As part of our “Meet Yale Internal Medicine” series, today’s Q&A is with Joseph Canterino, MD, Assistant Professor (Infectious Diseases).
Q: What led you to pursue medicine as a career?
A: I’ve loved the natural sciences for as long as I can remember. I think this laid the groundwork for my interest in medicine. I feel that medicine is a way for me to apply my interest in the sciences to help others and give back to my community.
Q: Why specialize in infectious diseases?
A: I first got interested in infectious diseases as a medical student in Brooklyn, taking inpatient and outpatient electives. I really admired the faculty and the fellows I rotated with. I also really enjoyed the pace of it, taking the time to think thoroughly and be nuanced about issues. I think infectious diseases brings medicine closest to my love of nature and science. It’s all about how people interact with the organisms in their environment and how we are all part of this elaborate ecosystem.
Q: Why did you choose to come to Yale School of Medicine (YSM)?
A: I first came to Yale in 2009 as an intern in the Internal Medicine residency program. My wife, Brienne Miner, and I were living in New York and knew we wanted to stay in in the northeast for residency. We interviewed at Yale and really liked it. We knew Yale would be full of talented people, but I think what surprised us was also how down-to-earth and friendly everyone was. Because Yale New Haven Hospital (YNHH) is a tertiary care medical center, we get referrals for everything and I knew that I would get a wide spectrum of training here, so I definitely wanted to train here.
Q: Why have you stayed at YSM?
A: Yale is a good, well-rounded place to learn infectious diseases. I really like the infectious diseases section here. They are very supportive. So, as my fellowship came to an end, it seemed only natural to stay. I was lucky enough that the section was looking for faculty for the newly acquired Saint Raphael Campus, which has turned out to be a perfect fit for me. I knew I would be able to continue to get a well-rounded infectious diseases experience and explore academic interests. Additionally, my wife was pursuing a career in Geriatrics, and Yale has an outstanding Geriatrics program, so It really worked out well for us to stay here at YSM.
Q: Tell me about your work in hepatitis C?
A: During my second year of infectious diseases training, I underwent additional training in HIV and hepatitis C and was treating patients with hepatitis C at the VA [VA Connecticut Healthcare System]. This coincided very well with this new treatment for hepatitis C, an oral pill regimen, which has transformed how we treat patients with the disease. Andre Sofair, MD, MPH in the Yale Primary Care Program wanted to start a clinic at the YNHH Saint Raphael Campus to treat patients with hepatitis C, so we teamed up to open a clinic within the Primary Care Center in the summer of 2015. We are putting together a manuscript to publish on our experience.
Q: How has the treatment for hepatitis C changed?
A: From the 1990s until 2013, treatment was generally a combination of interferon injections and a ribavirin pills, but this treatment had a huge number of side effects, so many people didn’t tolerate the therapy. Also, success rates were low, so most people did not end up getting treated. With the new oral regimens, the cure rates approach 100 percent and are very well tolerated. In the end, most people can get treated for 8 to 12 weeks with daily administration of a pill, so it's pretty remarkable.
Q: What is your career goal?
A: Unfortunately, we are seeing a lot of newly diagnosed patients with hepatitis C due to the opioid epidemic. We are really making inroads in treating the baby boomers, but there's a second wave behind them, young people who were infected due to injecting drugs. Unfortunately, I don't foresee there being an end in sight for treating hepatitis C, so one of my goals is to continue our clinic and expand the model to the other primary care centers if there is interest.
My other goal is the improvement of how we practice outpatient parenteral antibiotic therapy. There are probably 1000 patients a year between both YNHH campuses that get discharged from the hospital on intravenous antibiotics. These patients have an infection that requires a long course of intravenous antibiotics, but they are stable enough to leave the hospital. These patients require frequent follow-ups with us. They may have a number of side effects from the antibiotics or from the PICC line itself, so they require incredibly close monitoring. Some of my colleagues and I are working to standardize this process across both campuses and track the results with a database we are creating. I think it will improve outcomes and provide some exciting research opportunities.