Robert Gallo Wants to Fight

By Vincent Coppola
Worth June 1996

Doubt him if you wish. Hate him if you must. Get rich off him if you can. The world's best virologist doesn't give a damn about anything except curing AIDS.

Robert Gallo leans forward across the table, intense and staring. "Now, be fair," he says without a trace of humility. "Who would you go to if you wanted to form a great institute of virology?"

The question floats, rhetorical, in the quiet restaurant. Then Gallo whacks resoundingly at the near-silence.

"Me!"

Gallo catches himself, shrugging at his naked need for attention. This, he knows, is what has cost him endless grief and agita, probably even the Nobel Prize. "No," he says more quietly. "I can't say that." But Gallo has spoken the truth, and this time, he is betting, the truth will redeem him.

More than anyone, Robert Gallo is the embodiment of AIDS research in the United States. He was the man who proved that the virus now known as HIV, for human immunodeficiency virus, causes AIDS; he was the man who developed the test that safeguards the world's blood supply against the disease. He holds or shares 79 patents, and his discoveries have generated more than $1 billion in private-sector revenues.

Gallo, 59, is also a figure of immense controversy, pilloried by AIDS activists and suspected -- and later cleared -- by his peers of stealing a competitor's work. He was pointedly snubbed for a Nobel Prize, which, in retrospect, he probably deserved. In the 1980s, Soviet-bloc commentators even accused him of creating AIDS as a biological weapon.

His own pronouncements haven't helped: He has dismissed some HIV-positive critics, for example, as muddled because of the virus's effect on their brains. He charges that activists are deflecting research away from an AIDS vaccine because they have the disease already.

In short, whatever Gallo does attracts enormous attention. So it was big news when, in 1995, he abandoned his 30-year career at the National Institutes of Health to head his own research center, the Institute of Human Virology in Baltimore. After 15 years on the trail of an AIDS cure, years of triumph and howling frustration, Gallo now believes enough machinery is in place to allow capitalism to take over. "I have a strong feeling the government can't solve the problem," he says. "It's more solvable from the private side."

And more lucrative. In 1981, AIDS was an obscure illness that in the U.S. afflicted mostly an unpopular subculture. Today it is a multibillion-dollar industry employing thousands and serving an ever expanding market. Seventeen million people worldwide are infected with HIV. That number, coupled with the immense profit AIDS therapies can generate, has drawn scores of biotechnology and pharmaceutical companies into the hunt. Sales for Glaxo-Wellcome's AZT, a drug that slows the disease, topped $317 million last year.

Gallo's plunge into the private sector -- his institute contains a for-profit arm -- makes the trend official: AIDS is no longer just a public-health issue; it is big business, and from now on the fight against it will be conducted accordingly. Says Reijer Lenstra, a securities analyst for Smith Barney: "People are counting on him -- to make money."

As head of the Institute of Human Virology, Gallo will draw on $12 million in seed money from the state of Maryland and the city of Baltimore. And he has carte blanche to speed his discoveries to market through a private company, Omega Biotherapies, of which he is a founder and part owner.

Yet money doesn't completely explain Gallo's zeal to defeat AIDS (which sets him apart from many of the huge drug companies with which he'll compete). He's expending his effort on a vaccine, for example, though AIDS treatments are more profitable. Friends say he seems almost obsessed with AIDS -- an aging Ahab chasing the whale. "We do what our neuroses make us do," Gallo says. "It's a chemical reaction of some kind. I have no choice."

This operatic attitude is fundamental to Gallo. Even with strangers, his conversation veers wildly -- by turns flamboyant, melancholic, introspective. One minute he's describing arcane viral proteins, the next a grocer who sells him buffalo-milk mozzarella. Leonardo da Vinci, Salieri, the angel Gabriel, Lucifer -- all make appearances at Gallo's table, usually as self-references. Inflamed by such self-drama, Gallo is setting out to lead the biotechnology industry and its investors -- not to mention himself -- to their greatest, most profitable victory.

