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Well they’re terrific because it’s a venue where you get people who are . . . many of whom are quite influential in various different spheres. And the beauty of it is that you get people from all walks – from politics, from finance, economy, medicine, science, the media – all together in a very relaxed atmosphere where it’s just the general feeling of everybody interacting, talking to each other, taking the time to have a conversation. And then you have these various seminars that are set up to specifically address a particular issue. And it’s very, very informative and energizing to hear the experts in the field get a presentation, and then get questioned by the audience as to why they’re taking this particular viewpoint. So it’s a very, very stimulating ______ to be in a venue . . . It’s invaluable. And also it’s invaluable to get to meet people that you may be able to help, and can help you in your own endeavors.

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Recorded On: 7/6/07

Transcript: Well again, I’d have to provincially stay within my field of which I know. And if I had a hundred billion dollars to give away right now, I would quickly establish a strategic plan and an agenda to try and address both the low-hanging fruit of global health . . . things like malaria, bed nets, spraying indoors, getting drugs available, prevention of malaria in pregnant women. I would put a full court press on AIDS prevention both in this country and globally. And I would try to fix some of those issues in countries that don’t have any sustainable infrastructure. I think with 100 billion dollars, you can get some of the countries . . . a lot of the countries that don’t have a sustainable infrastructure to make them a healthy nation or a healthy country or what have you, and help them to get there. So I would get a plan and start executing it immediately.

Recorded On: 7/6/07

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Bioterrorism is a threat. It’s very, very difficult when you have to prepare for something that might not ever happen. So I have been very much involved in the preparedness for bio defense by developing vaccines, therapeutics, diagnostics for the category A and B agents that are the highest calculated risk by our Homeland Security officials. And what we’ve done to try and make that a worthwhile endeavor is as follows: to use the resources that you would apply to developing these vaccines, and these drugs, and these diagnostics to not only cover infections or microbes that would be deliberately released on the country, but also the broader bioterrorist. The worst potential bioterrorist is nature itself. If you look historically at what’s happened with epidemics, and the influenza pandemic in 1918, the threat of SARS, the HIV epidemic . . . So nature does a pretty good job of terrorizing the human civilization. So if you utilize the resources that you can apply to developing specific countermeasures for agents of high probability of bio terror, but make that be fungible, as it were, to increasing your capacity to respond to any agent, even those that naturally occur. So yes it’s a threat. You can never quantitate how great a threat it is. So why not spend the money not only protecting against the threat of deliberate terror, but also the threat of naturally occurring terror?

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Well first of all, for domestic health, the issue that’s crying out to be addressed, and it’s gonna take courage on the part of leadership, the President . . . It’s gonna take cooperation with the Congress. It’s gonna take an understanding and a flexibility on the part of the American public . . . is that we must address the fact that in this rich country of ours, we have 40-plus million people without healthcare insurance. So we’ve gotta be able to fix that problem, and fix it reasonably quickly so that when people lose their jobs, and with it lose their health insurance, and find out that they’re one job dismissal away from being completely vulnerable to disease and getting their savings and their family wiped out because they don’t have health insurance . . . We’ve gotta fix that problem. So if you’re asking me what I would think if the next president were to ask me my opinion, and what I would think from a domestic standpoint what we need to do, we really need to fix the healthcare delivery problem in this country with regard to universal health access to everyone.

It’s not gonna be easy, but I think it can be done. I think that if you have a flexible system where people can still have the choice of the doctor that they want . . . if they have insurance that they are able to pay for. But that doesn’t mean that you then not allow people who don’t have the wherewithal to have insurance that everybody has insurance. And everybody can get a doctor. It may not necessarily be the doctor of your choice, but it’s a doctor that’s well trained and paid well enough to be someone of high quality. So just because you go into a system where you’re assigned a doctor, if you have people who are well trained and well paid, and have good motivations for being in that, you can get good medical care. You don’t necessarily have to then exclude those people who wanna choose their own doctor, and are willing to pay to choose their own doctor. So I think you can get both worlds there. And also there’s enough profit margin in drugs and the development of drugs that I don’t think there’s gonna be an issue with the drug companies. There’s always going to be the need for new medications, better medications. So I don’t see that as an issue.

