Was 2018 the year in which salt consumption was dealt a major blow?

“No, not really. We’ll have to do a much better job of that. There is a lot of discussion on obesity and diabetes, and rightly so, but there is hardly any attention for the problems associated with salt. It’s strange that politicians are not doing anything about it. But perhaps a change is upon us. At any rate, I’m experiencing societal pressure to do something about it.”

Because salt poses a major threat to our health?

“As far as I’m concerned, salt is the number-two problem after smoking. Strangely enough, nowhere near enough attention is being paid to the subject. 80 percent of the salt we consume is added to our foodstuffs by the food industry. A preventive agreement of sorts has been signed recently, but it is far too wishy-washy and liberal, in that it leaves pretty much all the responsibility with food producers. We should take a leaf from Great Britain’s and Finland’s books. Those countries have far stricter regulations with regard to the amount of salt in our food. For this reason, I have joined WASH, which stands for World Action on Salt and Health. Nierstichting (the Kidney Foundation) is seeking to engender a public debate on salt. For instance, last year it had celebrity chefs prepare low-salt meals in Nieuwspoort, and it has entered into a debate on the subject with politicians, the food industry and scientists.”

If there is such a clear correlation between salt, high blood pressure and kidney failure, why are most governments so lethargic about tackling the salt problem?

“Who knows? It took us several decades to address smoking to the point where we are now. For instance, the USA has its Salt Institute, a lobby group that also represents Dutch companies such as Akzo Nobel. Their goal is to get people to question the correlation. However, it is absolutely beyond doubt that there is one.”

Which types of meals tend to contain too much salt?

  1. Ready Meals
  2. Pizzas
  3. Pre-packaged sauces
  4. Cheese, sausages and cold meats
  5. Bread
Ewout Hoorn puts on his gown in his office. In 2018 he gave his inaugural lecture. Image credit: Levien Willemse

I do suspect 2018 was a special year for you on a personal level. Not least because you gave your inaugural lecture in June. Am I right?

“You certainly are. Although I was actually appointed to a chair in 2017, things remained kind of quiet afterwards. So I was really looking forward to my inaugural lecture. It’s actually a good thing that there is some time between these two occasions, which allows you to prepare for the whole thing on an emotional level. The day of my inaugural speech was very special. It was not only attended by my friends and family, but also by my colleagues in the field, quite a few representatives of the Nierstichting, and – something I was particularly happy about – some of my patients. Actually, I give work-related presentations nearly every week, but generally, only my colleagues in the field will attend these. When you are giving an inaugural lecture, you are catering to all sorts of people. In other words, you must not only tell them about an aspect of science they might not be aware of, but you must tell it in a way they will understand as well. It was good to see that I managed to do so.”

Moreover, you were awarded a two-million-euro grant by a Danish foundation.

“Yes, the interview for that grant took place on the day before my inaugural lecture, in Copenhagen. I did need a Danish partner for the grant application. Fortunately, I had one – someone I met while working in Washington, DC. We complement each other very nicely. He mainly conducts fundamental research, whereas I mainly conduct clinical research. Well, the grant was for researchers working in tandem. We will use the money to appoint four people for a four-year period – two here in Rotterdam, plus another two in Aarhus. Our project focuses on investigating a new method to treat kidney failure.”

And on top of all that, you bought a house this year.

“Ha, ha. Yes, I did. We actually inspected that house on the morning of my inaugural lecture. If everything goes according to plan, we will be moving in in March 2019.”

Previously, you received a 1.25 million euros grant from Nierstichting. What did you do with that money?

“I’m using it to study the effect of potassium, which is basically a harmless type of salt, on kidney failure. I’m doing so in cooperation with academic medical centres in Leiden, Amsterdam and Groningen. Along with a few colleagues, I also organise the annual Winter School, in the middle of nature, for PhD students working in the field of nephrology. It’s a lot of fun, but its main objective is to preserve scientists for the field of nephrology. They are constantly being poached by oncologists, cardiovascular specialists and neuroscientists. Kidneys really are a niche.”

So by now two organisations have given you millions of euros to conduct research. Have you submitted any other grant applications recently?

