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Harden: Do you have Ken Sell's 1983 memo instructing that hepatitis precautions be taken? What did people do before 1983? Were there any special routines?
Whitescarver: Yes. We kept telling people to use very strict microbiological techniques in dealing with patients and their material. They had to treat it the same way they would hepatitis B. The reason we did that is because hepatitis B is so infectious that we thought it would provide protection if the AIDS virus turned out to be highly infectious also. Since the AIDS organism is not nearly as infectious as hepatitis B, it turned out to be a good precaution. We didn't think we were going to be dealing with anything of that scale. The epidemic certainly didn't parallel what one would expect in a far more infectious virus like the other ones they play with all the time around here. It just didn't seem to be that. AIDS wasn't as infectious, but it was, of course, highly lethal. Epidemiologically, AIDS seemed to be transmitted in a pattern like that of hepatitis B.
Rodrigues: One of the things that Dr. Richard Wyatt told us was that some investigators were concerned about introducing unknown AIDS specimens into the laboratory, not necessarily because of the risk to themselves but because they feared contamination of their existing cultures. For that reason, some labs were reluctant to look at these specimens and, perhaps, to initiate work on AIDS.
Whitescarver: No, I hadn't heard that, but I can understand. I studied Mycoplasma for my Ph.D. thesis. Everybody hated Mycoplasma, which were organisms they knew little about, because they got into tissue cultures and contaminated everything. So, I can see the reason for caution there.
Rodrigues: We'd like to round out your involvement with AIDS. When did you leave NIH?
Whitescarver: It was in 1984.
Rodrigues: Were you involved with AIDS at Emory University?
Whitescarver: No. After I got to Emory, and the year's service away from government had passed, I became a consultant to the contract that was doing some of these outreach activities. We tried to get AIDS activities going at Emory, but we never succeeded.
Harden: Would you comment on that? I have heard this from a number of people. Was this because of the conservatism of the Emory physicians?
Whitescarver: Not the physicians. The administration wanted nothing to do with AIDS. Then there was Grady [Henry Grady Memorial Hospital]. Grady is yet another story. Emory University Hospital agreed to take care of private patients with AIDS, but they were as sure as hell not going to cordon off any area and designate it as an AIDS area, because they believed that it would prevent patients from coming to Emory Hospital. They didn't want Emory recognized as an AIDS center. The Emory administration agreed that people could do basic research but discouraged anything having to do directly with AIDS patients, because they didn't want a stream of AIDS patients coming into the hospital. That was profound.
I can think of at least three attempts that we made to get something going in AIDS with support from the clinical investigators, who were very concerned. From my perspective as the dean for research, I always supported research that would bring money in to the university. I knew there was lots of money in AIDS. I was pretty well-connected to where the money was coming from, but the Emory administration preferred not to have the money. Even now, nothing is happening down there.
Harden: You said that Grady was another story.
Whitescarver: Grady's another story because as a city-county hospital, it happens to have a contract with the Emory medical staff to take care of patients. It is a training hospital. Grady does have lots of AIDS patients, as you would expect, but it's nil insofar as being an AIDS base. They don't have an AIDS clinic, even though they do see and take care of a lot of AIDS patients.
Rodrigues: For the record, when did you come back to NIH and what were the circumstances?
Whitescarver: I had visited Dr. Fauci on a couple of occasions when I came up to consult on the outreach contract. I would have dinner with him, and he would say something like, “Jack, you really should come back to Washington. You'd like it so much.” And, I would say, “Tony, yes, I love Washington and I miss it desperately. But, I can't afford to come back to government, nor can you afford me.” When he was appointed associate director for AIDS research–and when this office was being set up–he asked if I would come and consult. Actually, it was Mike [Michael] Goldrich who asked if I would come and consult on setting up the office. About the second time I came, Dr. Fauci said, “I need a deputy and I've been looking for a medical person.” I think he'd been turned down twice. I know that Richard Wyatt was offered the job, but he turned it down. He asked if I would be interested in taking the job as deputy. Of course, I really was interested in AIDS again, and I was really getting frustrated at Emory. So, I said, “Well, keep me on a personal services contract for a little longer and we'll see.” I came on full time in June.
Rodrigues: You've seen this organization grow up quite a bit in the last few years.
Whitescarver: Yes. The work load has grown since three or four people were handling it out of [Dr.] Jay's [Moskowitz] office. As to the policy aspects, we've taken on additional programs. We have now the loan repayment program, and we're starting to do regional meetings on something that was very poorly named: technology transfer. What that really means is taking new clinical information and getting it out to primary care and family care physicians. This is information such as how to take care of ARC [AIDS-related complex] and asymptomatic patients. We're going to do our first regional meeting–believe it or not–at Emory.
Harden: That's ironic, isn't it?
Whitescarver: HRSA wants to be involved, and we just met with HRSA representatives about collaboration and use of their education centers. They have twelve, I think, around the country. We will provide them resource information and speakers for their program. Things like this that we've taken on have brought a new level of effort to the office. We still have the same twenty-four hour turn-arounds from downtown, etc. to manage as well.
Harden: Do you have anything else that you wanted to add before we stop?
Whitescarver: No, but I'll help you track down that CIRID review. Have you talked to Nancy Brun?
Harden: Not yet.
Whitescarver: She actually wrote that report. I went on the site visit. She may have kept a copy. I didn't think that the AIDS presentation was something that we should put in that report. I saw that it was not relevant to the intent of that document. Nancy argued with me about that and since she wrote the report, it got in there. And, now, I'm very grateful that it did. But, it was she who got it in there. I didn't think that it was part of the document or had any relevance to the document.
Rodrigues: Are there any other names that come to mind of individuals who were involved at NIH?
Whitescarver: Have you talked to Ken Sell yet? Tom Quinn was involved in the very first development of Projet SIDA, the Zaire project. He can certainly tell you about the cooperation with CDC. You've talked to Dr. Clifford Lane. Dr. Lane was here from the very beginning. Yvonne du Buy can give you a good story on how NIAID took the lead at the NIH, after the period when leadership was rocking between the NIAID and Cancer [NCI]. She was involved when Cancer turned the lead over to NIAID. I think there are documents to support that, if they, too, haven't disappeared. I can't think of anybody else in those early days who might be able to give some interesting things from an historical perspective. There were some bizarre things that folks looked into as possible causes of AIDS, such as fungus. Tom Quinn, bless his heart, thought for a while that maybe something from dogs caused it, because all the gay people had dogs.
Rodrigues: Some of the theories are fascinating. Art [Dr. Arthur] Levine told me one about tanning salons. Apparently, gay men had bronze tans, and they got them by going to tanning salons. Some people thought that maybe the radiation from the salons was wiping out their immune systems.
Whitescarver: It might be interesting to talk to Bill [Dr. William] Jordan, because he was head of the [NIAID] Microbiology and Infectious Diseases Program and certainly was involved in all the early activities.
Harden: We certainly appreciate your talking with us, Dr. Whitescarver.
Whitescarver: I'm delighted. I'm very anxious that this documentation project be completed.
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