His turbulent life story, meanwhile, reveals another level to the fight. In his most private moments, one suspects, Gallo sees AIDS as the final showdown between himself and the God who let him down.

As a teenager, Robert Gallo lived in a house without music or Christmas. He was just 11 years old when his younger sister, Judith, was stricken with leukemia, sending a close-knit family spinning into chaos.

Gallo's father, Francis, had built a successful metallurgy company in Waterbury, Connecticut. The dour son of a northern-Italian immigrant, Francis Gallo was a workaholic who spent his evenings poring over trade journals, an agnostic who had shed the rituals of Catholicism. Gallo's mother, Louise, was just the opposite, a happily religious woman and part of a big southern-Italian family.

The young Gallo gravitated to his mother's side of the family -- all the grandparents, aunts, uncles, and cousins made him feel like he was at the center of things. He enjoyed the fun, the food, the argument and debate. Tall and rangy, he also developed a love for basketball. "In winter," he says, "we'd put rugs over the ice and keep playing."

When Judith grew sick, however, the family changed. Gallo spent weeks with relatives while his parents traveled to different hospitals. When he saw Judith for the last time, Gallo later told The Washington Post, she was "a ghost, a concentration camp victim." Her death settled over the family like a shroud.

Francis Gallo returned to the church, donating money, chanting rosaries, attending mass daily. "My father went to Judith's grave twice a day," Gallo says. "He made the rounds of every room where he had a picture of her, holding and kissing it." Celebration and happiness were banned; Robert was permanently displaced as a focus of love and attention.

Gallo blamed God for stealing his childhood. At 14, he began to abandon his family for the poolrooms and glass-strewn parks of Waterbury. He got drunk on cheap gin and lime rickeys. At a memorial service six years after Judith's death, a tormented Gallo stood up and shouted at his father, "When will this end?"

Gallo grew into a guaglione, a street-corner wise guy ready to challenge or shout down anyone who dared to get close to him. The streetwise bullying carried over into his adulthood: Even as a 50-year-old man, Gallo was famous for throwing elbows in pickup basketball games.

But other forces were stirring, too. As a child, he admired the scientific curiosity of an uncle who was a zoologist. His sister's illness provided him with another role model: Judith's pathologist. "My father wanted to kill him for not curing her," says Gallo, "but Marcus Cox was smart as a whip and critical of all other doctors." Cox lured Gallo off the basketball courts. Medicine became adventure, chemistry a challenge. "I got very focused," Gallo says. "And then consumed."

At Thomas Jefferson University School of Medicine in Philadelphia, Gallo discovered he couldn't bear to be around sick people -- a holdover, perhaps, from his sister's death. But microbiology, biochemistry, enzymes, genes, viruses -- these excited his passion. In 1965, after a residency at the University of Chicago, Gallo applied to the National Institutes of Health in Bethesda, Maryland. "I went there to learn research," he says. "But I found myself in the childhood leukemia ward. A lot of kids died. This was too much."He escaped once more to the lab, this time decisively. Research was like basketball; he would go one-on-one with God.

At the NIH, buildings are named after politicians who deliver funding -- Lowell Weicker, Claude Pepper, Sylvio Conti -- rarely after scientists who deliver breakthroughs. "When researchers leave," Gallo says, "they don't even name a toilet after you."

To some people, an honorary toilet might seem a fitting memorial to Bob Gallo's time at the facility, where he was as famous for his fulminating ego as for his genius. But Gallo's track record at the NIH -- and the money he generated for the U.S. government as a result -- would be astounding even if he'd never been drawn to AIDS research.

Rising to become chief of the National Cancer Institute's Laboratory of Tumor Cell Biology, Gallo discovered the first human leukemia virus (an entity many scientists refused to believe existed) and a number of oncogenes, cancer-causing time bombs buried in human cells. With interleukin-2, a compound that mobilizes white blood cells to fight tumors, he added a potent weapon to the anti-cancer arsenal.

