WEBVTT - Episode 1: Gay Plague 0:00:00.440 --> 0:00:03.000 Hey, this is Leon Napok. I'm the host of Fiasco, 0:00:03.240 --> 0:00:05.640 but you may also know me from the podcasts Slowburn, 0:00:05.840 --> 0:00:09.240 Think Twice, Michael Jackson, and Backfired the Vaping Wars. I'm 0:00:09.280 --> 0:00:11.880 excited to be sharing with you the next season of Backfired, 0:00:12.000 --> 0:00:15.960 titled Attention Deficit, which is now available exclusively on Audible. 0:00:16.800 --> 0:00:20.320 Backfired is a podcast about the business of unintended consequences. 0:00:20.840 --> 0:00:23.279 In the first season, my co host Ril Pardess and 0:00:23.320 --> 0:00:25.680 I dove deep into the world of vaping and how 0:00:25.680 --> 0:00:28.440 the well intentioned quest for a safer cigarette went awry. 0:00:28.960 --> 0:00:32.879 Now we're tackling ADHD and how the push to destigmatize 0:00:32.880 --> 0:00:35.879 this hard to define childhood diagnosis has led to an 0:00:35.920 --> 0:00:38.720 explosion of stimulant use in kids as well as adults. 0:00:39.000 --> 0:00:41.560 It's a story about the promise of psychiatry to fix 0:00:41.640 --> 0:00:44.640 our brains and the power of the pharmaceutical industry to 0:00:44.680 --> 0:00:47.600 shape how we and our doctors think about what's wrong 0:00:47.640 --> 0:00:50.239 with us. To hear both seasons of Backfired, go to 0:00:50.240 --> 0:00:53.600 audible dot com slash Backfired and start a free trial 0:00:54.040 --> 0:01:01.760 that's audible dot com. Slash Backfired is intended for mature audiences. 0:01:02.360 --> 0:01:05.080 For a list of books, articles, and documentaries we used 0:01:05.080 --> 0:01:07.720 in our research. Follow the link in the show notes. 0:01:14.840 --> 0:01:17.800 This is the Gay Life ksam's Public affairs show for 0:01:17.880 --> 0:01:20.880 gentlemen who prefer gentlemen, for women who prefer women, and 0:01:20.959 --> 0:01:23.360 for people who prefer people. You don't have to be 0:01:23.400 --> 0:01:26.959 gay to listen. Good Evening, I'm Randy Alfred Tonight. Our 0:01:26.959 --> 0:01:30.640 discussion is on the new diseases, the so called gay 0:01:30.720 --> 0:01:34.840 cancer and Later. In January of nineteen eighty two, a 0:01:34.959 --> 0:01:38.000 radio show in San Francisco featured an interview with a 0:01:38.040 --> 0:01:42.279 local nurse. His name was Bobby Campbell. Good Evening, Bobby, 0:01:42.400 --> 0:01:44.920 Good Evening, Randy. Let's start the story at the beginning. 0:01:45.319 --> 0:01:48.800 Campbell was twenty nine years old. About a year earlier, 0:01:48.840 --> 0:01:51.800 he had gotten sick from an unusual infection and spent 0:01:51.920 --> 0:01:55.040 four days in the hospital. It turned out there was 0:01:55.080 --> 0:01:56.800 something wrong with his immune system. 0:01:57.040 --> 0:01:59.720 I found that I had a low white blood cell count, 0:01:59.760 --> 0:02:01.880 which which is the main mechanism the body uses to 0:02:01.880 --> 0:02:02.640 fight off infection. 0:02:03.240 --> 0:02:06.280 Not long after his hospital stay, Campbell went on a 0:02:06.360 --> 0:02:10.800 hiking trip with his boyfriend on the California coast. Afterwards, 0:02:10.919 --> 0:02:13.920 he noticed purple spots on the soles of his feet. 0:02:14.200 --> 0:02:16.359 He figured they were blood blisters from all the walking 0:02:16.400 --> 0:02:19.880 he'd been doing. But then a few weeks past and 0:02:19.919 --> 0:02:23.880 the spots still hadn't gone away. Campbell and his boyfriend 0:02:23.960 --> 0:02:27.400 got worried. There had just been a few newspaper stories 0:02:27.440 --> 0:02:30.440 published about a rare form of skin cancer afflicting gay 0:02:30.480 --> 0:02:34.000 men in New York in San Francisco. It was called 0:02:34.200 --> 0:02:35.440 Capussi's sarcoma. 