Antibiotic Resistance and a National Action Plan

Guest post by Scott H. Podolsky, MD

podolskyAntibiotic resistance has been framed by Dame Sally Davies, the Chief Medical Officer for England, as “a ticking time bomb . . . arguably as important as climate change for the world.” Responding to the issue, on March 27th, President Obama’s Task Force for Combating Antibiotic-Resistant Bacteria released its National Action Plan. This is not the first time that reformers have called for a crusade to implement the rational use of antibiotics, or to keep up with antibiotic resistance. History shows that merely surfacing the issues around antibiotic resistance doesn’t ensure the will and funding necessary to enact a solution to the problem.

Antibiotics were the leading representatives of the post-World War II wonder drug revolution. They radically transformed medical practice, underpinning advancements ranging from chemotherapy to critical care medicine, but they simultaneously altered the expectations of patients with lesser (and indeed, unresponsive) conditions like head colds. And from the 1950s onward, leading infectious disease experts called for novel diagnostic resources to differentiate bacterial from viral infections, at the same time lamenting the seemingly irrational therapeutic exuberance of clinicians on the front lines. Already in 1954, the chief of the medical service at the Franklin Delano Roosevelt Veterans Administration Hospital in New York called for a “crusade for the rational use of antibiotics,” pointing to such concerns as allergic reactions, financial costs, bacterial or fungal superinfections, and the general diagnostic sloppiness that seemed to accompany widespread antibiotic administration. But by the 1960s and 1970s, as attention increasingly focused on antibiotic resistance genes that seemed to respect neither bacterial species nor nation-state boundaries, such antibiotic resistance came to serve as the focus of antibiotic reform efforts.

Calls to improve stewardship and link the local and global surveillance of resistant microbes increased from the 1970s onward, joining calls to curtail the use of antibiotics in agriculture, where they had been used to promote growth since the 1950s. For decades, though, advocates for antibiotic resistance failed to catalyze enduring reform, bumping up against faith in therapeutic progress, failed attempts to influence clinician prescribing patterns, and the lack of a centrally coordinated—let alone global—approach to the problem.

But by the 1980s and 1990s, more attention was being given to multidrug-resistant bacteria, and HIV/AIDS focused attention on emerging infections. In this context, scientists such as Stuart Levy and Joshua Lederberg began to agitate for a better coordinated and global response to antibiotic resistance. Such activities indeed proved catalytic, forcing antibiotic resistance onto the front pages of academic journals and popular media alike, eventually spreading terms like “superbugs” and “post-antibiotic era” throughout popular discourse. In ensuing decades, however, concerns have only increased in the setting of increasing globalization, a perceived reversal of pharmaceutical industry engagement with infectious diseases, and the enduring lack of a globally coordinated response to surveillance and use of antibiotics in clinical practice and agriculture.

The President’s National Action Plan appears at a critical time. It takes a broad approach, focused on efforts to improve surveillance, diagnostics, and stewardship, to rationalize the use of antibiotics in agriculture, to stimulate the development of novel antibiotics, and to improve global cooperation in confronting antibiotic resistance.  And it should be politically neutral. In 1968, Joshua Lederberg, who would come to play such a key role in moving antibiotic resistance onto the national radar, reported on (and named) the newly identified Marburg virus (ultimately found to be related to Ebola), stating of such global “evils” that they were “very unlikely to discriminate between Democrat or Communist or Maoist.” Antibiotic-resistant superbugs will hardly discriminate between Democrats and Republicans. Advancing the Action Plan from paper to a coordinated response commensurate with the scope of the problem will require financial, logistical, and political investments—and collaboration—beginning in the United States, at the same time that we attempt to engage antibiotic resistance on a global level.

Scott H. Podolsky is an internist at Massachusetts General Hospital, an associate professor of global health and social medicine at Harvard Medical School, and the director of the Center for the History of Medicine at the Francis A. Countway Library of Medicine. He is the author of The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics and Pneumonia Before Antibiotics: Therapeutic Evolution and Evaluation in Twentieth-Century America.

