MARCIA DAY CHILDRESS: OK Good afternoon.
Good afternoon.
Welcome to this combined medical grand round, Medical Center
Hour, and history of the health sciences lecture.
I'm Marcia Day Childress from the Center for Biomedical
Ethics and Humanities.
And we're so pleased to see all of you here today.
As I mentioned, this is a combined program
of medical grand rounds, Medical Center Hour,
and the history of the health sciences lectures.
The program is A Plague on All Our Houses-- Medical
Intrigue, Hollywood, and the Discovery of AIDS.
I bet you're wondering how all of that comes together.
35 years now after the discovery of AIDS,
the story of this disease and the momentous scientific,
medical, and sociopolitical changes it occasioned
is rich and complicated, even sensational.
In 1981, Dr. Michael Gottlieb, a young UCLA immunologist,
saw a cluster of five cases of immune dysfunction
and unusual opportunistic infections in gay men.
He wrote this up, and published it in The New England
Journal of Medicine.
Not long after, as personal physician
to Hollywood actor and AIDS patient Rock Hudson,
Dr. Gottlieb became the medical face
of this terrifying epidemic.
In this program, Dr. Bruce Hillman,
who was a medical school classmate of Michael Gottlieb,
probes the war of egos, money, academic power, and Hollywood
clout that advanced AIDS research in its first decade,
even as it compromised the medical scientist who
had discovered the disease.
As we'll hear, Dr. Hillman draws on interviews
with Dr. Gottlieb and others, to chronicle one
of the most important and contentious medical discoveries
of our time.
Many of us here remember the early days
of AIDS; frightening, formative.
But we may not know this particular story.
And many of us know Bruce Hillman as a radiologist,
indeed as Chair of UVA's Department of Radiology
for more than a decade.
But for many years now, Bruce has also been a writer.
And the story he'll share with us
is a new book, A Plague on All Our Houses-- Medical Intrigue,
Hollywood, and the Discovery of AIDS.
This is a brand new book, published actually
just yesterday by ForeEdge, the University
Press of New England.
UVA Bookstore has copies just outside the auditorium
upstairs for sale, and for signing by the author.
I'd like to thank the Department of Medicine
and the history of the health sciences
lecture series, from historical collections in the Claude Moore
Health Sciences Library, for being a part of our
bringing you this program.
And now we'll flashback to Dr. Hillman's days
at medical school at the University of Rochester,
where Dr. Michael Gottlieb was his med school classmate.
Welcome, Bruce.
BRUCE HILLMAN: Thank you, very much.
[APPLAUSE]
It's wonderful to come back here.
I have many fond memories, and I actually believe it or not,
I'm still fully employed here, even though I live elsewhere.
But it's great to see old faces, and I certainly
appreciate everybody's taking the time to come.
Let me say that my professional writing career, if you can call
it that, really began with the help of a number of people
here, Sharon Hostler in particular, Sharon's
in the audience.
And I was part of her critique group.
And even when I've left, I return telephonically
for help and advice.
And thank you, Sharon.
So I do have a few disclosures.
I did get an advance on the book.
And so I am beholden to University Press
of New England.
I'm on an advisory board for Philips Healthcare,
and as already been mentioned, I do
have this relationship with Michael Gottlieb
from medical school.
And you can decide for yourself whether it
infringes on the story or not.
Why did I write this book?
Well, it's not the first creative nonfiction book
that I've written.
I did write an earlier book called,
The Man who Stalked Einstein.
But as I was working that book through the editing process
and into press, I felt that this was
a story that needed telling.
I wanted to write a very interesting, but instructive,
story that had an important moral ending.
I wanted to provide insights into our world, a very little
understood world outside our cloisters of academic medicine.
The lessons learned, I think there
are important lessons learned both
from Gottlieb's experience, and also
for the whole issue of infectious epidemics.
And then it was a very interesting time.
And I wanted to talk about the context in time.
Now I have to tell you, I am going
to actually spoil the ending.
I'm going to tell you what the ending is.
But I have to tell you, there are many rich threads
to this story that I simply do not
have the time to address today.
And so obviously, I advise you to buy the book.
Let's start with the cultural backdrop.
This era was distinguished by two counterbalancing forces,
and we're talking now about the 1970s and the early 1980s.
There was a gay emancipation that
occurred around this time, sparked in 1969
by the Stonewall Inn riots.
Now many of you may remember what they were.
Many of you, I think, probably have never heard of it.
But there was a long history of police prejudice
towards gay men, and particularly in New York City.
And one night, in the very early hours,
they raided the Stonewall Inn, which was basically
a lowbrow flophouse and bar that was sort of a gay hangout.
There were riots, initially in New York and then
throughout the country.
And it took weeks to quell all of them.
But out of it, grew a pride in gay identity.
