Doctor, doctor: two amazing minds take on two deadly diseases. David Ho and Susan Love are working to rid the world of aids and breast cancer.
David Ho developed HIV cocktail therapy, which was introduced in the mid 1990s and has since made AIDS a chronic but manageable illness for many. Now he's focused on finding a vaccine. One-on-one with an AIDS pioneer.
OF THE COUNTLESS RESEARCHERS who've played a role in advancing the understanding and treatment of HIV/AIDS since 1981, Taiwan-born David Ho, 54, stands out. In the 1990s his lab at New York City's Aaron Diamond AIDS Research Center, which Ho helped found, yielded pioneering insights into the years-long battle waged between HIV and the human body's immune system. The results led to the development of highly active antiretroviral therapy (HAART), also known as "cocktail" therapy. The breakthrough earned Ho Time magazine's Man of the Year honor in 1996. He spoke to The Advocate by phone en route to the airport for a two-week trip to Taiwan, where he was scheduled to teach at a science camp for Chinese students.
You live in Chappaqua, the posh New York City suburb where the Clintons live--and you've traveled to China on AIDS summit trips with Bill. Are you rooting for Hillary in '08?
I'm a little up in the air. I'm an independent, but I'm certainly not voting for the Republican side. I think I'm leaning toward Obama--but [New York City mayor] Bloomberg might be a possibility if he runs.
Who's the best candidate on AIDS issues?
I don't know. Actually, Bush has done a lot better than I expected he would, especially with the programs abroad. Of course, many of them are abstinence-only programs that tie the hands of prevention workers, and that's not helpful. But he's committed a lot of funding.
Bring us up to date on your own research.
It's been focused almost entirely on AIDS vaccine development the past five or six years. Two of our vaccines are in early trials. Both of them inject five HIV genes to make proteins that will stimulate the immune system [to recognize and fight HIV].
Most vaccines tried to date haven't been able to engage both "arms" of the immune system--recognizing and fighting HIV--which is crucial. Will yours?
We think so. In patient samples in the labs we're seeing more of that reactivity.
What else excites you today in AIDS research?
Probably some of the basic research [on how the virus works]. We've learned that every cell in our body contains the ability to counter retroviruses [like HIV], even though HIV has figured out a way to fight back with a protein called Vif. So if we could develop a drug to inactivate Vif, we'd have a new class of anti-HIV drugs.
In the early 1980s, your colleagues would joke that you were always looking for gay men, meaning that you were trying to understand this new disease affecting them. Were you comfortable working with gays?
I trained in internal medicine in West Hollywood, so I had a large proportion of patients who were gay men even before AIDS, especially because I was already quite interested in infectious disease and there was a lot of hepatitis B and other STDs in that community.
Were you homophobic?
I was always very comfortable with gay men. I was even comfortable with my colleagues joking that I was always looking for them. Those early years were very emotional. Many of the patients dying then were the same age I was, and they were dying of mysterious infections of the brain, the retina, and the gut. It was not a dignified end, and, of course, the mystery added to the stigma and discrimination. We took care of a lot of patients who were shunned by family and friends.
Did you ever have a meltdown or feel like you were burning out?
No. Despite all the personal tragedies, the scientific part was interesting and fascinating and rapidly evolving. That's the part that kept me going.
Do you remember any of your patients particularly?
I remember about half a dozen of them very well--and fortunately, one of them is still alive and well. He's in Boston now, but we stay in touch via e-mail and phone.
Today, your lab works with newly infected patients to see if starting treatment right away can have a special benefit. A lot of those patients are young gay men. Do you ever want to just slap them upside the head?
[Laughs] Yeah, there are times I feel like doing that. They're so young. They have no recollection of the 1980s and early 1990s. It's a reflection of the complacency now toward the disease in this country because it seems to be manageable here.
Many people have accused you over the years of grandstanding and overreaching with your research. More than once, big announcements that you made--that HIV may be eradicable or that there was a multidrug-resistant supervirus afoot in New York City--haven't panned out. Are yon arrogant?
I'm confident. People love to simplify and rephrase what I've said, then criticize it. There's not a statement I'd take back. But it all got simplified to a one-sentence thing.
And now new research has revived your early suggestion that long-term treatment may eradicate HIV, especially in patients who start meds right away. Do you feel vindicated?
What I don't understand is that cancer patients want scientists to talk about curing it, but in HIV it's as though you'd committed an assassination to mention a cure. With that attitude we'll never have a cure.
To some you can really come across as someone who's never grieved or raged over AIDS, as if it's all about the science for you. Has working on this disease for 25-plus years changed you at all?
