Anne Goldfeld is a pioneer and a visionary leader. In work spanning clinical medicine, basic science, and human rights, she has broken through barriers and dogma to make fundamental paradigm shifts changing what we thought was not possible into a reality.
The quintessential physician-scientist, Anne has seamlessly and spectacularly straddled the interface between care in the poorest and most dangerous environments in the world, and the scientific bench at Harvard. All the while making fundamental scientific discoveries, and changing clinical practice impacting millions suffering from curable or treatable diseases, she has worked to change the tide of the great epidemics of her time, tuberculosis (TB) and AIDS. In parallel, she has addressed the great social issues of her time before they became celebrated causes, making a profound impact in each instance.
In all areas of her endeavor, she has challenged and overcome dogma, using her deep intelligence, commitment of heart, and gifts of insight and observation.
Trained as an internist and infectious disease specialist at Massachusetts General Hospital (MGH) and Harvard Medical School, she was perhaps the first medical resident who understood the importance of working and devoting herself to patients in areas of conflict or of extreme poverty in the early 1980s, well before there was a field of ‘global health’. She lobbied hard at a time when it was not accepted, to spend a month on the Thai-Cambodian border in May 1983 when she was a second year medical resident at MGH. Working to provide health care in what was at the time a no-man’s land between Thailand and Cambodia with constant shelling in an active war zone, she cared for refugees from the Khmer Rouge genocide and became deeply interested in the medical scars of torture and war, and in treating curable tuberculosis. Upon her return to Boston she began to work on what would turn out to be a landmark piece of scholarship documenting the medical and psychological signs of torture. This study was the first paper to describe the high rate of sexual violence that women experienced in war and torture, and literally opened up the whole field of gender-based violence (1). And around this time Anne chose to turn her career towards infectious diseases so she could be best prepared to help in conflict zones and in areas where patients did not have access to medicines, and
After completing her clinical infectious disease fellowship at MGH, she received equally intense training in molecular biology in the Biochemistry Dept. at Harvard University so she could apply her scientific interests in developing new therapies and vaccines. It is there that she started her seminal work on the regulation of the tumor necrosis factor (TNF) gene, the gene, which plays a major role in defense against infectious diseases whose overexpression is responsible for death from hemorrhagic viruses such as Ebola and malaria, and is at the root of many different forms of arthritis. In the lab, based on novel experiments, she first broke down the strong dogma at the time—facing down strong scientific resistance in the early years, that the TNF gene was only expressed in one cell type. Her studies led her to describe a new paradigm in understanding how genes are regulated in different cell types based on her discoveries (2). Furthermore, she was the first to describe how HIV avoided the host immune system and avoided triggering the activation of this gene and literally snuck into cells without setting off the cell’s antiviral responses (3). Even in those early years of her scientific training, her ability to make connections no one else was seeing, characterized her work.
In parallel with her scientific work, her profound commitment to the poor and afflicted in the world stayed strong. As this first phase of her scientific work came to a reflection point, she returned again to the Thai-Cambodian border in 1989, and was asked to lead the team of doctors and nurses for the American Refugee Committee team that ran the medical care for the 130,000 residents of the Site II South refugee camp. Confronted by daily human rights abuses by the Thai border guards, she began a systematic effort in the camp to document the violations using medical intake forms she developed based on her research of the medical signs and symptoms of torture. Her recording of clinical findings based on her research on torture, providing a first demonstration of a medical human rights approach that would be widely emulated.
As landmine victims were brought into the camp, she named it accurately a “medical epidemic” and began the first ever landmine prevention campaign in the world to educate refugees in the camp to not wander in the fields outside the camp to scavenge food or shelter materials in newly opened up and highly mined areas as the Khmer Rouge and Vietnamese backed troops withdrew further into Cambodia. Again, she used her documentary and scientific skills and snuck her camera into the camp to document carefully each casualty to use it to show the world what a landmine does (4).
