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

by Matt Richtel

Overview

A groundbreaking exploration of the human immune system—the key to our health and longevity—from the Pulitzer Prize-winning New York Times journalist and acclaimed author of A Deadly Wandering.

A cancer patient risen from the grave. An HIV patient considered a medical marvel. Two “invisible” women suffering the frustration and pain of autoimmunity. Matt Richtel uses the stories of these four people to tell the incredible story of the human immune system.

In this vivid narrative, Richtel builds on his acclaimed stories on immunotherapy in the New York Times, combining the latest science with interviews and engaging anecdotes from the world’s leading researchers to reveal how the body marshals its forces to fight bacteria, viruses, parasites, and tumors. He also explains how, sometimes, this wondrous system that is our first line of defense can become a threat, attacking our organs and other systems.

While modern life has freed us from many of the diseases that plagued humans in the past, it also puts unprecedented stress on the very system that keeps us healthy. The result has been an explosion of autoimmune disorders. Providing a clear look at the forces that drive survival and the body’s evolutionary history, Richtel details how immunologists are advancing medical breakthroughs; illuminates the close connection between the immune system and mental health, beauty, and weight; examines the latest findings about diet and nutrition on immunity; and offers us a glimpse of a future in which we lead longer, more comfortable lives. He also warns that we are weakening the system that protects us: rather than trusting the bodies’ natural defenses, many people turn to antibacterial soaps, immune boosters, and other products, resulting in the development of dangerous drug-resistant microbes that threaten health.

An Elegant Defense is the first work of popular science to look at this vital human system that is as complex and intricate as the brain yet remains widely misunderstood. Joining the ranks of The Emperor of All Maladies and I Contain Multitudes, An Elegant Defense is an exhilarating and wondrous exploration of the immune system that transforms our knowledge of the human body and offers advice to help improve wellness.

Product Details

ISBN-13:	9780062698537
Publisher:	HarperCollins Publishers
Publication date:	03/12/2019
Pages:	448
Sales rank:	22,843
Product dimensions:	6.10(w) x 9.10(h) x 1.60(d)

About the Author

Matt Richtel is a Pulitzer Prize–winning New York Times reporter and bestselling nonfiction and mystery author. He lives in San Francisco with his wife, Meredith, a neurologist, and their two children. In his spare time, he plays tennis and piano and writes (not very good) songs. Visit him online at www.mattrichtel.wordpress.com.

Table of Contents

Author's Note xi

Part I Lives in the Balance

1 The Ties That Bind 3

2 Jason 16

3 Bob 29

4 Linda and Merredith 33

Part II The Immune System and the Festival of Life

5 The Bird, Dog, Starfish, and Magic Bullet 47

6 The Festival 57

7 Festival Crashers 61

8 The Mystery Organ 73

9 The B-Word 85

10 T Cells and B Cells 94

11 Vaccines 101

12 The Infinity Machine 111

13 Transplant 119

14 The Immune System's Fingerprint 133

15 Inflammation 142

16 Fever 158

17 Flash Gordon 170

18 The Harmonious Way 182

19 Three Wise Men and the Monoclonal Antibody 184

20 A Second Immune System 192

Part III Bob

21 Sex Machine 211

22 Grid 214

23 The Phone Call 227

24 CD4 and CD8 232

25 Magic 241

26 The Prime 247

Part IV Linda and Merredith

27 Linda 261

28 The Wolf 268

29 Invisible Evidence 281

30 Best of Both Worlds (Sort Of) 291

31 Merredith 295

32 Should You Pick Your Nose? 315

33 Microbiome 335

34 Stress 350

35 Sleep 360

Part V Jason

36 A Word About Cancer 371

37 Laughter and Tears 377

38 The Lazarus Mouse 395

39 Wound Healing 405

40 Programmed Death 416

41 The Breakthrough 429

42 Jason Races Time 432

43 Shepherd of Death 438

44 Trials, Personal and Clinical 443

45 The Other Shoe 452

Part VI Homecoming

46 Bob 463

47 Linda 473

48 Jan and Ron 480

49 Jason Down the White Tunnel 495

50 Jason Rises 510

51 Apollo 11 513

52 Home 514

53 Jason's Way 531

54 The Meanings of Life 534

55 The Meaning of Jason 549

Acknowledgments 557

Editorial Reviews

01/14/2019

New York Times reporter Richtel (A Deadly Wandering) takes on “one of the world’s most complex organic systems” in this entertaining survey of the science of immunology. In punchy prose (“Picture a festival—a wide-open, take-all-comers bash. This is life inside your body”), Richtel covers the history of research into the field, including Jacques Miller’s thymectomies on mice in the 1950s and ’60s, which led to the discovery of T cells, a key immune system component; Peter Doherty’s more recent work on the major histocompatibility complex or MHC, “the single most varied or polymorphic of all human genes”; and, in the ’90s, the contributions of multiple scientists to HIV research. He also provides close-ups on the case histories of four people, including two women suffering from autoimmune disorders, interwoven through discussions of myriad present-day concerns: the recent spike in allergies in children; the dangers of overprescribed antibiotics; the problems that modern, antiseptic, and stress-filled lifestyles pose for the immune system; and the growing importance of monoclonal antibody therapeutics. In the course of examining “the broader environment surrounding our immune systems,” Richtel creates a hard-to-put-down account of the body’s first line of defense. Agent: Laurie Liss, Sterling Lord Literistic. (Mar.)

Publishers Weekly

★ 2019-01-13

An expert examination of the immune system and recent impressive advances in treating immune diseases.

