Colleagues of the late Anton de Craen remember his remarkable but too brief career.
In January the Geriatric Medicine community lost one of its most devoted and beloved scientists; Anton JM de Craen (Sep 1966 – Jan 2016). Trained as a clinical epidemiologist, Dr. de Craen (“Ton” to family and colleagues), received his doctorate from University of Amsterdam, The Netherlands on his thesis “Placebos and placebo effects in clinical trials”. Soon after graduation he was appointed as a co-director of the Dutch Cochrane Centre where he focused on concepts and methodologies behind systematic reviews and meta-analyses. In 2000, he joined the department of Gerontology and Geriatrics at the Leiden University Medical Center as a faculty member and spent rest of his career there. Apart from being the scientific head at departments of Internal Medicine/Gerontology and Geriatrics, since 2012 he served as an academic editor of PLOS Medicine. Just recently he was appointed as a Professor of Clinical Epidemiology, although sadly he could never deliver his inaugural lecture.
Ton de Craen has published over 400 peer-reviewed articles, and several more are yet to be published. Ton would want to deflect credit for majority of his publications to his colleagues and graduate students. However, doing so also underlines his remarkable contribution to the education and supervision of more than 40 PhD students. Ton was known for his dedication to teach both scientific and ethical principles of clinical research and scientific critical appraisal at different levels from bachelor students to senior clinicians working in the field of geriatrics. As highlighted in his professorship vision statement, he was greatly committed to improving medical care for older people through methodologically robust translational and clinical research. In-depth methodological knowledge, great biological insight, and his honest and direct character made him a genuine researcher who was not only after novel ideas but also keen on the accuracy of research methodologies. He loved teaching and learning and believed that working with ambitious and talented people was his major drive to come to work every day. He was a gifted teacher who could articulate complex methodological concepts in easily understandable terms with his unique sense of humour. When he was asked about his messy desk with piles of papers, with a smiling face he pointed at the quote hanging on his wall: “If a cluttered desk is a sign of a cluttered mind, of what, then, is an empty desk a sign? -Albert Einstein”.
Ton de Craen initiated and contributed to several national and international research projects which influenced our current understanding about biology of ageing and pathophysiology of age-related disorders. Since 2005 he was the co-principal investigator of the Leiden 85-plus Study, a landmark population-based cohort focusing on the health and well-being of the oldest old people. In the framework of this study, he and his colleagues showed that the association of conventional cardiovascular risk factors with cardiovascular outcomes attenuates or even reverses, a finding that has triggered a great deal of scientific debate on the methodological issues related to elderly cohort studies and potential new physiologic features of ageing. Besides the oldest old population, he focused on cognitive and functional well-being of older subjects at cardiovascular risk in the PROspective study of pravastatin in the elderly at risk (PROSPER) study. As a member of the PROSPER team, he was excited to pursue one of his interest in clinical science Mendelian randomization and causal inference. Inspired by Martijn Katan and George Davey Smith during a course in the south of France in 2006, Ton set out to investigate the potential of using genetic epidemiology to answer causal questions on diseases in older people. In a seminal work, he and his colleagues showed that it is unlikely that cancer is caused by lower cholesterol levels. More recently he played a central role in demonstrating that genetic predisposition to high LDL levels still contributes to mortality even in late life, providing a framework for initiating several projects within large international consortia.
The complex relationship between blood pressure and hemodynamic abnormalities with neurocognitive outcomes in old age was always intriguing to him. He and his colleagues reported that in late-life low rather than high blood pressure, in particular in frail subjects, is associated with higher risk of cognitive decline. This observation led him to being one of the initiators of the Discontinuation of ANtihypertensive Treatment in Elderly (DANTE) study Leiden; a randomised controlled trial to study the effect of increased blood pressure in relation to cognitive and psychiatric outcomes in patients with mild cognitive impairment. His involvement in the DANTE trial extended from the concept and study design to the analyses and interpretation of the data. As praised by an accompanied commentary, publication of the DANTE trial introduced a new line of interventional studies in geriatric medicine which focuses on discontinuation of medications rather than initiation of a new medication.
Ton was fond of using the well-known Latin phrase “Veni, Vidi, Vici” to describe the academic development of his colleagues and students. It is a fitting description of his career as he stepped into academia, learned and observed, and triumphed in science by influencing many lives and careers.
Behnam Sabayan is a clinician scientist working on the contribution of cardiovascular factors to brain aging. He largely owes his academic career to his mentor, Ton de Craen.
Featured Image credit: Behnam Sabayan