The Radcliffe Institute for Advanced Study at Harvard University is one of the world’s leading centers for interdisciplinary exploration, and Krishnan will be the Jeffrey S. and Margaret Mais Padnos Fellow during her yearlong fellowship there. 

“I’m honored to have won a Radcliffe fellowship,” she said. “In any given cohort you might find poets, playwrights, astronomers, mathematicians, historians and literary scholars all in conversation, and I’m deeply honored and excited to be part of that community.”

Krishnan, an assistant professor in the Department of Medicine at Georgetown University Medical Center and the Department of English in the ������Ƶ & Sciences, has a DPhil in English from the University of Oxford and an M.D. from Johns Hopkins University. She said she came to Georgetown in 2020 in part because she was drawn to the university’s interdisciplinary environment. 

“Students gravitate naturally toward work that crosses disciplines,” Krishnan said. “And the faculty are welcoming of it. Many of them are leaders in polyglot thinking and approaches. …It’s part of something I value deeply about Georgetown, which is its commitment to intellectual production in service of social and communal good.”

Her work on the Hilltop spans the history of medicine, literary studies and clinical research, and her interests include diagnostic thinking and clinical reasoning, as well as the pressing problems of diagnostic disparities and the diagnostic error in patient care. Krishnan has also published widely on historical and contemporary pandemics. 

“Dr. Lakshmi Krishnan’s scholarship is both exceptional and transformative in that it contributes substantially to both of her academic fields,” said , a professor and chair of the Department of English. “The significant recognition that she has received from prestigious fellowships like that of the Harvard Radcliffe Institute is a testament to the impact of her innovations. Through this fellowship and through her outstanding scholarly research, she is highlighting the interdisciplinary academic excellence of Georgetown’s English department, Medical School and Medical Humanities Initiative in an extraordinary way.”

In her upcoming book, Krishnan hopes that readers will learn a different understanding of where clinical reasoning comes from. 

“We tend to think of diagnosis as purely scientific, but it owes as much to narrative imagination as to the scientific method,” she said. “The doctor and the detective emerged as twin figures in the 19th century, and that kinship still shapes how physicians think today.”

(Top photo of Lakshmi Krishnan by Tina Krohn)

In published in Nature Ecology and Evolution, researchers set out to understand whether animals adapted to living in cities tend to have different viruses. The study was led by , a postdoctoral fellow in the at Georgetown University ������Ƶ and Sciences.

The COVID-19 pandemic has sparked substantial interest in where future outbreaks are at the highest risk of emerging. Scientists have long suspected that cities might be a hotspot for outbreak risk, thanks to species like rats that make their home alongside us. For Washington, DC, those problems are now close to home: in March 2022, the U.S. Centers for Disease Control and Prevention announced that the growing rat problem allowed a respiratory virus called Seoul hantavirus to infect two people in 2018.

Albery set out to study whether species like rats might play host to a greater number of these pathogens. In the study, Albery and colleagues examined the pathogens hosted by nearly 3,000 mammal species, and found that urban-adapted animals could host roughly ten times as many kinds of disease. However, they found that pattern was partly a problem of sampling bias: the same species were nearly 100 times better studied in the scientific literature.

“There are plenty of reasons to expect urban animals to host more diseases, ranging from their food to their immune systems to their close proximity to humans,” said Albery. “We found that urban species do indeed host more diseases than non-urban species, but the reasons for this appear to be largely associated with the way we study the ecology of disease. We’ve looked more at animals in our cities, so we’ve found more of their parasites—and we’ve started to hit diminishing returns.”

To Albery’s surprise, after adjusting for sampling bias, the team found that city-living species don’t seem to host more human-infective viruses more often than their rural counterparts. “Stunningly, although urban-adapted species have 10 times as many parasites, more than 100 times as many studies have been published on them. When you correct for this bias, they don’t have more human pathogens than expected – meaning that our perception of their novel disease risk has been overinflated by our sampling process.”

The study’s findings might exonerate city wildlife from being “hyper-reservoirs” of infectious disease. However, Albery cautions, that doesn’t mean cities are disease-free.

“This probably means that urban animals aren’t hiding as many important novel pathogens as we might think – those pathogens that might cause the next ‘Disease X’,” said Albery. “But they are still incredibly important carriers of many pathogens that we do know about. Rats, raccoons, and rabbits are still good at coexisting alongside us, and they still spread a lot of diseases to humans living in urban areas.”

, an author on the study and an assistant research professor at the C at Georgetown University Medical Center, said that the study highlights the value of scientific data. The researchers used a database called The Global Virome in One Network, created by the Verena Consortium (viralemergence.org), an open science network founded by Carlson and Albery.

“If we take the time to build better datasets, and look more closely at the patterns in them, we might keep overturning long-standing assumptions about who’s at risk from emerging diseases and why,” said Carlson.

The study concludes that future research should go beyond how many pathogens any given animal has, and start to explore how city living shapes the prevalence and transmission of those diseases. Understanding those phenomena may require researchers to collect much more data, particularly from new places; almost all of the disease data in the study came from the United States and Europe.

