For a historian interested in medicine's response
to the emergence of HIV/AIDS, there could probably have been no
greater vantage point than the NIH intramural program in the early
to mid-1980's. Dr. Victoria Harden, founding director of the Office
of NIH History in the Office of Communications and Public Liaison,
found herself in this privileged position, having arrived on campus
in 1984. At the third annual NIH History Day on Sept. 22, she treated
a Lipsett Amphitheater audience to an overview of NIH's assault
|NIH historian Dr. Victoria
Drawing on more than 20 years of research that will be incorporated
in a book about AIDS research at NIH, Harden reviewed milestones
in the epidemic. Such significant NIH contributions as co-discovery
of the agent that causes AIDS, and the first efficacious treatment
against the virus, served not only to honor individuals such as
former NCI virologist Dr. Robert Gallo (who was in the crowd) and
former NCI director Dr. Samuel Broder (who helped develop AZT)
but also to underscore the strengths of the intramural research
Indeed, the event began with an explanation of why NIH was in
such a good position to address the disease, which first came to
public attention in the summer of 1981. According to NIH deputy
director for intramural research Dr. Michael Gottesman, five factors
contributed to NIH's swift and productive response: a "critical
mass" of scientific expertise, especially experts in retroviral
biology; research infrastructure, including a Clinical Center willing
to admit patients with the new disease; the tight link between
clinicians and bench scientists; NIH's close ties with Congress,
patient groups and extramural colleagues, who could coordinate
efforts; and leadership at NIH that was "not just visionary, but
also courageous, both personally and intellectually.There was a
willingness to take risks, to drop what you were doing and head
in a new direction."
Perhaps the most prominent dropper of what he was doing was NIAID
director Dr. Anthony Fauci, who offered personal reflections on
the epidemic. He had been an NIAID clinician on the 11th floor
of Bldg. 10 when the first report of Pneumocystis carinii pneumonia
in a population of gay men was published in June 1981. "It was
just a curiosity," he recalled. "I thought it was something drug-related." A
month later, when a second report appeared, Fauci said he got goose
pimples. "I knew something was terribly, terribly wrong.It prompted
a major switch in my research direction. I was able to turn my
lab on a dime to focus on a disease that had no name, and, as yet,
| Dr. Michael Gottesman, NIH
deputy director for intramural research, outlined five reasons
why the campus was well-positioned to take on AIDS research.
|Harden and NIAID
director Dr. Anthony Fauci each gave their perspectives on
the first decade of NIH intramural AIDS research.
Within 3 years, the HIV/AIDS virus was found, owing largely to
what Fauci called "exquisite science" and massive new funding that
today represents 10 percent of NIH's research budget. Noted Fauci, "If
you put the resources in, you galvanize talent and get extraordinary
"We're still in the midst of the pandemic," he said. Some 40 million
people worldwide are thought to be infected with HIV/AIDS. "But
the amount we've learned has been unprecedented in the history
Harden's keynote address focused on the "intellectual history
of how the biomedical community came to understand this syndrome." Prior
to the AIDS epidemic, NIH had been institutionally unwieldy, a "great
ship" that lacked maneuverability, except in its intramural component.
It set formal boundaries between its interests, and those of sister
agencies FDA and CDC. Despite warnings that infectious diseases
were likely to become a major public health issue, NIH focused
primarily on chronic diseases.
An explosion of new knowledge in molecular biology took place,
roughly between the Hong Kong flu epidemic of 1968-1969 and the
advent of AIDS. "There was a major intellectual shift, and lots
of new discoveries in molecular biology and immunology," said Harden.
Among the best and brightest of that era were an inordinate number
of alumni of the NIH Clinical Associates Program. Just as AIDS
hit, NIH hosted a cadre of mid-career scientists, "most in their
early 40's, and most experienced in clinical work and research." This
army of sophistication attacked the new disease piecemeal; Harden
recounted the litany of now-famous names in AIDS pathogenesis studies,
etiologic work and, eventually, therapy.
Harden's account of the AIDS era through 1990 didn't overlook
lowlights along the way, including the inevitable grumbling over
first authorship on scientific papers, the tendency of large, well-funded
labs to snatch the successes of smaller ones, and the much-publicized
international dispute over which group of scientists first discovered
the AIDS virus. It was also sobering to realize, as the late deputy
director of NIAID Dr. James Hill once pointed out, that actor Rock
Hudson's death from AIDS did more to spur increased AIDS funding
than any research breakthrough did.
AIDS changed the way NIH works, Harden concluded. It pushed NIH
back to its historical roots in bacteriology by underscoring the
importance of addressing emerging and re-emerging infectious diseases.
It made NIH a household name, ushering in an era of surging public
interest in all matters of health. And it had the democratic virtue
of opening NIH to the influence of public activists; Fauci characterized
NIH's interaction with activists as "very productive."
"AIDS itself is not yet history," noted Gottesman. "There are
more people working on it than ever in the history of NIH.We hope
one day to declare victory."
The NIH History Day talks are archived at www.videocast.nih.gov,
and the Office of NIH History's web site (http://history.nih.gov)
has an extensive AIDS history collection.