SFMMS INTERVIEW
RIGHT TIME, RIGHT PLACE Donald Abrams, MD on his career as a pioneer in AIDS care and research, integrative oncology, medical cannabis, the right to die, and more. Steve Heilig, MPH Donald Abrams, MD finished his hematology/oncology fellowship at the University of California San Francisco just as the AIDS pandemic was exploding in San Francisco. From that challenging, even harrowing start, he went on to do landmark work on HIV itself and then on numerous other controversial medical issues. His papers have appeared in such journals as the New England Journal of Medicine and JAMA. Newly retired, he spent his whole career at “The General” and UCSF, winding up as a full professor of clinical medicine, chair of his division, and a leader in integrative oncology at the UCSF Osher Center for Integrative Medicine. A member of the SFMMS for decades, he looks back at his illustrious career here. This is from a dialogue we did for the New School at Commonweal in Marin. Interviewed by Steve Heilig, MPH. First I’d like to hear a bit about yourself in terms of where you grew up and how you first found your way into medicine. I was born in New York, and my family moved when I was five to Cleveland. I come from a long line of no doctors. They wanted me to be a rabbi, but I wasn't going to be a rabbi. Medicine, biology interested me and was probably what I was going to do. So I left Cleveland for the first time to go to Brown University where I was initially accepted into a seven-year program that was going to lead to an MD degree. But in the middle of my training, I went to Europe for my first time, came back and said, “Gee, I don't think I want to stay in Providence, Rhode Island for the rest of my life.” So I dropped out of that program and I tried to apply to medical schools, but everybody said, “Oh, you're not going to get in any place because you don't have any grades” because Brown was very progressive and did away with grades. But I wound up getting into Stanford, so that wasn’t too bad.
And how did you first get an inkling of your chosen specialty? I really thought I was going to be a psychiatrist. But I spent time at McLean hospital, which is Harvard’s psychiatric hospital, and I was working in the borderline unit, where I was more accepted as a patient than as a medical student. Then I went off to the Maudsley Hospital, which is the psychiatric Institute in London. And I was disturbed that what we called schizophrenia, they called depression. And what we call depression, they called an adjustment reaction. I said, “We're speaking the same language, but, they say this and we say that and I think I need something that's a little bit more definitive or measurable.” After Stanford, I did my internship and residency at Kaiser in San Francisco and I really bonded to a lot of my patients who had leukemia and cancers who were dying. I think for me, it had to do with my own fear of death that I always say was probably vibrated into me by my parents who lost three of my four grand24
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parents from my birth to my second birthday. My mother was 22 when I was born. She lost both of her parents and I feel that this sense of fear of losing people you love was inculcated into me and I needed to get over that. So by dealing with people who were at that transition, I found a lot of gratification. I first actually wanted to be a hematologist. But I got into my hematology fellowship at UCSF, right as AIDS broke, and AIDS was cancer-Kaposi’s sarcoma and non-Hodgkin's lymphoma. So in the middle of my hematology/oncology fellowship at UCSF, I changed my course a bit and stayed an extra year so I could get my boards in oncology instead of hematology.
And you ended up staying here, in fact, and practicing and working out of San Francisco General, which really became an epicenter for care and research. Yes. The first year of my hematology/oncology fellowship, I had a young woman die of a very bizarre leukemia. Right after she died, her father, who was in the military, came and showed me his lab report, and he had an even more bizarre leukemia. I said, “Oh, this is weird. This must be viral.” So I did a lecture for the fellows on virally induced malignancy. And in the second year of your fellowship, you're supposed to work in a laboratory and I really had no interest in that. But my mentors invited Harold Varmus to my lecture on virally induced malignancies, and he of course with Mike Bishop later got the Nobel Prize for their work on retroviruses and oncogenesis. This began a conversation between Harold and myself, which ultimately led to me spending the second year of my fellowship trying to work in his retrovirology lab, right at the time that AIDS exploded. I really thought AIDS was a retrovirus, just from what I knew about retroviruses, and I tried to convince some of the 34 postdocs that were in the lab that this disease is caused by a retrovirus, and you should help me look at some of the tissues I'm bringing back from patients that I was seeing in clinic. And everybody said, “Oh, well, there's really no such thing as a human disease caused by a retrovirus, you’re wasting your time.” Ultimately, I was really unsuccessful and frustrated in the lab. I was more interested in the syndrome of persistent swollen lymph nodes that I had perceived in gay men at Kaiser. I established a cohort, an observational study, looking at 200 gay men with swollen glands to see if they were going to go on and get the more severe manifestations of what we still weren't calling AIDS yet, but the Kaposi’s sarcoma and the pneumocystis, and that work made me think that “OK, I don't really have time to spend trying to extract DNA and RNA from lymph nodes. So I'm going to go back to the clinic” and that's what I did. That's when I moved from UCSF to San Francisco General. Paul Volberding WWW.SFMMS.ORG
