toledano/interview/38"/dt1st/mark2nd

By JESSICA TOLEDANO

Staff Reporter

Ever since Alexandra Levine was a little girl, she knew that she wanted to be a doctor except she didn't know why.

Today, as medical director of the USC-Norris Cancer Hospital and one of the nation's most highly regarded AIDS researchers, she has the answer: to improve and make a difference in people's lives.

A part-time job as a candy striper at Los Angeles County Hospital is what solidified her devotion to public medicine. After medical school at USC, she got a fellowship in hematology at Emory University and came back to work at USC. Her first big discovery came in 1978 when she developed a treatment for a type of lymphoma that saved a young woman's life. She was hooked to research and continued to work on new therapies.

Levine was the first researcher to discover the link between certain types of lymphoma and patients suffering from AIDS. She worked with world- renowned researcher Jonas Salk on a vaccine for HIV-AIDS that is currently in clinical trials, and was appointed to the prestigious Presidential Advisory Council on HIV-AIDS.

Levine grew up in Los Angeles with parents who encouraged her career path at a time when few women were entering the profession. She attributes her success to her parents' support.

Question: It was recently announced that AIDS was taken off the top 10 list of killer diseases. How do think this will affect people's attitudes toward the disease?

Answer: It is extremely exciting to me that we have developed successful or effective medication to prolong survival significantly in HIV and AIDS patients. In the United States, for example, the death rate from AIDS went down by almost 75 percent over the last several years. This decline has occurred while at the same time very effective combinations of anti-retroviral therapy are being used. The problem is that although we are much more effective in treating HIV, we certainly are not able to cure the disease in any sense at all. Moreover, there has been no decline in the number of new HIV-infected patients. So my only disquiet is the worry that the population in general will believe that this is no big deal anymore, and that's just not true.

Q: Do you think there will ever be a cure?

A: I believe we will be able to help patients have a normal life span, but I don't think we will be able to get rid of the last virus. HIV gets into the DNA. Once it's in the DNA, it lives as long as the cell lives. At this point in medicine we do not know how to get rid of genetic material. In 10 years, I think we will be able to create a vaccine, but with today's technology we don't have the ability to cure the virus.

Q: Given the drop in the death rate, do you think less money will be allocated toward HIV-AIDS research?

A: I think it is possible that AIDS research funding will go down because of the exciting new developments, but this would be most inappropriate. The problem won't really be solved until we have an effective preventive vaccine and also have a mechanism to cure the infection. We certainly don't have that yet.

The reason that I say the problems will remain is that it will be a tremendous burden to the infected patients to have to take these medications, which are costly and extremely difficult to take across an entire lifetime. In addition, there is increasing evidence that unless those pills are taken almost perfectly, the virus can learn to become resistant and may be resistant to all of the current available drugs. If an individual takes 80 percent of the medicines as prescribed, that is still not enough to prevent resistance.

Q: You do an extensive amount of research. What are you currently working on?

A: Basically, we work on studies that develop new drugs for people suffering from AIDS and think about ways to use a new drug that is not licensed yet. One study I am working on is an optimal therapy for patients with AIDS-related lymphoma. We are looking at the combination of chemotherapy with antiviral therapy, along with substances that will strengthen the immune system. We are also doing a study on the natural history of HIV-infected women as far as it relates to hormonal factors and pregnancy. Another area of research involves better means of treatment for lymphoma, where traditional treatment has failed. Also, I am looking at new drugs and new mechanisms for treating HIV itself.

Q: What has been your biggest research breakthough?

A: I defined the characteristics of lymphoma in the setting of HIV and defined the early attempts to treat the disease. I was the first in the country to define that lymphoma should be an AIDS-defining illness. I know lymphoma well and started to see extremely unusual types of lymphoma. I studied it and found that it was clearly different from regular lymphoma. It was an extremely exciting moment for me and changed my life.

Q: You have worked on AIDS research with Jonas Salk, the famous researcher. How did you get involved with that project?