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Walking hand and hand with the men and women who served

By Kathryn R. Marguy, JHUP Staff

mcmanusOn May 8, 2015, the seventieth anniversary of VE Day, thousands gathered at Horse Guards Parade in London to commemorate the end of World War II in Europe. A stage in the likeness of an aircraft hangar played host to hours of 1940s-themed performances. The bells from hundreds of England’s churches rang out in celebration, and dignitaries placed ceremonial wreaths to pay homage to those lost in battle. In the midst of these festivities, the imminent release of John C. McManus’ book, Hell Before Their Very Eyes, becomes all the more poignant.

Like the relatable, vivid prose of Eli Wiesel and the masterful research of Studs Terkel, McManus’ work expertly captures the experiences of American soldiers as they liberated Nazi concentration camps in the spring of 1945. There, they uncovered unspeakable horrors that would shock the world. Many of the soldiers who stormed the gates of these sites were young men, and no amount of military training could prepare them for the ghastly visions that lay ahead.

Kat Photo 1

The chapel at Cambridge American Cemetery in England.

As an editorial assistant here at Johns Hopkins University Press, I’ve had the privilege of working on several first-rate history books, but McManus’ project holds particular resonance for me. In the summer of 2012, I studied World War II history at St. Edmund’s College at Cambridge. What struck me during my experience was the way the British people remembered the “Good War.” The gruesome hardships of the 1940s are woven into the tapestry of their everyday lives. The reminders are inescapable, from the perfectly preserved corridors of the Churchill War Rooms to The Eagle, a small pub in Cambridge where the walls and ceilings are covered with the names of RAF airmen who would stop in for a pint.

Kat Photo 2

Ceiling of the chapel at Cambridge American Cemetery.

The experience left me ashamed of my textbook knowledge about the war. Dates, names, and treaties I’d come to know through my studies suddenly felt stale when compared to the visceral connection most Europeans my age have. With the same familiarity my American classmates showed discussing Martin Luther King’s “I Have a Dream” speech or the Kennedy assassination, my British counterparts would discuss World War II. Many of my colleagues had a personal connection to someone involved in the war. I envied their closeness to this fascinating time in history. It wasn’t until I visited places like the Ely Cathedral’s war memorial, stroked the keys of an original Enigma machine, and walked the narrow halls of the H.M.S. Belfast that it became real. Americans liberated the concentration camps on April 4, 1945, but without a physical link to these events, it is very easy to become distanced from the realities of this war.

Reading Hell Before Their Very Eyes is like walking hand and hand with the men and women who served—every word another step forward, every chapter a vivid diorama of war torn fields. And once the last page has turned, you will feel as if you were there, another brother or sister in arms, fighting for the future.

Kathryn R. Marguy joined the JHU Press staff as an editorial assistant in 2014.




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Wendy Queen appointed as the new Project MUSE Director

By Elizabeth Brown, Project MUSE staff

Cheers were heard when this announcement appeared last week on MUSE Commons, the Project MUSE blog.  Congratulations or our friend and colleague, Wendy Queen!

Wendy photo We are very pleased to announce the appointment of Wendy J. Queen as the new Director of Project MUSE. A 15-year veteran of the Johns Hopkins University Press, Wendy served as Deputy Director of MUSE beginning in 2014, prior to which she held progressive responsibilities including Associate Director, Publishing Technologies.

Wendy’s many activities in the scholarly publishing community include involvement in the Association of American Publishers (AAP) and the Association of American University Presses (AAUP). She has served on the COUNTER Board for over ten years, and is also a member of the North American Steering Group of the Association of Learned and Professional Society Publishers (ALPSP). Wendy was appointed Interim Director of Project MUSE in March 2015, and in April led MUSE’s largest event of the year, the Annual Publisher Meeting, expanded this year to include a 20th Anniversary celebration.

“Throughout her time with MUSE, Wendy has led efforts to consolidate our technology strengths, to regularize the ongoing development of platform functionality, and to streamline MUSE production workflows,” said Kathleen Keane, director of the JHU Press. “I am delighted to have her deep knowledge of the platform and her extensive experience with the needs of our many constituencies, from libraries and publishers to scholars and readers, brought to the task of leading the organization.”

