1. Why did you decide to pursue a career in medicine and why, in particular, did you decide to specialize in Neurology?
Actually, this is not a very easy question to answer. First of all, I didn't want to go into medicine at all. My father was a medical doctor. When I was a child, we traveled on the highway. There I saw that an accident occurred just in front of us with a car burning. Because he was a medical doctor and he had his equipment with him, he had to rescue those people out of the burning car, and I heard them crying, severely injured and bleeding. So I thought I would never want to be a doctor because I could not do that.
In high school, then I came into contact with psychology and psychoanalytics. That was very cool at that time, and people always wanted to be like Woody Allen or something like that. So I thought that could be an interesting part. And for that, I decided to study medicine, to become a psychologist or psychoanalyst or a psychiatrist.
But when I then was, in Tübingen, studying medicine, I realized that those people are really sectarians. There was no scientific basis for what they were doing and claiming. That's why I finally decided to go into more real research. And I got a job at the Neuropathology Department, where I did my doctoral thesis. And then, from there, I did my internship in neurology. So that was kind of the way which was not really straight going on, but a little bit more, like, also by chance, meeting people and having the possibility to go there. What I always wanted to do is to understand how the brain works. That was one of the real basic motivations.
Gloryren: Yeah, it always takes us a long time to find what we really want.
Yeah, exactly. There were some aberrations and it was not just a straight way to going to a certain place. I also actually studied philosophy in parallel to medicine, because I also was very interested in discussing topics in a broader frame as compared to what was possible in medicine.
2. How did your early youth experience shape your success?
I really thought about it during the weekend that what is really shaping your success. As I said, my father was a medical doctor, but I did not see him very much. So it was more my mother, who was a school teacher, who educated me. I was a single child so I got, kind of, all her emotions. And what I learned from her, I think, are very relevant things. Of course I learned reading and calculating, but also in a way, discipline, reliability, accuracy. And I very early on started to read a lot by myself. I was very curious to read, but I also started to practice a lot outside. I went into the forest, not only just for playing, but for constructing things. I was always trying to build houses and bridges and stuff like that, which gave me some kind of feeling how I could not only interact with the environment, but also bring certain projects into a final stage and have something created at the end. I think that somehow shaped me as a person - I knew I could rely on myself and I knew I could rely on my parents and my mother. So that was very important for me.
3. Who have been your greatest influences? What have they taught you and how have they inspired you?
When I studied Medicine in Tübingen I did my dissertation in neuropathology. My supervisor, Prof. Peiffer was a very important neuropathologist in Germany. He educated me not only in science but also a little bit in science politics. He would have wanted me to specialize in Neuropathology, but he realized, that I would not be happy with that. He suggested that I should try clinical neurology, where Professor Dichgans was the head of the department. He was a very dominant person at that time in clinical neurology in Germany. From him, I learned a lot in clinical neurology, attitudes towards research and also how to act as a Chairman and how to run a neurological university hospital.
The third person that was really influencing me was Professor Friedrich Bonhoeffer when I did my post-doc years at the Max Planck Institute of Neurobiology (in Tübingen). From him , I really learned how to get into science, into basic research, and also how to build up an international network of cooperation partners and friends.
4. Based on your experience, how important is it for a medical doctor to visit different hospitals or different countries?
Yes, I think this is a very important aspect of your education. As a medical doctor, you have quite a few options, at least in Germany, where you can go into private practice, a smaller hospital, but you can also go to a university hospital for your training in a specific field. I think it's very important, first, to learn about these different possibilities and see where your own passion is. Where do you want to be? Do you want to really be in a university hospital? If that's the case, it's very important to choose the place because there are quite substantial differences between the different locations. What do they offer? What is the focus there? And then, of course, what is your specific field?
