Session 10: What Have We Learned?

Panel participants:

Warner Green (moderator), Gladstone Institute of Virology & Immunology/UCSF)
Mila Pollock, Executive Director of Libraries and Archives, Cold Spring Harbor Laboratory
Bob Gallo
John Coffin
Bruce Walker

Warner: [00:00:00] —Is maybe to have each of the organizers, take a minute or two, and talk about what the meeting has meant to you? What the history, the future? Just to summarize in your own words what this meeting has meant. Why don’t we start, yes, please? [crosstalk]

Mila: I started this meeting with this sentence, that the past [00:00:30] helps the future. I was actually very, very happy to hear it again and again from those who made this happened, fight against epidemic, and putting tremendous effort to what we already know 35 years against AIDS and against HIV. I have a few slides, just to show you that in the scientific world today, for these 35 years, was 35—[00:01:00] how many? 400, it’s not easy for me to do it here but it’s 400,000 articles published. I’m talking about scientific work. I’m talking about scientists. It was really important—I didn’t know for—the green. When David Baltimore today [00:01:30] this morning he gave a talk, he said, and this is his quote, “HIV is the best-understood virus on the planet.” What we saw here, Cold Spring Harbor Laboratory and actually, the idea for this meeting, for this topic came from our president Bruce Stillman. It is incredible effort from scientists, and maybe it will be absolutely incredible effort for us to bring those major contributors to the field, to this place [00:02:00] and we have succeeded. This is all, and we’ve had 63 talks and discussions and our idea now to lead the world to hear the scientists. This is how it’s happened. We really wanted to bring, and as Vicki said it was incredible but this happened, all major contributors scientists to this field were in this room for three and a half days. I advise you all probably in a [00:02:30] couple of weeks to come to our site. You can see on the top, HIV/AIDS research, and its future. All the talks will be available there.

Warner: Thank you. Bob, would you like to say a few words?

Bob: Just repeat what she said. If we’re going to talk about the meeting I said, I don’t know how many people maybe a dozen that are participants that said it was the best meeting they’ve ever attended in their career. One or two [00:03:00] commented, “There was never anything like it before and there will never be anything like it again.” I actually agree with all of that. I think it’s the best AIDS meeting ever in this unique—let me say, there was meetings with more data, but this was the most thoughtful conceptual—and you get the feeling, I guess, for the individuals. Really feel like I got to know people in the field. I know John [Coffin] forever but I get to really know John, for example. [00:03:30] You really get to know the person and the thinking and see the development of the field from, I think the best people, you could get your hands on.

Mila: On internet, everybody can tête-à-tête speak to Bob, because they can hear his talk or everybody else like, all of us is 63 people.

Bob: Yes. I didn’t know that. I think a book is important but I don’t know, and it was your idea of booking and maybe getting it into a journal. We’d have to condense though [00:04:00] for a journal. For a book maybe not so much condensing.

Warner: John, your turn.

John: Listen, the meetings that we usually go to are very scientifically oriented. You hear a little bit of scientific background, and then what people are doing and so on. We came into this meeting with a somewhat different concept but one of the things that we encouraged the speakers to do was to weave the science of what they were doing along with their own personal story. [00:04:30] Quite frankly, I think we were very successful there, and I just learned a lot from the different backgrounds and the way all this different people kind of approach these problems from different directions. There are some people who came into because they’ve had relatives who had contracted and died of AIDS themselves from personal experience. Then there were others who came into, more like me, because they were challenged by the interest in the scientific problems, [00:05:00] and others because they were physicians and they really wanted—they saw a real problem for treating patient care. There was an extraordinary collection of getting these people together. Then there were, of course, activist community as well. The extraordinary combination of these I think is unique, actually. [crosstalk]

Bob: In clinical and—

John: It’s certainly contrast, for example, with the way cancer research is progressed over the years. Its approach to this now more when I came into it. Cancer research was very much in camps. There were [00:05:30] the clinicians and the scientists, and they barely talked to one another.

