Matt RichtelBesprekingen

Important book. I wish everyone with a cell phone and a car would read it.

Enjoyed the tie-in to the pandemic and practical examples.

Enjoyed the tie-in to the pandemic and practical examples.

A fascinating account of how our immune system works, illustrated by several case studies. While it makes a deep dive into the workings of our immune system, and how we came to learn about it, the author follows the lives of several individuals that illustrate different aspects. The book keeps a big-picture perspective of the role and impact of these processes on humanity.

I bought this book on one of my first trips back to the bookstore during the pandemic (for obvious reasons), but I didn't read it right away. As it turns out, I am glad that I didn't, as I talked my dad into choosing this for our ongoing buddy read project, and it was definitely better that way. Both on the chapter-a-week pace and having someone to dissect this with.

I did get a lot out of this book, though I often thought I would like it better if it had a better editor and/or it had been written by a scientist rather than a journalist. Still, this book is definitely framed around personal stories, and as a reporter he was well suited to telling those (though some of his little offhand societal observations provoked big eyerolls from me.)

I probably would have been more annoyed reading this alone, but this was good enough.

An Elegant Defense: The Extraordinary New Science of the Immune System:
An exploration of the human immune system illustrated with four immunotherapy cases to explain how our defense systems protect and sometimes injure the body.
The topic is interesting, the writing style mixes anecdotal with scientific details.

This is an interesting and valuable book, and I was intrigued by some of the details related to attention and multitasking. However, I do question why there were so many errors in a book on technology (isn't technology designed to capture errors in the absence of actual human editors?) - just the ones I noticed: the city Winnipeg spelled both correctly and incorrectly; a name spelled incorrectly (once); the city Hartford spelled correctly and incorrectly, very closely together; the use of the word "fullest" which apparently is acceptable nowadays but still grates on my nerves; the use of "honed in" when it should be "homed in"; and one that I don't believe I have seen in a book before - a paragraph repeated (just in case we weren't paying attention, I guess, which is the theme of the book!).½

First and foremost, this book is an example of American journalism at its very best. If you happen to subscribe to the notion promoted by one of our former presidents that the news media are the “enemy of the people,” read this book and if you have half a brain, you’ll quickly jettison that belief. This is a story that continues to be told, unfortunately, over and over: the story of auto deaths as a result of “distracted driving.” And, of course, as we all know, much of that distracted driving is from the use of cell phones by the driver, either talking or, more often, texting while driving. Matt Richtel cites many statistics in his book, but maybe the most concerning and telling is this: 98% of drivers polled agreed that texting and driving was dangerous. That sounds about right. But, of those 98%, a full 45% admit to texting and driving themselves. That is mind blowing. And think of your own experiences with drivers you’ve seen using cell phones, even after states have one by one passed laws making using cell phones illegal. Think of the last time you were behind another car at a stop light and the light changed to green. If that car just sat there while you waited to proceed, chances are pretty good that the driver is texting. Many times motorists will be talking on their cell phone in full view of anyone around them. And, after all, the chances of being pulled over for that are slim and none. Richtel’s book focuses on one case in Utah of distracted driving causing not one death but two, both fathers and both in the prime of their careers as rocket scientists. Utah is one of what I call “Don’t Tell Me What To Do” states, states that think requiring parents to have their children in child seats in the car is an infringement of their rights. Other states in this category are Mississippi, South Carolina, and even my own home state of Indiana. Since this accident happened in 2006, Utah and many of the rest of the DTMWTD states have come around and have passed texting and driving laws. Matt Richtel’s reporting, which resulted in a Pulitzer Prize, is largely responsible for getting the ball rolling. This book is that important. In fact, I think any driver taking Drivers’ Education should be required to read it as part of the course. One last thing: I listened to this book in its audio version. Kudos to narrator Fred Berman. If you’ve listened to any books, you know how important the reader is. Fred Berman did justice to this very important book.

Three years late with my review, I'm horribly embarrassed to say. It's the only time I've been seriously delinquent in reviewing an ER book, and it's particularly embarrassing in this case considering that I had requested this book because of my own ongoing experience with prostate cancer. Somehow, I just managed to mislay An Elegant Defense and just found it a week ago while doing some household clean-up and inventorying of my library.

