Gay Men's Health Crisis: Treatment Issues, Volume 7 no. 9 - October, 1993
Derek Hodel

AIDS activists, though mostly pleased to see Healy go (with the exception of Project Inform's Martin Delaney, who urged the Clinton administration to retain Healy, a Bush appointee), reacted with a mixture of caution and outright suspicion to news of Varmus' nomination. Many were familiar with the Nobel laureate only by reputation at UCSF ("brilliant," "impossibly arrogant," "doesn't suffer fools,") or through a letter Varmus wrote, urging his colleagues to oppose the Office of AIDS Research reforms, an activist initiative recently signed into law as Title XVIII of the National Institutes of Health Revitalization Act of 1993 (S.1).

AIDS activists were of mixed views as to how to respond to Varmus' nomination. Many, including the AIDS Action Council, the Treatment Action Group, AmFAR, and GMHC, took no position before or after the nomination, opting instead to respond only if specific allegations surfaced suggesting that Varmus would be unsuitable. Project Inform took the opposite approach, and in a letter to President Clinton signed by founding director Delaney, heavily criticized the nomination process, while stopping just short of opposing Varmus altogether. Delaney cited the need to appoint another woman to head the agency, the lack of input from the AIDS community, and Varmus' opposition to Title XVIII as his chief concerns.

In fact, the debate around Title XVIII had been heated, with scientists and activists alike divided about the amendment's relative merits. As with so many Washington debates, support for the two opposing sides (essentially the reformists v. the status quo-ists) was fired up by Washington-based lobbyists, spearheaded by the AIDS Action Council on one hand and the old-guard biomedical research lobby, led by the American Association for Medical Colleges (AAMC) on the other.

One way of doing that was to solicit letters from scientists and other big wigs, and of course, a Nobel laureate like Varmus was the biggest wig of all. (Dr. David Korn, dean of the Stanford Medical School, took a lead in opposing the legislation; Dr. David Ho, director of the Aaron Diamond AIDS Research Center, took the lead in supporting it.) Varmus' letter was standard lobbying fare -- filled with inflammatory language and characterized by a misleading interpretation of the legislation, it was designed to push alarm buttons on the Hill.

Varmus co-signed the letter with Mark Kirschner, PhD, his colleague at UCSF, and sent it to 21 Massachusetts research scientists, urging them to sign, in turn, an enclosed letter to Senator Kennedy, the principal Senate sponsor of S.1, opposing the Title XVIII provisions. Apparently the letter's appeal was not universal, however, as Kennedy's office reports that they never received it.

Interestingly, in a "Policy Forum" column in Science magazine (Vol 259, p. 444-5, 22 January 1993), co-authored with colleagues J. Michael Bishop and Kirschner, entitled "Science and the New Administration," Varmus makes a variety of observations on the administration of science that presumably are more reflective of his personal views. In an ironic echo of AIDS activists, Varmus notes that "agencies that should be working together to promote research in the life sciences instead remain separated in competing departments." He offers recommendations that seem surprisingly consistent with Title XVIII, including proposals to "generate a comprehensive plan for the best use of federal funds for biomedical research"; "establish the NIH as an independent federal agency and consolidate the authority of the director over the individual institutes"; and "...increase the NIH budget by 15 percent per year, which would double the budget in current dollars by 1998." Hmmm. Sounds familiar.

Outside the AIDS community, rumors of Varmus' nomination had circulated in the Beltway for months. Varmus has strong support among many scientists inside and outside the agency, particularly bench scientists. They speak of Varmus' background as a basic (as opposed to clinical) researcher with reverence, and herald his ascension as the advent of a new dawn for the troubled agency. Basic scientists love Varmus because he, unlike many of his predecessors, would bring considerable laboratory experience to the job, having spent much of his career inside a research laboratory. (Varmus won the Nobel Prize with Bishop in 1989 for their discovery that oncogenes, cancer-causing genes found in many cells, are present in the human genetic code, and are not foreign intruders.) Though four other Nobel winners worked at the NIH, Varmus will be the first to head the agency.

The reputed second runner-up for the nomination was Judith Rodin, PhD, a psychologist and provost at Yale. Behavioral scientists, predictably less enthused about Varmus than their biomedical colleagues, for the most part threw their support behind Rodin, who also had the advantage of being a woman. In light of Clinton's commitment to diversifying federal leadership, the prospect of replacing Dr. Healy, the first woman to head the NIH (a white male bastion if ever there was one) with yet another white male, caused quite a little consternation.

In a particularly Washingtoniana twist, when the Varmus nomination seemed imminent, supporters of Dr. Rodin, led by the American Psychological Society, took an unusual but effective course: they called AIDS activists in an effort to increase opposition to the Varmus nomination, and they called the media, claiming that AIDS activists were opposed to Varmus. Since the "AIDS activists v. real scientists" characterization had been very effectively shaped and employed by the title XVIII opponents, they recognized it immediately and raced into action. The AAMC rushed out an "Action Alert" to their Council of Deans, to alert them that "elements of the AIDS community" were threatening Varmus' nomination, and that immediate action was critical.

Meanwhile, the Clinton administration, still true to form, stalled for two more months. In that time, a group of AIDS activists requested -- and was immediately granted-- a meeting with Dr. Varmus. At the meeting, which was held on the Bethesda, MD, NIH campus, representatives from AAC, GMHC, TAG, and AmFAR chatted with Dr. Varmus about their support for Title XVIII -- and his opposition. During the meeting, Varmus listened attentively and asked several pointed questions. While declining to discuss his views in detail, he did indicate a need to better understand exactly how the original OAR (established by Congress in 1988) had failed to be effective.

Later, in a letter to meeting participants, Varmus said, "I now have a much clearer idea of what you are trying to achieve by expanding the role of the Office of AIDS Research and of why you have taken the positions reflected in S.1. My views on some of the issues have been altered by our conversation, and I now believe that we probably agree about most methods (the objectives were never in doubt). The next big job is to find an outstanding person to serve as Director of the OAR, and you can be assured that I will be looking for someone with energy, commitment, and strong scientific credentials."

As we go to press, it seems likely that Varmus will easily pass confirmation hearings when the Senate reconvenes in September. It seems just as likely that Secretary Shalala will cede significant authority for hiring an OAR director to Varmus, and that he, in turn, will play an important role in shaping the AIDS research agenda for the next several years. Clinton said, upon nominating Varmus, "as one of the world's leading medical researchers, Harold Varmus will bring great strength and leadership to the National Institutes of Health." -

-------------------- Derek Hodel is the Treatment Issues Director at the AIDS Action Council, a federal lobbying organization that represents 950 community-based AIDS service and advocacy organizations nationwide.

Copyright (c) 1993 - GMHC Treatment Issues. Noncommercial reproduction encouraged. Distributed by AEGIS, your online gateway to a world of people, knowledge, and resources. Direct Dial: v.34+: 714.248.2836; v.120/ISDN: 714.248.0433 Internet: telnet:aegis.com www: www.aegis.com

931001
GM070912

Copyright © 1993 - Treatment Issues. Reproduced with permission. Treatment Issues is published twelve times yearly by GMHC, Inc. All rights reserved. Noncommercial reproduction is encouraged. Subscription lists are kept confidential. GMHC Treatment Issues, The Tisch Building, 119 West 24th Street, New York, NY 10011  fredg@gmhc.org  http://www.gmhc.org

AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Bridgestone/Firestone Charitable Trust, Bristol-Myers Squibb Company, Elton John AIDS Foundation, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .