Raising the Consciousness for Identifying and Controlling Viral STDs

PREPARATION TO receive such an honor as the Thomas Parran Award is an interesting process. Initially, there is excitement and nervousness; eventually these feelings are replaced by the fear of deciding what to say. Such an event requires a real speech, not a slide presentation. Moreover it is an award based on "lifetime achievement" and named after a person of history. One's self- perception is not to feel that you have much history - let alone be told you've been around a field long enough to be called historical. However, the "lifetime achievement" designation does serve a purpose…to look back and reflect on what you have been doing for the last 20 years. Self-reflection is not an activity that our society of researchers rewards very often. After all, we are given public monies to push the envelope of knowledge forward, to seek out new problems, new issues, new technologies. We are rewarded for the new, not the old. Each box of slides is to depict something different. Each invitation to lecture demands something innovative. "Take few prisoners, walk forward. Okay, you can list leeward or starboard a little, but don't bore us with the old stuff." I promise not to bore you tonight-certainly King Holmes, in his introduction, has warmed up the crowd! But the call from Julie Schachter informing me of the committee's decision regarding the Parran award has brought with it all sorts of reflections. First was a perhaps prescient connection, one that my mother-in-law made when she first heard of the Parran Award years ago. Thomas Parran's brother was the obstetrician in Washington, DC, who delivered my wife Amy. Now, this could be taken several ways. My interpretation is that this portended Amy's role as "The shadow on my land" - portending her role in the furtherance of my career, initially, as the person who would sit at the dining room table (we never had a house with a study until much later) and work with me in constructing the line listings on the patients enrolled in my early studies of Reye's syndrome and genital herpes.1–6 Amy's handwriting, unlike mine, was legible. This allowed some semblance of consistency in results as one poured through each recitation of the listings. This "keeping the data honest" was a function later taken over by computers and most importantly by Drs. Jackie Benedetti and Judith Zeh who are the doctoral level statisticians to our viral disease research projects in Seattle and whose vigilance and intelligence have been a cornerstone of our work. The reflections from the call also brought a flood of memories on which I will digress because they include so many people involved in this society. Yes … it took a whole village to raise this investigator. How Did It Start How did I even get to this place? Well, it started with a friendship for over 25 years now with Walt and Peggy Stamm. Walt and I met as Epidemic Intelligence Service (EIS) officers at the Centers for Disease Control and Prevention (CDC) where we investigated an outbreak of hepatitis in a hemodialysis unit in Valhalla, NY. My first New England Journal of Medicine paper described this work.7 It was Walt who told me to look at the infectious disease program in Seattle, and it was Marvin Turck who recruited me to Seattle when I attended my first Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) meeting in Chicago in 1974.8 This led to my first momentous meeting with King Holmes, my postdoctoral mentor at the University of Washington. It was for me a moment indelibly inscribed in my memory bank. King's reputation as a hard-driving raconteur preceded him. I myself was nervous and excited as all new fellows are in embarking on their future lifelong career. I did not really question the wisdom or choice of my elders in assigning me to King; I was assured that "mother university" would take care of me during these 2 to 3 years of training. I popped my head into his office on July 1, 1975 - said"Hello, I'm Larry Corey." I was pleased he at least recognized the name and he said"Let's have lunch." His office had a spectacular view of Mt. Rainier. Later I learned that it was of enormous utility to King because it gave his advisees something to look at as they sat next to him while he trashed every other sentence that they wrote, every paper they wrote. For many years, he diligently rewrote all my carefully crafted sentences; sentences that he called "old world dribble." Of course my fellows believe that I do the same thing that King did to me, but without the view!!! Anyway, there was small talk as we rode down the elevator. We entered the typical hospital lunch line. As I pushed the plastic tray through the line, King asked his first question,"What were my interests." I answered, "Viral diseases." He looked back at me quizzically.(I imagined he was thinking, "Where did Marvin Turck get this guy?") I plowed forward with "There aren't many internal medicine virologists so I thought that would be a good career niche." King looked at me, paused, and said-laconically, I might add-"Sex is my career niche." I paled…the memory is still indelible. Kosher home, grandfather's a rabbi in the old country…studious…basically a nerd, moved to a city without corned beef, barely a bagel in sight, and then going to work on sexually transmitted diseases (STDs). My mother was telling people I was going to be a cardiologist. What am I doing here!! But what I was doing was learning the tools of one of the world's best trades, academic infectious diseases, from one of the world's best craftsmen and teachers. As a mentor, King was unparalleled. He led by example, had unending energy and patience. He opened doors, watched me walk and then run through them. He was first teacher, then colleague, and now a most dear friend. The training atmosphere in Seattle was unparalleled. My fellowship colleagues were Gary Schoolnik, Walt Stamm, Joel Meyers, Bob Jones, Bill Bowie, Luci Tomkins, and Henry Rosen. The faculty included Bill Kirby, Bob Petersdorf, Paul Beeson, John Sherris, Seymour Klebanoff, Harry Beaty, George Ray, and Russ Alexander. All were there to teach and help. I learned (1) that to cooperate meant quicker progress;(2) not to be afraid to solve problems quickly, you'll have more ideas than energy; and (3) when asked to participate in a program, say yes. "I'm happy to help you do this project," and "Yes, I think we can do this study." There was enthusiasm and a feeling that the opportunities were large. Establish a cohort, study a disease, and success would follow. Collaborate - learn to write and follow-up on your patients. In an understated manner King said at that first