Dr. Myron Cohen's work changes the game on HIV

mlocke@newsobserver.comDecember 30, 2012 

  • Myron “Mike” Cohen Born: May 7, 1950, in Chicago Family: Wife, Gail Henderson, chairwoman of UNC’s school of social medicine; daughter, Jessie Viders; son, Michael Henderson-Cohen; four granddaughters Education: University of Illinois, B.A; Rush Medical College, M.D.; University of Michigan, internship and residency; Yale University, fellowship in infectious disease Area of research: HIV prevention; landmark clinical trial found last year that early and effective treatment with antiretroviral therapies practically eliminates the possibility of someone with HIV transmitting disease to partner. Titles: Director of UNC-Chapel Hill’s Institute of Global Health and Infectious Disease; J. Herbert Bate Distinguished Professor of Medicine, Microbiology and Immunology; associate vice chancellor for medical affairs for global health; National Institutes of Health merit award; Co-principal investigator for the HIV Prevention Trials Network Reading table: Ken Follett century trilogy, Hilary Mantel’s “Bring up the Bodies” and John Grisham’s “The Racketeer” Air miles this year: More than 136,000
  • More information What did he do? Dr. Myron Cohen was the principal investigator in a major clinical trial that is changing the fight against HIV. The study revealed last year that early and effective treatment of HIV with antiretroviral therapies essentially prevents the patient from spreading the virus. The study is a game-changer, emboldening public officials to talk about the possibility of an AIDS-free generation.

Dr. Myron “Mike” Cohen breezed through a conference room in a fancy Washington hotel last month, scanning row after row of posters about HIV studies in the United States.

Each poster is like a puzzle piece – a tiny discovery about some part of a disease that Cohen has waged war against for 30 years.

He stops to grill a doctor from Washington about early testing for HIV. A few minutes later, he’s moving again, searching for an idea that will help him see the bigger picture.

At 62, Cohen is in a hurry, desperate to turn an observation about HIV prevention into an answer. He is frustrated by the rate at which HIV is continuing to take hold in America’s urban areas, particularly among gay black men. He is confounded that doctors in Europe are waiting longer than Americans to offer treatments to those infected. He is eager for the World Health Organization to start leaning on countries to do more for those plagued with HIV.

“We’ve got to do better,” he says flatly.

Last year, Cohen changed the global conversation about HIV. A clinical trial he directed proved definitively that early and effective treatment with antiretroviral drugs could essentially prevent those with HIV from spreading the disease.

The study catapulted him onto a worldwide stage. He’s been beckoned to conferences in every corner of the globe over the last year and invited to strategy discussions in Washington with White House officials. Though the clinical trial has emboldened public officials to dare speak of the possibility of an AIDS-free generation, Cohen knows it’s not enough.

The virus that causes AIDS has stalked Cohen for his entire career as an infectious disease doctor, and he feels the weight of all its unanswered questions every day. Cohen moves and talks frenetically, bringing the rush of an emergency room doctor to a body of work that has taken decades to develop. He wakes to work in the dark of night, as if he’s up against a massive deadline, as if each of the 34 million people in the world infected with HIV is his patient.

“We were so scared at first. The magnitude of the problem was startling,” Cohen says of his first encounter with HIV. “Then, we just got busy.”

From a cluttered office at the University of North Carolina at Chapel Hill, Cohen steers the global effort to stop the spread of HIV. He enjoys celebrity status in this insular community of doctors, virologists and public health experts. He’s funny and warm, and his provocative talks on HIV pack auditoriums.

Despite his currency at UNC and around the world, Cohen deflects praise and seems almost embarrassed by it. He insists much of his work was as simple as studying semen samples, where his team could see the concentration of virus in patients and their level of infectiousness.

“I figured out how to get men to masturbate,” Cohen says with a chuckle. “That’s my one skill and the secret to all of this.”

He would rather talk about the collaborators he has fostered and leaned on over the years. In truth, much of Cohen’s success is not in his unique research, but in the team he has assembled and inspired over two decades at UNC. While other competitive research universities manage large egos and backbiting, Cohen’s team at the Institute of Global Health and Infectious Disease celebrate each others’ victories and rarely defect to other institutions or private industry.

