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Harden: Would you elaborate on your earlier comments about the uniqueness of the NIH and especially the Clinical Center as a place to investigate any new disease? What are the pluses and the minuses?
Henderson: The pluses, I think, I have really underscored. We have a remarkable assemblage of basic scientists who understand almost every basic science principle that exists. We have “translational” investigators who are able to take basic science ideas and move them from the laboratory into clinical medicine. We have a wonderful infrastructure of equipment, of cutting edge technologies, and we have a clinical support staff that is second to none. So the pluses are the remarkable resources that are here to do wonderful clinical science.
I think that there are very few minuses that you will find from talking to investigators around the campus. Some minuses might be related to the fact that the Clinical Center is not a full-service hospital. If a person has an orthopedics problem we have to get an orthopedics consultant to come out here and that is uncomfortable, or, at best, it is cumbersome in some instances. I cannot think of too many other minuses.
Harden: What always strikes me, as we talk to people about this, is that even though the NIH is a huge place it becomes a very personal kind of operation. It is a very small village in that sense. For example, if somebody has an eye problem, you know whom to call, and in calling a person, you are relying on your personal knowledge about a person's skill, as opposed to a set of credentials on paper.
Henderson: Right. Over the years, the people who have been assembled here are stellar. So if you have an eye problem and you call the [Dr. Robert] Bob Nussenblatts of the world, you know you will get a stellar eye exam and insight not only into just what the lesions are, but how they might fit into the overall picture. The institution works remarkably well. When we had our external review last year, when the Secretary of Health and Human Services sent Dr. Helen Smits and a team in to look at us, one of the first things that we tried to explain to them is the extent to which the staff of the Clinical Center and the Institute/Center investigators are woven together like a piece of fabric. To take out part of that staff or to contract out for part of that staff we would do irreparable harm to the Clinical Center and to the Intramural Program, because it is all put together just as you say–you know whom to call and how that works–and it makes for very high quality care.
Harden: What is your sense about how well known this is among physicians and scientists? What about among the politicians, the general public, or the press?
Henderson: I think that the Clinical Center is not well-recognized by the general public, medical professionals or the press. I think people have been surprised to find out all the things that have happened in this building and all the wonderful things that have come out of here. It is really quite a remarkable place and has been, in my view, which is admittedly quite a narrow view, a wonderful investment of tax dollars, but I think very few people actually know what goes on here.
Hannaway: Another position, or something that you have been involved in, was the Physician's Advisory Committee on the Watkins Commission on the HIV Epidemic in 1987. Were there any interesting aspects of that? I am sure there were many, but could you tell us about some of them?
Henderson: This is one of my favorite stories because it shows how foolish I can be. Dr. Decker got me into that as well. I cannot recall exactly how my name first got thrown in the hat. But there were only four of us in Admiral Watkins’ “kitchen cabinet.” What happened is that Dr. Eugene Mayberry was the first commissioner and he quit; the second commissioner was Admiral [James] Watkins. All we knew about Admiral Watkins was that he had come from the Navy, that he was not a physician, that he had no medical background and did not know anything about AIDS.
So, the next thing I knew, I got a call from someone downtown wanting me to be one of four physician advisors to Dr. Watkins. They wanted a neurologist, Al Saah, who is an epidemiologist, and I cannot remember who the fourth person was.
Hannaway: We have a copy of the report so we can look it up.
Henderson: We were asked to meet with Admiral Watkins. So Dr. Saah and I took the Metro down to some building where they had offices and we went in and sat down with Admiral Watkins. He came in, sat down, and said basically, “Look, I do not know anything about this disease. The President has asked me to do this job and I am going to do it, and I am going to do a great job, but I have to learn and you all have to teach me.” He said, “By the next time you see me,” which was, I forget now when we were supposed to meet again, in six or eight weeks, or something like that, “I will much more knowledgeable about this disease.”
After the meeting, the physician advisors walked around the corner to the Old Ebbitts Grill and had a beer, and I said, “I am not going to do this. I do not want to have anything to do with this project.”
So I came back to the Clinical Center and tried to convince Dr. Decker that at some level, it was a conflict of interest for me to be involved in this commission because they were going to be evaluating us and so how could I be advising Admiral Watkins. He said to me sternly, “This man needs help. You go down there and help him.”