Outside the lab, Gallo sparked both intense loyalty and furious animosity. "Bob will run you over," says Anthony Fauci, an old friend and colleague who is now director of the National Institute of Allergy and Infectious Diseases. "He has this 'Screw you -- I'm the best and you're full of crap' attitude. He doesn't give a good goddamn who he pushes around -- or pushes aside. But then he'll say, 'I'm sorry, I love you.'"

Indeed, there was an unexpected vulnerability to the man. He poured out intimate details of his personal life, his troubled marriage, to colleagues and strangers alike. He emptied his pockets to street people and wore rumpled clothes. Yet he traveled like a lord and held good Italian food to be sacramental. "You never know if the guy wants to cure AIDS or go eat veal," says James Curran, dean of Emory University's Rollins School of Public Health.

Always pushing, always challenging, always pissing people off -- this was Robert Gallo at the NIH. "I get my stimulation out of trouble," he says with a wink. "The ferment gets me somewhere. But deep down I know I'm soft. I have no real enemies except myself."

That may have been true once, but it changed forever on April 23, 1984. That day, Gallo stood beaming alongside then U.S. health and human services secretary Margaret Heckler, facing a crowd of reporters and TV crews as he and Heckler announced to the world that "the probable cause of AIDS has been found." A blood test had been developed, Heckler said, and an AIDS vaccine would be available in a few years.

Along with this hopeful news, another message beamed out from the podium: This great triumph belonged to Robert Gallo.

The catfight that followed has been well hashed out, most notably in Randy Shilts's best-selling book And the Band Played On and in the subsequent TV movie, in which Alan Alda played Gallo like Rasputin, sealing Gallo's image as an unethical grandstander -- an image that persists to this day.

The immediate charge was that Gallo had stolen credit for the discovery of the AIDS virus from French researcher Luc Montagnier. Indeed, a year earlier Montagnier and his colleagues at the Pasteur Institute had isolated a virus (which they named LAV) from the lymph nodes of an AIDS patient -- a fact that was lost in the tumult of the Heckler press conference.

But the French scientists couldn't grow their virus or prove that it caused AIDS, things Gallo had done definitively. By all accounts, if Gallo had simply acknowledged Montagnier's contributions, he would have won the Nobel Prize for medicine. But he didn't and was condemned to wait years for a phone call that never came.

In part, Gallo was being slapped down for his hubris. But when it came out that he'd used a strain of the French virus -- the result, Gallo insists, of a laboratory contamination -- in developing his breakthrough blood test, Gallo found himself in a maelstrom. Now his fellow scientists didn't just brand him a boor; they sued him and called him a cheat.

Gallo eventually cleared his name when he proved he'd isolated the virus on his own. In 1993, the U.S. Office of Research Integrity dropped a bumbling, four-year investigation. Congressional investigators also backed off. Yet Gallo's reputation had been tarnished, perhaps forever. "Every time I think about it I grind my teeth," he says.

Had the flap been a street fight, the guaglione might have won. But Gallo's combative attitude didn't play well in the media spotlight. When Dani Bolognesi, director of the Center for AIDS Research at Duke University and a close friend of Gallo's, brought in media trainers to teach Gallo to handle the press better, he reacted, Bolognesi recalls with a laugh, "by practically throwing a punch at me."

Compounding these woes was Gallo's disastrous family life. In science, Gallo's voracious appetites have generally served him well; in personal relationships, they have driven him to the edge. Like his father, Gallo is a workaholic who has spent too many years straying from his wife and family. "Life was intense," he says, trying to explain.

Even before the discovery of the AIDS virus, Gallo's coups gave him the sort of sex appeal associated with stars in other fields: politicians, top executives, musicians. Wherever he went, he attracted eager graduate students, post-docs, nurses. And he traveled constantly. "I didn't have the discipline, fortitude, character, whatever it takes," Gallo says of those years.

His wife, Mary Jane -- Gallo's college sweetheart -- grew increasingly depressed. And the helix of advancement Gallo had cherished as a grandchild of immigrants was broken with their two sons, neither of whom finished college. "It's partially my fault," Gallo says. "I had a lot of marital problems."