In neurology, at that time when I studied medicine and later did my education in neurology, it was very clear that there are certain schools of education based on the Chairman and their genealogy. At that time, most of the Chairmen of the university departments in Germany came from Freiburg, where Hans Berger invented the EEG as a diagnostic. He had a school of young scholars who then all became Chairman all over Germany. It was very clear that this is a dominating figure and they had a very similar kind of educational principle. And I saw very early on that this is a very good school, and that this is also the most important school that really tries to link research and basic research together with clinical neurology. At that time, that was not the case in all places. So you could only select the places where those Chairmen also operated. And that's why I first went to Düsseldorf, where one of these persons was Chairman, Professor Freund, and later came back to Tübingen, where Professor Dichgans was heading.
So visiting different sites gives you a better estimation of where is really your optimal place and where you could get the best mentoring. In that context, it's also important, what are the connections of these hospitals to other places worldwide? Because that gives you then also the possibility for international networking. So I think it's very, very important initially to be open and then to select one of those places where you really get good mentoring and good possibilities for further development of your own spectrum of ideas and knowledge.
5. The University Medical Center Göttingen is internationally well-known for its excellence in cardiology and neurology. As the Head of the newly built Heart and Brain Center Göttingen (HBCG), first of all, congratulations! And could you please tell us more about it and what’s your plan for the following years on this position?
Traditionally, medicine is separated into different fields like cardiology, gastroenterology, surgery, neurology... But several years ago, we realized that to really understand the complex disorders that we deal with in a more comprehensive way, we need to cooperate much more intensely. We know that cardiovascular disorders affect the brain, but we also know, for example, that the brain affects the heart. There are certain disorders where the central autonomous network, which guides our sympathetic and parasympathetic system, can by emotional disturbances or stress influence heart function. If you want to understand these kinds of complex disorders like for example, Takotsubo cardiomyopathy, you really need to monitor both the heart and the brain. And you also need to implement new diagnostic instruments which allow the monitoring of both systems at one time in the context of Systems Medicine. Systems Medicine therefore means that you don't analyse just one organ and then on the next, and then you try to put results together. But, in an ideal way, you would do a examination and analysis at the same time.
In Göttingen, we had a tradition of good cooperation between Neurology and cardiology. Furthermore, several years ago, Jens Frahm from the Max-Planck-Institute for biophysical chemistry developed a new magnetic resonance imaging technology, called real-time MRI. With this technology you can generate MR pictures in high frequency. With this you see the pulsations of the heart, you see the pulsations of the blood vessels, you see the pulsations of the cerebrospinal fluid. We now try to combine these measurements from the heart and from the brain, also, together with electrophysiological measurements of the ECG and the EEG, and integrate these paramaters. Our goal here is to define new markers that show us how a person at risk would react, for example, to emotional stress or to physical stress, and how either of those would affect the heart or the brain.
To put this endeavor into practice we applied for a new research building. To that end, we applied for a funding at the Wissenschaftsrat, which is the German scientific council that decides upon buildings and new facilities for scientific research. It's a very competitive program, but we were successful and we got around 30 million euros to build this new facility which is currently constructed and will be opened by the end of this year. There, we will have instruments like those very new, innovative MR technologies and other new technology which will allow us at the same time to study patients, healthy controls directly with heart and brain measures and try to bring together this knowledge to further develop the field.
To be successful with that, not only neurologists and cardiologists, but also physicists, matemathicians and IT-people will work together in order to develop new algorithms that are necessary to integrate these different measurements into a profile.
Gloryren adds: Is this center the first of its kind in Germany?
Actually, our heart and brain building is the first one to be realized in Germany and it's a new pilot that we develop. And it's also a new concept of how disciplines interact. To do this, we also tried to open the fields concerning recruitment of professors. We now try to find people who work really at the junction of different fields. For example, we have recruited a professor for Cardioneuro Geriatrics. There, we also try to work together, because most of the elderly don't have only neurological or a cardiological problems, they have both. So, the best is not to transfer them from one ward to the other, but to really treat them in an integrated way by the specialists. So I think in the future we will not only try to separate (disciplines) even more and even more, but to also integrate at a certain level.