Bob: I think it was you, Paul that said that to me last, Paul. Yes, you! I learned something from Bruce, before he talks. Bruce talked about funny things that happened to him, and that he was bad going into science. And I’ve used that when I talk to students, let’s say at a graduation or something. students love it to hear how many times you fell on your head and how dumb you were.

John: Yeah, the ceiling fell on him.

Bob: I [00:06:00] learned at this meeting, so do adults. [laughs] Everybody was very happy to hear you falling over the place. Let me close it with one other remark, somebody also asked me, it was Hildebrand, where is Stephen? Where are you? Yes, right there in front of me. You asked me on the interview, the first question, “What’s special about Cold Spring Harbor?” You caught me off guard. I was looking at the beauty around me, and the buildings and I said, “You know, maybe it’s a modern cathedral—[00:06:30] compartmentalized cathedral, we look at that way.” I think, “Why did we have such ease in attracting everybody?” You think it’s you only but it’s the grounds here. [crosstalk] [laughter] It’s the grounds here, the history here and Jim [Watson]. I think people know that this is Jim’s home. I think that adds to the need to come, the desire to come, the environment in total. It was not just us good organizers, but it was an easy place to get people [00:07:00] to agree to. Okay, Bruce, your turn.

John: Let me just add one thing to that. In addition, Cold Spring Harbor has sponsored the most important science meeting in retroviruses for about 50 years now actually. I’ve been to 44 of them over the years, every single one since 1975.

Bob: Then there's those Banbury ones also.

Bruce: Yes, I think it was really fitting that the meeting was here, because Cold Spring Harbor and Banbury have played such a central role since the beginning of the [00:07:30] epidemic and bring scientists together. But I came into the field as a physician seeing patients and being confronted with a new disease. We had no idea what was causing it out. All we knew is that people died really rapid deaths, and with a lot of pain and suffering. What was interesting to me about the meeting was just tracing the history of this from the very beginning, when everything was a black box [00:08:00] to categorizing and cataloging how HIV slowly revealed its secrets to us as clinicians and scientists. Looking at the progress that’s been made since the beginning of the epidemic it does seem, on the one hand, like we’ve been working on this for decades. But that’s a very short period of time given the enormity of the problem. You connect those dots and you can’t come away but [00:08:30] be really inspired by the notion that we are actually going to solve this problem, when you see the progress that’s been made thus far. To me, the meeting actually ended up being really inspiring, and that’s what I’ll take away from it.

Warner: We have time now. We have about 25 to 30 minutes from the audience. Maybe I’ll start while you get warmed up. [00:09:00] I’ll start a little bit of history. Summer of 1981, the first HIV infected patient was seen in the [National] Cancer Institute, admitted to the branch that I worked on. We rotated in order, and a young hematology fellow from [Johns] Hopkins was rotating at the branch and he had responsibility for this patient. And what ensued was just the worst [00:09:30] of all downhill courses. It was six weeks of just one disaster after another. And the end of that six weeks, there was a strategic decision at the branch not to see any more of these patients. They were just too hard to take care of in the [NIH] Clinical Center. And it’s called a Clinical Center because it’s not really a hospital. Patient number two went to Tony Fauci, and I think back up on that and I think [00:10:00] “Boy, I’m sure, glad that worked out.” Because certainly, Tony, mobilized the NIH and has lead NIAID in a most persuasive way around HIV care. But it was a moment in time when things could have been somewhat different. I always wonder, “What if I’d have been one place back in the order? What if I did cared for that patient what would have happened?” I don’t know.

[laughter]

Warner: Yes, there [00:10:30] was a question here.

Participant 1: Yes. I have lot friends—

John: Can you wait for the microphone?

Audience 1: Yes. I have some friends, the gay men friends know about pre-exposure prophylactics but my straight girlfriends don’t and neither did my microbiology teacher. I just want to know why it’s not widely advertised or people don’t know about it.

