Tuesday, March 12, 2019

Q&A with Matt Richtel

Matt Richtel is the author of the new book An Elegant Defense: The Extraordinary New Science of the Immune System--A Tale in Four Lives. His other books include A Deadly Wandering. He is a reporter for The New York Times, and he lives in San Francisco.

Q: Why did you decide to write this book, and how did you choose the four people on whom you focused?

A: When you see someone rise from the dead, and you’re a journalist, you pick up your pen. You ask: what the heck just happened?! That is especially true when the Lazarus figure is a good friend. This was Jason. He was my buddy in high school, and a charming stud of an athlete with a great sense of humor.

Years later, when we were in our 40s, Jason got cancer. The treatments failed, one after the next. Finally, he wound up with 15 pounds of cancer in his back, his doctor tearfully put him in hospice – sent Jason home to die.

But Jason asked for, and got, one of the first-ever immunotherapy treatments. It was a last-ditch effort, to say the least. A few days after he took his first treatment, Jason’s girlfriend woke him up and said: Jason, get out of bed; you don’t believe this, your tumor is gone.

The treatment had sparked his immune system to fight back, with fury.

So I embarked on a journey to understand the immune system. What is this complex defense network? How does it work? How have we come so far that we can tinker with it to raise people from the dead?

I also realized that the immune system story is not, of course, just a cancer story. And this isn’t a cancer book. So I went looking for other real-life medical stories that I, and the reader, might connect to.

I found some amazing people. Bob Hoff got HIV on Halloween night of 1977 and has never had a symptom. His immune system is so remarkable that the federal government studies it.

Linda Segre and Merredith Branscombe are the other characters in the book. Each suffers from auto-immunity, with very different experiences. I chose them, and Bob and Jason, because each is both remarkable and yet ordinary; they are us, and we are them, and their stories provide accessible entry points to understanding the immune system, the key to health and longevity.

This is an Elegant Defense.

Q: How did you research the book, and what did you learn that surprised you most?

A: I combined two essential journalistic tactics: (1) I had the privilege to interview the most authoritative, remarkable scientists in the world, the Nobel prize winners and others who have given us our wisdom about the immune system; and (2) I let myself start by asking the simplest questions.

An editor friend of mine calls these “Smart-dumb questions.” They are the questions that seek to get at the most basic, elemental, core ideas. They are questions that address the basic logic of the immune system, rather than skip ahead to expert-level analyses without first understanding the essentials.

I reported this book, frankly, thanks to the indulgence of amazing scientists who gave me a poor-man’s Ph.D., allowing me to ask the basic stuff, teaching me over the course of two years the building blocks of the immune system, and then layering on the complexities. In short, I got to sit at the feet of the elder statespeople of immunology and I bring forth their wisdom.

The thing that surprised me most, and that comes out in the book, is that the immune system is built around the idea of balance, not around the idea of zealous attack. The immune system works because it seeks to do as little damage as possible in its defense of our bodies. That core idea ripples through our everyday health.

Q: What are some of the most common perceptions and misperceptions about the immune system?

A: Per the previous question, it is a wild misconception that you want to boost your immune system. When your immune system gets boosted, it is more dangerous to you, arguably, than any infection in the world. What you want to do is to keep your immune system in balance, to let it do its job in the way that millions of years of evolution have designed it to do.

This book explains the science and practicality of that wisdom and I won’t belabor it here, other than to say the ideas inform how we should live day-to-day.

Q: What do you see looking ahead when it comes to understanding the immune system?

A: One word: microbiome. Well, okay, two words: microbiome and brain.

The next big leaps may well come with research into the gut and the brain – particularly around dementia – and how these two parts of the body relate together with the immune system as the point of connection.

That’s a complex idea, so what do I mean? We’re only now beginning to understand how important and complicated is the collection of bacterium in our gut. Do not be fooled by the simplistic promises that it has been figured out yet. There are just too many molecules and interactions to make quick assertions about the microbiome.

That said, as I explain in the book, some early research is showing how essential the gut is to our daily health and in no small part because it is helping inform the immune system beyond the gut’s walls. This is related literally and figuratively to the brain.

In a figurative sense, the gut and brain are related because they have both been thought to be truly apart from the rest of the body, cordoned off, and, in particular, their health governed by forces other than our immune system.

That is not true of the brain as it is not of the gut. We are seeing that inflammation may well be responsible for many of the diseases of the brain. More literally, scientists have begun to peek into the way the microbiome may be directly involved in brain health. Stay tuned.

Q: What are you working on now?

A: Chiefly, I’m putting the finishing touches on a year-long project for The New York Times about the rise of drug-resistant bacteria and fungi. It is a wildly ambitious project I’ve spent a year engineering and I can’t wait to get it into the world. The name of the series, at present, is “Deadly Germs, Lost Cures.”

--Interview with Deborah Kalb. Here's a previous Q&A with Matt Richtel.

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