American Science’s “Odd Couple” – Dr.’s Koop and Fauci. (PART 4)

The following 5-part series is excerpted from an as yet unpublished history of 20th Century medicine in the United States by Mike Magee MD.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 IV: “We Are Fighting Disease – Not People.”

From 1983 to 1985, Koop was excluded from the Executive Task Force on AIDS established by his own HHS vice-secretary, Edward Brandt. Brandt was now gone, Heckler had been burned twice and was more than willing to push the increasingly popular Koop out front. The public was becoming more and more fearful, as the numbers of dead and infected rapidly rose. Politicians, and some physicians, were calling for mandatory testing, once a test had been developed to detect the virus in blood in 1985.(1) This followed heavily publicized cases of death from HIV tainted blood in hemophiliacs, and fears that the entire US blood supply might be contaminated.

If Chick and Fauci needed a climactic turning point, a moment that linked them together, it perhaps came on December 17,1984, when a young hemophiliac from Kokomo, Indiana, undergoing a partial lung removal for severe consolidated pneumonia, was diagnosed with HIV/AIDS. His name was Ryan White.(2) He was 14 years old at the time. He became infected while receiving an infusion of a blood derivative, Factor VIII, for his hemophilia. When he was cleared to return to school, 50 teachers and over a third of the parents of students from his school signed a petition asking that his attendance be barred. Koop clearly understood that continued inaction on his part would be unacceptable. This was what could happen in the absence of his leadership and the provision of proper health education. For Ryan White, after the state’s health commissioner and the New England Journal of Medicine reinforced that the child’s disease could not be spread by casual contact, he was readmitted to school in April, 1985. He would die 5 years later, and legislation, in his name, would open up much needed federal funding to care for those affected by the disease.(3)

When President Reagan, feeling the pressure, finally did direct Chick to create a report, he was more than prepared to respond. The Administration’s focus was on testing, detection and isolation. Koop would deal with those issues, but he already knew that his major emphasis had to be on prevention. He interviewed AIDS activists, representatives from the medical and hospital associations, Christian fundamentalists, and politicians from both sides of the aisle. (4)

Few knew fully what he was up to. One exception was his colleague and personal physician at the National Institute of Health, Infectious Disease specialist, Tony Fauci, who headed up the AIDS Research effort for the NIH.

Fauci had a troubled history with AIDS activists.(5) This dated back to a serious misstep by him on May 6, 1983. On that date, the Journal of the American Medical Association generated a press release, liberally quoting Fauci, titled “Evidence Suggests Household Contact May Transmit AID’s”. In the piece, the NIH scientist says, “We are witnessing at the present time the evolution of a new disease process of unknown etiology with a mortality of at least 50% and possibly as high as 75% to 100% with the doubling of the number of patients afflicted every six months…If routine close contact can spread the disease, AIDS takes on an entirely new dimension.” (6)

The release, not surprisingly caused a massive wave of public hysteria. The Religious Right came out of the woodwork. The executive vice-president of Moral Majority said, “We feel the deepest sympathy for AIDS victims, but I’m upset that the government is not spending more money to protect the general public from the gay plague.”(7)

Fauci was much more careful after that, taking good council from Koop on public information techniques. At the same time, Chick learned everything he could about the virus, its’ behavior and transmission from Fauci, which he intended to share with the public in the future. Fauci also was the first to actively include the vocal AIDS activists in the government’s scientific advisory boards in their effort to combat the disease. At first the target of their anger and frustration, as more and more died in the face of a clearly disinterested government and hysterical public, Fauci subsequently earned the praise and admiration of leaders of the AIDS activist community.(8)

Koop would consult with Fauci, day by day, as he formulated his drafts in secret. Fauci would later note, “He would come home from hearings downtown as things started to accelerate with HIV. As he was walking home, he had to pass my office. Around 7:30 at night, he would come knock at my door. He would say this thing about AIDS is very troubling, and I want to make the right impression on public awareness. He got it in his mind that we as the federal government need to be explicit about this — oral and anal sex, commercial sex. He was hell-bent on doing it. When it came out, it shocked a lot of people because of its explicitness.”(9)

The entire effort was quick, comprehensive and confidential. In October of 1986, he carefully walked the Administration through a draft tailored for approval, collecting all print copies as participants left the room, to make it more difficult for his detractors to organize a blocking effort, now or in the future. On October 22, 1986, the report was officially released, and challenged parents and schools to discuss AIDS, promote public education, and employ condoms for prevention. The report drew immediate criticism from the Conservative Right, but nothing compared to the furor that arose nineteen months later.

In the period following the initial report’s release, Koop quietly employed the Public Relations firm, Ogilvy and Mather, to make certain he had the messaging, language and imaging right. He then created an 8 page pamphlet for mail distribution, after raising adequate funding on the side, from various branches of government, to support the mass mailing costs of delivering 107 million copies of the publication to every household in America.(8)

In the forward he wrote, “At the beginning of the AIDS epidemic, many Americans had little sympathy for people with AIDS. The feeling was that somehow people from certain groups ‘deserved’ their illness. Let us put those feelings behind us. We are fighting a disease, not people…The country must face this epidemic as a unified society. We must prevent the spread of AIDS while at the same time preserving our humanity and intimacy.” (9)

His inside message was a call to action. His dramatic image was attached to the title: “A Message From The Surgeon General”.

Understanding AIDS was not an innocent read. It was frank and factual, covering anal and vaginal intercourse, injectable drug transmission, and condoms for starters. It promoted sex education beginning in elementary school and pierced the current messaging of the most popular Christian televangelists of the day with this comment: “Who you are has nothing to do with whether you are in danger of being infected with the AIDS virus. What matters is what you do.”

The messaging had been tested and found to be effective. The mobilization effort and quiet execution would have impressed the CIA. The huge 1988 print run required government printing press activities 24 hours a day for several weeks. Delivering the load for mailing utilized 38 boxcars. And approval for the mailing skirted normal procedure. When the eight page pamphlets began to arrive, the phones in the Senate offices of conservatives like Jess Helms rang off the hooks. Falwell and Robertson, and their like, were apoplectic. Attempts to halt it were futile. The mass mailing had been completed in bulk. There was no going back.

The medical community applauded loudly, as did the Press and the majority of the public. When his original Baptist patrons, and their captive Senators went after him, he took no prisoners. “I’m the nation’s doctor, not the nation’s chaplain”, he said.(8)

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Next: PART V – Forgive, But Never Forget

Entire Series with References.