A Bill Moyers Special - Becoming American: The Chinese Experience

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Public Affairs Television "Becoming American" Interview with David Ho, M.D.

BILL MOYERS: Well, let's start with where we are today in the world. Give me a sense of the research you're doing right now. What are you working on?

DR. DAVID HO: The major project that I'm focused on is to develop HIV vaccine to prevent the further spread of HIV. That's my biggest project. I think, for most of the research groups, there would be consensus that vaccine research has to be the most important thing we do today.

BILL MOYERS: Tell me something about the extent of the epidemic of HIV that the world is facing in the 21st century.

DR. DAVID HO: Well, HIV has already infected, cumulatively, over 60 million individuals worldwide. Right now it is killing approximately 20 plus million and about 42 million people are living with viral infection. We know that each day this epidemic continues to grow at a rate of about 14,000 new cases per day. It's astonishing.

BILL MOYERS: Are we making any progress?

DR. DAVID HO: Progress has been made. We've been confronting this epidemic, this virus for about 20 years. We now have a great deal of understanding of the basic properties of this virus. And this has translated importantly into a number of drugs that are useful therapeutically.

And in developed countries these medications could help control the virus and prolong the quality of life and the length of life.

BILL MOYERS: Is there any hope for a continent like Africa where it appears to be ravaging out of control?

DR. DAVID HO: There's always hope -- through science and scientific investigation. There's hope that ultimately we could come up with a vaccine to halt the spread of this infection in sub-Saharan Africa. But that's not an easy task and it's some years away so, for the foreseeable future, there's no question but that Africa will be devastated by this epidemic. Perhaps a whole generation could be lost to the epidemic. Of the 42 million people living with HIV, at least three quarters of them are in sub-Saharan Africa. In those African countries, the patients do not have access to the kind of therapies we have in the U.S. and Europe, and therefore they're condemned to die, and it is typically a slow and miserable death.

BILL MOYERS: Is it a stretch to say that this is comparable to the black plague that swept across Europe?

DR. DAVID HO: I think there's no doubt that the HIV epidemic is the plague of our millennium. We are already dealing with huge numbers of people infected and the projections for the coming decade are that somewhere between one and 200 million individuals might come down with this lethal infection. In addition, the second wave of the epidemic is spreading into Asia where half of the population resides so there's no doubt that the problem will get worse. Projections suggest that over the coming decade in India and China we could have perhaps 40 million infections by 2010.

BILL MOYERS: India and China together, 40 million. Are you doing any work in the country of your origin?

DR. DAVID HO: Oh, absolutely. For several years we've been working on the ground trying to take our vaccine effort over there to do a collaborative project with the Chinese scientists. We were tested in the field in China and we've been training people, building infrastructure, laboratories and clinics.

It's very gratifying to be able to come to this country from Taiwan, acquire my expertise and now be able to take it back and have it be useful to the Chinese government.

BILL MOYERS: How far back do your roots go in China?

DR. DAVID HO: A few generations on my father's side. I've been to our hometown in the Jungshi (PH) province, which is in the south, just north of the Canton (PH) province.

Though I was born in Taiwan, I never had the opportunity return to visit. The first time I was able to go was in 1978. That was the only time I met my paternal grandmother. So we are able to trace several generations there. Interestingly, my father's from this village in Kosh Shinghi and Jungshi, and just about everyone in the village has the same surname, Ho. (LAUGHTER)

BILL MOYERS: What was it like to see your paternal grandmother, to be there?

DR. DAVID HO: I only knew her through some descriptions given by my father. In fact, he never had a photo of her until the years after Nixon toured China and helped to open it up. It was quite an exciting experience for me because I'd never met my grandmother - I didn't even know what she looked like.

Oddly enough, we could not communicate with one another because she only spoke a local dialect, not Mandarin. I could only speak the Taiwan dialect and Mandarin, so we had a lot of trouble communicating. It was mostly through body language. It was just a fascinating trip for me in 1978.

BILL MOYERS: Tell me your Chinese name and what it means.

DR. DAVID HO: My Chinese name is Ho Dae He (PH). Ho is the surname. I'm not sure it has any particular meaning. But Dae He is probably as simple as it could be in terms of Chinese writing. Dae means big and He means one.

