A single line often inverts meaning once you see what it
answers, so neighbouring messages are always shown.
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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.
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March 24, 2004 - Had interesting and full day. Went to the National Defense University at Fort McNair, Washington, D.C. to participate in the DHS exercise of a hypothetical aerosolized anthrax attack on Chicago. It was for the benefit of press leaders. Secretary Ridge, Susan Neely (Assist. Sec. for Public Affairs, DHS), Ed Thompson (CDC) were the main players. It was exciting and the press totally enjoyed it and got engaged in active Qs and As. Virtually all of the senior producers and correspondents of networks, CNN, Fox, etc were present as were top print media. Frank Sesno (CNN) moderated it and Aaron Brown (CNN) was present. Tom Ridge relied virtually totally on me to answer medical questions. Also, had meeting at PEPFAR Headquarters (2100 Pennsylvania Avenue, N.W.) with Gary Edson, Randy Tobias, Robin Cleveland (OMB), Mark Dybul, Joe O'Neill and Ambassador Lange to discuss how we can work an AIDS issue into the upcoming G-8 meeting in June at Sea Island, GA. Gary and I proposed the possibility of highlighting the HIV Vaccine Enterprise that Rick Klausner and I have been working on for the past year. It would cost the USG virtually no new money since the "Enterprise" is a virtual organization that is proposing a strategic plan as described in our Science article. The POTUS can urge the G-8 countries to make a political commitment to make the Enterprise work.
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2004-04-02 00:00
Anthony S. Fauci
April 2, 2004 - White House (Situation Room) - Had meeting today as a culmination of a series of PCC meetings related to preparedness against pandemic influenza. We have been working with DHS, the VP's office and DHHS to develop a white paper of needs and plans. Today we brought it to the PCC + deputies (Claude Allen of DHHS). Meeting was chaired by Richard Falkenrath. Present were several WH and departmental people including Kristen Silverberg, Ken Bernard, Carol Kuntz, Bill Winkenwerder, Stewart Simonson, Allen Gilbert. We came to a good understanding of what we are ultimately going to put before the full deputies and ultimately the Principals.
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April 5, 2004 - White House (West Wing) - Met with Gary Edson. Attending were Carol Thompson, David Nelson and Gary's assistant Martina Strong. Discussed the G-8 issue regarding Gary's concern that the other countries will bring up the issue of generics and PEPFAR, i.e. the false impression that we (USG) are against generics , particularly the generic fixed dose combination of D4T, 3TC and nevirapine. Gary does not want the POTUS to be embarrassed if others blind side him with this. The PEPFAR people (Tobias et al) should have straightened this out at a recent (March 29-30) meeting in Botswana. There was a debate about WHO "pre-qualification" of these drugs and our concern about the criteria and data upon which these drugs were pre-qualified. Also, we discussed the issue of the POTUS proposing an endorsement of the HIV Vaccine Enterprise as our AIDS proposal for the G-8 meeting in June at Sea Island, GA. We will work with Gates (Patty Stonesifer) to endorse this, but the Gates Foundation is going to want us to promise even more money for an AIDS vaccine. Note that we are already spending>$500 million, vastly more than all other groups put together. Gary will rewrite the POTUS's G-8 proposal regarding the Enterprise and run it by me, Kristen Silverberg, Secretary Thompson, Amb. Tobias before we launch it to the G-8.
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April 6, 2004 - White House (EEOB) - Met with Kristen Silverberg, Robin Cleveland, Randy Tobias, Mark Dybul, Alan Gilbert, Press person from WH (?name, a woman), Joe O'Neill, and others to discuss issue of the bad press we are getting regarding the misperception that the USG and PEPFAR will not buy generics, particularly the fixed dose combination (FDC) of D4T, 3TC and nevirapine that CIPLA and Ranbaxy are selling. Decision was made to have Randy Tobias write and Op-Ed for The NY Times or the Washington Post (I will review it for him) and then have me and Randy as necessary do the TV circuit to get the truth out , i.e. that we will buy any drugs , even generics, so long as they are of high quality (safe and effective) and the lowest possible price.
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April 6-12, 2004 - Not much opportunity to implement issue above on April 6 because the entire Press is consumed with the deteriorating conditions in Iraq. Major insurgencies by both Sunnis (Fallujah) and Shiites (Baghdad) against American troops. Several US troops are getting killed each day and insurgents have resorted to kidnapping civilians from other countries who are working in Iraq, i.e. Japanese, Australians, UK, Chinese, etc. Bad situation that is getting worse.
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April 13, 2004 - White House (West Wing) - 2 meetings. First regarding the issue of the HIV Vaccine Enterprise and whether we should make this an initiative for the POTUS to present at the upcoming G-8 Summit in Sea Island, GA. Present was Kristen Silverberg, Martina Strong (Gary Edson's assistant), Joe O'Neill, Carol Thompson. I presented the idea to Kristen and explained what Gary and I had been working on for the past several weeks. I explained how we wanted the POTUS to challenge the G-8 to endorse and support the enterprise. The USG is already investing for FY-04 about $488 million while the entire world's contribution (including the USG) is about $600 to $640 million (these non-USG numbers are estimates. Hence, most of the action is us. She liked the idea and wanted to pursue it. She said that it would be a home run if we could spice it up with some new money. She mentioned about $100 million. I brought up that the usual scenario would be that NIH would have to absorb this "new" money since there really is no new money. Kristen feels that if anyone can squeeze new money out of Josh Bolten, it is me. She is going to bring the issue up to Josh. The second meeting was with Kristen, Joe O'Neill, Carole Thompson, Mark Dybul, Randy Tobias, Jenday Fraser (new US Ambassador to South Africa). Meeting took place in Margaret Spellings office since it is one of the larger offices. Margaret was not there. Discussion was regarding the options of how to address the FDC/generics situation in the context of the PEPFAR. We discussed a number of options. Our goal is to get the lowest possible price for drugs that are clearly safe and effective. Big issue with FDA since they clearly will not approve a drug based only on "pre-qualification" by WHO. There is much misunderstanding (see above) about the USG supposedly blocking generics since we are in the pocket of PHARMA. This is nonsense since we are concerned that we will be buying drugs that are not even generics; they are "knock-offs" from branded drugs. I like the option of pressuring our drug companies to put 3 drugs in a blister-pack (would take 1 month for the FDA to approve) to avoid the issue of potentially low quality Faces. Other good option is to work with the FDA to speed approval (probably take 1 year since you would have to do some pharmacokinetics and bioavailability studies first) of FDCs contained the branded drugs. Simultaneous option would be to ask the South African Medicine Control Council (their FDA) to regulate the knock-off FDCs and to only buy it if they approve them. This would be Africans making decisions for Africans. The only problem is that if they reject the drugs, it might look like a typical erratic South African move, i.e. Mbeki and Shabalala Misemang are notoriously weird. Alternatively, if they accept the drugs with scrutinizing them and they are no good, we would be buying bad drugs.