Ale: "Both my parents were general practitioners, but I chose to study physics." Later I also studied medicine in Rotterdam. During my PhD research, I was able to combine my computer skills with my knowledge of epidemiology. Based on the characteristics in 24-hour ECGs, I assessed the chance of patients suddenly dying within two years. After my PhD in 1990, I joined the Neurology department in Utrecht."
Ale started in Utrecht as trial coordinator of Dutch TIA Study in the Neurology department. "I analyzed data of Professor Jan van Gijn's research into the prevention of new vascular diseases in patients who had suffered a TIA or cerebral infarction. Patients who have had a cerebral infarction or TIA once have an increased risk of a new cerebral infarction. We compared the use of a very low dose of aspirin to prevent this with a somewhat higher dose of aspirin. Aspirin is a platelet inhibitor, which reduces platelet clotting. The study showed that there was not much difference in effectiveness, but that there were fewer hemorrhages. Since that study, the very low dosage has become clinical practice in neurology."
Since the first study in the Neurology department, aspirin has been the thread running through Ale's career. Together with his colleague Professor Rothwell from Oxford, he discovered that the efficacy of a low dose of aspirin is the highest immediately after a TIA or cerebral infarction. This recommendation is included in the Stroke Directive. "We always have a pack of aspirin in the kitchen cupboard at home."
Time is Brain
Responding to the question which results he considers the most important, he says: "The fact that my research has changed clinical practice. I have contributed to improving secondary prevention after a TIA or minor cerebral infarction."
He considers further research on cerebrovascular diseases important for the future. "That's more important than ever. We are getting increasingly older and hence strokes are becoming increasingly prevalent. A stroke is one of the biggest wastes of quality of life, as it leads to a great deal of disability. Unfortunately, it has always been an unpopular disease; you get it when you're older and there was little that could be done about it. Fortunately, things have changed. If the clot is removed within six hours, you're much better off. We also call that: time is brain."
What would he like to change about today's science? "Fewer rules, particularly on conducting research. A researcher must be able to be creative and free. This is only possible if managers show confidence and do not seal everything off with rules. We know the codes all right and we know where our responsibility lies. The red tape makes it difficult to conduct clinical trials and is not cost-effective."
One of Ale's best memories of UMC Utrecht illustrates how important it is that researchers stand up for their freedom. In 1990 the new UMC Utrecht at the Uithof did not have enough room to accommodate all employees. Ale worked from a site hut on a lawn in front of the hospital. "I also brought in clinical epidemiologist Yolanda van der Graaf. It was great. In that hut we felt free. In the Epidemiology department there was less need for a clinical epidemiology department at that time. However, we were extremely ambitious and passionate, and believed firmly in the added value of clinical epidemiology. Like a Gideon Force, we fought together with fellow clinical epidemiologist Petra Peeters and finally this department was established. The rest is history."