Global Health Chronicles

Dr. Gary Noble

David J. Sencer CDC Museum, Global Health Chronicles
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1:23 - Early life/Education

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Partial Transcript: To start off, could you tell us where you grew up, a little bit about your early family life, and where you went to college and medical school?

Segment Synopsis: Dr. Noble fondly describes the community where he grew up. His liberal arts education allowed him to test different fields in science before deciding on a pre-med degree. He shares his experience as a Rhodes Scholar at the University of Oxford, and how he earned his Harvard medical degree. Noble continues to describe how he was accepted into the EIS program and his first assignment as an EIS officer

Keywords: B. Dull; Bay of Los Angeles; Chief of the Virology Division; Clinton County; college; Deputy Director of CDC; farm; Harvard MD; Honour School of Mammalian Physiology; internship; J. Mason; Kansas City Field Station; L. Welt; Lansing, Michigan; liberal arts; Master in Public Health; mother; Omaha, Nebraska; Oxford; private; respiratory virology disease; T. Chin; T. Eickhoff; W. Dowdle

Subjects: Air Force; Alaska; Albion College; Balliol College; CDC [Centers for Disease Control and Prevention]; Colorado; EIS [Epidemic Intelligence Service]; Harvard University; Methodist church; Omaha Home for Boys; Peace Corps; Public Health Service; Rhodes scholarship; University of Michigan; University of North Carolina at Chapel Hill; University of Oxford; Yale University

12:46 - Sabbatical/Emerging cases

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Partial Transcript: How did you first learn about the cases of, the early cases of Pneumocystis carinii pneumonia and Kaposi’s sarcoma that were reported among homosexual men? I believe you were taking a sabbatical year back in Oxford, England, at the tie these first MMWRs were published in 1981

Segment Synopsis: When the June 1981 Morbidity and Mortality Weekly Report was published on the early cases of Pneumocytis carinii pneumonia and Kaposi’s Sarcoma, Dr. Noble was on sabbatical at Oxford University in the United Kingdom, it was after a meeting with Dr. Walter Dowdle at a conference in France when the magnitude of these findings hit him. Noble returned to CDC from his sabbatical to head up the Division of Viral Diseases.

Keywords: 1985; A. McMichael; administrative assistant; Assistant Director for Science; Associate Director for Science; Atlanta, Georgia; B. Lawrence; CDC virology lab; cell-mediated immunity; Director; Division of Viral Diseases; epidemiology of AIDS; F. Assaad; F. Murphy; Geneva, Switzerland; H. Jaffe; J. Curran; J. Skehel; London, United Kingdom; Mill Hill; new field; Oxford, United Kingdom; sabbatical; Strasbourg, France; T. Spira; W. Dowdle; Welsh; WHO Collaborating Centre for Influenza; WHO Division of Communicable Diseases; wife

Subjects: AIDS [acquired immunodeficiency syndrome]; CDC; International Congress of Virology; Kaposi’s sarcoma; Legionnaires Disease; MMWR [Morbidity and Mortality Weekly Report]; Pneumocystis pneumonia; swine flu; WHO [World Health Organization]

17:47 - Laboratory

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Partial Transcript: Can I take us back a little bit, though, first, to your time in the Division of Virology? I wanted to clarify: at the time, did the Division include both laboratory and epidemiologic components, or was it the time--?

Segment Synopsis: Dr. Noble explains how the labs worked in the Virology Division. Sharing the important role virologists played in the discovery of this new disease, how they knew it must be an infectious agent, not a bacterium or a parasite.

Keywords: Acting Director; bacterium; complement fixation; D. Francis; Division of Virology; electron microscopy; epidemiology; F. Murphy; H. Jaffe; J. Curran; J. McDade; Legionella; M. Coleman; Phoenix Field Station; R. Robinson; respiratory virus lab; serology lab; T. Spira; traditional virology; W. Dowdle

Subjects: AIDS; CDC; Legionnaires’ disease; The Task Force

21:42 - CDC Atmosphere

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Partial Transcript: What’s your recollection about the atmosphere at CDC during these early days?

Segment Synopsis: Dr. Noble explains the atmosphere at CDC during the early years, 1981, 1982, as an intense period. Initially Dr. Noble was working on respiratory vaccine development but then was asked to chair an international conference on AIDS.

