Burton J. Lee III left big-time medicine for big-time politics shortly after his good friend George Bush moved to the White House. Before long, he was up to his old tricks -- speaking his mind. This time, he was physician to the president and he was talking about policy issues such as health care financing, abortion and the AIDS epidemic.

None of it won him many friends in the upper reaches of the White House.

When Lee talked about expanding his "blue-collar" job (a term he borrowed from a predecessor) so he could advise Bush on national health issues as well as his personal health, some dismissed him as a "gadfly" and "loose cannon" who was "out of the loop." One White House official commented recently, "His policy views are considered inconsequential."

Lee describes himself more bluntly.

"Some people think I'm a big pain in the ass."

He is not exaggerating. An internist serving as an oncologist at New York's Memorial Sloan-Kettering Cancer Center, he was in the mainstream of American medicine, according to some colleagues. Others remember him as a "maverick" who went out of his way to shock.

"All of us were stunned, then grateful to the president for taking him away," a former colleague says of Lee's departure from a job that earned him three times the reported $100,000 a year he gets at the White House. "People around here are amused when they hear his comments about how he's going to convince the president to change things. The White House doctor is the person who coordinates the medical care within the White House, but not policy. He's supposed to be thinking about the president's health."

Lee's response is that "if my horizons were limited by strictly clinical care, I probably would have stayed at Memorial." In his opinion, doctors who care for U.S. presidents are driven off by "menial and day-to-day baggage-carrying," although Lee says he does very little of that sort of thing.

If he isn't effective in the "policy arena," he said during a recent interview at his White House office, it is because he is still a "minister without portfolio," not the adviser he expected to become when Bush offered him the job.

"Doesn't that seem a little stupid, that I'm not only not invited but actively kept out?" he asks. "It irritates the hell out of me."

At 60, Burt Lee would have you believe that he has been throwing down gauntlets throughout his professional career -- at Memorial Sloan-Kettering where he had a special interest in Hodgkin's disease, as an AIDS commission member during the Reagan era and, at the moment, at the White House.

"He's very direct," explains Jonathan Bush, Lee's longtime friend and the president's brother. "You can't get down on somebody like that."

Nevertheless, some do.

In an interview last November with the Journal of the American Medical Association (JAMA), Lee lobbed some critical volleys at the medical profession's health care delivery and financing, concerns that have become almost an obsession with him.

"Right now, whenever a patient is worked up for almost any medical condition, the physician will typically order 20 or so tests," he said. "There are many reasons, including professional liability, but we are never going to control the rise in cost until we remove the piecework aspect of medicine. As long as physicians are paid more to do more, they're going to find a way to do more tests and procedures and get paid more."

Peer group reaction was predictable.

"Greed may add to health care cost, but it is a minor factor. If Dr. Lee has information that proves otherwise, he should share it with all of us," Joe H. Woody, a Charlotte, N.C., physician, shot back in a letter to JAMA. "It appears that Dr. Lee has fallen victim to that well-known Washington disease Potomac Fever. Being near the center of power is heady stuff. One's perspective is easily distorted as one's ego is inflated."

Lee's rebuttal appeared in the same March 23 issue: Regarding costs, he said, "For confirmation, please listen to the public, big business, big labor, and the insurance companies." And as for Potomac Fever, he said, his views were the result of three decades in New York City's medical "trenches" and not in Washington's political corridors.

Lee's propensity for speaking his mind is no surprise to those who have known him through the years. Alan R. Nelson, president of the American Medical Association who represented it in ethics discussions before the AIDS commission, remembers Lee as "an independent thinker" respected for "the strength he brought" to that group at a time of infighting and ideological differences.

Frank Lilly, a New York geneticist and the Reagan AIDs commission's only openly gay member, who had considered resigning because there was no prominent physician or scientist with experience in AIDS, remembers that Lee was a receptive learner and responded dramatically in meetings with representatives of AIDS-related groups.

"It really woke him up. You could almost say he was zapped. I considered him to be on the side of the angels -- he took a relatively liberal view," says Lilly.

Though a practicing physician, Lee's only experience with AIDS had come while treating patients infected with the HIV virus who had developed leukemia and lymphomas.

"Everybody took the position that there were no doctors, no basic science experts on AIDS, and how were you going to run this commission?" says Lee. "But the point was not to write a medical report. We had to approach it from the point of view of the president, not the surgeon general... . We started off being challenged by everybody. I was going to die before I let that commission fail, so I sunk in my teeth."

Polly Gault, the commission's executive director at the time, says that Lee was "the glue" that held the commission together and was key in helping draft the outline of the panel's final report.

"He did a lot of research and he insisted that the commission deal with the real world, go to Harlem Hospital and to hospice facilities operated by AIDS groups," she says. Others describe Lee as shaken by testimony from AIDS victims and their families. "He said he knew how people discriminate against people with cancer, how they are treated differently," an AIDS activist recalls. "But he said, 'My God, how many times worse it is for these people with AIDS.' "

Among those whose ordeals affected Lee deeply was Ryan White, the Carmel, Ind., youth with hemophilia who contracted HIV in 1984 from blood products. When he died last April, Lee and First Lady Barbara Bush turned up without fanfare at the funeral.