Bruce: [00:11:00] I’ll take a stab at that. PrEP is pre-exposure prophylaxis. What it means, essentially, is that you take the pills that fight HIV ahead of time so that you don’t become infected. It’s recently been shown to be really spectacularly effective if people take it on a regular basis. It underscores the point that was apparent in this meeting is that we do have the tools if we could [00:11:30] apply all of them now to prevent infections much more effectively than what we’re currently doing. It’s just delivering those things, et cetera. It’s also an issue of education. There, I think we have to make much better effort to educate the population. Warner may actually want to talk about this because one of the cities that has been the most effective in rolling out PrEP and preventing new infections in San Francisco. [00:12:00] Warner, do you want to say something about that or Paul [Volberding]?

Warner: I could say something or Paul could say something as well. San Francisco has a program called ‘Getting to Zero’ and that is exactly what they’re trying to get, zero new infections with HIV. They’re making steady progress. Treatment as prevention is one of the getting, making sure that everyone who’s infected is on treatment, suppress their viral load to diminish their ability to transmit. But the curve really turned [00:12:30] down when in fact PrEP, pre-exposure prophylaxis, was introduced more broadly. You have to know that even soon after PrEP was approved, it was not welcomed. It was viewed with great skepticism. But now the communities are really embracing it and it’s really rolling out—FDA approval, CDC guidelines, reimbursement for PrEP. It’s really moving and it is highly [00:13:00] effective. If you take the pill, it’s 95 plus percent effective.

Participant 1: Yes. That I know. Just I’m concerned for my friends because I feel that if that’s another way that they can protect themselves at, what is it 98.9% or something?

Warner: Again, we need to be better about communicating, all the tools in the prevention toolbox.

Jim Curran: Hi. PrEP, [00:13:30] actually remains controversial in much of the community. I think, in the AIDS community, it’s less controversial, and almost all of the uptake has been in gay men, where it’s even less controversial. It remains controversial in heterosexual populations. Of course, the efficacy trials were very, very mixed in heterosexual populations when they were done. The other thing is that your girlfriends have to also think about pregnancy, chlamydia, gonorrhea, and things that are much more common [00:14:00] in women. So it's important to give holistic sex advice to people.

Jump to:

Video

The other thing I want to say, though, is that Patrick Sullivan, who is on our faculty at Emory, along with AIDSVu, is setting up something called a PrEP locator, which will give throughout the country in every county where people can get information about PrEP and can get PrEP. That’s something that could be advertised because that’s something that would be thousands of places where people can get it.

The other [00:14:30] issue, of course, is paying for it. And following the FDA and CDC guidelines which involved, first of all, HIV testing, but then also clinical studies and toxicity studies and repeat follow up. A lot of these things are barriers to the normal young people who are reluctant to sign up for Obamacare. So it’s a tricky business, but the PrEP locator should help anybody who wants information about it. There should be information to people, how to get it, when to get it, [00:15:00] how often to take it.

What I’m waiting for is injectable PrEP because I think the adherence, compliance issue is a problem with everything. We have to remember that condoms are 100% efficacious. Efficacy is always higher than effectiveness, which is much higher than program impact. If we want program impact, we got to get something a lot easier than daily pills.

Participant 1: I know.

Jim: Not just philosophy.

Bruce: You were just saying what you mean by injectable PrEP—

Jim: [00:15:30] At long duration.

Bruce: Yes. This is basically a drug in a form that would be given as an injection every few months, ideally, even less frequently than that and would give adequate drug levels so you wouldn’t have to take pills every day. It has been a real challenge globally in terms of dealing with the HIV epidemic that adherence being able to take the pills reliably every [00:16:00] day is key to success and that remains a really big challenge. As anybody who’s tried to take a two-week course of antibiotics knows it’s hard to remember to take pills every day.