Well, I will tell you, I have never been so wrong as I was about Admiral Watkins. He is a brilliant man. By the time we went back six weeks later he could speak the language of AIDS as well as anybody. In fact, we finally invited him out here to give Grand Rounds. He actually gave medical Grand Rounds here and talked about AIDS. I can still remember him answering questions. People were asking him medical questions about articles that had been written about cognition. He said “You are talking about that paper that was in the Archives of Neurology, and there is a much better paper in the Annals of Internal Medicine.” Participation in the Physician Advisory Group to Admiral Watkins was quite an experience. We spent hours with him and his staff basically going through issues just to try to give him our scientific reading of where the issues were at that time. He had two wonderful special assistants and the way his mind worked was he would take on an issue and we would talk about the issue in paragraphs, literally, just spinning off paragraphs for him. He would look at one of his assistants and he would say, “Do you have that?” She said, “Yes,” and we would move on to something completely different. We just spoonfed him about HIV infection as rapidly as we could and gave him a reading list and things to look at. He got up to speed faster than you would ever dream. He did not need an M.D. degree to do that. He was wonderful, and quite an impressive man.
Hannaway: None of this is apparent in the report, is it?
Henderson: He was a very smart man, and you get that from him very quickly.
Rodrigues: Yes. I think he gave a speech at the First World AIDS Day that was held at NIH and it was probably one of the best talks I have ever heard.
Henderson: He was astounding. I tend to get very quiet around him, not wanting to show my own ignorance. He was very smart, a very hard worker, true to his task, and did a great job, I think.
Hannaway: Did you have any involvement with Dr. June Osborn's commission?
Henderson: Yes. I testified before that commission once or twice, maybe twice.
Hannaway: She is rather impressive herself.
Henderson: She is a major star, and was also a wonderful choice. She was more of an academician than Admiral Watkins. He was just going to get the job done. He had a military, “We are just moving through this,” approach.
Rodrigues: We are coming to the end of our questions here and one of the questions that we ask all of the people that we have been interviewing is a two-part question. It has to do with how your involvement with AIDS has affected your professional and personal life. Some people seem as though they are very capable of keeping the two things separate. AIDS has not really created stress or problems for them in terms of overloading them with the immensity of the problems with which they are dealing. Some people see themselves as separating their professional lives from their personal lives; other people seem to have a harder time doing that. I was wondering if AIDS has created any problems in your life. Also one of the things that we have found intriguing is how some people said that, when they looked at their professional lives, how surprised they were at how far AIDS pushed them in directions that they did not think they might have gone.
Henderson: Absolutely. The AIDS epidemic certainly changed my professional life. I was going to be a clinical mycologist. I was doing hospital epidemiology just because it was a way to get a position to work in a basic science laboratory. There came a time when I had to choose between mycology and hospital epidemiology. I was in somewhat of a schizophrenic position. I was being paid a full salary by the Clinical Center to be the hospital epidemiologist. Dr. Bennett thought that I would only need to take 10 or 15 percent of my time to do that and that I would have 85 percent of my time to work in the laboratory. When I got here there was not any infrastructure for hospital epidemiology so we had to create it. It took me a year to get to the laboratory, but I finally did get there and worked successfully with him. But I came to a crossroads in my career where either I was going to have to do hospital epidemiology full-time or go back and work in the laboratory. I actually went down and had a long talk with the person who ran the Microbiology Laboratory, a man named [Dr. James] Jim McLowry, whom you may or may not know–he is retired now–and just sort of laid out my options as I was offered what to do. I said, “I have to make a decision because I am not getting enough done in the laboratory to justify my space with Dr. Bennett and because of the pressures of the Clinical Center and of trying to get this work done.” He said, “You have to do what you think is best.” I felt obligated, because the Clinical Center was paying my salary, so I became a full-time hospital epidemiologist. In some respects AIDS made hospital epidemiology a full-time job, not only at the Clinical Center, but at many places. There was so much angst about the risks and what was going on that you needed to invest substantial resources into it. So it clearly changed the course of my career.
In terms of how that affects your life, because I had the opportunity to do some of the things we have talked about, I always felt as though I was an insider who had wonderful inside information about this disease and that the country was ill informed about it. I had the opportunity early in the epidemic to return to my hometown, a town of 13,000 people, and talk about this disease to my undergraduate school, which has a student population of about 1,000. I have seen this as an opportunity for me to pay back the NIH at some level for what it has invested in me and also, I hope, to help people by doing that.
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