As chief of the Urban Health Study (UHS), the 47-year-old researcher studied needle users in what Marlon Perkins would have called their natural habitat. He pioneered the "bleach and teach" method, encouraging drug users to disinfect their syringes, and wrote or co-authored several medical papers that demonstrated how needle exchange programs slow the spread of HIV, including a 1994 landmark study published in the Journal of the American Medical Association. As a loyal partisan of the "harm reduction" movement, Watters argued that drug use should first be treated as a public health problem rather than a criminal one.
Watters' harm-reduction campaign came to an end on Nov. 20, when he was found dead in his Glen Park cottage by the mother of his child, Lesley Iura, who had been dispatched to check up on him after he failed to fly into New York City as promised. Watters was discovered lying face down on a couch with small amounts of blood coming from his nose and mouth. A preliminary coroner's report said, "Found on a cutting board on the kitchen table were a[n insulin] syringe containing a clear liquid, a spoon with a dried white powder on it, a glass of water, and small pieces of cotton with blood on them." There were also "empty wine bottles and prescription containers" and "apparent needle marks in the right antecubital fossa [the crook of the forearm]."
The suddenness and circumstances of Watters' death led the Coroner's Office to investigate it as a possible drug overdose -- and sent shock waves through AIDS prevention and harm-reduction circles.
"John's sense of ethics and intolerance for bureaucracy and bureaucrats was certainly my standard ... and the yardstick by which I measure my colleagues," says Moher Downing, a friend of 10 years who educates mothers about HIV transmission to their babies. "Having John die is, for us in AIDS, kind of like having Jerry Garcia die."
Former Bay Times reporter Tim Kingston calls Watters' death a "tremendous loss to the community. Everyone just keeled over from this. It's like the harm-reduction movement lost a -- he would prefer the term 'patriarch.' "
"He really looked at the large picture and was really at the leading edge of looking at many important public health problems," says Alan Lifson, an associate professor at the University of Minnesota who had worked with Watters for seven years. "I think he's really been a leader in many fields of epidemiology."
But Watters' death left several questions. Did the energetic and professionally driven professor run afoul of illegal drugs? Or was there a simpler explanation, such as a heart attack or a prescription-drug overdose, which friends and colleagues favor?
The San Francisco Coroner's Office will not determine the official cause of death for another four to six weeks, until thorough toxicology tests are completed. Meanwhile, sadness and speculation fills the air.
This much is known: A close friend of Watters expected him to arrive on an 11 p.m., Nov. 20 flight in New York. When Watters didn't show by 1 a.m., the friend learned from the airline that he hadn't even boarded the flight. The friend had spoken with Watters at 4:30 a.m. (Eastern time) on Nov. 20, at which time he planned to make the flight. (When she called again at 6:30 a.m., she got no answer.)
The friend called Lesley Iura and ask her to check on Watters; entering through the unlocked front door, Iura found the doctor's body and called emergency services. The officials examined Watters, searched the premises, and wrote out a receipt for his street clothes. A police officer took five Polaroids of the scene, and a coroner removed Watters' body for autopsy.
No suicide note was found, and no friend or colleague contacted could cite a motive for suicide. The highly regarded professor was working on seven different papers with Alex Kral, not to mention a letter on hepatitis transmission which was being reviewed for publication by the Journal of the American Medical Association. The UHS was about to receive additional grants -- one came in the day before his memorial service -- and Watters was about to start studying a new population of IDUs in the Bayview-Hunters Point district, "something John had been looking forward to for 10 years now," Kral says.
Watters was a national player; his obituary appeared in the Examiner, the New York Times, and the Washington Post, and also spawned a Chronicle story. Most of the obits acknowledged that the death was being investigated as a "possible drug overdose," but the Chronicle's Sabin Russell directly implied that Watters was using illegal drugs.