Jim: I certainly wouldn’t tell a young woman that she could take PrEP and avoid condoms, she should still use condoms. [crosstalk] The other lesson is from the family planning, history and family playing literature, which we can learn from. What are those technologies which really improved a woman’s right [00:16:30] and woman’s ability to have sex safely? One of those things is long-acting contraceptives, they are so-called LARCs which have saved many women, millions of women throughout the world.

John: To that point, I’m not an expert in this but I have heard people from these at-risk communities using the excuse for taking PrEP that they could then slack off on other methods of [00:17:00] prevention. It’s something you don’t like to hear because PrEP is—you miss a couple of pills and it’s no longer working.

Bob: It’s still experimental.

John: That kind of disinhibition is still a problematic issue that needs to be dealt with.

Anders Vahlne: What has been discussed these last days has been, where should you put the money for research, vaccines, or [00:17:30] for PrEP that we just discussed or for cure? What’s your opinion about this?

John: My answer is yes.

[laughter]

Anders: Yes, but if you have to choose?

Bob: I thought you were going to ask me something different, that you said you were going to ask me what we could have done better?

Audience 2: Okay. Yes.

Bob: We forgot already between there and here. [laughter] If you ask that question, that’s so full of controversy and I don’t think anybody really has an answer to that. Emilio [Emini] , wasn’t very optimistic about future for vaccine. Albert Sabin, before he died, wrote to Science on vaccines, "Now that I understand what a retrovirus is, a vaccine will be impossible yet we work on it." There is increments of progress. I was going to talk about it, but I saw that there would never be any time. [00:18:30] We have something that’s in phase one now. It’s based on, I think, rational concepts. It’s going really good in primates. But I already know the antibodies don’t last. I know that’s true of all gp120 vaccines. I know that they should all fail unless we solve this problem. For me, one of the things I want to do is while this goes slowly forward, and we’re now funded to do so, is try to understand why—and correct it—that the antibodies, the gp120 don’t last very long. [00:19:00]

See https://aidsvu.org

Right now, I think PrEP is important. If [Mark] Harrington were here, he’d be screaming at us that that’s a lot of things that has to be done. I think in high-risk groups, it’s certainly something that has to be very strongly considered. For me, I’m not, as you know, and I don’t want to get debates with some colleagues about it, I wrote what I thought in Science this week. It was quoted, shown by someone who thinks differently, our Australian queen (Sharon Lewin). [00:19:30]

You could debate it. I like the idea of long-term virus suppression. If we had a pill every six months, every four months, or something like that, and we had a reminder for it, that really worked. I mean, after all, we live with bacteria, we live with other viruses, if this became a harmless virus that you took a pill three times a year it for cheap, I wouldn’t complain. As long as I know I’m not being hurt and going to die prematurely from something else. The other approaches are highly experimental. [00:20:00] And in my view, there potentially have—spin-offs we don’t want, side effects that we would rather not see. I believe those side effects will be seen in some of the trials, or there’s something missing that I don’t understand. Because when you start playing around with activating T cells and it goes wider than the cell that you’re after I think we know from monkeys, we get in trouble. I don’t know.

That’s the direction I would go and that’s the answer to that. I certainly think all three. I couldn’t say stop this or stop that [00:20:30]. We divide the pie, whatever size the pie is, and hopefully it’s not one of those frisbees I used to get when I was a kid. Frisbee remember that? Is anybody here old enough to remember frisbee pies are that big? [crosstalk]

Bruce: Could I say something also? This has some parallels to the polio epidemic, I think. Barry Bloom, former Dean of the School of Public Health at Harvard [00:21:00] made a comment to me once along the way that really stuck with me that was: there was a lot of controversy about, where to put funds during the polio epidemic? Should you make more iron lungs that you knew could save children’s lives or should you put those funds towards a vaccine? Obviously, in the end, the vaccine has obviated the need for the iron lungs. I think there’s some parallels there that we have a lot [00:21:30] of tools that we can do for prevention, but we’re really not getting at the root of the epidemic then through that. We have this smoldering epidemic that can still flame up and I think we have to work towards vaccines and cure in parallel.

