Epidemiologist Caught in the Plague of Politics
Lots of youngsters spend time working in pharmacies or talking to their parents about their careers in healthcare. Not all of them go on to advising U.S. Presidents about science-based recommendations to deal with pandemics. One person did make this career journey, with two results: helping to save millions of lives while at the same time, having to endure death threats to himself and his family. Fortunately, his efforts have been praised by his professional peers and appreciated by millions of people worldwide.
FAMILY BACKGROUND
Anthony Fauci (AF) was born in the Brooklyn borough of New York City. His parents were first-generation Italian Americans, both college educated. His father worked as a pharmacist and the close-knit family, proud of their heritage, lived above his pharmacy. AF’s mother was a homemaker.
“Dad was generous to a fault when it came to accommodating customers who could not afford to pay their pharmacy bills,” recalled AF. “He kept a running account for them, much to the frustration of the rest of our family.”
CHILDHOOD
As a young boy, AF held various jobs in the family pharmacy, including working the register and delivering prescriptions. In his spare time, he enjoyed sports, playing baseball and basketball.
EDUCATION
AF was educated in Catholic schools, initially by Dominican nuns who demanded achievement and graded students down to a tenth of a point. At Regis, an elite Jesuit high school in Manhattan, the school motto is “Men for Others,” making personal gain secondary to public service. AF believed the school’s spirit was a “natural extension” of the environment of his upbringing at home.
Following high school graduation, AF enrolled in a Jesuit college, Holy Cross, in Worcester, Massachusetts before pursuing his interest in science at Cornell University’s medical school, where he graduated first in his class.
EPIDEMIOLOGY – ABOUT
Epidemiology is the branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health. It is the cornerstone of public health, shaping government and healthcare policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventative healthcare.
A key feature of epidemiology is the measurement of disease outcomes in relation to a ‘population at risk’, which is the group of people, healthy or sick, who would be counted as cases if they had the disease being studied.
Education degrees involving epidemiology are offered in two- and four-year programs. Two-year requirements may involve online, in-person and in-the-field learning to provide the advanced research and epidemiological skills needed to pursue senior positions in academia, hospitals, public health agencies, nongovernmental organizations and the private business sector.
Degrees requiring additional education include Master of Science, Master of Public Health and Doctor of Philosophy. Successful students are dedicated to learning quantitative methods, population-based studies and analyzing data to improve results.
Typical diseases studied include cancer, cardiovascular disease, infectious disease (such as the infamous covid pandemic) and other chronic diseases.
Graduates of the Master of Science programs have found employment as research analysts at consulting firms, program coordinators at community-based organizations, project directors at city, state and federal health commissions and leadership positions at non-profit organizations.
Master of Public Health graduates use their advanced research and epidemiologic skills to pursue senior positions in academia, healthcare management, public health agencies, nongovernmental and private sector organizations.
Doctors of Philosophy have found employment in postdoctoral positions, tenure-track faculty positions and management / research positions at government agencies.
STARTING AN ADULT CAREER AS AN EPIDEMIOLOGIST
Following medical school graduation, AF joined the National Institutes of Health (N/I/H.), rising through its ranks as an infection-disease specialist and immunologist. He cared for patients with rare autoimmune disorders and discovered that low doses of chemotherapy and steroids could be lifesaving, because they blunted these patients’ aberrant inflammatory responses. It was serendipitously perfect preparation for studying H.I.V. – so much so that AF describes feeling “the illusion of fate” when the disease’s first victims, mostly young gay men, began arriving at the N.I.H. Clinical Center. “I was trained for years as an immunologist and an infectious disease specialist. Here was a disease that certainly was infectious. It was also destroying the immune system and rendering the patients highly susceptible to opportunistic infections. AF redirected his efforts from inflammatory diseases to H.I.V., where at first, there was no medication to block the virus and half the admitted patients died of infections or cancer within 10 months.
CHALLENGE – ACTIVISTS DEMANDING FASTER CURES
While working to understand the causes and spread of H.I.V. as the first step toward developing medications and treatment plans including prevention, AF became a frequent target of gay activists, who saw that the government was failing them. He was accused of facilitating the deaths of hundreds, if not thousands of people with H.I.V. AF described the rationale for that attack as “I had not demanded enough money for AIDS. This ignored the fact that I had requested from Congress and the President the largest increase in resources given to an NIH institute since the famous ‘war on cancer’ in the 1970s.”
