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A Bill Moyers Special - Becoming American: The Chinese Experience

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

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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.

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