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What is the relationship between stress and immunology?

There is a fair bit of research going on about this. It is safe to say that chronic stress affects the immune system, but the size and importance of the effects have not really been established yet.

What are your thoughts on the placebo and nocebo effects and immunology. Can you tell yourself you are not going to get N1H1 and have a boost in immunity?

Almost nothing has been done on the placebo effect in human immunology, largely I think because of ethical concerns (is it right to lie to patients about what drugs they are receiving?) Nocebo effects (adverse) are quite common: Patients who get ill just seeing the doctor who gave them the drugs that made them sick, for example. In animals, conditioned immunosuppression has been repeatedly demonstrated. No one has done any research on that final question, as far as I know.

Is there a link between Osteogenesis Imperfecta and a lowered immune system, or would the lowered immune system be caused by something different?

There is no published association between OI and immune abnormalities. However, OI is a genetic condition that affects several body systems, some of which could lead to increased infection rates (such as the difficulty keeping airways clear that some OI patients have).

If you contract mono (since it is a form of herpes) can it manifest itself in the body as another form of herpes, say genital or oral?

There are 8 known human herpes viruses, but they have very different properties, and each causes its own set of problems; it’s like humans and rats are both in the mammal family butt are quite different otherwise. Herpes simplex 1 and 2 cause cold sores and genital herpes, respectively. VZV causes chicken pox and shingles. HHV 6 and 7 cause roseola. EBV and CMV cause infectious mononucleosis. HHV8 causes Kaposi’s sarcoma as seen mostly in AIDS patients.

Cancer surgeons are always cutting out lymph nodes in cancer patients. Setting aside any discussion of the necessity and efficacy of this, what, if any, are the medium to long term effects for your immune system of not having those lymph nodes?

Probably none. The surgeon rarely removes every last scrap of lymph node because they are simple too small to see; and the residual tissue can expand with time to replace it. And the rest of the body is full of lymph nodes to maintain immunity.

A general question about the type of med school that you have to pay for: It seems that many of the health problems that affect people in this country - type 2 diabetes, obesity, cancer, heart disease - are known to have a relationship to diet. And, yet, doctors are not generally known to have any knowledge or interest in diet. Has med school, or will med school, change to equip doctors with more knowledge of the role of diet in health?

At CU School of Medicine there is very extensive teaching about nutrition. It is old guys like JJ Cohen who weren’t taught much, (though even he had a whole course in it.) Patients seem to be a group who needs more teaching about healthy, rather than trendy, life style modifications.

There seems to be a wide variety in how people respond to H1N1 or other influenza. Some people get the full range of symptoms and others experience very mild symptoms. Does this have to do with the antibodies that are already built in one's immune system? Or does it have more to do with what variation of the virus they have been exposed to?

This is a very good question, and I’d have to say it must be both. I used to go to DC 3 times a year for very intense grant review meetings, and I’d always come home with a cold. I told my colleague that it was because my immune system was depressed by the stress of travel and work. He, a virologist, said that was nonsense: what really caused it was the exposure to a room full of people from around the country, all coughing new virus strains that we don’t have in Colorado on me. I think we were both kind of right.

In our household, we practice regular nasal washing...we increase this practice when we have been around sick people. We think that it has helped us stay healthy or it sometimes lessens the effects of a cold. Is there any fact supporting our belief or are we just making this up?

A study from Sweden reported in 2004: “A daily nasal spray with saline can prevent nasal symptoms of common cold in a population of otherwise healthy adults.” Another study compared zinc lozenges to hand washing and said hand washing is the best thing to do. So, use saline, not some special stuff (not zinc! it can permanently destroy smell receptors) and do it with clean hands.

When the last war with Iraq started, the US military began to be vaccinated for Anthrax. Had this vaccine been tried in humans prior to this and are there any known side effects?

Yes it had been tested, mostly in military volunteers. There is a pretty acrimonious literature about it, but I was unable to find a single study that showed convincingly that it is harmful. Nevertheless, 60% of people in the military think it is or may be, and do not want it. This issue was more intense when we believed that there was a risk of anthrax bioweapons in Iraq.

Heart murmur. What is it and what causes it?

Blood flow in the heart is supposed to be streamlined, like flow down a straight-sided river. If the valves become damaged, flow can be turbulent (either through the valve in the usual way, or backwards if the valve is leaky). Turbulence is audible, and listened for with the stethoscope; turbulence in heart blood flow is called a murmur.

Is strep throat a result of the harmful cross-reaction of bacteria and antibody (pg 13) and is there then a link to heart murmur?

People with a Streptococcus infection like strep throat make antibodies to the bacteria. A very small proportion of people make enough of an antibody that also binds to a protein associated with heart valves (this is called “cross-reaction.”) Then the immune system, thinking the heart is a bacterium, attacks it. This can lead to valve damage. Many older people with heart murmurs had rheumatic fever (as this cross-reaction following a Strep infection is called) as children. It is rare now because we treat so early with antibiotics that people make only a little antibody; but it is still common in the developing world.