Interview with Dr. James J. Goedert

This is an oral history interview with Dr. James J. Goedert of the National Cancer Institute on the history of the NIH response to AIDS. The interview was conducted on 10 March 1993 in Dr.Goedert's office in the Executive Plaza North Building in Rockville, Maryland. The interviewers are Dr. Victoria A. Harden, Director, and Dennis Rodrigues, Program Analyst, of the NIH Historical Office.

Harden: Dr. Goedert, I would like to start this interview by asking you to tell us about your background. Why did you decide to go into medicine? What was your undergraduate and medical school education? How did you come to the NIH?

Goedert: I was born and raised in Chicago. I think I started toying with the idea of going into medicine probably in high school, because I felt some desire to be of service to people in a practical way. Although I never considered myself a scientist, I had some aptitude for math and science, and so I thought that medicine was probably a reasonable path. That [belief] continued well into the middle of my college years at Yale, which is where I went as an undergraduate. I did not go whole-hog into premedical studies, but started early and went through a gradual transition. Again I found that I was not a scientist, per se, and was rather clumsy in the laboratory. I never really had an affection for laboratory science, but I did find that I still enjoyed science in a more general way. I also found that I was one of those peculiar people who actually had a liking for statistics. In addition, I liked psychology, so I was a psychology major as an undergraduate.

I was adequate in other fields, and enjoyed a diversified experience in college, ranging from literature to architecture and art, as well as taking the typical basic premedical sciences and the psychology major. I went to medical school at Loyola University in Chicago, the Stritch School of Medicine, which, at that time, was a three-year medical school. This meant that I started on July 1, right after I graduated from college in May, but I was able to dispose of the preclinical sciences in twelve months. Since I was not very keen on laboratory science, that was fine with me.

I enjoyed medical school very much, and when I got to the wards and the clinical rotations, I also found that I was particularly drawn to internal medicine. It was not the hands-on kind of approach that you get in surgery, but it was more diagnostic, cerebral, and deciphering. Beyond that, I felt a calling to take care of patients with cancer.

Harden: That is interesting. Many people become depressed taking care of patients who do not have a good prognosis.

Goedert: Yes. I did reasonably well in medical school and got some strong recommendations. I applied for a number of internships and matched at one of my first choices, Georgetown here in Washington, D.C. I had an extremely good clinical experience at Georgetown in all facets of internal medicine, ranging from emergency care and intensive care medicine to taking care of cancer patients. Again I felt a particular calling to the cancer patients, perhaps because it was obvious to me that simply listening to them and responding to their basic needs, especially for pain relief, was so much appreciated. After three years of internal medicine, I went into a Fellowship in Medical Oncology.

Georgetown had at that time, and still does have, a very strong program in medical oncology, but it was very much oriented, as I think most programs are, towards pharmacology and basic laboratory science. The one limitation on my own affection for oncology that I discerned was that I probably did not want to be completely consumed by taking care of cancer patients. I felt that it would be–or could be–quite depressing to do that 100 percent of the time. I thought that I would probably like to do some research, but not in pharmacology. I got the NIH [National Institutes of Health]–or maybe it was the NCI [National Cancer Institute]–manual and thumbed through it and I found the Environmental Epidemiology Branch with [Dr. Joseph] Joe Fraumeni and [Dr. Robert] Bob Hoover. It was still the growth era in cancer epidemiology at the NIH, and they took me on for a second fellowship year.

Harden: You did not have any particular epidemiology training until you entered this fellowship at the NIH?

Goedert: Absolutely none. No training whatsoever.

Harden: Except for your inclination towards statistics.

Goedert: Yes. But my knowledge was very basic. I only had one course in college and essentially a non-existent course in medical school.

Harden: I would like to ask you now what you think you might have done had AIDS not come up. We are at the point in your career when you saw one of the early AIDS patients in the Washington, D.C., area. This appears to have changed the course of your career.

Goedert: It changed the focus of my research, I think.

Harden: That is a good distinction. Please go ahead.

Goedert: I had already decided to do cancer epidemiology as my cancer research focus. It is not an area that most cancer centers have as a major research interest, so there is not much funding in the outside community. But, fortunately, there is the large Cancer Epidemiology Program at NIH. I came with the idea that I might be at NIH for two, or maybe three, years, and then eventually go to a university and try to eke out a position on grant support. I think, as is true for most fellows who come here, that I was unsure exactly what kind of cancer discoveries we could make. I was never intimidated by my lack of formal training, because I think the clinical training affords at least as much insight into cancer etiology as does some kind of formal training in statistics.