Gay individuals who had been cloistered
and who had been secretive about their sexual identity,
began to come out of the closet.
There also was what I would call a sexual emancipation that
led to tendencies to promiscuity, a whole bathhouse
culture.
So you may have heard of the bathhouses, the Everard,
and the Continental in New York.
There were the similar bathhouses
throughout the large cities of the country.
And then gay literature; plays, art, novels;
Larry Kramer was particularly influential with his play,
The Normal Heart, that occurred in the mid 1980s.
The counterbalancing force was the organization
of the religious right.
And that was very important.
Because it came at exactly the time, not just of gay
emancipation, but also at the time of AIDS.
The first reports of AIDS coincided as well.
And that was very important.
So remember the moral majority.
Some of you may or may not remember.
But this was an invention of Jerry Falwell.
And Jerry Falwell and Paul Weyrich
invented the moral majority, with the argument
that, in fact, the religious right had to organize.
And part of the reason they had to organize was, as he said,
"please remember, homosexuals do not reproduce!
They recruit!
And many of them are after my children and your children."
Now at that time, roughly 20% of the populace
was strongly members of the religious right.
And for the first time, they organized.
Why did they organize?
Again, Jerry Falwell, "the idea that religion and politics
don't mix was invented by the devil
to keep Christians from running their own country.
If there is any place in the world we need Christianity,
it's in Washington."
Now let me step aside for a moment
and mention that this is very much how the book is written.
When I could, I used the words of the individuals
who were relevant at the time.
And so rather than narrating it myself,
I do a lot of narrating myself, but just as
with that I'm going to quote people
if I feel it better tells you the story that I
want you to hear.
The religious right helped sweep Ronald Reagan into office.
And they had unprecedented access
to Congress, very conservative Congress
at the time, and the administration.
And there was a political backlash, not only to gay life,
but also to as I say, to AIDS.
It was typified by Nancy Reagan's famous comment,
"just say no."
Just say no replaced sex education
in the public schools.
So it was a matter of abstinence.
If only we could be abstinent that
would end the gay threat and the AIDS threat.
In fact, Ronald Reagan never mentioned the word AIDS
until 1987.
1981 was the year of its discovery.
1987, just before the end of his term,
he mentioned it for the very first time.
So let me introduce three characters who I mostly
will be quoting throughout this presentation.
The first is Dr. Michael Gottlieb,
first year as an assistant professor
in what he considered his dream job at UCLA.
He was Professor of Immunology in the Department of Medicine.
Dr. Andrew Saxon, his division head,
Associate Professor of what he called the CIA, the Clinical
Immunology and Allergy Division.
And Dr. Kenneth Shine, a name that
may be familiar to many of you who was the Professor
and Chair or the Department of Medicine,
later to from become the dean of the School of Medicine at UCLA,
and also to lead the Institute of Medicine.
All right.
Imagine, here you are.
You're Michael Gottlieb in 1981 in your first year
of appointment.
10 years now, you've been waiting for this appointment.
You've been training.
You've been putting aside the desires of family and yourself.
So at any rate, you've put aside.
You're delayed your gratification.
You've watched your high school and college friends go on
to have comfortable lives.
And you finally have your dream job.
You've been recruited.
You're a hot recruit out of Stanford's
immunology fellowship.
And there you are at UCLA.
I'm running out of stuff to say here.
[LAUGHS]
Perfect.
Thank you.
All right.
So at any rate, he's trying to establish himself
in all of the various venues of academics, in clinical work,
in teaching, and in research.
And he's got a fellow, Howard Schanker.
And he says to Schanker, go out and find me some good teaching
cases.
And sure enough, Schanker comes back with one.
He comes back with one at the exact same time
that the chairman of the department, Kenneth Shine,
had been at his chairman's rounds,
and an intern named Robert Wolf had
presented a very interesting and baffling case to him.
So now from two directions, he goes to see this patient.
And very shortly after that, there
are three additional cases that he becomes
aware of in rapid succession.
There were some things in common among these four cases.
First of all, they were all young men, 30 years or younger.
They all had an acute onset of opportunistic infections
after being very healthy just a month or so before.
They all had severe weight loss.
They all died within months of Pneumocystis carinii pneumonia,
and very fortunately for Dr. Gottlieb, right
down the hall from him there was a post doc, working
on helper T-cells, what we called then helper T-cells,
we now them CD4 T-lymphocytes.
And this gentlemen found, from samples of blood
in all of these patients, a deficiency of helper T-cells.
One last thing, all four patients were gay.
Gottlieb did just what the rest of us would do.
He went out.
He searched the literature.
He couldn't find anything like this.
He began to think to himself, wow.
This is what he said to me, "hey, this
is what you're here for.
You were meant to do new things, find new things, and eureka,
you go on to something that's going
to further your ambitions.
