An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives

  • By Matt Richtel
  • William Morrow
  • 448 pp.
  • Reviewed by Jason Tinney
  • June 26, 2019

A compassionate, compelling look at the body's true "bodyguard."

I straddle the fence on the subject of the human body. On one hand, I am absolutely in awe of the physical form we occupy, grateful to navigate life within this work of art, a true masterpiece. On the other, I’d just as soon not know what’s going inside. I imagine — in vivid terms — a battle of epic proportions in which organs and arteries are constantly caught in harm’s way.

In Matt Richtel’s compelling new book, An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives, the war metaphor looms large.

That titular defense “pits our internal forces against evil disease by using powerful cells capable of surveillance and spying, surgical strikes and nuclear attacks,” Richtel writes. “Like police in a time of martial law, the immune system seeks out threats and keeps them from doing mortal harm, ably discerning up to a billion different alien hazards, even ones not yet discovered by science.” 

Richtel, a Pulitzer Prize-winning New York Times journalist and author of the acclaimed A Deadly Wandering, enthusiastically and compassionately demystifies the science and the story of one of the most intricate and misunderstood landscapes of human biology — and the most rapidly changing, perhaps most crucial branch of medical research.

Rivaled only by the human brain in terms of complexity, the immune system — quite literally our bodyguard — plays a leading role in every aspect of our daily lives, our longevity, and, ultimately, our deaths.

Giving the reader an armband, Richtel leads us into what he calls the “festival of life” and makes the case that the war metaphor, often applied in arenas of medical research, is “misleading, incomplete — even arguably dead wrong. Your immune system isn’t a war machine. It’s a peacekeeping force that more than anything else seeks to create harmony.” He explains:

“The job of the immune system is to circulate through this wild party, keeping an eye out for troublemakers and then — this is key — tossing out bad guys while doing as little damage as possible. This is not just because we don’t want to hurt our own tissue. It is also because we need many of the alien organisms that live on and in us, including the billions of bacteria that live in our guts.”

In other words, Lysol and antibacterial soap aren’t great. And stop scolding your kids: Eating dirt isn’t so bad.

Richtel isn’t a doctor; however, his exhaustive research and journalistic zeal have allowed him to immerse himself in the topic. Over the course of 55 tersely written chapters divided into six sections, he weaves history with insights into current scientific advancements, all bolstered by interviews with leading physicians and immunologists.

Among them is Jacques Miller, whose research in the 1950s and 60s led to the discovery of T cells, and James Allison, who won the Nobel Prize in 2018 for his work disrupting the communication between cells and the immune system to “trick” cancer. 

Richtel’s accessible prose is pithy and tight, swift and straightforward. At times, though, he pushes the metaphor envelop. In describing nasty stuff like bird flu, Ebola, and smallpox, “festival crashers” as he calls them, the author likens these viruses to the bounty hunter “with a prickly green head” and other “nefarious and odd-looking characters” Han Solo encounters at the Cantina in “Star Wars.”

However, he does this with good reason and to great effect. For those of us without medical degrees, Richtel’s brushstrokes allow us into a world where laymen would otherwise be lost. He knows when to give the gas and when to pump the brakes.

When sifting through jargon like “side-chain theory” and “template-instructive hypothesis,” he assures his passenger that he’ll pull over at the next rest stop. “This is complex stuff. But a pep talk: This section is as deep and important as any in describing the wonder of the human body. Dear reader, please soldier on!”

Where Richtel excels is in the telling of the “tale,” as the title suggests. These four individuals and their intersecting journeys form his “immunological Goldilocks story: Two people had too powerful an immune system, one had too little, and one’s system was just right.”

There is Bob Hoff, who contracted HIV in the 1980s, just as the AIDS epidemic had begun to grip the world. Bob’s unique genetic make-up is so diverse that he’s been able to defend against the virus for nearly four decades. We also follow Linda Segre and Merredith Branscombe as they search for myriad treatments to release them from devastating autoimmune disorders.

“An unchecked immune system can grow so zealous that it turns as dangerous as any foreign disease. This is called autoimmunity,” Richtel writes. “Fully 20 percent of the American population, or 50 million Americans, develops an autoimmune disorder. By some estimates, 75 percent are women, with conditions like rheumatoid arthritis, lupus, Crohn’s disease, irritable bowel syndrome (IBS) — each terrible, frustrating, debilitating, hard to diagnose. Together, autoimmunity is the third most common disease category in the United States (after cardiovascular disorders and cancer).”

At the heart of these stories — and the catalyst for the book — is Jason Greenstein, Richtel’s childhood friend who developed terminal Hodgkin’s lymphoma. Greenstein’s saga, told equally through tears and laughter, transcends the medical and scientific aspects and makes An Elegant Defense a celebration of life and the journey we all share.

Jason Tinney is author of the story collection Ripple Meets the Deep and co-author of the play “Fifty Miles Away.”

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