And so simply put it's the big one. But my father would like to say he chose the name because it means the great one. (LAUGHTER) Now, my friends and my relatives used to kid me because Dae He is written with essentially four strokes. As easy as it could be in Chinese. They told me that my father chose that name because he was afraid I wouldn't be able to write. (LAUGHTER)

BILL MOYERS: What did he think when your face was on the cover of Time Magazine?

DR. DAVID HO: Well, you know, for parents it's probably the greatest thing since sliced bread. You know, now that I'm a parent, I feel that way about any accomplishment by one of my kids. So they were of course really excited and proud, and I'm actually seeing them so happy and proud. You know, I couldn't help but enjoy it with them. But for me, if it were just myself, it would be a different reaction.

BILL MOYERS: I'd like to think that when your father saw you on the cover of Time Magazine he thought, "I named him appropriately. He's fulfilled my expectations."

DR. DAVID HO: Well, I'm sure he said that too, - proudly to his friends - but he did not express that to me.

BILL MOYERS: Tell me about the village in Taiwan where you were born. DR. DAVID HO: My father left the mainland to teach in Taiwan, actually prior to the communist takeover of the mainland. And my mother was born in central Taiwan in a town called Tazhong (PH). They met because he was the teacher and she was the student. Old story. I was born in Tazhong, then a sleepy little town or city in central Taiwan. Today it's a pretty busy place with a few million people, and probably the third largest city in Taiwan.

The educational system in Taiwan is highly competitive, and even at the elementary level we were told that you had to excel, because if you didn't, you wouldn't get into middle school And of course everyone wanted to get into the best, or the better one's. And so starting about third or fourth grade you have school and then you have additional school or course work at night where tutors would be brought in. So it's highly competitive. And we were doing algebra in the fifth and sixth grade. I'm not sure that's necessarily healthy but we were told to focus on education.

BILL MOYERS: What were your interests then as a boy?

DR. DAVID HO: Well, I had a few role models. As a young boy, I saw my father left Taiwan to pursue higher education in the U.S. and, ultimately, became an engineer. Similarly I had, on my mother's side, an uncle who did the same. The fact that they left Taiwan to pursue higher education was valued a great deal by friends and relatives and that already told me that doing something like that -- scholarly -- was a good thing.

And then interestingly in the late '50s, so I would have been just eight or nine years old, two physicists from China, Yang and Lee, won the Nobel Prize. That was such a big development that they were glorified, they were deified. All the kids were told this is what you ought to follow. Science became a big part of what I was thinking about from then on.

BILL MOYERS: You saw yourself as wearing that white smock down there, someday in the future, right.

DR. DAVID HO: Well, I'm thinking back that I was influenced by those processes.

BILL MOYERS: You said your father left while you were still very young, why did he come?

DR. DAVID HO: Well, he determined that just teaching at the high school level - English, math and other subjects -- was not something he wanted to do long term. So he decided to take the necessary exam and apply to come to the U.S.. He actually went to multiple places -- Colorado, Utah and ultimately ended up in California and got his advanced degree from USC - the University of Southern California - in electrical engineering. When he left in 1957 he left behind my mother, myself and a younger brother and we did not see him until 1965 when the three of us came over.

He did it that way because he wanted to finish school, establish himself and become stable before moving us over. And also the climate for immigrations became much more favorable by then, and therefore we were given this golden opportunity to come over here and pursue our dreams.

Most people from Taiwan at the time felt that this is the land of opportunities. And if given the chance one should take it.

BILL MOYERS: But not many of you could come. There were strict quotas on the number of Asians and the number of Chinese who could come to this country.

DR. DAVID HO: Right. Throughout the '40s, '50s and early '60s, only those who came to pursue advanced degrees were permitted to enter the United States. It was difficult to come under other circumstances, and certainly not just immigration. We heard from my father, but not by telephone because we didn't have a telephone -- only through letters -- and he never returned for a visit. He went to the US on a slow boat and got so sick and it took so long that he didn't want to be doing that on a regular basis. So there was a period where we did not see each other for years.

BILL MOYERS: What did he tell you when he left? What did he tell your mother and-- and you and your siblings?

