With a decade gone, I can't help feeling a bit nostalgic. I completed my
training, got married, had a baby girl, adopted two cats and lived in three
states. I've lost loved ones, made a lot of new friends and said goodbye to
To all of that, cheers.
But while cleaning the ID desktop for 2010, it would be worthwhile to
point out a couple of things and leave some questions in the air:
- Universal healthcare — perhaps no other action will have
consequences so profound for the way medical care is rendered in this country.
Will it pass?
- The swine flu pandemic — as we were bracing for the H5N1 avian
influenza, a triple reassortant emerged to cause the first pandemic of the
millennium. And we saw an abundance of influenza activity during May and June.
What will happen next? What if the neuraminidase inhibitors become useless? It
took eight months to have a monovalent vaccine developed, tested and on the
shelves, but we are still 60,000,000 shy of the
160 million doses recommended to target the at-risk
groups. What can we learn from all of this?
- There's not a whole lot in the antimicrobial pipeline. We had a blast
with new antifungals, but we're still determining the optimal dosing for our
preemies. A fifth generation cephalosporin (ceftobiprole) and new
lypoglycopeptides (such as telavancin) are being studied to treat MRSA
infections, but it seems that it is going to be a while before we can use these
in children. We continue to debate how best to use vancomycin, while others
alert that "heteroresistant" populations may emerge during therapy and cause
- On the vaccine horizon…
- When will we move to version 3.0 of pneumococcal vaccines?
Invasive pneumococcal disease remains at historical low rates, but some
serotypes like 19A are surfacing as
- In 2010 will we have a trivalent or a quadrivalent flu vaccine?
More importantly, are we ready for
tissue-culture based vaccine manufacturing? Any
promise with influenza vaccines against conserved epitopes?
- Another year without a respiratory syncytial virus vaccine, and
American Academy of Pediatric’s Committee on Infectious
Diseases has recently trimmed both the number of doses and the target
population for palivizumab on a cost-benefit basis. Will
motabizumab, which is 40 times more potent against RSV
than palivizumab in vitro, translate into clinical benefits and reduce the
burden of RSV among high-risk patients?
- Looks like we continue to move forward with vaccines for malaria
and HIV, but how far we are from immunizing to prevent these voracious
- Interferon-gamma assays (cool and trendy) will soon replace the
tuberculin skin test (uncool and old-fashioned).
- Water in airplanes will be safer for passengers and the crew. After
15% of 327 tested airplanes had water with more coliforms than you should be
comfortable fighting, the Environmental Protection Agency has passed
new standards. Now, the five-billion dollar cost
implies that you either won't get the peanuts, or that you will have to spend a
quarter to use the restroom. Shame on all of you who drink airplane tap water!
- We have a new 2009 Red Book with a new font size! I hope the 2012
edition will not be printed in Garamond 8. What are we waiting for? Bible paper
pages and bibliographic references?
iDoc is envisioned to facilitate our job as
physicians. Wait… 2039 is still far away.
- No better place to advertise this great subspecialty than on the TV!
I suggest the following topics for Mike Rowe, the host from Dirty Jobs:
- Fecal transplantation for recurrent C.
New tampons with glycerol monolaurate that inhibit
staphlyococcal toxin synthesis.
- And the award-winner, "Recovery of Campylobacter
jejuni in feces and semen of caged broiler breeder roosters following three
routes of inoculation.”
Happy New Year and best of luck in 2010!
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