'We Will See New Emerging Infectious Diseases'
Q&A with Eric Poeschla, MD
By Mark Couch
(May 2015) Eric Poeschla, MD, joined the University of Colorado School of Medicine as Head of the Department of Medicine’s Division of Infectious Diseases in August 2014. He holds the Tim Gill Endowed Chair in HIV research.
He is a graduate of Yale Medical School and the University of California at San Francisco internal medicine residency and was a member of the Mayo Clinic Departments of Molecular Medicine and Medicine (Infectious Diseases) from 1999 to 2014.
Why did you pursue a specialty in infectious diseases?
After medical school and residency I did not want to zero in on one organ system. Infectious diseases afflict the whole body, and there are problems of global significance to be solved. I found this area very interesting on many levels, from the gene, to the organism, to the patient. New dis-eases arise all the time, unlike in other specialties. Viruses are fascinating. Working with them allows us to engage every day with biology’s most important and powerful idea: natural selection (viruses evolve fast). We work daily with the wonders of molecular biology (DNA, genomes, etc), the cell, immunity. Importantly too, I was a first-year medical student when the HIV epidemic broke though it wasn’t till later that I connected the dots on that.
How did you first hear about the HIV epidemic?
I was sitting on the steps of Yale Medical School with two classmates looking at the New England Journal report of unexplained cases of pneumocystis pneumonia in U.S. cities. We were mystified, but I really didn’t think that much about it until I went three years later to the University of California San Francisco (UCSF) to be a medicine resident. I went there because it was a great residency and I wanted to “go west, young man, go west.” And that was 1985 to 1988, the peak years, the big bad years of the HIV epidemic.
You could go down to the ER on a Friday night as an admitting intern and there’d be five or 10 very sick, too thin, and scared young people lined up on gurneys. You’d admit them. Half might be dead by the following Friday. Real clinical desperation. No one foresaw then that basic scientific research would produce miracle drugs and turn HIV disease into a very manageable condition akin to diabetes. Scientific researchers are the central heroes in the story. A central goal for me here: promote ID research, from bench to bedside. It’s the raison d’etre of an academic medical center.
What did you do at Mayo Clinic?
In 1999 I was recruited to Mayo’s Department of Molecular Medicine. I did not have a lab of my own yet. In Rochester, Minnesota, we built and funded one by teaming with great young students, fellows, and other colleagues. We made a discovery about how HIV docks onto chromosomes and inserts its genetic material and that was particularly exciting. It was also a good place to raise our two kids. After a decade or so there, I began to think about opportunities to lead creatively in ID. I entertained four different division chief jobs, but resisted moving, until this job convinced me in 2014.
What convinced you about this job?
Several things. I liked this division and its very talented people, their hunger to have impact and achieve excellence in the clinic, classroom and research laboratory. Second, I was given a real opportunity to build. Third, while it seems that the medical school moving to the Anschutz Campus (AMC) was a bit controversial back in the day, when I interviewed here last year it seemed like a no-brainer (many thanks to Phil Anschutz, whom I’ve not met but would like to). Beautiful, purpose-built facilities, a lot of opportunity. It’s expanding. Vigorous leadership in David Schwartz (Department of Medicine Chair), John Reilly (Dean), Liz Concordia (University of Colorado Health CEO), Scott Arthur (Development). And Steve VanNurden heading up the biotech side. Although there’s risk associated with all the changes happening here, it seemed and seems exciting. To use a microbiology metaphor there’s a sense of ferment, and freedom.
How big is the division now?
About 45 members total, including half at the AMC, half at a combination of Denver Health, the VA, National Jewish. Strength in diversity. We are now recruiting more scientists and clinicians, with specific goals in mind. It was striking that I arrived the same month that the Ebola crisis came to world attention.
How serious is that crisis?
Very serious in West Africa. Previously, outbreaks were small and could be contained by standard quarantine measures. The West African epidemic opened eyes. More generally, and crucially, emerging infectious agents of many kinds (some, like HIV-1 in 1981, that we can’t even imagine now) are and will continue to be major threats.
Do we have the resources and structures in place to make sure that people could be taken care of?
I’m very confident we do. I’m not surprised that there was an index case in Dallas last summer where people didn’t quite know what to do. The real concern would be if the nation didn’t learn the lessons from that incident. Now, we have in place the upgraded infection-control measures needed. There’s been superb campus-wide planning here on exactly what everyone would do. It’s been meticulously planned by many including prominently ID’s Dr. Michelle Barron. She and many others across the campus have done it really, really well.
What more should be done to help people in West Africa right now?
Two of our division members, Drs. Grace Marx and David Cohn, volunteered in Ebola treatment units in Sierra Leone this winter. They saved lives, with courage and skill, and we admire them very much. Globally right now, it’s about the end game in Guinea; governments and NGOs must stay focused since Ebola can spiral back fast.
What can we do here?
A lot. All of these costly emergency reactive measures in the field in West Africa are indispensable now. But it’s penny-wise and pound-foolish to only react that way. We’ve known about Ebola for 30 years. We’ve known about the threat of pandemic influenza viruses. We’ve known that viruses like HIV-1, avian influenza pandemics, can and will emerge.
Going forward it’s not a matter of if, it’s a matter of when. We will see new emerging infectious diseases. At some point, barring major research discoveries – you can’t predict if it will be next year, or 10 years from now – we will have a pandemic influenza strain that will kill many people. The really wise approach is to invest major funds in fundamental research now.
That’s a real mission of the ID division: research on emerging infectious diseases. It’s a great challenge because NIH funding is falling and indications are that it won’t increase for a good while. That’s so tough on scientists who’ve trained all their lives. So it’s really important to think about how to fund the very interesting, fundamental investigations into how infectious agents infect people, how they can be treated, how the immune system reacts, how vaccines and other protections can be developed.
Philanthropy is crucial. I can think of no more attractive target for successful people looking to give back than emerging infectious diseases in terms of protecting the world, helping people who are less fortunate, boosting U.S. national security, and protecting us right here in Denver