BRIAN LAMB: Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. How many years?
ANTHONY FAUCI: Thirty. Thirty years.
LAMB: In those 30 years, what's- have you ever had the feeling that something was going to get away from us when it came to one of these crises and disease?
FAUCI: Not that it was going to get away from us, but that it was going to be much more serious than anyone anticipated, and that really started off right from the very beginning of my career as the director of the Institute, when I first started seeing and taking care of HIV-infected individuals before we even knew it was HIV in the very early '80s-1981, the fall, winter of '81 into '82. It was very clear that this was something we had never seen before, and it was completely unpredictable what was going to happen.
And I got involved very early on and was concerned that many people in and out of government were considering this just a fluke among gay men that's some strange disease. But the way I saw it evolve and following it, it was quite scary. And unfortunately, my concerns were well-founded, because it turned out historically to be, and is today, one of the most devastating historic pandemics that we've ever experienced- civilization has ever experienced.
LAMB: When did you personally recognize this? Not, you know, maybe- is there an "aha" moment?
FAUCI: Yes. There was an "aha" moment. The "aha" moment was- it was the early summer of 1981. And the CDC, the Centers for Disease Control and Prevention, every week puts out something called Morbidity and Mortality Weekly Report, which is almost a pamphlet which gives you heads up on diseases or patterns of disease, like a flu is coming or a little outbreak of this, and then reported on their June 5, 1981 MMWR five men from Los Angeles who presented with a very unusual kind of pneumonia that you only see in people who have dramatically-suppressed immune systems.
And I looked at it and said, "Wow, five gay men." Why all gay men, and why this strange disease that you almost never see in healthy people? And they were supposedly completely healthy other than that. I thought it was a fluke, and put I it aside.
And then one month later, on the July 4th of 1981, the next MMWR appeared on my desk at the NIH. I was sitting there reading it and they said, "Now 26 men, not only from L.A., but from San Francisco and New York, with not only this strange pneumonia, but this strange kind of cancer that you only see in people who are immunosuppressed." And the thing that blew me away is that all of them were gay men. And I said, "Whoa. Something is going on here that's really bad, and this is likely a new disease." I had no idea what it was.
I didn't- I- it looked very much like it was an infectious disease, because when you looked at the patterns, it seems to have been spread by sexual contact. And that's when I really had a combination of an "aha" moment and an anxiety reaction where I was saying, "This is going to be bad."
And I made what I consider the transforming decision in my own career: I decided I was going to stop what I had been doing-rather successfully-for the previous nine or ten years and devote myself completely to studying what I felt would be an enormously difficult disease, and it, unfortunately, turned out that that was the case.
LAMB: When you look back at that period, I know- I've read that people were mad at you in your own operation. Who got mad at you for what reason that you took gays in and had them involved in the discussion?
FAUCI: Well, it was a combination. First of all, in a well-meaning way, my mentors, the people who had cultivated me in science and in academics, thought I was being foolish throwing away a very promising career in one area of medical research to go after something that they thought was going to disappear. This is just a fluke. It's going to go away.
Later on, as I began to take a leadership role in not only the research, but when I became director of the Institute-of the National Institute of Allergy and Infectious Diseases in 1984-there were people who were concerned, and I would say bordering on being angry with me, in that it was clear that I wanted to put more resources in this. Because even though it was still very early in the history of the pandemic, I wanted to get more government resources, I wanted more research.
And it became clear to me that we needed to embrace the gay community, the activists, to get a better feel for what was going on in the trenches with them. And there was a lot of resentment towards me on that. Resentment on the part of the scientists because they thought I was going to divert resources away from other important areas of infectious diseases. And I was arguing, "I don't want to divert resources. I want to get new resources. I want to argue before the Congress and before the president about why we needed more resources for this disease." So that was that area of resentment.
And then, the idea of activists playing a major role in some of the decision and policy-making in a research program was completely foreign and antithetical to many scientists. At the time, it was, "Well, this is- we are puristic scientists. We'll make the decisions about what needs to be done. We don't need to involve the community in this."
And I thought that that was not a good idea, because the community had a lot to offer. They were the ones that were suffering; it was an unknown disease. The rigidity of the regulatory process of getting drugs approved quickly that were experimental drugs that showed some efficacy was all a changing paradigm. We hadn't experienced that before.
LAMB: We'll come back to some of this, but I want to get to some- you know, we've seen a lot of you over the years, and I want to talk about your own background, your own life. But first, when did you make the decision and why that you were going to be available to the media? Because there are 27 institutes at the National Institutes of Health, and I can name maybe one or two others. You are always available to answer the questions. Why did you decide to do that?
FAUCI: Well it became clear to me that, particularly in the discipline that I was dealing with-infectious disease-particularly emerging infectious disease that would generate a lot of concern on the part of the public, that could be HIV-AIDS, that could be pandemic flu, that could be Ebola-you know, even this most recently now with the Ebola crisis-it became clear to me that the public needed to be educated to understand just what these issues meant to them personally and to the nation and the world.
And I was perplexed by seeing that scientists who shunned away from trying to explain things in plain English the way people could understand it. There was a culture back then, when I first started doing it, that scientists either didn't want to be bothered with the press or getting involved, or when they did, they spoke over people as opposed to trying to get people to understand.
