BOOK REVIEW
‘An Elegant Defense’ tours the human immune system
Last year, I was chatting with a journalist about the outbreak of a deadly new fungal infection when I was compelled to pause the conversation. I was struck by the ease with which my interviewer spoke about the obscure disease and wondered whether he might have a medical degree or, perhaps, a doctorate in immunology.
I was speaking with Matt Richtel, a Pulitzer Prize-winning journalist and author of the provocative new book “An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives” (William Morrow, 448 pp., eeeE). Richtel is not a doctor (nor does he pretend to be), but that hasn’t stopped him from tackling one of the most complicated and vexing topics in modern medicine: the human immune system.
We begin by meeting the author’s childhood friend, Jason, a traveling salesman with terminal cancer who is affectionately called Quasimodo by his girlfriend because of the tumor protruding through his back. Jason’s doctor has finally thrown in the towel, recommending hospice care for the patient he calls Steel Bull, a name that was given after a series of agonizing cancer treatments, which Jason managed with “a joke or smile.” His outlook sets the tone for this warm and heartwrenching book.
We also meet Bob, a man with an unusual immune system, one that protects him from a life-threatening virus, as well as Linda and Merredith, both struggling with excruciating autoimmune diseases that largely are unresponsive to treatment. Their stories were selected for a reason: The quartet, Richtel tells us, “comprise a kind of immunological
Goldilocks story: Two people had too powerful an immune system, one had too weak a system, and one’s system was just right.” It makes for a remarkable tale.
We also are given a quick tour through the history of the immunology, highlighting the discovery of antibodies, interleukins, immunotherapy and a phenomenon called phagocytosis. Richtel is a gifted storyteller – he can make even dry subjects like protein signaling come alive – but this section is diffuse and a tad superficial. (The discovery of penicillin is covered in just a few hundred words.) But this is not a history book; it’s a story about cutting-edge science, humanely told, by a journalist engaging with an outrageously difficult subject. He mostly succeeds.
There are some curious analogies here: xenophobia, racism, nationalism and Nazism all are compared to autoimmune disorders (I’m not sure I followed the reference to “Hitler’s autoimmune machine.”) Yet it’s this outside-of-the-box thinking that makes Richtel’s book so rich and engaging. He wants to push us, and be warned: You will be pushed.
By the final page, however, you will possess a deeper understanding of immunology and an appreciation of the ferocious battles that patients and doctors are fighting. In the concluding section, we arrive at a path forward, and a potential cure for the millions who suffer from diseases of the immune system. It’s a thrilling payoff.
I already knew Richtel could pass for a physician in conversation. I’m pleased to report that he nearly passes in writing, too.