Dr. Wayne Shandera

Wayne Shandera

MILLER: This is Dr. Bess Miller, and I'm here with Dr. Wayne Shandera. Today's date is March 8, 2017, and we are in Atlanta, Georgia, at the Centers for Disease Control and Prevention [CDC]. I am interviewing Dr. Shandera as part of the Oral History Project, the Early Years of AIDS: CDC's Response to a Historic Epidemic. We are here to discuss your experience during the early years of CDC's work on what would become known as AIDS, the Acquired Immunodeficiency Syndrome. Dr. Shandera, do I have your permission to interview you and to record this interview?

SHANDERA: Yes, you do, Dr. Miller.

MILLER: For this oral history of the early years of AIDS at CDC, we are focusing on the first several years, beginning in June of 1981 with the publication of the first MMWR on the five cases of Pneumocystis carinii pneumonia among homosexual men in Los Angeles, where you were stationed. You've had a very 00:01:00impressive career since those days, involving teaching, research and clinical care. I know you have been involved in doing research and mentoring on HIV/AIDS and providing clinical care to patients with AIDS for many years throughout your career, and we will want to hear about this as well. Let's begin with your background. Would you tell me about where you grew up, your early family life and then where you went to college?

SHANDERA: I grew up in Texas. I was born in Fort Worth and put up for adoption at two days of age. I grew up in San Antonio in a Czech and German household. The name Shandera is Czech, and it means equivalent to Sanders or descendant of Alexander. My mom was of a German background, and they were descendants of people who settled in the 19th century in the Texas German and Czech towns. I 00:02:00had a very large extended family, a very loving environment. I went to a Catholic grade school and a private high school and then received a partial scholarship to go to Rice University in Houston. I attended Rice for four years and then was accepted to Johns Hopkins for medical school and spent the four years in Baltimore. I matched in internal medicine at Stanford [University] in California and spent three years at Stanford.

MILLER: Who or what influenced you to go to medical school?

SHANDERA: I had an uncle who was a physician in downtown San Antonio. He was a GP [General Practitioner] who had an abundant practice and did a lot of gynecology, and he was something of a role model. Then in medical school, I remember [Dr.] William Greenough was an outstanding example of someone who combined the love for sciences with the service. He'd worked in Bangladesh. Then at Stanford, I had a number of attendings who were in infectious diseases: [Dr. 00:03:00Thomas C.] Tom Merigan and Jack Remington, and I remember them fondly and the impact they had. It was actually Jack Remington who recommended my going into CDC.

MILLER: Tell us more about that. It sounds like you were kind of a superstar. Medical school at Johns Hopkins, internship and residency at Stanford, and then fast-forwarding after EIS [Epidemic Intelligence Service] and Infectious Disease fellowship at Mass General. So how did CDC fit in there for you? Was that a difficult decision?

SHANDERA: CDC was a surprise. I didn't exactly know what it was about, and I think most physicians don't. As you have trained for three years in internal medicine, you want to do that. And then you end up in an office with a completely different mindset: from individual patients to group mentality. It's not always a facile transition, and at times I would work at volunteer clinics. 00:04:00I did that at the Venice and Silver Lake Clinics in Los Angeles in the evenings, free, just to be able to use some of my medical skills from residency days. But at the same time, CDC is something of a fraternity, especially when you're in the field, because you interact constantly with other field officers. We sent reports to each other, and these were pre-email, pre-fax days. We would send by mail reports of what we were doing. [Dr] J. Lyle Conrad was the director of field services, and I remember sending him reports as early as October about cases of unexpected lymphadenopathy occurring among gay men in the San Fernando Valley of Los Angeles.

MILLER: When you talk about field services and so on, you went through a so-called match to try and identify the best assignment for you. Did they have 00:05:00certain assignments at CDC headquarters, others in the field, and you matched with Los Angeles field service? Did you want to be in the field?

SHANDERA: No. I really thought I wanted to be at the center. I had more personal reasons for being back in the South, elderly parents, reestablishing friendships and relationships from Baltimore days, and I thought I wanted to be back in Atlanta. But I matched in Los Angeles, and I was a bit surprised. I included it because I thought it might be interesting, but I think it was my 10th choice or something.

