You are on page 1of 8

c 

 


This Sunday ³ June 5, 2011 ³ marks what public health considers the 30th
anniversary of the international epidemic of HIV -AIDS.

If you·d like a summation of the past 30 years, Larry Altman, the retired senior
medical writer of the New York Times, did an excellent job last Tuesday. And the
Centers for Disease Control and Prevention summed up, in a paper released at
noon ET, the state of the epidemic today.

I was not yet a reporter when the plague began, so my memories of that t ime are
not professional memories, but personal. I was a student, studying mostly theatre,
and almost all my friends were gay. And suddenly my friends were dying. People
who remember will know what I mean. We got used to seeing people we worked
and drank with looking, abruptly, like famine victims. We grew battlefield -numb
bringing meals, and attending memorials, and calling people·s mothers on their
death anniversaries. We knew when the multi -drug cocktails that changed the
course of the epidemic had arrived, not because we read the journal articles, but
because suddenly we could take our florists off our speed -dial.
I worry, in the complacency that has settled now around HIV as an almost -chronic
illness, that the stunning initial impact of this disease t hat changed the planet has
been somehow forgotten. So for my next three posts, I·m going to take you back to
those days.

A few years ago, I wrote a book chronicling the history of the Epidemic Intelligence
Service, the young disease-detective corps of the CDC. EIS officers, as they·re
called, were in on every major disease event of the last half of the 20th century:
the end of smallpox, the beginning of the end of polio. And though his name was
never well-known and has been almost forgotten, one of them alerted the world to
the first known cases of AIDS.

His name was Wayne X. Shandera, and the anniversary that we·ll mark on Sunday is
actually the 30th anniversary of the publication of his urgent b ulletin, the first in
any medical journal to describe a case of HIV.

O 
 O O            
      
 
 !"   
 #$


  
Los Angeles was just about the last place Wayne X. Shandera wanted to end up.

The wiry-haired physician had gone to college at Rice University in Houston,


crossed the country to medical school at Johns Hopkins University in Baltimore,
and then crossed back for residency at Stanford University outside San Francisco.
Now he was wondering whether to pack up again. He had been admitted to the
Epidemic Intelligence Service, and the group had asked him to list his preferences
for an assignment.

Shandera was 29 years old, a devout Catholic who read three languages and was an
accomplished organist. He loved living in the Bay Area; he liked the climate and
the architecture, and he felt at home in the left -leaning discourse that simmered
in its bookstores and coffee shops. Shandera had moved to San Francisco in 1977,
the year that activist Harvey Milk was elected to the city·s board of supervisors.
Milk was the first openly gay man to win a popular election anywhere in America.
When he was murdered a year later, gay men poured into the city, transforming its
colorful, casual decadence into a nexus of sexual flamboyance and political fury.
But Shandera had little contact with ga y San Francisco. Heterosexual, socially
conservative and somewhat shy, he would rather have gone to a chamber music
concert than a Pride parade.

At the moment, he was unsure where to go. Conventional CDC wisdom held that
headquarters offered the best EIS a ssignments. Atlanta made personal sense as
well. Shandera·s father was ill with colon cancer in San Antonio, and he had left
the promising beginnings of a relationship behind in Baltimore three years before.
In Atlanta, he thought, he would have easy airpl ane access in both directions.

On the other hand, he had just finished three years of caring for patients. He had
not had a course in statistics or epidemiology since his second year of medical
school, and he was weak in the necessary skills of sleuthing o ut the details of
outbreaks and writing coherent narratives about them. He might, he thought, get
more practice in a city or state health department. EIS matching lets candidates
list up to 10 choices. Shandera studied the list of possible postings and put the
Louisiana health department first, followed by eight jobs in Atlanta, and the Los
Angeles County health department dead last. It was a low probability, he thought;
the matchers never worked their way that far down a candidate·s list.

In June 1980, the notice arrived: After training in Atlanta, Shandera was to pack
up his Stanford apartment and move south to Los Angeles.

He was horrified. His colleagues were dismissive.

´You·re not going to find anything to work on there,µ his cardiology professor said.
´Except for a bunch of sexually transmitted diseases.µ

He had no idea how prophetic a statement that was.


It looked, at first, as though Shandera·s derisive professor had been wrong. There
were plenty of diseases in Los Angeles. There was a cluster of miscarriages in Long
Beach; two outbreaks of diarrhea, one in a day care center and one spread
throughout the city; a set of hepatitis cases among women who donated blood
plasma; and a puzzling outbreak of epidemic neuromyasthenia, a syndrome of
headache, fever and muscle weakness, among patients of a neurologist in Pacific
Palisades.

