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AN ELEGANT DEFENSE

The extraordinary new science of the immune system: a tale in four lives.

by Matt Richtel ‧ RELEASE DATE: March 12, 2019

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

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.

Pub Date: March 12, 2019

ISBN: 978-0-06-269853-7

Page Count: 448

Publisher: Morrow/HarperCollins

Review Posted Online: Jan. 12, 2019

Kirkus Reviews Issue: Feb. 1, 2019

SCIENCE & TECHNOLOGY

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BOOK REVIEW

by Matt Richtel

by Matt Richtel ; illustrated by Lee Wildish

THE RIGHT STUFF

by Tom Wolfe ‧ RELEASE DATE: Sept. 24, 1979

Yes: it's high time for a de-romanticized, de-mythified, close-up retelling of the U.S. Space Program's launching—the inside story of those first seven astronauts. But no: jazzy, jivey, exclamation-pointed, italicized Tom Wolfe "Mr. Overkill" hasn't really got the fight stuff for the job. Admittedly, he covers all the ground. He begins with the competitive, macho world of test pilots from which the astronauts came (thus being grossly overqualified to just sit in a controlled capsule); he follows the choosing of the Seven, the preparations for space flight, the flights themselves, the feelings of the wives; and he presents the breathless press coverage, the sudden celebrity, the glorification. He even throws in some of the technology. But instead of replacing the heroic standard version with the ring of truth, Wolfe merely offers an alternative myth: a surreal, satiric, often cartoony Wolfe-arama that, especially since there isn't a bit of documentation along the way, has one constantly wondering if anything really happened the way Wolfe tells it. His astronauts (referred to as "the brethren" or "The True Brothers") are obsessed with having the "right stuff" that certain blend of guts and smarts that spells pilot success. The Press is a ravenous fool, always referred to as "the eternal Victorian Gent": when Walter Cronkite's voice breaks while reporting a possible astronaut death, "There was the Press the Genteel Gent, coming up with the appropriate emotion. . . live. . . with no prompting whatsoever!" And, most off-puttingly, Wolfe presumes to enter the minds of one and all: he's with near-drowing Gus Grissom ("Cox. . . That face up there!—it's Cox. . . Cox knew how to get people out of here! . . . Cox! . . ."); he's with Betty Grissom angry about not staying at Holiday Inn ("Now. . . they truly owed her"); and, in a crude hatchet-job, he's with John Glenn furious at Al Shepard's being chosen for the first flight, pontificating to the others about their licentious behavior, or holding onto his self-image during his flight ("Oh, yes! I've been here before! And I am immune! I don't get into corners I can't get out of! . . . The Presbyterian Pilot was not about to foul up. His pipeline to dear Lord could not be clearer"). Certainly there's much here that Wolfe is quite right about, much that people will be interested in hearing: the P-R whitewash of Grissom's foul-up, the Life magazine excesses, the inter-astronaut tensions. And, for those who want to give Wolfe the benefit of the doubt throughout, there are emotional reconstructions that are juicily shrill. But most readers outside the slick urban Wolfe orbit will find credibility fatally undermined by the self-indulgent digressions, the stylistic excesses, and the broadly satiric, anti-All-American stance; and, though The Right Stuff has enough energy, sass, and dirt to attract an audience, it mostly suggests that until Wolfe can put his subject first and his preening writing-persona second, he probably won't be a convincing chronicler of anything much weightier than radical chic.

Pub Date: Sept. 24, 1979

ISBN: 0312427565

Page Count: 370

Publisher: Farrar, Straus and Giroux

Review Posted Online: Oct. 13, 2011

Kirkus Reviews Issue: Sept. 1, 1979

More by Tom Wolfe

by Tom Wolfe

More About This Book

BOOK TO SCREEN

WHY FISH DON'T EXIST

A story of loss, love, and the hidden order of life.

by Lulu Miller illustrated by Kate Samworth ‧ RELEASE DATE: April 14, 2020

A quirky wonder of a book.

A Peabody Award–winning NPR science reporter chronicles the life of a turn-of-the-century scientist and how her quest led to significant revelations about the meaning of order, chaos, and her own existence.

Miller began doing research on David Starr Jordan (1851-1931) to understand how he had managed to carry on after the 1906 San Francisco earthquake destroyed his work. A taxonomist who is credited with discovering “a full  fifth  of fish known to man in his day,” Jordan had amassed an unparalleled collection of ichthyological specimens. Gathering up all the fish he could save, Jordan sewed the nameplates that had been on the destroyed jars directly onto the fish. His perseverance intrigued the author, who also discusses the struggles she underwent after her affair with a woman ended a heterosexual relationship. Born into an upstate New York farm family, Jordan attended Cornell and then became an itinerant scholar and field researcher until he landed at Indiana University, where his first ichthyological collection was destroyed by lightning. In between this catastrophe and others involving family members’ deaths, he reconstructed his collection. Later, he was appointed as the founding president of Stanford, where he evolved into a Machiavellian figure who trampled on colleagues and sang the praises of eugenics. Miller concludes that Jordan displayed the characteristics of someone who relied on “positive illusions” to rebound from disaster and that his stand on eugenics came from a belief in “a divine hierarchy from bacteria to humans that point[ed]…toward better.” Considering recent research that negates biological hierarchies, the author then suggests that Jordan’s beloved taxonomic category—fish—does not exist. Part biography, part science report, and part meditation on how the chaos that caused Miller’s existential misery could also bring self-acceptance and a loving wife, this unique book is an ingenious celebration of diversity and the mysterious order that underlies all existence.

