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310 Can J Infect Dis Vol 14 No 6 November/December 2003

Witnesses

Lindsay Nicolle MD FRCP, Editor-in-Chief

Health Sciences Centre, Department of Internal Medicine, Winnipeg, ManitobaCorrespondence: Dr LE Nicolle, Health Sciences Centre, Department of Internal Medicine, GG443 – 820 Sherbrook Street, Winnipeg,

Manitoba R3A 1R9. Telephone 204-787-7029, fax 204-787-4826, e-mail [email protected]

In this issue, Dr Morris Goldner summarizes a series of struc-tured interviews with three colleagues in infectious diseases

and microbiology. The three individuals span about 70 years ofprofessional activity in the field, and come from backgroundsthat encompass basic laboratory research, clinical microbiologyand infectious diseases practice. The interviewees areEuropean – two from England and one from France. While mostof us in Canada look to the United States as our larger NorthAmerican community, the European experience in microbiol-ogy antedated any activity in North America and, over the lastseveral decades, has generally paralleled the experience here.

The three scientists initiated their professional careers atthree distinctly different moments in the development of theclinical and laboratory sciences of infectious diseases andmicrobiology. Professor Lacey describes the experience ofmanaging patients with infectious diseases before the avail-ability of antimicrobial agents – nothing could be done andavailable treatments such as serum therapy were themselvesdangerous and contributed to morbidity and mortality. Hewas also active through the exciting time when new agentsof unheard of efficacy for treatment of infections were firstdiscovered and applied in clinical practice. Common, previ-ously untreatable infections could be treated. There wereheady expectations of “conquering” infectious diseases.

Professor Dublanchet began his career at a point of highoptimism, when there was a belief that human history wouldbe fundamentally altered through the development ofantimicrobial agents effective for most infections. In the halcyondays of the early 1960s, before the inevitable progression ofantimicrobial resistance was fully appreciated, it was assumedthat infectious diseases would soon be a footnote in medicine.This was not, in retrospect, a good thing for academic infec-tious disease specialists. Schools of medicine questioned theneed for infectious disease expertise, as this field was pre-sumed to be a disappearing clinical problem. Dr Petersdorf, inSeattle, famously claimed we were arriving at the point whereall there would be for infectious disease physicians to dowould be to swab each other’s throats (1). ProfessorDublanchet saw the evolution from high optimism to today’smore realistic appreciation of the interdependence of microor-ganisms and humans, including the inevitable emergence ofmicroorganisms not just resistant to available therapy, but alsonew organisms not previously recognized as human pathogens.The adaptive genius of microorganisms together with technolog-ical achievements in health care practice have ensured a sus-

tained, even expanding, need for expertise in infectious diseasesand microbiology.

Professor Pallen, who has initiated a scientific career relativelyrecently, begins from a perspective of resistance as an immediateand future concern, and with an appreciation of the impact ofstructural issues in science and health care. These realities limitthe translation of scientific advances in infectious diseases topractical applications for control and management. Science isahead of our sociopolitical capabilities. But as someone whotrained in the recent exciting environment of the geneticrevolution, he still enthusiastically embraces a future whereimportant residual issues will be addressed through furthertechnological advances.

We are all, of course, witnesses to the development andprogression of infectious diseases and medical microbiologythroughout our own careers. Early in our career the view tendsto be forward, and as we become more senior we tend to lookbackward. All of us have a unique start point – for me, it wasthe late 1970s, as infectious diseases as a clinical subspecialty,only introduced into Canada within the previous 10 years,coalesced through standardization of training programs anddevelopment of the professional society.

The challenge of infectious diseases and microbiology is not astruggle, but an exploration. On reading Dr Goldner’s interviewsand considering our personal experiences, the evolution in infec-tious diseases and microbiology through the latter half of thetwentieth century is astonishing. Previously unthought of thera-peutic advances and treatment success are now the acceptednorm. Optimistic predictions of the demise of infections and pes-simistic predictions for the future of our specialty have bothrepeatedly proved false. Today, none of us want for work! Clinicalactivity in infectious diseases continues to expand – HIV, severeacute respiratory syndrome, West Nile encephalitis, Nipah virus,hantavirus, and extended-spectrum beta-lactamase producingorganisms only begin to describe the recent past. New infec-tions and new technology applied to diagnostic methodsexpand both our needs for and capabilities in microbiology.The interviews not only entertain us with personal observa-tions from these colleagues, but also provide a background tothe larger canvas of success, failure, and, above all, change, ininfectious diseases and microbiology.

©2003 Pulsus Group Inc. All rights reserved

EDITORIAL

REFERENCE

1. Petersdorf RG. The doctor’s dilemma. N Engl J Med 1978;299:628-34.

Nicolle.qxd 28/11/2003 3:36 PM Page 310

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