MILLER: Tell us a little bit more about the beginning of that, the setting of that assignment. You wind up with Los Angeles; you move out there. What was the scenario at--you were at the health department?

SHANDERA: I was sent to LA [Los Angeles] County Health Department. California is divided into the group in Berkeley and the group in Los Angeles, the LA area being almost half the state in population. So CDC has the equivalent of a state 00:06:00for Los Angeles. I was an EIS officer sharing office space with a parasitologist who wrote the local health bulletin. It was a vast communicable disease network that worked out of that office, with specialists only in hepatitis. Others were hospital-acquired diseases and a statistician just for the office. It was a large group.

MILLER: Who was your supervisor?

SHANDERA: [Dr.] Shirley Fannin, who grew up in the hills of Kentucky, was a single pediatrician who adopted a child with congenital heart disease. She was well known by the medical community and the public because she was often on television and enjoyed the limelight and was quite a colorful figure.

MILLER: Was she head of the health department?

SHANDERA: No. She was head of the communicable disease [unit]. You're asking me who the head of the health department was, and the name escapes me for the moment.

MILLER: But I remember Shirley Fannin as a very larger than life--

SHANDERA: She was. As Lyle Conrad said, she had a heart of gold, and she'd do anything for you.

MILLER: What did you begin doing in this assignment, before the AIDS issue?

SHANDERA: I had an abundance of activities. I had an outbreak of stillbirths in Long Beach, an outbreak of epidemic neuromyasthenia that a neurologist in Santa Monica identified, an outbreak of diarrhea at a daycare center in east Los Angeles, an outbreak of bacteremic campylobacter throughout Los Angeles County; another epidemic of non-A, non-B [hepatitis], which is now hepatitis C, with stem-cell donors.

MILLER: So you weren't bored.

SHANDERA: By no means. There was an abundance of things to do in Los Angeles.

MILLER: You mentioned Lyle Conrad, and he was the head of the field services.

SHANDERA: In Atlanta, that's right.

MILLER: What was your relationship with Lyle? Did he supervise you as well?

SHANDERA: I think he kept us at a distance. He was sort of avuncular or paternal, and he didn't keep a day's on--he didn't supervise projects. I wanted a more academic experience, with learning to write, and that's part of the reason I asked for a transfer to enteric diseases. My roommate from college worked with [Dr.] Paul Blake and told me about the great experience in enterics with learning to write, and more of an academic discipline.

MILLER: So in your second year did you move to----

SHANDERA: I moved to enterics, that's right. That was interesting, because I got to enterics just when everyone either retired or left, and there were only Paul 00:09:00Blake and myself in the office for the first week. I think [Dr. David] Dave Taylor was in Southeast Asia and the other principle investigators, too, but I had several outbreaks and was sent back to my hometown of San Antonio to investigate a typhoid fever outbreak.

MILLER: Did that round out your EIS experience?

SHANDERA: Oh, very much. Very much, exactly.

MILLER: Let's shift our focus to what was to become known as AIDS. How did you become aware of the early cases of Pneumocystis carinii pneumonia among gay men in Los Angeles?

SHANDERA: It was largely because of my acquaintance with [Dr. Michael] Mike Gottlieb. He is an immunologist allergist, and I think it's interesting that an allergist broke the outbreak. He was at Stanford when I was at Stanford. He was on the consultation service, with [Dr. Halsted] Hal Holman as the attending. He was the fellow and I was the resident in April of 1981, and that proved to be a 00:10:00key relationship, because we were both moving to LA at the same time. He was moving to UCLA [University of California, Los Angeles] as a faculty member, and I was downtown. Being in the habit of going to medical grand rounds, I often went to UCLA. I'd sit with him and talk about, oh, we need to do a project; we have to think of something together. We just thought about Dr. [Andrei] Calin in Stanford and HLA-B27's [human leukocyte antigen] association with gastroenteritis. We thought, what can we do? And we couldn't quite identify a project.

