PART TWO: 20 Years Later, AIDS Pioneer Reflects on Professional Conflicts
For Michael Gottlieb, AIDS brought a degree of celebrity when he became the consulting physician for Rock Hudson. When AIDS claimed the life of the famous actor, Gottlieb co-founded the American Federation of AIDS Research (AmFAR), the first truly national fundraising effort for AIDS treatment and research. He became a strong advocate for patient rights, and he supported community organizers on the local and national levels. He continued to see patients as part of his research and coped with their deaths. He also faced another reality: political resistance and unexpected consequences.
Years earlier Gottlieb had accepted a position at UCLA with hopes of improving the success of bone marrow transplants. Two days a week he saw patients with auto-immune diseases, rare immune deficiencies, and allergic conditions. The rest of his time he was doing research and teaching. But then AIDS changed his plans for a productive career of patient care, research, and teaching.
Denied Tenure at UCLA
Six years after he announced his discovery, Gottlieb was denied tenure at UCLA. His academic association was severed, and he no longer had access to the research facilities and teaching opportunities at his medical school. “The explanation was that my body of work did not merit it (tenure),” he recalled. He suspects more was involved. “I was an activist. I was probably a little too progressive on HIV issues for my medical school, and there were the inevitable academic political issues.”
In addition to co-founding AmFAR, Gottlieb also served on the board of directors for the new AIDS Project Los Angeles (APLA), an organization developed by the gay and lesbian community. He was appointed the California AIDS Advisory Committee to assist the state health department with its AIDS prevention strategies. The work took him away from his laboratory and UCLA.
“When I was at committee meetings,” he explained, “I was criticized for not being on campus.” In his own defense, he added, “I had been very productive. I helped the institution establish a foothold in a new area (HIV/AIDS) for which they have received significant funding.”
Relies on Private Practice
Gottlieb’s loss of tenure led to a new path. He established his private practice in Los Angeles, and 85% of his patients were exclusively those with HIV. Others presented with hepatitis C, other viral diseases, and general internal medicine concerns.
“In the pre-HAART (highly active anti-retroviral therapy, also known as the “AIDS cocktail” era, I can’t say that doctors’ prescriptions of therapy were any better than patients’ prescriptions. Doctors and patients played the same scenarios over and over again. You were there for your patients, and they knew that. You were holding their hands, helping them manage their fevers. It was a little like battlefield medicine, like working in a MASH unit, helping patients recover enough to send them out to do battle some more.”
AIDS Made Him Better Doctor
Today Gottlieb’s practice reflects the advances in AIDS treatment, and he notes the impact on his own medical practice.
“There’s no doubt that AIDS care made me a better doctor just as it did for nurses and other health care professionals. We all learned a whole more about the nature of compassion and the value of human interaction as a result of these experiences. We learned to appreciate life even more and to prioritize in your life for what was really important.”
Gottlieb also notes that patients approach their HIV care somewhat differently today, after years of personally researching every new experimental treatment.
“There is a little more reliance on doctors now that treatment is more scientifically grounded and now that therapy requires more fine-tuning of drug regimens. In the past, patients thought they had to stay on top of it all themselves; now patients seem to have given up some of that control over their care.”
Gottlieb said he also advises patients to not make HIV all-consuming in their lives, to not spend hours on end chatting over the internet about their condition. For himself, he stays current on vaccine development and gene therapy, and he participates in major conferences. He also tried to help get the early AIDS drug AZT approved for neo-natal mothers with HIV.
Although AIDS brought him great opportunities to influence what he once called “the major health threat of the century,” it also presented setbacks and disappointments in his personal life. He has retained his passion for his life today. “I love medical practice, I love treating patients.” Gottlieb has fashioned in his own path. “I am content with that,” he concluded.