Recorded On: 7/6/07

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I think his legacy in health will be very, very positive when it comes to international, global health.  I think the combination of the President’s Emergency Plan for AIDS Relief – the PEPFAR Program – and the President’s Malaria Initiative – the PMI – those two things alone, I think, from a health standpoint and from global recognition in the arena of health will be, in my opinion, the most important, and lasting, and positive legacy of this administration.

Recorded On: 7/6/07

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Well the big issues are the whole issue of global peace. I mean I think that’s one of the most important thing. I mean I’m a scientist and a physician, and that’s not my area; but it just seems to me that the destruction, and the death, and the threat, and the insecurity that goes along with people who are ideologically at such odds that it leads to destruction, and death, and killing. To me, that is a major issue. I’m sure there will always be wars; but I think we need to try as best as we can to understand what it is about people who are such at odds with us that they wish us harm; as well as analyze are we doing anything ourselves that are putting us at such odds with other people that we’re instigating this clash of cultures. It’s no news to anybody. You just pick up the newspaper any day, you see another example of conflict throughout the world. And that’s something that we’ve gotta pay a lot of attention to and do what we can . . . be it the Middle East problems, or the Israel-Palestine, Iraq-Iran, other nations. The Cold War which then warmed up, which is now getting back to a cold war. It’s kind of discouraging.

Recorded On: 7/6/07

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And again, this is just only a somewhat provincial view. There was a period in my own discipline of infectious diseases back in the late 19th century when people were just starting to appreciate the germ theory of disease. Instead of the historical components, we had these plagues. We had these influenzas. We have ______. We have this. We have no idea where it comes from. There were a group of people – Louie Pasture, Cook . . . all of the group from the Institute . . . Pasture, the German group, Matchnikoff and others – who were able to take a field that was completely bare bones and no one had any idea what was going on, to actually make those first initial discoveries that a microbe actually caused tuberculosis. You can actually take that microbe. You can inject it into someone or into an animal, and you can create the disease that you once thought was just some ______ from heaven that caused it. So the heroes and the people that I look up to were those people who struggled against a complete, vast unknown. Right now there’s so much known in science that when I and my colleagues do it – although we occasionally make transforming discoveries – we’re standing on the shoulders of giants who didn’t have what we have 100 or so years ago when they made those phenomenal discoveries.

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Well actually bioethics is a very, very important field. We as . . . As we get more and more in the arena of understanding science and getting better opportunities, the fact that you can do things with biological sciences that have an impact on a human being means you must have ethical standards. And paramount among these are when you do something that involves a human subject. As one example . . . There are a lot of bioethical issues, but for example if you’re trying to develop a new drug or a new vaccine, and you need to do experimentation, there has to be some fundamental, immutable principles of ethics that guide what you can and cannot do when you’re dealing with another human being. And there are also fundamental things that you can and cannot do when you’re dealing with life itself. I mean is it or is it not ethical to create an embryo, and to create a person for the purpose of getting an organ to give to someone else? I mean your knee-jerk reaction is absolutely not; but you need the ethical analysis of that to show why and how that is something that you need to stay away from. So I think that bioethics is one of the most important, evolving fields that we have. Because as science gets more and more sophisticated, and as the opportunities for transforming biological sciences occur, we’re going to be faced with more and more important ethical questions. And we can’t approach that by the seat of our pants. We have to have experts who study that and make that a career of analyzing the kinds of ethical issues and gaining experience so that when people come in, and they’re faced with a question of ethics in the biological sciences, at least you have a cadger of people who pay serious attention to that.