Keywords: AIDS world; L. Kallings; L. Montagnier; laboratory diagnostics; R. Gallo; respiratory vaccine development; specimens; W. Dowdle

Subjects: AIDS; CDC; FDA [Food and Drug Administration]; Institut Pasteur; Interagency Group to Monitor Vaccine Development Production and Usage; Japan; NIH [National Institutes of Health]; pertussis vaccine; Task Force; U.S.

25:18 - International AIDS Conference

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Partial Transcript: You said you got a call from Walt. Was there dialog within the various Public Health Service agencies who came up with this idea?

Segment Synopsis: Dr. Noble describes his experience planning the inaugural International AIDS Conference initially a task he did not want, but eventually agreed to the job. He explains that multiple agencies from around the world were called on to help plan the conference and how complicated some of the personal relationships affected his conference planning.

Keywords: 1985; A. Fauci; ahead; Berlin, Germany; incubation period; J. Curran; L. Montagnier; M. Heckler; modes of transmission; needle exchange posts; Paris, France; press conference; R. Gallo; uncertainty; W. Dowdle; Washington, D.C.

Subjects: AIDS; CDC; Emory University; Europe; FDA; HTLV-III/LAV [human T-lymphotropic virus type III/lymphadenopathy-associated virus]; International AIDS Conference; Morehouse College; National Institute of Allergy and Infectious Diseases (NIAID); NIH; Task Force

34:07 - Maximum-security laboratories

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Partial Transcript: Any issues, thorny issues that came up that you had to get involved in when you were the Assistant Director for Science in term of AIDS? It sounds like a lot of it, the Task Force, was directly-- so you were spared, at least a lot of some of that, as the Assistant Director.

Segment Synopsis: Dr. Noble recalls working on the design and building of the maximum-security labs and his discussions with CDC Director Jim Mason regarding those plans.

Keywords: administrative level; architects; disposal; J. Mason; janitorial staff; maximum security lab; not properly done; one memorable lapse; open atrium; pathogens; recommended; waste of space

Subjects: CDC

36:29 - National AIDS Coordinator

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Partial Transcript: I think it’s time to move on to talk about your tour of duty in Washington, D.C., as National AIDS Coordinator.

Segment Synopsis: Dr. Noble discusses his year as the National AIDS Coordinator, working just down the hall from Surgeon General Koop. Questions about testing were the focal point of much of his work that year. He also describes a meeting he sat in on, in which he presented a report that Prime Minister Thatcher had issued to the United Kingdom to President Reagan. The result of that was the national AIDS mailer “Understanding AIDS” which was developed when he returned to CDC. Noble describes the political environment was not his liking and found that ignorance created bias and prejudice.

Keywords: A. Fauci; advice; AIDS community; AIDS Coordinator; allowed; Assistant Secretary of Health; B. Artim; B. Obama; ban; bias; cabinet; cabinet meeting; Capitol Building; CDC Deputy Director for HIV; Chief of Staff; country; E. Koop; educate the public; G. Bauer; gay community; Great Hall; Hubert Humphrey Building; Ignorance; intense stigma; J. Mason; J. Wyngaarden; jumping off bridges; M. Thatcher; national mailing; NIH staffer; no discussion; O. Bowen; outcome; people with HIV; political environment; prejudice; press conference; Prime Minister of England; R. Reagan; R. Windom; repealed; report on AIDS; Secretary of HHS; spectrum of opinions; spokespersons; very contentious; W. Dowdle; White House

Subjects: AIDS; British government; CDC; Congress; Europe; FDA; federal government; HHS [Department of Health and Human Services]; HIV; HIV/AIDS; Johnson & Johnson [J & J]; National AIDS Plan; NIH; Ohio; Reagan Administration; state health departments; Surgeon General; United Kingdom

50:17 - Deputy Director for HIV

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Partial Transcript: It only lasted a year, and you came back to CDC. This is now taking us to 1987. You took on a newly created position as the Deputy Director for HIV.

Segment Synopsis: Dr. Noble describes how CDC Director Jim Mason asked him to take over the oversight coordination of all the components of CDC working on AIDS.