Anne made one of, if not, the first call publicly to eradicate landmines as a weapon of war in a press conference in Bangkok in December 1990 (6). She followed this with the first call to ban landmines before Congress in 1991 (5). And she began to write about what she had seen and about the global problem. She wrote op-ed after op-ed in the New York Times, Washington Post, LA Times, Boston Globe etc. alone and with Holly Myers urging for a ban (7). Anne was one of the earliest members of the International Campaign to Ban Landmines, which eventually won the Nobel Peace prize in 1997. Serving as an advisor to the Campaign in its early years, she co-founded the US Campaign to Ban Landmines with Myers in 1994 (6).
Simultaneously Anne worked at Harvard Medical School going deeper into immunology and discovering new molecules that regulated TNF and new patterns of gene regulation—work that continues until today. And increasingly, she applied her scientific skills to address the monumental problems of TB and AIDS in the world and more recently in the last 2 years, Ebola.
As the landmine campaign gained extraordinary global traction, and the refugees who had been in the border regions of Cambodia repatriated, Anne began to turn her attention to TB, forming the Cambodian Health Committee with a Cambodian colleague. Begun as a tiny NGO in the post-war destruction of Cambodia in 1994 to provide care in this country with one of the highest TB problems in the world non-existent TB care, it has gone on to have a massive impact on the suffering of adults and children from tuberculosis (TB) and AIDS, not only in Cambodia but also in Africa, and regionally in southeast Asia—most recently in Myanmar. The community-based strategies Anne and CHC pioneered have been scaled up to the entire country of Cambodia and they were at the origin of treating AIDS in the country.
Anne was one of the first people to see the connection between TB and HIV and their deadly synergy and while she began to scientifically document the terrible toll of TB and HIV co-infection and to seek scientific answers, she began to advocate publicly to address the human disaster of TB and AIDS. She engaged the photojournalist and celebrated war photographer James Nachtwey to focus on TB and on TB and AIDS and they began a long collaboration to show the suffering of people unable to access treatment for curable TB and treatable AIDS (http://www.womensconference.org/struggle-for-life/). The photoessay Nachtwey did of Anne’s work in 2003 (http://www.poyi.org/61/mpoy/nachtweythree01.php), earned him his 7th award as Photojournalist of the Year in 2004 and began to raise awareness of the problem. Anne and Nachtwey showed their work together (his pictures and her documentation of the stories) in exhibitions in Paris, Bangkok and Berlin. Anne’s work was featured in Nachtwey’s exhibits at the UN at the US capitol, and in a myriad of publications highlighting the disaster.
Meanwhile, Anne’s focus in the lab turned more and more to TB and AIDS. She pulled together the French/US/Cambodian team that would eventually perform the CAMELIA (Cambodian Early vs Late Introduction of Antiretrovirals) Trial, which is recognized by many as the most significant contribution to TB/HIV in the last decade. The CAMELIA study, published in the New England Journal of Medicine in 2011, showed that the earlier timing of AIDS drugs resulted in a 34% reduction in mortality (8), which translated on a global scale to ~450,000 lives saved yearly with the new regimen, which was then adopted by the World Health Organization. She would be awarded the Presidential Medal from the Cambodian Prime Minister in 2010 in recognition of this work.
Since 2008 Anne has expanded her work in Cambodia to Ethiopia where she began the countrywide program for drug resistant TB in the country with the NGO she co-founded in Cambodia, under its new name, Global Health Committee (GHC). Passionately committed to the basic human right of assuring that everyone has access to medicines for curable or treatable diseases, she brought the model that had been developed in Cambodia to Ethiopia. In a remarkable and almost unprecedented outcome, as she was told staring the program was impossible, the collaborative program of GHC and the Ethiopian Ministry of Health GHC has treated over 2000 patients as of May 2017 and has reported the highest outcomes in sub-Saharan Africa for treatment for drug resistant TB (11). Anne’s work again turned a dogma on its head—this time that therapy for this disease could not be offered safely and rapidly in a country such as Ethiopia. With the Ethiopian and Cambodian teams she is currently finding ways to expand care for drug resistant TB in Myanmar to children and hoping to initiate care in South Sudan in follow up to a mission she made there in 2014.