Renowned epidemiologist Mary Guinan shares stories from 40 years on the front lines of public health
May 07, 2018
By Kristi Birch
Mary Guinan, M.D., Ph.D., has devoted her career to fighting diseases around the world, including as an epidemiologist working in India to eradicate smallpox in the 1970s and as one of the very first physicians to investigate the AIDS epidemic in the 1980s.
Guinan, a Joy McCann Visiting Professor at the University of Kansas Medical Center, recently made her first trip to the Sunflower State to deliver a lecture in which she shared stories — many of which are chronicled in her 2016 memoir, "Adventures of a Female Medical Detective: In Pursuit of Smallpox and AIDS" — from her four decades of investigating disease. And to let people know that she isn't finished working just yet.
"I grew up with parents who were immigrants from Ireland, and they always told me that I was in the greatest country in the world and that I should be giving back what I was given," said Guinan.
An opportunity for prevention in Kansas
Guinan talked to the audience gathered in the School of Nursing auditorium about an often overlooked consequence of the nation's skyrocketing opioid epidemic: babies born addicted. One addicted baby is born every half-hour in the United States — that's 17,000 babies a year, Guinan pointed out. The cost just to stabilize an addicted baby averages $60,000.
Yet little is being done to prevent those addicted infants from being born. Guinan is looking to change that. "I remember my days working with AIDS, when I had to watch my patients have babies that were infected with a life-long disease, and it's happening the same way now," said Guinan. "That's one reason I came to Kansas: you aren't yet as affected as some other states, and you still have an opportunity for prevention."
Guinan's recommendation is improving access to long-acting reversible contraceptives. LARCs, which are either intrauterine devices (IUDS) or implants that can stay in the body for years, are nearly 100 percent effective in preventing pregnancy because they don't require the woman to remember to use them. The upfront cost of LARCs is much higher than other contraceptives, but because they last for years, they are cheaper in the long run.
Guinan encouraged the audience to gather clinical and financial data about the effectiveness of LARCs, particularly to prevent opioid-addicted babies. "I believe that Kansas can a model for showing the nation how to prevent and find a solution to this terrible epidemic," she said.
From Chiclets to Gandhi
Guinan's career path to the front lines of public health is full of twists, obstacles, danger, media mishaps and glass ceilings. The little girl people laughed at when she said she wanted to be a plumber or a doctor soldiered on to earn a chemistry degree at Hunter College, only to find that no jobs for chemists were listed in the female section of the then-segregated want ads of The New York Times.
She took a job developing chewing gum flavors in the same factory that made Chiclets. When she realized her male peers made more money, she applied to graduate schools in chemistry. But the programs either did not accept women or did not provide them with financial assistance.
When the U.S. space program expanded and federal dollars were allocated for students pursuing science degrees, she finally was accepted to a doctoral program in physiology at the University of Texas Medical Branch in Galveston. She also had secret aspirations of becoming an astronaut and took a class in space medicine. When she read the space program was not even letting women bring coffee into the command area, for fear their presence would distract the men, she shifted her focus to academic medicine.
After a post-doctoral fellowship at the National Institutes of Health, Guinan realized that to get a job as a researcher she also needed a degree in medicine. She was accepted to the Johns Hopkins University, where 10 percent of the medical school class was female. At Johns Hopkins, she heard about the WHO's smallpox eradication program. "It was the first time in history a disease would be eliminated from the world by the design of man," she said. "I wanted to be part of that."
But first, she'd have to navigate more gender bias. She was the only woman in her officer training class of 39 in the Epidemic Intelligence Service of the Centers for Disease Control and Prevention. When she volunteered to go to India, Guinan was told that the WHO was not taking women, even as they were practically begging for volunteers. So Guinan applied again, and learned it wasn't the WHO that was rejecting female volunteers, it was India.
This time, Guinan challenged the discrimination. Speaking to the director of the EIS, she pointed out that Indira Gandhi, the prime minister of India, was a woman. Guinan said she would write to Gandhi directly about this ban. The next week, without further explanation, Guinan was told she had been accepted. The work she would do in India was pure shoe-leather epidemiology.