“I am thrilled to have the opportunity to lead MUSE and continue the amazing work being done by the MUSE staff,” said Wendy.

Wendy began her career with JHU Press and Project MUSE as a web developer in 2000, working on the platform as it expanded to include content from numerous not-for-profit presses and journals beyond JHUP.  Eventually, Queen led a 15-person staff of technology and production professionals, whose accomplishments included the development of a critically important XML workflow for the journals content, and the integration of book content from the University Press Content Consortium (UPCC) into the MUSE platform. Wendy also led all of JHUP’s web development efforts for ten years, including publication of three online reference works.

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Social Research at eighty

Guest post by Arien Mack

In 2014, Social Research entered its eightieth year of continuous publication, and this year I entered my forty-fifth year of editing the journal. One anniversary is public, the other is personal. Both seem remarkable.

Founded as the journal of the University in Exile, which in 1934 was accredited as the Graduate Faculty of Political and Social Science at the New School for Social Research, Social Research has been concerned with the relationship between theory and practice and, more simply, with the intersection between political and social issues and the academic enterprise. While the papers in each issue are largely written by people within the academy, the subjects explored have been chosen because of their relevance to our political and social lives—not because of their relevance to the arcane subjects that are often the focus of heated academic debate.

sor.82.1_frontLooking through the early issues of the journal, it is clear that while they were not thematic, as almost all issues have been since around 1975, their focus was on the economic and political questions that arose during the Second World War and the post-war period. Those early issues were mainly authored by the predominantly European founding members of the University in Exile and the early Graduate Faculty, many of whom had played some role in political affairs in Europe prior to the war and in the United States after coming here, such as Hans Speier, whose brief biography (like those of all the authors whose work is republished here) appears at the end of this issue. This explains, at least in part, why the journal was so deeply engaged with concerns outside the academy.

That focus began to shift in the 1950s. Fewer and fewer Social Research authors were members of the Graduate Faculty of the New School, and the center of gravity of the articles that appeared veered away from political problems of the moment and toward more sociological questions. Not surprisingly, that shift largely coincided with the retirement and death of the journal’s founders.

As an inexperienced editor, I was faced in 1970 with whether to keep up the profile Social Research had developed by then, as more or less a journal of sociology, or try a different path that might nevertheless maintain a connection with the journal’s roots. I chose the latter path, and within a few years had moved from issues that were primarily miscellanies of essays to ones that were entirely thematic and for which all the papers were invited. The themes varied widely, from “The Religious-Secular Divide,” “Courage,” “Boredom” and “Is Peace Possible?” to “Happiness,” “Shame,” “Hope and Despair,” “Punishment,” “International Justice” and “The Limits of Knowledge.”

In 1988 we initiated an ongoing series that addressed transitions to democracy around the world, beginning with several issues on East and Central Europe after the collapse of the Berlin Wall and continuing with issues on South Africa, China, Iran, India, and Egypt, to name just a few. This is another way in which Social Research has kept faith with its roots. We continue to seek out authors not only from Europe but other parts of the world as well in an effort to prevent too provincial a focus and to try to maintain the international strengths of the early issues.

Also in 1988, the first Social Research conference took place. Entitled “In Time of Plague: The History and Social Consequences of Lethal Epidemic Diseases,” it inaugurated in what became the Social Research Conference Series at the New School. The thirty-second conference in the series, “Fear of Art,” took place earlier this year. The papers from each conference are published as special issues of the journal. These public conferences have immensely increased the journal’s outreach because they usually attract large audiences, both in person and online, and have considerably amplified our mission to bring scholarship to bear on the urgent political and social issues of our time.

Even in these days in which small magazines and journals are suffering from the many changes in technology and the enormous proliferation of online publications, we believe we are looking forward to a robust future for Social Research, one that continues the mission of its founders by exploring the subjects and questions that emerge from the perplexing social and political issues of our times, which invariably have deep roots in the past that need to be remembered. We are, of course, grateful to our loyal readers and to the many authors who have written for the journal over these 80 years.

 Arien Mack, the Alfred J. and Monette C. Marrow Professor of Psychology at New School for Social Research, is the editor of Social Research.

