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The science and practice of human immunology

The science and practice of human immunology

How I Became an Immunologist

Joshua D. Milner, MD
Chief, Genetics and Pathogenesis of Allergy Section
NIAID, NIH

What was your path to getting into Immunology?

As an 18 year old high schooler, I got into a program that placed summer students in labs at the NIH (since I had enough of being a camp counselor). Randomly, I was placed in Mike Lenardo’s lab, where it felt like important discoveries were being made on a daily basis, even though I couldn’t understand any of what was going on at the time. However, despite having been in other types of labs over the next few years while in college, my interest in immunology remained ever present. In medical school I did a year of research in David Hafler’s lab at Harvard, and eventually came back to the NIH for my Allergy/Immunology fellowship, where I was in the lab of the great Bill Paul, of blessed memory. The basic immunology I had learned formed the foundation for the translation to the clinic that is ever evolving—I get to see my patients not as simple clinic visitors, but as possessors of pathway disruptions that I need to find, which to me is a tremendous opportunity. My mentors, who made it seem like the sky was the limit when it came to discovery in immunology, are to thank for it. My lab is now around the corner from where I summered 18 years ago.

What do you think is important in immunology and/or medicine in the near future?

Of course the genomic revolution is happening faster than the medical field can keep up. We will have masses of critical genomic data with no questions even having been asked yet, as opposed to what we are used to, which is scientific questions awaiting data to answer them. Furthermore, the clinical relevance of the patient’s genomes on a thumb drive will be far greater than what scientists are used to when it comes to a new molecular finding. The translation will need to happen rapidly, and given that much of our organ of interest is easily available by phlebotomy, we should help lead the way to bridge the clinical management with novel genomic findings as patients come through.

Do you have any inspiring patient stories you would like to share?

Sometimes, particularly when it comes to certain types of chronic allergic conditions, patients and/or parents can become very difficult to manage. The impact on their lives and the lives of their family is immense. So when patients can keep a sense of humor when dealing with their malady, when they can be persistent in trying to find answers without ruining the partnership we are trying to forge in working them up, it is always inspiring. One such patient once attended a lecture I gave. His social skills and capacity to communicate were very limited, and his disease burden, shared by his father and grandfather, was intense. But when I mentioned that allergies may be due to the effects of moving from farming in the country to toiling in the big city, and analogized it to Taylor Swift’s transition from country to pop music, his doubled-over belly laugh might have been one of my favorite moments as a clinician.

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