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MASSACHUSETTS GENERAL HOSPITAL > HARVARD MEDICAL SCHOOL

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JOSHUA P. METLAY, M.D,, Ph.D.
Clinical and Research Fellow in Medicine

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General Internal Medicine Unit, $50-9
Massachusetts General Hospital
Boston, MA 02114-2698
(617) 724-4591
Fax (617) 724-3544

 

15 August, 1996

Joshua Lederberg, PhD
Rockefeller University

1320 York Avenue

New York, NY 10021-6399

Dear Dr. Lederberg,

Over six years ago we met, albeit briefly, on the stage of the Rockefeller University
auditorium during my graduation from the University. At that time I was being awarded
the PhD half of my joint degree, after completing my graduate studies under Ralph
Steinman. Subsequently, I completed my medical school training at Cornell, and my
internal medicine training at the University of Pittsburgh Medical Center. I am currently
a clinical and research fellow in general medicine at the Massachusetts General Hospital,
in Boston.

The point of this introduction is to provide a backdrop for my current interest in health
services research. I have been studying ways to measure outcomes for acute respiratory
infections, such as pneumonia. I remain, however, interested in the area of intersection
between this largely patient and population based research and my earlier efforts in basic
science. For example, I am studying variations in the management of patients with acute
respiratory infections, particularly in terms of antibiotic usage. Underlying this work is
the belief that inappropriate antibiotic usage is a major determinant of the rate of
emergence of resistant microbial pathogens. Yet, the growing evidence for this
phenomenon remains largely irrelevant to the vast majority of primary care physicians.

I was motivated by your recent editorial in JAMA on the importance of emerging and
reemerging infectious agents as a major priority for future research. I am writing to
inquire about opportunities to collaborate with those leading the basic research on this
growing problem, particularly in terms of the implications of these findings for clinical
practice. I am particularly interested in studying novel methods for translating the global
risks of inappropriate antibiotic usage into guidelines for the management of patients seen
in the primary care setting. Such projects could include developing strategies to monitor
the rates of antibiotic resistance in primary care settings and using tools such as cost
effectiveness analysis to incorporate the costs of antibiotic resistance into individual
patient care decisions. Ultimately, I believe that collaborative efforts between health
service researchers and basic scientists should form the core of essential future efforts to
address the problems of emerging antibiotic resistance.

Deu? ($41 /beterat ea)
I look forward to hearing from you regarding any information you have on potential
opportunities for collaboration or support for these projects.

Sincerely,

poe ead
Joshua P. Metlay, MD, PhD