Vaccine reformer

Dr. Palefsky

Joel Palefsky, MDCM’80, was instrumental in the securing of FDA approval of HPV vaccination in boys and men. (Photo courtesty of Joel Palefsky)

By Philip Fine

In the ’90s, as antiretroviral therapy was transforming HIV from a death sentence to a chronic disease, Joel Palefsky, MDCM’80, noticed another problem, the high incidence of anal cancers due to human papillomavirus (HPV) infection among men who have sex with men (MSM), as well as HIV-positive women and men.

The clinician scientist set out to find a link between HPV and anal cancer. Inspired by the Pap smear, a pre-screening technique for cervical cancer, he dreamt of an equivalent test to pre-screen men for anal cancer.

Today, the causal relationship between HPV, anal pre-cancer and anal cancer is well established thanks to his efforts

Much of his work has focussed on vaccine efficacy and early screening.

In a paper published in the New England Journal of Medicine, he looked at the ability of the HPV vaccine to prevent genital warts in men having sex with women, and included a sub-study of MSM patients. “We showed that we could actually prevent the cancer precursor lesions from developing.” This led to FDA approval of HPV vaccination in boys and men.

Palefsky, a professor at the University of California at San Francisco, is now leading a US$89 million study at 17 sites in 14 cities. It will screen women and men with HIV for pre-cancerous lesions, treating half of them and monitoring the others. “If we can show that the treatment results in a significant reduction in anal cancer, then we expect that screening high-risk groups will become a standard of care, just like we do for the cervix.”

In recognition of his groundbreaking work on the HPV vaccine—in particular, his contributions towards its approval for gender-neutral use—the McGill Faculty of Medicine has named  Montreal-born Palefsky the 2018 recipient of the Medicine Alumni Global Lifetime Achievement Award.

For Palefsky, the path to medicine began when his father, a furrier, warned him against following in his footsteps. At the age of six, his mother gave him an anatomy book that he still keeps on his bookshelf. He grew up surrounded by books, newspapers and intellectual discussions. He and his siblings became the first generation in the family to attend university, all enrolling at McGill.

He credits CEGEP with giving him a foundation in the basic sciences. However, it was at McGill (where he was accepted into the MDCM program without having to first complete another undergraduate degree) where he began to truly explore medicine.

“Our professors pushed the value of discovery, and advancing the field,” he says.

There he became interested in infectious disease and its role as a driver for clinical research.

He graduated as the AIDS/HIV crisis was beginning to announce itself in Canada and the United States. “It changed the entire paradigm. Here was an infectious agent that was slaughtering people and there was nothing you could do but watch.”

At the height of the epidemic, he undertook a fellowship in Infectious Diseases at Stanford University. “We were right in the thick of it when I arrived. I lost many patients and lost many friends. It was just horrendous.”

His career has been dedicated to an emerging sub-specialty with more questions than answers. “The joy is to be one of the contributors who can shed some light in a new area.”

There is still much more to learn about HPV, including its basic pathogenesis. “We’re focusing right now on developing new techniques to try and interrupt the virus itself as a more elegant and effective approach to cancer prevention.”

Palefsky has been at UCSF for more than 30 years and lives on the San Francisco Peninsula with his partner, Glenn Peacock. They are co-parents, with a lesbian couple, of a 22-year-old son, who, like Palefsky, works in an emerging field, using artificial intelligence to create art.

My son didn’t want to go into medicine, Palefsky explains, because he saw how hard I had to work.

Hard work, wasn’t that what his own father had tried to protect him from when he had discouraged him from going into the fur business?

“Don’t think for a moment that the irony was lost on me.”



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