Julius (Julie) Schachter: A Legend in the STD Field Who Changed the Trajectory of the STD Journal

A man for all seasons is defined by his conscience, remains true to himself while adapting to all circumstances and times despite external pressure or influence—Robert Whittington (1520) It is an honor to reflect on Julius Schachter's extraordinary career advancing Chlamydia trachomatis prevention and its impact on the lives of millions worldwide. Along with his mentorship of researchers and public health professionals, he changed the trajectory of the Sexually Transmitted Diseases (STD) journal. His contributions span numerous scientific disciplines, from basic immunology and pathogenesis to applied diagnostic and treatment studies using innovative clinical science and epidemiologic methods. He engaged in implementation and translational science for chlamydia prevention well before these disciplines were supported by the National Institutes of Health. GB: I first met Julie in 1986, when I entered the field of STDs as an outsider, taking on the role of San Francisco's STD Prevention Program Director, feeling unqualified. A few months into my new position, Julie called and invited me to his cluttered little office at the San Francisco General Hospital. Despite not knowing much about me, he suggested I focus on bacterial vaginosis, an area that lacked attention at the University of California, San Francisco, and offered the lab support. I told him my interests lay more in bridging science, policy, and programmatic efforts to make programs more evidence-based and science and policy more programmatically relevant. Thus, began a 34-year journey of mentorship, collaboration, and friendship between Julie and me. Although Julie lacked formal training as a clinician, epidemiologist, or public health practitioner, he recognized early that groundbreaking studies on chlamydia prevention required collaboration with clinicians, epidemiologists, and public health practitioners. A comprehensive account of Julie's seminal contributions to the field of chlamydia research exceeds the length allowed for this article, but we aim to highlight his unique impact on chlamydia prevention in several key areas. First, Julie's pioneering work in laboratory research led to the development and widespread availability of diagnostic tests for chlamydia, including tests utilizing self-collected genital and extragenital specimens. This advancement enabled innovative accessible chlamydia screening models, such as express visits and self-testing outside of a clinical setting, enhancing our ability to detect this common infection. Second, Julie's investigations into the human immune response to C. trachomatis infection have underpinned nearly every advance in understanding the pathogenesis of this infection and preventing devastating infertility sequelae through screening. Pelvic inflammatory disease, the precursor to infertility in young women, declined from 2006 to 2016. This decline is unlikely without Julie's advocacy demanding improved screening rates among young people. Third, Julie's clear and pragmatic thinking, skeptical nature, questioning of the status quo, and speaking out almost single-handedly shaped and improved the chlamydia research agenda of the National Institutes of Health, Centers for Disease Control and Prevention (CDC), and other funding bodies. In the mid-1960s, when sexually transmitted chlamydia was overlooked, he challenged the New England Journal of Medicine (NEJM). After identifying epidemiologic links to chlamydial conjunctivitis, he proposed a larger genital tract reservoir than the occasional case of conjunctivitis indicated and argued for its public health significance. The NEJM initially rejected his articles; according to Julie, because the topic was not of interest to their readership despite saying his observations were scientifically valid. But in 1978, the NEJM recognized that this STD was significant enough to publish his landmark series on chlamydia infections. This experience likely influenced how Julie reviewed articles during his tenure as editor in chief of the STD journal. Titles of his publications reflected his passionate opinions and unreserved honesty, including “Detection of C. trachomatis by Nucleic Acid Amplification Testing: Our Evaluation Suggests that CDC-Recommended Approaches for Confirmatory Testing Are Ill-Advised.” In the 1990s, when the CDC started funding chlamydia projects, Julie submitted a thoughtful proposal outlining the more important questions he thought the field should be asking. Although the proposal was unfunded, the next year the CDC released a new funding opportunity announcement that closely resembled Julie's proposal. Lastly, there are intangible attributes among scientists that are sometimes undervalued or go unnoticed, including integrity, collaboration, and mentorship. Julie exemplified these attributes throughout his career, particularly through his unwavering dedication of time and intellectual energy to mentoring multiple generations of young investigators and public health professionals. Julie was always available to help colleagues become the best versions of themselves. JC: In 1984, while searching for a dissertation topic related to PID, I came across Julie's NEJM chlamydia series and noted that all reproductive sequelae studies were either from Scandinavia or had methodological limitations. I pitched a more robust unfunded study design to Mr. Chlamydia himself which included participants from San Francisco and Los Angeles, a first. Julie quickly embraced the idea and got his laboratory team involved; without his support, I would not have had the career that I was fortunate to have. JM: Hired fresh out of college, I started as an entry level research technician in his laboratory. He was a daunting figure and his first comment about me was “who is that little girl?” Despite being young, I was eager to learn, and Julie saw potential in me. When I sought permission to write up a case report (my first paper), he encouraged me. Although he butchered my draft, he guided me through the revisions, and it was published. Throughout the years, Julie continued to mentor me in “all things chlamydia.” I was proud to be his lab manager and the Assistant Editor of STD. In addition, nothing was beneath Julie or too unimportant for his time or wisdom. GB: Julie was always willing to give state of the art chlamydia lectures for our STD Prevention Training Center, whenever asked, always without honoraria and even for classes with as few as 20 participants; the only thing he wouldn't agree to was having any of his lectures taped because he said, “what I say today could be outdated tomorrow.” However, we believe one of the most significant and unrecognized aspects of Julie's career was when he volunteered to lead the STD journal in 1989 (Fig. 1). Figure 1: Dr. Julius (Julie) Schacter. Over the ensuing 25 years, he changed the trajectory of this journal as the Editor-in-Chief. He improved the quality and quantity of articles and broadened the reach of content to cover not just scientific studies of academic interest but also areas of research translation and program science, implementation, and evaluation. He established a robust peer review process and created a diverse team of Associate Editors. Rather than simply rejecting sub-par work, he helped authors to improve their papers if he believed they could advance STD prevention. “Good enough” was always his mantra. Under his leadership, the journal became an inclusive platform for students and young professionals to publish as first authors. He added new sections more practical and relevant to local STD public health practice, including “The Real World of STD prevention” and a column for “Notes from the Field.” He encouraged the publication of “Supplements” that focused on specific issues. The publications frequency increased from 4 times a year to monthly. Submissions surged annually from 85 to 439, and the impact factor rose from 0.7 to 2.4. Although Julie was not a big fan of the impact factor, he acknowledged that until a better measure of the impact of scientific articles on practice is found, it indicates that someone read and cited the article rather than it sitting idly on a library shelf after publication. Julie understood that it takes a village to prevent STDs. He built an incredibly strong chlamydia prevention village of scientists, public health practitioners, clinicians, industry stakeholders, community members, and policymakers. His career is a model that future academics, program directors, and policymakers should be mindful of when working in the field of STDs.