Issue: 77

June: Reflections on the Fourth of July!
The long awaited warm summer season has finally kissed the beautiful white beaches of New Jersey!  God knows we have waited patiently for its arrival!  Families gather, my own included, and make lasting memories in the cool surf and sizzling sand.  Better than any medicine (Did I say that?  Please don't quote me! I'll deny it! JK!), we can finally relax and enjoy each other's company!

But hold on. Lest we become too complacent, there is a war on, not with our foreign adversaries, but with each other. We have become polarized and intolerant of each other's opinions.  We tend to become isolated by surrounding ourselves with like-minded people. As we approach our cherished Fourth, the crucible of Freedom, let us remember that we arrived here through bitter debate, unselfish compromise, and respect, if not agreement, for contrary viewpoints.

My youngest brother, a dedicated physician, and I have diametrically opposed political viewpoints and we had the opportunity to discuss them as we drove our celebrated 90 year old mother westward from her home outside Philadelphia to my brother's lovely home in Portsmouth, Ohio, several weeks ago.  We stopped in Gettysburg and paid our respects to the thousands of Americans who fought on that hallowed ground on July 1-3, 1863. We found the name of my great, great, grandfather, James Patrick McKenna, emblazoned in bronze on the base of the towering Pennsylvania monument. My brother was so moved, he cold not contain himself.  As we drove westward, he expressed his love for our country.  We disagreed on almost everything, but by the time we delivered our beloved mom to his Southern home, just north of the Kentucky border, I had a profound respect for his viewpoints, not that I agreed with most of them, but because they were coming from someone who worked everyday to make lives better.

My kid brother and I disagree on almost everything except the most important thing: make us better!  Find someone you disagree with, befriend him or her, and share a brew and a dog on the Fourth.  It's probably the best thing you can do to honor, celebrate, and advance our beloved United States!!!

John A. Schmidt, MD 
Poliovirus to the Rescue of Patients with Glioblastoma!!
As published in the June 26 online issue of the New England Journal of Medicine and discussed in the accompanying editorial, physician-scientists at Duke University Medical Center in Durham, NC, have devised a new and potentially breakthrough strategy for treating recurrent grade IV malignant glioma, the same brain tumor that tragically ended the life of Senator Edward Kennedy and is threatening the life of Senator John McCain.

The scientists injected a genetically engineered version of the poliovirus, the same virus that formerly caused child paralysis, and peaked in the US in 1952 with almost 52,000 reported cases and more than 3,000 deaths.  The iron lung machines collecting dust in the hallways of the Philadelphia General Hospital served as a stark reminder when I was a medical student at PENN.

As stated in UptoDate, "Immunization against poliovirus infection represents one of the world's great medical achievements.  The last cases of paralytic poliomyelitis in the United States occurred during a small outbreak in an unvaccinated religious community in 1978 and 1979.  All nations in the Western Hemisphere, Europe, Southeast Asia, and the Pacific Region are free of poliomyelitis. As of February 2018, poliovirus remains endemic in Nigeria, Pakistan, and Afghanistan" and it remains a major objective of the World Health Organization to eradicate polio worldwide by 2019, using the same population immunization methods that wiped out smallpox worldwide by 1979.   CDC recommends polio vaccination at each of the following ages: 2 months, four months, 6-18  months, and 4-6 years old.  Smallpox vaccination is no longer necessary because smallpox is extinct.

The virus used in the current polio vaccine was developed by Dr. Jonas Salk and involves inactivating ("killing") the virus with formaldehyde.   Dr. Maurice Hilleman of the Merck Research Laboratories played a key role in manufacturing the vaccine for widespread use.

You may recall there was a second polio vaccine developed by Dr. Albert Sabin.  Sabin emigrated to the United States from Russia at age 15, graduated from high school in Paterson, NJ, and received his undergraduate and medical degrees from NYU. He served in the US Army Medical Corps in WWII.  While working at the University of Cincinnati College of Medicine,  Sabin developed a vaccine that was still infectious but could not cause disease.  It is referred to as a "live, attenuated" vaccine.  The Sabin vaccine is still used in developing parts of the world because it is given orally and is ideal for mass immunizations to isolate outbreaks.  This was the vaccine I received as a child.  

The Sabin vaccine is no longer used in developed nations because it is known to rarely cause vaccine-associated paralysis.

While we no longer use the Sabin vaccine in the US, it taught us a valuable lesson: viruses can be modified to infect cells and engender a protective immune response without causing disease. This was essentially the approach used by the scientists at Duke. They re-engineered the poliovirus so that, once injected directly into the glioblastoma, it bound, entered and killed tumor cells without multiplying, spreading, and damaging normal cells. Moreover, infection of tumor cells is believed to induce an immune response allowing killer T cells ( cytotoxic T lymphocytes) to seek out and destroy glioblastoma cells that were never infected by the virus. The MRI images are dramatic showing decimated tumors!
No Longer a Backwater!
While once a scientific backwater, tumor immunology has matured to the point where lives are being prolonged if not saved.  As discussed in previous issues, CAR-T is a breakthrough technology, developed by Carl June and colleagues at the University of Pennsylvania School of Medicine, that uses the patient's own engineered T cells to kill tumor cells.  Moreover, monoclonal antibodies directed against PD-1 and PD-L1 are now coming into widespread use for the treatment of lung cancer and a variety of other difficult-to-treat cancers.  Harnessing the power of the immune system to kill tumors has given new meaning to the phrase, " Host Defense", and stands to revolutionize the field of oncology.
Now Hear This!
The office will be closed on Wednesday, July 4th.  Moreover, we will have reduced staffing July 2-5 to give my excellent colleagues a much deserved breather.  For emergencies, kindly contact me by text messaging or via our Patient Portal.

Valerie, Ms. Clark, Ms. Catong, Ms. Sentner, and I wish you a glorious Independence Day and restful summer!!
In This Issue
June: Reflections on the Fourth of July!
Poliovirus to the Rescue of Patients with Glioblastoma!!
No Longer a Backwater!
Now Hear This!
John A. Schmidt Jr., M.D.
Board Certified Internist
Dr. Schmidt is one of the leading internists in Monmouth County offering  Medical Home  services.  
He is an attending physician at Jersey Shore University Medical Center.
Dr. Schmidt is enrolled in the Maintenance of Certification Program of the American Board of Internal Medicine
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"May we think of freedom not as the right to do as we please, but as the opportunity to do what is right."

- Peter Marshall


John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
2006 Highway 71, Ste. 3, Spring Lake Heights, NJ 07762
Phone:  732-282-8166  
Fax:  732-280-0147 
Disclaimer: The articles in Healthy Living are for general information only and are not medical advice.
Discuss all medical concerns and treatment options with your physician.