Peter J. McDonnell, MD

He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

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 without doubt one of the most important and colorful figures of Classical Athens.

Born in 524 BCE, he became a leading statesman and general and his emphasis on making Athens into a naval power ensured Greece’s survival against the greatest threat it had ever faced: mighty Persia.

The value of a reputation: Mixing medicine, politics a bitter tool

, Thucydides states that “Themistocles was a man who exhibited the most indubitable signs of genius; indeed, in this particular he has a claim on our admiration quite extraordinary and unparalleled.”

He came from a middle class family and (like many geniuses) was apparently not considered to be a gifted student. 

As an adult politician, he is credited with building the city of Piraeus into the largest naval base in the Greek world, and argued that a strong navy would one day be needed for defense.

In 490 BC, the Persian army, under Darius, invaded Greece. In the land battle of Marathon, the Greeks prevailed and Persians retreated to lick their wounds.

During the next ten years, Themistocles grew the Athenian fleet from 70 to 200 triremes.

With a triple bank of rowers, the trireme could ram opposing ships and the soldiers (hoplites) aboard would leap onto the enemy vessel and slay their opponents.

A decade after his father failed to prevail at Marathon, Xerxes returned in 480 BC with his enormous army and navy, dwarfing the defensive forces of the Greeks.

The Greek fleet, composed of the independent fighting forces of the various city-states, needed an overall commander.

 A naval historian friend tells me that an election was held to select the leader of the Greek armada, with each captain being given a vote for who should be the leader.

The vote was not helpful, as some 300 candidates each received a single vote when each and every captain voted for himself.

A second election was then held, and this time the question being voted upon was: “If it must be someone other than you, who would you want to lead the fleet?” This time there was a clear answer, with virtually every vote cast for Themistocles.

Luring the large Persian vessels into a narrow strait, the smaller and more maneuverable Greek vessels picked off the invading ships one at a time, negating the Persian numerical advantage. The naval Battle of Salamis, still studied some 2500 years later, was a crushing defeat for the Persians. 

Shortly thereafter the Greek land army prevailed against the invading ground forces, and Persia ceased to be a threat. Themistocles had bought Greece some 500 years of power, by which time the Romans would ascent to preeminence.

Themistocles was the man of the hour. Even the Spartans, traditional hated rivals of Athens, foisted honors upon him.

But Themistocles’ glory was short-lived.Only four years after his landmark victory, Themistocles was accused of being thirsty for power and riches and was exiled by his fellow Greeks. In a testament to what must have been his incredible political skills, Themistocles fled by merchant ship to—of all places—Persia, where he was welcomed by Ataxerxes I.

He spent the last decade of his life as governor of Magnesia, honored by the Persians whose navy he had destroyed, while simultaneously being declared a traitor and condemned to death in absentia by the Greeks whose country he had saved from the Persians!

Personally, I love the idea of an election in which all the candidates are forced to choose the person who—if it cannot be them—would be best qualified to lead.

Articles

Ancient election offers lesson to modern voters

Themistocles: Everyone's second chance

 pandemic and the search for effective therapies and vaccines have consumed much of the world’s attention during the first half of the year. 

Results of recent reports from the University of Oxford indicate that dexamethasone, an inexpensive generic drug, significantly reduced deaths when used in very sick patients with 

Echoes of history: COVID-19 pandemic stirs memories, tests our mettle



The drug reduced deaths by a third in patients on ventilators and less severelyaffected patients receiving supplemental oxygen. Presumably the drug works by blunting the exuberant inflammatory response (the so-called cytokine storm) that the immune system mounts in some patients.

Dexamethasone is not the first drug with claims to be effective against the coronavirus. Remdesivir, in a study of 1063 patients funded by the National Institute of Allergy and Infectious Diseases, was shown to reduce median recovery time from 15 to 11 days. 

I can assure you that in academic medical centers like mine, where many were worried this spring that they would be overwhelmed by severely ill patients, a one-third reduction in the time these patients needed to be on a ventilator in our intensive care units was a very big deal.

COVID-19: Should ophthalmologists prepare for a second surge?