And I made a decision a long time ago that a) it was important for the public to understand. And if you really want to garner support from the Congress and from the administration, you had to be understood and you had to be in the public eye. Otherwise, it could just slip under the radar screen. And as it turned out, that was the truth. That was one of the reasons why there was a lot of attention paid to it.
LAMB: Do you have a boss?
FAUCI: You know in science, technically speaking, if you look at the executive branch of the federal government of which I'm in, so obviously the president is the boss. The department I'm in is the Department of Health and Human Services, so the secretary is the next level of the boss. And then there is the NIH, where you have an NIH director and multiple institutes, so technically speaking, that's the boss.
So when you're in a scientific and public health, there really is very little of that-the boss tells somebody to tell something-that you might see in another endeavor. It's more of a collaborative discussion, an intellectual deciding what the best direction to go is. Technically, someone is administratively your boss, but in reality, it's more of doing the right thing and the best thing and the most appropriate thing.
LAMB: Your institute's budget for a year is what now?
FAUCI: It's about $4.5 billion.
LAMB: How many people were directly in that department- your institute?
FAUCI: About 1,800 to 2,000.
LAMB: Physically, where are you located?
FAUCI: Bethesda, Maryland.
LAMB: Are you at the campus?
FAUCI: Right. Right on the main campus. Right off Wisconsin Avenue, Rockville Pike. Right there just a little bit north of Bethesda. It's about 5.5 miles to Washington, D.C.
LAMB: The first Doc in your family was your father, who was a pharmacist.
LAMB: Tell us about him. Where did, where did all this happen? Where did you- where were you born?
FAUCI: Well, I was born and raised in Brooklyn, New York, in the Bensonhurst section which was a- back then, and maybe even now, Brooklyn, if you took an aerial photo and looked at different sections, they were ethnically divided. There was the Italian-American section, the Irish section, the African-American section, the Puerto Rican section, et cetera. So I was in an Italian American section called Bensonhurst, and it was a very family-oriented, very warm and nurturing area to live in.
My father is first generation. His father was born in Italy. He came to the United States at the turn of the century, at the turn of the 20th- 19th to 20th century. My father was raised early on in the Little Italy section of New York and Manhattan, moved to Brooklyn, and then our family was raised in Brooklyn. He went to Columbia University College of Pharmacy, became a pharmacist, and that's what he did for the- all his life.
LAMB: So that's how he got the name "Doc".
FAUCI: Right. They called him "Doc". Back then, pharmacists were called "Doc" because- a little bit different than it is now. Many people who either couldn't afford to go to a doctor or didn't want to take the time of making an appointment would go in to their neighborhood pharmacy and explain their symptoms.
And my father never overstepped his bounds. If somebody needed to see a physician, he would say, "You better go see a physician." But often, he would give them the advice they needed to take care of what minor ailment they had.
LAMB: Mom- what was mom's background?
FAUCI: She- my mother went to Hunter College in New York City and got married at a very early age. In fact, my mother and father, interestingly, got married right out of high school. So my father went through pharmacy school, then my mother went through Hunter College, both married, and as soon as they had- my mother gave birth to my sister who's three years older than I, and then me, she became a homemaker for her whole life.
LAMB: The Jesuits teach you high school, college, Holy Crossâ€¦
LAMB: Regis High School in Manhattan. What impact- what does it mean to be taught by Jesuits? We hear about Jesuits all the time.
FAUCI: Well, it's a great experience, I have to say. They combine intense intellectualism with discipline, not in the sense of, you know, smacking you around, but intellectual rigor, discipline in how you handle yourself as a person, as a human being. And they have a general motto of-and I think this had a major influence on me and what I did-is the issue of service to others. That's very big.
That doesn't mean that people who don't go into public service are doing anything lesser with their lives, but they tend to have a, I wouldn't say a pushing, but a leaning towards something about what you do is public service, either everything you do, which turned out what I did by going into public service, or at least a part of your life. So it was- it was an interesting combination of concern for mankind as well as a good intellectual rigor.
LAMB: When did you want to be a doctor? Can you remember the time?
FAUCI: I think it was early high school. I'm very interested in people. I'm very much of a people person, and probably, as part of the Jesuit training, which is very steeped in the classics and the humanities.
So when I went to Regis High School we took four years of Greek, four years of Latin, a romance language, and ancient history and things like that. And when I went to Holy Cross, which is another Jesuit school, as a college, I took kind of a hybrid pre-med course. It was called- it's almost an oxymoron. It was called "A.B. Greek Classics dash Pre-Med."
So you were majoring in the humanities and the classics with a lot of philosophy, but you took enough science to get into medical school. And the idea about when I wanted to become a doctor- I like science, I like discovery, I like the challenges of science, but I also so much liked mankind and the humanities that it was just a natural fit that, where do you put science and people in the same bucket? And to me that was medicine.
LAMB: Who was an early mentor?
FAUCI: Probably some of the very young Jesuits in Regis High School. In the Jesuit training, it's a long, long training before you become a Jesuit priest. And back then they had what's called scholastics, or people who weren't yet ordained as priests, but they dressed with the garb of a priest and they taught in the high school. And there were a couple of those scholastics who had a major impact on me, just great people, highly intellectual and highly nurturing of you and what you wanted to do.