Gallo insists his marriage is on the upswing. But he doesn't downplay the despair he helped bring to his family. "People wonder how I got through those horrible years," Gallo says, speaking of the AIDS controversies. "I got through them partly because I had worse problems at home."

The world changed during the years Gallo spent submerged in battles of his own making. As early as the Heckler press conference, money had begun to edge out science as the engine of AIDS research. Virologist M. G. Sarngadharan remembers a team of lawyers corralling members of Gallo's lab in the weeks before the historic announcement.

"Several of us had to work nights and weekends preparing patent applications," Sarngadharan says. The resulting forms -- which would generate hundreds of millions of dollars in blood-test revenue for the federal government -- were submitted a few hours before Heckler took the podium.

And that was just a start. The enormous sales of AZT, the first relatively effective AIDS treatment, brought a previously unmoved Wall Street rushing into the fight against HIV. A health crisis and scientific puzzle became what Smith Barney analyst Reijer Lenstra calls "a tremendous race for the next generation of therapies."

HIV is a chronic infection that requires lifelong medication. The annual cost of treating and caring for those with HIV in this country is an estimated $15 billion and rising. This is both a tragedy and a huge opportunity. "We're talking millions of infected people," says James Curran, who headed the original AIDS team at the Centers for Disease Control. "Millions of insured infected people. You come up with a drug that extends lives for just six months and everybody will want it."

Small wonder that HoffmannLa Roche, Merck, Abbott Laboratories, Bristol-Myers Squibb, and Glaxo-Wellcome are pouring hundreds of millions of dollars into AIDS research. "It's hard to find a major drug company that doesn't have at least one AIDS-related project in its portfolio," says Lenstra.

The boom extends to biotechnology, where a successful AIDS therapy is the Holy Grail for many smaller companies. Companies involved in AIDS research now make up roughly 10 percent of the field. Biotech stocks were up 80 percent in 1995, outperforming even the booming technology sector. AIDS plays were "very hot," according to Bear Stearns's David Molowa. "They started hitting the milestones and delivering on promises they'd made years ago," Molowa says.

It is into this high-stakes ring that Gallo throws his hat. As soon as he was vindicated in the French virus mix-up, he stopped being an unacceptable risk for investors. Offers came quickly. Not the Harvard Medical School chair he might once have dreamed of, but solid opportunities in industry and academe. States saw Gallo as a magnet that would attract other investments: Maryland, Virginia, Pennsylvania, and the Carolinas, all eager to build their own biotech industries, each offered to construct an institute around him.

In the end, Maryland governor Parris Glendening (whose brother had died of AIDS) made the best bid. Maryland gave Gallo $9 million, while the city of Baltimore kicked in another $3 million. Gallo's research would be done under the auspices of the new institute at the University of Maryland at Baltimore, but his private company would be free to commercialize the results.

Gallo brings more than his reputation. He already has several promising projects on the fast track. Last fall, he identified what he called chemokines -- naturally occurring molecules that suppress HIV in vitro. These could prove a powerful treatment for AIDS. He's following up on the vaccine research of Jonas Salk and Daniel Zagury, and trying to develop a "vector vaccine," one that uses the smallpox virus to deliver particles that might trigger an immune response against HIV. He's developing a treatment for Kaposi's sarcoma, the deadly skin cancer seen in many AIDS patients.

Any of these paths could lead to a blockbuster product. "AIDS will soon drive the whole biotechnology field," Gallo predicts. "It will be worth ten times ten our efforts here."

Gallo's working style is best described as casually intense. At a recent seminar, his staff members, an elite drawn from the best medical and research centers in the world, loll around like bums: unkempt hair, beards, no socks, sweatshirts. Gallo himself slouches at the head of a conference table as a young Ph.D. named Raphael Mannino prepares to discuss what he calls "an intra-cellular cytoplasmic delivery system," a mechanism that might help deliver HIV-defeating genes to cells in the bone marrow.

