One of the countrys most
visible and admired physicians and the director of the National
Institute of Allergy and Infectious Diseases at the National
Institutes of Health, Anthony S. Fauci, M.D.,62 has
led the fight against AIDS and, in the process, won the trust
and respect of his one-time opponents.
By Donald N.S. Unger
of the signal features of AIDS activism in the late 1980s
was the vociferous attack mounted against federal agencies,
like the Centers for Disease Control (CDC), the Food and
Drug Administration (FDA), and the National Institutes of
Health (NIH). These agencies were accused of doing too little,
doing it too late, and often, of handcuffing individual doctors
and people with AIDS with medical regulations that were too
cumbersome to deal with a fast moving and deadly epidemic.
One of the most frequent accusers in this dialog was writer
and activist Larry Kramer, founder of Act Up, the AIDS Coalition
to Unleash Power, an organization founded in New York City
in March of 1987, with the avowed purposeas its name
impliesof taking a tactical line that might better
be described as uncivil disobedience.
One of the most frequent targets of Kramers rhetoric,
and of Act Up protests, was Anthony S. Fauci, M.D., 62,
the federal governments chief point man in the fight
against AIDS, who has headed the National Institute of Allergy
and Infectious Diseases (NIAID) at NIH since 1984.
By October of 1992, however, a curious series of things
had happened: When the Circle Repertory Company premiered
Kramers play, The Destiny of Me, that month
at New Yorks Lucille Lortel Theater as a benefit for
Gay Mens Health Crisisanother organization which
Kramer foundedFauci was in the audience.
On stage, most of the play is seen from the point of view
of the hospital bed of Kramers stand-in, the character
Ned Weeks, an AIDS patient undergoing experimental treatment,
who spends a chunk of his time berating or sparring with
his primary caretaker, Nurse Hanniman, or with her husband,
Weeks physician, the hospital administrator, Dr. Anthony
Della VidaDr. Lifeand no reasonably informed
member of the audience could have failed to identify the
model for the character.
These days, Kramer and Fauci describe each other as friends;
when Kramer is in Washington, Fauci takes him out for Italian
While this rapport might at first seem unlikely, the fact
is that AIDS activists and medical researcherswhatever
disagreements they had and continue to have about pace, funding
or methodsshare, and have always shared, a common goal.
Clarifying that, and moving an often sclerotic and stubborn
medical establishmentboth its public and private arms
and its formal and informal practiceshas been a key
part of what success there has been in fighting AIDS in the
United States in the past two decades.
Fauci has been one of a handful of people, in the higher
reaches of the medical establishment, at the fulcrum of that
Brooklyn Born and Bred
Anthony Stephen Fauci was
born in New York City on Christmas Eve 1940, the second of
Stephen and Eugenia Faucis two children. His parents,
both the children of immigrants, met as students at Brooklyns
New Utrecht High School and married when they were just 18.
He grew up in Bensonhurst, Brooklyn, where his father, a
Columbia University educated pharmacist, owned a neighborhood
drugstore, at 13th Ave. and 83rd St. The family lived in
an apartment above the store, and all pitched in when neededhis
father in the back, his mother and older sister, Denise,
at the register.
I was delivering prescriptions from the time I was
old enough to ride a bike, Fauci recalls.
Routinely cited in recent decades for the length of his
work day and the peripatetic nature of his job, Fauci took
on these habits early and came to them naturally. He was
that kind of kid, too.
He grew up surrounded by disparate influences that he seems
to have enjoyed and that seem to have benefited him: There
was his pharmacist father, known as Doc in the
neighborhoodwhom he describes as laid backand
his mother, also college educated, whom he describes as goal
oriented. There was an attraction to medicine and science
fostered from an early age, and a commitment to the humanities
nourished by premedical studies at Holy Cross that also encompassed
the study of Latin, Greek and philosophy.
