 photo: nikki kastner |
Professor Brian Gazzard retires this year as Chair of the British HIV Association but not, he tells Gus Cairns, from being one of the most influential and best-loved doctors in the HIV field
Brian Gazzard has created a tiny professorial sanctuary in the midst of medical chaos.
The top floor of the St Stephen’s Centre at the Chelsea and Westminster hospital is a warren of scruffy rooms overflowing with the detritus of NHS bureaucracy: files, papers, used cups, old medical equipment. But right at the end is a small, green, wood-panelled room, with a comfy chair, lined with pictures.
There’s a university tennis team smiling out in black and white; an intense young, bearded Gazzard addressing a 70s medical conference; artworks from patients; cartoon originals donated by their artists; and an aerial photo of a huge, white mansion.
From this donnish retreat, Brian Gazzard, 56, directs operations as one of the most influential, and certainly one of the most individual, HIV doctors in the world. He drapes himself over a chair, lights the first of a chain of Marlboro Lights, and keeps a delegation from a drug company waiting while he spins me an hour-long monologue about his life in and out of HIV.
For readers who’ve never encountered the Gazzard phenomenon, here’s a snapshot. You’re at a medical conference being poleaxed by lots of important but boring treatment data. Then a languid figure ambles on stage. The audience relaxes. They know for the next 20 minutes they will get an off-the-cuff, dauntingly erudite overview of HIV treatment, peppered with jokes, quotations and bitchy cracks at fellow experts. This is the Gazzard Show.
“ I became a doctor because I was interested in people and how they tick,” he says. He comes from a ‘standard lower-middle-class family’ with no medical tradition. Dad a bureaucrat; mum a housewife.
“ I was very left-wing. I wanted to change the world, change people. I went up to Cambridge in 1963.”
He completed his medical training, moved into gastro-enterology (“it was where the job opps were”). And was a consultant at the unheard-of age of 27.
“ It was all by chance, really.” He’s being falsely modest. He had a double-first at Cambridge and ‘walked off with all the academic prizes’. This is a very, very clever man.
But it’s Brian’s warmth that people relate to, and his almost agonised care for his patients. He tells me about the early days of HIV, when, as the hospital nearest Earl’s Court, the Chelsea and Westminster suddenly found itself dealing with an utterly new and savage epidemic.
“I will never forget my first 100 Aids patients,” says Gazzard, “though the many hundreds after them pass by in a blur. The first one was a guy called Tony Hill who came to us with PCP. Then suddenly all his partners were turning up, 30 or 40 guys with swollen lymph nodes, clearly unwell.
“ I learned so much from those first young men, who I was utterly unable to save. Their faces pass me by every day. I knew nothing about gay men, I was married with two kids. What I found confounded my stereotypes. Unbelievably nice people, many profoundly monogamous in their own way, nearly all of whom died with tremendous dignity.
“ One of the great revolutions of my life was meeting gay society. I was never focused on pleasure and I met people whose time on earth was dedicated to fun. It was very good for me.”
He swats back rumours that he’s dabbled in the gay side of things himself, though. “Just because you’re seen having a pint in the Coleherne with one of your patients doesn’t make you gay!”
The Aids catastrophe was also, despite its horrifying nature, an extraordinary professional opportunity.
“ All the other doctors thought I was mad working with this fatal disease. But we were learning about things like MAC, oesophagal candida, CMV, and so on; things most clinicians never see in a lifetime. A famous doctor called William Osler predicted in the 1900s that in his lifetime they would discover and defeat all the infectious diseases. He was wrong; here was a new one.
“ There was just a tremendous camaraderie in those days. There were parties when people died, I went to a lot of funerals. Tony Pinching (now a Professor at St Bart’s Hospital) and I would go out for drinks and discuss burnout but it never actually happened. The patients kept you going.”
Gazzard had his own Aids scare. “I pricked myself on a needle. One of the other doctors said: ‘Well, now you’ll know what its like to be HIV positive’. I spent three agonising months waiting till I could take the test, and two sleepless nights waiting for the results. I did it anonymously at another hospital.
“ It was negative, but in the process they discovered I happened to have an unusually low CD4 count - 350 - which has stayed that way ever since.”
In those days there was nothing that worked
against HIV, so every avenue was explored.
“
Prayer worked! We did a study where a group prayed for people in alternate
beds, and the ones who were prayed for did better. The trouble is, the study
was ruined because they kept moving patients from bed to bed.”
Then, equally suddenly, everything changed again. “The story that really revolutionised my life was about this guy who had been on dual-nucleoside therapy for years and years. He was a skeleton. He was bound to die. We put him on an indinavir combination as soon as protease inhibitors came along in 1996. Six months later this big fat man walked into the clinic. He’d put on 40 kilos. I had no idea that that was what he naturally looked like!