lunch, "There's this viral disease called genital herpes that no one knows much about, let's study it." Harry Adams had started to study genital herpes the year before I arrived.9 King introduced me to a physician's assistant named Michael Remington who taught me about clinical STDs and introduced me to the clinic and disease that has occupied much of my career. We started together in 1975 and have been together since. Mike has seen more genital herpes simplex virus (HSV) than anyone on this planet, and I learned then and now to listen to him. Parenthetically we have named our new disease management clinic devoted to herpes "the Remington as I will were also with other one in is not very to this His name is Paul and he was of the of Medicine at the University of and my for over years until he in It was Paul who taught me to be a and who the of the the University of of We a a clinical that not a but also a clinical and This research and would of to the would new quicker than ideas were and this has been perhaps the most in the Seattle viral disease success However, other were also were colleagues and the and herpes virus to Seattle for their career Bob and the problems and on from to run the King and a and dear friend. who at to the of and as a faculty and a the field of genital and herpes included at the of at of and at at University of in Larry in and in and now we we also There was to the the early the field was a were and new were My field of genital herpes led the It was the viral - hepatitis was by who did not to their was an - it was for and virus was not in the and virus and were a However, genital herpes was a and were I myself into the of this it was not were and we could to with were with genital barely or a of herpes simplex virus 2 was to the University of genital herpes had replaced as the The fellows in the Seattle program who were - - and patients with by and then My first faculty office was at the and we a of of one a my colleague, a paper this year on we so many It is because who first of in the As it of and to herpes were not in in the early In years later they are still not in - an to which we There were no or My first talk at genital herpes had me a slide for of genital as one could the virus I a study of this and a of with of this to genital It New England Journal of Medicine but it did to my reputation in Seattle as a that when it on I to my patients after this perhaps out of I started on an for a or an for genital with the and the and we the now called the of University also in this We a called the which is now in of and has a of over who is in the was the for the and had the of to take such as and it into The has been the for the on and that their now The The real in my career in the early and postdoctoral I think to me has heard my is to be than or has seen the small on the of my office that at first you not to look Well, I was - for the was into my The were in the we had the 3 years learning to study a for genital to the virus from and and the to a brought with and from the and the studies of for genital herpes was a and we led I think the led to as the first in infectious would have that this would be perhaps the we have to an infectious of the studies in this was one for genital a study and I at the University of The was a in which patients with genital herpes were for of or It very to us that something very momentous was to of the patients. when you have a the does not This study the course for the of the we what the could it to do more for and for moved The of an on a in people was to most and There were of from several than I was at and about the of our studies of about future or What moved these studies forward but was and postdoctoral John and John Each brought their and work to these early studies of the of genital and I think that we a in the field of genital herpes in a very years it was over - as an of for first and of for of and the were led by and and took the studies made it on to the There a or perhaps even a my run do I do excitement to have But the was because In Bob to Seattle as a postdoctoral to work on The syndrome of was by and in Seattle, and it that we to a program in after was Bob to at to learn to until my in with at was a It is still one as we in our on the of to an I the University of one of the My colleagues me with the of the clinical program in history. It from to over academic The years and were for me As of the there was to the other and to the researchers and my early years with the of with genital herpes in this The of an role in clinical and are and of It is an of that one I have to write about, but not and I to talk about the of research into the clinical care and public while we as researchers have our and our of the of from public monies to research is to these research into an public I will this as you might from the of this the for and the of clinical research in genital herpes to public for genital herpes has for me, a and process. The I will be is that of research into and more importantly public is not and that we as researchers to more and in this look at our work over the last 20 years and what it has for the public I can our a we have the public monies given to us We have the the and clinical for genital the history of genital of and a the role had on first and the of the of the in the history of genital and in the and the of in the the first for and the first studies of for clinical the that has the for to and and for from has led the to the of based and has the of that most do not with genital herpes but with what has been these are a for in these are the most of genital the history of studies that is to more than by can be on genital on of for and this genital herpes more to a than it that the of and of are the also a of than data that the of is about the same as about or of the be the has for the role as a in disease and an I in the In a study with that has been by people in the public we that most are really and that the of have We that with a with a most can be taught to clinical I will to this In studies led by we have in the last 3 years to the that it is that is the for and our studies that all or with We and have that for all the or the of for that can in be a for study to this is about to Such a study is to the of this but it is to that the that in will not into some clinical and at that can a viral disease in for an genital herpes has been to However, and of our have recognized that the to are that the of the the of disease in and that of such in genital is with viral from data the for to The is to the viral to which these are for all these research the data that we have for the public in the New England Journal of Medicine