LAMB: You did an interview with Science Magazine back in 2003 and they lead off this by saying, "Anthony S. Fauci," let's see, "works 14 hours a day, jogs for lunch, eats dinner with his family after nine, and continues working until bedtime, when he sleeps for about four and a half hours." How much of that is still true?
FAUCI: It's still true, I'd say, fortunately or unfortunately-I think fortunately-it still is. I do that. I work a lot of hours. I work most of the weekend. I don't do it as a drag. I do it because I like it and I'm energized by what I'm doing.
We, fortunately, likely through the creativity and the tolerance of my wife, who also works at the NIH and is the chair of one of the departments there, the Department of Bioethics-Clinical Bioethics-that we arranged our schedule when the children were growing up that, even though it isn't particularly healthy to eat dinner late at night-I preach to people about that-the only way we could as a family really be together every single day was when I would come home at quarter to nine, nine o'clock.
And my children, who would get out of school at three, most of them played sports and things after. They would come home and have a snack and then wait for me to come home, and we would have dinner together. They would either study more or go to bed, and I would go into my office and continue to work until midnight and go to bed and get up at around five o'clock.
LAMB: How old are those kids now, and what are they doing?
FAUCI: My eldest is 28, and she's a PhD student in clinical psychology at Boston College. She graduated from Harvard and then taught in the inner city minority areas in New York City and in Washington, D.C. and then went for further graduate training. So now she's in a PhD program because she got interested in clinical psychology.
My middle daughter is 25, and she's a first year medical student at the University of Pennsylvania. And my youngest just graduated from Stanford as a computer scientist, and she's working in San Francisco for Twitter. So she's a computer geek.
LAMB: Please tell us the story of meeting your wife.
FAUCI: Well, I had been at the NIH for about 10 years or so, and I just happen to have made a trip to China for a meeting- for a scientific meeting. And while I was away, the NIH-because it was the very beginning of the HIV/AIDS pandemic-hired a nurse who was a clinical nurse specialist. So my wife started off as a nurse before she got her PhD in ethics.
And she came to the NIH, and I didn't even know she was a new nurse because I was away for that week, and one of my patients was a person from Brazil who only spoke Portuguese. And my wife had just come back a few months earlier from two years with Project Hope in MaceiÃ³ in Brazil, and she was totally fluent in Portuguese.
So as I was talking to the patient, I wanted to tell the patient the patient had to go home, had to go rest, couldn't do activities, couldn't drink, couldn't indulge, because he was just recuperating. And I told them that I needed somebody to translate, and they said, "We just have this new nurse who just came back from Brazil. She can translate."
So I told her, I said, "Tell him he's got to do A, B, C, D and E." And she turned around and she spoke to him in Portuguese, and I found out later that he told her to tell the doc that there's no way. "The first thing I'm going to do when I get back there, I'm going to go to the Copacabana beach. I'm going to play around. I'm going to have some cachaÃ§a, and I'm going to have a ball. I've been in this place too long."
And she was horrified. She didn't want to say that, so she turned to me and said, "He said, fine. He's going to do that." And I didn't know. I believed it. So when I looked at her, she was just this very attractive young nurse, and I said, "Very interesting."
I was single. So I went back to my office. About a few days later, I told the head nurse, "Could you tell that nurse, Ms. Grady, to come to my office. I want to talk to her." She thought that she was going to get fired, because she thought that I had found out that she misled me about the patient.
So she walked into my office completely petrified that she was in trouble, and she sat there looking very nervous. I couldn't figure out why she was nervous. So I looked at her and said, "Well, you know, I didn't realize you had come here until just last week." I said, "Would you like to go out for dinner sometime?" She just fell right through the chair, and she said, "Of course, I will." And we got married a year later.
LAMB: In the same interview- they asked you the question in the Science interview. "You attended two Jesuit-run schools, are you a man of faith?" Let me read to you what you said if you don't remember.
"Broadly and generically, I am not a regular church-attender. I have evolved into less a Roman Catholic religion person to someone who tries to keep a degree of spirituality about them. I look upon myself as a humanist. I have faith in the goodness of mankind." What would- is that still accurate?
FAUCI: Totally accurate today.
LAMB: What does that say to the Jesuit education? They- did they talk you right out of the church?
FAUCI: No. It isn't that they talked me right out of the church, but I'm less enamored of organized religion than I am with the principles of humanity and goodness to mankind and doing the best that you can.
I think that there are a lot of things about organized religion that are unfortunate, and I tend to like to stay away from that and think more in terms of the principles that I learned from the Jesuits, from the Catholic religion, the principles that I run my life by. But the idea about the organization of religion is not something that I adhere to very much.
LAMB: The National Institute of Allergy and Infectious Diseases is responsible- what's the broad scope, and what do those 1,800 people do?
FAUCI: Well, it's either both the conduct and the administration and planning of research in all of infectious diseases, as well as in certain immune-mediated diseases like asthma or allergy and autoimmune diseases.
LAMB: Let me stop you and ask you, what is an infectious disease?
FAUCI: Well, an infectious disease is one that's caused by a microbe that's transmissible. The ones that you know of that are very, very clear: AIDS is an infectious disease caused by HIV, influenza, a recurrent problem every season. Every winter you get an influenza outbreak, and sometimes you get a pandemic that's very serious. Malaria, tuberculosis, childhood diseases, respiratory diseases, diarrheal diseases, sexually-transmitted diseases-all diseases that are caused by a microbe that, hopefully, you could prevent and/or treat.