Anders: Okay, this has been a history meeting, and you were all here during the epidemic from its start. In the hindsight, is there anything [00:22:00] that you would have done differently?

Bob: Yes, I would have done differently. I think I learned something that a scientist has power. When you’re the only group that really was aware and knowledgeable in depth of the story, you really do have power, and I did not realize that. There was a committee formed between leaders at HHS and I was on it and I lasted a week and I asked Jim Weingarten, the NIH Director, “Why [00:22:30] this wasn’t going on?” He said, “It is but you’re not on it anymore.” I said, “Why, what did I do wrong?" "Nothing,” he said, “But the other people couldn’t spell retrovirus." But I should have demanded that you needed somebody there. That’s one I didn’t do.

See Robert C. Gallo, “Shock and Kill with Caution,” Science 354, no. 6309 (October 14, 2016): 177–78, doi:10.1126/science.aaf8094.

The second was—to get back to the press conference. I actually should have said, “No, I’m not going.” I would have been in trouble, but how much trouble when you think about it? What could they have done to me? It’s like Howard Temin (1934–1994), who came up many times in this meeting, told me that he once came to NIH [00:23:00] when I was going through that [John] Dingell (1926–2019) stuff that Jon Cohen spoke about—who had been attacking David Baltimore, and now it was my turn. Howard called the press conference on the NIH campus to give me help. Howard was then told if he entered the NIH campus, they would arrest him. He would be arrested. It was a day he had received the Presidential Medal. He told me after, it was the one thing he really regretted in his career, because he had the press conference in a small hotel room, in a little hotel near NIH [00:23:30] campus. He said, “What could they have done to me?” The answer is they could have done nothing.

The third is more medical and that’s the hemophiliacs. The government in the United States was very proud of how fast they moved the blood test from our lab to the world but we had the blood test in February ‘84 quite ready. They came out with it in January, February 1985, a year later. I was sitting with a family of hemophiliacs, everyone was infected. The father, he infected the mother, the children were infected, four. [00:24:00] He was mad at [the] French government and what happened in not using our blood test for quite a while. He was suing and all this stuff and then I said to him, “When did you get infected?” He said, “Oh, July 1984, there was nothing you could do.” Then, I thought about it, “Nothing I could have done?” If we simply thought about it, Factor VIII was in concentrated packs. How many hemophiliacs are there? Six more technicians maybe. I could have assayed—if not the world, certainly, maybe we could have set up for the United States in Europe, and we [00:24:30] could have saved many, many, more lives, of certainly hemophiliacs. Not all the blood transfused people, we couldn’t do that. We wouldn’t have enough virus. We didn’t have enough hands.

Anders: If that had been sensitive enough, that’s it.

Bob: Yes, I think that would not have been a problem ultimately. I really don’t believe that. I know Robin [Weiss] made that point. I bowed to it but I don’t think that’s the case. At least we could have certainly tried.

So what did I not do? I did not do anything, thinking that these things are being handled by the bosses above me who had many layers. Not one boss thought of this, [00:25:00] or if they thought of it, they didn’t certainly do anything about it. So I think for me, the number one lesson when I look back, is that a scientist really does have power. When you are in a position of unique knowledge, like you have been, and many people here might be in their country for awhile, and you don’t have to just take—because somebody is your administrative boss, you can just say, “No, this is the way it has to be. I know more than you know.” I didn’t have the gumption to do that. That’s [00:25:30] what I regret.

Warner: John and Bruce?