Your job now, Michael, is to get this into print,
and be credited for having discovered something new."
Now in the same thought, he said to himself, wow,
these young men are dying.
And there's nothing I seem to be able to do for them.
What could this possibly be?
If this were you, a man who is just in his first year-- he
doesn't really have a mentor, locally.
As it turns out, he didn't really have mentors very much
throughout his entire life.
What would you do?
Anyone?
Well, he certainly didn't do what I would have done.
He was a lot more fearless than I. He called Arnold Relman.
Arnold Relman was the editor, probably
the most famous editor of our time of the New England
Journal of Medicine.
And he was a towering figure.
He was known by many as the conscience of medicine.
He invented the idea of the medical industrial complex.
And he railed against conflict of interest among physicians.
Michael Gottlieb, "I placed one phone call.
I didn't play telephone tag.
I spoke with a reasonable man you screened the call,
and he transferred me to his boss.
I said, here's what I have.
And he asked me a number of questions.
Are you sure of this?
Are you sure that?
I said, yes.
I think so."
Now Arnold Relman did more than that for Mike Gottlieb.
He said, you have to protect the public.
And you have to protect your primacy in having discovered
this disease.
So you should publish first, in the MMWR, the morbidity
and mortality weekly review, I think it is.
At any rate, you should publish in the MMWR.
And I'm going to put aside-- I'm going to hold in advance
the famous Ingelfinger rule, the notorious Ingelfinger rule
that said The New England Journal of Medicine
will not published anything that you have in some way
to communicated to the public before you waited,
before it was published in The New England Journal.
And sure enough, on December 10, 1981,
The New England Journal of Medicine
published its lead article, "Pneumocystis Carinii Pneumonia
and Mucosal Candidiasis in Previously Healthy Homosexual
Men-- Evidence of a New Acquired Cellular Deficiency."
Now people had been seeing this disease for a long time.
There were sporadic cases in virtually every big city
you can name.
But nobody leapt at the idea that this was an entirely
new and important disease.
Why Gottlieb?
What was there about Gottlieb that
led him to make this startling discovery?
He said, "unlike many physician researchers,
I was always case-oriented.
On my first day as a medical student
at the University of Rochester, our class
was admonished to learn to accept
the uncertainties of medicine.
We did not seek to verify a particular diagnosis.
We tolerated uncertainty."
Now, under normal circumstances, if this were you,
you'd move on.
You would be starting to research how this disease is
caused, what its transmission was, how to begin to treat it.
But Gottlieb got sidetracked.
He got sidetracked by things that he
was in no way prepared to handle,
and namely that was an author fight.
So as Gottlieb started to revise his manuscript,
The New England Journal word got around.
And one of the people who got an early look at it
was the intern, Robert Wolf, who had
referred the case to Gottlieb.
And it turned out that when presented to Shine,
he presented this as a case that was absolutely unique.
He didn't see what Gottlieb saw, but he raised
a great deal of interest.
What's more when Gottlieb sent Schanker around
for blood, his fellow, Robert Schanker, they cut a deal.
Wolf said that if I give you the blood,
I need to be an author on any manuscript that comes out
of this.
But he was left off.
Gottlieb never heard about this deal.
So Wolf went to Gottlieb.
He said, look, I got this arrangement.
And Gottlieb sort of blew him off.
So he went to the Chairman, and he said.
Ken Shine called Gottlieb into his office.
And this is what he said.
I saw-- this is what Kenneth Shine told me.
"I saw the manuscript in The New England Journal.
I remember saying to Gottlieb, why is Bob Wolf not listed
as a co-author?
Gottlieb said that he was just the referring physician.
But he was more than just the referring physician.
It was the beginning of a new antagonism, one
that Gottlieb couldn't possibly win."
Andrew Saxon also called Gottlieb into his office,
and said, I want to be an author on this paper.
Make me an author on this paper, and you carry this disease--
it wasn't called AIDS then.
He called it GRID, gay related and immune deficiency.
You can carry this forward on your own.
Andrew Saxon, "we walked in the room,
and has a candida granuloma on his finger, all swollen up,
and the patient was clearly gay.
He was overtly gay.
He was dramatically gay."
This is the second patient, now. "That's when the light came on.
There was more than one of these.
So we discussed this.
It was really exciting stuff, this new disease.
So that's the paper.
I was actually involved intellectually."
Gottlieb didn't necessarily agree.
"What was I going to say?
He was my immediate boss.
He suggested adding one sentence to the discussion.
We cannot rule out the possibility that
an unidentified exposure, toxin, or microbe played a role
in the development of the immune deficiency in these patients.
Does that one cover-your-ass statement
qualify him to be an author?"
As things turned out, he was right.
Gottlieb had put his money on a variety of CMV cytomegalovirus.