I'm giving this 4****. I think it could have been better. For some reason (and perhaps I'm just guilty of reading it a little too quickly), the technical medical chapters seemed a bit difficult for me. Years ago, back in the late 80s and through most of the 90s, my work as a lawyer included medical issues pertaining to HIV, so I was familiar with B cells, T-helper cells, and T-killer cells; but the medical research has expanded greatly in the current century. One interesting comment in this book involves the use of disabled HIV as a vector to insert an experimental gene into a young leukemia patient's system, something that would never have occurred without the extensive research on HIV-AIDS over the past decades.

Richtel primarily addresses HIV (involving a patient whose immune system has successfully combatted the virus apparently without significant medical intervention), auto-immune disease, and cancer, combining theoretical medical discussion with individual patient biographies (not always as well integrated as between theory and biography as I would have liked, but still fairly successful). One interesting discussion also involves an Alzheimer's patient, with consideration of immune-system factors that might be associated with Alzheimer's disease, though this is a rather cursory discussion and those interested in Alzheimer's might be better off reading The Problem of Alzheimer's: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It by Dr. Jason Karlawish, the co-director of the Penn Memory Center at the University of Pennsylvania School of Medicine in Philadelphia.

I'm going to give this one a reread, I think, in a few months. I'm scheduled for a first appointment with a Jefferson University (Philadelphia) dermatologist for a very serious rash, and some of the more technical immunological discussions in An Elegant Defense might prove of more personal interest to me once I get more involved in my own dermatological treatment protocols.

So, 4****, and an apology to the author as well as to LT-ER for the delay in this review.

I noped out near the beginning when the author claimed IBS as an autoimmune disease. He also blindly accepts the concept of autoimmunity being widely causitive despite a lack of evidence for numerous diseases. I checked Mr. Richtel's biography and decided, in the future, I will refrain from reading immunology books from somebody without any background in medicine.

Interesting and well written.

The book is about a car wreck in Utah in 2007 in which two scientists were killed. They were hit by a teenager who was tailgating a semi-tractor trailer and whose SUV crossed the center line multiple times before it finally clipped the oncoming car, causing it to careen into the oncoming traffic lane were it was hit by a heavily loaded pickup pulling a trailer. The teen driver said he had hydroplaned on wet roads. Later investigation showed that he had been texting while driving and he did not remember texting at all. How could that be? That is where the Attention Science part of the book comes into play and the reading becomes fascinating. The author goes back to the beginnings of Attention Science in WWII when scientists tried to figure out why RADAR operators missed so many incoming enemy planes when they plainly showed up on screens and follows the science throughout the investigation and into the court room.

Once the Utah Highway patrol figured out that the facts of the wreck didn't add up and started investigating, decisions had to be made about how to charge the driver who caused the wreck. Could he be tried? Did any laws currently on the books in Utah apply? Ultimately these questions led to the passage of some of the toughest distracted driving laws in the U. S. by the state of Utah in 2012.

Everybody thinks that they can multitask, but the scientific fact is that we can't. Our brains can only do one thing at a time and the brain selects what is the most important and puts the rest off to deal with later. That is what the science shows. The science is at war with business in this case. As the author points out, Telephone companies deliberately advertised the use of cell phones while driving and did so up until 2015. Cell phone towers were deliberately placed along interstate highways and popular main arterial highways to ensure that there would be few dropped calls. It turns out that even talking on a cell phone while driving is dangerous and increases the likelihood of an accident. There is little difference in the statistics of hands free talking on the phone or holding a phone while talking. The author takes the time to explain why, in general, talking to a passenger in the car with you is safer than using a phone - turns out that two pairs of eyes are better than one. The passenger acts as a second set of eyes and alerts the driver of things that they should notice. This book explains how the science, the implement, the driver, and our culture all come together to create a very dangerous situation for those who use cell phones while driving.

This was certainly an eye-opening book, and it will make any conscientious person put the wireless telephone in the trunk of the car each time they get in to drive, but it could have been a much better book than it was. The author gets into the weeds when he starts delving into the personal lives of everybody involved in this particular case and that part of the book gets monotonous. Even so, I think that the topic is so important that it should have many more readers than it seemed to get.½

I learned a few things, but this was a bit over my head. It would have helped if it focused more on the people in the case studies.

I found the weaving of the biographical details into what is essentially an explainer of how the immune system works more of a distraction than an effective hook.

This book is a combination of the story of an accident caused by a young Utah man texting in his car and a study of research into "attention science". It is a story and a sturdy well-told.

