Your life and lifestyle

I have found many studies showing the detrimental effects of recreational drugs on the body's defense system.

Benjamin Lau, M.D., Ph.D., is professor of microbiology and immunology at the School of Medicine, Loma Linda University, Loma Linda, California.

Let's call him Larry. A 28-year-old commercial artist, he consulted me about his frequent respiratory infections. Several doctors already had prescribed all kinds of antibiotics, which resulted in frequent yeast infections of the mouth. He came to see me because he wanted "no more drugs," since they just caused more problems.

I assessed his lifestyle habits care fully, but could not detect the culprit. He had been a vegetarian for 10 years and seldom ate sweets or greasy food. His cholesterol of 150, mg./dl. was one of the lowest among my patients. As for exercise he walked, jogged, and worked out regularly at the gym. In addition, five years previously he had quit alcohol and tobacco. Thus, I had difficulty suggesting any lifestyle improvements.

Several weeks later Larry admitted he had been smoking marijuana for many years. When I advised him to quit, Larry became furious, spewing forth all kinds of reasons not to. He showed me a number of "scientific" papers indicating that marijuana is harmless. Unfortunately, I was unable to convince Larry that smoking marijuana was responsible for his frequent infections. He left my office, never to return. Since that encounter seven years ago, I have found many studies showing the detrimental effects of recreational drugs on the body's defense system.

The defense system

The human body consists of several important organ systems, each of which carries on a special function. Of these various systems, the one most extensively studied recently is the defense and surveillance system, known to students in biology and medicine as the "immune system." In the past decade, much has been learned about this defense system. The organs comprising this system are: the thymus, a small organ behind the breastbone; the bone marrow, particularly abundant in the long bones; the spleen, situated in the left side of the belly; also the lymph nodes, scattered in strategic places throughout the body. There are also specific types of cells employed by this system that I will explain later.

How does this system protect us"? How does it patrol and identify invaders such as bacteria, viruses, and cancer cells? What is known with regards to lifestyle habits such as exercise, diet, drink, work, and stress that can enhance or diminish the function of this system? Our immune system is very much like the United States Department of Defense. When it works as it should, it protects against foreign invaders and maintains national peace. The Department of Defense employs various branches the Army, Navy, Air Force, and Marines, to name a few that help it do its job. Likewise, our immune system has at least five major branches the B lymphocytes (B for bone marrow), the T lymphocytes (T for thymus), the phagocytes (neutrophils, monocytes, and macrophages), the killer cells and the natural killer (NK) cells. Macrophages are the "national guards" stationed in various parts of our body while other cell types are found in the blood as a part of the white blood cells.

The B lymphocytes respond to various stimuli by producing antibodies that help fight many common infections. The four other types (and their subtypes) of immune cells directly attack foreign invaders such as cancer cells, bacteria, viruses or fungi. Some carry out their attack by secreting powerful chemicals called cytokines (cyto = cell, kine = active ingredient). We now recognize at least four subtypes of T lymphocytes: the helper T lymphocytes, which are always ready to help other cells; the cytotoxic T lymphocytes, whose main job is to control foreign invaders; the suppressor T cells, which act as military police to ensure that other cell types do not transgress their limit; and the fourth type of T cell, which is involved in a certain kind of allergy such as dermatitis in persons allergic to poison oak.

Immune cells recognize foreign intruders

The various types of cells circulate many times each hour throughout the body in the blood vessels, spleen, liver, and lymph nodes. Each cell type has detector molecules on its surface to identify foreign intruders and misbehaved members such as cancer cells. Scientists call these detector molecules the CDs, for clusters of differentiation. I would just simply call them clusters of detectors. The CDs are designated by numbers. For example, CD4 is associated with helper T cells, and CDS with suppressor T cells. IB AIDS patients, the vims destroys CD4 cells. As a result, there is a shortage of helpers and too many suppressors causing a weakening of the body's defense.

These immune cells can secrete powerful cytokines to keep intruders under control. It turns out that these cells also use cytokines to communicate with one another. Some of the cytokines are called interleukins meaning substances secreted by various types of cells to be used in "talking" to one another. Under normal conditions, these cells work together in an orderly manner, thus protecting the body from harm and danger. If these members of the defense department are doing so well, why, then, do we even get sick with such terrible diseases as AIDS and cancer? We may ask the same question of why a national defense department fails? The reason may be lack of ammunition, lack of strong leadership, or just poor quality of military personnel. By the same token, if members of our body defense system are not strong, if they are malnourished, or stressed out, then they too are unable to carry out their proper responsibility.