Mannino's system uses liposome, fat, and protein envelopes he calls cochleates to deliver DNA into a target cell. Typically, Gallo decides these cochleates look like Italian pastry shells. "Why don'tcha call 'em cannoli?" he asks the young scientist. Flustered, Mannino launches into a background discussion that bores Gallo.

Gallo: "How much longer you gonna take?"

Mannino (missing the point): "An hour, but I can take longer."

Gallo (straight-faced): "Every minute over, your honorarium goes down."

Mannino: "I wasn't planning on an honorarium."

Gallo: "That's good."

Actually, Gallo is very interested in Mannino's theories. It's just that, even pushing 60, he's most comfortable in the argot of Waterbury's street corners. After the meeting, he takes Mannino aside and praises him.

"I'm glib," he explains later. "I do like to one-up people. I love debate, but never to screw someone. This is the way I grew up. Everybody teased me, and I teased them. That's the way it is."

A hundred rsums are piled in his office from top-drawer researchers eager to cast their lot with him. Almost half his NIH lab staff hopes to follow Gallo to Baltimore. Robert Redfield, former chief of retroviral research at the Walter Reed Army Medical Center, will run Gallo's clinic. William Blattner, former chief of viral epidemiology at the National Cancer Institute, is heading up the epidemiology division. The reason is clear: Gallo continues to execute and inspire brilliant research efforts. "Bob has this uncanny ability to make connections that are off the wall and be right," says Edmund Tramont, director of the Medical Biotechnology Center at the University of Maryland at Baltimore. "That's his gift. He's a Michelangelo in that regard, a da Vinci -- a Cal Ripken."

In Gallo's new home, that's quite a compliment.

AIDS is a lifetime and, thus far, fatal disease. The blood-borne virus called HIV, spread by sexual contact, by transfusion, by intravenous injection, or in utero, targets a white blood cell called CD4. This cell normally orchestrates the body's defenses against an array of disease-causing agents.

Once infected, CD4 cells become factories that pump out millions of copies of HIV. Infected cells are destroyed as this viral stream bursts through membranes to infect other cells. As CD4 cells become depleted, the immune system breaks down, leaving patients vulnerable to opportunistic infections and rare cancers, a situation collectively known as AIDS.

Viruses are difficult to eradicate. "They use the human machinery to replicate," says Don Francis, a hero of And the Band Played On and head of the HIV vaccine program for Genentech, a biotech company. "If you poison the virus, you poison the human."

As a result, many researchers believe it makes sense simply to limit viral infections. Reduce the virus's bad effects or its ability to reproduce, the theory goes, and you stave off full-blown disease. In the case of HIV, a reasonable therapy might turn AIDS from a terminal disease into a merely chronic one.

A vaccine would do even more, of course. It would prevent HIV infection. But in the past few years, Bristol-Myers Squibb, Merck, Genentech, and a number of smaller biotech companies have slashed AIDS-vaccine research. Genentech was the industry's highest-profile flop: In 1994 it was left with 300,000 doses of vaccine when a government panel refused (for scientific reasons) to fund further trials. Other companies, already worried they'd be forced to sell their vaccines for peanuts in the third world, were chilled by the wasted millions. Many accelerated the move toward safer bets -- which mean therapies, not vaccines. "People will pay a lot to save themselves from something they have," explains James Curran. "With a vaccine, you're trying to sell something to people with nothing."

This isn't all bad. Coming on line is a new generation of reverse-transcriptase inhibitors (reverse transcriptase is the enzyme crucial to viral reproduction) that at this point appear to be more effective and less toxic than AZT, the best-known treatment in this category. In recent months drugs called protease inhibitors have generated a tremendous amount of interest and excitement. Taken as a pharmaceutical cocktail, different combinations of these drugs and AZT seem to reduce the concentration of HIV in the body by as much as 85 percent. That's the most dramatic news in AIDS research in a decade.

