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Gelmann: Bob's laboratory always worked more or less as a sole agent, relying on collaborators who brought in samples. There was not a whole lot of collaboration with the virology laboratory at the CDC that was headed by [Dr. Cirilo] Cy Cabradilla. If he did not head it, he was intensely involved in it. There were other collaborators who brought specimens and exchanged materials with Gallo, but there was no extensive collaboration with the CDC. I think the big exchange of materials or activity went on after I had left the laboratory. There is this famous story told about the 200 samples which Gallo was given blinded and how he was able to identify them based on the new serologic tests which had been developed from the viral reagents that [Dr. Mikulas] Popovic and [Dr. M. G.] Sarngadharan had isolated.
Rodrigues: Another thing that we have come across in our research was your name listed next to a series of different projects that NIH was initiating, some of which had to do with an efficacy study of human lymphoblastoid interferon in Kaposi's sarcoma.
Gelmann: What happened in the middle of 1983 was that I was in the process of making a career move, regardless of AIDS. It happened to fall right in the middle of the AIDS excitement. This was just after we published our papers in Science and had gone to the meeting in Cold Spring Harbor. I was packing up my stuff and moving to Building 10 when [Dr.] Françoise Barré-Sinoussi was visiting the laboratory after the Cold Spring Harbor meeting. She had come down to Bethesda and brought samples with her. I had made a decision completely independently to take a senior staff position in the Medicine Branch and return to doing a little more of clinical activities. Because of that move, my activities changed from doing laboratory research in AIDS to being involved in some of the clinical programs.There was a desire to establish clinical programs like those I was involved in in the National Cancer Institute. So we decided to focus our activities on the cancer aspect of AIDS, which was Kaposi's sarcoma. I was involved in those trials–when they began I was still in Gallo's laboratory–and had a commitment to go to the Medicine Branch. We also felt that it would give us an opportunity to collect our own patients and that those patients would provide us with the ability to learn about disease and collect samples. Since interferon was being used in Kaposi's sarcoma, we thought it would be a good idea to test whether it had some antiviral properties as well as antiproliferative properties. I became the principal investigator of that trial and then we began to accrue patients. I continued that Kaposi's work when I moved to Building 10.
Rodrigues: About how much longer did you pursue that?
Gelmann: I was involved with clinical AIDS work for about a year or two after I moved to Building 10. That was very much of an inter-branch collaboration. We had a large number of patients in the clinical studies and also a number of on-going ancillary laboratory studies. There was a cadre of research nurses, fellows, and other people who were interested in their care. Every week, [Dr. H. Clifford] Cliff Lane, [Dr.] Henry Masur and I sat down in a large conference room with all of the ancillary staff and went through [the records of] each and every patient who was on the various studies of the Clinical Center, NIAID, and the NCI. When patients were done with one study and appropriate for another, we transitioned their care. Laboratory workers from the FDA [Food and Drug Administration] and from elsewhere would come and give reports on viral testing, on reagents, what we needed to do, what we could give them and so on. That was a very rich and fruitful time for collaboration. An ad hoc AIDS working group sprang out of those meetings. That was from the initiative of Lane, Masur, and myself. We got together and started seeing patients on the ward, but then it would become overwhelming, so we sat down in the room once a week. Out of that came, for me, nearly fifteen or twenty papers. It was just a tremendous collaboration and where all those publications in my curriculum vitae come from.
Rodrigues: Maybe you could say a little more about how that AIDS working group evolved. It was confusing when we looked through the records since there were many different groups of people that seemed to come together for different purposes.
Gelmann: From my point of view, it evolved strictly out of the needs of clinicians trying to deal with the increasing number of patients. Henry was quite an expert in the clinical management; Cliff was working with Tony [Dr. Anthony] Fauci and had some new reagents that he wanted to try; and we were collecting our own patients to look at Kaposi's sarcoma. The clinical aspects of AIDS were pretty new and we did not know that much. So we were constantly consulting with each other while seeing patients on the ward. But as more and more patients came, the burden became so overwhelming that we just had to sit down and do it in an orderly fashion. In addition, so many other investigators were asking for blood, urine, and other samples, that we felt that the best way to do that was to coordinate this through a single meeting. That way, various protocols and requirements for different sample acquisition could be met, patient care would be optimized, and then patients who were done with one study could move on to another if they were eligible. It was really a grass-roots effort that just sprang out of the needs of the people who were involved.
Harden: What about your staff–the nurses, technicians and other people? Were you getting any particular feedback from them in terms of direct patient care and their concerns about AIDS?
Gelmann: In the research staff, everyone in this working group was dedicated and I guess we just accepted by observation that this was no more contagious than hepatitis B. We were careful, but not paranoid. Certainly we dealt with these patients and their materials carefully, but basically in the same way as we would for a patient with hepatitis. There was some greater concern among the general nursing staff, and it was addressed directly in meetings. The one thing we did early on was to proscribe contact of pregnant medical personnel with patients, because we knew that the patients were carriers and shedders of cytomegalovirus. That represented a potential threat to a fetus. There has been a lot written about regulations in handling and universal precautions. There has been a lot of adaptation, and also recommendations have come out of the CDC, but, fundamentally, not much has changed for us, since we took precautions from day one. Fundamentally, AIDS still has a similar transmission pattern to hepatitis B.
Harden: What about the behavior of the patients?
Gelmann: It was something we adapted to. To my recollection, there was not in our clinical activities, any specific support or focus on psychosocial aspects of AIDS care. I do not remember whether we did not have the personnel or whether we were too busy.
Harden: Were the patients generally cooperative?