Soon – but not soon enough for many suffering from AIDS and their vocal advocates – a drug, AZT, originally tested as a chemotherapy agent, while not effective against tumors, was proven by lab studies to be a potent inhibitor of H.I.V.
During an academic discussion about the progress enabled by AZT, a group of activists from ACT UP barged into the meeting room, yelling that AZT was poison and calling the physicians on the panel ‘Nazis’. This especially stung at least one of the physicians whose extended family were murdered by the Nazis during World War II. But AF, writing that he was mentally hurt by the accusation, admitted “In a strange way, I still did not blame the activists because if I had been in their position, I would have been just as angry.”
AF then invited several of the demonstrators to meet with him. “They were shocked. This was the first time in anyone’s memory that a government official had invited them to sit down and talk on equal terms, on government turf.” AF was able to clarify what drug development involved while the activists “played an increasingly important role in shaping my thinking and policy in these areas” which resulted in an increasingly important role in shaping policy in these areas.” The culmination of this collaboration was a “parallel track” of drug testing that expanded the availability of experimental treatments for AIDS beyond the rigid confines of clinical trials.
CHALLENGE – POLITICIANS GRANDSTANDING TO PRESS AND PUBLIC
AF’s commitment to his work on AIDS was such that when he was offered the directorship of the National Institute of Allergy and Infectious Diseases (NIAID), a purely administrative role, he insisted on being allowed to continue doing research and treating patients.
Recalling advice from a mentor as his professional influence increased, AF reminded himself each time he walked into the West Wing of the White House to advise the President and other government officials, that “this might be the last time you will walk through that door.” In other words, sooner or later there would likely be a choice between sugarcoating scientific but politically unwelcome news and losing influence, so one should mentally prepare to always do the right thing” because your advice must be based on science.
After being grilled by a U.S. Senator during a public hearing that he had “soft-pedaled” demands for more funding based on a dinner invitation from the then President, AF was privately hugged by the Senator (Ted Kennedy), who apologized for his harsh questions, which the Senator attributed to “needing to keep the heat on” the government’s involvement with the disease crisis.
Working with then President Trump on the covid pandemic was an interesting challenge for AF, according to AF’s autobiography, “A Doctor’s Journey in Public Service.” He wrote that when Trump realized the covid problem was not going away quickly enough, the president began to grab for an elixir that would be a quick cure, touting the (alleged) benefits of hydroxychloroquine. AF realized that “sooner or later I would have to refute him publicly” while trying to avoid presenting a rift between the president and the physician-head of the scientific advisory team for covid. So, AF tried to state his science-based corrections as diplomatically as possible and was surprised that Trump did not seem to hold them against him – unlike some of the president’s radical supporters who issued death threats against both AF and his family. These threats required AF to have a security detail posted at his home.
Such harassment did not end with Trump’s presidency concluded; indeed, the abuse got worse, as attacking AF became a badge of loyalty for extremist Trump supporters “as well as attacking established principles of public health.”
CHALLENGE – CATCHING UP TO CAUSES OF DISEASE
“If we knew in the first months of the covid pandemic what we know now, many things would have been done differently,” wrote AF in his book. “We learned, for example, that aerosol transmission of infection was important, and asymptomatic spread of virus played a much greater role in transmission than originally appreciated. This knowledge clearly would have influenced earlier recommendations for mask wearing, social distancing and ventilation.”
AF also believes that mask mandates could have been relaxed earlier but explains that although he privately made this recommendation to the C.D.C., he was hesitant to criticize the agency openly.
CAREER SATISFACTION
AF is known for being apolitical and for having friends on both sides of the (political) aisle. Thus, with his constant professional integrity, AF was able to work effectively with both Democrat (Clinton) and Republican (Bush, Sr.) administrations.
He takes professional pride in having educated willing listeners to the use of science, reminding all that “people associate science with absolutes that are immutable, when in fact science is a process that continually uncovers new information”
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This career story was based on multiple sources including an article written by Jerome Groopman, published by The New Yorker magazine on June 24, 2024 plus internet research.
