Everything basically started when the first PET camera in Finland arrived at TYKS, the Turku University Hospital.
Juhani Knuuti had graduated as a physician in 1985 and started out treating the elderly’s blood pressure and children’s ear infections at a health centre following his graduation. At first, he thought he would specialise in surgery, then in internal medicine.
In 1987, Knuuti ended up working in the clinical physiology unit at TYKS, which focused primarily on heart disease diagnostics. Shortly afterwards, in 1989, the hospital purchased a PET camera.
Positron emission tomography was a new imaging technique at the time, and very few in Finland were familiar with it.
In PET imaging, a tracer with a low level of radiation is injected into a vein, with the PET camera allowing for monitoring the tracer breaking down in the system. The technique enabled imaging the functionality of cells, tissues, and organs, as well as metabolism. Knuuti especially remembers the moment he first saw a colour image of glucose metabolism in the human cardiac muscle.
In 1989, professor Jaakko Hartiala asked Knuuti if he was willing to write a dissertation about cardiac PET imaging.
Medical researchers often start on a research track during their studies or initially contribute to research groups by pipetting or performing other simple tasks, gradually working their way up. Knuuti lacked this kind of experience entirely. However, he seized the opportunity with both hands because the all-new field of research was irresistibly tempting.
“People tend to think you decide your own way, that things happen as a result of your own conscious choices. In my career, I would happen upon an amazing opportunity and take it for whatever reason, which would take me to the next phase of my career.”
SThe next amazing opportunity came in 1996, when the PET Centre, jointly owned by the University of Turku, Åbo Akademi and TYKS, was granted National status and needed a director following the retirement of professor Uno Wegelius.
Knuuti had completed his doctorate in 1993, with a dissertation about the viability of the cardiac muscle. Naturally, PET imaging was used in the study. Despite his late start as a researcher, he had caught up quickly and published about forty scientific articles within a few years. However, he was still rather young and inexperienced — particularly for a director of a national, ultra-modern research unit. Regardless, that is exactly what he was appointed as in 1996, the same year he also became a professor.
“My publications and experience of the technique were probably the reason I was appointed. But of course, appointments like this also depend on the competition. At the time, I had no competitors with hundreds of publications about the subject matter. They simply could not have been made before then.”
Right from the start, the owners wanted the PET Centre to be one of the best in Europe. The pressure was mounting in the early years of the Centre. The facility had been expensive to build and continued to be expensive to maintain, and early on there were not many results to show. Knuuti had to show that the payers would get their money’s worth.
“A young researcher rarely gets the opportunity to use some of the best equipment in the world to realise their own ideas. We built up a really good team from nothing, because this kind of research hadn’t been possible in Finland before.”
In its early days, the PET Centre employed roughly twenty employees. Most of Knuuti’s researcher colleagues from that period have since advanced in their research careers to become professors or end up in leadership positions at hospitals.
“We were young people cut from a similar cloth, interested in the same thing, and we did a lot of all sorts of things. We didn’t look at the clock or think about weekends when we analysed our research.”
In the early 2000s, the PET Centre researchers had proven their mettle. As Knuuti himself puts it, the cuckoo had turned into a golden egg. The Centre got new cameras, a new building, and many new researchers.
“In those years, the attitude of our parent organisation changed completely. We had been the cuckoo that takes everyone’s money and produces nothing, but then we became the unit that produced a fourth of all the research in the entire hospital district and was chosen as the best of the university in a 2015 science evaluation by the University of Turku.”
Currently, approximately 200 professionals from various fields work at the PET Centre. They no longer simply research the technique but employ it in many ways. In addition to different fields of medicine, the Centre researches physics, chemistry, and radiochemistry, to name a few examples. The research staff comprises basic researchers, mathematics, sport and health scientists, and clinicians.
“If we hadn’t been surrounded by expertise in natural sciences, medicine, and many other fundamental sciences, the Centre as it is now wouldn’t have been possible. You need a mathematic modeller to handle the imaging information, a chemist to produce a new tracer, and you need a pharmacist as well to make sure you can give that tracer to people. Using the imaging equipment, on the other hand, requires physicists, trained bioanalysts, and radiographers.”
As the PET Centre cemented its position at the top of the scientific world, so did its director. In the 21st century, Knuuti has held numerous medical positions of responsibility both nationally and internationally while gathering tens of millions of euros in research funding. In 2015, however, he entered another entirely new phase of his career. He started a blog.
In the 1980s, Knuuti had already taken note of the incredibly bizarre things that were being told about medical science in public. It was strange to him how doctors and researchers did not participate in the health discourse by using factual information.
“But I was also a researcher for quite some time and did nothing. It’s hard for me to go and judge anyone for being too passive, I understand it completely”, he says now.
“I can mention the blog posts in the CV, but so far they haven’t been too useful to any academics. I would prefer if the third core duty of the universities would also merit researchers more clearly.”
Knuuti decided to start the blog because he wanted to do his part for popular science. His first blog post was published on the Turun Sanomat newspaper’s website on 9 March 2015. The title of the post asked, “How do you know a claim about health is nonsense?”
In nearly six years, well over a hundred blog posts have been published. The writings have not been confined to a small audience either, as Knuuti has become one of the most visible Finnish advocates for researched information and opponents of pseudoscience. In addition to his many accolades, Knuuti has also received plenty of criticism. In the eyes of a certain audience interested in nutrition, he is a Freemason corrupted by the pharmaceutical industry who manipulates research results to suit his agenda. This group includes not only laypeople but also individuals with doctorates.