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Know someone who needed surgery?

Gust post by Adam L. Kushner

I know someone who needed surgery. He was born by emergent C-section and had stomach surgery at 2 months and an appendectomy at 23.

He is alive today because of surgery. I am that person.

Throughout much of the world, the lack of surgical care leads to death or disability for millions of men, women, and children. Yet despite that reality, the global health community has not recognized the urgent need for surgical care. Surgery and anesthesia are integral to the treatment of traumatic injuries and obstructed labor. Many infectious complications need surgery. Surgery is often the best or only treatment for many cancers. But millions around the world lack access to such care.

kushnerIn 2013, I began teaching a course at the Johns Hopkins Bloomberg School of Public Health entitled “Surgical Care Needs in Low and Middle Income Countries.” The course covers surgical epidemiology, women’s and children’s health, and conflict and disasters. My new JHU Press book, Operation Health: Surgical Care in the Developing World, came out of that course. It covers care rarely discussed within global health: surgery and anesthesia. The chapters begin with a personal vignette; then, experts from around the globe present case studies, best practices, and topic overviews. Chapters tackle subjects such as C-sections in Ethiopia, clubfoot in Nepal, trauma in Tanzania, anesthesia in Ghana, and laparoscopy in Mongolia. The book, which is written for public health and medical students, is also accessible to the general reader.

I cannot say exactly what led me to train as a surgeon and practice in the developing world. What I do know is that to prepare to practice overseas, I also obtained a Master of Public Health  degree from Johns Hopkins in the middle of my surgical training. At that time—1998—there was almost no mention of surgery within public health. I remember knocking on dozens of doors, asking to join public health research projects that included surgical care. Time after time no one could help me.

I was not discouraged. I felt there must be a need for surgical care and finished my surgery training. For a decade, I practiced and taught in countries ranging from Iraq to Indonesia, Sierra Leone to South Sudan, and Niger to Nicaragua. My public health training had included much on what was needed to address conditions as HIV, tuberculosis, and malaria. The reality that I began to see was that surgical care was also needed. I treated women in obstructed labor; children with appendicitis and typhoid perforations; adults with fractures, hernias, and cancer. Many of these patients presented with late stage disease. I began to wonder how many patients were not seeking care, how many were dying in their villages and fields. How many were not as fortunate as I.

In 2008, along with local colleagues, we began documenting deficiencies in providing surgical care. A study in Sierra Leone showed no oxygen, limited sterile gloves and eye protection, and only 10 surgeons for a population of 6 million. We showed that Sierra Leone hospitals in 2008 were worse off than U.S. Civil War hospitals in 1864. Later, we conducted population-based surveys of surgical need in Sierra Leone, Rwanda, and Nepal. Estimates showed that up to 25% of the populations needed an operation, and that 33% might have died due to a lack of surgical care.

As the field of global surgery matures within global health, the question is not should we provide surgical care but how. Operation Health looks at this issue and provides some ways forward.

Adam L. Kushner is an associate in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health and a lecturer in the Department of Surgery at Columbia University. The founding director of Surgeons OverSeas, he has offered surgical care to patients in conflict, post-conflict, and disaster settings around the world.  His book, Operation Health: Surgical Care in the Developing World, was published this month by JHU Press.

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Happy birthday, Emily Jordan Folger

Guest post by Stephen H. Grant

Emily Jordan was born in Ironton, Ohio on May 15, 1858. Following her two older sisters to Vassar College, she emerged a bluestocking: a refined lady with intellectual, scholarly, and literary interests. Emily’s Vassar 1879 class of 36 students elected her class president for life. Although her undergraduate scrapbook attests to a few dates with nearby West Pointers, she met her husband to be in Brooklyn at a literary salon in the home of Charles Pratt, founder of the Pratt Institute. Henry Folger also graduated in 1879, from Amherst College, where he roomed with Charles Pratt Jr. Both Emily and Henry earned Phi Beta Kappa keys. Neither Emily’s nor Henry’s parents attended college.