DR. DAVID HO: You know, I was about six at the time, so I don't really recall what he said to me. But what I learned later on from discussions with him and my mother made it clear that he felt what he was doing was the best thing for the entire family because it would open up our futures. The only instructions he left with my mother was to make sure the kids are well educated.

Looking back, I think he's really very happy that he made that move to come over here because it really broadened the opportunities for the entire family. He did it at great personal sacrifice. I've heard him over the years talk about his initial years in America trying to study and work at the same time while sending some money back home to support the family, and there was a great deal of hardship. As I have gotten older I truly appreciate the effort he made, particularly during that juncture.

BILL MOYERS: What did your father think that this country offered that he could not get in Taiwan?

DR. DAVID HO: An advanced education, the pursuit of certain things like his field, electrical engineering, and later on computer science. The opportunities for those things do not exist in Taiwan back then. And still to this day those opportunities in Taiwan do not compare to such in our country here.

Of course, he faced hardships when he got here. Just as an example, he tells us, frequently, about one job. While he was going to school he had to put eggs in cartons - you know these cartons. The white workers were bigger, they had hands that were substantially bigger. My father is a small man with very small hands and he could not keep up because he could only put two eggs in his hands at a time. He has told us about doing that job for hours and falling behind other workers because he was not as well equipped to do the job.

And to do hold that kind of job and have to study at the same time, worrying about family and being so far away and not being able to see your sons and your wife, that's hardship enough. These are things that, in the initial years, we never did talk about very much. But now that I'm older with my own family, I actually welcome the opportunities to have these sorts of discussions with him. I've tried to tell his story to my own kids.

BILL MOYERS: Are they interested in your roots?

DR. DAVID HO: Yeah, I think so. You know, they always think that I'm exaggerating or my father is exaggerating. But, comparatively speaking, they have it pretty nice compared to me who in turn had it pretty nice compared to my father.

BILL MOYERS: The year you and your mother and your family came to join your father was 1965, the year the new immigration law removed the old quotas for non-European immigrants. Was your family aware of the law?

DR. DAVID HO: I knew absolutely nothing about it at that time, and even after arrival I did not know very much. I just knew that the conditions were better to allow us to come. I didn't know what that meant. To this day my father worship JFK and LBJ for what they did to have the laws changed so that his family could come. Certainly for a lot of Chinese Americans I know it's crucial, myself included.

I was 12. when I came and I remember thinking it's truly a different world. You know, you go from bicycles to cars, from shopping in the village market to supermarkets and from Chinese to English. I was a six grader and my brother was a fourth grader, and in Taiwan one does not learn English until you get to middle school so we had absolutely no exposure to the language. We did not know the alphabet. So we started from step one, and it was a culture shock on top of a language barrier. Looking back, I would say after one semester we were communicative in English and after a year or two I think we were pretty fluent. And I'm glad I don't have to go through that process as an adult. I think the brains of youngsters are wired in such a way that they can really adjust very quickly. And we did.

BILL MOYERS: You learned English quickly but how were you in regular classes, how did you learn math and social sciences and the other courses we expect of students in school?

DR. DAVID HO: Well, the social sciences were more difficult. Math was a breeze because it was easy to do the simply stuff that I was confronted with upon arrival, so, I got pretty good grades in math even from the very beginning.

But some of the other classes - until my English proficiency got to a certain level, it was a struggle. It was a tough time for me in the sense that, in Taiwan, I had been a pretty good student and then all of a sudden, I couldn't communicate. Therefore, I was generally viewed by others as the dummy in the class - you know, kids can be cruel at times. The first few months were really rough for me and my brother.

There were some ESL classes and that helped because, in those classes, all the other kids were going through the same process. But we still had to attend many other classes along with the regular kids and that was a struggle. But math wasn't a problem. I did math in Chinese. To this day, I still do my multiplication tables in Chinese. I do all my calculations in either Mandarin or Taiwanese actually. It's not as easy in English.

BILL MOYERS: How long did it take you to be accepted by your peers in school?

DR. DAVID HO: I think after a year or so people realized that I was communicating better. There were classes I could excel in. It's hard to make friends when you can't communicate, but my brother and I quickly adjusted after that initial year.

BILL MOYERS: The other kids clearly saw you as different. Did you see yourself as different?