Often, Knuuti’s critics are annoyed by e.g. his negative opinions on homeopathy, energy treatments, or low-carbohydrate diets. In many cases, they attack Knuuti as a person, not just his writing.
“It often takes conscious self-control and a night’s sleep not to react. And when I do react, it’s not to respond to that particular critic but the larger audience who reads their claims. That makes it easier for me mentally.”
Despite this, Knuuti admits being a target for abuse can be extremely tough.
Why, then, does he spend so much time on blog posts and social media? Doesn’t a professor have more important things on his plate?
Popular science, or making science understandable to a wider audience, is part of the universities’ third legally mandated core duty, which is community relations. However, Knuuti treats it as a hobby — albeit a massive time sink as hobbies tend to be. He often writes in his blog on weekend mornings while the rest of the family are still asleep. He still does not understand the opposition between science and popular science.
“I have learned a huge amount about things that aren’t part of the core of medical science in my daily life but are still considered important by people. I will say I am a better researcher and doctor because I also have an idea of these things.”
Traditionally, the core of a doctor’s work has been to provide the patient with the best possible treatment based on medical science. Social debate has not been part of the job description. However, the social media age has brought changes with it.
“It’s very important to influence people and be understandable, because that also affects the patient-doctor relationship. The patients are on social media and if the doctors are not, that void can easily get filled by all kinds of dingbats.”
Knuuti’s influence already exceeds his own blog. One of his lectures resulted in the foundation of Vastalääke ry by medical students, an organisation publishing easily understandable articles about health and science based on research. In 2019, the site received the award for the journalistic act of the year, and this year it received a grant from Tieteen Tiedotus ry to allow their operation to expand from Turku to other cities that offer medical studies.
“In five years, we have 50 to 100 doctors with training in popular science. This is exactly the kind of mass we need. There are too few doctors and researchers in Finland whom reporters ask questions from. When there are more of them, it also prevents issues from becoming embodied by a few select individuals.” While spending time on social media, Knuuti has noticed that people conversing on social media platforms form similar spontaneous connections as researchers. Those who are active in discussions about certain fields and subject matters usually know each other by name at the very least, despite never having met in person. The subject connects them, and the threshold for contacting each other is low.
For instance, in November, Knuuti was debunking misleading information featured in a Suomen Kuvalehti magazine opinion piece about the health risks of 5G technology. Knuuti and his professor colleagues Tapio Ala-Nissilä and Risto Ilmoniemi were contacted by Vesa Linja-Aho, the Group Manager of the National Electrical Standardisation Organisation SESKO, and together they wrote a reply to the original author of the Suomen Kuvalehti opinion piece, a doctor of medicine and surgery, “Using radiofrequency radiation-based devices is safe”.
And when Knuuti was writing his book Kauppatavarana terveys (lit. Health as a Commodity) published by Minerva in August 2020, he had social media health activists he had met on social media read through his text as peer reviewers.
Knuuti’s commentary is not exclusively limited to health-related matters. He is also concerned about the funding for science.
Measured by references to publications, Finland was the number one country in clinical medicine for a long time. According to Knuuti, the level was increased by the special state subsidies or EVO funding paid by the Ministry of Social Affairs and Health to university hospitals and intended for research, currently known as State Research Funding. Since 2005, State Research Funding has been cut back dramatically, and Finland’s position has plummeted as a result.
“The streams are minimal now. That is the main reason research has stalled.”
The first decade of the 2000s was the golden age for the Turku PET Centre as well, with funding easy to come by. Since then, finances have been tighter. In the health and social services reform proposal currently in preparation, research conducted at university hospitals is not mentioned at all.
“It’s as if this research didn’t exist. That is a massive concern for medical faculties. The universities obviously can’t conduct medical research without patients, in which the hospitals play a central role”, Knuuti says with exasperation.
Knuuti has recent personal experience of this as well, because his efforts to raise scientific awareness have not made a difference in his publication numbers. Lately, Knuuti has been developing diagnostics for coronary artery disease. Currently, doctors decide on sending patients with chest pain to further tests based on their age, sex, and probabilities based on the symptoms. However, these old metrics are rather ineffective and often lead to pointless and expensive additional testing on the patients. “If patients could be selected for further tests more accurately, the society would save a lot of resources. We have created a new tool for this.” Knuuti expects the research to influence global standards of care.
In the United States, new standards are slated to be published this year, and Knuuti expects they already acknowledge these latest studies.
“This is a great example of science being totally global. All science can be used by everyone.”
The universities emphasise their international nature more and more each year, but Knuuti believes the most important global networks are formed spontaneously around research. They cannot be forced via administrative decisions.
Even the aforementioned coronary artery disease diagnostics research got its start when Knuuti was contacted by a Danish research group. The Danes had access to a massive amount of patient materials they had been unable to utilise in their publications. The group asked Knuuti for help, and soon the cooperation produced several articles in major international media.
“If you want to do good research, you’ll create connections automatically with those with a natural need and motivation for scientific cooperation”, the Professor of the Year says.
Text: Tuomo Tamminen
Images: Milla Talassalo
English translation: Marko Saajanaho