Boston Physician Research Articles

Understanding Stakeholders' Perspectives to Increase COVID-19 Vaccine and Booster Uptake Among Black Individuals With Rheumatic Conditions.

Disparities in COVID-19 vaccine and booster uptake persist. This study aimed to obtain perspectives from community and physician stakeholders on COVID-19 vaccine and booster hesitancy and strategies to promote vaccine uptake among Black individuals with rheumatic and musculoskeletal conditions. We invited community leaders and physicians in greater Boston and Chicago to participate in semi-structured interviews using a moderator guide developed a priori. Participants were queried about how to best address vaccine hesitancy, strategies to target high-risk populations, and factors to identify future community leaders. Interviews were audio recorded, transcribed verbatim, and analyzed thematically using Dedoose. A total of 8 physicians and 12 community leaders participated in this study between November 2021 and October 2022. Qualitative analyses revealed misinformation/mixed messaging and mistrust, with subthemes including conspiracy theories, concerns regarding vaccine development and function, racism and historical injustices, and general mistrust of health care systems as the top cited reasons for COVID-19 vaccine hesitancy. Participants also shared demographic-specific differences, such as race, ethnicity, age, and gender that influenced the identified themes, with emphasis on COVID-19 vaccine access and apathy. Strategies for community-based vaccine-related information dissemination included personal storytelling with an iterative and empathetic approach, while recognizing the importance of protecting community leader well-being. To increase vaccine uptake among Black individuals with rheumatic conditions, strategies should acknowledge and respond to racial/ethnic and socioeconomic injustices that engender vaccine hesitancy. Messaging should be compassionate, individually tailored, and recognize heterogeneity in experiences and opinions. Results from these analyses will inform a planned community-based intervention in Boston and Chicago.

America's Original Immunization Controversy: The Tercentenary of the Boston Smallpox Epidemic of 1721.

The CoVID-19 pandemic marks the 300th anniversary of the Boston smallpox epidemic of 1721, America's first immunization controversy. Puritan minister Cotton Mather learned of inoculation for smallpox from Onesimus, a man enslaved to him. When the disease broke out in May 1721, Mather urged Boston's physicians to inoculate all those vulnerable to the disease. Zabdiel Boylston, alone among his colleagues, decided to proceed with the procedure, igniting a heated debate that occasionally grew violent. The division between the advocates and detractors of inoculation were as deep as religion and politics. Puritan ministers supported inoculation, asserting their right to control the lives of their flock. Challenging them were a secular class of medical professionals that proclaimed primacy in medical matters. The controversy was inflamed by a nascent newspaper industry eager to profit from the fear of contagion and the passionate debate. Despite the furor and physical risk to himself and his family Boylston inoculated 282 persons, of whom only 6 died (2.1%). Of the 5759 townspeople who contracted smallpox during the epidemic, there were 844 deaths (14.7%). In America's first effort at preventive medicine Boylston established the efficacy of inoculation, which helped support its acceptance in England, and later in the century, the adoption of Edward Jenner's technique of vaccination in 1796.

Vulgarly Called The Throat-Distemper: New Jersey’s Two-Century Struggle Against Diphtheria

In 1740, minister and physician Jonathan Dickinson of Elizabethtown, New Jersey, published “Observations on that Terrible Disease Vulgarly Called the Throat-Distemper,” a short treatise on the diagnosis and treatment of epidemic diphtheria for the benefit of physicians in Boston. Dickinson’s pamphlet was a landmark in American colonial medical literature. It was New Jersey’s first—and last—important original contribution to the medical literature on diphtheria. For the next two centuries, New Jersey, with no medical colleges or prestigious teaching hospitals of its own, would import the medical knowledge and innovations necessary to control and finally eradicate the disease that cruelly killed thousands of New Jersey children in the two centuries following Dickinson’s report. This article examines the processes by which New Jersey practitioners and public health officers imported, processed, disseminated, and applied the lessons of the germ theory and immunology in their two-century quest to banish one of the great scourges of childhood.

Robotic telestenting performance in transcontinental and regional pre-clinical models.

