By Anthony Fauci
Dr. Fauci is the director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.
Dec. 10, 2022
Although I hesitate to use the hackneyed expression “It seems like just yesterday,” it does feel that way as I prepare to leave the National Institutes of Health after over five decades. As I look back at my career, I see lessons that may be useful to the next generation of scientists and health workers who will be called on to address the unexpected public health challenges that will inevitably emerge.
At 81, I still can clearly recall the first time I drove onto the bucolic N.I.H. campus in Bethesda, Md., in June of 1968 as a 27-year-old newly minted physician who had just completed residency training in New York City. My motivation and consuming passion at the time were to become the most highly skilled physician I could, devoted to delivering the best possible care to my patients. This remains integral to my identity, but I did not realise how unexpected circumstances would profoundly influence the direction of my career and my life. I would soon learn to expect the unexpected.
I share my story, one of love of science and discovery, in hopes of inspiring the next generation to enter health-related careers — and to stay the course, regardless of challenges and surprises that might arise.
It was during my residency training that I became fascinated with the interface between infectious diseases and the relatively nascent but burgeoning field of human immunology. As I cared for many patients with commonplace as well as esoteric infections, it became clear that physicians and other health care providers needed more tools to diagnose, prevent and treat diseases.
To merge these interests, I accepted a fellowship at the National Institute of Allergy and Infectious Diseases at the N.I.H. to learn the complex ways cells and other components of the immune system protect us against infectious diseases. In doing so, I would follow the N.I.H. tradition of bench-to-bedside research by translating laboratory findings into the care of patients and, in turn, taking insights from the clinic back to the laboratory to improve the science.
Despite having no prior training in basic science research, I unexpectedly became captivated by the potential it had for making discoveries that would benefit not only my patients but also countless other people I might never meet, much less care for as their physician. My newfound love for this work posed a major conflict to my well-laid plans for practicing medicine. Ultimately, I chose to follow both paths: to become a research scientist and a physician caring for patients at the N.I.H., where I have been ever since.
Dr. Anthony Fauci delivering an AIDS-related talk in 1985.Credit…National Institute of Allergy and Infectious Diseases
There is so much discovery that can happen inside a laboratory and in the clinic — even when you least expect it. Early in my career, I was able to develop highly effective therapies for a group of fatal diseases of blood vessels called vasculitis syndromes. Patients who otherwise would have died instead experienced long-term remissions because of the treatment protocols I developed. My foreseeable future seemed well charted: I would spend my life working on conditions related to abnormal immune system activity.
Then, in the summer of 1981, doctors and researchers became aware of a mysterious disease spreading predominantly among young men who have sex with men. I became fascinated with this unusual disorder, which would become known as H.I.V./AIDS. The hallmark was the destruction or impairment of the very immune system cells the body needed to defend against it. I also felt a strong empathy for the mostly young gay men who were already stigmatized and now were doubly so as the disease wasted their bodies, stealing their lives and dreams.
Dr. Fauci and treatment team with a patient with AIDS at the N.I.H. in 1987.Credit…National Institute of Allergy and Infectious Diseases
Much to the dismay of friends and mentors who felt that I would be short-circuiting an ascendant career, and against their advice, I decided to completely change the direction of my research. I would thereafter devote myself to AIDS research, by caring for these young men at the N.I.H. hospital while probing and uncovering the mysteries of this new disease in my laboratory — something I have now been doing for more than 40 years.
A Conversation With Anthony Fauci, America’s Doctor
Dec. 10, 2022
Dr. Anthony Fauci, often referred to as America’s doctor, will retire at the end of the month, after nearly 55 years at the National Institutes of Health. Today, Times Opinion published a guest essay by Fauci, in which he reflects on his tenure and imparts advice to the next generation of scientists.
Fauci shares important chapters of his career, including his work developing treatments during the AIDS crisis and helping the nation navigate the coronavirus pandemic.
To accompany his essay, I asked Wolfgang Tillmans, a renowned artist known for his photos of youth culture in the 1990s, landscapes, still lifes and portraits, to photograph Fauci — his first assignment for the newspaper. Tillmans’s photographs are sophisticated yet approachable, which reminded me of Fauci himself — a man who has been at the center of firestorms and yet feels accessible.
Tillmans has also lived with H.I.V. for over two decades and has used the medications Fauci helped develop, a fact he shared with the doctor during their session together. Tillmans asked Fauci if he could record some of their conversation, an excerpt from which we are sharing, lightly edited, below.
Wolfgang Tillmans: The first cases of what would come to be known as AIDS were discovered in the United States in 1981. I started following the science of AIDS in my teenage years. I always felt there is a specific poignancy to a virus that builds itself into the DNA of the very cells that the body produces to fight against it. Besides this scientific interest, AIDS also accompanied and terrorized me growing up and coming out as gay. In 1997 my partner died of AIDS, and at the same time I found out that I was H.I.V. positive and was able to start the therapy, which you and others were working on inventing throughout those years. So meeting you feels like coming full circle. What were those early years like?
Anthony Fauci: It was the early 1980s. I started taking care of people with H.I.V. before we knew it was H.I.V. It was just a mysterious disease killing almost exclusively gay men, at first very concentrated in New York, San Francisco and L.A. The first few years were the most terrible, traumatic years of my professional career, because all of my patients were dying. It was very dark, dark years. And then when the virus was discovered, we started to really be able to develop drugs and screen drugs, starting in 1986, 1987, when we had AZT, a type of antiretroviral. By 1996, the cocktail of three antiretrovirals came around.
You got therapy just in time, one year after the cocktail?
Tillmans: Yes, I was lucky. I mean it was a long 10 years since 1986. Now people talk about it as if it was “just” 10 years, but so many lives were lost and despair reigned in those years.
Fauci: Then everything turned around. I mean, it went from bleak to patients doing well, leading a normal life span, if you get it right now.
Tillmans: Initially, you were not seen as having this tolerant or positive image. You got a lot of pushback from advocacy groups, like ACT UP.
Fauci: Yeah. I was one of the few people that was full-time involved in H.I.V. Not a lot of scientists wanted to get involved. The approach was a very rigid scientific and regulatory approach on the part of the federal government; clinical trials had to be very strict. Drugs took years to get through the approval process. There wasn’t a lot of money. But since I was so visible, the activists saw me and said, “You are the face of the federal government.” So they started being very disruptive and theatrical to gain my attention. But as soon as they gained my attention, I started to listen to what they were saying. And what they were saying was absolutely correct.
The government was not doing the optimal approach. It was too rigid. They didn’t include the gay population in discussions of the design of the clinical trial. One of the best things I’ve ever done in my life is that when the activists were demonstrating, everybody else was saying, “Arrest them, put them in jail.” I was the one that said, “No, no, no, bring them into my office and let’s talk about it.”
Now the people who were the activists are my best friends. In fact, in December, the activists from New York, the original ACT UP team, are coming down to Washington to give me a farewell dinner. It’s interesting history. The same people that were in the street saying, you know, “Hang him,” “Kill him.” They’re all coming down now to celebrate with me.