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Interview with Dr. Thomas C. Quinn
This is an oral history interview on the NIH response to AIDS with Dr. Thomas C. Quinn on 5 December 1996. The interview was conducted in Dr. Quinn's office at the Johns Hopkins University School of Medicine, Baltimore, Maryland. The interviewers are Dr. Victoria Harden, Director, NIH Historical Office and the DeWitt Stetten, Jr., Museum of Medical Research, and Dr. Caroline Hannaway, NIH Historical Consultant.
Harden: Dr. Quinn, we would like to start these interviews by asking you to describe briefly your personal background, where you grew up, where you went to school, and the positions you held before you came to the NIH.
Quinn: I was born 11 May 1947 in New Rochelle, New York. I attended the University of Notre Dame in South Bend, Indiana, and received my bachelor's degree and then went on to earn my master’s degree in parasitology. Since I wanted to spend more time taking care of patients in addition to working in a research laboratory, I earned a medical degree at Northwestern University in Chicago, Illinois. My research interests solidified during graduate school and medical school to include parasitology, particularly malaria-type research and the vector spread of filariasis. This was the beginning of my interest in epidemiology, but from the perspective of how the disease spread via an insect.
I completed my internship and residency in internal medicine at Albany Medical Center in New York in 1977. By then I had my bachelor's, master's, and a medical degree, and was board-certified in internal medicine.
Clinical practice was an option at that point, but I was still drawn to laboratory research, particularly clinical research, and I still had that burning desire to work on malaria. So I went to the National Institutes of Health in 1977 and joined the Laboratory of Parasitic Diseases. For the next two years Dr. Lou [Louis] Miller and Dr. David Wyler mentored me solely on immunology and malaria research. It complemented what I had done during medical school.
Harden: Before you go on, let me ask you to elaborate a little. We like to ask physicians in general what forces or influences convinced them to go to medical school. You indicated that you had been in parasitology and then decided to go to medical school rather than aiming at medicine from boyhood. Could you elaborate? What was so attractive about malaria and parasitic diseases? This is a very unusual field.
Quinn: It is unusual. I actually was interested in medicine during my college days, but I was torn between the two routes. Do I go and do graduate research solely, or do I go directly into medical school?
I signed up for a course in parasitiology with Dr. George Craig, who has since passed away two years ago. He stayed at Notre Dame his whole career, and he was the most enthusiastic person. He excited you about the possibilities of his type of research.
When you think about parasites and how they get into human beings and how they can take over–a red cell in the case of malaria; in the case of worms, in the intestine or migrating through lungs–it is absolutely fascinating that these organisms coexist with man, so that they can thrive and reproduce themselves and spread to another person. The parasites have worked out these mechanisms over centuries.
I would say it was Dr. Craig who got me interested in malaria and in parasitology. During my graduate year, he taught a course called tropical medicine, and that is what got me interested in the whole gamut of tropical diseases. There is always someone who touches you in your years of development, who angles you in a direction, and I would have to say he [Prof. Craig] had a lot to do with that.
On the medicine side, if there was someone who influenced me–and I think there was–it would be my uncle, who was a physician. He was an internist in private practice and never did research per se. He was a cardiologist. But I was close to him, and he used to take me into New York Hospital. He practiced at Cornell [University Medical Center] and was a very respected clinician. I liked biology, and this was medicine and biology fitting together, and I said, “I will give that a try as well.”
It was during the year that I was in graduate school that I decided to get a medical degree. I could just have stayed in the laboratory and gotten a Ph.D., and I was offered the chance to do that through a Public Health Service training award. But I felt I could do more in the area that I wanted to work in, which was international health, tropical medicine, if I had a medical degree.
But then I missed the research part. So for two years, I worked at a bench once again, just like I did in graduate school.
Lou Miller, whom you know is head of malaria research, just received the Bristol Award, a very famous award, last year in New York. What a great mentor he was!
Harden: Do you want to elaborate on the research you did during those two years at the NIH?
Quinn: When I got to the NIH, my two mentors encouraged me to learn a little about the immune response and how it deals with malaria. My immediate supervisor was David Wyler, who is now a professor at Tufts [University]–and Lou Miller. I dealt with an animal model, rats specifically, which got a malaria parasite called Plasmodium burgeii, that gets inside a red cell.
Right at this time, someone else in another laboratory working on another disease showed that you could label these red cells with a radioactive label trace, put them back into the animal, and then you could monitor the clearance of that infected red cell. No one had done it with malaria before. They had been doing it with other types of autoimmune diseases. I did it with malaria. It was the first time that had ever been done. Once the malaria parasite gets inside the red cell, the questions are how long does it last there, and where does it go. What I tried to discern was the natural history of an infected red cell with malaria in it. You could then manipulate the system in the laboratory. You could infuse immune sera and see that it clears that infected cell very rapidly. It showed that humoral antibodies were very important. If I took the spleen away from the rat, it could not clear the infected cell and the rat died. So it showed that the spleen was absolutely essential to the contribution of the immune response to the malaria parasite.
My first 10 or so publications reflect that early work. But it was basically the biology of malaria inside an erythrocyte, a red cell, and how the host–in this case, the rat–dealt with that particular infected cell.
Harden: This also reflects, does it not, that this was a fairly early period in the understanding of immunology at the molecular level?
