Interview with Dr. Anthony S. Fauci

This is an interview with Dr. Anthony S. Fauci, Director of the National Institute of Allergy and Infectious Diseases), in his office at the National Institutes of Health, in Bethesda, Maryland, on March 7, 1989. The interviewer is Dr. Victoria Harden, Director of the NIH Historical Office.

Harden: Dr. Fauci, could you begin by describing the home in which you grew up, your parents, your grandparents and siblings; what you enjoyed doing as a boy, and your elementary and secondary education?

Fauci: I was born in Brooklyn, New York. My grandparents on both my mother's and father's side were born in Italy, except for my grandfather on my mother's side, who was born in Switzerland. They came to the United States at the end of the nineteenth century. Both my parents were born in New York City and went to public schools in New York City. My father, Stephen Fauci, graduated from the College of Pharmacy, Columbia University, as a pharmacist. My mother, Eugenia Fauci, went to Brooklyn College and Hunter College. They married very young, when they were eighteen years old, and went to college after they were married, while they were still growing up. I went to the neighborhood parochial schools in New York City. I was brought up in a Catholic grammar and high school environment. I went to Our Lady of Guadeloupe Grammar School in Brooklyn and to Regis High School, a Jesuit high school in Manhattan. I had the interesting experience of having to take a bus and three separate subway trains to get from my home in Brooklyn to high school in Manhattan. I believe that my childhood was a typical, very happy, and very active growing-up period in New York City during the early forties. I was born in December of 1940 in New York City and grew up as a child in the World War II and post World War II years.

My major interest was sports. I lived in a very sports-oriented neighborhood. We used to play basketball from the beginning of the basketball season to the end, baseball throughout the spring and the summer, and then basketball and football again in the winter. My sister, who is three years older than I, also went through the same sort of school system, same grammar school I went to, went to an all-girls' Catholic high school, and ultimately St. John's University in New York City. She was a teacher before she stopped to raise her family.

Harden: Who were your boyhood heroes?

Fauci: My boyhood heroes were predominantly sports figures like Joe Di Maggio, Mickey Mantle, and Duke Snyder. I was unusual in that I grew up in Brooklyn but was a New York Yankees fan. I was somewhat of a sports outcast among my friends who were all Brooklyn Dodgers fans. This was the time the Dodgers were actually located in Brooklyn as opposed to Los Angeles, where they are currently located.

Harden: How did a young man who was devoted to sports decide to become a physician?

Fauci: I don't think I can tell you the precise time when I knew that I wanted to be a physician. It was very early on. I know that in high school, when I was deciding the options I would have in college, there really was no question that I was going to be a physician. I went to Regis High School, a Jesuit high school, which had a major impact on my career even up to today. It was a highly academic, exclusive scholarship school. Students from every parochial grammar school in all the five boroughs of New York competed to receive admission, making it highly competitive, and the courses were extraordinary. They were very heavily weighted towards the classics. We took four years of Greek, four years of Latin, three years of French, ancient history, theology, etc. When I was at Regis, it seemed that the very bright people in school really had just a few options. If you wanted to go into medicine, that was fine. The other choices were law, science, engineering, or careers like that. My interest in medicine stems from my keen interest in people, in asking questions and solving problems.

Also, I think there was subliminal stimulation from my mother, who, right from the very beginning when I was born, wanted me to be a physician. She never really pressured me in any way, but I think I subtly picked up the vibrations that she wanted very much for me to be a physician. When the time came to go to college, I went to Holy Cross College, which has an extraordinarily fine reputation for premedical work. They do it in a very interesting way, at least it seemed so back in the fifties. I went to Holy Cross in 1958 and graduated in 1962. At that time, it was not unusual for premedical students to take a very strong classics course in premed. The title of my premed course was “A.B. Greek Premed,” which was a classics course very heavily weighted with philosophy–32 credits of philosophy, plus French, Greek and Latin. At the same time we took the minimal scientific courses to get us into medical school. The students did very well, getting into the best medical schools in the country but with a very strong liberal arts background. The liberal arts background is something that was very much a part of my family because virtually all of my relatives on my mother's side–her father, her brother, and her sister's children–are all artists. They are successful people who made their living through the arts, usually painting. I was always and still am very interested in art, but I am somewhat of a frustrated artist because I certainly don't have the time, and probably not the talent either, to pursue it. I still am very interested in the classics. They were a very important part of my education.

