by Duke University School of Medicine
HeadScratchers is a mini-cast produced by the Duke University School of Medicine featuring experts from the School of Medicine answering intriguing questions about health and science. Tune in and email us your questions today at lindsay.key@duke.edu. Host/Producer: Lindsay Key Audio Producer: Anna Cassell Sound Engineer: Ivan Panarusky Executive Producer: Jill Boy Consultant: Alison Jones
Language
🇺🇲
Publishing Since
10/24/2019
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May 14, 2020
Immunology expert Allan Kirk, MD, PhD, discusses what compels the immune system to respond to danger, and how our immune systems change over time. Dr. Kirk is a transplant surgeon and the chair of the Department of Surgery. He is also professor in the Departments of Immunology and Pediatrics at Duke. Transcript: LK Welcome to HeadScratchers, a mini-cast from the Duke University School of Medicine. We ask Duke experts to help us understand the questions in science that have us scratching our heads. Today, we're speaking with Dr. Allan Kirk, a transplant surgeon and the chair of the Department of Surgery here at Duke. Dr. Kirk, what causes a person's immune system to weaken? AK The immune system is best envisioned as a way of sensing your environment, just like your nerve system. As it senses what's around you, it's continuously making decisions about what's important to respond to. And, if it's gonna respond, whether it's gonna be aggressive and try to attack it, or whether it's going to be passive and allow it. Each time it makes one of those decisions, it changes a little bit and becomes better. It develops memory. So nobody's immune system is the same. And in fact, a person's immune system is not the same day to day. Even identical twins have completely different immune systems by the time they're just a few weeks old, based on what they've been exposed to. But in general, time and exposure eventually leads to immune exhaustion. So the natural history of an immune cell as it responds, is to eventually become exhausted, meaning it can't respond anymore, so that you're not continuously having an immune response to something. Fortunately, you can make more of your immune system. But as you grow older, the things that help you make your immune system, like your thymus and your bone marrow, become less good at it, and you slowly run out of immune cells. The most common cause for your immune system weakening is just, then, living a long time -- which is a good thing. LK What types of factors go into the immune system’s decision to respond or not? AK Really, the immune system works hard to stay off unless something dangerous impels it to go on. When you're considering a context, you're looking for something called danger. That's actually an immunological term. And there are molecules that are associated with danger, with inflammation, with pain. And those things drive an immune system to assume that it's a dangerous context and make an aggressive immune response. Whereas, if those signals are not there, the assumption is that things are fine and there's no need to have an immune response. So something that's harming you, you should respond to, and something that's not, you should accept. In fact, if we would act more like our immune system, we might get along better. LK Thanks for listening. This podcast was produced by the Duke University School of Medicine, music by Blue Dot Sessions. Visit us online at headscratcherspodcast.duke.edu. You can also find us on all your favorite podcast players. Don't forget to hit the subscribe button -- and if you like us, leave us a review. Medical Disclaimer & Terms of use at https://bit.ly/2LrjWdh
April 23, 2020
Cancer expert Kelly Marcom, MD, discusses the role that genetics and environmental exposure play in the role of understanding why a person develops cancer. Dr. Marcom is a professor of medicine and member of the Duke Cancer Institute (DCI). He is part of a team of experts at DCI that offers genetic testing and counseling to people diagnosed with cancer, as well as people at risk of developing cancer. Transcript Lindsay Key: Welcome to HeadScratchers, a mini-cast from the Duke University School of Medicine. We ask Duke experts to help us understand the questions in science that have us scratching our heads. Today we're speaking with Dr. Kelly Marcom, an expert in genetics and cancer. Dr. Marcom, what are the factors that contribute to someone getting cancer? Dr. Kelly Marcom: Well, it's a very complex question, and one that we continue to work on very hard. Cancer is not a very intuitive disease process. Unlike a lot of things that affect our bodies, you know, you get a heart attack, you block a blood vessel -- those things are fairly straightforward. But cancer -- cancer is something that we don't naturally have a good intuitive understanding for. And it always then, consequently, is a bit of a mystery to many people why they got it. Fundamentally, cancer is a genetic disorder, by which I mean that the underlying cause of the problem is damage to the genes in the cells. But that understanding of cancer is really something that's still relatively recent. Watson and Crick identified DNA in the 50s, and so that began the whole process of understanding DNA and what it does. And, while people had always made observations about inherited patterns of cancer within families, it wasn't necessarily evident what the basis of that was. Now, prior to that time, there was a great deal of emphasis on the infectious nature of cancer, as caused by viruses. You can imagine, if you see cancer being transmitted through a family from one generation to the next, you might naturally assume that it's an infection. And there was a good scientific rationale for that: clearly it had been shown that certain viruses were responsible for certain types of cancer -- the most classic and probably