How Anthony Fauci Became America’s Doctor

How Anthony Fauci Became America’s Doctor

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Fauci revelled in the demanding coursework. “We took four years of Greek, four years of Latin, three years of French, ancient history, theology,” he recalled. He developed an ability to set out an argument and to bolster it with evidence—good preparation, it turned out, for testifying before Congress. Last year, at a dinner that Regis held in his honor, he said that the school had taught him “to communicate scientific principles, or principles of basic and clinical research, without getting very profuse and off on tangents.”

At the time, though, Fauci had no interest in becoming a doctor. “I was captain of the Regis High School basketball team,” he once told me. “I thought this was what I wanted to do with myself. But, being a realist, I very quickly found out that a five-seven, really fast, good-shooting point guard will never be as good as a really fast, good-shooting seven-footer. I decided to change the direction of my career.”

At school, Fauci’s accomplished peers were headed to careers in medicine, engineering, and the law. At home, he was steeped in the humanities: “Virtually all my relatives on my mother’s side—her father, her brother, and her sister’s children—are artists.” His mother helped tip the balance. “She never really pressured me in any way, but I think I subtly picked up the vibrations that she wanted very much for me to be a physician,” Fauci said. “There was this tension—would it be humanities and classics, or would it be science? As I analyzed that, it seemed to me that being a physician was the perfect melding of both of those aspirations.”

From Regis, Fauci went on to another Jesuit institution, Holy Cross, in Worcester, Massachusetts. His high-school faculty had left him little choice in the matter. “They just wouldn’t write a recommendation for you if you wanted to apply to Harvard or to Cornell, or Columbia,” he said. Fauci enrolled in 1958 and was pleased to find that the university took a broad view of premedical studies. He signed up for a program called Bachelor of Arts–Greek Classics–Premed. “It was really kind of bizarre,” he recalled. “We did a lot of classics, Greek, Latin, Romance languages. . . . We took many credits of philosophy, everything from epistemology to philosophical psychology, logic, etc. But we took enough biology and physics and science to get you into medical school.”

During the summers, Fauci worked construction jobs. One year, he found himself assigned to a crew that was building a new library at Cornell Medical College, on the Upper East Side. “On lunch break, when the crew were eating their hero sandwiches and making catcalls to nurses, I snuck into the auditorium to take a peek,” Fauci recalled in 1998, at the medical school’s centennial celebration. “I got goosebumps as I entered, looked around the empty room, and imagined what it would be like to attend this extraordinary institution. After a few minutes at the doorway, a guard came and politely told me to leave, since my dirty boots were soiling the floor. I looked at him and said proudly that I would be attending this institution a year from now. He laughed and said, ‘Right, kid, and next year I am going to be Police Commissioner.’ ”

Fauci graduated first in his class from Cornell in 1966, just as America’s involvement in Vietnam was accelerating. Every new physician was required to perform some kind of military service. “We were gathered in the auditorium at Cornell, early in our fourth year of medical school,” Fauci recalled. “Unlike today, we had only two women in the class and seventy-nine men. The recruiter from the armed forces came there and said, ‘Believe it or not, when you graduate from medical school at the end of the year, except for the two women, everyone in this room is going to be either in the Army, the Air Force, the Navy, or the Public Health Service. So you’re going to have to make your choice. Sign up and give your preferences.’ ”

Fauci wanted to work in the U.S. Public Health Service; his fallback was the Navy. He got his first choice, and ended up at the National Institutes of Health, which was then establishing itself as the country’s primary center for biomedical research. Nearly everyone in academic medicine spent some time at one of its branches; except for three years back at Cornell to complete his internship and residency, Fauci has spent five decades there.

In 1972, Fauci started as a senior researcher at the National Institute of Allergy and Infectious Diseases. He was drawn to investigating ailments that were difficult but not impossible to treat. “I wanted something that could make you very sick and kill you unless I intervened. And if I intervene, you’re essentially cured,” he told Ushma Neill, the editor of The Journal of Clinical Investigation, in 2014. “Now, that seems a little bit too simplistic, but that’s really the nature of most infectious diseases.”

Working in the lab of Sheldon Wolff, Fauci studied the molecular nature of fever. The field of immunology was still young, but scientists were rapidly learning how to manipulate the smallest components of individual cells, which opened the way to a decade of discovery.

Chronic fevers can have a number of underlying causes, among them an uncommon condition known as vasculitis—an inflammation of the blood cells that often occurs when the body’s immune system mistakenly attacks its own blood vessels. Many of Fauci’s vasculitis patients suffered from rare inflammatory diseases, such as granulomatosis with polyangiitis, which damages blood vessels in the lungs, kidneys, and other organs. The disease was almost always fatal.

