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| Archive : Spring 2006 |
HOW FOUR DOCTORS SPENT THE LAST
QUARTER-CENTURY:
Watching, terrified, as a trickle of
patients became a flood // Battling, bravely, against
activist outrage and social stigmas // Searching,
without pause, for answers // Advancing, inexorably, toward
a cure.
25 Years of AIDS
 By
Michael Hirson
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T wenty-five years ago, casual sex
carried little fatal risk, and homosexuality was
seldom discussed in mainstream society.
But all that changed during the summer of 1981, when several gay men in
New York and California died of rare infections their bodies should have
fought off with ease. The emergence of a new affliction, soon christened
with what became a terrifying acronym—AIDS,
for acquired immune deficiency syndrome—led to seismic shifts in
sexual attitudes and forever changed the relationship
between patients and the medical system.
Few people had a more intimate view of those changes
than Anthony S. Fauci, Robert C. Gallo, Mathilde
Krim and Bruce Walker. In 1981 the four were at different stages of medical
careers that might have been spent quietly toiling in labs and clinics.
Yet by fate and by choice, they found themselves at the front of the race
to unlock the secrets of a new disease. In the years that followed, they
took on unfamiliar, often uncomfortable roles—as targets (and later allies) of activists;
as politicians and educators; as diplomats and foreign aid workers.
Here, the four describe what they’ve learned during a quarter-century
of fighting AIDS. Their insights extend beyond AIDS to inform our understanding
of how medicine should solve essential problems, whether cancer or the
next pandemic.
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ANTHONY S. FAUCI //
1981: Chief, Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, Md.
2006: Director, National Institute of Allergy and Infectious Diseases, Baltimore
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I got goose bumps when I read the first reports of pneumocystis and
Kaposi’s sarcoma in the summer of 1981. These two conditions are
usually found in people with suppressed immune systems, such as those
undergoing chemotherapy. That they were occurring in gay men in both
New York and California suggested we were dealing with something infectious,
possibly sexually transmitted and definitely new.
As someone trained in both immunology and infectious
diseases, I felt as if I were somehow cut out to study this new syndrome.
I put together a team, and we did research all day, then stayed up at
night seeing very sick patients, almost all of them dying. I realized
that if this disease were sexually transmitted, there was no way it
would stay confined to the gay community. But it would take a long time
to change the perception that AIDS was a disease of gay people. When
I pushed aside my other research to focus exclusively on AIDS, my mentor
asked, “Why are you diverting a great career for a disease involving
40 people?”
In 1984 I became head of the National Institute
of Allergy and Infectious Diseases and began pushing the Reagan administration
and Congress for more funding for research, which we finally got. The
irony is that because I was the one making noise about the disease,
I became the public face of government in the eyes of AIDS activists.
Larry Kramer, the founder of the AIDS Coalition to Unleash Power, attacked
me in the media. His group would say, “Fauci, why are you killing
us?” I’d think, I’m not killing you—I’m
trying to help you!
One day the activists were demonstrating on our
campus, and I invited several up to my office. They were shocked—no
one had ever seriously listened to them before. There was this attitude
that the science would be contaminated if you brought nonscientists
into the process. But once you got past the theater, the activists were
making a lot of sense—why shouldn’t someone with weeks to
live, for example, be allowed to take an experimental drug?
That meeting opened a dialogue between the activist
community, doctors and regulators that led to many important changes,
including how the Food and Drug Administration runs clinical trials
and approves new treatments. Our interactions also proved that the constituency
of a disease can have important input into the scientific and regulatory
process. This has transformed medicine, and now we see activists for
virtually every type of disease. That first meeting also led to a truce
with Kramer, who has become one of my closest friends.
AIDS has proven that if you put a lot of money
into solving a problem and plan carefully, you can produce almost unimaginable
levels of scientific achievement. There are now more FDA-approved antiviral
drugs for HIV/AIDS than for all other viral infections. We got this
far by galvanizing the government and the scientific community to work
on this challenge even before the rest of the world realized its importance.
The area of research I consider most exciting today is also the most
sobering—coming up with a vaccine. HIV is unique in that the body
cannot produce neutralizing antibodies against the virus. This has prevented
us from creating a vaccine in the usual way—introducing something
that closely mimics the virus in order to build up immunity. A vaccine
against HIV will most likely look very different from what we’ve
used against such viruses as smallpox and measles. I don’t know
how long it will take, but I plan on staying involved until we get there. |
Next page | Pages: 1 2 3 4
From top: Photo by Jeffrey Markowitz/Corbis; Photo by George Tames/The New York Times
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