for me and no doubt for many of our listeners today. So massive thank you for your time, James.

Dr James: Oh thanks Jenelle, I very much enjoyed being here and chatting with you today. It was fabulous, so thank you for all you do as well and I wish you all the very best.

Jenelle: Cheers.

END OF TAPE RECORDING