As far as I can tell, 1 drug—hydroxychloroquine—has received an inordinate amount of attention in the lay press. Some described it as very risky, but we ophthalmologists are very familiar with hydroxychloroquine because we use it to treat patients with lupus, who generally tolerate it well, and we follow these individuals for signs of retina toxicity.

My view is that the truth will win out. Medicine is a science, I have always believed, and the truth will always become clear as additional research is performed and published. 

So I was confident that the issue surrounding hydroxychloroquine’s efficacy would become clear.

As such, when the almost 200-year-old prestigious British medical journal the 

published a paper reporting that hydroxychloroquine both was ineffective at treating the coronavirus and caused cardiac complications, my initial reaction was that we seemed to have had our answer: The drug is apparently not helpful. Science is science, after all.

Imagine my disappointment upon learning the following:

> The data used to reach the conclusion in the published paper may not exist. The Harvard professor who was lead author, Mandeep R. Mehra, MD, reported via a hospital spokesperson that “he never saw any of the data.” According to newsreports, the small company Surgisphere generated the data.

> Surgisphere claimed that it had access to enormous patient databases from health-care systems and electronic health records providers. But news organizations have reported that they cannot find any such organizations that are sharing their data, and Surgisphere declined to name any. Aneesh Chopra, former President Barack Obama’s chief technology officer, said he doubted the existence of the database. Jerome Kassirer, former editor of the 

, called the publication of the paper “a serious failure of peer review.”

published the paper based on questionable, unverified, or nonexistent data, it also published an unsigned editorial criticizing an elected American politician who had expressed his belief that hydroxychloroquine was likely effective. The 

, reporting on the editorial, made this understatement: “Rarely do publications with the 

’s influence use [their] full weight … to call for a president to be voted out of office.”

The eye and COVID-19: Providing fact, not fears

At a minimum, the juxtaposition of a political editorial with a subsequently retracted article allegedly based on nonexistent data is a black eye for the notion that politics and biomedical science are 2 different disciplines. 

reputation, built over 2 centuries, is now tarnished.

There is another old saying that when you mix medicine with politics, you end up with politics. This sad episode speaks to the truth of that shibboleth. 

The value of a reputation: Mixing medicine, politics a bitter pill 

An open letter to my department's graduates.

It’s rough out there. Move back with your 

-Thornton Melon (played by Rodney Dangerfield) in 

Dear Class of 2020 Residency Graduates (aka soon-to-be PGY-5s) and Graduating Fellows:

For the first time in the 95-year history of our institute, we will have no large public gathering to mark the completion of the final year of residency training and allow your faculty (now colleagues) to wish you continued success in person. 

We will miss the chance during the cocktail hour to shake your hands and those of your family and friends who have supported you during your years of hard work in medical school, internship, and residency that got you to this point. We will miss the chance to share a delicious meal together with you and a few hundred of your friends. We will miss the speeches, humorous anecdotes, baby photos, embarrassing comments, and laughs that always seem to come up each year at this event.

What we won’t miss is “The Skit,” in which residents use their musical, vocal, and dancing skills to poke fun at the foibles and idiosyncrasies of the chairman and professors. (OK, maybe the jokes about the professors are funny-but not those about the chairman!)

But mostly, we will simply miss you. This has been a remarkable year for your class, for American ophthalmology, and for medicine in general.  

In some ways, this coronavirus disease 2019 pandemic reminds me of the appearance of a mysterious illness that popped up when I was a resident. Now known as AIDS, that illness had a number of ophthalmic manifestations.
	
	No one knew what caused it or how it was spread, and there were no effective therapies. Many physicians, nurses, and the public were scared. Some projections said this new disease would kill one-third of the world’s population.
	
	


	
	Of course, biomedical science rose to that challenge, and today, seeing a patient who is HIV positive is more or less a non-event.  

A result of the need to protect patients and health care workers and save protective equipment, the number of nonurgent surgical procedures you will have completed in residency is less than projected. This is a non-issue. You will be constantly learning and mastering new techniques in the OR over the coming decades of your career. Ten years from now, you will neither remember nor care how many procedures you performed as a resident.

This is the opportunity for an old person (ie, me) to pass on to the graduating youth (ie, you) the secrets for subsequent success in your careers. I have to tell you that the secret is that there is no secret.
	
