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What was interesting at that point is that we had no one to run it. AIDS research was scattered throughout our immunology program, extramurally, and our microbiology and infectious diseases program, as well as the intramural program. That's why, in the fall of 1985, we decided that since this was so important to the institute, and since we had received additional money, we had to create an extramural program for AIDS. This concept was developed in the fall of 1985, when we had a transition team that helped put this together. The program was established in January 1986 with two people, Dr. John La Montagne as the director, and Dr. Maureen Myers as the treatment person. You can get a lot of history out of Dr. La Montagne and Dr. Myers about the very early days. Before the AIDS extramural program was established, Dr. La Montagne was the influenza program officer, and Dr. Myers was the antibiotics substances program officer in our Microbiology and Infectious Diseases Program. We all knew that they were the two of the most capable extramural program people we had. We were desperate and needed our best people to get this program started. A number of other people were also conscripted into this program: Dr. John Nutter, who was the head of program planning in the Office of the Director, became the head of the vaccine branch. A number of other people were pulled from here or there. The program started with two people and gradually added more. Now it has fifty to sixty people, and we still need more.
Harden: Would you talk about the relationships among NIAID, NCI, Food and Drug Administration [FDA], CDC–in other words, intragovernmental coordination? There has been some talk about tension between agencies and I'd like to understand better how intergovernmental coordination works.
Hill: I'm not sure that I have a good perspective on this. I think that there are other people from whom you'll get more information because I really have not seen a great deal of tension. I was involved with Tony Fauci and with Ken Sell. The Cancer Institute and Bob Gallo did their thing and we did our thing. I know that there were individual differences between scientists such as Mal Martin and Bob Gallo, but I don't know how it affected us overall. The one point where there was some contention was in the fall of 1986, when we were deciding whether we were going to go for a bigger push. We thought the Cancer Institute was going to go with us, but they didn't. They later reconsidered and decided it was important to them as well. I think the Cancer Institute did make a decision at that point that this was not going to be a major research commitment. It would be interesting if you could get someone from the Cancer Institute to give you their thinking through this period of time. I think there were signals that their main obligation was to cancer and not to AIDS.
I think that one of the things that permeated this period was not a friction or a rivalry between NIAID and the Cancer Institute but the fact that we think differently. There is a Cancer Institute approach and a NIAID approach. We just do things differently. I think what has evolved is that the NIAID and the NCI work together very well when each designs its own program and does its own thing. When we try to mesh things, it has not always worked well. I don't know the reasons for that, other than the fact that there just seems to be a different approach to dealing with things. It's even more interesting when you realize that we've hired a number of Cancer Institute people to take over parts of our program. Part of it comes down to something that I guess could be criticized from the outside. You'd like to think that everybody has the good of people at heart. That is so, but all the institutes see their individual roles and their missions, and there is a certain amount of self-interest and obligation to one's institute. We always look at it as from an NIAID approach and the good of this institute. I guess there might have been some appearance of conflict. I think it has been greatly overblown, however. The working relationships between individual people in NCI and NIAID have been extremely good, far better, than the public would think. Tony Fauci and Bob Gallo have worked together very closely. We have worked with NCI people on individual areas very well and also on committees.
Harden: I guess one of my concerns reading the literature about AIDS and from talking with some reporters, is this misconception that science is some sort of monolith and NIH is a monolith, and...
Hill: ... that all scientists should have the right answers, that there should not be any sort of disagreement on the approach, that everybody should be working single-mindedly, and so forth. I don't care how serious the problem is; I don't care how good everyone's intentions are. I think everybody's intentions have been good. There is no way that groups of people will not run into some differences of opinion over the way something is done. That often translates into disagreeing or bickering. I don't think there is any country, any program, or any situation that can work without differences. In spite of the fact that AIDS is a major international problem, there is no way scientists can work without some disagreements. The groups that stand on the outside and criticize this–whether it be the Congress, the gay rights groups, or the local medical groups–usually disagree on the way things should be done. How do they expect us to be any different? We are criticized by many different groups, for our approach, but, believe me, they have had their own setbacks and difficulties because of disagreements in the approaches to things. We all have the same goal. It is natural to have differences in opinion and approaches.
Harden: How would you evaluate the media's presentation of AIDS?
Hill: A number of reporters are very knowledgeable and not prone to panic and sensationalism. But occasionally it does flare up. In the early days of this epidemic, a lot of it had to do with the incredible severity of the disease. A lot of it had to do with the fascination with the fact that this was a disease of gay men. It was extremely sensational; it was a combination of attraction, repulsion, fear, and hysteria. This made any newspaper article on AIDS a front-page article. There were reporters who knew that any sort of article that had anything to do with AIDS was going to get a great deal of attention. A lot of people took advantage of that. There were several reporters, though, who very early on became real experts and did a good job. I think that, overall, the press has served more of a positive than a negative role. It has been able to educate people, but often it has depended so much upon the individual reporter and his or her knowledge. Many of the articles were written by reporters who were not science reporters and who had very little understanding of the basic principles of infectious disease transmission, immunology, and microbiology. Consequently, there was an awful lot of misinformation in their statements. In the early days, it was a matter of having people in the press who had an understanding of AIDS. They were constantly pushing for a sensational article, and we used to have to guard our clinics and labs from reporters who wanted to interview patients. They were there with their cameras. It was very difficult in the early days, when we would have to throw them out. In the long run, they have gotten a little more blasé, much more sophisticated, and they have done very well. By the same token, a lot of scientists involved in this area were not very media sophisticated.
Harden: They normally don't have to be.
Hill: No, they normally don't have to be. Scientists don't have the skills to be looking for all of those twists and turns of the question. That created some problems. There were some people early on, like Dr. Fauci, who have been excellent in using the media to get the right message across and not permitting the media to trick them into saying the wrong thing or having it come out in the wrong way. The media have, overall, exerted a positive influence. I think there have been some examples in which media people were very damaging. The majority of these people didn't know, didn't understand, or didn't take the time to make sure that their facts were straight.
Harden: Would you like to make any other comments or make a long-term prognosis about this disease?
Hill: You know I'm not a scientist any more, and I haven't been for a long time. I'm a science administrator, but by osmosis I hear a lot around here. I think that in the long run, we will have a drug to treat AIDS. I'm very confident that we will have some sort of chemotherapy or chemoprophylaxis. It is a matter of time. Though for people who are ill or about to be ill, the prospect of years of research is certainly not very encouraging, I think we will have a drug that will, if not wipe the virus out, at least keep it latent. I am far less optimistic about a vaccine. Eventually, we probably will have a vaccine that will work against a number of the strains or variations of the virus, but, clearly, that is in the future. The use of a drug as a prophylactic as well as treatment may be a practical thing within the next few years. I think that some sort of improved treatment regimen is not that far off, maybe a couple or three years. Clearly, people are already living much longer on AZT [3'-azido-2', 3'-dideoxythymidine]. We will basically control this disease, I think, but it's going to be a long time before these sorts of treatments and therapies are available for world-wide use, and in the meantime, we're going to have huge numbers of people dying. For the U.S. population that has access to an effective drug, whenever it becomes available, then fairly quickly–I think within the next two or three years–the prospect will be much better. I don't think that AIDS will automatically mean a death sentence, because I think that drugs will be found to treat the disease. I may be wrong, but I'm very optimistic.
Harden: Thank you very much, Dr. Hill.
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