A Jeep, an elephant, and something to believe in
In 1975, some 25 years after mass vaccination against smallpox had begun, outbreaks in India still existed because of missed vaccinations and vaccine shortages.
Assigned to the Uttar Pradesh region, Guinan set up camp in a mud hut, complete with rats. The WHO provided her with a Jeep, a driver and a medical assistant, who also served as a translator. Every day, they'd show villagers pictures of smallpox and pay 10 rupees to anybody who located a case. The team would then isolate the patient and hire people to vaccinate everyone within a 10-mile radius.
Sometimes the rivers were so deep that the Jeep couldn't cross, making it hard to create the 10-mile rings of immunity necessary to stop the disease from spreading. One day, out of the blue, a man approached Guinan and offered to supply her with an elephant. He showed her that she could climb up a ladder and sit in a saddle on the elephant's back, and the animal would then swim across the river.
If the river was so deep that water went over the elephant's back, the man offered to have the elephant lift her up with its trunk. Guinan declined. "'No, no, no,' I said," she remembered. "No circus acts for me!"
Nonetheless, the elephant turned out be "a dream addition to the team," taking the workers wherever they wanted to go. After nearly five months, the region was declared smallpox-free. "That's how I fell in love with public health," Guinan said. "I had found something I could believe in."
Dan Rather, Phil Donahue, 60 Minutes and Dr. Herpes
In 1976, Guinan joined the infectious disease training program at the University of Utah, home of some pioneering research on the herpes virus. Having long been plagued by cold sores, which are caused by a herpes virus, she was interested in working on this common problem. She studied topical ether as a treatment and presented her results at a national meeting attended by the media. Later that evening, she was surprised to see her image on TV and hear Dan Rather say, "Dr. Mary Guinan, an expert in genital herpes infections..."
Requests to talk about genital herpes poured in. At first, she tried to correct the misunderstanding, but it was a never-ending battle. Guinan found herself growing interested in the disease, especially how it affected women and their unborn children. In 1980, she returned to the CDC to work in the Venereal Disease Division, where she earned the monikers Dr. Herpes and Dr. Condom.
When she was asked to appear on the Phil Donahue Show, she hoped it would educate the public. Instead, she found herself responding to audience members who believed the CDC was covering up the herpes epidemic. So when 60 Minutes called, she refused, until the CDC director asked her to do the interview.
As concerned as she was about how her work would be portrayed, she was more worried about what her mother — a religious woman who never even said the word "sex" — would think of her daughter talking on TV about syphilis, herpes and gonorrhea.
Guinan considers it a show of support that when her mother called after the show aired, her comment was, "Congratulations, dear. Your hair looked very nice."
And the band played on
Guinan's work with STDs led to her becoming part of the CDC task force that first began investigating the mysterious illness affecting gay men in the early 1980s, before it was identified as the HIV virus. The task force's work was chronicled in the book and film, "And the Band Played On." Guinan is depicted as a soft-spoken woman who in one scene is shown baking a cake. "They didn't know how to portray a woman scientist," Guinan said.
From a hotel room in San Francisco, Guinan spent several weeks working 14-hour days, interviewing gay men diagnosed with Kaposi's sarcoma, a type of cancer that was an early sign of the disease, and collecting specimens. It was a sad time. "Everyone died," she remembered. The task force was able to confirm that the disease was infectious and could be transmitted sexually as well as through infected blood. It took years before French scientists identified the virus in 1984 and an HIV test was available in 1985.
Guinan became the first female chief scientific advisor at the CDC and went on to become the first female Nevada State Health Officer and the founding dean of the School of Community Health Services at the University of Nevada, Las Vegas.
Nonetheless, she regards her work with HIV as perhaps her most important. She wishes she could have done more to stop the disease, and she laments that although there are treatments for AIDS, there is still no vaccine for HIV. She remembers when many people assumed the disease was a problem only for gay people and drug users and didn't want even to think about it, let alone help them.
"It has been a privilege to help people who couldn't help themselves," Guinan said.