Heroes of Medicine

Alex McDonald practices family medicine and sports medicine at Kaiser Permanente in Southern California, USA. He talked with Medicom about Heroes of Medicine, and that's not a small task.

Medicom: “Do you actually have a personal Hero of Medicine?”

McDonald: “Yes, Aaron Rubin, my fellowship director, and Bob Salas, past director of the American College of Sports Medicine really nurtured me and inspired me to become the family medicine and sports medicine physician that I am today.”

Medicom: We made a list with some Heroes of Medicine and the first one on the list is Hippocrates. It's kind of a cheesy choice, but he promoted the idea that gods are not responsible for illnesses.”

McDonald: “Hippocrates can be viewed as the father of modern medicine, with his ideas about observation, prognosis, clinical skills, characterising diseases, and the formulation of illness versus health. Although there are so many ideas in modern medicine that can be attributed to Hippocrates, it is important to not only think about him, but also about all those who worked with him. It was likely a team effort, as medicine typically is. Since there are no great records from ancient Greece, we will never be certain who made which contribution.”

Medicom: “The next one on our list is Edward Jenner. I put down the date, 1796, because I think this was the date that was credited for the creation of the first vaccine. Do you remember the story there?”

McDonald: “Yes, Edward Jenner was responsible for creating the first vaccine in 1796. I think that Jenner discovered that an individual with cowpox was immune to smallpox. He then gathered samples from a cowpox sore which he gave to a boy named James Phipps. Two months later, Jenner tested the boy’s immunity by inoculating him with matter from a smallpox sore. The boy was not affected by smallpox and became the first vaccinated person ever. Vaccines are obviously critical in our lives today. We don’t die from all these communicable diseases in our twenties and thirties as people did back then. It is amazing to have that vision of boosting immunity in a time where we didn't know anything about this matter.”

Medicom: “Jumping ahead a few hundred years, the next heroes are James Watson and Francis Crick, who proposed the double helix structure of DNA in 1953, which I think is really phenomenal.”

McDonald: “I agree. This discovery was the foundation for multiple other discoveries and had implications for our health. I think about it every day because I work with hereditary disease and you have to know, for example, if DNA mutations are cis- or trans-mutations. I always like to say that medicine is a team sport, and in that context, I think it is important to mention Rosalind Franklin, who did a lot of the work too. Her efforts around crystallography were absolutely essential.”

Medicom: “Next on our list is Louis Pasteur and his work on microorganisms in the air and water, around 1864.”

McDonald: “Yes, he made some major contributions. Who knew that larvae didn't just come out of nowhere to feast on people’s meat that was left on the counter. There are so many things we take for granted in this day and age that come from Louis Pasteur’s work around hygiene control and micro-organisms. There's a whole department in the hospital for infection control based on his work regarding the molecular basis of diseases. I also think that we all underappreciate the fact that we can go to the grocery store and have expiration dates on foods, and that many foods have been pasteurised.”

Medicom: “That brings me to antibiotics, which is the next step down this road we just referred to. Antibiotics were discovered by Alexander Fleming in 1928, shortly after World War I.”

McDonald: “His discovery of penicillin was absolutely foundational. Hundreds of antibiotics have been developed since and saved millions of lives. Of course, now we're approaching a big crisis with antibiotic resistance. This is something to be concerned about and it will require new innovations that we may be able to put on the list of heroes when we make another one in the future.”

Medicom: “Next, we have Ignaz Semmelweis, an obstetrician who figured out that if he washed his hands between births, he could reduce the number of fevers that the new mothers caught. And he was actually ostracised for this idea.”

McDonald: “I think part of his credit went back to Louis Pasteur and once this germ theory was discovered, it gave extra credence to his work too. It is mind-boggling to think that washing your hands wasn't something that we did every day between every single patient. I think this is a great example of an important thing we should all have in medicine. We shouldn’t ostracise a new idea, even if it sounds crazy. We should listen to it and see if the data can confirm this idea.”

Medicom: “The next person on the list, Harold Varmus, changed the way we implement our information and knowledge. He actually won the Nobel Prize for his breast cancer research, but he also started the Public Library of Science, addressing the public need for medical knowledge.”