But then over the ensuing months, he called me several times about something unusual occurring among gay men in Los Angeles and that later he saw cases of pneumocystis. He had three cases at UCLA. There was a fourth at Cedars Sinai [Medical Center] that a colleague identified. Then Mike came down to my office, 00:11:00and, lo and behold, there was a fifth at St. John's [Medical Center] in Santa Monica on my desk that day. I've never been able to explain if this is just some super-unnatural serendipity or what exactly was the case. I know that [Dr.] Betty Agee and Shirley Fannin, the two directors of the office, knew many doctors in the area who were involved with the care of patients with this unexplained lymphadenopathy. They didn't know what it was. In fact, one of the leading lymphoma pathologists at USC [University of Southern California] called our office in December of 1980 and asked for an explanation of six cases of a distinct pathologic entity with unexplained lymphadenopathy. My officemate, the fellow who worked in parasitology, and I said, oh, it must be either gay or drug use. We interviewed the six, and we could get risk factors for only two of them. We couldn't pin it down.

So we knew for months that something unusual was going on, and I remember in the reports to Lyle Conrad that I would say, these look like the cancer patients I saw at Stanford. They seem to be so immunosuppressed, the ones we were hearing about, that had Candida [albicans]. They had the kind of manifestations of an immuno-suppressed state.

MILLER: That is incredible. So by July 4 an additional ten cases of PCP [Pneumocystis carinii pneumonia] were reported among gay men in California, and by August 28, 108 cases of one or both of the two diseases among gay men were reported nationally, and 40% had died. Did you have the opportunity to see some of the patients?

SHANDERA: I saw the very first patients. As I said, I saw the one in Santa 00:13:00Monica, and Mike and I got together at my apartment one Sunday and wrote up the MMWR [Morbidity and Mortality Weekly Report] article, the PCP article. This is, as I say, before fax or email, and we had to call it in word by word to CDC. The Centers for Disease Control, because it involved homosexual men, put it on the second page. They didn't want it on the first page.

MILLER: Say more about that.

SHANDERA: I can't say. The editor was [Dr. Michael B.] Mike Gregg. That was their policy. I don't know anything more about it. I know that the LA Times picked it up immediately. I got to go into the kind of Lou Grant room at the LA Times in downtown LA and discuss it with their science writer, who immediately saw the importance of that and put it on the first page of the Los Angeles Times.

MILLER: So you were involved in writing the--

SHANDERA: The very first publication, exactly right. I went over to the ICU 00:14:00[intensive care unit] at LA County [Medical Center] the next week, and there were two more cases of PCP. What we thought was just an isolated phenomenon occurring among a few gay men--at the time PCP sometimes occurred among starvation victims in Eastern Europe or patients with leukemia at Memphis St. Jude's--this was something unusual. I said, this is bigger than I thought. I had no idea that it was going to be the pandemic of the century. But I saw the next two cases, what would be the sixth and seventh, at the ICU at LA County.

MILLER: What were your feelings about the patients?

SHANDERA: That they were unusually immunosuppressed, that it was--we thought at the time--there was a publication from UC [University of California] San Francisco that CMV was particularly prevalent at that time among the gay community. We thought that maybe CMV was the cofactor, that there was a killer 00:15:00strain of CMV out there.

MILLER: Cytomegalovirus.

SHANDERA: Cytomegalovirus, that's right. So that was a real consideration. I moved back to Atlanta at the end of June, so I was really involved only in the first few cases. Then I was on the task force here for a while, but at the same time was also working in enteric diseases in a very short-staffed office. I went to about six or seven of the first meetings and then it took off in its own direction. I guess our paths diverged for awhile; they converged later.

MILLER: That is incredible. So they were in the intensive care unit; presumably these people died.

SHANDERA: Two additional ones. These weren't the ones that [were] reported. These were more cases than we --right.

