A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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Dec 7, 2003 - Major scandal at NIH with article in L.A. Times that shows that high NIH officials including Steve Katz, John Gallin and others have made hundreds of thousands of dollars consulting for pharmaceutical and biotech companies.
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Dec. 8-10, 2003 - Much media attention regarding the Fujian strain of influenza and the early indications of a bad season with deaths of children in Colorado and elsewhere. Vaccine has run out and people are panicking. 83 million doses distributed. I have already been and will be on CNN multiple times, MSNBC, CNBC, CBS, etc.
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Dec. 13, 2003 - Saddam Hussein captured by US Army outside of Tikrit, Iraq!! Leave for Iraq!
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Dec. 16, 2003 - Went to dinner reception at the home of Assistant Secretary of Defense for Health Affairs William Winkenwerder in honor of Dr. Khudair Abbas, Health Minister of Iraq. Present among others were Kristen Silverberg (who spent time in Iraq - see above regarding the books of HPIM-15 that I sent to Iraq), Ken Bernard, Surgeon General Richard Carmona, Congressman Fred Upton, etc. Iraqs really want me to go to Iraq for moral support of the Iraqi medical establishment and health system. They were all very appreciative of the books that I sent. It is still very dangerous in Iraq, but I am pursuing going with Secretary Thompson in Jan/Feb if possible.
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2004-01-21 00:00
Anthony S. Fauci
Jan. 21, 2004 - Over the past month a number of issues have arisen. There have been 34 cases of SARS in China. The Fujian strain of Influenza A escalated and now is declining. It may be that it was just a moderate year that peaked early and had people worrying about it being a catastrophic year. It may turn out that it was not that bad. Big worry is the appearance of H5N1 with 4-5 cases of jumping from chicken to man in Viet Nam and massive chicken illnesses and deaths in Viet Nam, S. Korea and Japan. We are all busy in planning for a potential pandemic flu. No transmissions from person to person. Also, we had been working on the document in response to the IOM report on "dual use" microbes. We (HSC, DHS, etc) established a Memorandum of agreement and a Charter for the National Science Advisory Board for Biosecurity to advise the Secretary, HHS, the Director, NIH, and the Secretaries of all of the Agencies involved in the conduct and support of potential dual use research in the life sciences. I presented the MOA and the charter to the Deputies in the situation room in the White House. It was well received and will ultimately be signed by the Secretaries. On the way out of the WH, I saw Margaret Spellings who said that the President was talking about me today in that he wanted to be briefed by a group including me and Julie Gerberding on prevention of HIV/AIDS by abstinence, be faithful and condoms (ABC). Jan. 21 - Feb. 25, 2004 - Very busy with many issues. Two Congressional Hearings: 1) House Gov. Ops - Pandemic Flu; 2) Full Approp (Senate) on BSE. Also, much stress with situation of outside activities. I was "interviewed" by Alan Slobodin as was Andy von Eschenbach, Francis Collins, Don Lindberg and ethics offices about "lecture awards". Does not appear to be a problem for me, but they will likely force much greater restrictions on outside activities. White House (Gary Edson) has asked me to put together a proposal for eradication of a few "neglected diseases" in developing countries similar to what I did for the PEPFAR. I was very persistent and finally got into TGT's party to go to Iraq. I feel almost an obligation to do this for my country even though I must admit it is a bit scary. It sounds corny, but it is the "Band of Brothers" feeling that I seem not to be able to get away from. I am a visible public servant and this is what I do. This is probably the most dangerous situation I will have ever been in. Will report details when I return.