And there is early evidence, as well, that Fauci had a streak
in him that was something between puckish and perversea
stubborn adherence to his own values and interests in the
face of local prejudice that had to have been fierce. Growing
up in post-war Brooklyn, playing baseball in Dyker Heights
Park, on Gravesend Bay, in the era of Jackie Robinson and
Pee Wee Reese, Fauci was a Yankees fan. Among his heroes
were Joe DiMaggio and Mickey Mantle, which, he says, made
him something of a sports outcast among his friends, Brooklyn
Dodgers fans all.
If he had been a sports outcast, he was an athletic one.
In a 1989 interview with the NIH Historical Office, he remembers, We
used to play basketball from the beginning of basketball
season to the end, baseball through the spring and summer,
and then basketball and football again in the winter. When
he was younger, he played CYO basketball in the neighborhood;
in high school, he captained the basketball team. Today,
hes a daily runner who has completed the New York and
Marine Corps marathons.
He attended Regis High School, a Jesuit school on Manhattans
Upper East Side. And the distance he had to travel to get
there is difficult to explain, for reasons of time or geography
and also for reasons of culture. Time and geography matter,
of course, in multiple ways: the trip took 75 to 80 minutes
each way, a bus and three subways during rush hour in both
directions. By rough calculation, all the time he spent commuting
during his four years at Regis, it cost him more than 70
days. And he didnt just let the time go: then,
as now, he was focused and organized. He was the kid on the
subwaypacked up against the other passengers, elbows
against his body, wrists and forearms folded inward, a book
almost on top his face, readingin his case, probably
Ignatius Loyola, at some point or other, and likely in Latin.
Time and geography also matter because Brooklyn was further
away from Manhattan in the 1940s and 1950s than it is today,
and Bensonhurst is deep Brooklyn, just a short three or four
milesa few stops on what was then the BMT Seabeach
local linefrom Coney Island and the beach. New York
is New York, but its also five boroughs and a million
neighborhoods. And working class, Italian and Jewish Bensonhurst,
might as well have been 15 light years away from Manhattans
Upper East Side, then, as now, one of the countrys
most affluent zip codes.
The Nefarious Act of Reading
In his commencement
address this past May, U.S. Poet Laureate Billy Collins 63whose
time at Holy Cross overlapped with Faucis, although
they didnt know each otherspoke with some nostalgia
of the 10 oclock dorm curfew of that era, and how students
learned to black out their rooms with towels,
newspapers and tin foil.
It was behind these drawn shades, Collins said, that
we indulged in the nefarious act of reading.
Fauci came to Holy Cross in the fall of 1958. He played
intramural sports when he had the time, but his days of more
organized competition were over. He had entertained the vague
idea that he might make the basketball team as a walk on,
but the competition was fierce, and he didnt quite
have the height. Always a fully engaged student, moreover,
he took to his premedical studies with gusto; the nefarious
act of reading didnt leave him a lot of spare
There was a certain spirit of scholarship up there, he
remembers, that was not matched in anything that Id
experienced. The idea of seriousness of purposeI dont
mean nerdish seriousness of purposeI mean the importance
of personal development, scholarly development and the high
standard of integrity and principles that became a part of
everyday life at Holy Cross. And that, I think, was passed
down from the Jesuits and from the lay faculty to the students.
The premed program covered enough science to get the students
into medical school, but also stressed the humanitiesa
continuation, in some ways, of what he had been taught in
high school. Fauci often credits part of his professional
success to the inculcation of Jesuit intellectual rigor that
was a core part of his education: an emphasis on organization
and logic, on succinctness and clarity of expression. Arguably,
the twinning of science and the humanities has proved useful
in his dual roles as physician and researcher as well.
Summers, he worked construction in New York, balancing personal
and scholarly development with a measure of dust and grit.
In the summer of 1961, before returning to Holy Cross for
his last year, he was part of a crew working on a new library
for the Cornell University Medical College (now the Weill
Medical College of Cornell University), about six blocks
east and 15 blocks south of his high school alma mater.