Pub Date: April 14, 2020

ISBN: 978-1-5011-6027-1

Page Count: 224

Publisher: Simon & Schuster

Review Posted Online: Jan. 1, 2020

Kirkus Reviews Issue: Feb. 1, 2020

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clock This article was published more than  4 years ago

Inside your action-packed immune system, it’s ‘good guys eating bad guys!’

Karen Iris Tucker is a Brooklyn-based journalist who writes primarily about genetics, health and cultural politics.

It was Halloween night in 1977. A young Robert T. Hoff was dressed as a mummy, having purchased a 30-foot roll of gauze at a fabric store and wrapped himself in it. At a party that evening, he had a fateful fling with a cute redheaded guy that changed the trajectory of his life. Hoff was diagnosed with HIV in 1984.

In that formative year of the AIDS crisis — more than a decade before the introduction of HAART, the “cocktail” combination of drugs that transformed treatment — such a diagnosis was unimaginably frightening and nearly always fatal. Yet Hoff never got sick. In the ensuing years, he’d inspect his body for telltale signs of the disease, including the purple lesions of Kaposi’s sarcoma, a type of skin cancer. His immune system continued to elude the virus; the disease never progressed.

“I would meet people and it was just unbelievable, they all died. I’d make new friends and all those guys died,” Hoff told Matt Richtel, a Pulitzer Prize-winning New York Times science reporter and novelist, of his harrowing early days living with HIV. He never took antiviral drugs, but Hoff’s immune cells remained numerous and healthy. Driven to understand how and why this could be, Richtel chronicles Hoff’s fascinating experience in a new book, “An Elegant Defense: The Extraordinary New Science of the Immune System — A Tale in Four Lives.” The book also follows the complicated health trials of two women with autoimmune diseases and one of Richtel’s childhood friends who battled cancer later in life.

In between these four personal stories, Richtel weaves in intricate, sometimes obscure details on the origins of and advances in immunology, the science of the human immune system. He also explores a relatively new mode of treatment, immunotherapy, which helps the immune system fight cancer and other debilitating diseases. To lend further color to the medical narrative, Richtel interviews leading scientists and physicians in the spheres of immunology and oncology, drawing out not only their scientific perspectives but also their soulful takes on mortality. In doing all this, Richtel brilliantly blurs the lines between biology primer, medical historical text and the traditional first-person patient story.

Richtel’s bedrock is his unabashed romance with the immune system, which he affectionately nicknames “an elegant defense,” for its complex ability to ward off any number of would-be invaders that could compromise our health. “It is an ever-vigilant, omnipresent peacekeeping force in the Festival of Life,” he writes early on in the book. Like a kid spinning a superhero tale, Richtel employs delightfully effusive prose, particularly as he relates such intricacies as the science of inflammation and the roles of the immune system’s most advanced fighters, T cells and B cells, which Richtel notes are two of the most effective biological structures in the world.

“Once a T cell or B cell finds its evil mate, its infection doppelgänger, it can set in motion a powerful defense, following hard on the innate reaction, bringing in defenders trained specifically to bounce out this particular antigen. Explosions! Implosions! Toxic gas attacks! Good guys eating bad guys!”

Knowing that some readers may be less inclined to follow the wondrous minutiae of immunology, Richtel harnesses his reporter’s eye for the human condition. Beyond Hoff’s miraculous story, he relays the frustrating, often agonizing medical conundrums that befall Linda Segre, a Type A avid golfer and partner at a consulting firm who is suddenly wracked by symptoms of rheumatoid arthritis, an autoimmune disease in which the immune cells attack the joints. He also shares the experience of Merredith Branscombe, who is ultimately diagnosed with both rheumatoid arthritis and lupus — an autoimmune disease that occurs when the immune system attacks the body’s tissues and organs. She embarks on a long and winding quest for medicines that will allay her often excruciating pain.

Richtel describes Branscombe as “an immune system tinderbox” and recounts seeing the skin on her arm immediately become red and swollen upon being briefly exposed to the sun. If Hoff’s immune system had blessedly accomplished the rarest of feats and was a true medical marvel, unfortunately, “Merredith’s immune system is far out of whack, unrestrained, a killer inside her. So is Linda’s,” Richtel explains.

