The New Science of the Body’s Immune System

CLEANLINESS IS BAD. Most of the cells in your body are not yours. Given half a chance your body will try to kill you. 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.

In An Elegant Defense: The Extraordinary New Science of the Immune System: A Tale in Four Lives, New York Times writer Matt Richtel 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.

In between the four personal stories in the book, 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.

On one level it is a fascinating and grossing account of the latest, and quite astonishing, discoveries involving the human immune system and how it works. But it is also a story about:

• People facing mortality
• The passion of scientists searching for truth
• Meditation on death and how all of us struggle with the ultimate mystery

Our new understandings may have implications that extend beyond our physical health, but primarily they can help make populations healthier and cure the people we love. Richtel, for his part, constructs from these four individual cases a compelling modern history of — as well as an elegant defense for — the preeminent science of our time.