He recounted the following anecdote at the Medical Schools
centennial celebration in April of 1998, and it was recently
reported in the Regis Alumni News:
One day during lunch break, while the rest of the
construction crew was sitting along the sidewalk on York
Avenue eating their hero sandwiches and making catcalls at
the nurses who were entering and leaving the hospital, I
snuck into the auditorium to take a peek. I got goose bumps
as I entered, looked around at the empty room and imagined
what it would be like to attend this extraordinary institution
a few minutes at the doorway, a guard came and politely told
me to leave since my dirty construction 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
Fauci received his M.D. from Cornell in 1966. He was ranked
first in his class. There is no record of what sort of footwear
he chose for commencement. Howard R. Leary was New York Citys
Police Commissioner in the spring of 1966. There is no record
of his ever having worked security at Cornell.
A Professional Lifetime in Public Service: Researcher,
Fauci has spent his entire
professional career at the National Institutes of Health.
He started as a clinical associate in the Laboratory of
Clinical Investigation at the National Institute of Allergy
and Infectious Diseases (NIAID) in 1968, after a two-year
residency at The New York Hospital-Cornell Medical Center.
By 1974, he was head of the clinical physiology section
of the lab. In 1980, he became chief of the Laboratory
of Immunoregulation (a position he still holds) and since
1984, he has been the director of NIAID.
The lab work that has dominated one major facet of Faucis
professional life isnt necessarily what lay people
imagine. On a day-to-day basis, doing science, as
a lot of researchers casually refer to it, encompasses most
of the same administrative, and even promotional, frustrations
as running a small business. Added to that are the imperatives
of academic and scholarly progress: publish or perish.
Dr. Peter Warburton, a molecular biologist who runs a lab
at the Mount Sinai School of Medicine in New York, puts it
this way, Running a research lab is supposed to be
fun; youre doing science, working hard but focusing
on your research, which hopefully you love and find endlessly
fascinating. But when you finally become successful enough
to get your own lab, reality clicks in, and you find out
how much administrative work is required to run a lab, and
how little time is left to actually do the science.
Suddenly, not only do you need to be a scientist, graphic
artist, technical author, public speaker and politician,
you also need to be a personnel and business managerand
an accountant, usually with a budget of several hundred thousand
dollars a year.
For Fauci, of course, the budget numbers are rather larger,
as noted below.
At the same time that he has continued to do lab research,
however, Fauci has never stopped seeing patientsand
he has continued both of those kinds of hands-on workas
his administrative duties have increased, along with their
attendant political and media responsibilities. While others
have sometimes characterized this as a difficult juggling
act, Fauci has always stressed the benefits. Others have
noted them, on occasion, as well.
In 1990, for example, journalist Randy Shilts, who would
later write an important memoir of the early years of AIDS, And
the Band Played On, wrote caustically in the San Francisco
Chronicle of researchers who no longer did research,
but singled out Fauci as an exception: Although the
federal governments leading AIDS celebrity, Dr. Anthony
Fauci of the National Institutes of Health, actually goes
into his immunology lab in Bethesda to work with test tubes,
a lot of the people you see quoted on TV as major laboratory
researchers dont. They have assistants don white coats
and do all that tedious work, even though theyre the
ones Dan Rather chats with once the results are in.
Politically, Fauci has overseen a huge increase in the budget
of NIAID. Figures in Government Executive Magazine put
the Institutes 1984 budget, at the beginning of his
tenure, at about $357 million per year; the 2003 budget will
be approximately $3.9 billion. In comparative terms, NIAID
had moved from taking up 7 percent of NIHs budget to
taking 14 percent, and from the sixth highest funded Institute
to the second.
While a great deal of attention has been focused on his
work on AIDS, Faucis scope is much broader than that,
as evidenced at the beginning of this year when he was one
of the most visible of the government officials publicly
discussing the threats posed by anthrax and other possible
bio-terror weapons. His is the timbre of voice that one wants
to hear in that sort of atmosphere: calm, reassuring, but
not falsely so. He spoke the facts and had a credible record
of speaking the truth under difficult circumstances.
The balancing act that he has accomplished between the various
parts of his career is underscored as much by what he has not done
as by what he has done. Twice, during the presidency of George
H. W. Bush, he was offered the position of director of NIH,
and twice, he turned the position down; on the second occasion,
he did so in the Oval Office.