Emily Jordan, 1879

Emily Jordan, 1879

Emily took one of the few jobs open to young women, teaching. She taught in the collegiate department at the Nassau Institute—Miss Hotchkiss’s school for young ladies—in Brooklyn. When she married Henry in 1885, she was obliged to give up her teaching job. For the next half century, Emily served as a full partner in one of the most prodigious literary feats of all time: assembling the largest collection of Shakespeare in the world.

Henry Folger corresponded with 600 booksellers, 150 in London alone. The underground vault of the Folger Shakespeare Library contains 258 linear feet of auction catalogs which arrived at Henry’s office, 26 Broadway in Manhattan, home of the Standard Oil Company where he worked for five decades. When he brought the catalogs home to Emily in their Bedford-Stuyvesant brownstone, her job was to identify the items she wanted in their collection. Henry put together a bid list, and paid for the winning lots from his oil fortune. Then Emily wrote up each item for the card catalog, developing writer’s cramp along the way.

A childless couple, the Folgers were singlemindedly devoted to the Bard. They received family only twice a year: Thanksgiving and January 1. Nieces remember that on these sparse occasions, their aunt expected them to recite poetry and rewarded them with a book with a five-dollar bill tucked inside. The Folgers attended no social events nor hosted any business dinners. When they went on vacation in Virginia, they lugged a special travel card catalog around with them. On their numerous voyages to England, they attended Shakespeare performances, went book hunting, and brought back poppy seeds from Stratford-upon-Avon.

Emily was a close adviser to her husband in the acquisition of eighty-two Shakespeare First Folios, the 1623 compilation of thirty-six plays, eighteen of which might have been lost to the world as they had not been printed. Emily had earned a masters degree at Vassar with a thesis on “The True Text of Shakespeare,” pointing to the 1623 publication as the most authoritative edition of the plays. Emily kept a fascinating play diary, where she wrote pages and pages of detail concerning the 125 Shakespeare plays she saw in her lifetime.

In 1919, the Folgers started buying up the fourteen redbrick rowhouses two blocks from the U.S. Capitol on land they had identified for a permanent repository for their Shakespeare collection. Each of the deeds noted Emily Jordan Folger as owner. She also held in her name bank vault and storage warehouse accounts where they stored books, manuscripts, playbills, prints, engravings, paintings, pieces of furniture, porcelain, armor, maps, charts, phonograph records, costumes, globes, musical instruments, and curios. Henry stayed beneath the radar.

In the late 1920s the Folgers continued their aggressive buying of Shakespeare items, but made the time to help design what would become the Folger Shakespeare Library with French-born architect, Paul Philippe Cret. They selected quotations to be etched in stone. They identified scenes from Shakespeare’s plays for relief sculptures on the library façade.

Emily Jordan Folger, 1931

Emily Jordan Folger, 1931

It was Emily’s Day on April 23, 1932, the 368th celebration of Shakespeare’s birthday, when, wearing a shoulder corsage of orchids, and lilies of the valley over her academic robe, she turned over the keys of the Folger Shakespeare Library to the chairman of the board of Amherst College, who was responsible for the administration of the Folger. Henry was not present. He had died suddenly two weeks after the cornerstone was laid. He had never seen one stone of his library. He had never seen all his books and Shakespeare treasures assembled together under one roof. Seamlessly, Emily took over the mantle to make the research library a reality. She died in 1936. The Folgers’ ashes are in urns behind a bronze plaque in the reading room. The Folger is a library, a theatre, and a mausoleum.

grant.collectingStephen H. Grant is the author of Collecting Shakespeare: The Story of Henry and Emily Folgerpublished by Johns Hopkins. He is a senior fellow at the Association for Diplomatic Studies and Training and the author of Peter Strickland: New London Shipmaster, Boston Merchant, First Consul to Senegal.


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Preview our Fall 2015 catalog

We’re excited about the books we’re publishing this fall, and we invite your to browse this online version of our brand new catalog. All titles available for pre-order. Enter code HDPD at checkout on our website to receive 30% discount, or call 800-537-5487 and mention the code when you order.
Fall 2015 very large Link to JHUP’s Fall 2015 Seasonal Catalog here. Follow JHU Press on Facebook and Twitter. We appreciate your interest in Johns Hopkins University Press!






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