DR. DAVID HO: Oh, absolutely. I looked different from most students in the school, and I couldn't communicate as well and my background was very different, so that initial period changed me a great deal because I was a fairly active, outgoing child in Taiwan and after arriving here, I became pretty much an introvert for a number of years. I gradually came back in the years following.

BILL MOYERS: Did you keep it to yourself or did you share it at home?

DR. DAVID HO: You know, I don't recall having lots of discussion on the problems. My father is not the type who would say "Let's talk about this and solve it together." He probably just thought that with time, we would overcome the problems - and I think he was correct.

BILL MOYERS: What did you come to appreciate about America as you continued to live here? What was it that made all of this worthwhile?

<DR. DAVID HO: Well, I think it's clear that, for me, I got a great overall education in my early years, but as I moved up the academic ladder -- once I got to college and particularly beyond college -- the opportunities offered here are incomparable.

For me, during the early years, there was always some emphasis on the quantitative sciences, probably because I had a father who is a electrical engineer and also because science and math are great equalizers in that if you have a handicap in communication those are much more objective fields. There's a right answer and there's a wrong answer and if you get it right you're right. Whereas in English or social sciences, it's more of a subjective field. That's why I see many of the immigrants go into areas where the language handicap would not be as significant a factor. And science and engineering allow many of the Chinese Americans to do that.

With the next generation we have our kids go on to tackle other things -- in law, in media and so on. But if you look at the Chinese American population of my father's generation, and to some extent my generation, we're heavily concentrated in the science and engineering areas.

I have kids-- 16, 21 and 24. Perhaps there's a chance for the youngest one to go into science. The oldest one is in the finance area. She's in the process of applying to business school. Our son who is 21 is a senior at MIT but his major is in economics./p>

BILL MOYERS: Do they see themselves as Chinese or Americans or as Chinese Americans?

DR. DAVID HO: They see themselves as Americans no doubt. Although from time to time they run into situations where they appreciate the fact that not everybody would see them as Americans.

But of course they are quite familiar with their heritage and they try to learn the Chinese language as well. But they're clearly Americans because they were born here and grew up here and have not lived for any extended period of time outside of the U.S.

BILL MOYERS: Was there an "aha" moment, a critical moment of recognition when you stopped thinking of yourself as a Chinese American?

DR. DAVID HO: I would say that there's never been an "aha" moment. It's a very slow transition. I actually became a naturalized citizen in 1970, about five years after coming, but I always thought of myself as an immigrant, a foreigner to some extent, and it is really through, I think, the fact that our kids are clearly American that we are American. And, you know, I have this ambivalence. Now that I'm looking back, I've been here so long that I sometimes forget I'm an immigrant, and there are times when I am reminded that I'm an immigrant-- by our society. You know, people will come up and say, "Where are you from?" "I'm from New York." And then they say, "Well, where were you born? Where are you really from?" And then I could go into my history because I am an immigrant and then I tell them that I was born in Taiwan, came over to California when I was 12.

But then for my children it's really tough. They say, " I was born in California and then raised in New York," but then people say, "Well, where are you really from?" And they don't really have much of an answer for that.

There's a certain attitude that I think is somewhat pervasive that an Asian face is automatically non-American. And yet we all know it is becoming much, much more common.

BILL MOYERS: The color of America is changing. The face of American is changing. It's remarkable what is happening. But there's still tension there, isn't there?

DR. DAVID HO: Sure, and some of it is self-inflicted. Some Chinese Americans segregate and feel that they're different. Obviously many people feel very differently, that we ought to integrate and speak up and get involved with the processes that make up America. We are Americans; we're just of a different heritage. Of course there's a lot of debate within the community. The Chinese American community is not a homogeneous one.

BILL MOYERS: When did you know you were gonna be a scientist?

DR. DAVID HO: That's a tough question because I have always been interested in science ever since I was a small kid. I went through middle school and high school with a great deal of interest in the sciences. I went to Cal Tech, which is a science school, but my interests within science have shifted a great deal over the years. Initially I was interested in the physical sciences, physics and so on. Then I saw that a new biology that was emerging in the early '70s and the impact that might have on the medical profession. That's why, rather late in the college years, I decided that I would go into medicine-- to pursue medical research which is obviously science.