Gloryren adds: This is a brand new concept and we hope that the Chinese hospitals could be inspired from it. Could you please let us know more about how the integration will work?
The idea is to start with certain common disorders, which affect both, heart and brain. That could be heart failure for example. Such patients would receive combined heart and brain diagnostics on a specialized ward, in our case in Department of Cardio-Neuro-Geriatrics and receive integrated new dianostices in the heart and brain center. Besides standard and high end conventional diagnostic they would also be recruited to experimental studies, e.g. with heart and brain real-time MR etc. To achieve this, you need people from neurology, you need people from cardiology, but you also need specialists in neuroradiology and MR development, physicists programmers etc. It's a whole bunch of different specialists, which you try to bring together for the purpose of integrating different new aspects into the clinical work.
In parallel, we have established clinician scientist programmes for neurologists and cardiologists in training and comprehensive research networks. Finally, we have satellites of the 2 german health centers for cardiology and neurodegenerative disorders in Göttingen, where translational research connenctions are established.
6. How do you balance your personal life, administration, clinical practice, research activities and lecturing?
I think, first of all, the concept of work-life balance is wrong. There is no balance between work and life because work is part of your life. So if you are not that passionate, that you really think what you do in your job or in research is really your life, then you should quit it. It's always very important to be aware that only things which really also make fun of and which, kind of, catch your attention is your life and that you should pursue. If you think you are wrong in that, you should quit.
For me, my personal life is very much integrated with my life in the hospital or in the lab, because it takes basically a lot of time during the day. And there, I think a good organization is very important. You need to know when to do what, and you need, also, to be clear about what you do by yourself, what you delegate to others, and what you do in teams. Because it's not that I, as a single person, can perform all this. I need a lot of help. I need a lot of cooperation with my senior residents, with my registrars, with the other professors, with my secretary, with the nurses, the study nurses, the lab members. So it's very important to have a good concept of how to organize these things in a way that you still catch the frame and you still know where you need to change things or to move things in another direction. But you also need to know where you just let people go, right? If you do it all by yourself, you get into micromanagement, which is not good. Sometimes you have to go down because there's a problem. But in most of the cases, you need to rely on the people that work with you, that you have educated, and that also work together in a very a good way.
I think for me, I can say I'm relatively good at organization. I know how to structure things, otherwise, I would be completely overwhelmed. We are one of the biggest University Hospitals in Germany. Neurology generates about 10% of the income of this University Hospital. And there are several hundred people working here (in Neurology alone), not only in the clinics but also in the different labs. So it's like, I would say, a medium-scale enterprise, and I'm, kind of, not only the Chairman, but I'm more like the Director of a symphony orchestra. So I need to know who plays the violin well. And when it comes to that, it must be supported by the whole orchestra. So that's, I think, how in general I try to do things. Also, I have timeslots, of course, for clinical duties. Today in the morning, I started with a conference where all patients are reported that came in during the weekend. So I know of every patient who is in my department, I also get their neuroradiology pictures and we make the decisions on how to proceed. Then I go to the wards, the intensive care ward, the stroke unit, etc, to see what's happening there. Now I have this interview with you. Later on, I visit my private patients. And in the afternoon, I have meetings with people in the lab or with people from outside or from other institutions here in Göttingen. And so you really need to place things in a very clear order. And by that, you still have enough time to do the things you want by yourself, because sometimes you need also time for thinking by yourself and reading.
7. You have been an active member of many leading organizations or societies both in the field of neurology and neuroscience, for example, you are the former President of German Society for Neuroscience and the President of 94th Congress of the German Society for Neurology. How important do you think these societies are to the fields and to the neurologists?
I think I must explain why I'm active in both fields. When I started my career, those (Neurology and Neuroscience) were basically completely separated fields. There were the neurologists who were talking about the disorders and about clinical studies, and there were the basic neuroscientists who were talking about animal models and basic research questions. I early on decided after I had started my training in neurology, to quit for a few years with a stipend from the German Research Council (DFG) to work at the Max Planck Institute for Developmental Neurobiology in basic neuroscience. So I tried, in my person, to combine both fields of clinical neurology and training neurology, and also education in basic neuroscience. And with that, I came also to the two societies.