Today we know that lifestyle habits are the major causes of cancer, coronary heart disease, AIDS, and other degenerative illnesses. How we live has a direct influence, either positively or negatively, on our immune system.

Lifestyle habits that intimidate the immune system

1. Alcohol—As a pastor you no doubt deal with this issue in your parish, since alcohol is the number one health problem in our society. A computer search of relevant literature reveals more than 100 scientific reports published in the past decade showing that alcohol consumption "down-regulates" the immune system. Several studies showed that alcohol profoundly decreases the normal function of B lymphocytes, cytotoxic T lymphocytes, natural killer cells, and phagocytes. 1,2 If you can imagine how a person behaves under the influence of alcohol careless, indifferent, unsteady that is how researchers discovered immune cells behave when they are bathed in an environment of alcohol. They don't seem to care about their responsibilities.

How much alcohol is needed to produce a harmful effect? Antibody production levels dropped more than threefold in individuals consuming only two drinks. In other words, after just two drinks, your antibody defenses operate at less than one third of the normal. In another study, cytotoxic T lymphocytes lost their resistance to the AIDS virus after individuals drank an average of four beers. The immune down-regulating effect of alcohol persisted for days, even after the alcohol was eliminated from the body.3,4

Studies have shown that "social drinking" in pregnant women not only harms the immune system, but also causes fetal abnormalities.5,6 Other studies show that alcohol abuse during sexual activity increases the risk of catching the AIDS virus.7

Furthermore, once a person is infected with a vims, alcohol hastens the development of the disease. All in all, the studies have shown that even small amounts of alcohol are harmful and can increase the likelihood and severity of infections.8 Incidentally, one needs to be aware of the hidden alcohol found in cough syrup and various beverages by reading bottle labels.

2. Tobacco—One large study involving 4,462 male subjects showed that smokers had lower antibody levels and CDS (cells patrolling virus-infected or cancer cells) counts.9 During beginning periods of smoking, there may actually be a slight enhancement of immune function (cells are more active, attempting to rid the irritant), but soon after follows a suppression of T cells, NK cells, and phagocytes.10 Passive smoking has also shown its effect on the immune system. Children of smoking parents suffer more allergies because of derangement of a type of B lymphocyte that makes IgE antibodies responsible for allergic reactions such as hay fever, asthma, and chronic sinus problems. 11 They are also more prone to respiratory infections.

One of my younger patients suffered from chronic ear and sinus infections. Different methods of treatment were unsuccessful. Learning that the father smoked, I encouraged him to quit. Initially dubious that his smoking had any thing to do with his son's poor health, he finally did quit and was pleasantly surprised to find that his son's chronic infection and allergy cleared.

3. Marijuana—Following tobacco, marijuana is the second most widely smoked substance in our society. We now know that marijuana suppresses the immune system, impairs reproduction, produces respiratory disease, and increases the risk of lung cancer. Research strongly suggests that the use of marijuana depresses T lymphocyte and macrophage activity. 12 Its use during pregnancy carries significant risks, including low birth weight and abnormalities of the fetus. Of the 20 recently published reports that I have reviewed, only four showed absence of harmful effects on the immune system, while the remaining 16 studies reported suppression.

Marijuana has a detrimental effect not only on the immune system, but also on the central nervous system. 13 I know a bright young man who smoked marijuana only two times and developed such severe depression and emotional disturbance that he was not able to function for years. His parents sought help from many physicians, but unfortunately his condition did not improve.

4. Cocaine—Research has just begun to reveal the suppressive effect of cocaine on cytotoxic T lymphocytes, NK cells, B cells, and phagocytes. There is evidence that cocaine can adversely affect the outcome of infectious diseases, particularly the illnesses caused by viruses. 14

In addition to these so-called recreational drugs, bear in mind that prescription as well as over-the-counter drugs can also hurt the immune system, and other body systems such as the digestive and the central nervous systems. Many times I have found professional colleagues suffering from anxiety attacks, severe depression, and persistent flu-like symptoms after taking a drug intended to help with sleep disorders or stress.