one of the most important being cervical cancer, caused by papillomavirus. And so that whole story really came together with understanding that cancer is developed because you get damage to the DNA that perpetuates the additional damage to the DNA, and propagates itself through the cancer cells, and leads then to unregulated growth. And figuring out how those viruses cause cancer was in damaging DNA, and damaging things in the cells in the cervix in the course of the virus growing. So if genetics are the basis of the cancer, what is the influence of environmental exposures? Most of the things that contribute from a lifestyle have to do with exposing your body to things that damage your DNA. Smoking is the biggest culprit. Too much sun -- that's going to cause DNA damage. All those lifestyle factors, they all have some exposure that increases that risk for DNA damage. Ultimately, when we understand why cancers develop, it first helps us understand how to treat it, but then also we use it to help us understand how to screen people for cancer, and then ultimately -- hopefully -- a better understanding about how to prevent it. LK: Thanks for listening. This podcast was produced by the Duke University School of Medicine. Music by Blue Dot Sessions. Visit us online at headscratcherspodcast.duke.edu. You can also find us on all your favorite podcast players. Don't forget to hit the subscribe button! And if you like us, leave us a review Medical Disclaimer & Terms of use at https://bit.ly/2LrjWdh
April 8, 2020
Addiction expert Nicole Schramm-Sapyta, PhD, discusses signs of addiction, who is most vulnerable, and the best antidote. Dr. Schramm-Sapyta is an associate professor of the practice in the Duke Institute for Brain Sciences and the Department of Psychiatry and Behavioral Science. Transcript: Lindsay Key: Welcome to HeadScratchers, a mini-cast from the Duke University School of Medicine. We ask Duke experts to help us understand the questions in science that have us scratching our heads. Today we're speaking with Dr. Nicole Schramm-Sapyta, an expert in addiction. Dr. Schramm-Sapyta, I'm curious. Coffee, cigarettes, opioids, alcohol, sugar: these are all substances that people consume and struggle with how much to consume. What is the difference between habit and addiction? Nicole Schramm-Sapyta: A habit is something we do out of convenience. We do it without thinking, and it makes things easier for us, or else we enjoy it. An addiction is something that we do over and over again, despite causing harm to our lives. And that's easy to see with drugs and alcohol; a little bit harder to see with cigarettes although we know the health risks; even harder to see with caffeine and sugar. But the main definition of addiction is that it's causing harm and yet the person is still doing it. LK: Is it possible for a person to become addicted to a drug after trying it one time? NS: The short answer to that question is no. Changes in the brain occur with every use of an addictive substance. And those changes in the brain take time to build up to the point of causing an addiction. So the things that might happen after the first time someone takes a drug are: they have a great time, they might feel better than they've ever felt before -- might feel what other people would call normal for the first time, and really want to keep taking it. But they have to keep taking it before true addiction emerges -- for those changes in the brain to occur that lead to compulsively take the drug over and over despite negative consequences. What really causes addiction is the combination of repeated taking of the drug with a brain that is otherwise vulnerable to those changes that form the really bad patterns of taking the drug despite negative consequences. People who have psychopathology, particularly depression and anxiety, are much more vulnerable to what we call self-medication. Another vulnerability comes from socio-economic factors, social factors: abuse, trauma in the home, other negative social circumstances that one might want to escape and use the drug to escape from. The most hopeful thing that I have learned in all of my years of research and getting to know people in recovery is that recovery is absolutely possible. But since it's a bio-psychosocial problem, we have to bring biological and psychological and sociological solutions to the problem. What has most inspired me about meeting people who are in recovery is the perspective that they have. They've been to the depths, done things that they absolutely regret, you know, stolen from family members just to buy drugs, lied to their family members, and yet they've managed to recover and figure out what really matters to them in life. The main antidote for addiction is a life filled with meaning and purpose. So if I have wonderful family, wonderful job, good friends, good reasons to get up out of bed and not get high every day, I've got an amazing life. And so people in recovery, they know what gives them meaning, and I find that incredibly inspiring. LK: Thanks for listening. This podcast was produced by the Duke University School of Medicine. Music by Blue Dot Sessions. Visit us online at headscratcherspodcast.duke.edu. You can also find us on all your favorite podcast players. Don't forget to hit the subscribe button -- and if you like us, leave us a review. Medical Disclaimer & Terms of use at https://bit.ly/2LrjWdh
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HeadScratchers is a mini-cast produced by the Duke University School of Medicine featuring experts from the School of Medicine answering intriguing questions about health and science. Tune in and email us your questions today at lindsay.key@duke.edu.
Host/Producer: Lindsay Key
Audio Producer: Anna Cassell
Sound Engineer: Ivan Panarusky
Executive Producer: Jill Boy
Consultant: Alison Jones
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