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An interview with the doctor behind the near-elimination of US deaths due to Rh disease.
John T Queenan, MD
John T Queenan, MD, professor and chair emeritus, Georgetown University School of Medicine, Washington, DC, may be best known in the OB/GYN and fetal and perinatal medicine communities for his pioneering research on Rhesus (Rh) disease management and prevention. Because of that work and his innovations in clinical teaching, Contemporary OB/GYN is very proud that Dr Queenan is the journal’s founding editor.
Following are excerpts of a recent Contemporary OB/GYN interview with Dr. Queenan.
Contemporary OB/GYN: How did you become interested in Rh disease?
Dr Queenan: In the 1960s when I was a resident at New York Hospital/Cornell Medical Center, I became fascinated by the fact that Rh-immunized mothers faced a 50% chance of losing a totally normal baby because it was exposed to a hostile environment. At that time, Rh-alloimmunization accounted for approximately 6000 perinatal deaths in the United States, and I saw the opportunity to help address the problem by contributing to better understanding of the mechanisms of Rh alloimmunization as well as in the areas of diagnosis and therapy.
Contemporary OB/GYN: What do you consider some of the most striking aspects of the work you have been involved in that has almost completely eliminated deaths due to Rh disease?
Dr Queenan: From my perspective, I think it is remarkable and unique that the research was being done as an international collaboration and was simultaneously investigating issues surrounding diagnosis, treatment, and prevention of Rh disease. Researchers from all over the world were working in these different areas. Then we would meet together to share our findings and exchange ideas.
Fetal medicine was very rudimentary at the time-we had no laboratory models for Rh disease and no ultrasound. Yet we made progress thanks to the cooperative effort among the researchers. Therefore, we saw rapid advancement from a time when we were evaluating Rh-immunized mothers only with history, physical exam, and measurement of Rh antibody titers to where we were performing amniocentesis, amniotic fluid Δ OD450 measurements, amniography, and were able to provide fetal treatment, beginning with intrauterine peritoneal transfusions.
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Contemporary OB/GYN: What were some of the obstacles you encountered?
Dr. Queenan: When Drs Vincent Freda, John Gorman, and Bill Pollock introduced the idea of postpartum Rh-immunoglobulin administration to clear Rh-positive fetal red cells from the circulation of Rh-negative mothers, they asked us to help test their hypothesis by treating women at our center. We were met by resistance from attending obstetricians who were reluctant to have their private practice patients exposed to an investigational therapy. Once the initial reports indicated success, they were eager to have their patients participate, but even after postpartum Rh immune prophylaxis proved effective, it took 5 years to approach 100% utilization. Later when 28 weeks Rh immune prophylaxis proved effective, it only took 1 to 2 years to reach near 100% utilization. The difference is probably explained by concerns during the professional liability crisis.
Contemporary OB/GYN: What was the genesis of your concept for creating Contemporary OB/GYN?
Dr. Queenan: It was 1972, I was Professor and Chair of Obstetrics and Gynecology at the University of Louisville, and I wanted to introduce a publication that would provide clinicians with timely information that would be useful for patient care and delivered in an easy-to-assimilate format. My basic idea was to identify clinical subjects that were most important in usual practice and to have the information presented by a leading expert in a clear, concise and practical way.
The success of Contemporary OB/GYN led to the launch of 3 other journals-Contemporary Pediatrics, Contemporary Surgery, and Contemporary Urology. Contemporary Pediatrics is still being published monthly today.
Dr John Hobbins and I also introduced the idea for the book Protocols for High-Risk Pregnancies: An Evidence-Based Approach based on the same concept of identifying important clinical problems and offering expert-based guidance to practitioners. The book is in its 6th edition and is edited by me, Dr Catherine Spong, and Dr Charles Lockwood.
Contemporary OB/GYN: What are some of your more recent projects?
Dr Queenan: Dr Larry Platt and I are currently co-chairs of the Quilligan Scholars Committee for the Quillgan Scholars Program of the Society for Maternal-Fetal Medicine. Named after Dr Edward J Quilligan and initiated in 2014, the program annually selects 5 outstanding OB/GYN residents based on their potential to be future leaders and provides them with special training and educational opportunities to advance their careers.
In addition, the Queenan Fellowships for Global Health program was started in January, 2015 through the Pregnancy Foundation and the Society for Maternal-Fetal Medicine. The fellowships, which represent a variety of opportunities, are designed to train future maternal-fetal medicine leaders in perinatal health for advancement of obstetric practice in underserved regions of the world.
Contemporary OB/GYN: What advice do you have for young physicians who wish to become involved in research?
Dr. Queenan: I would tell them to stay focused, always be asking “why?” or “why not?”, and to be willing to explore and adopt ideas and techniques from other areas of medicine. After all, the idea for treating severe fetal hemolytic Rh disease with intraperitoneal fetal transfusion occurred to Dr Bill Liley after he learned that intra-abdominal transfusions were being performed safely in villages in Africa to treat severely anemic children.