This is a strange book. The story, the plot, is one that made me shake my head.

At the heart of the story is Dr. Lyle Martin, although it takes a while to figure that out. He is a brilliant infectious disease specialist but has difficulty communicating his thoughts at times. Then, when he does articulate them they are far from brilliant - although other characters seem to think they are.

That's what stumped me - the writer is a prize-winning journalist for the New York Times. The NYT does not hire dummies. So we'll assume he has smarts. But the ideas in this book seem unthought-out and, honestly, ridiculous.

A brief gist: Some smart people are working for Google and are sent to a remote location in Nevada to work on a new, secret project. Jackie is brought into this project because she has a different way of seeing people, of observing. She had just started a class with Dr. Martin and developed an obsession with him, although he does not know it, or her.

Dr. Martin and a few others are on a chartered flight to Steamboat Springs, Colorado, for an infectious disease conference, when the world goes crazy. The pilot, emily, has to make a landing without control tower direction and when they land the ground is strewn with bodies. It looks like everyone is dead.

Martin puts on his Infectious Disease hat and his brain is engaged. Yet he cannot express his thoughts well, so there is much confusion and danger.

Are they dead? Will the plane's inhabitants be infected? How far does this strange condition spread? Those are the questions Dr. Martin has to answer, and by weaving back and forth in time the answer finally comes. But as I said, it's ridiculous.

Spoiler alert!------------------------------------------------------

Throughout the book Jackie and others note how people are stuck to their electronic devices. They are even drooling, unaware of their surroundings. This is a common theme in today's think pieces but here it is taken to an extreme. Jackie wants to slow everything down so people can stop and think again, on their own. I just never got the point of it and it seems stupid.

Matt Richtel, as far as I can tell, is not a scientist, researcher, or doctor, but has written this book about the science of our immune system. An interesting topic, and one I want to learn about, and oh how I wish the book had been written by someone like Siddhartha Mukherjhee or Atul Gawande. First, and not least, I was annoyed by his writing style. There are constant authorial interjections like, "but wait, there's more," and "You would think so, but you'd be wrong."

The book attempts to entwine the history of the science of our immune systems and the current status of our knowledge of immunology with the stories of four patients with immune system issues: Jason with cancer, Linda and Meredith with auto-immune diseases, and Bob with HIV. I think he went way overboard trying to filter the science through these personal stories, and did a fairly inept job of explaining the immune system, autoimmune diseases, and immunotherapy. Some facts filter through here and there, and I did learn something. I just wish for a more organized and well-written book on the topic.

Apologies are in order for this review because it is so delayed. The book is both a page turner and a survey text to our current understanding of the immune system. My copy of the book is profusely underlined and I consider this book an essential guide to health. If it matters to you and you get lost remembering the difference between interleukin and interferon, you have a useful guide here, though one lacking an index.

Anyone who pays the slightest attention to today’s world knows about the dangerous consequences of antibiotic overuse. I have read stories by Richtel on that very topic in the New York Times where he is a contributing writer. He says that by 2050 more people will die of resistant bacteria than from cancer.

Our understanding of immunity has changed profoundly, especially since the 1950s when vaccines and antibiotics became common and t-cells were discovered. Understanding our immune system continues to evolve at a dizzying pace, despite the unwise cutback in federal biomedical research. Breakthrough discoveries continue to be refined so quickly that one feels as if we are on the brink of a whole new paradigm. We no longer should see the immune system as a powerful killing machine but a powerful defense system which works optimally with “extraordinary powers of restraint.”

Richtel’s guide to understanding our immune system is accompanied by case histories of individuals who represent the challenges of managing health when faced with a deadly infectious agent or when our own bodies turn against us as they do with autoimmune disease. These stories help translate the complex world of neutrophils, cytokines, monocytes, and other key biological players into understandable terms. They also show the ongoing courage of people often caught between a rock and a hard place in choosing treatments. One of the people followed is one of Richtel’s best friends from childhood.

A key takeaway from reading Richtel’s book is that calling our immune system a defense system is inaccurate. That system is, in fact, capable of becoming aggressor and turning against us. When we say that someone has a weak immune system, it could be the very opposite, says Richtel.

