From April to June 2020, at the beginning of the pandemic, the Moscow State University Medical Center was a covid hospital. A team of doctors and scientists led by Kamalov managed to save more than 99% of patients and create their own COVID-19 treatment protocol. For their contribution to the fight against coronavirus, many employees received prestigious state awards, and the academician was awarded the Order of Alexander Nevsky.
On June 3, Armais Kamalov turned 60.
The scientist told TASS about the future of medicine, the danger of biological weapons and what it means to be strong.
- Armais Albertovich, in science, in the overwhelming majority of cases, you need a material base: devices, reagents, computing power. How can you assess the level of the reserves that are there to support the research in your field and in medical science in general in the country?
- Speaking about the material base, I would like to say that, of course, it is extremely important, especially for fundamental science; where serious research is carried out, there is always a need for appropriate funding, and among other things the need for expensive devices and reagents.
Unfortunately, Russia is not even among the top twenty countries in terms of research spending. We are inferior in terms of financing to the United States and some European countries by tenfold, if not more. A lot of attention is paid to science in China today.
This, of course, is a problem. But today we must understand that in addition to state subsidies for science, which probably account for over 50% of all expenses, grants from various foundations that actively involve research centers in research activities are a competitive source of funding. The competition is serious enough, these grants are not easy to get. Nevertheless, today it is a very important component of scientific funding, even though its volume needs to be increased.
More funding is needed if we want our science to be competitive. We understand that today’s fundamental research is the country’s future potential in all areas, including medicine.
Fortunately, today we can say that our country has been one of the first to create its own three vaccines in this pandemic. Today, they are considered to be one of the best. Although opinions differ, overseas scientific centers believe that their vaccines are more effective. But nevertheless, in this vein, I can say that we have successfully risen to the occassion.
If we talk about practical steps, I would say that we have managed to withstand the pandemic of the new coronavirus infection much better than the developed countries of Europe and the United States, where the level of medicine is considered to be higher. In this situation, the main role was played not so much by the advancement of medicine itself as by our healthcare system. In the Soviet era, it was considered to be one of the best healthcare systems in the world by WHO. This attitude was passed down from Semashko (Nikolay Semashko (1874-1949) was the first People’s Healthcare Commissar of Soviet Russia, one of the organizers of the healthcare system in the country that was founded on the same principles of organization and centralization - note TASS).
- The term “Semashko system” has recently come into use in the media.
- Sure. It was built on the principles of rigorous patient selection and triage. These principles have played a key role in the fight against the new coronavirus infection in our country. A clear-cut organization, adoption of the necessary quarantine measures, creation of a system for differentiating patients by “infectious - not infectious” diseases, their allocation to the appropriate hospitals and treatment groups.
As for the treatment of patients itself, it was a serious problem. At first, we received recommendations from our international colleagues. We didn’t really agree with them, since viral infections had never been treated with antibacterial drugs. And we knew that the first recommendations proposed the use of powerful antibacterial wide spectrum drugs, which in no way contributed to the treatment of the viral disease itself, while they led to a worsening of the patient’s condition due to a decrease in immunity. And other drugs that were widely used included: hydroxychloroquine, which was used to treat malaria, and drugs used in treating AIDS. It was not clear what the proposed treatment regimens were based on.
In our clinic, from the first day of work as a COVID hospital, an interdisciplinary council, consisting of leading specialists from the Medical Scientific and Educational Center of Lomonosov MSU, began to work. From the first days, according to the examination results of patients with a new coronavirus infection, a characteristic feature of the course of the disease began to emerge, associated with a tendency to hypercoagulability and thrombus formation. It was decided that all patients should be prescribed anticoagulant therapy. It became obvious that this infection affected not only the pulmonary system, but also the heart and liver and other organs. Subsequently, taking into account the experience gained, we developed a new protocol for treating COVID-19 patients - and it included the drugs that prevented the virus from entering the cell, which had an anti-fibrotic effect, and anti-inflammatory drugs that were prescribed after taking into account each patient’s history. This approach allowed us to achieve high clinical results, we managed to cure a significant number of admitted severely ill patients. The mortality rate was 0.94%. Of course, it was a collective success.
This protocol has been actively used in other clinics as well. And even our foreign colleagues adopted our experience in the treatment of this disease.
- There is now an ongoing “information war of vaccines”, on the one hand, and the fact that Russians are extremely reluctant to get vaccinated, on the other hand. Can you share your experience: what should be done to persuade relatives and acquaintances to get a vaccine shot?
- People have questions: not only about how effective the vaccination is, but, most importantly, about how safe it is. Serious research is underway to study the effectiveness and safety of new vaccines. The high mortality rate, the degree of complications that occur during the course of the disease, and in the post-COVID period the problems that may arise during the vaccination outweigh everything else. It seems to me that this is the main argument that should convince citizens to actively vaccinate.