0:02:35.919 --> 0:02:37.680 My boyfriend he said, oh, well, you know, cop, she 0:02:37.840 --> 0:02:40.040 does appear on the on the feet and legs. I said, 0:02:40.040 --> 0:02:40.920 feet and legs. 0:02:41.919 --> 0:02:42.720 How did you feel? 0:02:43.800 --> 0:02:47.160 It can't be me. I can't have this. It's not this, 0:02:47.320 --> 0:02:48.880 It's just a bloodlister. It's something else. 0:02:51.680 --> 0:02:54.960 Campbell got a biopsy. It showed that he did have 0:02:55.080 --> 0:02:59.959 Capussi's sarcoma, the disease some had started calling gay cancer. 0:03:00.680 --> 0:03:03.000 As a health professional, surely you had read of it. 0:03:03.800 --> 0:03:06.400 As a matter of fact, I had not read of it. 0:03:06.400 --> 0:03:08.840 It's so rare that until nineteen eighty one it was 0:03:09.080 --> 0:03:12.000 mentioned in medical dermatology textbooks with one paragraph and sort 0:03:12.000 --> 0:03:13.399 of glossed over onto the next thing. 0:03:14.000 --> 0:03:17.720 Campbell wanted to warn other gay men, especially those who 0:03:17.720 --> 0:03:20.040 didn't share his relatively privileged position. 0:03:20.960 --> 0:03:22.799 I really feel very fortunate in some ways, and that 0:03:22.919 --> 0:03:24.959 I have a lover who cares for me. I have 0:03:25.520 --> 0:03:28.840 real good health insurance, I can be on medical leave 0:03:28.880 --> 0:03:31.680 of absence. I have a lot of things going for me, 0:03:32.120 --> 0:03:34.760 and I'm worried about someone who may develop this disease 0:03:34.800 --> 0:03:38.880 and yet not have those pluses. So hopefully in my 0:03:39.000 --> 0:03:42.120 being a blabbermouth in this way has some payoff for 0:03:42.240 --> 0:03:45.600 this hypothetical person on Caster Street of Santa Monica Boulevard 0:03:45.680 --> 0:03:46.120 or whatever. 0:03:46.840 --> 0:03:50.240 This interview with Bobby Campbell is the earliest recording I've 0:03:50.280 --> 0:03:52.960 been able to find of someone talking in the first 0:03:52.960 --> 0:03:57.640 person about having AIDS. Of course, Campbell didn't know that's 0:03:57.640 --> 0:04:00.000 what it was, yet he just thought he had cancer, 0:04:00.800 --> 0:04:03.480 not realizing it was a symptom of something even worse. 0:04:04.720 --> 0:04:07.240 To me, that's what's so extraordinary about hearing him talk 0:04:07.280 --> 0:04:10.440 about it. He just knows so little about what's coming, 0:04:11.000 --> 0:04:13.920 and yet he's already certain that it's important and that 0:04:13.960 --> 0:04:15.360 people need to know about it. 0:04:16.000 --> 0:04:17.880 You've never been a closet cancer patient. 0:04:18.040 --> 0:04:20.840 No, I've never been a closet cancer patient. I tend 0:04:20.839 --> 0:04:23.000 to be very disclosing in the things that happened to me, 0:04:23.360 --> 0:04:25.920 But I just thought that the more I talked about it, 0:04:26.000 --> 0:04:27.680 the better it would be for me, and the better 0:04:27.720 --> 0:04:30.960 it would be for other people in my community. 0:04:31.200 --> 0:04:34.320 To help spread the word, Campbell took polaroid photos of 0:04:34.360 --> 0:04:37.320 his feet and put them on a poster. He hung 0:04:37.360 --> 0:04:39.640 it in the front window of a pharmacy on Castro 0:04:39.720 --> 0:04:43.400 Street in San Francisco. He also started writing a column 0:04:43.400 --> 0:04:47.320 in a local gay newspaper and distributed informational leaflets to 0:04:47.360 --> 0:04:50.719 other gay men while inhabiting a drag persona he called 0:04:50.880 --> 0:04:53.280 Sister Florence Nightmare, registered nurse. 