A colleague called early one morning and told me that her uncle had recently experienced severe depression and was suicidal. This gentleman had nightmares, a lot of fear, loss of appetite, and trouble sleeping. She gave the name of a new drug he was taking and wondered if per chance that could be the cause. Looking up the information, I read: "Rare (less than 0.5 percent) adverse reactions include nightmares, insomnia, confusion, hallucinations, anorexia (no appetite), depersonalization...." Statistics do not mean much to the person who experiences the side effects. To that person, it is 100 percent, not less than 0.5 percent. I told this young lady to bring her uncle to my office, and we would begin to help him get off the medication. The take-home message from this experience is that drugs used to combat anxiety or insomnia may ironically produce anxiety, depression, and insomnia as side effects.

In general, unless absolutely necessary, I recommend not taking any kind of drug. When drugs are required, I make it a point to help patients understand as much as they can about the drugs they are taking the intended use and possible side effects. I encourage them to read the Physicians' Desk Reference (PDR) or the inserts that come with the drugs. This practice enables the patient to be better informed.

5. Coffee—Caffeine has been shown to lower the response of T lymphocytes in both men and women. Both B cell and NK cell activity is decreased during coffee consumption. 15 These cells are needed for antibody production and natural defense, respectively. What many people may not be aware of is that caffeine is also present in many soft drinks and over-the-counter drugs.

A dentist friend of mine suffered from chronic fatigue syndrome with repeated viral infections. Since he realized that antibiotics do not help, he decided to get advice from my wife, who is a dietitian. She tried to help him improve his diet, but he still was not feeling well. Finally he was persuaded to give up coffee, and to his pleasant surprise, he overcame his chronic viral problem and enjoyed more energy.

6. Poor Diet—Both the American Cancer Society and the National Cancer Institute have recommended a reduction of total fat intake and an increase of vegetables, fresh fruits, and whole grains.16,17 These foods from plants are known to prevent cancer. Interestingly, our immune cells cannot tolerate high fat, either. High fat makes these cells lazy so that they cannot function at full capacity. On the other hand, green and yellow leafy vegetables and fresh fruits contain special phytochemicals (plant chemicals), vitamins, and minerals that make healthy immune cells. With a good diet, our immune cells are alert, active, and responsible in carrying out both their defensive and offensive functions. When the immune cells are healthy, enemies such as pathogenic bacteria, viruses, and cancers have less chance for survival.

A few years ago my colleagues and I published a study showing that sugar impairs the function of neutrophils, the type of white blood cells that destroy disease-producing bacteria. 18 We now know that sweets of any kind lower our resistance and make us vulnerable to all types of common infections. Children catch colds after eating rich desserts or candy. When mothers eliminate sweets from their children's diet, these youngsters no longer suffer frequent colds. I teach my students that 80 to 90 percent of the time when children get upper-respiratory infections (sore throat, sinus, or ear infection), it is because of a virus. A culture should be taken. If the culture does not show pathogenic bacteria, the child should not be given antibiotics. Antibiotics do not kill viruses, but will kill the good bacteria and will further lower the youngster's resistance. The best treatment and prevention for colds is a good diet with no junk food and sweets.

7. Stress—Studies in the 1960s suggested that stress may affect the immune system. Early studies carried out in animals showed that either physical or psychological stress increases blood levels of corticosteroid, or "stress hormone." The stress hormone in turn causes the depression of all the immune cells B cells, T cells, NK cells, and phagocytes. Human studies done in the past few years support this hypothesis. 19 For example, medical students have decreased NK cell activity and decreased helper T lymphocytes just before a major examination.20 A study involving more than 400 subjects shows that psychological stress increases susceptibility to the common cold.21 Individuals under stress experience more frequent and severe respiratory infections than those who experience less stress. Sleep deprivation, as a stress, has been shown to decrease T lymphocyte function. 22 Stress per se, however, is not necessarily detrimental to the person or the immune system. Rather, what matters is how the individual copes with the stress. Studies have shown that breast cancer patients who cope poorly with stress often have a poor prognosis, and vice versa.23 Clergy are in an excellent position to provide relief to individuals suffering from stress, thus providing not only spiritual help but also a boost to their immune system.

I have shared with you several lifestyle habits that may negatively impact the body's natural defense system. You have probably been aware of them for some time; now armed with scientific evidence, you can authoritatively warn against these habits. Next we will turn our attention to factors that can enhance and strengthen our immune system.

