An Interview with Matt Richtel

The science writer talks immunity, antigens, and the human side of wellness.

An Interview with Matt Richtel

What is the key to health and wellness, life and death? The immune system is part of the story and may be central to the answer. Matt Richtel, a Pulitzer Prize-winning journalist with the New York Times, explores the human connections to immunology in his new book, An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives.

In your book, you say, “Intervening on behalf of the immune system is no easy task.” Are we headed in the right direction with our intervention?

It depends on what your aim is. We are headed in the right direction in terms of finding the next and more precise way to attack cancers, autoimmunity, and other diseases. [But] we are only headed in the right direction if we use those tools in a precise enough way so that we do not cause more problems than we solve. This is true for any heavy industrial process over the past 100 years — cars, antibiotics, vaccines, processed foods — and it is certainly true for this revolutionary intervention of the immune system. If we can tinker with the immune system to keep it in finer balance? Great. If we throw it out of balance to cure disease, we will cause more problems than we solve.

Relationships, social support, and healthy habits matter, but how do we quantify the effect of a group like the Concerned Fellows League, which you mention in your book — the community of friends who cared for and supported each other through an illness?

I have this discussion all the time with my wife, who is a neurologist who treats people for chronic pain. It is a field where you regularly see physiologic symptoms that seem to relate to mood, trauma, upbringing, and other similar factors. Pain is subjective, and she has observed that someone may experience a pain level of 10 in response to a given stimulation, and someone else may experience the same thing and have a pain level of six.

The modulator/arbitrator may be mood. It is hard to disentangle these things. One of the fascinating aspects of where we are headed in science is that we are beginning to see the molecular signals to know if something physiological is happening, and at what volume. My hope is that, as we begin to get at the antibody and cellular and microbiome interaction, we become more discerning of what is physiological and at what point mood/trauma/anxiety/depression are accelerating/amplifying or dampening those physiologic symptoms.

Where do we put the impact of relationships and human interactions on health?

What people are discovering is that we are getting more precise medications that can be more powerful, and yet our natural processes should often be the go-to. Exercise, rest, nutrition, and human interaction should be the first step in healing. The marketplace does not support this the same way it does a pill or a procedure, and lifestyle modification like exercise and nutrition require a habit and effort on the part of a patient who is suffering.

The view from your book is like looking through a microscope with a human story pinned to each immunology concept. How does scientific storytelling differ from other types of writing?

The concept is easy to identify. Ideas are easy to come by. The execution of bringing the story and the science together makes it hard. What is difficult in the execution of nonfiction narrative is the discovery of the person who helps illustrate the elaborate metaphor, and then to allow the metaphor to develop based on what a human being experiences. There is a lot of gumshoe work finding the stories. You don’t lose the bedrock principle when you bring it into the human condition. You do have to marry the variables and vagaries that make a story unique without losing the concepts you want to elucidate.

What is the next big prize in immunology?

Two big areas where we are on the cusp, with lots of work to be done, are the microbiome and the brain. People have begun to connect the dots around inflammation and these two regions of the body. We may be learning more about dementia and neurodegeneration [and] the role of the microbiome and its role in keeping balance of the immune system and tamping down or inflaming inflammation.

We have just begun to understand how essential the word inflammation is to human health and to longevity. I suspect that great discoveries will come in understanding the role of inflammation. The immune system is the river that runs through human health, and there are entire tributaries that we don’t yet understand. And a key one is the brain. What happens with inflammatory signals in the brain, across the blood-brain barrier, and across the wall of the gut are areas still to be understood.

Immune boosters: Effective?

A juice store I visited had an advertisement for an immune booster. I was tempted to tell them that they got it all wrong! Please! Do not boost your immune system! Do not urge patients to boost their immune system! A boosted immune system leads to inflammation and can attack organs. What you want is a balanced immune system.

How did you stay away from the jargon?

I tried to inject some humor and say to the reader that I know that this stuff is mind-numbing. As a writer, you don’t want to talk down to a reader, but it is difficult stuff. A great editor at William Morrow helped me to make the choices; I said, “This is difficult,” let me pull it apart for you. The best example is “antibody,” which sounds like it is against the body [when actually] it is a major source of your defense of antigens, which is really what is against the body. So the answer is: metaphor and humor.

Any comment on the people who inhabit the world of science? Do they make writers look any saner?

These people are driven, sane, curious, and very frustrated. Finding money to do good research is very hard. I do not envy a grant writer. It is not easy. People who have made discoveries are artists who have found a question or a creative notion that they want to solve, and they have gone after it. It also requires a business side that is not often discussed. An academic doesn’t realize that they need a hard-nosed business mind. It is a truth that needs to be told to people and taught to people.

When I hear scientists talk, the effective ones figure a way to do projects that put food on the table and to keep alive the lifeblood of great discovery that has passion behind it. The passion will continue to drive the question.

[Editor's note: Click here to read the Independent's review of An Elegant Defense.]

Tyler Cymet, DO, is the chief of Clinical Education at the American Association of Colleges of Osteopathic Medicine and is a clinical associate professor at the New York Institute of Technology, College of Osteopathic Medicine and sees patients in the emergency department at the University of Maryland Capital Region. He is also the author of Health Info to Go: General Medicine and Addictionary: Guide to Drug User Terminology.

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