The interplay between cancer, autoimmunity, and our immune system is constant and ever-changing. Intricate communication systems exist within us and interference in these systems can enable cancer cells to become a threat. Cancer cells are with us even in states we would consider healthy. Understanding what chain of events threatens the previous equilibrium between cancer cells and a healthy immune response is a hot field of research. For example, research studies how to redirect internal signals so immune system T-cells, shut down by cancer cells, are reactivated.

Dr. Anthony Fauci, a leading immunologist and director of the National Institute of Allergy and Infectious Disease, speaks of immunoregulation rather than in the old language of a defense system. Richtel describes our immune system as a loaded gun. When fired and uncontrolled, you get autoimmunity problems.

Richtel takes basic components of immunity and disease and casts them in a new light. He does not get bogged down in the minutiae of complicated biology as he introduces key concepts but focuses on a few important details that relate to the big picture of an immune system. For example, he says bacteria have walls and human cells do not. Who knew? Many of us did not. That simple distinction matters when he adds that antibiotics prevent bacteria from building walls. You now have a new understanding behind the creation of antibiotics.

One of the fascinating parts of the book is learning about the communications network within our bodies. The components of our immune system are an unseen world within us, capable of signaling and communicating, adapting and learning. Infections can block the transmission of distress signals which should have triggered killer cells to act. It makes more sense to refer to two immune systems: one innate and the other adaptive.

In addition to the complex communication system, there is also a vast microbial world which has a role in our immune system. Half the cells in our body are bacterial, not human. Or as Richtel puts it, we are superorganisms. How cool is that! Or put in another context, the human genome alone is insufficient to ensure health. We need the input from our microbiome or gut bacteria, i.e., we have 2 genomes – our own and that of our microbiome. Your immunity is lacking if you miss certain bacteria because they keep the immune system in check so it does not attack you.

Beyond our own individual stories of health and disease, there is a greater story of how human immune systems evolved in such a way to ensure the survival of the species. If you are unable to read Richtel’s entire book, I strongly recommend reading his last 2 chapters where he talks about how everything is connected and the value of diversity, harmony and balance. Boosting our immune system should not be the endgame.

This is the kind of book that I should really enjoy, but I did not. The author's writing style was too distracted, jumping from place to place, leaving me not quite having a full understanding of what just happened and unsure of why the discussion had moved on to sometimes unrelated topics. The immune system is clearly a complicated topic, and this writing style did NOT lend itself to teaching it to a layperson.

In addition, the author frequently confused correlation with causation, which is one of my biggest pet peeves as a professor/engineer. Just because A and B both went up at the same time doesn't mean that A causes B. He also uses a lot of scare language about the "obesity epidemic" and how it's shortening our lifespans without any evidence whatsoever. I also disliked when the author said that antibiotics used in agriculture is the reason we are seeing antibiotic resistant pathogens, but then said that if you went to a 3rd world country that didn't use antibiotics in its livestock, that you'd have to worry about catching a superbug. Not sure how that logic holds up.

Not a complete waste of time reading this book, but it really wasn't well-written.

The Immune System of any creature is a remarkable thing. In the book, An Elegant Defense author Matt Richtel discusses these topics and more by talking about the impact of the Immune System on four particular lives. While the field of Quantum Mechanics might have the particle zoo, the author describes the Festival of Life in this book. We are still just dipping our toe into the depth of the immune system and what it is capable of or why it is capable of those feats.

Richtel talks about these matters in a conversational style that doesn’t throw too much jargon at the reader. Of course, he has to talk about Lymphocytes, T cells, B Cells, Interleukin, Natural Born Killer Cells, and a few other things, but he also talks about how these things were discovered in the human body and in the systems of other animals.

Richtel also clears up some common misunderstandings. While the idea of the Immune System as a police force is technically true, it also has an equally taxing job in being a peacekeeper of sorts. Your body contains multitudes of various beneficial critters as well. The Immune System also needs a way to differentiate between ‘self’ and ‘non-self.’ This is an essential task that goes wrong with remarkable frequency in our stress-filled present. These are called autoimmune diseases, and they can cause unprecedented havoc to your system. Lupus, Celiac Disease, Rheumatoid Arthritis, each one of them caused by an Immune System that failed to differentiate between friend and foe. An even worse case is in that of Cancer. Cancer is even more insidious since it is technically your cells.

Anyway, along the way with all of these developments in our understanding of immunity, the author also talks about vaccines and antibiotics. Finally, the author eventually leads to the development of drugs that suppress the immune system. This takes us full circle back to the four individuals that he opened the book with.

