October 1997
PROVIDENCE, R.I. — After five editions and 14 years as editor of the American Academy of Pediatrics (AAP) Red Book: Report of the Committee on Infectious Diseases, Georges Peter, MD, is stepping down.
"I was particularly aware in the editing of my last edition just how complex the process had become, and I think that new problems require new solutions. While I am certainly not at the stage in my career when I have any intention of retiring, after nearly 15 years, a change of editor will serve the process well in addressing the issues of the increasing complexity of the Red Book," he explained.
Peter's first term on the AAP Committee on Infectious Diseases began in 1979 and was supposed to end in 1985.
He began work on his first edition of the Red Book in 1983 and became an ex-officio officer on the committee in 1986 when he was appointed the permanent editor. Until then, a committee member served as editor during his or her six-year term. Each committee member served as editor one time during the term.
"When I first became editor, in retrospect, I was pretty junior and I got an immense amount of help from Phil Brunell. Subsequently, Stan Plotkin, Caroline Hall and Neal Halsey, the committee chairs who followed Phil, were similarly helpful in their contributions and encouragement," said Peter, who is director of the division of pediatric infectious diseases at Rhode Island Hospital, as well as professor of pediatrics at Brown University.
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In being editor, Peter noted, the increase in responsibility and time required has been considerable and it has been more than just the Red Book.
"My appointment as editor really was a wonderful opportunity because not only did I become dedicated to the preparation of the Red Book but also, I became very involved in other aspects related to the academy's work on immunization and other issue concerning infectious diseases, including seven years as an AAP liaison member of the Advisory Committee on Immunization Practices at the Centers for Disease Control and Prevention."
Peter also served on the National Vaccine Advisory Committee and the Advisory Commission on Childhood Vaccines, which he chaired in 1994.
Although Peter was editor of the 1986 edition, he noted that many organizational aspects of the Red Book simply followed the model developed by his predecessor Jerome Klein, MD, of Boston City Hospital and Boston University School of Medicine. Klein edited the 1982 edition.
"He made some very significant changes, which I further implemented. Klein deserves a lot of credit," Peter said.
Many changes in the Red Book since 1982 have resulted in the changes in vaccines and the childhood immunization schedule. Besides adding varicella (Varivax, Merck & Co.) and hepatitis B vaccines, recommendation for each one of the other vaccines have also changed. For example, Peter noted, the academy now recommends use of acellular pertussis vaccine instead of the whole-cell vaccine; the sequential schedule for poliovirus vaccine was adopted last fall; the measles epidemic in late 1980s prompted recommendation of a second dose of measles-mumps-rubella vaccine (MMR, Merck & Co.); and the introduction of a conjugate Haemophilus influenzae vaccine.
"Perhaps one of the most dramatic events during my years as editor has been the near elimination of the Haemophilus influenzae invasive disease," Peter said.
Beginning with the 1988 edition, Peter added a summary of major changes, designed to allow physicians to rapidly identify the significant difference from the last edition. The 1997 edition had 30.
More significant changes relate to HIV and AIDS, which was just beginning in the early 1980s. With the HIV epidemic, Peter said, has come markedly increased attention to opportunistic infections that HIV patients acquire; the Red Book committee has responded with more extensive chapters in the book such as Pneumocystis carinii and atypical mycobacterium.
While 1982 Red Book was 351 pages, the 1986 edition was 519. Each edition thereafter has increased by about 10%, he estimated, leading to the 1997 edition which is 702 pages, excluding the index. However, the growth in length is even greater, Peter said, because of the amount of print on each page has also increased.
As the book grew longer, the challenge of ensuring that different sections of the book were consistent became greater, Peter said.
"I've often wondered if we shouldn't have two Red Books one for HIV infections and related problems and the second for other aspects of pediatric infectious diseases," he said. "This might address the issue of increasing length, but would not simplify the process of the very important aspect of the Red Book, which is integration of the may facets of pediatric infectious diseases. Physicians and others who use this book appreciate having one source and we would lose a lot if we had two books rather than one."
Following the pattern of previous years, the 2000 edition is expected to increase in size, but Peter said it will not be unmanageable.
"In fact, the Red Book will become increasingly complex to prepare and will require that much more in terms of resources to prepare," he suggested. "I think that I had reached the point where I had taken the Red Book as far as I could and the time had come for new ideas and solutions."
Being editor of the Red Book, Peter said, has involved much more than simply editing a reference book. At times the Red Book was like a second full-time job, he said.
"I wouldn't be totally honest if I didn't say that I've worked very, very hard in the past 15 years, and in terms of my personal life, I've probably worked harder now that my children are grown up and my wife also has a very demanding job. So at the same time, that increasing amount time also was a factor in my decision to step down as editor," he said. "I look forward to the opportunity when perhaps I don't have quite as many responsibilities, at least in this area. But my decision was based on more than simply time. I had edited five editions and that was probably enough. However, I am certainly not about to take life easy."
Peter doesn't have any new projects planned yet, but expects to be busy with his work at the hospital and at the university. He also hopes to remain active within the AAP and will participate in other activities concerning immunization and the education of physicians, medical students and residents.
He will also remain involved with the AAP Committee on Infectious Diseases at least for the preparation of the next edition of the Red Book. "I am very loyal and committed to helping the committee on infectious diseases, so I want to be helpful," he said eagerly.
He does hope to spend more of his free time in competitive one-design sailing. Peter is an avid sailboat racer and has sailed in around 21 national championships and five world championships. Two years ago, he and his crew, which includes his daughter Allison, finished 12th in the Lightning World Championship in Kuopio, Finland.
Peter graduated in 1959 (A.B., cum laude) from Harvard and in 1964 from Harvard Medical School. Following graduation he completed a mixed internship of medicine and pediatrics at Strong Memorial Hospital, Rochester, N.Y., where he also served as a resident. He completed his residency at Children's Hospital Medical Center, Boston, in 1969 and a fellowship in immunology and infectious diseases at Harvard in 1972.
During 1966-1968, Peter served as a fellow to the National Institute of Arthritis and Metabolic Diseases in the Pediatric Metabolism Branch at the National Institutes of Health.
In 1972, Peter joined the medical faculty at Brown University and since 1984 has been a professor of pediatrics. Peter has authored more than 130 publications focusing primarily on pediatric infectious diseases.
"One of the things I've always enjoyed about pediatric infectious disease is that it really is a part of the mainstream of primary care because they are so common," he said.
Larry K. Pickering, MD, has been appointed new editor and Peter will work with him as editor emeritus. Pickering is director of the Center for Pediatric Research, a program of Eastern Virginia Medical School and the Children's Hospital of The King's Daughters where he is also chairman of pediatric research. He has served on the AAP Committee on Infectious Diseases for six years and worked as an associate editor on the 1994 and 1997 editions.
"I could not think of a better choice," Peter said. I worked with Larry on the last two editions of the Red Book and the committee as well as in the Pediatric Infectious Disease Society. He is immensely capable. He is well organized and knowledgeable and very effective at whatever he undertakes. I have no doubt that the Red Book will thrive under his leadership."
Editors Note: To George: One of the most hard working, committed, self effacing, wonderful people I have ever known. His contributions to pediatric infectious diseases through his work in the Red Book are monumental. I doubt if many people appreciate how tough this job is. It must be authoritative, accurate, carefully worked and up to date. It involves working with many individuals and organizations and keeping them all happy. Larry Pickering is a wonderful choice to succeed George, but not replace him. He is irreplaceable. I hope George uses his new found time for fun, but I cannot imagine him doing that. Smooth sailing and thank you, from all of us. —Phil Brunnell
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