Of course, individual contraindications for each specific person should be taken into account. Each vaccine has its own characteristics, but there are a few general rules: people with aggravated diseases who have a history of allergic reactions, immunological and oncological diseases should be treated with extreme caution. At the same time, studies should continue observation for a longer period of time, including observation related to the study of the formation of cellular immunity, both in patients who have survived the disease and those who have been vaccinated. This will answer the question of whether it is necessary to vaccinate those who have been ill and those who have been vaccinated not long ago.
Vaccination should be regarded as the biological protection of humanity. Let us recall at the very least such infections as smallpox, tuberculosis and others. Hundreds of thousands and millions of people lost their lives. Humanity managed to survive only because vaccines were created that created a significant barrier to the diseases’ further distribution. And we literally started to forget about those diseases.
And therefore, I think that if today we are correct, according to indications, to vaccinate our population, then to a certain extent we will be able to cope with this scourge that has befallen the entire world, all of humanity. I can say that I am an advocate of vaccination.
Another important thing that is worth mentioning. This pandemic has brought us back to understanding simple, routine hygiene practices in public places, including trivial hand washing, which is the foundation for preventing the spread of any infectious disease. We must remember that today it is a coronavirus infection, tomorrow it may be some other infection.
- Returning to more general problems of organizing research. What is the significance of scientometrics in your field? What should be the criteria to determine research effectiveness?
- There are also quite a few contradictions here. Scientometrics must be applied to absolute assessment. That is, on the one hand, we have the achievement of certain criteria, and on the other, we have the amount of funding allocated for a particular study. Without serious funding, it is certainly not necessary to believe that we will have a great, most advanced science. It is crucial to increase the volume of funding for the science in general.
Most often, the criterion for evaluating a scientist and a research team is publications in top-rated peer-reviewed journals, which really confirms the level of scientific research and evidence base.
No matter what kind of great articles you write, no matter the case it (such a science – note by TASS) will fall short of the science that is really focused on the human life, his health, the environment and all the processes that occur around us. And here it is important to make sure that the fundamental science is reflected in further applied scientific research, with the subsequent approbation of any given new method or device, which is later implemented in real life. In essence, it is important to ensure the creation of a certain product. And the government is extremely interested in this, since “naked science” does not ultimately bring economic benefits to the state.
And now it is obvious that in order to launch such large-scale projects, it is necessary to create consortia of several institutions that have different competencies to carry out the full cycle of all processes to achieve the translation of scientific research into practice.
- How are these issues resolved at Moscow State University?
- If we talk about the Moscow University, it is undoubtedly recognized as the leading scientific and educational institution of the country, since it has all the infrastructure and a team of scientists who are capable of solving the most complex government problems.
For example, in the field of medical science, we have the opportunity to discuss with employees of various faculties - chemistry, biology, physics, etc. - those issues that are of interest to the medical community. And thanks to inter-faculty cooperation, we are developing a joint program for the implementation of the research process: from fundamental science to practical healthcare.
And to date, we have implemented projects to create new medical equipment, new diagnostic methods, including new tumor markers, which are being clinically tested in our university clinic, and subsequently can be successfully used in the doctor’s practice. Today there is a need to create an Institute for Advanced Medical Research as part of the MSU Medical Scientific and Educational Center.
In this Moscow State University is very much different from other institutions, stand-alone institutes. There is both a fundamental and a clinical base that is capable of solving any “turnkey” problem in the field of biomedicine.
- What can you say about medical education at Moscow State University, how does it differ from other medical universities?
- A little bit of history. In 1930, the Faculty of Medicine was removed from Moscow State University, and the First Moscow Medical Institute was created. It was a difficult time then, the main task of the government was to provide the country with doctors and medical workers. In 1992, when Viktor Antonovich Sadovnichy was elected Rector of the Moscow University, with his first order he recreated medical education within the walls of a classical university, and the Faculty of Fundamental Medicine came to be.
Let's discuss the unique nature of medical training at Moscow State University. If we take teaching at medical institutes, students there receive basic scientific education in biology, chemistry, and physics at their departments. And at Moscow State University, we are talking about an inter-faculty medical education, because all these subjects are taught at the corresponding faculties, which transfer to them a colossal amount of fundamental knowledge that can be used in the future in their scientific and practical lives.
Viktor Antonovich understood that in order to create a biomedical cluster, it was necessary to have his own clinical base. And that is why in 2014, the Medical Scientific and Educational Center opened its doors, in fact it was the first university clinic within the walls of a classical university in our country. It is not for nothing that they believe that the most outstanding, breakthrough areas in medicine around the world are carried out precisely in university clinics, at the junction of fundamental and applied science.
