An Elegant Defense

February 1, 2019
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.

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Starred review from April 1, 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.

Copyright 2019 Library Journal, LLC Used with permission.

Starred review from February 15, 2019
Pulitzer Prize-winning reporter, nonfiction writer, and crime novelist Richtel adroitly mingles cellular biology, scientific history, medical research, and patients' experiences as he explains how the immune system primarily protects our health but is also implicated in cancer, AIDS, and autoimmune disorders (e.g., rheumatoid arthritis, lupus). He explores how the immune system recognizes self and other and how it distinguishes biological partner from biological foe. Richtel's discussion of immunology encompasses T cells and B cells, monoclonal antibodies, inflammation and fever, the human microbiome, and allies of the immune system (vaccines and antibiotics). Four individuals are cast as the faces of either hyperfunctioning or less than optimal immune systems. Jason, the author's friend from childhood, has late stage Hodgkin's lymphoma. Linda and Merredith have autoimmune diseases. Bob is HIV-infected but asymptomatic. The hygiene hypothesis gets hyped with one MD seriously suggesting, You should not only pick your nose, you should eat it (a yucky way perhaps to give your immune system a frequent workout). Ancient and intricate, highly effective and ever vigilant, your immune system is engaged in a perpetual biological balancing act, making trade-offs to keep the peace, to maintain homeostasis, to let the individual live as long as is practical." Richtel approaches this essential subject with awe, his writing meticulous and empathic.(Reprinted with permission of Booklist, copyright 2019, American Library Association.)