Well, a lot of it is about the science because that's my principal profession. But I think it changed me in that I have become more socially active than if I had worked on some other problem. Especially with our efforts in China, I take on a lot on the economic and humanitarian sides.
And finally, Dr. Ho, tell us something about you that's really gay.
You've completely got me there. I wish I knew what was considered gay.
Are you a Madonna fan?
No, not so much. Why? Would that be considered gay?
Murphy is a contributor to The New York Times and New York magazine.
Susan Love is known throughout the world as the mother of breast cancer advocacy. The outspoken surgeon debunks the myth that lesbians are at greater risk.
DR. SUSAN LOVE DIDN'T SET OUT TO become a breast specialist. But when she became a surgeon in the late 1970s, not only did men dominate the field, they often believed that women should operate only on other women. As a result, her male colleagues typically sent female patients her way, many of whom had breast problems.
Dr. Love saw an opportunity to make a difference, and she ran with it. Over the next 10 years, her controversial views about treating breast cancer and other breast problems garnered attention inside and outside the medical establishment. And when she published Dr. Susan Love's Breast Book in 1990, still widely referred to as "the bible for women with breast cancer," her reputation grew even more.
Today, Love serves as president and medical director of the Dr. Susan Love Research Foundation. Her goal is to develop a tool that could diagnose breast cancer so early it would find cells that, as she likes to say, "are just starting to think about becoming cancer." The foundation is located in Southern California, not far from the home she shares with her partner of 25 years, Helen Cooksey, and their 19-year-old daughter, Katie.
Forty years ago, how were women who had been diagnosed with breast cancer treated?
Back then, we didn't have mammography screening, so you would come in if you found a lump. You'd be scheduled for a surgical biopsy. If they found cancer, the doctor would perform a mastectomy. More often than not, the way you found out whether you had cancer-because the surgeon wasn't there and the nurses wouldn't tell you anything--was by looking at the clock. If you'd been in surgery for an hour, you'd had a biopsy. If it was three hours later, you'd had a mastectomy. And then when you left the hospital you wouldn't tell anyone what had happened because nobody talked about breast cancer.
What triggered the breast cancer activism of the 1990s?
In the late 1980s, there was a growing movement to make the biopsy and the mastectomy two separate procedures. My book came out in 1990. Women loved it, but doctors hated it, because the doctor was supposed to control all of the information and I was telling women all of our secrets. This was also the time when the AIDS movement was politicizing HIV. Women quickly realized that breast cancer--how it was treated, funding for research and treatment--was political as well. That's how I began working with breast cancer survivors to cofound the first grassroots breast cancer advocacy organization, the National Breast Cancer Coalition.
How is breast cancer treated today?
Now it's much more likely that you'd have a biopsy because something is seen on a mammogram. After you'd get your biopsy results, you'd see a surgeon, who would talk to you about your options--lumpectomy with radiation or mastectomy. We wouldn't take out lymph nodes unless it was necessary. After your tumor was removed, the surgeon would have it tested to see what type of treatments it would respond to, and then talk to you again about your options--chemotherapy, hormone therapy, Herceptin. You'd also probably get a second opinion, read lots of books, join a support group, or get involved in fighting for more research funding.
What will the field be like 20 years from now?
Once a year you will do a breast exam at home. You will put a special type of bandage on each nipple. Then, you'll massage each breast to release a drop of fluid onto the bandage. If the bandage turns blue, you will go to see your doctor, who will take more fluid out of your nipple to determine which specific breast duct is abnormal. The doctor will then squirt a treatment down that abnormal duct, and you'll be back to normal.
How can women reduce their breast cancer risk?
Exercise--working out and not being overweight--appears to reduce risk. Be careful not to get unnecessary radiation from X-rays. Eat a diet that includes a lot of fiber and is low in animal fat. And don't use hormones to treat menopausal symptoms for more than three to five years.
What's one of the most stubborn myths about breast cancer?
That lesbians are at higher risk. Studies have identified some of the factors that increase breast cancer risk, and anyone, straight or gay, who has these risk factors--such as never getting pregnant, drinking more than one drink a day, being overweight, not going to the doctor regularly--is at higher risk. There is nothing about being a lesbian, per se, that puts you at higher risk.
Rochman is a freelance writer based in San Francisco and medical editor for www. susanlovemd.org.
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|Author:||Murphy, Tim; Rochman, Sue|
|Publication:||The Advocate (The national gay & lesbian newsmagazine)|
|Date:||Sep 25, 2007|
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