The researcher who reported his findings to the federal agency was Michael Gottlieb, a 33-year-old assistant professor at the UCLA Medical School. I interviewed Gottlieb on the occasion of both the 5th and the 20th anniversaries of the CDC report. Below are edited excerpts.
PART ONE: “Five Years after Report on AIDS, MD Assesses “Health Threat of the Century,” American Medical News, June 20, 1986
“Reporting it to the CDC and to the world – that was an exciting time. We had no sense of the eventual serious side of this epidemic. That’s sobering, but the early months were very exciting.” Michael Gottlieb had reported to the world something new in medicine, a rare opportunity for someone just starting his career. He had just completed a post-doctoral fellowship at Stanford University, studying ways to prevent organ graft rejection. His field was the effect of radiation on the immune system. At UCLA Gottlieb intended to collaborate with the bone marrow transplant program.
“I was seeing patients two days a week, doing research, and teaching the rest of the time,” he recalled. He saw patients who presented with rare immune deficiencies and auto-immune diseases. “And then I encountered what we would later call AIDS.”
The excitement of the first report wore thin quickly, Gottlieb remembers. “Even the first cases were scary. There was an inexorable progression of disease, and we didn’t have any tricks to improve quality of life for patients. I began to get uneasy when we reported the initial five cases, but I really got scared when the case numbers hit 50.”
A month after Gottlieb’s report, New York and San Francisco physicians noted 26 cases of Kaposi’s sarcoma in gay men. Now the CDC recognized a multi-centric epidemic not confined to one location and an outbreak that involved serious opportunistic diseases and cancer.
Five years later there are now 20,000 cases of AIDS worldwide. Gottlieb noted the milestones that followed: French researchers and later their American counterparts discovered the AIDS virus in 1983 and 1984; AIDS awareness spiked with news of TV and film actor Rock Hudson’s AIDS diagnosis, and AIDS treatment centers developed in the country.
Becoming One of Rock Hudson’s Physicians
Gottlieb became an AIDS authority in the years that followed his report, and he soon found himself thrust into the media spotlight when the physician of Rock Hudson asked him to consult on the case. Gottlieb emphasized that the tragedy of Hudson’s illness and death was the same as that of the 10,000 others who have died of AIDS. But he admitted that giving news conferences changed dramatically. “There were more microphones on the lectern than I had ever seen before.”
Gottlieb has faced untold numbers of reporters during the last five years, and he has learned to choose his words carefully. But when he is asked what makes him angry about working with AIDS, his feelings surge to the surface.
“It makes me angry when AIDS is not taken seriously enough – when institutions fail to respond appropriately, when they play games of political convenience. I’m talking about the federal government and all levels of government. The lack of response is only going to make the problems worse,” he said.
Advocacy vs. Risk to Careers
He and his colleagues who are committed to bringing a speedy end to the epidemic face a common challenge: How much can you bite the hand that feeds you with research grants? “We push the system as hard as we can, and we look to where we can make a difference,” Gottlieb said. “They younger researchers particularly look to where they can advance knowledge toward a cure and effective treatments, balancing their advocacy against risks to their careers.”
Even in the early years, controversy and conflict hovered over every aspect of AIDS research, treatment, and prevention campaigns. Gottlieb became entangled in a dispute over appropriate images and language targeted to high-risk groups, especially when the materials were financed by local or federal government funds. He took an assertive, sometimes defiant, stand. “It is imperative to communicate risks … with whatever language it takes,” he said.
An AIDS Vaccine After Two More Years
What does Gottlieb think the next year holds for the efforts against AIDS? “In a practical sense we’ll see better drugs, more widespread drug trials involving more people, and significant progress toward a vaccine.” He estimated that a vaccine might be available in a minimum of two years.
For his own future, Gottlieb hedged, saying only that he expected to always be involved with AIDS with an emphasis on experimental therapies. “I’m going to pursue that work in an environment that gives me the greatest degree of daily satisfaction, and I can’t tell you more than that, he said. “What I am comfortable with is knowing that what I am doing is right.”
PART TWO: Dr. Michael Gottlieb Reflects on 20 Years of the AIDS Epidemic, Being Denied Tenure at UCLA and His Regret About Not Being More Cautious With Advocacy