America's Doctor
Portrait: Anthony Fauci
"Tony has a great skill for taking complex medical issues and boiling them down to simple kernels of information," says Clifford Lane, clinical director of NIAID, who has worked with Fauci since the earliest days of AIDS. Indeed, that skill has defined Fauci's entire career. Fauci, who came to NIH right after finishing his medical residency, remembers reading the first reports of unusual infections in gay men back in 1981 and getting goose bumps, thinking that this could be an infection transmitted by blood or sex and that he had no idea what it was. "As every month went by, I became more convinced that we were dealing with something that was going to be a disaster for society." Fauci, who was working in a laboratory at NIH, started studying the mystery disease and bringing patients there for treatment. "As a scientist, you're quite used to living in a pretty quiet, secure world," says Lane. "All of a sudden that part of your life is in a fishbowl. You had the feeling you couldn't do anything right, because people were still dying."
AIDS and anger. Fauci became a point man not only in research on the HIV virus but in dealing with the terrified, angry people it infected. "He swallowed some really tough moments," says Robert Gallo, codiscoverer of the AIDS virus. Gallo remembers when AIDS activists--who felt that NIH was not moving quickly enough to get the anti-HIV drug AZT on the market--screamed "murderer!" throughout a speech Fauci gave at the New York Academy of Sciences. "He just kept giving his talk," Gallo recalls. "I would have walked out." When Larry Kramer, the playwright and AIDS activist, called Fauci a "monster" and "incompetent idiot" and insulted his wife, Fauci made a point of meeting with him. "Tony was always a lot more willing to listen to them than I was," says Christine Grady, Fauci's wife, a nurse and bioethicist whom he met at an AIDS patient's bedside. "He always looked for the messages." One message: The activists had something to offer the scientists. Fauci invited Kramer and other activists to take part in NIH decisions on treatments, an invitation that horrified many researchers at the time but has since become common practice at NIH and other medical institutions. Fauci and Kramer became good friends, and still E-mail each other frequently.
Fauci says: "What I learned from HIV/ AIDS was that from the beginning you gotta level with people, you gotta tell them what you don't know, and you've got to explain risks in a way that is realistic without making someone feel better than they should." He has followed that prescription precisely in addressing bioterrorism, although he realizes it's a bitter pill. Americans, he says, aren't used to dealing with risks they can't control. "Fear about bioterrorism is an absolutely appropriate natural response," he adds. "How you handle this fear and channel it into something productive--such as accelerated preparedness, alertness, awareness--that's the tricky issue."
Channeling that fear, for Fauci, meant expanding his usual six-day workweek to the point where he was sleeping two or three hours a night. That let the famously hard-working physician keep up with his basic HIV research and continue running NIAID, where he has served as director since 1984, and see AIDS patients. "It was totally adrenaline and Starbucks," he says. At the same time, he was hustling to speed up antibioterror research already underway, including the testing of antiviral drugs that could be used to treat smallpox and developing new smallpox vaccines. Those projects have been vastly expanded since September 11 and will grow more once the $248 million in new bioterror funding slated for NIH is divvied up. Studies on diluting the government's existing stock of smallpox vaccine are almost completed. "By early February we're going to know if we have 75 or 150 million doses, and when we have that, I think we're in good shape," Fauci says. "It's not enough to have a vaccine for every person, but if you have 150 million doses, you can do some real serious vaccination there."
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