0:04:53.440 --> 0:04:55.120 So I think it's very brave of you to be 0:04:55.240 --> 0:05:00.760 here publicly discussing a very private and life threatening of situation, 0:05:01.279 --> 0:05:03.120 and I want to commend you and thank you for that. 0:05:03.680 --> 0:05:06.920 If I don't feel brave so much as maybe I 0:05:07.040 --> 0:05:10.760 show off, I am, but it's I don't know. I 0:05:11.000 --> 0:05:13.640 feel comfortable in doing it, and as a healthcare professional 0:05:13.640 --> 0:05:17.120 and an articulate person, I have a story to tell 0:05:17.160 --> 0:05:18.800 and I'm happy to do it. 0:05:18.800 --> 0:05:22.040 It would be another six months before Bobby Campbell's disease 0:05:22.200 --> 0:05:25.000 was given the name we know it by today. It 0:05:25.040 --> 0:05:28.080 would be a year before its underlying cause was identified 0:05:28.080 --> 0:05:31.600 as a virus that destroyed the immune system, and it 0:05:31.640 --> 0:05:34.520 would be more than a decade before an effective treatment 0:05:34.720 --> 0:05:35.320 was developed. 0:05:35.920 --> 0:05:38.040 Anything you want to add before we close for the evening, 0:05:38.520 --> 0:05:41.280 Take care of yourselves, brothers and sisters. You're the only 0:05:41.279 --> 0:05:41.800 one you've got. 0:05:48.200 --> 0:05:50.880 This season of Fiasco is about the early years of 0:05:50.920 --> 0:05:54.520 the AIDS epidemic, when a diagnosis was tantamount to a 0:05:54.520 --> 0:05:55.120 death sentence. 0:05:56.040 --> 0:06:00.719 AID syndrome has spread in epidemic, proportions of the victims 0:06:00.720 --> 0:06:01.159 have died. 0:06:01.400 --> 0:06:04.279 Over the course of eight episodes, you'll hear the story 0:06:04.320 --> 0:06:07.960 of a scandal unlike any we've covered before. It's a 0:06:08.000 --> 0:06:10.840 story about denial and misinformation. 0:06:10.440 --> 0:06:12.760 People are saying you can catch as from a mosquito 0:06:12.800 --> 0:06:14.560 bite are in swimming. 0:06:14.200 --> 0:06:17.400 Pools, and the politics of a disease that intensified old 0:06:17.440 --> 0:06:19.640 prejudices and activated new ones. 0:06:19.839 --> 0:06:21.880 I believe that God does not judge people. 0:06:21.920 --> 0:06:22.800 God judges sin. 0:06:23.200 --> 0:06:25.760 It's also a story about what people do in the 0:06:25.800 --> 0:06:30.159 absence of scientific clarity, when the authorities they depend on 0:06:30.480 --> 0:06:33.880 an answer to can't or won't figure out what to do. 0:06:40.960 --> 0:06:44.120 We'll return to Bobby Campbell in a bit. For now, 0:06:44.360 --> 0:06:46.400 I want to go back to the fall of nineteen 0:06:46.440 --> 0:06:50.000 eighty when a group of doctors and scientists scattered around 0:06:50.040 --> 0:06:54.159 the country first became aware that something inexplicable was happening 0:06:54.200 --> 0:06:59.960 to gay men. I'm Leon Napok from Audible and Prologue projects. 0:07:00.320 --> 0:07:04.360 This is Fiasco, season five, the AIDS Crisis. 0:07:05.040 --> 0:07:09.200 It's mysterious, it's deadly, and it's baffling medical science. 0:07:09.279 --> 0:07:13.040 A new deadly disease that no one understands, not where 0:07:13.080 --> 0:07:15.360 it comes from, how to treat it, or how to 0:07:15.400 --> 0:07:16.480 stop it from spreading. 0:07:16.760 --> 0:07:19.600 A great medical puzzle. It's known as gay plague. 0:07:19.680 --> 0:07:22.520 They are violating the laws of nature, and nature is 0:07:22.560 --> 0:07:23.320 striking back. 0:07:23.360 --> 0:07:26.120 What I was hearing was from patients. My circle of 0:07:26.240 --> 0:07:28.600 friends are disappearing. 0:07:28.080 --> 0:07:30.640 And within just five years, almost everyone I knew was 0:07:30.640 --> 0:07:31.320 dead or dying. 0:07:43.360 --> 0:07:46.880 One night in the fall of nineteen eighty, doctor Jeffrey 0:07:46.920 --> 0:07:49.520 Green was called into work to see a new patient. 0:07:50.200 --> 0:07:53.720 It was after midnight and the man needed Green's urgent attention. 