Unfortunately, there's no proof yet that any drug on the market makes AIDS less fatal. What's more, HIV is a hard virus to pin down: It replicates very rapidly and has an extraordinary potential for mutation -- which means it develops resistance to drugs, as it is already resisting AZT.

The drug-cocktail approach finesses this problem: The odds are that the virus won't become resistant to several drugs at once. But it raises questions about expense -- the new therapies will cost as much as $7,000 a year -- and the toxicity of multiple drugs. Says Don Francis: "The only time-tested approach to clearing an epidemic is with a vaccine -- and few are interested in it."

Yet a vaccine is perhaps Gallo's biggest goal -- and this makes his push into the private sector all the more timely.

At the infamous press conference in 1984, Margaret Heckler speculated that an AIDS vaccine would be available in a few years. Twelve years later, the world is still waiting for the perfect sugar cube that will stop the pandemic. According to epidemiologists, the much-publicized AIDS-prevention campaign is losing impact. In the U.S. alone, an estimated 40,000 people will become newly infected this year.

To some extent, Gallo takes this responsibility on his shoulders. "What is needed of me?" he asks rhetorically. "To solve the problem cheap, third world, forever. Imagine, one little shot and it's over." It's melodramatic, to be sure. But with Bob Gallo, melodrama is a spur. An AIDS vaccine -- what a comeback! What a slap to the Nobel committee!

Of course, Gallo has plenty of other goals, including developing AIDS therapies that rely on his identification last year (German researcher Reinhard Kurth made a concurrent discovery) of chemokines. And the vaccine hunt will have obstacles; no opera would be complete without them. Researchers have learned to be cautious about touting "breakthroughs" in a disease as relentless as AIDS. Success, thus far, has been measured by a few more months of life. Ultimately, Gallo believes, the best answer may be to genetically engineer human blood so that its cells are invulnerable to HIV.

"We have a gene therapy that I believe could solve the AIDS problem," he says. "What we will do is put a gene in the papa cells of the bone marrow that allows those cells never to be infected by HIV. They produce all the blood cells and all the T cells. They've got a selective advantage to survive because they can't be infected. Is it doable? Yes! We've done it in our lab for years. Soon we'll do it in vivo."But will it work as well as he hopes? Gallo won't express certainty. Even a guaglione eventually learns humility.

In 1986, President Ronald Reagan signed a bill permitting federal employees a limited profit on their discoveries. Gallo's share of the largesse since then: $100,000 a year for 17 years, on top of his salary. "Money's not driving Bob," says Anthony Fauci. "He's earned bupkes! He wants the big-bang discovery."

And indeed, though Gallo lives grandly, money doesn't seem to be one of his driving appetites. Would Ahab have turned Moby Dick into perfume? No, Gallo seems to be interested in the private sector mostly because capitalism promises him funding -- not wealth.

Gallo's Institute of Human Virology, just a few blocks from the Camden Yards baseball field, isn't fully staffed and won't be officially opened until November. Yet already Wall Street and the venture capitalists have come calling. From California, Lew Wasserman, former chairman of Universal Studios, and junk-bond king Michael Milken, who is battling metastatic prostate cancer, have approached Gallo.

Slowly, surely, Gallo is becoming the center of attention again. He's always been comfortable there: For the past 20 years, a thousand scientists from all over the world have flocked to Gallo's lab for a week of seminars and Lucullan feasting every summer. In India, Gallo was showered with flower petals. For a while, Francis Ford Coppola even followed him around trying to come up with "Gallo: The Movie."

To this heady mix, Gallo feels compelled to add more melodrama. "I have this insecurity," he whispers. "I don't know when I've done enough. Leonardo da Vinci didn't feel he contributed."

The comparison is pure Gallo, a clumsy mix of confession and hubris -- charming and irritating in equal measure. For a time, perhaps, he lost sight of his purpose. But things are clear now. Robert Gallo is again fighting AIDS, and AIDS, a worthy foe, is fighting Robert Gallo.