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Well science is telling us that we can do phenomenal things if we put our minds and our resources to it. I mean I think science is probably the best example of you put resources into something, and you let the creativity and the brilliance of the minds throughout the world – and certainly not only in this country . . . throughout the world – and phenomenally good things can happen. You’ve gotta make sure that there’s checks and balances on that, because science can also lead to things that are not so good. I mean there’s a whole ethical issues of manipulation at the genomic level. The whole issues of embryos and creating people to your own fashionable, boutique-liking. All those things you’ve gotta be really, really careful of. But science at its most pure, where you’re looking for discovery, and you’re gonna use discovery for the betterment of mankind . . . I think science stands out among some of the most important endeavors that the humankind can pursue.

Recorded on: 7/6/2007

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one of the things that I’m most proud of is something that is on the border between policy and science. And that is that a few years ago in 2002, when we had the drugs available in the developed world to have a major, major transforming impact on HIV/AIDS, we started to question what could be done in the developing world – particularly Sub Saharan Africa and the Caribbean. And Tommy Thompson and I were sent to Sub Saharan African countries by President Bush to look around and come back with a proposal of how the United States government might help in the arena of HIV/AIDS to those countries that are poor and don’t have the resources that we do. And we came back with a proposal first to try and block mother to child transmission of HIV. We presented it to the President and his closest advisors. They accepted it. But then they said they wanted to do something even . . . much more broad than that with a much greater impact. So we were tasked with . . . And I spent a lot of time on that – probably about six or seven months of my life working hard on that, which was well worth it – to put together a program of how we can get drugs, prevention, and care to millions of people in Sub Saharan Africa and the Caribbean. And we worked on it, presented it to the President, and with a lot of help from a lot people inside government, outside of government, faith-based organizations, advisors to the President, and people who really cared about it who were able to get the program to be accepted by the President, and to put it into effect by law. And that is the President’s Emergency Plan for AIDS Relief – or PEPFAR – which started out as a $15 billion dollar program over five years, which the president has now doubled to a $30 billion dollar program for the next five years to aim at preventing millions of infections, treating millions of people, and caring for people. It has been a huge success. The fact that I played a role in getting the thing developed, established and implemented is something that I feel very good about. So I don’t know.

Recorded on: 7/6/2007

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Well I think the media has a very powerful influence on almost anything and everything we do, because the general public gets their perception of what is going on in things they don’t have immediate access to from what they get through the media. I think the media can be a very positive influence by essentially holding people to task about the importance of high quality medical care. And when the media is scrutinizing you, then I think that’s a very good, positive thing for the field of medicine. So they can have a very positive . . . Also, the media makes the world and the general public aware of advances that may be of benefit to them much sooner than if it trickled down through the usual channels. So if you look at our society today with the media in general, and in particular with the Internet, the degree of sophistication of the general public about their health, what’s out there for them, the kind of things they need to avoid if they do get into a situation with a health problem, the kinds of things that are available to them, is really unprecedented. So the role of the media is really huge.

Recorded on: 7/6/2007

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I run a modest-sized laboratory that’s looking specifically at what we call the pathogenic mechanisms of HIV disease or AIDS. And I’ve been doing that literally from the very first weeks of the AIDS epidemic when we first realized we were dealing with a new disease in the summer of 1981

I can recall the very first years of the HIV/AIDS epidemic from the first patients that we admitted to our hospital in 1981 until the first drug was developed – AZT – in 1985, ’86 and early ’87. It’s that we were in a very, very difficulty psychological position where virtually all of our patients died. And when you’re a physician like I am who’s an infectious disease doc who’s used to curing people . . . Cause you know, when you get somebody who’s sick, they look very sick. They’re otherwise young and healthy. You treat them with an antibiotic and you take good care of them, they get better and you get a phenomenal feeling of gratification that you’ve really saved someone’s life and you turned it around. For the first several years with HIV/AIDS, it was very dark years because everyone who we took care of ultimately died. Then over a period from 1986, ’87 up through around mid-1990s . . . 1995, 1996 when the combination – what they call the cocktail of anti-HIV drugs – became available, there was an almost miraculous turnaround in the results of treating people with HIV where people would otherwise waste away and die before your very eyes were now getting back to leading normal lives. So that story of the interval between the early 1980s ‘til the mid-1990s really runs the spectrum of the dark years of great discouragement – of saying, “Oh my goodness. Every day I go to work and everybody that I’m taking care of ultimately dies” – to the hints of a good possibility that something good was happening from the mid-80s to the early ‘90s when drugs were coming along, but not quite the right combination until we got to the mid ‘90s. Up until today when the drugs that we have now, and the combinations have completely transformed how we take care of HIV-infected individuals. So it’s been a very interesting journey with very, very high peaks and very, very low valleys.