His team’s HIV research in foreign countries such as Malawi launched global partnerships for the university that enabled medical training for surgeons and obstetricians and has brought first-rate medical care to desperately poor countries. His teams are an economic engine for the university, harnessing nearly $60 million in grant funding in the coming year.

The story of how Cohen came to this pedestal is the stuff of a choose-your-own-adventure book. Though he has brought laser focus to the field of HIV research for 25 years, his early years brought a series of random choices and opportunities. One odd decision led to another and another that connected dots no one else could see.

“Even when I tell it, even though I lived it all, it all just seems so crazy,” Cohen says.

Doctor in a hurry

Cohen didn’t plan to become a doctor.

He grew up in a diverse neighborhood on the south side of Chicago, where his family made ends meet but not much more. He scraped together his savings from part-time jobs during high school and took out some loans to enroll at the University of Illinois in 1968. He thought he’d be a journalist.

But other men his age were coming home from Vietnam in body bags. Cohen drew a draft number so low in 1969 that he figured he might soon be one of them.

Other sadness pressed on him, too. During winter break his sophomore year, Cohen spent every day by the side of his childhood friend as he mounted a futile battle against leukemia. Cohen couldn’t get over the limits of modern medicine to heal his friend.

As doctors streamed in and out of his friend’s room, he listened closely, entranced by the language of medicine. Cohen decided to trade journalism for pre-med, a focus that would also protect him from the draft.

When he visited the dean’s office to figure out his new major, he got a big break: He met a representative from Rush University Medical Center, who was there to recruit students to the long-dormant medical school. He persuaded Cohen to apply.

For the next year, Cohen worked to catch up. He woke early and pushed hard to master organic chemistry and human anatomy. His fraternity brothers razzed him that his 4.0 grade point average would plummet in his new pre-med curriculum. It didn’t.

His roommate and childhood friend, Barry Allswang, remembers how seamlessly Cohen shifted into medicine.

“His intelligence borders on brilliance,” says Allswang, who also became a doctor. “He had this unbelievable ability to grasp things quickly.”

Cohen launched his medical career with a speed that would become his signature. He left for medical school without earning an undergraduate diploma – though he got it later – and skipped the standard entrance exams. By 24, he was a doctor in training at the University of Michigan. By 27, he was an internist at Yale studying infectious diseases.

‘Right man at the right time’

Cohen spent his earliest years glued to a machine that investigated a way in which white blood cells killed bacteria. It was myopic and tedious work that fed Cohen’s obsessive and compulsive tendencies.

When he took a job offer to teach and research at UNC, Cohen imagined doing similar lab research focused on gonorrhea.

But in the early 1980s, doctors around the country scrambled to treat a rash of patients with weakened immune systems, an obscure skin cancer and major lung distress. The disease was so closely linked to gay men that doctors had named the ailment Gay Related Immune Deficiency.

Cohen first laid eyes on the mysterious disease in the early 1980s. A doctor at UNC Hospital called him to consult on a patient with hemophilia.

The 30-something heterosexual man was desperately sick. He illness was vague, the origin unclear.

Cohen knew instantly that this man had the same sickness ravaging the gay communities of San Francisco and New York. Around the country, and in Chapel Hill, the death toll was staggering. With no treatments and more questions than answers, doctors watched thousands of patients die.

Cohen was a young doctor who loved impossible problems; eventually, he dedicated himself to figuring out how to slow the spread of what would be named HIV.

“He was the right man at the right time to turn his considerable skills toward trying to end this epidemic,” says Francis Collins, director of the National Institutes of Health and a former colleague of Cohen’s at UNC.

Constantly on the move

His career path set, Cohen attacked the disease – and built a research program – with tremendous zeal.

He sleeps as little as a few hours a night when he’s facing a big project or presentation and eats only when it won’t keep him from completing some pressing task. By the time his colleagues wander into their offices after daybreak, he has already filled their inboxes with a litany of questions or requests.

He types with one finger, so the notes are littered with misspellings and random capital letters. Often, they are punctuated by a joke or self-deprecating confession.

He travels constantly now, which rattles his need for quiet and perfect light to work at his computer. In the cities he visits most often, he knows exactly which hotel rooms suit him best.

When he is in Chapel Hill, he tries to cram a week’s worth of meetings into a day. He lobs career-altering questions or advice at his colleagues in chance hallway encounters.