LAMB: All right. Let me ask you the question, what is a microbe?
FAUCI: A microbe is an organism, and it depends on what it is, that has the capability of replicating and being transmitted from one person to another. So bacterias can live more freely; viruses need to get into a cell to live.
LAMB: So as we look at the world as an outsider generalist and you see the CDC, you see your institutions, the NIH, the World Health Organization, who's in charge?
FAUCI: No one needs to be in charge. Each has their own goal. And I think, within the federal government, it's relatively easy to explain. So take the Department of Health and Human Services, the three most commonly-recognized organizations that have to do with health and research are the CDC, the NIH and the FDA.
The CDC are the disease detectives. They do the surveillance. They track down disease. They recognize the outbreaks of new disease. They track them. They're very active with the Ebola outbreak right now in West Africa. They're very active when you have a flu season or an outbreak of West Nile fever.
The NIH is pure research. So when there's a disease, what we do in my institute, when you're thinking of infectious disease, is we understand how that disease evolves. We develop drugs, we develop vaccines, we do prevention modalities. So we do the research that allows you to intervene.
The Food and Drug Administration, the FDA, is the regulatory agency. And they make the regulation of approval or monitoring of drugs or interventions. That's within our own government. When you go globally, WHO is kind of like a global CDC and what the CDC is for us. They sort of coordinate health globally throughout the various nations.
LAMB: Let me show you some video that you probably haven't seen for a long time. This goes back to 1998. It's very quick. It's from the debate: George Herbert Walker Bush and Michael Dukakis. And they're talking about heroes.
(BEGIN VIDEO CLIP)
George Herbert Walker Bush: I agree with the governor on athletics, and there's nothing corny about having sports heroes, young people that are clean and honorable and out there setting a pace. I think of Dr. Fauci. You probably never heard of him. You did. [Debate moderator] Ann [Compton] heard of him. He's a very fine research- top doctor at National Institutes of Health working hard doing something about research on this disease of AIDS.
(END VIDEO CLIP)
LAMB: That was 1988. You remember that?
FAUCI: Yes I do.
LAMB: What was the impact on you when he mentioned that?
FAUCI: Well, I didn't know that- I didn't see the debate. I was out of town coming in on a plane, and the next morning when I walked into the NIH- as I walked into the lobby, people started going like this, and I said, "What is this all about?" They said, "What do you mean, what's this all about? The President called you a hero during a national debate that's been seen by a hundred million people," and I was totally surprised.
LAMB: Did you know him?
FAUCI: Well, very well. Yes. I've had the great privilege of getting to know President George H.W. Bush from the time that he was vice president. And when he was getting ready to run for president, he sincerely wanted to know more about this strange disease called AIDS, because quite frankly and disappointingly, the Reagan administration, of which he was a part-he was the vice president-President Reagan, who was a good man, did not, I believe, use the bully pulpit enough about calling attention to AIDS.
George H.W. Bush felt that this was important. So while he was still vice president, he came to the NIH and wanted to meet me. He said, "I want to meet this person, Fauci, who I see around doing all this with AIDS, to show me around."
And I spent considerable amount of time with him, introducing him to my patients, talking to him about what HIV is, and we struck up a friendship. And it was, you know, one of those great honors that just falls into your lap. As soon as we finished, he would invite me to the vice president's mansion for lunch and for receptions.
And then when he became president, it was wonderful because I had a direct input to him. He would call me up, or he would invite me to lunches. And even after he left the presidency, he still would write me notes, and he sent me a nice letter on my 60th birthday joking around saying, "I can't believe you're 60 years old. There's no chance of that," that kind of thing. He's a wonderful human being.
LAMB: How many presidents have you known personally?
FAUCI: Essentially all of them to a different degree. I knew President George H.W. Bush very well. When President Clinton came in, I got to know him, not on the personal friendship where he would invite me over, but got to meet with him and talk with him and with Hillary Clinton when she was first lady, and then after, when she went on to become senator for New York and then secretary of state. No doubt about that, eight years of that.
Then, when George W. Bush came in, I had met him originally when he was a staffer in the White House with his father. And we struck up a very good relationship, and I think that that was one of the reasons why he sent me to Africa in 2002 for the purpose of determining the feasibility of developing a program that might transform HIV/AIDS in the developing world.
So I got to be quite close with President George W. Bush related not only to the fact that I knew him through his father, but the fact that he took a very keen interest in global HIV/AIDS and allowed me to be one of the architects of the program which has now transformed HIV globally, the President's Emergency Plan for AIDS Relief or PEPFAR.
And luckily, now that President Obama is still quite interested and quite amenable to getting involved in solving the problems that I'm involved with. So I've had the great privilege of meeting several times at the White House and at the NIH with President Obama. So I have been very fortunate in that the presidents of the United States have been extremely amenable to listening to and helping out with the problems that we face vis-a-vis research and infectious disease.
LAMB: Twenty seven institutes in NIH, and you're just one of the 27.
LAMB: But clearly the most visible except for maybe Dr. Collins, who runs NIH. How many presidents have asked you to be the director of NIH?