Says one who came to know Lee in those days on the commission: "He can be a funny guy -- a classic noblesse oblige Republican who has this blue-blood stuff but through AIDS got sensitized to us all and the need to do something about it, in spite of the traditional Republican views."

It came as no surprise to some commission associates when George Bush, whose name Lee often invoked at meetings, appointed Lee his White House physician.

"I had a feeling he wouldn't mind at all if he could use his experience on the commission to get into politics," says a former associate.

Bedside Manner

A day seldom goes by that Burt Lee and George Bush don't check in with each other. Lee says "it's nothing formal." They talk about a great many things, but when Bush solicits his views on specific issues he always responds in writing.

According to Lee, the doctor-patient relationships between him and George and Barbara Bush are "on the personal side." Adding to their camaraderie are Lee's talent for telling a good story and his wife, Ann's, skills at skeet shooting. At Camp David, where the Lees are frequent guests, Ann Lee consistently defeats the president.

Lee says the two families have "multiple friends, contacts, scenarios and connections." One such connection is that Ann Lee's daughter by a previous marriage and the Bushes' daughter, Dorothy Bush LeBlond, were roommates at college. Another connection is that Lee's good friend and fellow Yalie, Secretary of Treasury Nicholas Brady, is also a close friend of George Bush.

"In the final analysis, that is probably why I am here," says Lee, "a combination of Nick and the president."

Like others in that exclusive fraternity some might call the Benevolent and Protective Order of George Herbert Walker Bush, Lee wears Roman numerals after his name, plays an aggressive game of tennis and traveled the high road to the White House by way of Andover, Yale -- he was five years behind Bush -- and Greenwich.

He was born and brought up, and spent his entire professional life, in a 10-block area bounded by Manhattan's East Sixties and Seventies.

Lee's father was a banker and his paternal grandfather was the first clinical director at Memorial Sloan-Kettering in its present 68th Street location.

"When I got there, most of the old-timers had been hired by him," says Lee, who arrived in 1960, four years after graduating from Columbia's College of Physicians and Surgeons with time out for residency at Bellevue Hospital and two years in the Army Medical Corps.

Friends remember him as a nonconformist. David Payton, an ophthalmologist, who has known Lee since they were adolescents, paints a picture of an environmentalist who will spend hours cleaning up a public beach at Martha's Vineyard and thinks nothing of picking up a gum wrapper while walking along a street in Greenwich.

"He does it very conscientiously, as a citizen's obligation. I've teased him about it, but I've never heard him speak about it. He just does it," says Payton.

Lee's critics know him as an often irascible eccentric whose unorthodox views on Hodgkin's, a disease he claims the medical profession knows little more about today than it did 30 years ago, are as alarming as they are inaccurate.

Once, at a meeting of fellow clinicians where Hodgkin's was under discussion, Lee says, he brought everybody up short with the question, "How come you've got a patient left with a profound T-cell permanent defect and you're running around saying you cured them? I would say you put what we know to be the Hodgkin's disease mechanism into remission but you haven't really cured the underlying disease. You don't even know what the underlying disease is."

Lee claims the ensuing uproar so infuriated his Memorial Sloan-Kettering bosses that for 10 years his superiors forbade him to talk to experts from the National Cancer Institute on grounds that he had been both wrong and stupid to comment.

Vincent T. DeVita Jr., who was head of the National Cancer Institute and was credited with the discovery of a type of chemotherapy used on Hodgkin's patients, says categorically: "As far as I am concerned the disease is curable, no question." Lee left Memorial Sloan-Kettering soon after the arrival of DeVita as the hospital's physician in chief.

Bruce Chabner, director of the institute's cancer treatment division, says, "I wouldn't criticize him, however. His interpretation of the facts may be correct... . Most people feel the disease is cured although the damage to the immune system isn't completely reversible. What Burton's saying is that unless you cure every manifestation of the disease, including the damage to the immune system, you really haven't cured the disease. The same thing can be said of a lot of diseases."

Burt Lee says he came under fire from his superiors another time, in 1981, for admitting a 21-year-old man suffering from a rampant herpes infection of the rectum. Though the man, a male prostitute, had no medical insurance, Lee went ahead and ordered an extensive work-up.

"They said, 'This guy is not a cancer case and the house staff is complaining and we think you ought to transfer him over to Cornell.' I said, 'Look, we are the best here in the world. We want the toughest cases that other people don't know how to take care of. I'm not going to transfer him anywhere. We're going to keep him here,' " Lee remembers.

Several months later, the man died.