	The qualities that allowed you to excel in medical school, secure a competitive residency training position, and perform so well as residents are qualities that will ensure your future success.  

You have worked very hard all along, and that work ethic will continue to stand you in good stead. Your love of learning will allow you to welcome the opportunity to master new technologies and surgical procedures that inevitably will come along in our highly innovative specialty.
	
	

 Coronavirus response: Generations react differently to COVID-19


	
	You have delayed gratification along the way, and that quality will allow you to resist the urge to rush out and buy the unnecessary material goods (a luxury car, an excessively large home) that others will tell you are required possessions of “rich doctors” like you.  

The gift of being able to help others is what attracted you to a career in medicine and keeping that first and foremost will help you when things like pandemics come along and your fellow citizens look to you for help and reassurance in their hour of need.
	
	Finally, this experience with “lockdowns” and “social distancing” will allow you to fully appreciate the joy of being with friends, family, and patients whenever possible. 

Rodney Dangerfield was right-it can be rough out there. But it can also be astonishing, rewarding, humbling, and a lot of fun. You’ll be fine. And, please, stay in touch. 
	
	

A message to the Class of 2020

The sun again will shine bright and clear

Keep on the sunny side, always on the sunny side

a song written in 1899 by Ada Blenkhorn and 

pandemic and the government’s advisories to stay in our homes except for essential business or trips to the grocery store, the risk exists that we could become couch potatoes who are eating and drinking too much, exercising too little and becoming lonely and saddened. Determined to not allow this to happen to yours truly, I have resolved along the way to see the positive aspect to each new development in this saga.
	
	

Echoes of history: COVID-19 pandemic stirs memories, tests our mettle 


	It began when the association between infection and air travel became evident and many companies and universities (including mine) banned or severely restricted air travel. “There is a bright side to this,” I thought. 

Because they woould not be traveling around the world giving lectures and being visiting professors, I would be able to see a lot more of my brilliant faculty members in meetings and around the institute. I was really looking forward to this.

But then we were told that we should stop meeting in groups and that unless they were engaged in “essential work” such as patient care, faculty should stay at home.  So no meetings with my faculty after all. 

But keeping on the sunny side, at least I would see the happy smiling faces of my residents and clinical faculty members from time to time.

But then came the rule that we were to wear masks all the time at work, except perhaps when alone in our offices. So no smiling faces to see during the workday.  

COVID-19: Hospitals, practices set PPE policies for ophthalmic use


	Again, keeping on the sunny side, I realized this was a golden opportunity to grow a beard and mustache. Not a ridiculously large beard, but the manly kind of silver and white growth that Sean Connery sported when he played the Russian submarine captain in 

. As all men know, the problem with growing such a beard or mustache is that it looks pretty bad until it has grown out adequately.  

Under a mask, no one would see the early scraggly appearance and, when the period of mandatory mask use expired, the dashing end product would be revealed to all!

But then came the rule that hospitals like mine are banning facial hair in order to allow effective seals of the N95 masks to reduce the risk of viral transmission.  

“So much for staying on the sunny side,” I thought as my secret plan to look like Sean Connery was dashed. A frown began to develop on my hairless face.
	
	

Coronavirus response: Generations react differently to COVID-19


	But then today I received an email that revealed there is light at the end of the tunnel. The message was an invitation to speak at a meeting in London, England in August of this year. I have been to London and it is a beautiful city with wonderful people.  

“But will the restrictions on travel and limitations on public gatherings be over by August?” I wondered as I read the invitation. Then I came to the sunny side of the message that cautioned against panic over the coronavirus and made a series of recommendations:  

“Kindly follow some of the safety precautions like-wash your hands frequently for one hour, kindly include ingredient garlic or ginger in your food or along with the hot water which produces heat and acts as a barrier.”  

Reading this list of protective measures restored the smile to my beardless and mustache-less visage. 
	
	

Author | Peter J. McDonnell, MD

Articles

Themistocles: Everyone's second chance

The value of a reputation: Mixing medicine, politics a bitter pill

A message to the Class of 2020

On the bright side .... looking for the positive amid pandemic's many negatives