From Defensive Strategy to Front Line in War on AIDS : Dr. William Paul leaves immunology lab to coordinate research, budgeting on the disease because of ‘obligation to do our best.’

Why would a bench scientist--an internationally known immunologist regarded as one of the best in his field--leave his laboratory to work in a hornet’s nest?

Put another way, why would anyone who has dedicated virtually his entire career to research willingly give most of that up to take on a job where he must juggle the competing interests of policy-makers, members of Congress, activists and researchers all involved in the battle against AIDS?

“This is a terrible disease,” Dr. William Paul says. “We all have some obligation to do our best. We all ought to get involved. I am motivated by a genuine wish to make whatever contribution I can.”

Paul, 57, who now heads the Laboratory of Immunology at the National Institute of Allergy and Infectious Diseases--part of the National Institutes of Health--is about to become director of the newly transformed Office of AIDS Research at NIH and NIH’s associate director for AIDS research.

He has been associated with NIH for more than 30 years and has headed the infectious disease agency’s immunology lab since 1970. He is an expert in the workings of cytokines--a family of chemicals produced by the immune system--and is the discoverer of one of them, interleukin-4.

The Office of AIDS Research was given new powers by Congress last year and is expected to wield considerable clout in deciding how the federal government will use its $1.3 billion in AIDS funding. Its responsibilities include developing a strategic plan for the NIH-wide AIDS research program, coordinating AIDS research activities across NIH and developing consolidated budget estimates.

It also will develop a budget for fighting AIDS, similar to the National Cancer Institute’s budget, which will be directly submitted to the President.

Paul also will oversee a soon-to-be-established national advisory council and administer a discretionary fund for exploring unanticipated scientific opportunities and unexpected public health crises.

Paul says he intends to listen to all voices in the AIDS community, from researchers to activists, but does not believe that the nation is ready to launch a “Manhattan Project” against AIDS, as some activists have advocated.

“If we were to invest our money in a crash program, we would have to be very wise in choosing, because we could easily make the wrong decision,” he says. “The consequence of (choosing wrongly) is that we would fall behind. It’s not yet clear where the great push should be.

“Most people don’t understand that most of the things scientists do don’t work. Those of us who have done it our whole lives know that. Others are not completely attuned to that--they don’t understand the frustration of trying something and not getting it quite right. That’s why a Manhattan Project won’t work. We could end up not doing things where the greater opportunities lie.”

His approach will be to “take a broader view of what needs to be done, to plan things to avoid duplication and seize the opportunities.

“The process has to be put in place where we put the best of our science and clinical investigation to work against this disease,” he says.

Many believe that Paul’s lack of prior involvement in AIDS research will be a strength, rather than a weakness, that he can assume his new duties unencumbered by activities or alliances that could color his thinking. If there are critics of his appointment, they have chosen to remain silent for now.

“Dr. Paul is a highly accomplished and respected immunologist who brings the intellect of a world-class scientist, a commitment to biomedical research and a thorough knowledge of the organization and operations of the NIH to this vital position,” said Dr. Mervyn F. Silverman, president of the American Foundation for AIDS Research.

Paul comes from the institute that has become known as the government’s lead institute on AIDS research. It is the same institute headed by Dr. Anthony S. Fauci, who ran the Office of AIDS Research before it was reconstituted. Fauci, who is deeply involved in his own AIDS research, long has served as the government’s leading spokesman for its AIDS research activities.

But those who supported the legislation that moved AIDS research and funding decisions into the new office had come to believe, whether true or not, that Fauci’s dual roles were a conflict of interest.

Fauci calls Paul “a very distinguished immunologist” and says: “I look forward to working with him. . . . I’ve known him for 25 years. He’s a good guy.”

Paul says he intends to try to continue to spend some time in his lab because “my work gives me pleasure,” although he acknowledges that “there will be days where that will be impossible.”