This month’s notable figure in public health does not stand alone in his crowning achievement- the discovery of HIV as the cause of AIDS. As a result, the other members that contributed to the discovery of the link between HIV and AIDS will also be given a nod.
Luc Montagnier was born in France in 1932 where he grew up amidst World War II and the German occupation of the country of France. He was inspired to pursue virology after learning of the discovery of the Tobacco Mosaic Virus and the subsequent research conducted on the virus. His early research in virology involved hand foot and mouth disease, which proved that viral double-stranded RNA can replicate in a similar fashion to DNA. His research then turned to oncogenic viruses, or viruses that cause cancers. He discovered that the genetic material contained within the virus is enough to have a cancerous effect. His research specifically focused on oncogenic viruses that contained RNA instead of DNA. These viruses became known as retroviruses. Dr. Montagnier’s lab began searching for retroviruses in human cancer patients.
In 1982, Dr. Montagnier became involved in HIV research in France due to the growing suspicion that the disease may be caused by a virus. Multiple virologists around the world were working to determine the composition of the HIV infectious agent. In early 1983, his lab discovered Lymphadenopathy Associated Virus (LAV), named for the virus isolated from patients displaying swollen lymph nodes in early stages of AIDS. The growth of the lymph cells in cultures utilized the technique discovered and developed by Dr. Robert Gallo. His lab’s discovery allowed researchers to grow T-cells and study the viruses that affect them, thus making LAV research possible. Dr. Montagnier, aided by the assistance of Françoise Barré-Sinoussi and Jean-Claude Chermann who both had previous research and experience with retroviruses, grew and examined LAV cells in cultures. These gentlemen recorded the RT activity in the culture and conducted valuable research in the growth and development of the samples of the new virus. In September 1983, in the midst of the AIDS outbreak, Dr.Montagnier made a presentation of his team’s scientific findings and data that linked the newly determined LAV to the disease in a causal manner. LAV would later become known at HIV. At the time this announcement was controversial because the viral data collected by Dr.Montagnier classified the virus in a different family from HTLV, the only known retrovirus of the time. However, closely followed research performed by Dr. Gallo and Dr.Jay Levy confirmed and extended the findings that the HIV virus was not part of the HTLV family. The 2008 Nobel Prize in Physiology or Medicine was awarded to Dr. Montagnier and Dr.Barré-Sinoussi for the discovery of HIV and their pioneering work in the field of virology. (There has been a controversial debate surrounding the members of the award as Dr.Gallo was notably absent from the recognition despite the use of his techniques and previous research in the discovery and testing of HIV)
Today, thanks to the research of Dr. Montagnier and other scientists, we now know that HIV stands for human immunodeficiency virus. The virus’s transmission to humans is linked to a type of chimpanzee in Central Africa. This transmission from animals established a new disease among the human population and eventually began a worldwide outbreak of HIV. The HIV virus attacks a component of the immune system, called T cells. Since it affects the immune system’s function, people with HIV are more likely to get infections and as the disease progresses, uncommon opportunistic infections and cancers can result from the body’s inability to adequately protect itself. AIDS is the most severe stage of HIV. At this level, the number of T cells is below 200 cells per cubic millimeter of blood (normal is 500 to 1,600). Unfortunately, there is no cure for HIV or for AIDS, but there is treatment available to prolong life and slow the progression of HIV. Without treatment, people with AIDS typically survive about 3 years, but people who are treated with antiretroviral therapy (ART) while in the HIV stages of the disease can live almost as long as their healthy counterparts.
For any readers interested in the complex (and slightly messy) discovery of HIV, a great dramatization of the events is displayed in the movies “And the Band Played On.“
This month’s “Notable Figure in Public Health” is Dr.Virginia Apgar. She played an important role in the development of a medical evaluation for newborns, called the “Apgar Score,” and she contributed to the development of an NGO organization that promotes awareness and funding for research.
