Rossdavidh's Reviews > An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives

An Elegant Defense by Matt Richtel
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When I was a youngster in school, the story I heard on the immune system was really pretty simple. It was the way your body fought infections, and it did that with white blood cells, that would attack and kill off anything that wasn't you. A lot has been learned since then, and this book is an attempt to update that picture, as well as tell the real human impact of what happens to four people who in one way or another have a problem with their immune system functioning. A major scientific story, plus four human stories, is a lot to pack into one book, but Richtel does a good job of it.

The first thing wrong with the story of the immune system that I learned, is that it leaves out a lot. It turns out that there is an entire other purpose of the immune system, besides fighting infection, and that is to identify when cells that used to be human cells in good standing, have gone rogue, and turned into something else. We call that cancer. It turns out we all have cancer, all the time, and our immune system is constantly finding those cells who have stopped playing on the good guys' team, and using one of several mechanisms to kill them off. Except, of course, when for one reason or another it fails to do so, and then we get "cancer", the kind where you know you have it, and you might die of it.

The second thing that is wrong with that old and simple story of the immune system, is that it doesn't mention the hardest part, which is not the killing of bacteria or viruses or cancerous tumors, but identifying which of them need to be killed. Richtel likens the immune system, not to a military, but more to a bouncer in a giant party, who has to deal with the troublemakers without disrupting the party too much. Of course, the thing that makes this most difficult is it is ALSO rather like the military, because it has to kill the enemy, in large numbers sometimes. Imagine a military operation that needs to take out the enemy without disrupting the party that they're at.

Because, one of the big things we have learned about ourselves in the last several decades, biologically speaking, is that the question of who we are and who we aren't is a lot more complicated than we thought. The bacteria that thrive, normally, in a healthy person's digestive system, are not the enemy. On the other hand, the cancerous cells which started from our own human DNA, are the enemy. So it's not as simple as "find the Other and destroy it". Even people who don't know anything about how this works, know one of the major molecules involved: histamines. Except they really know about antihistamines, which are drugs intended to block our own immune system's histamines, because they are making the mistake of (for example) deciding that juniper pollen is a horrible enemy which must be attacked at all cost, and that is why we get allergies. "Allergy" is a word for "your immune system attacking something that would not otherwise be a problem". If your immune system understood not to attack juniper pollen, you wouldn't have a problem during That Time Of Year (which is why people without the allergy can breathe in plenty of it with no ill effects; it's your own immune system that is responsible for the ill effects).

Some of the people Richtel follows are dealing with autoimmune disorders, where the immune system has gotten even further out of alignment, and now is attacking parts of the self. How could this ever happen? Well the details are still being worked out, but surely part of the answer is that sometimes, it NEEDS to attack parts of the self. The need to fight cancer, is a big part of the reason that our immune system sometimes has a hard time learning to relax.

There's a lot of science to cover here, and Richtel does a lot of switching back and forth between the science involved (and the history of that science), and the people he has chosen to tell us about who are impacted by it. Me personally, I could do with more of the science and less of the personal history, but there are plenty of others for whom it would be the opposite, and he does a good job of balancing the two.

Towards the end, we learn about techniques such as monoclonal antibodies, which are attempting to harness the immune system in new ways, to help it do a better job of knowing what (and when) to attack. The promise is great, but the potential complications are as well. For every headline about a potential new breakthrough, there is usually a quiet acknowledgement a year or two later that it wasn't as simple as at first thought. My guess is, that we will find it to be harder than expected to improve on the immune system, and there are a lot more ways to do the job more poorly than there are ways to improve on it.

What we can do, however, is stop messing with it. Excessive use of antibiotics, excessively sterile food and homes, and carcinogens in our environment, are three of the ways that we make this job harder. At the very least, the more we know about how the immune system does it's job, the better we can understand how to not get in its way.
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Reading Progress

May 5, 2019 – Started Reading
May 5, 2019 – Shelved
June 22, 2019 – Shelved as: white
June 22, 2019 – Finished Reading

Comments Showing 1-5 of 5 (5 new)

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message 1: by HBalikov (new)

HBalikov Excellent.......now I have to either read the book or find another way to update my knowledge of my immune system. I particularly liked the clear way that you summarized including: "It turns out we all have cancer, all the time, and our immune system is constantly finding those cells who have stopped playing on the good guys' team, and using one of several mechanisms to kill them off. "


Rossdavidh Well if you liked that, you will probably like this book! He does a good job of explaining the science in intuitive ways.


message 3: by Chrissie (new) - added it

Chrissie Thank you very much for your clear review.

Is T1 diabetes and Sjogren Syndrome discussed in depth?


Rossdavidh I wouldn't say "in depth", no, especially not Sjogren Syndrome (I don't recall that being mentioned).


message 5: by Chrissie (new) - added it

Chrissie Thank you for your help.


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