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Winter 2017

 

Letters

From the Editor

A Big Deal

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We live in an age of breathtaking change and progress, and the world of medicine is no exception.

For decades, we’ve been making major inroads in our knowledge of genetics.

Now, thanks to dizzying advances in computing power and “big data” analysis, to revolutions in measurement, to seamless connectivity, we stand on the brink of a new era of medicine—one that promises to transform the prevention, diagnosis and treatment of disease.

This is a big deal, a game changer, a paradigm shift. Which is why we decided to dedicate this issue of the magazine to the subject of precision medicine.

In the special report that begins on p. 16, you’ll learn how our scientists, engineers and clinicians—collaborating under the umbrella of Johns Hopkins inHealth—are setting the course for this new epoch in health care. Already, their advances are improving care for prostate cancer, multiple sclerosis, cystic fibrosis and more by allowing for treatment tailored to the individual patient.

Excited yet? I know I am.

Sincerely,
Sue DePasquale

P.S.
I’m pleased to share the good news that our Spring/Summer 2016 cover story by Rachel Wallach, “Stuck in Despair,” which explored why today’s medical residents suffer a high rate of depression, has received an award for excellence from the Association of American Medical Colleges. Judges praised Wallach for an “incredibly well-written article” that “tackled a difficult subject … head on.”

One of Ours, Too

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In your tribute to Dr. Gregg Semenza for his receipt of the Lasker Award [Circling the Dome, Fall 2016], you mentioned William G. Kaelin Jr. as a co-recipient.

Bill was on the Osler house staff from 1983 to 1986. I spent my first month of internship with him on the Osler 5 rotation. Aside from being brilliant at medicine and science, he was also hilarious and knew the entire lyrics to the theme song from The Patty Duke Show. His bellowing of, “But they’re cousins!” was welcome comic relief during long internship days.

Bruce C. Kone, M.D.

House Staff, 1986

Caution on Mass HPV Vaccination

One reason for the relatively low uptake of the HPV vaccine, as Dr. Krishna Upadhya suggests, may be that parents and pediatricians want to avoid the subject of sex (Second Opinion, Fall 2016). There are, however, cogent reasons why HPV vaccination is not in the best interests of children.

Fourteen million people may be infected with HPV in the United States annually, as Dr. Upadhya says, but vaccination is being promoted not to prevent HPV infection itself but to prevent cervical cancer, with which some strains of HPV are associated. From 2008 to 2012, the average annual number of cervical cancers diagnosed in the United States was 11,771 (or 7.4 of every 100,000 females). That may seem high—actually, it’s about the same as the number of infants with phenylketonuria detected by newborn screening in the U.S. annually—but in 1975, 30 years before HPV vaccination began, the incidence was twice as high, at 14.8 of every 100,000 females.

This drop is attributable primarily to Pap screening of women, beginning in their 20s. Unfortunately, HPV vaccination cannot replace Pap screening because the vaccines do not protect against all cervical cancer-related strains of HPV. Since vaccinated women should continue to have Pap smears, those cases prevented by vaccination would have been detected anyway. There is, unfortunately, evidence that HPV vaccination has lowered the rate of Pap screening.

Nor is HPV vaccination without harm. Associations with primary ovarian failure and other autoimmune disorders have been reported. Until more data are collected, caution is needed in promoting mass vaccination.

Neil A. Holtzman, M.D., M.P.H.

House Staff, Pediatrics, 1959–62 | Emeritus Professor of Pediatrics

Painful Memory

Your cover story on depression in physician trainees [“Stuck in Despair,” Spring/Summer 2016] has prompted me to respond based on an experience that I had decades ago.

One of our classmates in our second or third year (I have forgotten which) committed suicide. He was a very quiet person with few obvious friends, yet was a member of our fraternity. I knew him only as someone sitting at meals and doubt if I even had a conversation with him. The dean of the medical school called me since I was the president of the fraternity and asked if I would meet with the mother of my deceased classmate. Obviously, she was seeking some connection and explanation for this terrible tragedy. Of course I met with her, but as I [did], I became acutely aware that I was both unprepared and inadequate. No preparation for this encounter was offered [to me]. No representative from the school was present.

At that time, I was primarily in preclinical rotations and had not honed my skills in communications with patients and families. I had no anticipation of her needs or how I might offer comfort. I can remember the mother’s pleading face, but I have repressed what she asked and how I responded. It has taken me many years to reach peace with the school, which at that time seemed insensitive to the needs of its trainees. I still regret that I was unable to offer more adequate support for his mother in a time of her greatest need.

During recent visits to the campus, I do feel that the school has a more caring environment. Thank you for your courageous and sensitive article.

Robert L. Kriel ’63, M.D.

Adjunct Professor, Department of Experimental and Clinical Pharmacology, University of Minnesota

A Man Before His Time

It was disappointing that [Dr. Lawrence Egbert Jr.’s] obituary focused solely on the latter aspect of his career with its negative connotations [In Memoriam, Fall 2016].

As a medical student doing an elective rotation in anesthesia, I found Dr. Egbert to be an inspiring teacher. He was an innovative thinker and a proponent of evidence-based practice in a department that was otherwise in a gloomy period of transition, largely devoid of academic activity. A man before his time, Dr. Egbert actually foresaw the current trend toward nonpharmacologic pain relief and was a practitioner of hypnosis for labor.

I was personally disappointed when he left to assume a higher-ranking academic position in Virginia. It is regrettable that you could find nothing positive [to say] about this multifaceted individual who actually contributed much during his brief tenure at Johns Hopkins.

Richard Goldstein ’77, M.D.

Langhorne, Pennsylvania