The German Society for Neurology is an old one. It was established (in 1907). And as a clinician, you (naturally) become a member of this, but there was no society for neuroscience in general in Germany. So we, about 20 years ago, started to think about organizing such a society. And I was one of the founding members (Of the German Neuroscience Society). Because I was very involved for many years also organizing the meeting of the German Society for Neuroscience here in Göttingen, which is every other year, I became their President and I'm still a member of the board of the society as the clinical representative.
My ambition always was to combine these two fields, to bring basic researchers in more contact with clinicians to see what is really clinical-relevant, and on the other side, also to allow clinicians to sneak into basic research and to connect themselves to basic research labs. So I think both societies for their own fields are very important, but it's also important to do a little bit of both fields. And I hope that with developing also new instruments of education for young people, we are also successful with that. For example, when I came here to Göttingen in 2001, I joined an initiative which was started the year before by Erwin Neher the Nobel prize winner here in Göttingen together with Walter Stühmer, and Diethelm Richter. They had founded an institute called the European Neuroscience Institute (ENI-G). This is, again, a separate building that we also applied for and was built for junior research groups. These junior research groups are completely independent. They are not attached to a strong Chairman who tells them what they have to do, but they can do their own research. The only thing is that they have to bring in their money by acquiring a European research grant or a similar grant from the German government, which will support their own position and also some basic positions. And we provide mentoring, lab space, instrumentation, and everything. And we try to link, there, not only the clinics with the research institutions but also with the campus in Göttingen in general, because you know we have here several institutes, like the Max-Planck Institutes, the Leibniz Institute, the Helmholtz Institute, we will get a Fraunhofer Institute..
When I was president of the German Society for Neuroscience, we also built up an internet portal called das Gehirn (dasGehirn.info), the Brain, which is an educational website where interested people, pupils, people from the society can inform themselves about what is new in neuroscience, how does the brain work, and how do certain diseases develop. This is an educational instrument, but it was only possible when I was president that I approached a big foundation to get money for that, to build this portal. So in a way, if you engage in such societies, it gives you possibilities to cooperate and to also look across the border. I'm also a member of the Royal Society in England, in London, the Royal College of Physicians, and of course, with the connections there, I can also, on a European level, interact with people and try to influence European politics.
8. You are clinically active and at the same time a member of German National Academy of Sciences Leopoldina since 2005. How important do you think scientific research is to the clinical doctors?
The National Academy is not so much about basic research. If you have made important contributions to research in your field, you may be proposed for the Leopoldina membership. As the National Academy of Sciences in Germany it is a discussion forum for all scientific areas but also the main adviser for our government.
But apart from that, scientific research, of course, is very important for those clinical doctors who want to go into academia. I think one needs to distinguish between those who just want to become doctors. For them, clinical training and education are very important. And then, we have doctors who just want to go to research. For them, you only need to have basic clinical training. And then, there are those who really want to do both clinical and basic research. And for those, we have implemented special programs at our institution, which are called Clinician Scientist programs that I mentioned before. So, there, in parallel, they become clinicians and also basic researchers by training. And they switch between two positions and get very intense mentoring. That takes longer, and that should be reserved for those people who really want to stay in academia and become professors by themselves.
9. You enjoy great international reputation and influence no matter clinically or scientifically. What is your proudest career achievement to date and why?
I would say one needs to separate (my achievements) into research contributions and clinical and into structural development.
Let's start with research. I set out to implement animal models, of neurological disorders, where we could mimic the disease course, and then implement new neuroprotective strategies. We did this for example in multiple sclerosis, where we developed a model of optic neuritis in rats. And we could show that if you combine treatments that are immunosuppressive and neuroprotective, you could basically rescue the vision of these animals, which we could not do if we apply, for example, either cortisone alone or a neuroprotective strategy alone. This strategy has been transferred to a clinical study which demonstrated the superiority of this combined treatment approach.