The book is very good and taught me some things that I did not know.

I was lucky enough to receive a copy of this book from the Early Reviewers program...thank you, librarything! I requested it because someone I care for has an autoimmune condition and I wanted to understand more about it. Richtel provides an in depth, and accessible study of the immune system, using actual stories, both of people suffering from immune issues, as well as the doctors and scientists who studied the immune system. HIs book brought home to me how recent many of the discoveries are, and how vast and complex the human body is. He shares his wonder and appreciation for the studies and discoveries of others.

If you read this book, you'll never again think about the healing of a cut, an infection or an illness in quite the same way. If you love reading about science and health and are fascinated with the delicate balance that keeps us alive and healthy (or not), you'll enjoy this book. The author keeps it interesting and readable by presenting some of the science using 4 case studies. There were still some parts that were impossible to digest in a casual reading. I found it to be about as clear an explanation as possible of a complicated subject especially considering that the author gave a detailed history of immunology up to the present day.

I just finished An Elegant Defense by Matt Richtel, about our immune system. I wish I could be more enthusiastic. He wore me out! It's a fascinating subject, and he's good at making it understandable, but I wish he had simplified it even more. The interaction of all the acronyms that are hard to remember, along with the complexity of the immune system, make this a tough go for the neophyte. Those with some knowledge may have a much easier time of it. What doctors and researchers are finding out, particularly (for me) about autoimmune diseases, is amazing.½

Fantastic. I'm talking about the immune system, not the book. The immune system is amazingly complex and fascinating. The author does a creditable job explaining how it works. But one definitely gets the sense that he doesn't think most readers can fathom the hard science involved in understanding it. He attempts to make it accessible to the average reader by making it as much about the people, the researchers, doctors and patients as he does about the nitty-gritty of the immune system itself. This does make the book an easier read, but it left me with the feeling I had missed out on a more thorough understanding. For that, I will have to turn elsewhere. But for those who want a lighter touch and to see how the immune system influences the lives of real people in very human ways then I would highly recommend this work.½

When Jason, a close friend of journalist Matt Richtel, was afflicted with lymphoma and received an experimental new immunotherapy drug that, for a while, resulted in dramatic improvement, Richtel was inspired to learn all he could about the immune system and the new medical techniques involving it, and to share his friend's story. This book is the result, although it also features the stories of three other people as well as Jason's: two women with autoimmune disorders, and a man who possesses a natural immunity to AIDS.

Unfortunately, though, the result really isn't quite the book about the immune system I wanted to read. I feel kind of bad saying that. I certainly did learn some things, and some of the moments involving Jason that Richtel shares with us are quite poignant. (Although he does give in to the entirely understandable impulse to share more details about his friend than the book really needed.)

The truth is, Richtel is trying to do a really, really hard thing here. The immune system is fantastically complicated and still not entirely understood, and the field is full of dry, hard-to-remember terminology. Trying to convey all of that to the lay reader in a way that makes sense is difficult, maybe impossible. But, for me, at least, the book errs on the side of trying a little too hard to be accessible. There was one notable moment in here where I finally started getting really into the nitty-gritty science details he was talking about, really finally feeling interested and able to follow the complexities of the thing... and that's the point where Richtel stops his explanation cold with a "Whew!" and an apology for how hard that was to follow. Which I found really frustrating. There are also several moments in the more science-y sections when he deliberately leaves things out, saying he'll deal with that when he gets back to talking about the patients' stories, and moments during the patients' stories when he leaves things out and says he'll get back to that in the science-y parts. I know all of this is meant to help readers stay engaged, by breaking up the technical stuff and focusing on human-interest stuff, but for me it kind of backfired and just made it all harder to follow.

I will say that I do like the parallels he draws between the immune system and human society, including the importance of diversity and the danger of being so focused on protecting "self" against "other" that the "self" ends up being damaged. It's not scientific, by any means, but I think it's actually a very apt analogy.

Also not scientific, but less appealing, is Richtel's willingness to flirt a bit with the pseudoscientific ideas of so-called "alternative medicine." He doesn't do it much, fortunately, but the moments when he does had me rolling my eyes a little.

Anyway. I will say that while this isn't the book about the immune system I wanted, I can see how some -- especially, perhaps, readers with less of a science-y background -- might find it to be much closer to what they want.