FAUCI: George H.W. Bush two or three times, and I said no. And he was great. When I said no to him, he said, "I understand." People thought that he would get upset with me because I said no, and he was wonderful. He says, "I respect you for that. Continue to do what you're doing."
When President Clinton became president, his staff asked me if I was interested and said that they've heard that I would really be a very good Institute director- I explained to them exactly what I did to George H.W. Bush: that even though this would be a great honor, I don't even want them to ask me, because I don't want to have to say no. So I took my name out of the hat.
When George W. Bush became president, he specifically asked me, and again I said, as I said to his father, that although this is a great honor and it's a great position, I think I could contribute more to the nation and to the arena of biomedical research by staying in the position I am right now.
LAMB: Do you still see patients?
FAUCI: Oh yes. Absolutely.
LAMB: How often?
FAUCI: Two, three times a week. We make rounds, teaching rounds. I don't want to take the full responsibility of being the primary physician the way I was before I became director. That wouldn't be fair to the patients, because I have so many other responsibilities. But I make teaching rounds every single week, two, three times a week around- all year long for the, for the last several decades.
LAMB: What would you say to your fellow doctors about the way they should treat a patient?
FAUCI: Well, there are a lot of approaches to a patient. One is, first, with great respect, because you have a real privilege as a physician of having someone put into your hands their health, their pain, suffering, and sometimes even their lives. So you have to take that very, very seriously.
It's not just another job. It's a- you know, I think, I don't want to get too melodramatic, but it's a calling. I mean, it really is a certain level of a profession that has with it extraordinary responsibility. So that's the first thing I would impart on physicians, young physicians, when they ask me for advice. The other thing is, listen to your patient. Very often, if you listen to what the patient is telling you, you get a real head start on what's going on with them.
LAMB: What would you advise a patient to do in relationship to his or her doctor?
FAUCI: Try to be as- and- but it goes back and forth because it depends on what the- what the reaction of the doctor is to the patient. But try to be as open with your doctor and explain everything, because it's so important for the doctor to hear from you what it is that's bothering you, because there may be things that you do not think are important that are extremely important in the doctor's formulation about what is wrong with you and what needs to be done with you.
LAMB: Here you are in 1990 at a town hall meeting.
(BEGIN VIDEO CLIP)
FAUCI: In the 1990s we will be seeing some revolutionizing of the way we look at the treatment of HIV, because the end of the 1980s has created the concept that you'll see in the '90s of early intervention. Namely, treating people early on before they develop full-blown disease, prophylaxing them against opportunistic infections, to hopefully have the goal of the decade of the '90s to convert HIV infection into a chronic, manageable infection whereby you can test someone, counsel them, get them into the care of a physician, and treat them with a combination of drugs early enough on in the course of infection so that you might have a situation like many other chronic diseases where there's a of a feasibility of a reasonable, comfortable life span.
(END VIDEO CLIP)
LAMB: Twenty-five years later, here we are. What happened?
FAUCI: It happened. It happened. We were fortunate. We have drugs right now that, when given to people who are HIV infected- if someone comes in and- I could show you the dichotomy. In the early '80s, if someone came in to my clinic with AIDS, their median survival would be six to eight months, which means they would be- half of them would be dead in eight months.
Now, if tomorrow- when I go back to rounds on Friday and someone comes into a clinic who is 20-plus years old who is relatively recently infected, and I put them on the combination of three drugs, the cocktail of highly active antiretroviral therapy, I could accurately predict, look them in the eye and say, "We could do mathematical modeling to say that if you take your medicine regularly, you could live an additional 50-five zero-years."
So to go from knowing that 50 percent of the people are going to die in eight months to knowing that, if you take your medicines, you could live essentially a normal life span, just a little bit- a few years less than a normal life span. That's a huge advance.
LAMB: In 1991, a very familiar face stood up and said he had AIDS. I want to run the video, and then I want to ask you what impact this particular announcement had on this whole discussion.
(BEGIN VIDEO CLIP)
EARVIN "MAGIC" JOHNSON: Because of the HIV virus that I have obtained, I will have to retire from the Lakers today. I just want to make clear, first of all, that I do not have the AIDS disease, because I know a lot of you are- want to know that, but the HIV virus.
My wife is fine. She's negative, so no problem with her. I plan on going on living for a long time, bugging you guys like I always have, so you'll see me around. I'm planning on being with the Lakersâ€¦
(END VIDEO CLIP)
LAMB: So do you know this man? Andâ€¦
FAUCI: I do. I do. I've been on panels with Magic, in educational panels and talking about HIV, because he's an example of someone who was caught early, before he got sick. He said very accurately he has HIV infection, but he doesn't have AIDS. He was put on antiretroviral therapy, and he's doing fine. I was at a recent-last year-a panel with him where he and I were asking- were receiving questions from the audience and from a moderator. Yes.
LAMB: By the way, do you ever have somebody call your office and say, "I want to see Dr. Fauci. I want him- I want him to treat me as a doctor?"
FAUCI: Yes, they do.
LAMB: What do you do?
FAUCI: All the time.
LAMB: What happens?
FAUCI: Well, it depends on what's wrong with them. If they have something that was- is within their- the realm of what we do, we bring them in, and I have them seen in our clinic. If they- the NIH- in order to be seen at the NIH, you have to fit into a protocol, and many of the people who call actually directly do fit into the protocol, and we actually do take care of them.
