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Wednesday 08 October 2008

Robin Isaacs Pt1: Searching for HIV treatments

Posted in: HIV
By Jay Bennie - 16th May 2008

Dr Robin Isaacs
"I was always interested in science," says ex-Auckland medic Robin Isaacs, "and I wanted to do good things for people. When I went to medical school in the 1970s, there was a huge amount of hope associated with it, and it represented a good match of my interests and my desire to do some good for people in my life."

Now the Executive Director of Clinical Research in diseases and vaccines at one of the world’s biggest drug companies, Isaacs, 50, has overseen development of a new drug welcomed by New Zealand medics treating patients whose HIV has developed resistance to previous drugs.

Auckland born, bred and educated, Isaacs' medical education began at Auckland Medical School and was followed up by a stint as a house surgeon at Northland Base hospital in Whangarei. After returning to Auckland for a second year as a house surgeon he trained at Auckland Hospital in general medicine and infectious diseases. HIV had only recently emerged as one of the world’s most scary and least understood diseases. Until 1987 there were no treatments and gay New Zealand men were starting to get sick and die in alarming numbers.

"To say it was an interesting time would be an understatement," says Isaacs. "But it was also a very emotionally challenging time, both for the patients and for the physicians who were looking after them." He remembers that the infected men had nearly always come back from overseas where they had acquired HIV, in places like New York, London, San Francisco and Sydney.

Generations of gay men had left New Zealand, where homosexual acts were illegal and homosexuals were routinely persecuted without legal recourse, seeking a new life in the relative anonymity and freedom of large gay communities. "Their families had no idea they were gay, and it was sort of hard to explain what was going on to their families, without broaching that issue. And so, with the whole emotional context of 'coming out' for many of these people, when they knew that they had a disease which at that stage was a death sentence, it was a very trying time for the patients and it certainly added layers of complexity into treatment."

In 1987 Isaacs relocated to the USA for three years, to the University of Texas Southwestern Medical Centre in Dallas, to develop his research skills. Then he returned to his home city for a stint as the medical tutor specialist at Auckland Hospital. "I did infectious diseases (I.D.) consulting, along with the other I.D. positions. If I remember correctly, it was early 1987, just before I left, that the AZT treatment study was halted prematurely and people started to use AZT as monotherapy [ie. a ‘single drug’ regime] to treat the patients, and it produced some benefits, but they weren't long-term, and so it was a pretty tough time. When I got to the United States the hospital was overflowing with patients with severe immuno-deficiency associated with HIV."

Doctors and researchers were only beginning to understand how to deal with the onset of some of the terrible diseases people with HIV-compromised immune systems were falling prey to. "It was just incredibly complex. And I'm free to admit it, it was a very pressing time." Until HIV appeared, Isaacs recalls, specialising in infectious diseases meant dealing with patients who most often recovered from their infections. But HIV was different, untreatable, until AZT suddenly offered a faint glimmer of hope.

"I then had an opportunity to head back to the States," says Isaacs, "and I went back as an academic, as an Associate Professor, I did some patient care and more research, then in 1997 I joined Merck in the United States."

Although HIV has been a significant part of his professional interest since his early days of dealing with the emerging epidemic in New Zealand, he’s also been involved with research into antibiotics, anti-infectors and other medications addressing infectious diseases. "I had some particular interest in sexually transmitted diseases. Understanding syphilis was one of the things I spent a lot of my academic career doing. Since working at Merck I've worked on protease inhibitors such as Stocrin, which is still a lynchpin of HIV treatment and first therapy for patients, plus two nucleocides. [Now] I have a team that reports to me that works on a new drug, Raltegravir, which is approved outside of New Zealand in which will be approved in New Zealand some time soon."

It’s clear Isaacs' career has taken a significant professional tack away from dealing with patients in hospital settings. Next to oil companies, international drug companies are amongst the most criticised corporate entities on the planet, accused of overpricing, profiting from misery, and shady practises such as hiding side effects. What kind of person would be attracted to this environment? A past colleague of Isaacs, a senior NZ HIV specialist no less, confirms the impression of Isaacs as a brilliant, straight dealing no nonsense person who would never compromise his professional integrity for corporate politics.

"I was troubled with the prospect of moving into industry, it would be a lie to say that I wasn't, but it really has not been difficult. Merck is incredibly ethical. The science of what we do drives the development of what we produce. We all joke about 'joining the dark side' a la Star Wars, but the people there, and the people on the teams that work for me, are incredibly dedicated people who are very much driven by helping people."

Although Isaac's focus is on science, he acknowledges that drug companies such as Merck are businesses and must produce profits for shareholders. "Of course it's a publicly traded company, it has obligations to shareholders, it needs to generate income so they can create new products to bring to market. I think it does that, from my perspective, in the right way. Merck was literally the only company that I was interested in looking at."

For Isaacs, the appeal of working in a major research environment such as Merck is "how close I always feel I am to the cutting edge. And on the science side of the business, which I'm involved with, I don't sell drugs, I develop drugs."

Although HIV treatment has been a significant part of Isaac's career as a doctor and researcher, his seniority at Merck means HIV is just one of a broad range of research he oversees. "HIV has been a very important part of my career. But I have responsibilities that go beyond the [Merck] antiviral group now. So I get to see the HIV products, but also the other anti-infection products and our vaccines.

Hopefully I’ll still be at Merck for many more years, and I'll be able to bring forward more products that will be beneficial to people. We have a very strong commitment to the infectious disease area and to vaccines, and we have a very strong commitment to HIV. We were one of the first big pharmaceutical companies to get into HIV. Our efforts with HIV date back to the mid 1980's... We continue to look for for better ways to treat HIV infected patients. Hopefully, someday, a scientist - and hopefully it’ll be a scientist at Merck - will come up with a way to cure HIV.

This Sunday 18 May, AIDS Candlelight Memorial Day, presents part two of our interview with Robin Isaacs, in which he explains why HIV is so difficult
for researchers and patients to deal with, and how a new HIV drug is becoming available to HIV positive people with increasingly limited treatment options.

Jay Bennie - 16th May 2008