0:07:54.200 --> 0:07:57.080 I remember everything I remember about this patient because it 0:07:57.120 --> 0:08:00.840 was probably one of the most poignant moments of my life. 0:08:04.560 --> 0:08:08.160 It was about one o'clock in the morning, but when 0:08:08.160 --> 0:08:10.040 I saw him, he was in the intensive care unit 0:08:10.120 --> 0:08:12.640 and he was being intubated, being put on a breathing 0:08:12.680 --> 0:08:14.960 machine because he was gasping for breath and very short 0:08:15.000 --> 0:08:17.520 on oxygen and he needed to be put on the 0:08:17.560 --> 0:08:21.559 breathing machine for survival. Had a very high fever, and 0:08:21.960 --> 0:08:23.880 I was confused. I didn't know what was going on. 0:08:27.680 --> 0:08:30.680 Green was working in the Infectious disease unit at Bellevue 0:08:30.680 --> 0:08:34.400 Hospital in Manhattan. Bellevue was one of the biggest public 0:08:34.440 --> 0:08:38.200 hospitals in the country and an especially interesting place to 0:08:38.240 --> 0:08:42.080 be an infectious disease specialist because it was cheaper and 0:08:42.120 --> 0:08:45.880 more accessible than the private hospitals in town. Bellevue served 0:08:45.880 --> 0:08:49.360 as a safety net for patients from all walks of life, 0:08:49.400 --> 0:08:52.400 and because it was in New York. Many Bellvue patients 0:08:52.400 --> 0:08:56.960 were people from abroad carrying diseases that were uncommon in America. 0:08:57.040 --> 0:08:59.640 As Green put it, he and his colleagues saw a 0:08:59.640 --> 0:09:00.840 little bit of everything. 0:09:01.240 --> 0:09:04.839 They could be three four, five or even more new 0:09:04.920 --> 0:09:08.280 patients per day in terms of consultations, and I would 0:09:08.320 --> 0:09:11.360 go see those patients to give my opinion as to 0:09:11.400 --> 0:09:14.360 what was going on, to help make diagnoses, and to 0:09:14.440 --> 0:09:16.520 help in orchestrating the treatment. 0:09:17.000 --> 0:09:19.959 The patient Green saw that night in nineteen eighty had 0:09:19.960 --> 0:09:24.760 the initials HW. He was thirty eight years old. A 0:09:24.840 --> 0:09:28.000 round of tests confirmed that there was something seriously wrong 0:09:28.080 --> 0:09:29.199 with his lungs. 0:09:29.480 --> 0:09:30.599 Very poor oxygenation. 0:09:30.840 --> 0:09:34.439 His chest X ray was almost white, very advanced pneumonia 0:09:34.480 --> 0:09:35.880 in all five lobes of the lung. 0:09:36.360 --> 0:09:39.640 There didn't seem to be anything about HW's medical history 0:09:39.760 --> 0:09:41.640 that could explain what was happening to him. 0:09:42.240 --> 0:09:43.200 Before he was in debated. 0:09:43.200 --> 0:09:45.520 I was able to get a medical history, which previous 0:09:45.640 --> 0:09:49.640 to that admission was pretty benign. He was a guy 0:09:49.679 --> 0:09:53.720 in his thirties. He was a gay man. He was 0:09:54.240 --> 0:09:59.160 in the last throes of life. He lived long enough 0:09:59.200 --> 0:10:03.600 to go for an open lung biopsy, which is where 0:10:03.679 --> 0:10:06.719 the surgeon takes the patient to the operating room and 0:10:06.800 --> 0:10:09.960 through the rib takes a wedge of lung tissue to 0:10:10.040 --> 0:10:12.800 examine to see what we might be dealing with. And 0:10:12.840 --> 0:10:14.760 it was on that tissue that he saw these five 0:10:14.800 --> 0:10:16.920 different infections. 0:10:17.800 --> 0:10:21.479 Each of the five infections HW was fighting was extremely 0:10:21.600 --> 0:10:25.360 rare on its own. For all five to show up 0:10:25.440 --> 0:10:30.520 in one young, apparently healthy person was unheard of. Taken together, 0:10:30.960 --> 0:10:34.160 the infections seemed to suggest some kind of immune suppression. 0:10:34.840 --> 0:10:37.160 Someone with a healthy immune system could have fought them 0:10:37.160 --> 0:10:42.040 off without even knowing they had been exposed. HW had 0:10:42.080 --> 0:10:44.199 other symptoms too, and I. 0:10:44.120 --> 0:10:47.800 Remember seeing this very large purple lesion on the patient's nose. 0:10:48.440 --> 0:10:50.440 But we had bigger fish to fry, you know, with 0:10:50.480 --> 0:10:53.480 this guy, so we weren't so concerned about his skin lesion. 0:10:54.280 --> 0:10:57.400 The only thing that was clear was that HW's immune 0:10:57.400 --> 0:10:59.320 system had somehow gone haywire. 