She is the person who got the admission system for Medicine Studies changed from a lottery to a decentralised selection. By now Meike Vernooij is a radiologist and professor, and her goal is to unravel the mysteries of the brain. Dementia is one of the diseases she researches.
TEXT: Yasmina Aboutaleb
PHOTOGRAPHY: Geert Broertjes
"As a young child, as soon as I could read I would stay in bed for hours, reading in secret. I raced through my Arthur Conan Doyles and Agatha Christies," professor Meike Vernooij explains during her inaugural lecture. She’s standing on stage in the aula of Erasmus University. "That’s where my youthful – if not naive – desire originated to become a detective myself. I believe that I, as I stand here before you, am not that far off from that fantasy."
Vernooij’s chairmanship in Population Imaging is all about observation: as an example the radiologist tells the story of an MRI-scan of a woman with a tumor. Vernooij explains how she considers the scans carefully, how she looks for clues, and uses all given details to come to a conclusion – a diagnosis. And there you have it: the radiologist as a medical detective. The illnesses that Vernooij researches vary greatly, but their common denominator is always the brain. She explains as much a week later, in her office at the Erasmus MC. The brain is a grand mystery that Vernooij wants to unravel. "We know quite a lot about the brain by now, but there’s also so much we don’t know. And that’s frustrating," she says.
What draws you to the brain?
"What fascinates me is its complexity. A good example: I was working on my dissertation, we had one of those quote posters on the door: 'If the brain would be so simple we could understand it, we would be too simple to understand it.' The brain’s complexity is a huge challenge. What I like is the incredibly functional set-up of the brain. If something goes wrong, you can predict pretty accurately where in the brain that’s coming from. There’s a few simple rules: if your right arm is playing up, that’s your left brain, and probably from a specific area. On top of that there’s another layer of far more complex functions – cognitive ones, memory, executive functions. Those are less tangible, not as easy to pin-point in the brain. Which makes it all the more interesting to try and understand. Why is the one person more likely to experience a loss of brain function than the other?"
Ever since childhood Vernooij has had this curiosity and ambition to make the best out of every situation. "I’ve always felt like I could achieve more if I worked for it. Even in elementary school. If you can get a top grade for something, then aim for that top grade." Her drive made it so that in the summer of 1996, Vernooij – a 17 year-old – appeared in the evening news. She did her finals on nine different subjects, had a 9,6 average, but couldn’t get into her major of choice – Medicine – due to the lottery-style system of selection. This made for a political backlash that resulted in the changing of the system to a de-centralised selection.
What’s it like, looking back on that?
"Once you’ve been on television, everyone’s going to have an opinion about you. Some people thought that it was good that someone tackled the issues in the system. But others thought it was completely undeserved that Erasmus granted me a spot in Medicine outside of the lottery system. A story like mine, where someone tries to get into an institution based on their merit, would be received very different in the US. Here people tend to think: why would you think you’re that much better than the rest?"
"About 30% of all dementia cases can be prevented by reducing blood pressure"
One of the diseases you’re currently researching is dementia. What’s your contribution to the field?
"We know it’s a disease with a lot of lead-up. The moment that someone starts experiencing symptoms and ends up at the neurologist, there’s already been a long period – of perhaps decades – where there’s been a slow deterioration that’s gone unnoticed. That’s why my research focuses on the phase before the symptoms start showing. When people don’t yet experience the usual complaints, what is it that’s happening in the brain? If we can find clues in the brain then we can understand the life of the disease much better. And perhaps we can also recognise the telling markers, which will helps us in knowing who runs a bigger risk."
A good part of Vernooij’s research takes place in Erasmus Rotterdam Health Research, also known as the ERGO research. It’s a long- term population-wide screening, part of Erasmus MC, looking into the lives of about 15,000 people (of 40 and older) in the Rotterdam neighbourhood Ommoord. One of the things that are looked into is how diseases – such as dementia – start out and then develop. And just like with Vernooijs research, the goal of this project is to monitor people before the showing of symptoms.
What have you discovered about dementia so far?
"We believe that there’s two important paths that play a role. First of all: damage done to the small blood vessels in the brain. That damage can be caused by high blood pressure or smoking, but also genetics. Second: there’s a toxic protein that can damage the brain. Most probably it’s a play between those two, the protein and the blood-vessels damage. How that’d work, exactly – that’s what we’re looking into. The blood-vessel end of it is very interesting, because once you know that that’s caused by the standard risk factors like smoking and high levels of cholesterol, then you can do something about that. By, for example, lowering the blood pressure. Which is either way important to do when you have cardiovascular diseases. The good news is that the ERGO research has shown that about 30% of all dementia cases can be prevented by reducing blood pressure."
Rotterdam has always been a frontrunner when it comes to censuses. But on an international level, there’s a lot of other, bigger research projects that are gaining pace.
"That’s true. There’s other big censuses that have also started using population imaging – like in the UK and in Germany. They often set up big projects with the idea: the bigger the better. In the UK they have about a 100,000 people participating. The downside to that is that the research automatically becomes more shallow. When we do a scan, it’ll take about an hour, and we’ll really look into the brains in detail. These big projects, they’ll take an hour to look at the whole body – which means that maybe about ten minutes of that will go to the brain. But it’s also good we’re not the only ones doing this research. You can learn from each other, fill the gaps for each other. Competition is good, but you should really look at how you can collaborate, complement one another."
There’s quite some Rotterdam pride in there.
"Yes, just like in my inaugural lecture. I really wanted to emphasise that. I am very proud that this kind of research is being done in Rotterdam. The city has a mentality of, “less conversation, more action.” It speaks to the vision of the people who set up the research – a project like that, in the neighbourhood, with such a high response. People were talking about it, got excited about. People wanted to join in themselves, and called us, too. It’s been a great success."