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.