0:11:00.000 --> 0:11:02.559 I realized that this patient had to have come in 0:11:03.280 --> 0:11:06.439 with severe immune suppression for whatever reason. 0:11:06.480 --> 0:11:09.119 We weren't sure, but we felt. 0:11:08.880 --> 0:11:11.920 That the only way that he could have had all 0:11:12.000 --> 0:11:15.600 these things simultaneously would be basically an immune system that 0:11:15.679 --> 0:11:20.559 had died before he did. 0:11:21.640 --> 0:11:24.000 Jeffrey Green was one of the first doctors in the 0:11:24.040 --> 0:11:27.080 world to notice that a strange and deadly new disease 0:11:27.280 --> 0:11:30.160 was spreading in the United States. It was not how 0:11:30.200 --> 0:11:33.360 he thought his career would turn out. Growing up during 0:11:33.360 --> 0:11:36.240 the nineteen fifties in a sheltered, middle class neighborhood in 0:11:36.320 --> 0:11:39.679 Queen's Green always imagined that being a doctor would be 0:11:39.720 --> 0:11:41.760 a job in which he got paid to help sick 0:11:41.800 --> 0:11:42.720 people get better. 0:11:43.400 --> 0:11:47.360 I was birthed by my family's GP. He used to make. 0:11:47.200 --> 0:11:49.800 House calls, come give shots in the house, make me 0:11:49.840 --> 0:11:50.280 feel better. 0:11:50.360 --> 0:11:51.040 When I was sick. 0:11:51.600 --> 0:11:53.280 You know, he was like part of the family really, 0:11:53.440 --> 0:11:57.280 and as I was thinking about my future, even as 0:11:57.280 --> 0:11:59.200 a very young kid, you know, I always thought being 0:11:59.240 --> 0:12:02.120 a doctor would be a thing that I would like 0:12:02.200 --> 0:12:02.640 to try. 0:12:03.400 --> 0:12:06.680 By the time Green entered medical school in nineteen seventy two, 0:12:07.280 --> 0:12:09.439 doctors who made house calls were pretty much a thing 0:12:09.440 --> 0:12:13.160 of the past. Instead, Green went into the field of 0:12:13.200 --> 0:12:14.120 infectious disease. 0:12:15.240 --> 0:12:21.719 Communicable diseases recognize no boundaries, always watchful for epidemics. Practicing 0:12:21.760 --> 0:12:24.680 physicians constitute the first line of defense. 0:12:24.840 --> 0:12:29.440 I liked the idea of finding a problem, diagnosing a problem, 0:12:29.480 --> 0:12:33.000 and fixing a problem. Infectious diseases was the only one 0:12:33.000 --> 0:12:36.040 that attracted me. We had tools to actually cure people. 0:12:36.080 --> 0:12:38.760 I mean, sometimes people didn't make it, but for the 0:12:38.800 --> 0:12:42.760 most part, patients who got admitted with severe infections got better. 0:12:43.480 --> 0:12:46.600 The science of treating infectious diseases had advanced to an 0:12:46.640 --> 0:12:50.959 almost unthinkable degree during the twentieth century. For much of history, 0:12:51.160 --> 0:12:55.800 diseases like pneumonia and tuberculosis had routinely proved fatal. By 0:12:55.840 --> 0:12:58.840 the time Green entered the field, the vast majority of 0:12:58.880 --> 0:13:01.880 patients seeking treatment for infections could be cured in a 0:13:01.920 --> 0:13:02.920 matter of days. 0:13:03.520 --> 0:13:06.360 Now, at last, the hidden enemy could be examined under 0:13:06.400 --> 0:13:09.280 the probing such light of science. The hunt was on 0:13:09.440 --> 0:13:13.000 for contagious diseases and their causes, wherever they existed. 0:13:17.720 --> 0:13:22.200 Green's patient HW died just eight days after Green started 0:13:22.200 --> 0:13:25.680 taking care of him. To the doctor, it looked like 0:13:25.720 --> 0:13:30.120 a freak occurrence, not an accident, just deeply confusing. 0:13:31.000 --> 0:13:34.200 It was something nobody had ever seen. Of course, this 0:13:34.360 --> 0:13:37.559 was a one and only case. This was case one. 0:13:38.600 --> 0:13:43.000 Case two walked into Bellevue a few weeks later. Once again, 0:13:43.520 --> 0:13:46.520 Green noted that the patient was gay and was suffering 0:13:46.520 --> 0:13:50.360 from a strange infection in his lungs. Not long after, 0:13:50.920 --> 0:13:53.720 Green was making rounds at the hospital when he overheard 0:13:53.760 --> 0:13:56.080 a conversation about yet another patient. 