Scientists describe the brain as the most complex organ, but novelist and Pulitzer Prize-winning New York Times journalist Richtel (A Deadly Wandering: A Tale of Tragedy and Redemption in the Age of Attention, 2014, etc.) maintains that our immune system gives it a run for its money. Around 3.5 billion years ago, the earliest cells developed means to identify alien threats and (usually) fight them off. As organisms evolved greater complexity, their immune systems kept pace with mammals, humans included, which possess a dazzling collection of organs, tissues, wandering cells, DNA, messengers, and chemicals keeping watch on our "festival of life." "The thymus makes T cells," writes the author. "The bone marrow is the origin of B cells….The T cells, when alerted by dendritic cells, behave as soldiers, spitting out cytokines; the B cells use antibodies to connect to antigens as if they are keys in search of a lock. Macrophages, neutrophils, and natural killer cells roam the body, tasting, exploring, and killing." In the first of many jolts, Richtel downplays the claims of enthusiasts who urge us to attain the strongest possible immune system. Immunity resembles less a comic-book superhero than a trigger-happy police force, equally capable of smiting villains and wreaking havoc on innocent bystanders. To illustrate, the author devotes equal space to its role in fending off threats (infections, cancer) and attacking healthy tissues during allergies and autoimmune diseases such as asthma, diabetes, colitis, rheumatoid arthritis, and lupus. Scientific breakthroughs in producing specific antibodies have led to spectacularly effective—if toxic and wildly expensive—treatments for many. A newsman's truism insists that readers love articles that include real people, so the author introduces us to four. All illustrate the good and bad features of modern immunotherapy, but the courses of their diseases are too bizarre to be typical.

Richtel illuminates a complex subject so well that even physicians will learn.

Kirkus Reviews

Richtel approaches this essential subject with awe, his writing meticulous and empathic.

STARRED Review Booklist

Vividly told. ... Explicates for the lay reader the intricate biology of our immune system. ... Richtel succeeds in this formidable task.

JEROME GROOPMAN

In this thorough investigation, Richtel details the explosion of knowledge over the past 70 years. ... He weaves into his narrative four case studies [that] add a moving personal dimension.

“10 Books to Read This Month” BBC

Deeply affecting. … A compelling modern history of—as well as an elegant defense for—the preeminent science of our time.

Los Angeles Review of Books

Provocative. … Heart-wrenching. … Remarkable. … Richtel is a gifted storyteller. … A story about cutting-edge science, humanely told.

Matt McCarthy

Award-winning reporter Matt Richtel examines the scientific and human realities of immune anomaly through four case studies. … Through these harrowing accounts, Richtel interweaves the research history.

“Best Science Picks” Nature

A deeply reported and entertainingly written exploration of the human immune system and how it works.

USA Today (”5 Books Not to Miss”)

An engaging deep dive into our immune system.

Men’s Health

One of those rare nonfiction books that transcends the genre. ... A fascinating and engrossing account of the latest, and quite astonishing, discoveries involving the human immune system. ... An inspiring and wonderful read. ... I highly recommend this extraordinary book.

DOUGLAS PRESTON

Matt Richtel’s An Elegant Defense is a comprehensive and engaging primer on the body’s ‘ever-vigilant, omnipresent peacekeeping force.’ The immune system plays an essential role in fighting infections and cancer and in regulating our normal health. Read this superb book to better understand one of the enduring mysteries of human biology.

SANDEEP JAUHAR

A remarkable journey of exploration inside the human body. … Richly informative and engaging. … Eminently readable and with so many important takeaways, An Elegant Defense is well worth one’s investment of time.

Shelf Awareness

Plumbs the enormous impact of the human immune system. … Despite the topic’s staggering complexity… the heart and craft of a fine storyteller emerges most memorably.

Mercury News

A thorough, richly entertaining and just-wonky-enough beginner’s class in immunology through the case studies of four patients.

Wall Street Journal

Enlightening. … Readers who suffer from challenged immune systems will welcome validation for the physical and emotional trials they endure, gain deeper understanding of their ailments, and find hope for the future. Readers who are interested in the human body’s capacity to both harm or heal itself will be fascinated.

New York Journal of Books

A deeply reported account of how the immune system works. … Richtel weaves dense, complex research into suspense and human drama; his book reads, at times, like a harrowing mystery novel.

Spirituality and Health magazine

Richtel’s new book is so useful. ... Give[s] lay readers a means of understanding what’s known so far about the intricate biology of our immune systems.

The Week

Richtel brilliantly blurs the lines between biology primer, medical historical text and the traditional first-person patient story. ... Richtel harnesses his reporter’s eye for the human condition.

Washington Post

A sweeping overview of immunology’s history. ... The prose in An Elegant Defense is vibrant, conversational, direct and often funny. … The content is captivating and useful.

Science News

★ 04/01/2019

The human immune system is a true wonder. It defends the body against disease, but it can also turn against its host. Pulitzer Prize-winning New York Times reporter Richtel (A Deadly Wandering) uses four case histories to present this intricate system and its functions. In the process, he covers the history of important discoveries, the components of the system, and their processes. The narrative brings famous scientists such as Élie Metchnikoff and Paul Ehrlich to life, vividly portrays phagocytosis, and explains the intricate work of antigens and antibodies. If the immune system is not active enough, HIV/AIDS or cancer can attack. If it is too active, type 1 diabetes or lupus may occur. The author makes complex science accessible to lay readers while they explore a nonfiction page-turner. VERDICT An engaging story that promotes awareness of a body system that protects us. Public and consumer health libraries should consider this essential.—Barbara Bibel, formerly Oakland P.L.

Library Journal

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