Doctor Who Dedicated His Life to AIDS is Now the Head of the Department Preparing for Avian Flu
WASHINGTON, Nov. 22 — Anthony S. Fauci credits his Jesuit education with teaching him social responsibility. His years at Holy Cross College, and earlier at a Jesuit high school in his native New York, were long on philosophy, languages and ethics, but relatively short on sciences.
“I loved it,” said Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health for more than 20 years.
In selecting a career, specifically medicine over science, Dr. Fauci said he was guided as much by the fact that he was a “people person” as by his aptitude for science.
“I particularly like the idea of discovery and problem solving, and that intellectual philosophy that goes along with science,” he said.
Dr. Fauci is now a science administrator and lab director, as well as a policy adviser to the highest echelons of the U.S. government on such topics as AIDS, bioterrorism defense, and flu. If the much-discussed bird flu becomes a global pandemic, he will be one of the top advisers to the president. However he continues to see patients in the institute’s clinic twice a week, a commitment that is all but unheard of among directors of the NIH institutes.
“Every institute director says they do some [patient care],” said Samuel Broder, former director of the National Cancer Institute, “but it’s ceremonial.” He said Dr. Fauci was the only institute director who still dons a white coat and treats patients on a regular basis.
“My fundamental identity is as a physician,” Dr. Fauci said. “I cannot not see patients.” His continued involvement with patients also makes him a better medical administrator, he said, and keeps him in touch with reality.
But his demanding schedule leaves him little time for seeing patients. As institute director, Dr. Fauci must oversee and advocate for research on a very broad spectrum of health issues. A typical week will find him talking to Tim Russert on “Meet the Press,” for example, or speaking to National Public Radio’s “Talk of the Nation” on its “Science Friday” show.
Perhaps because of his background in the humanities, Dr. Fauci is regarded as a good communicator by his colleagues and friends. They say he is exceptionally good at explaining complex ideas-like the differences between bird flu and seasonal flu, for example, or the need for long term preparedness for cyclical epidemics of influenza-in terms that are easy to understand.
Charles A. Dinarello, who worked with Fauci at the institute and is now a professor of medicine at the University of Colorado, calls him “a layman’s spokesman.” Whether he is speaking about HIV or pandemic flu, said Dr. Dinarello, Dr. Fauci is able to talk at the public’s level, offering “knowledge without fear.”
Dr. Broder echoed Dr. Dinarello’s praise, noting that Dr. Fauci does not talk down to the public, and that people sense they can trust him.
As the institute’s director, Dr. Fauci oversees many projects, but his own lab work is focused on AIDS. He has been an AIDS researcher since the disease was nothing more than a puzzling group of symptoms showing up in gay men from major U.S. cities.
In 1981, Dr. Fauci was researching the immune system at the institute, studying autoimmune diseases like lupus and vasculitis. In June of that year he read about the first few cases of what would be called HIV in a report put out by the Centers for Disease Control and Prevention. By July, it was clear there were enough cases that the disease was not a fluke.
“That was the turning point of my career, if not my life,” said Dr. Fauci. He stopped his former research, to the dismay of many of his colleagues, and his lab began to focus solely on HIV.
It continues to be the focus of his lab work to this day. For the past 21 years since the virus HIV was discovered, Dr. Fauci has been studying the mechanisms by which the body destroys the immune system, hoping to find a way to stop it.
Dr. Fauci called finding a vaccine for HIV “one of the most difficult scientific problems.” He explained that the best vaccine is a small dose of the infection itself which the body then fights off and “remembers,” storing antibodies that will make it resistant the next time it meets that virus. That idea of a vaccine assumes that a majority of people can spontaneously recover from the disease in question. No one has ever spontaneously recovered from HIV.
Dr. Fauci said that is why his lab is working to understand what makes the body incapable of fighting HIV. Until that is found, there will be no vaccine.
The frenetic pace that Dr. Fauci’s work requires has its trade-offs. “I don’t sleep very much,” he said. He works “outlandish hours,” he said, coming in to work at 6:30 a.m. and often working until 10 or 11 p.m. six days a week.