So what happened afterward?
Well, Gottlieb, his career shot off meteorically
in ways-- I mean most of us here probably are very accomplished,
even the more junior people.
You can't imagine what happened to Gottlieb.
All of sudden, he was invited around the world.
He hobnobbed with the elite of medical and scientific worlds.
There's one wonderful anecdote his wife Cindy,
told me actually.
They actually had gathered a group
of people that seemed to recur at these various meeting sites.
And they called it the AIDS Discovery Club.
And they hold separate little social functions
for themselves.
And one day they were at a party for the AIDS Discovery Club,
and she's talking to Jonas Salk.
And a plate of canapes comes by.
And she picks one off, and she begins to look at it,
and she says, this looks like cock.
Is this cock?
And Dr. Salk took it from her, popped it in his mouth,
and said, yes it is.
The other thing that tended to make people angry
was, he seemed very interested in talking to the media.
And all of this together, sort of
got Michael Gottlieb full of himself.
And he thought, and this is what he told me.
"I'm going to become full professor,
and eventually I'm going to become dean."
So he had the idea of an academic career.
This was what he really wanted.
And about a year, he's a year and a half into his tenure
clock, and the clock's ticking, but very quietly.
And certainly it seemed as though the sky's the limit
for this young man's career.
Resentment began to develop between himself
and his division head.
Andrew Saxon felt that Michael Gottlieb really hadn't
done any research at all.
He'd just been lucky.
"The virologists who found the virus
were the really clever ones.
Because retroviruses were new.
They had to go after the problem intellectually, not just
trip over something."
So he's really very disdainful.
Michael Gottlieb in response, "he was an only child,
treated as brilliant his whole life, a Harvard grad.
But here I was in close quarters with him.
He was supposed to mentor my career development.
But he was never supportive, always undermining."
And I have many separate individuals
I interviewed who would agree with assessment.
Andrew Saxon agreed with parts of this.
"I wasn't supporting him fully, which was true.
I was not.
I don't remember anything personal or research-wise.
I mean his research was HIV, and mine
was B-cell immunoglobulins.
I was well-funded throughout my career.
I didn't need to work on AIDS."
Sounds a little defensive, actually, at least to me.
But again, resentments were developing
at even higher levels.
Kenneth Shine said of him, "he was talking to the media, very
self-promoting, and the result was a whole series of articles.
I wasn't present when he was having his conversations
with the media.
But it was clear where he was coming from."
Meaning he was trying to build his own image.
Gottlieb disagrees again.
"A major complaint about me was that I was self-promoting.
But I felt the charge was unfair.
It was intended, in part, to promote and add
to the stature of the medical school, and the hospital."
Sounds a little defensive to me as well.
A lot of defensiveness going on here.
The real problem was there was an absolute conflict
in sort of the ethical realm.
Here was Gottlieb, raised as a lower middle-class child,
whose father died when he was a teenager.
He never really was able after his father
died, to have the mentoring that he felt he really needed.
And we felt that the deck was stacked against him at UCLA.
That UCLA in the end would have much preferred
if somebody else had discovered the disease
any place other than UCLA.
The problem with UCLA, he thought,
was that this was a not-for-profit,
but really in every sense the way it acted,
the institution acted as a for-profit institution.
And that they didn't want the AIDS patients who
didn't have health insurance, or had
a very poor-paying Medicaid.
That the reputation of UCLA as an AIDS hospital would hurt,
not help, the institution.
Because it was really into the idea of developing its organ
transplantation, and recruitment for training programs
might suffer as well.
There was insufficient, in his view, Gottlieb's view,
insufficient space and money being
allotted to him and to his clinical and research
programs in AIDS.
And this is a continuing theme throughout his tenure.
Kenneth Shine disagrees again, "our policy
was that we would take care of these patients who
were suspected of having a diagnosis of AIDS.
We would not turn patients away.
And overall, we had an extremely good relationship
with the gay community.
They came to grand rounds and were presented as cases."
Don't you think if you listen to what they're actually saying,
is better than anything I can do for myself in this book?
So January, I just want to take you back to 1982 now.
1982 was really the year after the discovery of AIDS.
And it's right out of The New England Journal.
In January of '82, CDC was reporting
a new AIDS case every day.
By June of '82, 2 to 3 cases a day,
27 states, 8 foreign countries, and with a very high death
rate.
It's still like the [INAUDIBLE] today.
It was doubling, and doubling, and redoubling,
and nobody was paying attention.
Government particularly did not recognize this is an epidemic.
It was ignored by the administration officials,
the Reagan-- as I mentioned already,
the Reagan administration acted as though it didn't exist.
And there was no funding response.
This was not like, for instance, Legionnaires' disease
about the same time, where the single outbreak in Philadelphia
caused an enormous flow of money to occur.
