Over a nearly 40-year career at the head of the National Institute of Allergy and Infectious Diseases, Anthony Fauci, MD, has seen a seismic shift in the way that science is communicated to and received by the public. In conversation with JAMA Network Editor in Chief Kirsten Bibbins-Domingo, PhD, MD, Fauci reflects on his career at NIAID, the joys and challenges of advising 7 presidents, and shares his strategies for communicating scientific information in an ever-changing environment.
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[This transcript is auto-generated and unedited.]
Dr Bibbins-Domingo: Hello. I'm Dr Kirsten Bibbins-Domingo. I'm the Editor in Chief of JAMA and the JAMA Network. I'm joined today by Dr Anthony Fauci. Dr Fauci is the director of the National Institute of Allergy and Infectious Diseases. He's been adviser to seven presidents and is the chief medical adviser to President Biden. Dr Fauci announced recently that he's stepping down as the director of the NIAID, and he joins me today to talk about some of his reflections on his career. We know, Dr Fauci, as a physician, as a scientist, and as an extraordinary communicator, and he's going to talk with us and explore some of the themes at the nexus of all three of those issues. Dr Fauci, thank you for joining us.
Dr Fauci: My pleasure. Thank you for having me.
Dr Bibbins-Domingo: I'd like to start a little bit by just talking about the arc of your career up to this point. I read that you knew very early on that you wanted to be a physician. That you're from New York and you trained in New York at Cornell as a as an MD, and then joined the National Institutes of Health as a physician and a scientist. And it's common for people to think early about being a physician. But it sounds like from a very early stage, it was also about being a physician scientist. Would you like to tell us a little bit about that?
Dr Fauci: You know, not entirely. So, Kirsten, as a matter of fact, my main passion was clinical medicine. And when I went into medical school, it was really with the desire to be a physician, but to be someone whose main activity was dealing with patients. Because I loved clinical medicine and in my multiple years of residency, it was clear that it was something, with all due modesty, I was very good at it and I really liked it. I liked the interaction on a human basis with people. As part of my full development in a subspecialty, I had the fortune to be able to take a three-year fellowship in infectious disease and clinical immunology as a combined fellowship at the National Institute of Allergy and Infectious Diseases here at NIH. I wanted to use that almost as a personal experiment to see would I like research both basic and clinical, and was I any good at it? And it was my experience down at the NIH that really got me to be also passionate about the concept of discovery and science in the context of medicine. And I felt I certainly didn't want to give up the concept of clinical involvement. So as you know, from my career, although I do some basic research, the bulk of what I do is the nexus between clinical medicine and research. And I really discovered that during those three years at NIH and I had to make a big decision. It's a story I tell because it may, you know, give us some sort of inspiration if you want to call it that, to younger people who are at the stage at decision points in their life. I was fully intending to going back after three years at the NIH to the New York Hospital, Cornell Medical Center, where I wanted to get on the faculty, the staff and just take care of patients and do some teaching. And halfway through my fellowship, I began to fall in love with medicine. And the the chairman of medicine at the time at Cornell invited me after three years to go and be the chief resident in medicine, which is the stepping stone to just being on the clinical faculty. As you know, in many medical centers, this certainly is at the New York Hospital. But my mentor and the person who recruited me down to the NIH, Shelly Wolf, the late Shelly Wolf, he said, listen, I think that you really have what it takes to be an excellent scientist and clinical researcher. And he offered me literally a permanent tenured position at an extremely young age of 29 and a half, almost 30 years old, before I did my chief residency. And he said, we'll offer that to you right now if you want to stay. And I said, you know, I really want to top off and cap off my clinical training. So I really do want to go back and become chief resident. And he said, okay, I'll make a deal. We'll have a spot for you here at the NIH. Go to New York, do your chief residency. If you want to stay in New York, God bless you. I'll still love you. We'll still be friends. But that will be okay. However, if you want to come back and be a full time scientist physician as opposed to just the clinical practice physician, we have a job waiting for you. Dr Fauci And I obviously made the decision after my chief residency to come back. So it's kind of a little bit of a convoluted story, but it's real life and that's what actually happened right.
Dr Bibbins-Domingo: I love that because you can you can think of somebody's career, a prominent career like yours, as as being self-evident from the beginning. But but we oftentimes take these these turns that shift the direction of our careers. I also think it's important for physicians who are thinking about their career path, to think about the exploration of the other many ways in which one can have an impact as a physician, as certainly has been the case for you.
Dr Fauci: I mean, I tell students and others that ask me for advice about career, just keep an open mind because opportunities will come in front of you that you don't anticipate that might actually change your thinking about what you might want to do and have profound influence on the direction of your career. It's happened to me at multiple points in my career, including what I'm doing now as the director of NIAID.
Dr Bibbins-Domingo: Wonderful. What for you led you to be effective in that position and what types of lessons did you learn at that very early phase, that made you such a good communicator?