0:13:56.920 --> 0:13:59.679 While I was doing my note in this little cubicle, 0:14:00.360 --> 0:14:02.600 the other four or five people were discussing this case, 0:14:02.640 --> 0:14:04.600 and I was sort of listening peripherally to what was 0:14:04.640 --> 0:14:08.040 going on. And then I heard them snap an X 0:14:08.120 --> 0:14:10.719 ray into the X ray box, and I looked over 0:14:10.760 --> 0:14:15.439 my shoulder at the X ray, and I said, to them, 0:14:16.160 --> 0:14:19.600 is that patient gay? 0:14:19.720 --> 0:14:23.720 The other doctors were shocked. How could Green possibly know 0:14:23.800 --> 0:14:26.840 such an intimate detail about a patient? He had never met. 0:14:27.000 --> 0:14:27.960 The guy who was presenting. 0:14:28.000 --> 0:14:31.400 He was standing and holding this blue plastic folder with 0:14:31.800 --> 0:14:34.400 all the papers of his admission in his hand. He 0:14:34.480 --> 0:14:38.200 dropped it on the floor and the guy said to me, how. 0:14:38.040 --> 0:14:40.760 Did you know that? And I said, I don't know. 0:14:41.720 --> 0:14:42.680 I don't know how I knew it. 0:14:43.240 --> 0:14:45.080 And then later in the day I said, I know 0:14:45.120 --> 0:14:47.160 how I knew it, because that X ray looks like 0:14:47.480 --> 0:14:49.800 HW's X ray, the patient number one. 0:14:51.520 --> 0:14:54.960 Within several months, Green says he had encountered about a 0:14:54.960 --> 0:14:59.000 dozen patients who, like HW, were afflicted by rare forms 0:14:59.000 --> 0:15:03.400 of pneumonia and skin lesions. As you heard Bobby Campbell 0:15:03.440 --> 0:15:06.240 say in his interview on The Gay Life, those skin 0:15:06.360 --> 0:15:10.360 lesions were capaces sarcoma, a rare form of cancer typically 0:15:10.440 --> 0:15:14.200 found in people from sub Saharan Africa and older Mediterranean men. 0:15:15.240 --> 0:15:18.680 Some of Green's patients had other, even more unusual symptoms, 0:15:19.240 --> 0:15:23.760 including ones associated with diseases typically carried by animals, not people. 0:15:24.720 --> 0:15:28.720 We had typocarcosis, which is a pigeon fungus that caused 0:15:28.760 --> 0:15:33.840 the meningitis, you know. We had toxoplasmosis. We had disseminated 0:15:33.880 --> 0:15:37.320 microbacterial diseases, which is again a typical. 0:15:37.480 --> 0:15:40.560 Why these rare infections were suddenly popping up with a 0:15:40.560 --> 0:15:45.680 textbook medical mystery into many doctors, including Green, The fact 0:15:45.680 --> 0:15:48.360 that the first few cases had all presented in gay 0:15:48.440 --> 0:15:51.880 men seemed like a really important clue. 0:15:52.280 --> 0:15:57.480 It's a little embarrassing to discuss this because I thought 0:15:57.480 --> 0:16:00.160 we were looking at a gay disease. The first three 0:16:00.240 --> 0:16:03.120 or four cases that I saw were in people who 0:16:03.200 --> 0:16:05.880 were gay, so it wasn't that. 0:16:06.120 --> 0:16:08.960 Unusual for me to jump to that conclusion. 0:16:09.520 --> 0:16:12.680 It was the only clear connection Green could see between 0:16:12.720 --> 0:16:16.960 the patients. Soon, his assumption was that anyone suffering from 0:16:17.000 --> 0:16:20.320 this new affliction had to be gay, even if they 0:16:20.360 --> 0:16:21.360 refused to admit it. 0:16:23.080 --> 0:16:26.920 What happened was on case number four, the guy came 0:16:26.960 --> 0:16:31.240 in with numasisters pneumonia, and he also passed away, but 0:16:31.360 --> 0:16:35.400 before he did, he absolutely denied being gay. And I 0:16:35.480 --> 0:16:37.200 can't tell you how many times I asked the guy. 0:16:37.280 --> 0:16:39.720 He must have thought I was a freak or something, 0:16:39.760 --> 0:16:42.920 because I kept asking him, are you sure you're not gay? 0:16:43.080 --> 0:16:48.040 And after he passed away, I reached out to this 0:16:48.080 --> 0:16:51.000 woman who I became friendly with while she was visiting, 0:16:51.160 --> 0:16:52.440 and I said, what's a story? 