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Feb. 26, 2004 - Leave for Iraq! Feb. 26 - Mar. 1, 2004 Feb. 26 - Left for Amman, Jordan - Iraq on a Gulf Stream air force aircraft from Andrews Air Force Base. Trip purpose - "show the USA flag" in the context of health issues and determine whether the USG/DHHS/NIH can do more in the Middle East. On the trip was Secretary Thompson (TGT), Andy von Eschenbach, Bill Steiger, Press- Sanjay Gupta, Christy Feig and Joe Farre (CNN) and Mark Sherman (AP); Security - Jay Hodes. In Amman/Iraq we met Charles Curie (Head, SAMSA), Howard Zucker, Dr. David Smith (Humanitarian and Refugee Services), Andy Knapp and Mike Lonetto (Security advance), Adm Van der Wagner (USPHS). We landed in Marka Airfield in Amman and almost immediately changed planes to an Air Force C-130 to Baghdad. This would turn out to be one of the most memorable days of my life. In the approach to Saddam Airport we did a sharp "corkscrew" landing in which it felt like the plane flipped over. The airforce guys explained that this is the way that they avoid shoulder to air missiles as well as sporadic fire from AK 47s. In addition, the airport gets randomly mortared every day. These are just pockets of insurgents that rarely hit targets, the real targets are the convoys of troops accompanying cars (like ours) and isolated troops on patrol, as well as more recently, Iraqi police and officials who are trying to rebuild the country. We went from the airport to the "Green Zone" (relatively safe with high security, despite the fact that rocket and mortar attacks occur on almost a daily basis; these usually do not hit specific targets, but do cause casualties) in Baghdad with several car-loads of Special Forces and DoD Criminal Investigation Division (CID) security people and 4 Humvees full of Military police manning M-4s and fixed machine guns. The ride to Baghdad was thrilling and frightening. The alignment of the motorcade was that every time we passed a person(s) walking along the highway or a parked car or truck, the special forces car would insert themselves between the suspects and TGT's car (I was riding with TGT). When we passed an overpass or a car on our right, the Military police would aim their machine guns up at the overpass and swing around the turret of the machine gun as we passed the overhead. The reason is that frequently insurgents drop grenades from overpasses and run. We passed cars driving with people or when cars pulled up alongside, the military police and special forces would wave them over and point their guns directly at the driver. Reason - frequently, isolated cars drive by and shoot at the convoy. First stop - meeting with Ambassador Paul (Jerry Bremer) in his office in the imperial Palace formerly main palace of Saddam and now headquarters of the Coalition Provisional Authority (CPA). Tom Foley (Bremer's Deputy) was not present, but we met him later on in the trip). Had great discussion of the difficulties in transition to the governing council. He made an interesting statement that democracy is a concept that is foreign to the Iraqis. They are taking a lot of time with their constitution and agreeing on their form of government since they seek "consensus". Democracy means that the majority rules, and as we see in the USA, the minority has much power and the balance can and does changes. The Iraqis are not used to the majority winning a vote since historically, minorities get persecuted. They need to understand that minorities are minorities for a particular idea/law/regulation and that Sunnis, Shia's and Kurds can be minority, majority or both. Sunnis and Shia's can live together since there are many, many mixed marriages. Highly intellectual discussion. Bremer is an impressive man. Also, met Jim Haveman who is the USA Health person (also impressive). Jim was with us for most of the remainder of the trip in Iraq and Jordan. He thanked me for the books that I sent to Iraq from McGraw-Hill. Had lunch at the home of MOH Khudair Abbas. Present at the lunch was Dr. Ebrahim Al-Jafari, head of the Shiite Party and member of the Iraqi Governing Council (IGC)and Dr. Rajaa Khuzai a women OB/GYN physician and also member of the IGC. Had a very stimulating conversation regarding Iraqi politics, the history of Iraq medicine and how Iraq was the "jewel" of medical care and training in the 50s, 60s and early 70s. When Saddam came into power, he diverted money to weapons and neglected health. The system deteriorated and now it is terrible. They want to restore it. I also heard first hand of the cruelty and true insanity of Saddam and his sons Uday and Qusai and how they tortured and killed at will. Many of the people at lunch lived in exile or remained in Iraq, but had relatives who had been jailed, tortured or killed. The defining experience of the day was the visit to IBN Sina Hospital which is the combat (trauma) support hospital. I had to constantly hold back tears. Everyone carried a weapon in the hospital, even the doctors and nurses performing procedures in the OR or trauma rooms. I say young kids (18-25 yo soldiers) with bullet wounds in the face. Common wound is a cheek-through-cheek bullet that either kills the victim or goes right through without hitting vital structures. I am told that it is a common wound by snipers since the troops wear body armor up to their neck and a helmet down to their eyes. It is one of the few exposed parts. One such soldier was wheeled in as we were touring the hospital. He had