No funding, virtually no funding for AIDS.
There was intense fear.
And the main fears were especially
associated with gay men, health care workers,
and AIDS researchers.
I talked to a fellow who later became
the Director of the National Cancer Institute, Broder,
Samuel Broder.
He actually said to his researchers,
if you feel this is too dangerous for you, get out now.
And he was perfectly willing to let them do so.
There was something-- there seems
to be a lot of sort perverse humor associated with AIDS.
Andy Saxon told me about the 4-H Club.
The 4-H Club were heroine addicts, hemophiliac patients,
and of course, homosexuals.
It was still, despite the fact that this was spreading
to heterosexuals in the population,
still thought of as a gay disease,
and therefore heavily discriminated against.
Jerry Falwell again, "AIDS isn't God's judgments on homosexuals.
AIDS is God's judgment on a society
that tolerates homosexuals.
There was a coterie of conservative congressman
that suppressed recognition of AIDS, and in fact,
wouldn't even allow hearings on the subject to be held.
AIDS needed a white knight.
And one appeared, that man being Henry Waxman.
Henry Waxman actually is just retiring now
after, I think, 30 years in Congress.
But he was the first to wish to hold hearings.
He couldn't get anything going in Washington.
So he took it out to West Hollywood.
And the first congressional hearings
were held in Hollywood in 1982.
Henry Waxman when asked, well aren't you
doing this just because you represent
a sizable gay population?
He said, "No.
And what if I were?
I mean in Pennsylvania they're representing steelworkers.
And we see lots of lobbying for steelworkers."
He said, no, "I work on this issue
because it's the largest public health crisis of our time.
I work on this issue because I am a Jew,
and I understand what it means if your society doesn't
care whether you live or die."
That might have been the end of it.
Except that one day in 1984, in June 1984,
Gottlieb got a phone call from a private practicing
dermatologist, sort of a dermatologist to the stars,
in Los Angeles, in Beverly Hills.
And she said, I can't tell you who we're talking about.
But can you come out and see this patient?
The patient turned out to be Rock Hudson, one
of the biggest movie stars of his time, perhaps of any time.
He had a purplish mark on his arm
that actually had been seen by Nancy Reagan.
She was the first to point it out to him.
He came back.
He went to his dermatologist, Dr. Bussell.
And she called, as I said, Michael Gottlieb.
Gottlieb made the diagnosis of AIDS,
and began to care for Rock Hudson,
even though there was no available treatment
at the time.
Hudson underwent a number of experimental treatments.
He was on his way to the Cannes Film Festival.
He stopped in Paris for one of these experimental treatments
that Gottlieb had arranged for him.
And he collapsed in the lobby of the Ritz Hotel.
He was hospitalized in Paris.
His publicist confirmed that he had AIDS.
Didn't say anything about his sexuality,
although it was well known that in fact, he was homosexual.
At any rate, a huge uproar ensued.
Pierre Salinger called Michael Gottlieb,
asked that he be transferred back to Los Angeles to UCLA,
and rented a 747, an Air France 747
that he was the sole occupant of, he and his nurses,
to take him back to Los Angeles.
Michael Gottlieb, "my being Rock Hudson's physician attracted
a lot of national attention.
Several prominent members of the faculty
wanted to take part in Hudson's care.
There were people in the faculty who
demanded to be called into consult. When I said, no, they
got angry.
I should have been much more political and said,
oh, of course."
Gottlieb was isolating himself from the rest of the UCLA
faculty.
Now, Rock Hudson's death in early October of 1985
was a real watermark, a real change in what
was happening with AIDS.
A lot of people sympathized that would not
have ordinarily sympathized with the condition of homosexuality
and with AIDS.
Bruce Decker, an AIDS activist said,
"Hudson's illness and death have moved the fight against AIDS
ahead more in three months than anything
in the previous years."
Hudson, before he died, had in fact,
left $250,000, real money at the time, a quarter million dollars
to Michael Gottlieb to do what he
thought would be best to help to begin to fight this disease.
And to show that, in fact, research into AIDS
was critical.
The film community, which had been
very much against, or at least claiming
that homosexuals are not involved in the film
industry-- most of you would understand that this was
a ridiculous thing to say-- began
to line up in favor, because of the Hudson death.
Elizabeth Taylor, in particular, who
chaired the first large AIDS benefit,
the one that was hosted by Project Los Angeles in 1985.
So at any rate, How did Michael Gottlieb
get involved with Elizabeth Taylor?
Well, she showed up to visit Rock Hudson.
And she went to seek out Hudson's doctor, Rock Hudson,
they'd starred together in Giant,
and Hudson was her friend.
And she could see how nervous Michael Gottlieb
was in her presence.
She said to him, "I'm just a Jewish girl from Pasadena."
She was.