John: [chuckles] I could have done better was, get my own work into AIDS research sooner. I had been working in basic retrovirology since I was a graduate student in the late ‘60s. I had been working for many years on other retroviruses, but not HIV. I followed [00:26:00] the HIV story very closely as it evolved in the early 1980s and even wrote a couple of essays on the topic during the 1980s and early 1990s. I actually didn’t start doing any research on AIDS really until the late 1990s in a direct way. Then that was actually by accepting a part-time job to start an AIDS research—of what I believed to have been a very successful AIDS research organization as part of the National Cancer Institute. [00:26:30] But I, myself never actually turned my own laboratory's research to HIV and AIDS for a very long time after the start of the epidemic. Maybe it would have helped a little bit more, but I think I’m typical actually. Quite a few retrovirologists were quite slow to get into the business. I think that might have slowed down some progress. Our progress was remarkably fast compared [00:27:00] to any other infectious disease that’s ever come along.

Bob: Yet, Jonathan Mann (1947–1998) used to say, “The fastest in history of the onset of a mysterious disease 1982 to 1985, what happened?"

Bruce: Could it have been quicker not just from ‘82 to ‘85 but ever since then. I think one of the problems that we had was that we made the HIV field very insular. That was a plus in many ways, because we had our own study sections, we had our own methods [00:27:30] for allocation of funds. What it did was it set the HIV virologists and HIV immunologists and HIV molecular biologists separate from the rest of the scientific community. We had our own meetings. We would see the same people. And if I think about what I might have been able to do more of is to really search out people from other disciplines who weren’t working [00:28:00] on HIV, help them to understand that what the problems were, that we were facing. I think the same thing stands today, that there are a lot of solutions out there for problems that we’re dealing with that we’re just not accessing because science is built in such a siloed manner, and because if you’re not already in the HIV field you’ll never get a grant to study HIV.

Warner: Next question.

Audience 3: Going back to allocation of resources [00:28:30], I was wondering if you could speak about what efforts are being done to confront AIDS globally and what you think could be done better?

Bruce: What efforts are being made to confront AIDS globally and what could be done better? I think that it’s remarkable in many ways, how far we’ve come in terms of delivering antiretroviral medications [00:29:00] globally. There’s some 15 million people on therapy now, when in 2001, just prior to the UNGASS meeting that addressed the issue of global HIV and this issue of treatment, there was a widespread belief that you couldn’t treat people in resource scarce settings. I think there’s a tremendous amount being done. The problem was highlighted by some of the talks [00:29:30] here, and that is that for everybody that’s going on treatment, two more people are getting infected. And so we’re not making great ground, and all those people are going to have to be treated indefinitely. A lot of that has to do with just health systems and building health systems. My hope is that through confronting HIV, you end up empowering local health systems to provide better care on a [00:30:00] broader sense. We need technologies to directly address the particular problems in resource scarce settings, like point of care diagnostics and things like that, that really can facilitate getting more medications to more people. At the same time, we need to develop vaccines that don’t just work here, but will work globally.

I think there’s a real effort to keep that in perspective and that the [00:30:30] vaccines that are being developed now are really focused on that. Obviously, that’s where the brunt of the epidemic is. Salim Karim presented data showing that the incidents right now, in one of the highest burden areas in South Africa, is about 10% per year of women become infected, 16-year-olds, 10% of them are infected. By the age of 17, 20% are infected, all the way up to about half [00:31:00] of women being infected by the age of 25. Still really, really huge problems.

Jim: You wanted to comment on this?

Participant 4: Yes. Clinicians and historians and journalists are taught or learn communication skills and scientists do not always have the opportunity, nor the ambition to learn communication skills. I’m wondering how being involved in the early years of the epidemic [00:31:30] and doing this work and being part of the, sometimes, insular HIV community, what are some lessons that you’ve learned about communicating with multiple audiences? What lessons or advice do you give your people that you mentor and that you wish someone had told you before 1981?