How AIDS Changed Medicine
Its easy to forget,
some 20 years into the AIDS epidemic, both how terrifying
and chaotic the early onslaught of the disease was, and how
much AIDS activism has percolated through our approach to
other diseases, changing in many ways the entire doctor-patient
relationship in the United States, and the ways in which
drugs are tested and approved and research is funded.
As Fauci describes the pre-AIDS attitude of the medical
establishment: It was not traditional or acceptable
for anyone to question what physicians or public health personnel
did. We knew better; therefore it should be done this
AIDS changed that, he says.
With the HIV epidemic came the birth of a certain
form of activism that demanded participation in the
decision making, he says, particularly when it
was dealing with a deadly disease, for which there was no
But those changes were not instantaneous, of course, nor
were they consistentneither within the clinical practice
of medicine, nor within the medical research community. Its
easy, in retrospect, to say that unnecessary bureaucracy
shouldnt hold up the release of crucial medication.
But what do those terms mean without the words safe and effective?
The relationship of doctor and patient is similarly complex.
Most people would count it as progress that, over the past
20 years, physicians more often have been socialized to interact
with than to dictate to their patients. And the
AIDS crisis has been a key part of moving medicine in this
direction. At least in the beginning, it leveled the playing
field: doctors often knew no more than their patients, who
were then motivated to go out and find their own answers.
But taken to the extreme, this leveling of the doctor-patient
relationship can feel like an abdication of responsibility.
The first wave of the epidemic, in gay enclaves on both
coastsplaces like Greenwich Village, West Hollywood
and San Franciscowas heralded by a mix of patient complaints
both esoteric and mundane: a rash of otherwise healthy young
men coming down with normally rare diseases like Kaposis
sarcoma and pneumocystis pneumonia, odd yeast infections,
suffering inexplicable immunological failures; another group
in the same cohort suffered with chronic fevers, night sweats,
swollen glands, illnesses sometimes transient, sometimes
not, again without good explanations and not responsive to
This was frightening, first and foremost, of course, to
the people suffering from the disease, who, in the beginning,
didnt even have a name for what they were going through.
That fear and concern quickly spread through the local communities
that were hardest hit and into the population at large.
One of the early problems that the disease spawned was discrimination
against the people who contracted it, and an early reluctance
in some quarters to treat AIDS as everyones problem.
As Fauci puts it, It was and is a combination of a
real disease in the classic sense, a huge societal problem
with disenfranchised populations, an ethical issue, a social
issue, a very charged political issue, with conservatives
not really wanting to recognize that this
is something that we should pay attention toprobably
because the subjects of the disease were people who were
Immediately, this put public health officials dead center
in an agonizing struggle.
Walking Among Them
Carol Brown Moskowitz, a research
nurse and neurological nurse practitioner, recalls running
into a group of leather-clad men, many of them body pierced
and draped in chains, in the lobby of Washingtons Omni
Hotel, in the fall of 1988. They looked as if they might
be members of a motorcycle gang, but the Omni seemed an unlikely
place for a biker convention.
When she asked one of them who they were, he told her that
they were members of Act Up, and that they were
going out to make some noise at the FDA about the AIDS epidemic
and the lack of funding for research.
Make some noise they did. On Oct. 11, about 1,000 demonstrators
descended on the FDA facility in Rockville, Md., for some
nine hours and shut it down; there were almost 200 arrests.
A smaller group splintered off and headed out to Bethesda,
to the NIH campus.
What Fauci remembers about the demonstration, and the demonstrators
themselves, was the sense of layers: theatricality, genuine
anger, but also an underlying core of pain.
Like Carol Moskowitz, he mentions their clothing first.
They were dressed funny; they had all these strange
outfits; and they were screaming and cursing and yelling, he
recalls. And I looked at them, and I saw people who
were in pain. I didnt see people who were threatening
me, I saw people who were in pain. And thats exactly
what I saw, and I was very moved by the pain. Boy, they
must really be hurting for them to do this. And I think
I conveyed that to them, and they saw that thats how
I was feeling toward them.
Fauci asked the police and the FBI on the NIH campus not
to make arrests. He also asked that a handful of the demonstrations
leaders be brought to his office.