He draws frequently on the analogy of the immune system’s quest to identify the “self” and the “alien” within, in doing so highlighting society’s parallel struggle and the lessons we still need to learn. “Xenophobia, blind nationalism and racism, is an autoimmune disorder,” he says. “A culture, tone deaf in its own defense, attacks so aggressively that it puts itself at serious risk. Biology’s lessons, honed like water-polished stone, teach us that cooperation with our species’ diversity is undeniably key to harmony and survival.”

The heart of “An Elegant Defense” resides within the story of Jason Greenstein, Richtel’s friend since their early Little League baseball days in Boulder, Colo. Richtel describes Greenstein’s wanderlust and greasy old minivan, the entrepreneurial spirit that spurs “Greenie” to travel to far-flung casinos to sell trinkets, his high-pitched laugh, and his indefatigable optimism and off-color humor, even in the face of being diagnosed with terminal Hodgkin’s lymphoma. To give you a sense of the latter, when a deathly ill Greenstein drags himself to the Colorado Blood Cancer Institute and his doctor asks what’s going on, Greenie jokes, “I’ve been spending all my money in Vegas on hookers.”

Richtel confides that it is Greenstein’s journey with cancer that drew them closer and was also his impetus for writing the book. “The deep friendship I wound up forming with Jason captures a searing truth instructed by the immune system. We are in this together,” he says.

An Elegant Defense

By Matt Richtel

William Morrow. 435 pp. $28.99

I wrote How to Avoid a Climate Disaster because I think we’re at a crucial moment.

Amazing complexity

Four stories that explain how your body fights off disease.

The COVID-19 pandemic has sparked intense interest in and great questions about the immune system. Why would a virus kill some people while having little or no apparent effect on others—even those of similar age and background? What’s happening inside the body when it gets exposed to a novel virus? What happens when a vaccine gets injected into the arm? What is herd immunity? And so on.

If you’re asking these kinds of questions, you should pick up An Elegant Defense: The Extraordinary New Science of the Immune System , by Pulitzer Prize–winning New York Times reporter Matt Richtel. He wrote the book before the pandemic, which means there’s nothing here about COVID-19 or the virus that causes it. Nonetheless, Richtel’s timing was good, because his book gives you all the context you need to understand the science of immunity.

Even though I dropped out of college, I really enjoy reading textbooks. But I know most people who don’t have a degree in immunology prefer books with a story that brings scientific concepts to life. That’s exactly how Richtel constructs this book. He anchors it in the tales of four real people whose health challenges illustrate the immune system’s features and bugs. The most poignant of these is the story of Richtel’s lifelong friend Jason Greenstein, a traveling salesman who was diagnosed with Hodgkin’s lymphoma. (I came to know this form of cancer all too well when my friend and Microsoft co-founder, Paul Allen, was diagnosed with it while we were working together. He died in October 2018 of a different form of cancer.)

In the process of reading about the four people in An Elegant Defense , you absorb quite a lot of useful and interesting science. For example, you’ll learn about all the key components of the immune response … the ways pathogens can outsmart our defenses … how women’s heightened immune systems lead to longer life on average … how sleep, meditation, and exercise improve immune function … why the pursuit of immortality is a fool’s errand … and why following the “five second rule” for eating food that falls on the floor is actually a healthy thing to do.

Most important, you’ll come away with a much better understanding of our immune system’s awesome complexity—and the delicate, even precarious, tradeoffs inherent in its workings.

Millions of years of evolution have produced an immune system with multiple ingenious mechanisms for detecting and killing invaders, even ones it has never seen before. But seek and destroy is less than half of the story. Since the 1980s, immunologists have learned that the immune system is tuned to find a balance “between attacking and neutralizing real dangers and showing sufficient restraint such that its potency didn’t destroy the body,” Richtel writes. “This is what makes our defense so elegant.” In other words, evolution found a Goldilocks set point for the human immune system. When it’s working well, it’s aggressive enough to fend off most invaders but not so powerful that it’s constantly attacking its own cells.

One of the most exciting developments in all of science and medicine is our growing ability to tweak this balance in precise ways—an area I track closely and that Richtel covers well. In the course of telling the story of his friend Jason Greenstein’s cancer, Richtel describes effective new treatments that help our immune systems target our own cells that have gone rogue. Through the stories of lupus patient Merredith Branscombe and rheumatoid arthritis patient Linda Segre, Richtel helps us understand new drugs that tamp down the immune system for those who suffer from debilitating autoimmune disorders.

These treatments fall into a class of drugs known as “biologics,” which now make up more than a quarter of the entire pharmaceutical market. Traditional medicines are based on small molecules with relatively simple chemical structures. Biologics, in contrast, are derived from living cells and are much more complex in structure, making them expensive to manufacture and a big factor in the rising costs of health care. What makes them so appealing to doctors and patients is that they don’t go everywhere in the body; they target and modulate specific chemicals or cells at the core of the immune system’s responses. Therefore, they’re usually less toxic and more effective than traditional drugs.

