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Reflections on Science and a Pandemic
David D Ho, M.D University of KwaZulu-Natal Commencement Address, 30/11/01.
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What an incredible honour it is for me to come to South Africa as an honourary graduate of the University of KwaZulu-Natal. I am here today because I have been given more than my share of praise and recognition for recent advances made in AIDS research. Achievement in research seldom belongs to a single individual. Science is a richly collaborative endeavour, and my personal recognition is merely symbolic for the many important discoveries and contributions made by a cadre of talented scientists in the field. As Isaac Newton aptly put it, "If I had seen further, it is by standing upon the shoulder of giants."
I feel extremely privileged to work on AIDS, a disease with staggering dimensions. As a young physician in Los Angeles in 1981, I was forunate enough to witness the beginning of the visible part of the AIDS epidemic. Over the course of a year, young men, one after another, presented to the hospital with a multitude of opportunistic infections, leading to death within days to weeks. It was evident that their immune system was damaged. But, by what?
Their medical histories strongly suggested the possibility of sexually transmitted agent that caused immunodeficiency. and yet, any description of a similar syndrome was nowhere to be found in the medical literature. The disease was obviously new!
In this manner, AIDS appeared insidiously and mystified doctors and scientists alike. No-one could have predicted that 20 years later, we would face a global epidemic of HIV infection that is arguably the plague of the millennium.
Today, HIV continues to spread at an alarming rate, and several hundred million infections are expected in the coming decade. Even the tragic deaths caused by the diabolical acts of Setpember 11th are quietly dwarfed by the daily tolls of AIDS in Africa. I need not remind this audience that an uncontrolled AIDS epidemic in this region could offset the socio-economic gains made over the past few decades, not to mention the countless lives taken prematurely. For a biomedical scientist, what could represent a greater opportunity than to conduct research on a lethal microbe that threatens the health of the entire world?
Members of the graduating class, as you move on in life, be prepared to take advantage of the opportunities that are bubbled up by serendipity. Then have the courage and conviction in pursuing your goals and ideals.
To me, the pursuit of science is a noble profession, one filled with excitement. Nothing is more thrilling than the process of discovery. When the wonder of nature is revealed, one is left breathless. When a scientific mystery is unravelled, one is left awestruck. Imagine the joy and intellectual satisfaction when the constant expansion of our vast universe was discovered, or when the double helical structure of DNA was solved.
Imagine, as well, the fruits of science: the sense of accomplishment in those engineers when an electrical current was transformed into light, when sound waves were transmitted across long distances in a wire, or when a cushion of air was harvested to send man soaring into the sky.
Allow me a more modest but personal anecdote. Beginning in 1991, my colleagues and I had the privilege of working with structural biologists and medicinal chemists to test small chemicals that might intercalate into the active site of the HIV protease, an enzyme essential for the production of infectious progeny virus. So overwhelming was the excitement that overtook us when substances were found to potently inhibit the protease enzyme, thereby blocking viral replication in a test tube.
Three years later, we again had the privilege of being the first to administer one of these chemicals to infected patients. Unmatched were the joy and amazement as we watched the level of HIV fall, ever so dramatically. At first, little did we know that we were sitting on top of a fundmental discovery in AIDS research. But, shortly thereafter, by simply asking: "Why does the virus fall, and why does it fall in that manner?" it quickly dawned on us that HIV must be turning over rapidly, in a dynamic equilibrium with the host.
Using data from our patients, we proved that HIV replication in vivo was rapid and remorseless. In the course of only a few weeks, the old paradigm that HIV was largely a latent virus was completely shattered. So incredible was the ensuing intellectual satisfaction that I now fully appreciate the meaning of a line in the book, The Ascent of Man. It reads: "When the answers are simple, then you hear God thinking."
Despite the breakneck speed of scientific discoveries in the field, AIDS patients already faced two decades of horror and disappointment. But, because of science, there is now hope. In the past five years, with new knowledge and new therapies, it has become possible to control HIV so effectively that the virus is no longer detectable in the infected person.
This dramatic attack on the virus is associated with a substantial clinical benefit to the patient. For the first time in this dreadful epidemic, the tide has begun to turn against the virus in certain, fortunate parts of the world. Although a cure is still not in hand, "the worst fear - the one that seeded a decade with despair, the foreboding sense that the AIDS virus might be invincible - has finally been subdued." After years of cursing the darkness of AIDS, a candle of hope has been lit by science.
The AIDS pandemic, however, is still getting worse. Worldwide, most infected persons cannot access the promising new therapies, and much remains to be done in controlling the spread of this epidemic. It is my deepest hope that the recent scientific advances will inspire government, academia and the private sector to remain vigilant and to redouble their efforts to bring an end to this tragedy. ...
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