That began a relationship over many years that allowed
me to walk amongst them, Fauci says. It was really
interesting; they let me into their camp. I went to the gay
bath houses and spoke to them. I went to San Francisco, to
the Castro District, and I discussed the problems they were
having, the degree of suffering that was going on in the
community, the need for them to get involved in clinical
trials, since there were no other possibilities for them
to get access to drugs. And I earned their confidence.
It was in San Francisco, in February of 1989, that he met
Terry Sutton, a former school teacher, who was losing his
sight to cytamegalovirus, one of the secondary infections
then common among AIDS sufferers. The infection, it was already
known, could be treated with the antiviral medication ganciclovir,
but the FDA had not yet approved the medication for release.
The meeting was arranged by Martin Delany, the founder of
San Franciscos Project Inform, which had been on the
leading edge of getting both information and medicationoften
imported illegally from other countriesto people with
AIDS at a time when the government approval process was perceived
to be too slow.
I arranged for Tony to come to the Hilton Hotel, to
meet some people face to face, Delany remembers. It
was sort of based on the feeling that if people like him
would just get in the face of people who were really sick
and desperate over some of these regulatory issues, it might
change how they felt about them
That was how he connected
to them. And you could see clearly that he was moved emotionally
Less than four months later, in June of 1989, at the 5th
International AIDS Conference in Montreal, Fauci publicly
spoke out in favor of releasing ganciclovir to people who
needed it, and by the end of the month, the FDA had reversed
course and done so.
In the face of Faucis public change in position, theyd
had little choice.
Delany also points to the 6th International AIDS Conference
in San Francisco the following year as a time that solidified
a more positive view of Fauci in the activist community.
This was also part of a broader series of moves undertaken
by the researchers and public officials fighting the epidemic
to take account of the activists and people with AIDS: a
number of free passes to the conference were offered to activists,
community members and people with AIDS, who couldnt
afford the $550 cost of admission. There were nightly debriefings
and question and answer periods held at a local public auditorium
for people not attending the conferenceone of them
run by Fauci. Researchers joined an AIDS rally in downtown
San Francisco, where conference organizer and AIDS researcher,
Dr. Paul Volberding, told the crowd, The apparent divisions
between us are not real.
Undoubtedly, what Volberding had said was true as a matter
of spirit: everyone there was united in a desire to see the
disease conquered. What had changed significantly, between
Montreal and San Francisco, was the degree to which that
process was to be overtly open to patient input. In Montreal,
Act Up protesters had seized the stage; in San Francisco,
theyd had a place on the stage. Some joked that rioting
had now been given an official slot on the program.
This approach was not without its detractors, nor was a
loosening of the strictures on the release of new drugs universally
seen as a good thing. Many researchers worried that it would
now be difficult to get people to enroll in well controlled
clinical trials, and that the data from people who did enroll
might be contaminated by exposure to a broad variety of untested
medications. By managing to walk a line between conflicted
constituencies and work at redrawing those lines, often under
heavy fire, Fauci has succeeded as an administrator.
When to Take a Punch
Observing the strategic tussles
between Kramer and Fauci in the 80s and into the early 90s,
one might liken them to the Punch and Judy Show, with Kramer
always in the role of Punchand with a real bat. But
this would be to misunderstand what was going on, as, ironically,
the dramatist Kramer sometimes seemed to do.
One can see Faucis awareness of the dynamic of his
relationship with Kramer in an article Natalie Angier wrote
in The New York Times in February of 1994:
And through it all, Dr. Fauci accepts the criticisms,
and he accepts that someone must absorb the anger and terror
that AIDS has spawned, so why not somebody of strong vertebrae
who was raised on the streets of Bensonhurst? I was
on a C-SPAN program a couple of months ago with Tony, and
I attacked him for the entire hour, said Mr. Kramer. He
called me up afterwards and said he thought the program
went very well. I said, How can you say that? I did
nothing but yell at you. He said, You dont
realize that you can say things I cant. It doesnt
mean I dont agree with you.