during the early years of the AIDS epidemic when there was a lot of activists, pain, and concern about whether the government was paying enough attention to them. And for the most part, government officials, because of the confrontational nature of how the activists were trying to get what their concerns were heard by the FDA, by the federal government, by the Department of Health and Human Services, and even the NIH, they would be very confrontative. And that confrontational demeanor was met with, you know, the reflex of staying away from them and that they must be doing something wrong. What I decided to do back in those days was learn a lot about what it is they were saying, and finding out it doesn’t make any sense. And in fact, it turned out that it made a lot of sense. And what they were asking for was imminently reasonable.

one of the things that I’m most proud of is something that is on the border between policy and science. And that is that a few years ago in 2002, when we had the drugs available in the developed world to have a major, major transforming impact on HIV/AIDS, we started to question what could be done in the developing world – particularly Sub Saharan Africa and the Caribbean. And Tommy Thompson and I were sent to Sub Saharan African countries by President Bush to look around and come back with a proposal of how the United States government might help in the arena of HIV/AIDS to those countries that are poor and don’t have the resources that we do. And we came back with a proposal first to try and block mother to child transmission of HIV. We presented it to the President and his closest advisors. They accepted it. But then they said they wanted to do something even . . . much more broad than that with a much greater impact. So we were tasked with . . . And I spent a lot of time on that – probably about six or seven months of my life working hard on that, which was well worth it – to put together a program of how we can get drugs, prevention, and care to millions of people in Sub Saharan Africa and the Caribbean. And we worked on it, presented it to the President, and with a lot of help from a lot people inside government, outside of government, faith-based organizations, advisors to the President, and people who really cared about it who were able to get the program to be accepted by the President, and to put it into effect by law. And that is the President’s Emergency Plan for AIDS Relief – or PEPFAR – which started out as a $15 billion dollar program over five years, which the president has now doubled to a $30 billion dollar program for the next five years to aim at preventing millions of infections, treating millions of people, and caring for people. It has been a huge success. The fact that I played a role in getting the thing developed, established and implemented is something that I feel very good about. So I don’t know.

Recorded On: 7/6/07

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Well I grew up in a . . . in an inner city neighborhood called the Benson Hurst section of Brooklyn, which was a very embracing, warm, family-type neighborhood. So I was . . . from the time I was born and getting to know my friends and interacting in the community, there was always a feeling of people taking care of each other. So I think that was one of probably many factors that got me involved in what my ultimate career choice was, was in medicine, and ultimately taking care of people. But the atmosphere in which I grew up – not only from a family standpoint, but from the people that you contacted or came into contact with at any given time during the day – was one of a lot of warmth and positive interaction.

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We should ask ourselves continually, “Are we doing enough?” I mean I try to make that an exercise that I go through not infrequently to just step back a few yards every once in a while – every few months, every six months or so – and just analyze, “Am I doing enough? Am I doing everything I can be doing? And if not, what should I be doing? Am I doing things that are not relevant? And can I knock them off and replace them with things that are important? I think if you continually put your own feet to the fire, you can incrementally do better and better. I don’t think that you can just make a quantum leap in your accomplishments or your contributions; but don’t settle on your laurels. Just keep thinking, “What is it that I can do more and more, and better and better?” And just the exercise itself, even if nothing comes out of it, will at least keep you on your toes.

