American Science’s “Odd Couple” – Dr’s Koop and Fauci. (PART 5)

The following 5-part series is excerpted from an as yet unpublished history of 20th Century medicine in the United States by Mike Magee MD.

Part V: Forgive, But Never Forget.

Chick Koop’s opponents were still in a daze as the dust settled from the direct mail assault. But it had been well received by the American public, who appreciated the frank style and that they finally were “in the know”. Now they understood what this scary disease was, and whether or not they were at risk. The public began to coalesce and unify.

On the science side, the major pharmaceutical companies saw an opportunity to trigger flexibility and efficiency inside the FDA by joining hands with an unlikely partner. For the past seven years the AIDS epidemic had raged throughout America.

One year earlier, an AIDS activist group had coalesced in Greenwich Village, New York. They called themselves ACT UP (AIDS Coalition to Unleash Power).(1) They were largely HIV-positive individuals who were fed up with being given the cold shoulder by government health officials in New York City and Washington. They decided that if they were going to die, they would go down fighting.

They believed that step one in helping themselves was to better understand the science, especially the drug development process. If solutions weren’t coming off the pipeline, they decided it was time to find out why. Once they knew what to do, their step two was an “in your face” assault on the individuals and the institutions they felt were responsible, and that included the President, the Vice-President, the NIH, and the FDA for starters.(2)

On October, 11, 1988, at the end of a Columbus Day weekend of protests that had included a march on the Health and Human Services Offices in Washington, DC, they showed up in mass on the FDA campus. Approximately 1500 fully energized protesters drew broad national media coverage.

Their list of demands were clear and focused:

1. Quicker drug approvals. They wanted access to any new discovery as soon as basic safety and toxicity studies had cleared Phase I studies.

2. No use of placebos or double blind studies. Doing so with this deadly disease, they viewed, was unethical.

3. Studies must include a diverse population of patients including young and old, male and female, and all races and sexual orientations.

4. The experimental drugs must be covered by Medicaid and private insurers.

5. The FDA must support community outreach, and involve those with AIDS directly in the process.

The demonstration was titled, “Seize Control of the FDA”, and the elaborate outfits and placards delivered a simple message, “You are either with us or against us.” Tony Fauci of the NIH, who in June of 1988 had been publicly tarred as an “incompetent idiot” by ACT UP leader Larry Kramer in the San Francisco Chronicle, arranged meetings with leaders of the group, and discussions around their objectives.(3)

In June of 1989, in a meeting with activists, he wandered into FDA territory and endorsed a parallel tract for HIV drug approval. The New York Times headlined it.(2) The FDA was not thrilled with Fauci going “off the reservation”, but now they were aboard as well. Within 1 year of the protest, ACT UP’s proposal for a fast track, or parallel process, that would make new AIDS treatment available after clearing Phase I studies, was approved.(3)

Now, in addition to AZT, a second AIDS drug, dideoxyinosine, was made available.(4) President Reagan had approved the creation of the “National Committee To Review Current Procedures For Approval Of New Drugs For Cancer And AIDS”.(5) The task force included the top AIDS scientists, FDA and NIH staff, and the lead HIV activists. Fauci had survived, and would live to fight another day.

For Koop, life was never the same. After the pamphlet’s release, he received mountains of hate mail, but it only seemed to embolden him. He went to Falwell’s Liberty University and appeared on Pat Robertson’s “700 Club”. He told Pat, “No conservative Christian leader, no conservative Christian publication, to my knowledge, has been critical of the Surgeon General’s report or of me, but many constituents of those denominations and movements have been… I’ve gotten a tremendous amount of hate mail. It’s vituperative. It again assumes, you know, that I’ve departed the faith, whatever that means.”(6)

As the end of Reagan’s second term approached, Koop was once again asked by the President to generate a report. This time the President tossed him what he thought was a conservative soft ball. His enraged Moral Majority supporters, including Gary Bauer, had been looking for a way to signal to their constituents that Reagan was still in their camp. They had convinced themselves that there was good scientific evidence that abortion had a lasting negative physical and psychological effect on mothers. Reagan asked Koop to study it and report back.

With his usual diligence and thoroughness, he completed his work, and attempted to arrange a meeting with the President to share his findings. The meeting was blocked by Bauer as the President closed in on his final days of office. With few options, Koop released the news on January 9, 1989, that there would be no report, no conclusion. His investigation had determined that there was not sufficient evidence to warrant a conclusion, one way or the other. (7)

The double-cross was now almost complete. The new President, George H.W. Bush, now found the iconic Surgeon General too hot to handle and without hesitation moved him out. One year later, Koop published “The Agony of Deceit: What Some TV Preachers Are Really Teaching”.(8) In it Koop leveled an attack on televangelists who see sickness as a sign of sin, and who claim that resistance to healing reflects a lack of faith. While Falwell and Robertson, Koop reasoned, might sometime in the future “forgive,” he knew in his heart that they and their accomplices would never, ever forget.

When Chick Koop died at age 96, on February 25, 2013, Tony Fauci remembered him saying of the couple years earlier, ‘Tony, you do the science, I’ll do the education for the public.'”(9)

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Entire Series with References.