The best-known example of this type of drug is Humira. I have friends who take it and describe it in glowing terms compared to other treatments they’ve been prescribed. It’s made up of synthetic antibodies that dial down the production of a protein that’s thought to be at the root of a dozen major autoimmune disorders, including Crohn’s disease and ulcerative Colitis. (Incidentally, the term monoclonal antibody , which includes drugs like Humira, is abbreviated “mab,” which is why the generic name of so many new drugs ends in that suffix. You’ll notice it in most of the pharmaceutical ads you see on TV or in print.)

We’re just at the beginning of the mab revolution. For example, as scientists develop ways to make monoclonal antibodies cheaper and easier to administer, they could help fight diseases that disproportionately affect people in poor countries. I’m also excited about their potential for sparking advances in treatments for Alzheimer’s disease, which my dad had for years before he died  last fall. The immune system and the inflammation that it produces may well play key roles in neurodegenerative disease.

Back in simpler, pre-COVID-19 times, I read and reviewed  Dr. Siddhartha Mukherjee’s The Gene: An Intimate History . An Elegant Defense left me with the same sense of awe I had when I read The Gene . I marvel over the intricacy and sophistication of the systems that make up the human body. Now that I’ve read , I have a deeper, more nuanced appreciation for the system that is at the core of humanity’s fight against COVID-19 and everything our foundation’s Global Health program is trying to do.

Hannah Ritchie’s Not the End of the World is an essential antidote to environmental doomsday-ism.

The Song of the Cell proves that Siddhartha Mukherjee is one of the best science writers working today.

Vaclav Smil has written “a brief history of hype and failure."

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An Elegant Defense : Book summary and reviews of An Elegant Defense by Matt Richtel

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An Elegant Defense

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

by Matt Richtel

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Published Mar 2019 448 pages Genre: Science, Health and the Environment Publication Information

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Book summary.

Magnificently reported and soulfully crafted, An Elegant Defense is an epic, first-of-its-kind exploration of the human immune system and the secrets of health, by Pulitzer Prize–winning New York Times journalist Matt Richtel

A terminal cancer patient rises from the grave. A medical marvel defies HIV. Two women with autoimmunity discover their own bodies have turned against them. An Elegant Defense uniquely entwines these intimate stories with science's centuries-long quest to unlock the mysteries of sickness and health, and illuminates the immune system as never before. The immune system is our body's essential defense network, a guardian vigilantly fighting illness, healing wounds, maintaining order and balance, and keeping us alive. Its legion of microscopic foot soldiers - from T cells to "natural killers" - patrols our body, linked by a nearly instantaneous communications grid. It has been honed by evolution over millennia to face an almost infinite array of threats. For all its astonishing complexity, however, the immune system can be easily compromised by fatigue, stress, toxins, advanced age, and poor nutrition - hallmarks of modern life - and even by excessive hygiene. Paradoxically, it is a fragile wonder weapon that can turn on our own bodies with startling results, leading today to epidemic levels of autoimmune disorders. Richtel effortlessly guides readers on a scientific detective tale winding from the Black Plague to twentieth-century breakthroughs in vaccination and antibiotics, to the cutting-edge laboratories that are revolutionizing immunology - perhaps the most extraordinary and consequential medical story of our time. The foundation that Richtel builds makes accessible revelations about cancer immunotherapy, the microbiome, and autoimmune treatments that are changing millions of lives. An Elegant Defense also captures in vivid detail how these powerful therapies, along with our behavior and environment, interact with the immune system, often for the good but always on a razor's edge that can throw this remarkable system out of balance. Drawing on his groundbreaking reporting for the New York Times and based on extensive new interviews with dozens of world-renowned scientists, Matt Richtel has produced a landmark book, equally an investigation into the deepest riddles of survival and a profoundly human tale that is movingly brought to life through the eyes of his four main characters, each of whom illuminates an essential facet of our "elegant defense."

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Reader reviews.

"Starred Review. Richtel approaches this essential subject with awe, his writing meticulous and empathic." - Booklist "Richtel illuminates a complex subject so well that even physicians will learn." - Kirkus "A hard-to-put-down account of the body's first line of defense." - Publishers Weekly "One of those rare nonfiction books that transcends the genre. ... Fascinating and engrossing. ... What 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, New York Times bestselling author of Heart: A History

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Author Information

Matt richtel.

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.

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An Elegant Defense, by Matt Richtel- Book Review (and What to Read Next!)

It's probably safe to say that most of us are at least a little confused about the immune system, viruses, and illness. Especially with a pandemic on everyone's mind, your curiosity about how it all works may be at an all time high. Allow me to introduce you to An Elegant Defense , by Matt Richtel. 