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Well I think collectively, we should be paying more attention to what is going on around us in the world among people who don’t have the advantages that we have. I think that it is our responsibility as a society to pay attention to, to be aware of, and to the best of our capability help those people who are in dire straits, or relatively dire straits – be it in health, in poverty, or what have you – so that we can at least say that we didn’t look the other way when there were people who are global citizens and our neighbors, as it were – because we’re all joined together – and that we let that happen without trying to do something about it. So it’s attention to the problems of the world, particularly those people who are suffering and disenfranchised.

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I’m a born, cautious optimist.  So the answer to your question is I am optimistic.  I’m optimistic about how we’re gonna be able to handle the diseases that we have now, namely HIV and the global health issues of the developing world.  And I’m optimistic that we’re gonna be able to be prepared enough for new challenges that come along.  Because there is a perpetual challenge, these possibilities of emerging and re-emerging new infections.  And I’m also optimistic that we will see our way to getting the people – of this country, at least – to be covered so that they don’t have to worry about health, and getting sick, and not having the wherewithal to be taken care of.

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Well the big issues are the whole issue of global peace. I mean I think that’s one of the most important thing. I mean I’m a scientist and a physician, and that’s not my area; but it just seems to me that the destruction, and the death, and the threat, and the insecurity that goes along with people who are ideologically at such odds that it leads to destruction, and death, and killing. To me, that is a major issue. I’m sure there will always be wars; but I think we need to try as best as we can to understand what it is about people who are such at odds with us that they wish us harm; as well as analyze are we doing anything ourselves that are putting us at such odds with other people that we’re instigating this clash of cultures. It’s no news to anybody. You just pick up the newspaper any day, you see another example of conflict throughout the world. And that’s something that we’ve gotta pay a lot of attention to and do what we can . . . be it the Middle East problems, or the Israel-Palestine, Iraq-Iran, other nations. The Cold War which then warmed up, which is now getting back to a cold war. It’s kind of discouraging.

Well actually bioethics is a very, very important field. We as . . . As we get more and more in the arena of understanding science and getting better opportunities, the fact that you can do things with biological sciences that have an impact on a human being means you must have ethical standards. And paramount among these are when you do something that involves a human subject. As one example . . . There are a lot of bioethical issues, but for example if you’re trying to develop a new drug or a new vaccine, and you need to do experimentation, there has to be some fundamental, immutable principles of ethics that guide what you can and cannot do when you’re dealing with another human being. And there are also fundamental things that you can and cannot do when you’re dealing with life itself. I mean is it or is it not ethical to create an embryo, and to create a person for the purpose of getting an organ to give to someone else? I mean your knee-jerk reaction is absolutely not; but you need the ethical analysis of that to show why and how that is something that you need to stay away from. So I think that bioethics is one of the most important, evolving fields that we have. Because as science gets more and more sophisticated, and as the opportunities for transforming biological sciences occur, we’re going to be faced with more and more important ethical questions. And we can’t approach that by the seat of our pants. We have to have experts who study that and make that a career of analyzing the kinds of ethical issues and gaining experience so that when people come in, and they’re faced with a question of ethics in the biological sciences, at least you have a cadger of people who pay serious attention to that.

Well the important issues in global health are the fact that there are situations in the world where people are dying from diseases that are imminently preventable if we do the right public health measures. That is complicated, and this is one of the reasons why I find public health, in many respects, so invigorating and exciting. Because if it was just public health in a vacuum, it would be relatively easy. But it’s public health intertwined with poverty, disenfranchisement, wars, lack of leadership, environmental cataclysmic issues like tsunamis and earthquakes, and things like that. So we have . . . We’re living in a world where if you’re in the United States or in the U.K. or Canada, there are diseases that you don’t even think about because they don’t have any impact. You’re vaccinated against them. If you get sick, you get an antibiotic. The environment is not threatening, like malarias and mosquitoes and things like that. Then you go into Sub Saharan Africa and you see things that are unthinkable – 1.3 million people dying every year of Malaria, more than a million of which are less than five years old . . . many of which are less than one year old; one point six million people dying of tuberculosis; ______ diseases and respiratory diseases ravishing populations. These are things that can be prevented. So to me, one of the most challenging issues that I look at when you talk about global issues and global health is obviously, it isn’t as easy as just bringing medications there. You’ve gotta do it at the same time as you build a sustainable infrastructure in the countries involved so that they can ultimately fend for themselves. Going in, treating people for malaria, giving them bed nets, giving them . . . spraying their huts, etc., that’s all good, and that will decrease the whole issue of malaria in certain countries. But what we’ve gotta do is at the same time is to build what we call a sustainable infrastructure to help the world to get on a much, much more even keel with the developed world; and to prevent literally millions and millions of deaths each year. To me that’s the big challenge.