0:16:52.480 --> 0:16:55.200 I mean, was he gay. You know, he's not gay. 0:16:56.240 --> 0:16:58.200 And I said, well, so where did he live? He 0:16:58.240 --> 0:17:02.160 said so he was living in a halfway house for 0:17:02.280 --> 0:17:02.960 drug addicts. 0:17:03.800 --> 0:17:06.560 Intravenous drug users were known to be at high risk 0:17:06.680 --> 0:17:09.240 for any disease that could be spread through blood, like 0:17:09.280 --> 0:17:13.080 hepatitis B or C. But when Green went to Harlem 0:17:13.119 --> 0:17:16.240 to visit the halfway house, he learned something that seemed 0:17:16.240 --> 0:17:17.960 to confirm his original assumption. 0:17:18.680 --> 0:17:23.359 And I talked to people who knew him, and I 0:17:23.400 --> 0:17:26.199 started asking him the same question, and everyone said, no, 0:17:26.240 --> 0:17:26.880 he wasn't gay. 0:17:27.000 --> 0:17:29.400 But someone said, but he turned gay tricks. 0:17:30.320 --> 0:17:33.200 Green wasn't exactly sure what that meant, and asked the 0:17:33.240 --> 0:17:35.040 person to elaborate, and he. 0:17:35.040 --> 0:17:37.719 Said, well, to make money for his habit, he you know, 0:17:37.760 --> 0:17:38.640 he would go with men. 0:17:38.680 --> 0:17:40.199 He would go with women, he would you know. 0:17:40.720 --> 0:17:44.160 So, I said, finally I figured it out. It is 0:17:44.600 --> 0:17:47.280 something to do with gay sex or whatever. 0:17:47.800 --> 0:17:51.080 Looking back, it's striking how easy it was to conclude 0:17:51.080 --> 0:17:55.520 that the new disease was quote unquote gay related. Even 0:17:55.520 --> 0:17:57.439 when he was faced with someone with a history of 0:17:57.520 --> 0:18:01.320 intravenous drug use, Green remained and convinced that the patient's 0:18:01.359 --> 0:18:12.399 sexuality was the key factor. As more cases emerged in 0:18:12.440 --> 0:18:15.359 early nineteen eighty one. Green was sure that he was 0:18:15.359 --> 0:18:20.000 seeing something totally novel, and without knowing the cause, the 0:18:20.040 --> 0:18:22.680 best he could do was try to use existing treatments 0:18:22.680 --> 0:18:26.280 for his patient's symptoms. The trouble was the cases he 0:18:26.359 --> 0:18:30.320 was seeing sometimes required specialized medications that could be difficult 0:18:30.320 --> 0:18:35.280 to obtain. For instance, to treat numicistas pneumonia, Green needed 0:18:35.320 --> 0:18:39.880 a drug called pentamidine, but because the demand for pantamidine 0:18:39.920 --> 0:18:43.960 was usually incredibly low, it wasn't profitable for drug companies 0:18:44.000 --> 0:18:48.280 to market it. Instead, pantamidine was controlled and dispensed by 0:18:48.280 --> 0:18:52.119 the Centers for Disease Control in Atlanta, Georgia. The CDC 0:18:53.080 --> 0:18:54.399 so yet have to request it. 0:18:54.520 --> 0:18:57.119 They would take a history and if you had the 0:18:57.160 --> 0:19:02.440 requisite answers, they would release one patience worth of pentamidine 0:19:02.880 --> 0:19:04.919 for a treatment course of two to three weeks. 0:19:05.800 --> 0:19:09.919 The CDC was established in nineteen forty six primarily to 0:19:09.960 --> 0:19:10.920 combat malaria. 0:19:11.359 --> 0:19:14.560 CDC is one of the task forces of the Public 0:19:14.600 --> 0:19:15.360 Health Service. 0:19:16.320 --> 0:19:19.679 It quickly evolved into an all purpose first response service 0:19:19.800 --> 0:19:22.280 for various medical emergencies. 0:19:22.280 --> 0:19:26.480 Ready to help each state in its fife against communicable diseases. 