Margus Viigimaa, a professor at Tallinn University of Technology and head of research at the Cardiology Centre of the North Estonia Medical Centre, states that dealing with science gives a doctor a critical worldview.
The current situation – the coronavirus and the resulting highly demanding workload of doctors and nurses – is also reflected in other fields of medicine. Large clinical trial programmes have either extensively cut back on their activities or have been abandoned altogether. Patients whose diseases are of great interest to specialists simply cannot be invited to hospitals for examination.
At the same time, the new situation has put forward new hypotheses and asked for evidence – or facts that would refute the claims. Among other things, it has been asked whether medications for hypertension (i.e. higher than normal arterial blood pressure) or ACE inhibitors that relieve cardiac failure could promote becoming infected with coronavirus and worsen the course of the disease. The researchers’ answer to this was a firm ‘No’.
However, the opposite was also asked: do some heart disease medications have a positive effect in terms of COVID, and do diabetes medications help cure the disease? Here the answer is ‘Yes!’, although it has been proven only in the case of some medicines.
A new register is in the works
Fortunately, there is also progress in research that was started earlier. Despite the tumultuous times, it has been possible to establish a register for familial hypercholesterolemia, the register now including other hospitals in addition to the North Estonia Medical Centre. Master's students of Tallinn University of Technology dealt with the topic, but Professor Viigimaa also has a doctoral student at the same university, who analyses the treatment results of patients with high and very high cholesterol based on the information system of the North Estonia Medical Centre. In the last three years, 151 patients with a bad or LDL cholesterol reading of more than 5 mmol/L have been admitted to the hospital. Their progress is also monitored after the end of treatment.
Of course, keeping up-to-date with the latest information from the rest of the world is also important – only some time ago, Margus Viigimaa and 70 representatives of other countries participated in a teleconference on the reduction of inflammatory markers in the post-stroke phase.
But what is the difference between a doctor and a doctor with a Doctoral degree when it comes to making decisions on these issues? ‘Dealing with science provides a critical worldview,’ says Margus Viigimaa. ‘On the one hand, you understand what can be studied, what one study can in principle show, and on the other hand, you realise that some things cannot be studied at all.’
Recommendations are not made light-handedly
‘All advances in treatment have come through research,’ says Professor Viigimaa. ‘Treatment guidelines from Europe and America are not just arbitrary texts, they are based on a very strong and critical collegial approach, discussing all the pros and cons. If we make a strong recommendation for a medication or treatment method, it must be preceded by at least two randomised studies with two comparable groups, the results of which have been published in an authoritative scientific journal. Although we want to adopt new scientific advances quickly, patient safety is at least as important to us.’
Of course, it is very important for a doctor as a researcher to be able to design their own research. At the same time, Estonia’s small size sets its limits here. For example, patients recover very well by receiving certain treatment, but at the same time there should be another group that did not receive such treatment.
Engineers for medicine
Margus Viigimaa transferred from Tartu to Tallinn in 2004 to lead the Cardiology Centre of the North Estonia Medical Centre. Since then, his work has also been connected with Tallinn University of Technology. This partnership is indeed a bit unusual for a doctor. ‘When I say at the hospital that I am going to give a lecture now, colleagues often wonder about me going to Tartu,’ says Viigimaa. In reality, he only drives a few kilometres, as that is the distance that separates the North Estonia Medical Centre from the campus of Tallinn University of Technology.
Professor Viigimaa greatly appreciates the fact that the Technomedicum operated at the University of Technology for many years, from which the Department of Health Technologies was formed on 1 January 2017.
He highly recognises the current and past research conducted and the education that is provided by the University of Technology. Medical equipment engineers having received their training at TalTech work in various Estonian hospitals, and currently students are being trained in Digital Health, an international Master's degree programme with half of the students from Estonia and the other half from abroad.
‘When I first came here from Tartu, different methods of non-invasive blood pressure measurement were already being performed at the Technical University,’ Viigimaa recalls. ‘With my addition, intensive cooperation arose between the university and the North Estonia Medical Centre in this field. By comparing and applying different methodologies in the course of research, we designed an express device to be used in the study of patients with heart and kidney diseases. The device enables determining the age of the arteries, as well as their degree of calcification.’
According to Viigimaa, it is a great advantage for Estonia that medical and technological professionals cooperate with each other, and the staff of the Technical University also communicate directly with hospitals. Equally important, however, is the contribution of geneticists and genetic engineers to improving the potential for better risk assessment of cardiovascular disease and the implementation of accurate prevention.
A new way of life
Margus Viigimaa, who holds several positions at the same time, has actually gained some time as a result of the pandemic. In the past, he would travel abroad once a week or at least once every two weeks to give lectures, especially on weekends. Of course, giving online lectures also demands proper preparation, but it does not require time to travel to various locations.
But the remaining time is still filled with the usual activities: clinical work, research, research and development, finding the staff to conduct the study programmes, practicums, various expert assessments, evaluation of Horizon 2020 projects, opposition to doctoral dissertations, evaluation of candidates for the position of professor.
‘Research takes up most of my time, but if you don’t do clinical work, you end up with no ideas what to do as a researcher,’ explains Professor Viigimaa. ‘Sometimes you really think that effective treatment options are still limited in the work of a doctor, but helping people first-hand is so valuable and exciting that I cannot imagine life without it.’
At the university, Viigimaa primarily misses conducting classroom training. Admittedly, there has been a fair share of teaching and learning this autumn, engineers have been given medical knowledge, and hybrid lectures have been conducted, with some students in the auditorium and others in front of computers. But it still does not replace direct contact. Medicine is not a specialty one can learn by means of distance learning. The professor is also somewhat worried that many students work at the same time, meaning that they are under high stress.
But there is so much to be excited about!
What about the professor’s own workload at the age of 63? ‘I am having a serious dialogue with myself on this subject,’ admits the cardiologist and researcher. ‘But exciting projects have kept coming along, such as the use of biological medications to lower cholesterol,’ he said.
The work of a consultant also seems exciting to Viigimaa, although it may involve a bit more bureaucracy. And the opposition to dissertations is great for self-development. ‘Teaching students keeps the soul young, and I highly value their positive feedback,’ admits the professor. ‘Holding a lecture lasting three or four academic hours is a kind of mono-performance in itself. After that, you are completely exhausted, but at the same time happy, because you have been able to do something very beautiful. I know no other way.’
Author: Sulev Oll