She had converted for her third husband, third out of eight.
And of the three things she said that had she loved most
in the world, she had loved Michael Todd,
she had loved Richard Burton, and she'd loved jewelry.
And so about two weeks later, she calls Gottlieb.
She says, "I want to see my friend Rock again.
I don't want to run the gauntlet of all those newspapers,
and media, and so forth."
And so he arranged to take her in the back way.
He picked her up in Bel Air, drove her
in what he describes as his 10-year-old van,
to the back entrance.
Took her up a crate elevator.
And when the elevator stopped he hears a loud clunk.
And he said, what was that?
And she holds out the Krupp Diamond, the 32-carat Krupp
Diamond, and says, "oh, it's only my jewels."
At any rate, in 1985 we now have a full-blown worldwide
epidemic.
The modes of transmission that being sexual,
have been established.
Researches at the Institut Pasteur
have discovered the etiology, the viral cause of AIDS.
They called it LAV, it eventually became HIV.
Robert Gallo, and other NCI researchers
developed a test for HIV infection,
and AZT was under investigation.
Bill Misenheimer, who was the director of AIDS Project Los
Angeles, and how held that very large benefit this Elizabeth
Taylor is the chair, said that there
are three big draws in the world, Elizabeth the second,
the Pope, and Elizabeth Taylor.
Elizabeth Taylor was a natural when Gottlieb wanted
to use that quarter million.
And she because his spokesperson for the foundation
that he developed.
They all got together at a restaurant
that Elizabeth Taylor had picked out Santa Monica.
Michael Gottlieb, "we were unlikely group.
A doctor, a Xerox executive turned
activist who was openly gay-- that
was Bill Misenheimer-- and the greatest living movie
star in the world.
But that night it all gelled.
We were like kids, co-conspirators.
We sat there saying, we must do something."
Elizabeth Taylor said, "we decided night
we were going to make a difference.
God damn, we would."
Now, I don't have time to tell you
the story of Michael Gottlieb and amfAR,
it's detailed considerably in the book,
and the relationship with Elizabeth Taylor
is also discussed in this context.
And in late September 1985, just before Rock Hudson's death,
Gottlieb merged his foundation with a New York foundation
headed by a woman named Matilde Krim.
And there the three of them are, the first three from the left.
I don't know who the fourth woman
is, to be perfectly honest.
And they were announcing the formation of amfAR.
And amfAR of course has become an extraordinarily powerful
research machine for any disease,
but certainly for AIDS.
The clock is ticking.
We're now at five and a half years.
Gottlieb's getting anxious.
He wants to become an associate professor.
He wants tenure.
He goes up a year early for promotion.
Here's the case for Michael Gottlieb.
His curriculum vitae shows that he
has an international scientific reputation.
He's got letters of support for his promotion in tenure
from two national institutes, the Health Instruct directors,
and then the Nobel Prize winners from the Institut Pasteur.
He has 30 publications in really first-rate journals,
it's two or three in The New England
Journal, a couple in Lancet, a few in JAMA and so forth.
And he's first author on 12 of them, five senior author
publications, and he's just received word
that he's the PI for UCLA, the $10.3 million NIAID award.
So he's about to be well-funded as well.
Here's the case against Michael Gottlieb.
Andrew Saxon, "he was very bright.
He was a good guy.
But he got suckered by the entertainment industry.
You know, the Rock Hudson thing, Elizabeth Taylor stuff.
He got suckered by them."
The inference is that he didn't keep his eye on the ball,
he hadn't worked in his academics,
despite what it said on the CD.
I have more to tell you in a moment about that.
Kenneth Shine, "a large donor asked me,
why don't you want to take money for AIDS research?
so I said to him, what do you mean?
We're actively accepting gifts.
The man replied, well I asked Dr. Gottlieb
about giving money for research and he said to me,
give the money to amfAR.
This was very disturbing."
Kenneth Shine again, "it was increasingly clear
that Michael was not respected by his colleagues.
There were multiple issues.
He was publishing all this stuff that he hadn't really
done, the notion that he had divided loyalties between amfAR
and UCLA, whom he was dealing with, the celebrities,
and that he was not very effective."
This argument was offered both by Shine and by Saxon
that he has some way coerced people putting him
on as an author on papers where he had really not done
the work.
The validity of that, I was unable to determine
by asking others.
Andrew Saxon again, "it was like hawks,
you know how they bite their food
and then cover up with their wings and say, it's my food.
It was just too big to hold onto,
and he pissed off a lot of faculty."
The outcome, Andrew Saxon's words,
"Mike and I are not friends.
You know he didn't get tenure, right?
The reason he didn't get tenure was I wasn't supportive."
So here's this division head, the man
who helped him put together his dossier
for his promotion in tenure, saying in fact,
he had helped Gottlieb with that, but not necessarily
with promotion in tenure itself.