This study was conducted to evaluate the association of geographic distance with robotic telestenting performance by comparing performance measures in transcontinental and regional pre-clinical models of telestenting. Robotic telestenting, in which percutaneous coronary intervention (PCI) is performed on a remotely located patient, might improve PCI access, but has not been attempted over vast distances likely required to reach many underserved regions. Telestenting performance was compared in regional (Boston to New York [206 miles]) and transcontinental (Boston to San Francisco [3,085 miles]) ex vivo models of telestenting, wherein a physician in Boston attempted robotic PCI on endovascular simulators in New York and San Francisco, respectively. PCI was attempted over both wired and fifth generation (5G)-wireless networks. Outcome measures included procedural success, procedural time, and perceived latency. Procedural success was achieved in 20 consecutive target lesions in the regional model and in 16 consecutive target lesions in the transcontinental model. The transcontinental model had a greater latency than the regional model over both wired (121.5 ± 2.4 ms vs. 67.8 ± 0.9 ms; p < .001) and 5G-wireless networks (162.5 ± 1.1 ms vs. 86.6 ± 0.6 ms; p < .001), but perceived latencies were graded "imperceptible" in all cases in both models. Transcontinental and regional models did not have significantly different procedural times over wired (4.1 ± 1.9 min vs. 9.0 ± 7.1 min; p = .051) or 5G-wireless (3.0 ± 0.6 vs. 6.3 ± 1.2; p = .36) networks. Transcontinental robotic manipulation of coronary devices is now possible and was not associated with adverse performance compared to robotic telestenting conducted regionally.

Dr. Oliver Wendell Holmes on phrenology: Debunking a fad

ABSTRACT Oliver Wendell Holmes, Sr. (1809–1894) was a Boston physician, a professor of medicine at the Harvard Medical School, and a writer of prose and poetry for general audiences. He was also one of the most famous American wits of the nineteenth century and a celebrity not bashful about exposing costly, absurd, and potentially harmful medical fads. One of his targets was phrenology, and the current article examines how he learned about phrenology during the 1830s as a medical student in Boston and Paris, and his head-reading with Lorenzo Fowler in 1858. It then turns to what he told readers of the Atlantic Monthly (in 1859) and Harvard medical students (in 1861) about phrenology being a pseudoscience and how phrenologists were duping clients. By looking at what Holmes was stating about cranioscopy and practitioners of phrenology in both humorous and more serious ways, historians can more fully appreciate the “bumpy” trajectory of one of the most significant medical and scientific fads of the nineteenth century.

A Foundation Funding Frontier

A Foundation Funding Frontier

Women's Struggles to Practice Medicine in Antebellum America: The Troubled Career of Boston Physician Harriot Kezia Hunt

This essay discusses the failed efforts of Boston physician and woman's rights activist Harriot Kezia Hunt to study at Harvard's Medical School in 1847 and 1850. It explores the fractious and gendered nature of medicine in antebellum America and concerns about professionalism, gender roles, student retention, and interracial mixing at Harvard.

Perioperative Complications in the Cancer Patient: A Robust Prognostic Factor

As surgeons, we grew up learning about postoperative complications in the forum known as the Morbidity and Mortality (M&M) conference. We learned that certain genre of complications, such as intra-abdominal infections, myocardial ischemia, pneumonia, and deep venous thrombosis, portend especially detrimental outcomes for our surgical patients. The concept of the M&M conference developed from the seminal work of Dr. Ernest Amory Codman who, in the early 1900s working at Massachusetts General Hospital, recognized that in order to learn from our mistakes and improve patient care we had to discuss unsuccessful outcomes, quantify and catalogue these misadventures, and follow the course of our patients. These tenets espoused by Codman were not embraced by his fellow Boston physicians and he was invited to remove himself from the environment of the medical staff and hospital! Codman’s early endeavors into developing databases and reporting outcomes served, however, as the basis for the quality initiatives first developed by the American College of Surgeons (ACS) during the infancy of that organization in the second decade of the twentieth century. Subsequently, the creation of risk-adjusted instruments, such as the Veterans Administration (VA)initiated National Surgical Quality Improvement Program (NSQIP) launched in the early 1990s and the ACS–NSQIP promulgated to all hospitals more recently, has provided analytic tools not only to evaluate the consequences of surgical complications during the immediate postoperative period but to assess the ultimate effects of these events on the entire course of an illnesses, such as cancer. As an important derivative from the ACS–NSQIP, the Surgical Risk Calculator recently has been launched to facilitate the computation of the likelihood of 30-day outcomes for a large number of surgical procedures given the presence of preoperative comorbidities. The late Shukri Khuri, working with his VA colleagues using the VA-NSQIP database, showed that the 30-day complication rate is a robust factor in determining both short(30-day) and long-term survivals for all patients undergoing eight common operations. Although not directed previously to cancer patients, Khuri’s work suggested that the ‘‘inflammatory response’’ resulting from postoperative complications was a detrimental factor in determining long-term survival and was independent of patients’ preoperative risks. The importance of this work had obvious implications for patients with malignancy. The prognosis of cancer is dependent on adequate staging of patients. More recently, molecular markers along with anatomical staging have been added to the taxonomy of outcomes of cancer patients. Unfortunately, the role of comorbidities, although championed by some, continues to be unrecognized as a major factor in the outcomes of cancer patients. Along with this, we have generally failed to understand the importance of the postoperative complication on the future of our cancer patient. Perhaps complicated outcomes are associated with other factors. The adverse effect of blood transfusion has been delineated as a reason for reduced survival in cancer patients, perhaps as a consequence of reduced immunocompetence resulting from transfusion. Obviously patients with postoperative complications may have an increased This is an editorial to the article available at doi: 10.1245/s10434013-3267-0.