just been shot. I say shattered legs, abdominal wounds and Iraqi citizens shot in cross-fire and Iraqi insurgents getting x-rayed with a special forces person pointing an M-4 at him in case he tried to escape. I saw an Iraqi collaborator who was helping the Special Forces in the North and another Iraqi came up to him when no one was around and shot him in the back of the head. The bullet miraculously went through one posterior jaw and exited the face. When taken to the hospital, he told the SF who the attacker was that left him for dead and the SF had just left the hospital to "take care of him". Many army physicians and nurses recognized me either from TV or more often from Harrison's. I ran into a young neurosurgeon - Major Koop who knew me from HPIM. Upon return to the airport via "ambush alley", the 2 main Humvees of the 4 that escorted us back had young women at the machine guns. I inquired about this to our SF driver and he said that as of this week, women soldiers have more confirmed kills than men soldiers. Upon take off, we had the same corkscrew maneuver, but this time 2 airmen were at each window with radio contact with the cockpit in case they saw puffs of smoke or flashes indicating a shoulder to air missile or Ak-47 , at which point they would alert the pilot to divert. Landed in Amman; we did not sleep at the Rasheed Hotel in Baghdad since it was recently attacked with rockets while Paul Wolfowitz was staying there. Had a marvelous dinner at the home of the Jordanian MOH - Dr, Said. S. Darwazah. Also present was our team (minus the press), plus the US Ambassador to Jordan (Edward W. "Skip" Gnehm), Dr. Samir Khleif, (NCI), Director of the King Hussein Cancer Center in Amman and Said's brother Mazen and his father Samih. We talked for hours about the complex issues of Israel and Palestinians and Iraq and USA. It is clear that they want to live in peace with Israel, but they all feel that the USA in unfairly siding with Israel on not disallowing settlements. Clearly, one of the most stimulating evenings I have spent. The Jordanians are truly wonderful people and very friendly and affectionate to Americans. The food was incredibly good.
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Feb. 28, 2004 - Visited the King Hussein Cancer Center in Amman. Dr. Samir Khleif showed us around the modern facilities that have NIH-style telemedicine in real time. Toured the pediatric cancer wards with patients who had ALL, squamous cell carcinoma of ear and other tumors. There is a Jordanian Program called Project Iraq in which selected patients are chosen from sick Iraqis and are transferred to the Cancer Center for treatment. We say several Iraqi mothers with their sick children. Had a nice warm conversation with Princess Ghaida Salaam who is married to Prince Talal ibn Muhamed (Nephew of the late King Hussein) and Princess Dina who is also married to the nephew of the late king. Both women were beautiful, articulate and spoke perfect English. Princess Ghaida is the Chair of the Board of the Center and she recognized me from TV and said that she always wanted to meet me. I showed her my Harrison's textbook in the KHCC library. She spent years in DC and graduated from Georgetown in the 1980s. After the tour we had lunch and discussed the various programs. Afternoon was free and we visited archeological ruins in Amman. That evening, we had dinner at the home of Princess Ghaida. This was a most unusual evening; I was incredibly impressed by the Princess's husband Royal Prince Talal bin Muhamed. He and Princess Ghaida both graduted from Georgetown in the 1980s. He gave me a wonderful history of the Muhamed family that descended from King Faisal I, hundreds of years ago. The family split and one line took over Jordan and the other first went to Syria and then Iraq. He knew Sadam and his sons since he was a little boy and he feels that they were horrible sociopaths. He used to play with them as a child during visits to Iraq and vice versa for Jordan. Sadam gave him several guns as gifts. In Arab countries, a gift of a gun is a show of respect and affection. Talal was the favorite of his uncle King Hussein and told many stories of his loving relationship with the King. He proudly showed me his incredible gun collection (rifles, shotguns, and pistols). He was in the Jordanian paratroopers, is a polo player and rides motorcycles. I feel that this person could really be my friend if circumstances allowed. Very intellectal and stimulating discussion at dinner regarding the war in Iraq and the Israel-Palastine situation. He fees that the USA should have military rule in Iraq for 5 years before even considering handing over the government to the Iraqis. He said that the Iraqis would understand and respect this since what they want most is security. He feels that a situation similar to MacArthur and Japan would be desirable. We discussed how this would not be feasible politically in the USA, i.e. having a long-term occupation of Iraq. He is afraid of the instability that would follow in Iraq and the region if we handed the control of the government over to a governing council (which he feels is made up of some good people, but some people with no credibility such as Chalaby). In addition, he feels that the US military is so respected for their force and discipline, that this is the reason why the Iraqis fled. He stated that the Iraqis are a "fierce" and proud people and if the UN or the Poles and Spanish took over the security, the Iraqis would chew them up and anarchy would prevail. He states that no Arab country wants the USA to leave any time soon. a)