Lifestyle habits that boost the immune system

1. Vegetarian diet—In terms of diet, more and more scientific studies have confirmed the wisdom of the "original diet" prescribed by our Creator recorded in Genesis 1:29: "God also said, 'I give you all plants that bear seed everywhere on earth, and every tree bearing fruit which yields seed: they shall be yours for food'" (NEB). This "original diet" consists of grains, legumes, fruits, and vegetables. Scientific studies have now shown that these plant-based foods are not only adequate for proper nutrition, but extremely beneficial.

A German study showed that the total number of white blood cells, lymphocytes, and other subpopulations did not differ between vegetarians and nonvegetarians. However, the natural killer cells of the vegetarians had a significantly greater ability to kill cancer cells than the omnivorous controls by a factor of two. These researchers suggested that the enhanced NK cell activity may be one of the factors contributing to the lower cancer risk among the vegetarians.24

A large-scale collaborative nutrition study has been conducted by Chinese researchers, British nutritionists, and American scientists under the leadership of Dr. Colin Campbell of Cornell University.25 The study involved large populations in China and revealed that meat and milk are not necessary for good health. All the nutrients needed by the human race can be supplied by plant sources. The Chinese consume no cow's milk or dairy products, yet they have one of the lowest rates of osteoporosis in the world! The study shows that the plant-based diet is protective against cancer and coronary heart disease. Dr. Campbell found the data so convincing that he became a vegetarian himself.

A few years ago a prospective cohort study involving 122,261 Japanese men over a period of 16 years compared four lifestyle habits: smoking, drinking (alcohol), meat consumption, and the liberal use of green and yellow vegetables. The study concluded that those who did not smoke or drink and consumed a vegetable rather than a meat diet had the lowest incidence of cancer, hypertension, heart disease, and a variety of other illnesses as well.26

2. Exercise—Pleasurable exercise provides not only enjoyment and relaxation, but also beneficial strength to the immune cells.27 Aerobic exercise nullifies emotional distress and increases the activity of NK cells which are important in fighting cancer and viruses, including the AIDS virus. Moderate exercise in creases interleukin 2 (a cytokine produced by T lymphocytes) and tumor necrosis factor (a cytokine produced by macrophages).28 Both of these factors are needed for a normal host defense. Exercise also increases the total number of phagocytes. Individuals adhering to regular exercise programs experience fewer infectious episodes.

Speaking of the AIDS virus, you may be wondering why Magic Johnson's doc tors recommended retirement for the basketball superstar. The explanation is that stress of any kind may impair the immune function. Intense, vigorous, competitive exercise depresses both cell-mediated and antibody-mediated immunity.29 Especially with today's win-at-all-cost attitude, competitive exercise is stressful to athletes. This type of immune suppression is also seen with exercising to exhaustion or overtraining.

All in all, it appears that pleasurable and moderate exercise such as walking, swimming, and cycling benefits the immune function. At the same time, it may also lower the blood pressure, improve digestion, tone muscles, and provide over all physical and emotional health benefits. Studies from China show that meaningful and productive exercise, such as outdoor labor, gardening, and farming, is particularly beneficial.

3. Stress management—"Courage, hope, faith, sympathy, love, promote health and prolong life. A contented mind, a cheerful spirit, is health to the body and strength to the soul. 'A merry heart doeth good like a medicine' (Prov. 17:22)." This quotation from The Ministry of Healing (p. 241) has been applied to the field of Psychoneuroimmunology.

Stress, as mentioned before, is not necessarily detrimental to the person or the immune system. Appropriate stress management can actually benefit our defense mechanisms. In one controlled study, the enhancement of immune competence (an increase of NK cell activity) was demonstrated in 45 geriatric residents by providing relaxation and social contact.30 In another study, medical students who were given stress management had an increase of helper T lymphocytes compared with the control group.31

There are different ways one can reduce daily stress. For me, I find reading and meditating on the book of Proverbs to be most rewarding. I also find it useful to transform negative feelings into positive creative activities. My graduate students often experience frustrations because of busy schedules or failure in getting re search done. During their time of "low spirit," I encourage them to read an en lightening book or write something that is of special interest to them. Some of the most creative and thought-provoking write-ups have been produced during these times of discouragement. Most important of all, I have witnessed a restoration of positive emotions as a result of converting negative energy into positive activity.