Boston Medicine, Before and After

A Boston physician comments on the striking contrast between Boston's health care climate before and after the Boston Marathon bombing.

Notes on Contributors

Notes on Contributors

G. Robert Vincent Voice Library

The G. Robert Vincent Library at Michigan State University is a fascinating collection of recorded voices, the culmination of one man's obsession, drive, vision, devotion, tenacity, and talent. G. Robert Vincent was the collection's developer and, for many years, its main supporter and proponent. To understand its creation and contents, an overview of Vincent's life and career is necessary. Much of the background comes from a Ph.D. dissertation by Douglas E. Collar. (2) Dr. Collar's work was based on scrapbooks, unpublished manuscripts and interviews with Vincent, his family, and his associates. George Robert Vincent was born on 17 July 1898, in Boston, Massachusetts. His mother, Lisa Bloch, was a literary figure who wrote under the penname Lisa Ysaye. She was the daughter of a prominent Viennese rabbi and statesman. His father was the Boston physician Dr. John Vincent. Their marriage dissolved in 1902 and Lisa, with her two children, returned to her family home in Vienna, where Bob and his sister came under the influence of their strict grandfather, Joseph Bloch. Bob learned German, which was to be important throughout his life. His mother married Dr. Joseph Tarlau, another rabbi, in 1903; in 1905, the family moved to New York City, where three more sons were born to Lisa. Her eldest son, Bob, although an indifferent student, used his strong independent streak and zest for adventure to seek out more challenges than those offered by school and family life. In part because of his mother's association with publishers and literary agents, Bob developed an idea for a magazine for He worked his way into the offices of some of the most influential publishers and newspapermen of the day, and eventually, at age 12, succeeded in obtaining support for the publication of his own periodical, The Boys' Paper, which was published from 1910 to 1914. He wrote much of the content, sought articles and editorials from newsworthy figures, and included his mother's work from time to time. Bob never lacked the courage to introduce himself to important individuals and he never hesitated to persuade these leaders to write letters of support or introduction. Throughout his life, this self-confidence remained an asset that seldom failed him. One of Vincent's lifelong heroes was Theodore Roosevelt. After leaving the United States presidency in 1908, Mr. Roosevelt accepted a position as a contributing editor for The Outlook, a New York weekly. In the course of seeking articles, Vincent met Roosevelt and persuaded him to write a statement for The Boys' Paper. This was the first of several encounters. Perhaps the most formative meeting came in the summer of 1912. Vincent and his friends had formed The Boys' Progressive League, an offshoot of The Boys' Paper. Although too young to vote, they were vitally interested in the presidential election that year. Roosevelt formed the Bull Moose Party, a third political party, so that he could run for president again. The members of the League supported him and they wanted him to address a meeting of their organization. Vincent and four friends went to Roosevelt's home to present the invitation. With considerable foresight, Vincent borrowed an Edison cylinder recording machine from Thomas Edison, whose son Charles was Vincent's close friend. When Roosevelt declined the invitation due to time constraints, Vincent prevailed upon him to record a short speech to be played to the League members. This was a coup. The other youngsters doubted Vincent could succeed in getting Roosevelt to speak, and they certainly didn't envision having a recording. The speech lasts just under three minutes and is titled A message to the American boys. That the first voice Bob ever recorded was Theodore Roosevelt, even though on a fairly primitive machine, was to become a claim to fame that he enjoyed throughout his life. This experience helped set him on his ultimate career path. Later, the Edison Recording Division plated this wax cylinder and gave it to Bob, along with the original machine he used. …

Protecting Children From Toxicants

Protecting Children From Toxicants

‘Why I wrote The Yellow Wallpaper?’