LAMB: The interesting thing about the job that you have is that the government has decided, and I don't think a lot of people know this, that you're so important in the work that you do that they pay you a lot more money than they pay the Vice President of United States. They pay you more than they pay the Chief Justice of the United States. The last figure I saw was $335,000 a year.
LAMB: How did that happen in this town?
FAUCI: Well, at the NIH, there are- when you have positions that are difficult to recruit for, they have special exemptions where they can make the salary be flexible within a certain range that isn't the typical GS level, where you go in, you're a GS 14 or 15 or executive service.
They have a system that is flexible because it isn't permanent-they could take it away-that, for a period of time, they'll pay you a certain amount. And there are several of us at the NIH who are in that category where we would make more than if we were in a typical government slot.
LAMB: I also see you have a speaker's bureau that youâ€¦
FAUCI: Absolutely not.
LAMB: Maybe it was another?
FAUCI: No. Not me.
LAMB: Are you- what kind ofâ€¦
FAUCI: I don't take any money for any speaks- speech at all.
LAMB: Has money ever mattered to you?
FAUCI: No, not at all. Not at all. I mean, in the federal government, particularly when you have someone as visible as I am- I would go to a meeting, and the speakers would get thousands of dollars apiece. It's nothing. You just don't ever take- you don't want any semblance whatsoever of a conflict of interest.
In 2003, you testified before the senate about another subject.
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The pathogenesis means, how does this microbe cause its pathological effect, the genesis of the pathology? And that's what we're going to be studying very intensively now that we have the virus, because we're not sure at this point whether it's the virus itself that's causing all the damage in the lungs of the individuals, or if it's the virus together with what would be a normal immune response, but in some diseases, the immune response itself causes damage.
We have certain infections in which a certain type of an immune response can actually make the pathological effect worse. We see that in some cases of respiratory syncytial virus, in some cases of measles. So it's important for us to nail down the pathogenesis. The big item is vaccines.
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LAMB: Do you remember- of course you remember SARS, but do you remember- when you talk to a group like this, how do you talk- the language sometimes, you just- the average person gets lost.
FAUCI: Well, you have to make sure you are, you're understood. And I make it a very important goal that you don't want to make- you don't want to impress people and razzle-dazzle them with your knowledge. You just want them to understand what you're talking about.
LAMB: And what happened to SARS then? What's- where is it now?
FAUCI: SARS essentially disappeared. SARS came, we isolated the virus, we started to make a vaccine, which was successful. It looked pretty good in an animal model. And then all of a sudden, pure public health measures suppressed it, and it went away.
It was one of those diseases that are very common, which is a disease that's fundamentally an animal disease, and it jumps species from the animal to the human. And sometimes it's trivial and nothing happens and one person gets infected, but sometimes it adapts itself to the human, and it spreads from human to human. That's what SARS did.
But once you suppressed it, it essentially stopped. Because the next one that jumped into human didn't have the capability of spreading easily from person to person. So we dodged the bullet with SARS. We did.
LAMB: These numbers may be off. You can correct any of them. Since 1978, you've had 490 major lectureships, 33 visiting professorships, and 31 honorary degrees. Any of those numbers go up?
FAUCI: The honorary degrees have gone up.
LAMB: To what number?
FAUCI: Thirty eight, 39.
LAMB: Where do you find time for all this?
FAUCI: Well, you said it in the beginning, I don't sleep much.
LAMB: So really four and a half hours a night?
FAUCI: Yes. About five at the most.
LAMB: No doctor would tell you this, to only get four and a half hours of sleep.
FAUCI: That's true. It isn't the healthiest thing in the world. But when you physiologically get used to it, you get used to it. And that's it. And you wake up and you're fine.
LAMB: So, but when do you find time for all of the lectureships and theâ€¦
FAUCI: You know, I tend to do lectures that are, I think, important in their impact. I do- I really do honestly no boondoggling. For example, if someone says, "Well, we're having a meeting in St. John's in the Virgin Islands. We want you to go and talk about AIDS." I won't do that. If there is a national meeting where you are going to impart important information to a group of scientists, I may or may not do that.
I pick and choose enough so that I'm not so often away from my office that I would lose effectiveness. I'm very, very careful about not over travelling. I do things that you could do in one day. You know, fly up, do it, come right back the same day.
I don't do things, "Well, let's go out to a meeting at a ski resort," and you give a talk, and you stay there for three or four- I just zero do that. It's always in and out. And when you do that, you can be pretty economical for your time.
LAMB: Back in 2005, you were talking about another issue.
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FAUCI: Importantly, the virus has evolved to be able to jump from chicken to humans, still very, very inefficiently. So it's not something where it easily does that, and they have been really rare, like one or two cases, that have been definitively confirmed that it goes human to human.
So it still is a virus that has not been able to assume the capability of becoming a real classical pandemic. But when you see this smoldering activity going on, the migratory birds, and it's not just Southeast Asia, it's Russia, Kazakhstan. Now we're talking about Romania and Turkey.
So the bird flu, the infections of the birds, they're not going away. So the conditions that would be amenable to a pandemic are not resolving themselves. In fact, they're getting worse. So that is also a reason for the accelerated current activity.
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LAMB: What happened to bird flu?