Harden: Would you evaluate the broad, liberal arts, humanistic training and your Catholic upbringing in terms of how they have influenced your performance as a physician and as a researcher? I'm thinking of things like your world view, your interaction with patients, and your approach to ethical questions.

Fauci: You can't separate very well natural abilities in a vacuum from your training, or from the combination of factors that have an influence on how you perform. But certainly, the humanistic education that I had has had a very positive influence on my ability to deal with sensitive situations with people. I credit very much the Jesuit training in precision of thought and economy of expression in solving and expressing a problem and in the presentation of a solution in a very succinct, accurate way. This has had a major, positive influence on the fact that I enjoy very much and am fairly good at being able to communicate scientific principles or principles of basic and clinical research without getting very profuse and off on tangents. This is something that was drilled into us from the very early days in high school.

Harden: Did you continue your interest in sports in college?

Fauci: My interest in it continued, but not my active participation. In high school, I played competitive sports–I played basketball at a time when you could play basketball without being 6'9“ at the shortest. I don't think I would have any chance of playing basketball if I were in high school now. I enjoyed basketball, was the captain of the team and had a very successful time in high school. Alongside it, I played baseball. These were my two major sports. When I went to college, I continued to play a modest amount of intramural sports, but due to the nature of the premedical curriculum at Holy Cross, it was very difficult to be very active in sports. I did not play competitive basketball or even baseball at the college level, since they had very good teams. I could not play as much as I wanted to because the demands of the curriculum were such that you really had to put a lot of time into your studies.

Harden: Could you talk about your experiences at Cornell University Medical College and comment on how actually becoming a doctor compared to your earlier conceptions of the profession?

Fauci: This might be interpreted by some as being paradoxical, but I absolutely loved medical school. It certainly was demanding, but it was one of the most exciting experiences of my life. The exponential curve of knowledge accrual in medical school was so great that it completely overshadowed the fatigue and the stress factors and the other problems that are so commonly seen in medical school. Certainly, medical school training was very stressful, but unquestionably it ranked as one of the happiest periods of my life, because I was learning so much. The later years in medical school and in health care training and what had been my previous idealistic views about medicine did fit together. There really was the opportunity to apply a very basic scientific framework of knowledge to something that is very human, very personal, with all of the sensitivities associated with dealing with human beings. Here I had the advantage of the humanistic training that I had received earlier on in high school and in college. This is a nice dichotomy of medical school, and that's why I think that there is no question that I was meant to be a physician and a physician-scientist. I can't imagine in my wildest dreams doing anything else that would make me as happy as this makes me. I enjoy the polarity. There are strict scientific principles that have to be adhered to in medicine. At the same time a humanistic touch is needed in dealing with people. They have to be combined. You have to combine social aspects, ethical aspects, personal aspects with cold, clean science. It is the art of the physician to put them together in the care of a patient, in the development of a protocol for a disease, the diagnosis or treatment of a problem. This combination exists in every aspect of patient-involvement.

Harden: Who influenced you the most during medical school, especially in your decision to go into immunology?

Fauci: The people who influenced me most in medical school are different from those who influenced my decision to go into immunology. Taking medical school first: My heroes were the strict clinicians of the New York Hospital/Cornell Medical Center. They were and still are in so many respects the real heroes. My teachers, whom I saw on the wards as a student and during my internship and residency, were people whose entire lives were devoted to clinical medicine. They reached such levels of expertise in patient care, diagnosis, and the delivery of patient care that they were really super stars. I tried to emulate them and make myself as good a clinician as I possibly could be. They provided a great inspiration. I think that it is very important for a young medical student to have a role model. There were several of them around at the time.

