King of NIAID for 27 years celebrates highpoints of life as bureaucrat/scientist
Retails HIV/AIDS lore as immovable research pyramid, with its foundation stone missing
We don’t dare mention mythbuster Nancy Padian except casually, and get odd reply
Unmissable event today was Dr Anthony Fauci at the Faculty House, Columbia, telling his life story as a bureaucratic as well as scientific achievement. Oddly enough, the notice put up by the Global Strategy Seminar Lecture Series Summer Fever The History and Future of PandemicThreats and Global Public Health and sent in email mentioned the $4.8 billion budget the NIAID director had to spend last year, but this suddenly shrank to half size on the Web and omitted that salient fact, which seems a pity, since it surely counts as Dr Fauci’s greatest achievement.
Since he has been in place since 1984 when its budget was $320 million, Fauci has brilliantly cultivated the friendship of every President from Reagan to Clinton to Bush and Obama, all of whom have come for a briefing on the “science” of AIDS, and all of whom till now have acquiesced in grossly exaggerated public spending on this, the greatest boondoggle in public health in history, without so much as a murmur of resistance.
None of them it appears wanted to go up against the gay activist lobby with its early tendency to lie in the streets and play dead and otherwise put pressure on Dr Fauci to give them special treatment, which he immediately caved into, as he recounted with his slides. He responded to the very first ACTUP demo outside his Bethesda window by inviting five representatives up to his office and going out of his way to give in to their demands from that moment onward. He soon after supported their bid to gain access to drugs being tested but as yet unproven, which got him into the New York Times and in trouble with his superiors at HHS until Reagan heard about it and overnight all was blessed. Gay activists have been his advisors ever since, he explained, on all protocols of testing new drugs, which in HIV/AIDS now amount to some 25 or so which is more than have been developed for any other disease.
Fauci tried a new drug out on some illness when he started his career, and it worked, and he was covered with glory at age 27, so he naturally views drugs with great optimism, it seems. With these three pillars of support – the drug industry, gay activists and friendly Presidents – he has built a house of funding like no other. The funding is the life blood of a system of theory that is equally massive, and when presented in slides enumerating all its aspects in successfully countering the dire threat of HIV, seemed by the end of his talk immovable, a great irreplaceable impenetrable mass of interlocking assumptions and suppositions that specific objections might penetrate no more easily than arrows bouncing off the Cheops pyramid in Egypt.
So although we had reviewed AIDS general Nancy Padian’s remarkable proof in 1997 that heterosexual transmission of HIV was effectively impossible before going up to Columbia this afternoon, and carried a copy with us, we did not think it either promising or polite to raise the topic with Dr Fauci at any point in this celebratory event. In fact, when Dr Fauci first appeared in all his miniature sartorial splendor we instantly took our camera and greeted with a warm handshake (he felt he must know me it was clear!) said we must have a picture of him because he always wears such good suits. In fact, we took the liberty of asking him a few minutes later who was his tailor, and to our amazement he let us know that all his characteristic finery was “off the peg”. In other words, it is simply Fauci’s trim physique and ramrod posture that allows him to project a Savile Row image, not any skillful scissoring.
There is also one other ingredient in this kingly bureaucrat’s success at court ie with the Oval Office, and that is his rosy cheeked flesh and blood warmth and enthusiasm for life and belief in what he does, which charmed all his listeners to his side, and makes them very reluctant – we found at least – to disturb his peace of mind with any awkward question about how his house of cards could accomodate Nancy Padian without it all falling down.
2.22.35 So the query we came up with, finally, at the end of the line of young admirers and behind the one in hot pants and tanned legs, was this: Since you are clearly a scientist as well as a doctor, Dr Fauci, in fact more of a scientist by nature, it seems, and you have presented the science of HIV/AIDS as a united front, as it were, we wondered if in ruling the NIAID for so many years you were now treated too much like a king, with your people now reluctant to mention to you any doubts whether the ruling wisdom in HIV/AIDS science was correct.