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Feb. 29, 2004 - Last day in Iraq...mostly in the red zone. Some very exciting and somewhat scary moments with the convoy getting caught in traffic in another "ambush alley" (narrow streets and high buildings where insurgents frequently shoot down on US troops from roof-tops or windows). During several of these "stalls" in traffic, the special forces, military police escorts and the CID (criminal investigation division) of the army jumped out of the cars and ran alongside with their M-4s pointed a the roofs and windows. They also ran up to cars that were blocking traffic and pointed drawn pistols and cocked M4s right into the cars to get people to move. Visited the MOH in the AM, the Women's clinic, had lunch with Iraqi health people. This was all in the "red zone" and the SF had sniper observers on the roofs of the buildings surrounding the facility that we were visiting. We then left for the airport had a wonderful dinner at Baghdad airport (Bob Hope Dining Hall) with the troops of the 1st Armored Division, Military Police Brigade, the First Cavalry, and the 101st Airborne. Our troops are incredible, including the women. They are extremely well disciplined, polite, good looking and nice. General Scaparroti (Chief of Combat maneuvers) brought TGT and me into the "classified" command room of the base and showed us how they track hostilities on a real time giant computerized map screen. Met an incredible woman Major Rogers who was a beautiful, articulate and smart, 35-ish deputy chief of intelligence for the command. Also met Col. Flake who was the combat coordinator - one tough looking soldier. Also met Major (Doctor) John McGrath from the Medical Corps. He knew me right away since his wife is a physician (Allergist/Immunologist) and always talks about me. He asked for and got a picture of us together. Finally, we flew on Blackhawk helicoptors to Balad AFB to catch a C-17 to Rhein-Main AFB in Germany. The trip on the Blackhawk was tense and exciting. I sat 2 feet from the machine gunner who was focusing on the ground looking for flashes from small arms fire that happens all the time and usually misses the helicoper. As soon as they see a flash they immediately strafe the area with the M-50 machine gun. We flew all in the dark to avoid detection. We landed at Balad, stayed for awhile and mixed it up with the troops and then flew to Rhein-Main AFB near Frankfurt. From there we picked up the Gulfstream and flew back to Andrews AFB. We landed at 6:00 AM, March 1, 2004.
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March 2-19, 2004 - Following the Iraq trip a number of relatively important issues have arisen. There is sweeping interest in the conflict of interest arena with EZ forming a Blue Ribbon Panel on Conflict of Interest chaired by Norman Augustine and Bruce Alberts. Also, the NIH Ethics Advisory Committee (NEAC) is now reviewing all out side activity requests (as well as any already approved ongoing outside activities) for high ranking NIH officials such as IC Directors, Deputies, Scientific Directors, Clinical Directors, etc. The NEAC is co-chaired by Raynard Kington and Michael Gottesman. Happily they have approved my ongoing activities, including Harrison's. I met with the Blue Ribbon Panel and urged them to distinguish between outside activities that could be conflictual such as consulting for drug companies and those that are purely academic such as writing, editing, lecturing (not on your immediate work) and awards. They seem to "get it". I hope that their recommendations reflect this. Several investigations will come including GAO, IG, and a least 2 Congressional Committees. Also, the Congress is developing a subliminal hostility towards NIH because of the prior doubling of the budget and because our advocates are still screaming for a 10% increase in FY2005 instead of the 2.5% increase of the PB. Sen. Dominici called the NIHers "pigs" who are never satisfied. Moral in quite low. Good stuff going on with Gary Edson and the "neglected diseases" project. He really likes the proposal that I put together for Lymphatic Filariasis (LF) and leprosy and malaria. We are going through the exercise now of several meetings back and forth in deciding what to have the POTUS propose to the G-8 meeting in June in Sea Island. They want to have the POTUS show global leadership and urge the other G-8 countries to put up money and get involved; however, since we are already doing so much, he wants us to put up very little new money. We will probably have to re-direct money - no good deed goes unpunished. Gary also wants me to explore the possibility of making the HIV Vaccine Enterprise a possible proposal. He had spoken to Patty Stonesifer and she mentioned that Rick Klausner and I were working on this together. John Kerry won Democratic nomination prior to convention and he and Bush are going at it already. The big issue is the terrorism that is going on in Iraq with foreign Muslim extremists with ties to Al Quaeda almost daily blowing up mostly Iraqis and some US soldiers. Massive terrorist attack in Madrid a few days ago with bombs in trains; hundreds killed. Muslim extremists claim responsibility and say that they did it because Spain has helped the USA in Iraq. Incident occurred right before the Spanish elections and resulted in overthrow of the Party that supported Bush.