- Is the scientific work of students a resource for the development of science or an investment in the future? Or is it just an expense in and off itself?
- I have just started saying that our students receive a qualitatively different education in terms of fundamental knowledge. On the other hand, there are not many students in the fundamental medicine department. We started with dozens, and now there are 150 people. But these are not thousands who are trained in medical schools. Our groups are small. Close attention is paid to the individual education of each student in accordance with his interests and capabilities. In the fourth year, each student writes a term paper, and in the sixth year - a thesis. The level and quality of writing of these works can be equated in essence with the defense of a Ph.D. thesis. This is the level of our students.
Therefore, the study of theoretical fundamental sciences, training in your own university clinic makes it possible to mold a very strong graduate. They are ready-made researchers, well-trained novice doctors, and they get very easily integrated into any medical and scientific institution.
- A quick question about the sphere of your scientific interests. What are the advantages of minimally invasive methods?
- I remember the words of our teachers who said: “A big doctor is a big cut, a small doctor is a small cut.” It was believed that the size of the incision to one degree or another predetermined the level of the surgeon and the success of the surgical intervention.
To date, technical progress in medicine has led to the fact that those surgical interventions that were previously performed during open surgeries have undergone significant changes towards minimally invasive endoscopic, laparoscopic, robot-assisted operations. These minimally invasive techniques have not become less effective at all. On the contrary, due to precision technology using high-precision instruments and excellent visualization, doctors have the opportunity to demonstrate high levels of performance with the least number of complications. In terms of volume, these interventions are equivalent to open operations. Moreover, due to the low trauma, quick rehabilitation of patients is achieved.
But at this point it is too early to say that the era of open surgeries is over and they have lost their relevance. There are those diseases and medical areas in which one simply cannot do without performing open surgeries. And these are, first of all, reconstructive and plastic operations, surgeries for large oncological processes, traumatology, orthopedics, etc.
- How, according to your forecasts, will the minimally invasive medicine develop further?
- It seems to me that in the near future, development can be directed towards greater miniaturization and, of course, improved visualization. Modern endoscopy is a video technology with an image magnification of 150–160 times, it is the promise of combining endoscopic and ultrasound methods in one apparatus, and these are the various auxiliary methods for clarifying the localization of a pathological focus: chromoendoscopy, narrow-spectrum endoscopy.
In this day and age, the methods used make it possible to carry out studies up to microscopy, detailing the lesions of interest, and see the smallest vessels. For example, in urology, endoscopy allows, in most cases, without an incision through the natural urinary tract to penetrate the bladder, kidney, perform operations related to the removal of calculi, resection of tumors. Today, minimally invasive interventions have become a reality not only in urology. Take cardiology, for instance. Today, intervention procedures through the vessels allow complex surgeries to be performed without large incisions, with angina pectoris, acute coronary syndrome, and heart defects.
In any field of medicine, there is a breakthrough in terms of minimal invasiveness. The possibilities of thorough diagnostics open up broad prospects for the earliest detection of diseases, which contributes to the development of organ-saving and minimally invasive interventions when it comes to the diseases of the gastrointestinal tract.
- Medicine of the future - what is it?
- When we talk about minimal invasiveness, it's really great. In urology, for example, 90–95% of diseases are treated using minimally invasive techniques. Today it is a blessing for us and, of course, for the patient.
But if you look a little deeper, I would say that the medicine of the future is medicine without a scalpel. I mean figuratively - treatment without the use of surgical interventions. Nowadays, scientific and technological progress in medicine allows us to determine the person’s genetic passport at his birth, taking into account hereditary and other factors, to determine the likelihood of the occurrence of certain diseases. The time for such procedures is not far off, when, with the help of genetic engineering, we will be able to prevent the development of various diseases and not put the patient on the operating table.
At the Medical Scientific and Educational Center of Moscow State University, which I am in charge of, there is an Institute of Regenerative Medicine, which is spearheaded by Academician Vsevolod Arsenievich Tkachuk. This team of scientists has already approached the issue of creating gene therapy drugs aimed at restoring the lost functions of an organ. Biological matrices and bioengineering structures are created in order to be used in reconstructive interventions. Nowadays, there is such variety that can be offered as an alternative to conventional dosage forms, conventional plastic materials. Cellular technologies, regenerative medicine are new trends that scientists from around the world are crazy about.
Therefore, the fact that medicine is changing, that even now it is different is unambiguous. An operation is a measure of last resort, when, unfortunately, we cannot help the patient in any other way. The time will come when this category of patients will be successfully treated with the help of other ultra-modern methods.
- Men’s health has to do with areas filled with cultural taboos. How do you envision the educational and preventive work under these conditions?