BILL MOYERS: When you moved here, did you get an English name?

DR. DAVID HO: Yes, my brother and I were each given an English name, hence, I'm David. My father did it very simply, Dae He is D-A-E, and he just thought David was the closest thing. So that's how he chose it. And my brother is Hung Yee, and he picked Philip as something that's close to that

BILL MOYERS: And so the big one became David, the little one in the Hebrew Bible who slew Goliath. You must feel that way sometimes - like David with that stone when you confront the epidemic of HIV around the world.

DR. DAVID HO: I was involved in the HIV epidemic as a young physician, from the very beginning, from the initial identification of these cases. I was there when the mysterious cases emerged. For over a decade there was very little we could do about this viral infection, so, yes, for a long time we felt we were confronting a giant foe that was beating us every step of the way.

Luckily the tide has turned somewhat and we now have therapies that can control the virus, but we still have a long way to go. This virus is truly a tough opponent. There's absolutely no cure and there's no effective vaccine yet, so there's a lot to be done.

BILL MOYERS: What sustained you in those first ten years? I mean, you were up against something you really couldn't name, couldn't identify, had no answer to. What kept you going, you and your team, your researchers?

DR. DAVID HO: I think for many scientists it would be the same answer, an intellectual curiosity about what this thing is. Initially it was a total mystery so our first questions was, "What is the cause?" When the cause was identified as this virus we now call HIV, then the questions became how can we understand it, how can we dissect it, tease it out and know how this virus functions, how it attacks and destroys the immune system and so on and so forth?

Every step of the way there was a terrible disease and also a fascinating scientific challenge. Many of us want to help solve this mystery and at the same time solve this epidemic. That's what sustained us.

More recently, we have realized that an incremental gain in knowledge could translate into useful tools to combat HIV.

BILL MOYERS: Recount for me how you met up with AIDS?

DR. DAVID HO: Well, I had finished my medical school and was in the process of finishing up my training in internal medicine in Los Angeles in 1980-81, and I had taken on an extra year to be the chief medical resident.

It was during that period when a few gay men were coming in to the hospital with a multitude of infections, and these were not usual infections. These are infections that are only seen in immune compromised individuals - cancer patients who had been on chemotherapy, transplant patients who had been on rejection medications. So, the immune systems were wiped out and therefore they were susceptible to these infections by an organism that would normally not cause trouble. Yet these previously healthy young men were coming down with these diseases, which suggested that their immune system had been destroyed by something. Of course we did not know by what. That was a great mystery. I just jumped on that because it fascinated me. It was clear to me, even then as a young physician, that we were facing something new.

One could not find a description of such cases in the textbooks. I got interested because it was a scientific curiosity. I never realized that this would turn into the plague of the millennium. This epidemic gained importance when we realized we're not only tackling a fascinating scientific issue but we are also addressing a major public health concern. That's doubly gratifying.

BILL MOYERS: What has your research contributed to the field?

DR. DAVID HO: I think our biggest contribution to the field - the one I feel most proud of - is the fact that we showed the world what HIV is doing in the body of an infected person. Through our study of patients, we realized that the virus infects and replicates continuously, relentlessly at extremely high levels. It's constantly churning away, producing more progeny virus which in turn infect more of these important cells in the immune system.

This just goes on remorselessly for years and years. In that process, it wears down the immune system so that the person infected becomes susceptible to a multitude of ordinary bugs in our environment.

The ramification of this discovery is that we could actually quantify how fast the virus replicates and to what level. We also learned that every time HIV replicates, it makes mistakes, it makes mutations. You could say that's pretty stupid of the virus to make mistakes while trying to copy itself because many of the progeny virus would be defective or dead, but in fact it's a very clever strategy because some of the viruses will survive and those are more fit.

It allows HIV to change very rapidly and only allow a small subset of the progeny to dominate. What happens is that we're looking at Darwinian evolution going at a very, very fast clip. And this is all happening within the body of an infected person. The consequence is that when you try to treat HIV, because it's so capable of making these mutations, it will evade the drugs very quickly. It will evolve forms that become drug resistant. And therefore the drugs will fail after a short period of time.