McDonald: “I respect him deeply for starting and founding that movement because we're definitely moving towards an ‘open access only’ publishing system. I believe it was around the year 2000 that he started this library and I think that we're slowly but surely seeing the fruits of those efforts. Open access publishing is allowing patients, students, and citizens to read the original research. There are so many people doing amazing research all over the world. And if there's a way that they're able to connect and augment each other's efforts, then everybody wins.”

Medicom: “We're going on to number 8, James Lind.”

McDonald: “This guy was a naval officer and ship surgeon in the Royal Navy. In 1747, he had the hypothesis that scurvy is being caused by a lack of citrus fruits. He performed the first clinical trial that we know of. He gave some of the sailors a couple of oranges and a lime whereas some others didn’t get these fruits. He followed their outcomes with regard to scurvy and decided that his hypothesis was correct. He also did some work on improving the cleanliness of sailors; refreshing clothes and bedding below decks, air ventilation, and removing sulphur and arsenic from the workplace.”

Medicom: “Number 9 is someone who recently won the Nobel Prize for CRISPR gene editing, Jennifer Doudna.”

McDonald: “I was a medical student when this came out and I remember one of our professors going on and on about CRISPR gene editing and how this would revolutionise medicine and how we treat illnesses. Although I think the progress has been slower than we were predicting back in 2006, advances have been made, especially in the world of oncology and sickle cell anaemia. It also sped up a lot of other technologies, including vaccine development. CRISPR gene editing allows us to introduce healthy genes or mutations from a patient to discover their effects to the patient in a laboratory setting. I think that we're going to hear a lot more about that; it is entering the clinic now and it is changing the world.”

Medicom: “Next up is Mary Claire King. She's not a doctor or a clinician, but a mathematician. She proved that breast cancer could be a genetic disease."

Medicom:"But the reason why we’re listing her as a hero is that she really opened my eyes to the power of what you could do as a scientist to make the world a better place. She did humanitarian work performing pro bono sequencing of children 'lost' in the dictatorship of Argentina and placing them back with their families. There was bunch of grandmothers that met every week at a certain memorial in downtown Buenos Aires to despair together about the loss of their family members. Mary Claire collected blood samples of these people and matched 114 children with their families in the late eighties.”

Medicom: “Peter Ratcliffe, William Kaelin, and Greg Semenza won a Nobel Prize in 2019 for their work on hypoxia signalling. This work is essential to understand life itself and it has also driven a billion-dollar industry in oncology.”

McDonald: “I think this has implications for what I do every single day. When patients come in with sepsis, this work dictates care in these patients. If patients are showing cellular signs of hypoxemia, it will directly impact the care we provide. So, this work is foundational to what I do in the clinic.”

Medicom: “The next one on our list is Elizabeth Blackwell, who was the first female physician in the USA. She was soon joined by her younger sister, and together, the Blackwells founded the New York Infirmary for Indigent Women and Children, the first hospital staffed entirely by women.”

McDonald: “The story goes that she had a female friend who became ill and said she would've had better care from a female doctor. This really inspired her to go to medical school. This woman was well ahead of her time and now we celebrate February 3rd, her birthday, as Women's Physician Day. I think that we need to make sure that we continue to pay tribute to the revolutionary work that she did, while facing a lot of bias and criticism in her days.”

Medicom: “The last one I want to give a shout-out is Paul Farmer. He was a medical anthropologist and physician and was basically the godfather of global medicine. He did a huge amount of research and advocacy work for those who were sick and living in poverty around the globe.”

McDonald: “He has done so much work. With colleagues, he pioneered novel, community-based treatment strategies that demonstrate the delivery of high-quality healthcare in resource-poor settings. But I think especially his writing on health and human rights, and the social inequalities regarding the distribution of outcomes of infectious disease is amazing work. Here in the USA, we have significant disparities based on socioeconomic status as well. It's important that we continue to think about that. Bottom line, I think that he is a great choice for the final slot. He is absolutely inspirational and I hope his legacy lives on.”

 

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Posted on 19 July 202325 March 2024