“ You suddenly think: ‘I’ve been involved with a disease that killed everyone, and now I’m telling patients “You’ll die in bed of old age if you take your pills”.’
“We thought it was going to be easy from then on. Every GP would be able to treat HIV. That turned out to be totally untrue. Drug side effects like lipodystrophy made HIV perhaps less horrifying but just as interesting in terms of making life better for patients.
“ There was a certain bereft feeling when HIV became a more normalised condition. That camaraderie was lost.”
Gazzard set up BHIVA, the British HIV Association, in 1993, to regenerate some of that professional support and to serve as a centre of expertise for British HIV clinicians. He stands down as chair this year: “Though I want to quash rumours I’m retiring. In fact I’ve just signed another 20-year contract with this hospital.
“ I’m pleased that BHIVA has been influential. We were the first group of doctors in the world to say it was possible to start treatment later, and the first to say that non-nucleoside based regimes should be the ones of first choice. We led the Americans on that one.
“ Now the data is suggesting a rethink. It looks like it’s very important to treat before the CD4 count drops below 250, and that if you do, you might be able to buy yourself several years off drugs by taking them for one year.”
So if Professor Gazzard had
a crystal ball, what would
be the
state of
HIV in 10 years’ time?
“
I’ve oscillated in my opinion about an HIV vaccine. All the vaccines
we’ve discovered, such as the polio one, have been discovered by serendipity.
We’ve almost done too much studying of immunology, yet our whole paradigm
of HIV and the immune system may be wrong. Monkeys who stay well all their
lives stay well by NOT having an immune response to SIV, the monkey equivalent.
“ That’s why I’m excited about the use of interleukin-2. It’s called an immune booster but it actually deactivates T-cells, so they last longer, don’t burn out and die.
“ In general I’m an optimist. Early treatment will mean we’re able to interrupt therapy for prolonged periods. There won’t be overwhelming drug resistance. Once-a-day therapy will be the norm. We still won’t be able to eradicate the virus and I think the entry inhibitor drugs will be of limited use, but there will be other drugs targeting other viral genes.
“ On the prevention side, pre-exposure prophylaxis - giving people HIV pills to prevent HIV - may turn out to be the best answer. Microbicides may work, but the trouble is finding something that isn’t an irritant.
“ Globally - we’re at the point of being able to show that in countries like Botswana giving antiretrovirals to everybody isn’t pouring money down the drain. It can work. "
“One of the rewards for me recently has been discovering how the sense of stigma, both internal and external, disappears when you give people antiretrovirals.”
What of the Gazzard outside conference and consulting room? He’s always seemed to be a doctor with a wide ‘hinterland’ of many other interests.
“ I love classical music, of the era between Mozart and Tchaikowsky, and I’m a huge reader; get through several books a week, love Tolstoy and DH Lawrence. I love philosophy; I read Kant, Descartes and so on.
“I’m very interested in spirituality and comparative religion. One of the things those gay patients taught me was that unless you open yourself up to experience life, you don’t live it. I go walking in the Lake District - alone or accompanied - twice a year. And I love Chelsea Football Club! I’ve paid £800 for a season ticket, though I go very rarely. I used to be quite sporty - that’s me in the University Tennis Club there.
“
My biggest obsession is the exact use of words. In fact I’ve written a
novel. It’s complete crap - writing novels is more difficult than people
think - but it was very topical and editors were interested. I wrote it before
the Iraq war and it’s all about bioterrorism, anthrax, smallpox and so
on. If I retired I’d like to write my own, personal history of Aids.
“
I wrote the novel after my marriage broke up.”
Ah yes. Gazzard at first doesn’t want to talk about this, but it was such an open secret in the HIV community, and caused his colleagues such concern, that it seems appropriate.
“ I was married for 32 years. The breakup was a great sadness. I went through a period of quite serious depression.” The huge white mansion in the picture, he explains, was where he used to live with his wife.
“
It made me a much more empathic doctor. I used to say, ‘Oh, you’ll
get over that’. Now I know the difference a single kind word can make.
I’ve been very moved by the support I got.”
“
However,” he goes on with a glint in his eye, “I’ve now just
met a new young woman who wants to have children with me!”
He still lives with his children, aged 26, 20 and 19. Are they going to follow in his footsteps?
“No, they hate medicine.” What do they do? “They live off their father!” he snorts.
“ I probably get paid too much,” he adds, “but then I probably enjoy working too much, too; it was a factor in my marriage breakup. I’ve been 30 years a doctor and never had a boring day.
“In a way successes have come too early. What could possibly follow?”