“What this really accentuates is that we need to design more evenly distributed, more equitable sampling regimes if we want to find novel pathogens of humans; sampling needs to be more focused in wild areas of the world, but also in urban areas in less well-studied places,” said Albery. “Not only will this help us to find the new ones, but will improve surveillance of the old ones, and will ultimately help to address ages-old geographic biases in ecology.”

, M.D., Ph.D. and director of the program, says that “the minor comes at an opportune time for Georgetown and our greater DC community.” 

“The Medical Humanities, Culture and Society minor brings together traditional strengths of our institution — health education, research, scholarship and teaching in the humanities and social sciences,” she explains. “The need for the diverse perspectives in the growing medical humanities field has become more apparent than ever during the COVID-19 pandemic.” 

About the Medical Humanities Minor

Launched in 2019, the Georgetown Medical Humanities Initiative offers interdisciplinary courses open to undergraduates and medical students, an event series and a research mentorship and fellowship program. Due to the initiative’s success, the minor strives to re-center health and healing in a broader social, cultural and historical context. 

“This minor demonstrates that the rigor of scientific data and the spark of imagination can work together with exciting results,” says Nicoletta Pireddu, director of the . 

A unique strength of this program lies in its collaborative nature as well as it’s alignment with the university’s commitment to cura personalis. 

“Health practitioners cannot treat ‘the whole patient’ without recognizing and valuing their humanity in its many facets,” says Krishnan. “This minor engages faculty and students across the medical center and the arts and sciences, which opens up opportunities for creative, transdisciplinary teaching, research and collaboration.”

Soyica Colbert, dean of Georgetown College, notes that COVID-19 has underscored the need for this work now more than ever.

“As the pandemic has demonstrated, the future of healthcare will depend on our ability to attend to our interconnectedness and common humanity,” she says. “A cross-campus collaboration, the Medical Humanities brings together deep exploration in the sciences with rich humanistic inquiry that foregrounds ethical concerns and fosters dialogue.” 

Students who study the humanities alongside the sciences develop critical and analytical skills, research expertise, intellectual and cultural community and balance in their academic careers. Those who are interested in interdisciplinary areas such as narrative medicine, history of medicine, science and technology studies, public health, medical anthropology and ethics will benefit greatly from the minor’s course offerings. 

“The art of healing and wellness often goes beyond the tremendous advances made in science,” says Ed Healton, executive dean of Georgetown University’s School of Medicine. “Addressing the many facets of a person’s wellbeing – both patient and caregiver — requires creative approaches that are learned from many disciplines including art and literature. Those who experience the human condition through these different perspectives bring a holistic approach to human interactions.”

The interdisciplinary minor in Medical Humanities, Culture and Society will require three core courses and three electives and is designed to provide students with a firm foundation in the field. 

Students across the College, NHS, and SFS will be able to apply to the minor without application. Further information on the minor can be found on the Medical Humanities page. .

The group makes the case in an article, “” published in the Journal of Hand Surgery, and says it helps lay the foundation for other medical practices in the future.

The two senior authors of the article also share the name Michael Kessler, in addition to their mutual desire to engage in cross-campus research collaborations.

Handling Elective Surgery 

The coronavirus pandemic created new challenges for the healthcare system. As cases increased and hospitals reached capacity, healthcare workers began evaluating surgical needs and suspended those deemed to be elective. 

Michael J. Kessler, Ph.D., J.D., Michael W. Kessler, M.D. M.P.H., third-year medical student Philip Nelson (G’18, M’22) and fourth-year resident Stephen Lockey (G’17, M’17), the paper’s lead author, realized that due to the unprecedented nature of the virus, what qualified as elective hand surgery should be examined not merely on a surgical basis, but on a moral one as well. 

After drafting an article that laid out how the hospital guidelines ought to be developed from a clinical perspective, the doctors reached out to Michael J. Kessler, an ethics professor in the Department of Government and Theology and Religious Studies and managing director of the Berkley Center for Religion, Peace, and World Affairs, to develop the moral framework. He used the widely developed model developed by Kennedy Institute of Ethics professor Tom Beauchamp to create an implementable system. 

Michael J. Kessler, an ethics professor, explained that this was important to develop as what may be acceptable for a delay in one situation might be very detrimental in another. 

“For example, if you’re a 75-year-old retiree and you have an impacted tennis game due to a medical issue with your wrist, it’s different than if you are a 45-year-old day laborer who may not be able to earn an income after that point if you delay,” he says. “That is where our moral calculation comes into play.”

In their framework, the team outlined three considerations that must be evaluated before determining whether or not an individual surgery is elective or not. 

“First, a safe delay is possible only if deferral will not result in permanent injury,” says physician Michael W. Kessler, chief of Hand & Elbow Surgery in the Department of Orthopaedic Surgery. “Second, a delay in care will come with tolerable costs and impositions that can be appropriately managed in the future. Third, a safe delay will preserve the bioethical principle of patient autonomy.”

The group used three case study examples that consider individual patient characteristics and the pathophysiology of the condition. 

They have begun to examine other areas where their framework can be applied in medicine. Michael J. Kessler says that this collaboration allowed him and his colleagues to think about an issue through a multipronged approach. 

“What this demonstrated for me is how much opportunity there is for cross-campus cross-discipline conversations to take place,” he says. “It’s good to cast a wider net than the usual conversation partners, and I look forward to further interdisciplinary research with Michael W. Kessler in the future.”