Noting the fact that Watters studied IDUs and died in a room containing prescription drugs and "paraphernalia" in it, Sabin's Nov. 23 story drew this conclusion: "Colleagues at UCSF said they were shocked by the news. Although Watters devoted much of his work to the problems of drug users, they said, they did not know that he was a user himself."
A user of what? Drugs his doctor prescribed? Merlot from Napa? Every drug identified in the coroner's preliminary report is of the prescription variety: Ambien (a sleep-inducer), Lomotil (an anti-diarrheal), Paxil (an anti-depressant), Lorcet and Synalgos-DC (oral painkillers, presumably prescribed after his recent shoulder surgery), and erythromycin (an antibiotic). (Observing doctor/patient confidentiality, Watters' physician declined to discuss his treatment.)
The "dried white powder" on the spoon could have been salt or sugar, close friends say. In any case, if Watters had been injecting heroin, the spoon would have been blackened from cooking. Additionally, his colleagues found nothing unusual about a syringe being found in the home of a needle-exchange researcher, with one saying, "I've seen them [there], so I know there was nothing illicit about them."
Reached at the Chronicle, Russell stood by the story, saying the preliminary coroner's report justifies referring to Watters as a "user." Asked whether he thought his report's wording would be libelous if Watters were alive, Russell replied, "That's certainly a matter that can be brought up, [but] I feel that the report was based on the preliminary coroner's report. I would urge you to do your homework on this as well."
When Watters talked to SF Weekly earlier this year for a story about needle exchanges, he sprinkled cautious doctorly conclusions with hell-and-be-damned jabs at policy-makers he thought were too stupid to live. He would typically follow these with something like, "Ah, you'd better not print that -- oh, never mind, go ahead." Reporter Kingston also remarked on Watters' unique sense of humor, saying that on their first meeting, the doctor introduced himself as "the Lord of the Underworld, you silly little reporter."
Ever willing to discuss his work at length, Watters stalled at questions about the nature of his professional motivation. After expansive discussions about the AIDS death toll, Watters would actively steer conversation away from what he did after hours.
Colleagues and friends agree that Watters was devoted to Jake, his son by Lesley Iura, who just turned 8 in October.
"He absolutely adored his son; he lived for Jake," says Moher Downing. Watters had custody of Jake from Wednesday to Saturday each week, and fretted about how his and Iura's recent separation might affect the boy. It was Jake Watters' idea, Downing says, to bury his father's ashes alongside his grandfather's back in Massachusetts.
Watters was under a psychiatrist's care for bouts of depression, and it was widely known that he suffered from migraines.
"On a 10-point scale [of migraines], he had a 10. They were incapacitating," says Downing. He was widely known to have been using an anti-migraine injectable, manufactured by Cerenex Pharmaceuticals and brand-named Imitrex.
One doctor who treats migraines with Imitrex, but who requested anonymity, says the drug should not be prescribed to someone with a history of borderline hypertension and high cholesterol -- both of which Watters had. Told that Watters was in his late 40s and died suddenly in the middle of the night, having complained of heartburn earlier that day, the doctor opines that absent any unusual autopsy findings, "That was a heart attack."
Watters' colleagues at UHS, Jennifer Lorvick and Alex Kral, who make their livings studying IDUs, say he showed no signs of IV or other drug abuse. According to Lorvick, Watters had recently lost weight, appeared "trim and fit," and was on a strict diet to treat the high cholesterol and hypertension.
"[Even] if there was misuse of prescription drugs, it was accidental," says a friend familiar with the circumstances of Watters' death. "He loved Jake so much ... he would never, ever, ever do something to harm that." Lorvick adds, "To me personally it doesn't matter what he died of; what matters is that he died ... the cause is kind of immaterial."
Downing best expressed Watters' significance to the HIV/AIDS community. Shortly after his death, a Mission District women's clinic lost part of its Title 10 funding. "[This] one clinic's federal funding was taken away -- on World AIDS Day -- and I thought, 'What would John Watters do?'