- This is a huge problem. Unfortunately, we have to face the fact that men turn to us, in general, not at the earliest stages of the disease. This can be attributed primarily to cultural aspects, gender differences. For example, women are more organized, they often go to gynecologists. Men are much less likely to go to doctors. They seem to think that they can afford it all: eat in excess, drink alcohol in unlimited quantities, not engage in sports; in other words, a healthy lifestyle for most men is just words. And then the only thing that can help them is medicine. More often than not, men who have serious metabolic disorders leading to the development of various diseases show this type of thinking.
More time needs to be spent looking into the health of a healthy person, based on the principles of health-saving technologies as a guarantee of high-quality longevity.
There are also issues of the healthcare system itself, which requires changes in primary care on a fundamental level. It is necessary to create specialized offices for men, by analogy with antenatal clinics. There must be a system in place that will allow men to undergo prophylactic medical examinations, preventive examinations. If you remember, back in the day we used to have this kind of check-ups at all stages of a person's life, starting from kindergarten.
- It was impossible to get a job without a medical examination.
- Exactly. In the early days, men were not allowed to study and work without a certificate of medical supervision. I cannot understand why we still have this ill-fated “capitation” - per capita financing, when 5 thousand rubles a year are spent per person in an outpatient department. I would like to understand for myself how 5 thousand rubles can be used to provide both preventive and curative care to a patient within a year. With such a system, the polyclinic facilities have no interest in patients turning to them whatsoever. That is why we have so many neglected cases requiring hospitalization.
And to think that the need for inpatient treatment can actually be eradicated using even smaller funding, but with better care towards the patient, that it can help people save on the tons of money already spent on treatment of cardiological, oncological, and other diseases. It would be more profitable from the economic point of view. And, of course, it is better to prevent the disease or detect it in the early stages. This is precisely the prerogative of primary healthcare, which today requires serious optimization.
This also applies to the problem of the time allotted for the initial consultation with a patient. My teacher, Academician Nikolay Alekseevich Lopatkin, used to say: “Never interrupt a patient”. While telling his story, he will account for about 50% of a potential diagnosis. And when 12 minutes are allotted for each patient, it is very difficult for the doctor to make the right decision. There are things that need to be seriously revised.
- International contacts of doctors and scientists - how necessary are they with regards to the pandemic of the new coronavirus infection?
- These days, we are in close contact with the foreign colleagues. The experience of diagnosing and treating the new coronavirus infection is currently being studied. Our treatment protocol, created at the Moscow State University Medical Center, attracts the attention of colleagues around the world. Today, all across the globe, vaccines are being developed to prevent the spread of a viral infection, and measures are being put into place to facilitate the rehabilitation of post-COVID syndrome. We actively publish our own research findings, as well as constantly analyze the articles of our foreign colleagues. The fight against this virus has become the common task of all nations, of all mankind.
On the other hand, statements about the man-made nature of COVID-19 and the search for those responsible for the spread of this pandemic continue to be voiced. I cannot help but think that this is an alarming trend. The global community must take control of laboratories engaged in dubious biological research with shady purposes.
There are many laboratories that are funded today by the US Department of Defense. It is no secret that they are located in Georgia, Armenia and other republics. It is surprising that access to such laboratories is closed, and we have no idea what they are doing there. We can only guess. Therefore, I believe that the development of genetically modified viruses aimed at creating biological weapons should be banned all over the world, and the same goes for testing nuclear weapons. There is an organization called “Physicians of the World for the Prevention of Nuclear War”, I was once the co-chairman of this organization on behalf of Russia. Such organizations have always existed and will continue to exist. I think they provide huge benefits.
The cooperation between doctors is important. Because doctors, like nobody else, understand what man-made, biological and military disasters can lead to, what humanity may have to face. We must ring the alarm and, to a certain extent, be the ones who must prevent the use of such technologies.
- And the age-old journalistic question about the “secret of success”. Are you an organized person? Do you follow your own rules of leading a healthy lifestyle?
- I try to motivate myself. For many years I have been the head of the “Men’s Health” society. And I always said: if I don’t look good, no one will ever believe in my society and in my theories. The health of each person is in his own hands. I try, like many others, to abide by these rules. I believe that a strong person is not one who can afford everything without restrictions, but one who can force himself to give up temptations in life.
If we talk about the secret of success, perhaps it is my dedication and willingness to work. It is important for me to see a goal in front of me, to constantly move forward to achieve it. I consider myself a creative person, which allows me to find out-of-the-box solutions for many issues. I managed to form a wonderful team of the highest qualified professionals, dedicated to their work and medical duties. It’s easy to be a conductor when you only have stars in your orchestra...
Besedova Elena Ivanovna