Dr. Richard Marlink: Global Clinician

Dr. Richard Marlink with Harvard President Drew Faust in Botswana. Photo by Justin Ide/Harvard University News Office
Dr. Richard Marlink with Harvard President Drew Faust in Botswana. Photo by Justin Ide/Harvard University News Office

When he was an intern in New York City in 1980, Dr. Richard Marlink knew something was going on, he just didn’t know what. The hospital where he worked, St. Vincent’s, served patients from Harlem to Greenwich Village. “Mainly gay men, homeless people, and drug addicts used our clinics,” said Marlink. The staff began seeing a surprising number of rare conditions like Kaposi’s sarcoma and miliary tuberculosis—conditions usually seen only once or twice in a medical career.

In 1981, the CDC published an account of five gay men in Los Angeles with a rare form of pneumonia. The report was later acknowledged as the first scientific mention of AIDS. In retrospect, it’s clear that Marlink and his colleagues at St. Vincent’s had been treating some of the first AIDS patients. Thirty years later, Marlink would be responsible for putting more AIDS patients on treatment than almost anyone on the planet.

Richard Marlink, or Ric as his friends call him, grew up in Colorado and New Mexico. As a child, he visited his great uncle, Dr. Brownie Farrand, in the small town of Jordan, Montana. The only doctor in the county, Farrand dealt with everything from broken legs to eye glasses. Ric admired the way he talked to patients, learned their stories, and cared for them completely. From his great uncle’s example, Ric decided to become a doctor, too.

Twenty years later, Ric found himself in Boston as an oncology fellow at New England Deaconess Hospital. Oncology was a good fit because it covered all aspects of a patient’s health, managing problems that arose from having cancer and having to undergo harsh treatments to eradicate it. It was the mid 1980s. Ric was married and had just become a father.

Ric helped set up the first AIDS clinic in Boston, which consisted of a small exam table in a hospital utility closet. Little was known about AIDS at the time and fear and stigma were rampant. His patients were mostly gay men. Many of them had Kaposi’s sarcoma or other AIDS-related cancers.

“In the early days of AIDS, many of us were oncologists,” said Ric. Oncologists were used to caring for very sick people. The early AIDS drugs, like cancer chemotherapy, had harsh side effects. They were also ineffective. In the 1980s, most AIDS patients died.

When the head of his department, Dr. Jerome Groopman, suggested that he get some lab experience, Ric visited Dr. Max Essex at the Harvard School of Public Health. In the Essex Lab, Ric met an energetic post-doc named Dr. Tun-Hou Lee. Working with Essex, Lee had already made a number of important findings about the AIDS virus. “His excitement at discovery was infectious,” said Marlink, who quickly joined the team.

It was an exhilarating, exhausting time in AIDS research. Essex, his graduate student Dr. Phyllis Kanki, and colleagues discovered a second AIDS virus, HIV-2, in West Africa. Ric was on the team sent to Senegal to investigate. In Dakar, he examined prostitutes who were infected with HIV-2. He helped establish a study of sex workers to learn what problems the new AIDS virus caused in humans. “It was invaluable to have someone who could identify with the concerns of patients, especially from the physician/patient relationship,” said Essex.

Marlink examining a patient in Senegal in 1987
Marlink examining a patient in Senegal in 1987

The working conditions in Africa were difficult. Trained doctors and nurses were scarce and medical supplies were often nonexistent. In spite of these obstacles, Ric found the work rewarding. “A little bit can go a very long way in Africa,” he said.

The Harvard AIDS Institute (HAI) was established in 1988. Ric became Executive Director in 1992, a position he still holds. His mission, as he sees it, is to bring together people from different areas of public health to end AIDS globally. “Ric is extremely effective at connecting people,” said Essex. “He excels at raising questions and stimulating discussions among people from a wide variety of backgrounds.”

Over the past 20 years, Ric has created or led a number of important initiatives. In 1996, he was instrumental in organizing the Leading for Life Summit that brought African-American leaders to Harvard to respond to the AIDS crisis. In 1998, he created the Enhancing Care Initiative to improve clinical care for people living with HIV/AIDS in Brazil, Puerto Rico, Senegal, South Africa and Thailand. In response to the shortage of trained healthcare workers in Africa, he led the creation of the KITSO AIDS Training Program in 2000. To date, KITSO has trained over 9,000 healthcare workers.

From 2004 to 2012, Ric directed the HSPH PEPFAR program in Botswana, which helped the government place over 150,000 people on AIDS treatment. At the same time, he was the Principal Investigator of the Elizabeth Glaser Pediatric AIDS Foundation’s PEPFAR program which provided AIDS treatment to over 560,000 people in five other African countries.

Recently, Ric has led several studies to determine the best and most cost-effective models of AIDS treatment delivery in southern Africa. He co-taught a course at HSPH on Combating Infectious Diseases in Developing Countries. In 2011, he organized the AIDS@30 Symposium in Boston. You get the idea.

With so much of his time spent on conference calls and global travel, Ric Marlink still considers himself—like the great uncle who inspired him—a clinician. His job, he’ll tell you, is to improve healthcare for AIDS patients in poor settings. Only now, rather than treating several patients each day, his work impacts the lives of tens of thousands.