Doctor heads command post in war against illness

May 29, 1994|By Holly Selby | Holly Selby,Sun Staff Writer

Glimpses into the heart of Dr. John G. Bartlett's medical practice come through a stack of pink telephone slips piled on his desk.

By the end of every day, the number of business calls is at least 50. They come from doctors in Ann Arbor, Mich.; Birmingham, Ala; Boston; Sao Paulo, Brazil, and Sydney, Australia, all stumped by the course of an infectious illness. They also come from his publishers, chiefs of medical staffs in distant hospitals, activists and his patients with AIDS.

Dr. Bartlett is, in many ways, the physician of last resort for them all.

As chief of the infectious disease division at the Johns Hopkins Medical Institutions, he heads a command post in the war against illnesses from measles to hepatitis. Though in recent years much of the Hopkins arsenal has been aimed at the human immunodeficiency virus, which causes AIDS, the disease is only one among many enemies.

And, throughout the world, when doctors and patients can think of nowhere else to turn with an unrecognizable symptom, an incurable sickness, they call or write this office.

Every day, the doctor sifts through his message slips, painstakingly picking out the 10 or 20 from patients.

Eventually, he will return each call. But first the patients.

For years, the 57-year-old doctor has worked to answer their questions, but the onset of the AIDS epidemic in 1981 has given his efforts greater urgency.

"Dr. Bartlett has pushed to understand the practical applications of what we know about AIDS and to tell us how to put it to use," says Kristine Gebbie, the nation's AIDS policy coordinator. "He can explain honestly where we are in AIDS research: What we don't know yet and also -- in a quite positive way -- what we can do for people with AIDS now."

In 1980, one year before reports of AIDS cases began speckling the country, Dr. Bartlett became chief of the Hopkins infectious disease division, a unit with two other faculty members, a secretary and a budget of $263,000.

Since then, fueled in part by the mushrooming needs of AIDS patients, the division has grown to 99 staff members -- with a budget of $6 million. In 1993, Hopkins AIDS services were ranked second in the nation -- behind those at San Francisco General Hospital -- by medical professionals polled through U.S. News & World Report.

AIDS-related programs at Hopkins include clinical trials, a hospital unit and an outpatient clinic. Patients have access to the services of case workers, lawyers and financial specialists. Last year, 2,600 people received ongoing care at Hopkins for HIV or AIDS. Hundreds more came for consultations.

Constantly, Dr. Bartlett's goal is to gather information from every possible source -- people with AIDS, physicians, medical journals, research labs -- and to process it into the best course of treatment avail able. In turn, he passes that knowledge via conferences, committees, articles, books and conversations to other physicians and to patients.

It is a sweeping quest. But the doctor's reach, like his workday, is long.

"In a field as rapidly changing as HIV there is an immense need to translate the information and get it to as many people as possible, including clinicians and practitioners," says Dr. Paul Volberding, director of the AIDS program at San Francisco General Hospital. "In this, [Dr. Bartlett] has had a major impact in the world of HIV and AIDS."

In 1991, Dr. Bartlett and Ann Finkbeiner, a Baltimore science writer, wrote a book for people with the AIDS virus. Titled "A Guide to Living with HIV Infection," it is 368 pages and covers everything from whom to tell about a positive HIV test to the symptoms of AIDS.

Dr. Bartlett also has written more than 500 journal articles, been the co-author or the author of five other books and does a monthly column on AIDS for the Alternative, a local gay paper.

But the virus is unrelenting. In Maryland, 4,967 men and women have died from AIDS; nationwide, the toll is more than 200,000.

In research laboratories, there is no sight of a cure for HIV or a vaccine to halt its spread. And myriad questions surround the anti-viral drugs -- AZT, DDI, DDC -- that are used to treat it.

Still, Dr. Bartlett is an optimist, in that he never remains discouraged.

"When I first got to know him, I thought, 'Maybe this guy is just a little naive,' " says Garey Lambert, director of AIDS Action Baltimore.

Discoveries have been made that gave scientists hope of finding a successful weapon against AIDS, says Dr. Bartlett. "One by one, they all crashed: experiments with heat therapy, bone marrow transplants, all the drugs. None of it paid off.

"We had a fast start off the blocks [of research] and then brutal confrontations with reality, and it has been hard."

But, he says, somehow the epidemic will be stopped. "It has to be done. It will be done."

'Remarkable ability to focus'

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