Quinn: Very much so. At that point, we had not gotten very molecular. That was to come along in the subsequent years. But this research helped lay the groundwork for a better molecular understanding of the biology of malaria and for how to develop a better vaccine. I did not get into vaccines, but I hope that some of my work was instrumental in laying some basic building blocks towards what is now being tested in the field, a series of malaria vaccines.
The importance of malaria is that it is one of the leading causes of death in developing countries in young children. We will get to AIDS a little later, but when you ask is AIDS a leading cause of death, it is, but from ages 15 to 54. Usually you cut the age groups. If you ask, what is the biggest killer in Africa at ages less than 15, it may be malaria in some countries. It is a very important public health problem–and there are very few people working in the field.
I learned during this period to carry out basic research in a laboratory and to address very important clinical and basic research questions; reinforcing the scientific method that I had learned earlier in my undergraduate, graduate, and then post-graduate medical school days.
But now we come back, and you will see my cycle once again. I said, “All right, I have been working with rats for two years. This is a lot of fun, but I need more.”
Hannaway: So you go off to the University of Washington at Seattle?
Quinn: So off I go. How I went there is interesting. I decided I had to do a clinical fellowship in infectious diseases, and I interviewed at a couple of places. But one person actively recruited me. That was [Dr.] King Holmes, who is chief of infectious diseases out in Seattle [University of Washington], and who was probably at that time–we are talking about 1979–the leading clinical researcher in the field of sexually transmitted diseases. I decided that he was the person I wanted to work with. He said, “Come out. This is one of the best training programs in the country, and you will do well.” He came after me, and I was attracted to him and to the activities that were going on in Seattle, so I went out there.
When I got there, [Dr.] Seymour Clevenoff, who was actually chief of infectious diseases, another winner of the Bristol Award, said, “Why don’t you come work with me, because you have done malaria immunology research. We can look at immunologic mechanisms.” What he wanted me to do was go back into the laboratory. King was saying, “You came out here to do more clinical training in infectious diseases,” and clinical research was what I still wanted to do research on. I said to King, “You are right, and I am staying with you.” King was the one who had attracted me there and I owed him a certain obligation. And Seymour and I became very good friends. In fact, King said, “You can spend 20 percent of your time working with Seymour and his colleagues in the laboratory, but the rest of the time I want you working with me.”
Something happened in the first week that I was out there during all these negotiations. While I was talking with King–this is a famous story between King and me–he got a phone call, and it was about a patient in the emergency room. King was on call and the patient happened to be a gay man, a homosexual man, who had terrible, very severe diarrhea. They asked King, “What should we culture him for? How should we work him up?” Obviously he got cultures for gonorrhea and asked them to work the patient up for other intestinal parasites. My ears pricked up when I heard this, and I said, “What is going on?” He said, “It is very interesting. There is this big epidemic of parasitic infections among gay men in San Francisco and New York.” There are a couple of other people who reported that and deserve the credit. [Dr.] Ben King, who is now deceased, was one of those people, and there are a few others whose names are escaping me, but I could probably pull them out easily. He said, “Aren't you sort of a parasite expert?” and I said, “Yes.” He said, “There is your project. Off you go.” He said, “In fact, go to the emergency room right now and work up that guy.”
Hannaway: This was in 1979?
Quinn: Yes, 1979. I went over there and I worked this patient up, and he was biopsied. From the biopsy the gastroenterologist on the case diagnosed Crohn's disease. So they started treating him with steroids–the appropriate treatment for Crohn's disease. However, of all the cultures that we had gotten on him, one came up positive. It was for Chlamydia trachomatis of a form called lymphogranuloma venereum, or LGV for short. You get it through anal-rectal sex, and what it does is it causes a granuloma inside the colon, and that is a pathognomic finding of Crohn's disease. So a diagnosis of Crohn’s disease was being made on pathology that was actually due to an infectious agent. Immediately I said, “This is very interesting. Take him off the steroids, put him on tetracycline.” He got better in two weeks, went home, and there were no problems. He did not have Crohn's disease.
Everyone got excited by this. They said, “Tom, you found this. Go and start finding out what other infections these guys get. Go down to the gay bathhouses, go find out what they are doing, what their habits are, whom do they have sex with, how often do they have sex, how much anal-rectal sex,” and so forth. At that point, although there had been some studies on gay men, there had not been very many. I did not have much of a literature to work with.
Hannaway: In 1979?
Quinn: In 1979. I decided, “All right, this is an interesting project.” In fact, that is what I did for the next...
Harden: You were in Seattle then?
Quinn: This was all Seattle. For two years I worked with King Holmes, and we basically defined the polymicrobial etiology of gastrointestinal infections in gay men. What we found was a Pandora's box. They had everything. They had shigella, salmonella, they had camphylobacter, they had herpes, they had chlamydia, they had gonorrhea, they had syphilis, they had warts–and I could go on and on. They had Entamoeba histolytica, Giardia lamblia, and other types of parasites. There was everything in there. It was because of the sexual practices that they were engaging in. Large numbers of people were having multiple sex partners and they did not use condoms. That concept did not exist in the late 1970s. It would not be uncommon to find a man who had had a hundred sex partners in the previous week. This was unbelievable. And it was anonymous sex half the time. That was what was going on in San Francisco and in New York. I was not alone in doing these investigations.
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