Bruce: I think we assigned us generally do a poor job of communicating [00:32:00] our enthusiasm and our perspectives and a poor job of communicating what it is we actually do. I look at this also from a fundraising perspective of trying to get people to understand that actually donating to science can have a transforming effect. I think most people don’t really understand what the life of a scientist is that [00:32:30] we operate from grant to grant, until we get those grants we can’t do the work. It’s really constraining. I think it’s really important that we make that known. I think that’s a learnable skill that we don’t really teach people. Everybody’s totally overworked anyway, so it’s hard to know how to find the time, but I think it’s a really important point. I think it’s something that people really need to [00:33:00] think about. In an elevator spiel, talk about what it is you’re working on and get people to really understand the excitement of—

Bob: We need more science writers or science journalists, and they need to be involved in, perhaps, more meetings and get to know people, et cetera, like as occurred here.

Mila: I think that it’s also very important to communicate to deliver what you do to others. Because the notion about scientists that it’s quite a boring person who always [00:33:30] sits in the lab, I heard when I was a little girl. My mom always told me to go to the medical school, “Don’t even think about science.” It’s different now but it’s still not enough, people don’t know about scientists. They know what it’s produced, but how it’s done, people don’t know. Even this meeting, scientists started from their lives it’s like, how did they become a scientist? [00:34:00] What did they do? It’s very important for public to understand and it will be more appreciation if we collect the stories.

Jim Curran: I think Bob and Bruce you’ve both been scientists-activists and I’d like to encourage everybody to use your rock star status and your credibility as much as you can. People like Tony [Fauci] are deeply [00:34:30] hindered by being government employees and they can only do so much. Your article about the AIDS vaccine in The Washington Post, of people concerned about AIDS in Africa. When they hear that from Harvard professors or Maryland professors, that really means something to people. And I think that—I’m quite worried about commitment to AIDS. I’ll just mention two things. One is, the big battle over the NIH budget the last couple years. Tony [00:35:00] defended it, but many other people above Tony, and below Tony, and around Tony were in charge of it. There’s a big tendency to want to dismantle portions of the AIDS research budget in NIH. We have to speak out about that because there’s a lot of scientists who are speaking out for it. [crosstalk]

Bob: I wrote three or four editorials in The Washington Post in the last five years, they had no impact at all about anything.

Jim: That needs to be done. The second thing [00:35:30] is, don’t be fooled by fake political commitments. I’ll take the Obama administration and our next president, Hillary Clinton, as an example. At the time when the end of AIDS was being advertised, we had a situation where there was no increase in the PEPFAR budget and an actual decrease in overall amount of money for PEPFAR, at a time we were advertising end of AIDS. Which to me was a clear premature declaration of victory, [00:36:00] and moving on to the next priority. If we’re going to be serious about this in the long run, we have to be advocates as much as that.

And I want to just throw in my biggest regret, since I have a microphone, and that is, we inadequately dealt with the issues of substance abuse. I feel very guilty about it, because I was told that that wasn’t my agency that was another agency. But I had the bully pulpit and they didn’t and I should have done more about it. Because it remains the single biggest problem with adherence, [00:36:30] compliance. It is the very roots of the heterosexual minority and children’s epidemic in the United States. It created a huge problem that we haven’t recovered from and America still doesn’t care about it.

Jon Cohen: I want to address this just to all the scientists here. My first journalism job was at the Voice of America, writing for special English, which is the biggest radio program in the world. People use it to learn English and have for decades. We had a vocabulary [00:37:00] list of 1,200 words and we spoke at two thirds the pace of regular English. So it went something like this, “Today, four persons were injured when a hand bomb was thrown into a crowd.” Now, I’m not suggesting you speak at two thirds the pace or use 1,200 words. Limit your vocabulary and slow down. Those are two very simple things to communicate.

Audience 6: [00:37:30] Speaking as someone who’s just starting my medical and graduate education, I’d like to ask you as a group of panelists, what advice would you have for people who are entering into this world of HIV/AIDS, research and clinical care? What would you envision the world would look like for us 30 years from now, reflecting back, the way we’re reflecting back now?