Elegant Defense

Richtel writes in a way that breaks down scientific jargon to a digestible level for the average humanoid by following the stories of four individuals living with chronic illness. Their lives are impacted in different ways by cancer, HIV, rheumatoid arthritis, and lupus. Along the way, the author weaves together their stories along with the ins and outs of cellular function, scientific discoveries, and Nobel Prize-winning advances in treatments. Even the widely recognized Dr. Fauci gets a mention!

There are a decent amount of funny and touching moments that might even bring a tear to your eye. In fact, this book strikes a balance between scientific and anecdotal evidence so well, that it may begin to feel like reading a biography or a great journal article. If you're up for a real exploration of human health and resilience, give An Elegant Defense a read, and let us know what you think by reviewing this book yourself, or leaving us a comment below. 

Reader be warned: there are some themes such as animal-testing, violence, and death, which may be disturbing to some readers. 

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An Elegant Defense: The Extraordinary New Science of the Immune System

A Tale in Four Lives

Matt Richtel | 4.24 | 1,467 ratings and reviews

Ranked #6 in Immunology , Ranked #55 in Virus

Reviews and Recommendations

We've comprehensively compiled reviews of An Elegant Defense: The Extraordinary New Science of the Immune System from the world's leading experts.

Vinod Khosla Co-Founder/Sun Microsystem Explains for the lay reader the intricate biology of our immune system. (Source)

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Book Summary

New York Times science reporter Matt Richtel's An Elegant Defense illuminates the human immune system as never before, uniquely entwining intimate patient stories with science’s centuries-long quest to unlock the mysteries of sickness and health.

The immune system is our body’s essential defense network, a guardian vigilantly fighting viruses and illness, healing wounds, maintaining order and balance, and keeping us alive. Its legion of microscopic foot soldiers—from T cells to “natural killers”—patrols our body, linked by a nearly instantaneous communications grid. It has been honed by evolution over millennia to face an almost infinite array of threats.

For all its astonishing complexity, however, the immune system can be easily compromised by fatigue, stress, toxins, advanced age, and poor nutrition—hallmarks of modern life—and even by excessive hygiene. Paradoxically, it is a fragile wonder weapon that can turn on our own bodies with startling results, leading today to epidemic levels of autoimmune disorders.

Richtel effortlessly guides readers on a scientific detective tale winding from the Black Plague to twentieth-century breakthroughs in vaccination and antibiotics, to the cutting-edge laboratories that are revolutionizing immunology—perhaps the most extraordinary and consequential medical story of our time. The foundation that Richtel builds makes accessible revelations about cancer immunotherapy, the microbiome, and autoimmune treatments that are changing millions of lives. An Elegant Defense also captures in vivid detail how these powerful therapies, along with our behavior and environment, interact with the immune system, often for the good but always on a razor’s edge that can throw this remarkable system out of balance.

Drawing on his groundbreaking reporting for the New York Times and based on extensive new interviews with dozens of world-renowned scientists (including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases), Matt Richtel has produced a landmark book, equally an investigation into the deepest riddles of survival and a profoundly human tale that is movingly brought to life through the eyes of his four main characters, each of whom illuminates an essential facet of our “elegant defense.”

Dan Murphy book review: An Elegant Defense

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

Author: Matt Richtel (2019)

Dr. Dan Murphy

My entire career, I have had an interest in chiropractic and the immune system, sparked by seeing published anecdotes, journal studies and my own clinical experiences. When I saw this book profiled in The Wall Street Journal, Science News and Scientific American, I quickly picked it up. As always, I read this book with an eye toward chiropractic applications, and I found three that are noteworthy:

[dropcap type=”circle” color=”#COLOR_CODE” background=”#COLOR_CODE”]1[/dropcap] It seems that everyone is obsessed with enhancing immunology. Yet, Richtel thoroughly explains that the most important immunology problem today is an immune system that is working too well, overworking, resulting in the escalation of autoimmune diseases. He attributes this to the “hygiene hypothesis,” noting that a lifelong adequate immune response requires that humans actually be infected early in life. Over-cleanliness and other infection suppression efforts damage the immune system. He notes:

“The hygiene hypothesis stated that our environment has become so clean that it has left our immune system insufficiently trained.”

“What does an immune system do when it’s not properly trained? It overreacts,” accounting for the rise in autoimmunity.

This is consistent with chiropractic concepts and teaching on innate intelligence.

[dropcap type=”circle” color=”#COLOR_CODE” background=”#COLOR_CODE”]2[/dropcap] Unnecessary and overuse of antibiotics is not only bad for the person, but bad for all of humanity; it accelerates the evolution of pathogens by billions of years, putting all humans and all future generations at risk from bacterial diseases that are untreatable. Richtel notes:

“There is arguably no more powerful medicine on earth than antibiotics. They are vital for our survival. Full stop. But their widespread use also threatens now to cause the evolution of bugs that will make past plagues look like the common cold.”