In clinicl research, we developed what we call “one-stop stroke treatment”. For the people who have a large hemispheric infarct, they will not be sent first to the CT scan and then back again (to the emergency unit) and then into the angiography suite, but we just transport them directly into the angiography suite, where we do a very rapid (CT) scan and then (neuroradiologists) directly do the intervention with the thrombectomy. With that, we could cut half of the time between arrival in the hospital and recanalization and achieve much better outcomes of these patients.
Structurally, I think my major achievement was to establish a research cluster here in Göttingen together with my colleagues from other departments at the university medicine, the university and the research insitutes like the Max-Planck-Insitutes or the Helmholtz-Insitute and the German Primate Center. With this team we were successful in the first excellence initiative in Germany several years ago. With the money that we got through this and other grant applications, we could establish several new departments for Cognitive Neurology, Neurodegeneration Research and Neuroimmunology.
10. The COVID-19 pandemic is one of the biggest challenges facing modern healthcare. What impact do you see this having on the field of Neurology?
I think, what we learned is that Covid-19 is not only a lung disease, but it's also a brain disease. First of all, we see complications of the infection, not only because of hyposmia and acute symptoms, but we also see that sinus vein thrombosis or strokes are more often occurring in these patients. And that's why we also learned to apply early therapies like anticoagulation for these patients in order to prevent this. It's also of course also a side effect of vaccination, so we needed to learn how to deal with that.
And I think the most important problem that will still come up is Long-Covid. Most of the people with Long-Covid symptoms are not that much affected by their lung disease or by their heart disease, but by brain fog, because of concentration and cognitive problems. What we now try to do is to document what the direct effect of the disease really is, what the effect of a secondary problem being e.g. psychologically is. And how can we distinguish this from just a depression which can also occur? And most important, how can we develop treatments? To that end, we have organized a university-wide network over Germany, where we collect all patients with corona disease that were treated in the University Hospitals and we have a huge database now. And we try now to implement instruments for diagnostics to check whether, for example, there are alterations in the cerebrospinal fluid, or there are alterations of cognitive functions, or there are alterations of neurological functions in these patients, also in the long run. This is, I think, a prerequisite for developing new treatment strategies.
11. What advice would you give to someone hoping to start a career in Neurology or Neuroscience?
I would say do it. I think it's the most fascinating thing that you can do. I think our brain is the most complex and most interesting organ, and there is so much we still don't know, not only in the context of neurological diseases, but also in the context of our consciousness. Why are we conscious creatures that interact in such a complex way? There are so many things which we still don't understand, and I think it's only neuroscience and neurology who opened the way to scientifically address these questions. So everyone who's interested in this should go into neuroscience or neurology and we need those people. We need clinicians who are trained in neurology and we need good basic researchers and who help us to address these questions.
12. What would you have been if you had not been a clinician and scientist?
I think I would probably either have been an architect (or a philosopher), because I, as a child, liked to construct things and build things. I still like to do it, so architecture would have been an option because I also have a very good three-dimensional representation of things in my brain, so I can go through very complex environments and still get the relationships between objects. Or maybe a philosopher. As I said, I started studying philosophy and if you think about consciousness and the meaning of life, you always have to be somehow related to these questions. So those would have been probably two of the things I would have been interested in.
13. What are your hobbies?
Actually, on the one hand, I'm very much interested in contemporary art. I also collect contemporary art. I know quite a few contemporary artists that I meet in their studios and visit them. And it's always interesting to interact with them because we have completely different views of the world. And I get very interesting feedback on how they see science. And I, of course, can give them feedback about their art. So this is one part and the other one is gardening. I was very impressed by Chinese traditional gardening when I visited China and also later Japan. So I try to combine Chinese-style elements in my own garden, and also use it as a kind of recreation and contemplation area for myself.