On Call

A career in medicine is a life of discovery.  It is a life full of mystery and revelation.  It is one filled with hypothesis, experimentation, failure, and success.  It is a life of curious exploration - finding a thread, pulling it and seeing where it may lead.

In the late 1960s, as the Vietnam War raged, Anthony Fauci, a young man from Brooklyn, graduated from Cornell medical school.  At the time, all young, medical school graduates were given a choice of military service in the U.S. Army, Navy, Air Force or U.S. Public Health Service.  Fauci chose the latter.  So in 1966, he began his career at the National Institute of Allergy and Infectious Diseases (NIAID), a subdivision of the National Institute of Health (NIH).  From junior fellow ultimately to his role as institute director, NIAID would be the home base of operations for Dr. Fauci's journey in medicine.

Dr. Fauci has a storied career.  Occasionally, throughout history, one person plays an outsized role and leaves a definitive mark on the course of medical and social history.  He is certainly one of those people.  As we look across the landscape of medically related events over the past half century, Dr. Fauci's fingerprints are ubiquitously present.

In the early 1980's a June 5 issue of the CDC's publication, "Morbidity and Mortality Weekly Review (MMWR)"caught Dr. Fauci's eye.  This issue of the MMWR reported a strange form of pneumonia that generally affects immunocompromised individuals, this time in otherwise seemingly healthy men.  What ultimately came to be known as HIV/AIDS became the centerpiece of Dr. Fauci's research and clinical work ultimately leading him to a prominent position of advocacy before Congress and the White House in Washington DC.

As the new millennium dawned, the United States found herself embroiled in two separate conflicts - the war in Afghanistan and the war in Iraq which collectively became known as the War on Terror.  The Bush administration feared that bioagents could be weaponized against the American homeland.  This fear was substantiated in September 2021 as a 63-year-old Florida man became sick with what would eventually be identified as _Bacillus Anthracis_ (i.e. Anthrax).  Given his previous notoriety on Capitol Hill and in the White House as a medical expert regarding HIV/AIDS, Dr. Fauci was again asked by the Bush White House to be an advisor and spokesperson for the administration’s response to bioterrorism agents.

In 2009, the H1N1 Influenza outbreak commanded the attention of the new Obama administration.  Later, in 2014, emerging from the Democratic Republic of Congo, Ebola took center stage.  In both viral outbreaks, Dr. Fauci continued his role as advisor to the president and medical spokesman.

As events progressed, Dr. Fauci began filling a multifaceted role.  He maintained a clinical and research practice at the NAIAD.  Eventually he was promoted to the director of the NAIAD.  and he was active in Washington as an advisor to multiple presidential administrations regarding healthcare related matters.

In 2020, with echoes of previous infectious pandemics, an unusual increase in severe and fatal pneumonia began to be noticed in the city of Wuhan, China.  What would come to be known as the SARS-CoV-2 or COVID-19 pandemic would become the capstone of Dr. Fauci's career.  Echoing previous administrations, the Trump Administration called on Fauci to be the medical advisor for the medical and public response to COVID.

So, what do I think about this book? 

Dr. Fauci has certainly became a polarizing figure in modern American and scientific life.  As is true for anyone who has achieved a profound degree of prominence, he has a number of supporters and critics.  As you read this review, you too may even note in yourself a sense of animus or respect.  I certainly have my own feelings.  With regard to the book, here are a few of my takeaway thoughts from the book.

At the end of the day, this book is a memoir written by the principal character.  By definition, it is going to present his career in a positive light.  There is some speculation that Fauci may have written this book to get out ahead of critics.  I can't know his motives.  But like other memoirs in this genre, we have to remember that they are ultimately designed to make the principal character look good.  In memoirs, if we can look beyond the necessary self-aggrandizement, we can often glean a lot of helpful information about history and events that we can only experience from a far.  We can often begin to see the complexities of conditions or thoughts for a thing that may have the mirage of being needlessly obvious to us.

Like it or not, over the course of his long career, Dr. Fauci has played a very important and pivotal part in the development of scientific thought.  Though there is much to criticize about his approach and response to COVID, rarely is someone this deeply invested in a field always wrong.  Dr. Fauci's name as one of the lead authors on the Harrison's Textbook of Medicine, bears testimony to his commitment to the field of medicine.  And there are a great number of people living today who, knowingly or not, have Dr. Fauci to thank for transposing HIV from a death sentence to a manageable disease.

Money and influence are two very powerful forces.  When wielded well, they can be agents for great good.  However, when misappropriated, they create chaos.  Without careful attention, ego often erodes altruism.  And ego, when coupled with money and power can have unfortunate consequence.      

Time will ultimately tell on which side of the equation Dr. Anthony Fauci lies. But there is a good deal of evidence that Fauci used his budgetary authority through NIAID as well as his influence in the agency and with government officials to affect medical research and health policy in ways that are consistent with his ideas and desires. 

In the scientific community, it is well known that if Anthony Fauci is for you, grant funding is available and there are great opportunities.  But if Anthony Fauci turns his back on you, your opportunities cease to exist.

With regard to his work on the COVID pandemic, Dr. Fauci was instrumental in helping the medical industry innovate and deliver the COVID vaccine in unprecedented time.  But he is also responsible for many of the public health COVID response policies that have been since shown to be ineffective at best and harmful at worse.

So, should you read this book?  Yes!  It is a fascinating look into the last 50 years of medical history and a man that played an influential role in shaping the practice of medicine.  But you should also read with a sense of critical appraisal and remember that this is his spin on things.