Merle Sande, 68, pioneer in treating AIDS
NEW YORK - Dr. Merle A. Sande, a leading infectious-diseases specialist whose early recognition of the looming public health crisis posed by AIDS led to the development of basic protocols for how to handle infected patients, died of multiple myeloma on Nov. 14 at his home in Seattle. He was 68.
In 1981, while chief of medical services at San Francisco General Hospital, Dr. Sande (pronounced SAN-dee) and his colleagues began to note an ominous incidence of young men being admitted with pneumonia, cancers, and other serious illnesses, some of which defied easy diagnosis.
One patient, a young gay man, had contracted a lethal case of toxoplasmosis, a parasitic disease sometimes passed from cats to humans but unusual in a patient with a healthy immune system. Dr. Sande and others noted the appearance of pneumocystis - a form of pneumonia more commonly found in malnourished children or patients with weakened immune systems - in gay male patients in Los Angeles.
Facing an influx of similarly distressed patients, Dr. Sande realized that San Francisco was in the opening stages of an epidemic, the health crisis now known as AIDS, or acquired immune deficiency syndrome. He began to pose fundamental questions about effective practices for care of the sick and protection of medical staffs. In 1983, he argued successfully for the opening of a ward in San Francisco General for AIDS patients and also helped found an outpatient AIDS clinic there.
With Dr. Julie L. Gerberding, Dr. Paul A. Volberding, and others, Dr. Sande developed what became known as the "San Francisco model" for AIDS treatments. It was "a comprehensive and rational approach on how care is delivered that contrasted greatly with the fear and paranoia that prevailed at the time," said Dr. Warner C. Greene, a professor and colleague of Dr. Sande's at the University of California, San Francisco.
Greene said the model addressed a need for infection-control guidelines, clinical studies, and research financing. It became a template for AIDS centers nationwide.
Dr. Sande contributed throughout the 1990s to panels evaluating pharmaceutical AIDS therapies.