Was there a need perhaps for a Red Team in HIV/AIDS, along the lines of the teams in national security debates among experts trying to predict where the next threat would come from, which used scriptwriters and other creative types to imagine where terrorists might strike next? Oh no, replied our hero of AIDS, everything was very open to debate at NIAID, there was no inhibition in discussiong the problems still remaining.
So what were the still unsolved matters in HIV/AIDS science? Dr Fauci embarked with vigor on what appeared to be a favorite theme. The key puzzle in HIV/AIDS was why alone of all diseases the immune system was unable to keep it at bay by developing antibodies to it. After all, if a vaccine normally provoked antibodies to some threatening germ it would then work very well, since those antibodies would work well in repulsing and defeating the invader. But in the case of HIV, this was the last thing one wanted to happen, because it seemed those very antibodies were the signal of ultimate disaster.
We listened with fascinated horror to this absurdity as it unreeled, realizing that the director of a huge institution spending $4.8 billion worth of the public purse could not put two and two together for lack of will to even consider that his basic premise was false. The truth staring him in the face was that antibodies made to combat HIV did very well, as well as any other kind, and there was no scientific reason to suppose otherwise. There is negligible virus in the body after they have been raised – the needle in a haystack that PCR finds is effectively irrelevant, even if it were certain that it is actual viable virus (which is found only in 1 in 10,000 T cells of an AIDS patient, as we have known for 25 years). The antibodies work! They do their job. To wonder why they don’t is the speculation of a man blinded by a paradigm who cannot see in front of his nose. Or a director of the NIAID, it appears.
The meeting then broke up and people surrounded Dr Fauci to congratulate him and chatted to each other for about twenty minutes over coffee or Coke.
As he kindly wrote down his email in my notebook I said to him, So you definitely don’t need a Red Team, then, do you? but he didn’t reply.
Dr Fauci’s word on Padian result: Inexplicable.
2.47.30 We finally summoned up our resolve when Dr Fauci was spotted nearby with a junior sycophant, and joined him for a second. There’s one thing we wanted to ask you, what about Nancy Padian? Is she a reliable researcher? Yes, he replied firmly,Yes, she’s good! in a tone suggesting she was top notch in his book. So what about her study in 1997 when she couldn’t find a single transmission between heterosexual discordant couples, couldn’t find a single one over years.” Mmmhmm, said Dr. Fauci. Is that a big mistake, or what? ” I pursued.
“I don’t know,” said Dr Anthony Fauci. “I don’t know what… That’s unexplainable.”
“Yeah, funny thing, “I offered, hoping for more. But it was not to be. Dr Fauci suddenly decided it was time to go.
“Well, nice to see ya!” he said cheerfully, and departed.
“Yes, lovely, thanks very much,” I agreed with his receding, well fitted back. After all, I did very much appreciated his friendly manner and liberal responses to all my questions. Is there a warmer, more forthcoming top man in Washington, or in the whole of science? We’d say not.
But then as he himself said, his philosophy is simple. “It pays to be friends with everybody in Washington.”
And with everyone else, too.
The Holy Grail of HIV/AIDS science
Lest anyone get the wrong impression that Dr Fauci does not have all his theoretical ducks in a row, its only fair to give a verbatim transcript of our public question and answer, which went as follows:
Fauci: “In the government it’s pretty clear that you have got to be as transparent as possible. One the of the things that’s difficult in our day and age is the blogosphere. because any idiot can say whatever they want and it goes viral on you, and it’s kind of tough to play catch up with the truth now. That’s a hint about this movie that she mentioned!”
AL: Hi! My interest is in the science of HIV/AIDS and you’ve always been a bit of a scientist as well as a doctor in fact you seem more of a scientist than a doctor but you have presented the material today as if there really are no more questions or puzzles in HIV science and I think you’d probably agree that’s not quite true–”
“Yes yes” says Fauci cheerfully.
