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Interview with Dr. Jack Whitescarver
This is an interview with Dr. Jack Whitescarver, Deputy Director of the Office of AIDS Research (OAR) at the National Institutes of Health (NIH), in Bethesda, Maryland, on April 18, 1990. The interviewers are Dr. Victoria Harden, Director of the NIH Historical Office, and Dennis Rodrigues, Program Analyst.
Rodrigues: As some background information, could you tell us why you became interested in a career in biomedical research?
Whitescarver: I've always had a curious mind. I never thought of any other profession except biomedical research since my high school days, and so I pursued it. Right out of college I became involved in cancer research, and that led to virology, followed by the broader study of obligate intracellular parasites. To make a long story short, I jumped in the middle of a snowstorm from the Harvard School of Public Health and rickettsia to the NIH and the Grants Associates Program.
Rodrigues: When did you come to the Grants Associates Program?
Whitescarver: I came to the Grants Associate Program in 1977. My first appointment at the NIH was as special assistant to the director of the National Institute of Allergy and Infectious Diseases (NIAID), who then was Dr. [Richard] Krause.
Rodrigues: What were some of the issues and problems that you were working on in the late 1970s, before the Pneumocystis [Pneumocystis carinii pneumonia, PCP] and Kaposi's [sarcoma] cases started to appear on the scene? What were some of the things that you were involved in?
Whitescarver: My primary responsibility was to be the liaison between the NIAID and the private, public, and professional organizations that had interest in the programs of the NIAID. The NIAID, historically, had virtually no grass-roots support. It was my job to go out and engender interest among these groups to support the programs of the NIAID and to develop committees that would advise the NIAID on programmatic areas of emphasis. I was also the aide-de-camp to Krause; I got involved in virtually everything from the point of view of policy. But my first and foremost responsibility was dealing with constituent groups.
Harden: Could you elaborate on some of these groups? Were these particular infectious disease groups?
Whitescarver: Yes. We covered the whole gamut of the research efforts of allergy, immunology, and infectious diseases, so we were involved with the American Society for Microbiology (ASM), the American Academy of Allergy and Immunology, the Infectious Diseases Society, the Lupus Society of America, the American Social Health Association, and a myriad of other organizations that really didn't know much about the NIAID–except for the ASM, which knew a lot about NIH and NIAID.
Harden: What did you want them to do with you?
Whitescarver: We wanted a strong constituency base that could speak about the needs of the Institute to the Congress. The Heart Institute [National Heart, Lung and Blood Institute, NHLBI] made strides because of the strong support of the American Heart Association. With their politically sensitive committees and spokespersons, they had people who would speak to the Congress on behalf of the Heart Institute. The Cancer Institute [National Cancer Institute, NCI], with support from the American Cancer Society, had the same advantage. There was no society for allergy or infectious diseases that had any clout.
Harden: I guess the lack of public awareness about infectious diseases was a problem.
Whitescarver: That's correct, and that was one of Krause's goals: to popularize, to show that infectious diseases, allergy, and immunology are very important areas. In fact, his testimony to the Congress went along the lines of educating people that an infectious disease could crop up at any time, and that they always had historically. Just because we had a battery of antibiotics didn't mean that we had the cure-all for every infectious disease. There were no antivirals, for example, and there were lots of viral diseases. In the hundred years since [Louis] Pasteur, only eleven vaccines had been developed, so there was a lot of work to be done. Allergy was becoming truly a science rather than a sub-specialty, because we knew more about immunologic diseases than before. It was being put on a very sound scientific base.
Rodrigues: One aspect of this relates to the growth of some of the other institutes. Looking at the opportunities that were coming along to further work in these other areas, it seemed as if NIAID was probably suffering more than some of the other institutes in terms of having the resources and being able to capitalize on these opportunities. This had a bearing, I think, on the degree to which they could move on new problems.
Whitescarver: Yes. In those days, the NIAID had the lowest payline of any of the institutes, and the lowest award rate. We kept preaching that the poor get poorer and the rich get richer with these percent increases. We were not able to keep up with scientific opportunities, particularly in the mushrooming area of immunology. We were afraid that we were going to lose a lot of the immunologists because we couldn't afford them. We weren't about to let highly qualified, scientifically meritorious awards be held up in the NIAID that couldn't be paid. We would certainly release them to other institutes, but we didn't want to give away our whole portfolio. So, we had to have ways of getting more attention and money into the till. We had a broad area of responsibility, but not much flexibility.
Harden: This was also the time when some restructuring was being done in the intramural program of NIAID, was it not?
Whitescarver: Yes. Before I came on board with NIAID, Ken [Dr.Kenneth] Sell had been appointed as the scientific director, and he had reorganized the intramural program and instituted particular areas of emphasis. That's when Tony's [Dr. Anthony Fauci's] lab was established in immunoregulation. There was a lot of change going on, reflecting the scientific opportunities and the expertise of the NIAID. It was easier to recruit and to shore up scientific areas in those days than it is now.
Rodrigues: Do you recall when you first heard of these cases that became known as AIDS that were starting to be recognized on the West and the East Coasts?
Whitescarver: I certainly was aware of the four cases on the West Coast long before I knew anything about [Dr. Alvin] Friedman-Kien's work in New York on Kaposi's.
