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Pediatric pulmonology, ever changing, but happily in the same, old boat

Cornfield, David N.

Current Opinion in Pediatrics: June 2019 - Volume 31 - Issue 3 - p 328–329
doi: 10.1097/MOP.0000000000000761
PULMONOLOGY: Edited by David N. Cornfield

Department of Pediatrics, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, Stanford, California, USA

Correspondence to David N. Cornfield, MD, Department of Pediatrics, Center for Excellence in Pulmonary Biology, Stanford University School of Medicine, 770 Welch Road, Stanford, CA 94305, USA. Tel: +1 650 723 8325; e-mail:

Over the past 5 or so decades, pediatric pulmonology has embraced change, evolving as new knowledge moved from pipette to patient and, at times, patient to pipette. From the days when the best of care, even in most progressive medical centers and universities, could be little more than supportive, until today, when deep genotyping and thin phenotyping permit precise and effective care [1]. Today pulmonologists still enter patient rooms, stethoscope in hand, ready to listen, watch, examine, diagnose and learn.

Imagine, for a moment, the joy and wonder if pulmonologists, patients or families of decades past could behold the delivery of surfactant to a struggling near term infant, or a young adult with cystic fibrosis (CF) graduating from medical school or an asthmatic child never spending a single night in hospital. Indeed, with each successive year, pulmonary medicine has gained more healing power, driven by science, undergirded by compassion.

Pediatric pulmonary medicine, as exemplified by the pieces in the present edition of Current Opinion in Pediatrics is happily, ever changing. Yet, and still, pediatric pulmonology, retains an identity and culture that spans decades and continents. It is a puzzle, different, but the same. How is it, asks the philosopher, Plutarch, that the sailing ship, Theseus, was still the same ship when over time, in ports near and far, each plank and board was replaced until not a single original piece remained [2]. If the boat was no longer the Theseus, when did it actually become a different boat? Even with all pieces replaced, was it still the Theseus?

So, do we still sail on the same pediatric pulmonary boat, navigating waters known and known? Considering the pieces in present edition might provide guidance. In the article entitled ‘Genetic Causes of Surfactant Abnormalities’, (pp. 330–339) Dr Nogee elegantly weaves a thread from the physiology encountered in the nursery to the cell biology that underlies the clinical condition and finally, the underlying genetic cause. Dr Christopher Baker's careful review of the long-term challenges that confront some patients term (pp. 357–366). Willen et al. (pp. 349–356) comprehensively and elegantly review the current state of airway disease in patients with sickle cell disease, the first human molecular disease ever described, by Pauling et al. in 1949 [3]. Although the genetic abnormality, a single nucleotide mutation resulting in the replacement of glutamic acid by valine in hemoglobin, was described more than 40 years ago [4], incisive, genetic-based treatments have yet to arrive. Finally, Dr Benjamin Raby reveals the genetic complexity of the most prevalent of pulmonary illness, asthma (pp. 340–348).

Is pediatric pulmonary still the Theseus, the same boat? These contributions, I think, are instructive. Each piece emphasizes a commitment to the whole patient. Sickle cell anemia, although primarily a hematologic condition, commands our attention, calling for better understanding of the pulmonary manifestations of the disease. Children with chronic lung disease of infancy, as Dr Baker reminds us, often remain under our care for years. Drs Nogee and Raby shine a bright light on the genetics of illnesses once thought to be well understood, but only now, with the dawn of some deep knowledge is our relatively shallow understanding revealed. These pieces remind us to be continually engaged in, and by, the discovery process.

So, yes, we sail the same ship. Even as huge components of the field have changed, it is a commitment to managing the whole patient, perhaps imprinted into pediatric pulmonary psyche by our collective focus on CF, a durable, not time-limited patient–physician relationship, and a determination to engage with new knowledge that marks us pediatric pulmonologists.

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We would like to thank Dr Jeff Kahn for discussing the philosophical underpinnings of the ship of Theseus.

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Financial support and sponsorship

The current work was supported by the Center for Excellence in Pulmonary Biology, Department of Pediatrics, Stanford University, Stanford, California, United States. D.N.C. has received grant funding from the Burroughs Wellcome Foundation the National Institutes of Health and an unrestricted educational grant from the Mallinckrodt CO.

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Conflicts of interest

There are no conflicts of interest.

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1. Cornfield DN. Pediatric pulmonology: with thin phenotyping and deep genotyping, knowledge is power. Curr Opin Pediatr 2016; 28:310–311.
2. Rea M. The problem of material constitution. Philos Rev 1995; 104:525–552.
3. Pauling L, Itano HA, Singer SJ, et al. Sickle cell anemia, a molecular disease. Science 1949; 109:443.
4. Kan YW, Dozy AM. Polymorphism of DNA sequence adjacent to human beta-globin structural gene: relationship to sickle mutation. Proc Natl Acad Sci U S A 1978; 75:5631–5635.
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