Bob: Who [00:38:00] me?

Audience 6: The panel, collectively. [laughs]

Bruce: You can start, Bob.

John: 30 years from now. [crosstalk]

Bob: 30 years from now, well, Jim will answer that. I think I would hope it will be gone, but until that you’ll be working on something else productively.

Jim Watson: I’d like to ask you whether we need a new short folk written, you could say for [00:38:30] the new administration. Not 10 pages, not one page but enough to read it overnight and you would get the basic facts of it and exactly what was discovered when? What is the situation in Africa? What’s the situation in America? Just make it clear. It should be [00:39:00] written probably by a senator instead of scientist would put too much in. [crosstalk] What? Have you already written it?

Bob: John has nothing else to do.

Bob: He’ll be completely responsible too.

Jim: I’d like to be able to read a book is that I could from 8:00 at night to 10:00 then I’m finished. I’m a fast reader, but not too many of that [crosstalk] but just [inaudible 00:39:29]. [00:39:30]

Mila: One more question—this person.

Jon Cohen: I can particularly answer that, scientist running [inaudible 00:39:39] next president.

Jim: [crosstalk] [inaudible 00:39:40] You just paid someone $100,000.

Mila: You need the microphone.

Bruce: Jim, hold the microphone closer, hold it closer.

Jim: How much were it to cost? Say if Cold Spring Harbor wanted to, they will publish it. [crosstalk] [00:40:00]

Mila: He’s microphone is not working.

Jim: I think a more popular publisher would be JW Pepper.

Bruce: He’s microphone is not working yet.

Mila: No.

Jim: Are we talking about, it’s $100,000 effort, it’s $1 million effort. I think you could certainly do $200,000 and you’d get someone to do it. Can’t you just go to a drug company or someone like that, like Gilead and just say, “We want a book and [00:40:30] you’ll be properly thanked at the beginning of the book?” [inaudible 00:40:33]. How many people are there who could write? Are they in this room? [crosstalk]

Bruce: It sounds like maybe we should get together a little group to talk about that maybe after the session.

Jim: I think he could write. [crosstalk]

John: I second that.

Mila: Your last question.

Audience 7: My name’s—[crosstalk]

Jim: For example, which can communicate to these people and—

Bruce: We’ll talk. [00:41:00]

Jim: I think I would hate to see this meeting end without a book, but not a scientific book. I don’t think you know. What we need is a book can [crosstalk] be read by a 50-year-old person, for example [inaudible 00:41:16].

John: Like the president of the United States.

Bob: This is clear obligation of Jon Cohen. It’s your obligation now.

Jon: No one answered her question by the way.

Bob: 30 years from now I said I hoped that the disease is gone but if it’s not gone [00:41:30] it’ll clearly be heavily clinical and complicated therapies, I suppose.

John: There’ll still be people infecting. I think there’ll at least some transmission. I think it’s going to have to—hopefully it’ll decline substantially but they’ll still going to have to be dealt with.

Bruce: I would say go deep not wide. Get a skill set that allows you really to have a meaningful impact. I think a lot of people feel there’s so many different things to sample from. They may try and [00:42:00] get out to be doing ahead of them, being actually trained to do.

Warner: We have one last point.

Audience 8: I just want to very quickly say, I've been a health educator in schools and I started in New York City public schools with the sex drugs and AIDS curriculum, the first one ever put out. I’ve been teaching it ever since. Being in this room with all researchers who I’ve followed over the years it is like the first time I met the talking heads. You guys are legends. I thank you for [00:42:30] all the effort you’re putting in and thanks for all the advances and keeping us in the loop. Thanks.

Bruce: Thank you.

John: Thank you very much.

[applause]

Mila: Thank you. It’s a good summary.

[00:42:45] [END OF AUDIO]

See 4:50 in Jon Cohen's talk (9.1)

Page tree

Index