Not everyone was happy. Dr. Fauci’s U-turn had infuriated his industry PIs. Big Pharma’s front-line troopers were in open revolt against his ballyhooed reforms. The CRI system was proving a disaster for the industry. The AIDS community’s network of two hundred CRI doctors was testing anti-AIDS drugs in “parallel track” programs with low cost and quick enrollments. The community doctors, Nussbaum explained in 1990, “know more about treatment than do [Dr. Fauci’s] ivory-tower PIs hidden away from the realities of life and driven by careers that don’t reward them for furthering the public health.”74 So many AIDS patients were flocking to participate in CRI trials with caring doctors they knew and trusted that Dr. Fauci’s traditional Pharma PIs were having trouble recruiting volunteers to their clinical trials. The CRI was so successful that it began challenging the primacy of NIAID’s traditional top-down university-and hospital-based research. The PI network that formerly enjoyed an unchallenged monopoly on drug trials balked as the gay community’s upstart doctors threatened their exclusive position at NIAID’s billion-dollar research funding teat.
Big Pharma’s PIs were to Dr. Fauci what the Praetorian Guard was to the Roman emperors: Fauci was at once their commander and their hostage. Ultimately, they exercised life-or-death power over him. It’s worth recalling that the vast majority of Roman emperors died at the hands of their subordinates, with either assistance or acquiescence in their murders by their “loyal” Praetorians.
His fifty years at NIH are resounding proof of Dr. Fauci’s unerring survival skills. The political instincts that have made him history’s longest-lived—and highest-paid—public health apparatchik must have informed him that antagonizing his Praetorians would eventually be fatal. He needed to make peace.
Whether Dr. Fauci’s brief conversion was ever heartfelt, it was necessarily shortlived. Fauci’s managerial style and his deep reliance on his network of Pharma PIs doomed parallel track from the outset. Nussbaum always doubted Dr. Fauci’s authenticity: “Fauci’s conversion,” he concluded, “smacked of opportunism.” Subsequent history, including the history we are living today, supported Nussbaum’s cynical assessment.75
AIDS activists afterward learned that at the same time Dr. Fauci was telling them and Senator Kennedy’s office that he was finally testing AL 721, Teflon Tony was confiding to his Pharma PIs that he had rigged the AL 721 studies to fail: “I wanted to debunk it,” he reassured them.76 Just as he would do with hydroxychloroquine during the COVID crisis thirty years later, he designed his AL 721 clinical trials in a way that would ensure their failure and thus discredit the unpatentable medicine. Dr. Fauci told the Burroughs Wellcome PIs who dominated his “independent” committee, “Let’s put the thing into trial and get it over with once and for all.”77
Nussbaum’s verdict: “If there was any chance for a fair test for AL 721, it wasn’t going to come from Tony Fauci’s clinical trials system.”78
At first, his devious plan backfired. Instead of debunking AL 721, the NIAID study confirmed that AL 721 stopped viral replication. When those promising results began emerging, Dr. Fauci and his PIs cancelled the trial, making sure that AL 721 never went to Phase 2. Dr. Fauci told skeptical activists that he could not get any volunteers to enroll in the study. (In 2021, he would invoke the same bunko to kill NIAID’s ivermectin trials.)
Around the same time, activists realized that Dr. Fauci’s vows to test aerosol pentamidine—which he admitted before Congress was effective—were a subterfuge. Dr. Fauci opened clinical trials for aerosol pentamidine but again claimed, disingenuously, that he couldn’t populate them. Dr. Fauci’s sandbagging finally prompted frustrated HIV activists to finance and conduct their own trial of aerosol pentamidine. Completed in 1990, that study demonstrated the drug’s clear effectiveness against PCP. “The data had not been generated out of Tony Fauci’s multimillion-dollar drug-testing system,” Callen recalled. “That [Fauci’s] system has not been able to enroll a single person in its trials of aerosol pentamidine. The HIV community and community doctors generated the data. A private company, LyphoMed, funded the study.” Said Nussbaum, “The community has rolled up its sleeves and done an end run around federal incompetence and indifference.”79
Nussbaum points out that even at the height of Dr. Fauci’s “conversion,” NIAID continued to ignore hundreds of other effective drugs for opportunistic diseases because “PIs have their own scientific agenda, which is not necessarily the same as the country’s.”80
Dr. Fauci’s whole charade ended the moment the FDA approved AZT.
By then, Dr. Fauci had rigged the key committees that controlled drug approvals at NIH and FDA by stacking them with academic and industry scientists and doctors from his PI system: “Scientists who . . . made their entire careers in AZT . . . sat on committees voting on potential commercial competitors. Scientists who have had financial dealings with Burroughs Wellcome or other pharmaceutical companies have come to dominate the government’s entire clinical trials network.”81
While they actively stymied clinical trials for aerosolized pentamidine and AL 721, Dr. Fauci’s insider’s cabal greased the skids, allowing Burroughs Wellcome to skip animal testing and to proceed directly to human trials. This omission was unprecedented in the history of chemotherapy drugs, but again foreshadowed the decision to allow the Pfizer/BioNTech COVID19 vaccine to proceed to human testing without completing the usual panel of safety testing in animal models.82 Government researchers had thoroughly assessed AZT’s frightening toxicity, including its lethal effects on rodents after short-term exposures with minuscule doses. Neither NIAID nor Burroughs Wellcome ever completed any long-term animal study. Burroughs Wellcome financed Dr. Fauci’s fast-tracked human trials, fragmenting their study groups in twelve cities into small cohorts, making safety signals difficult to detect.
In 1987, Dr. Fauci’s team declared the human study a success and terminated it after four months of a proposed six-month study—a record-setting speed for chemotherapy approval. That four-month observation period was far too short for researchers to detect side effects that would occur in patients taking AZT for years, or even a lifetime. But Dr. Fauci argued that his decision to abort the study was the only ethical choice: after sixteen weeks, nineteen trial subjects in the inactive placebo group and only one participant from the AZT group had died—an outcome that could be hailed as an extraordinary 95-percent efficacy! Dr. Fauci said that those results proved AZT safe and effective against AIDS. Even more importantly for Burroughs Wellcome shareholders, Dr. Fauci cleared AZT for use on healthy HIV-positive people, meaning people with no symptoms. Following those brief clinical trials, FDA granted AZT fast-tracked Emergency Use Approval in March 1987.
A Moment of Triumph
For Dr. Fauci, the FDA licensure was a moment for exultation. After years of humiliation and failure with his critics pounding him against the ropes, he finally had something to show: a double-blind, placebo-controlled study of 3,200 people, which allegedly showed that AIDS patients receiving AZT survived at rates exponentially higher than those denied the treatment. Dr. Fauci now had a product that validated his clinical trial system. At this first whiff of AZT’s success, even before his AZT study was published, the young technocrat seized the moment to do what he always did best. He called a press conference.