He failed at the very lowest level, his department P&T
committee.
Here's Dr. Martin Shapiro, still the head of General Medicine
at UCLA, but a young tenured associate professor
at the time.
"Saxon was a serious scientist, and that's
what he wanted in his division.
You could look at the decision and say either
that Gottlieb had not sufficiently proven
his academic mettle or that the committee had voted down
the discoverer of the most important disease
of the 20th century."
Sounds hyperbolic, it does, the most important disease
in the 20th century.
But for the 200th anniversary, its 200th anniversary,
The New England Journal of Medicine
published an article, in essence lauding it's own work.
But it did choose a handful of articles
that it referred to as historical journal
articles cited.
One of these was Gottlieb's 1981 publication.
Out of the hundreds of thousands or articles they published,
one of them was Gottlieb's.
He had numerous troubles other than promotion and tenure.
The fact is that Ken Shine could have reversed that decision.
He chose not to.
We was dean at this point.
He also had great numbers of family problems,
particularly the death of his younger brother
that occurred just about the same time.
He chose not to give it another try.
He entered community practice, where he remains today.
The contract, UCLA was able to keep it,
they passed it along, in fact, to one
of Gottlieb's antagonists, Dr. David Golde.
Gottlieb said, "I saw myself as somebody on a mission.
That at a time when other people weren't
responding in a positive way to something tragic.
Horrible.
I was doing what I thought was the right thing.
The founding of amfAR and my notoriety around Rock Hudson
period, and my availability to the press over the first five
years of the AIDS epidemic, I hoped
my seniors would see the merit and the benefit,
but all of those things had settled it.
Just a few words, lesson learned, and then we'll close,
and I hope we have time for questions.
Gottlieb discovered AIDS because he was fearless.
Not only did he focus on the patients,
he dared to make a phone call that I simply would not
have thought of at all.
Even the possibility would have scared the Dickens out of me.
But by focusing on the patients, he
was able to find commonalities.
He saw the details.
He avoided wedging into some contradictory construct,
just because instead, he leapt to the possibility there
was something new.
And that was thinking out of the box,
and that was very important to his being the discoverer.
No problem, I hope that you now recognize that UCLA and Michael
Gottlieb were a poor fit.
I think this occurs frequently, and it
would be absolutely dangerous to both the institution
and the individual.
He didn't really keep his eye on the ball.
I mean the truth is, he found an awful lot much more
interesting and exciting than his academic work.
And he alienated colleagues.
He alienated his bosses.
He never had an mentor.
I can tell you that in many conversations we had,
he would mention this over, and over, and over again.
That with the early death of his father,
he felt he needed a mentor.
He never found one that was suitable.
I think this is general for all of us.
Mentors are absolutely essential,
not necessarily one individual for your lifetime,
though that can work.
But mentors progressively perhaps
over time that can help you with this institutional dynamics,
and also improve your decision-making.
A few lessons about the AID epidemic, prejudice
should not play a role.
And it played an enormous role in this story.
Prejudice should not play a role for how we prepare for
or react to new diseases.
The world is very small.
We have to act together, regardless of how we feel
about each other as nations.
We have to act as though this is inside our borders,
not outside.
And that silence is the enemy.
There was nothing but silence about AIDS.
Because of the prejudicial effect
of focusing on homosexuality.
We have to speak early and often,
and get the funding necessary to address new epidemics.
So I'm very grateful, as I've said,
for the invitation for the chance to come home,
and to talk about this book.
And I hope you're interested enough perhaps
to seek it out and read it.
I think it's a good story.
Thank you.
[APPLAUSE]
MARCIA DAY CHILDRESS: Thank you so much.
There's a lot in that story, as we've all heard.
That takes us back to an era that predates many in the room.
But there are also some themes that I
think are part and parcel of professional lives
we live today.
So there's probably plenty of threads
that people can introduce into the conversation.
When I bring you the mic, and we have
another mic on the other side, please identify yourself.
And the floor is now open.
BRUCE HILLMAN: I've got to tell you,
this is really intimidating room.
I suddenly realized I was probably going like this
the entire time.
BRIAN WISPELWEY: Thanks, Bruce, for bringing that to light.
It has been my-- and I've done-- I'm Brian Wispelwey,
I'm director of the HIV clinic here.
I started the clinic here in '86, but trained in Boston.
There's some interesting parallels in both places.
I did a Medical Center Hour a few years ago
where we were talking about some of these issues,
and how new epidemics change people's academic lives,
and not always so nicely.
Jerry Groopman was the co-discoverer of [INAUDIBLE],
and became Chief [INAUDIBLE] at my institution.
We were perjoratively called after that the gay VA,
plus everybody wanted to see Jerry.