Prescriptions for AIDS Battle

AIDS activists targeted Burt Lee as their way to reach George Bush in the fall of 1988. "A number of us were trying to ensure that all candidates would look at the AIDS problem, so I called Lee and asked what was the most strategic way to work with candidate Bush," says B.J. Stiles of the National Leadership Coalition on AIDS, who had dealt with Lee on the AIDS commission. "He said, 'Well, you start with me.' "

Some activists believe it was Lee who finally convinced the president that after 14 months in office it was time he provided more aggressive leadership in the fight against AIDS. Bush's March 29 speech calling for an end to discrimination, a commission recommendation that Reagan did not recognize, was the strongest statement to date from either the Reagan or Bush White House. Today, in what the AIDS community sees as a milestone, the president is scheduled to sign into law the Americans With Disabilities Act, which protects the rights of AIDS sufferers as well as people with physical or mental disabilities.

Lee continued to work behind the scenes as the sixth International Conference on AIDS drew near in June. He says he made some phone calls trying to find out within the system what could be done about U.S. immigration laws (eventually waived for conference participants) that bar people with AIDS from entering the country without special approval. "When I say, 'I make a phone call,' I mean that people say, 'Ah, people at the White House are interested in this.' "

Lee also works closely with Barbara Bush. Some in the AIDS community think that he asked her to place candles in windows at the White House this spring as part of a memorial for AIDS victims. In the early days of Bush's presidency, the First Lady's visits to care centers for children with HIV helped take some of the heat off the president. Lee sometimes accompanied her.

He remembers one particularly touching visit. "One young man told her about his loneliness, how his parents had let him go," Lee begins. "I can't even tell this story," he says in an emotion-choked voice. "At the end, Mrs. Bush turned around, put her arms around this guy, gave him a big hug and said, 'This is for the mother who let you go.' "

By late summer of 1989, AIDS activists were restive. Fearful that the new AIDS commission would be a sham unless at least one of its 15 members had the illness, a delegation of activists asked Lee to meet their nominee. She was Belinda Mason, a young Indiana woman infected with AIDS through massive blood transfusions during the birth of her second child.

Mason remembers Lee as "incredibly blunt ... I was impressed with his candor," and says he told her she was a "good out" for Bush, that it would be "a lot easier for him to accept a scrubbed-up like me who was harmless and inoffensive" -- that was how he was going to present her -- "and that nobody could complain about him appointing an AIDS victim."

But Lee also told her he was under no illusion about the influence he had on anybody. "He said, 'The president tells me it's going to be my call but frankly I don't think it is.' I think he was rather surprised that the president appointed me."

The next time Mason saw Burt Lee was after she had been appointed. "I felt Burt would tell me what water I was going to carry for the administration. But instead he said, 'I don't give a damn what you do. You don't have to have any marching orders from the Bush administration. Just be yourself.' "

The Doctor's Rounds

Lee has been on an unofficial mission of mercy around town lately. He consulted with Marilyn Quayle, who had a hysterectomy on Saturday. He also helped arrange for Czechoslovak Ambassador Rita Klimova to be admitted to Water Reed Army Medical Center for leukemia treatment.

"I told {Secretary of State} Jimmy Baker -- he's a friend of mine -- I want to help. But this is more on a volunteer sub-rosa basis and not official in my job description."

He has a four-doctor staff and says he runs his White House practice the same way he ran his 1,500-patient practice at Memorial Sloan-Kettering. Whatever the health problem, he'll arrange for his patients, who include any of the 2,400 White House staffers, the Cabinet and the Supreme Court who may want to consult him, to see the best specialist he can find.

"The president knows if there is any difficulty that I will bring in top people in the world, never mind the country."

For Barbara Bush's thyroid disorder, Lee says, he brought in specialists from Mayo Clinic but also from Walter Reed, where one of the leading authorities on Graves' disease is on the staff. It's Lee's job to accompany both Bushes when they have their routine medical checkups.

Lee says he will make the "medical call" in the case of presidential disability. "I'm going to definitely work through the chief of staff on issues of that type. We need coordination and a point man, and he's it."

Otherwise, what Lee calls "ideologic" differences with Chief of Staff John Sununu prevent them from ever working together. "It's unfortunate Governor Sununu and I have so many differences of opinion. It makes it difficult for me to have any kind of policy discussions."

Sununu, who declined to be interviewed for this article, issued a formal statement instead: "Burt Lee is a good doctor and has the president's full confidence. He is a good manager of the White House medical unit and an important member of our team. No one could be better suited for the job."

Last fall, Lee caused a flurry within the White House when he said his support for abortion rights prevented him from being considered for the surgeon general post. "I feel very strongly that anyone who takes that job {as surgeon general} should be able to support the president's position on abortion, and on this issue we differ," Lee said at the time.

The administration, however, said there were no litmus tests for candidates for top health jobs. Lee treats the incident with amusement. "The president rather enjoys having me around because I'm proof he doesn't have a litmus test," he says.

He vows he'll "continue to be a pain in the ass" and if support from major White House players isn't forthcoming, "eventually I'll have to challenge the president with it, but I don't want to do that at present... .

"I am 30 years in the business," says Lee. "I know more about what's going on in health care than anybody. There's nobody like me in this place."