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Harden: What is going to happen now under the new NIH Reauthorization Act? If I understand it correctly, the new funds for AIDS will be administered by the Office of AIDS Research rather than going to individual institutes. Is that correct? Does that mean that you have to apply to that office for funds?
Gallin: I have not had the opportunity to read the law, so I do not know exactly what it says. You should get that from someone who is an expert like Tony Fauci. Anything that I would say is secondhand. The one thing I could comment on is that one of the impacts of the whole AIDS crisis is that it has clearly enhanced the visibility and the scrutiny of science everywhere, including that of the intramural program. Doing science is more and more like being in a fish bowl. People are watching everything that you do. There is a real consciousness that somebody is looking at what you are doing, and a concern that you cannot do anything wrong. That sometimes can be a potential impediment to work.
Harden: Has the intramural program had much pressure from AIDS activist groups, for example, the way Dr. Fauci and the extramural program have had people questioning decisions? I refer to the activists' questioning of large-scale clinical trials.
Gallin: There has been a little pressure for some of the intramural investigators, but it has not been a major problem. Tony Fauci has really absorbed most of that himself. Two other diseases have been the source of major ACT UP-like activities: one is Lyme disease and one is chronic fatigue syndrome. These are other issues that historically would represent very interesting things to look into at some point. It is amazing how much of the outside pressure Tony Fauci has been able to absorb.
Harden: I have one final question and then Dennis may have some more before we leave. A recent National Research Council report says that AIDS, as far as the Council can see, will sink into the inner cities, into the drug-abuse population and the minority populations, most of whom do not vote. Does that mean that ten years from now there will be no political constituency for research on AIDS, and we will start to see the money dry up?
Gallin: I do not agree with that. I think that at first, some people believed that it would just be the homosexuals who had the disease. They were all going to die and then we would not have a problem. That did not happen. Now some people think it is going to be the drug abusers, but what we are learning is that AIDS is continuing to spread. I guess that, as long as there is sex and as long as people have sexual desires, there is a threat of AIDS just like with syphilis. I think it will be a major blow for the inner cities. But, unfortunately, I do not think AIDS is going to burn itself out in the near future.
Harden: I am coming back to what you said earlier about Africa because the National Research Council report is fairly narrowly focused on the United States. But in Thailand and in Africa AIDS is spreading rapidly through heterosexual sex.
Gallin: I do not know enough about the sexual habits of people there or the social structure of those places. I know that in Zaire the situation is very different from here. In Zaire a middle-class, or an upper middle-class male, will normally have multiple sexual partners in a year, many more than in this country. This perpetuates the problem.
Rodrigues: One question I had is about how the political activism has affected the way things operate in the intramural program. I think you have already touched on that by talking about the fish bowl effect, of feeling that you are under a magnifying glass. But another question that occurred to me goes back to the comment you made about Dr. Fredrickson, when you first came here, and his feeling that infectious diseases were a dead end street for research.
Gallin: I think the point of his statement was that, as we then had a mechanism for containing infectious diseases with marvelous antibiotics, did we think that this area needed intense research effort? I can see why someone might, around 1969, have thought that there was not an emerging epidemic. We had gone through a so called“era of the antibiotic.” Antibiotics had not been around for all that long, there were new ones coming on, and resistance had not yet emerged as a major problem, although it has subsequently become a problem. But Dr. Richard Krause, the former NIAID Director, very clearly predicted the future emergence of new infectious diseases in his book, The Restless Tide. He applied history to envision what was going to happen. That really was not a novel statement, but it was a nice twist, it was refreshing, it was timely. It needed to be stated.
Rodrigues: Some scientists say that AIDS was such a surprise that it took them totally off guard. They never expected this sort of disease problem. But, there are other voices saying that you can almost expect this to happen in the microbial world.
Gallin: Right, and we are seeing it today. These problems have not stopped and are not going to stop until we outsmart the bugs. Consider multiple-drug-resistant tuberculosis (MDR-TB). I do not think we can outsmart evolution. That is not likely to happen, not in our lifetime.
Rodrigues: But do you think the concept of having to be on guard for the emergence of totally new types of problem has changed the focus of research in the intramural program at NIH?
Gallin: I do not think it has changed the focus of research in the intramural program. I think it has changed the sensitivity of our benefactors, and who knows how long that will last? It is hard to predict the future. But I do not think that intramural scientists have changed their directions of research to a course of understanding emerging microbes and how that happens. Maybe we should. It is an interesting question. But I have not seen that happen. What pressures may cause a microbial change that may create new diseases resistant to therapy has not been approached. It is an interesting question, a very broad and very fundamental question that maybe we should start looking at.
Rodrigues: At one point when we were doing some research, I tried to identify people who are actually on the area of emerging diseases. I could not find many people who had tried to look at the common features of new diseases.
Gallin: This will probably come, I predict, as a fallout of the Human Genome Project. As we understand more about the human genome or any genome–animal genome, microbial genomes–we will understand what the weak points are in the genetic code, so to speak, that predispose the host to mutations, to change.
Harden: Thank you very much, Dr. Gallin, for talking with us.
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