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Point Guard in AIDS Fight
Fauci Attributes Success to Hard Work, Listening

By Robert Bock

The days are long, but rewarding, said Dr. Anthony Fauci of his position as director of the NIAID. Typically, he arrives in the office before 7 a.m. and doesn't leave until 8:30 or 9 p.m. He works weekends as well.

"The time component can drain your energy, but that's balanced by the energizing aspect of our mission, goals and accomplishments," he said. "The balance tips in favor of feeling very good about what you're doing, as opposed to feeling washed out."

Fauci joined NIAID in 1968 as a fellow in the institute's Laboratory of Clinical Investiga tion and rose steadily through its ranks. In 1974, he became head of the lab's clinical physiology section, and, in 1977, became the institute's deputy clinical director. In 1980, he was appointed chief of the Laboratory of Immunoregulation, a position he still holds. He became the institute's director in 1984. During his tenure, funding for AIDS research has risen from $60 million a year to just under $2 billion a year.

Dr. Anthony Fauci

During his early years as director, Fauci was often the target of AIDS activists, who held that the federal government was not doing enough to combat the emerging threat of the virus. One group went so far as to hang him in effigy. Although such confrontational tactics put off many of his colleagues in AIDS research, Fauci tried to see beyond the theatrical nature of their protests and listened carefully to what they had to say. As a result, the activist community became one of his greatest supporters.

"There was substance to the points they were making about clinical trials, about drug approvals, and about the direction of research in this area," he said. "They sensed my good intentions, and gave me a degree of trust that they had not given very many other people."

Fauci added that this mutual understanding led to a collaboration that ultimately became a model of interaction between scientists and their constituency groups.

In managing his institute, Fauci said he tries to keep himself well informed and sets the direction the institute should take. He relies on a philosophy he first learned from then NIAID clinical director Dr. Sheldon Wolff, who first recruited him to the institute.

"Surround yourself with the best and brightest people you can find," he said. "Don't feel that their expertise will lessen your authority — it will only amplify your capabilities."

This approach, he added, worked as well for him when he first managed a lab as it does in his current position as institute director. Fauci cautions against micromanaging one's staff. Rather, he said, he makes himself available for those who have questions, and listens carefully to any new ideas they might have. "Otherwise, I stay out of their way."

Regarding his institute's priorities, Fauci said he feels one of the greatest threats to humanity is emerging and re-emerging infectious diseases. At times, such disease entities can burst forth as deadly little blips on the radar screen, like the Ebola virus, during its last appearance in 1997, which swiftly killed about 100 people before disappearing. More alarming, he said, are the large-scale epidemics that can have a major impact on world health in a comparatively short time. The influenza epidemic of 1918 killed 750,000 people in the United States and more than 20 million throughout the world. More recently, the AIDS epidemic is uncontrolled and accelerating, particularly in developing countries.

"That's the nature of the interaction between microbes and humanity," he said. "There will always be a constant back and forth fighting for survival between the two."

Fauci believes, however, that major inroads against the infectious diseases threat will come from the ability to sequence the genomes of microbes. By learning how their genomes are structured, scientists will be better equipped to diagnose infectious diseases, design treatments for them, and vaccines to prevent them.

Another promising area under NIAID's purview, he said, is greater understanding of the immune system. Through unraveling its secrets, researchers may be able to prevent transplant rejection and to combat disease in which the immune system attacks the body's own organs and tissues — without resorting to toxic drugs. Similarly, greater knowledge of the immune system may also lead to design of more effective vaccines.

To date, the most challenging disease NIAID has had to contend with is the AIDS virus, he said. The institute has made great progress in understanding the pathogenesis of HIV infection as well as in developing an armamentarium of drugs to hold the disease at bay and prolong life. Still, progress has not come as quickly as Fauci would have liked.

"We still have a major problem with developing a vaccine," he said. "It's a problem that can be overcome, but, as in all complicated problems in biomedical research, it's going to take time."

Although he has learned much from his role as lab manager and institute director, Fauci credits a high school experience with teaching him one of life's greatest lessons. While a student at Regis High School in New York City, he played point guard for the school's basketball team.

"As good as you think you might be, it's not possible to do many good things alone," he said. "When you're part of a team, you have your own talents amplified and synergized with the talents of others — you make other people look good, and they make you look good."

The lesson, he explained, also applies to scientific research. Although individuals working alone have made striking discoveries in the scientific arena, research also involves a great deal of teamwork and reliance on others.

"Playing sports in high school was a really important lesson in how individual effort synergizes with a team effort, and how team effort can make an individual accomplishment look even more impressive."

(The author is the press officer for the National Institute of Child Health and Human Development and a member of the NIH Management Cadre class of 2000. This article resulted from an assignment to study science and leadership at NIH. Information about the NIH Management Cadre Program is available at http://mcp.nih.gov/.)


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