When his three teen-aged daughters got old enough, the family made it a point to start eating together at 9:30 every night, a practice Dr. Fauci described as “not particularly healthy,” but which allowed him to finally have a nightly dinner with his family. Lunch can be a tiny carton of Ben and Jerry’s “Cherry Garcia” ice cream between meetings.
“We’ve kind of gotten used to it over the years,” said Dr. Fauci’s wife Christine Brady, a medical ethicist at NIH. She works full-time as well, and the family had a live-in babysitter for many years, she said.
Drs. Fauci and Brady met when a patient of Dr. Fauci’s needed a Brazilian Portuguese translator and Dr. Brady who had spent time working in Brazil, spoke the language. A few weeks later Dr. Brady was walking down the hall and Dr. Fauci asked her to see him in his office before she left for the day. She thought it was about the patient. Instead, he asked her out to dinner.
Dr. Fauci is generally admired by his colleagues as someone who cares deeply about his work and the people it effects, but there was a controversy in 2002 concerning the ethics of some research the institute was involved in.
This centered on nevirapine, a drug administered to women with HIV in Africa to prevent them from passing the disease to their infants. A doctor inside the institute, Jonathan Fishbein, contended that research done on the drug in Africa was so flawed that health officials had to take blood samples from patients to determine whether they had been administered the drug. He charged that top officials, including Dr. Fauci, had information about side affects from the drug that was not reported to the Food and Drug Administration and the White House in a timely manner.
A panel from the National Academies’ Institute of Medicine, a non-profit organization that advises the nation on health matters, examined these claims this year, and determined that while there were flaws, they did not lessen the effectiveness of the drug in stopping the spread of AIDS in Africa. “They agree with what we originally said,” Dr. Fauci said.
Dr. Fishbein, who was terminated, said he could not comment because of a pending law suit.
Despite this controversy, Dr. Fauci is regarded by many of those who work with him as a dedicated scientist and humanitarian. Clifford Lane, acting deputy director of the National Institute of Allergy and Infectious Diseases, said of his boss, with whom he has worked since 1979, “As a scientist, Dr. Fauci is motivated to discover new things, as a physician.to improve the health of his patients, and as an institute director, he is strongly motivated to make new developments in medicine.”
Sidebar
“There’s a constant, metaphorical battle between microbes and human beings,” said Dr. Anthony S. Fauci, “And every once in a while you get a potential for real catastrophe, like pandemic flu.”
Flu, Dr. Fauci said, is totally unpredictable. History can provide a guide, but no guarantees. Every year the world population is exposed to what he calls “seasonal flu,” which changes slightly each year, a process known as “drifting.” Since 1968, the seasonal flu going around has been H3N2.
To keep up with drifting, Dr. Fauci said, vaccines change slightly year to year.
But ordinarily the changes in the virus are small enough that past years’ exposure offers people some protection, and there is no major public health risk. Even so, Dr. Fauci, 36,000 people are killed each year, just by seasonal flu.
A pandemic occurs when “a brand new virus, to which we’ve never been exposed, attacks the human race,” said Dr. Fauci. This has happened three times in the last century. In 1918 there was a catastrophic pandemic, which caused 50 million deaths worldwide, half a million to 700,000 in the United States. It was the worst pandemic mankind had ever experienced, including the Black Plague, he said.
The years 1957 and 1968 saw pandemic flu as new strains of the virus emerged, but each was relatively mild compared with 1918.
The bird flu, which has killed more than 60 people in Southeast Asia and recently appeared in China and Indonesia, is a “potential candidate for pandemic flu,” he said, because the human species has never been exposed to it. It is H5N1, a wholly different strain from seasonal flu. If it mutates to be spread efficiently from person to person, he said, it could be a threat.
The likelihood of a pandemic arising any one year, Dr. Fauci said, is very small, but the likelihood of it happening sometime is virtually inevitable.
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