The life and career of Dr.Apgar includes momentous accomplishments that have contributed to the direction of the medical field more than 50 years later. Her career began as a medical student at College of Physicians and Surgeons at Columbia University during the onset of the Great Depression. Despite the economic and social challenges of the time, she continued to thrive in her education and even graduated 4th in her class in medical school in 1933. She wanted to pursue surgery, a field completely dominated by men at the time. At the encouragement of Dr.Whipple, upon seeing her drive and skill, she was encouraged to pursue anesthesiology after the completion of her surgical residency. At that time, anesthesiology was not a recognized specialty and the field was still under continuous growth and development. She eventually trained with the first anesthesiology department in the country, located at the University of Wisconsin-Madison. She returned to Columbia University College of Physicians and Surgeons as an anesthesiologist in 1938, and when the field became a recognized specialty, she was appointed as the first full time female professor at the school.
During her time as a professor, her main focus was on obstetrical anesthesia. This is the study of the affects that anesthesia given to mothers during labor has on the newborn baby. During her study in this field, Dr.Apgar developed the Apgar Score. Changing the Face of Medicine states that the Apgar Score was “the first standardized method for evaluating a newborn’s transition to life outside the womb.” The Apgar Score scoring system evaluates newborns on their heart rate, respiration, movement, irritability, and color one minute after birth and again at five minutes after birth. The Apgar scor is represented by the APGAR acronym that represents Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration. This scoring method is now an established standard of evaluation for newborns around the world. The scoring method reduced infant mortality and laid the foundations of neonatology. Furthermore, Dr.Apgar and her partners were able to establish a correlation between a newborn’s Apgar Score and the mother’s delivery conditions.
In 1958, obtained her Master of Public Health degree from Johns Hopkins. Following this, she became involved in the March of Dimes organization for 15 years. In fact, the website states, “she became a pivotal figure in redirecting the March of Dimes mission in the 1960s from polio to birth defects and other infant health problems such as premature birth.” She acted as the head of the Division of Congenital Malformations. During her time with the organization, she promoted rubella immunization through the organization after a German Measles outbreak in the mid 1960s. She also worked tirelessly to reduce the stigma surrounding birth defects. She even co-authored a book with Joan Beck titled Is My Baby All Right? addressing birth defects.
This month, for the third edition of “Famous Names in Public Health!” This month I will focus on the medical side of healthcare by recognizing a figure who contributed significantly to the treatment of cardiac conditions. I have been reading “The Heart Healers” by Dr. James Forrester and have loved his story telling manner when describing the history of cardiac surgery, so I decided to choose a notable figure outlined in the story as the focus for this month’s segment. This man is Dr. C. Walton Lillehei, the father of open heart surgery.
In the years leading up to modern open heart surgery techniques, the field underwent many changes. Methods that were used in the 1950s are almost unfathomable by todays standards and ethics. However, it was in this time period that truly innovative (and dangerous) techniques were a long standing component in the quest for successful open heart surgery. Dr.Lillehei primarily focused on the yet-unsolved challenges to treating what were known as “blue babies,” or infants and children born with congenital heart defects that could not be repaired through medical treatment or closed heart surgery. These children often suffered symptoms of their disease without relief and were given the equivalent of a death sentence. While doctors could diagnose the conditions, they could do little to prevent the progression of the disease as structural problems in the heart failed to keep up with the demands of the patient’s growing body. Essentially, many of these children died due to an inability to efficiently pump blood to vital organs.
Dr.Lillehei was a pioneer in the development of heart-lung bypass systems and open heart surgery. In 1954, Dr. Lillehei performed the first successful open heat surgery using cross circulation with the father of the patient as the source of oxygenated blood. This method was used throughout numerous surgeries and put the “donor” at great risk of harm or injury, so the method was quickly abandoned as other forms of blood oxygenation developed. Dr.Lillehei was involved in the progression of open heart surgery methods moving forward. He helped implement the bubble oxygenator, hypothermia techniques, cardiac pacemakers and prosthetic heart valves. While some of these techniques are no longer used and the surgical devices he used have since undergone many changes to increase effectiveness, safety, and efficiency, Dr.Lillehei’s early involvement in cardiac care altered the trajectory of cardiac surgery, launching us into the future of medicine.
His career impacted many patients, medical staff, and physicians alike as he was active in academic and hospital administration positions throughout his career. After working as a surgeon at University of Minnesota Medical School , he served as the chairman of the department of surgery at Cornell University Medical Center and surgeon in chief at New York Hospital. He later returned to the University of Minnesota Medical Center and additionally served as chairman of the American College of Cardiology. The American Heart Association notes Dr.Lillehei’s lasting impact by stating, ” First- and second-generation Lillehei trainees have developed important techniques in transplantation, perfusion, coronary artery bypass, prosthetic valves, and congenital heart surgery.” This recognizes the lasting impact he had on cardiac surgery far beyond his own individual practice, research, and years of surgery.
