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The health care worker surveillance in AIDS was an extension of that. Stan [Dr. Stanley] Weiss, another person to whom you might be interested in talking, is active in this field. He is at the University of New Jersey Medical College in Newark. He is very energetic and expansive. He was involved through Hal [Dr. Harold] Ginzburg, who was at NIDA [National Institute on Drug Abuse] at that time, in some drug abuse cohorts. He also set up the surveillance mechanism for laboratory workers and worked on a case that is in the courts of New York, about this unfortunate woman doctor who became infected. It was obvious that health care workers–if there was any analogy to patterns of transmission of hepatitis–were at risk. There was also a tremendous problem of confidentiality and risk of disclosure. It forced us to stretch ourselves beyond what we had ever done before, in terms of setting up mechanisms to maintain the confidentiality and protect the privacy of the individual. When a woman doctor turned up positive in our initial screening, there was a great concern that NCI should be aware of the potential dangers. [Dr. Robert] Yarchoan and others were beginning to develop therapies. When people had their blood drawn, they were given an ID card with a number on it. No identifiers were maintained. It was just good fortune when a person called in for his or her results. Then there was the whole problem of the source of infections. Did the people who tested positive have pre-existing infections or had they sero-converted after a hospital exposure? The burden of proof was always on the side of proving that infection was not by sexual transmission.
We were the first to identify a hospital doctor who had become infected through an occupational exposure. However, when we reported this at the Interscience Conference on Antimicrobial Agents and Chemotherapy meeting, that particular presentation got laughed off the stage. It has been one of the themes that I stick to, however, and I have a very strong political philosophy in addressing this epidemic. I think that denial is a major component of our response to the epidemic. The Public Health Service and many other people are involved in that denial. One of my missions is to make the only contribution that I can legitimately make, which is that as a scientist. Thus, my contribution has been to make sure that good science blows bad policy out of the water and makes people confront the issues by discoveries which cannot be ignored by policy makers.
The health care worker was one such case, the laboratory worker was another. Until it happens, it is not real. That laboratory worker episode was one of the most trying and complex things in which I have ever been involved. There was a long lag between the time that we first recognized that the individual was infected and when we were in a position to report the finding publicly. Of course we immediately informed the laboratory workers and the biosafety office about this case, since we could not prove that the infection was acquired in the laboratory. The person was positive at the time of enrolment–weakly positive, so we could not rule out another source of exposure. We could not go and tell a bunch of laboratory scientists that AIDS was a laboratory infection without proof. We were working against technology. The technology for isolating this virus, despite Randy Shilts's statements in And the Band Played On, is very complex.
It was not until the spring of 1986-87, that a new technology came along that allowed the virus to be isolated. This is because in the early stages of infection, the virus may go into adherent cells more than into circulating cells. We could not get an isolate until Mika [Dr. Mikulas Popovic] developed his culture system for monocytes and Dr. Dave Waters, Ph.D., of Program Resources Inc. at our Frederick, Maryland [Cancer Research Facility] developed a whole blood coculture assay that allowed one to pull out the adherent cells containing the virus. Once isolated, we were able to have different laboratories characterize that the virus was indeed the laboratory strain being grown by the infected individual. This finding was immediately announced by the NIA safety people to alert people to the risks. There was a lot of resistance to that conclusion, however. It was dismissed as a contamination problem. Fortunately, we had two different laboratories that were independently isolating the virus and thus we were able to disprove the contamination theory.
The most unpleasant part of this work for me has been dealing with the media. Basically, I do not like to get out in front of the cameras. It causes me a lot of anxiety to talk to the press, because they invariably use what you say for the point they are trying to make rather than the one you are trying to make. I have never felt comfortable with that. I am much more comfortable with the role of a scientist who is in the laboratory trying to do good science. I would rather enforce policy by science than by getting up and saying something. It is much different from anything else in science, because of the profile that is involved and the potential for missteps. For example, the case of the second infected laboratory worker, who was identified by another investigator, was mishandled. Of course, I was the one who got the nasty calls: “How could you be so stupid and not tell that person for so long”? I said: “Hey, wait a minute; I didn't know anything about this.” In contrast, in the case of the first infected laboratory worker, everybody was informed from day one. We went to great lengths to prove that this person had been infected with the laboratory strain with which the person had been working; to identify with the safety people what the possible exposures were; to make sure that the person knew what the implications were, in order to prevent spread to a sexual partner, and so forth. It is very stressful. Working in the AIDS arena has been a very stressful experience.
Harden: Thank you, Dr. Blattner.
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