MILLER: So clinically, the ones in the ICU, did they have multiple pathologies or just Pneumocystis--

SHANDERA: I don't remember. I wasn't the caretaker for them. I just remember being told that they had mainly PCP, what we now call PJP [Pneumocystis jiroveci 00:16:00pneumonia], PCP, right. "J" being [Otto] Jirovec, the Czech investigator who discovered pneumocystis, because Pneumocystis carinii is a mouse pathogen.

MILLER: Incredible. What was the atmosphere among clinicians in LA during this period? Did you have an opportunity to go to any clinical conferences where these cases were presented?

SHANDERA: No. They wouldn't have been presented because nobody knew about this. The first reports of this actually were not in the MMWR. They were in the LA County News Bulletin, because my coworker, the parasitologist, wrote the local bulletin reporting on flu and other entities, and he said, oh, that's important. He put it in the LA County News bulletin. It actually preceded the MMWR, but it was a local publication. There were no clinical conferences about this at the time. It didn't have a name. It was gay-related immunodeficiency [GRID]. There 00:17:00was much uncertainty. There was much concern, because the epidemiology was so akin to hepatitis B, that the third group, besides gay men and drug users, that came down with this were healthcare workers. There was much fear among the medical community at the start of the outbreak, that they also would be involved. I remember this surgeon at UCSF [University of California San Francisco] who dressed up in a space costume each time she went into the OR [operating room]. There was much, much concern about that.

MILLER: At that early phase, were there hypotheses--you mentioned possibly a CMV variant. Were there other hypotheses?

SHANDERA: I did a small case-control study at the Hollywood Gay Men's Center just to see if there was some unusual entity like tetracycline or another 00:18:00antibiotic or something that was taken. I was later criticized for doing that without proper consent. I just felt that something needed to be done, in case it [an agent] could be taken off the market. I brought it [the study] back to Atlanta, and Paul Blake looked at it and said, yes, this is important. We looked at the data. There was nothing that was positive in what I could find from that small short survey, and I don't think that was ever published. I met Mike Gottlieb a couple of years ago. He practices in West LA, and we went for dinner. We both talked about the fact that there's a bit of revisionist history that's occurring with respect to this disease, and it bothers us.

MILLER: Tell me more about that.

SHANDERA: One is in [Dr. Siddhartha] Mukherjee's book Cancer:The Emperor of all Maladies [The Emperor of All Maladies: A Biography of Cancer]. He attributes the onset of the discovery of HIV [human immunodeficiency virus] to oncologists in New York in April or earlier in 1981, and it's just wrong. I've written to the 00:19:00author, and I never got an answer.

The second is CDC itself, who claimed that there was a run on pentamidine at the time, and neither of us can remember hearing that. People would say, oh, we knew about this because people were asking for so much Pentamidine for PCP. We worked with the group in parasitic diseases, because PCP was considered at the time a parasite. It's since been taxonomically discovered to be a fungus that is treated like a parasite, but it was through parasitic diseases that we worked. The group there later claimed that they had a run on Pentamidine, but I would think that either Mike or myself would have learned about that.

In addition, Mike Gottlieb and the group at UCLA very much wanted to be the 00:20:00first in print to go through the peer-review process of a standard publication. That would take months to a year, so it was felt that the use of the public health system was the way to get it out into print first. Mike called me, and he wanted to have it put in the MMWR for that reason. Incidentally, I was listed only as the Epidemic Intelligence Service officer, because that was the habit at the time: that you [CDC staff] did your work in the spirit of service, anonymously. Mike knew of doctors in New York that were working on a similar outbreak, namely Dr. [Alvin E.] Friedman-Kien, of Kaposi's sarcoma. He really felt that that was related to this, and that was going to go into print first. So he felt some urgency about printing this material through a Public Health Service publication first.

MILLER: Were you there long enough to know how reporting of these unusual cases 00:21:00started coming in to the health department? Was a surveillance system set up at that time?

SHANDERA: For other diseases?

MILLER: For this unknown--

SHANDERA: No. There was no surveillance system. In fact, we spent a lot of time talking about Campylobacter and an outbreak of that, and setting up a surveillance system for that in the county at the time. But it didn't have a name. It didn't have a [case] definition. It was only the next year that the group at CDC set up an abitrary construct of a definition to work with the entity.

