"I didn't know anyone who was a doctor": Professor Kevin Talbot's journey to founding the Oxford Centre for Motor Neurone Diseases

“There’s a mystique about careers. People get very fixated on the apparently obscure paths to get from A-Z and become convinced there’s some kind of secret way that they don’t know how to access. It’s complete nonsense really. So I think hearing individual stories is very illustrative and helpful for people.”

Pembroke Profile: Professor Kevin Talbot

Written by Sam Loxton, Pembroke's Head of Governance and Clerk to the Governing Body

Our Head of Governance, Sam Loxton, sat down with Professor Kevin Talbot to find out more about his unconventional journey to medicine, Pembroke, and the creation of a world-leading centre for research, diagnosis and treatment of motor neurone disease.

Were Professor Talbot to decide on a change of career he would do very well as a narrator of audiobooks. 

His is a “a mellifluous voice,” as Sir Andrew Aguecheek says of the Clown in Twelfth Night; “very sweet and contagious, i’faith.” 

Such a change would not benefit mankind, however, given his current position as Head of Nuffield Department of Clinical Neurosciences and distinguished career researching diseases of the nervous system – in particular his research understanding the mechanisms and finding treatment for motor neuron disease (also known as amyotrophic lateral sclerosis – ALS), which can fairly be called both essential and important.

“I assume that everyone gets the basic idea that dementia, Parkinson’s disease and motor neurone disease are a consequence of the aging nervous system. As the population ages, they become commoner and that is now a developing global emergency. But many people imagine that some magic pill will come along and put it all right, and it’s so much more complicated than that.”

Whilst his work primarily focuses in identifying the early pathological pathways activated in motor neurone disease, in his 25 years as a consultant-level neurologist Professor Talbot has dealt with all manner of neurological problems and neurodegenerative disease, including Parkinson’s (he co-led development of the Oxford Parkinson’s Disease Centre) and frontotemporal dementia (FTD). In this last disease he collaborates in a study my family are part of – the GENFI Initiative, which is a group of research centres across Europe and Canada with expertise in familial (genetic) FTD. My grandmother, two uncles, aunt, and mother all succumbed to familial FTD before they were 50; my sister will become symptomatic in the next 10 years. There is currently no treatment and little understanding of the condition. But practical research geared towards successful treatment of the condition will literally transform the lives of my relatives. 

I should really smother Professor Talbot’s boots with kisses; luckily, we meet over Teams. 

Professor Talbot’s association with Pembroke began in 2019 when, as the newly installed Head of Department, he realised he needed to know how best to support the 200 DPhil students under his Departmental wing and understand how the University and Colleges interact. He mentioned this to a few people who promised to “have words” with other people; words were had; and an invitation to lunch arrived from Dame Lynne Brindley (Master of Pembroke 2013-2020).

What followed sounds like a very strange, very Oxonian version of speed dating. 

Professor Talbot sat and ate lunch compliantly while a series of academics and College Officers sat opposite, spoke, listened, and left. Eventually a brace of Mathematicians descended. 

“He’s an applied mathematician,” said one; “I’m a pure mathematician. Do you know how to tell the difference?” Professor Talbot shook his head. “Well, a pure mathematician looks at their shoelaces, and an applied mathematician looks at your shoelaces.” 

“I thought this was hilarious. And a few weeks later I got a letter saying I’d been elected a Fellow of the College.”

Professor Talbot is one of three senior academic medics who sit on Governing Body as Trustee Fellows. Each runs a complex Department with hundreds of staff and considerable budgets. Unpaid by the College they have an association that brings with it a different and diverse community and a string of responsibilities distinct from those found at their respective Departments. They gallantly sit on College Committees and bring to Governing Body an essential broader perspective to College matters.

“I can say, look, within Departments this is how we might deal with this financial or disciplinary issues. I hope I bring something else to the college that might be useful and I get something in return, which is genuine interactions with great people that I didn’t know and a deeper understanding of how the University in all its byzantine complexity works.”

I explain, somewhat long-windedly, my interest in understanding how he reached his current eminence. 

“Der Weg ist das Ziel,” he responds crisply, apt for a man who sacrificed his hearing for his love of Wagner. “The journey is the destination.” 

How true, I think. But I didn’t anticipate the journey I was about to discover.

Born in the early 60s to Irish parents who emigrated to the UK in the late 1950s, Professor Talbot grew up in Lewisham, South London, in a working class Irish Catholic community. His parents had both left school at 14 and nobody he knew had a university degree. At 11 he gained a place at a grammar school in Battersea, travelling 90 minutes each way to the best school available to him, yet even there he found any aspirations that were seen as discordant with your class background: studying medicine or law or applying to Oxbridge were discouraged – “not so gently.” 

As a teenager he became interested in Physics and determined to become a particle physicist, eventually gaining a place at Bristol to read Maths and Theoretical Physics. During Sixth form he worked at a home for children with severe disability run by a Catholic charity; it was here he heard about an opportunity to spend a year working in Jerusalem in a hospital caring for children dying of neuromuscular disease. He applied and was accepted.

Were his parents nervous about him going?

“Well, they were terrified because all you ever heard on the radio or the TV was that the PLO were bombing Israel, but I was so politically naive and it just seemed like a very exciting opportunity. It was the first time I’d been on a plane.”

This excitement withered slightly when the bus from Ben Gurion Airport to Jerusalem promptly filled with heavily armed soldiers. One sat next to him and promptly fell asleep, his M16 falling into Professor Talbot’s lap like a deadly baby. 

The year spent at the hospital proved transformative.

“I grew as a person hugely. I decided I wanted to do medicine, and I wasn’t going to be put off by anybody.”