He once asked a young doctor to take a job he needed to fill at a clinic in rural North Carolina. They were passing each other in the stairwell.

Despite the demands on his time, Cohen has managed to foster deep friendships across the world. His grown children and wife, UNC social medicine chairwoman Gail Henderson, adore him, too.

His children, Jessie Viders and Michael Henderson-Cohen, say it took a long time for them to realize how important their dad was because he seemed to be available whenever they needed him. Viders remembers her father trouble-shooting a car problem in the middle of the night from China when she was in college.

“He made us feel like we were number one no matter what,” says Viders, 33. “The older I get, I wonder if my parents were superhuman.”

Cohen is fueled by a type of mania. But he is spared the dips of despair many researchers feel after a setback.

He’s wholly unfamiliar with depression or anything like it. For a doctor spending his career studying a disease that has no cure, that’s an invaluable gift.

Cohen first visited Africa in the early 1990s, answering an invitation to send a team to help Malawi figure out how to combat HIV. So many people in the African nation were dying that furniture makers spent their days building coffins rather than chairs or benches. Cohen took the bleak reality as a call to action.

“All I could feel was intense commitment,” Cohen says. “We would make this better.”

Nearly two decades ago, when Cohen first posed the question that would shape his landmark clinical trial, colleagues and funders shook their heads. Once antiretroviral drugs showed promise stymieing the disease, Cohen wanted to know if early and effective treatment could lower the viral loads of a patient so dramatically that he couldn’t transmit the virus to his partner.

Colleagues warned: You will never pull this off. Too much money, too many ethical questions, too little stability among couples that needed to be monitored.

Cohen couldn’t hear the word “no.”

‘A force of nature’

Cohen faced hurdle after hurdle, and despite the value of knowing the answer to the early treatment question, many believed knowing wasn’t worth the work. But Cohen knew that answers, not guesses, drive policy.

Pulling off the clinical trial had much to do with the relationships Cohen fostered over his career.

The National Institutes of Health was on the fence about the study for years. It would be pricey and unwieldy. The agency was firm about one aspect: Cohen would have to get the drugs donated.

He would have to convince pharmaceutical companies to swallow at least $20 million in lost profits for a project that could likely obligate them to more donations for decades to come.

Cohen stalked his connections at pharmaceutical companies. He flew around the world to meet with them. Between visits, he would call constantly, beginning each conversation with: “The answer is yes. How do we get there?”

“Mike’s a force of nature,” said Sally Hodder, an HIV doctor who Cohen had to convince to provide some of the drugs needed from Bristol-Myers Squibb. “You might be able to blow him off once, but never for a second time.”

Securing the drugs took five years.

Cohen finally prevailed with Hodder’s company in 2007 – the last of the needed donations, clearing the path for the full trial to start in 2009. Cohen sent Hodder two dozen roses.

More problems to solve

The result of the trial last year was a home run. The study proved that treating HIV prevented transmission, and it worked so effectively that NIH ordered the results be shared early and all trial participants be offered the drugs.

Many of the naysayers who needled Cohen for a decade now offer their praise.

The study results have posed a host of extra questions: Will the results last? Will the patients for whom they delayed treatment develop other health problems such as heart disease?

Cohen is still working seven days a week, even on vacation. Asked if he’ll scale back and think about retirement, Cohen laughs and jokes that he’ll be following up on the study someday from a nursing home bed.

Day to day, Cohen helps monitor HIV research being conducted globally, and as a merit scholar with the National Institutes of Health, he is locked in to important research for at least a decade more.

Cohen has long held the notion that his best work needs to be in front of him, and at 62, he’s hungry to make even more of an impact in the infectious disease arena.

One afternoon last month, Cohen raced to Duke University for a meeting with longtime collaborator and HIV researcher Bart Haynes. Cohen has been bothered by the resurgence of syphilis in China and a growing number of patients unresponsive to the standard antibiotic treatments.

Cohen hoped Haynes would have a brilliant idea on how to crack the code on this old, stubborn disease.

The conversation twisted and turned over properties of the bacteria but after an hour, no one had a good research idea.

Cohen leaned back in his chair and sighed: “We can’t ignore this forever.”

Twenty minutes later, he was on his feet, headed back to Chapel Hill for more meetings about impossible public health problems. He intends to solve them, too.

Locke: 919-829-8927

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