MILLER: What about the political climate around this? What was that like in LA? Was there beginning to be concern among the affected populations? Was there 00:22:00starting to be--this was the Reagan [President Ronald Reagan] era, so do you remember--

SHANDERA: I don't remember a lot of concern at that moment, because it wasn't well identified. I do remember that there was a real spirit of service and working for the underserved in the LA County health department. I think that philosophy as much as anything helped get this propelled; that there was an amazing sense--and Los Angeles also had an unusual liberal political climate, and it still does, but it did at the time. Paul Conrad was that wonderful cartoonist in the LA Times, and I'd go off to the--I lived in the Pico-Robertson area of West Los Angeles, and I'd pick up the newspaper the night before, every night at the lab a block away at the newsstand. I was there the night that John Lennon was killed, for example, I remember someone coming in and hollering that. Then in December of 1980, I remember that Conrad--that was the day right after 00:23:00the four nuns were killed in El Salvador, the Maryknolls, working there, and he took the Pietà and reversed it and had Christ holding one of the nuns, and it said "El Salvador" at the bottom. It was very touching. So you might think of LA as a rather shallow and superficial town. Many in northern California would say that instantly or unequivocally, but at the same time there was a real sense of compassion for the underserved, for the migrants, for the people who needed help in that city. I just assumed that that was kind of universal, but it isn't. LA really personified that.

MILLER: Tell us about any other aspects of your EIS experience, when you look 00:24:00back at that point.

SHANDERA: There was a lot of frustration at the time, because it's so different from what you've done. The transition isn't easy from medical residency to working in EIS, especially because we'd done most of our residencies in very academic centers. Then you'd go into a health department, where academics is not paramount at all; a sense of service is probably what guides the places to do things. It becomes a very sort of political world at times, too, and because of that it's not an easy adjustment. You have to test skills that you haven't necessarily trained for. You're sent back to Atlanta often to meet with others and discuss how you're adjusting to it.

The day-to-day work is quite different. You're alone in an office trying to find out--you're a disease surveillance officer trying to find out what unusual is 00:25:00going on in your community, and are you going to be able to do this? It's an unusual experience. I think it tests you and trains you with talents that you don't expect. I suspect that the field services positions taught you more leadership and positions that you'd use as a health officer, for example, than the field services, where you acquire more of the skills to write and use statistics properly.

MILLER: Throughout your career as an academic infectious disease specialist and clinician, you ended up working on many aspects of HIV/AIDS, both domestically and internationally. Can you tell us some about your research? For example, tuberculosis in Houston, Johannesburg or other--

SHANDERA: I've done a variety of projects, and I don't think I've done anything really paramount in any of this. What I've done the most of is take care of patients I've taken care of indigent patients with AIDS in Houston, and that's been the basis of my career. I've attended multiple meetings. I've presented at a lot of conferences, and I attended the early AIDS in Africa conferences where one of six of us were kidnapped in Kinshasa [Democratic Republic of Congo] at different times, each of us individually, ostensibly by thugs, but it was actually the local police that were doing it. So it's been a career with a sense of adventure, I think.

MILLER: Tell us about your experience treating indigent patients with AIDS over the years.

SHANDERA: I think it's been facilitated because of Ryan White funds, that it 00:27:00requires support money at either the local or national level. The hemophiliac with HIV from Indiana was the case that resulted in the outpouring of funds from Congress for AIDS that are still being used to run a lot of the AIDS clinics. Our patients in Houston are very indigent, and some can't even afford the co-pays for their medications. I'm concerned about what the local cuts are going to be now with their medical care. That's a real concern.

MILLER: Tell us about the early years. Were there services and clinics before there were drugs?