Keywords: CDC’s adolescent health programs; Center for Environmental Health; Center for Infectious Diseases; Center for Prevention Services; Deputy Director of CDC; education; FTEs [full-time equivalent positions]; herding cats; J. Mason; matrix management; National AIDS Advisor; NIOSH [National Institute for Occupational Safety and Health]; oversight coordination; P. Van Ness; Public Health Service Advisor; W. Dowdle; W. Parra; Washington, D.C.

Subjects: CDC; NAIEP [National AIDS Information Education Program]; WHO

54:34 - America Responds to AIDS

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Partial Transcript: But you must tell us about the centerpiece of what came out of the office: the “America Responds to AIDS” information campaign and I know it had multiple components. Tell us a little bit about America Responds to AIDS.

Segment Synopsis: Dr. Noble explains the process of how ad agency Ogilvy & Mather created the “America Responds to AIDS” campaign. How the conservative political environment of the mid-1980’s made it difficult to educate the public on condom use. Difficult to gauge the effectiveness of the campaign because other things were happening besides the campaign to change people’s attitudes and knowledge. Noble goes on to describe the designing the “Understanding AIDS” mail out so that kids would not inadvertently open the brochure. Dr. Noble’s sense of the responsiveness of the U.S. government would have been very different if the disease had affected a more mainstream population rather than homosexual men and IV drug users.

Keywords: Cabinet; coming home; condom use; convey; educate; focus groups; information tools; initial phase; J. Mason; kid proof; kids; meeting/convention; parents working; Philadelphia; posters; presented; President; public; public service announcements; pushback; S. Rabin; salacious material; school; storyboards; teenagers; three-side tear off; touchy issues; various groups; veterans; Washington office; Washington, D.C.

Subjects: government; Ogilvy & Mather; United States Postal Service

61:45 - Reflections

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Partial Transcript: Now that you can reflect back, decades later. How did that change you personally and professionally?

Segment Synopsis: Dr. Noble shares his view that public health needs to be primary and not based on political correctness. After retiring from the Commissioned Corps, Dr. Noble went on to pursue something different and worked for Johnson & Johnson to create a home HIV test kit. After test markets found little uptake to sustain commercial viability, they ceased the operation. He continued his career at J & J as Vice President for Medical Affairs for the next ten years.

Keywords: academic; anonymous testing; Chicago; Commissioned Officer; corporate staff; data; E. Koop; FDA approval; G. Hardy; head hunter; HIV positive anonymously; Humphrey Building; learn; legislative office [CDC Government Affairs Office]; Medical and Public Health Affairs; pharmacy; political correctness; primary; public health; smaller company; test for HIV; test markets; Vice President for Medical Affairs; Washington, D.C.; wasn’t profitable

Subjects: AIDS; CDC; Direct Access Diagnostics; FDA; HIV/AIDS; Johnson & Johnson; North Carolina; U.S. Public Health Service

66:55 - Closing thoughts

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Partial Transcript: Looking back with hindsight, which is a luxury, can you think of any aspects of CDC’s response where you thought maybe we could have done a better job, and conversely, where you think CDC really did an outstanding job?

Segment Synopsis: Dr. Noble remarks that he wished the recognition of heterosexual transmission had been shared with the public earlier. It would have done more in terms of political support. He also shares a humorous story about Dr. David Sencer, the CDC Director at the time, and how the CDC environment wasn’t a political one but rather one where CDC management would always “have your back”.

Keywords: 1918-1919; A. Kendal; antibodies; Atlanta, Georgia; bias; CDC Director; CDC directors; chains of command; D. Berreth; D. Sencer; Democratic administration; died; G. Ford; heterosexual transmission; homosexual; Influenza Branch; isolate; J. Mason; Marine recruit; millions of people; mortality curve; pandemic of influenza; pig farm; political fit; population; prejudice; Republican administration; respiratory illness; science reporter; swine influenza; W. Dowdle; W. Roper; Washington, D.C.; White House fellow; wild-eyed liberal organization; world

Subjects: CDC; FDA; Fort Dix; HIV/AIDS; influenza; Japan; NIH; South; swine flu; The New York Times; U.S. Marines; Walter Reed Military Institute; Wisconsin