Welcome to the second edition of “Famous Names in Public Health!” In this segment, I will give recognition to individuals who have made significant contributions to the fields of public health and medicine.
While Ygritte from “Game of Thrones” may disagree, it turns out that John Snow did know something. In fact, a man with the same moniker is credited as the father of epidemiology. Epidemiology is the study of the distribution and determinants health outcomes and diseases in a population.
John Snow lived in London in the 1850s, at a time when modern health practices didn’t exist. It was widely believed that diseases and illness had some divine component and could be a kind of Godly punishment. People did not wash themselves or their hands daily, and they certainly didn’t know much about how infections spread. Sewage and waste were dumped in the streets, and water sources were easily contaminated. Fecal-Oral transmission was not a term or a recognized cause of disease in those days. In fact, Germ Theory was still gaining momentum and acceptance among scientists at this time. Microorganisms were seen as a secondary result of infection, not the cause. Dr. Snow’s actions helped cement this theory and forever change the management of disease outbreaks for centuries to come.
It all started when an outbreak of cholera (which is briefly described here) in London in 1854. The outbreak began in Soho and caused a staggering 550 deaths in just 2 weeks. Due to this, Dr.Snow went door-to-door to track the progression of the disease, and he color coded a map of the city outlining the affected and unaffected residents. Through his work, he was able to analyze the information for patterns, and he discovered that everyone in the afflicted area used the same water pump, the Broad Street water pump. After presenting his findings, the handle to the pump was removed , and the amount of cholera cases in the community decreased dramatically.
Although it took a significant amount of time for the spread of cholera to be linked to contaminated water, despite the evidence found in Dr.Snow’s research, his methodical and systematic pursuit of knowledge and information, as well as his analysis that ruled out other possible contributing factors of disease set the foundation of epidemiological research in the future.
Dr. Snow is also noted to have contributed to the study of the new field of anesthesiology and to have linked cholera disease to water-borne conditions.
Welcome to the first edition of “Famous Names in Public Health!” In this segment, I will do my best to give credit and recognition to the scientists, activists, philanthropists, epidemiologists, and advocates who have made significant contributions to the field of public health. These individuals have changed the course of human health and have helped construct the world we live in and know of today.
To kick off our exploriation of the most influential contributors to the field, we are starting with Rita Colwell!
Rita Colwell holds a doctorate degree in oceanography from University of Washington as well as 55 honorary degrees and numerous other awards due to her research of infectious diseases from water sources and their impacts on global health. Dr.Colwell has been contributing to the field of microbiology and aquatic diseases for more than 40 years. She has contributed to more than 750 scientific papers and 17 books during her career, and she produced the film “Invisible Seas” (source). She has acted as the director of the National Science Foundation, president of CosmosID, Inc., held many advisory positions in the U.S. government, and has acted as an advisor, chairman or contributing member to many other organizations over the years.
Her research has been instrumental in predicting outbreaks and disease patterns by using the environment. This is particularly true of cholera, a disease that she centered her research efforts on for many years. Dr.Colwell has been instrumental in connecting temperature changes in water to outbreaks of cholera and her subsequent research has led to cost effective ways to filter water in order to reduce the spread of the disease. In fact, she determined that using sari and nylon filtration methods in areas of the world where people cannot reliably boil their water before drinking can reduce the incidence of the disease by approximately 39 percent!
Although she has already established herself as a groundbreaking professional in the field of environmental health and has led to monumental advancements in our understanding of water borne diseases and cholera, Dr.Colwell continues to add to the scientific community. One of her more recent endeavors is acting as the founding of GeoHealth, a scientific journal created by the American Geophysical Union . This journal will focus on research, reviews, and commentaries on the growing field of environmental sciences and its relation to human and environmental health. This venture continues to promote the growth and advancement of enviromental sciences and gives other scientists the opportunity to contribute to the foundation that Dr.Colwell’s earlier works laid for this community.