“it Was Like Nothing In Medical History
ROBERT GALLO AND LUC MONTAGNIER DISCUSS LEADING THE BATTLE AGAINST THE GREATEST EPIDEMIC OF OUR TIME
MORE THAN TWO DECADES AGO AN UNPRECEDENTED GLOBAL medical crisis began. Mysterious, deadly, and unexpected, an epidemic with an unknown cause started to claim victims in odd, seemingly unrelated groups. Gay men. Intravenous drug abusers. Africans. Haitians. Hemophiliacs. As the list grew, physicians worldwide slowly realized they were facing a truly new and powerful enemy.
Robert Gallo and Luc Montagnier provided the first important victories in the high-stakes war against what we now call AIDS, or acquired immune deficiency syndrome. Leading independent groups in the United States and France, they each linked the disease to a new contagion, which they named HIV (for human immunodeficiency virus). Then, in a move vital to diagnosing new infections—and protecting the blood supply—they developed a test to detect the presence of HIV.
They also endured a level of scrutiny and criticism seldom seen in the history of medicine. Gay activists accused the medical establishment of moving too slowly, while some religious leaders countered that AIDS was a divine act intended to punish homosexuals. Allegations of unseemly competition between Gallo and Montagnier provoked especially harsh criticism, receiving close inspection in the best-selling book by Randy Shuts And the Band Played On , which was made into a popular television movie in 1993. (Gallo was portrayed by the actor Alan Aida; Montagnier, by Patrick Bauchau.)
These days Gallo and Montagnier are completely supportive of each other’s work, a fact they stressed in the impassioned acceptance speeches they made when they were inducted into the National Inventors Hall of Fame on May 1, 2004. Luc Montagnier was born August 18,1932, in Chabris, France. He received his medical degree from the University of Paris in 1960 and then did a series of postdoctoral research fellowships in France and the United Kingdom. He was head of the viral oncology department at the Pasteur Institute when he did his first work on AIDS. In 1993 he cofounded the World Foundation for AIDS Research and Prevention. Robert Gallo was born March 23, 1937, in Waterbury, Connecticut. He received his M.D. from the Jefferson Medical College of Philadelphia in 1963, and he became a cancer researcher for the National Institutes of Health in Chicago after completing his residency in 1965. He is currently director of the Institute of Human Virology and Division of Basic Science at the University of Maryland Biotechnology Institute in Baltimore. They spoke about their careers while in Akron for the induction ceremony.
How did you become interested in medicine?
Luc Montagnier: I was always fascinated by science. When I was 15, I tried to set up a chemistry lab in the cellar of my parents’ house, and I knew some chemistry before I studied it at school. After that I was mostly fascinated by atomic energy, by 1945 and everything about atomic physics. But I realized that I should go more to the medical side of science because for physics I would need math, and I wasn’t good at math. So I shifted to medicine, and I started my medical study at the University of Paris. I went into research, working first on algae. I thought viruses were easier to work with than complex animals, so I decided to learn more about viruses. I went to Britain in 1960, spent three years near London and half a year in Scotland, and I learned a lot. I was able to make my first discovery, the discovery of the RNA double helix made by certain viruses like the polio virus. I came back to France and tried to apply what I had learned to viruses that cause cancer. At the time, the idea was that many cancers could be caused by viruses. I moved to the Pasteur Institute in 1972 to work on that.
Robert Gallo: I know precisely when I became interested in medicine, because my interest didn’t come out of any native curiosity about science. When I was 13,1 had an immensely powerful experience. My only sibling died a horrible death of leukemia. She was hospitalized at Harvard’s Children’s Hospital, and I saw medical research scientists for the first time. I saw her life extended by her being one of the first persons ever to receive chemotherapy, and that chemotherapy was with 6-mercaptopurine, which was invented by Gertrude Elion, a 1991 inductee.
In my last year in high school I fractured my back playing basketball. That was the last year practically everything in my brain was basketball. I was forced to reflect, and I had plenty of time to do so. My father had developed a close friendship with my sister’s pathologist, who became my friend. He was a very positive influence in nurturing young people heading toward careers in medicine or medical science.
How did you first hear about what we now call AIDS?
LM: In France in 1981 and 1982 there were very few cases, but there were already patients dying. Some young physicians who wanted to find the cause came to me. Also, the Pasteur Institute had a commercial subsidiary making a vaccine from plasma, and they were anxious to keep AIDS out of the plasma, so they came to me to do something about that. We were looking for viruses that caused cancer—breast cancer, cancer in lymphocytes—so we had the techniques to look for the source of the AIDS virus. We just applied what we knew, and we were very pleased to have a first experiment that gave us positive results in January 1983.
At the beginning of that month, I had received a biopsy from the swollen lymph nodes of a patient who was a young homosexual. In it I found the first hint of a virus, a retrovirus.