Dr Fauci: Well, I don't know if I can give you the precise evolution of that, but it's something that I think I had a natural capability of that. But also, I think something I learned during and I give credit, at least partial credit to the Jesuit trainings that I've had for eight years in my in my career, both in college and in high school in New York City, for example, at Regis High School, which is a very, very fine Jesuit high school in New York City, where they teach you right from the very beginning two tenets that I tell my fellows and students to try and develop precision of thought and economy of expression, which means know exactly what your message is, know what your audience is, and say it in a way that's concise, not meandering, and that actually delivers a crisp message. If you do that and practice that together with what, you have to have some natural capability of that. It's, I mean, you could do all the teaching in the world if someone doesn't have a little bit of that, I don't think you're going to create it. But if you have somewhat of a propensity to that, it's that focusing on knowing what your message is and being able to articulate it in a very crisp way. Because I have found throughout my career and the more and more I see others, the more I might confirm the style that I've developed is that if you meander around in trying to make a specific point, you lose your audience pretty quickly. If you don't know what your audience is, you may have a good message, but miss the way you present that message. So those are really some of the the guidelines that I've tried to sharpen in my own career, in my own ability and practice of communication, which is really very important. Communication in science. I mean, I have found in my own experience to be one of the most important things you can do.
Dr Bibbins-Domingo: Let's drill down on that a little bit more. I love that you have attributed this to your Jesuit training. Our producers here right before this interview said that they so enjoyed working with you at JAMA on these videos because you deliver messages in a clear way, in a concise way, and they're timely messages that are relevant to our audience. So exactly the points that that you raised, but it's really more difficult doing this when the science is unclear. And at the early phases of our new health threats like HIV, like Ebola, like COVID. The science is unclear and communicating at that point can be more challenging. What's the advice for doing communication when the science is not yet certain?
Dr Fauci: I think it's setting the ground rules in your communication that we tried to do sometimes with success and sometimes as hard as you try, it doesn't work because the general public often doesn't appreciate that when you're dealing with an evolving, dynamic situation, the way we were in the early years of HIV and the way we certainly were in the early weeks, two months of the COVID outbreak, to make it clear that you're going to have to articulate and communicate and often make recommendations and guidelines, because that's what the public looks to scientists and public health officials to do. But when you're dealing with the literally in real time emerging of new information, you've got to make it clear that to the best of our knowledge, what we know now, this is the information we have and therefore this is what our interpretation of it is. Leaving the open mind of both flexibility and humility to be able to say, you know, last month we thought that the virus was not particularly transmitted efficiently and therefore there wasn't that much of a of a need to be thinking of avoiding congregate settings or wearing a mask all the time. And now, X weeks or months later, we know that the virus has spread very efficiently from human to human, that 50 to 60% of the time it's spread by someone who has no symptoms. And in fact, masks actually do work outside of the health care setting. That changes the entire dynamics of what you thought early on when there was a lot of information saying, well, it's not a very efficient transmitting virus. It jumped from animal to human and it wasn't very efficient. Then you find out it's actually spread as much by aerosol as by droplets. We didn't know that in the first week, two or three, four weeks of January into February. So when you talk to the public, you've got to continue to emphasize that you're dealing with a dynamic situation and you will have to change as new data and new evidence comes about.
Dr Bibbins-Domingo: It's a as scientists and and as physicians, we're oftentimes expected to be the experts and so and to speak with authority that sometimes doesn't match completely with speaking with humility or saying we don't know. Which I think is what makes it oftentimes difficult in these environments, whether it's communicating publicly or just communicating with a patient about an area that we don't know. In this environment now, we're also talking about a highly polarized environment where people are coming at science and the sets of facts about science oftentimes from very different points of view, from very different, and that can make communication even even more challenging. You've faced that. Do we have strategies around communicating issues when you expect that the audience is going to hear the facts that you're communicating in very different ways?
Dr Fauci: Yeah, this has been both a challenge and I think one of the sadly one of the real stumbling blocks in our optimal response to this pandemic that we are currently experiencing is that there is in many respects, you know, people who have complete disregard for facts or distort facts and distort reality, deny data and make statements that are not at all backed by scientific information and scientific data. And what scientists have to do is just stick with the science and stick with the data. And it is very frustrating when you're dealing with individuals or institutions or groups that actually deny the reality or make statements that are just not backed up by that. You can't get rattled by that, which sometimes people do and just make sure you stick with the science and you have to do that consistently. You know, consistency in science is important. Changing when change is warranted is important. I mean, one of the classic examples that I found myself in a very difficult position was when I had to publicly contradict something that the President of the United States was saying. And you have to have respect for the people you're dealing with. Don't disrespect them, but you have to maintain your own integrity and to fulfill your responsibility to the public that relies on you as a scientist and a public health official to give you the facts and interpret the facts with you. I mean, the typical example was the whole issue of claiming that drugs like hydroxychloroquine were the new cure for for COVID, which was not backed by any data whatsoever. And yet there was a lot of pushback about that. You just have to stand your ground and stick with the data regardless of how much pressure is put on you. I did not relish or like the idea of having to publicly contradict something that the President or others in the White House said. I didn't like that because I have a great deal of respect for the Office of the Presidency, but to maintain my integrity and to fulfill my obligation to the American public, which is that is where my obligation lies. It's with the American public. I had to do that.