Fauci and his infectious-disease colleagues at the N.I.H. were frequently asked to visit the National Cancer Institute, which was in the same building as his lab, to consult on patients who were receiving chemotherapy. The drugs suppressed tumors, but they were highly toxic. And they had another side effect, Fauci told me: “Those people are susceptible to a lot of things like infections and bleeding, because the treatment has destroyed their immune systems.”

In 1990, Fauci was the government’s leading researcher focussed on the AIDS epidemic.George Tames / The New York Times / Redux

Fauci, together with Wolff, his mentor, wondered if this side effect could also be harnessed to help vasculitis patients, whose immune systems were overactive. “I thought if we could somehow give a cancer drug at a low enough dose perhaps we could turn the disease off without any of the secondary complications,” he recalled recently. “First we did it in a few patients, and, much to our delight, they had a total remission. Before you know it, we ended up curing a very, very lethal, albeit uncommon, disease.”

This technique enabled researchers to do effective work on lupus, rheumatoid arthritis, and transplant rejection. “If you look at immunology, it has from the very beginning been inextricably linked to infectious diseases,” Fauci said. “What is the immune system for? The immune system protects you against invaders from without—microorganisms—as well as, in some cases, the emergence of certain tumors from within.”

In 1981, a strange new syndrome emerged that transformed Fauci’s research and, eventually, the lives of millions of people around the world. “All of a sudden, this new disease comes along,” Fauci recalled, referring to what would soon come to be known as AIDS. “Even before the cause of it was proven to be H.I.V., everybody in the field knew that it had to be a virus. I said to myself, ‘Here it is, a virus, still to be determined, that’s affecting profoundly and destroying the human immune system.’ ” Fauci believed that he had been training all his life for a threat like this one. He was an expert in viruses and in the immune system—and he had always been attracted to combatting serious, even fatal diseases. “I wanted to be where the action was,” he said.

At first, few public-health officials seemed to care. In June of 1981, the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control, issued a paper that included an account of five young men, all gay, who had contracted pneumocystis, a form of pneumonia that had previously been reported only in people with dramatically impaired immune systems. The young men described in the study had all been healthy. “I thought it was a fluke,” Fauci recalled. “I put it aside on my desk, thinking that maybe this was some drug that they had taken that suppressed their immune system.”

A month later, an even more alarming report arrived from the C.D.C. Fauci read it with an uneasy sense that a disaster was looming: “I made the decision that I was going to stop what I was doing, much to the chagrin of my mentors, who were saying, ‘Why do you want to give up a great trajectory of a career to study a handful of gay men with this strange disease?’ But, deep down, I really knew that this was going to explode.”

Fauci wrote a paper to sound the alarm. “I called it my apologia pro vita sua—an explanation for what I’m doing,” he said. In the paper, Fauci pointed out that, although the disease “seems to selectively affect a particular segment of our society,” it demanded a medical solution. Moreover, he warned, “any assumption that the syndrome will remain restricted to a particular segment of our society is truly an assumption without a scientific basis.” Fauci sent the manuscript to The New England Journal of Medicine, in late 1981. It was rejected. “One of the reviewers said I was being alarmist,” Fauci said. He tried a different journal, The Annals of Internal Medicine, and the following June the paper was published.

In the laboratory, Fauci began making progress. He had been investigating B cells, which are involved in the production of antibodies. In 1983—before H.I.V. was even known by that name—his lab became the first to report that B cells became hyperactive in patients with AIDS. When a healthy person is invaded by a virus, antibodies mount a defense, but, when H.I.V. hijacked B cells, the antibody system went awry. Fauci and his team had identified one of the crucial features of AIDS. “We made that observation without having any idea of what we were dealing with,” he said in an interview for an N.I.H. oral history. “I think that speaks for sound scientific and clinical observation.” The politics of seeking a cure, though, would be far harder to manage.

On October 11, 1988, more than a thousand AIDS activists gathered outside the headquarters of the Food and Drug Administration, in Rockville, Maryland, to protest the agency’s glacial reaction to the epidemic. The activists knew that their community needed new treatments if they were to avoid catastrophe—but they were stymied by the F.D.A.’s drug-approval process, a remarkably inflexible system that typically took years.

That same day, another group of protesters marched onto the campus of the National Institutes of Health, in Bethesda, Maryland. They were headed for Building 31, the home of the National Institute of Allergy and Infectious Diseases. Fauci, who had become the institute’s director in 1984, was now the government’s leading scientist focussed on the AIDS epidemic. Even though he was not running the F.D.A., he appeared almost daily in the media to discuss the crisis. “My face was the face of the federal government,” Fauci told me. He was asked the same question nearly every day: why wasn’t the government moving faster? It didn’t help that the Reagan Administration seemed so indifferent to the plague.

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