Many and many a reader has asked that. When the story first came out, in the New England Magazine about 1891, a Boston physician made protest in The Transcript . Such a story ought not to be written, he said; it was enough to drive anyone mad to read it. Another physician, in Kansas I think, wrote to say that it was the best description of incipient insanity he had ever seen, and — begging my pardon — had I been there? Now the story of the story is this: For …

Complex Regional Pain Syndrome: What's in a Name?

Within a 2-year period in the 1940s, 2 Boston physicians published dramatically opposing views on the underlying nature of a syndrome now known as complex regional pain syndrome (CRPS). Evans suggested, in several papers in 1946-1947, that sympathetic reflexes maintain pain and dystrophy in affected limbs. Foisie, in 1947, suggested arterial vasospasms were key in the etiology of this pain syndrome. Evans' hypothesis established the nomenclature for this syndrome for 60 years, and his term, "reflex sympathetic dystrophy," guided clinical treatment and research activities over the same period. Foisie's proposed nomenclature was unrecognized, and had virtually no impact on the field. Recent evidence suggests that Evans' contribution to the field may have in fact led clinicians and researchers astray all those years. This focus article on CRPS compares recent observations with these 2 earlier theories and asks the question-what if we had adopted Foisie's nomenclature from the beginning? This article discusses 2 opposing historical views on the etiology of what is now known as CRPS, and how they affected nomenclature, research, and clinical therapy in subsequent decades. This focus article may help researchers and clinicians realize the importance of syndrome names, and how they may inadvertently misdirect research and treatment.

Reviews: Why Ellen Rosskam's Holistic Approach is Necessary: Excess Baggage: Leveling the Load and Changing the Workplace, Joining Sustainable Design and Substainable Livelihood: Beyond Child's Play, Sustainable Product Design in the Global Doll-Making Industry, Emerging Theories: Healthy Aging: Environmental Threats to Healthy Aging with a Closer Look at Alzheimer's &amp; Parkinson's Diseases

Environmental Threats to Healthy Aging, with a Closer Look at Alzheimer's &amp; Parkinson's Diseases, a report published by Greater Boston Physicians for Social Responsibility and the Science and Environmental Health Network (2008), explains emerging theories about contributors to and prevention of Alzheimer's and Parkinson's diseases. Replete with graphics, maps, and diagrams, the report links a surprising number and variety of toxic exposures early in life to these neurodegenerative diseases diagnosed later in life. It also describes their relationships in what is described as the “Western disease cluster.” Evidence that good nutrition, physical activity, comfortable socio-economic status, and social and intellectual engagement throughout life are associated with a sturdier cognitive status late in life is presented.

Photographs of Early Ether Anesthesia in Boston

Photographs of Early Ether Anesthesia in Boston

Patients’ Evaluations of Health Care Providers in the Era of Social Networking: An Analysis of Physician-Rating Websites

Internet-based social networking tools that allow users to share content have enabled a new form of public reporting of physician performance: the physician-rating website. To describe the structure and content of physician-rating websites and to assess the extent to which a patient might find them valuable. We searched Google for websites that allowed patients to review physicians in the US. We included websites that met predetermined criteria, identified common elements of these websites, and recorded website characteristics. We then searched the websites for reviews of a random sample of 300 Boston physicians. Finally, we separately analyzed quantitative and narrative reviews. We identified 33 physician-rating websites, which contained 190 reviews for 81 physicians. Most reviews were positive (88%). Six percent were negative, and six percent were neutral. Generalists and subspecialists did not significantly differ in number or nature of reviews. We identified several narrative reviews that appeared to be written by the physicians themselves. Physician-rating websites offer patients a novel way to provide feedback and obtain information about physician performance. Despite controversy surrounding these sites, their use by patients has been limited to date, and a majority of reviews appear to be positive.

Children's Environmenal Health: The School Environment

Children's Environmenal Health: The School Environment

Intravenous Immunoglobulin in the Treatment of Pemphigus

Prior reports, mostly from one physician in Boston, have suggested that high-dose immunoglobulin might be effective in patients with pemphigus

Aging: Environmental Threats to Elders’ Neurologic Health

Aging: Environmental Threats to Elders’ Neurologic Health