Dr. Fauci claims he does not take the intermittent blasts
personally. Thats the activist mode, he
said. When theres a disagreement their tendency
is to trash somebody. But I know that when Larry Kramer
says the reason were all in so much trouble is because
of Tony Fauci, hes too smart to believe that.
I dont want them to change or compromise that
mode, he added, as long as they dont
ask me to change my opinions.
What Fauci has accomplished over the course of his war on
AIDS is nothing short of amazing: he has managed to build
a bridge between deeply antagonistic constituencies, working
all the while under the relentless glare of media scrutiny.
And he has built that bridge using the tools he spent a lifetime
cultivatinga tireless work ethic, a scrupulous honesty
and an abiding sense of compassion.
Where Does He Get the Energy?
It also helps that
he has a spouse who shares his goals and values. Fauci is
married to Christine Grady, who completed her bachelors
degree, with a double major in nursing and biology, in the
mid-1970salthough she might have gone premed instead.
She returned to Georgetown University more than a decade
later, completing a Ph.D. in philosophy and bioethics in
1993. She currently heads the section on human subjects research
in the department of clinical bioethics at NIH.
In a 1997 interview with the NIH Historical Office, she
describes how she and Fauci met. Grady had spent two years
in the early 1980s working as a nurse educator and manager
of ambulatory care for Project Hope in Alagoas, Brazil; when
doctors needed someone to translate for a Portuguese-speaking
patient at the NIH hospital where she was working, they knew
who to ask.
I met him (Fauci) here over the bed of a patient who
happened to be from Brazil. I was called in as a translator
because this man wanted to go home, and they were afraid
to let him go home because the guy had vasculitis. His vasculitis
was not in great control. And so they said, Could you
come translate for Dr. Fauci? whom I had not metthe
inimitable Dr. Fauci everybody was afraid of. When
he came in, I thought, What are they so afraid of him
for? He is not so scary.
But it is actually a great story because Tony, in
his very serious way, said, Make sure that you do your
dressings every day and sit with your leg up, and I
forget all the details. But I translated that to the patient,
and the patient said, You are kidding. I am so sick
of being in this hospital. I am going to go home, I am going
to dance all night, I am going to go to the beach, I am going
to do this. So I think to myself, How am I going
to do this? So I turned around to Tony and said, He
said he would do exactly as you said. I kept a straight
face all the time.
When Grady was called to his office later that day, she
figured that she had been found out. As it happened, the
inimitable Dr. Fauci just wanted to ask her out on a date.
Married for 17 years now, they have three daughters, ranging
in age from 10 to 16. As a couple, they are in a better position
than most to understand each others work. During her
career, Grady not only worked with AIDS patients in the early
years of the epidemic, she also educated other nurses about
caring for patients with AIDS. Her doctoral dissertation,
published in book form in 1995, is titled The Search for
an AIDS Vaccine: Ethical Issues in the Development and Testing
of a Preventive AIDS Vaccine.
No fast take on the Faucis family life seems to be
complete without the notation that they tend to all eat dinner
together around 9:30 every nighttestimony both to their
busy schedules and to the importance that they ascribe to
spending time together.
One might ask: Where does Faucithe researcher, clinician,
administrator, politician, husband, fatherfind the
energy? The truth is the good doctor, like a long-distance
runner, seems to thrive on his efforts.
When asked about his multiple roles in the fight against
AIDS, he responds by discussing the multifaceted character
of the disease:
It was complex. It was a health problem; it was an
ethical problem; it was a legal problemthe legal rights
of these people. And I just felt that if this problem needed
to be tackled, I couldnt be completely unidimensional
about it. And the more I got into the other issues, the more
interesting it became, because they were all linked with
It doesnt seem to occur to Fauci that he is doing
the work of three people. For him, the key word is interesting. Fauci
is doing what he wants to do. On all fronts. And, for the
most part, it appears he always has. For his part, this makes
him, among other things, an extraordinarily fortunate man;
and he knows it.
Anthony S. Fauci, M.D., 62 Sidebar
Donald N.S. Unger is a New York City born writer of
fiction and nonfiction and a political commentator for
NPR affiliate radio WFCR. He lives in Worcester.