“What I wondered is if there is any kind of system at NIAID for people to make suggestions as to where you might have things wrong, a sort of Red Team, you know how in security they have these Red Teams now of scriptwriters and the like who suggest possible dangers and they deal with possible threats in that way, things they might not otherwise think of, is there a Red Team at the NIAID or are you somehow a king to whom the courtiers dont dare mention anything that might disagree with what you think?”
“I am treated with a phenomenal degree of disrespect!” laughs Fauci, along with the audience. “Don’t worry about that!” He went on: “We’re a free and open society at the NIAID, we do an awful lot of outreach to the scientific community. The granting process itself is a built in system for good ideas, the RO1 process of people putting interesting ideas in and getting peer reviewed but in addition to that we continually have workshops trying to figure out what the best approach is. It is clearly an ideas driven process as opposed to a king dictating what gets done. that in fact is antithetical to what science is. And by the way I am a pretty good doctor too! (Laughter).”
NSR: May I just ask you then what are the things we are still puzzled about that we haven’t solved yet? What kind of things are we wrestling with to see how they work?”
Dr Fauci: “Let me tell you the things that still give me headaches that we still dont know. The body does not make an adequate immune response against HIV. This is unprecedented in the history of any microbe. So if you look at the vaccines that we have made that are successful this is critical, because this is so unique that people don’t appreciate how unique it is. Take smallpox, polio, measles, three big killers and maimers. Smallpox kills 15 to 20 per cent of the people that it infects. That means 80 to 85 per cent get better and clear the virus. Polio its 90 per cent, 95 per cent. Measles doesn’t kill a lot but in some developing countries it kills a certain percentage. The interesting news is that a vast majority make an adequate response to kill the virus. So to make a vaccine we already have a proof of concept that the body is capable of making an adequate immune response that will not only clear the virus but will leave you with life long protection.
“Astoundingly that is not the case with HIV. The body does not make an adequate immune response. There is not one single case that has been documented about the 60 million people who have been infected, where somebody gets infected and gets the established disease and completely eliminates the virus from their body. ((Really? Aren’t you somewhat exaggerating things here, Dr Fauci? How about your so-called idiopathic cd4 deficiency or somesuch in which the vanishing of HIV in a body was renamed as such, or the thousands of HIV negative AIDS cases, described in Dr Duesberg’s book, and how about the vast majority infected who carry on for ten years on average without any sign of HIV’s effects or even presence until almost any disease overtakes them, even such as yeast infection, which is then put down to HIV, the HIV whose effects oddly enough are always known ailments which over ten years might bring anybody down with or without HIV, a virus which has no unique clinical conditions in its list of effects, as you yourself explained in your own paper on how antibodies plus other, cd8 cells suppressed HIV, in the book you and others wrote for doctors at NYU….but hey, who are we to interrupt the great man 9ontificating in the cause of his own cause celebre!))
“So we have a real problem. The real tenet of vaccinologists will tell you is that mimic natural infection and you’ll get a great vaccine, The one thing you dont want to do with HIV is mimic natural infection with a vaccine because natural infection doesn’t work.
“So we have the enormous challenge how do we get the body induce the body to make a response thats even more powerful than the natural response. That’s the one scientific issue that I think is the Holy Grail of HIV science!”
Of course, at that point, I should have said, Dr Fauci, Can I suggest an answer? Since there is very little HIV discernible in patients who have mounted an antibody response at any time, even when they are terminally ill with symptoms you ascribe to HIV, so little that it has to be detected by multliplying it geometrically with PCR, it does seem that HIV is a very effect stimulant of immune response, so effective that it works in a week or two in every case.
“So perhaps we have an answer to your search for the Holy Grail! How about HIV itself – could that be the Holy Grail you seek?!”
But of course one doesn’t want to rain on the parade of a man who has been invited to talk about his brilliant career. Especially the very likeable, enthusiastic, energetic Dr Anthony Fauci, one of our heroes of HIV/AIDS!