A simple prescription

How can we best maintain a healthy immune system? Here's a prescription:

1. Eat wholesome, unrefined foods. Each day include whole grains, fresh vegetables, legumes, and fresh fruits. Avoid fats, sweets, and stimulants. Drink plenty of water between (rather than during) meals.

2. Follow a regular exercise program. Remember, purposeful exercise is the most beneficial. If you live close to your office, try walking to work. If you cannot walk to work, perhaps you can walk around your house for 15 to 20 minutes in the morning and again in the evening after supper. Short-interval moderate exercise several times throughout the day is more beneficial than a long exhausting workout. Daily walking is a good time to have pleasant conversations with a loved one, so invite your spouse to come along.

If you walk alone, this is a wonderful time to speak silently with your heavenly Father. Take time to enjoy the natural surroundings of your home or workplace.

This form of exercise is guaranteed to relax you and reduce stress. WALK, WALK, WALK—walking is the best exercise, and it is also the best time to get bonus communication with the Lord.

3. Maximize your spiritual strength. As clergy you probably already have your "routine" devotional program. You may also have a special place in your home or office as an altar where you communicate with the Lord. I am now suggesting that you have a mobile altar where you can have bonus communication with the Lord on your walks. We can ask the Lord to help us cope with negative feelings of discouragement, bitterness, and hostility, and to give us peace. A devotional life full of love will aid in building a strong immune system.

1. R. R. Watson, "Ethanol, Immunomodulation and Cancer," Progress in Food and Nutrition Science 12 (1988): 189-209.

2. M. G. Mutchnick, H. H. Lee, "Impaired Lymphocyte Response toMitogen in Alcoholic Patients," Alcoholism, Clinical and Experimental Research 12 (1988): 155-158.

3. A. B. Glassman, C. E. Bennett, C. L. Randall, "Effects of Ethyl Alcohol on Human Peripheral Lymphocytes," Archives of Pathology and Laboratory Medicine 109 (1985): 540-542.

4. S. Johnson, R. Knight, D. J. Manner, R. W. Steele, "Immune Deficiency in Fetal Alcohol Syndrome," Pediatric Research 15 (1981): 908-911.

5. Z. Gottesfeld, E. L. Abel, "Maternaland Paternal Alcohol Use: Effects on the Immune System of the Offspring," Life Sciences 48 (1991): 1-8.

6. H. C. Tat, "Alcohol and Pregnancy: What Is the Level of Risk?" Journal de Toxicologie Clinique Experimental (Paris) 10(1990): 105-114.

7. M. A. Planta, "Alcohol, Sex and AIDS," Alcohol 25 (1990): 293-301.

8. J. D. Johnson, D. P. Houchens, W. M. Kluwe, D. K. Craig, G. L. Fisher, "Effects of Mainstream and Environmental Tobacco Smoke on the Immune System in Animals and Humans: A Review," Critical Reviews in Toxicology 20 (1990): 369-395.

9. F. Mili, W. D. Flanders, J. R. Boring, J. L. Annest, F. Destefano, "The Associations of Race, Cigarette Smoking, and Smoking Cessation to Measures of the Immune System in Middle-aged Men," Clinical Immunology and Immunopathology 59 (1991): 187-200.

10. P. Moszczynski, S. Slowinski, J. Lisiewicz, "Effect of Tobacco Smoking on Selected Immunologic Indices," Folia Haematologica (Leipz) (1989): 305-310.

11. C. G. Magnusson, "Maternal Smoking Influences Cord Serum IgE and IgD Levels and Increases the Risk for Subsequent Infant Allergy," Journal of Allergy and Clinical Immunology 78 (1986): 898-904.

12. M. D. Yahya, R. R. Watson, "Immunomodulation by Morphine and Marijuana," Life Sciences 41 (1987): 2503-2510.

13. D. P. Tashkin, "Pulmonary Complications of Smoked Substance Abuse," Western Journal of Medicine 152 (1990): 525-530.

14. C. C. Chao, T. W. Molitor, G. Gekker, M. P. Murtaugh, P. K. Peterson, "Cocaine-Mediated Suppression of Superoxide Production by Human Peripheral Blood Mononuclear Cells,' 'Journal of Pharmacology and Experimental Therapeutics 256 (1991): 255-258.