by the on the in in the has that of this work has been into even a public I would to this and perhaps that we in the and a about viral and I will that we this we will our public and our The and to for viral STDs with is a and one that will us into what I will call the for I and my wife but my is that we more and for to the of viral we look at to new for viral than as to we do we and more the of our will be In I feel that we do not forward we will as a research field and as a society I am not a Thomas in his on the the The of a career in public is that an has a to his whole to the learning and doing of his The be by the much that the of the is to every with or other to a of and The same thing is of and The for it is which who are good to with into some of the are the is one from our early were and what from us are our tools in not our as in the next from as the of the is I look the question of as … no a question of or no that has and now it is a question of or the of the for the It is no a question for the but one for the public The in the and and other viral are The is The of public is to or of an and while the tools to do so be to not even to a program with tools is public As in 1, the clinical and the of viral and STDs are viral and STDs are from an In the can be - so in viral which are and a for of with are in and viral and are for an is that most for STDs are and viral STDs are In other viral STDs are to STDs in the Thomas Parran as so by at this viral and STDs the of and and 2 the at for of are to the also have for the by or is more they in the the and of viral and STDs in 1, I of no program public that the of 2 for the of genital My is that the paper and the to a program to to a new for these for Control of could what is to an There in my to this (1) the tools to do and there the will or to do the tools to a program for in the is yes. have been in for a of these has in the last such as viral or and are going to more than a they are in to a the of a is about this is to the of an by How about 2 of the there the will or to this In my is the digress a and the and with or In other let's look at the and public to genital herpes and our of is After all, not let The for are and in (1) are and with and a can be to have clinical data that told they have genital patients their and the of during of In a the event was by as about were (3) as in our study by many of the with genital herpes with get as or other or and are given study on this was before were I the in 3 in even for we believe and some public it to me the of the that for genital and are and of a As what a program for is the and of that for for in The I would first as projects for such a program are (1) and in which for would be in the This is at it will and the would be to who are to in the last of the would be to who who are of who are in the The of and is to of in the As this in about of this is in our a very for of a Control the I feel that a program to in is what we this of our I and not what is the or most all be be in an to and from in the same on such to be But to be taken an the has preceded the in all It is a to the of of by and by This is for the virus but public for the the a program for is to First the will be than most other we in most to of who will to be me this it an However, to Thomas Parran it out such nervous as to the of work it will take to so many people with a viral disease that the not in public but with the of such a program and the in The of the is that there are data to that to with viral STDs does some in this is than but it is a and for for look at the of such an from such a program in Seattle where the studies the in the clinic as in and in As a program in a (we new and and As a the now about and in 2 with genital herpes one would the for herpes from every 2 years to every 2 years, a of a for an New and New such a program would take but it would also be good clinical as of these with think they have other and and are and for their these people are and told about of the and a in will they are really As of such by viral they are The of by studies these people are to this up even at a by we have a new in of all and of all new with an that is in to a me the in such an is so that I would the question around - aren't and to do this will It would take and to the about this viral to of and But this is can also be innovative. I would to the that the studies we on were with who and that our for the of genital We in Seattle have for such and I am other in these can do even But one thing is and to to the genital herpes - what are How it is it can be can be these be in such as or I in the field for in The of the to on and is and not for the because this is not does not we our to do What we to do is new to such as and are all to and to new of for the We that is not what most of our best or In my is the to help the the medicine can a and The of my talk is not to into the of such an program but to a It to me that it does us all good to to the of to with viral Parran was when he "The first in is to I think we can also help public by to more at the of This more to and more to the of to a few in which I feel we to more is in the For many it would to at until are for of we the viral with the to and with We in the public clinic are for a and public not it be and This is to me, as we do not this in many other public we get with and follow-up was not a of the is now - it is I am not the clinic or the with - the But I am that with an and it is not a public to to with because it is and might to who are but do not they have the disease is and do not to to it is as a to they have something they do not to It is made even when we as the care this person of the and function in the role of But it more to be of an that in of that in to will a to have a and to After all, we learned enough from that even of genital are the will disease and in a of Thomas Parran was on His for is the the the with the disease, and the as to the of It is the public that be to participate in these his ideas that it is that the to public are in my it be said that in no in the world has without it as as an Thomas Parran's for for Control of an has However, I feel we be that an will eventually perhaps even with one of the in clinical In the we a for the of that are of the of our society be to such while not are not and are to have some the of at such it will take to an the best we can would be a of the of over the next few years. In I am by the Parran Award and of the opportunities the people of these have given I my at the University of Washington, my Drs. and and of course my and who and me my I am to this society for the it has given me my career. it to and and it the to all