The reasons I went into immunology and research in general were due to an unusual situation. I left Cornell and went into my internship and residency in 1966. That was at the exponential phase of the Vietnam War, and every single physician went into military service. I can remember very clearly when we were gathered in the auditorium at Cornell early in our fourth year of medical school. Unlike today, we had only two women in the class and seventy-nine men. The recruiter from the Armed Forces came there and said, “Believe it or not, when you graduate from medical school at the end of the year, except for the two women, everyone in this room is going to be either in the Army, the Air Force, the Navy or the Public Health Service. So, you're going to have to take your choice. Sign up and give your preferences.” I had heard about the NIH and the opportunity there. At the time, the NIH was just blossoming, and everyone who had any role in academic medicine spent some time at the NIH. So I put down Public Health Service as my first choice, and then the Navy. Essentially, I came down to the NIH because I didn't have any choice. I was very lucky because I knew that it was a phenomenal scientific opportunity.

When I was trying to decide what laboratory to go to, some of my advisers at Cornell suggested very strongly that I pursue the field of immunology, since I had developed an interest in immunology in medical school. I had done some projects during the summer and had worked for a period with Dr. Marvin Schlesinger, who was the chief of gastroenterology division of the Department of Medicine. I also had worked with [Dr.] Graham Jeffries and [Dr.] Walter Rubin. The project I did as a student turned out to be a successful project. I was lucky, since that doesn't usually happen when you have a student project. Because of this research, I applied for the National Institute of Allergy and Infectious Diseases. It so happened that Dr. Schlesinger knew Dr. Sheldon Wolff at the NIH, and I came down to the NIH for an interview. I was interviewed by Dr. Wolff, and I immediately fell in love with the man. He was just my kind of person–intellectually and personally. I was accepted by Dr. Wolff right off. At the end of my residency, I came down to the NIH to work in the National Institute of Allergy and Infectious Diseases with Dr. Wolff. Over the years, even after he left the NIH, he emerged as the major mentor–personal and scientific–in my life. There have been a number of other individuals whom I have come into contact with who have had a major influence on me, but I think that Dr. Wolff clearly stands out as the person who made the greatest impact on my career.

Harden: Could you talk about the research you did with Dr. Wolff in his laboratory in this period?

Fauci: When I came down to what was the Laboratory of Clinical Investigation, of which Dr. Wolff was the laboratory chief as well as being the clinical director of the National Institute of Allergy and Infectious Diseases, I wanted to work on cellular immunology. But, interestingly enough, as popular as cellular immunology is now, there really were not very many cellular immunologists at the time, and certainly not in the Laboratory of Clinical Investigation. I went to work with Dr. John Johnson, who now practices rheumatology in Nashville, Tennessee. John was an immunochemist at the time, but he allowed me to work on problems in cellular immunology. I had to go around to different groups in different laboratories to learn the fundamentals of cellular immunology under the auspices of the Laboratory of Clinical Investigation. It was a great experience and a testimony to the flexibility of people like Dr. Wolff and Dr. Johnson, who allowed me to work in that field even though it wasn't their field of expertise. Dr. Wolff was mainly working on the pathogenesis of fever. I told him I didn't want to work on that, although it was a very interesting topic. I wanted to learn some basic cellular immunology with the ultimate aim of going into what has been my theme for the past twenty-one years–human immunobiology and the regulation of the human immune system. I was then, and still am, extremely interested in clinical medicine, and I have been successful in being able to mix and meld together the very fundamental, basic concepts of immunology with clinical medicine. It was Dr. Wolff who encouraged me. I worked on some projects looking at the regulation of the immune system in animals, with rabbit and guinea pig models. I learned from Dr. Baruj Benacerraf, who was down the hall in the Laboratory of Immunology; from [Dr.] David Katz, who worked with him; and from [Dr.] Carl Pierce and a few others. There were in the laboratory working with Dr. Johnson two people who have gone on to be very successful and prominent immunologists–[Dr.] Alexander Lawton, who is now at Vanderbilt [University] and chairman of pediatrics, and [Dr.] Herbert Reynolds, who is now chief of medicine at the Hershey Medical Center of the Pennsylvania State University. They were just Fellows with me at the time, and we taught each other immunology. However, though I liked it very much, my main desire was to get back to the New York Hospital/Cornell Medical Center and to be a clinician. That's what I really wanted to do. I liked the scientific environment, but my real love was taking care of patients.

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