The world of science in Bethesda, Maryland, stands in jolting contrast to the political world of Washington just down the road, where people expect questions to be answered quickly and decisively. But unlike the political world, science celebrates discovery and the unknown represents a challenge, not a weakness. In science, facts are things to be learned, not exploited. Data, not opinion, holds sway.
Dr. Anthony Fauci has led the National Institute of Allergy and Infectious Diseases for more than three decades. In a town where everyone picks sides, Fauci has mostly stayed out of politics. He sees himself as “an honest broker of science.” He gives little credence to political labels and has no patience for ideology that obscures discovery or stands in the way of cures. Fauci deals with medical fact and the painstaking, meticulous research of biological science. His questions grow out of his observations and insatiable thirst for research and for cures to disease.
Fauci greeted me outside his spacious office a few minutes after 7 a.m. This wasn’t his first piece of business for the day; he’d been at his desk since 6. He had a reputation as a workaholic, a nonstop guy. A small, super-fit man in his seventies who never lost his Brooklyn accent, Fauci still ran and worked marathon days. His suite of offices was crammed with books and journals and offered a gallery of his life. Pictures with patients, presidents, doctors, and researchers from around the world hung from the walls. They highlight Fauci’s work against killer diseases: HIV/AIDS, SARS, malaria, Ebola, and the Zika virus.
Fauci was especially proud of one picture. Taken around 1989, it shows him with President George H. W. Bush and his wife, Barbara, sitting in a crowded semicircle with researchers and AIDS patients. President Bush had just approved a large increase in AIDS funding that Fauci had sought. It was a sharp turn from Bush’s predecessor, Ronald Reagan. The funding opened a research pipeline that led to effective treatments for HIV/AIDS and brought dramatic and desperately needed breakthroughs. They came, however, only after years of suffering, controversy, and research.
A Mystery Killer
I first encountered Fauci in the early 1980s when he briefed on a mysterious ailment that seemed to be targeting gay men. The disease didn’t even have a name yet. I was covering the White House, where President Reagan was reluctant even to talk about it. He and his wife, Nancy, had plenty of gay friends from their days in California. The actor Rock Hudson, the first major celebrity to die of the disease, had attended a state dinner hosted by the Reagans just three weeks before he was diagnosed. But the ailment, with its implications of homosexuality, was a taboo subject in politics at the time.
Fauci had always been a questioner, an explorer. Like other scientists and researchers, he would see a problem—a disease or an illness—become fascinated by it, and turn it into a research question, derived in some fashion from the most fundamental question in the universe:
What’s going on here?
The autoimmune system had been Fauci’s specialty in medical school. Trained in immunology and infectious disease, he was absorbed by the question of why the human immune system sometimes turned on itself, robbing the body of its ability to fight off illness and infection. In his early work as a young researcher at NIH, Fauci had been researching an autoimmune disorder known as Wegener’s granulomatosis. The disease inflames the blood vessels in the lungs, kidneys, and upper airway. Symptoms include nosebleeds, sinus pain, coughing up blood, skin sores, and fever.
In a laboratory two floors above him, cancer researchers were conducting groundbreaking research into Hodgkin’s disease. Fauci regularly ran into his colleagues in the hallways or over a meal. They compared notes, shared observations, and told stories as doctors do. One thing his colleagues told him in particular caught his attention. It seemed cancer patients were prone to infectious diseases as a result of their chemotherapy. The chemo not only suppressed the cancerous tumors, but also the patients’ own immune systems. So Fauci wondered:
Could you turn off the immune system without killing the patient in order to cure a disease?
Fauci hypothesized that a delicate balance of low-dose, anticancer drugs could suppress the immune system in Wegener’s patients. He knew Wegener’s had no cure; treatments had so far been ineffective. Doctors had tried corticoid steroids and prednisone, but patients remained dangerously prone to bacterial infection or the flu.
To test his hypothesis, Fauci’s research team began experimenting with low levels of chemo drugs in control groups. They conducted clinical trials and pitted the new drugs against placebos. They tracked their patients over months and kept meticulous records about their health, age, condition, and progress.
“To my incredible gratification and I think a little luck,” Fauci told me, “it turned out that the drugs that we picked were just right.” The drugs also proved effective for other autoimmune diseases, and Fauci quickly made a name for himself. He appeared to be on track for an extraordinary career in the field of immunology. Then something unforeseen happened that changed Fauci’s life.
It began in his office on a Saturday morning early in June 1981. Fauci was scanning the Morbidity and Mortality Weekly Report, put out by the Centers for Disease Control (CDC). He read an item about five gay men in Los Angeles who had died as a result of a pneumocystis pneumonia. Caused by a fungus commonly found in the lungs of healthy people, this form of pneumonia can become deadly in those with weakened immune systems. Fauci did a double take and asked himself:
What is going on?
Why all gay men?
Why pneumocystis pneumonia in otherwise healthy gay men?
At first, Fauci thought recreational drugs might be the problem. That wasn’t his field of expertise, however, and he was busy with Wegener’s research. “What the hell,” he figured. “Forget it.”
A month later, another CDC morbidity report hit Fauci’s desk. It featured another alert about the same mysterious illness. Now it reported that twenty-six men had died, and not just in Los Angeles. Victims were in New York City and San Francisco as well. All were gay. All had seemed in perfect health before coming down with deadly pneumonia. Fauci was alarmed.
“This is going to be huge,” he said to himself.
Cultures Clash
Science, medicine, and experience drove Fauci to conclude that we were on the verge of a full-blown health crisis, a new and frighteningly unpredictable illness whose dimensions were completely unknown. He responded as a scientist and as a doctor, thinking in terms of public health. He had been trained to observe a problem and ask about it in a methodical way, putting impulse and judgment to the side.
Outside the gates of science and the NIH, however, there was an altogether different response. I was the White House correspondent for Associated Press Radio. I had recently returned from London, where I’d been based as a foreign correspondent. Now I was assigned to a noisy, cramped, show-offy place where reporters strutted their stuff to show how tough or influential they were, and the press secretary played power politics, leaking stories to those he liked and freezing out those he thought were unfair, unfriendly, or overly hostile. Welcome to the White House Briefing Room. We were just a few miles from NIH but we were in another universe.
On this day, in October 1982, someone in the press corps asked about this new and deadly illness that few others wanted to talk about. The reporter, Lester Kinsolving, was with WorldNetDaily, a conservative news organization committed to “exposing wrongdoing, corruption, and abuse of power.” His questions to Reagan’s press secretary, Larry Speakes, produced a surreal moment.