Gelmann: Immensely. They were one of the heroic stories of the whole AIDS saga. Initially, most of those patients were homosexual men and one of the great stories of the AIDS saga has been the response of the gay community: active, well informed, cooperative, supportive to each other and not particularly enjoying dying young. It is my personal belief that the AIDS activists, in terms of the experimental drug issue, have done all of us a favor, and cancer, sooner or later, is going to benefit from the model of the AIDS activists. In fact, there is now a group for cancer survivors being formed and becoming more vocal. It was the AIDS activists that taught us how to do that.
Rodrigues: As the work on AIDS began to expand, were there problems for you and your staff in terms of support, or did you find that the resources that you needed to carry out research and to expand this effort were forthcoming?
Gelmann: Intramurally, there was always too much money. My personal viewpoint–it is strictly my opinion–was that extramurally for a while, there was also too much money. This was a tremendous problem. People had to throw money at AIDS, because only then did the bureaucrats and legislators think that something was being done, and then the money came too fast. We could not adapt; we could not learn how to spend it as fast as it was coming.
Rodrigues: Now, you say that was true even for the intramural program at that time.
Gelmann: It is my personal view, that for the extramural program, it was true that when all of a sudden there was a tremendous expansion of the AIDS dollars, there was a lot of money that went to projects that were not properly conceived. It takes time to figure out how to spend the money and what experiments to do. But the public demanded that money be spent; that the problem be solved. That has changed. We went through a growing period, things evolved and there has been some incredibly useful work coming out of the studies of HIV at many levels. It has tightened up, now. But in the beginning, there was a huge waste.
Harden: We can take this one step further for a philosophical question about the public's view, the physicians, and scientific medicine. Do you think we can just pour money into a problem and a solution must be forthcoming, and, furthermore, if it is not, then anger is justified?
Gelmann: The understanding is forthcoming, and you do not need AIDS for that. I mean, look at sickle-cell anemia. We understand that down to the atomic level. So, the understanding is forthcoming. AIDS patients have certainly benefited. For example, AZT [3'-Azido-2', 3'-dideoxythymidine] basically came out of the intramural NCI program. AIDS testing of the blood supply is, after all, essentially safe. Just think, right now if we had no serologic tests, we could not guarantee our blood supply. What a disaster! There have been some major advances with this. We are learning about this virus. We have known about influenza much longer and have yet to be able to figure out how to make a vaccine that is useful for more than one season. We may have to wind up re-vaccinating people for the AIDS virus once we figure out which people we should vaccinate. But we have learned a lot in general about retroviruses from the work. The technical expertise that has poured into this and the biotechnology is wonderful. This will have ramifications for many different fields. This is not just AIDS. When you get down to such fundamental issues in biology, there is always spillover.
Rodrigues: You can look at the spillover of where things will go in the future, in terms of what we are learning, by looking at AIDS. The other part that a lot of people tend to discount is the work that was done immediately preceding the emergence of AIDS. For instance, look at all the work on HTLV-I and the techniques of cloning genes.
Gelmann: I am glad that Montagnier had the virus, but I am certain that there was no place in the world which was more ready to analyze its import and prove that it was the causative agent of AIDS than Gallo's laboratory. He had all the pieces in place; he had all the machinery to analyze new retroviruses, and it was what he had been trying to do for fifteen years. His people, namely Mika Popovic, learned how to grow it. Once they knew how to grow it and make enough of it to get reagents to study, then they knew what tests to do. That was the one place in the world where it needed to be to get things done fast. There is no question about that.
Harden: Do you think that the [John] Crewdson articles are tilting at the wrong windmill and, in a sense, splitting hairs or is there some justification for them?
Gelmann: Crewdson was trying to analyze personal behaviors, individual actions at particular times of some day of a week, and make a pattern or make some understanding of it. I am not sure I can understand those events in the same way that Crewdson did. Science works in funny ways, and a lot of it is opportunism. However, the sinister and conspiratorial aspects of Crewdson's account are perceived and were not real. If Bob Gallo gets the Nobel Prize, which he should, it will not be the first time someone, whom other people think to be difficult, wins the Nobel Prize. That is part of life. Mika Popovic had spent twenty years working with retroviruses. He came from the institute in Prague, one of the cradles of retrovirus research. Sitting in his little back room, he applied techniques that were twenty years old, trying to grow this thing. In a very ancient and European way, he would puff on his pipe, put his pipe down, and do some work and pick his pipe up again. The biohazard people would have shot him. But he was involved in a critical breakthrough in terms of growing viruses.In fact, at that time virus stocks were just not available. Making enough for anyone to prove it and to figure out what it was meant learning how to grow it. The French did not know how to grow it. They grew it in culture on fresh cells, and the virus did what it was supposed to do and killed the cells. So every two weeks they had to start their cultures all over again and they were never able to collect any and save it for the winter. Popovic derived the cell line that was resistant to killing by the virus. Therefore, you could grow and produce the virus and you could collect it in studies–protein studies, nucleic acid, make antibody tests out of it, and so on. There were all the people in place to do the mass testing, to take the blind samples from the CDC and prove the association. Gallo's laboratory was ready to do that.
Harden: It sounds as though Dr. Gallo's personality becomes the focus for a lot of people.
Gelmann: Throughout his career.
Rodrigues: I think that part of the problem people seem to have is that they expect physicians in particular, and probably scientists in general, to be individuals who are somehow beyond those weaknesses and frailties that we see in others. We are unforgiving when we see such things in them. The expectation is that someone in that kind of position is more than human.
Gelmann: It is hard to meet those expectations.
Rodrigues: One of the things you mentioned before was about how the AIDS patients and the AIDS activists helped not only their own cause but also other types of patient areas. Has any of the activism about AIDS hampered any effort or discouraged people from becoming involved in the research? It seems as if the federal researchers particularly, if you read some of the articles, were cast as villains by some of the more extreme activists.
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