SHANDERA: I did work in Parkland at University of Texas, Southwest Dallas, in 1987, and that was before--that was when AZT [azidothymidine] came out. It was the first medication that was available. We worked there just at the time the 00:28:00tests were becoming serologically available and at the time that the medications were available. We were probably brewing resistance, because we were treating with only single agents at the time, and when patients came in to the clinic for even Candida esophagitis, they had to be treated with amphotericin 3 times a week. We didn't have the armamentarium of antifungals, antivirals that we have now.

I remember a year before that CDC helped me get a job teaching preventive medicine in South Carolina. While I was there, I saw a TV show on the priest in Molokai that had the leper colony, and I thought, that's interesting. I should do something like that. I had a chance to work in AIDS in Dallas. I moved back into it, really--Father Damian, I was mentioning--moved back into it in Dallas in 1987. There was a tense political climate. There wasn't a nursing home that 00:29:00would take an AIDS patient in all of Dallas or Fort Worth. Finally one woman did, and she was on national television with the local health department, who found that her place wasn't clean and closed it down. There was a major church in downtown Dallas that said, "AIDS: the wrath of God." There was a lot of antipathy towards the AIDS community.

With individual patients, we found that some families were accepting; others were completely rejecting. There was a real tension associated with the disease at that time. It was Dr. Daniel Barbero, who ran the clinic, and myself who did most of the work. It was difficult, because the patients were so sick and dying so often that it was hard on the providers also at that time. I think that's changed markedly since then, fortunately.

MILLER: Many people at that time, and after that, certainly in Africa, many of 00:30:00the healthcare providers experienced burnout and just--

SHANDERA: We did. I did myself. I took off and I took some math graduate courses at SMU [Southern Methodist University] for a few months. Then I worked at the health department and got back into clinical medicine, but I just--you burned out very, very much. Then after that I received an academic appointment back at Baylor in Houston, where I'd been an undergraduate, and I moved back into an academic role after that.

MILLER: Tell us more about managing those patients.

SHANDERA: They became almost like family. You knew them so well in the early years, because they were there all the time. A nurse and I and the social worker and his wife even went to the funeral of a patient. At that particular funeral, 00:31:00I remember the brother getting up and saying, we didn't approve of his lifestyle, but we wish to offer condolences to the family. That sort of thing. But that sense of fear and judgmentalism pervaded even through the funerals. The patients were unusually kind and easy to work with, but at the same time there was an unbelievable sort of fear in the community about the disease in the '80s.

I remember that [Dr. C. Everett] Koop was appointed Surgeon General, which is one of the best things Reagan did about the outbreak. Because of that he [Koop] sent a letter to every household in the country, informing people about what HIV really is, and that helped us sway a lot of the attention and discrimination that existed. Then Rock Hudson developed the disease. He was the first really well-known figure that had AIDS. He was very much the macho character on screen, 00:32:00but his life that acquired AIDS [was] otherwise. In the process I think people understood the disease very differently, and so it helped it. There was subsequently a much greater offering of support through financial groups, like the group that Elizabeth Taylor and Mike Gottlieb founded in Los Angeles.

MILLER: Mike Gottlieb was involved--

SHANDERA: He was originally involved in that. He was on the original board. I think there were some problems in his relationship with Elizabeth Taylor that involved, it's public knowledge, and he's no longer in that. The patients were wonderful. They were easy to take care of, but at the same time there was a real sense of fear among the public at large. I think that that is much less so now. With the number of medications available and the fact that so many people know 00:33:00somebody who's had the disease--but it's a different disease to treat now. It's more like a chronic disease. It's like treating hypertension or diabetes or cancer. In fact many of our patients have all of those diseases as well, so you become a primary care provider for all of those entities.

MILLER: Were you ever afraid for your own health?

SHANDERA: One time I had a needle stick from a patient who had AIDS, after I was doing a spinal tap in a clinic that was not very well set up, and I did go on AZT for a few weeks. The medicine made me very sick, and fortunately nothing ever happened. But I had a needle stick doing a spinal tap, and that really worried me at the time. That was the only time I've really been concerned.

MILLER: When you look back, how did CDC training impact on your career?