A: In 1987, Jonas had been working on a concept for an AIDS vaccine, but was working in La Jolla and did not have access to patients. His son was a medical student at USC and he called the cancer center and knew that I was involved in AIDS research. He inquired if we might be able to work together.

My mother had just died in July of that year and it was a very hard time for me. I had stayed away from work for a couple of weeks. Then I got a call asking if I would come into work to meet with Dr. Salk. At that time, I had not come back to life yet. (In meeting) Dr. Salk, I wanted to be at my best and I wasn't going to be. I was going to be at my weakest.

(When) I came into the hospital to meet Dr. Salk, he walked right up to me and gave me a big hug, and said he understood what had happened. We had a good exchange and I realized that it was a very exciting project. I was very interested in his concepts and his vaccine and working and learning with him. That began an extremely close friendship that lasted until he died. He had developed an HIV vaccine and we started thinking about it as a therapeutic vaccine.

Q: Were you successful?

A: Yes and no. The vaccine still exists and it is in a very large national trial. The preliminary data remain exciting. There is an indication that the vaccine is able to stimulate the immune system against HIV and that individuals who are vaccinated seem to be doing better. The full results of the trial are not available yet. But the preliminary data were given at the International AIDS meeting in Geneva this year, and again, look very promising. As it relates to the use of this vaccine for a preventive vaccine, we still have not proceeded.

Q: How has your role as a doctor changed since the advent of managed care?

A: The advent of the managed care system is one of the most horrible moments in the history of my life as a physician. It has affected day-to-day medicine in the sense that I am seeing a consistent group of individuals who have come for a second opinion from an HMO setting. These individuals have been managed extremely poorly. Symptoms have been pushed aside and not evaluated, so that by the time a diagnosis is finally made, the patient has widely extensive cancer that could have been easily curable before. But now it is perhaps not curable or treatable at all. I am faced with this every single week.

I have one patient right now who was seen by the HMO staff about a year and a half ago for a fever, night sweats, weight loss and abdominal pain. Finally a CAT scan was done and it showed big lymph nodes. The HMO chose to believe that it was no big deal and sent him to a psychiatrist. One year later, he is diagnosed with what he always had, which was Hodgkin's disease, but now it is all over the liver and the rest of the body.

I believe the physicians in general are partly to blame for what has happened. We knew that there were problems with the system and we allowed others to find a solution. We did not take the time or perhaps have the time to deal with the problems ourselves, and now we are faced with an untenable situation in every way.

Q: How do you view the cutbacks at County-USC Medical Center?

A: It is extraordinarily shortsighted to build a 600-bed facility, when right now we have more than 800 in the hospital. The county has always been the site of last resort for individuals who have no other access to health care. If there are now 800 (patients) in an acute care facility, it is foolish to assume that 200 of the 800 are well enough to be on the street. It is absurd to me that the wealthiest country in the world has suddenly decided health care is a privilege, not a right.

Our floor at County is essentially 100 percent occupied all year and we have a waiting list that consists of 5 to 10 individuals. If our number of beds is cut, there will be unacceptable delays in therapy, and I expect that will eventually lead to unnecessary death.

Q: What do you do to get away from the intensity of your job?

A: I travel; the farther I go, the better it is. A lot of the travel is related to work and AIDS efforts, but I still enjoy and take extra time around it. This summer I was in China and Russia, as an example. I was working with the government in developing AIDS-prevention programs. My husband and I just built a house and the house is paradise to me. We have pets, I garden, we hike. But when I really have to go away, the only way I can do it is to go to a place that doesn't have normal phone service. No one can reach me in China.

Alexandra Levine

Title: Chief of hematology and medical director at USC-Norris Cancer Hospital

Born: Berkeley, 1945

Education: B.A. University of California, Berkeley; M.D. from University of Southern California

Most Admired Person: Jonas Salk

Career Turning Point: In 1981, when she saw the first person with what turned out to be HIV infection

Hobbies: Traveling, gardening, reading and writing

Personal: Married, no children

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