Well I think that’s . . . To me, it isn’t easy; but to me it seems to be easy. And that is to adopt a policy of health diplomacy. And to go out there . . . In fact, Governor Tommy Thompson spoke about this just this morning here in Aspen. And that is to make as an important goal that the United States and other developed countries will export global health; will help people in countries who have situations that they cannot handle – vis a vie health – but also to help them to build the infrastructure that they will need to sustain it on their own. And that’s helping to train physicians and healthcare providers; making the incentive for them to stay in their own countries, or return to their own countries after they train here in the United States; help them to do the very simple things like vaccinations and prevention of malaria by simple things like bed nets. Those are the kinds of things that we need to do. If we engage and put a fraction of the resources that we put into other areas . . . that we put into global health diplomacy, I think not only would it be good for the rest of the world, but the United States will be looked upon in a much more favorable light than it is currently looked upon.

Well I think his legacy in health will be very, very positive when it comes to international, global health. I think the combination of the President’s Emergency Plan for AIDS Relief – the PEPFAR Program – and the President’s Malaria Initiative – the PMI – those two things alone, I think, from a health standpoint and from global recognition in the arena of health will be, in my opinion, the most important, and lasting, and positive legacy of this administration.

Well first of all, for domestic health, the issue that’s crying out to be addressed, and it’s gonna take courage on the part of leadership, the President . . . It’s gonna take cooperation with the Congress. It’s gonna take an understanding and a flexibility on the part of the American public . . . is that we must address the fact that in this rich country of ours, we have 40-plus million people without healthcare insurance. So we’ve gotta be able to fix that problem, and fix it reasonably quickly so that when people lose their jobs, and with it lose their health insurance, and find out that they’re one job dismissal away from being completely vulnerable to disease and getting their savings and their family wiped out because they don’t have health insurance . . . We’ve gotta fix that problem. So if you’re asking me what I would think if the next president were to ask me my opinion, and what I would think from a domestic standpoint what we need to do, we really need to fix the healthcare delivery problem in this country with regard to universal health access to everyone.

It’s not gonna be easy, but I think it can be done. I think that if you have a flexible system where people can still have the choice of the doctor that they want . . . if they have insurance that they are able to pay for. But that doesn’t mean that you then not allow people who don’t have the wherewithal to have insurance that everybody has insurance. And everybody can get a doctor. It may not necessarily be the doctor of your choice, but it’s a doctor that’s well trained and paid well enough to be someone of high quality. So just because you go into a system where you’re assigned a doctor, if you have people who are well trained and well paid, and have good motivations for being in that, you can get good medical care. You don’t necessarily have to then exclude those people who wanna choose their own doctor, and are willing to pay to choose their own doctor. So I think you can get both worlds there. And also there’s enough profit margin in drugs and the development of drugs that I don’t think there’s gonna be an issue with the drug companies. There’s always going to be the need for new medications, better medications. So I don’t see that as an issue.

Disease in this country, we still have a problem with HIV/AIDS. Right now there are still 40,000 new infections each year in our nation. That has plateaued at 40,000 for the last 14 years. That’s disgraceful. We’ve gotta do something about that. And the CDC is already going in that direction by making testing for HIV a part of routine healthcare. There are a million people who are infected in this country with HIV, at least 25% of which do not know that they are infected. And the much greater majority of those people are the ones that are inadvertently transmitting the infection to others. So we’ve gotta get and break that wall, and push down that wall of 40,000 new infections each year from the standpoint of health in this country. That’s, to me, the first thing that we need to do.