Before this he had received the distinct impression that medicine was not for “people like me” – I’m reminded of the disgusting finding of the Oxford University Appointments Committee of William Golding in 1934 that he was “NTS with slight accent only” – “NTS” being slang for “Not Top Shelf”.  

“I didn’t know anyone who was a doctor,” he explains. “And the family doctor was an authority figure who was slightly scary.”

After returning from Jerusalem, he spent another two years working a diverse number of jobs (including at a home for adults with severe cerebral palsy and at Lewisham Borough Council) before starting at Charing Cross and Westminster Medical School (now part of Imperial College). It was a strange experience. 

“I was surrounded by 18-year-olds who were exam machines, many of whom had doctors for parents.” 

He was 21, replete with disquieting quantities of personal growth and real-world experience. 

More alarmingly, he was vegan. 

“Just me and a few Quakers at that point. I was viewed as slightly eccentric, possibly dangerous.” 

Yet the experience taught him something about the nature of studying medicine and the qualities needed to be a medical student which have endured to the present.

“Medical training is a tremendously democratising experience, and that’s one of the things that’s not really understood or talked about. But it’s miraculous how the journey through medical school levels people out at the end of it.” 

He is clear what characteristics are needed to be a successful medical student. 

“You need to be curious about how things work, and how they go wrong. You need to be interested in taking responsibility – because if you’re not interested in that you’re going to find it very distressing when its 3am and you’ve got to make a decision that could affect if someone lives or dies. And you’ve got to enjoy being with people in all their manifestations. Without those, medicine is not for you.”

It took time for him to find his feet at medical school and at the end of his second year failed his pharmacology examination, having to resit it in the summer. Yet this proved a well-disguised blessing. 

“I spent the whole summer reading an extremely large book of pharmacology and I became absolutely gripped by the subject, which is really applied physiology. So – drugs work on physiological systems and if you understand pharmacology, you understand how things work and how they go wrong.”

This fascination with mechanistic biology proved transformative for Professor Talbot and set him thundering towards his choice of specialism.

He spent time in a lab working to understand molecular medicine (this at a time where it was becoming clear the brain and its mysteries would be revealed by molecular genetics), working on Alzheimer’s disease under the supervision of a global expert. 

“I emerged from my medical training thinking: I want to be a neurologist, and I want to have a laboratory where I lead the investigation of mechanisms of disease with the view that there will be therapies at the end of it.”

And, very simply, that it was he had done for the last 30 years. 

His association with Oxford began in 1994 when he began a DPhil under the supervision of Professor Dame Kay Davies FRS. This is when he got into motor neurones specifically and the idea of what his specialty should be clarified.

“You need to understand the mechanism of the disease – how it works at the molecular level, how cellular failure causes a disease, and how you identify treatments that target this process. It was fantastic training for what I really wanted to do, which is to take a disease and work out the pathophysiology.

By 1997 he was able to move to Oxford with his family. He finished his clinical training and got a Clinical Lectureship at the University. In 2001 he received a MRC (Medical Research Council) Fellowship and was able to set up his own lab. This became the Oxford Centre for Motor Neurone Diseases which is today recognised as a flagship national referral centre for research but also diagnosis and treatment of motor neurone diseases. Success was not immediate.

“It’s didn’t all go well,” he admits. “I made some wrong decisions. I ran out of research money. But because the clinic and research program was seen as important I was given bridging by the University for a year.”

By this stage Professor Talbot had learnt how to run a lab: he won a second 5-year Fellowship and began to attract support from within the University and from external funders (such as charities working on motor neurone disease) who could see the inestimable value of his research. “Now in my laboratory research group, we are using the very latest techniques, such as using stem cells to grow nerve cells, to understand the precise molecular events which lead to cell death in the brain. This means understanding how our genetic make-up interacts with events in aging to lead to breakdown of cellular homeostasis. We believe that advances in neurodegeneration research will only come when we have the kind of precision in biological knowledge that has made cancer more treatable. To do this we have to take our analysis right into the interior ‘universe’ of the nerve cell. Luckily Oxford is the kind of place where we can take advantage of the opportunities to interact with basic scientists who have the analytical methods to allow us to ask detailed questions about the way that proteins interact in a cell at the nanoscale level under conditions such as cellular stress”.

When he describes the working in medicine and his life as a clinician researcher at the University, I recall his use of the word ‘Byzantine’ (defined by the OED as “complicated, inflexible, and underhand.”) I must say, discussions with academics always leave me slightly amazed any of them have any colour left in their hair, or indeed any hair left at all.

“Oxford has operated by being a sort of magnet for super bright people who are highly motivated and successful and who generate their own research funding. It doesn’t have an internal career structure that is fully supportive,” says Professor Talbot carefully. 

When he informs me that only 10% of academics in his Department have permanent contracts my jaw nearly dislocates.

Professor Talbot is very clear on the strengths of the Oxford model, where Department Heads will develop business cases, which are scrutinised, but which allow flexible approaches to recruitment if properly managed; the result is that the Oxford Medical Sciences Division is twice the size of any of its competitors in terms of grant turnover. These competitors (Cambridge, UCL, Edinburgh) have to varying degrees a more centrally controlled financial structure where some eminent pooh-bah will commit funding for particular positions from a central fund, which provides career stability but is also a more limited way to grow their capacity. 

“The quid pro quo of our model is that most people have a level of career uncertainty that historically has been tolerated, but increasingly career academics do not want to tolerate it.”

I wonder how he tolerated it.

“I’m an optimist,” he admits. “I felt things were going to work out. It would be interesting to talk to my wife about this,” he adds judiciously, “whether she felt this was okay or whether she thought it was a little crazy. I think she saw this was what I wanted to do, believed I could make it work, and was willing to make the sacrifices required.”

There can be no doubt that this spousal confidence was well placed.