“We are pulling back sharply on the use of antibiotics so that the element that saves us doesn’t lead to civilization-threatening pandemics.”

Once again, this is consistent with chiropractic concepts and teaching on innate intelligence.

[dropcap type=”circle” color=”#COLOR_CODE” background=”#COLOR_CODE”]3[/dropcap] Why does the subluxation exist as a mechanical phenomenon? It exists because humans evolved to use inflammation to survive infections; and that the resolution of inflammation is fibrosis. Richtel notes:

Inflammation is defined as “a curative reaction of organisms.”

“Pathogens, unlike the healthy cells in our own bodies, don’t like to stay in a particular area. They are built to cross borders, push into virgin tissue, spread, eat, and replicate.”

Pathogens initiate inflammation and inflammation initiates fibrosis. Fibrosis is the border wall:

“As the fibroblast cells come together, they form connective tissue, a bridge between the new and old tissue. At the wound site, the new tissue takes on a granular quality, hence its name granulation tissue. A kind of a tenacious web forms, a fibrous matrix that protects against invading pathogens.”

This fibrous matrix occurs in both infection and non-infectious inflammation, such as in mechanical injury or stress. This fibrous matrix will “limit the mobility of joints,” [Robbins Pathologic Basis of Disease], creating the need for chiropractic mechanical care.

For everyone interested in the newest information on the immune system with clear chiropractic applications, this is a great book.

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

• By Matt Richtel
• William Morrow
• Reviewed by Jason Tinney
• June 26, 2019

A compassionate, compelling look at the body's true "bodyguard."

I straddle the fence on the subject of the human body. On one hand, I am absolutely in awe of the physical form we occupy, grateful to navigate life within this work of art, a true masterpiece. On the other, I’d just as soon not know what’s going inside. I imagine — in vivid terms — a battle of epic proportions in which organs and arteries are constantly caught in harm’s way.

In Matt Richtel’s compelling new book, An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives , the war metaphor looms large.

That titular defense “pits our internal forces against evil disease by using powerful cells capable of surveillance and spying, surgical strikes and nuclear attacks,” Richtel writes. “Like police in a time of martial law, the immune system seeks out threats and keeps them from doing mortal harm, ably discerning up to a billion different alien hazards, even ones not yet discovered by science.” 

Richtel, a Pulitzer Prize-winning New York Times journalist and author of the acclaimed A Deadly Wandering , enthusiastically and compassionately demystifies the science and the story of one of the most intricate and misunderstood landscapes of human biology — and the most rapidly changing, perhaps most crucial branch of medical research.

Rivaled only by the human brain in terms of complexity, the immune system — quite literally our bodyguard — plays a leading role in every aspect of our daily lives, our longevity, and, ultimately, our deaths.

Giving the reader an armband, Richtel leads us into what he calls the “festival of life” and makes the case that the war metaphor, often applied in arenas of medical research, is “misleading, incomplete — even arguably dead wrong. Your immune system isn’t a war machine. It’s a peacekeeping force that more than anything else seeks to create harmony.” He explains:

“The job of the immune system is to circulate through this wild party, keeping an eye out for troublemakers and then — this is key — tossing out bad guys while doing as little damage as possible. This is not just because we don’t want to hurt our own tissue. It is also because we need many of the alien organisms that live on and in us, including the billions of bacteria that live in our guts.”

In other words, Lysol and antibacterial soap aren’t great. And stop scolding your kids: Eating dirt isn’t so bad.

Richtel isn’t a doctor; however, his exhaustive research and journalistic zeal have allowed him to immerse himself in the topic. Over the course of 55 tersely written chapters divided into six sections, he weaves history with insights into current scientific advancements, all bolstered by interviews with leading physicians and immunologists.

Among them is Jacques Miller, whose research in the 1950s and 60s led to the discovery of T cells, and James Allison, who won the Nobel Prize in 2018 for his work disrupting the communication between cells and the immune system to “trick” cancer. 

Richtel’s accessible prose is pithy and tight, swift and straightforward. At times, though, he pushes the metaphor envelop. In describing nasty stuff like bird flu, Ebola, and smallpox, “festival crashers” as he calls them, the author likens these viruses to the bounty hunter “with a prickly green head” and other “nefarious and odd-looking characters” Han Solo encounters at the Cantina in “Star Wars.”

However, he does this with good reason and to great effect. For those of us without medical degrees, Richtel’s brushstrokes allow us into a world where laymen would otherwise be lost. He knows when to give the gas and when to pump the brakes.

When sifting through jargon like “side-chain theory” and “template-instructive hypothesis,” he assures his passenger that he’ll pull over at the next rest stop. “This is complex stuff. But a pep talk: This section is as deep and important as any in describing the wonder of the human body. Dear reader, please soldier on!”

Where Richtel excels is in the telling of the “tale,” as the title suggests. These four individuals and their intersecting journeys form his “immunological Goldilocks story: Two people had too powerful an immune system, one had too little, and one’s system was just right.”

