the Human Immune System

By Emma Yaskinski


In An Elegant Defense, published last month by William Morrow, author Matt Richtel explores the incredible complexity of the human immune system while following four patients experiencing cancer, autoimmune disorders, and HIV.

In an exclusive interview with Incisor, the Pulitzer Prize winner says his latest book not only is a history of the science of immunity, but it also acts as a “cheat sheet” for both laypeople and medical professionals who wish a more comprehensive understanding of the human immune system.

Richtel, 52, has been a reporter with The New York Times since 1998. In 2010, he won the Pulitzer Prize for a series of articles on distracted driving.

After introducing the four main characters in An Elegant Defense – one of whom is his childhood friend, Jason, who battles a cancerous 15lb tumor – Richtel details the discoveries of adaptive immunity, vaccines, and the T and B cells underlying their effectiveness. Richtel describes how the cells and the rest of the body respond to infection through fever and inflammation.

Later, through the examples of two women with autoimmune disorders, he goes on to explain what can happen when the immune system is too active. He describes the effects of everyday behaviors, including managing stress, sleeping, getting cuts, taking antibiotics, and even picking our noses, on our immune systems and overall health.

Incisor had the opportunity to discuss with Richtel what he learned while writing the book, and what it may mean for dentists.

Answers are edited for length and clarity.


Q: Your book centers on four fascinating characters with situations unique to their immune systems. Why did you focus on these particular examples?

A: These four patients each represent something very significant in the way the immune system [functions]. One had cancer: an immune system that did not fully work. Two had autoimmunity: immune systems that were overpowering. And the fourth had an immune system that works so well it was studied by the National Institutes of Health. Their stories let me communicate the spectrum of immune possibility while making this science human and hopefully emotionally resonant


Q: There's this phrase that comes up pretty early in the book, "the immune system as a peacekeeping force." When did that phrase come to you and why did it stick?

A: I went into this book with a ton of misconceptions. It dawned on me fairly early on that the reality is that our immune system is much more tailored to try to cooperate with and interact harmoniously with the billions of microbes that make up our world. If our immune system was constantly on the attack, it would be scorched – earth, nuclear winter, and we'd all be squishy piles of white blood cells on the floor.


“The mouth is a really critical part of the body for our interaction with the outside world.”


Q: What are some of the other misconceptions that people have about at the immune system?

A: The biggest one is that you want to boost your immune system. This one has come to drive me nuts. I think the much better phrase is that we want to “support our immune system,” not boost it. And this would be true of every aspect of health. You want your family members, yourself, your patients, to think about supporting their immune systems but not boosting them so much that inflammation becomes as dangerous as an infection or pathogen itself.


Q: What role does oral health play in terms of the rest of the immune system?

A: The mouth is a really critical part of the body for our interaction with the outside world. It is a place where a healthy immune system is essential because it is here at these ports of entry that our immune system interacts with microbes, assesses how to interact with them, and determines whether to make peace, attack, and how hard.

It's a place to see how the immune system in that respect is faring. Is the immune system well balanced and doing its job holding off infection? Is it weakened? And this really interesting place for study between the relationship of health and the immune system. One of the great stories of the immune system revolves around the mouth, cold sores, and the Epstein-Barr virus. When the immune system weakens, you can see herpes quite literally crawl down from the ganglia into the mouth.


“It was like a biblical tale, like the story of Lazarus.”


Q: I found the chapter about wound healing especially interesting. Can you tell us a little bit about that?

A: Wound healing provides an insight into some of the key tradeoffs that the immune system has to make. When the body suffers an insult, and this could be an injury or an infection, it must heal.

But, in the course of doing that, it also demands cell division. Cell division by definition is essential and, in its own way, dangerous. Because when cells divide, they can mutate. Mutation can become cancer. Cancer, when it is subtle enough, can trick the immune system and lead to something that metastasizes. So frequent wounds can pose some risk. This is partly why activities like smoking and sunburn can present major carcinogenic propositions. When you talk about tobacco products that cause wounds, and in those wounds wind up the toxins that can inhibit proper DNA reproduction, you wind up with the seeds of cancer.


Q: Circling back to those four incredible characters, was there a particular moment in any of their stories that struck you even more than others?

A: So many… One of the characters, Jason, was in hospice with 15 pounds of tumor on his back, doubling every few weeks, and thanks to immunotherapy, his tumor disappeared in weeks. It was like a biblical tale, like the story of Lazarus. Insert the sound of my head exploding.


Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.

Other Recent Incisor Articles by Emma Yasinski:

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