SHANDERA: I think it gives you a group orientation, which most physicians don't have. You think about diseases of groups, and you think about prevention. Each time I teach a group of students, I end up the session always talking about what you can do to prevent further hospitalizations. Other than give vaccinations, can you give a course of antibiotics? What else should you do to teach them to prevent future illnesses? The orientation toward prevention is so important. When you hear something like on the news last night, about the $1 billion cuts in prevention, it's just very disturbing. It's almost inconceivable that that could occur. Prevention is so very important, and it's never been funded terribly well, but to cut even what's available is not good.

I think it also gave me a focus towards certain diseases, and I've kept up an interest in HIV. I've gone to countless conferences all over the world on HIV. 00:35:00Because I enjoy travel, that's been great. I enjoy other cultures and getting to know them and learning languages. That was a real benefit, growing up in a German and Czech household. I had the orientation toward hearing other languages, and so I picked them up fairly quickly. I belong to reading groups in German and French in Houston, and right now I've been studying Mandarin. I studied that when I was at CDC, but I dropped it many years ago. It's not easy.

MILLER: Fascinating. Were you involved in any clinical care or research internationally?

SHANDERA: I did a project on HLA and extrapulmonaryTB [tuberculosis] in South Africa, and I presented the results at a grand rounds at Chris Hani Baragwanath Hospital there. I've been on a mission board for a group in Guatemala, and I presented at countless other meetings elsewhere. Those are the main things I can 00:36:00think of.

MILLER: Has your faith or religion been a part of--

SHANDERA: I think it was part of the reason I went. When I first was assigned to Los Angeles, I just wanted to gasp and say, oh, I'm not going to move there. But there was a part of me that said I should. I was a member at St. Ann's at Palo Alto, and I thought, I felt some sense of obligation. I'm glad that I said yes to that and followed through with it. It would have been very different if I had spent my career just staying at Stanford. I think the tendency to want something very selfishly at some point in life differs very much from answering yes to a call that you don't quite understand. It allows you to offer yourself in a different way to the world. That's a very, very difficult issue, and it's something that people confront all the time.

MILLER: Which is?

SHANDERA: Saying yes to those calls and responses to go out and offer of yourself in a different way from your own kind of selfish desires.

MILLER: Sounds like it's really enriched your life.

SHANDERA: It has very much, that's right. It has.

MILLER: In closing, I'd like to ask you a little bit about the impact of AIDS on you in any way that we haven't discussed. You were really a part of something that changed the history and course of public health. How has that affected you personally?

SHANDERA: I think, being in internal medicine and epidemiology, there's always a great desire to know. That desire to know also involved a very personal aspect of my life, which is the adoption, which I never could find an answer to. I 00:38:00sought for 40 years and found the answer just this year, and that was through genetic testing services, by serendipity. I had an aunt who was tested four years ago and found out that I was her nephew. She thought, how can this be? I've never heard of you. She and her husband are academicians in Missouri and have been wonderful colleagues now in helping me with some of my work. We've published a book on social ethics this last year. I, in the process, have found the original couple who gave me up at a very early stage of their marriage in 1952. I found that I have a whole new family, with two other brothers and nephews that I had never met until just these last few months.

Sometimes the desire to know was so great that when I left CDC, I went to Mass General [Massachusetts General Hospital] and I worked on my fellowship. I knew a 00:39:00wonderful psychiatrist there, who said I had to find out what was causing this kind of deep-rooted unknowingness. The Harvard motto is "veritas," the truth; the truth will set you free. He really had me go in depth into this search, and I sought through many means for many, many years. It took an element of almost supernatural action to have an aunt test on a system that I was using as well, to actually find the individuals. They were ecstatic when I actually did find them. I found the mother only 12 days before she died, and she said it was like a forest opening up. She was in ecstasy that this actually finally occurred.

MILLER: That's marvelous. Any other final comments?

SHANDERA: No. I'm very grateful that I've had such an interesting and wonderful career, and I owe so much to CDC. Sometimes you get very upset with the 00:40:00administration. That's natural with any organization, but in the end I think the results have been very positive.

MILLER: Thank you very much.

SHANDERA: Sure.

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