There is Bob Hoff, who contracted HIV in the 1980s, just as the AIDS epidemic had begun to grip the world. Bob’s unique genetic make-up is so diverse that he’s been able to defend against the virus for nearly four decades. We also follow Linda Segre and Merredith Branscombe as they search for myriad treatments to release them from devastating autoimmune disorders.

“An unchecked immune system can grow so zealous that it turns as dangerous as any foreign disease. This is called autoimmunity,” Richtel writes. “Fully 20 percent of the American population, or 50 million Americans, develops an autoimmune disorder. By some estimates, 75 percent are women, with conditions like rheumatoid arthritis, lupus, Crohn’s disease, irritable bowel syndrome (IBS) — each terrible, frustrating, debilitating, hard to diagnose. Together, autoimmunity is the third most common disease category in the United States (after cardiovascular disorders and cancer).”

At the heart of these stories — and the catalyst for the book — is Jason Greenstein, Richtel’s childhood friend who developed terminal Hodgkin’s lymphoma. Greenstein’s saga, told equally through tears and laughter, transcends the medical and scientific aspects and makes An Elegant Defense a celebration of life and the journey we all share.

Jason Tinney is author of the story collection Ripple Meets the Deep and co-author of the play “Fifty Miles Away.”

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Elegant Defense, An: The Extraordinary New Science of the Immune System: A Tale in Four Lives Paperback – March 24, 2020

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National Bestseller

"Gives you all the context you need to understand the science of immunity. ... An Elegant Defense  left me with [a] sense of awe.” —Bill Gates, Gates Notes Summer Reading List

The Pulitzer Prize–winning  New York Times  journalist "explicates for the lay reader the intricate biology of our immune system" (Jerome Groopman, MD,  New York Review of Books )

From New York Times science journalist Matt Richtel, An Elegant Defense is an acclaimed and definitive exploration of the immune system and the secrets of health. Interweaving cutting-edge science with the intimate stories of four individual patients, this epic, first-of-its-kind book “give[s] lay readers a means of understanding what’s known so far about the intricate biology of our immune systems” ( The Week ).

The immune system is our body’s essential defense network, a guardian vigilantly fighting illness, healing wounds, maintaining order and balance, and keeping us alive. It has been honed by evolution over millennia to face an almost infinite array of threats. For all its astonishing complexity, however, the immune system can be easily compromised by fatigue, stress, toxins, advanced age, and poor nutrition—hallmarks of modern life—and even by excessive hygiene. Paradoxically, it is a fragile wonder weapon that can turn on our own bodies with startling results, leading today to epidemic levels of autoimmune disorders.

An Elegant Defense effortlessly guides readers on a scientific detective tale winding from the Black Plague to twentieth-century breakthroughs in vaccination and antibiotics, to today’s laboratories that are revolutionizing immunology—perhaps the most extraordinary and consequential medical story of our time. Drawing on extensive new interviews with dozens of world-renowned scientists, Richtel has produced a landmark book, equally an investigation into the deepest riddles of survival and a profoundly human tale that is movingly brought to life through the eyes of his four main characters, each of whom illuminates an essential facet of our “elegant defense.”

• Print length 448 pages
• Language English
• Publisher Mariner Books
• Publication date March 24, 2020
• Dimensions 6 x 1.01 x 9 inches
• ISBN-10 0062698494
• ISBN-13 978-0062698490
• See all details

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Editorial Reviews

“Vividly told. ... Explicates for the lay reader the intricate biology of our immune system. ... Richtel succeeds in this formidable task.” — JEROME GROOPMAN, New York Review of Books

“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

“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

“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.” — BBC, “10 Books to Read This Month”

“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, #1 bestselling author of The Lost City of the Monkey God

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

“Remarkable. … Richtel is a gifted storyteller. … A story about cutting-edge science, humanely told.” — Matt McCarthy, USA Today

“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, New York Times bestselling author of Heart: A History

“An expert examination of the immune system. … Richtel illuminates a complex subject so well that even physicians will learn.” — Kirkus , STARRED review

“Richtel approaches this essential subject with awe, his writing meticulous and empathic.” — Booklist, STARRED Review

“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.” — Nature, “Best Science Picks”

“A deeply reported and entertainingly written exploration of the human immune system and how it works.” — USA Today (”5 Books Not to Miss”)

“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 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

“An engaging deep dive into our immune system.” — Men’s Health

“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, “Book of the Week”

“Compelling. … Richtel enthusiastically and compassionately demystifies the science and the story of one of the most intricate and misunderstood landscapes of human biology. … A celebration of life and the journey we all share.” — Washington Independent Review of Books

“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

“A hard-to-put-down account of the body’s first line of defense.” — Publishers Weekly