Harden: Is there any formal training?

Goedert: Not cancer, per se, but epidemiology certainly.

Harden: I was thinking in terms of the CDC's EIS [Centers for Disease Control Epidemiological Investigative Service] Unit, that kind of epidemiological training. But for cancer epidemiology, which is, as you say, a fairly new program...

Goedert: The EIS program is more what we would call public health, which is practical experience in disease control, identifying the bug in the mayonnaise or something like that.

Harden: That is not what you were doing in this program, because it was in cancer epidemiology?

Goedert: Right. I think one of the things that continues from very early on in my time at NIH, and continues to be true of the most successful work that we do, is trying to approach the problem of cancer, AIDS, or any other disease, with as much breadth of knowledge as possible and with an open mind toward new possibilities. Without AIDS, I would be doing very much what I am doing now, but with more of a focus on cancer. I am actually getting back to the cancer field at the moment.

To give an example of the breadth of experience I had in the first few months that I was at NIH, there was an investigator here named [Dr. Elizabeth] Beth McKean who was a year ahead of me. She had also done part of her fellowship at Georgetown, so I knew her from there. Just in casual conversation we discovered that we each had a patient with an uncommon kind of cancer of the kidney, who had a minor congenital anomaly, an extra nipple. Beth had some formal training in clinical genetics and recognized that there could be an embryologic connection between the breast and the kidney. Through our connections with the oncology community here and at local hospitals where I had received some of my internal medicine training, we were able to address the question of whether there was a connection between extra nipples and kidney cancer. There was. Subsequently, we did this same kind of investigation with testicular cancer.

What I would probably be doing without AIDS is similar to that, identifying novel associations with particular cancer types, either in the clinical area, or, with the explosion in what is conventionally called biochemical epidemiology, using laboratory assays to identify new connections with disease associations, probably biochemical markers of cancer, as has been going on elsewhere in our program.

Rodrigues: I notice that you had another early paper besides the paper on the phenomena of the extra nipple. I believe that it had to do with...

Goedert: Polyarteritis nodosa?

Rodrigues: Right. I was wondering if there was any connection between that research and your interest in Kaposi's sarcoma, since it seemed that there might be a relationship, because the tumors have a lot of unusual vascularization. Was there a connection?

Goedert: It is a reasonable question, and it is not a potential association that has occurred to me before. I think polyarteritis is an inflammation of larger arteries, larger vessels, than is true of the small capillaries that proliferate in the Kaposi's sarcoma tumor. So I do not think there is any particular connection there. The potential connection that we identified in that one patient–it was a single case report of a woman whom I took care of when I was at Georgetown, (ironically, she had previously been seen at NIH by [Dr. Anthony S.] Tony Fauci because of her polyarteritis)–was the link between two diseases, that is, polyarteritis and hairy cell leukemia. The latter is a disease we still do not understand very well, but there have been some suggestions that it might be linked to retroviruses, to HTLV-II in particular. It is one of the few cancers that show remarkable regression with immune modulator therapy, that is, with IL-2 [interleukin-2] therapy. It suggests that there may, in fact, be some infectious disease link between the polyarteritis and the hairy cell leukemia.

I keep my eye out for such new associations, but I have not seen anything recently.

Rodrigues: But from what you were saying about the focus of your career, about looking for unusual associations, I can see why this early case of Kaposi's sarcoma in a young individual would be something to which you would probably gravitate.

Goedert: Absolutely. I do not know if we have talked about it before, but there is a personal story behind that case. It concerns my sister-in-law, who was in law school. An acquaintance of hers called me up and said, “Your sister-in-law said I should call you because my brother has a funny illness and his doctors can't figure out what it is.” She told me, “My brother is at NIH. Maybe he would know what it is.”

So I talked with this woman on the phone. Then I talked with her brother on the phone. He had had a biopsy and his doctors could not figure out what he had. The brother's question was, “They are going to do a lymph node biopsy. Should I go ahead with it?”

I said, “Absolutely. With the symptoms you have, it sounds as though it could be Hodgkin's disease, or something which is serious but completely treatable.”

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