We found that by doing the numbers and doing the proper calculations we could actually figure out a new strategy. You corner the virus and force it to make multiple mutations to evade multiple drugs at a given time. When you crunch the numbers you realize it becomes increasingly difficult for HIV to do this if you put three or four drugs in at the same time.

We then took this implication and testes it in patients. By mid 1996 we had a bunch of patients whose virus loads were controlled to a undetectable level using such a strategy.

BILL MOYERS: Do we still know why that happened?

DR. DAVID HO: Well, when we copy our DNA we use an enzyme in the body that the cell makes. The fidelity of that process is very high. The fidelity of the HIV enzyme that's required to copy it's genetic material is very low. So, it makes a lot of mistakes.

In addition, when you and I copy our DNA, we also have a proof reading function. If you make a mistake, you can fix it. HIV has no such mechanism. It's like a kid typing a term paper. They make a lot of typos and they don't actually proof read

BILL MOYERS: But it's such a stubborn foe. You have these therapies but there's still no cure.

DR. DAVID HO: I think you'll find that many scientists are suckers for punishment. I think we want to pursue tough problems. This one certainly is, but it's obviously a very worthy issue to study.

BILL MOYERS: Are they aware in China of what they're up against?

DR. DAVID HO: I think very gradually they have become aware. At least the very top of the Chinese leadership. They now intellectually understand that they're facing an epidemic that could affect ten million of their population by the year 2010 if they don't do something about this.

The trajectory for this epidemic is very steep in the next eight years or so. I think they understand it but they really need to embrace it and make it a priority. If you were to tell any national leader that 10 million of your citizens will die of a single catastrophe, he would treat that as a national crisis of the utmost importance. The Chinese leaders appropriately sprang into action when they had major floods that killed lots of people, but this will be much more devastating than that. I would like for them, and for many other national leaders, to really overcome the denial and accept that they are confronting a crisis and act accordingly.

BILL MOYERS: What's the one thing you would like for a layman to understand about HIV?

DR. DAVID HO: I think that this epidemic is still spreading at a alarming rate, both in the US and throughout the world. I think that because of the progress that's been made over the past few years, there's a level of complacency that has settled in, particularly amongst the public in the developed countries. They believe that this is now treatable, if not curable, it's not so bad. Yet it is a bad infection. It is devastating to many developing countries. Of course we all know about sub-Saharan Africa, but many people may not know the severe epidemic that is expected in Asia. So we really need to understand the true magnitude of the epidemic we're facing.

BILL MOYERS: I suspect that you would have accomplished great things in whatever field you chose, wherever you lived. But how do you think your life would have been different if you had stayed in Taiwan?

DR. DAVID HO: I've asked myself that question a number of times. I suspect I would have most likely pursued science and ended up dealing with, maybe not the same problem, but some other scientific challenge. And one way or another I probably would have made it to the US-- probably to study and then to confront a particular challenge.

But I must say that the efforts laid out by my parents, my father in particular during those early years, really made things a lot easier for me. So, I faced the language barrier, the culture shock as a youngster with family support. And it was a relatively brief and minor [challenge] in retrospect.

But if I were to come at a later stage, as an adult with many other responsibilities and challenges, the adjustment would have been more difficult, I think. And so, I often tell my kids now that I really appreciate the road paved by my parents for us. They actually lived through a great deal of hardship for our benefit.

You know, it's funny but I think my brother would agree with me completely - there was never any resentment [of my father's leaving us to go to America.] We knew that he was away doing something that other people considered noble, and so there was no resentment on our part. Of course, we missed having a father figure around, but he provided for us through his monthly check and we knew that ultimately he was going to open doors for us. In fact, that happened some eight years later.

BILL MOYERS: When you were Time's Man of The Year did you call him to tell him before the cover story appeared?

DR. DAVID HO: Yes, of course. I didn't find out myself until maybe a couple weeks before that issue came out. I thought they were just doing a major piece on our work. When he knew, he couldn't have been prouder. And in his own way, he told every one of his friends and relatives. He's not the kind who would hug you and kiss you -- you know, the typical stern Chinese father figure. But you could tell there was a great deal of joy in his heart at that crucial moment.

BILL MOYERS: Thank you very much, David Ho.

DR. DAVID HO: Thank you.