What’s the most challenging thing about this kind of research?
RG: When I first got involved with HIV, it certainly was different from anything I had experienced with cancer. The hardest part of the work was the politics, society at large, the bizarre theories. The psychosexual dynamics of HIV brought us into a different dimension, with problems I wouldn’t have had in research in cancer. These were things we’d had no training for, no experience with. We had to be much closer to the media; much closer to ethics—much closer to ethics we didn’t even understand sometimes, but that we had to be sensitive to; much closer to legal things; much closer to patients who were in your face. It was like nothing in medical history.
We were much closer to misunderstanding. When my colleagues and I developed a blood test for AIDS, I thought we were going to get another pat on the head, but instead we got anger. The activist community didn’t fully understand the necessity for the test. I was just astounded.
In 1985 I lectured at the International AIDS Conference. In my talk I described the properties of a recent sample of the virus we had gotten from Nigeria. Later that day I was asked to meet with the minister of health of Nigeria, and it was amazing. The people I met with were really angry with me. They said they didn’t have any virus in Nigeria and I shouldn’t be talking about it. But that was then. The now is that for 10 years I’ve had an extraordinary relationship with Nigeria, a close collaboration. I’m departing from the question, but this makes me think that there have been positive spinoffs from AIDS that are not only scientific but also social. There is a greater understanding of differences in sexuality. I think some amazing advances have come from the disease.
Did you realize when you were doing your initial research how serious and extensive a condition you were studying?
LM: Not completely at first. In the beginning we saw the virus only in gay men and in hemophiliacs who had received a contaminated blood product. Later we found it more broadly in men and women from Africa. We had the first evidence for that in 1983. A young woman from Zaire was hospitalized in France, and she died one week later. We had her blood, and her blood had the same virus. So we realized that the virus was also sexually transmitted from men to women and probably from women to men, and we began to ask if this epidemic could even be contained.
As two people who have been there from the absolute beginning, are you satisfied with the state of AIDS research today?
RG: Well, it’s certainly much better than it was. But I’m frustrated with the funding process. When something is so obviously big and serious, it merits a more efficient system.
What I mean is, if the world were on fire, you wouldn’t apply for grants that take two years to get funded to do something about it. That wasn’t done with the Manhattan Project. I believe there should be centers of excellence in virology throughout the Americas and Europe, covering every class of virus and then overlapping some. Any new epidemic that occurs, the head of the Centers for Disease Control here or together with European agencies could determine which institutes should find the cause, develop diagnostics, and start a vaccine, if needed, and therapy programs, if needed. We should also have more centers in developing nations that we collaborate with closely and help train. Even just thinking selfishly, that would give us better monitoring of the world.
Luc Montagnier will tell you it wasn’t by chance that he got involved in AIDS, because he was interested in virology. I was interested in virology. It’s not chance. No one told us we were responsible for finding the cause of AIDS and doing something about it. I was at a cancer institute, after all, and the first time I heard about AIDS it wasn’t terribly important. I mean, there were a half-dozen patients. Well, I was working in cancer, and I was happy with the leukemia viruses we had just discovered. Things were going well.
It was the calm before the storm. We decided to get involved with AIDS because it was a disease of the T cells, and T cells were our business. Nobody was particularly happy that we were getting involved with it. Nobody even particularly asked us any questions. When I think back on it, I get frustrated. If we’d gotten on it earlier, we could have saved lives. Why didn’t anybody think of that?
What do you think about the fact that part of your careers will be in the history books?
LM: Well, back when we were first working on this, we didn’t know if it would be historic or not. In 1983 we were more concerned with convincing our colleagues that we needed financial support. There were very hard discussions in the scientific community about whether we had the right virus or not, because there were other candidates. We were very concerned about that. Of course now we can write the history. I wrote a book about it a few years ago, and the story isn’t finished. There are many people, many groups, working with AIDS, trying to make new drugs and vaccines. We still have to find out exactly why the vaccines don’t work. I have some idea about this. I’m still working on it, and maybe there will be a new discovery that is as important as the discovery of the virus itself.
One thing all the misunderstanding about AIDS showed was the general depth of public ignorance about science. Do you ever worry about that?
RG: It is very much on my mind. It’s astounding because there’s so much on television and in the newspapers, but then when you talk to people, a large, large number—a high percentage, I’m afraid—have no understanding of science. A broad understanding of biology is not there. Some genetic understanding would be the most useful thing.
Early on you had trouble getting funding because AIDS baffled even health authorities. Did that affect your work?
LM: Yes, we were upset about that. We had the right thing, the right values, but we couldn’t do a lot because of limited financial means. It was very frustrating, but I think probably every scientist experiences that at some point in his career.
Are you optimistic that you’ll see a cure for AIDS?
LM: Yes, if I can live long enough. Yes. I would like to see the end of this very sad story.