Oh yeah. Bioterrorism. Bioterrorism is a threat. It’s very, very difficult when you have to prepare for something that might not ever happen. So I have been very much involved in the preparedness for bio defense by developing vaccines, therapeutics, diagnostics for the category A and B agents that are the highest calculated risk by our Homeland Security officials. And what we’ve done to try and make that a worthwhile endeavor is as follows: to use the resources that you would apply to developing these vaccines, and these drugs, and these diagnostics to not only cover infections or microbes that would be deliberately released on the country, but also the broader bioterrorist. The worst potential bioterrorist is nature itself. If you look historically at what’s happened with epidemics, and the influenza pandemic in 1918, the threat of SARS, the HIV epidemic . . . So nature does a pretty good job of terrorizing the human civilization. So if you utilize the resources that you can apply to developing specific countermeasures for agents of high probability of bio terror, but make that be fungible, as it were, to increasing your capacity to respond to any agent, even those that naturally occur. So yes it’s a threat. You can never quantitate how great a threat it is. So why not spend the money not only protecting against the threat of deliberate terror, but also the threat of naturally occurring terror?

Yeah. I mean there is comfort in that literally, as the weeks and months go by, our preparedness against this gets better and better. There certainly is the possibility that there will be a bio terror attack. If you’re well prepared and you have the counter measures in place, the impact on people will hopefully be minimal. I don’t think that people need to look upon this as the end of the world, where we would have a bio terror attack and we all die. That the chances of that are so vanishingly small as to be almost not under consideration; but there is the possibility that people could die or get sick from a bio terror attack. You can mitigate that . . . you can lessen the impact of it by doing what we’re literally doing every week and month now. And that is by trying to develop better countermeasures.

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Oh, that’s a difficult question. I’ll . . . I’ll start with the one that I’m very familiar with because it’s what I do. And I think that the whole issue of global health and health. I mean if you look at history, how diseases have shaped societies going back from the Bubonic plague of the early centuries, to the pandemic influenza of 1918, to the total decimation of the Inca and Aztec populations by measles and small pox, I think that health issues have played a major role on how society has been shaped. And then as the era of understanding disease and being able to do something about disease has occurred, there has been a rather dramatic protection against the unavoidable decimation of disease; but mostly in the developed world. And the thing that I see even now as an answer to your question is that we need to have a more global appreciation of the problems that other people have. Because it’s very interesting that some years ago when I was first getting involved in medicine – and even in the arena of infectious diseases, which is my subspecialty – there were people . . . very well placed people in this country who were actually saying that you can forget about infectious diseases because they’ve essentially been conquered. We’ve got vaccines. We’ve got anti-microbials. You can conquer infectious diseases. Which means they weren’t paying attention to as they were saying that – maybe in our own country in the United States, or Europe, or Australia, or Canada that was going on; but in the developing world, more than a million people were dying of malaria. A million and a half people were dying of tuberculosis. Hundreds of thousands, if not a million people were dying of neglected tropical diseases. So really disease has a major impact not only historically in the shaping of our society, but also even today where there are the “haves” and the “have nots” of the world. I would hope that an appreciation of that will have us continue to try and do more and more.

Well science is telling us that we can do phenomenal things if we put our minds and our resources to it. I mean I think science is probably the best example of you put resources into something, and you let the creativity and the brilliance of the minds throughout the world – and certainly not only in this country . . . throughout the world – and phenomenally good things can happen. You’ve gotta make sure that there’s checks and balances on that, because science can also lead to things that are not so good. I mean there’s a whole ethical issues of manipulation at the genomic level. The whole issues of embryos and creating people to your own fashionable, boutique-liking. All those things you’ve gotta be really, really careful of. But science at its most pure, where you’re looking for discovery, and you’re gonna use discovery for the betterment of mankind . . . I think science stands out among some of the most important endeavors that the humankind can pursue.

