WORCESTER MEDICINE
Game Changers Editorial Continued Tina Shiang, MD, writes an article on informatics and the future of radiology. She discusses artificial intelligence algorithms developed and cleared by the U.S. Food and Drug Administration for clinical use in interpreting radiological images, but offers the opinion that AI is unlikely to replace human radiologists any time soon. Dr. Shiang encourages other radiologists to learn about and explore the field of informatics and utilization of AI to augment a radiologist’s interpretations of images for the purpose of improving patient care. Charlotte Walmsley, a fourth-year medical student at University of Massachusetts T.S. Chan School of Medicine , gives us a student perspective on recent cancer advances after having worked at the Massachusetts General Hospital Cancer Center prior to starting medical school. She discusses the paradigm shift from the 20th-century surgery followed by chemotherapy to 21st-century treatments, which include targeted therapy and immunotherapy for cancer as well as more recently developed chimeric antigen receptor therapy, or CAR-T. She completes her article with encouraging data on the treatment of pediatric patients with leukemia and rare cancers exemplified by anaplastic thyroid cancer. In addition to these articles discussing game changers in medicine, our society curator, Dale Magee, MD, gives us a brief history of medical education in the United States with a discussion of the first women to earn medical degrees and 19th-century educational institutions intended to train female physicians. Federic Baker, MD, FAAFP, laments the missed opportunities and unfulfilled promises of electronic medical records software, citing poor software designs and workflows. He blames dysfunctional EMR programs as a factor in physician burnout and advocates for policymakers to hold EMR vendors and third-party payors accountable for EMR shortcomings. Peter Martin, Esq., in his column “Legal Consult” gives us an update on a recent Massachusetts Supreme Judicial Court decision regarding whether MassHealth is subject to a statute of limitations when it attempts to recoup overpayments for services rendered by a health care entity. Reassuringly, the answer is that there is a six-year limitation. We hope you enjoy and learn from the articles in this issue, and that you continue to read Worcester Medicine which focuses on a different theme each issue. Previous issues exploring topics affecting the medical community and the general public are available on our website: www. wdms.org/publications. + Peter Zacharia is an ophthalmologist in private practice in Worcester who has been on the editorial board of Worcester Medicine for several years.
The Remarkable Journey from Desiccated Scabs to Genomic Vaccines Anthony L. Esposito, MD George M. Abraham, MD
T
he practice of immunization against communicable
diseases is centuries old. Evidence exists that by 1000 BCE, Chinese practitioners were immunizing against smallpox by grinding up desiccated smallpox scabs and blowing the material through long, silver tubes into the noses of children. Immunization may also have been achieved in Asia by scratching material from a lesion of a patient with a mild case of smallpox into the skin of a susceptible person, a practice referred to as variolation. Not surprisingly, the use of such crude preparations resulted not only in protection against severe smallpox but also in the transmission of both mild and serious infections. Variolation was also practiced in Turkey and Africa before arriving in Europe and the Americas. Vaccine development in the west began in 1796 when Edward Jenner, a country physician, inoculated an eight-year-old boy with pus taken from a cowpox lesion on a milkmaid’s hand. A few weeks later, Jenner inoculated two sites on the boy’s arm with variolous material, either desiccated smallpox scabs or fluid from pustules. The boy remained well after that challenge as well as after a second. On the basis of 12 such experiments and other clinical cases, Jenner published a report, “Inquiry Into the Causes and Effects of the Variolae Vaccine,” in which he concluded, “the cowpox protects the human constitution from the infection of smallpox.” It was common knowledge milkmaids were unaffected by smallpox, a disease which killed 10 to 20% of the population in towns and cities. It is also of note that others in England and Europe had immunized subjects with material containing the cowpox virus. However, Jenner was the first to expose cowpox-vaccinated subjects to smallpox and to prove vaccination protected against the disease. Jenner’s investigations, and his efforts to disseminate what he learned, led to the eventual eradication of smallpox in 1979. It is not an understatement to say that Jenner’s work and the subsequent investigations it spawned have saved more lives than any other medical intervention in human history. Programs designed to vaccinate large populations against smallpox in the 1800s were met with criticisms and resistance based on religious, scientific and political grounds. Some of the objections were easy to understand. For example, the concept of scoring a child’s arm and exposing the open wound to infectious material from another human would have been daunting in any era. Other objections were anchored in religious beliefs
NOVEMBER / DECEMBER 2021
5