“The money I obtained from Nierstichting and the Danish Novo Nordisk Foundation gives me a lot of scientific freedom. It should be noted, though, that the university expects its professors to have this ability to obtain research grants. I’ve recently applied with NWO and Nierstichting for a few more grants, since grants are crucial to creating critical mass and expanding a field of research. It’s not something you should do on your own. Fortunately, I have a few PhD students who I think may follow in my footsteps.”

Ewout Hoorn walking in Erasmus MC Image credit: Levien Willemse

Back in your student days, you once wrote in a column that you really enjoyed ‘the combination of studying a subject, engaging in science, being a doctor and writing’. Is that still true today?

“Absolutely, which is just as well. I’d estimate that I spend 60 percent of my time conducting research these days, only I now carry out fewer tests myself. Instead, I spend more time supervising others. For instance, I no longer do lab work involving pipettes myself. I spend 30 percent of my time being a doctor, and the remaining 10 percent of my time are devoted to writing – particularly writing scientific articles and grant applications.”

What with your 60-to-70-hour working week, do you have any time to look after your children? Or is that your wife’s responsibility?

“No, no, not just her responsibility. It’s definitely something we discuss a lot at home, and she does bear most of the responsibility, but thankfully, we agree on the way it’s done. Of course I have long working weeks, but I do use my time very efficiently. For instance, I regularly drop my kids off at school or at the daycare centre and pick them up again, and I try not to spend too much time working on the weekends. My children are a natural counterbalance to my work. Without them, I’d definitely be a workaholic, a monomaniac. Children make my work seem much less important, and sometimes I need that.”

How do you relax?

“I do ten-kilometre runs a couple of times a week, to practice for the Bruggenloop [a 15km race crossing six bridges in Rotterdam – ed.] on 9 December. I make a conscious effort to pencil in some time for running, partially because the best ideas are often born when you take a step back or when you are relaxing. If you don’t relax, you extinguish your own ability to be innovative. Running helps, as does talking out loud, being in touch with fellow researchers, and going out for a good dinner with your research team every once in a while.”

Ewout Hoorn with a patient Image credit: Levien Willemse

Which would you pick: a new discovery in your field of study or putting a stop to the salt epidemic in the Netherlands?

“At the end of the day, every scientist dreams of making a discovery that will make a difference. Putting a stop to the salt epidemic is basically a matter of how to play the media and people. In short, I’d choose the former. Although I love being a doctor, I’d rather be a pioneering scientist who discovers things.

“This is why I work at an academic medical centre. It’s such hospitals’ duty to push boundaries in their fields of study. They are also increasingly under pressure from the outside world to do so. There are plenty of other hospitals in the Netherlands that can treat patients with regular disorders and afflictions. So I’m increasingly working with ‘special’ patients who are necessary for the birth of innovative methods, and I’m spending less and less time with ‘regular’ patients.”

What kind of ‘special’ patients are you working with?

“Well, I recently examined a patient who presented with an odd pattern, which may be indicative of a new syndrome. It turned out she had a congenital disorder affecting one of the kidneys’ potassium channels. Such cases, such ‘odd’ patterns, will often help you arrive at new insights.

“I look at how kidneys deal with water and salt, how certain processes contribute to the onset of kidney failure. You can learn a lot from congenital disorders. It is these rare disorders, the human knock-outs, that teach me more about the widespread disease called high blood pressure.”

Do fame and renown play a role in this drive to make new discoveries?

“No. You absolutely have to be ambitious as a scientist, and you must have a drive to succeed, as well as a certain amount of pride. But at the end of the day, I’d rather have this success reflect on the whole team than just on myself. That would make me much happier.”

Ewout Hoorn, 40, studied Medicine at Erasmus University, which also granted him a cum laude doctorate in 2007 for a PhD dissertation entitled Water and Salt: From Renal Mechanisms to Clinical Disorders. He has worked as an internist/nephrologist at Erasmus Medical Centre ever since, combining patient care, research and teaching duties. On 8 June he gave his inaugural lecture, entitled Water and Salt, in which he stated that salt is a silent killer. The lecture constituted his formal acceptance of his endowed chair at Erasmus MC. Hoorn shares a household with his partner and has two children.


part of special

This was 2018

2018 is (almost) over and therefore we are looking at the past year in review.