“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

“[An] entertaining and a worthwhile read.” — The Missourian

“Fascinating. ... Rooted in evidence-based research. ... Compelling.” — AudioFile

"Books like  An Elegant Defense  give mainstream readers insights into that process, insights that run deeper than those a textbook might provide. When we understand how science really works, perhaps we will be a bit less susceptible to anti-scientific seductions. Richtel’s elegant analogies and compelling human stories will help us remember the basic concepts of modern immunology long after the jargon and acronyms have been forgotten." — Commentary

“A mind-blowing page-turner with moving yet playful human dramas.” — MindBodyGreen

"Fascinating read, especially in the context of a pandemic. Through four personal stories, you discover the captivating complexity of our immune system, written in such a way that it’s an easy read for the layman." — Bloomberg News, A Best Book of 2020

“A valuable read that will help you understand what it takes to stop COVID-19. … A super interesting look at the science of immunity.” — Bill Gates

From the Back Cover

Magnificently reported and soulfully crafted, An Elegant Defense is an epic, first-of-its-kind exploration of the human immune system and the secrets of health, by Pulitzer Prize–winning New York Times journalist Matt Richtel

A terminal cancer patient rises from the grave. A medical marvel defies HIV. Two women with autoimmunity discover their own bodies have turned against them. An Elegant Defense uniquely entwines these intimate stories with science’s centuries-long quest to unlock the mysteries of sickness and health, and illuminates the immune system as never before.

The immune system is our body’s essential defense network, a guardian vigilantly fighting illness, healing wounds, maintaining order and balance, and keeping us alive. Its legion of microscopic foot soldiers—from T cells to “natural killers”—patrols our body, linked by a nearly instantaneous communications grid. It has been honed by evolution over millennia to face an almost infinite array of threats. 

For all its astonishing complexity, however, the immune system can be easily compromised by fatigue, stress, toxins, advanced age, and poor nutrition—hallmarks of modern life—and even by excessive hygiene. Paradoxically, it is a fragile wonder weapon that can turn on our own bodies with startling results, leading today to epidemic levels of autoimmune disorders.

Richtel effortlessly guides readers on a scientific detective tale winding from the Black Plague to twentieth-century breakthroughs in vaccination and antibiotics, to the cutting-edge laboratories that are revolutionizing immunology—perhaps the most extraordinary and consequential medical story of our time. The foundation that Richtel builds makes accessible revelations about cancer immunotherapy, the microbiome, and autoimmune treatments that are changing millions of lives. An Elegant Defense also captures in vivid detail how these powerful therapies, along with our behavior and environment, interact with the immune system, often for the good but always on a razor’s edge that can throw this remarkable system out of balance.

Drawing on his groundbreaking reporting for the New York Times and based on extensive new interviews with dozens of world-renowned scientists, Matt Richtel has produced a landmark book, equally an investigation into the deepest riddles of survival and a profoundly human tale that is movingly brought to life through the eyes of his four main characters, each of whom illuminates an essential facet of our “elegant defense.”

About the Author

Matt Richtel is a reporter at the New York Times . He received the Pulitzer Prize for national reporting for a series of articles about distracted driving that he expanded into his first nonfiction book, A Deadly Wandering , a New York Times bestseller. His second nonfiction book, An Elegant Defense , on the human immune system, was a national bestseller and chosen by Bill Gates for his annual Summer Reading List. Richtel has appeared on NPR’s Fresh Air , CBS This Morning , PBS NewsHour , and other major media outlets. He lives in San Francisco, California.

Product details

• Publisher ‏ : ‎ Mariner Books; Reprint edition (March 24, 2020)
• Language ‏ : ‎ English
• Paperback ‏ : ‎ 448 pages
• ISBN-10 ‏ : ‎ 0062698494
• ISBN-13 ‏ : ‎ 978-0062698490
• Item Weight ‏ : ‎ 1.13 pounds
• Dimensions ‏ : ‎ 6 x 1.01 x 9 inches
• #11 in Immunology (Books)
• #101 in Immune Systems (Books)
• #184 in History & Philosophy of Science (Books)

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About the author

Matt richtel.

Matt Richtel is a Pulitzer Prize-winning New York Times journalist and bestselling writer of mysteries and thrillers. His books are fast-paced, character-centered stories in which things are not always as they seem. The backdrop for the books is the modern world. Technology is everywhere. Everything moves at lightning speed, from conspiracy, to love, business, and violence. Technology is our slave. Or has it become our dark master?

The books relate to Matt's journalism. He won the Pulitzer Prize in 2010 for a series of stories on distracted driving. The next year, he wrote an acclaimed series for the New York Times called "Your Brain On Computers" exploring how heavy technology use impacts our behavior and our brains.

Matt lives with his family in San Francisco. He writes from an office with a window that looks onto the former house of baseball legend Willie Mays. He -- Matt, not Willie -- is an avid tennis player, takes pride in making guacamole and coffee, and writes the occasional song.

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