He did not solve all of the outbreaks, though they kept him busy. He worked hard,
but he was unhappy. Nothing he was doing seemed novel, and he had been
attracted to the EIS by the hope that he could help identify new health problems.

Twice in the past five years, the group·s members had helped identify previously
unrecognized diseases. In the summer of 1976, they had scrambled to an epidemic
of pneumonia that sickened 221 peop le and killed 34 at an American Legion
convention in a hotel in Philadelphia; by the end of the year, CDC scientists had
identified the pathogen causing it, dubbed it Legionnaires· disease, and exposed it
as the cause of two other, never -solved outbreaks in 1965 and 1968. Two months
before Shandera joined the EIS, in May 1980, the CDC had linked 55 severe cases of
fever, rash and Group A 
% infection, a constellation of symptoms
dubbed toxic shock syndrome, to women·s use of high -absorbency tampons.
Nothing that he was seeing in Los Angeles promised the excitement of those
discoveries.

He worried, too, that he wasn·t learning enough epidemiology. He missed the


intense supervision of residency. He had chosen public health, to start with, out of
a sense that he wanted to make more of a difference than he would working one -
on-one with patients in a hospital. In Los Angeles, he couldn·t see any evidence
that he was making much of a difference at all.

The clincher was that he loathed the place. In San F rancisco, he had biked
everywhere; now he owned an old Mustang and was immersed every day in the
city·s desperate traffic. The air quality was very bad that year ³ ´Some days we
couldn·t see across the street,µ said Frank Sorvillo, an epidemiologist who sh ared a
cubicle with him ³ and the frank materialism of the city grated on Shandera·s
sensibilities.
´In one day, I would see 20 migrant workers living in a garage in East L.A., and
then have to drive through Bel Air and be staggered by the contrasts,µ he said. ´It
was disturbing, and hard to work in. I was at odds with the city most of the time.µ

In the spring, Shandera asked the corps to transfer him. They offered him a job in
Atlanta, starting in a few months: late July 1981. He accepted.

There was something percolating through Southern California that spring.

Some of the health department·s epidemiologists heard reports from doctors they
knew, that patients in practices in the San Fernando Valley were complaining of
swollen lymph nodes and stubborn low -grade fevers. There was no obvious
diagnosis. Those symptoms could signal the start of lymphoma, a cancer of the
immune system that attacks a particular type of white blood cell, but tests were
finding no trace of cancer.

Most of the patients, the doctors said, were men.


At about the same time, a pathologist at the University of Southern California
called Shandera·s cubicle-mate Frank Sorvillo. He had evidence of cancers in a
cluster of six male patients. But there was something odd about what he was
seeing through the microscope; the pathology of these lymphomas was like nothing
he knew.

One of the patients was still in the hospital, and Shandera and Sorvillo went to
interview him. The man was a drug addict, but there was nothing else
extraordinary about him, nothing that would predispose him to an unusual
lymphatic cancer. They let the case go.

At University of California-Los Angeles, anomalous cases were showing up as well.


They were finding their way to Dr. Michael S. Gottlieb, an assistant professor o f
immunology who had joined the medical school staff in the summer of 1980. Like
Shandera, Gottlieb had come from Stanford and they had known each other there
slightly. Gottlieb was four years older, and had been a research fellow when
Shandera rotated through immunology as a resident; he had gone over cases and
journal articles with the younger doctor.

Gottlieb·s specialty was the immunology of organ transplantation. At Stanford, he


had looked for ways to persuade the body to accept transplants without usi ng
drugs to suppress the immune system, the only way known to keep organs from
being rejected as foreign. Unlike Shandera, Gottlieb liked Los Angeles. While at
Stanford, he spent some time at UCLA studying bone -marrow transplants, and the
university invited him to move south and open an immunologic research lab.
Gottlieb was one of the attending physicians ³ senior doctors who supervise the
training of younger ones ³ on the immunology service of the UCLA School of
Medicine. On a slow day in March 1981, he asked Dr. Howard Schanker, a fellow, to
patrol the hospital for patients whose cases might present teaching opportunities.
Gottlieb·s office was in the hospital basement. Schanker left for the upper floors.
Very shortly afterward, he came back.

´He had a quizzical look on his face,µ Gottlieb said. ´He said, ¶There is a guy
upstairs whose infections are really kind of strange.·µ

_ & '(           


    

Read More:

Excerpt Part Two

Excerpt Part Three




You might also like