BRUCE HILLMAN: I need to mention that he was an associate,
earlier on with Michael Gottlieb at UCLA
before moving to Boston.
BRIAN WISPELWEY: That's where the [INAUDIBLE] story began.
And one of my co-residents-- I was a senior resident--
a woman around '84, '83-84, came in with pneumonia,
and had none of the typical risk factor for HIV.
And had pneumocystis eventually discovered.
The resident called up Jerry, and said,
I think I have an odd case of AIDS.
There still wasn't an HIV test obviously, or HTLV.
And anyway progress, Jerry blew him off, and said, no.
That's not [INAUDIBLE].
It's just going to be a screwball case.
Eventually though they got interested when they found out
she got a transfusion in the late '70s.
The transfusion donor was still live, a single donor.
It was a gay male.
And then Jerry called up Gallo, who had the new HTLV
discovery, but no test.
And they tested both people.
This ended up being the case, The New England Journal
case that documented definitively blood transfusion.
There was already speculative, but not proof.
And the resident said, I've already written up
the case report to Jerry.
You know, I want to be on it.
And Jerry goes, no.
This is too big for you.
And the resident's name never got on the report.
So I think that happened on multiple levels.
And when I arrived here, we started the HIV clinic,
some of us.
And he got all of them under one roof, in '86-87.
And got approached by [INAUDIBLE] magazine or sort
of local posh thing.
And they want to do an article on AIDS and [INAUDIBLE].
And I naively said, sure.
And we did it.
And it got a cover and all of that.
And then I was called up by the then CEO,
saying how dare you do this.
We don't want to be known as the AIDS hospital, same as UCLA.
And so it continued to be on ongoing issue.
BRUCE HILLMAN: Yeah, very supportive.
Thank you.
JOHN ASHLEY: Hi, Bruce.
I'm John Ashley, the former CEO of the University of Virginia
Hospital.
And I can confirm that what Brian Wispelwey just said
was absolutely true.
[LAUGHTER]
MARCIA DAY CHILDRESS: Well, the history goes on.
Everything is local.
Somebody else?
We didn't mean for that to end the conversation.
BRUCE HILLMAN: Let me just say a word about how I got started
in the authorship business.
Because it is a local story.
Since we're telling local stories.
I've always wanted to write.
And I've written a lot medically and scientifically.
But one day I get this announcement in the mail.
And you probably still have things like this
that there has to be a two-hour enrichment program one
morning on creative writing.
And it is being run by Danny Becker and Sharon Hostler.
And I went.
I went because I was chairmen, and I
could do those sorts of things.
And I spent two hours.
And I learned a lot.
And at the very end, Sharon gave us to a sentence.
I don't remember what the sentence was.
But she said, write a paragraph as though you were starting
a novel on this sentence.
And I did that.
And then, oh, maybe a week or so later,
I get it off from Sharon.
She said, well I've been running,
or I've been part of this critique group for a while now,
and we have six women.
And we think maybe it's time we let a man in.
And we might be able to benefit from that.
Would you like to audition?
I had to audition.
And so I wrote a story called "The Lemon," which eventually
did get published a literary journal.
And they let me in.
I was a raw writer, I really was.
And these six women made me into a much, much, better writer.
They helped me by editing the entirety
of my first book, The Sorcerer's Apprentice,
that I wrote with Jeff Goldsmith.
And that was the start of my writing career.
So I'm very grateful.
MARCIA DAY CHILDRESS: Do you have anything?
COSTI SIFRI: Hi.
I'm Costi Sifri from infectious diseases.
I was just curious about what Dr. Gottlieb is now?
Like now, it sounds like he's sort of
expressed his maybe frustrations with lack of mentorship.
But just how is he now, personally?
How does he like practice?
Does he have a practice?
BRUCE HILLMAN: So he still does have a private practice,
virtually all of AIDS medicine.
In fact, the genesis of the idea for this book,
was I went out to LA in about the mid '90s,
and John Hanks-- John are you still here?
John Hanks was both an undergraduate school
and medical school classmate of myself.
And he was a medical school classmate of Gottlieb.
And he had been out to LA.
And said, you've gotta go see Gottlieb.
You've gotta see this practice.
I spent a day in the practice.
It was not sort of your poverty AIDS practice.
It was your upscale AIDS practice,
an awful lot of movie people.
But I was blown away by it.
I had not idea, despite the fact that the disease has
been around for 14 years, about how people were treated,
and the fear that still is present.
And so I called up Gottlieb when I was
done with the Einstein book.
And we talked it over, and we signed a contract.
And we agreed.
I would be the sole author.
Mike would get to look at stuff that I was writing.
He could make suggestions.
But I would decide what was in the book.
And so we did it that way.
And well, I think let's just say that Mike is still
in private practice.
Thank you very much.
This was great.
[APPLAUSE]