Harden: Could you discuss that meeting that you started to tell us about before this interview began? Was this the first time that there had been sort of an official meeting?
Whitescarver: This was a special site visit to the CIRID [Centers of Interdisciplinary Research on Immune Diseases] in Los Angeles at UCLA [University of California, Los Angeles]. The meeting's purpose was for a group of evaluators to look at the progress in this new program of an interdisciplinary center. Built in to each of these CIRIDs, by congressional mandate, was an outreach activity, so we had public people along on this site visit. The agenda that they gave us the night before was all about their progress in allergy and immunologically based diseases. The next morning, when we got to UCLA, they gave us another agenda, and I noticed that the primary difference was that they had added a presentation by [Dr.] Michael Gottlieb on Pneumocystis in these four male patients. I objected to that being put on the agenda because I didn't see the rationale of an infectious disease's being discussed as a part of the progress on allergy and immunology. But [Dr.] John Fahey said, “Well, now wait. Yes, it's an infectious disease, but it has a very interesting immunological profile to it.” So we left it on, and Mike talked about the four patients–two were homosexuals, one was a bisexual; those three had already died. The fourth was still living and had not admitted to being a homosexual.
This presentation was very curious to our group. The members didn't quite see how it fit in with what they were reviewing. There was a clinical allergist, a lawyer, and basic immunologists as well as clinicians. They didn't quite see why we were being told about this phenomenon, except that it was very curious that, in this disease entity, this Pneumocystis, the CD4s were down and the CD8s were way up–T4s and T8s. It was an interesting kind of observation that had not previously been noted in Pneumocystis patients, and it looked like the profile of an immunedeficient patient. These were young people, and none of them–even though their case history wasn't complete–had had any kind of disease or were taking any medication that would bring about this immune deficiency. I think that an infectious agent was suspected, but I'm not too clear on this. I think that the report might have it in it. I'm not so sure that John Fahey and Mike Gottlieb looked upon these particular Pneumocystis cases as opportunistic infections, like they saw in the cancer patients. Both of them have a lot of cancer patients. John Fahey, as you know, was in both areas, cancer research as well as basic immunology and clinical immunology. A footnote to this story is that some years later, the fourth person was identified as a Haitian. At that time, there was no reason to mention that this chap was a Haitian. It became a part of the report, however.
The cases posed an interesting immunological situation, and I remember talking about it to Mike. Given that Pneumocystis was opportunistic, I thought that if something was causing those T-4 cells to go down, or to change the normal immunological profile, we might have an infectious disease, and we certainly should be aware of that. So I came back to the NIAID and that was put in our report. It went down to the Congress, and we talked about it at the [NIAID] executive committee. It was not a special topic, but we talked about the review of the CIRIDs, which were kind of special to the NIAID because they were the first of the congressionally mandated activities. We knew that Congressman [George] O'Brien was particularly interested in them. So we all agreed that those four cases were very interesting; we must keep an eye on them. We weren't going to look further into them, however, because there seemed to be no real reason to pursue them dramatically.
Harden: It appeared to be an isolated situation?
Whitescarver: Yes. It just seems that we got involved gradually. I do remember we were talking about having to shift funds to support activities to look into this new disease entity, which appeared to be infectious and certainly had a very interesting scientific basis as far as immunology is concerned. Our first involvement was through Ken Sell, who immediately began to focus some research activities of the intramural program on the problem. Some intramural scientists began looking for the agent or agents, and their first thought was that it might have something to do with hepatitis, because all of these people had had hepatitis. Well, as it turned out, all those people had had everything else as well. That made us curious about whether the hepatitis vaccine had something in it. And, boy, did I get upset about that, because I'd been on a protocol over here–I had taken the hepatitis vaccine. I really got worried. Extramurally, things were much slower in getting started than intramurally. It was almost overnight that they started intramural research activities.
Harden: There's a considerable difference between how fast the intramural program can change and how fast the extramural program can change, isn't there?
Whitescarver: That's right. It takes a while for extramural. You've got to wait until applications come in. You can't just go out and direct activities. We've been criticized for being sluggish in getting started. I don't remember the exact date when the first patient was admitted, but I do recall that there was a snowstorm, and NIH was closed. It was right before an NIAID council meeting. Somehow I had gotten into work, and Krause was already in. We were the only two people on the seventh floor, and the telephones were ringing everywhere. I answered the phone at one point, and it was a physician from some area outside of Philadelphia. He said he had tried all over Washington–even the White House–but he couldn't get anybody. He needed some help, and he had tried everywhere. To this day, I don't know how he knew to call NIAID. He had a patient–a forty-odd-year-old man who had Pneumocystis, and he'd done everything he could do for him, but he was still very ill. Could we offer any advice? I said, “Well, I'm not a physician, but I'm sure we can offer you some advice. Hold on.” I called Krause, who talked with the man. He told me to call Tony [Fauci]. Tony was also in, and the patient was later admitted that same day around six o'clock. That was, as I recall, the first AIDS patient admitted to the Clinical Center, and Tony took care of him.
Harden: Can you follow that case any further or is this pretty much where you left it?
Whitescarver: That's where I left it. I'm sure it can be tracked down.
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