15. I. Melamed, J. D. Kark, Z. Spirer, "Coffee and the Immune System," International Journal of Immunopkarmacology 12 (1990): 129-134.

16. D. W. Nixon, "Nutrition and Cancer: American Cancer Society Guidelines, Programs, and Initiatives," CA—A Cancer Journal for Clinicians 40 (1990): 71-76.

17. R. R. Butrum, C. K. Clifford, E. Lanza, "NCI Dietary Guidelines: Rationale," American Journal of Clinical Nutrition 48 (1988): 888-895.

18. A. Sanchez, J. L. Reeser, B.H.S. Lau, P. Y. Yahiku, R. E. Willard, P. J. McMillan, S. Y. Cho, A. R. Magie, U. D. Register, "Role of Sugars in Human Neutrophilic Phagocytosis," American Journal of Clinical Nutrition 26 (1973): 1180-1184.

19. R. Ader, Psychoneuroimmunology (New York'- Academic Press, 1981).

20. J. K. Kiecolt-Glaser, R. Glaser, E. C. Strain, J. C. Stout, K. L. Tarr, J. E. Holliday, C. E. Speicher, "Modulation of Cellular Immunity in Medical Students," Journal of Behavioral Medicine 9(1986): 5-21.

21. S. Cohen, D.A.J. Tyrrell, A. P. Smith, "Psychological Stress and Susceptibility to the Common Cold," New England Journal of Medicine 325 (1991): 606-612.

22. J. Palmblad, B. Petrini, J. Wasserman, T. Akerstedt, "Lymphocyte and Granulocyte Reactions During Sleep Deprivation," Psychosomatic Medicine (1979), pp. 273-278.

23. S. J. Schleifer, S. E. Keller, M. Camerino, J. C. Thornton, M. Stein, "Suppression of Lymphocyte Stimulation Following Bereavement," Journal of American Medical Association 250, No. 3 (1983): 374-382.

24. M. Malter, G. Schriver, U. Eilber, "Natural Killer Cells, Vitamins, and Other Blood Components of Vegetarian and Omnivorous Men," Nutrition and Cancer 12 (1989): 271-278.

25. A. S. Moffat, "China: A Living Lab for Epidemiology," Science 248 (1990): 553-555.

26. T. Hiray ama, "Mortality in Japanese With Life-Styles Similar to Seventh-day Adventists: Strategy for Risk Reduction by Life-Style Modification," National Cancer Institute Monograph 69 (1985): 143-153.

27. A. R. LaPerriere, M. H. Antoni, N. Schneiderman, G. Ironson, N. Klimas, P. Caralis, M. A. Fletcher, "Exercise Intervention Attenuates Emotional Distress and Natural Killer Cell Decrements Following Notification of Positive Serologic Status for HIV-1," Biofeedback and Self-Regulation 15 (1990): 229-242.

28. G. T. Espersen, A. Elbaek, E. Ernst, E. Toft, S. Kaalund, C. Jersild, N. Grunnet, "Effect of Physical Exercise on Cytokines and Lymphocyte Subpopulations in Human Peripheral Blood," Acta Pathologica, Microbiologica, et Immunologica Scandinvica 90 (1990): 395-400.

29. N. Tvede, C. Heilman, J. Halkjaer-Kristensen, B. K. Pedersen, "Mechanisms of B-lymphocyte Suppression Induced by Acute Physical Exercise,'Vowrnal of Clinical and Laboratory Immunology 30 (1989): 169-173.

30. J. K. Kiecolt-Glaser, R. Glaser, D. Williger, J. Stout, G. Messick, S. Sheppard, D. Ricker, S. C. Romisher, W. Briner, G. Bonnell, R. Donnerberg, "Psychosocial Enhancement of Immunocompetence in a Geriatric Population," Health Psychology 4 (1985): 25-41

31. J. K. Kiecolt-Glaser, R. Glaser, E. C. Strain, J. C. Stout, K. L. Tarr, J. E. Holliday, C. E. Speicher, "Modulation of Cellular Immunity in Medical Students, "Journal of Behavioral Medicine9 (1986): 5-21.

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Benjamin Lau, M.D., Ph.D., is professor of microbiology and immunology at the School of Medicine, Loma Linda University, Loma Linda, California.

July 1992

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