Well I think if . . . And again, this is just only a somewhat provincial view. There was a period in my own discipline of infectious diseases back in the late 19th century when people were just starting to appreciate the germ theory of disease. Instead of the historical components, we had these plagues. We had these influenzas. We have ______. We have this. We have no idea where it comes from. There were a group of people – Louie Pasture, Cook . . . all of the group from the Institute . . . Pasture, the German group, Matchnikoff and others – who were able to take a field that was completely bare bones and no one had any idea what was going on, to actually make those first initial discoveries that a microbe actually caused tuberculosis. You can actually take that microbe. You can inject it into someone or into an animal, and you can create the disease that you once thought was just some ______ from heaven that caused it. So the heroes and the people that I look up to were those people who struggled against a complete, vast unknown. Right now there’s so much known in science that when I and my colleagues do it – although we occasionally make transforming discoveries – we’re standing on the shoulders of giants who didn’t have what we have 100 or so years ago when they made those phenomenal discoveries.

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Yeah. I think I do. And it gets back, again, to one of the things that I feel good about, is that during the early years of the AIDS epidemic when there was a lot of activists, pain, and concern about whether the government was paying enough attention to them. And for the most part, government officials, because of the confrontational nature of how the activists were trying to get what their concerns were heard by the FDA, by the federal government, by the Department of Health and Human Services, and even the NIH, they would be very confrontative. And that confrontational demeanor was met with, you know, the reflex of staying away from them and that they must be doing something wrong. What I decided to do back in those days was learn a lot about what it is they were saying, and finding out it doesn’t make any sense. And in fact, it turned out that it made a lot of sense. And what they were asking for was imminently reasonable. So I exercise a degree of flexibility and understanding that you can find a bit of good, if not a lot of good, in just about anybody if you try and listen to, and pay attention to the point they’re trying to make. So I would say that open mindedness, and taking a chance on giving a person the opportunity to explain their point of view is one of the things that I’ve worked on over the years to try and get better and better at that. And it really has held me in very good stead. Because I don’t think we would have developed the productive interactions with the activist community during the painful, early days of the HIV epidemic had I not paid a lot of attention to being very open-minded and not taking things personally; but just trying to understand the pain that was driving people to be so confrontative. So open-mindedness and flexibility, I think, are two of the qualities I have . . . I hope I have. I think I do.

Laughter) That is something I would say that you’re asking the wrong person because I probably don’t do that very well. I’m considered by my colleagues as a workaholic. But I do . . . I do enjoy a life. . . I particularly enjoy my children. I have a wonderful family, a wonderful wife who is very understanding of my crazy hours and my commitment to this issue of public service. And she’s very supportive of that. I have three wonderful children – 21, 18 and 15 – who are really my normalization meters. They are healthfully irreverent of me and my somewhat “exalted” position as it were, and they bring me back down to earth. So in answer to your question, my advice would be that don’t completely ignore the things in life that you will ultimately regret you ignored. And family has to be one of them. So whatever spare time I have, I focus it on my family. Everybody has different motivations that drive them, and I get asked that question a lot. “How do you balance that?” And it’s a very, very important question. There are some people who actually energize from working very hard and doing a lot, and leaving “this” amount for personal pleasures, whatever that might be. Sports, or vacations, or what have you. There are other people who function best when they have a significant chunk of what they do in that respect. One is not better than the other. One isn’t more noble than the other. It’s just what it is that works for you. But there’s a line beyond which you don’t want to cross; and I think that line is when you just don’t pay any attention to anybody else, including your family, and you’re just focusing in on work. I think that’s something that you have to be careful of. So you asked me what advice I have for younger people who are getting involved in a particularly labor-intensive line of work, it would be that you’ve gotta set your own balance of fun, pleasure, recreation and work. And it may be varied greatly from person to person; but don’t neglect the people who love you and that you love; because then you’re really making a big mistake. And that’s an absolute. That’s not a relative.