FAUCI: Well, it went away. So over the last few years, there have been these blips of a virus that's fundamentally a bird or another animal virus that jumps to a human, but it doesn't adapt itself to easily go from human to human. So you would see cases of H5N1, H7N9, things that are not human viruses-they are fundamentally animal viruses-that will jump.
The thing you have to worry about is that if it jumps enough, will it, by evolution, adapt itself to all of a sudden start saying, "I like being in a human," and essentially transmit more and more? That particular virus didn't do that. It just stayed in a very inefficient way from bird to human rarely and never going from human to human in any meaningful way.
LAMB: I want to read the first paragraph of a New York Times article from January 7th. This is by Denise Grady. "An unusual method for producing antibiotics may help solve an urgent global problem. The rise in infections that resist treatment with commonly used drugs and the lack of new antibiotics," excuse me, "to replace ones that no longer work." I know you know this story. The medicine- if I pronounce it correctly, it's Teixobactin.
FAUCI: You got it. Correct.
LAMB: And it's doctor- the lead author on this was Dr. Kim Lewis from Northeastern University. Did you play a role on this, and what is it?
FAUCI: Well, this- our institute funded the research, and this is another example of the National Institute of Allergy and Infectious Diseases. Not only do we do research, but most of what we do is we give grants to very competent scientists, like the scientist in this question, who do this. So we did have our, quote, "fingerprints" on this.
This is a very interesting finding, because we do have a significant problem with antibiotic resistance now- today in the modern day. And if we continue to have a problem with microbes becoming more and more resistant and not a new class of antibiotics to meet the challenge, we could get in trouble.
So things that would normally be easily treatable could become untreatable. So whenever we get a situation where you have a new class of antibiotics that could counter the emergence of resistance, that's something you want to pursue very vigorously, which will- which is what we're going to do.
LAMB: Did you know before this article came out in Nature magazine? You knew all about this?
FAUCI: We know about it because when you fund a researcher, when they're getting ready to publish something, they have to write it up, they submit it, it gets reviewed, it gets revised, and then it gets published. They let us know when they have a finding that's of considerable importance. So we knew about it before it hit the press.
LAMB: How much money does your institute spend a year on research?
FAUCI: On research, we spend the entire $4.5 billion. On anti-microbial research, we spend several hundred million dollars.
LAMB: All right. Let me just ask you this simple question about what is an antibiotic?
FAUCI: An antibiotic is a substance whose main purpose is to suppress or kill a microorganism. A typical one, if you have- the very common cause of pneumonia or middle-ear infections is a microbe called pneumococcus. And that's where you hear the word pneumococcal pneumonia. And the antibiotic is a substance that actually kills that.
So if I have pneumococcal pneumonia and I'm given penicillin, which is the classic type of an antibiotic, it will ultimately destroy the pneumococcus in my body. So it's essentially an antidote against a microbe.
LAMB: But the point of all this- the story we were just talking about is that you become resistant to antibiotics. Is there a point in someone's system where they- they're resistant to all antibiotics?
FAUCI: No. It's not the person who's resistant to the antibiotic; it's the individual microbe that becomes resistant. So there's no such a thing as you or I walking around saying, "Wow, we're resistant to antibiotics." It's a particular infection we might get. So we mightâ€¦
LAMB: And that would work that way in all people?
FAUCI: Yes. If a certain microbe- for example, we had a problem recently at the NIH with a microbe that was resistant to almost all antibiotics. We were able to track it down and suppress it. But that microbe, whether it was in you or me or the people in the hospital, it would still be resistant to the antibiotic.
LAMB: Now, you're 74?
LAMB: How long are you going to work?
FAUCI: I'm just going to keep doing it until I- I'm not effective, and right now I'm as energetic and, I believe, as effective as I've ever been.
LAMB: Who determines how long you stay there?
FAUCI: You get reviewed every few years by a committee-an outside committee-that reviews you and determines your effectiveness. And if it turns out you're not effective, then the recommendation is that you step down.
LAMB: So when there someday is a new director of your institute and he or she comes in and meets you and sits before you and says, "Tell me what I should look out for." And we're not talking about medicine, we're talking politics.
LAMB: As the head of this institution for over 30 years, what would you tell them?
FAUCI: Well, when you're dealing in the interface of politics, policy, and medicine, the thing that I have found to be very effective is be consistent, be totally honest, and don't tell people things that you think they might want to hear.
Tell them the truth that is based on evidence, because even though politicians, be they in the administration or in the Congress, may not be happy with what you tell them because it disappoints them, they will respect you, if after a while it's clear to them that you're telling them the truth based on scientific evidence. So that is the one thing that I would emphasize to anyone who follows me that that's how you can be successful in getting good science to drive policy.
LAMB: What do you tell them about dealing with Congress?
FAUCI: Be clear. Don't try to razzle-dazzle them. Don't talk down to them. Don't feel that because you're a scientist, you're so superior that you could talk over their heads. The most important thing is for the Congress to understand and appreciate what you're doing and the importance of your work.
So there's a balance between talking down to someone and not talking in such an esoteric way that someone doesn't have a clue of what you're talking about. You've got to do that balance where you can make the person feel that they really understand what you're talking about. They will like that because people like to learn. They'll feel good about that. They'll say, "Well. I've learned something today." And they will also respect you for being able to explain it to them.
LAMB: There was a time recently where, I don't know whether it's just media, but there were also politicians that were screaming that we didn't have control over Ebola.
