Photograph by Kevin A. Roberts
Asking Dr. J. William Campbell about his accomplishments is like prying secrets out of a KGB agent. But he does admit he was one of the few infectious-disease specialists willing to treat AIDS patients—back when laypeople thought of it as a vengeful plague that could spread with a handshake, and many doctors refused to take on patients who’d die before they paid their bill.
Today, many of Campbell’s 1980s AIDS patients are still alive, doing beautifully, and all he has to nag them about is getting their colonoscopy when they turn 50.
“HIV is a little piece of RNA that gets converted into DNA and slipped into your genes, so in a sense it’s an acquired genetic defect,” he says. “As much as 10 percent of DNA in our body represents old retroviruses that our ancestors managed to pick up and control. Just think of that! It is absolutely riveting.”
He’s still fascinated by his specialty, its constant stream of new data and insights into the fundamental questions of life. But his gentle Scottish face turns faintly pink, clashing with his plaid bow tie, when I mention how beloved he is at St. Luke’s Hospital. An attending physician, he’s often on the floors late into the evening, checking on his patients, solving the life-or-death riddles of infectious disease.
“I’m not like House,” he insists, referring to Dr. Gregory House, the detective-physician on FOX’s eponymous hit series. I’m not convinced. What about all the mysteriously ill people he has to grill to find out that they were in the Peace Corps years ago or served in Iraq or sat next to somebody on a plane who’d been vacationing on an island…?
He nods. “The way global warming is changing the seasons, we see even more diseases creeping up from the tropics. Also, we had three or four tick-related diseases in Missouri in March.” They used to hit in late May. “Ticks are fascinating: They have been around since amphibians, a couple hundred million years, but they really took off after the dinosaurs’ demise.”
I ask about more recent puzzles.
“Sometimes people think they have infections because they are running high fevers, and we end up diagnosing noninfectious diseases like familial Mediterranean fever. It comes from defects in what we call the innate immune system. We have many, many immune systems. If a bacteria gets into your body where it shouldn’t be—or a protozoa, a parasite, something—you have to do something right away. You can’t wait for days. So there’s a whole array of molecules that go into general action; that’s the innate immune system.”
What about all of the lives he’s saved, like the woman whose lungs collapsed with an isolated, tough-to-diagnose case of Legionnaires’ disease?
“Four months ago, we had a case of—and these are actually very frightening diseases—what’s called necrotizing fasciitis,” he says. He breaks off and forbids me to use the phrase flesh-eating. “That drives me nuts. It just sounds so Hollywood. You want to define things so people don’t get hysterical. You want to have things exact, because that’s the way you treat things.
“Anyway, he’d been hit,” Campbell resumes, “and strep got into the contusion. And those cases carry a 50 to 70 percent mortality [rate]. You have to act very quickly, in terms of surgery and antibiotics and immunoglobulins. The clock is really ticking—it goes so fast. This wonderful gentleman, we saved his life.”
I ask for more details, but what Campbell really wants to talk about is antibiotics.
“A pharmaceutical company gets a lot more money from Viagra. So we don’t have any new antibiotics. We are always trying to keep people from using them unless it’s clear-cut. If you’ve got a cold, take chicken soup, not a Z-Pak. The more antibiotics are out in the system, the more evolution continues, selecting for bacteria that have an increasing resistance. And antibiotics are used extensively in agriculture: You eat the chicken, and you are still getting the antibiotic.
“The second thing is that when we give somebody an antibiotic, it impacts good bacteria that live in your body,” he adds, speaking quickly now. “We are just beginning to learn about this. There’s some wonderful work from the National Institutes of Health: They have developed the technology to measure the types of antibodies, for instance, in our feces. If you give somebody an antibiotic for just a couple of days, you can find major disruptions in the colonic flora years later.”
Does he ever see all these microscopic squiggles, all the bacteria and protozoan parasites, as enemies attacking us?
“Oh no,” he says. “We’re part of a huge, in essence, ecosystem. In our body are billions of bacteria that normally live there. In fact, they are vital for our health. We’ve grown up together over millions of years.”
He rises, walks over to the inner window in his office, and peers down. He’s heard faint strains of Beethoven from the piano in the atrium, and he loves the complex order of classical music. That, and taking care of mysteriously ill patients—with no media attention, no hype, and no hysteria.