Dr Bibbins-Domingo: It seems, in this environment, there is an importance for, whether it's as a scientist or a physician or both, to speak to the facts as we know them. It's the responsibility, it seems to for all of us to do that more. Some of us will do it on very public stages. Some in more closed spaces. But in this highly polarized environment, there's there's also greater attack on on those who are speaking, fulfilling their responsibility as scientists and physicians. This environment probably has changed over your tenure in the office. Do you think this environment is, in fact, more polarized and there are more threats to those who are speaking out?
Dr Fauci: Without a doubt. I mean, it's it's day and night. I mean, I have been the director of NIAID for almost 40 years, 38 years. I've been dealing with HIV for the entire 41 years that we've had HIV, at least the recognition of HIV. There were disagreements back then, I think the activist community played such an important role in bringing to the attention of the science and regulatory community the need for flexibility. But those were disagreements based on some sound principles of flexibility and inclusion. Right now, the attacks on science are are really very disturbing. I mean, I'm a public figure, so it's clear that my life has been threatened and my family has been terribly harassed to the point of my needing federal agents to essentially protect us all the time. But there are many, many scientists who are not as public as I, who also get terribly harassed by an anti-science type of a trend that we're seeing in this country. I mean, it is not totally pervasive throughout the country, but there's enough of it to, I'm afraid, in some respects, intimidate scientists to wanting to speak out publicly on issues because of the fear of getting attacked themselves and their family and being harassed. That is such an unacceptable situation in society to have that. But it is, in fact, an unfortunate reality.
Dr Bibbins-Domingo: It is. It is. And and it does sound like it's getting worse. And and unfortunately, I worry that has a chilling effect on on on many who would like to be speaking out. And yet it is actually that's what's more needed at this point more than ever. Do you think that there are other things that we can be doing to to enable people to speak out more effectively? Scientists, physicians, or to protect those who are?
Dr Fauci: Yeah. I mean, I think that those of us in the field I mean, I'm not alone in this at all. But so many of my colleagues have got to continue to encourage the younger generation of people that although this is a negative aspect of what we are unfortunately experiencing now, the rewards of going in to science, the rewards of going into public health far, far outweigh the negative anti-science approach. And we just, you know, in many respects, reach out to our younger colleagues and tell them that we need you in science, we need you in medicine. We need you in public health. Don't be discouraged. I believe this anti-science trend will not last for a considerable period of time because at the end of the day, the truth will always come out. And people who are, you know, very vocal against reality, against facts, against data, are not going to win out in the end. So I would just hope that our younger generation don't get discouraged by that.
Dr Bibbins-Domingo: In your statement where you announced your retirement, you made it very clear that you are not retiring. And I want to give you the opportunity to tell us what you're going to be working on as you after you step down from from your current position since you're not retiring.
Dr Fauci: I know. My my wife tells me when people say that to just tell them you're not retiring, you're rewiring. Just I think an interesting way to put it. You know, I can't give you the details of what I'll be doing because the government ethics does not allow you to be negotiating anything on the outside unless you want to recuse yourself from everything, which I don't want to do. But I can tell you the broad 30,000, 40,000 foot principles of what I would like to do, the precise venue in which I do that I certainly have not worked that out, I'm not even discussing it, is that I do, when I said in my in my statement when I was talking about stepping down, I have been at the NIH for 54 years. I walked on to this campus in June of 1968 following my residency at the New York Hospital, Cornell Medical Center. And I've done that with that one year of exception when I went back as chief resident every day, including most weekends. I have a lot of experience here. I've been the director of the NIAID and I've had the privilege and real privilege of personally advising seven presidents of the United States and to lead an institution such as NIAID for the last 38 years. So I would like to use that experience by lecturing, by teaching, by writing with the with the purpose of what I said a moment ago, to inspire the younger generation of scientists and would be scientists and physicians and public health people to perhaps consider a career in public service or even in the private sector in the field of public health. So if I could use my many decades of experience to inspire and encourage young people, whatever wherever that venue is, you know, at another institution or just writing or traveling or lecturing. That's really what I want to do. But but and I don't know exactly what venue that's going to be.
Dr Bibbins-Domingo: Well, I'm sure we will all be waiting anxiously to to see where that will be. But there is no doubt that that that's an important area that lending your experience and commitment and and insights will really, I think, inspire many who want to pursue this path, as it has already inspired many. Dr Fauci, it's really been a pleasure, and I really thank you for taking the time to talk with us. You've been an important voice for our JAMA and the JAMA network audience, and we really have have looked to you, particularly over this period of the pandemic, and we will look to you as we continue to to work to promote science and to promote public health, as you have done. And we hope to have you back when we learn what you'll be doing next. But thank you on behalf of our audience.
Dr Fauci: I would be delighted to return with you at any time. Just feel free to let me know. I'd be happy to do that. And thank you for giving me the opportunity to be on with you today.
Dr Bibbins-Domingo: Not at all. Thank you so much.
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