0:19:27.600 --> 0:19:31.320 Anytime there was a major disease outbreak, the CDC was there, 0:19:31.640 --> 0:19:35.080 doing the investigative legwork and providing assistance to doctors and 0:19:35.160 --> 0:19:38.880 nurses on the ground. As a result, the CDC had 0:19:38.880 --> 0:19:41.000 a hand in some of the greatest achievements of the 0:19:41.040 --> 0:19:44.639 modern era, including the eradication of polio in the United 0:19:44.640 --> 0:19:47.560 States and smallpox all over the world. 0:19:47.920 --> 0:19:51.440 And historic victory over a dread disease. Here scientists usher 0:19:51.560 --> 0:19:54.040 in a new medical age with the monumental reports that 0:19:54.160 --> 0:19:58.480 proved the vaccine against crippling polio to be a sensational success. 0:19:58.920 --> 0:20:02.159 The CDC had special outposts at major airports where they 0:20:02.200 --> 0:20:05.960 distributed medications to the doctors who needed them. That was 0:20:06.000 --> 0:20:08.120 where doctor Green would get his pentamidine. 0:20:08.680 --> 0:20:09.720 I would get in. 0:20:09.720 --> 0:20:14.360 My car and drive to JFK and I think there 0:20:14.440 --> 0:20:19.480 is a CDC quarantine office and they had the shipment 0:20:19.560 --> 0:20:22.160 waiting for me, and I get back on the car, 0:20:22.240 --> 0:20:24.080 drive back to Bellevue and hang the drug. 0:20:24.680 --> 0:20:24.920 Soon. 0:20:25.280 --> 0:20:28.800 The trip to JFK Airport was part of Green's regular routine, 0:20:29.760 --> 0:20:33.800 but a CDC technician fielding his requests for pentamidine noticed 0:20:33.800 --> 0:20:36.119 that Green was not giving a reason for why his 0:20:36.240 --> 0:20:40.800 patients had numicistus pneumonia. The technician knew that it usually 0:20:40.880 --> 0:20:44.359 only appeared in patients who had compromised immune systems, like 0:20:44.440 --> 0:20:48.400 kids with leukemia or people who had received organ transplants. 0:20:48.840 --> 0:20:51.600 But Green wasn't indicating anything like that on the forms 0:20:51.600 --> 0:20:54.399 he was filling out. So either he was doing something 0:20:54.440 --> 0:20:59.120 wrong or there was an inexplicable new outbreak happening, one 0:20:59.119 --> 0:21:02.159 that the CDC needed to get on top of immediately, 0:21:03.160 --> 0:21:07.360 So the technician alerted her supervisor. Though the details were sketchy, 0:21:07.720 --> 0:21:10.960 there appeared to be a growing cluster of numisistus cases 0:21:10.960 --> 0:21:16.520 in New York. As it turned out, Green's requests for 0:21:16.560 --> 0:21:19.840 pantamidine were not the only troubling signal popping up on 0:21:19.880 --> 0:21:23.639 the CDC's radar at this time. By the late spring 0:21:23.680 --> 0:21:27.159 of nineteen eighty one, multiple physicians around the country had 0:21:27.160 --> 0:21:30.280 started asking the agency for help treating young gay men 0:21:30.359 --> 0:21:34.480 with inexplicable symptoms. Among the CDC officials on the receiving 0:21:34.560 --> 0:21:37.040 end of these requests was doctor Mary Geinan. 0:21:37.520 --> 0:21:41.679 We started getting phone calls from physicians saying, you know, 0:21:41.760 --> 0:21:46.320 I have this young man in the intensive care unit 0:21:46.920 --> 0:21:50.320 and he's dying and I don't know what's wrong with him. 0:21:50.720 --> 0:21:54.399 Geynan was a specialist in venereal disease, so when a 0:21:54.440 --> 0:21:57.280 written report on some kind of outbreak among gay men 0:21:57.480 --> 0:22:00.879 came into the CDC, she was asked to review it. 0:22:01.280 --> 0:22:04.600 Since it wasn't a disease that we knew about, there 0:22:04.680 --> 0:22:08.280 was no expert in CDC about it, but all of 0:22:08.320 --> 0:22:13.760 these men also had herpes virus infections, so they asked 0:22:13.840 --> 0:22:16.520 me to make a comment on it. 0:22:17.040 --> 0:22:20.080 The report would turn out to be a foundational document 0:22:20.160 --> 0:22:23.200