LAMB: You were out a lot talking about Ebola. How does that look now?
FAUCI: Well, from the United States' standpoint, it looks very good. We had a situation where a person came over inadvertently, not knowing they were infected, was infected, went to a hospital, infected two nurses. That created a tremendous degree of concern and panic.
What happened is that people extrapolated what they saw on the front page of the newspapers with all of the death and the suffering in Africa, that that was going to happen here. And what we try to do- what I tried to do when I was in front of the national audiences was say, "We're taking this very seriously for sure. But given our health care structure here and the ability to suppress the spread by identification, isolation, and contact tracing, this is not going to happen in the United States the way it's happening in West Africa. We may get a case or two," which we did, "but we're not going to have this out of control outbreak."
And if you say it enough and give the good scientific evidence for why that's the case, people believe it, and as it turned out, that's exactly what happened. There's no Ebola right now. We may get a case that might come in, but we'll be able to handle it.
LAMB: The flu.
LAMB: A lot of people I know got the flu shot. People over 65 got a double dose or the new dose or whatever it is, and I've known a ton of people that came down with the flu. Lots and lots of money was spent on the flu vaccine, and it isn't working.
FAUCI: Right. Well, it's not working optimally. That's for sure. Because each year, you make a calculated guess based on information that you gather of what's circulating towards the end of the season of your season and what's going on in the southern hemisphere.
LAMB: Who makes that guess?
FAUCI: WHO, in coordination with a group of- number of people including CDC, but it's mostly a WHO-type of health decision.
LAMB: The World Health Organization â€¦
LAMB: The U.N.
FAUCI: Yes, World Health Organization. And they have to make that decision in February of the prior season, because in order to start manufacturing the influenza vaccine, it takes about six months, so that by the middle to end of the summer, it's ready. You start distributing it into fall, and then it's ready for the winter season.
At the time the decision was made for this 2014-2015 season, they thought that this particular strain of H3N2, which is a designation of certain types of influenza, would be one type. As soon as they started manufacturing the vaccine, about a month and a half later, it became clear that the virus was drifting, and that means mutations and drifting, so that by the time you got to the flu season, the majority of the strains didn't match what was in the vaccine.
Now that's the bad news. The somewhat comforting news is that you still can get good benefit from vaccination even though there is not a perfect match, because there's what's called cross protection. So if I get vaccinated against an H3N2 that's not the exact one that's circulating in the community, I could still get a certain degree of protection. I might not be protected against getting infected, but I might be protected against getting serious disease or hospitalization.
LAMB: Do you get a flu shot?
FAUCI: I do, every year.
LAMB: Do you ever get the flu?
FAUCI: Well, I've gotten the flu in the past. I got the flu in the mid- to late '70s, and I was sicker than I've ever been. I did get the flu vaccine that season, so it didn't work on me, but it seems to have worked since then. I haven't gotten influenza in several years now.
LAMB: As you sit at your desk every day, what is your number one concern way out there?
FAUCI: Well, my one- number one concern way out there is the idea of emerging and re-emerging infections that we haven't been exposed to before that's spread by a respiratory route. So pandemic influenza that's really serious is something that bothers me and worries me a bit, and that's one of the reasons why one of the real priorities that we're working on right now in my institute is to develop what's called a universal influenza vaccine.
A universal influenza vaccine is one that you can take once or a couple of times in your lifetime, and it would cover all the strains of influenza. So you don't have to play this guessing game each year where you have to change your vaccine, or maybe every year or two, and keep getting vaccinated every year. If you can get a universal flu vaccine, where you give it a few times the way you would give a measles vaccine and forever be protected, or a polio vaccine and forever be protected, that's the thing we need to do.
LAMB: How close are you?
FAUCI: You know, I wouldn't- I- it's tough to predict. It's foolish to say, "We're going to have it in x number of years." But we've made some breakthroughs in the last three or four years that encourage me to think that within a reasonable period of time, we may have some form of universal flu vaccine.
LAMB: Only got a couple of minutes left. The toughest decision you've ever had to make?
FAUCI: Well, one of the toughest decision-I had a few-was when I made a decision during the middle of the early years of the AIDS pandemic to bring the activist community into our deliberations, because most of the scientific community, including my own staff, were totally against that.
They said the activists would be disruptive, that they would, you know, get in the way of what the scientific approach would be. I got to know the activists very well. I became friends with many of them. Today, some of them are very close to me.
LAMB: Do you still see Larry Kramer?
FAUCI: I still see Larry, I still talk to Larry. I still see, you know, the group that was in the movie "How to Survive a Plague," you know, Peter Staley and Mark Harrington and all those and Gregg Gonsalves and them. I still see them and interact with them.
I insisted that we bring the activists into our deliberations. And I made that decision knowing that there was going to be a lot of pushback from the scientific community, from the administrative community, from everyone. But it was the right thing to do.
So in some respects, it wasn't a tough decision. It was a decision that had some repercussions for me, because people were thinking I was "selling out" to the activists when I was saying, "Absolutely not. They have a lot to offer, and it's to our detriment not to bring them into the process."
LAMB: Dr. Anthony S. Fauci, 30 years plus director of the National Institute of Allergy and Infectious Diseases, we thank you very much for your time.
FAUCI: Really good to be with you.